Dr. Clay Moss: On Metabolic Health, Insulin Resistance, Peptides, & Sleep Hygiene | TUH #267

I think a lot of people relate aesthetic health to metabolic health. You can go years and years and have chronic disease even though you look good in the mirror.

You talk about how the most dangerous drug right now is comfort.

And the number one side effect of comfort is chronic disease. We live in a society where everything is becoming more comfortable to us, and yet we're getting sicker as a society, and I don't think that's coincidence.

When we talk about the basics to people about how impactful things like movement, stress management, community connection, and how food is medicine, they almost want to refute that because it seems like it's too easy.

There's so many things that we're living with in this unnatural world nowadays that if we just kind of get back to our roots a little bit, we can fix things one by one.

Can you talk a little bit about the importance of strength training muscle beyond just what we see in the mirror and why you think muscle is medicine?

To me, muscle is the root of—

Hey guys, welcome back to the Ultimate Human Podcast. Today I want to introduce you to someone who is redefining what it means to actually prevent disease. Dr. Clay Moss is a functional medicine physician who looks shredded in the mirror and was metabolically falling apart on the inside. He had strep throat 22 times in 4 years of college. His labs told a story his reflection never could. And that personal reckoning sent him on a mission to expose a hard truth. What looks healthy and what is healthy are two completely different things. In this conversation, we're going to go deep on fasting insulin, a biomarker that can predict disease 5 years before your doctor catches it. We're covering why strength training reduces mortality risk by 200 to 400%, more than any other drug ever created. And we're blowing the lid off the insurance system that is actively preventing you from getting the care you need. If you care about living longer, not just looking good, don't skip this one. Hey guys, welcome back to the Ultimate Human Podcast. I'm your host, human biologist Gary Brecka, where we go down the road of everything anti-aging, biohacking, longevity, and everything in between.

And I am so fired up for today's podcast because in, in the clinical world today, you have traditionally trained physicians that are sometimes, and for some reason, maybe a major life event, maybe curiosity, maybe it was because they had to solve a problem for a patient or something in their own life, or transitioning now to the functional medicine side, the root cause medicine. And today's guest is absolutely in that category. I'm a huge fan. We just did a whole podcast before we did the podcast, walking around the house. But welcome to the podcast, Dr. Clay Moss.

Yeah, man, thank you for having me. I've been a big fan for a long time, and let's see if we still have some content left in us after all that.

Yeah, I said this is going to be like one of the easiest podcasts I've done.

Because when I get people, uh, on the podcast like you, when I'm blessed enough to have, you know, real functional practitioners, um, especially those that have— I talk about this crossover from allopathic medicine, but it's an integration of allopathic medicine and, and functional diagnostics. You know, it's— I, I'm, I'm just such a curious person, and I'm curious on behalf of my audience. So I'm, I'm really pumped to run this for you today.

Yeah, man.

Um, you know, I notice in in, in your work and in watching a lot of the podcasts that, that you've done, you know, you, you talk a lot about metabolic health. And, um, and when I started, um, when I accepted the chairmanship of, uh, the Maha Action, Bobby Kennedy's Maha Action, uh, one of the things that, that astounded me was when we look at big data and you look at 85% of chronic disease, which is where the majority of our spending, our $5 trillion in spending annually, is going towards chronic disease. And you look at the spending on potentially preventable chronic disease. One of the things that constantly comes up is metabolic health and metabolic syndrome. And I wonder if a lot of people really understand what that means. Like when you say metabolic syndrome, to an average person, I think it sort of flies over their head.

Right.

So can you describe what metabolic syndrome is and what it means to be metabolically sick or metabolically healthy?

So I think the easiest way to describe that is, is the root cause of pretty much all chronic disease starts with your metabolism, your metabolic health. And what that is, at least in my eyes, the way I explain it to people, is the first thing you usually see in that is insulin resistance. So, you know, if we're eating ultra-processed food, high-carb diets, things that we really didn't used to eat back in the day, we're constantly flooding our body with insulin. That we have at very high levels that we didn't used to have. And that causes a whole slew of diseases that we're seeing rise at astronomical rates in a country that is more technologically advanced than it's ever been. Yeah, it's crazy because we're going up in so many categories and yet down in our health for the first time in history.

And the first time we've had a reversal in life expectancy in our recorded history was, was last year, you know, meaning like technically speaking, your children and my children have a shorter life expectancy than we do, right? Statistically speaking.

Yeah.

So it's frightening. Um, so metabolic health begins with, um, or, or metabolic, uh, disease begins with insulin resistance, right? You know, and I am of the school that, um, insulin resistance and high glycemic profiles are like the root of all evil, right? When you look at, like, you know, what are some of the first dominoes to fall in this whole consequential series of conditions? If I was to only pick one— and there's, there's, it's multifactorial— but if I was to only pick one, I would, I would agree that insulin resistance.

Yeah. And I even started to see this in myself when I was in college. So I grew up kind of with a human performance lens on medicine. I actually I was born and raised in the panhandle of Florida. The Andrews Institute, which at the time, and still is to an extent, the mecca of sports medicine, moved to my hometown. And so I'd be walking home from school and see these amazing athletes that you would only see on documentaries or live in games, you know, walking by my high school, or I would walk home and see them kind of through the, through the gate a little bit from the other side. And so I always grew up with this, this vision of human performance and how do I get there in the school of medicine? How do I become a physician and work in that avenue? And when I got into college, I had a complete identity crisis. I didn't know anybody in college. I started having panic attacks. I really didn't know who I was anymore. You know, I grew up in the same hometown. I knew who I was. I was an athlete. Everybody knew me. I knew everybody. And then you go to somewhere new and you're out of your element. You don't play sports anymore. Yeah. You know, you're trying to socialize. People don't know who you are. And I fell in love with weightlifting and that just kind of became my—

Yeah, you're pretty, pretty jacked. I have a lot of people more jacked than me on the podcast, but can we actually take him down a few notches?

Right. Yeah, well, AI edit this.

Yeah, yeah, little AI edit.

But the point I'm trying to make though is that I was still not taking care of myself from a baseline level. So even though I got so into weightlifting and athletics and quote-unquote aesthetic health. I had strep throat 22 times within 4 years while I was in college. Wow. So I was pretty much going to the doctor or the urgent care once every 2 months, getting diagnosed with strep, giving— getting antibiotics, getting a shot of steroids, and then being sent on my way, only to come back 2 months later and nobody asked about my sleep, my caffeine intake, what I was eating on a daily basis, the last, you know, how close to bedtime am I eating? How many days a week am I training? I was training 7 days a week. How, you know, I was having pre-workout at 5:00 PM, but I looked good in the mirror. And so I just assumed like, if I look good in the mirror, then this all has to be happening to me, not because of me or something that I'm doing, right? And so I think a lot of people relate aesthetic health to metabolic health. And I've come to realize that the mirror is a really poor judge of what's inside. And so we're trying to chase both aesthetics, because I do think there is some power behind looking good and feeling good, but also what's on the inside too, because you can go years and years and have chronic disease even though you look good in the mirror.

Yeah, I totally agree with that. And so when was it— was there like a eureka moment? Was it an aha moment, or was it sort of this slow transition from, um, traditional allopathic medicine to really wanting to be back at the root cause of, of medicine. Like, what was the— because you, you've really gone deep down the rabbit hole of peptides and, um, functional medicine, and, you know, what I would call the, you know, this, this new, uh, you know, surge in, in interest in longevity and anti-aging and bio-optimization, and not just living but thriving, right? Was there like a single aha moment or is this something that sort of evolved while you were in your medical training and you said, I really want to, you know, open my eyes to peptides and, you know, some of these other modalities that are available and outside of the traditional allopathic realm?

Yeah, I think it started when I was a patient back then. I think I developed somewhat of a hatred towards the medical system while I was trying to chase to become a physician. Yeah. Because I was just constantly being put through the wringer. I had strep 22 times in those 4 years. I was convinced to get my tonsils out. I got my tonsils out. I got struck 6 weeks after getting my tonsils out when they told me that wasn't possible. I was convinced to get sinus surgery because I literally couldn't hear my professors. I would call my parents in tears, like trying to study for the MCAT. So many things just gave me a little bit more of a deep dive into what patients actually go through when they are being let down by the medical system. And so I went into medical school. I thought that I was going to do surgery because that was the only lens that I had seen human performance through when I was young. I just thought all orthopedic surgeons, like, that's that's what I'll do and that's the only avenue to get there. And COVID hit during, towards the end of my first year of medical school, we all went home. I ended up getting a job at the Institute for Human and Machine Cognition. So I was working with like these really cool—

Human and machine cognition.

Yeah, so I was doing some DARPA-funded projects for special forces guys. And so I pretty much got to like be in the sun and play with AR-15s the entire summer.

That's cool.

Over COVID summer. It's funny 'cause I was outside all the time. I got to go home, I got to actually like stay grounded. I came back to school so much healthier than I was before. And then I went right into kind of the second half of the didactic learning and the clinicals. And what I learned was I wanna go back, like I wanna go back to the human performance stuff. Like how do I get a medical profession that allows me to do what I was just doing last summer? And so I go into these, these clinicals right in kind of the peak of COVID and the veil gets lifted a little bit on some of the negative things that were going on in the medical community. I was forced to get the COVID vaccine. I was told that, you know, I would get kicked out of medical school. And at the time, I was actually kind of drinking that Kool-Aid. I told my friends, I was like, you know, I think you might be selfish if you don't go get the vaccine because I was in—

I think a lot of people did. I mean, yeah.

As soon as I got the vaccine, I had a lymph node the size of a softball for 6 weeks in my armpit. I had chest pain that sent me to the emergency room twice.

Sent you to the emergency room?

Mm-hmm. I had chronic brain fog. My exercise tolerance went to the floor. So many different things happened. And whenever I started to bring it up to my classmates or professors, it was kind of like this, "Don't talk about it. It couldn't have been the COVID shot. Maybe it was just COVID." It's a coincidence, yeah. Then I get into the clinicals and, you know, we, I go into my emergency room rotation. We have patients that come in after car accidents. Anybody that comes into the hospital is tested for COVID. And one of them happened to test positive. And that patient passed away, unfortunately, from the injuries of his car accident and is being labeled as a COVID-related death. And so during that time—

You actually saw this happen.

Right. And so during that time, there was a lot of things that made me think like, I don't want to be a part of this. I want to go to more of a preventative style of health. I don't want to deal with health insurance. Like, I don't want to be under that model. I think the health insurance model takes the art out of medicine in many ways.

Makes it very algorithmic.

For sure.

If this, then that.

Exactly. And it's labeled as, oh, this makes it more efficient and more effective, when that's not really true. It takes the human out of medicine. That's what it really does. So I decided I didn't want to go into surgery because, you know, surgery is one of those things that something's broken by the time they're coming to you. You're not preventing anything. You're just kind of trying to fix the problem. And half those patients you'll probably see again because they're not fixing anything at a baseline level. Same thing with like, you know, internal medicine when you're in the hospital or all those other specialties, which I'm not hating on those. We're amazing. We're the best at treating acute conditions. Oh, no question in the world. but it just wasn't for me. So I approached my mentor and I said, hey, look, I don't want to do surgery. He told me that he would look into PM&R, which for your viewers and probably you, I don't know if you know, PM&R stands for physical medicine and rehabilitation or physiatry or PM&R. There's like 10 different names and that's probably why nobody knows what the hell it is.

Yeah.

Yeah. But basically what that is, is a specialty that asks the question, what are you capable of instead of what's wrong with you? And so I started looking into it and kind of the history behind PM&R is it started back in World War II, back in the FDR days, whenever he got polio or what we thought was polio, probably was, you know, Guillain-Barré or something. But the whole country was looking towards physicians to create more of a system that allows us to deal with soldiers coming back from World War II, dealing with insane injuries that we didn't see beforehand. So we needed to create this kind of rehabilitative space that medicine could be a part of. And from then that's transpired into, you know, inpatient care for traumatic brain injury, spinal cord injury, stroke, amputations. And then the outpatient side is more like non-operative sports medicine, interventional pain. So things like spinal injections and all of that to say, I kind of look back now at my time as a kid at the Andrews Institute, like peeking through the, the glass and I realized that half those doctors that I thought were orthopedic surgeons were PM&R doctors.

Ah.

And so I knew that I wanted to go into a more functional style practice. And I figured that if I could just take everything that I knew or was going to learn, currently I'm in residency in PM&R, and apply that to before disability or function is lost. Yes. You know?

Yeah, I think that's such a great, you have a saying that's, so I have a saying that aging, is the aggressive pursuit of comfort. Um, and you talk about how the most dangerous drug right now is comfort, and the number one side effect of comfort is chronic disease.

Yeah, for sure. I mean, we live in a society where everything is becoming more comfortable to us, and yet we're getting sicker as a society. I don't think that's coincidence.

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Now let's get back to the Ultimate Human Podcast. So you think that these, you know, if, if someone's listening to this podcast, and I'm going to go down the road of— I'm going to touch on female hormone therapy, I certainly want to take a little dive into peptides, um, and, and GLP-1s, uh, because you, you sort of view them as a double-edged sword, which, which I would agree with. Um, but if we were taking a step back and, and someone was like, you know, look, I, I am, uh, in the pursuit of living the healthiest, happiest, longest life that I could live. Where does somebody start? What are the biomarkers that they should be aware of and familiar with? What kind of testing should they do to develop this baseline? And what is sort of a blanket recommendation that you would give to every patient that walks through your door? Hey, you know, get your arms around these 3, 4, 5 things. We'll take a deep dive into your labs and then we'll kind of go from there.

Yeah. So I think we're visual beings. Like, I think we want to see results not only in our body, in the mirror, but we also want to gamify things. So in my mind, you know, me going and getting comprehensive labs, it's almost a competition to myself of like, let's see if I can do things from here in the next 6 months so that the next time that I test, I know that I'm in a little bit better space than I was the last time.

Yeah.

And that was nothing— that was something that I didn't go through when I was a patient. Actually, I didn't even get labs drawn one time whenever I would get tested for strep, and there were no follow-up visits. There was no trying to get to the root cause. And what I saw in the clinical space in, you know, family medicine and internal medicine practices, outpatient, was that we were— doctors can only see patients for like 6 to 12 minutes nowadays.

Yeah.

And so not only do you take the physical exam part out of it because you can't have the time to do that and take a history and do all of those things that we used to do very well, But we also don't get enough labs. Like, insurance isn't covering for a lot of these labs, like ApoB for your cholesterol, because we know that that's considerably better than a lot of these, like, LDL markers.

Sure.

Fasting insulin— like, that's probably my number one favorite lab on the planet. Yeah, because it— that goes out of whack, you know, possibly 5 years before your A1C goes out of whack. And so we can figure out if you're headed towards metabolic disease considerably earlier if your fasting insulin is elevated.

And what would be elevated?

So I would say anything above 10 would probably— I would consider elevated. You want to get as close to 5, if not below 5.

In a fasted state.

In a fasted state. You know, I would try to aim anywhere between 2 and 4. Yeah, ideally. But around 5 is not bad either. But yeah, I mean, I see people that have normal A1cs and a fasting insulin of 19, and it's like, you know, the train wreck's coming. Exactly. But that same person will be sent home by their primary care doctor and they say everything looks good.

You know, and when you have these elevated insulin levels too, you tend to see triglyceride levels follow because, you know, that, that, that insulin is barring that a little bit of that fatty— it's blunting that capacity to use, um, you know, fat as a, as an energy source. And so it builds up, and one of the first places it builds up in the blood. And I would argue that there is a much higher correlation between elevated triglycerides and elevated cholesterol than elevated cholesterol on its own. Right, right. These, these hypertriglyceridemia, um, which I don't know that there's a really good pharmacological solution to, but there's really good lifestyle solutions too, right? Um, you know, precedes a lot of these cardiovascular risk markers. And, and yet when we go just after that LDL cholesterol, you know, you see on most of these panels it's HDL, LDL, VLDL, triglyceride. That's kind of it, right?

And, um, and everybody's looking at their total cholesterol and saying that number when that number really is meaningless in the grand scheme of things.

Right, yeah. And why is it meaningless?

Well, it's because it's a breakdown of all of those other things, right? Like, you could have so many different ratios of your HDL to VLDL to LDL. And so saying total cholesterol is, is meaningless in the point that you have to take a deeper dive like we're talking about.

And in other words, of itself is not diagnostic for—

Exactly.

Cardiovascular disease.

Yeah, it's just saying like, oh, there might be a problem, but not actually telling you anything about the story.

Yeah, you know, so you want people to look at their insulin, their fasting insulin, so they're probably also the glucose and hemoglobin A1c to see where they stand. Um, what other markers do you think that people should become familiar with and get their arms around to get on this gamify schedule? Because I, I love that idea of, you know, I think a lot of people are like, well, if I don't know, uh, it's probably better, you know. Um, because everybody thinks, well, what if I get this test and I find something really, really bad? Yeah, well, if you do, then you can fix it. You're probably catching it early. Um, and, and we know in nearly every form of disease and pathology, early detection is, is your best way, uh, you know, out, right? But, um, so insulin, um, like your glycemic profile— what other markers do you think are important, especially in the younger generation, to look at, um, you know, as developing this baseline so they can make modifications?

Well, I think the hormonal stuff too. I think it's good to have a baseline of testosterone. Not saying that you should get on testosterone replacement therapy when you're 17 or 18. Yeah, but at least knowing what your baseline is whenever you're peak puberty, right after puberty, kind of in your prime years, so that when you get to that, you know, 30, 40, 50-year-old mark and you're having symptoms like brain fog, fatigue, low libido, you can see what your levels are then, compare them back to whenever you were 18, 20, 25, 30, and see if that might be the problem, right? Because if you're at a testosterone of 450 or 500 since 18 and you never had problems, and then you test at 40 and it's 450 or 500, Yeah, one doctor that only sees one value might say, oh, it's probably your testosterone, we'll give you that. But it's like, no, I didn't have problems back then and it was the same marker. So I'm a big fan of trending everything because that's the big thing is like, sure, it's great if you go get comprehensive labs done once, right? You can tell a lot from that. But what's so much better is tracking those over years because then we can see acute change. And we talk about other lab values. Um, homocysteine is a great one just to track. Overall inflammation load in your body, highly correlated to methylated B vitamins too. And that just intake and how well your body is to methylate. I know you've talked about that.

Yeah.

Um, high sensitivity CRP kind of tracks the same sort of metric, but a little bit more geared toward cardiovascular health. There's so many different things that we just don't include in the regular panel that whenever I have a friend that says, oh, I just went and got routine blood work and they send me their blood work, I'm like, ah, You know, if there's 5 or 6 different things that could really make a better picture here.

I want to get these numbers right, which is why I'm looking at this paper. But along with a colleague of yours, you helped develop a— now it was now published, actually— inpatient metabolic rehabilitation protocol.

So, yeah, I think this is fascinating. So I will give full credit to Dr. Joe Stanley. He's over at the James Haley VA. He's the one that's put this together. I'm really just a supporting role backup dancer for him. Backup dancer.

But yeah, no, he's—

He's very passionate about it. And part of the reason why I chose the program that I went to is because I was doing my residency interviews and I told all these program directors like, hey, I want to go into functional medicine, more lifestyle approach, kind of a root cause approach, maybe not even in the health insurance space. And I had 5 or 10 program directors look at me like, you're crazy. You don't want to go in academic medicine. We don't want you at this, this program. And that's fine. These guys that I work with currently were like that from the get-go. And it's hard to find people like that, especially at the VA hospital. I just don't see a lot of nuance there. Not saying that it's not, but he really went the extra mile and checked off so many boxes 'cause there's so much paperwork to get anything done in the government sector.

Oh yeah.

And has created this amazing program where we'll take one patient at a time who was originally in our inpatient rehab setting. Let's say they got a knee replacement and they came to us. If they were an appropriate candidate and seemed motivated, we would talk to them like, hey, you know, we do this intensive program where you can come for like 2 weeks and we'll teach you how to cook, we'll teach you what supplements that you can get, we'll do a full in-depth lab analysis on you, we'll teach you how to— good sleep hygiene. I mean, we really start from a bottom-up approach and then we track their lab values over time and they come back to us and not only do they lose weight, their, you know, depression scores go down, They don't need enough— as many medications as once were on. Their total body inflammation goes down, their arthritis goes away. I mean, all of these things in real time, now that I've been there long enough and get to track these patients, have gone, gone down. And so it's now it's starting to raise the question in the government sector of like, oh, well, if we could do this in an efficient way from the get-go, you know, from the very beginning, then we avoid all of these patients coming into the hospital later on. Yeah. So shout out to Dr. Stanley because he's been amazing at that.

Yeah, you know, Bobby Kennedy talks about that too. He's like, it's one thing to fix the broken system, it's another thing to just keep people out of the system. Yeah, I just want to read some of these markers because for those, you know, my audience that understands what these mean, um, this is a 7-day intensive program that produced pretty remarkable results. So in 36 days, um, one patient example saw triglycerides drop from 140, which isn't still extraordinarily high, but it's elevated, 140 to 55, so that's two-thirds. Um, LDL cholesterol cut in half from 130 to 66. Um, fasting glucose from 145 to 121. And maybe the most remarkably, homocysteine cut almost exactly 50% from 9.6 to 4.3. Um, all without a single new prescription, so no additional chemicals, synthetics, or pharmacological intervention. Um, food movement, stress management, and intention. I love that you use that word intention, right? One of the fascinating things about the research that we did in the mortality space was we knew that if you wanted to cut human beings' life expectancy in half, um, all you had to do was put them in isolation. And when we talk about the, the basics to people about how impactful things like movement, stress management, intention, community connection, and how food is medicine, it's, they almost want to refute that because it seems like it's too easy.

And I would say probably the biggest thing that we did in that program is, and we've had multiple other patients since then, that was kind of the first one that we were like, oh, this works.

Yeah, yeah.

But the biggest thing we probably did other than sleep hygiene, which I think is amazing and we're all missing out on this.

Yeah, I wanna talk about that too.

Yeah. We did a full elimination diet for 30 days and we put people back to a baseline level of inflammation.

What does that look like? What is an elimination diet?

So it's basically cutting out things like your gluten, your soy, highly processed foods, pretty much everything that has a high tendency to be reactive in a lot of people. And it's not like you're just eating one thing over and over again. You can still have a pretty decent diet doing that. But we cut it down for 30 days completely. No questions asked, we have to cut all these things out.

So what was eliminated? Soy, dairy?

I believe it was soy, dairy, gluten, any processed foods.

Good.

We kept red meat as long as it was grass-fed, grass-finished. So we made sure that everything was sourced correctly too, or at least tried to be. Sometimes people's wallets don't, they can't pay for certain up tiers or whatever, which is fine. So we kind of, worked with everybody on what we could afford, what we can't, how we're gonna do it, and any artificial dyes. You know, we kind of went into the weeds a little bit on that. And then after those 30 days, it was a re— no alcohol, that's a big one. That's a massive one.

That's a massive one.

And then after 30 days, we would reintroduce one thing at a time for a few days at higher doses. So like we didn't reintroduce, you know, starches, and then we'd reintroduce like gluten back into the diet. And if that person starts to, you know, and they're taking surveys this whole time of like their mental, you know, their mentation, how they feel, their pain. And if those levels start to drop, then we're like, okay, that's a problem, let's cut that one back out, we'll reintroduce one more thing. And so it makes people more aware of like what they put in their body is how they're going to feel.

Yeah. And then in addition to that, where they're— because you talk about stress management, um, and then I want to talk about sleep hygiene, but What did you do for stress management? Was this meditation? Was it breathwork? Was it exercise? Was it a combination?

Yeah. Our therapists work with the veterans and try to figure out what they want to do. 'Cause if you don't want to do it, then there's no point in doing it, right?

Yeah.

A lot of them in the VA system did tai chi, which is amazing because not only are you moving, but you're also getting a mindfulness aspect out of it. So you're kind of killing two birds with one stone, right? It's a little bit of a biohack in its own. 'Cause you're getting a little bit of a workout and movement out of it. And you're providing mindfulness, lowering stress levels. And so I think that was probably the most impactful for them. Some of them did meditation, some did yoga. It just depends on what their baseline functionality was like too. Some people couldn't tolerate yoga or tai chi, so we started with meditation.

And then did you make mobility like non-negotiable in this? Like some form of exercise?

Any form of exercise, even if it was walking, I mean, We have patients that can't walk to the end of their driveway, right? So like, let's make it to the first crack of the driveway on Wednesday, and then let's see Friday if we can make it 2 steps past that. I mean, it's about meeting patients where they are.

Yeah.

So, and we don't compare to anybody else that came before them or after them. And then after this whole thing, this is like one of the best things that I think, after they go through this whole protocol, we introduce them to those patients who had gone through the protocol before and volunteered to become part of a support group. So that when they get through it to the other side—

I love this.

They have like a wellness support group.

This is awesome.

It's amazing.

Yeah, because then you feel like you're part of a community.

You feel, you feel connected, which is one of the areas of, of medicine we rarely talk about, you know, that when, when people feel isolated— I mean, if you look at, you know, the number of these horrific crimes that are, that are committed by, um, you know, very often by teenagers, but they, they feel completely isolated, you know, they, they don't have best friends and a friend circle and community and connection. They feel like a loner.

Yeah.

And I think this exacerbates all forms of mental illness. PTSD. When people feel like I'm the only one that has this, nobody understands me, I'm unique in my suffering profile, they're, number one, probably less likely to raise their hand to get help. And number two, they just get inside of their own head. And this becomes like a snowball rolling downhill.

It's a perfect storm with so many different things. You take social isolation and then you take what's in our food nowadays. You take the amount of prescriptions that we're giving people with multiple drug interactions. You take the vitamin deficiencies that those prescriptions cause and those side effects. There's so many different things that you take the food that they're eating. I know you've probably seen the prison studies where they reintroduce whole food diets back into prison systems and—

Violence goes down.

Violence goes down tremendously. There's also, you know, with kids and ADHD, you know, putting them on a whole foods diet has the same effect, if not better effect, than putting them on medication.

Yeah.

So there's so many things that we're living with in this unnatural world nowadays that if we just kind of get back to our roots a little bit, we can fix things one by one.

Yeah, I totally agree. You know, you, you often have talked about, um, GLP-1s, and, and I feel like GLP-1s are kind of this double-edged sword. I mean, certainly They can be lifesaving for people that are morbidly obese or type 2 diabetics, have a lot of food noise in their, you know, just in their environment. Because I would put sugar addiction and food addiction right up there with nicotine, with alcohol, with some of the most difficult, you know, addictions that we suffer from. And I think because food is such a widely accepted resource, it's easy to have that addiction right in plain sight. You know, it's not like you're pulling out a handle of vodka. You know, you're just going for a Twinkie, you know. And, and so, you know, food noise, food addiction, you know, morbid obesity, type 2 diabetes. I think these are areas where GLP-1s have a massive role. But now, I mean, if you're listening to this podcast and don't know one person that's on a GLP-1, I would be shocked.

Yeah.

You know, it's not 6 degrees of separation anymore. It's 1 degree.

Yeah, definitely.

Um, and but you feel like they're a double-edged sword too, for sure. And for, for what reason?

So kind of going back to what you said, I think nowadays we're being targeted with sugar in our face all the time. You go to the movie theater and before you can even watch the movie, you watch that like salivating video of a Coke being poured into a bottle and you're just sitting there like, man, I need to go get a Coke downstairs. And So it's constantly in our face. And so it's worse than it was 50 years ago for like my parents and my grandparents. So I do think there is a little bit of targeting that goes on there. And GLP-1s, so what I'm seeing on the plus side, yes, it's taking people that maybe have passed their threshold of point of no return and giving them a tool to be able to get back to a healthier life. And that's what we need to be treating it as, is a tool, not the, miracle pill, not like, you know, the fountain of youth, but just a tool to be able to use in the grand scheme of things. And I think the problem that we're all facing is that in a lot of people, we're trading obesity for sarcopenia. So we're, we're not only— Exactly. So we're not only, uh, have more fat than we need to in society, we also have less muscle. And that's the double-edged sword right there. Because if let's just say you take a GLP-1 and you lose a bunch of fat, but you also lose all your muscle, and then you try to get off the GLP-1, muscle is the biggest metabolic organ that we have. It's a huge glucose sink that's independent of insulin. So regardless of your insulin insensitivity or sensitivity, you know, if you eat a big meal and you have a lot of muscle mass and you are using your muscle, it's a sponge. It doesn't even use insulin to, to do that process. So it takes it outta your blood. It gives you that buffer for maybe a poor diet every other day or whatever. And people are completely missing that. So we'll, you'll get skinny, but in a weird way they're actually getting fatter because their overall ratio of fat to muscle has actually gotten worse.

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Now let's get back to The Ultimate Human Podcast.

Mm.

And I like that you think that metabolic testing and BMI testing should be a, a part of everyone's protocol. Understand where they are with their muscle and their fat and their visceral fat. So do you think GLP-1s have a place in functional medicine if, if done properly with strength training and let's say the addition of peptides?

100%. I used to be anti-GLP-1 when I first came out. I was one of those people that was like, no, I think this is the bane of all existence.

I'm a big fan of retatrutide.

I think that it's going to be huge whenever it becomes more available. But I will say now we're seeing that it's cardioprotective, even though they control for weight loss. So even the people that lost less weight or more weight had the same cardioprotective effect from GLP-1s, possible cancer protective effect. So there's these, all this data that's coming out of the use of—

Neurocognitive effects.

Exactly.

Neuroinflammatory effects.

For sure. And so we're starting to see all of these things that it could play a good role in as being another tool. In the tool belt. But, you know, you and I were talking earlier, I think one of the first steps is putting that conversation back into the clinic setting rather than kind of the back alley black market setting. Because we're not, you know, once the FDA loosens up a little bit on peptides, I'm hoping that people don't have to go find these things on the internet. Yeah.

Yeah. I think the risk is, you know, not, and I hear physicians very often attack peptides and they will say things like there's no, safety data, there's no real gold standard data, gold standard science on it. That is patently false. In fact, I'll make available as a link an academic white paper with, with almost 800 cited research studies behind it. And some of these were gold standard studies that led to pharmaceutical approvals in other countries. I think we are going to see certain number of peptides, probably 14 of these peptides, move back onto the bulk list and be compounded by compound pharmacies so that you get stability, sterility, potency, where appropriate guarantees. You get beyond-use dates so that, you know, these peptides are not expiring. You get mixing and dosing instructions. You get a protocol that doesn't help you, you know, build tachyphylaxis, this desensitization response. I think the future for peptides is very bright.

I do too.

And I'm an enormous fan of peptides. I'd love to hear where you fall and what are some of your favorites, how would they be used, and what your clinical experience is with them.

So this is the most exciting frontier of medicine, in my opinion.

I love hearing you say that.

I love it.

And I'm a massive fan of peptides.

And so, and one of the sad things too, we talked earlier about how the health insurance model kind of takes the art out of medicine a little bit. I have talked to physicians that work at some of the highest performance academic centers in the world and ask them about peptides and kind of get this answer like, oh yeah, like I've heard about them, I don't really know much about them.

Yeah.

And it's like, okay, it's 2026. If you're a physician that's taking care of really high-level athletes or just high-performing people and you don't— you're just not in the system, first of all, you're probably working, you know, 8 to 6 every single day, seeing patients 6 minutes a day. You don't have time to look up the studies or look up what peptides are. But also it's just not in that setting. And so it's really sad that we're— we've taken peptides out of the academic space because we don't have the people that really need to get the word out on them and get more data and get better data on these things to head up those conversations. And it's like we need to get that back into the real-world clinical setting because it's so exciting. I'm not saying every peptide is great. There are probably multiple peptides that I wouldn't recommend people, but at least if we give it to a patient and provider interaction again, instead of like going and buying it from some third-party, you know, back alley online place, then you can have the conversations about, you know, safety versus side effects. You know, what's the risk-benefit ratio? What is this gonna give you? How to mix it? I mean, mixing is probably the biggest thing.

Mixing and dosing is the biggest.

All of these nightmare stories that you hear, a lot of them come from people that just don't mix it correctly and they're giving themselves, insane dose or no dose, right? You know?

Yeah.

So, so yeah, I really hope that they loosen the grip a little bit so that we as physicians can start learning about them more, because many of us don't know anything about it. And then also put it back in the clinical setting so that we can talk to patients about it in a safe way.

Yeah, I completely agree with you. I'd like to go through some of the peptides because, um, you know, peptides, uh, first of all, insulin is a peptide, um, GLP-1 is a peptide. We make a lot of these peptides endogenously.

I—

it's, it's not a voodoo sort of fringe area of science that, you know, a couple of gym bros got together and, and you started making cocktails like a lot of these SARMs and things like that that you see online. Um, these are, these are valid amino acid analogs. Um, they're hopefully made by licensed compound pharmacies. Um, and they're done with, uh, you know, in ISO 9001 clean rooms, positive pressure rooms, with real, um, parameters around them so that the dosage and then the strength and the potency can be guaranteed. And having been in the functional space now for about 10 years, you know, we have really seen— I don't want to say miracles with peptides, but, you know, when, when people are recovering from post-surgical, you know, injuries, when they're trying to improve their performance, when they're trying to improve their recovery, especially in athleticism. You know, most athletes are not overtrained, they're just under-recovered. So what if we dove into this category of peptides and, and, um, take GLP-1s for example, something like a retatrutide? What's the appropriate profile for, uh, someone that is interested in, in getting on retatrutide? Um, and, and when should they be considering something like that.

Yeah, I think it comes in the whole picture, right? Like, if you get full metabolic lab testing done, you have that conversation with your practitioner, you have some sort of metabolic disease that you want to address, whether that be, you know, central obesity or, um, you know, non-alcoholic fatty liver disease— that's the one that they really did all the studies on for retatrutide— for retatrutide. And it's an amazing medication for decreasing the amount of fat in your liver. Which we actually didn't really have any medications for prior to that. I think the, I think the, um, at the highest dose it had like a 100% cure rate of, or sorry, a cure of 80-something percent of people that were in the study at the highest dose over a span of like 50 weeks or something, which is insane.

Yeah.

I mean, that's really stubborn fat that's wedged into a vital organ.

Yeah.

That we're able to get down. So in that sense, I think it's amazing we can target these certain things that we know cause a lot of harm down the road. Um, but also like, you know, some people want to do it too because they're obese and they just want to lose weight and like they want an extra tool in the tool belt. And I think that's okay as long as you're getting enough protein, your strength training, and you're doing it under the guidance of a physician and you know your risks, then I think we should be able to have these conversations and not talk down on people for getting on a GLP-1 and doing these things. Right.

I couldn't agree with you more. I mean, I think they'll be a lot more common as, um, as, you know, functional, functional practitioners realize that these are more than just a weight loss tool. Um, and when they, when they use the full spectrum of these, the implication of these peptides. Um, let's talk a little bit about, um, vanity, because most people want to look better, they want to feel better, they want to have more muscles, they want to have less fat, they want to have clear skin. So In the world of peptides, um, and there's the category of growth hormone peptides, um, GHRPs, GHRHs, where do you fall in the growth hormone peptides? I've certainly taken them with phenomenal results. I think I'm in pretty good shape for a 55-year-old. I've been hanging with these 25-year-olds every morning with my, with my son.

Yeah.

Um, I don't think that— and, and by no means am I here to tell you how to get jacked. I I'm not jacked and I'm not a weightlifter and I'm not a bodybuilder, but I do feel amazing. Yeah, like, and, and I don't have any knee, hip, shoulder, rotator cuff, low back pain, and I exercise pretty intensely. Yeah, I really attribute that to peptides because I can tell if I'm not regularly on BPC-157 and TB-500, if I am, uh, not cycling growth hormone peptides I noticed degradation in my sleep. I noticed a degradation in my recovery almost instantly. Within 4 or 5 days, it can be like I'm off my— yeah, peptide dose. And I'm pretty militant about monitoring labs. I haven't seen inflammatory markers rise. I haven't seen, uh, markers rise in any of my liver enzymes, um, or alkaline phosphatase. I haven't seen reductions in EGFR, um, in my kidney function, or increases in BUN or creatinine. Um, so I'm, I'm absolutely convinced that these can be a tool in people's toolbox to reach, you know, their goals.

I did 75 Hard over the holidays, which was difficult when you're going home.

Did you actually do it?

I did.

You read the books the whole day?

Oh yeah, did it all.

The outside workouts are tough too.

I love it. Yeah, granted, when you're in Florida, it makes it a little bit easier.

Michigan's hard to do 75 Hard. That's 75 Super Hard.

Exactly. Yeah, so it was 75 kind hard for us, I guess.

Okay.

But I use peptides in order to kind of help my process along. So I was taking BPC-157, TB-500. Um, I did that for 3 or 4 weeks in the first stretch. Um, just because I had never worked out at that volume before and tracked my Whoop data. And it was crazy cuz I just figured it would have more of a local response on any aches and pains, but my Whoop data was amazing. I was getting green recoveries even though I was working out twice a day. Could be placebo. Placebo's a hell of a drug. But I was doing that. I was taking, um, sermorelin for a little bit of a growth hormone boost during that, under the guidance—

at night before bed.

Yep, an injection at night before bed, 5 days a week, 2 days off, under the guidance of a clinician. So I took my lab— I took my labs before and after too, and all of my lab results actually got better, not worse. Um, so I was doing this under, you know, good care and guidance.

So you're taking the BPC and the TB-500 for tissue and wound repair?

Exactly.

Can you talk a little bit about, to the extent that you know, that the, the mechanism of action of these, and, you know, why would somebody take BPC-157 or TB-500?

Yeah, so I know that they're a really great anti-inflammatory. Um, we don't really have a lot of data around whether you should inject it locally versus, you know, subcutaneous, but just the anecdotal data that I've heard from numerous people with aches and pains in certain areas that do inject it more locally they tend to get better a lot faster than they would before. Um, so I was doing it, you know, I had like some golfer's elbow that I was working out with and just kind of pushing through. And so I was injecting it locally into that area, got better within a couple of weeks. Um, then after that got better, I was just injecting it, you know, subcutaneously. And I just felt like I wasn't getting those, those like next day aches and pains like I was previously. Now I'm 28 years old, so it's like what level was I really at before? I think that, you know, an older population might have a little bit better bang for your buck in some peptides because your body decreases the amount of those hormones that it makes over time. So, um, I kind of went low and slow and, and it really helped me. I mean, it really did. I did not expect to have as positive of an experience with that high volume of training that I did.

You know, you, you, you've also talked about, I want to go back to the muscle for a second. Um, Gabriel Lyon says muscle is our metabolic currency. You've talked about muscle as medicine. I've heard Mark Hyman say, if you want to live a long life, lift heavy weight. Right.

Yeah.

So, you know, there are, you know, a lot of iconic figures in this space that are really trying to draw people's attention back to strength training, muscle, You know, I notice in my parents that are— they're older, they're both— my mom's 80, my dad's 82. They're both very deconditioned. And, um, you know, my father because he's partially handicapped, my mom bilateral knee replacements. And cognition, um, follows this decline in, in muscle function. So can you talk a little bit about the importance of strength training muscle beyond just what we see in, in the mirror and why you think muscle is medicine.

Well, one, I think we've just been paying attention to cardio for like the last 40 or 50 years, and we've realized that we're leaving an entirely, um, important sector of human health, especially physical health, on the table, which is strength training.

Yeah.

And I think strength training got a bad rap from like all the gym bros back in the day wanting to just get bigger.

Yeah.

And And we've just kind of disregarded that. I mean, if we look at the mortality data, I think, you know, being strong compared to being weak has somewhere in between a, you know, 200 and 400% difference in overall mortality risk, right?

Absolutely true.

Which is massive. I mean, if you look at things like diabetes or hypertension or smoking, it doesn't even compare to that.

Yeah, and there's no pharmacological intervention that even remotely moves the needle like that, right?

So like, yeah, like if— let's just say, you know, you have diabetes, you can supplement insulin for diabetes for a pancreas that's not putting enough out, or for pancreas that's putting too much out and you're not sensitive. You can't supplement for being under-muscled, right? So it's something that we don't really have a fix for on the medical side. And so it's really in the hands of the patient to be able to do that. And there's so many benefits. I mean, it increased brain-derived neurotrophic factors. So you talk about the cognition. It also is that glucose sink. So maybe you become a little bit less insulin resistant, which does wonders for your mentality too. You've, you've talked about Alzheimer's being type 3 diabetes, right? So muscle is in this grand scheme of being able to get you to a better level of metabolic health that all of these diseases stem from. So to me, muscle is the root of where all disease stems off from.

Yeah, and I think that another message that is starting to resonate in our industry is that it's never too late to start strength training. And, you know, there are people listening to podcasts that are in their 60s, 70s, maybe even in their 80s, like my parents. Um, and the benefits that they— even if they have gone their entire lifetime relatively sedentary, or it's been years since they've been on a, you know, practice field for, for any kind of sport, um, there is enormous benefits from even starting today with with a strength training program, resistance training program.

There was a— the Lift More study was, I believe, I came— it came out a few years ago, was looking at, I think it was primarily women aged 65 and older that either had osteoporosis or osteopenia. And they compared two groups of women. One of them was lifting heavy, like 5 rep max heavy for multiple compound movements, where the other was doing, you know, more like 12 to 20 repetitions, which is kind of what we originally would put people on because, you know, 20 years ago we'd say anybody that age, don't lift heavy 'cause you'll break something, right? But when you see, what you see if they're doing it in this controlled setting with a trainer that's making sure they have good form, not only did we stagnate bone mineral loss, we increased bone mineral density, which we never thought was possible before.

That is so incredible.

Yeah, so you have all these people that we've been telling like, oh yeah, we just wanna like play it safe now and just try to minimize how much bone you lose. It's like, no, no, no, if you're 70 years old, you can still, increase your bone mineral density if you get on a good regimen. And it doesn't mean you have to go and start powerlifting in the gym. Yeah, but go in the gym, maybe get a personal trainer 1 or 2 times just to teach you how to do something and just get moving because it has so many good benefits to it.

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Now let's get back to the Ultimate Human Podcast. Yeah, um, I, you know, I think it's, it's hard to talk about metabolic health and longevity without bringing hormones into the picture. You know, one of the things I really applaud the FDA for doing was removing the black box warnings from female hormone therapy. Um, you know, Marty Makary has talked about how 50 million women unnecessarily suffered because of these black box warnings that basically bastardized the Women's Health Initiative study and made women and, and practitioners, um, think twice about hormone therapy because it increased their risk of breast cancer, right? Um, you know, years ago there were, um, there were these correlated links between stem cells and cancer when we basically started peeling back the layer of the onion wasn't coming from the stem cells, coming from the procedure. And so shedding a light on some of these misnomers, it's so astounding to me how long sometimes it takes to turn the aircraft carrier in medicine, right? Like, how long did we sit with this food pyramid? How horrible was the war on saturated fat? You know, front cover of Time magazine.

Which literally led to this decades-long, uh, war on saturated fat, demonization of salt over sugar. I mean, there's countless things that—

and, and, and yet the entire time, this hockey stick spike in chronic, chronic disease. So how important is it, um, to have your hormones checked? Are you a— are you a fan of bioidentical hormone therapy?

For 100%.

Yeah, 100%. And do you have any experience in female hormone therapy?

So I'll tell you this right now. One of my number one regrets, and it's, granted, it's nothing that I could have done, but is not knowing how beneficial female hormones were 10 years ago because my own mother didn't get on them. And now she's, you know, 60, 61 years old. It's harder for her to tolerate after she's gone, you know, 10+ years in menopause. And I just know all of the benefits that those can cause if you're able to do it in a smooth transitional way. Now, granted, women can get on hormone— hormones later and still have good benefit, but if you're able to do it in that perfect balanced kind of ballet of going into menopause and being able to transition through that process with a good hormone clinic or physician that's, you know, well-versed in doing those things, yeah, then it's amazing for women because women have been looked down on for so many years. I mean, I remember when I was in medical school and I was talking to, you know, menopausal-aged women, and they'd be telling me that they're having brain fog, less libido, fatigue, night sweats, all these things. And then I go and talk to the practitioner that I was working with, and they're like, oh yeah, that's just, that's just what women go through.

Yeah, yeah, that's just age.

And by the way, we got a patient that's coming up in 2 minutes, so hurry it up. And then it's like, yeah, so we've just kind of brushed women aside in that way. And like you said, like Marty's book really touches on this amazingly, like that study back in 2002 or 3 with the Women's Health Initiative was a faulty study kind of to begin with. The findings came out before the study actually came out. And then when the study came out, you realized the findings really weren't statistically significant. They were using synthetic versions of all the hormones. And now we talk about how the healthcare space does patients wrong in certain areas. One thing that we don't talk about enough is it really did physicians wrong in this way because we don't, we learn about bleomycin and all these other cancer drugs in medical school when 95% of us won't go into oncology, but we learned zero about hormone replacement therapy, and that's the basis of human life.

Yeah, it's so, it's so astounding to me. You know, I, uh, my wife and I, Sage, you know, we, we've done podcasts on this. We've been very vulnerable about it and very transparent about it. She did this Dutch test while she was going through menopause, and I'm telling you what happened to her 3 weeks after getting on hormone therapy, um, after Dr. Sartor really dialed in, uh, her dosages, was mind-numbing. I mean, libido, brain fog, uh, her, uh, water retention, her sleep. I mean, her cortisol and melatonin were completely inverted. Um, the, the— her short-term recall, like, the, the lack of, of brain fog, just the, the crushing exhaustion, the mood swings. All gone.

Anxiety. I mean, it's one of the greatest antidepressants that we can give a woman.

Yeah.

Anybody. Someone that's really close to me came to me the other day and said that her husband had just got on testosterone replacement therapy in his late 50s, 60, and said that her husband is more patient than he's ever been in his entire life.

And you think testosterone, roid rage, right?

Exactly, right? It's just simply not true.

So misunderstood.

So where do you see, you know, what does the future hold for Dr. Moss? I mean, what is your vision of your practice? Your impact, you know, how, how are you going to bridge this gap between allopathic medicine and functional medicine, um, to impact the patients that you're going to see?

Yeah, so I think I want to— so I'm pursuing, um, formal education also in the functional medicine space through a couple of places like A4M and all these places that you go to and do online fellowships with, because we don't learn that in the academic setting. Or at least not through that framework, right?

Yeah.

So thankfully I've had that my residency program is not brutal enough to where I don't have time to explore other things that I'm interested in. So I'm able to do that along with my formal residency training. And with PM&R, I get to, you know, do a lot of hands-on things like ultrasound-guided injections with PRP or stem cells.

And super cool.

And so what I want to do is take that PM&R knowledge of, you know, how do we get a patient back to being as functional as possible. Take the functional medicine side of, you know, how do we avoid chronic disease and kind of morph those into a good practice that 10 years ago when I was the patient, I wish that I would have gone to, right? Where you're recognizing things early, you're getting a sense of like what a patient's going through on a day-to-day basis. You don't just have to sit with a patient for 6 minutes and then push them aside. Yeah. You can actually sit down. So, you know, I have a year left of formal training, so I'm trying to, build that runway out a little bit and see what's possible. I don't think I'll operate in the health insurance space as it currently stands, or at least I hope I don't have to.

Yeah, I want to say this too, um, you've talked about the payer system too, like the difference between cash pay and, and, um, insurance-covered events. Like, just the— this is sheer voluminous difference in cost. Like, the same CBC labs that they bill an insurance company $400 for a patient can get for $35.

So I got, last year when I had health insurance, I don't have health insurance anymore, I do crowdfunding, but I got estrogen, testosterone, free testosterone, sex hormone. I got 5 basic hormonal labs from my primary care doctor and I get the bill in the mail and I paid $98 and I was like, oh God, I wonder what they billed insurance. I looked at it and they billed insurance $1,500 for those 5 labs. And so I was like, okay, well, thank you. First thought is, thank God I have insurance, right?

Yeah. And I only paid $98.

Exactly. So I go back to the same lab's website and I go to order those lab tests like I was— like I would be doing it for a patient. And I put all 5 of those labs in and see what it costs. And it's $66 total cash pay. So I paid more with insurance than I did if I just went and paid cash. And I'm seeing this in a lot of different places. Right? Like, wow, you see insurance bill for an MRI at like $15,000 when you can go pay $400 for an MRI down the street some places. So I think the cash pay system gets demonized a little bit because people think that the physician or whoever owns the practice is selfish by going cash pay. And sometimes it is more expensive. But I also think that if you're trying to be preventative, the money that you spend on the front end could also save you a lot of money and, and heartache and family trouble and all these other things on the back end.

Yeah, no, no, no question at all. We saw the same thing when we were starting our functional medicine clinic. You know, we, we would have, uh, we started with a traditional insurance model and it just became so difficult to manage. I mean, that's why like really successful medical practices have an entire division that just does billing, um, because you could get a PhD in billing, and it would drive our clinicians up a wall because they would spend so much more time trying to justify procedures and write medical necessity letters for relatively simple procedures.

Prior authorizations.

Yeah, you have to fit the algorithm. You know, I remember, you know, a woman walking into a clinic with an irregular node in her upper axillary region, and it was nodular. It wasn't there 6 months earlier on palpation, you know, all the signs that you wouldn't want to see, um, you know, close proximity to the lymph nodes. And so she just said, okay, I want to, um, order a biopsy and some additional imaging, and got rejected, right? And, um, so she wrote a medical necessity letter and it got rejected again. And eventually what she realized when she spoke to the insurance company was, um, because the statistical incidence of cancer in that age woman was so low, and this was considered a non-covered procedure. And she's like, I get that, but here is all of my clinical analysis. Everything about my training tells me this needs to be biopsied and it needs to be imaged, um, and here's why. And then they, they gave her another whole framework to write another letter. So in the third letter, they finally covered —teacher.

I know somebody who has, who had prostate cancer and had to get, or sorry, testicular cancer and had to get his testicles taken out. And insurance denied his, their, you know, authorization to get testosterone replacement therapy for that the first time. So they had to go through an entire appeal process. It's like, how do you expect that person to make testosterone if they have no testicles?

Right. Yeah. Yeah. I mean, so I think, you know, a lot of that idiocracy we're going to hopefully see change over time. But while we're waiting to change the system, keeping people out of the system is the, is, is the best route. Um, you know, the final thing I want to touch on, because you mentioned it in your, um, approach to metabolic syndrome, uh, with sleep hygiene. And, um, I love that term, but I think a lot of people don't know what that means.

You know, how do we draw attention to our sleep?

What are some hygienic— I'm actually about to do a massive 2-day free sleep challenge. I do them every quarter, but I'm interested in your opinion on what, what does good sleep hygiene look like to you?

So I think a lot of people treat sleep in a vacuum. They're just saying, I'm not sleeping well, and they don't look at anything that's surrounding that event except for them lying down and actually closing their eyes. And I see this all the time, and you'd be surprised. But I think if you really look at everything that leads up to sleep, not only in the first, you know, couple hours right before you get in bed, but the entire day, right? Are you getting up in the morning and getting natural sunlight? I mean, that's— Andrew Huberman brought this kind of to the forefront and it's been huge in that whole community lately because that cortisol spike that you get early in the morning from having natural sunlight, you can't reproduce that indoors.

I mean, maybe with some sort of like— 10,000 lumen.

Exactly. Yeah. But you, and for most purposes, you can't reproduce that. So if we're not getting that cortisol spike in the morning that's coming down throughout the afternoon, then we're staying at a baseline level of stress hormone throughout the entire day that doesn't help us. Taper off at the end. And then we have that wired and tired feeling when our head hits the pillow of like, wait, I've been tired all day. I could have just fallen asleep at my chair at work. But when I finally get to bed, I can't go to sleep because my, my mind is racing. Right. So I think starting in the morning with natural sunlight as, as quickly as you can possibly get it, like get that sun in your eyes. Don't stare at the sun. But then, you know, later in the day, how late are you having your meals in the afternoon? Right. Yeah. Are you eating at 9 p.m. and trying to go to bed at 10? Yeah. So I try to get, you know, 2, hopefully 3 hours before I go to bed is my last meal because you need that time to digest.

I saw dramatic improvements.

Yep. Doing that. Cutting down the temperature in the room to, you know, I sleep anywhere between 66 and 69 degrees. Mm-hmm. Um, some people even go lower than that. Yeah. And I think that because it brings your core body temperature down. Mm-hmm. Taking a warm shower can help do the same exact thing. Sauna before sleep is amazing for that. Cutting out light in your bedroom is the biggest one that I see. Yeah. I mean, we have, Our— whenever you see our room from the street, it looks like a haunted house because there's only red lights in our bedroom upstairs.

I love that.

So like getting, you know, amber lights in the bedroom so that you're not having that blue light exposure that is ramping your melatonin back down. Using a sleep mask whenever you travel. You know, we're in a hotel right now.

Oh, I love all of this.

Yeah. I mean, there's so many things. Using a white noise machine if you have like a ton of road noise and stuff like that nearby. There's so many different— magnesium, magnesium glycinate is like so easy to do right before bed. It's, it's fairly cheap supplement. Um, there's, there's tons of things. And also I think one of the most underrated things is trying to get on the same sleep schedule as whoever's in the bed with you, like your spouse or girlfriend or boyfriend or whatever it is. That is huge because if you're getting, you know, if you're waking up at 10:00 AM but they're waking up at 5:00 AM and they're waking you up, you're not getting 8 hours of sleep.

And, and, you know, usually I find in couples— and Sage and I are this way— one is a deep sleeper, one is a light sleeper, right? So like, she can get out of bed 10 times at night. I don't know, I mean, she could have a dance party on her side of the bed and I would not even know. I'm jealous.

We're the opposite.

Yeah, but, but if I— when I wake up, if I have to use the bathroom at night, I am so intentional about how I get out of this bed. I mean, it looks like I'm trying to commit a crime. Yeah, I slide the— I move my legs over onto the floor. I sort of slowly, you stand up because I know that she's so sensitive to, you know, me getting up, getting out of bed. And if I get right, you know, and then I sort of fall back into bed, throw my eye mask on, and I'm like right back out, well, she's up for another 35 minutes. Yeah. Um, because I've, I've broken her out of that sleep. But, but I think sleep hygiene, whole food diet, mobility being non-negotiable, which you talked about, strength training, so fundamentally basic but so incredibly impactful.

And it makes you feel amazing. Like, if you get good sleep, you work out, you look good in the mirror, so you have that confidence booster. I mean, when you start to string all of these things together, it's not a chore. It, it makes you feel and look amazing. Yeah. So people are happier than they've ever been when they start to implement these things.

I love that you're saying that. So, Dr. Clay Moss, how does my audience find, find you? How do they find out more about you?

Yeah, probably mostly on Instagram is where I do most everything, just @DrClayMoss, Dr. Clay Moss. Okay, um, just Dr.

Clay Moss, md-drclaymoss. Yep, don't even have a website yet.

I'm sure we'll get there at some point. That's all right. We're cut and dry at this point. But yeah, they can find me on there. I'm pretty responsive and everything.

So if you have questions— that's phenomenal. You know, I wind down all of my podcasts by, by asking all my guests the same question, um, and there's no right or wrong answer to this question, but what does it mean to you to be an ultimate human?

Doing— probably doing 80% of the things right and leaving 20% to actually be a human being. I think we get really caught up in all of these things a lot of times. And then I don't want to die and realize that I've been, you know, in a protocol my entire life.

Yeah, paralysis of analysis. Right.

So just not letting perfect be the enemy of good, but also taking the steps to really do what you need to do. Taking care of your own health is the most selfless thing that you can possibly do. I mean, if you look at patients in the hospital that have not been taking care of themselves, like, sure, the end of their life is like really sad and debilitating, but also at the same time, their family is the one that's really taking the brunt of the force. Yeah. If you have a patient that's, you know, really obese with diabetes that's spending their last few weeks or months at home and needs to be changed, dressed, taken out, you know, out of the bed. If you take care of yourself, it gives you so much more ability to take care of others around you. And so in that instance, I think it's really selfless thing to do is to, to go and get checked out, start doing all of these things and try to get back on track if you're not already there.

That's so amazing. Dr. Moss, thank you so much for coming on The Ultimate Human Podcast. We're going to follow your journey. I hope you'll come back on the podcast again. I, I feel like there's a book in the making somewhere. Maybe when you get out of residency, you got a little time on your hands. Um, we're gonna head over into the VIP group right now. I got tons of VIPs that are so excited and have a whole list of questions for you. If you're interested in becoming a VIP, just go over to theultimatehuman.com/vip, and I will see you live in one of these sessions. But until next time, that's just science.