Armchair Expert with Dax Shepard - Richard Isaacson (on Alzheimer’s prevention)

Episode Date: August 8, 2024

Dr. Richard Isaacson is a neurologist with a focus on the treatment and prevention of Alzheimer's disease. Richard joins the Armchair Expert to discuss who his medical idol is, the importance of preventative medicine, and how he got involved in Alzheimer’s research. Richard and Dax talk about the core tenants of brain health, some of the main factors of developing dementia, and how to lower the risk of developing amyloid in the brain. Richard explains how important diet is for cognitive ability, what role genetics play in developing brain diseases, and the need for modifying your physical activity as you age. Learn more about your ad choices. Visit podcastchoices.com/adchoices

Welcome, welcome, welcome to Armchair Expert, Expert's Line Expert, I'm Dan Shepard and I'm joined by Lily Padman. Hi there. Hi, this is our first laboratory episode where we do labs real time. We do, the beginning of the episode is us getting blood taken and you'll hear a bunch of that.

Enrolling in a study, I don't think I've ever been a part of a study before this. That you know of. Well, that's true. I guess they're probably on our phones, they're probably running all kinds of. Exactly. But not to worry if you feel like it's boring

at the beginning, I thought it was interesting. But it ends and then we get into a real interview. What if the whole episode was us just getting blood taken? The reason we're getting our blood taken is because our guest is Dr. Richard Isaacson. You probably remember, if you listen to this Andre Gupta episode, he had done a piece on Alzheimer's

and interacted a bunch with Richard because he is one of the foremost experts on Alzheimer's. He's a neurologist with a focus on the treatment and prevention of Alzheimer's disease. And he is the director of the Precision Prevention Program at Atria. And the Atria Institute provides coordinated healthcare and comprehensive predictive testing to enable a highly personalized approach to well-being.

And we are now enrolled in a study. So cool. And he's not going to take this unsolicited advice, but if he changed his name to Dr. Playful, it would work. He's very playful, but very knowledgeable. Yes. Although Dr. Playful sounds a little too sexual. Sick, sick, yeah.

Okay, so we'll stick with Dr. Richard Isaacson. Please enjoy. We are supported by Squarespace. Guys, we have a Squarespace website that's just gorgeous. That Wabi Wab, you built that yourself using all the templates, yeah? I sure did.

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He's an uptrendsper. He's an up man. He's an object man. He's an object man. He's an object man. He's an object man. He's an object man. He's an object man. This is exciting. Hi. Nice to meet you.

Pleasure. Pleasure. Right on deck. Now, we probably, cause you're gonna do glucose? No, not glucose. In theory, for the finger pricks, we probably, because you're gonna do glucose? No, not glucose. In theory, for the finger pricks, you don't have to fast. If you ever want to do the actual blood draw, which is the big panel, which is the Boston Heart and all the cholesterol, all the other stuff, metabolism, that's gotta be fasted. Thanks for wearing white pants, I appreciate that. I know! Thank you.

I didn't even think about that. I'm wearing white pants. I've only gotten blood everywhere, like once. Well, you're in a white shirt. Well I have this. Oh you're going to put that on? Oh yeah. I can put a blanket over my legs. No it's going to be okay.

You really anticipate gushing? No, no. I can't believe you have this full lab set up. We have people in New York that get blood draws and we have a kit now. Grip strength monitor. Oh I'm getting white. So we'll start with the blood stuff? Yeah I'm ready.

Okay. Yeah let's do it We're gonna need you to turn your head and cough. Okay wonderful I feel like I'm at a bar like serving. I know You can set this up at a bar people get drunk and do it exactly This is the one if you want to bleed everywhere, so I'm gonna use the blue ones Okay, why it's just a bigger. It's a bigger gauge. Yeah, we're going to do four cards. So this is a research study.

So we're learning. This is a research study. It's voluntary. Basically we're trying to figure out the colloquial way of saying it is, can we develop like a cholesterol test for the brain? So just like we know what HDL is, the good cholesterol, even though that may not be true, LDL, ApoB, and triglycerides and all these things. Basically we're trying to do that for the brain. So we're making progress.

Boston Heart Labs is the lab we use. It's a clinical test that you can order clinically, but it looks at all the particle fractions. It looks at metabolic numbers. You can check your apo-E gene. But if you do want to do that, it's all included in the research, and then you would have to check those boxes.

But that we would set up a mobile blood draw and we would get that at some point. And yet there is zero identifying information in any way shape or form you guys are gonna be somewhere like a 115 person or so in the study Sanjay was the OGs Let's do some blood Do that first Ready to rock and roll ladies first. Oh

The goal here is to actually for people to eventually be able to do it by themselves Because it's research, we're doing four cards at a time Hopefully only one or two is necessary But we're getting extra because we have to do research-y type things Basically it's a little prick Shouldn't be painful at all Have you ever done this before? You've done this before? Had a little prick?

It's just right there. Oh my god. It can't be resisted. It's just sitting on a silver platter. It can't be resisted by you. You could not resist. Okay, so I't help. Great. Could you do this at home, do you think, one day? Definitely. Great. Good to hear, because that's the goal. We're trying to democratize access to brain health care.

I mean, anyone who has diabetes has to do this like every day, right? Exactly. You got it. No. Okay. I'm sorry. I did some hamburger hanging out.

Yuck. Okay. That's it. Look at that. You're a champ. Next victim. Okay. And three. Two. One. Oh boy. How'd that go? Wonderful.

Hurt? No? No, no. Great. Oh, there we go. You got a bleeder. Like when you do a blood draw, it's the vein. And this is a mixture of capillary blood, which is a mixture of arterial blood, like from the arteries and from the veins. So the reason we have to validate or prove that the tests work is because it's a different blood source.

And that is it. Bobby Wob. Your turn. Wow, that was easy. Look at you guys. You guys are chimps. I'm on mic now, Rob, so turn! Wow, that was easy. Look at you guys, you guys are champs. I'm on mic now, Rob, so I'm gonna add some content. Does this feel like peer pressure,

or do you have genuine interest in this? I have genuine interest. You do, okay. How old are you? I'm 36. Great, perfect. Nice getting people from all over the age spectrum is really, really helpful.

Oh, I'm supposed to ask you guys a couple of questions about age and family history. Anyone have a family history of Alzheimer's here? Grandmother. On which side? Fathers. Okay. Maternal grandmother. Great. Okay. Anyone Parkinson's, vascular, dementia? And you have? My grandfather has dementia. Maternal grandfather.

I'm sorry about that. That's terrible. And? I don't think so. Parkinson's, vascular, Lewy body. What a crap. Nothing? Okay. And? White privilege. Terrible and I don't think so Parkinson's vascular a little bit right nothing. Okay, and white privilege Okay, three two one and you don't really feel it either. Did you wow? Love it? Okay, we're all pretty high. I don't know if that was That you're warned about that

Is it fair for me to guess that you're not normally administering this part of the test? You probably have a nurse. Well, we have two nurse practitioners and a research coordinator. I've done this probably half a dozen times. Okay, I said five, it was six. Yeah, it was yours.

Well, this is four, five, and six. Four, five, and six, here you go. So you've done it three times. Yeah, the Langham Hotel New York has blood on the carpet for me, that is for sure. We've done this in interesting places, but sure. Well, we appreciate that you're doing it here. Absolutely. I wonder if everyone in the trial,

where do you get these people? It's Bezos, it's Zuckerberg, it's us. He's not saying anything. It's Zos, it's Zuckerberg, it's us. He's not saying anything. This is like the most warped sample size ever. The vast majority of people are like normal people. There's probably 15% are exceptionally wealthy. How do people sign up?

Yeah, how do people get enrolled in this? They've emailed the Alzheimer's Prevention Clinic, which we started over a decade ago. At Cornell, a lot of those people came. A lot of families do it. For example, we see a person with Alzheimer's and Clinic, which we started over a decade ago, at Cornell. A lot of those people came. A lot of families do it. For example, we see a person with Alzheimer's and then we do the family members. Sure. Which is really the meat of what we do. Yeah.

Is it time for that? Yeah, yeah, you guys want to do a... Okay, so, left-handed. Yes, sir. And just doing a little grip. But that's not to say that's my strongest hand. Should I be using my strongest hand? Your strongest hand, yeah. No, he's my right. Oh really? You can do both. Wow that's pretty good.

Okay you win again. Kilograms! Did you want it in pounds? Actually kilograms is okay. Thank you. You're supposed to do it as hard as you can. Yep. Oh god. Definitely broke my wrist, but it was worth it. That reaction. I do want to do my left hand after this just to see. Because I assume that my right is. Okay. Oh no, it's not great. No, it's not bad. That's actually not bad at all.

When do we get to your grip strength? 27. Just hold that so I can make sure. 58. 58. Good job. Jesus. Pretty good. 27 just hold that you can make sure 58 Pretty good Oh, do you beat me what did he get what the Wow Wow No, you you won, but. I know, but I just wanna see.

This is my own curiosity. You were 55.3? Yeah. No, no, you were 58.6. Oh, sorry, yeah, press that. Okay. Oh, close, no, you're right, you're right, it was stronger. What's average for a woman and a man? There's like percentiles and you have to like look

and there's, yeah. No, no, no, actually everyone did really well on, everyone did well on grip strength. Okay. Oh, this is so funny. Everyone did well on grip strength. We should do more things where we get less. Yeah, no, this is fun.

Okay, so just depending on how much we use of that real audio, just wanna bring everyone to speed. We started with a pin prick to the fingers, all three of us, and we put it on four different cards, and then we went on to a mobile Lo-Fi Dexa scanner, right? It's a biometric scale. And it's gonna tell us what? Percent body fat and muscle mass.

What about bone? Not this version. This is kind of like a screening test, which is pretty good, and it's an at-home scale, which is helpful, but it's not gold standard, but it's helpful. And then we had a hand grip strength test, which was really fun, and Rob was very strong.

I was hoping to beat Rob by a lot more than I did. That was impressive. Have you done it? I have, I've done everything. What is your hand strength? Don't fib. Wait, in kilograms? Yeah.

Oh, I don't remember. Well, guess what? You get to take a test now too. No, no. Here we go. We've never put a guest on the spot like this. Well, we're gonna today. Let me show you my blood biomarkers.

This is good. I put my best foot forward. But my hand's sweaty because of the excuses. It's an athlete who blames his equipment. Oh my gosh, hold on. I got this, no, I had a plastic glove on. I love this. It matters so much to us.

Hold on, I'm starting again. Oh, it wasn't. Humans are incredible. Oh, I'm so upset. My hands are incredible. Oh, I'm so upset. My hands are sweaty. I have your blood. Yeah, you have blood on your hands. I can't even...

No, this isn't fair. I can't even do this forever. I'm so upset. No. He's using two hands now. Oh my god. That was 44? That's not bad hands now. Oh my god, that was funny. 44? That's not bad at all, I don't think.

It's wonderful. 47, recently. It was 47 recently. Presently. Oh my god. Oh my god. Oh, fuck, that was so funny. My body fat's okay.

Anyway. Ah, Sunjay was really fun, we should add. You're kinda here, because we had Sunjay on, he did a multi-part series on Alzheimer's, and you are a large part of that investigative work he did. Sanjay's the man. Yeah. Isn't he the most loved? Have you hung out with him socially? I met him briefly like a decade ago and I haven't told him this.

I met him at like a backstage at Dr. Oz or something and I'm a fanboy. Now I know Sanjay and it's like amazing that I've gotten to know him mostly during COVID, but I wanted to be Sanjay 20 years ago. He's a six year grad. I'm a six year medical school grad like called the Baby Doc program. The way he could just communicate science, it's just different.

And that was my career path a little bit when I was in academics. Used to teach the faculty how to communicate your science. So that's kind of what I did. And I looked up to Sanjay and now it's so cool, but I don't think of it like that. I kind of like separate it. How old are you?

46. Three years in my junior and you're probably nine years? Yeah, around there. Okay, he's mid fifties. Looking great. Then he wrote a great article that I read talking a lot about you.

And he, yeah, he said he knew you over the years and he would often reach out to you for certain topics. We were in touch a lot during COVID because the shit was hitting the fan in the world and you have to have a network of specialists that you can rely on. And Sanjay was always the fan in the world and you have to have a network of specialists you can rely on and Sanjay was always there when I had questions and he had questions for me.

He's always calling me about interesting people. I'll just put it that way. Yeah, I bet. He's probably a conduit. I bet when people bump into Sanjay, yeah. This is the same with- Adam. Do you know Adam Grant?

I don't. Well, he'll really connect you with everyone. Oh boy. No more. Yeah, be careful. You wish. No more. You have to do this everywhere. And then when did you meet Atiya?

I met Peter in 2014-ish at the Breakers Hotel. Oh, down in Florida. We were speaking at some, I didn't even know what I was doing, I don't know, and didn't know who Peter was aside from, he had this blog or microblog, but it was like a decade ago, and he would talk about nutrition.

I knew of him from some nutrition stuff, and it was me, Peter, and Jay Walker, the Priceline guy. It was 11 p.m., I was exhausted. Next thing we know, it's like one, two o'clock in the morning, we're all talking on a couch, and I'm arguing with Jay Walker, I enjoy Vegas, and I thought that you could beat the slot machines, because I had a method.

My uncle lived in Vegas, my aunt, because he has like hundreds of patents on slot machine randomization codes or so. I'm totally probably mangling this, because this was a method. My uncle lived in Vegas. Because he has like hundreds of patents on slot machine randomization codes or something. I'm totally probably mangling this because this was a decade ago. I wouldn't have known that at all. So he has all this intellectual property, whatever. And I'm like, so did I beat it?

Did I win? He's like, it's all random. Oh. And I'm like, no, no, no, no, trust me, trust me. Jacks are better, high limit, $5. Like I had it all figured out. And you really believed it? 100%.

Oh my gosh, wow. This illustrates like I had it all figured out. And you really believed it. 100%. Oh my gosh, wow. This illustrates a fascinating point about all of us. No matter how smart you get, and in fact, a lot of people talk about Dunning-Kruger effect, it almost affects smart people more. It's more dangerous to be really smart in one area, because you can be misled, but you genuinely thought you had a system

for slot machines. I was certain of it. And were you shook when he explained to you how that was impossible? I'm still not okay. Like I've never gone back to the high limit slot. No, now I play craps, six and eights. The best odds is what I choose, but I'm still upset.

Yeah, they say craps is mathematically the best odds. Yeah, pass lines, six and eight, Vegas. That's as good as it's gonna get. Exactly. I mean, Peter's one of the more influential top tennis or so medical people in my career. That's changed the way I think about medicine. And I was pushed into a little box because I was always trying to get ahead of

things. And we have a sick care system, but I'm a preventative care kind of guy. And Peter just saw things the way I saw things. So it was just really reassuring, motivating. He mentored me in a way to say, you know, I was in academics and I had to prove what I was doing, but he really helped. He kind of told me to stick to it. Did you participate in Outlive at all? I feel like I saw a version of that book when it was either called the manifesto or it was very long and very different. I think

I mentioned on some page, I think I gave feedback, but I didn't see Outlive until I got a copy of it. So our history is we interviewed Peter. It was very fun. We walked out. Turns out he's a bonkers gear head like I am. So then we started doing a lot of motorsport stuff together. So now we're just pals. But when I was learning of Sanjay's work vis-a-vis you,

I was like, oh, this is very Outlive. The brain health is a metabolic condition. This all feels very, very in keeping with what Atiya's prevailing theory on all this is. Yeah, and we sometimes disagree. And when I've disagreed with Peter, it's caused me to like go down very long time consuming, complicated and expensive rabbit holes to prove or just prove like this whole genetic thing. Him and Bob Kaplan, Nick Stenson is awesome, the guy who does the podcast now now but I was running in Central Park 2018 and he was talking to Bob

Kaplan about how genetics it doesn't help and 23andMe is bad and I'm just like what do you mean I think you can personalize care and this is more brain health and he said something I got so pissed off and ran my fastest 10k or whatever around the reservoir and then we did like a half a million dollar research study to try to prove whether or not genetics was whatever. And we spent a lot of time and a lot of money. And now we've talking about- Who won?

Well, he's talking about Clotho and APOE and he's talking about all these things. So, you know, we were both right because doing whole genome sequencing, for example, is super expensive, super time consuming. We did it on like a whole bunch of people during COVID, spent a whole year on it, spent a lot of money. And 44% of the time, we found something that was impactful of money, and 44% of the time we found something that was impactful,

but greater than 50% of the time we didn't. So that's the challenge with genetics, but that was fun. I've been fighting tooth and nail about these blood-based biomarkers, trying to develop this cholesterol test for the brain, using blood tests for the brain, which we can talk about, but I'm not sure he's fully convinced yet, but he is talking about them now.

So- Right, we're gonna earmark cholesterol because he has kind of a provocative take on cholesterol that's very appealing to me because I've always just had high cholesterol regardless of what my diet is. Are you a LP little a guy or just an LDL guy or a poopy high guy?

I have low high density and high low density. So the reverse of what you want. Yes, the absolute opposite of what you would hope for. Maybe sort of, HDL is complicated. Yeah, and absolute opposite of what you would hope for. Maybe sort of. HDL is complicated. Yeah, and I've since started taking a lot of red yeast. I have lowered it into a same level. Isn't it more about the ratio or no?

Let's earmark it though, because we need to do a full cholesterol deep dive. But let's start with your story, which you already said. You had this accelerated medical school plan. You had a BA at 19. Does that mean you entered college earlier? In New York, I made the cutoff, so I was young. I graduated high school at 17, did a lot of AP classes,

and I clipped out of stuff and whatever those tests were. Missed a lot of parties. Oh, it was terrible. But I was a substitute teacher for a while, because that's how I made money in med school, and the riverboats, that's gambling. But I had a substitute teacher for a while, because that's how I made money in med school and the river boats, that's gambling. But I had a lot of college credit. I did finish my undergrad requirements

in the first two years. Actually, it was a BLA, Bachelor in Liberal Arts. Oh. Okay. I've never heard that differentiate. I learned how to ask seminal questions in life. Would you like fries with that? Sure, sure, sure. I don't know what I learned in my BLA.

Will you be eating in or taking out? Exactly, then medical school. So I was 17 years old, I remember this vividly. Got my white coat, I'm in rounds in the hospital on Tuesdays and Thursdays for part of the day. I'm in medical school on Tuesday. My docent is what it's called, like a mentor. We go around and around the University of Missouri,

Kansas City, go-roos, fighting kangaroos. And we basically learned when we were young that medicine can be taught early. And then the founder of our medical school went over to China and went over all these different places and learned that a lot of countries out there you start med school out of high school. This was a unique program. I have regularly wondered why the BA is necessary because even if you're on the medical path only 20% of what you're studying is applicable to that. Why are we doing all this other stuff?

We're not what we're going for. I can see both sides of that argument, but I think being well rounded, getting psychology classes, understanding liberal arts, I did take history of rock and roll. And I did take some of those silly, but kind of cool classes. I think it's important. I don't know if the full four year degree, but I'm very supportive of the combined. Well, let me hit you with even more provocative. People hate this opinion.

I think surgeons should skip a ton of the stuff That's a tough opinion because you really need to be medical to be a surgeon critical care when the stuff's hitting the fan You got to know general medicine. Do you need to know mitosis and meiosis and do you need to know organic chemistry? You're a human mechanic. This is a very valid point biochemistry, I don't know what I remember from it or what I learned in Orgo. I remember benzene rings, but how that does anything. And then adding you're a surgeon. I think it's even less applicable.

So I don't know, some of it's a little gratuitous. But alas, why were you in such a hurry? I knew 100% that I wanted to be a doctor. Well, you have an older brother though. You got it. I had a picture of C. Everett Koop on my wall, the old surgeon general. Oh, wow. Oh! Oh wow!

Oh wow! Oh yeah, yeah, I wanted to be Surgeon General, like in fifth grade. So when you say you wanted to be a son, you really did. Oh, I had these like aspirations. Do you not have a Vivek Murthy poster in your office? He's wearing a speedo.

Oh! As he's done. No, no, no. No, I shouldn't have said that, no. So my brother is a neurologist, 13 years older than me. He's the smart one in the family. I'm the better looking one. Clearly this is a podcast, so that works out.

And I had my neuroanatomy made ridiculously easy and understandable book, and I used to bring it on a camp trip because I was like that dorky kid. But I wanted to be a neurologist. I kind of knew it. I thought the brain was cool. And I went to medical school with a plan

and I just wanted to just do it. Okay, so there's any number of fields you could have probably focused on as a neurologist. How do you get driven into Alzheimer's and dementia as a specialty? It was a little circuitous because I was fascinated by the brain, thinking skills, memory, cognition,

I always thought it was interesting. I also kind of enjoyed the fast-paced nature of medicine, so for a little bit I thought I was gonna be like a vascular neurologist with strokes and do like what cardiologists do and put piping in and put balloons and stents and I kind of went down that phase. But vascular neurology, cardiovascular medicine and brain health and cognition were the things I was most drawn to. You know the family history of Alzheimer's disease. I was several family members with the disease. My uncle Bob, amazing guy, was diagnosed when I was in high school.

Back then there were no treatments. In the years going into medical school, there were no treatments. And I wanted to be a neurologist since I was like eight years old. You can't do anything. My Uncle Bob introduced my parents. My Uncle Bob saved me when I was, you know,

drowning in the pool. Yep, yep. Very common uncle. Thing to do. Yeah, a lot of people get rescued by their uncles. Oh my God. Navy guy, still remember. I don't go near the water anymore,

but seriously, I don't go near the water anymore, but seriously, I don't go in the pool. I live in Florida. That's the whole thing. Now really quick, you could have one or two reactions that as you enter a field, nothing's known about it. So you're like, why am I gonna go practice this thing where you have no impact on anyone?

A, if you're kind of defeatist and pessimistic like myself, or you could go, wow, this is a field where I could actually make a real mark on it because no one knows what the fuck they're doing. It was probably the latter because there's the decade of the brain. I don't know when this was. I think it was the 90s or 2000s or something. And it was supposed to be like when the decade was over,

the brain is gonna be understood and then the decade ended and there really wasn't that much traction. Was that driven by FMRI? Was there a technological breakthrough that was supposed to unlock all these secrets? You know, it was a saying that tried to get people interested and tried to get funding, whatever the saying was. Because we could say the least understood organ

at that point. Yep, it's kind of like a venture bet. You know how venture capitalists put a long hedging bets or VC or whatever the term is, but you put money in and then 10, 20 years down the line, you know that something's gonna change. I kind of thought about that. I wanted to be challenged in my career.

I wanted to do something that I'm interested in. Long position. Yeah, long position. That's what I'm trying to say, exactly. And I thought or predicted or was hoping that 10, 15, 20 years after I graduate med school, that's when it would hit. And guess what?

I know, I know. That's incredible. You're actually living and realizing your dream. It's crazy. So give us a brief history of Alzheimer's as a disease When is it first identified? When do we get that label and how are they diagnosing it back then and walk us up to when you enter the scene? Yeah, so over a hundred years ago Alois Alzheimer is the doctor's name and Augusta Deter

Deter was the first person that was given the diagnosis and it's a little funny But she was given this diagnosis of Alzheimer's and she had a very uncommon form of Alzheimer's disease and she had early onset Alzheimer's in her 50s and she was shown to have cognitive changes before she passed and when she passed they looked at the brain and there was amyloid in the brain and there were these pathological features and amyloid is a sticky protein that builds up in the brains of people with Alzheimer's there's also this tau protein and tau tangles and amyloid and tau characterize the disease but I'm doing characterized with It's a sticky protein that builds up in the brains of people with Alzheimer's. There's also this tau protein, a tau tangles,

and amyloid and tau characterize the disease. But I'm doing characterized with my carrots or fingers like in the air, quotes, thank you. So the brain looked like amyloid and tau, and the patient looked like this, so the disease was characterized that way. That's something that didn't make sense to me, and it still doesn't make sense to me,

and this is not a common belief in my field. What aspect of it didn't make sense to me. And it still doesn't make sense to me, and this is not a common belief in my field. What aspect of it didn't make sense? They were saying, hey, look at these two proteins. This brain is riddled with it. It has an abnormal amount that we don't see often. This must be the cause of it. It's probably interrupting neurons from communicating. A gummy plaque, like an engine analogy.

The causative part was the problem for me. Yeah, right, like is this the result of a disease or is this the cause of the disease? Exactly, and to me, the term biomarker is a biological something that can be a hallmark of a disease or a condition. Just because there was amyloid and tau there, like it didn't jive with me,

because I'm a clinician first. 80, 90% of the time a neurologist makes a diagnosis, it should be made based on the clinical history. And I was seeing patients, and also in my own family, like I had a family member, I was sitting next to her at a wedding, and she kept repeating herself. It took years for conventional medicine that were following this amyloid and tau diagnostic criteria, this framework that was set decades before

to be able to make a diagnosis. But I saw something, I could feel something with the eye movements and something was different. Something felt off. And if something feels off, but the amyloid in town may or may not be there, then there's gotta be something else that precedes it. Right. Right.

And that's what changed things for me. And that's why I went this way. This is the great universal conundrum in medicine period. I have my own example of that, which is people with arthritis or psoriatic arthritis like mine often have low vitamin D and the original assumption was low vitamin D leads to inflammation, but then at some point,

someone finally said, no, low vitamin D is the result. Understanding the order of these things is imperative and makes the world a difference. It's very hard to figure out. If you have a contrarian viewpoint, it's hard to go up against. And get funding to research it. Impossible.

And you know, that's something actually that Peter encouraged me to just keep going. You know, my old chairman, Dr. Cliff Sapra at Beth Israel Deaconess Harvard Medical School, he wrote this email to me, he said, you know, Richard, you're a trailblazer, you're doing great things. In 2006, I remember the email, I printed it,

it was on my wall next to C.E.E.R.C. Coop. Sanjay, Sanjay never made the wall one day. But he said, you're a trailblazer. I said, wow, he's saying this about me, little old me, I'm like 20 something years old, but there's not easy funding mechanisms to do this so you're gonna have problems in your career and he was a hundred percent right and I've had to beg and plead and ask and beg again and traditional grant writing doesn't

really work because you write a grant and then you submit it and then it takes six months nine months and then no one gets it in the first and then you get funded two years later and that grant was written based on science that you just zoomed past. And in prevention and reducing risk, the science moves even faster. And it's contrary and it's controversial. So I just kept striking out and striking out and striking out.

Most of our funding 70, 80% are donations and philanthropy. And that's how we did it. Was your original goal to uncover whether the amyloid was a product of or the cause of? Or did you have a more specific, narrower objective? So in 2006, a paper came out looking at omega-3 fatty acids and its relationship to brain health and cognition and Alzheimer's risk.

It was convincing. You take omega-3 fatty acids, which to me made intuitive sense, good for the brain. Here we go, quotes, quotes again, okay. I learned, I learned. It's good for the brain, the outcomes are good. And everyone in my field shunned it. So it's not possible.

Omega-3 is not amyloid, it's tau. But it's the synapse, it's the brain cell, it's oxidative stress, it's mitochondrial. There's other things that omega-3 fatty acids do. They would have wanted it to reduce amyloid and tau to be a convincing gotcha. As some of us would say, that really grinds my gears. It just ate at me.

So I said, okay, I'm gonna start putting people on omega-3 fatty acids and I'm gonna track stuff. Basically conducting your own. In my clinic patients. Because I was interested in vascular brain health, Dr. Arthur Agatzen, also one of my mentors on the Agatzen calcium score, is the South Beach Diet guy. But before that, I met him in 2001

when I was a lowly intern at Mount Sinai Medical Center in Miami, the way he thought about things was just different. And he believed in nutrition, he believed in prevention. I started putting people on omega-3 fatty acids and checking their cholesterol, even though I'm a neurologist, which is kind of okay for stroke doctors, but not really for Alzheimer's specialists.

I saw the cholesterol getting better. And I said, okay, I don't know what that does. And maybe the cog tests were maybe a little better, I don't know, but it wasn't working the same in everybody. Can I ask you a dumb question now? I'm always curious about this with blood tests, which is if you find it present in the blood, does that necessarily mean that the body is using it,

absorbing it, bringing it into protein synthesis, or does it just mean it's floating around because you dumped it in there? Does that make any sense? Like how do we know that it's being used as opposed to just present? So the way to check it with omega-3 fatty acids, Dr. Hussein Yassin did some amazing work

where they did spinal taps to see how much omega-3 is. It's making it into your. Basically, and I may be mangling this conceptually a little bit because basic science, I didn't do too well in orgo. I got to be in organic chemistry in medical school, but that's not important anyway, right? Omega-3 is like a perfect thing.

So people with an ApoE4 variant, ApoE4 is the most common genetic risk factor for Alzheimer's disease. 25% of the population have it. There's four of us in here. Probably one of us have it. Rob. Because he had the grip strength.

I know, I gotta get rid of him. He's my closest competition to grip strength. So APOE4 increases risk, but omega-3 fatty acids preferentially protect against Alzheimer's in people with the ApoE4 variant. Now you have this concept of personalized medicine, precision medicine. We've heard about this in cancer.

We've heard about this in other conditions, and that's kind of what just changed the way I think about Alzheimer's disease. Well, we should point out another paradigm you inherited, which I think has pervaded medicine the whole time, which is we have this really weird compartmentalized view of the brain as something completely separate from the rest of the body. There's this blood brain barrier. So even though omega-3s, I'm sure people are arguing at that time that's not even making it to the brain, you know, there's this kind of arbitrary division. That's its own paradigm you're fighting against. So I'm gonna say something that I don't know if I've said before. I've said in

lectures maybe, but I believe Alzheimer's is a medical condition when people have like high blood pressure or high cholesterol or diabetes. Well, people can have kidney failure. My buddy, Dave, his mom was on dialysis. Terrible. Well, she had diabetes. She had uncontrolled vascular risk factors, and it affected the end organ, the end organ damage. Downstream. Exactly. Of the kidney. And this is very controversial, but I absolutely believe it. I feel it, but I've seen it.

The end organ damage of various medical conditions of the body in certain people, whether they're genetically susceptible or otherwise, is the brain. While elevated cholesterol, blood pressure, blood sugar, don't really think that causes Alzheimer's disease, it can fast forward Alzheimer's pathology in a certain person. So I believe that Alzheimer's is a medical condition most of the time or a lot of the

time and I'm not sure exactly what that is. It depends on the person's genetics, depends on the individual characteristics. You know, men and women are very different. Women that go through the perimenopause transition with the 8.4 variant, the estrogen drops, the amyloid goes up, you need to intervene then and follow very closely. Hormone replacement therapy is controversial, but it's a whole thing.

I believe that you can prevent, reduce risk for, delay onset of whatever word you wanna use that you feel comfortable with. What I'd be wrong to say like a lay version of saying it is the whole system's connected, nothing's compartmentalized, you have an overall metabolic health, and if you have poor metabolic health,

it may materialize in any number of down river symptoms. It could be a kidney issue, it could be a brain issue. Depending on your genetics. And I remember learning about all these concepts. Megan Leary, she taught me, trust but verify. You don't have to always trust the dogma, just don't believe blindly. Dr. Kaplan explained to me, you know, trust but verify. You don't have to always trust the dogma, just don't believe blindly. Dr. Kaplan explained to me,

and he was telling me the story about the bedside, C. Miller Fisher, and he was the stroke guy, and he would tell these stories about intermittent interruption of behavior, and that was a sign of uremia, which is a kidney problem, and I'm like, wait a minute, you can make a diagnosis of a kidney failure based on the way someone's cognition changes

What that's what got me to like link that medical? conditions medical disease is Related to the brain and the brain function something called pseudo dementia of depression someone can be depressed with low serotonin levels And have problems with attention or speed of processing. If someone's not paying attention, they can't remember things. That's not dementia. That's a cognitive problem that is related to low serotonin. If you're not encoding the memory,

then you can't remember it later. That's a pseudo dementia of depression. So all things biological can cause cognitive changes. Cholesterol, problems with executive function, vitamin D, omega-3s, they're metabolic health. When I think of metabolism, I think of memory. People with elevated fasting blood sugar and diabetes, twice the risk of Alzheimer's disease,

but there's a correlation. You hear and you see the high blood sugar and you do the cognitive testing and... It's usually... It's a little lower. Correlated. Yep. Stay tuned for more Armchair Expert, if you dare.

This is a great opportunity right now. Sorry, I'm gonna fold you into an ongoing argument by proxy with Monica's father, who is so smart, Ashok, he's one of the smartest guys in the world. Her maternal grandfather passed of dementia and he also was diabetic. He cut out rice from his diet. Ashok observed that those were pretty correlated

with the acceleration of dementia. You're not representing him properly. And so Ashok is decided, even though he is pre-diabetic, he's gonna start eating rice again because he's made this connection. Small amount, small amount. He's worried. Wait, wait, this's gonna start eating rice again because he's made this connection. Small amount, small amount. He's worried. Wait, wait, this is maternal.

Right, they are not related. Okay. But he felt that his brain decline started once my grandfather fully took rice out of his diet. So my dad has stopped eating carbs basically because he's trying to be healthy. And then he second guessed that decision because of all this and he thought he might

incorporate rice in a little bit more. And look, the thing is, I don't know what erasing carbs fully from a diet, it could affect your brain and energy. Like you said, it's all connected. And different people with different genes respond differently to different diets, which is why nutrition research is all just completely

discombobulated and impossible. But if someone wants to do a test like that, an experiment on themselves, what we preach and what we suggest is what we call an N of one trial. An N of one trial is a person uses themselves as their own control. You make one change, you then repeat the blood test before and after. You check your body fat, you check your muscle mass. You do some change, you then repeat the blood test before and after.

You check your body fat, you check your muscle mass. You do some cognitive tests, I'd imagine. In our program, yes, but even people out there that don't have access to a preventive neurologist because there's a handful of us, even less, single digits, the key here is if he's gonna make that change, try to have some objective data.

There's so many variables here. Well, I'll say it, because I'm not a doctor and I won't get sued, but granddad had a diet that led to diabetes. The diabetes had a terrible impact on his brain health. He cut out the carbs, but it was far past that point. And Nishoke observed this decline because he was observing diabetes at a stage

where it required the deduction of all the rice. To be fair, we don't know his age 100% unfortunately, but probably around 94 when he died. This isn't a situation of like a young death or something like that. So he was diagnosed with diabetes fairly young. I mean, he was probably in his 40s or 50s, lived with that for a long time before there was a pretty steep decline in cognition. So that's what my dad's doing. He's not like, oh. Dr. Isaacson's not gonna give us a full verdict.

That's okay, I'll ensnare other people into this. Well you did this, not me. No, no, I know. Well, you bring in the age thing because you gotta have sustenance, you don't wanna lose weight and you need to have enough nutrients. So was part of the decline

related to nutrition density and malnourishment? This is leaning towards Ashok now. There is some plausibility here, but. Tell Ashok to call me later. He would love to. Good job, honey, that kinda went your way. I'd want my dad to be right. Yeah, of course.

Don't we all? Okay, so at what age do you dedicate your work and focus to prevention? You adopt this view that this is treating it downriver. Generally, the outcomes aren't great. My grandma, when she got it, there was nothing. And it was very much posed to us as a genetic thing. She just had this.

There's nothing environmental she did. This is what her genes wanted for her. Alzheimer's disease and other neurodegenerative disorders such as Parkinson's disease, Lewy body dementia, start in the brain and body, because Parkinson's actually can start peripherally, decades before the first symptom begins. I knew this, I saw this, I felt this, right?

That's the subjective, the clinical, like you felt something was wrong, but then you couldn't detect it until later. And then about 2009, I said, if I'm gonna see someone with Alzheimer's, a person with Alzheimer's, my patient, and their family member wants to try to do something to reduce their risk, then maybe I should see families.

That was the first concept. That makes a ton of sense. When you see a family, and I learned this very quickly, I'm I should see families. That was the first concept. That makes a ton of sense. When you see a family, and I learned this very quickly, I'm a pattern recognition guy. This is not rocket science. I don't understand the biology as well. I don't get the ortho, you know, the benzene ring. This is pattern recognition.

It's not like I'm trying to figure out some scientific milieu of some advanced theory of biochemistry. You find out all nine family members swam in this creek, no one's swam in, and they all have glowing fingers. You're like, okay. Exactly.

And I was treating a patient of mine, amazing guy, retired physician, wrote a major textbook and he had two children and one looked more like the dad and the other one didn't. And it was my job to deduce what that was, that feeling, your gut impression. What does that mean? Can you find a biological marker?

Can you find a cognitive testing marker? Can you find a body composition marker? Can you find something? And that's what set it off. And I talked to the son, who's also a physician in the hallway. That was my first Alzheimer's prevention consult ever for 40 minutes in a hallway. Talked to the daughter later in the same week in medicine. Things happen in threes. Dr. Agatzen referred me to my first Alzheimer's prevention patient. Dr. Agatzen published on this calcium score in like 1989.

When did it make the diagnostic guidelines for cardiology? What year do you think? 2015. 2018. Well, I was gonna say, I got pitched having one in 2020. Okay. And it's the first time I ever heard of it. So I have to assume it was relatively new in 2020

for me to go get that test. Over 30 years. Nuts. It's okay that you got it and that's a good thing. I've never heard of it, so I have to assume it was relatively new in 2020 for me to go get that test. Over 30 years. Nuts. It's okay that you got it, and that's a good thing, and I believe in it, but maybe not for you, because we're playing the long game with you, and 10-year risk can be deduced by the calcium score.

In a younger person in their 40s, maybe the calcium score isn't the perfect measure. It's a good, quick measure, it's quick, it's 100 bucks, whatever it is, tiny little bit of radiation. Oh no, I'm talking about the one where I went in and they put fluid in, they looked at my heart and they told me how much calcium I had in every single artery.

A CT angiogram? I wouldn't remember the name of it, but they give you a percentage of calcium build up in every single artery in your heart. That's what you leave with. And to my enormous shock and amazement, I was zero. I was preparing for much worse. Yeah, okay, I think that was a calcium score.

There is more advanced testing now, using instead of just a quick cat scan, a little, it's called a CTA, a CT angiogram, where they can use artificial intelligence to understand where in the blood vessels there are soft plaques, not just hard plaques. Hard plaque is calcium. That's one degree of risk. To me, soft plaques is what I want to know for you.

If your calcium score is zero, okay, that means your risk in 10 years is low, but you're in your 40s, so why is your risk going to be high? To me, getting soft plaques is something that want to know for you. If your calcium score is zero, okay, that means your risk in 10 years is low, but you're in your 40s, so why is your risk going to be high? To me, getting soft plaques is something that I'm very interested in. There's different-

Is that like the predecessor to a hard plaque? Exactly. It would turn into, okay. Yeah, and there's things that I believe you can do proactively before there's a problem to maybe even have regression in the plaques, and that's what we're trying to do now. And what we do is we use what we find in the heart

to try to correlate what does that mean for the brain, and how does that mean with cognitive function? We do know that having a high calcium score increases your risk of vascular dementia two decades later. So soft plaques has to be the same thing, but we don't fully understand it. And is it executive function? Is it memory?

Is it speed of processing? Is it attention? Everything that our cardiology friends have been doing and preventive cardiologists have done, now we have to do this for the brain and we have to understand. People say like, what's good for the heart is good for the brain. That is like so oversimplified.

It's a good saying to kind of get you motivated and get you, you know, okay, I got to pay attention. There's a lot of nuance there. That's what we're trying to sort out. Okay, so Sanjay did all these tests and you wrote a great piece on it. I recommend everyone read it. It's on c of nuance there. That's what we're trying to sort out. Okay, so Sanjay did all these tests and he wrote a great piece on it. I recommend everyone read it, it's on cnn.com. We went through, okay, when was it labeled disease?

We got that. Oh, here's a quick question about Alzheimer's. Since its discovery and an accepted diagnostic approach, are we seeing an increase or decrease? Oh, this is a good question. And this is one of those incidents prevalence questions. Explain the difference between them. I wasn't good at that class either.

That's like a statistics question. Let me figure this out. So one is the prevalence is, I don't know how many people have it, but the incidence means how many people have it per group of people or proportion. I may have mixed that up, but different studies will say different things.

I believe the total number of cases out there are going up because we have an aging population. We have a lot of things that are charting up over the last 30 years. We also have obesity charting up. There's a lot of factors you could correlate probably. The rates are actually coming down for Alzheimer's. Well, they are. But the number is high. But the total number is higher because we have an aging population.

I got you. It depends on what statistics you look at, what study you look at, what the risk factors were. But because we're getting better control over vascular risk factors like diabetes, high blood pressure and high cholesterol, if we can slam the brakes on those, we're gonna delay cognitive decline in Alzheimer's. Okay, that makes sense.

I wonder how Ozempic is gonna like. This is what we look at. We have multiple people in our study where we do the blood biomarkers. And Sanjay outed me by the way. Yeah, yeah, I think on this show. Yeah, he did. Thanks, my bud.

Well, he was the patient, so he was allowed to say whatever you said to him. Hippo, hello. For science, I took three doses of terzepatide, manjar, and I got a blood test before, and then I got a blood test afterward. You did an N of one. You did too, you're hired.

So we did an N of one. I don't have You're a student. You're hired. Thank you. So we did an N of one. I don't have the results back yet, but we'll get those back very soon. And then I'll just come clean. I then did another experiment. By the way, when I went on this terzepatide, the GLP-1, and I have nothing to disclose, I don't have any relationships with pharmaceutical companies or supplement companies or anything like that.

I tried to keep it clean. I wish I did have relationships. I would have paid off my student loans earlier. It took me 22 years to pay off my student loans. But when I did this, my LDL dropped from 109, which was like borderline. My APO-B was 72, which I'm like, when do I need something?

My LDL dropped from 109 to 60. What? On the? For three doses of TERS-Epidotide. Wow. My body fat went down from 20.5 to 17. How long is three doses? I spaced it out.

I was experimenting on myself. I did dose one, then I did eight days for the second dose, and I felt like a little sick, and I waited 13 days for the third one. 2.5 milligrams is the lowest you could get with the injections, and it just floored me. I didn't leave my couch for three, four days. No kidding.

I was so sick, because I didn't need it. I was doing an experiment. I guess what I was asking is, how long was the window you were on at? A month. So in a month you dropped 3%. You know, interestingly, I lost a little muscle mass, but I gained it back. I have more muscle mass now than I did six months ago,

because I did a second end of one. I felt that 2.5 milligrams of trisepatide was too much for me, so I did the unthinkable, thanks to my niece. She was the guinea pig first, but we got compounded tersepidide, which I shouldn't be talking about, but whatever, it's all good.

And I injected one milligram and then 1.1 and 1.2. And then after three doses, I got terrible heartburn and I'm like, I'm done. And then I got another blood draw. So I used myself as an N of one study with the real tersepidide and then the compounded tersepidide. And we're gonna look at amyloid and tau before and after.

So terzepotide is the active ingredient in all these different brands? It's a Manjaro and Zepound are terzepotide ozempic and Wigovie are semaglutide. Okay. So semaglutide is a GLP-1 it's been out for, by the way, these GLP-1 drugs have been out for decades. Yes, when I argue with people about these,

I go, this isn't brand new. Yeah, 20 years oral. The semaglutide injections have been out for decades. Yes, when I argue with people about these, I go, this isn't brand new. Yeah, 20 years oral, the semaglutide injections have been out for like five, six years, and the terzepotide injections, just like a year or two. And the ones you're running on the block market just a few weeks old. Exactly, yeah. I don't know that I'm gonna do that again.

That was very bad. So has your cholesterol stayed down? It went back up to 90. Okay, but still much better than 109. You know what? And my ApoB was 68. I didn't check my ApoB the second time, but my ApoB is lower and my LDL is lower.

With GLP-1s, there's vast amounts of data that suggest that people that take GLP-1s, so semaglutide, terzepatide, all the brand names, absolutely have lower risk of dementia and Alzheimer's. There's actually a study being funded by the semaglutide company. it's called EVOKE, I believe, and it should report out in a year or so, where semaglutide, the oral, is being used

in a preventative trial to see if it can delay mild cognitive impairment, the first symptomatic stage of Alzheimer's, from progressing to the dementia phase. So there are randomized double-blind placebo-controlled trials ongoing now using GLP ones to try to Reduce the risk and try to look at the effects. We have patients our study is a biorepository study So you donate your plasma get your blood drawn and when people are in our study, they are treated by their own doctors So dr. Agatzen actually treats one of the patients that was in the CNN documentary Simon amazing amazing guy and dr

Agatzen prescribed terzepatide. And Simon took terzepatide, he went an hour and a half of strength training three times a week, so as not to reduce muscle mass. Because the critics of it will point out that it's very common to lose muscle mass. There's a lot of micromanaging and nuance here, but I don't exactly agree with that

if the person sticks to the plan. Like I won't allow one of my patients to continue on terzepatide if they are not doing strength training, not happening and no refills, like forget it. I want the embodied, I want to take him pictures. I want to see what your body fat is, what your muscle mass is. Yeah.

So what we do in our research study is we look at the change over time in blood based biomarkers, amyloid, tau, all these other markers. And we're trying to figure out when people are seeing their doctors to reduce their risk of Alzheimer's disease based on modifiable risk factors, does that have a downstream positive or negative or neutral effect on the brain markers? We've only presented 15 patients.

You know, at the American Academy of Neurology meeting and we're presenting some new data at the Alzheimer's Association International Conference, we have little bits of data, but the data looks amazing. The GLP ones are working. Anti-amyloid drugs just had a new FDA approval for a new anti-amyloid drug. We have Licanumab and Dananumab.

People go on the anti-amyloid drugs and the amyloid and tau improve. People go on GLP-1s, amyloid and tau improve. Okay, but really quick, so back to your original question decades ago of whether the amyloid and tau was a result or the cause, when people are seeing a reduction in the amyloid and tau, what are you deducing from that?

Great question, it's a biomarker of disease. That's what I believe amyloid and tau are. I don't know what causes Alzheimer's disease. If anyone can tell me that they are definitively certain that they know what causes Alzheimer's disease, I'll respectfully disagree, because there's a lot of smart people. So I guess, yeah, it doesn't answer the question

because even if you're seeing a reduction in the amyloid and then an improvement in the cognitive function, you can't really then conclude, oh, it was the amyloid that caused it. You could say, well, whatever this treatment is, it's reducing the production of the amyloid and tau. So anti-amyloid drugs reduce amyloid and reduce tau. Okay, that's easy.

Right, but if you were only reducing the symptoms non amyloid targeting drugs are still lower this guy Kevin He just exercised he changed his diet and he reduced alcohol by 30% No anti amyloid drugs no GLP ones nothing and his amyloid in town normalized Someone just told me last night was having dinner with a woman whose father has got Alzheimer's and she was saying that yeah, alcohol is really powerful in this. Specifically in people with the APOE4 variant,

especially two copies of the APOE4 variant. 1% of the population has two copies of APOE4. Smoking, alcohol, poor diet, poor exercise, much worse effect on people with one or more copies of E4. We are going to find out if we have these. So today, all we did was just the finger prick test. That would require a fasting blood draw. Yeah, I gotta find out if I have that.

I do too, I'm nervous. You more than me, I don't smoke or drink. Yeah, I do drink. Okay. So it'd be helpful to know. Genes are not your destiny. You can win the tug of war against your genes. And I really believe if someone has the 8.4 variant,

great, I know what to do about it. One copy, no big deal. I believe you can neutralize the negative impact of that gene, probably 80, 90% of it, by living the right lifestyle and modifying risk factors. Let's talk about if you have that gene, what factor are you going up in your odds of getting it? Because a lot of these things,

like when we did a 23andMe thing and you get these results back and you actually start looking at the uptick that the gene predicts, it's like 30% more likely. Well, 30% more likely is not that big. Have you guys both done 23andMe? Yeah. Yeah, a while ago.

So you have a Pooey4. Oh, we know. Oh, it's there. If you log into 23andMe, you scroll down, you have to take some health quizzes and just verify that you understand the limitations. You'll see a very dapper looking neurologist pop up. He very good looking dapper, dapper guy.

Pretty low hand strength though. Very low hand strength. Oh, you got me. That was in better shape than. There will be a video in education materials that is personalized based on your genotype. Oh really? It's already there?

It's there. Oh my God, I wanna go look. Maybe to, yeah. That wasn't one that they were flagging. Yeah. Yeah, we did that like six years ago. Those videos are recorded in like 2017, 2018. Oh wow, so we already know.

Again, if you have the APOE marker, what percentage are you more likely to get Alzheimer's? I'm glad we're talking about this because the answer to this question is impossible to figure out. And every media story out there will say, two copies of APOE4 equals an eight to 10 to 12 fold risk or you have a 90% chance of getting Alzheimer's

if you have two fours. That is such bullshit. Different people with different genes respond differently. I have so many APOE4 patients, and this is clinical observation. Taller, lighter eyes, lighter skin, thin. The impact of 4-4, I don't see it. Clotho, for example, can neutralize it.

The gene right upstream and right downstream, APOE C1, which is a cholesterol gene, Tom 40, which is a mitochondrial metabolism gene. It's the total picture, it's called polygenic risk. If there's one four, was it from mom or dad? Because maternal history is worse than paternal. Men with four four, eh, not that big of a deal. Women with an E4, higher risk.

Why? Perimenopause transition. So what is the APOE4 risk in a woman who goes on hormone replacement therapy during the perimenopause transition? Well, it's not the same as a woman that has the gene that doesn't go on HRT and has a rapid withdrawal of estrogen and the enamel it starts.

Oh my God, I need to find out right now. You gotta start shooting up some. Perimenopause is on its way. Well, hold on. You're. I mean, you know, it can happen in your 30s. It's not gonna happen in your 30s. Late 30s.

The roof could also cave in on us. That could happen. Liz thought she had it. Yeah, Kristen's, I think, been convincing her. Yeah. I think y'all are gonna have a rude awakening, when it really in. That could happen. Liz thought she had it. Yeah, Kristin's I think been convincing herself. I think y'all are gonna have a rude awakening when it really. Well, whatever. Still good to know as early as possible. I agree and there's something you can do about it.

Fearing genes means that there's a misconception or misunderstanding of what the genetic information is telling you. Knowing your numbers, knowing your genes, there are things that you can do about it. You can grab the bull by the horns, and same with cancer. This is the future of medicine. Yeah, your genes are interacting with the environment.

Robert Sapolsky's book had just a great section about, we had this Lamarckian fear of how evolution worked, and lo and behold, it kind of works in both directions. We have a full chemistry set that can be turned on and off as needed more than we previously thought. They're a full chemistry set that can be turned on and off as needed more than we previously thought. They're a little more variable than we thought. Agreed.

Sanjay brought this up, but we have a sick care system, not a preventative healthcare system. Our entire healthcare system is built the wrong way. We're treating disease, whether it's cardiovascular disease or Alzheimer's decades after. It's too late in so many cases. And to get ahead of things, to have these conversations, Alzheimer's shouldn't be talked about in your 60s, 70s, and 80s.

It should be talked about in your 30s, 40s, and 50s. When I was in academic medicine, aside from struggling getting grants and trying to see patients and not getting reimbursements, you know, you see a patient, there's no code that is a reimbursable code for an insurance company to reduce risk for Alzheimer's. Yeah, it's like they need to go back toursable code for an insurance company to reduce risk for Alzheimer's.

Yeah, it's like they need to go back to the drawing board and they gotta go, all right, what's our total output for these insured people? It's two trillion a year. What if we divert 35% of that and we take this other approach? It's like looking at it like vaccines. But they need to be proved

that they're gonna win financially, but they're gonna win financially. It's just, I think, shifting that, what a heavy, slow-moving ship it is. Rebuilding medicine from the ground up with a preventative mindset, I think, is really the only way to do it. I do a lot of research now at the Institute

for Neurodegenerative Diseases in Florida. It's amazing, we get to do fun things and fancy things, and outside of academia, when you get a donation or you get something, you get to use it right away. In academia, there's all this red tape. I practice now in a place called Atria and Atria is both in New York and in Palm Beach and this is a different way to practice medicine. You don't have to worry about insurance because it's set up in a different way. It's trying to engage the science, the cutting-edge science with the medical practice immediately and it's preventative health care

first. You have the sick care, you have the preventative health care and it's just a different way to practice medicine and that's just not prime time right now and I can't wait until it is. You can feel, I'd imagine, that you're approaching a tipping point. I think like the enormous popularity of Attiya's book, I think people actually feel empowered

by this mindset and approach, which is you're not just waiting for the knock on the door to tell you you have this disease, you're going, you know, you're gonna be largely in control of who knocks on the door. That's comforting. It's daunting. Lifestyle changes scare people.

It's hard to create habits. But for me, that's just very empowering. It's the future. How do we get there sooner? You know, it takes 17 years on average for something proven in medical science today to get translated into medical practice. Commercial insurers now, if they're gonna do something

to prevent a disease in you 20 years from now, you know what they're doing? They're saving money for their competitors because people don't stay in the same insurance companies. They just flip around. I've had three different insurance companies in the last like four or five years. And that's a problem.

Medicare and Medicaid, okay, it's 65. They pay for a bunch of stuff. Yeah, because they're kind of the only system set up that could enact some kind of system, but you're joining it way too late. This is just an opinion question. I want to preface it by saying this. Do you think Alzheimer's existed in the Paleolithic era? Well, did people live long enough?

What was the average lifespan? But that's very misleading. People love to say that people only lived to 40. That's bullshit. People lived to 80 and 90. Infants died at a rate of 35%, which drives down the overall mean age. Oh, I didn't know that, okay.

Even look at our scientists. Galileo lived to 89. If you made it to 20, you could make it pretty far. They had to have manifested symptoms of cognitive decline. How to diagnose Alzheimer's back then, I'm not sure. We just have a lot of modern diseases. A lot of people would agree on that. Our diet was very specific.

You didn't have probably type two diabetes. That's an evolution result of our diet. The level of coronary disease we have certainly wasn't existing in a hunting and gathering population. It's hard for me to guess and there's just so many differences. I don't know. I could speculate either way. Yeah. Let's just say this. Do you think that the treatment that would be widely recommended would involve physical activity, community, a diet that's

probably fruits, nuts, vegetables and protein? Those are the tenants. People come to me in New York, people were on the wait list for four and a half years. We have thousands of people that have reached out based on the CNN documentary. We have had hundreds and hundreds of people on a waiting list for years. And it's like, I don't even know how to do this. This is why we're trying to scale care

using low cost finger prick tests. Hopefully bring costs down. We could do a test through the mail and screen positive. You're working on an app too that can administer the cognitive portion of the test. The cognitive assessments retain your brain. It's an NIH funded study that people can go on. We had a 1500 person study fill in 48 hours.

Wow. Wow. Then we had another NIH study filled a thousand people. There's so much demand. We have to figure out a way to scale this and we're just scratching the surface. One day we'll fix these things. Because the things I'm reading about, so a lot of the, let's just put it this way. You couldn't have lived almost any other way 6,000 years ago.

It wasn't an option. All the things you're prescribing, you had to live that way. You had to eat that way. You had to do physical exercise all day long because you had to forage and you had to do these things. The medicines that are there now, and even thinking about vitamins and supplements, those are a drop in the bucket, or something in an ocean,

or something in a swimming pool, whatever that's saying is, if you don't have the basic tenons down of regular physical activity between strength trading and cardiovascular, do you neglect sleep? Fast forward amyloid, that's when the trash gets taken out, and you need to sleep, you need to prioritize sleep, you need to prioritize mental health and stress mitigation.

Well, as you said, depression can lead to decline in pseudo. Not only can it cause a pseudo dementia, but it's actually a risk factor for dementia due to Alzheimer's disease also. So the core tenants of brain health are the things that we have control over. The micromanaging, all the fancy GLP-1s and the inject this and that,

it's just not gonna do anything for you if you don't have the other things right. That's, I think, a concept that people don't fully understand. Yeah, that's like moving in from 80% prevention, pushing yourself up to 100% prevention will involve all those other things. But I guess I think that's what's wonderful

and empowering about a TS book, which is the bulk of the important stuff is very doable. I don't need to have access to you. I agree. What we try to do is get free educational resources online because people do have a lot of nuanced questions related to APOE. What is the difference between a brain healthy diet

and a heart healthy diet and a brain healthy exercise and heart healthy exercise? There is nuance there. And we try to just push that out there. Not on social media, but we put videos. We have a free Mastering Brain Health course on ind.org. It's totally free. Two hours of me just blab in front of a camera and-

IND.org? IND.org, yeah, it's our foundation. Can we talk about a couple of the fun ones? I wouldn't mind giving people a few pointers while we're here. Please. This is from Sanjay's article. He said, loading the spine with additional weight

helps activate core muscles such as abdominal and obliques, as well as stimulating the growth of new bone cells. This could lead to a critical redistribution of the fat, muscle, and bone in the body and help drive down any insulin resistance that I may be genetically predisposed to and eventually lower my risk of developing amyloid in the brain.

So yeah, just how you work out. Well said. I don't recall telling him that, so he learned that on his own. So that's pretty amazing. But osteoporosis and osteopenia. When a bone is not very dense, it's one of the leading causes of death.

You think of women that have osteoporosis and they fall and break a hip. Well, men get it too. So it's men and women. Calcium intake, vitamin D, okay, there's lots of things. But just staying physically active and weight training, doing strength training is absolutely critical for building and maintaining muscle mass as we age. You know interesting with Sanjay, when I was talking to Sanjay about what he does and his exercise and like he's so fit, he does

everything right, he's so on it. But conceptually when we did the scale and the this and everything, what happened was is he's been doing the same activities over the last two decades. and as you get older you need to personalize or modify some things because your body is different 20 years later. You're the same person on the inside in some ways but you're different. Your bones are different, your muscles are different, your nutrition is different, your sleep is different, aging causes specific changes. So doing things passive. So if you're gonna go for a walk anyway try a weighted vest or a rucksack.

Just add a little bit of load. If you're going to exercise and you wanna lose body fat, well, work smarter, not harder. Zone two exercise, keeping a pulse rate of 60, 65% of your max heart rate. That's the body fat burning mode. As a Peloton enthusiast during the pandemic, you can go all out and do your HIIT,

but it's not as efficient to burn body fat. You keep your pulse lower. Good for your max VO, not great for your body fat burning. So you wanna do all the stuff. You wanna have a comprehensive. And you personalize it based on your numbers. So if you have 8.04, if you have low body fat,

high body fat, high muscle mass, low muscle mass, you can personalize an exercise routine that targets these individual numbers. And then you track the numbers. That's the core of precision medicine, precision exercise. Who you will, who's gonna help us? Yeah. Who's gonna tell us exactly what to do

based on these numbers? I don't know how to do that myself. And if I don't, no one does. Clear, of course. Obviously. Where's the show? Where's the show from? I wish medicine could move at a faster pace,

and it's not doctors' fault. Doctors try the best they can. How do you get 15 minutes per patient? How is that even fair? And reimbursement from, like our healthcare system is broken, but preventative healthcare in the United States, that's the disaster and the remedy that we need to fix these problems long-term.

How do you learn this? Well, there's a preventative medicine subspecialty of medicine. You can be board certified in preventive medicine and lifestyle medicine, that's an actual subspecialty. You can go see a preventive cardiologist, that's different from a treatment cardiologist, although oftentimes they do both.

I'm a preventive neurologist. There are places out there that do this. I'm a preventative health doctor, I'm a preventative medicine, not certified in preventive medicine, but I work with a preventive medicine specialist. I work with a family practice nurse practitioner. I work with a preventive medicine, not certified in preventive medicine, but I work with a preventive medicine specialist. I work with a family practice nurse practitioner. I work with a team of physicians and a team of allied health care professionals, PAs, NPs, physical therapists.

We have a whole comprehensive team. If you don't have access to that kind of care, A, try to seek it out. Just try to find someone that's preventive minded. If you can't, talk to your doctor and see what they can do for you. And if 15 minutes isn't enough, you gotta be a citizen scientist. And this is terrible until our healthcare system is fixed. But we're trying, we're putting educational resources. It's all free. We're trying, but I wish I had better answers. I wanna introduce a concept that I think about often,

and maybe you'll agree with it, maybe you'll disagree with it. But I think for me, kind of a light bulb moment was your body is the ultimate responsive machine. So this stuff that's kind of counterintuitive, but as you say, bone density health, you lift heavy, your body has to respond. It has to make the bones thicker. It makes the bones thicker, you have more blood production. It has to make the bones thicker. It makes the bones thicker, you have more blood production.

It has to make the tendon attachment stronger. It has to make the tendons more flexible. As you load it, it responds. And just as a mindset knowing that the body will respond to what you throw at it. So if you want it to be a certain way, there's a paradigm there that I don't think people generally think about their body.

They think their body. They think their body like, oh, I should eat good and put good stuff in my body and that will magically make everything good downriver. No, it's kind of the opposite. You stress the fuck out of it and it reinforces itself. I think when it comes to the concept of food as fuel, I eat to live, not live to eat.

Maybe I'm lucky, like I don't enjoy food. I like chocolate milkshakes. And actually since using these GLP ones, I almost can't even eat a cheeseburger anymore and my chocolate intake has come down. I feel like it's reset my brain. It's been really interesting. But I believe food is fuel.

I eat different levels of protein and different amounts of protein at different time based on did I do strength training that day. That's how Dax lives too. Yeah, and conceptually was I taught that in health class, like three meals a day. By the way, do we really need three meals a day? That's a whole different concept.

Is that pyramid correct? Oh, definitely, I mean, my God. Oh my God, the food pyramid is like so broken. And our whole system of education in America between food and exercise, your body, kinda like you said, it's like a sports car. It's even better than a sports car. Your body is a sports car, you drove at 180,

and the next day it went 185. And then you drove it at 185 and it retrofitted itself to go 190. It's actually even better. The body's incredible. Treat it that way. Yeah, yeah, yeah. Give it the fuel that it needs.

It's a machine and you need to nourish it and you need to make it change its tires and you need to stretch and you need to build muscle and maintain muscle. So conceptually, I think we're looking at medicine the wrong way and it affects the brain in a negative way. Stay tuned for more Armchair Expert, if you dare. ["The Armchair Expert's Theme"]

Last thing I want you to talk about, because it's so stupid that I want to talk about it, which is toe spacers. This is preposterous. This is the one that hit me. I was like, well, I'm certainly not doing that. So yeah, I mean, I guess it makes sense with the way I just described the body,

which is it responds and it keeps things healthy that are being used. So yeah, talk about your toes. When you use different parts of your body that haven't been used, you learn how to use them and you can refine. I am far from the expert here. Beth Lewis has taught me a ton

and I've listened to her podcasts and watched her videos, but use it or lose it. And movement and motor rehabilitation. When you pay attention to your toes, you activate pathways and signals and preventing movement disorders. We talked a lot about Alzheimer's disease and vascular, Parkinson's disease, Lewy body dementia.

What about movement rehab and maintaining or focusing on movement as a way to prevent a movement disorder? These are biological diseases, but they're also motor conditions and motor diseases. So I think conceptually, toe spacers learning something new, a new language, a new skill, these are things that it sounds out of the box,

but it makes a lot of sense. Yeah, it's the longest nerve in the body, obviously, from your brain to your toes, and if that then fatigues and atrophies, then things now further up, reverse, start. Yeah, the whole thing, it's like a gray scale on Game of Thrones. It starts moving through your body.

All right, I have one self-serving question then I'll let you go. I tell myself that this is a really great job for myself because I have to six times a week learn a lot about somebody, learn a lot about their discipline, hold it for several hours while I talk to the person. Is this good?

And I also look at some of my heroes, right? Like Letterman just so fucking sharp. Stern is so sharp. And again, how you say, you know, you just recognize patterns, you can't help but ignore it. And I go, yeah, there's something to having to engage in a very intense way, what part of your brain has to be activated to do that. Socialization and communication and learning new things,

staying intellectually active is critical for maintenance. It's called the Katzmann theory of cognitive reserve. So building a backup system, building backup pathways, if something goes wrong, you're gonna have a backup there. So basically, reinforcements are coming through all the different neurons and brain pathways. I think the other thing here is having a sense of purpose. What you guys do is you spread the message far and wide

on topics that are really important. I appreciate this. Thank you for allowing me to talk about our research, our work, trying to democratize access to care. You're doing a service and you have a sense of purpose. You come to work X days a week, X podcasts a day, whatever it is, and you're giving back. And the countries that have the earliest retirement years,

like the younger the people retire, have the earliest onset of cognitive decline and dementia. Yeah, that makes sense. There's like robust data about that? Oh yeah, directly correlates. Well, that's not promising for a future in which AI has replaced everyone's jobs. People have fucking Alzheimer's at 30.

We're gonna need to define purpose or figure out our purpose in a different way. Outside of making that sweet, sweet green. Whatever it takes. Well, Dr. Isaacson, this has been a blast. I can't wait for our results will be very public. And we definitely want the follow-up stuff. We want full, we wanna go all the way.

Especially, and I've heard some stuff about cholesterol. We earmarked that. Should we do? A little bit. Yeah, especially, and I've heard some stuff about cholesterol. We earmarked that. Should we do? A little bit, yeah. Yeah, let's do a few seconds on cholesterol. Yeah, you know, the test that we do is a regular cardiovascular disease risk panel. That's what the company does.

We use it for brain health. We have the cholesterol test for the brain. That's the research. That's the stuff we're doing here. And then we have the usual blood tests. So different cholesterol particles, different risk factors. Is someone an over-absorber orber or over producer of cholesterol? There is a

precision way, a personalized way that I believe that people need to be treated for cholesterol in a brain-friendly manner. This is a controversial complicated whole thing but I'm pro statins. I think statins do amazing things and meta analysis and they're protective and they reduce all these bad things from happening. But in the wrong person at the wrong dose versus the right person at the right dose, we can personalize and individualize cholesterol management in a more brain healthy targeted way. And this is what we do. So one of the benefits of the testing, it's in a research study that you're getting access to it.

It's all free and people can participate in all that kind of stuff. But the challenge here is how do we interpret the cardiovascular test for the brain? So in the panels that we'll get, we're going to understand why you have high cholesterol stuff, but the challenge here is how do we interpret the cardiovascular test for the brain? So in the panels that we'll get, we're going to understand why you have high cholesterol and then you treat it accordingly. And that's the future of medicine. We're going to look at your blood sugar. For example, hemoglobin A1c, you've heard about this.

It's like the diabetes test. It's like a really bad test in a lot of people. Depends on how long your red blood cells live, you're going to get a false up or down, whatever. What's your fasting blood sugar and what's your fasting insulin levels? Those are really important. Do you have inflammatory markers? So if you have high cholesterol but your inflammatory markers are flat,

like your blood vessel inflammation marker is flat, well, that probably means that you don't have problems in your vessels yet. But if your blood vessel inflammation comes up and your cholesterol is high, then we better do something. So it's like if this, then, and if that, and if this, and we have all these paradigms, and then we personalize it for brain health,

we're gonna check your omega-3 fatty acid levels. We're gonna look at testosterone and hormones, estrogen, for example, which is complicated for men, easier in women to understand. Thankfully, we finally understand this now after years. And we're gonna look at other things like B12 level and homocysteine, and if you wanna slam the brakes on brain shrinkage and possibly even improve memory a little bit, you can use a certain type of B complex vitamins to lower homocysteine and if you want to slam the brakes on brain shrinkage and possibly even improve memory a little bit you can use a certain type of

B complex vitamins to lower homocysteine but if you have one gene versus another then we need to use a different type of B vitamin so basically there's dozens of blood tests that we'll do to try to give you a personalized plan and I understand that this is in a research study and I understand this is like still early days but this is not rocket science the goal of our work is to try to figure out what is the minimal amount of tests in the cheapest, most accessible way? Can we do this all through finger prick?

Then people don't have to go get a blood draw. Comes in the mail, you send it away in the mail, you get marching orders. Yep, you stick it into a computer and it pops out. We are mission driven and we want to democratize access. Let's just get people the care they deserve. Create online resources, videos are like easy to make, a little graphic design, a little whatever, email in your thing,

you get the result back and you get a personalized plan. The other thing that I always want to say is we also have to promise not to over promise. This is like super exciting stuff. I love it. And the results that our team has seen, you know, you can watch the CNN documentary like Simon's brain got bigger. I have multiple people whose brains are getting bigger and their amyloid and tau has improved. What is happening here? All this stuff I was talking about is real, but there's a lot of people that could do everything right

and still get Alzheimer's disease. And those are different people with different genes and different risk factors. You have figured out some subset of the pool. Yes. And there'll be many others that need a more bespoke approach. That's exactly it.

And all we need is a little more funding and a little more time. Okay, this was great. I'm so glad Sanjay turned us on to you. Good luck with all of this. I hope to God you get massive funding and we figure out how to fix all this stuff upriver. Personalize care. Let's do it.

All right, be well. Appreciate it. Next up is the fact check. I don't even care about facts. I just wanna get in their pants. I was freezing last night. Oh, in the can? Oh yeah, like Jethro had it at 67.

Not his money. Ha ha ha ha ha ha ha ha ha ha ha ha ha ha ha ha ha ha ha ha ha ha ha ha ha ha ha ha ha ha ha ha ha ha ha ha ha ha ha ha ha ha ha ha ha ha ha ha ha ha ha ha ha ha ha ha ha ha ha ha ha ha ha ha ha ha ha ha ha ha ha ha ha ha ha ha ha ha ha ha ha ha ha ha ha ha ha ha ha ha ha ha ha ha ha ha ha ha ha ha ha ha ha ha ha ha ha ha ha ha ha ha ha ha ha ha ha ha ha ha ha ha ha ha ha ha ha ha ha ha ha ha ha ha ha ha ha ha ha ha ha ha ha ha ha ha ha ha ha ha ha ha ha ha ha ha ha ha ha ha ha ha ha ha ha ha ha ha ha ha ha ha ha ha ha ha ha ha ha ha ha ha ha ha ha ha ha ha ha ha ha ha ha ha ha ha ha ha ha ha ha ha ha ha ha ha ha ha ha ha ha ha ha ha ha ha ha ha ha ha ha ha ha ha ha ha ha ha ha ha ha ha ha ha ha ha ha ha ha ha ha ha ha ha ha ha ha ha ha ha ha ha ha ha ha ha ha ha ha ha ha ha ha ha ha ha ha ha ha ha ha ha ha ha ha ha ha ha ha ha ha ha ha ha ha ha ha ha ha ha ha ha ha ha ha ha ha ha ha ha ha ha ha ha ha ha ha ha ha ha ha ha ha ha ha ha ha ha ha ha ha ha ha ha ha ha ha ha ha ha ha ha ha ha ha ha ha ha ha ha ha ha ha ha ha ha ha ha ha ha ha ha ha ha ha ha ha ha ha ha ha I was acting like I was at a hotel. What a prick. Oh, he's a nice guy. He is, he's lovely. He might actually not have touched it. They were there fixing, do you remember when you would turn on the air in there, it'd go pump, pump, pump, if the bathroom fan was also on? It'd make that clicking noise.

They finally fixed that and they were there monkeying with it and when I went in there last time, I turned it off and it was on 66. I should have adjusted it, but maybe he just turned it on and left it. Maybe he's not a prick. Maybe. Maybe.

Also could still be a prick. No, he's not. No, we'd love Jethro Bovingdon. The way the TV folds out, I laid my head where my feet would be normally to watch TV. And so I wasn't under the blanket, so I was just in my underpants.

And I started shivering, and I was like, oh my God. I'm so jealous. I was just walking, and then before I knew it, I grabbed the thing, put it on 72, and hid under the covers. My number one complaint about our house, even though I love it, is the upstairs,

you really can't cool it down. You can keep it from getting hot, but you can't really get it. You don't have an extra air conditioning up there? No, it's totally inadequate. And then this maddens me. So when the girls, it's not cold enough in the room, they, and the temperature is set at 72, right?

But it's 75 in there or whatever. So they put it down to like 60, right? And I try to explain, would you do that too, Monica? To lower it though, it is gonna register at a lower temp, even if it's not 75. I mean. If it's 75 in there and they have it on 74 and it never gets to 74, it's working as hard as it can

already to get there. To get to 74. So if you put it on 60, it's still never gonna. Because 75 is just like the lowest it's gonna be. Well, it's just the point is it's not variable. It's on or it's off. And so if you have it set to a lower temp than it is in the room, it's on as hard as it can work.

Right, to try to get it down. And all that happens when you get frustrated and you put it at 62, in the middle of the night, once it has cooled down enough and it can, then they wake up freezing, and they gotta wake up in the middle of the night and adjust it up. And I'm just always, I've many times tried to explain,

it's on or it's off, it's not gonna blow. Colder air or get there quicker, because you have it it lower maybe you should get an ice block and a fan Maybe and a big bucket to keep and a big capture the water melting I did get given this crazy portable cooler from BendPak and I haven't used it yet But I think somehow it's an air conditioner that you don't have to have an exhaust fan for, have you seen these? Yes, I want one. I think maybe I should just put that in the girls' room

and blast it, it's big industrial. Is it similar to a, so is it something you plug in or no? Yes, you plug it in, but I don't think it's a swamp cooler because that's another thing you can have, right? Yeah, like the Home Depot bucket. Yeah, and water's running through it. Yeah, and you cut a hole in it. Oh wow, I don't even know all those steps.

Oh. You gotta buy a bucket with the thing you buy and then cut a hole in it. Yeah, a hole cutter and then you gotta size a little camping fan to fit in there. Oh wow, I don't know about this one. So, Monty, why do you have a headache, do you suppose? Did you under hydrate yesterday?

Well, we gave a lot of blood this morning. Oh, it started post blood giving? Yeah. Oh. Interesting. So maybe it is that. We did give a lot of blood. Is a ding ding ding, because this is for Richard Isakson, so this is perfect. Oh, I can't believe

it timed out that way. Yes, we did a follow-up test today. A lovely lady came and took. Holly. Her name is Holly, shout out. She came and took a lot of our blood and then did more finger pricks. Now we're gonna get full real results

I'm very excited about. Yeah, and I have to give blood every few months. I do a blood panel because I'm on hormones. And so I'm used to that, but we gave, she filled 11 vials. I've never, outside of when you donate blood to the Red Cross, have I given that much blood. I did have the thought, I was like, I'm technically, when I'm at my regular weight,

which I am right now. Not anymore after losing that blood. Exactly. Two pounds of blood. I'm not my regular weight, which I am right now. Not anymore after losing that blood. Well, exactly. Two pounds of blood. I'm not allowed to give blood. Normally. Yes, and so I did have the thought when she was taking so much, like, huh,

I don't think I'm actually allowed to do this. Give this much blood. But I did, and it was fine, but I do have a headache. And she told me, Rob, she broke your patient confidentiality. You got a little unwell, right? I got nauseous immediately after. It was like, am I supposed to be? I'm supposed to pass out.

Oh, you got woozy. No, it was like, I wanted to throw up. It wasn't even a woozy. Oh, that sounds the same. Woozy. A woozy pass out, I guess. And whatever. I think those both, yeah.

That's the same. A lot of overlap. But I gave blood a lot for egg retrieval. But you had to go every other day and they took blood. Not 11 vials. Yeah, what, a vial? A couple vials. A couple vials.

Yeah, I normally don't have any problems. I didn't really, I just, I have a headache. But it also could be that yesterday I made pork chops. Made eight pork chops? I made made pork chops. Made eight pork chops. I made four pork chops. Oh wow. And they were so good. They were.

Yes. I think pork chops are a hard thing to make at home. It is. I was scared. They dry out easy, right? So I dry brined for over a day in the fridge. Tell me about a dry brined. Okay, so it's a brine, not a brine.

And it's also pork chops, not chop. What did I say? You said I made a pork chops yesterday. Oh, okay. Okay, well, you put a ton of salt and pepper. First, you have to get really good pork chop. Okay. And you get it at McCall's.

I get it at McCall's. I get it at McCall's. You went to the new location. How to deliver. They have a delivery service. Oh, wonderful. They moved out of our neighborhood. I know. So they're the thick pork chops.

Even harder to cook. And then you put like, you salt and pepper it very liberally. And then Max, who's a very good cook, gave me the idea, I said, oh, do I just like put it in the fridge on a plate? And he said, don't worry, bacteria doesn't jump, so that's fine, but put it on a drying rack on a baking sheet. Yeah, so that it can have air flow.

And so I did that and over 24 hours, this is Alison Roman's recipe by the way, and I decided at the beginning of the summer when she first posted the video that I was gonna make it during the summer. It was a summer goal. Okay, one of your summer goals. Yeah, and summer's.

Fastly. I don't wanna talk about it, but it's leaving, it's leaving, it's on its way out. And so I had to do it and I did it and it was so good. You bake them? No, skillet. Pan fry. Oh yeah.

Seven minutes on one side, five on the other. It's very crisp and it was delicious. Do you wrap it and let it sit for any amount of minutes? Not wrap, but rest, yeah. Just a rest. Rest it for a while. Okay. And I had a caper, thyme, garlic sauce on top.

I made a polenta with corn. Oh my God. Paprika and Parmesan. Jesus. And roast, and then cabbage, and you cook it in the pork fat. Whoa. And a tomato salad.

And did you eat all four by yourself? Yeah. No, I didn't. I had friends over. Okay, wonderful. And the reception, I'm sure, was? It was very positive. Oh, good.

I was happy. I was scared. It was a big, scary thing I did. Mm. Well, I applaud your valiance. Yeah. And we watched Olympics, and we ate it. Okay, Olympics.

Oof, oof, oof. This'll be a few days late, but we gotta Olympics, we ate it. Okay, Olympics. Oof, oof, oof. This'll be a few days late, but we gotta talk about it. Obviously. A lot of the things happened. Big stuff happened. Heartbreak and... Victory. Well, what's really funny is we've already,

you and I've chatted a little bit about it, and we already had two different takeaways from both very big events. Well, also, we haven't even, Simone, like we've missed a lot. Okay, Simone, yeah we've missed a lot. Okay, Simone, yeah, is just eviscerating. The comp?

Yes. Which is great, she's won everything she's competed in. She's so good. Love her so much. Love her so much. I learned a lot about her on the podcast I did, Blind Landing. Oh, the one that you did right after the all around?

The all around competition. I learned a lot. She's extremely generous. She has her own gym, and she invites a lot of people to come train there, a lot of international people to come train there. Competitors. Yeah, and I wanted to talk to you about this.

I felt that the gymnast really proved my theory that the big brand commercial that we brought up before, that that message is incorrect. I wanted to text you about it, but I thought I'd wait and do this in person. You're wrong. I mean, this will be a circular debate. Did you watch?

You can't wish well for the person you're trying to beat, or you're wishing that you don't win. No. This is a oxymoron or paradox. Let me tell you about winning, okay? Let me teach you something about winning. Okay, great. You want to beat someone at their best.

Sure, that's fine. So you want them to do the very best they can and you wanna do the best you can and you wanna win. But you wanna win, I mean, that's the end. You know what this debate is identical to? Oh, net versus global or? Gross? No, worldwide versus international versus domestic.

No, it's the debate I endlessly am in and shouldn't be in anymore about selfishness. You can act selflessly out of selfishness, but you know I don't think an animal can do anything but be selfish. And in their selfish pursuit, they can be quite selfless. So just you believe that you can be motivated. Yeah.

I want every, I, when I. And a lot of people do. I recognize a lot of people think that. Well, they're cheering for each other. They're being very supportive. But they wanna win and they don't want the other person to win. That's all it's about for me is like,

they don't wish that the person win. Yeah, that's not the argument. The argument is that you have to be insanely cutthroat. You have to be, have noroat. You have to be- Like Kobe or Jordan. Have no empathy. You have to, yeah. And you don't.

You can want to win and not want somebody else to feel bad or lose or do their worst or- I agree with you. I don't think you have to want the person to feel bad or suffer, but you have to want them to not win minimally. That's it. And I think that's all the commercial says. I don't. You want them to not win. Minimally, that's it. And I think that's all the commercial says.

I don't, you want me to play, I can't play. No, we're not gonna play. But people should go and. Yeah, a lot of people agreed with you. A lot of people don't like that commercial. In the comments, people agreed. Also, not everyone, me, is talking about it. So it obviously worked, it got people to talk.

Although I have not seen that commercial since I said it. Oh. Mm. Ah. You think they really. They pulled it. Well, it's also interesting because they have Shaqari on so many of those, and it says winning,

and she didn't win, and I'm like, what happens then? They film those commercials. Pull it. It's like, get it out of there. Get it out, I don't want everyone to see it again. Pull it. Did you have that thought too? Yeah, well I had the thought of,

God, this fucking, the pressure again, it's like you're on all these commercials and then you have to deliver. Oh, it's also the result is the difference in tens of millions of dollars. It's like the rest of your life. She better still get that money. Listen, I love her so much.

So we had different reactions to Shikari getting silver. I was like completely devastated and crestfallen and heartbroken. Yeah. And I wanted to appeal and start a campaign. Well, ding ding ding, we'll circle back to that. Okay, because there was a bunch of weirdness that happened before her race, right?

Yes, we found this out after. But didn't it happen to, the only thing that gives, so you did tell me that and that's really interesting, you should tell everyone about that. But also, the same woman did beat her in the semis, so that's at least comforting. It's not like she blew that woman away and then she was in this weird bus situation and then lost.

That would be unacceptable. Like, that would be really hard. But you don't know what's gonna happen on any individual race. And if you just lost an hour. Q Noah Lyles, he lost, he did not win either the quarters of the semis and he won the final.

Okay, so your reaction was like, you were really happy for her, she got so low. No, I was like, I was sad for her, but I was also happy for the person who won. Oh, sure. I was like, oh man, that sucks. And also because I felt that the pressure was insane on her and that didn't feel fair.

But I was happy for this woman who won, that's so happy. From St. Lucia, is that where Erin? Yeah, St. Lucia. 300,000 people. Two were 300,000. Whatever Erin said. Two or 300,000, yeah, yeah. Whatever Erin said. A few hundred thousand people to draw from

and they have the fastest woman on the planet. I love that. That's awesome. See, that's happy. And I was also happy that Shaqari, she was such a good sport. She was. She looked happy.

Yep, she did. She probably was upset, but she also, I think, was like, yeah, fuck yeah, I got a silver medal in the Olympics, like that's damn good. It's nuts, she's the second fastest human on the planet. Do we know if she was faster three years ago or not? I don't know what her age is doing, if she's gotten faster or slower,

but what would be heartbreaking is that she could've got gold last time in Tokyo, but. I be heartbreaking is that she could have got gold in Tokyo. I think she's gotten faster. I think she's become more and more of a front world. World is that what it's called? Oh yeah, not nationals. That would be domestic, not international. Not international box office.

Okay, then Noah Lyle was like the- Lyle's. Lyle's, yeah, as I said, pork chop. No, the opposite scenario, which is like, he was finishing second, second, and I was like the- Lyle's. Lyle's, as I said, pork chop. Now the opposite scenario, which is like he was finishing second, second, and I was like, oh no, I'm losing face. Sha'Carri, I was like, oh yeah, she's gonna do it. Noah was like, what's going on?

Although low expectations, 200's his event. Exactly. Yeah. And even it was spoiled for me that he won before I could see it. I'm so sorry that happened. And there's a weird bullshitty thing with the programming. Like all the stuff's spoiled for me that he won before I could see it. So sorry that happened. And there's a weird bullshitty thing with the programming. Like all the stuff's available for me

once it airs, it records. But for some reason the final was, you couldn't view it until the seven o'clock re-airing and then not until 11 in that block. Even though you recorded it? Exactly, it didn't record. I'm recording every Olympic event and that one was unavailable.

They did this with the Formula One race one time. I've got a phone to pick. I think something happens where it bumps up against local program. I don't know what happened. Oh my God, well I saw it live. How exciting was that? Because it did not look like he won.

I know. Even when I saw the replay, knowing he won, my first reaction was, oh, well, the Jamaican must have disqualified himself and come out of the blocks early. Like that Jamaican won, how's now he gonna win? But boy, by oh God, by oh boy, boy oh boy. They show that freeze frame and he was,

he's like four inches ahead. Four inches, not four inches, like one centimeter. One centimeter ahead. One centimeter ahead. Four inches, not four inches, like one centimeter. One centimeter ahead. One centimeter ahead. Fuck, he really won it, it was crazy. It was really, that was really heartwarming. Okay, then I felt really bad for that silver. See, yeah.

You were happy when Shikari lost for the, yeah. You're very underdoggy, I get it. I want my friends to be happy and I want underdogs to be happy. Yeah. I want everyone to be happy. See, this is why the commercial doesn't work for you. You wanted everyone to win. It's like our guy we've been rooting for won

and you feel bad and that's great. There's a group of folks. No, listen, listen. Okay. I'll cut this. I love Fred, okay? I don't love Noah. I like him, I like him, but he's on the verge for me

of being too cocky and I can buy it to a certain extent, but sometimes it's too much. So, you know, there's a little bit of like- I think you can leave that in there. A lot of people are wrestling with that. I don't wanna say anything disparaging because I do really like him. He's a nice fucking boy.

Like forget like all the whatever bragging he's doing. He's with his whole family. He's got no group of like buddy. He's with his mom and dad all the time. He's a sweet, sweet boy. Also on the dock, he's encouraging other people to be cocky, which I like, right? Like that's what made me like him.

It's like he's- He told the English guy, he's like- Yeah, it's like don't be so modest. Yeah, you're gonna fucking break that. What are you talking about? Yes, so I like him a lot for that. Wasn't Usain Bolt telling him to be cocky too? Oh, maybe.

That the sport needs it. Well, that's the whole thing. Oh, that's interesting. I think it also, it depends what you loved growing up. So, Muhammad Ali's the number one braggart. He started this whole thing, this genre of athlete that's exuding confidence in braggadocia and trying to intimidate his opponents

through this mental battle. So while it was happening, people hated that about Muhammad Ali, right? But then he becomes a legend and he occupies such a place in history and obviously he's such a, an incredible role model historically and he stood up for the right stuff

and all this stuff. Now you watch it and you find it quite charming and you also go like, yeah, it was very effective. And because that's the example I grew up loving, I look at Noah Lyles with an S and I go, yeah man, he's following right in the footsteps of Muhammad. And it's actually so brave because man, if you don't do it,

the fucking embarrassment of having bragged so much. I couldn't be that way, because I don't believe in myself all that much, but the risk that he's taking on by doing this and trying to transcend the sport, make it bigger than just running all that stuff, you know, I'm for it. I'm for it too, but I just personally,

I like quiet luxury. Sure, sure, sure. I like a quiet. Not a purple Lamborghini with a Gucci symbol. No, I don't. I just like you to be quiet and win. Talk with your actions. Exactly.

Okay, but it makes it so much more fun. It's fun, he's great. I'm really bad at one. I'll also say, the one interview afterwards I love so much is he's like, I'm gonna be honest with you, I didn't think I got it. I said to the Jamaican, I think you got this one. He goes, then I saw that photo and I said,

my lord, I'm incredible. I thought that was the greatest 180. He's like, my lord, I'm incredible. But he had the cutest little wink. Like he's letting you know he knows it's people. No, it's great. Look, it's great. It's great.

I love it. I love it. And then I didn't feel that bad for the Jamaican. That was his very first Olympics. That margin, the five millions of a second or whatever it was. 10 millionths of a minute. I cannot, I would die.

That's hard to process. But even look at Freddie. I love Fred. Fred's only 0.2, he's like 0.02. I know, it's all so close. I said it last time, but I gotta say it again. What's insane is that these guys in Formula One are getting the same time down to the 1,000th sometimes.

That's, like when you see in a 10 second race and it happens, it's mind blowing, but then you think about a minute and 12 second lap. I know that one for me is less because it's a machine and it's not a body. But there's so many variables. It's like a different manufacturer, a different driver, a different, all this stuff stuff and somehow they get,

those are the same margins in Formula One. Yeah. Speaking of cocky athletes, I rewatched Air this weekend. You did. I love that movie. Who's cocky in that? Jordan.

Oh, he's not very cocky. Yeah. You think? I like it on him. Yeah, that's the thing a little. Uh, yeah. Is he? I like it on him. Yeah, that's the thing a little, we are all full of contradictions, but he's the number one hate your opponent guy.

He is the embodiment of that commercial. He had to find something he hated about each team he played and he wanted to, he actually wanted ill will to fall upon them. He went even a step further than I'm comfy with. Yeah, but he- He's handsome. Didn't the pistons kind of make him that way?

Probably. When he came out of the gate. I think he was that way in North Carolina. He was? Yeah, if you watched Last Dance, I think he had some weird rivalry he gave himself. They're all fake in his head. But he also has chips on it.

He has a lot of chips on his shoulder. Yeah, and chips in his bank account. Oh, hell yeah. Yeah, and chips in his bank account. Oh, hell yeah. Ooh, baby. Yeah, and at the end of that movie, they remind you. Oh, God, the numbers at the end of that movie are fucking mind blowing. Of air? Yes.

Why, what's it say? He makes $400 million in passive income a year on the shoes. A year. A year. So he's made like $5 billion. As he should. Yeah. Don't get me started.

I love it and I bet, I watched that speech a few times, two speeches. I watched this, Matt's speech, well, okay. Are we gonna talk about it? Are we gonna talk about the elephant in the room? Oh, I know about this. Mm-hmm. There's a reason I did a little marathon.

I watched air and then I watched Good Will Hunting. Oh, you were in a real. I was in a mood. This is post pork chops? I was taking them back. Oh wow. Now this is Friday. No wonder you have a headache.

Oh, this is Friday. No, yeah, this is Friday. By the way, you might have from all the salt you put on your pork chops. Saturday night. Okay. I was gonna go to sleep till Good Will Hunting, but then I kept watching.

Wow. You know what's weird? I applaud you. Thank you. It was weird, cause it's been a minute since I've watched it. Okay. Other than watching it in my head, you know?

And they're so young in that movie. Probably way younger than I think they are. Yeah, they're like probably 24. Well, sure, I was, Bree and I went on one of our first dates and I was 20 and she was 19 or 21 and 20. Yeah, I think they won the Oscar when Matt was like 25. Oh wow. So they must've shot it when they were 24

or three or something. I wanna rewatch. Oh, God is it a good movie. But also it was weird because now they're way too young for me. You feel weird being horny? To be horny for? No. Don't you allow yourself to.

I do. Good. I do, but I really had to jump some mental hurdles because I was like, oh my God, they look so boyish. Right. I mean, and for my whole life, they were always. Old. Old and hot. Yeah, mature.

And now they're young and hot. Yeah. And that's uncombed. Don't fight that. There's no ethical issue there. First of all, they're 20, you could fuck a 24 year old and be fine. I did think about that. I was like, you know, legally this is fine anyway.

Yeah, yeah, yeah. Who do I just find out's dating someone like, oh, yeah, we have a friend I just found out. She's our age and she's dating a 20. Dating a 20, yeah, 24 maybe. Good job. And I was like, good work, man. Fuck yeah, it's about time.

Flip the script, ladies. I have heard from Liz that male sex drive goes down as they age and women's goes up until menopause. And so there is a period of time where it actually makes sense for an older woman to be with a young guy. It always makes sense, yeah. I mean, I'm sad because I'm not a young guy anymore, but. Me too. Do you think your sex drive'm not a young guy anymore, but. Me too.

Do you think your sex drive has gone down? Oh God, yes. See, yeah, I think she's right about that. Oh, it happens, yeah. Anyway, okay, so the reason I watched Air. Okay. Oh yeah, the speech, she made such a good speech. I watched it twice.

Yeah, yeah, yeah. And then. Wait, what speech did you makes such a good speech. I watched it twice. Oh, and then. Wait, what speech did you watch? Is Oscar speech? No, no, no, no, in air. Oh, Matt makes an impassioned speech. Yes. Yeah, yeah, yeah.

Well, listen, he's, I mean, I'm reticent to declare someone the best actor, but what I'll say is there's nobody better than Matt Damon. He's so fucking good. And for all the reasons when we interviewed him, I said to him, he's not flashy. It's so natural. He's so not an attention seeker.

He's just like so fucking consistent. And the variety of characters he's played are when you contrast them against each other, it is a flashy career. He's as good as it gets. He's as good as it gets. He's so good at it. Anyway, he makes a great speech,

but then Viola Davis makes an incredible speech. Yeah, an even better speech on the phone about value and worth and it's so good. So I love that movie. I had a BMI bonnet to get some Matt back in my life for me to reclaim him as mine, as he is. Yes, of course.

Because you have done the worst thing imaginable. God, dude. Aaron's referring to my muscles. I told him this story and I explained, the only thing I can explain why Matt's interested in me is that of my muscles. That's what I've concluded. I think that's why he was willing to start chatting.

No, you hung out with him this summer a little bit. And we're falling in love. What are you, I'm trying to, people need to know why you're mad. Is it worth losing me as a friend to gain him as one? Are you gonna make it that way? I'm just wondering what you're willing to lose. I'm kidding, obviously. And I have to say I'm kidding. No, I have to make it clear. I'm just wondering what you're willing to lose. I'm kidding, obviously.

And I have to say I'm kidding. No, I have to make clear that I'm kidding because one of the mean comments is like, why does Monica care who Dax is friends with? I was like, go fuck yourself. You have no idea who we're talking about. But anyway. I was walking down the street, leaving Deadpool,

as I discussed, great film. Great film. And I happened to walk right over his star. Yes. So I was like, the street, leaving Deadpool, as I discussed, great film. Great film. And I happened to walk right over his star. Yes. So I was like, what a prime opportunity. I'm always looking for an excuse to contact him. So I took a picture of myself in front of his star and I wrote in all caps, rock hard.

Yeah. And then he wrote something back very lovely. I will not dishonor it by saying what he said, but he sent a very beautiful text back, which put a real spring in my stuff. And I was coming directly from there to meet you at Reefer Madness. So it had just happened.

Yeah. And again, we were back to the thing, there's no way I can keep that from you. It would have felt weirdly unethical to keep that from you. I appreciate that. And I showed you and you left your body. Your skeleton left your body and marched around the room. It did take flight. And then you re you left your body. Your skeleton left your body and marched around the room. And then you-

It did take flight. And then you re-entered your body. The text was so beautiful and kind and like- Loving. The everything I could ever dream of to hear from him. I get it. Delivered it to you. That's, whoa.

I mean, look, by the way, I agree with him. Do you? Some days, I agree with what he said, obviously. I know the perfect comp is like you and Pitt are not. I am gonna become best friends with him. I have fully declared that. Yep, and then you gotta show me the text. I'll show you like one or two

and you'll see that there have been others. Oh, okay. But you don't get to see those. Okay, all right. Okay, just prepare yourself now for how that will feel. I hope both those men are flattered by this and don't feel exploited by this. Let me just say that.

I hope so too. It's only flattering. Yeah, if I lose this new friendship because I put it up. This is like, who was it? Someone was dating Halle Berry. There's an infamous story. And then they were on stage and she had called

and he answered on stage and then there was a bit of showing off and then they broke up. And I guess this is identical to that. Although you brought it up. Does that make me? Yeah, then they broke up. And I guess this is identical, although you brought it up. Does that make me, does that get me out of jail? Well I hope you're not in jail because he's just a great person. He is, I'm learning that, yeah. You are onto the right path.

I guess that's really what this all circles back to is. You have an eye for talent. I do, my instincts are just always correct and I wish you would remember that. He's impossibly sweet. Yeah. How does this make you feel Aaron? Oh yeah, this is great. What an opportunity.

I was very excited for Dex and immediately said, oh, uh-oh. Oh, for me, for me. Yeah, for you, yeah. Uh-oh, uh-oh. No, I'm happy. I want more love in this world. The more people who love him. But I thought you were asking, is Aaron threatened?

That is what I was asking. Oh God, no, I didn't even know that's what you're asking. Ha ha ha ha ha ha. Don't be crazy. Oh, that's right. Oh man. Well, that's the right answer, there's nothing to be threatened by.

No, no, no. It is very truthful, I believe. I'm mad. Ha ha ha ha ha. I'm mad. My number is 313. 300. And my name is. What if I gave you his number

and then you went out to the Hollywood Boulevard and shot a picture of yourself and friend that just cold texted that photo. Got your number from Dax. I'm his original best friend. Thought we should meet. Oh, mama. I did think when I was watching the movies,

I think it's great. And I think it was very, very sweet what he said. But, and there is, there's a one person. Hold on, be honest. I am being honest. I know, I just gotta ask one question. Okay. Did any party, be honest, any party.

Did you get PQs? No, no, no, no, no. I mean always. Anytime he's involved. No, no, did you go, and just wait till you get to know him better? Any hint of a voice say that? No.

Okay. I mean, I did think he doesn't know him that well. It's early to be saying stuff like this. It's adjacent. I'm kidding. I'm kidding. I did not think that. I did think there's a small percentage, very small,

like 3% that feels uncomfortable. I have a guess at a potential thing, which is I think you might be feeling some weird tension of your fantasy world and your real world overlapping and intersecting. Yes, that's, it's like he, He's another entity. He represents something else for me.

And he lives on another planet almost. Does it demystify him a bit that he's friends with me? It's not that it demystifies him, but. He's fallen off of Mount Olympus if he's friends with me. No, there's something like when he came here, that moment is an indicator that dreams can come true. Like that's a weird thing to say, but that is. It's like, oh my God, I used to sit in my bedroom

and dream of an interaction like this. It's just like life is long, but things kind of come full circle and that's a beautiful. Like life is magical. That's sort of life is long, but things kind of come full circle and that's a beautiful, like life is magical. That's sort of like for me, what he and my interactions with him represent. So yeah, when you're like hanging out with him and you're my best friend, it's like,

wait, this is fucking up my thing. And it's very compartmentalized. He's the, Ben and Matt are the only people left really that remain special to me. Magic. Yeah, yeah. Everyone else is real. Like they're just humans and humans can be difficult

and tricky, but those two like have remained. I've kept them in a very precious little box in my head and you are like prying open that box. Yes, I understand. With your little grubby mechanical hand. Greedy hand. Grease. There's grease on my porcelain box. Fried chicken grease.

On my porcelain box. So anyway, I just wanna be honest about that, but that's only 3%. No, I just wanna be honest about that, but that's only 3%. No, I understand. 97% is very happy. Yeah, it's interesting. Yeah.

Oh, blood. I just wanted to say that Aaron and I tried Moo BBQ. Oh yeah. Moo. Have you been now? Yeah, that's good. It's not as far, I thought it was downtown, but it's not, it's Lincoln Heights or something. We got it delivered. Oh, yeah. Have you been now? Yeah, that's good. It's not as far, I thought it was downtown, but it's not, it's Lincoln Heights or something,

which got it delivered. Oh, you did. I think. Oh, I've tried it. Maybe I didn't check it. It's a nice experience. You should go. You guys loved it.

It's really cool in person, yeah. I felt like we were in Texas. Yeah. Like when we went to Schmidty's. Yes, exactly, that's the one, yeah. Yeah. Yeah, where you walk up to that counter. You're not huge into barbecue, are you, Monica? I the one. Yeah. Yeah. You walk up to that counter.

You're not huge into barbecue are you Monica? I like it. You should go. Yeah. It's outrageous. We had a brontosaurus rib. That was as big as a picnic table. It was ridiculous.

It had a full brisket on it. Like we had ordered brisket. It's a beef rib. And then there was brisket attached to a bone. Oh wow. And we got the burger. And we got the sausage. And sausage.

Cold-swelled potatoes. Yeah. That sounds yummy. Did you see the French pole vaulter? Okay. I've only. Oh my God. Guys, I've only, I've gotten,

I've seen in the comments that I missed it and it's filling me with panic. You guys saw it? Yeah, yeah, yeah. Incredible. No, you took the watch for five seconds. Yeah, oh yeah. This is a clip. It's everywhere.

What happens? His dick gets stuck on the- His dick and balls get stuck on the fucking pole. He's over and then his penis just knocks it off. I did see it. Kristen showed it to me. I guess I assumed that was, I was like, is that from this Olympics? Cause I would have, okay. Yeah. Yes. Then it it to me. I guess I assumed that was, I was like, is that from this Olympics?

Cause I would have, okay. Yes, it's wonderful. It's fantastic. Cause it gets completely stuck and his body keeps going down and then it slingshots out. It's a nice packet. Yeah, great.

Yeah, it's getting tangled up. You had been waiting and you got a really good one. Yes, and soon as track and field started, I was like, here we go, here's the dicks. They're out and about. Yep. Oh, this is great, cause Aaron's here. Can we ask him?

So we were talking about how much I like the penises in the Olympics. Yeah. And then I said, I'm a 10, that I like looking at penises. Yes. And then I asked Rob what he was and he thought he was a six. And what are you? At looking at penises. And then I asked Rob what he was and he thought he was a six. And what are you?

At looking at penises? Yeah, like them bouncing in the outfits and anytime you can see them. Being abused by it. Yeah, it's more than looking at them. Sure, sure, sure. It's a general obsession with penises. Year by year, I like them more.

So I like them a lot right now. Okay, great. Like I watched that video 50 times Like I like the balls and I was trying to see where the balls met the dick and what was happening and Then I was picturing mine and if it was like, you know some nights it's real Acorned up and small and sometimes it's really warm like it is and small. Sometimes when it's really warm, like it is in France, it might look like that. Oh.

Oh. Oh. Oh yeah. So you were looking at more of like a climatological look. I'm always thinking of a climate control, because I always have to make an excuse before anything happens. Did I tell you that was my idea?

I wanted to do a contest where it's a small penis contest. Like you have to go on the cold plunge for three minutes naked and then get out and then we measure everything. And they're like 10 men compete. I would love that contest. I would run away with the gold on the small penis. Yeah, presumably some men's penises

would disappear entirely. Yeah. Like just go inside the body. They go inside. Yeah. They go inside, yeah. Bye. Okay, so are you willing to quantify it with a number? Eight. Eight, great.

Room to grow. That's good. Pun intended. There you go. Well, yeah, I don't think I ever could be. You've been a 10 for a long time. From the jump, right? Yeah, yeah, yeah. Yeah, yeah, yeah, yeah. How about-

You came out with it before anyone was willing to look at a penis. Thank you. I was a trailblazer. Yeah, you were. So I think what he's saying is he agrees with me that you over-index. Sure.

And you always have. Yeah, I was more making, I was assuming men like it. Well, let me ask you this, when you're watching Righteous Gemstones and there's that great scene and it's like our lead character is making a speech and behind him's playing on a big movie screen, this guy's penis walking around his head

and the whole speech is his penis moving back and forth. Like that's as funny as it gets for me. That is funny. But everyone laughed at that, that's as funny as it gets for me. But everyone laughed at that, that wasn't Jenna. That was just funny. Like that's like a funny, clever thing to do in a show. Yeah, it's my favorite kind of joke is when you get one of those penises.

Yeah, penis jokes. It looks ridiculous. I mean, a lot of people have been catching on over the years. Yeah. The small, small penis. Oh, in the Patriot. been catching on over the years. Yeah. The small, small penis. Oh, in the Patriot. Yes, we have a child.

Oh, hello. Hi. Hi. Oh my God. Oh my Lord, honey. It's beautiful. Wow. It's a work of art.

Oh my gosh. That's really good, Linky. Say what? Oh, as you should. Did your dad have blue eyes? He did not. Oh. He absolutely did not.

They're just. But Aaron's are. I had an empty socket so I had to fill them in. Oh, I love it, honey. Tell people what happened. Oh, Lincoln has drawn, done a painting of a can of Ted Seger's. Yeah, it looks good.

It's really good. It's really good. It's really, really good. Do you want us to keep it up here? Very good artist. Maybe this will go on the new filming space. We can put it here for now on top of the thing. Oh yeah, put it, lean it under the tap. Oh, I love it, I love it.

Lean it under. Yeah, you like lean it against the tap. We can put this, yeah. Let it stay. Good job, Linky. Cute. Thank you. Linky. Cute. Thank you. Really good.

I love you. Bye, buddy. Bye. Bye. Okay, bye. That's a, Delta's nailed that bye. She always says bye that way. Bye.

Wait, penises. Vaginas. Vaginas. But back to some facts. Okay, great. Because I do have some. Alzheimer's episode is an important episode. Yeah, it's important. We should give it some, whatever the opposite of levity is. Some gravity.

Some gravity. Okay, the calcium test. So there's two, carotid ultrasound for neck arteries. Yeah, I've done that. Okay, and then there's a CT angiogram. It's called a CTA. It's a medical imaging test that uses a CT scan and a contrast dye to create detailed pictures

of blood vessels and tissues in the body. And you said you had that, right? Yeah, and they tell you before they inject you with the contrast that it's gonna feel like you peed your pants, which I was so excited about. Of course, yeah. Wouldn't you look forward to that feeling? Yeah, yeah.

Did it? Not as much as I wanted it to. It made my whole chest cold in a fun way. Ooh. Yeah, but I did wanna feel like I had wet myself like a baby. And I'd say, oopsie, whoo gaga. Did a boo boo.

Okay, so most CTAs take about 15 minutes with the actual scanning only taking a few minutes. Patients typically don't need to be admitted to the hospital for a CTA. I was not admitted in and out. Okay, great. There's also a coronary artery calcium score, that's CAS. That's a non-invasive imaging test

that can help detect early signs of heart disease. Mine, with the contrast, gave me a calcium score. They would tell you what percentage calcium. Yeah, it's just more intense. Yeah. Okay, prevalence versus incidence. Prevalence, the proportion of a population that has a specific characteristic at a given time,

regardless of when they developed it. Prevalence is usually expressed as a percentage of the population. For example, in a one-year study of diabetes, prevalence would include anyone who had diabetes during that year, whether they had it at the beginning or developed it later. Prevalence can be a useful tool for planning health services.

Incidents, the number of new cases of a characteristic that develop in a population during a specific time period. Incidents can also be a measure of the risk of getting a disease during a given period. For example, in a one-year study of diabetes, incidence would only include people who developed diabetes during that year. Incidence is often reported for infectious diseases and researchers may study it to help identify causes and prevent future cases.

Even with that explanation, yeah, it's not the most obvious difference. Well, new cases versus all cases. Mm-hmm, yeah. I guess it is easy when you phrase it that way. Because it's saying, is it increasing? Is the incidence increasing? All right, well I thought maybe we would look

to the 23andMe and see if we could find our APO. Remember, he says it was on it. But I can't find that, that's from years ago. I know, I cared a lot when he said it and I was like, I'm gonna do that and then I just never thought about it Again, you know for me. I think like if you're already doing everything that's prescribed for it What's the point of knowing like it'd be one thing if you were like, I don't want to make these life changes

So I'm only gonna do it if I find out I'm an increased risk. Mm-hmm, but if I'm already doing all the stuff Doesn't really matter. I need to know. Right, yes, because you could do much more heavy weight training. I know. You're not looking forward to that. No. Who's got the time? What part of it?

Just the thought of the exertion? No, because I like cardio. Right. I just, it is time. It is that. It's like, I don't add that in., it is time. It is that. It's like, I don't add that in. Like, there's no time. Just no time.

Only time for brining. Paleolithic. I know you don't like this. You don't like this. And I know, and you already said it in here that it's bullshit and people did live to be very old. Yeah. But. Well, what I, yeah.

It includes infant mortality. Yeah, but life expectancy in the paleolithic stage was 33. But again, because of an infant mortality rate at like 60%. Although it says 75% of deaths were caused by infection, including diarrheal diseases, Thomas, that resulted in dehydration and starvation. Thanks for putting it into our note. Yeah, I didn't think you'd know what that meant.

Yeah, yeah, yeah. Um, so. Yeah, I'm. I know what you mean. You do, yeah, and if you look up Italy 1600s life expectancy, it's probably in the 40s, and yet we had Galileo at 80. We know all these people documented that lived into their 80s and 90s.

From these eras where people- They're not Paleolithic. But there's, if you believe Yuval Harari, we were actually much healthier in the Paleolithic era because we weren't keeping animals. So we weren't getting all the animal transference pathogens, which most of our diseases have come from living with animals.

Tell me about it. How are your dogs? I love them. I know. I'm obsessed. He loves them like crazy. You should have met, they had a little tiny guy here last week.

They had a, just stopped in for a week. Yeah, you guys fostered a little puppy and he was really cute. He was outrageously cute. He just bounced around the backyard. He hopped like a bunny. His name was Cowboy. Oh my God.

Not the most suited name. He was also the runt of the litter, which is a weird name, the runt cowboy. He was really cute though. You would have liked him because he was a little doodle-ish. Mm-hmm. Yeah, who knows what he was.

Gotta get snuggle with him. Yeah, you could have. I've told you, every time Aaron's walking his dogs, people are yelling out the window, what kind of doodle is that? Yeah. Ha ha ha ha ha. Ha ha ha ha ha ha.

Yeah, people love a doodle. Oh, man. They love a doodle. They love a doodle. Hey man, what kind of doodle you got there? Oh, look at this. Well, that's it. We'll tell everyone our results. Oh yes, from this.

Our blood results. I don't even know what results are in the car. I'm not even sure what we're going gonna learn, but I guess we'll know. Hopefully a lot from 11 vials. I know, right? I wanna know the exact day I'm gonna die. They're like, you're gonna die at 9.30 on March 29th, 2065. No, 2090.

Yeah, it's nice, it'll be 115. That's a great age to die, good year. All right, well well I love you. Well, Erin will still be around for Monday's fact check. But we are gonna invite people to go meet Erin at the Avett Show in Detroit. Oh, yeah, I'll get the details. Okay, get your deeds.

But Erin's gonna be at the Avett Show with the Ted Seeger's Tasting Station. Party. Talk about a marriage of Mm-hmm. Party, party. Talk about a marriage of things we love. Yeah, I like that. All right, how's your headache feel? Did it get any better during this? Yeah, my Advil kicked in.

Okay, wonderful. I mean, my pain reliever kicked in. Yeah, you don't wanna endorse. I don't know who's the sponsor. I'm not in. Okay. All right. Okay, love you, bye.

Love you. Love you.