What Men Don’t Know About Their Health Can Hurt Them

Mark Hyman, MD

Dr. Mark Hyman is leading a health revolution—one focused on using food as medicine to support longevity, energy, mental clarity, happiness, and so much more. Mark Hyman, MD is a practicing family physician and an internationally recognized leader, speaker, educator, and advocate in the field of Functional Medicine. He is the founder and director of The UltraWellness Center, Founder and Senior Advisor for the Cleveland Clinic Center for Functional Medicine, a fifteen-time New York Times best-selling author, and Board President for Clinical Affairs for The Institute for Functional Medicine. He is the founder and chairman of the Food Fix Campaign, dedicated to transforming our food and agriculture system through policy.

He is a co-founder and the Chief Medical Officer of Function Health. He is the host of one of the leading health podcasts, The Doctor’s Farmacy with 150+ million downloads. Dr. Hyman is a regular medical contributor to several television shows and networks, including CBS This Morning, Today, Good Morning America, The View, Fox, and CNN.

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Full Transcript

Automatically generated. Please forgive any typos or errors in the following transcript. It was generated by a third party and has not been subsequently reviewed by our team.

Dr. Mark Hyman:
Coming up on this episode of the Doctor's Pharmacy,

Dr. George Papanicolaou:
My little mantra is I want to be at the level of fitness that I can do anything I want to do physically at any moment in time.

Dr. Mark Hyman:
Welcome to the Doctor's pharmacy. I'm Dr. Mark Hyman. That's pharmacy with an f, a place for conversations a matter. And if you're a guy out there listening or if you're a woman who's got a guy, you're going to find this conversation fascinating about how to actually look at fitness in middle-aged men in a way that really matters. Things that we don't typically look at. We're going to talk about VO two max and body composition, this special episode of Health Bytes with one of my colleagues at the Ultra Wellness Center, great physician, Dr. George Papapa Nicola, who's a graduate of the Philadelphia College of Osteopathic Medicine. He's board certified in family medicine and he's also an I-F-M-C-P Certified Doctor of Functional Medicine certified doctor. He has worked in the health service, the Navajo Reservation, and he's been working at our practice at Adult Women Center for many years now and is one of our great team there.
And today we dive into the topic of fitness for middle-aged men, particularly talking about what we need to measure and why it's important, including something called VO two max, which is a measure of your fitness level and your body composition, learning about your muscle mass, which is a critical measure of fitness and your body fat composition. And we're going to talk about how to fix those things. We're going to talk about some great cases where we use those measurements to address people's health, and we're going to talk about a whole area of fitness and health and aging and what you can do about it. So let's dive into this conversation with Dr. George Lau, one of my colleagues and friends from the Ultra Wellness Center in Lennox, Massachusetts. Alright, welcome back George to the Doctor's Pharmacy. Appreciate having you back again,

Dr. George Papanicolaou:
Mark, it's always a pleasure to be

Dr. Mark Hyman:
Here. Now, for those of you listening may not know George who are just joining the podcast, George is one of my colleagues at Delta UltraWellness Center in Lennox, Massachusetts. We have a practical five physicians, three PAs physician's assistant, seven nutritionists a great staff, and we take care of people from all over the world with chronic difficult conditions or people who want to just up level and optimize their health and find out how to basically hack the code of biology and understand how their bodies work, how to work with it, and how to up grade your biological software. So that's what we're going to talk about today, is how do we upgrade our biological software with a very important drug that has the power to do almost everything you'd want it to do to treat depression, to improve your lifespan, your health span, to reduce inflammation, to optimize your hormones, to balance pretty much everything in your body drug.
And this drug I'm talking about is available at no cost to all of you everywhere on the planet. And it's called exercise. Now, George, we learn medical school did not learn a heck of a lot about exercise. In fact, we probably learned nothing about exercise except to tell our patients to eat less and exercise more, which is about the most useless piece of advice I've ever heard a doctor say. Eat what and how do I exercise and why does it matter and so forth. So today we're going to get into the science of why it's important to understand the nature of exercise, what it does to our biology, and particularly how do we measure our fitness level, how do we measure the way our bodies are responding to exercise and why that's important for overall health. Now we in medicine don't really think about how to measure someone's fitness very well.
We have the six minute walk test and we have grip strength and we have sort of certain biometrics we use and certain physiatrists will use it or certain doctors will use it, but it's kind of marginal. And at the Ultra Wellness Center, we really take a deep dive into every aspect of someone's health, including their fitness because it plays a role in everything huge from heart disease to diabetes to cancer, to dementia to depression to a DD. I mean, the list goes on and on. So George, you yourself are big exerciser. I'm jealous of your biceps, to be honest with you. He's got weights in his office, got, I think he's seeing patients. He's actually there pumping iron in the back of his office.

Dr. George Papanicolaou:
Mark, you're my motivation, mark, you are my motivation though. You are one shit

Dr. Mark Hyman:
Man. I don't know. I'm doing okay, but I think we have the capacity at any age to maintain or even gain a tremendous amount of fitness. We do. You and I are both in our mid sixties and we're pretty damn fit. And I dunno if there's a story, I dunno if you saw it in the news, George, about this guy who was in the seventies or something and he was hanging around some jam or somewhere and he saw a rowing machine or maybe there was one in a garage. And he basically started in his seventies, started rowing on a machine, and now he's like a world champion in the 90-year-old plus category. And his fitness level measured by something called VO two max, which is what we're going to get into, actually got better and not only got better but was equivalent to people in their thirties and forties. So what that speaks to is that we see this study kind as we age, but we don't really know what to do to avert it. And we see this all the time. There are patients who are chatting before about these guys who come into the office and who are our age and look like they're 20 or 30 years older, right? Yeah. So George, how do you get so into exercise and tell us a little bit about your own sort of background and focus on fitness and health.

Dr. George Papanicolaou:
This is fascinating. We had this conversation a long time ago and it's more or less how did I get into functional medicine. I used to always wired to think that way. My parents, when I grew up, it was the early sixties and they were smokers and I just had an adversity to that lifestyle from the very beginning. It was just innately in my DNA. And so I was reading, I remember it was a Dr. Mendel's vitamin book and supplements and way then I was reading that when I was an adolescent. So I was just into that stuff. And then I met my wife when I was 18 and her mother was brilliant. She was a homemaker, stayed at home in Western Pennsylvania, but she would read nutrition action letter back in day.

Dr. Mark Hyman:
Oh yeah, I remember that. Yeah.

Dr. George Papanicolaou:
Nutrition action letter. And she was already talking about the toxins of Teflon and she was already talking about omega threes and she could tell you at the dinner table what vegetables had, how much calcium and magnesium. So

Dr. Mark Hyman:
That's the whole nutrition part. How about the exercise part?

Dr. George Papanicolaou:
Well, but that was the whole piece of that whole, I was always intrigued by fitness and nutrition, but the fitness piece, I just was always an athlete from the very beginning. I always liked to be athletic. I talked about this many times and I've written blogs about it and I have a DHD and exercise is my medicine. It's actually when I have a DHD patients, whether they're kids or adults, the first thing I write for them is their exercise prescription because when I exercise, it increases my ability to concentrate. When I exercise, I feel much better, I sleep much better, I'm in a better mood and I'm more able to serve the people around me. So exercise is just my all round drug.

Dr. Mark Hyman:
It's such an incredible drug. I just got back from Patagonia and I was trekking 10, 15 miles a day up and down mountains and I felt amazing. My nervous system felt great, my energy was great. I had no mood issues, which I usually don't have, but I just felt more at peace and more everything was like, wow, this is amazing. I mean, literally if I'm using my brain for 10 hours a day, I'm tired. But if I'm using my body, I actually feel better.

Dr. George Papanicolaou:
So one of my internal lines that I speak to myself, my little mantra is I want to be at the level of fitness that I can do anything I want to do physically at any moment in time within reason. That's right. So let's say you would call me up to St. George, you got to fly to Patagonia. We're having this great trek. You're going to think this is amazing. I get on a plane, I could do it and I can do it. Well, I'm not going to slow anybody down and I'm going to enjoy it and so will the people around me. My goal is always to be at a level of fitness where I can get on my bike and ride 25 or three. That's right.

Dr. Mark Hyman:
Do whatever you want.

Dr. George Papanicolaou:
Remember, remember that time you and I just got on our bikes and we rode 25 miles. We had a great time. And you were pretty good on the hills, by the way.

Dr. Mark Hyman:
Yeah, yeah. Well George, the truth is we have that capacity. There's this guy who I love to watch on Instagram and uncle stop who's a French dude, I don't understand anything about, it's all in French, but I want you, he's like basically goes out, he's 78 years old on his deck on mountains and somewhere in the mountains of France and he does 25 pull-ups. He's incredibly ripped and fit. He makes us look like 98 pound weaklings. I mean, this guy is unbelievable and I'm thinking, and he does it in the winter with no clothes on. It's basically no shirt, some sweatpants. And it just speaks to the fact that our bodies have the capacity, but the problem is we decline as weight. So tell us, George, what starts to happen to men and women as they start to get over 30? What's the physiological process? We, we don't think of 30 as old, but it's actually when the decline starts to happen, that leads to frailty, disability dysfunction and disease, which exercise can completely prevent for the most part.

Dr. George Papanicolaou:
As I thought about this, I just want to make this point that my mother-in-law, she's going to be 92. And when I ask her how she's doing, she tells me I'm doing well, George, but what's the alternative? So what's the alternative to not exercising it's inactivity And inactivity at any age will cause something called anabolic resistance. Okay, anabolic resistance is the muscles inability to grow in mass or in strength. And so that can we talk about it happening with older adults, but it can happen when you're younger. And so we want to fight off the anabolic resistance. And the way you do that is through exercise. And so when we think about what we need to be doing, one of the things I think about when we think about chronic disease and aging longevity and mortality is when does it become a problem? Well, it becomes a problem very early on in life.
And as you said, you see a shift between 30, 40, 50 years old and that's when we really need to be focusing on exercise and what do we need to be focusing on? We need to be focusing on our cardio, respiratory fitness and also making sure that we're doing some form of resistance training because we know both of those through lots of different studies, randomized clinical trials data, we've seen that both aerobic fitness and resistance training and strength training are directly related to decreasing the chronic diseases and chronic conditions that are associated with decrease in our quality of life, in our length of life. We know that. So those are the things that we tend to stop doing, particularly men who are in their bread-winning years, building their careers, they'll tend to be a little bit more sedentary. And when that happens, you begin to build up that anabolic resistance, you stop making the muscle mass and

Dr. Mark Hyman:
You lose, you start to steadily lose muscle, and

Dr. George Papanicolaou:
When you lose muscle, you lose metabolic ability and you lose this protein of reservoir that will protect you if you become ill as you get older. And it's very hard to overcome the anabolic resistance. So one of the goals that we have at the Ultra Wellness Center is to work with people very early on in their treatment plans if they're at that place where they're well enough to be focusing on fitness and exercise. Sometimes they're not well and we have to get them to that point, but we want to get them to that point. And what we want to focus on is getting measurements like the VO two max and like a body composition which become their baseline information for where they're at. And then we can design a program for them to improve their aerobic fitness and then also help them begin to build back that muscle mass if they've lost it.

Dr. Mark Hyman:
Yeah, I think this is just a critical point, George, that we don't realize what happens to us slowly and inexorably as we get older. And we can be the same weight as we were at 25, it's 55, it's 65, and actually be twice as fat. You're metabolically unhealthy even if you're a normal weight. And there's actually a word for it. It's called skinny fat or tophi thin on the outside, fat on the inside or metabolically obese normal weight. And this is a well-recognized medical condition and it's completely caused by the lack of attention to one of the most important organs in our body, which is muscle and muscle fitness and muscle mass and muscle quality. And all of that is something that's completely under our control. And if you look at the data, it's quite striking. You see a steady loss of muscle all the way through life, but it's totally reversible.
And I saw this in myself, I saw it, and then I was able to completely reverse it and actually have more muscle now than I did when I was 25, which is quite amazing. And I'm like, well, how did that happen? It's totally possible and it's totally possible, but it's something that most people don't focus on as a thing like, okay, diet, diet, diet. And yeah, I know I need to exercises, go to the gym, I don't, but maybe they may not be doing the right thing than gym now may not be exercising the right way. And so it's like anything, if you want, you take a drug or a supplement or whatever, you need to know the right dose and the right quantity, the right frequency and the right, absolutely. So mechanism. So it actually does what you want to do. I think

Dr. George Papanicolaou:
One of the things that we know you mentioned earlier on and we always talk about is what happens in conventional medicine. For years I had a conventional practice. I've gone to my conventional doctor for years and they would bring up my weight or my BMI. And I think the point that you just made is that the BMI is just your body mass index. That mask can be anything. It can be fat, it can be muscle, and that's not really, we're finding that that's not really a good measure of your metabolic fitness.

Dr. Mark Hyman:
It says what you're saying is the thing that everybody talks about with relation to obesity, which is body mass index is kind of a poor measurement for what's really going on under the hood that you can be, for example, Shaquille O'Neal or a bodybuilder and have an extremely high body mass index. So you have like 35 and maybe that's considered severely obese, but actually you're just solid muscle. Or you could be a body mass of 22, which is perfectly normal, a body mass index of 22 and be metabolically obese and diabetic because you have no muscle and you're eating tons of crappy food, but you're gained the weight. And so it's sort of an inaccurate measurement. Absolutely. I want to talk to you about how do we actually measure this At the Ultra Wellness Center, we do a number of different measurements that can quantify your level of fitness and your level of muscle and your level of fat and quality of it.
We can even look at mitochondrial function, which is a critical aspect of your health. So we look at things that most physicians and practices don't do as a way of creating a customized personalized set of recommendations to optimize your health. And of course, it's not just around exercise, it's around everything. We look at your nutrition, we look at your hormones, we look at your immune system, we look at your gut, we look at toxin levels. So we look at all of it as it affects all of it, but today we're just talking about this whole issue of fitness and why we need to think more carefully and nuanced about it. So let's talk about how do we measure the two most important aspects of fitness, which is basically your cardiovascular fitness and your muscle fitness. Yes. So let's talk about cardiovascular fitness first. How do we measure that? So

Dr. George Papanicolaou:
Cardiovascular fitness is measured using something called your VO two max. And essentially that's basically the maximum amount of oxygen you can deliver to your cells during your maximal amount of activity. And so that can be done in a lab and you do a V two max. You're going to get on a bike, you're get on a treadmill and they're going to put a mask on you which is going to then be able to measure your oxygen utilization. So you'll start exercising and then you'll increase your exercise until you put your max amount of activity or exhaustion. And then they've been measuring your O2 metabolism the entire time. And then they'll be able to then determine the maximum amount of oxygen uptake in utilization, and that will be your VO two max.

Dr. Mark Hyman:
So essentially that's measuring how much oxygen you breathe in and how much carbon dioxide you breathe out, which is an indirect measure of your metabolic rate. And it determines how many calories you can burn a minute, how much oxygen you can burn 'em in. So basically your metabolism, because I have a slow metabolism, well, they might be right because if you have a low VO two max, you're burning far less calories per minute because the rate limiting step of burning calories by the way, is how much oxygen you can process per minute. That's called the VO two max. The volume of oxygen,

Dr. George Papanicolaou:
It's

Dr. Mark Hyman:
In liters per minute,

Dr. George Papanicolaou:
It's m mls per minute per kilogram.

Dr. Mark Hyman:
So it's basically how much oxygen can you utilize. And so a guy like Lance Armstrong who wins the tour to France can maybe have a much higher utilization. His VO two max may be 90, whereas the average guy who's like a diabetic might be 15 and someone who's fit might be 45. My watch says I'm 46 and I'm superior. I don't know at this age, but I used to be 55, 55 V two max when actually measured last time. I don't, my watch is accurate, but it's really a critical measurement.

Dr. George Papanicolaou:
I think V two

Dr. Mark Hyman:
Max for everything for longevity. If you look at the longevity trajectory, it's probably the thing that is most correlated with longevity.

Dr. George Papanicolaou:
So talking about VO two max and body composition and muscle mass are two of my favorite things to talk about with my patient because they're correlated to so many things, both of them. There's a vast amount of data for both your cardio respiratory fitness, which is measured by your VO two max and your muscle mass and muscle strength to the top 10 leading causes of death in the United States, also to the 35 chronic conditions that lead to them. And two of the chronic conditions that are listed at near the top are sarcopenia, which is loss of muscle mass and decrease in your cardio respiratory fitness or your aerobic fitness,

Dr. Mark Hyman:
Which are two things that traditional doctors never look at or measure,

Dr. George Papanicolaou:
Look at or treat. And they're highly correlated because if you look at the traditional markers of cardiovascular disease, which are going to be hyperlipidemia, hypertension, and inflammation, if you look at the markers of metabolic disease, which are going to be insulin resistance, obesity, inflammation, inflammation again, basically what happens is that they lead to atherosclerotic vascular disease,

Dr. Mark Hyman:
Meaning coordinating the arteries, clogged arties in

Dr. George Papanicolaou:
Your brain, which means your heart, your body, which you're going to be getting less blood flow to your muscles. And if there's less blood flow to your muscles, there's going to be less what oxygen delivery. And then what happens is now if you're not aerobically fit, then you're getting less oxygen to your muscles, then your muscles stop growing. And so then that leads to some of that loss of muscle mass. So your aerobic fitness and your ability to maintain your muscle mass and strength are very much correlated, interconnected. And they're interconnected. And that's why we have to pay so much attention to them. Because going back to it, I want to emphasize it one more time. Both of them, through vast amounts of data since 1950, have been highly correlated to chronic disease, decrease health span and increase in mortality. Yeah. That's why we got to focus on

Dr. Mark Hyman:
I really agree, and I want to sort of bring it back to the kind of gee sites for a minute.

Dr. George Papanicolaou:
Yeah, I want to go there too because

Dr. Mark Hyman:
When I wrote my book Young Forever, I talked about one of the key hallmarks of aging, which not my deficient, is sort of the scientists who come together and say, what, as we get older, what are the hallmarks? What are the criteria? What are the phenomena we see as we get older? And one of the things we see is a dysfunction and a decline in our mitochondria. Absolutely. Now, as medical school, we learn about mitochondria in first year medicine and the biochemistry and the kreb cycle, and then we're basically all told to forget about it. It has no relevance for clinical medicine. And so most physicians have no clue how to diagnose problems with mitochondria or to actually treat them. And yet mitochondrial function is critical to almost everyone in the chronic disease, whether it's diabetes, have decline, mitochondrial function, autism, heart disease, I mean, you name it, it's there. It's mitochondrial disease, and yet we learn nothing about it. And so we actually now have a window into how to look at mitochondria through things like VO two, accessing body composition. Some of the other tests we do at the Ultra Wellness Center are like organic acids, mitochondrial swabs, which we can look at your actual mitochondrial function. So there's a lot of ways we can diagnose what's going on, and then we have really clear ways to treat it through diet and lifestyle exercise, which we're going to get more into and very supplementation. So

Dr. George Papanicolaou:
Getting back to the VO two max, I know we want to go into the weeds on that. We could spend the whole day just talking about VO two max. You brought the mitochondrial piece. Well, the whole point of getting oxygen to the cell is to get it into the mitochondria to produce energy. And so when you talk about the Krebs cycle, there's not a day that goes by that I'm not looking at the Kreb cycle at least 10 times. There's not a day that goes by that I'm not looking at the four respiratory changes of the mitochondria because we do that testing in our office and people are shocked like, wow, what are you talking to me about? Well, I'm talking about the most important thing to your health. You're mitochondria. I'm really working out well, right? And why? There's a host of various reasons.
We're going to focus on exercise piece today, but we know there's a nutritional piece and we know there's some other pieces to that including genetics. Just to go back to our athletes, an Olympic cross country skier or a Tour de France winter, they're born with VO two maxes, like eighty five ninety, you and I we're born 40 to 60. We might be able to give it a little higher through training, which we'll talk about later. But there is a genetic piece to all of this, but you can train it. And it's really important to know that VO two max, it declines with age just as muscle mass does. And again, both declines are associated with decrease in health span and decrease in longevity and increased mortality. So the whole point, what I want to hopefully we really get to our listeners today and our viewers, is that you have to at a very early age begin to incorporate exercise into your lifestyle. Because if you come to meet age 50 and you are metabolically imbalanced or you're obese or you already have metabolic syndrome and you're not an exerciser, it would be easier for me to get you off a crack
Than to get you to start exercising. It's an extraordinarily difficult habit to begin late in life,

Dr. Mark Hyman:
But you can and you to by the way, and

Dr. George Papanicolaou:
You have to, it's not an option. And the Ultra Wellness Center where all the doctors are versed in this, all of the PAs are versed in this. We work with nutritionists and we work with exercise physiologists to help you get over any barriers that may exist for you. And that's why people come and we get, and since you published your last book forever, young, young, young Forever,

Dr. Mark Hyman:
Bob Dylan, that was Forever

Dr. George Papanicolaou:
Young, fre, you're so much into rock and roll than I am. But needless to say, we've been getting a lot more patience and clients that want to really focus on their longevity. And I'll spend, so this is something I spend a lot of time reading about, thinking about, and then finding ways to reduce the barriers for my patients. So with the VO two max, getting back to that, we get that measured. We either have people get that done local to their environment, or there's are some places near Ultra Wellness Center that we can have 'em get their VO two max measured. And for many people, it's brand new information, but it then becomes a really great marker for them because we can then give them a fitness program that's designed specifically to improve your oxygen delivery and oxygen utilization, which will then improve your VO two max and give you that cardio respiratory health that you're going to need as you age.

Dr. Mark Hyman:
And by the way, the side effect is you feel much better. Oh my gosh, you have more energy. Oh gosh, when you burn more calories sitting down, doing nothing. And the reason I like it, I get to eat more. I mean, I like to eat, but when you increase your VO two max, you basically just burn more calories sitting down, doing nothing. It's

Dr. George Papanicolaou:
A vital sign in my way of thinking for my patients. I don't want to see them in the room unless they've had a VO two max and they've had their body mass composition done because those are two, to me, those are vital signs that if I don't know them, I can't give you everything that you need to be

Dr. Mark Hyman:
Healthy. Yeah, I don't know if there's good data on this, but I think your VO two max is probably as important or if not more important than measuring your blood pressure or your cholesterol or your blood sugar. It's that important. And we don't look at it in

Dr. George Papanicolaou:
Medicine. Well, they're highly correlated. I mean, V two max is correlated to your lip levels and also blood pressure. So there are some studies that make that

Dr. Mark Hyman:
Correlation, and I don't want people to feel listening to that. They can't start late in life because there's this guy I read about who was a French dude who decided he was a post office worker and retired at 65 and he was going to take up cycling and at 105, he could cycle basically a 14 minute mile, which is really fast. And his VO two max was that of a 30-year-old, and he decided, I think at 103 or something that he wanted to improve his VO two max. So he basically got on a training program to improve his VO two max, even at 103 years old, you can absolutely. So George, take us through, we basically measure it through a lab, essentially a cardiometabolic lab with a cardiometabolic cart that measure your oxygen and carbon dioxide exchange, and you get a number, and there are other sort of surrogate ways you can do it through various watches, and I don't know how calculations, but basically it's a really important number to know we get your number.
Okay. The average person that I see who's not that healthy is maybe their twenties, even teens. It should be kind of typically as you get older it gets lower, but typically in your thirties, it's in the thirties, it starts to go down. When I was 45, mine was 55. So it's possible to keep it high at any age. So when you start to see these people and you do this testing, what is the sort of strategy then around cardiometabolic fitness? And soon, we're going to get into body composition in a minute, but I want you to stay tuned for that because it's a really important conversation. And I think it's again, one of those unmeasured vital signs, which is muscle. You talked about sarcopenia, which is a condition that is correlated with almost every feature of aging. And in fact, it's probably the reason we age so much and yet we don't ever measure it or talk about it in medicine either is big gaps.
And again, this is what we've been doing in my practice for 30 years at Kenya Ranch before and then here at the Ultra Wellness Center. And so how do you approach someone who comes to your office and maybe you can tell us a story of a patient who has measured the otax, it's low, and what do you find in those patients? What do you do for them? How do you tell them to increase their VO two max? What's the scientific method essentially for increasing scientifically your VO two max and your metabolism and your mitochondria and your fitness level?

Dr. George Papanicolaou:
Sure. So as with everything in functional medicine, it's all personalized. There's just so much that goes into how I'm going to create a program from somebody to their history with exercise, to any injuries that they may have to their current status in terms of their work environment to social environment and any disease process they may be struggling with. So it's always going to be personalized, but there's a general approach. So the general approach is you need to have an aerobic baseline. So you start with zone two. Zone two is basically 60 to 70% of your maximal heart rate.

Dr. Mark Hyman:
It doesn't sound like very much.

Dr. George Papanicolaou:
No, it's not. But that is your base.

Dr. Mark Hyman:
So can you have a conversation when you're working at that level? Yeah,

Dr. George Papanicolaou:
So that's conversational exercise. I explain to people, if you and your wife are on a treadmill and you're next to each other, you can have a conversation where you can get one or two sentences out and need to take a breath. If you get more than a sentence or two out, then you're not working hard enough. And if you can't breathe, you're working too hard. The reason why that's important is that's your aerobic capacity. You're going to maintain a metabolic rate in which you're using up oxygen and you're not beginning to create too much lactate. Once you go through that threshold, then you become a little more anaerobic and you can't maintain that long enough. And that aerobic level allows you to develop that oxygen delivery system that's very important to maintaining your VO two max on a mitochondrial level. So you need to get that baseline, and that should make up the majority of your training of your VO two max.

Dr. Mark Hyman:
So is that like a brisk walk or is that a jaw light? It

Dr. George Papanicolaou:
Has to be brisk enough. It has to be brisk enough that your heart rate is up, you're sweating a bit, and you're definitely can't have a full conversation. It's not walking the dog and talking about your investment portfolio with your

Dr. Mark Hyman:
Buddy. Right. Okay. So how does somebody figure out their zone two? Because there's a calculation in medicine, which is your maximal heart rate is two 20 minus your age. That's the maximum heart rate that you should get at your age. Now I'm, let's say I'm going to 65 this year, so that's 1 55 1 what?

Dr. George Papanicolaou:
Well, I think it's

Dr. Mark Hyman:
1 55. 1 55, okay. Now I'm highly trained, so I often get my heart rate to 180. This is great. This is great. I get it to 180. I'm like, oh, I'm going to die. No, I'm not going to die. I'm just fitter. And so my maximum heart rate is younger than I would calculate, but for most people it's two 20 minus races are maximal and then it's 60, 70%, 60 to 70% of that. Now, there are devices, like I have a Garmin watch and there's many other devices, Samsung, apple, so forth, Fitbit, and a lot of the measure your cardiometabolic health. And this watch tells me when I'm in zone two, when I'm in zone one to five and I can see where I'm in my exercise routine, and that's really helpful. But for most people, how do they determine what's their true maximal heart rate and their true zone two?

Dr. George Papanicolaou:
So for most everybody, it's really going to be that calculation. The way I work with people is you do that calculation, but to your point, there's something called the rating of perceived exertion, and it's your ability to understand where you're at in your fitness. So I can get my heart rate up still into the one eighties. So my max heart rate, I get into 180 8, 1 90, I'm okay.

Dr. Mark Hyman:
I don't also glitch in my watch, but the other day it said 1 99. I'm like, I don't think that's right.

Dr. George Papanicolaou:
But the reality is that if I go to my calculated zone two, I'm not working hard enough. So I go by my rating of perceived exertion. I'm not in zone two until I'm at that point where I'm getting one sentence out. So I always tell my patients, correlate your calculation with your experience.

Dr. Mark Hyman:
That's one sentence out, and then you have to take a breath and do another one pretty much. Is that the idea? Yeah,

Dr. George Papanicolaou:
Pretty much one to two sentences out. I mean, for all intents and purposes and our practical level, which I'm truly trying to make it for my patients, make this as lower the threshold as much as we can make it as practical as possible. So the only real tools that you won't have, you'll get from us, that will be your VO two max and your body comp. But after that, I want you to be able to do everything else at home.

Dr. Mark Hyman:
So what you're telling someone to do zone two, how long do they have to do it? How many days a week? And then what else do you do to increase your VO

Dr. George Papanicolaou:
Two max? Okay, so the recommendation is about 150 minutes of zone two activity just for basic cardiovascular health. Will 300 be better? It's the law of diminishing returns 150 or more, maybe 150 to 200. That's about 30 minutes to 45 minutes of zone two activity per day. That could be swimming, that could be running, that could be treadmill, that could be rowing, whatever you like. It could be biking. Okay. Then what then is going to increase your VO two max? Zone two is considered moderate.

Dr. Mark Hyman:
Oh, by the way, that's more exercise than probably 85%,

Dr. George Papanicolaou:
86, 80 6%. Let's go. 86% of Americans do not meet that goal. Yeah. So 80, 86% of

Dr. Mark Hyman:
America, America, you got to get moving.

Dr. George Papanicolaou:
So 86% of America is sedentary and inactivity leads to disability and mortality. So go back there anyhow, so then you have that baseline, and at least 10 to 20% needs to be high intensity interval training. That baseline is more of your moderate intensity training. When you compare the two, high intensity interval training is far superior. I think I've read a number eight times more superior in improving your VO two max than moderate cardio respiratory training or intensity training. So the high intensity interval training is when you get up to 90, 85 to 90% of your max, and then you maintain that for an interval period rest, then do that interval again.

Dr. Mark Hyman:
Basically the speed you'd be at if you're running from a tiger for 30 to 60 seconds, as long as you can maintain it, and then you take a break and you kind of go slow it really slow for three minutes and then you do it again. There's all these different

Dr. George Papanicolaou:
Approaching, right? So what you want to do with your high intensity interval training is you start with your baseline. So you warm up and then you do your baseline training and you do it on a different day. So you'll do your zone two activities Monday through Friday or let's say Monday, Tuesday, Wednesday, and then on Tuesday, Saturday, you do your high intensity. Your high intensity, the intervals will be, you can go one-to-one to three. So let's say do 30 seconds of running as fast as you can, then you can rest for 90 seconds. As you increase your fitness level, you can increase the duration of your intensity. So instead of 30 seconds, you can go up to three minutes. And so as you are able to do that, that is your subjective measure that your VO two max is improving. So then you can increase. So you start 30 seconds, you rest 90. Then as you get more and more fit, you may go one minute and rest three minutes.

Dr. Mark Hyman:
So do this on a treadmill on a bike,

Dr. George Papanicolaou:
And then if you get really fit by the way, then you can do one to two, one to one. So then you do one minute really hard, only rest one minute, one minute really hard, and that way. So that's progressive.

Dr. Mark Hyman:
And how long you have to do that? Like 10 minutes? Half an hour,

Dr. George Papanicolaou:
20 to 30 minutes.

Dr. Mark Hyman:
Yeah. So it's 23 minutes twice a week, twice

Dr. George Papanicolaou:
A week at most.

Dr. Mark Hyman:
Not that much. No. Right. No. And you're saying it has a dramatic effect.

Dr. George Papanicolaou:
Dramatic effect. Yeah. Yeah. You'll definitely see an increase.

Dr. Mark Hyman:
Yeah. I saw a paper years ago, I wrote about, I think in my book, ultra Metabolism, that if you compared traditional aerobic training to VH max training and people would exercise less minutes, less duration, higher intensity, they would exercise far less and get far more fit and burn nine times more calories if they actually were just, and it is basically burning more while you're sitting on the couch. Watching TV is we're talking about here.

Dr. George Papanicolaou:
And one of the concepts I want to bring up is the idea of what we call exercise snacks. You can think about it in regards to aerobic training, and you can think about it in regards to your strength training as well. These exercise snacks, you can get just as much benefit doing a five minute high intensity interval training three times a day or four times a day than doing it all 20 minutes at one time. So you can, in the course of your day, instead of napping or just keep working or eating, you can just take one to three minutes and do a high intensity interval workout. You can do right in your office. So

Dr. Mark Hyman:
Do burpees. Yeah,

Dr. George Papanicolaou:
Do burpees and do intervals of them 30 seconds on, 30 seconds off. And you can do that for three to five minutes, recover. And if you do that four times a day, there's your 20 minutes.

Dr. Mark Hyman:
That's amazing. It doesn't have to be all at once.

Dr. George Papanicolaou:
Yeah, it doesn't have to be all at once. And that's what I really want to emphasize to our viewers and listeners, is that we want to try and find ways to get you to exercise that lower the threshold, lower the bar, make it less confusing, make it less complicated, use your own body, use minimal amount of equipment, and that way you're more likely to do it. So that's how you take a 40-year-old who's lost their way and get them back on track. Tiny steps, tiny changes that lead to bigger changes, and then ultimately hugely improved fitness, longer life, healthier life.

Dr. Mark Hyman:
Yeah, no, I absolutely agree, George. And I think what's quite amazing is studies I've seen on people who with dementia using VO two max training, they put 'em on a bike and they do VO two max training and they cognitively improved dramatically.

Dr. George Papanicolaou:
And there are also,

Dr. Mark Hyman:
And part of it's because it basically creates this thing called miracle grow in the brain or called BDNF, which is one of the things that gets triggered by exercise. So I think it is quite amazing when you see the power of this when there's no drug that can do it, but you going to have a stationary bike and you goes as fast you can, and your brain wakes up pretty damn good,

Dr. George Papanicolaou:
Pretty damn good as another. Just looking at more data, there are studies that have been done that looked at people that have cardiovascular disease, have had catheterizations, and they compare their improvements in functionality using moderate intensity exercise versus high intensity exercise. They're able to do high intensity exercise and they make vast improvements in their VO two max and their functional capabilities doing high intensity exercise. So even if you've had a cardiovascular event, you can do high intensity training and increase your VO two max and your functional capability.

Dr. Mark Hyman:
And it's not just a vanity metric. It's actually a really an important metric of how you're aging, what your metabolic health is, what your fitness level is, and how it's going to determine everything that happens going forward. So again, this is something you're not going to get at your regular doctor. You're not going to get the right prescription. You're not going to know exactly what to do. And it's the kind of stuff we do at the Ultra Wellness Center. I want to talk about the other important measurement that you mentioned earlier, which is something we also do at the Ultra Wellness Center called body composition. Now, what is body composition?

Dr. George Papanicolaou:
So body composition is really what are you made up of? We've just been talking about cardiovascular fitness, you're talking about heart, you're talking about blood vessels, but when we're talking about your body comp, we're talking about fat and we're talking about muscle. Those are your two major body parts or body subtypes. So they're really important because they're metabolically active and fat has its role in providing us energy, but when we have too much fat, we have certain types of fat, it's inflammatory, and it alters our insulin sensitivity, which has a significant role in metabolic syndrome. And then the development of cardiovascular disease, which is the leading cause of death in men and women. So we need to really be aware of fat, but we're not always aware of fat because when we go to our conventional doctor's office, we get a BMI and BMI is not telling us anything about body comp. No. It's just telling us about your total mass compared to your surface area,

Dr. Mark Hyman:
Right?

Dr. George Papanicolaou:
Whoever thought that would make any type of sense. So when we do a body composition, we can actually look and see how much muscle mass do you have, particularly axial muscle mass. Muscle mass in your arms, muscle mass in your legs. They're highly correlated to your health span. Then we could also look at your body fat. So when we look in the mirror, we see our fat. If we do a waist to hip ratio, which is actually better than BMI when it comes to identifying what your body, your body count might be, because it really represents your visceral adiposity and visceral adiposity.

Dr. Mark Hyman:
Belly fat,

Dr. George Papanicolaou:
Belly fat, English. So you're

Dr. Mark Hyman:
A smart jerk. You can use English.

Dr. George Papanicolaou:
Yeah, so belly fat. So that's obvious. But you also can get your visceral adiposity, not your centrifugal adiposity, but your ce,

Dr. Mark Hyman:
Your visceral is around your organs, inside

Dr. George Papanicolaou:
Your visceral organ. That's the fat inside around

Dr. Mark Hyman:
Your organs and your belly.

Dr. George Papanicolaou:
Yeah, inside. And that's a really measurement that really opens up people's eyes because when they see on their body composition that their visceral fat is above what it should be, they're like, wow, I can't see that. So well, that's the really dangerous stuff. And so when we do a body composition, the body composition that's really used most in research and in practical medical and exercise physiology settings is your bioelectrical impedance. And that's when you send an electrical signal through the body and the electrical signal at a low level frequency will pass through the different tissues and it passes through the tissues at different rates. Each tissue is going to impede the flow of that electricity based on what it's made up of. So we're 70% water. The electrical signal is going to go pass quickly through the water versus fat. It's going to go slower. And so using a computer algorithm, you can then begin to define what a person's made up of based on the electrical signals that you got from the test. So we use an InBody in the practice, and it has multiple

Dr. Mark Hyman:
Electrics, pretty advanced machine. It was very expensive, but we got it. We think it's such an important vital sign.

Dr. George Papanicolaou:
And it's a really good one. And it's a really important one. Everybody gets it when they come in and it has eight electrodes that are spread between your hands and your feet. And so it's very sensitive and it can pass multiple different frequencies. So it is very sensitive and it's very accurate in being able to determine how much fat of it is visceral, how much of it is not, and also look at your muscle mass. And when you compare it to dexa, it actually will, that

Dr. Mark Hyman:
Sort of what's used a lot of research. It's kind of an X-ray, which is some low level radiation that's used to check bone density, but also can check body composition and fat and muscle and distribution. So that's also used to measure body.

Dr. George Papanicolaou:
It's also used, but his BAI, so it used to be the gold standard, but his BAI has really increased and the technology has really improved. BI

Dr. Mark Hyman:
Actually I is body

Dr. George Papanicolaou:
Impedance. Body impedance analysis analysis.

Dr. Mark Hyman:
So it's basically using what we just talked the InBody machine,

Dr. George Papanicolaou:
Right? Embodied machine. Yep. Thank you for helping me make this simple for people. That's

Dr. Mark Hyman:
Okay.

Dr. George Papanicolaou:
That was my goal. Make it simple for you. Okay. So in doing that, the BIA will actually more accurately determine your muscle mass, because DEXA doesn't account for any fat that might be in the muscle, so it will overestimate your muscle mass. So BIA is actually really effective. And if you can get that done, you can certainly get it done in our office, but if you can get it done, that's a really good baseline for knowing, okay, where am I at with my body composition? And what does that mean? It means I would actually distill it down to being able to say, where am I at metabolically? Because how much fat and how much muscle you have in comparison to one another really does determine if you're going to be metabolically flexible and metabolically stable.

Dr. Mark Hyman:
That's right. And metabolic health is such a huge issue because it's a problem across America in a way we've never seen before. According to data I've talked about before, out of Tufts, 93% of Americans are metabolically unhealthy, and it has to do with some degree of problem with body composition, with fitness, with nutrition, it's all there. But this is a huge factor, and I just want to sort of emphasize what you said. Everybody who comes to the Ultra Wellness Center, when they check in and get their vital signs done, they get their blood pressure, they get their respiratory rate, their heart rate, their temperature, and their body composition. It's just basically one of the vital signs and we check it on everybody. Absolutely. And I think we learned so much about our patients, and it's such an important tool to help 'em understand where they are in their overall health. And it's such a critical measurement. It should be done as part of every doctor's. Absolutely. And especially since 93% of people have, so imagine we have a problem, 93% of the population. We don't have a really good way of measuring that in the average doctor's office, and we don't even pay attention to it. And yet, it's one of the most important things we need to look at. And it's important we can do something about it. We can actually change it, and we can alter our body composition at any age

Dr. George Papanicolaou:
Though, mark, as you're talking to me and my little A DHD brain is just fired off in 10 different directions. I'm thinking about not even the doctor's office. Mark, how about schools? Oh, yeah. How about what is this thing about having kids sit in a classroom all day long? That's a great idea. And then they want to put me on a leash when I'm in third grade because I want to get up and move. Anyhow.

Dr. Mark Hyman:
People have EDD exercise deficiency disorder, not a DD.

Dr. George Papanicolaou:
So once you have your body composition, then we can start some real serious work. And as I tell everybody, just as a quick aside, I have patients come into the Ultra Wellness Center and they seem to be really proud of one piece of their medical record, and that's their supplement list. They love their supplement list. And I get people that come in with 23 different supplements that they've gotten from different podcasts and the health and wellness space, and they're really proud and they think I'm going to tell 'em, well, that's great. But when I look at what they're doing for exercise, I say, you know what? Let's put that piece of paper aside because you cannot supplement your way out of no exercise

Dr. Mark Hyman:
Or a bad diet or anything

Dr. George Papanicolaou:
Else, or a bad diet.

Dr. Mark Hyman:
Right. It's called a supplement, not a replacement. Yeah,

Dr. George Papanicolaou:
Exactly. So the reality is is that I tell people we're going to spend our time on lifestyle because if I can't fix your lifestyle, it's going to be really hard for me to help you reach your goals or if you're ill, to get you to be healthier. So lifestyle is critical. We've talked about the cardiovascular aerobic piece, and now there's the body comp. Let's just begin to understand, okay, what do we do to change that body composition? Specifically if we look at the data around muscle, we understand that you need muscle mass and you need strength. Muscle mass provides you that metabolic center where so much of your metabolism is going to occur, and it has a lot to do with glucose metabolism.

Dr. Mark Hyman:
I just want to emphasize that what George said is so important. Your muscle is where your metabolism happens for the most part. It's in other parts, obviously your heart, your brain, your organs, but the vast majority of your metabolic function happens in muscles. Where you

Dr. George Papanicolaou:
Produce your muscle is the biggest organ in your body. It also becomes not only that metabolic reservoir, but it's a protein reservoir, an amino acid reservoir. So if we take it down to the point where you get older and maybe you get sick or you fall, you have an accident and you're sedentary for a while, you need a reservoir of protein and amino acid to recover. If it's not there, then you've just taken a step down and you have no ladder to get back.

Dr. Mark Hyman:
So it happened to a lot of elderly people when they got covid, they just had no capacity to deal with it, and they had no protein reserve. And they're often protein malnourished. And that protein is required to make your immune system, for example, your antibodies are made from proteins. Your immune system functions on protein. So if you have not the right amount of protein, you're in trouble. And if you don't have the reservoir in your muscles, you're doubling in protein I doubly in trouble.

Dr. George Papanicolaou:
So then that's the muscle mass piece. But then there's the strength piece. So there's muscle mass, but you need to have strength with that muscle. So the strength is your functionality.

Dr. Mark Hyman:
So you can't do that big muscles. They have to actually be functional and

Dr. George Papanicolaou:
Functionally strong. They have to be strong. And so you have to think about it in both ways. And then when you think about it that way, then you have to think about protein and its role in helping to build and repair muscle. But protein by itself is not going to lead to strength. That's when you need resistance training.

Dr. Mark Hyman:
It's like putting ingredients for soup on the stove, but not turning the heat on.

Dr. George Papanicolaou:
Exactly

Dr. Mark Hyman:
Right. So approaching is the ingredients, but the heat is the exercise,

Dr. George Papanicolaou:
And that's resistance training. And there's just a lot

Dr. Mark Hyman:
Of otherwise known as weightlifting, strength training, band training, body weight training. There's a million ways to do it.

Dr. George Papanicolaou:
And so there is resistance to resistance training. People just don't like to do it. When I talk to my patients, they're just like, I don't

Dr. Mark Hyman:
Like to. My God. I hated that. I was like, this is painful. This is uncomfortable. I couldn't do two pushups when I was 50 years old. I did 10 pushups. I would be sore for a week. I'm like, this is ridiculous. I don't want to do exercise. It makes me feel horrible. So I just never did it. And then I started when I was like 59. I'm like, all right, I know I'm supposed to do this. I tell everybody to do it. I'm not doing it. I better do it. And it just changed my life,

Dr. George Papanicolaou:
Dude. When I see you on Instagram pumping iron in the gym, I am impressed. I mean, seriously, you work hard when you work, man.

Dr. Mark Hyman:
I try. I try. But what's so important to realize right now is there's a huge problem in our society, which is the Ozempic craze.

Dr. George Papanicolaou:
Oh, yes.

Dr. Mark Hyman:
And the reason I'm bringing it up is ozempic makes you lose fat and muscle. And if you're on Ozempic or Wegovy or Monja or any one of these drugs and ones coming around every minute, you have to pay attention to what we're saying today. You have to have the right amount of protein more than you think about a gram per pound. And we'll talk about that per day. And you need to focus on resistance training if you're going to be on those drugs. Absolutely. And if you don't, what'll happen is you'll lose muscle and fat, but muscle burns seven times more calories than fat. So when you get to the weight you want, you'll have a slower metabolism. And eating a lower amount of food will actually make you gain weight. So this is a huge problem. And this is why often people can't get off the drugs and they don't do it properly. And I am not opposed a hundred percent to these drugs. I just think they're overused, and they're also not prescribed in a way that's taking care of the side effects of these drugs by properly addressing the protein needs and the resistance training needs that are increasing when you're taking these drugs.

Dr. George Papanicolaou:
I can't agree with you more. And if you hadn't made the point I would have. These are called GLP one

Dr. Mark Hyman:
Agonists.

Dr. George Papanicolaou:
Agonists. And they have a role. They have a role, but

Dr. Mark Hyman:
Our bodies make it, by the way, there's a lot of ways to increase our body making gpu.

Dr. George Papanicolaou:
Yeah. And they have a role. Our body makes it, but they're being co-opted from weight loss specifically. And when you lose weight rapidly or lose weight ever, you can lose 20 to 30% of that in muscle.

Dr. Mark Hyman:
Well, in Ozempic, I think it

Dr. George Papanicolaou:
It's higher. 40 or 50% of the weight be 40 to 50. Absolutely.

Dr. Mark Hyman:
50% of the weight you're losing is muscle, which is a disaster. And that

Dr. George Papanicolaou:
Is a disaster. And so in regards to using these drugs for weight loss the way we are now using them in our country, very difficult for me to find rationale for that. I've always been about, and that's why we're having this conversation. It's about lifestyle and capturing that lifestyle early in life so that you can maintain it and improve it and excel as you get older. So glad we took that little journey over. Yeah, I

Dr. Mark Hyman:
Think it's important

Dr. George Papanicolaou:
To the dark side

Dr. Mark Hyman:
Because it sort of speaks to why, for example, everybody who know ozempic needs a body composition before they start, track them every month to see what's going on. These machines are easy, you just stand on it. It's like a wet scale, a fancy scale that you stand in for a few minutes and it measures everything. And I think if we don't do that, in my view as someone who would be prescribing one of these drugs, I would consider malpractice. If you don't focus on muscle health and prevention of muscle loss when someone are on these drugs, I think it's akin to malpractice. And if you don't measure body composition and track it, it's like it's putting people on a diuretic where you lose potassium and not checking your potassium, right? Absolutely. It's like, well, as a doctor, if you're on a certain drug, you need to check liver function test. It affects the liver function. So you just know to track the things that other problems. And we don't do that with these drugs. And to me it's criminal and I think it's a quick fix, boom, boom, lose weight. But we're creating a whole society of people who are going to become a more sarcopenic, have more muscle, wasted everybody,
And lower metabolism. And then it's a vicious cycle of getting the weight back, eating less food, and being in this horrible, horrible tailspin that it's hard

Dr. George Papanicolaou:
To get. Absolutely. And we are so body shape centric and we are so fat centric that we are losing sight of the fact that you emphasize, and I want to emphasize again because I've had this conversation recently with colleagues and with you as well, that using these drugs, using GLP ones have a real downside to them. And using, particularly for weight loss is an issue because you're losing fat, but you're losing muscle. And that is even more important. You may look good, but now you're,

Dr. Mark Hyman:
You'll be skinny fat,

Dr. George Papanicolaou:
You're going to be, well, I don't know what's skinny muscle. Skinny

Dr. Mark Hyman:
Might mean you look thin, but you're actually fat. Exactly. That's what we

Dr. George Papanicolaou:
Call a skinny fat. Yeah, yeah, skinny fat, right? Yeah. So yeah, you're in bad shape. So I think you and I totally 100% agree on that and have the same viewpoint. And then there's also the complications that we've talked about before that can come with those drugs including intestinal obstruction. Yeah,

Dr. Mark Hyman:
There's a whole, I've done a podcast on that. We'll link to the show notes, but let's talk about body composition and resistance training in particular. I think there's two parts of body composition, what you eat. And I always say you can't exercise your way out of a bad diet. So if you don't get your diet sorted, and I'm going to spend a few minutes on that in a minute, you're going to have trouble. There's people who are in the gym all day long and overweight. I actually had a guy who was my trainer at Equinox when I lived in New York, who was ripped, could do. He was so strong. I mean he could literally go put, I don't know, 150 pounds on him and do pullups. I'm basically two body weights and do pull-ups. I can't even do one pull up way. And he kind had this thick layer of fat all over him and I said, why don't you try eating this way for a little bit? And I have a before and after picture of him, which is quite amazing. And he was even more rich, but had lost that layer of fat and it was metabolically more healthy, even though he was so strong, he still hadn't had his diet sorted. So diet really plays a role. Huge. Let's talk about what is the dose and frequency of resistance training? What are the types available and what should people do A little bit intimidating? Oh

Dr. George Papanicolaou:
My gosh, yes.

Dr. Mark Hyman:
If you're a bodybuilder, I mean, I would go to these gyms with all these bodybuilders and it's this skinny guy. I'm like, Ugh, I'm sort of intimidated here. I don't know what to do. I don't want to hurt myself. I'm worried about this. How do you address the problem of just getting started if you've never done this before?

Dr. George Papanicolaou:
That's the million dollar question. And this is why people don't do resistance training because the bar is really high. It means they need to buy equipment because, or go to a gym. Then when you get to the gym and then they're, you see all these machines, which ones do I use?

Dr. Mark Hyman:
Everybody can afford a trainer, right?

Dr. George Papanicolaou:
When I get on the machine, how much weight do I use? Do I use a little weight and do lots of reps? Do I use the heavy weight and not so many reps? What's my range of motion? Do I do full range of motion? Do I do short length partials? Do I do long length partials? What do I do centric?

Dr. Mark Hyman:
What do I do? Yeah.

Dr. George Papanicolaou:
So in preparation for today's talk, I said to myself, okay, I can't go through the entire science of strength training, but I'm going to try and just distill it down. So what we want to do is we definitely need to do progressive resistance training in order to gain muscle mass. And okay, so progressive resistance training means that you start out whatever exercise you choose, one that everybody might know there's a curl. Alright, so you're going to start out with five pounds. Well, you do it the first time you do it, man, I could barely get to eight. Okay, alright, so then you're going to go back three days later or maybe go back the next day you do a different body part, but three days later you're going to go back, you do your curl and you know what? You're going to notice that you actually do two more reps.
It's not necessarily because you got stronger, it's because you actually got more efficient biomechanically the message from your brain to your muscle. Some of the metabolic efficiencies occurred already, not necessarily stronger, not necessarily bigger muscle mass yet, but more efficient. But three weeks down the road, you're going to find that it's really easy. Now it's time to increase your weight. And so now you're going to 7.5 pounds. So by the time three months comes, if you've been really consistent, you're going to find that you've progressively increased your resistance and now your net from five pounds, you went up to 15 pound curl. That is going to correlate to increased strength and increased muscle mass. As long as you're eating correctly, you need to fuel that with the right amount of carbohydrates and healthy fats. And you're going to also have to supply the building blocks with protein. If you're not getting the protein, then you're not going to be able to repair, you're going to get injured and you're not going to build a muscle mass and strength that you're looking for. So that's just a really basic basic.

Dr. Mark Hyman:
So progressive resistance training, I think that's an easy concept to understand. You slowly build up the amount and of, but how many days a week should you do this? I mean, what are the different types people can do? What are the low friction ways? For example, I didn't really ever do any weight training. So I went to the gym and I got a trainer and I could afford it, thank God. And I learned a lot and I kind of started and then covid happened and kind of fell off. And then I went and learned about band training, resistance bands, traveling a lot. I move around a lot and I can't always get to a gym or I'm busy and I don't have time to go to the gym, get to there, change, do the thing, change again, shower, come back, drive home. It took a whole thing.
So I'm like, I just need to be efficient. And I learned about TB 12, which is Tom Brady's band resistance training program when Tom did this solely and he ended up being a seven time Super Bowl world champion. So I think he knows what he's doing. And I started doing these bands and I could do them anywhere. I could hook 'em to a doorknob. I need a floor and a door and I'm good. And I'm able to literally build my strength and it's so easy. And I can do light bands at first, heavier bands, heavier bands. I can do about 20, 30 minutes three or four times a week. I like to do five if I can, but even that keeps me going. And so it doesn't have to be a big project. And there's a lot of apps. I know there's a TB 12 app you can use, but I think how do people just think about getting started on

Dr. George Papanicolaou:
This? So what you referred to are some of the alternatives to our classic understanding of progressive resistance using weights. So there are bands, there are kettlebells, there are body weight exercises. All of these can increase strength. They might be more difficult to increase the muscle mass and hypertrophy because you might not be able to get the number, get to the amount of resistance you need or the number of reps you need effectively to increase hypertrophy. So I will generally suggest to people that they move towards using weights for the resistance training. And you can do that at home. You can do that in a gym, usually recommend that you do at least two days a week. I think if you're doing two days a week, you're just breaking,

Dr. Mark Hyman:
Staying even.

Dr. George Papanicolaou:
You're breaking it, you're breaking in. I think if you're doing three days a week, you, you're going to be able to accomplish your goals four days a week, you're going to be able to squeeze a little bit more water out of the sponge five days a week, you're now probably nearing addiction. And how many of you do

Dr. Mark Hyman:
George?

Dr. George Papanicolaou:
Three to four. Three to four. There are weeks I get one or two. I mean, quite honestly, again, a quick aside, you cannot maintain the same exercise level throughout the year, whether you're a world champion or a national champion or a really high level collegiality. You just can't. And you have to concentrate on different areas of your physical health, whether it be nutrition or your fitness. And there's various forms of fitness that you need to train at different times of the year. One of my favorite bike riders of all time is Lance Armstrong. I just think that regardless of anybody may say, despite all his

Dr. Mark Hyman:
Problems,

Dr. George Papanicolaou:
Regardless of anybody may say Lance Armstrong worked harder than anybody, well

Dr. Mark Hyman:
That'll help from his friend. Yeah.

Dr. George Papanicolaou:
Well, we can put that aside for now. But he still really worked hard and I had a huge amount of respect for Lance, but needless to say, when he was, I could probably in the middle of winter when I was really riding hard, probably gone to Austin and ridden with Lance because he probably wasn't doing intervals and sprints. He was probably doing 5, 6, 7 hours on the bike and I could just hang on his wheel and let him drag me around, but I would be able to hang with him, right, because you're working on something different. He then changes his program so that as he's getting closer and closer to spring classics and finally to the Tour de France where he's getting more specific into power and sprinting, then I'm just taking pictures,

Dr. Mark Hyman:
Right? Same thing with strength training, right? Yeah.

Dr. George Papanicolaou:
The same thing with strength training to get back to it is I'm not going to sit here and tell everybody 365 days a year, I have the consistently same program. It's impossible. I don't. But I stay at that level where if I am too busy and I am on vacation, I can take that break and get very quickly back into my routine without that much of a loss and get right back to my physical fitness level and then continue to build as I need to for my next challenge in my life. So strength training one and one, I'm going to give it to your right, simple, get to the gym. I do think getting to a gym is probably going to be the most effective way to begin the process once you understand how to do it using kettlebells. I'll take one thing back. One thing you can do is the Instagram and YouTube are huge resources for exercise programs. So I will take this back. My wife has turned me onto this recently. She has a whole catalog on her phone of Instagram posts of different resistance training and weight training programs that involve kettlebells, body bands, everything. So the bar for doing those things actually is so much lower than it used to be.

Dr. Mark Hyman:
And body weight, I'm

Dr. George Papanicolaou:
Actually going to take back what I just said. I don't think you need to go to the gym to start. I don't go to YouTube. Go to YouTube and Instagram. Pick your favorite, pick your favorite, whether it's bands, whether it's kettlebells, whether it's body weight, and you'll be able to find a plethora of different exercises that you can do at home in the office. So you can just

Dr. Mark Hyman:
Start there. You've got to be careful to not overdo it and be like where you injure yourself, you have to start, yeah,

Dr. George Papanicolaou:
We're going to hope that everybody's going to be using common sense,

Dr. Mark Hyman:
But well, what Mark Twain said, right? No, the problem with common sense is not too common right

Dr. George Papanicolaou:
Now. I've heard you say that before. I should have known. So you always start low, go slow. There's no rush. You'll make your gains with time. But when it comes to actual, if you're going to use weights, which is my favorite approach, then here are the things that people always wonder about. Which exercises should I do? Well, you want to do exercises that use more than one joint. They're going to give you the most metabolic response.

Dr. Mark Hyman:
For example,

Dr. George Papanicolaou:
For example, would be a squat, squat, squat, a deadlift, even a bench press, you are using multiple joints. The bench press, if you do bench press, squat, deadlift, you bench press, squat, deadlift, you're talking about the power lifts and those, if you just concentrated on those, you're going to get a full body workout that's going to put you in a really good position of right now, those they take a, so it

Dr. Mark Hyman:
Doesn't take a lot is what you're saying. It doesn't take a lot. And you don't have to go crazy. You don't have to be in the gym all the time. And you can actually learn a few key exercises that build large muscle strength and core strength and stability. Really, really important. And that's why I love bands. They're so easy and portable and they do all those things.

Dr. George Papanicolaou:
So on the weight piece, again, people are always wondering, should I do how much weight and how many reps? So it really depends. But I would say that for getting, if you want a good solid middle of the ground program, then you want to try to do anywhere from eight to 12 reps. Should I go to exhaustion or should I not go to exhaustion? Should my last rep be completely, I can barely get it up or not. Well, there's some mixed data and some recent data indicates that getting to two to three reps before exhaustion is going to give you the same benefit. So you don't have to go to exhaustion,

Dr. Mark Hyman:
You don't have to have so much pain, right?

Dr. George Papanicolaou:
And so eight to 12, your last one can be one to two to maybe three reps from exhaustion. There it is. There's your repetition number. Your weights should be weights that allow you to do eight to 12 reps. So you just find a weight, you have to test it out and figure out your first couple of times you go, which, what are you going to use? And then here's something transformed my recent weightlifting. So there's long length partials, there's full range of motion, and then there's short length partials. So when they compared, so full range of motion is when you do a curl like this, full range of motion from that position. A short length partial is you start here and go like

Dr. Mark Hyman:
This. So you start halfway and then you finish.

Dr. George Papanicolaou:
Yeah, long length partial. You start with the muscle fully extended and stretched and just go part way, part way. One third to half. Yeah. Right. And what does that do? So recent data is shown that when you compare the long length to the short length partial, the long length partial, there's not even a comparison in terms of strength.

Dr. Mark Hyman:
So short length is better than long length? No,

Dr. George Papanicolaou:
No long length. Length than length. Long length. Long length. And when you compare long length, a full range of motion, long length is still superior. Amazing. So you can do a long length partial and get the same benefit as if you're doing a full range of motion. The benefit I find for me in that regard, and for people that are going to be lifting,

Dr. Mark Hyman:
Is that why your biceps are bigger than mine?

Dr. George Papanicolaou:
I don't know. I don't know. Mark, look, I'll write your next program for you. Make sure you get your biceps. So when you do the long length partial, what I like about it is I can actually use more weight. I can actually, and I just find it's much less stress on my overall system body, right? So this

Dr. Mark Hyman:
Is fabulous.

Dr. George Papanicolaou:
These are basic things. I want people to get your weight. You pick weights that you can do eight to 12 reps. You don't have to go to exhaustion, but if you want to, you can two to one to three reps before exhaustions. All you need to go to, you need to progressively increase your weights over time. And then you can use any type of format. You can use bands, you can use kettlebells, you can use body weight. And again, as we talked about with aerobic training, you have these exercise snacks. You can do exercise snacks with your resistance training as well. As you mentioned, I have dumbbells in my office and I use those for my exercise snack during day.

Dr. Mark Hyman:
No, I mean, I just talked to Lee Hood, who's one of the world's premier scientists in systems biology and medicine, and he's 85 years old. He does 150 pushups a day. So not all at once obviously, but he drops in 30 here, drops in 30. There you that five times today, that's 150 pushups. Very impressive. So George, this has been a great conversation about how do we look at things that are often missed with traditional medicine, what we do at the UltraWellness Center to look deeply into someone's health and wellbeing and actually optimize their health and even treat diseases using exercise. How do we measure the fitness level using VO two max? How do we measure body composition using our in-body diagnostic machine we have in the office? And using that data to help inform people about what's going on with their body and how to adjust their lifestyle to correct the problems so they don't get into trouble in the longterm.
The one thing we didn't talk about, I just want to touch on for a few minutes before we finish, is diet. Because body composition in particular and cardiovascular fitness to a lesser degree is so correlated with our diet. And part of the challenge we've had is that we don't want eat enough of the right kinds of protein, and two, we eat too much of the wrong kinds of carbohydrates. And that will lead to increasing belly fat, visceral fat, fat marbled in your muscles, which you said we couldn't measure the dexa marble. You don't want to rib eye muscle. You want a filet mignon muscle, right?

Dr. George Papanicolaou:
No wagyu,

Dr. Mark Hyman:
No Wagyu beef muscles, but that's basically what everybody in America's walking around with. It's true. And so we need to really help people understand that they need to reduce their refined starches and carbohydrate in their diet. They need to increase the good fats and they need to increase the quality protein. When I say quality protein, we've talked a lot about this in the podcast with Gabrielle Lyon, with Don Lehman and others, and we'll link to those shows. But the quality protein matters. It does. And if you want to build muscle, you need muscle. It's sort of if you want to build muscle, you need to eat muscle. And if you eat beans, it doesn't work as well. You can, if you eat massive amounts or you have a highly processed bean powders or grain powders, you can concentrate the proteins and then they add extra amino acids, they add extra basically synthetic amino acids to jack up the quality of the protein, which if you are committed vegan, you can do, but you have to do that like a garden of life.
Sport protein, for example, has 30 grams of protein, but they also add all these other amino acids, which aren't naturally in the products that are in. Yeah, exactly. So you have to eat either whey protein, beef, chicken, fish, lamb, these be bison, whatever you want to eat and make sure it's the right kind. It's regenerative raised. There's great sources and we'll link to the absolutely places you can get to force of nature, whether regenerative meats or zootopia fish with the great quality fish, it's not toxic and so forth, go away I like. But you need the right amount of protein. And the right amount of protein is more than we typically think. If you're resistance training and you're doing the exercise, you need about a gram per pound, which is almost double what is considered the requirements. And just so people know, the requirements that we have are based on avoiding protein malnutrition.
So to avoid protein malnutrition, which is what was more prevalent when these guidelines were established, you need about 0.8 grams per kilo, which is about half of what I'm talking about. It's not the amount you need to put on muscle or optimize your health. And secondly, as we get older, you mentioned early in the show, we have anabolic resistance, which means we are more resistant to putting on muscle. So we need to overcome that resistance with more protein, more exercise. So really nutrition plays a huge role. We deal with all that at the Ultra One Center. We look at your metabolic health through multiple lenses, including the body composition measurements and VO two max measurements.

Dr. George Papanicolaou:
So yeah, I 100% agree with that. And you mentioned the different speakers you've had on your show talking about protein. And so the literature on protein, the number that seems to have floated out in the last year or so has been like 1.6 grams per kilo. And so I would say that having looked at literature, definitely want to be somewhere between 1.2 to 1.6 depending on your exercise activity. Do you need to get above 1.6? Maybe? Probably not. Even if you're lifting, I think 1.6, if you think about 1.6 grams per kilo for me is 130 grams per day. It is a lot of protein for me. I mean, I definitely need to use a protein powder shake, right?

Dr. Mark Hyman:
Yeah. But before the show here, we just had a protein shake and that was about 40 grams each boom like that. It was a sub

Dr. George Papanicolaou:
Protein shake. So I can't get to 130 without a protein shake. Right? And I think going back to your point,

Dr. Mark Hyman:
Well, if you had steak for breakfast,

Dr. George Papanicolaou:
I had a really good steak last night, I made it myself. Anyhow, yeah, high quality proteins with grass fed beef. Farm raised poultry, get fish at least two to three times a week, get it from good clean sources and you can get your protein. But God gave us cattle and bison for a reason, and he gave us canines for a reason. Cattle and bison, they are protein factories. They eat the plants, they now take all the amino acids and all the proteins from all of the plants, combine them into one muscle that we can eat.

Dr. Mark Hyman:
Yeah, they have four stomachs. That's why they can do it. We only one stomach

Dr. George Papanicolaou:
Because plant proteins are a little bit harder for us to digest and get out the amino acids that we need. So now,

Dr. Mark Hyman:
And they eat all day. I was in Rwanda, people were like, oh my gosh, gorillas, they're so strong and all they do is eat plants. I'm like, yeah. And they basically have intestines that are two or three times larger than ours, and all they do all day is eat and they eat 50 pounds of food a day. Are you going to eat 50 pounds of food? Probably not. If you ate 50 pounds of grass, you'd be fine. Like I said, you can overcome the issue with plant protein if you eat enough of it, but it's almost impossible to do that. So George, thanks so much for enlightening us about the role of exercise, the role of measuring the biomarkers, health and fitness, metabolic health VO two max body composition. Again, it's just part of what we do at the Ultra Wellness Center. We took a deep dive into all your biomarkers, into your full spectrum of health. We are really in the practice of creating health. Absolutely. And what I say is, no matter how sick you are, we help you get healthy. And as a side effect, disease goes away. So George, thanks so much for being on the podcast again. Hopefully if those listening expire, you'll come see us at the Ultra Wellness Center. Just go to ultra wellness center.com to learn more about what we're doing and hope we see you soon.

Dr. George Papanicolaou:
That'd be great. Thanks, mark.

Dr. Mark Hyman:
Thanks George. Thanks for listening today. If you love this podcast, please share it with your friends and family. Leave a comment on your own best practices on how you upgrade your health and subscribe wherever you get your podcasts. And follow me on all social media channels at Dr. Mark Hyman, and we'll see you next time on The Doctor's Pharmacy. I'm always getting questions about my favorite books, podcasts, gadgets, supplements, recipes, and lots more. And now you can have access to all of this information by signing up for my free Marks Picks [email protected] slash marks picks. I promise I'll only email you once a week on Fridays, and I'll never share your email address or send you anything else besides my recommendations. These are the things that helped me on my help journey, and I hope they'll help you too. Again, that's dr hyman.com/marks picks. Thank you again, and we'll see you next time on The Doctor's Pharmacy.
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