Dr. Casey Means: Transform Your Health by Improving Metabolism, Hormone & Blood Sugar Regulation

00:00:00.000 | - Welcome to the Huberman Lab Podcast,

00:00:02.240 | where we discuss science

00:00:03.660 | and science-based tools for everyday life.

00:00:05.840 | I'm Andrew Huberman,

00:00:10.120 | and I'm a professor of neurobiology and ophthalmology

00:00:13.200 | at Stanford School of Medicine.

00:00:15.240 | My guest today is Dr. Casey Means.

00:00:17.680 | Dr. Casey Means did her undergraduate degree

00:00:19.920 | at Stanford University and her medical degree

00:00:22.440 | at Stanford University School of Medicine.

00:00:24.880 | She is one of the world's foremost experts

00:00:26.760 | in metabolic health.

00:00:28.100 | Today, we discuss how metabolic function and dysfunction

00:00:30.840 | impacts our health.

00:00:32.160 | In particular, we discuss mitochondria,

00:00:34.000 | which are involved in energy production within our cells,

00:00:36.680 | and the various things that we can each and all do

00:00:39.040 | to ensure proper mitochondrial function,

00:00:40.980 | which is essential, not just for things

00:00:42.680 | like body composition and physical and mental energy,

00:00:45.920 | but also our ability to regulate hormones,

00:00:48.360 | blood sugar, and much more.

00:00:50.280 | We discuss how exercise, even simple exercise like walking,

00:00:54.480 | as well as sleep, as well as more vigorous exercise,

00:00:57.220 | and in particular, nutrition,

00:00:58.740 | including the types of foods we eat,

00:01:00.520 | the timing of food intake,

00:01:02.160 | and the sources and quality of those foods' impact

00:01:05.060 | are mitochondria and other aspects of metabolic function.

00:01:08.120 | We also discuss how particular micronutrients

00:01:10.360 | within specific foods can directly impact

00:01:13.000 | mitochondrial and metabolic health.

00:01:15.040 | Dr. Means explains how mitochondria, inflammation,

00:01:18.040 | and reactive oxygen species,

00:01:19.840 | which are the byproducts of metabolism in our cells,

00:01:22.320 | can combine to create conditions of obesity,

00:01:25.240 | as well as ways that we can manage those things,

00:01:27.660 | or even reverse mitochondrial inflammation

00:01:31.060 | and reactive oxygen species dysfunction

00:01:33.460 | in order to reverse obesity, reverse diabetes,

00:01:36.860 | and enhance our health in myriad ways.

00:01:39.060 | By the end of today's discussion,

00:01:40.380 | you'll have a clear picture of the cellular processes

00:01:42.460 | that occur in the brain and body

00:01:44.140 | that underlie metabolic disease and metabolic health.

00:01:47.540 | And most importantly, you'll have a very clear picture

00:01:49.960 | of the actionable items that we can each and all carry out

00:01:53.060 | every day and every week in order to ensure metabolic health,

00:01:56.700 | proper mitochondrial function,

00:01:58.500 | and indeed that can also impact body composition

00:02:01.420 | and overall feelings of wellbeing.

00:02:03.660 | I would also like to share that Dr. Casey Means

00:02:05.500 | has a terrific new book coming out.

00:02:07.380 | I know it's terrific because I've read it.

00:02:09.280 | It is entitled "Good Energy,

00:02:11.100 | The Surprising Connection Between Metabolism

00:02:13.300 | and Limitless Health."

00:02:14.660 | If you're interested in the book,

00:02:15.900 | we provided a link to the book in the show note captions.

00:02:19.220 | Before we begin, I'd like to emphasize that this podcast

00:02:21.920 | is separate from my teaching and research roles at Stanford.

00:02:24.680 | It is however, part of my desire and effort

00:02:26.700 | to bring zero cost to consumer information

00:02:28.660 | about science and science related tools

00:02:30.600 | to the general public.

00:02:31.980 | In keeping with that theme,

00:02:33.200 | I'd like to thank the sponsors of today's podcast.

00:02:35.940 | Our first sponsor is Maui Nui Venison.

00:02:38.780 | Maui Nui Venison is the most nutrient dense

00:02:41.200 | and delicious red meat available.

00:02:43.100 | I've spoken before on this podcast

00:02:45.040 | and with several expert guests on this podcast

00:02:47.560 | about the fact that most of us should be seeking

00:02:49.680 | to get about one gram of quality protein

00:02:52.420 | per pound of body weight every day.

00:02:54.620 | Not only does that protein provide critical building blocks

00:02:57.300 | for things like muscle repair and synthesis,

00:02:59.900 | but also for overall metabolism and health.

00:03:02.220 | Eating enough quality protein each day

00:03:03.980 | is also a terrific way to stave off hunger.

00:03:06.620 | One of the key things however,

00:03:07.820 | is to make sure that you're getting enough quality protein

00:03:10.060 | without ingesting excess calories.

00:03:12.240 | Maui Nui Venison has an extremely high quality protein

00:03:15.300 | per calorie ratio,

00:03:17.060 | such that getting one gram of protein

00:03:18.620 | per pound of body weight is both easy

00:03:20.460 | and doesn't cause you to ingest an excess of calories.

00:03:23.280 | Also, Maui Nui Venison is absolutely delicious.

00:03:26.380 | They have venison steaks, they have ground venison,

00:03:28.860 | and they have venison bone broth.

00:03:30.780 | I personally like all of those.

00:03:32.260 | In fact, I probably eat a Maui Nui Venison burger

00:03:34.660 | pretty much every day.

00:03:35.900 | And occasionally I'll swap that for a Maui Nui steak.

00:03:38.460 | And if you're really on the go,

00:03:39.620 | they have Maui Nui Venison jerky,

00:03:41.740 | which has 10 grams of protein per stick

00:03:43.660 | at just 55 calories.

00:03:45.460 | If you'd like to try Maui Nui Venison,

00:03:47.320 | you can go to mauinuivenison.com/huberman

00:03:50.940 | to get 20% off your first order.

00:03:52.700 | Again, that's mauinuivenison.com/huberman.

00:03:56.560 | Today's episode is also brought to us by Eight Sleep.

00:03:59.500 | Eight Sleep makes smart mattress covers

00:04:01.160 | with cooling, heating, and sleep tracking capacity.

00:04:04.200 | Now I've spoken many times before in this podcast

00:04:06.300 | about the critical need to get sleep,

00:04:08.260 | both enough sleep and enough quality sleep.

00:04:11.100 | When we do that, everything, our mental health,

00:04:12.940 | our physical health, performance in any sports

00:04:15.140 | or school, et cetera, all get better.

00:04:17.140 | And when we're not sleeping well or enough,

00:04:19.260 | all those things suffer.

00:04:20.540 | One of the key things to getting a great night's sleep

00:04:22.780 | is that your body temperature actually has to drop

00:04:24.820 | by about one to three degrees in order to fall

00:04:27.260 | and stay deeply asleep.

00:04:28.580 | And in order to wake up feeling refreshed,

00:04:30.300 | your body temperature actually has to increase

00:04:32.260 | by about one to three degrees.

00:04:34.020 | One of the best ways to ensure that happens

00:04:35.860 | is to control the temperature of your sleeping environment.

00:04:38.620 | And with Eight Sleep, it makes it very easy to do that.

00:04:41.540 | You program in the temperature that you want

00:04:43.280 | at the beginning, middle, and end of the night.

00:04:45.160 | You can even divide the temperature

00:04:46.480 | for two different people,

00:04:47.320 | if you have two different people sleeping in the bed,

00:04:49.200 | and it tracks your sleep.

00:04:50.580 | It tells you how much slow wave sleep

00:04:51.880 | and rapid eye movement sleep you're getting.

00:04:53.780 | It really helps you dial in the correct parameters

00:04:55.980 | to get the best possible night's sleep for you.

00:04:58.120 | I've been sleeping on an Eight Sleep mattress cover

00:04:59.840 | for well over three years now,

00:05:01.440 | and it has completely transformed my sleep for the better.

00:05:04.220 | If you'd like to try Eight Sleep,

00:05:05.520 | you can go to eightsleep.com/huberman

00:05:08.320 | and save $150 off their Pod 3 cover.

00:05:11.480 | Eight Sleep currently ships in the USA, Canada, UK,

00:05:14.440 | select countries in the EU, and Australia.

00:05:16.720 | Again, that's eightsleep.com/huberman.

00:05:20.020 | Today's episode is also brought to us by AeroPress.

00:05:23.120 | AeroPress is like a French press,

00:05:24.720 | but a French press that always brews

00:05:26.120 | the perfect cup of coffee,

00:05:27.400 | meaning no bitterness and excellent taste.

00:05:29.800 | AeroPress achieves this

00:05:30.920 | because it uses a very short contact time

00:05:33.080 | between the hot water and the coffee.

00:05:34.800 | And that short contact time also means

00:05:36.460 | that you can brew an excellent cup of coffee very quickly.

00:05:39.040 | The whole thing takes only about three minutes.

00:05:41.080 | I started using an AeroPress over 10 years ago,

00:05:43.560 | and I learned about it from a guy named Alan Adler,

00:05:45.840 | who's a former Stanford engineer, who's also an inventor.

00:05:48.640 | He developed things like the Arobi Frisbee.

00:05:50.620 | In any event, I'm a big fan of Adler inventions.

00:05:52.920 | And when I heard he developed a coffee maker, the AeroPress,

00:05:55.840 | I tried it and I found that indeed,

00:05:58.040 | it makes the best possible tasting cup of coffee.

00:06:00.340 | It's also extremely small and portable.

00:06:02.560 | So I started using it in the laboratory

00:06:04.240 | when I travel on the road and also at home.

00:06:06.400 | And I'm not alone in my love of the AeroPress coffee maker.

00:06:09.360 | With over 55,000 five-star reviews,

00:06:12.000 | AeroPress is the best reviewed coffee press in the world.

00:06:15.000 | If you'd like to try AeroPress,

00:06:16.280 | you can go to aeropress.com/huberman to get 20% off.

00:06:20.960 | AeroPress currently ships in the USA, Canada,

00:06:23.440 | and to over 60 other countries around the world.

00:06:25.640 | Again, that's aeropress.com/huberman.

00:06:29.000 | And now for my discussion with Dr. Casey Means.

00:06:32.200 | Dr. Casey Means, welcome.

00:06:33.960 | - Dr. Andrew Huberman, thank you so much for having me.

00:06:36.840 | - Really excited to talk to you today

00:06:38.480 | about all things health.

00:06:41.140 | One of the things I love so much about your work

00:06:43.220 | is that you really give people a sense of agency

00:06:46.880 | through knowledge and actionable tools,

00:06:49.680 | which is very near and dear to my mission and my heart.

00:06:53.040 | But to kick things off,

00:06:55.080 | let's talk about metabolic function and dysfunction.

00:06:59.380 | I think most people hear the word metabolism

00:07:01.500 | and they think, okay, the burning of energy.

00:07:04.080 | Maybe they think about ATP.

00:07:05.440 | Maybe they think about calories in, calories out,

00:07:07.800 | that sort of thing.

00:07:08.640 | But what are we talking about

00:07:10.160 | when we're talking about metabolic function and dysfunction?

00:07:13.040 | Because these are really important concepts

00:07:14.920 | for everyone to understand.

00:07:16.120 | - Yeah, I think you're exactly right.

00:07:17.800 | I think that when we hear the word metabolism,

00:07:19.720 | the first thing that comes to most people's minds

00:07:21.760 | is my weight.

00:07:22.720 | Do I have a fast metabolism or do I have a slow metabolism

00:07:26.000 | or something like basal metabolic rate?

00:07:28.060 | And I think what's really important for people to realize

00:07:31.400 | is that metabolism is actually the foundation of all health.

00:07:36.040 | It is the core foundational pathway

00:07:39.160 | that drives all other aspects of health.

00:07:44.040 | And it's also the core foundational pathway

00:07:47.240 | that's truly getting crushed in the modern American world

00:07:50.660 | and underlying nine of the 10 leading causes of death

00:07:54.600 | in the United States today.

00:07:55.840 | It's really quite relevant to everyone.

00:07:58.000 | And the spectrum of metabolic rooted disease is vast

00:08:03.000 | and actually really relevant to most Americans.

00:08:05.920 | The latest research

00:08:06.920 | from American College of Cardiology suggests

00:08:09.120 | that 93% of American adults have suboptimal metabolism.

00:08:14.120 | And we can go into what that means.

00:08:15.840 | But fundamentally, when we're talking about metabolism,

00:08:20.000 | we're talking about how we convert food energy

00:08:24.480 | to human energy.

00:08:26.040 | So we take in a astonishing 70 metric tons or so

00:08:31.040 | of food in our lifetime.

00:08:33.880 | And that is potential energy.

00:08:35.600 | It's energy from the environment that's outside of us

00:08:38.760 | that through our metabolic pathways gets converted

00:08:42.080 | to a currency of energy that can then be used to pay

00:08:46.760 | for essentially every chemical reaction inside our body.

00:08:51.520 | And the bubbling up of all of those chemical reactions

00:08:55.600 | is our lives.

00:08:57.480 | And so when metabolism is not working properly,

00:09:01.720 | it's essentially creating underpowered cells.

00:09:04.440 | And like any city or factory or machine,

00:09:07.720 | not having adequate power will lead to dysfunction.

00:09:12.720 | And the reason that the metabolic spectrum of disease

00:09:17.480 | is so vast is because we have over 200 cell types

00:09:21.800 | in the body and underpowering in different cell types

00:09:26.800 | is going to look like different symptoms

00:09:30.920 | because underpowering in a astrocyte

00:09:33.440 | is gonna look different than underpowering

00:09:35.000 | an ovarian theca cell or an endothelial cell.

00:09:37.680 | It's going to look different,

00:09:39.080 | but the core foundational process that is dysfunctional

00:09:43.080 | can actually be the same.

00:09:44.080 | And I think the biggest blind spot in Western healthcare

00:09:49.080 | and actually the reason that health outcomes

00:09:54.240 | are actually getting worse every year in the United States

00:09:59.000 | is because fundamentally we are ignoring metabolic health

00:10:03.480 | and metabolic dysfunction.

00:10:05.320 | We are laser focused on the downstream symptoms

00:10:10.320 | that result from metabolic dysfunction

00:10:13.400 | in different cell types.

00:10:15.040 | And we spend all of our energy focusing on those symptoms,

00:10:20.040 | playing whack-a-mole with them,

00:10:22.900 | and really ignoring that underlying foundational root cause

00:10:26.880 | of metabolic function.

00:10:28.800 | And what's so fascinating to me

00:10:31.160 | and what I saw in the healthcare system

00:10:32.940 | as like a super subspecialist, as an ENT surgeon,

00:10:37.600 | is that the more we specialize in healthcare,

00:10:41.240 | we have over a hundred specialties now

00:10:43.120 | that we've just like invented in the healthcare system.

00:10:45.920 | The more we specialize in healthcare,

00:10:49.380 | the sicker we're actually getting.

00:10:52.380 | So the more we do technological innovation

00:10:55.340 | in all these different specialties,

00:10:57.280 | the sicker we're getting.

00:10:59.360 | And I think what the real nugget there

00:11:02.460 | that everyone really needs to understand

00:11:03.720 | is we've bought into a system where we value specialization

00:11:07.440 | and this is the game in Western medicine.

00:11:10.040 | But while we've done that, what has happened

00:11:13.360 | is we have the worst chronic disease epidemic

00:11:16.120 | and the lowest life expectancy

00:11:17.840 | of any high-income country in the world.

00:11:21.600 | And the reason is because in that specialization,

00:11:24.460 | we're focused on the downstream manifestation

00:11:27.080 | of underpowering of cells, the cell-specific symptoms

00:11:31.400 | and not the metabolic function itself.

00:11:34.400 | So really our chronic disease epidemic in this country,

00:11:36.840 | it is a metabolic dysfunction epidemic,

00:11:39.880 | an underpowering epidemic.

00:11:41.880 | And that is the biggest blind spot in healthcare.

00:11:45.440 | And I think a focus on metabolic function

00:11:50.440 | as the center of our healthcare system,

00:11:54.320 | it's a completely new paradigm for health

00:11:58.340 | that is urgently, and I cannot overstate enough,

00:12:01.580 | it's urgently needed.

00:12:03.500 | We know we're not in the right paradigm right now

00:12:06.940 | when we have 100 isolated specialties

00:12:09.440 | and yet 85 to 90% of the conditions in those specialties,

00:12:13.660 | if you go to the science and look at the real physiology

00:12:17.260 | is metabolic dysfunction.

00:12:19.560 | So that's kind of the landscape

00:12:21.540 | of what metabolic dysfunction is

00:12:23.260 | and how it's kind of creating a big blind spot

00:12:27.420 | in the healthcare system that really represents

00:12:30.740 | an outdated way of categorizing disease

00:12:35.740 | that unfortunately is killing us, I would say.

00:12:40.820 | - Yeah, thank you for that.

00:12:41.840 | I have several reflections and a question.

00:12:45.300 | First off, the analogy that comes to mind

00:12:47.580 | is an assembly line that's constructing,

00:12:50.600 | let's say an automobile,

00:12:52.100 | and it sounds like 80 to 90% of the automobiles

00:12:56.180 | that are coming off that assembly line are not working well.

00:12:59.900 | Tires aren't aligned, engines isn't working well,

00:13:02.020 | transmission isn't working, has a bunch of issues.

00:13:04.740 | And no factory, no car manufacturer would tolerate that

00:13:09.740 | nor would the customers,

00:13:11.900 | but we're tolerating that in ourselves,

00:13:13.860 | it sounds like, many people are.

00:13:15.980 | And then accepting the fact that then a bunch of

00:13:19.020 | other businesses are gonna crop up,

00:13:20.520 | like the business that aligns the tires,

00:13:22.160 | the business that goes and repairs the pistons.

00:13:24.240 | And essentially, when you talk about these multi specialties

00:13:28.160 | that have evolved in the medical care system,

00:13:30.800 | they provide an opportunity to go and fix the problems

00:13:34.680 | or try and ameliorate the problems.

00:13:36.000 | But really what we need to do to make this analogy

00:13:38.840 | much briefer than it otherwise would be

00:13:40.360 | is just to go further up the assembly line,

00:13:43.840 | figure out whether or not the hardware is correct,

00:13:46.120 | the software is correct,

00:13:47.160 | and where the hardware and software are becoming deficient

00:13:50.120 | in this analogy where we are the automobile

00:13:54.580 | that's essentially coming off the conveyor broken.

00:13:56.720 | And the good news is, and I know this

00:13:58.960 | because I've read your book

00:14:00.160 | and because I follow your work very closely.

00:14:02.860 | The good news is that we each and all can take matters

00:14:07.400 | to some extent into our own hands,

00:14:09.280 | collaborate with healthcare providers

00:14:11.560 | and repair metabolic dysfunction,

00:14:14.080 | essentially make us metabolically functional.

00:14:16.160 | So the question therefore is,

00:14:19.600 | I think most people when they hear metabolism,

00:14:23.360 | they think energy.

00:14:25.160 | And when we hear energy, we think ATP sometimes,

00:14:30.160 | but typically people think about mitochondria,

00:14:33.000 | the powerhouse of the cell, so to speak.

00:14:35.060 | So you've talked about the trifecta or the big three,

00:14:39.760 | mitochondria, inflammation, and oxidative stress

00:14:44.000 | as three critical factors underlying metabolic dysfunction.

00:14:48.180 | And I'm presuming those are also the avenues to address

00:14:52.320 | in order to create metabolic function.

00:14:53.980 | Because ultimately what we want, of course,

00:14:56.560 | is an optimistic picture

00:14:57.600 | that we can actually take some control,

00:14:59.640 | that we have some agency in all of this,

00:15:01.300 | which I believe we do.

00:15:02.140 | So if you would, could you get us all on the same page

00:15:05.300 | about what are mitochondria and what do they do?

00:15:07.400 | Why are they so important?

00:15:08.480 | Then we can turn to inflammation and oxidative stress.

00:15:10.600 | - Yes, absolutely.

00:15:11.800 | So the mitochondria are the structure within the cells.

00:15:16.560 | We have 40 trillion cells,

00:15:18.080 | and each cell might have a handful

00:15:19.760 | or many thousand mitochondria.

00:15:21.640 | And they are the magical part of the cell

00:15:25.380 | that does that conversion process of food breaking down

00:15:30.380 | and then converting to energy,

00:15:32.840 | translating it to a currency of energy

00:15:34.520 | our body can recognize.

00:15:36.280 | And so currently what's happening

00:15:40.080 | is that our environment,

00:15:42.320 | the environment that our cells exist in

00:15:45.640 | across every single facet of our life

00:15:50.640 | over the past 50 to 75 years has changed rapidly.

00:15:55.260 | You look at how our food system has changed

00:15:57.600 | from whole real food and good soil to industrial food.

00:16:00.920 | Our sleep habits have changed.

00:16:02.360 | We're sleeping less.

00:16:03.280 | It's very fragmented.

00:16:04.400 | Our movement patterns have changed.

00:16:06.600 | We're sitting 80% of the waking day.

00:16:09.140 | Our time in nature has changed.

00:16:11.280 | We actually are indoors as Americans,

00:16:13.600 | 93% of a 24-hour period.

00:16:15.320 | So that totally changed our relationship with light.

00:16:17.800 | We have 80,000 synthetic toxins in our food, water, air,

00:16:21.320 | personal care products, home care products.

00:16:24.020 | We live a thermoneutral existence now with our thermostats.

00:16:26.840 | There's no real swings in temperature

00:16:28.420 | unless you're intentionally trying to.

00:16:30.640 | And then our emotional health is very different.

00:16:32.920 | We are very much exposed

00:16:34.840 | to low-grade chronic stress triggers.

00:16:36.840 | So across food, sleep, movement, emotional health,

00:16:40.000 | toxins, light, and temperature,

00:16:42.040 | things are not what they once were.

00:16:43.560 | And it's changed in the blink of an eye.

00:16:46.060 | I mean, the light bulb was created in 1806.

00:16:48.720 | This is like 0.04% of human history

00:16:51.560 | that we've even had artificial light.

00:16:52.840 | So things have changed.

00:16:54.040 | And the unique thing

00:16:57.280 | about all of these changes in our environment

00:16:59.960 | is that each one of those pillars,

00:17:02.040 | each of those changes in our environment

00:17:04.000 | synergistically directly hurts the mitochondria

00:17:08.400 | through different mechanisms, the chronic low-grade stress,

00:17:11.960 | the sitting, the ultra-processed nutrient-devoid food,

00:17:15.280 | even the blue light at nighttime,

00:17:18.360 | all of it through different core biologic mechanisms

00:17:22.160 | synergistically hits this part of the cell, the mitochondria.

00:17:25.680 | So we have the food coming in,

00:17:28.080 | but we're not doing a good job of converting it

00:17:30.460 | to an energy form we can use.

00:17:32.960 | So we have these underpowered dysfunctional cells

00:17:35.440 | because of mitochondrial dysfunction

00:17:36.920 | caused by our environment.

00:17:38.740 | And of course, what happens if you've got energy substrate

00:17:42.440 | that you can't process, it's gonna be stored.

00:17:44.360 | And that's of course why we have an obesity

00:17:46.720 | and overweight epidemic that's affecting close to 80%

00:17:50.320 | of American people. - That's so wild.

00:17:51.600 | - It's just, we talk about obesity like it's the problem.

00:17:55.320 | Obesity is one branch of a tree

00:17:58.840 | that's rooted in this mitochondrial dysfunction

00:18:02.520 | that's caused by our environment.

00:18:05.280 | And just to back up a little bit,

00:18:08.080 | to just sort of share kind of maybe like how I sort of

00:18:12.280 | started thinking about that,

00:18:14.020 | I had trained as an ENT surgeon

00:18:17.640 | and I was at Stanford Medical School.

00:18:19.720 | And I was so fascinated by this idea of like,

00:18:23.000 | the way that we're defining the diseases we're treating

00:18:28.960 | in like a specialty like ENT is like,

00:18:31.840 | I saw sinusitis day in and day out

00:18:34.360 | and we'd have these patients on the table

00:18:36.680 | that we'd be literally drilling into their skulls

00:18:38.680 | to suck out sinus pus.

00:18:40.560 | And that's like the treatment for sinusitis.

00:18:42.520 | And the way we diagnose the patients is we say like,

00:18:45.280 | okay, this patient has sinusitis

00:18:48.320 | if they have facial pressure, purulent pus,

00:18:52.560 | nasal discharge, nasal obstruction and low sense of smell.

00:18:56.720 | So if they have these symptoms, then they have this disease.

00:19:00.840 | But when you actually go to the science

00:19:03.000 | and you actually go to the studies of like,

00:19:05.660 | what is actually happening to create this,

00:19:08.680 | what you find is a lot of papers

00:19:10.640 | about mitochondrial dysfunction.

00:19:13.080 | Because sinusitis is in a chronic inflammatory condition

00:19:17.560 | where the cells are essentially sensing some threat

00:19:22.080 | and then they mount this immune response

00:19:24.020 | that creates swelling and then you get pus buildup.

00:19:27.040 | But we confuse the pus buildup with the disease,

00:19:31.160 | which is actually happening inside the cells.

00:19:34.040 | And so you start looking at PubMed as a clinician

00:19:38.240 | through a slightly different lens of like,

00:19:40.080 | what's actually happening in the cells?

00:19:42.760 | And what you find for almost every chronic disease

00:19:45.540 | we're seeing in the US is that you will find a lot of papers

00:19:49.080 | on how the mitochondria are dysfunctional,

00:19:52.240 | lower ATP generation in a lot of these cell types.

00:19:55.800 | And then what does that do?

00:19:56.640 | And this gets to your question

00:19:57.560 | about chronic inflammation and oxidative stress.

00:19:59.460 | Well, when you've got that dysfunctional mitochondria,

00:20:02.320 | let's say in a nasal mucosal tissue,

00:20:05.840 | that is a cell that can't do its job.

00:20:07.600 | That is a cell that's underpowered

00:20:09.080 | and what could be more threatening to the body

00:20:10.680 | than a cell that can't do its job?

00:20:12.600 | So interestingly, those cells will initiate

00:20:17.160 | a whole process, which is called the cell danger response.

00:20:21.420 | It's work that's been done by Robert Navio at UCSD,

00:20:26.240 | where basically they understand the mitochondria

00:20:28.880 | is not working properly.

00:20:30.120 | This is, of course, caused by the environment.

00:20:31.680 | And they will actually release extracellular ATP,

00:20:34.440 | which is not really supposed to go outside of the cell.

00:20:37.840 | And that creates a massive innate immune response

00:20:42.840 | saying like, I'm underpowered, I need help.

00:20:45.780 | My mitochondria is broken.

00:20:46.940 | This is the cell releases ATP outside of the cell.

00:20:51.240 | Usually the concentration of ATP

00:20:52.600 | is a million times higher inside the cell.

00:20:55.160 | So releases it almost as a neurotransmitter,

00:20:57.080 | a purogenic neurotransmitter

00:20:58.840 | that massively activates the immune system to come and help.

00:21:02.960 | But the immune system comes and is like,

00:21:05.920 | not much we can do for you here.

00:21:07.620 | Because the problem is not something

00:21:10.240 | that the immune system can help with,

00:21:12.320 | like grabbing a bacteria and lysing it,

00:21:15.120 | or taking care of some cells infected with the virus.

00:21:18.880 | The problem is outside the body.

00:21:20.900 | It's the environment.

00:21:22.140 | So you end up getting this tornado of dysfunction,

00:21:25.180 | of mitochondrial dysfunction caused by the environment,

00:21:28.060 | leading to the cell danger response,

00:21:29.960 | which leads to innate immunity.

00:21:32.740 | And then on top of this, you get the oxidative stress,

00:21:35.820 | which is the third piece of the trifecta,

00:21:37.860 | which is essentially these mitochondria

00:21:39.380 | trying so hard to do their work,

00:21:40.740 | but they're not working properly.

00:21:41.960 | So they create damaging metabolic byproducts

00:21:44.000 | called oxidative stress, free radicals

00:21:46.660 | that cause more damage.

00:21:47.860 | So this is happening in the nose.

00:21:51.380 | It's happening all over the American body

00:21:54.060 | because of our environment.

00:21:55.140 | So you've got these tornadoes of interrelated physiology

00:21:58.820 | of mitochondrial dysfunction, chronic inflammation,

00:22:02.860 | oxidative stress, which if you start going to the research

00:22:07.860 | as a clinician who's focused on symptoms

00:22:12.200 | and confusing those for the disease,

00:22:14.380 | and look at what's the pathophysiology of arthritis?

00:22:17.620 | What's the pathophysiology of Alzheimer's dementia?

00:22:21.060 | What's the pathophysiology of type 2 diabetes,

00:22:23.460 | obesity, fatty liver disease,

00:22:25.420 | polycystic ovarian syndrome, erectile dysfunction?

00:22:28.340 | It all traces back to this trifecta

00:22:32.340 | that no medication or surgery,

00:22:34.340 | you obviously can't operate on oxidative stress.

00:22:36.780 | You can operate on the downstream symptoms.

00:22:38.460 | So that's the real secret that I really feel like

00:22:42.460 | we need to reorient the healthcare system around

00:22:45.380 | since 90% of healthcare costs

00:22:48.620 | go towards treating the downstream symptoms of these.

00:22:52.460 | And for every marginal dollar

00:22:54.060 | we're spending on treating symptoms,

00:22:55.580 | we're getting, the rates are going up

00:22:57.780 | because they're doing nothing

00:22:58.700 | to actually affect that trifecta.

00:23:00.500 | But to really make it simple,

00:23:02.300 | I like to think of this trifecta of what I call

00:23:06.260 | trifecta of bad energy,

00:23:07.260 | trifecta underlying metabolic dysfunction

00:23:09.820 | of chronic inflammation, mitochondrial dysfunction,

00:23:11.820 | oxidative stress as chronic inflammation

00:23:14.300 | is biochemical fear, it's response to a threat.

00:23:18.220 | Mitochondrial dysfunction is kind of like

00:23:20.060 | rolling blackouts, it's not enough power.

00:23:22.780 | And the oxidative stress is like wildfires.

00:23:25.620 | So it's kind of, what's funny to me a little bit

00:23:27.780 | is like what's happening inside the cell

00:23:29.300 | is almost like what's happening like in our society.

00:23:31.820 | It's like, this is like living in California.

00:23:33.340 | It's like blackouts, fire, fear.

00:23:36.020 | And that's literally what's happening inside our cell

00:23:38.540 | because of the environment.

00:23:39.980 | And again, the optimistic news that you alluded to

00:23:43.620 | is that we actually have tons of tools and tests

00:23:48.620 | that can actually help us understand

00:23:51.540 | our level of metabolic health

00:23:53.220 | and even give us hints about inflammation,

00:23:55.220 | oxidative stress and mitochondrial dysfunction.

00:23:57.300 | And it's very easy to improve

00:24:00.220 | if we know what we're actually focused on.

00:24:02.740 | - Well, that's reassuring

00:24:03.620 | and we're definitely gonna go there.

00:24:05.580 | I appreciate the analogy to living in California.

00:24:07.540 | I've lived here my entire life.

00:24:09.460 | I have been outside of California,

00:24:11.020 | but perhaps the only thing you left out

00:24:14.220 | besides rolling blackouts, fires,

00:24:16.140 | and what was the other one?

00:24:16.980 | - Fear.

00:24:17.820 | - And fear is high taxes.

00:24:18.740 | The taxes, the health debt on the body.

00:24:21.340 | So in any case, not to be too dark and pessimistic.

00:24:24.780 | - Well, that's the healthcare cost.

00:24:25.900 | - I maintain great hope

00:24:27.220 | and still a lot of love for California.

00:24:29.500 | - It's pretty great.

00:24:30.340 | - It's got, it's great aspects

00:24:32.540 | and it's not so great aspects.

00:24:33.900 | And I can say that as a lifelong California resident,

00:24:36.860 | there are other wonderful places to live.

00:24:38.620 | A couple of questions.

00:24:39.820 | First of all, about places to live.

00:24:41.260 | You've been talking a lot about in the United States.

00:24:43.980 | Are some of these same issues with metabolic dysfunction

00:24:46.460 | occurring outside of the United States?

00:24:47.940 | I would imagine so.

00:24:49.100 | - Yep.

00:24:49.940 | Any country where we've exported the standard American diet

00:24:53.060 | and some of the other norms of Western living

00:24:56.540 | are starting to see the same rates of chronic disease.

00:25:00.880 | But like, it is worth not mincing words here.

00:25:05.060 | Of all high-income countries in the world,

00:25:08.800 | the United States has the worst chronic disease rates

00:25:12.180 | and the lowest life expectancy

00:25:13.820 | and our life expectancy is going down.

00:25:16.240 | And we spend about twice as much on healthcare

00:25:19.300 | than the second highest spending country in the world.

00:25:22.060 | So we are abjectly failing

00:25:24.720 | and that failure is predicated in our cult

00:25:29.220 | of siloing conditions into different specialties

00:25:34.220 | and not focusing on this root cause.

00:25:38.600 | And I want to just be super clear.

00:25:40.700 | There's a war being fought right now

00:25:43.500 | to get us to believe that siloing is the way

00:25:46.480 | because as you alluded to, siloing is profitable.

00:25:49.900 | If you can convince doctors and people

00:25:53.900 | that there are 10 different symptoms or separate things,

00:25:56.360 | then they're going to 10 different specialist's office.

00:25:59.320 | Meanwhile, 75% of American adults are overweight and obese,

00:26:04.320 | some of the highest in the world.

00:26:07.540 | A full 50% of American adults now have prediabetes

00:26:11.640 | and type 2 diabetes.

00:26:12.640 | 50%, 30% of teens have prediabetes.

00:26:16.320 | 40% of Americans have a mental health diagnosis.

00:26:19.940 | Cancer is set to reach 2 million cases this year in 2024,

00:26:24.680 | highest ever in recorded history.

00:26:26.580 | Alzheimer's is going up.

00:26:28.120 | Fat and liver disease is affecting 40% of adults,

00:26:30.360 | 18% of teens.

00:26:31.720 | Autoimmune disease is skyrocketing.

00:26:33.500 | Infertility is going up at huge rates.

00:26:36.040 | All these things are going up all at once in the U.S.

00:26:38.900 | and yes, in many of the other countries

00:26:40.620 | that are eating our diet.

00:26:41.860 | And there's no sign of it slowing down.

00:26:45.280 | And so that's really, if you look at the research

00:26:49.060 | through this different lens,

00:26:50.500 | you'll find that all of those diseases trace back

00:26:53.000 | to metabolic dysfunction caused by our environment

00:26:56.580 | that no shot, pill or surgery can really address

00:27:00.420 | unless we unpack the environmental piece.

00:27:03.700 | - Scary picture.

00:27:05.240 | I'm glad that you're-- - But hopeful.

00:27:06.720 | - But hopeful. - We can fix it.

00:27:07.720 | - Exactly, I'm glad that you are creating solutions.

00:27:10.880 | And I should say, and just remind people,

00:27:13.240 | I said this in my introduction,

00:27:15.200 | but you're talking about siloed medical care,

00:27:18.680 | you're talking about the kind of standard medical system,

00:27:21.700 | but let's not forget, right?

00:27:24.480 | I happen to be a faculty at Stanford.

00:27:25.840 | You did your medical training at Stanford.

00:27:28.120 | You are a medical doctor, right?

00:27:29.580 | I mean, you have a MD and are highly trained.

00:27:32.520 | You were an ENT.

00:27:33.560 | You're a nose and throat doctor.

00:27:34.660 | So if anyone would be familiar with the industry

00:27:38.660 | and the practice and the educational system around this,

00:27:42.040 | it's you.

00:27:42.880 | So you're not speaking outside your ballywick.

00:27:45.500 | So before we pivot to solutions,

00:27:49.020 | I know people are eager to hear solutions,

00:27:50.740 | but in order to understand

00:27:51.800 | how to best apply those solutions,

00:27:53.100 | I do think it's worth drilling into some of the issues here

00:27:55.980 | just a little bit more.

00:27:57.140 | You talked about underpowered cells.

00:28:00.780 | You've also alluded to the fact

00:28:02.060 | that most people are consuming enough

00:28:04.580 | and probably excess amounts of caloric energy.

00:28:07.020 | - Yes.

00:28:07.940 | - So is it the lack of mitochondria

00:28:11.940 | or mitochondrial dysfunction

00:28:14.420 | that's at the root of the problem?

00:28:15.700 | The analogy I come up with is you've got a power plant

00:28:19.100 | that can convert incoming power line

00:28:21.500 | to power that can be distributed to a community.

00:28:25.500 | The community in this analogy

00:28:26.860 | being the organs and cells of the body.

00:28:29.460 | There's plenty of potential energy.

00:28:32.180 | But there's something about the power plant

00:28:34.460 | that is inefficient or dysfunctional.

00:28:37.740 | There are shorts,

00:28:38.580 | there are circuitry that's just not working

00:28:41.240 | such that the energy that the community can benefit

00:28:45.340 | from the cells and organs of the body is just not there.

00:28:48.580 | So it's not a lack of input,

00:28:50.420 | it's a lack of conversion and output.

00:28:53.200 | And the consequence of this,

00:28:55.580 | we see in the form of excess adipose tissue

00:28:57.680 | and all the downstream effects.

00:28:59.180 | It's not just aesthetic,

00:29:00.320 | it's really all the downstream effects of visceral fat,

00:29:02.580 | subcutaneous fat, et cetera.

00:29:04.780 | What is it that would improve access to energy

00:29:10.780 | and energy utilization in cells?

00:29:12.820 | Is it simply a matter of getting the mitochondria

00:29:15.220 | to function better?

00:29:16.640 | Or is it that one can actually create more mitochondria?

00:29:20.260 | - This is the key question for how we can get healthy.

00:29:22.820 | And it's really about creating capacity in the body

00:29:29.420 | to turn more potential energy to usable energy

00:29:32.960 | as opposed to taking that potential energy

00:29:36.720 | and shunting it to a storage form.

00:29:38.480 | It's all just like, I think about everything visually

00:29:41.040 | and I'm like, you got the circular cell

00:29:43.000 | from high school biology textbook,

00:29:44.420 | inside are all the little mitochondria

00:29:46.040 | with the squiggly lines inside.

00:29:47.280 | And it's just like there's Xs through those mitochondria.

00:29:50.160 | So instead of, after glycolysis and you've got the pyruvate,

00:29:53.480 | instead of going through the mitochondria,

00:29:55.400 | it's being shuttled into something else.

00:29:57.880 | And I mean, this is fundamentally

00:29:59.260 | the cause of insulin resistance

00:30:00.620 | because when the body senses that the mitochondria

00:30:03.340 | can't do that conversion process,

00:30:05.620 | the cell basically says, because I can't convert this,

00:30:09.880 | I don't have the capacity to convert it to usable energy.

00:30:12.540 | I'm gonna take the substrates and I need to block them.

00:30:15.460 | I mean, you've got to turn them to basically a storage form,

00:30:17.940 | which inside the cell could be toxic fats

00:30:20.140 | like ceramides and diacylglycerol.

00:30:22.880 | And I'm also gonna block the cell

00:30:25.480 | from taking any more substrates

00:30:27.540 | because I can't do anything with them.

00:30:29.780 | That is fundamentally a route of insulin resistance.

00:30:31.780 | So the body says, okay,

00:30:32.940 | we're gonna block the ability of the insulin receptor

00:30:35.300 | to transduce its intracellular signaling pathway.

00:30:38.980 | We're gonna block it.

00:30:40.500 | And when that insulin binds,

00:30:42.260 | we're not actually gonna allow for glucose to come in.

00:30:44.180 | So essentially insulin resistance is the cell compensating

00:30:47.740 | for the mitochondria being broken

00:30:49.980 | and telling the insulin receptor

00:30:52.140 | that it's not gonna be functional.

00:30:54.800 | And so you don't get the glute receptors

00:30:57.500 | on the cell membrane to allow the glucose to come in.

00:30:59.700 | So that's insulin resistance.

00:31:01.940 | Again, we talk about that as the problem,

00:31:04.420 | but the problem is actually inside the cell

00:31:06.900 | leading to that.

00:31:08.140 | So that's why just giving someone insulin

00:31:10.820 | isn't necessarily the answer.

00:31:11.900 | We have to increase mitochondrial capacity

00:31:14.340 | to let the flow happen through it to energy,

00:31:17.400 | which then trickles up

00:31:18.440 | into relieving a lot of these problems.

00:31:19.940 | So to answer your question,

00:31:21.940 | what we really wanna do to increase our metabolic capacity

00:31:26.060 | from a first principles perspective,

00:31:28.020 | it's we need to make more mitochondria.

00:31:32.020 | We need to get each mitochondria to be more functional.

00:31:37.020 | And we need to have each more functional mitochondria

00:31:40.020 | processing more energy substrates.

00:31:42.260 | It's really that simple.

00:31:43.740 | And the beauty is we can do all of those things.

00:31:46.060 | If you actually break down

00:31:47.580 | like what those three things mean,

00:31:49.660 | it means promoting mitophagy,

00:31:51.900 | the recycling of old mitochondria to new mitochondria.

00:31:55.340 | It means promoting mitochondrial biogenesis.

00:31:58.260 | It means increasing the oxidative capacity

00:32:01.380 | of our individual mitochondria.

00:32:03.820 | It means improving mitochondrial fusion,

00:32:06.160 | which is actually when mitochondria come together

00:32:08.240 | to form long chains of mitochondria that are more efficient.

00:32:11.240 | So there's like a lot of technicality

00:32:13.340 | to like what it means to print more mitochondria,

00:32:16.140 | have them each be more efficient

00:32:17.420 | and have each one do more work.

00:32:18.840 | But that's really what we wanna do.

00:32:21.980 | And that's when it just kinda gets into the simple habits.

00:32:24.380 | Like there's simple things we can do

00:32:25.820 | for each of those things.

00:32:26.820 | For mitophagy, we can focus on various types

00:32:30.740 | of like endurance exercise

00:32:32.900 | and high intensity interval exercise.

00:32:35.540 | There's compounds like urolithin A that promote mitophagy.

00:32:38.640 | When we talk about improving our oxidative capacity,

00:32:43.640 | this is things like the sprint workouts.

00:32:45.660 | We wanna build more mitochondria.

00:32:47.500 | This is resistance training,

00:32:48.700 | literally telling the body to make more.

00:32:53.100 | But first principles, it's how do we get more

00:32:56.420 | of these working better, doing more work every day?

00:32:59.180 | And then we think about, you look at the data on walking

00:33:01.840 | and it's like people who walk more than 7,000 steps a day

00:33:05.240 | have a 50 to 65% lower chance of dying in 10-year followups.

00:33:10.160 | And it's like, yeah,

00:33:11.000 | because walking is literally a glucose disposal signal.

00:33:14.900 | So you're just simply asking.

00:33:16.400 | It's not a great biogenesis signal.

00:33:18.020 | It's not a great mitophagy signal, but it's a great disposal.

00:33:21.060 | So if you're doing lifestyle habits

00:33:23.260 | that do one of those three things,

00:33:24.700 | which we can of course go into more,

00:33:26.780 | you're improving the cell's capacity

00:33:28.980 | to do that conversion process better.

00:33:33.260 | - I'd like to take a brief break

00:33:34.460 | and acknowledge our sponsor, AG1.

00:33:36.980 | By now, most of you have heard me tell my story

00:33:38.900 | about how I've been taking AG1 once or twice a day,

00:33:41.580 | every day since 2012.

00:33:43.300 | And indeed that's true.

00:33:44.720 | I started taking AG1 and I still take AG1 once

00:33:47.220 | or twice a day because it gives me vitamins and minerals

00:33:50.180 | that I might not be getting enough of

00:33:51.580 | from whole foods that I eat,

00:33:53.220 | as well as adaptogens and micronutrients.

00:33:56.140 | And those adaptogens and micronutrients are really critical

00:33:58.500 | because even though I strive to eat most of my foods

00:34:01.120 | from unprocessed or minimally processed whole foods,

00:34:04.040 | it's often hard to do so, especially when I'm traveling

00:34:06.300 | and especially when I'm busy.

00:34:07.980 | So by drinking a packet of AG1 in the morning

00:34:10.220 | and oftentimes also again in the afternoon or evening,

00:34:13.540 | I'm ensuring that I'm getting everything I need.

00:34:15.500 | I'm covering all of my foundational nutritional needs.

00:34:18.140 | And I, like so many other people that take AG1 regularly,

00:34:21.140 | just report feeling better.

00:34:22.700 | And that shouldn't be surprising

00:34:23.980 | because it supports gut health.

00:34:25.240 | And of course, gut health supports immune system health

00:34:27.880 | and brain health.

00:34:28.860 | And it's supporting a ton of different cellular

00:34:30.980 | and organ processes that all interact with one another.

00:34:34.480 | So while certain supplements are really directed

00:34:36.260 | towards one specific outcome,

00:34:37.820 | like sleeping better or being more alert,

00:34:39.940 | AG1 really is foundational nutritional support.

00:34:43.300 | It's really designed to support all of the systems

00:34:45.620 | of your brain and body that relate to mental health

00:34:47.820 | and physical health.

00:34:48.840 | If you'd like to try AG1,

00:34:50.140 | you can go to drinkag1.com/huberman

00:34:53.500 | to claim a special offer.

00:34:54.940 | They'll give you five free travel packs with your order,

00:34:57.340 | plus a year supply of vitamin D3K2.

00:34:59.980 | Again, that's drinkag1.com/huberman.

00:35:03.800 | There's a lot of great science

00:35:06.380 | and a lot of great stuff related to testing

00:35:09.620 | and assessment of one's metabolic health

00:35:12.480 | that we should get into and we'll get into.

00:35:14.540 | But since we touched on lifestyle

00:35:16.660 | and because we've been talking about

00:35:19.260 | the sort of dysfunctional dark side for a bit,

00:35:21.540 | maybe we could just touch on some of the lifestyle factors

00:35:24.680 | that you just mentioned.

00:35:25.880 | 'Cause I do think it's important that people

00:35:27.820 | really start to feel into their sense of agency.

00:35:29.760 | And here we're talking about things

00:35:31.980 | that are relatively low time investment,

00:35:34.660 | certainly don't have much financial cost

00:35:37.020 | in the sense that they could be done in gyms

00:35:38.820 | and with fancy equipment, but they don't require that.

00:35:41.520 | Again, I wanna point out that these are not

00:35:45.060 | like strict prescriptives, but if you had a magic wand

00:35:49.660 | and because you are interested in the health of humans,

00:35:52.500 | let's talk about a few of these things

00:35:55.320 | that can improve glucose disposal

00:35:59.100 | and mitochondrial function, mitophagy,

00:36:01.920 | the removal of dead or dysfunctional mitochondria

00:36:04.660 | so they can be replaced.

00:36:06.400 | Let's talk about the walking one first.

00:36:08.060 | You said 7,000 steps a day.

00:36:09.380 | I don't track my steps.

00:36:11.180 | What are we really talking about there?

00:36:12.620 | We're talking about taking the stairs

00:36:13.820 | and trying to walk as much as possible.

00:36:15.460 | Maybe we were gonna just give

00:36:16.820 | like a really crude prescription.

00:36:18.180 | You're a doctor, so you can prescribe things.

00:36:20.740 | What would you tell people to do?

00:36:22.100 | Like how many short walks per day?

00:36:23.820 | Is it like three?

00:36:24.940 | Is it five?

00:36:26.700 | What are we talking?

00:36:27.540 | - I would say, I mean, at least three,

00:36:30.660 | I would say aiming for more than that is good though.

00:36:33.300 | So to sort of just give a sense of the picture of walking,

00:36:37.420 | if walking were a pill,

00:36:38.780 | it would be the most impactful pill we've ever had

00:36:42.540 | in all of modern medicine.

00:36:44.500 | There was a paper in JAMA,

00:36:47.820 | 6,300 participants followed for 10 to 11 years.

00:36:52.820 | And the people who simply walked 7,000 steps per day

00:36:59.180 | compared to less than that had an up to 70% lower risk

00:37:03.860 | of all-cause mortality in the follow-up period.

00:37:05.900 | So not causality, but it's pretty incredible.

00:37:08.860 | They've done follow-up research

00:37:10.620 | with slightly different numbers showing,

00:37:12.660 | again though, like many thousands of people

00:37:15.620 | in the study followed for about 10 years,

00:37:18.340 | 8,000 to 12,000 steps per day

00:37:21.420 | was associated with 50 to 65% lower all-cause mortality.

00:37:26.300 | And this has been played out in many studies

00:37:28.100 | showing about a 50% reduction in Alzheimer's,

00:37:31.700 | dementia, obesity, type two diabetes,

00:37:34.300 | depression, cancer, gastric reflux,

00:37:37.620 | just all across the board.

00:37:39.700 | And I think the key thing is that it's not about the steps.

00:37:44.380 | It's about the fact that muscle contraction is medicine.

00:37:49.100 | When we contract our muscles,

00:37:50.620 | even in a very like low-grade way,

00:37:52.980 | like walking or doing a couple of air squats,

00:37:55.460 | you know, we're activating AMPK

00:37:57.500 | and we are essentially causing that cell

00:38:02.420 | to have a stimulus to push glucose channels

00:38:05.780 | to the cell membrane.

00:38:06.980 | Most of the time, the glucose channels are like in vesicles,

00:38:10.460 | in little bags inside the cells.

00:38:12.820 | They're not on the cell membrane.

00:38:14.700 | So of course that's gonna keep the glucose

00:38:16.660 | in your bloodstream not being processed by the mitochondria.

00:38:20.540 | So when we think about steps,

00:38:22.540 | it's a proxy metric for just moving more throughout the day.

00:38:26.220 | So let's take two people.

00:38:27.740 | You have a person who's walking for one to two minutes

00:38:30.900 | every 30 minutes throughout the day.

00:38:33.340 | Maybe they're exercising at the end of the day

00:38:34.860 | or the beginning of the day, maybe they're not.

00:38:36.460 | That person is stimulating glucose channels

00:38:40.100 | to be at the membrane all day.

00:38:43.340 | Now let's take another person

00:38:45.180 | who works out really hard for one hour

00:38:47.900 | in the beginning or the end of the day.

00:38:49.180 | They feel great about it.

00:38:50.100 | They've checked that off their box,

00:38:51.420 | but they're sitting the entire rest of the day.

00:38:53.800 | Yes, they have gotten the benefits from the exercise,

00:38:57.120 | but for a lot of that day,

00:38:58.940 | those glucose channels are inside the cell,

00:39:01.240 | not doing the work they could be doing.

00:39:03.300 | So I think about these little teeny short walking breaks

00:39:06.580 | or pushup breaks or air squat breaks

00:39:08.420 | every 30 minutes or so throughout the day

00:39:11.260 | as me essentially inside the cell

00:39:13.940 | pushing the glucose channels, the cell membrane,

00:39:16.100 | to make them constitutively active.

00:39:18.540 | It's totally different physiology and it's so easy.

00:39:21.580 | So it's not about the steps.

00:39:22.620 | It's about muscle contraction regularly throughout the day.

00:39:27.500 | And this has been shown out

00:39:28.860 | in actually more clinical research, which has taken,

00:39:31.280 | there's been several studies, two that I think are fascinating

00:39:34.260 | where they basically took two groups and they said,

00:39:36.020 | okay, we're gonna have you walk 20 minutes before each meal,

00:39:39.380 | three times a day, 20 minutes after each meal.

00:39:43.280 | So that's also three times a day,

00:39:44.820 | or for like two minutes every 30 minutes throughout the day.

00:39:48.340 | - So these are three separate groups?

00:39:49.340 | - Three separate groups.

00:39:50.180 | - So either 20 minutes before, either 20 minutes after, or?

00:39:53.580 | - Two to three minutes every 30 minutes.

00:39:55.620 | All added up to 60 minutes of walking

00:39:58.580 | or light jogging a day.

00:40:00.180 | I'm kind of paraphrasing two different studies

00:40:01.940 | that showed the same thing.

00:40:02.840 | One was jogging, one was walking,

00:40:04.200 | but it was basically chunks versus short walks

00:40:08.300 | every 30 minutes throughout the waking day.

00:40:10.940 | The groups that do the short movement

00:40:14.220 | regularly throughout the day,

00:40:15.780 | even though the total time is the same

00:40:17.940 | across all the groups,

00:40:18.980 | have significantly lower 24-hour glucose level averages,

00:40:23.140 | 24-hour insulin level averages.

00:40:25.140 | They are metabolically healthier.

00:40:26.740 | And I believe, and the research mechanistically has shown

00:40:29.500 | that it's because we're constitutively

00:40:31.060 | putting these channels of the membrane

00:40:33.940 | to take up the substrate, use the substrate.

00:40:36.460 | So this is not to replace exercise,

00:40:39.900 | but I think it's a reframe.

00:40:41.600 | I think the concept of exercise

00:40:44.500 | is something we're really very wedded to

00:40:47.540 | in our Western culture.

00:40:49.120 | And you look at more like the Blue Zones

00:40:50.740 | and the Centenarians,

00:40:51.580 | and it's like they're kind of moving

00:40:52.820 | as built into their everyday life.

00:40:54.020 | So we've taken movement out of our everyday life

00:40:57.460 | as these knowledge workers,

00:40:58.740 | as we've been industrialized.

00:41:00.540 | And then we think that exercise replaces

00:41:03.700 | that all-day movement,

00:41:05.220 | but biochemically, it does not.

00:41:07.940 | So I think a big part of kind of digging ourselves

00:41:10.460 | out of this chronic disease mess

00:41:12.100 | and creating capacity for mitochondria

00:41:14.140 | is finding ways to take a lot of the activities

00:41:16.500 | we do now seated,

00:41:17.980 | and just find a way to do more of them moving,

00:41:21.300 | standing, or walking.

00:41:22.900 | Or if that's tough,

00:41:24.580 | you really need to sit at your desk all day,

00:41:26.460 | then every 30 minutes,

00:41:28.020 | taking two minutes to do some just light movement,

00:41:32.580 | flex those muscles,

00:41:33.660 | get the glucose channels of the membrane,

00:41:35.260 | get the mitochondria active.

00:41:37.540 | So, and I think another fascinating stat is like,

00:41:41.340 | our gym memberships in the US have doubled

00:41:44.280 | since the year 2000,

00:41:45.740 | and obesity has gone up in the same period.

00:41:47.740 | So there's some mismatch between our obsession with exercise

00:41:50.980 | and our actual outcomes that we're seeing.

00:41:53.500 | And I think it's that we have not actually rebuilt

00:41:57.860 | constitutive movement into our daily lives.

00:42:00.060 | - Very interesting,

00:42:00.900 | 'cause I think a lot of people are now working out,

00:42:03.260 | so to speak, doing resistance training,

00:42:04.940 | which I think is terrific.

00:42:06.020 | - Terrific, yeah.

00:42:06.860 | - Used to be such, you know,

00:42:08.660 | so restricted to niche subculture stuff,

00:42:11.060 | like bodybuilding, preseason football, military, et cetera.

00:42:13.740 | And now it's a more ubiquitous for everybody,

00:42:17.140 | men, women, young, old, that's terrific.

00:42:19.300 | Same thing with things like yoga and cardiovascular training.

00:42:21.980 | I mean, I like to study the history of exercise culture,

00:42:26.820 | and it wasn't, but in the '60s when, you know,

00:42:29.220 | jogging was considered kind of like,

00:42:30.660 | whoa, that's like a really esoteric niche culture thing.

00:42:33.120 | So lots changed.

00:42:34.780 | I love the prescriptives you gave

00:42:36.140 | because it's just very straightforward.

00:42:37.980 | A couple of short walks, it just makes so much sense.

00:42:41.580 | And I love the visual,

00:42:43.120 | and I hope people will really hold it in mind.

00:42:45.160 | So I'll reiterate it.

00:42:46.740 | The translocation of these energy utilization stores

00:42:52.220 | of vesicles, as you call them,

00:42:53.620 | these little packets from the center of the cell

00:42:56.140 | out to the cell surface,

00:42:57.100 | where then they can be involved, excuse me,

00:42:59.620 | in metabolic processes and the utilization of energy

00:43:02.540 | in ways that otherwise they wouldn't.

00:43:05.020 | And glucose disposal being a big part of this.

00:43:07.500 | So I have heard that a short walk after a meal

00:43:10.160 | will reduce blood glucose in a way that's really dramatic.

00:43:13.380 | - Huge amount, 30, 35%,

00:43:15.900 | just taking a walk around the block after a meal.

00:43:18.020 | That's definitely a prescription I think everyone should do

00:43:21.020 | 'cause the research is so strong on it,

00:43:22.900 | is that building in simply a 10-minute walk around the block

00:43:27.900 | or a dance party in the kitchen,

00:43:29.820 | moving your muscles for 10 minutes after a meal

00:43:33.060 | can drastically reduce your glucose response

00:43:36.180 | 'cause you're just bringing all those channels

00:43:37.500 | to the membrane, you're taking up the glucose,

00:43:38.780 | you're using it.

00:43:39.620 | It's a whole different physiology

00:43:40.620 | than sitting on the couch after a meal.

00:43:42.380 | That's very high impact.

00:43:43.620 | It's high leverage if it's after a meal.

00:43:45.440 | So highly recommend that.

00:43:46.620 | And the levels data and clinical data

00:43:49.120 | has shown that out time and time again.

00:43:51.120 | - Whenever I go to a city like New York

00:43:53.640 | when I am forced to walk more,

00:43:55.860 | I always just feel so much better.

00:43:57.740 | We also know that the optic flow

00:43:59.300 | that one experiences with walking

00:44:00.960 | has some interesting effects on the limbic pathways

00:44:03.140 | and quieting of some of the anxiety

00:44:05.300 | and stress-related pathways.

00:44:07.360 | This links up with things like EMDR,

00:44:09.140 | although there are factors that are separate from EMDR.

00:44:12.900 | Basically moving through space, not outer space,

00:44:15.820 | but walking through space with optic flow

00:44:17.620 | has a certain anxiety reduction function in the brain,

00:44:22.120 | which they're beautiful data there, in my opinion.

00:44:25.480 | Okay, so that touches on walking.

00:44:27.720 | You did mention higher intensity exercise.

00:44:30.120 | So let's keep it within the cardiovascular realm for now.

00:44:33.880 | So getting heart rate way, way up,

00:44:37.800 | getting breathing hard for some minutes each week,

00:44:42.800 | maybe a couple of times per week.

00:44:45.520 | It seems that's a good way to increase mitochondrial

00:44:47.860 | function and mitochondrial number, is that right?

00:44:50.960 | - Yeah, so you take sort of each type of exercise.

00:44:54.840 | We've got walking, we've got resistance training,

00:44:57.520 | we've got high intensity interval training,

00:44:59.800 | we've got endurance training,

00:45:01.800 | and then we've got sort of more like zone two.

00:45:05.040 | So we've got these different flavors

00:45:08.400 | of how we get our heart rate up,

00:45:09.680 | how we get the blood flowing, what we signal to the cells.

00:45:12.160 | And each one actually has like a slightly different impact

00:45:15.120 | on the mitochondria.

00:45:16.120 | When we think about biogenesis,

00:45:17.840 | we're thinking mostly like endurance exercise

00:45:21.320 | and really more of that zone two.

00:45:24.840 | And like that is really gonna be a stimulus inside the cell

00:45:28.160 | to print more mitochondria.

00:45:30.460 | When we think about improving mitochondrial fusion,

00:45:32.840 | high intensity interval training

00:45:34.240 | is really, really good for that.

00:45:35.860 | When we think about resistance training,

00:45:37.580 | it's like that's like muscle hypertrophy,

00:45:39.360 | we're gonna be creating more muscle cells

00:45:40.680 | and we need more mitochondria for those.

00:45:42.120 | So each one has kind of a different impact.

00:45:45.480 | And I think this is where honestly,

00:45:47.320 | I think the regular guidelines that we have

00:45:49.560 | even by our government actually make a lot of sense.

00:45:53.360 | It's like work every major muscle group three times a week

00:45:56.560 | in a resistance type training,

00:45:58.160 | and then work to get 75 to 150 minutes

00:46:02.080 | of moderate to strenuous activity.

00:46:03.300 | So 75 minutes of strenuous activity

00:46:05.860 | or 150 minutes per week of moderate activity.

00:46:08.440 | So that actually makes a lot of sense.

00:46:11.280 | 80% of Americans are not meeting

00:46:13.480 | those very basic guidelines.

00:46:15.420 | And 20% of Americans don't get any physical activity

00:46:18.120 | really at all.

00:46:18.960 | Activity for the average American

00:46:20.520 | is 3,000 to 4,000 steps per day,

00:46:23.560 | which is less than two miles.

00:46:25.200 | So we are not even close to even meeting

00:46:27.400 | the basic recommendations that are out there.

00:46:29.960 | But I think those are pretty reasonable.

00:46:32.140 | Resistance training two to three times a week,

00:46:34.560 | most major muscle groups and working to get the heart rate

00:46:40.100 | up moderate level for 150 minutes a week

00:46:43.620 | or strenuous for 75 minutes a week.

00:46:45.940 | Those are going together to be potent stimuli

00:46:50.900 | for biogenesis, mitophagy, mitochondrial fusion,

00:46:54.340 | for increasing antioxidant enzymes

00:46:56.600 | that are gonna protect the mitochondria

00:46:58.660 | from that oxidative stress.

00:47:00.260 | And the one that's just actually not in there

00:47:04.220 | in sort of the basic recommendations for Americans

00:47:06.520 | is the walking.

00:47:07.360 | And I would just absolutely add to that

00:47:09.200 | at least 7,000 steps per day

00:47:11.640 | based on what the data is showing,

00:47:13.940 | which honestly would probably take

00:47:16.740 | less than an hour total to do.

00:47:19.140 | And if you break it up throughout the day,

00:47:20.820 | it's just a few minutes a day.

00:47:22.740 | So that right there are gonna be like a big multifaceted

00:47:27.340 | set of signals for increasing mitochondrial capacity

00:47:31.140 | in different ways.

00:47:32.740 | - Terrific.

00:47:33.800 | What are your thoughts on under the desk treadmilling?

00:47:36.900 | I don't own one of these,

00:47:38.100 | but, and I try and get walks

00:47:39.800 | and I definitely do my three resistance training

00:47:42.700 | extra sessions per week,

00:47:44.660 | different muscle groups on different days.

00:47:46.260 | So it ends up being each muscle group

00:47:48.260 | is hit directly once and indirectly a second time.

00:47:50.920 | But I like to do a long hike once on the weekend,

00:47:54.460 | run in the middle of the week that's 30, maybe 35 minutes.

00:47:57.060 | And then some VO2 max really short workout,

00:47:59.420 | 12 minutes total, where basically I'm just going for,

00:48:02.740 | you know, the feeling that my heart

00:48:04.420 | is gonna jump out of my chest

00:48:05.540 | and I'm gonna die from gasping of air.

00:48:07.980 | But luckily thus far I haven't died.

00:48:09.980 | Nonetheless, the total time commitment isn't that great,

00:48:13.280 | but I find that I'm at a desk a lot

00:48:15.220 | and I have a standing desk.

00:48:16.980 | Is it wise to get a treadmill to treadmill under the desk?

00:48:19.380 | Seems like it would be one of the best things

00:48:20.860 | one could do.

00:48:21.900 | - I'm a massive fan of under treadmill desk

00:48:24.300 | because genuinely I believe that if we move more

00:48:28.580 | of our daily activities that we're doing seated indoors

00:48:31.180 | to outdoors moving, it would radically change

00:48:34.980 | the health of the United States

00:48:36.620 | with real physiology underneath it.

00:48:38.700 | So there's actually been research on under desk,

00:48:42.580 | standing desk that is pretty interesting, small studies,

00:48:45.420 | but they, you know, took a handful of people.

00:48:48.540 | I think it was around 10 in a workplace environment

00:48:51.940 | and they had them use under desk treadmills

00:48:54.620 | for two and a half hours per day during the workday.

00:48:59.260 | So not a lot at very so speeds for two weeks.

00:49:03.340 | And people lost on average, 2.6 pounds of fat

00:49:07.740 | and put on 2.2 pounds of lean mass.

00:49:10.780 | - Wild.

00:49:11.620 | - In a very short period of time.

00:49:13.020 | The study makes a somewhat wild claim

00:49:17.160 | that if this were extrapolated to a year,

00:49:20.300 | we anticipate that we could see a loss of 44 to 66 pounds.

00:49:25.300 | - Assuming it's a linear progression.

00:49:27.460 | - Exactly.

00:49:28.460 | - Which is not the case folks.

00:49:30.020 | - That's why I'm saying it was a pretty,

00:49:31.740 | but that was there in the discussion.

00:49:34.140 | And, but I think that short period is quite interesting.

00:49:37.800 | So that's pretty significant.

00:49:40.620 | And that's just for two and a half hours a day.

00:49:42.780 | So I think now that they're about $150 on Amazon,

00:49:47.460 | these under desk treadmills,

00:49:48.860 | I think for anyone who's a knowledge worker,

00:49:50.820 | it's a good thing to have at your house.

00:49:52.300 | And the way I use it is like,

00:49:53.700 | I basically just force myself to start my day

00:49:56.420 | on the treadmill desk.

00:49:57.380 | And I say to myself,

00:49:58.220 | if I don't like it after five minutes,

00:49:59.620 | I'll sit down if I need to sit,

00:50:00.820 | but I'll start and just see how it feels.

00:50:02.660 | And then an hour goes by and I've forgotten I'm even on it.

00:50:06.920 | - Is that right?

00:50:07.760 | So you're able to work without thinking about

00:50:09.300 | having to treadmill.

00:50:12.100 | - I am putting it at such a slow speed.

00:50:14.820 | I think I'm usually walking at like one mile per hour.

00:50:17.900 | I mean, it's very, very glacially slow.

00:50:20.620 | I do put my aura ring on my second toe when I do this,

00:50:23.500 | because otherwise it doesn't count my steps.

00:50:25.320 | Because if your hands are at your desk,

00:50:27.100 | they won't count your steps.

00:50:29.220 | - Because the aura rings measuring hand.

00:50:31.140 | - Accelerometry, yeah.

00:50:32.300 | But it's incredible how even at a 1.0,

00:50:36.180 | one mile per hour speed after two to three hours,

00:50:38.500 | you're easily gonna get six, seven, 8,000 steps

00:50:40.820 | and then throw in a couple other short walks

00:50:43.100 | throughout the day and you're getting there easily.

00:50:45.020 | So it's just a great way to build back in

00:50:49.580 | what modernity took away.

00:50:51.740 | And that unfortunately is unavoidable,

00:50:54.180 | that regular movement for good physiology.

00:50:56.800 | So I'm a big fan of them.

00:51:00.020 | And the data suggests that for a couple hours a day,

00:51:02.900 | they can actually have an impact on body composition,

00:51:05.860 | which I think is a great, easy,

00:51:08.300 | inexpensive thing for people to do.

00:51:10.940 | But if you don't wanna buy one,

00:51:12.220 | like just set those timers and build in the walks

00:51:16.780 | throughout the day outside.

00:51:18.160 | - Terrific.

00:51:19.420 | Yeah, I'm a fan of getting walks when I can.

00:51:22.380 | I also, one of your thoughts on, there was a study,

00:51:24.980 | I'm not sure if you're familiar with it,

00:51:26.920 | published at the University of Houston,

00:51:28.920 | where they looked at what they called soleus pushups,

00:51:32.020 | which all the gym goers are gonna roll their eyes.

00:51:35.740 | Imagine sitting down and pressing your toe

00:51:41.360 | against the ground and raising your heel.

00:51:42.880 | So kind of like seated calf raise,

00:51:44.320 | but no weight right under the desk.

00:51:45.680 | And this study had some remarkable claims and conclusions,

00:51:50.460 | which included, as I recall,

00:51:53.200 | that the activation of this muscle,

00:51:54.560 | the soleus, which makes up about 1%

00:51:56.360 | of the body's total musculature,

00:51:58.800 | involved, caused rather,

00:52:01.280 | a disproportionate use of blood glucose.

00:52:05.560 | So it mobilized blood glucose in a good way.

00:52:07.960 | And the idea was if people would,

00:52:12.080 | it's not just bouncing your knee,

00:52:13.320 | but would actively push their toes against the ground

00:52:15.640 | and raise their heels as they were seated and doing work,

00:52:18.360 | that somehow there would be a positive effect

00:52:20.600 | on metabolism and blood glucose utilization.

00:52:23.200 | I talked a little bit about this on social media

00:52:24.960 | and a few other podcasts.

00:52:26.440 | And it was interesting to see the sort of attacks

00:52:28.360 | that I got, like people really didn't like the idea

00:52:30.920 | that this was any different than so-called NEAT,

00:52:33.720 | non-exercise activated thermogenesis.

00:52:36.160 | So it's known that people that fidget a lot

00:52:37.720 | or move around a lot burn a lot of calories.

00:52:40.400 | This actually goes back to some really beautiful work

00:52:43.100 | several decades or more ago from Rothwell and Stock,

00:52:47.120 | who talked about like the fact that animals

00:52:49.360 | and people who fidget a lot burn a lot of energy.

00:52:52.040 | They tend to be thinner,

00:52:52.920 | they tend to have lower adipose tissue stores.

00:52:55.380 | And it's because they're just burning a lot more calories.

00:52:58.840 | And this is actually what people who suffer from anorexia,

00:53:02.200 | which is by the way,

00:53:03.040 | the most deadly of the psychiatric conditions.

00:53:04.720 | So it's talking about true anorexia,

00:53:07.280 | are encouraged not to do

00:53:09.200 | because they either do it spontaneously

00:53:12.360 | or they learn that it's a very efficient way

00:53:13.840 | to burn calories and that's not what they need.

00:53:16.280 | But many people do need to burn more calories.

00:53:18.040 | So bouncing the knee,

00:53:20.160 | that thing that drives everybody crazy,

00:53:21.600 | if you're not the one doing it.

00:53:23.280 | Soleus pushups.

00:53:24.760 | What are your thoughts about this and that study?

00:53:26.440 | We don't have to pick it apart in detail,

00:53:27.880 | but I thought it was kind of interesting.

00:53:29.440 | It's all coming back to just moving the body

00:53:32.620 | as much as possible during the day.

00:53:34.240 | Contracting muscles, contracting muscles.

00:53:35.840 | - Contracting muscles, it's medicine.

00:53:37.160 | And I find the concept of knee just endlessly fascinating,

00:53:42.080 | 'cause we kind of come up with this term

00:53:43.920 | non-exercise activity thermogenesis,

00:53:45.880 | and the data is really good about it.

00:53:47.680 | Like it's basically shows that this is a prime

00:53:50.720 | potential intervention for the obesity epidemic.

00:53:54.280 | And it all goes back to the cell.

00:53:56.480 | Like it's essentially a stimulus

00:53:58.440 | that's telling the body to stay metabolically active

00:54:02.320 | as opposed to keeping all those metabolic pathways

00:54:05.800 | dormant during the day.

00:54:07.400 | And I think that it just, it is funny though,

00:54:11.480 | that like we have these acronyms for basically like,

00:54:13.960 | this is just the way life was 100 years ago.

00:54:16.680 | If you look at like the 1800s,

00:54:20.800 | almost 100% of Americans lived on a farm,

00:54:23.240 | basically like pre-industrialization, pre-urbanization.

00:54:26.720 | Most Americans, not 100%, but close lived,

00:54:30.720 | they grew some of their own food.

00:54:32.020 | They lived either on a farm or had a large garden.

00:54:34.220 | Now that number is less than 1%.

00:54:36.280 | So like movement was just built into everything we did.

00:54:39.600 | And you think from there, like what has happened?

00:54:41.600 | Like we were outside, we were moving,

00:54:45.000 | our activities of daily living involved movement.

00:54:47.960 | And if you just take the grocery example,

00:54:49.500 | then it moved to like, okay, maybe farmer's markets

00:54:51.720 | and sort of like outdoor open air markets.

00:54:54.560 | Then it's supermarkets.

00:54:55.960 | Then it's, now it's literally buying food online

00:55:00.960 | with the click of the button.

00:55:02.080 | And now some people aren't even doing that.

00:55:03.520 | They're literally on the food

00:55:04.560 | delivered to them with Uber Eats.

00:55:05.840 | So at every level we've taken away movement

00:55:09.040 | from everyday life.

00:55:09.880 | And now we have sort of an acronym to like bring it back in.

00:55:12.240 | But really it's about just, you know,

00:55:14.480 | giving the body stimuli that the cells have been entrained

00:55:19.360 | to expect throughout all of human history

00:55:21.560 | and building the back into our modern life.

00:55:23.840 | So I think NEAT, it's incredibly important.

00:55:27.080 | And I think it also brings up this point

00:55:28.780 | that like is so critical, which is like,

00:55:32.240 | I really think our way out of this chronic disease epidemic.

00:55:38.680 | And even for people who are listening,

00:55:39.840 | don't have a chronic disease,

00:55:40.740 | any real chronic symptoms we're dealing with.

00:55:42.980 | And just the fact that we're not feeling

00:55:44.120 | as good as we could.

00:55:44.960 | Like the way out is pretty simple.

00:55:47.260 | Like it's some of these basic things

00:55:50.740 | like walking more throughout the day,

00:55:52.940 | moving more throughout the day,

00:55:54.460 | getting outside, you know, eating clean, unpoisoned food.

00:55:57.740 | A lot of these things that have the best data are so simple.

00:56:04.180 | And I think it's like really important

00:56:06.540 | to just always remember like the game and the industry,

00:56:09.800 | it's all about how complex can we make it?

00:56:12.820 | Like specialization, talking about some of the minutiae,

00:56:16.740 | but like at the end of the day,

00:56:18.240 | all the simple habits that we know are healthy,

00:56:20.580 | like fundamentally improve cellular biology.

00:56:22.740 | And like some of these things like the NEAT,

00:56:25.140 | like the walking, like it's emblematic of the fact

00:56:28.340 | that some of the simplest solutions

00:56:31.340 | are the ones that are by far the most effective.

00:56:34.060 | And I think the biggest misconception

00:56:37.100 | in healthcare right now is that the way out

00:56:39.640 | and the way to get really back

00:56:41.820 | to true incredible health is complicated.

00:56:45.260 | Like it's really not that complicated.

00:56:47.060 | We've got to move more, you know,

00:56:48.540 | throughout the day, that's one of them.

00:56:49.700 | And, you know, on each pillar that we touched on earlier,

00:56:52.620 | food, sleep, all of this, you know,

00:56:54.780 | when we talk about the simple habits that we know work,

00:56:56.900 | the reason they work is 'cause they all positively impact

00:56:59.980 | the mitochondria, they positively impact oxidative stress,

00:57:02.640 | they positively impact inflammation.

00:57:05.380 | So, yeah.

00:57:06.560 | - I love it.

00:57:07.400 | I love simple solutions that hit multiple cellular pathways

00:57:11.800 | that can make everybody healthier.

00:57:14.720 | I'd like to just take a quick break

00:57:16.160 | and acknowledge one of our sponsors, InsideTracker.

00:57:19.160 | InsideTracker is a personalized nutrition platform

00:57:21.800 | that analyzes data from your blood and DNA

00:57:24.440 | to help you better understand your body

00:57:26.080 | and help you reach your health goals.

00:57:28.040 | Now, I've long been a believer

00:57:29.240 | in getting regular blood work done for the simple reason

00:57:31.920 | that many of the factors that impact our immediate

00:57:34.320 | and long-term health can only be addressed.

00:57:36.560 | That is, can only be measured with a quality blood test.

00:57:39.900 | Now, one issue with many blood tests out there

00:57:41.800 | is that you get information back about lipid levels,

00:57:44.280 | hormone levels, metabolic factors, et cetera,

00:57:46.720 | but you don't know what to do with that information.

00:57:48.880 | With InsideTracker, they make it very easy

00:57:50.600 | to understand your levels and what they mean

00:57:53.240 | and specific actionable items that you can undertake

00:57:56.080 | in order to bring those levels into the ranges

00:57:58.200 | that are optimal for you.

00:57:59.560 | InsideTracker also offers InsideTracker Pro,

00:58:02.560 | which enables coaches and health professionals

00:58:04.800 | to provide premium and personalized services

00:58:07.280 | by leveraging InsideTracker's analysis

00:58:09.200 | and recommendations with their clients.

00:58:11.320 | If you'd like to try InsideTracker,

00:58:12.800 | you can go to insidetracker.com/huberman

00:58:15.840 | and you'll get 20% off any of InsideTracker's plans.

00:58:18.640 | Again, that's insidetracker.com/huberman.

00:58:22.200 | I'd like to talk about assessment,

00:58:24.600 | blood tests in particular.

00:58:26.680 | I remember in college,

00:58:27.640 | I was just very curious about blood testing

00:58:30.180 | and I had read a little bit about it,

00:58:31.640 | but it was really hard to access.

00:58:33.680 | I actually went to the student health center and said,

00:58:35.840 | can I just get my lipids measured,

00:58:38.960 | some hormone stuff measured?

00:58:40.160 | I was in great health.

00:58:41.000 | I just want to do that.

00:58:42.680 | And they're like, no, what's the issue?

00:58:44.920 | Why would you do that?

00:58:46.000 | Now it's very easy to find places that will do blood tests,

00:58:48.620 | but there is some cost often.

00:58:50.600 | And nowadays, thanks to your efforts,

00:58:54.880 | your innovative and engineering efforts

00:58:57.640 | and the efforts of others,

00:58:58.940 | there are ways to measure what's in your blood

00:59:02.720 | and blood glucose in particular

00:59:04.360 | with continuous monitoring and with snapshot monitoring.

00:59:08.760 | So let's talk about blood tests.

00:59:12.320 | What do you think are the three to five things

00:59:15.940 | that basically everybody, if they can,

00:59:18.560 | should know about what's circulating in their blood?

00:59:21.280 | I'm imagining LDL, HDL, this kind of thing.

00:59:25.000 | I guess ApoB is a big favorite of our friend, Peter Atiyah.

00:59:29.960 | Fasting blood glucose, continuous blood glucose,

00:59:33.480 | post meal, et cetera.

00:59:34.740 | Just kind of evaluating how exercise, food, et cetera,

00:59:37.000 | impacts blood glucose.

00:59:38.360 | And then I'll leave the other categories open

00:59:40.160 | 'cause my point here is not to answer the question.

00:59:42.480 | That's what comes to mind.

00:59:43.320 | - You've got the big ones.

00:59:45.040 | So this is key is that every single person listening,

00:59:50.040 | I hope after this episode will go to their health record

00:59:54.600 | or send their doctor a message

00:59:56.440 | and at least get the following test.

00:59:59.060 | And the first seven that I'll mention are very basic

01:00:04.060 | and people might take umbrage to them

01:00:06.400 | because obviously there's a lot of debate

01:00:08.160 | about what's everyone's favorite lab test.

01:00:10.440 | But I think about it as what are the basics

01:00:12.840 | that everyone should know?

01:00:13.920 | And then what's the next tier up

01:00:15.960 | that are easy to access and are cheap

01:00:17.680 | that'll give you a lot more richness,

01:00:19.160 | but which you still might have to fight your doctor for.

01:00:22.040 | So the first few that you will not have to fight

01:00:23.860 | your doctor for and are often free on an annual physical

01:00:26.140 | and literally define metabolic syndrome

01:00:28.600 | are fasting glucose, fasting triglycerides,

01:00:31.760 | HDL cholesterol, hemoglobin A1C, total cholesterol,

01:00:35.680 | waist circumference and blood pressure.

01:00:37.960 | - Okay, sorry, I hate to interrupt

01:00:40.000 | and my audience hates it even more,

01:00:41.400 | but I'm gonna just, could you just explain

01:00:43.480 | what each of those is and what it corresponds to?

01:00:46.920 | - Yes. - Great, thank you.

01:00:47.760 | - And I will say, first of all,

01:00:48.920 | the reason I'm choosing these,

01:00:50.240 | it's not even my own choice really.

01:00:52.160 | It's two reasons.

01:00:53.140 | One is that the two studies over the past five years

01:00:57.500 | that have shown us in large populations

01:00:59.500 | that the vast majority of American adults

01:01:01.500 | are metabolically dysfunctional use those biomarkers.

01:01:04.020 | So I think because of that, it's important to know them.

01:01:06.300 | And the two studies that I'm referring to

01:01:07.740 | are one from UNC in 2018,

01:01:10.180 | which showed that based on those biomarkers,

01:01:13.380 | 88% of American adults have suboptimal metabolism.

01:01:17.500 | And then a follow-up study

01:01:18.740 | from the Journal of the American College of Cardiology

01:01:21.020 | from last year showed that that number has gone to 93.2%

01:01:25.180 | of American adults are suboptimal in their metabolism.

01:01:28.340 | And these are the metrics that they use

01:01:31.780 | and they're very basic.

01:01:32.820 | If you had to pay out of pocket,

01:01:34.060 | they would be less than $100.

01:01:35.660 | So let's talk through them.

01:01:37.780 | Why they're great is because together,

01:01:41.620 | they give you kind of like a tapestry

01:01:43.940 | of what's actually happening inside the cell.

01:01:46.540 | If you choose to look at them that way,

01:01:48.740 | if you read the tea leaves of them,

01:01:51.500 | are the doctors often, if they see all these lab tests,

01:01:55.420 | it'll be in an electronic health record.

01:01:56.840 | We've all been through this experience.

01:01:58.860 | They'll come up on the screen

01:02:00.020 | and there'll either be like a green, orange,

01:02:02.580 | or red color next to it.

01:02:04.340 | Like it's high, it's low, it's borderline.

01:02:06.540 | And the doctor will basically, it's very algorithmic.

01:02:08.980 | Oh, your LDL is high, we need to bring it down.

01:02:12.020 | Oh, your glucose is high, we need to bring it down.

01:02:13.420 | Oh, your blood pressure is high, we need to bring it down.

01:02:15.060 | But what I'm inviting people to do

01:02:16.180 | is understand a little bit about each test

01:02:17.780 | and then read the tea leaves

01:02:19.220 | of what it's telling us about our mitochondria.

01:02:21.860 | So let's start with fasting glucose.

01:02:25.300 | So fasting glucose, when you look at these studies

01:02:29.260 | that I'm referring to, they call optimal less than 100.

01:02:33.980 | So to define whether you were in that 88 or 93%,

01:02:37.180 | you had to essentially be in their optimal range

01:02:40.020 | for all biomarkers, not on medication.

01:02:42.060 | So I'll quickly run through what their ranges were.

01:02:44.860 | My ranges for optimal are tighter than these,

01:02:46.980 | but fasting glucose less than 100,

01:02:49.540 | triglycerides less than 150,

01:02:52.340 | HDL above 40 for men or 50 for women,

01:02:56.420 | hemoglobin A1C less than 5.7%,

01:02:59.660 | total cholesterol to HDL ratio less than 3.5 to one,

01:03:04.660 | waist circumference less than 35 inches for women

01:03:07.740 | or 40 inches for men,

01:03:09.060 | and blood pressure less than 120 over 80.

01:03:11.780 | If those things were in those ranges

01:03:15.260 | and you weren't on medication for blood sugar

01:03:17.300 | or blood pressure or whatnot,

01:03:20.020 | you were considered optimally metabolically healthy.

01:03:22.820 | That's now 6.8% of Americans.

01:03:25.200 | All of these biomarkers are easy to change

01:03:28.940 | in one to two months, I would say,

01:03:30.500 | with simple lifestyle habits.

01:03:32.100 | - Could you remind us what hemoglobin A1C is?

01:03:34.100 | I think most people are familiar with HDL cholesterol

01:03:36.460 | being the quote unquote good cholesterol

01:03:38.340 | and LDL being the bad cholesterol.

01:03:40.660 | And as I say that, I know I'm gonna get dogpiled.

01:03:43.300 | - Yeah, oh, totally, yeah.

01:03:44.940 | I'm not sure that I adhere to that.

01:03:47.060 | I'm not sure I don't adhere to that.

01:03:49.320 | I'm not sure about a lot of things.

01:03:51.180 | But I am sure that most people think of them that way.

01:03:54.860 | So just to stay functional here,

01:03:57.460 | we'll frame it that way for now with the caveat

01:04:00.440 | that that might not be the whole story,

01:04:02.220 | isn't the whole story.

01:04:03.380 | But triglycerides, fat in the blood, fatty stuff.

01:04:07.860 | - That's so key to understand about the triglycerides.

01:04:11.060 | We don't wanna confuse triglycerides with eating more fat.

01:04:14.500 | Triglycerides are a storage form

01:04:17.260 | of excess carbohydrates in the blood.

01:04:19.780 | So this is why it can tell us something about,

01:04:22.020 | and I know you and Rob Lustig talked about this at length,

01:04:24.420 | but it's- - And Lane Norton.

01:04:25.980 | - And Lane, yeah.

01:04:26.820 | - Yeah, I mean, one of the things that's really tricky,

01:04:28.500 | gosh, is that the language around nutrition and health

01:04:31.660 | is complicated because people hear the word fat,

01:04:33.560 | they think body fat,

01:04:34.940 | but then they also think the macronutrient fat.

01:04:37.660 | We just need more words to better parse the reality.

01:04:42.740 | In biology, we call the two major groups of people,

01:04:47.140 | lumpers and splitters.

01:04:48.460 | Lumpers like to lump everything together.

01:04:50.460 | It oversimplifies and complicates.

01:04:52.180 | Splitters like to split everything,

01:04:53.740 | give a name for everything,

01:04:54.980 | individual name for everything.

01:04:56.380 | It complicates.

01:04:57.220 | And so there's a middle ground, right?

01:04:58.580 | There's a land of reasonable people and nomenclature.

01:05:02.620 | And unfortunately, that does not exist on the internet,

01:05:05.220 | nor does it exist in any one specific subfield

01:05:08.140 | of medicine or science.

01:05:09.020 | I mean, so much of the confusion out in the world

01:05:11.320 | is because of a lack of adequate language

01:05:14.220 | in order to explain.

01:05:15.120 | Okay, so the triglycerides are a reflection

01:05:17.620 | of excess carbohydrate intake.

01:05:19.340 | - And how it's helping us with that tapestry

01:05:21.580 | of understanding the trifecta of bad energy

01:05:24.220 | is that if you think about it,

01:05:25.300 | let's just go back to that cell and that poor mitochondria

01:05:28.740 | that's being absolutely decimated by our environment

01:05:32.540 | and its capacity is low.

01:05:34.020 | Okay, so that mitochondria is like,

01:05:35.780 | I can't process glucose or fatty acids to ATP very well,

01:05:38.560 | so I'm gonna block their entry into the cell.

01:05:42.020 | So now you've got glucose rising in the bloodstream.

01:05:45.180 | So, okay, fasting glucose,

01:05:46.620 | that was one of our biomarkers.

01:05:47.700 | If that's going up, that is a little bit of that tapestry

01:05:50.900 | of maybe something's going on inside the cell

01:05:52.560 | that's blocking the entry into the cell,

01:05:54.020 | so it's rising the bloodstream.

01:05:55.100 | Okay, well, where's all that?

01:05:56.820 | The body does not want lots of glucose

01:05:59.060 | floating around in the bloodstream

01:06:00.260 | because it can literally independently cause

01:06:03.180 | endothelial dysfunction,

01:06:04.460 | which is basically blood vessel problems.

01:06:06.980 | It can cause oxidative stress in the bloodstream.

01:06:09.560 | It can cause glycation,

01:06:10.820 | which is sugar literally just sticking to things.

01:06:13.360 | The body doesn't want that glucose high in the bloodstream,

01:06:16.540 | so it converts it to triglycerides to be stored

01:06:20.400 | in a storage form of energy.

01:06:22.400 | That's a key point that I think is helpful to understand

01:06:24.640 | is that the body,

01:06:25.560 | it's always trying to kind of keep things in the right range

01:06:28.360 | so it'll convert things.

01:06:29.480 | So then triglycerides, a picture in your blood

01:06:33.220 | of glucose being high and triglycerides being high

01:06:37.040 | is very much should signal to everyone

01:06:40.680 | when they look at their labs

01:06:41.800 | that there's probably something going on inside the cell

01:06:45.720 | that's blocking the cell from being able to use and process.

01:06:48.240 | It's a sign of mitochondrial dysfunction

01:06:50.260 | and chronic overnutrition.

01:06:51.880 | Too much substrate, not enough processing,

01:06:53.920 | glucose is gonna go up, triglycerides are gonna go up.

01:06:56.840 | And so then if you kind of squint and read the tea leaves,

01:06:59.640 | it's like, huh, I think metabolic dysfunction.

01:07:01.640 | And what's fasting is that the travesty

01:07:04.060 | in our healthcare system

01:07:05.140 | is that a patient might go into the doctor

01:07:08.300 | and their fasting glucose is 99,

01:07:11.380 | one point under what we'd consider the normal range

01:07:14.060 | and their triglycerides are 149,

01:07:15.940 | one point under what we'd consider the normal range

01:07:18.460 | from these things.

01:07:20.380 | That doctor might say to that patient, you're totally fine.

01:07:23.700 | Both glucose and triglycerides are normal.

01:07:26.340 | But that's just really problematic

01:07:30.620 | because they're on the upper end of normal

01:07:32.880 | for both of those.

01:07:34.480 | And so really what that would say to me

01:07:36.120 | as someone thinking about the mitochondria

01:07:37.480 | is like this person

01:07:38.320 | is definitely metabolically dysfunctional.

01:07:40.600 | They're on the highest end of normal

01:07:42.560 | for both triglycerides and glucose.

01:07:44.280 | There's something,

01:07:45.320 | there's definitely insulin resistance going on here.

01:07:47.400 | I would much rather see that glucose at 73

01:07:50.440 | and that triglyceride at 50,

01:07:52.460 | which to me would say,

01:07:53.840 | oh, this cell's processing through energy, great.

01:07:57.120 | And things are moving through

01:07:58.960 | and we're not backing up in the bloodstream.

01:08:01.060 | We're not converting to triglycerides.

01:08:02.460 | So that's where really optimal ranges get in.

01:08:04.900 | But so that's glucose and triglycerides.

01:08:07.780 | Why, if those are starting to creep up,

01:08:09.260 | it's a sign that something is happening metabolically.

01:08:12.020 | And then when we look at some of the other biomarkers,

01:08:15.020 | so hemoglobin A1C is really,

01:08:17.740 | so that's a marker that's looking at

01:08:19.380 | how many of the hemoglobin molecules

01:08:22.360 | that are in the red blood cells that carry oxygen,

01:08:24.940 | how many of those hemoglobin molecules

01:08:28.020 | have sugar stuck to them,

01:08:31.080 | and that's glycation.

01:08:32.860 | So you're looking at glycated hemoglobin.

01:08:35.440 | And you can imagine that if the concentration of glucose

01:08:38.160 | is higher over time,

01:08:40.920 | more glucose is gonna stick to red blood cells.

01:08:43.000 | And that's gonna create a higher percentage

01:08:45.080 | of glycated hemoglobin.

01:08:46.960 | So that's why that lab is represented as a percentage.

01:08:50.080 | So less than 5.7 is what we want.

01:08:53.080 | - You want those cells nice and smooth and slippery.

01:08:55.560 | - No sugar stuck to them, causing dysfunction.

01:08:58.320 | And because blood cells last for about nine to 120 days,

01:09:03.260 | hemoglobin A1C is giving us basically a snapshot

01:09:06.780 | of average blood sugar levels over nine to 120 days.

01:09:11.280 | And if that average is higher, again,

01:09:13.420 | probably a sign that cells are rejecting glucose

01:09:16.300 | from the cell and it's causing a rise in the bloodstream.

01:09:19.380 | And then just talking about one other biomarker

01:09:23.180 | in that that we talked about, which was blood pressure,

01:09:25.720 | people might say, well, how does blood pressure relate

01:09:27.760 | to like what's going on inside the cell,

01:09:29.600 | you know, in the mitochondria and whatnot?

01:09:32.560 | And the fascinating link is that

01:09:34.920 | when that cell becomes insulin resistance,

01:09:38.080 | which again is a compensatory mechanism

01:09:40.580 | for mitochondrial dysfunction,

01:09:42.580 | the insulin is gonna rise in the blood

01:09:46.080 | 'cause the body's insulin resistant.

01:09:47.480 | So the body's gonna churn out more insulin

01:09:49.200 | to try and overcome the insulin block

01:09:50.760 | to drive the sugar into the cells.

01:09:52.120 | So insulin levels rise.

01:09:53.240 | Well, insulin is one of the key activators of nitric oxide,

01:09:58.240 | which is the molecule in the blood that dilates

01:10:01.040 | and relaxes blood vessels.

01:10:02.480 | And so when we become insulin resistant

01:10:04.460 | and we're not responding to that insulin signal,

01:10:07.820 | we end up getting less nitric oxide activity.

01:10:09.760 | So this is how kind of looking at even these very basic,

01:10:13.060 | very cheap biomarkers through the lens

01:10:15.560 | of basic cellular physiology, we can start to see,

01:10:19.480 | man, my body might be like underpowered.

01:10:22.080 | I might have a mitochondrial issue here.

01:10:24.600 | So that's a few of those tests

01:10:26.960 | that we really wanna shoot for.

01:10:28.480 | - Terrific, and thanks for bringing up blood pressure again.

01:10:31.000 | It's sort of comes across to many people as old school,

01:10:35.800 | right, but when Atiyah was here,

01:10:38.520 | one of the several times he was here,

01:10:39.880 | he really pushed on blood pressure

01:10:41.720 | as such a key metric, right?

01:10:43.560 | I mean, obviously, if blood pressure is high,

01:10:46.960 | you're getting less nitric oxide through whatever means here.

01:10:51.580 | Vessels and capillaries are constricted.

01:10:54.520 | Cells aren't able to use the energy that's coming in.

01:10:57.940 | There's excess energy.

01:10:58.800 | There's buildup of metabolic waste.

01:11:00.400 | There's all this stuff.

01:11:01.560 | And now we can start to see the picture

01:11:03.880 | that's trying to emerge.

01:11:04.880 | And as you mentioned briefly,

01:11:07.320 | these markers can be put into healthy range

01:11:09.840 | or maybe even fantastic range in a very short period of time.

01:11:13.700 | So we'll talk about how to go about that.

01:11:16.340 | In terms of getting a basic blood test,

01:11:19.600 | as your physician, what's the secret code?

01:11:22.500 | I'll give away one that a former guest

01:11:27.300 | who's also an MD shared,

01:11:28.940 | which is oftentimes if you ask your physician

01:11:31.300 | for a blood test, they will say,

01:11:33.020 | "Well, unless there's a particular need

01:11:34.740 | "or you're struggling with something,

01:11:36.440 | "they won't give it to you."

01:11:37.740 | But if you have a shift from baseline in a symptom

01:11:41.580 | or in a number that can help,

01:11:43.540 | all the physicians are gonna come after me now with,

01:11:45.460 | I guess, with stethoscopes.

01:11:48.460 | I'm willing to stand my ground.

01:11:50.000 | If you want a blood test,

01:11:53.680 | it's often useful to mention

01:11:55.040 | that there's been some market shift.

01:11:57.200 | You wanna be honest, right?

01:11:58.520 | But some market shift in sleep, in lifestyle,

01:12:01.920 | in how you feel standing up, sitting down.

01:12:04.200 | I'm not trying to lace people's minds with ideas

01:12:06.640 | to create narratives here,

01:12:08.380 | but oftentimes where physicians are resistant,

01:12:12.080 | there'll be more amenable if they understand that,

01:12:14.720 | "Hey, like something's changing."

01:12:15.980 | And the patient's saying something's changing.

01:12:17.400 | It actually would be irresponsible of them

01:12:18.740 | to not give the blood test.

01:12:19.760 | So there you go.

01:12:21.360 | Bring it on, MDs.

01:12:22.680 | - Yeah, truly.

01:12:23.520 | And I think the nice thing about these,

01:12:25.520 | again, very basic tests,

01:12:27.300 | and there are so many other tests

01:12:28.800 | that I talk about in my book

01:12:29.640 | and that you've talked about on your podcast,

01:12:31.000 | ApoB, uric acid, fasting insulin, HOMA-IR, HSCRP,

01:12:35.400 | liver function tests, GGT,

01:12:36.960 | all these other tests that are great

01:12:38.360 | that can really tell us more about mitochondrial dysfunction,

01:12:41.680 | oxidative stress, chronic inflammation.

01:12:43.780 | But the ones I'm mentioning

01:12:44.920 | are the ones that you will not have to fight

01:12:46.600 | with your doctor about.

01:12:47.560 | - Oh, good.

01:12:48.640 | - Everything I just mentioned,

01:12:49.980 | the doctor should order on an annual physical.

01:12:52.920 | And it's really about us learning

01:12:54.880 | to actually read the tea leaves of what they're saying

01:12:57.720 | and not look at them in this algorithmic way,

01:12:59.840 | but how together, if they're creeping up

01:13:02.680 | or if many of them are a little bit high,

01:13:05.680 | we need to focus all of our energy

01:13:07.840 | on improving mitochondrial capacity, basically,

01:13:09.900 | and bring those numbers down,

01:13:11.240 | which we can do very, very quickly.

01:13:12.400 | Once you start getting the mitochondria

01:13:13.680 | moving through more of those substrates,

01:13:14.960 | a lot of them will just naturally come down.

01:13:16.840 | Now, in the book, I give scripts

01:13:19.440 | to literally talk to your doctor with,

01:13:21.040 | because you are gonna get pushback.

01:13:23.820 | Often, if you ask for a fasting insulin,

01:13:25.620 | I would say probably, I mean,

01:13:26.760 | even though doctors are waking up a little bit,

01:13:29.000 | like maybe 85% of people are gonna have their doctor say

01:13:31.880 | they won't order that for them.

01:13:32.920 | So I actually think there's a huge benefit.

01:13:35.320 | I hate to say it, but like going outside the system,

01:13:37.340 | this is where I think innovation has been valuable.

01:13:40.580 | There's a lot of like amazing companies

01:13:43.040 | doing direct-to-consumer lab testing,

01:13:46.280 | so you can basically avoid the hassle,

01:13:48.320 | and some of them are very affordable.

01:13:50.400 | There's Function Health is a company

01:13:53.600 | that's doing 110 biomarkers,

01:13:55.820 | including all the key metabolic biomarkers

01:13:58.400 | for less than $500, and they'll do it twice a year,

01:14:00.960 | so you don't ever have to, and then they do interpretations.

01:14:04.000 | InsideTracker, Next Health, Levels is doing labs,

01:14:08.560 | and so there's a lot of this springing up

01:14:11.200 | because I think people are sick of fighting

01:14:13.280 | with their doctors to get a crumb of information

01:14:16.560 | about their health, and we should probably be testing these,

01:14:21.560 | I would say, three to four times a year,

01:14:25.440 | and the beauty is is that like,

01:14:27.360 | I think a lot of what keeps people down in the health world

01:14:30.960 | is that they're confused about what to do.

01:14:33.880 | There's a lot of noise.

01:14:35.000 | There's a lot of different strategies.

01:14:37.440 | Do I do paleo, keto, carnivore, vegan, Mediterranean?

01:14:42.440 | Do I do HIT or Zone 2 or eccentric?

01:14:46.760 | It's like there's so much noise,

01:14:48.960 | and the beauty with having a plan

01:14:52.340 | for understanding your biomarkers regularly

01:14:54.200 | is that you can cut through all the noise.

01:14:56.380 | Try a strategy, see where you stand,

01:14:59.700 | retest in a few months,

01:15:01.920 | and see if you're moving in the right direction.

01:15:04.120 | You don't have to trust your doctor.

01:15:06.360 | You don't have to trust me.

01:15:07.200 | You don't have to trust anyone.

01:15:08.720 | You can literally trust your own labs,

01:15:10.600 | and I say to people, like, if your labs are optimal,

01:15:15.600 | and the ranges I just mentioned are not optimal,

01:15:18.560 | like you wanna actually get to better than all of those,

01:15:20.840 | if your key metabolic biomarkers are optimal,

01:15:25.840 | if you feel absolutely freaking incredible

01:15:28.880 | and you have no symptoms,

01:15:30.560 | then you're probably doing the right strategy,

01:15:32.520 | whatever that is, vegan, keto, whatever,

01:15:34.660 | like an exercise in your lifestyle

01:15:36.520 | because that is showing that your cells

01:15:38.720 | are fundamentally working properly.

01:15:41.640 | So I think that's just a really empowering message.

01:15:43.680 | Now there's phenomenal companies that are cropping up

01:15:45.800 | to basically help allow people to do this

01:15:48.720 | on their own schedule,

01:15:49.720 | which I think is really the future of health,

01:15:51.280 | and actually will help lessen, I think,

01:15:54.620 | some of the intensity of the diet wars,

01:15:57.200 | 'cause it's like people can just say,

01:15:58.160 | like, I trust my strategy.

01:15:59.480 | I know I'm doing what's right for me

01:16:00.780 | 'cause look at all my biomarkers, and I feel great.

01:16:05.400 | - Yeah, what used to be the before and after,

01:16:08.140 | pre-diet exercise, post-diet exercise photos

01:16:13.800 | on social media are now starting to also include numbers,

01:16:16.740 | which is kind of interesting.

01:16:18.200 | I mean, obviously these aren't randomized controlled trials,

01:16:20.480 | but it's cool to see people posting their numbers

01:16:23.600 | of things that are not just related to aesthetics

01:16:27.200 | but are, or body weight, but are related to health metrics.

01:16:31.560 | - Yeah.

01:16:32.400 | - So it's fun.

01:16:33.760 | I think it speaks to a more scientific

01:16:36.400 | or at least a more quantitative approach to things,

01:16:39.200 | and I think it's inspiring for people.

01:16:41.360 | Thanks for putting those scripts in the book

01:16:43.160 | that people can refer to.

01:16:44.400 | Let's say that I go in for these blood tests.

01:16:48.760 | I do the basic seven,

01:16:50.400 | and I find that my fasting glucose is a little high.

01:16:53.200 | My triglycerides are a little high.

01:16:55.280 | My LDL is a little high.

01:16:57.880 | Maybe a few other things are okay.

01:16:59.320 | So I'm kind of in the, you know,

01:17:01.880 | not in the red zone, but I'm in the like,

01:17:04.360 | you should probably pay attention to these things.

01:17:06.060 | What are some of the things that one can do

01:17:08.000 | in order to try and move those needles

01:17:09.960 | in the right direction?

01:17:11.780 | I know we talked about walking and movement before.

01:17:13.960 | What are a few others?

01:17:14.920 | And maybe we could start to touch into nutrition

01:17:17.420 | a little bit, and then we'll pivot

01:17:18.840 | to insulin and blood glucose.

01:17:20.580 | - I think on the highest level,

01:17:24.120 | it's about running through what are the science-based things

01:17:29.040 | that we know in our environment

01:17:30.520 | can lead to metabolic dysfunction,

01:17:33.480 | and take honest stock of how those factors

01:17:36.480 | are playing out in your life,

01:17:37.640 | and then choose a few to start moving

01:17:39.840 | in a different direction.

01:17:41.200 | So the ones that I think are ones

01:17:44.820 | that we can really control,

01:17:46.320 | and that we know, based on the science,

01:17:49.440 | are impacting our mitochondrial metabolic health

01:17:51.360 | is the food, the sleep, the movement,

01:17:53.200 | the emotional health, the toxins,

01:17:54.840 | our relationship with light,

01:17:55.760 | and our relationship with temperature.

01:17:57.500 | And your journey to optimal metabolic health

01:18:01.180 | might be totally different from mine,

01:18:03.000 | 'cause I might really need to focus on the food,

01:18:05.660 | and the sleep, and the emotional health,

01:18:07.200 | and you might really need to focus on the toxins,

01:18:09.040 | and the light, and the movement.

01:18:10.900 | And so a lot of it is actually taking stock

01:18:13.820 | on where the levers are in your own life.

01:18:15.900 | Where are you crushing it,

01:18:17.140 | and where is there a lot of room for improvement?

01:18:20.060 | So step one is knowing that those are the things

01:18:24.980 | in our environment that we need to basically improve

01:18:28.300 | to give ourselves the best capacity.

01:18:30.060 | And then, of course, checking your biomarkers

01:18:31.700 | to make sure your interventions are working.

01:18:33.860 | But food, I think, is one that is totally unavoidable.

01:18:37.240 | Of those pillars, those seven pillars,

01:18:39.460 | food is one that most of us are getting wrong,

01:18:41.880 | and that we really actually have to get right

01:18:43.780 | to improve our metabolic health, for a lot of reasons.

01:18:46.880 | I mean, our bodies are basically 100%

01:18:49.740 | molecularly made from food.

01:18:51.540 | - That's so wild.

01:18:52.380 | - It's so wild.

01:18:53.260 | Every time I think about that, it kind of blows my mind.

01:18:55.980 | - Like, babies are 3D printed from food, basically,

01:18:58.900 | inside a woman's body.

01:19:00.300 | It's wild to me.

01:19:01.680 | And then, what's so cool about the body,

01:19:03.620 | what brings me just immense awe every day

01:19:05.780 | is that we have this conception in our Western world

01:19:08.820 | that the body is like a thing

01:19:10.380 | that we're with throughout our life,

01:19:11.580 | 'cause we kind of look the same, and we age slowly.

01:19:13.740 | So it's like, Casey is a thing, and Andrew is a thing,

01:19:15.900 | but the body is actually a process.

01:19:18.660 | The body, and there's this amazing Taoist statement,

01:19:20.820 | like, "Life is a process, not an entity."

01:19:23.980 | - I love that.

01:19:24.820 | - And the way--

01:19:25.640 | - No, I'm sorry to interrupt.

01:19:26.700 | I'm just, I always wish that if people could understand

01:19:31.700 | that with biology and health,

01:19:34.940 | understanding the nouns and the names is important,

01:19:37.580 | but it's verbs.

01:19:38.660 | It's verbs, verbs, verbs.

01:19:40.440 | If you understand that things are processes,

01:19:42.740 | or processes, depending on who you are

01:19:44.620 | and where you live in the world,

01:19:46.180 | it all becomes so much more tractable.

01:19:49.140 | - Yes, and it's so much more hopeful,

01:19:51.420 | because if I'm a process, if you're a process,

01:19:54.020 | then every day we're eating, we are changing the process.

01:19:58.220 | Whereas if you think you're a thing, then there's no hope,

01:20:02.220 | 'cause I'm just, I'm Casey, and that's who I am,

01:20:04.140 | and I have this disease, you know?

01:20:06.660 | And I think so much in our language, actually,

01:20:08.940 | of healthcare, both our Western

01:20:12.020 | sort of de-spiritualized nature,

01:20:13.540 | like we don't really have a lot of curiosity with process,

01:20:16.500 | but even like the ideas, the way we talk about disease,

01:20:19.640 | I have diabetes, and we don't even talk

01:20:24.620 | about diabetes cures, which now a lot of people

01:20:27.100 | are curing their diabetes, we call it remission.

01:20:29.740 | Like it's this thing that's a part of you,

01:20:31.660 | and I think, I just love this idea

01:20:33.580 | of like we're evolving every day,

01:20:35.100 | and food is so important, because again,

01:20:37.100 | we take in 70 metric tons of food in a lifetime,

01:20:39.540 | two to three pounds per day,

01:20:40.820 | one metric ton per year on average,

01:20:43.140 | and that is like the printer ink.

01:20:44.620 | That's the 3D printer ink to create

01:20:46.620 | tomorrow's version of ourself,

01:20:47.900 | which is molecularly different than the Casey of today.

01:20:50.780 | That's a hopeful message,

01:20:52.140 | because if we can give the body food,

01:20:55.260 | which I think we, again, our conception of food,

01:20:58.980 | I think, is very limited.

01:21:00.520 | Food is the molecular building blocks of the body.

01:21:05.020 | It is the cell-signaling functional molecules

01:21:08.700 | that tell our cells what to do.

01:21:11.300 | They act as transcription factors, epigenetic modifiers,

01:21:16.300 | cell-signaling pathway intermediates,

01:21:19.900 | and it's also, of course, the substrate

01:21:22.740 | to change what the microbiome does,

01:21:24.420 | and the composition of the microbiome,

01:21:26.300 | which is basically a pharmacy inside our bodies

01:21:28.340 | to create different molecules that can affect our health.

01:21:30.780 | So food is certainly a calorie is a calorie

01:21:35.540 | from the concept of thermodynamics,

01:21:37.480 | but from the concept of molecular information,

01:21:40.600 | it has three massively important parts

01:21:43.460 | that are unavoidable for creating cellular health.

01:21:47.800 | So I would just say that that is the pillar

01:21:49.960 | that we can be happy to drill into

01:21:52.020 | of what do we really do to build

01:21:56.060 | as much metabolic health as possible.

01:21:57.820 | - Yeah, I want to focus now, if you're willing, on food,

01:22:02.240 | not just macronutrients, proteins, fats, and carbohydrates,

01:22:05.180 | not just calories, although that as well,

01:22:07.420 | but things like timing, things like fasting,

01:22:10.240 | and micronutrients, which I think

01:22:12.680 | is a highly underexplored topic.

01:22:15.480 | So with respect to food, gosh, I feel like

01:22:19.160 | we've all been exposed to pretty much every variation

01:22:22.200 | of it's all calories in, calories out.

01:22:25.840 | And by the way, I believe in the laws of thermodynamics.

01:22:29.160 | So yes, total caloric load matters.

01:22:32.600 | Total energy expenditure matters, without question.

01:22:36.120 | Within the framework of not consuming excess calories,

01:22:41.120 | there's a lot to explore, however.

01:22:44.840 | I can just say for myself, for what it's worth,

01:22:47.360 | I'm not very hungry until 11 a.m., noon, or one.

01:22:51.220 | I'm okay not eating until then.

01:22:52.800 | And just, you know, water, electrolytes, and caffeine

01:22:55.860 | does me just fine.

01:22:56.740 | I can exercise, et cetera.

01:22:57.820 | But once I start eating, I really enjoy eating,

01:22:59.780 | and I mostly like the proteins.

01:23:01.380 | I like meat, and fish, and eggs,

01:23:02.620 | and I like cheese, and vegetables, and carbohydrates,

01:23:05.200 | and fruit, and all of it.

01:23:07.100 | I like all the stuff.

01:23:08.180 | And I tend to like single or few ingredient foods.

01:23:11.420 | I just naturally do.

01:23:12.340 | So I've been lucky in that way.

01:23:14.720 | But I know a lot of people like sandwiches, processed foods,

01:23:19.500 | things that are combinations of ingredients.

01:23:22.580 | What do we know about kind of, I don't want to say optimal,

01:23:27.580 | but if one, we're going to explore different ways of eating

01:23:31.260 | for sake of adjusting these biomarkers

01:23:33.120 | in the right direction and improving metabolic health.

01:23:36.100 | Is there kind of a generic jumping off point?

01:23:39.540 | Would most people, for instance, be wise to cut back

01:23:43.300 | on the total number of sugars,

01:23:44.720 | or the total amount of sugar, rather,

01:23:47.380 | perhaps reduce the amount of carbohydrate

01:23:48.980 | and replace it with some lean quality protein?

01:23:51.900 | I mean, are there generalizations that we can make?

01:23:54.540 | Or is it really all just about

01:23:56.020 | not getting excessive calories

01:23:57.580 | and trying to get those calories

01:23:58.900 | from the most nutrient-rich sources?

01:24:02.500 | Well, just drilling in on two things you just said there.

01:24:04.460 | So one thing you said that was interesting

01:24:05.980 | was that you're lucky that you like all of those foods.

01:24:09.020 | And then the second thing was,

01:24:10.340 | is it just about not getting excess calories?

01:24:13.080 | But I think what's interesting about both of those

01:24:15.420 | is that I would argue that the reason you like those foods

01:24:19.180 | is because you have given your body enough whole real foods

01:24:23.000 | that now everything in your biology, neurobiologically,

01:24:27.380 | your reward circuitry, your microbiome,

01:24:30.480 | your satiety hormone threshold,

01:24:33.060 | all of these are now basically creating a situation

01:24:36.060 | in which you like those foods.

01:24:37.580 | And then the caloric thing fits into that

01:24:39.860 | because the reason we're eating excess calories,

01:24:42.780 | the reason chronic nutrition is happening,

01:24:45.180 | and the reason we are quite literally in the United States

01:24:49.180 | eating ourselves to death for the first time

01:24:52.680 | in human history is because we're not eating real food.

01:24:56.940 | And we're eating 60 to 75% of our calories

01:25:01.620 | of ultra processed nutrient depleted foods

01:25:06.080 | that fundamentally don't give ourselves what they need.

01:25:11.080 | And a real premise that I think is so important to realize

01:25:15.580 | is that our cells are brilliant.

01:25:17.700 | And if the cells aren't getting what they actually need

01:25:20.880 | to function properly, they will drive you to eat

01:25:25.840 | until they get their needs met.

01:25:27.720 | Unfortunately, because the ultra processed food

01:25:31.640 | is designed to be highly addictive,

01:25:33.880 | and it's devoid of what the cells actually need

01:25:37.120 | for good function, we end up eating ourselves into a grave.

01:25:41.080 | And now almost 80% of Americans are overweight or obese,

01:25:45.280 | close to 50% of the country is obese.

01:25:47.960 | We literally gloss over this as a culture.

01:25:50.000 | It has become so normal in such a short amount of time.

01:25:52.000 | But I always think about the fact that like,

01:25:55.040 | there are really no other animal species in the world

01:25:58.760 | that have obesity and chronic disease epidemics.

01:26:02.160 | And they don't have social media,

01:26:04.200 | they don't have experts, they don't have PubMed,

01:26:05.980 | they don't have the FDA, they don't have the USDA,

01:26:08.480 | they don't have any of it.

01:26:09.320 | And they have somehow figured out a way

01:26:11.280 | to stay at a healthy weight and to not get heart disease.

01:26:14.240 | And it's because they're eating real food

01:26:16.280 | that meets the needs of their cells.

01:26:19.000 | And so I think to just boil that down,

01:26:22.400 | the root cause of the problem

01:26:24.160 | is that we have a toxic food supply

01:26:25.680 | that's no longer filled with the molecular information

01:26:29.460 | that our body needs to know to be satiated

01:26:32.720 | and to function properly.

01:26:34.580 | And so through the complex biology of satiety hormones

01:26:39.340 | and neurobiology and microbiome function,

01:26:42.320 | we are driven to eat so, so, so much more.

01:26:44.820 | So truly the jumping off point for anyone

01:26:49.380 | on the quest to better health is to eat

01:26:52.580 | as much real unprocessed food from good soil as possible.

01:26:57.580 | And of really of any dietary philosophy they want.

01:27:01.540 | Truly, I think if someone's eating real unprocessed food

01:27:04.540 | from good soil who is plant-based or who is keto,

01:27:09.020 | they are gonna have such a higher chance

01:27:10.660 | of meeting their body's actual fundamental needs.

01:27:13.740 | And the good thing about biomarker testing

01:27:15.380 | is they can track for themselves

01:27:16.740 | if they are having good cellular function.

01:27:18.700 | And with that strategy,

01:27:20.380 | there's been studies that have panned this out.

01:27:22.780 | We know that the more ultra-processed food you eat,

01:27:24.700 | the higher risk of obviously obesity,

01:27:26.580 | but also chronic diseases are.

01:27:27.780 | But then of course, there's an amazing study

01:27:29.680 | from Kevin Hall just recently

01:27:32.220 | where he basically locked people up at the NIH

01:27:34.140 | and for two weeks he had them eat ultra-processed food

01:27:36.180 | and for two weeks he had them eat real food.

01:27:38.620 | And people ate 7,000 more calories in the two-week period

01:27:43.620 | when they were eating ultra-processed food

01:27:46.860 | versus the unprocessed food.

01:27:48.920 | - They were locked at the NIH?

01:27:50.420 | - I mean-- - I've been to NIH

01:27:51.560 | quite a bit.

01:27:52.400 | It's great for a day job or a day visit.

01:27:55.980 | I don't know that I wanna be locked there.

01:27:57.260 | That sounds like the Stanford Prisoner Experiment.

01:28:01.300 | - I say this tongue-in-cheek and with such admiration

01:28:03.660 | for what he had to do,

01:28:04.500 | but I think it's so amusing that we have this

01:28:07.100 | totally frankenfood toxic food system

01:28:10.340 | that's largely ultra-processed.

01:28:12.220 | And it took amazing Kevin Hall

01:28:15.220 | to basically do an NIH-funded study

01:28:17.940 | where people, what I say by locked

01:28:19.540 | is that they were inpatients at the NIH

01:28:22.980 | and every, had ad lib, unlimited access to food

01:28:27.100 | during each of those two-week interventions.

01:28:29.420 | So it was two weeks of ultra-processed food,

01:28:31.100 | two weeks of unprocessed or minimally processed food.

01:28:33.780 | And they could eat whatever they wanted,

01:28:36.260 | as much as they wanted in both groups,

01:28:39.600 | and then they would weigh every single bite

01:28:41.740 | that was left on their trays.

01:28:43.060 | So they knew exactly, exactly how many calories they ate.

01:28:46.220 | And literally just giving people this ultra-processed food,

01:28:48.980 | which is devoid of what our bodies need

01:28:52.300 | and therefore will drive people to eat more.

01:28:55.940 | They ate 500 calories more per day

01:28:59.260 | for a total of 7,000 calories more in that two weeks.

01:29:02.280 | And they gained about two pounds

01:29:04.860 | and then lost two pounds in the unprocessed group,

01:29:07.620 | which makes sense, of course,

01:29:08.620 | 'cause a pound is about 3,500 calories.

01:29:10.660 | And so we have to do these kind of crazy studies

01:29:14.140 | just to prove what we kind of know is true,

01:29:16.500 | which is that this ultra-processed food environment

01:29:18.700 | that's cropped up for the past 50 years

01:29:20.820 | is an experiment that has failed.

01:29:22.980 | It has failed.

01:29:24.420 | Close to 45% of kids are overweight or obese now.

01:29:27.580 | It's not working, and that really is the root cause.

01:29:31.180 | So I think a lot of food is about quality

01:29:34.100 | and how do we actually really meet the needs of the cells

01:29:39.180 | that our satiety hormones get secreted

01:29:41.100 | and we naturally stop eating?

01:29:42.900 | 'Cause just telling people eat less calories

01:29:46.500 | but eat whatever you want, that just doesn't work.

01:29:50.100 | We have to inspire the body

01:29:51.980 | to not want to eat excess calories,

01:29:54.460 | which we do by stimulating satiety hormones,

01:29:59.460 | helping the microbiome support that process

01:30:03.660 | and then change our reward circuitry,

01:30:05.140 | which is done with nutrient-rich,

01:30:07.980 | the most nutrient-rich food we can possibly get.

01:30:10.580 | And that's why I mentioned the soil,

01:30:11.780 | because our food is drastically depleted of nutrients.

01:30:15.220 | So when we look at that 70 metric tons of food

01:30:17.540 | we're eating in a lifetime, it's just fasting.

01:30:20.500 | That's the information for our body,

01:30:23.060 | what it's gonna be built from, how it's gonna function.

01:30:25.060 | Well, right now, 60 to 75% is ultra-processed,

01:30:29.180 | so we slash the value,

01:30:30.460 | 'cause the ultra-processing just slashes the nutrients.

01:30:32.740 | We slash the value of that 70 metric tons.

01:30:35.860 | And then we have crappy soil,

01:30:38.660 | 'cause our industrial agriculture system,

01:30:40.340 | which means the food in some cases

01:30:42.300 | has 70% less of key micronutrients in it.

01:30:45.780 | So that 70 metric tons,

01:30:47.180 | what's actually useful for our body

01:30:48.820 | becomes so much smaller.

01:30:51.780 | So what we wanna do is basically expand the value

01:30:55.420 | of that substrate we're putting in the body.

01:30:57.980 | And that means real food, unprocessed, from good soil,

01:31:01.020 | meet the needs of the cells, naturally don't be hungry,

01:31:03.820 | maintain a healthy weight.

01:31:05.140 | And something I talk about is that we could,

01:31:09.380 | I mean, we could talk about nutrition,

01:31:10.540 | the biochemistry of nutrition all day,

01:31:11.900 | but in my review of the biology and the biochemistry,

01:31:16.900 | there's five main things I think we can strive for

01:31:19.460 | in our food that can really help

01:31:21.500 | meet the needs of our cells.

01:31:23.500 | And when it really comes,

01:31:26.020 | there are obviously more things our body needs,

01:31:27.780 | but if we strive for these five things,

01:31:29.420 | we will ultimately, I think, eat a really healthy diet.

01:31:31.620 | And that is fiber, omega-3s, adequate healthy protein,

01:31:36.620 | a good amount of probiotics and high antioxidant sources.

01:31:41.580 | And if we build our diet around knowing a few things

01:31:45.380 | in each of those categories that we really love

01:31:47.380 | and stock our kitchen with it

01:31:48.580 | and make our meals a mixing and matching

01:31:50.700 | of each of those components,

01:31:52.660 | and we get a good amount of those,

01:31:54.260 | we will give the body a lot of what it needs

01:31:57.740 | to have mitochondrial health, reduce chronic inflammation,

01:32:01.140 | reduce oxidative stress.

01:32:03.020 | - It's interesting for me to take a step back

01:32:05.260 | from nutrition as it's typically presented

01:32:08.500 | and think about the brain, the hypothalamic circuitry

01:32:11.980 | that drives hunger and satiety and things like that.

01:32:14.820 | And to map that onto what I've heard,

01:32:17.380 | and I believe to be true based on my view of the literature,

01:32:20.380 | which is that we are largely,

01:32:21.980 | meaning these circuits in the brain

01:32:23.700 | make us largely amino acid foraging machines

01:32:28.700 | because we need those amino acids

01:32:30.140 | in order to carry out metabolic processes

01:32:32.540 | and reconstruct any tissues that need repair and recovery,

01:32:36.340 | not just from exercise, but just daily turnover,

01:32:39.200 | removal of waste, et cetera.

01:32:40.640 | So we're foraging for amino acids unconsciously.

01:32:46.500 | We're foraging for micronutrients.

01:32:48.980 | And of course we need macronutrients.

01:32:51.060 | We need enough energy from proteins, fats,

01:32:52.980 | and carbohydrates, or some either combination of the three.

01:32:56.320 | I feel like I'm sort of in the dying category of omnivores,

01:32:59.340 | right, I'm neither, you know, I'm not meat-based

01:33:02.020 | and I'm not plant-based, I'm an omnivore.

01:33:04.780 | I think most people are omnivores actually,

01:33:06.340 | but omnivores aren't discussed quite as much

01:33:09.740 | as the other categories, at least not on social media.

01:33:12.600 | But that, you know, where we think of ourselves

01:33:14.860 | as getting hungry and wanting to eat.

01:33:16.700 | And I think eating the food,

01:33:21.700 | some of them that I listed off before,

01:33:23.700 | like meat and fish and eggs and vegetables and fruits,

01:33:26.060 | and some, I do like starches, like rice, oatmeal,

01:33:28.740 | some pastas, some sourdough breads and things.

01:33:31.220 | I love butter, who doesn't love butter?

01:33:33.640 | Of course, none of that stuff in excess, olive oil.

01:33:35.980 | But if one looks at kind of that buffet of options,

01:33:40.980 | you realize you can get some high-quality amino acids,

01:33:45.460 | you can get some high-quality lipids.

01:33:47.780 | You probably wanna get more of them from olive oil

01:33:50.260 | than from butter, but you can get the micronutrients

01:33:52.700 | you need provided those food sources are healthy.

01:33:55.220 | Now contrast that with a highly processed diet

01:33:57.780 | or even a minimally processed diet,

01:33:59.960 | and you can get the taste, you can get the macronutrients,

01:34:03.500 | you can get the calories, but you don't,

01:34:06.220 | meaning the brain doesn't really have a sense of,

01:34:08.900 | it can't directly map taste, calories, micronutrients

01:34:13.340 | onto one another.

01:34:15.540 | And so you can imagine that the neural circuits,

01:34:18.180 | and here is a little bit of hypothesizing/conjecture,

01:34:21.220 | but that the neural circuits responsible for hunger

01:34:23.220 | and satiety would get immensely confused

01:34:26.980 | by what's in a highly processed food, right?

01:34:30.300 | A Snickers bar, if you like sweets, tastes pretty good,

01:34:33.220 | but it's unclear what's in it, except sugar,

01:34:35.620 | except it's got a certain Snickers bar taste, right?

01:34:39.220 | But if the circuits of the brain are really trying

01:34:42.260 | to drive us to get amino acids and micronutrients

01:34:47.580 | for bodily health and repair, well then highly processed

01:34:51.220 | and even moderately processed food

01:34:53.180 | has just got to be pure confusion.

01:34:55.460 | I'm sorry to go long here, but it reminds me

01:34:58.260 | of an idea I had once where like,

01:35:00.820 | imagine if you took a pill that greatly increased

01:35:03.620 | the level of dopamine, norepinephrine, acetylcholine,

01:35:06.620 | and serotonin all at once, that's polypharmacology.

01:35:10.220 | And it might make you feel a certain way,

01:35:11.620 | maybe good, maybe bad, and then afterwards,

01:35:13.180 | you'd probably have a bit of a crash

01:35:14.540 | from as the drug wore off, no doubt you would.

01:35:17.160 | But let's say you wanted more of that feeling,

01:35:19.900 | you wouldn't really know what to go look for

01:35:21.420 | because you don't know what was in it

01:35:23.580 | because it's polypharmacology.

01:35:25.100 | So I feel like highly processed food is polypharmacology.

01:35:28.560 | Whereas when you are eating foods

01:35:30.580 | that create a more pure experience of micronutrients,

01:35:34.100 | amino acid content, calories, and taste,

01:35:36.460 | those four things map to one another,

01:35:38.420 | that intuitively we can start to understand,

01:35:40.500 | oh, I like this food and it's good for me,

01:35:43.000 | and this is enough of it, right?

01:35:45.260 | I don't know anyone of reasonable size

01:35:48.600 | that eats like four ribeye steaks, they eat one.

01:35:52.280 | I mean, I'm sure there's some freaks out there that do that,

01:35:54.320 | but one, even small piece of quality meat is very satiating.

01:35:59.320 | - Yeah, you will self-regulate 'cause the body,

01:36:03.020 | like every other animal in the world,

01:36:05.320 | is exquisitely designed to regulate hunger

01:36:09.560 | on a very intuitive level if we eat natural food.

01:36:14.680 | It's, you know, I think it's almost ridiculous

01:36:17.360 | to talk about calories in isolation

01:36:19.820 | because the reason we're eating more calories

01:36:22.580 | is because we're eating ultra processed food.

01:36:26.060 | And so, but I love what you just said, Andrew,

01:36:29.220 | about the brain and the polypharmacy.

01:36:32.060 | I think that literally is, I've never heard that said,

01:36:34.860 | and I think it's like processed food

01:36:36.760 | is like polypharmacy of food.

01:36:38.300 | It is the definition of processed food,

01:36:40.420 | which I know you talked about with Rob Lustig,

01:36:42.020 | the NOVA4 criteria, is literally,

01:36:44.340 | it's breaking down foods into these constituent parts

01:36:47.880 | that were never meant to be separated from each other,

01:36:50.080 | like the endosperm of a wheat kernel,

01:36:53.420 | separate from the bran and the, you know, the germ,

01:36:56.880 | and then take that and like a little science experiment,

01:36:59.600 | pair it up with all these other individual components

01:37:02.180 | and synthetic chemicals that are made in a factory

01:37:04.980 | and put them together to create this thing that the body,

01:37:07.820 | I truly think our insatiable hunger,

01:37:12.000 | again, we're eating ourselves to death in the United States.

01:37:14.900 | That's the reality.

01:37:16.340 | Our insatiable hunger and our chronic disease epidemic

01:37:19.340 | fundamentally is a lot of, it's mass cellular confusion.

01:37:22.940 | And when you think about what chronic inflammation is,

01:37:25.620 | chronic inflammation is biochemical fear

01:37:30.140 | on the cellular level.

01:37:31.460 | Well, when you put this stuff into the body

01:37:33.400 | that's never seen before,

01:37:34.980 | obviously that's gonna generate some confusion.

01:37:37.660 | And, you know, you could trace that back

01:37:40.020 | to what that really means with leaky gut

01:37:41.740 | and, you know, all the sorts of the real physiology of that.

01:37:44.920 | But there's a wonderful book

01:37:48.560 | that is called "The End of Cravings" by Mark Schatzer.

01:37:51.220 | He also wrote "The Dorito Effect,"

01:37:52.620 | but he talks a little bit about what you're talking about,

01:37:54.440 | which is this ideal that processed food

01:37:56.040 | is actually the ultimate sort of food-based variable reward.

01:38:01.040 | So in the way that it, in like things that,

01:38:03.480 | I mean, I'm speaking back expert here,

01:38:05.100 | but things that the body can't predict

01:38:08.040 | what the outcome is gonna be

01:38:09.200 | are gonna kind of get you in that dopamine motivation pathway

01:38:13.240 | and that's actually what processed food is doing

01:38:15.280 | is it's every time we eat a different,

01:38:18.320 | we think we're eating a tortilla,

01:38:19.600 | but it's like completely different

01:38:21.120 | than all the other weird tortillas,

01:38:23.720 | ultra-processed tortillas on the shelf.

01:38:25.020 | So every time we eat tortilla

01:38:26.600 | and our brain is this incredible prediction machine,

01:38:29.980 | and as it's coming towards our mouth,

01:38:31.960 | we're predicting what the load is gonna be,

01:38:33.920 | but we have no idea.

01:38:35.040 | Is it a Coke Zero?

01:38:36.000 | Is it a Diet Coke with aspartame?

01:38:37.680 | Is it a regular Coke?

01:38:38.760 | It all tastes the same,

01:38:40.160 | but the nutrients that are in our gut are totally different.

01:38:42.520 | So we end up actually triggering the motivation pathways

01:38:45.680 | because of processed food representing a variable reward,

01:38:50.680 | whereas every time you eat a ribeye,

01:38:53.420 | your body's pretty much getting a similar thing each time,

01:38:57.080 | and so the prediction matching is gonna be more conducive

01:39:02.080 | to getting off the motivation treadmill for more,

01:39:07.260 | which I think is so fascinating.

01:39:09.900 | But I think backing up a little bit,

01:39:12.520 | one concept I have for food that really helps me

01:39:15.920 | is really thinking about

01:39:18.180 | the body's always trying to help me be satiated

01:39:20.520 | and trying to help reduce my cravings.

01:39:22.280 | I literally just have to give the body what it needs.

01:39:25.080 | I have to stimulate the body in a way that it will serve me

01:39:29.040 | and giving me satiety hormones

01:39:30.760 | to basically regulate my hunger.

01:39:32.240 | And again, with visuals, I think it's so helpful.

01:39:35.560 | I think about these cells lining our small intestine

01:39:38.900 | that literally have nutrient sensors

01:39:41.100 | and literal receptors on the cell membrane

01:39:44.100 | in the luminal side of the gut that's facing all the food

01:39:46.860 | that are just sitting there waiting to bind

01:39:50.300 | with these things in our food that will stimulate the cell

01:39:53.400 | to make the satiety hormone

01:39:54.920 | that poof, effortlessly makes us not hungry,

01:39:57.720 | gets rid of that grip of attachment to cravings

01:40:00.340 | that all of us are so plagued by.

01:40:02.700 | And I think we have this intense conversation

01:40:07.280 | happening in society right now about GLP-1 analogs

01:40:10.080 | and Ozempic and Menjara and all these things, GLP-1 agonists.

01:40:13.380 | But we rarely talk about the fact

01:40:16.360 | that we have nutrient sensing cells of the gut,

01:40:19.440 | the L-cells of the gut,

01:40:20.740 | that when stimulated appropriately will make GLP-1.

01:40:24.160 | And when stimulated the way they want to be

01:40:26.680 | will secrete hordes of GLP-1 for us.

01:40:29.600 | And so how do we actually think about

01:40:31.480 | just literally giving the body what it needs

01:40:33.280 | to stimulate the satiety hormones?

01:40:35.020 | And the processed foods aren't giving us those things.

01:40:37.120 | The things that are gonna stimulate those cells,

01:40:42.120 | well, the things that will,

01:40:43.740 | I mean, this is kind of fascinating

01:40:44.840 | if you don't mind going down a little road.

01:40:46.280 | No, please, please.

01:40:47.840 | With the GLP-1 conversation,

01:40:50.580 | I feel like so missing from the conversation

01:40:53.080 | is the idea that from a first principles perspective,

01:40:56.560 | there's three ways our body could make more GLP-1.

01:40:59.760 | We make more cells that make it, L-cells of the gut.

01:41:03.920 | Each of those cells makes more GLP-1.

01:41:06.600 | And importantly, we can also inhibit the inactivator

01:41:10.560 | of GLP-1, which is an enzyme called DPP-4.

01:41:13.320 | So GLP-1 actually gets rapidly degraded

01:41:16.280 | by DPP-4 in the body.

01:41:18.020 | So if we can figure out how to inhibit DPP-4,

01:41:20.840 | we can raise our GLP-1 levels.

01:41:22.320 | - What is DPP-4?

01:41:23.820 | - It's an enzyme that breaks down GLP-1 rapidly.

01:41:26.960 | - I think you said that and I missed it, I apologize.

01:41:28.080 | - It's so fascinating.

01:41:29.400 | And so how often have you seen in the headlines,

01:41:31.440 | oh, here's some strategies to inhibit your DPP-4?

01:41:34.000 | Never, because Ozempic is on track

01:41:38.000 | to be the highest grossing med in human history.

01:41:39.920 | And just like we talked about in the beginning of the episode

01:41:43.000 | the whole industry,

01:41:44.920 | this $4 trillion healthcare industry

01:41:47.720 | is desperate for us to not understand

01:41:50.720 | how to do the things that drugs could do for us.

01:41:53.000 | So when we look at those three first principles approaches

01:41:56.000 | of how do we make more L-cells,

01:41:57.400 | get them to produce more GLP-1 from each L-cell

01:41:59.920 | and then inhibit the breakdown to the inhibition of DPP-4.

01:42:03.480 | For the first one, we know that short chain fatty acids,

01:42:07.300 | which of course are the by-product

01:42:08.860 | of microbial fermentation of fiber in the diet,

01:42:11.240 | stimulates the differentiation of more L-cells in the gut.

01:42:14.360 | So more short chain fatty acids, more L-cells.

01:42:16.800 | - Can we translate that into support the gut microbiome?

01:42:19.680 | - Eat more fiber.

01:42:20.500 | - Eat more fiber.

01:42:21.340 | And we had Justin Sonnenberg from Stanford

01:42:23.820 | on a world expert in gut microbiome

01:42:25.960 | and he was a big proponent of,

01:42:28.640 | based on work he's done with Chris Gardner

01:42:30.760 | and others at Stanford, so happens,

01:42:33.120 | of ingesting one to three servings

01:42:36.240 | of low sugar fermented foods each day.

01:42:38.920 | Things like sauerkraut, kimchi.

01:42:40.940 | Again, low sugar variety is probably best.

01:42:43.560 | - Right, not kombucha.

01:42:44.400 | - Yeah, maybe not.

01:42:45.560 | You said not kombucha?

01:42:46.560 | - Yeah, 'cause that's gonna be like the highest sugar

01:42:48.600 | of the fermented foods, which people often go to,

01:42:51.200 | but now that's become soda.

01:42:52.040 | - And often costly too.

01:42:52.860 | And pretty costly.

01:42:53.700 | The sauerkrauts, you can actually make your own sauerkraut.

01:42:55.840 | Tim Ferriss had a great recipe for this

01:42:58.120 | in "The 4-Hour Chef."

01:42:59.440 | You have to be careful because you can create

01:43:02.760 | some unhealthy ferment.

01:43:03.640 | You have to do it the way he describes.

01:43:05.000 | So check out the recipe, it's online.

01:43:07.480 | Or you can buy sauerkraut and the brines,

01:43:09.660 | drinking the brine off the sauerkraut

01:43:12.640 | or off seems to be good for the gut.

01:43:15.120 | - That's such a great point,

01:43:16.240 | which is that ultimately we want the short-chain fatty acids,

01:43:21.200 | which is the medicine that the microbiome are making for us

01:43:25.100 | through the microbial fermentation process.

01:43:26.940 | And we can basically do that in three ways.

01:43:28.800 | One is we can eat more fiber, which is prebiotics.

01:43:31.880 | We can also eat more polyphenols

01:43:34.000 | because we're now learning that the microbiome

01:43:35.840 | actually processes, they ferment polyphenols from our,

01:43:39.240 | which is basically, you'll find those in colorful fruits

01:43:42.160 | and vegetables, spices, teas, cocoa, things like that.

01:43:47.000 | So fermentation of polyphenols and fiber

01:43:49.400 | to short-chain fatty acids, which then we absorb.

01:43:52.840 | And then, like you just said, in a fermented food,

01:43:56.820 | the bacteria in that food will be making

01:43:59.480 | short-chain fatty acids by fermenting the food in there.

01:44:01.900 | And then if we drink that,

01:44:02.880 | we're getting the short-chain fatty acids directly.

01:44:04.700 | So that's the kimchi, sauerkraut, Greek yogurt,

01:44:09.300 | kvass, which I'm obsessed with,

01:44:11.100 | which is like low-sugar kombucha.

01:44:12.700 | It's like made with fermenting beets, basically.

01:44:14.820 | - That's good stuff.

01:44:15.660 | - It's such good stuff.

01:44:16.740 | Miso, natto.

01:44:18.180 | So that's one.

01:44:19.020 | That has been shown to differentiate

01:44:20.340 | more L-cells in the gut.

01:44:22.020 | We also know that people with type 2 diabetes

01:44:24.100 | have much fewer L-cells in the gut.

01:44:26.500 | And it's hard to know what the causality is there,

01:44:29.800 | but I think a safe assumption is like,

01:44:32.140 | if we keep our blood sugar under better control

01:44:34.140 | and sort of stay out of that diabetic range,

01:44:35.940 | it probably lends itself.

01:44:37.000 | I don't know what the chicken and the egg is there,

01:44:38.660 | but blood sugar stability, more L-cell differentiation.

01:44:41.500 | And then actually ginseng has been shown

01:44:44.100 | to improve L-cell differentiation.

01:44:48.500 | So that's just sort of one set of things.

01:44:50.700 | And I don't think the dose on ginseng has been settled,

01:44:55.320 | but very high antioxidant component plant.

01:44:58.900 | When we look at actually stimulating more GLP-1,

01:45:01.460 | you've talked about yerba mate, I think,

01:45:03.580 | having like a mild effect on GLP-1,

01:45:06.740 | but there's actually a lot of other things

01:45:09.300 | in the literature.

01:45:10.540 | Protein, of course, very potently stimulates

01:45:13.620 | these nutrient receptor cells,

01:45:14.980 | and specifically like valine and glutamine

01:45:18.180 | seem to have a potent stimulatory effect on GLP-1.

01:45:21.340 | So you're gonna find that in like meat and turkey

01:45:24.380 | and eggs and things like that.

01:45:26.940 | - What are your thoughts on supplementing L-glutamine?

01:45:29.140 | It's controversial.

01:45:30.340 | I know that some people do it in an effort

01:45:32.980 | to relieve leaky gut,

01:45:34.580 | but there aren't any randomized control trials for that.

01:45:37.740 | So depending on one stance on what's required

01:45:41.560 | for kind of a threshold for adopting something,

01:45:46.140 | some people will say that's crazy.

01:45:47.540 | Other people really swear by supplementing L-glutamine.

01:45:50.300 | Maybe it's through this route of increasing L-cells

01:45:54.620 | that some of the gut relief might exist.

01:45:56.740 | I guess we'd have to explore it.

01:45:57.880 | So that's speculative, folks.

01:45:59.340 | So this is interesting.

01:46:01.220 | These are ways to increase the cells that then make GLP-1.

01:46:04.060 | So fiber, prebiotic, probiotic fiber, and fermented foods.

01:46:07.380 | - Antioxidants, lowering blood sugar, ginseng.

01:46:10.360 | So those are kind of the L-cell ones.

01:46:12.360 | The actual secretion of more GLP-1,

01:46:16.780 | one of the most potent ones,

01:46:18.660 | and the study that looks at this,

01:46:20.100 | like the bar graphs are very clearly

01:46:22.220 | statistically significant, lots of asterisks,

01:46:24.700 | is actually thylakoids.

01:46:26.460 | - Thylakoids, tell me more about thylakoids.

01:46:28.220 | - Thylakoids are so fascinating.

01:46:29.980 | Thylakoids are actually a structure in plants

01:46:33.220 | that are part of the chloroplasts.

01:46:35.420 | So chloroplasts, and this also is fascinating

01:46:38.180 | 'cause chloroplasts are basically the plant version

01:46:40.100 | of mitochondria, essentially.

01:46:42.220 | And thylakoids are a molecule in the chloroplasts.

01:46:45.220 | And there's actually been research that shows

01:46:46.820 | that when you eat about 100 grams of spinach,

01:46:50.840 | which gives you five grams of straight thylakoid

01:46:55.840 | over 12 weeks daily, it led to a significant increase

01:47:00.220 | in GLP-1, and again, I don't remember the exact,

01:47:02.740 | it was two or three-fold higher secretion.

01:47:06.160 | So this is in part, so that's a direct stimulatory effect

01:47:10.420 | of the L-cells, and so this equates

01:47:13.260 | to 3.5 ounces of spinach a day, which is like nothing.

01:47:16.760 | So just getting those-- - Raw spinach

01:47:17.980 | or cooked spinach?

01:47:18.820 | - I think, I actually, I don't think it actually,

01:47:21.020 | it might've said in the methods, but I would imagine raw

01:47:24.100 | because you wanna get those undenatured thylakoids

01:47:28.460 | in the gut.

01:47:29.540 | So just kind of another, and actually thylakoids

01:47:32.500 | do a lot of other interesting stuff.

01:47:33.860 | They inhibit lipase in the gut,

01:47:35.740 | and so actually help more fat get down

01:47:38.180 | to the distal small bowel and promote satiety.

01:47:40.480 | So this is one of the reasons why you talk about,

01:47:42.780 | oh, the people who eat all these healthy foods and greens,

01:47:45.260 | they're less hungry.

01:47:46.100 | It's like, it's biochemistry.

01:47:47.860 | There's stuff happening in there

01:47:49.500 | that is making the hunger signals go down

01:47:53.460 | through things like inhibiting lipase,

01:47:56.820 | improving GLP-1 secretion.

01:47:58.340 | So other things for GLP-1 secretion, the thylakoids,

01:48:01.500 | also fiber's been shown, specific amino acids,

01:48:04.180 | so high-protein foods, things that involve a lot

01:48:06.420 | of valine and glutamine, green tea,

01:48:09.300 | and specifically the ECGC

01:48:14.300 | that is one of the compounds in green tea,

01:48:16.680 | that's been shown to stimulate GLP-1, curcumin.

01:48:20.460 | So there's several things that are all in that whole food,

01:48:24.340 | basically things you would associate with a healthy diet,

01:48:27.600 | but we actually know they stimulate GLP-1.

01:48:29.460 | So those are all things I try to include in my diet.

01:48:31.740 | And the last one is inhibition of DPP-4.

01:48:34.120 | And that one, there's just actually,

01:48:36.020 | when you look at the research,

01:48:37.020 | there's some kind of random foods

01:48:38.480 | that tend to inhibit DPP-4, black beans, Mexican oregano,

01:48:43.480 | other forms of oregano, rosemary, guava,

01:48:47.700 | and I wrote this one down

01:48:50.460 | 'cause it's a word I hadn't seen very much

01:48:51.940 | before I started digging into this, but muricetin,

01:48:54.100 | which is found in berries, cranberries,

01:48:56.100 | and peppers, and Swiss chard.

01:48:58.100 | So all that is to say,

01:49:00.300 | ultimately, many of us are gripped by cravings.

01:49:05.680 | And the idea of just not being constantly driven to eat more,

01:49:10.680 | which I would argue that about 80% of Americans are,

01:49:16.940 | feels really hard to overcome.

01:49:18.980 | But a lot of it is literally just communicating to yourselves

01:49:22.700 | in a clear way through food to help you be satiated.

01:49:27.220 | And the science can show us how to do this.

01:49:29.620 | And a lot of it comes down to eating,

01:49:31.700 | essentially, what you were talking about,

01:49:33.420 | how you eat omnivorous protein,

01:49:35.560 | healthy sources with nutrient density,

01:49:39.720 | and lots of colorful fruits, vegetables,

01:49:44.320 | spices, herbs, things like that.

01:49:47.960 | So, yeah.

01:49:49.200 | - Yeah, it's interesting.

01:49:50.440 | Again, these aren't randomized controlled trials,

01:49:53.520 | nor are they peer-reviewed studies,

01:49:54.720 | but I have a few friends who I've known for most of my life

01:49:57.920 | who really struggled with their weight,

01:50:00.080 | carried a lot of excess weight,

01:50:02.440 | and were starting to suffer health issues in their,

01:50:05.900 | even their 30s, but in their 40s.

01:50:08.080 | I'm 48, so they're my peers,

01:50:09.460 | and so they're about that age range.

01:50:11.380 | And they've all done extremely well,

01:50:15.180 | meaning they lost a tremendous amount of body fat,

01:50:18.940 | are terrifically healthy now,

01:50:21.140 | by way of basically restricting their food intake

01:50:25.100 | to protein, so fish and meat, eggs, fruits and vegetables.

01:50:31.460 | They basically just cut out starches,

01:50:33.700 | but I don't think it was the starches per se.

01:50:36.420 | I think it was the satiety that comes from eating

01:50:39.660 | high-quality protein, fruits and vegetables,

01:50:42.320 | and from limiting the number of highly processed foods.

01:50:46.460 | And actually the toughest thing for all of them

01:50:48.060 | was to stop asking me, or themselves,

01:50:51.800 | rather, like, can I include this condiment, this, this?

01:50:55.100 | And what's interesting is all of them now

01:50:57.140 | seem to really enjoy eating foods in their more pure form.

01:51:01.060 | And I'm not somebody that, like, pushes this on my friends.

01:51:03.340 | They just come to me and say, like,

01:51:04.740 | how do I lose 50 pounds without having to exercise

01:51:09.220 | it all off, you know, as the only source of weight loss?

01:51:14.100 | They all exercise as well, but it's just so daunting

01:51:17.540 | to try and lose, you know, 20, 30, 40 pounds,

01:51:20.100 | and to do so quickly, and then to keep it off,

01:51:22.080 | 'cause they've all had the experience of going on a diet,

01:51:23.860 | and then, you know, exercising a lot.

01:51:26.340 | The point here is that I really think

01:51:28.000 | there's something powerful about that relationship

01:51:30.060 | between taste, macronutrient value,

01:51:33.820 | micronutrient value, and satiety.

01:51:37.540 | I think there's really those powerful associations

01:51:39.660 | because the brain is such an associative machine.

01:51:41.920 | One thing that I should have said before,

01:51:45.020 | and I know most people are familiar with Ozempic,

01:51:47.620 | and its commercial names are, I forget what the-

01:51:51.740 | - Ozempic is the commercial name,

01:51:53.620 | and Mungiaro, and Mugovi, and yeah.

01:51:56.060 | - Got it, is that GLP-1 acts more or less

01:51:58.860 | as an appetite suppressant, powerful appetite suppressant.

01:52:02.760 | So many millions of people are now taking GLP-1 analogs,

01:52:07.760 | is that right?

01:52:09.820 | - I think there were over 20 million prescripts

01:52:11.580 | in the United States last year.

01:52:13.660 | - Is it expensive?

01:52:14.860 | - It's $20,000 per year.

01:52:17.300 | - Does insurance cover it, typically?

01:52:19.260 | - Right now, insurance is covering it for indications,

01:52:23.220 | but there is a all-out assault

01:52:26.820 | from the pharmaceutical industry

01:52:29.540 | to essentially classify obesity as a genetic disease

01:52:33.900 | and a chronic disease in order to be able

01:52:37.340 | to feed this medication more into the insurance pathway,

01:52:42.340 | and essentially get more taxpayer dollars

01:52:44.660 | to pay for this medication.

01:52:46.280 | And it is extremely expensive,

01:52:50.260 | and it's on track to be the highest grossing medication

01:52:52.260 | in human history because it's now being recommended

01:52:55.980 | for people with obesity, type 2 diabetes,

01:52:58.380 | and then the American Academy of Pediatrics recently

01:53:01.540 | has talked about giving this to children as young as 12

01:53:04.500 | as part of the first line for overweight.

01:53:08.660 | And I think really it's such a travesty

01:53:13.300 | based on the conversation we've had,

01:53:15.980 | because what Ozempic does not do in any way, shape, or form

01:53:20.180 | is impact the toxic environment that we're living in

01:53:22.860 | that's hurting our mitochondria.

01:53:24.660 | Losing weight is different

01:53:26.060 | than improving mitochondrial function,

01:53:27.900 | and mitochondrial dysfunction is the root cause

01:53:30.140 | of basically every chronic illness and symptom

01:53:33.940 | that's torturing American lives today.

01:53:35.680 | And so in many ways, it represents the ultimate Band-Aid

01:53:40.380 | for an environment that is not changing.

01:53:43.680 | And when you think about what we could do

01:53:47.240 | with $20,000 per year, and it's a weekly injection.

01:53:52.240 | So people will say, "Well, per person."

01:53:54.020 | Like, oh, and it's a medication

01:53:56.600 | that is intended to be taken for life,

01:53:59.300 | because when people come off this medication,

01:54:01.700 | many people are gaining back all of the weight

01:54:05.280 | or even more weight afterwards.

01:54:07.300 | And then there's been conversations,

01:54:08.580 | Peter Atiyah is waiting on this, about loss in lean mass.

01:54:12.340 | Part of the weight loss is disproportionately muscle.

01:54:15.040 | And so there's a lot of concerns about it

01:54:18.020 | above and beyond its ability

01:54:19.540 | to lower the number on the scale

01:54:21.100 | that we should all be very alert to,

01:54:23.360 | because the reality is that the 40 trillion cells

01:54:28.060 | in our body are in an environment

01:54:30.480 | in the Western world right now

01:54:31.840 | that is not conducive to core biologic functioning.

01:54:36.720 | And there is obviously no shot

01:54:39.380 | that can mitigate the multi-front assault on our biology

01:54:44.380 | that ultimately generates a body

01:54:47.060 | that's immensely profitable

01:54:49.460 | for those 100 specialties of healthcare.

01:54:51.660 | So we're living in this matrix and this game

01:54:55.100 | of a devil's bargain between a $4 trillion healthcare

01:54:58.740 | and pharmaceutical industry

01:54:59.700 | and a $6 trillion processed food industry

01:55:02.060 | that all want us to think that the answer is found in a shot

01:55:06.260 | and we don't need to change anything about our lifestyle.

01:55:07.940 | But of course, these simple habits

01:55:10.300 | that we're talking about, eating real food,

01:55:11.960 | moving, walking, et cetera, getting out in the sunlight,

01:55:15.280 | rapidly can increase our mitochondrial capacity

01:55:17.980 | and are just the most disruptive thing that we can do

01:55:22.980 | in our culture today is learn about metabolic health

01:55:25.660 | and improve it.

01:55:26.500 | And it's just interesting to see what's happening

01:55:29.500 | in the media with sort of the assault

01:55:30.980 | against these empowering habits

01:55:33.140 | and very in favor of a medication like Ozempic.

01:55:37.900 | And then when you trace, unfortunately, incentives there,

01:55:40.980 | a huge percentage of these outlets

01:55:43.540 | that cover Ozempic as a miracle drug,

01:55:45.900 | their bills are paid by pharma, 60% of mainstream media

01:55:49.100 | advertising budget is pharma.

01:55:50.500 | And so, I just say that because I think it's a scandal

01:55:55.500 | that we give so much airtime to these medications

01:55:59.340 | and not to simple metabolic habits

01:56:01.140 | that can make us feel so incredible

01:56:04.020 | and really change our core biology.

01:56:06.180 | - So walking, exercise, eating minimally processed

01:56:09.100 | or non-processed foods.

01:56:10.540 | You also mentioned temperature.

01:56:14.380 | - Yeah.

01:56:15.220 | I'm very interested in that.

01:56:16.180 | But before we go a little bit further down the path

01:56:19.000 | of what one can do in terms of having agency

01:56:21.420 | over their metabolic health,

01:56:22.820 | I just feel obligated to just entertain the possibility,

01:56:27.500 | presumably somebody who's really struggled

01:56:29.700 | with their weight a long time,

01:56:31.380 | maybe because of excess cravings,

01:56:34.180 | challenges in regulating their appetite or whatever.

01:56:37.540 | We don't know what the reasons are.

01:56:39.540 | Maybe they injured their knee and they can't exercise.

01:56:41.740 | I mean, this happens, right?

01:56:43.420 | At least not yet.

01:56:45.120 | Take a GLP analog like Osempic.

01:56:49.440 | Loses some weight, probably loses some muscle also.

01:56:52.240 | One would hope that that would give them the sense of,

01:56:54.200 | okay, now I can move my body better.

01:56:55.640 | I'll start exercising, eating better as well.

01:56:57.760 | I think that I have to imagine

01:56:59.080 | that there's a middle case condition

01:57:01.480 | where people are not just relying on pharmaceuticals

01:57:03.720 | and not just relying on behavioral routes

01:57:08.520 | to improve metabolic health, but can do both, right?

01:57:11.840 | I mean, and one would hope they are

01:57:13.400 | if they're already taking these meds.

01:57:15.040 | Or is it the case that when people have a pill

01:57:17.040 | or an injection or a potion that it gives them

01:57:19.720 | the effect that they want, that they just remain sedentary?

01:57:22.360 | - I think we have to look at history here.

01:57:24.520 | I mean, first of all,

01:57:26.160 | there have been other weight loss medications

01:57:28.720 | throughout history that you've talked about in the podcast,

01:57:30.760 | like the Fen-Phen, and then there was another one,

01:57:33.520 | I think even before that,

01:57:34.760 | that made people, their temperature go up,

01:57:36.860 | that you've talked about.

01:57:37.700 | - Okay, yeah, so the two of these are,

01:57:38.520 | I used to work on thermal regulation as an undergrad.

01:57:40.640 | So Fen-Phen was eventually banned

01:57:42.720 | because it caused some cardiac issues.

01:57:44.860 | I believe it was a stimulant, fenfluramine.

01:57:47.320 | Sorry, it's not fenfluramine alone.

01:57:49.380 | It's a combination of things.

01:57:50.680 | That's why it's called Fen-Phen.

01:57:52.280 | And then dinitrophenol, which was based on the observation

01:57:57.280 | that workers in ammunitions factories

01:58:00.460 | were being exposed to this stuff

01:58:01.840 | and losing a lot of body fat and weight.

01:58:04.600 | It actually made its way into the sports community.

01:58:07.180 | It's highly deadly, highly deadly.

01:58:10.760 | Don't even look it up, it's highly deadly.

01:58:14.920 | Because the moment people start looking it up,

01:58:16.240 | they started thinking about dabbling

01:58:17.400 | the way the internet is now.

01:58:18.720 | Dinitrophenol, and I think it has to do

01:58:22.080 | with sort of processing of the mitochondria.

01:58:27.080 | I think this is happening in the electron chains

01:58:30.080 | in the mitochondria.

01:58:30.920 | So anyway, free electron, look it up.

01:58:34.660 | - Yeah. - Excuse me.

01:58:37.340 | The bottom line here is that there've been plenty of drugs,

01:58:41.580 | mostly stimulants, used to help people lose weight.

01:58:44.620 | And, or that have acted directly on the mitochondria.

01:58:47.980 | It has not worked out well, historically.

01:58:50.340 | - Right. - It just hasn't.

01:58:51.300 | - And I think that I'm not just gonna lump,

01:58:54.940 | it's a different mechanism.

01:58:55.900 | So I don't wanna lump it in with past weight loss drugs.

01:58:59.160 | However, if you look at the trends throughout history,

01:59:02.260 | the medicalization and pharmacology

01:59:06.940 | towards chronic issues has been an abject failure.

01:59:11.220 | I can, I don't know of,

01:59:12.780 | and I'm sure people can correct in the comments,

01:59:14.720 | but of a single chronic condition

01:59:18.460 | for which the explosion of the pill

01:59:21.220 | to treat and manage that condition

01:59:23.460 | has lessened the rates of that condition.

01:59:25.940 | The more SSRIs you prescribe, the more depression we have.

01:59:29.820 | The more metformin we prescribe,

01:59:31.820 | the more type two diabetes rates are going up.

01:59:34.940 | The more Ozempic is being prescribed, obesity is going up.

01:59:39.300 | You know, this is, on Wall Street, they're not,

01:59:42.740 | this is on track to be a blockbuster drug,

01:59:46.220 | and they're not assuming the rates of obesity

01:59:49.020 | are gonna go down.

01:59:50.140 | That wouldn't actually make sense for the business model.

01:59:52.980 | I mean, these are being talked about

01:59:53.860 | at the JPMorgan Healthcare Conferences.

01:59:56.020 | Do you think they're thinking that this is gonna plummet?

01:59:57.820 | No, like there are,

01:59:59.140 | I can't think of very many chronic conditions

02:00:02.580 | for which the explosion of the medication

02:00:05.140 | has reduced the frequency of the disease.

02:00:08.260 | That's really something to think about,

02:00:10.780 | and the reason is because of exactly

02:00:12.980 | what we started this conversation with.

02:00:14.320 | They're not actually truly impacting

02:00:18.500 | or healing the root cause physiology.

02:00:21.200 | In some cases, they're worsening

02:00:23.040 | that root cause physiology,

02:00:24.260 | like they are inducing oxidative stress.

02:00:26.140 | They may help with the symptomatic management,

02:00:30.220 | but not actually reducing that trifecta

02:00:32.360 | that we talked about in the beginning,

02:00:33.540 | and so why do we have reason to believe

02:00:35.940 | that medicalizing obesity

02:00:39.120 | and not actually getting at the root cause,

02:00:42.180 | which has to be impacted by multimodal gentle nudges

02:00:47.100 | in our daily life habits and environment,

02:00:49.720 | that that's actually gonna reduce

02:00:50.840 | the rates of the condition, so.

02:00:52.540 | - No, that's very helpful.

02:00:53.900 | Okay, so I'll then return to the other question

02:00:56.860 | about temperature.

02:00:58.260 | What are some things that can do with temperature?

02:01:00.020 | And by the way, as I do this, I can't resist any longer.

02:01:03.020 | Casey, Dr. Means brought me this jar of blueberries.

02:01:05.480 | People that know me know

02:01:06.320 | that I'm a drive-by blueberry eater,

02:01:08.600 | so if there's blueberries out on a table,

02:01:11.000 | I'm gonna take some.

02:01:11.840 | I've never eaten during a podcast,

02:01:14.160 | but I'm going to now, so I'll try and chew quietly.

02:01:17.600 | Do you want some?

02:01:18.520 | - Sure.

02:01:19.360 | - I love blueberries, and no, I don't eat them one by one,

02:01:24.920 | but I'm going to try and eat them quietly,

02:01:26.320 | so we'll keep them here in the middle for the time being,

02:01:29.280 | and I'm gonna eat them by the handful,

02:01:30.680 | just 'cause I got hungry.

02:01:32.180 | And you mentioned berries earlier,

02:01:33.420 | and it triggered a neural circuit for me.

02:01:35.480 | So what about temperature?

02:01:37.720 | People that know me, or even that just listen

02:01:40.360 | to the podcast know that I like the cold shower thing,

02:01:43.040 | cold plunge thing.

02:01:43.880 | I don't do it every day.

02:01:45.780 | I don't do it after resistance training workouts

02:01:47.940 | for at least six hours, and mostly keep it on days separate

02:01:50.960 | from the resistance training,

02:01:52.560 | because there are some data that can inhibit hypertrophy

02:01:55.960 | and strength adaptations.

02:01:58.240 | But I like it.

02:01:59.880 | I like it.

02:02:00.720 | It feels good.

02:02:01.960 | I feel great afterwards for many hours,

02:02:04.100 | and I believe there are some health effects,

02:02:05.960 | and I'm willing to weather the storm of naysayers,

02:02:10.960 | because more and more data keep emerging.

02:02:13.420 | That's the case.

02:02:14.300 | Not all the data are spectacular.

02:02:17.320 | One paper on this actually was just retracted.

02:02:19.320 | We need to do an update to an episode to,

02:02:22.320 | it's not work from my lab,

02:02:23.320 | but I still think that there's a lot of really terrific work

02:02:25.960 | on deliberate cold exposure.

02:02:28.720 | What's the deal with temperature and mitochondria?

02:02:31.040 | So no one has basically described this better than you.

02:02:34.160 | I feel like on your platform,

02:02:36.000 | but I think about it very, very simply.

02:02:38.240 | Throughout human history, humans have really,

02:02:43.480 | in so many different parts of the world,

02:02:44.880 | been exposed to hugely fluctuating temperatures.

02:02:47.320 | Like if you look at the Sahara desert,

02:02:48.960 | or like a regular day in Colorado,

02:02:50.960 | it's like you can go from,

02:02:52.840 | let's talk about the Sahara desert.

02:02:53.880 | You can go from 30 degrees to 110 degrees

02:02:56.120 | in the span of one day.

02:02:57.560 | And like even the concept of indoors

02:02:59.940 | is like a relatively new concept in human history.

02:03:03.680 | Four walls, you know, insulation,

02:03:06.280 | then central heating and cooling.

02:03:08.200 | That's like the last 50, 75 years in most homes.

02:03:11.960 | And so this idea,

02:03:14.160 | our cells have evolved to respond

02:03:18.120 | to big swings in temperature that very recently

02:03:20.520 | we have totally pulled away.

02:03:22.640 | And I think that when I think about the mitochondria

02:03:26.080 | and increasing their capacity,

02:03:27.320 | I'm thinking about,

02:03:28.160 | well, how do I use different energetic signals

02:03:30.960 | in my environment to essentially get the mitochondria

02:03:34.120 | to do better work?

02:03:35.680 | And we can think about all the different types

02:03:37.080 | of energy that we're exposed to.

02:03:38.320 | Solar energy, thermal energy, acoustic energy,

02:03:41.440 | mechanical energy, you know, food energy.

02:03:44.040 | Like that's basically what our environment is, right?

02:03:46.620 | And thermal energy is a big one of those.

02:03:48.560 | We can speak to our mitochondria

02:03:51.120 | with the language of thermal energy and say,

02:03:53.680 | hey, it's cold outside.

02:03:56.460 | We need you to print more of yourselves or work harder

02:04:00.600 | such that we can create heat inside the body

02:04:02.580 | to respond to this stimulus.

02:04:04.320 | And so that's kind of the framing that I use for it.

02:04:08.080 | And like, you know,

02:04:09.480 | this data is hard to know if it's totally accurate,

02:04:11.500 | but like our population is cooling.

02:04:15.060 | And some, I think it was data out of Stanford actually,

02:04:17.960 | that was showing that like our temperature

02:04:19.480 | has gone down like 2% or something like that

02:04:21.840 | in the last hundred years.

02:04:22.760 | And that fundamentally is mitochondria

02:04:25.520 | not working as well as they should.

02:04:27.480 | Research has shown we're making less ATP

02:04:29.480 | in a lot of our cells.

02:04:30.460 | And that's, you know, a function of mitochondrial dysfunction.

02:04:33.080 | One fun fact, I don't know if you knew this,

02:04:36.080 | but the body makes about 88 pounds of ATP per day

02:04:40.480 | for like the average American.

02:04:41.480 | So we're constantly making it,

02:04:42.760 | and we're constantly recycling it in this like, you know,

02:04:45.800 | like basically make it, use it, make it, use it, make it.

02:04:48.360 | So fast that like we essentially don't change our weight,

02:04:51.640 | but it's kind of, and of course, as it's being broken down,

02:04:53.960 | ATP to ADP, we release heat.

02:04:55.820 | And so I just think of cold as like one of the tools

02:04:59.680 | in our tool belt to talk to the mitochondria to say,

02:05:03.520 | make more heat.

02:05:05.760 | And in a world in which our mitochondria are under siege,

02:05:09.080 | I think it's a valuable,

02:05:10.520 | often very inexpensive one that we can use.

02:05:13.440 | Of course, it does not supplement

02:05:16.880 | or replace food, sleep, exercise,

02:05:21.000 | but I think it can be a very valuable tool to stimulate,

02:05:23.880 | you know, through that signal to basically make more heat.

02:05:27.000 | And, you know, we know, of course it can help.

02:05:29.520 | And the data, you know, is mixed,

02:05:31.560 | but like increase brown fat,

02:05:33.800 | which is like mitochondrial dense fat

02:05:35.360 | and have it do more work and whatnot.

02:05:37.000 | So ultimately brown fat is mitochondrial dense fat,

02:05:39.560 | and we wanna, you know, help promote that.

02:05:41.520 | So that's how I use cold.

02:05:42.700 | And then on the heat side, you know,

02:05:44.640 | just fascinating how that's kind of acting

02:05:46.440 | to help metabolic health

02:05:48.200 | through the activation of the heat stock protein,

02:05:49.980 | some of which have, you know,

02:05:51.280 | the ability to upregulate antioxidant defense systems

02:05:53.700 | and quell some of that wildfire that we talked about

02:05:56.700 | that can hurt our mitochondria.

02:05:57.960 | So I put them lesser on my list,

02:06:01.840 | but, you know, 'cause we just can't,

02:06:04.600 | we can't avoid the food and, you know,

02:06:06.960 | the sleep and the movement,

02:06:08.380 | but I think it's a great tool that we can use.

02:06:10.720 | - I love it.

02:06:11.560 | I will just point out that the reason the brown fat

02:06:13.560 | is brown at all is because of the density of mitochondria.

02:06:16.700 | It's literally brown down the microscope.

02:06:18.380 | This is not the kind of fat that is subcutaneous,

02:06:21.380 | although it, you know,

02:06:22.220 | it sits around the scapulae, neck, upper back.

02:06:24.300 | There's other pockets of it on the body too.

02:06:26.660 | And such an interesting tissue.

02:06:28.600 | Yeah, I don't know why deliberate cold exposure

02:06:31.460 | is so controversial.

02:06:32.320 | I think it's because people who don't like it,

02:06:34.620 | and frankly, no one likes getting in it.

02:06:36.760 | The best part is getting out and how you feel afterwards.

02:06:39.020 | But I think nothing grates on people

02:06:43.160 | like deliberate cold exposure

02:06:44.440 | if they don't like deliberate cold exposure.

02:06:45.960 | And there's no requirement for it,

02:06:47.120 | but I think it's a very interesting stimulus.

02:06:49.200 | And I think there's also a very interesting relationship

02:06:51.680 | between light and temperature

02:06:52.720 | because in most areas of the world,

02:06:55.080 | as days get longer, meaning more sunlight available,

02:06:58.080 | temperatures go up.

02:06:59.700 | And nowadays we can really divorce ourselves

02:07:02.040 | from all this like day lengthening

02:07:03.560 | and shortening temperature fluctuations,

02:07:05.880 | which is not to say that we should all be running around

02:07:07.840 | in a minimal amount of clothing outdoors,

02:07:10.520 | but there's just such beautiful data

02:07:12.900 | from Dr. Susanna Soberg's work showing, for instance,

02:07:17.460 | that deliberate cold exposure

02:07:19.580 | then leads to one feeling more comfortable

02:07:22.380 | at cold temperatures

02:07:23.220 | because you become essentially more of a furnace.

02:07:26.300 | - That's right. - More brown fat.

02:07:27.620 | Anyway, we could go on and on,

02:07:29.140 | but I think it's yet another lever of autonomy

02:07:32.620 | in terms of taking control of one's health.

02:07:34.900 | As you said, not as critical as food intake

02:07:39.900 | and quality amount and maybe timing as well.

02:07:43.200 | Speaking of timing, what are your thoughts on fasting?

02:07:45.160 | And then of course, movement and exercise.

02:07:47.680 | - The way I conceptualize the idea of fasting,

02:07:49.640 | obviously this is one where we need more words, right?

02:07:52.040 | Because the word fasting is so limited.

02:07:54.400 | There's so many different parts of this, but-

02:07:56.520 | - Skipping breakfast for me would be that,

02:07:58.600 | or skipping dinner.

02:07:59.860 | Sometimes I'll skip dinner,

02:08:00.700 | sometimes I'll skip breakfast.

02:08:01.720 | - Right.

02:08:04.240 | I think that some of the most interesting data

02:08:06.560 | that I've seen has been about

02:08:08.800 | if we reasonably compress our eating into daytime hours

02:08:13.800 | during the part of the diurnal cycle

02:08:16.220 | when we are supposed to be eating,

02:08:18.240 | so essentially matching our chronobiology with our behavior,

02:08:23.160 | which we are diurnal organisms,

02:08:25.480 | so we kind of need to respect that.

02:08:27.200 | Like when we do that and we compress it in a moderate way,

02:08:31.000 | our metabolic health is better.

02:08:32.880 | And so some of the studies that have looked at this,

02:08:36.120 | one that was interesting was,

02:08:37.800 | and I think very hopeful for people,

02:08:39.560 | is that if you take all the food,

02:08:41.860 | all the calories that you're gonna eat

02:08:44.280 | and eat them in a six-hour window versus a 12-hour window,

02:08:48.960 | totally same amount of calories, exact same food.

02:08:51.960 | This is a controlled experiment.

02:08:53.560 | People who eat the same amount of calories

02:08:56.680 | in a six-hour period are gonna have much lower,

02:08:59.360 | statistically significantly lower glucose,

02:09:02.800 | 24-hour glucose and insulin levels

02:09:04.400 | compared to people who just space it out

02:09:06.000 | over the course of a 12-hour period.

02:09:08.520 | And it makes sense because if you're spacing that food out

02:09:12.600 | over the course of 12 hours,

02:09:14.600 | that is a different biochemical milieu

02:09:17.640 | in your body throughout the day.

02:09:18.520 | It's kind of similar to the walking.

02:09:20.000 | It's like you are then stimulating insulin

02:09:23.060 | several more times.

02:09:24.920 | You are exposing the bloodstream to insulin and glucose

02:09:28.760 | just more throughout the day

02:09:30.680 | and giving the bloodstream less of an opportunity

02:09:34.760 | to just sort of be clear from that glucose and that insulin.

02:09:38.440 | And so compressing our eating window

02:09:40.520 | seems to be helpful for metabolic health.

02:09:43.880 | And it's a bang for your buck, right?

02:09:45.520 | Like you can eat the same amount of food.

02:09:46.960 | You just have to eat in a shorter period of time.

02:09:48.620 | So for people who wanna eat a lot,

02:09:51.600 | maybe just consider compressing it

02:09:53.440 | into daytime hours, six to eight-hour window.

02:09:56.680 | - Yeah, for me, six is tough.

02:09:58.040 | Six is tough, yeah. - The one-meal-per-day thing

02:09:59.400 | is tough.

02:10:00.240 | I have friends like Lex Friedman

02:10:01.540 | that do the one-meal-per-day thing.

02:10:02.680 | I end up eating so much food at that meal

02:10:04.760 | that I experience a lot of mechanical distress.

02:10:08.000 | And it's typically later in the day.

02:10:09.520 | I think an eight- to 10-hour window

02:10:11.040 | has worked well for me most days.

02:10:13.660 | I know as soon as we talk about intermittent fasting,

02:10:16.960 | which is what, or time-restricted feeding, same thing,

02:10:19.200 | which is what we're talking about right now,

02:10:21.560 | I'm sure somebody's gonna call up the,

02:10:24.320 | there's been a study that's been circulating

02:10:27.520 | about a massive increase in cardiovascular risk

02:10:30.880 | in people doing intermittent fasting,

02:10:32.760 | in particular, the six-hour feeding window.

02:10:34.800 | I just wanna point out-

02:10:35.840 | - Worse study.

02:10:36.960 | - As far as I know, I could be wrong,

02:10:38.720 | but as far as I know, that study is still in abstract form.

02:10:42.200 | It's not yet peer-reviewed.

02:10:43.880 | It's like the fact that studies

02:10:47.060 | that haven't been peer-reviewed

02:10:48.800 | aren't even close to being peer-reviewed

02:10:50.680 | are being put out there as new stories.

02:10:53.600 | It's really problematic

02:10:55.480 | 'cause I can tell you as somebody

02:10:57.080 | who sat on the editorial boards

02:10:58.700 | of many journals for many years,

02:11:00.040 | I still sit on a few, reviewed countless papers,

02:11:03.040 | I've submitted and had to deal with reviews

02:11:04.840 | on countless papers.

02:11:06.400 | The fact of the matter is until the reviews are done,

02:11:09.800 | the revisions are made,

02:11:11.220 | that paper may never see the light of day,

02:11:13.240 | and it may end up in a journal

02:11:15.000 | that is barely worthy of a placemat.

02:11:18.120 | It might end up in a high-tier, high-quality journal,

02:11:20.220 | but it might not.

02:11:21.060 | So just because there was, quote-unquote, a study done

02:11:23.560 | means very little, but it means especially little,

02:11:26.400 | maybe nothing until it's peer-reviewed.

02:11:28.800 | - Absolutely, and the methods were very poor in that study.

02:11:31.260 | It was a recall-based study, I think,

02:11:33.560 | for two days of recall of people's diets,

02:11:37.320 | which is notoriously very bad in terms of accuracy.

02:11:40.300 | So yeah, and I think I'm not in any way suggesting

02:11:43.080 | that a six-hour window is the optimal window.

02:11:45.120 | I'm just sharing the data that suggests

02:11:47.440 | that compressing the window

02:11:49.680 | seems to have a favorable effect,

02:11:52.760 | and I certainly don't do six hours,

02:11:54.600 | but I think when you look at

02:11:55.840 | what the average American is doing,

02:11:57.960 | which is the average American has 11 eating events per day,

02:12:02.720 | and 50% of Americans eat over a 15-hour window per day.

02:12:07.720 | I can recall those because I remember

02:12:10.560 | when I was writing the book,

02:12:11.720 | I was like, that's a long time, 15 hours and 11 events,

02:12:16.720 | and every time you're doing that,

02:12:18.720 | you're going to be stimulating this glucose rise

02:12:21.400 | in the bloodstream, exposing the blood vessels

02:12:24.080 | to that glucose.

02:12:24.920 | You're gonna be turning on all the pathways with insulin

02:12:27.560 | to basically store it, and so it's strain for the body,

02:12:30.880 | and so I think giving the body times intentionally

02:12:34.920 | to allow insulin to come down

02:12:38.540 | and to allow glucose to come down,

02:12:41.240 | what that does is it generates metabolic flexibility.

02:12:43.960 | It gives our body an opportunity to have space

02:12:47.960 | to use accessible glucose

02:12:50.240 | and then convert into using stored fat,

02:12:54.360 | and that ultimately is metabolic flexibility,

02:12:56.520 | the ability for the body,

02:12:57.760 | giving the body opportunities to use glucose,

02:13:00.560 | but then have times when there's not high glucose

02:13:03.640 | and insulin around to actually get into the fat stores,

02:13:07.160 | and I think one of the reasons why we have

02:13:10.000 | such a massive overweight and obesity rates in the country

02:13:14.600 | is because with the way, the culture of eating right now,

02:13:18.600 | 11 eating events per day,

02:13:19.800 | eating over the course of 15 hours per day,

02:13:21.880 | I would imagine the average American body

02:13:23.960 | is rarely, if ever, tapping into their fat stores

02:13:28.200 | for energy in a meaningful way

02:13:29.680 | because we always have glucose available to the body.

02:13:33.440 | If you think about, again,

02:13:35.040 | the stats about ultra-processed food,

02:13:37.640 | about 70% of the items on the shelves

02:13:40.400 | in the grocery store are ultra-processed food,

02:13:41.840 | and those ultra-processed foods are built on

02:13:44.160 | refined added sugars and refined added grains,

02:13:46.920 | so we very rarely give the body the opportunity to rest

02:13:50.280 | and move into fat burning,

02:13:51.520 | and that's where compressing the eating window

02:13:54.880 | can be valuable.

02:13:56.160 | Obviously, people have talked about this before,

02:13:59.520 | but fasting can be a stressor for the body,

02:14:03.600 | especially if your body's not used to using fat for energy,

02:14:07.720 | and so it's something to ease into and go slow,

02:14:09.920 | but I think if you're slowing down enough

02:14:12.680 | to really hear what your body's signal are saying,

02:14:14.920 | you can kinda know whether I think your fasting

02:14:17.880 | is working for you or not.

02:14:20.120 | I can tell, if I've got too many other things going on,

02:14:22.640 | I haven't slept well, a lot of stress,

02:14:25.240 | I can tell that fasting's kinda making me jittery

02:14:27.560 | and not feel good versus if I'm really,

02:14:29.520 | if I have good capacity, I can feel

02:14:31.280 | that it's actually making me feel really incredible,

02:14:33.360 | and so tune in with your body, obviously,

02:14:36.160 | and you can check your biomarkers.

02:14:37.720 | If you have a CGM on,

02:14:38.680 | you can see what's happening in your glucose.

02:14:40.280 | If you have a ketone monitor,

02:14:41.280 | you can see what's happening in your ketones

02:14:42.720 | and really actually track,

02:14:43.760 | which I think makes fasting actually even more fun.

02:14:48.200 | I'll mention one other piece of data

02:14:49.480 | that I think is actually really kinda fun as well

02:14:52.000 | with timing of eating.

02:14:53.320 | There was a study that looked at people

02:14:55.880 | who ate the exact same meal at 9.30 a.m. or 8.30 p.m.,

02:15:00.880 | so basically after dark,

02:15:03.560 | essentially in the part of the diurnal phase

02:15:05.360 | when we probably shouldn't be eating

02:15:07.440 | versus early in the morning, 9.30,

02:15:11.040 | and the glucose and insulin responses

02:15:13.280 | for the same meal at 8.30 p.m. were significantly higher

02:15:17.360 | than when eating at 9.30 a.m.,

02:15:19.240 | and so again, bang for your buck.

02:15:21.360 | It appears that eating in that earlier part of the day

02:15:24.520 | when we're active and our chronobiology is set up

02:15:27.560 | for metabolism and activity,

02:15:30.840 | we have a lower glucose and insulin response.

02:15:33.880 | There's also some evidence that melatonin,

02:15:37.080 | which is secreted as we get closer to sleep,

02:15:40.800 | has somewhat of an effect

02:15:42.840 | on impairing our insulin sensitivity transiently,

02:15:45.440 | and so we may actually just be not absorbing the glucose

02:15:48.240 | from those meals effectively later at night,

02:15:50.360 | so I tend to kinda move a little bit more low-carb,

02:15:54.800 | I would say, throughout the day based on that data

02:15:57.400 | and what I've seen on my continuous glucose monitor,

02:15:59.360 | basically just higher spikes

02:16:01.040 | for the same meal later in the day,

02:16:02.480 | so why not just kinda move it up earlier?

02:16:05.680 | - Very interesting, something I'll definitely try.

02:16:07.720 | I tend to push my carbohydrates

02:16:09.440 | to a little bit later in the day for sake of sleep,

02:16:12.000 | unless, of course, I've done resistance training,

02:16:16.080 | which I aim to do three times a week,

02:16:18.680 | and post-resistance training,

02:16:19.840 | I try and get some starchy carbohydrate in me

02:16:22.960 | just to replenish glycogen,

02:16:24.360 | and that then tends to reduce

02:16:27.480 | my carbohydrate craving later in the day.

02:16:29.040 | I love bread and butter, bread and olive oil, pastas,

02:16:31.480 | and the other day I found this Argentine place,

02:16:33.840 | and I love the steaks there,

02:16:34.800 | but they had gnocchi that it took everything I had,

02:16:38.000 | every neural circuit that releases GABA

02:16:41.400 | in addition to my brain

02:16:42.360 | to not order three of those orders, it was so good.

02:16:45.480 | - But you can walk after the gnocchi.

02:16:46.800 | - Oh yeah, sure, I'll allow myself to do those things.

02:16:49.120 | I'm not super restricted,

02:16:50.200 | but again, I tend to eat high-quality foods.

02:16:52.400 | By the way, these blueberries are amazing.

02:16:54.680 | Then you figure out where you got those

02:16:55.840 | 'cause they're just tangy enough.

02:16:58.040 | I'm doing everything I can to just not take the jar

02:17:00.160 | and funnel them into my mouth.

02:17:03.720 | Yeah, I think if we're looking at blood sugar,

02:17:08.720 | blood glucose, and insulin,

02:17:10.800 | and as long as we're talking about that,

02:17:13.280 | I did use a levels tracker, and yeah, full disclosure,

02:17:16.360 | they're a sponsor of the podcast regularly,

02:17:18.340 | and I learned a ton.

02:17:20.360 | I'll tell you what I learned.

02:17:21.600 | I learned that, indeed, my blood sugar goes up after I eat,

02:17:26.600 | that certain foods,

02:17:28.480 | although the foods that did this surprised me,

02:17:32.440 | certain foods tend to spike my blood sugar quite a bit.

02:17:37.440 | Grapes, that shouldn't be surprising.

02:17:40.080 | Food order was very powerful for me.

02:17:44.840 | I know that the data on food order are a little bit mixed,

02:17:47.080 | and it's controversial, but I like to eat like the French.

02:17:50.480 | I like some soup, then I like my entree,

02:17:52.320 | and I like the salad at the end.

02:17:53.800 | That turned out to have the steadiest and lowest rise

02:17:57.620 | in blood glucose for me, and then across time.

02:17:59.640 | I also found that I love hot sauna.

02:18:02.040 | I go so hot with the sauna

02:18:04.040 | that I've been accused by Rogan and other people,

02:18:06.280 | I'm gonna turn myself into a brisket,

02:18:08.760 | but after the sauna, my blood sugar spikes,

02:18:13.760 | presumably because I'm a bit dehydrated,

02:18:16.760 | and it's the concentration of blood glucose.

02:18:19.320 | Is that possible?

02:18:20.160 | Does that make sense?

02:18:20.980 | - It does make sense, but also the heat

02:18:22.800 | can affect the accuracy of the sensor itself.

02:18:25.320 | - Ah, okay, so that could be it too,

02:18:27.040 | but yeah, basically what it allowed me to do

02:18:28.560 | is make a few adjustments in terms of foods

02:18:30.560 | that I eliminated or eat less of,

02:18:32.840 | food ordering within a meal,

02:18:34.800 | and I find that I'm very susceptible to,

02:18:37.960 | if I don't include enough fat, dietary fat in the meal,

02:18:41.840 | then my blood glucose spikes,

02:18:43.320 | even if it's just like tuna, right?

02:18:45.520 | But by including olive oil and other things,

02:18:47.680 | it really blunts it, and of course here,

02:18:50.480 | we're doing correlative anecdata,

02:18:53.480 | but for me, I felt far better

02:18:56.160 | when I included a bit more fat,

02:18:59.660 | and when the food order was adjusted

02:19:01.720 | the way I mentioned before,

02:19:03.160 | always including a little bit of fiber really helped,

02:19:05.200 | and that makes sense, right?

02:19:06.040 | Slow the absorption of the food, presumably.

02:19:09.080 | So I found that it was a very valuable experiment for me.

02:19:14.080 | Again, this isn't an advertisement.

02:19:15.720 | It just so happens I did this and really benefit from it.

02:19:19.580 | What are some other things that one can learn

02:19:21.600 | from continuous monitoring of blood glucose?

02:19:24.320 | What are some things to watch for

02:19:25.640 | that might signal a problem,

02:19:27.160 | and what are some fun things that one could do

02:19:29.020 | to explore and experiment?

02:19:30.560 | 'Cause I like to explore and experiment.

02:19:31.880 | Yeah, well, I mean, a lot of the things

02:19:34.320 | that you just naturally learned

02:19:35.860 | are the things that have been shown in data,

02:19:39.000 | and like you said, some of this data,

02:19:40.600 | it's like small studies, small groups of people,

02:19:42.880 | but for instance, adding fat and fiber to meals

02:19:46.200 | has a significant and repeatable impact in populations

02:19:49.960 | on lowering glucose response.

02:19:52.160 | Fat, probably in some part due to slowing gastric emptying

02:19:56.600 | and actually slowing the digestion process,

02:19:58.720 | so the rise in the bloodstream is gonna slow down,

02:20:01.020 | and then fiber, both for that reason,

02:20:02.720 | but also because fiber can, in a sense,

02:20:05.320 | create a mesh sort of blocking the absorption

02:20:08.280 | of some of the glucose that's in the meal,

02:20:10.200 | so literally kind of actually preventing you

02:20:12.560 | from absorbing all of the carbs,

02:20:15.300 | and we've actually seen that in the levels data set

02:20:18.060 | that the more fiber people include with their meals,

02:20:21.440 | we see essentially a direct relationship

02:20:24.400 | with lowering of their glucose excursions,

02:20:26.760 | which is really exciting,

02:20:27.880 | 'cause fiber is something that you can add

02:20:30.480 | to meals very easily.

02:20:32.000 | I put basil seeds, chia seeds, hemp seeds, flax seeds

02:20:35.360 | on a lot of my food at this point,

02:20:37.360 | 'cause it's essentially a little bit of fat, a lot of fiber,

02:20:41.920 | and it kind of just helps you kind of get more

02:20:44.400 | from your meal.

02:20:46.080 | So what you can learn, so I think step one,

02:20:49.880 | the way I think about a glucose monitor,

02:20:52.160 | first of all, I'll say the purpose of the glucose monitor

02:20:54.360 | is not to game the system and get flat glucose.

02:20:58.360 | The purpose of the glucose monitor is curiosity.

02:21:01.120 | It's to start to understand how,

02:21:03.960 | essentially an MRI for how all of our different dietary

02:21:09.400 | and lifestyle strategies are creating this readout

02:21:11.920 | of glucose in our body,

02:21:13.160 | which I think can be really interesting,

02:21:14.920 | and in a world where so many cards are stacked against us

02:21:17.520 | with diet and lifestyle,

02:21:18.880 | and where there's a lot of confusion

02:21:20.120 | about what's right for us,

02:21:21.320 | that can be very helpful in actually reducing

02:21:24.200 | the confusion and the cognitive load of our choices.

02:21:27.480 | We know that keeping your blood sugar

02:21:31.400 | through the course of a lifetime in a low and healthy range,

02:21:35.200 | so I don't mean up and down spikes during the day,

02:21:37.200 | but keeping your blood sugar healthy

02:21:38.800 | throughout the course of your lifetime

02:21:40.200 | is probably the best thing we can do for longevity,

02:21:43.480 | staying insulin sensitive, staying out of the diabetic range.

02:21:47.520 | And so one thing that the glucose monitor does for us

02:21:50.200 | is just give us more awareness and agency

02:21:54.040 | into what the trends of our glucose are over time,

02:21:57.960 | as opposed to a literally one data point snapshot

02:22:02.560 | once a year in the doctor's office,

02:22:04.200 | which is what the majority of us are used to.

02:22:06.440 | I really love the idea

02:22:10.080 | that people who are able to wear glucose monitors

02:22:12.440 | every now and again, maybe once a year,

02:22:14.400 | or maybe more than once a year,

02:22:16.680 | they know what their glucose is.

02:22:18.840 | And so they're never gonna walk into a doctor's office

02:22:21.760 | and have a bomb dropped on them

02:22:24.240 | about prediabetes or type 2 diabetes,

02:22:26.120 | 'cause you have the data, which is ultimately,

02:22:28.920 | I hope, the world that we can move towards

02:22:30.360 | for a lot of biomarkers.

02:22:31.840 | So you can see trends over time,

02:22:33.520 | which I think is very valuable.

02:22:35.080 | One thing that's fascinating

02:22:36.680 | in terms of early prediction of metabolic disease

02:22:39.520 | is that you can see how long it takes your glucose

02:22:42.520 | to come down after a meal.

02:22:44.520 | So in a normal, healthy, insulin-sensitive body,

02:22:47.800 | even if the glucose goes way up,

02:22:49.520 | it should come way down very quickly,

02:22:51.400 | 'cause the insulin is binded to insulin receptors

02:22:53.600 | and the glucose is getting taken up, and it'll lower.

02:22:56.800 | - What is quickly over the course of?

02:22:58.280 | - It should be down by two hours,

02:23:01.000 | but from what I've actually seen

02:23:02.760 | in our most insulin-sensitive people,

02:23:04.720 | and also in research

02:23:05.680 | that looks at young, healthy populations,

02:23:07.800 | you should basically be spiking and coming down,

02:23:10.240 | spike about 45 minutes and come down hour and a half,

02:23:13.280 | 90 minutes to two hours.

02:23:15.160 | - This is after, sorry, after last bite?

02:23:18.080 | - After last bite,

02:23:18.960 | although it's hard to kind of exactly know.

02:23:20.800 | But yeah, meal is over.

02:23:22.120 | I would say about 45 minutes to go up to the peak

02:23:24.320 | and then start coming down very quickly.

02:23:26.400 | Now, if you start to see that glucose is going up

02:23:30.720 | and then trailing very slowly back down to normal,

02:23:35.080 | maybe taking more than two hours, three hours,

02:23:38.000 | that is gonna be one of those early indicators

02:23:41.280 | of potential insulin resistance.

02:23:43.280 | Your body's not clearing the glucose,

02:23:45.200 | but that's not a metric that we use

02:23:47.040 | in standard practice at all.

02:23:49.760 | And I've actually seen myself very insulin-sensitive.

02:23:53.280 | My insulin is like 2.5.

02:23:55.160 | And if I don't sleep and I am stressed

02:23:58.760 | and I have been sitting,

02:24:00.200 | my glucose will take way longer to come down.

02:24:02.600 | I have become transiently insulin-resistant.

02:24:05.080 | So I think that's just fascinating to see that.

02:24:06.840 | So looking, what that ultimately,

02:24:09.040 | the metric that we call that is area under the curve.

02:24:12.080 | You want a low area under the curve,

02:24:14.560 | AUC, after a glucose spike.

02:24:16.520 | So you wanna spike and come down quickly.

02:24:18.320 | That's gonna, if you shade the area under the curve,

02:24:21.240 | it's a small amount.

02:24:22.360 | If you go up and then trail off for two to three hours,

02:24:26.760 | that's gonna be a lot of shading under that curve.

02:24:30.360 | And high AUC is associated

02:24:31.920 | with insulin resistance, basically.

02:24:34.320 | Another thing that you can see

02:24:37.280 | is essentially glycemic variability.

02:24:42.520 | And glycemic variability, GV,

02:24:44.520 | is a metric of how spiky your curves are.

02:24:47.680 | Fassane paper out of Michael Schneider's lab

02:24:51.720 | at Stanford in 2018 called

02:24:54.240 | "Glucotypes Reveal New Patterns of Glucose Dysregulation."

02:24:58.760 | Totally landmark study,

02:25:00.600 | but basically they put continuous glucose monitors

02:25:03.240 | on non-diabetic individuals

02:25:05.120 | who by standard criteria of diabetes do not have diabetes.

02:25:08.960 | And he showed that on a CGM, a continuous glucose monitor,

02:25:13.960 | you have these low variability people

02:25:16.160 | that are pretty much flat throughout the day

02:25:17.660 | with little teeny rolling hills after their meals.

02:25:21.080 | You have moderately spiky people,

02:25:22.520 | and then you have very spiky people

02:25:24.040 | who are going up, down, up, down, up, down, up, down.

02:25:26.280 | When you correlate those different patterns

02:25:28.260 | of glycemic variability in non-diabetic people,

02:25:31.440 | you find that the spikier they are,

02:25:33.720 | the worse their biomarkers are metabolically

02:25:35.640 | across the board, insulin, triglycerides, et cetera.

02:25:38.640 | So basically they're showing signs

02:25:41.440 | through variability of underlying dysfunction

02:25:44.660 | that you would never know from a standard test.

02:25:47.160 | Those are the people who I imagine

02:25:48.600 | are probably gonna go on to develop diseases.

02:25:50.480 | And yet, based on standard criteria,

02:25:52.360 | their doctor's telling them that they're fine,

02:25:54.640 | that they're all the same.

02:25:55.840 | So he also showed in that study

02:25:57.760 | that non-diabetic individuals, when you have a CGM on,

02:26:01.440 | are going into the diabetic range

02:26:03.440 | and the pre-diabetic range a fairly significant amount.

02:26:07.340 | And we would never know that

02:26:08.640 | if you weren't actually tracking a movie of the glucose.

02:26:12.840 | So glycemic variability, area under the curve,

02:26:16.240 | those are two things.

02:26:17.360 | Another really interesting thing

02:26:18.360 | you can know from a CGM is dawn effect.

02:26:20.820 | So dawn effect is basically a term in the literature

02:26:24.780 | for how high your glucose rises

02:26:27.800 | right when you wake up in the morning.

02:26:29.460 | I don't know if you noticed this when you were wearing a CGM,

02:26:32.000 | but some people notice that the second they wake up,

02:26:34.800 | their glucose jumps up five, 10, 20, 30 points.

02:26:39.080 | What's happening here

02:26:40.120 | is that the cortisol awakening response

02:26:42.360 | to actually get you to wake up and get out of bed,

02:26:44.760 | that cortisol can cause you

02:26:47.720 | to dump a bunch of glucose from your liver

02:26:49.680 | 'cause it's basically saying stress hormone, cortisol,

02:26:52.680 | we gotta get up, we need glucose to fuel the muscles,

02:26:54.840 | let's dump a little glucose.

02:26:56.240 | So it's normal, but what the research shows

02:27:00.680 | is that magnitude of dawn effect

02:27:02.960 | is correlated with insulin resistance.

02:27:06.320 | So the more the dawn effect you're getting,

02:27:08.680 | I think it can signal maybe the more stress you're under,

02:27:11.280 | the more cortisol you have floating around,

02:27:13.260 | how big your cortisol awakening response is.

02:27:15.520 | But also if you imagine

02:27:16.480 | if you're dumping all that glucose from your liver

02:27:18.320 | and your cells aren't taking it up well

02:27:20.140 | because you're insulin resistant,

02:27:21.880 | that response, that dawn effect is gonna be higher.

02:27:24.800 | So I don't have the numbers right in front of me,

02:27:28.200 | but typically I would wanna see a dawn effect,

02:27:31.560 | I think of like less than 10 points.

02:27:33.400 | So you wake up and you may very well see a rise,

02:27:36.520 | this is absence of any food yet,

02:27:38.720 | and you do not wanna see that going up 20, 30, 40 points.

02:27:43.040 | Some people see a little bump again

02:27:44.360 | with caffeine in the morning because it's more cortisol.

02:27:46.840 | And so that's another thing

02:27:49.480 | that standard stuff would never tell you.

02:27:52.400 | So those are kind of some of the looking

02:27:54.840 | at early predictors of metabolic dysfunction.

02:27:57.080 | More of the fun stuff is like actually just figuring out

02:28:00.080 | how is food affecting your body?

02:28:01.680 | And this is where people really enjoy it

02:28:03.200 | and figure out like, oh my God,

02:28:05.120 | this food that I thought was healthy

02:28:06.880 | is actually not serving me.

02:28:09.880 | And actually a lot of people I think

02:28:11.400 | were trying to make healthy choices.

02:28:13.560 | My boyfriend, when we started dating,

02:28:15.960 | he started using levels.

02:28:17.440 | His healthy snack, he worked in Venice,

02:28:21.200 | would be to go to Moon Juice and get,

02:28:23.240 | oh gosh, I don't wanna throw Moon Juice

02:28:24.720 | under the bus here, but he would get like--

02:28:26.040 | They have some tasty stuff there.

02:28:26.880 | They do, but he would get this green juice

02:28:28.800 | that was sweetened with dates and it was like $9

02:28:31.480 | and this was like the healthy choice.

02:28:33.400 | And he saw the second he put on levels

02:28:35.320 | that it was causing a huge spike,

02:28:37.640 | like 50, 60, 70 points, and then he was crashing.

02:28:41.200 | And he was actually trying to make a good decision.

02:28:45.880 | So now he's swapped his snacks out for more like,

02:28:49.640 | grass-fed cheese and some flax crackers

02:28:52.200 | and maybe like a venison stick or something,

02:28:54.480 | like grab-and-go stuff that isn't spiking his glucose.

02:28:56.600 | But I think it can help people figure out

02:28:58.800 | which foods are doing what I want them to do

02:29:01.480 | and which maybe aren't.

02:29:04.000 | And same thing happened for so many of our members

02:29:07.000 | with oatmeal, unfortunately oatmeal,

02:29:09.640 | instant oatmeal is one of the biggest spikers

02:29:11.400 | in our data set for breakfast.

02:29:13.360 | And a lot of people are making that choice

02:29:14.880 | 'cause they think it's heart healthy.

02:29:16.480 | And in many people, it's actually causing

02:29:19.400 | a big glucose excursion and crash.

02:29:22.240 | And then in some other people, it's not.

02:29:24.440 | And so it's really helping with,

02:29:26.800 | what are the sneaky spikers?

02:29:28.080 | And then where's the biochemical individuality?

02:29:31.120 | And there was a phenomenal paper

02:29:33.600 | out of Israel from Cell about seven years ago

02:29:38.600 | called Personalized Nutrition

02:29:41.880 | by Prediction of Glycemic Responses.

02:29:43.840 | It made big waves, but it basically showed

02:29:45.640 | that you and I could eat the same handful of blueberries

02:29:49.880 | and have totally different glycemic responses.

02:29:54.880 | So the idea of glycemic index

02:29:57.400 | as like a certain amount of food

02:29:59.240 | with a certain amount of glucose

02:30:00.240 | causes a certain glucose rise,

02:30:01.760 | it kind of debunked that.

02:30:03.560 | And that matters because repeated,

02:30:07.120 | sustained glycemic variability over time

02:30:09.160 | is not good for our health.

02:30:10.600 | We wanna choose the foods or balance the foods

02:30:12.920 | that are gonna keep us relatively more stable.

02:30:15.880 | So that's very helpful,

02:30:18.400 | just understanding your personal response to food.

02:30:20.560 | And then what are the lifestyle strategies

02:30:22.360 | that you can use?

02:30:23.480 | Sleeping better, walking after meals,

02:30:25.840 | more resistance training, cold plunging,

02:30:28.840 | breath work that can actually serve

02:30:31.920 | to modulate the food environment

02:30:34.920 | to actually reduce the glucose spikes.

02:30:36.960 | And people find that all of those things

02:30:38.600 | can positively impact glucose spikes,

02:30:40.280 | especially the walks after the meals.

02:30:41.640 | But it's been fascinating to see a lot of women,

02:30:45.480 | especially like menopausal women in our community

02:30:47.920 | who find that their glucose patterns are getting worse

02:30:51.080 | because estrogen's dropping,

02:30:52.520 | and that's gonna really take a hit on insulin sensitivity.

02:30:56.560 | They start resistance training,

02:30:58.600 | glucose comes kind of right back down.

02:31:00.800 | So because of the monitor,

02:31:02.600 | they can feel more confident in the intervention

02:31:05.520 | they've chose to do to help with metabolism,

02:31:07.880 | and that kind of creates a virtuous cycle.

02:31:10.440 | So those are some of the big things.

02:31:13.880 | - Those are big.

02:31:15.280 | - Can I mention one more?

02:31:16.120 | - Please. - I know, I love that.

02:31:17.880 | I could obviously talk about this all day.

02:31:19.360 | - Wonderful. - I think it's fascinating,

02:31:20.440 | but this is just one more that I think is fascinating

02:31:22.400 | 'cause this was a paper in "Nature" from last year

02:31:26.400 | that talked about, and this may actually be

02:31:29.000 | one of the most valuable things to people,

02:31:30.880 | which is that, again, talking about cravings,

02:31:33.960 | we all wanna get off the craving grip.

02:31:36.800 | This paper in "Nature" showed that essentially

02:31:39.800 | when people spike their glucose

02:31:41.240 | with high-carb, high-starchy foods,

02:31:43.200 | they'll often have a big crash afterwards.

02:31:45.720 | And the reason for that is because a big spike

02:31:47.400 | leads to a lot of insulin secretion,

02:31:48.960 | and then you soak up all the glucose,

02:31:50.260 | and sometimes you can actually go below your baseline.

02:31:53.180 | So a small spike usually won't lead to a crash,

02:31:56.160 | but a big spike often will.

02:31:58.040 | That's called reactive hypoglycemia,

02:32:00.080 | postprandial hypoglycemia.

02:32:03.320 | A lot of people think they're dealing with hypoglycemia

02:32:06.040 | when in fact what they're really dealing with

02:32:08.460 | is that they're spiking their glucose too high,

02:32:10.400 | and then they're crashing. - I see.

02:32:12.240 | - And the paper showed that the extent of post-meal dips,

02:32:17.240 | the crash after the spike, was predictive

02:32:20.480 | of 24-hour energy intake and cravings for carbohydrates.

02:32:24.400 | And this makes sense.

02:32:25.520 | If you crash low, that is a signal to your body.

02:32:29.100 | We have to get our glucose back up,

02:32:32.320 | and it will drive you to eat high-energy foods,

02:32:36.320 | carbohydrate-rich foods, and cravings.

02:32:38.000 | So one of the best things we can do,

02:32:39.640 | I believe from my personal experience,

02:32:41.680 | from members' experience,

02:32:42.600 | and with some data to support this,

02:32:44.340 | is that one of the adjuncts we can use

02:32:47.200 | to manage our cravings is actually

02:32:50.240 | to lower the extent of our spikes so that we crash less.

02:32:54.320 | And so that was a fasting study looking at CGM data.

02:32:57.760 | - That's interesting.

02:32:58.600 | So the CGMs can reveal things,

02:33:01.900 | not just in the immediate meal period,

02:33:03.960 | but can relate to sort of downstream consequences.

02:33:07.880 | Yeah, again, I found it to be tremendously useful.

02:33:10.420 | I'm so glad you mentioned sleep, by the way.

02:33:12.440 | I'm gonna resist the temptation

02:33:13.680 | to rattle off 20 studies showing that.

02:33:15.920 | - Oh, God.

02:33:17.160 | - You know, even having too much bright light in a room

02:33:20.440 | while one is sleeping at night, even dim light,

02:33:22.520 | which is, you know, I don't wanna scare people

02:33:23.960 | into thinking they have to sleep in complete darkness,

02:33:25.760 | but although an eye mask can be great,

02:33:28.680 | can alter morning blood glucose levels

02:33:31.520 | in, I believe it was adults and kids as well.

02:33:34.200 | It's a study in proceedings

02:33:35.200 | in the National Academy of Sciences.

02:33:37.520 | I have to go back and check if it included kids,

02:33:39.600 | but pretty striking.

02:33:41.240 | And then it's, there's something very clear

02:33:44.160 | about the fact that when people get

02:33:45.720 | the early night sleep of four to five hours,

02:33:47.800 | but then don't get the REM-dominating, you know,

02:33:52.320 | last hour or two of sleep in the morning

02:33:54.240 | that resting blood glucose is altered.

02:33:56.520 | It's so interesting to think about what's going on in sleep.

02:33:58.400 | There's at least one paper that I'm aware of

02:34:00.180 | where they had people breathing into a tube during sleep

02:34:02.200 | to measure what sorts of metabolism they were undergoing.

02:34:05.640 | And it's interesting, during a full night's sleep,

02:34:08.160 | all of us seem to transition

02:34:10.720 | between different forms of metabolism.

02:34:14.280 | I'll send you this paper.

02:34:15.120 | It's really cool.

02:34:15.960 | And I'll put a link to it in the show note caption

02:34:17.680 | such that at one portion of the night,

02:34:19.400 | we're metabolic, we're relying more on,

02:34:22.280 | let's just call it sugars for sake of simplicity.

02:34:24.440 | Other times we're more ketone dominant.

02:34:26.080 | There's a market shifts in metabolism throughout the night.

02:34:29.280 | It's almost like the brain and body cycle

02:34:30.960 | through all the different modes

02:34:32.240 | of metabolism throughout the night.

02:34:34.680 | And then almost like a rehearsal of the metabolic pathways.

02:34:38.240 | If, you know, we can anthropomorphize a bit here,

02:34:40.600 | but then if sleep is truncated,

02:34:43.300 | it clearly has an effect on daytime fuel regulation.

02:34:47.900 | Just so interesting.

02:34:48.740 | So getting sufficient sleep,

02:34:50.880 | getting quality sleep is absolutely key.

02:34:53.440 | There's a lot for people to pay attention to,

02:34:54.800 | but you've given us a lot of tractable avenues

02:34:56.720 | for people to do that, that are mostly behavioral.

02:34:59.440 | There's a few don'ts, but mostly some do's.

02:35:02.000 | We haven't mentioned that, you know,

02:35:03.400 | you don't need to even perhaps belong to a gym.

02:35:05.620 | It's like, and with the cold exposure thing,

02:35:07.880 | I always say, you know, if anything,

02:35:08.760 | it'll save you money on the heating bill.

02:35:10.200 | So there's a literally potential negative cost there.

02:35:16.020 | - I think levels and other CGMs are really interesting

02:35:19.240 | and valuable to experiment with.

02:35:21.960 | What sorts of other stuff is going to soon be monitored

02:35:25.240 | in our blood?

02:35:26.060 | 'Cause for instance, I would love to know

02:35:27.680 | continuous hormone levels, lipid levels,

02:35:30.640 | blood sugar levels.

02:35:31.800 | I mean, are we moving past just blood glucose

02:35:35.680 | and are there soon to be other things in these monitors

02:35:40.440 | so that when we, and by the way, if you haven't used these,

02:35:42.560 | it's really cool.

02:35:43.400 | You just take your phone, you scan it over the sensor,

02:35:45.540 | and then it basically gives you a chart graph

02:35:47.440 | of what's going on in your bloodstream.

02:35:49.680 | - And now they're all, the latest gen of each of them

02:35:52.520 | are all Bluetooth now.

02:35:53.560 | So no more scanning, which is kind of nice.

02:35:55.640 | And the answer is yes.

02:35:57.360 | There are several different analytes

02:36:00.260 | that we're going to be able to track.

02:36:01.400 | And Abbott, which is one of the three main manufacturers

02:36:05.880 | of CGMs has announced that they have a new product

02:36:09.080 | called the Lingo, which is going to actually be able

02:36:11.400 | to measure ketones, lactate, and alcohol continuously,

02:36:16.400 | which is pretty interesting from like a metabolic,

02:36:18.660 | comprehensive metabolic standpoint.

02:36:20.180 | Different sensors for each, not all in one.

02:36:23.940 | So I think we'll have to like polka dot ourselves

02:36:26.380 | if we're tracking all those things.

02:36:28.420 | And then Dexcom, which is the other main company

02:36:33.340 | that makes CGMs has just announced

02:36:35.620 | they're coming out with an over-the-counter

02:36:37.100 | non-prescription version of a CGM

02:36:39.620 | called the Stella later this year.

02:36:41.200 | So there's exciting things happening in the industry,

02:36:43.820 | and I really do think continuous monitoring,

02:36:47.420 | it's going to expand to a lot of these other things

02:36:50.580 | that you're talking about, hormones, et cetera.

02:36:52.680 | And I mean, it really needs to.

02:36:54.620 | I think that snapshots of dynamic system

02:36:58.680 | are just never going to really be able to give us

02:37:00.720 | a full picture on what's going on.

02:37:02.460 | And what we really want to be able to do

02:37:05.920 | to dig our way out of this healthcare crisis,

02:37:08.020 | I think is empowerment individually

02:37:10.840 | and understanding how this rapidly changing environment

02:37:13.760 | is affecting our own biology.

02:37:15.260 | So we can make the targeted choices

02:37:17.200 | to hopefully change the environment

02:37:19.720 | to be more conducive to cellular health.

02:37:21.440 | And continuous monitoring is a closed loop biofeedback

02:37:24.940 | that can help us with that decision-making

02:37:28.080 | and essentially predict failure of the system

02:37:30.980 | rather than wait for failure of the system

02:37:33.260 | before we do something about it.

02:37:34.840 | So yeah, I think a lot's coming down the pipeline.

02:37:37.280 | - Love it. - Yeah.

02:37:38.120 | - Let's talk a little bit about mindset.

02:37:42.060 | This is a really interesting topic

02:37:43.620 | that you include in your book.

02:37:44.940 | We've had guests come on and talk about growth mindset.

02:37:47.020 | Stress can be enhancing mindset.

02:37:48.440 | I'm big on mindset because I'm interested

02:37:51.940 | in how our cognitive reframing or cognitive framing

02:37:55.180 | can just change the way our biology works

02:37:57.240 | and vice versa, of course.

02:37:58.720 | But you talk about mindset in a certain context.

02:38:01.820 | And one of the favorite passages around that

02:38:05.260 | that I really enjoyed was the relationship

02:38:07.360 | between kind of like trying to control everything

02:38:10.680 | and nature and how getting into nature itself

02:38:15.680 | can be valuable for us.

02:38:18.200 | So maybe touch a little bit on mindset, if you will.

02:38:20.640 | And what are your thoughts on nature,

02:38:23.200 | literally getting out of doors?

02:38:25.000 | - Yeah.

02:38:25.840 | So I think that mindset and more broadly than mindset,

02:38:33.080 | I think psychology and our relationship specifically

02:38:35.920 | with fear and control,

02:38:38.220 | I think they're probably the most under-recognized thing

02:38:42.140 | that is impacting the metabolic health crisis,

02:38:44.680 | the chronic disease epidemic.

02:38:46.160 | There has been data that's looked into this.

02:38:47.800 | We know that there's studies showing

02:38:49.200 | that loneliness impacts mitochondrial function

02:38:52.040 | and that loneliness is a risk factor

02:38:53.680 | and stress is a risk factor in these things.

02:38:55.440 | And something really fascinating actually with the CGM data

02:38:59.080 | is that many people who wear a CGM,

02:39:01.360 | I don't know if you saw this,

02:39:02.400 | but when you feel stressed,

02:39:04.920 | it actually has a diabetogenic effect.

02:39:07.160 | It literally causes our blood sugar to go up

02:39:09.480 | when we feel stress.

02:39:11.760 | And that can be a fascinating unlock for people to realize,

02:39:16.440 | I kind of feel like I'm okay right now,

02:39:18.360 | but my body is telling me something different.

02:39:21.680 | It's telling me that biochemically,

02:39:24.360 | I'm actually releasing energy stores from my liver,

02:39:27.320 | glucose, to fight some threat

02:39:29.760 | that I wasn't really aware of.

02:39:31.600 | So we definitely understand there's this link here,

02:39:34.320 | but it's certainly not made its way into clinical practice.

02:39:37.440 | So the way I think about it

02:39:39.080 | is that what we know about the cells

02:39:41.000 | and especially the mitochondria

02:39:42.360 | is that the mitochondria

02:39:43.800 | are more than the powerhouses of the cell.

02:39:45.920 | They actually are a part of the cell

02:39:49.360 | that is constantly tracking resources and threats

02:39:53.560 | and are basically modulating energy resources based on that.

02:39:56.800 | And the threats can be anything.

02:39:58.480 | They can be a virus, they can be,

02:40:00.360 | and this is all coordinated through this thing

02:40:01.800 | called the cell danger response.

02:40:03.560 | It can be a virus, it can be a toxin in the environment,

02:40:06.400 | it can be lack of micronutrients

02:40:08.040 | for the electron transport chain

02:40:09.400 | that it needs to do its function.

02:40:11.560 | It can also be psychological threats

02:40:14.200 | because of course our psychological milieu

02:40:16.760 | translates through nerves and hormones and neurotransmitters

02:40:21.560 | and our microbiome to affect our cellular biology

02:40:24.160 | throughout our whole body.

02:40:25.000 | Our cells hear every single thought

02:40:26.800 | that we're thinking through biochemistry.

02:40:29.840 | And when a cell and a mitochondria

02:40:33.880 | are getting the message

02:40:36.240 | that there is a threat or something to be afraid of,

02:40:38.800 | they are going to change metabolic function

02:40:41.600 | towards defense alarm, threat response,

02:40:44.960 | and away from repair, homeostasis,

02:40:49.120 | building, essentially thriving.

02:40:52.000 | So, and I think what's really

02:40:55.680 | maybe the most unnatural thing about our modern world,

02:40:59.240 | you know, the food of course is unnatural,

02:41:01.440 | 70% is ultra-processed,

02:41:02.960 | but we also have this device in our hands

02:41:07.960 | literally with us all the time,

02:41:11.480 | streaming fear-inducing media into our brains and eyeballs

02:41:16.480 | every waking moment of the day, if we let it.

02:41:19.480 | So we're glued to our screens and our devices,

02:41:22.280 | and right now, essentially the traumas and fears

02:41:25.840 | of 8 billion people all over an entire globe

02:41:28.920 | are now ours to process.

02:41:30.880 | And our cells and our mitochondria,

02:41:33.760 | there is no escaping it.

02:41:35.040 | They are going to respond to that.

02:41:37.720 | And so I think a big part

02:41:39.840 | of the metabolic health conversation is,

02:41:41.800 | how do we create a sense of safety in our bodies

02:41:47.760 | no matter what is happening outside of our bodies?

02:41:50.400 | And this can come down to,

02:41:53.640 | every person's journey will be different for this,

02:41:55.840 | 'cause the things that cause a sense of threat or fear

02:41:59.120 | for any two people are gonna be different.

02:42:01.200 | And I think some of the main categories is,

02:42:04.120 | one, unresolved childhood trauma,

02:42:07.300 | like something that I think

02:42:08.440 | is getting a lot more talked about these days,

02:42:10.680 | but like what's embedded in our nervous system,

02:42:12.800 | these limiting beliefs and memories that are really wired

02:42:15.560 | that create a sense of hypervigilance in us

02:42:17.320 | sort of all the time.

02:42:18.560 | What's coming in through our devices,

02:42:20.200 | our phones, our computers,

02:42:21.560 | the media that we're exposed to,

02:42:23.400 | that's constantly giving a fear signal.

02:42:25.820 | And I think on a broader level,

02:42:27.820 | a big Western one that we don't talk about

02:42:30.480 | is literally like existential fear of mortality.

02:42:33.880 | We have a very de-spiritualized,

02:42:36.040 | very uniquely death-fearing culture.

02:42:39.160 | Like you look at other cultures, Eastern, indigenous,

02:42:43.080 | the Stoics, they all had intense curiosity about death.

02:42:46.600 | We talk about the cycles of life.

02:42:48.060 | There's this real engagement with it

02:42:51.400 | that we are so afraid of in the Western system

02:42:55.480 | to the extent that our entire healthcare system,

02:42:57.760 | actually, I think, we've built it around,

02:43:01.200 | like we're not gonna help you thrive.

02:43:05.080 | We're just gonna do whatever we can

02:43:06.360 | to make sure you don't die.

02:43:07.680 | Like it's built in everywhere.

02:43:10.120 | And so we've got the devices,

02:43:12.440 | we've got the childhood trauma,

02:43:14.040 | we've got the fear of mortality.

02:43:16.080 | We have a very poor system of mental healthcare

02:43:20.900 | in the culture.

02:43:22.100 | And I think that through all these things,

02:43:25.500 | Americans are getting crushed mindset and psychology-wise.

02:43:29.480 | And that is a big, big trigger of our mitochondria,

02:43:33.060 | essentially diverting resources

02:43:34.540 | towards defense threat and alarm

02:43:36.540 | rather than homeostasis building repair.

02:43:39.540 | So again, it comes back to taking really honest stock

02:43:45.180 | of what are the true fear triggers in our lives

02:43:49.100 | across those and others

02:43:51.020 | and creating a sense of safety in our minds and bodies,

02:43:56.360 | no matter what the external world looks like,

02:43:58.540 | which may mean putting boundaries up to the media,

02:44:02.420 | doing the therapy, doing the different modalities.

02:44:04.660 | What I believe, and I talk about in the book,

02:44:06.580 | getting back to the question about nature,

02:44:08.960 | is one of the best things that we can do

02:44:11.540 | is actually literally just go outside.

02:44:14.860 | And it sounds so simple,

02:44:17.820 | but one of the most astonishing stats

02:44:21.660 | I literally found in researching this entire book

02:44:24.340 | was that the average American is spending

02:44:25.780 | 93.7% of their time indoors.

02:44:28.580 | - Wild.

02:44:29.420 | - 93.7, that's in a car or in a building.

02:44:34.420 | So we are locked in these cages,

02:44:38.620 | staring at fear-inducing media,

02:44:41.100 | and our mitochondria are like, what?

02:44:44.400 | Like, I don't know where to channel my energy.

02:44:46.980 | It's just, it's short-circuiting, I think.

02:44:49.220 | So many things happen when we go outside, as you know.

02:44:51.540 | I mean, even what the vision system

02:44:53.520 | is doing to our anxiety levels.

02:44:55.680 | We are getting sunlight, which of course,

02:44:57.900 | for complex reasons is very helpful

02:45:02.360 | for our metabolic health separately,

02:45:04.060 | entrains our chronobiology,

02:45:06.320 | and light from the sun is an incredible regulator

02:45:11.320 | of our mitochondrial function.

02:45:14.620 | But it also, it's our best teacher.

02:45:18.140 | You know, when we're out in nature

02:45:19.580 | and we really look at how beautiful the world is

02:45:21.940 | and the cycles of nature,

02:45:23.160 | we see the cycles of, you know, the seasons,

02:45:26.580 | and we see the awe of the sun and the trees,

02:45:30.040 | and just all this alchemy that's happening outside of us.

02:45:33.080 | We see, you know, spring to summer to fall to winter.

02:45:36.580 | We see the tides moving in and out.

02:45:38.780 | Everything's in phases.

02:45:40.500 | And I think when we reflect and meditate

02:45:44.160 | on all the cycles and the polarities in nature,

02:45:48.480 | night and day, cold and hot,

02:45:51.760 | new moon, you know, quarter moon, full moon,

02:45:55.500 | you know, all these things,

02:45:57.600 | it's actually, it entrenches on a subconscious

02:46:01.200 | and conscious level that there is a fundamental harmony

02:46:05.880 | and pattern to the world we're living in

02:46:08.120 | that is bigger than us,

02:46:09.320 | and that is fundamentally good and beautiful.

02:46:12.740 | And we are locked inside of the four walls of our house.

02:46:16.500 | I think we get very scared.

02:46:18.460 | We get very controllable.

02:46:20.260 | And the system wants it that way,

02:46:21.860 | because when we are scared

02:46:23.020 | and when we are existentially afraid,

02:46:24.900 | we will literally do anything.

02:46:27.300 | We will buy anything, do anything, watch anything

02:46:30.460 | that will in some way ameliorate that pain

02:46:33.700 | that we're feeling.

02:46:35.420 | And we will take any pill, we'll get any surgery,

02:46:38.800 | anything that makes us feel like we're controlling

02:46:41.760 | this seemingly out of control situation.

02:46:44.440 | And that's what drives us into all the dopamine loops,

02:46:47.080 | you know, the social media, the processed food,

02:46:50.000 | the porn, the gambling, the alcohol, all of it.

02:46:52.520 | It's all to ameliorate, I think, ultimately fear.

02:46:56.880 | And I think, yeah, I think by actually really

02:46:59.400 | just spending a lot more time,

02:47:01.000 | try and get that 93.7% down to like 50%,

02:47:04.040 | spend as much time as you can outside.

02:47:05.760 | We know that people who spend more time outside

02:47:07.920 | are metabolically healthier.

02:47:08.880 | And I think it's from pleotropic reasons.

02:47:11.200 | But I think one of it is that it is the ultimate

02:47:15.040 | convincing of abundance and fundamental abundance

02:47:20.880 | in our world and of awe,

02:47:24.040 | which I think is really the antidote to fear.

02:47:27.640 | And that has a profoundly soothing effect

02:47:31.480 | on our psychology and the sense of scarcity

02:47:35.680 | that drives a lot of the decisions

02:47:37.520 | that actually make us unhealthy.

02:47:40.280 | It's fundamentally rooted in scarcity.

02:47:43.280 | And I think also when we realize we are part of nature,

02:47:47.720 | again, going back to that Taoist statement,

02:47:49.480 | we're a process, not an entity.

02:47:51.940 | Realizing like, you know, all the trees around us

02:47:55.680 | when we take that walk, even in a city,

02:47:57.320 | we see all the trees, all those plants,

02:47:58.880 | all those leaves are making the oxygen

02:48:00.640 | that process, that literally let us

02:48:02.240 | do oxy-phosphorylation.

02:48:03.680 | And that sun and that leaf on the tree,

02:48:06.920 | the sun's energy is literally being stored

02:48:09.680 | in the carbon-carbon bonds that the plants

02:48:11.780 | are generating in photosynthesis,

02:48:13.680 | that ultimately all metabolism is,

02:48:16.400 | is unlocking the potential energy stored from the sun

02:48:19.360 | to create the human energy that lets us love

02:48:21.520 | and move and live and think

02:48:22.920 | and do all the things we love to do.

02:48:25.020 | And then it just becomes so obvious.

02:48:27.720 | Like, of course we have to like eat real food.

02:48:30.960 | And of course we have to not poison our soil

02:48:32.720 | with pesticides.

02:48:33.560 | And of course we have to like, you know,

02:48:35.880 | care about the environment and we have to get outside

02:48:38.120 | and move and we have to be in the sunlight during the day

02:48:39.840 | because we are the environment.

02:48:41.960 | We are a process that's constantly

02:48:44.080 | in dynamic conversation with it.

02:48:47.120 | And I think, I think a lot of people will find

02:48:52.120 | that their health gets a lot better

02:48:53.960 | if they spend radically more time outdoors.

02:48:56.120 | And I think a lot of people might say,

02:48:58.120 | well, I can't, I work on a computer.

02:48:59.680 | And I'm like, you know, Rome is burning.

02:49:02.080 | Like we're sick as hell right now.

02:49:04.080 | We need to get creative.

02:49:05.200 | Like move your computer outside,

02:49:07.920 | take a walking meeting, open your mail outdoors,

02:49:11.360 | chop your vegetables on your balcony at your apartment.

02:49:14.660 | Like we have to find a way to connect back with our source,

02:49:18.360 | understand that the world is abundant and harmonious,

02:49:21.580 | re-entrench the belief in our connection with nature.

02:49:25.920 | And then let all of our dietary and lifestyle strategies

02:49:28.920 | stem from that sense of gratitude and awe.

02:49:31.480 | And that will lead us right where we need to go,

02:49:33.080 | which is a really, I think, joyful experience

02:49:38.120 | of our health journey that's rooted fundamentally

02:49:41.680 | in connection rather than us being siloed

02:49:45.020 | from all of this, which going back

02:49:47.360 | to the beginning of the conversation,

02:49:48.560 | that's fundamentally what's wrong

02:49:49.520 | with the healthcare system.

02:49:50.520 | It's silos and we have siloed ourself

02:49:52.920 | from all of the life-giving things in our environment.

02:49:55.720 | And that has ultimately led us to be very, very, very sick.

02:49:58.440 | And we've just, I think we got to go back outside.

02:50:01.040 | So that's one of the things,

02:50:02.000 | but there's many other things we can do

02:50:03.800 | to change those, our relationship with fear.

02:50:06.820 | But we can't change the world as a whole,

02:50:11.820 | but we can change what happens inside our body

02:50:15.840 | in terms of how we respond to it.

02:50:17.400 | And for our mitochondria's sake, we have to.

02:50:19.960 | We have to create a sense of safety in our bodies

02:50:23.920 | for our mitochondria to do the work we need them

02:50:25.880 | to do for health.

02:50:27.200 | - I love it.

02:50:29.240 | And I love it for many reasons.

02:50:30.920 | I think it was my, I know it was my friend

02:50:35.360 | and former guest on this podcast, Rick Rubin,

02:50:37.480 | who several times early in our friendship,

02:50:39.840 | he said, "Back to nature, the only truth."

02:50:44.840 | And I asked him what he meant by that.

02:50:47.120 | And, you know, 'cause Rick can be a little bit,

02:50:50.200 | I'm cryptic sometimes, not always, but sometimes.

02:50:53.360 | And what he was saying is, you know, it's a real thing.

02:50:55.360 | You know, you can immediately feel the connectedness

02:50:58.200 | between the human experience and life of other types,

02:51:02.920 | plants, animals, you know, sunlight, the circadian rhythms

02:51:06.360 | and the rhythms of light and dark,

02:51:09.900 | because they impact us so powerfully.

02:51:11.800 | I mean, if there were ever a force in the world

02:51:16.800 | that impacts how we feel, it's the circadian rhythm.

02:51:19.520 | It's the rising and setting of the sun.

02:51:21.060 | It's the impact of light and dark.

02:51:22.960 | And then all the other things that you talked about today,

02:51:25.900 | I can't help but reflect on kind of your take

02:51:28.120 | on kind of what a lot of, not all,

02:51:30.960 | but a lot of modern society attempts to do.

02:51:34.760 | It attempts to do a lot of good things too, I believe.

02:51:36.780 | I'm a believer in technology,

02:51:38.980 | but that it, if I were to translate,

02:51:41.260 | it sounded like what you were saying is that

02:51:44.840 | it gives us a sense of loss of control by instilling fear,

02:51:48.920 | like we don't have control.

02:51:50.000 | And then there are a number of,

02:51:52.780 | let's just call them programs in the world

02:51:55.320 | that then sell back the illusion of some sense of agency,

02:51:58.840 | little by little, right?

02:52:00.200 | Temporary agency, and then puts you back into the cycle.

02:52:02.480 | And there's something about going into nature,

02:52:04.160 | which just removes one from all of that,

02:52:07.280 | at least temporarily,

02:52:08.500 | gives you a more basic understanding

02:52:10.320 | of the relationship to self and things around us.

02:52:12.820 | Even just looking, being able to see it to a distance,

02:52:16.240 | we know is powerful for the brain, reducing anxiety.

02:52:19.440 | We know being outdoors for two hours or more per day

02:52:21.480 | reduces myopia and nearsightedness.

02:52:23.340 | This is independent of all the other effects

02:52:25.400 | of circadian rhythms, et cetera.

02:52:28.800 | Anyway, and on and on.

02:52:29.840 | So I second and third and hear here

02:52:34.160 | all the statements you made before.

02:52:37.640 | I also just have to say,

02:52:38.680 | I really appreciate how you are able to

02:52:41.840 | tackle the cellar biology, the molecular biology,

02:52:46.440 | the macroscopic things that we can all do,

02:52:49.120 | walking, resistance training, cold exposure, sleep,

02:52:52.920 | high-intensity interval training,

02:52:56.260 | and make a case for each and all of those

02:52:58.440 | as it relates to the underlying biochemistry.

02:53:01.120 | And weave all that together in a way that then

02:53:04.000 | you beautifully wrapped into this idea

02:53:05.720 | of connecting to nature

02:53:06.920 | and not divorcing ourselves from modern life,

02:53:08.860 | but really looking at the ways

02:53:09.800 | in which certain components of modern life

02:53:11.400 | are really making us sick.

02:53:12.760 | Not just the behaviors, not just the do's and the don'ts

02:53:16.120 | that it's kind of imparting on us,

02:53:18.000 | but also kind of the psychology around it.

02:53:20.980 | It's that it is quietly, but powerfully oppressive

02:53:25.040 | is the message that I'm getting.

02:53:26.720 | And that we have to take a stand against it.

02:53:28.360 | And the way to take a stand against it

02:53:29.680 | is to do what are very basic

02:53:32.400 | and fairly easy to access things,

02:53:34.240 | making better choices about food, timing,

02:53:36.800 | quality, amount, exercise, and on and on.

02:53:40.000 | So I'm running long in my response

02:53:43.120 | to your much more eloquent description of mindset.

02:53:46.880 | But what I wanna say is on behalf of myself

02:53:49.840 | and everyone listening, I so appreciate,

02:53:52.040 | we appreciate the work that you're doing

02:53:54.080 | to be a medical doctor specialized in one of these silos,

02:53:57.140 | and then to take a step out and say, nope, not me.

02:54:00.600 | I'm gonna do what I see as best for the greater good

02:54:03.840 | in terms of giving people tools,

02:54:05.100 | giving people a sense of agency and autonomy

02:54:07.160 | to take control of their health.

02:54:08.680 | This is in some ways a heretical idea,

02:54:11.520 | but luckily the numbers of folks like you are growing

02:54:16.840 | and you're a real leader in this field by example

02:54:20.000 | and by the incredible work you're doing

02:54:21.400 | with technology and information sharing.

02:54:24.040 | Love, love, love the book.

02:54:25.720 | I did go through it front to back.

02:54:28.360 | I haven't tried the recipes yet,

02:54:29.760 | but thank you for bringing the blueberries.

02:54:31.100 | I'll try the recipes, at least one of them.

02:54:33.880 | And I just wanna thank you for sharing what you do

02:54:36.780 | and for continuing to do what you do.

02:54:39.720 | We need it and we appreciate it.

02:54:42.360 | So thank you. - Thank you.

02:54:44.080 | - Thank you for joining me for today's discussion

02:54:45.860 | about metabolic function with Dr. Casey Means.

02:54:49.120 | If you're learning from and or enjoying this podcast,

02:54:51.660 | please subscribe to our YouTube channel.

02:54:53.500 | That's a terrific zero cost way to support us.

02:54:55.960 | In addition, please subscribe to the podcast

02:54:58.200 | on both Spotify and Apple.

02:54:59.960 | And on both Spotify and Apple,

02:55:01.240 | you can leave us up to a five-star review.

02:55:03.440 | Please check out the sponsors mentioned at the beginning

02:55:05.640 | and throughout today's episode.

02:55:07.160 | That's the best way to support this podcast.

02:55:09.640 | If you have questions for me or comments about the podcast

02:55:12.520 | or topics or guests that you'd like me to consider

02:55:14.420 | for the Huberman Lab podcast,

02:55:15.940 | please put those in the comment section on YouTube.

02:55:18.200 | I do read all the comments.

02:55:19.960 | If you're not already following me on social media,

02:55:22.200 | I am Huberman Lab on all social media platforms.

02:55:25.000 | So that's Instagram, Facebook, X, Threads, and LinkedIn.

02:55:29.040 | And on all those platforms,

02:55:30.480 | I discuss science and science-related tools,

02:55:32.640 | some of which overlaps with the content

02:55:34.200 | of the Huberman Lab podcast,

02:55:35.560 | but much of which is distinct from the content

02:55:37.280 | on the Huberman Lab podcast.

02:55:38.580 | Again, that's Huberman Lab on all social media channels.

02:55:41.840 | If you haven't already subscribed

02:55:43.060 | to our Neural Network newsletter,

02:55:44.800 | our Neural Network newsletter

02:55:46.100 | is a zero cost monthly newsletter

02:55:47.760 | that includes podcast summaries,

02:55:49.480 | as well as protocols in the form of brief

02:55:51.440 | one to three page PDFs that cover everything

02:55:54.000 | from learning in neuroplasticity

02:55:56.120 | or how to improve your sleep, optimizing dopamine,

02:55:58.640 | deliberate cold exposure, deliberate heat exposure.

02:56:01.040 | There's a foundational fitness protocol,

02:56:02.760 | all available, completely zero cost.

02:56:04.580 | You simply go to HubermanLab.com, go to the menu tab,

02:56:08.040 | scroll down to newsletter and enter your email.

02:56:10.280 | And I should mention that we do not share your email

02:56:12.280 | with anybody.

02:56:13.320 | Thank you for joining me for today's discussion

02:56:15.040 | about metabolic health with Dr. Casey Means.

02:56:17.920 | And last, but certainly not least,

02:56:20.120 | thank you for your interest in science.

02:56:22.120 | (upbeat music)

02:56:24.700 | (upbeat music)

Dr. Casey Means: Transform Your Health by Improving Metabolism, Hormone & Blood Sugar Regulation

Chapters