Plain English with Derek Thompson - Health Fads and Fictions: VO2 Max, Supplement Mania, Sunlight, and Immortality

Episode Date: April 19, 2024

Today's show is a critical look at some of the most popular health fads of the moment, with return guests Steve Magness and Brad Stulberg, from the Growth Equation and the ‘FAREWELL’ podcast. We��re talking VO2 max, the benefits of sunlight, so-called morning and nighttime “stacks” (complex multivitamin routines for optimizing your energy and sleep), and Silicon Valley dreams of immortality. Plus, a rant from Derek about the supplement mania of independent media. If you have questions, observations, or ideas for future episodes, email us at [e-mail]. Host: Derek Thompson Guests: Steve Magness & Brad Stulberg Producer: Devon Baroldi Links: The ‘FAREWELL’ podcast: https://thegrowtheq.com/farewell-podcast/ The FDA's note on dietary supplement regulation: https://www.fda.gov/news-events/rumor-control/facts-about-dietary-supplements Joe Rogan's supplement stack: https://jrelibrary.com/articles/joe-rogans-supplement-stack/ Huberman's sleep stack: https://www.nsdr.co/post/andrew-hubermans-sleep-cocktail The Mayo Clinic on creatine: https://www.mayoclinic.org/drugs-supplements-creatine/art-20347591 Learn more about your ad choices. Visit podcastchoices.com/adchoices

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New episodes starting March 28th. On Spotify or wherever you get your podcasts. Today, a critical look at some of the most popular health fads of the moment with returned guests Steve Magnus and Brad Stahlberg from the Growth Equation and the Farewell podcast. We are talking V-O-2 Max, the benefits of sunlight, and so-called morning and nighttime stacks, or complex multivitamin routines for optimizing your energy. sleep. But first, before all that, a bit of table setting from me about the rise of independent health media in an age of declining trust in health institutions. We are now four years

after the pandemic started and still living with COVID in many senses of the word. It's not just that the virus is still in circulation. The ripple effects of the pandemic are not diminishing in many cases. In the world of health and health information, especially the post-COVID world is, I think, distinct from what came before it. If the New York Times writer, David Wallace Wells wrote this week, COVID upended, quote, the structure of our epistemic faith. We were told groceries were dangerous. No, then we were told they were safe.

We were told parks were dangerous. No, actually, never mind. They're safe. We were told going on walks without a mask. Very dangerous. Oops, nope. Sorry about that. We were told masks didn't work.

And then that they did work. And then maybe that they didn't work again. but also, no, actually they do work, but it depends on the mask and how you wear it. There has been, especially in the ideological center and right, an implosion of trust in our health institutions like the FDA and the CDC. And a part of that implosion is the fault of the FDA and the CDC and so many other public health authorities, each of which screwed up so many times in full public view that to record their mistakes would require like a 10-hour podcast. But it's left us with the world where many people in independent media now hold themselves up as

ersatz authorities. Don't trust the FDA, they say. Trust me on ivermectin. Don't take that vaccine, they say. Vitamin D and deadlifts are all you need to fight this pandemic. Don't wait for human trials. Don't wait for clinical trials. That's big pharma.

That's the deep state, FDA. That's the evil they. trust me. Sometimes the way I think about it, it's not that trust in public health has gone away, but rather that the gravity of trust has reversed its polarity in the post-COVID age. Trust used to trickle down from authority.

The FDA says this, the CDC says that, and we do what they say. Now for many people, trust is more bottom up. Joe Rogan said this. He must be right. or Brian Johnson, the former tech exec, now building a protocol to live forever. Brian Johnson said this. He must be right.

The future of trust seems to be bottom up. I think about this a lot when it comes to the subject of supplements. Some of the biggest DIY health voices and independent media personalities in the world, people like Joe Rogan or the scientist Andrew Heberman, whose collective audiences number in the tens of millions, now make millions of dollars hawking supplements. And these are not incidental advertisements, I want to point out. This is not like a movie podcast that says today's show about Babylon is sponsored by Allstate.

Many of these podcasters are de facto health gurus. People go to the podcast for health advice. So it's my opinion that there is a special obligation for health science communicators to be rigorous in the way that they communicate the health of the products they sell. And this is where I am most skeptical about the way bottom-up science is practiced in some corners. I'm not sure many people who use these supplements that are being sold understand exactly what they're buying. Legally speaking, there is a big and important difference between a supplement and a medicine. Supplements are sometimes talked about as if they do medicine-like things.

And if you go to CVS, Walgreens, they appear on shelves next to medicines. But supplements are not medicines. That is, they are not intended to treat, diagnose, mitigate, prevent, or cure any disease. That's what medicines do. And medicines in America have to be approved by the FDA before they can be sold or marketed.

They have to demonstrate their effectiveness in clinical trials. Supplements do not. A supplement does not have to work to be legal. Instead, supplements have a totally different set of legal obligations. Most importantly, they have to be safe. If you make a gummy, call it a supplement, and put cyanide in it, you're going to prison. Second, the label in a supplement cannot make false evidentiary claims.

You can't grind up a bunch of dead leaves and put it in a neural capsule and say it cures glaucom. that's also illegal. But if I go into a big backyard and I take a bunch of grass and random leaves from my backyard and I put it in a blender, and then I put shreds of my blended garden in a pill, and I call this pill Derek's dietary supplement. And I make vague health-sounding claims like Derek's dietary supplements supports the optimized life. DDS is a comprehensive formula to provide daily support where the body needs it most. DDS is a natural nutrition solution formulated to support whole body healthy living. That is legal. DDS doesn't have to treat, mitigate, or cure one goddamn thing. It just has to not kill you or make an explicit lie.

So when I see the independent media space getting rich by merchandising supplements, I think the legal standard of supplements is pretty important to point out. Since 1994, when the law governing FDA oversight of dietary supplements was last updated, the industry has grown 20-fold. The supplement industry has grown 20-fold in 30 years. I'm not sure the consumer is responsible for that 20-fold increase know exactly what they're putting in their bodies. The mainstream media, sometimes calls these folks low trust. But that's kind of funny, because it takes a ridiculous amount of trust to put something mysterious and unregulated and often untested in your body every day

believing it's saving your life. It's just a different kind of trust placed in a different kind of authority. Not top-down trust, but bottom up. Before we go, let me make one thing crystal clear. Science is about experimentation. and I'm not against people embodying the spirit of experimentation in their own bodies. I also have no doubt that some of these supplements work in a few minutes. In fact, you're going to hear a defense of creatine, a very popular supplement for muscle gain,

which has been extensively researched by universities and health systems around the world. But that's the key, extensive, third-party, objective research that you can read is what scientific knowledge is based on. Most supplements, however, are a kind of informational desert in the medical landscape, a territory of land that is barren of data. Because if you're an influencer

and you want to sell a dietary supplement that does nothing, you don't need data at all. All you need is a supplement. sucker. I'm Derek Thompson. This is plain English. Brett Stolberg, welcome back to the show. Hey, it's great to be back. Thanks for having us. Steve Magnus, welcome back to the show. Thanks. Excited for this one, Derek. So last year I had you guys on and we went through some of the hottest health fads at the moment,

separating fact from fiction as best we could. And I wanted to have you back not only because last year was a lot of fun and I learned a lot, but also because I have a lot of questions about a new set of hyped up health advice. And Steve, I want to start with you. V-O-2-Max. If you're a listener who is anywhere approximate to the health and lifespan world, there is a 90% chance.

You have heard the term V-O-2 Max in the last year, maybe the last month, possibly the last 15 minutes. This is a health and fitness metric that seems to have exploded in a popular consciousness in large part thanks to the best-selling book Outlive by Peter Attia.

The New York Times, just recently last week called V-O-2 Max, quote, the best way to track fitness and longevity, end quote, the best way to track fitness and longevity. Steve, ground floor level, please. What is V-O-2-Max? You know, I got to say, as an exercise scientist, it kind of humbles me that this has now come out as the thing

when we've been able to measure V-O-2-Max since about the 1930s. But anyways, what is VOT2 max? Quite simply, it's the maximum amount of oxygen that we can utilize. So it's essentially like how much oxygen can you breathe in and then go through your circulatory system and then utilized by the muscles. And that's what it is. So the way we measure it is pretty simple. you get put on a treadmill or a bike in an exercise science or doctor's lab they hook you up to a mask

that mask has a tube that runs into a machine or a bag that essentially measures how much oxygen you're breathing in and out okay and then they ramp up the exercise you start really easy and then the speed gets faster on the treadmill every one or two minutes depending on the protocol and you keep that going until essentially you cry uncle which is like You're so exhausted that you either fall off the back of the treadmill, which happens with elite athletes, or more so with regular people, you just, you know, scream, hit stop, and just are done. And generally, at the end of, you know, the fastest that you're going on that treadmill, your oxygen consumption is at its highest level.

And whatever that number is, is your V-O-2 max. And we use that as a marker of, it's kind of a surrogate indicator of cardiovascular. or aerobic fitness. And kind of the way I like to describe it is it's kind of the measure of the engine size of the car. So it's kind of that big number that we use holistically to look at aerobic fitness. Does it work? Does it teach us anything useful?

That's a good question. So it does, but I'd argue that it's not as much as we think it does. And there's for a couple of reasons here. I just use analogy as like the car. car engine. When it comes to performance, V-O-2 Max among elite athletes doesn't correlate that well once you're pretty good. Meaning, if I lined up, you know, everyone from who ran in college all the way to the Olympic champion and looked at their V-O-2 maxes, I couldn't tell you who was the best of the best, because they all have pretty big engine sizes and it doesn't determine, you know, performance. So the

correlate to performance isn't that good. And if we use the car analogy, it's like, Of course not. We need to know the size of the gas tank, your miles per gallon, whether you can convert that energy from the engine into torque and the tires, all that thing. Same thing applies to humans. When we look at longevity, which are health or mortality, which is where it's kind of reached its peak here, it does correlate very well to decrease in mortality. There's been a slew of research that shows that cardiorespiratory fitness, if you compare the highest of the high group

versus the lowest, the lowest group has about a five times five times increase of mortality. But the thing is, Derek, and this is the key part, V2 Max is an indicator, and if you look at the vast majority of those studies, they don't actually use V02 Max.

So what do they use? They use the speed that you reached at the end of the treadmill when you called, you called uncle when you quit. So I think this is really important because we confuse the thing. We say, oh, it's V-O-2-Mex, it's V-O-2 Max. Vast majority of times in these mortality longevity studies,

it's not. We use that speed or incline or watts on the bike and say essentially like, how fast can you get until you're exhausted on this test? And that is what correlates to mortality, longevity, etc., which I think, again, VOTU max matters. It correlates to that. But I think it gives us a very simple, you know, more profound solution, which is you don't need to know your VO2 Max number.

You just need to know your fitness. And it sounds like you need to know how fast you can run. If the actual data point that was being correlated was the speed that the tread end was going, then it seems like another way that I can learn the equivalent of my VO2 max is that rather than go into a doctor's office and pay whatever amount of money it is in order to get my VO2 max score and possibly fall on the treadmill and hurt my head, I can actually just plug in maybe to like some website, like, how fast do I run a mile? How fast do I run two miles? And if it can essentially tell me the equivalent of my, you know, per mile speed, that I'm getting something

similar to the data that VO2 Max would be giving me. Is that right? It seems, because I think you just said is speed is similarly predictive of cardiovascular health as the volume of oxygen that can be utilized by the body, which is much more complicated than just pressing start and stop on the mile. Big O. And what I would say is it's not just running. It's you could do this for any that is relatively aerobic, which just basically means that it lasts longer than a couple minutes. And all we're looking for is, are you relatively fit compared to the population or not? So you can even look at these studies and, you know, get some rough numbers. And since one of them that found, you know, the mortality risk, found that the highest group

that had the best chance was anybody who ran basically a 21-minute 5K or faster. That was the elite fitness that put you in the best, you know, reduced mortality group. So you can find all this numbers. But all I would challenge, you know, listeners to say is, yes, V-O-2 Max matters, but we complicate the crap out of it. All we have to really do and understand is, like, where am I in terms of my fitness? And I would challenge the listeners to say, you know, you can compare to everybody else, but what's probably most helpful is compare to yourself. Am I getting fitter or as I age, maintaining my fitness over time, which you can do one in a

myriad of ways. You can go down to your track and run a mile. You can go sign up for the Fun Run 5K, compare your times. You can have a loop that you do on your bike and see, hey, am I going a little bit faster? Or is this a little bit easier in terms of, am I breathing a little bit less? Is my heart rate a little bit lower? Whatever metric you want to use is just fitness that matters. Brad, I want to bring you in here because it sounds like the case Steve is making is that

milespeed is just about as predictive of cardiovascular health as VO2 max. But mile speed is something old and familiar. It doesn't have the sheen of sophistication. You don't sound smart. If you talk about miles speed, miles speed, mile speed, you do sound smart when you're talking about, you know, milliliters of oxygen that can be utilized by the body, you know, at maximum of exhaustion. But it's, I don't want to crap over VOTMX too much because it seems like if you lift up a little bit, the important thing that it is telling us is that even for people who go

to the gym a lot, who lift weights a lot, you can't just rely on lifting weights. Cardiovascular health running is still really, really important. You should have shook your head in an ambivalent way. Do I have that wrong? Do you disagree that VOTMX is, is telling us that. we should do a lot of pure cardio when we work out? All right. So first I'm going to dive into the weeds of the science, and then I'll try to pull up at a high level. So there are no good, big studies that look at individuals

that concurrently strength trained and aerobically trained, and then look at mortality as an end point. So what we can do is we can look at people that strength train and say that people that go to the gym four times a week and strength train tend to live much longer on average than people that don't, and we can say that people with really good aerobic fitness tend to live on average longer. We don't know if there is added benefit

for the person that strength trains four days a week and then also runs three days a week. However, I would say that, yeah, you want to have good cardio-respatory capacity. The reason I was kind of smiling and ambivalently shaking my head is Steve's going to go to mile speed because Steve ran a four-minute mile 401. It's like the bane of his existence back in the day.

So Steve is a runner. And Steve alluded to this, though. it's not just mile speed. So I couldn't run a fast mile to save my life because I haven't run in 10 years, but I could get on the skierg and I could produce a decent amount of wattage over eight minutes. I could do a set of 20 squats with a fairly heavy weight on my back and put out pretty good outcomes over two minutes. These are all ways, to Steve's point, to kind of test, like can you do a fair amount of

work with a given amount of stimulus or load in a given amount of time? and as long as that number is going up, then you're getting fitter, and you're going to be fine. I think that when Steve told me that we're coming on the show, the first thing I texted him is like, yeah, I agree. V-O-2-Mex is good. You could do a lot worse,

but I really think, like, the Stolberg method would be, can you take a brisk walk for an hour, can you very quickly get up two or three flights of stairs, and then if you're on the ground, can you get up with ease? And my guess is that would be as predictive of longevity as any VO2 max number. But they're all just kind of the same ways of pointing it,

like, do you have decent general fitness for life? I think I understand walking up flights of stairs, and I definitely understand brisk walks. Before we go to the second health ad here, what's so special at being able to stand up? What did you say? Get off the ground without effort? Yeah, get off the ground with relative ease.

It's just a good measure of strength and coordination, and particularly as we get older. One of the biggest risks of early death is falls. It's really common that someone 75 or older falls, they fracture their hip, now they're bedbound for three weeks, and things very quickly spiral from there. So having decent bone density in a good musculoskeletal system, i.e. strength is somewhat important as well. And this kind of gets to the government guidelines, which are like 150 minutes a week of moderate to intense aerobic activity and two days of strength training. And if everyone did that, we'd have a very healthy population in terms of fitness. Yeah, this is a theme that we're going to return to, I think, whether or not the FDA is our friend or our enemy when it comes to nutrition and health guidelines.

I want to move on from VO2 Max to another incredibly popular idea that people should do every single day in order to improve their health, which is to get morning sunlight. Andrew Huberman, the Huberman Lab podcast, this might be the idea that is most famously associated with him, the importance of early morning sunlight. Brett, how do you feel about this? Is it, is it, is obviously not over-technical, like the O2Mex? What does the science tell us about early morning sunlight exposure? It's good for us. So I think that the reason that it takes off is it's a very simple thing that anyone can do. And then we feel good.

It's like why people take supplements, right? It's very easy to take a supplement. You feel like you're doing something for your health. It makes you feel good in the know. In the case of morning sunlight, when we have exposure to daylight, it helps regulate our circadian rhythm. It sets off a whole cascade of hormones that regulate the sleep wake cycle, which is just a fancy way of saying. It tells us like, all right, time to wake up and start to get energy for the day. And deep down inside our neurology, it also is saying, all right, about

12 hours from now, you're going to start getting tired. It's why jet lag sucks. It's because you know, you fly in its light and then you land in its light. And it's been 12 hours. It makes no sense to your body. So yeah, getting morning sunlight is great. great. Do you have to wake up at a specific time? Do you have to do it within 10 minutes of waking up? Does it have to be from a specific angle? Maybe there are marginal benefits on the scale of a tenth of a percent, but I think the general guideline is try to get outside early in the day. And again, it's good for circadian rhythm. It's probably good for vitamin D. Sometimes the suggestion to get early morning sunlight is folded into ever increasingly complicated morning routines. I

I think one of the more popular ideas that people take away from health podcasts, and the He Ribbon Lab is a part of this, is that they get really complicated morning routines, morning stacks, so to speak, evening routines, sleep stacks. You and I were emailing a little bit about this, and you had really a fascinating way of thinking about the way that we in the 21st century, in an ironically secular age, think about morning and nighttime routines that we have come to call stacks taking from technological language. How do you think about this obsession with complex routines in morning and evening stacks? So I think obsession is the key word here, because there's nothing wrong with having routines

and rituals. They're quite conducive to priming us to perform at our best. They help to mark the passing of time and imbue our life with gravity and meaning. So routines and rituals are fine. What is interesting to me is when we get into that level of obsession and the routines and rituals become very complex. Some people call them protocols and you kind of have like a protocol for everything. And growing up, my aunt was an extremely religious Orthodox Jew. And she had rituals and routines for everything. And I can't help but be reminded a little bit of that when I hear and I see some of these people implementing these health routines and rituals. And then, of course, the point of religious routine and ritual is for many people, it's a sense

of structure in their life. If you believe in the afterlife by engaging in these rituals and routines, you are essentially getting the religious version of immortality. It gives you a sense of control over an inherently uncontrollable world. And again, like, there's nothing wrong with ritual and routine. For all these reasons, they're a good thing. But when they're taken to the next level, it was shortly after you published your wonderful essay in the Atlantic on the decline of religion and how it leads to gaping hole. So my brain said, well, in a way, this is kind of replacing religion. Like, it is a secular religion.

And then that so many religions are pointed at the afterlife, this religion has pointed at living forever. It's two sides of the same coin. I am endlessly fascinated by the decline of religion and the many ways that people, and especially Americans, because America has always been particularly religious as a rich industrialized country. the many ways that we try to recreate religion without church and belief and how sometimes we get it right and sometimes you get it wrong. And I love the nuance that you had there because on the one hand, ritual is wonderful. A morning routine, even one that might have no actual FDA phase three clinical trial effect can still have a placebo effect. It can still make you feel like you're getting a hold on the day.

And a placebo is just as good as a real effect, as long as it involves one person. So there's all sorts of ways in which on the one hand I can say, look, do your overly complex evening routine, do your overly complex morning routine, that's all fantastic. But one big difference, I think, between what we call stacks or protocols and what I suppose religions called rituals, is that rituals tended to be either collective or focused on something outside of the self. It was focused on a relationship with God or a relationship with a congregation,

maybe a relationship with the family, something like Shabbat dinner. Whereas it seems to me, like when I hear all these people, espouse a kind of caveman masculinity where it's like, be as strong as you can and as stoic as you can

so that you can survive as if alone all by yourself, then I think to myself, oh, you know, like, you're telling people to be as strong as they can without any kind of, you know, relational strength. And that's a,

It's a weirdly post-religious approach to trying to optimize or trying to find self-actualization. See, do you have stacks, protocols, overly complex morning and evening routines that you want to defend briefly here? I have a nine-month-old daughter, so all my stack, sleep routines, et cetera, I've gone out the window. But, yeah, my daughter is eight months old. So, yeah, you're 30 days ahead of me on the morning. in the evening stack. Congratulations, by the way. Thanks. But I think there's a degree of it, which is, like, you said it. Like, routines can help. Rituals can help. Like, there's some supplements, there's some ideas that can help. But if you look at the best of the best performers, they

generally don't have as elaborate routines or rituals as, you know, the people on Instagram. And I was always joked about this. I was a long-time runner, as Brad mentioned, coached high school, college, professional Olympic athletes for a long time. And we used to joke of like, hey, we invented all these morning routines. For instance, like the fasted exercise cardio, the getting up and exercising and seeing sunlight. Why?

Not because we were trying to maximize anything, but it was because we were training in Houston, Texas, and it was miserable if you didn't get out and run before, like, 7 a.m. So you didn't feel like eating beforehand. You fasted and you got up and got your run in. And I think I think that is important here is not to tear down routines, rituals, whatever, but I think we miss the thing. Generally those routines things are like the final 2% and not the thing that actually matters, which is are you finding a way to get out exercise, to get sleep, to like eat enough calories to fuel you, all of those things that make up the big 98%.

Where I would push back, and I would expect that you would agree with this generally, so it's not exactly a fight, but where I suppose I would push back is the idea that for lots of people who listen to these podcasts, who listen to Heberman or Rogan and think,

I'm going to do whatever they just told me to do, they're not coming from the perspective of, I'm an Olympic-level runner. I already have the conscientiousness to go to the gym for five days a week. They're coming from a different position where they have a problem. Maybe their problem is insomnia, right?

Maybe it's just they have trouble falling asleep and they don't know the basic facts of you probably shouldn't have like a shot of whiskey just before you try to go to sleep. That's going to destroy your circadian rhythm. They don't necessarily know the basics of it's better to eat earlier rather than later in the evening. And even something as simple as a sleep stack

of just having like four little boxes of things that they take at night, where they're like, I'm going to take this and this and this and this, add structure to a life that was previously unstructured. So Brett, how do you feel about that, you know, defense of the sleep stack, the evening stack, even the morning stack, that for a lot of people that are doing this, they aren't people who have strong rituals that can poo-poo over-hyped rituals. they're people who don't have rituals

that are being introduced to a theory of organizing their day. If that is the end outcome for these people, then I think it's a good thing. If they have the means to be able to afford the cost of these various

supplements, and then if the supplements aren't tainted. We know from research to 25% of supplements are tainted, meaning they have things in them that are not as advertised. I personally, and very cautious whenever considering any kind of supplement because of that. I would rather like light a candle at night and make coffee in the morning.

Because again, like, I do think, and I want to keen on this, there's this feeling of like the modern time warp where one day bleeds into the next, especially if you work remotely, and you kind of just like float through life. And weekends and weekdays and everything just blurs. And then you're like, holy crap, where did time go? And I think a big reason for that feeling is because we don't have seasonal or daily or weekly rituals. You know, we don't go to church.

We don't have Shabbat dinner. Most people don't do the solstice. Most people don't wake up and say a morning prayer or whatever it is. And those markers of transitional time, those are really important. Like, they help us derive meaning from our life so everything doesn't blur together. So there's nothing wrong with those rituals and routines. I think, to your earlier point, like those tend to be wrapped up in collectives. And the purpose of those tends not to be to slurricular.

sleep better or to have more energy to perform better, the purpose of those is to like sit back, take stock, and reflect. So if you take, you know, magnesium and melatonin and whatever else is on offer and you use that as a moment to sit back and reflect on your day and, you know, welcome nightfall to go into the next day, that's fine. But if you're taking it is like this panacea that is going to cure your insomnia and then it's, if anything, making you more focused on your sleep, you get what health psychologists call an ironic effect, which is simply the more you try to do something, the worse off you are. So the more that you've had episodes on this, but the more that you try to sleep and the more that you obsess over your sleep, the more likely

your sleep will become problematic. Because the key to falling to sleep is just to let go and release. We've been talking so much about supplements. I think we should dive right into it. There are obviously a lot of extremely popular health advice podcasts who shows are essentially funded by supplements. Heberman Lab has AG1. Rogan has a whole panoply of supplements. that he hawks. I think it's important to say from the top that from a legal basis, supplements are not like FDA-approved medications.

They don't have to be FDA-approved. If you have a molecule or a mix that you want to sell and you have a claim that it treats or prevents or cures some disease, you need FDA approval in order to make that claim and sell that molecule or mix. But if you have a product that is safe, that passes certain basic good manufacturing practice

and standards. And you have a sort of structural claim, like my fish oil mix will be good for memory or my calcium mix is good for bone density. You do not need FDA approval. You can simply sell your product, even though you retain the legal downside if your product ends up killing someone, obviously.

Steve, I want you to start on this. How do you feel generally, about what I would describe as a kind of explosion of supplement hawking in the health podcast world and really just in the health influencer world. I mean, it is a space of media that is generally funded by an unregulated set of promises. Maybe I'm gilding the lily here, but how do you feel about it? You know, Derek, regulation often gets like hammered, but in this case, it's like much needed. And there's historical precedents from this. Okay, look, the FDA was going to regulate supplements. Back in the 80s, they were looking at it. They said, hey, we're going to do it.

And then late 80s, early 90s, Utah Senator, Orrin Hatch, you know, gets together, finds the compromise and says, hey, we're going to classify this as something different. And he was getting a lot of funds like support from supplement companies. And for good reason, it's big business. And since then, it has just exploded, and its modern iteration is the supporter of the health podcasts. I mean, that's where sponsors come from. And I think there's, you know, where do I feel about it? I think it comes back to what Brad said earlier, is if you look at the research, between 15 and 50 percent of supplements are contaminated with something,

including contaminated supplements that would cause a positive, a doping test, in sport and get you banned. So we're talking, you know, ingredients that do something, potentially harmful. And I think if we're having a discussion or podcasts on supplements or health or what have you, I think we do our audience a disservice when we sit there and, you know, don't disclose that a lot of these things don't work. A lot of these things are contaminated. A lot of these things are essentially combine a bunch of stuff together that sounds

healthy, some of which is healthy, but combine it all together, promise a miracle cure, and then give it to people. And then what research shows us from psychology is that often if you take that magic powder or magic pill, it has kind of a licensing effect. You stop doing the things that actually help you, you know, be healthier. You stop paying attention to your diet as much, or eating those fruits and vegetables, or like, doing the exercise that you might need. to because you're like, ah, I'm covered. Like, I took this, you know, this powder with 75 different vegetables included. Do you have anything specific to say about AG1, which was the supplement that came under scrutiny and the Heberman profile in New York Magazine? I mean, here's,

here's all I can say is I'm not here to hate on any specific supplement companies, but if you look at the research, there is no research on it. Okay, there is no research that shows that it does anything at all. And to me, if you look at the supplements that actually work, can it make a difference? Things like creatine in terms of strength, things like caffeine for performance, things like, you know, iron if you're your endurance athlete and are, you know, iron deficient or calcium and vitamin D for, you know, stress fracture health and runners, or even in endurance athletes, beat, supplement has a performance-enhancing effect. If you look at all those things that we know work,

there's a long history of science and research, studying them in multiple domains and showing, hey, these have an effect. And generally, when you look at companies that go down that path, they help fund some of that research or support it or at least put it out there where, hey, we want this independently tested and verified. And I'm very hesitant at supplements or companies that don't do that.

Because to me, it tells me, like, hey, we're just going to combine a bunch of ingredients that sound good. But our goal is to sell things. And then even more so, I think, if you look at, are they going the, like, we're going to spend literally millions to sponsor popular health, you know, podcasters or influencers and not do any of the hard work to see what happens or see what the effect is, I think that tells you, like, maybe they don't have the confidence in the product, you know, product, because a good scientific study that says, like, hey, this works, look what, look at

the market for creatine. It's exploded because it does something. I want to hold on creatine for just a second before we continue to analyze the general supplement market and as it intersects with the health media space. What is the deal with creatine? Because I'll admit, there's a part of me that sort of folded it into the airy promises of health influencers and said,

I'm not going to trust that yet. Brad, you're shaking your head. Creatine actually does something? What is the thing that it does? Well, I'm a hyper responder to creatine, so I'm like the ultimate creatine evangelist. But here's what creatine does. So creatine helps your muscles essentially

produce the fuel that drives powerful, strong movements, a deadlift, a heavy squat, a bench press. About 40 to 60 percent of people that take creatine monohydrate respond to it, meaning it actually does something for them. The people that do respond to it, it's pretty profound. You gain about five pounds in lean muscle mass, and your strength goes up from anywhere two to five percent. So we're talking about you take like a 300 pound squat and you make it 315 pounds. For an athlete, that is enormous. Creatine, as Steve mentioned, has been studied for the last four decades. It is an extremely safe supplement.

It's been used by athletes. It's been used by laypeople who just try to get stronger. It's also extremely cheap because it is so ubiquitous, presumably. I will say that something very interesting happens, even with creatine. Is a part of this health, I don't know, 17.0, there's been so many iterations. you now see a lot of muscle scientists, they're exercise scientists that also work out. And now they're starting to latch in and like,

well, maybe creatine has cognitive benefits. Or maybe there's this little bit of a signal that shows that creatine can help with Parkinson's. And there I'm a little bit skeptical because I think motivated reasoning is powerful of a drug as any of these supplements. So if you're taking something already to make you stronger, of course you're going to want to latch on to the idea

that it has these other benefits. But here's what I would say. I think that if you are interested in gaining muscle, particularly for a performance-based reason, and you've yet to try creatine, it is a supplement that can help, again, somewhere on the order of 40 to 60% of people, and it has a genuinely quite good safety profile. This segment is brought to you by creatine. No, I'm only joking. That's fascinating.

I know very, very little about this world. And, you know, the truth is to go back to one of the first statements that Steve made, I'm not sure how I feel about light regulation of supplements. I'm not scandalized by our having different standards for different kinds of promises. If there's going to be one set of chemicals, like caffeine, it essentially just says this is going to give you more energy. I don't think that should be regulated the same way that, like, a cancer prevention pill should be regulated.

What I am scandalized by is people in the health advice. space promising cures that avoid scrutiny. And I especially have a problem with it when, in the case of people like Rogan that are more center-right coded, they're not just in the health advice space promising medical cures that haven't been interrogated and scrutinized. They are at the same time often criticizing the regulatory regime that for all of its mistakes and the FDA has made mistakes is doing its best overall to try to make sure that the promises that molecules have on the label are actually accomplished in general representative populations. Brad, once more to you before we change the subject,

I mean, how do you feel about the sort of environment of FDA skepticism, even FDA hate that we have right now, as it exists, especially in the world of health and nutrition? All right. So I don't know if I'm a lot to swear, but I'm going for it. The FDA has one major fuck up in our lifetime, and that is the opioid epidemic. And people that are skeptical and don't want to trust the FDA and that have a family member that suffered from addiction to opioids and perhaps death, like they have every reason to be skeptical. I hesitated when I said one. About 15 years ago before that, Vioxx, popular anti-inflammatory painkiller, was on the market for quite a long time before it got pulled due to severe complications.

That's like... I'll just, I'm just to jump in. I do think that the FDA has almost certainly made errors of both commission and omission. I'm sure that if they've made mistakes approving drugs that shouldn't have been approved in the way they were approved, I'm sure they've also probably made mistakes not approving drugs that if they're on the market, would make people healthier too. We're not going to do a whole segment right now on the FDA's batting average of the last decade. But suffice it to say the FDA has made mistakes.

Back to you. Correct. Yes. And I think that's important to stay. And there's a process for remedying those mistakes. Drugs get pulled from the market. So on and so forth. So yes, institutions have all sorts of failings.

But the opposite is some guy in Murray, Utah, in his basement, putting together a concoction and then telling you that it's going to be this elixir for longevity or health. and I'd go with the FDA's batting average over the guy in the basement. So that's thing number one. I think thing number two is there's often in these like more right-coded, you know, the government's not being honest, so take this supplement or eliminate seed oils or only eat all-meat diet, whatever it is. There's a lot of straw manning here.

So you look at the actual FDA in U.S. ADA recommendations for food, nutrition. and it's like eat 2,000 calories a day. You look at the plate that they put out. It's like a small portion of starch, carbohydrate. Then there's some sort of lean protein and then fruits and vegetables. I can assure you that no one has issues with lean body mass eating 2,000 calories a day

based on the FDA plate. Then you go look at exercise. Again, 150 minutes of moderate to vigorous aerobic exercise and strength training two days a week, if everybody did that in eight, 2,000 calories of that plate, we would have an extremely healthy population. So the problem is that very few people are educated on and follow these regulations.

There is an enormous problem with the built environment that favors foods that are ultra-processed and highly palatable and not very satiating that contribute to ill health. We have very few walkable cities. People don't ride bikes in this country. So there are all kinds of problems, but to point it like these one or two regulators and blame it on them, when their actual guidelines are precisely what we should be following, it just kind of like it's a false boogeyman. And I think the other part of this is that if you look at some of these influencer podcasters, they often often sell their own supplements. And this is part of the, you know, the big issue because it's so easy to create a supplement company.

I mean, Derek, Rad, like, we could start one tomorrow. And then what you're selling is not, does this work? You're essentially selling your platform and your image. And I think with influencers, this has exploded because, like, if you're someone who looks jacked and, like, looks fit, you're going to sell a hell of a lot of supplements. But I think, you know, they're exploiting that. When if you peel back the layer and you look underneath, I mean, we know from examples like the liver king. Like what's underneath the supplements. I love the liver king. All over Twitter,

yes. Yeah, it's not, it's not the whatever, you know, liver supplement he's taking that works. It's not that he's just eating raw like pteratosaurus rex liver right on camera. Okay. Right. It's the drugs. It's the steroids. But in that get, that knocks me even further for a loop because often we hate on the FDA and drugs. And then we're, you know, we're taking, you know, drugs that, to a degree, aren't regulated or monitored well, in terms of various steroid concoctions. And I think that's the hidden underbelly that is also very rarely discussed. Last thing I'll add here is I think something that is just like a really sad example of this. And I try to be a pretty forgiving human being and give people the benefit of the doubt.

But someone that I think is just beyond the pal is the Sandy Hook denier, Alex Jones. and he built his entire empire on supplements. So before the conspiracy theories, before the crazy takes, he's a supplement guru. And like, so this, this is, this traces itself back a long time. And I remember looking into this for a project I was working on in the midst of the pandemic, early on when he was one of the loudest anti-vaccine voices, he was selling lung immunity boost through a website. site that looked like it was designed by my seven-year-old in the 80s. And like, I can't imagine what was in this thing, but I wouldn't be surprised if it was like,

I don't know, like rolled up baking soda with a little bit of bacon. Like, the point is, it just is mind-numbing that we can trust those things, but not an actual regulatory body. And I think, like, once you start to see the grift in extremists, you start to see it elsewhere in less extreme versions. everything we've been talking about, I think, fits under a bucket that I've been very interested in the last few years, which is the bucket of trust. I mean, we're going to have listeners who think that the conversation we just had about the FDA and pharmaceutical companies was

borderline insane, because they just decided that the FDA is bought and paid for by Big Pharma, and all Big Pharma wants to do is make us think we're sick and give us all the drugs. I'm sure there's listeners like that. There's been a lot of listeners who think that we're exactly right, that are relatively high trust in the FDA, think that like so many other government and non-government agencies in the world that's generally doing its best, has a non-1,000 batting average.

But what I find so interesting is that at the end of the day, you have to trust something. You have to trust something. And so you have a lot of influencers who are telling the public to not trust agencies and not trust old traditional authorities.

And they're essentially saying, put your trust in me. Like, where does the trust come from? Does it come from third-party evaluations of the quality of supplements that are being sold by Alex Jones? No, it's coming from a conflation with, I think Alex is generally right in his anti-institutional takes, and therefore, I'll put whatever mix he pours into a box and puts a label on into my body.

And we're not going to fix the trust problem here because it's unbelievably complicated, but fundamentally it comes down to the fact that I actually don't. think maybe it makes sense to think of people as being high trust versus low trust. I think everyone trusts someone or something. And it's so interesting that we live in a world where individuals, rich, millionaire, especially ripped liver king individuals, can merchandise individual trust in themselves by essentially getting people to put their money where their trust is and just buy mixes of supplements. I think it's a really fascinating phenomenon. I want to close another phenomenon that I find incredibly interesting, and I just want your guys' minds on it.

I'm very interested in the longevity space, and this group of people, maybe most famously or infamously, Brian Johnson, who are willingly turning themselves into guinea pigs in order to try to live forever, who are taking cocktails of drugs and hundreds of pills a day in order to extend their health span. I think people like this, I'm so torn on this because on the one hand, I think there's something profoundly and irreducibly creepy to me about making life extension, the centerpiece of your life. It strikes me as like a fundamental misallocation of attention. Like the point of mortality cannot be designing yourself around the illusion of immortality that it seems like an obvious error. And yet at the same time, a part of me thinks, look, if a group of people are willing to turn themselves to human guinea pigs,

and, you know, put rhinoceros DNA in their butt, hoping that it will extend their virility. Well, if stuff like this turns out to work from a phase three clinical trial standpoint, and it helps the world, maybe more power to them, they turn yourself into a human guinea pig. What do I care? I don't live your life.

How do you guys think about, feel about this general space of people who are essentially obsessed with pushing off the inevitable. Steve, you first. I think there's a couple things. First, we have to look at are the measures that they're using actually accurate.

Because when we look at the Brian Johnson's of the world, many of the things that are like, oh, I made, you know, my internal life clock, this age, this age, this age, this age. You look at the science, and there's not any good science behind it. Some of the stuff there is,

but a lot of it is not. It's like marketing, hype. The second thing that I think is really important here is can these experiments actually tell us anything, which is kind of what you're getting at. If this person wants to do whatever they want and take 50 different things and exchange their blood or whatever crazy thing it is, that's on them. I agree. But does it actually tell us anything? And there, I would argue probably not because it's not good science. Now, I'm not trying to be the representative of science, but maybe analogy here works. As a coach, If I say, Derek, I'm going to make you run a faster mile so we can get that VO2 max up and you can live longer.

And I give you, you know, over the next 60 weeks, I give you 50 different individual workouts and meal plan and sleep plan and all that stuff. And you get a little bit faster. Can I point to workout number 17 and say, when you went to the track and you did these 100 meter repeats, this is the thing that improved you? I can't because we threw a lot at you. I can get a rough idea, but we threw a lot at you. And I think that's what you're seeing when you're changing all of these different things, when you're taking 7,500 different supplements, when you're doing all these different interventions, can you tell us that it is changing X, Y, and Z?

Most likely not, because we know from science, what do we have to do? We have to kind of isolate to figure out what the effect is, because the cumulative effect is different. And then the last thing I'll say on these is my number one thing when I come back, to it is, are they just doing this for curiosity's sake, for their own sake, or do they have a supplement line they're selling? And I think that often is a giveaway of maybe what are the intentions behind it? And like, can you trust them? All right. So if I may, I have so many thoughts on this. The first is Neil Postman amusing ourselves to death. I think there's just a lot a shock value in putting rhinoceros DNA in your butthole and measuring your erections.

And I think being in the limelight and having attention and people care about what you're doing is addictive. And I think that there's definitely some of that it play. I think to Steve's point, I just pulled it up, right, because I don't know this guy too well, but looks like Brian Johnson sells the blueprint longevity stack. I'm quoting from his website, the world's best health protocol in lower cost than fast food. And he's got four different longevity mixes, four different pill bottles. And I kid you not, his main supplement that's pictured on my screen right now is called snake oil. And to me, this is like some Hannah Arendt, like just try to confuse the masses between what's true and what's not. And, you know, Derek and Brad are going to say that I'm selling snake oil.

Well, I'm just going to call it snake oil. And that'll really confuse people. So I see all of this and it just makes my brain explode. Now he can do whatever he wants to do and people can pay as much or as little attention to him as they want. I personally don't pay much attention to him, but I'll tell you what, if the rhinoceros DNA extends my life by two years and we go through a scientific process to prove it, I'll be first in line to put it in my butt. I've read everything you just have to end it there. Like just absolutely no context. We're going to end it there. going to end it there. I think generally I agree. I think I still, maybe despite myself,

might be slightly more positive in Brian Johnson than it sounds like you guys are. There's a part of me that does find it vampirically creepy. And another part of me that's like, man, like, this guy is doing stuff that is so outlandish. If there is a possibility that he accidentally falls into something that could help millions of people live a little bit more healthily. And I don't know what that something is. And to Steve's fantastic point, if you're changing what you're doing at every single minute of your waking life, it's going to be even harder to disentangle what has the largest intervention effect, especially because N will always equal one here. But there's a part of me, maybe just a hopelessly optimistic part of me that

Thanks. You know what, crazy guy, go do it. Put those injections in your body. I just hope to God you end up discovering something that scales for n-equals $1 billion. Any final thoughts, Steve? You know, I can see that point. I don't have as much hope as you, but, you know, a lot of scientific discoveries have been people stumbling around in the dark, so maybe he stumbles on to something. And then, you know what? How will we know what works? Because we'll actually do good science to see if it has an effect. And I think that part of the process is really important. Amen to that. Thank you guys so much. This is so fun. We'll do it again next year. Thank you.

Thank you for listening. Plain English is produced by Devin Biroldi. We've got new episodes every Tuesday and Friday. If you like what you're hearing, give us five stars and a nice review on Apple Podcast or Spotify or wherever you get your podcast for feedback and episode suggestions, email us at plain English at Spotify.com.