Jordan Metzl, MD, on High-Performance Ways to Optimize Lifespan and Healthspan

Living a life in full is a conversation you always wanted to have with that person who gave an amazing TED Talk, or the author of one of your favorite books, or that inspirational Olympian you always wanted to know more about. It's graduate level conversations with those making a difference in the world and in the lives of others. This show brings you new ideas and approaches so that you can live a life in full. I'm your host, Dr. Chris Stout and I hope you enjoy this episode. This episode is sponsored by our new video course, how to Publish in the New Millennium. From Scientific Journals to Best Sellers, it's an asynchronous course offering so you can watch it when it's convenient for your schedule. It's based on eight video lessons and provides three hours of material with new concepts, stories and examples, and it includes several attempts at humor. You'll learn about the best ways to submit a manuscript to a peer reviewed journal, the mechanics of book contracting, what publishers are looking for, how to evaluate and negotiate a contract, royalties, advances, copyright and ownership, why to never first submit a manuscript to a publisher when you need an agent and when you don't, and the differences between publishers. You'll learn about ebooks, print on demand, Amazon's CreateSpace and KDP programs and other non traditional approaches to publishing, along with how to tell if a platform is of high quality or not. We do a deep dive into marketing, how to create media kits and what goes into them, along with examples how to create a great Amazon author page, how book signings work and how to be invited to do library talks and the economics of both, along with developing speaking engagements, promotional tours and being a podcast guest, as well as a number of other publicity aspects. We cover blogging and provide additional resources to help you in crafting your work and making it better. This is a rich, fun and fact filled course that covers everything you need to know from a practical and actionable perspective. It's for anyone wanting to get their written work into the world, be it academia, popular media, or both. Join the masterclass in Getting Published. To learn more, please visit tinyurl.com getting publishedcourse thanks. Welcome to another episode of Living Life in Full. I'm your host, Dr. Chris Stout. With a practice of more than 20,000 patients, Dr. Jordan Metzl is widely known for his passion for sports medicine and fitness. He received his MD from the University of Missouri, completed his residency at Tufts University, and completed fellowships at Vanderbilt University in Adult Sports Medicine and Harvard Medical School, Boston Children's Hospital in Adolescent Sports Medicine. His academic appointments are as an associate attending physician and associate attending pediatrician at the Hospital for Special Surgery, which in my opinion I think is one of the premier orthopedic surgery centers in the United States. In addition to his busy medical practices in New York City and Stamford, Connecticut, Dr. Metzl is the author of the best selling titles Running Strong, the Exercise Cure and the Athlete's Book of Home Remedies. He's also authored three other books including the Young Athlete and he serves as the medical columnist for Triathlete Magazine. He's a highly sought after teacher and fitness instructor. He lectures nationally and internationally to health organizations, fitness communities and in wellness venues on the topics of sports medicine, fitness and preventive health. He's been recognized in Castle Connolly's America's Top Doctors in the New York metro area since 2007, as well as being named one of New York Magazine's top doctors for over 15 years. His research interests include the treatment and prevention of running related injury, the effectiveness of preventive wellness programs, and the prevention of youth sport injury. Dr. Metzl appears regularly on media programs including the Today show, on radio including National Public Radio, and in print media including the New York Times, discussing the issues of fitness and health. In addition to his busy medical practice and academic interests, he practices what he preaches. He created Iron Strength Workout, a functional fitness program for improved performance and injury prevention that he teaches in fitness venues throughout the country. The workout is featured free online where it's been performed by more than 9 million athletes around the world and was also featured in the New York Times. He's a former collegiate soccer player and Dr. Metzl is a 33 time and maybe more by the time of this conversation. Marathon runner and a 12 time Ironman finisher so far. Hey Jordan, it's great to be connected.

Well, thank you so much Chris. Nice to hear you say such nice things and it's a pleasure to connect.

Awesome. Well, I guess we have one of your uber brothers to thank for this, Jamie. He's one of our rare two time guests on the show, so tip of the hat to him for connecting us.

Well no, he's a great guy and we try and always help each other in our family and I appreciate that he did that.

That's nice. Well, let's get into it as we spoke before off mic that there's so many things I want to discuss with you and get your opinion and perspective on, but maybe for context, let's start with your origin story about your life path and career as a sports medicine doctor and orthopedic doc.

Sure, sure. So I grew up in Kansas City, Missouri and one of the great places in our country and grew up in a family where my dad is now a retired pediatrician, my mother is a psychoanalyst and grew up in a very health oriented family of my three brothers. Three of the four of us are medical doctors and Jamie, who you know, will readily dispense medical advice on any subject if you ask him. So there's a of medicine going around in our household. And I was definitely from a young age interested in becoming a doctor. There are picture family pictures of kind of going to do rounds at the hospital with my dad with a kind of a small plastic doctor's bag. And I kind of always was enamored with the idea of helping other people. And I kind of knew from a young age that's kind of what I was destined to do. I didn't know exactly how, but I kind of eventually, over time, ended up as an English major and then into medical school and then into residency, initially in pediatrics because I liked kids a lot. But then I started gravitating towards the kids who were involved in sport. I felt like those issues around them and their families were particularly interesting and I could certainly relate to those. So I did eventually a fellowship in sports medicine and I did two, one in adult sports medicine and one in adolescent and pediatric sports medicine. Then I started a sports medicine practice at a place called Hospital for Special Surgery, which is the preeminent orthopedic hospital in the world, which I'm very honored to be at. Just started building a practice and over time that has evolved into kind of a whole life sports medicine practice where I take care of people from kind of 8 year old gymnasts to 85 year old people doing the marathon. The commonality, everybody, is that they all want to move and my job is to help them do that. The other interesting piece, I think is that along the way I was certainly very interested in sport and am interested in sport myself. I'm actually sitting here today getting ready to run the New York City half marathon tomorrow. So my legs are up and I'm drinking some water. And the figures you gave at the beginning, I have to update those.

Okay.

They're thankfully a little bit low, but still I'm doing events and races regularly. But my life outside of medicine was a lot involved in kind of sports and athletics and started running marathons in med school, actually triathlons in med school, marathons and residency.

Wow.

And have tried to do at least one or two marathons a year. Ever since then, which is, you know, a lot of them.

So what are your current stats? Update us. Let's get our data straight. So how many, how many marathons and how many triathlons I've done now?

37 marathons and 14 Ironman distance triathlons, but a bunch of other stuff too. But in any case, I had this kind of life of sport and life of medicine and they were two very separate things. So I had my medical life during the day, during the week, and then on evenings and weekends I would go out and do sport. And over time I noticed that the people in the sport world had some interesting injuries and injury patterns. For example, the runners, even though they spent much less time training than the triathletes, were hurt much more often. And I started thinking about my own self and I was doing both of those sports and I started basically realizing that A, the medicine of exercise was something that I could not only talk about for myself, but start prescribing to my patients. And B, I had some really, I think, individual experiences, both as a doctor and as an athlete around the ways I could help keep people active and healthy, including getting them to think about strength training as a big piece of what they do to keep themselves healthy. So long story short, my worlds of medicine and fitness started approximating each other and I started prescribing exercise to my patients. And then I ended up starting one of the first physician led fitness initiatives called Iron Strength, which is basically a community fitness program designed to teach people how to kind of strengthen their muscles and be active. And initially this started as a really kind of small concept in the basement of a gym. One of my patients was the general manager at one of the gyms here. And we started very small with about 20 people in a room. And that's now grown. We're now 11 years in and we have a listserv of more than 35,000 people that kind of get our information and sign up to do our classes both in person and online. We get different grants from different organizations. I've been super lucky to help to kind of put events on. We do usually two or three events every summer on the flight deck of the Intrepid, which is the aircraft carrier. We get over 1000 people to these events and it's just awesome to see how this has grown. It's all around the concept of promoting health. And so in my practice today, not only do I kind of fix people's needs, but I figure out strategies of how to keep them active and strong. And so I Kind of see my role now as both on the orthopedic and sports medicine side, fixing injuries and then on the kind of exercise side. How do I keep people active to do what they want to do and how do I encourage them to do more? So these two worlds have kind of slowly approximated each other. And then I've been lucky along the road, along the way to do a whole series of different writings and books and the like that complement those ideas. So it's been a slow, steady, but really rewarding trajectory that I look back on and I'm very happy with.

That's great. Do you feel like the combination of being an athlete and working with athletes from the sports medicine side informs, like the orthopedic aspects of your surgery or vice versa? Like you see a certain number of, you know, labial tears, or you see certain kinds of, you know, ACL repairs and think, hmm, what's, you know, what's. Is this the whole running thing? I mean, it also, it kind of reminds me of Christopher McDougall's Born to Run, that oftentimes, you know, people take a swim class to learn how to swim, but there's not a necessarily an elementary school running class that teaches people how to run. So a lot of us, myself included, you know, kind of have to learn that or have to be taught that different ways. How does that work as a surgeon and as a sports medicine doc?

So my focus actually, so my specialty of sports medicine and I come on the non operative side of sports medicine. So we have, in our sports medicine department, we have both operative and non operative. And I am on the non operative side, meaning my job. 95 plus percent of the injuries in sports medicine are non operative shin splints and knee pain and ankle sprains and broken wrists and all those kind of things that don't need surgery. So my role is first of all to take care of all those injuries. And then second of all, there's a lot of gray area in there. So, for example, meniscus tears, you know, the vast majority of meniscus tears don't need surgery. So I see a lot of people in my office where I try and essentially keep them out of surgery, unless they need surgery, in which case then I refer them to one of my colleagues that does the surgical side of stuff. So that's a very interesting perspective which is kind of interlaced through all of my books and writings in that trying to, for example, in Athlete's Book of Home Remedies, the first book I did, you know, there's a whole column of what's your injury, how do I take care of it at home, and then do I need surgery? And surprisingly many times the answer is no, unless the answer is yes. But my job, but my job is very much to try and figure out who are the nos, who are the yeses, and who are the in betweens, and how do I kind of manage each of these conditions, you know, appropriately. And there's a, there's just so much gray in there, especially with technology, because, you know, technology has really changed our, our ability to see things. So for example, MRI has been around about 50 years and you know, knees have been around for many millions of years. So are you telling me that meniscus tears weren't around 100 years ago, 200 years ago, 300 years ago, 5,000 years ago? They definitely were. And you know, they weren't treated surgically. They were generally not even fully appreciated. And by and large, people did fine. You may be surprised to know that the incidence of arthritis in people's knees is greater in the post industrial revolution and in the pre industrial revolution. So this whole kind of evolution towards technology and less activity may not necessarily be the best thing for us. But in any case, in my field, I'm very much about ways to try and keep people moving in the least invasive way possible. And the second part of your question, it definitely does influence how I, how I see the world, how I give information to people, how I think about optimizing people's movement patterns. I'm quite lucky. At hss, we have a whole kind of research lab where, for example, if I see you with running injury and I first figure out what the injury is and fix the injury. The second part of that discussion is how do we prevent that injury from happening in the first place? So what are the things we have to change? Do we have to shorten your stride to do you have to build your strength? Are you in the right shoes? Those kind of things. And I'm able to send somebody to our mechanics lab and let them look at that person, how they're moving, and figure out what modifications we can make to get them not only back on the road, but how do we keep them on the road. And so I think there's a lot in there around these things. And there's been so much great change. There's been also so much change which is, I would say, kind of profiteering on some of these issues. So trying to figure out the good stuff from the hype has been, you know, an ongoing issue I can imagine, you know.

Well, in your book Running Strong, the Sports Doctor's Complete Guide to Staying Healthy and Injury Free, you know, as I mentioned, you know, I. No one kind of taught me how to run. And when I was a kid, I had, like, just whopper orthopedic issues. And I was in these shoes that I called clodhoppers. You know, they were like, Until I was 12 years old, I mean, I never had a pair of capes. I never had a, you know, pair of tennis shoes or anything like that. And then like I said, you know, like McDougall's thing and people taking a look at the barefoot running craze, if you will, and looking at, you know, now hokas, which seems almost kind of like the anti, you know, zero drop kind of shoe, how does someone, you know, naive like me, but that enjoys running and doesn't enjoy getting hurt, you know, start to separate the wheat from the chaff or the snake oil from, you know, kind of what's. What's legit? Do they need to come get a consult from you? Do they get it from, you know, taking a look at running strong or what are some of the tips that you would offer from your experience?

Sure. So, first of all, I'm definitely starting from a place that I want everybody to move. People often ask me, what's the best form of exercise? What's the Holy Grail? And to me, the Holy Grail is something you will do day after day, week after week, month after month, year after year. So the Holy Grail of exercise is compliance. So if you're somebody that likes to run, then you're going to run. If you're somebody for whom running is akin to cod liver oil, then you're generally not going to run. Or if you do, you're going to be frowning, you're going to hate it, and you're going to quit. So the first thing I would tell you is if you love to run, I want to help you run. And I think everybody can run or walk. And I think it's certainly obviously very healthy for a number of reasons. But within that, there is definitely not a one size fits all in terms of, you know, what you can do. And I often think about, you know, if you line up 100 people who are training for a marathon, and, you know, I've been lucky enough to work in a study group here at HSS where we are looking at some of these issues, how do you figure out who's going to get hurt, who can do it, who can't do it. And what are some of the factors in that? So we have actually been doing a whole series of interesting studies looking at those types of issues. Things such as, you know, training programs, which seems to be among the biggest issues, and that people who try and load on miles too quickly, what we call the acute to chronic workload issue, they try and ramp up their mileage too quickly without building enough base. Those people tend to get hurt. Furthermore, foot mechanics, run mechanics. You asked about the shoes. When Born to Run came out, I was. My office was quite busy with people who either tried to do barefoot running or minimalist running in Central park, and they got hurt. And they were kind of wannabe, you know, folks from Born to Run, and they definitely were not. And so we had a lot of those. And similarly, these very cushioned shoes have a host of issues as well. Sometimes cushioned shoes are fine, but if you're mechanically challenged, if your foot rolls into the middle too much, if your hip drops in, you know, that cushion is actually working against you. It's like walking on the road versus walking in the sand. And if you have a mechanical issue, meaning your foot rolls in too much, oftentimes when you step on that sand, that that extra roll is accentuated and you end up rolling more. And so, you know, what I would tell people is that there's not a perfect answer. It's dependent upon you, your body, your mechanics of your body, your stride, your strength, what distances you're doing. So, for example, if you run in a certain kind of shoe and you're not having any problems and you like it, God love you, that's all I need to know. But if you're coming in to see me because you've had Achilles problems or knee problems or shin problems or hip problems, those kind of things, we start to look at not only the injury, but why it happened. And oftentimes, shoe wear is one of the common things that we can kind of look at and modify to try and fix that.

Yeah, I, you know, I. I kind of have nerded out. You get into your favorite shoe, so to speak, and then, you know, then whatever company stops making it or, you know, something happens. But then I've kind of come maybe with a little maturity and a little less hubris to saying, okay, these are the kinds of shoes I'm going to run when I'm on a trail. And those are not the same shoes when I'm going to be, you know, on a trip and pounding around, you know, on. On asphalt or on, you know, city sidewalks. Or something. It's just those little kinds of tweaks. And I found just in terms of efficiency and things too, like, you know, hill repeats and, you know, just kind of like having the, just like you'd have the proper gear, proper kit for, you know, bicycling if you're mountain biking versus if you're road racing, you know, you need to kind of tweak and do that. And I don't know, you know, why, for me at least, you know, it took me kind of so long to kind of get that insight that, like you said, you know, one size and one situation does not fit all. So I love what you said about, you know, what, what works best is the one that you enjoy and that you, that you keep up at it. And that makes me think about one of your other books, the Exercise Cure. And in it you just give a great portrayal of and you do it kind of a little tongue in cheek of. There's this miracle drug, this miracle thing that can reduce the progression or reverse type 2 diabetes. It can help with weight control and cardiac issues and hypertension and emotion and sleep, improving sleep. And the silver bullet is exercise. So how is it that, like with your program, iron strength and stuff, how is it that. What are the baby steps or the things. Does someone have to have a health issue? Do they need to get diagnosed with hypertension or some kind of ailment first? Is that the motivator or what are good ways, maybe from almost like a sports psychology kind of way to get people into properly dosing and finding the proper kind of exercise cure for them?

Well, Chris, it's interesting. We, you know, in Exercise Cure, I make the argument that if you were going to take a drug that worked for every single person who took it, young or old, rich or poor, anywhere around the world, it worked for every single patient who took this drug. It was 100% effective across the entirety of health. So neurologic issues, sleep, depression, anxiety, sleep issues, cardiac issues such as high blood pressure, hyperlipidemia, high lipids, endocrinologic issues like diabetes type 2, particularly among others. But really, every single body system, it was 100% effective. The more you took of this drug, generally, the better you did. There was almost no possibility you could overdose on this drug unless very, very rare instances. And it was 100% safe. People were like, dude, I need that drug, right? And so that is the concept of exercise. We actually looked at starting, which is now in its probably seventh or eighth year, a seminar at Cornell for the med school called Prescribing the medicine of exercise. And this seminar was basically a seminar to teach medical students to prescribe exercise to their patients when they became, you know, practicing physicians. And so we started hunting around for a curriculum in which to put this seminar on with. And there was really no standard curriculum. It didn't exist. And people have said, like, yeah, it's good to teach your patients about exercise, but the truth of the matter is, if you go see your doctor and you say, I want to exercise, and say, all right, great. 30 minutes a day, which is the American College of Sports Medicine recommendation, and you're like, yeah, well, I have arthritic knees. What should I do? Or I have hypertension, what should I do? Or I have diabetes, what should I do? Or I'm 80 years old. What should I do? Or I want to play soccer in college. What should I do? And it's immediately apparent that we're doing a terrible job teaching our physicians of the future how to think about preventive health. I like to talk about the fact that the CDC has done a study in the early 2000s looking at the factors that affect health. And of those, about 20% are genetic, 20% are interacting with the healthcare system, and roughly 60% are related to lifestyle, sleep, exercise, diet. And yet we spend almost no effort in our medical education thinking about that 60%, or teaching people how to talk to their patients or think about that. So, you know, all those things lead me to tell you that I think the medicine of exercise is so hugely impactful for people and that I think as a medical community, we don't do a great job teaching people how to prescribe that to their patients. And, you know, I think especially in the past couple years, I think we've noticed such a huge disparity in the people who are active and healthy versus the people who are inactive and unhealthy when exposed to something like Covid.

Yeah, yeah, yeah. Really huge differences. I mean, it was just, you know, headline kinds of things. So for the aspect of health and wellness, is the flip side of that from of exercise, then diet and nutrition or how do those things interact with each other?

It is. And if you don't mind, I'd love to pick up that comment just for a second on the. On the COVID issue, because I think it really does tie into this, if that's okay.

Absolutely.

There was an interesting study that was done at the beginning of the pandemic. If you are part of the Kaiser Healthcare system in California, you are in a closed medical system where basically you're a patient in that system. And so all of the care you get is within that system, meaning you see Kaiser primary care doctors, you see Kaiser neurologists or orthopedic surgeons or whatever, but it's all inside that system. So the, the benefit of that is it's a closed data system where you basically can collect data on patients across a number of conditions. One of the things they do there is, in addition to height, weight, blood pressure, respiratory rate, pulse, when they start to see their patients for their annual checkups, they have something around an activity index score where they get an idea of how active their patients are throughout the year. And that's a recorded score that they put into their chart along with these other metrics. Then when Covid happened, they basically looked, and this is before the vaccine was available, they looked at how patients did in terms of hospitalization, death with COVID how sick they got if they required hospitalization and if they died. And they then compared that to their activity index from the two years prior to their diagnosis. So if they were diagnosed with COVID they looked then for the two years preceding to see how active they were. And they had almost 45,000 patients. So a massive number of patients that they looked at in that study. And there was a statistically significant difference with illness, hospitalization, and death in the people who had a higher index of activity compared to the ones who didn't.

Wow.

So I found that to be incredibly powerful information and incredibly powerful information that I think, quite frankly, we don't do a good enough job talking about, because I think a lot of the discussion has been around appropriately, vaccines and masks and all those super important things for communal wellness. But I think for individual wellness, you know, thinking about taking care of your own preventive health and preventive wellness has just, I think, in the last several years, become increasingly something which is a topic we need to kind of think about, talk about. And it's almost like you can't talk about that. Like, we want health to be something we outsource to everybody else and we don't take enough personal responsibility for. And so, you know, it's helped me kind of focus some of these thoughts, which I think are, you know, it's not to say people who are active can't get disease. Right. It's not to say that we didn't have active, healthy people get cancer or Covid or whatever and have, you know, really terrible outcomes, even though they were doing everything right. So it's not to say that, but it's. It's to say that on a population based basis, when you start looking at trends of, you know, disease expression in all different types of diseases, you know, this idea of preventive wellness is incredibly compelling and makes a big difference. And I feel like we don't do a good enough job teaching that, talking about it, or teaching people how to do it. And I think this past couple years has really, you know, I hope one of the lessons that comes out of that is that it's very important to start thinking about that, you know, for yourselves individually, because we don't really encourage that, nor do we. I think. I would love to see us start thinking about incentivizing wellness. People respond to. Think about a kindergartner that wants to come home with a report, they want a gold star to put on the fridge. And so we have to start thinking about how we get gold stars for people for doing the kind of behaviors we want them to do rather than just paying for their diseases after they happen, which is much more expensive.

Right? Yeah, that's such a good point. I think the issue of kind of proper incentives, you see a lot of tech and apps and even some third party payers starting to kind of experiment with that in wellness. I think one of the issues historically had been that, you know, most of us get our health care insurance by virtue of our employer and our employer wants to have healthy employees, but also wants to, you know, keep an eye on the bottom line and what healthcare costs are. And then oftentimes it becomes, you know, all these mutations of healthcare insurance with HMOs and PPOs and TPAs and all these other kinds of intermediaries where you get that disconnection between the provider and the patient and then you amplify that out with, you know, health and exercise. Well, who's, you know, there are, I think, some innovative wellness programs that, you know, do incentivize their employees, you know, to take walks or to take breaks or to take vacations and the whole psychological, physical aspects of those things as well. But it is a tough thing to kind of get the traction to it. But I hope that message, you know, of what an incredible real world study, you know, doesn't get lost over time. Because you're right, the individual aspect of it versus the public health, infectious disease aspect of it, you know, are not two separate kinds of things.

Yeah. And I think that I'm kind of curious to hear your thoughts on this, but I feel like we don't do a good enough job thinking about how we, how we transmit that information and it's almost like people feel like. I was listening to the excerpts of the State of the Union, and in one of the comments, the president talked about diabetes and lowering the cost of insulin. He was talking about a type 1 diabetic who. There's nothing you can do. If you are type 1 diabetic. You've had it since that's in your genetics, and there's nothing you can do. That's about 5% of diabetics in the United States. 95% of diabetics are type 2 diabetics. And type 2 diabetes is not entirely, but largely preventable and treatable with lifestyle and a diet, exercise, et cetera. It's related to being overweight and not being active. Largely. Not all, but largely. There's a genetic component to it as well, but certainly largely. And so I tweeted out how it's great that we're talking about lowering the cost of insulin, but we should start thinking about incentivizing behaviors so people don't get diabetes in the first place. Yeah, type 2 diabetes in the first place.

Yeah.

Because that's where we spend the most of our money. And you would have thought that, you know, I insulted everybody's mother.

I was gonna say, you're taking a chance there on Twitter, man.

How dare you say that? People, you know, people are victims or whatever. And it's like, no, you have to be account. So I feel like the whole idea of accountability across society in general, but definitely with respect to health, I feel like there's really something in there around getting. Encouraging people to be accountable for their own health and health behaviors, decisions, and rewarding people who are doing it the right way. And I think that we have to start thinking about that, because what we're doing on the flip side is, you know, we spend more than $3 trillion a year, more than any country in the Western world by far, on health care. But what we're really doing is we're paying for these diseases, which are largely preventable through lifestyle medicine. And so that's everything from the foods people eat to, you know, the ways they. The ways they move or don't move. And the problem is these problems are just getting worse because it's easier to do everything from your, you know, work from home, order food from home, socialize from home. And I think the pandemic has been very challenging for those kind of things because people are not encouraged to move as much as they should be.

Yeah, that really is a good point. I just was reading in this last week's Wall Street Journal. There was an article about, gosh, I forget what town it was, but that the mayor was really kind of concerned because there was, I think they were giving city employees three or four days a week that they could work away. And there was a concern that if those people were coming down to their office in this governmental building that, you know, that, that supported a variety of other kinds of ancillary, you know, augmenting businesses. You know, there's the, the dry cleaners and the, the, the bus and the, the restaurants and the places people would go for lunch and these kinds of, you know, knock on effects. I hadn't even really thought about that in the context of, you know, working remotely. But how about like, do you have thoughts? And this is kind of a tricky one for me at least, like with. We had done some, some colleagues back at the College of Medicine at University of Illinois in Chicago looked at food deserts and how in a lot of impoverished areas where they're, you know, people aren't working period, because of a variety of, you know, reasons that are not, you know, self inflicted, but even, you know, like the, the nearest place they couldn't get fresh, fresh vegetables, the nearest place where they typically got their food was a, you know, a 711 or something which was all, you know, just prepackaged and processed any nutrition out of it, just about eat the bag as well as eat what was inside of it. Do you have thoughts about that for people that do want to be on less medication and try and take those initial formative foundational steps to try and combat those kinds of issues, or is that just a political social issue?

No, I think it's both and I appreciate asking that. I mean, listen, these are complicated issues that have developed over decades. And the problem that we're running into is that the disparity between those who have and those who don't have has grown over decades. But I don't think we have to take that lying down. So, for example, looking at things such as on government assistant food programs, what are the things you can buy with those types of things, you know, right now I think you're totally right that in areas where there is less money, there are less food options. And that's absolutely true. But it's also true that if you go into a 711 or wherever with federal assisted food vouchers, you can buy, you know, whatever you want. So you can get potato chips or Coke or whatever. And you know, and so. But if there were a category of food you could only get with those vouchers, then you would see those products showing up in places.

That's a good point. Yeah. That's.

Yeah.

Supply and demand of the market. That's really.

You better believe it.

Yeah. Yeah.

So I think that those. Those are some of the kinds of things that we could start thinking about. It's not popular to say that, but I feel like the flip side is what we're doing now, which is just throwing money at disease.

Yeah. And.

And that's just getting more and more expensive, and there's more and more disease. And I think Covid really helped highlight some of that stuff. As you saw a number of these areas where people have more health problems. Those people got a lot sicker. They were sicker, they got hospitalized, they died at higher rates. And so the question now is not, did that happen? The question is, what can we do to try and deal with that? And so I think throwing money at the problem is not the issue. I think. To me, I think it's starting to think about how we reshape that discussion. So we think about preventive health in a way. But again, it's difficult because everybody's very sensitive to choice in everything we do. You can't tell me to take the vaccine. You can't tell me what to eat. You can't tell me whatever. And so if you take the vaccine, you'll be less ill, and you're less likely to get other people ill. Yep. You can't tell me what to do. If you eat these foods and not those foods, you're less likely to, you know, to be overweight and get ill and whatever. Yeah. You can't tell me what to eat. So, you know, I think I don't want to be living with Big Brother, but I think there's something in there around helping people make the right decisions when we are. Because if. I guess the way I think about it is if, you know, we can either kind of pay for prevention or we can pay for disease, and disease is much more expensive.

Right. You know, and I can't quote them off the top of my head, but I know they're just ridiculous. But, like, the amount of money spent in medical intervention, you know, like in the last five years of a person's life versus, you know, the. The course of it, you know, all things considered, you know, unless someone has some kind of chronic disease that they've suffered with for decades, but, you know, it's just. Just astronomical and just unbelievable. So. And it's, you know, it's those kinds of things. You don't. You don't refuse treatment to that person, say, well, you know, Mr. Smith, you really should have taken better care of yourself. And because you didn't, we're not going to, you know, do this or that. So I think it makes it really kind of a challenge. And I don't know, I mean, you know, we hear about blue zones and stuff and lifestyle areas where longevity is greater. And I think one of the things I want to just kind of say out loud with you in this kind of a conversation too is that it's also quality of life. I mean, we can, we can, we can extend people's life, you know, to a certain degree, but man, if they're not ambulatory, if the quality of life is such that, you know, that they, I've worked clinically with a lot of folks that were aged and you know, were not happy and you know, wish they hadn't lived that long, you know, and they weren't necessarily, you know, they. How can I say this? They, the, their inability to do what they did in their youth because now they had these chronic diseases that kind of caught up with them because of hypertension or because of being on 12 different meds and these meds interact with the other and cause them to have to take another med. You know, it just, it really kind of boxcars and catches up with people to have a very poor quality of life in those, you know, the last years of their life, which I think is just, you know, hugely sad.

Yeah, I mean, I think that that's, you know, it's, it's a complicated issue. But you know, I think the concept of exercise cure was, I was talking about both adding, you know, life to your years and years to your life.

Yeah, yeah, yeah.

And I think they're both important, you know, the so called kind of lifespan and health span. How long you're healthy and how long you live for are both important. And I think we can do a good job of improving both on a societal level. Now the issue is that, you know, as I mentioned before, you can do everything right and still end up with a disease through bad luck or genetics or whatever. But I think our thought is, on average, what are the best things we can do for people? And that's where I think some of this discussion happens.

Yeah, absolutely. Well, let's maybe do a little bit of a deeper dive into the diet, nutrition stuff. I mean, you see a lot of that at least, you know, and I see a lot of it. Maybe it's a biased sample, but you know, there's, there's A variety of different kinds of diets out there that probably seem a bit faddish. And it's probably the issue of diet is similar to the issue of exercise. You know what, what's the best diet? It's the one that you can, you know, stick with and that has good efficacy. But like I experiment with time restricted eating. Like I use this thing, this Zero app. I don't know if you've ever heard about that. But I also then like, I tend to supplement with like magnesium and zinc because I tend to get dehydrated and cramp up a lot. I spend a lot of time in saunas and in the wintertime I try to boost my vitamin D. And I'm a big fan of inulin and probiotics and things like that. Do you have thoughts or feelings about some areas where there is maybe broader population data that says these are generally good things? And it might be fattish now because it's popular, but it is a good long term kind of approach to tweak your diet a little bit or pay attention to these kinds of things or try and minimize processed foods or what. What are your thoughts around that?

Yeah, all the above. I mean, I think so. So I guess I would first tell you that I am not an absolutist in anything that I do. So there are some people who can say, all right, I'm going to cut out carbs out of my diet and they can go carb free in their diet or I'm going to only eat in this window and that's just how I'm going to do it. Or I'm going to have no sugar and that's what I'm going to do. And maybe it's because I don't have the personality to do that. Maybe it's because I've not been, you know, I feel like there's an effect and then there's, there's a cause of the effect you've done. And I feel like you can get a rebound phenomena to any number of these issues. So I'm not an absolutist and I'm definitely some of everything. A little bit of meat, a little bit of red meat, you know, a little bit of carbs, you know, a little bit of sugar. I'm not an absolutist in any way. I think the things that we are learning more about are that first of all, this kind of pre processed diet is obviously unhealthy. I tell my patients that if it's not going to expire for three years you should not eat it generally.

You know, I heard someone say that if you read the ingredients and your great grandmother wouldn't recognize some of the words, you shouldn't eat it. So I thought that was also a good rule of thumb around kind of what is. Exactly.

Yeah, yeah, exactly. So I think that's number one. Number two is that I do think that certainly for some weight control practices and, you know, I think it's important to mention that people's metabolism changes as they age. Everybody has a different metabolism based on, you know, their age, their genetics, what they've done when they were younger, all those types of. Of things. So you may find this equation changes for you over time based on what you're doing, you know, where you are in life, etc. But that the concept of eating windows, I think, is gaining some traction. I remember there was a picture early on in the research on restricted eating on the front of the New York Times, and they had two monkeys on the front of the New York Times. I remember this. But one monkey had been kind of eating a normal, regular, scheduled diet. And one monkey was on a restrictive eating pattern. And it was some of the early work done on longevity. And looking at these two, I think they're monkeys or chimps, and looking at basically the effect of several years of eating behavior on these animals who started out looking the same. And so I have one of my good friends is an orthopedic surgeon, hilarious guy. And I sent him the picture of these two monkeys and one monkey looking at his kind of his blood pressure and all of his blood values. It turns out the guy who'd been doing restrictive eating was generally healthier in his blood metrics and in his blood pressure, et cetera. And I sent him the picture, and I don't mean to use a bad word, but this guy had a colorful bad word and he didn't know which one was. She said, look at that miserable monkey who is the restricted one. Look at that poor guy, man.

Yeah, I remember, like, talking about, like, under eating, and it said it increases longevity and says, well, it doesn't really increase it. It just seems like you're living longer because you're so, so miserable.

So I remember thinking that was pretty damn great response, you know, since then, I think, I think this idea of eating windows. By the way, he is now, this guy I'm talking about is now a eating window guy. He's lost a bunch of weight and he looks awesome. So he's kind of like the miserable monkey now. Right. But he looks good but he looks good doing it. Exactly. But this concept of eating windows, I think from a metabolic point of view makes sense if that's something you are looking to do. So we talk about this a lot and I tell him, like, listen, you get up, you have a meeting, you do whatever, you know, I get up and the first thing you know, I get up at 5:30 and I'm out the door to try and go do my workout before the day starts to try and turn my metabolic clock and my metabolic furnace on for the day. And so, you know, for me I need calories to burn unless I'm trying to, you know, lose weight for a thing or you know, a triathlon or something. But I do think this concept of eating windows metabolically makes the most sense of anything.

Okay, all right.

If that's something you're doing, how do you do it? What's your window?

I do a 18 6. And for me it, it's, it's, it's interesting because my, my wife tried it for about two weeks and she like always we both exercise in the morning, but she has classes she goes to, she, you know, loves the Y classes and stuff. So that gets her up and out and going. And then I kind of, you know, of course dilly dally and you know, we have a little more coffee and then need to check the email one more time or whatever. And then, you know, finally get to my routine, whatever it is that day. And I never ate breakfast. I always kind of woke up as a kid with a little anxiety about going to school and never, never had breakfast. And the, it's just, it's like I, and then I don't, for me with most of my exercise, like I don't like to eat and then go for a run. So it's easy to. Then, you know, okay, I've dilly dally now and now I'm finally getting out to my run and then when I get back it's sort of like I'm not real hungry because I just ran. So it just sort of organically for me makes it really pretty easy. And if, you know, you think about like most people, if you sleep eight hours and if you didn't eat an hour before and an hour after, there's 10 hours of fasting just by not doing much of anything other than just having a nice eight hours of sleep and not eating immediately before bed or you know, hopping out of bed and eating. So, so that's kind of worked for me. I worked up to that. Periodically I try and have maybe for no reason other than just being a nerd. Like maybe fast 124 hour period twice a month. And I don't, I don't hold religiously to that. I don't have really any good reason for that other than just some days it's like I'm busy or I'm doing a couple of other more, honestly more physical kinds of things. So it's like I just kind of, of lose the appetite. But yeah, it's, it's been, it's been helpful for me. I, you know, my last name is Stout. I used to be very obese, so as a boy, because I couldn't run. So I'm very sensitive about, you know, not having my weight creep back up and being very, you know, concerned with that. But I don't really, I don't get the jitters. So again, my wife tried it, she got shaky, she felt uncomfortable. And, you know, she needs to kind of be like you kind of fuel the furnace a little bit and then, you know, go, go do whatever it is that, you know, she's working on that day. So. But yeah, and that, that speaks to your point, Jordan. Like the, you know, to each his own. You know, what, what works for you is what you should kind of keep doing. You know, if I did this and gained weight, I'd be like, well, this is kind of dumb. This isn't working, or I need to do something else, depending upon what my goal was. So. Well, let, let's, let's talk about this. Kind of maybe is a decent segue into nature, nurture. And, and maybe I'm just channeling your brother here, but with genetics again, being kind of nerdy around this stuff, I had my 23andMe stuff done. And one of the results was saying that because of my genetic circumstance that I was more suited to be a sprinter rather than a distance runner. And this is like after I've done not nearly as many marathons as you, but a few ultras, and it's like, oh, no wonder this sucked so much. But it's sort of interesting. Like, you know, are there epigenetic Gattaca kinds of aspects to these kinds of things? Or should someone, you know, just, hey, right off the bat, I need to get my genetic stuff done and then, you know, tweak my diet, tweak my exercise, recalibrate my expectations, or is it, you know, nature be damned and if I want to go run for long distances in the woods, I'll go do that. Or do you have, do you have any thoughts or advice to like, a patient that would come to you with that kind of a question.

Yeah. So I had these discussions with different people in my world in different ways. And I guess I would start by telling you that it's not uncommon that. That I see a teenage ballet dancer. And in New York, we have a number of kind of elite level ballet schools. And so we have these kids that want to be ballerinas often. And, you know, there's kind of a pyramid system in the ballet world where you start, everybody starts at the lowest level, and then as the levels go up, it's essentially kind of Lord of the Flies meets ballet, and they kind of get picked off along the way. And so the part of that discussion happens around, you know, the body you have and is it suited to be a classical ballerina and that, you know, that is everything from what you look like to your. Your joint mobility to your strength, your flexibility. When people. When kids go up on point about age 11 or 12, there's another kind of breakout period. And then it gets to the point where your kind of natural turnout, how much your hips turn out, how much rotation you have between your femur and your acetabulum, and that's different for every single person. The ball and socket joints different for every single person. And so, you know, some of these kids just do not have the natural turnout. And so they end up trying to force the turnout by pushing their foot on the floor and turning their hip out. They often come in with achy knees saying that my knees hurt. And what they're trying to do is force their turnout from the floor instead of from their hip. And they end up ultimately, you know, being kind of weaned out into other. Other sport. But the discussion I will sometimes have with people as young, young teens is, listen, I know you love ballet, and I don't want you to become frustrated, but the way your hips are built, you're never going to get to the level that you want to get to. So we have to think about either channeling this into another activity, such as kind of diving or whatever, or recognizing that I don't want you to keep pushing yourself till you kind of get hurt or get frustrated, that I want you to be doing things that you love, doing activity for your life. And so if you get frustrated around this too early, you know it's going to be a problem. And, you know, ultimately, it may not sink in. The first discussion, the second discussion, it's interesting because as a sports medicine doctor, my hope is to encourage every one of my patients to meet every one of their goals. And so it's always hard to say, listen, your goal isn't totally possible based on, you know, the fact. Your nature. But it's important, too, because otherwise they just keep doing it and they keep getting frustrated, they keep getting hurt. And so there's that piece. However, in the recreational world, you know, people that want to, you know, run marathons or do ultra marathons that are built for sprinting, genetics, you know, I take all that stuff with a big grain of salt. But I kind of think at this point, we're very much in the TMI era of data that, you know, you can figure out what's your VO2 max and how much your maximum sleep should be and what your optimal cadence is. And you're like, all right. God, getting all this stuff. What's my continuous glucose monitoring? Yeah, it's great. Yeah. But what the hell am I going to do with that? So I feel like there's almost too much information in some ways.

Yeah.

And again, I guess it gets back to being somewhat of a minimalist. I would say to people, what do you love doing? And it doesn't matter to me if you're first or last or any place in between. What do you love doing? Number one. And are you getting injured doing that thing? Is it causing problems? Are you coming in to see me with, you know, stress fractures or, you know, whatever. If that's the case, then we have to rethink. If it's not and you're not looking to, you know, win a gold medal in the Olympics, then I think just do what you love doing. Because I do think we're in this realm where the information. There's all these companies convincing you, well, you know, Olympic athletes get this information, so you should have it, too.

Yeah.

Like, yeah, what the hell are you gonna do with that information?

That's good. Well, it's interesting, too, because. Thank you for that, by the way. That's. That is very helpful. And I. It's sort of like, you know, I never had any illusions that I would win an ultramarathon, but it's just sort of like, that wouldn't necessarily kill me. Yeah. So. But. So let's segue into this area then. And you have great expertise from both the professional and the personal around the aspects of marathons and stuff. And I'm old enough to remember that someone completing a marathon was like an, oh, my gosh. You did what kind of thing? Or finishing an Ironman distance triathlon or whatever. It's like, oh, my God, it's sort of like that was just like a big bucket list kind of thing. Maybe not so much for triathlons because it seems like whoever does triathlons really kind of kind of keeps up doing triathlons, but maybe sometimes marathons because people weren't necessarily that kind of a distance. It's a big commitment to both of our big commitments to training, etc. But anyway, it just seemed like to me in my little world that, you know, that was kind of like a lot of people were one and done, you know, I'm not going to ever do that again. Best part of running, stopping, blah, blah, blah. But now you see like there's tons of ultra distance runs, there's Spartan races, so you can, you know, run under barbed wire and do other crazy stuff. There's Ultramans, there's, you know, all these kinds of things. Like first I have a couple questions about that, but what, what do you think of that? I mean, is that just from a sociological perspective, not just a medical or physiological perspective, but what, why is that? Is it just human nature and competition or what, what are, what are your perspectives?

So, so people have looked at. And by full disclosure, the next book I'm working on is a book on motivation. What motivates people to do and how do we think about the doers versus the not doers?

Okay, good.

We're still a couple years out, probably.

All right, well, we'll get some fundamental thoughts out here.

Yeah, exactly. But what motivates people to do. And so I think the main things that you've seen, and especially in the past couple years, you've seen this when people didn't have access to it are, you know, do I belong to a tribe? What does my tribe do? The import of community. Right. The importance of community as part of that. So, you know, there's been some, even on social media, there's been some big studies around looking at your quote unquote friends on things like Strava and how your friend's behavior influences your behavior to do more and different things. And so the tribe you keep, the community you keep what that community does, who you surround yourself with virtually or in person, you know, so when you do an ironman, which for people who may not know, which is a 2.4 mile swim, 112 mile bike ride and then a full marathon at the end, which takes about 12 hours to do

or something around there, three weeks for me.

So no, no, that's fine. But when you do that, when you do that, it's completely Normal. So it's completely normal to do these all day exercise training for it. It's completely normal to basically Nair your entire body and get rid of body hair, like armpit hair, chest hair, leg hair. It's completely normal to eat these massive meals and walk around in spandex shorts and whatever else. And then you, you go to do one of these races and everybody around you is in that same world and it's completely normal. And then you go and you finish and you go to the gas station on the way home and everyone looks at you like, dude, those guys are freaks. And we're like, no, you're freaks.

That is a great observation, that.

But it's, it's, but again, it's a lot around the community you're in and what, that, what's the norm for that community. And so I think that things like spartan races, there are communities of people that go do spartan races or they want to go through the shock tank and the cold water plunge or climb under barbed wire or you know, like get electrocuted by an eel. But there's a lot in there that is, you know, I think around this kind of normalizing, much like in marathons were like, everybody does a marathon, you know, that's what you do. And it's part lifestyle, it's part community. And my general feeling is anything is awesome unless you're getting hurt a lot. And then I think we have to rethink.

Gotcha. Well, this makes maybe a good segue into some of the other things I want to kind of start to discuss with you and get close to wrapping up. But in the aspects of all these kinds of things, let's now shift and have the mindset of people that are well and fit and now kind of want to ratchet up that the performance aspect of it and then also mitigate risk and the risk of injury. So, you know, I'm a big fan of like recovery. And you've also already talked about prevention. But then you see these guys like the Iron Cowboy or Dean Carnese doing these super ultras, like every day, you know, a triathlon every day, a marathon every day or whatever, every day kind of thing. But with in some sense like no recovery. I mean, yeah, they sleep or yeah, they stopped doing whatever it was they were doing for 10 hours earlier that day. But does it cause you, as a physician, as a scientist, as an athlete to think any differently about recovery or injury prevention? Or are these guys just superhuman? Or how do you sort all that out?

Well, I guess I have a couple Comments on that. First of all, I will tell you that in the world of stuff, sports medicine, the first thing we kind of learned a lot about was injuries. Who got what injury, how that injury pattern happened. So if you were a skier, you were likely to get this injury. If you were a baseball player, likely to get that injury. So we learned a lot about injuries, and we learned about injury patterns. And so the beginning field of sports medicine was a lot around identifying injury patterns. And then as a natural outgrowth of that, we started thinking about prevention strategies to prevent those injuries. So, you know, getting the right kind of ski binding torque or throwing the right number of baseballs, or throwing or throwing mechanics or running mechanics or the right kind of running shoes, thinking about for each sport, how we not only recognize the pattern, but how we prevent that pattern from happening, how we break that pattern to keep people doing their sport. We then got into the fields of preventive training, preventive conditioning, performance enhancement around those things. And I think that was probably the next domain. And to me, the wild west, where we are now the last frontier of sports medicine, is around recovery. And we have no idea yet really what makes good recovery, what makes some people recover better than others. What are the best ways to think about recovery? Is it icing? Is it heat? Is it compression? Is it, you know, vibration tools like these massage guns? I use all those things in my practice, but can I tell you, scientifically, this works better than that? Not particularly. I kind of do. I. I generally put some of that stuff into the category of can't hurt medicine, meaning I think, probably help you and I'm definitely not going to hurt you, and it's worth trying. But this kind of concept of recovery is very interesting. We do know that, you know, certain bodies recover quicker than others. Age has a role in that, definitely, as does your body type, if you're in the right sport for what you're. But that also, I would tell you that the human body is an amazing machine and it's probably more capable of doing things than you think it is. And so I think that's a piece of that as well.

Gotcha. That's great answer. Yeah, I mean, it's just. It's sort of like, you're really making me feel dumb, Jordan, because it's sort of like I wrestle with these things and you say it's like, well, yeah, yeah, that makes good sense.

You're thinking about a lot of other things. All day I'm just thinking about. Oh, thanks. Good save.

So one of your other books is that I Enjoyed a great deal is the workout prescription. And in it you talk about like 10 and 20 and 30 minute high intensity interval training workouts and things. And I know that again the faddish kinds of stuff, I mean this is, I think these are good things because it gets, you know, pick your poison, you know, what it was, what, what do you dig, what do you like, what do you want to play with and try and keep or try and not do, but like, you know, high intensity interval training hiit stuff, you know, CrossFit or kettlebells or there's, you know, people do stuff with maces and ropes. I was a decade ago like real into, you know, Tony Horton and P90X and P90 and all that. I did a hundred ton challenge a few years ago. There's the may is kind of the time that CrossFit does the MRF. Now people are like looking at, focusing just on like having fast miles again. I, I guess you're gonna probably say like whatever, you know, works and, and fits with you. But are there any of those in particular that are helpful in the context of your workout prescription? Maybe in terms of efficiency minimizing injury? You know, I used to work at ATI physical therapy and there was kind of a, you know, a dark joke about, you know, CrossFit is, you know, very good for physical therapy because it, you know, it incentivize, you know, a lot of folks come in with injuries as a result of, you know, trying to do something healthy and good. So how do you again, physiologically, sociologically, biomechanically think about that?

Yeah, so the idea of workout prescription was to teach people to embrace intensity. I'm actually doing a whole lecture at a sports medicine conference out in Colorado in a couple months on exercise intensity. And the message is I want people not to be afraid of intensity for themselves and for their patients. There is certainly a self selected group that ends up in the crossfits of the world. But in general, exercise intensity is tremendously efficient. Not only for the efficacy of your workout but for, you know, it shortens your time. Yeah, it improves the function, it improves the outcome. You basically get more for less out of intensity several times a week. I really want people to think about intensity, but that's something that you need to start, you know, thinking about in conjunction. Hopefully doctors who know something about exercise can help you think about what's the right kind of intensity for me, how do I do that? How do I, how do I measure my own intensity? How do I measure my own intensity level? You know, I think there's some really interesting stuff in that concept around exercise intensity. But you know, these days, you know, if you go to orange theory or CrossFit or, you know, a number of these workout classes, you know, I remember when Exercise Prescription came out, there were not nearly the number of avenues to start thinking about exercise intensity as there are now. And so I think for the vast majority of people it's terrific. Again, much like my ballet story, there probably is a self selected group that incurred that likes to think about intensity. But I think people shouldn't be afraid of intensity and that exercise intensity is everybody, is something everybody could and should embrace I think, you know, throughout their entirety of their lives. I have people in their 60s and 70s and their 80s that come to my workout classes I teach in Central park once a month that are free and they come out and they do burpees in their 70s and 80s. Pretty awesome. So I hate burpees. No, everybody hates burgers.

Yeah, they were, that's the point. Yeah. So like, is this then like in the concepts of like the different zone trainings, like 1, 2, 3, 4, 5 kind of thing or.

Yeah, and actually intensity can be perceived exertion, it can be zones, it can be heart rate. You know, you can get as technical as you want, but the bottom line is just huffing and puffing. So you can't really talk very well. I think that's the, that's the easy way.

That's good, that's good. Well, how about just. Do you have a couple more minutes for a few more questions?

Sure, sure.

Great. So I want to maybe wrap up with talking a little bit about like some of the technologies around these things. Do you have like, not, not in the sense of endorsing anything or whatever. We're, we're not, we have no commercial, commercial interest or sponsorships. But things like, like, I'll tell you what I like. I, I, I'm a big fan of like chilipat for like helping my sleep in terms of being able to have, you know, proper temperatures and stuff and coolness. I'm a big fan of sauna. I had a couple of things that I had done kind of crazy stuff that they provided people that had participated like with the NormaTec compression, you know, like pumps you up and then relaxes and things like that. Do you have like any recovery maintenance, prevention tech tool, gizmos that, that you like or that you personally use if you, if you don't mind sharing those.

Yeah, I know, yeah, I'm a big fan of the, you Know, the compression products, I think, among others, Hyperice does a nice job. They kind of do all the massage guns and massage balls and, you know, vibrating rollers and the compression. You know, they're very much in this kind of world of recovery. And I think my one comment is I think they're all great. I think they all fall into Ken hurt medicine. And I think there's not a one size fits all for every single person. And I. And I think the goal is to. To just try what, what to see what, you know, try different things and see how you do. Because there's such a wide spectrum of things, you know, that people can do. But generally, I think that we will hopefully get more information in the future on recovery, because I think that's, again, how quickly you turn around and do something else makes a big difference in how you do and how, you know, some of the injuries we see from, you know, ramping up that acute to chronic workload ratio are a lot about recovery. And people take longer to recover as they age. Recover as they age. How do we. How do we help them recover quicker? You know, ice baths are so popular for a long time, and now they're not that popular at all. Yeah, I always hate. Which makes me happy because I always hate ice baths.

Unless you're Wim Hof, you know, hate, hate it. Well, let's maybe wrap up with, if you don't mind from maybe kind of a personal thing. I mean, you. You have been really kind of a role model for me because you seem to be able to manage, you know, these, you know, just really good, consistent athletic performance. You evangelize it and talk about it in ways that make it very accessible, be it, like you just said, you know, your monthly free Central park things, your, you know, the, you know, online kinds of things, the books, etc. Etc. So I just, I want to just show my appreciation, my gratitude. I think that's. That's really wonderful. Thank you for the gift that you've given all of us with that. And you had mentioned a little bit, you know, we talked a little bit around the pandemic and, you know, hopefully, knock on wood, we're coming, like, off the depths of it. I'm sure we'll see, you know, little things, different places and different times and whatnot. But are there things from a. From your medical practice that you learned from it? Just in particular, you kind of talked about it in the broad spectrum of, like, the study, you know, that was done out in California and stuff. But, like, did you make changes in your clinical practice, did you adapt your workout program? Like, how did that affect you professionally and personally, if you don't mind?

Sure. So I think the past couple years, you know, I think a lot of the stuff I was talking about before this intersection of medicine and fitness and preventive wellness and, you know, was I proselytizing that? I probably was. I probably am. Guilty as charged. But I think that, I think in the past couple years those overtones and undertones have become, have moved more mainstream.

Yeah.

And I'd say that's one of the things that I think people are really kind of thinking about is how do I stay healthy? How do I stay quote, unquote, well, how do I think about wellness for myself, for my family, for my community? I think those things have become more mainstream and I think people are more kind of into thinking about those types of things. And you saw it in all different ways, people embracing outdoor exercise, outdoor activities. You know, they couldn't travel overseas, so they were doing national parks and, you know, going hiking and, you know, all kinds of things that they weren't doing so much before. And, and so I think the past couple years has really kind of, you know, I'm not going to lie, being a healthcare provider in the last two years has really been challenging. Yeah, yeah. You know, you, you go to work, you, you know, people have pain, both physical and mental, emotional, from everything that's been going on.

Right.

You're there as a kind of receiving that for a long time. The only time people were leaving their houses was to come see us.

Yeah.

And then they would go back. People were kind of, you know, now you have people who kind of, you know, you go outside at 2:00 in the afternoon, everyone's out walking your dog, and you're the, you're the dummy in your office when everyone else is working from home. What did I do wrong? But it's been challenging, you know, to kind of absorb all that, to be around all of it. But, but I still think it's a, you know, it's like I feel blessed to have the, the platform to be able to encourage people to, to think about some of these things. And I hope to be doing it for, you know, my goal is to do, you know, either a marathon or an ironman or Something in my 80s is probably my goal.

I would say that's great. You know, Peter Attia talks about the centenarian Olympics or something, and the idea isn't like from the Olympic, Olympic Olympics, but just to be able to have this back to what we talked about, like quality of life, you know, to be able to pick up your grandchild, to be able to, you know, pull yourself out of the swimming pool, you know, to be able to put your luggage in the overhead bin and do that all without, you know, injury or what have you. And I would say, Jordan, you know, you really have been, I think, a, an early inspiration with these kinds of things. And I hope you can kind of feel like you can take a victory lap to say that, you know, the fact that now this does become mainstream and that people are more aware of it and that people, like you said, are now starting to figure out ways to incorporate it into medical school training programs and curriculum, I think is, again, a testament to, you know, what you've been able to do and the influence and impact that you've had. And, and just personally, again, it's been a great conversation to be able to have this and to pick your brain. You're an amazing wealth of knowledge and experience. So for people that in the audience that want to know a little bit more about your work, how to get your books, follow you on social, what are some of the ways we can do that? And we'll put that in the socials.

Sure, sure, sure. So I use everything, it's Dr. JordanMetzl for Instagram and Twitter and, and Facebook and then all my books and all the above are on Amazon under just my name.

Great.

And yeah, that's probably the easiest two ways.

Awesome. Good. We'll put that into the show notes. Well, again, thanks so much for the time. I know you have a crazy schedule. Good luck with the race tomorrow. Hope all goes well and looking forward to keep in touch, my friend.

I appreciate it. Thanks so much. I really enjoyed our conversation.

Me too. Living a Life in Full is a production of Stout Media, a subsidiary of Gordian Knot, LLC. Assistant producer Gracie Wong Music Dan O' Brien executive producer and host Dr. Chris Stout to learn more, stop by our website at lifeinfull for show notes. And please remember, recommend this to your friends and subscribe on your favorite platform. And as for the obligatory disclaimer, this podcast is for general information uses only and does not constitute the practice of psychology, medicine, nutrition or other professional health care services, including the giving of medical or psychological advice. No doctor patient relationship is formed. Lastly, and perhaps most importantly, I take conflicts of interest seriously. For all of my disclosures as well as show notes, please see livingalifeinfull.org podcast and my LinkedIn profile. Thanks. And until next time,