Dr. Peter Attia
speaker
5,258 appearances
36 recordings
6 series
first heard Jan 2024
last heard Jun 2025
Dr. Peter Attia’s voice in public audio — every appearance, attributed to the second.
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Anything that interrupts the production of ATP is fatal. So an extreme example of that is cyanide. Everyone's heard of cyanide as a poison. If you take cyanide, you'll be dead within seconds because cyanide blocks one of the transporters in the production of ATP. So it just gives you a sense of how critical it is to have an infinite and abundant supply of ATP. Oxygen is also essential for that.
That's why without oxygen, you can only survive for a couple of minutes. longer than you can without cyanide, but not much longer. So how does it work? So we breathe in air and that air goes into our lungs and that air goes through our lungs into these distal things called capillaries where hemoglobin is bringing the waste product called carbon dioxide back to the lungs and there's a gradient of
Partial pressure between oxygen and carbon dioxide such that a switch takes place. The air that we breathe in delivers some of its oxygen to the hemoglobin molecules. And the carbon dioxide diffuses off that into the air. And we breathe out air that is lower in oxygen and higher in carbon dioxide than what we breathed in. So if I go, that was high oxygen, low carbon dioxide. Whew.
That was low oxygen, high carbon dioxide. And that's happening every second of every day. That oxygen, that hemoglobin molecule that's carrying oxygen is carrying it to every cell in my body because every cell in my body needs oxygen. And that cell in the body is taking the oxygen to run that chemical reaction to make ATP, and it's shuttling back carbon dioxide.
And it's just the most incredible thing in the world to imagine how frequently this is happening. And the more you exercise, the more you consume oxygen. So oxygen consumption is a proxy for energy demand. So... We can measure this. Now to do so, you have to put a mask on because I have to be able to measure very precisely two things.
I have to be able to measure exactly the flow rate of air going in and out of your mouth. And I have to be able to measure very precisely the concentration of oxygen coming out. If I know those two things, I can calculate how many liters per minute of oxygen you are consuming. So you and I sitting here right now are probably consuming less than half a liter a minute.
So call it 500 cc a minute of oxygen right now, because you have to consume some to be alive. And look, I'm moving my arms around and you're nodding and taking notes. So if you're sleeping, you might be consuming 300 milliliters of oxygen per minute. That's the lowest level. If you were to get up and we were to walk around here, that number might go up to 800 milliliters per minute.
If we were to walk a little more briskly, we might be at a liter per minute of oxygen. If I said, let's go out in the parking lot and jog, well, we might get up to like 1.5 liters per minute. We pick up the pace a little bit, we'll get to two liters per minute. If I start really, really running us hard, we're gonna get to three and a half, four liters per minute.
Well, at some point, I am going to push you so hard that you will achieve your maximum level of oxygen consumption. And if I push you any harder and faster, you won't extract more oxygen from the air. You may go faster, but you will do so through a process that does not involve the consumption of oxygen.
You will do so through an anaerobic glycolytic pathway, but you will have achieved your maximum consumption of oxygen. And that number has a very special name. It's called VO2 max. So VO2 max measured in liters per minute is the maximum amount of oxygen you can consume.
And the only way you can measure that again is to have this mask with very, very fancy apparatus that measures both of those things I said, and you have to be stressed hard. So we typically do this on a treadmill or on a bike. So your colleagues that came into 10 Squared yesterday, they did it on treadmills. They ran.
And they ran them and ran them and they ran them until they couldn't go any faster. And then we measured how many liters per minute of oxygen they were consuming. Now, that answers what VO2 max is. So the next question is, Does this matter?
Well, the short answer is we don't have a single metric of humans that we can measure that better predicts how long they will live than how high their VO2 max is. And it's not even close, to be completely clear. So if you compare somebody who is in the top 2% to someone who is in the bottom 25% for their age,
The difference in mortality is 5x 500% Yes, 400% technically because with hazard ratios you you you go To to a 2x hazard ratio is 100% I guess yeah So let's look at you. So yes, see you've pulled this chart out, which is one of my favorite charts. Okay, so you oh By the way, there's one other thing I should state we normalize this by weight
Okay. So we always divide that number of liters per minute by how many kilograms you are. So the number is actually reported as milliliters per kilogram per minute.
Okay. All right. So if we look at somebody who is your age, male, 30 to 39... If their VO2 max is below 35 milliliters per kilogram per minute, they are in the bottom 25%. Conversely, if they are at 53 milliliters per kilogram per minute, they are in the top 2.5%.
So to be clear, if you take a 35-year-old man, and one of them has a VO2 max of 53, and the other one has a VO2 max of 35, there is a 400% difference in their all-cause mortality over the coming year.
That's right. Now, this becomes more and more profound as you age, because the all-cause mortality ratio for a 35-year-old is incredibly low. It's like 1%. So that means you're comparing 1% to 4%. It's not that big a deal. But when you get up to my age, so I'm two decades older than you. So now the low bar, the bottom quartile, is less than 29. The high bar is more than 50.
Well, my relative mortality in the next decade is probably 2% to 3%. So now multiply that by four. Okay. When I get into my marginal decade, the low bar is 18. The high bar is 36. That's a 2x difference in VO2 max. A 4x difference in mortality is huge when the all-cause mortality for an 85-year-old is going to be the one-year mortality for that person is more than 10%. Yeah.
So one of the things that we do is we sort of think through this, not just through the lens of mortality, which is what I just walked you through here, but also healthspan, which is kind of what you were talking about earlier with the graph of strength and disability. So we have another figure that we show people that on the x-axis shows age, and on the y-axis shows VO2.
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