Adam Schafer (2:18)

Hit pause. Hit head on over to my pumpstore.com that's it. Enjoy the rest of the show.

Justin Andrews (2:23)

Welcome to the show Rhett.

Dr. Rhett Langley (2:25)

Thanks for having Me?

Justin Andrews (2:26)

Yeah. So tell us a little bit about what you do, your background, so the audience can kind of know where you're coming from.

Dr. Rhett Langley (2:31)

Yeah. So primarily I run a clinic in Houston, Texas. It's called Thrive Medicine, and we specialize in metabolic health, sexual health. You know, I'm boarded in anesthesia and pain medicine. That's my traditional training.

Justin Andrews (2:47)

Okay.

Dr. Rhett Langley (2:48)

And then I spent the last seven years after doctor training really learning how to actually, you know, make people well.

Justin Andrews (2:55)

Okay, explain metabolic health and what that. Because that's. You hear that a lot now. Like, this is like a big thing now in medicine or in treatment or in the wellness space. What is that? Exactly.

Dr. Rhett Langley (3:07)

Yeah. So when you go on this crusade to try to help people and you look at, let's just say, this large list of symptoms that people have, whether it's, you know, and I break it down into like two large factions. There's sick people and there's people with problems that may not be determined as sick by the medical community. Right? So sick people could be like, hey, I have cancer, dementia, sexual dysfunction, cardiovascular disease. And then over here is this, you know, esoteric, not otherwise specified, have fatigue, brain fog. I have, you know, skin inflammation, sleep disorder, etc, mood liability. When you look at all of that stuff, the really at the bottom of that rabbit hole is the. Is the term metabolic dysfunction, right? And real simple definition of that is the physiology. The physiologic processes in the body are not functioning properly, right? And it starts with looking at glucose, looking at fat, and then that translates into worse things like cardiovascular disease, like we said, sexual dysfunction, issues with the brain, so on and so forth.

Justin Andrews (4:20)

So, okay, so it's essentially the. You're looking at taking what you consume and turning it into energy in that process. Although I just simplified it, it's a very like, the like, complex process we're talking about the metabolism. There's a lot of things that are happening.

Dr. Rhett Langley (4:36)

Yeah, yeah, okay. Yeah. I mean, if I said to you, like, hey, food is fuel, you'd say, okay, cool podcast, bro. Great. But. But essentially, you know, that's what it is. We're talking about, like, exchanging oxygen to CO2, taking in stuff, having your body utilize that appropriately and making sure that that physiologic process is dialed in.

Adam Schafer (4:58)

How much can this really affect someone's ability to build muscle or burn body fat efficiently? I mean, in our experience, training tons of people, I've experienced this where, you know, you know, you've got them on a good diet, you're exercising correctly, and then their body's just not responding and it's not adding up. And many times there's other root causes. So, like, how significantly can it impact that ability to build muscle or burn body fat?

Dr. Rhett Langley (5:30)

Yeah, I think, I think it's. It's a huge impact, right? So it has a very, very large impact if you in. And honestly, you know, bodybuilders get this, right? They utilize insulin also to put on muscle. Right? And they also know, like, I even saw, you know, of course the algorithm has, has control of me, but I saw the other day, one guy was touting, he's like, hey, if you're, if you're fat already or if you can't see your abs, don't try to put on muscle. So they're already catching on to the fact that it's not just calories in, calories out, you know, that, you know, how much we eat and what we eat is really, really important. But when we look at what's going on underneath the surface, it has a huge effect on our performance, whether we're putting on holding onto fat or adding that to muscle. And then all the other problems that come from that process not being dialed in.

Justin Andrews (6:19)

Now, doesn't exercise applied appropriately in diet improve the metabolic health of somebody? Like, those are also methods that can help with that, right?

Dr. Rhett Langley (6:30)

Yeah, a thousand percent. I mean, even so, I would say, like, that's. Hate to get to the point, but that's the overarching theme, right? Lifestyle modification. And if you look at. So you're going to hear me talk about these studies a lot, but some of the really, really large behavioral modification studies, one of them was Diabetes Prevention Program, the Look Ahead Trial. Those were behavioral modification. Those studies were RCTs, right. And we're talking 5,000 people showing that behavioral modification most likely beat out other interventions. Right. And what was that? That was looking at calorie intake, looking at physical activity. Right. And then the other major thing here, the major thing, especially when we're talking about CGMs or what we do in our clinic, is they had a structured program. So they put these people through a structured program. Right. You just can't give someone data or tell them like, hey, eat more, move less. Like, cool. You have to spend time with these people and teach them and, you know, modify that as you go along.

Justin Andrews (7:36)

So what made you move from. So you. Were you an anesthesiologist or trained as one? Did you practice?

Dr. Rhett Langley (7:41)

No. Yeah. Yeah. No. I mean, I still do some anesthesia.

Justin Andrews (7:43)

Okay, so what made you move from there to this space? I was so different in the sense that, like, you know, in anesthesia, you're, you know, you're titrating people's anesthesia, making sure everything's okay during surgery. That's what you do now. You're like, cool. Let's look at your whole life.

Dr. Rhett Langley (8:01)

Yeah.

Justin Andrews (8:01)

Let's look at your lifestyle. Let's look at your diet. Like, what made you move into that space? Was there something that happened? Oftentimes I talked to doctors who do that. Like, they either had their own health issue or a family health issue. Was it something like that?

Dr. Rhett Langley (8:11)

Yeah, I mean, you know, to answer the question first and then back up and tell the story. It was subtle, and I think people relate to this. I thought I was healthy and felt bad and didn't know that. Right. And, you know, maybe you guys can relate. I was like, I was 90s fit, bro. Right. So I was. This was prior to my awakening where I thought I was doing a bunch of stuff. I was going to the gym twice a day. You know, and back in the day, maybe you can relate was Inno Explode. Muscle milk. Good time cell tech.

Adam Schafer (8:46)

Yeah, we're all the same age.

Dr. Rhett Langley (8:49)

I'm dating myself.

Adam Schafer (8:50)

Yeah, we're all the same age.

Dr. Rhett Langley (8:52)

You know, Men's Health magazine was my bible. Oh, yeah. And, you know, at that time, don't judge me. This was like, dial up. So checking the sources was not a thing. Right. So if Men's Health told me, like, hey, tequila, Tequila stimulates metabolism. Like, all right, cool, let's go. Right. Um, you know, calming your nervous system or mental fitness was two drinks, lie in bed, negative feedback loop. Right? Like, you suck, bro. That's how I was taught. That's how we grew up. And then, you know, choosing the wrong relationships. Right. So it wasn't until. And again, you know, let's just. I'll stop joking just for a second. So going through doctor school, and doctors get hazed a lot. A lot about, like, oh, it's not appropriate training, or that's out of context. And I will totally say on this podcast that there's an indoctrination in every professional school. Right. However, Dr. School broke my ass to be a really, really badass doctor. Right. Like, it will turn you into a warrior. And when you do procedural medicine, like anesthesia, you. You have to. You do one, you suck. You do 10,000, you're badass.

Justin Andrews (10:04)

Right? Right.

Dr. Rhett Langley (10:05)

I don't say that arrogantly, but, you know, back to the story, like, when I met my wife, she was like, hey, you know, are those dark circles under Your eyes, Is that like a birthmark? And I was like, no, that's probably something else. That's really, really bad. Right? I was irritable, moody, and because of doctor school, like, I knew how to sleep four hours and get it all done. Right? Drink late at night to help myself go to sleep, wake up at six. I can handle it. All right, Right. So that was just a wake up call, right? I was like, okay, I feel good, but something else is going on. I was hitting the gym twice a day and I had. I was puffy fit. You guys probably can relate that to. I was like, puffy fit, right? And so I knew how to do something. I was like, okay, well, this isn't working. Sarah, my wife, kind of jolted me into action. Like, hey, you don't look good either. I was like, well, I don't know. I'm hitting the gym twice a day. It's great. And I realized all my other friends who were doctors also had no idea how to take care of themselves. Right? So to put. Put it back into context with doctor school, like, you know, if your arm fell off, I was your guy. You know, if you got impaled by a fence, I'm your guy. Right. If you have an anaphylactic reaction, I can help you. Fatigue. My penis doesn't work. You know, hey, my have some skin inflammation and brain fog. No idea. So that kind of took me on the course of like, okay, well, we need to figure this out, right? I've got to do something different because I spent all of my life trying to become this thing, and we need great doctors, and I can save a life for sure, but can I save a life on the other end?

Justin Andrews (11:41)

What I really appreciate when doctors move into the space because you guys have some of the best training I've ever seen on how to go through and decipher through studies, data, how this. You're trained that way. You're trained to look at things in that way. And so when you get pointed in the right direction, some of the best. In my experience, working with doctors doing what you do, some of the best results happen because you've got that training. What was the first place you looked or what were the first things you did for yourself to kind of move things in a different direction?

Dr. Rhett Langley (12:18)

Yeah, for me, it was, you know, just personal, was. It was sleep. Right. So sleep is a superpower. I thought that five hours of sleep was just what we did.

Justin Andrews (12:29)

Yep.

Dr. Rhett Langley (12:29)

Right. And honestly, after I decided, like, hey, this is something I need to work in or at least give Myself, a sleep window. Like, it's all a sudden, like, my brain woke up. But the other thing that I started looking into is like, okay, well, what am I eating? You know, who are the people in my life? All of the things that seem really, really basic, you know, if I said them on the podcast, they're like, yeah, of course. Like, that's how you fix yourself. But you have to understand and apply into your life and then do it over a long period of time. Right? So at the time when I was this period of discovery, I was literally just looking at stuff, and then I would dive right in. That's how I got connected to Nutrisense. Right. If you really want me to tell that story, I was. At the time, Nutrisense was new. And now that I'm even telling the story, it was really new because I was like, hey, you know, what are these CGMs? And in fact, full disclosure, I was like, metabolic dysfunction was not taught to me in medical school that term. And I don't even know. I mean, I've been through a lot of stuff, even war, so I'm not sure if even someone even said it, but at the time that I was trying to get healthy, it had just started to become popular, at least in my world. And so I was like, okay, well, you know, what is this cgm? You know, what is this company? Nutrients. So I called the company.

Justin Andrews (13:46)

Oh, so you called them?

Dr. Rhett Langley (13:47)

I called them.

Justin Andrews (13:48)

Oh, wow.

Dr. Rhett Langley (13:48)

And that's how I did everything else. I mean, that's how I learned about peptides, and that's how I learned about. I would just find something and call the person.

Justin Andrews (13:54)

Okay.

Dr. Rhett Langley (13:55)

And at the time, it was new. So usually I would get the person on the phone. So when I called Nutrisense, I was like, hey, I'm interested. I'm a doctor. And this guy Dan jumped on. He talks faster than I do. And so he's like, yeah, I own the company. I was like, well, where do I get more information? He's like, I own the company. He's like, did you not hear what I said? So anyways, that's how. And again, that's how I learned. I would just find something that I was interested in, figure out if it was going to have an impact in health, and then just dove right in.

Adam Schafer (14:28)

Well, tell me more about that process with Dan and, like, asking him. So you get him, you start asking questions. Are you instantly like, oh, I believe in this. Or it's a. Like, what starts? What piques your interest in it? Do you order one? And Start testing it yourself. Like, tell me about the evolution of that and how that unfolds for you.

Dr. Rhett Langley (14:47)

Yeah, well, even that first conversation was like an hour conversation of us just talking about, you know, whatever business life and how the CGM impacts people's lives. And, you know, I'm going to be honest, when it first came out, there was a lot of heat, like, oh, yeah, it's just a gimmick, and blah, blah, blah.

Justin Andrews (15:02)

Yep.

Dr. Rhett Langley (15:03)

So, of course, I was also trying to start my clinic. And mind you, this was. I don't know, it was. It was late 2019 in, like, right before COVID hit. So there's a lot of other stuff going on, but I started. I was like, okay, let me order a few of these. I had a few clients, right. And I was like, oh, this is it. I'm gonna put everybody on this cgm. We're gonna start learning about metabolic health. And by the way, I'm also going to learn about metabolic health. Right. So I started trying it. And the app was new, but the biggest difference, even for me, and I'll. I have no problem saying this as a doctor, is as I was learning as I went, but also talking with the dietitians. Right. And so. And at the time, my wife was. My wife's a dietitian, so she was in her residency finishing dietetics, so just even getting on the. Even getting on the. A call or a zoom with these dietitians. And I was. I was special. I was like, hey, hey, I want to talk to your dietitians. I was constantly wanting to talk to these people, like, teach me, teach me. What do you do here? What do you do here? What do you do there? So for me, it was an awesome period of discovery, and I could tell that. That this was a different tool because it was helping me understand how to change my behavior. Yeah, right.

Adam Schafer (16:20)

So I love, like, some. There's been some cool CGM stories, like, or cgm, when you. You remember the first, like, aha. Or like, well, that's weird because I've seen times where you see somebody who. One person eats a food and they react a certain way, and then another person eats that food, reacts completely different. Do you remember the first time you had kind of like that for yourself or for a client?

Dr. Rhett Langley (16:44)

Yeah, absolutely. And again, like I said, we're just going to get raw on this podcast. Around the time it was, Carnivore was really, really popular. Right. So, of course I'm trying to learn. I'm like, oh, Carnivore, this has to Be it. Like, let's. Let's try this. And it was the same time that I was doing the cgm.

Justin Andrews (17:03)

So you're eating just me and you put on a glucose monitor.

Dr. Rhett Langley (17:06)

Yeah.

Justin Andrews (17:06)

And you're expecting zero spice.

Dr. Rhett Langley (17:09)

Yeah. But I mean, even me, like, it's, you know, my wife knows how extreme I am. Was like, I'm gonna be flat, dude. I'm just trying. We want no glucose spikes. Right. Let's be as flat as possible.

Justin Andrews (17:19)

Can we pause for a second? Your wife's in. In residency as a dietitian, and she knows you're just gonna eat meat. About Carnivore diet, what was that like at home?

Dr. Rhett Langley (17:31)

I am dying. Because when she hears this, she's going to be like, he knows. Because I would be like, no, no, no, that's it. I would hear something. Be like, that's it. Plants are going to kill you. She's like, you're dumb. I'm not doing any plants. She's like, dumb. And of course, it's fine for me telling that because you have to. You have to do this stuff.

Justin Andrews (17:51)

Yeah.

Dr. Rhett Langley (17:51)

To figure it out. Right.

Justin Andrews (17:53)

Yeah.

Dr. Rhett Langley (17:53)

So, yes, I went through a carnivore phase and I was like, yeah, that was dumb. But no, yeah, she.

Justin Andrews (18:00)

I mean, but the expectation is I'm eating no glucose, I'm having no carbs, no sugars, no fiber.

Dr. Rhett Langley (18:08)

Right.

Justin Andrews (18:08)

And so I should have flat. Yeah.

Adam Schafer (18:10)

What you actually see, though.

Dr. Rhett Langley (18:12)

Yeah, well, what you see is in the. In the longer. Again, you know, I don't recommend Carnivore. The longer you take it out, the more variability potentially you have.

Justin Andrews (18:20)

Right.

Dr. Rhett Langley (18:21)

So even eating protein, you're going to have an insulin response.

Justin Andrews (18:24)

That's right.

Dr. Rhett Langley (18:25)

And so, of course, think about me, you know, I'm trying to teach people and learn. And I'm like, okay, this is not making sense. Maybe I should eat some plants. And she's like, yeah, you're dumb.

Justin Andrews (18:37)

Yeah. So explain something, because my favorite aspect of the. Of CGMs and now that they're more popular is just something that we noticed as trainers now. We couldn't. I couldn't put. I couldn't give you, you know, a blood marker or measurement, but I just trained enough people to know, like, everybody responds different. It's really weird. She could eat this in the morning and then this guy eats the same thing. And it's appropriate. Calories macros are, you know, appropriate, but he just feels like crap when he eats the same thing that she does. And you just see this enough times as a trainer to go there's a big individual variance. I can't explain it. I didn't even, I didn't even know how to explain it back then. But then you get CGMs that confirm, oh yeah, like this guy eats a potato, she eats a potato, he has a crazy response, she seems to be, okay, explain why do we think that happens? Like, what's going on there?

Dr. Rhett Langley (19:30)

Yeah, I mean, when you look at variability and you know, when I'm working with clients, the number one thing people do is they say, okay, well I had a potato. And then I have this response, or let's say they have a response, they're like, oh yeah, it was definitely the potato. And I was like, well, let's think about it. Let's look at all these data points. Because you're a human, you have a complex, complex question, complex answer. Right. So instead of just saying like, hey, you had the potato, let's look at what happened the last five days. Was your sleep bad? Did you get in a couple of arguments with your significant other? How was your hydration? Did you work out that day? Right. So even looking at lifestyle and also looking at the physiology of the human. Right. Yeah. How much fat are you carrying? Right. What, what else are you eating with the potato, around the time of the potato. So it helps us kind of decipher what, what else.

Justin Andrews (20:25)

It's as individualized as it can get.

Adam Schafer (20:28)

And even more importantly, and I think the bigger conversation here is, and I remember unlocking this with clients, was because one might say, well, who cares? Who cares if it's got this risk, who cares? Yeah, it gets a little bit if it's the same amount of calories and I stay within my calories. But what I started to connect the dots to is when you see that how difficult it is for the client to fight off cravings and other things when, when you see these huge swings. And that to me is the important conversation is that, you know, because that's where someone, well, if I just follow calories, who cares if these foods make me go up or down? But when you talk about behavior modification and how important that is in this whole process, if you didn't realize it, that you have this reaction to a certain food, it makes it that much more difficult for you to stay on track. So talk a little bit about that because I think that's the bigger conversation more so than the variability of a client spiking or not spiking.

Dr. Rhett Langley (21:23)

Yeah, yeah, absolutely. I think honestly that that's the take home message is when you are a good practitioner or trainer or doctor or whatever. If you want to make an impact in someone's life, it's going to be behavioral modification. And there's randomized control trials that show that. So it's easy. For me, this is an amazing tool because when someone looks at a glucose spike and they say, who cares? For me, I can put it in context. I could say, okay, well, you know, you're a busy executive, and we know that glucose variability is going to have an impact on cognitive function or executive function. Right. When someone. When a client comes to me and they're like, hey, when I say, okay, what are your goals? They go, I want to feel better. And I'm like, okay, well, when you unpack that define it. Yeah, it's. It's mental resiliency. So cool. Like, you want to feel better in your body or. No, you want to be James Bond. Right? I want to. I want to make a decision and then have a plan to kill everybody in the room. Right. So. So that's executive function. If I said, hey, who cares? But also when. When you're having all these spikes all day, it's going to lower. It's going to lower your executive function, your ability to make decisions. Right. The highest form of thinking is thinking about what you're thinking. Yeah.

Justin Andrews (22:35)

Metacognition.

Dr. Rhett Langley (22:36)

Yeah. So it puts it in a different context for that client. And hopefully. And again, you have to work on that over time. So not just, like, having one instance with the client. Let's work it. Work on it. Over 300 days or 600 days. Right.

Justin Andrews (22:51)

How hard or easy was this transition for you? Because coming from someone who's a doctor, so you. You. You. You're one of the. You're probably the kind of guy that's like, I'm gonna make a change. I'm just gonna do it. I'm just gonna decide. I'm just gonna do it. Then you also work in the medical system, which is like, you know, you show up, someone has something wrong, do this, do that, and you're gone. Now you're working with people on behavior change. Do you ever get frustrated because it's really hard to change behaviors?

Dr. Rhett Langley (23:19)

Yeah. Yeah. I mean, what I would say is it wasn't as hard. That's what I like to do. Right. That. I mean, I was in the military, so if you tell me, like, hey, you suck. Do more, I'm like, okay, sir. Yes, sir. Like, cool. That's how I respond. Right. I want someone to tell me. And again, you know, your circle is the collection of, you are the collection of the five people you hang out with. Right? So in fact, that's where I shine. And everybody, at the end of the day, the best doctors, they become a coach. The good ones become a life coach. On top of taking the data, on top of prescribing the medicine, right? You sit down with the patient and you over and over again. But it was awesome perspective because I would go over here and try to make someone well, right, and train them on doing XYZ and then go over here to conventional medicine where people are dying and yes, save some lives. But having that dichotomy helped me understand, like, hey, if you don't change, you're going to get to this side of the.

Justin Andrews (24:16)

Yeah. I had, I had some really interesting experiences early on as a trainer that really just, just defied my, my knowledge of blood sugar and all that stuff just because, you know, I knew I had. I understood very basic things. But I remember once I had a client was pre diabetic, so we had to test his. His blood sugar often. And I'll never forget we had a really hard leg workout. And his diet at this point was good because he was trying to get out of prediabetic diabetic stage. And he went home and he calls me up, say, dude, my blood sugar's through the roof. I'm like, we just worked out. That doesn't make any sense. It was the first time I understood how stress could cause a dramatic ride. Just cause your liver to dump a bunch of, you know, glucose in your system. I remember when I first got that call, that can't be right. Test yourself again. He's like, no, dude, it's real high. And I'm like, oh, like, what did we do wrong? And I just had no idea that stress could cause that.

Dr. Rhett Langley (25:07)

Yeah, yeah, that's. That's actually one of my platforms. You know, it's like 20, 26, right? You can't just be a husband. You can't be a father and have a 9 to 5. You got to now have a 5 to 9, like a 10 to 2. You got to know how to day trade crypto. So like all day we are literally in fight or flight. Okay? So. And everyone understands, like, that there's a reason. There is a reason, physiological reason for that, right? Blue light hits your eyes, cortisol rises, you wake up and you hunt or gather. Right? Again, that's a simplistic term. It gets towards the night, lowers. You go to bed. Staying in that all day is a problem. And teaching clients that like Hey, I can make your labs look beautiful. We can make your body composition look beautiful. And also I would argue that that's going to help you be more resilient. But if you stay in this high nervous system activity state, it is going to kill you. Um, and we even see that in, in glucose, right? One of the interesting studies that I like to talk about with the clients, it's like you might not see, even with stress, you might not see that cortisol effect with fasting glucose. And when you go to a conventional doctor's office, they're going to check a fasting glucose, right? But we do see it in postprandial, so we see it after you eat. And I always reference this one study where they are they artificially created like a stress test. It was like a social stress test, because this is straight nightmare fuel. And I'm saying this as I'm sitting in front of three people, but they would have you eat, so you eat your oatmeal and then within the hour, you immediately go to another room and you have a mock panel job interview. And so then they would measure like the glucose, right? Or the other option is you would eat and then you would go into a live audience and do math equations, right? If you messed up, you had to start over. So, I mean, and think about that, right? You might have again, you got to close deals, right? It's business, but you're having your meal in a high stress situation. Not to mention all the other, other stuff that we have to deal with in today's world. And I always tell clients, I'm like, you get what you practice, and I'm not immune to this stuff, right? My, my wife, the best thing she ever said to me was, you love putting yourself in a constant state of shitting your pants. And I was like, thank you. Despite your best efforts. That's something really cool. You know, I'm not immune to this stuff. Like, we. I deal with stress all the time. I'm a business owner. It is like this all day, and then we're expected to come home and lower our nervous system. But that's slowly killing you, right? And so the CGM is a good way to show people, like, hey, if you do this, this is not good. So we need to do something to

Justin Andrews (27:47)

help along those lines. What are some of the practices you've. You've applied with, with clients to help them with that part of it?

Dr. Rhett Langley (27:54)

Yeah, yeah, yeah. Well, and what's interesting too is when I ask them, like, hey, what do you do for stress they'll say something like, okay, well, I listen to music and I'll push them a little hard. I'm like, no, no, no. Which, it's fine. Music helps you. But what do you do to lower your nervous system activity, lower your heart rate, lower the sympathetic activity, you know? And one of the biggest takes takeaways I have for stress, I learned while I was in the military. You know, I was deployed for a year in Afghanistan with Special Forces. And you have that constant high level of stress of, I don't know, whatever, getting. Getting blown up. And I learned it from Special Forces. So, you know, where is this coming from? Our limbic system. Right. Limbic system wants us to be safe. Routine. A routine. Your brain notices routine as safe.

Justin Andrews (28:47)

Predictable.

Dr. Rhett Langley (28:48)

Yeah. So even in. Even in war, what do we do? We clean our weapon. We go get a haircut. We make our beds. Right. We prepare whatever. You're the bullets. Right. So sticking to a routine will make your brain feel safe. And that's why some people think like, oh, well, that's a very boring lifestyle. But actually the brain does like routine.

Adam Schafer (29:09)

Was that strategically put in by the military for that reason?

Dr. Rhett Langley (29:12)

Oh, yeah, absolutely.

Adam Schafer (29:13)

Did you know that while you were going through it, like, were you aware of that or is this you reflecting and knowing?

Dr. Rhett Langley (29:17)

No, no, I was like, I told you I was just a fitness bro. Like, okay, cool, this is what we do, you know, but also, and I don't mean this to sound arrogant, I didn't. My mind was not constantly on, you know, whether a rocket was going to come over and hit us, especially when one of them hit your friend. You know, I was just. It was a very peaceful time, surprisingly, because we had one place to eat, one place to get a haircut. There was also just one haircut. You didn't have to tell them what haircuts. One place to work out, you know, and one job to do.

Justin Andrews (29:47)

Yeah.

Dr. Rhett Langley (29:47)

So that routine, you know, I. I would go as far as to say there's times where I'm experiencing more stress in this chaotic environment than I did on deployment.

Adam Schafer (29:57)

Interesting.

Justin Andrews (29:58)

What are some of the. The practices that you've noticed that have the biggest impact on somebody's measurements? Variability? Is it exercise? If so, what type of exercise is it? The diet, probably sleep routine. Sleep. Like, what are the ones that you notice most?

Dr. Rhett Langley (30:15)

Yeah, I mean, the obvious ones are sleep. You know, sleep is a superpower. We've. I think you guys have talked about the studies on those. But even if you look at studies on sleep, independent of obesity, having a regular Sleep schedule is going to make your, your glucose more stable. Right. Going to bed at the same time, that's another one I had to learn. Right. Because I don't know you guys and my wife's probably going to kill me. But she goes to bed late. I go to bed, I'm Grandpa Langley, right. I go to, I try to go to bed between 9 and 10, she's more after midnight. And so of course I want to spend time with her when I, when that even if I get an eight hour window and I try to go to bed at midnight or 1, I feel like the next day. Yeah, right.

Justin Andrews (30:58)

You jet lag yourself.

Dr. Rhett Langley (30:59)

Yeah. I mean obviously body composition. So what I, what I tell my clients, I understand when they leave the clinic, you know, our, our overlords have set up the system that's going to attack you. Right. Toxic people, toxic water, toxic air, toxic foods, etc. So we work on making the body more resilient and that's lean mass to fat mass. So obviously the lever there is resistance training. Yes, you should do some cardio, but trying to get that fat level down. Right.

Justin Andrews (31:32)

Change your body composition, I love. You know, years ago I did research on insulin sensitivity and how exercise, different modes of exercise affect insulin sensitivity. And now this is what I thought I would see. But to see the studies back it up and just how much was pretty cool to see that strength training, of all the forms of extra, you know, it doesn't burn a ton of traditional strength training doesn't burn a ton of calories. You'll burn way more calories doing Zumba or running than you will lifting weights for the same time. But the, the insulin sensitivity was like in gaining lean body mass was huge. I remember reading one study with obese individuals who lost no weight, they just gained a little bit of muscle.

Dr. Rhett Langley (32:12)

Yep.

Justin Andrews (32:13)

And they saw these huge improvements in insulin sensitivity. What's happening there? Why is it such a big game changer? Why is it not just burn calories? What is it about building muscle that does this?

Dr. Rhett Langley (32:25)

Yeah. So if you look at those studies, for every, I think it was for every 4% in lean mass, it was a 4% decrease in hemoglobin A1c, which is obviously a conventional test they used to check blood sugar. Then 6% decrease in fasting glucose. But the idea is that muscle is your biggest sink for glucose. Right. So 80% of that, the glucose that's circulating is gonna go into muscle and be stored as glycogen or be utilized. Right. So that's step one and Then also muscle is a neuroendocrine organ, so it's gonna also secrete myo kinds that would assist with not only brain power. Right. Allowing you to make better decisions, but also just make you feel better in general.

Justin Andrews (33:06)

Yeah, I, there was one study I read out of, I want to say it was Australia, where they were looking at the impact of exercise on Alzheimer's and they were, they were looking at the beta amyloid plaque and the strength training was the only intervention they found to halt the progression and might have even looked like it was starting to reverse. And they compared to other forms of exercise. And my theory is it had to do with the insulin sensitivity because, you know, cognitive decline, Alzheimer's, dementia, some researchers will call it type 3 diabetes.

Dr. Rhett Langley (33:38)

Absolutely.

Justin Andrews (33:39)

So, yeah, so talk about the brain health benefits of having improved, you know, improved sensitivity to insulin.

Dr. Rhett Langley (33:48)

Yeah, a thousand percent. We just talked about more time above range or let's say glucose variability, less executive functioning. But when you take that out over time, obviously Alzheimer's and, or dementia has a metabolic component. And the other thing, other association I'll make is when you have metabolic disease, you have vascular disease. So one of the issues with the brain is highly sensitive to changes in energy, right. Glucose requires a lot of energy. Right. I think they're clocking the optic nerve as one of the, one of the levels that requires the most oxygen. So requires a lot of oxygen and energy, glucose, very sensitive. If you look at people who have insulin resistance, you're going to increase your risk of dementia by almost 70%. And then vascular dementia is higher than that. Right. And for me, you know, this is my personal sentiment, but if you look at all these problems that humans have, one component is always going to be blood flow, right? That's how the body talks, that's how it brings in oxygen, that's how it brings in nutrients, and that's how it takes out toxins. You know, so dementia's on the rise, Alzheimer's on the rise. And that pathophysiology is very, very, very similar. The whole point of this talk is like, how can I take a look at someone who's sick and try to not do stuff to get to that point? Right? So someone who has dementia, I mean, that there's nothing worse than losing your mind, especially if you're able bodied. So those are very, very, very, those correlate strongly.

Justin Andrews (35:24)

I always found it interesting when people would debate or question whether or not cognitive decline was a result of metabolic dysfunction. When we've had studies, been around for a long Time. We've known this for a long time that if you put a person with Alzheimer's or dementia on a ketogenic diet, we see improvements in cognitive function. Not that that's a cure, but obviously something's going on there because we're switching energy sources and suddenly their scores move in the opposite direction of where they've been moving for the last, you know, 10 years. So to me, that seems like a very obvious. Like there's something metabolically going on here.

Dr. Rhett Langley (35:59)

Yeah. And you see how also the, how sensitive the brain is to neuroinflammation, right?

Justin Andrews (36:03)

Yeah.

Dr. Rhett Langley (36:04)

So when you have impaired glucose, you have impaired fat deposition and that, those, that sugar, that circular circulating around the brain is going to cause inflation inflammatory products, and you can even have acute cognitive changes while the sugar's high.

Adam Schafer (36:19)

Well, I'm curious to ask you about with the rise of GLP1s and like, what you found, you know, in your own practice or if you prescribe or,

Justin Andrews (36:29)

you know, if you've combined that with

Adam Schafer (36:31)

these glucose monitors and like, what kind of data and results you've seen from that.

Dr. Rhett Langley (36:37)

Yeah, I. You know, when something gains popularity, we all win because we, everyone starts using, especially if they can make money on it off of it. Right. Then we all get all these studies and we see how safe it is and all the other stuff it can do. We use GLP ones. And I was using GLP ones for a long time before it kind of got popular. And so I love them. I think they have profoundly positive effects. And I'll tell you the context of how you need to use them, but it does two things. And I talked about those behavioral studies where people were watching what they ate and they had a structured program. So the way I look at GLP1s is it is chemical boot camp. Right. So when you put this in your body, it's going to be really hard. And I'll tell the clients, like, it is really hard to eat poorly because you get really sick. Right. That's what I've seen in my clinic. Right. And what do I mean? Well, if you have two glasses of wine and a piece of pizza and some ice cream, you're gonna have a bad night. And so it becomes chemical boot camp. Right. So even if I can't be with them there the whole time, and I'll even tell them, I'm like, hey, you're gonna get sick. Not that I want you to get sick, but you won't do it again. Right. And so that medication has really, really two been two large Benefits one, it's gonna lower appetite and, and lower gastric emptying. So people are gonna eat less caloric restriction, and then, boom, it's gonna fix insulin sensitivity, or let's say enhance insulin sensitivity. And so you even see, like, the FDA has now approved it for cardiovascular risk, right? Less hospital admissions, lower cardiovascular events, and then even kidney protection. So chronic kidney disease they're using, it's FDA approved, and kidney disease is a vascular disease. Those go hand in hand.

Justin Andrews (38:28)

Are we seeing improvements in insulin sensitivity from GLP1s independently? Just like exclusively of the weight loss? Like, are you. Like, if someone has a CGM using GLP1 before they lose weight, how do

Adam Schafer (38:40)

you tease that up?

Justin Andrews (38:40)

How do you tease that up? You'd see it right away, I guess you would use it and you'd see.

Dr. Rhett Langley (38:43)

Well, essentially you also. Yeah, you can see that away right away in the cgm. But they have studied the medication. They know the mechanism of action, right? So even before, again, remember, they're using this in diabetics before it got popular.

Adam Schafer (38:57)

20 years, 20 plus years it's been around.

Dr. Rhett Langley (38:59)

So we already know that it makes the periphery more sensitive to insulin or improves glucose control within the body.

Justin Andrews (39:07)

So side question. Maybe you don't know the answer to this, but I'm now seeing a lot of talk around PDE5 inhibitors like Cialis, not for what you typically would get prescribed for, which is erectile dysfunction, but for longevity. They're showing now that there's reductions in stroke and heart disease. Do you see any different when people use a cgm? Do you see a reduction? Do you see an improvement in insulin response or blood sugar response from them?

Dr. Rhett Langley (39:33)

Sal, are you asking me for a

Adam Schafer (39:34)

script of just subtle way of asking?

Dr. Rhett Langley (39:39)

Yeah. And honestly, that's how we use it too. And you know, a lot of guys in gym use it for performance, right?

Adam Schafer (39:46)

They've been doing that since we were all kids.

Dr. Rhett Langley (39:47)

Whether that helps for performance or not, that's what they're using it for. So. And I can easily relate this to stuff that kills you. So the end product of phosphodiesterase inhibitor is nitric oxide, right? Nitric oxide. Your body makes nitric oxide and you need nitric oxide for autoregulation, which is just a fancy term for the blood vessels relaxing and squeezing in relation to the amount of oxygen you need, right? So, yeah, absolutely. Like, we're. They're using it on the regular to improve of blood flow. And as I told you, like, for me, the whole discovery of me becoming this wellness doctor is realizing Like I'm a blood flow doctor. When organs died, it's blood flow, and that's what people die of is cardiovascular. Heart attack and stroke. Right. You don't die of diabetes. It's the same thing with sexual dysfunction. Right. The same vessels in your penis or vagina are the same vessels in your heart and they work the same way.

Justin Andrews (40:42)

Yeah. And so we see if somebody uses a PDE5 inhibitor, do we automatically. Are you seeing immediate, like, changes in their CGM readings? Is it, is it showing up in that way or does it take longer?

Dr. Rhett Langley (40:57)

Yeah, the context for me is more of blood flow.

Justin Andrews (41:02)

Okay, Right.

Dr. Rhett Langley (41:02)

So it's more of improving blood flow to organ.

Justin Andrews (41:06)

Sure.

Dr. Rhett Langley (41:07)

Right.

Justin Andrews (41:07)

Okay. Yeah. Exercise is the, essentially the vascular system. Relaxing, contracting.

Dr. Rhett Langley (41:12)

Yeah. Yes. And. And also when you have metabolic dysfunction, the biggest issue is vascular dysfunction. Right. Vascular inflammation. Right. That process, that cascade of. You've heard that. That term or I've heard a couple of people say, like the difference between a sick person and a healthy person is a teaspoon of sugar in your blood sugar. The major insult is insult to the endothelium, the inner, that glycocalyx, that slimy layer of the vessel. Right. And you know, even if you look at. Let's just talk about like sexual dysfunction in men across the general population, it's like 25%, which I think is still kind of ridiculous. Right? That's one in four.

Justin Andrews (41:57)

Yeah.

Dr. Rhett Langley (41:58)

When you look at someone with metabolic resistance, that jumps to like 50%. It's like half. So clearly that's a vascular issue. Clearly, heart attack and stroke is a vascular issue. Right. And that's the problem. So. And when you have hypertension or diabetes, you have high blood pressure. Right. The diabetes is causing the high blood pressure.

Adam Schafer (42:17)

What, what percentage of your clients that you're helping battle with sexual dysfunction?

Dr. Rhett Langley (42:23)

I mean, anecdotally, like, in my opinion, it's an epidemic. It's a lot. I mean, probably half of my clinic is sexual dysfunction. And this is also, this is also jaw dropping. This is, this is gonna rock your world. Like the people with metabolic resistance, or, excuse me, when you have obesity, up to a 13 fold increase in hypogonadism. And I'm not saying sexual dysfunction is just testosterone.

Justin Andrews (42:49)

Right.

Dr. Rhett Langley (42:50)

It's blood flow, it's multifactorial.

Justin Andrews (42:52)

It's all connected.

Dr. Rhett Langley (42:53)

Yeah. If a guy comes to me and he's like, hey, I hate my wife and, you know, she insults me and I don't get interaction. I'm not going to say, hey, it's your metabolic health Right. Our brain is our biggest sexual organ. Right, Right. So we're going to unpack that a little bit. But I'm going to say like, hey, let's look at some labs, let's check the physiology. But I think it is an epidemic. Like it is not only on the rise, but it's ridiculous. And the other thing I'll talk about real quick is women. The, and this, this shocked me. The percentage of women across the population that have sexual dysfunction is 43% general population. Yeah.

Justin Andrews (43:29)

So that, how do they measure sexual dysfunction for women? Because you're not measuring erection, you know, erectile.

Dr. Rhett Langley (43:33)

Yeah, yeah. And, and that's a good question because. Yeah, that's a good question because passive pathophysiology is the same. It's still blood flow to these sexual organs. So desire, dryness, pain. Right. Libido, orgasm. Right. And then, and one interesting connection I will make from that. The behavioral modification, the look ahead trial, such a prolific trial that they had these spin off studies and one of them was women's sexual dysfunction. And so in that trial, of the people who had metabolic resistance or had obesity, 50% had sexual dysfunction. With the modification or this structured program, 30% went into remission. So again, you know, that statistic is shocking. 43%. It's higher with people in women, but it's, you know, we see a man, we're like, okay, I can't get an erection. It's obviously a vascular issue. Right, right. But women struggle with this too.

Justin Andrews (44:33)

Interesting.

Adam Schafer (44:34)

Wow.

Justin Andrews (44:34)

How, how are CGMs being used now for behavioral modification? Because CGMs measure your glucose in real time. How do you combine that with coaching or you know, behavior to like, what are you looking at? And how are you using that as a tool to help somebody?

Adam Schafer (44:52)

Yeah. I'd like you to take me through a week one. I just signed up with you. I've got metabolic dysfunction. Yeah. What do you do? You just let me eat what I normally eat and monitor me first. Do you give me stuff like tell me what a week looks like when we get together?

Dr. Rhett Langley (45:07)

Yeah, well, I also, you know, again, I operate out of the clinic too, so I have the benefit of taking comprehensive labs. Right. So we. It's even, even more interesting when I can show them the labs and then show them the cgm, which is this beat to beat, look at their glucose and then give them the context of like, hey, if you don't do this, these are the problems. But week one is really just what I want to do is I want to get their baseline right so do

Adam Schafer (45:32)

you do your thing?

Dr. Rhett Langley (45:33)

I'm like, don't. Because you know what people do?

Adam Schafer (45:35)

You guys are in the space.

Justin Andrews (45:36)

Right.

Dr. Rhett Langley (45:37)

You know, and even when you ask that, you know the 90% clean bros, right? I eat 90 clean. Right. I'm like, okay, well, let's like test it. And. And that's also like, the biggest takeaway is I get clowned sometimes by clients. I'm like, hey, you should, you should. How's your sleep? Oh, sleep hygiene. They're like, yeah, don't even go like, I know that. And I do it. I'm like, okay, well, let's unpack that. Well, there's eight or nine steps to sleep hygiene. What you find out is they're maybe doing 2, 40% of the time and 3, 10% of the time. Right. It's the same thing with all of the other lifestyle modifications they're doing some of it, not all the time. So week one, I'm like, don't change anything. And they still will, right?

Justin Andrews (46:19)

Yeah.

Adam Schafer (46:19)

I actually have to make it a point to, like, listen, if you ever occasionally have a Snickers that let have that, I want you to do that thing.

Dr. Rhett Langley (46:26)

Yeah.

Adam Schafer (46:26)

You gotta be, give me a week.

Dr. Rhett Langley (46:28)

And that's. That's also the problem with other companies that don't have that one on one dietitian contact. Or even in my clinic, if someone puts something just the bias of checking, you're gonna be living a lot better than you normally do. Right? Yeah. So you're gonna be like, oh, I'm good.

Justin Andrews (46:44)

Perfect.

Dr. Rhett Langley (46:45)

Take this thing off and go back to what I'm doing.

Justin Andrews (46:47)

Yeah.

Dr. Rhett Langley (46:47)

And so that's what I told you. The biggest impact is this stuff is if I told you, hey, move more, eat less. You're like, cool podcast, bro, but you need to do that over a long period of time. All of these little nuances to add up. Yeah, right.

Justin Andrews (47:02)

How have you gotten to the place where the more you look at the stuff, because I'm sure you get some of this pushback. Like, I gotta plan my sleep. I gotta do all these steps. I gotta look at this. That the other. It's. Have you gotten a place where you're like, well, I think the world is just designed to make us really unhealthy. So that's why we have to do all this. We weren't really supposed to wait, though.

Adam Schafer (47:23)

I want to. I want to. Because I know it doesn't end where Take me step by step, because it links to what you're going, where you're going right now. Like, okay, so the client here's my week, and I'm assuming he's got similar advice. Like, how we take someone. It's not like, do all these things. Yeah, right. Because I'm sure you've already learned that that doesn't work very well either when you give them the. All the answers. So. So I do this week, and you. You see all this, that jumps out at you, and we. And we look and so what. What does it look like? Do you choose one big rock? Do you. Like, this is the first lever we're gonna pull? Like, how do you coach me through that after you get my labs and week that I give you? Because that's probably what it is for most people, right? Let's be honest.

Dr. Rhett Langley (48:02)

Yeah, well, the first thing I do is set expectations. And. And I'll even say this. You know, I'm giving away all my little secrets. But. But I'll be like, look, you will know what I'm saying. Don't believe me. Well, you'll believe it when you see it. But you'll know what I'm saying is true when you feel better. But I was like, this is not going to change in 30 or 60 days. It may change in 300 or 400 days, and we are going to work through it step by step. Right? And I will give, you know, our slogan at thrive is called empowering your health. So I'll tell the client, like, here's what I think the biggest levers are, and I'll give them a choice. I'm like, you should start with one of these three, but only start with one at a time, right? Because I want you to see on the CGM how. What impact that has or the way you feel or, you know, your behaviors, you know, and that's also what the app will do, is it gives you context. When did you eat? How are you feeling? What did you do? Who did you talk to? Right? Because I told you, people will automatically associate something. I felt like shit today. It's probably because I had the tacos. Like, well, it's probably the taco and also the stress with your, you know, friend. I don't know. Yeah, right.

Justin Andrews (49:09)

Yeah.

Dr. Rhett Langley (49:10)

You got to bring all that stuff into context. And what I also call it is your health circle. And again, I am not immune to this. As you say, like, the. The overlords have us all under this distraction and things that are killing us. So I'm not immune to that. But when I'm feeling bad, I go and data check myself and go, oh, you know, I didn't take, I didn't, I was not on my sleep game, you know, or I changed my diet a little bit or something was off. And so then the client learns, put these pieces of the puzzle back into place, they start feeling better.

Adam Schafer (49:45)

How do you discern between what you know is the three biggest levers and then also what you've probably pieced together as the easiest for adherence. So this is something that over decades of coaching people, I sure have the math equation to get this person in the great best shape of their life. But I also know, and I know that this is the biggest lever, but I also know too that could be a big step for a lot of people. And so sometimes I don't always advise the biggest lever or the best thing. So how do you like, first of all give me what those kind of levers are and then how do you discern where you go first with a client? Is it always the same or is, do you notice based off of the conversation, like this guy's gonna have struggle doing, pulling this lever?

Dr. Rhett Langley (50:30)

Yeah, for, well, for me the biggest levers personally that I work with in clients are gotta be, they have to be resistance training followed by food. Right. You know, and specifically, let's just say that, you know, for me, I told you, it's, we want to make the body resilient. Yeah. Right. I want to get their body composition better to make them this well oiled machine and go out in the world and handle toxins, whatever that is. So we know that that's resistance training. And also probably is going to be a caloric deficit, which means we gotta stick with protein. I understand that that's going to overwhelm them, but I try to stick to something that's going to build trust. And generally when people start losing weight and they feel maybe they have a little bit of better, better body image so that it puts them in a positive state of mind. You know that one of the ways the brain works is error correction. So everyone thinks like, okay, cool, you know, dopamine is a reward molecule and it is, and it's all about anticipation, but it's error correction. So if you look at high performers, they are in this, this range where it's not too hard and not too little. Right. You don't want to make it too hard or too little. Just write where you make a mistake, fix it and the CGM can show you. Yeah. Like hey you, you did great all week. And then Friday you just, I don't know, you the bed. And then boom, you feel Bad. Correct. And get back that, that's you get dopamine in your brain. So that's, that's how you actually rewrite your brain.

Adam Schafer (51:58)

It's so cool to hear you answer the, in that, that way coming from your profession and your angle. Because I feel like although we're in similar fields, we come at at different angles and those are the first, the first two things that we tell people. And it's, it's get. Can I get them to the gym once or twice a week, full body strength training routine and can I get them to eat high protein?

Dr. Rhett Langley (52:18)

Yeah.

Adam Schafer (52:19)

And it's. And those two things are such big rocks and levers that it does tend to fix a lot of the other things. And if I can just get them to commit to that, then I could start to, to build off of that. So to hear you say that from you know where you're standing and all the like, that just shows how many people you've probably helped in your career. Because that's what we talk all about all the time. And people kind of mock or, you know, make fun of or scoff at that. That's like what we, we simplified down to. But it's like, man, those are such big rocks that if someone consistently hits high protein intake, we know that it's going to naturally start to modify their cravings and their calories. And if they just do two full body workouts a week, the amount of muscle and strength that they can build and what that will do metabolically for them strength wise. And a lot of times it even improves some sleep and energy. So it's, it's cool to hear that that that's what you distilled it down to.

Dr. Rhett Langley (53:12)

Yeah. And we've got the studies to prove that. Right. You know, I'll just to follow up on that. It's cool that you said that too because I think that having diagnostics and advanced medicine is great. It's awesome. You know, I studied in Texas Medical Center MD Henderson. There's all this stuff. But I think what happens is we scoff at. So we have a bunch of advanced diagnostics and the treatment may still be very coarse. Right. Some may just tell the guy like the in the bottom of the boat, like, hey, we need more coal. You know, all right, less coal, less coal. And people look at that and they're like, it's basic, dude. Like really? That's what's going to change. And it goes back to what I'm saying that if you did that. And yes. I'm not saying only that there are nuances for a long period of time, you would win over time, metabolically. Chronic illness, et cetera.

Justin Andrews (54:04)

What I find interesting about CGMs is that watching someone's glucose in real time, you can actually diagnose or at least it points you in a lot of different directions, not just food. For example, how many times have you seen someone's CGM spike in the middle of the night and say you might have sleep apnea. Yeah, let's look at your sleep and see if you're snoring or what the deal is. It's interesting. It points to a lot of different things because a lot of things can cause a spike.

Dr. Rhett Langley (54:31)

Yep. And that's the, the benefit of continuous data. Because before that, how would you know? Yeah, you wouldn't know of anything that's going on. And go ahead.

Justin Andrews (54:40)

As I say, how do you use this data then to coach someone? Is it questions like, hey, we're noticing this, that what's going on? What happened at that time?

Dr. Rhett Langley (54:48)

Yeah, the. I mean, again, the plat, the platform that I like to use is let the client figure it out themselves with my guidance. Right. So it always starts with asking like, hey, you know, one, just the thought of them putting the CGM on, they start taking more data points and you check your own health journey, like without the cgm, you're maybe not thinking about like, oh, man, I feel bad. It must be, you know, again, the, this, you know, whatever I ate in the morning, it's probably a collection of stuff. So with continuous data, we can go back and look at it. The other thing that Nutrisense is doing right now is leveraging AI so they have this nora, right, that will put this stuff in front of your face. So again, we know the best way to win with a client is touch points. Right. You honestly just flood them with interaction. And so NORA will bring up trends and bring up data, even data that looks the same across weeks. Or like when you're putting in inputs, it'll show you outputs. Right. So it bridges the gap between your meetings with either the physician or the dietitian.

Justin Andrews (55:58)

Any supplements that actually make a difference with what you see on the cgm. Like berberine. I hear about berberine all the time.

Dr. Rhett Langley (56:06)

Yeah, berberine is great. There's berberine, there's alpha lipoic acid, and

Justin Andrews (56:11)

you'll actually see it, you'll be able to measure it.

Dr. Rhett Langley (56:13)

Yeah. The difference though is that just remember that the all in context. So berberine is not instantaneous. Okay. And that's because also bioavailability so you need to take it over a long period of time. Another one is like myoinositol. That one's awesome. So it's also used in like pcos. So like, you know, that's a great one. But we're just working on basic deficiencies. Iron, vitamin D, magnesium, zinc. But yes, I mean, you know, again, it's complex answers complex questions. Right. You got to take berberine for a long time. It's hard to just say, hey, I took berberine and then I saw the effects.

Justin Andrews (56:51)

Got it.

Adam Schafer (56:51)

What about the, the GMO product that zbiotic makes?

Justin Andrews (56:54)

Oh, you know, there are.

Adam Schafer (56:55)

You'd be a great person to ask that.

Justin Andrews (56:56)

Yeah. So they made a product that this bacteria is modified to convert unused sugar into fiber.

Dr. Rhett Langley (57:04)

Akkermansia.

Justin Andrews (57:05)

Good question. I'm not sure.

Dr. Rhett Langley (57:07)

Okay.

Justin Andrews (57:07)

But I know that they modified the bacteria so it's their own patented whatever that theoretically should make a difference. Right. Because it goes from thousand percent. Okay. Okay.

Dr. Rhett Langley (57:16)

Yeah.

Adam Schafer (57:16)

And I mean that'd be a fun test then.

Justin Andrews (57:18)

Yeah.

Adam Schafer (57:18)

So cool to give you something.

Dr. Rhett Langley (57:19)

Yeah, yeah. And, and again, extend the study over time. Right. Like you gotta make it almost like a cut out all the other variables. Same meals.

Justin Andrews (57:28)

Yeah, of course.

Dr. Rhett Langley (57:28)

Same timing.

Justin Andrews (57:29)

Of course.

Dr. Rhett Langley (57:30)

But the gut also their nutrients, they do a gut microbiome test. So we're understanding that gut is very complex. It's a great way that food interacts with the world. And when the bacteria are in proper alignment, they can help your glucose.

Justin Andrews (57:46)

It's interesting you brought up myo inositol because that's been promoted forever as an anti anxiety supplement. And I'm wondering now if the anti anxiety effect is from a regulating of blood sugar.

Dr. Rhett Langley (57:59)

Yeah, well, and one of the things it does is it helps cellular movement. So like storage to the end of the cell to the nucleus. So DNA basically enhances mitochondria. It's just like nad anything. Anytime you enhance mitochondria, you can have lower inflammation, lower anxiety, better sleep, et cetera.

Justin Andrews (58:16)

Creatine, do you recommend along those lines? We must recommend creatine quite a bit.

Dr. Rhett Langley (58:21)

Million, billion, thousand percent should be part of your daily stack. They even have done studies that show so data that shows when paired with exercise can improve glucose sensitivity. And then of course we know now that we're stacking it for brain effect too. Right. You just have to do more. I think brain absorption is a little less. So pump your dose.

Adam Schafer (58:43)

Yeah, you brought up the alarming stat with women, the 43%. Anything else? And you're such a data driven guy. You got all this great, all this great analytics that you can go back to anything else that was alarming to you, like that you've come across that like, surprised you or was like, man in the data. Yeah, yeah. Just.

Dr. Rhett Langley (59:03)

Yeah, there's another, like another one that comes to mind and it just deals with men. It's prostate. So as we're aging, a lot of people are having prostate issues. Right. And I think, I mean, again, even me going up through the medical community, it's like just something that old guys had. Right. They just went to pee five times a night. And so you see this. So now we're also starting to learn that's also a metabolic component. So the data is now showing that with insulin resistance and there may, it may be a dose response. So the worse it is, the larger the prostate. So it can increase your risk of BPH hypertrophy threefold. So again, if you talk about the impact on a man's life, sleep, if I'm having to get up five, get five or six times to sleep, it's gonna destroy everything else. Right.

Justin Andrews (59:54)

Downstream effects.

Dr. Rhett Langley (59:55)

Yeah. So we fix that in the clinic and it's life changing. It's something that people overlook. I mean, a guy will come in and be like, I'm only going to pee once a night. Changes his life. Yeah. Wow. Not to mention improved blood flow, sexual functions.

Justin Andrews (60:09)

What about. So you hear a lot now, a lot in regards to cancer. That.

Dr. Rhett Langley (60:13)

Yeah.

Justin Andrews (60:14)

One of the driving forces behind cancer is metabolic dysfunction. Are you, are you up to date with some of this research? I know cancer is very complex, but.

Dr. Rhett Langley (60:22)

Yeah, yeah, yeah. No, and that brings up a good point. So when you talk about metabolic dysfunction, everyone understands glucose, but the other flip of that coin is fat deposition. Right. So when you're, when this system is impaired, you have a tendency to add fat. And not just fat, it's bad fat, ectopic fat, visceral fat. That's the fat that kills us. And so if you look at the risk of someone having high visceral fat and increases cancer risk by 44. And I'm talking about colon cancer, pancreas, cancer, like the stuff that can kill you. Right. And then the other really important statistic of just having visceral fat is. Increases your mortality twofold. Right. So. So we know there's a connect connection between metabolic resistance and cancer. And yes, glucose has an effect, but I just want to point out that abnormal fat deposition, which is killing people. Right. It's a big, big. Makes you big risk factor.

Justin Andrews (61:24)

When you look at just Studies and surveys on people that lose weight and the fail rate so high. Right. Something like 85% or 90% gain the weight back type of deal. Do you see greater success rates when people lose weight through using a CGM and a coach versus doing it on their own? What does that look like in comparison?

Dr. Rhett Langley (61:45)

Yeah, I wish I had some cool statistics on that. I can just tell you in reality and you guys are in the same space. Right. And you know what I can point out is those the RCTs are those really, really large trials, as I told you, of behavioral modification. What they were given was coaching. So they had behavioral groups. They were taught what macros are or they were taught and then they had follow up and though. And even the, the effects of positive, you know, lower depression, lowered anxiety and how they thought they had a lower perceived stress of sticking to a plan. So that take home message is like, cool, you can get a cgm. Cool. You know, you have these companies where you can just go like, hey, I can go order my labs. It needs context.

Justin Andrews (62:33)

Yeah.

Dr. Rhett Langley (62:34)

It needs follow up. And even like, you know, as a physician, like I can't do, do it all, you know, so a whole team and that's how we work in my clinic as well.

Justin Andrews (62:44)

Yeah, yeah. No, I would have guessed that for sure. Just from, from my experience, I think behavior change is hard and it takes some time and you need a coach there and then you need some grace and you're going to screw up and then. Yeah, but over time, far better success rate.

Adam Schafer (62:57)

Tell me a little bit more about the, the AI that Nutrisense is using. I haven't, I haven't played with that in a while and so like is it, is it giving me like, it starts to pick up on my patterns of like Saturdays I tend to do these.

Dr. Rhett Langley (63:10)

Oh, wow.

Adam Schafer (63:11)

And does it give you like a notification or something?

Dr. Rhett Langley (63:13)

Yes, yes.

Adam Schafer (63:14)

Positive and negative kind of trends.

Dr. Rhett Langley (63:15)

Yes. It puts it in your face, right?

Adam Schafer (63:17)

Oh, that's kind of cool.

Dr. Rhett Langley (63:18)

And the other thing too is the more inputs, the more outputs. Right. So if you're saying, hey, I went to bed at this time, hey, my day was stressful, hey, I worked out, it's going to tell you last week you did this and this is what we saw. And so think about that when that's so cool, when I can't sit there and harass you and it's harassing you

Adam Schafer (63:40)

to think, yeah, well what's so cool about that is one of the things that I talk about a lot in the show is that a lot of what you do with good coaching is really just helping clients connect the dots.

Dr. Rhett Langley (63:51)

Totally.

Adam Schafer (63:52)

You know, half the time, I mean, and we're all, probably all in this room guilty of this at one point in our lives, you know, eating foods that totally didn't agree with us and just thought that your stool was normal. That's just. You have a bad day. It was like not going like, no, that's actually because you ate this thing.

Dr. Rhett Langley (64:07)

Right.

Adam Schafer (64:08)

You felt that way also. Your sleep was. It's like, it's just there. We're so. It's amazing to me how disconnected we are to how food affects us and how. And just so a lot of it's connected also. Now having an AI tool that's monitoring you, that's kind of giving you that feedback loop is incredible because it's like an ongoing coach who's just kind of reminding you, like, because then they start to connect it, I'm sure they go like, oh, that's the third time that I didn't get to bed at this time. And I also know. So one of my favorite things to talk about with the. The glucose monitors that I noticed and it was that poor nights of sleep, the cravings on the next day.

Dr. Rhett Langley (64:46)

Yeah.

Adam Schafer (64:46)

What? Like, that was mind blowing to me. And literally just becoming aware of that may help me combat it in the daytime. So it was just like, if I knew, I got up and it was like, damn, that was a poor night. Slept. I know what I was in for that day. And because I was aware of that, it made me. It made it easier for me to resist that. It was like, why all of a sudden I'm craving this crappy food. I've been on my diet, but it's like, oh, that's right, I've got that bad night of sleep. I think things like that, like people just don't realize how. How much of what's going on with their sleep and their habits are connected to all these cravings and other in their moods and all this stuff. And so having an AI tool that is also giving you that feedback, that's. That's rad.

Dr. Rhett Langley (65:27)

Yeah, it's huge. It's just like I talked about, you know, when. When something happens, you correlate it with something that day or maybe the day before. What if it, you know, complex questions. Complex. What if it was seven days before? What if it was 15 days before? So aggregating that data really expands. Like, whoa. It's very thought provoking. Right?

Justin Andrews (65:45)

Yeah.

Dr. Rhett Langley (65:46)

And even if, you know, so, hey, I had a bad night of sleep. I know when I have bad night of sleep, I have cravings. Stick to your routine. Right. You're like, I am not going to even go over there. Where the ice cream is or whatever it is, is your weakness. Right. Yep.

Justin Andrews (66:00)

How well or how quickly is Nutrisense growing? Because they're one of the best at combining kind of coaching with monitoring. Is it a growing field in general? And how's Nutrisense doing with it?

Dr. Rhett Langley (66:12)

Yeah, Nutrisense is, is crushing. And I mean, you know, I don't, I don't know of another company that utilizes coaching. And so, yeah, there are other CGM companies.

Justin Andrews (66:22)

Yeah.

Dr. Rhett Langley (66:23)

But the coaching is where it's at or the one on one with dietitians, with experts. And so people want that. Right. I mean, I have a bunch of clients that come to me that are fallout from, you know, hey, I got my labs, no one helped me. Right. Putting it in context. So Nutrisenses is blowing up in that sense. And so, yeah, it's really exciting. And then the other thing too is when, as I said, when something gains popularity, we get to study it. So hopefully the, the future forward is continuing to look at this data and then trying to get real world stuff. For example, like, they're looking at CGM and changes in arterial flow, which would lend itself to like, hey, what, what's going to set you up for death? Cardiovascular disease. Right. Right. Now, I can't say it's a diagnostic tool, but the more data, the more we can see. The whole point of the talk is how do I not end up over there? One, how do I feel better? And two, how do I not end up sick or dead?

Justin Andrews (67:24)

What do you do for Nutrisense? Exactly. Or with Nutrisense?

Dr. Rhett Langley (67:28)

Yeah, so I am. So currently I'm the medical director and, you know, these CGMs are being offered commercially. But if you were to get a CGM back in the day, it would come through me. You might see my name on it. Yeah, I got a lot of phone calls in that day. Hey, Dr. Langley, I need another CGM. I was like, oh, talk to Nutrisense. But yeah, no, I mean, I work closely with the dietitians and the team at Nutrisense. You know, my clinic handles stuff, complicated situations in a much larger conglomerate of stuff. But we work hand in hand. Our clinic, my clinic is very much like talking to people at Nutrisense. We use the dietitians at Nutrisense, et cetera.

Adam Schafer (68:05)

How did that, how did that. I mean, we. You talked about how that relationship started and you almost were like a customer first.

Dr. Rhett Langley (68:11)

Yeah.

Adam Schafer (68:11)

How did that develop into the relationship you have now with them?

Dr. Rhett Langley (68:15)

Yeah, well, like I said, and Dan's probably going to kill me for telling the story, but, you know, Dan and I built a relationship because I was just interested. I wanted to know everything. Hey, let me talk to your dietitians. And at the time I was doing stuff across country, right? So I had all of these medical licenses. And once we built a relationship, he was like, hey, because we're, they're having Trouble getting the CGMs out. He's like, hey, I need a doctor who's willing, who's excited, who talks really fast, like me and has some medical licenses. And I was like, cool. I need a CEO that talks faster than me. Like, let's go, go. So that's really it. Like that really started the whole relationship and a little bit of other truth here. I was more excited. I was like, hey, teach me, let me use this stuff. And you know, I'll be your medical director. No payment, nothing like that.

Justin Andrews (69:11)

That's so crazy.

Dr. Rhett Langley (69:13)

So that helped, but it did supercharge me into like building my own own clinic and learning more.

Adam Schafer (69:18)

Now, have you guys become friends or just business? I mean, what's it have you guys. I mean, imagine you're, you're bugging him that much. He brought you in. You guys probably built somewhat of a relationship even.

Dr. Rhett Langley (69:27)

Yeah, yeah, we're bros. We're bros. He's always trying to get me to hang out and I was telling him like, dude, I have a lot to do. But yes, yes, we'll go to Burning man at some point. I'm not having a CGM on when we do.

Justin Andrews (69:43)

Okay, how are peptides showing up on CGMs? Are you noticing any changes? I'm assuming the growth hormone releasing ones. You'll probably see an impact. And are you seeing anything with like the, like the BPCs and the.

Dr. Rhett Langley (69:58)

Yeah, that's a good question. Haven't specifically studied it, but you know, again, even with peptides, like in my opinion, very safe molecules, the longer you take them, the longer you have to understand what they do. So some of those growth hormones, secretagogues, if you look at some of the studies, I think it's closer, like a week, 11, 12. If you're on it, you may have some increase in IGF1, which we know is going to change glucose a little bit. So that's a good question. I haven't really looked at that yet, but honestly, another tool in the toolbox to show people.

Justin Andrews (70:29)

What about hormone Therapy. How is that improve? How is that changing or improving? So the guy comes in low testosterone doesn't get, doesn't rise from improving behaviors. You put them on testosterone.

Dr. Rhett Langley (70:40)

What do you see typically in their overall health?

Justin Andrews (70:44)

No, in their CGMs. Do we notice anything with, with improvements?

Adam Schafer (70:47)

Well, downstream for sure, because then they build muscle and then you see it.

Dr. Rhett Langley (70:50)

Yeah, sorry. Yeah. So, so again, to me, like, having normal testosterone lowers cardiovascular risk. Why? We know it's going to burn visceral fat and that's The Major Killer 2, it's going to help you add muscle. There's. I've seen one study where it says it may, it may almost add up. Even without working out, you may have a change like 7 to 8%.

Adam Schafer (71:10)

That's wild.

Dr. Rhett Langley (71:11)

That's, that's insane. Right? I told you, every 4% lowers your hemoglobin A1C like another 4%. So, so you do see a downstream effect. Right. And then again, having metabolic resistance is going to increase your, your risk of hypogonadism up to 9 to 13 fold, which is like ridiculous. Right. So it's an epidemic. And there are certain things you would want. Better sleep, better mood and better body composition. Fix your testosterone.

Adam Schafer (71:44)

Now, I know you haven't, you haven't had your clinic for decades, but have you noticed even in the short time you have, the rise in like young men with like.

Dr. Rhett Langley (71:55)

Epidemic. Yeah, epidemic. In fact, I forgot to say this, but. So across the general population, let's say it's 24%. But a new study came out last year where they looked at 18 to 34 year olds and they gestured and this was a question year. 34%, which is insane. And also I personally believe that it's underreported. Right. Because yeah, you know, you're not, you don't really want to tell someone at that age, maybe you have problems.

Adam Schafer (72:27)

I know it's underreported because we get DMS and messages from young men all the time that haven't even gone and seen their doctor and talked about it. And so there's not, not everybody's reporting it.

Dr. Rhett Langley (72:35)

Where it gets tricky is. And you, you know, as a good clinician understands, it's not an absolute number. Right. You know, you may be low and not having symptoms low or you may be normal and having symptoms. Right. You have to look at the number and talk to the client.

Justin Andrews (72:51)

Yeah. I would imagine that's due to poor health and probably pornography, which is real common now in young men.

Dr. Rhett Langley (72:57)

A thousand percent. Yeah.

Justin Andrews (72:58)

So it's probably a Good combination of the two because, I mean, historically, you would not see any sexual dysfunction in that age group. That's like when you don't have any.

Dr. Rhett Langley (73:05)

Yeah. And that's the other thing to point out. It's not all. Like I said, it's not all metabolic health. If a guy comes in and says, hey, I'm looking at porn and I'm masturbating like, 37 times a day, I'm gonna be like, hey, let's unpack that a little bit. Yeah, that's probably not healthy.

Justin Andrews (73:17)

That's not too much. Calm down. Jeez. Right, Justin, wait.

Adam Schafer (73:21)

37 numbers.

Dr. Rhett Langley (73:24)

You're all getting C after the show.

Justin Andrews (73:28)

Well, good deal. Yeah. Well, this will be great, man. Thanks for coming on. Appreciate you.

Dr. Rhett Langley (73:32)

Yeah, thanks for having me.

Justin Andrews (73:33)

Kind of breaking this down. I think the future of. I think far more people now are becoming aware of the value of coaching. I think that GLP1s or GLPs have increased the awareness around it because, yeah, you lose weight, but you also lose muscle. So now you know your typical doctor saying you might need to strength train. And so I think that this is all good. I think we're moving in a better direction than we have in a long time. And you add a, you know, a glucose monitor to that, and you've got this wonderful. We've never had tools like this. Like, as a trainer, it was just me and my client. But if I had a, you know, glucose monitor and if I had a GLP1 working with some of my clients, that stroke, I think my success rate would have doubled for sure.

Dr. Rhett Langley (74:17)

Yeah. Yeah. And we're gonna see that for sure. We're gonna see that. This is the future very close. I would just say, you know, if you're gonna set up a clinic, you're gonna have a program. You gotta have good coaching. I don't care if you're a doctor.

Justin Andrews (74:27)

Agree 100.

Dr. Rhett Langley (74:28)

You've got to spend time with these people.

Justin Andrews (74:31)

Thanks for coming on, man.

Dr. Rhett Langley (74:31)

Yeah, thanks for having me.

Sal Di Stefano (74:33)

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