Peter Attia challenges survivorship bias in longevity studies, arguing that health span outweighs mere lifespan. He details his four pillars for heart disease prevention: no smoking, blood pressure under 120/80, optimized lipids, and insulin sensitivity, while critiquing cold plunges for muscle growth and warning against unproven biohacks like stem cell injections. Attia emphasizes proactive lifestyle investment over reactive medicine, noting that 99% of Alzheimer's stems from environmental factors like insulin resistance rather than genetics. Ultimately, he advocates for a future "health fiduciary" to guide daily decisions, asserting that prevention remains superior despite AI advancements in drug discovery. [Automatically generated summary]
Transcriber: nvidia/parakeet-tdt-0.6b-v2, sat-12l-sm, and large-v3-turbo
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Why Cold Plunging Is Bullshit00:08:43
What's up everybody?
Today we're very excited to have our guest here who's going to teach us all about why my sperm doesn't swim and how we can live till we're 100 years old and most importantly why actually this is what I'm really excited about.
Why people who live to 100 are full of with their advice.
I thought this was so good because I've had this I think there's a contrarian in me.
So whenever I hear the 100 year old people going I smoke a pack a day and I drink whiskey and I'm like this is important and I'm watching you in this interview and this was so validated.
You're like you say something to oh by the way it's Pirate.
Oh what's up so you say this thing and it was just so validated.
You're like yeah yeah these people are like super freaks in terms of their ability to live long.
They're not doing anything specific.
Survivorship bias.
Yeah.
So it's like it's like LeBron telling you how to pick up girls at a nightclub.
It's like I don't need your advice.
I need a guy who's like 5'6 who's getting late every single night.
Can you break down why people who live to 100 are the last people we should get advice from?
So genes don't play much of a role in how long you live up until about 80.
So it really turns out what you do matters a lot.
Plus luck.
We could talk about where luck factors in.
But for those people that make it to 90s, hundreds, they're called centenarians and then super centenarians.
It's virtually all genetic.
And what every study of these people has demonstrated is they live long despite what they do, not because of what they do.
And to your point, they are on average more likely to smoke, more likely to drink, less likely to exercise, and more likely to eat junk food.
Wow.
Wow.
So all these people in like Italy who are like, yeah, you just eat pasta once a day.
It's like, no, you just got some good genes.
You got great genes.
Does that account for blue zones as well?
Yeah, the blue zones is a totally interesting and different issue going on.
This is a very controversial topic, and I fall on one of the.
Wrong place to do it.
Yeah.
So I actually think the whole blue zone thing is a bit of a myth.
Talk that shit.
And I and ice baths, right?
It depends what you're doing them for.
To look cool with your shirt off?
Oh, that's very good.
Yeah.
That is the ice bath, right?
It's an excuse to show your body.
It's an Instagram thing.
Thank God.
Okay, keep going.
Keep going.
Blue zones.
So a big problem with the blue zone things is the sort of record keeping of how long people live and birth certificate stuff.
There's like a lack of birth certificate integrity.
There are a lot of places that reportedly had very high degrees of longevity.
And if you follow on the x-axis, like when did birth certificates get introduced, like it vanished from longevity.
They're just making up how old they are.
Yeah, a lot of that is going on.
And then the truth of the matter is there's this whole kind of people don't understand causality sometimes.
So if you went into the gym and you saw a whole bunch of super fit people running on treadmills, you would think that you could be lulled into the belief that Lululemon tights make you fit.
Right.
You could be lulled into the belief that fancy blue over-the-ear apple headphones are good for muscle mass.
Like you could create a story and not realize, no, it's actually all the exercise they're doing that's helping.
And people who exercise also happen to wear Lululemon tights and apple pod, you know, whatever AirPods and blah, So the whole thing is just, you know, we tend to infer too much causality from a lot of that stuff.
Some of the things that are, you know, assigned to the blue zones make sense.
Like, does eating, you know, healthier food make more sense than eating junk food?
Of course it does.
But to think that there are these really specific blue zones and we need to kind of go and figure out everything they're doing.
Because some of the ideas that are proposed are like exercise less because people in blue zones don't exercise much.
Again, I just think that on its phase level and stuff just doesn't make sense.
Yeah.
Interesting.
Okay.
So, wait, the sauna cold plunge thing.
Can you parse those two things?
And can you explain why cold plunging is kind of bullshit?
Well, I don't, I wouldn't say it's bullshit.
It's just not, it's not going to make you live longer.
Okay.
There's no, there's no evidence at least that sauna is going to make you live longer.
Um, pardon me, cold plunge.
Um, can I can I ask one thing about cold plunging?
Yeah, and I know nothing.
I'm going to be like the most ignorant person in the audience.
This is my experience in doing it.
I wonder if it is just, have you ever gone like skydiving?
No.
Have you ever gone bungee jumping?
No.
He's trying to live forever.
Yeah, that's right.
But then he's also like swimming with sharks to kind of let him know.
So I don't know if I believe 100% live forever.
But okay, sometimes you do these scary things.
And then when you survive them, there's this like release of dopamine.
Yeah, yeah.
And it's a positive dopamine.
Yes.
And the positive dopamine makes you feel amazing in the moment.
So in 60 seconds without skydiving or bungee jumping, I get a positive dopamine that makes me feel amazing.
Is it just the quickest way to feel good?
First of all, that's actually a great insight.
And that's absolutely one of the two pieces of the benefit of cold plunge.
So it turns out that our bodies want to preserve a dopamine homeostasis, which just means a balance.
So anytime we have something that induces a little bit of discomfort, the body will try to compensate by making more of the sort of positive neurotransmitters, including dopamine.
And that's why exercise, by the way, the pain you experience when you go out for a hard run.
So cold immersion has been demonstrated to improve mood, although it turns out not in everybody.
So there are a subset of people who have just experienced the pain and they don't get any of the positive from it.
So you get nothing when you hop in.
I don't like cold plunging.
I get out and I go, I'm cold.
My feet are cold and miserable.
My feet are tingly and that's it.
But I do love saunas.
So, and we'll talk about sauna in a second.
The other thing that cold plunge does is it reduces inflammation.
And there are times when that's a good thing to do.
And there's times when you don't want to do that.
So it turns out if you're X, if your goal of resistance training is to add muscle mass, you actually don't want to get into a cold plunge after.
Because the inflammation is actually bringing blood to those.
No, the inflammation is part of the repair process.
It's the repair process that adds size and strength.
So if a person is saying, hey, I want a cold plunge, but I'm also, I don't want it to interfere with my strength training, then they kind of have to set, you know, we don't know exactly how much separation, but I would say like, don't do it on the day of, you know, to be safe.
So it shouldn't be this like religious thing that people are doing every single day.
I mean, I don't think anything should be a religious thing we're doing every day, but if you're doing it every day thinking it's going to make your whatever, give you immortality, it's not.
And if you're doing it every day, then it might have some negative consequences, certainly with respect to resistance training.
But again, for some people, like for me, the mood effect is really profound.
Oh, it's amazing.
I absolutely love cold plunging.
Yeah.
Get in an argument with your wife, hop in a cold plunge, get out.
You're like, my marriage is perfect.
What were we even arguing about?
So, yeah, no, I think, I think.
And the other thing that's a little frustrating is nobody knows the exact dose response.
So, like, how long you should be at what temperature, right?
So, it just feels like we're competing to go colder.
Yeah, yeah.
Like, Joe just calls me a pussy every time.
I'm like, dude, it's if it's not 60 degrees, I'm not getting in that fucking thing.
But I do feel like guys are going, okay, I could be at 37.
Dove is trying to be at, I forget what it was, maybe 45 for two minutes.
But if you're not really getting any different, yeah, I mean, I think I've tried to figure this out so many which ways.
Actually, this would be a great question for me to put to one of the research AI engines and see if they can just pull all the data.
Because a lot of the studies will do long immersion at modestly cold temperatures.
So 55 degrees for 30 minutes.
Right.
But I don't want to take 30 minutes.
So I'm not going to do that.
So it's got to be colder.
Yeah.
So I mean, I don't, I don't have the answer.
I do 42 degrees for 10 minutes.
You're in there for 10 minutes.
Yeah.
And I mean, I don't know.
Is that better than doing 35 degrees for five minutes?
I have no idea.
But the reason I can't keep it at 35 is my wife won't get in it.
And so then I'm just going to be turning the temperature up and down and up and down.
So 42 is about the lower limit that she'll put her legs in.
She means she won't sit in that.
Go in together.
Yeah, but she'll stand in it and I'll immerse.
Like I'll go to my neck.
I mean, you don't got to call her a pussy.
We could have just thought she was into her neck, too.
Wait, so you're both in.
What are you doing for those 10 minutes?
Hagler Sold The Fight00:05:49
Are you like...
First of all, she will not even put her legs in for 10 minutes.
So she'll be like, all right, I'm done with this.
I'm going to go someplace else.
But do you get any benefit out of just putting like yeah, yeah, you do.
I think for her, because she's a runner, she makes your life uncomfortable for her.
She wants to, you know, she wants to, you know, she goes for a long run.
She loves to get in there after and just get the inflammation on her legs.
Yeah.
I want to go into your background a little bit because I think your background is very interesting.
And then I want to go into all these different versions.
We would call them like, and I don't want to be reductive, but like health hacks, life hacks, biohacks.
Do you not like that term hack?
I don't.
In comedy, we hate that term.
It's like it's the worst term for anything that has to do with comedy.
So benefits or whatever you want to replace with it.
But your life is quite interesting.
So your parents are from Egypt.
They moved to Toronto.
Yep.
You were born in Toronto?
Yep.
Okay.
You want to be a boxer?
How do you, how does that even happen where you're training and you decide you want to be a boxer?
And how supportive of your Egyptian parents?
Immigrant parents who see this clearly brilliant young man who's doing great in school, I imagine.
I wasn't, but oh, really?
No.
Yeah.
He's getting punched in the head every day.
Yeah, maybe that's part of it.
So boxing, where does boxing?
So it all happened in April of 1985.
Okay.
When Marvelous Marvin Hagler and Tommy Hearns fight, the greatest fight to this day that I've ever seen.
That opening round, bro.
Yeah.
Yeah.
The most violent three minutes of boxing ever.
I think Hearns breaks his right hand on Hagler's head.
Hagler's head is the hardest head in the history of the state.
His defense was just walking straight in with his head forward.
It's like juggernaut.
It's amazing.
Yeah.
And you have to remember, I mean, you know this because you're a big boxing fan.
Nobody expected that.
Like you just didn't think.
You thought like Hagler was going to counter punch.
Hagler was going to try to take him the distance.
Nope.
He was like, nope.
I'm walking through you.
I'm walking right through you.
And Hearns won the first round.
Yeah.
Yeah.
I mean, any other person would have been done.
Yeah.
No human at 160 pounds could have survived that fight.
Yeah.
And yeah, there was just something about that that just, I don't know why.
Like I'm watching that and I'm thinking, I want to be that guy.
Was your dad a big boxing fan?
Nope.
And I just was like, I want to be that guy, Marvin Hegeler.
That's the one I want to be.
Because he just stalked him.
Yeah.
It was like, he's, because I realized like he wasn't.
And then, of course, as I became obsessed with Hagler and began to learn everything about him retroactively, and I realized like he's the guy that I want to be because he's not the biggest.
He's not the strongest.
He's not the fastest.
He's not the best at anything.
But in aggregate, he is the best.
And he's the best because his will is.
His will something.
His will is second to none.
And he, oh, the other thing is most boxers don't stay in shape all year.
They kind of never got out of shape.
So training camp was just finishing school.
Yeah.
Wow.
Which is also tough on the body.
I mean, we can get into that.
Like sometimes you need a break for the intensity that these guys train.
I really regret when he was inducted into the Boxing Hall of Fame.
I really regret that I didn't go as like a fan just to see it.
Because, you know, of course, he died in 2020 or 2021, died too young.
He's like, now we're going deep cup, but Hagler is so fascinating because he quits boxing.
I believe after the Leonard fight.
Yep.
He wanted a rematch.
Leonard wouldn't give it to him.
He basically just got pissed and moved to Italy and started making movies.
He becomes a movie star in Italy.
Yeah.
He's like the first black guy in Italy.
And then he just becomes a movie star.
So have you seen any of Hagler's?
This is a real fan.
How's the acting?
It's not that great.
Definitely a better boxer.
Fair enough.
Fair enough.
Yeah, that's interesting that Leonard wouldn't give him another shot because Leonard wasn't a scared fighter.
No, I think Leonard.
Look, I have to say that.
Did he give that decision to Leonard or?
No, 115, 113 Hagler.
I think I've watched that fight a hundred times.
Yeah.
I hated Leonard when I was growing up, despised him, couldn't stand him.
And then when he got that decision against Hagler, I thought it was the most disgusting thing ever.
I will say this.
Today, my respect for Leonard is enormous.
Like now I look back and I think like, my God, was that guy special?
Unbelievable.
And he fought a really strategic fight against Hagler.
Like he avoided that kind of contact.
Tommy was like, I'm going to knock you out.
And why would you not think that?
You're knocking everybody out.
And Leonard was like, I'm going to wait till the last 30 seconds of the round.
My corner's going to yell and I'm going to start swinging.
And if it lands, it lands if it doesn't, but I think I can steal rounds.
And I think he did a good job of that.
Yeah, I think in retrospect, I mean, as you probably know, all of this, but Hagler sold the fight, right?
So he, in exchange, Hagler demanded a higher purse than Leonard.
This was a very important thing to Hagler's ego because, you know, Hagler, remember, no Olympic glory.
He toils in obscurity for a decade.
Nobody knows who he is before he's finally a champion.
And Leonard, the golden boy, I mean, he's livid with how this guy had everything handed to him, right?
So the point of pride for Hagler was, I'm going to make more money on this.
On the VA side.
Yeah, I'm getting more money.
And to do that, he traded three things.
He traded duration.
This was back in the day when the IBF still sanctioned 15-round fights.
Oh, so what did they make?
He sold down to 12.
That's right.
Ring size, 24 down to 20.
Right.
Glove size.
Which I don't think was a benefit to him to have a smaller ring.
It was a.
Sorry, sorry.
He traded bigger rings.
He went to an update.
Yeah, sorry.
He traded up in ring size and he traded up in glove size.
The glove size is, I mean, the glove size is huge.
Leonard vs Gagnon Showdown00:02:53
Yeah.
Yeah.
And then on top of that, he came out and boxed Orthodox for the first time.
He thought he could trick them.
It's just a bad decision.
It was a series of wonders.
And still, whatever.
From watching it, I had him winning.
But again, close fight.
Yeah.
So then from that day, you start boxing.
Yeah.
Okay.
So, and then the parents go, what is this stupid little hobby?
Yeah, they were just, you know, this is an awful, awful, you know, I think they were wisely mindful of like, but you get hit in the head, right?
And you come home with black eyes.
I think it, you know, so how old was I?
I'm trying to think, I guess I was 13.
Yeah, 12, 13.
I think by the time I was in high school, it was probably a bit more of a concern because, you know, I didn't want to go to college.
I didn't like school.
So they were definitely concerned.
Hello, everyone in Dubai.
Andrew Schultz here.
It's come to my attention that the Chamakis have been acting up again.
Yeah.
Looks like they might need another talking to.
So I've spoken to my podcast co-host, and we've decided to take our talents back to the Emirates to give another spanking to those V-Tech driving naughty little rascals.
We're going to be going out there.
We're going to be doing some stand-up.
Maybe a little live podcast action at the Coca-Cola Arena October 7th.
We'll see you all there.
Very excited to try that Dubai chocolate.
And no, I don't mean when a prince shits on a hooker's chest.
I'm talking about the actual chocolate, so don't get your ideas whirling and swirling.
We'll see you soon.
Tour dates.
Your boy's going to be in Dania Beach for Lauderdale this weekend, September 11th through the 13th.
I don't know why they gave me that date, but they did.
September 25th through 27th.
I'm going to be in Cleveland, Ohio.
Dubai, October 5th.
I'm pretty sure tickets are sold out, but they might have released some more.
So go there.
October 16th through 18th, Rhode Island.
Also, there's more dates on the website, but one I will shout out, October 23rd through 25th.
We've already sold out one show, so y'all should buy your fucking tickets to that because they will sell out.
But those dates and more at akashing.com.
We got some big announcements coming in a couple weeks.
Can't say what they are, but I'm very excited.
We'll get back to y'all soon.
God bless.
Guys, there's a lot of cities we can suck Mark Gagnon's dick coming up.
I hope you're ready.
October 23rd, Nashville, Tennessee.
October 24th, Mobile, Alabama.
Stop sucking your brother's dick and suck Mark Gagnon's.
October 25th, New Orleans, Louisiana.
Hey, guys, I'm going to be honest.
I went there.
Fucking, it's one of my favorite cities in America.
The comedy market is dog shit.
Prove me wrong.
Go to Mark Gagnon's show.
Try to suck his dick.
November 16th, Hoboken, New Jersey.
I forgot November 9th, Denver, Colorado.
November 23rd, Philadelphia.
December 5th, Fort Wayne.
December 6th, Detroit.
Those tickets are available at MarkGagnonLive.com.
Now, let's get back to the show.
How do you end up going to Stanford if you weren't good at school?
So at the very end, as I'm finishing high school, I have this amazing experience with this incredible teacher who really saved my life.
Stop Sucking Your Brother's Dick00:15:52
His name was Woody Sparrow.
And he was my math teacher.
And he called me into school early one day and said, you know, hey, you know, I heard you're not going to university.
And I said, yeah, that's right.
And he said, well, say a bit more why.
And I told him why.
And he said, well, look, I'm not going to try to talk you out of it.
I mean, if that's your dream, like that's, I don't think anybody should talk anybody out of their dreams, which right off the bat I thought was an awesome thing to say, right?
And then he just said something that I thought was, you know, just, it just changed the course of my life forever.
He goes, you know, I just think it would be a mistake if you didn't go because you'd be, you know, you have a gift for math that I don't think you realize.
And if you, if you, if you don't pursue it, you'll never, you'll never find out.
And I think you could, you could do really, you could do some good things doing that.
And that, I don't know why.
There was something about Woody saying that that really changed everything.
And I really gave it thought.
And I really decided to come back for that extra year of high school and then, you know, follow in his footsteps, actually.
So then I went on to do math and engineering in undergrad, which is what he had done.
And he was an engineer as well.
Could you get into a school like Stanford with just one good high school?
So for undergrad, I went to school in Canada.
Got it.
And then I went to Sanford for med school.
Got it.
And this is, when do you become surgeon?
After medical school, then you apply to do these, to this thing called a residency where you then apply all over again and you apply to all these hospitals and you decide what you're decide what you want to do and where you want to do it.
Okay.
At what point in time do you realize you're pre-diabetic?
Because the lore in your life is so fascinating.
Like you could have been punch drunk, then you skipped out of that because of Captain Jack Sparrow or whatever.
And then you go and you become an engineer, mathematician, then you decide to become a surgeon.
There's also some health issues, which I think it was around the time I swam that Catalina Channel.
Okay.
Catalina Channel is Los Angeles.
There's an island off of Los Angeles 20 miles away, let's say around depending on what part you swim to.
Yeah, the closest point's like 21 miles.
Right.
And you willingly chose it wasn't some sort of punishment that you had to do.
It's Jamie Alcatraz.
That's what it feels like.
So, okay.
So you find out that you're pre-diabetic.
Pre-diabetic, this is not like based on diets.
This is not based on lifestyle, right?
This is genetic.
No, I mean, I think it was, you know, again, I kind of look back at those days and I think there were probably a lot of contributing factors.
I was probably, I think my diet was a little too carb heavy for my own good, despite the fact that I was swimming 28 hours a week.
You were just eating koshery every night or what?
What was I eating?
Like, I mean, I was like, do you know what that is?
The Egyptian dish?
Oh, ask your parents what kosher is.
I was, you know, drinking too much Gatorade, probably not sleeping enough for sure.
I definitely wasn't sleeping enough.
And sleep, not sleeping plays a huge risk factor in diabetes.
Okay.
So I think it was just kind of like a perfect storm of things.
Okay, so you get just overweight.
Oh, really?
Oh, yeah.
Oh, wow.
I imagine if you're swimming to Catalina Island, you're just kind of ripped.
So when do you, like, how big were you?
Probably like 25 pounds heavier than I am now.
Interesting.
So you're not, you're not fat to the point where you're like, I'm going to have a problem in my life.
I mean, my wife famously said when I got off the boat, this was, I think, not the first time.
This was the second time.
You know what I'm about to say?
Someone tried to feed you a fish?
No, literally, I'm just, this was after the swim that took 14 and a half hours into the current.
I get on the boat and she says, you should work on being a little less, not thin.
Wow.
Wow.
So all of your research is really her credit.
You know what I mean?
She bullied you into this.
She shamed me into it.
Wow.
Thank goodness.
I wish I could find it, but someone took a picture of as she's saying that.
I got a Coke in one hand, a burger in the other.
My belly's hanging out over my bathing suit.
Wow.
And she's like, Yeah, congrats.
But listen, let's work on this thing.
It's more elliptical, you know?
Okay, so then, so what happens?
When do you apply?
Just from doing research on you and just kind of like talking to you, it seems like there's a very obsessive side of you.
And that if you can turn that obsessive thing into boxing, we're swimming to Catalina Island or whatever it is.
Once you lock in, you're locked the fuck in.
When do you lock the fuck in on longevity?
Around that time.
So my daughter is born in 2008.
And as you now know, I think there's just the most incredible thing happens to a guy when the child is born that, at least for me, didn't happen even at 20 centimeters dilated.
Like, you know, I think for women, they're becoming attached to that baby throughout the pregnancy.
And we're just like, what is it?
And we had this cat at the time that I was obsessed with.
And my wife never lets me live this down.
I would routinely say every night, and our cat's name was Midnight.
I was like, I just, I hope, I don't know, but I hope I can love our daughter as much as I love her.
But I loved midnight.
Like this.
Midnight's awesome.
This night is a podcast.
We need honest conversations between you and your wife.
That's the fucking cold plunge.
I love midnight.
Oh, I mean, we rescued this little alley cat in inner city Baltimore and she was so precious.
And so I was like, yeah.
And so when, like, when my wife is in labor, I was like at my laptop in the side of the room building a model, doing work.
And she's like, you know, I'm having a baby over here.
And I was like, as soon as that baby's out, I will be there, but I have to get this stuff done.
And again, I was just...
What?
You're crazy.
Her shot name is totally justified.
Totally justified.
Her disname is great.
He's like, he's like, baby, breathe, breathe.
Once that baby came out, there are a whole new set of genes that just get transcribed.
All of a sudden, I'm like, oh my God, I get it.
And I do wonder, does that happen to like would Bill Maher experience that?
Someone who's so famously yes.
I think there are certain people maybe that have a genetic disposition where they don't care.
Maybe there's a little more sociopathy or whatever that's called.
But I think assuming that Bill is just a regular guy like us, I think the same exists.
If you don't love your kids, I mean, it must be pathological.
Yeah.
Like to a degree.
I don't want to diagnose someone, but it feels like there's something unhuman happening.
Well, and I think this is an interesting guess for which I have no data, but just through the lens of evolution, I think it even makes sense for boys, for males, to have this feeling greater than females.
And here's why.
If you think back to evolutionary times, right?
You know, think back to 100,000 years ago, there was no ambiguity for the woman who her child is.
She carried the child.
Yep.
The male does not know who his child is.
Yep.
So there has to be some other switch.
I still watch.
I'm just hoping I got it right.
I'm looking at her every day.
Like, I think that's me.
So I'm convinced that there's some other switch either through, you know, the smell of your kid or something that completely switches the male on.
So he's like, yep, that one's mine.
Like, no one gets to hurt that one.
Yeah.
So you felt that immediately.
I can't believe it.
I can't believe how profound it was.
Yeah.
And to your question, so to your question that I've taken too long to answer, I think that was the moment when all of a sudden I was like, oh, you know, all this other shit I'm interested in, swimming far and doing all these extreme things.
Yeah, that doesn't really interest me nearly as much.
You know what really interests me is I would like to live long enough that I get to see her have a kid one day and that I get to experience this again and again and again.
Dude, the first, one of the first thoughts, I don't know the first thought, but one of the first thoughts I had when I held my daughter was, I wish I didn't wait so long to do this so I could spend more time with you.
41 now.
So I had her at 40.
And that, and it was like, I think those are under the same umbrella, which is like, how can I be around you longer?
And I know that, you know, there's, we have limited time here.
And I know at 40 instead of 20 or 30, I've shaved off a decade or two that I could be with you.
I don't regret the decision.
I waited for the perfect person to do it.
I'm glad we did.
But like this impulse to be around them, spend time with them.
Yeah, it smacked me in the face.
It was insane.
So it would be cool to know that there are like some sort of like genes that get turned on in that experience.
Again, I'm sure somebody out there smarter than me has figured it out, but that's that's been my impression.
Okay, so you have the experience, which let's assume a lot of dads do, which is like, okay, I kind of need to be fit.
I kind of need to be healthy so I can be around.
It's a great motivator.
It's like the best motivator.
I think there's even like a biblical term, like every baby comes with a basket of bread.
This idea that like you start making more money when you have a kid.
And it might just be the urgency.
It's like, I should take that gig.
I should do that thing.
It's funny, even after having my kid, like, I don't think I've done drugs since.
And I was never like a drug guy, but like a little here and there.
But yeah, it's like, is it worth the risk?
Like this one night, God forbid something's in it.
Yeah.
I mean, I don't even really drink anymore since having a kid.
Isn't that?
Yeah.
Just like, I mean, also waking up early.
You know what I mean?
I mean, that, I'm like, I can't be hung over.
I have to be up at 6:30.
So there's so many things that get tapered down to like early childhood.
100%.
Have you heard that new parents or new dads will gain body weight in the months around the birth?
I don't know if this is.
I have heard this.
I don't know if I don't know if it's because these women be eating.
I don't know if it's been validated.
And you can't just let them eat dessert, right?
And then they feel guilty.
We're just being good support husbands.
Okay, so you lock in on longevity, right?
And at the time, although truthfully, when I started thinking about it, all I thought about was heart disease at the beginning.
Because that is.
That's the disease that kills my family.
And so my foray into it was really through, I really want to understand heart disease and I really want to understand why all the men in my family die of heart disease.
And what do I need to do to make sure that, you know, at the time my daughter's born, I'm 35.
So what do I need to do to make sure I'm not dying at 60?
Like, you know, I mean, some men in my family died at 45.
From heart disease.
Yeah, from heart disease.
Jesus Christ.
Okay.
What is the first thing when addressing heart disease?
Is that diet?
Not necessarily.
I mean, I didn't know this at the time, but I now can tell you with much more clarity.
You know, heart disease obviously has a pretty strong genetic component.
But at the end of the day, there are four big modifiable things you just have to manage.
Like you can't smoke.
Your blood pressure has to be below 120 over 80.
Your lipids need to be perfectly dialed in and you want to be as insulin sensitive as possible.
And if those four things are true, I mean, you're set for life.
Gotcha.
Now, some people can do that with diet.
Some people can do it with exercise and some people need drugs to do it.
It's everything's everybody's different.
Okay.
This is, I'm curious about the heart disease stuff because I'm on a statin.
I remember going in to get some of my heart check.
I think it was actually like when we were trying to have a kid, it was really difficult.
And I was like having breathing problems.
And it was really just caused by stress.
But I was like, let me get my heart checked and that kind of shit.
And then the doctor came and was like, yeah, you've got some calcification, like a very minor calcification.
And I thought he was like lying at me.
I was like, me?
I'm like exercising every single day.
I'm in like prediction.
Yeah, completely.
He's like, yeah, we recommend this like statin.
I was like, I'm on a fucking blood pressure medication.
Like, what the hell is going on?
What are you, what is your feeling on using pharmaceuticals to essentially prevent these illnesses?
And what are this negative, potential negative side effects of that?
So the short answer is if you, if you had a house that was being built by a general contractor and that contractor came to you and said, Andrew, I just want you to know, I don't believe in saws, hammers, and screwdrivers, but I like all of these other tools.
You'd be like, what are you talking about?
Shouldn't you have all the tools?
You're the general contractor.
And so I always find it amazing when I run into people of all persuasions who say, I will only use diet and exercise to fix myself.
And at the other end of the spectrum, you have these people that are like, give me every drug in the world, but don't tell me about exercise and nutrition.
It's like, do you understand how hard the problem is we're trying to solve?
Do you understand the inevitability of death?
He said this once like everything is working against you.
Like entropy is dragging you into the grave.
If you need a medication to lower your blood pressure, you take that medication to lower your blood pressure.
Now, will weight loss come naturally first?
Sure, by all means, because there are other benefits that come.
So in other words, if you take an individual that is overweight, not exercising and has high blood pressure, if you said to me, Peter, would you rather give them a drug to lower their blood pressure or get them to exercise and lose weight to do it, if they both produce the same blood pressure, no questions asked.
This is a better approach because there are other benefits that are being captured through exercise and weight loss beyond just the blood pressure.
But if that person either just can't or won't do those things, I'm not going to be punitive and say, well, you're not working hard enough.
Sorry, I'm going to withhold this.
No, of course not.
And secondly, you can do both because a lot of people end up losing weight.
They exercise, but they still have what's called essential hypertension.
They have normal, normal, healthy looking people that are walking around with high blood pressure.
It's a silent killer.
Yeah.
That is the tricky thing is that so much is aesthetics.
We look at somebody in shape and assume that they're healthy.
And a lot of what's going on under the hood is the thing that could end up killing you.
Yeah.
And the same is true with lipids, right?
Like lipids are even more genetically determined than blood pressure.
What are lipids?
So our body makes cholesterol.
It's essential for every cell in your body needs cholesterol to exist.
And the most important hormones in your body are made out of cholesterol.
So testosterone, estrogen, progesterone, all made out of cholesterol.
And you, because cholesterol is a lipid, it's a fat, it can't be traveled.
It can't travel in our bloodstream because our blood's water without a chaperone, without something to carry it that makes it soluble.
And that's those things are called lipoproteins.
And they have different densities.
And one of them is called low density lipoprotein, LDL.
That's your LDL levels.
Got it.
And that LDL does some good things, but it does some really bad things.
And it's the only one that does this really bad thing.
I guess the VLDL does it too.
But it enters an artery wall.
And if it gets stuck in that wall, it undergoes a chemical process called oxidation.
And the body, regrettably, but understandably, thinks that there's a problem there and it excites an immune response.
And the immune response leads to a cascade of events that ultimately result in the body trying to repair the damage, the final stage of which is the calcification that showed up on your CT scan.
So the calcification you see on coronary arteries is the result of the body laying down concrete on Chernobyl.
LDL Oxidation Explained00:02:11
Got it.
So what does the statin do?
Stop the body from laying down the concrete or stop it.
The statin very specifically, because there are lots of different drugs that treat this, but what statins do specifically is they tell the body to make less cholesterol.
The liver, in response to that, says, I'm going to make more LDL receptors on my surface to pull more LDL out of circulation.
So they lower the LDL cholesterol by tricking the liver into thinking it needs more of it.
Brilliant.
Yeah.
Now, to your question about a side effect, of all the drugs that are used today that lower cholesterol, statins have the most side effects.
Oh, Jesus.
I don't even know if I want to know.
Well, the good news is you clearly don't have the most significant side effect, which is muscle soreness.
5% of people get muscle soreness.
Got it.
That's a lot, right?
When you think about how frequently these drugs are used, one in 20 people is going to feel like they've had the worst workout of their life every day.
So this shows up pretty quick.
Okay, so yeah.
So you get that.
You take them off the drug immediately.
That goes away within days.
Then there are other side effects that are more subtle, and you just have to be watching for them.
And one of them is insulin resistance.
So if you see over time, glucose tolerance getting worse and worse.
In my book, that's a reason to stop using a statin.
The other thing is sometimes the liver function tests get a little, liver enzymes that are known as liver function tests get a little elevated.
That's also a reason to do it.
But again, you know, 20 years ago, you didn't have a choice.
Today, when I hear people go on these anti-statin rants, I'm like, okay, like, don't go on a statin.
Like, go on a PCSK9 inhibitor.
Go on azetamib.
Go on bampidoic acid.
Like, there are so many other cleaner drugs today that are more expensive.
And we don't have, you know, so they don't have necessarily, and they're not, some of them are not as potent as statins, although PCSK9 inhibitors are, that it's, it's a, it's, it's become a little bit of a silly excuse.
If, if you're, you know, if your LDL cholesterol, your Apo B, which is really the marker of interest, is too high, you, you know, just, it's an unforced error.
It's an own goal to walk around with elevated levels.
When To Stop Statins00:02:50
Got it.
But so you're not essentially against a statin.
Not at all.
No, no, no, no.
Got it.
Not at all.
It's again.
And for most people, they can tolerate them just fine.
I'm sure this is happening a lot in your industry as it's exploded.
But in an effort to make content, I feel like people are looking for their hot take on a very popular thing.
And they are disseminating potentially harmful information so that they can get attention and clicks.
Yeah, this is what I envy so much about your world.
Like when you're a comedian, your hot take just needs to be funny.
Yeah.
Like you would think.
But now apparently we get presidents elected.
So this is not the best thing, but go on.
Yeah, but in my world, you're right.
It's how can I make something more frightening?
How can I show you something more contrarian?
How can I be more extreme?
We talk about this all the time.
The truth is boring.
And you can't get clicks on boring.
So you have, so a lot of times people will find a way, not always boring, obviously.
There's a lot of novel research and you change things, but like it is way, whoever is most salacious is going to win the eyeballs on the internet.
But that's not maybe what's going to make people healthy.
All right, guys, we're going to take a break real quick so we can talk about BILT.
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Fasting For HRV Boosts00:15:33
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Can I ask you a controversial one in regards to insulin resistance?
I recently just read Jason Feng's book, The Obesity Code, which you're mentioned in.
Actually, I'm sure you knew this.
There's a reference to you swimming in it.
But he talks a lot about insulin resistance and insulin production in regards to fasting and intermittent fasting.
So I'm curious your opinion on both forms of fasting and how that relates to weight gain, you know, in comparison to, you know, calories in, calories out, that type of.
Mark fasts.
I love fasting.
He does intermittent fasting.
He's also, you know, been our friend for a decade and we've known him not doing it.
And nothing has changed in his body.
He looks no different.
His body hasn't changed for seven years.
He doesn't eat for two days in a row now.
He looks exactly the fucking same.
What would you call him retarded?
What is that?
What do you call people like that?
No, Eating disorder, body disorder.
I'm deeply in autophagy right now, so I'm actually elevated.
I see things better than you guys.
I'm seeing in colours.
That's the other bullshit he says is that when he doesn't eat, he gets really focused.
No, he has four zins in his foreskin, and then he's literally lying all the time.
But we have it.
We got it right.
Can you not zin when you're fasting?
You can if you do low doses, and especially if you do the unflavored ones, because sometimes he's kidding me.
He's already talking to himself.
I'm telling you, I'm dying.
Our juice tends to be selfish.
Shellfish.
We also need to have ladies around the system.
I'm the dumbest health guy.
You can do the flavored Zen because it breaks the fast.
If in high doses, sometimes it will trigger.
Dr. T, let me tell you about health.
I'm so glad you're here.
I'm actually so excited to explain this to you, okay?
I always tell you, I'm the dumbest guy when it comes to like health stuff because I'll see something.
I just bought a Vegas nerve stimulator because I'm like, oh, this is the thing.
And so anytime I see you...
You tell me, well, I got it.
I see medical quacker and I go, this is what I need.
Speaking of mint.
The mint.
Yeah, yeah.
Go, go, go, go.
Here you go.
Sorry.
There you go.
Are these bad for us?
These are.
It depends on what dose.
Mine is statin.
How many milligrams are these?
Six.
This is six.
Oh, that's too much for me.
You can only do three at a time.
You do the threes?
I do threes.
I got my nicotine toothpicks here.
That's what that was.
I knew it.
I knew it.
I had no clue why he was saving the toothpick on the couch.
He took it out.
He laid it on the couch.
I was like, what the fuck is this?
You're going to hurt your meal on one end.
He's got a toothpick saving for later.
The son of immigrant parents.
You know what I mean?
Okay, tell us about your Vegas nerve.
I mean, where do we start?
First, I want to know about intermittent fasting.
Okay.
Oh, yeah.
How dumb am I?
I have a fasting winner from four to six.
I do high protein, high fat, low carbs.
Am I an idiot?
No, you're definitely not an idiot.
I just think you might be over-indexing on something.
All available data.
That's Mark's life.
I know.
I know.
All available data says that the benefits of intermittent fasting are accrued through the amount of calories you restrict.
In other words, and this has been studied.
So if you take two groups of people and one group of them does 2,000 calories spread out over the course of the day, and the other group does the exact same 2,000 calories, but they eat them in six hours or four hours.
There's no difference, except that the people who do intermittent fasting have a tendency to lose a bit more muscle.
Why?
I'm not sure.
I got a counterpoint.
I'm on Google.
You know, it could be making models good.
It could be that they're not fully normalized for the same amount of protein.
It could be that they're putting too much protein in one time of day and then they're not getting enough muscle protein synthesis during the time when they're fasting.
I'm not really sure.
And it could be that we just simply don't have the studies done right and maybe there is no difference or, you know, maybe there is a difference.
But intermittent fasting is an awesome tool for people if it's in some ways it's the easiest way to calorie restrict.
And at the end of the day, calorie restriction is a really important thing to create energy imbalance.
Energy imbalance is necessary if you're metabolically unhealthy.
In other words, you have to create an energy deficit if you're metabolically unhealthy.
So having frequent insulin spikes throughout the day has no effect on overall muscle mass or weight loss compared to having one insulin spike in the middle.
According to all of the data we have, it does not.
Not just a little bit, all of the data.
You do that shit for nothing.
You're going to be eating all day, Mark.
See, I could be like these guys.
But maybe in other words, I don't know if for you.
And by the way, when I kill it over here, when I needed to be at my absolute lightest, which was 15 pounds lighter than I am now, I was doing one meal a day too.
Not because I thought it was giving me some enormous health benefit, but because it was simply the easiest way to restrict my calories was to basically, I don't know how the hell I did it.
It was so miserable to get up, work out, not eat, you know, stay all day, come home, do another workout, then eat dinner and then go to bed and do it all over again.
Imagine what it's like for your friends and family who have to fucking hear about it.
I don't talk about it.
I don't even say anything.
I'm never bringing up.
Have you considered it?
One of my favorite stickers.
There's this place in Austin that always has like a funny slogan outside of it.
And they had one the other day that said, what happens if a vegan does CrossFit?
Which do you hear about first?
Oh, he was doing CrossFit.
He is everything but vegan.
He's like almost there.
No, no, no.
I wouldn't do the exact opposite.
I wouldn't do vegan.
You also said you needed to be your lightest.
You were doing one meal a day?
Yeah.
What was that need for?
Oh, for cycling.
Oh, so not for doing stand-up on the weekends sometimes.
What about Thor?
Mark, you're done.
You're done with the fast.
I have 20 more dumb things I do.
I do want to hear about the Vegas nervous.
There's another dumb thing he does.
He fasts for like two, three days at a time.
Very infrequently, but yes.
But is that good or is that bad?
I don't know.
I mean, I used to eat disorder.
I used to fast like crazy.
I used to do seven to 10 days a quarter.
Like at the top of the quarter, I would do seven to 10 days straight fast.
And then on the other two months in the quarter, three days.
So I would do like 10 days, three days, three days, seven days, three days, three days, 10 days, three days, three days.
Why?
Well, my hope was that it was doing a complete purge of all precancerous cells.
And, you know, but again, trying to replicate the benefits we see in animals and caloric restriction.
The problem is after three years of doing this, I lost 20 pounds of muscle, which is not a lot on a guy like me who doesn't have much to begin with.
And I was just like, okay, you know what?
I wish I had a biomarker that could prove to me that there was some huge benefit here.
But absent this, I just don't think there is.
So I don't know.
Maybe there's a benefit to it.
I just don't know.
I also don't eat late at night.
That way I sleep better.
And I think that makes sense.
Because the empirical data is clear.
You guys eat like Europeans.
Don't just say another obvious.
I breathe oxygen.
I didn't just say an obvious thing.
Of course.
You're not supposed to eat late at night.
We do this.
What time do you have dinner?
I have dinner at 9.30 or 10.30.
I sleep like shit.
I'm out here bitching about it every single day.
I don't have a choice.
9 at fucking 11 p.m.
You have that window.
You stop eating itself.
Tell us about your little vagus nerve system ready, guys.
Go.
All right.
This is my new dumb thing I'm on.
So I just saw an ad on Instagram and I was like, this is it.
And it stimulates the vagus nerve and lowers your parasympathetic nervous system and helps me sleep.
Does it?
I've only done it for three days and my whoop was off for one of them.
Do you feel any different?
No.
What is it?
Where do you put it around your neck?
So you sleep with this thing around your neck?
No, no, you just do it for one hour before you go to sleep.
And it is what are you doing during that one hour?
Typically, reading.
Can you be doing anything?
Could you be watching TV?
Could you be suggested that you're ideally going down, which then now we're getting into causal and corollary stuff?
And then, yeah, you also get into that's exactly right.
So let me get this straight.
If I get this straight, I don't like what you said.
I really don't like what you said stress because this is turning out to be my favorite piece of the shit on Mark Miles.
You're missing everything.
If I put these electrodes on my neck and lay in bed peacefully for an hour before going to bed, will it make me sleep better?
Yeah.
It could.
And what would happen if you just didn't have them on your neck and you lay in bed peacefully for an hour reading your Hitler books or whatever you're doing?
I don't know.
You're into those things.
What do you think would happen?
Do you think you would sleep better?
Well, I do that anyway.
This is like when somebody who eats junk food all the time becomes vegan and they just start eating lettuce and they're like, veganism is the key.
That's the same thing, right?
Okay.
But I read every night anyway.
Now I'm trying this and seeing if it gets my HRV up.
Well, you know what?
128, by the way.
120?
128.
128?
Just saying.
Celsius, though.
It's not even real.
It's like, is that in what's called RMSS squared?
Okay, what is this supposed to be?
What is this supposed to be?
I mean, that's absurdly high for an adult.
That's how I felt.
I was like, there's no way this is true, but this is.
And is high good?
All things equal.
Hold on, let me find it for you.
Hold on, hold on, hold on.
Let's get it.
I feel like a T is getting a little competitive right now.
What's yours, Atia?
Oh, mine's super low.
I have very low HRV.
I'm in the 30s.
What?
Yeah.
Mark, there's no way you got 128.
It could be.
I mean, I have seen people.
What's the average range?
Oh, it's pretty genetic, believe it or not.
But the average, and it declines by age.
So for people our age.
That was on Saturday.
I don't know what any of this means.
He just hooked his whoop up to his baby.
Look, you know what?
Your six-month average is 88 milliseconds.
I don't know what whoops' algorithm is, but I'm assuming they do it with there's two ways you can calculate HRV, and they differ by about a factor of three.
So assuming these guys do it the way most consumer products do it, you would be at the upper, upper end of what an adult would be at.
But again, so that's great news.
We don't know if that means anything.
What it tells us.
He suck, Margo.
He sucks.
I'm getting you guys all nursing things.
But the point is, but a relative change is what you should be paying attention to.
So if your average is, you know, whatever for the month, your average is 92, then you want to know, like, is this thing dramatically taking you up from that?
I don't know how you got a 124, but man, that's impressive.
I just said I slept on the road in a hotel.
But what is that I did know when you have a high HRV?
Like, well, all things equal.
It says your parasympathetic tone is higher, your sympathetic tone is lower.
That's a good thing.
Like, how does it affect the body?
Because when I was growing up, HIV was a horrible tone.
No, no, no, it's not.
It's not that.
No, no, no, it's HRV.
HRV.
We do have Alley G. What about homo safety?
That could have been.
That's a great accent.
There's four British scientists around him that kept taking it serious.
He goes, no, whatever you do in your life, it's fine, both.
I know.
Your wife's a homo?
Yakosha.
Okay, but what is HRV?
What are the benefits of HRV?
HRV means how much variability is there in between your heartbeats.
And what it measures is if the sympathetic system, the fight or flight system, is like the gas pedal and the parasympathetic, the rest or digest system is like the brake pedal.
HRV basically tells us what is the balance of throttle to break.
And so when you are sleeping, you want to be in a rested state.
You actually want your HRV to be as high as possible.
So why one person has an HRV of 100 and one person has an HRV of 30 and one person has an HRV of 50, whatever, that seems to be just a genetic issue.
But for a given individual, there are things that are going to lower your HRV.
And those are things that we ought to avoid.
So I'm sure all of you have learned this if you have a wearable.
Drink alcohol before bed.
There is no sure way to tank your HRV.
Eat food before bed, HRV goes down.
Sleep in a hot room, HRV goes down.
You know, all of these things are going to kind of overtrain.
So something as good as too much exercise, HRV goes down.
Do you use a wearable?
I don't, but I sleep on a mattress called an eight sleep.
Yeah, eight sleep is fantastic.
Yeah.
I think it's a genius.
And by the way, I'm an advisor to them, so now I should just disclose all that stuff.
All that disclosed.
But what I thought was so-I have a mattress cover.
Okay, the covers, but nobody wants to leave their mattress initially.
It's a really daunting task to change.
You're sleeping pretty good.
I don't, I think 99% of people who use eight sleep use the mattress cover.
But I think that was the great innovation because I've heard other mattress companies.
Oh, yeah, yeah.
There was a buddy of mine, who was an engineer, he was working on a cooling mattress.
And I was like, bro, now you got to convince people to buy this like science mattress.
No, if you get something that goes over it, yes, they'll do it.
They'll try it once or twice.
If they don't like it, maybe they send it back.
I just thought it was a really smart innovation.
It is, it is hands down the thing I have become most dependent on that most differentiates the quality of my sleep at home versus being in a hotel.
Really?
I mean, I am obsessed with this thing, and my sleep at home is Phelpsian.
So I run it to work like my body is supposed to work.
So you're supposed to get into bed.
I don't know.
I have mine at like minus five when I get into bed and then rapidly get cooler.
And then before I wake up in the morning, warm me up a little bit.
And that kind of mimics sort of what you want to be able to do.
Does it affect you and your wife?
You can separate them.
So she doesn't like it as cold as mine.
Sometimes you got to fuck with her, though.
I mean, freezing up.
Oh, your HRV is a little low.
Oh, maybe you should be nicer when I come off the beach.
Microplastics And Sperm Health00:15:11
Okay, can I ask about your supplement stack?
Sure.
He gets his question a million times.
Okay, can I ask about my supplement stack?
That's what you really want.
That's really what I was wondering.
That's really it.
It's daily creatine.
I think it's a go.
Why is creatine good?
I mean, I think it's pretty good if you're training.
You know how it works.
I'm assuming you kind of understand the gist.
It holds water.
That's a net effect of it, but that's not the desirable effect of it.
You know, everything in energy metabolism is about transferring phosphates.
So you've heard of ATP?
Yep.
Yeah.
So ATP is the energy currency.
So creatine phosphate is the fastest form of phosphate delivery.
It gets in it.
Okay, got it.
So it aids recovery.
So more creatine means more creatine phosphate.
So AIDS in performance, basically.
There's also some benefit, some evidence that it improves cognition.
Although that seems more pronounced in people who are deficient in creatine, which might be more likely in vegetarians than non-vegetarians.
So maybe if you're a vegetarian, in addition to supplementing a whole bunch of things like B vitamins, you might want to even more consider creatine.
But for the most part, I think creatine is a good thing to be supplemented.
I have a friend of mine who religiously uses creatine now.
And by religiously, I mean two weeks he's on it.
And my friend Jason, and his body, he looks like a penguin.
Is that a side effect?
Does it do that to you?
No.
There's no real data that would show that.
Okay, it's a great thing you're good, man.
Magnesium before you sleep.
Yeah.
For sure.
Okay.
Like vitamins, A, B, C, D, any of those?
Some of them.
I think D is good to get D, you should think about what's the level you're trying to get to.
So it's, I think if you, you know, getting your vitamin D to between 40 and 60 for most people requires supplementation.
But most people are like deficient in vitamin D.
Yes.
So supplementing is solid.
Yeah, but just you always have to measure the level to make sure, you know, you're not doing too much or not doing too little.
Okay.
Fish oil or coddler oil?
I think so for most people, but you got to get a good source of it because it's there's so many contaminations out there.
So like Carlson's is a good brand.
Nordic Naturals is a good brand.
I have no affiliation with these companies, but they're clean.
So meaning third-party testing comes in and makes sure they don't have heavy metals in them and stuff like that.
Got it.
And then what is your coffee protocol?
Caffeine, rather.
Yeah, I love coffee.
Unfortunately, I'm a super fast metabolizer of caffeine.
So I don't really get a jolt from it, but I just love the ritual and the taste and the flavor.
And I recently switched over to this machine that is all glass and metal.
So it makes a really nice drip coffee, but without any of the plastic.
Because I have been trying to get rid of obvious sources of microplastics.
Not that I'm like fanatical about this, but continue.
Yeah.
So hot water and plastic is something I'm trying to avoid, right?
So it occurred to me after making this podcast on the topic.
I was like, man, every morning I put coffee in that thing and it drips scalding hot water through 27 layers of plastic into my glass carafe.
I was like, there's got to be a way to do this.
So now that I discovered this thing, which I can't remember what it's called, but it's like, it's an all-glass version.
A listener sent it to me because I was lamenting on the podcast that I couldn't find something.
And they're like, cutting boards that are not made out of wood.
Like they'll have like, I guess, plastic cutting boards and you'll get tons of microplastics from that kind of stuff.
Yeah, I like the wooden ones for.
Even breaking if you're in an urban area and every time a car uses their brakes, right?
It's like sending like millions of microplastics into the air.
Yeah, I mean, I think at some point there's kind of like the 80-20 rule on this stuff.
With relatively low effort, I think you can eliminate 80% of your exposure.
And then you could drive yourself crazy and not get the other 20% out.
And just leave that out.
Yeah, just ignore that stuff.
Okay.
Do you have any more?
Not for supplements, no.
Okay.
We all have tons more questions.
Oh, nicotine was the other one.
Oh, yes.
Well, let me ask one question before, just because we're on microplastics, because the second that I told the whole world that my sperm doesn't swim, I got a lot of very concerned people, including you.
It was really great.
Like, so I think one of your guys that works for you hit up and was like, hey, Dr. T, we'd love to hit you up and talk to you about your sperm.
And I was like, that sounds like really awesome.
If it was a year ago when I couldn't breathe.
But no, this is great.
And then you sent me this like awesome podcast, which is out now with Dr. What was his name?
Paul Trek.
Paul Trek.
Okay.
I got a lot of like online diagnoses about certain things.
People are like, yo, watch out for the microplastics.
I'm starting to read all these articles about like what's happening in male fertility.
And they say like sperm quality has decreased 50% in the last 50 years.
Can you kind of can you talk about that a little bit?
Just like, is sperm quality decreasing in America?
Is that, are we just testing it better?
You know, what is happening with microplastic?
Does that affect it?
What do you think affected mine?
So I think that there are so many things going on and it's impossible to say which one or two or three you're driving.
It's kind of like the U.S. healthcare system.
You know, when someone says, why does the U.S. spend more than twice what any other country spends?
I'm like, how much time do you have?
Because it's, it's, I'm going to have to explain the entire system.
I won't do that here on the sperm issue, but it's a lot of things, right?
So as males are getting older at the time of wanting to reproduce, age is driving down quality.
But at what age?
I was told that that doesn't happen until we're like 60.
No, I mean, at 50, you fall off a cliff from the standpoint of the quality of the sperm.
Got it.
But remember, as you're getting older testosterone's going down as well, then you factor in if testosterone is going down and more men are using testosterone replacement therapy, that's also reducing fertility.
If you're using actual exogenous testosterone, the relationship between obesity and metabolic disease is also pretty significant.
And men, on average, today are much fatter and less healthier.
That doesn't explain you, but clearly there's something going on at the population level there.
That also probably has the greatest impact on declining testosterone levels is just inflammation, obesity, more aromatization, meaning turning testosterone into estrogen.
You know, it's funny.
I don't think, I don't know enough about STDs, so I don't know if they're going up, but STDs play a pretty big role in infertility as well.
So yeah, if you get like an infection of the epididymis, which is the collecting system on the back of the testes, and you get recurrent epididymitis.
And again, you can get those from UTIs or other things, but STDs are the most common cause of that.
So again, I don't really know what's going on with chlamydia and gonorrhea these days.
I don't sort of see that stuff in my practice, but my guess is that that could be playing a role.
So I think it's probably a death by a thousand cuts.
I don't think there's a smoking gun.
Do microplastics play a role?
Yeah, it's possible.
What would they do?
I read some reports saying they found microplastics in sperm samples.
Yeah, I mean, maybe.
I don't know that that by itself is a smoking gun here.
You know, you can find microplastics in many things, and I don't know if it's causally driving the problem that you're seeing.
That said, all things equal, I'd probably prefer not to see microplastics in sperm than to see them, especially as we talk about in that podcast.
I mean, the process is so it's so hard to believe it actually happens.
Can you break down the process of impregnating a woman?
Yeah, I mean, I think, again, I think Paul does a much better job, but the gist of it is that, you know, when a guy ejaculates, 100,000 sperm come shooting.
100 million.
Sorry, 100 million sperm, thank you.
Go shooting into the vagina.
And you said it best, right?
It's like, it's like wave after wave of soldier just getting destroyed, destroyed, destroyed.
And finally, as the acidity of that environment and the harshness of that environment, a few of them manage to get through.
And then now they're in the uterus.
And then they've got this whole other challenge because they have to eventually make their way up the fallopian tube.
But the punchline is like only about 100 of the 100 million make their way to the egg.
How insane is that?
So 100 million start, 100 end up going there.
I think it was like 100 million by the time you have, because the pH in the in the vagina is like quite acidic.
Yes, right.
So I think it narrows it down to 5 million.
And then going through the fallopian tubes, you're down to 100 sperm.
That's your chance every time you do it.
And they have to swim.
And we were talking about this before the podcast.
A sperm in order to get from the vagina to the egg has to swim the equivalent size-wise of us swimming 20 miles.
Catalina.
Yeah, so you think of the energy requirement of that little flagellar tail on the back of a sperm.
Oh, that was cool too.
About how, like, each one has a limited amount of fuel, essentially.
So each sperm has the fuel and it's used to get to the egg.
And after that, there's one reserve.
Yeah.
One way.
That's it.
So it's a rocket.
Yeah.
That's wild.
Now, is it the first sperm to reach the egg or does the egg have any selection process?
So interesting.
So as the once you now get down to that group that are getting to the sperm to the egg, it's the first one that gets embedded that actually triggers this incredible electrical system, like a force field forms around the egg and no other sperm can get in.
And the reason that's so important is you would create what's called aneuploidy, where you have multiple copies of chromosomes if you do this.
And that would be catastrophic.
So that to me is my favorite part of that is there's this whole calcium channel that like flips a switch.
The second, like the millisecond that that first sperm makes contact, it's just a, and then away it goes.
But how crazy is it that like your fastest quote unquote, I don't know if they're the best, but the first few lines, we're talking about 95 million, your 95 million best sperm get axed the second they touch the shore.
Wow.
Right.
So the last five million who are just like chilling, hanging out, like watching to see what went on are the only ones that end up getting there.
So is there an argument that if you were to select sperm like in vitro or something like that, that those might be potentially part of the first wave?
Such a great question.
But of course, right?
So I guess the question is, are the first ones that get out stochastically determined to be the first ones out?
Or is there a selection benefit to being the first one out?
If there's a selection benefit to being the first one out, then it means IVF is probably altering that mix because IVF would be just picking randomly.
If there's no survival reason why those first ones are out and the five million are at the back, then it probably wouldn't matter.
Okay, that's what you would hope.
Because they do like sperm cleaning is what they call where they essentially look for like the healthiest versions and they'll take them and plant them.
But God forbid, if they weren't like supposed to be there.
Ooh.
But then again, if they are the strongest, that's a lot of pressure on my kid.
You were the best of the best.
You better get A's.
Wow.
Okay.
I'm curious.
Do you have any, I've heard people say like, oh, don't put your phone in your pocket for sperm health, any of that stuff.
Like heat from your phone or like from a laptop.
And then additionally, like any EMF stuff that you've ever read research on?
Yeah, I have looked at a lot of this research.
I don't find any of the EMF data compelling, which is going to generate a lot of hate comments in the YouTube guys.
I'm sorry.
Because, boy, everybody wants to believe EMF is the cause of all evil.
What is EMF?
The stuff, the waves out of your airbuds and your genes and stuff like that.
Electromagnetic frequency that causes yourself.
Oh, I got to go and get stuff like that.
Sleeping next to your phone, people say, is bad.
Heat is a real issue.
So it turns out that hot tub, what did Paul say in this podcast?
He said he could render any guy completely infertile.
By just going in a hot tub.
By doing four hot tub sessions a week.
And then he said his.
To which I was like, this needs to be a form of birth control.
Some people say.
I mean, your buddy said that he would go, I think, or was it you?
One of your buddies were trying to get pregnant and they would go in the sauna with his nuts in the sauna.
And he would just keep the ice pack on his nuts.
But I imagine that the fact that the testicles can elevate and descend is specifically so that they can maintain a temperature that's beneficial to them, right?
Well, yeah, that's mostly for cold protection, not heat protection.
So that's why he was saying cold plunge is not, he doesn't concern himself with cold plunge and fertility because they can't.
Because they can descend and they can get a warm plant.
They can keep themselves warm.
It's that they can't dissipate heat.
Oh, that makes sense.
So that's why they have nowhere to go in the hot tub.
Is there any long-term effect or is it just temporary?
Sounds like from him, it's just, it's just transient.
What about desert people?
Like people where the temperature does get to 100 degrees, 105 degrees.
Yeah, again, air doesn't conduct temperature nearly as well as water.
So the thermal coefficient of water is so high.
That makes sense.
That's why when you're in 105 degree water, it's actually uncomfortable.
You're in 105 degree air, you can stand it for a long time.
What about the red light therapy on your junk?
Oh, yeah, I saw people talking about this a couple of years ago.
This was all the rave, right?
For increasing testosterone.
I don't know anything about it.
My guess is like all that stuff is kind of like rearranging the deck chairs in the Titanic.
Like maybe it helps a little bit.
I'm not sure if it really helps a ton.
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What's the biggest bullshit biohack?
Like, what's the thing that you roll your eyes at every time you see people promoting it?
Boy, there's so many.
All right, give us 10.
Dangerous Stem Cell Hype00:10:05
So I think a lot of the sort of stem cell stuff is pretty freaking dangerous.
I think that there are probably instances in which stem cells could be really helpful.
I think if you tore a muscle, you know, if you tore your rotator cuff or something, I would love to see a study where we looked at non-operative management.
So just sort of PT rehab versus PT rehab plus stem cell injection.
Would there be a difference?
The answer is maybe, right?
But when you look at sort of the grotesque misuse of this stuff in areas where it's just clearly not going to play a role, for example, the intravenous administration of this stuff or the intrathecal administration of this stuff.
I mean, intrathecal, like into the spinal cord and stuff like that.
I mean, there's just no plausible mechanism by which you're going to inject stem cells into somebody's bloodstream that they're not going to get completely torn up by the cells in the lung.
And the best case scenario is it does nothing, but the worst case scenario is you've wasted a ton of money and you've potentially subjected yourself to some infection or something like that.
And we don't hear enough of those stories.
I do hear some of those stories of the people who get horrible infections when they go down to Costa Rica or Colombia to get their stem cell treatments, which says nothing of how much money is being spent on this sort of thing.
So my guess is there's some signal there, but it's like most of what you're seeing is not.
This is a huge industry.
Yeah, it's actually kind of remarkable that it exists.
But I mean, I shouldn't say that.
Anytime you can do something to convince people without data that something works, it's a win-win, right?
I'm just so shocked that it's become so normalized.
I haven't heard really any pushback about it outside of you.
Now, I haven't done much research.
Again, I'm like completely ignorant to all this stuff, but but wow, so the stem cells, you don't see you see marginal benefit potentially and no real data to back it?
Definitely no data.
So, so people that talk about data are talking about anecdotal data.
Like, you know, my cousin Joey, I mean, he showed his stem cells and he's 100% better.
It's like, okay, well, I mean, again, maybe Joey would have got better anyway because, you know, so you can't, you cannot study these things without blinding and without randomization.
You simply can't.
And who's signing up for the blind stem cell study?
Right.
If you've got enough money to get your shoulder fixed and you're willing to go to fucking Columbia to do it, then you want the real stuff.
Yeah.
Are there other peptide stuff is total nonsense.
BPC 157.
Yeah, so let's take that one.
It's the most popular.
Can we like, what is it?
Yeah, so BPC 157 is an analog of something called vascular endothelial growth factor, VEGF.
So what is VEGF?
So VEGF is a molecule in the body that promotes something called angiogenesis, which is the creation of new blood vessels.
So angiogenesis is really important in certain processes.
In fact, it's important for cancer, right?
So cancer has to utilize VEGF to spread and grow.
So many years ago, a drug called Avastin was introduced that was an anti-VEGF drug.
To limit the growth of target this thing, right?
Okay.
So, but there are clearly times when you would want lots of angiogenesis, when you want proliferation of blood vessels.
And so the thinking is that if we give people BPC-157 and they have an injury, maybe it improves healing.
And I think it's possible, but there are a couple of challenges with this, right?
So you can take BPC-157 orally, but the bioavailability is only 10 to 20% because the acid in the stomach tends to rip peptides apart.
So it's not clear that you can take enough of this stuff by mouth to actually meaningfully get it into your body.
Furthermore, how much would you need to take?
Like, let's say your patella tendon is the thing that's flared up and you really just want to get more blood flow there.
Should you just be injecting BPC-157 there?
The half-life of it is like one to two hours.
So then the question becomes like, how often do you have to use this stuff?
I mean, you need to be injecting it three times a day.
And again, without any data, we just don't know.
So I think there's biological plausibility to it.
But if that weren't enough, you know, the FDA has cracked down on these things and said, like, come on, guys, we need to see some data if we're going to let you use these things.
So now pharmacies can't make this stuff anymore.
So now when people buy peptides, they have to do it in a very shady way, which is they have to buy it from a manufacturer who claims that they're only selling it for research purposes and that you're only buying it for research purposes.
And then until they get shut down, and then it's like a kind of a game of whack-a-mole, but there's no quality control.
And truthfully, like I would really like to see this studied so that we could know.
Like, I'd like to see what's called an IND, which is, you know, means like the FDA stamps this with an investigational new drug status and let it get studied.
And let's decide once and for all, like, does this work?
Because I'm sure there's going to be a time in my life when I'm going to want every trick up the sleeve that could be used to address these things.
There are some peptides that actually I will say completely do work.
They're biologically identical to certain hormones in the body.
So samoralin, for example, is basically a growth hormone analog.
It works perfectly well.
But then you have to ask the question, you know, what are the pros and cons of taking growth hormone?
Yeah.
Yeah.
What is your, I know many people that when they hit like, you know, 35, 40, their testosterone goes down and doing, you know, TRT and growth hormone stuff to get it back to that baseline level.
Yeah.
What are your thoughts on that?
I mean, totally different things.
I would say when it comes to TRT, I think the data are really good at the benefits of TRT in a low T state.
Obviously, you have to be aware of certain situations.
Like, you know, if you want to have kids, TRT, you have to be, I wouldn't recommend TRT to somebody who still wants to maintain fertility.
I would recommend HCG, which is another way to increase testosterone production without giving testosterone and shutting down endogenous production, the body's production.
Growth hormone is a more complicated one.
And I still have two minds on this, which is on the one hand, there's really no data one way or the other saying it's good or bad, right?
Actually, that's not true.
There are data saying it's good in certain cases, like HIV wasting, right?
So people like back in the 80s when we didn't have highly active antiretroviral therapy for patients with AIDS, you had nothing to offer these people but like high doses of steroids and growth hormone.
And by the way, dramatically improve their quality of life.
So we know that at least in the case of AIDS wasting, growth hormone was amazing.
I've never met a person who took growth hormone who didn't say they felt better.
So the question is at what cost?
I've never taken it, but I tell you, I'm sure at some point I'm probably going to be like, you know what?
Let's try.
I don't care about the risks anymore.
I'm old enough.
I feel crappy enough.
It's time to start taking it.
But, you know, I'm only 52.
I'm going to, I'm going to hold out a little bit longer before experimenting.
Right.
What about like NAD or all these like cosmetic IV drips?
Yeah.
NAD is another one where there's a great argument for why you would take it because NAD levels decline as we age and NAD is very important.
So that if you took those, if I told you there's this really important thing in your body and it gets lower with age, the obvious answer is I should be taking more of it.
Okay, totally get that.
So then the question becomes, how do you take it?
So there's basically two ways you can take NAD.
You can take it in an intravenous infusion.
I think that's a total waste of time because one, they're giving you probably way more than you need.
And how many times, how often can you do that?
Like even if you were the most committed junkie, like would you do that once a week?
Right.
Right.
That's not going to create like the half-life of NAD is quite short.
That's not going to meaningfully contribute to your total body levels of NAD.
So people then try these.
And the other way you can take NAD is through formulations that you take under the tongue so that they get absorbed in your lymphatic system.
That might be more promising.
I'm kind of interested to see how that pans out.
And then there are people that take these NAD precursors.
One of them is called NR and one of them is called NMN, which you've probably heard of.
And, you know, frankly, there's no evidence that those get turned into NAD in meaningful enough quantities.
They do a little bit, but they don't seem to get turned into it enough to really matter.
And also all of the clinical trials, and I say clinical trials kind of in quotes because they're usually industry-funded trials, but all of these experiments, they don't tend to show very interesting outcomes except in very esoteric cases.
So there was probably the best study that people point to, the two best studies that people point to.
One is in people with Lou Gehrig's disease.
I think they were given NR and the people that were given NR had a slightly longer time till they needed to go on a ventilator.
And I mean, I don't know how clinically relevant it was, but to somehow suggest from that outcome that we should all be taking NR is a huge stretch.
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When you said you were pre-diabetic, how did you fix that?
It's like I was also a pre-diabetic two years ago and I just have to like cut out a lot of sugar.
I mean, mostly at that point, it was, you know, changing my diet, you know, and losing a ton of weight.
I mean, frankly, weight loss fixes most problems.
RFK has started taking out red dye.
He started his crusade against like these dyes and stuff and food.
Is that a pressing problem?
You think in the American diet, these like red dyes and things like that.
Have you looked into that research?
I've looked into it a little bit and I can't imagine anything wrong with getting rid of red dyes.
In other words, I don't think anything bad happens because we take out the red dyes.
Alzheimer's Prevention Strategies00:13:38
I would be remember the expression in planes, trains, and automobiles when he's like, are you surprised?
And he's like, if I woke up in the morning with my head sewn into the rug, I'd be less surprised.
I think if like red dye, if the removal of red dyes fixed our health system, that's how surprised I am.
Yeah, yeah, yeah, yeah.
I don't think that's by a thousand cuts, but it might be one of the cuts.
Maybe.
Okay.
Just doing research on you, I love the fact that you're speaking a lot about like the emotional component of longevity and how important that is.
And just because I think there are ways to kind of biohack at the cost of enjoying your life, spending time with friends and like figuring out what the right meters that you should pull on are.
Like specifically having community, I think is like crucial.
And the isolationism that a lot of people are dealing with in America, probably around the world, is you could say like there's a version of it where it's not, I don't want to say slow death, but it will knock off years from your life.
Right.
How do you like maybe this is something that you're working on early in life, but how do you, how do you communicate to a 30-year-old, hey, you want to live to 80?
You better have some fucking friends that you hang out with.
Because that's not something you could solve for at 75.
Yeah, that's such a great point.
How do you convince the 30-year-old?
So look, this is going to sound like a dumb thing to say, but I feel a little detached, right?
So I don't, so a 30-year-old is a full generation below me, right?
So I don't know what a 30-year-old, I don't necessarily have an appreciation for what a 30-year-old is struggling with today relative to what I was struggling with at 30.
So, but I think you're right.
I think there's the world is so different today that I'm sure that there's a greater sense of isolation.
I just don't think you can overstate the whole point here, which is everything you want at the end of your life, you have to be able to work backwards from and start now.
So if you want to be fit when you're 80, do you know how fit you need to be when you're 30?
Like you don't get to be an out of shape pug until you're 75 and go, it's hammer time.
Yeah.
So you have to get in shape now.
Like all the exercise I do now is not for now.
It's for 80.
It's for 80.
Yeah.
I mean, this is something.
So the same is true on the relationship front, right?
So I think you want to bust friend group at 80?
Yeah.
And I want my kids.
I don't remember who said this.
Yeah, I wish I could remember who said it so I could attribute it to them.
But somebody said the greatest source of wealth is having adult kids who want to come and spend time with you.
Right.
So if you, let's, let's unpack that for a moment.
So that says, okay, do you accept that?
Well, I think anybody who has kids would accept that.
So, okay, I want my kids are 17, 11, and 8, and I want them to constantly come back and be with me till the day I die.
Okay.
What do I have to do to make that true?
Hold a trust fund over their head.
I mean, how much do I need to spend time with them now or can I ignore them now?
You got to spend time.
Exactly.
So it's like, so all the, so, so, for example, like people say, oh, Peter, you exercise so much.
I'm like, I don't exercise that much.
Like, you should see what I used to do.
Like, I phone it in when I work out, right?
I mean, like, if I'm given the choice between an extra workout or a game of chess with my kid or playing soccer with my kid, I'm always going to pick doing the thing with my kid because I know that those years are very finite.
And that's the investment, right?
That's like, I have to invest in these relationships today because I know what I want tomorrow.
And the same is true with my wife, with my friends and stuff.
So I think that's the way to position it is all the choices you make today are compounding choices.
And work backwards from what you want.
So, okay, to that end, reactive medicine is going to get really good.
And I imagine with AI, I don't know exactly how it's going to affect it.
I'm curious your take on that.
But reactive medicine is going to get better.
The better reactive medicine gets, I imagine the less proactive we will be with our longevity.
So if I know, for example, if I get cut, I could just throw some neosporin or I could take an antibiotic.
I'm not really worried about getting cut.
But back in the day, if you got cut, you fucking died.
You worry about getting cut.
Are you at all knowing how important it is to plan for your last decade and knowing how prolific the drugs are going to get that help you think at least that you don't have to plan?
Are you worried that that's going to deteriorate, that planning that is so vital?
At least in people's minds.
I mean, perhaps for some.
I think, you know, there are some areas where I think I'm hopeful that drugs are going to get a lot better.
But it's going to be a while before I think we could safely say that prevention is still not the best management strategy for cancer, for heart disease and for dementia.
And I think that especially for cancer and dementia, we really don't have amazing treatment options.
Advanced cancer is advanced meaning cancer that has spread from its primary site, metastatic cancer.
You know, it's almost uniformly fatal still.
We have about an increase, overall survival has increased about 10% in 50 years.
So I still think the approach of early detection and taking all the preventive measures is going to matter for a long time.
Furthermore, lifespan is not the only metric, right?
Health span also matters.
Can you explain the difference between those two?
I think people get confused with that.
Yeah, lifespan is the easy one.
It's how long you live.
And so that's the one that the medical system is fixated on: how many years are you going to be alive?
And we're pretty good at stretching out time that we are alive with chronic disease.
But health span is what more people care about.
More people care about the quality of their life.
And actually, most people, almost without exception, would take a slightly shorter life at a higher quality all day.
Exactly.
Give me productivity through my everybody wants to live to 100, et cetera.
Of course, in our heads, we're all like, I'm going to get to 100.
Give me productive 80 years.
Like I'm playing paddle every day until I'm 80 instead of being wheelchair bound from 70 to 100.
Yep.
I think most people take that.
Yep.
I think that's.
And in order to do that, you're talking, you have to take preventative measures.
Yeah.
And you have to do hard things.
You have to exercise.
Like you've got to, you've got to watch what you eat.
You've got to tend to your sleep.
You've got to do these things for which we don't have great pills that are substitutes.
Can you explain the dementia, the correlation between, I don't know what it is, is like diet or health or what you can do.
My dad has dementia.
It's like what preventative measures can you take for that?
Well, again, dementia is really complicated because there are so many different types of it.
There's Alzheimer's disease specifically, but then there's vascular dementia, Lewy body dementia.
My dad has non-amyloid plaque Alzheimer's.
So usually Alzheimer's defined by the amyloid plaque buildup.
They haven't found enough in it, but they're still like, you're showing all the symptoms of this.
So they don't even know what the fuck to do about it.
So I'm curious, like what.
So genetics play a pretty big role in this.
I'm sure they've done the appropriate genetic testing to see how much of this was kind of genetically driven.
And then there are a whole bunch of factors that can increase risk.
Don't answer for whether any of these participated in your dad's, but like everything from high blood pressure, high cholesterol, insulin resistance, poor sleep, high stress, those are just the ones we know about inflammation, certain types of infections, right?
There's now a lot of infect a lot of evidence that's emerged in the last six months that suggests that reactivation of shingles, especially an ocular version of shingles where the virus gets near the eye, that could even increase the risk.
So now we're, you know, we've always been pretty adamant about people getting their shingles vaccine once they hit 50, but that's yet another reason I think that everybody, once they hit 50, in fact, I got my shingles vaccines when I was in my 40s.
I was like, fuck it, I'm not waiting until I'm 50.
Yeah, yeah, yeah.
Well, just from the standpoint of shingles being such a miserable, awful experience.
So, but you said blood pressure and insulin resistance.
My dad does have high blood sugar and he has become insulin resistant.
So are you saying that like potentially, obviously there are genetic factors, but like could diet have also sped up that process potentially with him?
Yeah.
Oh, fuck.
It's horrifying to figure out that there's something that could have been done to stop that.
Yeah.
I mean, I always thought it was just like you either got it or you don't.
It's genetics.
Yeah.
And again, there's a genetic component to all of these diseases, but you really can, if you start early enough, you can circumvent a lot of the genetics.
Certainly not every case.
Look, there are cases of Alzheimer's disease that are predetermined.
But fortunately, the predetermined cases represent less than 1% of cases.
So there are a handful of genes that guarantee a person will get Alzheimer's disease.
And tragically, these people succumb to the disease in their 50s usually.
But again, that's 1% of cases.
So 99% of cases are there's a genetic component, but they seem to be triggered by insulin resistance, hypertension, hyperlipidemia.
This is the stuff that I think is so motivational, right?
Like once you learn about that, I mean, did you guys learn that Alzheimer's was something that you could be doing?
We didn't learn this in med school.
Why would these guys have learned about it?
It's kind of crazy.
No offense, but I went to nursing school, but yeah, I did.
I never heard that before.
But it's, I mean, like, I would have loved to know about this.
My dad's starting every morning with a corn muffin from the deli.
Like, that can't be good for him.
Yeah.
Yeah.
Wow.
No, medicine has a huge blind spot to this topic.
Why is that?
I think it just has to do with the structure of reimbursement and payment built around diagnostic codes and intervention.
So medicine has basically two types of interventions: drugs and procedures.
And so we have codes for both drugs and procedures and diagnoses.
We don't have code for prevention.
Yeah, we don't really have a billing system that makes sense to say, oh, you know, John came in today to see me and I noticed that he's a little pre-diabetic.
But rather than just write him a prescription for metformin, you know, I spent half an hour with him and I figured out that he's not sleeping that well.
So I walked him through some of the CBTI techniques for improving his sleep.
Like there's no way.
Like, how would you pay somebody for that?
It's sort of like...
The reward system isn't built for it.
Yeah, yeah, yeah.
So then it trickles down.
So then it's not going to be part of the education system.
So, I mean, if you like, people often ask me, like, well, why should I listen to anything you say?
Like, you trained as a surgeon.
Like, how does your surgical training have anything to do with what you do today?
And I was like, yeah, you're right, nothing.
Like, nothing.
But here's the point.
Had I gone and done internal medicine or family medicine or rheumatology, it would still be, the answer would still be nothing.
Yeah.
Right.
Like, all these things I've learned over the past 15 years, would they were not going to be things you were going to learn in a standard medical system?
And by the way, I'm not saying that that standard system isn't wonderful.
It is.
Like we owe a lot to that Medicine 2.0, as I call it, system.
But it's really at the limits of what it's going to solve.
So we need to make some fundamental changes.
Yeah, we just have to have two systems that run in parallel.
You have to have your Medicine 2.0 system for when you have pneumonia, when you have a heart attack, when you get cancer, when all of these things happen that are horrible, you need the system that we have right now to fix it.
But we have to be spreading some resources over to a system that says, hey, when you're 20 years old, why don't I start doing all this stuff in you so that when you're 75, you look more like a 55-year-old internally?
There's definitely like, it seems that there's a thirst for it.
I mean, obviously you spearheading it and then, you know, Rogan taking such an interest in it.
Like, I don't know if this is directly from you guys.
I assume it is, but like, I've heard that even young people are drinking like 10, 15% less.
Yeah, I've seen stats about that.
Yeah.
And I mean, smoking has gone way down, like, you know, which are nice things.
And maybe you want humans to have some agency over their own body.
Like, maybe it's not only up to the medical industrial complex to tell us what to do.
Like, maybe it is good that we do some research and we start going, yeah, well, maybe if I eat right in exercise, that this will be better for me.
But at least having access to the information is important.
That's crazy that 99% of dementia could have environmental effects that have sped up the process.
Yeah.
And just to be clear, there's a spectrum within there, right?
There are some people that are going to have two copies of an APOE4 gene.
MRI False Positives Problem00:07:04
They're going to have it.
Well, they won't necessarily have it, but they're going to have a 10 times higher rate of having it.
But then there's still something that might trigger it.
But look, half the case, a third of the cases of Alzheimer's disease don't even have one copy of the ApoE4 gene.
Now, they might still have some other gene that we don't know yet is participating in this, but we have to believe that there are significant environmental triggers.
And I think that plays more of a role than what we see in cancer.
I think in cancer, you have more of kind of the bad luck problem where just cells are constantly turning over DNA and then you just eventually, you know, you make so many mistakes and eventually one gets out that the immune system evades.
And that's why I think we still, and we will always see people who do everything right get cancer.
Yeah.
And you said how important early detection is when it comes to cancer.
How do you feel about like full-body MRI scans?
I think they, again, we do them with our patients, but we are pretty careful about doing it.
And we don't necessarily recommend everybody do it because you open up a can of worms with that stuff.
So first of all, most MRI scanners out there are garbage.
So they're not even remotely good enough to be doing this.
MRI in general is just kind of a crap technology.
What's that?
Compared to CT scan.
Yeah, the magnet.
The magnet makes a ton of noise.
But I mean, the problem with MRI is it's not a standardized.
This is, it's hard to explain this without getting really into the physics of it, which is super cumbersome.
But like a CT scan has a quantifiable unit of measurement.
So when you look at a CT scan, it might look like it's black and white and different shades of gray, but every one of those pixels can be described in something called a Hounsfield unit.
And you know exactly what the color of that is.
And it's perfectly quantifiable and it's reproducible no matter what machine you get it done in.
So some machines might have a higher resolution.
Some machines might go faster and some machines might have more or less radiation.
But the image reliability is one language.
With MRI, it ain't that way.
So an MRI from one hospital could speak a different language than MRI from another.
Holy shit.
And so you are relying on our radiologist to sort of try to look through this thing.
And so you might ask, well, why do we even do MRIs?
There are some things for which when you add contrast and you run a certain protocol, you get a much better look at certain types of tissue.
But for this application for cancer screening, it's nowhere near as good as CT, but we just don't want to put people through that much radiation.
So we use the MRI with no contrast.
But, you know, there are most of the companies that are out there advertising to do this are kind of running lousy protocols.
And, you know, they're doing it really cheap.
But the problem is you're missing cancers.
And more importantly, you're catching a lot of things that aren't cancer.
So you're getting a lot of false positives.
And that creates a ton of emotional stress for people and can lead to a lot of follow-up procedures.
And so when we talk to our patients about doing this, our view is you don't do this unless you're willing to go down a rabbit hole where we saw a nodule on your thyroid.
It's probably not cancer, but now we can't ignore it.
So we have to do an ultrasound.
We're going to have to put a needle in it, take a biopsy.
And I would say 20% of our patients are like, yeah, don't sign me up for that.
Forget it.
We had a friend whose mom went in.
They saw some what they thought, I guess, were like tumors.
And they, in the moment, diagnosed her with stage four.
They're like, this is, we probably have maybe a couple of years left.
Like, we're going to go in and look at them, but it looks like it's spread.
I think stage four is when it's spread to multiple parts of the body.
Take them out, do the biopsy.
They're like, oh, they're all benign.
All right.
New lease on life there.
I mean, there's a part of you that goes, oh my God, I feel so lucky.
And then there's another part of you like, what is this system where they go, you're going to die in two years?
And they go, oopsie.
We didn't know.
I mean, it's crazy.
What about AI as a diagnostic tool?
Like, as that's on the horizon, how does that work?
Yeah, AI will help radiologists a lot, but it won't help MRI until this problem gets solved.
So until MRI is speaking the same language, it doesn't matter.
Excuse me.
Until the MRI's pixels are all standardized, AI can't do anything.
What can AI do for?
What will AI do for just medicine in general?
How will it affect longevity?
Like, where do you see it playing a part?
God, there's so many ways.
It's already playing a pretty interesting role in drug discovery.
So how do we create drugs?
So a lot of times drugs are designed.
They're not, meaning you know the receptor that you want to activate or block, and you know its 3D structure and you know what the protein is that makes it.
And you say, okay, well, I have to make something that fits into here.
So in the olden days, you had to do it by trial and error.
So you're just throwing different proteins at it in solutions.
Yeah, what if I put this amino acid next to?
What if I string these 2,000 amino acids together?
Will they fold in the right way to make a structure that fits there?
Well, the guy that the company that won the Nobel Prize last year was a, it's a company that spun out of Google.
They came up with an AI engine that now can predict from the amino acid sequence how it will fold and what the shape will be.
So you don't have to do the trial and error because you can just make the drug.
Oh my God.
So much cheaper, so much faster.
Yeah, I mean, I don't want to overplay it.
So much faster and cheaper for that step.
That's step one of 27.
Right.
You still have, I mean, I'm being a bit facetious, but now you still have to go and test that drug in mice.
Then you have to get an IND.
Then you have to do a phase one, then a phase two, then a phase three.
That's actually what takes the most time and costs the most money.
But that's still a really big deal.
And by the way, if AI simulations can speed up the second and third day.
Yeah, then we could start to take it.
So how would you create data sets with fake mice or with AI versions of mice?
You'd have to do it off real data to start, probably.
And of course, you'd have to come up with models that could understand what's happening and create perhaps some sort of synthetic data off smaller sample sizes or things like that.
So maybe you run a smaller sample size, but you get enough data out of there that you can simulate what would happen on a larger data size.
I mean, that's where you get the exponential increases when you can use the, they're not called fake data samples.
They're called synthetic data samples.
Once you create synthetic data samples for something, you're out of here, right?
Yeah, I mean, I guess it's, it's still hard for me to kind of wrap my mind around what that's going to mean in humans.
But if I just think about what I've watched AI do when I muck around with it now versus a year ago versus two years ago, I mean, you know, it's just done that.
So it's, it's what that means, it's really hard to sort of imagine what it could do.
There are also some super, super unsexy things that AI could be doing that would like lower the cost of healthcare.
Synthetic Data Samples00:04:40
Like our healthcare system has such a high administrative burden.
And we're talking about seven to eight hundred billion dollars of money.
Most pure admin.
Of just admin burden, which you could, I mean, AI could do all of that stuff.
Wow.
That's significant.
Seven to eight hundred million of pure admin.
Billion.
Sorry, billion of pure admin.
I'm thinking about countries where they're offering it.
They're just offering universal health care.
Imagine what that means for them.
I mean, well, they have much less admin costs than us.
Because why?
They've already adjudicate payments.
So when I say the administration, the admin here has, how do I take the payer and the provider and adjudicate the claim and make the payment?
That's where the insane friction is in our system, which is unique to us.
Is there like you're around a very morbid topic, right?
We're talking about trying to avoid death.
So you can't not think about death.
There's got to be a lot of like positive and happy, joyful things that are coming out of this.
You have to see people change their lives, turn their lives around.
Like, I feel like we fixate a lot on like what could potentially be killing us and how we're being harmed.
But like, are there a lot of circumstances where you're seeing people in their 30s, their 40?
Like, I'm 40.
Mark's in his 20s, late 20s, probably pretty much 30 or 40 already.
Oh, no, late 20s.
And then, and Alice in his 30s.
So like, like, is it, have you seen this?
Have you seen this start to like impact these younger generations?
And is there like a part of you that's very proud to see them taking it this seriously?
Are there certain people that you're working with that you're seeing like life-changing things happen to?
Like, I don't want to just fixate on like what's negative about this.
I think it's a cool moment in history where we have access to this information.
It's terrifying because I don't know if an ice bath is good or bad.
I don't know if a song is good or bad.
Like, this is the cost of having free information out there is that there's going to be a lot of things that mislead you.
But like, well, give us some hope.
I know that you're busy.
You got to get out of here.
But like, where do you get excited at seeing the positive benefits of this longevity research?
Yeah, I mean, I think honestly, for me, it's, I mostly think of the positive stuff.
I don't, I don't, I mean, sometimes I get into an existential funk about mortality.
Probably everybody does if they think about it enough.
And, you know, if you lose a parent, you know, you have these moments that are really jarring where you can't understand what is life sometimes.
But, but that's, I don't spend a lot of time on that.
I, I, I've sort of, I, I think much more about both my individual aspirations, you know, as a, as a, as a husband, as a father, uh, with my friends and things of that nature.
And, and that's, you know, that's just very exciting to me.
And, and as you said, my patients are, you know, wonderful and I love, I love watching all the ways we reduce risk in them.
And then, you know, finally, I think a lot about things I'm excited about when how to actually scale this and make this kind of something that we can deliver to everybody.
How do we do that?
We do it with software, right?
We do it with software and AI.
And that's kind of the next frontier for what I, you know, where I, where I think we should be going.
Are you going to put out like an informational app?
You're going to put out some sort of, what is it?
Like an encyclopedia of this information where we can.
No, I think information by itself is not sufficient.
I think it has to be more action-oriented.
It has to be more of a co-pilot, like kind of a health fiduciary.
So it's sort of like if you had me standing next to you every single day helping you decide how to exercise, how to eat, what to do, what to do with any results you have, but on a day-to-day basis, right?
Not some sort of grand once a year sort of overhaul.
Over time, these benefits would compound a lot.
So again, I think this is not.
How can the average person access that?
I imagine your time is no, no, but of course, but again, if you scale me via software, yeah.
So is that something you're working on?
Yeah.
And then when do we think you're being a little hesitant about sharing this information, so I imagine it's in development, but when do we think we get a look at that?
Because I think this is transferred.
Sooner rather than later.
Really?
This year, hopefully.
What?
Early next year.
And are you partnering with anybody on this?
Philip Morris, maybe?
Tobacco As A Vice00:05:18
We have a Marlboro sponsor.
Exactly.
They're the lead sponsor.
But this is all you guys.
This is, wow.
And I mean, I have so many questions about this because I think this is the trickiest thing.
I imagine for all of us, it's like political information.
I don't know what the fuck is right or wrong.
Everything's filtered in through people's biases.
And then we get into science where it's like we already are so ignorant to it.
The second you say BPC 157, I'm like, well, it must be good.
You know, it just sounds so technical.
Exactly.
It's got to be.
Somebody called it the Wolverine peptide.
And I was like, I want to be Wolverine, right?
You've heard all this shit, right?
No, I don't spend time on social media.
I don't.
Oh, it's so much fun.
I can't.
Again, that's part of my longevity strategy.
I cannot look.
I mean, when I look at Instagram, like it never shows me that crap.
Like, it's showing me stand-up.
It's showing me gun videos, cars, F1.
Okay, the last thing I guess I was curious about is nicotine.
Oh, yeah.
That's my only real vice.
Maybe not my only, but one of the vices that I'm drawn to.
And I know there's so much conflicting research and Eutropic, but if that even means anything.
So how do you use nicotine?
Most days I probably don't, except for the toothpicks, which I love.
But, you know, if I do, I'll probably do three milligram pouch once a day.
The data are, I mean, obviously you have to separate tobacco from nicotine.
So tobacco is the problem, not nicotine.
And most nicotine is synthetic, but you have to make sure of that.
So there's probably a downside in tobacco-derived nicotine, even without a combustion product.
So be mindful of that.
So I always tell people, kind of make sure you're using synthetic tobacco.
Pardon me, synthetic nicotine.
It does have high potential for addiction.
So you kind of have to be super careful about that.
That tends to become a bigger issue the higher the dose goes.
So, you know, if you're keeping it below five, six milligrams a day, your potential for dependency is low.
But, you know, once you're into the 20, 30 milligrams a day, your potential for dependency is very high.
It can definitely interfere with sleep.
So people doing it later in the day are going to potentially, if not likely, impede their sleep.
What's the half-life for nicotine?
I should know that and I don't remember.
Are we talking six hours, two hours?
I did a podcast on this where if someone's interested, they can go back.
And it was actually kind of recent.
It was probably like, I mean, I recorded it probably six months ago, but it probably came out three months ago.
Long enough that I wouldn't do it.
You know, I wouldn't do it kind of later in the day if you're struggling with sleep.
You know, there's probably for some people some short-term cognitive benefit, but it can be offset by the withdrawal as well.
It's also an interesting molecule in that at one dose, it creates sort of heightened awareness.
And then as the dose gets higher, it creates relaxation.
So that's in some ways kind of the benefit of it.
I don't know if you noticed that, but at a certain dose, you'll actually, it's really calming.
It's not activating.
It's quite common.
But the first, I always feel like the first hit of it is activate.
Yes.
Really locks you in.
I didn't think about it as a relaxation medicine.
I don't know if I want to even call it medicine.
That's interesting.
Pretty awesome, this nicotine.
It is.
It's, you know, I would say it's got obviously a very, very bad rap through tobacco.
Yeah.
As it should in that way.
But I don't know.
I just caution people not to go too crazy on it.
I think, you know, I've got friends that are, they can't get, they're taking 30 milligrams worth of pouches a day and they can't stop.
And so I think in that situation, I would be concerned.
Yep.
That's great.
All right.
Well, listen, Dr. Atia, we appreciate you coming here, bestowing your boxing knowledge, and then some longevity stuff.
Congratulations on your New York Times best-selling book.
I think it's been on there for like 100 weeks or something like that.
It's pretty insane.
Seems like people want to live.
So we are going to continue tuning in.
I'm really looking forward to this thing that you're building.
I think that would be.
Well, I'll tell you this.
When we have it out, we can talk about it fully and walk in.
That'd be really cool.
But because I think it's something that we all need.
I think one of the scariest things about longevity is knowing what information is.
It's a signal to noise.
Yes.
And I think that's the same thing with politics.
I think it's the same thing with, God, everything.
I mean, nutrition, especially.
Every day somebody's telling me something is good.
And then the next day, actually, it causes cancer.
So, you know, really what I'd like to congratulate you on is it feels like you've been quite disciplined.
I think there are a lot of people that are in your field.
They get a lot of exposure and notoriety, and they very quickly cash in and they stamp some supplement thing and they can make, you know, hundreds of millions of dollars on it.
But if it's actually bullshit that doesn't do anything, maybe we lose trust.
And I haven't seen you do that.
I'm sure you've been given a million different opportunities to do that.
So I think that that's really cool and you've chosen to be disciplined.
And because of that, we trust you.
And thank you so much for sharing your time, my brother.