#299 ‒ Optimizing muscle protein synthesis: the crucial impact of protein quality and quantity, and the key role of resistance training | Luc van Loon, Ph.D.

Luc van Loon is an internationally renowned expert in skeletal muscle metabolism. In this episode, Luc starts with an exploration of the roles of insulin and triglycerides in endurance exercise, highlighting their impact on skeletal muscle metabolism, and he offers profound insights into the significance of protein in this context. He elucidates how different protein types and forms influence muscle protein synthesis rates, exploring the nuances of protein absorption, digestibility, amino acid quality, and their implications for performance and recovery. Delving deeper, he differentiates between animal and plant protein sources, unraveling the distinctive properties of various protein types, from the differences between whey and casein to the emerging trends in collagen protein supplementation. Moreover, Luc dissects the intricate connections among physical activity, lean muscle mass, muscle protein synthesis induced by resistance training, and dietary protein.

We discuss:

Luc’s background and insights about fuel selection during exercise [3:30];
Fuel utilization during endurance exercise [9:30];
Fat metabolism, intramuscular lipids, and the nutritional dynamics of endurance sports [17:15];
The optimal window for replenishing intramuscular fat stores and glycogen post-exercise [25:15];
Luc’s interest in protein metabolism and exploration of amino acids' dual role as building blocks and signaling molecules in driving muscle protein synthesis [32:15];
How protein metabolism differs between sedentary individuals and those engaged in predominantly strength training or endurance training [38:45];
The basics of how proteins are digested and absorbed, and how muscle protein synthesis is measured [50:30];
How factors like food texture, cooking methods, and protein composition impact muscle protein synthesis, and the importance of protein distribution throughout the day [59:45];
Differences in whey and casein proteins, and the ability of ingested protein to stimulate muscle protein synthesis [1:03:30];
Dietary protein distribution and quantity for the maximization of muscle protein synthesis [1:09:00];
Muscle loss with age and inactivity and the importance of resistance exercise to maintain type II muscle fibers [1:17:15];
Differences between whey and casein proteins, and the importance of both quantity and quality of protein sources [1:28:30];
Optimizing muscle protein synthesis: exercise, timing of protein intake, protein quality, and more [1:37:00];
How to preserve muscle while trying to lose weight [1:46:00];
Anabolic resistance and overcoming it with physical activity [1:55:45];
Importance of protein intake and physical activity in hospitalized patients [2:06:30];
Reviewing the efficacy of collagen supplements [2:13:30];
Plant-based diets: how to ensure a balance of amino acids, and other considerations [2:20:30];
Future research: understanding protein metabolism in the brain [2:23:45]; and
More.

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🔑 Key Takeaways

Understanding insulin and glucose role in endurance exercising, the difference between animal and plant protein, and the importance of timing and type of protein from resistance training for muscle building.
Researchers use stable isotopes to measure energy derived from carbohydrates in sports drinks during endurance exercise, providing accurate information on energy expenditure and sources of fuel.
Athletes efficiently use stored fat as energy during exercise, while people with type 2 diabetes may struggle due to insulin resistance
During exercise, athletes use intramuscular lipids as a fuel source, while individuals with diabetes keep them stored due to constant free fatty acids. Insulin's role is less significant in muscle uptake during exercise due to AMPK pathway stimulation, and muscles absorb more free fatty acids from inactive muscles.
Athletes must consume sufficient fat during multi-day events to maintain optimal performance, as the body takes 45 minutes to prime fatty acids for use and relies on intramuscular fat stores. Replenishing glycogen and intramuscular fat within the first few hours is crucial.
Exercising at least 150 minutes a week can maximize insulin sensitivity and glucose homeostasis benefits, while fatty acid uptake into muscle cells lasts up to 48 hours. MCTs may enhance fat oxidation during high-intensity exercise but gastrointestinal distress is a challenge. Carbohydrates remain a practical approach for most athletes.
Athletes have structured muscle tissue due to efficient protein synthesis and metabolism, while sedentary individuals have unstructured muscle tissue, emphasizing the importance of proper protein intake for muscle health.
Muscles are dynamic, constantly breaking down and building new proteins, requiring anabolic stimuli for maintenance through nutrition and exercise
The body builds different types of proteins based on the specific demands of various training types, involving complex molecular pathways and nutrient availability.
Adequate protein signaling and availability of amino acids are crucial for muscle protein synthesis, similar to a parking lot where cars can only enter when the light is green and there are cars present.
Research shows that different forms and consumption methods of protein impact digestion, absorption rates, and subsequently muscle protein synthesis and metabolic responses.
Thorough chewing, food type, preparation methods, and amino acid composition all influence digestion and absorption of nutrients, impacting health and well-being.
Digestibility, rate of digestion, and amino acid composition impact muscle protein synthesis. Plant vs animal, cooked vs uncooked, and food processing affect digestibility. Chewing and processing rate digestion. Leucine-rich amino acids stimulate muscle growth.
For optimal muscle protein synthesis, some individuals may need to consume 30 grams or more of protein per meal, especially when eating real food
Older adults in hospitals receive only 0.8 grams of protein daily, falling short of recommended 1.2-1.5 grams, leading to significant muscle loss and increased risk of falls
Age-related muscle loss isn't continuous or inevitable. It's a series of declines triggered by periods of inactivity, which can be prevented through regular physical activity, especially resistance training.
A 100-gram protein dose can increase muscle protein synthesis for a longer period of time than previously thought, challenging the notion that the body can only effectively use around 40-50 grams of protein in a meal.
Consuming protein immediately after a workout enhances muscle protein synthesis, making it more sensitive to food intake. Prioritize protein intake, especially after workouts, for muscle growth and recovery.
Consuming protein after exercise doesn't change muscle growth or recovery, but long-term supplementation may enhance gains
Maintain a balanced diet with enough protein, train consistently, and consider caloric restriction or intermittent fasting for weight loss. Be cautious with excessive time restriction to avoid disproportionate loss of lean mass.
Adding protein shakes and resistance training outside of feeding window aids in preserving lean mass during weight loss, enhancing overall weight loss results and muscle growth.
Aging can lead to anabolic resistance, a condition where the body has decreased ability to build muscle from protein. This is problematic as older adults often eat less and move less, worsening the issue. Causes include potential digestion, absorption, or muscle uptake issues, as well as insulin signaling.
Physical activity is crucial for muscle sensitivity to amino acids and optimal protein assimilation. Immobility reduces muscle response, and exercising older individuals can help restore normal muscle function.
Resistance training maintains muscle health, prevents negative side effects, and is essential for overall well-being during cancer treatment or hospitalization. Prioritizing exercise and proper nutrition can improve health outcomes.
Eating protein-rich snacks before bed can enhance muscle recovery and growth, especially for older people or those recovering from illness.
Collagen supplementation doesn't significantly boost muscle protein synthesis. Focus on essential aminos in meals instead.
Understanding the unique protein needs of vulnerable populations and the brain's high protein turnover rate requires ongoing research
Listeners can access curated content from previous episodes of The Drive podcast through 'Qualys', a member-only benefit. This is a convenient way to learn from past episodes without having to listen to each one in full.

📝 Podcast Summary

Discussing Insulin, Glucose, and Protein for Endurance Exercising

Professor Luke Van Loon, an internationally renowned researcher in skeletal muscle metabolism, exercise metabolism, sports and clinical nutrition, and aging, discussed the importance of insulin and glucose for endurance exercising and the role of protein in muscle protein synthesis. He highlighted the differences between animal and plant sources of protein, as well as specific types like whey and casein, and the impact of food preparation on protein digestion. The conversation also touched on the relationship between activity, lean mass, building muscle, and protein from resistance training, emphasizing the importance of timing and type of protein. Overall, the episode underscores the significance of understanding the science behind nutrition and protein to optimize health and wellness. To learn more about Luke's research and the benefits of a premium membership, visit peteratiamd.com/subscribe.

Measuring Carbohydrate Use in Endurance Exercise with Stable Isotopes

During endurance exercise, the body primarily uses carbohydrates as fuel, and researchers can measure the exact amount of energy derived from carbohydrates in sports drinks using stable isotope research. This method, called doubly labeled water, can provide accurate information about energy expenditure over a long period of time. The body has multiple sources of carbohydrates, including muscle and liver glycogen and plasma glucose, and researchers can distinguish between them using different labels. Additionally, researchers can study the use of intramuscular triglycerides and fatty acids. For endurance athletes, maintaining a steady supply of carbohydrates is crucial for preserving liver glycogen and optimizing performance.

Athlete's muscles adapt to use more fat during exercise

During exercise, the body of an athlete adapts to use more fat as an energy source, storing more intramuscular triglycerides. These triglycerides are located inside muscle fibers and are readily accessible for energy provision, especially at the beginning of exercise. Mitochondria, the energy producers in cells, are attached to these lipid droplets, acting like a backpack. This adaptation allows athletes to use their limited carbohydrate stores more efficiently. The muscle cells of an athlete and someone with type 2 diabetes may contain fat, but the presence of mitochondria on the lipid drolets is a key difference. In the case of type 2 diabetes, insulin resistance may prevent the efficient use of these lipids as an energy source.

Intramuscular lipids: A substrate source for athletes vs permanent storage for individuals with diabetes

During exercise, the role of intramuscular lipids varies significantly between athletes and individuals with diabetes. In athletes, these lipids serve as a substrate source that is constantly being used, while in individuals with diabetes, they remain in a permanent storage state due to the constant presence of free fatty acids in the circulation. Insulin plays a role in determining the rate of esterification and lipolysis in the fat cell, but during exercise, insulin's role in facilitating fat uptake is less significant due to the stimulation of the AMPK pathway. A fascinating finding from a study was that during exercise, the muscle takes in more free fatty acids from inactive muscles, leading to an increase in intramuscular lipids. Athletes have the capacity to consume fat during steady-state exercise, but they may choose to limit carbohydrate intake due to the potential GI discomfort of consuming large amounts for extended periods. Overall, understanding the role of intramuscular lipids and insulin in muscle function during exercise can provide valuable insights into the mechanisms underlying insulin sensitivity and resistance.

During long endurance events, the body relies on fat for energy

During endurance events lasting over 20 hours, the body relies on a combination of glycogen, endogenous fat stores, and exogenous substrates like fat and protein for energy. While glycogen is important, especially in the first few hours, fat becomes increasingly crucial for longer events due to its longer replenishment time. Ultra-endurance athletes report that they cannot perform optimally without sufficient fat intake during multi-day events. The body takes around 45 minutes to prime fatty acids for use, making it essential to maintain adequate intramuscular fat stores. The window for replenishing intramuscular fat and glycogen is within the first few hours following exercise, with insulin-independent glucose uptake allowing for efficient muscle storage. Exercise itself helps maintain glucose homeostasis by activating GLUT4 transporters in the muscle membrane, enhancing glucose uptake without the need for insulin.

Exercise's Impact on Insulin Sensitivity and Glucose Homeostasis Lasts Up to 48 Hours

The window for insulin sensitivity and glucose homeostasis improvement after exercise lasts up to 24 hours. For those with diabetes, aiming for at least 150 minutes of exercise per week can maximize the benefits from each meal. The fatty acid uptake into muscle cells also continues for up to 48 hours. Intramuscular triglycerides and free fatty acids from adipose tissue contribute equally to fat oxidation during exercise. Medium chain triglycerides (MCTs) can enhance fat oxidation during high-intensity exercise, but gastrointestinal distress is a challenge in consuming large volumes. Research on MCTs as a performance enhancer is ongoing, but carbohydrate use remains a more practical approach for most athletes. The athletes' paradox of high intramuscular fatty acids in diabetic and obese individuals, as well as athletes, sparked an interest in diabetes research and exercise to improve insulin sensitivity and substrate metabolism.

Muscle tissue quality differs between athletes and sedentary populations

The quality of muscle tissue differs significantly between active individuals, such as athletes, and sedentary populations, like those with diabetes. The muscle tissue of athletes is firm and structured, resembling a piece of good steak, while the muscle tissue of sedentary individuals is more akin to a blob with no structure. This difference is due to changes in protein synthesis and metabolism. Protein is a crucial macronutrient made up of amino acids, which are the building blocks of all tissues, including muscle. Humans can produce some amino acids endogenously, but nine essential amino acids must be obtained through diet. Amino acids not only serve as building blocks but also directly stimulate muscle protein synthesis by activating the mTOR pathway. Every day, the body synthesizes approximately 300 grams of protein, with an average person consuming around 70-100 grams per day. The remaining protein comes from the breakdown of tissues and their subsequent recycling. Understanding the importance of protein and its role in muscle health can provide valuable insights into maintaining muscle quality and overall health.

Muscles are constantly evolving

Our muscles are constantly breaking down and building new proteins, with a turnover rate of about one to two percent per day. This means that the proteins in our muscles are completely refurbished every 50 to 100 days. To maintain muscle mass, we need to provide anabolic stimuli through nutrition and exercise to counteract the natural breakdown process. The process is measured by infusing stable isotope-labeled amino acids and tracking their synthesis rates in muscle tissue. This fascinating discovery sheds light on the dynamic nature of our bodies and highlights the importance of proper nutrition and exercise for muscle health. It's a reminder that our bodies are not static, but rather constantly evolving and adapting.

The body responds differently to various types of training in terms of muscle protein synthesis

While we know that protein intake and exercise stimulate muscle protein synthesis, the body's response in terms of which proteins to build and in what structure is still a mystery. The body seems to make different adaptations based on the type of training, such as building myofibrillar protein in bodybuilders and mitochondrial protein in endurance athletes. The exact molecular signal from the tension on the muscle to the synthesis of specific sets of proteins is complex and involves numerous pathways, some of which are still not fully understood. It is known that different fibers are recruited in different types of training, but this is not the complete answer. For example, high rep, low weight training can also lead to hypertrophy and the recruitment of type 2 fibers. The bodybuilder's upregulation of mTOR and the role of nutrient availability in muscle protein synthesis are also important factors, but the cascade from stimulus to muscle protein synthesis is still not fully understood.

Protein synthesis requires both signaling and amino acids

The body requires both the right signaling responses and the availability of amino acids for sustained muscle protein synthesis. This is similar to having a parking lot where cars can only enter when the light is green and there are cars present. The digestion of protein begins in the stomach with the addition of acid, followed by the breakdown of protein in the duodenum and the release of free amino acids. Some amino acids are used to build intestinal protein, while others are released into the portal vein and eventually the circulation for use by various tissues. Unlike fat and glucose, which can be stored in large quantities, excess protein is not stored as such but can be oxidized or, over time, converted into fat. Contrary to popular belief, not all excess amino acids are immediately oxidized, and a significant portion can be stored as protein, particularly in muscle tissue. The recent study mentioned in the discussion further highlights the importance of the type and timing of amino acid intake for muscle protein synthesis.

The form and consumption method of protein affect digestion, absorption, and muscle protein synthesis

The way our bodies process protein, specifically through digestion and absorption, plays a crucial role in muscle protein synthesis and overall energy balance. Researchers have gone to great lengths to understand this process, including using intrinsically labeled protein from cows to study the digestion and absorption of amino acids. These studies have shown that the form of protein, such as casein versus whey, can impact digestion and absorption rates, leading to differences in muscle protein synthesis. Additionally, the way protein is consumed, such as in the form of a steak versus minced meat, can also impact digestion and absorption rates, potentially influencing muscle protein synthesis and metabolic responses. Overall, these findings highlight the importance of considering the role of protein processing in our understanding of muscle growth and energy balance.

The way we prepare and consume our food impacts digestion and nutrient absorption

The way we prepare and consume our food significantly impacts digestion and absorption of nutrients. For instance, chewing thoroughly can enhance the antibiotic response to feeding and improve overall digestion. The type of food and its preparation methods also matter. Ground beef, for example, has faster gastric emptying and more rapid digestion and absorption due to the easier attachment of enzymes. Similarly, rapidly digestible proteins like whey stimulate muscle protein synthesis to a greater extent compared to slowly digestible proteins like casein, despite similar digestion and absorption rates. The amino acid composition, particularly the amount of leucine, also plays a role in the metabolic response. Ultimately, the food choices we make and how we prepare them can have a significant impact on our health and well-being.

Factors Influencing Muscle Protein Synthesis

The rate and efficiency of muscle protein synthesis are influenced by multiple factors, including the digestibility of the protein source, the rate of digestion, and the composition of amino acids. Digestibility can differ between plant-derived and animal-derived proteins, as well as between cooked and uncooked proteins. The rate of digestion can be affected by factors such as food processing and chewing. Lastly, the composition of amino acids, particularly leucine, plays a crucial role in stimulating muscle protein synthesis. When aiming to optimize muscle protein synthesis for lean body mass maintenance or growth, it's essential to consider these factors and their interactions. The goal may not always be to maximize muscle protein synthesis at the highest peak, but rather to achieve a sustained, time-released effect.

Protein intake for muscle protein synthesis

For optimal muscle protein synthesis in healthy adults, consuming around 20 grams of protein per meal is recommended. However, this assumption is based on studies using milk and egg protein concentrates. Real food may require a larger serving size due to lower digestibility and absorption rates. Therefore, some individuals may need to consume 30 grams or more of protein per meal to achieve the same effect. The need for more protein intake does not equate to advocating a high protein diet. Even sedentary individuals already consume more than the recommended minimum of 0.8 grams per kilogram of body mass per day. Healthy, active individuals naturally consume more protein, ranging from 1.1 to 1.3 grams per kilogram per day, without conscious effort. Medical professionals often recommend higher protein intakes, up to 1.6 grams per kilogram for muscle growth and even up to 2 grams per kilogram for high-volume training.

Older adults in hospitals aren't getting enough protein during their stay

Older adults undergoing elective hip or knee surgery in hospitals are not receiving enough protein to maintain muscle mass during their stay. Despite clinical guidelines recommending 1.2-1.5 grams of protein per kilogram of body mass daily, these patients are only receiving 0.8 grams and consuming 0.5 grams, leading to a significant loss of lean muscle mass – approximately 1.4 kilograms or 3 pounds in just four days. This rapid muscle loss, particularly of type 2 fibers, which are essential for power and strength, can make older adults more susceptible to falls and hinder their recovery. Additionally, early hospital discharge due to COVID-19 concerns may further exacerbate muscle loss by limiting opportunities for type 2 fiber activation through daily activities, such as climbing stairs.

Discrete declines in muscle loss during aging

Age-related muscle loss, or sarcopenia, is not a continuous, inevitable process. Instead, it's a series of discrete declines precipitated by periods of inactivity. These declines can be deliberate, such as taking a vacation, or forced by injury or illness. The belief that muscle loss is an unavoidable part of aging is a misconception. Research shows that a sedentary lifestyle leads to deterioration in various systems, including cardiovascular health and brain function. Therefore, a muscle-centric view of aging might be the most important perspective. Regular physical activity, ideally resistance training, can help prevent these declines and improve overall health and well-being in older adults.

Whey vs Casein Protein: Differences in Digestion and Muscle Synthesis

The difference between whey and casein protein, when consumed in identical amounts, lies in their digestion speed and the resulting impact on muscle protein synthesis. While whey protein is rapidly digested and absorbed, leading to a greater spike in essential amino acid concentrations and a more significant stimulation of muscle protein synthesis, casein protein is slower to digest. However, over longer periods of time, casein catches up and contributes to muscle protein synthesis as well. A recent study challenged the conventional thinking that the body can only effectively use around 40-50 grams of protein in a meal for muscle protein synthesis. This study, which used intrinsically labeled protein and intravenous infusions of amino acids, found that a 100-gram protein dose still increased muscle protein synthesis for a longer period of time, suggesting that the body's response to protein intake may be underestimated due to the limited duration of previous studies. Despite this new finding, it's important to note that having a distribution of protein intake throughout the day is still recommended for optimal muscle health, rather than relying on one large meal or drastically reducing the number of meals consumed. The body is capable of utilizing protein for a longer period of time than previously thought, and the response to protein intake can vary greatly depending on the individual and the duration of measurement.

Impact of protein source on muscle protein synthesis

The source of protein, whether it's from casein or whey, significantly impacts the rate of muscle protein synthesis. While casein has a slower digestion rate and may promote muscle protein synthesis for a longer period, whey is rapidly digested and absorbed, peaking within 30-75 minutes. However, when comparing meals instead of protein powders, cooked meat or animal-derived proteins have similar kinetics to concentrated protein isolates. Consuming a full meal with vegetables, potatoes, and fiber takes longer to digest and absorb, around 2-3 hours longer. From a practical standpoint, consuming protein immediately after a workout significantly enhances muscle protein synthesis, making the muscle more sensitive to the anabolic response to food intake. This effect lasts beyond the immediate post-workout meal and carries over to the next day's meals. Therefore, it's essential to prioritize protein intake, especially after workouts, to maximize muscle growth and recovery.

Timing of protein intake after exercise doesn't significantly impact muscle gain or recovery

The timing of protein intake after exercise may influence when the response occurs, but it doesn't necessarily impact the total amount of muscle gain or recovery. The study found that consuming 60 grams of protein immediately after exercise did not reduce the response to breakfast the next morning. However, there is evidence that long-term protein supplementation can increase muscle mass and strength gains. It's important to note that the long-term benefits of consuming a rapidly absorbed, high-quality protein immediately after exercise are still unclear. Overall, while there is no downside to consuming a protein supplement following a workout, it's important to consider the potential drawback of relying too heavily on supplements and neglecting whole foods in your diet.

Proper nutrition and consistent training key for weight loss

Proper nutrition, specifically containing sufficient protein and good foods, is crucial before considering protein supplements. Consistent training and a caloric deficit are key factors in weight loss, achieved through strategies such as caloric restriction, dietary restriction, or time restriction (intermittent fasting). However, it's essential to note that intermittent fasting may not lead to additional weight loss when caloric intake is normalized throughout the day. Additionally, under-muscled individuals should be cautious with excessive time restriction due to potential disproportionate loss of lean mass.

Preserving Lean Mass During Weight Loss

Time-restricted feeding can help with weight loss, but it may be challenging for women with low lean mass to consume enough protein during their feeding window. To address this issue, adding protein shakes outside of the feeding window and incorporating resistance training can help preserve lean mass while losing fat mass. This approach allows individuals to achieve their goals of weight loss and muscle preservation simultaneously. Additionally, regular exercise enhances the body's response to protein intake, making every meal more effective in promoting muscle growth.

Understanding Anabolic Resistance in Aging

Physical inactivity and aging can lead to anabolic resistance, which is the body's decreased ability to build muscle from the protein we consume. This is problematic because when we become sick or less active, we both eat less and move less, exacerbating the issue. The cause of anabolic resistance is still not fully understood, but it may involve issues with digestion, absorption, or muscle uptake of amino acids, as well as insulin signaling. Researchers are currently exploring these areas to better understand the underlying mechanisms and find ways to mitigate anabolic resistance. An early study on anabolic resistance was conducted by Mike Renney and his team in 2005, who observed that older adults had a reduced muscle protein synthetic response to essential amino acids compared to young adults. This concept was later confirmed by other studies, revealing that while basal protein synthesis is similar between young and older adults, the muscle's response to protein intake is diminished in older populations.

Muscle response to amino acids and protein assimilation depends on physical activity

Physical activity plays a crucial role in muscle sensitivity to amino acids and protein assimilation. When muscle is immobilized, even for a short period, it becomes less responsive, demonstrating a significant anabolic resistance. This effect is more pronounced than the age-related differences in muscle response. Therefore, maintaining physical activity is essential for optimal muscle function throughout the lifespan. Additionally, exercising older individuals can help bring their muscle response back to normal levels, suggesting that activity may be the primary determinant of anabolic resistance.

The importance of resistance training for muscle health during cancer treatment or hospitalization

Physical activity, specifically resistance training, is crucial for maintaining muscle health and overall well-being at any age, even during cancer treatment or hospitalization. Despite the lack of hormones or proper nutrition, muscle mass can still be gained and negative side effects can be prevented. Unfortunately, there's a disconnect in medicine when it comes to implementing these simple yet effective interventions alongside treatments. The medical system should prioritize and communicate the importance of exercise and proper nutrition as essential medical interventions to build trust and improve health outcomes. A small change, such as providing protein before sleep, could make a significant difference in muscle preservation. It's time to prioritize these interventions and bridge the gap between what we know and what is being practiced.

Consuming protein before bed aids muscle recovery

Consuming a protein-rich snack before bed can help with muscle recovery and reconditioning, as well as potentially prevent muscle loss in older people or those in the hospital. This is because the body continues to synthesize muscle protein during sleep, and providing additional protein in the evening can lead to increased protein intake and improved muscle recovery. Additionally, while collagen is a valuable source of glycine and proline, it is not necessary to consume collagen supplements specifically for these amino acids, as they are already present in a balanced form in animal-derived proteins and milk proteins. The body also synthesizes both myofibrillar and muscle connective proteins in response to exercise, but only myofibrillar protein synthesis is increased by the ingestion of protein. Therefore, focusing on consuming a high-quality protein source, such as animal-derived protein or milk protein, is the most effective way to support muscle recovery and growth.

Collagen's Role in Muscle Protein Synthesis

Collagen supplementation does not significantly increase connective tissue protein synthesis rates in muscle compared to whey or casein protein, especially in the presence of exercise. The muscle contains only a few percent of collagen, so it might be more important for tendons, ligaments, bone, and cartilage. However, collagen is a good source of glycine and protein, but it's a low-quality protein from the perspective of amino acid balance. To maximize muscle protein synthesis, aim for 2-3 grams of leucine in a meal, and focus on getting enough leucine, lysine, and methionine across the day or in a meal, rather than worrying too much about the specific protein source. Well-balanced meals with different plant-based proteins can compensate for the lower content of these essential amino acids.

Exploring the complex relationship between nutrition, health, and the human body

While plant-based diets may have health benefits for some, it's important to consider the specific needs of vulnerable populations, such as those with health conditions or eating less due to illness. High-quality protein sources are crucial for these individuals to maintain lean mass and overall health. Additionally, the brain's protein turnover rate is almost three times as high as muscle, and every organ in the body is constantly breaking down and building up, which is a fascinating aspect of human biology. Researchers like Luke are exploring questions related to this, such as which amino acids are disproportionately used by the brain. Overall, understanding the complex interplay between nutrition, health, and the human body requires ongoing research and exploration. If you're interested in diving deeper into these topics, consider becoming a member for exclusive access to premium content.

Exploring the Best of The Drive with Peter Attia through 'Qualys'

The Drive by Peter Attia offers a wealth of information on health, nutrition, and performance through a variety of formats. One such format is the member-only podcast, "Qualys," which compiles the best excerpts from previous episodes. This is a convenient way for listeners to catch up on past episodes without having to listen to each one in full. Additionally, members receive other benefits. To access these perks and learn more, visit peteratiamd.com/subscribe. You can also find Peter on YouTube, Instagram, and Twitter, and leave reviews on your preferred podcast platform. The podcast is for informational purposes only and does not constitute medical advice. Always consult healthcare professionals for medical concerns. Peter discloses all conflicts of interest on his website.

Recent Episodes from The Peter Attia Drive

#301 - AMA #59: Inflammation: its impact on aging and disease risk, and how to identify, prevent, and reduce it

In this “Ask Me Anything” (AMA) episode, Peter delves into the often misunderstood concept of inflammation. He first defines inflammation and differentiates between acute inflammation and chronic inflammation, the latter of which is linked to aging and a plethora of age-related diseases. Peter breaks down the intricate relationship between chronic inflammation, obesity, and metabolic health, and highlights the signs that might suggest someone may be suffering from chronic inflammation. From there, the conversation centers on actionable advice and practical steps one can take to manage and minimize chronic inflammation. He explores how diet plays a crucial role, including the potential benefits of elimination diets, and he examines the impact of lifestyle factors such as exercise, sleep, and stress management. Additionally, he discusses the relevance of food inflammatory tests and concludes by examining the potential benefits and drawbacks of drugs and supplements in managing inflammation.

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 private RSS feed or our website at the AMA #59 show notes page. If you are not a subscriber, you can learn more about the subscriber benefits here.

We discuss:

Defining inflammation (and the cultural impact of Napoleon Dynamite) [1:45];
Acute vs chronic inflammation [8:00];
The connection between chronic inflammation, aging, and age-related diseases [11:00];
The impact of inflammation on metabolic health [18:30];
Understanding and diagnosing chronic inflammation: blood tests and other approaches, and challenges with measurement [20:00];
Factors that contribute to low-level chronic inflammation [28:00];
Minimizing inflammation through diet [29:45];
The important role of fiber for gut health and inflammation [33:45];
A closer look at the impact of trans fats and saturated fats on overall health [34:45];
Why Peter prefers dietary fiber from food sources over supplements [38:30];
Debunking “superfoods”: emphasizing proven methods over marketing claims for reducing inflammation [39:00];
Is there any value in over-the-counter food inflammatory tests? [42:30];
Food elimination diets: how they work, symptoms and markers to watch, challenges and limitations [45:15];
Identifying dietary triggers for gut-related symptoms through low-FODMAP diets like the “carnivore diet” [51:15];
Dairy: the complex role of dairy on inflammation and individual responses [55:00];
Wheat: the complexities and conflicting evidence around wheat's inflammatory effects [57:45];
How exercise influences inflammation [1:02:00];
How sleep quality and duration impacts inflammation [1:07:00];
The potential impact of chronic psychological stressors on inflammation [1:13:00];
The impact of oral health on inflammation and overall well-being [1:15:00];
The role of medications in managing chronic inflammation [1:18:15];
Supplements: evaluating the efficacy of various anti-inflammatory supplements [1:22:15];
Parting thoughts and takeaways [1:27:00]; and
More.

Connect With Peter on Twitter, Instagram, Facebook and YouTube

enMay 13, 2024

#300 - Special episode: Peter on exercise, fasting, nutrition, stem cells, geroprotective drugs, and more — promising interventions or just noise?

In this special edition celebrating 300 episodes of The Drive, Peter discusses a variety of popular topics and health interventions and classifies them based on their level of evidence and relevance using the following categories: proven, promising, fuzzy, noise, and nonsense. Peter first delves into the topic of geroprotective molecules, covering rapamycin, metformin, NAD and its precursors, and resveratrol. Next, he explores the significance of metrics like VO2 max and muscle mass, as well as emerging concepts like blood flow restriction and stem cells. The conversation extends to nutrition, addressing questions surrounding long-term fasting, sugar consumption, sugar substitutes, and the contentious role of red meat in cancer. Peter not only provides his current stance on each topic—most of which have been covered in great detail in the previous 300 episodes—but also reflects on how his opinion may have evolved over the years.

We discuss:

Defining the categories of “proven, promising, fuzzy, noise, and nonsense” [3:15];
Rapamycin [9:30];
Metformin [17:00];
NAD and its precursors [24:30];
Resveratrol [32:45];
The importance of VO2 max, muscle mass, and muscular strength for lifespan [38:15];
Blood flow restriction (BFR) training [44:00];
Using stem cells to treat osteoarthritis or injury [51:30];
Fasting as a tool for longevity (and why Peter stopped his fasting protocol) [55:45];
The energy balance theory [1:06:30];
The idea that sugar is poison [1:12:00];
The idea that sugar substitutes are dangerous [1:22:15];
The debate on red meat and cancer [1:28:45]; and
More.

Connect With Peter on Twitter, Instagram, Facebook and YouTube

enMay 06, 2024

Special episode with Dax Shepard: F1 and the 30th anniversary of Ayrton Senna’s death

This is a special episode of The Drive with Peter’s friend and fellow car enthusiast Dax Shepard. In this podcast, which commemorates the 30th anniversary of the death of Brazilian Formula One legend Ayrton Senna, Dax sits down with Peter to better understand what made Senna so special and why Peter remains an enormous fan. This conversation focuses on Senna’s life, the circumstances of his death, and his lasting impact and legacy on the sport of F1.

We discuss:

Peter’s interest in motorsports began as a child [2:30];
The drama and dangers of F1 [6:00];
What made Senna special [13:00];
What Senna meant to Brazilians [24:00];
The cause of the fatal crash [28:15];
Why Peter is obsessed with Senna [40:30];
Being the best versus having the best record [43:30];
Senna’s unique driving style and incredible intuition about automotive engineering [46:30];
Back to the day of the dreadful race [53:00];
What Peter believes caused the crash [1:02:45];
Views on dying young, in the prime of life [1:13:00];
Senna lives on in his foundation and in safety changes adopted by F1 [1:21:00];
Statistics aren’t enough for fandom, and why people like who they do [1:24:15];
The biggest difference between F1 today and F1 in the 80s [1:28:30];
Senna’s driving superpower [1:30:30];
The fastest drivers currently in F1 [1:38:30];
Current F1 obsessions [1:45:00];
How hard it is to do what the top F1 drivers do [1:50:15];
Dax’s love of motorcycles and his AMG E63 station wagon [1:52:15];
Awesome Senna mementos from Etsy [2:01:15];
What makes specialists interesting, and Max’s devotion to F1 [2:10:15];
What Senna might have done if he had not died that day [2:14:00];
Michael Schumacher and Max Verstappen are also top F1 drivers [2:17:30];
Interlagos in Sao Paulo Brazil is always an incredible experience [2:18:45]; and
More.

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enApril 29, 2024

#299 ‒ Optimizing muscle protein synthesis: the crucial impact of protein quality and quantity, and the key role of resistance training | Luc van Loon, Ph.D.

We discuss:

Luc’s background and insights about fuel selection during exercise [3:30];
Fuel utilization during endurance exercise [9:30];
Fat metabolism, intramuscular lipids, and the nutritional dynamics of endurance sports [17:15];
The optimal window for replenishing intramuscular fat stores and glycogen post-exercise [25:15];
Luc’s interest in protein metabolism and exploration of amino acids' dual role as building blocks and signaling molecules in driving muscle protein synthesis [32:15];
How protein metabolism differs between sedentary individuals and those engaged in predominantly strength training or endurance training [38:45];
The basics of how proteins are digested and absorbed, and how muscle protein synthesis is measured [50:30];
How factors like food texture, cooking methods, and protein composition impact muscle protein synthesis, and the importance of protein distribution throughout the day [59:45];
Differences in whey and casein proteins, and the ability of ingested protein to stimulate muscle protein synthesis [1:03:30];
Dietary protein distribution and quantity for the maximization of muscle protein synthesis [1:09:00];
Muscle loss with age and inactivity and the importance of resistance exercise to maintain type II muscle fibers [1:17:15];
Differences between whey and casein proteins, and the importance of both quantity and quality of protein sources [1:28:30];
Optimizing muscle protein synthesis: exercise, timing of protein intake, protein quality, and more [1:37:00];
How to preserve muscle while trying to lose weight [1:46:00];
Anabolic resistance and overcoming it with physical activity [1:55:45];
Importance of protein intake and physical activity in hospitalized patients [2:06:30];
Reviewing the efficacy of collagen supplements [2:13:30];
Plant-based diets: how to ensure a balance of amino acids, and other considerations [2:20:30];
Future research: understanding protein metabolism in the brain [2:23:45]; and
More.

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enApril 22, 2024

#298 ‒ The impact of emotional health on longevity, self-audit strategies, improving well-being, and more | Paul Conti, M.D.

Paul Conti is an author and practicing psychiatrist who specializes in helping people heal from trauma. In this episode, Paul returns to The Drive to delve into the intricate relationship between emotional health, healthspan, and lifespan. He first challenges common assumptions about the inevitable decline of emotional health with age, providing strategies for conducting a comprehensive audit of internal emotional health. He establishes a framework for the foundation of good emotional health: a balance between the generative drive, the assertive drive, and the pleasure drive. Paul also explores the nuanced dynamics of motivation, happiness, and satisfaction as it relates to material possessions, draws connections between physical and emotional well-being, confronts the impact of negative self-talk, and describes how making peace with our mortality can foster a sense of hope, purpose and well-being. Additionally, Paul offers many practical insights into initiating emotional health improvements and navigating the search for a suitable therapist.

We discuss:

The importance of prioritizing emotional health as we age [2:45];
The impact of emotional health on healthspan and how to foster a proactive approach to emotional well-being [7:00];
The discrepancy between outward success and inner fulfillment, and the importance of a healthy “generative drive” for genuine well-being [13:00];
A deeper dive into generative drive: impact on human behavior, resilience, purpose, and more [23:15];
Evaluating one’s inner self: introspection, self-awareness, challenging societal norms, and returning to the basics of physical and emotional well-being [29:00];
Self-auditing tools: introspection, curiosity, and exploring underlying reasons for unwanted behaviors [41:45];
Breaking free from destructive cycles by understanding the continuum of self-care and addictive behaviors and remaining curious [50:15];
Critical self talk: the malleability of one’s inner dialogue and the potential for transformative change with perseverance and self-compassion [1:00:15];
Slowing the anger response and gaining insights into the underlying triggers to achieve lasting change and self-understanding [1:13:45];
Foster gratitude and humility by achieving balance between the three drives—assertion, pleasure, and generative [1:20:45];
The conflict between intellectual understanding and emotional feelings, problematic comparison frameworks, and the importance of living in the present with intentionality [1:24:15];
How making peace with our mortality can foster a sense of hope, purpose and well-being [1:34:45];
Advice for finding a compatible therapist [1:43:45];
The key components of therapeutic progress [1:57:00];
The caricatures of four common patient phenotypes, and how to get through to them [2:05:30];
How Paul manages his own well-being and the emotional challenges that come with his line of work [2:15:15]; and
More.

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enApril 15, 2024

#297 - AMA #58: Iron: its role in health, testing methods, and strategies for preventing and managing iron deficiency

In this “Ask Me Anything” (AMA) episode, Peter delves into the crucial yet often overlooked topic of iron and iron deficiency. He explores why iron is indispensable for the body, explains the repercussions of iron deficiency, and sheds light on the prevalence of this issue and who is most susceptible. Peter outlines strategies for increasing iron levels, covering dietary iron, supplementation, and infusion options, while also discussing the suitability of each approach for different individuals. Shifting gears, Peter tackles rapid-fire questions on creatine and sodium, as well as inquiries related to his book.

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 private RSS feed or our website at the AMA #58 show notes page. If you are not a subscriber, you can learn more about the subscriber benefits here.

We discuss:

Overview of today’s topics and the importance of understanding iron levels in the body [1:45];
The importance and ubiquity of iron in the body, and the role of the protein called ferritin [4:30];
The processes of iron absorption, utilization, and transportation [9:30];
Options for testing iron levels and how to interpret the results [13:45];
What does it mean to be iron deficient, and how is it different from anemia? [17:15];
Symptoms of iron deficiency and/or anemia [22:15];
How prevalent is iron deficiency, and who is most susceptible? [24:30];
The importance of consuming an adequate amount of iron daily to prevent deficiency [30:30];
The best way to improve iron levels for someone who is deficient [34:45];
Iron supplementation: various formulations and potential side effects [37:45];
Intravenous iron infusion as an alternative to oral supplements -- plus restless legs syndrome and other topics [42:00];
Iron supplementation: who should and should not consider it [44:00];
Peter’s approach to creatine and his pre- and post-workout supplements [50:15];
Navigating sodium intake: effect on blood pressure, who should use precaution, and other considerations [54:45];
Peter’s thoughts about the potential of writing another book [57:15]; and
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enApril 08, 2024

#296 ‒ Foot health: preventing and treating common injuries, enhancing strength and mobility, picking footwear, and more | Courtney Conley, D.C.

Courtney Conley is an internationally renowned foot and gait specialist. In this episode, Courtney delves into the intricate world of foot anatomy and functionality. She explores the complexities of the foot, discussing its anatomy, common injuries, and the importance of understanding its structure in preventing issues. She covers a range of foot ailments, factors contributing to them, treatment options, and prevention strategies. She delves into the significance of loading, balance, range of motion, and posture, emphasizing the crucial role of strength in preventing both injuries and falls. Additionally, she sheds light on the interconnectedness of the kinetic chain, from the leg muscles down to the foot, and how issues within this chain can cascade downstream, leading to various injuries and pathologies. Additionally, she provides a comprehensive overview of footwear, discussing suitable options for both adults and children to promote foot health and mitigate potential problems.

In addition to this interview, Courtney also recorded a series of videos to better explain a number of the concepts discussed such as diagnostic tests that are used to determine mobility and strength and the exercises one should perform to improve the outcomes based on the diagnostics. The interview will be available to everyone while the videos from the gym will only be available to paid subscribers (found at the end of the show notes page).

We discuss:

Why Courtney chose to specialize in the foot [3:30];
The vital role of foot strength, function, and health in human movement and well-being [6:15];
Anatomy of the rear foot and midfoot [10:15];
The development of flat feet, the impact of footwear, and the benefits of going barefoot [19:45];
Anatomy of the forefoot, common injuries, and why most injuries occur in the forefoot [23:15];
Foot musculature and its role in maintaining foot stability and preventing deformities like bunions and hammer toes [30:15];
The intrinsic musculature of the foot, plantar fasciitis, footwear, and more [39:00];
Plantar fasciitis: diagnosis, causes, and treatment [51:30];
Posterior leg muscles: strength assessment methods, role in ACL injuries, and more [59:15];
Lateral and medial muscles: ankle stability, arch support, big toe stabilization, and exercises to strengthen and prevent injuries [1:04:15];
Importance of strength of lower leg muscles for gait and preventing shin splints, stress injuries, and more [1:08:15];
Tendinopathies and other common pathologies related to the anterior and lateral compartments of the foot [1:13:00];
The importance of midfoot integrity, ankle dorsiflexion, and a discussion of gait alterations [1:19:45];
Proximal stability and its implications for posture and movement patterns [1:27:00];
The age-related decline in foot sensation and strength [1:32:45];
Common toe injuries, treatment, and how to prevent further progression of the injury [1:36:30];
Preventing falls and managing arthritis with proactive foot care and exercises [1:46:45];
Footwear: advice for picking shoes that promote foot health [1:54:45];
Footwear for runners [2:05:30];
The importance of prioritizing footwear that promotes natural foot movement and strength while considering individual comfort and foot health needs [2:09:30]; and
More.

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enApril 01, 2024

#295 ‒ Roadway death and injury: why everyone should care and what you can do to reduce risk | Mark Rosekind, Ph.D.

Mark Rosekind is an expert on road safety and a policy leader with more than 30 years of experience enacting strategic, practical, and effective data-based solutions that enhance driver and pedestrian safety and health in complex environments. In this episode, Mark delves into the persistent issue of accidental deaths resulting from roadway accidents, a concern for those focused on longevity given its consistent risk throughout life. From exploring statistics on car crashes to identifying the demographics most at risk and the key locations of incidents, he uncovers various risk factors including distractions like smartphone usage, the influence of alcohol and cannabis, the dangers of sleep deprivation, and speeding. Mark also provides practical advice for both drivers and pedestrians to enhance safety, while delving into the potential and challenges of emerging technologies such as autonomous vehicles. Additionally, Mark provides valuable resources for listeners, particularly parents navigating the road safety landscape with teenage drivers.

We discuss:

Mark’s background and education, and the profound impact of transportation accidents on human lives [4:15];
From sleep science to safety leadership: Mark’s journey in transportation innovation [14:15];
Stats on transportation accidents and fatalities [18:00];
Historical trends in road fatalities and the key contributors—impairment, distraction, and more [28:00];
The demographics of drivers involved in crashes, and the life-saving potential of better driver education programs [34:30];
The most critical areas where drivers need to be hyper-aware to protect themselves [41:00];
The role of the National Transportation Safety Board (NTSB) in accident investigations, and the importance of data sources like event data recorders (EDRs) in accident reconstruction and investigations [47:00];
The dangers of phone use while driving [53:45];
How drunk driving was addressed through advocacy and legal changes [1:01:30];
The need to address distracted driving and the psychological impact of distracted driving accidents on both victims and perpetrators[1:07:15];
Navigating the roads and lowering your risk of accidents: weather, human error, and defensive driving [1:15:45];
The impact of impaired driving: alcohol, cannabis, prescription drugs, and more [1:26:15];
Mitigating the effects of vehicle speed [1:38:15];
The promise and challenges of autonomous vehicles for road safety [1:44:15];
Automatic emergency braking (AEB): the effectiveness and challenges of implementing AEB as a standard feature in new vehicles [1:53:00];
Sleep deprivation: the impact of poor sleep, drowsiness, and disrupted circadian rhythm on driving [1:58:15];
Protecting pedestrians: strategies for reducing the risk of fatal accidents with pedestrians on foot or bicycle [2:02:30];
Empowering safe driving: essential resources and tips for parents and teenage drivers [2:14:00];
Promoting a culture of proactive safety: parting thoughts from Mark [2:19:15]; and
More.

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enMarch 25, 2024

#294 ‒ Peak athletic performance: How to measure it and how to train for it from the coach of the most elite athletes on earth | Olav Aleksander Bu

Olav Aleksander Bu is an internationally renowned sports scientist acclaimed for his coaching prowess with elite athletes spanning a diverse range of sports disciplines. In this episode, Olav delves deep into the intricacies of VO2 max and its profound impact on performance. They explore the relationship between VO2 max and ATP production, energy efficiency, and power, as well as the impact of low-intensity training on VO2 max. The conversation extends to Olav’s experiences pushing the boundaries with high-performance athletes and the data driven interventions he uses to improve performance. They also dissect the role of lactate threshold, discuss other important metrics to track, and explore the exciting possibility of utilizing a portable VO2 testing device as a practical alternative to traditional lab-based assessments.

We discuss:

Olav’s background, expertise in exercise physiology, coaching experience, and interest in the extremes of human capability [4:15];
The processes of energy conversion within the human body and its implications for performance [9:30];
Improving movement efficiency, and the importance of mindfulness in training to optimize performance [20:00];
The relationship between VO2 max, power output, and endurance performance in different sporting contexts [34:45];
How VO2 max is measured in the lab, and why it’s a crucial predictor of both lifespan and quality of life [44:45];
Absolute vs relative VO2 max, the significance of functional threshold power in cycling, and the importance of longer duration tests for accurate assessments [54:00];
Portable VO2 testing devices as a practical alternative to lab-based tests [1:05:15];
The complexities of measuring ventilation and its impact on performance metrics like VO2 max and heart rate [1:15:45];
Training interventions to increase VO2 max, and factors that impact performance outcomes [1:23:30];
The respiratory exchange ratio (RER) and endurance sports, and how factors such as diet composition and exercise intensity influence RER values and performance [1:32:45];
Science-guided training for versatile athletes: maximizing VO2 max, power, torque, and cadence in cycling, and the importance of incorporating diverse stimuli to enhance performance [1:41:00];
Physiological limitations on VO2 max [2:02:15];
The different energy systems used during work, and other things to monitor like VCO2 and heart rate [2:06:00];
Lactate threshold and other metrics to guide your training [2:10:30];
Analysis of a lactate power curve: exploring lactate dynamics in endurance training and performance [2:23:15]; and
More.

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enMarch 18, 2024

Cardiovascular Fitness

#293 - AMA #57: High-intensity interval training: benefits, risks, protocols, and impact on longevity

In this “Ask Me Anything” (AMA) episode, Peter delves into the topic of high-intensity interval training (HIIT), starting with addressing some common misunderstandings around this type of exercise and breaking down what HIIT truly entails. He examines the correlation between HIIT and VO2 max, a vital metric for overall health and longevity, and describes the beneficial impact of HIIT on longevity when incorporated properly. Additionally, he emphasizes the importance of building a wide base of cardiovascular fitness, reveals the optimal protocols for incorporating HIIT into a balanced routine, and discusses the risk of injury and other potential drawbacks of HIIT.

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 private RSS feed or our website at the AMA #57 show notes page. If you are not a subscriber, you can learn more about the subscriber benefits here.

We discuss:

Common questions about high-intensity interval training (HIIT) [1:30];
The origins of HIIT [3:15];
Defining HIIT training and differentiating it from sprint interval training (SIT) [5:45];
Why HIIT is often touted as a more efficient way to exercise [14:00];
Navigating the nuances of HIIT research: understanding limitations and the importance of a blended exercise routine [20:30];
The four pillars of exercise [24:15];
Using HIIT to improve VO2 max [26:00];
HIIT training for the untrained individual: impact on VO2 max and the interplay between exercise-induced adaptations and potential weight loss [33:00];
Sprint interval training (SIT) vs. HIIT: comparing the relative improvements in VO2 max and the impact of longer duration intervals [40:00];
Benefits and limitations of HIIT, drawbacks of overtraining with HIIT, and the importance of a diversified routine to increase total cardiorespiratory capacity [44:15];
HIIT protocols Peter recommends [58:45];
The risk of injury and other potential drawbacks of HIIT [1:02:15];
The importance of incorporating a balance of continuous moderate-intensity cardio and HIIT when aiming for longevity [1:04:00]; and
More.

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