Dr Paul: "Health Influencers are Liars" | The truth on testosterone, nonnutritive-sweeteners, Ozempic, fitness, vo2max, seed oils, rapamycin, and carbs - The Nick Standlea Podcast

Episode Transcript
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(00:00):
Coming up on the Nick Stanley Show. Health influencers promise these massive
results with very little effort.
How can we identify who's telling us the truth and who isn't?
We really don't need to look any further than exercise, as unsexy as that sounds.
Seed oils is a hot topic right now. There is a toxic dose in which it will cause cancer.

(00:22):
VO2 max, non-nutritive sweeteners, rapamycin. I don't have anything against carbohydrates.
Ozempic good. Is Ozempic bad? What are your thoughts on testosterone supplementation?
Dr. Paul, welcome back to the show. Should we be getting our health information

(00:42):
off of Instagram and TikTok?
A few months back, I decided I wanted to check out a health expert that I really
admire to see what sort of content he was putting out.
And after I got off this site, I was hit with all of this misinformation and
half-truths coming from every direction. It just blew me away.
Right? I'd go to this one guy's site, and he'd have over 200,000 followers.

(01:07):
And I'd go to this girl's site, and she'd have like 2 million.
And I was hearing things like, you must eat organ meat, and carbohydrates will
kill you, and non-nutritive sweeteners, and seed oils are the devil.
And every man must be on testosterone and no women should be on hormone replacement
therapy and so on and so on.

(01:29):
It just killed me. So those things are not true?
No, they're not true. And hopefully we'll get into that in a bit. Let's start with...
How we can identify who's telling us the truth and who isn't.
What are the telltale signs of somebody who's BSing their way through health information?

(01:52):
Well, a lot of these health influencers use a lot of different tactics, right?
They promise these massive results with very little effort.
Yeah. They like to use these big sciencey words like microbiome and mitochondria and autophagy.
These are things I don't even think they know what they even mean, right?

(02:14):
They like to pray in areas that we just don't quite understand.
They do a lot of different things. They use superlatives all the time.
It's the best or it's the worst.
You always have to do this or you never ever have to do it.
They talk about single mechanisms instead of like looking at overall big outcomes.

(02:34):
Right. And trying to understand what a true expert is, is sort of counterintuitive
because true experts usually aren't that sure of themselves.
They usually use words like maybe and it depends.
And sometimes they even say, I don't know. Yeah. Right.
They understand that there's a lot of nuance in the questions that are asked,

(02:56):
that things aren't typically black or white, that a lot of things live in the gray.
If they won't go to the gray, stay away. I feel like so many people,
when they don't know where to get information, go with the follower count, right?
If they have a million followers, they must know what they're talking about.

(03:19):
Is that true or not true? Well, no, I mean, I think that's what's so difficult
about things today, right?
So all of a sudden, anyone, there's no barrier to entry.
Anyone can have a platform. form. And then all of a sudden, once you have a
ton of followers, you have credibility.
I mean, did we not learn anything from the liver king? That makes absolutely no sense.

(03:41):
Well, let's clear up some misconceptions.
Where should we start? With all this misinformation and half-truths out there,
it's very easy for people to get lost in the weeds, especially regarding the
hierarchy of importance regarding health and longevity.
So I'm an ER physician and I deal with life-threatening, life-ending illness every shift.

(04:04):
But a big part of my job is really understanding the hierarchy of importance, right?
So it's like, do I go see the guy that just got stabbed in the chest?
Or do I see the woman that has a tampon stuck in her vagina, right?
Do I go see the lady that's having this acute ischemic stroke that can't speak
or can't move the right side of her body?

(04:25):
Or do I see the kid with a bead stuck up his nose? Right?
Now, what do you do if you have to choose between the kid with the bead up his
nose and the lady with the tampon?
I'd probably go with the bead. Okay. Yeah. I'd probably try to see the kid first.
Okay. Okay. Fair enough. But continue. Try to get the parents out of there. Right. Yeah.

(04:46):
Yeah. And then there's a guy with penile discharge. So he'd probably be after
that. Okay. You know. Okay.
But anyway. Anyway, so, regarding the hierarchy of importance.
If we want to get out of the weeds, if we want the biggest bang for our buck,
we really don't need to look any further than exercise, right?
As unsexy as that sounds.

(05:08):
But if we look at all-cause mortality, like by far the greatest lever that we
can pull is on the exercise front, right?
If we look at two parts of exercise, VO2 max and strength,
if we look at VO2 max and we we compare those that are at the bottom 25th percentile
compared to those that are the two and a half, top two and a half percentile,

(05:30):
basically the elite group,
there is a 400% decrease in all-cause mortality.
I mean, that's massive. If we look at strength, those that are at the bottom
compared to those that are at the top, there's a 200% decrease in all-cause mortality.
I mean, those are massive numbers and we should compare those to understand

(05:50):
what we're talking about to the things that we understand affect all-cause mortality,
right? So let's talk about diabetes.
Let's talk about blood pressure. Let's talk about smoking. Those increase your
risk of all-cause mortality by 20 to 40%. So let's look at smoking.
What's the increase in mortality for smoking? Smoking is about 40%. Okay.

(06:11):
But there's a 400%, a 10X difference based on VO2 max.
Yes. It's the greatest lever we can pull regarding mortality.
Right. 100%. Now, real quick, will you explain what VO2 max is?
Yeah. So VO2 max is basically the maximum amount of oxygen our body can uptake

(06:33):
during intense exercise.
Okay. And basically, it's just the greatest predictor of cardiorespiratory fitness
and basically aerobic performance.
And how do I improve that? that. There's lots of ways to improve it.
But so basically, what we need to do is do you need to do two different things.

(06:54):
So you need to first get a very strong aerobic base.
And then you also need to do targeted interval training.
So when you're talking about the aerobic base, that's really like zone two type training.
So you're pushing the mitochondria in your slow twitch muscles to the absolute
maximum, you're like redlining them.
Okay, so this correlates with basically, if you If you like numbers like I do,

(07:16):
it correlates with a lactate of like one point five to one point nine.
But you could also just look at your maximum heart rate and take 70 percent of that.
And if you're wearing a fitness tracker, you can just go off that heart rate
or you can use something called relative perceived exertion,
which is basically just.
You're exercising at a point where it would be difficult to hold a conversation.

(07:39):
So that would be your zone two training. So you need to do that.
But let's let's talk about something else real quick. So zone two training is
actually imperative for people that are metabolically ill, because as we become
metabolically ill, our mitochondria actually become reprogrammed.
And in this reprogramming, right, we need to actually force them to start working normally again.

(08:01):
And so this type of exercise actually puts such a strain on them that it makes
them work efficiently again, allows us to grow more of them and allows our mitochondria
to become bigger. So they just become more efficient.
So that's zone two. And then the targeted interval training.
So we're not talking about intervals that you do at your like your typical CrossFit

(08:21):
box. They're going to be longer.
We're not doing the Tabatas or the hits, the 20 seconds on, 10 seconds off.
They're longer. It's like three to eight minutes at a time.
So the protocols are probably the
best data behind them is going to be the Norwegian four by four protocol.
So you basically do four minutes on three minutes off.

(08:43):
You do that four times. So it's 16 minutes total work, 25 minutes total time.
And like, whoa, does that improve your VO2 max?
Like it blows me away, right? How much that improves it. So I was on the Ironman
circuit like, I don't know, three or four years ago.
And I did most of my training through basically just the moderate intensity

(09:06):
exercise, more of it just through all of the zone two.
But I just wish I would have incorporated more of these targeted intervals because,
I mean, it just improves your fitness just exponentially.
It's amazing. Yeah, when I was in playing college soccer, there was a training regimen.
It was a Swedish invention, but the Swedish national team was using it and it

(09:32):
was a it was a full sprint around the track and then you walk a lap and then
you sprint a lap, walk a lap.
You do that four times and then it was three fourths of the track in a sprint
and then walk three fourths of it.
Do that until you had gone
four times and then half the track and
then a quarter of the track and then you wind down with just

(09:55):
walking two laps at the end nothing built
fitness like that interval training which sounds quite similar and you when
you do this now do you do it on a on a bike or do you do it running does it
matter no i do it on a peloton typically yeah so there's There's different ways
to basically figure out what your VO2 max is, right?

(10:16):
So you can either go to like an exercise physiology lab if you're special.
If you're rich, you can buy like an at-home monitor called the VO2 master. Or you can just do it.
You can just basically choose any activity you want. Most people choose running
and they'll run for 12 minutes as
hard as you can, as far as you can while wearing like a fitness tracker.

(10:39):
And you basically just see how far you went. And then you put that into an online
calculator and it spits out your VO2 max.
OK. And so another reason why this is so such an important thing to look at,
because it can give us basically a glimpse into the future of what our life might look like.
OK. OK, so there's these evidence-based graphs that have VO2 max on the y-axis and age on the x-axis.

(11:05):
So like taking me for an example. So my VO2 max is above 50 right now.
And so that puts me in the elite group for my age. But I'm not elite at anything
anymore. I'm just simply trained to achieve that metric.
But if you look at the graph, I can plot myself out. And then I can look at
20, 30, and 40 years and see what I'll be able to do during those times.

(11:28):
So when I'm 80, I should be able to carry heavy loads upstairs and be able to
walk briskly up an incline.
So if I can do that when I'm 80, I'll be happy.
But if we look at someone that's at the bottom quartile, at the 25th percentile, right?
So right now their VO2 max is probably, if they're 40, their VO2 max is probably around 36, 37.

(11:52):
That means that they're able to run about a 10 minute mile. Okay.
Let's look at them in 40 years. What are they going to be able to do?
They are going to have difficulty walking on a trail and they might be able
to walk on flat surfaces.
Now, those two endpoints are distinctly different. Yeah.

(12:12):
And I think this is an exercise that everyone should go through.
We should think about the things that we want to be able to do at the end of
our life and look at the VO2 max that that requires and then basically reverse
engineer it and see where we need to be now, right?
And I think most of us will be shocked because.

(12:32):
We'll realize that most of us are heading for a nursing home,
right? We're going to be bed bound and just hanging out in bed all day.
And some people say, that sounds great. I'm just going to be in bed and watch TV. Sounds great.
But I mean, I work at a small community hospital that just happens to be surrounded
by numerous skilled nursing facilities and nursing homes.

(12:52):
I have never met one patient that is stoked to be in a nursing home.
So if you want to be able to do adventures, if you want to hang out with your
grandkids, if you want to travel,
if you want to be able to lift up your wife's suitcase while you're traveling,
you know, you're going to have to have a much higher VO2 max than you think you need.

(13:14):
Right. It's going to it's going to require you having an above average VO2 max
for your entire life to ensure that you're going to be able to do those things
that you want to be able to do in the future. Sure. Dr.
Paul, that sounds really hard. Now, look, I like to exercise.
I enjoy it. It gets my head right.
So it's not hard for me to get into the gym. But what would you say to all the

(13:37):
people that hate exercising?
And you're saying this is a longevity hack.
Getting out there, running, biking, putting in that time and energy is going
to achieve the biggest bang for our buck in terms of longevity and increasing our health span.
But what about all those people that just say, man, it would just be so much

(13:58):
easier to buy something on the internet that I saw on TikTok.
It'd be easier to get an injection of something, whether it's a weight loss drug or testosterone.
What do we say to those people? I realize that this is not sexy, right?
But I think we have to to stop looking for the shortcut, for the hack,

(14:20):
for the easy road, because I don't really think there is an easy road.
Those sexy routes aren't going to get you stronger. They're not going to get you healthier.
They're not going to get you faster, right?
It really comes down to sweat, repetitions, hard work, and discipline.

(14:40):
I mean, when we look at the difference and the difference in all-cause mortality,
it is obvious that exercise is the longevity hack.
Like there is nothing else that even comes close to those numbers.
When you have a 400% decrease in all-cause mortality, and when you're comparing

(15:02):
that to diabetes and high blood pressure, and that's 20 to 40%, I mean, come on.
If you wanna live long, if you wanna be healthy, if you want to be free from
suffering in the long road.
It's exercise. And it just kills me that people argue about this supplement

(15:22):
versus another supplement or this nuance of their diet versus this nuance of someone else's diet,
because those things just barely move the needle.
If you want the biggest bang for your buck, if you want to get out of the weeds, it's exercise.
Well, that poses a problem for the influencers because then you don't have content.

(15:45):
To get people upset about. You don't have content to just fill the need of the
algorithm to just keep talking about this supplement versus that supplement.
It's hard to build a 1 million follower Instagram account if you're just going
to tell people to do the right things, like get out there and exercise.
It is tough. And it's even more tough because people are sodium tribal in nature nowadays, right?

(16:09):
Yeah. Everyone just wants to tell everyone else. They They feel like it is their
destiny to tell everyone else why what they're doing is the best and why what
everyone else is doing is the worst. Right. Yeah.
Yeah. It sort of destroys their whole platform.
But I mean, we have to get out of the weeds. We have to start realizing where
we need to put our energy, where we need to put our focus.

(16:32):
My point here isn't for everyone to be thin or whatever. My whole point is for
us just to be metabolically healthy and to be free from suffering.
I have this interesting view into the world being an ER doctor,
right? So I deliver babies and I pronounce people dead.
But I see what happens to people midway through when they are metabolically

(16:56):
unhealthy and they have visceral fat on board.
It just causes nothing but suffering. What I want for people is for their health
spans to be long, and then they have this sharp, steady decline at the end of
their life towards a peaceful death.
Who wants a very short health span within this decline that's slow and painful

(17:19):
and full of suffering? Like, that's not what we want.
But if we keep on going in the same trajectory, that's where we're headed.
And I'm just generally concerned about the population at large because it's
just not looking so good.
I heard a good one the other day from Scott Galloway, who, you know,

(17:42):
I've become a very big fan of recently, hoping to have him come on the show.
Come on, Scott. Let's do it.
He said, show me someone who sweats more than they watch people sweat,
and I'll show you somebody who's in shape. and probably feels good and is enjoying
their life. I thought that was a man.

(18:03):
And that's what I dig about him is he will get things down into these pithy one liners.
And it just made me think about, OK, how much are you exercising versus how
much are you watching people exercise on TV?
100%. Yeah. Let's talk about strength, because that was the other big hack that you had.
That was a 200% decrease in all mortality. All cause mortality.

(18:26):
Yeah. All cause mortality. And when you say that, let's unpack that real quick.
What is all cause mortality?
Basically, deaths from every cause. So, I mean, that can be broken down into
like cardiovascular mortality or cancer-based mortality or metabolic-based mortality, right?
Those are all like subgroups within that. But we're talking about all deaths, all comers.

(18:50):
So you're saying the data is showing you that if we do strength training and VO2 max training,
that is functions like a prophylactic against not just heart disease, which we might expect,
but also things like stroke and other causes of death that we wouldn't think

(19:12):
are directly related to our physical fitness.
So cardiovascular disease is the number one cause of mortality in the world, right?
20 million people die per year of cardiovascular disease.
And so a lot of people will think, well, obviously VO2 max or getting a great
cardiorespiratory fitness is going to affect my cardiovascular health.

(19:35):
And that's probably why it affects all cause mortality so strongly.
But it goes way beyond that because as we get older, there's all these things
that come in life that are these unexpected stresses, right?
Whether we have a surgery or we have to undergo chemotherapy or we have a respiratory illness.

(19:56):
And what having a strong and elevated VO2 max allows us is it gives us basically
this reserve, this reserve to be able to produce energy during During times of stress,
during times of need, to be able to combat those things that are unexpected
and allows us to get through those things and be able to tolerate that surgery,

(20:20):
to be able to tolerate that chemotherapy.
Okay, I had a strength plan to all of this. Okay. So, regarding strength.
So, a major impediment to...
Are just daily living is the age-related decline in muscle mass,
also known as sarcopenia.
So when I talk about impediments, I'm just talking about like being able to

(20:43):
go to the restroom or getting in and out of bed, right?
And so getting in and out of a car, getting in and out of car,
getting up and down stairs, whatever.
And so a lot of people think that this is an issue for the distant future. Like, yeah, I'm 43.
I don't need to worry about that now. I'll worry about it later, right?

(21:04):
But the problem is we start losing our strength at age 40.
We start losing 1% of our muscle mass at age 40.
And we lose things like speed and acceleration and power even exponentially
earlier and faster, right?

(21:25):
And this can be seen in professional athletes that happen to compete in,
you know, power and speed type sports.
I mean, they're weeded out in their late 20s and early 30s.
And that's because the aging process is already taking root. This muscle decline.
And we talk about basically movements that require strength.

(21:48):
Strength we're talking about the loss or the atrophy basically
of type 2 muscle fibers these are the strength type fibers
which is in opposition to our endurance or like type 1
fibers so we start losing these fibers at
about 40 and some people think that this is due to that this is just simply
inevitable i don't think so i think it's basically due to this vicious positive

(22:14):
feedback loop of inactivity and deconditioning.
So basically meaning that it's just because of a lack of stimuli.
I mean, we have seen in paper after paper that older people are still able to
develop and maintain muscle mass throughout their life. So it's not that it's inevitable.

(22:35):
It's that we're just not working hard enough.
We're not giving our bodies the stimuli to maintain our lean mass,
to build muscle mass. And if we want to maintain a healthy life that's free
of suffering, I think this is pretty important.
And as we enter the middle ages of our life, you've got a career requires a

(23:00):
lot of sitting, usually.
If you're working in an office, you've got kids for many people and suddenly
your time is really constricted.
But you're saying if you want to continue to feel good and live healthy, make this a priority.
You've got to make time like I mean, the way I do it is I wake up early and

(23:24):
I get all of this done in the morning before anyone else is awake. wake. Right.
And I think, I mean, there's some people that are, you know,
that are early risers and some that go to bed late, but I just really see that
doing it early makes sense because.

(23:44):
There's nothing that gets in my way of getting that workout done.
Right. There's no one that needs help. I don't need to make lunches.
I don't need a whatever, help someone with homework. work.
I'm not dealing with fighting kids or whatever. But if you wait till the end
of the day, I mean, I think that's when things sort of go off the tracks, right?

(24:06):
You come home and it's like, or you had a hard day at work and you got in traffic
and you come home to a messy house and you come home to a wife that's not happy with you.
There's a pretty good chance you're probably not going to get that workout in, right?
So I like to get it done in the morning. But whenever you want to do it.
Yes. It's just about building habits.

(24:26):
It's about becoming a person that exercises.
It's about forming a new identity.
It's just about doing it. People like to analyze, analyze, analyze,
and then they're just paralyzed and then they get nothing done.
Right. It's like, we've got to be impatient with action and then be patient

(24:46):
with the results. We've got to just do.
So get out there and exercise is the number one message here.
100%. Yeah. Okay. If we get into the specifics of that exercise,
let's talk about what type of strength training should we be doing first.
To achieve these good outcomes. Yeah, I mean, regarding strength training,

(25:10):
I like to take a personal, like just a balanced approach.
I don't think we have to do, it doesn't have to be a ton. It can be a couple
times a week, you know, three to five sets of three to five different exercises,
you know, change it up, make sure you're hitting your arms, make sure you're
hitting your legs. I personally really like compound movements.

(25:31):
So, I mean, I like to do bench press squats and deadlift, but you don't have
to do that. You can do machines.
You can do isolation type exercises.
It's just, you know, achieve a balanced approach.
I don't think there's any magic formula to it. It's just put stress on your
body, work those muscles and
try to maintain your muscle mass and hopefully gain some along the way.

(25:55):
How often do you lift?
I lift four times a week. How long is each workout? If I want to look like you. I'm not a normal person.
I do a lot of sort of bizarre things, right? So I wake up, I go downstairs, I get a cup of coffee.
Usually I'm woken up by the dogs. So they're jumping on my chest.

(26:15):
And that's usually around four o'clock, right? I don't really have much sand when I wake up.
Go downstairs, grab a cup of coffee, go out to the garage.
And then the dogs and I go on what I call a rough and ruck.
Right. So it's basically I'm just walking the dogs, but I'm rucking.
So I put a backpack on with weights in it. Usually it's like three to five miles.
If it's a weightlifting day, then I'll train with weights.

(26:37):
And usually that's an hour to two.
I'll usually hit some sort of aerobic type conditioning, you know,
either hit zone two or do some targeted intervals.
And that's four times a week. And on the other three days, I'll do things like
yoga or just do the Peloton or things like that. But I try to be active every day.

(26:57):
The only days that I'm not active are days that I'm coming off of overnight
shifts because it's just too much stress on my body.
So those are my 100% day off. I just lounge and sleep.
Okay. And the rucking is not...
Your aerobic activity. So you do the ruck, the lift, and then onto the bike.
Yeah, so I, yeah, again, I'm not normal.

(27:18):
But yeah, so I ruck, and right now I'm rucking with 130 pounds in my pack,
and I try to walk as fast as I can with that.
It probably looks like I'm walking the speed of someone that's,
you know, 20 years older than I am, but I'm trying to push it as fast as I can.
And yeah, that, it actually does work me aerobically pretty well.
Well, by the end, I'm exhausted and it's hard for me to breathe.

(27:41):
If somebody wants to start rucking because there's a lot of research coming
out, it's a relatively new trend.
And I have seen lately some research showing it has a T as big on it,
that there is there are massive benefits to your health from rucking.
Obviously, we can't all start at 100 plus pounds. Oh, I wouldn't.

(28:02):
No, I think you start at like 10 or 20 pounds. Yeah. OK. Yeah.
I really love the Go Ruck brand. I mean, it's just, it's amazing. It's very tough.
Like I've had no problems with it whatsoever.
And you just start small, just throw on the backpack, throw on a little vest
and, you know, go for a one mile walk and see what's happening,
you know, and try to hit some hills and try to walk hard.

(28:25):
And you'll be like, whoa, this is pretty intense.
And it really helps a lot with your stability as well, which is what I I really
like because the dogs are going to pull me in every direction.
And in the morning we see coyotes and we see skunks and so they're going crazy.
And so it just really helps with my stability too.
Okay. So if we're looking big picture, we're not getting lost in the weeds on

(28:48):
individual supplements.
You talked about that hierarchy of impact, things that are really going to make a difference.
What else is on that list? Top five or six or seven things.
So if I had to go over my hierarchy of
importance it would start with exercise it would be workout
often workout hard workout vigorously focusing on vo2 max and strength it would

(29:13):
be eat a energy balanced diet based on real food avoiding energy toxicity and
diabetes it would be do not smoke.
Significantly limit your alcohol intake, do something to manage your chronic
stress, and ensure that you're getting enough quantity and quality of sleep.

(29:39):
And I think if you do all of those things, then you're 95% of the way there, right?
That's the lion's share of the things that we need to worry about.
And if you do all those things, then we can worry about that other 5% and we
can get into supplements and other things.
But until you have those things covered, like I've said before,

(30:02):
it makes no sense to debate over this supplement or another or this part of
your diet versus another because it just doesn't matter, right?
It's just those things just move the needle so little compared to these big movers.
On this hierarchy, you mentioned diet.
Now, one thing in doing a little research for this, I noticed a lot of these

(30:22):
health influencers talk about calories in, calories out is not a real thing.
In fact, several of them say calories are not a real thing.
What do you think about that? I think it's absolutely unbelievable, right?
I mean, calories are a real thing. They're just simply a unit of measurement.

(30:44):
It's like saying gravity isn't real or seconds on a clock aren't real, right?
Calorie is just the unit of energy it takes to heat one gram of water by one degree Celsius.
And when we talk about calories referring to food, it's just referring to the
potential energy that's stored in the bonds of food that through digestion and

(31:07):
metabolism and absorption, we're able to basically capture that energy.
So it doesn't make a bunch of sense for us to just store a bunch of ATP in ourselves, right?
Because ATP is just too highly reactive and we would just have a bunch of micro
explosions going on all the time. So that doesn't really make sense.
So we need to store this energy in glycogen and in triglycerides,

(31:31):
which are the storage form of fats and carbohydrates.
A lot of these guys, they've actually come out and said that this is created
by the food industry, right?
That the food industry wants people to feel like they are gluttons and sloths.
And when these influencers say things like that, that really gets me going.

(31:56):
And I take it personally, right?
You are not a glutton or a sloth because you're overweight.
All that it means is that for your level of energy expenditure,
you have exceeded that in your intake. It's just simple math.
I mean, the last time I checked, math isn't judgmental, is it?
It depends on who you ask these days.

(32:18):
But we as humans insert that judgment, right?
I mean, I know that when I was obese, when I was overweight,
when I weighed in the mid 300s, I didn't wake up every morning and say,
I can't wait to eat as much as I can and sleep all day.
No. I mean, I was playing college football. I was extremely active.

(32:41):
I had decent cardiorespiratory fitness.
I had excellent strength.
All that it meant was that I ate more than I burned.
There's no judgment there. It's just math. Yeah. You know?
So, I mean, we can dive into calories in, calories out a little bit if you want to.

(33:03):
Because even though people think that this sounds so simple,
it's just calories in, calories out.
And a lot of times people equate simplicity with things being easy.
But unfortunately, this is neither simple nor easy.
It's actually complicated and difficult.
Because basically, as we decide that we're going to calorically restrict,

(33:26):
as we're going to decrease our calories, our genes,
our body, our biology basically fight against us and try to decrease our caloric
expenditure, right? Right.
In the past, starvation has been our biggest issue and our genes are basically
wired to fight like hell against starvation.

(33:47):
And when we talk about restricting calories, that's basically just controlled starvation.
And so, of course, our body's going to fight like hell against us.
Right. That's the way that we're wired.
And it's only the last 50 years or so that we've had to deal with all of these
excess calories since this processed food revolution.

(34:08):
And our genes and our bodies just don't know how to handle it. Right.
And so what makes this even more difficult is that.
People think calories in, calories out. It sounds like it's static and independent,
but they're actually dynamic and independent, right?
They move upon each other. So as we try to change this energy balance,

(34:32):
our body actually does things through physiologic adaptations to try to make
us either maintain the same weight or get back to the weight that we were at
previously through things like metabolic adaptation or constrained energy theory.
I mean, it's just Just wild how hard our body will fight against us to try to

(34:52):
get us back to our baseline weight or to the weight that we were previously.
I mean, I remember this feeling so well when I was overweight.
So I hurt my knee playing college football.
I came home, decided I was going to lose all the weight.
And I remember sitting upstairs in my bedroom in my parents' little townhome.

(35:14):
And I just felt horrible, right? I felt hungry.
I felt tired.
I felt lightheaded. I felt nauseated.
And I think you can look at these things in one of two ways,
right? You can either rejoice in it or you can hate it.
And I just decided I'm gonna rejoice in this feeling because I can actually tell that it's working.

(35:41):
So to recap that humans evolved over tens of thousands of years where we did
not have access to an abundance of food.
So we had a natural curb on the amount that we would eat.
It was nature's way of keeping us in shape. Plus, we're moving a lot more.

(36:03):
Is that correct so far? Yes. Okay. So then now that we do have this massive
abundance of food and it's made even worse by over-processed and ultra-processed foods,
which we can get into in a bit,
we're now at a point where when we try to use controlled starvation,

(36:26):
as you put it, try to diet, try to restrict
our calories, our body is actually going to fight back against that and try
to return us to the weight we're at.
And that's why it's so difficult to lose weight, so painful to get into the
shape that we want to be in.
But one hack for that is to when you start to feel horrible as a result,

(36:49):
that's how you know it's working.
That's the type of pain we can lean into a little bit. You can lean into it a little bit, right?
It just sort of takes that stoic principle of reframing, right?
You can either hate it or you can love it.
It's going to be painful and it's going to be hard.
It just is. How long does it take for our body to reset what that baseline is, right?

(37:14):
Because you used to be well over 300 pounds. So you had this transition period
where it is making you feel sick to lose weight.
You're obviously in tremendous shape now, nowhere near 300 pounds.
Your body's not fighting you anymore to get back to that baseline.
How long does it take to shift your baseline?

(37:37):
It's not exactly clear.
I would say that I am still not...
Totally back. Like it's a constant struggle, right?
So I still, to this day, have to restrict something.
And that's the key to any type of weight loss. You have to restrict something.

(37:57):
So you can either restrict based on overall calories and do caloric restriction.
You can do something called dietary restriction, where you actually restrict
like a macronutrient, either carbohydrates or fats, or you can restrict through time.
I've decided that I restrict through carbohydrates. I don't have anything against

(38:17):
carbohydrates. If you're metabolically healthy, carbs are fine.
But for me, it's the easiest way to restrict.
And I think that is the key to diets. And that's what has been shown repeatedly.
It's been shown repeatedly that all diets are equally horrible at losing weight.
The key is adherence and consistency.

(38:40):
So for me, restricting carbohydrates is not hard. And so that's what I do.
So I restrict carbohydrates to this day. And what I like about that is that
sort of a gateway to me restricting processed food as well.
And so I think that's really helped me out. But I think if I was just let myself

(39:00):
eat ad libitum, I would probably be 270, 280 right now.
I would guess if I just let myself eat all that I wanted.
Let's talk about processed foods for a second.
What role do they play in all of this? A study by Kevin Hall came out in 2019,

(39:24):
which basically showed that if you had people that just ate regular food,
ad libitum, and processed food,
ad libitum, the people that ate processed food actually ate 500 more calories per day.
So these foods, and I don't think we understand exactly what it is.

(39:46):
It's probably a combination of things. It's like, it's not just the sugar.
It's not just the fats. It's not just the salts.
It's probably a combination of those things with the mouthfeel, with the texture.
But they've basically just been engineered by these geniuses in the food industry
to make us want to consume more.

(40:07):
You really want to make sure you're focusing on getting enough protein and enough fiber.
And sometimes those processed foods don't have those in them.
But is there anything inherently bad about those things that are making us sick?
I don't know. But they make us definitely consume more.
And it is then that energy toxicity, the excess in calories, that leads to issues.

(40:32):
Why is gaining fat so bad for you? Right? So...
You can actually store fat in two different places. You can store it in your
subcutaneous space or you can store it in and around your viscera.
And subcutaneous would be under the skin.
Yeah. So subcutaneous is just below the skin.
This is where we evolved to store excess calories.

(40:53):
This is the safest place to store calories, even though it's not like aesthetically
or culturally pleasing to some people.
Or you can store it in and around your viscera. So actually like inside or around your organs.
And once the fat gets to inside and around your organs, that's when we have metabolic problems.

(41:15):
That's when we get lots of inflammation.
So Peter Atiyah explains this in like this bathtub analogy where calories in
is basically the faucet from a bathtub, the water coming in,
and then the calories out is going to be the drain. And right.
And we have this bathtub. tub. So when calories in exceed calories out,

(41:36):
that bathtub starts to fill and everything's fine, right?
We can have subcutaneous fat and it's not a problem.
Everything is fine until that bathtub starts to then overflow.
And then that water starts to hit the floorboards and destroy other parts of the house.
And that's exactly how it works with our visceral fat.
So everything's fine as long as we're just storing it in our subcutaneous space.

(42:00):
But once that starts to overflow into our viscera, that's when we have the problem.
And an important thing to say is that not everyone that is obese is metabolically ill.
Because we have different fat storage capacities, which is usually based on genetics.
So those that are Asian have a much smaller fat storage capacity than Caucasians, let's say.

(42:24):
And I think this needs to be a major wake-up call for people,
right? Because if we look at the numbers...
40% of people are obese, but 90% of us are metabolically ill. 90%?
Yes. Wow. So even though you may look in the mirror and be like,
oh, I look pretty thin, you may have a lot of visceral fat that is causing a lot of harm.

(42:51):
So we've got to pay attention, and it's important to understand our underlying health.
How do we identify that? I mean, if I'm someone who's thin and I have a lot
of visceral fat, which again, just to be clear, means fat in and around the
organs, how would I know?
You can get something called a DEXA scan. It's basically like an x-ray and that

(43:13):
can basically partition out where your different modes of fat are stored basically.
And that's a simple test. It's usually done in the elderly population.
It's what looks at sort of the density of your bones to tell you if you're getting,
it looks at your lumbar spine and your two hips to see if you're basically getting
osteoporosis or osteopenia.

(43:35):
But another thing that it does is it can look at different areas where we're
accumulating fat and then also give us an idea of how much muscle mass we have.
And then that, and we can use then our measurements and then compare them to
known metrics and then see where we sort of line up.
Okay. Now I have Kaiser insurance. Good luck.

(43:57):
Yeah. If I go in there, will they give me one of those scans?
Probably not unless you're 65.
Okay. But they're not expensive. It's like a hundred bucks to go to a,
to go get it done. Okay. And an independent operator.
You can just talk to me and I'll write you a script. Okay.
There we go. What would those independent places be called?
If I wanted to search one on Google, do I need a... I would just search like

(44:21):
DEXA scan near me. Okay. And then it will pop up and then...
OK, most of the time you'll need a prescription. But a lot of times,
I mean, a lot of these places have workarounds where just like with,
you know, testosterone treatment, you just sort of see a doctor, but not really.
And they just sort of get you a script in there. So, OK, and for anyone who's
interested, that's D-E-X-A.
OK, how concerned do people need to be about the possibility of this viscera fat?

(44:48):
If I am keeping up on my strength training,
keeping up on my VO2 max training, should i be
worried about that or am i probably in good
shape oh you're probably fine you're most
likely fine if you are following my hierarchies of importance right if you're
exercising hard and vigorously and often and you are basically consuming a diet

(45:13):
based on real food and avoiding avoiding energy toxicity and diabetes,
then the likelihood of you having a lot of visceral fat is very low.
Okay. For those that are concerned that think they may be on the border that
are looking at their blood markers and they're just not quite what they want to be.

(45:34):
If you're having problems losing weight, so on and so forth.
And I would get the DEXA to really see. You mentioned smoking and alcohol in
there among that hierarchy of impact.
I'm just going to keep calling it that the was smoking and alcohol.
How much is too much? How do we know if we're exceeding where we should be?

(45:59):
I don't want to just leave it at a feeling if I have.
I mean, obviously, you shouldn't be a regular smoker. let's just say I have
one cigarette a week, one cigarette a month, one cigarette a year.
Where do we cross the line of too much? You cross the line at one.
Yeah. Okay. One is too much. Smoking has been shown to be detrimental.

(46:24):
It doesn't matter how much you do it. You shouldn't do it at all.
And the same actually goes for alcohol.
I mean, there used to be this thought about the French paradox,
right? That alcohol could extend your lifespan or whatever.
But that's pretty much been debunked now in the literature.
And the literature shows that even one drink is toxic to you.

(46:48):
And I know that alcohol is such a big part of many people's lives, right?
So it's hard to say, don't drink it all.
I think if you're having like one drink a day, that's probably fine. wine.
But anything more than that, you have to realize that alcohol is a poison.
You're not getting any benefits from it.

(47:10):
Now, there's some people that
use it for stress release and to try to feel better after a hard day work.
And if you're just having one drink, that's fine. But if you're having two,
three, four, five, then you just have to realize that it's causing.
Problems to your health and it's toxic to
you what's the difference between let's say

(47:30):
i don't have one drink a day let's say i don't drink until all
week until saturday but then i have three drinks
is that the same or different than say one drink a day i'm not exactly sure
what the literature says on that but if i had to guess i would say it was better
to space them out i I recently watched Tim Ferriss on the Chris Williamson podcast,

(47:54):
which I am a big fan of.
Guy does great work. His team does great work.
And they were discussing alcohol and the tradeoff between optimum health,
which would be zero alcohol, and then the upside with alcohol in a social capacity.
He said, I don't drink very often, but getting together with some friends over

(48:19):
dinner and having a bottle of wine is this special experience for us.
I thought that was a nice take on it and jived with what you had written on
the subject in terms of there are no easy fixes.
There are just tradeoffs between different things.
Can you talk about tradeoffs in general when we're looking at these different pieces of our health?

(48:44):
The way that I like to look at things when we're talking about taking a supplement
or a medication or doing other some sort of intervention is that we have to
realize that there are very rarely like true solutions that are going to solve everything.
Everything has tradeoffs and there's almost always a downside to everything, right?

(49:05):
We need to look at the risks and the benefits and the probabilities of each.
I think it's very difficult for people to understand that two opposing truths can both be true. Right.
So let's take like the COVID vaccine, for example. Right. Let's get into trouble.
Yeah. People hate COVID. We hate the COVID vaccine.
Everyone's going to get upset as we discuss this. Yes, 100%.

(49:27):
Perfect. I'm sure people will hate me after this, but that's okay.
I just can only be who I am.
So COVID and politics are the two things that are the most polarizing.
They just upset everyone. one.
And and yet I think right now we're at a moment in time.
I mean, it's just like with the health influencers putting out nonsense.

(49:48):
If normal, rational people don't discuss some of these more difficult topics
that are polarizing, that vacuum is filled by people who just spout nonsense.
So let's lean into it. Yeah. So I mean, so regarding the COVID vaccine, right?
People have a hard time accepting that two opposite things can both be true, right?

(50:12):
So what are truths about the vaccine? The truths are,
It decreases hospitalizations, right? And in subgroups of people, it has decreased death.
But there are other truths. There are downsides that then there are truths.
Yeah, you get the vaccine and it might make you feel horrible.
You might get myocarditis, an inflammation of your heart tissue.

(50:34):
You might get a pulmonary embolism, which is a blood clot that goes to the lung.
Those things are horrible as well. But it's all about looking at the risks and
the benefits and the probabilities of each, right? So I'm an ER doctor.
I work in a small little community hospital.
And my hospital was hit so hard by COVID, right?

(50:54):
I would see multiple people die per shift from COVID during the pandemic.
It got so bad that the morgue was filled and we actually had to stack dead.
We had to rent these refrigerated trucks and stack dead people on top of one
another, like inhumanely. It was one of the most traumatic things I've ever had to deal with.

(51:18):
You know, just shoving these dead people on top of one another.
It was like from a horror movie.
Yeah. And so during this time, I was scared for my life.
I was scared that I was going to bring the virus home to my family and infect
them and that they would get sick. So did I take the vaccine?

(51:40):
Hell yeah, I took the vaccine. I got three of them, right?
Because at that point, the benefits of living far outweighed the risks of myocarditis,
pulmonary embolism, and not feeling well from getting the vaccine. But guess what?
I haven't gotten a vaccine since. And why is that? Because COVID isn't as virulent.

(52:05):
People aren't dying from COVID anymore unless you are at the extremes of age
or extremely immunocompromised.
And so now the risks for me far outweigh the benefits because I don't want to
feel horrible after getting the vaccine.
I don't want the risk of myocarditis. I don't want the risk of pulmonary embolism. So I don't take it.

(52:28):
That doesn't mean that everyone shouldn't take it. If you're elderly or you're
immunocompromised, you should probably still get the vaccine.
But that's an individual decision that I made on the data for myself.
And I think that's the way we need to look at everything. Any medication we take, anything.
I mean, we can talk about Ozempic, right? People are always saying, is Ozempic good?

(52:52):
Is Ozempic bad? You hear that all over the place. I mean, Ozempic's your favorite topic, right? Right.
Nick sends me, you know, a couple articles a week about Ozempic.
What do you think about this?
You would think that he was on it. Right. Right. He just looks this good naturally,
you know, but for the record, I have not taken Ozempic. I haven't prescribed him Ozempic yet.

(53:12):
Anyways, so there are truths about Ozempic.
Ozempic will cause a significant amount of weight loss.
Right. You look at the data and half the people lost 15 percent of their body
weight. a third of people lost 20%. It's incredible.
And what I see clinically is probably even better than that.
But there are other truths to that, too. You're going to have GI upset.

(53:37):
You're going to be nauseous. You're going to vomit. You might have diarrhea.
You might lose desire. You might lose lean muscle mass.
Your sympathetic tone may increase. You might even get bad things like colonic paralysis, right?
So in people that have a substantial amount of weight to lose,
the benefits of losing a substantial amount of weight far outweigh the risks of those other things.

(54:05):
But if you have 10 pounds to lose,
I think the risks are too great. And so therefore, you probably shouldn't take it, right?
The benefits of losing 10 pounds isn't greater than all of those risks.
And so the decisions need to be nuanced. We need to look at people individually
and talk about the truths that we know and present both the good and the bad.

(54:30):
And we have to make educated decisions.
It's not just everyone needs to take the vaccine. seen.
Everyone needs to be on Ozempic. Sorry. You know, I mean, it's nuanced.
Why don't we just look at the real data? Why does it have to be so polarizing?
Why does it have to be the best or the worst?
Because things just don't work that way. Most things are in the middle.

(54:52):
Right. It's not binary. It's not. It's not good or bad.
I really feel like the entire vaccine controversy and the the pandemic in general
would have gone in a smoother, more healthy pattern for society.
Had there been more high level health providers speaking to people like they

(55:17):
are adults, like you just did just now,
instead of minimizing risks or putting mandates out, most adults,
Adults, if they are given information, can make good choices.
And I appreciate you doing that right now. Yeah. I mean, I'm not saying the
government did everything right. It was a very tough time.

(55:39):
Yes. They were trying to just figure it out as they were going.
Yes. They had no idea what was going on. Yes. They should have been more transparent
with the potential downsides of the vaccine.
True. Right. They basically just said, everyone needs to take this without telling
us the potential downsides.

(56:00):
And that is not the way things should be done.
But what I mean, I understand where they were coming from because they were
thinking about the greater good. They just wanted to stop this in its tracks.
Was it the right thing to do?
Probably not. But hindsight's always 20-20. And we can always look back and
say how we can do things better.

(56:20):
And there's lots of things that we should have done differently.
But I think people are just trying to do the best that they could do and was
it perfect definitely not but it was never going to be perfect yeah in no situation
would it ever be perfect right yeah,
Who was our guy? The guy that he started a podcast and he was one of the top

(56:41):
infectious disease experts in the world prior.
Who was that guy? Michael Osterholm.
I felt like he was one of the few voices during the pandemic.
He started his own podcast.
It never got to be very big.
He dealt with numerous pandemics over his entire career.

(57:03):
He talked about the disease. He talked about the vaccines. He talked about every
aspect of it in nuanced terms like you're doing right now.
And it gets to the heart of what we're discussing today because his voice was
not amplified by either the algorithms or by the media.
He never got a ton of traction, even though he would regularly make predictions

(57:27):
about what would happen with COVID in general over the next month or two.
It was incredible how spot on he was on a regular basis about what was coming next.
I'm seeing this, that, and the other piece of data. That likely means we're
going to see an uptick in COVID infections and hospitalizations.
Or he would look at the data and see the opposite.

(57:47):
I think we're going to see it drop. And sure enough, that's what would come to pass.
But we do have a real problem right now. Now, I mean, COVID is just a nice metaphor
for what we're talking about with health information,
where it is very difficult for people who speak in nuanced terms to find an
audience and to be amplified by either the algorithms or the media to get good

(58:11):
information out there to people.
Should we not trust people with huge six packs and masks?
No degrees.
You've just got to always be skeptical, right? I mean, you can't turn your brain off.
You can't just accept what they're saying.

(58:33):
You can't just accept every headline at face value, right?
If you don't understand what they're, if you don't understand a word, you've got to look it up.
If you don't understand the concept, break it down until you do.
If you don't understand how something works, dig into it until you actually understand it.
We've got to question things and then you'll gain knowledge.

(58:55):
And then from there, hopefully we'll get to the truth.
But yeah, it's a big issue because things that aren't sexy aren't getting any traction.
But the problem is, is that the stuff that isn't sexy is usually the stuff that works.
And when someone's speaking like a used car salesman and they're using tons

(59:17):
of superlatives and they're selling something that's a panacea that's going
to make you stronger and faster and sexier and have the best sexier life and lose weight.
And I mean, those things just don't work.
Like if there was a panacea out there, we would all be on it. Like, let's be real.
And so, I mean, that's the problem is the sexy stuff.

(59:41):
Sells, but it doesn't work. And the stuff that's nuanced and the stuff that
works isn't selling right now. It's not what's catching the algorithm.
It's not what's catching the eyes of people, right?
It's only the interesting stories that get played, not the ones that are just,
good information. Yeah.
But if you want to be sexy, you got to put in the hard work.

(01:00:06):
True.
Let's turn our attention to sleep, because you also mentioned that in the hierarchy of needs.
Talk to me about sleep. Sleep needs to be one of the major foundations for health.
Like I used to be one of the people that believed I'll just sleep when I'm dead.

(01:00:28):
When I was going through Through college and through med school,
I mean, I would sleep maybe three and a half, four hours a night.
It was like study all day, go out at night, hardly sleep, wake up, take a test.
And I was just exhausted all the time.

(01:00:48):
And after looking at all of the research and all the data, I just had to change my ways.
I now have to prioritize sleep. Like I make it an absolute priority.
I go to bed early. My family knows it.
They don't like it all the time. But I mean, I'm in bed at 830 or nine and I
ensure that I get a good seven or eight hours of sleep every night.

(01:01:14):
And if I don't, I'm napping. I love to nap.
And the research really shows that it's all about not only getting enough quantity,
but but quality of sleep, meaning that we're getting into enough of our deep
sleep and our REM sleep, right?
And so these things actually have huge impacts on our health.

(01:01:37):
So when we're talking about deep sleep, right, this is basically like having
overnight blood pressure medication and overnight diabetic medication.
It helps regulate our blood pressure and our glucose so much.
I know that when I don't get quality sleep, when I'm wearing my glucose meter,

(01:01:59):
my sugars are so much higher than they are if I get a quality sleep, right?
So it's important from a metabolic standpoint to ensure that you're getting quality sleep.
And then regarding REM sleep, I mean, that's like an overnight therapy session.
It really has massive impacts on our mental health.

(01:02:21):
And so, yeah, I think it's of utmost importance to make sure that we are getting
both quantity and quality of sleep.
There seems to be a lot of new research on that.
We knew sleep was rest time for the body and a rejuvenation process for the body.
But it's also a rejuvenation process for the brain. And if...

(01:02:43):
Your mental health is not doing well. If you're feeling like you dislike other
people irrationally or everybody dislikes you, sleep might be the answer there.
Oh, 100%. I mean, during sleep is when the brain actually drains itself of all
of its toxins and all the bad stuff going on.

(01:03:04):
It takes these coordinated movements of the brain to be able to flush all of
the toxins out. And that also happens during deep sleep.
So, yeah, we've got to rejuvenate the brain. We've got to rejuvenate the body.
It's got to be a foundation and it's got to be something that we actually,
you know, make a priority. authority.

(01:03:25):
Let's touch on stress because that was also in your hierarchy of needs.
And I think it's a really nuanced topic, right? It's not that we want to live
stress-free, but there is certainly a point where there's too much.
So how do we balance that? How much stress is too much? How much is too little?
Where do we find the Goldilocks zone?

(01:03:45):
What's important is that that we realize that chronic stress truly also affects our overall health.
And we need to be doing something, not weekly, not monthly.
Daily to try to alleviate our chronic stress.
And that can be different things for different people. For some people,

(01:04:07):
that's exercise. For some people, that's meditation.
For some people, that's cold plunging. For some people, that's going in the sauna.
But it needs to be something that's done on the daily to help rejuvenate these
things, to make sure that all of your inflammatory markers are basically at bay.
And it's something that requires work. And it's not something that's easy.

(01:04:29):
And sometimes it requires diving into some hard things and dealing with stuff
that we don't want to deal with.
But again, like you got to do it real simple one, turning off these things, right?
Just having periods of time where you shut them off from a psychological perspective.
A lot of what goes on with the phone is self-soothing when we are in a high

(01:04:53):
stress state, it feels good to just mindlessly do this and just see clips of
whatever on your favorite service.
And it will make us feel a little bit better in the moment,
but all you're doing is tamping that stress down and not really dealing with it because all these

(01:05:16):
images and videos that we're seeing are probably subtly drip by drip by drip
adding to your stress levels because there's so much content that makes us feel
that we are less than not enough or just misinformation,
which causes more mental chaos,

(01:05:39):
which has negative effects on our bodies and so all that to say it's a really
simple thing i'm going to shut it off for the next 30 minutes and then maybe
the next week you try for 45 minutes and then the next week an hour various.
Phone makers have hired people from the casino industry that were experts at

(01:06:02):
getting slot machines to catch people's attention and to draw them in and keep them engaged.
They've used that same sort of research with the phones.
That's why notifications are such a big deal. It's popping up all the time,
grabbing your attention, sucking you back in.
And simply by turning it off, you give yourself a chance to actually connect with what's going on.

(01:06:28):
Your phone example is similar to everything else that we're dealing with in life, right?
Everything else that has been weaponized, whether it be food or alcohol.
All of these things are just weaponized to basically take our mind off of things
that really matter, right? We just try to numb things.
We try to tamper them down. Where, I mean,

(01:06:50):
that's why I think meditation is so special is that it forces you to sit still
and be with your thoughts and actually see what's going on in your brain and
maybe have some insight into actually what's going on into your subconscious.
Unconscious, and it gives us a chance to actually deal with those things.

(01:07:11):
Because everything else is just about eating a lot of food and trying to numb
those feelings, or drinking those feelings away, or taking in edibles so I don't
have to feel this, or whatever it may be.
I think we just need to actually sit with our feelings and understand what's
going on in our brain, because it's trying It's trying to tell us something a lot of the time, right?

(01:07:35):
It's trying to tell us, well, we're feeling this way or acting this way because
of things that have happened in our past.
And until we actually sit down and deal with these issues, nothing's ever going
to get better. Well, you know, I love to talk about cold plunging.
I find it is such a hack to useful meditation.

(01:07:57):
I did it this morning. Every time I'm going to record, I start the morning with
a cold plunge and then a sauna and the cold plunge, even though I think I was
in for three to four minutes this morning.
It's such a intense present
moment experience you it's very difficult to check out when you are in 45 degree

(01:08:20):
water right you have to experience that in the present moment you have to breathe
or at least that's a really great way to help you through the experience so
you're thinking about your breathing,
And from there into that hot sauna, I just find it's so easy to slip into a
meditative state where you can sit with your thoughts and better understand what's going on inside.

(01:08:49):
I think it switches you into a state where you are forced to be receptive rather than reactive. Right.
You're sitting there in that cold water and you have no option but just to receive
it and to actually feel the cold. You can't run away from it.
Right. And so it just puts you in that whole mind frame of, all right,

(01:09:10):
let's receive these feelings. Let's receive these thoughts.
Let's actually understand what the hell is going on inside of our brain. Yeah.
All right, Dr. Paul, let's talk about seed oils, because now you really want me to get into trouble.
I followed your recommendation in that I started looking at a couple of health influencers. Okay.

(01:09:32):
And the algorithm worked its magic. So I was inundated with health influencers.
Seed oils is a hot topic right now. I mean, people love to just rail against seed oils.
And I couldn't make heads or tails of whether or not they're the worst thing
that's ever happened to humanity.
Or if this is kind of making a mountain out of a molehill. Can you clarify that

(01:09:55):
for us? Yeah. So I'm probably going to be very unpopular here.
But, you know, the fact that do seed oils actually negatively affect our health? Yeah.
The answer is no. Now, seed oils are extremely energy dense,
and they are added to processed foods.

(01:10:18):
And as we've talked about, processed foods leads to overconsumption.
That leads to energy toxicity, which is basically just having too many calories.
And that is the problem. It is the energy toxicity.
It is having too many calories. that is the problem, but there's actually nothing

(01:10:38):
inherently bad about seed oils themselves.
Before we jump into seed oils, let's get a little foundation on fats.
So just so we better understand what's going on here, what seed oils are.
So there's foods that contain fats usually have the full spectrum of fats.
We can have like red meat, they have saturated fats and they have some unsaturated fats.

(01:10:58):
And then we have salmon, they have more unsaturated fats and then lesser are saturated fats.
And saturated fats are basically just long carbon chains with a single bond.
These are usually solid at room temperature, and these are going to be high
in red meats, high in milk products, high in like the skin of poultry.

(01:11:19):
Then we have unsaturated fats. All unsaturated fats mean is that there is a
double bond in that carbon chain.
So you can have monounsaturated fatty acids, which are going to be from foods
like avocados, olives, or almonds.
And then you can have your polyunsaturated fatty acids, which are basically
your omega-3s and your omega-6s. So omega-3s, obviously very important.

(01:11:41):
Hopefully we talk about that in a bit, but there are both marine and plant-based types.
Omega-3 just basically means that it's a polyunsaturated fatty acid.
So there's more than two double bonds.
But the omega-6s, that is our seed oils.
Okay, so it's a polyunsaturated fatty acid that usually comes from vegetables,

(01:12:01):
from seeds, and from leafy greens.
And so, especially people in the,
carnivore-type community have basically completely villainized and demonized
seed oils, which I don't completely understand.
Because if you look at the data, it's just not there, right?

(01:12:24):
So epidemiology is a type of study that basically shows correlation,
but it does not show causation.
So it basically just shows in association.
Let's unpack that correlation versus causation real quick, because I think that's
a key component to understanding when things are related versus causative.

(01:12:46):
Explain that for everybody, the difference between correlation and causation,
and then we'll continue with your thought.
So correlation just basically means that there is an association, right?
The epidemiology shows that there is an association between seed Seed oils and poor health outcomes.
Just because those things are associated does not mean that seed oils cause

(01:13:13):
poor health outcomes, right?
There can be a couple of things going on.
One, it could mean that seed oils cause poor outcomes, but it could also mean
that people that consume seed oils just live an unhealthier lifestyle,
and that's what causes poor health outcomes, right? Right.
So epidemiology only shows correlation or association, but not causation.

(01:13:37):
And if we were going to put a simple example of that, you could say.
People who are wealthy have really nice manicured lawns.
There's a strong correlation between those two things because they can hire
a gardener to take care of their lawn.

(01:13:57):
But the lawn, the nice lawn does not have any causation.
There's no causality between the lawn and being wealthy.
There's a strong causality between having a high income and being wealthy,
right? If you have an abnormally high income, there's excess money,
you will eventually become wealthy.

(01:14:18):
And when we talk statistics, it's very difficult but extremely important to
tease out the difference between causality and causation.
So health influencers will often cite studies, basically, that support their facts.
Right. Okay. Right. But we need to understand that you can pretty much find

(01:14:39):
a study to support anything you believe.
Yeah. But the key is to basically look at the data as a whole and to understand
what types of studies actually prove causation.
So, for example, right, there are studies out there that show that smoking does

(01:15:01):
not cause lung cancer, even though we know that's not to be not know not to be true. Right.
But if we look at a meta-analysis and a meta-analysis is basically just a study
of studies trying to find an overall outcome. Okay.
So within this hundred studies, 99 of them show that smoking causes lung cancer.

(01:15:24):
And one of them shows that it doesn't. Which one are you going to believe, right?
I would hope that you believe the 99 and not the one.
It's important to look at the data as a consensus, like overall,
instead of looking at one single study.
And then it's also important to understand what kind of studies can actually

(01:15:48):
prove causation, right? Right.
So the gold standard for proving causation are going to be human randomized control trials.
That is the gold standard. There are other things that can do it pretty well, too.
Things like Mendelian randomization, which is too complex to get into for this talk.
And genetic studies can also do a decent job. But we must realize that epidemiology

(01:16:12):
shows correlation and not causation.
You know, for example, non-nutritive sweeteners are associated with obesity, right?
Now, we don't know whether non-nutritive sweeteners cause obesity or whether
that people that are obese are eating more non-nutritive sweeteners trying to

(01:16:33):
get to a less obesogenic state, right?
So that's epidemiology just gives us that correlation. But to understand what
the causation is, you have to do a randomized controlled trial to understand the difference.
Yes and and just to unpack
that example there that you gave a little bit so you
might have a lot of people who are overweight or obese

(01:16:54):
and they are drinking more diet soda let's say to try to bring their weight
down that is it's the reverse because they're obese they're drinking more of
the diet soda it's not necessarily that drinking a bunch of diet soda led them to becoming Exactly.
When we're talking about seed

(01:17:14):
oils, the epidemiology shows an association with poor health outcomes.
With non-nutritive sweeteners, the epidemiology shows a correlation with obesity.
But that doesn't mean that it's causative. You have to look at randomized controlled
trials to understand if it's causative.
With seed oils, if we look at the randomized control trials, if we actually compare,

(01:17:39):
so we do a one-for-one substitution of seed oils, omega-6 fatty acids,
for saturated fats, and we look at the outcome difference in these two groups, what do we find?
Seed oils have lower cardiovascular disease compared to saturated fat.
Seed oils have lower inflammation compared to saturated fat.

(01:18:04):
Seed oils have significantly improved metabolic health. You have greater insulin sensitivity.
You have lower hemoglobin A1c. You have less liver fat.
So when you actually look at the randomized control trials, seed oils don't
seem that bad. So we're not breaking even.
There's actually a decrease in these negative markers.

(01:18:26):
Yeah. And I chose saturated fat because most of the people that are demonizing
seed oils are on that carnivore camp and they love their saturated fats and
they want to be able to eat as much of their fatty cuts of meat with lots of
saturated fat as possible.
And when you attack the fatty ribeye, you attack the carnivore.

(01:18:48):
So you can't do that. so let's attack the
seed oils and it makes absolutely no sense
well let's talk about a
carnivore diet then what do
we need to know about eating a lot of red meat well I mean you just have to
be careful with the amount of saturated fat that you take in okay the carnivore

(01:19:09):
community will also has also come out and said things like LDL cholesterol doesn't
matter right which is absolutely Absolutely absurd.
LDL cholesterol is the causative agent of cardiovascular disease.
Cardiovascular disease is the number one killer in the world.

(01:19:31):
It kills 20 million people per year.
Every 31 seconds, someone is having a heart attack, right? And so you have these
health influencers saying, this doesn't matter.
Well, I think that they should be held personally responsible because they are
causing metabolic metabolic ill health and potentially early death in their followers.

(01:19:52):
I mean, this is absolutely crazy, right?
So we can build on these studies a little bit.
So when we look at LDL cholesterol, we can see that the Mendelian randomization,
that the genetic studies, that the lifetime exposure to LDL,
there is a dose-dependent effect on cardiovascular disease.
We can look at epidemiology and it shows that it's an independent risk factor.

(01:20:15):
We can look at the mechanistic studies, which basically show that LDL can penetrate
the endothelium and cause cardiovascular disease.
It is all there. There is absolutely no question.
And so why does this even matter, right? So because cholesterol actually is
really important in our bodies, which most people don't realize.

(01:20:35):
Like people think that cholesterol should be demonized or it doesn't matter,
but it's actually super important. It's this complex ringed molecule that every cell in our body makes.
It's the backbone to all of our hormones, to testosterone, to estrogen, to cortisol.
It helps us digest fatty foods. And it helps our cell membranes be really fluid

(01:20:58):
so that our enzymes can function basically more efficiently.
Okay? And as we age, our cholesterol levels tend to, our LDL cholesterol levels tend to increase.
But it's mainly asymptomatic, we don't realize it, so you can have sky-high
LDL cholesterol levels and be totally and feel great.

(01:21:21):
But if we actually look at childhood and we look at someone's that's that's
a child, their LDL cholesterol level, maybe it's like 30.
By the time they get to 18, 19, 20, they're actually already starting to develop
cardiovascular disease.
And this is what I was talking about, the lifetime exposure to cholesterol, to LDL cholesterol.

(01:21:42):
That's what's important. So if we look at autopsy studies like that happened
during times of war or after a homicide or a bad car accident,
and we actually look at the coronary arteries of these kids,
of these 18, 19, 20-year-olds, they actually already have cardiovascular disease developing.
The way that current medicine views cholesterol, it doesn't make any sense, right?

(01:22:06):
If we know that something is the causative agent, if we've proven that,
then we should probably eliminate it.
Today's medicine, we basically use a 10-year risk.
And once your 10-year risk of MACE, of major adverse cardiac events,
reach 5%, once that risk is 5%, your doctor will give you medicine to lower your cholesterol. all.

(01:22:28):
And your insurance company will then pay for your prescription at the pharmacy.
This makes no sense to me because if it's the causative agent,
we need to actually get it down low and get it down early.
This is like saying you can smoke all you want until your risk of lung cancer,

(01:22:48):
your 10 year risk of lung cancer reaches 5%. Then you shouldn't smoke anymore. more. Right.
Does that make any sense? Is that what we tell people? No, we say never smoke ever.
And I just view this the same way. We need to try to get these levels down low
and get them down early so that we try to avoid the most common cause of mortality in the world.

(01:23:13):
Are there other interventions in medicine that should be done earlier,
but aren't because of the current insurance structure that we have,
just like you talked about with heart disease and not bringing in intervention
until it reaches a critical point.

(01:23:34):
Well, I think that's the problem with medicine in total today, right?
Medicine today is based on acute care.
I mean, that's basically what I do. I'm an ER doctor. People come to me when
things go wrong. They come to me when there's a heart attack, when there's a stroke.
When they get stabbed, when their arm gets cut off, whatever.

(01:23:56):
But the disease process starts so long before that, and no one realizes it.
And this is my main issue with medicine, because so many of the things that
people come to see me with are 100% preventable.
So maybe we don't have the true causation, like with LDL cholesterol or ApoB,

(01:24:20):
which is probably more important that we didn't get into.
Maybe we can. But all of these things, if we actually took more of a preventative
rather than an acute response, could be ameliorated, right?
We could control our glucose.
We could make sure we don't have visceral fat.
We can make sure our cholesterol levels are within normal ranges.

(01:24:40):
We could do all these things if we practice medicine in a different way.
Being more preventative instead of reactive. Exactly. Once again,
good time to remind everybody that nothing in this episode constitutes medical
advice to any individuals out there.
Everything should be taken on a personal basis and you should talk to your medical

(01:25:03):
provider specifically before making any major changes to your life.
Sounds great. Okay, let's talk about non-nutritive sweeteners in a little bit more detail.
Which sweeteners are we talking about and are they really that bad for you?
We call these non-nutritive sweeteners now because stevia basically is not artificial.

(01:25:25):
And so that's why we adopted that term instead of artificial sweeteners. Okay.
So in terms of weight loss, when we look at what we sort of talked about before,
when we look at the epidemiology, there is a correlation between non-nutritive
sweeteners and obesity. Okay.
But as we've learned, hopefully, that we don't know whether the non-nutritive

(01:25:49):
sweeteners actually cause people to be obese or whether people that are obese
or overweight are just trying to get to a less obesogenic state eating the non-nutritive sweeteners.
So we must look to the randomized controlled trials regarding weight loss.
So if we look to the randomized controlled trials, we can see that there was
a study that basically separated a group that drank sugar-sweetened beverages

(01:26:13):
and a group that drank non-nutritive sweetened beverages.
So basically soda versus diet soda.
And what did they find? They found a six-kilogram weight loss in six months
in favor of the non-nutritive sweetener group.
Six kilograms is 13 pounds. That's a lot of weight, right?

(01:26:35):
I mean, I know multiple people that have lost a substantial amount of weight.
More than that, all they've done is traded in Coke for Diet Coke.
I mean, we're talking like 20 to 40 pounds.
So in absolutely no scenario could this be a bad thing.
If you are losing visceral fat, if you are getting more insulin sensitive,

(01:26:58):
if you are lowering your hemoglobin A1c, these are all positives.
It is a positive thing.
Now, I love Diet Coke, right? But I don't drink it every day.
I drink it when I go out to dinner, when we go out to sushi, or when I'm on vacation.
Do I think that Diet Coke for you is better than water?

(01:27:21):
Probably not. Do I think that it's better for you than beer?
100% yes. So the things people want to know about with non-nutritive sweeteners
are weight loss, cancer, and the microbiome.
All right, so let's hit on the cancer thing.
So if we look at the epidemiology, 20% of the studies shows that there is a

(01:27:41):
correlation between non-nutritive sweeteners and cancer.
Only 20% show a correlation, meaning that the other 80% don't even show that, right?
But we don't hear about these studies that don't show anything.
Those aren't interesting.
We only hear about the studies that are shocking, that will get likes,

(01:28:01):
that will get views, right?
So we only hear about the 20%. We don't hear about the other 80%.
And when we're dealing with cancer, there's usually a dose response, right?
Like with, I keep on using it, but like with smoking and lung cancer.
The more you smoke, the more likely you are to get cancer. Right.
This hasn't been shown in any of the data, all right? There is no dose response.

(01:28:26):
And then people will come back and say, but there is a toxic dose in which it will cause cancer.
Well, no shit. There is a toxic dose, right? I mean, come on.
If you look at the data, you have to drink between 20 and 800 cans of diet soda
per day to cause toxicity.

(01:28:49):
I mean, if we want to talk about toxicity, basically everything can have toxicity.
Some of the worst overdoses I see in the ER are from Tylenol and aspirin.
When you take them at the recommended amounts, they're fine.
When you take too much of them, they will kill you.
The other day, I just saw this lady with psychogenic polydipsia.

(01:29:11):
She was a schizophrenic.
That basically just means that she habitually drinks water, right?
It causes their sodium to become very low.
It causes them to be confused and sometimes seize.
She was seizing. She was having intractable seizures. I had to put her on life
support. So even water has a toxic dose.

(01:29:32):
Oxygen even has a toxic dose. We breathe 21% oxygen.
If we give someone 100% oxygen for too long, they're going to have oxidative
damage and free radical damage.
There is a toxic dose for anything. And I don't think anyone's hitting that 20 to 800 cans per day.
At least very few people are right.
I once saw a news article on coffee that talked about how bad caffeine was for you.

(01:30:02):
And when I dug into it a little bit deeper, this was based on people who were
drinking 20 cups of coffee per day.
That seems like an extremely unlikely scenario. But the news organization that
presented this was extrapolating that into that caffeine is bad for you.
Coffee will cause all these negative effects.

(01:30:25):
And I think it goes right to the heart of what you're discussing here,
which is that things in moderation are completely different than if you try
to extrapolate from a toxic dose of anything,
even water. Exactly. Yeah.
And then so onto the microbiome, right? So this is an area where the health

(01:30:47):
influencers love to pray.
They love to pray in areas that we do not have complete understanding.
This is one of their tactics.
So if you talk to a person that's an expert on the microbiome,
they'll say, well, you should probably talk to us in about two or five or 10
years when we actually understand what's going on with the microbiome. We don't know yet.

(01:31:09):
So there are studies that show that non-nutritive sweeteners change our microbiome. That is true.
So non-nutritive sweeteners aren't inert. They're doing something,
but we don't know whether that's bad, good, or neutral. We just don't know.
And people have to realize that. So does it cause weight gain?

(01:31:29):
No. Does it cause cancer?
Not unless you're drinking 800 cans a day. And does it affect the microbiome?
Yeah. But we don't know whether that's good, bad, or indifferent.
That reminds me, I saw a neuroscientist talking about the phrase used by a lot
of influencers, this changes your brain.

(01:31:51):
And this neuroscientist said, you know, every thought you have causes a tiny change in your brain.
So everything, every experience you have all day, every day for your entire
life is changing your brain.
And someone that throws that out there like that is the end of the argument.
This changes your brain. He said, that's probably not somebody you should be

(01:32:12):
listening to. Yeah. I mean, the brain is plastic.
It should be evolving and changing every day. It's called learning. Right.
Yes. Yes. One other thought that popped into mind when you said a study that
shows a 20 percent increase in the likelihood of cancer.

(01:32:33):
Now, Danny Kahneman wrote the book Thinking Fast and Thinking Slow,
which is a challenging read. But I love that book.
And he touches on this. And so does it's up here somewhere.
Robert Chialdini with his book Influence. people are affected by the way that
numbers are used in phrasing.

(01:32:55):
So if we say a 20% chance of causing cancer, that will get people to freak out a little bit.
Whereas you said an 80% chance of not causing cancer, we assume,
well, 80%. So it's probably not going to happen.
And the example that was used in the influence book was that operations could
be something really simple where they say this operation has a 99% success rate.

(01:33:18):
Everybody goes, all right, well, then I'm that sounds fantastic.
But if you flip that phrasing and just say this has a 1% chance of failure or
a 2% chance of failure, suddenly people are focused on the failure mechanism
and they think it's abnormally dangerous to them to undergo that procedure.
And that's something else to be careful of with influencers,

(01:33:41):
if you see them emphasizing the small number to make it seem scarier,
that might be a reason to not listen to them.
Yeah, and something else to realize when we're talking about these percentages,
right, when we're talking about these effects, most of the time we're talking about relative risks.
So we're getting into probabilities here, and this can be confusing, but just to explain it.

(01:34:05):
So if my absolute risk of death right now is 10%, okay, and then let's just
say smoking increased that by 10%, what does that actually mean?
What you do is then you take 10% of the 10, which is one.
So my absolute risk of death is actually 11%, right? These are relative risks.

(01:34:31):
So you don't take the absolute number. It depends on what your actual absolute risk is.
And then you accommodate accordingly, if that makes sense.
I just want people to understand that we're talking about relative risk, not absolute.
It does. There was a good example of that on the Bill Maher's show on HBO recently,
and he talks about the I think it was a measles outbreak and there was a 300

(01:34:55):
percent increase in measles, measles cases in this state.
And he said, that sounds like a lot, doesn't it? I mean, a 300 percent increase. One case.
I believe it had gone from 10 to 30. We're talking about less than 0.2 percent
of the population they were actually looking at.

(01:35:16):
They said this is not this is not even news.
Right. If it really hit critical mass, that would be terrible.
But it was a way of just moving those numbers around to make it seem more clickable.
And I've always liked that phrase that statistics don't lie,
but liars use statistics. Yeah.
So you just have to be very careful when you're looking at relative risks,

(01:35:40):
because you always have to have an absolute risk that accommodates for that.
So you actually understand what's going on. Let's hit another hot topic online.
What's the truth behind the relationship between protein and cancer?
So there are quite a few people out there or some of the influencers that are
basically stating that animal protein causes cancer and that we should not be eating animal protein.

(01:36:07):
We should be eating plant protein instead.
But to sort of get into this, into the details, we'll have to do a little bit
of background on stuff. Okay. We'll talk about...
MTOR, which will be super important when we talk about rapamycin in the future,
which is my favorite longevity agent, which I think is super exciting,
which I think everyone should really know about and read about.

(01:36:27):
And then we'll do some background on protein itself. So mTOR is basically one
of the most important mediators of longevity, basically at the cellular level.
OK, and it's highly conserved, meaning that you can basically find it in everything
from From yeast to flies to worms to apes to mice to humans.

(01:36:52):
All right. So evolution is deemed very, very important.
So the job of mTOR is basically to balance the availability of nutrients with
the organism's need to reproduce and grow.
Okay. So when we have a lot of nutrients, mTOR is turned on.
The cell divides, proteins are created, and you go towards reproduction. production.

(01:37:16):
When nutrients are scarce, mTOR is suppressed, and we go into this recycling mode.
It's something called autophagy, which tons of people love to talk about,
and I don't think they actually understand what the hell is going on.
But autophagy is basically when we're going to break down old existing proteins
into their individual amino acids, and then they are rebuilt into new proteins.

(01:37:38):
That's autophagy. It's like recycling.
Cell division is put on hold. Reproduction is put on hold in hopes of basically
conserving energy Okay, so that's sort of mTOR in a nutshell and I think it
will make more sense in a bit when we get back to it,
so if we talk about protein background on protein, so protein really serves

(01:37:59):
two main functions right mobility and Metabolism so when we talk about mobility,
so I mean a large portion of deaths especially later in life happen to do with a,
Age-related decline in muscle mass or sarcopenia that we talked about with strength.
And this age-related decline in muscle mass oftentimes lead to falls, okay?

(01:38:20):
I mean, if you're 65 or older and you fall and break your hip,
there is a 25% chance that you will be dead in six months to a year. I mean, muscles matter.
And if we talk about metabolism, I mean, muscle is the site where we use all of our glucose.
Glucose it's likely the site where insulin resistance

(01:38:41):
begins and it's the house for our mitochondria where
we're going to be able to oxidize and utilize all of our
fats so it's it's of utmost importance that we basically maintain our lean muscle
mass and maximize protein synthesis to our utmost abilities if we want to have
a healthy life so amino acids are really sort of the building blocks for protein

(01:39:05):
itself right you know masses amino acids are put
together to form a protein. And this is done based on our DNA.
And I was just going over this with my daughter for her, you know,
biology final, her freshman year.
So hopefully we all sort of have a grasp on this.
But proteins can be simple, or they can be complex, and they have different turnover rates, right?

(01:39:25):
They can be simple, like insulin that are 51 amino acids, or they can be complex,
like myosin with thousands.
And they have different turnover rates. So insulin made only last 15 minutes
and things like collagen, maybe the half-life is like 250 days.
So that's why when Lauren, my daughter, hurt her knee playing volleyball,
she hurt her MCL, it took so long for it to heal.

(01:39:50):
So many people talk about protein quality. So what does that mean?
So protein quality is basically looking at our nine essential amino acids and
the bioavailability of those amino acids.
Bioavailability is basically our ability to digest and absorb the protein.
So basically what that means is that we have to eat nine of these amino acids

(01:40:12):
and we can make the other 11.
Okay. So when we look at animal-based protein, it has all of our essential amino acids.
When we look at animal-based protein and we look at isolates like whey or soy
or corn, their bioavailability is also very high.
It's like 95%. But when we look at plant protein, the protein is really there

(01:40:35):
for the purpose of the plant.
Okay, so a lot of the protein is going to be stuck in the fibers of the leaves,
the stems, the flowers, and we just can't access that protein.
We're just not able to because it's caught up in the fiber, in the insoluble fiber.
So the bioavailability of plant protein might be 40% to 60%.

(01:40:57):
So why this is important is because if we look at a wheat cereal box,
okay, and we see that there are four grams of protein in this wheat cereal box,
and the bioavailability of wheat is only 40%, that means we're only getting
less than two grams of protein from that wheat cereal, right?
So it's all very complex.

(01:41:18):
So it's like, what the heck are we going to do with all this information?
And that would apply to a protein powder as well. So a plant-based protein powder
that has 20 grams of protein in it, and then a whey-based protein powder that
has 20 grams of protein in it.
Because of the bioavailability, I'm actually going to synthesize a lot more
of the whey protein than I would the plant protein.

(01:41:40):
It might be as low as 40% on the plant one. Not when you're dealing with isolates.
So like I said before. So, animal protein and isolate protein,
even if it is plant-based, like soy, corn, potato, pea, that bioavailability
is very high. It's like 95%.
So, you will get it all. It's when you're eating the plant as a whole that hasn't

(01:42:04):
been broken down, that hasn't been isolated, its bioavailability is much less.
And you're into that 40% to 60% range.
So, the isolates are fine. Yeah. Okay. I'm finding out so many things that I'm wrong about today.
And I'm so excited. That was one I did not fully understand.
The artificial sweeteners, I'd be the first one to say I thought those were much worse for you.

(01:42:28):
And I'm just really enjoying learning about all of this. This is fun to talk
about. Yeah. I love talking about it.
Real good data. And my hope is just that people are happy and healthy and free from suffering.
You know, I mean, that's all I think that we can really hope for.
Getting back to it. So this is all super complex.

(01:42:50):
And if you're plant based, you're like, well, what the hell am I supposed to
do then? This doesn't make any sense.
So if we look at the RDA, the recommended dietary allowance,
it tells us that we should be eating 0.8 milligrams per kilogram of protein per day.
Unfortunately, this was created about 40 years ago and is based on flawed amino

(01:43:12):
acid studies, which basically underestimated the amount of amino acid losses.
And what that means is that we actually need to be intaking much more protein than that 0.8.
So most experts in this arena will say that you should eat about one gram of
protein per pound of body weight.
And if you hit that absolute number, it doesn't matter if you're plant-based,

(01:43:35):
it doesn't matter if you're elderly, you should be just fine.
So you've got to hit the absolute number.
So if I am 200 pounds, I need 200 grams of protein each day.
Yeah. So I weigh, I don't know, depends on the day. I weigh in between 210 and 217 pounds, right?

(01:43:55):
Fluctuation's based on water weight. I try to take in about 215 grams of protein per day.
Got it. The elderly, they basically, their capacity to perform protein synthesis
remains throughout life.
We know that. We know that they can continue to build muscle.
But their efficiency goes way down.
So muscle protein synthesis, like we've talked about, is stimulated by mTOR.

(01:44:20):
So now we'll get into mTOR.
But what stimulates mTOR? We have leucine, which is an essential amino acid. We have insulin.
We have resistance training. And we have hormones. OK, as we age,
we no longer have that hormonal influence.
So it's of utmost importance. It is absolutely imperative for the elderly population

(01:44:42):
to make sure they're getting enough protein and they're doing resistance training
so they can maximize their protein synthesis and maintain their lean body mass.
And if you're 65 and older, should you be on protein supplements?
I mean, I think if you can get it in real food, get it in real food.
But a lot of times it is hard to hit.

(01:45:04):
You know, that one gram of protein per pound of body weight eating real food.
So do I supplement? Yes, I supplement with whey protein.
And I like whey protein because it's very high in leucine. And leucine is what
stimulates muscle protein synthesis.
And so when you're dealing with some of the plant-based proteins,
some of them don't have as high a leucine content.

(01:45:27):
So you just have to be a little wary. Things like potato, things like corn,
they have very high leucine content.
So I would err on using things like that. But some blends are great too.
You can use blends of like soy and pea to get an excellent, complete,
essential amino acid package too.
Now, did we answer the question, does the protein cause cancer?

(01:45:50):
We have not even gotten to that yet. That was all just the background.
We're just building up to that. We're just getting in there. We're just building up.
But something before we get to that, I'd like to say first is that protein needs
to be the foundation for our diets.
OK, so if we happen to think that we need to calorically restrict,

(01:46:12):
some people will say, I'm going to decrease my protein percentage by this much
and my carbohydrate percentage by this much and my fat percentage by this much
to reach that caloric restriction. But that's not what we need to do.
Protein is an absolute number. It is one gram per pound of your body weight.
That needs to be the foundation.

(01:46:34):
So if you're calorically restricting, so if I happen to calorically restrict,
I can restrict my fats and carbohydrates all I want if I'm trying to lose weight.
But I still need to maintain my 215 grams of protein per day.
Does that make sense? That does make sense. Question on the GLP-1s,

(01:46:54):
the weight loss drugs. Okay.
Because you eat so much less when you're on them, is there a real risk there
of not getting enough protein?
Yeah. I mean, that's why a lot of people are losing a significant amount of
muscle mass or lean mass on those.
So when you're on the GLP-1s, it's important that you hit that protein mark.

(01:47:18):
Like that has to be the foundation to make sure that you're not losing it.
Because when you lose weight, you're going to lose a little bit of lean mass regardless.
Because when you lose fat, it has a little bit of lean. It has some protein
and it has some water in it.
So if you happen to do a DEXA scan and you looked at your overall lean mass, even if you lost.

(01:47:41):
Only fat, it's going to register that you lost a little bit of lean mass too,
because you're losing some water and some protein in that fat.
But we need to make sure that we are not losing muscle itself when we are dieting.
And the way to do that is to put pressure on mTOR to maintain muscle protein synthesis.

(01:48:01):
So that way we don't lose lean muscle.
And that's one of the other benefits of exercising too, right? Right.
So exercise can help us perform something called discriminant fat loss,
where we're actually preferentially losing adipose or fat tissue while maintaining our lean muscle mass.
So that's that's why exercise is important as well.

(01:48:23):
So if you're just dieting or if you're just using Ozempic, there is a chance
that you will lose a substantial amount of lean mass.
OK, let's keep going down this protein and cancer. Yeah, so the argument at
hand, basically, is that animal protein has a lot of leucine.
Leucine stimulates mTOR. mTOR leads to cell division. Cell division leads to

(01:48:46):
cancer, right? That is the argument.
And the plant-based people basically say, well, plant-based protein has less
leucine, so it must be better for you.
And that's an interesting argument, right? I buy it.
It's very mechanistic, right? It's very influencer-esque, but unfortunately,
again, when you look at the data, it's just not true.

(01:49:09):
There was a big study out of Australia, over 240,000 people looked at meat eaters
versus non-meat eaters, and what did they find?
The exact same cancer rates and the exact same mortality rates.
There's no difference, right? Right?
Animal meat does not cause cancer.

(01:49:31):
There was a recent meta-analysis that also came out that said that this thought
that animal meat causes cancer is likely untrue and that we should not limit
our meat consumption based on it.
It's just not true. It's just nonsense, right?
So, yes, leucine stimulates mTOR.

(01:49:54):
That is true. But we need to realize that there is a big difference between
acute truncated responses and chronic perpetual responses.
And this might be getting into the weeds some, but I think it's important for
people to realize so they can fish through this a little bit.
So, yes, leucine stimulates mTOR. It's acute.

(01:50:14):
It's truncated. It lasts about four hours. Right.
There's a big difference between that and leucine stimulating mTOR forever causing an issue.
Right. So there's a big difference between acute and chronic.
And even people in the medical community don't understand this.
So let's take exercise for an example, right? So say I told you I want you to

(01:50:38):
do something that raises your heart rate, raises your blood pressure,
raises your oxidative damage, raises your free radicals.
You'll say, I don't want to do that. It sounds horrible.
Right. But that's exactly what exercise does in the short term.
But what does it do in the long term?
It actually does the opposite of all those things.

(01:50:58):
It decreases your heart rate. It decreases your blood pressure.
It decreases your inflammation.
So we can't look at acute responses and think that is going to be the overall
outcome. It just doesn't work that way.
Just like we can't look at single mechanisms and think that's what the overall
outcome is going to be, right?

(01:51:20):
Anything we put in our body...
Does not affect one mechanism. It doesn't affect one thing.
It affects tens to hundreds to thousands of mechanisms.
I can make a case for you why anything could be bad.
I can make a case for carbohydrates, for protein, for fats, for broccoli, for kale, for apples.

(01:51:41):
I mean, apples have arsenic in it, for goodness sake, you know?
So we can't just look at single mechanisms because Because there are both good and bad things.
We have to look at the overall data, the overall outcome, right?
So, Lane Norton explains this as a mutual fund, which I love.
So, a mutual fund is basically equated to the overall outcome and single stocks

(01:52:03):
within that mutual fund are going to be equated to single mechanisms.
So, if I told you that this mutual fund is up 80%, which is like an overall
outcome, you'd be stoked. You'd be like, yes, I want to buy that or no,
I'm not going to sell mine.
That's awesome. It's up. I'm making money, right?
Do you really care that two stocks within that mutual fund are down 90% even

(01:52:28):
though the total thing is up 80%?
I don't think anyone cares. You care about the overall outcome, right?
And that's how we've got to look at it. But a lot of these influencers might
be looking at single stocks to continue with that mechanisms.
Yes, yes. Yes. And they're saying that stock is down 90%. Your portfolio is

(01:52:51):
going to die if you don't address that thing right now.
Yes. But you're not looking at the entire picture, right?
So you can, you can look at broccoli and there are negative things about broccoli.
It is true, but the overall outcome of eating broccoli is so good that it basically
wipes out those negatives.

(01:53:11):
So you can't look at single mechanisms and think that is the overall outcome.
We've got to look at the bigger picture.
And when they're pointing out these single mechanisms, it's just a tactic.
And it just isn't true when you see it in media articles all the time.
New study on broccoli could be terrible for you all the time, all the time.

(01:53:34):
And it's very confusing as a consumer without a medical background,
without years of studying the entire bodily process, without having been in
the practice of medicine for a decade, several decades.
I look at those articles and they're coming at me and I just think,

(01:53:54):
is there anything I can eat or drink that's not going to kill me? Well, exactly.
Are we just supposed to photosynthesize? I mean, I can make an argument for
anything to make it negative from a mechanistic point of view.
Right. But we can't look at these single mechanisms.
We must look at the overall outcomes.
Are carbohydrates bad for you? Well, if you look at a single mechanism and see

(01:54:18):
that glucose increases insulin and that's going to lead to diabetes,
we can't eat sugar, but that's not necessarily true. Carbohydrates can be great for you.
Do we limit our fats because it's going to lead to cardiovascular disease?
Well, we should limit it somewhat, but their fats are important too because
it's going to be the backbone for some of our hormones, for testosterone.

(01:54:40):
Like you've got to look at the overall picture. Sir, we can't pick out these
single mechanisms or we're going to be driven to eat nothing and just photosynthesize
and be plants. So I can eat broccoli and drink coffee.
You can eat all the broccoli you want until you reach that toxic dose because
everything has a toxic dose.

(01:55:02):
But yes, in moderation, broccoli is wonderful.
Kale is wonderful. Carbs are wonderful.
Bats are wonderful. Protein is the foundation.
Yeah, as a mediator, that makes me feel good.
It should. Good. Let's talk about testosterone, because there is an inundation
online in terms of advertisements for testosterone clinics and influencers pushing testosterone.

(01:55:28):
It's going to improve your sex life. You're going to put on more muscle.
You're going to think more clearly. You're going to feel 20 years younger,
especially for men. Most of it is targeted at men.
What are your thoughts on testosterone supplementation?
Yeah. So I think that this is part of the influencer protocol, right?
It's they're selling a panacea. They're selling something that's going to make everything better.

(01:55:54):
And anytime someone is trying to sell you that is going to sell you something
that is going to fix everything in your life, it's likely false, right?
There are very rarely true solutions. there are trade-offs, and everything has a downside.
So the problem with testosterone is that we went from a time when it was very

(01:56:17):
difficult to get testosterone, right?
You had to have two laboratory values of total testosterone that were below 300,
and you had to have symptoms, meaning that if you had a number of 295 and 305,
even though those are essentially the same exact lab value based on errors that
are built into these reference values,

(01:56:38):
you could not get testosterone to a time where anyone can get testosterone if
you just go to a TRT clinic, right?
So I can't say all TRT clinics. There are a few.
Maybe like one or two that are doing a good job. So there are some out there
that are doing a good job. But the majority of them are not.

(01:57:01):
And when I think of these TRT clinics, you know what song comes to mind? What's that?
No FX, Oxymoronic.
Okay. The healers have become the harmers. They're just pharmaceutical farmers.
It's time they change the oath to the hypocritic. or the parasitic.

(01:57:25):
They're just speaking the truth. It's just what it is. Like they are biased
towards selling products.
That is how they make their money. Of course, they're going to be biased towards
selling testosterone or things that augment testosterone, you know? Yeah.
So, I mean, the decision whether someone should be put on testosterone treatment

(01:57:45):
should be really nuanced.
It should first and foremost be based upon symptoms.
Then it should be based on their free testosterone levels, which are best correlated with symptoms.
And then we have to take into account their age and comorbidities,
right? So what are the symptoms?
The symptoms are decreased energy, decreased libido, difficulty having erections,

(01:58:11):
depression, decreased sleep quality, increased putting on fat mass.
But what we found is that free testosterone basically best correlates with those symptoms.
And the reason why this is nuanced is because basically we only know half of
the math equation, okay?
We only know what the free testosterone is, but we have no idea how many receptors

(01:58:37):
they have, how sensitive those receptors are to testosterone,
or if those receptors are saturated or not.
So basically we only understand how loud someone Someone is yelling,
but we have no idea how well that message is being heard. That makes sense.
What does all this mean and how does it work? So let's dive in,

(01:58:57):
just get a little bit of foundation here.
Okay. So inside the brain, there's something called the pituitary.
All right. That releases hormones. It releases FSH and LH.
Those basically travel through the blood down to the testicles and will stimulate
both sperm and testosterone production. FSH hits the sertoli cells,
makes sperm, LH hits the leydig cells, makes testosterone.

(01:59:22):
Once testosterone is actually produced, it's converted into other hormones.
We get 0.3% to estradiol, 6% to DHT, our most potent androgen.
Then, testosterone is bound to proteins. It's bound 50% to albumin,
44% to SHBG, 4% to corticobinding globulin. Excuse me, that was a tongue twister.

(01:59:45):
And that leaves, if you're doing the math, that leaves 2% free.
It is that 2% which is important, which basically correlates with our symptoms, okay?
So, there's been this thought, this theory that something called andropause occurs in men.
Basically, it's like synonymous to menopause in women, that our free testosterone declines with age.

(02:00:09):
But this is actually found not to be true.
If we are healthy, our total testosterone typically stays in the normal ranges.
It is the acquisition of comorbidities that actually causes our total testosterone to go down.
But what does go down with age is our free testosterone.
And this is because our SHBG, one of those proteins that bind testosterone,

(02:00:31):
goes up. So as that goes up, it binds more of the testosterone so that less
is active, okay? So that goes up with age.
SHBG is mainly determined by genetics, but it's also determined by insulin, by estradiol, and by T4.
And if there are abnormalities in those hormones themselves,

(02:00:53):
those need to be addressed prior to the treatment, okay?
So this is more nuanced than people give it credit for.
So, what are the different ways that we can treat low testosterone?
So, first, there's Clomid. It's a pill. Basically, it works as a CIRM.
It's a Selective Estrogen Reuptake Modulator.

(02:01:14):
So, basically, this works centrally. So, it stimulates FSH and LH to go down
to the testicles to produce testosterone.
Okay? And sperm, actually. But there's a problem with...
Clomid because it actually hits the estrogen receptor and negatively impacts that.
And so there's a discrepancy effect for some men, about 40% of men,

(02:01:37):
actually, when they take Clomid, they have no sexual desire and they're not able to get erections.
So estrogen is extremely important in our ability to perform sexually.
Okay. There's also HCG. So HCG is an injectable.
It's pretty cumbersome to work with. It's fragile. It can be on the expensive

(02:01:59):
side, but it also works centrally. It mimics LH.
So that will then go down to the testicles and help it produce more testosterone.
And then there's testosterone, of course. You know, it's what most people are
using now. But there's different modes of application.
There are the injectables. There are you can take it nasally or you can take it orally.

(02:02:22):
So injectables by far are the one that is used the most, right?
So when testosterone is injected, it should be injected subcutaneously twice
a week at physiologic doses.
It's subcutaneous because we actually get higher blood levels when it's done
subcutaneous versus in the muscle itself.

(02:02:43):
It should be done twice a week based on the half-life of testosterone.
Testosterone and it should be done at physiologic levels because we don't want
to get the side effects. Okay.
So I like my patients to inject basically on Sunday and Thursday that way.
And the peak, it usually peaks usually around 24 hours.

(02:03:03):
And so that way people are ready for the week and then ready for the weekend.
Okay. There's two different types of testosterone that people can inject,
cipionate and enanthate.
Cipionate is more anabolic and it has more water retention.
So I like older people, those that are elderly, to use enanthate.
I think there's lower side effects.
Now, what you don't want to do is go to a TRT clinic and basically have this

(02:03:28):
injected once every two weeks at like 200 milligrams or more.
This is going to cause erythrocytosis, which is basically a thickening of the
blood, which can lead to poor health outcomes.
So not long ago, I saw this 43-year-old guy who's my age came in with acute stroke-like symptoms.
He couldn't move the right side of his body, right?

(02:03:50):
And after talking to him for a while, he said, oh, yeah, and I've been going
to this TRT clinic that's been injecting me twice a week or twice a month with testosterone.
And I'm like, oh, man, let's check your blood levels. And sure enough...
He had erythrocytosis and this thickening of the blood can lead to adverse outcomes
such as heart attacks and strokes.

(02:04:12):
And was this causative or was it just correlative?
I don't know, but it should at least make everyone pause and realize there are
real downsides to testosterone, right?
It's not just a panacea. There are downsides.
So there can be downsides beyond the erythrocytosis and beyond the infertility.

(02:04:33):
It can make your testicles basically shrink down to the size of raisins, which can't be fun.
And I think it affects our mental health.
And I think there's still a question regarding cardiovascular disease,
which is I think most people would probably disagree with me on.
There was a recent randomized controlled trial on humans that basically looked

(02:04:56):
at testosterone and cardiovascular outcomes because they were hoping to basically
put all of this concern at bay.
And what they did is when they actually gave the testosterone,
they only increased the total testosterone by about 150 milligrams.
And when we increase total testosterone by augmentation, it usually goes much higher than that.

(02:05:19):
So in the study, they said that testosterone does not cause cardiovascular issues.
Well, that's probably true at 150 milligrams, but we usually increase it so much more.
So I don't know if when I'm increasing a patient to 300 times that or 450 more
than their baseline, if that's going to have cardiovascular effects.
So I just don't know. So I don't think that's determined yet.

(02:05:42):
And then people always want to know about prostate cancer and testosterone,
right? Initially, there was a big concern that testosterone treatment caused prostate cancer.
And this was based on a single patient in 1941 in which two people got the Nobel Prize for.
And since then, it's been completely been debunked. Yeah.
The American Urology Association, the AUA, came out recently with guidelines

(02:06:05):
saying that there is no correlation between.
Testosterone treatment, and prostate cancer.
What we do know, though, is that it's better to be chemically castrated,
meaning that you have no testosterone.
That's good. Or it's good to have testosterone in the normal range.
But what's not good is to be hypogonadal or have low testosterone.

(02:06:28):
That actually leads to increased risk of high-grade prostate cancer.
It's like an inverted U, right so it's okay to be castrated or have no testosterone
it's okay to be in the normal range but it's probably not good to be hypogonadal
that could lead to increased risk hypogonadal it's a great testosterone great
word yeah i try it could be a good band name the hypogonadals,

(02:06:58):
okay so it sounds like testosterone is similar
to any medical treatment
where if you need it
it can be a very good thing for you and if
you don't need it it could be detrimental yes
and so like anything it's about weighing up those risks and benefits the example

(02:07:21):
that comes to mine was a reporter who was talking about the GLP ones taking
Ozempic and he was well over a hundred in excess of a hundred pounds overweight.
And he was looking at the negative effects based on these GLP GLP ones versus the positives.
And he came to the conclusion that there were a number of negative effects that,

(02:07:46):
and some are unknown, right?
That we don't even know what the long -term negative effects are,
because this is brand new in the way that these drugs are being used.
But the thing that became clear was being 150 pounds,
whatever the number was, 150 pounds overweight for him, that posed greater risks
in his mind to his long-term health than whatever the potential negative side

(02:08:09):
effects of these drugs might be.
So it made sense for him to take ozempic
to lose that weight to get into a much more healthy range
and with a lot of these drugs it's the
same situation just like i was saying like
i like to treat people with glp-1s that
have a significant amount of weight to lose if you only have 10 pounds to lose

(02:08:32):
the risks at that point outweigh the benefits right why would you take on the
risk of having colonic paralysis paralysis if you only have 10 pounds to lose.
It just doesn't make any sense.
And then regarding testosterone, if you don't need it, you shouldn't take it.
Look at the bodybuilding industry.
I mean, those guys are dropping like flies.

(02:08:55):
If you don't need it.
I probably shouldn't be injecting. So if I don't need it, I mean,
I can get jacked on testosterone, but I'm going to have to pay the piper at
some point. You always have to pay the piper.
Yeah. It's always going to come back and get you. Yeah.
Yeah. Yeah. So there's other modes of delivery for testosterone.
You can do nasal. I'm excited about nasal.

(02:09:17):
There's research coming out that basically shows that there's no change in spermatogenesis,
meaning it's not going to affect fertility. And that's one of the big issues with testosterone.
More research needs to be done, but if that actually turns out to be true,
it'll probably be the most sought-after mode of application for testosterone.
There's also the orals. It took a long time for the orals to be approved by

(02:09:38):
the FDA because they caused basically liver failure.
But in 2019, the first one came out. I think there's like three out now.
You take them twice a day. You have to take them with fatty foods.
So they're used by the lymphatic system, and they work great as well. Colonic paralysis.
What does that look like? That doesn't sound good.
Colonic paralysis. So your colon does something called peristalsis,

(02:10:01):
meaning that it has these rhythmic type contractions and that's what pushes
food from the stomach down to the anus.
So if your colon is basically paralyzed, food then does not move, right?
And so at some point, everything's gonna back up and you're basically going
to have like an obstruction or it's going to back up so much that your bowel

(02:10:25):
is going to expand and then eventually perforate or explode.
So, yeah, it's not pleasant. That makes for a disturbing picture. Yeah. Okay. What is AI?
Not artificial intelligence, but it's a...
This word was getting thrown around in some of these videos. Is it aroma?
Aromatase inhibitors? Yes. Yeah. So that's another way that some of these TRT

(02:10:49):
clinics will try to increase your total testosterone.
So if you remember back to what we talked about before, so testosterone will
be converted to estrogen, about 0.3% of it.
So if you inhibit that conversion, you can then increase your total testosterone.
And so some clinics like to do this to increase your testosterone levels.

(02:11:10):
This is not a good idea, right? Men need their estrogen in between 30 and 50 on your blood levels.
And if you're decreasing it below that 30 mark, you're going to be into trouble.
Like we saw with Clomid, right? So estrogen is extremely important in sexual
function. So if you decrease it too much, you're going to have problems with erections.
You're going to have problems with sexual desire.

(02:11:32):
And on top of that, you're going to have problems with mental health,
fat deposition, and bone density.
I mean, unless your estrogen is off the charts, way above 50,
then maybe you can microdose with aromatized inhibitors.
But I would be very, very careful.
And if your clinic is prescribing these right out of the gate, I'd leave.

(02:11:55):
Other thoughts on testosterone? I have tons of thoughts on testosterone. I can go on for days.
So another way that these clinics try to increase your total testosterone is
using 5-alpha reductase inhibitors.
And a lot of people know about these because these are what are used for...
Or alopecia or premature hair loss, right?

(02:12:16):
It's also used in the BHP arena or benign prosthetic hypertrophy.
As men age, their prostate tends
to grow and then we can have issues with urinating and things like that.
So these drugs are used in that arena, but it's also used in the testosterone
arena because testosterone is converted to DHT.
So they try to stop that conversion to increase the total testosterone,

(02:12:38):
which again is not a good idea. I mean, DHT should be coveted.
It's our most potent androgen, right?
I typically never prescribe these type of medications to anybody because of
the potential side effects.
There's something called post-finasteride syndrome, which the data says about
5% of men may suffer from.

(02:13:01):
I think it's probably more because erectile dysfunction is part of this.
And I think as men age, they just think that erectile dysfunction is part of aging.
So then they may not understand that. No, it's actually a side effect from this medication.
So I think it's underreported. But post finasteride syndrome not only affects
erectile function, which actually is permanent, like last forever,

(02:13:25):
even when you stop the medication, but it also affects your mental health.
Like it can lead to anxiety and depression and even suicidality.
So I saw a guy probably six months ago that he came in, he was 30,
and he had just tried to hang himself, right?

(02:13:45):
His wife came in and his kids, he had a lovely family, and I was just chatting with him.
And his wife said, yeah, I mean, he's been suffering from premature hair loss.
And he started taking this, you know, 5-alpha reductase inhibitor a little while ago. go.
And after that, he just totally changed, right? First, he couldn't get erections.

(02:14:08):
And then he just became depressed and anxious. And now we're here.
And he tried to hang himself.
And again, I don't know if that medication caused that or if it just happens to be associated.
But regardless, I mean, this is a 30-year-old dude that tried to hang himself

(02:14:29):
that was just on a 5-alpha reductase inhibitor.
For me, that's scary enough to never want to try this stuff.
And I don't put any patients on it
because I think there are better options in both
the hair loss world and in the bph world
they're just equally as good if not better so
i try to never prescribe them what are some of those drugs called like

(02:14:53):
the names of the specific drugs of which ones the
the one that the gentleman was on the finasteride okay propitia is that one
of them propitia is the one milligram dose so finasteride is sort of the trade
name it's what's It's used for BPH is the five milligram dose and the Propecia
is used for alopecia orally at the one milligram dose.

(02:15:14):
On the enlarged prostate, are there any treatments for that now?
And I just think of this because when you mentioned that, I have this vivid
memory of my grandfather.
I mean, this was years ago, but we were at a sporting event together and we
were at urinals next to each other.
And when we exited the bathroom, he said, God, I'd give anything to have a stream like that again.

(02:15:37):
And I had to ask, so what do you, what do you mean? He said,
oh, you'll find out when you're my age.
But I've since come to learn, I mean, basic urination can become very uncomfortable
for men when they reach their golden years.
So is there any progress being made on that front? Yeah. I mean,
it's a big issue for older men.

(02:15:58):
I mean, I would say probably once a shift, I probably see a guy coming in with
horrible abdominal pain that hasn't been able to urinate for...
24 hours or so. And it's like he's in labor, just excruciating pain.
And we end up having to put a catheter in him to release all the urine.
And then we're talking about like liters of urine coming out. It's crazy. Wow.

(02:16:22):
So are there other things that we can treat BPH with? Yes, there are different
alpha blockers, which work great.
And what I like for more of like a prophylactic almost treatment are the phosphodiesterase
inhibitors like Cialis.
So you can take those low dose daily to basically stimulate overall prostate health.

(02:16:45):
It increases prostate blood flow and can help maintain that stream.
And so I like those as well. Are you going to be walking around with erections
all the time if you're on that?
Not all the time, but it's just much easier to get them. Yeah.
Okay. Okay. My wife enjoys them.
Gotcha. Well, good for her.

(02:17:06):
Let's switch over to women for a second. What about hormone replacement therapy
for women? Is there a connection with cancer?
Are there other adverse effects? Is it good? Is it bad? Let's get some truth on that.
Yeah, so I think that this one, this question requires a little bit more nuance,
and I don't think there's like a yes or no or right answer.
But I do think that all women should at least be going to their primary care

(02:17:29):
physician or their gynecologist to at least understand the potential risks and
benefits and probabilities of each for getting hormone replacement therapy.
The Women's Health Initiative.
Is like, it's a major muff, a major swing and a miss on the medical community, right?

(02:17:50):
That basically turned the entire medical community off of hormone replacement therapy for women.
This study was basically based
on the belief that women go through menopause, their hormones go down.
If we replace them, they should feel better.
It should help cardiovascular disease and improve
prove bone density okay and the

(02:18:13):
issue was is that we didn't have any real hard data
we only had epidemiology saying oh it looks like this is working well and so
the nih said well we need some hard data so that's why they came out with the
whi okay so let's just go just talk about the menstrual cycle real quick just
to give us an understanding of women's hormones in general Okay.

(02:18:34):
So an NHI National Health Institute.
Yes. Okay. So the menstrual cycle usually lasts about 28 days,
give or take a few days. It can be different from woman to woman.
Day zero is typically when the woman starts to menstruate, starts to bleed,
starts to have her period.
Her hormones are at an all time low.
Okay. After that, her estrogen starts to increase.

(02:18:54):
The estrogen is increasing in hopes of basically having the ovary release a
follicle or for ovulation to take place.
That usually happens about day 14. After that, estrogen starts to come down
and the progesterone starts to increase.
As progesterone increases, basically its job is to basically get the inner lining

(02:19:17):
of the uterus ready to accommodate a pregnancy.
And the female body usually knows if that happens at about day 21.
And most of the time, women are not pregnant. it. So after day 21,
both estrogen and progesterone basically just crashed down.
And it is those last seven days in susceptible women that basically leads to PMS type symptoms.

(02:19:38):
And that's a real thing. And we know it's real because if we give women progesterone
during those last seven days, their symptoms magically go away. Okay.
So what do women experience during menopause? So there's There's two main types of symptoms.
All right. Initially, it's going to be hot flashes and like night sweats.
And those can last for years and they can be really bad for a lot of women.

(02:20:01):
And then after that, we get more of the long term effects, the vaginal atrophy,
the dryness, and then also like the bone issues.
They get osteopenia and osteoporosis. OK.
And what is vaginal atrophy?
Are you serious? Well, I mean, I think I know what it means,
but... It's when the vagina just starts to atrophy. It's smaller.

(02:20:26):
Atrophy's away. Gotcha. Okay. Just wanted to clarify. Yeah.
Continue. It became well known a long time ago that during menopause,
women's hormones are going to start decreasing.
Initially, we just gave women estrogen. And this turned out to not be a great thing.
Because if we just gave estrogen to women with a uterus, it actually led to

(02:20:48):
increased risk of uterine cancer.
And so what we realized quickly is we needed to get progesterone 2 to antagonize
that. And that basically worked well.
The endometrial or uterine cancer went away.
And so that became the basic standard treatment. And that's the treatment that
we now use, the estrogen progesterone combo.
Okay. So back to the WHI, the Women's Health Initiative, this big randomized

(02:21:14):
controlled trial that basically wanted to see if hormone replacement therapy
was beneficial in and women, okay?
So there was two main arms in this treatment. There was one arm that had women
with a uterus, and so they got estrogen and progesterone, or they got a placebo.
The other arm was women without a uterus that had had a hysterectomy,

(02:21:35):
and they got estrogen, or they got a placebo, okay?
And a lot of the things that happened in this study were a little bit bizarre.
So the women were much older than they typically are when we start women on
hormone replacement therapy.
The women in this trial were much sicker than the general population.
None of these women were symptomatic. So all of these things are different than

(02:21:59):
typical when we treat women.
And they also use different hormones than we actually use now.
So now we use bioidentical estrogen and progesterone.
The estrogen is delivered in a patch and they're both bioidentical.
In this study, they used oral equine estrogen, meaning that it was estrogen

(02:22:20):
that was isolated from the urine of pregnant horses and synthesized into,
it was isolated out and synthesized into pills.
And the women took it orally and they used synthetic progesterone,
both of which we do not use any longer.
So what did they find in this study? What were the actual results?
Well, once the results came out and the headlines came out, the headlines basically never went away.

(02:22:47):
They basically said that women with a uterus that got the estrogen and progesterone
had an increased risk of breast cancer.
And that increased risk was said to be 25%, which seems really scary and massive
until you actually dive into the data and look deeper.
The numbers. So what did the numbers actually say? It was a difference between

(02:23:10):
four in 1000 and five in 1000 getting breast cancer.
So yes, that is a relative risk increase of 25%. But what is the absolute risk?
The absolute risk is 0.1%. So that 25% is totally out of context, right? Right.

(02:23:30):
Totally out of context. Because we went from 0.4 percent to 0.5 percent. Yeah.
Which we're still at an extremely unlikely event.
Exactly. So, I mean, there were two negative things that happened in this study.
Right. There was an increase in cardiovascular disease, which we basically done
away with because we know that giving oral estrogen increases coagulability,

(02:23:52):
thickens the blood, leads to bad events.
Now we give the patch and it actually has shown that women on the patch have
lower events of cardiovascular disease. So that's gone away.
But what about the other group, right? What about the other group that didn't
have a uterus, that just got estrogen?
What happened to them? There was actually a decrease in breast cancer in that

(02:24:13):
group, in the WHI, though it wasn't statistically significant.
But if you look at that data, then that would probably lead many,
it leads me to believe that it was probably the a synthetic progesterone that
was the problem. And we don't use that drug anymore.
So at most, the absolute risk is 0.1% for getting breast cancer.

(02:24:33):
And it's probably much less than that. I think the overall moral to this story
is, is you can't just take headlines at face value, right?
You've got to actually dive into the data a little bit and realize if what they're
saying is actually true because sometimes it's not.
And finding good sources with people that you can trust.

(02:24:56):
Because most of us are not equipped to dive that deep into this type of data.
And that's why I appreciate people like you who are trying to just spread good,
truthful, actionable information.
So, yeah, I mean, is there a risk of breast cancer? Yes, there is.
But it's not that large. And sometimes the effects of menopause are so significant

(02:25:21):
for some women that sometimes the benefits of making those go away outweigh the risks.
And that's why you just need to at least talk to your physician about the possibilities.
This isn't the answer for everyone, but it could be the answer for some and
resolve a lot of pain and undue suffering.

(02:25:42):
Let's talk about supplements. And obviously, we can't get into every supplement that is available.
That will have to be a future episode. But let's just hit the low-hanging fruit,
three to five good supplements that have got strong data behind them that are safe to use.
What supplements should we be on, if any?
You know, regarding supplements, I think it's very important to go back to the

(02:26:05):
hierarchy of importance, right?
So we've got to make sure that we are hitting those big things first and taking
care of that 95%. And once we have that 95% taken care of, then we can look
to the supplements, right?
The supplements are only going to move the needle a little bit, just a little bit.
They're not going to do a ton to improve your health by an exponential amount.

(02:26:31):
It's just not going to happen. Okay. So with that in mind, so five low hanging
fruit supplements that I think that are safe, have good data,
and can provide some benefit.
Creatine would have to be number one, five grams per day.
Creatine has been around a long time, has very minimal side effects.

(02:26:53):
It's proven to be very safe.
Some people get a little bit of GI upset with it. If you do just split it up
into two doses, take two and a half in the morning, two and a half at night.
I mean, creatine has been shown to improve muscle mass, body composition.
It's now shown to have cognitive effects and it's even showing now to help with

(02:27:14):
mental health, like creatine, pretty amazing.
And it's relatively inexpensive.
Now, some of these supplement companies are trying to reinvent the wheel.
Okay. They're coming out with all these different types of creatine,
buffered creatine, and all of these things are either equally as good as creatine
monohydrate or less good. And they're way more expensive.

(02:27:35):
So they're all trying to come up with these because creatine doesn't cost that
much. And so they're not making any money. So they're trying to reinvent the
wheel, just stick with the basics.
Creatine, monohydrate, five grams, up to 10 grams if you weigh a bit more.
Yeah. Okay. I mean, I take 10 grams.
I think those that are over, like there's no hard data on this,

(02:27:55):
over 170, 180 pounds, you can take 10 grams per day.
Okay. I'm taking 10 grams as well. That's why you look so good. It's lovely. Yeah.
It's a great supplement. Next would be, you know, like a protein isolate, such as whey protein.
Like we've said before, for a lot
of people, it's difficult to get all the protein you need in real food.
So I like whey. It's high in leucine, but whey is actually made from milk.

(02:28:20):
So some people can't tolerate the lactose in it. And if you can't tolerate the
lactose, then you can use something like a hydrolyzed whey, which basically
takes care of most of those issues.
Other isolate proteins are great as well. If you're plant-based,
like I said before, you can use potato or corn.
Those are very high and leucine or use a blend, you know, to be able to make

(02:28:40):
sure that you're getting all the protein that you need. Okay.
Got a third one? I've got many more. We can keep on going.
So the next would have to be magnesium. So magnesium is basically involved in
like over, it's a cofactor for over 300 enzymatic reactions in the body.
It's imperative for bone health. About 60% of our magnesium is actually stored in our bones.

(02:29:04):
It's important for insulin sensitivity. It's important for nerve transmission.
And it's important for DNA repair. pair.
And the reason that I put this so high on the supplement list is that if we
look at the data, most people are deficient in magnesium.
Probably the majority of the US population is.

(02:29:24):
So the RDA for magnesium for men is 420 milligrams per day.
For women, it's 320 milligrams per day.
But if we look at dietary surveys, it looks like we're probably only getting
about 250 milligrams per day per person. Our soil isn't as good.
We're taking medications that basically decrease the absorption of magnesium,

(02:29:45):
such as like PPIs, which are used, proton pump inhibitors, which are used for
like gastritis or GERD or things like that.
And alcohol intake basically makes us pee out more magnesium.
So really all things point to supplementation. Just remember that like magnesium
oxide that's used for constipation. So you don't want to take that.
That's just going to go straight through you but there's a couple supplements that

(02:30:06):
are great like slow mag or bio optimizers
magnesium that has seven different elemental forms both of those are high quality
work great okay what's our number four supplement after magnesium i'd have to
say vitamin d i mean vitamin d it's
much more than a vitamin it's actually converted into a steroid hormone,

(02:30:29):
meaning that it actually travels to the nucleus of the cell and affects gene expression.
So it's extremely important. If you look at the data about, gosh,
5% of the protein encoded genome actually is regulated by vitamin D itself.
Okay, what's going to come next? I'd probably say omega-3 fatty acids.

(02:30:50):
These are really one of my favorite supplements. There are just countless benefits.
So they're good for heart health, for brain health, for mental health.
They decrease inflammation through like protectants and resolvents.
They thin your blood like aspirin. They lower your triglycerides.
I mean, the benefits are really countless.

(02:31:13):
And if we look at the data, I mean, a lot of people are deficient in omega-3
fatty acids. So yes, you can get them from fatty fish, like salmon,
but a lot of people aren't eating a lot of fatty fish.
And a lot of the people in the plant-based community believe that they can get
their omega-3 fatty acids from something like ALA, which is basically an omega-3

(02:31:35):
fatty acid which is produced by plants.
But the conversion from ALA to EPA or DHA, which are the marine-based omega-3s,
it's actually very small.
So you actually need to be intaking the marine-based DHA, EPA to get these benefits.
There was a study that came out of Harvard, like in 2009, I believe,

(02:31:58):
that looked at the top six causes of preventable death.
And number six was being deficient in omega-3 fatty acids.
They equated that to about 84,000 deaths per year, which is insane, right?
The way that we can actually measure omega-3 fatty acids in our blood,
you can actually do a random blood test, which isn't as good because it's basically

(02:32:20):
a short-term marker of our omega-3s.
But the better way to do it is to look at our omega-3 index,
and that's actually looking at the omega-3 fatty acids actually in our red blood
cells, and it's a better long-term marker.
The guy that created this is Dr. Bill Harris, and he's sort of the guru, the goat of omega-3s.
So he's found in studies that if you have an omega-3 index that's greater than 8%, that's good.

(02:32:45):
And if you're less than 4%, that's deficient.
So initially, when he started doing these studies, he found that people that
had an omega-3 index of greater than 8%, they had a 90% decrease in sudden cardiac death,
which is crazy because cardiovascular mortality is the number one cause of mortality in the world.

(02:33:06):
So that sounds pretty important. It's also been shown from studies that taking
omega-3 fatty acids has actually been shown to expend your lifespan by about five years.
And this is interesting because there's often been said that there's a longevity
tax for living in the US versus Japan.
And they say there's a five year longevity tax for living here versus Japan.

(02:33:28):
People in Japan eat a lot of fatty fish and they have very high omega-3 indexes.
So it just equates perfectly, which is interesting. And there was another study,
the last one that I'll point out, that basically looked at two different groups. It looked at smokers.
So it looked at those that smoked and didn't smoke and looked at those with
high omega-3 indexes and those with low. Okay.

(02:33:50):
And it looked at life expectancy. Pretty obviously, those that didn't smoke
and had high omega-3 indexes, they basically lived the longest.
Those that smoked and had low omega-3 indexes, they lived the shortest amount of time.
But the two groups in the middle had the same life expectancy,
basically meaning that it was equating having low omega-3 indexes with smoking.

(02:34:16):
Now, this is just correlative, but it's interesting nonetheless.
And I think that this makes a good point in that people oftentimes just focus
too much on what they shouldn't be eating.
Where if we actually focused on, gosh, I need to consume omega-3 fatty acids.
Gosh, I need to consume protein. gosh i
need to consume fiber like there's really no other

(02:34:37):
room for eating anything else so let's focus on
what we need to take to to maintain our health
and focus less on what we don't need to eat how
do we get from that four percent range to that eight percent range so the data
basically shows if you take two grams per day of a fish oil supplement that
should get you from the from the deficient range to the sufficient range okay

(02:34:58):
i like the nordic naturals brand with lemon flavor there's There's no fishy taste,
and it works great. Very high quality.
My wife will appreciate that because I smell like fish taking the...
Omega supplements that i'm taking right now you're burping them up
yeah i gotta i gotta switch horrible so these natural
you just don't get that at all yeah lovely lovely that's

(02:35:20):
a great recommendation and appreciated by jessica
okay let's turn to something that is cutting
edge really exciting rapamycin what is it what can it do for us is it really
going to extend lifespan if we look at centenarians those that live to be over
100 years of age right so they don't simply Simply get cardiovascular disease

(02:35:42):
when they're 50 and live well with the disease.
They basically delay or evade that disease altogether.
And we're not talking about two, three, four years. We're talking about decades.
So what they do is they basically extend the period of their health span. And then they decline.
They basically shrink that period of decline at the end of their lives.

(02:36:05):
Okay. So how do they do this? So the bad part is really short.
It's really short. Not only is life longer and health span is stronger,
the end, which is never pleasant. The short, steep, and painless.
Yeah. Yeah, that's what you want. You don't want that slow, steady decline that
comes along with being metabolically ill or having visceral fat.
Right. That's what we don't want.

(02:36:26):
So how do these people do this? So they basically, they picked the right parents,
right? That's what they did.
But our genes don't really care if we live that long. What our genes care about
is that we grow up, we reproduce, and that we raise our young.
So genes that prove to be detrimental to our health later in life are not weeded

(02:36:50):
out because they're just not selected for, right?
So if we look at longevity, if we look at these people that are living to be
100 plus years, it doesn't seem to be related to one gene like ApoE4 or FOXO3.
It seems to be related to multiple genes, probably hundreds,
if not thousands, each making its own like small contribution leading to that longevity.

(02:37:15):
Now, some people find this disheartening because there's no magic bullet, right?
But I don't think so. I think that we can still alter and change our gene expression
by our environment, by our behaviors and by medications.
And so when we're talking about life extenders, what we're talking about is
how medications that we take can then influence our gene expressions to allow us to live.

(02:37:42):
So the problem with this, with studying this in humans, is that there's very
little tolerance from the public and from regulatory agencies regarding side
effects in healthy people.
But this is taking place in animals.
So we have seen that multiple medications that we take as humans when given
to animals have extended their lives.

(02:38:05):
And while we may not be animals, while we may not be mice, there still are a
lot of biological things that are similar that we can extrapolate a lot of information from this.
The NIA, the National Institute on Aging, basically created the ITP,
which is the Interventions Testing Program, to basically test out longevity

(02:38:26):
molecules on mice to see if we can extend their lifespan.
And so far, four molecules have shown to extend the lifespan in these mice.
The first one is rapamycin, which we'll do a deep dive on in a second,
my favorite longevity-enhancing molecule.
The second two are going to be canagliflozin and e-carbose, and those are both

(02:38:48):
diabetes medications, actually.
And the last is 17-alpha-estradiol, which is actually like a weaker estrogen
than we produce in our bodies.
Two interesting ones that are on the horizon are meclizine and astaxanthin.
Now, these are interesting because they're actually over-the-counter medications, right?
So meclizine, also known as bonine, is used for motion sickness.

(02:39:10):
And astaxanthin is basically found in crustaceans. It's what gives salmon their
sort of pink fleshy color.
And so salmon that are farm-raised, they're basically just bathed in truckloads of this stuff.
So those two molecules are looking very promising. It's something to keep an
eye on because they're over the counter and can be very easy to get your hands on.

(02:39:31):
What I think is equally as important is to realize what's not on this list, right?
So we have the nicotinamide family. It is not on that list.
The nicotinamide family being NAD, NR, and MN.
Resveratrol is not on this list, and metformin is not on this list. So regarding NAD.

(02:39:52):
So the research is looking more and more like it's not going to have any benefit on humans.
It's still possible that it could, but I personally wouldn't waste my money on these supplements.
Resveratrol has been completely debunked. Regarding longevity, do not waste your money.
And then metformin is interesting because while metformin did not show any benefit in these mice,

(02:40:18):
when we look at actual epidemiology or observational data, when we look at diabetics
that take metformin, they actually look like they might live longer than healthy
adults not on metformin without diabetes,
and they get lower cancer rates.
So what's actually going on right now is something called the TAME trial,
which is sort of the first of its kind, which is a randomized control trial

(02:40:40):
to actually see if metformin is indeed a longevity-enhancing molecule in humans.
So that data is to be determined and should be out in the next five to ten years. Right.
So rapamycin is fascinating. It was basically found on Easter Island.
It was initially found to have very strong antifungal effects.

(02:41:04):
So it could be used for athletes' feet, things like that. Then it was found
to have very strong immunosuppressive effects.
So it was used actually on patients that were getting transplanted organs to
help them accept their organs so they wouldn't be rejected.
It was found that rapamycin basically worked to decrease cell growth and cell division.

(02:41:24):
And eventually it was found to work on mTOR.
MTOR's main job is basically to balance the amount of nutrients we have with
the organism's need or want to basically divide and reproduce.
Rapamycin affects mTOR, and that leads to longevity.
But this seemed to be, there seemed to be something that was quite daunting,

(02:41:45):
that was hard to overcome.
It was this immunosuppressive effect, right? We're giving this as a chemotherapy
or as something to help decrease the immune system so that we can accept organs.
Well, that probably isn't great for us as humans, right?
But in 2014, a fascinating study came out that basically showed that when you
give rapamycin at a moderate dose weekly, it actually improved immune function.

(02:42:10):
But when you give it daily at a low dose, it suppresses immune function.
Meaning that rapamycin works more as immunomodulator rather than immunosuppressor.
So most people in this arena now that are into taking longevity enhancing molecules
are taking in between six to eight milligrams per week.
And you need to make sure this is enterically coded so that it's not broken down by the stomach.

(02:42:33):
And so a lot of times you can't have this compounded. So you actually have to buy the real drug.
And you do need a prescription for that one, right? You do need a prescription,
which is a good thing because like with all things, I think like we've talked
about this entire time, right? There's no solutions.
There's just trade-offs. You've got to look at the risks and the benefits and

(02:42:54):
the probabilities of each so you can make an educated decision decision,
whether, you know, this molecule is right for you or not. Dr.
Paul, thank you so much for coming in. If anybody wants to know more and learn
more about their health, longevity, increasing health span, where can they find you online?

(02:43:15):
You can find me on Instagram at Dr. Paul Rodenberg. You ready to go lift some heavy things?
Oh, let's do it. Let's get animalistic and lift some heavy weights.
Let's do it. Can't wait. All right, let's go.
And of course, nothing Nothing in this episode or any future episodes should
be considered to be medical advice.
Every situation is individualized to the person involved, and you should check

(02:43:38):
with your medical provider before making any major changes to your life.
That said, we are trying to put good information out there and help you to ask
better questions to licensed health providers.
Okay, everybody, until next time, ask questions, don't accept the status quo, and be curious.

(02:43:59):
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Dr Paul: "Health Influencers are Liars" | The truth on testosterone, nonnutritive-sweeteners, Ozempic, fitness, vo2max, seed oils, rapamycin, and carbs

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