A (29:17)
I would say that I still focus on certain areas to optimize, I still pull certain levers and what I would say I have become much better at and it takes practice. It's going to sound so rudimentary is asking simply what are you optimizing for before you optimize, why are you optimizing? And it's easy I would say, particularly if you are being shaped by social media, which seems to basically offer you the seven dead layer cardinal sins on a silver platter. You get to pick your poison. If you're being shaped by that, then you can end up optimizing without a direction necessarily or a question. You haven't interrogated the direction. And that could be because you're following someone online who's a multi billion dollar real estate developer slash serial entrepreneur, slash fill in the blank and the chase for money is on. But that never really gets interrogated. I think the four hour work week does a good job of breaking down kind of work for work's sake and money for money's sake. But for me personally, for instance, it's like, okay, if I'm going to quote unquote, optimize my health, well, we've got a problem right out of the gate. Optimize isn't well defined. What does that mean? And health isn't well defined. What the hell does that mean? So for me, I'll give you an example from the health perspective. If you read a book like outlive by Dr. Peter Attia. Great book. One of the few books. If people are asking me what I think about longevity and all the tech billionaires want to live forever and flying to Honduras for questionable genetic therapy and so on, what do I think of all this? I would say start with Outlive. If you actually want to have the longest health span possible where you're functioning at a high level for the longest period of time, I would check out that book. And I don't want to paraphrase too heavily here, but in effect you can figure out without a whole lot of fancy analysis what is most likely to kill you based on what kills everybody in your family. In my case, it's probably not going to be cancer. Could be, probably not. It is almost certainly going to be something cardiovascular or neurodegenerative disease. So for me, I have three relatives right now with rapidly progressing Alzheimer's disease, including those who do not have the genotype. If we look at, say, APOE status, right, they're APOE3.3, whereas I'm APOE3.4. So that's scary. There are other factors to consider for Alzheimer's. I am doing things to try not to die from something that is hopefully preventable from the perspective of cardiac health, cardiovascular health, and then also trying to mitigate my risk of neurodegenerative disease. And that's why I'm in ketosis right now, for instance, and jury's out on some of this. But very plausibly there are mechanisms by which going into ketosis on a fairly regular basis for a few weeks at a time, let's just say in my case, two or three times a year, may have neuroprotective effects, also anti cancer effects. And people can listen to my interviews with Dominic d', Agostino, who's a researcher out of Florida, or other people for the science behind this. And it's also an intervention. And this comes back to your question about optimizing that is very, very well studied in the sense that I have very high confidence that the downside risk is low and very manageable. Whereas if you're just mainlining GLP1 agonists, amazing results that we've seen in the literature so far. But have we had anyone on these for 10, 20 years? No. At least not 20 years. Maybe some of the first monkeys shot into space, like me with the accelerated tms and the DCS has been on for that period of time. That doesn't mean don't use GLP1 agonists, but understand that there are a lot of unknown unknowns with the ketogenic diet. It's like, look, the ketogenic diet and its modern incarnation using heavy cream or other types of fats was designed for epileptic children. And this goes back probably a hundred years at this point, if not a hundred years close to it. And humans have the metabolic machinery to go into ketosis and have had that machinery for millennia upon a millennia upon millennia. That would be an example of something that passes the test for me of seemingly credible upside potential, even if we don't understand all the mechanisms, limited downside potential that I can offset with certain prescription drugs. Let's just say because I'm a cholesterol hyper Absorber and okay, great, we're going to do that. Intermittent fasting would be another one during ketosis or outside of ketosis. The one thing that has most dramatically changed my blood tests with respect to specifically insulin sensitivity and avoiding prediabetes, which runs rampant in my family. Intermittent fasting, in my case, that means I'm eating within an eight hour window. Each day might be even a little shorter, like 2pm to 8pm and that's it. I just don't eat until 2pm or 3pm and for some folks, it's arguably better for you if you do like a 12 noon to 8pm kind of eating window. It's also called time restricted feeding. There's a lot of good science for this, not just in animal models, but in humans. And the results I've seen from that are just absolutely incredible. And it's so simple because you don't actually need to change what you eat, you're just changing when you eat. So those would be two that people might think of as optimizing. And then I'm taking a handful of prescription drugs to offset the cardiovascular risk because it doesn't matter if I am eating an all fat diet, an all protein diet, a vegan diet, a fill in the blank diet. There are certain biomarkers that are just trash, they're so bad. And that seems to be just straight from the code, straight from DNA. And for that reason I'm like, ah, I'm no spring chicken anymore. You know what, I think I'll just bite the bullet and take some of these. And when, for instance, I talk with my doctors now, the first thing is if you have a blood test and something is out of range, my recommendation would be before you get on 12 different drugs to deal with it. And if it's an emergency, it's an emergency. But if it's not an emergency, right, like your triglycerides are high. All right, well it's probably not going to kill you in the next week. My recommendation would be talk to your doctor, replicate the test, do the test again the next week, maybe on a different day, and see if you can replicate the error. Because for instance, if you had a heavy weekend of drinking or a fatty meal the night before, and then you do your blood test 8:00am the next morning, fasted. Well, you might look like you're on the road to having a heart attack in two months, but actually it was just behavior and diet. So replicate, replicate. That would be number one. Don't base the outcome of the basketball match on one photograph like try to get tested more frequently and pay attention to when you're getting tested. So if you're, for instance, coming back to the example I gave, if you're taking your test, your blood test on Monday mornings, make sure your next test that you're comparing it to is also on Monday morning. If it's Wednesday morning, it might be completely different, by the way, if it's something like cortisol, testosterone, et cetera. These things have diurnal cycles. They really fluctuate throughout the day. So if you get a test at 8am I've seen this with friends of mine, male friends, who get a test at like 8am and I have to interrogate how they did things for them to Sherlock Holmes this. But they're concerned about their testosterone levels or the free testosterone. They take a test at 8am Looks great. They do another test three months later, six months later, they do it at 11am and it's 200 points lower. Looks crazy. And it's not crazy. They don't actually, in this case, this guy had no problem. He was about to get on all sorts of hormone replacement therapy and all this stuff that is pretty powerful. And I said, go back, do it at 8am Again, two weeks, let's see what happens. Guess what? It was the same as the first test. So that's step number one. And then when I'm looking at possible interventions for me, again, I'm not a doctor, don't play one on the Internet. But the way I approach it, and people get very little guidance on this, most doctors are overstretched, right? They get 11 minutes per patient. The easiest thing for them to do is say, look, this guy has a problem or this gal has a problem. If we throw these three drugs at it, it's probably going to fix it. My job, as far as I'm concerned, as far as my time allows, is to keep this person from dying. Okay, start these three drugs. But what I have tried to do, and I did this with my own particular cardiac situation and I think Boston Health is the testing that I did to get a more granular understanding of things with a little higher resolution. But since I am a cholesterol hyper absorber that informs the type of drug I might take doesn't necessarily have to be something like a statin. And there were three or four drugs that, that I was suggested to take. And I said, what is the longest studied of these with the best side effect profile that is the most innocuous that I can start with and we can do another test in two months, this is not an emergency. I'm not about to have a pulmonary embolism or a heart attack. Don't have any arteries blocked. What is it? And it was in my case, not everybody, something called ezetimibe, otherwise known as zetia. Very well studied, very well tolerated. I said, let me try this in case I am a hyper responder. Because sometimes you can be a hyper responder or a non responder. But I was like, let me just try it out. And statistically very unlikely that I would be. The doctor said, nonetheless, tried it two months later, retest, guess what, I'm a hyper responder. So I was able to use the minimum effective dose for medication and ultimately added one more thing. But how many decades of possible side effects did I just spare myself by doing basically like one and a half drugs instead of starting with four or five and doing that indefinitely from that.