<p><a href="https://peterattiamd.com/qps4/?utm_source=podcast-feed&utm_medium=referral&utm_campaign=250303-pod-qps4&utm_content=250303-pod-qps4-podfeed"> View the Show Notes Page for This Episode</a></p> <p><a href="https://peterattiamd.com/subscribe/?utm_source=podcast-feed&utm_medium=referral&utm_campaign=250303-pod-qps4&utm_content=250303-pod-qps4-podfeed"> Become a Member to Receive Exclusive Content</a></p> <p><a href="https://peterattiamd.com/newsletter/?utm_source=podcast-feed&utm_medium=referral&utm_campaign=250303-pod-qps4&utm_content=250303-pod-qps4-podfeed"> Sign Up to Receive Peter's Weekly Newsletter</a></p> <p>In this quarterly podcast summary (QPS) episode, Peter summarizes his biggest takeaways from the last three months of guest interviews on the podcast. Peter shares key insights from his discussions on diverse topics such as aerobic efficiency and VO2 max with Olav Aleksander Bu; insulin resistance with Ralph DeFronzo; economics of the US healthcare system and cost-saving strategies with Saum Sutaria; diagnosis and treatment of autism, ADHD, and anxiety in children with Trenna Sutcliffe; and strength training with Mike Israetel. Additionally, Peter shares any personal behavioral adjustments or modifications to his patient care practices that have arisen from these fascinating discussions.</p> <p>If you're not a subscriber and are listening on a podcast player, you'll only be able to hear a preview of the AMA. If you're a subscriber, you can now listen to this full episode on your <a href="https://peterattiamd.com/members/private-podcast-feed/?utm_source=podcast-feed&utm_medium=referral&utm_campaign=250303-pod-qps4&utm_content=250303-pod-qps4-podfeed">private RSS feed </a>or our website at the <a href="http://peterattiamd.com/qps4/?utm_source=podcast-feed&utm_medium=referral&utm_campaign=250303-pod-qps4&utm_content=250303-pod-qps4-podfeed">episode #338 show notes page</a>. If you are not a subscriber, you can learn more about the subscriber benefits <a href="https://peterattiamd.com/subscribe/?utm_source=podcast-feed&utm_medium=referral&utm_campaign=250303-pod-qps4&utm_content=250303-pod-qps4-podfeed">here</a>.</p> <p><strong>We discuss:</strong></p> <ul type="disc"> <li>Overview of topics to be discussed [2:00];</li> <li>Olav Aleksander Bu Pt.2 episode: metrics to track aerobic efficiency and insights about VO2 max, and the ability of increased carbohydrate consumption to boost performance [4:30];</li> <li>The best practices for performing a VO2 max test, the differences between VO2 max training and all-out efforts, and the role of energy intake in endurance performance [14:45];</li> <li>Ralph DeFronzo episode: the pathophysiology of insulin resistance and type 2 diabetes—how they impact different organs, flaws in conventional diabetes treatment, and more [24:30];</li> <li>Understanding type 2 diabetes beyond the traditional triumvirate of features: the "ominous octet" describes changes in other organs [31:45];</li> <li>Pharmacological treatments for insulin resistance and type 2 diabetes [41:30];</li> <li>The importance of early detection and intervention in insulin resistance [50:30];</li> <li>Saum Sutaria episode: the economic and systemic drivers of high healthcare costs in the U.S. [54:00];</li> <li>Reducing health care costs: redefining health insurance, lowering drug prices while maintaining innovation, leveraging AI for efficiency, and more [1:07:15];</li> <li>Trenna Sutcliffe episode: insights on autism, ADHD, and anxiety in children—definitions and diagnosis [1:11:45];</li> <li>Exploring the rising prevalence of autism spectrum disorder [1:17:15];</li> <li>Trenna's views on caring for children with autism [1:21:15];</li> <li>Misconceptions around vaccines and autism [1:26:00];</li> <li>Mike Israetel episode: insights about strength training, minimum effective dose, troubleshooting plateaus, tips for beginners, and more [1:28:15];</li> <li>Topics Peter is interested in exploring in future podcasts [1:40:15]; and</li> <li>More.</li> </ul> <p>Connect With Peter on <a href="https://twitter.com/PeterAttiaMD">Twitter</a>, <a href="https://www.instagram.com/peterattiamd/">Instagram</a>, <a href="https://www.facebook.com/peterattiamd/">Facebook</a> and <a href="https://www.youtube.com/channel/UC8kGsMa0LygSX9nkBcBH1Sg">YouTube</a></p>
Actionable Insights
1. Maximize VO2 Max Test Accuracy
Follow a specific protocol for VO2 max testing: test at your normal training time, be well-rested, minimize travel the day before, perform a 6-minute easy warmup, 3 minutes at threshold, 2-3 bursts at PVO2 max, then rest 10-15 minutes before the test. This ensures an accurate and maximized test result.
2. Execute VO2 Max Intervals Effectively
When doing 3-8 minute VO2 max intervals, aim for a constant power output that feels easy for the first minute, good at the halfway point, and becomes miserable in the last minute, allowing you to repeat the effort across multiple intervals. The goal is to preserve power across all intervals, not to kill yourself on the first one.
3. Train GI for Endurance Carbs
High-performance endurance athletes (triathletes, cyclists) can train their gastrointestinal system to tolerate much higher carbohydrate intake (up to 240 grams per hour at 12% mixture) during long events, effectively doubling fuel octane for performance.
4. Weekly VO2 Max Training Schedule
Incorporate one day a week of interval training (3-8 minute intervals) alongside three days a week of Zone 2 training to improve VO2 max.
5. Proper VO2 Max Test Warmup
Ensure a proper warmup before a VO2 max test, including escalating power efforts, as inadequate warmup (e.g., just 5 minutes on a treadmill) leads to a ‘garbage protocol’ and an underestimated VO2 max.
6. Measure Aerobic Efficiency: Critical Power
If you want metrics beyond VO2 max for higher-end aerobic efficiency, consider measuring your Critical Power as it’s easier to calculate than FTP from shorter tests.
7. Boost VO2 Max with Beetroot
Consume beetroot concentrate, which is rich in nitrates, to boost VO2 max by about 5% in amateur athletes by converting to nitric oxide, aiding vasodilation.
8. Breath Holds During VO2 Max
As you approach failure during a VO2 max test, do a few breath holds, as this produces a significant boost in the measured VO2 max due to reactive overconsumption of oxygen.
For a truly all-out effort, consider a reverse Tabata protocol: 10 seconds all out, 20 seconds rest, repeated eight times. This is about the closest the human body can get to an ‘all out’ effort and will increase VO2 max.
10. Understand VO2 Max Interval Pain
Understand that true Tabata (20s on, 10s off) is an ‘all-out’ effort that is harder in peak pain than VO2 max intervals (3-8 minutes), which involve a lower peak pain but greater area under the pain curve. VO2 max intervals (3-8 min) are more effective for increasing VO2 max than Tabata.
11. Acetaminophen for Endurance: Consider Trade-offs
Consider that acetaminophen (Tylenol) can boost peak endurance performance by 1-2% by reducing pain perception, but it may impair heat dissipation, raising questions about its worthwhile trade-off.