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What REALLY Causes Chronic Disease — and How to FIX IT | Dr. Robert Lufkin — Transcript

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0:00If I put food into my mouth and it goes into my stomach and my "GI" tract,
0:04no matter what the food is, it's gonna drive inflammation,
0:07because inflammation is the body's natural protection
0:10against foreign material.
0:12Fructose, when it's metabolized, detoxified by the liver,
0:15it's handled the same way, or in a very similar fashion to alcohol.
0:19It produces fat,
0:20and it damages the liver eventually and drives this fatty liver disease.
0:25Stress is not what happens in the world.
0:28Stress is how we respond to what happens in the world.
0:31And stress is affecting our inflammation
0:34directly drives inflammation, drives insulin resistance,
0:38all these things.
0:39I was blown away by the fact that both physical exercise,
0:42but also mental exercise could show, within a short amount of time,
0:47actually changes in the brain,
0:48presumably related to its effects on B-D-N-F,
0:51brain derived neurotrophic factor, which
0:54certain parts of the brain, like you'd expect,
0:57the hippocampus can actually increase in size
0:59with these various activities.
1:01So it's really amazing.
1:03"Rob," as a conventionally trained doctor who later went on to teach other doctors,
1:09I'm curious, where along that journey...
1:12did cracks start seeping in that
1:14what you had learned
1:16might not be totally right?
1:18Thanks,
1:19"Jesse." That actually came all of a sudden,
1:22just my background.
1:23I've spent
1:24my whole career
1:25as a professor in
1:26a couple different medical schools here in southern California.
1:30So I got to practice medicine, teach, do research.
1:34The point is,
1:35I represent the establishment, the medical establishment.
1:39I'm not a fringe doctor.
1:40I'm not a conspiracy theorist.
1:42<break time=“1.66s"/>
1:44I drank the "Kool-Aid." I'm mainstream.
1:48But what happened to me,
1:50which is what happens to many people in this path,
1:54I came down with four
1:55chronic diseases sort of suddenly hit me like a train,
1:59and I went to my doctors, and they prescribed me medicines for them,
2:04prescription meds,
2:06and they assured me I needed to be on those for the rest of my life.
2:11And
2:12I knew that wasn't going to end well. So
2:15that was really
2:16what prompted me to begin
2:18an inquiry
2:19and re examine
2:20my beliefs
2:22about
2:23the way things worked in medicine, and it was
2:26really a revelation.
2:27How far back does that go when you started to get sick and
2:30accumulate these medications?
2:32Yeah, it was about.
2:33<break time=“1.99s"/>
2:35About ten years ago when it happens, and
2:39it happens to a lot of people when they reach a certain age.
2:44Most adult Americans are
2:46obese.
2:47Half have hypertension.
2:48Most are diabetic or pre diabetic.
2:51So these chronic diseases are
2:53coming on to all of us,
2:56but they all happened right about the same time.
3:00-
3:00And unfortunately, a lot of people
3:02who go down your path end up on medications like you
3:05talked about for life and
3:07don't know of another way.
3:08So I'm just curious where
3:11as a doctor,
3:11obviously you have a little bit of a different world than a layperson,
3:15but what was it for you specifically?
3:17You're taking these meds.
3:19It's controlling the symptoms.
3:22What was that crack for you where you saw
3:24maybe theres a different path here?
3:27Yeah.
3:28Part of it was
3:30the diseases I knew
3:31that I had, which were gout, hypertension,
3:35dyslipidemia and pre diabetes, which are common diseases
3:39that everyone had.
3:41I thought they were very separate diseases.
3:46I thought they were being controlled by the prescriptions.
3:50But knowing what I know about those diseases.
3:54The future, at least as far as longevity, didn't look great for me.
3:59And
4:00I still have kids that aren't even in high school yet.
4:04So
4:05I wanted to be able to,
4:06out of self interest, really.
4:08It forced me to look for other options just to see
4:12if there was any other possibility
4:14to... an alternative to what I was doing.
4:18So what were the first steps for you,
4:20what part of the alternative health realm did you stumble into
4:23and start to make changes in,
4:25to work your way back?
4:26Well, as it turns out,
4:28a friend of mine is "Gary Taubes," who is a science writer.
4:33And he was writing
4:34a lot of books about
4:36Nobel laureates and all, but...
4:38he had just transitioned into writing about nutrition science,
4:43and
4:44he was writing a book called "Good Calories,
4:47Bad Calories." We really didn't talk about that,
4:50and I really wasn't paying attention to his work.
4:54But --
4:54when this happened, I sort of went back to his book.
4:58I looked at "Nina Teicholz's" book, a great book on
5:02saturated fat, and
5:03I began... looking at the more current research...
5:07that I wasn't
5:08necessarily on top of. And
5:11many of my colleagues at the medical schools and
5:15certainly the doctors I went to weren't on top of either.
5:20And I began to see that
5:21there was a lot of new understanding
5:24and new approaches
5:26to these diseases,
5:27<break time=“2.54s"/>
5:30I wasn't told about.
5:31You touched on something there when you're telling your story about
5:35the different chronic diseases, the fact that
5:38you felt like these were all from different areas
5:41and they were separate silos...
5:43One of the positive messages through what we're going to get into today
5:47is that there's a common route... to
5:49chronic disease.
5:50And when we apply some pressure on these different levers
5:54we're going to talk about,
5:55we can begin to correct...
5:57for everything at once.
5:58So it's not very siloed like I said before where
6:01we need to look at symptoms and then how do we whack that separate symptom?
6:05We're going to get to the root of things by what we're going to get into today.
6:10Exactly. And
6:11that was one of the revelations to me, certainly, that
6:15these diseases were
6:17integrated,
6:18not only the four diseases that I came down with,
6:22but as we'll see. The
6:23many, many diseases, the diseases that statistically,
6:28you and I and most of your listeners will die of,
6:32is a very short list. And it's
6:35things like cardiovascular disease, Alzheimer's disease, cancer.
6:41But
6:42it blew my mind to think that all of these diseases,
6:46there were common root causes
6:48that when you begin to improve
6:51one, you improve
6:52your chances with all of them.
6:55And it's something that I don't think
6:58mainstream medicine
7:00is still on top of it,
7:01and
7:03this message... is not
7:04getting out there as it should.
7:06Well, let's talk about this common root, which is metabolic dysfunction,
7:11what that is, and then we'll get into different ways to
7:15improve that.
7:16Yeah, absolutely.
7:17<break time=“5.99s"/>
7:23One model that I've heard that I like to repeat is
7:27the diseases I had...
7:28were seemingly unrelated.
7:30I had arthritis, and then I had high blood pressure.
7:33And...
7:34most people don't think of arthritis and blood pressure as being related.
7:38They're clearly different.
7:40And then diabetes, --- that's a whole nother disease.
7:43And that's the way our mainstream medicine is.
7:46But
7:47the fascinating thing is that, well, the metaphor, I guess,
7:51is that. <break time=“2.89s"/>
7:55Let's say
7:56I have a problem, and my problem is my floor is wet
7:59in my house, so I get a mop and I mop it up.
8:01And then another problem is
8:03the door is wet, there's water on the door.
8:06So I get something and I wipe the door off.
8:08But
8:09I'm treating the symptoms
8:11for these various conditions when actually the problem
8:14is not with the floor, and the problem is not with the door.
8:18The problem is with the roof.
8:20And there's a leak in the roof, and
8:23the roof is sort of the metaphor for the root cause.
8:26And
8:27rather than... taking prescription medicines for
8:30my blood pressure, my diabetes, my gout, are these other things
8:36which
8:37I was told,
8:38and I thought not only control the symptoms,
8:41but actually
8:42manage the disease. I thought
8:44the disease was
8:45under control.
8:47But actually
8:49what I learned is that
8:51they managed the symptoms, but frequently with many diseases.
8:56<break time=“1.34s"/>
8:57They block the symptoms,
8:59which is not necessarily a good thing because you forget you have the disease,
9:04but the disease goes on and continues to progress...
9:07And that's a fundamental problem
9:10for example,
9:12with a heart attack,
9:14if you or I happen to go into
9:16hospital, God forbid, to have a heart attack these days,
9:21where the blood flow
9:22is limited to our heart muscle through an obstruction in the coronary artery,
9:27which is the number one cause of death, statistically, for all of us,
9:33we will get what's called a stent,
9:35which is a mechanical opening of the blood vessel.
9:38And
9:39for many people, it's
9:41wow,
9:42thank God I got
9:43my heart attack taken care of.
9:45Done with that.
9:46I got a stent, all is good.
9:48When, in actual fact,
9:50the stent only prevents me from dying on the table,
9:53perhaps. And
9:54studies have shown that stenting the
9:56blood vessel
9:57doesn't do anything to the long term outcome of the disease.
10:02In fact, the cardiovascular disease, what's called atherosclerosis,
10:06continues to progress in all the blood vessels and even in the stent.
10:11- Unless I
10:12do other things.
10:13But the stent itself is just sort of a band aid,
10:17and
10:18that's true for
10:19insulin.
10:20With type two diabetes, it'll keep me from dying of an
10:23acute
10:24high
10:25glucose problem,
10:26but it doesn't control the long term complications of diabetes
10:29or high blood pressure.
10:30I take blood pressure medicines, my blood pressure goes
10:34down, I think I'm done.
10:36But actually,
10:37the damage to the blood vessels is continuing on in the background,
10:41but
10:43I'm just not aware of it anymore.
10:44My doctor doesn't care because my blood.
10:47Well, not that he doesn't care, she doesn't care.
10:50It's that
10:51it's managed and the blood pressure's down.
10:54So
10:55the
10:56fundamental problem was that
10:57the approach that I was given was managing the symptoms,
11:00but to your point,
11:02didn't address the basic underlying metabolic conditions...
11:05that were the root cause.
11:07And as you explain
11:09these different areas and approaching it through symptoms,
11:12it gets me thinking about a microcosm of that,
11:15what the body does with insulin
11:18as our metabolic health degrades,
11:20and it tries to manage that blood glucose by making more and more insulin,
11:25and we become insulin resistant.
11:28So
11:29there's the overt taking insulin, like you were talking about.
11:33But then the body also is compensating in its own way
11:36as our metabolic health degrades,
11:39which
11:40can take
11:4110, 20 years before
11:42full on type two diabetes occurs,
11:44and all kinds of damage can be done in the meantime.
11:47Yeah, absolutely.
11:49<break time=“2.22s"/>
11:51The whole metaphor
11:52or the whole
11:53disease of type two diabetes, my thinking really changed on that.
11:57I used to think that
11:58type two diabetes was...
12:00like many diseases.
12:01As a doctor, I thought, well, you either have it or you don't.
12:06It's an on off switch,
12:07and that's the way our healthcare system is set up,
12:10for billing. When
12:12your audience has probably heard about hemoglobin "A1C" as a marker for diabetes,
12:17and once it gets over 6.5% in the United States,
12:20you're a diabetic.
12:21And if it's below that, you're not. -
12:23You may be pre diabetic, but it's sort of an on off switch.
12:27But
12:28to your point,
12:29diseases like diabetes
12:30and Alzheimer's disease and cardiovascular disease,
12:34and all these diseases
12:36are present for years, if not decades, before
12:39the doctor will actually diagnose them... in us.
12:42And...
12:43it's really in our best interest to begin to address them
12:47in the prevention stage and not wait until the doctor says,
12:51yep, you've got Alzheimer's disease.
12:53You've got diabetes because
12:55you really had it
12:57for years or decades beforehand.
12:59And the other thing about type two diabetes that my thinking has changed is,
13:05- - there's a fascinating study that
13:08just came out with adult Americans
13:12without diabetes.
13:13These are healthy adult Americans.
13:16And if you plot their
13:17hemoglobin "A1C," basically, this blood test for diabetes.
13:22If you plot it over time, it goes like this.
13:25The older they get, the higher the "HbA1c" goes.
13:28And what does that mean? -
13:31- The way I think of it is
13:33it's like gray hair.
13:34In other words,
13:35hemoglobin "A1C" is going to get higher and higher.
13:39And diabetes is something that many, if not all of us,
13:42certainly many of us will get if we live long enough and don't
13:46die of something else first...
13:48In other words,
13:49what does that mean?
13:51When I make choices about my lifestyle,
13:53when I make choices about my metabolic health,
13:56I want to do those choices as if I were a diabetic,
13:59a type two diabetic now, because
14:02I'm already on the path to it.
14:04Even if I haven't crossed the threshold where my doctor will
14:08diagnose it, I'm en route to it.
14:11If you're enjoying the episode,
14:12let me know by clicking like and subscribe below.
14:15Thank you so much. And now back to the show.
14:17Well,
14:18what I really like about your book is you get to the
14:21root of all this with "TOR" or "mTOR."
14:24So let's talk about what that is.
14:26And then when it's gone awry, it's not a bad thing in and of itself.
14:31It's something that we all need.
14:33But with the current diet that
14:35westerners are taking in high in carbohydrates,
14:39we're causing it to be triggered
14:41more often than we like.
14:42So let's take it all the way back to "TOR" talk about what that is,
14:46and then we'll work down
14:48to metabolic dysfunction,
14:49which then leads to all these chronic diseases.
14:52So
14:53it's all connected.
14:54I love
14:55"TOR." That's one of my favorite molecules.
14:58And
14:59arguably, it's probably
15:00one of the most important biological switches
15:05that there are yet.
15:07The amazing thing is
15:09"mTOR," or "TOR," wasn't discovered
15:11until
15:13the end of the 20th century. --
15:14But
15:16we now know that it's conserved evolutionarily over billions of years.
15:21What does that mean?
15:22It's present all the way from yeast
15:25to human beings.
15:26So any molecule that's present in all those organisms
15:30has to be important at a very, very fundamental level.
15:34And "TOR is."
15:35It's a simple thing.
15:37It's a switch.
15:38It's a biological switch that detects the presence of nutrients,
15:42and by nutrients, primarily glucose
15:45and
15:46oxygen to some extent, and insulin
15:48a little bit also. And...
15:50when nutrients are present, it just instructs the cell to grow.
15:54So it's like a gas pedal you turn to on
15:57when it detects nutrients, and the cell grows.
16:00And
16:01that's
16:02an absolutely essential thing for every cell to recognize,
16:05because
16:06if you grow when there are no nutrients, you'll die.
16:10Conversely,
16:11if there are no nutrients present, "TOR" turns off
16:15into the off side.
16:17And what happens then?
16:18Well, it tells the cell not to grow,
16:21but it also tells the cell to turn on something
16:25called autophagy, which is kind of repair, where it gets rid of
16:30older, damaged...
16:32parts of the cell. And
16:33it's actually a good thing.
16:35It's a healthy thing. So
16:37healthy organisms have "mTOR" turned both on and off.
16:41Both growth and repair are good.
16:44And your -- point you made is that
16:47modern humans
16:49have "mTOR"
16:50turned on
16:51all the time, or too much being turned on.
16:54And the reason is
16:55arguably starting 12,000 years ago in the agricultural revolution,
17:00when we first began to domesticate plants.
17:03Before that, if you imagine hunter gatherers
17:06"TOR" would be turned on when you --- capture a buffalo and eat a buffalo,
17:11and then maybe it's turned off for a couple of weeks while you're hunting,
17:16and then it gets turned back on.
17:18It goes off and on.
17:19But beginning 12,000 years ago with agriculture,
17:23food became more and more available.
17:25And then it just rapidly accelerated in the last
17:2920 to 40 years -- well, before that, with refrigeration, and then
17:35most recently with junk food,
17:37which makes up the majority of our food supply now to the point where
17:43people are eating all the time, and
17:46"mTOR"
17:47is turned on for
17:48most of us - on the
17:50on side, which
17:51contributes to cell growth.
17:54Now, cell growth
17:55is
17:56important when we're young and -- our bones are growing,
18:00our brains are maturing.
18:01But there's a
18:03theory of longevity which is gaining a lot of
18:06acceptance, is that
18:08turning "mTOR" on
18:09in this on state drives hyper function, and the hyper function
18:15actually
18:16drives the chronic diseases, all the ones that kill us.
18:20Cardiovascular disease is hyper function.
18:24The blood vessel
18:25wall proliferates and it's overgrowth.
18:28Cancer, of course, is a poster child for hyper function
18:32cells...
18:33grow beyond control and they spread, they metastasize.
18:37Alzheimer's disease -- represents the ultimate failure of our
18:41medical research establishment.
18:43If you think about it,
18:45we've had decades of time to do the research.
18:48We've had essentially unlimited financial resources,
18:51and what have we come up with?
18:53There's no single -- pharmacological intervention for Alzheimer's
18:57that has any effect. And
19:00even our understanding of what causes Alzheimer's
19:03<break time=“1.92s"/> is flawed
19:06the beta amyloid hypothesis is really falling apart now.
19:09And
19:11there's reason to believe that Alzheimer's is driven by a type of
19:15inflammation and hyper function,
19:17among other causes. If you
19:19follow "Dale Bredesen's" work and -certainly
19:22metabolic disease, as we'll talk about.
19:25-- If we correct metabolic abnormalities with things like ketosis and all,
19:31we can actually... reverse
19:33Alzheimer's disease,
19:34no drug
19:35can
19:36cause the brain fog to go away in some patients,
19:39not all patients, but it actually improved their function.
19:44So
19:45"mTOR" is fascinating.
19:47And the great thing about
19:49"mTOR" is - - we can influence it by
19:52our lifestyle choices.
19:53Certainly with nutrition, we can avoid
19:56foods that turn "mTOR" on, but also with sleep, with exercise,
20:01with stress, other things that turn "mTOR" on.
20:04And there's actually a drug that specifically targets "mTOR,"
20:08which many people are taking for off label use,
20:12for longevity. Although...
20:13I wouldn't recommend
20:15replacing lifestyle changes and just say, hey, here's a pill.
20:19I don't need to do anything.
20:21This is a pill.
20:22It's going to turn "mTOR" down...
20:25That's probably not the right approach for now.
20:28Was I correct in saying that "mTOR" would be the root of chronic disease,
20:33though, and then
20:34it being triggered too much
20:36would lead to metabolic dysfunction and then chronic diseases
20:40like Alzheimer's and cancer.
20:42Do I have that right?
20:43Yeah.
20:44"mTOR"
20:45is a major metabolic switch in a network of switches like
20:48"AMP" kinase and other things.
20:50But "mTOR" arguably is one of the most important
20:54ones.
20:55And when we turn "mTOR" on
20:56and nutrients are possible,
20:59if you think about it, when nutrients are possible,
21:02food is coming into the cell, foreign matter is coming into the cell.
21:07So what else does "mTOR" do? When
21:09nutrients
21:10are present and it tells the cell to grow,
21:13it wants to
21:14protect itself, so it turns on inflammation.
21:18So when "mTOR's" turn on, it's also an inflammation switch.
21:22And
21:24inflammation, as we'll see, is
21:26at a root cause, one of the drivers
21:29that metabolic disease drives, and vice versa,
21:33that causes all these chronic diseases.
21:36So,
21:37to your point,
21:39we can do some interesting experiments with "mTOR," because there's this drug...
21:45that's a very specific drug that targets "mTOR," that will turn "mTOR" off into...
21:51this healthier repair state, this autophagy state.
21:55And so you might think, well, if "mTOR" is so fundamental in aging
22:00and longevity.
22:01What evidence -- do you have for
22:04it working in anything at all?
22:06So, there's some interesting experiments.
22:10If you look at, let's say, aging, the phenotypes of aging.
22:15I'm a poster for it.
22:17Wrinkles, gray hair, receding hair. --
22:20Periodontal disease, hearing loss, all these things are phenotypes of aging.
22:25We all recognize them.
22:27The drug
22:28that
22:29is available is called rapamycin...
22:31It was discovered on Rapa Nui in the soil from a bacteria
22:36in the 1960s. And
22:38because of its discovery,
22:40they needed to understand
22:42what rapamycin worked on, and they found out this molecule,
22:47they named it "TOR," which is,
22:50for lack of a better name, target of rapamycin.
22:54<break time=“4.77s"/>
22:59We can do some simple experiments. Well,
23:02in mice that in the mouse model
23:04for hair loss and gray hair, with aging,
23:07you give rapamycin to these mice and the hair starts to grow back
23:12and the coloration returns.
23:14It's less gray than before.
23:16What about wrinkles in humans?
23:18In a prospective trial,
23:20rubbing rapamycin on a double blinded prospective rapamycin cream on the skin
23:27once a day for
23:28six months.
23:29These humans then underwent punch biopsies of both hands,
23:33and
23:35the rapamycin...
23:35treated hand showed return of the collagen basal layers,
23:39and
23:40they were visibly
23:41younger looking skin with the rapamycin...
23:44being applied to that.
23:45Interestingly,
23:46the "FDA" has just approved rapamycin cream about twelve months ago,
23:51not for aging or wrinkles, but for other...
23:54cancer type diseases...
23:56But it's now being used off label for that.
23:59But the list goes on and on.
24:01You apply rapamycin to
24:04animals with hearing loss, with age related hearing loss, and
24:09the hair cells regrow in the cochlea and...
24:12some of the hearing improves.
24:14You add rapamycin to. -
24:16- There's one disease of aging that most people don't think
24:20of as a disease of aging,
24:22but it affects 50% of our population, 100% of the time,
24:26if they live long enough.
24:27And that, of course, is ovarian failure or menopause.
24:31So
24:32if this miracle "mTOR," affects something fundamental about aging and longevity,
24:37it should affect menopause, too.
24:39So when they give rapamycin to...
24:41the rats or mice to the mouse model,
24:44it increases their litter size, they become more fertile, and
24:49they have a longer fertile window.
24:52In other words, it delays menopause.
24:54So for
24:55all these
24:56applications that are now human trials in place for,
25:00I quoted a lot of animal studies,
25:02but they're beginning to look at human things.
25:05So
25:06this is fascinating.
25:07These things all have different mechanisms,
25:10if you think about it, for aging.
25:12But rapamycin
25:13somehow gets to a basic root cause... But...
25:16you may say, well, wait a minute.
25:19Nobody dies of
25:21baldness.
25:22Nobody dies of menopause, nobody dies of gray hair.
25:25This doesn't really affect longevity.
25:27It sure may make us look younger, may make our skin better.
25:32But
25:33what happens...
25:34if "mTOR" is so fundamental to our longevity.
25:36What happens when we apply "mTOR"
25:39to these diseases of aging that actually kill us?
25:42Like I said,
25:43it's a short list. Number one is cardiovascular...
25:46disease, heart attacks, and strokes.
25:49Number two is cancer.
25:50Number three is Alzheimer's.
25:52Okay,
25:53what happens
25:54with
25:55"mTOR" when we turn it down in those.
25:57Well, actually,
25:59we talked about stents before,
26:01the mechanical things that are put in blood vessels.
26:05When most people get heart attacks, now they get these stents.
26:09The problem with the stents, as we alluded to, is
26:13the disease continues and the other blood vessels continue to clot down,
26:18and the stents actually re clot off
26:20with atheromas
26:21over time. So
26:24what does turning down "mTOR" do?
26:26Well, actually, there's now an "FDA" approved indication
26:31if you coat the stents with rapamycin
26:34dramatically slow or even stop the atherosclerosis from occurring.
26:39So it's "FDA" approved to stop atherosclerosis.
26:43And there are studies underway where now taking oral rapamycin
26:48may slow down -
26:49- atherosclerotic disease
26:51in all of us. Okay, that's
26:53great. It works for that.
26:55What about cancer?
26:56Cancer is a completely different
26:59disease, completely different organ,
27:01different
27:02organization, different mechanism. Actually,
27:08let's look at a human model for cancer, -
27:12-- is transplants.
27:13You know what the most common cause of death,
27:16I didn't know this, but when I first started looking at this,
27:20the most common cause of death in a transplant patient,
27:23let's say heart transplants,
27:25within the first five years of getting a new transplant,
27:28is.
27:29No,
27:30no, I don't know.
27:31I thought it was --- organ rejection or something.
27:33Because that's what you're worried about when you transplant something in.
27:36You'd think, yeah.
27:37Yeah, you give immunosuppressive drugs, it's actually
27:42cancer, because
27:43the immunosuppressive drugs
27:45lower the immune system and people get more higher rates of cancer.
27:50-
27:51Makes sense now that you say it.
27:52Yeah.
27:53Yeah, as it turns out, rapamycin, in fact,
27:55its first "FDA" approved indication, is for
27:58helping with
27:59organ rejection.
28:01There's a large population of patients who routinely get
28:04rapamycin for organ rejection.
28:07And then there's another group...
28:09also who have transplants, who may get something else
28:12that also works, but just isn't rapamycin.
28:16But what they found in this study was that
28:19in this population whose human population is predisposed to
28:23getting huge amounts of cancer,
28:25when they're given rapamycin, the cancer rates dropped by 50%.
28:29<break time=“2.69s"/>
28:32And now to the point where there are at least eight
28:35"FDA" approved indications for rapamycin for treatment for cancer,
28:39things like metastatic renal cell cancer,
28:42which is the most common type of kidney cancer,
28:44and other types as well. So it's like
28:47- whoa,
28:48something's going on here at a fundamental level.
28:51The last one is Alzheimer's disease.
28:54What evidence do we have that "mTOR" is involved in Alzheimer's disease?
28:59Well,
29:00there's an animal model for Alzheimer's disease
29:03that in the mouse, it's called the
29:07mouseheimer model,
29:08where they actually get cognitive impairment.
29:11They forget their keys, whatever the mouse equivalent is, and...
29:15they have progressive dementia and everything.
29:20When these mice are given
29:21rapamycin versus
29:23placebo,
29:24it actually reverses their mental fog and their mental acuity returns
29:29back towards normal
29:31to the point.
29:32Now the University of Texas is
29:34having a trial go... underway...
29:37with rapamycin as a treatment for Alzheimer's disease.
29:40It's a multimillion dollar study that's underway.
29:44But if you think about it,
29:46we talked about ketogenic therapies and all.
29:49Ketosis is really a way of turning that "mTOR" switch back to the repair mode,
29:55because
29:56the nutrients it senses is glucose.
29:58And when you're in ketosis or on a ketogenic diet,
30:02your body is burning
30:05butyrate and ketones
30:07type substances rather than glucose.
30:10So your glucose levels are very low,
30:12and your "mTOR" tends to turn back like that...
30:16But
30:17it's amazing.
30:18"mTOR" seems to play a role in
30:21these chronic diseases.
30:23And then
30:24the last question is
30:26there any evidence
30:28that
30:29you can reverse
30:30the appearances of aging, you could
30:33reverse
30:34or slow the chronic diseases that determine mine and your longevity?..
30:39Is there any evidence to show
30:42giving rapamycin improves longevity itself
30:46in humans. And the answer is,
30:48there's no direct evidence because it's very hard to do
30:52longevity studies in humans. Humans live...
30:5470 years, very soon, 100 years.
30:57But the point is, it's hard to do longevity studies.
31:00But there is a gold standard longevity study that you may have talked
31:05about with your audience before
31:07that's run by the federal government. They use mice.
31:10It's called the Interventions Testing Program,
31:13or the "ITP." And
31:15mice are great because they only live three years.
31:18So you could do a longevity study and know the results in three years.
31:22And the great thing about this longevity study,
31:25the "ITP," is
31:26you and I, as citizens, can write in and suggest drugs to test...
31:30And
31:31what they do is they just take these mice that are
31:33not lab mice.
31:34They're actually wild type mice with genetically diverse appearance.
31:38They're in three different labs around the country,
31:41so it's not even one lab.
31:43And then they give them.
31:45Half the mice just get raised normally, they live their lives and die.
31:49The other half get whatever the intervention is,
31:52typically the drug, the substance, and then at the end, they look at
31:56the lifespan of the mice, and is there a difference between
31:59the intervention and the regular mice? And
32:02is there an improvement?
32:03Is there a longevity effect?
32:05Because we get to suggest everything.
32:09This has been around for 20 years.
32:11There have been some amazing things tested,
32:14green tea,
32:16curcumin,
32:17"NAD" supplements, "CoQ10"... statins,
32:20all kinds of stuff
32:23that people
32:24wonder about for longevity.
32:27The interesting thing is, most of these
32:30had no effect. And
32:31there are
32:32only a handful of things that have an effect,
32:36and by far
32:37the most powerful,
32:38most significant effect that knocks it out of the park is rapamycin...
32:43And... one last
32:44nuance to it.
32:46When they did the rapamycin study,
32:48typically they give the drugs for the whole life of the mouse,
32:53which
32:54is not really realistic for you and I, because -
32:57- we're
32:58older and
32:59we don't get a chance to start it from birth anymore,
33:03and we may not want to.
33:05We don't know that that's a good idea.
33:08But for this, the last
33:09for the rapamycin trial, they messed up on making the food, and --
33:15they wound up, they couldn't get the supplements right.
33:19So
33:20the -- mice didn't start the rapamycin until they were the equivalent
33:25of 60 to 70 years old in human
33:28years.
33:29And even starting at that late age, they saw this dramatic longevity benefit.
33:36Wow. So we've talked about a ton of positives.
33:39Any negatives?
33:41Yeah. Well, rapamycin, it's one thing.
33:44Just to be clear.
33:45- The very first use of rapamycin.
33:48And the groundbreaking use for which it got "FDA" approval in 1999...
33:53was for
33:54immune suppression for renal cell transplants
33:57and other organ transplants.
33:59So
34:00immune suppression is a good thing.
34:02If you have a transplanted organ from a foreign donor in your body,
34:07it's kind of a bad thing for you and I
34:10to suppress your immune system, because immune system is important
34:15for all sorts of things. And
34:17most doctors, if you go to your private doctor and say,
34:21hey,
34:22I'm thinking about taking rapamycin for longevity,
34:25they'll go, whoa, whoa, whoa.
34:27No, no, no. You don't want to take that.
34:29That's an immunosuppressant.
34:31And
34:32so there's a lot of misunderstanding about rapamycin.
34:34To be clear,
34:36when humans take rapamycin, and
34:38it's "FDA" approved for a number of indications,
34:41but it's not approved for longevity,
34:43just because longevity is not an "FDA" indication or it's not
34:47considered a disease or aging.
34:49When people take rapamycin for longevity,
34:51they typically do it instead of the daily dose,
34:54which is the
34:55renal transplant immune suppression dose, they do it once a week.
34:59And that once a week,
35:00the half life of rapamycin is short enough,
35:0348 hours that it's gone in a couple of days or at least significantly decreased.
35:08So...
35:09there's that misunderstanding about rapamycin.
35:12So there's
35:14a lot of
35:15uncertainly
35:16with physicians, but what about safety
35:19profile?
35:20That's a key point. -
35:23Rapamycin is actually
35:25very safe drug.
35:26There aren't a lot of contraindications for it.
35:30There's a report in the literature,
35:32someone tried to commit suicide with rapamycin with over ten
35:36times the recommended dose
35:39in one shot.
35:39They went into the "ER" and basically nothing happened.
35:43<break time=“5.50s"/>
35:49The toxicity profile is very good.
35:51The side effects of rapamycin are, -
35:55- the one thing some people note are mouth ulcers,
35:59little
36:00cold sores or aphthous ulcer.
36:02A small percentage of patients get these.
36:05They're reversible.
36:06They go away, and
36:08they usually stop.
36:09But other than that,
36:11the biggest thing about rapamycin is we really don't understand it.
36:16---
36:17- We're just at the beginning of all these things.
36:21It's a little bit of --- the Wild West.
36:24Even the dosage that people take, it's
36:27almost arbitrary.
36:28The dosage
36:29that we take, there's not a lot of
36:32data. It's still coming in.
36:34So
36:35it's kind of a leap of faith to
36:38to take these drugs. I think
36:40the message
36:41that I try and communicate, and I certainly practice it myself, is
36:47that
36:48rapamycin is powerful.
36:49-- It does work on "mTOR,"
36:52but
36:53something even more powerful
36:55is our lifestyle.
36:56And I would never take rapamycin before
36:59I did all the lifestyle stuff first, because
37:03why is that?..
37:04Rapamycin works.
37:06The "ITP,"
37:07done deal. Why not just take it?
37:09Well,
37:10some interesting results came out. In the last
37:1324 months, the "ITP"
37:15took another drug called
37:16acarbose, which has a small lifespan benefit.
37:20And when they combined, well, actually
37:24there's another drug called metformin, which people also take for longevity.
37:29Metformin had no effect
37:31on the "ITP."
37:32That doesn't mean it doesn't work at all -
37:35for longevity, nobody knows.
37:37But at the dose it was given,
37:39if something fails the "ITP," it just means that
37:42dose, it didn't work.
37:43If you take an antibiotic, if you take too low a dose, it won't work.
37:48But that doesn't mean it doesn't work. Theoretically,
37:51metformin failed the "ITP," but when they combined metformin with rapamycin,
37:56they got an even greater effect than rapamycin alone.
37:59So there's some synergy with "AMP" kinase that rapamycin
38:03that metformin effects with rapamycin. But
38:06my point was about twelve months ago,
38:09they published a paper
38:11where they combined acarbose with
38:13rapamycin.
38:14Acarbose has a small benefit in the "ITP." Rapamycin has a huge benefit.
38:19When they combine the two of them,
38:21they got a greater benefit than either one of them
38:26separately...
38:26So there's some kind of synergy that we just don't understand.
38:31So
38:32rapamycin may be a great idea for longevity,
38:34but
38:35if you want to cover your bets, I would do longevity
38:38fix my diet, my sleep, my exercise, stress,
38:41all those other things as well, because
38:44otherwise you're leaving a lot on the table and you can miss out.
38:48And
38:49rapamycin, or whatever longevity
38:52stack you use will
38:54likely be potentuated by your lifestyle.
38:58And when it comes to rapamycin,
39:00is it totally downregulating "mTOR?"
39:03How much of an effect does it have? Because...
39:06we know "mTOR," again, isn't bad or good, it's just regulating how often it's
39:12activated.
39:13So what kind of effect does the drug have on "mTOR" specifically?
39:18Yeah, that's a great question.
39:20Unfortunately, nobody knows.
39:22We don't have good,
39:24they're not good molecular markers in a clinical sense for "mTOR." --
39:29If I -- do "NAD" supplementation for example,
39:33I could check
39:34with, if I do "NMN" or
39:36"NMR," I can
39:38check my "NAD" levels.
39:40With "mTOR,"
39:41there aren't easy clinically accessible
39:44indicators of that.
39:46We know from -- the science that it's --- affecting "mTOR" and
39:51these downstream effects,
39:53but there aren't easy indicators. So
39:56when I take my daily dose of "mTOR"
39:59or my daily dose or my weekly dose of rapamycin,
40:03people say, well, how do you feel?
40:06I say I feel great, but
40:08I'm also fasting, I'm exercising, I'm doing all sorts of other things.
40:13So it's hard to tell
40:15what the actual effect is. -
40:17And it's not like I stop it and I feel bad or I take too
40:21much and I get side effects.
40:24It's really a black box. And
40:26that's the challenge with this particular longevity drug.
40:30It's both good and bad, but
40:32it's something that we'd like to,
40:35hopefully in the future we'll know much more about it and get
40:39better indicators that we can follow that it's working and figure out
40:44even what the right dose is. -
40:46So you're taking it on a weekly basis.
40:48How long have you been doing that for?
40:51I think im going on three years now. -
40:54Well, lets get into diet specifics, talk about what we can eat specifically
41:00to down regulate the "mTOR"
41:02and when were eating.
41:04And you've mentioned ketosis, but lets get into
41:08how all that works, the physiology.
41:10Sure, yeah,
41:11before we get into diets
41:13with nutrition,
41:15there's one thing people can do
41:18that I talk about in the book,
41:20even if you don't want to change what you eat,
41:24you say, forget I'm not into diets.
41:26Is there anything else I can do with my eating?
41:29And actually the answer is yes. -
41:31- Just by
41:32changing when you eat, you can improve
41:35your metabolic state and turn down "mTOR" and do different things like that.
41:41And that is to
41:42eliminate snacking.
41:44My mom was a dietitian, so I was raised on the misguided
41:48idea that
41:49you eat many small meals throughout the day and da da da,
41:53all that. So
41:54instead
41:55what I recommend is
41:56start off when you get done with dinner. What I did,
42:00I brush my teeth immediately because I'm basically lazy and
42:04I knew if I snacked again,
42:06I'd have to brush my teeth again.
42:08So I said do it that way. And then,
42:11eliminate snacks between meals and
42:13if you're
42:14feeling
42:15really,
42:16if you really want to do something, you can eliminate breakfast,
42:20skip breakfast if that works for you, or even skip lunch.
42:24That's what I do.
42:25And I have one meal a day with my kids when they get home,
42:29and... I'm basically fasting.
42:31Most of the other time I
42:32have coffee
42:34or water,
42:35but no calories during those times. So
42:38that's the first thing you can do. -
42:40- Just eat a certain...
42:41narrow your eating window, because
42:43when you're not eating, nutrients are not coming in.
42:46Inflammation is going to be turned down just because
42:50if you think about it, a lot of things affect inflammation.
42:53We talked about "mTOR," but even eating itself
42:56if I put food into my mouth and it goes into my stomach and my "GI" tract,
43:00no matter what the food is, it's going to drive inflammation,
43:04because inflammation is the body's natural protection
43:07against foreign material,
43:08and food is foreign material going in.
43:10So every time I eat, I'm turning on inflammation.
43:13If I eat all the time or all the time I'm awake,
43:16inflammation will be turned on all the time.
43:19So even
43:20narrowing the eating window is a way of turning down inflammation.
43:24And... depending on how long that window is,
43:26you may even get into ketosis in a favorable...
43:29metabolic state there.
43:31So that's the first thing.
43:33Second thing you could do without changing what you eat that's
43:36going to help your nutrition.
43:38That helped me
43:39was to think about macronutrients.
43:42Your audience, I'm sure,
43:44knows that proteins and fats are the two essential macronutrients.
43:48We need to have those.
43:49We'll die if we don't have them.
43:51The third macronutrient, of course, carbohydrates, we don't need.
43:55It's non essential. And...
43:57there's several human civilizations that exist without significant
44:01amounts of carbohydrates,
44:02all in their diet.
44:03And as it turns out, carbohydrates are the things that
44:07drive insulin
44:08more than the others.
44:09They turn on "mTOR" more than the others.
44:12And
44:13even
44:14if you want evidence of
44:16how
44:17potentially problematic
44:18carbohydrates could be in our diet, that drug, acarbose,
44:22that I mentioned, that
44:24potentiates the effect of rapamycin
44:27in the longevity "ITP" program.
44:29The way acarbose works, it's really interesting.
44:33It's an "FDA" approved drug, but it's for diabetes.
44:36It's for type two diabetics and type one diabetics as well,
44:41I think.
44:42But
44:43it's not absorbed really significantly in the body.
44:46And the only way acarbose works is in our guts,
44:49and it blocks the absorption of carbohydrates,
44:53so
44:54it slows carbohydrate absorption. And...
44:56at least in the animal model, taking acarbose,
44:59slowing carbohydrate absorption produces all longevity benefits.
45:04So
45:05you can
45:06do the same thing or get a similar effect.
45:09In other words, slow carbohydrate absorption.
45:12If you think of carbs as
45:14the enemy or what you want to avoid.
45:17But I have a meal here in front of me with a bunch of pasta
45:21and maybe some cheese and
45:23something else.
45:25- I know that
45:26rather than eating the carbohydrates first,
45:29which
45:30on an empty stomach,
45:30spike my glucose and have rapid absorption,
45:33I can get a similar, acarbose effect by eating fat first,
45:37maybe having the cheese beforehand or the olive oil with a salad,
45:42and that will coat the lining of my gut,
45:45maybe some protein as well, and save the carbs for the end.
45:49And that will delay the absorption of the carbs,
45:52and the harmful effect of the glucose spikes will be
45:56mediated. So those are two things you can do
45:59nutrition wise before you even touch what you eat.
46:04All right, so
46:05cutting down on snacking, narrowing the eating window,
46:09and then eating fats before carbohydrates.
46:12Yeah, fats and proteins.
46:14Either one will
46:15block it,
46:16so then
46:17becomes the
46:18what to eat.
46:20And
46:21that's an interesting thing.
46:24Well, let me say first that...
46:26I have no dog in the diet game. I love my vegan friends.
46:29And protein, yeah.
46:32I love my -- carnivore friends.
46:34In fact, I was a vegan for
46:37ten years at one point.
46:39I've been a carnivore for a while.
46:41I think
46:42personally,
46:43we can all be healthy
46:45or unhealthy on a vegan diet or
46:48all the way to a carnivore diet.
46:50It's just the choices we make in between.
46:54And there are pitfalls with each of those diets.
46:57I think there are a lot more pitfalls with a vegan diet.
47:01There's a lot more vegan junk food than there is carnivore junk food,
47:06but it's present in each one.
47:08So I -- welcome, you can.
47:10You don't have to switch your type of diet.
47:13It's just that
47:14the food you eat within that diet.
47:17So, -- the main thing I avoid
47:20is junk food.
47:21And I have to say...
47:23full disclosure, I'm a recovering junk food addict.
47:27I
47:28love junk food. I can't keep it in the house.
47:31I've got a teenager and a younger daughter.
47:35And they
47:36are continually
47:37trying me.
47:38But I find just like an alcoholic, I don't keep liquor at my desk.
47:42I don't keep it in the house.
47:43Same thing with junk food. So...
47:45everybody agrees junk food's bad.
47:47The question is,
47:49how do you define junk food? And
47:51that's a problem because
47:53you have organizations like the American Heart Association saying that
47:59vegetable oil is heart healthy. --
48:02I don't agree with that.
48:04I think it's
48:05not heart healthy.
48:07So the key thing is defining how you define junk food.
48:11So for me, there are three things...
48:14that I look out for.
48:16Just in generalities
48:18junk food. -
48:19Some things
48:20that...
48:21will let you know that something's junk food.
48:24It typically comes in a box.
48:27It's frequently brightly colored to attract children..
48:31It
48:32has a long ingredient list. -
48:35But specifically, the things that I do are, first of all,
48:41carbohydrates. -
48:43Because of the things we talked about with
48:46insulin stimulation,
48:48I try to keep carbohydrates to a minimum, especially refined carbohydrates
48:54and sugars.
48:55So I have to watch out with fruits.
48:57Modern fruits are very rich in sugars, unlike the fruits that our ancestors eight
49:0310,000 years ago.
49:05Also things like starches.
49:08My wife's Chinese, so she
49:10grew up on rice.
49:11That's part of her cultural... legacy.
49:14So
49:15rice is out
49:16any of the
49:17starches that break down into glucose.
49:19So first thing is just to eliminate carbohydrates as
49:23much as possible in my diet. --
49:27Once I've done that, the second thing I also watch out for is
49:31something called industrial oils or
49:34ultra processed oils or seed oils.
49:36They have a healthy sounding name called vegetable oils,
49:40but they, they don't contain vegetables.
49:42And in my opinion,
49:43they're not healthy at all because they drive inflammation
49:47and
49:48make all the diseases we're talking about worse.
49:51- So these are,
49:52I'm sure you've talked about them on your program,
49:56but
49:57these oils, the problem is, the more I began looking at it,
50:00these oils are in nearly every single
50:04salad dressing
50:05that's available.
50:06<break time=“2.33s"/>
50:08They're in mayonnaise, they're in hummus,
50:11they're in all the junk foods.
50:13Why are they in the junk foods?
50:15Because they're relatively stable
50:17and
50:18they don't degrade over time.
50:19They're very cheap.
50:21So you can replace more expensive butter
50:23that -- turns rancid with these seed oils.
50:26<break time=“2.12s"/>
50:28And the food lasts longer.
50:30So seed oils is the second thing.
50:32<break time=“5.01s"/>
50:37It's basically...
50:39carbohydrates - and
50:41seed oils. And the last thing
50:43is sorta counterintuitive.
50:45And I certainly wasn't expecting at all was grains,
50:50even whole grains.
50:52And why is that?..
50:53I don't have celiac disease, which is
50:56a disease that some people have that's gluten intolerance.
51:00But
51:01I believe, like many experts do, that
51:04much of the adult population
51:07are allergic
51:08to
51:09proteins in grains,
51:10if not gluten itself, but other proteins.
51:13And this allergy drives a low grade inflammation that we
51:17may not even be aware of.
51:19It may manifest as
51:20irritable bowel disease.
51:22It may manifest as anger or depression.
51:25It may manifest as brain fog.
51:27It may manifest as
51:29exacerbating any of the diseases.
51:32So for that reason, I don't eat grains.
51:35Also, in the United States, grains are soaked,
51:38most of them in a weed killer called glyphosate,
51:41which
51:42at least 34 countries around the world have banned for health reasons.
51:47But
51:48our grains are
51:49soaked in it. And then the last thing is grains.
51:53- Most grains have a large amount of carbohydrates,
51:57so
51:58they're ruled out for that reason.
51:59So when I avoid those three things, I'm pretty much on the path to
52:05healthy eating.
52:06And it turns down,
52:08it helps me
52:09with my fasting, because people say,
52:12how can you go and only eat one meal a day?
52:15What kind of iron willpower do you have?
52:18Well, I don't have iron willpower,
52:21but...
52:22when people go into ketosis, their -- appetite decreases, and
52:26it controls your appetite and allows you to go longer periods without craving
52:31food.
52:32And
52:33do you test for ketosis?
52:34Because the way you eat one meal a day controlling carbs,
52:38I'm curious if you're going in and out of it or just staying in ketosis.
52:43Yeah, the
52:44urinary tests are not that great for you.
52:47You can test your
52:49blood, urine for markers, but that's not good.
52:53That's
52:54not that useful for ketosis that I found.
52:56You can do a blood test, stick your finger,
53:00but I hate sticking my finger.
53:02So
53:03I had a breath meter
53:04from one company that you blow into, and it...
53:08detects that.
53:09I check it for a while, and I'm reliably in ketosis.
53:12And
53:13so the short answer is no, I don't check it.
53:16I don't check it routinely every day because
53:19I'm pretty much doing everything I could to be in ketosis,
53:22and there's not --- much
53:24more I could do.
53:25I can't push the accelerator down much more.
53:28But that is the goal, though, to be in ketosis 24/7?
53:31For me -- it is, and
53:35it's not for everybody.
53:37Everybody has different things. But,
53:40the amazing thing is...
53:43we're finding that this
53:45metabolic state, which
53:48an indicator is being in some form of ketosis,
53:52is
53:53it basically
53:54reverses seizures.
53:56We know that that's the oldest application for ketogenic diet,
54:01is stopping seizures, and it's still being used today.
54:06-
54:07Putting people in ketosis will reverse mental illness.
54:11Not everyone, not all mental illness,
54:14but as "Chris Palmer" and "Georgia Ede" have shown,
54:17some patients with
54:18psychiatric
54:20psychosis, manic compression, to the point where they're hospitalized
54:25on medications and they no longer have a job,
54:28and they can't be with their family.
54:31When "Chris Palmer" put --some of the patients on a ketogenic diet.
54:36-
54:37Many of them are now going home and some of them off all medications.
54:41<break time=“2.95s"/>
54:44And there are now independent studies.
54:46One just came out at "Stanford"
54:49doing just that. So
54:50something about ketosis
54:52also
54:53helping in
54:54mental health.
54:55And I asked
54:56"Chris Palmer," he's a psychiatrist at "Harvard" Medical School,
54:59"McLean" Hospital, who's written a book about,
55:03about ketogenic
55:04diets for
55:05psychiatric conditions.
55:06I said, "Chris," it's great, but how do you know it really works?
55:11Give me an anecdote.
55:12And he says, well, one of my patients, "Bill,"
55:16he was in the hospital with
55:18psychosis, schizophrenia.
55:20And the hallmark of schizophrenia, your patients may know, is we hear voices.
55:25Voices talk to us.
55:26A schizophrenic patient will frequently have those.
55:30So
55:31when "Bill" went on this diet,
55:32"Chris" was able to stop all his medications
55:36and
55:37literally send him home. And he's back with his family.
55:40He now has a job,
55:41and
55:42it's not, doesn't work that way with all patients,
55:45but
55:46even any patients.
55:47And there's a significant portion where it does.
55:50So
55:51"Chris" said he goes, yeah, "Bill" knows that.
55:54He says
55:55he knows that when he slips and has a piece of junk food,
55:59and he starts going out of ketosis,
56:03he knows he's out of ketosis because suddenly the voices will
56:07start talking to him again.
56:09And as soon as he goes back into ketosis, the voices stop.
56:13So
56:14it's something about this
56:16metabolic health, which ketosis is one path to it, but
56:20for Alzheimer's disease, people drink
56:23exogenous ketones like "MCT" oils,
56:26or even going into ketosis
56:28can
56:29for some patients. Again, not all patients
56:31have dramatic effects on Alzheimer's disease,
56:34which is really
56:35untreatable.
56:36"Heather Sandison," who you may have had on your program,
56:40she runs
56:41a group. -She's a physician,
56:42runs a group of nursing homes around the country
56:45that specialize in Alzheimer's disease...
56:47She's a protege of "Dale Bredesen" who's written extensively on it.
56:52Her nursing homes are unlike any other nursing homes that I'm
56:55aware of for Alzheimer's disease,
56:57because the patients actually go there and they get better
57:01and then they go home...
57:02Most patients, sadly,
57:04my mom just died of Alzheimer's disease.
57:07Most patients with Alzheimer's disease, it's a one way street.
57:11You go in and you get worse and worse and worse,
57:14and you eventually die.
57:16Well, I talked to "Heather" about
57:19what's her secret in these nursing homes.
57:22A number of different things.
57:24A big program, but
57:25one foundation is
57:28the only type of food they serve in the nursing home is a ketogenic diet.
57:32So it's
57:33high in
57:34healthy fats, and meat and eggs, and
57:36things like that.
57:37And they avoid the foods that I just mentioned that
57:41I avoid there. So
57:42I said the same question to "Heather." I go,
57:45oh, that's great, you do the ketogenic diet,
57:48but how do you know it works?
57:50Do you have any evidence for it?
57:52And she said, well, yeah, there's
57:55Mister "Jones." -
57:56I know that the ketogenic diet is working for him,
58:00because when he's in ketosis and his grandchildren come in to see him,
58:04he smiles and hugs them and remembers all their names.
58:07But when he goes out of ketosis,
58:10the same thing happens.
58:11They come in the room and he doesn't recognize them,
58:14and there's
58:15nothing happens there. -
58:17The point is, there's something about
58:20this ketogenic diet that
58:22affects not only mental health and Alzheimer's disease,
58:26blood pressure, we've talked about.
58:28There's evidence that ketogenic diet is now being used in
58:33certain types of cancer, for adjunctive treatments
58:37for cancer.
58:38It's evidence that the ketogenic diet...
58:40also affects cardiovascular disease.
58:43And as we talked about with "mTOR,"
58:45"mTOR" and rapamycin is one method to being metabolically healthy.
58:50And
58:51ketosis, if a ketogenic diet is for you, it's another path to get there,
58:56or even something to do in addition to your rapamycin or whatever you're doing.
59:01So
59:02these all are working at some
59:04basic, primitive,
59:06primal mechanisms
59:07that help
59:08our health and longevity.
59:11It's just fascinating I think.
59:14You talked about "MCT" oil there...
59:16Do you personally use "MCT" oil or exogenous ketones
59:20to bring you. I guess you're always in ketosis,
59:23but do you use them as an adjunct or do you recommend them to people?
59:28Yeah, it's a great
59:29question. There's a lot of
59:31good work being done on "MCT" oils.
59:34"Dom D'Agostino" our friend, is working on those and all.
59:38<break time=“3.02s"/> They
59:41famously have some dramatic results with Alzheimer's disease.
59:46Literally, it's this woman.
59:49She was a physician.
59:50Her husband had Alzheimer's disease, severe mental problems.
59:55She started feeding him...
59:56"MCT" oils and other exogenous ketones and was able to reverse
1:00:01this disease and bring him back,
1:00:03significantly.
1:00:04And the only reason she thought of it, because she was a
1:00:09neonatologist, essentially, where they
1:00:12were familiar with "MCT" oils and certain applications there.
1:00:16So, yeah, it works there.
1:00:18I was just with "Chris Palmer" at a conference a few weeks ago,
1:00:22and someone from the audience asked "Chris,"
1:00:26so
1:00:27what about
1:00:28exogenous ketones for psychiatric conditions?
1:00:30And
1:00:31"Chris" said that, at least in his experience,
1:00:34and he's not aware of any case reports that
1:00:37while they do work in -- Alzheimer's disease and other things for
1:00:42these mental health conditions,
1:00:44he's not aware of exogenous ketones doing that.
1:00:47So
1:00:48it may be
1:00:49some benefit you get from
1:00:50nutritional ketosis versus exogenous ketones.
1:00:53- It just shows
1:00:55how much... we have to learn by this whole thing.
1:00:59But it's just fascinating,
1:01:02all the possibilities out there. And
1:01:05the one thing
1:01:06from "Chris's" work
1:01:09is that
1:01:10all of us. <break time=“2.33s"/>
1:01:13It's great for mental health.
1:01:16But most of -- your audience, me and you,
1:01:19are probably not going to be diagnosed with a clinical
1:01:23mental illness in our lifetime,
1:01:26statistically... But
1:01:27on the other hand, we're all human.
1:01:30We all go through ups and downs with our wives,
1:01:33our spouses, our children, our...
1:01:36coworkers, our friends, our employees, our bosses...
1:01:40We all get angry, we all get
1:01:42anxiety, we all get stress. And
1:01:44you can't help but wondering...
1:01:47what possible
1:01:48benefit, improving our metabolism
1:01:51through
1:01:52one of these approaches with "mTOR" or ketogenic diets
1:01:55could have just on society in general, the way
1:01:59we get together.
1:02:00- Famously, political
1:02:02organizations now,
1:02:03the Republicans don't talk to the Democrats,
1:02:06and vice versa, when
1:02:0830 years ago,
1:02:09it wasn't that way at all.
1:02:11The world is changing in subtle ways about the way people
1:02:15get together.
1:02:16And junk food is amplified in the last 30 years.
1:02:19And driving all these things, I wonder if it's driving...
1:02:23the way people get along with each other.
1:02:25You can't help but
1:02:27wonder that question.
1:02:28So when it comes to your diet, there's three different pieces.
1:02:33The seed oils, the no grains...
1:02:34and lowering of carbs for you, ketosis, you take that down to
1:02:38that level. For somebody that wants to use
1:02:41these guide rails,
1:02:43two of them are black and white, but the low carb piece is a bit gray,
1:02:47depending on if they want to go all the way down to ketosis or not
1:02:52for the average person, would you say that's
1:02:54the goal,
1:02:55to get to ketosis or just to lower the carbs?
1:02:59And then expand upon that, things like fruit and
1:03:03it sounds like you're not having any fruit,
1:03:05but for people that are more metabolically healthy,
1:03:09is that okay?
1:03:10How do you look at that whole
1:03:11gray area within the carb realm?
1:03:14Yeah, I do have fruit.
1:03:15-- Once in a while, but I'm aware that it has
1:03:18high fructose in there.
1:03:20They're downsized to that.
1:03:22There's a whole -- discussion around that. But I think
1:03:26the goal necessarily isn't ketosis for everybody.
1:03:30It's not for everybody, but to be clear, there are people...
1:03:34who are in ketosis their entire lives.
1:03:37I was just talking to a patient of mine
1:03:40whose daughter
1:03:42has had epilepsy since birth, and none of the medications worked.
1:03:48None of the surgical options were possible.
1:03:51And she's now
1:03:53been on a ketogenic diet her entire life, and that's the way she stops her seizures.
1:03:59So it is -- possible to be on this, but
1:04:02anyway,
1:04:03I think the goal is to be metabolically healthy.
1:04:06How we get there are different ways.
1:04:08And if you want to be in ketosis,
1:04:12I like fasting. -
1:04:13I have a clear, my brain fog goes away. I feel better
1:04:17now that I did when I was snacking all day long and having a big lunch
1:04:22and then falling asleep in meetings and stuff like that.
1:04:26So it's just,
1:04:27you have to look at yourself. But I think
1:04:31the goal is in ketosis, and ketosis isn't for everybody.
1:04:35But
1:04:36you can
1:04:37use the ideas from it by
1:04:38cutting back your different things.
1:04:40And of the three things I do,
1:04:42it's interesting.
1:04:43I think it's important to note that,
1:04:45but they all have a different time scale as far as the effects.
1:04:48<break time=“1.93s"/>
1:04:50If you cut out sugars and cut out carbohydrates,
1:04:53you can see the effect.
1:04:54In 24 to 48 hours, there will be an effect on your body.
1:04:58You'll begin noticing things.
1:05:01Cutting out grains, though,
1:05:03you have to wait longer because the effect on the immune system
1:05:07and all typically
1:05:09can wait about three months.
1:05:11I have people who go, hey, I cut out all grains for a month,
1:05:15and nothing happened. So
1:05:17doesn't work for me.
1:05:18But see, you need to wait longer for that.
1:05:22And the bad news is with seed oils, it can be the half life of seed oils,
1:05:27because they're stored in our fat could be even years.
1:05:31So
1:05:32could be a
1:05:33long time before you see the results of those.
1:05:35But
1:05:37in my opinion, seed oils are really
1:05:40the only reason people
1:05:42put seed oils in food
1:05:44is for convenience
1:05:46and cost in some cases.
1:05:47But there's no taste advantage of seed oils.
1:05:51Nobody says,
1:05:52I like canola,
1:05:53I want some "Crisco," I want some vegetable oil.
1:05:57So
1:05:58that should be an easy substitute.
1:05:59If you're willing to make the effort
1:06:02to exclude those from your diet, you can do that.
1:06:06Things like carbohydrates, though, are different.
1:06:10There are tastes that are activated
1:06:12sugar, that's activated...
1:06:14grains, the same way baked goods.
1:06:17I love baked goods.
1:06:18There's nothing I'd rather have than --
1:06:21bagels and baked goods.
1:06:22There's only one thing I love more than baked goods,
1:06:25and that's my children.
1:06:26I want to live to see them,
1:06:28and I want to live to see my grandchildren.
1:06:30<break time=“2.39s"/>
1:06:32You could make those.
1:06:34We all get to make those choices ourselves.
1:06:37But it's all a matter of degree, and...
1:06:40I'm trying to illustrate maybe an extreme case with me.
1:06:43Everybody doesn't have to be as extreme as I am,
1:06:46but
1:06:47you could
1:06:48take what you want from what I'm doing and apply little bits and pieces of it
1:06:52in your own lives,
1:06:53and hopefully you'll get a benefit from it.
1:06:56One area you drill deep into in your book is fructose,
1:06:59which is under the carb realm
1:07:01and fatty liver...
1:07:02So let's talk about that connection there
1:07:05and the physiology that happens in the body when we're
1:07:08consuming too much of that.
1:07:10Yeah,
1:07:11our understanding of fructose has dramatically changed...
1:07:15in the last few years. It's
1:07:18fructose...
1:07:19As your audience may know, it's one of the primary...
1:07:23sugar molecules, glucose and fructose, when you combine them together,
1:07:30make
1:07:31table sugar sucrose.
1:07:34For many years, fructose
1:07:36was felt to be the good sugar.
1:07:39In other words, unlike
1:07:41glucose, if I eat glucose
1:07:43and
1:07:44have my rice or my carbs,
1:07:46my
1:07:47insulin will spike and
1:07:49my glucose will spike in my bloodstream.
1:07:53If I eat pure fructose,
1:07:55which happens to be a sweeter molecule than glucose,
1:07:59so it actually tastes sweet.
1:08:02If I eat pure fructose,
1:08:03my insulin doesn't spike and my glucose doesn't spike,
1:08:08to the point that
1:08:09the American Diabetic Association,
1:08:12which is not an organization to be trusted for all sorts of reasons,
1:08:18we can get into later if you want, but
1:08:21they used to recommend that diabetics
1:08:25substitute fructose for glucose and just eat fructose,
1:08:29because, hey, it doesn't affect your insulin,
1:08:32it doesn't affect
1:08:34your glucose.
1:08:35It's a safe alternative, and it tastes sweet.
1:08:39The problem is,
1:08:41fructose. <break time=“2.37s"/>
1:08:44It's exactly the same
1:08:46chemicals in fructose, carbon, hydrogen and oxygen.
1:08:49But they're just as in glucose, but they're just rearranged slightly.
1:08:54So they're very similar that way. But
1:08:56they're handled completely differently by the body.
1:09:00Every single cell, practically in the body,
1:09:02can utilize glucose for energy.
1:09:05Fructose, no cells in the body use it,
1:09:08except in the liver, where it's essentially detoxified
1:09:11for most of the fructose in our body. So
1:09:15the liver is a detoxification organ.
1:09:18That's where alcohol goes.
1:09:19When we drink alcohol,
1:09:21it goes to the liver and it gets detoxified there.
1:09:25And
1:09:27it used to be up until 1980
1:09:28that
1:09:29when people damage their liver,
1:09:32they get what's called fatty liver disease.
1:09:35And the number one cause, if you had fatty liver disease,
1:09:39you were most likely to
1:09:42be an alcoholic or have alcoholic liver disease.
1:09:45That's what it was called, alcoholic fatty liver disease.
1:09:49Something
1:09:50strange happened. A new disease appeared in 1980 that
1:09:53had never occurred before,
1:09:55and to the point it's now the number one liver disease,
1:09:58the number one cause of liver transplants.
1:10:01But it didn't exist before 1980, largely. And
1:10:04it looks just like alcoholic fatty liver disease,
1:10:06to the point that
1:10:08patients would come in, they'd be diagnosed with these
1:10:11damage to their liver, and the doctor would go, oh,
1:10:14you've got alcoholic fatty liver disease.
1:10:17You need to quit drinking.
1:10:18And the, patient would go, I don't drink.
1:10:21I've never drank.
1:10:22And the doctor would say, sure, but just stop it.
1:10:25<break time=“4.09s"/>
1:10:29That created some tension there in the doctor patient relationship until
1:10:34children started coming in with
1:10:36this fatty liver disease. And they
1:10:38said, well, you've got alcoholic fatty liver disease.
1:10:41They go, this is a six year old child.
1:10:44They've never had alcohol.
1:10:46How can they have fatty liver disease? And anyway,
1:10:49what they discovered was that fructose,
1:10:52when it's metabolized, detoxified by the liver,
1:10:55which is the main place it goes, it's handled
1:10:58the same way, or in a very similar fashion to ethanol,
1:11:02alcohol,
1:11:03and it produces fat and it damages the liver eventually and drives
1:11:06this fatty liver disease.
1:11:08<break time=“1.92s"/>
1:11:10What happened in 1980
1:11:11that
1:11:12fatty liver disease is now caused by fructose and not alcohol?
1:11:16Because
1:11:17if you look at the drinking rates for alcohol,
1:11:19it hasn't changed that much.
1:11:21It's pretty much the same.
1:11:23But something happened with
1:11:25the discovery of a compound called high fructose corn syrup,
1:11:29which is
1:11:31just a way of extracting something from corn...
1:11:34that's made of fructose and glucose.
1:11:36It's similar to table sugar, but it doesn't have that
1:11:40chemical bond there.
1:11:41But it doesn't really matter. But
1:11:43the thing was, high fructose corn syrup
1:11:46became widely available
1:11:48and it was placed in all junk foods.
1:11:50And it replaced the alternative, which was cane sugar.
1:11:54Cane sugar is sort of crunchy and it crystallizes and
1:11:57doesn't -- have a good taste.
1:12:00High fructose corn syrup stays fluid.
1:12:02You can put it on the shelf for twelve years.
1:12:05All good junk food, it'll last forever.
1:12:08And the other thing about it
1:12:10is it's subsidized by the government.
1:12:12Corn is one of the crops that is artificially lower in cost.
1:12:16So
1:12:17high fructose corn syrup is low in cost. So what happened?
1:12:21Everybody switched out cane sugar for high fructose corn syrup and "Coca-Cola,"
1:12:26"Pepsi." All the soda companies
1:12:28switched out high fructose corn syrup, and
1:12:31junk food just exploded. And
1:12:34this non alcoholic fatty liver disease exploded to the point that now when
1:12:39someone comes in with a fatty liver,
1:12:42you don't ask them if they drank alcohol.
1:12:46But the problem is,
1:12:47most of the medical establishment still considers it to be of unknown cause.
1:12:53It's vaguely related to metabolism.
1:12:56Even today
1:12:57you hear that
1:12:58although experts like "Robert Lustig" at the University of San Francisco
1:13:04did a prospective, controlled study
1:13:06with
1:13:07children, and he basically substituted,
1:13:09he removed fructose from their diet and substituted glucose.
1:13:14And in a matter of weeks,
1:13:15he was able to reverse the fatty liver disease in these children
1:13:20just by removing the fructose.
1:13:23There's tremendous evidence, in my opinion, it's caused by fructose.
1:13:27-- If you want to,
1:13:29this is shown throughout history, because
1:13:33fatty liver
1:13:35didn't start out as a disease.
1:13:37It started out as
1:13:38a culinary <break time=“1.75s"/>
1:13:41item with "foie gras,"
1:13:43which
1:13:44has been around at least since Egyptian times,
1:13:47where Egyptians learned to
1:13:49give geese fatty liver.
1:13:50And if they wanted to do that, they didn't give them alcohol,
1:13:54they didn't give them sugar or glucose, but they gave them
1:13:58things that had a large amount of fructose.
1:14:02Figs in particular.
1:14:04And the same thing thats true today, too.
1:14:07<break time=“2.05s"/>
1:14:09You dont feed them protein, you dont feed them fat,
1:14:12you feed them high carbs, especially fructose.
1:14:16Anyway, thats a rambling conversation
1:14:20about fatty liver disease...
1:14:22The lie is that we don't know what causes fatty liver disease.
1:14:26And I think the evidence is overwhelming, and
1:14:29I've cited it in my book.
1:14:31These aren't my ideas.
1:14:32All I'm doing is reading the literature as I interpret it.
1:14:36But it's due, in the vast majority of cases,
1:14:39to fructose toxicity. And
1:14:41I think we all need to be concerned about fructose,
1:14:45even if we don't have fatty liver disease, that
1:14:48it's something to
1:14:49at least be cautious of. And
1:14:52one last point about fatty liver disease.
1:14:55It was usually only diagnosed when the liver enzymes,
1:14:58the liver blood markers, got very high. With
1:15:02"CT" scanning,
1:15:03it's possible to make the diagnosis on an x-ray image.
1:15:07And
1:15:08one interesting study where they scanned
1:15:11adult patients coming in for colonoscopy, which
1:15:14is unrelated to fatty liver disease.
1:15:16And they just looked at all their livers,
1:15:19and they found upwards of 50% of them had fatty liver disease,
1:15:24but they weren't diagnosed.
1:15:26And then they looked at the radiology reports that the radiologist
1:15:30dictated. <break time=“2.28s"/>
1:15:33Only 10% were dictated of those as fatty liver disease.
1:15:37And then they looked at the follow up of the radiology reports,
1:15:41and
1:15:42less than half of those had any follow up from the referring physician.
1:15:46So it's not on people's radar yet.
1:15:49It's a marker for
1:15:51insulin resistance, it's a marker for inflammatory disease,
1:15:55it's a marker for metabolic health.
1:15:57All these things get tied together.
1:16:00And the good news is
1:16:01you talked about Doctor "Lustig's" research,
1:16:03if it's caught early enough, it's reversible.
1:16:06That's right.
1:16:07In all of us.
1:16:08Hopefully,
1:16:10we could do that.
1:16:11And I mentioned it doesn't
1:16:13spike glucose...
1:16:14and it doesn't directly spike insulin.
1:16:17So you think, well, what's bad about it?
1:16:20Well, it drives insulin resistance in the liver.
1:16:24So even though
1:16:26the acute changes are not spiked,
1:16:29fructose in itself will drive insulin resistance.
1:16:33Fructose
1:16:34also... converts to
1:16:36uric acid, which is a driver for gout.
1:16:40And it also drives -
1:16:42the endothelial...
1:16:43glycocalyx, which is the lining of our blood vessels,
1:16:48which drives hypertension and cardiovascular disease.
1:16:52It affects nitric oxide production, which controls those.
1:16:56So, the sugar we eat ---
1:16:58can actually drive
1:17:00hypertension
1:17:01and cardiovascular disease...
1:17:03through these mechanisms.
1:17:06One of the things that typically happens when somebody adopts a lower carb diet,
1:17:10ketogenic diet,
1:17:12is they're going to have less
1:17:14plants in the diet, less fiber.
1:17:17And that would be one of the common arguments against going low carb,
1:17:21because we need to eat a lot of plants and get our fiber in,
1:17:24get our diversity of different plants.
1:17:27How do you look at fiber?
1:17:29Is that something you're concerned about with the way you eat?
1:17:33And how do you feel about in general?
1:17:35Yeah, I think
1:17:36fiber
1:17:37is good,
1:17:38especially non soluble fiber that slows the absorption of
1:17:43the bad things
1:17:44in our gut.
1:17:45I don't think it's good enough that I should eat carbohydrates
1:17:50in order to get it so
1:17:52I can eat low carb
1:17:54things that have fiber, like celery and
1:17:58relatively
1:17:59unsweet vegetables, I think are a good source source of that.
1:18:04-- Personally, I think that
1:18:07the carbohydrates are
1:18:09a bigger danger to me than
1:18:12low fiber. But I do get fiber in my diet for sure.
1:18:16If you weren't though, would you be concerned?
1:18:18Because there's a group of people these days in the health space
1:18:21saying fiber is overrated,
1:18:22we don't need fiber.
1:18:24Would you take it that far?
1:18:25Yeah,
1:18:26I don't exclude it just because I don't think the evidence is that
1:18:31strong that it's actually harming me.
1:18:34But
1:18:35I do agree that
1:18:36the value of fiber has been exaggerated. ---
1:18:40Many people were taught that...
1:18:42a low fiber diet causes diverticulitis and
1:18:45certain bowel diseases like that,
1:18:47when it's probably related to other things like inflammation,
1:18:52metabolic factors that we've been talking about,
1:18:56rather than the fiber in the diet.
1:18:58And how do you feel about supplements?
1:19:01You've stated the perimeters of your diet.
1:19:03Following those, do you feel like they're essential?
1:19:07Is there any you're taking?
1:19:08Yeah, I think supplements are.
1:19:12Well, first of all,
1:19:13we want to correct any deficiencies that we have.
1:19:17So
1:19:19you can eat -- the best diet that you want,
1:19:22but if you have a
1:19:24genetic issue with
1:19:26- methionine metabolism
1:19:28or folate metabolism
1:19:30or vitamin D,
1:19:31you may need to take vitamin D supplements or you may need
1:19:35to take other supplements.
1:19:37I think supplements are good to correct
1:19:41basic levels
1:19:42and then going beyond that,
1:19:45correct deficiencies, basically.
1:19:47So going beyond it,
1:19:49it really depends on the supplement and what you believe
1:19:53in it.
1:19:55There's been a whole explosion about resveratrol and
1:19:59debunking that,
1:20:00which was a sirtuin activator that's very controversial.
1:20:04This found in grapes that was popular
1:20:0720 years ago.
1:20:09We've touched on the longevity supplements
1:20:12like metformin or...
1:20:14the non prescription berberine has some of the similar effects.
1:20:18- Talked about rapamycin and some of these other things.
1:20:22So I think...
1:20:23I would do those on a case by case basis, depending on your individual...
1:20:29viewpoint, what you've seen to be valuable.
1:20:32And -- the short answer is nobody really knows.
1:20:36And if anybody tells you they do -- I wouldn't trust them.
1:20:41How do you feel about organ meats,
1:20:43either through supplements or whole food form to
1:20:47add additional nutrients to the diet?
1:20:49Yeah,
1:20:50when I was growing up, my mom used to feed us liver,
1:20:54and that was probably a good thing.
1:20:56One of the good things she did. --
1:20:59But
1:21:00I get it in
1:21:01theory -- I haven't gotten to the point where I'm taking the organ meat capsules,
1:21:07and I don't order organ meats a lot
1:21:11when I do it. But
1:21:13in theory, I agree with it.
1:21:15I haven't done a deep dive in it...
1:21:18I might draw the line
1:21:20at brains, certainly because of prions
1:21:23and --- that kind of thing.
1:21:25<break time=“1.90s"/>
1:21:27In principle, I could see the value
1:21:30of those... in
1:21:31getting nutrients because, hey, eating red meat,
1:21:34it's not as simple as that, or eating meat, it's about,
1:21:38well,
1:21:39what did the meat eat?
1:21:41And if they were fed corn, which most meat is fed these days
1:21:45it's the same corn that's subsidized as cheap,
1:21:48and it's
1:21:50unhealthy. So you want -- grass fed, grass finished,
1:21:53all those things.
1:21:56It gets
1:21:57really complex really fast. And if you just eat the muscles,
1:22:00then like you say, you're missing the organs and
1:22:04different things there. -
1:22:06- A lot of nuance and complexity.
1:22:10And when you're buying meat,
1:22:11how much of a concern is it for you to get grass fed,
1:22:14grass finished, organic?
1:22:16Is quality a big concern?
1:22:18Yeah,
1:22:19given the choice, I will. Yeah.
1:22:22I think organic - is
1:22:24valuable in meats and many of the produce,
1:22:28it's valuable as well. And
1:22:31I'll pay attention to those things for sure.
1:22:34So we've went deep into
1:22:36diet.
1:22:37What you eat, when you eat.
1:22:38What are some of the other big levers
1:22:41we want to look at when it comes to metabolic health?
1:22:44Wow. Well,
1:22:46one
1:22:47that completely caught me by surprise.
1:22:50I was unexpected.
1:22:51I knew it played a role, but...
1:22:54I sort of underestimated the role.
1:22:57And that was
1:22:59mindset... and sort of mental approach
1:23:02to things. -
1:23:04And it's
1:23:05almost like
1:23:07the future
1:23:08we
1:23:09imagine, how we look at the world, how we
1:23:12envision the future, how we envision our future,
1:23:16affects the future we will have.
1:23:19In other words, it's not
1:23:20just about
1:23:22not being depressed, not having anxiety, which is certainly a big factor.
1:23:28We want to be healthy,
1:23:29but I think it goes above just the baseline.
1:23:33Being mentally healthy.
1:23:34We want to go beyond that and have a mindset
1:23:38of abundance
1:23:39and a mindset of
1:23:40having a purpose in our lives.
1:23:42It's no surprise that... many people
1:23:45retire,
1:23:46or many people die at age 66 in this country.
1:23:49And why is that?
1:23:50Well, that's because they retire at age 65,
1:23:54lose their purpose.
1:23:55What is it? Firefighters,
1:23:57most of them die within five years after retiring.
1:24:01-- There's
1:24:02some
1:24:03interesting statistics there about
1:24:04purpose. So I think
1:24:07the future we imagine for ourselves
1:24:10can be the future we create.
1:24:12In other words. -
1:24:13If
1:24:15I... look at...
1:24:17older age as
1:24:18a time of infirmity, a time of decline, a time of -
1:24:26- impairment,
1:24:28it's nothing I look forward to.
1:24:31And
1:24:32there's a good chance it will likely become that for me.
1:24:36If I look at
1:24:37my life as a age of abundance, a possibility
1:24:40of
1:24:41goals I want to accomplish down the road, there's a good chance that will happen.
1:24:46I used to make,
1:24:49not a joke, but a comment about
1:24:51talking about the phenotypes of aging, all the stuff like wrinkles and
1:24:56gray hair that we talked about before.
1:24:59And I used to say, well,
1:25:02- we could take botox for wrinkles.
1:25:05I'm in Southern California, that's...
1:25:07very popular here.
1:25:09I'm obviously not taking it. -
1:25:12But
1:25:13I sort of made the comment. Well,
1:25:15the sad part is that people who
1:25:17could take botox for wrinkles, but
1:25:20people will eventually find out that taking botox for wrinkles
1:25:24doesn't make you live longer.
1:25:26It doesn't affect your longevity at a core level.
1:25:29And then
1:25:31I began to have conversations with people, and they said,
1:25:35are you sure of that?
1:25:36In other words. And
1:25:38what they were pointing out is that people who
1:25:42embrace youthful vitality, they look at their life as
1:25:46something happening long term,
1:25:48and they make the effort to
1:25:51get the botox, or
1:25:53they look at life as
1:25:55powerful, rather than someone
1:25:57looking at it like, I'm dying.
1:25:59I'm going to die.
1:26:01And guess what?
1:26:02One of these days, I'll be right.
1:26:04That's true, they will.
1:26:06People who look at it as a chance of empowerment
1:26:09actually may live longer. So people,
1:26:13getting the botox, and it's about the mindset.
1:26:16I have a friend,
1:26:18talking to him, and I said, yeah, what are you doing this summer?
1:26:22He goes,
1:26:23I'm going to "Burning Man." It's probably the last one I'm going to go to,
1:26:28though
1:26:29because he's in his seventies.
1:26:30And I think, well, why?
1:26:32What's going on? --
1:26:34You planning on dying or something? And
1:26:37that was sort of the unspoken thing, well, I'm going to be, I'm old,
1:26:42but
1:26:43with that attitude. You are old.
1:26:45You will be old.
1:26:46But if -- it's like, no, I'm, I'm going to go,
1:26:50I'm winning. I'm going to go on my hundredth
1:26:53to the burn and
1:26:54do this or whatever
1:26:56festival or
1:26:57event. You look forward to
1:27:00that. That mindset plays a role.
1:27:02And
1:27:03then I began to ask myself,
1:27:04oh, well, sure, that makes sense.
1:27:07How could it possibly tie in mechanistically?
1:27:12We're all evidence based.
1:27:14We want scientific papers.
1:27:16How can we make a mechanism...
1:27:18that ties in mindset, -- to
1:27:21aging better? Well, one thing is stress.
1:27:24If we look
1:27:25towards our future life as a life of joy, abundance, accomplishment and purpose,
1:27:30I'm going to do great things.
1:27:32It may be great things with my kids or my grandkids or maybe
1:27:37great things for my charity or my job or whatever I'm doing,
1:27:41but
1:27:42looking towards the future as a place of abundance.
1:27:45- It
1:27:46changes the way
1:27:47we experience stress. And stress
1:27:49is affecting
1:27:50our inflammation.
1:27:51It directly drives inflammation, drives insulin resistance,
1:27:55all these things.
1:27:57So how do we affect stress
1:27:59by our mindset?
1:28:01Stress is really interesting.
1:28:03This is another wake up call
1:28:05for me that I hadn't thought of before,
1:28:08stress is one of the biggest drivers
1:28:11in aging
1:28:12and all these things through inflammation and these other factors.
1:28:17But
1:28:18stress.
1:28:21You ask people what causes stress is, well, what happens to me in the world?
1:28:25It's the environment.
1:28:27I don't get to
1:28:28pick the political candidates or pick there's an earthquake.
1:28:31-- Stuff happens.
1:28:35And
1:28:36it's stressful.
1:28:38Well, that's true, sort of, but it's not completely true,
1:28:41actually.
1:28:42Stuff happens in the world and we don't get to control what happens in the world.
1:28:48But
1:28:49stress is not what happens in the world.
1:28:52Stress is how we
1:28:53respond to what happens in the world.
1:28:56How we, you, me, everyone else,
1:28:58individually responds to what happens in the world.
1:29:01And so
1:29:02a similar thing can have a different response.
1:29:05Where it starts raining,
1:29:06I could get really stressed out because my nice new clothes
1:29:10are ruined and da da da,
1:29:12it's a stressful experience.
1:29:13On the other hand,
1:29:14it's raining, it's warm, it's beautiful. It's glorious.
1:29:18I love it. I love the feel of rain.
1:29:20It's a beautiful moment. Or
1:29:22an extreme example.
1:29:23I have surgery.
1:29:24It's extremely painful.
1:29:26I'm extremely stressed out.
1:29:28The same amount of pain.
1:29:30A similar surgery could be a joyous experience to someone
1:29:33else who's having a baby.
1:29:35<break time=“4.44s"/>
1:29:39Stress, we get to filter through our expectations,
1:29:43through our view of the world, through the reality
1:29:46that we create,
1:29:48and we get to create it through our mindset.
1:29:51And
1:29:52I think this is really underestimated and
1:29:55its really
1:29:56overlooked opportunity
1:29:58in healthcare and longevity for all of us.
1:30:01You mentioned inflammation there, tying the stress to health as a whole.
1:30:06Any other ties, physiology wise?
1:30:08Yeah, I mean.
1:30:09<break time=“2.65s"/> The stress,
1:30:13inflammation is
1:30:14<break time=“2.59s"/>
1:30:17the ground truth on that, but also driving
1:30:20<break time=“2.41s"/>
1:30:22metabolic conditions like
1:30:24insulin resistance.
1:30:26Inflammation, insulin resistance, metabolic disease are all
1:30:30interrelated. So
1:30:32I think it drives
1:30:33all of those as well.
1:30:35And just
1:30:36the stress really frames our reality.
1:30:39In other words,
1:30:40if I look at the future and it's very stressful,
1:30:44that's a very dark future, and
1:30:46I'm not
1:30:47happy about it, and
1:30:49maybe I don't want to live that long.
1:30:52On the other hand, if the future
1:30:55is joyous with opportunities, not that everything is happy.
1:30:59- But
1:31:00if I look at it with
1:31:02an
1:31:03attitude, a mindset of growth,
1:31:06a mindset of abundance, it changes the way the reality appears,
1:31:11I think.
1:31:12And pivoting off of stress
1:31:14into exercise, these two are tied together,
1:31:17exercise being
1:31:18a modality we can use to drive down our stress.
1:31:22And also exercise is tied to metabolic health through
1:31:26even walking after meals, putting on muscle mass.
1:31:30So I'll have you bring exercise in and talk about how you use that personally
1:31:35and how people can use that as a tool for metabolic health.
1:31:39Yeah, exercise...
1:31:41is huge, and I want to divide it into two parts.
1:31:46First is - the
1:31:48obvious one, physical exercise.
1:31:50And then if we can
1:31:51come to mental exercise.
1:31:53But physical exercise
1:31:54is really important for all sorts of reasons.
1:31:57Exercise in itself is stressful.
1:31:59<break time=“2.14s"/>
1:32:01But it's a good kind of stress.
1:32:05We react to it positively and all.
1:32:08One thing I wasn't aware of that was sort of a wake up call,
1:32:12but maybe it shouldn't have been. Is that...
1:32:15exercise, like almost everything else we do, there's
1:32:18a good amount and a bad amount.
1:32:21In other words, low amounts of exercise, which
1:32:24most of us fall into
1:32:25is bad.
1:32:26But there's actually -- some growing evidence that large amounts of exercise
1:32:31beyond a certain point could be harmful. So...
1:32:33it's kind of a U shaped curve.
1:32:35And the data came in with ultra marathoners,
1:32:38ultra athletes,
1:32:39where they actually have increased calcium scores,
1:32:42and they have increased coronary artery calcium
1:32:45out of proportion to their age group or anything that they felt is tied to
1:32:50the stress of this exercise.
1:32:52But then you may say, well, maybe
1:32:54it's spurious, it's related to calcification,
1:32:57but it's not really heart disease.
1:32:59It's just calcification.
1:33:01The vessel may be due to flow or something,
1:33:04but then a darker...
1:33:05part became revealed,
1:33:07and they actually have myocardial fibrosis and
1:33:10abnormals of heart, abnormalities of heart wall function,
1:33:14which is really concerning. So
1:33:16I guess the point is that
1:33:19there's a sweet spot for exercise.
1:33:21Most of us are not doing enough,
1:33:24but on the far extreme, we need to be at least aware that
1:33:28we don't want to do too much,
1:33:30certainly to injure our bodies with our joints and everything else,
1:33:34but also, there's a basic cardiometabolic
1:33:37factor going on there. So I think
1:33:40that's important. -
1:33:41- Resistance training
1:33:43for osteoporosis,
1:33:45muscle mass for glucose metabolism, just
1:33:48handling insulin, handling all these things.
1:33:52There's so many
1:33:53advantages of exercise and...
1:33:55the physical exercise. I think
1:33:58that's huge.
1:33:59The mental exercise is sometimes overlooked
1:34:02with people, but I think it's equally important.
1:34:06What blew me away was that my training is in radiology.
1:34:10So
1:34:12looking at x-rays and stuff like that,
1:34:14I was blown away by the fact that
1:34:18things like both physical exercise, but also mental exercise, could show,
1:34:23within a short amount of time, in a matter of months,
1:34:27actually changes in the brain, actual brain growth,
1:34:31presumably related to its effects on "BDNF," brain derived neurotrophic factor,
1:34:37which
1:34:38certain parts of the brain, like you'd expect the hippocampus,
1:34:42can actually increase in size...
1:34:44with these various activities...
1:34:46It's really amazing
1:34:49for
1:34:50mental activity.
1:34:51It's not
1:34:52like watching TV or watching a movie.
1:34:55Something passive. But
1:34:56ideally, it's something active that's engaging -
1:35:00your brain.
1:35:01Ideally, you could do something that engages
1:35:05both physical and mental activity, like playing a musical instrument or
1:35:10something where you're
1:35:12doing both is good. If you're
1:35:14not doing that...
1:35:16I just started doing -
1:35:18- a language.
1:35:19"Duolingo." I can do it on my phone.
1:35:22It's a free app, doesn't cost anything.
1:35:26I do it
1:35:27five minutes a day.
1:35:28I'm now at 1400 days, a continuous streak. --
1:35:33Slowly but surely, five minutes a day.
1:35:35I'm learning Mandarin Chinese.
1:35:37<break time=“3.13s"/>
1:35:40What I'm doing
1:35:41the next level up after if you're learning a language
1:35:45and you want to up your game,
1:35:47there's so many resources
1:35:49on the internet today.
1:35:50So what I did is I took "Siri" or my
1:35:53app on my phone,
1:35:54whatever your "Alexa," "Siri," whatever you use.
1:35:57But I just had it change into Mandarin only.
1:36:00So now if I say, hey "Siri," set a timer for 15 minutes.
1:36:06It
1:36:07will basically, it responds in Chinese, it says, I don't know what you just said.
1:36:12So now
1:36:14it forces me,
1:36:14every time I interact with "Siri," I have to do something -- to,
1:36:19one, get my pronunciation right
1:36:22so that it works.
1:36:23So I now I say, hey "Siri,"
1:36:25___ And
1:36:28now, sure enough,
1:36:3020 minutes. So
1:36:36there are all sorts of things you can do like that.
1:36:40If you're not into foreign language,
1:36:43obviously, crossword puzzles, -Sudoku, those kinds of things like that.
1:36:48But
1:36:50mental stimulation,
1:36:51even just
1:36:52going for a walk and talking to your neighbor
1:36:55engaging in community, engaging in
1:36:58the
1:36:59Blue Zones were very popular for longevity a few years ago,
1:37:03and -- with
1:37:04certain parts of the country,
1:37:06certain parts of the world where people had very long life expectancies.
1:37:11And "Dan Buettner" popularized it with a
1:37:14TV series. --
1:37:16There
1:37:17were a lot of
1:37:18wonderful things about a community,
1:37:21certain types of food, getting together,
1:37:24working in the fields.
1:37:26<break time=“3.30s"/> But the
1:37:29sense of community,
1:37:31a lot of the other stuff has been criticized recently,
1:37:34like the record keeping, probably
1:37:38confused the ages, and that was probably a thing.
1:37:41And then, sadly, the
1:37:42whole Blue Zone brand has recently been sold to
1:37:46a group with strong religious...
1:37:48affiliation, which has a strong nutritional agenda,
1:37:52which... may
1:37:53influence the messaging with that.
1:37:55But I think there's a lot of good things to be said
1:37:58about community
1:38:00and family
1:38:01and social interactions with the Blue Zone theory,
1:38:04but that applies
1:38:05to the brain exercise anyway.
1:38:07All right,
1:38:08tying in another piece that fits with the brain and with stress,
1:38:12sleep.
1:38:13Let's talk about its impact on metabolic health when we're getting
1:38:16enough and then when we're not.
1:38:18Yeah.
1:38:18And I think this is a place where the medical profession is so
1:38:22messed up with this, because
1:38:25I, like many people in my profession, or many other professions, I used to
1:38:31carry a beeper around, a pager, and I would be on call 24 hours a day,
1:38:36seven days a week, and I'd get called all weird hours.
1:38:39My sleep would get disrupted. But
1:38:42somehow I thought I was being tough and
1:38:46I was helping my patients when actually I was probably hurting them.
1:38:51And
1:38:52one wake up call to me in this book, was, in researching this book, was that -
1:38:57- you hear some people, like "Elon Musk," saying, oh,
1:39:01I only need 4 hours of sleep a night. ----
1:39:04There's a growing evidence that
1:39:06for exercise,
1:39:07for so many of the things that
1:39:09<break time=“2.02s"/>
1:39:11the cost benefit curve for sleep, for quantity of sleep, is fairly narrow.
1:39:16In other words,
1:39:17it appears that
1:39:18risk of cardiovascular disease and other diseases,
1:39:21all these metabolic diseases that I've been talking about
1:39:25is a fairly narrow window, around 8 hours...
1:39:28And so maybe some people can get by at 7 hours,
1:39:30maybe some people need nine.
1:39:32But if you need much more than that,
1:39:34or if you think you can get by much less than that,
1:39:38you may be kidding yourself.
1:39:40And sleep, we know directly with sleep deprivation,
1:39:43you take college kids, and
1:39:45there have been controlled studies with this.
1:39:48They sleep deprived them,
1:39:50and immediately their insulin resistance goes up.
1:39:53Their metabolism is messed up,
1:39:55their glucose
1:39:56is screwed up, there's inflammation.
1:39:59So it directly affects these -- primal metabolic markers that
1:40:03we're taking.
1:40:04So the wake up call for me was
1:40:07sleep quantity, which really -- helped.
1:40:10And then the other thing was
1:40:12sleep quality. So
1:40:13you've got to get the right amount, but it's got to be good sleep.
1:40:17And there are a number of trackers on your phone or
1:40:20different things that you can do
1:40:23to look at that.
1:40:24An interesting thing happened to me once
1:40:27I began on this path and changed my lifestyle and everything,
1:40:31I noticed that
1:40:32I was sleeping a lot better.
1:40:34I don't know what it was.
1:40:35I don't know what it was.
1:40:37I wasn't paying attention to it, but I was sleeping a lot better,
1:40:41to the point that I didn't need an alarm clock anymore.
1:40:44So I just sort of woke up naturally. And...
1:40:47now I figure if I need an alarm clock to wake up,
1:40:50I'm probably not getting enough sleep.
1:40:52<break time=“2.48s"/>
1:40:55It's fascinating, but, yeah, sleep,
1:40:57I think, is another area that's
1:40:59overlooked in our
1:41:01toolkit for metabolic health.
1:41:03You mentioned trackers there for somebody who's tuned into this point...
1:41:07And
1:41:08they've taken in a lot of different information,
1:41:11different areas, where they're...
1:41:13wondering where they're at on this continuum of metabolic health.
1:41:18How does testing fit into this for somebody early on to see where they're at
1:41:23and then ongoing to... continue to
1:41:26keep track of their progress?
1:41:28Yeah,
1:41:29I think testing
1:41:30is key
1:41:31to know
1:41:32where we are on that course.
1:41:34And like we talked about -- the earlier the better.
1:41:38These changes start happening
1:41:41in people's thirties,
1:41:42although these chronic diseases usually don't hit till people are 40 or so,
1:41:48although they're getting earlier and earlier,
1:41:51we're seeing now cancer,
1:41:53colon cancer hitting in younger and younger populations,
1:41:57and... obesity.
1:41:58Type two diabetes used to be called adult onset diabetes.
1:42:02Now
1:42:03it's occurring in children.
1:42:05Similarly, hypertension and everything. -
1:42:09Tracking early
1:42:11is good. Some of the markers I would look at is
1:42:16hemoglobin "A1C," which is a marker for glucose damage.
1:42:20It's a metabolic marker for insulin resistance.
1:42:24You can
1:42:26absolutely measure fasting insulin.
1:42:29I use a panel
1:42:31that I do from
1:42:33a finger stick at home.
1:42:35I get about 20 markers.
1:42:37I do it
1:42:38once a month or two.
1:42:39And it gives me
1:42:40hemoglobin "A1C," insulin,
1:42:43"LDL." -- Cortisol, testosterone,
1:42:46"FSH," homocysteine.
1:42:47It's just a whole
1:42:49thing.
1:42:50And now these tests are getting so inexpensive and so easy,
1:42:53you can even do them from your home and
1:42:56begin to track where you are in this.
1:42:59And it's never too early
1:43:01to start thinking about metabolic health and to live a healthy lifestyle...
1:43:06because
1:43:07we don't know
1:43:08how early these things really start.
1:43:11And the sooner we engage in prevention, I think the better the outcome.
1:43:16And what's the name of that test you were just talking about,
1:43:18the finger prick?
1:43:19Yeah, I have it on my website.
1:43:22You can get it from a company called "SiPhox." S-I-P-H-O-X.
1:43:27But I have a discount on my website.
1:43:30I think
1:43:31it comes out to be about $15 a test or so. But
1:43:36it's significantly less than
1:43:38the "SiPhox" site.
1:43:39But that's who we use, and it's a great one.
1:43:42So either on my website or at "SiPhox," either one,
1:43:45you can
1:43:46try it out.
1:43:47All right,
1:43:48"Rob." We'll link that up in the show notes.
1:43:50We'll link up your new book, your
1:43:51website, your social media, everything.
1:43:53And really enjoyed this conversation.
1:43:55The new book is fantastic.
1:43:56I was telling you before we connected.
1:43:58And I just want to thank you for coming on and sharing all
1:44:01this about metabolic health.
1:44:02It's going to help a lot of people. Thank you.
1:44:05Yeah, this
1:44:06has been fun, "Jesse." I just got my first copy of it.
1:44:09It's full of pictures inside. -- "Haha."
1:44:12Nice. I had the"PDF," so.
1:44:14Hopefully people enjoy it.
1:44:15No that looks good...
1:44:16Congrats and thanks again.
1:44:18Thanks so much for having me on your program.
1:44:20It was a real honor.
1:44:22Now that you're done,
1:44:23you're going to want to head over here and catch this next incredible episode.
1:44:26You don't want to miss it.
1:44:27I'll see you over there.
1:44:29Everyone needs to care about this, because metabolism and metabolic health,
1:44:34it is the core foundational...
1:44:36layer that all health is built upon.
1:44:39That is the biggest blind spot in western

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