The Dr. Hyman Show - Why You’re Still Tired — And How to Fix It (with Dr. Andy Galpin)

Episode Date: June 18, 2025

On this episode of The Dr. Hyman Show, Dr. Galpin, a leading expert in human performance, shares how to use your blood work, sleep metrics, and movement data in a way that actually helps you feel bett...er—not just check more boxes. We discuss:  • What most people get wrong about sleep—and how to fix it • Why early testing can change your long-term health • How muscle impacts your brain, hormones, and aging • What high performers do differently—and how to apply it to your life Whether you want more energy, better sleep, or a smarter way to track your health—this one’s a game changer.  Tune in—you don’t want to miss it. View Show Notes From This EpisodeGet Free Weekly Health Tips from Dr. Hyman https://drhyman.com/pages/picks?utm_campaign=shownotes&utm_medium=banner&utm_source=podcast Sign Up for Dr. Hyman’s Weekly Longevity Journal https://drhyman.com/pages/longevity?utm_campaign=shownotes&utm_medium=banner&utm_source=podcast Join the 10-Day Detox to Reset Your Health https://drhyman.com/pages/10-day-detox Join the Hyman Hive for Expert Support and Real Results https://drhyman.com/pages/hyman-hive This episode is brought to you by LMNT, PerfectAmino, AirDoctor, Big Bold Health and Sunlighten. Get a free LMNT Sample Pack with any order—just head to drinklmnt.com/hyman. Get pure essential amino acids today. Go to bodyhealth.com and use HYMAN20 to get 20% off your first order. Get cleaner air. Right now, you can get up to $300 off at airdoctorpro.com/drhyman. Try HTB Immune Energy Chews for yourself, visit bigboldhealth.com and use code DRMARK 25 at checkout to get 25% off your purchase today. Visit sunlighten.com and save up to $1400 on your purchase with code HYMAN.

Transcript
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Starting point is 00:00:00 Coming up on this episode of the Dr. Hyman show people are doing right like why am I still tired like I try to sleep Well, I exercise I eat good like they're still feeling exhausted You should feel a little bit tired in the afternoon. You should feel pretty tired at night. These are normal things This is not dysfunction Dr. Andy Galpin who has helped elite athletes to peak performance from the Olympics to pro sports to the military breaks down how to decode fatigue Sleep and energy using science not guesswork. If you have high quality muscle, it's really hard to have metabolic problems.
Starting point is 00:00:31 Sleep regularity is more important than people think, meaning going to bed and waking up at the same time every day. When it comes to perceived feeling, your energy levels, that regularity will play a bigger impact than the total hours. Let's talk hydration because most people are getting it wrong. If you're feeling tired, foggy, crampy, or just off and it could be your electrolytes, I see it all the time in my community, especially with folks who are active, eating clean, or doing intermittent fasting. That's why I use and recommend Element.
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Starting point is 00:01:30 Right now, Element is offering my listeners a free sample pack with two of each of their most popular flavors. Citrus salt, raspberry salt, watermelon salt, and orange salt. That's eight single serving packets for free. Go to drinkelement.com slash Hyman to claim your free sample pack with any order. That's www.drinkelement.com slash hymen. I'm always looking for ways to help my patients optimize recovery, build muscle, and improve their overall health. That's why I recommend Perfect Amino, a pure essential amino acid supplement designed to maximize protein synthesis without the caloric impact. Perfect Amino provides all the essential amino acids your body needs in a ratio
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Starting point is 00:02:34 for better health and vitality. I encourage you to try Perfect Amino today. Go to bodyhealth.com and use code Heiman20 for 20% off your first order. You'll be amazed at the results. Before we jump into today's episode, I wanna share a few ways you can go deeper on your health journey. While I wish I could work with everyone one-on-one, there just isn't enough time in the day, so I've built several tools to help you take control of your health. If you're looking for
Starting point is 00:02:56 guidance, education, and community, check out my private membership, the Heiman Hive, for live Q&As, exclusive content, and direct connection. For real-time lab testing and personalized insights into your biology, visit Function Health. You can also explore my curated doctor-trusted supplements and health products at DrHyman.com. And if you prefer to listen without any breaks, don't forget you can enjoy every episode of this podcast ad-free with Hymen Plus.
Starting point is 00:03:20 Just open Apple Podcasts and tap Try Free to start your seven-day free trial. Well, Andy, so good to have you on the Dr. Hyman show. It's been a long time coming. I've followed your work for a long time, and I also think you're doing stuff which is really great, which is taking what you've learned from elite athletes and extreme performance needs to the everyday person
Starting point is 00:03:39 who's struggling with just how do I feel better, do better, and function better, right? So I think there's a lot of insights that you've learned. I want to unpack those today and get into it. I want to start with something that is really a big issue in America, which is energy or should I say the lack of energy and this issue of fatigue and everybody's struggles, you know, I'm just wondering from your perspective and in terms of the work you see see what's the most common cause of the fatigue?
Starting point is 00:04:06 That's out there this sort of endemic fatigue in America. Yeah, I'm glad you started this because you're right I'd say of all the people that We've worked with their coach or seen this is probably the number one thing most common Thing that comes up. I think the best place to start is realizing number one, fatigue itself is not pathology. It is normal to be tired. This is actually a good thing because we're now getting signals from the body, in some sense, right?
Starting point is 00:04:32 We don't want the, I'm exhausted all day, I can't function without 600 milligrams of caffeine, right? So there's limits here, of course. But I'm saying that because we have actually dealt with a lot of people who are struggling with this concept. The first sign of fatigue they get, they then pathologize it, they think that there's a disorder or they have a deficiency, and then they run down the spectrum of problems, right? So we don't want to cause problems and overanalyze when they don't really exist.
Starting point is 00:04:57 You should feel a little bit tired in the afternoon. You should feel pretty tired at night. Like these are normal things. This is not dysfunction. So fatigue is not automatically dysfunction. If it is the point where it's disrupting your life, we're having a second conversation and we'll spend most of our time there. But it was important for me to point that first part out. Although I don't know, Andy, I used to have lots of energy when I was younger and it changed over time. And I remember when I started medical school, I just would have even energy all day. And then somehow I thought that I was supposed to drink coffee in medical school yeah and I never drank coffee before medical school
Starting point is 00:05:31 and then I would like have this crash in the afternoon what is going on you know with that I mean I think I think it's not normal really to feel sluggish in the afternoon is it well some some amount of let's define again sluggish versus I feel a little bit more tired. I'm not feeling at 10 out of 10 energy and focus and concentration. If it is I can't move, I can't get throughout the day, now, and we wanna make a change with that,
Starting point is 00:05:57 now we have a conversation, right? So number one, you may not have to overthink this. Simple things like maybe 10 minutes of backing off is enough. You'll be stunned. Again, you might not have these pathologies or anything going on. It could be the fact that you have podcasts
Starting point is 00:06:17 coming in all day. You have nonstop stimuli coming in. You have everything firing at you at all cylinders. And that didn't happen when you were 20. You weren't on your phone all day when you were 20. There wasn't a phone. There wasn't a phone. We had landlines when I was 20.
Starting point is 00:06:30 Right, but there wasn't the internet, there wasn't these things, so when we hear these stories a lot of times, I'm thinking, I know, but the world you live in now is not the world you lived in 20 years ago. Definitely not, no. And so now you might need strategies now that you didn't have to have in that time,
Starting point is 00:06:43 which could be as simple as, for you, you might need strategies now that you didn't have to have in that time, which could be as simple as, for you, you might get super restored by just literally setting a timer for 12 minutes and going and standing out in the sun. Someone else that might not do anything at all, they might need to close their eyes and lay down. Fall asleep, don't fall asleep, I don't really care. It might be physical activity.
Starting point is 00:06:59 There's lots of different things that give people energy back, and it can be as short as this eight to 12 minute window. So my first stopping place in this journey is to say like, okay, what do we really mean by fatigue? Are you noticing it happening on days when you're writing? Or are you noticing it happening on days when you trained really hard in the morning?
Starting point is 00:07:16 Like what is the thing that's kicking? There may be something there that is going, hey, you had your hardest training session this week. Let's not be surprised when you're a little bit tired this afternoon. That's not a dysfunction, right? I could go on and on examples, but this, this first landing stop is again, making sure that
Starting point is 00:07:30 we're really understanding. There's normal variations in our energy. Normal variations. That's true. But what I'm talking about people who just feel tired. Okay. Exhausted all day.
Starting point is 00:07:38 We don't have to overthink this one either. The first place we're going to look now is sleep. Yeah. Somewhere, depending on the data source you look at, 70 to 80% of sleep disorders will go undiagnosed. I can't tell you how many people we've had come through, I sleep fine, I sleep great, I sleep pretty good. And then we actually run proper analyses on them
Starting point is 00:08:00 and they have anywhere between moderate to severe sleep disorders. We actually had one guy, very interesting, in Colorado. He lived in multiple houses. So he lived at sea level, normally. Older guy, drank a lot, didn't take care of his health, but he was fine. A little bit of snoring, energy was pretty much okay.
Starting point is 00:08:20 And then when he went to his house in Vail, he went from moderate to extreme sleep apnea. He had no idea. He was just giving this like energy things like I don't understand. Well, his house was at like 9,500 feet, right? Pretty high, yeah. That will exacerbate sleep disorders massively.
Starting point is 00:08:36 So his tiny sleep disorder here became hugely problematic there. And it was so bad, we had to basically intervene and say like, you have a strong risk of a real cardiovascular event happening here at elevation, because his snoring, his everything, like, went off the charts.
Starting point is 00:08:50 So things like that can happen where, again, he didn't have a traditional, if you went to a sleep hospital, you'd be diagnosed with a sleep disorder, but that didn't mean he had great sleep. He just didn't recognize it. And we've seen things like this happen a number of times. That's a pretty, like, esoteric example I gave you,
Starting point is 00:09:07 like a really deep one. But we see this stuff happen often. My energy's super, super low. Like the common one is I think I need testosterone. Okay, fine, that's between you and your doctor, up to you. But have you actually diagnosed your sleep? Have you done anything there? Well, no, I sleep fine.
Starting point is 00:09:22 Or I use a consumer wearable. Okay, great, these are awesome for many things. But you've now spent all this money on a high level dietician. You spent all this money on a trainer and then you've done nothing for your sleep. You haven't really analyzed it at the highest level possible.
Starting point is 00:09:41 Just because you don't have a clinical disorder doesn't mean you don't have something there that is causing a ton of fatigue. I remember when a patient, when I had, they said, Dr. I don't know why, I'm just tired all the time. I said, how many hours a night do you sleep? He's like, five hours. I'm like, I think you need to sleep eight.
Starting point is 00:09:55 That'll be $500, please. Yeah, exactly. You know? Yeah, get more sleep. Right. I tend to skip past that one, actually, because some people just like, I already sleep seven and a half or whatever.
Starting point is 00:10:06 But you're right, many people don't even get close to the number. But once you've had that number, if you're the person who says like, I do sleep my seven, or we'll get this one a lot. Man, even if I sleep eight and a half for nine hours, I still feel tired. Yeah.
Starting point is 00:10:21 Okay, sure. But if you slept for five hours for the two weeks before, that one night is not gonna fully restore you. This will take plenty of time. And high quality effective sleep looks different for different people. And so precision is available there. We can start to figure out what is ideal recovery for you,
Starting point is 00:10:37 what actually solves that problem or what doesn't. So there's just a lot more granularity we can get with sleep, but that is always the first place we're gonna look. What are the problems that most people have with sleep? What's causing them? The biggest one that people don't pay attention to outside of total sleep is sleep regularity. So they'll say, hey, I got my eight and a half hours
Starting point is 00:10:54 or seven and a half or whatever it is, but we had social jet lag. Social jet lag is this idea of, you basically give yourself jet lag on the weekends, not because you sleep less, but because you sleep in a two or three hour different time domain. So let's say you go to bed at 10 on the weekdays,
Starting point is 00:11:11 wake up at six, there's your eight hours. But then on the weekends, you stay up till 2 a.m. and sleep till 10. You still got your eight, but you've given yourself jet lag because you're now four hours off. For 20 year olds, you can get away with that. For early 30 year olds, you can get away with that. For early 30 year olds, you can get away with that.
Starting point is 00:11:26 But past that, it becomes really debilitating. This is a really common, I sleep eight hours, I use my tracker, it says I'm at eight and a half, but I'm exhausted all the time. Sleep regularity is more important than people think. Meaning going to bed and waking up at the same time every day. When it comes to perceived feeling, your energy levels,
Starting point is 00:11:45 that regularity will play a bigger impact than the total hours will. That is the thing that's gonna make you feel awful. You can survive on seven, six and a half, like if you have to, if it's really consistent. Very hard for people to survive on inconsistent sleep schedules. And by survive, I mean feeling good.
Starting point is 00:12:01 Feeling great, right? Not death, that's a sort of separate issue. But the sleep- No partying anymore, that's it. Yeah, of course you wanna, feeling great, right? Not death, that's a sort of separate issue. But the sleeper- No partying anymore, that's it. Yeah, of course you wanna live your life, right? And be resilient, but you also wanna be reasonably consistent, right? Now somebody like the lot of the clients we work with,
Starting point is 00:12:16 and you're the same way I'm sure I am, actually do physically travel a lot. So we have to manage this in consistent schedules that are outside of our routine. So if you're in a situation, let's say you're also a shift worker or somebody that has inconsistent work schedules and you don't have the ability to control
Starting point is 00:12:35 and go to bed at the same time, other options you can have is trying to become more resilient to sleep changes. And that's something that few people really talk about. When we have conversations like this, a lot of people will hear things like, well that's great, I love to go to bed at nine o'clock every day and sleep
Starting point is 00:12:49 till seven a.m. or whatever the case, but not possible with my schedule. Okay, I get it. That's most of the world actually, right? Everyone we work with, all of our athletes, all of our military, all of our government leaders, they're all on wild schedules. They don't have, they're not at home every day.
Starting point is 00:13:07 Understand. What can you do? Become hyper resilient to change. So there's this whole facet within sleep where we can optimize resilience. And resilience is actually one of our biggest keys. What we focus on at Absolute Rest is not optimizing sleep in terms of sleeping 10 hours a night, right?
Starting point is 00:13:24 This whole idea of sleep optimization actually takes a lot of people in the bad direction. You don't necessarily want to be an optimal sleeper. You want to be a resilient sleeper, which means you can still sleep for six hours and show up the next day dialed in, performing and executing. You can have an inconsistent schedule
Starting point is 00:13:42 and we can still be great. That is where I think most people will get more bang for their buck is focusing in on that sleep resiliency. That's such an important concept, Andy, because whether it's your blood sugar or your metabolism or your brain health, the goal here is how do we build more physiological resilience, more ability to have elasticity in our activities, behaviors, so that we're not like stuck in a rigid physiological pattern. And disease really is less and less and less resilience. When you look at what disease is, it's the loss of physiological
Starting point is 00:14:19 resilience and metabolic and physiological flexibility. And so what you're talking about is, how do we build more flexibility? So can you unpack, how do we do that? It sounds good, but like, I'm very curious. Yeah, so your brain will do a lot of that for you if you get out of its way, specifically for sleep. Here's what I mean. If you're looking at a wearable and you're getting hyper-focused on the amount of minutes
Starting point is 00:14:43 you spend in deep sleep, we're probably already in the wrong conversation. Yeah, I do that. Right? I'm like, oh shoot, I only got 30 minutes. I'm like, I got an hour. Oh, I got, you know, like. Not good. For a bunch of reasons.
Starting point is 00:14:57 Number one, accuracy is an issue. But even the concern, deep, the idea of deep sleep is not a manufactured term, but it actually changes what categorizes, what counts as deep sleep. There's a whole litany of problems. Different trackers will tell you different amounts. Different amounts. Right.
Starting point is 00:15:13 So like at the gates, you should know that again, we're dealing with problematic data. Yeah. And now you're making real life decisions, changing therapies and drugs and supplements and lifestyle routines based on. How am I going to be? This is not a good strategy, right? And now you're making real life decisions, changing therapies and drugs and supplements and lifestyle routines based on- How I'm gonna view that. That this is not a good strategy, right? We wanna be concerned with things like, all right, if you had a day where you sat here
Starting point is 00:15:32 and you did five hours of podcasting, you had five different guests in that came in for an hour, you did five podcasts and you had four meetings, I would expect a different sleep architecture tonight than if you had a day off today and you went and played in the lake for two hours. Yeah, which I did yesterday. Okay, right?
Starting point is 00:15:49 You should not have the same amount of deep or N3 or slow wave and REM as you had that night before, because there's a different cognitive load. There's a different physical load. So what we want to do, in fact, if we made this word, Mark, and I said, hey, we're going to put you through sleep restriction training. So we used to call it like back in the day.
Starting point is 00:16:03 And we're going to load you down to five hours of sleep per night. And we're gonna load you down to five hours of sleep per night. And then we're gonna stay at five hours of sleep no matter what. You're gonna go to bed at midnight, wake up at five every single day. That's like a nightmare.
Starting point is 00:16:12 You know what would happen to your deep sleep? It would rock it up. Why? Because your body would learn pattern recognition really quickly. I don't have eight hours to mess around. I will get into deep, I will get into rim, I will get into these cycles hyper fast
Starting point is 00:16:27 because there's no wiggle room there. If I do the opposite and I let you have a, you lay in bed for two hours and you sleep for nine, then we would see the exact opposite effect here, right? So you get less deep sleep? You wouldn't get less per se, but your body wouldn't have as much rush to get into it, to stay into it, the rhythms would be,
Starting point is 00:16:44 the architecture would be different, is the most accurate way I can say it. The pattern would look different, right? So now when you're comparing your data, and you're not paying attention to the fact that what happened to your sleep the last couple of nights, and all of a sudden, oh my God, last night I got this, got my 90 minutes of deep sleep.
Starting point is 00:16:59 Well, are you coming off a sleep restriction? Did you sleep, were you traveling? Well, yeah, of course it is. It wasn't the supplement you did. It wasn't the meditation or thing. It's the fact that you were sleep deprived or the opposite. Oh my gosh, my deep sleep went down. Okay, by a few minutes, don't care.
Starting point is 00:17:15 Maybe you're fine. Maybe you're actually now sort of restoring back to baseline and getting into a gray spot. So you can develop more resiliency by understanding what's happening in these scenarios and doing different strategies that help you. We use something at Absolute Rest called the wind down index.
Starting point is 00:17:34 And so this is not only sleep- So you mentioned Absolute Rest a couple of times. Can you just share with us what that is? Yeah, that's our sleep company. So this is born out of, many years ago, I was at one of these like behind closed doors human performance meetings or people were trying to unpack,
Starting point is 00:17:50 how do we get people on Mars and how do we get high performers and athletes? And sleep came up and we pretty quickly realized that even the most high profile athletes, the richest government leaders and executives, the only thing we have for sleep is a sleep hospital or a consumer grade wearable. And everyone looked at me, they're like,
Starting point is 00:18:11 surely these million dollar or billion dollar athletes have, I'm like, we got nothing else here. And so we actually came together on the spot and created this company, Absolute Rest, where we said, if you had to maximize sleep performance and not sleep duration, sleep resilience. What would it look like? Well, I would wanna know exactly how somebody's sleeping.
Starting point is 00:18:30 And again, nothing about against consumer wearables. They're awesome, we use them at absolute rest. But we wanna know exactly the highest precision gold standard. I want the same exact technology in a sleep lab in your house. We created that. We have full FDA approval.
Starting point is 00:18:43 We can run full medical grade clinical sleep studies on people in your house. We created that. We have full FDA approval. We can run full medical grade clinical sleep studies on people in their house. And now in Illinois, do we not only look at things like their sleep staging, you know, REM and things like that, but we look at fragmentation and stability within that. We can look at when you're on your right side versus your left side or your back. We can start to see exactly how you're sleeping.
Starting point is 00:19:02 And that's critical because below that, we now can then figure out why. So maybe you're having these mild apneas that wouldn't qualify again as a medical disorder, but they're only happening on your right shoulder. This is actually something that's happened many times. And now you get somebody off the right shoulder and their sleep apnea goes down by 90% in day one
Starting point is 00:19:19 and never comes back. It's a slight pillow change. We've had one recently where actually somebody was having a little bit of blocking of their nose at night, couldn't breathe through their nose, didn't realize it, went to mouth breathing. Happening because there was a little bit of dander stuff
Starting point is 00:19:32 happening in his sheets. So all we had him do is start washing his sheets once a week instead of like once every couple of months, like most men do, right? Yeah. He's a housekeeper. Boom, problems are gone now, right? So there's sometimes really easy solutions,
Starting point is 00:19:48 but we got those because we understood how he was sleeping at a gold standard level, and then we understood why. And so we look at blood markers, we look at genetic markers, we look at behavioral. Are there blood bond markers for sleep? Totally.
Starting point is 00:20:01 Like what? Absolutely. Well, you start with basic stuff you would think of. Hematocrit, hemoglobin, ferritin, iron levels. Really good example. If you see somebody who doesn't exercise, they're unfit, but you see hematocrit and hemoglobin are really high.
Starting point is 00:20:14 Really good chance you've got some sort of apnea. Spleen will go nuts, right? If you're choking at night, your spleen will start kicking out red blood cells. You'll start to see hematocrites 51, 52s, right? You start seeing hemoglobin 16s for men, a little bit lower. Women, you might see like 48 hematocrit.
Starting point is 00:20:32 You start seeing hemoglobin 13s, 14s. Now I looked at one of my athletes and I'm like, great, we're fit. But you go, oh, you don't exercise at all. Hmm, great. Now you might just genetically have good markers there, but probably not. And then you start looking at things like MCV
Starting point is 00:20:48 and other markers, and you just go down this whole line, you get into ferritin, like all these other markers, 20, 30 markers you can look at, and you start to realize all these are high in the presence, and now you start looking at inflammatory markers. Starting to get up there high. And you start to build this story,
Starting point is 00:21:01 it's not one marker that you could just look at. It's this combination of things that you have to cross out for false positives, false negatives, and you start to see. But that first one, really high, and we know that's the case. There's a lot of data on this. If you have to take somebody that has apnea
Starting point is 00:21:16 and put them on CPAP, hematocritin, hemoglobin will come down. You're like, oh, that's if they're elevated. Right, if they're elevated. If they're starting from oxygen, they make more red blood cells. Yeah, right, and you start to look at like 90 day distributions, red blood cell size, and you're trying to see, oh, they're coming down.
Starting point is 00:21:30 Why? Because those red blood cells don't have to hang on for 150 days anymore, because they know they're out of limitation. So I know that was like a little bit technical, but. Yeah, interesting. It's things like that where you can start to paint a picture and say,
Starting point is 00:21:40 hey, now we're guiding towards different therapies. We don't need you to go on iron. Or we want, whatever, like you get false senses. And low iron does lead to sleep disruption. Totally, right? Even if your blood counts normal, if you have low ferritin. Of course, right?
Starting point is 00:21:54 And that's gonna happen in over probably 30% of physically active people. Which people don't realize. And the doctors usually don't check. No, not at all, right? So you wanna look at a bunch of markers there. As part of function health, we do all that, which is really pretty amazing.
Starting point is 00:22:07 We've seen a lot of people deficient. Yeah, you can actually start to see indications of those from the blood first. So you start to see those things pop up, your algorithms that function are probably gonna flag and say, hey, how's your energy? Oh, subject to questionnaire is low. Interesting, here, you should go get a sleep study done.
Starting point is 00:22:26 Don't get it done at a hospital. Get it done at home so we can do three or four or five nights, not like one weird night at a sleep hospital where- We're all wired up and it's strange. Yeah, all those wires are, you don't need them anymore. The technology can be done all wirelessly. Yeah. So this can be done and then have that analyzed
Starting point is 00:22:43 and looked at and say, okay, great, actually, we don't need medication yet. We need actually to improve sleep and then get out of the way. The body will actually recover back how it wants to. We don't have to over-medicate, over-supplement. So what are the most common things you're seeing with sleep and the lack of sleep resilience
Starting point is 00:22:57 and how do you get people towards a better sleep resilience? Yep, so the step number one we already covered, more consistent. Consistent is always our starting place, as close as we can within that. Past that, I started talking about the wind down index. Why I brought that up. If you look at something like sleep onset latency,
Starting point is 00:23:17 how long it takes you to fall asleep at night, right? The general numbers there are gonna be five to 20 minutes. Right, so if you're falling asleep within like two minutes, that's probably a good sign that you're sleep deprived. Takes you 20, 25, we're gonna have other issues falling asleep, especially 30 plus minutes to fall asleep on average per night. All right, we don't have a good fall asleep strategy.
Starting point is 00:23:38 Here's why this stuff matters. If you are exhausted, you might fall asleep really, really quickly. But if you're not physiologically wound down, you'll oftentimes wake up at two in the morning, three in the morning. Boom. Kind of tired but wired, yeah.
Starting point is 00:23:52 Tired and wired, right? You'll fall asleep from exhaustion, but you'll only get those three or four hours, can't go back to sleep. Then you'll look at blood glucose and you know, that's gonna be a problem, right? And so it's not necessarily a carbohydrate issue in this particular case.
Starting point is 00:24:05 It's the fact that you're, look at your resting heart rate, look at your pulse wave, look at sort of this cardiopulmonary measures, and you'll start to see other signs that corroborate. You're asleep, but you're not down-regulated. You're really pretty wired. So the common person of,
Starting point is 00:24:20 a lot of people wake up at the middle of the night at some point, but it happens all the time. I may be sweaty, I may be out of breath, I can't get back to sleep. That's gonna tell us, okay, we're not winding down. So in that particular case, you build resiliency by saying, I know I'm gonna have a limited window today,
Starting point is 00:24:38 or I'm off schedule, fine. I can get better at that by having a consistent wind down routine, because that will actually down regulate me and give me more quality sleep in those same hours. Because I'm not spending the first 40 minutes actually trying to just bring my heart rate down or. So wind down like hot bath, meditation.
Starting point is 00:24:55 It's incredibly individual. Breath work, yoga. Some of them are great. What's really key to wind down routines, it is not the act, it's the pattern. The number one key to wind down routine is to is not the act, it's the pattern. The number one key to wind down routine is to have some consistent thing you're doing. Whether that consistent thing is even whatever, right? It can be journaling. It can be write down the things you have to do tomorrow.
Starting point is 00:25:16 Fine. Those things might not work for you. What you want is the 60 to 90 minutes prior to sleep to be doing the same-h things that you do. If that is all those things you mentioned, fine, great. Love them all. I don't do any of those really, like that don't work for me, but you want to kind of do the same things. What do you do?
Starting point is 00:25:34 So for me, we have little kids, so we're always going to go through the little kid routine, right? We're doing all the things in order at the pretty much the same times with the kids. That's my pattern too. Cause I'm going through that. Like that's tremendous joy.
Starting point is 00:25:47 That's me, I'm being present. I've checked out of work. I'm not on my phone. I'm not doing emails. I'm reading stories. We're doing all the things and wrestling with the kids and making mom mad because I'm wrestling with kids five minutes before bed.
Starting point is 00:25:59 But that 40 minute routine with my kids is my first 40 minutes. That is my internal signal that I'm done for today. I don't care what else happens, I'm not checking my email when I'm playing with my kid. Not gonna happen, right? From there, then I'm going in, we're gonna shower. That's great.
Starting point is 00:26:15 And then I'm getting in, I'm 1000% gonna watch TV. You're gonna watch TV? 100% of the time. Like TV you'll be on. I might watch a Seattle Mariners game. I might watch whatever. I'm not watching like a murder mystery, but we'll watch oftentimes like 20 to maybe 40 minutes
Starting point is 00:26:30 of TV. The blue light doesn't bother us at all. We use environmental sensors. So we're testing everything. We're looking at melanopic light, not just total lux. Like we have everything measured and monitored. All this technology I use myself. So I can objectively say that stuff does not negatively
Starting point is 00:26:46 impact my sleep, but it positively impacts my psychological downregulation. It is a click in my brain. What if your team loses? Is that? Ask my wife, she'll say different. That's a stress. Yeah, but for me personally, I really enjoy that stuff,
Starting point is 00:27:02 but I don't do it very often. So when the TV goes on for me, it is a huge click that, okay, you're done. That's it. All that other stuff on your phone, it does not matter. All you're worrying about is like, what the three, two pitches on the sixth inning, the fourth batter, like what's,
Starting point is 00:27:18 you're gonna throw a curve ball, is gonna go off speed, is he tunneling that pitch? Like, and then my wife will generally read, or she's watching the same thing too, right? But that's her thing too, right? She's like, I can get lost in this book now. No, I don't have to worry about anything else. So it's really consistent.
Starting point is 00:27:33 So when I travel, when I'm doing things, if I'm off schedule, it's pretty easy. Like I was just in the Middle East for a couple of weeks. My wife was in New York this weekend. When I'm way times ones off, I keep the same system, right? I keep the same exact system, even if I'm two or three or six hours off schedule. And it just signals my body of going, you ate,
Starting point is 00:27:52 you did this, and you did this in this row. In order, far easier. And so when I looked at that stuff objectively on our whole bunch of metrics, my wind down index is very, very similar, regardless of time zone I'm in, when I can keep that pattern up. When it gets dissimilar is when that thing gets thrown off.
Starting point is 00:28:09 You're kind of cueing your body, you know, like Pavlov's dog to have a certain response at a certain time. That's exactly right. By a certain stimulus, right? Yeah, exactly right. And if you're- Like called behavioral conditioning.
Starting point is 00:28:21 Pattern recognition is the single biggest physiological feat we have as humans. That is the thing we are most talented at. If you want to call this resilience and sensitivity, this is a great thing too, right? If you become too sensitive, your pattern recognition is, now I have this window. If you're listening, my fingers are right next to each other.
Starting point is 00:28:40 And so now when I bump up against those walls, things feel out of whack, out of place. This is discomfort. But if my window is huge, now I'm super resilient, I can still land that plane regardless of the turbulence. And that's ultimately what we're after. So your question was, how do we develop more resilience? That's one of my big keys,
Starting point is 00:28:59 is getting a consistent timing mechanism in your brain that says, this is what's gonna happen, therefore we fall asleep quickly, we do it effectively, even if I'm in a different time zone, even if my total duration is short, I start it off on the right foot and that will be more restorative sleep. It's so tragic that historically in this country,
Starting point is 00:29:18 sleep has been seen as a weakness. It certainly was when I was in residency in medical school. Of course. And I believe that sleep was optional. Yeah. For years, I was working as a resident and then a family doctor in a small town where I delivered babies.
Starting point is 00:29:36 Not too far from you actually in Idaho. Oh, nice, okay. Yeah, a little town and I would take the ER call 24-7. I did the next day, I'd have to go to work and see patients or I'd have to deliver babies and it was my schedule was not set. And I worked 80 hours a week and it was, I think I really just read my sleep rhythms.
Starting point is 00:29:56 Well, you know what's crazy, people don't appreciate this about medical doctors because they tend to get kind of a lot of grief more recently. They just in a couple of years ago, reduced the residency hours from 120 week to 80 or something like that. Yeah. Let that sink in.
Starting point is 00:30:11 It's still nuts, but it's like two work weeks in one is a big improvement over three work weeks in one. But that was like, if you're a medical doctor in America, you probably did many months of a hundred plus, legitimate hundred plus hours per week. And now they made it soft on these new doctors.
Starting point is 00:30:28 Yeah. So soft. Yeah. We, we, we had a, we had a, we had a big, uh, uh, concession in my residency where we had a, uh, labor organizer, uh, and negotiator as one of the residents and he negotiated our contract so that we basically got off at noon the day after call. So instead of working 24 hours and then going again till the following night at six o'clock,
Starting point is 00:30:52 we got off at noon after a whole night with not sleeping, which is still not. 20 years of negotiations. Which is still not. Yeah. So sleep is a real reason for this lack of energy is what you're saying. It is the most one.
Starting point is 00:31:04 After that, I would say categorically, you now start thinking about energy in versus energy out. Sleep is a real reason for this lack of energy is what you're saying. The reason- It is the most one. After that, I would say categorically, you now start thinking about energy in versus energy out. So energy in could be a number of different things. It could be total caloric intake is too high or too low. Could be carbohydrates are too high or too low. It could be a distribution. It could be a timing.
Starting point is 00:31:21 You eat too frequently. You eat infrequent for your physiology. But you're gonna to start thinking, okay, if I'm sleeping great effectively, objectively sleeping well, and do I not have enough energy? All right. Am I doing something that's there? And is it a lack of energy or is energy instability?
Starting point is 00:31:38 Meaning I feel pretty good from 9 a.m. to noon, but then I get really tired. Okay. You don't have a lack of energy. You just have these wild waves of energy. Now that's where the nutrition side could come in. Okay, let's maybe tinker with less frequent eating or more frequent eating or more fiber or more protein. Like there's lots of different ways
Starting point is 00:31:56 that you could play with that. And that has come up a lot where that has actually been the solution is you just need to actually, your eating strategy is ineffective. The other big category would be the opposite energy output. You're training too hard. Your volume is way too high or you had a big jump in exercise volume miles or lifting weights or whatever the case is too much high intensity for you right now.
Starting point is 00:32:21 Right. Or it could be the opposite. Your body doesn't produce energy because you have poor mitochondrial function. You have low muscle mass, right? So it's something on that end of the energy output. Or your body is unduly stressed. So it's burning a lot of energy internally that you don't realize. We call these hidden stressors. This could be psychological stress. Let's use example if you have a cold, an infection, but you don't realize it. You don't have a runny nose or whatever. Anyone that's had like kind of cold, you're just exhausted.
Starting point is 00:32:53 You have no idea why. Well, your body is burning legitimate amounts of ATP to try to fight off this infection, you didn't realize it. And this is where things like micronutrient deficiencies or pathologies or stuff like that, like these things can cause fatigue and exhaustion outside of it, right? So those are real things.
Starting point is 00:33:12 They are very far down the list. Again, let's not overthink this. If you're tired, make sure you're sleeping well. Make sure you're eating and you're not, we're there. This is, we've seen people that have resting fit people. VO2 max is 60 plus for men, right? 58 plus.
Starting point is 00:33:29 And you're resting heart rate's 70. 70. 65. That's high. You have respiratory rate, overnight respiratory rate of 17 breaths per minute. Which is high. This is not somebody who's cardiovascularly unfit.
Starting point is 00:33:40 Why are you exhausted all day? Well, I see. Sympathetic drive is full throttle all day. You're breathing, you're basically like kind of jogging all day. And then you're training hard. So your view to max is up there, but we can see this is why you're exhausted. It's the fact that we actually have to bring that down a little bit. You're over, you're over, over breathing.
Starting point is 00:34:01 You're chronically hyperventilating, not pathologically, but just below that. So it's things like that. We're starting to look on those second layer, second tiers and saying, okay, sleep is fine. Check that off. Nutrition is great and solid. You're burning too many calories, not because you're training in this case, sympathetic drive. So now we can do lots of different strategies, which could include any things we talked about
Starting point is 00:34:20 from meditation to maybe you need to see light more frequently to you need to actually take a little bit more time off work to do you realize which work tasks give you energy and which ones take energy away. A lot of people have not made that connection. The introvert extrovert kind of stuff, right? It's this. Yeah, this is pulling energy from you, right?
Starting point is 00:34:44 So if you're an introvert like me and you're in shaking hands and an appearance all day, I don't care if I take 50 steps, I'm gonna be exhausted at the end of that day. Like I can eat 12,000 calories and I will be physically exhausted at the end of the day because I just don't like being out with people that much. So maybe it has nothing to do with anything else there,
Starting point is 00:35:01 it's the fact that you haven't recognized and realized you need more social interaction if you're an extrovert to give more energy back. We could give you a bunch of examples, but you're getting the point. It's really figuring out what gives you energy, what takes your energy, and then maybe making some structural changes
Starting point is 00:35:15 to your lifestyle or daily routine that balance that a little bit more. Figuring out what is it that makes you resilient in less fragile in terms of your sleep architecture and your ability to rest and turn off at night. Cause you got, you know, like you said, you over-exercise at which is it most people's problem. A lot of your probably you work with. Yeah, for sure. A lot of our non-athletes that come to our coaching programs, that's that. I remember watching something with Kobe Bryant. He was like, yeah, you know, the reason I sell
Starting point is 00:35:45 is because I get up early and I work out and then I work out three times a day. Whereas my other competitors don't work out as much. And so I train and I'm better. So I'm like, I don't know, is that good or bad? Some people get there. It worked for him to be a better performer for sure. Yeah, you know, like next week I'll be up in Canada
Starting point is 00:36:03 with a guy named Cam Haynes. Cam's almost 60. And- 60. 60 years old. A couple of days ago, he ran 250 miles. Damn. 250, right?
Starting point is 00:36:12 He did this for his book launch. I think it's called Endure or something like that. He's 60, he has a broken foot. And he ran 250 miles. On a broken foot. On a broken foot. Prior to the race, he knew it was broken. It's been broken for months, right? Breathing clean air is one of the simplest ways to support your
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Starting point is 00:38:58 Discover how these powerful tools can support your wellness journey at sunlighten.com. Visit sunlighten.com and save up to $1,400 on your purchase with code HYMAN, that's H-Y-M-A-N. The way that Cam gets through the world is maximal grit, right? He doesn't optimize, he doesn't perfect, he does the opposite. I'm gonna put myself through insane things like that,
Starting point is 00:39:24 like Kobe's example, right? Insane amount of pain. Because it gives him the mental edge of saying, okay, you deserve the win now, right? Where other people don't need that to get to that same place. So some of our- Probably not happening in my lifetime.
Starting point is 00:39:36 For sure, right? I might bike 100 miles, but running 250 miles? Well, either way, right? So for you, you wanna be in this place where you have the ability to express true grit. Sometimes the answer is you need to be tougher. And sometimes the answer is you're over-optimizing. So this is one thing, kind of with people
Starting point is 00:39:58 that are taking more on us and autonomy of their own personal life and control, optimize leads to problems, right? Because it leads to sensitivity. So if you have to have like a 90 minute routine, like I was saying earlier, if you have to have that to even fall asleep, and if one thing in your 90 minute routine goes wrong
Starting point is 00:40:17 and you can't fall asleep for an hour, you've done wrong. That's not resilient at all. Now you become hyper sensitive. If you have to have your morning routine, if you have to do your breath work, you have to exercise. Right, you can't go a day without exercising.
Starting point is 00:40:31 We've had many people like that. Okay, this is actually not, this is fragile. You're very fragile, right? Laird Hamilton is a good friend of mine. He would always be like, don't let me leave you in the woods. Which is like his way of saying, if like you're over there worried because you're like, didn't do your warm you in the woods. Which is like his way of saying, if you're over there worried
Starting point is 00:40:45 because you didn't do your warmup today and we're on the wave or something, I don't care, I'm leaving you behind. Don't be so precious. Laird Hamilton. Yeah. Be more resilient, be able to execute and have a great day even if you have a broken foot.
Starting point is 00:41:00 Even if you didn't get your nootropics in today. Even if you didn't do your breath work and you follow. Sleep is a big thing and your absolute rest is it is a it's a Pretty intensive program. That's that's not for everybody, right? Yeah, it's pretty it's pretty expensive. It's pretty intensive a hundred percent Yeah, yeah this is you know if you have to get sleep right and you wanted everything to know about sleep and You want a guided coaching throughout the whole thing like that? That is that program at the at the core and you have a new coaching throughout the whole thing. Like that is that program at the core.
Starting point is 00:41:25 And you have a new device that goes along with it. Yeah, so we can run, again, full FDA clinical sleep studies on your fingertip. It's not a tracker. It's not like a check your sleep score with a proprietary algorithm and all that stuff. So that tracker itself is a part of the big program. And the wearables are not that great?
Starting point is 00:41:46 I mean, because I'll walk from where three at night and get three different reports in the morning. Like, one said you slept like 10 hours, one said I slept eight, one says I got 30 minutes of deep sleep, one says I got an hour, one says I got 100% score, and one said I got a 70% score.
Starting point is 00:42:02 I'm like, wow. We are pro everything. Wearables and trackers can be really effective for rough calibration, right? So some people have, as you're aware, some people have no idea what they're eating. They have no sense of what their sleep is. A tracker, great.
Starting point is 00:42:20 An aura, a whoop, they're gonna get people roughly calibrated, that's awesome. They're good for accountability. Lot of people will make better choices with their behaviors. The bad behaviors, the dumb behaviors. The I ate a pizza right before bed. The alcohol, the inconsistent,
Starting point is 00:42:37 because they know they're getting tracked. They know they wanna do better. So it can be good for awareness, it can be good for calibration, it can be good for internal accountability. For be good for calibration, it can be good for internal accountability. For us, when my athletes know I'm watching, like they make better choices. So those are all tremendous.
Starting point is 00:42:52 And if you look at the hundreds of thousands of people that now use that, it's in that good thing. So if your entry point is that, I'm all for it. That's great. But what you don't wanna do is what we talked about earlier. Use the minute detail of the sleep stage to freak out. Right.
Starting point is 00:43:10 Are you familiar with orthosomnia? It's like orthorexia, which is obsessing about your food. I imagine obsessing about your sleep. These are clinical sleep disorders that are induced from sleep trackers. Wow. That's a whole new diagnosis. So you just have to be like, make sure you're not, from sleep trackers. Wow. That's a whole new diagnosis.
Starting point is 00:43:25 So you just have to be like, make sure you're not, if you care that much, no offense, but if you care that much, you probably shouldn't be spending $400 on a wearable and making all those decisions. Yeah. Like there are better solutions. So bottom line, like sleep is a big cause of fatigue.
Starting point is 00:43:43 Huge. Learn simple practices that can help you become more sleep resilient and less fragile all around your sleep. Yep. Get a wind down routine. And if you've done all 50 of those things, go to the next level.
Starting point is 00:43:56 Like go get some objective testing done because of the fact that you can, you could legitimately have a sleep disorder. And all the meditation in the world is not gonna fix that. Right, if you have sleep apnea, or you have some thyroid issue, or something else is going on.
Starting point is 00:44:12 100%. Heavy metal poisoning, or yeah, there's a million reasons why sleep goes wrong. So you don't wanna ignore the medical reasons, but if you've kind of crossed it over the list, then you can go deeper. So I wanna sort of transition transition into talk about what you've learned in your decades of working with elite athletes,
Starting point is 00:44:28 Olympic athletes, top professional sports athletes, MVPs, you know, just the best of the best. And you, you, you've learned a lot from people like that, that can apply to the rest of us. Cause most of us aren't that, right? Sure. Most of us are just trying to figure out how to do a little bit better. And I guess, let's sort of start out by talking about
Starting point is 00:44:50 what are the insights that you've gotten from high performers about what they do that applies to us? When I say high performers, I will talk about athletes as much as you want, but we also have worked with the most elite military groups, people that run huge corporations. Executives athletes.
Starting point is 00:45:07 That don't even exercise, I guess is my point. So when I say high performer, I mean the smartest people, the best decision makers, people that, this is high performance for us, right? Physical sports is one avenue, but performance could be, again, you're a better writer, you're more creative. We work with some of the most famous musicians in the world, right? These are high performers to us. So answering that question, what do people that perform at these high levels, physically, mentally, cognitively,
Starting point is 00:45:33 creatively, whatever, there's not one thing that they all do. Some of them eat really well. Some have no concept what they're eating. Some of them are metabolically healthy. Some are not everything you can imagine here, I would say I could show you an example of somebody who's the best in the world and they don't do any of those things, right? I think the one lesson from all of them though, would be in general, being tough helps.
Starting point is 00:45:59 And tough is great because tough can be built. So if you are running companies and you do not want to get up on Saturday and you don't want to work and you're tough, you can get it done, right? If you're an athlete and you have to go talk to the media about why you suck today, that's really hard. They don't feel hard in the weight room
Starting point is 00:46:18 when they're lifting weights and when they're exercising when they're tired, but maybe being in front of a camera is really hard for them. Sitting in front of the gym and them telling you, like, you're not gonna play this year, we're cutting your, those are hard conversations that most people don't realize happen
Starting point is 00:46:34 at professional levels, not just sports, but running companies, having a hard conversation with a kid, with an adult, like those are really tough. So my biggest lesson from most people is the ones that tend to be tough tend to do the best more often. And I do believe. And how do you get to be tough? It's a learnable thing, it is a practice.
Starting point is 00:46:55 In the sense of physical tough is fine, right? You can do that. But it is, the ones that I just talked about are saying, okay. Mental toughness. Start when you can, right? So have that first conversation and it's gonna be awful and go poorly
Starting point is 00:47:10 and then keep doing it. Expect failure, expect it to not go great. And then you just have to trust the fact that you know you need to get to here and you know the first time you lifted weights, you didn't squat a thousand pounds. And so the first time you learn weights, you didn't, you know, squat a thousand pounds. And so the first time you learn this skill or this practice or whatever, it's never going,
Starting point is 00:47:29 it's not going to be pretty, but you keep going. And if you can believe that, then you can get past that. That is developing toughness. It is developing skill. If you're Cam Haynes, you're tough no matter what. Cam Haynes' kid just ran like a 2.30 marathon in jeans and then did 10,000 pull-ups in 24 hours. What?
Starting point is 00:47:47 Like, the Haynes gene is incredible. They genetically are just super tough. That seems harder than running 250 miles. That's right. 10,000 pull-ups. 10,000 pull-ups in 24 hours. I don't think I can do 20. I think his other kid ran the marathon
Starting point is 00:48:00 with like 45 pounds on his back and like combat boots. Yeah, I went to med school with a family like that. Those guys were just like, he would put on 50 pounds and go skiing for two hours, cross country skiing up in the mountains. We had another guy actually, Lance McCullers Jr., Texas guy, plays for the Astros. He just pitched last week
Starting point is 00:48:22 for the first time in like three and a half years. And the toughness he had to have for those three and a half years, because he kept getting hurt. Everybody got mad at him, all the fans, you're taking all of our team's money, like all these things. His tough was like, we have a three or four year horizon. We have to get through this. And I don't get to do the thing I like at all.
Starting point is 00:48:43 Because he was injured. Because it hurt and then he kept getting hurt and just. So there are different forms of toughness and the only way to build those things is just continuing to go after those, to continuing to try, show back up, you fell off your diet, fine, it's okay, be tough, get it going again. You lapse on the button. What is that saying when the It's okay, be tough. Get it going again.
Starting point is 00:49:05 You lapse on the question. What is that saying when the going gets tough, the tough get going? Yeah, like grit. However you wanna connect to. There's actually an incredible book written about this. Yeah. I think a UPenn professor about grit.
Starting point is 00:49:17 Yeah, Angela Duckworth's. Yeah. Grit book. As a key strategy for success in life. It's hugely important. The grit of dealing with your five-year-old who just like won't. But why does some people have grit and some people don't?
Starting point is 00:49:30 Some people like stub their toe and they're off work for six months. Other people, they're like in a car accident and they're working as soon as they can open their eyes. Yeah, yeah. I don't know, it's a little bit out of my area. I can tell you one thing. I know Andrew, Andrew Beberman, a friend of mine, you're friends with Andrew. Yeah, yeah, of course. He't know, it's a little bit out of my area. I can tell you one thing. I know Andrew, Andrew Beberman, a friend of mine,
Starting point is 00:49:45 you're friends with Andrew. Yeah, yeah, of course, yeah. He talks a lot about some of the new data in the last couple of years about there's specific areas of the brain that are developed when you push through on discomfort. And so there's actual physical structure that gets smaller when you don't do that very often.
Starting point is 00:50:00 It gets larger when you do it more often. And so that was like a pretty new finding. Another way, so you can exercise your way. You can exercise? I mean, I mean, metaphorically, exercise your tough part of your brain. 100%. By doing the hard things. I think that if you would pull up the neuroscientists
Starting point is 00:50:17 in the room here, I think they would all agree with, largely agree with that. Yeah, you know, I experienced this recently. I was, had an unfortunate situation with my back and ended up, you know, having pretty severe back surgery and I lost like, you know, 15 pounds and I was in bed for a bit and, uh, it was tough. And when I got out and I literally. Couldn't walk.
Starting point is 00:50:40 I had a walker. And so, you know, four months ago, I was on a walker and couldn't walk. And I literally had to, from within a week or maybe the day, actually the day after my surgery, I had to start with physical therapy, which means I had to stand up for the first time. I had to learn how to sit down in a chair as I was laying on my back.
Starting point is 00:51:02 I had to learn how to stand up. I had to just learn how to stand up. I had to just learn how to walk without a walker and a cane. And then I had to learn how to walk without a cane. And I mean, it was, and I remember just feeling like crap. Like you just, after you go through that, I just, I had no energy. I slept for four hours a night for six weeks. I was exhausted.
Starting point is 00:51:24 And every day I got in the gym and I work with my physical therapist. And I work with my trainer. And even when I was like, I am just want to like lay in bed and binge on Netflix and disappear from the world. I got out there and did it because I knew that if I just put one foot in front of the other, and if I just built those building blocks that I could get back. And I've gained 20 pounds back. I have could get back and I've gained 20 pounds back I have my energy back and I have my strength back. I'm fitter than I was before the surgery
Starting point is 00:51:52 I'm in less pain and I you know, it was like but that I think most like my doctor said to me like mark most Most people who went through what you went through would still be on a walker at this point And you're like in the gym every day, lifting weights and, you know, yeah, well, you had running two beds, three businesses. You had that skill because of residency, because of probably a thousand of the things you've done in your life where you know what resistance looks like. You know what then getting over it, you don't want to do it, but you know what the back end looks like.
Starting point is 00:52:24 And there was probably many days where you failed. You didn't do it or you, but you know what the back end looks like, right? And there was probably many days where you failed, you didn't do it, but you know what that world looks like. I did the best I could, which was not as intense or as much as I could do. Yeah, you know, as a scientist, you learn this pretty early one way or the other. When you try to publish papers, you go through peer review.
Starting point is 00:52:40 Peer review is just a nice way of saying everybody gets to tell you how terrible your paper is. Yeah. Right? So if you can't handle things like criticism, you learn to develop it, right? You have to get tough in that sense of saying, okay, great, they're probably right there. If you're out in the public sphere,
Starting point is 00:52:58 if the first time you get a mean comment on social media and like you just want to get back on there and fire back away, okay, you can develop that toughness over time. And so wherever tough means to you in different areas, it can be worked on, it can be improved if you expose yourself. You have to keep exposing, you had to show up to the gym.
Starting point is 00:53:16 You had to. It reminds me of that quote by Lao Tzu said, the journey of a thousand miles begins with one step. There you go. And it's just like one step. Yep. And for so many people, it's hard to take that one step to make that one incremental change in your life
Starting point is 00:53:30 or your behaviors or your diet or your exercise or your sleep routine or whatever it is to actually start to compound the benefit that you see over time. We always say the hard part about making changes in life is acceleration, not velocity. So here's what I mean. If you are used to waking up and running five miles every morning,
Starting point is 00:53:50 running five miles is not hard because that is the constant velocity you're at. Yeah. But if you are used to walking, running zero miles and you go to run one mile, that is a huge difference. That is far harder than the person who runs five every day. That's true. Because it's acceleration, it's change of direction, it's massive start, it's massive stop, right? That's true.
Starting point is 00:54:12 That is the hard part, but you have to always remind yourself, acceleration is going to be harder. But once you get past that, and that becomes the norm, then this will be easy. Yeah. And so it's just getting through that mentality, or getting, reminding yourself constantly of it's going to be hard. And so it's just getting through that mentality or getting, reminding yourself constantly
Starting point is 00:54:26 of it's going to be hard. It's gonna suck. Yeah, because if you're like 300 pounds, trying to get down to 150 is a very daunting idea. Impossible feeling. But it's possible one little step at a time. And I've seen this dozens and dozens of times with my patients.
Starting point is 00:54:43 If once they sort of catch the threshold where they realize they can do it, and they have the right information, they have some early wins, it's powerful to see what can happen to people. Yeah, you wanna, in the cases like that, when people are trying to make traumatic changes, where we have found the most consistent success,
Starting point is 00:54:59 is you have to get some consistent practice. Don't let perfect be the enemy of good. So don't worry about getting really expensive sleep study done and blood work done and all this stuff. I don't care if your plan is perfect at all. Give me consistency. The weight will start coming off.
Starting point is 00:55:18 Now we'll get the plan better. Give me some room. Now you kinda had it right, just do it. Just do it. So Andy, there's a lot of myths out there in the fitness and longevity space. What are the big ones that are coming across your horizon and that you're trying to dispel on a regular basis?
Starting point is 00:55:36 Yeah, I think this is actually kind of bring, this last part of the conversation would bring up several and that would be that there is one eating strategy that we all should have. That there is one workout. That's better. That this type of training is better than that type of training or, uh, you should have this many hours or minutes. None of that is objectively true for all of us. None of that. If you want an example, routine or protocol to get started, cause you're in that place of, I don't even know what to do. I've never used supplements on a workout. Like I'm so lost. Great. Pick one thing. Go buy an app. Go buy a PDF. Go buy a work. And just so you have a plan. But let's not fall ourselves into the sense of thinking that there is every woman going through menopause has to work out this way. What every 30 year old has to do this with their training. None of those things are true.
Starting point is 00:56:25 They're just simply not. And they can. What you want, what your goals are, where you're starting, where you need to get to. Your physiology is different, right? Like your ancestry is completely different. Your baseline is different. All this is there.
Starting point is 00:56:36 And so that stuff can be suffocating for people. I realize again, people want examples so they know where to get started. That's great, that's fine. But the biggest global myth would be that, that there is, fill in the blank, nutrient or otherwise, that is either awful and evil for us or we have to do it. Well, there's certain things I think are probably,
Starting point is 00:56:58 no, there's plenty of things that are- Like trans fats and high fructose corn syrup, I'm like a hard no on those. Sure, for you, like great, right? I don't know. I think from anybody, shouldn't be eating those things. Well, I don't think anyone's gonna do well eating a bunch of them. No, right.
Starting point is 00:57:11 But once in a while, for sure. You can probably objectively say, no one will do well eating a lot of those. That's right. I probably, they're probably somebody. There's something. But yeah, so there's these- And I think everybody should exercise.
Starting point is 00:57:21 The question is what, how much, how frequently, what kind of exercise. Of course, right? Yeah. There's a thousand things we could bucket into like, think everybody should exercise. The question is what, how much, how frequently, what kind of exercise. Of course, right? There's a thousand things we could bucket into like, basically everybody should drink water. Okay, fine, like I'm not gonna, but many of the finer level of detail,
Starting point is 00:57:36 how many grams of this, how many ounces, like, okay. There's not as many hard and fast rules there. Physiology is really good at finding a way. If you give it the space, right? If you have the opportunity, it will find ways. You talk about these concepts of aging and you say you're not anti-aging, you're anti-being fragile, anti-fragile.
Starting point is 00:57:55 What does that mean? So I'm younger, right? And by the way, I'm not anti-aging either. We all age, we all get older. Like I'm not anti that, because I am that. But I'm pro healthy aging. And I'm pro being more resilient. And I'm pro being more flexible.
Starting point is 00:58:14 It's like I want to be able to do whatever I want to do. Like if I want to go heli-skiing tomorrow, I want to do that. I want to ride my bike 50 miles, I want to go do that. Here's what I mean by the anti-aging thing. If you wanted to maximize the amount of lifespan and wellness span, health span, however you wanted to find that, you could.
Starting point is 00:58:32 You could take away all your risk. You could go to zero. You could never leave your house. You could eat the same thing every day. You probably will live longer if all of your risk was taken to zero. I know somebody like that. So do I. Right? you probably will live longer if all of your risk was taken to zero. I know somebody like that.
Starting point is 00:58:46 So do I. Right? And I say this with love because I wrote an exercise program, okay? So you can do that. And you write it from the perspective of minimizing risk. Yeah. My personal philosophy,
Starting point is 00:58:59 and again I've said this in public, it's not a, we're not talking behind our friends back here. My philosophy is the opposite. I'm more sounds like aligned with yours, which is I wanna be able to go out and be whatever I wanna be in any given moment. And I want my Achilles to be resilient
Starting point is 00:59:17 against going playing a pick up game of basketball and not tear tomorrow. I want my energy to be resilient to where if I don't have food for a day, I can still be fine and not get cranky and grumpy I want to also be able to drink some wine and not feel like my head is gonna explode for two months, right? I want to be able to be all of these things. I'm not going to do those things very often I'm not going to do these things very often
Starting point is 00:59:38 But I want the ability to touch into areas where I can feel All of the joys and experiences of life that are the way that I wanna live them. While also then not compromising my long-term health at all. I want very, so that's what anti-fragile means to me. Is I wanna be able to have a week of really poor sleep because we're doing this huge thing in one of our companies and I'm super excited about it and we're building. Like I remember Dr. Dre had a line that said,
Starting point is 01:00:07 if you've never worked 48 straight hours on something, you've never done something interesting. That was his thing of if you get so into what you're doing and you should have the ability to cruise and not to be like, well, no, it's 3 p.m. I gotta start my wind down routine. No chance, right? I wanna be able to do wild stuff that doesn't put me in a,
Starting point is 01:00:28 well, I'm just gonna live however I wanna live, and if I die at 60, I die at 60. I'm not interested in that at all. I wanna live as long as I possibly can, but be as resilient and anti-fragile as possible so that a bad exchange, somebody's mad at me, something happened, okay, fine. A positive thing, great.
Starting point is 01:00:45 I wanna be able to handle those insults, like jumping out of basketball court and not having something blow. Or again, somebody being mad at me and yelling at me or getting the argument at work and not ruining my day for a week, right? Like that's where that stuff is. It's basically being physically, emotionally,
Starting point is 01:01:00 psychologically, even spiritually resilient, right? Yeah, we wanna be resilient, but we wanna also be present, because one thing you could do is desensitize to all of it, which is not good either, right? So somebody who is constantly working for delayed gratification has a hard time being present. Right, so you're never gonna have the piece of cake,
Starting point is 01:01:21 you're never gonna take the day off and go play in the lake the whole day, because you got work to do, right? Then you're gonna have a hard time being in the moment and experiencing what I personally think is part of our joys of life. Absolutely. But if all you ever do is choose immediate gratification,
Starting point is 01:01:36 have a cheeseburger every day, sleep in today, don't work, have the wine, well then your delayed gratification needs some work, right? Make better choices. So it's finding that balance for you and your threshold of saying, Well, then your delayed gratification needs some work, right? Better choices. So it's finding that balance for you and your threshold of saying, how do I still choose some presence
Starting point is 01:01:52 and immediate gratification while doing mostly delayed gratification? Yeah, I mean, the way I think about it is, in order for you to be resilient and be flexible and be able to do what you want, that's my definition of health. I wanna wake up in the morning and do whatever it is that brings me joy that I wanna do.
Starting point is 01:02:08 I wanna hike up a mountain, I wanna do that. Last January I hiked in Patagonia and I was able to do a 15 mile hike in a day with a mile vertical elevation. That's some work. Up and a mile vertical down. And it was like the mile vertical was compressed in like three and a half miles up and down. And how sore were your quads the next day?
Starting point is 01:02:28 You know, it wasn't so bad. Really? No, I had poles. I don't care. So I did poles on the way down. I don't care at all. I did poles, I did straight to the weight. And we had crampons and we did the whole thing.
Starting point is 01:02:42 And then the glacier in Patagonia, and no, I'm 64 years old, and I don't wanna have to think twice about whether I can do that or not. Now, there may be a point in life when I'm 100, maybe I won't be able to do that, I don't know, but why not? Like, I see these guys sprinting and running
Starting point is 01:02:58 at 100 years old. My inspiration in junior high was this guy named Mr. Gibson, who was my gym teacher. And he showed us movie that, you know, like things would happen when you're a little kid, have these imprinting effects on you. I was like 14 and I saw this movie and I was like, holy shit.
Starting point is 01:03:17 And it was a movie about people who were doing extreme athletic feats with all sorts of problems. Like one guy had no feet and ran the Boston Marathon and this guy Larry Lewis was 105 years old. He lived in Marin in Northern California and he would run across the Golden Gate Bridge every day, five miles to go to work as a waiter all day. And he would run home at the end of the day.
Starting point is 01:03:42 I mean, when I was in my 20s, I ran to medical school four miles and ran back four miles every day, but that, when I was in my 20s, I ran to medical school four miles and ran back four miles every day, but that was, I was in my 20s. And I'm like, wow, if that's possible, then it's possible. You know? And so that's my definition of health. And I think in order to do that,
Starting point is 01:03:56 you have to make regular deposits in your health account. You can make withdrawals, right? If all you do is make money and save it, you're never gonna enjoy life. But, and my mother always used to say that money is energy. It's meant to be used. But you also have to save energy to spend energy. You have to save your money to spend your money.
Starting point is 01:04:15 And the same thing with your health. I think you have to make more deposits and withdrawals throughout your lifetime. And the cumulative benefit is that when you're older, you can do whatever it is you wanna do. Like I went heli-skiing last year for the first time in my life. Crazy. You know, I mean, I wish I didn't have to wait until I was 65,
Starting point is 01:04:33 because it was so much fun. Yeah. You know, I can afford it now, I can do it. Before I had little kids and a family, and it wasn't as accessible. But you know, that's how I define health. And it's not just the absence of disease, it's, you know, that, that's how I define health. Um, and it's, it's not just the absence of disease. It's,
Starting point is 01:04:47 it's something beyond that that allows us to be resilient and not fragile. You will, you and I are very aligned on that, right? I don't do disease at all. Like the traditional medical disease, I'm not an MD. We, we do the opposite end of the spectrum. If you want to think about that as sports, great. If you want to think about that as the ability to do 12 hours of work on your computer. Yeah. Great. I want you to be able to sit there and not be like, Oh, I just have to go. Like, no, like get through it, be able to be focused. Can you perform cognitively really hard work for long periods of time? Like you're able
Starting point is 01:05:19 to hike all day through exhaustion. Right. So I want the physical capacity. I wasn't even that tired There you go, right now now my wife she she it was in South America So there's all these great wines But I don't really think that much and she was drinking wine at night and I wasn't and we got back our biological age scores Oh sure. Yeah, hers were worse mine were better What elevation were you guys at? I'll be pretty high. Um, you know, it's not that high there I think as I was like 10,000 feet. Okay, that's enough to get a physiological effect though. Yeah, but it wasn't like, you know Like stupid high it was just because it starts it starts low, you know It sort of brings us to this fact of like, okay. Well, how do we need to think about?
Starting point is 01:05:59 our physical activity as we age because you know in your 20s 30s is different than your 40s 50s 60s and for me, I I don't have many regrets in life, but When I was younger, I thought you know cardio aerobic was important and you know, I was a yoga teacher So I did a lot of yoga and I thought that was my quote strength training And I was kind of a skinny kind of guy who was kind of not that muscular and I was like I don't really like gyms. I'm intimidated to go in like a Gold's gym in Venice. So I'm like, whoa, you know,
Starting point is 01:06:32 like all these guys literally could pick me up with one finger and I'm like, I just feel a little intimidated and insecure. And plus gyms are smelly and I don't loud and I don't really like it. And I hurt and if I did 10 pushups, it would hurt for three days, and I'm like, this is no fun. And I kind of put it off, put it off, put it off.
Starting point is 01:06:51 And I started when I was 59 to start to really seriously get into strength training, yeah. And my dad, I got him when he was 89 started. Sure. But it really has changed my life. And I was sort of shocked at how much I end up enjoying it, liking it, and how much of a difference it's made, and how much more I focus on it than I did
Starting point is 01:07:15 when I was younger, and particularly even more than cardio. So can you talk about how our training should evolve as we get older? If you think about this idea we've been talking about a lot, anti-fragile. Here's what this means. You want ability to do wild stuff, climb a mountain, work all day, great. Even lower level than that.
Starting point is 01:07:32 If you want to survive, your body has to have certain physiological capabilities. It needs to be able to produce and utilize energy. It needs to be able to recover. It needs to be able to move through space. So then back engineering, what training do I have to do to fill in that gap? That's how I always think about this question. Number one, this is basic physical activity. I don't even mean structured exercise. This
Starting point is 01:07:53 is step count. This is, are you moving throughout the day? Because you can train and do all the lifting of weights and all the cardio. And if your step count is just a rough guide here, there's nothing magical about step count, but as a rough guide, a physical movement is 500 steps per day. There's a lot of data to suggest you're not going to be optimizing health. So humans were meant and have spent many, many, many, many millennia moving a lot throughout the day. And so if that movement needs to be exercise, great. If that movement needs to be a standing treadmill or walking treadmill work, if that just that movement needs to be a standing treadmill or walking treadmill to work,
Starting point is 01:08:26 if that just means you walk three times a day or you stand up paddleboard, whatever it is, you garden. You, my wife was a middle, or a preschool special ed teacher for many years, and she would do 30,000 steps a day because she's just running two feet back and forth all day, just handling four-year-old autistic kids, right? So she didn't need any more physical activity.
Starting point is 01:08:47 Where we're, say, 30 years old, I would come home being in a laboratory, pipetting chemicals and taking muscle biopsies all day. Like, I hadn't moved all day. I hadn't moved, and she's like, so I needed to, at that point in my life, had to re-engineer movement. I had to walk throughout the day.
Starting point is 01:09:01 She did not need to go on a walk ever for her life, right? So step number one is that, is there some movement and you may need to structure that in. I may need to feel like exercise to you. Could be three 10 minute walks a day or whatever. Or it could be like, hey, my lifestyle is already physically active. That box is checked, okay?
Starting point is 01:09:19 The next step up then is, do we have a ability to handle a high heart rate, cardiovascular capacity, maximal aerobic capacity, VO2 max. You could define this and organize this a lot of ways, but your heart and your whole quality of pulmonary system will do better if it can handle really high bouts of high intensity. So again, engineer this. Do you get something like that in your day already based on your vocation? Yes, then I
Starting point is 01:09:47 don't need to do as much high intensity intervals in my training. Or I get none of that, then I might need to do some interval training. This could be on a bike on a rower. This could be sprint work. This could be your pickleball game. This could be a lifting about a bout of weights, but as more of a high intensity interval type of circuit training, yeah, thousand ways you can get weights, but as more of a high intensity interval type of circuit training. Yeah.
Starting point is 01:10:07 Thousand ways you can get there, but something at least once in your week where your heart rate gets as high as you can get it. I don't even care if you measure it, but just, you know what I'm talking about. But it's interesting, you know, we look at, and I learned in medical school that the maximal heart rate of someone
Starting point is 01:10:21 is 220 minus their age. So I'm 65, so for me that would be 155. 220 minus 65 is 155. But I routinely get into high 170s. If I'm playing tennis, if I'm doing heavy duty exercise. So the body can do more, right? Well, so you know how the 220 was? It doesn't mean I'm sick, right?
Starting point is 01:10:44 Yeah, yeah. I'm not sick. You know how 220 minus your It doesn't mean I'm six, right? Yeah. I'm not sick. You know how 220 my ester age was developed, that equation? I don't actually. So it's like a lot of science. It's, it's not as rigorous as one would think it's a rough guide.
Starting point is 01:10:55 I'm still routinely over 200 beats per minute. I'm not 20 years old. Yeah. Right. Um, we've had elite endurance athletes, elite athletes who their view to max is well, or their max2 max is well below, or their max heart rate's well below predicted.
Starting point is 01:11:08 So they are a 25 year old, but their max heart rate's 170. And their elite VO2 max is 75, 80, right? World record holders, things like that. So your maximum heart rate, that number 220, master age, the story, the lore, is that was actually written out on like the back of a sheet on a plane ride. So a couple of guys were headed to a conference and they had to have some way to kind of present something and they're just like, ah, two 20 miles to age and like ransom numbers.
Starting point is 01:11:32 Like, yeah, that works out pretty well. Oh, that busts that man. Yeah, it's, it's not, um, I, we can do that with actually a lot, a lot of, of physical, but it does matter. Like when you get older to do more strength training, doesn't it? Well, we haven't got there yet, but yes. So baseline physical activity. So get your heart rate up to a good amount.
Starting point is 01:11:53 Not even heart rate up, like the low physical activity. This is zone one, zone two, zone zero. I don't care what zone you have. This is moving. You have to move because you have to actually engineer the ability to create low levels of energy very consistently. Right, people that can do this stuff all day
Starting point is 01:12:08 don't have loads of energy. They're not tired or exhausted all day. People that don't, that sit all day, they're way more likely to be that person that's exhausted all the time. Because their mitochondria don't work as well. It's everything. Mitochondria is one way to explain it,
Starting point is 01:12:23 but it's a whole cascade of physiological things that just don't work very well. So baseline physical activity, low level physical activity. So basically what you're saying is human beings, just like food, require exercise to function properly. Yeah. Now you move up to that higher intensity stuff. Then you have to say, okay, great.
Starting point is 01:12:40 Cellular stuff is okay. Endocrine system's probably okay. Lymphatic system's probably okay. Immune system's probably okay because I'm doing my physical activity. Things are moving, things are pumping, things are functioning. I'm just keeping my brain alive, we're flowing.
Starting point is 01:12:53 I got high heart rate up, so that kept my left ventricular, left ventricle functioning well, it kept my heart, like the physical structures of your heart and lungs grew great. But you haven't really taken care of muscle health yet. So skeletal muscle, very specifically, is not gonna respond optimally
Starting point is 01:13:10 to those first two things I said. You don't have to, but if you look at, there's lots of research on lifelong strength trainers, lifelong endurance athletes. Neither one of them are at their best. Meaning if all they do is training training or all they do is cardio. We've done this research in our lab with twins, right?
Starting point is 01:13:31 So monozygous twins, exact same DNA with different things. And when you look at the folks who don't lift weights, they don't tend to have as high of muscle quality. They start to lose power and speed more frequently. This is a problem as you age successfully because now your reaction time slows down. Your ability to catch yourself from a fall slows down because you don't have speed and foot power
Starting point is 01:13:54 and the eccentric strength to catch yourself and brace and stop the fall and a whole host of things happen. And so adding in strength training, however that looks for you, if that means to be you need to walk into the gym for 30 minutes, get on a couple of machines, not know what you're doing, that's fine.
Starting point is 01:14:14 Like that is enough for most of you. I don't know about that. Not only are you doing it, you're gonna cause yourself injury sometimes, right? Generally, when you're starting, you're gonna be okay. Unless you're doing things really heavy and really aggressively, you're fine. If you just pop on a machine, kind of do eight to 10 reps, don't really know what you're doing things really heavy and really aggressively, you're fine. If you just pop on a machine,
Starting point is 01:14:27 kind of do eight to 10 reps, don't really know what you're doing, you're actually gonna be fine. But having some component in those three domains, now by doing that, you've also probably built some proprioception, some balance. Hopefully you're going through full range of motion,
Starting point is 01:14:44 so now you're working on flexibility and mobility. Because every time I talk about things like this, people are like, you don't talk about flexibility. I'm like, well, you don't need to necessarily go out of your way to train it. If you're moving properly, if you're lifting weights in a full range of motion, then flexibility is in large part taken care of.
Starting point is 01:15:01 If you want to add some more on top of that, great. All for it. Like go ahead, if you want to, if that wanna add some more on top of that, great. All for it, like go ahead. If that means yoga, awesome. That means stretching, great. Pilates, like fine, all those. But from a physiological need to survive, those are the things. They keep all those systems intact
Starting point is 01:15:17 and there's ample research now on the brain. So you're talking about dementia and Alzheimer's prevention heavily positively benefited by these things. And so if you're doing about dementia and Alzheimer's prevention, heavily positively benefited by these things. And so if you're doing those three categories, you're metabolically going to be healthy. Your bones will be healthy. Your joints will be healthy and your brain will stay healthy. That is going to be our massive quad effecta for staying alive for a long time.
Starting point is 01:15:42 So at least once a week for all of those, if you like lifting weights more and you wanna do two or three times a week with it, great. If you're more into endurance and you wanna do that and you wanna keep strength training once or twice a week, fine. You can shift along the spectrum here, but I would say most people need to have
Starting point is 01:15:58 at least one of those three components every week. And as a doctor, when you begin to understand the physiology of exercise, what actually happens to your body and the profound, like the profound changes that happen in your body when you exercise, that literally can mitigate slow or reverse most chronic diseases. And that can actually or reverse most chronic diseases. And that can actually activate all these longevity pathways
Starting point is 01:16:28 in your system. And you mentioned a lot of them. There is nothing else on the market that can do that. Yeah, I mean, if you start stacking up sleep and exercise, everything else, of course nutrition would be up there, but if you won't bang for your buck, everything else gets of course nutrition would be up there, right? But if you want bang for your buck, everything else gets way down the list of magnitude now. Like way, way down the list.
Starting point is 01:16:53 I always say you can't exercise your weight on a bad diet, so that is true. So you can, I see a lot of people are exercising a lot and still very overweight or metal-looking healthy because they haven't changed their diet. So certainly related to body size and body composition, yeah, you're gonna have a really hard time catching up to the plate.
Starting point is 01:17:09 Yeah, what you were saying before reminded me what Peter Ortiz says, don't major in the minors and minor in the majors, which essentially is like, the majors are sleep, exercise, what you eat, and then everything falls below that, right? Yeah, I mean, as long as you're not like in this energy toxicity, then like, and the fact that, right? Yeah, I mean, as long as you're not like in this, this energy toxicity, then like, in the fact that what I mean by that is,
Starting point is 01:17:29 your total caloric intake is egregiously and excessively higher than your expenditure, right? And there's a lot of stuff within that, but if you do that and your body composition's okay, the next biggest thing is you can swing our sleep and exercise. Like, and it really does have a huge impact on you. Again, we've done some of this work in our lab, you
Starting point is 01:17:49 can you pick the thing that you're most interested in. You know, I want to have more energy, you want to, I'm worried about dementia. Okay, fine. Like, and we can show you data on data on data that are just gonna like overwhelm you. And what's great about this, like I'm so tickled for the last decade, because as an exercise scientist, this is stuff we've been screaming for 30 years. And now the other communities are catching on
Starting point is 01:18:13 and we're like, communication. Like we've been saying this, I actually took, when I was a PhD student, we did our anatomy class in med school. So I was the only PhD in there, the rest were future MDs. but the guy teaching it was a PhD Not an MD, right? So it was like alright and we would go you remember med school you would go through these Just onslaught you do a whole medical chapter a day
Starting point is 01:18:37 Yeah, right in the curriculum the next day is the next chapter right? Yes a lot And we spent like two and a half or three days on diabetes medications, right? And you're just going through, okay, this is what this does. Here's contraindications, here's side effects, here's mechanism, blah, blah, blah, blah, blah, right? And you just go through them all, and I'm just like pulling my face off,
Starting point is 01:18:57 or my skin off my face, because I'm like, this is awful, I hate all this, right? But you have to know it, okay, great. And then he gets to the very end, and he's like, oh yeah, and then we forgot and you'll know where this story's going. But he said, we forgot the last drug on the market. It does everything we've talked about already.
Starting point is 01:19:12 It has a higher actitude of effect. It has no side effects. And like, I knew where he was going. Like immediately I was like, finally. He's finally gonna say it. After two days of torture and all the kids are like, they got their notebooks out, their pens are ready to write this drug down.
Starting point is 01:19:25 And I won't say the word on here, but he said, it's bleeping exercise. And slammed on the table and walked out. And I was like, there you go. And now even this week, there's other data that got published on type two diabetes and muscle mass. Effectively showing if you have high quality muscle mass, it's extraordinarily rare to have type two diabetes.
Starting point is 01:19:43 And you just don't get it. When you look at type 2 diabetics, the armatic hynoid, half as function, half as effectively as people who don't have type 2 diabetes. And that is related to exercise. If you have high quality muscle, it's really hard to have metabolic problems. It's not impossible, but it's really hard.
Starting point is 01:20:01 And so when you look at like a, what can I do about it? There, maybe you have something going on with, you have something happening psychologically and food is a problem or trauma or like, at least something you can do is have good muscle. Good muscle will help you metabolically more than just about anything. And then you can work on the diet
Starting point is 01:20:20 if that's the sticking point or, we'd want you to start there, but you get my point of saying, boy, get muscle. It's important for brain health, heart health, hormone health, digestive health, lymphatic function, muscle health. I mean, this- And your system runs through muscle.
Starting point is 01:20:34 You know, I co-founded a company we see called Function Health that- Yeah, yeah, I've heard. Deep, comprehensive biomarker testing. And we're looking for all sorts of things and we're recognizing that their are biomarkers of mental health, metabolic health, cardiovascular health, so many different things, brain health.
Starting point is 01:20:51 But you kind of look at it from a little different angle and you co-founded a company called Vitality Blueprint, which looks at blood work for performance, which is the other end of the spectrum, not disease, but like, what can your blood test tell you about where you are in the spectrum of human performance and optimizing that? And how do we look at biomarkers and customized approach to health
Starting point is 01:21:13 that can expose hidden gaps in our energy performance resilience that we can learn from blood testing? So what are the most important blood biomarkers for performance that are overlooked and that you can act on things that you can make a difference with? Yeah. So it's not necessarily about the blood
Starting point is 01:21:30 markers. There are some esoteric ones at the very end. Right. So for example, for a high performance athlete, we might spend more time on a panel of magnesium related markers. So not just serum magnesium. That's a really bad way to understand magnesium in a system, right? Because it's almost all in bone, but something like magnesium RBC, right? There's all their ways. Okay. Copper, zinc, like there's some other things we would do on a micronutrient end of the spectrum
Starting point is 01:21:56 that you're probably not getting as just a general health. But to be honest, Mark, like that's, we don't spend a ton of time on those ones. We look at almost all the same markers you probably have on your... What's your best panel at function? Probably 100 markers? Yeah, 110 compound markers, and then 60 at half a year, yeah. Great. Our biggest panel at vitality is 100 and some, right? And it's probably, if I had to guess... Probably the same ones. Any of the same? Probably. Yeah.
Starting point is 01:22:26 What we do differently is entirely based upon how we're analyzing and interpreting it. That's the big thing. If you're here because you are concerned about whether you need hormone therapy or you think you have a clinical issue, go to function. Vitality cannot help you. If you wanna know your LP little A, April B,
Starting point is 01:22:46 I'm sure you guys measure those. We don't even measure them. We believe they're important, but that's not something I can modify to make you perform better tomorrow. Go to function for all that, to work with your team. What we are going to do is look at those markers and say, do you have a bunch of things that are suboptimal?
Starting point is 01:23:05 Maybe you don't hit a clinical threshold, but you're on the low end and you're not on what we call our high performance range. So you wouldn't be here to have the most energy. You wouldn't be here to have the most muscle recovery. You're not as anabolic as we could possibly be. Now, do we have a string of these? What patterns are we recognizing?
Starting point is 01:23:23 And what can we do with that? And how do we have a string of these? What patterns are we recognizing and what can we do with that? And how do we program solutions that are not that are something that an athlete can do? And there was lifestyle, nutrition, and or third party certified supplements. Right? We don't give medications, drugs, any of those things come out of because our athletes can't use it. Right. And whatever reason that's your doctor's perspective.
Starting point is 01:23:45 I can give you a thousand examples. We talked about a couple earlier, but let's take a look at something like hematoc or hemoglobin just because we brought that up earlier. So when you look at endurance exercise, the single most important adaptation you will get is total blood volume. That's the name of the game.
Starting point is 01:24:01 You want to go after more blood volume. If you see more blood volume, your fitness will be up. If it goes down, it is the opposite. Most people have no idea. This is a total blood volume game. Now, I doubt you've ever ordered a total blood measure. No, I was like, what is that test? You can't, right?
Starting point is 01:24:17 It's not something you're gonna order. Okay, good, I was like, wait, did I miss that in medical school? You did actually, okay, let me ask you this. You may or not remember these numbers, but if you had somebody come into your clinic and their total blood volume was eight liters, most MDs are gonna go get them on a diuretic right now,
Starting point is 01:24:34 you're gonna have a cardiovascular bat, right? Sure. I'm gonna look at that and go, that dude's super fit. Because they'll both be true, right? You have to know the context. One's a heart failure patient, one's an athlete, they're different, right? true, right? You have to know. One's a heart failure patient, one's an athlete, they're different.
Starting point is 01:24:46 Exactly. Right. Same blood marker and a different range. Right. So total blood volume is our key. Now on a blood test where you would go from that is hematocrit hemoglobin. Right.
Starting point is 01:24:55 You can't get total blood. It's difficult thing. And so the numbers I said earlier, if you're female and your hematocrit is 44, 45, 46, your male, it's a little bit higher, 47, 48, 49. Okay, great. Now I'm gonna stack that up against something like hemoglobin.
Starting point is 01:25:10 And your hemoglobin for females, 13, 14, 15, male, 15, 16, 17. I'm looking at that going, great, pretty good markers there. Function my flag those and go, hey, these are higher than they should be. There may be some cardiovascular stuff. Go get checked out.
Starting point is 01:25:28 Totally different thing, right? So the same exact numbers is the interpretation where we would look at then that next is something like the sleep apnea stuff. Are you seeing no hydro energy? No, it's great throughout the day. No sleep apnea. Great. These are training induced.
Starting point is 01:25:40 We know you've been exercising. Here's our questionnaire. Do you train a lot? Yeah. Okay. Interpreter there. Then we could go on to other ones and say, let's look at cholesterol markers. Cholesterol markers, not from your heart disease perspective,
Starting point is 01:25:53 but as an inflammatory marker. Like specifically like things like LDL. If you see elevated blood glucose in LDL and somebody's eating really well and training really hard, and then you start looking at second and third, tertiary markers of inflammation, like CRP, creatine kinase, like ESR. And you start to say, wait a minute, those are all fine.
Starting point is 01:26:13 A creatine and creatine, creatine kinase, all these are good here, but LDL is elevated. Okay, now actually go talk to your doctor. You might have something happening here, familial or some other reasons, right? But if we look at that and go, okay, blood glucose is a little bit high and hemoglobin numbers a little bit off, we can actually cross
Starting point is 01:26:32 reference, is this acute dehydration? Is this chronic dehydration? Is this inflammation from exercise? We stack on something like AST and ALT. And liver tests. Uh, liver tests. Well, ALT very specifically, right? But AST is the most amount of AST in your body
Starting point is 01:26:45 is in muscle. So you will always see, almost always see elevated AST in people that have a lot of muscle mass. We see the same thing in liver too, because it's a relationship there. Yeah, if a patient goes like 270 pounds of solid muscle.
Starting point is 01:27:02 Oh yeah. Well, your AL, your liver tests are off. He's like, yeah. Yeah, and he's not going through liver failure. No a solid muscle. Like, well, your liver tests are off. And he's like, yeah. Yeah, and he's not going through liver failure. No. Right, so you could actually look at something like Cystatin C and start going down to GT and other markers and saying like,
Starting point is 01:27:11 okay, we can cross-reference, your liver's fine. What you're seeing is you're jacked. You have a lot of muscle, right? And so it's to be able to look just at the markers themselves and understand, oh, this is an exercise or this is an endurance athlete. This is somebody that has just a lot of muscle mass. Now, what do we do about it?
Starting point is 01:27:30 So when you look at the same markers, albumin, sodium, potassium, I almost guarantee everybody has had albumin on every blood test they've ever done. For sure. And almost never. Which is the protein in your blood, yeah. Yeah, it's the protein in your blood
Starting point is 01:27:44 that carries tons of markers, cortisol, and of all the hormones, tons. It's never out of range. So most people skip right by it, right? Well, it is if you're malnourished, yeah. It's super high in only one case, basically, in the case of your dehydration, right? So, cause it's a concentration issue, right?
Starting point is 01:28:03 Now we're going to go back to hematocrit and hemoglobin. They're also concentration issues, right? So, cause it's a concentration issue, right? Now we're going to go back to hematocrit hemoglobin. They're also concentration issues, right? So they're matter. So if you see albumin, hematocrit, hemoglobin, all going after the same thing, then we can look. If hemoglobin, or sorry, if albumin is normal, you'll see acute dehydration. If hematocrit and hemoglobin are up,
Starting point is 01:28:24 cause they're concentration issues. But if all three are elevated, now we can see acute dehydration if hematocrit and hemoglobin are up because their concentration issues. But if all three are elevated, now we can see chronic dehydration. Those all three will be within the reference range, but they'll all be on the upper end. So you're kind of reading the tea leaves. You're seeing the same thing that everybody else sees as a doctor. Yeah. But you're you're picking up clues within those biomarkers that everybody else is missing. The 100%. It's that interpretation. And they give you insights into the level of fitness,
Starting point is 01:28:52 health, performance, dehydration, all sorts of subtle things that affect the quality of your ability to perform and function, whether you're a corporate athlete or a professional athlete. Yeah, right? So because these things are not, again, clinical cutoffs, but someone's not asking to say, what's my disease risk?
Starting point is 01:29:10 They're saying, I want to look, feel, perform better right now. And so our granularity is different. Our expectations, the reference ranges that we use, are entirely based upon maximum health. We published a study a couple of years ago where we looked, you're familiar with NHANES database. That's the National Health Nutrition Examination Survey.
Starting point is 01:29:28 You're very familiar with that. Every year and basically the government surveys the population, does blood work and various diagnostic tests, history. Questionnaires. It's a great way of tracking a population. We learned a lot from it. Like 90% of us are nutritionally deficient, for example.
Starting point is 01:29:42 This is, what has it been going on for 30 plus years? Yeah. So you have good data on people over 30 years, right? Now there's an enormous amount of problems with NHANES, right, but if you were to go to order a blood test right now from anybody and something is high or low, what they mean by high or low is on a bell curve, right?
Starting point is 01:30:00 Yeah, you're out of the normal reference range. But that normal reference range is 95 percentile. So if you are high, that means you're in the high two and a half percentile. But let's say, Mark, you're in the 95th percentile. I don't wanna be in the, like, I wanna, you're just a little bit not diabetic. Yeah.
Starting point is 01:30:19 Like, whoa, whoa, whoa, hold on, time out, right? Like, as a medical doctor for general population, that is, that's what we should be screening, right? Like as a medical doctor for general population, that's what we should be screening, right? Like huge disease. But I'm like you though, as a doctor, I don't look for what's quote normal. I look for reading the tea leaves about where are the edge cases,
Starting point is 01:30:37 where are the people moving in the wrong direction that it can be subtle. Exactly. That aren't like, you know, the lab range is vitamin D is 30. Well, I think it should probably be 45 can be subtle. Exactly. That aren't like, you know, the lab range is vitamin D is 30. Well, I think it should probably be 45 to be optimal. Our performance range is 55. Yeah. Exactly. 55 to 75. Or ferritin. You know, the reference range for your iron stores is 16.
Starting point is 01:30:56 Well, it should be probably 45 or 50 to be good. Right. So you so that's another great example, right? Like you there's actually recent papers on ferritin very specifically. You'll see reference ranges. Like you happen to know offhand what your guys's Faraday reference range. 16. Okay.
Starting point is 01:31:10 There's a low inlet. What's the high end? Probably would flag. Okay. You'll see 300 to 400, right? So you get your labs back and your Faraday won't say that it's higher or low unless it's lower than 15 or higher than 400.
Starting point is 01:31:24 300, right? It's crazy. What am I doing here, right? Despite ample data that says like, yo, if you're over 180, you're going to have inflammatory problems, you're going to have oxidative stress, like you're going to have all these things there, right? So going with the NIH or the NHANES thing,
Starting point is 01:31:38 here's what I was saying. We looked in that database and what's interesting is there was no relationship between the amount of muscle mass people had and their strength training history. In that database. You know what that tells us? How did they get their muscle?
Starting point is 01:31:54 If they had a lot of muscle, we had no bearing or understanding if they lifted weights or not. Which means people in those national databases have generally accrued their muscle by just being bigger. Larger people, eight more, bigger body mass, comes along with more muscle. That's the type of population that we're using
Starting point is 01:32:16 to build these reference ranges on. Yeah. Do you want to be compared to that? No. Okay, so. My sister, as you said used to tell funny jokes. She says when the Vermont farmer was asked, how's his wife?
Starting point is 01:32:29 He says, compared to what? Compared to what is the answer. Always, right? So we are comparing to what we believe based upon the available data, our 20 years of database internally and how you should be performing at your best. And then from there, we're going to work to craft and what's really careful and specific about this is we're going to work to craft solutions that are solving as much we can.
Starting point is 01:33:00 What's causing biomarkers to be up. So there's a handful of biomarkers. You mentioned vitamin D. That's a really easy one. If vitamin D is low, the solution is very simple. Get vitamin D up, right? You want to use sunlight. We would all advocate for that most, right? You want to go to food, you want to go to supplements.
Starting point is 01:33:15 That's your choice. But low biomarker, get that biomarker up. That's not the case for other biomarkers though. Just because you, like for example, if your sodium is low, you don't need to ingest more sodium in your diet. You don't need more electrolytes. That's a, because that is not a, that is a systematic marker that is telling us something about acute fatigue and chronic fatigue.
Starting point is 01:33:39 That is a overtraining. That is a sympathetic overdrive marker. So if you start to look at things like sodium and potassium ranges and sodium is trailing low, still within the reference range, potassium is trailing high sodium potassium ratio specifically starts getting below 30 or above 35. I now know this is nothing to do with your diet per se. It's nothing to do with you needing a banana or a packet of element, right? Which all in love of. This is a case of you saying,
Starting point is 01:34:11 okay, your allostatic load is too high. What is going on here? We need to reduce fatigue. That is the entire thing. That is the key function of like, it's not necessarily looking at the market and saying it's higher load than therefore take this thing, take less of this thing. It is trying to backpedal and say, well, what is the key function of like, it's not necessarily looking at the market and saying it's higher load than therefore take this thing, take less of this thing.
Starting point is 01:34:26 It is trying to backpedal and say, well, what is the cause of that? And so when we can come back in that particular case and say, Hey, you actually need to tone down your training a little bit. And then those markers go back up. Stress response goes up when you're training too much.
Starting point is 01:34:38 And every single time in that exact example, what do you think happened to DHEA pools? What do you think happens to total testosterone? What happens to free testosterone? They're plummeted, right? And so we get to like, oh, my low testosterone's, my testosterone's low, that's why I'm tired. No, no, no, no, no.
Starting point is 01:34:58 You're tired because of up here. Fix that and then watch that testosterone go way up. There's plenty of cases when you need to take exogenous testosterone, but you get the point here. So, so we really have to rethink the whole way we interpret lab tests, which is not what's quote normal, which is just a statistical number based on averages in a population and the population, if it's
Starting point is 01:35:19 sick, it's going to be skewed sick. Right. It's, it's where we can read the tea leaves to sort of interpret variations from that normal range that give you clues about what's happening either for disease or things that affecting your energy, performance, fitness, quality of your health, even if you don't have a disease.
Starting point is 01:35:35 A hundred percent. Right. So we were trying to say, you want to perform at your best. You tell me what performance I don't care. I want to be able to do ABC. Fine. Now we're going to look at that and say, if you
Starting point is 01:35:44 wanted to perform at your absolute best, tell me what performance. I don't care. I want to be able to do ABC, fine. Now we're gonna look at that and say, if you wanted to perform at your absolute best, what would that look like? Right, it's not necessarily about having fancy new markers. It's taking the information we already have in front of you and getting more extraction of more objective data, asking very scientifically validated questions.
Starting point is 01:36:03 What's your objective? How do you feel? Right, so A, B, and C is here, but I feel great. That might be a normal thing. So what we create is what we call molecular signatures of people, and we establish this signature of people, and now we understand what is your normal variation. So I have a handful of things,
Starting point is 01:36:21 and you'll see this really commonly in happens. And how do you vary from your optimal? Bingo. As opposed to somebody else's optimal like mcv tends to be very high in people not very like a little bit elevated. I can guarantee your mcd is probably at the upper end all the time probably up there all the time normal for you probably you might even be out of the reference range pretty normal thing right if you were out of the reference range for another marker though like albumin if your albumin was constantly seven, I'd be like, that's a problem. I don't care what your argument you're going to make. That is a problem. So there is clear distinction of like, this is dysfunctional.
Starting point is 01:36:54 And then there is, these markers are really sensitive. These markers are really insensitive. What is your normal meal? You, what is that molecular signature that comes with your lifestyle, where you live, the water you drink, what kind of foods you eat. And now let's create deviations from that. That allows us to then not beat our head in the wall with supplements or whatever, to try to fix something that is not actually a problem. And I think what's really exciting, Andy, is that things like sodium-potassium ratio, like that's something doctors never learn anything about. It's really clear and super present.
Starting point is 01:37:32 Right, and so I think what's really exciting is we're entering an era where you're not gonna have to rely on an individual doctor or an individual exercise physiologist, but we're gonna enter an era where we're gonna be able to use AI to help us look at all the world's literature on how to optimize for performance or health using biomarkers and get insights that we never had before.
Starting point is 01:37:56 Well, combined with your individual data. That's right. Search the literature and give me my end of one, right? Because this is a combination. As a medical doctor, from your perspective, you have your evidence-based practice. And then you have the, well, I've been working with this girl for 15 years.
Starting point is 01:38:11 I know her physiology. How do you meet that in the middle? That is the new age of meeting the middle. Now let's have AI scan all the literature. I can't catch it all. But let's also integrate your unique signature and let's figure out what is the path forward for you based on your goals and wants and desires and whatever else that you certainly care about right? This is our new Avenue forward
Starting point is 01:38:34 Our stuff is software Yeah You can take any of your old blood work and upload it through our stuff and have it all analyzed interpreted for you in this exact Frame of mind amazing so someone can take function and go great Here's my blood report go to my medical doctor in this exact frame of mind. So someone can take function and go, great, here's my blood report, go to my medical doctor, then take their function thing, upload on vitality and go, great, I want now the performance swing.
Starting point is 01:38:52 Yeah, I wanna do that. I wanna do that. Yeah, let's take a look at it. I wanna do that. You think we're testing too much or not enough? That's a really good question. Here's how I'll frame my answer. In the next two to five years,
Starting point is 01:39:05 that question will be entirely different because of technological advances that are gonna allow you to do some of the things we have to do in venous, full normal blood draws at home in a continuous fashion, like continuous glucose monitor. Great, well now that technology is advancing where we can get a lot of biomarkers continuously, where we can get kits at home,
Starting point is 01:39:24 and we can do tests at home, and there's a lot on the market now, a lot of themarkers continuously, where we can get kits at home, and we can do tests at home. And there's a lot of them are clunking, don't work, and their numbers are way off. I've tested a ton of them. But it doesn't take a stretch of the mind to think, it's gonna be there. Maybe it's three years, five years. It's gonna be, Theranos probably won't ever happen.
Starting point is 01:39:40 But okay. So how does this look when we can repeat these tests? And we've done lots of experiments where we do full hundred markers every day for like six days, right? And it's like, how much these? So we're getting a sense now of stability and instability of individual markers
Starting point is 01:39:53 and variants within people. Yeah. That is where this thing is gonna go. So when you ask about like, we testing too frequently or infrequently, it kind of depends on what your aptitude for this stuff is. If you're the-
Starting point is 01:40:04 I don't mean frequency, I mean enough biomarker. Cause you know, a lot of the medical profession goes, there's too much unnecessary testing, it leads people down the wrong road, and- I'll answer this one. And anxiety, and it's unnecessary, it's too costly, blah, blah, blah, blah.
Starting point is 01:40:20 I don't think that's for a public official to decide, right? I like a ton of this stuff. This is what I do I have also seen that case. I have seen that case where people have given themselves extreme legitimate clinical anxiety Depression from things like that our our clients if they don't have the right in Guidance with our people have come into our coaching program paid a lot of money and we've had to go you're done We're taking your, some of our athletes, John Rom professional golfer. He's said this a bunch publicly, so I can say it. The, the whoop or the, or how to get taken off the sleep tracking was causing issues with him.
Starting point is 01:40:57 The same thing with blood. We've had plenty of our clients were like, dude, you're done. Like this is a net negative big time. And that was the opposite. So I don't think this is something we could generally say of like there, if we're thinking about what should the government pay for, that's a different question, right? What should be covered free for me? Those are different questions.
Starting point is 01:41:17 I understand if you're a official that's making those decisions and you want to make an argument that we shouldn't be making it free to have Mark's 400 panels measured for everybody at age 20. Okay. But that's really different than me paying cash on my own pocket to do what I want with my medical service. That's a That's a fundamentally different thing. I agree. And I think we're entering an era where
Starting point is 01:41:40 the costs are coming way down. Way down. The capacity to do not just more, just general blood tests, but metabolomics, proteomics, omics, literally pennies. Yeah. I mean, we're seeing just amazing scale, like Moore's laws applying to medicine too. Of course.
Starting point is 01:41:59 And so what was a billion dollar test to get your genome sequences now 300 bucks. 300 bucks, yeah. So it's like, okay If if and and then the question is what do you do with all that data? How do you make sense of it? And that's where AI machine learning comes in I think in my view it's always good to know like I've never been sorry by knowing more data about an individual Yeah, help me guide them about what's going on
Starting point is 01:42:21 It all comes down to a couple of things run Again, knowing your patient, in your case, knowing your person you're working with, how do they respond, how they react, that stuff. But I would make a really strong argument, and I would fight anybody on this, if possible, at age 30, maybe 35. Get a baseline. Of everything.
Starting point is 01:42:41 Here's what I mean, everything. A VO2 max test. A full dex of scan of bone density. Now those numbers. And body comp? Yeah, body composition, of course, right? Metabolic health testing. Way over 100 biomarkers, blood-based biomarkers. A cognitive test, right?
Starting point is 01:42:59 All this stuff should be done at around 30, 35. The vast majority of people will walk out of that test with no medical problems. And that would be the point. That would be the exact point. And now we don't repeat that every year, maybe even every five years, but let's get it at 30.
Starting point is 01:43:17 And now when you're 40, we repeat. Because when you show up to our program at 40, and your VU2 max is 25, and filling the blank, right? Let's take a more egregious one. Your total testosterone is 400, and your fatigue, low energy. Maybe you were at 300 when you were 25.
Starting point is 01:43:41 Maybe it's up. I don't have any idea. 400 is like this gray zone, right? I'm like, I don't know. Maybe it was a thousand. And now it's 700 and that's why you feel, cause you're down 300. There's way more complication to that.
Starting point is 01:43:53 But you see the point. I don't have any idea what baseline is. We do this, which was actually like, there's so much crossover between our groups, it's funny. So I know you guys just got Ezra. Imaging, yeah. Cool. So you're you guys just got, um, Ezra imaging. Yeah. Cool. So you're doing blood and MRIs for cancer, right?
Starting point is 01:44:08 Yeah. So you're doing blood for disease and much more. Yeah. We do the same thing, but you know what we do with our MRI scans? We use Springbok. Springbok does the same thing, 20 to 30 minute, full MRI, full body MRI scan.
Starting point is 01:44:22 And it gives us a three dimensional image of every muscle in your body. No, there's no cancer screen there. I have no idea. I don't care. But what I can look at is what's the exact size of your vastus lateralis on your right leg versus your left leg. What's your hamstrings groups look like, like
Starting point is 01:44:39 each individual muscle. Interesting. And so now I have baseline. So for Lance McCullers, for Walker Bueller, another one of our major league baseball pitchers, I'm gonna look at every single rotator cuff muscle. And I'm gonna watch it develop every single year, ideally twice a year, and start to say,
Starting point is 01:44:57 okay, you have to have your elbow and shoulder be able to throw 100 pitches a game for 30 games a year. So the development of your infraspinatus by 10% versus your Terry's minor, this is a big deal for us. I wouldn't do that for you, you don't care, right? But I might look at it and go. Not throwing any pitches. I might look at it and go, oh, do you realize
Starting point is 01:45:18 your trap on your right side is 25% larger than your left side, and you would have a lot of neck pain? Weird. Oh, your gastroc on your right side is 40% larger than your left side, and you would have a lot of neck pain? Weird. Oh, your gastroc on your right side is 40% larger than on your left side, and that hip's been bothering? We can start to see huge- Information, yeah.
Starting point is 01:45:34 Asymmetries, but if you do it at 30 or 35, whatever, now we have that baseline. Do you know what sarcopenia is? I know you know the term. Yeah. But scientifically, we don't even agree what sarcopenia is. Muscle loss, but what does it mean? But how much is normal?
Starting point is 01:45:49 How much is not? Well, you know why we don't know? We have no database. I have no idea what a normal amount of muscle is. I have no idea. All we have is like BMI studies. But imagine if everybody was scanned through a spring block and I can say the average 60 to 65 year old male, his vastus medialis was this big.
Starting point is 01:46:11 And I could do the distribution, the 95% distribution that we do on blood work for every muscle in your body. And so now you get that ACL, you get that knee replacement and they clear you after four weeks because you're not in pain, you know, your flexibility is back. But I can look and go, whoa, whoa, whoa, whoa, whoa. That vascular lateralis is 80% of where it was
Starting point is 01:46:33 before the surgery. We need to now write five more physical training sessions or physical therapy. This is why we're justifying it. We're not back to return. Or we're aging improperly. This is where you were every five years we run the scan and now we are seeing this advanced drop in muscle mass.
Starting point is 01:46:50 The thousand things, right? So what we're doing is very similar, but I'm doing it from this end of the spectrum and you're doing it from. Yeah, it's true. I mean, you're talking about muscle mass and muscle function and the variations, but I think our ability to get large data sets
Starting point is 01:47:11 on individuals is gonna change our whole healthcare system. And as the costs come down and as it becomes more democratized, people wanna use their HSAs or FSAs to pay for it. There's just so much we can learn. I mean, it didn't occur to me until after Function acquired Ezra, which is a full-body MRI and imaging company
Starting point is 01:47:33 that also does other imaging, that combined with liquid biopsies and full-body biomarker testing and annual serial full-body MRIs, which we've gotten down to 499, which all 37 a day. I saw that announcement. I was like, what? Yeah, it's crazy.
Starting point is 01:47:53 Right. We cut the price. Cause it was like, it was like, yeah, it was like 1500 or something. Yeah. Five times less price. Yeah. And it, it just sort of the light bulb went on and I'm like, well, if you start when you're say 35 and do that, you never have to die from cancer.
Starting point is 01:48:10 No one ever has, we can't prevent getting cancer, but we can make dying of cancer a historical footnote by getting this data every year. My dad died of cancer at 91. My sister died at 57. My dad was otherwise very healthy. Walked his dog two, three miles a day, was playing tennis at 90 years old,
Starting point is 01:48:28 but he's a smoker when he's younger. And if he'd had this low dose CT and if my sister had the full body MRIs, they never would have died. And I realized, wow, I have a choice. Like I can make dying of cancer optional. If I ignore it, I might die of cancer. But if I do screening every year,
Starting point is 01:48:51 I'm never gonna die of cancer because when you pick it up in stage one or two, it's over 95% survival at five years, which is basically a cure. So yeah, it's a different era. Okay, so. Well, you can do it. So my point here would be, um,
Starting point is 01:49:07 something like spring back can be, it doesn't require a special machine. It can be done on any machine. So now let's add that on top of the cancer screen. Yeah. And now you never have to die of low muscle. So Copini can be gone. Yeah. It's right there. Right. Well, we do, we do actually offer MRI body composition testing. It might be different than what it's totally different be gone. Yeah. It's right there, right? Well, we do actually offer MRI body composition testing. It might be different than what you're doing. Oh, it's totally different, right?
Starting point is 01:49:28 Yeah, because you're getting how much muscle versus body fat, which is great. But now let's image and 3D model every single muscle. That's crazy. It's amazing what we can do. So you've done a lot. You've built labs, you've coached champion athletes, you've done plenty of analysis of people,
Starting point is 01:49:43 fireworks and blood and sleep. What do you do? What are your non-negotiables? Because you're talking about resilience and flexibility. You've got to have stuff that you just like. That's Andy's non-negotiable. What's your daily non-negotiable? Okay, I don't like non-negotiables
Starting point is 01:49:57 in the traditional sense. I, as I said earlier, I want to be able to not work out and be fine with it. I want to be able to not eat and be fine with it, right? Now there's certain things I'd like to do. I like to lift weights. I like to exercise. I live up in the mountains.
Starting point is 01:50:12 I love, like I'm so obsessed with wild animals, particularly deer and things like that. Like that is my jam. It's my new Instagram. Like if I'm spaced out at work, I'm not on my phone. I'm for sure looking out my window for deer. You don't have to redo that. In Austin here, we got deer on the lawn everywhere.
Starting point is 01:50:28 Right in the city's lawn. I'm coming in on my property all the time. I texted my wife and I was like, yo. Yeah, if there's the apocalypse, we'll be fine. There'll be plenty of food to eat. Yeah, nuts. We have deer all over the property, but that was. No predators here, is what I mean.
Starting point is 01:50:41 The only real, honestly, like my true non-negotiables, as in things I force myself to do every day, is some sort of involuntary gratitude. Wow. Thankfulness, right? So no matter where I'm at, no matter what I'm doing, I always try to remind myself, because it's still wild to me. It's wild I'm sitting in this room.
Starting point is 01:51:05 Like you've been around for so long. If I'm not wrong. Thanks. And I'm like 20 years ago, I'd be like, hey, what are the chances are you'd be in a room with Mark Hyman? Say zero. Zero, right?
Starting point is 01:51:16 Where I come from, my background, the kids I grew up with, I'm like, the things I've done, I was just in the Middle East. I've been with the world's most successful athletes. I'm like, my business partners and I, my wife and I, my brother and I, I'm still just like, how, how did this all happen? Yeah.
Starting point is 01:51:34 So the one non-negotiable for me is always, no matter what. Being grateful. Being grateful because all of us have been through trauma at some point and you know that all this could go away. All this could go away by the time we finish this podcast, right?
Starting point is 01:51:51 So that's the only thing. There are things I like to do more than this stuff, but the one thing that I will say, like no matter what the day is your situation, if I'm on the side of a mountain somewhere, like I'll be next week in Canada trying to chase down a bear and I'm freezing or whatever the case is going on.
Starting point is 01:52:05 It's like, yo, this is pretty rad. This is a pretty cool thing you get to do every day. So that is on my- Gratitude, I love that. That's a good one. That's a good non-negotiable. I think that's someone everybody should take home. And if you had to kind of sort of just distill your work
Starting point is 01:52:20 into a principle or two that people could understand, what would you say it is? I think I've hit a lot of my major philosophical points at this far. One maybe I'll add to this is a saying that I stole from Bill Bowerman. It's the way I finish every episode of my podcast. If you have a body, you're an athlete.
Starting point is 01:52:40 If you look at something like the NBA Combine, the NFL Combine, like these testing events that they do prior to drafting a player, and you looked at all the testing they go through, and then you look at a longevity clinic, you're gonna notice this is really, really similar. All right, so I do this a lot of times when I present, so I'm kind of giving it away,
Starting point is 01:53:03 but if we take Brian Johnson, right, who's clear with wanting to live for forever, the most longevity person we could follow, right, on the end of the spectrum. Whatever, okay. And the opposite end of the spectrum. And we went to Fred Warner, one of the best football players in the world.
Starting point is 01:53:21 I might talk to those two dudes in the same day. And if we started putting a list down of what do they care about? And we said VO2 max and metabolic flexibility and healthy joints and reaction time, hand-eye coordinate. I could fill this whole list out and they would be the same. And then at the very end, it'd be like, I wanna never die, okay.
Starting point is 01:53:41 And then the very end over here would be, I need to make sure I'm over 225 pounds and I need to sack a quarterback and my shoulder needs to have this ability. Okay, fine. So there are some ends there. But the reason that we've built our lab, the way we have in these companies, the way we have,
Starting point is 01:53:57 is because I fundamentally believe that. I want to give everyone the opportunity to look however they want to look. You might want to look skinny. You might want to have way more muscle. You might want to look however they wanna look. You might wanna look skinny, you might wanna have way more muscle, you might wanna look like, fine. We have the ability, the technology and the knowledge to help people look how they wanna look physically.
Starting point is 01:54:15 That sounds vain, I always hated that, but as I got older, I'm like, man, that's actually really important. People don't like how they look, that sucks. That has a big impact on their life. So I want you to look however you wanna look, and if I don't like how that looks, that sucks. That has a big impact on their life. So I want you to look however you wanna look. And if I don't like how that looks, that's fine. That's up to you.
Starting point is 01:54:29 You wanna feel a certain way, right? You wanna feel more energetic. You wanna feel more focused. You wanna feel less back pain. Okay, whatever that feel is to you. And then the third one, you wanna perform. You define perform. Wanna be able to paddleboard for six hours
Starting point is 01:54:44 or hike up a mile elevation. You want to be able to perform, be more focused with your kid, be more present, not distract. I don't care. But if I were to say, hey, give me the ability to have these three areas and you tell me the rules of the game,
Starting point is 01:55:02 and then you tell me the restrictions. Oh, and by the way, I only have $1,000 I can spend. Oh, and by the way, I'm an alcoholic and I refuse to stop drinking. Okay. Good luck with that. These are the things we get, right? Oh, and by the way, I'm on a plane twice a week.
Starting point is 01:55:16 Fine, you tell me the rules of the game, tell me what's not negotiable, and then I'm gonna do everything, and you can see I get really passionate about this. I'm like, let's go. Now let's find solutions, because you're an athlete. That's what I'm gonna do everything. And you can see, I get really passionate about this. I'm like, let's go. Now let's find solutions because you're an athlete. That's what I'm treating you as. You have a performance you have to hit.
Starting point is 01:55:30 I don't care if that's sports. I don't care if that's physical. You like, this is a game. I'm competing now. I'm gonna win. Like we're gonna go after this thing. You told me some ridiculous thing. You're not willing.
Starting point is 01:55:40 Cool. Great. You have a medical thing we can't, well fine. You give me those hard, give me that hard case. Give me that thing that is impossible and then we're gonna go deploy all means and solutions and we will find this damn anchor. We will get that anchor out of the way
Starting point is 01:55:56 and you're gonna crush. Like that is what I get hyper passionate about. Probably why I don't get like as personally passionate about population- wide health stuff. Yeah. I got a great, great, but like, I want that other person who's just like, yo, AB and C are going on. I'm not gonna let you change those at all.
Starting point is 01:56:13 But now find a way to make, great, let's go. Like, let's go. And now we're gonna do this, this, this. And we just get after it. That's great. So we attack every time. Like, that's why we say, if you have a body, you're an athlete.
Starting point is 01:56:23 If you want to use those abilities and skills a good take home to kick a ball better cool If you just want to be a healthier age year if you want to live to forever, I don't really care So great. I mean it's such a great thing you do because you know most of medicine is focused on sort of the end stage diseases and not on performance or optimization or feeling better or things that matter to people. Like yeah, it matters not to die from some terrible thing.
Starting point is 01:56:57 Fine, but like every day people living their lives, they just wanna feel better. They just wanna be able to do the things they love to do and not be restricted. And your work has really helped people to understand what that is. So how can people find you? Where can they learn more about your work
Starting point is 01:57:13 and what you're doing and all the things you're working on? Yeah, I really appreciate all that. The thing that I hate about longevity is it's unfalsifiable. But feeling better now is an A-B test. You did or you didn't better there. So my podcast is perform with Dr. Andy Galpin. It's only in seasons. So season two just came out, season three would come out next year or something like that. So it's pretty easy to follow along with. We have a new lab that we're building in Parker university. So we're building a 64,000 square foot human performance lab.
Starting point is 01:57:46 And you actually outlined exactly what that lab does two seconds ago. It is that, it is my belief in understanding where the limits of human capacity, how do we push adaptability and resilience. And we have some that will be open to the public, it's not open yet. But we're conducting-
Starting point is 01:58:03 I'm gonna go, it's not that far from here. Yeah, man, we'll have you down. Well, we have some technology in there that doesn't exist in the world anywhere else. Can't wait. So we have that. And then. Name me when it's open.
Starting point is 01:58:12 Yeah, we'll actually get you there for pre-opening. Okay, great, great. Which would be easy. And then website and social media are. Great, and your website's andygalpin.com? Yep. Great. Well, Andy, thanks for what you do.
Starting point is 01:58:23 Thanks for being so passionate about it. Thanks for caring how to make each of us feel a little bit better, do a little better, live a little bit more fully, and be grateful for everything in our lives. So thank you for being on the podcast and doing everything you do. It's an honor, pleasure.
Starting point is 01:58:37 Don't forget, there's a way to listen completely ad free. With Hymen Plus on Apple Podcasts, you can enjoy every episode without any breaks. Just open Apple Podcasts and tap Try Free to start your seven day free trial. If you love this podcast, please share it with someone else you think would also enjoy it. Don't forget, there's a way to listen completely ad free. With Hymen Plus on Apple Podcasts, you can enjoy every episode without any breaks.
Starting point is 01:59:02 Just open Apple Podcasts and tap try free to start your seven-day free trial. You can find me on all social media channels at Dr. Mark Hyman. Please reach out. I'd love to hear your comments and questions. Don't forget to rate, review, and subscribe to The Dr. Hyman Show wherever you get your podcasts. And don't forget to check out my YouTube channel at Dr. Mark Hyman for video versions of this podcast and more. Thank you so much again for tuning in. We'll see you next time on the Dr. Hyman Show. This podcast is separate from my clinical practice at the Ultra Wellness Center, my work at Cleveland Clinic, and Function Health where I am Chief Medical Officer. This podcast represents my opinions and my guests' opinions. Neither myself nor the podcast endorses
Starting point is 01:59:38 the views or statements of my guests. This podcast is for educational purposes only and is not a substitute for professional care by a doctor or other qualified medical professional. This podcast is for educational purposes only and is not a substitute for professional care by a doctor or other qualified medical professional. This podcast is provided with the understanding that it does not constitute medical or other professional advice or services. If you're looking for help in your journey, please seek out a qualified medical practitioner. And if you're looking for a functional medicine practitioner, visit my clinic, the Ultra Wellness Center at UltraWellnessCenter.com and request to become a patient. It's important to have someone in your corner who is a trained, licensed health care practitioner and can help you make changes, especially when it comes to your health. This podcast is free as part of my mission to bring practical ways of improving health to the public.
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