Superpower Founder Max Marchione - billionaire health protocols and the future of medicine

Hello, fellow data nerds! Welcome to World of Das. I'm your host, Oren Hoffman, CEO of Incubate and GP of Flex Capital. Discover more episodes, get weekly data-as-a-service news, original content, articles on data, and more at worldofdas.com. That's worldofdas.com. Hello, fellow data nerds! My guest today is Max Marchione. Max is the co-founder of Superpower, a digital health platform to make preventative and personal medicine accessible to everyone in the world. Max, welcome to World of Das.

Thanks, Oren. Excited to be here.

Okay, now what does a billionaire-level health protocol look like today? If you could just spend money no matter what, what would you be spending it on? Again, you don't want to waste your time, but what would you be spending on if money was no problem at all?

I love this first question. I feel like so many podcasts are like, so tell me how you got here, tell me what you do. This is fun. Gosh, Well, I need to be a billionaire to properly put it to the test, but—

because remember, if you're a billionaire, your time is also super valuable, so you don't want to just spend random time on stuff either, but you're happy to spend money on things.

Totally. So I think it starts with testing as much as possible. And if I were a billionaire, every 1 to 3 months I'd be conducting a set of tests. Blood testing is the most basic, and I'd test over 100 biomarkers. Hormones, inflammation, metabolism, cardiovascular health, liver health.

And basically you have the phlebotomist come to your house or wherever you are and just come and get the blood and then give you your test results back on those things. Okay.

Yep, I'd probably do same day every month, and it would take 10 minutes. The phlebotomist would do it. I would also do gut microbiome testing a little bit less frequently, but I'd still do it. Toxin testing as well. If my levels were elevated in anything I would test more frequently because I'd be undergoing a protocol to fix that.

Toxin testing with blood. How do you do it? What's a toxin test?

So urine is urine. Okay. One of the ways you can also do it with blood and you can also do it with hair. But I would do the urine one most often because it's easy to get a broad set of diagnosis. And that will look at mold, heavy metals, and environmental toxins, things like bisphenol A, BPA, which a lot of people are exposed to nowadays. So that's where I'd start.

And do those change a lot over time? Does that tell you something about your own health if they are changing?

One of my beliefs is that a lot of people have an overexposure of, of toxins and that is disrupting metabolism. It is disrupting hormonal balance. It is disrupting all sorts of other functions. And some people would even contend that having too many of these toxins result in cancer, Alzheimer's, or heart disease down the road. That has been something which was hand-wavy up until 5 years ago. And every year that goes by, there's more research to support it. The classic example being microplastics now being linked to cardiovascular disease and neurodegeneration. And that's a harbinger of what's to come when we start to understand how synthetic and non-synthetic things in the world impact health. So that's where I'd start, diagnostics.

But sorry, but if I get my toxins done 3 months ago, is it really going to change that much today, 3 months later, or is it one of those things just every couple of years I should— where it's like, I know your blood could be changing quite a lot.

I was in the 99th percentile for over 15 toxins. In other words, I had a lot of toxins in my body. And that was heavy metals, like mercury. It was plastics, like BPA.

Because you're eating like sushi. Okay. Yeah.

And it was several mycotoxins from mold. And when I started a protocol to systemically detoxify these things, my levels would change every week and certainly every 3 months. So I think if you're actively trying to target your levels, then you should see a delta every month and definitely every 3 months.

Oh, got it. So if you have high and you're just trying to go down, you're trying to say, okay, is this working or something, then you want to be measuring. But if your toxins are relatively low, you don't need to work on it, then maybe you don't have to get a test that frequently or something.

Yes, 100%. I think what's useful about starting with a broad baseline of tests is you start to understand what is going wrong, and that informs where you should be retesting.

And by the way, and so far everything you're talking about, you might have to be well to do, but you definitely do not have to be a billionaire to do any of these things. These are things that might cost you maximum in the thousands of dollars per year right now, and maybe you can find a lot cheaper alternative. What else would you be doing?

I would do organic acid testing. I would do less frequently, uh, full body imaging such as MRI and ultrasound and CT scans. Look, if you do the full set of all of these diagnostics, you're still only set back maximum $10K. So it's not actually that expensive considering this is billionaire level care. Assuming I've got all of those diagnostics, the next thing as well gets expensive, which is paying a genius doctor to take all of this data, spend hours and hours thinking about it and processing it and performing compute. Basically, take getting a genius doctor who can connect the dots. That's expensive because very few doctors are genius doctors. Maybe if assume genius is 3 standard deviations, that's 0.3% of the population.

I would assume whether it's you guys or other software tools or even just ChatGPT is going to be able to be very helpful on some of these things going forward.

ChatGPT and AI with enough context prompting and medical knowledge will far outperform the best genius doctors.

Yeah.

And look, we're some way off that. These doctors who charge $100,000 to $500,000 a year to see them, they tend to be pretty good. I know many of them, several are advisors, and if I was a billionaire, I would 100% pay for them.

Yeah, yeah, why not?

Totally. And I do think they still know things that the AI does not know. I call it latent knowledge, knowledge in the brains of doctors that's not on the internet, not in medical textbooks, not in papers, but that these doctors have seen work over 50 years. Now, that knowledge is also going to end up in AI.

I have one of those expensive doctors, and one of the things he does very well is he's very good at nagging me. And of course, you don't need a medical degree to be good at nagging somebody. And he'll be like, Oren, look, you're not building muscle mass fast enough. And he makes me feel bad that I didn't put on enough muscle mass or that I'm not moving my markers in the right way. And he does lots of things like that. The AI doesn't seem like it's good at nagging me to go do things, and I don't feel bad about disappointing the AI, but I feel bad about disappointing my doctor.

Yep, I agree. And there'll be all the people out there, they'll be like, no, AI can do that. Look, it can nag, it can nudge, it can be proactive.

Yes, that's right.

There's a reason people still use personal trainers. Oh, you haven't really needed a personal trainer for a long time. Bodybuilders certainly don't need one. They could do their own programming. We know that is true. They know how to put together a program, but they still get personal trainers. I mean, that's the human component.

To me, the reason a personal trainer is okay, you paid for the personal trainer, you've got an appointment 6 AM on Monday, whatever, you already paid, so you kind of really need to show up. You just feel like a total idiot If your alarm goes off, you're like, nah, I just want to sleep or something. So to me, the best, most important thing in personal trainer isn't the fact that they're helping you do the workout. That is good. They can help you with your form and a bunch of other things. It's great. But you actually do do the workout. And then of course, then you do the full workout that you really should be doing and not the partial workout. And then you just go sit in the spa or something. You do the real one that you're supposed to do. So again, it's more of that accountability. That's there, that's why it's so valuable.

Yeah, yeah. And I think that's analogous to a doctor or a coach holding someone accountable to lose weight as well. So I think if I was a billionaire, I would certainly have people holding me accountable and pushing me and telling me what to do. Then if I was a billionaire, I would start getting experimental on the therapeutic side. And this is where it gets expensive, right? So assuming we know everything about you, we've collected all the data, assuming that we've connected the dots between the data, you using a really smart human brain and lots of human time, or in the future, an AI brain and AI time. Now's the expensive part, which is actually therapies, and they're a long tail of therapies. I would take quite a lot of peptides. Some people say they're risky. I think I've always been very risk-averse, and I think that they've crossed the safety threshold for me.

What's an example? Because I keep hearing people talk about peptides, it's now in the water. What are some examples of things that you think people should be looking at or taking?

So I'll give the billionaire version and then I'll say what people should actually take. Yeah, the billionaire version, I would do NAD every week. I would add vitamins to that.

And why is that the bill? I mean, NAD is not that expensive.

Every week it's going to set you back $1,000. Okay, look, it's not really expensive, but for a lot of people that's not cheap.

That's pretty expensive.

Yeah, if you're doing it via an IV. With 500 milligrams. I'd add glutathione, I'd add vitamins, I'd add minerals. I would use that instead of many supplements. Then if I look at the peptides that I think are actually helpful for people, it depends what they're targeting. So two of the biggest drugs of all time are insulin and GLP-1s. They're both peptides. And GLP-1s are a harbinger of where the world is going, which is that pharmacology is used for human enhancement. A lot of the people I know who use GLP-1s don't use them because they're obese, they use them because they're optimizing themselves. Bodybuilders now using GLP-1s. For weight loss, right? So they're an example of a peptide used for human enhancement. And when someone sets a goal, I would say, here's a pharmacological intervention akin to something you'd see in a sci-fi movie that can help you achieve that goal. For example, if you break a bone or tear a ligament, I would say, here's BPC-157. And I've seen a lot of friends recover 2 times faster from—

wow.

If you have scarring, I'd say, here's GHK-CU and BPC-157. Let's get rid of that scar. You know, all the doctors said you can't get rid of it. Let's get rid of the scar. I've seen lots of friends do that. If you said to me, my HRV is really low and I've done a test for mitochondrial efficiency and health and can't seem to fix it, I'd say, well, maybe we should experiment with MOTC. Again, this is not medical advice. These are not compounds which you can take today, but they're legal in all states. But I think that the future of health starts to look like biotech, and I suspect many of the compounds will come in the form of small proteins, which we call peptides.

One of the things that's hard is that everybody is so different. You and I, we look somewhat alike. You're a much better looking version of me. We probably have very different DNA, we have different metabolism, different everything. And so what works for you might not work for me, and vice versa. How do we start figuring out that protocol? Because even working out, I can see certain people are responding better, they build muscles in a way that I don't do, or vice versa.

I sit at both extremes. One is I believe people are radically different and we need radically personalized medicine. And at the same time, I believe there's an 80/20 that actually generally applies.

Get some sleep, get some exercise, eat decently.

And I think the same applies to exercising, as people spend hours and hours and hours learning about the best way to exercise, the best timing of protein, the best everything. And the reality is, if the only thing you knew was go to the gym every day, push really, really damn hard until you're really tired, eat a ton of protein, and make sure you're going up in weight every week, and you just did that and you ignored everything else, my sense is more people would put on muscle. And I think there's a similar thing in healthcare, which is that people are— want to learn more and find out more and have the perfect thing for them versus doing the things which we know work.

Yep. And probably the opposite is just like, don't do bad stuff. If you really wanted to be unhealthy, what would you do? And just write a whole list of all the things you would do if you wanted to be unhealthy, and then try to eliminate as many of those things off the list. That's probably a good way to also be relatively healthy.

Yep, agree. Then if we look at the personalization side, I do suspect that the best doctors, these genius doctors, and AI is going to be able to personalize and drive really material outcomes as a result. One example, just of myself, 2 years ago, because of Superpowers test, I found out I had prediabetes, which was surprising because I wasn't overweight, I didn't eat much sugar, I felt fine. And I went to a bunch of doctors and no one really knew what to do. They're like, oh, so eat less sugar, exercise a bit more. None of it worked. I still had prediabetes. Then one of these genius doctors said to me, take a mega dose of thiamine. There's vitamin B1. The normal dose is 5 milligrams. They said take 400 milligrams, and I took 400 milligrams a day of thiamine, and my prediabetes disappeared. My metabolic health improved. And it's like, where is that in the literature? You won't really find it online. Will that work for everyone? Certainly not, otherwise I think we would have discovered it. But it works for me as an n of 1. So I do think there's going to be a lot of things in this category which the combination of AI, humans, connected systems can solve.

This is why testing is so important too, because everyone is in some ways experimenting on themself all the time, even with a diet or whatever. They're always experimenting on themself. And then you want to say, okay, is this experiment actually working? Is it producing something? And we don't want to wait 30 years to learn. So having some sort of interval of every few months can be really helpful.

Yeah. And look, even if only a subset of the population tests, that will give us data to start to segment the rest of the population and provide personalized medicine for them. So I suspect that's where we get to.

I do the blood test. I freaking hate it. I hate the phlebotomist. Even I have a phlebotomist comes to our house and then sticks me with some needles and it's just weird. And I really want the finger blood test or just the thing that's just in my arm and it's constantly reading. When's that going to happen?

So there are really 3 directions that I suspect the world will go in here. One is we have the devices on the arm. We have them already. A tasso is the main one. They can collect a small sample of blood, and new machines and new labs are good at drawing data from a small sample of blood. The problem is that error rate is quite high, variance is quite high, accuracy is lower. So if you're okay with needles, I always say needles are better. The second thing we're going to get are wearables or devices that continuously provide some of these biomarkers. I know someone who has developed a ring that can continuously monitor hormones. So she has started with progesterone and estradiol, but that can be used for any hormone— cortisol, testosterone, thyroid hormones.

It's non-invasive. It's literally just a ring around your finger, but somehow through infrared or something can figure out some of these things.

Yep. I can't share how she's done it. When all the VCs hear this podcast, they're going to be like, whoo, but it is really, really impressive. We're going to see lots of devices that non-invasively monitor biomarkers continuously.

I assume there's a lot of ways of even your Apple Watch or whatever, like they've got some sort of infrared that goes in and you can look at blood vessels other ways. There's lots of ways, if even if it's not as good, not even nearly as good, but if it's all the time, you can get the error rate out over time.

Yep. Apple has been trying to crack this for years. They patented something in the mid-2010s, which was a microneedle in the Apple Watch that could detect blood sugar levels. Dexcom and Abbott have tried to do it as well. The non-invasive continuous monitor for X, whether it's glucose, a metabolite, or hormone, has been a holy grail that no one has really been able to crack. We're inevitably going to get it. There's a lot of funding going into a lot of companies targeting the problem.

I mean, there are people who claim they can even do things on your camera right now, maybe I could learn something about you just based on the coloring of your face. As long as I, if I have a good camera that's constantly seeing you, I could start to, oh wow, maybe he didn't get as good of a sleep last night or some other things. You could start to learn things just like in these, maybe like even a very perceptive human could do. Yep.

I'm really optimistic. And I think that's the third way, which is continuous interaction with devices in the world and detecting disease that way. And we're a little bit further off there. It's hard to actually build the mapping between what you're seeing and what's happening. But I think we'll get there. I am optimistic.

Because if you think of the CIA or whoever, intelligence services, when they're trying to learn about foreign leaders, sometimes there's a rumor leader of X country has cancer or something. They're trying to do a lot of analysis about how they walk, and they're trying to do lots of analysis about their face and their body movements and I don't know if any of these things really work at all today, but you can imagine over time, like, these can be really good. Maybe you can learn something about yourself through these systems.

Yeah, I've heard of people using that to predict Alzheimer's, Parkinson's, neurodegenerative diseases, and the mapping there is probably clearer because they result in changing the brain, which changes how we move. I wouldn't be surprised if we end up being able to do it for cancer as well.

Interesting.

I suspect that diagnostics will commoditize and become ubiquitous and zero cost far faster than therapeutics. And I suspect the future of healthcare looks more like therapeutics than diagnostics, and I suspect the future of healthcare looks more like enhancement than prevention. I actually think prevention becomes table stakes.

And then is there a sense that a 7-year-old should be doing something very different than a 50-year-old doing something very different than a 30-year-old and those types of things?

Yeah, there certainly is. When I was 12 years old, my liver enzymes were just outside the normal range, and every doctor said to me, don't worry about it, it's just outside, basically in the normal range. Several years later, I learned that I was in the 97.5th percentile. That's what a normal range is, 95th percentile, two-sided. So basically, I was worse than 97.5% of the entire population. Not of 12-year-olds, right? As a 12-year-old, your liver should be very healthy. Of the entire population.

Oh, the entire population.

The entire population.

And they said no, including like some 90-year-old has been drinking their entire life.

Totally. Yeah, yeah. People smoking, drinking, with chronic diseases, obese, overweight, and they're like, oh no, you're okay. And where we, I think, inevitably need to get to is where we have reference ranges by gender and by age, because the liver of a 12-year-old— I would have been 99.999% as a 12-year-old. And then it's like, oh shit, this is really out of range, start taking action.

Yeah, interesting. So if we want to make this more mainstream for everybody and we want everyone to be healthier, we want everyone to start, or at least everyone, let's say, in a relatively wealthy country like the United States to be healthier. What are some steps? There's still the obvious stuff. It's still the 80/20 rule. None of the stuff is that expensive. Get some sleep, get some exercise, a few less chocolate cakes or something. Maybe cut down on your drinking and smoking a bit, but how do we institutionalize this?

If I could wave a magic wand and change one thing in the US, I'd start with the food system. I think that's where a lot of the problems are. Unfortunately, that requires public sector intervention, which is going to be challenging. If I look at a way that we can drive change more easily as an individual company or from a private sector standpoint, I do think democratizing access to information, both about medicine and about your body, is really important. About medicine, a very classic example is Huberman. I genuinely think that people listen to Huberman have become healthier. Most of my friends who listen to Andrew Huberman get sunlight in the morning now, and they take a few more steps during the day. That is a small change that does drive health outcomes. Maybe they practice gratitude more and breathe more deeply. At the same time, I think we should democratize access to information of what's going on in your body And that looks like making testing easy. What I see is when someone does a comprehensive blood test or any test and they see something is wrong with them that they were not aware of, the first reaction is, shit, I gotta fix this, help me, what's wrong, alarm bell. And I think that people don't even know what's wrong with them today. There are 100 million Americans that are pre-diabetic and 80% of them don't know it. So it's like very hard to drive behavior change without actual information.

From the data side— and this is a data podcast— one of the things that irks me is it's just really hard to get your data. It's hard to move your data. It's hard to send your data some other place. Everyone's got some proprietary format, or it's— you're getting a bunch of PDFs here and there, or your medical records don't really move easily. Can you imagine a world where it's just much easier to ingest and bring in and manage your own data and ship it to or give access to people you want to have access to it, etc.?

Yeah, we want everyone to have all of their data in one place, and we do that for people today. We integrate with the EMRs and we pull it in. Different labs use different machines with different units and different ranges. We normalize that. We have a team of scientists that builds out the normalization algorithms. We integrate wearable data, we allow you to conduct new tests, and the implication is we get to a world where we have 3 kinds of data simultaneously that basically no one else has. One is multi-omic, multimodal data— genome, blood tests, microbiome, etc. Two is longitudinal clinical data, not what's happening at the level of your biology, but what are you presenting with, what's happening to you over time. Do you get sick? Do you not get sick? We partially get that through medical records, but then also get it by virtue of taking care of someone.

Asking people, yeah, or whatever.

Totally. And genomics, 23andMe doesn't really have that. They give you one survey. They never actually cared for people. Um, but their data was still valuable. They just sold out of bankruptcy for $250 million. The third kind of data is continuous wearable data. And I think what's interesting about that is when you look at multiple wearables in concert, and then intersect that with the longitudinal clinical data and the multimodal multi-omic data. And no one has all three of those data sets. And the implication of having them— one is that as a patient or person, I feel more empowered and I can make better decisions today. But two is that we actually start to be able to discover new things because of the mapping that exists across these three sets of data.

One thing I find is that when I'm traveling, I'm getting less exercise, I'm not sleeping well, I'm just much more susceptible to getting sick or whatever it might be. I know you're someone who travels all the time. For people who can't see this on video, you're in a hotel room right now. What do you do to just make sure you keep it up in the right way while you're traveling?

On Monday of this week, I got back to SF, San Francisco, from Austin. And I'd been at a leadership retreat thing and I'd hardly slept at night because I was working through the night. And I came down with a really bad sore throat. And that same day I was meant to fly out to Saudi Arabia for some big important meetings. I'm like, oh shit, here we go, 18-hour flight on a really bad sore throat off of a weekend where I already didn't have sleep. What do I do? I took a peptide. I took thymosin alpha-1, and 36 hours later the sore throat had disappeared completely. And I just was left with a runny nose. Now I've got a little bit of a runny nose, but I'm perfectly healthy. I was exercising just before. So I think again, we have biological tools that we can now use to not get sick. When someone gets sick in the office, we'll give them thymus now for one, and the sickness disappears every time. Not medical advice.

I think of myself as relatively knowledgeable about all this stuff, and I've never heard of any of those things you've mentioned before. So some of these things are still really at the forefront or really not yet in the mainstream for sure.

Yeah. And look, there's a stack of other things people can do, but none will be as effective. So I actually have it online that I send to friends when they get sick, maxmarchione.com/immune. And that's what I used to do. And that improved health post-sickness and pre-sickness by maybe 50 to 70%. Dimethyl-alpha-1 for me is more like a 70 to 90%. It's really powerful. Wow.

Oh my gosh. Okay. That's crazy. And the downsides are what?

None, as far as I'm aware.

Wow. Okay. That's crazy.

But again, not medical advice. Yeah.

Not medical advice. This is a podcast.

I don't know if it's legal. I definitely didn't order or take it ever in the US.

Okay.

Only in places where it's legal.

Okay. Got it.

I don't know where those places are.

Some of these things are not even approved in the US or anything.

I think the class is Category 2 or Category 3 by the FDA. They recognize but not approved. My approach to those things is if there's any risk of harm, and if there has been evidence of harm over the past 30 years of their use, stay away from them. If they've been used for 20 to 30 years with no evidence of harm, then explore. In exploring, I'll go around to the best doctors I know, the ones who charge $100,000 per patient. They tend to be 50 to 70 years old. They're billionaires' doctors, and I ask them, what do you think? And if there's consensus amongst them, then I deem it safe, which is a heuristic way of reasoning through it. I also try to, at a high level, understand the mechanism, but I think that's less useful than listening to experts and seeing anecdotes or anecdota, as I call it. Most of the smart people I know who are very deep in the biohacking world will use these compounds.

These things are somewhat fads and trendy. 3 years ago, everyone was talking about metformin and they're using metformin, and now it just seems like people aren't talking about it as much. It's not being The same doctors were talking about it. Now they don't usually recommend it as much today. Maybe it will come back and you just go down the list of all the different things. So they go in and out of fads pretty quickly.

Yeah, they can. Depends how long they've been around. The longer something has been around, I think the more likely it's going to continue to be around. The Lindy effect, I've heard it called.

Yeah, but metformin's been around forever, but then it got like super popular a few years ago.

Yeah, my problem with metformin is if you actually understand the mechanism, it's hard to create a case for why you should take it. But one of the mechanisms of action for longevity is that it downregulates mTOR, and mTOR is increased through things like protein. mTOR is required to put on muscle. By downregulating mTOR, you reduce the risk of malignant cellular growth— all cellular growth, but also malignant cellular growth, aka cancer. And therefore, some people take An mTOR associated with longevity, potentially causal, and therefore people take metformin. And it's the same reason people might not eat red meat or avoid protein. It's potentially the same reason why if we purely look at epidemiology, which is just like observation, not understanding mechanisms, if we purely look at epidemiology, someone might say red meat is bad. My problem with metformin is that what it's also saying is put on less muscle, downregulate anabolism. And like, I don't want that. I'm happy to consume red meat even if it might take a couple of years off my life. I'm willing to make that performance trade-off or quality of life trade-off. And metformin for me is problematic because it will make it harder to put on muscle mass. And my view is, at least when you're younger, putting on muscle mass is going to improve longevity more than taking metformin between the age of 20 and 30.

Yeah, almost certainly it will. Putting on muscle mass is important even when you're older too.

Certainly.

Obviously it just gets harder and harder to do as you get older. Of the things that are out there and that are current technology things, what things do you think we're just not making full use of?

So I do think peptides that have been around for a very long time, I'm like, GLP-1s have been around for decades. It's just that we slightly modified the chain of amino acids in a way that slightly changed the effect and allowed large pharma companies to patent it that they became mainstream.

And today there's a creatine craze. Everyone's taking it. I'm taking it. Everyone's taking it. I don't even know why sometimes I'm taking it, but my wife thinks I look better now that I take it. What do you think about some of these things?

I'm bullish on creatine. It's one of the most studied compounds and it's been around for decades.

Is what you're saying is like the downside's low, correct?

Yes, I will happily take something if there's an equivocal upside, but close to zero downside.

Yeah, why not? The downside might just be you have to take it and there might be some cost to it or something. Creatine is obviously super cheap.

Yeah. If I look at things that are underrated, my sense is sunlight's still probably a little bit underrated. I think that micronutrients and minerals are underrated. 10 years ago we had the like multivitamin craze.

Sunlight, because most of us get so little sunlight. We're working indoors, maybe we sit by a window or something, but it's just not the same. And then when we do get sunlight, like we're slapping on tons of sunscreen as well. Should we just be out walking more in nature more, or taking meetings outside, or trying to do at least our hobbies outside, play tennis or something? How do you think about that?

Yeah, I think all of those things certainly help. I think it helps to absorb sunlight through your whole body as well. Not just your face. Now, it's hard to take your shirt off and walk down the street. I think that it's important to get sunlight in your eyes, not through a glass window.

But people are wearing sunglasses too outside.

Totally. So I keep a list of what I call irrational beliefs, which are things that people say are stupid that sometimes come true. And one of the things on that list of irrational beliefs is that we aim for synchronicity with our bodies. And in the context of sun, synchronicity means that if you're outdoors, If you're at the beach, be barefoot, don't wear sunscreen, and don't wear sunglasses. That's like synchronous. We're not sending mixed signals to our body, saying to our body, well, you're in the sun, therefore your body is getting UV, your eyes are getting UV, and we're not sending mixed signals. Again, this is an irrational belief because it's more something that comes from intuition than fully understanding mechanism. And a lot of the time, these beliefs won't come true.

So you're not wearing sunscreen, basically?

If I'm gonna be outdoors for a very long time and get sunburned, then I'll wear it. If I'm outdoors day to day, I'm not wearing sun cream.

You're wearing in the old days to protect against sunburn, but not to protect against sun, quote unquote, damage, which is a lot of people are wearing sunscreen every day. They're putting on sunscreen wherever they're driving their car, they're wearing, putting sunscreen on their hands or something.

Yeah, no, certainly not. Particularly a lot of the chemical sun creams. I think they're more harmful than helpful. If I do use sun cream, it's mineral based. Something like zinc is a classic example. And I think sun cream's overused, but yeah, that's my view. Okay.

Interesting. Okay. Sorry, I cut you off before, but you're saying, okay, sun is one of them. Okay. I like that. That just seems like at least make you happier. I don't even know how good your health is, but it seems like you're just going to be happier if you're outside a little bit more. You're going to smile a little bit more. What else?

Yeah, for most people, I see it improve their energy levels. Improve their sleep, and improve their hormone balance. The other reason people might use sun cream is preventing wrinkles. I think that's the most valid reason to use sun cream. The next thing I'd say is micronutrients and minerals. I think that there was a period where people thought these were interesting. Now people aren't talking about them as much anymore. We're talking about creatine and magnesium, but what about maybe vitamin D? But what about all of the other minerals and nutrients? There's a long tail of nutrients A, B, not just one B, B1, 2, 6, 9, 12, C, D, E, K, and then there are a handful of minerals.

And how do you think about some of these B6 and B12s and the curcumins and things? But they're like, I don't even know. It's like, I take them, I'm not sure if they're good or they're not, and I'll talk to my doctor about them. And you don't want to take 500 pills every day either. It's just so annoying.

I think a lot of the ones people are taking the wrong form. They have additives in them. I was trying to— I was in the pharmacy in Riyadh in Saudi Arabia the other— I was trying to buy a vitamin C and a vitamin D, and every single bottle— and this is the same in the US— is full of shit. Preservatives, additives, soybean oil, canola oil, all sorts of shit.

Oh really? Okay.

Yeah. Many of the forms and the dosing is completely off in the US. For example, B12, you can get as methylcobalamin, cyanocobalamin. Cyanocobalamin is cheaper, so that's what you see everywhere. It's nowhere near as effective. B9, folate.

So I'm looking at my B6 one right now, and then it says, okay, B6, whatever, but it says other ingredients, hypoallergenic plant fiber, cellulose. I don't know what that is. Yeah, vegetarian capsule. Okay, well, that makes sense. It's a capsule. And then ascorbyl palmitate.

They're fine. This already sounds like, okay, healthy ones. That one's okay. The classic pharmacy ones are worse. So one is additives, two is the actual specific kind of the vitamin, three is the dosing, which is often completely off. Often it's just symbolic that the thing's in there rather than effective. And then four is the combination or the synergy between nutrients. For example, if you have vitamin D, you need vitamin K for absorption, and ideally you want K1, K2. And if you have K2, there are two forms of K2. MK4 and MK7. And good luck finding a multivitamin that thinks about all of these factors. So, and minerals are the same. People add electrolytes and you add 3 electrolytes. Now there's 70 trace minerals and our water used to contain them, our soil used to contain them, but it doesn't anymore. And what I found is with all these hacks to increase testosterone, I found literally just get sunlight, improve mineral balance, improve micronutrient balance, and testosterone will improve. As a simple example.

Is there one test, one marker? If I just know this thing, this is going to tell me so much.

Gosh.

Because one of the problems is, is you're in the top 0.01% of people knowledgeable about this stuff. You're thinking about it. For the rest of us mortals, it's become so overwhelming. We just want to measure one or two things. We want to know what's going on. We're already relatively healthy, and we just want to make sure we're optimizing the small number of things. And then try to get that better or something. Well, I asked this to Bryan Johnson, he was on this podcast, and he said resting heart rate before you go to bed or something. He was trying to get something relatively simple.

Yeah, I'll give two answers. One, and it's biased, is the Superpower Score, and I'm cheating because that's an aggregate of dozens of biomarkers. The second is biological age, because that is also in a way an aggregate of lots of different things. There are different measures of biological age, but many will regress a set of biomarkers against time to death. So moving that up or down will improve health. I think Bryan's one is interesting, resting heart rate before bed. My problem with that is I do believe that people could have a low resting heart rate before bed and still not be healthy. I think that would actually be quite easy. So therefore it's more gameable than say superpower score or biological age. But those are 3 that I think are interesting.

Okay, interesting. Where do you think is the most misunderstood biomarkers when people are talking about it? Where do you think just either what's in the ether is wrong or Vanderhuman is wrong? Like all those, where are we misunderstanding things today?

I think that there's a lot of misinformation out there about hormones, testosterone in particular. I think that the sex hormone system it's quite complex. And there are a lot of people who see low testosterone and rather than solving for the foundations of health that support testosterone production, they take testosterone or enclomiphene.

Yeah, there's a lot of people who are getting testosterone injections or whatever today just because, yeah, they see that low testosterone marker.

I think there's more information in AST and ALT, the liver enzymes than the world tends to give them credit for, partially because they're showing the amount of work your liver is doing to process everything in the environment, including toxins. I think they're like a proxy measure for toxin exposure. They can also be a measure for metabolic health, and I don't think a lot of people understand them that way, but they're related to processing fructose, for example, and therefore you can partially understand metabolic health through those liver enzymes. The reason I call them out is not because they're the best biomarkers ever, but because they're very under-ignored. Compare that to something like ApoB. A lot of people are talking about that now. That's the biomarker that is, according to many, the best predictor of heart disease, or the number one thing you want to lower for heart disease. The reason I think ApoB is less interesting is because there's a smaller set of conclusions you can draw from it. If you have high ApoB, it's basically like your atherosclerotic burden is high, your plaque is more likely to calcify, it's more likely to calcify, therefore lower it. Whereas AST and ALT are more systemic and more complex and interface with other biomarkers to tell a broader story.

If you think of guys— Peter Attia, he has moved a bit from diet's important to exercise is more important. That's his arc maybe some of the pharmacological stuff is less important and exercise is more like— where do you think that is on the spectrum and how do you think we should be thinking about these things?

Depends who he's talking to. For the average American, fix diet. If you're talking to an educated and healthy crowd that's already eating somewhat well, then the nuances of diet matter.

Like it doesn't make sense to optimize from the 90th to 99th or something. Yeah.

Okay, I eat pizza, I eat cookies. I still think my diet's really healthy, but that stuff's fine. I eat croissants, it's not going to kill me.

I mean, I love cookies. I love cookies.

Yeah, there we go. For people who are generally healthy like us, exercise matters more. For the average American, I think diet matters more.

Okay, got it. So really depends on where you are on the spectrum and then start with that.

Look, in the future, pharmacology will matter more than any of it. I was staunchly anti-pharma until a year ago. If we fast forward 100 years, does the future of healthcare look more like perfect diet, perfect exercise, perfect sleep, or does it look more like a magic pill? Definitely in 100 years it looks more like a magic pill.

Yeah, and you can already see that with these GLPs.

Totally. Yeah, and sometime between now and 100 years' time, a magic pill has to exist, and I contend they're coming along in the next 5 to 10 years, and GLP-1s are one of the first examples. Obesity has gone backwards for the first time in 60 years in the United States. Obesity is potentially the number one killer. So I'm increasingly pro-pharmaceutical as we have more biotechnology and more biotechnological advancements.

One of the problems with the pharmaceutical is you don't know how they interact with you, so interact with each other. So you've got the GLP, but then you're taking these three other things, and then they may cancel each other out, or they may have negative effects if you take them together? Because these things, it's so hard to test all these different things in different environments.

Yeah, I don't know enough about that to comment. I guess some things that I believe is when you're injecting versus going through the gut, you probably have less of those interaction effects because you're not exposing them to each other in the gut and relying on your gut and liver to process it and it to pass through the gut wall.

Yeah, one of the nice things about the GLPs is like 99% of people who have them are injecting today. They're not taking a pill.

Yeah, some countries do this around the world. I remember speaking to my parents growing up in Italy, and my mom was like, oh yeah, I get sick and they give me this little injection, and that was just normal. This is what, 1970, 1980, and you're getting injections to heal? She's like, yeah, it's like totally normal, and they all know what to inject for what. And that really shocked me, and it surprised me that that hadn't been more globally distributed. But I do think we'll see more things delivered by an injection rather than via a pill, just because downside is lower and upside is higher.

And you think for the GLPs— I have so many friends who are on them, and then they go off them, and they put the weight back on. You have one friend, and he lost a lot of weight, then he went off it, then he put the weight back on. But he said one of the reasons he put the weight back on is he knew in the back of his head that he could always take it off again by taking the drugs. So there was just less of an incentive Essentially what I'm worried about is we become a little bit more reliant on some of these. Do you think that is a problem, or do you think the drugs are just going to get better, or it's just, it's going to be fine to be reliant on it?

I think we are going to become more reliant on them. I do think that for a lot of people, they can't get the weight off to start with. And when you lose weight once, it makes it easier to stay at that weight. It makes it easier to reset, have more energy, start exercising, keep it off. You do need to stay at a low weight for some time. So there might have been an argument that your friend should have stayed on them longer to normalize and stabilize at that weight. I do think that if you're combining biological intervention with lifestyle change, it's going to be far more effective. But the reality is, every year the US gets fatter and fatter. So like, yes, we can say let's just get everyone doing perfect lifestyles. It's not working. It has not worked in 60 years. We need something to change either at level of the food system regulation or pharmacology. And I think we're starting to see one early example of that. And I think we'll see much better examples going forward.

Now we've covered most of the fads that people have been talking about, or most of the things we've been talking about, but there's two things that I'd seen a lot of people talking about. I don't think we've covered yet. The first one is cold exposure. What do you think about that?

Good, but overrated. Like, I don't think it's going to materially change much. It might have a small impact on lifespan, it might have a small impact on hormones, it might make you feel a little bit better. It's good for inflammation for sure, it's good for recovery for sure, but I think it's overrated at the moment. Okay.

And second would be fasting intermittent.

So fasting within a day is, I think, good for some people for gut health reasons. We're not meant to be snacking all day long. And I think it can be effective for weight loss.

The 16 off, 8 on type of thing or whatever. Yeah.

Yeah, it can be effective for weight loss purposes as well because you're compressing the same calories into a smaller window, so you feel full during that window and you're less likely to overeat. I don't think it impacts longevity much, controlling for the effects of just fewer calories. I don't think it impacts longevity much. Longer fasts, I think, do increase lifespan, and we understand some of the mechanisms such as autophagy that result in increased lifespan. I don't think they're going to make it to the mainstream because if you have done a 3 to 5 day fast before, it's really brutal. So I just don't think it's going to make it to the mainstream.

A longer fast, you're really talking about a 3 plus?

Yeah, it's a 3 to 5 or 3 plus. Yep.

And why do you think that 3 day, is it just because it's flushing things out? Why is that so valuable?

So autophagy, which is the process of your cells, I don't know the exact scientific language, but I think it's your cells renewing, or your organs or parts of your body renewing, that process of autophagy starts around day 2, 2.5, and therefore the longer fast is helpful. And I'm sure there are other mechanisms as well that make the longer fast helpful.

And do you have your own protocol for it? On day 1, no food, day 2, little bit of miso soup or something.

And I don't know, do you have some sort of protocol on it, or lots of Salt, lots of electrolytes, eating fewer carbs leading into the fast, having exogenous ketones at the start of the fast as well, so I enter ketosis faster.

What does that mean?

So your body can burn glucose or ketones for energy. Most of the time our body is burning glucose. When we enter into ketosis, our body runs ketones, which are fats. Part of the purpose of fasting is to get your body to enter into ketosis, and when your body's in ketosis, the fast becomes easier. Unfortunately, that normally takes 1 to 2 days to get into ketosis. So day 1 and 2 are typically the hard parts of the fast, and day 3 and 4 are actually easier. Now, you can accelerate your path to day 3 and 4 by taking ketones exogenously in a liquid form and drinking them. They taste foul, but they get you into ketosis faster, which makes your fast easier. Interesting. Okay, cool.

You've got a couple of interesting, I would say, contrarian beliefs.

Maybe one—

I don't even know if it's that contrarian anymore, but you had said a couple times that 7 hours of sleep could make you less sleepy than 8+ hours of sleep. What do you mean by that?

I just see this anecdotally across a lot of people, which is that when you have 7 hours of sleep, you feel more energetic than 8 hours. I don't fully understand the mechanism, But I've seen it anecdotally enough to believe that there's something we don't fully understand there. There might be a mechanism that's understood, but I believe that anecdote and observation is the first step in the scientific method. And before we have research papers, we have hypotheses. So many of these things exist in the world of hypothesis, and then hopefully one day someone will explore them and turn them into science, as we call it.

You're anti-AirPod, though you are wearing them right now. So what do you mean by anti-AirPod?

So I think for most of the day, the potential risk of AirPods outweighs the benefits. The benefit is that I can walk around without having a cable on or without big headphones. The potential risk is brain damage and cancer. Now, the chance of that risk is super low. I do not think AirPods give you brain damage, but I do think there's a very, very low probability they could. and because of the very low probability they could, I'll choose to not use it. There's smart people who think similarly. We do know that electromagnetic radiation impacts the brain. We also know that all electromagnetic radiation follows an inverse square law with distance. Intensity is an inverse square law with distance. So if something's that far away, if something's a foot away, it's not emitting that much EMF. When it's literally inside your ear, like squeezed inside your ear, that's really close to the brain. You don't have much to protect it, so there could be more of an impact there, even from something as small as Bluetooth, than people think. There's also anecdotes of some people saying, I started using AirPods and XYZ happened. There are smart people who avoid them, and there are anecdotes of advanced doctors they know, cancer doctors, who genuinely believe that AirPods are giving people brain cancer. And when I take into account all of this, my conclusion is they're almost definitely safe, they might be a risk, and therefore most of the time I won't use them. Now sometimes I'm traveling, I lost my cable headphones, I'm going to use them, but I'm not wearing them all day long, 6-7 hours for every call, listening to every song. I'll instead get cable headphones for that.

Okay, another thing I saw that you did is you sometimes listen to things at 4x speed, which I don't even know where the setting is to go do that. How did you train yourself to do that?

I'm unfortunately capped at 3.5x now. The podcast app I used to use got up to 32x, but they decommissioned it, sadly. So 3.5x is what Spotify and Audible can get to. And part of it is having high-quality headphones. It makes a difference blocking out surround sound. Part of it is doing it often. So just continuing to increase the speed at which you listen. And then part of it is recognizing you've got to process less. That's the reality. Like, I'm not going to understand more at 4x speed.

But are you listening and not doing anything else? You're just closing your eyes? Because I feel like I can process more, but if I'm driving or if I'm doing some other thing, which is usually what I'm doing when I'm listening, I'm working out, or I do while I lift weights, I don't know if I'll be able to process it at that speed.

I won't listen to things unless I'm doing something else, otherwise I feel like I'm wasting time.

Yeah.

Okay. So I am doing something else. It's not always 3.5x.

So you can still listen at 3.5x?

Depending on what it is, certainly. Andrew Huberman, 3.5x any day of the week. He's very structured. He's very clear and he speaks slowly. Whereas Marc Andreessen, he's not getting 3.5x.

No, Marc Andreessen, he is one of the fastest speaking people moving around.

Yeah. Also depending on my mental state, sometimes I'm in 3.5x mood, sometimes Fuck it, I'm brain fried. 2x. I just wanna chill.

Okay, got it. I listen to a lot of science books. It's very hard for me to really get over 1.5, 1.6, but then a typical podcast, I might be more at 2. I haven't tried to go over 2, but maybe I should. I'm gonna experiment with it. I'll let you know how it works. And so I know that on my podcast, for the people who listen to my podcast, I definitely sound much smarter at 2x. So if you're listening to this right now at 1.3, 1.4, just move it up to 2. First of all, you'll get it done faster, and you'll think that Oren Hoffman is just a much smarter person. All right, last 2 questions we ask all of our guests. What is a conspiracy theory that you believe?

Oh gosh, so many things that I'll get canceled for.

They don't get canceled anymore. It doesn't happen anymore.

Oh, you don't know some of my conspiracy theories.

Okay. All right.

That's fair. I do think the AirPods one is one I tend to take reasonably seriously. I do think that vaccines have a bigger impact than we understand. They might be related to things like autoimmunity. They might be related to things like autism. I don't know, but I think that we've pushed under the rug the possibility that they might have that relationship.

Or they might for some small number of people or something like that or whatever. Yeah.

Yeah. My response with these things is typically, I don't know. And if there's a very low chance, there's a 5% chance I'm going to explore it rather than just saying no. I do believe that magic exists, and I think it has always existed. And over time, magic becomes called science. 200 years ago, if someone said to you, this rock is emitting waves through your body and it's going to kill you, people would have laughed at you. Now we know that's the thing, it's a radioactive rock. This rock can kill you, that's magic, pseudoscience shit. Same with a mobile phone, we're shooting energy around the Earth and we're going to see someone else's face, that's magic. So I think there's a lot of things today which we laugh at, that are the radioactive rocks of today's era, that we will call science. And I like this idea of the science of applied magic. How can we actually learn to harness some of these things which we call magic? For example, I have a friend who through touch can make someone feel tingles anywhere in their body, and you can placebo control this because others who pretend they can do it can't actually do it, and you can heal people as a result. And I know several billionaires who he has healed. And who swear by him.

So cool.

So I do believe that there's a lot of this stuff that we just do not understand, and people call it bullshit today, but we'll call it science soon enough.

Yeah. All right, this is great. Last question I want to ask all of our guests. I've almost asked you this question almost every time, so maybe just asking you for a new one. What conventional wisdom or advice do you think is generally bad advice?

Listen to advice. I think that most advice is not that helpful. We go on Twitter and we read articles about how X company did this thing. Or here's how to build a company culture, or here's how to do B2B sales, or here's how to fundraise. I think 90% of it should be ignored in favor of just reasoning from first principles. I think often the actual story is different to the marketing, which is online. Everything online ends up being marketing. So the answer is typically discard 80 to 90% of advice, reason from first principles, be hypercritical of advice.

But you can't spend the time reasoning for first principles for everything. I mean, It sounds like you're the type of person who reasons much more than the rest of us, but still, I have no idea if the world is round. I honestly have not really reasoned it through at all, but I just accept that it is round and I could probably spend the time improving it to myself, but I just have never done it. So there's just certain things you just have to go with that's out there based on your experience, or you just don't have the time to do it all. How do you know when to go first principles?

I think that intuition and heuristics matter a lot. Many of the things I said in today's episode, I did not understand the first principles and the mechanisms of.

Yeah, okay, got it.

The scientists will laugh at me and I'll be like, yeah, and I just saved 10 weeks researching it because I'm relying on experts and that's a strong enough heuristic for me.

Yeah, okay.

That's the main thing that I would say there. Okay, cool.

Well, this is amazing. Thank you, Max Marchione, for joining us on World of Das. I follow you @MaxMarchione on X. Twitter. I definitely encourage our listeners to engage with you there. This has been a ton of fun, and I really learned a lot.

Thanks, Arun. This was really fun.

Thanks for listening. If you haven't already done so, please subscribe to World of Das wherever you consume your podcasts— YouTube, Apple, Spotify, and more— and please help us get discovered by leaving a review. And check out worldofdas.com. That's World of Das, D-A-A-S, and of course connect with me on Twitter @Auren. That's A-U-R-E-N. Would absolutely love to hear from you.