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I am an artist in muscle growth and fat loss; my canvas is my own body, and I want to learn how to sculpt it very well.

I've gained a lot of muscle over the years, and for me, the whole journey is fundamentally a personal one—wanting to occupy a body that is two things: one, that I aesthetically enjoy being in, and two, that I had a large hand in creating or curating. The curation is almost as fun as the creation. Like when you see an artist draw something on a canvas, a huge amount of joy comes from creating the main arc—the main shapes, lines, and colors. But when an artist has something almost complete and adds small details, the process becomes even more rewarding. Once you have something that looks amazing, you're optimizing. There’s something beautiful about that. It’s like watching someone take a finely tuned F1 car, make a few final adjustments, and polish it off—just beautiful. Not that my body is attractive. It’s not. It’s grotesque.

Anybody who wants to have more muscle and less fat probably has something to learn from a bodybuilder. I often say to my patients, "If you really want to understand how to manipulate nutrition to be lean, you should understand what bodybuilders are doing."

The list of 90-year-olds who wish they were less strong and muscular is very short, right? But at the end of life, most people say the opposite: "I wish I was stronger. I wish I had more muscle."

Almost nobody accidentally becomes hypermuscular to the extent that the trade-offs become apparent. Probably the biggest short- to medium-term trade-off is opportunity cost—things you could have done outside of the gym. But the science of resistance training shows that for almost all the health, longevity, and quality-of-life benefits, the amount of training needed per week is measured in the 1 to 3-hour range.

People get incredible benefits from minimal time investment. Probably the biggest return on investment the average person can make is training for roughly half an hour twice a week—Monday and Thursday. If done properly, this can provide an unbelievable amount of benefits across the board.

You can get some benefits from submaximal efforts, but resistance training is based on applying high forces and high levels of fatigue to drive improvement. If you're trying to be a special operator—a Navy SEAL-type person—but the sound of gunfire freaks you out, you’re in the wrong place. Similarly, in weight training, pushing very heavy loads or lighter loads close to muscular failure is necessary. People describe it as unpleasant—a burn in the muscle, a lot of pain, the weights slowing down. It takes psychological effort to keep going. Unlike zone two cardio, where you can still breathe and talk a little, weight training is different. Because it’s so intensive, you need lots of recovery time between sessions. Each session disrupts and damages the muscles, but the total physiological changes per session are high.

If you're not working hard per unit of time, you’ll need a lot more work—that’s endurance training. But if you train intensely, you won’t need as much volume, nor can you recover from it. That’s why even professional bodybuilders only spend around 8 to 10 hours per week in the gym. For people just looking for basic benefits, 1 to 2 hours a week is enough—if they push sufficiently hard. You can recover from more if you prioritize recovery, but too much training makes you constantly sore and tired.

The drive required to be good at endurance training, at least the base-building part, involves a state of calm—equanimity. You get your flow going, music playing, breathing steady, and you just crank. In lifting, you have to turn up the intensity to really feel the maximum effort. You can hop on a bike for an hour at zone two every day, and when asked if you’re tired, you might say, "A little, but I also feel refreshed." But you don’t feel refreshed after grinding the leg press for five sets of 15. You feel like someone beat the crap out of you.

The nervous system accumulates fatigue the way any system pushed to its limits does. Various components experience wear and tear, and certain substrates deplete and need to be replenished. For example, in the axon of any given nerve, there’s a balance of electrolytes inside and outside the cell that allows electrical signals to propagate. But if you push the system hard enough, it gets out of balance. Your body has to pump electrolytes back into place, but the structures responsible for this are proteins, which wear down and need to be replaced. Protein synthesis takes minutes, hours, or even days—not seconds. You can think of it like a transatlantic cable. If you push too much current through it, or if fish nibble at it long enough, you’ll need to start replacing it. Similarly, at neuron-to-neuron junctions—or the neuromuscular junction between a neuron and a muscle—neurotransmitter vesicles get depleted. If you run low, the electrical signal arrives, but there isn’t enough neurotransmitter to communicate effectively, leading to profound fatigue and weakness.

Replenishing neurotransmitters takes time. A clear illustration of this is MDMA (Ecstasy). People who use it deplete certain neurotransmitters and don’t feel the same the next day—it takes time to recover. Similar mechanisms are at work when you push to true failure on a squat or leg press. Your nervous system and muscles are maxed out, leading to homeostatic disruption all along the axon, in the cell body, and at the synaptic cleft. Neurotransmitters get depleted, waste builds up, and it takes time to fix. That’s why people don’t regain their prior strength immediately after resistance exercise. Depending on intensity, recovery takes anywhere from several hours to several days. If your workouts are really hard, it may take days before you can train that muscle group again. However, because much of this fatigue is local, you can train unrelated muscle groups on consecutive days. For example, if you destroy your chest and triceps one day, you can still train your back and biceps the next. While most fatigue is local, some is systemic. The central nervous system (brain and spinal cord) has mechanisms for managing central fatigue. Tim Noakes was a proponent of the "central governor model," and while his exact interpretation may not be correct, central governing definitely happens. When your body detects high levels of fatigue, it pulls back on overall effort. Some neural structures might still be firing at full capacity, but they’re degraded enough that full capacity isn't really full capacity anymore. In all these ways, and more, accumulated fatigue forces the body to back off. If you think you can train ultra-hard for the same muscles twice a day, every day, you’re welcome to try—in a medically supervised context. You won’t last. That said, weight training is incredible because even after a single session, your body continues upgrading for days. Few things in life work like that—you can do 20 to 30 minutes of intense resistance training, and for days afterward, your nervous system, muscles, and tendons continue adapting. It’s a powerful, lasting effect.

When you're entering the gym, if you're training properly, you are asking a lot of your physiology—you are pushing it to its limits. If you're not, you're not using your time best and not getting the best outcomes because the absolute best results come from pushing very hard. Not necessarily to the limit, but you have to test the limits.

It is not obvious why, for example, being on a bike—even if you are riding at a very high level of power—differs so much from weight training. Remember, on a bike, your leg is moving around 90 times per minute, so even if you do a one-minute all-out effort, that’s 90 reps, or call it 45 reps per leg. That's nothing compared to an all-out set for 10 reps in the gym—there's a huge difference in force.

Your body has excellent sensing mechanisms for tension, metabolites, and other factors that cause muscle growth. When it detects that you're pushing on the pedal, it will give you a solid response. But if you keep pushing on the same pedal over and over, the system desensitizes to muscle growth. The biggest reason for this is likely that the human body evolved over hundreds of millions of years—long before we were even human—in an environment of food insecurity. To justify allocating significant resources to muscle growth, there needs to be a strong, distinct signal. If you are myostatin-deficient, then simply existing causes muscle growth.

For a variety of reasons, including this one, doing one set close to failure yields significant gains. Doing three sets close to failure gives substantially more gains—but not three times as much. Doing five sets close to failure improves results only slightly beyond three. And performing seven or eight sets close to failure in one workout is statistically indistinguishable from five.

Study after study shows that training one or two reps away from failure is often statistically indistinguishable from true failure training. This is likely due to the exponentially higher nervous system demands of training to absolute failure. For efficiency and long-term sustainability, training to failure every session as a rule is probably suboptimal. Most sessions should be one or two reps in reserve.

The people who really need to be in the gym are the ones who aren’t in the gym.

Most people need 15 to 30 total working sets for their whole body per session. You can condense that into 30 minutes, but you're working almost the entire time. It’s generally a good idea to do sets of 10 to 30 repetitions. With these loads, you don’t need much rest to perform well. You can achieve meaningful strength increases with a lower absolute load, reducing injury risk.

If you're not an expert yourself, it’s very difficult to determine who is truly knowledgeable and doing a good job.

There’s a concept called accumulated fatigue or cumulative fatigue. Your muscles and body recover well between sessions, but not 100%—maybe 90% or 95%. If you multiply 0.95 by 0.95 by 0.92 by 0.9 by 0.95 enough times, you’re down to 50% recovery in six to eight weeks. At that point, how could you possibly be making gains? For the average person training consistently, one week out of every eight—one week every two months—should be taken off from the gym. Stay active, maybe do some bodyweight squats or push-ups, but ideally, go on vacation. If not, take it easy: reduce work stress, relax with family, have some fun, and allow your body to recover in a way it never can between sessions. Once a year, take at least two full weeks off—we call this active rest.

Inconsistency, especially when you're older or under significant professional stress, is something professional bodybuilders cannot afford, and neither can you. If you do everything right five or six days a week and have one off day, you’ll do great. But if the good days are outnumbered by the bad days, you’re not doing your due diligence. That brings up sleep, stress management, and other factors that can be the difference between making significant gains or none at all.

I was smart enough from the beginning to always monitor my blood pressure—that’s a huge killer for people on drugs. I also paid attention to my lipid values, another major risk. I eat healthily almost all the time, and that has made a big difference.

I'm totally comfortable with every choice I’ve ever made. It’s been one hell of a run. Understanding your own mortality and coming to grips with it is important for anyone, but especially for someone who has taken the risks I have with my body. It wouldn’t surprise me if I had a heart attack an hour after we finish filming this. I won’t die surprised.

Don’t mess with your body without really thinking through what you’re doing. Like a race car driver—no one gets into that car thinking, "This is the safest thing I could be doing." That would be nuts. But most of them have come to grips with the risks. They know they could die, but they’ve accepted it. They’re well-compensated, and it’s been worth it to them. Most importantly, they did what they really wanted.

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