Dr. Labib Ghulmiyyah: How to Improve Sperm Count and Fertility Naturally | TUH #251

For me, I always say healthspan starts in the womb because the maternal environment is what the fetal environment is. That's going to be your early stages of life and then eventually your adult diseases.

1% year-over-year reduction in sperm count, 2% year-over-year reduction in fertility rates. And you start to combine these statistics. 1% doesn't sound like a big deal until you realize, okay, well, in 10 years we're down 10%.

If you look at the sperm count dropping, And at the same time, you see, for example, the production of plastic and other chemicals is going up. Small dosages that can accumulate and cause problems with time.

What are some of the must-haves or must-dos that society, men and women both, need to be engaged in on a regular basis?

So I think it's always a good opportunity to What if I told you that the health of your future child is being decided right now before you even conceive? Today's guest is someone I met halfway around the world in Saudi Arabia at the Zenos Longevity Summit. We recorded a podcast there and it got so much traction we had to bring him back to finish the conversation. Dr. Labib is a board-certified OB-GYN, specializing in maternal fetal medicine, fertility, and women's health. But what makes him different is how he approaches pregnancy, not as a 280-day event, but as a 1,000-day journey that starts long before conception and extends throughout the first 2 years of a baby's life. In this episode, we're diving into the fertility crisis no one's talking about— plummeting sperm counts, rising miscarriage rates, and why lifestyle, not just genetics, is programming the next generation. We're also getting into the black box warning the FDA just lifted on hormone replacement therapy, why 50 million women needlessly suffered, and how migration, stress, and even sleep debt are secretly sabotaging fertility. This is for the young couples trying to conceive, the parents who want healthy, resilient kids, and anyone who wants to understand how the first 1,000 days of life set the stage for longevity. So welcome to the Ultimate Human Podcast. I'm I'm your host, human biologist Gary Brecka, and today we're going down the road of fertility, pregnancy, hormones, and how to give your kids the ultimate shot at a long, healthy life. 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 today we're actually catering to those young couples trying to conceive, looking at how they have a healthy pregnancy.

And listen up, men, It's not just for the ladies anymore. I have a doctor here today to talk about how couples can prepare for pregnancy, fertility, healthy sperm counts, and really healthy, happy babies that are going to live a long time. And we're going to go down the road of nutrition, pregnancy, wellness. I'm so excited for this podcast.

We actually started this podcast in Saudi Arabia.

We were short on time and we had so many positive comments that I brought this guest back today. So welcome back to the podcast, Dr. Labib Gomaa.

Thank you, Gary. Thank you. I'm so ready, excited for round 2 of the discussion.

Yeah, so am I. And ironically, we both live in Miami.

Exactly. Yeah, so I don't know why we did the sign. We should do it again.

I don't know why we did the podcast in Saudi Arabia.

We had to go halfway around the world.

But, um, we were both at the, uh, Zenos Longevity Summit.

Was amazing summit. I mean, that side of the world is really waking up to wellness, longevity. Um, it's just astounding what's going on over there with development and their commitment to health and wellness and keeping people out of the system. But I really enjoyed the podcast, and I felt like we were just getting into the meat, and then we had to cut the time short. So I'm really excited to run this with you today. You know, I remember you talking about, um, this pregnancy being 1,000 days of pregnancy, you know, the 365 days plus another 700 days. And, you know, I, I'm, I'm concerned about, uh, you know, fertility rates, um, they're the drop in sperm counts. You know, when, when I was at a Maha recent, uh, meeting recently, and they were talking about the 1% year-over-year reduction in sperm count, 2% year-over-year reduction in fertility rates, and you start to combine these statistics, 1% doesn't sound like a big deal until you realize, okay, well, in 10 years we're down 10% in sperm count and another possibly 20% in fertility. And what do you think is the biggest contributor to these things?

Well, I think lifestyle is absolutely a risk factor for how sperm counts are dropping. If you look at the sperm count dropping and at the same time you see, for example, the production of plastic and other chemicals is going up. So one curve is coming down, one is going up. I mean, it's probably a contributing factor, maybe not the only factor, but there is something there. There is. Fire happening, the sperm counts are dropping. And also we can— we're seeing more miscarriages. We're seeing more couples going to, you know, artificial reproductive technologies like IVF. Not only—

and it's not an easy process.

Yes, it is. It is a complicated process. But today there's, you know, more advanced technology that would probably make it easier on couples. But again, it is time-consuming, it's stressful. It would cause anxiety. And then plus you have the women go through testing, injections, the retrieval process and all of that. And then of course, then you have the pregnancy, which could sometimes be twins and triplets, which makes things more complicated.

Yeah, you can't get pregnant, then all of a sudden it's like, bam, there's 3 for you.

Exactly. So a lot of people criticize and say, oh, people are going to IVF very quickly. And not being patient, but there is more infertility out there. So. Right. And I think you mentioned the 1,000 days. Yes. The pregnancy is usually 280 days, 40 weeks, but I call it the 1,000 days because there's the before, which is super important.

Yeah.

And then the pregnancy itself, the 280, and then the first 2 years of life, which I think dictates a lot of our biology and how we're going to become, you know, later on if we're going to develop diseases. So even the first 2 years of life, whether you're being breastfed, whether depending on what you're eating, what are you being exposed to in the first 2 years of life, your epigenetics will change. And this is where the biology is, you know, programmable in the best way. Of course, we can change things later on, but the earlier you do it, the better you're going to be able to cope with life and the stresses of life.

And yeah, you know, I have this theory that in this whole longevity, biohacking, anti-aging movement, what I've seen is kind of an underlying theme nobody really talks about is a lot of what we're doing is just getting back to the basics— whole food diet, uh, sleep, mobility, sunlight, grounding, you know, sense of community, sense of purpose. And if couples are listening to this podcast right now, and I really would encourage especially young couples that are trying to conceive to listen to this, you know, I've, I've 2 kids that are coming into this age. My son Cole, he's 25, um, and, uh, he's getting married in September, and he and his fiancée have been together a long time and are starting to have this conversation. And, you know, I, I know there's a lot of people in their peer group. My, my daughter's 27, she's starting to think about this too. So this is something that's very near and dear to my heart. And so for young couples that are listening to this, you know, I think that we think of pregnancy and conception and birth and what happens to the, the fetus and the child during this 2-year period as largely being the woman's role, right? She gets pregnant, she has the baby, she cares for the baby, she breastfeeds the baby. But I liked what we began to talk about in Saudi because you were really talking about it as a couple's journey and like the contribution that men can make to ensuring, or at least increasing the odds that they have really healthy, happy, amazing children with strong immune systems that are really prepared for life's journey. So I wonder if we could back up a little bit from the event of pregnancy and talk about this road to a healthy pregnancy for young couples, men and women.

Yeah, I think what your son Cole is doing is super important. He's talking about it and preparing for it. And I think you are also excited to become a grandfather, although you don't look like one. But yeah, I think it's not only the parents, the grandparents also get, you know, excited. And I think, yeah, you know, I haven't felt this yet, but I'm sure the feeling of a grandfather or, you know, having son of a son or a daughter of— that's, that's, yeah, probably gives you the utmost joy in life.

And so weird because I never wanted to be a granddad and now I'm like so excited to be. It just makes me sound old.

Yeah, yeah. No, I feel old. And Lebanon, we say like the, the son of the son is more precious than your son. So I think, you know, the next generation is so important. So that's why I think we need to take care of ourselves before going to that journey. So preparing is super important. And yes, the dad gives half of the genetic material, right? So how come, you know, people say he doesn't have a role? He has a huge role. I think 50% of the genes are from the dad. So therefore it's super important for the dad to be in good health, right? The problem is that when we're 20, 25, we think we're invincible. Nothing's going to happen.

My son doesn't think he can be killed by a bullet, right?

Yeah. So we might not be careful. And I think a lot of people just go with the flow, maybe get into drinking, exploring things in life, which is fine. But I think when you're ready for a pregnancy, you need to back up a little bit, go back to the basics, what our ancestors did in the past. Today we're doing the same thing, like you said, but maybe with more advanced technology and trying to get results a bit faster. You know, thinking of your nutrition, your sleep, your energy levels, your focus, all these. If you, if you work on a few things and you don't have to work on all of your, your pillars. And actually, this is where I thought about what I call the vitality formula. And for me, that's basically a very small, simple approach because people get overwhelmed. I'm fatigued, I'm not healthy, I'm broke.

Right.

And actually those are only signals that your body is telling you about. And you need to start working on one of those pillars. If you work on your sleep, your nutrition, all at the same time, initially you might not get good results. So I think starting on one pillar at a time and then maybe stacking them together at some point, and that's how, that's how you will change your lifestyle. But this should be for men and women. Because they're uniting their, you know, their gonads and their sperm and their eggs in order to create a human. So you have to prepare.

Yeah, it's such a miracle. And, you know, I like some of the simple advice. I want to touch on some of those that I know you've spoken about, but moderate exercise, resistance training, something you call the critical window, 6 months of consistent exercise. Actually showing measurable improvements in sperm count, sperm motility, morphology of sperm, and reducing DNA fragmentation. So this is like new even for someone like me, that, that male can— a young man can have that much influence over the caliber of his sperm, which obviously is 50% of the way to creating this human life. So, you know, talking specifically to the men, Um, what are some things that young men can do? Stop drinking, probably right off the bat, and then the obvious drugs, smoking. But, you know, maybe limit or discontinue the drinking. But to have the healthiest sperm, you know, you hear, well, you shouldn't get into a hot tub, and, um, you know, you probably shouldn't be an ultra endurance athlete, which sadly for my, my son Cole is not. Um, he's not going to want to hear that. He's running 100 miles in like 10 days.

This is amazing.

Yeah, he's doing the 10 Ironmans at the end of the year, but he So we'll do it next year. But, you know, if young men are listening to this, like, what are, you know, some simple shifts that they can make to really sort of prepare their body to be producing healthy sperm that, you know, improve the morphology, sperm count, motility?

I mean, the sperm is the output of what your endocrine organ, which is the testes, produce. So it's going to reflect a lot of if there's inflammation in your body, if you're not sleeping well, you know, you have high insulin levels, if you're not hydrated well, all this is going to show up. So for me, sperm count is like kind of one of the vital signs of our body. I tell a lot of my friends or like patients that, you know, get tested, do a sperm count. You can do a home sperm count. I know there's the guidelines don't recommend a certain age, but why not? Why not see where you are? Because you don't want to be surprised later on when you're ready to have kids. Check your sperm count. If it's good, it means you're doing the right things. If it's starting to get worse, maybe you need to look back at your lifestyle and start changing things. Like you said, hot tubs, putting your laptop on your lap for hours and hours because of all this emission that comes out and the heat. Yeah, our cell phones are in our pockets a lot of times, but I think toxins and what we're eating, what we're putting in our bodies, on our skin because, you know, men are using more personal care products today. And so everything can play a role. Yeah, it accumulates. Those small doses of toxins can accumulate and become cumulative. So you don't have to be poisoned by mercury or lead to get affected. You can have small dosages that can accumulate and cause problems with time.

Yeah.

So definitely exercising. We know how much it will decrease the inflammation, improve your insulin, your muscle mass, all this. Reflect on what's coming out of your body.

That's so good.

Which is sperm.

Yeah. And in, you know, a lot of, um, women— I'm, I'm a, I'm a big fan of genetic methylation testing, and I've been pounding that soapbox for, for years. But there is a correlation between gene mutations in women, especially, um, like MTHFR, and frequency of miscarriage and, um, and even infertility. And and certain birth defects. And I won't say that they're causal, but there's certainly a, a, a high correlation.

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Now let's get back to the Ultimate Human Podcast. So would you recommend that young women get methylation testing and then maybe start to address some of those methylation deficiencies by supplementation or dietary changes?

I mean, if I answer this question, a lot of people are going to, you know, also put me in the controversy standpoint. But I do agree fully with you that, yes, those could play a role. They're not maybe the major thing. If you go by the guidelines today of our, you know, ACOG and other things, they do not recommend to do those on everyone. Even with women that have miscarriages. But again, I think it's logical.

Yeah.

Sometimes, you know, the studies, you know, could be not well-designed. So you can criticize a lot of those things. If it's a simple test and it can make a difference and the treatment is, you know, folate or changing their diet, why not? In certain situations. Yeah. So I wouldn't say test everybody today. I mean, next year if I come back to your podcast, I might say, I might say it differently. But today, based on what data we have, I wouldn't screen everyone. But yes, maybe someone with multiple miscarriages, a family history of neural tube defects, we might check those, but not across the board. I would definitely supplement them and make sure their nutrition has enough folate, choline, omega-3, all these things in order to improve the outcome of the pregnancy.

I'm going to list in the podcast show notes some of the supplements, or at least key nutrients that you talk about for sperm quality— zinc, selenium, methylated B vitamins, huge fan, methylfolate, omega-3s, antioxidants like C and E and CoQ10, and lycopene, which is like in tomatoes and watermelons, bell peppers. Yeah. What's lycopene's role in improving sperm quality? That's kind of a new one.

They're also a very potent antioxidant. So anything that could lower your oxidation will improve how the DNA or how the sperms multiply and divide, and that will have less fragmentation. Of course, the data is not robust on just lycopene supplementation, but it comes as part of the multi-nutrient or the rainbow that men and women should eat in order to improve their gametes.

I love this idea of couples going into this and coming out of this together. Right? I mean, I, I have 3 children, and, and I can tell you, when, when we had our first child at 27, and, um, you know, I really did view this as really being my wife's role at the time.

Yeah.

And not really realizing the impact that I could have had. And by the grace of God, we had 3 very healthy children, and they're all doing amazing as adults. But, you know, I wish I'd had this information then because I was already doing some of those things. It was fairly healthy. I wasn't drinking a lot. I was I was eating a pretty decent diet. But had I known this, I think it would have been a little different going through this with my wife at the time as a couple instead of it being such a unilateral journey.

Yeah, I think also to simplify things, we don't want couples to worry much about this and cause anxiety. But today we're living in a toxin and a soup. Of toxins. So we have to be more careful. Maybe, you know, our ancestors didn't worry much about this because they were having healthier food, less processed food, less toxins. But today there is some— there's an enemy that's hitting us. So we have to be careful, men and women, before, during, and then especially after the pregnancy. I think the support from the men helping raise the kid, all the habits that we have, there's a lot of studies. If the If the father is athletic and he likes sports, your kids automatically will mimic and will see things that you do at home.

It's amazing. It's like some kind of genetic programming where characteristics are passed on. And even though you can't point to this gene causes you to have this outcome, if you have this gene, you're going to like sports. If you like to have this gene, you're going to be more cerebral or left-brained or right-brained. But it is kind of fascinating how characteristics are passed from generation to generation. And I've actually been reading and studying about trauma being passed from generation to generation, embedded in our, you know, our genetics, which is really—

Yeah, trauma, stress, all these, you know, change how our genes are expressing. And if you're pregnant during that time and you're under so much stress, then this could affect You know, because for, for me, I always say healthspan starts in the womb. So it even starts before birth. So whatever the mom is feeling, if she's chronically stressed and she's not happy, this will reflect into the blood flow to the placenta and therefore nutrients will be less, you know, given to the baby. And then their genes are going to be expressed in a different way. So when they're born, they might be born at a lower weight than they're supposed to be. And this is going to lead to other chronic, maybe diseases later on. So, so yeah, everything is related. And the more you read, the more you learn, the less you know. You know, it's so, it's so complicated how the genes interact among each other. We are what our environment is. So I think it's, it goes both ways. Whatever we give our environment, it gives us back.

Yeah.

And I think that, that relationship we should control because the maternal environment is what the fetal environment is.

Yeah.

And it's going to be your, your early stages of life and then eventually your adult diseases. Yeah. Today we talk a lot about trying to live, you know, longer or healthier, better. And we— most people start in their 40s or 50s. Oh, today I want to start living better. And, you know, whatever I've done in the past, forget it. No, I mean, like, I know we have to prepare for our, you know, last 10 years or marginal decades that a lot of experts talk about. This is important, but I think starting early and I see a shift, the new generation, the new generation are, are more health conscious than what maybe we were. So I'm happy that there's more awareness of that. But simplifying things, not complicating things, not causing anxiety, empowering women and men and couples, anybody that wants to have a kid, even if you're going through IVF or egg freezing, you want to freeze your eggs. To maybe later on use them. Also, you have to go through that process, make sure you're— before you start freezing your eggs. Of course. Of course.

You know, I, I really love this concept. So, you know, prepping for the pregnancy, then, then you conceive. And where do you fall on supplementation during the actual pregnancy? Methylated multivitamins or, you know, methylated prenatals? Or non-methylenedione prenatals. I don't want to put words in your mouth, you know, for a woman to be supplementing with during that time of pregnancy for adhesion and healthy fetal growth. Where do you fall in that?

Well, there's a couple of nutrients that are super important, including iron, for example. I think that's the number one method that people think about because the placenta needs iron, the baby needs iron.

You can see it in the color of the placenta.

Exactly. The woman's blood volume almost doubles during pregnancy. So she becomes a little bit anemic or what we call hemodilution. So you're going to need more iron for multiple things in pregnancy. So iron is number one. If you are iron deficient or you have an issue with your iron absorption or metabolism, you will have a higher risk of developing a smaller baby, what we call fetal growth restriction. So iron is key, especially if you don't get it in your diet or you're not absorbing it well. And then of course you have the B vitamins, which are basic frameworks for DNA synthesis. You have to have those. Vitamin D. There's a lot of data about vitamin D levels and developing diabetes in pregnancy, preeclampsia. Of course, it's important for the bone. So vitamin D is actually— it's considered like a hormone. So vitamin D is super important. But again, you have to supplement. The right amounts. So checking labs, supplementing them with the right dose, with a good quality supplement. If you can give them those through a diet, it'll be even better absorbed. But unfortunately, the diet is not always available for everyone to, to have the optimal levels in pregnancy. So that's why we have to supplement. So yeah, a good prenatal vitamins that have those including choline, DHA for brain development, all of those are important today. To take the right supplement. I think in the very near future, and I think there's a couple of companies now working on like very specific tailored prenatal for every single patient. So for example, a woman might not need that much vitamin D, but she needs more iron, she needs more choline. So based on testing on nutrigenomics, we can tailor a specific supplement for, you know, Mrs. X and Mr. X instead of us taking the same multivitamin across the board.

Yeah, yeah. That's another thing.

I think this is coming very soon and it makes sense.

Yeah, it makes a lot of sense.

If you don't have, for example, the MTHFR mutation, you might not need, let's say, that much folate versus someone who has it, for example.

Yeah, that makes a lot of sense. So, you know, I've read a lot of literature around vaginal versus cesarean section delivery, and I know there's confusion around this. There's people that fall into both camps. People say it doesn't matter at all. Um, there are OB-GYNs like the one that was, uh, or is our clinic director, that's a big believer on trying to have a vaginal birth to the extent that you can. And a lot of that has to do with how the fetus is inoculated, you know, through the vaginal canal. Um, where do you fall in that, you know, conundrum of cesarean versus vaginal birth?

And if there was a preference, you know, well, my straight answer is The way we're supposed to be born is vaginal. That's how God created us. But of course, with advancement in science, C-section became available and they do save a lot of lives. They can make a huge difference in certain situations. But the goal is always to try to have a normal delivery as long as it's safe for the mom and safe for the baby. This is the way to go because there's a lot of benefits from the way the baby, you know, moves in the canal, all these cardinal movements of labor, and then eventually the inoculation from the vaginal flora, the skin-to-skin touching that happens. There's definitely a lot of benefits. Otherwise, I don't think God would have created us to deliver that way. Right? Right. I mean, but the C-sections have a role. And I think, like I said, they save lives. But the problem is, like everything in medicine, people abuse them.

And I think a lot of them are for convenience.

For convenience for the patient. I'm not talking about doctors. I mean, I've done plenty of C-sections, but those were done for indications. But a lot of times the patients would come to you like, I want a C-section because I don't want to go through labor. It's a long process. I want to keep my pelvic floor healthy because I heard vaginal delivery can cause damage to my pelvic floor. And we know if it's done the right way at the right timing, it will not cause sexual dysfunction or other things. And yes, it is a stressful time. You will rehab eventually your pelvic muscles through special treatments and therapies with specialists, but it's way less risky than a C-section. At the end, the C-section is a surgery, so there is bleeding, infection. You could injure organs. So we keep C-sections when it's needed. And I, you know, my message to people, don't abuse it. Yeah. Not just because you want to deliver on a certain day of the year.

Yeah.

I want to pick the birthday.

Yeah. I want to deliver on the 16th at 2:00 in the afternoon. And you can now.

Yeah.

That's because one C-section after another is going to lead to more complications. Now we know after, let's say, a third C-section, if you have an issue with your placenta, you can end up having what we call placenta accreta, and that can lead to death and complications. So C-sections are great when needed, but our ultimate goal is to deliver normally in a safe way for the mom and for the baby. That's— I agree fully with any physician. And I think this is the oath that we swear by to make sure moms are safe and babies are safe without being heroic and then using the C-section when needed.

Right. And so you go through this birth process And then you have this brand new fetus in the world. Um, for someone that has a birth that was non-vaginal, that was through C-section, are there things we can do to mitigate some of those consequences of having not had a vaginal birth, like, um, prebiotic or probiotic supplementation, um, or trying to inoculate the baby's, you know, gut flora so they're not so, uh, colicky and, and have some of these other, you know, skin conditions and others? Because what's fascinating to me lately is, is You know, the impact the gut microbiome has even at a fetal level. I mean, we know that adults, when they do long course of antibiotics or other things to actually destroy their gut flora, they have all kinds of consequences that we don't draw back to the gut. And now we know the importance of the gut microbiome. Yes. And so if they miss that inoculation period vaginally, are there ways for, you know, young parents to actually supplement these kids with?

I think the first step, the most important first step is to do skin-to-skin, like put the baby on the mom's skin. And if the mom can't, let's say she's in a C-section and it's not feasible sometimes, then the dad. So even our skin flora can help inoculate. There are, you know, few trials, small trials doing like inoculating the vaginal flora or smearing the babies. I don't think there is any proof yet that it will make a huge difference in the long term. But those are still ongoing studies. But I think starting with the skin, putting the baby even in the C-section, they can put the baby on the mom's skin while the obstetrician is finishing the C-section. That will help a lot, calm the baby's nervous system, because the baby will start hearing the mom's heartbeat, which he or she was hearing when they were in utero. So putting the baby there on the skin will improve breastfeeding chances, plus they would, of course, get inoculated by the mom's skin. And then dads can do it. So I'm sure you've seen a lot of pictures of dads putting the kids on their chest. Of course, if they have a lot of hair to shave it so that the skin— but touching the skin to skin is so important, like from the first minute. Pheromones. Yes, the first minute or 2 minutes of life are critical. So as soon as you remove the baby, you put the baby on the mom's skin in a C-section or a normal delivery. I think that's one of the first steps that will make a huge difference. Probiotics and other things, I'm not really aware of any, you know, robust studies on that, but it makes sense is to replace, you know, whatever the probiotics needed, but nothing like the probiotics of the mom because her vaginal flora will change based on the trimesters of pregnancy. And then at the time of the delivery, it will be exactly the composition of her bacteria will be exactly what the baby needs. That's so wild.

Yeah.

So supplementing with probiotics, I don't know which one, you know, that's so— I don't think we're there, but maybe in the future we can maybe test the probiotics of the mom and then tailor or create a probiotic specific and give that to the baby. Yeah, maybe.

Yeah.

So all these, all this precision medicine I think is on the way, but today I think doing the skin-to-skin immediately is probably the best thing you can do for your kid.

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Now let's get back to The Ultimate Human Podcast. So amazing. You know, I had a, a Harvard scientist on my podcast, actually, when we were in Dubai, uh, Dubai, and They do, uh, in his laboratory they do these customized probiotics where they take a stool sample and they culture your, your flora and they look at, you know, the different strains of bacteria and which ones you're deficient in, which ones you have an excess in. And what's really fascinating was how much they could predict about the person having nothing other than their gut flora, their, their, their actual profile of their gut flora. Like, this is somebody who gets seasonal flus more frequently than the average. This is somebody who doesn't have a lot of endurance. This is somebody who is very likely to have skin conditions like eczema, psoriasis. It was incredible, the mapping that they've done from specific gut flora, both in excess and in deficiencies, to like these manifestations in, in the real world.

You are, you are, you are what you eat. Yeah. And you are what you know, you're surrounded with, you know, your friends, your community, you eventually blend into it. So whatever you're surrounded with becomes you. And yeah, I believe the gut is so important and, you know, especially in pregnancy because it— there's a lot of interaction between the gut, the vagina, the gut and the uterus. And I'm sure there's a gut-placental connection somehow, which we still probably don't know about. But this is amazing to be able to, let's say, tailor a specific probiotic maybe to give to the baby eventually. So maybe we should test pregnant patients and tailor a probiotic for them so that in case they end up with a C-section, we give it to the baby. Yeah. I mean, I don't know, that might be a nice project you and I maybe we can create. All right, let's do it.

So, so new probiotic coming soon, guys.

Yeah. So I think skin to skin is the best thing you can do for your kid in minute one of life.

Yeah. And then in the precious important months immediately after delivery. You know, we— I think the consensus is in that if you can breastfeed, you should be breastfeeding. Um, and for whatever reason, a lot of women, um, can't, either for anatomical reasons or other reasons they can't. Um, and so now they fall back on having to feed babies formula. And I had the, uh, Health and Human Services Secretary, but I also had gentleman named Kyle Diamantes, who's the head of human foods at the US FDA. And one of the big focuses and projects that, uh, he's aligned with, and they're, they're really researching right now, are infant formulas. And do we really need to put, um, pro-inflammatory seed oils in as the, you know, sole means or major means of, of, of fat of these um, you know, these, these fatty acids. So if a woman has to, um, it can't breastfeed for whatever reason, um, you know, I know a lot of the young pregnant women, especially in my circle— I've got two in my company right now— and, you know, they're ordering their infant formulas from Europe, um, because they've gone down the rabbit hole of the research and they're like, they're just better quality formulations there. They're seed oil-free. And here there's some regulatory guidelines that force different ingredients to have to be in there because it has to meet a certain profile. So where do you fall on infant formula? And is there— I've, yeah, I've seen both sides of the spectrum, you know. Um, uh, Dr. Barbara O'Neill— or she's not a doctor, but Barbara O'Neill, um, saying, well, um, goat's milk is very close to mother's milk. And then I've had other people say that there's nothing wrong with infant formula. And some people say that you should only get it from Europe.

I don't think there's anything like the breast milk because like, you know, the vaginal microbiome, for example, your microbiome, your milk consistency changes, you know. So if you deliver, let's say at 27 weeks, the consistency of the milk that comes out is going to be different than if you deliver at term. So it's made in a way to give the baby what the baby needs at that age. Oh, wow. Yes. The antibodies that are in it, there is no way a formula can mimic breast milk. And unfortunately, yes, like you said, there might be a lot of things added to the milk to make it maybe more tasty for the baby that might be hurting. I'm not an expert, I'm not a pediatrician, so I cannot comment that. But yes, my to-go first is milk, is breast milk. The other option, of course, to try to get the least amount of formula that's not inflammatory or causes gas. And you can know, like, for example, in my experience, my wife breastfed for 3 months. Then she couldn't anymore. So we moved to formula. We had to change 10 formulas in order for the kid to not have gas and colic. So which is not normal to have, you know, colics and why that severe colic. So it might be one formula not working for that specific kid. But yeah, the world of formula is a, you know, is a huge problem. A lot of hospitals are shying away from having formulas on board. Some, some hospitals used to give away formulas on discharge.

Right.

A lot of them stopped that because, you know, they don't want to promote those formulas. So it's, it's, it's a difficult situation. But again, the first 2 years of life, if you give the baby those inflammatory components, you're going to make things worse. Yeah. So, yeah, try to find the most natural way. There are, you know, donor milks that, you know, women donate some milk. It could be maybe a better option. Not everybody accepts those. But yeah, breastfeeding should not be difficult. I think putting too much pressure on the woman is going to make her maybe not like to breastfeed or feel this social pressure. By the way, doing skin-to-skin in the first minute will improve your breastfeeding rates. I've seen it firsthand. A patient telling me, I don't want to breastfeed. Please don't even open the subject. I don't want to breastfeed. Don't even tell me the benefits. I know. I'm doing formula from minute one. And then I remember we're doing rounds and the baby was in the room and the pediatrician was talking to the woman and she's like, can I try something and just put this baby next to your breast? And she took off, of course, her blouse and put the baby. The baby just crawled to the nipple and started sucking. Really? Yeah. And the mom started crying. She's like, I want to breastfeed, you know? So, so, so, so really, like, before trying you have a lot of oxytocin that comes out, which will make you calm and bond you with the baby.

I'm not—

we don't pressure women. We empower them to try to breastfeed. Yes, there are sometimes anatomical things that will not let you breastfeed. But if you can breastfeed, try even a month, even 2 weeks, even a few days will make a huge difference in the baby. But going back to formula, I really don't have an opinion about it because because I know there's so many formulas out there and each one says they're the best, but they can never mimic breast milk.

Yeah, yeah. You know, I'm deep down the rabbit hole of this right now. So when I, when I come to some conclusions, I'll share them with you. I'd love to get your—

Yeah. And then maybe we can eventually, like I said, do tailored or specific formulas for each baby depending on their gut microbiome. So maybe we need to look into that in the future.

I love that. I love that concept. So now these couples are on this journey together. The man still, you know, plays, plays a huge role. I mean, the father's presence, we know, especially in young children, is critically important. Um, breastfeeding, critically important. But, uh, yeah, I've been deep down the rabbit hole of this whole toxic exposure and pro-inflammatory compounds and a lot of, um, in a lot of different infant formulas. But, you know, the sad thing is it's restricted by the regulatory guidelines. Like, you have to have this and you can't have that.. And so it limits the capacity to structure these in ways that might be healthier for babies. I think you're going to see a lot of that change because, you know, human foods, the US FDA is really open to widening these lanes to the extent that there's evidence, you know, that to say that this is priority.

I think this should be, you know, the number one priority because we are what we eat and, you know, we need to have a nice, you know, clean, food supply. Like you said, some people are going to other countries to get different type of food. So no, I think this should be our priority because a lot of the diseases are related to food.

We know that. And so as an OB-GYN, you're not only dealing with deliveries, obviously you're also dealing with women's health issues. And there was a big announcement by the FDA recently removing black box warnings from female hormone therapy. And they corrected the narrative around the Women's Health Initiative study, uh, that incorrectly was, uh, you know, when, when they, they didn't— most people don't read a published study, and so they take the narrative and the headlines that comes from the headlines, and they intentionally or unintentionally— I mean, I have to think that it was intentional, um, you know, redirected women away from hormone therapy. And, you know, if you talk to Marty Makary, the head— the commissioner for the FDA— he'll say that 50 million women needlessly suffered because they were told that, um, you know, hormone therapy increased their risk of breast cancer, when in fact it actually decreased their risk of breast cancer. There was not even, uh— there's certainly nothing causal, and there was a correlation between taking these, you know, having hormone therapy and and increasing your rate of breast cancer. What I find fascinating is, you know, menopause for a lot of women is beginning earlier and earlier, right? It can start in their late 30s. So you start to have these weird symptoms— mood changes, weight gain, water retention, fatigue, brain fog, um, you know, mood and emotional issues. And immediately I think most women look to their outside environment and go, okay, it's either my spouse or my career or my job, my kids, my stress. But very often these are the hormonal changes going on. And, you know, it's my belief that they can benefit very often from hormone therapy. But where do you fall in that, you know, whole debate on hormones?

I think today it's not a debate anymore. I think the WHO misled not only women, but misled physicians. Yeah, happy to hear you say that. When the WHO came out, I was still a resident. 2001, 2002. And, you know, we discussed it in our journal club and, you know, that was a robust study. You know, we should not be giving, you know, women, you know, HRT. And even though, like in our residency and as an OB-GYN, we don't see a lot of menopausal women. So add to that, you know, the training and postmenopausal treatment is not as robust as it should be. And I think this is changing very soon. So we did not have a lot of experience with, you know, giving HRT. Plus we were like afraid. So in my first few years of practice, I would tell women, yes, take HRT just to treat your hot flashes, 5 years, and then that's it. You would stop them because we don't know the risk of breast cancer or cardiac diseases. And if you want to continue, that's at your own risk. I used to make actually few patients sign consents like they're taking it at their own risk because that's what the data told us and we're following evidence-based. But yeah, if you want to talk about the WHI, the type of estrogen that was used, the design of the study, the age of the woman, we can talk for 2 hours. But yeah, it was some, some sort of— it doesn't reflect what the real problem is right now. Women are going into menopause maybe a little bit earlier. Yes, they would benefit from, from, from hormone replacement, especially the newer bio— or I call them body identical because they're identical to the body. They're still, you know, manufactured in a way. Yeah, yeah. And other things. But, but there's chemically very similar to their own estradiol and progesterone and testosterone. Yes. Women will benefit on multiple levels, you know, from, from, from their skin all the way down to their, to their organs and bones and vaginal health, sexual health, mental health. So there's a lot of benefits, you know, for HRT. But also I think we should always kind of personalize things, the dosages, who should benefit, when to start, when to stop, work on the pillars initially, their inflammation, their gut, their toxins before throwing in hormones without thinking. And it becomes like a recipe. It should not be a recipe. It should be a tool that we have to give women those medications that I think are just replacing what they lost. We're not giving them supraphysiological doses, just optimize. Yeah, bring them back where they are because they deserve to be functioning. The workforce today is almost 50/50 men and women. You have CEOs that are women. So imagine a CEO in a meeting and she's sweating and she forgot what she thought about.

I mean, right.

It's so important. This happened to my wife.

We just did a podcast on it. I mean, I, I, I lived it day to day. I mean, like, it just over a period of— slowly over a period of several months, my wife was becoming kind of a different person. And, and, um, what really drew my attention to it, um, was when she got frozen shoulder. She got adhesive capsulitis. And it's typical. So yeah, I didn't realize how typical it was, and there's not a lot of literature on it. And so I started going deep down the rabbit hole of it, and, and You know, all of this, the symptomology including the frozen shoulder, was linked back to menopause. And then of course, then when she started having hot flashes, that was the big flashing red light. And we did a test called a Dutch test. It's 24-hour urine test, and it gave us so much information, um, that her OB-GYN was able to tailor her hormone, uh, treatments and, and if you're a woman and you want to see that podcast, we actually give Sage's exact hormone dosages on there. We go through the Dutch test in detail. But what was astounding to me— she became a different person, I'm sure, in 3 weeks. A completely different human being. It was like the woman I met, you know, 10 years prior. I mean, mood improved, sleep improved, libido came back. Of course. Thank you very much. Of course. And that was a nice plus. Libido came back like a freight train. Her, you know, her waking energy improved. She, she would tell me, she's like, I'm sitting down to send a wire from my bank to pay this bill, and I've done this a dozen times and I literally can't figure it out.

Yeah. She's like, I hear this all the time. Like, it's not me. Like, I feel like a different person. So yeah, definitely hormones play a role.

But even, even a frozen shoulder. Yeah. Which I was like, you know, she went from being able to only raise her arm to here to wham, right?

Straight up, straight up in the air. And of course, you know, it's not only, you know, your musculoskeletal system, your cardiovascular system, your skin, which is so important, you know, for women and their beauty. You know, they start aging very fast if they're without HRT. I see a lot of women undergoing, let's say, you know, facelifts and the ones that are not on hormone replacement, the results are usually weaker and last less. So it can help on all levels. And I'm so happy that they removed this stigma on estrogen causing cancer because I think we're in the right directions using them the correct way for the right patient, the right dose, the right route is what's important. And that's where physicians and healthcare workers, midwives, those are the people that can you know, help those, those women. Um, and at least the help is there now.

You know, I, I, uh, I try not to get my information from TikTok and Instagram. I try to get it from, from clinical studies and then put it on Instagram and TikTok. But, um, I, I've been reading a lot lately about— because we, we, we struggled with this when we were young parents, um, you know, with having the kids sleep with you, right? And it's the best. I mean, let's just be be honest, having your baby in the bed with you or your young child in the bed with you and they're all snuggled up, you do not want to just get up and go dump them in the crib or give them away. But now there seems to be some evidence emerging that, you know, kids that actually do break that law and sleep with their parents early on— I mean, you don't want your 50-year-old sleeping with you, but, you know, it does look weird.

Yeah, yeah, yeah, yeah.

It's a little weird when they're your size. But, you know, that there's some evidence that this bond and this unity actually creates children and adolescents that have less incidents of anxiety.

Absolutely. I saw that study. It was out, you know, a few weeks ago. Yeah, a few weeks ago. Yeah. Yeah. Because, you know, our son is like 6. He sleeps in our bed.

There you go.

Yeah, just like that. But the problem is a lot of nights he comes comes in, we put him, he sleeps in his bed. But then I would say every night he would come. Yeah. A lot of nights he would kick me out. He's like, you know, I mean, I wake up, I wake up very early, but sometimes kick you out into the kitchen. No, it's him. Okay. At 3 AM, 4 AM, he starts, you know, no room for you, Dad. But, but yeah, and then we thought, oh, we need to break this, this cycle, keep him in the room. But when I saw the study, it makes sense. But like everything, you have to have a balance. There's, yeah, sure, there should be a point. Yeah, a point where, you know, he has to have independence, he will probably or she will probably won't want to sleep in your bed anymore. They want their own room and blah, blah, blah. But definitely this bonding, this connection, there's some chemistry that goes on, pheromones or I don't know what they are, or the energy that goes between humans when they are sleeping next to each other that could, you know, maybe help the kids have less anxiety. They will feel safe.

So it's all connected. My wife used to accuse me of being lazy because You know, we would take turns when, when our firstborn, my, my daughter, would wake up in the middle of the night, start crying. And my solution was go pick her up, bring her back to the bed because I was so exhausted. Yeah, just lay down and she would go back to bed. I'm like, this, this is working, right?

The easy way, the easy way.

But yeah, the little chair next to the crib, you know, to try to, you know, get her back to sleep and sneak her back into the crib. She'd start crying again.

I'm like, but if you think about it, you know, the baby was connected to the mom through the umbilical cord. They were in their uterus. Suddenly putting them alone in a crib is weird. Same thing with twins. They were used to being close to each other. There's a lot of debate whether you should separate them and at what age you should separate them or keep them sleeping next to each other. I think it's important to keep the internal environment kind of the same when you're out and slowly disconnect them from each other, for example, or disconnect the kid from you. So it's okay if your, I guess, kid sleeps in your bed. I'm sure a lot of people comment on this saying yes, no, it's controversial, but at the end, whatever works for you.

I think you should just make the decision as a parent and quit worrying about the rest of it. Mother Nature has a way of kind of taking care of itself. One day your kid's not going to wake up and just come running into your bed. You know, I used to, I used to hear the, like, the pitter-patter of the feet coming down the hallway, or they're running something. Yeah, yeah, sometimes they run. Yeah, because, you know, kids that wake up alone, I mean, if they've got high catecholamines or something, they go right to worst-case scenario. Yeah, exactly. There's an alligator under the bed, there's a monster in the closet, and they beeline for your, for your bed. Yeah. And it's, it's kind of hard to just carry them back in.

Like I said, the body will adjust. Uh, you know, the, the nice thing about the body, it, you know, it puts priority to what it needs to fix first. So that's why I tell people to try to fix one thing at a time, because if you overwhelm the body to fix everything in different directions, it's going to get overwhelmed. But the body knows, like, now my priority is, let's say, sleep. So it will fix your sleep in a way. Now my priority is to reproduce, so you will fix your gonads. So yeah, the body is amazing. Machine, I would say.

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Now let's get back to the Ultimate Human Podcast. I've also heard you talk about a topic that might be somewhat controversial. About migration as a health disruptor. And because we have such mixed cultures and mixed migratory patterns all over the world. And it's, you know, that migration, adapting to a new culture, language, new social norms has its set of stressors. Absolutely. And you talk about some of the statistics in migrant population. Right. And I wonder if you might touch on that for, you know, what, what does that look like for people that are either relocating to a new country, new culture? What does it look like for people that are coming from another culture and trying to assimilate?

Yeah.

I mean, today there's around 300 million people around the world that migrate. Some of them migrate across borders. Some people migrate in the same the same country but different regions. So, but humans migrate in search of food, career, family safety. Some are forced to, let's say, migrate. Some just do it by choice for other, you know, more opportunities in life. So migration is common and it's increasing today because it's easy. It's easy to migrate today. But yes, I think migration is not only, you know, changing geography, it's changing your physiology. And honestly, I learned this from myself, from my own experience, because I migrated a few times in my life. And it takes time for your body to adjust. Your microbiome changes from one country to another. Really? Because that's the water you're drinking, the food you're eating. Like, for example, now when I go back, let's say, to Lebanon in the summertime, if I eat something there, I might have an upset stomach because my flora changed living in Miami and using the water of Miami, for example. Example. Sure. So your physiology is not that good, by the way. Yeah, I know.

Don't even start it. Yes, yes, municipal water here.

Yeah, I just saw your reverse osmosis system, so I think this is also another message to people: clean their water before drinking it. So yeah, your physiology changes by migrating, not only your geography, your physiology, your friends might change, a new job. So I think it's always a good opportunity to use migration in a positive way. Not to make it dramatic, even if you had to be forced to migrate. But your circadian rhythm will change. But the body, like I said, is amazing and it will adapt to this migration. And people need to be aware of it, that if you're migrating, it might take you 3 or 4 months to adapt to your society.

Is that what you refer to as the healthy immigrant effect?

Yes. Yes.

Yeah. Yeah. And you need to be positive about it and And even if you've lost everything and you move to a different country, it should be an opportunity to start from scratch. Any bad thing that happens, I think, in everybody's life should be taken in a positive way and try to build on it. And this all reflects in your physiology and your energy will change, your sleep patterns will change. So yeah, I think migration is a topic that not many are talking about, but it plays a role in our health because we are constantly migrating and traveling around the world.

You know, it wouldn't be the Ultimate Human Podcast if we, if we didn't talk about some of the fixation that people have on longevity and anti-aging and not just for women, but for, for men as well. Knowing what you know, experiencing what you've experienced as a physician, everything from delivering babies to managing female hormone therapy to, you know, your, your, your lens on, on, on migration. What are just some of the must-haves or must-dos that society, men and women both, need to be engaged in on a regular basis?

Yeah, I think first you mentioned the obsession with, like, say, longevity and healthspan. I think we should not, you know, have this obsession. Unfortunately, you know, people now are so obsessed on doing everything at the same time. And, and this is what's causing sometimes more anxiety, right? Sometimes doing more labs can cause more anxiety. So I think we should use labs more as a framework to help us improve things, not, you know, to do so many labs because this is going to make you more anxious. You mentioned the beginning basics, you know, your sleep, your food and your stress levels. I think those are the first thing that we need to do because, you know, being obsessed with like longevity and how you might miss things in life that you need to enjoy. So you have to have a good balance in improving your health, enjoying life, but at the same time living, you know, in a healthy way so that you can function, have good energy and transmit this to your kids. And to your environment. Yeah. So yeah, the first thing is not to obsess about, you know, longevity and living longer. Just obsess about living healthier now. I think that's— and if you like to do this certain hobby, do it in a healthy way. If you like to play padel or you like to play tennis or soccer, do it, but in a way that you will enjoy it. And don't obsess about, you know, hacks that might not work for you, might work for some other people. And like I said, sleep is so important. I mean, I'm discovering this every day because I have issues with sleep and I'm trying to fix that because the nights I sleep well, I am so productive and I feel so— yeah. And the nights I don't, I'm in debt for sleep and my whole concentration, my whole energy collapses. So focus on sleep because there are people say, oh, I'll sleep when I die. Yeah, I hear this all the time. You know, you live once, you live once. Sleep is for losers.

Yeah, you'll sleep when you die.

Take the hill. I think the hours you are awake will be so much more fruitful if you have slept the night before. Yeah. So I think that's the main message. And of course, we know sleep improves your fertility, improves your weight control, your gut microbiome, your brain, your It's unbelievable, you know, how important sleep is. And then food, like we talked about, is what, what we are because it's going to affect our hormones, which in turn will affect our life.

Yeah, I would totally agree with that. I mean, I think that you can get paralysis of analysis very quickly by just going out there, just Googling around about a good supplement, Googling around about the best biohacking modalities. And I think very often we just forget that we have data on this already. We have big data, we have Blue Zone studies, and there is not much that matters if you don't get sleep, whole food dieting, and mobility. Just making exercise kind of non-negotiable. And these are— this doesn't matter if you make $2 an hour or $2 million an hour. It's not a socioeconomic thing. It's just a human thing.

And movement is cheap.

I mean, movement— yeah, movement's cheap. And, and, and, and, you know, what's interesting is, you know, you, you, you want it to be this one special thing. You know, like, I was always fascinated when I would look at, like, Blue Zone studies, and it was like the goat herders and sheep herders and—

yeah, that were, that were living the, the longest life.

Because, you know, like, sheep wanders down over the hill, they walk over and get the sheep, they bring the sheep back up. Then they brought their lunch with them and they ate out in the sun, you know, or ate out under retreat and they have fresh air. And, and, um, you know, Casey Means was talking about how we spend 97.5% of our time indoors now. Yes. Um, and I'm conscious about trying to force myself out outside. And, and I will say that of all the biohacking— you know, you walked around here— I mean, of all the biohacking modalities that I have, um, in all this, you know, fancy, fancy equipment, nothing really makes me feel better than getting sunlight on my skin in the morning, doing a round of breathwork, going for a grounded walk. Or I mean, when I'm in Colorado, I walk and have this little 4-mile loop that I do with a weighted vest. And I come back and I'm like, I feel really good. Like, I feel like spiritually good.

Absolutely. Yeah, yeah, yeah. The connection with nature. Yeah.

All these—

yeah.

Western medicine, they do— or Eastern medicine, they do forest bathing.— yeah, yeah. Somebody actually sent me a slide of some of the hospitals in the '30s and '40s, and they had sunbathing balconies, hospital beds.

Yeah. On rooftops. Rooftops.

Yeah.

Yeah.

And then we just lay the patients out in the sun.

It tells you, you know, like our ancestors knew a lot. Yeah. But we just had to prove it with, you know, with studies. But there's a lot of things that are done that are really, you know, basic that our ancestors did without even maybe noticing that they are, you know, beneficial. And, you know, with time they— we lost those skills, I guess. Yeah. But yeah, nature, walking outside is amazing. But yeah, unfortunately, because of work and because of, you know, people want to succeed all the time and there's so much pressure on us that we are stuck inside on our laptops and on phones with junk lighting. Yeah, you just have to, you know, go out and walk. And I think what you've done here is almost like nature. Yeah, yeah. Trying to bring the— yeah, your air is so clean and, you know, everything is amazing. But, but like you said, going outside is still no replacement for—

no, yeah, yeah, yeah. I mean, I think the more disconnected we get from Mother Nature, the more, the more isolated we become. You know, I don't think that we were genetically programmed or ancestrally designed to be indoors this much in artificial lighting and artificial temperatures. You know, our bodies are so adaptive. It's incredible how resilient we are. You know, that's why I love the application of some of these hormetic stresses like sauna and cold plunging. And you don't have to be obsessive about it, but those things make it— make a difference. They actually build resilience.

And of course, if you do it with, with friends, it'll be even, you know, you know, better because, you know, also the community is so important.

Yeah.

So that community, that sense, that sense of community is huge.

Yeah, huge.

So in your practice, um, where are you going? How has, how has your actual practice evolved? Like the way that you look at your patients now? Have you zoomed out now and you actually start to consider lifestyle, diet, stress? Whereas maybe— and I'm not putting words in your mouth— when you got out of med school first started seeing patients, it's sort of a by-the-numbers kind of thing.

I think you're not putting words in my mouth. These are my words. Okay. That's exactly what I want to say. Yes. Yeah. You become, you know, after training, you know, you become a bit kind of a robot and you do the right things. You save lives, you do C-sections, you do hysterectomies. And so you're doing the right things. But yeah, that zoomed out, you know, 360 view of lifestyle. I'm starting to appreciate it maybe in the last 4 or 5 years how important it is. Yes, we used to be told lifestyle is important, but we never dug into— like a patient would come in for 10, 15, 20 minutes. Yeah, I wouldn't know much about her life. Right. You can't really dig in. Yeah. So but I think digging in into every person's lifestyle, the way they sleep, what they eat, when they move, what are things happening in their life as far as stresses, the relationships. I mean, those take time to know a person. You can't know a person within 5 minutes. But yes, definitely my view on pregnancy, whenever I see a woman that has a baby, a small baby, I start thinking, is it things she ingested? Is it the food? Is it, you know, her blood pressure? Why is her blood pressure high? Is it, you know, related to, you know, her stresses in life? Where does she live? So like, yes, my view to things have changed, no doubt.

Have you seen patterns in your practice?

A few patterns. Yeah, a few patterns in lifestyle. Yes. Yes. I mean, definitely women that have a very hectic lifestyle with, you know, very high demanding jobs, you would feel sometimes their pregnancies, they might end up with more IVF sometimes. I mean, again, those are just observations. I'm not saying anyone who's a high achiever will need IVF, but yeah, you have those those patterns that you are seeing, you know, people that have no access to food, they only have access to junk food. They end up being overweight, having preeclampsia, preterm labor, emergency C-sections. Yes, there is a pattern, no doubt. I know that. But now just the way I think about a pregnant patient is different than what I did, you know, 5, 6 years ago.

Yeah. Yeah. Just amazing. I'm, I'm so glad that you came back so we could—

I'm so happy you had me for round 2.

Yeah. And it's, it, it still, uh, strikes me that we had to meet halfway around the world and we had to finish it, and we're right— you're right up the street. Um, you know, I have a group of, uh, folks that are my VIP clients and, or VIP members, and so we're going to go into the, the VIP group and now have a little private podcast because I let them know who's coming on on the podcast, they have some questions for you. If you're actually interested in becoming a VIP, just go over to theultimatehuman.com/vip and you can get it, take advantage of the private podcast. You can ask Gary anything. You can get my AI, you can feed it labs, you can feed it genetic testing, you can ask it anything. It's an incredible community of like-minded people that's going to change the world. But, um, before I end every podcast, I, I ask my guests the same question. And if you watch the podcast, you know it's coming. There's no right or wrong answer to this question. And that is, what does it mean to you to be an ultimate human?

I think being— you know, I did not— I knew you were going to ask this question. I didn't want to prepare it. I wanted it to be, you know, to come out from what we're discussing. I think an ultimate human, you should be A person who is connected to yourself, connected to the people around you. Give as much as you take from others so that, you know, the day you are not here on Earth, people remember you, that you were someone who impacted their life in a positive way. And then at the same time, Being a human is, you know, enjoying life, not to take things all the time seriously. And then, you know, being able to live in a healthy way and then not dying suffering. I think that's, that's how I see health span and ultimate human meaning.

Yes. Yeah. No, that's amazing. Dr. Labib, you're amazing. I'm glad that you came back.

And thank you for having me. Round 3 is going to be the trying the biohack gadgets you have.

For sure.

We'll do a whole podcast episode on it.

You're welcome back anytime. You should do this.

Yeah, you're my, you're my neighbor, so you're welcome back anytime. So thank you for coming on. And until next time, guys, that's just science.