The Science of Stress Adaptation: Why Some Get Stronger While Others Burn Out

Health is synonymous with robust function in the systems that we need for life, and disease is dysfunction in those same systems. So, health equals function and disease equals dysfunction. So, any technique that improves function will improve health.

There's obviously a lot of doctors out there who are well-known on the podcast circuit. Yeah, see them all over the place. And then, there are others who I consider to be like diamonds in the rough who I like to have on my show and expose to the world. And today's guest is one of those individuals. He's out of Portland, Oregon, Dr. Cody Stroedman. This is his book, by the way. I'm holding it up for those of you watching the video, "Your Life, Your Choice." And, Cody sent this to me and as you can see, I've got plenty of pages folded over. I always, when I interview an author, just read the book cover to cover and like to take a deep dive into the things that I think are really going to help you, the listener, learn some new things. So, the shownotes as we go through this are going to be at BenGreenfieldLife.com/Adaptive. BenGreenfieldLife.com/Adaptive. Because Cody, you have the subtitle here, "For Your Life, Your Choice: The Rise of Adaptive Medicine." So, I guess we should just address the elephant in the room right away. What is adaptive medicine?

Great question. So, adaptive medicine came out of a 10-year obsession with— to try to answer one question, and that is, what is health? During that time, I became a naturopathic doctor and acupuncturist, where I was trained to diagnose disease and treat and manage it with a whole bunch of tools ranging from pharmacology, supplements, herbs, nutrition, and more.

By the way, how long does that take to do naturopathic medicine and acupuncture?

For me, it took 6, and that was the, the faster time track. So it ranges between 4 if you're just wanting to get the ND, and they got 5 years. So it varies, but for me It was a 6-year sentence.

Yeah. And did you grow up kind of like in the, not the stereotype, but like the hippie patchouli oil alternative medicine mom gives you homeopathics instead of vaccines type of environment or did something else draw you to naturopathy?

Yeah, not at all. I grew up in, born and raised in Kansas, more rural. It's opposite, in fact, very anti-hippie and just more of the conventional route. But, um, I got to naturopathic medicine for various, various reasons, one of which is my mother's sickness. And after that, I just really wanted to answer what is health. And I realized that pills can be helpful in emergent conditions, but they're not going to boost overall health. So that's why I went the route that I did, to understand health so I could help improve myself and help others improve their health as well.

Okay, yeah, what happened with your mom?

Cancer. So she got breast cancer and then got remission from that, and then ovarian cancer, and that was ordeal, and eventually she just succumbed to that. And that really hit me hard. I was in naturopathic medical school at the time, and to tell you the truth, Ben, that just turned the tables on a lot of things. She tried almost everything, and that hit me hard and really developed my thought process around adaptive medicine, which is attempting to transform individuals' life into living, breathing medicine. By their own behaviors. I'm of the opinion that we have everything that we need to prevent, treat, and oftentimes reverse diseases. We just need to put that into action. And that's what the book and the philosophy Adaptive Medicine is all about.

Yeah. And assuming this goes beyond just positive thoughts and the biology of belief, what's an example of, of like a, a lifestyle practice you would consider to be medicine?

Oh man, there's so many of them. Uh, many of them that you've already talked about— exercise, functional circadian rhythm being one. The whole premise of adaptive medicine is that adaptation is in and of itself medicine, because from a physiological perspective, health is synonymous with robust function in the systems that we need for life, and disease is dysfunction in those same systems. It's really that simple. So health equals function and disease equals dysfunction. So any technique that improves function will improve health. And that is the adaptive process, which follows a very simple protocol: challenge, recover, and repeat. And so when you challenge those systems regularly with the right dose, which I talk about in my book, which is environmental hormesis, allow it to recover and align that with a functional circadian rhythm, you will improve function, your health will improve, and your overall quality of life will get better. So that is adaptive medicine.

Environmental hormesis. So basically you're throwing challenges at your body, your body's adapting, your cells are more resilient and you're just basically weaving that into a daily cycle.

[Speaker:BEN_GREENFIELD] Exactly.

[Speaker:JASON] Okay. Alright, cool. So, I want to talk about some of these environmental hormetic stressors and things that help us to adapt. You cover a lot in the book. We're going to kind of dip our toes in here and there. But one thing that I noticed early on in the book, you're talking about circadian rhythm and you say it's a 24-hour cycle, which I think a lot of people know. And then you also say it contains 3, what you, what you call ratios. What does that mean?

Right, so I would agree most people have heard of the 24-hour clock or the circadian rhythm and associate it with the clock, but the ratios are what sets that clock. And each ratio has a stimulatory input that wakes the body up and a recovery input that brings it back down into rest and recovery so it can repair. So the first ratio is light versus darkness. Light, especially in the early morning, anchors the clock. It tells the brain that it's time to get up and get after it, and then also sets a timer for melatonin release later in the day, which improves sleep. So that's number 1. Number 2 is movement versus rest. Most of the body isn't exposed to light, so movement becomes one of the stimulatory inputs by increasing metabolic demand. And of course, rest helps you shift your body back into recovery. And then, the third ratio is eating versus fasting. Eating will literally ring the dinner bell for the trillion microbes residing in your digestive tract and impact hormones and neurotransmitters and a whole bunch of other things that are great for the body. Whereas fasting gives your body a break and allows it to recover.

Ben Greenfield: I just got back from Germany a couple days ago, and what you just described is I think one of the keys beyond Ambien, modafinil, and all these pharmaceuticals people use for managing the circadian rhythmicity that just tends to get just shattered during travel. And I mean, what you just described is so simple, but I mean, if I get to— let's say I'm traveling back east and I get to my final destination at, I don't know, 6:00 PM and I want to adapt super fast. That means that I'm not doing the— I don't know, you hear about Joe Rogan and The Rock, they talk about first thing, go hit the gym. The gym is bright lights, it's movement, and typically post-workout fueling. I will opt instead for sauna, infrared sauna, walk outside in the dark in the fresh air, And then, if I do need to eat, really light. And then, the morning, just, you know, that's the blue light overhead in the gym, big protein-rich meal. But, just those ratios alone when it comes to travel are a game changer.

[Speaker:BEN_GREENFIELD] I wholeheartedly agree. And, I like the eating aspect because a lot of people know about light and jet lag, but if you're eating balanced, your fast-fed cycles are off, it's metabolic jet lag. So ultimately, even with circadian rhythm dysfunction, shift work, when you're traveling, you line those stimulatory aspects up when you want to be active and the recovery aspects up when you need to rest. That is by far the best adaptive approach for circadian rhythm alignment. So, you're firing on all cylinders no matter where you're at or where you're going.

Ben Greenfield: Yeah. Gary Breck has this approach where if— and he travels a lot, a lot more than I do. He only eats even when he's traveling at the time that he would normally be eating in his home time zone if he wants to maintain his circadian clock at his home time zone. So, that means basically you would have a watch and time 1 is the time back home and time 2 is where you're at and you're only eating when you normally eat breakfast, lunch, and dinner in time 1. I think that's a decent approach if you're just popping all over the place, but then, The flip side of that is if you're traveling and you're in a location for a longer period of time, like I was in Germany, I shift my clock more rapidly by eating at the times that they're actually eating in the zone that I'm in. And, I'll even go so far as to— actually, I'd love to hear your thoughts on this. I'm a fan of intermittent fasting, but to get the body onto the clock more quickly, I will make sure I actually have a protein-rich breakfast sometimes even before hitting the gym if I, if I want to get adapted more quickly to a time zone.

Interesting. Yeah, I'm unfamiliar about the macros and how that impacts the circadian rhythm. More so the expert in the timing, really. And intermittent fasting is a whole nother topic altogether because a lot of people confuse it with caloric restriction, when in my perspective, time-restricted eating, which is commonly referred to as intermittent fasting, it's a circadian rhythm diet. And to tell you the truth, Ben, like, I don't know about protein and how it early in the morning sets up the clock or doesn't. Maybe you could help me out. So, that seems to be your go-to strategy. You've had good results with that?

Yeah. The main reason for the protein is I think there is a little bit of an upregulation of the mTOR response that does feed into circadian rhythmicity. So, instead of the green juice for breakfast, opting for the eggs and olive oil, with avocado seems to do a better job for me getting me onto that time zone. But then, what you mentioned about intermittent fasting being more of a circadian rhythm thing than a calorie restriction thing, it is interesting because you see studies that compare for weight loss intermittent fasting calorie restriction and they tend to be pretty even. But I think what a lot of people miss is those studies are just looking at weight loss.

Exactly.

And with intermittent fasting, like you're saying, there's a lot more, right?

Yeah, there's a lot more. So like I said, intermittent fasting, the circadian rhythm, it goes within those 3 ratios. And as you probably know, if any one of those are off, your cortisol is going to be out of balance, your testosterone, your hormones are going to be out of balance, which impacts how you recover, how your metabolism runs. So there's definitely crossover, but the key distinction in which a lot of companies don't make is that caloric restriction is completely different than time-restricted eating. It's often lumped in together, and that just makes research just difficult to try to suss out, well, what's actually being looked at? Is it circadian rhythm biology or overall caloric balance?

Right. And the circadian rhythm biology then is going to affect downstream, like inflammation, hormones, etc. So yeah, I think having a period of time during a 24-hour cycle where you're not like, you know, shoveling food into your gaping maw is a good idea regardless of whether you're interested in weight loss.

Exactly. Yeah, it just gives your body that time to recover.

Yeah, yeah. Breath is another interesting one. You go pretty deep into breath and you talk about some things that people might not think about when it comes to breathing, including you have one method for improving respiratory function. I think you call it inspiratory— was it inspiratory muscle training?

Inspiratory muscle training. I absolutely love it. It's simple and it's very, very straightforward. You breathe through a small hole and this adds resistance, which strengthens your breathing muscles. And this added resistance increases the negative pressure inside the lungs, which is needed to pull air into them, by up to 28 times compared to normal breathing. So essentially, it's a, it's a pressure workout. And the reason why I love it and why this matters is because when you strengthen your breathing muscles, You improve lung and cardiovascular function, which in the real world translates over to better oxygen efficiency, lower blood pressure, and improved athletic performance. And this is a big deal because lung function is, is strongly associated to be one of the strongest predictors of overall health and longevity. And the best part about inspiratory muscle training is that all it takes is 30 resisted breaths a day. That's it, just 30 breaths a day to get all those benefits. So, as long as you're getting resistance on the inhale, you are building those strengthening or strengthening your breathing muscles and you can tap into all those adaptive benefits.

Ben Greenfield: Okay. So, 30 inhales a day. And by the way, I noticed you mentioned it could lower systolic blood pressure by 9 points, right? So, if I'm normally 129/79, I could drop down to 120/79 as an example. But 30 inhales a day, would this be literally as simple as grabbing a straw, one of those fancy microplastic-infused straws and just pulling in 30 times?

Yeah, you could do that. You could pucker your lips. You can buy an inexpensive tool. There's plenty of inspiratory trainers out there online. I use the Breather Fit. I'm not associated with this company at all. I just like it. It's been reliable for me. But the key point here is as long as you're getting resistance, you're good to go. And the studies typically show 50 to 75% of an individual's rest maximal inspiratory pressure, which just means as long as the last few breaths are challenging, similar to lifting, you want your last couple reps to be challenging, but you still want them to be controlled and repeatable. As long as it's within that window, you're going to get those adaptive benefits.

And how fast should it be? Like, is it— is it real quick? Or a long drawn-out inhale?

Well, there's going to be resistance, so it tends to be more slow because you're really inhaling and trying to get that resistance. Remember, the negative pressure in the chest can go up to 28. So, it tends to be a little bit more long and drawn out just because it's very, very difficult to do a quick inhale with resistance.

Yeah. I've got this one called the Relaxator and it kind of looks like a whistle. I'll use that sometimes when I'm walking and it is a resisted breath in and— or, I'm sorry, it does not allow you to breathe in through your mouth. So, you're breathing in through your nose, but you're breathing out against resistance. So, I guess that's more like expiratory muscle training, right?

Yeah. If you're breathing out, it's interesting the muscles required for exhalation are mostly the abdominal muscles, but you can still blow against resistance like a heavier balloon or the that whistle thing that you use when you walk. You can still get benefits, but the inspiratory muscle training aspect is unique just due from the inhale, adding resistance to the inhale.

Ben Greenfield: Yeah. I did not realize how impactful that was on blood pressure. So, big bookmark for those of you out there working on blood pressure, inspiratory muscle training, 30 per day, just like breathing through a straw or like Cody said, through puckered lips. That was a pretty cool one. I hadn't heard of that before. And then related to breathing, you also talk about carbon dioxide. Tell me about carbon dioxide.

Yeah, and before we get there, I just wanted to touch like the, the science on inspiratory muscle training, those benefits of reduced blood pressure. The study showed that even after the participants stopped, those results were maintained for 6 weeks after. So it's really a good adaptive response and a very, very easy thing to incorporate into your schedule. In regards to lowering blood pressure. And then, so now on to carbon dioxide. Let's, let's talk about why somebody would even want to leverage carbon dioxide in the first place. So carbon dioxide has a powerful effect on the body. When CO2 levels rise, our blood vessels will dilate, and this improves oxygen efficiency, and it tends to calm the nervous system. But when CO2 levels drop, The opposite happens. Our blood vessels will constrict, oxygen delivery decreases. It tends to excite the nervous system. A simple— a great example of this would be blowing up a balloon. So all that huffing and puffing will decrease your CO2, which will cause blood vessels in your brain to constrict temporarily and decrease blood flow. So even though you got plenty of oxygen, that's not happening in the brain, which causes the dizziness. So Ultimately, what you people want to do when they train CO2 is to improve their tolerance to it, which is CO2 tolerance, and that's trainable. And there are a few— and the reason you want to do that is to get all those benefits. You want better blood flow, you want a calm and relaxed state, and you want improved oxygen. And that's what a higher CO2 tolerance does. And there's a couple easy ways individuals can do that. So number one would just be nasal breathing, especially during, say, zone 2 cardio. Because the nose will naturally slow the breath, which allows for CO2 retention. The next, very easy, is just breath holds. This causes CO2 levels to increase and trains your body to stay calm when these levels start to rise.

Okay. But, by the way, breath holds, does it matter if you do a breath hold on the inhale or a breath hold on the exhale, like full lungs or empty lungs?

That's a good question. So, with CO2 training, It's just all about the CO2. So if you do a full exhale then hold, obviously your breath hold's probably going to be a little bit shortened as long as you didn't hyperventilate beforehand. But you're, you're wanting that to build that CO2 tolerance. So really it doesn't matter in, in regards to building the CO2 tolerance. But if you're wanting to maximize your breath hold, obviously holding on an inhale would be preferred.

Yeah, and a lot of people, they, they are focused on HRV their readiness score, vagal nerve tone, the high CO2 levels, if those are more parasympathetic, that could translate into training for a better HRV, right?

Oh, absolutely. Better HRV, better resting heart rate. It has all sorts of benefits just because it has that calming relaxing state on your nervous system along with better blood flow and everything that I've just mentioned.

And you say in the book, anytime you're exhaling longer than you inhale, CO2 levels would rise and that would have the calming effect, right?

Exactly. And, that's why a lot of the breathwork centered around improving sleep either requires a short inhale and extending the exhale or holding your breath. It's all back to that basic physiology of increasing that CO2.

I got deep into CO2 a couple of years ago. And then, this guy, he's actually a former podcast guest, Anders Ohlsen, he sent me this thing called the CARDiHALER, C-A-R-D-I-H-A-L-E-R. Cardihaler, and I've got a canister of medical-grade CO2 on the floor underneath my desk here, and it attaches to the cardihaler, which pulls in the CO2. And then, there's another tube that goes to a mask that I can put on just at some point during the day. I typically put it on for 15 to 20 minutes while I'm checking emails, and it will feed you anywhere from 4 to 8%. Carbon dioxide that you just breathe through this mask while you're working. Have you seen devices like this before?

I have, and that's an interesting topic. So, when I was writing this book, I kept coming across papers that said inhaling CO2 at higher levels would reliably put people into an anxious state or sometimes a full-blown panic attack. And I'm a fairly skeptical guy, so I wanted to see if this was true and have my own experience. So, I set up an experiment myself. With 7% CO2. I started slow and 2 minutes a day and worked my way up to 20. And to tell you the truth, Ben, the only thing that I noticed was rosy cheeks, and then afterwards I felt more calm.

Yeah, you don't feel calm during, you feel calm after. Like, during, you almost feel like you're a little bit oxygen-starved.

Yes. Yeah, you're breathing heavier, uh, things of that nature. And that points to the CO2 tolerance. I think, uh, breathing machines like you just mentioned is a great way to passively increase your CO2 instead of breath holding and nasal breathing and all those other tricks that can increase your CO2. So, that's been my experience with it. What have you noticed doing this every day?

Ben Greenfield: The main thing is vasodilatory effects. So, you definitely get, like you mentioned, the rosy cheeks but almost more vascularity afterwards, which is indicative of better blood flow, vasodilation, possibly the effect of blood pressure that happens from that. And then, you're kind of zenned out. I like to do it— usually, I've got a lot of reactive work between about 4:00 and 6:30 PM leading up to pre-dinner. And I'll pump it out at some point during or right before I start into all of that. And it seems to have this mild anxiolytic effect.

[Speaker:BEN GREENFIELD] Yeah, absolutely. It doesn't surprise me. That doesn't surprise me at all. Have you noticed any long-term benefits other than those immediate zen-like effects when you're doing it?

Ben Greenfield: Not necessarily that I've quantified. I mean, I stack a lot of stuff during the day, but with the— because you talk about CO2 and all these things in the book like how it dilates blood vessels and activates vagal nerve function. But then, there's another really big book that just came out on a host of benefits of carbon dioxide therapy in terms of vascular function, bone density, goes into neurological function, a whole bunch of effects that I kind of fingers crossed assume that this 7% CO2 inhalation each day is helping with. I think a lot of people just aren't aware though that you can actually train your CO2 tolerance and even use machines like that to just increase your CO2 even more.

I agree, it's definitely on the fringe, and CO2 is considered the bad boy of breathing. You know, everybody focuses on oxygen, but to tell you the truth, like, CO2 is a powerful lever that we all can push to improve oxygen delivery. And this, it's simple, like, you can modify your breath. There's simple machines like you just mentioned to improve CO2 tolerance, and it has a significant impact on overall function.

Yeah, there's even machines that, that do it transdermally. Like, there's, uh, It's almost like a sauna called the HOCCAT. It stands for what? Hypoxia something, something carbonic acid transdermal. And, it's actually feeding CO2 into this sauna unit. So, it's combining heat, transdermal CO2, and ozone. And then, there's this other device that I've come across a couple of times at health conferences. It literally looks like the blueberry boy from Willy Wonka, and it's like this suit that you wear that feeds carbon dioxide into the suit for transdermal absorption.

Have you tried that?

I tried it once. Yeah, it was like, I don't mind putting a mask on while I'm checking emails, but for me to climb inside a full-on suit and just lay there, I don't think it'd be the best use of my time.

It's just a bit much.

Yeah. Yeah, yeah. Then hypoxia, you also get into this idea of intermittent hypoxic training. So, tell me about hypoxia.

Ben Greenfield: In regards to hypoxia, that's in my regards, it's one of the best biohacks for mitochondrial function and oxygen efficiency. By far, it's at the top of the list for that. Honestly, Ben, it's one of my favorite tools. And, for individuals, hypoxia is just briefly lowering oxygen. And, this happens in the womb. So, the fetus is exposed to around 3 to 5 minutes of hypoxia multiple times a day. And researchers have claimed that this improves their antioxidant capacity and stress resilience. And then when we do this in adulthood, it activates over 100 genes responsible for repair and cellular survival, predominantly by activating one particular gene of oxygen regulation, hypoxic inducible factor 1 alpha, which unleashes a cascade of benefits. Growth factors, mitochondrial function, oxygen delivery. It's even been shown to increase our circulating stem cells by 50%, which is huge, all by briefly lowering oxygen. Briefly being the key word, that's the intermittent part. And most people will get a good shot of hypoxia during high-intensity muscle or high-intensity training, but most of those adaptations will happen in the muscles being worked. Whereas with intermittent hypoxic breathing, you're giving your body a whole cell— a whole hypoxic signal which impacts the brain, heart, lungs, blood vessels, mitochondria, and more. You're literally priming the system from a whole adaptive response. That's why I like it so much. It's just a minimum effective dose with huge upshot of adaptations to the whole system. And I've developed a breathing technique called the Adaptive Breath that's anybody can do, and it's, it's free, it's simple, and it has 3 phases if you want to hear more about it.

Yeah, yeah, definitely.

Okay, so the first one is resonant breathing, which just means a 5-second inhale followed by a 5-second exhale, and this calms the nervous system and improves oxygen delivery. And then the second one is— second phase is the hypoxic phase, which goes for 3 to 5 minutes and ends with a pressure phase that helps build our baroreceptor sensitivity and trains our body how to adapt to changing pressures. So, those 3 components are 1 round. And ideally, someone would repeat this 3 to 5 times to fully tap into the adaptive benefits.

Ben Greenfield: Okay. I got the resonance part where you're going 5 seconds in, 5 seconds out. I actually just did a big podcast on resonance breathing with Jay Wiles who even developed this lamp that kind of lights up that helps walk you through a resonance breathing cycle. It's called an Ohm Lamp. But then, you said you go from that into, you said, 3 to 5 minutes of hypoxic training?

Of hypoxic breathing, right?

Hypoxic breathing. So, what's that look like?

So, it's a breath hold after the initial oxygen phase. And then, once that CO2 starts to climb and you get that breaking point, that panicky sensation that we all get, instead of breathing in again, you just take a quick breath, just a quick in and out. And, this decreases that CO2 but doesn't fully oxygenate the system. So, you can maintain hypoxia for as long as you want, but ideally, we want that to be in that hormetic window, hence the 3 to 5. So, that's how it's done. That's the hypoxic phase.

Okay. So, just one massive breath hold where every time you start to get oxygen-starved, you're just out real quick and back in.

Very similar to the SOMO breath. Are you familiar with the Renegade Pharmacist?

Yeah, the Renegade Pharmacist. He actually was one of the first guys I ever interviewed about breath. I met him literally in a sauna at an event. I think we were in Estonia or Finland or one of these Northern European countries. And, he was in the sauna, I'm sitting there in the sauna, and there's this dude across from me doing these weird breathwork cycles. And, I started chatting with him about it and that's who he was, the Renegade Pharmacist. And then, he wound up coming on my show. My sons and I did his multi-week breathwork training. Which is great. And so, yeah, very familiar with him. But then, the hypoxia, back to your 3 steps, you do the several minutes of the hypoxic breath hold. And then, what'd you say the third one is?

[Speaker:BEN GREENFIELD] It's a pressure phase. So, essentially after that, you just breathe in, take a full inhale, and do the Valsalva maneuver, which is increasing internal pressure similar to blowing up a difficult balloon or straining during your morning bowel movement. So, you increase pressure and that trains those baroreceptors. So, it's full-on increasing CO2, decreasing oxygen, increasing pressure, just a full adaptive breathwork.

Ben Greenfield: Okay. So, as I'm doing this Valsalva pooping, not pooping maneuver, how long am I holding that one?

30 seconds.

Okay. So, it's pretty quick, just basically all out. It sounds kind of similar to the end of like a Wim Hof cycle where you breathe in, in, in, and in and just try to shoot all the energy out the top of your head. Instead, this one, you're kind of doing an internal pressure buildup.

Yeah, yeah, very similar. So, like you said, the pressure adds or is applied to the Wim Hof method. I believe on the Soma Breath as well. It's been a while since I've done it. Maybe you can speak to that. But yeah, it just incorporates at the very end, increases the pressure, just helps drop you in. And then, often I'll use a pulse oximeter which measures your oxygen levels. Most of the time, I'm still hypoxic even though I'm still doing the pressure change. So, that's just an interesting caveat.

So, if somebody was going to quantify, they're nerdy enough to do this with a pulse oximeter, what would you consider hypoxia to be? If somebody's normally at whatever, 97% to 99% oxygen saturation, what are you looking for for hypoxia?

Anything below 90% is the hypoxic window in the research. Tries to go around 80 to 90 in the intermittent hypoxic breathing literature. But even with this technique, it's not uncommon to dip below into the mid to high 70s temporarily as your body will adjust and bring it back. What I like about this is if you're, you're dipping too low, just take a longer inhale, just take a longer breath, and you can go up and you can titrate just based on that pulse ox.

Okay, got it. Have you seen these gyms, uh, like the, uh, or not gyms or devices like the Cellgym, which is just a mask that you wear that brings the oxygen up and then down as a form of, I think they actually call it intermittent, I-I-H-H-T, intermittent hyperoxic hypoxic training. Yeah.

So, I mean, this would just be a free version of that and that's exactly what the machines do except you're breathing the whole time so you don't get that CO2 fluctuation. It just decreases oxygen and then floods you, so you're getting that pulse of high and low oxygen.

Yeah. I know there's another unit called the LiveO2 that you can use while you're exercising, same thing. That's a good point. You don't get the CO2 effect that you're getting from just manually doing it yourself.

But, I mean, you could stack that with a different machine like you're doing yourself for a passive CO2 boost as well.

So, this is really— Climb inside your Bubble Boy suit and then put an IHHT device on and— Best of both worlds, baby. Somebody's going to do it, by the way. I guarantee somebody's going to do it.

I have no doubt.

No way we could talk about environmental hormesis without diving into cold therapy. So, what's your cold therapy practice?

So, for years, I've been going in the river before going to the gym. And, because it's a river, I go mid-fall to early spring when the water is cold. But, I got to tell you the truth, Ben, that my Schedule has changed due to an aggressive beaver taking over my spot. So there I am one morning in the river, just up to the neck, just enjoying myself, and I hear this breathing behind me. I turn around and about 10 feet away I just see a beaver's head swimming at me and then just disappears under the water. And that was more frightening than the cold. So I just bolted to the—

Accompanied by the Jaws side effects.

Exactly. So I bolted to the shore, looked back, and there's this beaver just smacking his tail on the water. And I was like, oof. So, I tried it again a couple of times that week, had this— a similar run-in. I wasn't in the water, I, you know, checked the scene. But needless to say, I'm doing cold showers for now and my routine is 3 to 5 minutes before going to the gym. And even though I know there's a bunch of physiological benefits, I primarily do it for discipline because I never want to do it. I never want to get in the cold. But every time that I do experience that discomfort for 3 to 5 minutes, I'm always glad I did. And it's a good way to start your day off with a win.

You're the third guy on the podcast. I think Brad Kearns and Thomas Seeger also brought this up who recommends the cold therapy before the gym. It's hard to explain unless you actually do it, unless you've actually tried it, but it is one of the best free versions of a pre-workout drink that, I mean, it beats the pants off any Pre-workout blend. And, I know for some people, it almost creates too much friction. It's like, "Wait, first you told me I got to go to the gym and suffer for a little while and now you're telling me I got to get cold before I do it." But, if you are demotivated to exercise or whatever, like back to the jet lag travel thing for me, if there's any resistance to exercise and you just even hotel room, like you said, 2-minute cold shower, total game changer pre-workout.

Absolutely. It's so simple. I love it. I write in the book how Beethoven allegedly would put cold water on his face before he composed just to wake his system up. That's exactly what the cold does. It's the best biohacker ever. It's just a quick 2 minutes, you're good to go. It's like a shot of coffee.

Yeah. And there's effects, I mean, beyond just exercise. I think you mentioned cancer in the book for cold, which I thought was interesting because you hear about cancer hyperthermia. It's big in Europe, like hyperthermic treatments to enhance the efficacy of chemo or as an adjunct therapy with chemo or as its own protocol for heat shock proteins and cancer cell cytotoxicity. But I don't think I've ever heard anybody talk about cold in cancer.

Yeah. So, And in the book, I talk about cold being specifically used to counteract some of the negative side effects to chemotherapy, particularly peripheral neuropathy, which is this nerve damage that typically appears in the hands and feet. And I want to stress that this condition is excruciating. I've had patients describe it as if they were walking on glass or someone's holding a lighter under their foot. And worse still is that it can persist for years after the treatment has ended. So it's, it's, it's a big, big thing. And if we could alleviate that with simple cold, that would be great. That's exactly what the research has shown. So what they do is place cold gloves and socks on patients undergoing chemotherapy. They apply this chilly treatment 15 minutes before and keep it on until 15 minutes after. What the results show is that it can almost completely abolish chemotherapy-induced peripheral neuropathy against the most commonly used chemotherapeutics. Which is huge, absolutely huge. And then this same treatment is also applied to the scalp to help mitigate hair loss. I absolutely love that. This is a perfect example how we can use environmental hormesis to protect function.

Yeah, it makes me think too about that, like the protocol they use in this study with the, the cooling gloves and cooling socks. Is that something people can just purchase? Do you know if that's available or if it's just more of a medical technology they used?

No, you can absolutely purchase it. I checked on Amazon, believe it or not, when I was writing the book, and there's a bunch of cool mittens and socks that individuals can buy.

There would have to be considering how many underwear companies have popped up. There's probably Brian Johnson is partially responsible for, and this is great for making more widespread the notion that, yeah, if you're going in the sun and your boys are getting hot, you're going to decrease your sperm count. So now, you can get like Snowball's underwear and ice diaper underwear to keep the testicles cool while you're in the sauna. So, you could do the same thing for things like cooling the body if you didn't have access to jumping in cold water with like gloves, socks, cap, et cetera. Ben Greenfield: Yeah.

And the underlying mechanisms here why that helps out with chemotherapy is when you apply cold to the surface, the blood vessels will constrict, reduces blood flow. So, that means less exposure to the chemotherapy's toxicity to those affected areas. I mean, that's ultimately why it works. And you're right, you can apply that to anywhere in the body if you'd like to, but this one that I talk about in the book is specific to peripheral neuropathy.

Ben Greenfield: Yeah. And related to cancer, you point out the power of cold, especially in combination with chemo, but then you have I think what you described is the most robust non-pharmacological intervention for cancer that exists.

Yeah. So that was a statement from a paper published in Nature Communications by Pomato and Watson. And I love it so much is because it showcases the collective data on caloric restriction and fasting in regards to its anti-cancer properties. Now, I want to be clear here because this is kind of a taboo subject. There is no human clinical trials evaluating prolonged fasting for treatment for cancer, not one. And I find that unbelievably fascinating given the fact that we have robust animal studies, strong epidemiological studied studies, and there are shared physiological mechanisms between mammals that show fasting creates a potent anti-cancer environment. Prolonged fasting in particular activates genes and compounds that disrupt cancer, activates anti-cancer immunity, and improve mitochondrial function, along with a long list of other benefits. In fact, one of the biggest impacts fasting is, is metabolic in nature. And this is the whole principle of the metabolic theory of cancer that was pioneered by Otto Warburg and Carl and Gudrun Kore back in the 1920s, and since later work with Thomas Seyfried. Great book I would recommend is Tipping Over the Truth by Travis, uh, Krusofferson. Which he lays this out and really gets into that. And I'm a big advocate of metabolic theory of cancer, but I want to preface it with most cancers are glucose dependent. They just love sugar, but some types of cancer are metabolically flexible and can utilize ketones. So here I want to preface that metabolic theory of cancer is a good strategy and it's not a guarantee.

Yeah, I'm sure there must be publicly available data on which types of cancer would be would basically not be responsive to carbohydrate restriction or a ketogenic diet?

There is some, but it's a little hard to, to get down into the weeds with that just because there's so many cancers and each one hasn't been studied altogether. But just to throw this out here, only 10% of all cancers are due to DNA problems in the nucleus. All the other ones, um, 90%, are predominantly mitochondrial in nature and do benefit quite well with metabolic theory of cancer, metabolic treatments that is, such as prolonged fasting and caloric restriction.

Okay. So, in this case, because earlier we were talking about fasting and caloric restriction being kind of two different beasts, with cancer, is the calorie restriction as important as the compressed feeding windows or some form of fasting?

In regards to cancer, it seems to be the most protective response is the ketones levels itself, like shifting the body over to ketones because most cancers don't have that metabolic flexibility. You're essentially creating an environment that is stacking the odds against cancer and improving overall healthy cells because they do have that metabolic flexibility.

[Speaker:BEN_GREENFIELD] Right. And unless someone say, well, okay, so if I wanted to control, say, cancer growth, I could just stay on my current diet but start using drinkable ketones, you would still have an issue with high levels of glucose and arguably even in some cases, high levels of amino acids and mTOR activation still contributing to the cancer problem, right? You couldn't just— basically what I'm saying is you can't just elevate ketones exogenously by drinking one of these drinks but then just keep stuffing your face with carbs and protein if you wanted the best approach for cancer.

Ben Greenfield: Right. Yeah. All the growth factors for cancer are going to be present. Insulin is going to be there. They're going to get a robust response of sugar, and that's just going to feed, feed them. So ideally, you just want your whole body to be in a ketogenic state, and this can be done either through prolonged fasting, a well-formulated ketogenic diet, or dare I say, even carnivore diet in some folks, to get a long-lasting response, to get that anti-cancer environment.

Okay, got it. Now, a lot of people would hear you say carnivore diet as a therapy for cancer and say, well, what about the all the, like, you know, red meat contributes to cancer studies?

Well, all the red meat studies, I I don't want to disagree with them all, but, um, they're— how do I say this— they could be improved. They could be improved greatly just due to their methodology. A lot of them don't distinguish between the different types of meat, and they don't account for different lifestyle factors that contribute into cancer. And a lot of nutritional studies, actually, they try to isolate one particular thing, but it's, it's a lifestyle. If meat was damaging and caused cancer, you would see it across the world, and you don't. Different populations have different results, which is reflective of an individual's lifestyle. And to my knowledge on the carnivore diet in regards to cancer, I, I'm unaware of any studies that have even looked at it. In fact, I've— in regards to carnivore diet, there's only, as of writing this book, only one study out of Harvard, and it was a survey, and it didn't even touch cancer. It talked about type 2 diabetes, heart disease, and a lot of other types of conditions. Which was astonishing, the, the results of that. So carnivore diet itself is amazing a lot for not only cardiovascular disease, autoimmune disease, and a bunch of other diseases, but in specific regards to cancer, I don't think that the evidence or research is out there yet, but physiologically it makes sense.

But big difference between the, uh, like the overweight, you know, red-faced businessman or businesswoman throwing down an espresso martini and 20-ounce French cut ribeye, mowing through the bread basket, and the Brussels sprouts drenched in Parmesan cheese 5 nights a week, and someone who's at home having grass-fed, grass-finished beef and maybe some organ meats and high-quality forms of carnivore nutrition in a controlled environment without alcohol, carbs, stress, circadian disruption, et cetera.

[Speaker:BEN_GREENFIELD] Absolutely. Well said. Well said.

Yeah. Okay. I know we're bouncing around, but there's so much in this book. Heat shock proteins, which I mentioned earlier, heat stress, I'm a big fan of it. We've talked about a lot before on the podcast, but you have an interesting section where you talk about apparently what's a commonly prescribed pharmaceutical. I think it's a pharmaceutical. I believe it's called HCTZ. And then, You present heat stress as a pharmacological alternative to that. Can you get into that?

So, the pharmacological agent is called hydrochlorothiazide, abbreviated HCTZ, just because no one can pronounce that. But I presented in the book as heat is heart medicine. That's the section of the book where I talk about this and lay out evidence of how repeated heat stress has been shown to prevent, treat, and even reverse several forms of cardiovascular disease, high blood pressure being one of them. And here's the contrast between hydrochlorothiazide. So it is one of the most commonly prescribed first-line treatments for hypertension. At typical doses of 25 to 50 mgs, uh, and a patient can expect a blood pressure reduction of around 10 points on the systolic and 5 points on diastolic. Now with heat, it generates similar, if not way greater, results. And a study I bring up in the book is they looked at hypertensive patients who took 2 sauna sessions for 3 months. That's it, just 2 sauna sessions, 3 months. And their average, their average systolic reduction was 23 points.

Wait, wait, you mean 2 sauna sessions total over 3 months, or like 2 per week for 3 months?

Oh, sorry, good clarification. So 2 times a week for 3 months. Yeah, so their average systolic reduction was 23 points. and their diastolic was 9 points. So that's huge. That's almost double of what the HCTZ pharmacological agent was. And these adaptive benefits, why that lowers the pressure, it was because of the adapt— adaptations to heat stress, including improved blood vessel function, reduced arterial stiffness, improved baroreceptor sensitivity. And together, all of this lowered blood pressure and improved cardiovascular function. So, in other words, heat stress is indeed cardiovascular medicine.

Especially if you do your resisted inspiratory muscle training while you're in the sauna or you drag your bubble suit with the CO2 delivery into the sauna and do inspiratory muscle training in the sauna wearing your bubble suit.

Stack them up.

Yeah, just stack them up, baby. That's super interesting about blood pressure. I mean, if anyone struggles with blood pressure, automatically we've got two pretty potent natural methods of adaptive medicine for this already in this podcast. Now, what about heat stress? This is something I've wondered, and I'm pretty sure there's a link, but I will often do sauna more frequently when I'm traveling or when I'm about to do a big bout of traveling to strengthen the immune system. Is there something to that?

Ben Greenfield: Absolutely. But context here matters in regards to does heat stress help decrease sickness. Our resiliency is determined by how well our system is functioning. So even if someone reg— is a regular sauna goer, they can still get sick if the recovery is poor, they're not sleeping good, their circadian rhythm is off, etc. So it's not a cure-all. That said, it is a powerful form of medicine because it mimics a fever and it definitely activates our immune system. One single session will activate both branches of the immune system: the innate, which acts as our first line of defense, and our adaptive immune system, which creates antibodies for more targeted response. Heat stress will also increase our circulation, which improves immune surveillance. And then at the same time, speaking of your heat shock proteins, that will help our immune system recognize infected cells and compromised cells to help clear them out. And what's really cool is one single session will increase heat shock proteins. Uh, it'll peak for about 2 days. So essentially you're priming your whole system for enhanced immunity for a couple of days after one single session. And the last point here I want to make is heat stress will improve compounds that are antiviral in nature, such as interferon gamma, which will inhibit viral replication. So together, this is just a huge, easy, simple adaptive boost that you can make to improve overall immune function with the hopes of decreasing your ability to get sick, increase your resiliency.

You think there's anything to the idea of doing it while you're already sick?

You know, I, I go back and forth with that. My idea is if you're, you're already sick, you're already— your body's already stressed out, I wouldn't add additional stress to it. Just focus on recovery, sleep, hydration, the basic things that your body knows how to deal with, and improves recovery too.

I want to come back to the carnivore diet real quick because something I was thinking about since we had that exchange is that it does eliminate, and I think this is one of the reasons it helps people who have pretty significant gut issues, it eliminates a lot of plant defense mechanisms that might be irritating to someone with autoimmune issues, especially at high doses. And yet, when you look at the EGCG in green tea or curcumin or a lot of other bitter herbs and spices, they themselves as plant toxins can induce a little bit of hormetic stress. So, aren't you missing out on some elements of adaptive medicine if you're going strict carnivore?

Ben Greenfield: Yes and no. And here I would go back to where we're at in the body. We're always— challenge is breaking down the body and then recovery builds it back up and we want balance. For a lot of people that go on carnivore diet, and I understand that perspective, I go on the carnivore diet myself for about 3 months every year, just because that's how long it takes me to get rid of a quarter of a cow. So I love it, I feel good on it. All right, but, but yeah, so that's what we're working with. And so for a lot of people that find great benefit with the carnivore diet, they may be overtaxing their body. It just gives them a chance to, to balance it back up. It gives the body a break because they're not consuming so many plant defense chemicals as their normal food. That being said, from adaptive standpoint, you're right, the goal is not to eliminate every stressor The goal is to expose the system to small brief challenges so it can improve function. I would say EGCG and curcumin are great examples of that adaptive principle because at low doses such as green tea or sprinkled turmeric onto your food, they act as hormetic stressors in the body. This increases our internal defense systems and increases antioxidants in our repair pathways. And this response, interestingly enough, our body's response is often greater than that challenge. This leads to overall reductions in inflammation and acts as an overall net positive. However, there is a hormetic aspect to it. High levels of EGCG in curcumin, and most plant defense chemicals for that matter, will have the opposite effect. It'll be inflammatory, overwhelm the system, and cause more more harm than good. So, I'm less focused on diet ideology and more focused on function. If an individual function and feels good with no plants, that's fantastic. That's the right move for them at that particular time.

Ben Greenfield: Yeah. And it's not like super black and white, huh? Because you could do a carnivore diet and let's say, yeah, you aren't going to do a bunch of big-ass salads and bread hurts your gut and you're not going to do alcohol But you could do carnivore and have a cup of green tea or antioxidant-rich coffee in the morning. And then, when you are preparing your meat, use some choice herbs like rosemary, thyme, you mentioned turmeric, and kind of just weave them in condiment style here and there.

Ben Greenfield: Yeah, absolutely. And then, just listen to your body. I believe your body is the best doctor out there. You know your body better than anybody and you know how it functions. So, if you Add in the rosemary and then brain fog starts coming, maybe not choose that. Maybe your body doesn't do good with rosemary. But yeah, the whole idea of small stressors added in to improve function, I mean, is rock solid and it can be accomplished with the carnivore diet as well.

Yeah. There was one section in here for people who want to get the benefits of fasting but also stay swole. You have like this mineral trick for maintaining body mass You know what I'm talking about?

So the mineral trick is good old-fashioned baking soda. So here's how it works, or why it works rather. So in prolonged fasting, ketone levels will rise, which is a good thing, that's what we want, but they need to be neutralized in order to be cleared from the body. So early on, the body uses sodium to accomplish this task, but after a few days, our sodium levels will start to drop, and this acts as a stress response. Cortisol will go up. Well, before I get there, when sodium levels drop, these are the symptoms of the keto flu. This is like fatigue, headaches, irritability. It's low sodium levels. That's the keto flu.

Yeah, a lot of people think it's just low blood glucose, but a lot of times it's just like mineral depletion.

So a great way to do that is just a pinch of, um, salt, normal salt, depending on your duration of the fast, or baking soda. So that's one of the mechanisms. And then also the second issue is when ketones are acidic, so they create a mild form of metabolic acidosis. So to compensate, our body will break down protein to form ammonia to help act as a pH buffer. And baking soda deals with both. It replaces the sodium, and then the bicarbonate helps buffer that pH so you don't have to break down protein for the body to compensate.

So if I have the average, like, kitchen teaspoon, how much of that in terms of baking soda are we talking?

That's a great question. There is considerable variation with sodium excretion between individuals during prolonged fasting. So a very conservative approach would be 3 to 4 grams of sodium bicarbonate. I believe that's a teaspoon. And you will—

yeah, that's like not a heaping teaspoon, right? Um, I've seen some studies where they did this to improve lactate buffering and sports performance in athletes, and they actually use small amounts for 2 hours going into a competition. One of the reasons for that, for doing a gram 4 times rather than say, whatever, 4 grams once, is the gastric distress that higher doses of baking soda can cause. So, I'm assuming if you're fasting and you want to maintain muscle or if you're shifting into ketosis and you want to ease the transition that doing a few almost You know, 1 gram, like just the tip of a teaspoon a few times a day would be a reasonable approach.

Absolutely. Yeah, spread out throughout the day, that's the best approach to alleviate, like you said, those— the gas, the gastric stuff, and all those negative side effects. That's a, that's a perfect approach. And if you're doing like a 24 to 48-hour fast, you're not really going to get into the high ketones where the metabolic acidosis is a factor. Just simple sea salt. Just get some electrolytes and that's going to help you out to get over the ketogenic hump, the keto flu hump. It's just going to make you feel better and experience just more enjoyable.

Bold font on page 309 of your book, it says, "A person's flexibility is directly linked to their perception of pain." Tell me about that.

So, this one's fascinating. I learned this myself in the book. I was shocked. So most people think stretching is about lengthening the muscles, okay? But in most cases, range of motion is limited by our nervous system. So this means that our brain acts as a governor by restricting movement based on our perceived level of pain or instability. Instability— and perceived is the key word here, because when we perform novel movements or stretch, the receptors in our muscles, ligaments, and tendons will send information back to the brain. If the position feels unstable, the nervous system will increase tension to stop you. So think of it like when you just tweaked your back, your whole spinal column, the muscles will just constrict and get really tight. This is a protective mechanism. So that's how stretching works. However, when you— but when you stretch and engage in novel movements that slightly introduce new ranges of motion, you're essentially training your brain and your nervous system that these positions are safe. Which ultimately allows you to bend, twist, and move more freely and reduce musculoskeletal pain.

Okay, got it. Have you ever come across the concept of voodoo flossing or heard of it?

Yes, years ago. And, um, and it's essentially compression and then movement alongside that. Is that correct?

Yeah, you kind of like using an elastic band. Um, I learned this from Kelly Starrett, and you, you'll wrap around a joint and that limits the pain and allows you to kind of like retrain the muscle to to move through pain-free range of motion. So, if you have tennis elbow, for example, I'll hold up my arm here, you'd wrap an elastic band above and below the joints, the same elastic band at 50% blockage making sure that you still have blood flow returning the fingers. And then, you kind of move the arm for a couple of minutes through different ranges of motion. And, I think it's using similar mechanisms as what you've just described in terms of stretch, like putting the muscle on stretch, actually decreasing pain perception. And beyond just injury prevention in terms of mobility, you actually get this loss of pain when you stretch or when you stretch with that Voodoo floss on.

And have you used this practice before?

Yeah, I use it for my knee all the time. I just got back from several days of snowboarding in the Alps and I was Voodoo flossing my left knee every morning before I went out. Total game changer. And, we're talking just 2 minutes, wrap above the joint, below the joint. You could just go to YouTube or maybe I'll put a video in the shownotes of how to do it. And, you just need an elastic band, which is super easy to travel with anywhere in the world. And, combining that with stretching, I think is super underrated for pain.

[Speaker:BEN_GREENFIELD] Oh, that's great. Yeah. Thank you for that. I'll have to look into that.

Cody Strohman, we barely even scratched the surface of everything that's in "The Rise of Adaptive Medicine." I did want to ask you, you're obviously licensed and practice in Portland, Oregon, but do you do telemedicine and anything like that if anybody ever wanted to hop on a phone call with you?

Yeah. Most of my work I do is remote and I still do one-on-one consulting for people who want to improve their health and performance. But then most of my focus now is working with my wife, Dr. Cindy, through our program called Fertility for Two. We work with couples who are trying to conceive by helping both partners improve their health and fertility so they can expand their family and model healthy behaviors to their children.

I thought Fertility for Two was like how to have twins.

Fertility for Two just means we treat both partners, man and female.

Yeah, got it. That's cool.

Yeah, everything we do is online and we work with couples from all over the country. And if anybody would want to check us out or learn more, just hop on to adaptive-medicine.com, fertilityfortwo.com, or anything social, Fertility For Two. That's the handle. Okay.

I'll, I'll link to all this in the show notes. So you learned how to lower your blood pressure, but also you learned if you get some of those like ice pack underwear and do a call with Cody and his wife or use their Fertility For Two, higher chances that you will populate the planet. BenGreenfieldLife.com/Adaptive are the show notes. I'll link to everything that Dr. Cody and I talked about. Dude, thank you so much for coming on the show.

No, it's been a pleasure. Thank you.

Alright, folks. Thanks for watching. Do you want free access to comprehensive shownotes, my weekly roundup newsletter, cutting-edge research and articles, top recommendations from me for everything that you need to hack your life, and a whole lot more? Check out BenGreenfieldLife.com. It's all there. BenGreenfieldLife.com. See you over there. Most of you who listen don't subscribe, like, or rate this show. If you're one of those people who do, then huge thank you. But here's why it's important to subscribe, like, and/or rate this show. If you do that, that means we get more eyeballs, we get higher rankings, and the bigger the Ben Greenfield Life show gets, the bigger and better the guests get and the better the content I'm able to deliver to you. So, hit Hit subscribe, leave a ranking, leave a review if you got a little extra time. It means way more than you might think. Thank you so much.