← The Dr. Hyman Show
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- [00:00]
A
Coming up on this episode of the.
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Dr. Hyman show, people who are doing it right, like why am I so tired? Like, I try to sleep well, I exercise, I eat good, like they're still feeling exhausted.
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You should feel a little bit tired in the afternoon, you should feel pretty tired at night. These are normal things. This is not dysfunction. Dr. Andy Galpin, who has helped elite.
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Athletes to peak performance from the Olympics.
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To pro sports to the military, breaks down how to decode fatigue, sleep and energy using science, not guesswork. If you have high quality muscle, it's really hard to have metabolic problems.
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Sleep regularity is more important than people think, meaning going to bed and waking up at the same time every day.
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When it comes to perceived feeling, your energy levels that regularity will play a bigger impact than the total hours.
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Let's talk hydration, because most people are getting it wrong. If you're feeling tired, foggy, crampy, or just off, it could be your electrolytes. I see it all the time in my community, especially with folks who are active, eating clean or or doing intermittent fasting. That's why I use and recommend Element. Element is a zero sugar electrolyte drink mix that skips all the junk. No sugar, no food dyes, no artificial ingredients. Just science backed hydration with sodium levels that Support optimal health 2 to 3 times what current guidelines recommend. It's a game changer for athletes, biohackers, busy parents and anyone who wants to feel and function their best. Even Navy Seals and Olympians use it. This summer. Try Elements Limited time New flavor Lemonade Salt. I've been mixing it with cold water post workout. It's delicious. Right now, Element is offering my listeners a free sample pack with two of each of their most popular flavors. Citrus salt, raspberry salt, watermelon salt and orange salt. That's eight single serving packets for free. Go to drinkelement.comhyman to claim your free sample pack with any order. That's drinkelement.com Hyman I'm always looking for ways to help my patients optimize recovery, build muscle and improve their overall health. That's why I recommend Perfect Amino, a pure essential amino acid supplement designed to maximize protein synthesis without the caloric impact. Perfect Amino provides all the essential amino acids your body needs in a ratio that's fully absorbed and highly effective. Unlike other protein sources, it has almost no caloric impact, won't break a fast, and helps you build lean muscle faster and more efficiently. Whether you take it before or after a workout, during a fast, or even before bed. Perfect Amino supports faster recovery, improved endurance and better performance. It even helps preserve and build lean muscle during fat loss while promoting healthier, more elastic skin by supporting collagen production. This isn't just about improving workouts, it's about optimizing your body's protein building process for better health and vitality. I encourage you to try Perfect Amino today. Go to bodyhealth.com and use code HYMAN20 for 20% off your first order. You'll be amazed at the results. Before we jump into today's episode, I want to share a few ways you can go deeper on your health journey. While I wish I could work with everyone one on one, there just isn't enough time in the day. So I've built several tools to help you take control of your health. If you're looking for guidance, education and community, check out my private membership the Hymenhive for live Q&As, exclusive content and direct connection. For real time lab testing and personalized insights into your biology, visit Function Health. You can also Explore my curated doctor trusted supplements and health products@doctor hyman.com and if you prefer to listen without any breaks, don't forget you can enjoy every episode of this podcast ad free with Hyman Plus. Just open Apple Podcasts and tap try free to start your seven day free trial.
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B
Well Andy, so good to have you on the Dr. Hyman Show. It's been a long time coming. I followed your work for a long time and I also think you're doing stuff which is really great, which is taking what you've learned from elite athletes and extreme performance needs to the everyday person who's struggling with just how do I feel better and do better and function better. Right. So I think, I think there's a lot of insights that you've learned. I want to unpack those today and get into it. I want to start with something that is really a big issue in America, which is energy. Or should I say the lack of energy and this issue of fatigue and everybody's struggles. You know, I'm just wondering from your perspective and in terms of the work you see, what's the most common cause of the fatigue that's out there? This sort of endemic fatigue in America?
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C
Yeah, I'm glad you started this because you're right. I'd say of all the people that we've worked with or coached or seen, this is probably the number one thing, most common thing that comes up. I think the best place to start is realizing, number one, fatigue itself is not pathology. It is normal to be tired. This is actually a good thing because we're now getting signals from the body in some sense. Right. We don't want the. I'm exhausted all day. I can't function without 600 milligrams of caffeine. Right. So there's limits here, of course. But I'm saying that because we have actually dealt with a lot of people who are struggling with this concept. The first sign of fatigue they get, they then pathologize it. They think that there's a disorder or they have a deficiency and then they run down the spectrum of problems. Right. So we don't want to cause problems and overanalyze when they don't really exist. You should feel a little bit tired in the afternoon, you should feel pretty tired at night. Like these, these are normal things. This is not dysfunction. So fatigue is not automatically dysfunction if it is the point where it's disrupting your life. We're having a second conversation and we'll spend most of our time there. Yeah, but it was important for me to point that first part out because.
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B
You know, I don't know, Andy. I used to have lots of energy when I was younger and it's changed over time. And I remember when I started medical school, I just would have even energy all day. And then somehow I thought that I was supposed to drink coffee in medical school and I never drank coffee before medical school. And then I would like have this crash in the afternoon. What is going on with that? I mean, I think it's not normal really to feel sluggish in the afternoon, is it?
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C
Well, some amount of. Let's define again, sluggish versus I feel a little bit more tired. I'm not feeling at 10. At a 10. Energy and focus and concentration. If it is, I can't move, I can't get throughout the day now. And we want to make a change with that. Now we have a conversation. Right. So number one, you may not have to overthink this. Simple things like maybe 10 minutes of backing off is enough. You'll be stunned. You again, you might not have these pathologies other than going on. It could be the fact that you have podcasts coming in all day, you have non stop stimuli coming in, you have everything firing at you at all cylinders. And that didn't happen when you're 20. You weren't on your phone all day when you were 20.
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B
It wasn't a phone landlines when I was 20.
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C
Right. But there wasn't the Internet, there wasn't these things. So when we hear these stories, a lot of times I'm thinking, I know, but the world you live in now is not the world you lived in 20 years ago.
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B
Definitely not.
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And so you might need strategies now that you didn't have to have in that time, which could be as simple as for you. You might get super restored by just literally setting a timer for 12 minutes and going and standing out in the sun. Someone else that might not do anything at all, they might need to close their eyes and lay down, fall asleep, don't fall asleep. I don't really care. It might be physical activity. There's lots of different things that give people energy back. And it can be as short as this 8 to 12 minute window. So my first stopping place in this journey is to say, like, okay, what do we really mean by fatigue? Are you noticing it happening on days when you're writing, or are you noticing it happening on days when you trained really hard in the morning? What is the thing that's kicking? So there may be something there that is going, hey, you had your hardest training session this week. Let's not be surprised when you're a little bit tired this afternoon. That's not a dysfunction. Right. I could go on and on examples, but this first landing stop is again making sure that we're really understanding there's.
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Normal variations in our answer.
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Normal variations.
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That's true. We're not talking about people who just.
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Feel okay, exhausted all day. We don't have to overthink this one either. The first place we're gonna look now is sleep. Yeah, Somewhere. Depending on the data source you look at, 70 to 80% of sleep disorders will go undiagnosed. I can't tell you how many people we've had come through, I sleep fine. I sleep great. I sleep pretty good. And then we actually run proper analyses on them and they have anywhere between moderate to severe sleep disorders. We actually had one guy, very interesting in Colorado. He lived in multiple houses, so he lived at sea level normally. Older guy, drank a lot, didn't take care of his health, but he was fine. A little bit of snoring energy was pretty much okay. And then when he went to his house in Vail, he went from moderate to extreme sleep apnea. He had no idea. He was just giving this energy. Things like, I don't understand. Well, his house was at like 9,500ft. Right?
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B
Pretty high.
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C
That will exacerbate sleep disorders massively. So his tiny sleep disorder here became hugely problematic there. And it was so bad we had to Basically intervene and say, like, you have a strong risk of a real cardiovascular event happening here at elevation because his snoring, his everything, like, went off the charts. So things like that can happen where, again, he didn't have a. A traditional. If you went to a sleep hospital, you'd be diagnosed with a sleep disorder. But that didn't mean he had great sleep. He just didn't recognize it. And we've seen things like this happen a number of times. That's a pretty esoteric example. I gave you a really deep one. But we see this stuff happen. Often my energy's super, super low. The common one is, I think I need testosterone. Okay, fine. That's between you and your doctor. Up to you. But have you actually diagnosed your sleep? Have you done anything there? Well, no, I sleep fine. Or I use a consumer wearable. Okay, great. These are awesome for many things. But you've now spent all this money on a high level dietitian. You spent all this money on a trainer, and then you've done nothing for your sleep. You haven't really analyzed it at the highest level possible. Just because you don't have a clinical disorder doesn't mean you don't have something there that is causing a ton of fatigue.
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B
As I remember when a patient went, I had. They said, doctor, I don't know why, I'm just tired all the time. I said, how many hours a night did you sleep? It's like five hours. I'm like, I think you need to sleep eight. That'll be $500, please.
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C
Yeah, exactly. Yeah, get more sleep.
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B
Right?
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C
I tend to get past that one, actually, because so many people are like, I already sleep seven and a half or whatever. But you're right, many people don't even get close to the number. But once you've had that number, if you're the person who says, like, I do sleep my seven, or we'll get this one a lot, man, Even if I sleep eight and a half or nine hours, I still feel tired. Yeah, okay, sure. But if you slept for five hours for the two weeks before that, one night is not gonna fully restore you. No, this will take plenty of time. And high quality, effective sleep looks different for different people. And so precision is available there. We can start to figure out what is ideal recovery for you, what actually solves that problem or what doesn't. So there's just a lot more granularity we can get with sleep, but that is always the first place we're gonna look.
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B
What are the problems that most people have with sleep, what's causing them.
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C
The biggest one that people don't pay attention to outside of total sleep is sleep regularity. So they'll say, hey, I got my eight and a half hours or seven and a half or whatever it is. But we had social jet lag. Social jet lag is this idea of you basically give yourself jet lag on the weekends not because you sleep less, but because you sleep in a two or three hour different time domain. So let's say you go to bed at 10 on the weekdays, wake up at 6, there's your eight hours. But then on the weekends you stay up till 2am and sleep till 10, you still got your eight, but you've given yourself jet lag because you're now four hours off. For 20 year olds you can get away with that. For early 30 year olds you can get away with that. But past that it becomes really debilitating. This is a really common, I sleep eight hours, I use my tracker, it says I'm at eight and a half but I'm exhausted all the time.
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B
Sleep regularity is more important than people think, meaning going to bed and waking up at the same time every day.
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C
When it comes to perceived feeling your energy levels that regularity will play a bigger impact than the total hours will. That is the thing that's going to make you feel awful. You can survive on seven, six and a half like if you have to, if it's really consistent. Very hard for people to survive on inconsistent sleep schedules. By survive I mean feeling good, feeling great. Right. Not death. That's a sort of separate issue.
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B
But no partying anymore. That's it.
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C
Yeah. Of course you want to live your life right. And be resilient, but you also want to be reasonably consistent. Right now somebody like a lot of the clients we work with and you're the same way. I'm sure I am. Actually do physically travel a lot.
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Yeah.
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C
So we have to manage this. Inconsistent schedules that are outside of our routine. So if you're in a situation, let's say you're also a, a shift worker or somebody that has inconsistent work schedules and you don't have the ability to control and go to bed at the same time. Other options you can have is trying to become more resilient to sleep changes. And that's something that few people really talk about. When we, when we have conversations like this, a lot of people will hear things like, well that's great. I love to go to bed at 9:00 every day and sleep till, you know, 7:00am or whatever the case, but not possible with my schedule. Okay, I get it. That's most of the world actually, right? Everyone we work with, all of our athletes, all of our military, all of our government leaders, they're all on wild schedules they don't have. They're not at home every day. Understand? What can you do? Become hyper resilient to change. So there's this whole facet within sleep where we can optimize resilience. And resilience is actually one of our biggest keys. What we focus on at absolute rest is not optimizing sleep in terms of sleeping ten hours a night. Right. This whole idea of sleep optimization is actually takes a lot of people in the bad direction. You don't necessarily want to be an optimal sleeper. You want to be a resilient sleeper, which means you can still sleep for six hours and show up the next day dialed in, performing and executing. You can have an inconsistent schedule, and we can still be great. That is where I think most people will get more bang for their buck is focusing in on that sleep resiliency.
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B
That's such an important concept, Andy, because whether it's your blood sugar or your metabolism or your brain health, the goal here is how do we build more physiological resilience, more ability to have elasticity in our activities, behaviors so that we're not like, stuck in a rigid physiological pattern. And disease really is less and less and less resilience. When you look at what disease is, it's the loss of physiological resilience and metabolic and physiological flexibility. And so what you're talking about is how do we build more flexibility? So can you unpack?
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How do we do that?
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It sounds good, but like, I'm very curious.
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C
Yeah. So your brain will do a lot of that for you if you get out of its way specifically for sleep. Here's what I mean. If you are looking at a wearable and you're getting hyper focused on the amount of minutes you spend in deep sleep, we're probably already in the wrong conversation.
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Yeah, I do that, right? I'm like, oh, shoot, I only got 30 minutes.
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I got an hour.
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Oh, I got.
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Not good. For a bunch of reasons. Number one, accuracy is an issue. But even the concern. The idea of deep sleep is not a manufactured term, but it actually changes what categorizes what counts as deep sleep. So there's a whole litany of problems.
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Different trackers will tell you different amounts.
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Different amounts, Right. So like at the gates, you should know that, again, we're dealing with problematic data.
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Yeah.
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And now you're making real life decisions, changing therapies and drugs and supplements and lifestyle routines based on problematic data. This is not a good strategy. Right. We want to be concerned with things like, all right, if you had a day where you sat here and you did five hours of podcasting, you had five different guests in that came in for an hour, you did five podcasts, and he had four meetings, I would expect a different sleep architecture tonight than if you had a day off today and you went and played in the.
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Lake for two hours, which I did yesterday.
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Okay. Right.
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Yeah.
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You should not have the same amount of deep or N3 or slow wave and REM as you had the night before, because there's a different cognitive load, there's a different physical load. So what we want to do, in fact, if we made this word mark and I said, hey, we're going to put you through sleep restriction training. So we used to call it, like back in the day. And we're gonna load you down to five hours of sleep per night, and then we're gonna stay at five hours of sleep no matter what. You're gonna go to bed at midnight, wake up at five every single day like a nightmare. You know what would happen to your deep sleep? It would rock it up. Why? Because your body would learn pattern recognition really quickly. I don't have eight hours to mess around. I will get into deep, I will get into rem. I will get into these cycles hyper fast, because there's no wiggle room there.
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B
Yeah.
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C
If I do the opposite and I let you have a. You lay in bed for two hours and you sleep for nine, then we would see the exact opposite effect here. Right.
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B
So you get less deep sleep.
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C
You wouldn't get less per se, but your body wouldn't have as much rush to get into it, to stay into it. The rhythms would be, the architecture would be different. Is the most accurate way I can say the pattern would look different. Right. So now when you're comparing your data and you're not paying attention to the fact that what happened to your sleep last couple of nights? And all of a sudden, oh, my God, last night I got this, got my 90 minutes of deep sleep. Well, are you coming off a sleep restriction? Did you sleep for. Were you traveling well? Yeah, of course it is. It wasn't the supplement you did. It wasn't the meditation or thing. It was the fact that you were sleep deprived or the opposite. Oh, my gosh. My deep sleep went down okay. By a few minutes. Don't care. Maybe you're fine. Maybe you're actually now sort of restoring back to baseline and getting into a great spot. So you can develop more resiliency by understanding what's happening in these scenarios and doing different strategies that help you. We use something at absolute rest called the wind down index. And so this is not only.
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B
So you mentioned absolute rest a couple of times. Can you just share with us what that is?
- [17:39]
C
Yeah, that's our, that's our sleep company. So this is, this was born out of many years ago. I was at one of these like behind closed doors, human performance meetings or people are trying to unpack how do we get people on Mars and how do we get high performers and athletes? And sleep came up and we pretty quickly realized that even the most high profile athletes, the richest government leaders and executives, the only thing we have for sleep is a sleep hospital or a consumer grade wearable. And everyone looked at me, they're like, surely these million dollar or billion dollar athletes have. I'm like, we got nothing else here. And so we actually came together like on the spot and created this company Absolute Rest where we said if you had to maximize sleep performance and not sleep duration, sleep resilience, what would it look like? Well, I would want to know exactly how somebody's sleeping. And again, nothing about against consumer wearables. They're awesome. We use them at absolute rest. But we want to know exactly the highest precision gold standard. I want the same exact technology in a sleep lab in your house. We created that, we have full FDA approval, we can run full medical grade clinical sleep studies on people in their house. And now do we not only look at things like their sleep staging, you know, REM and things like that, but we look at fragmentation and stability within that. We can look at when you're on your right side versus your left side or your back, we can start to see exactly how you're sleeping. And that's critical because below that we now can then figure out why. So maybe you're having these mild apneas that wouldn't qualify again as this medical disorder, but they're only happening on your right shoulder. This is actually something that's happened many times. And now you get somebody off the right shoulder and their sleep apnea goes down by 90% in day one and never comes back. It's a slight pillow change. We've had one recently where actually somebody was having a little bit of blocking of their nose at night, couldn't breathe through their nose, didn't realize it went to mouth breathing happening because there was A little bit of dander stuff happening in his sheets. So all we had him do is start washing his sheets once a week instead of like once every couple of months like most men do. Right.
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B
Dude's a housekeeper. Boom.
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C
Problems are gone now. Right. So there's sometimes really easy solutions, but we got those because we understood how he was sleeping at a gold standard level, and then we understood why. And so we look at blood markers, we look at genetic markers, we look at behavior.
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B
Are there blood biomarkers for sleep?
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C
Totally.
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B
Like what?
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C
Absolutely. Well, you would start with basic stuff. You would think of hematocrit, hemoglobin, ferritin, iron levels. Really good example. If you see somebody who doesn't exercise, they're unfit. But you see hematocrit and hemoglobin are really high. Really good chance you've got some sort of apnea. Spleen will go nuts. Right. If you're choking at night, your spleen will start kicking out red blood cells. You'll start to see hematocrit 51, 52s. Right. You start seeing hemoglobin 16s for men a little bit lower. Women, you might see like 48 hematocrit. You start seeing hemoglobins 13s, 14s.
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B
Yeah.
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C
Now, I looked at one of my athletes and I'm like, great, we're fit. But you go, oh, you don't exercise at all. Hmm, great. Now, you might just genetically have good markers there, but probably not. And then you start looking at things like MCV and other markers, and you just go down this whole line and you get into ferritin, like all these other markers, 20, 30 markers you could look at. You start to realize, oh, these are high in the presence. And now you start looking at inflammatory markers, starting to get up there high, and you start to build this story. It's not one marker that you could just look at. It's this combination of things that you have to cross out for false positives, false negatives, and you start to see, but that first one, really high. And we know that's the case. There's a lot of data on this. If you have take somebody that has apnea and put them on cpap, hematocrit and hemoglobin will come down. You're like, oh, that's if they're, if they're, if they're elevated, right.
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B
They're starting from oxygen, they make more red blood cells.
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C
Yeah, right. And you start to look at like, like 90 day distributions, red blood cell size. And you start to see, oh, they're coming down. Why? Because those red blood cells don't have to hang on for 150 days anymore because they know they're out of limitation. So I know that was like a.
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B
Little bit technical, but yeah, interesting.
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C
It's things like that where you can start to paint a picture and say, hey now we're guiding towards different therapies. We don't need you to go on iron or we want you whatever. Like you get false senses.
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B
And low iron does lead to sleep disruption.
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C
Totally. Right.
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B
Even if your blood count's normal, if you have low ferritin.
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C
Of course. Right. And that's gonna happen in over probably 30% of physically active people.
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B
Which people don't realize and doctors usually don't check.
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C
No, not at all. Right. So you want to look at a bunch of markers there as part of function health.
- [22:05]
B
We do all that, which is really pretty amazing. We're seeing, you know, a lot of people deficient.
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C
Yeah. You can actually start to see indications of those from the blood first. So you start to see those things pop up. Your algorithms that function are probably going to flag and say, hey, how's your energy? All subjective questionnaires, low. Interesting. Here you should go get a sleep study done. Like don't get it done to hospital, get it done at home. So we can do three or four or five nights. Not like one weird night at a.
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B
Sleep hospital where you're all wired up and it's strange.
- [22:35]
C
Yeah. All those wires are. You don't need them anymore. The technology can be done all wirelessly. So this can be done and then have that analyzed and looked at and say okay, great. Actually we don't need medication yet. We need actually to improve sleep and then get out of the way. The body will actually recover back how it wants to. We don't have to over medicate over supplement.
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B
So what are the most common things you're seeing with sleep and the lack of sleep resilience. And how do you get people towards a better sleep resilience?
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C
Yep. So the step number one we already covered more consistent. Consistent is always our starting place. As close as we can. Within that past that we. I started talking about the wind down index. Why brought that up? If you look at something like sleep onset latency, how long it takes you to fall asleep at night. Right. The general numbers there are going to be five to 20 minutes. Right. So if you're falling asleep within like two minutes, that's probably a good sign that you're sleep deprived. Takes you 20, 25. We're gonna have other issues falling asleep, especially 30 plus minutes to fall asleep on average per night. All right, we don't have a good fall asleep strategy. Here's why this stuff matters. If you are exhausted, you might fall asleep really, really quickly. But if you're not physiologically wound down, you'll oftentimes wake up at two in the morning, three in the morning, boom.
- [23:51]
B
Kind of tired, but wired.
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C
Yeah, tired and wired, right. You'll fall asleep from exhaustion, but you'll only get those three or four hours, can't go back to sleep. Then you'll look at blood glucose and you know that's gonna be the problem. Right. And so it's not necessarily a carbohydrate issue in this particular case. It's the fact that you're look at your resting heart rate, look at your pulse wave, look at sort of these cardiopulmonary measures and you'll start to see other signs that corroborate you're asleep, but you're not downregulated. You're really pretty wired. So the common person of a lot of people wake up at the middle of the night at some point. But the it happens all the time. I may be sweaty, I may be out of breath, I can't get back to sleep. That's going to tell us, okay, we're not winding down. So in that particular case, you build resiliency by saying, I know I'm going to have a limited window today or I'm off schedule. Fine. I can get better at that by having a consistent wind down routine because that will actually down regulate me and give me more quality sleep in those same hours because I'm not spending the first 40 minutes actually trying to just bring my heart rate down or so.
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B
Wind down like hot bath, you know.
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C
Meditation, it's incredibly individual work. Yoga, Some of them are great. What's really key to wind down routines, it is not the act, it's the pattern. The number one key to wind down routine is to have some consistent thing you're doing. Whether that consistent thing is even whatever. Right. It can be journaling, it can be write down the things you have to do tomorrow, fine. Those things might not work for you. What you want is the 60 to 90 minutes prior to sleep to be doing the same ish things that you do. If that is all those things you mentioned, fine, great, love them all. I don't do any of those really. Like they don't work for me. But you want to kind of do the same things. What do you do so for me way of little kids. So we're always gonna go through the little kid routine, right? We're doing all the things in order at the pretty much the same times with the kids. That's my pattern too because I'm going through that like that's tremendous joy. That's I'm being present. I've checked out of work. I'm not on my phone, I'm not doing emails, I'm reading stories. We're doing all the things and wrestling with the kids and making mom mad because I'm wrestling with kids five minutes before bed. But that 40 minute routine with my kids is my first 40 minute. That is my internal signal that I'm done for today. I don't care what else happens. I'm not checking my email when I'm playing with my kid. Not gonna happen right from there. Then I'm going in, we're gonna shower, that's great. And then I'm getting in. I'm a thousand % gonna watch TV. You're gonna watch TV 100% of the time. Like TV you'll be on. I might watch a Seattle Mariners game. I might watch whatever I'm not watching like a murder mystery. But we'll watch oftentimes like 20 to maybe 40 minutes of TV. The blue light doesn't bother us at all. We use environmental sensors, so we're testing everything. We're looking at melanopic light. Not just total lux, like we have everything measured and monitored. All this technology I use myself so I can objectively say that stuff does not negatively impact my sleep, but it positively impacts my psychological downregulation. It is a click in my brain.
- [26:53]
B
What if your team loses? Is that.
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C
Ask my wife, she'll say different.
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B
That's a stress.
- [26:59]
C
Yeah. But for me personally, like I really enjoy that stuff, but I don't do it very often. So when the TV like goes on for me it is a huge click that, okay, you're done, that's it. All that other stuff on your phone, it does not matter. All you're worrying about is like what the three, two pitches on the sixth inning for the fourth batter, like what's going to throw a curveball, he's going to go off speeds, he tunneling that pitch.
- [27:21]
B
Like yeah.
- [27:22]
C
And then my wife will generally read or she's watching the same thing too, right? But that's her thing too, right? She's like, I can get lost in this book now. I don't have to worry about anything else. So it's really consistent so when I travel, when I'm doing things, if I'm off schedule, it's pretty easy. Like I was just in the Middle east for a couple of weeks. Wife was in New York this weekend. When I'm way time zones off, I keep the same system, right? I keep the same exact system, even if I'm two or three or six hours off schedule. And it just signals my body of going, you ate, you did this and you did this in this row in order. Far easier. And so when I looked at that stuff objectively on our whole bunch of metrics, my wind down index is very, very similar regardless of time zone I'm in. When I can keep that pattern up, when it gets dissimilar is when that thing gets thrown off.
- [28:10]
B
You're kind of cueing your body, you know, like Pavlov's dog, to have a certain response at a certain time.
- [28:15]
C
That's exactly right.
- [28:16]
B
By a certain stimulus, right?
- [28:17]
C
Yeah, exactly right.
- [28:18]
B
And if you're like called behavioral conditioning.
- [28:21]
C
Pattern recognition is the single biggest physiological feat we have as humans. That is the thing we are most talented at. If you want to call this resilience and sensitivity, this is a great thing too, Right. If you become too sensitive, your pattern recognition is now I have this window, this, if you're listening, my fingers are right next to each other, right. And so now when I bump up against those walls, things feel out of whack, out of place. This is discomfort. But if my window is huge now, I'm super resilient, I can still land that plane regardless of the turbulence. And that's ultimately what we're after. So your question was how do we develop more resilience? That's one of my big keys, is getting a consistent timing mechanism in your brain that says this is what's going to happen. Therefore we fall asleep quickly, we do it effectively, even if I'm in a different time zone, even if my total duration is short. I started off on the right foot. And that will be more restorative sleep.
- [29:14]
B
It's so tragic that historically in this country sleep has been seen as a weakness.
- [29:20]
C
It's great.
- [29:21]
B
It certainly was when I was in residency in medical school, of course. And you know, I believe that sleep was optional.
- [29:27]
C
Yeah.
- [29:28]
B
For years I was working as a, you know, resident and then as a family doctor in a small town where I delivered babies. Not too far from you actually in, in Idaho.
- [29:39]
C
Oh, nice.
- [29:40]
B
Okay. A little town. And I, you know, did the ER call 24 7. I did. The next day I'd have To go to work and see patients or I'd have to deliver babies. And it was, my schedule was not set and I worked 80 hours a week and it was, you know, I think I really destroyed my sleep rhythms.
- [29:56]
C
Well, you know what's crazy, people don't appreciate this about medical doctors because they tend to get kind of a lot of grief. More recently they just, in a couple of years ago, reduced the residency hours from 120 a week to 80 or something like that. Yeah, let that sink in.
- [30:12]
B
It's still nuts, but it's like two work weeks in one is a big improvement over three work weeks in one.
- [30:16]
C
But that was like if you're a medical doctor in America, you probably did many months of a hundred plus legitimate hundred plus hours per week. And now they made it soft on these new doctors and brought it so soft.
- [30:31]
B
Yeah, we had a big concession in my residency where we had a labor organizer and negotiator as one of the residents and he negotiated our contract so that we basically got off at noon.
- [30:46]
A
The day after call.
- [30:47]
B
So instead of working 24 hours and then going again till the following night at 6:00, we got off at noon after a whole night with not sleeping.
- [30:56]
C
Which is still 20 years of negotiations.
- [30:58]
B
Which is still not.
- [30:59]
C
Yeah.
- [31:00]
B
So sleep is a real reason for this lack of energy is what you.
- [31:03]
C
Say it is the most one. After that, I would say categorically, you now start thinking about energy in versus energy out. Right. So energy in could be a number of different things. It could be total caloric intake is too high or too low. Could be carbohydrates are too high or too low. It could be a distribution, it could be a timing. You eat too frequently, you ate infrequent for your physiology. But you're going to start thinking, okay, if I'm sleeping, great, effectively, objectively sleeping well, if do I not have enough energy in, am I doing something that's there and is it a lack of energy or is energy instability meaning I feel pretty good from 9am to noon, but then I get really tired. Okay, you don't have a lack of energy. You just have these wild waves energy. Now that's where the nutrition side could come in. Okay, let's maybe tinker with less frequent eating or more frequent eating or more fiber or more protein. Like there's lots of different ways that you could play with that and that. And that has come up a lot where that has actually been. The solution is you just need to actually, your eating strategy is ineffective. The other big category would be the opposite energy output. You're training too hard, your volume is way too high. Or you had a big jump in exercise volume, miles or lifting weights or whatever the case is. Too much high intensity for you right now, right? Or it could be the opposite. Your body doesn't produce energy because you have poor mitochondrial function. You have low muscle mass. Right? So it's. It's something on that end of the energy output. Or your body is unduly stressed, so it's burning a lot of energy internally that you don't realize. We call these hidden stressors. This could be psychological stress. Let's use example. If you have a cold, an infection, but you don't realize it, you don't have a runny nose or whatever, anyone that's had, like, kind of cold, you're just exhausted. You have no idea why. Well, your body is burning legitimate amounts of ATP to try to fight off this infection. You didn't realize it. This is where things like micronutrient deficiencies or pathologies or stuff like that, like these things can cause fatigue and exhaustion outside of it. Right? So those are real things. They are very far down the list. Again, let's not overthink this. If you're tired, make sure you're sleeping well. Make sure you're eating and you're not over there. This is. We've seen people that have resting, fit people. VO2 max is 60 plus for men, right? 58 plus. And your resting heart rate's 70.
- [33:31]
B
70. That's high.
- [33:34]
C
Your respiratory rate overnight respiratory rate of 17 breaths per minute, which is high. This is not somebody who's cardiovascularly unfit. Why are you exhausted all day? Mm. Well, I see sympathetic drive is full throttle all day. You're breathing. You're basically like, kind of jogging all day, and then you're training hard. So your VO2 max is up there. But we can see this is why you're exhausted. It's the fact that we actually have to bring that down a little bit. You're over, over breathing. You're chronically hyperventilating. Not pathologically, but just below that. So it's things like that where we're starting to look on those second layer, second tiers and saying, okay, sleep is fine. Check that off. Nutrition is great and solid. You're burning too many calories. Not because you're training, in this case, sympathetic drive. So now we can do lots of different strategies, which could include any of the things we talked about, from meditation to maybe you need to see light more frequently to you need to actually take a little bit more time off of work to do you realize which work tasks give you energy and which ones take energy away. A lot of people have not made that connection. The introvert, extrovert kind of stuff, right?
- [34:42]
B
Yeah. Very individual.
- [34:43]
C
Yeah, yeah. This is pulling energy from you. Right. So if you're an introvert like me and you're in shaking hands, in an appearance all day, I don't care if I take 50 steps, I'm going to be exhausted at the end of that day. Like I could eat 12,000 calories and I will be physically exhausted at the end of the day because like I just don't like being around people that much. So maybe has nothing to do with anything else there. It's the fact that you haven't recognized and realized you need more social interaction if you're an extrovert to give more energy back. You, you could, we could give you a bunch of examples, but you're getting the point. It's really figuring out what gives you energy, what takes your energy and then maybe making some structural changes to your lifestyle or daily routine that balance that a little bit more.
- [35:19]
B
Figuring out what is it that makes you resilient.
- [35:21]
C
Yeah.
- [35:22]
B
And less fragile in terms of your sleep architecture and.
- [35:26]
C
Yeah.
- [35:26]
B
Your ability to rest and turn off at night because you got, you know, like you said, you over exercise, which isn't most people's problem.
- [35:32]
C
No.
- [35:33]
B
But a lot of people probably use. You work with.
- [35:35]
C
Yeah, for sure. A lot of our non athletes that come to our coaching programs, that's that.
- [35:41]
B
I remember watching some interview with Kobe Bryant. He was like, yeah, you know, the reason I sell is because I get up early and I work out and then I work out three times a day whereas my other competitors don't work out as much. And so I train and I'm better. So I'm like, I don't know, is that good or bad?
- [35:58]
C
Some people get there.
- [35:59]
B
It worked for him to be better performer for sure.
- [36:01]
C
Yeah. You know, like next week I'll be up in Canada with a guy named Cam Haynes. Cam's almost 60 and 60. 60 years old. A couple days ago he ran 250 miles.
- [36:11]
B
Damn.
- [36:12]
C
250. Right. He did this for his book launch. I think it's called Endure or something like that. He's 60, has a broken foot and he ran 250 miles on a broken foot. On a broken foot. Prior to the race. He knew it was broken. It's been broken for months. Right.
- [36:27]
A
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- [39:14]
C
The way that Cam gets to the world is maximal grit, right? He doesn't optimize, he doesn't perfect, he does the opposite. I'm going to put myself through insane things like that. Like Kobe's example, right? Insane amount of pain because it gives him the mental edge of saying, okay, you deserve the win now, right? Where other people don't need that to get to that same place.
- [39:35]
B
So some of it probably not happening in my lifetime for sure, right? Nor am I might bike 100 miles, but running 250 miles, well either way, right?
- [39:43]
C
So for you, you want to be in this place where you have the ability to express true grit, sometimes the answer is you need to be tougher and sometimes the answer is you're over optimizing, right? So this is one thing kind of with people that are taking more onus and autonomy of their own personal life and control, optimize leads to problems, right? Because it leads to sensitivity. So if you have to have like a 90 minute routine, like I was saying earlier, if you have to have that to even fall asleep, and if one thing in your 90 minute routine goes wrong and you can't fall asleep for an hour, you've done wrong, that's not resilient at all. Now you become hypersensitive. If you have to have your morning routine, if you have to do your breath work, you have to exercise. You can't go a day without exercising. We've had many people like that. Okay, this is actually not. This is fragile. You're very fragile. Laird Hamilton's good friend of mine, he would always be like, don't let me leave you in the woods. Which is like his way of saying if like you're over there worried because you're like, didn't do your warmup today and, like, we're on the wave or something. I don't care. I'm leaving you behind. Like, I'm not. Don't be so precious, Laird Hamilton. Yeah. It's like, be more resilient. Be able to execute and have a great day, even if you have a broken foot, even if you didn't get your nootropics in today, even if you didn't do your breath work and you follow.
- [41:04]
B
Sleep is a big thing. And your absolute rest is a pretty intensive program. That's not for everybody, right?
- [41:10]
C
Yeah.
- [41:11]
B
It's pretty expensive. It's pretty intensive.
- [41:13]
C
100%.
- [41:13]
B
Yeah.
- [41:14]
C
Yeah. This is if you have to get sleep. Right. And you wanted everything to know about sleep, and you want a guided coaching throughout the whole thing like that. That is that program at the. At the core.
- [41:25]
B
And you have a. A new device that goes along with it. That's.
- [41:29]
C
Yeah. So we can run full FDA clinical sleep studies on your fingertip. It's not a tracker. It's not like a check your sleep score with a proprietary algorithm. It's all that stuff. So that tracker itself is a part of the big program.
- [41:44]
B
And the wearables are not that great, are they? I mean, because I'll often wear three at night and get three different reports in the morning. Like, one said, you slept, like, 10 hours. One slept. I said eight. One says, I got 30 minutes of deep sleep. One says I got an hour. One says I got 100% score and then said I got a 70% score.
- [42:02]
C
I'm like, we are pro everything. Wearables and trackers can be really effective for rough calibration. Right. So some people have. As you're aware, some people have no idea what they're eating.
- [42:16]
B
Yeah.
- [42:16]
C
They have no sense of what their sleep is. A tracker. Great. An aura, a whoop. They're gonna get people roughly calibrated. That's awesome. They're good for accountability. A lot of people will make better choices with their behaviors. The bad behaviors, the dumb behaviors, the I ate a pizza right before bed, the alcohol, the inconsistent because they know they're getting tracked. They know they want to do better. So it can be good for awareness. It could be good for calibration. It could be good for internal accountability.
- [42:45]
B
Yeah.
- [42:45]
C
For us. When my athletes know I'm watching, like, they make better choices.
- [42:50]
B
Yeah.
- [42:51]
C
So those are all tremendous. And if you look at the hundreds of thousands of people that now use that, it's in that good thing. So if your entry point is that I'm all for it. That's great. But what you don't want to do is what we talked about earlier. Use the minute detail of the sleep stage to freak out. Are you familiar with orthosomnia?
- [43:12]
B
It's like orthorexia, which is obsessing about your food, I imagine, obsessing about your sleep.
- [43:17]
C
These are clinical sleep disorders that are induced from sleep trackers.
- [43:22]
B
Wow. It's a whole new diagnosis.
- [43:25]
C
So you just have to be like, make sure you're not. If you care that much. No offense, but if you care that much, you probably shouldn't be spending $400 on a wearable and making all those decisions. There are better sleep.
- [43:40]
B
So bottom line, sleep is a big cause of fatigue.
- [43:43]
C
Huge.
- [43:44]
B
Learn simple practices that can help you become more sleep resilient and less fragile around your sleep. Get a wind down routine.
- [43:52]
C
And if you've done all 50 of those things, go to the next level. Like go get some objective testing done because of the fact that you could legitimately have a sleep disorder. And all the meditation in the world is not going to fix that.
- [44:07]
B
Right. If you have sleep apnea or if you have some thyroid issue or something else is going on, a hundred percent heavy metal poisoning or. Yeah, there's a million reasons why sleep goes wrong. So you don't want to ignore the medical reasons, but if you've kind of cross it over the list, then you, you can go deeper. So I want to sort of transition into. Talk about what you've learned in your decades of working with elite athletes, Olympic athletes, top professional sports athletes, MVPs, you know, just the best of the best. And you, you, you've learned a lot from people like that that can apply to the rest of us. Because most of us aren't that right.
- [44:42]
C
Sure.
- [44:43]
B
Most of us are just trying to figure out how to do a little bit better. And I guess let's sort of start out by talking about what are the insights that you've gotten from high performers about what they do. That applies to us.
- [44:57]
C
When I say high performers, I will talk about athletes as much as you want, but we also have worked with the most elite military groups, people that run huge corporations, executive athletes that don't even exercise, I guess is my point. So when I say high performer, I mean the smartest people, the best decision makers, the people that. This is high performance for us. Right. Physical sports is one avenue, but performance could be. Again, you're a better writer, you're more creative. We work with some of the most famous musicians in the world. Right? These are high performers to us. So answering that question, what do people that perform at these high levels, physically, mentally, cognitively, creatively, whatever, there's not one thing that they all do. Some of them eat really well. Some have no concept what they're eating. Some of them are metabolically healthy. Some are not. Everything you can imagine here, I would say I can show you an example of somebody who's the best in the world, and they don't do any of those things. Right. I think the one lesson from all them, though, would be, in general, being tough helps. And tough is great because tough can be built. So if you are running companies and you do not want to get up on Saturday and you don't want to work and you're tough, you can get it done, right? If you're an athlete and you have to go talk to the media about why you suck today, that's really hard. They don't feel hard in the weight room when they're lifting weights and when they're exercising, when they're tired. But maybe being in front of a camera is really hard for them. Sitting in front of the GM and them telling you like, you're not going to play this year, we're cutting your. Those are hard conversations that most people don't realize happen at professional levels. Not just sports, but running companies. Having a hard conversation with the kid, with an adult, those are really tough. So my biggest lesson from most people is the ones that tend to be tough tend to do the best more often.
- [46:52]
B
How do you get to be tough?
- [46:53]
C
It's a learnable thing. It is a practice in the sense of physical, tough is fine, right? You can do that, but it is. The ones that I just talked about are saying, okay, mental tough. Start when you can, right? So have that first conversation and it's going to be awful and go poorly and then keep doing it. Expect failure, Expect it to not go great. And then you just. You just have to trust the fact that you knew, you know, you need to get to here. And you know, the first time you lifted weights, you didn't, you know squat, £1,000. And so the first time you learn this skill or this practice or whatever, it's never going. It's not going to be pretty, but you keep going. And if you can believe that, then you can get past that. That is developing toughness. It is developing skill. If you're Cam Haynes, you're tough no matter what. Cam Haynes's kid just ran like a 2:30 marathon in jeans and then did 10,000 pull ups in 24 hours.
- [47:46]
B
What?
- [47:47]
C
Like, the Hanes gene is incredible. They genetically are just super tough.
- [47:51]
B
That seems harder than running 250 miles.
- [47:54]
C
Nuts, right?
- [47:54]
B
10,000 pull ups.
- [47:55]
C
10,000 pull ups in 24 hours.
- [47:57]
B
I don't think I can do 20.
- [47:59]
C
I think his other kid ran the marathon with like 45 pounds on his back and in like combat boots.
- [48:05]
B
Yeah, I went to med school with a family like that. Those guys were just like. He would put on £50 and go skiing for two hours. Cross country skiing up in the mountains.
- [48:15]
C
We had another guy actually, Lance McCullers Jr. Texas guy, plays for the Astros. He just pitched last week for the first time in like three and a half years. And the toughness he had to have for those three and a half years because he kept getting hurt. Everybody got mad at him, all the fans. You're taking all of our team's money, like all these things. His tough was like, we have a three or four year horizon, we have to get through this. And I don't get to do the thing I like at all.
- [48:44]
B
Because he was injured, because I'm hurt.
- [48:45]
C
And then he kept getting hurt. And just. So there are different forms of toughness and the only way to build those things is just continuing to go after those, continuing to try show back up. You fell off your diet, fine. It's okay. Be tough, get it going again. You lapse.
- [49:06]
B
What is that saying? When the going gets tough, the tough get going.
- [49:10]
C
Yeah. Like grit. However you want to. Like grit.
- [49:12]
B
Yeah. There's actually an incredible book written about this by, I think a UPENN professor about grit.
- [49:18]
C
Yeah. Angela Duckworth's grit book.
- [49:21]
B
As a key strategy for success in.
- [49:23]
C
Life, it's hugely important. The grit of dealing with your 5 year old who just like, won't.
- [49:28]
B
But why does some people have grit and some people don't? Some people like, you know, like stub their toe and they're off work for six months. You know. Other people.
- [49:34]
C
Yeah.
- [49:35]
B
You know, they're. They're like in a car accident and they're working as soon as they can open their eyes, you know.
- [49:40]
C
Yeah, yeah. You're. I don't know, it's a little bit out of my area. I can tell you one thing. I know Andrew Huberman, a friend of mine. You're your friends?
- [49:46]
B
Yeah, yeah, of course. Yeah.
- [49:48]
C
He talks a lot about the. Some of the new data last couple of years about there's specific areas of the brain that are developed when you push through on discomfort. And so there's actual Physical structure that gets smaller when you don't do that very often. It gets larger when you do it more often. And so that was actually a pretty new finding.
- [50:05]
B
No way. So you can exercise your way.
- [50:08]
C
You can exercise.
- [50:09]
B
I mean. I mean. I mean, metaphorically exercise your tough part of your brain 100% by doing the hard things.
- [50:16]
C
I think that if you would pull up the neuroscientists in the room here, I think they would all agree with. Largely agree with that.
- [50:21]
B
Yeah. You know, I experienced this recently. I was. Had an unfortunate situation on my back and ended up, you know, having pretty severe back surgery. And I lost, like, you know, 15 pounds.
- [50:32]
C
Yikes.
- [50:33]
B
And I was in bed for a bit, and it was tough. And when I got out and I literally couldn't walk, I had a walker. And so, you know, four months ago, I was on a walker and couldn't walk. And I literally had to from within a week or maybe the day. Actually, the day after my surgery, I had to start with physical therapy, which means I had to stand up for the first time. I had to learn how to sit down in a chair as opposed to laying on my back. I had to learn how to stand up. I had to just learn how to walk without a walker and a cane. And then I had to learn how to walk without a cane. I mean, it was. And I remember just feeling like crap, like you just after you go through that. I just. I had no energy. I slept for four hours a night for six weeks. I was exhausted. And every day I got in the gym and I work with my physical therapist and I work with my trainer. And even when I was like, I am just want to, like, lay in bed and binge on Netflix and disappear from the world, I got out there and did it because I knew that if I just put one foot in front of the other and if I just built those building blocks that I could get back, and I've gained 20 pounds back. I have my energy back. I have my strength back. I'm fitter than I was before the surgery. I'm in less pain. And it was like. But that I think my doctor said to me, look, Mark, most people who went through what you went through would still be on a walker at this point. And you're in the gym every day lifting weights and. Yeah, well, you had problems running two business, three businesses.
- [52:11]
C
You had that skill because of residency, because of probably a thousand other things you've dealt with in your life where you know what resistance looks like, you know what, then getting over it. You don't want to do it, but you know what the back end looks like. Right. And there was probably many days where you failed, you didn't do it, or you. But you know what, that works.
- [52:29]
B
Or I was, I did the best I could. Which was, you know, not as intense or as much as I could do.
- [52:34]
C
Yeah. You know, as a scientist, you learn this pretty early one way or the other. When you try to publish papers, you go through peer review. Peer review is just a nice way of saying everybody gets to tell you how terrible your paper is. If you can't handle things like criticism, you learn to develop it. You have to get tough in that sense of saying, okay, great, they're probably right there. If you're out in the public sphere, if the first time you get a mean comment on social media and you just want to get back on there and fire, back away. Okay. You can develop that toughness over time. And so wherever tough means to you in different areas, it can be worked on, it can be improved. If you expose yourself, you have to keep exposing. You had to show up to the gym.
- [53:17]
B
It reminds me of that quote right loud. So said, a journey of a thousand miles begins with one step.
- [53:22]
C
There you go.
- [53:23]
B
And it's just like one step. And for so many people, it's hard to take that one step to make that one incremental change in your life or your behaviors or your diet or your exercise or your sleep routine or whatever it is.
- [53:35]
C
Yeah.
- [53:35]
B
To actually start to compound the benefit that you see over time.
- [53:40]
C
We always say the hard part about making changes in life is acceleration, not velocity. So here's what I mean. If you are used to waking up and running five miles every morning, running five miles is not hard because that is the constant velocity you're at.
- [53:54]
B
Yeah.
- [53:55]
C
But if you are used to walking, running zero miles and you go to run one mile, that is a huge difference. That is far harder than the person who runs five every day.
- [54:06]
B
That's true.
- [54:07]
C
Because it's acceleration, it's change of direction, it's massive start, it's massive stop.
- [54:11]
B
Right. That's true.
- [54:12]
C
That is the hard part. But you have to always remind yourself acceleration is going to be harder, but once you get past that and that becomes the norm, then this will be easy.
- [54:21]
B
Yeah.
- [54:22]
C
And so it's just getting through that mentality or reminding yourself constantly of it's going to be hard.
- [54:28]
B
Yeah. Because if you're like, you know, 300 pounds, trying to get down to 150 is a very daunting idea. Impossible Feeling, but, but it's possible one little step at a time. And I've seen this dozens and dozens of times with my patients. If, if, if once they sort of get, catch the threshold where they realize they can do it.
- [54:48]
C
Yeah.
- [54:48]
B
And they have their information, they have some early wins. It's, it's powerful to see what can happen to people.
- [54:53]
C
Yeah. You, you want to. In the cases like that, when people are trying to make dramatic changes, where we have found the most consistent success is you have to get some consistent practice. Don't let perfect be the enemy of good. So don't worry about getting really expensive sleep study done and blood work done and all this stuff. I don't care if your plan is perfect at all. Give me consistency. The weight will start coming off now. We'll get the plan better. Give me something.
- [55:21]
A
Nike kind of had it right.
- [55:22]
B
Just do it.
- [55:23]
C
Just do it.
- [55:25]
B
So, Andy, you know, there's a lot of myths out there in the fitness and longevity space. What are the big ones that are coming across your horizon and that you're trying to dispel on a regular basis?
- [55:37]
C
Yeah. I think this actually kind of bring. This last part of the conversation would bring up several. And that would be that there is one eating strategy that we all should have, that there is one workout routine that's better, that this type of training is better than that type of training. Or you should have this many hours or minute. None of that is objectively true for all of us. None of that. If you want an example, routine or protocol to get started because you're in that place of. I don't even know what to do. I've never used supplements. I don't work out like, I'm so lost. Great. Pick one thing. Go buy an app, go buy a PDF, go buy a work. And just so you have a plan. But let's not fall ourselves into the sense of thinking that there is. Every woman going through menopause has to work out this way. What every 30 year old has to do this with their training. None of those things are true. They're just simply not. And they can.
- [56:27]
B
Well, it's about what you want, what your goals are, where you're starting, where you need to be.
- [56:30]
C
Your physiology is different. Right. Like your ancestry is completely different. Your baseline is different. All this is there. And so that stuff can be suffocating for people. I realize again, people want examples so they know where to get started. That's great, that's fine. But the biggest global myth would be that, that there is, you know, Fill in the blank. Nutrient or otherwise. That is either awful and evil for us or we have to do it.
- [56:56]
B
Well, there's certain things I think are probably. No, there's plenty of trans fats and high fructose corn syrup. I'm like a hard no on those.
- [57:02]
C
Sure. For you. Like, great, right?
- [57:06]
B
I don't know. But I think from anybody shouldn't be eating those things.
- [57:09]
C
I don't think anyone's going to do well eating a bunch of them.
- [57:11]
B
No. Right. But once in a while, for sure.
- [57:13]
C
You can probably objectively say no one will do well eating a lot of those.
- [57:16]
B
That's right.
- [57:16]
C
I probably whatever. Probably. They're probably something.
- [57:18]
B
There's something.
- [57:20]
C
But yeah. So there's these.
- [57:21]
B
And I think everybody should exercise. The question is what, how much, how frequently, what kind of works, right? Yeah.
- [57:26]
C
There's a thousand things we could bucket into. Like, basically everybody should drink water. Yeah, okay, fine. Like, I'm not gonna. But many of the, the finer level of detail. How many grams of this? How many ounces? Like, okay, yeah, there, there's not as many hard and fast rules there. Physiology is really good at finding a way. If you give it the space. Right. If you let it have the opportunity, it will find ways.
- [57:48]
B
You talk about these concepts of aging and you say, you say you're not anti aging, you're anti being fragile. Anti fragile. What does that mean?
- [57:57]
C
So I'm younger and by the way.
- [58:00]
B
I'm not anti aging either. We all age, we all get older. I'm not into that because I am that. But I'm pro healthy aging, of course. And I'm probing more resilient and I'm probing more flexible. Right. It's like I want to be able to do what I want to do. Like if I want to go heli skiing tomorrow, I want to do that. I want to ride my bike 50 miles, I want to go do that.
- [58:21]
C
Here's what I mean by the anti aging thing. If you wanted to maximize the amount of lifespan and wellness span, health span, however you want to define that, you could, you could take away all your risk. You could go to zero. You could never leave your house. You could eat the same thing every day. You probably will live longer if all of your risk was taken to zero.
- [58:45]
B
I know somebody like that.
- [58:46]
C
So do I. And I say this with love because I wrote his exercise program. Okay. So you can do that. And you write it from the perspective of minimizing risk. My personal philosophy. And again, I've said this in public. We're not Talking behind our friends back here. My philosophy is the opposite. I'm more sounds like aligned with yours, which is I want to be able to go out and be whatever I want to be in any given moment. And I want my Achilles to be resilient against going playing a pickup game of basketball and not tear tomorrow. I want my energy to be resilient to where if I don't have food for a day, I can still be fine and not get cranky and grumpy. I want to also be able to drink some wine and not feel like my head is going to explode for two months. Right. I want to be able to be all of these things. I'm not going to do those things very often. I'm not going to do these things very often. But I want the ability to touch into areas where I can feel all of the joys and experiences of life that are the way that I want to live them while also then not compromising my long term health at all. I want very. So that's what antifragile means to me is I want to be able to have a week of really poor sleep because we're doing this huge thing in one of our companies and I'm super excited about it and we're building. Like I remember Dr. Dre had a line that said, like, if you've never worked 48 straight hours on something, you've never done something interesting. Like that was his thing of like, if you get so into what you're doing and you should have the ability to cruise and not have to be like, well, no, it's 3pm I gotta start my wind down routine. Like no chance. Right. Like I want to be able to do wild stuff that doesn't put me in a well. I'm just going to live however I want to live. And if I die at 60, I die at 60. I'm not interested in that at all. I want to live as long as I possibly can, but be as resilient and antifragile as possible. So that a bad exchange, somebody's mad at me, something happened. Okay, fine. A positive thing. Great. I want to be able to handle those insults like jumping on a basketball court and not having something blow or again, somebody being mad at me and yelling at me or getting the argument at work and not ruining my day for a week. Right. Like that's where that's.
- [60:58]
B
That stuff is basically being physically, emotionally, psychologically, even spiritually resilient.
- [61:04]
C
Yeah, right. Yeah, we want to be resilient, but we want to also Be present. Because one thing you could do is desensitize to all of it, which is not good either. Right. So somebody who is constantly working for delayed gratification has a hard time being present. So you're never going to have the piece of cake. You're never going to take the day off and go play in the lake the whole day because you got work to do.
- [61:24]
B
Right.
- [61:25]
C
Then you're going to have a hard time being in the moment and experiencing what I personally think is part of our joys of life.
- [61:32]
B
Absolutely.
- [61:33]
C
But if all you ever do is choose immediate gratification, have the cheeseburger every day, sleep in today, don't work, have the wine, well, then your delayed gratification needs need some work. Right. Make better choices. So it's finding that balance for you and your threshold of saying, how do I still choose some presence and immediate gratification while doing mostly delayed gratification.
- [61:55]
B
Yeah. I mean, the way I think about it is in order for you to be resilient and be flexible and be able to do what you want. That's my definition of health. I want to wake up in the morning and do whatever it is that brings me joy that I want to do. I want to hike up a mountain. I want to do that. You know, last, last January, hiked in Patagonia and I was able to do a 15 mile hike in a day with a mile vertical elevation.
- [62:19]
C
That's the work.
- [62:20]
B
And a mile vertical down. And, and it was like the mile vertical was compressed in like three and a half miles.
- [62:26]
C
And how sore were your quads the next day?
- [62:28]
B
You know, it wasn't so bad really. No, I, I had, I had poles.
- [62:33]
C
I don't care.
- [62:33]
B
I did poles on the way down.
- [62:35]
C
I don't care at all.
- [62:36]
B
I did pulse, I did straight to the weight and you know, we had crampons and we like, you know, did the whole thing and then the glacier in patagonia and now 64 years old. And I don't want to have to think twice about whether I can do that or not.
- [62:51]
A
Now there may be a point in.
- [62:52]
B
Life when I'm 100, maybe I won't be able to do that. I don't know. But why not? Like, I see these guys sprinting and running at 100 years old. My inspiration in junior high was this guy named, named Mr. Gibson, who was my gym teacher and he showed us movie that, you know, like things would happen when you're a little kid have these imprinting effects on you. Right. I was like 14 and I saw this movie, and I was like, holy shit. And it was a movie about people who were doing extreme athletic feats with all sorts of problems.
- [63:24]
A
Like, one guy had no feet and.
- [63:25]
B
Ran the Boston Marathon. And this guy, Larry Lewis, was 105 years old. He lived in Marin in Northern California. And he would run across the Golden Gate Bridge every day, five miles to go to work as a waiter all day. And he would run home at the end of the day. I mean, when I was in my 20s, I ran to medical school four miles and ran back four miles every day. But I was in my 20s, and I'm like, wow, if that's possible, then it's possible. And so that's my definition of health. And I think in order to do that, you have to make regular deposits in your health bank account. You can make withdrawals, totally. Right. If all you do is make money and save it, you're never gonna enjoy life. Right. But my mother always used to say that money is energy, and it's meant to be used, but you also have to save energy to spend energy.
- [64:13]
C
Right.
- [64:13]
B
You have to save your money to spend your money. And the same thing with your health. I think you have to make more deposits and withdrawals throughout your lifetime. And the cumulative benefit is that when you're older, you can do whatever it is you want to do. Like, I went heli skiing last year for the first time in my life.
- [64:29]
C
Crazy.
- [64:29]
B
You know, I mean. I mean, I wish I didn't have to wait till I was 65, but. Because it was so much fun.
- [64:34]
C
Yeah.
- [64:35]
B
You know, I could afford it now. I can do it. Before, I had little kids and a family, and it wasn't as accessible, but it. You know, that that's how I define health. And it's not just the absence of disease. It's. It's something beyond that that allows us to be resilient and not fragile.
- [64:52]
C
Well, you and I are very aligned on that, Right. I don't do disease at all like the traditional medical disease. I'm an md. We do the opposite end of the spectrum. If you want to think about that as sports, great. If you want to think about that as the ability to do 12 hours of work on your computer, great. I want you to be able to sit there and not be like, oh, I just have to go. No, get through it. Be able to be focused. Can you perform cognitively, really hard work for long periods of time? Like, you're able to hike all day through exhaustion. Right. So I want the physical capacity.
- [65:23]
B
I wasn't even that tired.
- [65:24]
C
There you go.
- [65:25]
B
Right now, my wife, she, she, it was in South America, so there's all these great wines, but I don't really drink that much. And she was drinking wine at night and I wasn't. And when we got back, our biological age scores.
- [65:37]
C
Oh, sure, hers were worse.
- [65:39]
B
Mine were better.
- [65:40]
C
What elevation were you guys at? Probably pretty high.
- [65:43]
B
You know, it's not that high there. I think it was like 10,000ft.
- [65:47]
C
It was okay. That's enough to get a physiological effect, though.
- [65:50]
B
Yeah, but it wasn't like, you know, like stupid high if it was just because it starts, it starts low, you know, and it sort of brings us to this fact of like, okay, well, how, how do we need to think about our physical activity as we age? Because, you know, in your 20s, 30s, it's different than your 40s, 50s, 60s. And for me, I don't have many regrets in life, but when I was younger, I thought, you know, cardio aerobic was important. And, you know, I, I was a yoga teacher, so I did a lot of yoga. And I thought that was my quote, strength training. And I was kind of this skinny kind of guy who was kind of not that muscular. And I was like, I don't really like gyms. I'm intimidated to go in. Like, I went to Gold's Gym in Venice once. I'm like, whoa. You know, like, all these guys literally could pick me up with one finger. And I'm like, I just feel a little intimidated, insecure. And plus, gyms are smelly and I don't loud and I don't really like. And I hurt. And if I did 10 push ups, it would hurt the 10 for three days. And I'm like, this is no fun.
- [66:49]
C
Yeah.
- [66:50]
B
And I kind of put it off. Put it off, it off. And, and I started when I was 59 to start to it really in the strength training. Yeah.
- [66:57]
C
Okay.
- [66:57]
B
And my dad, I didn't, I got him when he was 89, started on, sure. But. But it really has changed my life. And I was sort of shocked at how much I ended up enjoying it, liking it, and how much of a difference it's made and how, how much more I focus on it than I did when I was younger and particularly even more than cardio. So can you talk about how our training should evolve as we get older?
- [67:21]
C
If you think about this idea we've been talking about a lot anti fragile. Here's what this means. You want ability to do wild stuff, climb a mountain, work all day. Great. Even lower level Than that, if you want to survive, your body has to have certain physiological capabilities. It needs to be able to produce and utilize energy. It needs to be able to recover, it needs to be able to move through space. So then back engineering, what training do I have to do to fill in that gap? That's how I always think about this. Question number one, this is basic physical activity. I don't even mean structured exercise. This is step count. This is are you moving throughout the day because you can train and do all the lifting of weights and all the cardio. And if your step count is just a rough guide here, there's nothing magical about step count. But as a rough guide of physical movement is 500 steps per day, there's a lot of data to suggest you're not going to be optimizing health. So humans were meant and have spent many, many, many, many millennia moving a lot throughout the day. And so if that movement needs to be exercised, great. If that movement needs to be a standing treadmill or walking treadmill at work, if that just means you walk three times a day or you stand up, paddle board, whatever it is, you garden, you. My wife was a middle or a preschool special ed teacher for many years and she would do 30,000 steps a day because she's just running two feet back and forth all day, just handling four year old autistic kids. Right. So she didn't need any more physical activity. Where we're say 30 years old. I would come home, being in a laboratory, pipetting chemicals and taking muscle biopsies all day. I hadn't moved all day. I hadn't moved. And she's like, so I needed to at that point in my life had to re engineer movement. Yeah, I had to walk throughout the day. She did not need to go on a walk ever for her life. Right. So step number one is that is there some movement and you may need to structure that in. I may need to feel like exercise to you. Could be three 10 minute walks a day or whatever. Or it could be like, hey, my lifestyle is already physically active. That box is checked. Okay. The next step up then is do we have a ability to handle a high heart rate, cardiovascular capacity, maximal aerobic capacity, VO2 max. You could define this and organize this a lot of ways, but your heart and your whole cardiopulmonary system will do better if it can handle really high bouts of high intensity. So again, engineer this. Do you get something like that in your day already based on your vocation? Yes. Then I don't need to do as much high intensity intervals in my training or I get none of that, then I might need to do some interval training. This could be on a bike, on a rower. This could be sprint work. This could be your pickleball game. This could be a lifting about of weights, but as more of a high intensity interval type of circuit training.
- [70:06]
B
Yeah.
- [70:07]
C
Thousand ways you can get there. But something at least once in your week where your heart rate gets as high as you can get it. I don't even care if you measure it, but just you know what I'm.
- [70:16]
B
Talking about, like, but you know, it's interesting, you know we look at. I learned in medical school that the maximal heart rate of someone is 220 minus their age. So I'm 65. So for me that would be 155. 220 minus 65 is 155.
- [70:30]
C
Sure.
- [70:31]
B
But I routinely get into high 170s.
- [70:33]
C
Yeah.
- [70:33]
B
If I'm you know, playing tennis, if I'm, you know, doing heavy duty exercise. So the body can do more.
- [70:41]
C
Right, well, so you know how the 220.
- [70:43]
B
It doesn't mean I'm six, right?
- [70:44]
C
Yeah, yeah.
- [70:45]
B
I'm not sick.
- [70:45]
C
You know how 220 minus your age was developed that equation?
- [70:48]
A
I don't actually.
- [70:49]
C
So it's like a lot of science. It's, it's not as rigorous as one would think. It's a rough guide. I'm still routinely over 200 beats per minute. I'm not 20 years old.
- [70:59]
B
Yeah, right.
- [71:00]
C
We've had elite endurance athletes, elite athletes who their VO2 max is well below or their max heart rates well below predicted. So they are a 25 year old, but their max heart rate's 170 and their elite VO2 max is 75, 80. Right. World record holders, things like that.
- [71:16]
B
Yeah.
- [71:16]
C
So your maximum heart rate, that number. 220. Master age. The story, the lore is that was actually written out on like the back of a sheet on a plane ride. So a couple of guys were headed to a conference and they had to have some way to kind of present something and they're just like 220 my age and like ran some numbers like yeah, that works out pretty well.
- [71:36]
B
Oh, that busts that man.
- [71:38]
C
Yeah, it's not, we could do that with actually a lot, a lot of physical activity.
- [71:44]
B
But it does matter like when you get older to do more strength training, doesn't it?
- [71:47]
C
Well, we haven't got there yet, but yes. So baseline physical activity to get your.
- [71:52]
B
Heart rate up to a good amount.
- [71:53]
C
Not Even heart rate up, like the low physical activity. This is zone one, zone two, zone zero. I don't care what zone you have, it's moving. You have to move because you have to actually engineer the ability to create low levels of energy very consistently. Right. People that can do this stuff all day don't have lulls of energy. They're not tired, exhausted all day. People that don't that sit all day, they're way more likely to be that person that's exhausted all the time.
- [72:18]
B
Their mitochondria don't work as well.
- [72:20]
C
It's everything. Mitochondria is one way to explain it, but it's a whole cascade of physiological things that just don't work very well. So baseline physical activity, low level physical activity.
- [72:30]
B
Basically what you're saying is human beings, just like food, require exercise to function properly.
- [72:34]
C
Yeah. Now you move up to that higher intensity stuff, then you have to say, okay, great. Cellular stuff is okay. Endocrine system's probably okay. Lymphatic system's probably okay. Immune system's probably okay. Because I'm doing my physical activity, things are moving, things are pumping, things are functioning. I'm keeping my brain alive. We're flowing. I got high heart rate up. So that kept my left ventricular, Left ventricle functioning well. It keep my aorta, like the physical structures of your heart, and let us go. Great. But you haven't really taken care of muscle health yet. So skeletal muscle, very specifically, is not gonna respond optimally to those first two things. I said you don't have to. But if you look at. There's lots of research on lifelong strength trainers, lifelong endurance athletes.
- [73:21]
B
Yeah.
- [73:23]
C
Neither one of them are at their best.
- [73:26]
B
Meaning if all they do is strength training or all they do is cardio.
- [73:29]
C
We've done this research in our lab with twins. Right. So monozygous twins, exact same DNA with different things. And when you look at the folks who don't lift weights, they don't tend to have as high muscle quality. They don't. They start to lose power and speed more frequently. This is a problem as you age successfully, because now your reaction time slows down, your ability to catch yourself from a fall slows down because you don't have speed and foot power and the eccentric strength to catch yourself and brace and stop the fall. And a whole host of things happen. And so adding in strength training, however, that looks for you, if that means to be. You need to walk into the gym for 30 minutes, get on a couple of machines, not know what you're doing, that's fine. Like that is enough.
- [74:15]
B
I don't know about that. Not only do you're going to cause yourself injury sometimes, Right.
- [74:18]
C
Generally when you're starting, you're going to be okay. Unless you're doing things really heavy and really aggressively, you're fine. Right. If you just pop on a machine, kind of do 8 to 10 reps, don't really know what you're doing, you're actually going to be fine. But having some component in those three domains now, by doing that, you've also probably built some proprioception, some balance. Hopefully you're going through full range of motion. So now you're working on flexibility and mobility. Because every time I talk about things like this, people are like, you don't talk about flexibility everywhere. I'm like, well, you don't need to necessarily go out of your way to train it. If you're moving properly, if you're lifting weights in a full range of motion, then flexibility is in large part taken care of. If you want to add some more on top of that, great. All for it, go ahead. If that means yoga, awesome. If that means stretching, great. Pilates, fine, all those. But from a physiological need to survive, those are the things, they keep all those systems intact. And there's ample research now on the brain. So you're talking about dementia and Alzheimer's. Prevention heavily, positively benefited by these things. And so if you're doing those three categories, you're metabolically going to be healthy, your bones will be healthy, your joints will be healthy, and your brain will stay healthy. That is going to be our massive quad factor for staying alive for a long time. So at least once a week for all of those. If you like lifting weights more and you want to do two or three times a week with it, great. If you're more into endurance, you want to do that and you want to keep strength training once or twice a week, fine. You can shift along the spectrum here. But I would say most people need to have at least one of those three components every week.
- [76:02]
B
And as a doctor, when you begin to understand the physiology of exercise, what actually happens to your body and the profound like, like the profound changes that happen in your body when you exercise that literally can mitigate slow or reverse most chronic diseases.
- [76:22]
C
Yeah.
- [76:23]
B
And that, that can actually activate all these longevity pathways in your system.
- [76:30]
C
Yeah.
- [76:31]
B
And you mentioned a lot of them. There is nothing else on the market that can do that.
- [76:37]
C
Yeah. I mean, if you start stacking up sleep and exercise, everything else, of course, nutrition would be up there. Right. But if you want bang for your buck, everything else gets way down the list of magnitude now. Like, way, way down the list.
- [76:53]
B
I always say you can't exercise your weight of a bad diet. So that is true. I see a lot of people are exercising a lot and still very overweight or metabolically because they haven't changed their diet.
- [77:03]
C
Certainly related to body fat, body size and body composition. Yeah. You're going to have a really hard time catching up to the plate.
- [77:09]
B
Yeah. Before reminded me what Peter TIA says, don't major in the minors and minor in the majors. Which essentially is like the majors are sleep, exercise, what you eat.
- [77:19]
C
Yeah.
- [77:20]
B
And then everything falls below that, Right?
- [77:22]
C
Yeah. I mean, as long as you're not like in this, this energy toxicity, then like in the fact that. What I mean by that is you're total caloric intake is egregiously and excessively higher than your expenditure. Right. And there's a lot of stuff within that. But if you do that and your body composition is okay, the next biggest things you can swing are sleep and exercise. Like, it really does have a huge impact on you. Again, we've done some of this work in our lab. You can. You pick the thing that you're most interested in. You know, I want to have more energy. I'm worried about dementia. Okay, fine. Like, and we could show you data on data on data that are just going to like overwhelm you. And what's great about this, like, I'm so tickled for the last decade because as an exercise scientist, this is stuff we've been screaming for 30 years. And now the, the other communities are catching on and we're like communication. Like we've been saying this. I actually took when I was a PhD student, we did our anatomy class in med school. So I was the only PhD. And then the rest were future MDs. But the guy teaching it was a PhD, not an MD. Right. So it was like, all right. And we would go, you remember med school? You would go through these, just onslaught. You do a whole medical chapter a day.
- [78:38]
B
Right.
- [78:38]
C
In the curriculum. The next day is the next chapter. Right.
- [78:41]
B
It's a lot. It was a lot.
- [78:43]
C
And we spent like two and a half or three days on diabetes medications. Right. And you're just going through, okay, this is what this does. Here's contraindications, here's side effects, here's mechanism, blah, blah, blah, blah. Right. You just go through them all. I'm just like, like pulling my face off or my skin off my face. Because I'm like, this is awful. I hate all this. Right. But you have to know it. Okay, great. And then he gets to the very end and he's like, oh, yeah, and then we forgot. And you'll know where the story's going, but he said, we forgot the last drug on the market. It does everything we've talked about already. It has a higher aptitude of effect. It has no side effects. And like, I knew where he was going immediately. I was like, finally. He's finally going to say it after two days of torture. And all the kids are like, they got their notebooks out, their pens are ready to write this drug down. And I won't say the word on here, but he said it's bleeping exercise and slammed on the table and walked out.
- [79:32]
B
That's right.
- [79:32]
C
And I was like, there you go.
- [79:34]
B
That's it. That's right.
- [79:35]
C
And now, even this week, there's other data that got published on type 2 diabetes and muscle mass, effectively showing if you have high quality muscle mass, it's extreme, extraordinarily rare to have type 2 diabetes.
- [79:44]
B
Yeah, yeah. I mean, it's interesting.
- [79:45]
C
You just don't get it when you.
- [79:46]
B
Look at type 2 diabetics. Their mitochondria are half as functioning, half as effectively as, as people who don't have type 2 diabetes. And that is related to exercise.
- [79:56]
C
If you have high quality muscle, it's really hard to have metabolic problems. Yeah, it's not impossible, but it's really hard. And so when you look at like a, what can I do about it there, maybe you have something going on with. You have a, something happening psychologically and food is a problem or trauma or like, at least something you can do is have good muscle. Good muscle will help you metabolically more than just about anything. And then you can work on the diet, if that's the sticking point or. Yeah, we want you to start there. But you get what my point is saying.
- [80:25]
B
Yeah, no, boy, get muscle. Important for brain health, heart health, hormone health.
- [80:29]
C
Yeah.
- [80:30]
B
Digestive health, lymphatic function, muscle health.
- [80:32]
C
I mean, this endocrine system runs through muscle.
- [80:34]
B
You know, I co founded a company recently called Function Health that. Yeah, I've heard deep, deep comprehensive biomarker testing.
- [80:40]
C
Yeah.
- [80:41]
B
And you know, we're looking for all sorts of things and we're recognizing that they're biomarkers of mental health, metabolic health, cardiovascular health, so many different things, brain health. But you kind of look at it from a little different angle. And you, you co founded a company called Vitality Blueprint. Which looks at blood work for performance, which is the other end of the spectrum, not disease, but like what can your blood test tell you about where you are in the spectrum of human performance and optimizing that? And how do we look at biomarkers and customized approach to health that like can expose hidden gaps in our energy performance resilience that we can learn from blood testing.
- [81:21]
A
So what, what are the most important.
- [81:23]
B
Blood biomarkers for performance that are overlooked and that you can act on things that you can make a difference with?
- [81:28]
C
Yeah. So it's not necessarily about the blood markers. There are some esoteric ones at the very end. Right. So for example, for a high performance athlete, we might spend more time on a panel of magnesium related markers. So not just serum magnesium. That's a really bad way to understand magnesium in a system. Right. Because it's almost all in bone, but something like magnesium rbc. Right. There's other ways. Okay. Copper, zinc. There's some other things we would do in a micronutrient end of the spectrum that you're probably not getting as just a general health. But to be honest, Mark, like that's. We don't spend a ton of time on those ones. We look at almost all the same markers you probably have on your. What's your best panel at function? Probably 100 markers.
- [82:11]
B
Yeah. 110 biomarkers and then 60 and a half a year. Yeah.
- [82:15]
C
Right. Our biggest panel @ vitality is 100 some. Right. And it's probably, if I had to.
- [82:21]
B
Guess, probably the same ones.
- [82:23]
C
Many of the same. Probably.
- [82:26]
B
Yeah.
- [82:27]
C
What we do differently is entirely based upon how we're analyzing, interpreting it. That's the big thing. If you're here because you are concerned about whether you need hormone therapy or you think you have a clinical issue, go to function. Vitality cannot help you. If you want to know your lpob, I'm sure you guys measure those. Yeah, we don't measure them. Yeah, we believe they're important, but that's not something I can modify to make you perform better tomorrow. Right. Go to function for all that to work with your team. What we are gonna do is look at those markers and say, do you have a bunch of things that are suboptimal? Maybe you don't hit a clinical threshold, but you're on the low end and you're not in what we call our high performance range. So you wouldn't be here to have the most energy, you wouldn't be here to have the most muscle recovery. You're not as anabolic as we could possibly be. Now, do we have a string of these? What patterns are we recognizing and what can we do with that? And how do we program solutions that are something that an athlete can do? In other words, lifestyle, nutrition and or third party certified supplements. Right. We don't give medications, drugs, any of those things come out of because our athletes can't use it. Right. Whatever reason. That's your doctor's perspective. I can give you a thousand examples. We talked about a couple earlier. But let's take a look at something like hematic or hemoglobin. Just because we brought that up earlier.
- [83:53]
B
Yeah.
- [83:54]
C
So when you look at endurance exercise, the single most important adaptation you will get is total blood volume. That's the name of the game. You want to go after more blood volume. If you see more blood volume, your fitness will be up. If it goes down, it is the opposite. Most people have no idea. This is a total blood volume game. Now, I doubt you've ever ordered a total blood measure. No.
- [84:14]
B
I was like, what is that test?
- [84:16]
C
You can't, right? It's not something you're going to order.
- [84:19]
B
Okay, good. I was like, wait, did I miss that in medical school?
- [84:23]
C
You did, actually. Okay, let me ask you this. You may or not remember these numbers, but if you had somebody come into your clinic and their total blood volume was 8 liters, most MBs are going to go get them on a diuretic. Right. Now you're going to have a cardiovascular event, right?
- [84:36]
B
Sure.
- [84:37]
C
I'm going to look at that and go, that's it. That's a super fit. Because they'll both be true. Right. You have to know, one's a heart.
- [84:44]
B
Failure patient, one's an athlete, they're different.
- [84:46]
C
Exactly. Right. Same blood marker and a different range. Right. So total blood volume is our key. Now on a blood test, where you would go from that is hematocrit, hemoglobin. Right. You can't get total blood. It's a difficult thing. And so the numbers I said earlier, if you're female and your hematocrit is 44, 45, 46, your male, it's a little bit higher. 47, 48, 49. Okay, great. Now I'm gonna stack that up against something like hemoglobin. And your hemoglobin for a female is 13, 14, 15, male 15, 16, 17. I'm looking at that. Going great. Pretty good markers there. Function might flag those and go, hey, these are higher than they should be. There may be some cardiovascular stuff. Go get checked out. Totally different thing Right. So the same exact numbers is the interpretation where we would look at. Then that next is something like the sleep apnea stuff. Are you saying no? How's your energy? No, it's great. Throughout the day. No sleep apnea. These are training induced. We know you've been exercising. Here's our questionnaire. Do you train a lot? Yeah. Okay, interpret there. Then we could go on to other ones and say, let's look at cholesterol markers. Cholesterol markers. Not from your heart disease perspective, but as an inflammatory marker. Like, specifically, like things like ldl. If you see elevated blood glucose and LDL and somebody's eating really well and training really hard, and then you start looking at second and third tertiary markers of inflammation like crp, creatine kinase, like esr, and you start to say, wait a minute, those are all fine. Creatinine, creatine or creatine. All these are good here. But LDL is elevated. Okay. Now actually go talk to your doctor. You might have something happening here, familial or some other reasons. Right. But if we look at that and go, okay, blood glucose is a little bit high and hemoglobin number is a little bit off, we can actually cross reference. Is this acute dehydration? Is this chronic dehydration? Is this inflammation from exercise? We stack on something like AST and alt.
- [86:40]
B
Liver test.
- [86:41]
C
Liver test. Well, ALT very specifically. Right. But AST is the most amount of AST in your body is in muscle. So you will always see, almost always see elevated AST in people that have a lot of muscle mass. We see the same thing in liver, too, because it's a, like, it's a relationship there.
- [86:56]
B
You have a patient like that who's like 200 and like 70 pounds of solid muscle.
- [87:02]
C
Oh, yeah.
- [87:02]
B
Like, well, your ale. Your liver tests are off me.
- [87:05]
C
Like, yeah, yeah, he's not going through liver failure.
- [87:07]
B
No.
- [87:07]
C
Right. So you could actually look at something like cystatin C. You can start going down GT and other markers and saying like, okay, we can cross rummage. Liver's fine. What you're seeing is you're jacked. You have a lot of muscle. Right. And so it's being able to look just at the markers themselves and understand, oh, this is an exerciser. This is an endurance athlete. This is somebody that has just a lot of muscle mass. Now what do we do about it? So when you look at the same markers, albumin, sodium, potassium, I almost guarantee everybody has had albumin on every blood test they've ever done, for sure. And Almost never.
- [87:42]
B
Which is the protein in your blood.
- [87:43]
C
Yeah, yeah. It's the protein in your blood that carries tons of markers. Cortisol.
- [87:48]
B
Yeah.
- [87:48]
C
Anabolic hormone stones. It's never out of range. So most people skip right by it. Right.
- [87:54]
B
Well, it is if you're malnourished. Yeah.
- [87:56]
C
It's super high in only one case, basically in the case of your dehydration. Right. So because it's a concentration issue right now we're going to go back to hematocrit, hemoglobin. They're also concentration issues. Right. So they're matter. So if you see albumin, hematocrit, hemoglobin, all going after the same thing, then we can look if hemoglobin, or, sorry, if albumin is normal, you'll see acute dehydration. If hematocritin, hemoglobin are up because they're concentration issues. But if all three are elevated now we can see chronic dehydration. Those, all three will be within the reference range, but they'll all be on the upper end.
- [88:34]
B
So you're kind of reading the tea leaves. You're seeing the same thing that everybody else sees as a doctor.
- [88:39]
C
Yeah.
- [88:39]
B
But you're picking a clues within those biomarkers that everybody else is missing the 100%. It's that interpretation and they give you insights into the, the level of fitness, health, performance, dehydration, all sorts of subtle things that, that affect the quality of your ability to perform and function, whether you're a corporate athlete or a, you know, professional athlete.
- [89:04]
C
Yeah. Right. So because these things are not, again, clinical cutoffs, but someone's not asking to say what's my disease risk? They're saying I want to look, feel, perform better right now. And so our granularity is different. Our expectations, the reference ranges that we use are entirely based upon maximum health. We published a study a couple years ago where we looked. You're familiar with NHANES database, that's the.
- [89:27]
B
National Health Nutrition Examination Survey.
- [89:29]
C
You're very familiar with that.
- [89:30]
B
Every year, and basically the government surveys the population, does blood work and various diagnostic tests, vaccinate. It's a great way of tracking a population. We learn a lot from it. Like 90% of us are nutritionally deficient, for example.
- [89:42]
C
This is what has been going on for 30 plus years. So you have good data on people over 30 years right now there's an enormous amount of problems with enhance. Right. But if you were to go to order a blood test right now from anybody and something is high or Low. What they mean by high or low is on a bell curve. Right? Yeah.
- [90:01]
B
You're out of the normal reference range.
- [90:03]
C
But that normal reference range is 95 percentile.
- [90:05]
B
Yeah.
- [90:06]
C
So if you are high, that means you're in the high two and a half percentile.
- [90:09]
B
Yeah.
- [90:10]
C
But let's say, Mark, you're in the 95th percentile.
- [90:14]
B
Yeah.
- [90:15]
C
I don't want to be the night like I want to. You're just a little bit not diabetic.
- [90:19]
B
Yeah.
- [90:19]
C
Like, whoa, hold on. Timeout. Right. Like as a medical doctor for general population, that is. That's what we should be screening. Right. Like huge disease.
- [90:29]
B
But I'm like you, though, as a doctor. I don't, I don't look for what's quote, normal. I look for.
- [90:34]
C
Yeah.
- [90:34]
B
Reading the tea leaves about where the. Where the edge cases where people moving in the wrong direction.
- [90:40]
C
Yeah.
- [90:40]
B
That it can be subtle.
- [90:41]
C
Exactly.
- [90:42]
B
That aren't like, you know, labyrinth ranges. Vitamin D is 30. Well, I think it should probably be 45 to be optimal.
- [90:49]
C
Or our performance range is 55.
- [90:51]
B
Yeah. Or. Yeah, exactly.
- [90:52]
C
55 to 75.
- [90:53]
B
Or Ferritin, you know, the reference range for your iron stores is 16. Well, it should be probably 45 or 50 to be good. Right.
- [90:59]
C
So you. So that's another great example. Right. Like you. There's actually recent papers on ferritin. Very specifically, you'll see reference ranges like, do you happen to know offhand what your guys's ferritin reference range?
- [91:09]
B
16.
- [91:10]
C
Okay.
- [91:10]
B
It was the low end.
- [91:11]
C
What's the high end? Probably would flag. Okay. You'll see 300 to 400. Right. So get your labs back. And your ferritin won't say that it's higher, low, unless it's lower than 15 or higher than 400.
- [91:25]
B
Crazy.
- [91:26]
C
What am I doing here? Right. Despite ample data that says, like, yo, if you're over 180, you're going to have inflammatory problems, you're going to have oxidative stress. Like you're going to have all these things there.
- [91:34]
B
Right.
- [91:35]
C
So going with the NIH or the NHANES thing, here's what I was saying. We looked in that database and what's interesting is there was no relationship between the amount of muscle mass people had and their strength training history, really, in that database. You know what that tells us? How did they get their muscle if they had a lot of muscle that hadn't. We had no bearing or understanding if they lifted weights or not. Which means people in those national databases have generally accrued their muscle by just being bigger. Larger people, eight more. Bigger body mass comes along with more muscle. That's the type of population that we're using to build these reference ranges on.
- [92:18]
B
Yeah.
- [92:20]
C
Do you want to be compared to that?
- [92:21]
B
No.
- [92:22]
C
Okay.
- [92:23]
B
So my sister always used to tell a funny joke. She says when the Vermont farmer was asked, how's his wife? He says, compared to what? Compared to what? Is the answer always?
- [92:35]
C
Right?
- [92:36]
B
Right.
- [92:36]
C
So we are comparing to what we believe based upon the available data, our 20 years of database internally, and how you should be performing at your best. And then from there, we're going to work to craft. And what's really careful and specific about this is we're going to work to craft solutions that are solving as much we can. What's causing biomarkers to be up? So there's a handful of biomarkers. You mentioned vitamin D. That's a really easy one. If vitamin D is low, the solution is very simple. Get vitamin D up. Right. You want to use sunlight. We would all advocate for that most. Right. You want to go to food, you want to go to supplements. That's your choice. But low biomarker, get that biomarker up. That's not the case for other biomarkers, though, just because, like, for example, if your sodium is low, you don't need to ingest more sodium in your diet, you don't need more electrolytes, because that is not. That is a systematic marker that is telling us something about acute fatigue and chronic fatigue. That is over training. That is a sympathetic overdrive marker. So if you start to look at things like sodium and potassium ranges, and sodium is trailing low still within the reference range, potassium is trailing high, sodium potassium ratio specifically starts getting below 30 or above 35. I now know this has nothing to do with your diet per se. Has nothing to do with you needing a banana or a packet of element. Right. Which all in love of this is a case of you saying, okay, your allostatic load is too high. What is going on here? We need to reduce fatigue. That that is the entire thing there. That that is the key function of like, it's not necessarily looking at the market saying it's higher, low. Then therefore, take this thing, take less of this thing. It is trying to backpedal and say, well, what is the cause of that? And so when we can come back in that particular case and say, hey, you actually need to tone down your training a little bit, and then those markers go back up.
- [94:36]
B
Stress response goes up when you're training too much.
- [94:39]
C
And every single time in that Exact example, what do you think happens to DHEA pools? What do you think happens to total testosterone? What happens to free testosterone? They're plummeted. Right?
- [94:51]
B
Yeah.
- [94:51]
C
And so we get to like, oh, my low testosterone's. My testosterone's low. That's why I'm tired. No, no, no, no, no. You're tired because of up here. Fix that and then watch that testosterone go way up. Right. There's plenty of cases when you need to take exogenous testosterone, but you get the point here.
- [95:09]
B
So we really have to rethink the whole way we interpret lab tests, which is not what's normal, which is just a statistical number based on averages in a population. And the population, if it's sick, it's going to be skewed sick.
- [95:21]
A
Right.
- [95:22]
B
It's where we can read the tea leaves to sort of interpret variations from that normal range that give you clues about what's happening, either for disease or perhaps things that affecting your energy, performance, fitness, quality of your health, even if you don't have a disease.
- [95:38]
C
100%. Right. So we were trying to say you want to perform at your best. You tell me what perform means. I don't care. I want to be able to do abc. Fine. Now we're going to look at that and say, if you wanted to perform at your absolute best, what would that look like? Right. It's not necessarily about having fancy new markers. It's taking the information we already have in front of you and getting more extraction of more objective data, asking very scientifically validated questions. What's your objective? How do you feel? Right. So A, B and C is here. But I feel great. That might be a normal thing. So what we create is what we call molecular signatures of people and we establish this signature of people and now we understand what is your normal variation. So I have a handful of things and you'll see this really commonly in house.
- [96:23]
B
How do you vary from your optimal?
- [96:24]
C
Bingo.
- [96:25]
B
As opposed to somebody else's optimal?
- [96:26]
C
Like MCV tends to be very high in people. Not very like, a little bit elevated. I guarantee your MCV is probably at the upper end all the time. Probably up there all the time. Normal for you, probably. You might even be out of the reference range. Pretty normal thing. Right. If you were out of the reference range for another marker, though, like albumin, if your albumin was constantly seven, I'd be like, that's a problem. I don't care what your argument you're going to make, that is a problem. So there is clear distinction of like, this is Dysfunctional. And then there is. These markers are really sensitive. These markers are really insensitive. What is your normal milieu? What is that molecular signature that comes with your lifestyle, where you live, the water you drink, what kind of food you eat? And now let's create deviations from that that allows us to then not beat our head in the wall with supplements or whatever to try to fix something that is not actually a problem.
- [97:22]
B
And I think what's really exciting, Indy, is that things like sodium potassium ratio, like, that's something doctors never learn anything about.
- [97:30]
C
It's really clear and super present.
- [97:32]
B
Right. And so, so I think what's really exciting is we're entering an era where you're not going to have to rely on an individual doctor or an individual exercise physiologist, but we're going to enter an era where we're going to be able to use AI to help us look at all the world's literature on how to optimize for performance or health using biomarkers and get insights that we never had before.
- [97:57]
C
Well, combined with your individual data.
- [97:59]
B
That's right.
- [98:00]
C
Search the literature and give me my N of 1. Right. Because this is a combination. As a medical doctor, from your perspective, you have your evidence based practice and then you have the, well, I've been working with this girl for 15 years. I know her physiology. How do you meet that in the middle? That is the new age of meet in the middle. Now let's have AI scan all the literature. I can't catch it all. But let's also integrate your unique signature and let's figure out what is the path forward for you based on your goals and wants and desires and whatever else that you certainly care about. Right. Incredible. This is our new avenue forward. Our stuff is software. You can take any of your old blood work and upload it through our stuff and have it all analyzed, interpreted for you in this exact frame of mind.
- [98:42]
B
Amazing.
- [98:43]
C
So someone can take function and go, great, here's my blood report. Go to my medical doctor, then take their function thing, upload in vitality and go, great. I want. Now the performance swing.
- [98:52]
B
Yeah, I want to do that.
- [98:55]
C
Yeah, let's take a look at it.
- [98:55]
B
I want to do that. You think we're testing too much or not enough?
- [98:59]
C
Oh, that's a really good question. Here's how I'll frame my answer. In the next two to five years, that question will be entirely different because of technological advances that are going to allow you to do some of the things we have to do in Venus. Draw Full normal blood draws at home in a continuous fashion, like continuous glucose monitor. Great. Well, now that technology is advancing, where we can get a lot of biomarkers continuously, where we can get kits at home, we can do tests at home. And there's a lot of the market now. A lot of them are really clunky and don't work. And their numbers are way off. I've tested a ton of them.
- [99:32]
B
Yeah.
- [99:33]
C
But it doesn't take a stretch of the mind to think it's going to be there. Maybe it's three years, five years, it's going to be Theranos. Probably won't ever happen. But okay, so how does this look when we can repeat these tests and we've done lots of experiments where we do full hundred markers every day for like six days. Right. He's like, how much these. So we're getting a sense now of stability and instability of individual markers and variance within people. That is where this thing is going to go. So when you ask about like we testing too frequently or infrequently, it kind of depends on what your aptitude for this stuff is. If you're the.
- [100:04]
B
I don't mean frequency, I mean enough biomarker. Because, you know, a lot of, a lot of. A lot of the medical profession goes there's too much unnecessary testing. It leads people down the wrong road.
- [100:14]
C
I'll answer this.
- [100:15]
B
Pairings and anxiety and it's unnecessary, it's.
- [100:18]
A
Too costly, blah, blah, blah, blah.
- [100:20]
C
I don't think that's for a public official to decide. Right. I like a ton of this stuff. This is what I do. I have also seen that case. I have seen that case where people have given themselves extreme legitimate clinical anxiety, depression from things like that. Our, our clients, if they don't have.
- [100:37]
B
The right guidance with it.
- [100:39]
C
Our people have come into our coaching program, paid a lot of money and we've had to go, you're done. We're taking your. Some of our athletes. John Rom, professional golfer. He's said this a bunch publicly, so I can say it. The. The whoop or the. Or had to get taken off the sleep tracking was causing issues with him. The same thing with blood. We've had plenty of our clients were like, dude, you're done. Like this is a net negative big time. And that was the opposite. So I don't think this is something we could generally say of like there. If we're thinking about what should the government pay for? That's a different question. Right. What should be covered free for me, those are different questions. I understand if you're an official that's making those decisions and you want to make an argument that we shouldn't be making it. Free to have Mark's 400 panels measured for everybody at age 20. Oh, okay. But that's really different than me paying cash out of my own pocket to do what I want with my medical choice. That's a, that's a fun.
- [101:37]
A
I agree.
- [101:38]
B
And I think we're entering an era where the costs are coming way down.
- [101:42]
C
Way down.
- [101:43]
B
The capacity to do not just more just general blood tests, but metabolomics, proteomics, omics. For literally pennies.
- [101:51]
C
Yeah.
- [101:52]
B
I mean, we're seeing just amazing scale. Like, you know, Moore's law is applying to medicine too, of course. And, and so what was a billion dollar test to get your genome sequence is now 300 bucks.
- [102:04]
C
300 bucks? Yeah.
- [102:05]
B
So it's like, okay, if, if, and, and then the question is, what do you do with all that data? How do you make sense of it? And that's where AI, machine learning comes in, I think. In my view, it's always good to know. Like, I've never been sorry. By knowing more data about an individual.
- [102:19]
C
Yep.
- [102:19]
B
To help me guide them about what's going on.
- [102:22]
C
It all comes down to a couple of things. Run again. Knowing your patient, in your case, knowing your, your person, who you're working with, how do they respond, how they react, that stuff. But I would make a really strong argument, and I would fight anybody on this, if possible, at age 30, maybe 35. Get a baseline of everything. Here's what I mean. Everything. A VO2 max test, a full DEXA scan of bone density. Now those numbers and body count. Yeah. Body composition, of course. Right. Metabolic health testing. Way over 100 biomarkers, blood based biomarkers, a cognitive test. All this stuff should be done at around 30, 35. The vast majority of people will walk out of that test with no medical problems. And that would be the point. That would be the exact point. And now we don't repeat that every year, maybe even every five years, but let's get it at 30. And now when you're 40, we repeat. Because when you show up to my, to our program at 40 and your VO2 max is 25, and that's not good. Fill in the blank. Right. Let's. Let's take a more egregious one. Your total testosterone is 400 and your fatigue, low energy. I think I have. No, maybe you were at 300 when you were 25. Maybe it's up. I don't have any idea. 400 is like this gray zone, right? Of like, I don't know, maybe it was a thousand and now it's 700. And that's why you feel because you're down 300, there's way more complication. But you see the point. I don't have any idea what base science we do this, which was actually like, there's so much crossover between our groups, it's funny. So I know you guys just got Ezra imaging.
- [104:05]
B
Yeah.
- [104:06]
C
Cool. So you're doing blood and MRIs for cancer, right?
- [104:08]
B
Yeah.
- [104:09]
C
So you're doing blood for disease and much more. Yeah, we do the same thing. But you know what we do with our MRI scans? We use Springbok. Springbok does the same thing. 20 to 30 minute full MRI, full body MRI scan. And it gives us a three dimensional image of every muscle on your body. There's no cancer screen there. I have no idea. I don't care. But what I can look at is what's the exact size of your vastus lateralis on your right leg versus your left leg. What's your hamstrings groups look like? Like each individual muscle.
- [104:41]
B
Interesting.
- [104:42]
C
And so now I have baseline. So for Lance McCullers, for Walker Bueller, another one of our major league baseball pitchers, I'm going to look at every single rotator cuff muscle and I'm going to watch it develop every single year, ideally twice a year, and start to say, okay, you have to have your elbow and shoulder be able to throw a hundred pitches a game for 30 games a year. So the development of your infraspinatus by 10% versus your Terry's minor, this is a big deal for us. I wouldn't do that for you. You don't care. Right, But I might look at it.
- [105:13]
B
Not throwing any pictures, I might look.
- [105:15]
C
At it and go, oh, do you realize your trap on your right side is 25% larger than your left side and you've been having a lot of neck pain. Weird. Oh, your gastroc on your right side is 40% larger than on your left side. And that hip's been bothering. We can start to see huge information asymmetries. But if you do it at 30 or 35, whatever. Now we have that baseline. Do you know what sarcopenia is? I know you know the term. Yeah, but scientifically we don't even agree with. Sarcopenia is muscle loss.
- [105:47]
B
But what does it mean?
- [105:49]
C
But how much is normal, how much is not? Well, you know why we don't know. We have no database. I have no idea what a normal amount of muscle is. I have no idea. All we have is like BMI studies.
- [106:01]
B
Right.
- [106:01]
C
But imagine if everybody was scanned through a springbok and I can say the average 60 to 65 year old male, his vastus medialis was this big. And I could do the distribution, the 95% distribution that we do on blood work for every muscle in your body. And so now you get that acl, you get that a knee replacement and they clear you after four weeks because you're not in pain, you know, your flexibility is back. But I can look and go, whoa, whoa, whoa, whoa, whoa. That Valcus lateralis is 80% of where it was before the surgery. We need to now write five more physical training sessions or physical therapy. This is why we're justifying it. We're not back to return.
- [106:42]
B
Yeah.
- [106:42]
C
Or we're aging improperly. This is where you were. Every five years we run this scan and now we are seeing this advanced drop in muscle mass. Yeah, the thousand things. Right.
- [106:54]
B
Incredible.
- [106:54]
C
So what we're doing is like very similar, but I'm doing it from this end of the spectrum and you're doing it from.
- [107:01]
B
Yeah, it's true. I mean, you know, you're talking about, you know, muscle mass and, and, and, and muscle function and, and the variations. But you know, I think our ability to get large data sets on individuals is going to change our whole healthcare system. And as the costs come down and as it becomes more democratized, you know, people want to use their HSAs or FSAs to pay for it. There's just so much we can learn. I mean, it didn't occur to me until after function acquired. Ezra, which is a full body MRI and imaging company that also does other imaging that combined with liquid biopsies.
- [107:39]
C
Oh, sure.
- [107:40]
B
And full body sort of biomarker testing and annual serial Full Body MRIs, which we've gotten down to 4.99, which $37 a day.
- [107:51]
C
I saw that announcement, I was like, what?
- [107:53]
B
Yeah, it's crazy, right? We cut the price because it was.
- [107:57]
C
Like, it was like. Yeah, it was like 1500 or something.
- [107:59]
B
Yeah. Five times less price.
- [108:01]
C
Yeah.
- [108:02]
B
And it just sort of. The light bulb went on and I'm like, wow. If you start when you're say 35 and do that, you never have to die from cancer. No one ever has. We can't prevent getting cancer. Yeah, but we can make dying cancer a historical footnote by getting this data every year. My dad died of cancer at 91. My sister died at 57. My dad was otherwise very healthy. Walked his dog two or three miles a day, was playing tennis at 90 years old. But you know, he's a smoker when he's younger. And if he'd had this low dose CT and if my sister had the full body MRIs, they never would have died. And. And I realized, wow, I have a choice. Like, I can. I can make dying of cancer optional. If I ignore it, I might die of cancer. But if I do screening every year, I'm never going to die of cancer. Because when you pick it up in stage one or two, it's over 95% survival at five years, which is, you know, basically a cure. So, yeah, it's a different era. Okay, so you can do it.
- [109:05]
C
So my point here would be something like Springbok can be. It doesn't require a special machine. It can be done on an MRI machine. So now let's add that on top of the cancer screen.
- [109:17]
B
Yeah.
- [109:17]
C
And now you never have to die of low muscle sarcopenia. Could be gone. Yeah, it's right there. Right.
- [109:24]
B
We do actually offer MRI body composition testing. It might be different than what?
- [109:28]
C
Oh, it's totally different. Right? Yeah. Because you're getting how much muscle versus body fat, which is great. But now let's image and 3D model every single muscle.
- [109:35]
B
That's crazy. It's amazing what we can do. So you've done a lot, You've built labs, you've coached champion athletes, you've done plenty of analysis of people, Primarks and blood and sleep.
- [109:46]
A
What do you do?
- [109:46]
B
What are your, like, non negotiables? Because you're talking about resilience and flexibility. But, like, you gotta have stuff that you just like. That's Andy's non negotiable. What's your dealing?
- [109:55]
C
Okay, I don't like non negotiables in the traditional sense. As I said earlier, I want to be able to not work out and be fine with it. I want to be able to not eat and be fine with it. Right now there are certain things I'd like to do. I like to lift weights, I like to exercise. I live up in the mountains. I love. I'm so obsessed with wild animals, particularly deer and things like that. Like, that is my jam. It's my new Instagram. Like, if I'm spaced out at work, I'm not on my phone. I'm for sure looking out my window for deer.
- [110:25]
B
You don't have to do that in Austin. Here we got deer on the lawn everywhere.
- [110:28]
C
We're in the Lawn.
- [110:29]
B
I'm coming out of my property all the time.
- [110:31]
C
I texted my wife, I was like.
- [110:32]
B
Yo, yeah, if there's the apocalypse, we'll be fine. There'll be plenty of food to eat in Austin.
- [110:37]
C
We have deer all over our property.
- [110:39]
B
Without us, no predators here.
- [110:42]
C
The only real honestly, like my true non negotiables, as in things I force myself to do every day, is some sort of involuntary gratitude.
- [110:56]
B
Wow.
- [110:56]
C
Thankfulness. Right. So no matter where I'm at, no matter what I'm doing, I always try to remind myself because it's still wild to me. It's wild. I'm sitting in this room like, you've been around for so long.
- [111:08]
B
Thanks.
- [111:10]
C
And I'm like, 20 years ago, it'd be like, hey, what are the things the chances are you'd be in room with Mark Hyman, say zero. Zero. Right? Where I come from, my background, the kids that I grew up with, and I'm like, the things I've done. I was just in the Middle East.
- [111:23]
B
Yeah.
- [111:24]
C
I've been with the world's most successful athletes. I'm like, my business partners and I, my wife and I, my brother and I, I'm still just like, how? How did this all happen?
- [111:34]
B
Yeah.
- [111:35]
C
So the one non negotiable for me is always, no matter what, being grateful. Being grateful. Because all of us have been through trauma at some point and you know that all this could go away, all this could go away by the time we finish this podcast. Right. So that's the only thing. There are things I like to do more than other stuff. But the one thing that I will say, like, no matter what the day is your situation. If I'm on the side of a mountain somewhere, like, I'll be next week in Canada trying to chase down a bear and I'm freezing or whatever the case is going on, it's like, yo, this is pretty rad. This is a pretty cool thing you get to do every day. So that is on my gratitude.
- [112:13]
B
I love that. That's a good one. That's a good non negotiable. I think that's someone everybody should take home. And if you had to kind of sort of just distill your work into a principle or two that people could understand, what would you say it is?
- [112:24]
C
I think I've hit a lot of my major philosophical points this far. One maybe I'll add to this is a saying that I stole from Bill Bowerman. It's the way I finish every episode of our podcast, of my podcast. If you have a Body, you're an athlete. If you look at something like the NBA combine, the NFL combine, like these testing events that they do prior to drafting a player, and you looked at all the testing they go through, and then you look at a longevity clinic, you're going to notice this is really, really similar. All right, So I do this a lot of times when I present, so I'm kind of giving it away. But if we take Brian Johnson, right, who's clear with wanting to live for forever, the most longevity person we could follow, right on the end of the spectrum, whatever, okay? And we went the opposite end of the spectrum, and we went to Fred Warner, one of the best football players in the world. I might talk to those two dudes in the same day, and if we started putting a list down of what do they care about? And we said VO2 max and metabolic flexibility and healthy joints and reaction time, hand, eye, coordinate, I could fill this whole list out and they would be the same. And then at the very end, it'd be like, I want to never die. Okay? And then the very end over here would be, I need to make sure I'm over £225 and I need to sack a quarterback, and my shoulder needs to have this ability. Okay, fine. So there are some ends there. But the reason that we've built our lab the way we have and these companies the way we have is because I fundamentally believe that I want to give everyone the opportunity to look however they want to look. You might want to look skinny, you might want to have way more muscle. You might want to look fine. We have the ability, the technology, and the knowledge to help people look how they want to look physically. And that sounds vain. I always hated that. But as I got older, I'm like, man, that's actually really important. People, like, don't like how they look. That sucks. That has a big impact on their life. So I want you to look however you want to look. And if I don't like how that looks, that's fine. That's up to you. You want to feel a certain way. You want to feel more energetic, you want to feel more focused. You want to feel less back pain. Okay, Whatever that feel is to you. And then the third one, you want to perform. You define perform. You want to be able to paddle board for six hours or hike up a mile elevation. You want to be able to perform. Be more focused with your kid. Be more present, not distract. I don't care. But if I were to say, hey, give me the ability to have These three areas and you tell me the rules of the game and then you tell me the restrictions. Oh, and by the way, I only have $1,000 I can spend. Oh, and by the way, I'm an alcoholic and I refuse to stop drinking.
- [115:11]
B
I'm not good at that.
- [115:13]
C
These are the things we get right. Oh, and by the way, I'm on a plane twice a week. Fine. You tell me the rules of the game, tell me what's not negotiable, and then I'm gonna do everything. And you can see I get really passionate about this. I'm like, let's go now. Let's find solutions. Because you're an athlete. That's what I'm treating you as. You have a performance, you have to hit. I don't care if that's sports, I don't care if that's physical. You like, this is a game. I'm competing now. I'm gonna fucking win. Like we're gonna go after this thing. You told me some ridiculous thing. You're not willing. Cool, great. You have a medical thing. We can't. Fine. You give me those hard. Give me that hard case. Give me that thing. That is impossible. And we're gonna go deploy all means and solutions and we will find this damn anchor, we will get that anchor out of the way and you're gonna crush. Like that is what I get hyper passionate about. It's probably why I don't get like as personally passionate about population wide health stuff. Yeah, great, great. But like, I want that other person who's just like, yo, A, B and C are going on. I'm not gonna let you change those at all. But now find a way to make great. Let's go. Like, let's go. And now we're gonna do this, this, this, and we just get after it.
- [116:20]
B
That's great.
- [116:20]
C
So we attack everything. That's why we say if you have a body, you're an athlete. If you want to use those abilities, that's a good take home to kick a ball better. Cool. If you just want to be a healthier ager, if you want to live to forever, I don't really care.
- [116:34]
B
So great. I mean, it's such a great thing you do. Because most of medicine is focused on sort of the end stage diseases and not on performance or optimization or feeling better or things that matter to people. Like, yeah, it matters not to die from some terrible thing, fine. But every day people living their lives, they just want to feel better. They just want to be able to do the things they love to do and not be restricted. And your work has really helped people to understand what that is. So how can people find you? Where can they learn more about your work and what you're doing and all the things you're working on?
- [117:15]
C
Yeah, I really appreciate all that. The thing that I hate about longevity is it's unfalsifiable. But feeling better now is an A B test. You did or you didn't. Better there. So my podcast is perform with Dr. Andy Galpin. It's only in seasons, so season two just came out. Season three will come out next year or something like that. So it's pretty easy to follow along with. We have a new lab that we're building in Parker University. So we're building a 64,000 square foot human performance lab. And you actually outlined exactly what that lab does two seconds ago. It is that it is my belief in understanding where the limits of human capacity, how do we push adaptability and resilience. And we have some that will be open to the public. It's not open yet, but we're conducting.
- [118:03]
B
I'm gonna go. It's not that far from here.
- [118:04]
C
Yeah, man, we'll have you down. Well, we have some technology in there that doesn't exist in the world anywhere else.
- [118:08]
B
Can't wait.
- [118:09]
C
So we have that and then pay.
- [118:11]
B
Me when it's open.
- [118:13]
C
Yeah, we'll actually get you there for pre opening.
- [118:15]
B
Okay, great, great.
- [118:16]
C
Which would be easy. So and then website and social media are great.
- [118:20]
B
And your website's andygalpin.com.
- [118:22]
C
Yep.
- [118:22]
B
Great. Well, Andy, thanks for what you do. Thanks for being so passionate about it. Thanks for caring how to make each of us feel a little bit better, do a little better, live a little bit more fully and be grateful for everything in our lives. So thank you for being on the podcast and doing everything you do.
- [118:37]
C
It's an honor. Pleasure. Thank you.
- [118:38]
A
Don't forget there's a way to listen completely ad free with Hyman plus on Apple Podcasts. You can enjoy every episode without any breaks. Just open Apple Podcasts and tap try free to start your seven day free trial.
- [118:50]
C
Thank you so much.
- [118:50]
A
If you love this podcast, please share it with someone else you think would also enjoy it. Don't forget there's a way to listen completely ad free with Hyman on Apple Podcasts. You can enjoy every episode without any breaks. Just open Apple Podcasts and tap try free to start your seven day free trial. You can find me on all social media channels @DR. Mark Hyman, please reach out. I'd love to hear your comments and questions. Don't forget to rate, review and subscribe to the Dr. Hyman show wherever you get your podcasts. And don't forget to check out my YouTube channel at Dr. Mark Hyman for video versions of this podcast and more. Thank you so much again for tuning in. We'll see you next time on the Dr. Hyman Show. This podcast is separate from my clinical practice at the Ultra Wellness center, my work at Cleveland Clinic and Function Health where I am Chief Medical Officer. This podcast represents my opinions and my guests opinions. Neither myself nor the podcast endorses the views or statements of my guests. This podcast is for educational purposes only and is not a substitute for professional care by a doctor or other qualified medical professional. This podcast is provided with the understanding that it does not constitute medical or other professional advice or services. If you're looking for help in your journey, please seek out a qualified medical practitioner. And if you're looking for a functional medicine practitioner, visit my clinic, the Ultra Wellness center at ultrawellnesscenter.com and request to become a patient. It's important to have someone in your corner who is a trained, licensed healthcare practitioner and can help you make changes, especially when it comes to your health. This podcast is free as part of my mission to bring practical ways of improving health to the public, so I'd like to express gratitude to sponsors that made today's podcast possible. Thanks so much again for listening.