What the American Heart Association gets right (and wrong) about alcohol. 🍷

The AHA’s latest statement on alcohol & cardiovascular health is a step forward but misses some key points.

Here’s a breakdown of what they get right, where they fall short, and what it means for you. 🧵 1/ Alcohol’s reputation has shifted, and the AHA reflects the growing skepticism about alcohol’s benefits.

Moderate drinking was once hailed as heart-healthy (think red wine 🍷). The AHA now says there’s “no proven cardiovascular benefit.”

Cultural attitudes are shifting too—thanks to folks like Andrew Huberman (@hubermanlab); whose video on alcohol has 7.5M+ views on YouTube), more people are questioning alcohol’s health halo.

Zone 2 training

What is it? What are the best ways to train it? And what are the key physiological adaptations?

A group of experts recently came to a consensus about this training zone. Here’s what they had to say. 👇🏼 What is zone 2?

Physiological resilience is your ability to resist a decline in performance under prolonged stress.

It’s being called the “fourth pillar of endurance performance.”

Here’s what you need to know about durability and how you can improve it. 👇🏼 For years, the Joyner model (from the 1990s by Dr. Michael Joyner) has been the gold standard for predicting endurance success. It hinges on three pillars:

- VO₂ max (max oxygen uptake)

- Running economy (oxygen cost per kilometer)

- The sustainable fraction of VO₂ max (linked to lactate threshold).

Together, these predict marathon times with decent accuracy—until fatigue kicks in.

Enter physiological resilience, the “fourth determinant” gaining traction in endurance research. Coined as “durability,” it’s the ability to resist performance decline during prolonged exercise under stress. Think of it as your body’s robustness against fatigue, distinct from mental toughness. A new review by Andrew Jones and Brett Kirby explores the concept.

Is high-carb fueling really necessary for prolonged exercise? 🍏🥖🚴🏻

New study on low-carb vs. high-carb diets for endurance performance shows:

- equal performance outcomes during time-to-exhaustion testing.
- improved performance on both diets with the ingestion of just 10 g of carbs per hour!

The nail in the coffin for the obligatory role of muscle glycogen? ⚰️

Let’s break down the study 👇🏼 The study set out with three primary aims:

1. To evaluate whether endurance performance (time-to-exhaustion at 70% VO2 max) differs between athletes adapted to low-carb and high-carb diets over six weeks.

2. To determine the impact of carbohydrate supplementation during exercise on endurance performance across both dietary patterns. This included investigating whether minimal carbohydrate intake (10 grams per hour) during exercise could enhance performance and mitigate exercise-induced hypoglycemia, regardless of the athlete’s habitual diet.

3. To investigate the time course of metabolic and performance adaptations to low-carb and high-carb diets, with a focus on their influence on endurance performance.

Alcohol and cancer. What’s the link?

A new advisory from the surgeon general lays out the evidence.

The conclusion? No level of alcohol is safe when it comes to cancer risk.

Here are some of the key points 👇🏼 The advisory emphasizes the urgent need to inform the public about alcohol as a significant preventable cause of cancer. It calls for immediate action to address widespread misinformation and under-awareness.

🔑 Key findings:

Alcohol is a direct cause of cancer, contributing to nearly 100,000 new cases and 20,000 deaths annually in the U.S. Globally, alcohol-related cancers accounted for 741,300 cases in 2020.

Despite evidence, fewer than half of Americans recognize alcohol as a cancer risk, compared to 91% for radiation and 89% for tobacco. This lack of awareness has remained stagnant for nearly two decades.

Dr. Rhonda Patrick just released a deep-dive episode on all things protein.

Here are a few things to know 👇🏼 1. Muscle Mass, Aging, and Protein

Age steals your muscle, but protein can help fight back.

📉 Age-related muscle loss: Starting at 50, muscle mass declines by ~1% annually, with strength dropping even faster (~3% per year). Regular strength training slows this loss.

🏋🏾 Protein and muscle retention: Resistance training combined with higher protein intake (~1.6g/kg/day) enhances muscle mass (+27%) and strength (+10%) compared to training alone.

🧱 Anabolic resistance in aging: Older adults need ~0.4g/kg protein per meal to stimulate muscle protein synthesis. Exercise mitigates anabolic resistance, enabling better protein utilization.

VO2 max—how much of it is genetics and how much is trainable?

In this thread, I’ll discuss a long-running debate about whether or not everyone “responds” to exercise training. 👇🏼🧵 Current public health guidelines recommend moderate to vigorous aerobic physical activity for around 150-300 minutes each week.

Studies have shown an average increase in VO2 max ranging from 15% to 20% can occur through guidelines-based exercise programs.

However, more frequent or intense training can lead to even higher increases in VO2 max, averaging around 25% to 30%.

This suggests that individuals of various backgrounds and fitness levels can experience improvements in VO2 max through training, though certainly at the highest levels of fitness, there is less room for improvement.

What determines VO2 max?

And what are its limiting factors?

The primary factors can be classified as:

Central factors 🫀

- pulmonary diffusing capacity
- maximal cardiac output
- oxygen-carrying capacity of the blood

Peripheral factors 🦵🏼

- skeletal muscle characteristics

Read on to learn more 🧵👇🏼 Lungs

The pulmonary system (the lungs) can limit VO2 max under certain circumstances:

- exercising at moderately high altitudes
- people who have asthma or other chronic obstructive pulmonary diseases. 

Trained individuals with an extremely high cardiac output may undergo arterial oxygen desaturation during maximal exercise — the blood moves too quickly through their pulmonary system to become fully saturated with oxygen.

The ability to increase exercise capacity in individuals with pulmonary limitations shows the presence of a pulmonary limitation to VO2 max, however, the lungs don’t appear to be a limiting factor in trained individuals or people without pulmonary diseases.

Breathing hyperoxic air (air that contains more oxygen than normal) doesn’t increase VO2 max in normal people, but it does in highly trained athletes (in whom a pulmonary limitation might be present due to the abovementioned factors).

Exercise volume or intensity: which is more important for promoting training adaptations? 🫀🫁

A recent meta-analysis explores this question & provides evidence on how training variables influence mitochondrial content, capillarization, and VO2 max.

Let’s explore. 👇🏼 The main focus was on the comparison between different training intensities, which the authors defined as:

- Low- and moderate-intensity continuous endurance training: an intensity below the second ventilatory threshold, 4 mmol/L blood lactate, 87% of maximal heart rate, 87% of VO2 max, or 75% of Watts max.

- High-intensity interval or continuous training: an intensity above the second ventilatory threshold, 4 mmol/L blood lactate, 87% of maximal heart rate, 87% of VO2 max, or 75% of Watts max.

- Sprint interval training: protocols involving maximal or supramaximal efforts lasting 4–90 seconds.

Marathon training W1/D1

10 miles easy
Marathon training W1/D2 (part I)

- 6-mile tempo run @ goal marathon pace

- 4-mile warmup and 2-mile cooldown

⏱️: 5:38, 5:41, 5:38, 5:33, 5:36, 5:34

Super pleased with today. The effort was very manageable despite heat and humidity.

First part of today’s double threshold session. Trying something new and might run again (shorter) this afternoon.

High-intensity interval training for plaque reduction 🫀

Is HIIT safe and effective for people with heart disease?

🧵 Exercise is a wonder drug for cardiovascular disease (CVD) prevention and reversal.

One of the biggest risk factors for CVD development is the buildup of plaque in the coronary arteries (the arteries surrounding the heart that provide it with its own blood supply).

The best time of day to exercise for health ⏰

Should you workout in the morning or the afternoon to maximize the metabolic benefits?

A 🧵 Clinically, about 1/3 of adults have metabolic syndrome — a cluster of conditions including abdominal obesity, high blood pressure, high blood glucose, high triglycerides, and low HDL cholesterol.

Resistance exercise for cardiovascular health 🫀

The AHA just dropped a new Scientific Statement on the benefits of strength training.

You're going to want to bookmark this.

🧵
Epidemiological evidence 🌎

Adults who participate in RT have nearly a 15-17% lower risk for all-cause and CVD mortality vs. adults who report no RT.

The maximum risk reduction occurs at 30-60 minutes/week.

Despite this, only 28% of US adults participants in RT 2 days/week.

Endurance exercise and atherosclerosis

Is working out too hard detrimental to heart health?

🧵
There’s no better way to improve your chances of aging gracefully and reduce your risk of major noncommunicable diseases than to get adequate levels of physical activity.

Exercise is great for blood glucose control.

Is there a “best” time to exercise to obtain the most benefit?

A 🧵 Blood glucose and insulin sensitivity exhibit a diurnal rhythm — glucose tolerance is better in the morning compared to the afternoon and the evening.

Glucose levels are lowest around the midpoint of our sleep. In people with impaired glucose tolerance or type 2 diabetes, the nadir in nighttime glucose is followed by a rise in glucose between 3 and 9 a.m.; this is referred to as the dawn phenomenon and occurs due to the body increasing its glucose production (referred to as endogenous glucose production).

Time-restricted eating vs. calorie counting for weight loss.

Does fasting have unique benefits? Or is it all about "calories in, calories out"?

Check the link in my bio for an in-depth post.

Keep reading for a🧵
Fasting has several well-regarded benefits, and though many of them have only been studied in animal models to date, evolutionarily conserved processes that we share with our non-human relatives suggest that these benefits may also apply to us.

Strength training vs. endurance training for healthy aging

As we get older, muscle fiber type changes, strength declines, and neuromuscular atrophy occurs.

Are lifelong athletes protected? And what's the best type of exercise to counteract aging?

A thread 🧵
Aging is typically accompanied by declines in maximal strength, force-generating capacity, and muscle mass.

This loss of size and strength occurs primarily in type II (“fast-twitch”) muscle fibers, resulting in an increase in the proportion of type I (“slow-twitch”) fibers.

Caffeine, genes and exercise performance. ☕️

Caffeine is one of the most well-studied ergogenic aids ever - and also one of the most (legal) effective ones.

Let's talk about how caffeine improves performance and the role of genes.

Thread 🧵
Exercise physiologist Dr. David Costill made significant contributions to the study of caffeine and exercise performance. His research played a pivotal role in understanding the effects of caffeine during exercise.

Nose breathing for heart health. 🫀

There are claims that nasal-only breathing is superior to mouth breathing.

How does their physiology differ? And does nose breathing really produce beneficial effects on the body?

Thread. 🧵
Nasal breathing warms, humidifies, and filters air; it also leads to greater production of nitric oxide (NO) in our airways, enhancing vasodilation.

In addition, when we breathe through our nose, we use our diaphragm, lowering the metabolic cost of breathing.

🧵

If you’re trying to improve your aerobic capacity, what’s the best way to do it?

High intensity intervals? Lactate threshold runs? Long slow endurance training?

Here are the top protocols to optimize VO2 max 👇🏼 Aerobic base building (low- to moderate-intensity training) is an important aspect of all training programs. ⛰️

But if you’re interested in increasing cardiorespiratory fitness (VO2 max), there seems to be a clear winner in terms of which intensity is best.

If you’re trying to practice nasal breathing during endurance/cardio or a strength session, let me introduce you to a tactic I’ve tried once or twice.

It sounds crazy (and intense), buts it’s literally zero cost and incredibly effective.

The “mouthful of water run.” This tactic was apparently practiced by the Apache tribes—who were well-known for their stamina and endurance ability.

Ala the Tarahumara tribes profiled in the book “Born to Run”.