Danger of Sitting Too Much - with Dr. Kelly Starrett | The Empowering Neurologist EP. 23

Hello, I'm Dr. David Perlmutter, and welcome again to The Empowering Neurologist. You know, the truth of the matter is we spend an awful lot of time sitting on our rear ends, and as it turns out, there are significant health consequences associated with this sedentary activity. This is a terrific new book. It's called Deskbound, and it's standing up to a sitting world. Really, brings this information to our attention, written by Dr. Kelly Starrett. He is a coach, he's a physical therapist, he's also a New York Times bestselling author, author of Becoming a Supple Leopard and his more recent publication Ready to Run, both New York Times bestsellers and also Wall Street Journal bestselling lists as well. This is his latest book, it's called Deskbound, and it was just released a couple of months ago. In 2015, he launched standupkids.org, a nonprofit organization that was founded by his wife, Juliette, and the organization's mission is to get what are called stand-up desks into public schools around the country to help combat the epidemic of sedentary lifestyles and inactivity in children. So, we're going to explore The detrimental effects of remaining in a seated position throughout the course of our day, how impactful this information is, and in terms of its relevance to so many of our modern maladies. And I'm really looking forward to this interview. So here we go. So with that introduction, let me say hello to Dr. Starrett. How are you doing today?

I'm well, thank you so much.

Great. Well, we're talking about your new book, and here it is, as I talked about in the introduction, terrific book. A lot of people are going to need this message and are getting this message because, as I mentioned, a lot of people are spending way too much time sitting on their rear ends. I almost feel bad having this discussion with you while I'm sitting down after reading your book. But that said, you know, in the intro of your book, you quote Dr. James Levine from the Mayo Clinic who says that sitting is the new smoking. What about that?

I think the issue around, you know, looking at sitting— sitting is the poster child for a bigger problem. And that's really a sedentary lifestyle. And that, you know, if, if we look at how the— how Harvard is defining sedentary lifestyle, how the CDC, the WHO, all of these bodies around public health are looking at sedentariness, they really define it as sitting more than 6 hours a day. And then we can be a little bit more granular. Do you drop below 1.5 metabolic equivalents of activity? It turns out when you sit down, basically your body shuts down. Physiology downregulates. I think what Dr. James Levine is pointing out is that, hey, when we sit, we're exposing a whole bunch of downregulatory physiology on the human, and that really has a kind of ultimately an aggregating cascade of dysfunction that expresses itself Given enough time, and it always does.

Well, you know, one of the things that's— that we often talk about is the role of our lifestyle choices, including food but also activity, as an epigenetic modulator. In other words, changing the expression of our DNA. And for those of us in neuroscience, we're really interested in aerobic activity and being active in terms of increasing the body's production of what's called brain-derived neurotrophic factor to grow new brain cells. But To get back to, to the introduction, in fact, a quote from him was that 1 hour of sitting ends up leading to 2 hours of lost lifetime. That's pretty profound.

It is profound. And, you know, that there's always the risk here is saying, you know, this is about fearmongering, you know, don't sit. And really what ends up happening is that we end up, you know, sort of discarding the entire thing. Because if we're really taking more of a cogent model or cogent view of this, we're going to see That you probably commute in the car, you sit at a desk at your board meeting, and pretty soon, you know, just the day-to-day— I went out to a nice dinner with my wife and I sat for an hour. And it really— I don't think we're looking at how sort of insidious this environmental load is. And it's almost like we forgot to think to ourselves, hey, we can make the, you know, the environment fit the physiology. We don't have to take the physiology and make it fit the environment. Really, I think those points where we say, hey, it's like sitting, it's smoking, you're losing life expectancy, I think what we're trying to do is bring consciousness to this change and to the fact that a lot of the choices that we make around our physiology, we take for granted. What we're seeing is that human beings were designed to be in constant motion. Look a lot at the brain and brain function and the relationship between activity and brain function. Well, we can really extrapolate that and take it in any direction. One of the things that we do in our movement and mobility practice when we work with the world's best athletes is we prioritize nervous system first, and that we see that the organization of the nervous system, literally the geometry and the mechanics of the spine, really end up being compromised when we're sitting. That's how we ended up ultimately, for us, coming to this conversation. What I really think is interesting is that we fail to think about the fact that looking at skill acquisition as a biological process in the brain, that neurons that fire together wire together. Practice doesn't make perfect. Practice makes permanent. We really start to ask, well, what are the shapes that we're adopting as a matter of habitus all day long, and what are the implications on my breathing, on my— the patency of my airways and my head forward neck position on my jaw. Really, you can just check the boxes of very interesting things that happen when we, you know, adopt these positions of less than optimal function.

I feel like I better sit up straight or I'm going to be criticized here. So there is a tendency, I think, in our modern world to think that, well, I sat all day long, but if I go to the gym after work for an hour, I can offset that. And I think you make it pretty clear that that just isn't reality.

Well, you know, it's the equivalent, I think, of smoking and jogging. You know, those sort of things, they're anathema. And the problem is that we have seen, and the research is that gym memberships have tracked our global— our rise in obesity rates in the United States. So we think that people are doing the right thing. But as you know, looking at non-exercise activity, background activity, as really the The bigger meal, and that what we're looking at is exercise is almost like a condiment. Exercise already is a loaded term. When we say, hey, you should be physically active, well, I mean, there is a great diversity of physical practices there. If you actually drill down, for my wife and I, about what we think is most important is, hey, do you have a physical practice? That physical practice has to include more non-exercise activity like walking. That's not going to be as cardioprotective as breathing harder or certainly as bone protective or immune effective by gaining some muscle, but the background is, hey, you have to keep all these physiologic processes running. The bottom line is that when we sit, they literally shut off. When we look at diabetes rates in America, new research out in the last month that says basically diabetes rates in America up 400%. Wow. For the first time, we've gone over the tipping point. There are more obese Americans than non-obese Americans. I mean, just sort of check the boxes that matter to you as a person. And then we look around and say, well, hey, I really feel like people are trying to do the right thing. They really are. We've seen a consciousness around some eating habits shift. It's going to take more time there, right? We've seen people exercise. The popular culture has certainly popularized high-intensity exercise. But underneath that, we're still making this type 1 error, this foundational error, which is we are not doing what we were designed to do, which is to be in constant motion. And that's not radical change. It's a small change.

So there's a big paleo movement. And the paleo movement really, as you know, is mostly centered on trying to emulate our Paleolithic ancestors' diets. And the reason that's important is because our genome has evolved in close responsiveness to the diet that— to which it has been exposed over tens of thousands of years. But I think I'm really hearing now from you that our level of physical activity is also an epigenetic kind of arrangement, that our level of physical activity communicates quite well with our genome. And now suddenly, in the past 100 years or 200 years, We're not sending those signals back to our genome anymore. And that may explain increasing rates of obesity and diabetes, etc.

And I think, you know, as we know, if we take the work done by Charles Perrow, who was a sociologist out of Yale, who looks at— his great book is called Normal Accidents. And he looks at complex systems and the, and the, all of the difficult processes that are bundled in that. And it's really difficult to string out a single aspect and say, hey, look, there's correlation between this and this in the short term. And the problem is that these systems are so complex that we add complexity on top of it. We're going to track, you know, we're going to track how many steps you take and we're going to get all these blood panels. And really, it really, you know, I'm going to take this turmeric at 2:00 AM. And what we end up happening is that we don't see the simplicity, the overlying principles on top of that. I think it's naive of us to say that technology is going anywhere. You know, we're not going to, we're not going to see regression in screen usage. The Kaiser Family Foundation did research in the last 3 or 4 years that said that kids between 8 and 18, independent of economic socio cohort, literally are spending 7.5 hours a day on this in front of a screen. And so what we have to do is then, you know, look at how do we have better Blocked behavior. How do we take the choice away? If technology is not going anywhere, then it's a lot easier for us to just make an environment that automatically protects us. And that, for example, is what we've done at our daughter's school. Our daughters are both at the first all-standing school in the world. What we've done is taken away the opportunity to sit in a chair. Kids can sit on the floor anytime they want, which is, you know, that great piece of research that said, hey, can you get up off the ground? without using your hands as a predictor of mortality. So suddenly we're taking kids through full ranges of motion and then we've created an environment that's a more movement-rich environment. The kids are in constant motion. They, uh, there's a fidget bar at the bottom of the desk. And as a matter of non-choice, kids can either sit on the ground or they can be in a position that actually reflects their own physiology. The desks are individually heighted to them. And all of a sudden now this technology creep where we're becoming more sedentary because we're in front of the TV, because we're on the phone, because, you know, All of those things are non-starters. It's not really an issue. I think that's the way we want people to start to view this. We can look at our environmental sitting load as optional versus non-optional. Our contention is if you just kick out the non-optional— kick out the optional sitting, then already you're going to make a massive difference towards improving this epigenetics and genetics. We just have to run the experiment long enough. And you will see massive changes.

Well, you know, again, just to drive home the importance of the work that you're doing and this problem in general, your book mentions that the World Health Organization characterized a sedentary lifestyle as being the 4th leading cause of death in the world. And, you know, that's, that's right up there with other things that we, you know, we always talk about. And it's basically, again, this, this mismatch between who we used to be And our environment. So it's an environment-gene mismatch that we can correct, basically by reading your book and doing the things that you talk about. So tell us what we can do. What are the steps that we could take today to make changes?

Well, the first thing we'd like you to do is, you know, begin to see the world as the choices that you're making with your body every day. And the simple one, again, is look at the opportunities when you can sit or when you could stand or move. Can I take that meeting? Can I, can I walk instead? Can I, can I, uh, you know, work at my, check my email in a different position? And already that, you know, differentiates and splits sort of the, the, the load into, hey, I have managed to just get rid of all of the junky food out of my diet simply by not having it in the house. That's one of the ways we look at this, right? The second thing is, you know, what we see is that there is a little bit of entropy around getting started and especially the workplace. I need a doctor to get to have a note that says that I can have a standing desk. Well, if we back out on that for a second, really— What? I know, right? Is that, you know, you don't need a doctor's note to stand. That's, that's like asking your doctor, do I need to go to use the washroom? And what we know around adherence is that the more steps between someone and an action, the less likely they are to take the action. My doctoral work was on barriers to adherence. And so one of the things that we want is to have people say, look, if you, if you have an option to stand up, all you need is an Amazon box and then a phone book, place to put your foot. And those things have cost you very little. And that's not a very gorgeous looking, you know, workstation setup, but it's a start. The other thing you're going to need to know is that, you know, we have habituated ourselves to these sitting postures and we see the adaptation in the tissue and in the motor control because those are patterns that I've adopted for 14 to 16 hours a day is what the average person is sitting. Then when I go to stand up and open the hip and require more thoracic extension and shoulders back, I'm going to be like a baby deer standing up for the first time. What we recommend is that you put yourself on a little shaping gradient. Make a commitment to stand for 30 minutes this week. Next week, bump it up a little bit. Stand for 45 minutes a day during the week. Then pretty soon you've aggregated because what we see— Which is very common in the workplace in the United States. It's all or nothing. I've been sitting at my workstation for 50 years and I'm going to stand up and people are cooked. They're weak. What's interesting is it really does track what we've seen in kids, that kids now are running the mile a minute and 20 seconds slower than their parents, which is pretty amazing. We're seeing that all measures of trunk stability and trunk strength, core strength There we're seeing degraded abilities in our kids now. And we have to ask, you know, what's going on? Well, we're using the chair as a surrogate for our spine and the musculature of our spine. And what we need to do is look at the shift from sitting to standing more, the same way we train a marathon. Hey, let's, let's make small changes that are really manageable so that you're not confronted with your limitations of strength, stamina, and, you know, just biomechanics.

Well, I thought it was really interesting how you even described how college-level football players spend an inordinate amount of time just sitting. These are, these are guys that are really involved in some very, very intense training and then execution as well, but basically they're spending much of their time sitting.

And that's, that's right. And what I think what's interesting is we came to that conversation because we were helping their coaching staff solve a sequelae of problems around what looked like short up, stiff quads, low back pain. When we said, hey, look, it's not that they're not doing the right intervention. They had really excellent strength and conditioning staff, wonderful physio medical staff, but it turns out they couldn't overcome this resting problem. What's interesting is that when we work in the highest levels of sport, so I spend a fair amount of time in the NFL. I talk to those coaches and say, why can't you solve these problems? They're like, oh, it's the kids in college. Then you go to the college universities, and I spend a lot of time there. I'm like, what's the problem? They're like, these kids in high school, they're They're so broken. Then you're all the way down into high school and the coach is like, yeah, my kids can't air squat. They don't have fundamental movements. They look like they're these little shrimps all the time. We're asking them to open up and be powerful. Then they really are— they kick the can back down to middle school. That's, in our experience, is where we have seen fundamental divergence in primary motor patterns. It begins in the first grade. Literally, if you watch any kindergarten without warm-up, They sprint to the playground. They all run naturally. They run on the ball of their foot, right? They strike like human beings are supposed to run. They leverage their heel cords, right? Then halfway through the first grade, those kids start to heel strike. What's interesting is that we have introduced this noxious load that is so insidious but so consistent that it— that fundamentally changes how kids are moving, and then we end up sort of on this parallel track of function. Right. When we start to pan back out and again look at the bigger pictures, adult diaper industry is a $1.2 billion industry in the United States because we're sitting on our pelvic floor, that the endopelvic fascia doesn't even wind up until you're weight-bearing through the pelvis. What we see is, as you know, is that the body is so miraculous at solving mechanical problems so that we can go on. We confuse that compensation. Right. We can produce massive amounts of insulin to to buffer the 16 donuts I just ate for a while, and then I can't buffer it anymore, right? The same thing can be true for any aspect of your physiology around this. To your point, what we're seeing is that even in our healthiest populations— I'll put that in quotation marks because I'm not sure a 19-year-old male is the healthiest guy— but what we're seeing is that it wasn't enough to overcome this sitting load. When we pan back out and look at any of the other aspects, of the physiology and the function, we have to ask what is the underlying, sort of let's say pathology, what is the underlying noxious stimulus? It turns out that it's the sedentary lifestyle, which also is allegory for wretched positioning.

Well, you know, obviously that low back pain is an incredible source of morbidity, disability, and lost revenue here in America. And I think you made it very clear in your book How related low back pain is to remaining sedentary. But you also offered up, as you did in Supple Leopard, some exercises to do. So what, you know, how do people get started? Let's say they have the book in hand. Where do we go for an individual who does suffer from low back pain? What's the first step for him or her?

The way we can— one of the ways that we evaluate good programming or good thinking is that it has to scale. Is that, do the principles hold true? Are the systems mutually accommodating at any level of intervention? So for example, you know, when we're, when we're looking at someone who has, you know, nonspecific low back pain or low back pain, well, the first thing we do instead of trying to medicate— we want to deal with your pain. This is important, right? Chronic pain is a real problem. Just look at the opiate problem. But the real issue here is, you know, you're not— there's something around your moving unless you have pathology, you have Spinal cancer, or you've been in a car accident, the chances are the underlying pathology is a movement-related or failure to move pathology. It's easy to say that disuse is catabolic, that tissues basically are tissues because they withstand load and they're systematically stressed, and that's how the system even hydrates tissues. I have to be moving. So to pan back out for people for a second, your lymphatic system is your primary part of your immune system. It's how we clear congestion and swelling and move fluids out of the body, and that's driven through muscle contraction. So if I'm not squeezing my muscles or using my muscles, then those lymphatics literally stagnate, and this is why you get cankles after an airplane. So again, coming back to that idea is the first thing we want to do is say, hey, let's make sure that we're not just band-aiding over a problem. And let's start looking at the environmental loads. Let's get you standing more. And then let's also apply some technique to the body because I think this is the issue, is that anytime someone comes into our practice and is having a movement-related dysfunction, the first question we ask is, how are you moving? Let's see how you move because that's the intersession change that's going to make the most difference. How someone carries themselves for 24 hours is far more important than any intervention I can load onto them in 45 minutes or an hour. And so we try to empower the person to move well first, and that's what the first half of the book is about.

So you though mentioned— I don't think it's the first half of the book, it's later on— just now mentioned about how it is when you get off an airplane and how stiff you can be. But you had some really great tips for those of us who end up traveling a lot. I think one of the ones you mentioned was to make friends with your neighbors right off the bat. But traveling is a bear sometimes for us who— Absolutely. Lecturing and things like that. What can you— what kind of tips can you give us?

Well, one of the things that we think of is, you know, we know that there are going to be periods of our life, of modern life, where you're going to be compromised. You're just going to be in a bad position. And this— you can be one of my police officers, you're wearing body armor and a utility belt, riding a car. It means, hey, look, this is your job. So how are we going to do that? We can't— you know, at some point we still need police officers in cars. And so the idea here is Well, we can program sufficiently to some soft tissue work, some movements, some breathing. There's things that we can put in as a physical practice, as a position or skill transfer set of exercises that helps us to ameliorate the compensation or the effects. So, you know, one of the things that people love to do, they get off the airplane and they go for a run and I'm like, whoa, whoa, whoa. I mean, you know—

I did that last night.

It happens.

Exactly that. That's right.

And so what we would say is, hey, instead of just going for a run, let's go for a walk first. And I'm not saying you can't run, but let's develop a 10-minute routine or a practice that helps us to address some of the stiffness or disuse or static positions that we've been in. And because this is an intervention we're recommending to people that's 10 minutes a day, it's the equivalent of brushing your teeth a couple times a day. We want you to spend 10 minutes a day working on the health of your soft tissues, working on some Simple myofascial dysfunction, right? When we give people the right solutions and antidotes and we have this small dose action over weeks and months, it makes a massive amount of change. What we've really tried to do is strip down the jargon and give people really simple interventions that re-empower them to be able to address stiffness or myofascial pain. One of the things that's shocking I think as a clinician, as you can relate, is someone comes to you and they're literally on fire. You're like, well, what do you know about you being on fire? You have low back pain. Well, I don't know. I just woke up and I was like that. Okay, so we don't have much consciousness around it. I'm like, well, what are you doing to make yourself feel better? They're like, I came and saw you. I think we have completely removed ourselves. Yeah. We've removed ourselves from responsibility, not because we're lazy. But because it's not been part of our human experience, that our moms don't do it, our dads don't do it.

Yeah, it's cultural. In Western cultures, we are kind of given to the notion that we can do whatever we want, live our lives come what may, and then hope that there'll be an Alzheimer's pill, or there'll be something to lower the blood pressure or treat the diabetes. And, you know, you're right, it's all about self-empowerment through, through education. And, you know, I really want to emphasize again to our viewers That this is a very, very user-friendly approach, that this book is going to walk you through what you want to do. It's very, very straightforward. I've spent actually quite a bit of time looking at it. One of the things I see a lot of in addition to low back pain is knee pain. People end up going to the orthopedist and having their knees injected with steroids, and it seems to me that we now recognize that a lot of Yeah. And I think a lot of knee pain comes from weakness of the quad muscles. And no doubt sitting in a chair all day or in the car is going to cause weakness of your legs in general, but I think the quads specifically bear a huge detriment when they're not being exercised. And I think they play a huge role in keeping the knee stable, especially the kneecap. So what do you tell people about strengthening their quad muscles that might help alleviate their knee pain?

Well, first and foremost, what's nice to think about is we're always taking a 2-pronged approach. One is, how is the efficiency of the mechanical system? That means if your quadriceps are stiff, if the connective tissue, the fascia in the upper leg is stiff and not sliding and is fibrotic from just poor use, then it's easy to immediately, for lack of a better word, feed some slack to the system. The physicians around the turn of the century coined a term called theater sign, right? Which describes this patella pain, pain in the kneecap when you sit. And what's happening is when you sit, your rectus femoris, one of the heads of your quadriceps, which goes from your kneecap basically up to your pelvis, is under tension and it just pulls your kneecap into your femur, into your leg bone statically. And that's enough to over time, given enough duty cycles, to sort of create a little sensitization in that area. One of the things that we see is that a lot of times when people have pain, clearly function is a big part of it, but one of the easiest things you can do is take the handbrakes out of the system, take some of the internal resistance and overtension out of the system, which means simple rolling, simple myofascial release. When we point out to people how strange it is that their quads are strangely attached to their knee, they're shocked. Ida Rolf, the wonderful biochemist, had this great saying. She's like, where the rats get in is not where they chew. I think when we give people a basic template of saying, hey, what are the tissues above and below the area you're having pain? Let's take a crack at improving their health, improving their perfusion, and you might be surprised that you might resolve that. But the other component to the biomechanic Resolution is also the motor control that we have to teach people to squat appropriately, and we have to teach people that there's skill underneath the human being. Any movement tradition from yoga to Pilates, you come out of the martial arts and you'll see that people have solved what the stable position of the shoulder is and how to move. The problem is that those things are buried in our movement traditions and sometimes dissociated from our modern experience. So should you have a movement practice? Absolutely. It doesn't— we remain agnostic what that is, but teaching that motor control around making stable hips, you know, getting people strong enough, makes an immediate difference. I mean, we see people who are so detrained that we put them on an exercise bike and they get stronger, which is not really the way to strengthen quads. It's also important that we recognize that your brain isn't wired for a single muscle group. Your brain is wired for movement patterns. What this means is that the positions and patterns that we employ day to day are really ultimately the expressions of the formalized movement we see in the gym. Deadlifting is picking something up off the ground with a hip hinge that protects my spine. Squatting appropriately in the gym is the same way that my daughters get picked up by my wife. What we're looking at is When we train movements and not just, hey, let's get on the leg extension machine, then all of the systems that need to upregulate, upregulate. It turns out, for example, a couple of my coaches just came back from China where they were working with the junior national Olympic team in China. The kids move meticulously. They move exactly like the way that we describe movement in the book here. It's exactly the same. These kids aren't really that strong, but their efficiency is so high that they don't have to be that strong at age 10 because their mechanics are rock solid. The wheels on their car are pointing straight.

Yeah.

What's interesting is that before every lifting session, the kids run a mile. There's that cardiorespiratory demand. Then it's high skill for years and years and years. At the end of every training session, the kids walk on each other. They're all responsible for their own tissue health, and that's part of this entire training experience that we have 10-year-olds standing on each other's quads and mashing each other out because they recognize that stiffness is a limitation to performance. We can take that concept and say stiffness is a limitation to your life performance.

Well, I think the notion that you're talking about in Deskbound has been picked up in terms of retail because we're now seeing stand-up desks really starting to proliferate. So I think there's a move on some progressive companies to begin to incorporate stand-up desks, or at least make— making that approach available to their workers.

And we have to, you know. I just was in Silicon Valley lecturing to 120 HR managers for big corporations, and I said, hey, how's it going? Are you spending more money or less money on healthcare and wellness? And they were like, oh, we're just dumping money down this tube and we haven't changed anything. You know, the number of sick days remains the same. The, you know, what's interesting now is that we really are on the nascent bubble of research looking at addressing the sedentary lifestyle. And some research is coming out that we see fewer lost user days, um, you know, that people are more productive. We use this little calculator with my wife, but it turns out that a 42-year-old woman who's about 135 pounds, if she stands at her workstation, she burns an additional 100,000 calories a year.

Wow.

You can imagine suddenly, even from an issue of addressing colds, that if I'm sitting and collapsed, I see poor diaphragm function, poor breathing function, which means that I'm not circulating the lymph around my thoracic cavity, right? We just— it's a simple biological mechanical system, and that when we put it into the right environment, it's remarkable how robust and resilient it is.

This is really very fascinating for me, and because, you know, our work has all been, again, the mismatch between diet as it relates to human health and disease resistance and physiology in general. And now, you know, we're looking at mechanics and You've done amazing work in your 3 books in bringing this information to light. I want to congratulate you, and I want to thank you for sharing this information with us. I hope you continue to do the work because we sure need to hear your message.

I appreciate that. One of the nice things about this piece, this message piece, it's the same thing we're seeing in performance nutrition. Which is eat food. Turns out food, real food, food that rots, food that isn't white, right? Food that your grandparents would recognize. That's the foundation for humans and human function. And now we're sophisticated enough to say, hey, you have a damaged MTFR gene, so we need to upregulate a little folate so we can turn the little wrenches a little bit, right? I don't, I don't process, I don't make enough vitamin D. I have to take a lot of vitamin D up here in Northern California. Yeah. I can tweak the knobs on that, but what we know is that the bottom line is, are you eating food? Did you have 6 to 8 fistfuls of vegetables today, Kelly? Yes or no? Because if you didn't, chances are you need some magnesium, or you could eat 6 to 8 fists of vegetables, right? When we look at the movement and this application of fitness as turning those little wrenches, but the bottom line is the equivalent of eating real foods again, right? Just managing, getting off the junk and expressing how humans are supposed to work is the same thing as So, what we're seeing is that everyone's working together, and we're all going to end up at the same place.

I think you touched upon something that is actually really valid, and that is, while, you know, we in medicine do like to utilize the approaches to what is called personalized medicine, looking at the genetic single nucleotide polymorphism uniqueness of every individual, you mentioned MTHFR. How we're subtly different in terms of our genetics and how subtle things like more folate or vitamin D or what have you might be important for each individual based upon their genetic evaluation. And yet the broad strokes of simply getting your butt out of the chair and being more active, eating a diet that has higher levels of fiber, lower carbohydrates, welcoming fat back to the table, these are the simple broad strokes that I can feel comfortable in terms of making generalized statements to people about, write books about, and lecture about. Again, you know, there are— everybody has their nuances that are required, their idiosyncrasies, but in general, we've got to get moving, we got to get eating right. I mean, I think that's the simplest way that I can put it.

I completely agree. And I think what people don't realize is that they don't feel as good as they could feel. They don't live the life physically, the self— the physical self-actualization that they're entitled to with very little input. Yes,

sir.

I think the human being, we always are trying to point positive and say, eat this way, not because you may or may not get cancer, diabetes, or all these other sequelae, right? Instead, eat this way, and guess what? You sleep better, you feel better, you look better naked. I mean, all aspects of your personal being, the clarity, the whole thing, energy goes up. And that's what we're trying to point is saying that, hey, look, you don't have to even exist. And you might feel great, but you might even be able to feel better. And that's, that's an important piece of this.

Wow. Well, listen, thank you so much for your time. This has been really very, very intriguing, very interesting, and most of all, very empowering, not just for me, but for our viewers as well. So I'm hoping we get a chance to run into each other soon.

Please, please, and thank you so much for all the work you do. I mean, really, it's so miraculous to look around and see really progressive people who come from a formal science background and yet really are in the trenches helping people solve the day-to-day problems of downregulation or dysfunction of the human. I really appreciate your work. Thank you.

Thank you. We'll talk soon. Well, that was really fascinating information, really eye-opening information, especially when you remember the, the, what Dr. Starrett talked about in terms of how much time people are typically spent sitting down. I'm even concerned about the fact that I'm sitting down to do this interview. Interesting information. Again, here is the book. It is called Deskbound: Standing Up to a Sitting World. It's an excellent read, wonderful images in terms of what you can do to change our very, very— your very, very sedentary lifestyle and pave the way for better health. Thanks for joining us. I'm Dr. David Perlmutter. Thank you.