Peter Attia on Growing Muscle Fast, Danger of Cold Plunge, & How You Are Ruining Your Testosterone

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Hank joined BJ's Wholesale Club the day he became a father of 30. I coach football. Now, Coach Hank saves up to 25% off grocery store prices. 30 pounds of pasta, 3 cases of protein bars, 75 sports drinks. And that's just pregame. He knows teamwork. And BJ's knows savings. This is your home, Coach. Home of the Save. Join for just $20 at BJ's.com slash mesquite and save 10 cents per gallon for 6 months. Open soon. Limited time offer. New members only. BJ's. Home of the Save. What's up everybody. Today we're very excited to have our guest here who's going to teach us all about why my sperm doesn't swim and how we can live till we're 100 years old. And most importantly, why, actually this is what I'm really excited about, why people who live to 100 are full of shit with their advice. I thought this was so good because I've had this, I think there's a contrarian in me. So whenever I hear the 100-year-old people going, I smoke a pack a day and I drink whiskey, and I'm like, this is fucking bull. And I'm watching. I'm watching you on this interview, and this was so validating. You're like, you say something to, oh, by the way, it's Pyrrha Tia. Oh, what's up, Pyrrha Tia. So you said this thing, and it was just so validating. You're like, yeah, yeah, these people are like super freaks in terms of their ability to live long. They're not doing anything specific. Survivorship bias. Yeah. So it's like, it's like LeBron telling you how to pick up girls at a nightclub. It's like, I don't need your advice. I need the guy who's like 5'6", who's getting laid every single night. Can you break down why people who live to 100? Are the last people we should get advice from? So genes don't play much of a role in how long you live up until about 80. So it really turns out what you do matters a lot. Plus luck. We could talk about where luck factors in. But for those people that make it to 90s, 100s, they're called centenarians and then super centenarians. It's virtually all genetic. And what every study of these people has demonstrated is they live long despite what they do, not because of what they do. Exactly. That's a good point. They are on average more likely to smoke, more likely to drink, less likely to exercise, and more likely to eat junk food. Wow. Wow. So all these people in like Italy who are like, yeah, you just eat pasta once a day. It's like, no, you just got some good genes. You got great genes. So does that account for blue zones as well? Yeah. The blue zones is a totally interesting and different issue going on. This is a very controversial topic and I fall on one side of it. Wrong place to do it. Yeah. So I actually think the whole blue zone thing is a bit of a myth. Talk that shit. And ice baths, right? It depends what you're doing them for. To look cool with your shirt off? Oh, that is very good. Yeah. That is the ice bath, right? It's an excuse to show your body. It's an Instagram thing. Yeah. Thank God. Okay. Keep going. Keep going. So a big problem with the blue zone things is the sort of record keeping of how long people live and birth certificate stuff. There's like a lack of birth certificate integrity. There are a lot of places that reportedly had very high degrees of longevity. And if you follow on the X axis, like when did birth certificates get introduced? Like it vanished. The longevity vanishes. So they're just making up how old they are. Yeah. A lot of that is going on. And then the truth of the matter is there's this whole kind of people don't understand causality sometimes. Yeah. So if you went into the gym and you saw a whole bunch of super fit people running on treadmills. You would think that. You could be. Yeah. You could be lulled into the belief that Lululemon tights make you fit. Right. You could be lulled into the belief that fancy blue over the ear Apple headphones are good for muscle mass. Like you could create a story and not realize, no, it's actually all the exercise they're doing that's helping. And people who exercise also happen to wear Lululemon tights and Apple pod, you know, whatever AirPods and blah, blah, blah, blah, blah. So, so the whole thing is just, you know, we tend to infer too much causality from a lot of that stuff. Some of the things that are, you know, assigned to the blue zones make sense. Like does eating, you know, healthier food make more sense than eating junk food? Of course it does. But, but to think that there are these really specific blue zones and we need to kind of go and figure out everything they're doing because some of the ideas that are proposed are like exercise less because people in blue zones don't exercise much. And again, I just think that on its face, a lot of that stuff just doesn't work. It doesn't make sense. Yeah. Interesting. Okay. So wait, the sauna cold plunge thing, can you parse those two things and can you explain why cold plunging is kind of bullshit? Well, I don't, I wouldn't, I wouldn't say it's bullshit. It's just not, it's not going to make you live longer. Okay. There's no, there's no evidence at least that sauna is going to make you live longer. Um, pardon me, pardon me, cold plunge. Um, can I, can I ask one thing about cold plunge? Yeah. And I know nothing. I'm going to be like the most ignorant person in the audience. This is my experience in doing it. I wonder if it is, have you ever gone like skydiving? No. Have you ever gone bungee jumping? Nope. He's trying to live forever. Yeah. But then he's also like swimming with sharks to Catalina Island. So I don't know if I believe a hundred percent live forever, but, uh, okay. Sometimes you do these scary things and then when you survive them, there's this like release of dopamine and it's a positive dopamine and the positive dopamine makes you feel amazing in the moment. So in 60 seconds without skydiving or bungee jumping, I get a positive dopamine that makes me feel amazing. Is it just the quickest way to feel good? Uh, first of all, that's actually a great insight and that's absolutely a, one of the two pieces of the benefit of cold plunge. So, uh, it turns out that our bodies want to preserve a dopamine homeostasis, which just means a balance. So anytime we have something that induces a little bit of discomfort, the body will try to compensate by making more of the sort of. Yeah. Positive neurotransmitters, including dopamine. And that's why exercise, by the way, the pain you experience when you go out for a hard run. So, so, so cold immersion has been demonstrated to improve mood, although it turns out not in everybody. So there are a subset of people who just experienced the pain and they don't get any of the positive from it. So you get nothing when you hop out of the car. I don't like cold plunging. I get out and I go, I'm cold. My feet are tingling and that's it. That's it. But I do love saunas. So we'll talk about sauna in a second. The other thing that cold plunge does is it reduces inflammation. And there are times when that's a good thing to do. And there's times when you don't want to do that. So it turns out if your goal of resistance training is to add muscle mass, you actually don't want to get into a cold plunge after. Because the inflammation is actually bringing blood to those. The inflammation is part of the repair process. Right. And it's the repair process that adds size and strength. So if a person is saying, hey, I want a cold plunge. But I'm also, I don't want it to interfere with my strength training. Then they kind of have to set, you know, we don't know exactly how much separation, but I would say like, don't do it on the day of, you know, to be safe. So it shouldn't be this like religious thing that people are doing every single day. I mean, I don't think anything should be a religious thing we're doing every day. But if you're doing it every day thinking it's going to make your whatever, give you immortality, it's not. And if you're doing it every day, then it might have some. Negative consequences, certainly with effective resistance training. But again, for some people, like for me, the mood effect is really profound. Oh, it's amazing. I absolutely love cold plunging. Yeah. Get in an argument with your wife, hop in a cold plunge, get out. You're like, my marriage is perfect. What were we even arguing about? So, yeah, no, I think, I think. And the other thing that's a little frustrating is nobody knows the exact dose response. So like. Like how long you should be. At what temperature. Right. It just feels like we're competing to go colder. Yeah. Like Joe just called me a pussy every time. I'm like, dude, it's, if it's not 60 degrees, I'm not getting in that fucking thing. But I do feel like guys are going, okay, I could be at 37. Dove is trying to be at, I forget what it was, maybe 45 for two minutes. But if you're not really getting any different. Yeah. I mean, I think I've tried to figure this out so many, which ways I actually, this would be a great question for me to put to one of the research AI engines and see if they can just pull all the data because a lot of the studies will do long immersion at modestly cold temperatures. So 55 degrees for 30 minutes. Right. But I don't want to take 30 minutes. I'm not going to do that. So I got, it's gotta be colder. Yeah. So I, I mean, I don't, I don't have the answer. I do 42 degrees for 10 minutes. You're in there for 10 minutes. Yeah. And I mean, I don't know, is that better than doing 35 degrees for five minutes? I have no idea. Um, but the reason I can't keep it at 35 is my wife won't get in it. And so then I'm just going to be turning the temperature up and down and up and down. So 42 is about the lower limit that she'll put. her legs in. she won't just sit in that go in together yeah but she'll stand in it and i'll immerse like i'll go to my neck i mean you don't gotta call her a pussy you know we just thought she was into her neck too so you're both in what are you doing for that for those 10 minutes are you like first of all she will not even put her legs in for 10 minutes so she'll be like all right i'm done with this i'm i'm gonna go someplace else but do you get any benefit out of just putting like yeah yeah you do i think for her because she's a runner like to make your life uncomfortable you know she wants to you know if she goes for a long run she loves to get in there after and just get the inflammation off her legs yeah i i want to go into your background a little bit because i think your background is very interesting and then i want to go into all these different versions we would call them like and i don't want to be reductive but like health hacks life hacks bio hacks do you do you not like that term hack i don't we in comedy we hate that term it's like it's the worst term for anything that has to do with comedy so uh benefits or whatever you want to replace with it but um but your life is quite interesting so your parents are from egypt they moved to toronto yep you were born in toronto yep okay you want to be a boxer how do you how does that even happen where you're training and you decide you want to be a boxer and how supportive of your egyptian parents immigrant parents yeah who see this clearly brilliant young man who's doing great in school i imagine i wasn't but oh really no yeah he's getting punched in the head every day yeah maybe that's part of it so to boxing where does boxing so so it all it all happened um in april of 1985 okay when marvelous marvin haggler and tommy hearns fight the the greatest fight to this day that i've ever seen that opening round bro yeah yeah the most violent violent yeah three minutes of boxing ever i think hearns breaks his his right hand on haggler's head haggler's head is the hardest head in the history of the story and his defense was just walking straight in with his head force like juggernaut it's amazing yeah and you have to remember i mean you know this because you're a big boxing fan nobody expected that like you just didn't think you thought like haggler was going to counter punch haggler was going to try to take him the distance no he was like no i'm walking through i'm walking right through you and hearns won the first round yeah yeah i mean any other person is down would have been done yeah no human at 160 pounds could have survived that fight yeah and uh and yeah there was just something about that that just i don't know why like i'm watching that and i'm thinking i want to be that guy was your dad a big boxing fan nope and i just was like i want to be that guy marvin haggler that's the one i want to be what because he just stalked him yeah it was like he's because i realized like he wasn't and then of course as i became obsessed with haggler and began to learn everything about him retroactively and i realized like he's the guy that i want to be because he's not the biggest he's not the strongest he's not the fastest he's not the best at anything but in aggregate he is the best yeah and he's the best because his will is his will his will is second to none and um and he oh the other thing is most boxers don't stay in shape all year they kind of he was committed he never got out of shape so training camp was just finishing school yeah wow which is also tough on the body i mean we can get into that like sometimes you need a break for the intensity that the guys train yeah i really regret when he was inducted into the boxing hall of fame i really regret that i didn't go as like a fan just to see it because you know of course he died in 2020 or 2021 died too young he's like now we're going deep cup at haggler so fascinating because he quits boxing i believe after the leonard fight yep he wanted a rematch leonard wouldn't give it to him he basically just got pissed and moved to italy and started making movies he becomes a movie star in italy yeah he's like the first black guy in italy and then he just becomes a movie star so have you seen any of haggler this is a real fan how's the acting it's not that great definitely a better box fair enough fair enough yeah that's interesting that leonard wouldn't give him another shot because leonard wasn't a scared fighter no i think leonard look i also did i have taken that decision to leonard or no 115 113 haggler i think i've watched that fight a hundred times yeah um i hated leonard when i was growing up despised him couldn't stand him like and then when he got that decision against uh haggler i thought it was the most disgusting thing ever i will say this today my respect for leonard is enormous like now i look back and i think like my god was that guy special unbelievable and he fought a really strategic fight against haggler like he avoided that kind of contact tommy was like i'm gonna knock you out and why would you not think that you're knocking everybody out yeah and leonard was like i'm gonna wait till the last 30 seconds of the round my corner's gonna yell and i'm gonna start swinging and if it lands it lands if it doesn't but i think i can steal rounds and i think he did a good job of that yeah i think in retrospect i mean as you probably know all of this but haggler sold the fight right so he in exchange haggler demanded a higher purse than leonard this was a very important thing to haggler's ego because you know haggler remember no olympic glory he toils in obscurity for a decade nobody knows how he's going to do it before he's finally a champion and leonard the golden boy yeah i mean he's livid with how this guy had everything handed to him right so the point of pride for haggler was i'm gonna make more money i'm gonna be the a side yeah i'm getting more money yeah and to do that he traded three things he traded duration what do you this was back in the day when the ibf still sanctioned 15 round fights oh so what did they make it sold down to 12 that's right ring size 24 down to 20 right glove size which i don't think was a benefit to him to have a smaller ring it was a it was uh sorry sorry he traded bigger rings he went up yeah sorry he traded up in ring size and he traded up in glove size the glove size is i mean the glove size is is huge yeah yeah and then on top of that he came out and boxed orthodox for the first thought he could trick him that was just a bad decision just like he just it was a series of wonders and still whatever from watching it i had him winning but again close fight Yeah. So from that day you start boxing. Yeah. Okay. So, and then the parents go, what is this stupid little hobby? Yeah. They were just, you know, this is an awful, awful, you know, I think they were wisely mindful of like, but you get hit in the head, right. And I think it, you know, so how old was I? I'm trying to think. I guess I was 13. Yeah. 12, 13. I think by the time I was in high school, it was probably a bit more of a concern because, you know, I didn't want to go to college. I didn't like school. So they were definitely concerned. Hello everyone in Dubai. How do you end up going to Stanford if you weren't good at school? So at the very end, as I'm finishing high school, I have this amazing experience with this incredible teacher who really saved my life. His name was Woody Sparrow. And he was, he was my math teacher. And he, he called me into school early one day and said, you know, Hey, you know, I heard you're not good at math. And I said, well, I'm not good at math. And he said, well, I'm not good at math. And I said, I'm not going to university. And I said, yeah, that's right. And, uh, he said, we'll say a bit more. Why? And I told him why. And he said, well, look, I'm not going to try to talk you out of it. I mean, if that's your dream, like that's, I don't think anybody should talk anybody out of their dreams, which right off the bat, I thought was an awesome thing to say. Right. Um, and then he just said something that I thought was, you know, it just, it just changed the course of my life forever. He goes, you know, I just think it would be a mistake if you didn't go because you'd be, um, for math that I don't think you realize. And if you, um, if you, if you don't pursue it, you'll never, you'll never find out. And I think you could, you could do really, you could do some good things doing that. And, and that, I don't know why there was something about Woody saying that, that really changed everything. And I really gave it thought and I really decided to come back for that extra year of high school and then, uh, you know, following his footsteps actually. So then I went on to do math and engineering in undergrad, which is what he had done. He was an engineer as well. Could you get into a school like Stanford, which is one good high school. So for undergrad, um, I went to school in Canada and then I went to Stanford for med school. Got it. And this is when do you become surgeon? After medical school, then you apply to do these, to do this thing called a residency, where you then apply all over again and you applied all these hospitals and you can decide what you're, you decide what you want to do and where you want to do it. Okay. At what point in time do you realize you're pre-diabetic? Cause the lore in your life is so fascinating. Like you could have been punch drunk. Then you skipped out of that because of captain Jack Sparrow or whatever. And then, and then you go and you become an engineer, mathematician, then you decide to become a surgeon. There's also some health issues, which I think, yeah, it was around the time I swam the Catalina channel. Okay. Yeah. Catalina channel is Los Angeles. There's an Island off of Los Angeles, 20 miles away, let's say around, depending on what part you swim to. Yeah. The closest point's like 21 miles. Right. And you willingly chose. It wasn't some sort of punishment that you have to do. So, okay. So you find out that you're pre-diabetic. Pre-diabetic. This is not like a based on diets. This is not based on lifestyle, right? This is genetic. No. I mean, I think it was, uh, you know, I, again, I kind of look back at those days and I think there were probably a lot of contributing factors. I was probably, I think my diet was a little too carb heavy for my own good, despite the fact that I was swimming 28 hours a week. You were just eating koshery every night or what? What was I eating? Like, I mean, I was like, you know what that is? The Egyptian dish. Oh, ask your parents what koshery is. Um, I, I was, you know, drinking too much Gatorade, probably not sleeping enough for sure. I definitely wasn't sleeping enough and, and sleep, um, uh, not sleeping is it plays a huge risk factor in, in, in diabetes. Okay. Um, so I think it was just kind of like a perfect storm of things okay so you get i was you know just overweight oh really oh yeah oh wow i imagine if you're swimming to catalina island you're just kind of ripped so when do you like how how big were you probably like 25 pounds heavier than i am now interesting so you're not like you're not fat to the point where you're like i'm gonna have a problem in my life i mean my wife famously said when i got off the boat this was i think not the first time this was the second time you know what i'm about to say someone tried to feed you a fish no literally i'm just this was after the swim that took 14 and a half hours into the current i get on the boat and she says you should work on being a little less not thin wow wow that's all of your research is really her credit you know she bullied you into this she shamed me into it wow thank goodness okay you I wish i could find it but someone took a picture of as she's saying that i got a coke in one hand a burger in the other my belly's hanging out over my bathing suit wow and she's like yeah congrats but listen let's let's let's work let's let's work on this thing a little more elliptical you know okay so then so what happens when do you apply just from doing research on you and just kind of like talking to you it seems like there's a very obsessive side of you and then you're like oh my god i'm gonna be like oh my god i'm gonna be like oh my god i'm gonna be okay so then so what happens when do you apply just from doing research on you and just kind of like if you can turn that obsessive thing into boxing with swimming to catalina or whatever it is once you lock in you're locked the fuck in when do you lock the fuck in on longevity um around around that time so my daughter is born in 2008 and as you now know there i think there's just the most incredible thing happens to a guy when the child is born that at least for me didn't happen even at 20 centimeters dilated like you're like oh my god i'm gonna be like oh my god i'm gonna be like oh my god i'm gonna be like oh you know i think for women they're becoming attached to that baby throughout the pregnancy and we're just like what is it and we had this cat at the time that i was obsessed with and i my wife never lets me live this down i would routinely say every night and our cat's name was midnight i was like i just i i hope i don't know but i hope i can love our daughter as much as i love but i loved midnight like this and midnight's awesome this is the podcast we need honest conversations between you and your wife that's the podcast and it cold plunges i love midnight oh i mean we rescued this little alley cat in inner city baltimore and she was so precious and and so i was like yeah and so when like when my wife is in labor i was like at my laptop in the side of the room building a model doing work and she's like you know i'm having a baby over here and i was like as soon as that baby's out i will be there but i have to get this stuff done and i'm like i'm gonna have to get this stuff done and i'm like i'm gonna have to get this stuff done again i was just once that baby came out there are a whole new set of genes that just get transcribed and all of a sudden i'm like oh my god i get it and i do wonder does that happen to like would bill marr experience that someone who's so famously doesn't like kids i think i think i think the answer is yes i think there are certain people maybe they have a genetic disposition where they don't care maybe there's a little more sociopathy or whatever that's called but i think assuming that bill is just a regular guy like us i think the same if you don't love your kids i mean it must be pathological yeah like to a degree i don't want to diagnose someone but it feels like there's something you know unhuman happening well and i think this is an interesting process for which i have no data but just through the lens of evolution i think it even makes sense for boys for males to have this feeling greater than females and here's why if you think back to evolutionary times right you know think back to a hundred thousand years ago there was no ambiguity for the woman who her child is right she carried the child yep the male does not know who his child is yep so there has to be some other i still don't i'm just hoping they got it right you know i'm looking at her every day like i think that's me so i'm i'm convinced that there's some other switch either through you know the smell of your kid or something that completely switches the male on so he's like yep that one's mine like no one gets to hurt that one yeah so you felt that immediately in i can't believe it i can't believe how profound it was yeah and to your question so to your question that i've taken too long to answer um i think that was the moment when all of a sudden i was like oh you know all this other shit i'm interested in swimming far and doing all these extreme things yeah that doesn't really that doesn't interest me nearly as much you know what really interests me is i would like to live long enough that i get to see her have a kid one day and that i get to experience this again and again and again dude the first one of the first thought i don't know the first thought but one of the first thoughts i had when i held my daughter was um i wish i didn't wait so long to do this so i could spend more time with you 41 now so i had her at 40 yeah and that and it was like i think those are under the same umbrella yeah which is like how can i be around you longer and i know that you know there's we have limited time here and i know at 40 instead of 20 or 30 i've shaved off a decade or two that i could be with you i i don't regret the decision i waited for the perfect person to do it i'm glad we did but like this impulse to be around them spend time with them yeah it smacked me in the face it was insane so it would be cool to know that that they're like some sort of like genes that get turned on in that experience again i i'm sure somebody out there smarter than me has figured it out but but that's that's been my impression okay so so you you have the experience which which let's assume a lot of dads do which is like okay i kind of need to be fit i kind of need to be healthy so i can be around it's a great motivator it's like the best i think there's even like a biblical term like every baby comes with a basket of bread this idea like you start making more money when you have a kid and it might just be the urgency it's like i should i should do that thing um it's funny even after having my kid like i i don't think i've done drugs since and i was never like a drug guy but like a little like here and there but i yeah it's like is it worth the risk like this one night god forbid something's in it yeah i mean i don't even really drink anymore since having a kid isn't that yeah just like i mean also waking up early you know i mean i'm like i can't be hung over i have to be up at 6 30 yeah so there's so many things to get tapered down in like early childhood 100 have you heard that new parents or new dads will gain body weight in the months around the birth i don't know i haven't heard this i don't know if i don't know if it's because these women be eaten i don't know if it's been validated but uh and you can't just let them eat dessert right and then they feel guilty yeah we're just being good support okay so so you lock in on longevity right and at the time although truthfully when i started thinking about it all i thought about was heart disease at the beginning because it's a disease that kills my family and so so my my foray into it was really through i really want to understand heart disease and i really want to understand why all the men in my family die of heart disease and what do i need to do to make sure that you know at the time i'm my daughter's born i'm 35 so what do i need to do to make sure i'm not dying at 60 like you know i mean some men in my family died at 45 from heart disease yeah from heart attacks jesus christ okay what is the i mean at the time i didn't know this at the time but i now can tell you with much more clarity you know heart disease obviously has a pretty strong genetic component but at the end of the day the there are four big modifiable things you just have to manage like you can't smoke your blood pressure has to be below 120 over 80 your uh lipids need to be perfectly dialed in and you want to be as insulin sensitive as possible and if those four things are true i mean you're set for life gotcha now some people can do that with diet some people can do it with exercise and some people need drugs to do it it's everything's everybody's different okay this is i'm curious about the heart disease stuff because i'm on a statin i remember going in to get some my heart check i think it was actually like when we were trying to have a kid it was really difficult and i was like having breathing problems and it was really just caused by stress yeah but uh i was like let me get my heart checked and that kind of shit and then the doctor came and was like yeah you've got some calcification like a very minor calcification and i thought he was like lying i mean i was like me i'm like exercising every single day i'm in like he's like yeah we recommend this like statin i was like i'm on a fucking blood pressure medication like what the hell is going what are you what is your feeling on using pharmaceuticals to essentially prevent these illnesses and what are this negative potential negative side effects of that so the the short answer is if you if you had a house that was being built by a general contractor and that contractor came to you and said andrew i just want you to know um i don't believe in saws hammers and screwdrivers but i like all of these other tools you'd be like what are you talking about shouldn't you have all the tools you're the general contractor yeah and so so i always find it amazing when i run into people of all persuasions who say i will only use diet and exercise and i'm not going to do that because i'm not going to do that because i'm not going to exercise to to to you know fix myself and at the other end spectrum you have these people that are like give me every drug in the world but don't tell me about exercise and nutrition it's like do you understand how hard the problem is we're trying to solve like do you understand the inevitability of death you said you said this once like everything is working against you yeah like entropy is dragging you into the grave yeah if if if you need a medication to lower your blood pressure you take that medication to lower your blood pressure right now you should wait naturally for sure by all means because there are other benefits that come so in other words if you take an individual that is overweight not exercising and has high blood pressure if you said to me peter would you rather give them a drug to lower their blood pressure or get them to exercise and lose weight to do it if they both produce the same blood pressure no questions asked this is a better approach because there are other benefits that are being captured through exercise and weight loss beyond just the blood pressure but if that person either just can't or won't do those things i'm working hard enough sorry i'm going to withhold this no of course not and secondly you can do both because a lot of people end up losing weight they exercise but they still have what's called essential hypertension they have normal normal healthy looking people that are walking around with high blood pressure it's a silent killer yeah that is the tricky thing is that so much is aesthetics we look at somebody in shape and assume that they're healthy and a lot of what's going on under the hood is the thing that could end up killing you yeah and the same is true with with lipids right like lipids are even more genetically determined and they're more likely to genetically determine than blood pressure what are lipids uh so our body makes cholesterol it's essential for every cell in your body needs cholesterol to exist and the most important hormones in your body are made out of cholesterol so testosterone estrogen progesterone all right all made out of cholesterol um and you because cholesterol is a is a lipid it's a fat it can't be travel it can't travel in our bloodstream because our blood's water without a chaperone without something to carry it that makes it solid and it can't travel in our bloodstream because our that makes it soluble and that's those things are called lipoproteins and they have different densities and one of them is called low density lipoprotein ldl that's your ldl levels that's right and that ldl does some good things but it does some really bad things and it's the only one that does this really bad thing i guess the vldl does it too but it enters an artery wall and if it gets stuck in that wall it undergoes a chemical process called oxidation and the body regrettably but understandably thinks that there's a problem there and it excites an immune response and the immune response leads to a cascade of events that ultimately result in the body trying to repair the damage the final stage of which is the calcification that showed up on your ct scan so the calcification you see on coronary arteries is the result of the body laying down concrete on chernobyl got it so what does the statin do stop the body from laying down the concrete or stop it the the statin very specifically because there are lots of different drugs that that treat this but what statins do specifically is they tell the body to make less cholesterol the liver in response to that says i'm going to make more ldl receptors on my surface to pull more ldl out of circulation so they lower the cholesterol and they lower the cholesterol and they lower the cholesterol and they don't lower the ldl cholesterol by tricking the liver into thinking it needs more of it brilliant yeah now to your question about a side effect of all the drugs that are used today that lower cholesterol statins have the most side effects oh jesus i don't even know if i want to know well the good news is you clearly don't have the most significant side effect which is muscle soreness five percent of people get muscle soreness got it that's a lot right when you think about how frequently these drugs are used one in uh 20 people is going to feel like they've had the worst workout of their life every day wow so this shows up pretty quick okay so yeah so you get that you take them off the drug immediately you um that goes away within days then there are other side effects that are more subtle and you just have to be watching for them and one of them is insulin resistance so if you see over time glucose tolerance getting worse and worse in my book that's a reason to stop using a statin the other thing is sometimes the liver function tests get a little liver enzymes that are known as liver function tests get a little elevated that's also a reason to do it but again you know 20 years ago you didn't have a choice today when i hear people go on these anti-statin rants i'm like okay like don't go on a statin like go on a pcs k9 inhibitor go on ezetimibe go on bampidoic acid like there are so many other cleaner drugs today yeah that um are more expensive and we don't have um you know so so they don't have necessarily and they're not some of them are not as potent as statins although pcs k9 inhibitors are um that it's it's a it's it's become a little bit of a silly excuse if if you're you know if you're ldl cholesterol your apo b which is really the marker of interest is too high you you know just it's an unforced error it's an own goal to walk around with elevated levels got it but so you're not essentially against a statin not at all no no no no not at all it's again and for most people they can tolerate them just fine i'm sure this is happening a lot in your industry as it's exploded but in an effort to make content i feel like people are looking for their hot take on a very popular thing and they are disseminating potentially harmful information so that they can get attention and clicks yeah this is what i envy so much about your world like when you're a comedian your hot take just needs to be funny yeah like yeah you would think and it's like but now apparently we get presidents elected so this is not not the best thing but god yeah but in my in my world you're right it's how can i make something more frightening how can i show you something more contrarian how can i be more extreme we talk about this all the time the the truth is boring and you can't get clicks on boring so you have so a lot of times people will find a way not always boring obviously there's you know a lot of novel research and you change things but like it is way whoever is most salacious is going to win the eyeballs on the internet but that's not maybe what's going to make people healthy right back to the show can i ask you a controversial one in regards to insulin resistance i recently just read uh jason feng's book uh the obesity code which you're mentioned in actually i'm sure you knew this there's a there's a reference to you swimming in it um but he talks a lot about insulin resistance and uh insulin production in regards to fasting and intermittent fasting so i'm curious your opinion on both forms of fasting and how that relates to weight gain you know in comparison to you know calories in calories out that type of uh i don't know i don't know i don't know i don't know if you're interested mark fasts i love fasting he does intermittent he does intermittent fasting he's also you know been our friend for a decade and we've known him not doing it and nothing has changed in his body he looks no different his body hasn't changed for seven years he doesn't eat for two days in a row now he looks exactly the same yeah what would you call him retarded what is this no no no no what do you call people like that no no no no eating disorder your body is no no no yeah can we diagnose him deeply in autophagy right now so i'm actually elevated i see things better than you guys i'm seeing in color that's the other he says is that when he doesn't eat he gets really focused no he has four zins in his foreskin and then he's really like you not zen when you're fasting you can if you do low doses and especially if you do the unflavored ones because sometimes oh you see this you are hitting me yeah he's already talking to himself i'm telling you i'm selfish we're selfish we always have ways around the system i'm the dumbest health guy do the flavoreds in because it breaks the fat it's in high doses sometimes it won't trigger dr t let me tell you about health i'm so glad you're here i'm actually so excited to explain this to you okay i always tell you i'm the dumbest guy when it comes to like health stuff because i'll see something i just bought a vegas nerve stimulator because i'm like oh this is the thing and so anytime i see tell me well i see i see medical quackery this is what i need uh the uh speaking of which the mint yeah yeah i won't take it go go go go here you go sorry there you go are these bad for us these are uh it depends on what does mine is statin how many how many milligrams are these six this is six oh that's too much for me wait really i can only do three at a time you do the three i do threes do you want it i got my nicotine toothpicks here that's what that was i knew it i knew it i had no clue why he was saving the toothpick on the couch he took it out he laid it on the couch i'm like what the is this the son of immigrant parents you know what i'm saying okay tell us about your vegas nurse i mean where do we start first i want to talk about intermittent fasting okay oh yeah how dumb am i i have a fasting winner from four to six they do high protein high fat low carbs am i an idiot no you're definitely not an idiot i just think you might be over indexing on something all available data that's mark's life i know all right i know all available data says that the benefits of intermittent fasting are accrued through the amount of calories you restrict in other words and this has been studied so if you take two groups of people and uh one group of them does 2 000 calories spread out over the course of the day and the other group does the exact same 2 000 calories but they eat them in six hours or four hours there's no difference except that the people who do intermittent fasting have a tendency to lose a bit more muscle why i'm not sure we gotta counterpoint you know it could be that they're not fully normalized for the same amount of protein it could be that they're putting too much protein in one time of day and then they're not getting enough muscle protein synthesis during the time when they're fasting i'm not really sure and it could be that we just simply don't have the studies done right and maybe there is no difference or you know maybe there is a difference but um intermittent fasting is an awesome tool for people if it's in some ways it's the easiest way to calorie restrict and at the end of the day calorie restriction is a really important thing to create energy imbalance energy imbalance is necessary if you're metabolically unhealthy so in other words you have to create an energy deficit if you're metabolically unhealthy so having frequent insulin spikes throughout the day has no effect on overall muscle mass or weight loss compared to having one insulin spike in the middle according to all of the data we have it does not not all of the data you're doing that shit for nothing you could be eating all day mark but maybe not but maybe not right because in other words i don't know if for you and by the way when when i needed to be when i needed to be at my absolute lightest which was 15 pounds lighter than i am now i was doing one meal a day too not because i thought it was giving me some enormous health benefit but because it was simply the easiest way to restrict my calories was to basically i don't know how the hell i did it was so miserable to get up work out not eat you know stay all day come home do another workout then eat dinner and then go to bed and do it all over imagine what it's like for your friends and family who have to fucking hear about it i don't talk about it i don't even say anything i never bring it up have you considered one of my favorite one of my favorite stickers there's this there's this there's this place in austin that always has like a funny slogan outside of it and they well they had one the other day that said um what what what happens if a vegan does crossfit which do you hear about first oh he was doing crossfit he's everything but vegan he's like almost there no no i wouldn't do the exact opposite i wouldn't do you also said you needed to be your lightest you were doing one meal a day yeah what was that need for oh first cycling oh so not for doing stand-up on the weekends sometimes just checking what about the i have 20 more dumb things i do i do want to hear about the vegas here's another dumb thing he does he fast for like two three days at a time infrequently but yes but is that good or is that bad i don't know i used to do that i used to fast like crazy i used to do seven to ten days a quarter like at the top of the quarter i would do seven to ten days straight fast and then on the other two months in the quarter three days so i would do like ten days three days three days seven days three days three days ten days three days three why well the my hope was that it was doing a complete purge of all pre-cancerous cells and you know but but again trying to replicate the benefits we see in animals and caloric restriction the problem is after three years of doing this i lost 20 pounds of muscle um which is not a lot on a guy like me who doesn't have much to begin with and i was just like okay you know what i'm going to do i'm going to do this i wish i had a biomarker that could prove to me that there was some huge benefit here but absent this i just don't think there is so i don't know maybe there's a benefit to it i just don't know hmm i also don't eat late at night that way i sleep better and i think that's that makes sense because the empirical data is clear everybody like come on you guys you guys eat like europeans you don't just say another i breathe oxygen no no you just say an obvious thing of course you're not supposed to eat late at night you're supposed to eat late at night you're supposed to eat at night that's the benefit what time do you have dinner i have dinner at 9 30 or 10 30 but i sleep like shit okay i'm out here bitching about it every single day i don't have a choice they eat at fucking 11 p.m you have that window you stop eating at six tell us about your little vegas nerve system go all right this is my new dumb thing i'm on so i just saw an ad on instagram and i was like this is it and it stimulates the vegas nerve and lowers your uh parasympathetic sympathetic sympathetic nervous system and uh helps me sleep does it i've only done it for three days and my whoop was off for one of them so do you feel any different no what is it where do you put it around your neck so you sleep with this thing around no you just do it for one hour before you go to sleep and it is what are you doing during that one hour typically reading can you be doing anything i think you'd be watching tv could you be i think it's suggested that you're ideally going down which then now we're getting into causal and corollary stuff and then yeah you also get into that's exactly right so let me get this straight if i put these if i if i put these electrodes on my neck and lay in bed peacefully for an hour before going to bed will it make me sleep better yeah it could and what would happen if you just didn't have them on your neck and you lay in bed peacefully for an hour reading your hitler books or whatever i don't know you're into those things what would you what do you think would happen do you think you would sleep better well i do that anyway this is like when the when somebody who eats junk food all the time becomes vegan and they just start eating lettuce and they're like veganism is the key that's the same thing right okay but i read every night anyway now i'm trying this and seeing if it gets my hrv up i well you know what 120 by the way 120 128 128 just saying celsius though it's not even real it's like is that in uh what's called rmss squared okay i don't know what is this supposed to be what is this supposed to be i mean that's absurdly high for an adult that's that's how i felt i was like there's no way this is true but this is and it's high good all things equal hold on let me let me let me find it for you hold on hold on i feel like a t is getting a little competitive right now what's yours atia oh mine's super low i have very low hrv i'm in the 30s what yeah mark there's no way you could be i mean i have seen people what's the average range oh it's it's it's pretty genetic believe it or not um but the average and it declines by age so for people our age that was on saturday i don't know what any of this means he just hooked his baby look you know what your six month average is 88 milliseconds i don't know what whoops algorithm is but i'm assuming they do there's two ways you can calculate hrv and they differ by about a factor of three so assuming these guys do it the way most consumer products do it you you would be at the upper upper end of what an adult would be at but again so that's great news we don't know if that means anything but but the point is on a but a relative change is what you should be paying attention to so if your average is you know whatever for the month your average is 92 then you want to know like is this thing dramatically taking you up from that i don't know how you got a 124 but man i don't know that's impressive i just had a baby and i slept on the road in a hotel but what does that mean when you have a high hrv like well all things equal it says your parasympathetic tone is higher your sympathetic tone is lower that's a good thing for you like how does it affect the body because when i was growing up hiv was a horrible no no it's not it's not that no no it's hrv the one about homo sapiens four like british scientists around that kept taking it serious it's not whatever you do in your life is fun bro okay but what is hrv what are the benefits of hrv hrv means how much variability is there in between heartbeats and what it measures is if the uh sympathetic system the fight or flight system is like the gas pedal and the parasympathetic the rest or digest system is like the brake pedal hrv basically tells us what is the balance of throttle to break okay and so when you are sleeping you want to be in a rested state you actually want your hrv to be as high as possible so why one person has an hrv of a hundred and one person has a hrv of a hundred and one person has a hrv of a hundred and one person has an hrv of thirty and one person has an hrv of fifty whatever that seems to be just a genetic issue um but for a given individual there are things that are going to lower your hrv and those are things that we ought to avoid so i'm sure all of you have learned this if you have a wearable drink alcohol before bed there is no surer way to tank your hrv eat food before bed hrv goes down sleep in a hot room hrv goes down uh you know all of these things are going to kind of over train so if something as good as too much exercise hrv goes down do you use a wearable um i don't but i i sleep on a mattress called an eight sleep yeah eight sleep is fantastic yeah i think it's genius and by the way i'm an advisor to them so now i should just disclose all that so all that disclosed yeah but what i thought was so i have a mattress cover okay the cover is but nobody wants to leave their mattress initially it's a really daunting task to change matter you're sleeping pretty good i don't i think 99 of people who use eight sleep use the mattress cover but i think that was the the great innovation because I've heard other mattress companies. There was a buddy of mine who was an engineer. He was working on a cooling mattress. And I was like, bro, now you've got to convince people to buy this like science mattress. No, if you get something that goes over it, yes, they'll do it. They'll try it once or twice. If they don't like it, maybe they send it back. I just thought it was a really smart innovation. It is, it is hands down the thing I have become most dependent on that most differentiates the quality of my sleep at home versus being at a hotel. Really? I mean, I am obsessed with this thing and it, my, my sleep at home is it's, it's Phelpsian. So I run it to work like my body is supposed to work. So you're supposed to get into bed. I don't know. I have mine at like minus five when I get into bed and then rapidly get cooler. And then before I wake up in the morning, warm me up a little bit. And that kind of mimics sort of what you want to be able to do. Does it affect you and your wife? You can separate them. So she doesn't like it as cold as mine. Sometimes you gotta fuck with her though. Freeze it up. Oh, your HRV is a little low. Oh, maybe you should be nicer when I come off the beach. Okay. Can I ask you about your supplement stack? Sure. He gets this question a million times. Okay. Can I ask you about my supplement stack? That's what you really wanted. That's really what I was wondering. That's really it. Daily creatine. I think it's a go. Why is creatine good? Um, I mean, I think it's, it's pretty good if you're training. Um, you know how it works. I'm assuming you kind of holds water. Uh, that's a net effect of it, but that's not the desirable effect of it. It, um, you know, everything in, in energy metabolism is about transferring phosphates. So you've heard of ATP. Yeah. Yeah. So ATP is the energy currency. So creatine phosphate is the fastest form of phosphate. So it gets it. Okay. Got it. So more creatine means more creatine phosphate. So aids in performance basically. Um, there's also some benefit, uh, some evidence that it improves the body's immune system. So it's a good thing. Yeah. Yeah. It's a good thing. It's a good thing. It's a good thing. It's a good thing. I think it's a good thing. It's a good thing. It's a good thing. It's a good thing. It's a good thing. It's a good thing. It's a good thing. Creatine, which might be more likely in vegetarians than non-vegetarian. So maybe you're a vegetarian in addition to supplementing a whole bunch of things like B vitamins that you might want to even more consider creatine. But for the most part, I think creatine is a good thing to be supplemented. I have a friend of mine who, who religiously uses creatine now. And by religiously, I mean two weeks he's on it and my friend Jason and he, his body, he looks like a penguin. Is that a side effect? Does it do that to you or no? There's no real data that would show that. Okay. So creatine, you're good. Magnesium before you sleep. Yeah, for sure. Okay. Uh, like vitamins, A, B, C, D, any of those? Uh, some of them, I think D is good to get D you should think about what's the level you're trying to get to. So it's, um, I think if you, you know, getting your vitamin D to between 40 and 60 for most people requires supplementation, but most people are like deficient vitamin D. Yes. So supplementing is solid. Yeah. But just, you always have to measure the level to make sure, you know, you're not doing too much or not too little. Okay. Fish oil or cod liver oil. I think so for most people, but you got to get a good source of it. Cause it's, um, um, there's so many contaminations out there. So like Carlson's is a good brand. Nordic naturals is a good brand. I have no affiliation with these companies. Um, but they're clean. So meaning third-party testing comes in and make sure they don't have heavy metals in them and stuff like that. Got it. And then what is your coffee protocol? Uh, caffeine rather. Yeah. I love coffee. Uh, unfortunately I'm a super fast metabolizer of caffeine, so I don't really get a jolt from it, but I just love the ritual and the taste and the flavor. And I recently switched over to this machine that is all glass and metal. So it makes a really nice drip coffee, but without any of the plastic. Cause I have, I have been trying to get rid of obvious sources of microplastics. Not that I'm like fanatical about this, but continue. Yeah. So hot water and plastic is something I'm trying to avoid. Right. So, so I, it occurred to me after making this podcast on the, on the topic, I was like, man, every morning I put coffee in that thing and it drips scalding hot water through 27 layers of plastic into my glass carafe. I was like, there's gotta be a way to do this. So now that I discovered this thing, which I can't remember what it's called, but it's like, it's an all glass version. A listener sent it to me. Cause I was lamenting on the podcast that I couldn't find something. And they're like, check that cutting boards that are not made out of wood. Like they'll have like a, I guess, plastic cutting boards and you'll get tons of microplastics from that kind of stuff. Yeah. I like the wooden ones. Even breaking. If you're in an urban area, every time a car uses their brakes, right. It's like sending like millions of microplastics into the air. Yeah. I mean, I think at some point there's kind of like the 80, 20 rule on this stuff with relatively low effort. I think you can eliminate 80% of your exposure and then you could drive yourself crazy and not get the other 20% out and just leave that out. Yeah. Just, just ignore that stuff. Okay. Do you have any more? Not for supplements. No. Okay. We all have tons more questions. Nicotine was the other one. Oh yes. Well, let me ask one question, just because we're on microplastics, because the second that I told the whole world that my sperm doesn't swim, I got a lot of very concerned people, including you. It was really great. Like, so I think one of your guys that works for you hit up and was like, Hey, Dr. T would love to hit you up and talk to you about your sperm. And I was like, that sounds like really awesome. If it was a year ago when I couldn't breathe, but no, this is great. And then you sent me this like awesome podcast, which is out now with Dr. Who was his name? Paul Trek. Paul Trek. Okay. I got a lot of like online diagnoses about certain things. People are like, yo, watch out for the microplastics. I'm starting to read all these articles about like what's happening in male fertility. And they say like sperm quality has decreased 50% in the last 50 years. Like, can you kind of, uh, can you talk about that a little bit? Just like is sperm quality decreasing in America? Is that, are we just testing it better? You know, what, what is happening with microplastic? Does that affect it? What do you think affected mine? So, uh, I think that there are so many things going on and it's impossible to say which one or two or three are driving. And it's kind of like the U S healthcare system. You know, when someone says, why does the U S spend more than twice what any other country spends? I'm like, how much time do you have? Cause it's, it's, I'm going to have to explain the entire system. I won't do that here on the sperm issue, but it's a lot of things, right? So as, as males are getting older at the age that they're getting older, they're getting older, they're getting older, they're getting older. Um, but at what age I was told that that's, that doesn't happen until we're like 60. Um, no, I mean, at 50, you fall off a cliff from the standpoint of the quality of the sperm. Got it. Um, but remember as you're getting older, testosterone's going down as well. Then you factor in if testosterone is going down and more men are using testosterone replacement therapy, that's also, uh, reducing fertility. If you're using actual exogenous testosterone, the relationship between obesity and metabolic disease is also pretty significant. And men on average today are much fatter and less healthier. That doesn't explain you, but clearly there's something going on at the population level there that also probably has the greatest impact on declining testosterone levels, um, is just inflammation, obesity, um, more aromatization, meaning turning testosterone into estrogen. Um, you know, it's funny. I don't think I don't know enough about STDs, so I don't know if they're going up, but STDs play a pretty big role in, for infertility as well. So yeah, if you get like, um, uh, an infection of the epididymis, uh, which is the collecting system on the back of the testes and you get recurrent epididymitis, and again, you can get those from UTIs or other things, but STDs are the most common cause of that. Um, so again, I don't, I don't really know what's going on with chlamydia and gonorrhea these days. I don't sort of see that stuff in my practice, but my guess is, uh, that's, that, that could be playing a role. So I think it's probably a death by a thousand cuts. I don't think there's a smoking gun. Do microplastics play a role? Yeah, it's possible. What would they do? I read some reports saying they found microplastics in sperm samples. Yeah. I mean, maybe I don't know that that by itself is a smoking gun here. You know, I, you know, you can find microplastics in many things and I don't know if it's causally driving the problem that you're seeing. That said, all things equal, I'd probably prefer not to see microplastics in sperm than to see them. Um, talk about on that podcast. I mean, the process is so it's, it's so hard to believe it actually happens. Can you break down the process of impregnating a woman? Yeah. I mean, I think, again, I think Paul does a much better job, but the gist of it is that, you know, when a guy ejaculates a hundred thousand sperm come shooting a hundred million, a hundred million sperm, thank you. Uh, go shooting into, uh, the vagina and you said it best, right? It's like, it's like wave just getting destroyed, destroyed, destroyed. And finally, as the acidity of that environment and the harshness of that environment, uh, you know, a few of them managed to get through and then they, now they're in the uterus and then they've got this whole other challenge because they have to eventually make their way up the fallopian tube. But the punchline is like only about a hundred of the hundred million make their way to the egg. How insane is that? So a hundred million is going to end up going there. I think it was like a hundred million by the time you, cause the pH in the, in the vagina is like quite acidic. So I think it narrows it down to 5 million and then going through the fallopian tubes, you're down to 100 sperm. That's your chance every time you do it. And they have to swim. And we were talking about this before the podcast, a sperm in order to get from the vagina to the egg has to swim the equivalent size-wise of us swimming 20 miles catalina yeah so you think of the energy requirement of that little flagellar tail on the back of a sperm oh that was cool too about how like each one has a limited amount of fuel essentially so each sperm has the fuel and it's used to get to the egg and after that there's one reserve yeah one way that's it so it's a rocket yeah i mean wild now is it the first sperm to reach the the egg or does the egg have any selection process uh so interesting so as the once you now get down to that group that are getting to the sperm up to the egg it's the first one that gets embedded that actually triggers this incredible electrical system like a force field forms around the egg and no other sperm can get in and the reason that's so important is you would create what's called aneuploidy where you have multiple copies of chromosomes if you do this and that would be catastrophic so that to me is my favorite part of that is there's this whole calcium channel that like flips a switch the second it embeds the second like the millisecond that that first sperm makes contact it's just a and then away it goes but how crazy is it that like your fastest quote-unquote i don't know if they're the best but the first few lines we're talking about 95 million your 95 million best sperm get axed the second they touch the shore wow right so the last five million who are just like chilling hanging out like watching to see what went on are the only ones that end up getting there so is there an argument that if you were to select sperm like in in vitro or something like that that those might be potentially part of the first wave such a great question but of course right so so i guess the question is are the first ones that get out stochastically determined to be the first ones out or is there a selection benefit to being the first one out if there's a selection benefit to being the first one out then it means ivf is probably altering that mix because ivf would be just picking randomly if it's if there's no survival reason why those first ones are out and the five million are at the back yeah then it probably wouldn't matter okay that's what you would hope yeah because they do like a sperm cleaning is what they call where they essentially look for like the healthiest versions and um and they'll take them and plant them but god forbid if you know they weren't like supposed to be there oh but then again if they are the strongest that's a lot of pressure on my kid wow okay i'm curious do you have any uh i've heard people say like oh don't put your phone in your pocket for sperm health any of that stuff like heat from your phone or like from a laptop and then additionally like any emf stuff that you've ever read research on yeah i have looked at a lot of this research i don't i don't find any of the emf data compelling which is going to generate a lot of hate comments in the youtube guys i'm sorry because boy everybody wants to believe emf is the is the cause of all evil what is emf the stuff you know the waves out there your earbuds and your phones and stuff like that electromagnetic frequency next to your phone people say is bad um heat is a real issue so it turns out that hot tub what did what did paul say in this podcast he said he could render any guy completely infertile by just going in a hot tub by doing four hot tub sessions a week and then he said uh his to which i was like this needs to be a form of birth control some people say yeah i mean the uh your buddy said that he would go i think it was at you there was one of your buddies were trying to get pregnant and they would go in the sauna he would bring an ice pack on his nuts in the sauna he would just keep the ice pack on his nuts but i imagine that like the fact that the testicles can like elevate and descend is specifically so that they can maintain a temperature that's beneficial to them right well yeah that's mostly for cold protection not heat protection so that's why he was saying cold plunge is not he doesn't concern himself with cold plunge and fertility because they can keep themselves warm it's that they can't dissipate heat oh that makes sense so that's why they have nowhere to go in the hot tub is there any long-term effect or is it just temporary sounds like from him it's just it's just transient what about desert people like people where the temperature does get to 100 degrees 105 degrees yeah again air doesn't conduct temperature nearly as well as water so the thermal coefficient of water is so high that makes that's why when you're in 105 degree water it's actually uncomfortable you're in 105 degree air you can stand in for a long time what about the red light therapy on your junk oh yeah i saw people talking about this a couple years ago this was all the rave right for increasing testosterone yeah yeah i don't know anything about it i i my guess is like all that stuff is kind of like rearranging the deck chairs in the titanic like i maybe it helps a little bit i i'm not i'm not sure if it really helps a ton all right now let's get back to the show what's what's the biggest bullshit biohack like what's the thing that you roll your eyes at every time you see people promoting it boy there's so many all right give us 10 so i think um a lot of the sort of stem cell stuff is pretty freaking dangerous um i think that there are probably instances in which stem cells could be really helpful um i think if you tore a muscle you know if you tore your rotator cuff or something i i i i would i would love to see a study where we looked at non-operative management so just sort of pt pt rehab versus pt rehab plus stem cell injection would there be a difference the answer is maybe right but when you look at sort of the grotesque misuse of this stuff in areas where it's just clearly not going to play a role for example the intravenous administration of this stuff or the intrathecal administration of this stuff i mean what's intrathecal like into the spinal cord and stuff like that i mean there's there's just no plausible mechanism by which you're going to inject stem cells into somebody's blood bloodstream that they're not going to get you know completely torn up by the you know the the cells in the lung and at the best case scenario is it does nothing but the worst case scenario is you know you've wasted a ton of money and you've potentially um you know subjected yourself to some infection or something like that and we don't hear enough of those stories i do hear some of those stories of the people who get horrible infections when they go down to you know costa rica or colombia to get their stem cell treatments which says nothing of how much money is being spent on this uh sort of thing so so my guess is there's some there's some signal there but it's like most of what you're seeing is is not um this is a huge industry yeah it's it's actually kind of remarkable that it exists but i mean i shouldn't say that anytime there's a anytime you can do something to convince people without data that something works it's a win-win right i'm so i'm just so shocked that it's become so normal normalized i i haven't heard really any pushback about it outside of you now i haven't done much research and again i'm like completely ignorant to all this stuff but but wow so the stem cells you don't see you see marginal benefit potentially and no real data to back it definitely no data so so people that talk about data are talking about anecdotal data like you know my cousin joey i mean he has stem cells and he's 100 better it's like okay well i mean again maybe joey would have got better anyway because you know so so you can't you can't not study these things without blinding and without randomization you simply can't and who's signing up for the blind stem cell study right if you've got enough money to get your shoulder fixed and you're willing to go to fucking columbia to do it then you want the real stuff yeah are there are there other uh yeah i think a lot of the peptide stuff is total nonsense bpc 157 yeah so let's take that one it's the most popular so can we like what is it yeah so bpc 157 is an endothelial growth factor veg f so what is veg f so veg f is uh is a is a molecule in the body that promotes something called angiogenesis which is the creation of new blood vessels so um angiogenesis is really important in certain processes in fact it's important for cancer right so cancer has to utilize veg f to to grow and to grow and to grow and to grow and to grow and grow yeah um so many years ago a drug called avastin was introduced that was an anti-veg f drug to limit the growth of right target this thing right okay so um but there are clearly times when you would want lots of angiogenesis when you want proliferation of blood vessels and so the thinking is that if we give people bpc 157 and they have an injury maybe it improves healing and um i think it's possible but there were a couple of challenges with this right so you can take bpc 157 orally but the bioavailability is only 10 to 20 percent because the acid in the stomach tends to rip peptides apart so it's not clear that you can take enough of this stuff by mouth to actually meaningfully get it into your body furthermore how much would you need to take like let's say your patella tendon is the thing that's flared up and you really just want to get you know more blood flow that way so you can take bpc 157 and you can take bpc 157 and you can should you just be injecting bpc 157 there um the half-life of it is like one to two hours so then the question becomes like how often do you have to use this stuff i mean you need to be injecting it three times a day um and again without any data we just don't know so i think there's biological plausibility to it but if that weren't enough you know the fda has cracked down on these things and said like come on guys we need to see some data if we're gonna let you use these things so now we're going to have to do a lot of research and we're going to have to do a lot of pharmacies can't make this stuff anymore so now when people buy peptides, they have to do it in, in a very shady way, which is they have to buy it from a manufacturer who claims that they're only selling it for research purposes and that you're only buying it for research purposes. Um, and then until they get shut down and then it's like a kind of a game of whack-a-mole, but there's no quality control. And truthfully, like I would really like to see this studied so that we could know, like, I'd like to see what's called an IND, which is, you know, means like the FDA stamps this with an investigational new drug, uh, status and let it get studied. And, um, and let's decide once and for all, like, does this work? Because I'm sure there's going to be a time in my life when I'm going to want every trick up the, up the sleeve that could be used to address these things. Um, there are some peptides that actually I will say completely do work. Um, they're biologically identical to certain hormones in the body. So, um, some oralin, for example, um, is, is basically a growth hormone analog works perfectly well. Um, but then you have to ask the question, you know, what are the pros and cons of taking growth hormone? Yeah. Um, yeah. What is your, I know many people that when they hit like, you know, 35, 40, their testosterone goes down and doing, you know, TRT and growth hormone stuff to get it back to that baseline level. Yeah. What are your thoughts on that? Um, I mean, totally different things. I would say when it comes to TRT, I think the data are really good at the benefits of TRT, you know, in a low T state. Um, obviously you have to be aware of certain situations. Like, you know, if you want to have kids TRT, you have to be, I wouldn't recommend TRT to somebody who still wants to maintain fertility. I would recommend HCG, which is a, another way to increase testosterone production without giving testosterone and shutting down endogenous production. The body's production growth hormones is a, is a, is a more complicated one. And I, I, I, I still have two, I'm two, I'm of two minds on this, which is, um, on the one hand, there's really no data one way or the other saying it's good or bad, right? Actually, that's not true. There are data saying it's good in certain cases like HIV wasting, right? So people like back in the eighties, when we didn't have highly active and highly active antiretroviral therapy for, um, patients with AIDS, you had nothing to offer these people, but like high doses of steroids and growth hormone. And by the way, dramatically improved their quality of life. Um, so we know that at least in the case of, AIDS wasting growth hormone was amazing. Um, I've never met a person who took growth hormone, who didn't say they felt better. Um, so the question is at what cost, um, I've never taken it, but I tell you, I I'm sure at some point I'm probably going to be like, you know what, let's try it. I don't care about the risks anymore. I'm old enough. I feel crappy enough. It's time to start taking it. But you know, I'm only 52. Uh, I'm going to, I'm going to hold out a little bit longer before experiment. Right. What about like NAD or all these like, um, cosmetic IV drips? Yeah. Um, NAD is another one where it there's a, there's a great argument for why you would take it because NAD levels decline as we age and NAD is very important. So that if you took those, if I told you there's this really important thing in your body and it gets lower with age, the obvious answer is I should be taking more of it. Okay. Totally get that. So then the question becomes, how do you take it? And I'm like, I don't know. I don't know. I don't know. I don't know. I don't know. I don't know. I don't know. I don't know. So there's basically two ways you can take NAD. You can take it in an intravenous infusion. I think that's a total waste of time because one, they're giving you probably way more than you need. And how many times, how often can you do that? Like, even if you were the most committed junkie, like, would you do that once a week? Right. Right. That's not going to create like the half-life of NAD is quite short. That's not going to meaningfully contribute to your total body levels of NAD. So people, and the other way you can take NAD is through formulations that you take under the tongue so that they get absorbed in your lymphatic system. That might be more promising. I'm kind of interested to see how that pans out. And then there are people that take these NAD precursors. One of them is called NR and one of them is called NMN, which you've probably heard of. And, you know, frankly, there's no evidence that those get turned into NAD in meaningful enough quantities. They do a little bit, but they don't seem to get turned into it enough to really matter. And also all of the clinical trials, and I say clinical trials kind of in quotes, because they're usually industry funded trials, but all of these experiments, they don't tend to show very interesting outcomes, except in very esoteric cases. So there was probably the best study that people point to. The two best studies that people point to, one is in people with Lou Gehrig's disease. I think they were given NR and the people that were given NR had a slightly longer time till they needed to go on a ventilator. Hmm. And I mean, I don't know how clinically relevant it was, but to somehow suggest from that outcome that we should all be taking NR is a huge stretch. Guys, let's take a break to tell you about the David Protein Bar. It's a protein bar with a simple concept. It is the most protein with the least calories. That's all you're doing. 28 grams of protein, 150 calories. Find me another protein bar with those kinds of macros. You cannot. It's a very simple concept. Zero grams of sugar, 150 calories. 28 grams of protein. That is the best, healthiest macros you will ever see on a protein bar. And adequate protein, as everybody knows, is critical for building and preserving muscles now and as we age. 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When you said you were pre-diabetic, how did you fix that? It's like I was also a pre-diabetic two years ago and I just have to like cut out a lot of sugar. And yeah, I mean, mostly at that point it was, you know, changing my diet, you know, and losing a ton of weight. I mean, frankly, weight loss fixes most problems. RFK has started taking out red dye. He started his crusade against like these dyes and stuff and food. Is that a pressing problem? You think in the American diet, these like red dyes and things like that. Have you looked into that research? I've looked into it a little bit and I, I can't imagine anything wrong with getting rid of red dyes. In other words, I don't, I don't think anything bad happens because we take out the red dyes. I would be, remember the expression in planes, trains and automobiles when he's like, are you surprised? And he's like, if I woke up in the morning with my head sewn into the rug, I'd be less surprised. I think if like red dye, if the removal of red dyes fixed our health system, that's, that's how surprised I'd be. Yeah. I don't think. Death by a thousand cuts, but it might be one of the cuts. Maybe. Okay. There's a, just doing research on you. I love the fact that you, you're speaking a lot about like the emotional component of longevity and how important that is. And just because I think there are ways to, to kind of biohack. At the cost of enjoying your life, spending time with friends and like figuring out what the right meters that you should pull on are, um, like specifically having community, I think is like crucial and the isolationism that a lot of people are dealing with in America and probably around the world is, is you could say like, there's a version of it where it's not, I don't want to say slow death, but it will knock off years from your life. Right. How do you, like, maybe this is something that you're working on early in life. life, but how do you, how do you communicate to a 30 year old, Hey, you want to live to 80? You better have some fucking friends that you hang out with. Cause that's not something you could solve for at 75. Yeah. That's such a great point. Um, how do you convince the 30 year old? So look, this is going to sound like a dumb thing to say, but I feel a little detached, right? So I don't, so a 30 year old is a full generation below me, right? So I don't know what a 30 year old, I don't necessarily have an appreciation for what a 30 year old is struggling with today relative to what I was struggling with at 30. Um, so, but I think you're right. I think there's, the world is so different today that I'm sure that there's a greater sense of, of, of isolation. Um, I just don't think you can overstate the whole, the whole point here, which is everything you want at the end of your life, you have to be able to work backwards from and start now. So if you want to be, fit when you're 80, do you know how fit you need to be when you're 30? Like you don't get to be an out of shape pug until you're 75 and go it's hammer time. Yeah. So you have to get in shape now. Like all the exercise I do now is not for now. It's for 80. It's for 80. Yeah. I mean, this is something, the same is true on the relationship front. Right. So, so I think bus friend group at 80. Yeah. And, and, and, and I want, I want my kids, I don't remember who said this. Um, yeah, I wish I could remember who said it so I could attribute it to them, but somebody said the greatest source of wealth is having adult kids who want to come and spend time with you. Right. So if you let's, let's unpack that for a moment. So that says, okay, do you accept that? Well, I think anybody who has kids would accept that. So, okay. I want my kids are 17, 11 and eight and I want them to constantly come back and be with me. Until the day I die. Yeah. Okay. What do I have to do to make that true? Hold a trust fund over their head. I mean, how much do I need to spend time with them now? Or can I ignore them now? You got to spend time. Exactly. So, so it's like, so, so all the, so, so for example, like people say, oh, Peter, you exercise so much. I'm like, I don't exercise that much. Like you should see what I used to do. Like I phone it in when I work out. Right. I mean, like if I'm given the choice between an extra workout or a game of chess with my kid or playing soccer with my kid, I'm always going to pick doing the thing with my kid. Cause I know that those years are very finite. Um, and that's the investment, right? That's like, I have to invest in these relationships today because I know what I want tomorrow. And the same is true with my wife, with my friends and stuff. So I think that's the way to position it is all the choices you make today are compounding choices and work backwards from what you want. So, okay. To that end, reactive medicine is going to get really good. And I imagine with AI, I don't know exactly how it's going to affect it. I'm curious your take on that, but reactive medicine is going to get better. The better reactive medicine gets, I imagine the less proactive we will be with our longevity. So if I know, for example, if I get cut, I could just throw some neosporin. I could take an antibiotic. I'm not really worried about getting cut. But back in the day, if you got cut, you fucking died. You worried about getting cut. Are you at all knowing how important it is to plan for your last day, decade and knowing how prolific the drugs are going to get that help you think at least that you don't have to plan? Are you worried that that's going to deteriorate that planning that is so vital, at least in people's minds? I mean, perhaps for some, I think, you know, there are some areas where I think, um, I'm hopeful that drugs are going to get a lot better. Um, but it's, it's, it's going to be a while before I think we could safely say, that prevention is still not the best management strategy for cancer, uh, for heart disease and for dementia. And, and I think that especially for cancer and dementia, we really don't have amazing treatment options. Um, advanced cancer is, uh, advanced meaning cancer that has spread from its primary site, metastatic cancer, you know, it's almost uniformly fatal still. Uh, we have about, an increase, overall survival has increased about 10% in 50 years. So, um, I still think the approach of early detection and taking all the preventive measures is going to matter for a long time. Furthermore, lifespan is not the only metric, right? Healthspan also matters. Can you explain the difference between those two? I think people get confused with that. Yeah. Lifespan is the easy one. It's the how long you live. Um, and so that's the one that the, the medical system is fixated on is how many years are you going to be alive? And, and we're pretty good at stretching, stretching out time that we are alive with chronic disease, but healthspan is what more people care about. More people care about the quality of their life. And actually most people, almost without exception would take a slightly shorter life at a higher quality all day. Exactly. Give me productivity through my, everyone wants to live to a hundred, et cetera. Of course, in our heads, we're all like, I'm going to get to a hundred. Give me productive 80 years. Like I'm playing paddle every day until I'm 80. Instead of being wheelchair bound, from 70 to a hundred. Yep. I think most people take that. Yep. Yeah. I think that's, and in order to do that, you're talking, you have to take preventative measures. Yeah. And, and you have to do hard things. You have to exercise. Like you gotta, you gotta watch what you eat. You gotta tend to your sleep. You gotta do these things for which we don't have great pills that are substitutes. Can you, can you explain the dementia, uh, the correlation between, I don't know what it is. It's like diet or health or what you can do. My dad has dementia. It was like, what preventative measures can you take for that? Well, again, dementia is really complicated because there are so many different types of it. There's Alzheimer's disease specifically, but then there's vascular dementia, Lewy body dementia. My dad has non amyloid plaque Alzheimer's. So usually Alzheimer's is defined by the amyloid plaque buildup. Yeah. They haven't found enough in it, but they're still like, you're showing all the symptoms of this. So they don't even know what the fuck to do about it. So I'm curious, like what? So genetics play a, a pretty big role in this. I'm sure they've done the appropriate genetic testing to see how much of this was, was kind of genetically, uh, driven. Um, and then there are a whole bunch of factors that can increase risk. Don't don't answer for whether any of these participated in your dad's, but like everything from high blood pressure, high cholesterol, insulin resistance, poor sleep, high stress. Those are just the ones we know about inflammation, certain types of infections, right? So we're, there's now a lot of, in fact, a lot of evidence that's emerged in the last six months that suggests that, um, reactivation of shingles, especially an ocular version of shingles where the virus gets near the eye that could even increase the risk. So now we're, you know, we've always been pretty adamant about people getting their shingles vaccine once they hit 50, but that that's yet another reason. I think that everybody, once they hit 50, in fact, I got my shingles vaccines when I was in my forties, I was like, fuck it. I'm not waiting until I'm 50. Yeah, yeah, yeah. Well, just from the standpoint of shingles being such a miserable, awful experience. Um, so, um, but you said blood pressure and insulin resistance. My dad does have high blood sugar and he has become insulin resistant. So you're saying that like, obviously there are genetic factors, but like, could diet have also fed up that process potentially with them? Yeah. Oh fuck. It's horrifying to figure out that there's something that, that could have been done to, to stop that. Yeah. I mean, growing up, I always thought it was just like, you either got it or you didn't get it. Yeah. I mean, growing up, I always thought it was just like, you either got it or you don't. It's genetics. Yeah. And, and, and again, there's, there's a genetic component to all of these diseases, but, um, you, you really can, if you start early enough, uh, you, you can circumvent a lot of the genetics. Certainly not every case. Look, there are, there are cases of Alzheimer's disease, um, that are predetermined. So, but fortunately the predetermined cases represent less than 1% of cases. So there are, there are, there are a handful of cases that are predetermined. There are a handful of genes that guarantee a person will get Alzheimer's disease. Um, and, and tragically these, these people succumb to the disease in their fifties usually. Um, but again, that's, that's 1% of cases. So 99% of cases are, there's a genetic component, but, but they seem to be triggered by insulin resistance, hypertension, hyperlipidemia. This is the stuff that I think is so motivational, right? Like once you learn about that, I mean, did you guys learn that Alzheimer's was something that you could potentially learn this in med school? Why would these guys have learned about it? It's kind of crazy. No offense, but I went to nursing school, but yeah, I did. I'd never heard that before. I mean, like I would have loved to know about this. My dad's starting every morning with a corn muffin from the deli. Like that can't be good for him. Yeah. Yeah. Wow. No medicine has a huge blind spot to this topic. Um, why is that? I think it just has to do with the structure of reimbursement. And payment built around diagnostic codes and intervention. So medicine has basically two types of interventions, uh, drugs and procedures. And so we have codes for both drugs and procedures and diagnoses. We don't have code for prevention. Yeah. We don't really have a billing system that makes sense to say, Oh, uh, you know, uh, John came in today to see me and I noticed that he's a little pre-diabetic. Um, but rather than just write him a prescription for metformin, you know, I spent half an hour with him and I figured out that he's not sleeping that well. So I walked him through some of the CBTI techniques for improving you to sleep. Like, like there's no way, like how would you pay somebody for that? It's sort of like the reward system isn't built for it. Yeah. Yeah. Yeah. So then it trickles down. So then it's not going to be part of the education system. So, I mean, if you like, people often ask me like, well, why should I listen to anything you say? Like you trained as a surgeon, like how does your surgical training have anything to do with what you do today? And I was like, yeah, you're right. Nothing, like nothing. But, but here's the point. Had I gone and done internal medicine or family medicine or rheumatology, it would still be the answer. It'd still be nothing. Yeah. Right. Like all these things I've learned over the past 15 years, would they were not going to be things you were going to learn, uh, in a, in a, in a standard medical system. And by the way, I'm not saying that, that that standard system isn't wonderful. It is like, we owe a lot to that medicine 2.0 as I call it system. Um, but it's, it's really at the limits of what it's going to solve. So we need to make some fundamental changes. Yeah. We just have to have two systems that run in parallel. You have to have your medicine 2.0 system for when you have pneumonia, when you have a heart attack, when you get cancer, when all of these things happen that are horrible, you need the system that we have right now to fix it. But we have to be spreading some resources over to a system that says, Hey, when you're 20 years old, why don't I start doing all this stuff in you? So that when you're 75, you look more like a 55 year old internally. There's definitely like, it seems that there's a thirst for it. I mean, obviously you spearheading it and then, you know, Rogan taking such an interest in it. Like, I don't know if this is directly from you guys. I assume it is, but like, I've heard that even young people are drinking like 10, 15% less. Yeah. I've seen stats about that. Yeah. And, uh, I mean, smoking has gone way down, like, you know, which are nice things. And maybe you want humans to have some agency over their own body. Like maybe it's not only up to the medical industrial complex to tell us what to do. Like, maybe it is good. We do some research and we start going, yeah, well, maybe if I eat right and exercise that this will be better for me. But, uh, at least having access to the information is important. That's crazy that 99% of dementia could have environmental effects that have sped up the process. Yeah. And just to be clear, there's a spectrum within there, right? There are some people that are going to have two copies of an APOE4 gene. They're going to have it. Well, they won't necessarily have it, but they're going to have a 10 times higher rate, but then there's triggered it. But, but look, half the case, a third of the cases of Alzheimer's disease don't even have one copy of the APOE4 gene. Now they might still have some other gene that we don't know yet is participating in this, but, but we, you know, we have to believe that there are significant environmental triggers. Wow. And I think that plays more of a role than what we see in cancer. I think in cancer you have more of kind of the bad luck problem where just cells are constantly turning over DNA. And then you just eventually, you know, you make so many mistakes and eventually one gets out that the immune system evades. And, and that's why I think we still, and we'll, we will always see people who do everything right, get cancer. Yeah. Yeah. And you said how important early detection is when it comes to cancer. How do you feel about like full body MRI scans? Um, I think they, um, again, we do them with our patients, but we are, we're pretty careful about doing it. And we, we don't necessarily recommend everybody do it because you open up a can of worms with that stuff. So first MRI scanners out there are garbage. So they're not even remotely good enough to be doing this. MRI in general is just kind of a crap technology compared to CT scan. Yeah. The magnet, the magnet makes a ton of noise, but that, I mean, the problem with MRI is it's not a standardized, this is, it's, it's hard to explain this without getting really into the physics of it, which is super cumbersome, but like a CT scan has a quantifiable unit of measurement. So when you get a CT scan, it might look like it's black and white and different shades of gray, but every one of those pixels can be described in something called a Hounsfield unit. And you know exactly what the color of that is. And it's perfectly quantifiable and it's reproducible no matter what machine you get it done in. So some machines might have a higher resolution. Some machines might go faster and some machines might have more or less radiation, but the image there's reliability, there's one language with MRI. It ain't that way. So an MRI from one hospital could speak a different language than an MRI from another one. Completely. Holy shit. And so you are relying on a radiologist to sort of try to look through this thing. And so you might ask, well, why do we even do MRIs? Well, there are some things for which when you add contrast and you run a certain protocol, you get a much better look at certain types of tissue. But for this application for cancer screening, it's nowhere near as good as CT, but we just don't want to put people through that much radiation. So we use the MRI with no contrast. But most of the things that are out there advertising to do this are kind of running lousy protocols and, you know, they're doing it really cheap. But the problem is you're missing cancers. And more importantly, you're catching a lot of things that aren't cancers and you're getting a lot of false positives. And that creates a ton of emotional stress for people and can lead to a lot of follow-up procedures. And so when we talk to our patients about doing this, our view is you don't, don't do this unless you're willing to go down a rabbit hole where. We saw a nodule on your thyroid. It's probably not cancer, but now we can't ignore it. So we need to do an ultrasound. We're going to have to put a needle in it, take a biopsy. And I would say 20% of our patients are like, yeah, don't sign me up for that. Forget it. We had a, we had a friend whose mom went in, they saw some, what they thought I guess were like tumors. And they, in the moment diagnosed her with stage four. They're like, this is probably have maybe a tumor or something. And we're like, we're going to go in and look at them, but it looks like it's spread. I think stage four is when it's spread up to multiple parts of the body. Take them out, do the biopsy. They're like, oh, they're all benign. All right. New lease on life there. I mean, there's a part of you that goes, oh my God, I feel so lucky. And then there's another part of you like, well, what is this system where they go, you're going to die in two years? And they go, oopsie. We didn't know. I mean. Yeah. It's crazy. What about AI as a diagnostic tool? Like as that's on the horizon, how is that? Yeah. AI will help radiologists a lot, but it won't help MRI until this problem gets solved. So until. MRI is speaking the same language. It doesn't matter. Yeah. Excuse me. Until the MRIs pixels are all standardized, AI can't do anything. What can AI do for, what will AI do for just medicine in general? How will it affect longevity? Like where do you see it playing a part? God, there's so many ways. It's already playing a pretty interesting role in drug discovery. So how do you, how do we create drugs? So a lot of times drugs are designed. They're not there. Meaning you, you know, the receptor that you want to activate or block and you know, it's 3d structure and you know what the protein is that makes it. And you say, okay, well I have to make something that fits into here. So in the olden days you had to do it by trial and error. So you're just throwing different proteins at it. And so what if I put this amino acid next to, what if I string these 2000 amino acids together? What if I string these 2000 amino acids together? Will they fold in the right way to make a structure that fits there? Well, the guy that the company that won the Nobel prize last year, uh, was a, it's a company that spun out of Google. They came up with an AI engine that now can predict from the amino acid sequence, how it will fold and what the shape will be. So you don't have to do the trial and error because you can just make the drug. Oh my God. So much cheaper, so much faster. Yeah. I mean, I don't want to overplay it. Um, so much faster. And cheaper for that step. That's step one of 27, right? You still have, I mean, I'm being a bit facetious, but now you still have to go and test that drug in mice. Then you have to get an IND. Then you have to do a phase one, then a phase two, then a phase three. That's actually what takes the most time and costs the most money, but that's still a really big deal. And by the way, if AI simulations can speed up the second and third step, then we could start to take. How would you create data sets with, with fake mice or with AI versions of mice? Um, you'd have to do it off real data to start probably. And of course you'd have to come up with models that could understand what's happening and create perhaps some sort of synthetic data off smaller sample sizes or things like that. So maybe you run a smaller sample size, but you get enough data out of there that you can simulate what would happen on a larger data size. I mean, that's, that's where you get the exponential increases when you can use the, they're not called fake data samples. They're called synthetic data samples. Once you create synthetic data samples for something, you're out of here. Yeah. I mean, again, it's, it's, it's still hard for me to kind of wrap my mind around what that's going to mean in, in humans. But if I just think about what I've watched AI do when I muck around with it now versus a year ago versus two years ago, I mean, you know, it's just done that. So, so it's, it's what that means. It's really hard to sort of imagine what it could do. There are also some super, super unsexy things that AI could be doing that would like lower the cost of healthcare. Like our, our healthcare system has such a high administrative burden and, and it, you know, we're, we're talking about seven to $800 billion of money, pure admin of just admin burden, which you could, I mean, AI could do all of that stuff. Wow. That's significant. Seven to 800 million of pure admin, sorry, billion of pure admin. I'm thinking about countries where they're offering it. They're all just offering universal healthcare, Imagine what that means for them, I mean. They have much less admin costs than us. Because why, they've already streamlined it? They don't have to adjudicate payments. And that's where the admin shit is. Yeah, the admin here has, how do I take the payer and the provider and adjudicate the claim and make the payment? That's where the insane friction is in our system, which is unique to us. Is there, like, you're around a very morbid topic, right? We're talking about trying to avoid death, so you can't not think about death. There's got to be a lot of, like, positive and happy, joyful things that are coming out of this. You have to see people change their lives, turn their lives around. Like, I feel like we fixate a lot on, like, what could potentially be killing us and how we're being harmed. But, like, are there a lot of circumstances where you're seeing people in their 30s, they're 40, like, I'm 40, Mark's in his 20s, late 20s, probably pretty much 30 or 40 already. Well, no, late 20s. And Allison is 30, so, like, have you seen this? Have you seen this? How are you able to, like, impact these younger generations? And is there, like, a part of you that's very proud to see them taking it this seriously? Are there certain people that you're working with that you're seeing, like, life-changing things happen to? Like, I don't want to just fixate on, like, what's negative about this. I think it's a cool moment in history where we have access to this information. It's terrifying because I don't know if an ice bath is good or bad. I don't know if a sauna is good or bad. Like, this is the cost of having free information out there is that there's going to be a lot of things that mislead you. But, like, give us some hope. I know there's. You're busy. You've got to get out of here. But, like, where do you get excited at seeing the positive benefits of this longevity research? Yeah, I mean, I think, honestly, for me, it's. I mostly think of the positive stuff. I don't. I mean, sometimes I get into an existential funk about mortality. Probably everybody does if they think about it enough. And, you know, if you lose a parent, you know, you have these moments that are really jarring where you can't understand what is life sometimes. But that's. I don't spend a lot of time on that. I sort of. I think much more about both my individual aspirations, you know, as a husband, as a father, with my friends and things of that nature. And that's, you know, that's just very exciting to me. And as you said, my patients are, you know, wonderful. And I love watching all the ways we reduce risk in them. And then, you know, finally, I think a lot about things I'm excited about. How to actually scale this and make this kind of something that we can deliver to everybody. How do we do that? We do it with software, right? We do it with software and AI. And that's kind of the next frontier for what I. You know, where I think we should be going. Are you going to put out, like, an informational app? You're going to put out some sort of. I don't know. What is it? Like an encyclopedia of this information? No, I think information by itself is not sufficient. I think it has to be more action-oriented. It has to be more of a co-pilot, like kind of a health fiduciary. So it's sort of like if you had me standing next to you every single day, helping you decide how to exercise, how to eat, what to do, what to do with any results you have. But on a day-to-day basis. That's right. Not some sort of grand once-a-year sort of overhaul. Over time, these benefits would compound a lot. So, again, I think this is not. How can the average person access that? I imagine your time is. No, no, but of course. But again, if you scale me via software, yeah. So is that something you're working on? Yeah. And then when do we think. You're being a little hesitant about sharing this information, so I imagine it's in development. But when do we think we get a look at that? Because I think this is transformative. Sooner or later. Yeah, then later. Really? Yeah, this year, hopefully. Whoa. Early next year. And are you partnering with anybody on this? Philip Morris, maybe? We have a Marlboro sponsor. They're the lead sponsor. But this is all you guys? This is. Wow. And I mean, I have so many questions about this, because I think this is the trickiest thing. I imagine for all of us, it's like political information. I don't know what the fuck is right or wrong. Everything's filtered in through people's biases. And then we get into science, where it's like we already are so ignorant. Ignorant to it. The second you say BPC-157, I'm like, well, it must be good. You know, it just sounds so technical. Yeah, it's gotta be. Somebody called it the Wolverine peptide. And I was like, I want to be Wolverine, right? You've heard all this shit, right? No, I don't spend time on social media. I don't. Oh, it's so much fun. I can't. I can't. Again, that's part of my longevity strategy. I cannot look. I mean, when I look at Instagram, like, it never shows me that crap. Like, it's showing me stand-up. It's showing me gun videos, cars, F1. Okay, the last thing I guess I was curious about is nicotine. Oh, yes. That's my only real vice. Maybe not my only. But one of the vices that I'm drawn to. And I know there's so much conflicting research, nootropic, if that even means anything. Yeah, yeah. So how do you use nicotine? I mean, most days I probably don't, except for the toothpicks, which I love. But, you know, if I do, I'll probably do three milligram pouch once a day. The data are. I mean, obviously, you have to. You have to separate tobacco from nicotine. So tobacco is the problem, not nicotine. And most nicotine is synthetic. But you have to make sure of that. So there's probably a downside in tobacco-derived nicotine, even without a combustion product. So be mindful of that. So I always tell people, kind of make sure you're using synthetic tobacco. Pardon me, synthetic nicotine. It does have high potential for addiction. So you kind of have to be super careful about that. That tends to become a bigger issue. The higher the dose goes. So, you know, if you're keeping it below five, six milligrams a day, your potential for dependency is low. But, you know, once you're into the 20, 30 milligrams a day, your potential for dependency is very high. It can definitely interfere with sleep. So people doing it later in the day are going to potentially, if not likely, impede their sleep. What's the half-life for nicotine? I should know that, and I don't remember. Are we talking six hours, two hours? I did a podcast on this where, if someone's interested, they can go back. And it was actually kind of recent. It was probably like, I mean, I recorded it probably six months ago, but it probably came out three months ago. Long enough that I wouldn't do it, you know, I wouldn't do it kind of later in the day if you're struggling with sleep. You know, there's probably, for some people, some short-term cognitive benefit. But it can be offset by the withdrawal as well. It's also an interesting molecule in that at one dose, it creates sort of heightened awareness. And then as the dose gets higher, it creates relaxation. So that's, in some ways, kind of the benefit of it. I don't know if you noticed that, but at a certain dose, you'll actually, it's really calming. It's not activating. It's quite calming. But the first, I always feel like the first hit of it is activating. Yes. Really locks you in. I didn't think about it as a relaxation medicine. I don't know if I want to even call it medicine. That's interesting. Pretty awesome, this nicotine. It is. It's, you know, I would say it's got obviously a very, very bad rap through tobacco. Yeah. As it should in that way. But I don't know. I just caution people not to go too crazy on it. I think, you know, I've got friends that are, they can't get, they're taking 30 milligrams worth of pouches a day and they can't stop. And so I think in that situation. In that situation, I would be concerned. Yeah. That's great. All right. Well, listen, Dr. Atiyah, we appreciate you coming here, bestowing your boxing knowledge and then some longevity stuff. Congratulations on your New York Times bestselling book. I think it's been on there for like a hundred weeks or something like that. It's pretty insane. Seems like people want to live. So we are going to continue tuning in. I'm really looking forward to this thing that you're building. I think that would be. I'll tell you this. When we have it out, we can talk about it fully and walk in on it. That'd be really cool. But because I think it's something that we all need. I think one of the scariest things about longevity is knowing what information to trust. It's signal to noise. Yes. And I think that's the same thing with politics. I think it's the same thing with, God, everything. I mean, nutrition, especially. Every day somebody's telling me something that's good. And then the next day, actually, it causes cancer. So, you know, really what I'd like to congratulate you on is it feels like you've been quite disciplined. I think there are a lot of people that are in your field. They get a lot of exposure and notoriety, and they very quickly cash in, and they stamp some supplement thing. And they can make, you know, hundreds of millions of dollars on it. But if it's actually bullshit that doesn't do anything, maybe we lose trust. And I haven't seen you do that. And I'm sure you've been given a million different opportunities to do that. So I think that that's really cool. And you've chosen to be disciplined. And because of that, we trust you. And thank you so much for sharing your time, my brother. Thank you for having me, guys. Thank you. Thank you.