Daily Steps To Reduce Your Chances Of Getting Cancer

Coming up on this episode of the Doctor's Pharmacy.

Oysters, why do they top the list? You got 10 to 15 calories per oyster, so let's just say, you know, six oysters, 60 calories. And for those 60 calories, you're getting 768 milligrams of long chain omega-3 fats, you're getting 340% of your vitamin B12, you're getting, gosh, at least a third of your iron, you're getting 500% of your daily need of zinc.

I mean, on and on and on.

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Episode of the Doctor's Pharmacy. Hi, this is Lauren Fee and one of the producers of the Doctor's Pharmacy. Numerous things can contribute to cancer development and cancer recurrence. Studies show diet, exercise, thoughts, feelings and environmental toxins all influence the initiation, growth and progression of cancer. Yet many doctors fail to treat the.

Root cause of cancer.

On today's compilation episode, Dr. Hyman talks to Dr. Drew Ramsey, Dr. Todd LePine, Dr. Elizabeth Boham, Dr. Peter Attia, Keegan Allen, and Tom Hopper about things we can do every day to promote health and reduce cancer risk.

They discuss the importance of a high.

Nutrient diet, maintaining a healthy weight, optimizing.

Sleep, reducing sugar intake, and so much more. Let's jump in. Well, what a nutrient profiling system is, is it just tries, it's just a system for looking at what foods have the most of those nutrients per calorie? And then what a good nutrient profiling system does, and Dr. LaChance and I really wanted to create a good one because oddly there are, I think, 27 nutrient profiling systems in the world that have been created. Some people have seen ones like the ANDI or NuVal, you know how many have been about mental health?

None.

None. And so what we, a good nutrient profiling system does looks at food categories. So we're not saying kale, kale, kale, kale. People say, well, I don't like kale. Can't eat too much of it. You'll go into hypothyroidism. Exactly. Oh, no, it's toxic now. that's toxic work. But what we say is leafy greens. And so what we did is we scored, we looked at all of the top foods for these nutrients, scored them and then created a list of the top plant and animal foods. And so first of all, they're the foods that top the list, which I just think are interesting. Like oysters, clams and mussels are in the top five on the animal side. And the reason we did animal foods is that no nutrient profiling system usually has any meat or any animals in it because it's all based on calories usually and plants always have fewer calories. But most people eat meat or seafood so we wanted to give folks a list of which had the most nutrients.

And why were the shellfish the top ones?

Top ones, because think about oysters, why do they top the list? You got 10 to 15 calories per oyster, so let's just say six oysters, 60 calories. And for those 60 calories, you're getting 768 milligrams of long chain omega-3 fats, you're getting 340% of your vitamin B12, you're getting, gosh, at least a third of your iron, you're getting 500% of your daily need of zinc. I mean, on and on and on, you're getting some vitamin C in oysters. Okay, let's go get some oysters. Yeah, exactly. All that for 60 calories. And that's just, and on the other side, looking at plants, things like watercress top the list. And why just watercress? Lots of nutrients, no calories or very few calories. And so that's a great example of nutrient density, those foods. And so the food categories that people should be looking for are things like leafy greens, the rainbow vegetables, more seafood, and if you're eating meat and red meat, to look more towards wild red.

Meats or grass-fed red meats. So, this is fascinating. So, the diet that prevents cancer, heart disease, dementia, depression, and fixes most chronic.

Illness is the same diet. It's really, well, it's where we got off in medicine. We kind of separated out mental health and brain health from the rest. Like you're saying, kind of like somehow the blood brain barrier was like, Thou shall not pass. We didn't think think that sure those same, all those same activities that we think about in terms of our general health and the foods we want people to eat and the things we want people to do, move their bodies, connect, be part of their community. Yeah, that's key to your brain health and your mental health.

Yeah. And the trouble with, you know, our food supply is that it's often depleted. Even if you're eating the best foods, you know, you have an organic farm, the soil matters in terms of what's in the food.

Yeah.

And if you're going on depleted soils, which most of our soils more like dust and dirt.

Well, they're just like chemicals in, chemicals out. I mean, it's really, you know, if you, if you, if you grow, live, you know, if you, if you live by the foods you grow, you don't, you know, you don't do it the way that a lot of food is grown. And even, you know, even organic food, it's funny as you drive through the produce belt and I encourage people to do this and you look out, you know, you'll see organic stuff out there.

Yeah.

But, it It doesn't look like a, it doesn't look like a healthy farm somehow. It's got a lot of food on it, but it doesn't smell right. The people working it, they, they, I don't know, they don't seem happy in a certain way.

The, the, it's because of their big monocrop organic farm. Yeah, it's a big monoculture. You know, you look at a big.

Kill the soil, which should produce great soil. They, they, there's a ton of tillage, there's a ton of diesel spent, there's a ton of compaction. And, and it's a real I think it's a challenge right now.

Industrial organic is what Michael Pollan calls it.

It is, and in a lot of ways, that's been a huge victory because we have a conversation about organic, right?

It's better than- and organic was just found to reduce cancer by 25% in people who had it.

This French study, right? I mean, so there's something there. So it's a step in the right direction, but when you think about where I'm from and you drive around, Our soil is pretty rough in Crawford County, but boy, you wanna, I would say that a lot of places, Mark, where we live, if you'd take a lot of Americans, they wouldn't know they were in America, because it's just that whole central notion, that Central America or middle American notion of a small farm and what that looks like and how that functions. Some cows, couple pigs, not a monoculture, a nice garden for all your food and for sharing with your neighbors. That has died in a way. And I think- Wendell Berry calls it.

The unsettling of America.

Yeah, and I think that, you know, maybe dead is not, that's on life support, and maybe we're seeing a shift now.

It seems like it's coming back. There's more smallholder farms.

I hope so. I mean, it's definitely coming back. You see it on the coasts, you see it around urban centers, but there's still a lot of places that don't, you know, where it's not happening, and that kind of combo of you know, I would say agritourism and interest in food, but also just interest in farms. But I'm hopeful.

So my question was going down the path of, okay, if our, even organic isn't the best that it could be. If the foods have been bred in a way to create more starch, a lot of the phytochemicals have been bred out of it, the nutrients aren't there because of the soil, even if it's the best organic farm. And by the way, Dan Barber and Walter Robb, former CEO of Whole Foods, have created a seed company to actually reinvent new seeds to breed them so they have flavor and they have nutrient density and they're phytochemical rich. It's a very different idea than breeding them for yield or for pest resistance or water or drought. But they're doing all that too, but they're doing both. So the question is, if that's true, then do we need supplements? And do you use nutritional supplements in your practice to treat mood disorders.

So, I think even with the food we have today, you can still get all the nutrients you need. It's actually challenging if you look at all the recommended daily allowance and you think what you would need to eat to meet that. It's a little challenging. It requires some thinking about it. I always tell people, no, just eat nutrient-dense food. You'll be fine. But if you start scratching your head and add it up, it can be tough.

I had a patient once who was like, I don't want to take supplements. so I literally looked every food up and I'm like, okay, selenium, it's in Brazil. So I have two Brazil nuts a day. I have 17 pumpkin seeds. I have, you know, two cups of, you know, broccoli or whatever it is. And I was like, okay, fine.

If you want to do that, go ahead. Let's check your nutrient levels. Well, I have that problem where I don't like the idea of turning a meal into a math equation. And so, yeah, I myself, I mean, I'm 44 and I stopped taking all supplements probably about maybe 10 or 15 years ago. I guess that's not entirely true. I'll take a little omega-3 sometimes, and certainly in my practice for non-seafood eaters or for individuals who are just kind of eating seafood every now and then, especially for individuals who don't want to try a medicine and they've never, and even for individuals who do, I'll put them on a 1 to 2 gram milligram grams of fish oil. I mean, in the trials that fish oil is very, in the science, in the studies of depression is one of these things that has statistical significance, but it's not able to show clinical significance in the meta analyses that you get about a point reduction on a Hamilton D depression rating scale. That said, you can't take fish oil.

And be eating processed oils which displaces it. You can't be eating piles of sugar. It's like, you know, and you wonder a lot of the studies are designed.

Well, you wonder, one do they control for that? And two, you know, we have all these SNPs now in the elongase genes in terms of how we process omega-3 fats. What's the genetic variation?

Yeah, I mean, there's that.

There's also that, you know, if you have somebody who's a seafood eater versus not.

But.

The bottom line is I think that there are certain supplements that should be tried, especially when people are struggling with traditional antidepressant response. A lot of people I'll see, they'll have been on a medicine, it works some with cheerfulness or with sleep, but they're not eating well and for whatever reason they're not going to start eating well. So, that's a really good example of somebody who a multivitamin or something with zinc or magnesium certainly anybody who's low. I mean, I always have that feeling like if you're low, I definitely like... Do you test your patients? Yeah, yeah. I don't do as extreme or not even extreme, maybe as thorough, but I certainly test everybody. I mean, I think what you were saying earlier, I think any mental health clinician who misses, I mean, it is malpractice if you miss a thyroid problem, a B12 deficiency, syphilis, I mean, there's a bunch of biological causes of depression. and I think you and I see that get missed sometimes where it's like this is not, this is not even functional medicine. This is just basic medicine.

Yeah, it's all good medicine. Yeah, it's good medicine. I mean, I, I, you know, in my practice, I see the common deficiencies you're testing are vitamin D, magnesium, Omega-3 fats, sometimes iron. Yep. And the B vitamins, particularly around homocysteine and methylation issues, which is this cycle of folate B12 and. B6. And so I find that giving people a multi and fish oil and vitamin D and maybe a little magnesium usually has enormous impact. And what you think is that even if you're going to get them to.

Change their food right away, there's some, you know, that takes a little bit in, in, I think we're changing the food.

I, I feel, I feel like we're so depleted. It's just.

Yeah.

Well, it's hard. And it's also, it's really hard when you're depressed. Yeah. You know, so I think what, it also gives people something to do. yeah, because you do. I mean, depression causes a lot of carbohydrate craving and a lot of, you know, we eat. We call it comfort food for a reason because we eat it when we want to be comforted. I mean, I know when I'm in.

That bad spot, man, I'm.

I'm a mac and cheese guy. Yeah. It gives you a little serotonin.

Yeah.

Don't give me. Don't give me any talk about carbs. I need, like, my comfort food. But it's.

I think it's something else.

The other one that's, I think, exciting is the L-methylfolate. It's just exciting in the idea that it's actually a prescription drug for depression. Well, it's called Deplin, but it's a B vitamin that got you served by, am I allowed to say that? It's a B vitamin that got you served by Big Pharma is the way I think about it, which is you have L-methylfolate, which is folate that has a methyl group added onto it.

And instead of that being five bucks, it's 200 bucks.

But you can get it for five bucks. You can get it. But the idea that we're just now, because this is going to be the next frontier mark, as you know, which is we're going to start really getting into precision psychiatry. I mean, that's my most, my favorite new center at Columbia is the Center for Precision Psychiatry.

There is that.

There's a center there's a center for precision psychiatry, there's a center for practice innovation, there's a center for women's mental health. I mean, there's going to be a new center for media and mental health that's going online. And precision psychiatry is just that, which is, there's no, I mean, one of the things I think is interesting is there's nobody that's more critical of psychiatry than ourselves. Because nobody sits with the failure. Well, nobody sits with it, like, you know, until you sit with getting an antidepressant prescription wrong and then getting it right and knowing that somebody suffered because you didn't make the right choice. When you sit with that, you want to get it right more than anybody else because that's your job. And so it's an exciting time between the new knowledge of the microbiome, the psychiatric genetics, which it's not there yet, but man, it's getting close. We're, I hope, going to see the tide turn on our mental health epidemic. We are going to see the tight turn on our mental health epidemic mark. We won't rest until it does, deal?

No, no, we can. No, it's, I mean, it's the food stupid, as you know, to paraphrase a former president. But it's like, people don't get how powerful it is and how impactful and.

How quick it works. How do you get people to see it though? Because I feel like when we tell people, hey, eat right, feel right, they get that. When we say, you know, food is medicine.

You know what I do? I just I think often incrementalism doesn't work because people don't see a change. So people are eating a crappy diet, I said just stop the soda, but they're eating like garbage. They're not gonna feel better. So I put people usually for, I said 10 days, you can do anything. So I put them on a basically elimination diet, I call it the 10-day detox diet for 10 days. And they can experience without me telling them the changes that happen in their body, in their brain, in their mood, their energy, their sleep. and it's quick. So you usually can get people to do anything for 10 days and then they go, oh, okay. Well, they have to, I mean, I.

Think any good behavioral change, it's like we can't tell you, you can't read about it, the study is not going to help the sound bite, the science. You have to experience it working. And as soon as you experience that, that extra energy, that better, what I find the better sleep quality, where, you know, I'm expecting to hear like more mood, more energy. People are like, you, know, Doc, but I'm really sleeping better. and all those ways that, you know, that then makes nothing affects mood, I would say, like sleep. So it's.

Yeah, it's amazing. Well, if you were able to change Psychiatry and you had sort of an autocratic, you know, wand that you could wave in.

I got to be the emperor of Psychiatry.

Yeah. I mean, would you throw out the dsm-5? Would you say every psychiatrist needs to get trained in functional medicine, nutrition and.

I do a few things.

One is I'd want America to really meet psychiatry because I think so often when they think about psychiatrists, they think about Freud, they think about some old white guy with a beard, and they don't think about our current president, Altha Stewart, first African-American female president of the American Psychiatric Association, or they don't think about my colleague, Christina Mangurian, who's, she was like one of these stellar, she's my medical student, now she's the vice chair for health equality and diversity at UCSF. So these are women who are leading psychiatry and we are diverse and we are desperate to find, well, we're desperate for a few things. One, we're desperate to better, we have a lot of solutions. We have, for example, I just, you know, the number one way to treat schizophrenia or to keep people with schizophrenia really well, it's not an antipsychotic. That helps for a lot of them with symptoms, but it's a job. And so there's a program spearheaded by the Office of Mental Health and Lloyd Sederer in New York and Columbia Center for Practice Innovation that looks at that and now makes sure that there are, I think there are 7,000 families in New York who are getting employment support when they have early.

So, basic simple things that aren't medical care that are things that are happening outside the hospital.

Yeah, and so I would wanna see more programs like that. I think that there needs to be certainly training in, I would say not just nutrition, but also in lifestyle and lifestyle modification. I think that gets dumbed down in medicine in general. and we don't know how to do it. And I think a lot of times doctors don't think they should do it. And maybe that's true, maybe it's not, but what doctors need to do is easy. Yeah, but even writing a prescription for food and exercise, some systems, that's all they're going to do. But building out that capacity, I would want us to, I guess then you want to hear my number one change, I guess I've come upon this this week as I've been really thinking about innovation in mental health. The number one change I want to see is I want us to stop meeting patients when they're mentally ill. I want us to start meeting patients and helping them stay mentally well. Because the most powerful tool that I have as a psychiatrist is the power of prevention. And no one comes to talk to me or think about talking to me or fights the stigma to talking to me until they're late in the game.

And.

And that's great.

I'll.

I'm gonna get them better. Wherever you. Wherever you meet me, I'm gonna help get you better, but I'm gonna help. you get yourself better actually is the way to put it. But I hope that what changes and what is changing is that we start having a language to talk about our mental health and to recognize that we all have this. I think people think about folks like you and me, one of the things I love about you is you talk about being depressed and people think, oh, you're a brilliant, successful physician. You're an innovator. You don't have depression. And it's like, no, you do and you have. And that's what that's what I hope is going to change in terms of the field and the DSM, the diagnostics. I mean, there are smarter guys than me thinking about that. I think that's just, yeah, we're gonna have a reckoning that the way we've been doing it has been necessary without the DSM.

That's a way of labeling people based on symptoms or what mental illness they have. It doesn't tell you why.

It doesn't tell you why it's a symptom-based diagnostic approach because it's hard. We don't know why. What I love is now there's a big idea in psychiatry, not big idea, but a new idea. The inflammation has a lot to do with depression. That's been an idea in functional medicine and in wellness for 15 years. So that's changing. And I think that we're going to see more of an integrative model. The other thing is I would just hope that we come out of the shadows a little bit and that we're collaborating and integrating more and more, especially with wellness. Yeah, I agree.

I think rethinking mental health and changing our meaning we attach to a lot of it, which isn't necessarily always psychological, often is, but it's not always. And how do we combine that with a psychological approach? That's the original, you know, the original.

Psychiatry, the model they teach us is the bio-psycho-social model.

And except they usually leave out the bio.

Well, you know, the bio is they.

Leave out some of the biology.

But serotonin, well, let's give it any press. Serotonin is like the worst brandy thing.

That happened for psychiatry.

Why does serotonin get put up? Hundreds of molecules in the brain. Nobody even knows about BDNF. BDNF is a hormone that makes your brain grow. That's the one we care about. That's what food and exercise and psychotherapy.

All have in common.

It hung up on serotonin. Hey everyone, it's Dr. Mark. I know a lot of you out there are practitioners like me, helping patients heal using real food and functional medicine as your framework for getting to the root cause. What's critical to understanding what each individual person and body needs is testing, which is why I'm excited to tell you about Rupa Health. Looking at hormones, organic acids, nutrient levels, inflammatory factors, gut bacteria, and so many other internal variables can help us find the most effective path to optimize health and reverse disease. But up till now, that meant you are usually ordering tests for one patient from multiple labs. And I'm sure many of you can relate how time consuming this process was and then it could all feel like a lot of work to keep track of. Now there's Rupa Health, a place for functional medicine practitioners to access more than 2,000 specialty labs from over 20 labs like Dutch, Vibrant America, Genova, Great Plains and more. Rupa Health helps provide a significantly better patient experience and it's 90% faster. letting you simplify the entire process of getting the functional medicine lab tests you need and giving you more time to focus on patients. This is really a much needed option in functional medicine space and I'm so excited about it. It means better service for you and your patients. You can check it out and look at a free live demo with a Q&A or create an account at RupaHealth.com that's R-U-P-A-Health.com Now let's get back to this week's episode of the doctor's pharmacy. 95% of chronic disease is driven by exposome. And I think I heard a guy say recently that it's not your DNA, it's your dinner that matters most. And I think that is a great quote because it sort of speaks to the fact that we can't change our genes, but we can change how those genes are turned on or off or expressed. And the exposome essentially is talking about what our biology and our genes are exposed to over the course of our lifetime and how that influences the course of our health. And in functional medicine, and here at the Ulchewana Center, the things that we do really well are look at the exposome. So tell us more about, you know, what are the kinds of things you think of when you're looking at a patient to assess their exposome and how that's contributing to their health?

Well, you know, you mentioned earlier about your experience with heavy metals. So heavy metals can be disruptive. And so we oftentimes will look and assess for heavy metal toxicity, have a heavy metal burden. So when we check for heavy metals, guess what?

Everyone has them.

We all have exposure. I mean, I don't think I've ever.

Seen a negative heavy metals. I did it a few times. People who are vegans and never eat fish and they've always done that and have no fillings. Yeah. Very rarely do you ever see and probably are good detoxifiers. Yeah.

And then you just, but almost everybody else has some. A small amount. A small amount. Some have a lot. And they're in the environment. So, you know, burning of coal. Coal gives off mercury and it gets into the water. So you eat land. In lead, yeah. So, you get some exposure. So, heavy metals disrupt enzymes in the body. They disrupt detoxification enzymes. So, things like mercury lead, aluminum, arsenic, cadmium for cigarette smokers. In fact, some of the first time I actually learned that is when I had a patient who was a heavy cigarette smoker and I checked heavy metals and the cadmium was off the charts. I'm saying, where's this coming from? And, it turns out that- Cigarettes. Cigarettes, the tobacco for whatever reason, it accumulates cadmium and you see heavy cadmium in cigarette smokers. So heavy metals can be a source of toxicity.

And they can cause all kinds of symptoms, right? So give us some general symptoms that you'd see in a patient with heavy metal toxicity. Because when you go to your regular doctor, they're like, what is your lead and mercury and arsenic and cadmium? aluminum levels. They're not checking that, right?

Yeah.

Well, the other thing that's also interesting is that when you look at metals, there's this whole theory now about neurodegenerative conditions. And it's thought that metals play a role in what's called metallo-stasis. So metals disrupt the folding of proteins. So when you have excess amounts of metals in the body, it causes proteins to misfold. and misfolded proteins are tied in with a lot of neurodegenerative conditions, including things like ALS, things like Alzheimer's. And there's an interesting study that just came out this past week, and I'll send you the paper mark about the role of excess iron. So we think iron is good. Well, guess what?

Not too much.

Too much iron is not good. And especially free iron. Iron is a very reactive metal. I was a chemistry major, so I always liked to always look at the chemistry. So when you look at- that explains it all. Yeah, exactly. I'm a science nerd. So when you look at metal, I.

Was a Buddhism major.

And so iron is reactive and it reacts with oxygen. So when you leave, you know, something metal metallic outside, it rusts because it oxidizes with it interacts with oxygen. So our bodies actually keep iron wrapped up and we keep that in the molecule called hemoglobin. We wrap up iron. And if you don't, if you have free iron in the body, you get the fenton reaction. Basically, your body starts to rust. And I've seen this in patients with hemochromatosis. so when you have chemochromatosis, which is a genetic condition that causes you to not be able to get rid of your, your iron, which is a metal.

Which is about 10 of the population.

Has some degree of that. Exactly.

Yeah.

And what happens is iron is found in all tissues because blood is in all tissues. And when that iron can't get detoxified, you build up iron in your liver, your heart, your pancreas and your brain and your joints. And guess what? You rust. you get a rusty tin man.

Exactly.

You can develop, in fact, one of the first times I had your pancreas. Exactly. You get diabetes, liver failure, heart, cardiomyopathy, you name it. Heart failure. Exactly.

So, so dementia. Dementia.

Exactly. That's a mess. So, so, so I call, we call it metal trafficking. And looking at the role of metals is really, I think, important. Aluminum also, excess amounts of aluminum has been associated with increased risk for Alzheimer's. And again, it's probably related to these metals actually causing proteins to misfold.

So we shouldn't be using that aluminum.

Deodorant or cooking from those aluminum bands.

No.

Or aluminum, you know, antacids, soda cans and. Yeah, but like the.

Oh, yes. Oh, yes. Antacids often have aluminum. Exactly. Yeah. There's a lot of aluminum in us for. So, so heavy metal. So we, we see heavy metals as one of the big exposure areas.

How, how, for example, would we assess someone's heavy metals? Because we do the, you can do the urine provocation testing for. for heavy metals, which is, you know, what we do a lot in patients with provoking with DMPS and. Or DMPS. Or DMPS, exactly. Yeah, you can do that. You can also assess it in the blood. And there's, there's different, like when you check mercury, there's two different forms of mercury. Mercury takes organic and inorganic mercury. And, you know, organic mercury tends to.

Accumulate in the hair, so you can actually assess.

That's more from, like, fish, for example. Fish. Yeah, like methyl mercury. Right, right. So you can assess it in the hair, you can assess it in the blood, and you can also assess things in the urine.

And they sort of, each of them.

Give you a different perspective.

And inorganic is from your fillings. From fillings. And from pollution. Yeah. You know, the thing is people say, oh, you got these silver fillings or no problem. The dentists say they're great. But, you know, you and I both know that when we've seen these patients, they do have high levels of inorganic mercury. You can look at their tests, and it does affect their health. And you remove the fillings, the mercury levels come way down. I've seen this. over and over again, and then patients feel better. Now, this is not well accepted as a thing in dentistry, except if you look at what most dentists do now, they moved all the way from these, quote, silver fillings, which are mostly mercury. Yeah. Without saying they're bad, it's like, well.

They'Re not bad, but we don't do it anymore. There's too much of a liability. It's a can of worms. So basically, this is, if they were to admit that there's a problem, because once you remove mercury from the tooth, it now becomes a toxic waste product.

And it's fully regulated.

Fully regulated. Yeah, that's interesting.

So ask your dentist.

It's fine in your mouth, but remove it.

Now it's a toxic, toxic product. Yeah, that's interesting. Ask your dentist. If, if mercury is so safe, then why can't you throw it in the garbage? And why do you have to dispose of it by the regulations set forth by the EPA as a toxic waste? I always thought that's an interesting point. You know, if you can't answer that, then you shouldn't be putting it in your mouth. So we can look at the blood, we can look at the urine. The problem with the, the typical blood test is if you haven't had a current exposure, your body clears it after 90 days and it doesn't necessarily get rid of it. It might store it in your tissues and your liver and your muscles and your brain. And so you can't really tell. And that's why this challenge test can help pull it out. Exactly. And then we get a real more.

Accurate view of what's happened over the course of your life. And the big thing, this is a clinical program. I'm sure you've seen this, is lead. Now, we tend to have less lead toxicity now because we're not using lead paint. We don't use lead and gasoline. we don't have lead pipes, or at least unless you have old buildings. But I have seen this in a few patients, especially in women, where in menopausal women, after menopause, they'll have accelerated bone loss. So, lead gets stored where? In the bone.

Yes, in the bone.

So, as a woman goes through menopause and she's had a body burden of lead and it's sort of sitting in the bones, and all of a sudden, you're now digging up the bones and you're peeing. When you go through menopause, you pee out your bones. That's how you do it. And we can, you can just do a test called bone resorption testing, which checks for the collagen breakdown products of bone. And when you see increased bone resorption, you know that they are peeing out their bones. And when you see high levels of lead, you know that they're actually getting exposed. And it's like dripping lead out of the body.

And, I mean, not actual bones coming out of your urinary tract. It's just a breakdown product.

Right.

But that would hurt.

But it's sort of like, you know, it's like, you know, when you get osteoporosis, where do your bones go? You literally pee them out.

Well, speaking about the bones, digging up the bones, there was a study I read years ago that they had to dig up this graveyard in Europe and they had to remove the bones and put them somewhere else. And so what they did was they decided to check the bones for lead. and they compared that to today, and they found there was a thousand times more lead in the bones of modern people than there were 300 years ago.

Wow. Yeah.

So it's in there. That's incredible. And I think that mercury is also one of those factors that is just so common because it comes in our diet, it comes in our fillings, it comes in pollution. and it's probably one of the most undiagnosed things I've ever seen. And, I certainly became an expert in it not by sort of design, but because I got really sick from mercury poisoning. And, that's what led to me to have this chronic fatigue syndrome and kind.

Of figure this whole thing out. And then, you know, what's the old term is the mad hatter. Remember, you know, in Alice in Wonderland, the mad hatter, right? Well, they used to use mercury when they made hats. And, what they found out is that when you got mad, if you had enough mercury, it affected your brain. you'd have delirium and other symptoms because it has a brain effect.

The other thing about these problems with toxins is that they don't manifest the same in everybody, right? So they might make you crazy, they might give you autism, they might give you Alzheimer's, they might give you chronic fatigue syndrome, they might give you an autoimmune disease. They might cause weight gain. I had a woman who was a fitness trainer and ate perfectly and she had these 40 pounds she couldn't lose. and I took her history and thought she might have some mercury issues and we tested her and she had very, very high levels and we treated her and over the course of the number of months without changing anything else just by treating her mercury, her weight dropped 40 pounds. Wow. Wow, that's amazing. So it can, yeah, because it's, we know that there's these compounds called obesogens, which are environmental toxins that cause obesity. They interrupt your mitochondrial function, your energy production, your hormones and metabolism. So really it's important really dig deep. So besides these heavy metals, you know, what other things can we look for that most physicians don't look for?

Pesticides.

Pesticides.

Big one. Big one.

So herbicides, pesticides. Yeah. Yeah.

So pesticides are the compounds that we use on plants to keep the bugs from eating them. And there are, you know, there's a whole bunch of them, and you can actually measure them. There's labs that will actually measure pesticide levels. One of the pesticides, which is a real bad one, it's actually, I think, have been banned in Europe, is the nicotinoids. That's the one that they associated with bee colony collapse. And pesticides, interestingly, are also associated with ADD and they, I think, yeah, that study where they, they looked at the children who lived downstream from pesticide exposure and they, they checked how they would draw and such. And it was a big difference between those who had high levels of pesticides and how their brains worked versus those who had low levels of pesticides because they're neurotoxins. They're basically a pesticide works on the nervous system of insects. And our nervous system is not that different than an insect. And high levels of pesticides are not good things.

No. I mean, and the other thing is, is farm workers and their kids, the kids through various diagnostics and neurologic testing, they found they've lost 41 million IQ points being exposed to pesticides.

Yeah, yeah, exactly. And there's an interesting study that looked at pesticides in Japanese populations. And, the interesting one is that they found higher levels of pesticides in people who ate more fruits and vegetables.

Yeah.

That's counterintuitive, right? But, it's not counterintuitive because if you have pesticide-laden fruits and vegetables, you're gonna have higher levels of pesticides. So, it's not just don't eat your.

Fruits and vegetables, eat your organic fruits and vegetables. Yeah, I mean, there was a paper recently published linking pretty clearly the fact that that organic food eaters had much less cancer than people who ate traditional fruits and vegetables. And the Dirty Dozen is a great guide from the Environmental Working Group of one of the 12 most contaminated foods. So strawberries I love, but I would never eat a conventional strawberry because it's one of the most pesticide and herbicide laden things. And glyphosate, which is another compound, it's not a pesticide, it's an herbicide. It's sprayed on 70% of our crops. Yes. And it's the most abundant agrochemical used around the world. world and it destroys our microbiome. Yeah. It's literally like an antibiotic that kills your own microbiome as well as the microbiome of the soil. So that leads to all these other complications. And when you go to your traditional doctor, they're not measuring your glyphosate, they're not measuring your pesticide levels, they're not measuring your heavy metals, and you're coming in with all these symptoms that could be related. And so part of the difference with.

Functional medicine is we actually start to think about these things.

Yeah.

And we have methods of diagnosing them and we have methods of treating them. Right. So how do you begin to thinking.

About treating these things.

Yeah. You talk about glyphosate. That's. I think that's a big one. And. And that's. That's sort of the elephant in the room because it's ubiquitous. It's so prevalent. And we do testing for that now.

I don't know if you've been measuring.

I do.

I measured mine. I was shocked. I mean, I. I eat clean. I try not to eat GMO. I do travel, although not anymore. Maybe at levels are lower, but I. I eat organic, and I really am focused on detoxification. and my glyphosate levels were in the 50th percentile, which is pretty high considering I'm on the extreme end of paying attention to this because it's in everything. And if you don't know where your food's coming from, it likely has it because it's on everything.

Exactly. And you mentioned it because the glyphosate is actually an herbicide which is supposed to not affect the human system because it works on a different pathway, the shikimate pathway. And that pathway is actually in bacteria. so when you ingest glyphosate, it actually has an adverse effect on the, the gut microbiome.

Yeah.

And there's some interesting work by Stephanie Seneff, and she has a whole bunch of data linking the increased use of glyphosate with linking it, not necessarily causative, but linking it, correlating it with autism. And I, I think there's some truth to that, because what you're doing is there is if you're having higher levels, especially early on, that you may be disrupting the microbiome, which is in turn affecting the gut-brain axis.

Absolutely. For sure. I mean, we know that most kids with autism have terrible guts. By helping their gut, they get better. I mean, there's studies showing just giving.

A kid a fecal transplant who's got autism helps fix their autism. Yeah. Well, the other interesting thing about autism is that, you know, we talk about there's how, you know, kids with autism is their social interaction. And a lot of the, you know, the social hormone is oxytocin. It's the love molecule.

And what we found out is that.

The gut bacteria actually produce oxytocin.

The good ones.

The good ones. The good bugs.

Yeah.

So it makes sense that, you know, when you have disruption of the microbiome, you may be disrupting the social network of your gut, which may be playing a role, you know, one of many factors in this autism spectrum condition that we're seeing.

So if you want to have happy, healthy relationships, you got to fix your gut, too.

Yeah, exactly. Happy gut. Exactly.

So let's talk about once we started to identify all the factors in the exposome, right? Your diet, stress levels, the air you're drinking, I mean, the air you're breathing, the water you're drinking, you know, the light you're exposed to, these are also, you know, influences on your gene expression. Light pollution, light pollution, you know, environmental toxins, all these factors, your microbiome are influencing your genes and your gene expression and your health. but when we see a traditional doctor, and you're not here at the Ultra Wellness Center and the Functional Medicine Doctor, you're not really getting evaluated for all these things, right? No. So here we were able to test and measure these things and we know which one to look for depending on the patient's story. And once we find these things, what can we do to relieve that burden? Because it's kind of depressing. You go, well, what can I do? I've got all these exposures, we've got all these toxins, but you related to me before a story about a woman who had a significant exposure to pesticides and you treated her and she got better.

No, it was actually PCBs. PCBs.

Yeah.

And up in the Berkshires with General Electric, we have the whole PCB saga up here. So PCBs are these persistent organic pollutants. They basically stay in the body. And in general, I'm going to make a generalization here, is a lot of environmental toxins are lipid soluble, which means they love fat. so they get stored in fat. And when they get stored in fat, your body's not able to detoxify them as well. And as they accumulate, they can disrupt the endocrine system, cause insulin resistance. And PCBs have been known to do this. It affects the thyroid, they affect insulin resistance. And this lady wanted to be tested for it. And so I went ahead and tested her for it, and she had high levels of PCBs. So I started to support her detoxification with for for fat soluble PCBs with cholestyramine. And what's that? It's a it's a molecule that prevents the it's actually originally used for cholesterol. So it was because cholesterol gets recycled in the body. Your body eliminates cholesterol and then you're bile through your liver. Through your bile. Exactly. Because cholesterol is a good molecule. Cholesterol is the building block of all your hormones. It's for cellular membranes and cholesterol gets a bad rap, but, you know, cholesterol can be a very good molecule. But the compound cholestyramine was originally designed to lower your cholesterol to prevent the recycling of your cholesterol. And it works for other things. I think, you know, some of the work with Richie Shoemaker with his use of it's an interesting story that he has, how he was using it for mycotoxins and how it helps the body to eliminate mycotoxins.

And when I treat this, those are mold related toxins. They just recirculate and create chronic inflammation. Yeah, it's like a merry-go-round. So you might have been exposed to mold ten years ago, but the mold toxins keep in your body and keep causing neuroinflammation, which is why people have brain fog and fatigue. And that's another one of those things in the exposome is mold. We didn't even talk about that. Yes. That's another huge one.

Yeah, in mycotoxins, yeah, definitely. But in this lady, we treated her with lifestyle changes, but also I used cholestyramine and I did it sequentially. I was over about a year and slowly her levels came down and as she did that, guess what? She started being able to lose weight.

The waist-to-hip ratio is great measurement that we can all do and repeat on our own. So what you do is you get your waist circumference and to find the right place for your waist circumference, it's in between, you know, you find your lowest rib and you find your upper hip bone and then you put the tape measure in between and that's considered your waist circumference. So if you find that lowest, your last rib, and your hip bone and go in between the two, that's considered your waist circumference.

It's like your belly button.

And then your hip.

Yeah.

You know, some people's belly button hangs down or is in a different place. So it's not always the belly button, but it is around that area. Yeah. And then their hip circumference is, you know, it's considered over the greater trochanter. But if you don't know where that is, I always say to people, go over the largest part of your hip because that just makes your number look better. So you want to, you know, get the biggest hip circumference as you can have. Not that you want it, you know, you want to be, you know, way overweight, but it's you pick the biggest hip circumference to determine your waist to hip ratio if you can't figure out where that greater trochanter is.

Yeah.

So for for the the goal for Caucasian people for Caucasians is to have a waist circumference less than 35 inches for women and less than 40 inches for men. for Asian and Indian ethnicities, it's stricter, less than 31 inches for women and less than 37 inches for men. And that waist to hip ratio is a great measurement to do. So for women, you want to be less than 0.8 and for men less than 0.9 is the waist to hip ratio you want to have. So you want, you know, a smaller waist than hip, of course, And the neat thing, this is a really simple test you can do and something you can check every month. You can redo your waist-to-hip ratio every month and watch your progress and say, okay, what am I doing? What do I need to do? And it's a really inexpensive way to figure out, is this a problem for me?

Yeah, that's really huge. And I think it's also important what you said in that people of Indian or Asian descent can have significant visceral fat and all the complications from it at much lower weights. So they may, if you look at their weight, their weight might be perfect. It might be less than 25, 23 in their body mass index, which is 25 or more is overweight. But they may be full of this visceral fat and they can be diabetic, they can be thin and they look thin, we'll call them skinny fat. So they have the same issues as someone who is overweight. but they're just over fat.

Yes, or Tofey, right? Thin on the outside, fat on the inside. So, you know, if you are a smaller person, then that's where also that waist to hip ratio can be really helpful. And you're right, you're right. No test is ever perfect. So for some people, the waist circumference or the waist to hip ratio isn't giving us all of the information. There's a lot of other biomarkers that of course tell us that somebody has too much visceral adiposity, that somebody is carrying too much weight around the belly. You know, if we see a high C-reactive protein or marker for inflammation, it makes us wonder, okay, do they have metabolic syndrome, insulin resistance, visceral adiposity? If we see that fasting insulin greater than five, that's when we say, okay, this is something we have to pay attention to. if we see too many small dense LDL cholesterol particles, we've spoken about that before, you know, that's a sign that somebody has insulin resistance or visceral adiposity. If we see, we also check for things like oxidative stress, too many free radicals being produced, that's a sign. If their liver function tests are high or they have signs of fatty liver, that can also be because of this visceral adiposity or gout, high uric acid, that can also be because of this. Or that pattern in cholesterol, the high triglycerides, low HDL, all of these things can give us a sign, give us information and say, okay, this person is struggling with metabolic syndrome, insulin resistance, or probably because of visceral adiposity.

And you often notice all these things at the same time, right? So you see a pattern. and it's really pretty easy to diagnose when you know what to look for. So you get inflammation, you get abdominal cholesterol, you get high blood sugar, high insulin, lots of oxidative stress, your liver. I mean, these are, these are all things that seem seemingly are treated like.

Separate problems, but they're all connected to this visceral fat. And what's amazing is to watch them improve when we make shifts or changes in somebody's lifestyle, you know, or, you know, there's lots of things that can contribute to from toxins in the environment to shifts in the microbiome to poor diet, you know, having a nutrient-poor diet, eating too many refined carbohydrates and simple sugars, not getting enough exercise, poor sleep, too much stress can all contribute to it. But when we shift somebody's lifestyle and when we make shifts in these issues that they're dealing with, we see these these markers, these biomarkers improve significantly. So, it's really fun to watch. We see it improve all the time. So, I'm going to get into the.

Causes a little more deeply in a minute. But, there is another test that we often do, which I like a lot. And, it's sort of the gold standard. It's called the DEXA body composition test. And, it's like a x-ray, a very low-dose x-ray. I mean, you have to basically take 50 of these to equal one flight across the country from New York to California in terms of radiation. and it measures the compartments of your body, your arms, your legs, your belly, and can tell you what the fat is, where it is. And, and it's pretty compelling. There's also MRI technology that does a CT technology, liver fat measurements. So there's a lot of ways to look at this, but it is really the central problem of our time. And, and there are many causes, but the major cause is our Ultra processed high starch sugar. that's the biggest cause because that drives insulin and insulin drives all the available fuel that you've eaten into your fat cells in your belly. And then it keeps the fat there, prevents this breakdown process called lipolysis of your fat, and it produces all these inflammatory compounds, and it screws up your hormones, and it makes you hungry all the time, and it slows your metabolism. So it's the worst possible thing. and it's really driven predominantly by that. So we know that a high carbohydrate in the sense of starch and sugar diet, because vegetables are carbohydrates, so you can eat as much of those you want, is the biggest driver of this. But there are other causes, right? And you mentioned a few of them. So let's kind of go through some of the unusual things that might be driving this, whether it's the microbiome, toxins, and other things that drive inflammation.

You know, I always, just in terms of the most common cause, right? I get so concerned when I see, you know, a young child, maybe like eight or nine, and their parents are buying them a, you know, a muffin and a sugary coffee drink or sugary, you know, beverage for breakfast. And I'm like, oh, no. You know, it's just a setup. It's a setup for them to have problems for their whole life, you know? And I think that it's important that people take care of those basics like you mentioned. But we always look for, you know, sometimes people are doing or they feel like they're doing everything right and there's hidden reasons for why they start to develop visceral adiposity and that belly fat when they're really doing a lot of things correctly. And one of the things that I find that people don't realize is what happens when they start to lose lean muscle mass as they get older. So, you know, we might be exercising a good amount every day, but if we're not working really hard to maintain that good lean muscle mass, what happens after the age of 25 is we slowly lose lean muscle mass. And then it's just so much easier for the body to put on excessive fat. And we know that having good lean muscle mass and exercising really keeps our insulin sensitive. and so that's one thing that people that slowly catches up with people and they become more insulin resistant over time. And, and you mentioned toxins. You know, unfortunately, there's been multiple, multiple toxins associated with this visceral adiposity.

So, I want to underscore what you just said. I want, Liz, I want to, I want to underscore what you just said. Yeah. Because you basically said something really important. Absolutely. Around muscle loss when you get older and, and muscle loss is really could be thought of as replacing muscle with fat. So you could be the same weight at 65 than you are 25, it'd be twice as fat. And that fat in your muscles, it's not just in your belly, is also this poor metabolic fat. And it leads to this increasing phenomena with all the consequences that we see of disease. So I feel like this is a really important thing that people understand. So exercise, basically strength training, building muscle and aerobic exercise, even interval training, will help improve metabolic function and help keep this insulin resistance at bay as we age. Because it is something that affects almost everybody as you age unless you do something actively about it. So let's talk about toxins.

You do have to work really hard at it, you know? I mean, it's so easy to maintain. Well, I don't know if it's so easy, but it's so much easier when you're younger to maintain your lean muscle and as you get older, it's really work. People are like, I do go for a walk every day. And I'm like, it's not enough for you right now. And getting in two days a week where you really are working on resistance type exercise, there's so many ways you can do that.

That.

Really can make a big difference. So, yes, so toxins. BPA is a toxin that's been unfortunately associated with with visceral adiposity, fatty liver metabolic syndrome. And BPA, bisphenol A, is that hard plastic that is pervasive, unfortunately, in our environment and has been associated with breast cancer, but it's also been associated with insulin resistance. So I think it's important that we recognize that there are a lot of toxins out there that are impacting our insulin sensitivity and possibly through how it damages our mitochondria and there's more to it sometimes than just our food intake. And we always really have to dig and look for that when we're working with our patients.

For sure. We call these things obesogens. They're petrochemical toxins. They're even heavy metals I've seen. So we really have to be alert to people are not losing weight and they're not successful doing the basics stuff of diet and lifestyle change. What else is there? And there are other things. like the microbiome. So maybe we can share a little.

Bit about that and what we're learning. The microbiome, I think, is so fascinating, right? I mean, there's so much information there that we're learning, and there's going to be so much more that we're going to learn over time. And I don't think we have it obviously all figured out, but we know that there's certain bacteria in our digestive system that are associated with less inflammation and a healthier weight. And there's certain bacteria in our digestive system that are associated with more inflammation in the body and having an easier time with weight gain.

So.

It'S fascinating, the association between the microbiome and this whole process of insulin resistance. And so, you know, when somebody comes in and we're trying to figure out what's going on with them, we want to work on all angles here. And, you know, we want to ask those questions of what's going on in your digestive system. is, you know, how are your bowel movements and how do you feel after you eat? And are there foods that you're not tolerating? Because we can work to manipulate that to help improve somebody's metabolism.

Yeah. And also, you know, anything that causes inflammation, right, could cause weight gain. So people might be having food sensitivities that are causing it, or they're exposed to mold in their environment. or they have latent infections. Yes. Because anytime there's inflammation, it drives insulin resistance independent of the cause. So the biggest cause, just, you know, not to get too down on that rabbit hole of these things, the biggest cause, obviously, is sugar and starch. Those are the two biggest things that are driving inflammation. But there are a lot of other things that people need to think about that also do it. Now, people listening might be going, okay, yada, yada, yada. Okay. All this great science about belly fat, what it does and why it's bad and how to test for it and, you know, what causes it. But how do I get rid of it? Is the big question. How do you actually get rid of it?

And.

I think it's so gratifying practicing functional medicine and at the Ultra Wellness Center where we work, it's so gratifying seeing this because this is one of those kind of slam dunk, idiot proof things for most people. And it happens so quickly and it's so striking because people are always struggling with this I'm like, well, if you understand biology and how the body works and how it functions, which is really the foundation of functional medicine, which is understanding how to work with the body rather than against it, you can drive these biological changes really quickly and, and really change the quality of the fat dramatically. And the, and the fat, and just give you a quick example, and then we'll go into what to do about it. This is one of my favorite studies that I've read recently is a study looking at gastric bypass basically they said, well, you know, gastric bypass works because it causes all these, you know, amazing changes in hormones and appetite and blah, blah, blah, blah, blah, blah, blah. So there's all these theories about why it works. Well, somebody decided maybe we should test this theory. So they took a bunch of people who are really overweight and they gave them gastric bypass on half of them. The other half just ate the diet that the gastric bypass people ate after they had the surgery. and there was no difference. But very quickly, within days of changing their diet, the quality of their fat changed, and it went from being inflammatory fat that's driving all these problems to really shifting that. And so it can happen pretty quick. Even if you're still a little overweight, you can still have the metabolic and health benefits. And, of course, you still need to get the weight down. But I think it's just an interesting phenomenon. So I kind of love that. study. So let's talk about, you know, what, what do you do and some case studies that you've had that really sort of illustrate the ways in which we can use this strategy of, of function and science, functional medicine, the science to drive real change for these patients in their, not only their, their belly fat, but all the other biomarkers and health issues and consequences that come from having this belly fat.

Absolutely. Like we were talking about the visceral adiposity, that belly fat is associated with high levels of insulin in the body and insulin resistance. And that means that the body isn't listening to its insulin as well as it used to. And so that high level of insulin, as you mentioned earlier, causes us to store calories and to just gain weight. It makes us more hungry, but it also makes it much harder to lose weight. So one of the things we really, when you were talking about, okay, how do we really work with our physiology? is we want to prevent insulin spikes because we know that higher levels of insulin are what's really driving us to gain this visceral adiposity. And so, as you mentioned, it's those refined carbohydrates and sugars that drive up insulin levels in the body. And we know that if we just ate just fat, we wouldn't secrete a lot of insulin. And protein, we secrete some insulin, but not as much as with carbohydrates. so what's really important is bringing down the percentage of calories that somebody's getting from carbohydrates, especially the refined and processed carbohydrates that cause that insulin spike. And so I always talk to people about that having that balance of the, you know, good healthy fat and some, and lots of fiber and some protein at every meal and just pulling away the simple sugars and refined carbohydrates because that brings the insulin down and makes us less likely to hold on to that weight around our belly. So that's really the first area we always work on. And, you know, we can dive into a couple cases to as examples.

So this is really a great point. So basically the key to this is keeping your insulin levels low because as long as your insulin levels are high, the body really has a one-way street of fuel into your fat cells. So basically insulin locks the fat cells in your belly and prevents the breakdown, we call it lipolysis, they're the breakdown of this belly fat. So like you said, how do you cut insulin levels? Well, you've got to cut out the starch and sugar, especially if you're an extreme case, if you have a lot of belly fat, you really need to be more strict, like no sugar, grains, beans, even some fruit. And then as you start to become more metabolically healthy and resilient, you can add things back. But it's really key to be really religious about it. And also, there are other factors like artificial sweeteners that are driving this and there are other carbohydrates we might think are okay. We're eating whole grains or eating whole wheat bread or eating, but they may not for people who are really insulin resistant. be helpful. And what you also said was so important about fat. Fat doesn't cause any spike in insulin. And you see this phenomenon, and this is just a great story I learned from David Ludwig, who's a professor at Harvard, one of the greatest scientists in this field. And he said, Mark, if you were to take a type 1 diabetic, and this is very different than type 2, which is basically from eating sugar and starch, type 1 diabetics have an autoimmune disease that damages their pancreas. They cannot make insulin. So the presenting symptoms, and every doctor learns this in first year medical school, are they're hungry all the time, they're peeing all the time, and they're losing weight. So they could be eating 10,000 calories a day and lose weight. Why? Because there's no insulin. So that's really the key. And a ketogenic diet is the most extreme version, but there are a lot of other approaches to eating more fat, less starch, and the continuum of all that. So I I think that's really important. And protein is really important too. But if you eat too much protein, you can also get insulin spike. So light is a big problem. Light pollution.

Light pollution.

Exactly. I mean, there was a book I read years ago called Lights Out, which describes the advent of chronic disease and obesity with the light bulb.

Yes.

And how that affects our sleep wake cycles, how it affects our circadian rhythms, how it affects our hormones, how it affects our metabolism. which is something we don't really don't think about.

Exactly.

Especially in traditional medicine, we never learned about light.

Exactly.

But now, you know, there's, I mean.

And one of the best things that you can do, and I try to do this as often as I can, is early in the morning exposing yourself to light. So, darkness tells you to go to sleep. Light tells your body to wake up. And, exposing your eyes without, actually even without glasses, to the sun I'm merely a sun worshipper now. I sort of, you know, you know, sun gazing is very, very powerful for sleep.

You're blind, but you sleep fine. Yeah, right.

Yeah, you're blind, but you sleep fine. Exactly. But exposure to light shortly after you get up is one of the things that helps to synchronize and set your circadian rhythm.

Every morning, my wife and I, we get up and we take the cats for a walk around the yard. Yes, our cats go for a walk. They're well trained. Burmese cats. And, we literally walk around and get the sunlight and spend 20 minutes out there just walking around the yard. And, it's just so nice to get.

That sunlight in the morning. Exactly, yeah. And, you want to do it relatively early within 20-30 minutes of getting up and exposing yourself to the sunlight is.

Very, very helpful for synchronizing your body clocks. So, that's one reason that people are having so many sleep issues. And, what are other reasons people have.

Sleep issues other than the light pollution? Sometimes it can be medications, medication side effects. Some of the people are taking these stimulants, so I'm tired. So here, your doctor gives you Ritalin or Adderall, and then that is a stimulant and it's sort of keeping you up. Excess amounts, overuse of caffeine or having caffeine too late in the day. Some people are very caffeine sensitive and they can't have any kind of tea or coffee.

Yeah.

People in general, I'm going to say that if you have one or two cups of green tea, coffee, and it's early in the day, it's not going to affect your sleep. The half-life of coffee is about six hours. So in six hours, half of it's.

Out and then another six hours, a quarter of it.

Definitely nothing after noon, right? Exactly. Nothing after noon.

Exactly.

And most people, it's not going to affect them. And alcohol is a big sleep. Oh, alcohol is a big one. In fact, I was telling you about a case. So I had a patient who was eating late at night. That's another one. That's another one, right? Another one. And that actually, I think, also affects sleep also. Because when you're sleeping, you don't want to be digesting. You really want to be in a fasting state.

One is going to interrupt your sleep.

And two is going to make you fat.

Yeah, exactly.

That's basically storing it instead of metabolizing. That's how Sumos, right? The Sumo diet.

That's how Sumos get fat. They eat and go to sleep. That's right. That was actually a, that was actually a chapter in my book, one of my first books, Ultra Metabolism, was called.

The Sumo Wrestler Diet. Right, because the Sumos have a recipe for knowing how to put weight on. You eat and go to sleep. And, it was a simple patient came into me and they were eating late at night. It was like anywhere between 8 to 10 o'clock at night and they were having a couple of glasses of wine, which that sounds okay. Well, it was a combination of eating late at night and those two glasses of wine or alcoholic drinks, and very commonly, especially as you get older, maybe after 45-50, you'll get what's called rebound insomnia. So, the alcohol sort of relaxes you, whatever, but when it wears off, the brain sort of wakes up. And, I started to experience this myself when I started turning 45-50, and so I'm very aware of it.

So, any patient- so, you drink wine in the morning.

You drink wine in the morning, exactly. happy hours at noon.

So no coffee or wine after lunch. Yeah, right.

So one of the things that you do with patients is get them aware of their circadian rhythm, their sleep-wake cycle, the importance of light in the morning, darkness at night, and then also get them off for maybe two months of getting them off of all alcohol and all caffeine and sort of see where their baseline is. See where their baseline is. And then it's for them to decide how much and how often and when to have those things, which a good cup of coffee is pleasurable, a glass of wine is pleasurable, but too much.

Too late is not a good thing.

Yeah.

And there are other things that are sort of off the chart a little that people don't think about, but I had severe mercury poisoning and that really interrupted my sleep. So, insomnia can be related to heavy metals and toxins, for example. It can be related to thyroid problems. People have low-grade or low thyroid function, that can be a sleep disruptor, hormonal issues. Obviously, menopause is another one. Yeah, menopause. Even like blood sugar issues, people who are diabetic or pre-diabetic, they can get hypoglycemia in the middle of the night that wakes them up, they get night sweats and hot flashes. So, there's a lot of reasons people have sleep issues that are biological that you can fix.

And even nutritional factors, low magnesium and other factors can be really a big issue. Exactly, yeah. And it is interesting you say because there are some people who will have a very big cortisol response at nighttime. Cortisol is the adrenal hormone sort of your get up and go hormone. We're supposed to have cortisol rising as we wake up. There's a test that we do called the cortisol awakening response. How much does your cortisol rise as you get up? Well, there are some people that will have problems with cortisol secretion at nighttime when it should be really, really low. that's another thing that I think is the important thing that interrupts people's sleep is excess amount of cortisol stress hormone at nighttime.

Yeah, that's what my wife yells at me for reading a COVID-19 news at night before bed. She's like, you,'re not gonna sleep, man. I'm like, yeah, you're right. But you're right, you don't want to be watching scary things and stimulating things and get your adrenaline up before you go to bed. And, I think often we live a sleep-disruptive lifestyle. So, we eat late, we drink, we have lots of lights, we engage in stimulating activities before bed, 24/7 news, email before bed. We don't do things to wind down. Just having a simple sleep hygiene routine. I'm really ridiculous about this, but at least an hour, maybe even two hours before you turn everything off, off. You maybe I take a hot bath with Epsom salt. I put lavender drops in there because lavender actually reduces cortisol levels to lavender essential oils. I've made my room completely black. I have a blackout shade. Even have eye shades, earplugs if you need them if you live in a noisy area.

Yeah, I use this when I travel.

Blue blocker glasses. So, there's a lot of ways to structure your environment so that it's really but make sure the temperature is right.

Yeah. You just, there's another, another clinical case. I had this older gentleman who.

He.

Was, had a whole bunch of different kinds of problems and had probably a little bit of early Parkinson's mild sort of slowing down. He's in his, in his late 70s. And he, on his own, you know, was, was found out that when he turned the thermostat down from 70 degrees to 64 degrees, he slept so much better. And again, that's the other thing is what happens to animals at nighttime, they're actually out in nature. And guess what? We're animals too. We're actually designed to be out in nature. And that lowering of the temperature also, I think, is very, very good for inducing sleep. And I actually think, this is my own sort of theory, is that when you take the warm bath and then you go to bed in a colder environment, that shift of the temperature differential, I just get very relaxed when I do that.

True. I mean, the best sleep I had in years was I would I was doing backcountry skiing with my daughter last year in Utah in the middle of winter, and you're climbing up, so exercising, getting up the hut. Well, you're sleeping in an unheated hut in a sleeping bag, and it's like 30 degrees or, like, it's freezing. But, you know, you got your hat on, you're like, I just have like a baby. And, and, and I, my wife and I have, this is a common debate. You know, she actually had a comedy skit about this, which is, I don't know how she has seen that. How to go to bed winter coat with a hat on. And so, we figured out this solution, which is this really cool thing called the Chili Pad. And, it's something you can buy, which you put, it's filled with water. It's like a water that goes through it and it cools it. It's like an air-conditioned water. And, I can have like 64 on my bed and she can be like 75 on the other side. And, it's the best. And, I use that and I sleep great because in New York, when I had an apartment, the radiator was on. I couldn't control the temperature in the winter. You open the window, it's too cold. Yeah, exactly. So, I had this thing and it was like the best invention ever. And they have ones with different size, you can switch it for the guys and girls. So it's really important to get the temperature right. So there's all these really simple hacks. So I think it's really important for people to think about how do they optimize their sleep? Because why is sleep so important and what are the consequences of chronic sleep deprivation?

Sleep deprivation is obviously one of the things is that if you have sleep deprivation, you get angry and irritable. You're very irritable. It actually affects the amygdala part of the brain, the primitive part of the brain that's a sort of fighting kind of a thing.

So when you see people who are chronic- Was America sleep deprived? Is that the issue here?

Yeah, yeah. Is that hour or so hostile? We might even have the POTUS might be sleep deprived. Well, we know he is. Yeah, yeah, he could very well be. And so when you don't get good restorative sleep, you know, they say that, you know, seven to eight hours is ideal. There are some people who need more, there are a little bit people who need less, but most of the time you want to ask, I ask my patients, when you wake up, do you feel like your batteries are charged or do you feel refreshed? That's really, I think, the key thing. And also looking at patients, how quickly can they fall asleep? It's not how much time you're in bed. It's like, can you fall asleep relatively easily? I had a patient the other day who it takes me two hours to fall asleep.

Oh my God.

Why is that? Okay, then you got to go down the laundry list. What are you doing at night that may be impairing that? And then you just need to have that good sleep hygiene. It's key.

It's so important. And I think, you know, we know chronic sleep deprivation affects your mood, causes depression, it affects your risk of, for example, dementia. Your brain can't clean yourself.

Exactly. You just brought the next. The next thing. And the danger of that is that what we found out is that our bodies, our brains, are about two percent of our entire body weight, but they consume 20 of our energy in the body. So they're highly metabolically active, which means that they also produce a lot of metabolic waste. Yeah. Exhaust. Basically. Exhaust.

Yeah.

And the garbage. And guess what? Your brain takes out the garbage at night. So if you're not getting good, deep restorative sleep, you can't clean the the brain. There's a whole system in the brain called the glymphatic system, which is the lymphatics of the brain that allow you to take those metabolic toxic waste products out of the brain. And, what happens is they sort of open up at night as you're sleeping. And, if you are not getting good sleep, you're basically not taking the garbage.

Out of your brain. Just like not flushing the toilet in your brain. Exactly. Exactly. You know what? For what?

Exactly.

So, yeah, this is really important. So you get, you get increased risk of brain inflammation, increased risk of dementia, increased risk of depression. Your, your cognitive performance goes way down. Yeah. Which is striking. You know, I remember the study I saw of Sharpshooters, like, basically, you know, snipers. Yeah. And they're, you know, accuracy was like 99 when they were awake with eight hours sleep. And then seven hours, maybe it was like 97. Yeah. And then six hours, like 80. 5 hours was like 50%. It was like a coin toss.

Are they gonna hit the target or not? Exactly. And then also, the sleep deprivation is worse than alcohol. You're actually more mentally impaired with sleep.

Deprivation than you are being drunk. Yeah, I get that for sure. And I think we have to understand that sleep is not a nuisance or a waste of time. It's something to be cultivated and optimized, and it's critical to your health, your immune function, we're now in this age of COVID-19 and sleep is one of the best things you can do to make your immune system more resilient. So making sure you get enough sleep and understanding how to create the structures for you to sleep well. And then, you know, for those people who are not getting better on the sleep front, even trying all these cool techniques and things we talked about, whether it's the blue blocker glasses or getting their sleep hygiene right or maybe me be using a chili pad and their temperature, right, all stuff. If you're not getting better, there may be other reasons for it. And that's where in functional medicine we dig deep. We find heavy metals and thyroid issues, gut issues and nutritional factors that may play a role in sleep disruption.

Yeah, and the other thing, which, and this is something that's probably not on the radar of most doctors and even also integrative doctors is EMFs. So if anybody's gone camping, when you're camping out in the wilderness, guess what? You are not around electrical.

Yeah, that's what happened to Utah.

So it didn't have any EMS around. Exactly. Yeah. Yeah. So, so. And when you go out, can't, can't actually going camping for a week will help to reset your circadian clock. And I also believe that when you're camping, you're earthing, you're grounding, and you're actually on, on the ground, literally. And you also are not surrounded by EMFs. And I do know that EMFs affect our bodies in many, many ways.

And I, I, that's not all hype.

It's not hype at all. I mean, our body, when we measure an EKG, we're measuring electrical signals of our heart. We're measuring an EEG, we're measuring electrical signals of our brain. So our brains are our bodies are bioelectric beings and we interface and interact with energy signals, whether it's light, sound or EMF vibrations. And without question, they can affect our physiology. There's been evidence that EMF exposure can predispose towards more autoimmunity. and I do know that when you sleep and you ground yourself, you will sleep better. My theory is I think it's related to the fact that when you're in a building, you're on a lot of EMFs.

Yeah, my wife got into this. In New York City, she got one.

Of those EMF detectors. Yeah.

And it has this score on it and you can see the green light is okay, yellow caution, red is severe danger. In our apartment in New York, it was severe danger all the time. And then we brought it close to our phone or other things or to the Wi-Fi, it would like kind of explode. And she decided she wanted to protect us and she basically created a Faraday cage around our bed. Essentially got a special kind of cloth that blocks electromagnetic frequencies, a special grounding sheet. She hung it over our bed. And if you go in there, you can't make a cell phone call, you can't get on Wi-Fi. You're like, It literally blocks everything out, which is really amazing. So, we started using that in New York because in New York there's so much. You go on anybody's router and you'll see there's hundreds of Wi-Fi opportunities.

Yeah, and without question, it's not like you can draw a blood sample or get a urine sample to check EMFs. It's one of those things where you need this special device. And, this is not voodoo stuff. This is not wacko, crazy stuff. This is real stuff. stop. Our bodies are affected by electromagnetic.

Some people have more sensitivities. Absolutely. They're just like everything. You know, people are more gluten sensitive, people can more EMF sensitive. And I think there's a wide variety.

Of how people respond. But if you're struggling, these are the kinds of things to think about. So. And, and you think, you know, what do psychiatrists do now, nowadays, to treat refractory depression? They use pulse magnetic field to the brain.

That's, that's an energy.

It's an energy signal. Right. They don't even know how it works. They just do it. It's like they used to do ECT where paralyze you. And then this is a more modern version.

Exactly.

It's a more modern version. Exactly. And, but it really shows you that our bodies have an interaction in some type of complex, energetic fashion with our body. Yeah, it's so important.

I think, I think we see so many people struggle with sleep. They don't prioritize sleep. They don't understand how to get their bodies to sleep. They don't understand what their bodies require. You know, all the things we talked about from dietary things, whether it's, you know, getting off of sugar and I mean, I have so many people do what we call the 10-day reset, which.

Is like a lot of patients love it.

And what's amazing is they report, I might be sleeping better. You get off alcohol, you get off caffeine, you get off sugar, you clean up your diet, and all of a sudden your hormones start being regulated properly. Your brain chemistry and your neurotransmitters start getting regulated and back in balance, and you start to sleep better and you.

Feel better and you have more energy. And it's like, wow, who knew that all these things were connected? And then the other thing, this is a very important thing is, and this ties in with the coffee because you and I enjoy a good cup of coffee. of coffee. The interesting thing about how coffee works is that coffee blocks adenosine receptors. And, you were talking earlier about ATP. So, the fuel of our body is ATP, adenosine triphosphate. So, there's three phosphate groups attached to this molecule. And, as we go throughout the day, ATP gets degraded into ADP, which is two phosphate molecules, and then to adenosine monophosphate, and then to just plain old adenosine. As our bodies, and the more you exercise, guess what? The better you sleep. The reason for that is our body has a buildup of adenosine. So as our bodies go throughout the day, we're active, physically. It's good to get more adenosine. The adenosine will slowly build up and then in certain parts of the brain, that triggers the sleep mechanism. Guess what? If you look at the structural molecule, the caffeine fits into the adenosine receptor.

So that's why it prevents us from feeling tired. Okay, so I just got this new espresso machine. Does anybody in the market for a new espresso machine? So, how about decaf? Is that okay?

Yeah, so that's, but again, caffeine can definitely, and actually there's actually some interesting thing with coffee intake, epidemiologically, a couple of cups of coffee actually have preventive effects for Alzheimer's and Parkinson's. so it's not all bad.

It's not all bad.

And the one thing I was going.

To say was the dose and the timing.

It's the dose and the timing, like anything. And the other thing that's really, I think, important with coffee is to make sure it's organic because that's one of those highly sprayed things like strawberries. You don't want to eat if they're not organic.

Coffee is one of those things. You just don't touch it unless it's organic. Yeah, very important. And there's some great companies out there that do this. Purity Coffee is a great one. I encourage people to check that out. And I think, you know, we are a society of sleep-deprived people. we think sort of lack of sleep is a badge of honor. I certainly learned that in medical school. We don't learn how to prioritize sleep, how to practice sleep hygiene, how to identify the things as a practitioner of how to help people sleep. We give them medications. And sometimes medications can be helpful, but they really do create a vicious cycle and a problem.

Yeah, exactly. You're totally right. In fact, there was an article recently that came come out with the chronic use of these benzodiazepines, increasing your risk for Alzheimer's. So, the sleep medications, things like triazolam and Ambien and those types of things, when you use them chronically, there's actually been an association with increased neurodegenerative conditions, even some of the anticholinergics, which are also used for. So, you really, yeah, you want to use them very carefully and judiciously, and there are some patients that may have some esoteric sleep disorders, things that we don't quite understand that may need chronic use of those things. But by and large, those things are to be used for a brief period of time. And then you do, there's a lot of other things that you should have in your toolbox to treat. And we do that at the UlTrawana Center.

We use melatonin, we use magnesium, we'll use things like GABA, glycine, theanine, glycine, we'll use herbs. like Valerian, Passionflower, Hops, and we often see real improvement with these just simple treatments.

What I realized is actually I do, I have a much more important goal than I've ever thought of before because those other goals were quite arbitrary. How fast can you ride 40 kilometers on your bike? Or can you swim to Catalina Island? Those are interesting but quite arbitrary. But a much more interesting goal to me is how could I be the most kick-ass 100-year-old to make sure that when my kids are in their 60s and their kids are in their 30s and their kids' kids are the age of my kids today, what is the life that I imagine living? And I mapped out 18 things that I need to be able to do physically to feel fulfilled.

Wow.

Yeah.

Very, very specifically. Okay. I need to be able to carry four bags of groceries up a flight of stairs. Pardon me, four bags of groceries up four flights of stairs.

All at the same time. Yeah, carry four.

Because I could do that today, and I love the fact that I don't have to take an elevator to walk up to my apartment. Okay. Like I like that.

I need to be able to get up off the floor. Which you have to do in New York, by the way. We have no elevator in our building.

So you have to walk up the stairs with your groceries and your luggage.

Yeah.

I need to be able to get up off the floor using a single point of support. And why do I realize that? Because I realize my boys, who are two and five, we play on the floor a lot. We're playing with stuff and I have to come to their world. They're not going to come sit at the table and play with me. I have to get on their floor and play with their toys there. And I love doing that, but you have to be able to get up after doing that. And how many hundred-year-olds do you see that can actually stand up on their own with a single point of support? Or even get up out of a chair. That's right. I have to be able to put — which, by the way, is why most people end up in a nursing home.

It's not because of a disease, because they can't get up out of a chair anymore. More.

Yeah, this — this what I call — well, there's a whole larger discussion, but I'll give you a few more. So I have to be able to put a 30-pound bag in an overhead compartment of an airplane. In other words, I want to be able to travel through an airport and actually put my stuff away. And I noticed I travel a lot, and I noticed how many people can't actually put their bag up or take their bag down. And I just don't want to be that guy. And not because they're short. No, no, it's just like there's something wrong. Their shoulder, their back, something like that. Their neck, neck. I want to be able to pull myself out of a swimming pool without stairs. So you gotta be able to lift yourself up. So anyway, I've got 18 of these things. And look, they're subject to change. I'm sure I'm going to think of other things, but they basically come down to a level of physical exertion that I want to be able to have. And by the way, there's a lot of things I'm not going to be able to do when I'm 100 that I can do now. Before we started this, I was showing you some pictures of places in Hawaii where we're hunting, and some of the terrain is the most complicated terrain in the history of the world. I mean, will I be able to hunt like that when I'm 100? Probably not. And I'm willing to accept certain things, but these 18 things became my bottom line. Like, I want these things. And now, even though I'm only 46, that gives me 54 years to train to do that. And each of these things then projects back into milestones. So if you want to be able to do those things I just described when you're 100, you do what's called backcasting. well, what do you need to be able to do when you're 90? And then what do you need to be able to do when you're 70 and 60 and 50? So right now, I'm very fixated on what the 50-year-old version needs to be able to do to make sure I hit those 18 things when I'm 100. And so that becomes the centenarian Olympics, is this event that I'm training for. So I now do have an event in life and it requires a totally different way of training. And it's totally foreign to me. well, it's a much, much greater emphasis on stability, which gets virtually no attention. So Mobility is the big buzzword. Everybody wants to talk about Mobility this, Mobility that, flexibility, balance. All of those things matter, and they're all a subset of stability. But stability is the thing that most of us have lost generally by the time we're five. So if you look, I'm lucky. I have a two-year-old so I get this beautiful first-hand view of amazing movement is meant to look like. And when you look at the things that they can do, you realize that every inch of them is connected. So when they're moving their arm, when they are doing something on the floor, when they're rolling, when they're turning, everything is connected. They are transferring force across their body through the muscles and not the joints. And then something happens. I mean, there are a lot of things that happen that I won't get into just for the sake of time, but one of the biggest insults is we start doing things that sitting down. Yeah, once we start sitting, we lose our connection to our pelvic floor. And it's this cylinder that sits within our body from our diaphragm to our pelvic floor and around all of the muscles that, you know, line this tank. As we lose that connection, all of a sudden we start to lose the ability to connect what's happening here to what's happening here and what's happening here to what's happening here. And all of these chronic injuries start to crop up. So both on a personal level, I've experienced, I mean, what I can only describe as the most remarkable transformations in terms of my own physical health, without relying on surgery to fix injuries that I've- Like what?

What do you do to fix- oh.

I mean, I have torn labrums in both shoulders that at one point left me completely unable to do even one push-up. My elbow was in such debilitating pain that I could I could barely, I mean, I could still function, but I was basically in pain 24/7. And of course, to learn that that was coming from the inability I had to stabilize my scapula. So anytime I was doing anything that was pulling or pulling up or carrying anything, it was transmitting force all to this joint as opposed to these huge muscles we have here that were designed to transmit that force. Pain up, I figured out a different.

Way of training and figured out a.

Totally different way of training. And so now we're actually bringing this our patients.

Is this like Pilates or strength training?

I would take a broader step back and say, do you know who Bruce Lee is? Remember Bruce Lee? Yeah.

Yeah.

So, the karate guy.

Yeah.

Yeah. So one of the things about Bruce Lee that I just always idolized was this system that he created called Jeet Kune Do. So Jeet Kune Do, the way of no way or the way of the intercepting fist, was this martial art that he created where he took something to the tune of 30 different martial arts and he in his own words, extracted what was useful from each of them and discarded what was useless. So to create sort of this unbiased view of what he was trying to optimize for, which was self-defense. And so this approach that we're taking is the same one, which is you take little pieces of yoga, Pilates, lots of pieces out of something called dynamic neuromuscular stabilization, all sorts of different training programs, and we're sort of building a protocol around how does one regain stability in the core, in the hips, in the scapula, in the neck, all of these areas. And so through that, then you learn how to transmit force correctly. And now you do the strength training, you do these other types of training that are necessary. So basically the four pillars of preparing for the centenarian Olympics is the stability piece, the strength piece, the aerobic piece, which is the mitochondrial efficiency piece, and then the anaerobic piece. so lots of things that are missing from that. This threshold training is not a part of it. Because I actually think- You- like going super fast.

Interval training?

Interval, yes. Basically where I think most people are training incorrectly for longevity is you have super high intensity interval training like a Tabata, something like that, and then you have this sort of what we call zone two aerobic base training. A lot of people are spending too much time right in the middle. and they're, so they're not getting enough of the benefits here or here. And, you know, I think that, I think there's a lot of emerging data. James O'Keefe, I'm sure you know Jim's work, cardiologist, you know, looking at sort of athletes heart stuff, you know, higher, you know, we were seeing athletes that are seven to 10 times more likely to get atrial fibrillation.

Yeah.

And, and again, I think that's largely the result of spending too much time at that sort of sub-threshold area, which is, again, that's important if you're trying to win a race. I'm not saying that that type of training shouldn't be done, but you have to be clear on your objective. And if your objective is to win a race, then you have to train at that zone. But if your objective is to do.

All these things that I have on my list of 18, which is more.

Functional life, physical fitness.

Right.

Physical fitness is incredibly efficient mitochondria, incredibly fit aerobic base, with the capacity to take very hard short-term bursts.

Amazing. Okay, so back to the other aspects of the centenarian. So it's not just the physical part, it's all the- Right, so the physical.

Piece is one part of it. Then so we talk about sort of physical or exoskeleton demise, and then there's a cognitive piece, and then there's an emotional piece. And so I think the three parts of health span than our physical, cognitive and emotional. But doesn't the physical also depend on nutrition? Oh, yes, yes, yes. Remember, these are the objectives. So I'm talking about the outcomes, right? Yeah, yeah, yeah. So you have, I sort of think of the five tactics that we have, right? The nutritional piece, the exercise piece, the sleep piece, the distress management piece, the drugs and supplements. Those are your tools to affect change. But ultimately, what we're trying to do is enhanced longevity, that means delaying death by delaying the onset of chronic disease and then enhancing health span by enhancing that exoskeleton, cognition, emotional health.

So one is not getting the bad stuff that's going to kill you and the other stuff is how do you supercharge your system to function optimally?

Yeah, because — and they're kind of related, but — They are, but they do require very — each of those four axes require very deliberate attention. the not dying part requires attention. And basically, you're gonna die, if you're a non-smoker in the developed world, you're very likely to die from atherosclerosis, cancer, or an accident. And again, you can dive into what those accidents look like. This is where you see an intersection with the physical centenarian Olympics piece, right? What's the leading cause of death overall? It's accidental death. but when you leave that to people who are in their ninth decade or eighth decade, it becomes accidental falls. So a fall becomes a more likely cause of demise when you get older. And as you sort of alluded to earlier, it's not always that you just fall and die. It's usually that you fall and you break your hip, and the broken hip results in immobility that very quickly begins to spiral your quality of life, and you end up in the nursing home and all these other things. so it's fighting all of these, you're sort of fighting all these fronts, which is why I think one should be paying attention to every possible tool they have to make this change.

So in terms of the food part of healthy aging and getting to 100, you talk about a lot of different techniques, whether it's intermittent fasting, calorie restriction, fasting itself, ketogenic diets, all of which seem to do really amazing things. which are all similar, whether it's boosting your own stem cells, helping your mitochondria work better and clean them up, increase your antioxidant levels, reduce inflammation, boost your hormones that need to be boosted, reduce the ones that need to be reduced. It's pretty amazing when you start to look at these mechanisms. How do you parse what's the right approach for the long term? And you earlier mentioned that you fast. So you do a ramp up to fast with keto, keto, and then you fast for a while.

A week and then come off it with a keto diet for a week. So, it's like KFK, we call it KFK sandwich. So, a week of keto. KFC. Yeah, I missed me some KFC. So, yeah, a week of keto, a week of fasting, a week of keto. I do that quarterly. And so, again, I think with nutrition, I like to take a big step back and say, what are we talking about here? So, I sort of start at one side and I say, there's this thing called the Standard American Diet and I think we we can all agree, no matter what your dietary bent is, we can all agree the standard American diet is not a good diet. I don't think we need much more evidence of the futility of that. So then the question becomes, how would you escape the gravitational pull of this thing? And in my practice, I think there are two ways, there are two techniques to get people out of that pull. One of them is is dietary restriction. And dietary restriction is anytime you restrict some element of the diet. So it's taking away carbohydrates. Yes, taking away some part of the what. So you're not really restricting the when and you're not restricting the how much, but you're restricting the what. So this has the largest number of things in its bucket, right? So this is a low-carb diet, a low-fat diet, a Mediterranean diet, a paleo diet, a vegetarian diet, a vegan dibloa. You need scientific notation to count the number of things that fit in that bucket. And they all get termed diet, which I sort of don't find typically appealing. The second major way to get people to escape the gravitational pull of the standard American diet is time-restricted feeding, where you don't restrict explicitly what they eat or how much they eat. You just restrict when they eat and you begin to compress that window of feed. eating. And those two things are not necessarily done in isolation. You can then start to combine those things and say, well, because we're going to see any form of dietary restriction, almost without exception, is an improvement over the standard American diet, which is why I sort of get a kick about these warring feuds that exist in these camps. My paleo diet's better than your vegan diet, and blah, blah, blah. The answer is they're both infinitely better than what you were doing before. And by the way, they be infinitely idiotic, right? So the paleo brownie and the vegan cookie are equally bad. Of course. But you can take the best of both worlds. You can take sort of the best of dietary restriction and combine it with time-restricted feeding and then you get an even more potent tool. And then you move from there into intermittent fasting, where you take these periods, in my opinion, sort of three days is the minimum effective dose. Five days is probably the sweet spot. sevent days is also with benefit and totally doable. And you either fast in a complete way, which is my preference personally, to just water only for those periods of time or in a hypocaloric way.

Like the Prolon fast.

That's right. So Prolon is one example of that. It's something called a fast mimicking diet, I think is their trademark name, for a hypocaloric five-day fast.

Yeah.

And obviously there's an infinite number of permutations and combinations to how you would go about doing intermittent fasting. And again, we usually by the time a patient's been with us for about a year, we are really pushing them into that world where they're going to be spending some time doing that. Not all year long, but for periods of time.

Well, by definition, not all year long.

Of course, yeah, it's intermittent by the nature of its name.

But intermittent fasting you can do every day.

Well, no, I refer to that as time restricted feeding. And that's why I really like to be strict about the terminology. So time restricted feeding isn't really a fast. It's just not eating for certain periods of time. We reserve the term intermittent fasting for fasts of three days or longer. Or if not outright fasts, hugely reduced caloric intake.

So do you think people should do time restricted eating every day?

I don't know. This is tough, Mark, because I think one of the challenges, remember how I said if I could be zaar for a day, I would change dinner time. yeah. I haven't eaten yet today. What time is it? It's almost seven o'clock.

So I know we gotta go.

And so this will be my only meal today. But the problem is, so I'm gonna eat a little more than I normally would because it's, you know, it's the only thing I've eaten today. And I know that that's actually not great for my circadian rhythm. It's actually, I'm gonna pay a little bit of a price when I sleep tonight because let's say I eat dinner at seven tonight and I'm gonna eat more than I normally would. And let's say I go to bed at 10. I just know that my body works best if I've got a much bigger gap between when I eat, especially a large meal and when I sleep. So, no, I don't think everybody should do this every day. And in fact, I like to mix it up quite a little bit. And I actually, I really love to mix it up and reverse it and sort of do all of my eating early in the day, especially when I'm in New York because I don't have my kids here and my family's not here, so I don't have this pressure to like, you know, having dinner with.

Your family is a really important thing. The problem is in America, you know, most breakfast is dessert.

Well, yeah, but I mean, we can work through that, right? I mean, I'm confident that a committed individual can have a good breakfast, but the bigger issue is the social one, right? Like so much of our lives revolve around dinners and that. But I think time-restricted feeding very likely has benefits. I think it's a bit soon to tout the magnitude of them because so much of that research has been done in mice or other animals, and especially in mice. As you know, the metabolism of a mouse is so different from ours. So the benefits that you see by giving a mouse a 16-hour fast are unbelievable. But that's not the same as you or I going 16 hours without food. That's probably closer to you or I going two to three days without food.

Yeah. So for you, what does your day look like? How do you construct all the things you've learned about these five pillars of health and longevity? how do they integrate into your daily life? You're a busy guy. You have practices on two coasts. You have a family. You're sleeping around. You're doing podcasts. How does it work for you?

You know, I was just talking about this with my assistant this morning because I was sort of. Or maybe it was yesterday. And I sort of said, you know, I haven't meditated in a few days, and I really feel the difference. Like, I'm really, really snippy and grouchy and. Just generally kind of a jerk. And she's like, you know, she's like, look, Peter, you just need to be more disciplined about this. You're so disciplined about, like, you never miss a workout. You're really disciplined about, you know, all these things you do. You're very disciplined about your archery. You know, you're up there practicing twice a day, every day when you're home and blah, blah, blah. And she's like, you know, we need to get back to a routine that we've done in the past, which is we used to put your meditations on the calendar. And it was, you treated it like you treated an appointment. And I was like, you know, you're right. I've been, I've been a little bit out of my routine, which is, so for me, the right day is I wake up and I meditate before I do a single other thing, before I make a coffee, certainly before I look at email or anything like that. And over the past few days, I think I was just, something came up and so there's a little bit of an issue going on in my life and it sort of pulled me out of my routine a bit. But in many ways, I think the bottom line is these are all things that whether it's exercise, nutrition, meditation, sleep, you have to prioritize them. And people don't want to do these things. And one of the exercises I do with patients is I sit down and we look at the 168 hours in a week and look at where they're allocating time. And I say, look, I could say you run a hedge fund or something. I say, your whole job is capital allocation. You're an asset allocator. You take money and your job is to decide where to put it into which companies to generate the right profile of return, liquidity, volatility, etc. So you are an asset allocator. Well, I said, well, everybody's an asset allocator when it comes to an even more precious commodity than money, which is time. And this is one where we're all the same. We all get 168 hours in a week and you got to figure out how you're going to spend them. And I'm really committed to saying eight hours of those every single night are going to be for sleep. And that means I really want to get my seven and a half hours a night total at least of eight hours in bed. and that's a sacrifice. Because there's a lot of times when I'd like to stay up and watch a movie or screw around on Twitter or whatever. You can pick a hundred things that you could do, but I'm really committed to allocating that time. And then you sort of go through this and say, well, for example, using food, how much time do people really allocate to thinking about food choices? Because you have to be kind of deliberate about it. It requires, for me at least, surrounding myself with good food choices because I actually really struggle with food. If left to my own devices, Mark, I could just eat nonstop junk food all day, every day. And so the reason I don't is not because I have some great discipline. It's because I surround myself with good food choices. It's like the worst thing I can possibly eat in a moment of weakness is a piece of dark chocolate. You don't have it in the house.

I don't have Ben and Jerry's Chunky Monkey in my freezer, because if it was there and I had a long.

Day and I was tired, I would eat it. Me too. And I think it's okay, I think people need to start accepting the fact that it's okay to say that that, like we are humans and we're not perfect. And to me, this is why I love sort of behavioral economics and the work of Richard Thaler and others is you change the default environment. And that's where you wanna put your bandwidth. That's where you wanna put your energy.

Is change your environment.

Change your environment so that you don't have to constantly rely on willpower to eat a certain way or to do a certain thing. So basically my whole life is basically one big hack that tries to make eating, sleeping, meditating, doing all the things that matter to me as frictionless as possible so that when there is friction.

I'm — Make the easy choice. I used to be vegetarian too, and I loved sugar and starch and bread and pasta. I bought into the whole low-fat movement.

And, you were doing it for health reasons? You were vegetarian because you thought that was healthier.

Health reasons, yes. And, I thought this was the way to go. And, it's interesting now that I've sort of cleaned up my diet and got rid of the starch and the sugar for the most part. If I look at pictures of myself without a shirt when I'm 30, I'm way scrawnier and kind of flabbier than I am today at 60, right? Yeah. And I don't do that much exercise. You know, like, if I'm in the gym, like, five times a month, weightlifting, that's a lot. Right. You know, I do yoga, I'll do other stuff, but I just, you know, just because I'm busy, I'm planning on doing more. Yeah, it's tough. Yeah. Maybe I'll get you to help me. You look like you know what you're doing. And, and I, and I, then I got very sick, and I started to sort of look at what I was doing and had to sort of shift. And as a science changed, I began to sort of look at, you know, because I, I think ideology is so problematic in nutrition. There are all these diet Wars. There are always people in conflict with each other. Paleo vegan, this that.

Yeah.

And it's kind of crazy because, oh, little religions, aren't they? Yeah, it is. But, you know, I, I said, let's get, let's get away from that because, you know, I, I came up with this term Pegan, which is a joke. Yeah. It was, like, paleo vegan. Yeah. And, and I, I just published this book, Food Fix, and it was number one in Paleo and number one in vegan books. Yeah.

And I think you're good.

Because we have far more in common with each other than with the standard American processed diet. So, you can be a chips and soda vegan, right? Or you can be a cheeseburger, whatever, bacon, paleo, but that's not necessarily either of them are good, right? It's more going towards whole foods. So, your question was, what would I say to people? I think it's really easy to just sort of start simply, you know, if you're eating industrial food, like stop doing that. If you look at the ingredients and you see refined flour, soybean oil, or high fructose corn syrup, just don't eat it. If you can, the next step would be look for non-GMO certified foods. Not because GMO, we know, is that bad for you. It may be, it may not be. There's a lot of controversy about that. But it's a form of agriculture that's a structure of the environment. And there's often other things in there like glyphosate, which is Roundup, which they spray on 70 different crops from canola to corn to wheat to soy. And that is definitely harmful for a microbiome. It destroys our gut bacteria, which affects everything. And it's linked to cancer. And there is a $2 billion lawsuit that settlement of the judgment about Roundup or glyphosate or weed killer. And so, just be aware that if you just stop those things, the quality of your gut, you're already making a difference. Yeah, you're making a difference in your body. Yeah, whatever you do. And so, those are really simple things we can do. And then, if you can, try to look at what you're eating. Is it whole food? I mean, is it something you can recognize? Like an almond or almond butter? It's not that many steps of processing.

Because most food gets processed in some way.

We cook it or.

Yeah, it's all got some kind of man intervention.

Yeah.

Yeah. But if you, you know, most of the time I just eat stuff that looks like what it is, you know, broccoli is a broccoli, you know, it's a fish to a fish, grass-fed meat.

Well, I was caught at what I said to him when, when we first started, when, when he was a pretty diabetic vegan sick man in Australia. I call it the, the of the Earth diet.

Yeah.

So if you're eating stuff that the Earth naturally provides, then you're never really in harm's way. How many steps did it take to get from the field to the fork?

Yeah, right. Exactly. If you can trace them all, okay. But if you don't know how it.

Got like that, then yeah, we've got a problem. The ingredients list is your ingredient, right? A sweet potato is a sweet potato.

A piece of chicken breast is a.

Piece of chicken breast. There's no ingredient list on that. Yeah, exactly. It is what it is. And I think, the, the other thing I found as well, which is important thing to talk about, I think, is how people who do make the shift, they have to go through a process themselves. Like, I know went through a process where I kept going back. I kept going, oh, I want that. I still, that addiction to that kind of food doesn't just disappear. I didn't do it overnight.

Yeah.

My wife always says this to me. She was like, you know, when I'm talking to people saying, you just do this, you just do that. She's like, Tom, you have to remember that you took two years probably to just not eat any of this stuff anymore. So your taste buds have to change. You have to give your taste buds time to make that change and really know what things taste like again. Like broccoli can taste freaking awesome.

Right, it's so true. When people get off that for a week even, and then they have blueberries, they go, my God, this is candy. And I think people don't understand how how hard it is because of the biology of sugar. It's not a moral failing, it's not that you're weak willed, but you cannot overcome your biology with willpower. It will fail every time. So you have to use science and the science of sugar is fascinating because it not only drives mechanisms that make you gain weight because it produces more insulin so it stores belly fat, it makes you hungry, it slows your metabolism and it locks the fat in the fat cell so it can't get out. It's like a one-way turnstile, you're not gonna can't get out. And, and when you look at the biology on the brain, it's even scarier. So in really well-controlled studies, they've shown that by looking at brain Imaging and blood tests, eating the exact amount of calories, protein, fat, carbs and fiber in a shake, like a milkshake, they just swapped out the level of the kind of carbohydrate so that one raises your blood sugar a lot and one does It's like a slowly digested starch. When they did that, they found that the brain imaging showed that the addiction center, which is stimulated by heroin or cocaine or whatever, gets lit up like crazy by the sugar and their insulin goes up, their blood sugar goes up, their adrenaline goes up. So sugar causes your adrenaline to go up, your cortisol, which is the stress hormone, so it literally creates a biologic stress.

The interesting thing that I wanted to add to volume this back to you, with your immune system, sugar is not.

The only culprit to lowering your immune system.

There are canola oils, there are what other foods?

Lifestyle as well.

Like I find, you know, like stress.

And fatigue and lack of sleep are ones that can drop it for sure. That's a cycle, is that like if.

You eat sugar, if you eat processed foods, then you don't really sleep that.

Well, they don't really move that well.

And it's just... Yeah, well the other part about eating a diet of processed food and sugar is it depletes your nutrients. nutrients, right? It actually doesn't have the vitamins and minerals and nutrients you need to metabolize stuff. So the people who are often the most nutritionally deficient are the most obese, which is kind of surprising. How can you be malnourished and obese at the same time? The nutritional density of our food is so important and processed food just doesn't have it and sugar depletes our nutrients like B vitamins. And so when you have low levels of zinc, and you have low levels of vitamin D and low levels of omega-3 fats and low levels of iron and vitamin A, your immune system can't function. So in the developing world, we know very clearly that the kids who die from diarrhea or respiratory infections or measles is because they're malnourished. If a kid's get measles who's well nourished in America, they're not going to die from it usually. But in the developing world, these kids die all the time from basic disease cause they're so malnourished. And I think we are a malnourished country. 90% of us are deficient. And so the best way to build your immune system is to eat whole food, cut out the sugar, make sure you take your vitamins, get enough sleep, like you said, deal with stress as a huge factor. And I think, you know, I think something simple like just meditation. Yeah. It's so powerful.

Yeah, it's a thing that doesn't have to be woo-woo, but it works.

We just don't talk about that enough. people just understand. And the fact that we eat about 152 pounds of sugar per person. Yeah. That's almost half a pound a day. Yeah. It's sugar. Well, it's hidden in every single thing that you could pick up.

When we were at the gym.

Yeah.

We go to the. The bar.

The.

The bar at the gym.

They have, like, a smoothie or something. Yeah. Oh, my God. Yeah.

Everything that is laid out that says.

Healthy, organic, gluten-free is so counterproductive at the.

And you know, everything you see in there, there's like signs for Coca-Cola in some gyms and stuff.

Yeah.

That's awful.

You go to those green smoothie things and you look at the label, it.

Has more sugar than a can of Coke.

Yeah.

I mean, that's just insane.

And then people become addicted to it.

Because they're like, well, I'm eating healthy. I'm drinking this healthy juice.

But what they're doing is they're spiking their insulin levels.

They're becoming addicted to this fruit fructose almost.

I'm sure that some of it maybe even is a hidden And there's so many different names for hidden sugars now.

There's like 200 names for sugar. If you Google names for sugar, you'll see it'll come up with a list of like 200 different things that you don't even know are sugar.

Yeah, that's one of the things that started me on the journey of like, I'm just not gonna eat anything that isn't whole food. Because I remember thinking, well, there's all this other stuff in there now. Like, I started off just being trying to avoid sugar. And then I looked at everything else. I was like, what is that? I can't even pronounce that, let alone put it in my body and think it's actually going to do anything good. So I started to just go, no, I can't put that in anymore.

I mean, the average American eats three to five pounds of additives every year. Yeah, it's really deliberate. And the biology of addiction in the food is not like an emotional response. It's not because you have no willpower. It really is hijacking your brain chemistry and your metabolism in ways that we don't really understand. And so, I've seen people within a very short time really transform that.

The food is medicine theory, there's so much in that and I think people can really take the steps forward in terms of a mindset. Because that's the thing, changing mindset is the first step. You saying this, it took a while from you and me chatting back and forth to really go, no, there is actually something in this.

Yeah.

And changing that mindset. So once you change that mindset and just keep driving that through of food is medicine, food is medicine, you'll see the difference. Simple as that. It's so easy really when you get down the road, but you've got to put the steps in place to actually get there. And that's not easy.

Yeah, something I teach all the time is that food isn't just calories, it's information. Yeah. And so are you upgrading your biology or downgrading it with every bite? Right. And it affects everything, your hormones, your brain chemistry, your immune system, your microbiome. And every aspect of your health is controlled by what you're eating. And it's literally like codes. It's like you're putting in malware into your body. Yeah, that's what it is.

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