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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 returns to dive deeper into his groundbreaking work as an endurance coach, exercise scientist, engineer, and physiologist. The discussion explores his data-driven approach to coaching, unpacking key performance metrics like functional threshold power, VO2 max, and lactate threshold, while emphasizing the importance of consistent testing protocols. Olav shares insights on how training methodologies differ across sports, the impact of nutrition on endurance performance, and the evolving strategies for carbohydrate metabolism in fueling athletes for races. Olav concludes with a discussion on the use of artificial intelligence for optimizing training insights and performance.

We discuss:

• Olav’s unique, engineering-driven approach to endurance coaching [2:45];
• Definitions and applications of key performance metrics: FTP, power, anaerobic threshold, and lactate threshold [4:45];
• Lactate threshold: factors affecting lactate threshold, testing protocols, and how elite athletes' efficiency affects their performance and lactate profiles [14:15]
• VO2 max: definition, testing, factors affecting its accuracy, and methods for optimizing oxygen utilization in elite athletes [22:15];
• Testing VO2 max: common mistakes and key factors to consider—preparation, warm-up, timing, and more [34:00];
• VO2 max testing continued: measuring instruments, testing protocols, and advanced insights gained from elite athletes [41:45];
• The influence of supplements like beetroot concentrate and adaptogens on VO2 max and performance [49:45];
• How respiratory quotient (RQ) reflects metabolic shifts during exercise, the challenges in measuring and interpreting RQ in elite athletes, and the physiological adaptations needed for prolonged endurance events [53:30];
• Triathlon training: the challenge of maintaining elite performance across triathlon distances, metabolic efficiency, and swimming challenges [1:03:15];
• How reducing drag in swimming could revolutionize performance and the role of biofeedback tools in optimizing efficiency across various endurance sports [1:07:00];
• How endurance athletes prioritize effort regulation using RPE, heart rate, and power output, and the role of lactate in cardiac and athletic efficiency [1:20:00];
• Lactate’s role as a fuel, buffering methods to combat lactic acidosis, and the variability in athlete response to bicarbonate supplementation [1:25:45];
• The physiological mechanisms behind differences in performance between two elite athletes: lactate transport, cardiovascular efficiency, and compensatory systems [1:33:00];
• Comparing interventions like acetaminophen to enhance performance in high-heat conditions versus natural adaptations to heat [1:37:15];
• Advancements in nutrition science, changes in cyclist body composition, and the impact of fueling strategies on athletic performance and growth [1:39:30];
• Optimizing endurance performance with utilization of carbohydrates, and the potential role of ketones [1:48:00];
• Insights gained from elite performers in the 2020 and 2024 Olympics [1:58:30];
• The use of artificial intelligence to optimizing training insights and performance [2:06:30]; and
• More.

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Trenna Sutcliffe is a developmental behavioral pediatrician and the founder and medical director of the Sutcliffe Clinic in the San Francisco Bay Area, where she partners with families to provide care for children facing behavioral challenges, developmental differences, and school struggles. In this episode, Trenna shares her journey into developmental and behavioral pediatrics, including her pioneering work at Stanford and her expertise in autism, ADHD, and anxiety—the "three As." She explores the diagnostic processes, the overlap and comorbidities of these conditions, and the importance of personalized treatment plans that address both medical and environmental factors. Trenna offers valuable insights into the changing prevalence of autism, the impact of evolving diagnostic criteria, and the range of therapies and medications available to support children and their families. She also discusses the challenges in accessing care and the critical need for a holistic approach that bridges healthcare and education.

We discuss:

• Trenna’s passion for developmental-behavioral pediatrics (DBP), and the process of diagnosing anxiety, ADHD, and autism [3:15];
• Understanding anxiety and ADHD: assessing impairment and self-esteem and identifying anxiety and emotional well-being in young patients [9:45];
• The evolving diagnosis of autism: understanding the spectrum and individual needs [16:30];
• The dramatic rise in autism spectrum disorder (ASD): genetics, environment, expanded diagnostic criteria, and more [25:45];
• Exploring epigenetics and the potential multigenerational impact of environment exposures on susceptibility to certain disorders [37:15];
• The evolution of autism classifications, and the particular challenges for children with level 1 (mild) autism due to a lack of support [41:15];
• The broadening of the autism spectrum: benefits and risks of expanded diagnostic criteria and the need for future frameworks to focus on better outcomes [48:00];
• The overlap between ASD, ADHD, and anxiety [57:15];
• Understanding oppositional defiant disorder, and the importance of understanding the “why” behind a behavior when creating treatment plans [1:00:45];
• Defining developmental-behavioral pediatrics (DBP), and Trenna’s professional journey [1:07:00];
• Updated methods of ABA (applied behavioral analysis) therapy: evolution, controversies, challenges of scaling autism care, and the need for tailored interventions [1:13:45];
• Advice for parents trying to find and evaluate care for children with autism, ADHD, or anxiety [1:22:45];
• Tailored treatments for ADHD: balancing stimulant medications with behavioral training [1:28:30];
• The interplay between medication, behavioral therapy, and neuroplasticity in managing ADHD, and the potential to grow out of the need for medication [1:39:45];
• Using medication to treat anxiety and other symptoms in kids with autism without ADHD [1:44:45];
• FAQs about medicating children with ADHD: benefits, side effects, dosage, and more [1:46:30];
• The “superpowers” associated with level 1 autism [1:48:45];
• The next steps to increase support for children with ASD, anxiety, and ADHD [1:50:45]; and
• More.

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James Clear is the author of the New York Times bestseller Atomic Habits. His extensive research into human behavior has helped him identify key components of habit formation and develop the “Four Laws of Behavioral Change.” In this episode, James provides insights into how both good and bad habits are formed, including the influence of genetics, environment, social circles, and more. He points to changes one can make to cultivate more perseverance and discipline and describes the profound impact habits can have when tying them into one’s self-identity. Finally, James breaks down his “Four Laws of Behavioral Change” and how to use them to create new habits, undo bad habits, and make meaningful changes in one’s life.

We discuss:

• Why James became deeply interested in habits [2:00];
• Viewing habits through an evolutionary lens [6:15];
• The power of immediate feedback for behavior change, and why we tend to repeat bad habits [9:30];
• The role of genetics and innate predispositions in determining one’s work ethic and success in a given discipline [14:45];
• How finding one’s passion can cultivate perseverance and discipline [23:30];
• Advantages of creating systems and not just setting goals [29:30];
• The power of habits combined with self-identity to induce change [36:45];
• How a big environmental change or life event can bring on radical behavioral change [50:45];
• The influence of one’s social environment on their habits [54:30];
• How and why habits are formed [1:00:45];
• How to make or break a habit with the “Four Laws of Behavior Change” [1:09:45];
• Practical tips for successful behavioral change—the best strategies when starting out [1:16:30];
• Self-forgiveness and getting back on track immediately after slipping up [1:30:45];
• Law #1: Make it obvious—Strategies for identifying and creating cues to make and break habits [1:40:00];
• Law #2: Make it attractive—examples of ways to make a new behavior more attractive [1:48:00];
• Law #3: Make it easy—the 2-minute rule [1:59:00];
• Law #4: Make it satisfying—rewards and reinforcement [2:03:45];
• Advice for helping others to make behavioral changes [2:06:15]; and
• More.

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In this special episode of The Drive, Peter tackles a wide range of listener questions submitted over the past year. The discussion spans essential topics such as exercise—covering grip strength, traveling workouts, and why Peter doesn’t consider exercise an ideal weight-loss strategy—and the top biomarkers everyone should track. He also explores promising new longevity research, his evolving views on longevity, and frameworks like “objective, strategy, tactics” for personalized decision-making. The episode wraps up with insights on building good habits and a glimpse into Peter’s recent reading list.

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 Special AMA show notes page. If you are not a subscriber, you can learn more about the subscriber benefits here.

We discuss:

• Overview of episode topics (and Peter’s car stereo saga) [1:45];
• The importance of grip strength and the best methods for training it effectively [3:45];
• Exercise while traveling: strategies for staying active and maintaining an exercise routine [14:45];
• Why women should prioritize strength training [18:00];
• The limited role of exercise in weight loss and its greater importance in improving health, body composition, and insulin sensitivity [19:45];
• The “top five most important biomarkers” for assessing health [22:45];
• Promising developments in longevity research [28:15];
• The development of Klotho as a neuroprotective drug: challenges, timelines of trials, and more [34:00];
• Peter’s updated view on the potential of epigenome manipulation to restore aged cells to their youthful state [39:45];
• How reversing age-related epigenetic changes in immune cells could revolutionize our approach to aging and disease [43:30];
• The “objective, strategy, tactics” framework, and the importance prioritizing impactful lifestyle habits over less significant health trends [49:30];
• Strategies for building and maintaining good habits [56:45];
• How to think about drugs and supplements as part of a longevity toolkit [1:02:00];
• Peter’s recent reading list [1:05:15]; and
• More.

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In this "Ask Me Anything" (AMA) episode, Peter dives deep into one of the most frequently discussed and often misunderstood topics: nutrition. From weight loss and maintenance to the intricate relationship between nutrition and exercise and body composition, Peter addresses the complexities of nutrition research and explores the perennial question of whether there is a "best diet." He provides practical insights on how to choose the right diet for your unique needs, discusses the role of protein and processed foods, and outlines the key questions to help you optimize your approach to eating.

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 #66 show notes page. If you are not a subscriber, you can learn more about the subscriber benefits here.

We discuss:

• The key nutrition-related topics to be discussed [1:30];
• Why Peter is not fond of discussing nutrition: limitations of nutrition research, the pitfalls of extreme certainty in dietary discussions, and the body's adaptability to varied diets [3:30];
• Key health metrics to monitor to evaluate the effects of nutrition [9:30];
• The relationship between nutrition and exercise as they relate to weight loss, maintenance, and gain [12:30];
• How increased muscle mass from resistance training impacts calorie burn, body composition, glucose metabolism, and overall health benefits [19:45];
• Comparing the impact of fitness and nutrition on lifespan and healthspan: data showing fitness to be a more significant predictor of mortality than nutrition [23:30];
• The myth of a “best diet,” factors that determine the effectiveness of a diet, and data suggesting benefits of the Mediterranean diet [39:00];
• How long to trial a new diet, the importance of measurable goals, and the appropriate timescales for observing meaningful changes [48:30];
• The inherent challenges in nutrition research: variability in dietary exposures, limitations in study design, the body’s adaptive nature which dampen the effects, and more [51:15];
• Nutritional approaches for chronic diseases like cardiovascular disease and type 2 diabetes [58:45];
• Emerging studies on dietary interventions for non-alcoholic fatty liver disease (NAFLD) and metabolic dysfunction-associated steatotic liver disease (MASLD) [1:02:45];
• Practical considerations for individuals to identify the best diet for them: protein intake, energy balance, macronutrient adjustments, and micronutrient levels [1:06:00];
• Understanding processed vs. ultra-processed foods [1:09:15];
• The effects of ultra-processed foods on health [1:12:30];
• Questions that someone should ask themselves if they’re looking to fine-tune their diet [1:18:15]; and
• More.

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Dr. Saum Sutaria is the Chairman and CEO of Tenet Healthcare and a former leader in McKinsey & Company’s Healthcare and Private Equity Practices, where he spent almost two decades shaping the field. In this episode, Saum unpacks the complexities of the U.S. healthcare system, providing a detailed overview of its structure, financial flows, and historical evolution. They delve into topics such as private insurance, Medicare, Medicaid, employer-sponsored coverage, drug pricing, PBMs and the administrative burdens impacting the system. Saum’s insights help connect healthcare spending to broader economic issues while exploring potential reforms and the role of technology in improving efficiency. Saum highlights how choice and innovation distinguish the U.S. healthcare system, explores the reasons behind exorbitant drug prices, and examines the potential solutions, challenges, and trade-offs involved in lowering costs while striving to improve access, quality, and affordability. The opinions expressed by Saum in this episode are his own and do not represent the views of his employer.

We discuss:

• The US healthcare system: financial scale, integration with economy, and unique challenges [5:00];
• Overview of how the US healthcare system currently works and how we got here [9:45];
• The huge growth and price impact due to the transition from out-of-pocket payments in the 1950s to the modern, third-party payer model [18:30];
• The unique structure and challenges of the US healthcare system compared to other developed nations [22:00];
• Overview of Medicare and Medicaid: who they cover, purpose, and impact on healthcare spending [27:45];
• Why the US kept a employer-sponsored insurance system rather than pursue universal healthcare [32:00];
• The evolution of healthcare insurance: from catastrophic coverage to chronic disease management [36:00];
• The challenge of managing healthcare costs while expanding access and meeting increased demand for chronic illness care [44:15];
• Balancing cost, choice, and access: how the US healthcare system compares to Canada [48:45];
• The role of the US in pharmaceutical innovation, it’s impact on drug pricing, and the potential effects of price controls on innovation and healthcare costs [56:15];
• How misaligned incentives have driven up drug prices in the US [1:05:00];
• The cost of innovation and choice, and the sustainability of the current healthcare cost expenditures in the US in the face of a shrinking workforce and aging population [1:11:30];
• Health outcomes: why life expectancy is lower in the US despite excelling at extending lifespan beyond 70 [1:18:45];
• Potential solutions and challenges to controlling drugs costs in the US while balancing choice and access and preserving innovation [1:26:15];
• Balancing GLP-1 drug innovation with affordability and healthcare spending sustainability [1:40:00];
• Reducing healthcare spending: complexities, trade offs, and implications of making needed cuts to healthcare expenditures [1:46:45];
• The role of government regulation, opportunities for cost savings, and more [1:56:15];
• Hospital billing: costs, charges, complexities, and paths to simplification [2:01:15];
• How prioritizing access and choice increased expenditures: reviewing the impact of healthcare exchanges and the Affordable Care Act [2:08:00];
• Feasibility of a universal Medicare program, and what a real path to sustainable healthcare looks like [2:15:45];
• The challenge of long-term care and the potential of innovation, like device-based therapies and AI, to improve health [2:23:15]; and
• More.

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Bill Perkins is one of the world’s most successful hedge fund managers and entrepreneurs, and the author of the bestseller, Die With Zero. In this episode, Bill unpacks the Die With Zero philosophy which challenges conventional thinking related to the balance between health, wealth, and time—the three variables important for fulfillment. Bill makes the case that we should strive for maximum net fulfillment rather than net worth (or even health). He argues that we need to optimize our life to have memorable experiences before it’s too late and that most people are over-saving and under-living. Bill also explains how one can apply the principles in Die With Zero to break out of “autopilot” and optimize their life to achieve maximum net fulfillment.

We discuss:

• Bill’s upbringing, background, and first job on Wall Street [2:45];
• A missed experience and feeling of regret that shaped Bill’s thinking [13:45];
• Thinking in terms of time, and the relationship between money, time, and health [16:30];
• Solving for net fulfillment and allocating your time based on the seasons of life [26:45];
• How Bill thinks about risk, opportunity costs, and the difference between fear and risk tolerance [35:00];
• Optimizing for fulfillment, finding purpose outside of work, and more [41:15];
• Thinking about the order of experiences you want to have based on seasons of life [49:30];
• Bill’s unique perspective on philanthropy and a more impactful way to give money away [54:15];
• Applying the principles in ‘Die With Zero’ to maximize fulfillment [1:03:30];
• How to break out of living life on autopilot [1:13:45];
• When should your net worth peak? [1:17:30];
• Taking calculated risks [1:21:00];
• Bill shares a lesson from his incredible birthday [1:24:45];
• How Bill’s philosophy has evolved since writing Die With Zero [1:33:30]; and
• More.

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