Andrew Schulz's Flagrant with Akaash Singh - Peter Attia on Growing Muscle Fast, Danger of Cold Plunge, & How You Are Ruining Your Testosterone

Episode Date: September 16, 2025

YERRR – the boys sat down with Dr. Peter Attia to break down the real science behind longevity, healthspan, and why most “biohacks” are straight-up BS. We’re talkin’: – Cold plunges, Zyn, fasting & the truth about supplements – Creatine, caffeine, cholesterol, and sperm counts (!?) – Stem cells, TRT, peptides, and the fake science behind the hype – How to actually prevent cancer, heart disease & dementia – Plus: AI in medicine, false positives, and the secret weapon for longevity It’s myth-busting meets masterclass. All that and more on this week’s episode of FLAGRANT. INDULGE. 0:00 Intro 00:57 Genes + Blue zones = myth 4:02 Cold plunges effectiveness? 9:25 Attia's background + Hagler Obsession 16:33 Getting to Stanford + Becoming a surgeon 18:16 Being pre-diabetic + Fatherhood 24:30 Locking in on longevity + Heart disease 28:45 Use all the tools + Cholesterol management 34:57 Chasing content 38:40 Insulin resistance, Zynning & Fasting 46:30 Causality with Sleep + HRV + Wearables 53:12 Supplements - Creatine, Mg, Vits, Caffeine 57:23 Sperm quality issues, 100 sperm + EMF 1:08:12 BS Biohacks - Stem cells, Peptides, TRT, NAD 1:21:21 Weightloss, Red dye + Need for a plan 1:26:15 Prevention is still king + Healthspan 1:29:12 Dementia + Reward system 1:36:07 Cancer, Full body MRI + False positives 1:39:43 AI's role 1:43:38 The real positives + Nicotine Learn more about your ad choices. Visit megaphone.fm/adchoices

What's up everybody? Today we're very excited to have our guests here who's going to teach us all about why my sperm doesn't swim and how we can live to we're a hundred years old and most importantly why actually this is what I'm really excited about why people who live to a hundred are full of with their advice. I thought this was so good because I've had this I think there's a contrarian in me so whenever I hear the hundred year old people going I smoke a pack a day and I drink whiskey and I'm like this is and bull and I'm watching you in this interview, and this was so validating. You're like, you say something to...

Oh, by the way, it's Pierrotia. Oh, what's up? So you said this thing, 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 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 five, six, who's getting late every single night. Can you break down why people who live to 100 heard are the last people we should get advice from?

So genes don't play much of a role in how long you live up until about 80. So it really turns out what you do matters a lot. Plus luck, we could talk about where luck factors in. But for those people that make it to 90s, hundreds, they're called centenarians and then super centenarians, it's virtually all genetic. And what every study of these people has demonstrated is they live long despite what they do, not because of what they do. And to your point, they are, on average, more likely to smoke, more likely to drink,

less likely to exercise, and more likely to eat junk food. Wow. 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 jeans. 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.

Yeah. So I actually think the whole Blue Zone things have been. of a myth. Talk that shit. And I think... And ice baths, right? It depends what you're doing them for. To look cool with your shirt off? Oh, then it's very good. Yeah. That is the ice bath, right? It's an excuse to show your body. It's an Instagram thing. Yeah, yeah, yeah. Thank God. Okay, keep going. Keep going. So, so a big problem with the Blue Zone things is the, 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 longevity vanishing up how old they are yeah a lot of that is going on and then the truth of the matter is there's this whole kind of people don't understand causality sometimes so if you went into the gym and you saw a whole bunch of super fit people running on treadmills. You would think that you could be lulled into the belief that Lulu Lemon Tites 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 Lulu Lemontites and Apple pod, you know, whatever, air pods and 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 phase, a lot of that stuff just doesn't make sense. Yeah. Interesting. Okay. So, wait, the sauna cold plunge thing, can you parse those two things? And can you explain why cold plunging is kind of bullshit? Well, I don't, I wouldn't say it's bullshit. It's just not, it's not going to make you live longer.

Okay. There's no evidence, at least, that sauna is going to make you live longer. Pardon me. Sorry, pardon me, cold plunge. 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 kind of live forever. So I don't know if I believe 100% live forever. But, uh, okay, sometimes you do these scary things. And then when you survive them, there's this like release of dopamine. Yeah, yeah, yeah.

And it's a positive dopamine. Yes. And the positive dopamine makes you feel, amazing in the moment. So in 60 seconds, without skydiving or bungee jumping, I get a positive dopamine that makes me feel amazing. Is it just the quickest way to feel good? First of all, that's actually a great insight, and that's absolutely one of the two pieces of the benefit of cold plunge. So it turns out that our bodies want to preserve a dopamine homeostasis, which just means a balance. So anytime we have...

something that induces a little bit of discomfort, the body will try to compensate by making more of the sort of positive neurotransmitters, including dopamine. And that's why exercise, by the way, the pain you experience when you go out for a hard run. So cold immersion has been demonstrated to improve mood, although it turns out not in everybody. So there are a subset of people who just experience the pain. And they don't get any of the positive from it. So you get nothing when you hop out of the... 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 sonnas. 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. Yeah, the inflammation is part of the repair process. Right, 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 the effect of resistance training um but again for some people like for me the mood effect is really profound oh it's amazing i i absolutely love cold plunging yeah getting an argument

with your wife hopping a cold plunge get out you're like my marriage is perfect what we're even arguing about so yeah no i think i think um 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, yeah. Like Joe just called me a pussy every time I'm like, dude, if it's not 60 degrees, I'm not getting in that fucking thing.

But I do feel like guys are going, okay, I could be at 37. Dove is trying to be at, I forget what it was, maybe 45 for two minutes. But if you're not really getting any different... Yeah, I mean, I think... I've tried to figure this out so many which ways. Actually, this would be a great question for me to put to one of the research AI engines and see if they can just pull all the data. Because a lot of the studies will do long immersion at modestly cold temperature. So, 55 degrees for 30 minutes.

Right. But I don't want to take 30 minutes. I'm not going to do that. So it's got to be colder. Yeah. So, I mean, 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? no idea. But the reason I can't keep it at 35 is my wife won't get in it. And so then I'm just going to be turning the temperature up and down and up and down. So 42 is about the lower limit that she'll put her legs in. She won't sit in that. Go in together. Yeah, but she'll stand in it and I'll immerse. Like, I'll go to my neck. I mean, you don't got to call her a pussy. You know what I just thought she was into her neck too? So wait, 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, I'm done with this. I'm, I'm, I'm going to go someplace else. But do you get any benefit out of just putting, like, yeah. Yeah, you do. I think for her, because she's a runner. You get to make your life uncomfortable. She wants to, you know, she wants to, you know, if she goes for a long run, she loves to get in there after and just, yeah, get the inflammation under her little, I want to go into your background a little bit, because I think your background's very interesting. And then I want to go into all these different versions. We would call them like, and I don't want to be reductive, but like health hacks, life hacks, biohacks. Do you 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, benefits or whoever you want to replace with it. But your life is quite interesting.

So your parents are from Egypt. They moved to Toronto. Yep. You were born in Toronto? Yep. Okay. You want to be a boxer. How do you, how does that even happen where you're training and you decide you want to be a boxer?

And how supportive of your Egyptian parents. Immigrant parents. Yeah. Who see this clearly brilliant young man who's doing. and grade in school, I imagine. I wasn't, but... Oh, really? No.

Yeah, he's getting punch in the head every day. Yeah, maybe that's part of it. So boxing, where does boxing... So it all happened in April of 1985. Okay. When Marvelous Marvin Hagler and Tommy Hearns fight, the greatest fight to this day that I've ever seen. That opening round, bro.

Yeah, yeah. The most violent... Violent three minutes of boxing ever. I think Hearns breaks his right hand on Hagler's head. Hagler's head is the hardest head in the history of the story. His defense was just walking straight in with his head for it. It's like juggernaut. It's amazing.

Yeah. And you have to remember, I mean, you know this because you're a big boxing fan. Nobody expected that. Like, you just didn't think, you thought like Hagler was going to counterpunch. Hagler was going to try to take him the distance. No, he was like, nope. I'm walking through you. I'm walking right through you.

Yeah. And Hurons won the first. round. Yeah. Yeah. I mean, any other person would have been done that no human at 160 pounds could have survived that fight. Yeah. And yeah, there was just something about that that just, I don't know why. Like, I'm watching that and I'm thinking, I want to be that guy. Was your dad a big boxing fan? Nope. And I just was like, I want to be that guy, Marvin Hagler. That's the one I want to be. Because he just stalked him. Yeah, I was like he's, because I realized like he wasn't. And then of course, as I became obsessed with Hagler and began to learn everything about him retroactively.

And I realized, like, he's the guy that I want to be because he's not the biggest. He's not the strongest. He's not the fastest. He's not the best at anything. But in aggregate, he is the best. Yeah. And he's the best because his will is second to none. And he, oh, the other thing is most boxers don't stay in shape all year. They kind of, 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 these 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 but how we're so fascinating because he quits boxing i believe after the leonard fight yep he wanted a rematch Leonard wouldn't give it to him.

He basically just got pissed and moved to Italy and started making movies. He becomes a movie star in Italy. Yeah. He's like the first black guy in Italy. And then he just becomes a movie star. So have you seen any of Hagler's... This is a real fan. How's the acting? It's not that great.

Definitely a better 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. Also, did you give that decision to Leonard or? No, 115, 113, Hager. I've watched that fight a hundred times. Yeah.

I hated Leonard when I was growing up, despised him, couldn't stand him. And then when he got that decision against a Hagler, I thought it was the most disgusting thing ever. I will say this, today, my respect for Leonard is enormous. Like now I look back and I think, like, my God, was that guy special? unbelievable. And he fought a really strategic fight against Hagler. He avoided that kind of contact. Tommy was like, I'm going to knock you out. And why would you not think that? You're knocking everybody out. And Leonard was like, I'm going to wait to the last 30 seconds of the round. My corner's going to yell, and I'm going to start swinging. And if it lands, if it doesn't, but I think I can steal rounds. And I think he did a good job of that. Yeah, I think in retrospect, I mean, as you probably know all of this, but Hagler sold the fight, right? So he, in exchange, Hagler demanded a higher purse than Leonard. This was a very important thing to Hagler. ego because you know haggler remember no Olympic glory he toils in obscurity for a decade nobody knows who he is before he's finally a champion and Leonard the golden boy 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 mean this was back in the day when the IBF still sanctioned 15 round fights. Oh, so what did they make it? He sold down to 12. That's right. Ring size, 24 down to 20.

That's right. Glove size. Which I don't think was a benefit to him to have a smaller ring. It was a, it was a, sorry, sorry, he traded bigger rings. He traded up. Yeah, that makes sense. He traded up in ring size, and he traded up in glove size. The glove size is, I mean, the glove size is huge.

Yeah. Yeah. And then on top of that, he came out and boxed Orthodox for the first. He thought he could trick him that. It was just a bad decision. It was a series of wonders. And still, whatever, from watching it, I had him winning, but again, close fight. Yeah.

So from that day, you start boxing. Yeah. Okay. 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? We come home with black eyes. I think, you know, so how old was I'm trying to think, I was 13?

Yeah, 12, 13. I think by the time I was in high school, it was probably a bit more of a concern because, you know, I didn't want to go to college. I didn't like school. So they were definitely concerned. Hello, everyone in Dubai. Andrew Schultz here. It's come to my attention that the Chmachis have been acting up again. Yeah.

Looks like they might need another talking to. So I've spoken to my podcast co-host. And we've decided to take our talents back to the Emirates to give another spanking to those V-Eyton. tech driving naughty little rascals we're going to be going out there we're going to do some stand-up maybe a little live podcast action at the coca cola arena october 7th we'll see you all there very excited to try that dubai chocolate and no i don't mean when a prince shits on a hooker's chest i'm talking about the actual chocolate so don't get your ideas whirling and swirling we'll see you soon coo tour dates your boy's going to be in dania beach for lauderdale this

weekend, September 11th through the 13th. I don't know why they gave me that date, but they did. September 25th through 27th. I'll be in Cleveland, Ohio. Dubai, October 5th. I'm pretty sure tickets are sold out, but they might have released some more. So go there. October 16th through 18th, Rhode Island. Also, there's more dates on the website, but one, I will shout out October 23rd to 25th. We've already sold out one show, so y'all should buy your fucking tickets to that because they will sell out. But those dates and more at Akash Singh.com. We got some big announcements coming in a couple weeks. Can't say what they are, but I'm very excited. We'll get back to y'all soon. God bless. Guys, there's a lot of cities where you can suck Mark Gagnon's dick coming up. I hope you're ready.

October 23rd, Nashville, Tennessee, October 24th, Mobile, Alabama. Stop sucking your brother's dick and suck Mark Gagnon's. October 25th, New Orleans, Louisiana. Hey, guys, I'm going to be honest. I went there. It's one of my favorite cities in America.

The comedy market is dog shit. Prove me wrong. Go to Mark Gagnon show. Try to suck his dick. November 16th, Hoboken, New Jersey. I forgot November 9th, Denver, Colorado. November 23rd, Philadelphia. December 5th, Fort Wayne, December 6th, Detroit.

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Car gurus. How do you end up going to Stanford if you weren't going to 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 my math teacher. And he called me into school early one day and said, you know, hey, you know, I heard you're not going to university.

And I said, yeah, that's right. And he said, 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? And then he just said something that I thought was, you know, it just changed the course of my life forever. He goes, you know, I just think it would be a mistake if you didn't go because you'd be, you know,

you have a gift for math that I don't. think you realize and if you if you if you don't pursue it you'll never you'll never find out and I think you could you could do really you could do some good things doing that and and that I don't know why there was something about Woody saying that that really changed everything and I really gave it thought and I really decided to come back for that extra year of high school and then you know following his footsteps actually so then I went on to do math and engineering in undergrad which is what he had done and he was an engineer as well could you get into a school like Stanford, which is one good high school.

So for undergrad, I went to school in Canada. Got it. 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 want to do and where you want to do it.

Okay. At one point in time, do you realize you're pre-diabetic? Because the lore in your life is so fascinating. Like, you could have been punched drunk, then you skipped out of that because of Captain Jack Sparrow or whatever. And then you go and you become an engineer, mathematician, then you decide to become a surgeon. There's also some health issues, which I think shift the course of your life. 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 had to do. Escaping Alcatraz. That's what it feels like, right? So, okay. So you find out that your point. pre-diabetic. This is not like based on diets. This is not based on lifestyle, right? This is genetic. No, I mean, I think it was, you know, again, I kind of look back at those days and I think there are 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 kosheries. I was, you know, drinking too. I was, you know, drinking too much Gatorade, probably not sleeping enough for sure. I definitely wasn't sleeping enough. And sleep, not sleeping, it plays a huge risk factor in diabetes. Okay. So I think it was just kind of like a perfect storm of things. Okay. So you get this? And I was, you know, just overweight. Oh, really? Oh, yeah. Oh, wow. I imagine if you're swimming to Catalene Island, you're just kind of ripped. So when do you, like how big were you? Probably like 25 pounds heavier than I

now interesting so you're not like you're not fat to the point where you're like i'm going to have a problem in my life i mean my wife famously said when i got off the boat this was i think not the first time this was the second time you know what i'm about to say someone tried to feed you a fish 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 what I mean she bullied you into this she shamed me into it wow thank goodness okay 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 work let's let's work on this thing a little more elliptical you know Okay. So what happens? When do you apply? Just from doing research on you and just kind of like talking to you, it seems like there's a very obsessive side of you. And that if you can turn that obsessive thing into boxing, we're swimming to Catalina, whatever it is. Once you lock in, you're locked the fuck in. When do you lock to fuck in on longevity?

Around that time. So my daughter is born in 2008. And as you now know, I think there's just a just, the most incredible thing happens to a guy when the child is born that at least for me didn't happen even at 20 centimeters dilated like you know I think for women they're becoming attached to that baby throughout the pregnancy and we're just like what is it yeah 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 hope I don't know, but I hope I can love our daughter as much as I love. But I loved midnight.

A midnight's awesome. This is the podcast. We need honest conversation between you and your wife. That's the podcast. And a cold plunge. I love midnight. Oh, I mean, we rescued this little Alley Cat in inner city, Baltimore. She was so precious.

And so I was like, yeah. And so when my wife is in labor, I was like at my laptop in the side. of the room building a model doing work and she's like you know I'm having a baby over here and I was like as soon as that baby's out I will be there but I have to get this stuff done and again I was just

I just yeah what yeah you're crazy her shot of he was totally justified totally justified now her dissoning is right the point is he's like he's like baby breathe breathe

once that baby came out there are a whole new set of genes that just get transcribed and all of a sudden I'm like oh my god I get it and I do wonder does that happen like would Bill Maher 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 I think I think the same exactly. If you don't love your kids, I mean, it must be pathological. 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 guess for which I have no data, but just through the lens of evolution, I think it even makes sense for boys, for males, to have this feeling greater than females. And here's why. If you think back to evolutionary times, right, you know, think back to 100,000 years ago, there was no. ambiguity for the woman who her child is.

Right. She carried the child. Yep. The male does not know who his child is. Yep. So there has to be some other switch. I'm just hoping they got it right. I'm looking at her every day.

Like, I think that's me. So I'm convinced that there's some other switch either through, you know, the smell of your kid or something that completely switches the male on. So he's like, yep, that one's mine. like no one gets to hurt that one. So you felt that immediately? I can't believe it. I can't believe how profound it was. Yeah.

And to your question, sort of to your question that I've taken too long to answer, I think that was the moment when all of a sudden I was like, oh, you know, all this other shit I'm interested in, swimming far and doing all these extreme things. Yeah, that doesn't really, 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 thoughts, 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 don't regret the decision I waited for the perfect person to do it I'm glad we did but like this impulse to be around them spend time with them yeah it smacked me in the face it was insane

so it would be cool to know that there are like some sort of like jeans that get turned on in that experience again I'm sure somebody out there smarter than me has figured it out but that's been my impression

okay so you have the experience which let's assume a lot of dads do which is like, okay, I kind of need to be fit. I kind of need to be healthy so I can be around. It's a great motivator. It's like the best motivator. I think there's even like a biblical term like every baby comes with a basket of bread,

this idea like you start making more money when you have a kid. And it might just be the urgency. It's like I should take that gig. Yeah. I should do that thing. It's funny. Even after having my kid, like I don't think I've done drugs since. And I was ever like a drug guy, but like a little like here and there.

But yeah, it's like is it worth the risk? like this one night, God forbid, something's in it. Yeah. I mean, I don't even really drink anymore since having a kid. Isn't that? Yeah, just like, I mean, also waking up early. You know what I mean? I'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 if this. I have heard this.

I don't know if it's not. That's because these women be eaten. I don't know if it's been validated. And you can't just let them eat dessert, right? And then they feel guilty. We're just being good support. Okay, so you lock in on longevity, right? And at the time...

Although truthfully, when I started thinking about it, all I thought about was heart disease at the beginning. Because that is... That's the disease that kills my family. And so my foray into it was really through... I really want to understand heart disease and I really want to understand why all the men in my family die of heart disease. And what do I need to do to make...

sure that, you know, at the time 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 disease. Jesus Christ. Okay. What is the first thing when addressing heart disease? Is that diet? Um, not necessarily. Um, the first, 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, there are four big modifiable things you just have to manage like you can't smoke your blood pressure has to be below 120 over 80 your lipids need to be perfectly dialed in and you want to be as

insulin sensitive as possible and if those four things are true i mean you're set for life gotcha now some people can do that with diet some people can do it with exercise and some people need drugs to do it it's everything's everybody's different okay this is i'm kind of i'm kind of 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 and was really 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 pre-dison check completely he's like yeah we recommend this like statin I was like I'm on a fucking blood pressure medication like what the hell is going. 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. And so I always find it amazing when I run into people of all persuasions who say, I will only use diet and exercise to fix myself. And at the other end of spectrum, you have these people that are like, give me every drug in the world, but don't tell me about exercise and nutrition. Do you understand how hard the problem is we're trying to solve?

Like, do you understand the inevitability of death? You said this once, it's like, everything is working against you. Yeah. Like, entropy is dragging you into the grave. Yeah. If you need a medication to lower your blood pressure, you take that medication to lower your blood pressure. Right. Now, you should try to do it naturally first?

Sure, by all means, because there are other benefits that come. So in other words, if you take an individual, that is overweight, not exercising, and has high blood pressure. If you said to me, Peter, would you rather give them a drug to lower their blood pressure or get them to exercise and lose weight to do it? If they both produce the same blood pressure, no questions asked. This is a better approach because there are other benefits that are being captured through exercise and weight loss beyond just the blood pressure.

But if that person either just can't or won't do those things, I'm not going to be punitive. And say, well, you're not working hard enough. Sorry, I'm going to withhold this. No, of course not. And secondly, you can do both because a lot of people end up losing weight. They exercise, but they still have what's called essential hypertension. They have normal, healthy-looking people that are walking around with high blood pressure. It's a silent killer.

Yeah. That is the tricky thing is that so much is aesthetics. We look at somebody in shape and assume that they're healthy. And a lot of what's going on under the hood is the thing that could end up killing you. Yeah. And the same is true with lipids, right? Like, lipids are even more genetically determined than blood pressure. What are lipids?

So our body makes cholesterol. It's essential for every cell in your body needs cholesterol to exist. And the most important hormones in your body are made out of cholesterol. So testosterone, estrogen, progesterone, all made out of cholesterol. And you, because cholesterol is a lipid, it's a fat, it can't be travel. It can't travel in our bloodstream because our blood's water without a chaperone, without something to carry it that makes it soluble. And those things are called lipoprote.

and they have different densities, and one of them is called low-density lipoprotein, L-D-L. That's your L-D-L levels. That's right, got it, got it. And that L-D-L 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 understand 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 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 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 them. Well, the good news is you clearly don't have the most significant side effect, which is muscle

soreness. 5% of people get muscle soreness. Got it. That's a lot, right? When you think about how frequently these drugs are used, one in 20 people is going to feel like they've had the worst work out of their life every day. Wow. So this shows up pretty quick.

Okay. So you get that. You take them off the drug immediately. That goes away within days. Then there are other side effects that are more subtle, and you just have to be watching for them, and one of them is insulin resistance. So if you see over time glucose tolerance getting worse and worse, in my book, that's a reason to stop using a statin.

The other thing is sometimes the liver function tests get a little liver enzymes that are known as liver function tests get a little elevated. That's also a reason to do it. But again, you know, 20 years ago, you didn't have a choice. Today, when I hear people go on these antistatin rants, I'm like, okay, like, don't go on a stent. Like, go on a PCSK9 inhibitor. Go on isetamide. Go on Bampidoic acid. Like, there are so many other cleaner drugs today that are more expensive. And we don't have, you know, so they don't have necessarily, and they're not, some of them are not as potent as statins,

although PCSK-9 inhibitors are, that it's become a little bit of a silly excuse. If you're, you know, if your LDL cholesterol, your APOB, which is really the marker of interest, is too high, you know, 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, you would think. And it's like... But now, apparently, we get presidents elected, so...

This is not the best thing, but go on. 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 truth is boring. And you can't get clicks on boring. So you have, so a lot of times people will find a way, not always boring, obviously. There's a lot of novel research and you change things. But like, it is way whoever is most salacious is going to win the eyeballs on the internet but that's not maybe what's going to make people healthy all right guys we're going to take a break real quick so we can talk about built if you're into points this is a must for you you got to use built because you'll probably get your points on your dining purchases and your travel expenses but the biggest expense of all if you're a renter is rent so why not get points for that your biggest monthly expense paying rent with built Unlocks flexible points that can be redeemed toward hundreds of hotels, airlines, a future rent payment, your next lift ride, student loan balances, and more. But here's where it gets even better. Build isn't just about points. They're actually helping you build credit by reporting your rent payments to credit bureaus for free.

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that leaves plenty of room for autumn adventures. and see for yourself how Volvo's legendary safety brings peace of mind to every crisp morning commute. This September, lease a 2026 XE90 plug-in hybrid from $599 biweekly at 3.99% during the Volvo Fall Experience event. Conditions supply, visit your local Volvo retailer or go to explorevolvo.com. Can I ask you a controversial one? In regards to insulin resistance. I recently just read Jason Fung's book, The Obesity Code, which you're mentioned in, actually. I'm sure you knew this. I don't.

Oh, there's a reference to you swimming in it. But he talks a lot about insulin resistance and insulin production in regards to fasting and intermittent fasting. So I'm curious your opinion on both forms of fasting and how that relates to weight gain, you know, in comparison to, you know, calories in calories out, that type of... Mark fasts. I love fasting. Intermitt fasting. He does intermittent fasting. He's also, you know, been our friend for a decade.

and we've known him not doing it. And nothing has changed in his body. He looks no different. His body hasn't changed for seven years. He doesn't eat for two days in a row now. He looks exactly the fucking same. What would you call him retarded? What is the...

What do you call people like that? No, no, no, no. Eating disorder, body, in his body. No, no. He wasn't jealous. I'm 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 bullshit, he said. When he doesn't eat, he gets really focused. No, he has four zins in his foreskin. And then he's really high-haired. Can 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 kidding me. Yeah, it's bullshit. He's already talking to himself as it. I'm telling you, I'm the dumbest health guy ever. We're selfish. We all have ways around the system. I'm the dumbest health guy. You can't do the flavored zin because it breaks the fast.

If in high doses, sometimes it will trigger. Dr. T, let me tell you. I'm so glad you're in here. I'm actually so excited to explain this to you, okay? I'm the dumbest guy when it comes to 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... And tell me, well, I go, I see medical clacker and I go, this is what I need.

Speaking of which. The mint, yeah, yeah, yeah. Go, go, go, go, go, here you go. Sorry, there you go. Are these bad for us? These are... Depends on what dose. Mine is Stan.

How many? Milligrams are these six. This is six. Oh, that's too much for me. I can only do three at a time. You do the three? I do three's, yeah. 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 a toothpick on the couch. He took it out. He laid him on the couch. I'm like, what the fuck is there's that toothache? He's got to hurt your meal or what it. He's got a toothache he's saving for later.

The son of immigrant parents, you know what I'm here? Okay, tell us about your vagus nerve. I mean, where do we start? First, I wonder about it? Intermitt fasting, okay? Oh, yeah. How dumb am I? I have a fasting winner from four to six.

I do high protein, high fat, low carbs. Am I an idiot? No, you're definitely not an idiot. I just think you might be over-indexing on something. All available data. That's Mark's life. I know, I know. All available data says that the benefits of intermittent fasting are accrued

through the amount of calories you restrict. In other words, and this has been studied. So if you take two groups of people and one group of them does 2,000 calories spread out over the course of the day, and the other group does the exact same 2,000 calories, but they eat them in six hours or four hours, there's no difference except that the people who do intermittent fasting have a tendency to lose a bit more muscle. Why? I'm not sure. I got a counterpoint, so we'll go to it. 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 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 just a little bit 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 at my absolute lightest which was 15 pounds lighter than I am now I was doing one meal a day too not because I thought it was giving me some enormous health benefit but because it was simply the easiest way to restrict my calories was to basically, I don't know how the hell I did it.

It was so miserable to get up, work out, not eat, you know, stay all day, come home, do another workout, then eat dinner and then go to bed and do it all over. 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'd never bring it up. One of my favorite stickers, there's this place in Austin that always has like a funny slogan outside of it and they

had one the other day that said what happens if a vegan does crossfit which do you hear about first oh he was doing crossfit he's everything but vegan he's like almost there no no no I wouldn't do vegan I wouldn't do anything I wouldn't do vegan you also said you needed to be your lightest what you were doing one meal a day

yeah what was that need for oh for cycling oh so not for doing stand up on the weekends sometimes I just checking What about Mark, you're done, you're done with the fasting I have 20 more dumb things I do I do. I do want to hear about the Vegas

He'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. Three days, three days, three days, seven days, three days, three days, three days, three days. Why? Well, my hope was that it was doing a complete purge of all pre-cancerous cells and, you know, but again, trying to replicate the benefits we see

in animals and chloric restriction. The problem is, after three years of doing this, I lost 20 pounds of muscle, which is not a lot on a guy like me who doesn't have much to begin with. And I was just like, okay, you know what? I wish I had a biomarker that could prove to me that there was some huge benefit here. But absent this, I just don't think there is. So, I don't know. Maybe there's a benefit to it.

I just don't know. 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. It's everybody like, Alan. Like, come on, you guys, you guys eat like Europeans.

You eat at 10 o'clock. Don't just say another obvious. I breathe oxygen. No. I didn't just say an obvious thing. Of course you're not supposed to eat late in night. That's the bedness. What times do you have dinner?

I have dinner at 9.30 or 10.30 at night. But I sleep like shit. Okay? But I'm not here bitching about it every single day. I don't have a choice. They eat in a fucking 11 p. You have that window. You stop eating at six.

Tell us a bunch of your little Vegas nerve system. Where do you got. Go. All right. This is my new dumb thing I'm on. So I just saw an ad on. and I was like, this is it. And it stimulates the vagus nerve and lowers your parasympathetic or sympathetic nervous system and helps me sleep. Does it? I've only done it for three days and my

whoop was off for one of them. Do you feel any different? No. What is it? Where do you put it around your neck? So you sleep with this thing around your neck? No, no, you just do it for one hour before you go to sleep. And it is, what are you doing during that one hour? Typically reading. Can you be doing anything? Could you be watching TV? Could you be doing work? 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... I don't like you saying. I really don't like you said. This is turning out to be my favorite episode. This shit on Mark Miles. You're missing everything. If I put these electrodes on my neck and lay in bed peacefully

for an hour before going to bed, Will it make me sleep better? Yeah. It could. And what would happen if you just didn't have them on your neck and you lay in bed peacefully for an hour reading your Hitler books or whatever you're like, I don't know, you're into those things. What do you think would happen?

Do you think you would sleep better? Well, I do that anyway. This is like when somebody who eats junk food all the time becomes vegan and they just start eating lettuce and they're like, veganism is the key. That's the same thing, right? But I read every night anyway. Now I'm trying this and see if it gets my HRV up. I, well, I, 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 what's called RMSS squared?

Okay. I don't know. What is it supposed to be? What is this supposed to be? I mean, that's absurdly high for an adult. That's how I felt. I was like, there's no way this is true, but this is. And is high good?

All things equal? Hold on, let me find it for you. Hold on, hold on. I feel like Atia is getting a little competitive right now. What's yours, Atia? Oh, mine's super low. I have very low HRV. I'm in the 30s. What? Yeah. Mark, there's no way you got 128.

It could be. I mean, I have seen people. Wait, what's the average range? Oh, it's pretty genetic, believe it or not. But the average, and it declines by age. So for people our age. That was on Saturday. I don't know what any of this means. He just hooked his whoop up to his baby.

Look, you know what? Your six-month average is 88 milliseconds. I don't know what Whoop's algorithm is, but I'm assuming they do it with... There's two ways you can calculate HRV, and they differ by about a factor of three. So assuming these guys do it the way most consumer products do it, you would be at the upper, upper end of what an adult would be at.

But, again, so that's great news. We don't know if that means anything. what it tells it. No, no, no, what? He suck, no. I'm getting you guys old nursing rings. But the point is, but a relative change

is what you should be paying attention to. So if your average is, you know, whatever, for the month, your average is 92, then you want to know, like, is this thing dramatically taking you up from that? I don't know how you got a 124, but man, that's impressive.

I just had a baby. I did. I slept on the road in a hotel. But what does that mean, though, 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 time. No, no, it's not. It's not. No, it's HRV. HV. H.R. H.R. H.E. The one about homo sapiens. That clip. And there was four, like, British scientists around her that kept taking it serious. There's not whatever you do in your life.

fall in both. I'm not a hummus. Your wife's a homerole? Yucca shit. Okay, but what is HRV? What are the benefits of HRV? HRV means how much variability is there in between your heartbeats? And what it measures is if the sympathetic system, the fighter flight system is like the gas pedal,

and the parasympathetic, the rest or digest system is like the brake pedal, HRV basically tells us what is the balance of throttle to break. And so when you are sleeping, you want to be in a rested state. You actually want your HRV to be as high as possible. So why one person has an HRV of 100 and one person has an HRV of 30 and one person has an HRV of 50 or whatever, that seems to be just a genetic issue. But for a given individual, there are things that are going to lower your HRV. And those are things that we ought to avoid.

So I'm sure all of you have learned this if you have a wearable, drink alcohol before bed. There is no surer way to tank your HRV. Eat food before bed. HRV goes down. Sleep in a hot room, HRV goes down. You know, all of these things are going to kind of overtrain. So something as good as too much exercise, HRV goes down. Do you use a wearable?

I don't, but I sleep on a mattress called an eight sleep. Yeah, eight sleep is fantastic. Yeah. I think it's a genius. And by the way, I'm an advisor to them, so now I should just disclose all that. For all that disclosed. But what I thought was so brilliant. I have a mattress cover.

Okay. The covers, but nobody wants to leave their mattress initially. It's a really daunting task to change matters. You're sleeping pretty good. I don't, I think 99% of people who use eight sleep use the mattress cover. But I think that was the great innovation because I've heard other mattress companies. Oh, yeah, yeah. There was a buddy mine who was an engineer who was working on a cooling mattress.

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. And 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 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 got to fuck with her though I may freeze it up oh your HRV's a little low maybe you should be nicer when I come off the beach okay can I ask about your supplement stack sure he gets this question of million times. Okay, can I ask you about myself? That's what you really want about. That's really what I was wondering. That's really it. Daily creatine. I think it's a go. Why is creatine good? I mean, I think it's pretty good if you're training. You know how it works. I'm assuming you kind of understand the gist. Holds water. That's a net effect of it, but that's not the desirable effect of it. It, you know, everything in in energy metabolism is about transferring phosphates. So you've heard of ATP. Yeah. Yeah. So ATP. Yeah. So ATP. he's the energy currency. So creatine phosphate is the fastest form of phosphate delivery. So it gets it. Okay, got it. So AIDS recovery. So more creatine means more creatine

phosphates. So AIDS in performance, basically. There's also some benefit, some evidence that it improves cognition. Although that seems more pronounced in people who are deficient in creatine, which might be more likely in vegetarians than non-vegetarian. So maybe for 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 religiously uses creatine now. And by religiously, I mean two weeks.

He's on it. And my friend Jason. And his body, he looks like a penguin. Is that a side effect? Does it do that to you 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 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've got to get a good source of it because it's, there's so many contaminations out there.

So like Carlson's is a good brand, Nordic Naturals is a good brand. I have no affiliation with these companies, but they're clean, so meaning third-party testing comes in and makes sure they don't have heavy metals in them and stuff like that. Got it. And then what is your coffee protocol? Or caffeine, rather. Yeah, I love coffee. unfortunately I'm a super fast metabolizer of caffeine so I don't really get a jolt from it but I just love the ritual and the taste and the flavor and I recently switched over to this machine that is all glass and metal so it makes a really nice drip coffee but without any of the plastic because I have 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 it occurred to me after making this podcast on the topic. I was like, man, every morning I put coffee in that thing and it drips scalding hot water through 27 layers of plastic into my glass carafe. I was like, there's got to be a way to do this. So now that I discovered this thing, which I can't remember what it's called, but it's like, it's an all glass version. A listener sent it to me because I was lamenting on the podcast that I couldn't find something. And they're like, check that. cutting boards that are not made out of wood, they'll have, like, I guess, plastic cutting boards,

and you'll get tons of microplastics from that kind of stuff. Yeah, I like the wooden ones, frankly. Even braking, 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 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 before, just because we're on microplastics, because the second that I told the whole world that my sperm doesn't swim, I got a lot of very

concerned people, including you. It was really great. So I think one of your guys that works for you hit up, it 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. What was his name? Paul Trekk.

Paul Treck. 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, can you talk about that a little bit? Just like, is sperm quality decreasing in America?

Is that, are we just testing it better? You know, what is happening with microplastic? Does that affect it? What do you think affected mine? So I think that there are so many things going on, and it's impossible to say which one or two or three are driving. It's kind of like the U.S. healthcare system. You know, when someone says, why does the U.S. spend more than twice what any other country spends? I'm like, how much time do you have?

Because it's, I'm going to have to explain the entire system. I won't do that here on the sperm issue, but it's a lot of things, right? So as males are getting older at the time of wanting to reproduce, age is driving down quality. But at what age? I was told that that doesn't happen until we're like 60. No, I mean, at 50, you fall off a cliff from the standpoint of the quality of the sperm. Got it. But remember, as you're getting older testosterone's going down as well, then you factor in,

if testosterone's going down and more men are using testosterone replacement therapy, that's also reducing fertility if you're using actual exogenous testosterone. The relationship between obesity and metabolic disease is also pretty significant, and men on average today are much fatter and less healthier. That doesn't explain you, but clearly there's something going on at the population level there. That also probably has the greatest impact on declining testosterone levels, is just inflammation obesity, 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. 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. Uh, and again, you can get those from UTIs or other things. But, STDs are the most common cause of that. So again, I don't really know what's going on with chlamydia and gonorrhea these days. I don't sort of see that stuff in my practice. But my guess is that could be playing a role.

So I think it's probably a death by a thousand cuts. I don't think there's a smoking gun. Do microplastics play a role? Yeah, it's possible. What would they do? I read some reports saying they found microplastics in sperm samples. Yeah, I mean, maybe. I don't know that that by itself is a smoking gun here.

You know, you can find microplastics in many things. and I don't know if it's causally driving the problem that you're seeing. That said, all things equal, I'd probably prefer not to see microplastics in sperm than to see them, especially as we talk about in that podcast. I mean, the process is so, it's so hard to believe it actually happens. Can you break down the process of impregnating a woman? Yeah, I mean, I think, again, I think Paul does a much better job. But the gist of it is that, you know, when a guy ejaculates, a hundred thousand sperm come shooting.

100 million sperm, thank you, go shooting into the vagina. And you said it best, right? It's like wave after wave of soldier just getting destroyed, destroyed, destroyed. And finally, as the acidity of that environment and the harshness of that environment, 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 the way up the fallopian tube. But the punch. line is like only about a hundred of the hundred million make their way to the egg how insane is that yeah so a hundred million start a hundred end up going there i think it was like a hundred million by the time yeah because the pH in the in the vagina is like quite acidic yes very low so i think

it narrows it down to five million and then going through the philobian 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 us 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 no reserve. One way. That's it. That's a rocket. That's wild. Now, is it the first sperm to reach? the egg or does the egg have any selection process?

So interesting. So as the, once you now get down to that group that are getting to the sperm, 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 aniploidy, 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 X the second they touch the shore. Wow. Right? So the last five million who were just like chilling, hanging out, like watching to see what went on are the only ones that end up getting there.

So is there an argument that if you were to select sperm, like in vitro or something like that, that those might be potentially part of the first wave? Such a great question. But of course, right? So I guess the question is, are the first ones that get out stochastically determined to be the first ones out? Or is there a selection benefit to being the first one out? If there's a selection benefit to being the first one out, then it means IVF is probably altering that mix because IVF would be just picking randomly. If there's no survival reason why those first ones are out on the $5 million are at the back, then it probably wouldn't matter. Okay, that's what you would hope. Because they do like sperm cleaning is what they call where they essentially look for like the healthiest versions. And they'll take them and plant them. But God forbid if they weren't like supposed to be there.

Ooh, but then again, if they are the strongest, that's a lot of pressure on my kid. Like, you were the best of the best. You better get A's. You know what I mean? Wow. Okay. I'm curious, do you have any, I've heard people say, like, oh, don't put your phone in your pocket for sperm health, any of that stuff. Like, heat from your phone or like from a laptop.

And then additionally, like, any EMF stuff that you've ever read research on. I have looked at a lot of this research. I don't find any of the EMF data compelling, which is going to generate a lot of hate comments in the YouTube guys. I'm sorry, because, boy, everybody wants to believe EMF is the cause of all evil. What is EMF? The stuff, you know, the waves out of your earbuds and your phones and stuff like that. Electromagnetic frequency that comes out of your phones. Sleeping next to your phone, people say is bad.

Heat is a real issue. So it turns out that hot tub, what did Paul say in this podcast? He said he could render any guy completely infertile. By just going in a hot tub. by doing four hot tub sessions a week. And then he said his friends, to which I was like, this needs to be a form of birth control. Some people say.

Yeah. I mean, your buddy said that he would go, I think it was it you, one of your buddies were trying to get pregnant and they would go in the sauna with... He would bring an ice pack on his nuts in the sauna. He would just keep the ice pack on his nuts. Wow.

But I imagine that the fact that the testicles can elevate and descend is specifically so that they can maintain a temperature that's beneficial to them, right? Well, yeah, that's mostly for cold protection, not heat protection. So that's why he was saying cold plunge is not, he doesn't concern himself with cold plunge and fertility because they do come in. They can't 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 transient. What about desert people? Like people where the temperature does get to 100 degrees, 105 degrees. Yeah, again, air doesn't conduct temperature.

nearly as well as water. So the thermal coefficient of water is so high. That makes sense. That's why when you're in 105 degree water, it's actually uncomfortable. When you're in 105 degree air, you can stand it for a long time. What about the red light therapy on your junk?

Oh, yeah, I saw people talking about this a couple years ago. This was all the rave, right, for increasing testosterone? Yeah, yeah. I don't know anything about it. My guess is like all that stuff is kind of like rearranging the deck chairs and the Titanic.

Like maybe it helps a little bit. I'm not sure if it really helps it. ton. All right, guys, you see the blue light. So I got to talk to the noodle dicks out there, like myself, maybe, who knows? I don't know, because I've been taking blue chew. I've been chewing it up. And that shit is performance enhancing in the most important realm of performance. Guys, if you have a lady you need to impress, maybe it's your wife, maybe it's a girl that you're just going on a couple of dates with and you're trying to get her to stay. Then you need to pop yourself a blue chew and perform at your peak, guys. You see that blue light? That blue light don't

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use the promo code flagrant first month for free 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. I think that there are probably instances in which stem cells could be really helpful. I think if you tore a muscle, you know, if you tore your rotator cuff or something, I would love to see a study where we looked at non-operative management. So just sort of PT rehab versus PT rehab plus stem cell injection. Would there be a different? 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 intrithical? 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 bloodstream that they're not going to get, you know, completely torn up by 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 Columbia to get their stem cell treatments which says nothing of how much money is being spent on this 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 it's 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 normalized i i haven't heard really any pushback about it outside of you now 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 people that talk about data are talking about anecdotal data. Like, you know, my cousin Joey, I mean, he had stem cells and he's 100% better. It's like, okay, well, I mean, again, maybe Joey would have got better anyway because, you know, so you can't, you cannot study these things without blinding and without randomization. You simply can't. And who's signing up for the blind stem cell study?

Right. If you've got enough money to get your shoulder fix and you're willing to go to fucking Columbia to do it, then you want the real stuff. Yeah. Are there other 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.

What is, can we, like, what is it? Yeah, so BPC 157 is an analog of something called vascular endothelial growth factor, VEGF. So what is VEGF? So VEGF is, uh, is a, a molecule in the body that promotes something called angiogenesis, which is the creation of new blood vessels. So angiogenesis is really important in certain processes. In fact, it's important for cancer, right? So cancer has to utilize VEGF to grow and spread and grow. So many years ago,

a drug called Avastin was introduced that was an anti-vegef drug. To limit the growth of Right, target this thing, right? Okay. So, but there are clearly times when you would want lots of angiogenesis, when you want proliferation of blood vessels. And so the thinking is that if we give people BPC 157 and they have an injury, maybe it improves healing. And I think it's possible, but there are a couple of challenges with this, right? So you can take BPC 157 orally. but the bioavailability is only 10 to 20 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 there. Should you just be injecting BPC 157 there? The half-life of it is like one to two hours. So then the question becomes like, how often do you?

you have to use this stuff. I mean, you need to be injecting it three times a day. And again, without any data, we just don't know. So I think there's biological plausibility to it. But if that weren't enough, you know, the FDA has cracked down on these things and said, like, come on, guys, we need to see some data if we're going to let you use these things. So now pharmacies can't make this stuff anymore. So now when people buy peptides, they have to do it in a very shady way, which is they have to buy it from a manufacturer. who claims that they're only selling it for research purposes and that you're only buying it for

research purposes. And then until they get shut down and then it's like a kind of a game of whack-a-mole. But there's no quality control. And truthfully, like, I would really like to see this studied so that we could know. Like, I'd like to see what's called an IND, which is, you know, means like the FDA stamps this with an investigational new drug status and let it get studied. and let's decide once and for all, like, does this work? Because I'm sure there's going to be a time in my life

when I'm going to want every trick up the sleeve that could be used to address these things. There are some peptides that actually, I will say, completely do work. They're biologically identical to certain hormones in the body. So, Samoralin, for example, is basically a growth hormone analog. It works perfectly well. But then you have to ask the question, you know, what are the pros and cons of taking growth hormone?

Yeah. Yeah, what is your, I know many people that when they hit like, you know, 35, 40, their testosterone goes down and doing, you know, TRT and growth hormone stuff to get it back to that baseline level. Yeah. What are your thoughts on that? I mean, totally different things. I would say when it comes to TRT, I think the data are really good at the benefits of TRT in a low T state. Obviously, you have to be aware of certain situations like, you know, if you want to have kids. kids, TRT, you have to be, I wouldn't recommend TRT to somebody who still wants to maintain fertility.

I would recommend HCG, which is another way to increase testosterone production without giving testosterone and shutting down endogenous production, the body's production. Growth hormones is a more complicated one. And I'm of two minds on this, which is on the one hand, there's really no data one way or the other saying it's good or bad, right? Actually, that's not true. there are data saying it's good in certain cases, like HIV wasting, right? So people like back in the 80s when we didn't have highly active anti-retroviral therapy

for patients with AIDS, you had nothing to offer these people, but like high doses of steroids and growth hormone. And by the way, dramatically improve their quality of life. So we know that at least in the case of AIDS wasting, growth hormone was amazing. I've never met a person who took growth hormone, who didn't say they felt better. So the question is, at what cost? I've never taken it, but I tell you, I'm sure at some point I'm probably going to be like, you know what? Let's try.

I don't care about the risks anymore. I'm old enough. I feel crappy enough. It's time to start taking it. But, you know, I'm only 52. I'm going to hold out a little bit longer before experimenting. Right. What about like NAD?

or all these like cosmetic IV drips. Yeah, NAD is another one where there's a great argument for why you would take it because NAD levels decline as we age, and NAD is very important. So that if you took those, if I told you there's this really important thing in your body and it gets lower with age, the obvious answer is I should be taking more of it. Okay, totally get that. So then the question becomes how do you take it? So there's basically two ways you can take NAD.

You can take it in an intravenous infusion. I think that's a total waste of time because, one, they're giving you probably way more than you need. And how many times, how often can you do that? Like, even if you were the most committed junkie, like, would you do that once a week? Right. That's not going to create a, like the half-life of NAD is quite short. That's not going to meaningfully contribute to your total body levels of NAD. So people then try these and the other way you can take NAD is through formulations that you take under the tongue so that they get absorbed in your lymphatic system. That might be more promising. I'm kind of interested to see how that pans out. And then there are people that take these NAD precursors. One of them is called NR and one of them is called NMN, which you probably heard of. And 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 until they needed to go on a ventilator. And I mean, I don't know how clinically relevant it was, but to somehow suggest from that outcome that, like, we should all be taking NR is a huge stretch.

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See you all later. When you said you were pre-diabetic, how did you fix that? Because I was also a pre-diabetic guy two years ago, and I just have to, like, cut out a lot of sugar. 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 started taking out red dye.

He started crusade against, like, these dyes. stuff and food. Is that a pressing problem? You think in the American diet, these like red dies and things like that. Have you looked into that research? I've looked into it a little bit, and I can't imagine anything wrong with getting rid of red dies. In other words, I don't think anything bad happens because we take out the red dies. 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 the removal of red dye, if the removal of red dies fixed our health system, that's how surprised I'd be. Yeah, yeah, 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, uh, you're speaking a lot about like the emotional component of longevity and how important that is. And just because, I think there are ways to kind of biohack at the cost of enjoying your life, spending time with friends, and, like, figuring out what the right meters that you should pull on are, like, specifically having community, I think, is, like, crucial. And the isolationism that a lot of people are dealing with in America and probably around the world is, you could say, like, there's a version of it where it's not, I don't want to say slow death, but it will knock off years from your life, right? how do you like maybe this is something that you're working on early in life but how do you how do you communicate to a 30 year old hey you want to live to 80 you better have some fucking friends that you hang out with because that's not something you could solve for at 75 yeah that's such a great

point 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. So, but I think you're right. I think there's, the world is so different today that I'm sure that there's a greater sense of isolation. I just don't think you can overstate the whole point here, which is everything you want, at the end of your life, you have to be able to work backwards from and start now.

So if you want to be fit when you're 80, do you know how fit you need to be when you're 30? Like, you don't get to be an out of shape pug until you're 75 and go, it's hammer time. Yeah. So you have to get in shape now. Like all the exercise I do now is not for now. It's for 80. It's for 80. Yeah.

I mean, this is something. So the same is true on the relationship front. Right. So I think. You want a bus friend group at 80? Yeah, and I want my kids. I don't remember who said this. Yeah, I wish I could remember who said it so I could attribute it to them.

But somebody said the greatest source of wealth is having adult kids who want to come and spend time with you. Right. So let's unpack that for a moment. So that says, okay, do you accept that? Well, I think anybody who has kids would accept that. So, okay, I want, my kids are 17, 11, and 8, and I want them to constantly come back and be with me till the day I die. 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 it's like, so all the, so, so for example, like, people say, oh, Peter, you exercise so much. I'm like, I don't exercise that much. Like, you should see what I used to do.

Like, I phone it in when I work out, right? I mean, if I'm given the choice between an extra workout or a game at chess with my kid or playing soccer with my kid, I'm always going to pick doing the thing with my kid. Because I know that those years are very finite. And that's the investment, right? That's like, I have to invest in these relationships today because I know what I want tomorrow. And the same is true with my wife, with my friends and stuff. So I think that's the way to position it is all the choices you make today are compounding choices. And work backwards from what you want.

Yep. So, okay, to that end, reactive medicine is going to get really good. And I imagine with AI, I don't know exactly how it's going to affect it. I'm curious your take on that. But reactive medicine is going to get better. The better reactive medicine gets, I imagine the less proactive we will be with our longevity. So if I know, for example, if I get cut, I could just throw some neosporin or I could take an antibiotic. I'm not really worried about getting cut.

But back in the day, if you got cut, you fucking died, you worried about getting cut. Are you at all, knowing how important it is to plan for your last decade and knowing how prolific the drugs are going to get that help you think at least that you don't have to plan? Are you worried that that's going to deteriorate that planning that is so vital, at least in people's minds? I mean, perhaps for some. I think, you know, there are some areas where I think I'm hopeful that drugs are going to get a lot better. But it's going to be a while before I think we could safely say that prevention is still not the best management strategy for cancer, for heart disease, and for dementia. And I think that especially for cancer and dementia, we really don't have amazing treatment options. Advanced cancer is, advanced meaning cancer that has spread from its primary site,

metastatic cancer, you know, it's almost uniformly fatal still. We have about an increase. Overall survival has increased about 10% in 50 years. So I still think the approach of early to 10%. and taking all the preventive measures is going to matter for a long time. Furthermore, lifespan is not the only metric, right? Health span also matters. Can you explain the difference between those two?

I think people get confused with that. Yeah, lifespan is the easy one. It's the how long you live. And so that's the one that the medical system is fixated on, is how many years are you going to be alive? And we're pretty good at stretching out time that we are alive with chronic disease. But health span is what more people care about. More people care about the quality of their life, and actually most people, almost without exception, would take a slightly shorter life at a higher quality all day.

Exactly. Give me productivity through my – everyone wants to live to 100, et cetera. Of course, in our heads, we're all like, I'm going to get to 100. Give me productive 80 years. Like, I'm playing paddle every day until I'm 80 instead of being wheelchair bound from 70 to 100. Yep. I think most people take that. Yep.

Yeah. I think that's right. And in order to do that, you're talking, you have to take preventative measures. Yeah. And you have to do hard things. You have to exercise. Like, you've got to watch what you eat. You've got to tend to your sleep.

You've got to do these things for which we don't have great pills that are substitutes. Can you explain the dementia, the correlation between, I don't know what it is, is like, diet or health or what you can do? My dad is dementia. It's like, what preventative measures can you take to 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-ameloid plaque Alzheimer's. So usually Alzheimer's defined by the amyloid plaque buildup. They haven't found enough in it, but they're still like, you're showing all

the symptoms of this. So they don't even know what the fuck to do about it. So I'm curious, like what So genetics play a pretty big role in this. I'm sure they've done the appropriate genetic testing to see how much of this was kind of genetically driven. And then there are a whole bunch of factors that can increase risk. Don't answer for whether any of these participated in your dads, but like everything from high blood pressure, high cholesterol, insulin resistance, poor sleep, high stress. Those are just the ones we know about inflammation, certain types of infections, right? There's now a lot of evidence that's emerged in the last six months that's suggests that reactivation of shingles, especially an ocular version of shingles where the

virus gets near the eye, that could even increase the risk. So now we're, you know, we've always been pretty adamant about people getting their shingles vaccine once they hit 50, but that that's yet another reason. I think that everybody once they hit 50, in fact, I got my shingles vaccines when I was in my 40s. I was like, fuck it. I'm not waiting until I'm 50. Yeah, yeah, yeah. Well, just from the standpoint of shingles being such a miserable, awful experience. so but you said blood pressure and insulin resistance my dad does have high blood pressure and he has become insulin resistant so you're saying that like potentially there are genetic factors but like could diet have also fed up that process potentially with them yeah fuck it's

horrifying to figure out that there's something that that could have been done to to stop that yeah i mean i always thought it was just like you either got it or you don't as genetics Yeah. And again, there's a genetic component to all of these diseases, but you really can, if you start early enough, you can circumvent a lot of the genetics. Certainly not every case. Look, there are cases of Alzheimer's disease that are predetermined. But fortunately, the predetermined cases represent less than 1% of cases. So there are a handful of genes that guarantee a person will get Alzheimer's disease. And tragically, these people succumb to the disease in their 50s usually. Okay. But again, that's that's one percent of cases. So 99% of cases are, there's a genetic component, but they seem to be triggered by insulin resistance, hypertension, hyperlipidemia, poor sleep.

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 or something that you could potentially? We didn't learn this in med school. Why would these guys have learned about it? of crazy. No offense, but I went to nursing school, but yeah, I'd never heard that before. But it's, I mean, like, I would have loved to know about this. My dad's starting every morning with a corn muffin from the deli.

Like, that can't be good for them. Yeah. Yeah, wow. No, medicine has a huge blind spot to this topic. Why is that? I think it just has to do with the structure of reimbursement and payment built around diagnostic codes and intervention. medicine has basically two types of interventions, drugs and procedures.

Hmm. And so we have codes for both drugs and procedures and diagnoses. We don't have code for prevention. Yeah, we don't really have a billing system that makes sense to say, oh, you know, John came in today to see me and I noticed that he's a little pre-diabetic. But rather than just write him a prescription for metformin, you know, I spent half an hour with him and I figured out that he's not sleeping. well so I walked him through some of the CBTI techniques for improving your sleep like there's no way like how would you pay somebody for that it's sort of like the reward system isn't built for it yeah yeah yeah so then it trickles down so then it's not going to be part of the

education system so I mean if you like people often ask me like well why should I listen to anything you say like you trained as a surgeon like how does your surgical training have anything to do with what you do today and I was like yeah you're right nothing like nothing But here's the point. Had I gone and done internal medicine or family medicine or rheumatology, the answer would still be nothing, right? Like all these things I've learned over the past 15 years, they were not going to be things you were going to learn in a standard medical system. And by the way, I'm not saying that that standard system isn't wonderful. It is.

Like we owe a lot to that medicine 2.0, as I call it, system. But it's really at the limits of what it's going to solve. 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 this is directly from you guys i assume it is but like i've heard that even young people are drinking like 10 15 percent less yeah i have i've seen stats about that yeah and uh i mean smoking is gone way down like you know which are nice things and maybe you want humans to have some agency over their own body like maybe it's not only up to the medical industrial complex to tell us what to do. Like maybe it is good that we do some research and we start going, yeah, well, maybe if I write an exercise

that this will be better for me. But at least having access to the information is important. That's crazy that 99% of dementia could have environmental effects that have sped up the process. Yeah, and just to be clear, there's a spectrum within there, right? There are some people that are going to have

two copies of an APOE4 gene. They're going to have it. Well, they won't necessarily have it. it, but they're going to have a 10 times higher rate of having it. But then there's still something that might trigger it. But look, half the case, a third of the cases of Alzheimer's disease don't even have one copy of the APOE4 gene. Now, they might still have some other gene that we don't know yet is participating in this, but, 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. Right. 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 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 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 of all, most MRI scanners out there are garbage. So they're not even remotely good enough

to be doing this. MRI in general is just kind of a crap technology. What's that noise about? 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 C.T. scan has a quantifiable unit of measurement. So when you look at a CT scan, it might look like it's black and white and different shades of gray, but every one of those pixels can be described in something called a Houndsfield unit. And you know exactly what the color of that is, and it's perfectly quantifiable and it's reproducible no matter what machine you get it done in. So some machines

might have a higher resolution, some machines might go faster, and some machines might have more or less radiation, but the image reliability. There's one language. With MRI, it ain't that way. So an MRI from one hospital could speak a different language than MRI from another one. 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, you know, there are most of the companies that are out there advertising to do this are kind of running lousy protocols. And, you know, they're doing it really cheap. But the problem is you're missing cancers. And more importantly, you're catching a lot of things that aren't cancer. So you're getting a lot of false positives. And that creates a ton of emotional stress for people and can lead to a lot of follow. follow-up procedures. And so when we talk to our patients about doing this, our view is you don't

do this unless you're willing to go down a rabbit hole where we saw a nodule on your thyroid. It's probably not cancer, but now we can't ignore it. So we 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 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 couple years left like we're going to go in and look at them but it looks like it's spread I think stage four is when it's spread 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 what is this system where they go you're to die in two years and they go, oopsie, we didn't know. I mean, it's crazy. What about AI as a diagnostic tool? Like, as that's on the horizon, how is that playing? 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 MRI's pixels are all standardized, AI can't do anything. What can AI do for... What will AI do for just medicine in general? How will it affect longevity? Like, where do you see it playing a part?

God, there's so many ways. It's already playing a pretty interesting role in drug discovery. So how do you, how do we create drugs? So a lot of times drugs are designed. They're not, meaning you know the receptor that you want to activate or block. And you know 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 it sticks. Yeah, what if I put this amino acid next to, what if I string these 2,000 amino acids together? Will they fold in the right way to make a structure that fits there? Well, the guy that, the company that won the Nobel Prize last year was a, it's a company that spun out of Google, they came up with an AI engine that now can predict from the amino acid sequence how it will fold. and what the shape will be. So you don't have to do the trial and error because it will do it for you. You can just make the drug.

Oh, my God. So much cheaper, so much faster. Yeah, I mean, I don't want to overplay it. So much faster and cheaper for that step. That's step one of 27. Right. You still have, I mean, I'm being a bit facetious, but now you still have to go and test that drug in mice. Then you have to get an I-N-D.

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 Thursday, yeah, yeah, yeah, yeah, then we could start to take. So how would you create datasets with fake mice or with AI versions of mice? You'd have to do it off real data to start, probably. And, of course, you'd have to come up with models that could understand what's happening and create perhaps some sort of synthetic data off smaller sample sizes or things like that. So maybe you run a smaller sample size, but you get a.

enough data out of there that you can simulate what would happen on a larger data size. I mean, that's where you get the exponential increases when you can use the, they're not called fake data samples. They're called synthetic data samples. Once you create synthetic data samples for something, you're out of here, right? I mean, again, it's still hard for me to kind of wrap my mind around what that's going to mean in humans. But if I just think about what I've watched AI do when I muck around with it now versus a year

ago versus two years ago, I mean, you know, it's just done that. So 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 health care. Like our health care system has such a high administrative burden. And, you know, we're talking about $7 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. 7 to 800 million of pure admin. Billion. Sorry, billion of pure admin. I'm thinking about countries where they're offering it, they're just offering universal health care. Imagine what that means for them.

I mean. Well, they have much less admin cost than us. Because why they've already. They don't have to adjudicate payments. So when I say, 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 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 is where you're seeing people in their 30s, they're 40, like, I'm 40. Marks in his 20s, late 20s, probably pretty much 30 or 40 already. No, late 20s. And then, and Allison is 30.

So like, like, is it, have you seen this, have you seen this start to, like, impact these younger generations? And is there, like, a part of you that's very proud to see them taking it this seriously? Are there certain people that you're working with that you're seeing, like, life-changing things happen to? Like, I don't want to just fixate on, like, what's negative about this. I think it's a cool moment in history where we have access to this information.

It's terrifying because I don't know if an ice bath is good or bad. I don't know if a 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 that 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 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, 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, 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 what I you know where I where I think we should be going are you going to put out like an informational app you're going to put out some sort of what is it like an encyclopedia of this information where we can no I think information by itself is not sufficient I think it has to be more action oriented it has to be more of a co-pilot like kind of a health fiduciary. So it's sort of like if you had me standing next to you every single day,

helping you decide how to exercise, how to eat, what to do, what to do with any results you have, but on a day-to-day basis, right? Not some sort of grand once a year sort of overhaul. Over time, these benefits would compound a lot. So again, I think this is not. How can the average person access that. I imagine your time is no, no, but of course, but again, if you scale me via software, yeah. So is that something you're working on? Yeah. And then when do we think I, 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 rather than later. Really? Yeah, this year, hopefully, 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 to it. The second you say BPC 157, I'm like, well, it must be good.

You know, it just sounds so technical. Exactly. It's got to be. Somebody called it the Wolverine peptide. And I was like, I want to be Wolverine. Right? You've heard all this shit, right? No, I don't spend time on social media.

I don't. Oh, it's so much fun. I can't. Again, that's part of my longevity strategy. I cannot look. I mean, when I look at Instagram, like, it never shows me that crap. Like, it's showing me stand up. It's showing me gun videos, cars, F1.

Okay, the last thing I guess I was curious about is nicotine. That's my only real advice. Maybe not my only. But one of the devices that I'm drawn to, and I know there's so much conflicting research, Neutropic, if that even means anything. So how do you use nicotine? Most days I probably don't, except for the toothpicks, which I love. But, you know, if I do, I'll probably do three milligram pouch once a day.

The data are, I mean, obviously you have to separate tobacco from nicotine. So tobacco is the problem, not nicotine. And most nicotine is synthetic. But you have to make sure of that. So there's probably a downside in. tobacco-derived nicotine even without a combustion product, so it would 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 dependencies 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 I

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 notice 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 activated. 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, it's got obviously a very, very bad rap through tobacco. Yeah. As it should in that way. But I don't know. I just caution people not to go too crazy on it. I think, you know, I've got friends that are, they can't get, they're taking 30 milligrams worth of pouches a day and they can't stop. And so I think in that situation, I would be concerned. Yeah. That's great. All right. Well, listen, Dr. Attia, we appreciate you coming here, bestowing your box. boxing knowledge and then some longevity stuff.

Congratulations on your New York Times Bell Selling book. I think it's been on there for like 100 weeks or something like that. It's pretty insane. It 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 would be really cool. Because I think it's something that we all need. I think one of the scariest things about longevity is knowing what information signal to noise. Yes. And I think that's the same thing with politics. I think 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 one is it feels like you've been quite disciplined. I think there are a lot

of people that are in your field. They get a lot of exposure and notoriety and they very quickly cash in and they stamp some supplement thing. And they can make, you know, hundreds of millions of dollars on it, but if it's actually bullshit that doesn't do anything, maybe we lose trust. And I haven't seen you do that. I'm sure you've been given a million different opportunities to do that. So I think that that's really cool and you've chosen to be disciplined and because of that, we trust you. And thank you so much for sharing your time, my brother. Thank you for having me guys. Thank you.