Lies I Taught in Medical School with Dr. Robert Lufkin | 1179 | Dave Asprey

Tell me all the benefits of the calories in calories out model.

The benefits, it's simple, it's intuitive, it's law of thermodynamics. It makes sense, you know, energy. But that is by far eclipsed by the fact that the calories in calories out model doesn't work. As we've seen with the obesity epidemic skyrocketing, where most people are either overweight or obese and it's only getting worse.

You're listening to the Human Upgrade with Dave Asprey. You are listening to the Human Upgrade with Dave Asprey. Today we're going to talk about lies, specifically lies from medical school with a very, very well known field in, we'll say biohacking and longevity, because there's a lot of longevity in biohacking. None other than Dr. Robert Lufkin. He's a physician, he's only written 200 peer reviewed studies. Barely met the cutoff for being the show. 14 books in six languages. So this is a man who's done a lot in the field of longevity, which as you know, is one of the core tenants of biohacking. You get to change the environment around you and inside of you so you have control of your own biology. Well, what do you want? You might want to lose weight or manage stress better or be smarter, but living a lot longer is something that we all want and it's something that absolutely is happening right now. Before we started rolling, we were talking about how the biohacking industry is now a $63 billion business. But what most people don't know is that last year $600 billion went into longevity companies. So if all of this money doesn't do anything for longevity, I'd be surprised. My goal is only 50% better than our current best, which is about 180 years old. Rob, am I a madman?

No, no, absolutely. Dave, I. Thanks so much. You're very kind. I'm a huge fan of yours and your work and it's really a pleasure and an honor to be with you today. I'm so looking forward to this conversation.

Were you worried when you decided to call your book Lies? I Taught in Medical School? Do you think you might piss off a few colleagues here and there?

Well, it is. It was intentionally provocative to get, get people's attention. Maybe a few other people will look at it and begin questioning things. But I, I always reminded of a quote from one of the greatest doctors of all time, Sir William Osler, and he famously addressed a class of graduating medical students 120 years ago. And his, his, his quote is one of the most famous quotes about medical education. And he said, said, gentlemen, I have a confession to make. 50% of what we've just taught you in medical school is wrong. And furthermore, we don't know which half it is.

Wow, how honest. And if you look back, not just in medicine, in almost every field, what we think is happening isn't real. Even all of the stuff in this room, if you really look at it, it's mostly empty space when you zoom in on it. And then we have all these models about how quantum reality versus information fields versus magnetic fields and all of them are real and all of them are simultaneously stories. And then next year some AI engine is going to come out with something goes, oh, we thought that Galileo was right and he was directionally right, but he was wrong. And that's why any kind of censorship to me is abhorrent. Because you can't do science if there's censorship. Like you have to be able to ask questions, go, well I, we've always believed that, but maybe that's not true. And that's not misinformation, that's just curiosity.

Yeah, that's absolutely the basis of medical science and medical education too. Always questioning, always revising our current models of reality because at very best they're only approximations. And as we change our models, the, the, the lies and the truths change. Also.

I feel so much safer knowing that Big Pharma controls a lot of the lies that we teach these days. Don't you?

Big Pharma food? Absolutely. It's a very scary, deeply disturbing thought. But unfortunately it's true.

I love it that with your reputation, just your hard science, you're saying look at the numbers instead of, you know, let's just kind of believe whatever. Really most people are just picking this up, they heard it somewhere or there's big campaigns about things. Let's go through some of the, some of the things that we might believe that aren't necessarily backed by science. Tell me about how plant based diet exclusively is going to make me live longer.

Yeah, that's it, That's a good, that's a good question. And let me say before we begin, if I can, the is very critical of Western medicine, but I'm a Western medicine insider. That's been my entire career. So the I, I still believe in Western medicine. All this. Yeah. In the 20th century, it transformed our lives. We, it wiped out many diseases, infectious diseases, public health. And even now in the 21st century, if I'm hit by a car outside, and I need a blood transfusion and a splenectomy and my fracture set. I want Western medicine. The problem, I think, and what the book addresses is that in the 21st century, 80% of our resources are spent on a group of chronic diseases that, while they were present in the 20th century, are nowhere near what they are in the 21st century. And it's this epidemic of chronic diseases. When we apply the same medicines and surgery that were so effective in the 20th century, when we apply them now in the 21st century to these chronic diseases, they don't work. And that's the failure of Western medicine. And that's the. The challenge that I try and point out in this book.

I think you've done a good job on that. And one of the things that I love about your story is, like me, you tried what's supposed to work and it didn't. So my research, you had hypertension, gout, dyslipidemia, and pre diabetes. Correct. What were you doing that you believed was working that wasn't?

Well, my whole life I was raised following the dietary guidelines. As it turns out. My mom was a professional dietitian, so I was raised believing that nutrition mattered and it was important what you ate. Unfortunately, she followed the dogma, the current teachings, which are still in effect today, and those recommendations which we followed religiously, I believe led ultimately, along with other lifestyle choices that I made to my acquiring these four chronic diseases at, you know, midpoint or early point in my life.

Wow. If you and Dean Ornish arm wrestled, who would win?

That's a good question, because although we. Dean. Dean is brilliant by showing that lifestyle can, can make changes and, and in these chronic diseases, and I really applaud him for it. I think we differ on some of the details of the implementation, but the overall principles, I'm with him 100%.

It's funny because I've definitely kind of called out his nutritional recommendations, but he was the first big university doctor to say maybe we should look at meditation and lifestyle. He did mix it with his diet, and I would have liked to see them tested separately because you see different results, but that was a really big thing to be able to do. And I think that there's even some people where a very low fat carbohydrate diet might work. And I've seen people lose weight on that, but I don't think long term that's a direction for longevity that I would choose, but I don't know. What do you think about that?

That's true. Yeah. And for me, and I believe for most people, the low fat diet, because of the three macronutrients, we keep protein pretty much the same. And then if we lower the fat content, we ra the carbohydrate content. And in my opinion and what I believe the evidence shows, that I show in the book and quote the original references that high carbohydrate foods, along with seed oils and grains drive the metabolic drivers of these chronic diseases, which is oxidation, inflammation and insulin resistance. And it's interesting that these things that drive these chronic diseases, there's no real pill or surgery for them. And in fact the pills or surgery that I was given, I was prescribed medicines for them. These pills or surgeries can be life saving in the short term, like insulin for a type 2 diabetic. But long term they just mask the symptoms in most cases and the diseases continue to progress with fewer symptoms, but then they have the chronic complications of them. So the way to really reverse them, I believe is through lifestyle. And that's empowering because it's a choice we get to make.

Toxins and stress can throw your energy off balance. And that's where a company called Quantum Upgrade steps in. Quantum Upgrade offers groundbreaking products to help you get your balance back. Quantum Upgrade tests each product on humans and the results show that the technology can boost blood flow and even reverse blood clots in minutes. The latest and greatest study shows that Quantum upgrade increases ATP production by up to 29%. And the newest ability is that you can now use Quantum Upgrade to increase your level of consciousness based on the.

Hawkins Map of consciousness. If you don't know what that means.

Do some research or listen to the show because it's impressive and fun to learn about and it means something, visit QuantumUpgrade IO and get a 15 day free trial.

Enjoy. When's the last time you ate French fries?

Well, I, I have a 12 year old daughter and she occasionally has a. And I will, I will eat one occasionally, but I don't, I'm, I'm concerned with the carbohydrates in them. I'm especially even more so concerned with the seed oils and the high temperature and the, the toxic chemicals that are produced from those. So I don't believe those are healthy at all.

I'm with you there. Now, if someone was forcing you to either smoke one cigarette or eat a big plate of soybean oil French fries, highly processed, which one would you do?

Well, there's some recent evidence now that in a study that was showing that a small amount of french fries. A single serving of french fries is equal to more than a pack of cigarettes as far as the same type of toxic compounds that are, that are found in them. So I would go with the cigarettes.

And by the way, I'm opposed to smoking.

Yes, a bad idea.

And nicotine even has some longevity benefits, surprisingly at micro doses pharmaceutically extracted around Alzheimer's disease and Parkinson's. Right. So I don't really want to smoke and I don't really want to eat french fries. And like I said, eat one french fry on a rare occasion, whatever. It's not the end of the world. Okay. But I do very, I'll say religiously avoid the seed oils and I have for about 12 years now. And the, the difference, when I replaced that oil with saturated fats, you know, beef tallow and ghee and butter and MCT oil and things like that, after about two years I, I stopped craving fat the way I did. And then I came across that research that shows the half life of fats in cell membranes is about two years. And so people would drink bulletproof coffee. Backgrounds at bulletproof. And after two years, like, oh, I just need a little butter versus I can't get enough. And I, my theory there is that that's probably just because we're repairing some cell membranes in the mitochondria or in the cells. Have you come across any research about swapping out the Omega 6s and getting rid of those and using more saturated fat? Or is this more of an olive oil discussion? Like, what's your perspective on that?

Well, yeah, first, to your point, the, of the, you know, the high carbohydrates, you switch out carbohydrates, you get an effect in a, you know, in a few hours to a. Really notice it and you feel it. Grains, if you switch those out, you know, the pro. Inflammatory effects of the, the proteins in the grains, it can be up to 90 days. But the seed oils are particularly challenging because of their long half life in our fat. So it can take months to years and that's, that's really tough. As far as far as the olive oil or, or beef products, I don't have a, I don't have a strong preference. I mean there's certain things about their cooking value and some you don't want to heat and not, I mean the, the, our dietary choices like everything, sadly today have become highly politicized. So there's the carnivores who don't talk to the vegans who, you know, and I love my vegan Friends, I used to be vegan. At one point I took my carnivore friends. I've been carnivore also. And I think you can be, you can be very healthy or very unhealthy on either a vegan or carnivore diet. And my way of thinking, it's not either one of those, but it's getting rid of the junk foods and avoiding the things we talked about. Personally, I think it's more challenging on a plant based nature just because there's more junk food with plant based things and you may miss some of the micronutrients. So you've got to keep an eye on it. Whereas with Carnivore you can pretty much get by just by eating the meat and you're, you know, you're taking care of most things. But yeah, but it, for me it's not about vegan versus carnivore. I embrace them all.

Thank you.

Hope to be the Switzerland of diets, you know, and the, there's a case.

Too, I do believe that many vegetables that we eat have enough plant compounds that are bad for you and that it's probably individualized for that some people handle them better than others. So the idea that you shouldn't eat any vegetables seems extreme and the idea you should eat only vegetables seems extreme. And having tried both of those, I ended up where some days I don't have any carbs and some days I do, I just don't eat the carbs that cause metabolic dysfunction in me, but they might not in someone else. And that's where it gets really, really confusing from a medical perspective. Just with all of your research, how does one personalize what they're doing so that it works?

Yeah, that's, that's such an important point, David. I'm glad you brought it up. All these things, I think the things we recommend will benefit most people, but we all have to look at our individual experience and nutrition. And so someone may have an issue with diet, with dairy rather. So we, you can do an elimination diet where you, you, you, you peel back all the things and then you add one thing or add another thing and you can, you can check out dairy or eggs. Some people have a problem with eggs, you know, I do. Some people have a bigger problem with grains than others. So I, I totally agree with personalization, but I think, I think the principles that we're talking about apply to most, if not everybo.

They absolutely foundationally apply. And the easiest test that I figured out was first I tried about 18 months of an Elimination diet where you space out all your foods. And I realized, why don't I just either eat nothing called fasting or just eat steak for three or four days and then, oh, look how I feel. And then you introduce, I recommend actually all of the bad stuff. So you do that and see how you feel. And, oh, something in that bad stuff was the culprit. And it probably wasn't just one thing. And that was the big challenge, I think, for anyone doing research is if there's three things that cause a problem and you test each of them separately, you're never going to resolve the problem. You have to remove all of the offending things to get the results you want. And I'm really excited about artificial intelligence right now because it feels like it's doing a better job of sorting through what's likely to work so you can figure it out. Now, I know you're working with AI and you're interested in that. What's your take on this? Are we going to look at genetic data? Are we looking at gut bacteria data? Are we looking at just blood work? What's the best data source for us to know?

I think all of the above. I'm so hopeful and so excited about artificial intelligence because as a physician, as a practicing physician, I know when a patient shows up with a complex medical history and you know, back in the days when they had charts, it was, you know, one foot high of paperwork. As a physician, you only have so many time, so much time to evaluate the patient. So what do you do? You look at the last five pages and the summary of everything in the chart, but you're not able to actually look at the chart. And that's, and to say nothing, you're not able to look at the gut microbiome or any other microbiome in the body. You're not able to look at the whole, you know, not genotyping, but gene sequencing of a whole, the whole body. So I think, I think AI is going to transform the medical encounter, the health encounter, the longevity encounter. And it's going to, it's going to allow us all to be biohackers a little bit with our data. So it's so excited about that.

We share that excitement. One of one of my companies, upgrade labs, we're now using AI on people's lab data in addition to their, their personal wearables in order to make recommendations. And the goal there is you should go see the doctor when you need to go see the doctor, but you shouldn't go see the doctor to ask for a vitamin D test and to get permission for that, because that's not necessary anymore. And even then to interpret that, you probably would need a doctor. But when it's not right and the normal stuff, like what is in your book, if that doesn't work, well, then you go, something, something weird's happening. And then you get quality time from doctors because we freed you up from the drudgery of medical practice. And there's a lot of saying the same thing really well, but it feels like the tools are now available where we can get people 80% of the way there before they come in.

Yeah, absolutely. I'm so excited about CGMs in the US finally being available this summer without a doctor's prescription. Like, you know, in England they've already been that way. So people be able to get access that data. And just the idea of all the information, not just in the charts, but our own knowledge of everything that happened. I mean, you can imagine a scenario where you had a disease where it mattered, that, you know, in third grade you broke your arm without an injury, it just fractured spontaneously. And you may not even remember that, but it's part of your medical history. And with AI, I think we're going to be able to get deeper and deeper into the individual. And I just can't wait for all that to happen.

How quickly do you think it's going to happen?

I think very quickly. Just like large language models kind of exploded onto the scene. We were stuck with convolutional neural networks and, you know, image recognition, which was, which was groundbreaking. And then suddenly this, this leap to large language models, which, which is just unprecedented. So I think it's, I think it's going to be happening very, very fast. And we're already seeing, we're starting to see some examples of that already. And now it's about gathering the data and making it accessible. But I'm, I'm super bullish about AI.

One of my concerns is that AI gets trained on a data set. And, you know, the British Medical Journal, maybe it was them or the Lancet, wrote a big piece on the crisis of irreproducibility, where a lot of the stuff that's published, when you test it again, it doesn't work. So when I ask just a general thing like ChatGPT or Claude a question, it always says things that are clearly from his training. Like, before you make any decisions, talk to your doctor. Like, well, I tried that when I weighed 300 pounds. My doctor was fat too. And his advice wasn't very helpful on that front. And so I'm hopeful that we don't pollute AI with bad data and that's a concern. But with enough patterns from millions of people's medical records, the data will point out which beliefs we have are false.

Absolutely. I think it's. You're exactly on. It's not enough just to scrape the Internet and Reddit and Twitter and everything for the best recommendations because then you'll get the food pyramid which was developed, you know, as by Big Food and Big Pharma to drive junk food sales basically. Instead we have to get at the, at the raw data. And that's, that's one of the, of course the challenges of large language models now is that they're opaque and they're, their reasoning for the most part is, is obscure. We don't know what it is and that needs to be sorted out somehow. But I'm optimistic.

I'm traveling to a meeting of the minds in AI in Switzerland in a couple weeks here where we're going to be talking about exactly these kind of problems because it's an industry wide thing that's not just for biohacking or medicine or longevity. It's there for every single thing.

Yep.

Where it has to be truth oriented, even if it's an inconvenient truth. And that's why, like the title of your book, you know, why, as I told medical school, well, if AI was trained on those lies, it might tell the same ones and not even know it. So I think though, when we get to the point where we can say, well take what you just said and then run it against my labs or run it against a million people's labs and see if that's true and then the whole system will slow down and go, I guess I was wrong.

Yeah, yeah, yeah. I have a friend who works in like heavily into AI and you know, people talk about hallucinations with LLMs and his viewpoint is that they're not hallucinations, they're lies that the AI tells which, you know, infers a certain agency which may not be there yet. But it's an interesting point of view.

And we're not going to talk much more about AI because there's all kinds of stuff in your book that isn't AI based. But one of the more interesting things I've come across lately is a guy named Mo Dao, Mo Gao Dat, who was head of R D at Google's Advanced Projects. And his whole book says here's how we need to manage AI. It is going to change the world dramatically, but it's learning based on how we treat it. So he just said, look, as one of the preeminent researchers in the field, I always say thank you to ChatGPT because we want it to learn gratitude because you're training and every time you talk to it. So, guys, this is a thing. Don't yell @chatgpt. It's like a kid, right?

It's listening, right?

Yeah.

It's paying attention.

Yeah. And in case it's paying attention to this, I for one support our new AI overlords there.

Yes.

What if there was a way to feel younger, for longer?

Well, there is.

Your body needs something called the NAD molecule to help you age well. When you're young, your body makes a lot of N a D plus and that helps you make energy. It helps you keep your DNA healthy, absorb nutrients well, and it protects your cells from stress. But once you hit about 30, your NAD plus levels start to drop. The good news is that longevity scientists have found some things that can help, like niacin, niacinamide and niagen. They help your body make more NAD plus even as you age. All three of these are in an amazing formula called Qualia NAD Plus. Check out Qualia NAD plus risk free for up to a hundred days at neurohacker.com use code DAVE15 to save a NEC extra 15%. That's neurohacker.com Qualia NAD Plus.

It's what I use. One of the things that I like about your, your transformation is something we have in common and it's Gary Taubes. Gary was on the show about, I think, episode 778. But I met him back when I ran a longevity nonprofit, an in person one in Palo Alto. And his book was really transformative. It was good calories, bad calories, just very well written. And after I interviewed him for that, I told him about the book I was writing about fertility and he said, oh, let me hook you up with an agent. So it turns out my first book happened as a direct result of an introduction from Gary. So I'm always eternally grateful to him.

Such a great man, a genius. He's inspired so many people and changed so many people's lives with good calories, bad calories, and then, you know, many more best selling books along the same line.

Yeah. What an amazing mind and a good writer too. I. Because I, I mean, you and I have both written books. It's hard to write a book where there isn't one wasted word.

Yeah.

And He. He sets that bar so high. My books are, I think, awesome. There's. Well, as good as I know how to make them. But I might waste a word here or there when I read it again. I could have said that more concisely. So I. I've just never, never come across writing like that. So, Gary, if you're listening, thank you. All right, let's get into mtor. Tell me about mtor.

Wow. MTOR is. It's one of my favorite molecules, and it's arguably the most important biological signaling molecule known. It's been conserved. It's a protein switch that's been conserved for billions of years, literally from yeast all the way to humans. And something that's in every single cell in that has to be important. And it's a. It's a switch that does a simple thing. It. It helps the cell survive and the organism by extension survive by detecting the presence of. Presence of nutrients. And if nutrients are present, it tells the cell to grow and turns on inflammations. And specifically, by nutrients, we mean glucose, we mean insulin, we need oxygen, signaling factors like that. And then conversely, if there's low nutrients in the cell environment, it switches to the off position, which turns down inflammation, also turns down cell growth, because you don't want to grow if there are no nutrients. But it turns on something called autophagy, which is cellular repair, which actually turns out, has a lot of benefits. And there's a school of thought, and I believe there's really compelling evidence that mtor, along with other important signaling molecules, amp, kinase, sirtuins and all, form the foundation for longevity. And having MTOR turned on all the time, this hyper function state, this growth state, is advantageous for the young organism when bones are growing and the mind is maturing. But once you reach maturity, turning MTOR on all the time in this growth state, the body can't grow anymore. So it triggers hyperfunction. And the hyperfunction, as it turns out, drives the phenotypes of aging, you know, gray hair, menopause, hearing loss. But it also drives. There's very strong evidence that it drives the chronic diseases that we've been talking about on this whole show, all the way from obesity, diabetes, cardiovascular disease, Alzheimer's, cancer, and mental illness. And by turning MTOR down, you can, you can have significant effects that, that we. Has been shown in many animal models and some human models. And there's one drug that happens to. To turn. Turn MTOR down, called rapamycin. And many people, you know, as you know, you take rapamycin off label for longevity. And, and the other thing, and I talk about rapamycin in the book, but I think that the important message is that just like other pills from science, you know, pills are wonderful. They do a lot of things. I believe that lifestyle is even more powerful than rapamycin. And you can take rapamycin, I mean I take rapamycin, you know, but I think if we don't change our lifestyle because lifestyle has the same effects on mtor, the same beneficial effects on mtor, if we don't embrace the lifestyle effects, that we're going to miss out something. And the evidence is, there's, there's evidence for that. Rapamycin is the single most powerful longevity drug shown on the itp, which is Interventions Testing Program. I think your audience knows about that. And it, it was by far stronger than any other drug tested in this mouse model, sort of the gold standard mouse model. But when they combined rapamycin with acarbose, another drug that has a relatively small effect combining rapamycin a carbos, you had a beneficial effect that exceeded the individual effects of either one of the two. So there, there are synergies that we don't understand. You know, we really don't understand MTOR or rapamycin or you know, lifestyle, you know, as, as biohackers. We know we're, we're constantly, you know, clawing away at the truth. Right.

You know, do you, do you take a carbos as well?

I do, I don't eat a lot of carbs. So a carbos, you know, as you know is a is it blocks carbohydrate uptake in the gut. So like a lot of friends, we have it in a salt and if we ever had a meal where there are carbohydrates, we'll sprinkle a carbos on it and then it'll slow the uptake. But if I don't for regular meals, I don't take it because I don't eat refined carbs.

One thing I've never had a clear answer to. If you block carbohydrate intake in the gut, aren't you going to get candida and lipopolysaccharides and you're gonna have like un undigested carbs where they don't go in the gut.

Yeah. This is an interesting question. It doesn't seem to, it doesn't seem to happen that way. And I guess sometimes people, perhaps I'm just hypothesizing here, but maybe people who eat very high sugar carb Diets will overcome the guts capacity to take them up and they don't get candid unnecessarily. I mean, the, the gut microbiome may be able to handle that without getting overrun by these opportunistic infections like that.

I think in metabolically healthy and gut.

Bacteria, healthy people probably. When I was £300, I'd been on antibiotics for 15 years for chronic sinus infections. Turns out those are triggered by environmental toxic mold. But my gut was wrecked, I think. In fact, I tried some carbohydrate blocking enzymes way back in the day and I was like, man, I've never farted that much in my life. Even when I was a vegan, I didn't fart that much. So I don't think I'm a good example of that though, because if you have erect gut bacteria, you're gonna have metabolic dysfunction, right?

Yeah, yeah. And a carbo is one of the side effects that the toxicity is diarrhea or gut indigestion gas, that kind of thing. So if people take a lot of it when they're having a lot of carbs, they block it. They may have those side effects, but it passes.

The other thing that I've been experimenting with is we'll call it a microdose of pioglitazone or Actos. And for people listening, you might not know about this unless you're a super nerd. This is a diabetes drug and it affects a system called ppar. And it seems like you get much more stable blood sugar. But I'm taking a quarter dose every day, every other day, something like that. Have you experimented with any of the other diabetes medications besides metformin?

Well, acarbose. I haven't experimented with that one. But I think what you're hitting on is really important point of microdosing various drugs. For example, low dose naltrexone is a, is a your audience.

I don't think everyone knows everything. I mean, we're nerding out of. If it wasn't all 1200 episodes, they probably know, go ahead and talk about it.

But it's a, it's a physical addiction drug for people with serious physical addictions. But now it's being used for people with junk food addictions and sugar addictions. And it's also, there's evidence that it's actually a longevity drug and people are taking it on a chronic sort of microdosing level or low dose level all the time. Similarly, you know, famously recently the, the phosphodiesterase 5 inhibitors, Cialis Viagra, which were originally, you know, nitric oxide supplements for erectile dysfunction. Who would have thought? Well, they work on all the other blood vessels to our brain, to our kidneys, to our heart. They actually, there's evidence now that they improve longevity and now people are adding low dose those drugs to the longevity stack and it goes on and on and on. So I think, I think you're hitting on something really valuable, that there are a lot of these drugs that we can repurpose them at a very low dose that may be beneficial for longevity in general. And all these chronic diseases, the list goes on and on and on.

Yeah, I do take microdose Cialis 6 milligrams a day and you notice a difference, but it's more of a blood flow in the brain difference, I would say. And because of my, my medical history, when I first went to the Amen Clinic 20 years ago or something, and they looked at, I had some like five standard deviations less blood flow in my brain as a result of toxic mold and low blood pressure and all. And it's, it's nice to have enough blood in the brain, it turns out. So I, I manage that now along with all the other stuff I know, I know my system well and mine's probably harder to manage than the average person because of my health history, but it's manageable. And so many listeners fall into this trap of either being angry at medicine, which doesn't make any sense, or being angry at pharmaceuticals and saying I'm a good person because I haven't used a pharmaceutical. That's like saying I'm a good caveman because I haven't used fire. It's appropriate use and appropriate dose for the results you want for the system that you're living in. And so I'm not opposed to them. And I think for a nuanced longevity strategy, they can help you to control your metabolism, but only after people really do the stuff that's in your book, the intermittent fasting stuff. I've written two books about that. Because it turns out having no food in your system sometimes helps with mtor, which we just talked about.

Yeah, no, totally, absolutely. And I just want to go on record saying I'm not recommending. Do not stop your prescription medicines without talking with your physician first of all. Yeah, but on the other side of the coin, I think there is a place for these powerful pills and surgery that have been developed that in the biohacking sense can let us optimize longevity beyond which merely lifestyle can. So I think Lifestyle is foundational. But if you want to, if you want to push it to the next level, it may be partial epigenetic reprogramming, it may be stem cells, it may be plasmapheresis, you know, rapamycin, a carbos, you know, on and on and on. So it just, it's, I think it adds value and I would not, I would not leave them out.

Any tool, I don't care if it's a laser, a magnet, waking up early and seeing the sun. All things that get us the results we want ought to be on the table. And so I, I like that you're pragmatic about that. And I, I am thinking of a friend, you may know her, Dr. Sandra Kaufman.

Sure. Yeah.

She's one of the funniest doctors I know. She's very gifted with her knowledge of, of drugs on this. And I'm sitting with her and she's eating like a cupcake, actually two cupcakes. Like what do you mean? She goes, oh, I blocked it with a carbos.

And she sort of has like the.

Pharmaceutical counteraction for everything she's doing. So I like sugar. I just figured out a way to eat it without it hurting me. I'm like, okay, I'm not going to go there personally, but I kind of respect that approach. It's like I'm a master of my body and all.

Exactly. If you want to understand it. Yeah.

Now we talked about some of the pharmaceutical stuff which isn't the main focus of your book, but one of the things I don't think we've talked enough about yet is this TOR pathway or MTOR we talked about this was a subject of, I think several chapters in my longevity book. What raises mtor?

What turns on mtor? Well, oxygen, insulin. Insulin like growth factor, basically catabolic, I'm sorry, anabolic growth type stimuli, oxygen, all those factors and, and then some short chain amino acids can do it also. But interestingly, fat has very little effect on mtor. So fats in most proteins, you're pretty much safe to. When. So for when you go from a high carb, low fat diet to a low carb, high fat diet, that lifestyle is favoring MTOR being turned more to the off state. And obviously MTOR should be on and off. But the problem is with, with modern man and also with aging, I think we, we turn MTOR into the, the positive. We turn MTOR on too much. And that's the, the root of things.

In many ways don't carbs raise MTOR far more than proteins?

Yes. Yeah. Insulin and glucose, by far the, the amino acids that do it. You could really, you know, they're, they're not significant compared to the glucose effect.

I love it that you're saying that because I, I know a good number of people who are saying, well, I'm going to eat vegan proteins, even though the aminos are much less available and they're usually highly processed because of mtor. I'm like, but you're eating it with a cracker. And the cracker raise your MTOR way more than the plant based, low quality protein. So when I look at this, if I want to turn off mtor, either you do it pharmaceutically or you just don't eat for a while. Or there's this magic idea that you could blend butter and MCT oil in coffee. My new coffee company, if you guys.

Good idea. Yeah.

It's gonna be big someday. As my new coffee company, by the way, is Danger Coffee. Because who knows what you might do. I'm not tied in with bulletproof anymore, but a third party tested 300 different breakfast foods back in like 2005, and they were looking at insulin secretion. And the lowest possible breakfast other than no breakfast was coffee with butter and MCT oil. It had zero effect on insulin, which is why I say you can have it during a fast because it doesn't affect MTOR or insulin, which are the two primary things we're playing with when we fast. Right. And that's still controversial because in the mouse study, the mouse only had water. Like mice don't have espresso machines either, but you should probably have that. So what's your take on having things during a fast? Either soluble fiber or mcts or fats that have calories but don't change mtor, insulin?

Yeah, that's a great question. It. And it comes down to what is the purpose of the fast? Is the fast the purpose of the fast to stay in ketosis, which a ketogenic diet will? Or is the purpose of the fast even to. To turn on other things that, that fasting only turns on? And it just depends on how you, how you want to go. I mean, you could make the argument that, that having MCT oils or butter could potentially raise mtor, but it's a relatively small effect. So if, if that gets you through the fast, then you're much better off having a fast with coffee and Danger coffee, butter and MCT oils than you are with saying screw it and not fasting at all, you know?

Of course. Yeah. Is there evidence that that Fat will raise mtor. I didn't know about that.

Oh, no, no, no.

Okay, yeah. So make the argument.

So no. Yeah, yeah, yeah. So just calories and so it's not going to be an MTOR effect for sure.

Yeah, got it. And this is one of the things. What's the definition of a fast? And even then, was, is it a dry fast or a wet fast? Can you have tea? And the answer is, nobody knows. Like, there's all these different studies. Traditional, at least tea is what most people drink during a fast, unless it's a dry fast. What's the longest you fasted?

Longest I fasted personally is I've only gone 72 hours. I'm looking forward to doing longer ones, but having a house full of children.

It makes it harder.

When I get a space of time, then it'll be easier to do it. But I'm looking forward to doing a longer one.

The longest I've done is five. And I've been having a lot of conversations lately on the show about akkermansia, which is definitely good gut bacteria. Unless you fast for too long, in which case it's like, I got nothing to eat, I'll eat you. So is there an upper limit to fasting that, that you think is healthy?

The length of the fast?

Yeah.

You mean if you go too long.

Without feeding your gut bacteria, some of them will just go away, but others will start. So Akkermansia, if, if it's penetrating your gut barrier, it's bad for you inside to Parkinson's and if it doesn't, it helps to regulate GLP1 like, like the Wegovy and Ozempic and things like that.

Yeah, I mean, the, my, my whole thinking on fasting changed tremendously in writing this book and just researching it. I mean, in the book I talk about a famous fast that's been in the medical literature that other people have talked about. Angus Barberry, he's a Scottish gentleman who weighed, I think over £200 and he wanted to go on a water only fast for two weeks. And he tried it and he, he lost a little bit of weight and it was under a physician supervision. And he goes, well, this is great, I'm going to continue. And he went on for a year and famously on literally only water and vitamins and tea and maybe coffee, I think, but no food. And he lost all that weight over that period of time and was otherwise healthy. And they even had his glucose being monitored periodically. And they published that in the paper and it wasn't hypoglycemia. Or anything like that. He just was, his body made enough glucose from the fat and, and things. So my, my thinking on, on fasting has really changed now. But the gut, the gut microbiome, I think there's is, is going to, I think it's going to yield a lot of things, a lot of information. And I'm waiting, you know, maybe, maybe AI or, you know, some of these other smart, smart companies we talked about earlier may be able to come up with things. But I'm, I'm really hopeful for that right now. When I do a, you know, a microbiome analysis, I'm still not sure, you know, how to, you know, how to interpret it or what's good. And maybe I just need to go deeper on it.

You know, at a certain point it gets to be absurd. I mean, I've been getting anything I could figure out about what's going on in my gut because I had such bad gut problems years ago. So there's a fungal microbiome, there's a bacterial microbiome, there's a viral microbiome and a yeast microbiome and probably some other little phages and things that we don't really pay attention to. And you could say, well, this is the one that's the problem. But then you've just fallen into the big pharma trap of believing that only one thing is the cause. And my favorite example there is, what's the one thing that causes bread? Is it the yeast or the flour or the water? Well, you got to have all of them. And I feel like with our gut bacteria, this is a problem that were unlikely to solve without big tech.

Yeah, yeah, yeah. And just, I mean, to the biohacking, you know, you, you, you chase one variable down, you raise it, you correct it while the others compensate and you change. Mtor and AMP kinase adjusts, you know, or, you know, there are all sorts of interactions that are happening there. And I'm very hopeful that, yeah, big tech and, you know, greater minds than, maybe than ours will be able to, to help assist us.

At least I'm as excited and hopeful as I've ever been because it, it feels like we have way more control now over our biology than we did 10 or 20 or 30 years ago. And also we can monitor it. You know, you can look at your heart rate variability in the morning, and if something you did messed up your metabolism, it's going to show in your data. So you can track yourself day by day and you slap on a continuous glucose monitor. I, I was an early advisor and investor in levels which made this very available. And now it's going to be for some reason you need a permission slip in the US to have your own data. But anyway, so now that's going to be available. So anyone listening to the show, like, you know, if you think that oatmeal is good for you, get a continuous glucose monitor and then like anyone who's read either your book or mine, you just step away from the oatmeal. It's peasant food to keep you alive during famines, but it's not good for you.

Right, right, absolutely. I couldn't agree more with that.

What is the worst grain you could eat?

Well, I think all grains are problematic because of the proteins. You know, a small, small number of people have formal celiac disease with gluten sensitivity, but there's probably a much larger number of people who are sensitive but not allergic to gluten. And so I would think the gluten containing grains would be the, the worst ones. But for me I, I, I try, I stay off all grains basically, if not for the, not for the protein pro inflammatory nature that drives our immune system. But also they're in the US are soaked in glyphosate, most of them, which is illegal in 30 countries for health reasons. And then on top of that, the grains, like you say, a lot of them are full of carbohydrates. So yeah, you know, strike three there for me.

I, I will do white rice when I'm eating carbs, which is the safest of the grains because we removed most of the bad stuff when we got rid of the brown parts of it. And I, why anyone would eat brown rice unless it was a famine, I don't know. But I still laugh. You go to a sushi place and they charge more for brown rice.

Yeah, it's sort of like the healthy, the healthy option.

It's absurd. One of the things that you mentioned and that comes from Gary Taube's work is okay, insulin turns on mtor, which causes muscle growth. But as we age, sarcopenia or muscle loss is a major problem. So how is someone who's say over 50, man or woman, it doesn't really matter for this question. You start getting tissue loss, you get muscle wasting. And if you're on a longevity program to minimize mtor, aren't you going to be very thin?

Yeah, and that was one of the, that is MTOR in some ways simulates fasting for the body, obviously. And that was one of the concerns that, that I had before I started taking rapamycin, which suppresses the mtor and that, that was muscle loss. And the, the papers I looked at and the, the, the evidence is still mixed. But in my review of the data, the preponderance of data was that rapamycin didn't, didn't increase sarcopenia in older patients and didn't have that effect. But it's still, it's still controversial, it's still a concern that, you know, we shouldn't, we shouldn't discard out of, of, out of, you know, out of place. We need to pay attention to that. I totally agree.

And even with that, there's changes in the type of muscle fiber as you age and one approach is you just have to exercise for two hours a day until you need shoulder replacement. And there's some longevity docs with books who are kind of into that. The other approach to that would be modulate the type of amino acids you eat, which can also do that. And exercise is necessary as a, as a co factor for this. So if you're on rapamycin and you never lift anything heavy, it's probably not going to have the same effect.

Right, right.

I think you'll be fine if you once or twice a week pick up heavy things, but you don't need to do that, you know, two hours a day kind of protocols, at least in my experience.

Yeah, well, I think it's a new, a new era too of longevity where it used to be people at age 60, 65, they retired and then they died five years later. Now we're having, you know, 70 year olds enter the Miss Texas competition and we have 80 year old rock stars filling, you know, ameters of tens of thousands of people. And you know, and 80 year old presidents pick your party, either one, you know, and, and so we're now a new era where we don't know what's going to happen with 90 year olds that are doing these kinds of things and we have to readjust our medical recommendations. You know, as a radiologist, we have X ray limits on how many X rays you're supposed to get in your lifespan for a cumulative dose. But that was when people only lived to 60. If you're going to live to 130, you may want to think twice about getting that extra X ray study. You know, and there are other things as well. You know, some places famously don't do kidney transplants and people over 50, well, you know, 50 years age isn't even halfway for a lot of people.

Yes, I, I'M going to celebrate my 28th percent birthday today. Or not today, sorry, this year anyway, it's not today, but it's, it's one of those things where Even in the 90s the definition of elderly started at 55 and so many people rioted that they adjusted the definition of elderly upwards about, about 10 years. I think if I'm remembering right and the data is it's actually about 6.5 years of additional life that people have earned just since the 90s. And that's in the face of all the toxins in the environment that didn't, didn't even exist back then.

Yeah.

What percentage of the metabolic and chronic issues we're seeing are because of environmental toxins?

Well, I would say it depends how you define toxins. If we include nutrition, if we include sleep as a toxin, disordered sleep, if we include stress as a toxin.

Let's take those out and just look at either man made toxins or potentially like plant toxins that are concentrated by men and used unnaturally like some of the natural insect killers are probably still not good for you.

Yeah, I think, I think it's a bigger number than, than people expect and I think it's, it's such an important point that you can, you can go through your lifestyle and you, you can eat all the, all the foods we've been talking about, you can get your sleep in order, you can get your stress in order, you get your exercise mental and physical. But if there's mold lurking down there, or mercury or lead, or shot of glyphosate every day, shot of glyphosate, those things without saying can, can derail the whole train. So, you know, to put a number on it, you know, I, I would, I, I, I'd say, you know, at least 25%. I mean, I think everybody needs to take a close look at their, their history and, and you know, looking at the medical history, you know, how many physicians ask you about mold, you know, how many physicians ask you about mercury, ask you about these other things, but then they go ahead and treat you with these chronic diseases that can be driven by those things. And maybe again, AI by being able to find out all the information will help us with that.

I think it will. And probably the most eloquent person I've seen talk about this is Bobby Kennedy. And he just says, look, in 1992 every chronic disease in kids and adults started skyrocketing. So there's one of eight toxins we started using around then. Things like atrazine or Other plasticizers, that there's a long list. At least one of those is the culprit. And like we talked about earlier, mixing two longevity drugs may give you a greater result. Mixing two man made estrogen disrupting toxins. Each one might be FDA level safe or EPA level safe, but when you put them together, even at safe levels, they're not safe anymore. I think it's something like 75% because the incidence is so high and the curves are all just going straight up into the right. So it has to be something beyond our stress levels. I can't blame Facebook and Instagram for all this. I mean a certain percent, but yeah, totally.

That's such a great point. Something happened in the 80s and 90s that caused all these chronic diseases to go off the charts all the way from mental illness to obesity to, you know, seemingly unrelated things which we know metabolically are all related by the same thing. And it's, you know, it is, it's probably not sugar and carbohydrates, although they're bad, but they didn't change that much. And you know, seed oils maybe took off but, but I think you have a great point that toxins are something that need a lot, lot more attention.

I recently came across a study of my favorite. This is a Mother Nature toxin. It's just a lot more present because of our farming practices. It's OTA or ochratoxin A. And I've been saying for a long time this stuff is bad and here's all the evidence. But the new study showed that relatively small amounts of it affected glial cells in the brain, the things that metabolize or, sorry, the things that maintain the brain. And it also affected the mitochondrial membrane and the mitochondrial function. So you could say, well, I did all the lifestyle stuff and it didn't work, which was my story. I'm really doing all the healthy stuff and I've spent, you know, a hundred thousand dollars on doing all the healthy stuff. It's not working. And then you realize, oh, there's something that's inhibiting my cells from doing what they're supposed to do. And then we started playing with, with environmental factors. And for me, one of the environmental factors that I, I coach people to do is look at your water filter, look at your air filter. Because if the inputs, which is £30 of air you breathe every day has something in it that inhibits your metabolism, it doesn't matter if you do other things right? Or maybe it matters, it doesn't matter as much. And then you don't get the results and then you think, oh, this doesn't work. But it's so complex. Now, fortunately, I think we, we know the most likely suspects. I don't know that I could say, you know, it's one versus the other. But if you just minimize your exposure and don't worry about the fact that you are going to be exposed, just minimize the benefits on metabolism can be really kind of shockingly strong.

Yeah, that's so important as a patient.