Understanding Alzheimer's: The Intersection of Genetics, Diabetes, and Brain Health - Full Transcript

00:00hey everyone welcome to the drive hey everyone welcome to the drive podcast I'm your host Peter attia Rhonda it is so great to see you Rhonda it is so great to see you especially on that awesome remote setup especially on that awesome remote setup especially on that awesome remote setup that I almost shouldn't have said to that I almost shouldn't have said to that I almost shouldn't have said to people was remote because it really people was remote because it really people was remote because it really feels like we are in person about as feels like we are in person about as feels like we are in person about as close to in person as we've been in a close to in person as we've been in a close to in person as we've been in a few years few years few years it's really great it's really great to it's really great it's really great to it's really great it's really great to see you Peter it's it's been a minute see you Peter it's it's been a minute see you Peter it's it's been a minute yeah well we'll meet together soon in a yeah well we'll meet together soon in a yeah well we'll meet together soon in a couple of months so I'm looking forward couple of months so I'm looking forward couple of months so I'm looking forward to that to that to that um there's a lot to catch up on over the um there's a lot to catch up on over the um there's a lot to catch up on over the past few years we've obviously exchanged past few years we've obviously exchanged past few years we've obviously exchanged a bunch of emails about things that we a bunch of emails about things that we a bunch of emails about things that we each find interesting each find interesting each find interesting um and I think in the last couple of um and I think in the last couple of um and I think in the last couple of years well let's just pause it in the years well let's just pause it in the years well let's just pause it in the last five years was the last time we did last five years was the last time we did last five years was the last time we did a podcast just going back to that point a podcast just going back to that point a podcast just going back to that point I think both of us have evolved a lot in I think both of us have evolved a lot in I think both of us have evolved a lot in our thinking uh and I think we've done our thinking uh and I think we've done our thinking uh and I think we've done so unapologetically that's the nature of so unapologetically that's the nature of so unapologetically that's the nature of science that's the nature of what we do science that's the nature of what we do science that's the nature of what we do and we're trying to learn so and we're trying to learn so and we're trying to learn so um in thinking about our discussion um in thinking about our discussion um in thinking about our discussion today

01:00today today I think we both agreed it would be most I think we both agreed it would be most I think we both agreed it would be most enjoyable to at least spend some time enjoyable to at least spend some time enjoyable to at least spend some time talking about areas where your thinking talking about areas where your thinking talking about areas where your thinking has evolved but I think first we wanted has evolved but I think first we wanted has evolved but I think first we wanted to start with to start with to start with I don't want to put words in your mouth I don't want to put words in your mouth I don't want to put words in your mouth but maybe that which you're thinking but maybe that which you're thinking but maybe that which you're thinking about the most right now would that be a about the most right now would that be a about the most right now would that be a safe assessment if we were to start to safe assessment if we were to start to safe assessment if we were to start to talk about dementia specifically talk about dementia specifically talk about dementia specifically Alzheimer's disease and maybe the change Alzheimer's disease and maybe the change Alzheimer's disease and maybe the change in how you think about that in how you think about that in how you think about that it would it would it would um so you know I for me personally um so you know I for me personally um so you know I for me personally I have neurodegenerative disease on my I have neurodegenerative disease on my I have neurodegenerative disease on my mind quite a lot because Alzheimer's mind quite a lot because Alzheimer's mind quite a lot because Alzheimer's disease and Parkinson's disease both run disease and Parkinson's disease both run disease and Parkinson's disease both run in my family so and I have a genetic in my family so and I have a genetic in my family so and I have a genetic predisposition so for me you know predisposition so for me you know predisposition so for me you know understanding everything I can do you understanding everything I can do you understanding everything I can do you know with my with my diet with my know with my with my diet with my know with my with my diet with my lifestyle just you know exposure to or lifestyle just you know exposure to or lifestyle just you know exposure to or limiting exposure to certain things Etc limiting exposure to certain things Etc limiting exposure to certain things Etc becomes Paramount right because I don't becomes Paramount right because I don't becomes Paramount right because I don't want to get Alzheimer's disease and

02:00want to get Alzheimer's disease and want to get Alzheimer's disease and Parkinson's disease Parkinson's disease Parkinson's disease so um like as you know Peter the the so um like as you know Peter the the so um like as you know Peter the the Alzheimer's disease field has been it's Alzheimer's disease field has been it's Alzheimer's disease field has been it's been quite a roller coaster in a way been quite a roller coaster in a way been quite a roller coaster in a way like I mean we've had this dominating like I mean we've had this dominating like I mean we've had this dominating sort of I think sort of I think sort of I think um hypothesis this amyloid hypothesis as um hypothesis this amyloid hypothesis as um hypothesis this amyloid hypothesis as it's called so there's you know one of it's called so there's you know one of it's called so there's you know one of the major pathologies of Alzheimer's the major pathologies of Alzheimer's the major pathologies of Alzheimer's disease are amyloid plaques in the brain disease are amyloid plaques in the brain disease are amyloid plaques in the brain and there are other pathologies Tau and there are other pathologies Tau and there are other pathologies Tau Tangles also glucose hypo metabolism so Tangles also glucose hypo metabolism so Tangles also glucose hypo metabolism so you know glucose uptake into the brain you know glucose uptake into the brain you know glucose uptake into the brain is impaired and also uh perhaps even the is impaired and also uh perhaps even the is impaired and also uh perhaps even the utilization of glucose as well so uh utilization of glucose as well so uh utilization of glucose as well so uh these are like three major pathologies these are like three major pathologies these are like three major pathologies of Alzheimer's disease and of Alzheimer's disease and of Alzheimer's disease and it seems as though the majority of it seems as though the majority of it seems as though the majority of targeting targeting targeting you know how how Science And scientists you know how how Science And scientists you know how how Science And scientists have decided to Target have decided to Target have decided to Target you know Alzheimer's disease is through you know Alzheimer's disease is through you know Alzheimer's disease is through this amyloid anti-amyloid you know this amyloid anti-amyloid you know this amyloid anti-amyloid you know hypothesis and as you know we've had

03:00hypothesis and as you know we've had hypothesis and as you know we've had quite a few failed trials although of quite a few failed trials although of quite a few failed trials although of recent a little bit more I would say you recent a little bit more I would say you recent a little bit more I would say you know possible success maybe but um know possible success maybe but um know possible success maybe but um generally speaking it's been it's like generally speaking it's been it's like generally speaking it's been it's like we need to go okay like are we just are we need to go okay like are we just are we need to go okay like are we just are we just trying to treat a symptom here we just trying to treat a symptom here we just trying to treat a symptom here or are we too far Downstream like what or are we too far Downstream like what or are we too far Downstream like what what's the deal and I started reading what's the deal and I started reading what's the deal and I started reading some Studies by some Studies by some Studies by at USC and axel Dr Axel montane who was at USC and axel Dr Axel montane who was at USC and axel Dr Axel montane who was trained with um Dr slovovic and now has trained with um Dr slovovic and now has trained with um Dr slovovic and now has his own Lab at the University of his own Lab at the University of his own Lab at the University of Edinburgh in Scotland and I recently did Edinburgh in Scotland and I recently did Edinburgh in Scotland and I recently did a podcast with him on my on my podcast a podcast with him on my on my podcast a podcast with him on my on my podcast and uh Axel and it was really like when and uh Axel and it was really like when and uh Axel and it was really like when I started to read some of this I started to read some of this I started to read some of this literature and I'm going to talk about literature and I'm going to talk about literature and I'm going to talk about like what you know this sort of new I like what you know this sort of new I like what you know this sort of new I don't know it's not even necessarily new don't know it's not even necessarily new don't know it's not even necessarily new but like but like but like you know it's not a new way of you know it's not a new way of you know it's not a new way of understanding it but it is in a way understanding it but it is in a way understanding it but it is in a way because in in the public opinion the because in in the public opinion the because in in the public opinion the public mind it's a new way public mind it's a new way public mind it's a new way um and this is sort of like okay well

04:00um and this is sort of like okay well um and this is sort of like okay well what are the underlying causes of you what are the underlying causes of you what are the underlying causes of you know of dementia and so there's you know know of dementia and so there's you know know of dementia and so there's you know three major types of dementia three major types of dementia three major types of dementia Alzheimer's disease being like the most Alzheimer's disease being like the most Alzheimer's disease being like the most common there's uh um small vessel common there's uh um small vessel common there's uh um small vessel disease cerebral small vessel disease disease cerebral small vessel disease disease cerebral small vessel disease and then vascular dementia those are the and then vascular dementia those are the and then vascular dementia those are the three most common three most common three most common forms of dementia but like is there a forms of dementia but like is there a forms of dementia but like is there a common underlying denominator between common underlying denominator between common underlying denominator between those and on top of that like what what those and on top of that like what what those and on top of that like what what sort of Lifestyle factors and genetic sort of Lifestyle factors and genetic sort of Lifestyle factors and genetic factors do we know really increase the factors do we know really increase the factors do we know really increase the risk of Alzheimer's disease and dementia risk of Alzheimer's disease and dementia risk of Alzheimer's disease and dementia well we know having an apoe4 allele so well we know having an apoe4 allele so well we know having an apoe4 allele so this is a version of a gene that is this is a version of a gene that is this is a version of a gene that is known to increase the risk of known to increase the risk of known to increase the risk of Alzheimer's disease if you have one of Alzheimer's disease if you have one of Alzheimer's disease if you have one of them it increases the risk twofold if them it increases the risk twofold if them it increases the risk twofold if you have two if you got one from Mom and you have two if you got one from Mom and you have two if you got one from Mom and one from Dad it could be up to tenfold one from Dad it could be up to tenfold one from Dad it could be up to tenfold and this isn't like an early onset and this isn't like an early onset and this isn't like an early onset Alzheimer's disease it's it's more of Alzheimer's disease it's it's more of Alzheimer's disease it's it's more of what's called late onset which is the what's called late onset which is the what's called late onset which is the normal sort of age-related you know normal sort of age-related you know normal sort of age-related you know progression of Alzheimer's disease but progression of Alzheimer's disease but progression of Alzheimer's disease but that Gene really does play a role in in that Gene really does play a role in in that Gene really does play a role in in in you know in someone's risk

05:00in you know in someone's risk in you know in someone's risk the other thing we know is type 2 the other thing we know is type 2 the other thing we know is type 2 diabetes right I mean so I mean that diabetes right I mean so I mean that diabetes right I mean so I mean that over I don't know somewhere between 50 over I don't know somewhere between 50 over I don't know somewhere between 50 to 80 percent of people with Alzheimer's to 80 percent of people with Alzheimer's to 80 percent of people with Alzheimer's disease also have type 2 diabetes like disease also have type 2 diabetes like disease also have type 2 diabetes like that's a lot there's definitely that's a lot there's definitely that's a lot there's definitely something going on right I mean yeah something going on right I mean yeah something going on right I mean yeah this is where you hear and let's sort of this is where you hear and let's sort of this is where you hear and let's sort of pause there for a moment because I want pause there for a moment because I want pause there for a moment because I want to go back to sort of the premise of to go back to sort of the premise of to go back to sort of the premise of your interest which is your interest which is your interest which is you are at increased risk so just even you are at increased risk so just even you are at increased risk so just even if you just think about this personally if you just think about this personally if you just think about this personally and therefore presumably you're and therefore presumably you're and therefore presumably you're interested in quote unquote prevention interested in quote unquote prevention interested in quote unquote prevention and as you've probably heard on my and as you've probably heard on my and as you've probably heard on my podcast you know prevention is still a podcast you know prevention is still a podcast you know prevention is still a word that doesn't quite resonate within word that doesn't quite resonate within word that doesn't quite resonate within the field the field the field which is in other words which is in other words which is in other words up until very recently I think the NIH up until very recently I think the NIH up until very recently I think the NIH didn't even acknowledge the idea of didn't even acknowledge the idea of didn't even acknowledge the idea of prevention as a strategy within this prevention as a strategy within this prevention as a strategy within this field and in fact preventative neurology field and in fact preventative neurology field and in fact preventative neurology or preventive neurology I suppose or preventive neurology I suppose or preventive neurology I suppose um is is really something that is still um is is really something that is still um is is really something that is still kind of on the outskirts most people are

06:00kind of on the outskirts most people are kind of on the outskirts most people are thinking about what to do when you have thinking about what to do when you have thinking about what to do when you have Alzheimer's disease not as many people Alzheimer's disease not as many people Alzheimer's disease not as many people are thinking about the question that are thinking about the question that are thinking about the question that you're asking and that a few other you're asking and that a few other you're asking and that a few other people are asking which is people are asking which is people are asking which is what's in our control because yes you what's in our control because yes you what's in our control because yes you alluded to APO E4 which I'm sure we'll alluded to APO E4 which I'm sure we'll alluded to APO E4 which I'm sure we'll talk more about but what you just said talk more about but what you just said talk more about but what you just said about type 2 diabetes would suggest that about type 2 diabetes would suggest that about type 2 diabetes would suggest that if you believe you can prevent type 2 if you believe you can prevent type 2 if you believe you can prevent type 2 diabetes wouldn't that at least suggest diabetes wouldn't that at least suggest diabetes wouldn't that at least suggest you have the probability or possibility you have the probability or possibility you have the probability or possibility of preventing or delaying Alzheimer's of preventing or delaying Alzheimer's of preventing or delaying Alzheimer's disease sorry so I didn't mean to disease sorry so I didn't mean to disease sorry so I didn't mean to interrupt you but I want to highlight interrupt you but I want to highlight interrupt you but I want to highlight the important implication of that the important implication of that the important implication of that statement exactly exactly the it's so statement exactly exactly the it's so statement exactly exactly the it's so important I think that um looking at important I think that um looking at important I think that um looking at Alzheimer's disease and understanding Alzheimer's disease and understanding Alzheimer's disease and understanding sort of the underlying cause of it opens sort of the underlying cause of it opens sort of the underlying cause of it opens up you know these new avenues for up you know these new avenues for up you know these new avenues for prevention and also treatment you know prevention and also treatment you know prevention and also treatment you know um and of course there are people that um and of course there are people that um and of course there are people that do get Alzheimer's disease early in life do get Alzheimer's disease early in life do get Alzheimer's disease early in life I mean these are these are people that I mean these are these are people that I mean these are these are people that could come down with it in their 40s or could come down with it in their 40s or could come down with it in their 40s or 50s that's sort of an app you know

07:0050s that's sort of an app you know 50s that's sort of an app you know people are outliers in that in that case people are outliers in that in that case people are outliers in that in that case but it does happen and but it does happen and but it does happen and um so obviously there's not there there um so obviously there's not there there um so obviously there's not there there are there are things that um are there are things that um are there are things that um you know you might do everything right you know you might do everything right you know you might do everything right and still like have that terrible and still like have that terrible and still like have that terrible genetic combination right so um but with genetic combination right so um but with genetic combination right so um but with respect to the apoe4 respect to the apoe4 respect to the apoe4 um and type 2 diabetes understanding um and type 2 diabetes understanding um and type 2 diabetes understanding again is there something like common again is there something like common again is there something like common going on here that we can sort of going on here that we can sort of going on here that we can sort of understand as a foundation to what is understand as a foundation to what is understand as a foundation to what is the what are the initial like things the what are the initial like things the what are the initial like things going wrong going wrong going wrong to lead to Alzheimer's disease and um to lead to Alzheimer's disease and um to lead to Alzheimer's disease and um and that is where vascular dysfunction and that is where vascular dysfunction and that is where vascular dysfunction particularly the blood vessels and particularly the blood vessels and particularly the blood vessels and capillaries that are lining the capillaries that are lining the capillaries that are lining the blood-brain barrier blood-brain barrier blood-brain barrier seems to be a really really early seems to be a really really early seems to be a really really early event that is common between all types event that is common between all types event that is common between all types of dementia and between Type 2 diabetes of dementia and between Type 2 diabetes of dementia and between Type 2 diabetes and apoe4 so people with type 2 diabetes and apoe4 so people with type 2 diabetes and apoe4 so people with type 2 diabetes as you know can I interrupt for a second

08:00as you know can I interrupt for a second as you know can I interrupt for a second Rhonda tell folks what the blood-brain Rhonda tell folks what the blood-brain Rhonda tell folks what the blood-brain barrier is I think it's it's obviously barrier is I think it's it's obviously barrier is I think it's it's obviously going to be an important part of this going to be an important part of this going to be an important part of this discussion and I and not everybody might discussion and I and not everybody might discussion and I and not everybody might understand what it is or why it's so understand what it is or why it's so understand what it is or why it's so important important important so the blood-brain barrier and um you so the blood-brain barrier and um you so the blood-brain barrier and um you know this is again know this is again know this is again you know I am not a neuroscientist I'm you know I am not a neuroscientist I'm you know I am not a neuroscientist I'm just you know I am a Scientist but I just you know I am a Scientist but I just you know I am a Scientist but I have I have an interest in this and so have I have an interest in this and so have I have an interest in this and so I've done a lot of reading in this in I've done a lot of reading in this in I've done a lot of reading in this in this field this field this field um the blood-brain barrier serves a um the blood-brain barrier serves a um the blood-brain barrier serves a couple of functions I mean one is it is couple of functions I mean one is it is couple of functions I mean one is it is providing it's it's there's a providing it's it's there's a providing it's it's there's a combination of different cell types that combination of different cell types that combination of different cell types that make up the blood-brain barrier and a make up the blood-brain barrier and a make up the blood-brain barrier and a lot of vasculature right and so um blood lot of vasculature right and so um blood lot of vasculature right and so um blood flow you know things things are brought flow you know things things are brought flow you know things things are brought to the blood-brain barrier and oxygen to the blood-brain barrier and oxygen to the blood-brain barrier and oxygen glucose other nutrients and they are you glucose other nutrients and they are you glucose other nutrients and they are you know transported across the blood-brain know transported across the blood-brain know transported across the blood-brain barrier but it also as the word implies barrier but it also as the word implies barrier but it also as the word implies barrier provides a barrier to things barrier provides a barrier to things barrier provides a barrier to things that you don't want to get into your that you don't want to get into your that you don't want to get into your brain so you know we don't want red brain so you know we don't want red brain so you know we don't want red blood cells getting into our brain you

09:00blood cells getting into our brain you blood cells getting into our brain you know we don't we don't want a variety of know we don't we don't want a variety of know we don't we don't want a variety of other molecules proteins that are other molecules proteins that are other molecules proteins that are floating around in our circulation to floating around in our circulation to floating around in our circulation to get into our brain and so when the get into our brain and so when the get into our brain and so when the blood-brain barrier begins to break down blood-brain barrier begins to break down blood-brain barrier begins to break down and it's kind of an people like think and it's kind of an people like think and it's kind of an people like think are a lot more familiar with when the are a lot more familiar with when the are a lot more familiar with when the barrier the gut barrier starts to break barrier the gut barrier starts to break barrier the gut barrier starts to break down I think it's a it's a sort of down I think it's a it's a sort of down I think it's a it's a sort of become more of a common theme that become more of a common theme that become more of a common theme that people are focused on gut health and so people are focused on gut health and so people are focused on gut health and so you'll hear the word um mostly you hear you'll hear the word um mostly you hear you'll hear the word um mostly you hear the word leaky gut I don't really like the word leaky gut I don't really like the word leaky gut I don't really like that term I think it's intestinal that term I think it's intestinal that term I think it's intestinal permeability but you know the tight permeability but you know the tight permeability but you know the tight junctions these proteins that are junctions these proteins that are junctions these proteins that are holding endothelial cells together in holding endothelial cells together in holding endothelial cells together in the gut when those open up you you get the gut when those open up you you get the gut when those open up you you get that term you know leaky gut or as it that term you know leaky gut or as it that term you know leaky gut or as it really should be called intestinal really should be called intestinal really should be called intestinal permeability well in the brain you also permeability well in the brain you also permeability well in the brain you also have endothelial cells and you have have endothelial cells and you have have endothelial cells and you have tight junctions and when those tight tight junctions and when those tight tight junctions and when those tight junctions also break apart and we can junctions also break apart and we can junctions also break apart and we can talk about like what's you know at the talk about like what's you know at the talk about like what's you know at the root of that that leads to permeability root of that that leads to permeability root of that that leads to permeability of the blood-brain barrier and therefore

10:00of the blood-brain barrier and therefore of the blood-brain barrier and therefore two things happen you know one you are two things happen you know one you are two things happen you know one you are allowing then things from circulation to allowing then things from circulation to allowing then things from circulation to get in the brain cause which you know get in the brain cause which you know get in the brain cause which you know wreaks havoc on the brain and sort of wreaks havoc on the brain and sort of wreaks havoc on the brain and sort of leads to this vicious cycle of leads to this vicious cycle of leads to this vicious cycle of neuroinflammation inflammation in the neuroinflammation inflammation in the neuroinflammation inflammation in the brain but also you're disrupting the brain but also you're disrupting the brain but also you're disrupting the transport of important nutrients oxygen transport of important nutrients oxygen transport of important nutrients oxygen you know glucose I mean blood flow is you know glucose I mean blood flow is you know glucose I mean blood flow is disrupted to the brain as well disrupted to the brain as well disrupted to the brain as well so um the blood-brain barrier and and so um the blood-brain barrier and and so um the blood-brain barrier and and maintaining that Integrity is very maintaining that Integrity is very maintaining that Integrity is very important and both apoe4 and type 2 important and both apoe4 and type 2 important and both apoe4 and type 2 diabetes lead to permeability of that diabetes lead to permeability of that diabetes lead to permeability of that and so with um type 2 diabetes you know and so with um type 2 diabetes you know and so with um type 2 diabetes you know people people have hypoglycemia right people people have hypoglycemia right people people have hypoglycemia right they have elevated blood glucose levels they have elevated blood glucose levels they have elevated blood glucose levels and that over time leads to Advanced and that over time leads to Advanced and that over time leads to Advanced glycation end products these are glycation end products these are glycation end products these are basically like the cross they basically like the cross they basically like the cross they cross-linked proteins and you know a cross-linked proteins and you know a cross-linked proteins and you know a variety of other things that you know in variety of other things that you know in variety of other things that you know in in the vasculature and that basically in the vasculature and that basically in the vasculature and that basically damages the blood-brain barrier and

11:00damages the blood-brain barrier and damages the blood-brain barrier and leads to permeability leads to permeability leads to permeability um apoe4 it's a you know there's a um apoe4 it's a you know there's a um apoe4 it's a you know there's a variety of other mechanisms that happen variety of other mechanisms that happen variety of other mechanisms that happen but essentially you can measure the but essentially you can measure the but essentially you can measure the permeability of the blood-brain barrier permeability of the blood-brain barrier permeability of the blood-brain barrier looking at a variety of biomarkers and looking at a variety of biomarkers and looking at a variety of biomarkers and proteins in cerebral spinal fluid but proteins in cerebral spinal fluid but proteins in cerebral spinal fluid but also in plasma and these have been shown also in plasma and these have been shown also in plasma and these have been shown by Dr slovovic Dr montane to occur I by Dr slovovic Dr montane to occur I by Dr slovovic Dr montane to occur I mean it's like decades before the onset mean it's like decades before the onset mean it's like decades before the onset of you know cognitive impairment and of you know cognitive impairment and of you know cognitive impairment and it's literally you can find it in more it's literally you can find it in more it's literally you can find it in more than 50 of all dementias so it's re and than 50 of all dementias so it's re and than 50 of all dementias so it's re and it's happening independent of of amyloid it's happening independent of of amyloid it's happening independent of of amyloid accumulation Tau Tangles as well so uh accumulation Tau Tangles as well so uh accumulation Tau Tangles as well so uh it's you know either something that's it's you know either something that's it's you know either something that's happening before well before and in fact happening before well before and in fact happening before well before and in fact blood-brain barrier permeability blood-brain barrier permeability blood-brain barrier permeability is also um the blood-brain barrier is is also um the blood-brain barrier is is also um the blood-brain barrier is essential for removing toxic compounds essential for removing toxic compounds essential for removing toxic compounds from the brain and a variety of from the brain and a variety of from the brain and a variety of different processes you know happen to different processes you know happen to different processes you know happen to allow this to occur so for example you

12:00allow this to occur so for example you allow this to occur so for example you you activate the lymphatic system during you activate the lymphatic system during you activate the lymphatic system during sleep right and a lot of people are sleep right and a lot of people are sleep right and a lot of people are aware of this your brain sort of swells aware of this your brain sort of swells aware of this your brain sort of swells during sleep and the lymphatic system is during sleep and the lymphatic system is during sleep and the lymphatic system is pushing the cerebral spinal fluid pushing the cerebral spinal fluid pushing the cerebral spinal fluid through the brain clearing out debris through the brain clearing out debris through the brain clearing out debris amyloid plaques you know things like amyloid plaques you know things like amyloid plaques you know things like that well that doesn't you need the that well that doesn't you need the that well that doesn't you need the blood-brain barrier to be intact to blood-brain barrier to be intact to blood-brain barrier to be intact to occur yeah so I mean that makes sense occur yeah so I mean that makes sense occur yeah so I mean that makes sense that basically if you have blood brain that basically if you have blood brain that basically if you have blood brain barrier permeability happening that you barrier permeability happening that you barrier permeability happening that you would start to have the accumulation of would start to have the accumulation of would start to have the accumulation of amyloid so it's sort of like amyloid so it's sort of like amyloid so it's sort of like um and accumulation I never thought of um and accumulation I never thought of um and accumulation I never thought of that by the way Rhonda that's that I that by the way Rhonda that's that I that by the way Rhonda that's that I never thought of what you just said never thought of what you just said never thought of what you just said which is if your blood-brain barrier which is if your blood-brain barrier which is if your blood-brain barrier can't hold the back pressure which is can't hold the back pressure which is can't hold the back pressure which is what would be the case if it were what would be the case if it were what would be the case if it were permeable you would not have the back permeable you would not have the back permeable you would not have the back pressure to maintain pressure to maintain pressure to maintain glymphatic flow that never actually glymphatic flow that never actually glymphatic flow that never actually occurred to me until you said that so occurred to me until you said that so occurred to me until you said that so very interesting mechanistic tie to that very interesting mechanistic tie to that very interesting mechanistic tie to that problem problem problem right and there's also like the other right and there's also like the other right and there's also like the other types of and I'm not familiar with all types of and I'm not familiar with all types of and I'm not familiar with all the types of ways the brain like there's

13:00the types of ways the brain like there's the types of ways the brain like there's other like parenchyma and stuff that are other like parenchyma and stuff that are other like parenchyma and stuff that are like you know cleaning out the brain all like you know cleaning out the brain all like you know cleaning out the brain all of those things are not happening as of those things are not happening as of those things are not happening as good when your blood-brain barrier you good when your blood-brain barrier you good when your blood-brain barrier you know is dysfunctional right and then know is dysfunctional right and then know is dysfunctional right and then another point is the ability of things another point is the ability of things another point is the ability of things to interrupt and get into the brain that to interrupt and get into the brain that to interrupt and get into the brain that shouldn't so one of the things you know shouldn't so one of the things you know shouldn't so one of the things you know everybody learns in Pharmacology or everybody learns in Pharmacology or everybody learns in Pharmacology or medical school is that there are certain medical school is that there are certain medical school is that there are certain drugs that penetrate the blood-brain drugs that penetrate the blood-brain drugs that penetrate the blood-brain barrier there are certain drugs that do barrier there are certain drugs that do barrier there are certain drugs that do not the implication being certain not the implication being certain not the implication being certain molecules can pass through certain molecules can pass through certain molecules can pass through certain molecules cannot well presumably the molecules cannot well presumably the molecules cannot well presumably the leakier that barrier is the more things leakier that barrier is the more things leakier that barrier is the more things that maybe we evolved to not have across that maybe we evolved to not have across that maybe we evolved to not have across that barrier do indeed cross and perhaps that barrier do indeed cross and perhaps that barrier do indeed cross and perhaps that's a part of what you just said that's a part of what you just said that's a part of what you just said right which is this increase in right which is this increase in right which is this increase in inflammation that is now coupled with an inflammation that is now coupled with an inflammation that is now coupled with an inability or a decreased ability to to inability or a decreased ability to to inability or a decreased ability to to clear out debris clear out debris clear out debris exactly in fact exactly in fact exactly in fact um you know so work from Dr montane has um you know so work from Dr montane has um you know so work from Dr montane has shown that fibrinogen which is you and I shown that fibrinogen which is you and I shown that fibrinogen which is you and I are familiar with this protein it's are familiar with this protein it's are familiar with this protein it's something if you are measuring your if

14:00something if you are measuring your if something if you are measuring your if you're doing an inflammatory biomarker you're doing an inflammatory biomarker you're doing an inflammatory biomarker panel right I mean so so that's it's panel right I mean so so that's it's panel right I mean so so that's it's it's an it's it's a protein that's it's an it's it's a protein that's it's an it's it's a protein that's involved in blood coagulation but it's involved in blood coagulation but it's involved in blood coagulation but it's also something that is a marker of also something that is a marker of also something that is a marker of inflammation you know and fibrinogen is inflammation you know and fibrinogen is inflammation you know and fibrinogen is not supposed to be in the brain but it's not supposed to be in the brain but it's not supposed to be in the brain but it's found in the brain in people with a found in the brain in people with a found in the brain in people with a leaky blood-brain barrier and not only leaky blood-brain barrier and not only leaky blood-brain barrier and not only um so what's it doing in there it um so what's it doing in there it um so what's it doing in there it disrupts a cell type called disrupts a cell type called disrupts a cell type called oleodendrocytes these are a cell type oleodendrocytes these are a cell type oleodendrocytes these are a cell type that make myelin um that sort of fatty that make myelin um that sort of fatty that make myelin um that sort of fatty white structure that's important for you white structure that's important for you white structure that's important for you know electric signals being fired know electric signals being fired know electric signals being fired throughout the you know brain and it throughout the you know brain and it throughout the you know brain and it it's basically toxic to them so you it's basically toxic to them so you it's basically toxic to them so you basically start to have these in you basically start to have these in you basically start to have these in you know lesions and stuff in the white know lesions and stuff in the white know lesions and stuff in the white matter part of the brain white matter matter part of the brain white matter matter part of the brain white matter hyperintensities as you're probably very hyperintensities as you're probably very hyperintensities as you're probably very familiar with a very common in small familiar with a very common in small familiar with a very common in small vessel disease also you can see that in vessel disease also you can see that in vessel disease also you can see that in people with Alzheimer's as well but you people with Alzheimer's as well but you people with Alzheimer's as well but you know know know um getting that fibrinogen in the brain

15:00um getting that fibrinogen in the brain um getting that fibrinogen in the brain like that that's happening because it's like that that's happening because it's like that that's happening because it's allowed to get in there and that you allowed to get in there and that you allowed to get in there and that you know so so the the permeability of the know so so the the permeability of the know so so the the permeability of the broad brain barrier again like as you broad brain barrier again like as you broad brain barrier again like as you mentioned you know basically preventing mentioned you know basically preventing mentioned you know basically preventing stuff from getting in your brain that stuff from getting in your brain that stuff from getting in your brain that you don't want in there that's number you don't want in there that's number you don't want in there that's number one but also the trans support I think one but also the trans support I think one but also the trans support I think you also alluded to this you're not you also alluded to this you're not you also alluded to this you're not getting things like glucose into the getting things like glucose into the getting things like glucose into the brain and in fact all these Transporters brain and in fact all these Transporters brain and in fact all these Transporters they're they're in the endothelial cells they're they're in the endothelial cells they're they're in the endothelial cells they're in these these these cells that they're in these these these cells that they're in these these these cells that are that are making up the blood-brain are that are making up the blood-brain are that are making up the blood-brain barrier barrier barrier and when you start to disrupt that and when you start to disrupt that and when you start to disrupt that blood-brain barrier those Transporters blood-brain barrier those Transporters blood-brain barrier those Transporters like are dysfunctional like are dysfunctional like are dysfunctional um you know so you're for example one of um you know so you're for example one of um you know so you're for example one of them is the glute one transporter this them is the glute one transporter this them is the glute one transporter this transports glucose into the brain as you transports glucose into the brain as you transports glucose into the brain as you start to get a disruption in blood-brain start to get a disruption in blood-brain start to get a disruption in blood-brain barrier function glucose Transporters barrier function glucose Transporters barrier function glucose Transporters they go down and and so you're talking they go down and and so you're talking they go down and and so you're talking about like not getting enough glucose about like not getting enough glucose about like not getting enough glucose into the brain which is again that's one into the brain which is again that's one into the brain which is again that's one of the you know pathological features of of the you know pathological features of of the you know pathological features of Alzheimer's disease right not getting

16:00Alzheimer's disease right not getting Alzheimer's disease right not getting enough glucose into the brain that's enough glucose into the brain that's enough glucose into the brain that's actually an interesting explanation actually an interesting explanation actually an interesting explanation because because because a very subtle point you made that might a very subtle point you made that might a very subtle point you made that might not be picked up on everybody is you not be picked up on everybody is you not be picked up on everybody is you mentioned the glute one transporter as mentioned the glute one transporter as mentioned the glute one transporter as opposed to the glute4 transporter and if opposed to the glute4 transporter and if opposed to the glute4 transporter and if my memory serves correctly my memory serves correctly my memory serves correctly the brain has glute ones as opposed to the brain has glute ones as opposed to the brain has glute ones as opposed to glute fours and glute ones are insulin glute fours and glute ones are insulin glute fours and glute ones are insulin independent is that correct yeah for the independent is that correct yeah for the independent is that correct yeah for the most part I mean it they're insulin most part I mean it they're insulin most part I mean it they're insulin independent I mean that's that's my independent I mean that's that's my independent I mean that's that's my understanding understanding understanding um and why that's interesting is because um and why that's interesting is because um and why that's interesting is because it seems a bit counter-intuitive that a it seems a bit counter-intuitive that a it seems a bit counter-intuitive that a condition that leads to insulin condition that leads to insulin condition that leads to insulin resistance of course type 2 diabetes is resistance of course type 2 diabetes is resistance of course type 2 diabetes is the essence of insulin resistance it the essence of insulin resistance it the essence of insulin resistance it seems counterintuitive that that would seems counterintuitive that that would seems counterintuitive that that would produce a hypometabolic state in an produce a hypometabolic state in an produce a hypometabolic state in an organ whose glucose Transporters are organ whose glucose Transporters are organ whose glucose Transporters are insulin independent except when you insulin independent except when you insulin independent except when you explain it the way you did which is it's explain it the way you did which is it's explain it the way you did which is it's not the insulin resistance of the glute not the insulin resistance of the glute not the insulin resistance of the glute one transporter that's the problem the one transporter that's the problem the one transporter that's the problem the way it is for the glute4 transporter in

17:00way it is for the glute4 transporter in way it is for the glute4 transporter in the muscle instead it's the actual the muscle instead it's the actual the muscle instead it's the actual mechanical disruption if I'm mechanical disruption if I'm mechanical disruption if I'm understanding you correctly of that understanding you correctly of that understanding you correctly of that transporter because of the way it's no transporter because of the way it's no transporter because of the way it's no longer presumably held in place by the longer presumably held in place by the longer presumably held in place by the barrier itself that allows glucose to barrier itself that allows glucose to barrier itself that allows glucose to get across is that did I did I get across is that did I did I get across is that did I did I understand that correctly okay 100 understand that correctly okay 100 understand that correctly okay 100 correctly and then this is you know this correctly and then this is you know this correctly and then this is you know this isn't like Dogma like this is like this isn't like Dogma like this is like this isn't like Dogma like this is like this is definitely known it's definitely is definitely known it's definitely is definitely known it's definitely where I'm heading it's my opinion but where I'm heading it's my opinion but where I'm heading it's my opinion but there is evidence of it and I think I'm there is evidence of it and I think I'm there is evidence of it and I think I'm I think it's time to explore this I think it's time to explore this I think it's time to explore this evidence a little closer and a little evidence a little closer and a little evidence a little closer and a little deeper because deeper because deeper because um type 2 diabetes and it you know you um type 2 diabetes and it you know you um type 2 diabetes and it you know you hear that the term type 3 diabetes and I hear that the term type 3 diabetes and I hear that the term type 3 diabetes and I think people think about it in the way think people think about it in the way think people think about it in the way of the brain being insulin resistant and of the brain being insulin resistant and of the brain being insulin resistant and you know maybe there's something to that you know maybe there's something to that you know maybe there's something to that but I you know I don't know if that's but I you know I don't know if that's but I you know I don't know if that's exactly what's going on I think the type exactly what's going on I think the type exactly what's going on I think the type 2 diabetes is disrupting the blood-brain 2 diabetes is disrupting the blood-brain 2 diabetes is disrupting the blood-brain barrier through a variety of mechanisms barrier through a variety of mechanisms barrier through a variety of mechanisms including you know the the advanced

18:00including you know the the advanced including you know the the advanced glycation end products and the vascular glycation end products and the vascular glycation end products and the vascular I mean the vasculature disruption in I mean the vasculature disruption in I mean the vasculature disruption in type 2 diabetes is well known I mean type 2 diabetes is well known I mean type 2 diabetes is well known I mean they have all sorts of you know problems they have all sorts of you know problems they have all sorts of you know problems right retinopathy that you know the the right retinopathy that you know the the right retinopathy that you know the the neuropathy like all this I mean they're neuropathy like all this I mean they're neuropathy like all this I mean they're they they're disrupting their they they're disrupting their they they're disrupting their vasculature including these tiny tiny vasculature including these tiny tiny vasculature including these tiny tiny little blood vessels that are like little blood vessels that are like little blood vessels that are like smaller in size than are like the smaller in size than are like the smaller in size than are like the diameter of a hair those things are like diameter of a hair those things are like diameter of a hair those things are like disrupted at the blood-brain barrier and disrupted at the blood-brain barrier and disrupted at the blood-brain barrier and when you disrupt them your their blood when you disrupt them your their blood when you disrupt them your their blood flows decrease and the Transporters are flows decrease and the Transporters are flows decrease and the Transporters are going down I mean there's all sorts of going down I mean there's all sorts of going down I mean there's all sorts of problems and so I think problems and so I think problems and so I think um um um you know fixing the diabetes obviously you know fixing the diabetes obviously you know fixing the diabetes obviously would be like the you know Downstream would be like the you know Downstream would be like the you know Downstream thing to do but like it's kind of a new thing to do but like it's kind of a new thing to do but like it's kind of a new mechanism right it's kind of a new way mechanism right it's kind of a new way mechanism right it's kind of a new way of understanding it and of understanding it and of understanding it and um you know so right in other words it um you know so right in other words it um you know so right in other words it explains the observation so there's an explains the observation so there's an explains the observation so there's an observation that is unmistakable which observation that is unmistakable which observation that is unmistakable which is type 2 diabetes I don't know the is type 2 diabetes I don't know the is type 2 diabetes I don't know the number but I think it approximately number but I think it approximately number but I think it approximately doubles your risk of Alzheimer's disease

19:00doubles your risk of Alzheimer's disease doubles your risk of Alzheimer's disease so in other words even if you're sitting so in other words even if you're sitting so in other words even if you're sitting there walking around with two copies of there walking around with two copies of there walking around with two copies of the APO E3 allele having type 2 diabetes the APO E3 allele having type 2 diabetes the APO E3 allele having type 2 diabetes means you might as well have a copy of means you might as well have a copy of means you might as well have a copy of an E4 allele from a risk perspective and an E4 allele from a risk perspective and an E4 allele from a risk perspective and what this is saying is what this is saying is what this is saying is well it's not entirely clear at the well it's not entirely clear at the well it's not entirely clear at the surface why type 2 diabetes would impact surface why type 2 diabetes would impact surface why type 2 diabetes would impact the brain through the lens of the brain through the lens of the brain through the lens of traditional thinking of glute4 traditional thinking of glute4 traditional thinking of glute4 Transporters which are insulin dependent Transporters which are insulin dependent Transporters which are insulin dependent in other words it isn't just an insulin in other words it isn't just an insulin in other words it isn't just an insulin resistance problem but I think these two resistance problem but I think these two resistance problem but I think these two other things matter right this what you other things matter right this what you other things matter right this what you said about the microvasculature again said about the microvasculature again said about the microvasculature again what I think a lot of people don't what I think a lot of people don't what I think a lot of people don't realize is how destructive type 2 realize is how destructive type 2 realize is how destructive type 2 diabetes is to the kidneys diabetes is to the kidneys diabetes is to the kidneys um right because those tiny tiny blood um right because those tiny tiny blood um right because those tiny tiny blood vessels right people are familiar with vessels right people are familiar with vessels right people are familiar with amputations and things that occur in amputations and things that occur in amputations and things that occur in digits because of that impotence right digits because of that impotence right digits because of that impotence right all of these things where blood vessel all of these things where blood vessel all of these things where blood vessel is essential in small blood vessels and is essential in small blood vessels and is essential in small blood vessels and so there's that which feeds into the so there's that which feeds into the so there's that which feeds into the vascular path that you've discussed but vascular path that you've discussed but vascular path that you've discussed but it's this also this disruption of

20:00it's this also this disruption of it's this also this disruption of glucose transport directly across that glucose transport directly across that glucose transport directly across that transporter so I think it's actually a transporter so I think it's actually a transporter so I think it's actually a very compelling thesis for how type 2 very compelling thesis for how type 2 very compelling thesis for how type 2 diabetes could be acting via those two diabetes could be acting via those two diabetes could be acting via those two prongs prongs prongs um to to ultimately result in high um to to ultimately result in high um to to ultimately result in high hypomatabolism hypomatabolism hypomatabolism I do too yeah and um and then of course I do too yeah and um and then of course I do too yeah and um and then of course the Cascade of inflammation that happens the Cascade of inflammation that happens the Cascade of inflammation that happens after that so after that so after that so um you know the other thing that's also um you know the other thing that's also um you know the other thing that's also very interesting is and again this so very interesting is and again this so very interesting is and again this so we're talking about type 2 diabetes and we're talking about type 2 diabetes and we're talking about type 2 diabetes and very big implications there for the very big implications there for the very big implications there for the prevention of Alzheimer's disease right prevention of Alzheimer's disease right prevention of Alzheimer's disease right I mean you there's a lot you can do as I mean you there's a lot you can do as I mean you there's a lot you can do as you've talked about you know to prevent you've talked about you know to prevent you've talked about you know to prevent and even you know treat you know with and even you know treat you know with and even you know treat you know with diet and lifestyle right type 2 diabetes diet and lifestyle right type 2 diabetes diet and lifestyle right type 2 diabetes but also um what's really interesting but also um what's really interesting but also um what's really interesting and you know I was sort of on this Trail and you know I was sort of on this Trail and you know I was sort of on this Trail years ago I published a sort of years ago I published a sort of years ago I published a sort of Integrative review on the role of the Integrative review on the role of the Integrative review on the role of the omega-3 DHA transporter mfsd2a in the omega-3 DHA transporter mfsd2a in the omega-3 DHA transporter mfsd2a in the brain and um what's really interesting

21:00brain and um what's really interesting brain and um what's really interesting that is that animal studies when you that is that animal studies when you that is that animal studies when you disrupt that transporter it causes like disrupt that transporter it causes like disrupt that transporter it causes like 50 you know breakdown of the blood-brain 50 you know breakdown of the blood-brain 50 you know breakdown of the blood-brain barrier and like like greater than 50 barrier and like like greater than 50 barrier and like like greater than 50 loss of Omega-3 in the brain loss of Omega-3 in the brain loss of Omega-3 in the brain so in my opinion it's sort of it's It's so in my opinion it's sort of it's It's so in my opinion it's sort of it's It's you know that's animal evidence of you know that's animal evidence of you know that's animal evidence of course there's human evidence where course there's human evidence where course there's human evidence where mfsd2a Transporters decrease with age mfsd2a Transporters decrease with age mfsd2a Transporters decrease with age particularly rapidly in Alzheimer's particularly rapidly in Alzheimer's particularly rapidly in Alzheimer's disease and with apoe4 it leads to so disease and with apoe4 it leads to so disease and with apoe4 it leads to so there are genetic there are genetic there are genetic you know abnormalities and mutations you know abnormalities and mutations you know abnormalities and mutations that occur in that transporter where that occur in that transporter where that occur in that transporter where people have less of it and they have people have less of it and they have people have less of it and they have microcephalies they have like smaller microcephalies they have like smaller microcephalies they have like smaller heads and they also have cognitive heads and they also have cognitive heads and they also have cognitive dysfunction dysfunction dysfunction um sort of cognitive impairment things um sort of cognitive impairment things um sort of cognitive impairment things like that as well like that as well like that as well um um how do we know that Rhonda so that's how do we know that Rhonda so that's how do we know that Rhonda so that's um let's even put the pathology aside um let's even put the pathology aside um let's even put the pathology aside the the the sort of Latter category but the the the sort of Latter category but the the the sort of Latter category but let's just talk about

22:00let's just talk about let's just talk about um well again what you've said explains um well again what you've said explains um well again what you've said explains something we've empirically felt is true something we've empirically felt is true something we've empirically felt is true and the evidence suggests it but this and the evidence suggests it but this and the evidence suggests it but this provides a mechanism right which is APO provides a mechanism right which is APO provides a mechanism right which is APO E4 carriers need a higher level of EPA E4 carriers need a higher level of EPA E4 carriers need a higher level of EPA and DHA to get the same benefit that and DHA to get the same benefit that and DHA to get the same benefit that appears to be empirically correct that appears to be empirically correct that appears to be empirically correct that would provide an explanation would provide an explanation would provide an explanation something else you said is it's almost something else you said is it's almost something else you said is it's almost like you know we talk about amino acid like you know we talk about amino acid like you know we talk about amino acid or protein uh resistance basically or protein uh resistance basically or protein uh resistance basically um anabolic resistance as a person ages um anabolic resistance as a person ages um anabolic resistance as a person ages they need more and more protein to get they need more and more protein to get they need more and more protein to get the same effect it's almost like you're the same effect it's almost like you're the same effect it's almost like you're saying if you know aging itself could saying if you know aging itself could saying if you know aging itself could create some resistance to dietary EPA create some resistance to dietary EPA create some resistance to dietary EPA and DHA that might require more as time and DHA that might require more as time and DHA that might require more as time goes on do you think there are also just goes on do you think there are also just goes on do you think there are also just genetic differences within the variant genetic differences within the variant genetic differences within the variant of normal quote unquote I.E of normal quote unquote I.E of normal quote unquote I.E non-pathological where non-pathological where non-pathological where one person would need more EPA and DHA one person would need more EPA and DHA one person would need more EPA and DHA to afford them the same benefit of to afford them the same benefit of to afford them the same benefit of protection as another person protection as another person protection as another person I do I know there's at least a couple

23:00I do I know there's at least a couple I do I know there's at least a couple that are known that are known that are known um and and so like some people have um and and so like some people have um and and so like some people have certain Gene variants that actually they certain Gene variants that actually they certain Gene variants that actually they respond better to for example omega-3 respond better to for example omega-3 respond better to for example omega-3 supplementation and others don't supplementation and others don't supplementation and others don't um where they would actually need a um where they would actually need a um where they would actually need a higher dose and I think there's many higher dose and I think there's many higher dose and I think there's many more to be explored like we haven't more to be explored like we haven't more to be explored like we haven't unlocked all of that yet when I say we I unlocked all of that yet when I say we I unlocked all of that yet when I say we I mean the scientific Community not me not mean the scientific Community not me not mean the scientific Community not me not me personally me personally me personally um but I I do you know with the omega-3 um but I I do you know with the omega-3 um but I I do you know with the omega-3 and this again really hits home the and this again really hits home the and this again really hits home the preventative sort of role here that we preventative sort of role here that we preventative sort of role here that we can you know have in our Alzheimer's can you know have in our Alzheimer's can you know have in our Alzheimer's disease risk disease risk disease risk I so with the mfsd2a like this the these I so with the mfsd2a like this the these I so with the mfsd2a like this the these Transporters are actually lost um so Transporters are actually lost um so Transporters are actually lost um so there's a type of cell called parasites there's a type of cell called parasites there's a type of cell called parasites pair e with an i not to be confused with pair e with an i not to be confused with pair e with an i not to be confused with a parasite they um they back they a parasite they um they back they a parasite they um they back they basically basically basically have these like big feet that wrap

24:00have these like big feet that wrap have these like big feet that wrap around the endothelial cells at the around the endothelial cells at the around the endothelial cells at the blood-brain barrier and they serve blood-brain barrier and they serve blood-brain barrier and they serve really too important many important but really too important many important but really too important many important but two main important functions one is they two main important functions one is they two main important functions one is they are they're basically constricting and are they're basically constricting and are they're basically constricting and dilating and like helping squeeze like dilating and like helping squeeze like dilating and like helping squeeze like the flow of blood so they're like the flow of blood so they're like the flow of blood so they're like they're regulating blood flow to the they're regulating blood flow to the they're regulating blood flow to the brain but they also are very important brain but they also are very important brain but they also are very important for that barrier and they start to fall for that barrier and they start to fall for that barrier and they start to fall off with age these parasites and off with age these parasites and off with age these parasites and inflammation plays a big role on that inflammation plays a big role on that inflammation plays a big role on that um but the mfsd2a Transporters are um but the mfsd2a Transporters are um but the mfsd2a Transporters are concentrated on those cells too right concentrated on those cells too right concentrated on those cells too right and so you'll see like hot spots of and so you'll see like hot spots of and so you'll see like hot spots of where the parasites basically when Once where the parasites basically when Once where the parasites basically when Once those pericites start to fall off those pericites start to fall off those pericites start to fall off that is uh when basically immune cells that is uh when basically immune cells that is uh when basically immune cells and everything starts going into the and everything starts going into the and everything starts going into the brain it's like the start it's like the brain it's like the start it's like the brain it's like the start it's like the start of the vicious inflammation cycle start of the vicious inflammation cycle start of the vicious inflammation cycle in the brain of the leakage amyloid in the brain of the leakage amyloid in the brain of the leakage amyloid accumulation just everything Downstream accumulation just everything Downstream accumulation just everything Downstream right and so um those there's something right and so um those there's something right and so um those there's something there with those Transporters of Omega-3

25:00there with those Transporters of Omega-3 there with those Transporters of Omega-3 that are right at the same site you know that are right at the same site you know that are right at the same site you know of where you lose those parasites which of where you lose those parasites which of where you lose those parasites which is also really interesting and again is also really interesting and again is also really interesting and again there's a lot of there's a lot of there's a lot of animal evidence that suggests the role animal evidence that suggests the role animal evidence that suggests the role of that transporter in blood-brain of that transporter in blood-brain of that transporter in blood-brain barrier Integrity also again you can barrier Integrity also again you can barrier Integrity also again you can kind of like Connect the Dots here where kind of like Connect the Dots here where kind of like Connect the Dots here where you think okay well this is a DHA you think okay well this is a DHA you think okay well this is a DHA specifically a d it's DHA and specifically a d it's DHA and specifically a d it's DHA and phospholipid form transporter so it's phospholipid form transporter so it's phospholipid form transporter so it's like okay there's got to be something like okay there's got to be something like okay there's got to be something here with the omega-3 and you know here with the omega-3 and you know here with the omega-3 and you know there's I know there's a variety of there's I know there's a variety of there's I know there's a variety of scientists that are investigating this scientists that are investigating this scientists that are investigating this but I'm sort of excited that I I am now but I'm sort of excited that I I am now but I'm sort of excited that I I am now going to be part of of a team so I I've going to be part of of a team so I I've going to be part of of a team so I I've joined the fatty acid Research Institute joined the fatty acid Research Institute joined the fatty acid Research Institute which is Bill Bill Dr Bill Harris's which is Bill Bill Dr Bill Harris's which is Bill Bill Dr Bill Harris's Research Institute and as a research Research Institute and as a research Research Institute and as a research associate associate and we are we've associate associate and we are we've associate associate and we are we've sort of secured a small Grant to look at sort of secured a small Grant to look at sort of secured a small Grant to look at the role of omega-3 with blood-brain the role of omega-3 with blood-brain the role of omega-3 with blood-brain barrier integrity and biomarkers and

26:00barrier integrity and biomarkers and barrier integrity and biomarkers and people a variety of different people people a variety of different people people a variety of different people that have that have that have small vessel disease that perhaps go on small vessel disease that perhaps go on small vessel disease that perhaps go on to get Alzheimer's disease and so I to get Alzheimer's disease and so I to get Alzheimer's disease and so I think there needs to be more research in think there needs to be more research in think there needs to be more research in this area because it really it the this area because it really it the this area because it really it the implications here I think are really implications here I think are really implications here I think are really important with omega-3 intake I mean important with omega-3 intake I mean important with omega-3 intake I mean it's one of like it's one of like it's one of like you know so there's two main lifestyle you know so there's two main lifestyle you know so there's two main lifestyle interventions I think that that are interventions I think that that are interventions I think that that are important with with respect to the important with with respect to the important with with respect to the blood-brain barrier three actually three blood-brain barrier three actually three blood-brain barrier three actually three so not basically not getting or fixing so not basically not getting or fixing so not basically not getting or fixing your type 2 diabetes and then the your type 2 diabetes and then the your type 2 diabetes and then the omega-3 intake and like defining that omega-3 intake and like defining that omega-3 intake and like defining that will be sort of tricky but you know full will be sort of tricky but you know full will be sort of tricky but you know full stop most people in the United States stop most people in the United States stop most people in the United States don't they're not eating enough fatty don't they're not eating enough fatty don't they're not eating enough fatty fish and they're not supplementing with fish and they're not supplementing with fish and they're not supplementing with omega-3 which is sort of an alternative omega-3 which is sort of an alternative omega-3 which is sort of an alternative and it was like I think it was like a and it was like I think it was like a and it was like I think it was like a 2012 study out of Harvard that 2012 study out of Harvard that 2012 study out of Harvard that identified omega-3 low omega-3 intake identified omega-3 low omega-3 intake identified omega-3 low omega-3 intake from fish so the Marine type of Omega-3

27:00from fish so the Marine type of Omega-3 from fish so the Marine type of Omega-3 not not the plant AOA as one of the top not not the plant AOA as one of the top not not the plant AOA as one of the top six preventable causes of death so it six preventable causes of death so it six preventable causes of death so it was up there with basically like it was was up there with basically like it was was up there with basically like it was smoking and blood pressure and you know smoking and blood pressure and you know smoking and blood pressure and you know obesity and being sedentary low omega-3 obesity and being sedentary low omega-3 obesity and being sedentary low omega-3 was like it blew my mind and the the was like it blew my mind and the the was like it blew my mind and the the they calculate there's some you know I'm they calculate there's some you know I'm they calculate there's some you know I'm not a biostatistician but there was some not a biostatistician but there was some not a biostatistician but there was some calculation done with estimating the calculation done with estimating the calculation done with estimating the number of deaths caused by not getting number of deaths caused by not getting number of deaths caused by not getting in enough Omega-3 each year it was like in enough Omega-3 each year it was like in enough Omega-3 each year it was like the same as the same number of deaths it the same as the same number of deaths it the same as the same number of deaths it was like 84 000 deaths a year from low was like 84 000 deaths a year from low was like 84 000 deaths a year from low omega-3 intake from fish I wonder though omega-3 intake from fish I wonder though omega-3 intake from fish I wonder though if that's also just a marker for poor if that's also just a marker for poor if that's also just a marker for poor health I know that's the challenge of health I know that's the challenge of health I know that's the challenge of all of those studies right is totally in all of those studies right is totally in all of those studies right is totally in some cases with smoking it's pretty some cases with smoking it's pretty some cases with smoking it's pretty obvious that there's causality there I obvious that there's causality there I obvious that there's causality there I think there also is with blood pressure think there also is with blood pressure think there also is with blood pressure um I I but you know you could argue that um I I but you know you could argue that um I I but you know you could argue that never in the history of the world has never in the history of the world has never in the history of the world has there been a person there been a person there been a person who has you know I'm making I'm being a who has you know I'm making I'm being a who has you know I'm making I'm being a bit facetious who has you know a high

28:00bit facetious who has you know a high bit facetious who has you know a high omega-3 index who eats junk food and omega-3 index who eats junk food and omega-3 index who eats junk food and fast food all day right like those those fast food all day right like those those fast food all day right like those those can't co-exist I want to ask one can't co-exist I want to ask one can't co-exist I want to ask one clarifying question Rhonda clarifying question Rhonda clarifying question Rhonda certainly I know that when you're certainly I know that when you're certainly I know that when you're talking about Omega-3s you're referring talking about Omega-3s you're referring talking about Omega-3s you're referring to the Marine variant of which we have to the Marine variant of which we have to the Marine variant of which we have EPA and DHA EPA and DHA EPA and DHA but the transporter if I understood but the transporter if I understood but the transporter if I understood correctly is it a transporter only for correctly is it a transporter only for correctly is it a transporter only for DHA and it's phospholipid form and if so DHA and it's phospholipid form and if so DHA and it's phospholipid form and if so where what is the importance of EPA in where what is the importance of EPA in where what is the importance of EPA in this this this great question um so the mfsd2a great question um so the mfsd2a great question um so the mfsd2a transporter that I've been referring to transporter that I've been referring to transporter that I've been referring to is specific to DHA and DHA the form of is specific to DHA and DHA the form of is specific to DHA and DHA the form of DHA is DHA is DHA is lysophosphatidylcholine DHA lysophosphatidylcholine DHA lysophosphatidylcholine DHA and that you know so that that specific and that you know so that that specific and that you know so that that specific we we we make it and so we basically get when we make it and so we basically get when we make it and so we basically get when we take in DHA from fish or from a take in DHA from fish or from a take in DHA from fish or from a supplement uh our bodies the higher

29:00supplement uh our bodies the higher supplement uh our bodies the higher amount of DHA that we take in we add amount of DHA that we take in we add amount of DHA that we take in we add that lysophosphatidylcholine group to that lysophosphatidylcholine group to that lysophosphatidylcholine group to the DHA we also have DHA and free fatty the DHA we also have DHA and free fatty the DHA we also have DHA and free fatty acid form bound to albumin and albumin acid form bound to albumin and albumin acid form bound to albumin and albumin is not supposed to that doesn't get into is not supposed to that doesn't get into is not supposed to that doesn't get into the brain but it takes it to the brain the brain but it takes it to the brain the brain but it takes it to the brain blood-brain barrier and the free fatty blood-brain barrier and the free fatty blood-brain barrier and the free fatty acid can sort of diffuse passively acid can sort of diffuse passively acid can sort of diffuse passively across the blood-brain barrier as well across the blood-brain barrier as well across the blood-brain barrier as well same with EPA with respect to your same with EPA with respect to your same with EPA with respect to your question oh I see but because the question oh I see but because the question oh I see but because the phospholipids on the DHA it needs a phospholipids on the DHA it needs a phospholipids on the DHA it needs a dedicated transporter whereas the dedicated transporter whereas the dedicated transporter whereas the unphosphorylated we're not unphosphorylated we're not unphosphorylated we're not phosphorylated the one that doesn't have phosphorylated the one that doesn't have phosphorylated the one that doesn't have a phosphate a a phosphate a a phosphate a side chain phosphatidyl lipidine can side chain phosphatidyl lipidine can side chain phosphatidyl lipidine can diffuse without a transporter exactly diffuse without a transporter exactly diffuse without a transporter exactly yeah so there's that so it's free fatty yeah so there's that so it's free fatty yeah so there's that so it's free fatty acid Bounty albumin and it can just acid Bounty albumin and it can just acid Bounty albumin and it can just diffuse across okay brain yeah so that's diffuse across okay brain yeah so that's diffuse across okay brain yeah so that's how EPA is generally getting in the how EPA is generally getting in the how EPA is generally getting in the brain and then second question for you brain and then second question for you brain and then second question for you on that thread on that thread on that thread uh and feel free to go into as much uh and feel free to go into as much uh and feel free to go into as much depth as possible because I know this is depth as possible because I know this is depth as possible because I know this is actually a very important topic that is actually a very important topic that is actually a very important topic that is somewhat controversial

30:00somewhat controversial somewhat controversial what do you see as the relative what do you see as the relative what do you see as the relative importance of DHA and EPA the the importance of DHA and EPA the the importance of DHA and EPA the the conventional thinking I think is that conventional thinking I think is that conventional thinking I think is that EPA probably more important in the heart EPA probably more important in the heart EPA probably more important in the heart DHA probably more important in the brain DHA probably more important in the brain DHA probably more important in the brain I'm sure that's a gross I'm sure that's a gross I'm sure that's a gross oversimplification but can you expand on oversimplification but can you expand on oversimplification but can you expand on that that that I can try I don't know that it's really I can try I don't know that it's really I can try I don't know that it's really known so um so you know my the way I known so um so you know my the way I known so um so you know my the way I personally think about both EPA and DHA personally think about both EPA and DHA personally think about both EPA and DHA so there there's a variety of so there there's a variety of so there there's a variety of metabolites and of DHA metabolites and of DHA metabolites and of DHA um that are involved in resolving um that are involved in resolving um that are involved in resolving inflammation so these are resolvins the inflammation so these are resolvins the inflammation so these are resolvins the marisens the spms protectants and EPA marisens the spms protectants and EPA marisens the spms protectants and EPA also has uh some of those metabolites as also has uh some of those metabolites as also has uh some of those metabolites as well and it also plays a direct role in well and it also plays a direct role in well and it also plays a direct role in inflammation through the sort of um inflammation through the sort of um inflammation through the sort of um I don't want to say inhibition but like

31:00I don't want to say inhibition but like I don't want to say inhibition but like dampening the prostaglandins and dampening the prostaglandins and dampening the prostaglandins and glucatrines and a lot of the other glucatrines and a lot of the other glucatrines and a lot of the other inflammatory processes so it's kind of inflammatory processes so it's kind of inflammatory processes so it's kind of like a an approach where your your like a an approach where your your like a an approach where your your affecting inflammation from multiple affecting inflammation from multiple affecting inflammation from multiple ways right it's like a multi-pronged ways right it's like a multi-pronged ways right it's like a multi-pronged approach and I mentioned fibrinogen approach and I mentioned fibrinogen approach and I mentioned fibrinogen earlier about like fibrinogen you know earlier about like fibrinogen you know earlier about like fibrinogen you know it's an inflammatory protein well it's it's an inflammatory protein well it's it's an inflammatory protein well it's involved in coagulation but it's a mar involved in coagulation but it's a mar involved in coagulation but it's a mar is something that we do measure as a is something that we do measure as a is something that we do measure as a marker of inflammation so marker of inflammation so marker of inflammation so um there's studies showing that people um there's studies showing that people um there's studies showing that people that are exposed to particulate air that are exposed to particulate air that are exposed to particulate air matter their fibergenic fibrinogen goes matter their fibergenic fibrinogen goes matter their fibergenic fibrinogen goes up but if they have a higher dose of up but if they have a higher dose of up but if they have a higher dose of Omega-3 or higher intake of Omega-3 it Omega-3 or higher intake of Omega-3 it Omega-3 or higher intake of Omega-3 it blunts that effect again through the blunts that effect again through the blunts that effect again through the inflammation right so you know both DHA inflammation right so you know both DHA inflammation right so you know both DHA and Pa are important in my mind for the and Pa are important in my mind for the and Pa are important in my mind for the brain as well I mean there's a variety brain as well I mean there's a variety brain as well I mean there's a variety of studies that have looked at even of studies that have looked at even of studies that have looked at even depression and like you can you can depression and like you can you can depression and like you can you can induce depressive symptoms in a person

32:00induce depressive symptoms in a person induce depressive symptoms in a person by injecting them with what's called by injecting them with what's called by injecting them with what's called lipopolysaccharide which is a component lipopolysaccharide which is a component lipopolysaccharide which is a component of the outer cell membrane of of the outer cell membrane of of the outer cell membrane of gram-negative bacteria we have millions gram-negative bacteria we have millions gram-negative bacteria we have millions of those in our gut in fact there's of those in our gut in fact there's of those in our gut in fact there's about one gram of lipopolysaccharide or about one gram of lipopolysaccharide or about one gram of lipopolysaccharide or LPS for short it's also referred to as LPS for short it's also referred to as LPS for short it's also referred to as endotoxin there's about one gram of that endotoxin there's about one gram of that endotoxin there's about one gram of that in our gut well you can inject people in our gut well you can inject people in our gut well you can inject people with a low dose of that something that with a low dose of that something that with a low dose of that something that actually would be actually would be actually would be somewhat you know I would say equivalent somewhat you know I would say equivalent somewhat you know I would say equivalent to someone with intestinal permeability to someone with intestinal permeability to someone with intestinal permeability and it can cause depressive symptoms in and it can cause depressive symptoms in and it can cause depressive symptoms in people compared to those given a placebo people compared to those given a placebo people compared to those given a placebo and you can blunt that and you can blunt that and you can blunt that depressive symptom effect with EPA depressive symptom effect with EPA depressive symptom effect with EPA probably because of the inflammatory the probably because of the inflammatory the probably because of the inflammatory the blunting of the inflammatory response blunting of the inflammatory response blunting of the inflammatory response and there have been some and there have been some and there have been some you know this is like this is a field you know this is like this is a field you know this is like this is a field that's again understudied underfunded that's again understudied underfunded that's again understudied underfunded but you know some preliminary evidence but you know some preliminary evidence but you know some preliminary evidence randomized controlled trials small randomized controlled trials small randomized controlled trials small randomized controlled trials that need randomized controlled trials that need randomized controlled trials that need to be of course repeated with larger

33:00to be of course repeated with larger to be of course repeated with larger sample sizes you know they're basically sample sizes you know they're basically sample sizes you know they're basically showing that showing that showing that supplementation with EPA can help with supplementation with EPA can help with supplementation with EPA can help with depression yeah this is such a depression yeah this is such a depression yeah this is such a frustrating thing for me and I obviously frustrating thing for me and I obviously frustrating thing for me and I obviously I know it is for you and for many others I know it is for you and for many others I know it is for you and for many others including Bill Harris including Bill Harris including Bill Harris um um if you took the cost of one phase three if you took the cost of one phase three if you took the cost of one phase three anti-amyloid failed drug trial just take anti-amyloid failed drug trial just take anti-amyloid failed drug trial just take one of them right like there's been one of them right like there's been one of them right like there's been dozens of them just take the dollars dozens of them just take the dollars dozens of them just take the dollars that were spent on one of those that were spent on one of those that were spent on one of those guaranteed to fail phase three trials guaranteed to fail phase three trials guaranteed to fail phase three trials and put that money into a preventive and put that money into a preventive and put that money into a preventive trial that looks at something that's got trial that looks at something that's got trial that looks at something that's got real feasibility or you know something real feasibility or you know something real feasibility or you know something that's really interesting like the that's really interesting like the that's really interesting like the optimal supplementation of DHA in the optimal supplementation of DHA in the optimal supplementation of DHA in the right patient population group we could right patient population group we could right patient population group we could have an answer have an answer have an answer and yet you know for obvious reasons and yet you know for obvious reasons and yet you know for obvious reasons there's an incentive to do a phase three there's an incentive to do a phase three there's an incentive to do a phase three drug tile on a candidate with an IND uh

34:00drug tile on a candidate with an IND uh drug tile on a candidate with an IND uh there's not an incentive from a there's not an incentive from a there's not an incentive from a financial perspective to study these financial perspective to study these financial perspective to study these other things other things other things um um and I think for a disease like and I think for a disease like and I think for a disease like Alzheimer's disease that's particularly Alzheimer's disease that's particularly Alzheimer's disease that's particularly problematic because as I suspect we'll problematic because as I suspect we'll problematic because as I suspect we'll discuss discuss discuss you know you know you know unlike cardiovascular disease where yes unlike cardiovascular disease where yes unlike cardiovascular disease where yes prevention is still the best strategy prevention is still the best strategy prevention is still the best strategy you can come in late to the game and you can come in late to the game and you can come in late to the game and still make a difference still make a difference still make a difference I don't think the evidence is I don't think the evidence is I don't think the evidence is particularly compelling that that is particularly compelling that that is particularly compelling that that is true for Alzheimer's disease now I'd true for Alzheimer's disease now I'd true for Alzheimer's disease now I'd love to be wrong love to be wrong love to be wrong but I have yet to see compelling but I have yet to see compelling but I have yet to see compelling evidence that you can be a Johnny come evidence that you can be a Johnny come evidence that you can be a Johnny come lately to that pathology and have an lately to that pathology and have an lately to that pathology and have an impact impact impact it's hard to fix those leaks in the it's hard to fix those leaks in the it's hard to fix those leaks in the brain once they're started right I mean brain once they're started right I mean brain once they're started right I mean and that and that also is why I think and that and that also is why I think and that and that also is why I think there have been failed trials also with there have been failed trials also with there have been failed trials also with there have been a few with there have been a few with there have been a few with omega-3 supplementation people that omega-3 supplementation people that omega-3 supplementation people that already have Alzheimer's disease and already have Alzheimer's disease and already have Alzheimer's disease and you're giving them like I don't know at you're giving them like I don't know at you're giving them like I don't know at most two grams I've seen studies like most two grams I've seen studies like most two grams I've seen studies like 500 milligrams I'm like are you kidding 500 milligrams I'm like are you kidding 500 milligrams I'm like are you kidding me like you you know patience with high

35:00me like you you know patience with high me like you you know patience with high triglycerides or cardiovascular problems triglycerides or cardiovascular problems triglycerides or cardiovascular problems four yeah I know at least four you know four yeah I know at least four you know four yeah I know at least four you know this is this this is this this is this something that has the safety of a something that has the safety of a something that has the safety of a nutrient but literally acts can act like nutrient but literally acts can act like nutrient but literally acts can act like a pharmacological drug you know it's you a pharmacological drug you know it's you a pharmacological drug you know it's you know higher Doses and so um I I agree know higher Doses and so um I I agree know higher Doses and so um I I agree with you I think it is much more with you I think it is much more with you I think it is much more challenging to fix challenging to fix challenging to fix you know when you when you have you know when you when you have you know when you when you have Alzheimer's disease and certainly like Alzheimer's disease and certainly like Alzheimer's disease and certainly like I'm talking about like the leaks in the I'm talking about like the leaks in the I'm talking about like the leaks in the brain but like then what happens after brain but like then what happens after brain but like then what happens after that the amyloid accumulation and like that the amyloid accumulation and like that the amyloid accumulation and like when you start to get to this level when when you start to get to this level when when you start to get to this level when you're you've got all of that I mean you're you've got all of that I mean you're you've got all of that I mean good luck it's gonna be it is going to good luck it's gonna be it is going to good luck it's gonna be it is going to be challenging and you're going to have be challenging and you're going to have be challenging and you're going to have to take it's not going to just be to take it's not going to just be to take it's not going to just be fixing the amyloid you're going to have fixing the amyloid you're going to have fixing the amyloid you're going to have to have a cocktail that are going to have a cocktail that are going to have a cocktail that are going multiple angles I think in order to get multiple angles I think in order to get multiple angles I think in order to get some improvement I think the amyloid and some improvement I think the amyloid and some improvement I think the amyloid and perhaps also fixing this the blood-brain perhaps also fixing this the blood-brain perhaps also fixing this the blood-brain barrier leaks as well maybe at the same barrier leaks as well maybe at the same barrier leaks as well maybe at the same time with the cocktail may help a little time with the cocktail may help a little time with the cocktail may help a little bit but prevention is the way to go I bit but prevention is the way to go I bit but prevention is the way to go I mean like it's so much better to not get

36:00mean like it's so much better to not get mean like it's so much better to not get Alzheimer's disease than to try to fix Alzheimer's disease than to try to fix Alzheimer's disease than to try to fix it once you have it because it's it is a it once you have it because it's it is a it once you have it because it's it is a very complicated disease with lots of very complicated disease with lots of very complicated disease with lots of things going on so things going on so things going on so um you know I think that the strategies um you know I think that the strategies um you know I think that the strategies that that can be done that that can be done that that can be done um and they're not that child they're um and they're not that child they're um and they're not that child they're not that difficult right so we talked not that difficult right so we talked not that difficult right so we talked about type 2 diabetes I mean there's about type 2 diabetes I mean there's about type 2 diabetes I mean there's there there's no there's no reason why there there's no there's no reason why there there's no there's no reason why someone should have it someone should have it someone should have it like right I mean like you you should be like right I mean like you you should be like right I mean like you you should be able to yeah it's I would I would phrase able to yeah it's I would I would phrase able to yeah it's I would I would phrase it as I do not believe for a moment the it as I do not believe for a moment the it as I do not believe for a moment the type 2 diabetes is inevitable to our type 2 diabetes is inevitable to our type 2 diabetes is inevitable to our species whereas I do believe species whereas I do believe species whereas I do believe atherosclerosis is inevitable atherosclerosis is inevitable atherosclerosis is inevitable of course I also think most people don't of course I also think most people don't of course I also think most people don't need to die of it so there's a there's a need to die of it so there's a there's a need to die of it so there's a there's a that's a very Stark contradiction the that's a very Stark contradiction the that's a very Stark contradiction the disease is inevitable as in as much as disease is inevitable as in as much as disease is inevitable as in as much as humans will have lipoproteins that carry humans will have lipoproteins that carry humans will have lipoproteins that carry apob we will get atherosclerosis but apob we will get atherosclerosis but apob we will get atherosclerosis but again we have the technology to delay again we have the technology to delay again we have the technology to delay the onset of that disease to the point

37:00the onset of that disease to the point the onset of that disease to the point where it should not be the cause of where it should not be the cause of where it should not be the cause of death we should be dying with it but not death we should be dying with it but not death we should be dying with it but not from it I would also argue that cancer from it I would also argue that cancer from it I would also argue that cancer is inevitable to our species I it you is inevitable to our species I it you is inevitable to our species I it you know it is simply a stochastic problem know it is simply a stochastic problem know it is simply a stochastic problem where if you live long enough and if you where if you live long enough and if you where if you live long enough and if you accumulate enough genetic mutations and accumulate enough genetic mutations and accumulate enough genetic mutations and we can do lots of things to reduce the we can do lots of things to reduce the we can do lots of things to reduce the risk of that and to delay the onset of risk of that and to delay the onset of risk of that and to delay the onset of that and to detect cancer early and be that and to detect cancer early and be that and to detect cancer early and be more successful in treating it but the more successful in treating it but the more successful in treating it but the incidence of cancer strikes me as incidence of cancer strikes me as incidence of cancer strikes me as something that is inevitable with enough something that is inevitable with enough something that is inevitable with enough age I actually don't feel that way about age I actually don't feel that way about age I actually don't feel that way about type 2 diabetes in other words I think I type 2 diabetes in other words I think I type 2 diabetes in other words I think I share your point of view which is it's share your point of view which is it's share your point of view which is it's not something that is necessary we don't not something that is necessary we don't not something that is necessary we don't have to eventually get it and I think have to eventually get it and I think have to eventually get it and I think that makes it all that much more tragic that makes it all that much more tragic that makes it all that much more tragic that you watch how many people are that you watch how many people are that you watch how many people are suffering from this disease and how much suffering from this disease and how much suffering from this disease and how much damage it's causing not just in the damage it's causing not just in the damage it's causing not just in the disease itself but as you said it's such disease itself but as you said it's such disease itself but as you said it's such an amplifier of the what I what I refer an amplifier of the what I what I refer an amplifier of the what I what I refer to as the horsemen right it's what it to as the horsemen right it's what it to as the horsemen right it's what it does to your risk of cardiovascular

38:00does to your risk of cardiovascular does to your risk of cardiovascular disease cancer and Alzheimer's disease disease cancer and Alzheimer's disease disease cancer and Alzheimer's disease is actually why the death toll for type is actually why the death toll for type is actually why the death toll for type 2 diabetes is so grossly 2 diabetes is so grossly 2 diabetes is so grossly underappreciated underappreciated underappreciated yeah it's accelerating the aging process yeah it's accelerating the aging process yeah it's accelerating the aging process right I mean like the the molecular yeah right I mean like the the molecular yeah right I mean like the the molecular yeah it's gasoline on the fire of Aging I it's gasoline on the fire of Aging I it's gasoline on the fire of Aging I don't I do I am I would I'd have to don't I do I am I would I'd have to don't I do I am I would I'd have to really reflect on it but I can't think really reflect on it but I can't think really reflect on it but I can't think of a process that accelerates aging more of a process that accelerates aging more of a process that accelerates aging more than type 2 diabetes than type 2 diabetes than type 2 diabetes right right right I mean maybe a morbid obesity but like I mean maybe a morbid obesity but like I mean maybe a morbid obesity but like they're probably also type 2 people I they're probably also type 2 people I they're probably also type 2 people I would argue only only in the context of would argue only only in the context of would argue only only in the context of insulin resistance which gets us right insulin resistance which gets us right insulin resistance which gets us right back on that path yeah yeah so right back on that path yeah yeah so right back on that path yeah yeah so right um so I mean I think the good news there um so I mean I think the good news there um so I mean I think the good news there is is is uh not that it's easy but it's like we uh not that it's easy but it's like we uh not that it's easy but it's like we sort of know what it takes to to treat sort of know what it takes to to treat sort of know what it takes to to treat it and prevent it it and prevent it it and prevent it um and it doesn't necessarily look like um and it doesn't necessarily look like um and it doesn't necessarily look like the strategies that are being deployed the strategies that are being deployed the strategies that are being deployed unfortunately at the level of the Ada I unfortunately at the level of the Ada I unfortunately at the level of the Ada I want to ask you one other thing that we want to ask you one other thing that we want to ask you one other thing that we haven't talked about but I I want to haven't talked about but I I want to haven't talked about but I I want to know if it pertains to the blood-brain know if it pertains to the blood-brain know if it pertains to the blood-brain barrier at all and that's blood pressure

39:00barrier at all and that's blood pressure barrier at all and that's blood pressure so hypertension and I guess so hypertension and I guess so hypertension and I guess hyperlipidemia also pose enormous risk hyperlipidemia also pose enormous risk hyperlipidemia also pose enormous risk for not just cardiovascular disease for not just cardiovascular disease for not just cardiovascular disease where they are two of the three biggest where they are two of the three biggest where they are two of the three biggest drivers of risk but they also pose a drivers of risk but they also pose a drivers of risk but they also pose a risk risk risk um in Alzheimer's disease and I I wonder um in Alzheimer's disease and I I wonder um in Alzheimer's disease and I I wonder do either of those act specifically do either of those act specifically do either of those act specifically through the blood-brain barrier through the blood-brain barrier through the blood-brain barrier it is another really uh important it is another really uh important it is another really uh important modifiable modifiable modifiable lifestyle factor that can affect lifestyle factor that can affect lifestyle factor that can affect Alzheimer's disease risk and you know so Alzheimer's disease risk and you know so Alzheimer's disease risk and you know so blood pressure maintaining good blood blood pressure maintaining good blood blood pressure maintaining good blood pressure so I mean basically you want to pressure so I mean basically you want to pressure so I mean basically you want to be systolic below 130 right I mean like be systolic below 130 right I mean like be systolic below 130 right I mean like once you get to 130 the Sprint trial once you get to 130 the Sprint trial once you get to 130 the Sprint trial would even say 120 120 yes yeah would even say 120 120 yes yeah would even say 120 120 yes yeah um and the the blood pressure itself so um and the the blood pressure itself so um and the the blood pressure itself so getting that blood flow to the brain getting that blood flow to the brain getting that blood flow to the brain blood brain Bearer specifically is so blood brain Bearer specifically is so blood brain Bearer specifically is so important important um when you don't have you know that um when you don't have you know that um when you don't have you know that that when that blood flow doesn't you that when that blood flow doesn't you that when that blood flow doesn't you know basically isn't able to get to the know basically isn't able to get to the know basically isn't able to get to the blood-brain barrier

40:00blood-brain barrier well enough well enough well enough um those tiny little vessels start to um those tiny little vessels start to um those tiny little vessels start to like just fall off and it's one of the like just fall off and it's one of the like just fall off and it's one of the reasons why exercise also is so so reasons why exercise also is so so reasons why exercise also is so so important important um so yeah blood pressure there's been a um so yeah blood pressure there's been a um so yeah blood pressure there's been a variety of studies that have looked you variety of studies that have looked you variety of studies that have looked you know of course as you mentioned you know know of course as you mentioned you know know of course as you mentioned you know the the observational data is is never the the observational data is is never the the observational data is is never able to establish causation but it's able to establish causation but it's able to establish causation but it's still an interesting point to look at in still an interesting point to look at in still an interesting point to look at in combination with many other types of combination with many other types of combination with many other types of data right but especially when it's data right but especially when it's data right but especially when it's always in the same direction I mean I always in the same direction I mean I always in the same direction I mean I think that's what always that's what think that's what always that's what think that's what always that's what differentiates the epidemiology around differentiates the epidemiology around differentiates the epidemiology around for example exercise and blood pressure for example exercise and blood pressure for example exercise and blood pressure from the epidemiology around nutrition from the epidemiology around nutrition from the epidemiology around nutrition the epidemiology around Nutrition a it the epidemiology around Nutrition a it the epidemiology around Nutrition a it has very low Hazard ratios and it's has very low Hazard ratios and it's has very low Hazard ratios and it's always changing the direction it's always changing the direction it's always changing the direction it's moving in suggesting that whatever's moving in suggesting that whatever's moving in suggesting that whatever's being studied probably doesn't matter being studied probably doesn't matter being studied probably doesn't matter yet when you look at you know the yet when you look at you know the yet when you look at you know the epidemiology of smoking blood pressure epidemiology of smoking blood pressure epidemiology of smoking blood pressure dyslipidemia exercise dyslipidemia exercise dyslipidemia exercise much bigger Hazard ratios virtually much bigger Hazard ratios virtually much bigger Hazard ratios virtually always pointing in the same direction so always pointing in the same direction so always pointing in the same direction so it strikes me that the latter is signal

41:00it strikes me that the latter is signal it strikes me that the latter is signal the former is noise the former is noise the former is noise right good point right good point right good point um um yeah so blood pressure is associated yeah so blood pressure is associated yeah so blood pressure is associated particularly um so you know 50 of people particularly um so you know 50 of people particularly um so you know 50 of people adults in the US have hypertension and adults in the US have hypertension and adults in the US have hypertension and about 20 of young adults like we're about 20 of young adults like we're about 20 of young adults like we're talking people age 18 to 39 have talking people age 18 to 39 have talking people age 18 to 39 have hypertension like that's crazy right and hypertension like that's crazy right and hypertension like that's crazy right and and it's actually the the high blood and it's actually the the high blood and it's actually the the high blood pressure it's the cumulative exposure to pressure it's the cumulative exposure to pressure it's the cumulative exposure to high blood pressure that's really high blood pressure that's really high blood pressure that's really damaging the vasculature and so it's the damaging the vasculature and so it's the damaging the vasculature and so it's the younger people younger people younger people um it's the people that have it earlier um it's the people that have it earlier um it's the people that have it earlier in life that should be the most in life that should be the most in life that should be the most concerned and are the least right those concerned and are the least right those concerned and are the least right those are the ones that are like I'm young you are the ones that are like I'm young you are the ones that are like I'm young you know I can worry about it later but yeah know I can worry about it later but yeah know I can worry about it later but yeah so high blood pressure is associated so high blood pressure is associated so high blood pressure is associated with dementia risk particularly when you with dementia risk particularly when you with dementia risk particularly when you have it like before you know the 50s have it like before you know the 50s have it like before you know the 50s like so when you start when you get it like so when you start when you get it like so when you start when you get it in your you know before the 50s or you in your you know before the 50s or you in your you know before the 50s or you know midlife once you start to get high know midlife once you start to get high know midlife once you start to get high blood pressure in older age like 70 80. blood pressure in older age like 70 80. blood pressure in older age like 70 80. it's not as much associated with you

42:00it's not as much associated with you it's not as much associated with you know the the Alzheimer's disease and know the the Alzheimer's disease and know the the Alzheimer's disease and dementia risk so um it really does seem dementia risk so um it really does seem dementia risk so um it really does seem like cumulative exposure is the the key like cumulative exposure is the the key like cumulative exposure is the the key factor there but um you know again one factor there but um you know again one factor there but um you know again one of those things that you know is a of those things that you know is a of those things that you know is a lifestyle Factor that's easily lifestyle Factor that's easily lifestyle Factor that's easily modifiable exercise improves blood modifiable exercise improves blood modifiable exercise improves blood pressure pressure pressure sauna improves blood pressure right sauna improves blood pressure right sauna improves blood pressure right those are two you know basically those are two you know basically those are two you know basically low-hanging fruit lifestyle and low-hanging fruit lifestyle and low-hanging fruit lifestyle and interventions some people do have interventions some people do have interventions some people do have Gene polymorphisms where they're very Gene polymorphisms where they're very Gene polymorphisms where they're very sensitive to salt intake instead of sensitive to salt intake instead of sensitive to salt intake instead of intake and and that combination of those intake and and that combination of those intake and and that combination of those people with like a higher sodium intake people with like a higher sodium intake people with like a higher sodium intake really seems to Skyrocket blood pressure really seems to Skyrocket blood pressure really seems to Skyrocket blood pressure it also I think is one like you were it also I think is one like you were it also I think is one like you were mentioning nutrition I think it's also mentioning nutrition I think it's also mentioning nutrition I think it's also looking at the combination of genes and looking at the combination of genes and looking at the combination of genes and diet most nutrition studies don't do diet most nutrition studies don't do diet most nutrition studies don't do that like they don't and there is an that like they don't and there is an that like they don't and there is an interaction going on and I do think interaction going on and I do think interaction going on and I do think that's why some of the sodium intake that's why some of the sodium intake that's why some of the sodium intake blood pressure literature is just a blood pressure literature is just a blood pressure literature is just a little more little more little more um yeah it's all over the place

43:00um yeah it's all over the place um yeah it's all over the place complicated yeah right I wanted to ask complicated yeah right I wanted to ask complicated yeah right I wanted to ask you a question about exercise but before you a question about exercise but before you a question about exercise but before I do that I want to actually pick up on I do that I want to actually pick up on I do that I want to actually pick up on something you just said how optimistic something you just said how optimistic something you just said how optimistic are you are you are you I don't know let's bracket this with I don't know let's bracket this with I don't know let's bracket this with let's say in the next decade let's say in the next decade let's say in the next decade that we will have more of a sense around that we will have more of a sense around that we will have more of a sense around what Precision Nutrition looks like as what Precision Nutrition looks like as what Precision Nutrition looks like as it pertains to genes and polymorphisms it pertains to genes and polymorphisms it pertains to genes and polymorphisms of them in other words of them in other words of them in other words people talk the talk like oh I did this people talk the talk like oh I did this people talk the talk like oh I did this test and it told me I should be eating test and it told me I should be eating test and it told me I should be eating this that and the other thing but the this that and the other thing but the this that and the other thing but the reality of it is there's nothing that's reality of it is there's nothing that's reality of it is there's nothing that's available today that's come close to available today that's come close to available today that's come close to offering that type of insight offering that type of insight offering that type of insight a do you believe that that type of a do you believe that that type of a do you believe that that type of insight is available you used one insight is available you used one insight is available you used one example which I would agree with you on example which I would agree with you on example which I would agree with you on which is that there are probably which is that there are probably which is that there are probably different levels of genetic different levels of genetic different levels of genetic susceptibility to sodium that might susceptibility to sodium that might susceptibility to sodium that might suggest one person needs to be eating suggest one person needs to be eating suggest one person needs to be eating two grams a day of sodium and another two grams a day of sodium and another two grams a day of sodium and another person needs four grams a day but do you person needs four grams a day but do you person needs four grams a day but do you think it will get further than that and think it will get further than that and think it will get further than that and How likely do you think we will be to

44:00How likely do you think we will be to How likely do you think we will be to extract that information extract that information extract that information I I do think 10 years we're going to I I do think 10 years we're going to I I do think 10 years we're going to know a lot more about you know Precision know a lot more about you know Precision know a lot more about you know Precision Nutrition Nutrition Nutrition um obviously Precision medicine as well um obviously Precision medicine as well um obviously Precision medicine as well uh because there's also an interaction uh because there's also an interaction uh because there's also an interaction between you know pharmacological between you know pharmacological between you know pharmacological treatments and genes as well as you know treatments and genes as well as you know treatments and genes as well as you know so um you know in 10 years we're so um you know in 10 years we're so um you know in 10 years we're definitely going to be a lot further definitely going to be a lot further definitely going to be a lot further than we are now the the problem is and than we are now the the problem is and than we are now the the problem is and this is this is always the problem we've this is this is always the problem we've this is this is always the problem we've already alluded to it a few times is the already alluded to it a few times is the already alluded to it a few times is the incentive for funding to study those incentive for funding to study those incentive for funding to study those things that aren't necessarily going to things that aren't necessarily going to things that aren't necessarily going to be super profitable be super profitable be super profitable um it's you know you the the the the um it's you know you the the the the um it's you know you the the the the government the NIH we get there's a government the NIH we get there's a government the NIH we get there's a certain amount of funding that you can certain amount of funding that you can certain amount of funding that you can get from them and and they often like to get from them and and they often like to get from them and and they often like to study one sort of thing you know it's study one sort of thing you know it's study one sort of thing you know it's hard for like the nutrition when there's hard for like the nutrition when there's hard for like the nutrition when there's like multiple things involved it's like like multiple things involved it's like like multiple things involved it's like they're just like too complicated you they're just like too complicated you they're just like too complicated you know know um and so you know there's a lot of um and so you know there's a lot of um and so you know there's a lot of funding from funding from funding from Pharma industry for example and then

45:00Pharma industry for example and then Pharma industry for example and then they put in lots of money because they they put in lots of money because they they put in lots of money because they are incentivized to do that when it's a are incentivized to do that when it's a are incentivized to do that when it's a when it's a drug right so when it's a drug right so when it's a drug right so um that that's my one concern with the I um that that's my one concern with the I um that that's my one concern with the I would say gene diet interaction when would say gene diet interaction when would say gene diet interaction when it's more on nutrition but there there it's more on nutrition but there there it's more on nutrition but there there are people that are there's a there's are people that are there's a there's are people that are there's a there's it's a growing field of research for it's a growing field of research for it's a growing field of research for sure and I do think with there's sure and I do think with there's sure and I do think with there's technology is advancing too I mean so at technology is advancing too I mean so at technology is advancing too I mean so at the point that our technology is the point that our technology is the point that our technology is advancing with AI and stuff I think advancing with AI and stuff I think advancing with AI and stuff I think that's we're going to start to see an that's we're going to start to see an that's we're going to start to see an exponential there honestly so I am exponential there honestly so I am exponential there honestly so I am optimistic that in 10 years that's going optimistic that in 10 years that's going optimistic that in 10 years that's going to be a lot easier to sort of delineate to be a lot easier to sort of delineate to be a lot easier to sort of delineate what a person should eat based off of what a person should eat based off of what a person should eat based off of you know their the genetic makeup you you know their the genetic makeup you you know their the genetic makeup you know versus just what you know generally know versus just what you know generally know versus just what you know generally we think is healthy and and do you think we think is healthy and and do you think we think is healthy and and do you think that that will be at the level of that that will be at the level of that that will be at the level of macronutrients or micronutrients like macronutrients or micronutrients like macronutrients or micronutrients like what what do you think how much what what do you think how much what what do you think how much heterogeneity do you think there is heterogeneity do you think there is heterogeneity do you think there is among people as it pertains to factors

46:00among people as it pertains to factors among people as it pertains to factors like that like that like that I think both for sure I mean there I think both for sure I mean there I think both for sure I mean there there's there are there are differences there's there are there are differences there's there are there are differences in the response to macronutrient intake in the response to macronutrient intake in the response to macronutrient intake and the response to micronutrient intake and the response to micronutrient intake and the response to micronutrient intake and there are people you know like and there are people you know like and there are people you know like there's there's vitamin D polymorphisms there's there's vitamin D polymorphisms there's there's vitamin D polymorphisms right where people right where people right where people um you know for whatever reason they um you know for whatever reason they um you know for whatever reason they actually even so so maybe they they actually even so so maybe they they actually even so so maybe they they evolved in a place where they were so evolved in a place where they were so evolved in a place where they were so like there was so much like there was so much like there was so much um um sun or something like I don't like I sun or something like I don't like I sun or something like I don't like I don't know what the cause is but like don't know what the cause is but like don't know what the cause is but like some people they have to supplement with some people they have to supplement with some people they have to supplement with high doses of Omega-3 to get uh you know high doses of Omega-3 to get uh you know high doses of Omega-3 to get uh you know to be able to convert the vitamin D to be able to convert the vitamin D to be able to convert the vitamin D cursor to actual the hormone right the cursor to actual the hormone right the cursor to actual the hormone right the steroid hormone steroid hormone steroid hormone um and and so and that's and like you um and and so and that's and like you um and and so and that's and like you know that's just one example there's know that's just one example there's know that's just one example there's selenium I mean there's there's selenium I mean there's there's selenium I mean there's there's magnesium there's a lot of different magnesium there's a lot of different magnesium there's a lot of different micronutrients that are off and there's micronutrients that are off and there's micronutrients that are off and there's omega-3 there's omega-3 as well omega-3 there's omega-3 as well omega-3 there's omega-3 as well exactly there's B vitamins yeah so I do

47:00exactly there's B vitamins yeah so I do exactly there's B vitamins yeah so I do think that it plays it does it will kind think that it plays it does it will kind think that it plays it does it will kind of of of more people are looking into it and more people are looking into it and more people are looking into it and again with advancement in technology again with advancement in technology again with advancement in technology things will become cheaper and easier to things will become cheaper and easier to things will become cheaper and easier to do and that's going to create an do and that's going to create an do and that's going to create an exponential in my opinion where it's exponential in my opinion where it's exponential in my opinion where it's like okay maybe in a couple of years like okay maybe in a couple of years like okay maybe in a couple of years we'll start to really see an explosion we'll start to really see an explosion we'll start to really see an explosion and then after that explosion and then after that explosion and then after that explosion exponential happens where people are exponential happens where people are exponential happens where people are building off of that because you know building off of that because you know building off of that because you know that's how it works right so um yeah that's how it works right so um yeah that's how it works right so um yeah that's kind of where I think it's going that's kind of where I think it's going that's kind of where I think it's going and I'm excited about it I think that's and I'm excited about it I think that's and I'm excited about it I think that's where it needs to head I think it's where it needs to head I think it's where it needs to head I think it's going to clear up as you mentioned all going to clear up as you mentioned all going to clear up as you mentioned all the conflicting data with nutrition I the conflicting data with nutrition I the conflicting data with nutrition I mean nutrition studies are a mess mean nutrition studies are a mess mean nutrition studies are a mess designing the right trial I mean the designing the right trial I mean the designing the right trial I mean the part of the reason for that is because part of the reason for that is because part of the reason for that is because we have evolved these genes and when we have evolved these genes and when we have evolved these genes and when it's a drug and you don't have I mean it's a drug and you don't have I mean it's a drug and you don't have I mean with it with the exception of yes with it with the exception of yes with it with the exception of yes there's there's the the cyp enzymes and there's there's the the cyp enzymes and there's there's the the cyp enzymes and stuff that help us metabolize stuff that help us metabolize stuff that help us metabolize xenobiotics things that are not a xenobiotics things that are not a xenobiotics things that are not a vitamin or a mineral or essential amino vitamin or a mineral or essential amino vitamin or a mineral or essential amino acid or fatty acid rights I mean it's acid or fatty acid rights I mean it's acid or fatty acid rights I mean it's foreign to our body but by and large foreign to our body but by and large foreign to our body but by and large when you give someone a drug like when you give someone a drug like

48:00when you give someone a drug like they're starting with zero levels of they're starting with zero levels of they're starting with zero levels of that drug in their body and you give that drug in their body and you give that drug in their body and you give them the dose that you're giving them them the dose that you're giving them them the dose that you're giving them it's like clear you're giving them a it's like clear you're giving them a it's like clear you're giving them a dose and it's it's going to be different dose and it's it's going to be different dose and it's it's going to be different than people getting a placebo right it's than people getting a placebo right it's than people getting a placebo right it's going from zero to something whereas going from zero to something whereas going from zero to something whereas when you do this nutrition study a when you do this nutrition study a when you do this nutrition study a micronutrient you know you give them a micronutrient you know you give them a micronutrient you know you give them a vitamin or a mineral they're not they're vitamin or a mineral they're not they're vitamin or a mineral they're not they're not nobody's starting with zero for one not nobody's starting with zero for one not nobody's starting with zero for one your your placebo group could have high your your placebo group could have high your your placebo group could have high levels of that and unless you measure levels of that and unless you measure levels of that and unless you measure something you'll never know right so something you'll never know right so something you'll never know right so it's it's very different when you're in it's it's very different when you're in it's it's very different when you're in all the trials are sort of all the trials are sort of all the trials are sort of um they're trying to mimic that gold um they're trying to mimic that gold um they're trying to mimic that gold standard of a randomized controlled standard of a randomized controlled standard of a randomized controlled trial with a pharmacological drug and trial with a pharmacological drug and trial with a pharmacological drug and it's just you you can't you have to like it's just you you can't you have to like it's just you you can't you have to like put in so much more effort with put in so much more effort with put in so much more effort with nutrition with the drug you don't have nutrition with the drug you don't have nutrition with the drug you don't have to start doing blood samples of this and to start doing blood samples of this and to start doing blood samples of this and that and measure the drug and make sure that and measure the drug and make sure that and measure the drug and make sure people aren't deficient in that drug of people aren't deficient in that drug of people aren't deficient in that drug of course they're deficient in the drug course they're deficient in the drug course they're deficient in the drug before they start the trial they don't before they start the trial they don't before they start the trial they don't it's like a drug you know so it's like a drug you know so it's like a drug you know so um yeah it's such a good point Rhonda um yeah it's such a good point Rhonda um yeah it's such a good point Rhonda and I'm going to use two examples to and I'm going to use two examples to and I'm going to use two examples to highlight why this is so important and highlight why this is so important and highlight why this is so important and because it ties to two things we've been because it ties to two things we've been because it ties to two things we've been talking about right so

49:00talking about right so talking about right so if you look at how a blood pressure if you look at how a blood pressure if you look at how a blood pressure trial is done trial is done trial is done it is exactly what you say it's titrated it is exactly what you say it's titrated it is exactly what you say it's titrated meaning it's done the way a Pharma trial meaning it's done the way a Pharma trial meaning it's done the way a Pharma trial is normally not done is normally not done is normally not done so a blood pressure trial says let's so a blood pressure trial says let's so a blood pressure trial says let's just bring in a whole bunch of people just bring in a whole bunch of people just bring in a whole bunch of people with high blood pressure okay you guys with high blood pressure okay you guys with high blood pressure okay you guys on the placebo or on the low treatment on the placebo or on the low treatment on the placebo or on the low treatment arm we're going to manage you to a blood arm we're going to manage you to a blood arm we're going to manage you to a blood pressure of 140 over 90 but no lower you pressure of 140 over 90 but no lower you pressure of 140 over 90 but no lower you guys in the treatment arm we're going to guys in the treatment arm we're going to guys in the treatment arm we're going to manage you to 120 over 80 or better manage you to 120 over 80 or better manage you to 120 over 80 or better and by the way and by the way and by the way we're managing to the outcome not the we're managing to the outcome not the we're managing to the outcome not the drug so I'm agnostic as to whether this drug so I'm agnostic as to whether this drug so I'm agnostic as to whether this person needs a higher dose or a lesser person needs a higher dose or a lesser person needs a higher dose or a lesser dose we're checking the outcome here and dose we're checking the outcome here and dose we're checking the outcome here and so if we did a vitamin D trial that way so if we did a vitamin D trial that way so if we did a vitamin D trial that way it would be a very different trial and it would be a very different trial and it would be a very different trial and one of my biggest criticisms of vitamin one of my biggest criticisms of vitamin one of my biggest criticisms of vitamin D trials and why I think we don't have D trials and why I think we don't have D trials and why I think we don't have an answer as to whether supplemental an answer as to whether supplemental an answer as to whether supplemental vitamin D is valuable is they don't do vitamin D is valuable is they don't do vitamin D is valuable is they don't do this this you take the people you divide them into

50:00you take the people you divide them into you take the people you divide them into two groups you give one group of placebo two groups you give one group of placebo two groups you give one group of placebo you give one group usually a very low you give one group usually a very low you give one group usually a very low dose somewhere between two to four dose somewhere between two to four dose somewhere between two to four thousand IU daily but we don't actually thousand IU daily but we don't actually thousand IU daily but we don't actually know know what the level goes to in other words a what the level goes to in other words a what the level goes to in other words a better vitamin D trial would be we take better vitamin D trial would be we take better vitamin D trial would be we take a bunch of people whose vitamin D is a bunch of people whose vitamin D is a bunch of people whose vitamin D is below 30. in one group we give a placebo below 30. in one group we give a placebo below 30. in one group we give a placebo and in another group we give whatever it and in another group we give whatever it and in another group we give whatever it takes to get them to I'm making this up takes to get them to I'm making this up takes to get them to I'm making this up but 80. then we would see is there a but 80. then we would see is there a but 80. then we would see is there a difference between this group that's difference between this group that's difference between this group that's below 30 and this group that gets to 80 below 30 and this group that gets to 80 below 30 and this group that gets to 80 regardless of the dose it took to get regardless of the dose it took to get regardless of the dose it took to get them there because of course that may them there because of course that may them there because of course that may include part of the problem so I think include part of the problem so I think include part of the problem so I think your point is an excellent one and I your point is an excellent one and I your point is an excellent one and I think it's something that listeners need think it's something that listeners need think it's something that listeners need to be aware of when they're scrutinizing to be aware of when they're scrutinizing to be aware of when they're scrutinizing Trials of this nature which is a Trials of this nature which is a Trials of this nature which is a negative trial doesn't mean the thing negative trial doesn't mean the thing negative trial doesn't mean the thing doesn't work if the trial wasn't doesn't work if the trial wasn't doesn't work if the trial wasn't designed correctly designed correctly designed correctly right and it often it's right and it often it's right and it often it's I mean it's a matter of money too right I mean it's a matter of money too right I mean it's a matter of money too right like to measure all those things you like to measure all those things you like to measure all those things you know it's just it's cheaper to just give know it's just it's cheaper to just give know it's just it's cheaper to just give someone the vitamin D supplement and someone the vitamin D supplement and someone the vitamin D supplement and then look at the outcome and go oh it

51:00then look at the outcome and go oh it then look at the outcome and go oh it didn't work and then you have another didn't work and then you have another didn't work and then you have another confusing piece of literature out there confusing piece of literature out there confusing piece of literature out there that people are like oh but it's you that people are like oh but it's you that people are like oh but it's you know it says that vitamin D supplement know it says that vitamin D supplement know it says that vitamin D supplement supplements do nothing yeah it's it's supplements do nothing yeah it's it's supplements do nothing yeah it's it's it's a big problem and I do again I it's a big problem and I do again I it's a big problem and I do again I think as you know our Technologies are think as you know our Technologies are think as you know our Technologies are advancing that that's going to become advancing that that's going to become advancing that that's going to become less of a problem as well less of a problem as well less of a problem as well um so I mean at least I hope I mean I um so I mean at least I hope I mean I um so I mean at least I hope I mean I guess you never know but guess you never know but guess you never know but um um yeah so I want to go back to something yeah so I want to go back to something yeah so I want to go back to something you talked about earlier which is you you talked about earlier which is you you talked about earlier which is you just touched on exercise and just touched on exercise and just touched on exercise and um um I want to kind of visit now the suite of I want to kind of visit now the suite of I want to kind of visit now the suite of things that exercise does because people things that exercise does because people things that exercise does because people who listen to this podcast know if who listen to this podcast know if who listen to this podcast know if there's one thing I just can't stop there's one thing I just can't stop there's one thing I just can't stop talking about it's exercise but I think talking about it's exercise but I think talking about it's exercise but I think there's a reason for that right it's not there's a reason for that right it's not there's a reason for that right it's not just that I love exercise it's that the just that I love exercise it's that the just that I love exercise it's that the the evidence is overwhelming that a the evidence is overwhelming that a the evidence is overwhelming that a person who exercises especially at the person who exercises especially at the person who exercises especially at the right amount right like we're talking right amount right like we're talking right amount right like we're talking not just 30 minutes a week type thing not just 30 minutes a week type thing not just 30 minutes a week type thing but if you're really doing the work

52:00but if you're really doing the work but if you're really doing the work you're having a greater impact on the you're having a greater impact on the you're having a greater impact on the reduction of risk of Alzheimer's disease reduction of risk of Alzheimer's disease reduction of risk of Alzheimer's disease than any other intervention you can take than any other intervention you can take than any other intervention you can take now there are lots of interventions that now there are lots of interventions that now there are lots of interventions that matter sleep matters nutrition as we matter sleep matters nutrition as we matter sleep matters nutrition as we talked about type 2 diabetes all these talked about type 2 diabetes all these talked about type 2 diabetes all these things matter but but the risk reduction things matter but but the risk reduction things matter but but the risk reduction that comes from exercise is enormous that comes from exercise is enormous that comes from exercise is enormous what do you think are the mechanisms by what do you think are the mechanisms by what do you think are the mechanisms by which that is happening because I which that is happening because I which that is happening because I suspect there's many oh definitely um suspect there's many oh definitely um suspect there's many oh definitely um there's definitely many mechanisms there's definitely many mechanisms there's definitely many mechanisms happening and um I would I would first happening and um I would I would first happening and um I would I would first of all 100 agree with you like there's of all 100 agree with you like there's of all 100 agree with you like there's nothing better than exercise and I mean nothing better than exercise and I mean nothing better than exercise and I mean of course any exercise is better than of course any exercise is better than of course any exercise is better than none but none but none but for me because as I mentioned at the for me because as I mentioned at the for me because as I mentioned at the start of this this podcast I'm very start of this this podcast I'm very start of this this podcast I'm very focused on neurodegenerative disease focused on neurodegenerative disease focused on neurodegenerative disease I I I specifically sort of design my workout specifically sort of design my workout specifically sort of design my workout routine based off of what I think routine based off of what I think routine based off of what I think are going to give me the biggest brain are going to give me the biggest brain are going to give me the biggest brain benefits and benefits and benefits and what I've sort of come to the conclusion

53:00what I've sort of come to the conclusion what I've sort of come to the conclusion of is that intensity does make a of is that intensity does make a of is that intensity does make a difference with respect to the difference with respect to the difference with respect to the neurobiological effects exercise neurobiological effects exercise neurobiological effects exercise intensity and intensity and intensity and there are some mechanistic reasons for there are some mechanistic reasons for there are some mechanistic reasons for that but just talking about like that but just talking about like that but just talking about like what's moderate intensity exercise what's moderate intensity exercise what's moderate intensity exercise what's considered vigorous intensity what's considered vigorous intensity what's considered vigorous intensity exercise right if you look at some of exercise right if you look at some of exercise right if you look at some of the recommendations out there by the the recommendations out there by the the recommendations out there by the Committees that have you know there's a Committees that have you know there's a Committees that have you know there's a team of scientists Physicians that sort team of scientists Physicians that sort team of scientists Physicians that sort of analyze all this data and then make of analyze all this data and then make of analyze all this data and then make these Health recommendations based off these Health recommendations based off these Health recommendations based off of that data of that data of that data it's 150 to 300 minutes of moderate it's 150 to 300 minutes of moderate it's 150 to 300 minutes of moderate intensity exercise which intensity exercise which intensity exercise which I think they Define as like 50 to 70 I think they Define as like 50 to 70 I think they Define as like 50 to 70 percent of maximum heart rate percent of maximum heart rate percent of maximum heart rate vigorous intensity they they say you vigorous intensity they they say you vigorous intensity they they say you know 75 minutes I guess a week know 75 minutes I guess a week know 75 minutes I guess a week um and that would be more of you know um and that would be more of you know um and that would be more of you know you're getting above the like 75 to 85 you're getting above the like 75 to 85 you're getting above the like 75 to 85 max heart rate so

54:00max heart rate so max heart rate so um that's that's what they I think um that's that's what they I think um that's that's what they I think Define as something like that vigorous Define as something like that vigorous Define as something like that vigorous and they have a variety of examples you and they have a variety of examples you and they have a variety of examples you know there's there's the World Health know there's there's the World Health know there's there's the World Health Organization and um you know there's a Organization and um you know there's a Organization and um you know there's a variety of committees that are sort of variety of committees that are sort of variety of committees that are sort of they come to that same conclusion uh for they come to that same conclusion uh for they come to that same conclusion uh for me me me I like to go higher intensity and this I like to go higher intensity and this I like to go higher intensity and this is something I kind of was looking is something I kind of was looking is something I kind of was looking forward to talking to you about because forward to talking to you about because forward to talking to you about because it has to do with how do you measure it has to do with how do you measure it has to do with how do you measure like so there's the there's the Mac the like so there's the there's the Mac the like so there's the there's the Mac the estimated heart rate which is what I do estimated heart rate which is what I do estimated heart rate which is what I do I've estimated and again all sorts of I've estimated and again all sorts of I've estimated and again all sorts of problems with that based on your problems with that based on your problems with that based on your physical meaning as estimating your physical meaning as estimating your physical meaning as estimating your maximum heart rate to take a percent maximum heart rate to take a percent maximum heart rate to take a percent event okay right yeah right I mean so so event okay right yeah right I mean so so event okay right yeah right I mean so so basically you know like if the more fit basically you know like if the more fit basically you know like if the more fit you are like you could be doing a more you are like you could be doing a more you are like you could be doing a more vigorous intensity exercise but your vigorous intensity exercise but your vigorous intensity exercise but your heart rate like doesn't go as high as heart rate like doesn't go as high as heart rate like doesn't go as high as someone who's not fit right someone who's not fit right someone who's not fit right um and then people that are older so um and then people that are older so um and then people that are older so there's of course I would say problems there's of course I would say problems there's of course I would say problems with that but um generally speaking with that but um generally speaking with that but um generally speaking that's one way but I'm also very that's one way but I'm also very that's one way but I'm also very interested in lactate and I know you are interested in lactate and I know you are interested in lactate and I know you are as well

55:00as well as well um for me um for me um for me I I actually want to get my lactate I I actually want to get my lactate I I actually want to get my lactate levels high like High levels high like High levels high like High um and and the reason for that is the um and and the reason for that is the um and and the reason for that is the neurobiological benefits so lactate as neurobiological benefits so lactate as neurobiological benefits so lactate as you know was once thought to be this you know was once thought to be this you know was once thought to be this sort of sort of sort of and metabolic byproduct with no like it and metabolic byproduct with no like it and metabolic byproduct with no like it was like you know useless well not only was like you know useless well not only was like you know useless well not only just useless actually it was thought to just useless actually it was thought to just useless actually it was thought to be harmful right so be harmful right so be harmful right so um at least to Performance yeah right um at least to Performance yeah right um at least to Performance yeah right harmful to Performance with respect to harmful to Performance with respect to harmful to Performance with respect to people thought it was like causing their people thought it was like causing their people thought it was like causing their muscle soreness right and that's sort of muscle soreness right and that's sort of muscle soreness right and that's sort of you know as you know now that it's not you know as you know now that it's not you know as you know now that it's not it's not lactate it's the the proton it's not lactate it's the the proton it's not lactate it's the the proton buildup right so lactate is sort of in buildup right so lactate is sort of in buildup right so lactate is sort of in homeostasis of lactic acid and it's the homeostasis of lactic acid and it's the homeostasis of lactic acid and it's the protons that we're sort of responsible protons that we're sort of responsible protons that we're sort of responsible for that and neither of them are for that and neither of them are for that and neither of them are responsible for the soreness you feel responsible for the soreness you feel responsible for the soreness you feel the next day that's the micro trauma of the next day that's the micro trauma of the next day that's the micro trauma of course like the the soreness and the course like the the soreness and the course like the the soreness and the burn from the hydrogen ion is gone you burn from the hydrogen ion is gone you burn from the hydrogen ion is gone you know minutes after you stop exercising

56:00know minutes after you stop exercising know minutes after you stop exercising right yeah yeah exactly uh so the right yeah yeah exactly uh so the right yeah yeah exactly uh so the lactate that gets into so you're lactate that gets into so you're lactate that gets into so you're generating lactate when you basically generating lactate when you basically generating lactate when you basically are pushing your are pushing your are pushing your mitochondria inside your muscle cells to mitochondria inside your muscle cells to mitochondria inside your muscle cells to a point Beyond they can where they can a point Beyond they can where they can a point Beyond they can where they can generate enough energy in the form of generate enough energy in the form of generate enough energy in the form of ATP adenosine triphosphate then they ATP adenosine triphosphate then they ATP adenosine triphosphate then they sort of have to figure out another way sort of have to figure out another way sort of have to figure out another way like your cell has to figure out another like your cell has to figure out another like your cell has to figure out another way to get the energy right so this is way to get the energy right so this is way to get the energy right so this is where glycolysis comes into play so this where glycolysis comes into play so this where glycolysis comes into play so this is happening outside of the mitochondria is happening outside of the mitochondria is happening outside of the mitochondria and I'm sure your listeners have heard and I'm sure your listeners have heard and I'm sure your listeners have heard all this before but for those that all this before but for those that all this before but for those that haven't you know the the lactate haven't you know the the lactate haven't you know the the lactate generation is then from from that you generation is then from from that you generation is then from from that you know metabolism of glucose outside of know metabolism of glucose outside of know metabolism of glucose outside of the mitochondria and that's happening the mitochondria and that's happening the mitochondria and that's happening when again you reach that threshold of when again you reach that threshold of when again you reach that threshold of you know basically you're pushing your you know basically you're pushing your you know basically you're pushing your your your muscle cells hard enough and your your muscle cells hard enough and your your muscle cells hard enough and their mitochondria can't keep up with their mitochondria can't keep up with their mitochondria can't keep up with you know producing enough energy you know producing enough energy you know producing enough energy so the lactate itself and this is this I so the lactate itself and this is this I so the lactate itself and this is this I mean these studies date back to like the

57:00mean these studies date back to like the mean these studies date back to like the 70s uh it's been shown that lactate that 70s uh it's been shown that lactate that 70s uh it's been shown that lactate that it gets into circulation it gets into circulation it gets into circulation and it's used by other organs as a human and it's used by other organs as a human and it's used by other organs as a human source for one as a fuel yeah and the source for one as a fuel yeah and the source for one as a fuel yeah and the Brain being a big one and and this is Brain being a big one and and this is Brain being a big one and and this is now you know this has been you know now you know this has been you know now you know this has been you know Decades of of research but Decades of of research but Decades of of research but um Dr George Brooks has you know he was um Dr George Brooks has you know he was um Dr George Brooks has you know he was like one of the first to propose this like one of the first to propose this like one of the first to propose this lactate shuttle Theory and he's you know lactate shuttle Theory and he's you know lactate shuttle Theory and he's you know of course provided evidence for him for of course provided evidence for him for of course provided evidence for him for that as many others have as well where that as many others have as well where that as many others have as well where you know during exercise and after you know during exercise and after you know during exercise and after exercise the lactate that is generated exercise the lactate that is generated exercise the lactate that is generated you know from muscles that gets into you know from muscles that gets into you know from muscles that gets into circulation is consumed by the brain circulation is consumed by the brain circulation is consumed by the brain this has been shown in humans and animal this has been shown in humans and animal this has been shown in humans and animal studies of course but it's consumed by studies of course but it's consumed by studies of course but it's consumed by the brain and also not only is it the brain and also not only is it the brain and also not only is it consumed uh it's acting as a signaling consumed uh it's acting as a signaling consumed uh it's acting as a signaling molecule and increasing at the molecule and increasing at the molecule and increasing at the blood-brain barrier it lactate itself blood-brain barrier it lactate itself blood-brain barrier it lactate itself has been shown to be responsible for the

58:00has been shown to be responsible for the has been shown to be responsible for the production what's called veg F this is a production what's called veg F this is a production what's called veg F this is a it's a vascular endothelial growth it's a vascular endothelial growth it's a vascular endothelial growth factor veg F and what it's doing at the factor veg F and what it's doing at the factor veg F and what it's doing at the blood-brain barrier is it is growing new blood-brain barrier is it is growing new blood-brain barrier is it is growing new vessels and repairing damaged one so vessels and repairing damaged one so vessels and repairing damaged one so that brings it back to what we're just that brings it back to what we're just that brings it back to what we're just talking about right the damage the talking about right the damage the talking about right the damage the vascular damage at the blood-brain vascular damage at the blood-brain vascular damage at the blood-brain barrier lactate itself is a signal to barrier lactate itself is a signal to barrier lactate itself is a signal to increase that veg f it also increases increase that veg f it also increases increase that veg f it also increases brain derived neurotrophic Factor bdnf brain derived neurotrophic Factor bdnf brain derived neurotrophic Factor bdnf at the brain at the blood-brain barrier at the brain at the blood-brain barrier at the brain at the blood-brain barrier and in the brain as well and in the brain as well and in the brain as well um and so you know where is bdlf um and so you know where is bdlf um and so you know where is bdlf produced produced produced many places many places it's produced in many places many places it's produced in many places many places it's produced in it's produced in in in the capillaries it's produced in in in the capillaries it's produced in in in the capillaries and in the vascular system in the heart and in the vascular system in the heart and in the vascular system in the heart and muscle is produced in the brain and muscle is produced in the brain and muscle is produced in the brain um and so the brain so exercise um and so the brain so exercise um and so the brain so exercise increases brain derived neurotrophic increases brain derived neurotrophic increases brain derived neurotrophic factor in many different parts of the factor in many different parts of the factor in many different parts of the body in many different organs and body in many different organs and body in many different organs and tissues and it's really interesting tissues and it's really interesting tissues and it's really interesting because there's some evidence that the

59:00because there's some evidence that the because there's some evidence that the sheer force of blood flow so essentially sheer force of blood flow so essentially sheer force of blood flow so essentially like the more vigorous you are like the more vigorous you are like the more vigorous you are exercising your blood is just your exercising your blood is just your exercising your blood is just your heart's pumping right and your blood is heart's pumping right and your blood is heart's pumping right and your blood is just going faster right it's moving just going faster right it's moving just going faster right it's moving faster well that sheer force on the faster well that sheer force on the faster well that sheer force on the actual endothelial cells lining the actual endothelial cells lining the actual endothelial cells lining the blood vessels blood vessels blood vessels is a signal to increase bdnf as well is a signal to increase bdnf as well is a signal to increase bdnf as well super interesting stuff there but um it super interesting stuff there but um it super interesting stuff there but um it also increases bdnf you know in in also increases bdnf you know in in also increases bdnf you know in in muscle which it plays a role in muscle which it plays a role in muscle which it plays a role in repairing damaged muscle it's it repairing damaged muscle it's it repairing damaged muscle it's it increases in plasma increases in plasma increases in plasma brain Drive neurotrophic Factor although brain Drive neurotrophic Factor although brain Drive neurotrophic Factor although there's a little controversy controversy there's a little controversy controversy there's a little controversy controversy about this it can cross the blood-brain about this it can cross the blood-brain about this it can cross the blood-brain barrier and it also is produced in the barrier and it also is produced in the barrier and it also is produced in the brain as well so all of those things and brain as well so all of those things and brain as well so all of those things and brain Drive neurotrophic factor is a brain Drive neurotrophic factor is a brain Drive neurotrophic factor is a really important for many reasons I mean really important for many reasons I mean really important for many reasons I mean it's a it's a it's a um it's a it's it's important for um it's a it's it's important for um it's a it's it's important for long-term uh potentiation it's important long-term uh potentiation it's important long-term uh potentiation it's important for neuroplasticity so long-term for neuroplasticity so long-term for neuroplasticity so long-term potentiation is you know they're potentiation is you know they're potentiation is you know they're maintaining that can basically maintaining that can basically maintaining that can basically strengthening the connections um of the strengthening the connections um of the strengthening the connections um of the synapses that are connecting neurons

1:00synapses that are connecting neurons synapses that are connecting neurons it's involved in in basically long-term it's involved in in basically long-term it's involved in in basically long-term memory form uh retention but also um memory form uh retention but also um memory form uh retention but also um it's important for neuroplasticity so it's important for neuroplasticity so it's important for neuroplasticity so brain Drive neurotrophic Factor plays a brain Drive neurotrophic Factor plays a brain Drive neurotrophic Factor plays a really important role in that and that really important role in that and that really important role in that and that is also something that decreases with is also something that decreases with is also something that decreases with age and it's essentially I think a age and it's essentially I think a age and it's essentially I think a really easy way to think about it is uh really easy way to think about it is uh really easy way to think about it is uh your brains like your ability to reshape your brains like your ability to reshape your brains like your ability to reshape and restructure with the changing and restructure with the changing and restructure with the changing environment and like like as you're environment and like like as you're environment and like like as you're aging things are changing in the brain aging things are changing in the brain aging things are changing in the brain and like you have to be able to respond and like you have to be able to respond and like you have to be able to respond to that like your brain responds in a to that like your brain responds in a to that like your brain responds in a plastic way and that happens very well plastic way and that happens very well plastic way and that happens very well when we're younger not so well when when we're younger not so well when when we're younger not so well when we're older not so well in certain we're older not so well in certain we're older not so well in certain disease States like depression disease States like depression disease States like depression neurodegenerative disease and so that neurodegenerative disease and so that neurodegenerative disease and so that brain Drive neurotrophic Factor plays an brain Drive neurotrophic Factor plays an brain Drive neurotrophic Factor plays an important role in that but I am going important role in that but I am going important role in that but I am going for higher lactate and for higher lactate and for higher lactate and um so I much to you like to your um so I much to you like to your um so I much to you like to your basically I based off of your basically I based off of your basically I based off of your recommendation I got the lactate meter recommendation I got the lactate meter recommendation I got the lactate meter the Nova the one that you have and I've the Nova the one that you have and I've the Nova the one that you have and I've been I've been using that to kind of try been I've been using that to kind of try been I've been using that to kind of try to get my lactate higher to get my lactate higher to get my lactate higher um than typically what I think you are

1:01um than typically what I think you are um than typically what I think you are doing with your um a completely doing with your um a completely doing with your um a completely different type of um training well we do different type of um training well we do different type of um training well we do we do kind of both ends right so on the we do kind of both ends right so on the we do kind of both ends right so on the one end of the spectrum one end of the spectrum one end of the spectrum what what we want to do is increase our what what we want to do is increase our what what we want to do is increase our mitochondrial capacity to maximize mitochondrial capacity to maximize mitochondrial capacity to maximize aerobic metabolism and there are two aerobic metabolism and there are two aerobic metabolism and there are two ways to do that meaning you have to do ways to do that meaning you have to do ways to do that meaning you have to do two things the way I describe this to two things the way I describe this to two things the way I describe this to people is people is people is the way one of my coaches described it the way one of my coaches described it the way one of my coaches described it to me when I was a you know uh fledgling to me when I was a you know uh fledgling to me when I was a you know uh fledgling cyclist cyclist cyclist your aerobic capacity is a pyramid your aerobic capacity is a pyramid your aerobic capacity is a pyramid and the area of that pyramid is your and the area of that pyramid is your and the area of that pyramid is your total aerobic capacity total aerobic capacity total aerobic capacity and to have the largest area of a and to have the largest area of a and to have the largest area of a pyramid you need the widest base and the pyramid you need the widest base and the pyramid you need the widest base and the highest peak highest peak highest peak right a pyramid with a narrow base and a right a pyramid with a narrow base and a right a pyramid with a narrow base and a high peak yeah high peak yeah high peak yeah not as good a pyramid with a very wide not as good a pyramid with a very wide not as good a pyramid with a very wide base and a shallow Peak also not great base and a shallow Peak also not great base and a shallow Peak also not great you want wide base high peak well in you want wide base high peak well in you want wide base high peak well in that analogy the base is your Zone 2

1:02that analogy the base is your Zone 2 that analogy the base is your Zone 2 threshold right it's how much work can threshold right it's how much work can threshold right it's how much work can you do while keeping lactate at that you do while keeping lactate at that you do while keeping lactate at that sort of threshold that George Brooks and sort of threshold that George Brooks and sort of threshold that George Brooks and you go saw Milan talk about of about two you go saw Milan talk about of about two you go saw Milan talk about of about two millimole so what differentiates the millimole so what differentiates the millimole so what differentiates the best aerobic athletes from someone you best aerobic athletes from someone you best aerobic athletes from someone you know say with type 2 diabetes which know say with type 2 diabetes which know say with type 2 diabetes which would be the opposite end of that would be the opposite end of that would be the opposite end of that Spectrum where you have real metabolic Spectrum where you have real metabolic Spectrum where you have real metabolic dysfunction or rather mitochondrial dysfunction or rather mitochondrial dysfunction or rather mitochondrial dysfunction dysfunction we're talking a four-fold difference in we're talking a four-fold difference in we're talking a four-fold difference in watts per kilo output and you just have watts per kilo output and you just have watts per kilo output and you just have to train at that level you have to get to train at that level you have to get to train at that level you have to get to that threshold and train right there to that threshold and train right there to that threshold and train right there so you know this morning that was the so you know this morning that was the so you know this morning that was the workout I did right was a zone two ride workout I did right was a zone two ride workout I did right was a zone two ride where I'm just riding right at a lactate where I'm just riding right at a lactate where I'm just riding right at a lactate level of 1.9 millimole was where I was level of 1.9 millimole was where I was level of 1.9 millimole was where I was today but you do need to do what you're today but you do need to do what you're today but you do need to do what you're describing as well you have to do the describing as well you have to do the describing as well you have to do the pyramid building you have to build the pyramid building you have to build the pyramid building you have to build the peak of that pyramid those are the VO2 peak of that pyramid those are the VO2 peak of that pyramid those are the VO2 max sets and you know generally The max sets and you know generally The max sets and you know generally The Sweet Spot for building those is three Sweet Spot for building those is three Sweet Spot for building those is three to eight minutes of all-out effort for

1:03to eight minutes of all-out effort for to eight minutes of all-out effort for the respective the respective the respective um duration so obviously what you can do um duration so obviously what you can do um duration so obviously what you can do for three minutes and no more is harder for three minutes and no more is harder for three minutes and no more is harder than what you might be able to do for than what you might be able to do for than what you might be able to do for eight minutes or no more my favorite are eight minutes or no more my favorite are eight minutes or no more my favorite are four minutes so for example on Sunday four minutes so for example on Sunday four minutes so for example on Sunday that was my workout it was I actually that was my workout it was I actually that was my workout it was I actually did an hour of that zone two you know did an hour of that zone two you know did an hour of that zone two you know kind of two millimole stuff kind of two millimole stuff kind of two millimole stuff and then did four minute awful repeats and then did four minute awful repeats and then did four minute awful repeats where it was like much much higher power where it was like much much higher power where it was like much much higher power for four minutes and then I rested for for four minutes and then I rested for for four minutes and then I rested for four minutes and then went again for four minutes and then went again for four minutes and then went again for four minutes and then rested for four four minutes and then rested for four four minutes and then rested for four minutes and at the end of those four minutes and at the end of those four minutes and at the end of those four minute blocks you know my lactate will minute blocks you know my lactate will minute blocks you know my lactate will be 15 or 16. be 15 or 16. be 15 or 16. and wow and then at the end of a four and wow and then at the end of a four and wow and then at the end of a four minute rest it might be down to six or minute rest it might be down to six or minute rest it might be down to six or seven seven seven and then we do it again and do it again and then we do it again and do it again and then we do it again and do it again and do it again so yeah long-winded way and do it again so yeah long-winded way and do it again so yeah long-winded way of saying you want both right you want of saying you want both right you want of saying you want both right you want to build that pyramid to be as wide and to build that pyramid to be as wide and to build that pyramid to be as wide and as tall as possible what I don't think I as tall as possible what I don't think I as tall as possible what I don't think I appreciated though was that the brain is

1:04appreciated though was that the brain is appreciated though was that the brain is getting a benefit from those lactate getting a benefit from those lactate getting a benefit from those lactate Peaks Peaks Peaks yes it's getting a benefit and they yes it's getting a benefit and they yes it's getting a benefit and they don't like you know it's cleared quite don't like you know it's cleared quite don't like you know it's cleared quite quickly yeah so I mean like you know I quickly yeah so I mean like you know I quickly yeah so I mean like you know I mean it's minutes if you do nothing it's mean it's minutes if you do nothing it's mean it's minutes if you do nothing it's yeah if you just stopped you know you'll yeah if you just stopped you know you'll yeah if you just stopped you know you'll I mean and of course athletes are even I mean and of course athletes are even I mean and of course athletes are even better at this right like an amazing better at this right like an amazing better at this right like an amazing athlete would clear lactate Within athlete would clear lactate Within athlete would clear lactate Within you know they'd go from 10 millimole to you know they'd go from 10 millimole to you know they'd go from 10 millimole to two millimole in minutes two millimole in minutes two millimole in minutes yeah for me um yeah like you know 20 yeah for me um yeah like you know 20 yeah for me um yeah like you know 20 minutes later I'm back to my 0.9 you minutes later I'm back to my 0.9 you minutes later I'm back to my 0.9 you know millimole Baseline but um you know know millimole Baseline but um you know know millimole Baseline but um you know that that lactate also is is it's it's that that lactate also is is it's it's that that lactate also is is it's it's important for neurotransmitter synthesis important for neurotransmitter synthesis important for neurotransmitter synthesis your your um making glutamate the major your your um making glutamate the major your your um making glutamate the major excitatory neurotransmitter of the brain excitatory neurotransmitter of the brain excitatory neurotransmitter of the brain it's it's important for making it's it's important for making it's it's important for making precursors to that norepinephrine I mean precursors to that norepinephrine I mean precursors to that norepinephrine I mean these are all been shown in human these are all been shown in human these are all been shown in human studies also animal studies studies also animal studies studies also animal studies um so for me I do a lot of Tabata um so for me I do a lot of Tabata um so for me I do a lot of Tabata training and um so that's even more

1:05training and um so that's even more training and um so that's even more intense because you're only doing 20 intense because you're only doing 20 intense because you're only doing 20 seconds on and 10 seconds off so that's seconds on and 10 seconds off so that's seconds on and 10 seconds off so that's that's really intense yeah it is I do um that's really intense yeah it is I do um that's really intense yeah it is I do um and I do 16 of those and I do 16 of those and I do 16 of those um so I do you know like eight and then um so I do you know like eight and then um so I do you know like eight and then separated by like a 30 second you know separated by like a 30 second you know separated by like a 30 second you know break and then I do another eight break and then I do another eight break and then I do another eight um and four minute blocks um and four minute blocks um and four minute blocks yeah and then well it's a total of about yeah and then well it's a total of about yeah and then well it's a total of about 10 minutes but um so the first minute 10 minutes but um so the first minute 10 minutes but um so the first minute I'm in like zone two and then by like I'm in like zone two and then by like I'm in like zone two and then by like the end of that minute I'm like zone the end of that minute I'm like zone the end of that minute I'm like zone three and then I go into zone four like three and then I go into zone four like three and then I go into zone four like you know so it's like what are you doing you know so it's like what are you doing you know so it's like what are you doing this on are you doing this on an air this on are you doing this on an air this on are you doing this on an air bike I'm doing it on a Peloton right and bike I'm doing it on a Peloton right and bike I'm doing it on a Peloton right and my Apple watch is is you know beaming my my Apple watch is is you know beaming my my Apple watch is is you know beaming my heart rate and my zones heart rate and my zones heart rate and my zones um on to my screen which is kind of um on to my screen which is kind of um on to my screen which is kind of they're all estimated of course again uh they're all estimated of course again uh they're all estimated of course again uh you know so but but I do that five five you know so but but I do that five five you know so but but I do that five five days a week it's again I think um you days a week it's again I think um you days a week it's again I think um you know the for me the efficiency also so know the for me the efficiency also so know the for me the efficiency also so I'm trying to maximize the the

1:06I'm trying to maximize the the I'm trying to maximize the the neurobiological effects for me with neurobiological effects for me with neurobiological effects for me with exercise and I really find exercise and I really find exercise and I really find um pretty compelling evidence that um pretty compelling evidence that um pretty compelling evidence that intensity is really important with intensity is really important with intensity is really important with respect to that for for the brain not respect to that for for the brain not respect to that for for the brain not that there isn't a benefit for you know that there isn't a benefit for you know that there isn't a benefit for you know lower intensity exercise uh but and it's lower intensity exercise uh but and it's lower intensity exercise uh but and it's certainly people doing you know moderate certainly people doing you know moderate certainly people doing you know moderate intensity like the more time you put in intensity like the more time you put in intensity like the more time you put in like the volume of training right is like the volume of training right is like the volume of training right is like you know you're gonna probably find like you know you're gonna probably find like you know you're gonna probably find some equivalent there right but with the some equivalent there right but with the some equivalent there right but with the lactate though that's the one mechanism lactate though that's the one mechanism lactate though that's the one mechanism I'm like that is really something I I'm like that is really something I I'm like that is really something I personally am trying to optimize for and personally am trying to optimize for and personally am trying to optimize for and I it it's definitely a consequence of I it it's definitely a consequence of I it it's definitely a consequence of intensity right intensity right intensity right um but and and the fact that uh it's um but and and the fact that uh it's um but and and the fact that uh it's it's cleared so quickly uh and it's it's cleared so quickly uh and it's it's cleared so quickly uh and it's transient like I'm wanting it on I'm transient like I'm wanting it on I'm transient like I'm wanting it on I'm wanting a lot of it like each day I'm wanting a lot of it like each day I'm wanting a lot of it like each day I'm wanting to keep doing it right like so I wanting to keep doing it right like so I wanting to keep doing it right like so I kind of I do those those types of kind of I do those those types of kind of I do those those types of training but you know there are there training but you know there are there training but you know there are there are other ways to do it that you might are other ways to do it that you might are other ways to do it that you might want to consider right so you might want

1:07want to consider right so you might want want to consider right so you might want to say look I'll do those tabatas two to say look I'll do those tabatas two to say look I'll do those tabatas two days a week I'll do some longer slower days a week I'll do some longer slower days a week I'll do some longer slower cardio and to be clear like when I'm cardio and to be clear like when I'm cardio and to be clear like when I'm doing that zone two it's still it's not doing that zone two it's still it's not doing that zone two it's still it's not trivial like I mean I'm still my heart trivial like I mean I'm still my heart trivial like I mean I'm still my heart rate's still 140 when I'm doing that rate's still 140 when I'm doing that rate's still 140 when I'm doing that zone two zone two zone two um but what you could do is use Blood um but what you could do is use Blood um but what you could do is use Blood Flow Restriction Flow Restriction Flow Restriction um when you're lifting weights on the um when you're lifting weights on the um when you're lifting weights on the other days and that will get your other days and that will get your other days and that will get your lactate through the roof so lactate through the roof so lactate through the roof so um four days a week you know I'll do um four days a week you know I'll do um four days a week you know I'll do Blood Flow Restriction at the end of Blood Flow Restriction at the end of Blood Flow Restriction at the end of every workout every workout every workout so uh two days will be upper body two so uh two days will be upper body two so uh two days will be upper body two days will be lower body and especially days will be lower body and especially days will be lower body and especially on the lower body days so you've got on the lower body days so you've got on the lower body days so you've got these huge cuffs at the upper part of these huge cuffs at the upper part of these huge cuffs at the upper part of your thighs and I'll do you know leg your thighs and I'll do you know leg your thighs and I'll do you know leg presses leg extension leg curl and presses leg extension leg curl and presses leg extension leg curl and finish up on an air bike and by the time finish up on an air bike and by the time finish up on an air bike and by the time you take those cuffs off you take those cuffs off you take those cuffs off all that lactate that's been pooling in all that lactate that's been pooling in all that lactate that's been pooling in your legs for 10 minutes will flush your legs for 10 minutes will flush your legs for 10 minutes will flush through systemically and your systemic through systemically and your systemic through systemically and your systemic lactate level surges so even though your lactate level surges so even though your lactate level surges so even though your levels get to what's your life oh I mean levels get to what's your life oh I mean levels get to what's your life oh I mean not as high as I would get on an all-out

1:08not as high as I would get on an all-out not as high as I would get on an all-out Sprint I mean like the highest I've ever Sprint I mean like the highest I've ever Sprint I mean like the highest I've ever had my lactate is about an 18 or 19 but had my lactate is about an 18 or 19 but had my lactate is about an 18 or 19 but I can still hit the mid teens doing I can still hit the mid teens doing I can still hit the mid teens doing um doing Blood Flow Restriction um doing Blood Flow Restriction um doing Blood Flow Restriction so that's incredibly High yeah point you so that's incredibly High yeah point you so that's incredibly High yeah point you know it's funny when I used to coach uh know it's funny when I used to coach uh know it's funny when I used to coach uh athletes I worked with an Olympic athletes I worked with an Olympic athletes I worked with an Olympic swimmer who could get to 26 and still be swimmer who could get to 26 and still be swimmer who could get to 26 and still be conscious I mean I say that sort of half conscious I mean I say that sort of half conscious I mean I say that sort of half jokingly not that too much lactate would jokingly not that too much lactate would jokingly not that too much lactate would render you unconscious but the pain that render you unconscious but the pain that render you unconscious but the pain that you must be in when you're lactate is 26 you must be in when you're lactate is 26 you must be in when you're lactate is 26 is is comical to me but he could he is is comical to me but he could he is is comical to me but he could he could finish a swim race like a could finish a swim race like a could finish a swim race like a something like a 400 individual medley something like a 400 individual medley something like a 400 individual medley which is you know probably the highest which is you know probably the highest which is you know probably the highest lactate generating race there is because lactate generating race there is because lactate generating race there is because it's all out upper body lower body it's all out upper body lower body it's all out upper body lower body assault have a lactate of 26 to 24 to 26 assault have a lactate of 26 to 24 to 26 assault have a lactate of 26 to 24 to 26 millimole and four minutes later jump in millimole and four minutes later jump in millimole and four minutes later jump in the pool again and do a race and and the pool again and do a race and and the pool again and do a race and and enter the pool with a lactate of maybe enter the pool with a lactate of maybe enter the pool with a lactate of maybe six six six it's pretty amazing that's amazing what it's pretty amazing that's amazing what it's pretty amazing that's amazing what um so so my point is like you could

1:09um so so my point is like you could um so so my point is like you could diversify the training a little bit and diversify the training a little bit and diversify the training a little bit and if you're still because again you'd if you're still because again you'd if you're still because again you'd still get that lactate hit but you'd still get that lactate hit but you'd still get that lactate hit but you'd also be diversifying the training also be diversifying the training also be diversifying the training um because I do think performance um because I do think performance um because I do think performance it's hard to make the performance gains it's hard to make the performance gains it's hard to make the performance gains if you're really doing an all-out Tabata if you're really doing an all-out Tabata if you're really doing an all-out Tabata five days a week I think that is hard five days a week I think that is hard five days a week I think that is hard performance gains are you talking about performance gains are you talking about performance gains are you talking about within the Tabata itself in other words within the Tabata itself in other words within the Tabata itself in other words it's hard to make gains on the power it's hard to make gains on the power it's hard to make gains on the power output that you want to be generating output that you want to be generating output that you want to be generating because that's when you're doing 20 on because that's when you're doing 20 on because that's when you're doing 20 on 10 off right you're you're trying to get 10 off right you're you're trying to get 10 off right you're you're trying to get as much power as you can in those 20 as much power as you can in those 20 as much power as you can in those 20 seconds seconds seconds um and that those are those are what we um and that those are those are what we um and that those are those are what we call match burning workouts like you're call match burning workouts like you're call match burning workouts like you're you're you're burning all the matches you're you're burning all the matches you're you're burning all the matches that day right those are yeah I'll tell that day right those are yeah I'll tell that day right those are yeah I'll tell you something that's interesting I you something that's interesting I you something that's interesting I started I don't have you ever tried started I don't have you ever tried started I don't have you ever tried doing an aerobic or a high you know high doing an aerobic or a high you know high doing an aerobic or a high you know high intensity workout with like mouth tape intensity workout with like mouth tape intensity workout with like mouth tape where you're just breathing through your where you're just breathing through your where you're just breathing through your nose nose nose um so I mean you're limited of course I

1:10um so I mean you're limited of course I um so I mean you're limited of course I mean at some point you're you're not mean at some point you're you're not mean at some point you're you're not going to get to your you're going to be going to get to your you're going to be going to get to your you're going to be limited by depending on you know for me limited by depending on you know for me limited by depending on you know for me at least I'm at least I'm at least I'm I can't do my all-out best without mouth I can't do my all-out best without mouth I can't do my all-out best without mouth breathing at the end once I reach 215 to 220 Watts 215 to 220 Watts I can't sustain maybe 225 Watts I need I can't sustain maybe 225 Watts I need I can't sustain maybe 225 Watts I need to start breathing through my mouth I to start breathing through my mouth I to start breathing through my mouth I need to at least need to at least need to at least every other breath use my mouth and I I every other breath use my mouth and I I every other breath use my mouth and I I would expect everybody sort of different would expect everybody sort of different would expect everybody sort of different there there there right exactly people are different I right exactly people are different I right exactly people are different I mean different nasal I mean like mean different nasal I mean like mean different nasal I mean like different sinuses and shapes of your different sinuses and shapes of your different sinuses and shapes of your nose and everything I just recently nose and everything I just recently nose and everything I just recently started doing it it was kind of odd started doing it it was kind of odd started doing it it was kind of odd because I actually maybe I'm not going because I actually maybe I'm not going because I actually maybe I'm not going like I'm I pr'd the first time I did it like I'm I pr'd the first time I did it like I'm I pr'd the first time I did it and I I didn't you know like I wasn't and I I didn't you know like I wasn't and I I didn't you know like I wasn't going as hard on my all outs but I think going as hard on my all outs but I think going as hard on my all outs but I think on my rests I was going harder on my 10 on my rests I was going harder on my 10 on my rests I was going harder on my 10 seconds off I was like not really

1:11seconds off I was like not really seconds off I was like not really bringing my resistance down have you bringing my resistance down have you bringing my resistance down have you tried doing it where you do nothing on tried doing it where you do nothing on tried doing it where you do nothing on the off a pure off the off a pure off the off a pure off what do you mean just like keep going what do you mean just like keep going what do you mean just like keep going don't don't yeah don't don't spin don't don't yeah don't don't spin don't don't yeah don't don't spin whatsoever so do the 20 seconds all out whatsoever so do the 20 seconds all out whatsoever so do the 20 seconds all out and then the 10 seconds you're not and then the 10 seconds you're not and then the 10 seconds you're not spinning at all oh I've never tried that spinning at all oh I've never tried that spinning at all oh I've never tried that give that a try well I think the goal is give that a try well I think the goal is give that a try well I think the goal is to make the hard as hard as possible and to make the hard as hard as possible and to make the hard as hard as possible and so being truly off for 10 seconds will so being truly off for 10 seconds will so being truly off for 10 seconds will make it more likely that you can deliver make it more likely that you can deliver make it more likely that you can deliver the maximum wattage during the 20 the maximum wattage during the 20 the maximum wattage during the 20 seconds seconds okay I've been doing I've been trying to okay I've been doing I've been trying to okay I've been doing I've been trying to do the opposite where I'm like okay am I do the opposite where I'm like okay am I do the opposite where I'm like okay am I off I like keep I'm like you know zone off I like keep I'm like you know zone off I like keep I'm like you know zone three I like I'm I'm really like uh I'm three I like I'm I'm really like uh I'm three I like I'm I'm really like uh I'm still I'm still I'm still putting in still I'm still I'm still putting in still I'm still I'm still putting in quite a bit of um Power right like that quite a bit of um Power right like that quite a bit of um Power right like that that's good too I don't want to say just that's good too I don't want to say just that's good too I don't want to say just that there's you know those are those that there's you know those are those that there's you know those are those are we used to call that sweet spot are we used to call that sweet spot are we used to call that sweet spot workouts where you would go zone three workouts where you would go zone three workouts where you would go zone three zone five zone three zone five zone zone five zone three zone five zone zone five zone three zone five zone three zone five three zone five three zone five um but what you really probably want to um but what you really probably want to um but what you really probably want to be doing in a Tabata is zone six Zone

1:12be doing in a Tabata is zone six Zone be doing in a Tabata is zone six Zone one six one six one what's zone six it one six one six one what's zone six it one six one six one what's zone six it depends on the system so uh yeah yeah depends on the system so uh yeah yeah depends on the system so uh yeah yeah basically I mean so technically the basically I mean so technically the basically I mean so technically the literature on this would suggest that we literature on this would suggest that we literature on this would suggest that we are only able to hold full maximal are only able to hold full maximal are only able to hold full maximal effort for 10 seconds effort for 10 seconds effort for 10 seconds anything we do that's longer than 10 anything we do that's longer than 10 anything we do that's longer than 10 seconds we are applying some Governor to seconds we are applying some Governor to seconds we are applying some Governor to the system the system the system now so even now so even now so even so at 20 seconds you're true you're even so at 20 seconds you're true you're even so at 20 seconds you're true you're even if you don't realize it you're somewhat if you don't realize it you're somewhat if you don't realize it you're somewhat pacing yourself even if you're trying to pacing yourself even if you're trying to pacing yourself even if you're trying to go yeah I'm not doing maximum yeah I'm go yeah I'm not doing maximum yeah I'm go yeah I'm not doing maximum yeah I'm not I'm not for sure like my husband not I'm not for sure like my husband not I'm not for sure like my husband like he seems like he really gets to like he seems like he really gets to like he seems like he really gets to that all out but I'm not for sure I am that all out but I'm not for sure I am that all out but I'm not for sure I am I'm I'm definitely not maximum at my 20 I'm I'm definitely not maximum at my 20 I'm I'm definitely not maximum at my 20 seconds no way yeah that that makes seconds no way yeah that that makes seconds no way yeah that that makes sense because I don't think one could do sense because I don't think one could do sense because I don't think one could do that five days a week I think you would that five days a week I think you would that five days a week I think you would I think you would fry yourself you know I think you would fry yourself you know I think you would fry yourself you know it's also really interesting Peter is it's also really interesting Peter is it's also really interesting Peter is that though like by by like the fourth that though like by by like the fourth that though like by by like the fourth or fifth day

1:13or fifth day or fifth day um um I'll still like I'll be I'll be pring so I'll still like I'll be I'll be pring so I'll still like I'll be I'll be pring so I'm always competing against myself and I'm always competing against myself and I'm always competing against myself and by what metrics by wattage oh the by what metrics by wattage oh the by what metrics by wattage oh the Peloton no no I'm not nearly as Peloton no no I'm not nearly as Peloton no no I'm not nearly as scientific as you okay so Peloton ranks scientific as you okay so Peloton ranks scientific as you okay so Peloton ranks you ranks you you ranks you you ranks you um based yeah based off of so but isn't um based yeah based off of so but isn't um based yeah based off of so but isn't it based on kilojoules or Watts isn't it it based on kilojoules or Watts isn't it it based on kilojoules or Watts isn't it based on average wattage it is yeah okay based on average wattage it is yeah okay based on average wattage it is yeah okay yeah but I don't know all those off the yeah but I don't know all those off the yeah but I don't know all those off the top of my head like you're writing top of my head like you're writing top of my head like you're writing everything down I'm not doing that yeah everything down I'm not doing that yeah everything down I'm not doing that yeah um but my lack but that doesn't surprise um but my lack but that doesn't surprise um but my lack but that doesn't surprise me Rhonda because the way to get maximum me Rhonda because the way to get maximum me Rhonda because the way to get maximum wattage is to hold your highest constant wattage is to hold your highest constant wattage is to hold your highest constant maximal wattage and go so zone four held maximal wattage and go so zone four held maximal wattage and go so zone four held indefinitely will produce a much higher indefinitely will produce a much higher indefinitely will produce a much higher average wattage than zone three average wattage than zone three average wattage than zone three alternating with five or six alternating alternating with five or six alternating alternating with five or six alternating with one so yes if you are if your with one so yes if you are if your with one so yes if you are if your metric of success is what is my total metric of success is what is my total metric of success is what is my total average wattage over the course of this average wattage over the course of this average wattage over the course of this workout it will not be a Tabata workout it will not be a Tabata workout it will not be a Tabata it will be a steady state all I can you it will be a steady state all I can you it will be a steady state all I can you know it's what's that's actually what's know it's what's that's actually what's know it's what's that's actually what's called FTP functional threshold power called FTP functional threshold power called FTP functional threshold power which is what technically the Peloton is

1:14which is what technically the Peloton is which is what technically the Peloton is using to estimate your zones have you using to estimate your zones have you using to estimate your zones have you ever done the FTP test on the Peloton no ever done the FTP test on the Peloton no ever done the FTP test on the Peloton no so that's that's actually probably worth so that's that's actually probably worth so that's that's actually probably worth doing doing doing so if you go into the Peloton there's so if you go into the Peloton there's so if you go into the Peloton there's called there's something called I think called there's something called I think called there's something called I think it's called fitness test and it's going it's called fitness test and it's going it's called fitness test and it's going to have you do either you get to pick to have you do either you get to pick to have you do either you get to pick two eight minute all outs separated by two eight minute all outs separated by two eight minute all outs separated by some rest I forget how much or 120 some rest I forget how much or 120 some rest I forget how much or 120 minute all out I prefer the 20 minute minute all out I prefer the 20 minute minute all out I prefer the 20 minute all out I think it's a better test all out I think it's a better test all out I think it's a better test it will take your average wattage over it will take your average wattage over it will take your average wattage over 20 minutes 20 minutes 20 minutes it will multiply it by 0.9 it will multiply it by 0.9 it will multiply it by 0.9 and it will say that is your functional and it will say that is your functional and it will say that is your functional threshold power which is defined as the threshold power which is defined as the threshold power which is defined as the maximum power you can hold for one hour maximum power you can hold for one hour maximum power you can hold for one hour and in cycling and Peloton uses this and in cycling and Peloton uses this and in cycling and Peloton uses this system that is the metric by which the system that is the metric by which the system that is the metric by which the zones are set zones are set zones are set so zones one through seven are a so zones one through seven are a so zones one through seven are a function of power not heart rate and function of power not heart rate and function of power not heart rate and they are all a function of that FTP they are all a function of that FTP they are all a function of that FTP number number number now again none of that's necessary for now again none of that's necessary for now again none of that's necessary for Tabata right Tabata didn't rely on

1:15Tabata right Tabata didn't rely on Tabata right Tabata didn't rely on knowing those zones it wasn't about knowing those zones it wasn't about knowing those zones it wasn't about titrating to a given heart rate it was titrating to a given heart rate it was titrating to a given heart rate it was simply a question of go as hard as you simply a question of go as hard as you simply a question of go as hard as you humanly can for 10 seconds humanly can for 10 seconds humanly can for 10 seconds and then do nothing for 10. and do that and then do nothing for 10. and do that and then do nothing for 10. and do that eight times eight times eight times so yeah I'm definitely using a different so yeah I'm definitely using a different so yeah I'm definitely using a different you're using kind of a slightly you're using kind of a slightly you're using kind of a slightly different protocol where I think like different protocol where I think like different protocol where I think like you're doing a workout where you're you're doing a workout where you're you're doing a workout where you're going much harder during the rest and going much harder during the rest and going much harder during the rest and then not as hard during the workout then not as hard during the workout then not as hard during the workout because you wouldn't be able yeah it's because you wouldn't be able yeah it's because you wouldn't be able yeah it's definitely right no I'm definitely I'm definitely right no I'm definitely I'm definitely right no I'm definitely I'm definitely not doing it the way I guess definitely not doing it the way I guess definitely not doing it the way I guess uh and how high are your lactates and uh and how high are your lactates and uh and how high are your lactates and you check your lactate at the end of the you check your lactate at the end of the you check your lactate at the end of the both sessions after the two rounds both sessions after the two rounds both sessions after the two rounds after uh so it's a so the two round it's after uh so it's a so the two round it's after uh so it's a so the two round it's all like what continuous thing like it's all like what continuous thing like it's all like what continuous thing like it's you get like a 30 second you know rest you get like a 30 second you know rest you get like a 30 second you know rest period between the two eight you know period between the two eight you know period between the two eight you know sessions but like I'm again doing I'm sessions but like I'm again doing I'm sessions but like I'm again doing I'm not resting yeah you're going hard I'm not resting yeah you're going hard I'm not resting yeah you're going hard I'm going I'm like probably zone three yeah going I'm like probably zone three yeah going I'm like probably zone three yeah so um at the end of that now my lactate so um at the end of that now my lactate so um at the end of that now my lactate doesn't get nearly as high as as yours

1:16doesn't get nearly as high as as yours doesn't get nearly as high as as yours but I'm I'm typically like around but I'm I'm typically like around but I'm I'm typically like around seven to eight millimolar seven to eight millimolar seven to eight millimolar um so you know that could give you an um so you know that could give you an um so you know that could give you an idea of my maybe uh I you know I'm what idea of my maybe uh I you know I'm what idea of my maybe uh I you know I'm what I call a committed exerciser you know I call a committed exerciser you know I call a committed exerciser you know I'm not I'm not an athlete as I would I'm not I'm not an athlete as I would I'm not I'm not an athlete as I would consider you are I'm sure well actually consider you are I'm sure well actually consider you are I'm sure well actually it's it's it's actually quite different it's it's it's actually quite different it's it's it's actually quite different there's the best athletes in the world there's the best athletes in the world there's the best athletes in the world like world class right so both Michael like world class right so both Michael like world class right so both Michael Phelps and Lance Armstrong You could Phelps and Lance Armstrong You could Phelps and Lance Armstrong You could argue two of the greatest argue two of the greatest argue two of the greatest um both actually put out relatively low um both actually put out relatively low um both actually put out relatively low lactate levels so you don't know you lactate levels so you don't know you lactate levels so you don't know you might be one of those people who's so might be one of those people who's so might be one of those people who's so efficient that you don't actually make efficient that you don't actually make efficient that you don't actually make much lactate so it's not much lactate so it's not much lactate so it's not um it's it's not it's it's actually you um it's it's not it's it's actually you um it's it's not it's it's actually you know like I don't think Michael Phelps know like I don't think Michael Phelps know like I don't think Michael Phelps is probably even when smashing World is probably even when smashing World is probably even when smashing World Records probably ever seen a lactate Records probably ever seen a lactate Records probably ever seen a lactate above 10. above 10. above 10. yeah but I'm definitely not one of those yeah but I'm definitely not one of those yeah but I'm definitely not one of those guys guys guys it would be interesting to differentiate it would be interesting to differentiate it would be interesting to differentiate for sure I mean for sure I mean for sure I mean um you know but like I do know for um you know but like I do know for um you know but like I do know for example so when you are doing at least a

1:17example so when you are doing at least a example so when you are doing at least a high intensity interval type of training high intensity interval type of training high intensity interval type of training which I would say that this you know which I would say that this you know which I would say that this you know would you agree this yeah this type of would you agree this yeah this type of would you agree this yeah this type of thing definitely would fall into that um thing definitely would fall into that um thing definitely would fall into that um and of course there's a people and of course there's a people and of course there's a people generalize this term and stuff but generalize this term and stuff but generalize this term and stuff but that's a whole other issue um but like that's a whole other issue um but like that's a whole other issue um but like that does like you are sort of forcing that does like you are sort of forcing that does like you are sort of forcing adaptations on your mitochondria adaptations on your mitochondria adaptations on your mitochondria to make more mitochondria right because to make more mitochondria right because to make more mitochondria right because your your your body's like oh I no your your your body's like oh I no your your your body's like oh I no longer can use my mitochondria to make longer can use my mitochondria to make longer can use my mitochondria to make energy I gotta like rely on this other energy I gotta like rely on this other energy I gotta like rely on this other process glycolysis so as an adaptation process glycolysis so as an adaptation process glycolysis so as an adaptation to that you increase mitochondrial to that you increase mitochondrial to that you increase mitochondrial biogenesis and that's been shown now in biogenesis and that's been shown now in biogenesis and that's been shown now in several studies several studies several studies um in human studies right that you can um in human studies right that you can um in human studies right that you can you can increase mitochondrial you can increase mitochondrial you can increase mitochondrial biogenesis now also aerobic training biogenesis now also aerobic training biogenesis now also aerobic training does that as well but it's really a does that as well but it's really a does that as well but it's really a question of time I mean to me this is question of time I mean to me this is question of time I mean to me this is what sort of comes down to what you were what sort of comes down to what you were what sort of comes down to what you were saying earlier so if somebody says to me saying earlier so if somebody says to me saying earlier so if somebody says to me I've only got 10 minutes a day to devote I've only got 10 minutes a day to devote I've only got 10 minutes a day to devote to aerobic training what does it need to to aerobic training what does it need to to aerobic training what does it need to be well the answer is clearly it needs

1:18be well the answer is clearly it needs be well the answer is clearly it needs to be the type of training that we're to be the type of training that we're to be the type of training that we're talking about here now if someone says talking about here now if someone says talking about here now if someone says to me I don't want the minimum effective to me I don't want the minimum effective to me I don't want the minimum effective dose I want the dose I want the dose I want the maximum result then I'm going to say maximum result then I'm going to say maximum result then I'm going to say well would you be willing to give me 90 well would you be willing to give me 90 well would you be willing to give me 90 minutes a day minutes a day minutes a day in which case we could do in which case we could do in which case we could do we could build you the biggest pyramid we could build you the biggest pyramid we could build you the biggest pyramid basically right I need I need like an basically right I need I need like an basically right I need I need like an hour I need an hour a day to build you a hour I need an hour a day to build you a hour I need an hour a day to build you a mega pyramid mega pyramid mega pyramid um but some people don't have the time um but some people don't have the time um but some people don't have the time or desire or interest to do that in or desire or interest to do that in or desire or interest to do that in which case yeah we would need to just which case yeah we would need to just which case yeah we would need to just get people to doing get people to doing get people to doing um you know it I I get asked this um you know it I I get asked this um you know it I I get asked this question all the time question all the time question all the time um I think in 10 minutes a day of cardio um I think in 10 minutes a day of cardio um I think in 10 minutes a day of cardio and you know probably 30 minutes a day and you know probably 30 minutes a day and you know probably 30 minutes a day four times a week with strength four times a week with strength four times a week with strength you can get amazing results but you have you can get amazing results but you have you can get amazing results but you have to be laser focused and there's no to be laser focused and there's no to be laser focused and there's no messing around like it's you know I'm messing around like it's you know I'm messing around like it's you know I'm sure when you're done that 10 minute sure when you're done that 10 minute sure when you're done that 10 minute workout workout workout there's no ambiguity about how hard there's no ambiguity about how hard there's no ambiguity about how hard you've worked

1:19you've worked you've worked um no not at all so it's not it has to um no not at all so it's not it has to um no not at all so it's not it has to be very vigorous yeah be very vigorous yeah be very vigorous yeah it does it does it does um and I do I do also use Peloton for my um and I do I do also use Peloton for my um and I do I do also use Peloton for my strength training as well and there's a strength training as well and there's a strength training as well and there's a lot of like paired sets and super sets lot of like paired sets and super sets lot of like paired sets and super sets and so it's like non-stop you know and so it's like non-stop you know and so it's like non-stop you know training where I'm I mean it's training where I'm I mean it's training where I'm I mean it's definitely like I'm putting effort in definitely like I'm putting effort in definitely like I'm putting effort in but it's not a long session either and but it's not a long session either and but it's not a long session either and um I do try to do that like it you know um I do try to do that like it you know um I do try to do that like it you know I'm I'm putting I'm probably putting in I'm I'm putting I'm probably putting in I'm I'm putting I'm probably putting in the minimum amount of strength training the minimum amount of strength training the minimum amount of strength training that I can personally do which is like that I can personally do which is like that I can personally do which is like 40 to 50 minutes a week and um I used to 40 to 50 minutes a week and um I used to 40 to 50 minutes a week and um I used to not do any you know so like even that's not do any you know so like even that's not do any you know so like even that's like like like um all right we have some we have some um all right we have some we have some um all right we have some we have some stuff we're going to talk about at stuff we're going to talk about at stuff we're going to talk about at dinner here because because there's I'm dinner here because because there's I'm dinner here because because there's I'm not trying to talk you into doing a not trying to talk you into doing a not trying to talk you into doing a little bit more but I want to ask you little bit more but I want to ask you little bit more but I want to ask you where do you put your sauna in relation where do you put your sauna in relation where do you put your sauna in relation to this do you to this do you to this do you um do you dissociate in timing sauna um do you dissociate in timing sauna um do you dissociate in timing sauna from your exercise do you go right into from your exercise do you go right into from your exercise do you go right into the sauna after you work out how do you the sauna after you work out how do you the sauna after you work out how do you incorporate that incorporate that incorporate that it varies so I um I I do both a you know

1:20it varies so I um I I do both a you know it varies so I um I I do both a you know a regular what's you know dry sauna a regular what's you know dry sauna a regular what's you know dry sauna actually I don't use it as a dry sauna I actually I don't use it as a dry sauna I actually I don't use it as a dry sauna I I do a lot of steam I do a lot of steam I do a lot of steam um as well but but I do that but I also um as well but but I do that but I also um as well but but I do that but I also do hot tub so I do jacuzzi as well and do hot tub so I do jacuzzi as well and do hot tub so I do jacuzzi as well and both of those you know forms of heat both of those you know forms of heat both of those you know forms of heat stress have been shown to increase stress have been shown to increase stress have been shown to increase um you know heat shock proteins which is um you know heat shock proteins which is um you know heat shock proteins which is sort of a biomarker of heat stress and sort of a biomarker of heat stress and sort of a biomarker of heat stress and um both of them also been shown to um both of them also been shown to um both of them also been shown to increase brain Drive neurotrophic Factor increase brain Drive neurotrophic Factor increase brain Drive neurotrophic Factor as well so heat I think also plays a as well so heat I think also plays a as well so heat I think also plays a role in that like stress response but um role in that like stress response but um role in that like stress response but um I it depends on the day so I often will I it depends on the day so I often will I it depends on the day so I often will in this sauna I like to read scientific in this sauna I like to read scientific in this sauna I like to read scientific papers or listen to podcasts like like papers or listen to podcasts like like papers or listen to podcasts like like the drive or like I'll listen to like if the drive or like I'll listen to like if the drive or like I'll listen to like if someone's on Tim Ferriss issue like someone's on Tim Ferriss issue like someone's on Tim Ferriss issue like there's only a couple of podcasts that I there's only a couple of podcasts that I there's only a couple of podcasts that I ever listened to uh yours is one of them ever listened to uh yours is one of them ever listened to uh yours is one of them um so it's not like that's like my time um so it's not like that's like my time um so it's not like that's like my time or like because there's no other time or like because there's no other time or like because there's no other time like if I'm in the car with like my like if I'm in the car with like my like if I'm in the car with like my child like most the time I'm listening

1:21child like most the time I'm listening child like most the time I'm listening to you know Frozen music or whatever you to you know Frozen music or whatever you to you know Frozen music or whatever you know like it's not I'm not listening to know like it's not I'm not listening to know like it's not I'm not listening to to the drive so to the drive so to the drive so um uh so I so it's like what it depends um uh so I so it's like what it depends um uh so I so it's like what it depends on what I'm doing but also on what I'm doing but also on what I'm doing but also we I like to do do hot tubs at night so we I like to do do hot tubs at night so we I like to do do hot tubs at night so typically the sauna will be in the day typically the sauna will be in the day typically the sauna will be in the day so I do my workout in the morning I'll so I do my workout in the morning I'll so I do my workout in the morning I'll have this on a warmed up and ready to go have this on a warmed up and ready to go have this on a warmed up and ready to go and I'll get right into the sauna after and I'll get right into the sauna after and I'll get right into the sauna after my workout and I either have a paper in my workout and I either have a paper in my workout and I either have a paper in hand or I'm going over a presentation or hand or I'm going over a presentation or hand or I'm going over a presentation or something something something um I find it's really interesting I um I find it's really interesting I um I find it's really interesting I don't know if you've ever tried this or don't know if you've ever tried this or don't know if you've ever tried this or observed it but uh observed it but uh observed it but uh I've this goes way back to my you know I've this goes way back to my you know I've this goes way back to my you know days as a graduate student when I first days as a graduate student when I first days as a graduate student when I first started using the sauna I realized that started using the sauna I realized that started using the sauna I realized that like if I would go over a talk that I like if I would go over a talk that I like if I would go over a talk that I was going to give like a departmental was going to give like a departmental was going to give like a departmental meeting or whatever you know I was meeting or whatever you know I was meeting or whatever you know I was giving a talk giving a talk giving a talk if I went over it and thought about like if I went over it and thought about like if I went over it and thought about like what I was gonna say in the sauna man what I was gonna say in the sauna man what I was gonna say in the sauna man did I remember it better like it was did I remember it better like it was did I remember it better like it was like very clear that there was something like very clear that there was something like very clear that there was something going on with my memory and I mean very

1:22going on with my memory and I mean very going on with my memory and I mean very very consistent of course you know me I very consistent of course you know me I very consistent of course you know me I like was diving into the literature I'm like was diving into the literature I'm like was diving into the literature I'm like there's got to be something to like there's got to be something to like there's got to be something to explain this and uh you know lo and explain this and uh you know lo and explain this and uh you know lo and behold there's like a very like there's behold there's like a very like there's behold there's like a very like there's like certain growth factors uh that you like certain growth factors uh that you like certain growth factors uh that you that you make that you make that you make um that in this in the sauna with heat um that in this in the sauna with heat um that in this in the sauna with heat stress that do affect like memory so um stress that do affect like memory so um stress that do affect like memory so um you know plausible plausible you know plausible plausible you know plausible plausible um you know hypothesis there but anyways um you know hypothesis there but anyways um you know hypothesis there but anyways so if I have something going on like a so if I have something going on like a so if I have something going on like a podcast or a presentation what's your podcast or a presentation what's your podcast or a presentation what's your protocol protocol protocol um what's your temperature and duration um what's your temperature and duration um what's your temperature and duration in the Sun in the Sun in the Sun so typically I like to it depends on how so typically I like to it depends on how so typically I like to it depends on how hard I went on my like my workout too or hard I went on my like my workout too or hard I went on my like my workout too or if I'm doing it like right after the if I'm doing it like right after the if I'm doing it like right after the workout or if I'm like midday just like workout or if I'm like midday just like workout or if I'm like midday just like I'm gonna take a break from what I'm I'm gonna take a break from what I'm I'm gonna take a break from what I'm doing at my computer and I'm gonna go doing at my computer and I'm gonna go doing at my computer and I'm gonna go read a science paper in the in the sauna read a science paper in the in the sauna read a science paper in the in the sauna so like it really all depends so like it really all depends so like it really all depends um generally speaking if I go in right um generally speaking if I go in right um generally speaking if I go in right after I'm I do my Tabata session I after I'm I do my Tabata session I after I'm I do my Tabata session I probably stay in about 20 to 25 minutes

1:23probably stay in about 20 to 25 minutes probably stay in about 20 to 25 minutes and it'll my temperature is like 175 and it'll my temperature is like 175 and it'll my temperature is like 175 degree Fahrenheit degree Fahrenheit degree Fahrenheit um if I am not going in right after a uh um if I am not going in right after a uh um if I am not going in right after a uh you know training session then I'll stay you know training session then I'll stay you know training session then I'll stay in longer I'll I'll stay in probably a in longer I'll I'll stay in probably a in longer I'll I'll stay in probably a little bit longer than 30 minutes little bit longer than 30 minutes little bit longer than 30 minutes um sometimes I'm pretty I'm pretty um sometimes I'm pretty I'm pretty um sometimes I'm pretty I'm pretty adapted too and my temperature will be adapted too and my temperature will be adapted too and my temperature will be you know 175 180 sometimes I also do the you know 175 180 sometimes I also do the you know 175 180 sometimes I also do the the humidity which makes it hotter feel the humidity which makes it hotter feel the humidity which makes it hotter feel hotter as well hotter as well hotter as well um so so I guess anywhere between 20 to um so so I guess anywhere between 20 to um so so I guess anywhere between 20 to 30 minutes and temperatures anywhere 30 minutes and temperatures anywhere 30 minutes and temperatures anywhere between 175 to 180. I find that I between 175 to 180. I find that I between 175 to 180. I find that I like I like I used to do really really like I like I used to do really really like I like I used to do really really hot and I just sort of like above like hot and I just sort of like above like hot and I just sort of like above like 190 like I was doing 190 and I it was 190 like I was doing 190 and I it was 190 like I was doing 190 and I it was giving me like my head I was getting giving me like my head I was getting giving me like my head I was getting headaches more easier and um and so I headaches more easier and um and so I headaches more easier and um and so I didn't you know I just didn't like it didn't you know I just didn't like it didn't you know I just didn't like it and I didn't feel good and I didn't feel good and I didn't feel good I was getting dehydrated how long did

1:24I was getting dehydrated how long did I was getting dehydrated how long did you sauna during your pregnancy how far you sauna during your pregnancy how far you sauna during your pregnancy how far uh did were you able to to and what do uh did were you able to to and what do uh did were you able to to and what do you what do you I'm sure women ask you you what do you I'm sure women ask you you what do you I'm sure women ask you this all the time and I I've never I this all the time and I I've never I this all the time and I I've never I don't I don't know that I have an answer don't I don't know that I have an answer don't I don't know that I have an answer to the question to the question to the question I didn't so I I didn't so I I didn't so I first found out that I was uh pregnant first found out that I was uh pregnant first found out that I was uh pregnant when I was um touring Finland and that when I was um touring Finland and that when I was um touring Finland and that like everyone was like it was like sauna like everyone was like it was like sauna like everyone was like it was like sauna right it was like we were going touring right it was like we were going touring right it was like we were going touring saunas yeah saunas yeah saunas yeah you're a son of VIP yeah I was and I'm you're a son of VIP yeah I was and I'm you're a son of VIP yeah I was and I'm like holy crap like what am I gonna do like holy crap like what am I gonna do like holy crap like what am I gonna do um so I I felt like at that early early um so I I felt like at that early early um so I I felt like at that early early stage I mean literally like I found out stage I mean literally like I found out stage I mean literally like I found out I was pregnant in Finland I was pregnant in Finland I was pregnant in Finland so um I I did do a lot of sauna touring so um I I did do a lot of sauna touring so um I I did do a lot of sauna touring and stuff and and cold and you know cold and stuff and and cold and you know cold and stuff and and cold and you know cold plunging and all that um at that stage plunging and all that um at that stage plunging and all that um at that stage but right after when I got on the plane but right after when I got on the plane but right after when I got on the plane come back home Sana was out and the come back home Sana was out and the come back home Sana was out and the reason I sort of aired on the side of reason I sort of aired on the side of reason I sort of aired on the side of Koch I mean you can I talked to women in

1:25Koch I mean you can I talked to women in Koch I mean you can I talked to women in Finland and I was and they were like oh Finland and I was and they were like oh Finland and I was and they were like oh yeah I sauna throughout pregnancy and yeah I sauna throughout pregnancy and yeah I sauna throughout pregnancy and like you know you'll you'll find those like you know you'll you'll find those like you know you'll you'll find those anecdotes and you know certainly anecdotes and you know certainly anecdotes and you know certainly certainly in that culture certainly in that culture certainly in that culture um but I you know there there is a body um but I you know there there is a body um but I you know there there is a body of evidence mostly looking at like hot of evidence mostly looking at like hot of evidence mostly looking at like hot tub tub tub um you know and it's this is common like um you know and it's this is common like um you know and it's this is common like it's common knowledge like pregnant it's common knowledge like pregnant it's common knowledge like pregnant women shouldn't get in the hot tub right women shouldn't get in the hot tub right women shouldn't get in the hot tub right I mean like like you go to any Spa like I mean like like you go to any Spa like I mean like like you go to any Spa like it's like it's like it's like um known but um there's there's a body um known but um there's there's a body um known but um there's there's a body of evidence that it can you know of evidence that it can you know of evidence that it can you know something might increase the risk of something might increase the risk of something might increase the risk of like sort of like a fetal alcohol like sort of like a fetal alcohol like sort of like a fetal alcohol syndrome sort of thing in Offspring syndrome sort of thing in Offspring syndrome sort of thing in Offspring where it's like or even neural tube where it's like or even neural tube where it's like or even neural tube defects so I was concerned that going in defects so I was concerned that going in defects so I was concerned that going in the sauna the sauna the sauna um perhaps could increase the risk of um perhaps could increase the risk of um perhaps could increase the risk of something like that and so I decided something like that and so I decided something like that and so I decided that it just wasn't worth it and and so that it just wasn't worth it and and so that it just wasn't worth it and and so I did not sauna at all like throughout I did not sauna at all like throughout I did not sauna at all like throughout pregnancy and I even waited a little bit

1:26pregnancy and I even waited a little bit pregnancy and I even waited a little bit like while um breastfeeding and stuff like while um breastfeeding and stuff like while um breastfeeding and stuff like I I waited probably like I don't like I I waited probably like I don't like I I waited probably like I don't know six months or so before I really know six months or so before I really know six months or so before I really got back into sawning now all the while got back into sawning now all the while got back into sawning now all the while I was exercising throughout pregnancy I was exercising throughout pregnancy I was exercising throughout pregnancy and so many benefits to that but um kind and so many benefits to that but um kind and so many benefits to that but um kind of back to your question the other of back to your question the other of back to your question the other protocol I do is at night and it's protocol I do is at night and it's protocol I do is at night and it's interesting because doing the hot tub at interesting because doing the hot tub at interesting because doing the hot tub at night I'm like we're in we're in that night I'm like we're in we're in that night I'm like we're in we're in that hot tub and it's kind of also the time hot tub and it's kind of also the time hot tub and it's kind of also the time that my husband and I get together away that my husband and I get together away that my husband and I get together away from our child right I mean it's like from our child right I mean it's like from our child right I mean it's like our time we're like out the Stars you our time we're like out the Stars you our time we're like out the Stars you know you know like dark sky like it's know you know like dark sky like it's know you know like dark sky like it's nice and nice and nice and um that is something that like my um that is something that like my um that is something that like my husband likes to do it like literally husband likes to do it like literally husband likes to do it like literally like he wants to do it every night like he wants to do it every night like he wants to do it every night because it helps his his sleep so because it helps his his sleep so because it helps his his sleep so tremendously tremendously tremendously um I don't have as much of an issue with um I don't have as much of an issue with um I don't have as much of an issue with like my latency or my sleep like in like my latency or my sleep like in like my latency or my sleep like in general general general um but he does like he falls like my um but he does like he falls like my um but he does like he falls like my natural bit like I'm asleep by 9 30 and natural bit like I'm asleep by 9 30 and natural bit like I'm asleep by 9 30 and it's like no like I can fall asleep it's like no like I can fall asleep it's like no like I can fall asleep within like you know I'm asleep in 10

1:27within like you know I'm asleep in 10 within like you know I'm asleep in 10 minutes like I get in the bed and like I minutes like I get in the bed and like I minutes like I get in the bed and like I can be asleep in 10 minutes like he is can be asleep in 10 minutes like he is can be asleep in 10 minutes like he is not that way uh and so the doing doing not that way uh and so the doing doing not that way uh and so the doing doing the hot tub and he likes the hot tub the hot tub and he likes the hot tub the hot tub and he likes the hot tub that really helps his sleep so so I end that really helps his sleep so so I end that really helps his sleep so so I end up doing that a lot as well and up doing that a lot as well and up doing that a lot as well and sometimes I'll do like both I'll do the sometimes I'll do like both I'll do the sometimes I'll do like both I'll do the sauna and hot tub in the same day it sauna and hot tub in the same day it sauna and hot tub in the same day it just it all depends but exercise is the just it all depends but exercise is the just it all depends but exercise is the most important I mean like that's like most important I mean like that's like most important I mean like that's like like you know that that I have to get like you know that that I have to get like you know that that I have to get and I go for the vigorous type of and I go for the vigorous type of and I go for the vigorous type of exercise there are studies looking at exercise there are studies looking at exercise there are studies looking at intensity intensity intensity with respect to dementia risk cognitive with respect to dementia risk cognitive with respect to dementia risk cognitive you know impairment you know you'll find you know impairment you know you'll find you know impairment you know you'll find all sorts of things but lit like I think all sorts of things but lit like I think all sorts of things but lit like I think the most common thing that is is pretty the most common thing that is is pretty the most common thing that is is pretty thematic is that the more thematic is that the more thematic is that the more effort you put in the more time you put effort you put in the more time you put effort you put in the more time you put in the the bigger the uh the benefit in the the bigger the uh the benefit in the the bigger the uh the benefit with respect to cognitive health so with respect to cognitive health so with respect to cognitive health so dementia risk and also it depends on how dementia risk and also it depends on how dementia risk and also it depends on how it's I'll give you an example there was it's I'll give you an example there was it's I'll give you an example there was a longitudinal study where women who

1:28a longitudinal study where women who a longitudinal study where women who women by the way as you know are I think women by the way as you know are I think women by the way as you know are I think proximately at a two-fold higher risk proximately at a two-fold higher risk proximately at a two-fold higher risk for Alzheimer's disease that's right for Alzheimer's disease that's right for Alzheimer's disease that's right super interesting but um so this is in super interesting but um so this is in super interesting but um so this is in women and they were studied for you know women and they were studied for you know women and they were studied for you know decades and I think it was like starting decades and I think it was like starting decades and I think it was like starting from like the 70s up until like 2010 or from like the 70s up until like 2010 or from like the 70s up until like 2010 or something and they came in something and they came in something and they came in um for a physical like they were like um for a physical like they were like um for a physical like they were like they were put on a bike exercise bike they were put on a bike exercise bike they were put on a bike exercise bike and they're like Fitness was measured and they're like Fitness was measured and they're like Fitness was measured like it was like empirical data okay and like it was like empirical data okay and like it was like empirical data okay and this was like I don't know five to seven this was like I don't know five to seven this was like I don't know five to seven times so like over the you know course times so like over the you know course times so like over the you know course of you know it was like 40 years or of you know it was like 40 years or of you know it was like 40 years or something exactly something like that something exactly something like that something exactly something like that um and and the and the women that you um and and the and the women that you um and and the and the women that you know were the most fit by their know were the most fit by their know were the most fit by their measurements on you know this like cycle measurements on you know this like cycle measurements on you know this like cycle test they did yeah it's probably VO2 max test they did yeah it's probably VO2 max test they did yeah it's probably VO2 max VO2 max VO2 max VO2 max um and I think yeah so it was cardio um and I think yeah so it was cardio um and I think yeah so it was cardio respiratory Fitness that's right and respiratory Fitness that's right and respiratory Fitness that's right and then um those those women that were the then um those those women that were the then um those those women that were the most fit had like a like they were like

1:29most fit had like a like they were like most fit had like a like they were like the reduction in um like Alzheimer's the reduction in um like Alzheimer's the reduction in um like Alzheimer's like Risk was like so robust I think like Risk was like so robust I think like Risk was like so robust I think there was something like um like there there was something like um like there there was something like um like there were nine times less likely to get or were nine times less likely to get or were nine times less likely to get or something crazy like that uh the ones something crazy like that uh the ones something crazy like that uh the ones that were moderate like so they had like that were moderate like so they had like that were moderate like so they had like a moderate cardio respiratory Fitness a moderate cardio respiratory Fitness a moderate cardio respiratory Fitness they were like four or five times you they were like four or five times you they were like four or five times you know uh like they had a four or five know uh like they had a four or five know uh like they had a four or five fold reduction fold reduction fold reduction but then you'll like look at another but then you'll like look at another but then you'll like look at another perspective study same deal where they perspective study same deal where they perspective study same deal where they cut like they they don't come in and get cut like they they don't come in and get cut like they they don't come in and get anything measured but they come in for a anything measured but they come in for a anything measured but they come in for a questionnaire or they get they get a questionnaire or they get they get a questionnaire or they get they get a questionnaire every you know whatever it questionnaire every you know whatever it questionnaire every you know whatever it was over the course of like 40 40 or 50 was over the course of like 40 40 or 50 was over the course of like 40 40 or 50 years or something and and it's like years or something and and it's like years or something and and it's like there's it's the answer all these there's it's the answer all these there's it's the answer all these questions like oh how often do you jog questions like oh how often do you jog questions like oh how often do you jog or bike or do you play tennis or or bike or do you play tennis or or bike or do you play tennis or whatever and you look at that study and whatever and you look at that study and whatever and you look at that study and there's like no association between there's like no association between there's like no association between between physical activity and dementia between physical activity and dementia between physical activity and dementia risk and I'm like hmm like that's risk and I'm like hmm like that's risk and I'm like hmm like that's interesting because this other study interesting because this other study interesting because this other study where they're actually measuring where they're actually measuring where they're actually measuring something showed a robust reduction uh

1:30something showed a robust reduction uh something showed a robust reduction uh in dementia risk and so I again it go it in dementia risk and so I again it go it in dementia risk and so I again it go it hits home this like okay what study are hits home this like okay what study are hits home this like okay what study are we looking at like question you'll find we looking at like question you'll find we looking at like question you'll find questionnaire studies that also show you questionnaire studies that also show you questionnaire studies that also show you know a benefit like you know people that know a benefit like you know people that know a benefit like you know people that are physically fit and the more fit they are physically fit and the more fit they are physically fit and the more fit they are there's like a linear dose response are there's like a linear dose response are there's like a linear dose response effect right where you see you know effect right where you see you know effect right where you see you know people that put in more effort they're people that put in more effort they're people that put in more effort they're training for a longer period of time and training for a longer period of time and training for a longer period of time and they're um you know doing it more they're um you know doing it more they're um you know doing it more vigorate more vigorous or more volume vigorate more vigorous or more volume vigorate more vigorous or more volume both right like they have the greatest both right like they have the greatest both right like they have the greatest benefit with respect to dementia risk benefit with respect to dementia risk benefit with respect to dementia risk which isn't so surprising to me which isn't so surprising to me which isn't so surprising to me yeah but this the studies that are yeah but this the studies that are yeah but this the studies that are unambiguous as you said are the ones unambiguous as you said are the ones unambiguous as you said are the ones that actually measure VO2 max because that actually measure VO2 max because that actually measure VO2 max because there's no denying what you're measuring there's no denying what you're measuring there's no denying what you're measuring it's a very objective measurement and it it's a very objective measurement and it it's a very objective measurement and it basically takes out the training basically takes out the training basically takes out the training component because it captures that component because it captures that component because it captures that benefit it's the readout state of the benefit it's the readout state of the benefit it's the readout state of the training and it basically says look training and it basically says look training and it basically says look maybe it doesn't matter if you do five

1:31maybe it doesn't matter if you do five maybe it doesn't matter if you do five high intensity workouts a week or two high intensity workouts a week or two high intensity workouts a week or two high intensity five low intensity like high intensity five low intensity like high intensity five low intensity like what matters maybe more is the output what matters maybe more is the output what matters maybe more is the output I don't know if that's the case but but I don't know if that's the case but but I don't know if that's the case but but there's no denying that people who have there's no denying that people who have there's no denying that people who have a high VO2 max are doing something that a high VO2 max are doing something that a high VO2 max are doing something that people who have a low VO2 max are not people who have a low VO2 max are not people who have a low VO2 max are not and that's what's being captured in and that's what's being captured in and that's what's being captured in those studies and you know the numbers those studies and you know the numbers those studies and you know the numbers are astronomical uh you know I won't go are astronomical uh you know I won't go are astronomical uh you know I won't go into them again because people on this into them again because people on this into them again because people on this podcast have heard it too many times podcast have heard it too many times podcast have heard it too many times because I I can't I can't stop talking because I I can't I can't stop talking because I I can't I can't stop talking about the the benefits of having a high about the the benefits of having a high about the the benefits of having a high VO2 max VO2 max um but I want to touch on something else um but I want to touch on something else um but I want to touch on something else you just said a second ago which is you you just said a second ago which is you you just said a second ago which is you you noted that that women are indeed at you noted that that women are indeed at you noted that that women are indeed at twice the risk of Alzheimer's disease to twice the risk of Alzheimer's disease to twice the risk of Alzheimer's disease to men men men um of course Parkinson's flips that men um of course Parkinson's flips that men um of course Parkinson's flips that men are at higher risk but focusing on are at higher risk but focusing on are at higher risk but focusing on Alzheimer's disease for a second Alzheimer's disease for a second Alzheimer's disease for a second is there any evidence is there any evidence is there any evidence that there are gender differences in that there are gender differences in that there are gender differences in response to exercise in other words are response to exercise in other words are response to exercise in other words are women more responsive to the benefits or

1:32women more responsive to the benefits or women more responsive to the benefits or more amenable to the benefits of more amenable to the benefits of more amenable to the benefits of exercise than men because they are at a exercise than men because they are at a exercise than men because they are at a higher risk genetically higher risk genetically higher risk genetically um it's um it's um it's it's studies looking at the response to it's studies looking at the response to it's studies looking at the response to exercise with respect to exercise with respect to exercise with respect to um you know the sex differences but like um you know the sex differences but like um you know the sex differences but like as you mentioned like there's definitely as you mentioned like there's definitely as you mentioned like there's definitely differences with respect to their you differences with respect to their you differences with respect to their you know Alzheimer's disease risk know Alzheimer's disease risk know Alzheimer's disease risk um so and I I do know like there are um so and I I do know like there are um so and I I do know like there are there are there are there are um um different mechanisms that could you know different mechanisms that could you know different mechanisms that could you know like so women have different like like so women have different like like so women have different like there's different metabolic responses to there's different metabolic responses to there's different metabolic responses to exercise maybe also uh you know exercise maybe also uh you know exercise maybe also uh you know hormonally different I I'm just like hormonally different I I'm just like hormonally different I I'm just like this this would make sense right like I this this would make sense right like I this this would make sense right like I don't know that this has all been don't know that this has all been don't know that this has all been studied I haven't seen that data but studied I haven't seen that data but studied I haven't seen that data but like hormonally different responses to like hormonally different responses to like hormonally different responses to exercise that would be plausible immune exercise that would be plausible immune exercise that would be plausible immune system effects as well you know there's system effects as well you know there's system effects as well you know there's there's so many exercises affecting the

1:33there's so many exercises affecting the there's so many exercises affecting the immune system so we haven't even talked immune system so we haven't even talked immune system so we haven't even talked about like myokines like these are like about like myokines like these are like about like myokines like these are like you know these are molecules being you know these are molecules being you know these are molecules being secreted by our muscles we talked about secreted by our muscles we talked about secreted by our muscles we talked about lactate that's not a myokine that's a lactate that's not a myokine that's a lactate that's not a myokine that's a you know it's a metabolite but I mean you know it's a metabolite but I mean you know it's a metabolite but I mean we're physical activity when we force we're physical activity when we force we're physical activity when we force our muscles to work hard we're making our muscles to work hard we're making our muscles to work hard we're making something called a myokine sometimes something called a myokine sometimes something called a myokine sometimes it's referred to as an extra kind but it's referred to as an extra kind but it's referred to as an extra kind but like this is you know this is irisin is like this is you know this is irisin is like this is you know this is irisin is one il-6 is another one il-6 is another one il-6 is another um there's there's other ones as well um there's there's other ones as well um there's there's other ones as well but like these these are also affecting but like these these are also affecting but like these these are also affecting the brain and they're effective in the brain and they're effective in the brain and they're effective in cancer risk right there may be cancer risk right there may be cancer risk right there may be differences in in respect to like differences in in respect to like differences in in respect to like myokines that are being secreted uh with myokines that are being secreted uh with myokines that are being secreted uh with with respect to how um you know the with respect to how um you know the with respect to how um you know the stress of exercise how how that response stress of exercise how how that response stress of exercise how how that response is happening is happening is happening um let's dive into that let's talk about um let's dive into that let's talk about um let's dive into that let's talk about cancer because Rhonda while I think both cancer because Rhonda while I think both cancer because Rhonda while I think both of us are and and I think there are of us are and and I think there are of us are and and I think there are others who share this point of view others who share this point of view others who share this point of view completely convinced uh and I in fact I completely convinced uh and I in fact I completely convinced uh and I in fact I just don't see how one could not be at just don't see how one could not be at just don't see how one could not be at this point convinced of the benefit that

1:34this point convinced of the benefit that this point convinced of the benefit that exercise poses to the brain exercise poses to the brain exercise poses to the brain it seems much harder to make the case it seems much harder to make the case it seems much harder to make the case for cancer in fact when you think about for cancer in fact when you think about for cancer in fact when you think about some of the things that are such obvious some of the things that are such obvious some of the things that are such obvious problems with respect to dementia for problems with respect to dementia for problems with respect to dementia for example disrupted sleep poor exercise example disrupted sleep poor exercise example disrupted sleep poor exercise Etc clear relationship Etc clear relationship Etc clear relationship very hard at least for me to make the very hard at least for me to make the very hard at least for me to make the case that bad sleep is related to cancer case that bad sleep is related to cancer case that bad sleep is related to cancer although I think it is right but I don't although I think it is right but I don't although I think it is right but I don't the data aren't clear right like you can the data aren't clear right like you can the data aren't clear right like you can certainly make the case that horrible certainly make the case that horrible certainly make the case that horrible sleep would lead to a weakened immune sleep would lead to a weakened immune sleep would lead to a weakened immune system a weakened immune system system a weakened immune system system a weakened immune system especially the cellular system more than especially the cellular system more than especially the cellular system more than the humeral system the humeral system the humeral system would easily lead to an increase in not would easily lead to an increase in not would easily lead to an increase in not necessarily cancer initiation but cancer necessarily cancer initiation but cancer necessarily cancer initiation but cancer propagation propagation propagation but again the data are are so much less but again the data are are so much less but again the data are are so much less obvious let's talk about this obvious let's talk about this obvious let's talk about this relationship between exercise and cancer relationship between exercise and cancer relationship between exercise and cancer right on the surface it should make right on the surface it should make right on the surface it should make sense

1:35sense sense exercise is good cancer is bad more exercise is good cancer is bad more exercise is good cancer is bad more exercise should mean less cancer how exercise should mean less cancer how exercise should mean less cancer how compelling are the data and I'll admit compelling are the data and I'll admit compelling are the data and I'll admit that I haven't that I haven't that I haven't gone as deep here as I have on gone as deep here as I have on gone as deep here as I have on cardiovascular disease and cardiovascular disease and cardiovascular disease and neurodegenerative disease neurodegenerative disease neurodegenerative disease so I it's also another area that I'm so I it's also another area that I'm so I it's also another area that I'm very very interested in because I mean very very interested in because I mean very very interested in because I mean as you start to get into your fourth as you start to get into your fourth as you start to get into your fourth decade of life you like you've you've decade of life you like you've you've decade of life you like you've you've now had a friend or a family member that now had a friend or a family member that now had a friend or a family member that has come down with cancer and you see has come down with cancer and you see has come down with cancer and you see just I mean I mean you're a physician so just I mean I mean you're a physician so just I mean I mean you're a physician so of course you've you've experienced it of course you've you've experienced it of course you've you've experienced it on you know at a different level but on you know at a different level but on you know at a different level but like you just see how terrible it is you like you just see how terrible it is you like you just see how terrible it is you know to get cancer and know to get cancer and know to get cancer and um in like and that it really the best um in like and that it really the best um in like and that it really the best best hope is best hope is best hope is obviously to try to not get it to obviously to try to not get it to obviously to try to not get it to prevent and there are as you mentioned prevent and there are as you mentioned prevent and there are as you mentioned there are things that I mean there there there are things that I mean there there there are things that I mean there there are definitely things that uh can are definitely things that uh can are definitely things that uh can modulate that risk that are a little you modulate that risk that are a little you modulate that risk that are a little you know genetic you know Wise that are know genetic you know Wise that are know genetic you know Wise that are harder to kind of move the needle but um

1:36harder to kind of move the needle but um harder to kind of move the needle but um overall so with respect to cancer overall so with respect to cancer overall so with respect to cancer incidents it's interesting if you look incidents it's interesting if you look incidents it's interesting if you look at like you you were talking about some at like you you were talking about some at like you you were talking about some of these elite elite athletes right I of these elite elite athletes right I of these elite elite athletes right I mean like people winning the Tour de mean like people winning the Tour de mean like people winning the Tour de France and uh people that are Olympic France and uh people that are Olympic France and uh people that are Olympic medalists or maybe that have even just medalists or maybe that have even just medalists or maybe that have even just entered the Olympics I mean you have to entered the Olympics I mean you have to entered the Olympics I mean you have to be quite an athlete to just get into the be quite an athlete to just get into the be quite an athlete to just get into the Olympics right and there's been a lot of Olympics right and there's been a lot of Olympics right and there's been a lot of interesting studies quite a quite a few interesting studies quite a quite a few interesting studies quite a quite a few um that I have seen and you know this is um that I have seen and you know this is um that I have seen and you know this is these are studies where these are studies where these are studies where um you know observational data again um um you know observational data again um um you know observational data again um so obvious obviously caveat with that so obvious obviously caveat with that so obvious obviously caveat with that looking at people looking at people looking at people um that have just entered the Olympics um that have just entered the Olympics um that have just entered the Olympics and you know over the course of like and you know over the course of like and you know over the course of like from 1912 to 2010 or something like that from 1912 to 2010 or something like that from 1912 to 2010 or something like that like you know just decades and looked at like you know just decades and looked at like you know just decades and looked at all cause mortality cancer-related all cause mortality cancer-related all cause mortality cancer-related mortality and compared it to like the mortality and compared it to like the mortality and compared it to like the general population so there's a couple general population so there's a couple general population so there's a couple of studies that have come out of the U.S of studies that have come out of the U.S of studies that have come out of the U.S and if you look at you know both of and if you look at you know both of and if you look at you know both of those studies one of them was actually those studies one of them was actually those studies one of them was actually looking at medalists and the other one looking at medalists and the other one looking at medalists and the other one was just looking at people that like was just looking at people that like was just looking at people that like were in entered the Olympics

1:37were in entered the Olympics were in entered the Olympics um they they saved about one and a half um they they saved about one and a half um they they saved about one and a half to two years like in in other words they to two years like in in other words they to two years like in in other words they were of life from not getting cancer and were of life from not getting cancer and were of life from not getting cancer and about five to six of just basically they about five to six of just basically they about five to six of just basically they they had a five to six year they had a five to six year they had a five to six year um what you could call lifespan um what you could call lifespan um what you could call lifespan extension compared to the general extension compared to the general extension compared to the general population same with like French uh population same with like French uh population same with like French uh French Olympians as well some very French Olympians as well some very French Olympians as well some very similar where it was like you know five similar where it was like you know five similar where it was like you know five years they lived on average five years years they lived on average five years years they lived on average five years longer than people you know than the longer than people you know than the longer than people you know than the general population and they were there general population and they were there general population and they were there it was attributed that they basically it was attributed that they basically it was attributed that they basically saved you know two years of life from saved you know two years of life from saved you know two years of life from not getting and dying from cancer not getting and dying from cancer not getting and dying from cancer um I guess I should say dying from um I guess I should say dying from um I guess I should say dying from cancer because they are two different cancer because they are two different cancer because they are two different things but that would be like at the things but that would be like at the things but that would be like at the elite level and it's interesting because elite level and it's interesting because elite level and it's interesting because you go well two years are just like you go well two years are just like you go well two years are just like that's it I mean that's kind of I that's that's it I mean that's kind of I that's that's it I mean that's kind of I that's how I see it I'm like really like two how I see it I'm like really like two how I see it I'm like really like two years um it's funny because I remember years um it's funny because I remember years um it's funny because I remember when I was a postdoc my my postdoctoral when I was a postdoc my my postdoctoral when I was a postdoc my my postdoctoral mentor Bruce Ames mentor Bruce Ames mentor Bruce Ames um he had said to me once or actually um he had said to me once or actually um he had said to me once or actually more than once um you know I once read

1:38more than once um you know I once read more than once um you know I once read you know there's of all the things that you know there's of all the things that you know there's of all the things that you can do like if you prevent cancer you can do like if you prevent cancer you can do like if you prevent cancer you really only save about two years of you really only save about two years of you really only save about two years of your life your life your life and I always thought I'm like no way no and I always thought I'm like no way no and I always thought I'm like no way no way way way um but anyways um so so that would be um but anyways um so so that would be um but anyways um so so that would be like at the extreme extreme end when like at the extreme extreme end when like at the extreme extreme end when you're looking at the the you know the you're looking at the the you know the you're looking at the the you know the actual athletes actual athletes actual athletes um they are they're definitely less um they are they're definitely less um they are they're definitely less likely to die from cancer than than likely to die from cancer than than likely to die from cancer than than general population people but when you general population people but when you general population people but when you look when you're talking about look when you're talking about look when you're talking about prevention so there's a difference prevention so there's a difference prevention so there's a difference between between between you know if you read a study and it says you know if you read a study and it says you know if you read a study and it says you know people that are Physically you know people that are Physically you know people that are Physically Active are X percent less likely to to Active are X percent less likely to to Active are X percent less likely to to you know die from cancer like cancer so you know die from cancer like cancer so you know die from cancer like cancer so cancer mortality is decreased that's not cancer mortality is decreased that's not cancer mortality is decreased that's not necessarily the same thing as not necessarily the same thing as not necessarily the same thing as not getting cancer right that just means getting cancer right that just means getting cancer right that just means you're not dying from cancer uh so the you're not dying from cancer uh so the you're not dying from cancer uh so the study is looking at cancer prevention study is looking at cancer prevention study is looking at cancer prevention really seem to focus on a specific type really seem to focus on a specific type really seem to focus on a specific type of exercise and that is aerobic exercise of exercise and that is aerobic exercise of exercise and that is aerobic exercise for whatever reason there's not a lot of for whatever reason there's not a lot of for whatever reason there's not a lot of literature on strength training and

1:39literature on strength training and literature on strength training and cancer prevention you you can find uh cancer prevention you you can find uh cancer prevention you you can find uh studies on you know strength training studies on you know strength training studies on you know strength training and cancer-related mortality but with and cancer-related mortality but with and cancer-related mortality but with prevention I really um it's it's sort of prevention I really um it's it's sort of prevention I really um it's it's sort of focused on for whatever reason on focused on for whatever reason on focused on for whatever reason on aerobic exercise and it does seem like aerobic exercise and it does seem like aerobic exercise and it does seem like there are certain types of cancer that there are certain types of cancer that there are certain types of cancer that are more responsive are more responsive are more responsive to exercise with respect to um you know to exercise with respect to um you know to exercise with respect to um you know basically having a reduced risk and some basically having a reduced risk and some basically having a reduced risk and some of those cancers are ones that that are of those cancers are ones that that are of those cancers are ones that that are we should care about so breast cancer we should care about so breast cancer we should care about so breast cancer you know what's the lifetime risk of you know what's the lifetime risk of you know what's the lifetime risk of breast cancer for a woman it's about one breast cancer for a woman it's about one breast cancer for a woman it's about one in eight it's pretty pretty high for the in eight it's pretty pretty high for the in eight it's pretty pretty high for the average woman right average woman right average woman right um of course many different lifestyle um of course many different lifestyle um of course many different lifestyle factors play into that and exercise you factors play into that and exercise you factors play into that and exercise you know is is one of those factors know is is one of those factors know is is one of those factors colon cancer is another one that seems colon cancer is another one that seems colon cancer is another one that seems to be quite responsive to be quite responsive to be quite responsive um lifetime risk of colon cancer for um lifetime risk of colon cancer for um lifetime risk of colon cancer for average woman is like 1 in 23 for a man average woman is like 1 in 23 for a man average woman is like 1 in 23 for a man it's like 1 in 25 or something like that

1:40it's like 1 in 25 or something like that it's like 1 in 25 or something like that the reason I'm mentioning as as you know the reason I'm mentioning as as you know the reason I'm mentioning as as you know Peter lifetime risk of can't like if Peter lifetime risk of can't like if Peter lifetime risk of can't like if you're talking about like esophageal you're talking about like esophageal you're talking about like esophageal cancer some cancer where it's like one cancer some cancer where it's like one cancer some cancer where it's like one in 500 I mean you're more likely to die in 500 I mean you're more likely to die in 500 I mean you're more likely to die in a car wreck than get esophageal like in a car wreck than get esophageal like in a car wreck than get esophageal like you know one of those cancers I think it you know one of those cancers I think it you know one of those cancers I think it was esophageal cancer but you get my was esophageal cancer but you get my was esophageal cancer but you get my point where the lifetime risk is is point where the lifetime risk is is point where the lifetime risk is is already kind of you know quite low for already kind of you know quite low for already kind of you know quite low for for the general person or the average for the general person or the average for the general person or the average person person person um so so breast cancer colon cancer and um so so breast cancer colon cancer and um so so breast cancer colon cancer and then uh there's a few other cancer types then uh there's a few other cancer types then uh there's a few other cancer types that are are quite responsive but those that are are quite responsive but those that are are quite responsive but those two in particular kind of stand up two in particular kind of stand up two in particular kind of stand up because with prevention because with prevention because with prevention um and also with like with respect to um and also with like with respect to um and also with like with respect to people that are diagnosed with cancer people that are diagnosed with cancer people that are diagnosed with cancer and have those cancers and then they and have those cancers and then they and have those cancers and then they engage in physical activity as well engage in physical activity as well engage in physical activity as well um it's very like you see a very robust um it's very like you see a very robust um it's very like you see a very robust response with respect to like reducing response with respect to like reducing response with respect to like reducing cancer mortality and also recurrence cancer mortality and also recurrence cancer mortality and also recurrence being you know being you know it's like being you know being you know it's like being you know being you know it's like 50 like so you see like you know cancer 50 like so you see like you know cancer 50 like so you see like you know cancer mortality is reduced by a 50 cancer mortality is reduced by a 50 cancer mortality is reduced by a 50 cancer recurrence is reduced by 50 in those recurrence is reduced by 50 in those recurrence is reduced by 50 in those individuals diagnosed with breast or

1:41individuals diagnosed with breast or individuals diagnosed with breast or colon cancer or colorectal cancer that colon cancer or colorectal cancer that colon cancer or colorectal cancer that are engaging in more physical activity are engaging in more physical activity are engaging in more physical activity so the question is well how much and you so the question is well how much and you so the question is well how much and you mentioned like you have a lot more mentioned like you have a lot more mentioned like you have a lot more knowledge with respect to cardiovascular knowledge with respect to cardiovascular knowledge with respect to cardiovascular disease and I would argue the data disease and I would argue the data disease and I would argue the data really I would say really I would say really I would say suggests that you actually probably need suggests that you actually probably need suggests that you actually probably need to do more exercise to do more exercise to do more exercise um to sort of reap the cancer um to sort of reap the cancer um to sort of reap the cancer preventative benef benefits then you do preventative benef benefits then you do preventative benef benefits then you do cardiovascular benefits you know even cardiovascular benefits you know even cardiovascular benefits you know even you know some of the metabolic benefits you know some of the metabolic benefits you know some of the metabolic benefits and I don't know why that is but um it and I don't know why that is but um it and I don't know why that is but um it seems as though you know like like seems as though you know like like seems as though you know like like getting more to that upper limit of what getting more to that upper limit of what getting more to that upper limit of what these you know committees are these you know committees are these you know committees are recommending so 300 minutes a week of recommending so 300 minutes a week of recommending so 300 minutes a week of moderate intensity exercise moderate intensity exercise moderate intensity exercise um or maybe 150 minutes more of like um or maybe 150 minutes more of like um or maybe 150 minutes more of like what they would Define as vigorous which what they would Define as vigorous which what they would Define as vigorous which actually I think is a little bit their actually I think is a little bit their actually I think is a little bit their vigorous is a little bit below what my vigorous is a little bit below what my vigorous is a little bit below what my definition would be but um anyway so definition would be but um anyway so definition would be but um anyway so so it seems like the the the amount of so it seems like the the the amount of so it seems like the the the amount of exercise you actually have to put in a

1:42exercise you actually have to put in a exercise you actually have to put in a little bit more time and effort for for little bit more time and effort for for little bit more time and effort for for the cancer but any any amount is the cancer but any any amount is the cancer but any any amount is beneficial so it's not like you know oh beneficial so it's not like you know oh beneficial so it's not like you know oh well I can't do 300 minutes therefore I well I can't do 300 minutes therefore I well I can't do 300 minutes therefore I shouldn't even care well that's not true shouldn't even care well that's not true shouldn't even care well that's not true because there is there are benefits you because there is there are benefits you because there is there are benefits you know even with like any type of physical know even with like any type of physical know even with like any type of physical activity uh so you know activity uh so you know activity uh so you know that's all the observational data and that's all the observational data and that's all the observational data and you can find anywhere between a 10 to 20 you can find anywhere between a 10 to 20 you can find anywhere between a 10 to 20 reduction in basically people are that reduction in basically people are that reduction in basically people are that you know they're less likely to get you know they're less likely to get you know they're less likely to get can't you know breast or colorectal can't you know breast or colorectal can't you know breast or colorectal cancer 10 to 20 again when you're cancer 10 to 20 again when you're cancer 10 to 20 again when you're talking about a type of cancer with a talking about a type of cancer with a talking about a type of cancer with a with a higher lifetime risk with a higher lifetime risk with a higher lifetime risk um it makes more it's it's more um it makes more it's it's more um it makes more it's it's more compelling right compelling right compelling right um so I'd be curious to see if the data um so I'd be curious to see if the data um so I'd be curious to see if the data line up with the cancers that are known line up with the cancers that are known line up with the cancers that are known to increase in Risk due to obesity so to increase in Risk due to obesity so to increase in Risk due to obesity so right after smoking obesity is obviously right after smoking obesity is obviously right after smoking obesity is obviously the second leading uh modifiable risk the second leading uh modifiable risk the second leading uh modifiable risk factor associated with cancer factor associated with cancer factor associated with cancer I've always thought that was an I've always thought that was an I've always thought that was an oversimplification because we use

1:43oversimplification because we use oversimplification because we use obesity as a proxy but I think it's obesity as a proxy but I think it's obesity as a proxy but I think it's probably insulin resistance that's the probably insulin resistance that's the probably insulin resistance that's the true marker that obesity is serving as a true marker that obesity is serving as a true marker that obesity is serving as a poor man's version of poor man's version of poor man's version of um it would be interesting to see um it would be interesting to see um it would be interesting to see because there are certain cancers because there are certain cancers because there are certain cancers including breast and colorectal by the including breast and colorectal by the including breast and colorectal by the way where obesity amplifies risk there way where obesity amplifies risk there way where obesity amplifies risk there are other cancers where obesity doesn't are other cancers where obesity doesn't are other cancers where obesity doesn't seem to play as much of a role it would seem to play as much of a role it would seem to play as much of a role it would be very interesting to align the be very interesting to align the be very interesting to align the exercise data with the Obesity insulin exercise data with the Obesity insulin exercise data with the Obesity insulin resistance data and see if exercise is resistance data and see if exercise is resistance data and see if exercise is disproportionately reducing risk in disproportionately reducing risk in disproportionately reducing risk in those cancers for which obesity is a those cancers for which obesity is a those cancers for which obesity is a risk risk such a good point Peter and I think such a good point Peter and I think such a good point Peter and I think there is at least some data to suggest there is at least some data to suggest there is at least some data to suggest that you are correct with that so that you are correct with that so that you are correct with that so um I mean what is there like 13 or so um I mean what is there like 13 or so um I mean what is there like 13 or so cancer types that like obesity is yeah cancer types that like obesity is yeah cancer types that like obesity is yeah it's either 13 or 17 something like that it's either 13 or 17 something like that it's either 13 or 17 something like that yeah yeah and yeah yeah and yeah yeah and um and and and breast and colorectal

1:44um and and and breast and colorectal um and and and breast and colorectal cancer are on that list and so um yes so cancer are on that list and so um yes so cancer are on that list and so um yes so it the aerobic exercise it the aerobic exercise it the aerobic exercise um it you know there's I think there's um it you know there's I think there's um it you know there's I think there's direct mechanism so like you know direct mechanism so like you know direct mechanism so like you know aerobic exercise is you know directly aerobic exercise is you know directly aerobic exercise is you know directly you're making those Maya kinds and like you're making those Maya kinds and like you're making those Maya kinds and like you know some of these myokines have you know some of these myokines have you know some of these myokines have been shown to to basically been shown to to basically been shown to to basically um decrease the production of like um decrease the production of like um decrease the production of like growth factors created from cancer cells growth factors created from cancer cells growth factors created from cancer cells and they're like they also like kill you and they're like they also like kill you and they're like they also like kill you know are killing cancer cells know are killing cancer cells know are killing cancer cells um uh you know through a variety of um uh you know through a variety of um uh you know through a variety of other mechanisms also the other mechanisms also the other mechanisms also the anti-inflammatory effect you know from anti-inflammatory effect you know from anti-inflammatory effect you know from from exercise as well so you're you're from exercise as well so you're you're from exercise as well so you're you're having a strong anti-inflammatory having a strong anti-inflammatory having a strong anti-inflammatory response but back also like there is a response but back also like there is a response but back also like there is a little bit of that okay well exercise is little bit of that okay well exercise is little bit of that okay well exercise is also like improving insulin sensitivity also like improving insulin sensitivity also like improving insulin sensitivity and it's you know your in combination is and it's you know your in combination is and it's you know your in combination is particularly in combination with dietary particularly in combination with dietary particularly in combination with dietary strategies weight loss you know your the strategies weight loss you know your the strategies weight loss you know your the weight loss itself is is basically a weight loss itself is is basically a weight loss itself is is basically a important component of the cancer

1:45important component of the cancer important component of the cancer reduced cancer risk so I think you're reduced cancer risk so I think you're reduced cancer risk so I think you're totally I think it's a combination of totally I think it's a combination of totally I think it's a combination of these things where it's like the the these things where it's like the the these things where it's like the the Direct effects from from exercise and Direct effects from from exercise and Direct effects from from exercise and there's also you know it's really there's also you know it's really there's also you know it's really interesting because as I mentioned interesting because as I mentioned interesting because as I mentioned people that even have cancer people that even have cancer people that even have cancer um the the the um the the the um the the the response like it it seems like you know response like it it seems like you know response like it it seems like you know physical activity like I am not an physical activity like I am not an physical activity like I am not an oncologist and you know many more oncologist and you know many more oncologist and you know many more oncologists than I do I don't know that oncologists than I do I don't know that oncologists than I do I don't know that I've you know I don't know how common it I've you know I don't know how common it I've you know I don't know how common it is for for oncologist to prescribe is for for oncologist to prescribe is for for oncologist to prescribe exercise as an adjunct exercise as an adjunct exercise as an adjunct um sort of treatment to you know um sort of treatment to you know um sort of treatment to you know whatever the person you know whatever whatever the person you know whatever whatever the person you know whatever type of treatment whether it's type of treatment whether it's type of treatment whether it's immunotherapy or radiation or immunotherapy or radiation or immunotherapy or radiation or chemotherapy or a combination whatever chemotherapy or a combination whatever chemotherapy or a combination whatever um I I don't know how common it is but um I I don't know how common it is but um I I don't know how common it is but um the the data is more and more um the the data is more and more um the the data is more and more compelling and I think it's become more compelling and I think it's become more compelling and I think it's become more and more compelling over the years that and more compelling over the years that and more compelling over the years that really uh really uh really uh exercising is it seems to be very

1:46exercising is it seems to be very exercising is it seems to be very important for reducing cancer metastasis important for reducing cancer metastasis important for reducing cancer metastasis and also dramatically and you know and also dramatically and you know and also dramatically and you know decreasing cancer recurrence and so a decreasing cancer recurrence and so a decreasing cancer recurrence and so a really interesting mechanism by which really interesting mechanism by which really interesting mechanism by which this is likely occurring is literally this is likely occurring is literally this is likely occurring is literally through that Shear Force mechanism I was through that Shear Force mechanism I was through that Shear Force mechanism I was describing for the brain well describing for the brain well describing for the brain well as you know you know cancer cells tumor as you know you know cancer cells tumor as you know you know cancer cells tumor cells sort of escape the site of the cells sort of escape the site of the cells sort of escape the site of the tumor and they make their way into tumor and they make their way into tumor and they make their way into circulation it's called a circulating circulation it's called a circulating circulation it's called a circulating tumor cell or circulating cancer cell tumor cell or circulating cancer cell tumor cell or circulating cancer cell depending on the study you read and you depending on the study you read and you depending on the study you read and you know these circulating tumor cells are know these circulating tumor cells are know these circulating tumor cells are like traveling throughout the vascular like traveling throughout the vascular like traveling throughout the vascular system to distance sites and they sort system to distance sites and they sort system to distance sites and they sort of take camp and then like it's like of take camp and then like it's like of take camp and then like it's like kind of seed of you know a new tumor kind of seed of you know a new tumor kind of seed of you know a new tumor forming in another tissue forming in another tissue forming in another tissue um well it's really interesting because um well it's really interesting because um well it's really interesting because these cancer cells cancer cells are so these cancer cells cancer cells are so these cancer cells cancer cells are so messed up as you know like they're just messed up as you know like they're just messed up as you know like they're just they're like they're completely wonky they're like they're completely wonky they're like they're completely wonky and very very sensitive to stress any

1:47and very very sensitive to stress any and very very sensitive to stress any type of stress they have these type of stress they have these type of stress they have these mechanical mechanoreceptors on their mechanical mechanoreceptors on their mechanical mechanoreceptors on their cell surface that are responsive to cell surface that are responsive to cell surface that are responsive to force Shear Force so when you get your force Shear Force so when you get your force Shear Force so when you get your blood pumping it's like it's like a blood pumping it's like it's like a blood pumping it's like it's like a hurricane that like just wipes it out hurricane that like just wipes it out hurricane that like just wipes it out they die because they can't they can't they die because they can't they can't they die because they can't they can't they can't stand just the sheer force of they can't stand just the sheer force of they can't stand just the sheer force of the blood flow through you know the the blood flow through you know the the blood flow through you know the vascular system and so so and this is vascular system and so so and this is vascular system and so so and this is where you'll see you know studies you where you'll see you know studies you where you'll see you know studies you can sort of pair it so you compare the can sort of pair it so you compare the can sort of pair it so you compare the mechanistic studies and they've been mechanistic studies and they've been mechanistic studies and they've been there have been some studies looking at there have been some studies looking at there have been some studies looking at circulating cancer cells and it's like circulating cancer cells and it's like circulating cancer cells and it's like people with those are like three times people with those are like three times people with those are like three times more likely more likely more likely to have cancer metastasis and um and so to have cancer metastasis and um and so to have cancer metastasis and um and so on but um they're they're again there on but um they're they're again there on but um they're they're again there are studies showing that like physical are studies showing that like physical are studies showing that like physical activity like dramatically decreases and activity like dramatically decreases and activity like dramatically decreases and this there's been randomized trials this there's been randomized trials this there's been randomized trials showing it dramatically decreases showing it dramatically decreases showing it dramatically decreases circulating cancer cells in people circulating cancer cells in people circulating cancer cells in people um compared to whatever their the other um compared to whatever their the other um compared to whatever their the other you know standard treatment that they're you know standard treatment that they're you know standard treatment that they're you know being given you know being given you know being given um and so like kind of pairing that data

1:48um and so like kind of pairing that data um and so like kind of pairing that data with looking at you know other data with looking at you know other data with looking at you know other data where exercises is being prescribed to where exercises is being prescribed to where exercises is being prescribed to to patients and it is beneficial with to patients and it is beneficial with to patients and it is beneficial with respect to their cancer metastasis respect to their cancer metastasis respect to their cancer metastasis reduction and also mortality reduction reduction and also mortality reduction reduction and also mortality reduction you know like 50 mortality reduction you you know like 50 mortality reduction you you know like 50 mortality reduction you know versus recurrence as well so I do know versus recurrence as well so I do know versus recurrence as well so I do think think think there is substantial evidence to suggest there is substantial evidence to suggest there is substantial evidence to suggest that being Physically Active is a good that being Physically Active is a good that being Physically Active is a good measure measure measure um for cancer prevention and you know I um for cancer prevention and you know I um for cancer prevention and you know I don't again there's also a lot of don't again there's also a lot of don't again there's also a lot of differences there are sex differences as differences there are sex differences as differences there are sex differences as well like I don't know why but in some well like I don't know why but in some well like I don't know why but in some cases women respond better cases women respond better cases women respond better um you know and there's certain cancer um you know and there's certain cancer um you know and there's certain cancer types that respond better lots of types that respond better lots of types that respond better lots of variables here like I'm I feel like I'm variables here like I'm I feel like I'm variables here like I'm I feel like I'm speaking in a general way but like but speaking in a general way but like but speaking in a general way but like but like there are lots of things to like there are lots of things to like there are lots of things to consider right there are cancer types consider right there are cancer types consider right there are cancer types and and there are sex effects and there and and there are sex effects and there and and there are sex effects and there are as you mentioned other covariates are as you mentioned other covariates are as you mentioned other covariates there's obesity and there's you know

1:49there's obesity and there's you know there's obesity and there's you know insulin resistance and age as well so I insulin resistance and age as well so I insulin resistance and age as well so I mean there are lots of nuanced as as mean there are lots of nuanced as as mean there are lots of nuanced as as usual but I do think that you can make usual but I do think that you can make usual but I do think that you can make the case that like if you like what can the case that like if you like what can the case that like if you like what can I do you know in my life to reduce you I do you know in my life to reduce you I do you know in my life to reduce you know reduce my my my risk of getting know reduce my my my risk of getting know reduce my my my risk of getting cancer reduce my risk of dying from cancer reduce my risk of dying from cancer reduce my risk of dying from cancer reduce my risk of getting cancer reduce my risk of getting cancer reduce my risk of getting Alzheimer's disease reduce my ribs from Alzheimer's disease reduce my ribs from Alzheimer's disease reduce my ribs from getting dementia reduce members from getting dementia reduce members from getting dementia reduce members from getting cardiovascular disease reduce my getting cardiovascular disease reduce my getting cardiovascular disease reduce my risk for type 2 diabetes like the only risk for type 2 diabetes like the only risk for type 2 diabetes like the only Panacea there is is exercise it's Panacea there is is exercise it's Panacea there is is exercise it's exercise right I mean that that is it is exercise right I mean that that is it is exercise right I mean that that is it is it is the case and it is the case and it is the case and um unfortunately it's the thing that you um unfortunately it's the thing that you um unfortunately it's the thing that you have to put the most effort in it's have to put the most effort in it's have to put the most effort in it's certainly a lot easier to take a certainly a lot easier to take a certainly a lot easier to take a supplement to take a pill supplement to take a pill supplement to take a pill I do think there is an argument that I do think there is an argument that I do think there is an argument that omega-3 is one of the omega-3 is one of the omega-3 is one of the it's up there I think I think getting it's up there I think I think getting it's up there I think I think getting yourself to a good omega-3 status and yourself to a good omega-3 status and yourself to a good omega-3 status and defining what that is is still like defining what that is is still like defining what that is is still like being investigated but

1:50being investigated but being investigated but um I do think that's a low-hanging fruit um I do think that's a low-hanging fruit um I do think that's a low-hanging fruit that should not be ignored but exercise that should not be ignored but exercise that should not be ignored but exercise as you've talked about many of times is as you've talked about many of times is as you've talked about many of times is the king is the king the king is the king the king is the king um and and that's that's the thing that um and and that's that's the thing that um and and that's that's the thing that you should focus on if you I mean any I you should focus on if you I mean any I you should focus on if you I mean any I mean obviously if you're obese weight mean obviously if you're obese weight mean obviously if you're obese weight loss exercise is part of that program loss exercise is part of that program loss exercise is part of that program and like like I don't think that anyone and like like I don't think that anyone and like like I don't think that anyone that's obese would be worrying about all that's obese would be worrying about all that's obese would be worrying about all the other things like they need to like the other things like they need to like the other things like they need to like lose weight and any personal trainer and lose weight and any personal trainer and lose weight and any personal trainer and Coach like probably is going to help you Coach like probably is going to help you Coach like probably is going to help you do that like just you eat less like do that like just you eat less like do that like just you eat less like that's calories and calories out it like that's calories and calories out it like that's calories and calories out it like matters to some degree like if you're matters to some degree like if you're matters to some degree like if you're not eating as much yeah but but as you not eating as much yeah but but as you not eating as much yeah but but as you said exercise matters not just on the said exercise matters not just on the said exercise matters not just on the energy balance side but exercise makes energy balance side but exercise makes energy balance side but exercise makes you for example more sensitive to you for example more sensitive to you for example more sensitive to satiety hormones so satiety hormones so satiety hormones so um you know look I I have kind of a um you know look I I have kind of a um you know look I I have kind of a belief here that the the person who is belief here that the the person who is belief here that the the person who is overweight uh the person who is obese overweight uh the person who is obese overweight uh the person who is obese and who is clearly eating more than they and who is clearly eating more than they and who is clearly eating more than they should be uh isn't doing that by choice

1:51should be uh isn't doing that by choice should be uh isn't doing that by choice maybe some are but but for the most part maybe some are but but for the most part maybe some are but but for the most part it's hard for me to imagine there's it's hard for me to imagine there's it's hard for me to imagine there's someone who's listening to this who's someone who's listening to this who's someone who's listening to this who's obese obese obese who isn't wanting to not be obese and who isn't wanting to not be obese and who isn't wanting to not be obese and who is otherwise struggling with Hunger who is otherwise struggling with Hunger who is otherwise struggling with Hunger right right um and I think that you know that's one um and I think that you know that's one um and I think that you know that's one of the challenges is why is it that a of the challenges is why is it that a of the challenges is why is it that a person who is not in energy balance is person who is not in energy balance is person who is not in energy balance is not responding to the normal satiety not responding to the normal satiety not responding to the normal satiety signals and I think there's a lot of signals and I think there's a lot of signals and I think there's a lot of reasons on the food science side we reasons on the food science side we reasons on the food science side we could talk about a whole bunch of could talk about a whole bunch of could talk about a whole bunch of reasons why our food has been hijacked reasons why our food has been hijacked reasons why our food has been hijacked our food is void of nutrients our food our food is void of nutrients our food our food is void of nutrients our food is hyper palatable it's far too is hyper palatable it's far too is hyper palatable it's far too available there's a whole bunch of available there's a whole bunch of available there's a whole bunch of reasons but I think one thing that reasons but I think one thing that reasons but I think one thing that doesn't get enough attention is this doesn't get enough attention is this doesn't get enough attention is this thing which is an exercising person has thing which is an exercising person has thing which is an exercising person has a better sense of nutrient requirement a better sense of nutrient requirement a better sense of nutrient requirement they have a better their body they have a better their body they have a better their body physiologically is more in tune with physiologically is more in tune with physiologically is more in tune with their repetitive needs and so even their repetitive needs and so even their repetitive needs and so even though I don't think exercise matters as

1:52though I don't think exercise matters as though I don't think exercise matters as much as intake purely on the energy much as intake purely on the energy much as intake purely on the energy balance side in other words I think it's balance side in other words I think it's balance side in other words I think it's more about reducing input than more about reducing input than more about reducing input than increasing output but a part of that increasing output but a part of that increasing output but a part of that equation is the feedback loop that equation is the feedback loop that equation is the feedback loop that exercise brings so yes exercise brings so yes exercise brings so yes exercise just matters and and I also exercise just matters and and I also exercise just matters and and I also think that think that think that you know especially in this discussion you know especially in this discussion you know especially in this discussion of cancer and breast cancer is the of cancer and breast cancer is the of cancer and breast cancer is the example you brought up example you brought up example you brought up you know so many women are so petrified you know so many women are so petrified you know so many women are so petrified of hormone replacement therapy because of hormone replacement therapy because of hormone replacement therapy because of this awful you know study the Women's of this awful you know study the Women's of this awful you know study the Women's Health Initiative which was completely Health Initiative which was completely Health Initiative which was completely misinterpreted but just to use one misinterpreted but just to use one misinterpreted but just to use one example of what we spoke about example of what we spoke about example of what we spoke about even the people who ran the study who to even the people who ran the study who to even the people who ran the study who to this day some of them at least a subset this day some of them at least a subset this day some of them at least a subset still maintain that conjugated equine still maintain that conjugated equine still maintain that conjugated equine estrogen plus MPA the synthetic estrogen plus MPA the synthetic estrogen plus MPA the synthetic progesterone increased the risk of progesterone increased the risk of progesterone increased the risk of breast cancer even those people will breast cancer even those people will breast cancer even those people will acknowledge it did not increase breast acknowledge it did not increase breast acknowledge it did not increase breast cancer mortality cancer mortality cancer mortality so even if you take the most

1:53so even if you take the most so even if you take the most favorable to the Whi the Women's Health favorable to the Whi the Women's Health favorable to the Whi the Women's Health Initiative study reading Initiative study reading Initiative study reading the reading is that conjugated equine the reading is that conjugated equine the reading is that conjugated equine estrogen plus MPA estrogen plus MPA estrogen plus MPA increased the incidence of breast cancer increased the incidence of breast cancer increased the incidence of breast cancer by 0.1 percent in absolute risk but did by 0.1 percent in absolute risk but did by 0.1 percent in absolute risk but did not increase breast cancer mortality so not increase breast cancer mortality so not increase breast cancer mortality so here you have basically a non-event that here you have basically a non-event that here you have basically a non-event that has most people panicked senseless most has most people panicked senseless most has most people panicked senseless most women panicked senseless when confronted women panicked senseless when confronted women panicked senseless when confronted with taking hormones during the with taking hormones during the with taking hormones during the perimenopausal period perimenopausal period perimenopausal period and yet at the other end of that and yet at the other end of that and yet at the other end of that Spectrum we have a treatment that has Spectrum we have a treatment that has Spectrum we have a treatment that has more than a log fold benefit in the more than a log fold benefit in the more than a log fold benefit in the other direction I.E in reducing risk other direction I.E in reducing risk other direction I.E in reducing risk and I wish I wish people would just and I wish I wish people would just and I wish I wish people would just allow their attention to be allocated allow their attention to be allocated allow their attention to be allocated proportionate to the size of the impact proportionate to the size of the impact proportionate to the size of the impact I'm I'm 100 with you and and with kind I'm I'm 100 with you and and with kind I'm I'm 100 with you and and with kind of to kind of just highlight or of to kind of just highlight or of to kind of just highlight or emphasize what you just said you know

1:54emphasize what you just said you know emphasize what you just said you know there are studies with women who are there are studies with women who are there are studies with women who are doing moderate drinking which I mean doing moderate drinking which I mean doing moderate drinking which I mean depending on the study you read it's depending on the study you read it's depending on the study you read it's like I mean for women moderate drinking like I mean for women moderate drinking like I mean for women moderate drinking is like it's like you know three drinks is like it's like you know three drinks is like it's like you know three drinks a day or something like it's a lot wow a day or something like it's a lot wow a day or something like it's a lot wow um and like that incr like that um and like that incr like that um and like that incr like that literally like translates to a lifetime literally like translates to a lifetime literally like translates to a lifetime risk of breast cancer it's like one in risk of breast cancer it's like one in risk of breast cancer it's like one in six or something like that where it's six or something like that where it's six or something like that where it's pretty significant but you don't hear pretty significant but you don't hear pretty significant but you don't hear about women about women about women petrified of like drinking you know like petrified of like drinking you know like petrified of like drinking you know like two glasses of wine a night two glasses of wine a night two glasses of wine a night um which I mean some people do like it's um which I mean some people do like it's um which I mean some people do like it's you know not it's actually not uncommon you know not it's actually not uncommon you know not it's actually not uncommon um and and so I it's like again it's one um and and so I it's like again it's one um and and so I it's like again it's one of those things that you were saying of those things that you were saying of those things that you were saying where it's like like looking at like where it's like like looking at like where it's like like looking at like what's going to impact my risk more what what's going to impact my risk more what what's going to impact my risk more what is going to lower my risk more like what is going to lower my risk more like what is going to lower my risk more like what should I focus on like what's like the should I focus on like what's like the should I focus on like what's like the most important thing I think obesity most important thing I think obesity most important thing I think obesity does you know it absolutely impacts does you know it absolutely impacts does you know it absolutely impacts breast cancer

1:55breast cancer breast cancer um same with you know physical activity um same with you know physical activity um same with you know physical activity in the opposite direction has it I mean in the opposite direction has it I mean in the opposite direction has it I mean just really enormous benefits and then just really enormous benefits and then just really enormous benefits and then alcohol consumption alcohol consumption alcohol consumption um is another one even even a mild um is another one even even a mild um is another one even even a mild alcohol consumption I would say that alcohol consumption I would say that alcohol consumption I would say that like like I don't want to go there because it's I don't want to go there because it's I don't want to go there because it's like so like so like so it's complicated and I like I can't even it's complicated and I like I can't even it's complicated and I like I can't even like begin like there's there's I've like begin like there's there's I've like begin like there's there's I've gone on there I've gone there Rhonda gone on there I've gone there Rhonda gone on there I've gone there Rhonda I've gone there I'm I go I go out on the I've gone there I'm I go I go out on the I've gone there I'm I go I go out on the limb and I'm gonna say it there is no limb and I'm gonna say it there is no limb and I'm gonna say it there is no amount of alcohol that is healthy amount of alcohol that is healthy amount of alcohol that is healthy um the J curve is a misnomer and what I um the J curve is a misnomer and what I um the J curve is a misnomer and what I think I would say is think I would say is think I would say is somewhere between zero and one there's somewhere between zero and one there's somewhere between zero and one there's probably that much there's not that much probably that much there's not that much probably that much there's not that much of an increase in Risk but there's not a of an increase in Risk but there's not a of an increase in Risk but there's not a reduction in Risk right so the for what reduction in Risk right so the for what reduction in Risk right so the for what for for mortality in general mortality for for mortality in general mortality for for mortality in general mortality yeah yeah yeah yeah yeah so in other yeah yeah yeah yeah yeah so in other yeah yeah yeah yeah yeah so in other words you know they talk about the sort words you know they talk about the sort words you know they talk about the sort of J curve where complete abstinence is of J curve where complete abstinence is of J curve where complete abstinence is a greater risk than you know one drink a a greater risk than you know one drink a a greater risk than you know one drink a day uh but but I think both the day uh but but I think both the day uh but but I think both the mendelian randomization makes that not

1:56mendelian randomization makes that not mendelian randomization makes that not makes it clear that that's not true and makes it clear that that's not true and makes it clear that that's not true and then secondly when you look at all the then secondly when you look at all the then secondly when you look at all the confounders of the people who are confounders of the people who are confounders of the people who are drinking zero drinks and what confounds drinking zero drinks and what confounds drinking zero drinks and what confounds their mortality their mortality their mortality um I I feel very comfortable saying that um I I feel very comfortable saying that um I I feel very comfortable saying that there is no dose of alcohol that is there is no dose of alcohol that is there is no dose of alcohol that is healthy but you know healthy but you know healthy but you know at a very low dose I got probably four at a very low dose I got probably four at a very low dose I got probably four to seven drinks per week it probably has to seven drinks per week it probably has to seven drinks per week it probably has immeasurable immeasurable immeasurable um or pardon me um or pardon me um or pardon me not immeasurable you probably can't not immeasurable you probably can't not immeasurable you probably can't quite quantify the harm quite quantify the harm quite quantify the harm um that that would be my take and and so um that that would be my take and and so um that that would be my take and and so I I I'm I I I'm I I I'm I'm comfortable saying that I really I'm comfortable saying that I really I'm comfortable saying that I really feel confident that that is the case feel confident that that is the case feel confident that that is the case um and that you know things like the um and that you know things like the um and that you know things like the French paradox have far better French paradox have far better French paradox have far better explanations as one example explanations as one example explanations as one example yeah I I I tend to think I mean there's yeah I I I tend to think I mean there's yeah I I I tend to think I mean there's the data is also a mess like you like I the data is also a mess like you like I the data is also a mess like you like I agree with you and um it does seem like agree with you and um it does seem like agree with you and um it does seem like you know like can you have your weekend you know like can you have your weekend you know like can you have your weekend you know glasses of wine like absolutely

1:57you know glasses of wine like absolutely you know glasses of wine like absolutely I think you can and you know with I think you can and you know with I think you can and you know with respect to the cancer risk and like respect to the cancer risk and like respect to the cancer risk and like that's that's considered you know it's that's that's considered you know it's that's that's considered you know it's mild I mean it's less than you're having mild I mean it's less than you're having mild I mean it's less than you're having less than one drink a day and the only less than one drink a day and the only less than one drink a day and the only evidence I've really seen against the evidence I've really seen against the evidence I've really seen against the the mild is on the National Cancer the mild is on the National Cancer the mild is on the National Cancer Institute site where they like it's one Institute site where they like it's one Institute site where they like it's one of those cancers where it's like one in of those cancers where it's like one in of those cancers where it's like one in 500 like it it increases your risk of a 500 like it it increases your risk of a 500 like it it increases your risk of a cancer that you already have a lifetime cancer that you already have a lifetime cancer that you already have a lifetime risk of one in 500 and it's still less risk of one in 500 and it's still less risk of one in 500 and it's still less than one percent of an increase like than one percent of an increase like than one percent of an increase like yeah to me it's like your life you can't yeah to me it's like your life you can't yeah to me it's like your life you can't you can't measure it you can't I can't you can't measure it you can't I can't you can't measure it you can't I can't measure it yeah it's a classic example measure it yeah it's a classic example measure it yeah it's a classic example of the dose makes the poison but don't of the dose makes the poison but don't of the dose makes the poison but don't confuse that the poison is a poison confuse that the poison is a poison confuse that the poison is a poison right so another example would be right so another example would be right so another example would be cigarettes cigarettes cigarettes if you smoked a cigarette twice a week if you smoked a cigarette twice a week if you smoked a cigarette twice a week literally one cigarette twice twice a literally one cigarette twice twice a literally one cigarette twice twice a week would your risk of cancer go up yes week would your risk of cancer go up yes week would your risk of cancer go up yes but you wouldn't be able to measure it but you wouldn't be able to measure it but you wouldn't be able to measure it that doesn't change the fact that that doesn't change the fact that that doesn't change the fact that cigarettes are harmful right to mention cigarettes are harmful right to mention cigarettes are harmful right to mention heart disease like that that is not a heart disease like that that is not a heart disease like that that is not a linear like that like yeah yeah no no I linear like that like yeah yeah no no I linear like that like yeah yeah no no I mean I mean it's it's it but but even mean I mean it's it's it but but even mean I mean it's it's it but but even just focusing on cancer right like it just focusing on cancer right like it just focusing on cancer right like it really comes down to kind of

1:58really comes down to kind of really comes down to kind of establishing causality right is tobacco establishing causality right is tobacco establishing causality right is tobacco causally related to disease yes it's causally related to disease yes it's causally related to disease yes it's it's it's a harmful thing to take it's it's a harmful thing to take it's it's a harmful thing to take but the dose matters right like again but the dose matters right like again but the dose matters right like again just being glib one cigarette a week is just being glib one cigarette a week is just being glib one cigarette a week is it's probably increasing risk but we it's probably increasing risk but we it's probably increasing risk but we don't live long enough to see that to don't live long enough to see that to don't live long enough to see that to see the separation of those kaplan-meyer see the separation of those kaplan-meyer see the separation of those kaplan-meyer curves right maybe if we lived maybe if curves right maybe if we lived maybe if curves right maybe if we lived maybe if our natural lifespan was 500 one our natural lifespan was 500 one our natural lifespan was 500 one cigarette a week would be sufficient to cigarette a week would be sufficient to cigarette a week would be sufficient to see a spreading of those lines but at an see a spreading of those lines but at an see a spreading of those lines but at an 80-year lifespan you have to get up to 80-year lifespan you have to get up to 80-year lifespan you have to get up to 10 cigarettes a day before we can see 10 cigarettes a day before we can see 10 cigarettes a day before we can see where that is by the way I'm making that where that is by the way I'm making that where that is by the way I'm making that up I'm not advocating to nine cigarettes up I'm not advocating to nine cigarettes up I'm not advocating to nine cigarettes a day but you know what I'm getting at a day but you know what I'm getting at a day but you know what I'm getting at right and I think that's my point with right and I think that's my point with right and I think that's my point with alcohol it's it's it's simply just a alcohol it's it's it's simply just a alcohol it's it's it's simply just a question of of that but but I just want question of of that but but I just want question of of that but but I just want to make sure people aren't taking away to make sure people aren't taking away to make sure people aren't taking away from this that you know look I probably from this that you know look I probably from this that you know look I probably have anywhere from zero to four drinks a have anywhere from zero to four drinks a have anywhere from zero to four drinks a week but when I'm drinking those four week but when I'm drinking those four week but when I'm drinking those four drinks across two or three days it's not

1:59drinks across two or three days it's not drinks across two or three days it's not going through my mind that this is going through my mind that this is going through my mind that this is healthy healthy healthy it's like yeah this is a hedonic it's like yeah this is a hedonic it's like yeah this is a hedonic pleasure that's not good for me but it's pleasure that's not good for me but it's pleasure that's not good for me but it's enjoyable that's enjoyable well how do enjoyable that's enjoyable well how do enjoyable that's enjoyable well how do you feel about apoe4 carriers and you feel about apoe4 carriers and you feel about apoe4 carriers and alcohol consumption like our view in the alcohol consumption like our view in the alcohol consumption like our view in the practice is that they are indeed more practice is that they are indeed more practice is that they are indeed more susceptible susceptible susceptible um to the deleterious effects of alcohol um to the deleterious effects of alcohol um to the deleterious effects of alcohol um and also I would say they're just um and also I would say they're just um and also I would say they're just more susceptible in general to the more susceptible in general to the more susceptible in general to the deleterious effects of poor sleep which deleterious effects of poor sleep which deleterious effects of poor sleep which is one of the ways that I think alcohol is one of the ways that I think alcohol is one of the ways that I think alcohol is disproportionately hurting the brain is disproportionately hurting the brain is disproportionately hurting the brain um you know I think poor sleep um you know I think poor sleep um you know I think poor sleep is is causally driving Alzheimer's risk is is causally driving Alzheimer's risk is is causally driving Alzheimer's risk and cardiovascular disease risk I'm less and cardiovascular disease risk I'm less and cardiovascular disease risk I'm less clear on cancer clear on cancer clear on cancer but in as much as most people that are but in as much as most people that are but in as much as most people that are drinking alcohol drinking alcohol drinking alcohol are doing so in the evening and anybody are doing so in the evening and anybody are doing so in the evening and anybody who's used a sleep tracker you know you who's used a sleep tracker you know you who's used a sleep tracker you know you don't need to be Matt Walker to to very don't need to be Matt Walker to to very don't need to be Matt Walker to to very quickly do the experiment on yourself quickly do the experiment on yourself quickly do the experiment on yourself and compare a night of sleep with no

2:00and compare a night of sleep with no and compare a night of sleep with no alcohol a night of sleep with alcohol alcohol a night of sleep with alcohol alcohol a night of sleep with alcohol they're different they're different they're different um yeah and and so so through that lens um yeah and and so so through that lens um yeah and and so so through that lens I would just say you know if we have we I would just say you know if we have we I would just say you know if we have we have lots of patients with E4 in our have lots of patients with E4 in our have lots of patients with E4 in our practice including a number of E4 e4s we practice including a number of E4 e4s we practice including a number of E4 e4s we dispro you know even though those dispro you know even though those dispro you know even though those patients represent only two percent of patients represent only two percent of patients represent only two percent of the population they're probably about the population they're probably about the population they're probably about seven or eight percent of our patient seven or eight percent of our patient seven or eight percent of our patient population and population and population and [Music] [Music] [Music] um um again we say look unless this really again we say look unless this really again we say look unless this really means the world to you it's probably not means the world to you it's probably not means the world to you it's probably not worth the drink worth the drink worth the drink and if you are going to have a drink and if you are going to have a drink and if you are going to have a drink here are some principles for how you here are some principles for how you here are some principles for how you might minimize the damage right in terms might minimize the damage right in terms might minimize the damage right in terms of the number you might have how long of the number you might have how long of the number you might have how long you might have it before bed that kind you might have it before bed that kind you might have it before bed that kind of thing of thing of thing exercise you know when I exercise you know when I exercise you know when I um a couple of things just because you um a couple of things just because you um a couple of things just because you brought up the sleep and uh for one so I brought up the sleep and uh for one so I brought up the sleep and uh for one so I started wearing a continuous glucose started wearing a continuous glucose started wearing a continuous glucose monitor largely because of you monitor largely because of you monitor largely because of you um and I've been a very bad influence on um and I've been a very bad influence on um and I've been a very bad influence on some things you've done the lactate some things you've done the lactate some things you've done the lactate monitor the CGM yeah well I started monitor the CGM yeah well I started monitor the CGM yeah well I started wearing it when I was a new mom so this

2:01wearing it when I was a new mom so this wearing it when I was a new mom so this was you know like five years ago and was you know like five years ago and was you know like five years ago and that can't be a good time to wear a CGM that can't be a good time to wear a CGM that can't be a good time to wear a CGM but but although it must have been but but although it must have been but but although it must have been interesting right it was extreme so here interesting right it was extreme so here interesting right it was extreme so here here I am coming into this like oh I'm here I am coming into this like oh I'm here I am coming into this like oh I'm going to learn about the foods I eat and going to learn about the foods I eat and going to learn about the foods I eat and how my body you know responds to those how my body you know responds to those how my body you know responds to those foods and lo and behold the biggest and foods and lo and behold the biggest and foods and lo and behold the biggest and most compelling and most important data most compelling and most important data most compelling and most important data point or many points because I had many point or many points because I had many point or many points because I had many of them that I sort of learned from of them that I sort of learned from of them that I sort of learned from wearing my continuous glucose monitor wearing my continuous glucose monitor wearing my continuous glucose monitor which I'm sure most of your listeners which I'm sure most of your listeners which I'm sure most of your listeners know about where you're measuring your know about where you're measuring your know about where you're measuring your glucose level like continuously was the glucose level like continuously was the glucose level like continuously was the effect that my sleep Interruption had on effect that my sleep Interruption had on effect that my sleep Interruption had on both my fasting blood glucose and my both my fasting blood glucose and my both my fasting blood glucose and my post print where I was like like I could post print where I was like like I could post print where I was like like I could get like pre like what we can be get like pre like what we can be get like pre like what we can be considered like pre-diabetic like I was considered like pre-diabetic like I was considered like pre-diabetic like I was like blown away I was like what is this like blown away I was like what is this like blown away I was like what is this is insane is insane is insane um and then what I also sort of um and then what I also sort of um and then what I also sort of gleamed from this was that when I like gleamed from this was that when I like gleamed from this was that when I like was on days

2:02was on days was on days and the effect lasted about I would say and the effect lasted about I would say and the effect lasted about I would say like about 48 hours or so when I did like about 48 hours or so when I did like about 48 hours or so when I did work out and at the time I was doing a work out and at the time I was doing a work out and at the time I was doing a lot of high intensity interval training lot of high intensity interval training lot of high intensity interval training I was like an hour long spin class I I was like an hour long spin class I I was like an hour long spin class I used to go to you know where they do all used to go to you know where they do all used to go to you know where they do all this interval training this interval training this interval training um that it almost completely blunted um that it almost completely blunted um that it almost completely blunted that effect where I even though I was that effect where I even though I was that effect where I even though I was dog tired last thing I want to do is go dog tired last thing I want to do is go dog tired last thing I want to do is go to my damn spin class I was just like to my damn spin class I was just like to my damn spin class I was just like this is like I can't it's going to be this is like I can't it's going to be this is like I can't it's going to be bad for me if I go that's how I felt bad for me if I go that's how I felt bad for me if I go that's how I felt like it's gonna be bad for me but it was like it's gonna be bad for me but it was like it's gonna be bad for me but it was completely the opposite where I mean completely the opposite where I mean completely the opposite where I mean like this crazy glucose you know like this crazy glucose you know like this crazy glucose you know dysregulation and whatever the causes dysregulation and whatever the causes dysregulation and whatever the causes for that I'm sure you know much more for that I'm sure you know much more for that I'm sure you know much more about that than I do about that than I do about that than I do um it was almost completely blunted and um it was almost completely blunted and um it was almost completely blunted and it was so profound and it was like the it was so profound and it was like the it was so profound and it was like the one all the food stuff you know I one all the food stuff you know I one all the food stuff you know I learned a little bit of interesting but learned a little bit of interesting but learned a little bit of interesting but really that was the thing that for me really that was the thing that for me really that was the thing that for me was like I have to work out no matter was like I have to work out no matter was like I have to work out no matter what no matter what like I have to no what no matter what like I have to no what no matter what like I have to no matter how I feel it doesn't matter it's matter how I feel it doesn't matter it's matter how I feel it doesn't matter it's beneficial and there there's also it was

2:03beneficial and there there's also it was beneficial and there there's also it was a really interesting study a really interesting study a really interesting study uh caveat observational data you never uh caveat observational data you never uh caveat observational data you never know like there's reverse causation all know like there's reverse causation all know like there's reverse causation all the problems with any study but it was the problems with any study but it was the problems with any study but it was it was looking at the it was looking at the it was looking at the um you know sleep habits and so people um you know sleep habits and so people um you know sleep habits and so people that had slept you know was poor sleep that had slept you know was poor sleep that had slept you know was poor sleep or interrupted sleep something of that or interrupted sleep something of that or interrupted sleep something of that nature I can't remember the all the nature I can't remember the all the nature I can't remember the all the exact things that were measured with exact things that were measured with exact things that were measured with respect to sleep but respect to sleep but respect to sleep but um people that you know didn't sleep as um people that you know didn't sleep as um people that you know didn't sleep as long or had poor sleep Whatever by long or had poor sleep Whatever by long or had poor sleep Whatever by whatever measurements had a higher whatever measurements had a higher whatever measurements had a higher all-cause mortality which is not that all-cause mortality which is not that all-cause mortality which is not that surprising but only in people that surprising but only in people that surprising but only in people that weren't physically active and to me I weren't physically active and to me I weren't physically active and to me I was like oh wow that's interesting it's was like oh wow that's interesting it's was like oh wow that's interesting it's interesting and it's like you know interesting and it's like you know interesting and it's like you know exercise can forgive a lot of sins in exercise can forgive a lot of sins in exercise can forgive a lot of sins in many ways it really can and you know so many ways it really can and you know so many ways it really can and you know so you're talking about your you know your you're talking about your you know your you're talking about your you know your patients with E4 E4 and I'm sitting here patients with E4 E4 and I'm sitting here patients with E4 E4 and I'm sitting here going oh my gosh I've got one of those going oh my gosh I've got one of those going oh my gosh I've got one of those and I'm already like it's like it's a and I'm already like it's like it's a and I'm already like it's like it's a lot it's a burden you have to like you

2:04lot it's a burden you have to like you lot it's a burden you have to like you have to calculate things you have to be have to calculate things you have to be have to calculate things you have to be very very very um you know specific in your the actions um you know specific in your the actions um you know specific in your the actions you take and like things that you don't you take and like things that you don't you take and like things that you don't do things you do right and and for me do things you do right and and for me do things you do right and and for me it's like okay am I gonna like I'm it's like okay am I gonna like I'm it's like okay am I gonna like I'm having a party we're gonna have some having a party we're gonna have some having a party we're gonna have some mimosas whatever like mimosas whatever like mimosas whatever like I'm gonna exercise no matter what like I'm gonna exercise no matter what like I'm gonna exercise no matter what like and that might take off some of the and that might take off some of the and that might take off some of the stress right I'm not saying I'd go out stress right I'm not saying I'd go out stress right I'm not saying I'd go out like I I personally like I I personally like I I personally um I hardly drink and mostly because I um I hardly drink and mostly because I um I hardly drink and mostly because I am E4 I have one allele and I have uh am E4 I have one allele and I have uh am E4 I have one allele and I have uh pretty much come to the conclusion that pretty much come to the conclusion that pretty much come to the conclusion that it my brain can't repair damage as well it my brain can't repair damage as well it my brain can't repair damage as well as my husband's who doesn't have any as my husband's who doesn't have any as my husband's who doesn't have any four allele four allele four allele um with that said um with that said um with that said um you know I occasionally will I'll um you know I occasionally will I'll um you know I occasionally will I'll have like maybe you know a glass or two have like maybe you know a glass or two have like maybe you know a glass or two of wine usually if that's my preference of wine usually if that's my preference of wine usually if that's my preference but uh you know a week but even I mean but uh you know a week but even I mean but uh you know a week but even I mean last time I had a drink was like last time I had a drink was like last time I had a drink was like Valentine's Day you know so it's been Valentine's Day you know so it's been Valentine's Day you know so it's been it's been a while it's been a while it's been a while um but at least I think with the sleep um but at least I think with the sleep um but at least I think with the sleep sorry with the exercise you know again

2:05sorry with the exercise you know again sorry with the exercise you know again it's like it does it seems to forgive a it's like it does it seems to forgive a it's like it does it seems to forgive a lot of sins honestly I like that way of lot of sins honestly I like that way of lot of sins honestly I like that way of describing it yeah yeah I think well I describing it yeah yeah I think well I describing it yeah yeah I think well I kind of borrowed that from Stuart kind of borrowed that from Stuart kind of borrowed that from Stuart Phillips I think I think he was the one Phillips I think I think he was the one Phillips I think I think he was the one that said it to me because I was like that said it to me because I was like that said it to me because I was like this is like yeah that's right I heard this is like yeah that's right I heard this is like yeah that's right I heard that that's right I remember him saying that that's right I remember him saying that that's right I remember him saying that on your podcast so he gets he gets that on your podcast so he gets he gets that on your podcast so he gets he gets all the credit all the credit all the credit um and that of course brings us into the um and that of course brings us into the um and that of course brings us into the whole like protein intake and muscles whole like protein intake and muscles whole like protein intake and muscles yeah yeah so so let's set this up for yeah yeah so so let's set this up for yeah yeah so so let's set this up for listeners because you know you and I listeners because you know you and I listeners because you know you and I have talked about this a lot in fact I have talked about this a lot in fact I have talked about this a lot in fact I remember remember remember probably the last time this is probably the last time this is probably the last time this is pre-covered because we were both in San pre-covered because we were both in San pre-covered because we were both in San Diego you and your husband were for Diego you and your husband were for Diego you and your husband were for dinner I think I cooked up some fresh dinner I think I cooked up some fresh dinner I think I cooked up some fresh venison that I had just killed and we venison that I had just killed and we venison that I had just killed and we were kind of talking about protein and were kind of talking about protein and were kind of talking about protein and I think at the time both of us were kind I think at the time both of us were kind I think at the time both of us were kind of struggling with two competing ideas of struggling with two competing ideas of struggling with two competing ideas in zeroscience in zeroscience in zeroscience um um and those two ideas that seemed

2:06and those two ideas that seemed and those two ideas that seemed dialectical they seemed at odds was on dialectical they seemed at odds was on dialectical they seemed at odds was on the one hand there's this body of mostly the one hand there's this body of mostly the one hand there's this body of mostly kind of animal literature that suggests kind of animal literature that suggests kind of animal literature that suggests lower protein intake is associated with lower protein intake is associated with lower protein intake is associated with a longer life a longer life a longer life but on the other hand there's this but on the other hand there's this but on the other hand there's this literature that says lower protein literature that says lower protein literature that says lower protein intake is associated with more Frailty intake is associated with more Frailty intake is associated with more Frailty in humans in humans in humans and that's associated with a shorter and that's associated with a shorter and that's associated with a shorter life so how do we reconcile these two life so how do we reconcile these two life so how do we reconcile these two things and and we didn't we didn't have things and and we didn't we didn't have things and and we didn't we didn't have a great resolution on that I mean we a great resolution on that I mean we a great resolution on that I mean we both kind of felt like we were sort of both kind of felt like we were sort of both kind of felt like we were sort of scratching our heads thinking at least I scratching our heads thinking at least I scratching our heads thinking at least I don't want to speak for you but my don't want to speak for you but my don't want to speak for you but my thought thinking at the time this is thought thinking at the time this is thought thinking at the time this is again three and a half years ago again three and a half years ago again three and a half years ago probably was probably was probably was we just got to find the minimum we just got to find the minimum we just got to find the minimum effective dose what's the minimum effective dose what's the minimum effective dose what's the minimum effective dose of protein to not undergo effective dose of protein to not undergo effective dose of protein to not undergo mandatory catabolism mandatory catabolism mandatory catabolism and that's what that's what the dose is and that's what that's what the dose is and that's what that's what the dose is so and of course it's not clear how you so and of course it's not clear how you so and of course it's not clear how you find that dose theoretically you would

2:07find that dose theoretically you would find that dose theoretically you would use a metabolic cart and try to identify use a metabolic cart and try to identify use a metabolic cart and try to identify nitrogen balance and things like that nitrogen balance and things like that nitrogen balance and things like that but of course no one can do that outside but of course no one can do that outside but of course no one can do that outside of a lab so it was a bit of a head of a lab so it was a bit of a head of a lab so it was a bit of a head scratcher scratcher scratcher now I my thinking has evolved so much on now I my thinking has evolved so much on now I my thinking has evolved so much on this but I'd like to hear first of all this but I'd like to hear first of all this but I'd like to hear first of all I'd like to hear your formulation of the I'd like to hear your formulation of the I'd like to hear your formulation of the problem that I did I formulated the way problem that I did I formulated the way problem that I did I formulated the way you would and I guess more importantly you would and I guess more importantly you would and I guess more importantly tell me how you're thinking today tell me how you're thinking today tell me how you're thinking today yeah so you actually did a very good job yeah so you actually did a very good job yeah so you actually did a very good job formulating sort of uh my my mentality formulating sort of uh my my mentality formulating sort of uh my my mentality with respect to protein intake and with respect to protein intake and with respect to protein intake and Longevity Longevity Longevity um back in you know 2019 prior to that um back in you know 2019 prior to that um back in you know 2019 prior to that but like you know even even up until not but like you know even even up until not but like you know even even up until not even that long ago to be honest you know even that long ago to be honest you know even that long ago to be honest you know there's of like as you mentioned a large there's of like as you mentioned a large there's of like as you mentioned a large body of animal evidence but also like body of animal evidence but also like body of animal evidence but also like there was coupled you know this coupled there was coupled you know this coupled there was coupled you know this coupled you know epidemiological data where you you know epidemiological data where you you know epidemiological data where you think where you know people are looking think where you know people are looking think where you know people are looking at you know vegetarians are taking in at you know vegetarians are taking in at you know vegetarians are taking in lower amounts of protein and they're all lower amounts of protein and they're all lower amounts of protein and they're all cause mortality and they're cancer cause mortality and they're cancer cause mortality and they're cancer mortality and they just study after mortality and they just study after mortality and they just study after study after study and they have a lower study after study and they have a lower

2:08study after study and they have a lower all-cause mortality lower cancer all-cause mortality lower cancer all-cause mortality lower cancer mortality but mortality but mortality but but only in those individuals who are but only in those individuals who are but only in those individuals who are not obese not sedentary sorry are not obese not sedentary sorry are not obese not sedentary sorry are sedentary are smoking or you know they sedentary are smoking or you know they sedentary are smoking or you know they had some unhealthy lifestyle Factor so had some unhealthy lifestyle Factor so had some unhealthy lifestyle Factor so in other words the people taking in in other words the people taking in in other words the people taking in higher protein animal protein uh who higher protein animal protein uh who higher protein animal protein uh who were basically healthy were basically healthy were basically healthy had a similar cancer-related mortality had a similar cancer-related mortality had a similar cancer-related mortality all-cause mortality as these vegetarians all-cause mortality as these vegetarians all-cause mortality as these vegetarians okay so and similarly studies where they okay so and similarly studies where they okay so and similarly studies where they normalized for fruit and vegetable normalized for fruit and vegetable normalized for fruit and vegetable intake high protein versus low protein intake high protein versus low protein intake high protein versus low protein no difference in right in in in early no difference in right in in in early no difference in right in in in early mortality right so yes it seemed that a mortality right so yes it seemed that a mortality right so yes it seemed that a lot of the data that we're espousing low lot of the data that we're espousing low lot of the data that we're espousing low protein were confounded by lifestyle protein were confounded by lifestyle protein were confounded by lifestyle choices and high protein was also choices and high protein was also choices and high protein was also negatively confounded by high calorie as negatively confounded by high calorie as negatively confounded by high calorie as the most obvious the most obvious the most obvious exactly and with the animal data and

2:09exactly and with the animal data and exactly and with the animal data and this is probably this is probably this is probably where my mentality has shifted the most where my mentality has shifted the most where my mentality has shifted the most because I had never like I wasn't really because I had never like I wasn't really because I had never like I wasn't really of the opinion that vegetarian diets of the opinion that vegetarian diets of the opinion that vegetarian diets were Superior to you know meat eating or were Superior to you know meat eating or were Superior to you know meat eating or I guess omnivore types of diets that I guess omnivore types of diets that I guess omnivore types of diets that were healthy omnivore types of diets were healthy omnivore types of diets were healthy omnivore types of diets like I I I like because of what you were like I I I like because of what you were like I I I like because of what you were saying like that data was you know it saying like that data was you know it saying like that data was you know it was nuanced and it wasn't just like you was nuanced and it wasn't just like you was nuanced and it wasn't just like you know so I wasn't that wasn't something I know so I wasn't that wasn't something I know so I wasn't that wasn't something I was that has shifted in my you know the was that has shifted in my you know the was that has shifted in my you know the way I've been thinking but with respect way I've been thinking but with respect way I've been thinking but with respect to you know a lot of the animal data in to you know a lot of the animal data in to you know a lot of the animal data in the you know the mechanisms and you can the you know the mechanisms and you can the you know the mechanisms and you can you can you know restrict a mouse of you can you know restrict a mouse of you can you know restrict a mouse of protein and make it live longer and not protein and make it live longer and not protein and make it live longer and not get cancer and you know all these things get cancer and you know all these things get cancer and you know all these things that you see study after study I mean that you see study after study I mean that you see study after study I mean it's just like the longevity science and it's just like the longevity science and it's just like the longevity science and that whole field is like dominated by that whole field is like dominated by that whole field is like dominated by that like at least that like at least that like at least was and there's now I think some was and there's now I think some was and there's now I think some pushback going on but there's still a

2:10pushback going on but there's still a pushback going on but there's still a large you know group of scientists that large you know group of scientists that large you know group of scientists that are you know still you know publishing a are you know still you know publishing a are you know still you know publishing a lot of animal data and and this is where lot of animal data and and this is where lot of animal data and and this is where I sort of started to I sort of started to I sort of started to look into some of these exercise look into some of these exercise look into some of these exercise physiologists people physiologists people physiologists people um that like Stuart Phillips um that like Stuart Phillips um that like Stuart Phillips I know you've had like um I know you've had like um I know you've had like um like exactly like these these like like exactly like these these like like exactly like these these like giants in the field that are doing the giants in the field that are doing the giants in the field that are doing the research and uh Brad schoenfeld is research and uh Brad schoenfeld is research and uh Brad schoenfeld is another one where they're they're another one where they're they're another one where they're they're looking at protein intake they're looking at protein intake they're looking at protein intake they're looking at uh you know strength training looking at uh you know strength training looking at uh you know strength training and its effect in humans right in humans and its effect in humans right in humans and its effect in humans right in humans um on muscle protein synthesis and also um on muscle protein synthesis and also um on muscle protein synthesis and also just like looking at data with respect just like looking at data with respect just like looking at data with respect to muscle mass and you know all cause to muscle mass and you know all cause to muscle mass and you know all cause mortality and you know Alzheimer's mortality and you know Alzheimer's mortality and you know Alzheimer's disease dementia we didn't you know talk disease dementia we didn't you know talk disease dementia we didn't you know talk about that but like strength training about that but like strength training about that but like strength training also you know can modify that risk also you know can modify that risk also you know can modify that risk um also cancer mortality and so um yeah

2:11um also cancer mortality and so um yeah um also cancer mortality and so um yeah strong grip versus weak grip monotonic strong grip versus weak grip monotonic strong grip versus weak grip monotonic change in grip strength 70 reduction in change in grip strength 70 reduction in change in grip strength 70 reduction in incidents and mortality from dementia I incidents and mortality from dementia I incidents and mortality from dementia I mean 70 reduction in Risk remember mean 70 reduction in Risk remember mean 70 reduction in Risk remember people don't understand you can't reduce people don't understand you can't reduce people don't understand you can't reduce risk more than a hundred percent so it's risk more than a hundred percent so it's risk more than a hundred percent so it's not like increasing risk which can be not like increasing risk which can be not like increasing risk which can be 100 200 300 when you're talking risk 100 200 300 when you're talking risk 100 200 300 when you're talking risk reduction 70 is staggering it is reduction 70 is staggering it is reduction 70 is staggering it is strength matters yeah it does it does strength matters yeah it does it does strength matters yeah it does it does and you're not like they're you know as and you're not like they're you know as and you're not like they're you know as you know and many of your listeners like you know and many of your listeners like you know and many of your listeners like there's two important signals for you there's two important signals for you there's two important signals for you know your your muscle of strength know your your muscle of strength know your your muscle of strength obviously a big component of that is obviously a big component of that is obviously a big component of that is like physically working them but you like physically working them but you like physically working them but you know protein intake plays a plays a role know protein intake plays a plays a role know protein intake plays a plays a role there as well and I think it was Stuart there as well and I think it was Stuart there as well and I think it was Stuart Phillips like phrased it this way where Phillips like phrased it this way where Phillips like phrased it this way where you know you know the the animals that were that that are the the animals that were that that are the the animals that were that that are being studied in these labs are in a being studied in these labs are in a being studied in these labs are in a sterile environment right you know sterile environment right you know sterile environment right you know they're in a sterile environment they're they're in a sterile environment they're they're in a sterile environment they're not being exposed to influenza and all

2:12not being exposed to influenza and all not being exposed to influenza and all these infectious diseases and you know these infectious diseases and you know these infectious diseases and you know like like any of us have we've had a like like any of us have we've had a like like any of us have we've had a parent or a relative or someone that has parent or a relative or someone that has parent or a relative or someone that has gone into the hospital and maybe had bed gone into the hospital and maybe had bed gone into the hospital and maybe had bed rest rest rest um and then come out and like like I had um and then come out and like like I had um and then come out and like like I had a grandparent who like I mean literally a grandparent who like I mean literally a grandparent who like I mean literally couldn't walk after a back surgery I it couldn't walk after a back surgery I it couldn't walk after a back surgery I it was like I mean for forever like that was like I mean for forever like that was like I mean for forever like that was it that was like that was their was it that was like that was their was it that was like that was their downfall it was like the trajectory just downfall it was like the trajectory just downfall it was like the trajectory just went down completely down and you know went down completely down and you know went down completely down and you know so losing that muscle mass you know when so losing that muscle mass you know when so losing that muscle mass you know when you're in older age you're in older age you're in older age um obviously building up a bigger um obviously building up a bigger um obviously building up a bigger Reserve in in youth like in in middle Reserve in in youth like in in middle Reserve in in youth like in in middle adulthood whatever like that's that's adulthood whatever like that's that's adulthood whatever like that's that's very important but like you know these very important but like you know these very important but like you know these animals that people are manipulating the animals that people are manipulating the animals that people are manipulating the protein restriction in them like they're protein restriction in them like they're protein restriction in them like they're not being exposed to that right they're not being exposed to that right they're not being exposed to that right they're not they're not losing like I don't know not they're not losing like I don't know not they're not losing like I don't know how what percentage like it's it's how what percentage like it's it's how what percentage like it's it's pretty intense like how much they you pretty intense like how much they you pretty intense like how much they you know you can lose from like three weeks know you can lose from like three weeks know you can lose from like three weeks of bad rest of bad rest of bad rest um um and and also like you know as it's been

2:13and and also like you know as it's been and and also like you know as it's been pointed out by um people in your I think pointed out by um people in your I think pointed out by um people in your I think Matt kibberlin like these you know mice Matt kibberlin like these you know mice Matt kibberlin like these you know mice are dying from like cancer right like are dying from like cancer right like are dying from like cancer right like cardiovascular disease they're not cardiovascular disease they're not cardiovascular disease they're not they're not dying from the same diseases they're not dying from the same diseases they're not dying from the same diseases and it's not even the same type of and it's not even the same type of and it's not even the same type of cancer that humans get like human we get cancer that humans get like human we get cancer that humans get like human we get a lot of these epithelial like tumors a lot of these epithelial like tumors a lot of these epithelial like tumors solid tumors they're like dying from solid tumors they're like dying from solid tumors they're like dying from lymphomas you know like that's so lymphomas you know like that's so lymphomas you know like that's so there's a lot of differences there as there's a lot of differences there as there's a lot of differences there as well well well um where I you know I don't like there's um where I you know I don't like there's um where I you know I don't like there's a lot of interesting and I'm all the one a lot of interesting and I'm all the one a lot of interesting and I'm all the one to I've talked a million times about to I've talked a million times about to I've talked a million times about animal studies animal studies animal studies um and it's I think they're important um and it's I think they're important um and it's I think they're important mechanistic data like there's things you mechanistic data like there's things you mechanistic data like there's things you just won't ever get from humans uh you just won't ever get from humans uh you just won't ever get from humans uh you know but at the end of the day I started know but at the end of the day I started know but at the end of the day I started to realize that you know looking at this to realize that you know looking at this to realize that you know looking at this you know mice in a sterile environment you know mice in a sterile environment you know mice in a sterile environment where they're not really being exposed where they're not really being exposed where they're not really being exposed to the same stimuli as humans things are to the same stimuli as humans things are to the same stimuli as humans things are very different in terms of Aging very different in terms of Aging very different in terms of Aging um I don't I just I wasn't I was like um I don't I just I wasn't I was like um I don't I just I wasn't I was like this it was falling apart in my mind this it was falling apart in my mind this it was falling apart in my mind basically it was like all falling apart

2:14basically it was like all falling apart basically it was like all falling apart I'm like oh my goodness this isn't I'm like oh my goodness this isn't I'm like oh my goodness this isn't doesn't make any sense like this isn't doesn't make any sense like this isn't doesn't make any sense like this isn't what to be looking at if I'm if I'm what to be looking at if I'm if I'm what to be looking at if I'm if I'm wanting to really focus on healthy Aging wanting to really focus on healthy Aging wanting to really focus on healthy Aging for myself you know and forever for for myself you know and forever for for myself you know and forever for everyone else right so I think that's everyone else right so I think that's everyone else right so I think that's kind of what was the Tipping Point for kind of what was the Tipping Point for kind of what was the Tipping Point for me was just kind of that realization of me was just kind of that realization of me was just kind of that realization of the importance of muscle mass and how the importance of muscle mass and how the importance of muscle mass and how you know some of these animal studies you know some of these animal studies you know some of these animal studies you look and you're like oh they're they you look and you're like oh they're they you look and you're like oh they're they have you know they're a little bit of an have you know they're a little bit of an have you know they're a little bit of an improvement in their cardiovascular improvement in their cardiovascular improvement in their cardiovascular health and I'm like oh exercise okay is health and I'm like oh exercise okay is health and I'm like oh exercise okay is it better than exercise no it better than exercise no it better than exercise no um you know like the things that were um you know like the things that were um you know like the things that were improved I was like exercise does that improved I was like exercise does that improved I was like exercise does that exercise does that like this isn't exercise does that like this isn't exercise does that like this isn't convincing me that I need to like do convincing me that I need to like do convincing me that I need to like do that you know so that you know so that you know so um um I think it was just kind of like the I think it was just kind of like the I think it was just kind of like the shift in the way I viewed the data like shift in the way I viewed the data like shift in the way I viewed the data like the lens I was seeing it through yeah the lens I was seeing it through yeah the lens I was seeing it through yeah I'm still waiting for somebody to I'm still waiting for somebody to I'm still waiting for somebody to demonstrate for me that if there is an demonstrate for me that if there is an demonstrate for me that if there is an increase in the risk of cancer increase in the risk of cancer increase in the risk of cancer associated with higher protein intake

2:15associated with higher protein intake associated with higher protein intake in humans I'd like to see that in humans I'd like to see that in humans I'd like to see that Quantified Quantified Quantified but I would like to see somebody but I would like to see somebody but I would like to see somebody demonstrate that if there is an increase demonstrate that if there is an increase demonstrate that if there is an increase in risk that quantifiable increase in in risk that quantifiable increase in in risk that quantifiable increase in Risk is greater Risk is greater Risk is greater then the offset of sarcopenia then the offset of sarcopenia then the offset of sarcopenia because that's something for which there because that's something for which there because that's something for which there is no ambiguity is no ambiguity is no ambiguity we have all the data in the world to we have all the data in the world to we have all the data in the world to point to the devastation of sarcopenia point to the devastation of sarcopenia point to the devastation of sarcopenia on an aging population on an aging population on an aging population and we know full well that two things and we know full well that two things and we know full well that two things have to be true to avoid sarcopenia have to be true to avoid sarcopenia have to be true to avoid sarcopenia adequate protein intake which as you age adequate protein intake which as you age adequate protein intake which as you age gets bigger and bigger that number goes gets bigger and bigger that number goes gets bigger and bigger that number goes up and up and up due to anabolic up and up and up due to anabolic up and up and up due to anabolic resistance resistance resistance coupled with strength training so here coupled with strength training so here coupled with strength training so here we have something for which there is no we have something for which there is no we have something for which there is no uncertainty you must consume increasing uncertainty you must consume increasing uncertainty you must consume increasing amounts of protein and you must do amounts of protein and you must do amounts of protein and you must do strength training to ward off sarcopenia strength training to ward off sarcopenia strength training to ward off sarcopenia as you age and if you don't here's your

2:16as you age and if you don't here's your as you age and if you don't here's your mortality trajectory and it's awful mortality trajectory and it's awful mortality trajectory and it's awful let's compare all of that to this let's compare all of that to this let's compare all of that to this questionable risk for which frankly I questionable risk for which frankly I questionable risk for which frankly I don't see data and I'll add one more don't see data and I'll add one more don't see data and I'll add one more point to what you said Rhonda which is point to what you said Rhonda which is point to what you said Rhonda which is I think this story got confounded by our I think this story got confounded by our I think this story got confounded by our good friend C elegans good friend C elegans good friend C elegans right so let's go back 29 years roughly right so let's go back 29 years roughly right so let's go back 29 years roughly call it 30 years directionally when some call it 30 years directionally when some call it 30 years directionally when some very seminal and interesting work was very seminal and interesting work was very seminal and interesting work was published looking at the daf 16 mutation published looking at the daf 16 mutation published looking at the daf 16 mutation in or maybe it was daf2 I can't remember in or maybe it was daf2 I can't remember in or maybe it was daf2 I can't remember if it was daf 2 first or daf 16 but it if it was daf 2 first or daf 16 but it if it was daf 2 first or daf 16 but it was the analog of the igf receptor and was the analog of the igf receptor and was the analog of the igf receptor and if you knocked out that Gene you could if you knocked out that Gene you could if you knocked out that Gene you could double the lifespan from roughly two double the lifespan from roughly two double the lifespan from roughly two weeks to four weeks or four weeks to weeks to four weeks or four weeks to weeks to four weeks or four weeks to eight weeks I forget what it was of uh C eight weeks I forget what it was of uh C eight weeks I forget what it was of uh C elegans this worm and the implication of elegans this worm and the implication of elegans this worm and the implication of that was profound I mean that I don't that was profound I mean that I don't that was profound I mean that I don't want to down play the most important

2:17want to down play the most important want to down play the most important takeaway from that which was lifespan takeaway from that which was lifespan takeaway from that which was lifespan was malleable was malleable was malleable that that turned out to be very that that turned out to be very that that turned out to be very interesting interesting interesting um um I could go on my rant about why C I could go on my rant about why C I could go on my rant about why C elegans is not an organism or a or an elegans is not an organism or a or an elegans is not an organism or a or an animal model that offers any insight animal model that offers any insight animal model that offers any insight into us into us into us um you know based on its sell based on a um you know based on its sell based on a um you know based on its sell based on a whole bunch of things about its biology whole bunch of things about its biology whole bunch of things about its biology but nevertheless but nevertheless but nevertheless it somehow became knocking out daft2 or it somehow became knocking out daft2 or it somehow became knocking out daft2 or daf 16 was tantamount to dropping IVF uh daf 16 was tantamount to dropping IVF uh daf 16 was tantamount to dropping IVF uh igf insulin like growth factor one to igf insulin like growth factor one to igf insulin like growth factor one to zero zero zero is the key to longevity and the way to is the key to longevity and the way to is the key to longevity and the way to do that is to have no protein do that is to have no protein do that is to have no protein and I think that story is is so and I think that story is is so and I think that story is is so incorrect but somehow it's become part incorrect but somehow it's become part incorrect but somehow it's become part of Dogma so I think I think that's the of Dogma so I think I think that's the of Dogma so I think I think that's the other piece of this that just kind of other piece of this that just kind of other piece of this that just kind of won't go away won't go away won't go away um yeah it's it's funny because I I've um yeah it's it's funny because I I've um yeah it's it's funny because I I've done those experiments in with my own

2:18done those experiments in with my own done those experiments in with my own hands when I was at the Salk Institute hands when I was at the Salk Institute hands when I was at the Salk Institute and I was in Andy Dillon's lab who had and I was in Andy Dillon's lab who had and I was in Andy Dillon's lab who had trained with Cynthia Kenyon who made the trained with Cynthia Kenyon who made the trained with Cynthia Kenyon who made the discovery right back in was it early 90s discovery right back in was it early 90s discovery right back in was it early 90s or something yeah Philly was 93 or 94. or something yeah Philly was 93 or 94. or something yeah Philly was 93 or 94. yeah and you know like it was it was yeah and you know like it was it was yeah and you know like it was it was very exciting for me at the time because very exciting for me at the time because very exciting for me at the time because it was like oh this is a homologous Gene it was like oh this is a homologous Gene it was like oh this is a homologous Gene we have we have we have and I'm watching it go from a 15-day and I'm watching it go from a 15-day and I'm watching it go from a 15-day lifespan to like a 30 plus day and not lifespan to like a 30 plus day and not lifespan to like a 30 plus day and not only that the health plan was remarkable only that the health plan was remarkable only that the health plan was remarkable yeah they were youthful I mean like you yeah they were youthful I mean like you yeah they were youthful I mean like you could see them you look at a microscope could see them you look at a microscope could see them you look at a microscope and you see how they move around it is and you see how they move around it is and you see how they move around it is very apparent they were acting like a very apparent they were acting like a very apparent they were acting like a youthful young larva that had like not youthful young larva that had like not youthful young larva that had like not been born long ago right uh but then you been born long ago right uh but then you been born long ago right uh but then you also realize they go into this dour also realize they go into this dour also realize they go into this dour state where like in order to get that state where like in order to get that state where like in order to get that you know lifespan extension they're like you know lifespan extension they're like you know lifespan extension they're like like going into this like metabolic like going into this like metabolic like going into this like metabolic stasis and like this like this thing stasis and like this like this thing stasis and like this like this thing that we don't do like humans don't do that we don't do like humans don't do that we don't do like humans don't do doubt like we're not you know we we it's doubt like we're not you know we we it's doubt like we're not you know we we it's it's a completely separate it's a completely separate it's a completely separate um sort of pathway that is required for

2:19um sort of pathway that is required for um sort of pathway that is required for that lifespan extension and I think you that lifespan extension and I think you that lifespan extension and I think you know to your point about the igf-1 the know to your point about the igf-1 the know to your point about the igf-1 the insulin insulin insulin um you know like growth factor receptor um you know like growth factor receptor um you know like growth factor receptor um and also the insulin pathway they're um and also the insulin pathway they're um and also the insulin pathway they're kind of both like tied into that kind of both like tied into that kind of both like tied into that um you know the the fact of the matter um you know the the fact of the matter um you know the the fact of the matter is is that that is a growth factor is is that that is a growth factor is is that that is a growth factor and you know as we have talked about you and you know as we have talked about you and you know as we have talked about you and I have talked about this before you and I have talked about this before you and I have talked about this before you know growth factors in the context of a know growth factors in the context of a know growth factors in the context of a tumor can tumor can tumor can allow tumor cells to override cell death allow tumor cells to override cell death allow tumor cells to override cell death mechanisms so they can continue to mechanisms so they can continue to mechanisms so they can continue to survive when they otherwise might have survive when they otherwise might have survive when they otherwise might have been you know signaled to die right been you know signaled to die right been you know signaled to die right um and so there can be a problem with um and so there can be a problem with um and so there can be a problem with too much igf-1 in the context of a tumor too much igf-1 in the context of a tumor too much igf-1 in the context of a tumor and what causes that High hf1 Is Up For and what causes that High hf1 Is Up For and what causes that High hf1 Is Up For Debate uh but I think Debate uh but I think Debate uh but I think at the end of the day it's not that high at the end of the day it's not that high at the end of the day it's not that high igf-1 that is necessarily causing the igf-1 that is necessarily causing the igf-1 that is necessarily causing the tumor I think you know like there are

2:20tumor I think you know like there are tumor I think you know like there are things that you can do in your lifestyle things that you can do in your lifestyle things that you can do in your lifestyle like like exercise actually causes igf-1 to go exercise actually causes igf-1 to go exercise actually causes igf-1 to go into muscle where you're repairing into muscle where you're repairing into muscle where you're repairing damaged muscle it's helping muscle damaged muscle it's helping muscle damaged muscle it's helping muscle repair it goes into your brain it's repair it goes into your brain it's repair it goes into your brain it's important for like neurogenesis a little important for like neurogenesis a little important for like neurogenesis a little bit of controversy there I know but like bit of controversy there I know but like bit of controversy there I know but like I'm in the camp that you adults are I I'm in the camp that you adults are I I'm in the camp that you adults are I mean like their studies showing multiple mean like their studies showing multiple mean like their studies showing multiple studies showing that you can take an studies showing that you can take an studies showing that you can take an older adult put them train them for a older adult put them train them for a older adult put them train them for a year year year and their hippocampus will grow by like and their hippocampus will grow by like and their hippocampus will grow by like one to two percent like there's multiple one to two percent like there's multiple one to two percent like there's multiple studies also another study showing this studies also another study showing this studies also another study showing this with the sub ventricular zone so these with the sub ventricular zone so these with the sub ventricular zone so these are two regions of the brain where it is are two regions of the brain where it is are two regions of the brain where it is my opinion I I believe data that says my opinion I I believe data that says my opinion I I believe data that says that adult neurogenesis or the growth of that adult neurogenesis or the growth of that adult neurogenesis or the growth of you know new neurons as an adult is you know new neurons as an adult is you know new neurons as an adult is occurring and occurring and occurring and do you think that part of the vehicle do you think that part of the vehicle do you think that part of the vehicle for exercise to do that is through igf-1 for exercise to do that is through igf-1 for exercise to do that is through igf-1 uh-huh yeah absolutely it is interesting uh-huh yeah absolutely it is interesting uh-huh yeah absolutely it is interesting I mean animal Studies have shown that I mean animal Studies have shown that I mean animal Studies have shown that again we you know we all know about the again we you know we all know about the again we you know we all know about the caveats it does does it translate to caveats it does does it translate to caveats it does does it translate to humans we don't know but you know often

2:21humans we don't know but you know often humans we don't know but you know often time you have to take the whole body of time you have to take the whole body of time you have to take the whole body of evidence the human evidence couple it evidence the human evidence couple it evidence the human evidence couple it with mechanistic data with animals and with mechanistic data with animals and with mechanistic data with animals and try to kind of put together a story to try to kind of put together a story to try to kind of put together a story to the best of your ability I mean that's the best of your ability I mean that's the best of your ability I mean that's that's all we're gonna get you know and that's all we're gonna get you know and that's all we're gonna get you know and so um yeah igf like you you always hear so um yeah igf like you you always hear so um yeah igf like you you always hear about I want to lower igf-1 but you you about I want to lower igf-1 but you you about I want to lower igf-1 but you you know it's actually like important for know it's actually like important for know it's actually like important for the brain and important for muscle and the brain and important for muscle and the brain and important for muscle and and the way to get it to the brain is and the way to get it to the brain is and the way to get it to the brain is through exercise like that's that's through exercise like that's that's through exercise like that's that's that's known and it's been shown again that's known and it's been shown again that's known and it's been shown again in human studies as well so um I think in human studies as well so um I think in human studies as well so um I think also part of the the problem here is in also part of the the problem here is in also part of the the problem here is in some respects um people that are doing I some respects um people that are doing I some respects um people that are doing I mean really impeccable animal research mean really impeccable animal research mean really impeccable animal research like you look at you know the data and like you look at you know the data and like you look at you know the data and it's like oh they're doing the study it's like oh they're doing the study it's like oh they're doing the study great like this isn't this is a good great like this isn't this is a good great like this isn't this is a good study I mean like you can't poke holes study I mean like you can't poke holes study I mean like you can't poke holes in it with respect to the animal world in it with respect to the animal world in it with respect to the animal world but then sort of Translating that to but then sort of Translating that to but then sort of Translating that to humans and considering like who are we humans and considering like who are we humans and considering like who are we talking to are we talking to an talking to are we talking to an talking to are we talking to an overweight obese person maybe they're

2:22overweight obese person maybe they're overweight obese person maybe they're probably getting enough protein they're probably getting enough protein they're probably getting enough protein they're getting enough you know they're like I getting enough you know they're like I getting enough you know they're like I don't know that they have to worry so don't know that they have to worry so don't know that they have to worry so much about protein intake I think they much about protein intake I think they much about protein intake I think they need to focus on losing you know losing need to focus on losing you know losing need to focus on losing you know losing that unhealthy weight that unhealthy weight that unhealthy weight but that's also really important and I but that's also really important and I but that's also really important and I think some some scientists and also think some some scientists and also think some some scientists and also Health uh you know and science Health uh you know and science Health uh you know and science communicators also sort of maybe it it's communicators also sort of maybe it it's communicators also sort of maybe it it's hard you have to like and I've been sort hard you have to like and I've been sort hard you have to like and I've been sort of guilty that as well like of guilty that as well like of guilty that as well like disentangling who are we talking to are disentangling who are we talking to are disentangling who are we talking to are we talking to the obese person who we talking to the obese person who we talking to the obese person who clearly needs to focus on weight loss or clearly needs to focus on weight loss or clearly needs to focus on weight loss or are we talking to the healthy physically are we talking to the healthy physically are we talking to the healthy physically active person who's now terrified to active person who's now terrified to active person who's now terrified to take protein in because they they read take protein in because they they read take protein in because they they read about some animal study where too much about some animal study where too much about some animal study where too much protein increases mortality right protein increases mortality right protein increases mortality right um so I mean and also I think age is um so I mean and also I think age is um so I mean and also I think age is such an important part of this again so such an important part of this again so such an important part of this again so if you look at that um if you look at that um if you look at that um I think it was Levine in 2017 had that I think it was Levine in 2017 had that I think it was Levine in 2017 had that study where they look at the study where they look at the study where they look at the relationship between protein and igf-1

2:23relationship between protein and igf-1 relationship between protein and igf-1 but stratified by so they stratified by but stratified by so they stratified by but stratified by so they stratified by protein intake low medium high low protein intake low medium high low protein intake low medium high low medium high and then they looked at medium high and then they looked at medium high and then they looked at middle-aged people so 50 to 65 and then middle-aged people so 50 to 65 and then middle-aged people so 50 to 65 and then people over 65. and in people age 50 to people over 65. and in people age 50 to people over 65. and in people age 50 to 65 there was a relationship between 65 there was a relationship between 65 there was a relationship between protein intake and igf higher protein protein intake and igf higher protein protein intake and igf higher protein intake was associated with higher igf intake was associated with higher igf intake was associated with higher igf now it wasn't a huge difference this now it wasn't a huge difference this now it wasn't a huge difference this gets over stated constantly but it was gets over stated constantly but it was gets over stated constantly but it was statistically significant statistically significant statistically significant but what often gets ignored is the but what often gets ignored is the but what often gets ignored is the people over 65 there was no statistical people over 65 there was no statistical people over 65 there was no statistical difference whatsoever between protein difference whatsoever between protein difference whatsoever between protein intake and igf-1 intake and igf-1 intake and igf-1 again this is taken as Dogma that the again this is taken as Dogma that the again this is taken as Dogma that the more protein you have the higher your more protein you have the higher your more protein you have the higher your igf-1 and in people over 65 that's not igf-1 and in people over 65 that's not igf-1 and in people over 65 that's not the case now why do I harp on that the case now why do I harp on that the case now why do I harp on that I harp on that because it isn't exactly I harp on that because it isn't exactly I harp on that because it isn't exactly that population that I am most concerned that population that I am most concerned that population that I am most concerned with sarcopenia with sarcopenia with sarcopenia so so

2:24so If the message is somehow getting If the message is somehow getting If the message is somehow getting transmitted to somebody listening to transmitted to somebody listening to transmitted to somebody listening to this who's 65 or older that I shouldn't this who's 65 or older that I shouldn't this who's 65 or older that I shouldn't be eating protein and they might not be eating protein and they might not be eating protein and they might not even know that it's through igf but even know that it's through igf but even know that it's through igf but somehow high protein is going to give me somehow high protein is going to give me somehow high protein is going to give me cancer and you know that's because cancer and you know that's because cancer and you know that's because someone who telling them that is talking someone who telling them that is talking someone who telling them that is talking about through the lens of igf the answer about through the lens of igf the answer about through the lens of igf the answer is first of all no it's not and secondly is first of all no it's not and secondly is first of all no it's not and secondly the greatest risk you face again is the greatest risk you face again is the greatest risk you face again is going to be the res the results of low going to be the res the results of low going to be the res the results of low muscle mass and low strength and even if muscle mass and low strength and even if muscle mass and low strength and even if we believed which I don't but even if we we believed which I don't but even if we we believed which I don't but even if we believed that in that age you know then believed that in that age you know then believed that in that age you know then the younger people eating more protein the younger people eating more protein the younger people eating more protein leads to more igf which is bad I would leads to more igf which is bad I would leads to more igf which is bad I would argue that the absolute risk of death is argue that the absolute risk of death is argue that the absolute risk of death is so much lower in that group so much lower in that group so much lower in that group that the absolute difference in that the absolute difference in that the absolute difference in mortality between the younger and the mortality between the younger and the mortality between the younger and the older in the presence of high protein is older in the presence of high protein is older in the presence of high protein is no comparison what I mean is higher no comparison what I mean is higher no comparison what I mean is higher protein across the board is going to

2:25protein across the board is going to protein across the board is going to save more lives than it would ever hurt save more lives than it would ever hurt save more lives than it would ever hurt in younger people even if you could in younger people even if you could in younger people even if you could convince yourself at higher protein convince yourself at higher protein convince yourself at higher protein intake was associated with increased intake was associated with increased intake was associated with increased mortality mortality mortality and so again I find these data and so again I find these data and so again I find these data unassailable unassailable unassailable um especially in the older population I um especially in the older population I um especially in the older population I think Matt cable and I did talk about think Matt cable and I did talk about think Matt cable and I did talk about this on a podcast once and this on a podcast once and this on a podcast once and I worry that you know as you do that I worry that you know as you do that I worry that you know as you do that that that information is is not making that that information is is not making that that information is is not making its way clearly to people of the its way clearly to people of the its way clearly to people of the susceptible age group susceptible age group susceptible age group right and I think also that the thinking right and I think also that the thinking right and I think also that the thinking about a lot of people are focused on the about a lot of people are focused on the about a lot of people are focused on the the recommended daily allowance of the recommended daily allowance of the recommended daily allowance of protein right like well then right like protein right like well then right like protein right like well then right like what is the what are these old ass what is the what are these old ass what is the what are these old ass studies that were not done correctly studies that were not done correctly studies that were not done correctly using the wrong tracers what are they using the wrong tracers what are they using the wrong tracers what are they like like what is that telling me about like like what is that telling me about like like what is that telling me about what how much protein I should take in what how much protein I should take in what how much protein I should take in and this is also another sort of change and this is also another sort of change and this is also another sort of change in my like it was a turning point for me in my like it was a turning point for me in my like it was a turning point for me because I didn't I knew nothing about

2:26because I didn't I knew nothing about because I didn't I knew nothing about the uh fault like you know the the the uh fault like you know the the the uh fault like you know the the errors the recommended dietary analysis errors the recommended dietary analysis errors the recommended dietary analysis I know I know everything about I know I know everything about I know I know everything about micronutrients and rdas but I knew micronutrients and rdas but I knew micronutrients and rdas but I knew nothing about the protein and um once I nothing about the protein and um once I nothing about the protein and um once I talked to Stu I mean it was it was clear talked to Stu I mean it was it was clear talked to Stu I mean it was it was clear he was like oh no those we we did we he was like oh no those we we did we he was like oh no those we we did we repeated those studies him and many repeated those studies him and many repeated those studies him and many others using different tracers and I others using different tracers and I others using different tracers and I can't tell you all this the tracers and can't tell you all this the tracers and can't tell you all this the tracers and stuff because it's you know it's a stuff because it's you know it's a stuff because it's you know it's a certain not my field but certain not my field but certain not my field but um it was like no we determined that the um it was like no we determined that the um it was like no we determined that the like the minimum was really more like like the minimum was really more like like the minimum was really more like 1.2 grams per kilogram weight not 0.8 1.2 grams per kilogram weight not 0.8 1.2 grams per kilogram weight not 0.8 and and to me I was like oh wow you know and and to me I was like oh wow you know and and to me I was like oh wow you know because you know well you you don't because you know well you you don't because you know well you you don't store protein so it's like okay well store protein so it's like okay well store protein so it's like okay well this is this is important because I mean this is this is important because I mean this is this is important because I mean that's a big difference that's a big difference that's a big difference um and then on top of that when you um and then on top of that when you um and then on top of that when you start to get into the Physically Active start to get into the Physically Active start to get into the Physically Active people or elderly population as you people or elderly population as you people or elderly population as you mentioned anabolic resistance where mentioned anabolic resistance where mentioned anabolic resistance where they're basically like their their they're basically like their their they're basically like their their muscle isn't getting that signal you muscle isn't getting that signal you muscle isn't getting that signal you know as well to increase muscle protein know as well to increase muscle protein know as well to increase muscle protein synthesis from the same amount of

2:27synthesis from the same amount of synthesis from the same amount of protein that they're younger self would protein that they're younger self would protein that they're younger self would right so they actually need more of a right so they actually need more of a right so they actually need more of a dose you know up to like I don't know dose you know up to like I don't know dose you know up to like I don't know 1.6 1.8 we're talking we basically tell 1.6 1.8 we're talking we basically tell 1.6 1.8 we're talking we basically tell people aim for one gram per pound which people aim for one gram per pound which people aim for one gram per pound which would be 2.2 grams per kilo would be 2.2 grams per kilo would be 2.2 grams per kilo um because the other thing that um because the other thing that um because the other thing that complicates it Rhonda is not all protein complicates it Rhonda is not all protein complicates it Rhonda is not all protein is created equal so you know if you're is created equal so you know if you're is created equal so you know if you're eating on if you're getting a reasonable eating on if you're getting a reasonable eating on if you're getting a reasonable amount of your protein in uh In from amount of your protein in uh In from amount of your protein in uh In from from Plants you're getting a lower from Plants you're getting a lower from Plants you're getting a lower bioavailable amino acid you're also not bioavailable amino acid you're also not bioavailable amino acid you're also not getting the same quantity of leucine getting the same quantity of leucine getting the same quantity of leucine Lysine and methionine which are probably Lysine and methionine which are probably Lysine and methionine which are probably the three most important amino acids the three most important amino acids the three most important amino acids anyway so anyway so anyway so um you know one of the things Don Layman um you know one of the things Don Layman um you know one of the things Don Layman talked about was talked about was talked about was if you really want to be rigorous about if you really want to be rigorous about if you really want to be rigorous about this you probably want to track those this you probably want to track those this you probably want to track those amino acids and you really want to say amino acids and you really want to say amino acids and you really want to say look make sure you're getting one gram look make sure you're getting one gram look make sure you're getting one gram at least of methionine per day at least of methionine per day at least of methionine per day two to four grams per serving of leucine

2:28two to four grams per serving of leucine two to four grams per serving of leucine and lysine now again for a lot of people and lysine now again for a lot of people and lysine now again for a lot of people that's too nerdy but but you know you that's too nerdy but but you know you that's too nerdy but but you know you can go through the math a couple of can go through the math a couple of can go through the math a couple of times with certain things that you eat times with certain things that you eat times with certain things that you eat repeatedly and you'll realize that's repeatedly and you'll realize that's repeatedly and you'll realize that's probably more protein in aggregate than probably more protein in aggregate than probably more protein in aggregate than a person is used to eating and as you a person is used to eating and as you a person is used to eating and as you said when you start to factor in said when you start to factor in said when you start to factor in those two other categories of risk right those two other categories of risk right those two other categories of risk right more demand so when you're doing those more demand so when you're doing those more demand so when you're doing those high intensity workouts you are ripping high intensity workouts you are ripping high intensity workouts you are ripping apart muscle fibers when you're lifting apart muscle fibers when you're lifting apart muscle fibers when you're lifting weights when you're rucking when you're weights when you're rucking when you're weights when you're rucking when you're doing all these other things we have to doing all these other things we have to doing all these other things we have to do you're demanding more amino acids for do you're demanding more amino acids for do you're demanding more amino acids for the turnover and then of course anabolic the turnover and then of course anabolic the turnover and then of course anabolic resistance I think is the biggest issue resistance I think is the biggest issue resistance I think is the biggest issue and and something that truthfully up and and something that truthfully up and and something that truthfully up until two years ago I just wasn't paying until two years ago I just wasn't paying until two years ago I just wasn't paying enough attention to I I wasn't enough attention to I I wasn't enough attention to I I wasn't appreciating that my older patients had appreciating that my older patients had appreciating that my older patients had had an additional problem that younger had an additional problem that younger had an additional problem that younger patients didn't have with respect to patients didn't have with respect to patients didn't have with respect to that signal that signal that signal so that's a lot 2.2 grams per kilogram so that's a lot 2.2 grams per kilogram so that's a lot 2.2 grams per kilogram by way that's I mean I struggle like I by way that's I mean I struggle like I by way that's I mean I struggle like I to get for me to get 1.6 like I'm to get for me to get 1.6 like I'm to get for me to get 1.6 like I'm supplementing I'm taking whey protein

2:29supplementing I'm taking whey protein supplementing I'm taking whey protein like I I just can't it's like how many like I I just can't it's like how many like I I just can't it's like how many like so how many meals like typically like so how many meals like typically like so how many meals like typically four yeah because it's hard yeah it has four yeah because it's hard yeah it has four yeah because it's hard yeah it has to be and and one like so so for me to be and and one like so so for me to be and and one like so so for me it's really two meals and two snacks and it's really two meals and two snacks and it's really two meals and two snacks and the snacks are just protein snacks so so the snacks are just protein snacks so so the snacks are just protein snacks so so it's a it's a shake so one of them is it's a it's a shake so one of them is it's a it's a shake so one of them is just a whey protein shake and then one just a whey protein shake and then one just a whey protein shake and then one of them is I eat these venison jerky of them is I eat these venison jerky of them is I eat these venison jerky sticks so five venison jerky sticks has sticks so five venison jerky sticks has sticks so five venison jerky sticks has 50 they're 10 grams a piece 50 they're 10 grams a piece 50 they're 10 grams a piece um and they're really good they're you um and they're really good they're you um and they're really good they're you know super pure venison know super pure venison know super pure venison um it's you know Wild game amazing um it's you know Wild game amazing um it's you know Wild game amazing product and I I should disclose I'm an product and I I should disclose I'm an product and I I should disclose I'm an investor in the company that makes them investor in the company that makes them investor in the company that makes them by the way by the way by the way um I was gonna ask do you make them is um I was gonna ask do you make them is um I was gonna ask do you make them is it like no yeah but I I know that people it like no yeah but I I know that people it like no yeah but I I know that people say well I know everything about it and say well I know everything about it and say well I know everything about it and I know that the quality is there I know that the quality is there I know that the quality is there um um so those are two snacks right they're so those are two snacks right they're so those are two snacks right they're otherwise they're relatively low in otherwise they're relatively low in otherwise they're relatively low in calories right like my whey protein calories right like my whey protein calories right like my whey protein shake doesn't really have anything else shake doesn't really have anything else shake doesn't really have anything else in it except some frozen berries and in it except some frozen berries and

2:30in it except some frozen berries and almond milk almond milk almond milk um and then the venison sticks are what um and then the venison sticks are what um and then the venison sticks are what they are and then and then two meals they are and then and then two meals they are and then and then two meals that are you know gonna have protein and that are you know gonna have protein and that are you know gonna have protein and for me again A lot of times like it's for me again A lot of times like it's for me again A lot of times like it's going to be an omelet and then you know going to be an omelet and then you know going to be an omelet and then you know protein dinner so yeah it's um not gonna protein dinner so yeah it's um not gonna protein dinner so yeah it's um not gonna deny it it's work it's it's not deny it it's work it's it's not deny it it's work it's it's not um it probably consumes more of my um it probably consumes more of my um it probably consumes more of my dietary planning and dietary attention dietary planning and dietary attention dietary planning and dietary attention than anything else I I don't pay any than anything else I I don't pay any than anything else I I don't pay any attention to how many carbs and fat I attention to how many carbs and fat I attention to how many carbs and fat I eat anymore uh I'm just paying attention eat anymore uh I'm just paying attention eat anymore uh I'm just paying attention to protein intake to protein intake to protein intake it's something I never really paid it's something I never really paid it's something I never really paid attention to at much at all attention to at much at all attention to at much at all um you know until and I would say like um you know until and I would say like um you know until and I would say like last June or July is when I really last June or July is when I really last June or July is when I really started focusing on strength training started focusing on strength training started focusing on strength training you know both for my muscle mass and you know both for my muscle mass and you know both for my muscle mass and also bone mineral density like I mean also bone mineral density like I mean also bone mineral density like I mean yep like like that's another thing where yep like like that's another thing where yep like like that's another thing where it's like you want you want to like it's like you want you want to like it's like you want you want to like that's you want a reserve of that as that's you want a reserve of that as that's you want a reserve of that as well especially as a female right like well especially as a female right like well especially as a female right like so that that those are like folks so that that those are like folks so that that those are like folks focusing on the strength training and focusing on the strength training and focusing on the strength training and also the protein intake and it's been

2:31also the protein intake and it's been also the protein intake and it's been quite challenging I've always sort of quite challenging I've always sort of quite challenging I've always sort of focused on micronutrients and I and it focused on micronutrients and I and it focused on micronutrients and I and it is is you know it's still a focus of mine and you know it's still a focus of mine and you know it's still a focus of mine and like making sure I'm getting enough of like making sure I'm getting enough of like making sure I'm getting enough of those and I do supplement as well those and I do supplement as well those and I do supplement as well um you know in addition to trying to eat um you know in addition to trying to eat um you know in addition to trying to eat like leafy greens and getting some you like leafy greens and getting some you like leafy greens and getting some you know some of the veggies and stuff it's know some of the veggies and stuff it's know some of the veggies and stuff it's either going to be roasted veggies for either going to be roasted veggies for either going to be roasted veggies for me or like salad but um the protein me or like salad but um the protein me or like salad but um the protein intake is like it's been it's been intake is like it's been it's been intake is like it's been it's been challenging and I find I typically do challenging and I find I typically do challenging and I find I typically do three meals three meals three meals um one of them is is like a a protein um one of them is is like a a protein um one of them is is like a a protein meal snack so it's like some salmon or meal snack so it's like some salmon or meal snack so it's like some salmon or like a homemade turkey burger or like a homemade turkey burger or like a homemade turkey burger or something like that but then the protein something like that but then the protein something like that but then the protein shakes also is where I I just have to do shakes also is where I I just have to do shakes also is where I I just have to do I guess that I don't really consider it I guess that I don't really consider it I guess that I don't really consider it a meal but it kind of is and um you know a meal but it kind of is and um you know a meal but it kind of is and um you know it's it is like it's it's satiating the it's it is like it's it's satiating the it's it is like it's it's satiating the protein like Shake is definitely protein like Shake is definitely protein like Shake is definitely satiating and I'm already it's even kind satiating and I'm already it's even kind satiating and I'm already it's even kind of hard because when you work out like of hard because when you work out like of hard because when you work out like as you mentioned your your satiety you as you mentioned your your satiety you as you mentioned your your satiety you know hormones go up like you're like I'm

2:32know hormones go up like you're like I'm know hormones go up like you're like I'm not hungry like I don't like necessarily not hungry like I don't like necessarily not hungry like I don't like necessarily want to eat like it it takes a while want to eat like it it takes a while want to eat like it it takes a while before I can actually like even get an before I can actually like even get an before I can actually like even get an appetite you know yeah so there's all appetite you know yeah so there's all appetite you know yeah so there's all these like competing things where I'm these like competing things where I'm these like competing things where I'm like trying to get the protein but I'm like trying to get the protein but I'm like trying to get the protein but I'm like I'm not really hungry and I'm like like I'm not really hungry and I'm like like I'm not really hungry and I'm like I know I need it and you know so all I know I need it and you know so all I know I need it and you know so all these little these little these little um important factors and yet again um um important factors and yet again um um important factors and yet again um important to sort of you know highlight important to sort of you know highlight important to sort of you know highlight that you know I don't know that someone that you know I don't know that someone that you know I don't know that someone who is overweight or obese necessarily who is overweight or obese necessarily who is overweight or obese necessarily needs to focus so much on that right I needs to focus so much on that right I needs to focus so much on that right I mean would you agree right that's right mean would you agree right that's right mean would you agree right that's right yeah I mean fortunately most people who yeah I mean fortunately most people who yeah I mean fortunately most people who are what I call overnourished are also are what I call overnourished are also are what I call overnourished are also adequately muscled and they can actually adequately muscled and they can actually adequately muscled and they can actually in the short run in the short run in the short run be okay losing lean mass in fact it's be okay losing lean mass in fact it's be okay losing lean mass in fact it's very difficult to lose heaping amounts very difficult to lose heaping amounts very difficult to lose heaping amounts of body fat while preserving lean mass of body fat while preserving lean mass of body fat while preserving lean mass so we tend to focus more on the caloric so we tend to focus more on the caloric so we tend to focus more on the caloric restriction coupled with the training restriction coupled with the training restriction coupled with the training we use the training as a way to offset

2:33we use the training as a way to offset we use the training as a way to offset some of that lean mass loss some of that lean mass loss some of that lean mass loss um and and then we can come back to it um and and then we can come back to it um and and then we can come back to it but but yeah now that said for people so but but yeah now that said for people so but but yeah now that said for people so it depends on the strategy right depends it depends on the strategy right depends it depends on the strategy right depends on the dietary strategy so for people on the dietary strategy so for people on the dietary strategy so for people who are using tracking kind of the who are using tracking kind of the who are using tracking kind of the caloric restriction way we would still caloric restriction way we would still caloric restriction way we would still set a protein Target that is at two set a protein Target that is at two set a protein Target that is at two grams per pound because of the satiating grams per pound because of the satiating grams per pound because of the satiating benefits that you said right also you benefits that you said right also you benefits that you said right also you have the thermogenic effect and the have the thermogenic effect and the have the thermogenic effect and the benefits of protein over fat and benefits of protein over fat and benefits of protein over fat and carbohydrate from a thermogenesis carbohydrate from a thermogenesis carbohydrate from a thermogenesis standpoint standpoint standpoint but when you have people that are going but when you have people that are going but when you have people that are going about it via dietary restriction or time about it via dietary restriction or time about it via dietary restriction or time restriction as their strategy for restriction as their strategy for restriction as their strategy for cutting calories it can become a little cutting calories it can become a little cutting calories it can become a little overwhelming and when you force high overwhelming and when you force high overwhelming and when you force high protein you sometimes end up getting protein you sometimes end up getting protein you sometimes end up getting high calorie with it high calorie with it high calorie with it so that's where we would say just don't so that's where we would say just don't so that's where we would say just don't pay attention to it as much just focus pay attention to it as much just focus pay attention to it as much just focus on the the drtrtr approach The Other on the the drtrtr approach The Other on the the drtrtr approach The Other Place Rhonda where we do pay a lot of Place Rhonda where we do pay a lot of Place Rhonda where we do pay a lot of attention to protein is in the few of

2:34attention to protein is in the few of attention to protein is in the few of our patients that are taking glp-1 our patients that are taking glp-1 our patients that are taking glp-1 Agonist so I've been a pretty public Agonist so I've been a pretty public Agonist so I've been a pretty public uh critic might be too strong a word but uh critic might be too strong a word but uh critic might be too strong a word but I've certainly expressed my reservations I've certainly expressed my reservations I've certainly expressed my reservations about the ubiquitous use and the liberal about the ubiquitous use and the liberal about the ubiquitous use and the liberal use of glp-1 agonists especially in use of glp-1 agonists especially in use of glp-1 agonists especially in people you know just trying to lose 10 people you know just trying to lose 10 people you know just trying to lose 10 pounds right like it's one thing if pounds right like it's one thing if pounds right like it's one thing if you're 100 pounds overweight and you've you're 100 pounds overweight and you've you're 100 pounds overweight and you've tried everything by all means the tried everything by all means the tried everything by all means the benefits clearly outweigh the risks but benefits clearly outweigh the risks but benefits clearly outweigh the risks but you know the you know the you know the um I got to get my Beachbody on for the um I got to get my Beachbody on for the um I got to get my Beachbody on for the wedding this summer I'm going to lose 10 wedding this summer I'm going to lose 10 wedding this summer I'm going to lose 10 pounds let me fire up some semi-glutide pounds let me fire up some semi-glutide pounds let me fire up some semi-glutide or terzapatide I think that's a net or terzapatide I think that's a net or terzapatide I think that's a net negative personally and in those negative personally and in those negative personally and in those patients not that we're giving it to patients not that we're giving it to patients not that we're giving it to those patients but in any patient who's those patients but in any patient who's those patients but in any patient who's on a glp-1 Agonist we feel it is so on a glp-1 Agonist we feel it is so on a glp-1 Agonist we feel it is so essential to hammer home protein because essential to hammer home protein because essential to hammer home protein because those drugs are so effective at those drugs are so effective at those drugs are so effective at squashing appetite that I mean we've squashing appetite that I mean we've squashing appetite that I mean we've seen people who basically just want to seen people who basically just want to seen people who basically just want to drink alcohol when they're on it and drink alcohol when they're on it and drink alcohol when they're on it and they'll lose weight like crazy because they'll lose weight like crazy because they'll lose weight like crazy because they're you know not getting that many

2:35they're you know not getting that many they're you know not getting that many calories but they're like yeah I just calories but they're like yeah I just calories but they're like yeah I just like wine yeah I'm just losing muscle like wine yeah I'm just losing muscle like wine yeah I'm just losing muscle drinking wine drinking wine drinking wine um yeah so yeah I totally like I've I've um yeah so yeah I totally like I've I've um yeah so yeah I totally like I've I've got um some acquaintances that are of got um some acquaintances that are of got um some acquaintances that are of that category where it's like you know a that category where it's like you know a that category where it's like you know a stay-at-home mom wants to lose 10 pounds stay-at-home mom wants to lose 10 pounds stay-at-home mom wants to lose 10 pounds has the the means to to get it and does has the the means to to get it and does has the the means to to get it and does it and it and it and um there they I mean I have we haven't um there they I mean I have we haven't um there they I mean I have we haven't measured muscle but I look at them and measured muscle but I look at them and measured muscle but I look at them and I'm like you look like you're wasting I'm like you look like you're wasting I'm like you look like you're wasting your like your muscle is wasting like your like your muscle is wasting like your like your muscle is wasting like you know you're not if you're not eating you know you're not if you're not eating you know you're not if you're not eating you're not taking in proteins I mean you're not taking in proteins I mean you're not taking in proteins I mean like that makes 100 sense and it also I like that makes 100 sense and it also I like that makes 100 sense and it also I don't know maybe we'll talk about this don't know maybe we'll talk about this don't know maybe we'll talk about this when you come on my podcast but like I'd when you come on my podcast but like I'd when you come on my podcast but like I'd love to like because you used to do a love to like because you used to do a love to like because you used to do a lot of fasting yeah lot of fasting yeah lot of fasting yeah um I know you've kind of no you don't do um I know you've kind of no you don't do um I know you've kind of no you don't do as much at least of the long you know as much at least of the long you know as much at least of the long you know long fast and boy we could I would love long fast and boy we could I would love long fast and boy we could I would love to get into that um you can decide to get into that um you can decide to get into that um you can decide whether we should do that do that next whether we should do that do that next whether we should do that do that next time or we could talk a little bit now time or we could talk a little bit now time or we could talk a little bit now but um but yeah that was also like like but um but yeah that was also like like but um but yeah that was also like like the biggest the biggest the biggest you know there was another shift in my

2:36you know there was another shift in my you know there was another shift in my um understanding of you know fasting and um understanding of you know fasting and um understanding of you know fasting and time restricted eating a lot of people time restricted eating a lot of people time restricted eating a lot of people use time restricted eating they they use time restricted eating they they use time restricted eating they they sort of practice it by skipping meals um sort of practice it by skipping meals um sort of practice it by skipping meals um and I don't know necessarily that's the and I don't know necessarily that's the and I don't know necessarily that's the way to do it but people do that way to do it but people do that way to do it but people do that um it's just you know what people do and um it's just you know what people do and um it's just you know what people do and when you're skipping a meal you're when you're skipping a meal you're when you're skipping a meal you're skipping your protein right and so skipping your protein right and so skipping your protein right and so you're not getting as much as you're you're not getting as much as you're you're not getting as much as you're basically becoming uh you know losing basically becoming uh you know losing basically becoming uh you know losing muscle mass because you're not you're muscle mass because you're not you're muscle mass because you're not you're not getting that that important signal not getting that that important signal not getting that that important signal especially if you're not doing especially if you're not doing especially if you're not doing resistance training right then it's like resistance training right then it's like resistance training right then it's like kind of a disaster and that was also kind of a disaster and that was also kind of a disaster and that was also something uh that I hadn't thought about something uh that I hadn't thought about something uh that I hadn't thought about a lot and I know you've helped you've a lot and I know you've helped you've a lot and I know you've helped you've got a lot of experience in it on both got a lot of experience in it on both got a lot of experience in it on both personal and clinically uh but um I mean personal and clinically uh but um I mean personal and clinically uh but um I mean I'll I'll share with you briefly how we I'll I'll share with you briefly how we I'll I'll share with you briefly how we think about that so so on the on the think about that so so on the on the think about that so so on the on the time restricted feeding part we we agree time restricted feeding part we we agree time restricted feeding part we we agree that that the greatest drawback is that that that the greatest drawback is that that that the greatest drawback is that the patients get protein deficient so so the patients get protein deficient so so the patients get protein deficient so so time restricted feeding as a strategy

2:37time restricted feeding as a strategy time restricted feeding as a strategy for weight loss vis-a-vis caloric for weight loss vis-a-vis caloric for weight loss vis-a-vis caloric restriction restriction restriction is very effective with a small enough is very effective with a small enough is very effective with a small enough feeding window so you know a 16 8 you feeding window so you know a 16 8 you feeding window so you know a 16 8 you can eat your way into obesity with a can eat your way into obesity with a can eat your way into obesity with a 16-8 but once you start getting down to 16-8 but once you start getting down to 16-8 but once you start getting down to a 24 or a 22 too basically just doing a 24 or a 22 too basically just doing a 24 or a 22 too basically just doing one meal a day really getting one meal a day really getting one meal a day really getting restrictive restrictive restrictive um for the most part you're going to um for the most part you're going to um for the most part you're going to lose weight lose weight lose weight um the problem is by definition you're um the problem is by definition you're um the problem is by definition you're not going to get enough protein in not going to get enough protein in not going to get enough protein in because even if you managed to scarf because even if you managed to scarf because even if you managed to scarf down one gram per pound of body weight down one gram per pound of body weight down one gram per pound of body weight in a single meal you wouldn't be able to in a single meal you wouldn't be able to in a single meal you wouldn't be able to utilize those amino acids you kind of utilize those amino acids you kind of utilize those amino acids you kind of tap out at about 40 to 50 amino acids tap out at about 40 to 50 amino acids tap out at about 40 to 50 amino acids per meal so if you sat there and had 160 per meal so if you sat there and had 160 per meal so if you sat there and had 160 you just flushed a bunch of them down you just flushed a bunch of them down you just flushed a bunch of them down the toilet right there they're literally the toilet right there they're literally the toilet right there they're literally not coming on the toilet they're coming not coming on the toilet they're coming not coming on the toilet they're coming out as via vis-a-b urine right coming out as via vis-a-b urine right coming out as via vis-a-b urine right coming out the urea cycle so out the urea cycle so out the urea cycle so um um the the the um um the thing that we would counsel people the thing that we would counsel people the thing that we would counsel people on if they're going to use time

2:38on if they're going to use time on if they're going to use time restricted eating is they have to have restricted eating is they have to have restricted eating is they have to have protein snacks outside of their feeding protein snacks outside of their feeding protein snacks outside of their feeding window so if they're going to say look window so if they're going to say look window so if they're going to say look I'm gonna I'm gonna I'm gonna I'm going to only have kind of a a lunch I'm going to only have kind of a a lunch I'm going to only have kind of a a lunch at two o'clock and a dinner at seven at two o'clock and a dinner at seven at two o'clock and a dinner at seven o'clock o'clock o'clock we'll say fine but you still have to we'll say fine but you still have to we'll say fine but you still have to have two protein snacks outside of that have two protein snacks outside of that have two protein snacks outside of that and that becomes challenging because and that becomes challenging because and that becomes challenging because those protein snacks can't really have those protein snacks can't really have those protein snacks can't really have much else in them they have to be very much else in them they have to be very much else in them they have to be very low calorie otherwise otherwise you're low calorie otherwise otherwise you're low calorie otherwise otherwise you're not really doing time restricted feeding not really doing time restricted feeding not really doing time restricted feeding and of course a lot of people get and of course a lot of people get and of course a lot of people get phosphorylated over this they say but oh phosphorylated over this they say but oh phosphorylated over this they say but oh my God that's like outside of my feeding my God that's like outside of my feeding my God that's like outside of my feeding window will that impair autophagy to window will that impair autophagy to window will that impair autophagy to which I argue you're not getting any which I argue you're not getting any which I argue you're not getting any autophagy doing a single daytime autophagy doing a single daytime autophagy doing a single daytime restricted feeding anyway it doesn't restricted feeding anyway it doesn't restricted feeding anyway it doesn't matter but if people are getting gut matter but if people are getting gut matter but if people are getting gut benefits from taking that time off then benefits from taking that time off then benefits from taking that time off then yeah they're going to miss out on those yeah they're going to miss out on those yeah they're going to miss out on those because you're I just don't see how you because you're I just don't see how you because you're I just don't see how you can get the gut rest if you're trying to can get the gut rest if you're trying to can get the gut rest if you're trying to get those amino acids so you might have get those amino acids so you might have get those amino acids so you might have to really start to cycle those things to really start to cycle those things to really start to cycle those things um but yeah long-winded answer to

2:39um but yeah long-winded answer to um but yeah long-winded answer to why I think fasting can really be at why I think fasting can really be at why I think fasting can really be at odds with the adequate maintenance of odds with the adequate maintenance of odds with the adequate maintenance of muscle and as we get older you know I muscle and as we get older you know I muscle and as we get older you know I think that I'm I'm just entering my think that I'm I'm just entering my think that I'm I'm just entering my sixth decade this is a very high sixth decade this is a very high sixth decade this is a very high priority for me priority for me priority for me oh really wow you look great Peter I oh really wow you look great Peter I oh really wow you look great Peter I didn't so you're you're in your life no didn't so you're you're in your life no didn't so you're you're in your life no six decades so I oh yeah yeah so you six decades so I oh yeah yeah so you six decades so I oh yeah yeah so you just so yeah yeah gotcha yeah just so yeah yeah gotcha yeah just so yeah yeah gotcha yeah um well but I love that I love that you um well but I love that I love that you um well but I love that I love that you thought I was 60. that's awesome well thought I was 60. that's awesome well thought I was 60. that's awesome well you know you know I think Joe Rogan's you know you know I think Joe Rogan's you know you know I think Joe Rogan's entering that and that's kind of what I entering that and that's kind of what I entering that and that's kind of what I was thinking and he looks I mean like was thinking and he looks I mean like was thinking and he looks I mean like you know that you can you can definitely you know that you can you can definitely you know that you can you can definitely see the people that like put in the work see the people that like put in the work see the people that like put in the work and work out and and you know they do and work out and and you know they do and work out and and you know they do aerobic they do strength training like aerobic they do strength training like aerobic they do strength training like you look at them there was like a study you look at them there was like a study you look at them there was like a study published on that too like a bunch of published on that too like a bunch of published on that too like a bunch of Bio biological markers of aging and Bio biological markers of aging and Bio biological markers of aging and biomarkers of Aging were measured and biomarkers of Aging were measured and biomarkers of Aging were measured and then like there was like people looked then like there was like people looked then like there was like people looked at pictures and like ranked their their

2:40at pictures and like ranked their their at pictures and like ranked their their age and their their you know age and their their you know age and their their you know quote-unquote biomarker biological age quote-unquote biomarker biological age quote-unquote biomarker biological age so like according to all these so like according to all these so like according to all these biomarkers that basically say they're biomarkers that basically say they're biomarkers that basically say they're chronological age maybe older than their chronological age maybe older than their chronological age maybe older than their biological age where they looked like biological age where they looked like biological age where they looked like their biological age not their their biological age not their their biological age not their chronological age you know so that chronological age you know so that chronological age you know so that that's that's also important although I that's that's also important although I that's that's also important although I sometimes feel like excess exercise can sometimes feel like excess exercise can sometimes feel like excess exercise can prematurely age you as well I've prematurely age you as well I've prematurely age you as well I've certainly seen a lot of and I don't know certainly seen a lot of and I don't know certainly seen a lot of and I don't know how much of that is the sun damage how much of that is the sun damage how much of that is the sun damage because of course a lot of exercise is because of course a lot of exercise is because of course a lot of exercise is done outdoors and of course uh Sun can done outdoors and of course uh Sun can done outdoors and of course uh Sun can play a horrible role in that play a horrible role in that play a horrible role in that um well so we've been you know we've um well so we've been you know we've um well so we've been you know we've we've I've taken up more of your time we've I've taken up more of your time we've I've taken up more of your time than I said I would but I want to ask than I said I would but I want to ask than I said I would but I want to ask you kind of just one last thing is there you kind of just one last thing is there you kind of just one last thing is there any other just sticking with this theme any other just sticking with this theme any other just sticking with this theme of of things that you believe today that you things that you believe today that you things that you believe today that you didn't believe three or four years ago didn't believe three or four years ago didn't believe three or four years ago or things that you believed three or or things that you believed three or or things that you believed three or four years ago that you don't believe four years ago that you don't believe four years ago that you don't believe today is there anything we haven't today is there anything we haven't today is there anything we haven't touched on because we've we've talked touched on because we've we've talked touched on because we've we've talked about some really good ones about some really good ones about some really good ones um I think those are the the really um I think those are the the really um I think those are the the really important ones off the top of my head

2:41important ones off the top of my head important ones off the top of my head um I definitely don't want to get into um I definitely don't want to get into um I definitely don't want to get into the whole covet thing at this point but the whole covet thing at this point but the whole covet thing at this point but I've my view has changed on on things as I've my view has changed on on things as I've my view has changed on on things as that has progressed and changed as well that has progressed and changed as well that has progressed and changed as well um so I don't want to like not mention um so I don't want to like not mention um so I don't want to like not mention it but uh yeah so but um the the most I it but uh yeah so but um the the most I it but uh yeah so but um the the most I think the most important things would be think the most important things would be think the most important things would be um muscle mass protein intake also I um muscle mass protein intake also I um muscle mass protein intake also I like fasting and I think the effects of like fasting and I think the effects of like fasting and I think the effects of time restricted eating on weight loss time restricted eating on weight loss time restricted eating on weight loss specifically when you're looking at that specifically when you're looking at that specifically when you're looking at that outcome being attributed to caloric outcome being attributed to caloric outcome being attributed to caloric restriction I think that is something restriction I think that is something restriction I think that is something that I've it's it's you know I wasn't that I've it's it's you know I wasn't that I've it's it's you know I wasn't always you know buying into that but I always you know buying into that but I always you know buying into that but I do it is still my opinion there are do it is still my opinion there are do it is still my opinion there are benefits to eating within your circadian benefits to eating within your circadian benefits to eating within your circadian rhythm I mean so like you know eating rhythm I mean so like you know eating rhythm I mean so like you know eating eating late at night when you're making eating late at night when you're making eating late at night when you're making melatonin two to three hours before bed melatonin two to three hours before bed melatonin two to three hours before bed you're basically inhibiting insulin you're basically inhibiting insulin you're basically inhibiting insulin secretion and I don't like there's data secretion and I don't like there's data secretion and I don't like there's data showing that you will you know your

2:42showing that you will you know your showing that you will you know your glucose levels will be higher with the glucose levels will be higher with the glucose levels will be higher with the same exact macronutrient intake as if same exact macronutrient intake as if same exact macronutrient intake as if you eat it earlier so I do there are you eat it earlier so I do there are you eat it earlier so I do there are benefits circadian benefits and I also benefits circadian benefits and I also benefits circadian benefits and I also think you mentioned the the gut rest and think you mentioned the the gut rest and think you mentioned the the gut rest and like digestion like digestion like digestion um you know resting like how having that um you know resting like how having that um you know resting like how having that rest period like your body can't so DNA rest period like your body can't so DNA rest period like your body can't so DNA repair mechanisms you mentioned repair mechanisms you mentioned repair mechanisms you mentioned autophagy like those things happen when autophagy like those things happen when autophagy like those things happen when you're not digesting so like in that you're not digesting so like in that you're not digesting so like in that process like isn't happening so you have process like isn't happening so you have process like isn't happening so you have to have like a rest period to have like a rest period to have like a rest period um for repair processes to occur and I um for repair processes to occur and I um for repair processes to occur and I don't know that I necessarily I think don't know that I necessarily I think don't know that I necessarily I think autophagy is as good as the the markers autophagy is as good as the the markers autophagy is as good as the the markers that we are sensitive assays that we that we are sensitive assays that we that we are sensitive assays that we have to measure it and I don't know that have to measure it and I don't know that have to measure it and I don't know that it's settled with respect to how long I it's settled with respect to how long I it's settled with respect to how long I personally think there's probably even personally think there's probably even personally think there's probably even in between meals there's some amount of in between meals there's some amount of in between meals there's some amount of autophagy a topologies are happening in autophagy a topologies are happening in autophagy a topologies are happening in us it is yeah it's not like we're not us it is yeah it's not like we're not us it is yeah it's not like we're not but is it clinically significant right but is it clinically significant right but is it clinically significant right or more so than say exercise would or more so than say exercise would or more so than say exercise would induce yeah no right exercise like no

2:43induce yeah no right exercise like no induce yeah no right exercise like no like extras nothing like the exercise is like extras nothing like the exercise is like extras nothing like the exercise is like that's my point like how long would like that's my point like how long would like that's my point like how long would you need to fast to to get the benefits you need to fast to to get the benefits you need to fast to to get the benefits how long would you need to fast to get how long would you need to fast to get how long would you need to fast to get the benefits of an amazing workout and the benefits of an amazing workout and the benefits of an amazing workout and what my thinking is right probably a what my thinking is right probably a what my thinking is right probably a long time long time long time um you know you might have to go a full um you know you might have to go a full um you know you might have to go a full day without food or a couple days day without food or a couple days day without food or a couple days without food to get the benefits of that without food to get the benefits of that without food to get the benefits of that but but you're right I think without but but you're right I think without but but you're right I think without biomarkers a lot of this stuff is very biomarkers a lot of this stuff is very biomarkers a lot of this stuff is very difficult to speculate on because we difficult to speculate on because we difficult to speculate on because we can't really extrapolate from mice on can't really extrapolate from mice on can't really extrapolate from mice on this stuff I I think I I don't it's so this stuff I I think I I don't it's so this stuff I I think I I don't it's so non-linear that I don't think I could non-linear that I don't think I could non-linear that I don't think I could and I've never heard anybody offer a and I've never heard anybody offer a and I've never heard anybody offer a very compelling argument either for what very compelling argument either for what very compelling argument either for what the quote-unquote answer is the quote-unquote answer is the quote-unquote answer is I I agree we can extrapolate from Ice I I agree we can extrapolate from Ice I I agree we can extrapolate from Ice and and and um the way I view it though is more of a um the way I view it though is more of a um the way I view it though is more of a cumulative effect where I'm thinking you cumulative effect where I'm thinking you cumulative effect where I'm thinking you know like I think it's better to just know like I think it's better to just know like I think it's better to just eat within a circadian window and do I eat within a circadian window and do I eat within a circadian window and do I think that's going to have a cumulative think that's going to have a cumulative think that's going to have a cumulative effect on you know metabolism and yes I effect on you know metabolism and yes I effect on you know metabolism and yes I think that it's better that I'm not

2:44think that it's better that I'm not think that it's better that I'm not eating you know within a 15-hour window eating you know within a 15-hour window eating you know within a 15-hour window like eating you know with which most like eating you know with which most like eating you know with which most people in the United States they people in the United States they people in the United States they actually do eat like they're eating from actually do eat like they're eating from actually do eat like they're eating from start to finish like a lot of people are start to finish like a lot of people are start to finish like a lot of people are eating like you know within a 15 hour eating like you know within a 15 hour eating like you know within a 15 hour period And so um is that going to like period And so um is that going to like period And so um is that going to like if you're exercising maybe it maybe it if you're exercising maybe it maybe it if you're exercising maybe it maybe it doesn't matter maybe you're right maybe doesn't matter maybe you're right maybe doesn't matter maybe you're right maybe they can't even a 15-hour window we they can't even a 15-hour window we they can't even a 15-hour window we don't really know but um I tend to think don't really know but um I tend to think don't really know but um I tend to think probably the Circadian component like probably the Circadian component like probably the Circadian component like does play some role does play some role does play some role um but the question is is it is it um but the question is is it is it um but the question is is it is it significant you know is it significant significant you know is it significant significant you know is it significant uh I am of the opinion it probably is uh I am of the opinion it probably is uh I am of the opinion it probably is cumulative if for no other reason I cumulative if for no other reason I cumulative if for no other reason I think it just is on sleep right I mean think it just is on sleep right I mean think it just is on sleep right I mean if on sleep yeah exactly like if you if on sleep yeah exactly like if you if on sleep yeah exactly like if you just look at the benefits of just look at the benefits of just look at the benefits of risk nighttime food restriction in terms risk nighttime food restriction in terms risk nighttime food restriction in terms of as you pointed out the where you know of as you pointed out the where you know of as you pointed out the where you know we're least insulin sensitive and the we're least insulin sensitive and the we're least insulin sensitive and the negative impacts probably of negative impacts probably of negative impacts probably of thermogenesis and other things on on

2:45thermogenesis and other things on on thermogenesis and other things on on sleep sleep sleep you know that that's probably the most you know that that's probably the most you know that that's probably the most compelling reason even if nothing else compelling reason even if nothing else compelling reason even if nothing else mattered if we couldn't measure it but mattered if we couldn't measure it but mattered if we couldn't measure it but but those those day those are so but those those day those are so but those those day those are so abundantly clear right like you you know abundantly clear right like you you know abundantly clear right like you you know that's that's as clear as that's that's as clear as that's that's as clear as how alcohol impairs sleep you know a how alcohol impairs sleep you know a how alcohol impairs sleep you know a late night meal is a is a great way to late night meal is a is a great way to late night meal is a is a great way to destroy a good sleep absolutely right destroy a good sleep absolutely right destroy a good sleep absolutely right and most I think most people have but and most I think most people have but and most I think most people have but it's anecdotally like people realize it's anecdotally like people realize it's anecdotally like people realize that as well yeah that as well yeah that as well yeah um so yeah I think I think I think we um so yeah I think I think I think we um so yeah I think I think I think we covered uh a lot of the the things that covered uh a lot of the the things that covered uh a lot of the the things that of my my perspective has shifted as any of my my perspective has shifted as any of my my perspective has shifted as any scientist that's following data should scientist that's following data should scientist that's following data should you know I mean some people argue oh you you know I mean some people argue oh you you know I mean some people argue oh you change you know how can I yeah yeah you change you know how can I yeah yeah you change you know how can I yeah yeah you know follow you you're you know change know follow you you're you know change know follow you you're you know change your mind it's like well like when new your mind it's like well like when new your mind it's like well like when new data comes out like you have to reassess data comes out like you have to reassess data comes out like you have to reassess things like I recess the supplements I'm things like I recess the supplements I'm things like I recess the supplements I'm taking I mean the supplements I take Now taking I mean the supplements I take Now taking I mean the supplements I take Now versus five years ago you know totally versus five years ago you know totally versus five years ago you know totally different not all of them they're different not all of them they're different not all of them they're certain base things like that I like

2:46certain base things like that I like certain base things like that I like vitamin D omega-3 like those are like vitamin D omega-3 like those are like vitamin D omega-3 like those are like super important I think but you know super important I think but you know super important I think but you know like you have you have to reassess like you have you have to reassess like you have you have to reassess things because new data comes out and things because new data comes out and things because new data comes out and you know you might have a new you know you might have a new you know you might have a new understanding of things that we didn't understanding of things that we didn't understanding of things that we didn't know we have new tools we have you know know we have new tools we have you know know we have new tools we have you know it's it's always getting better so you it's it's always getting better so you it's it's always getting better so you have to kind of reassess things have to kind of reassess things have to kind of reassess things so Rhonda for folks to follow you so Rhonda for folks to follow you so Rhonda for folks to follow you obviously your podcast found my fitness obviously your podcast found my fitness obviously your podcast found my fitness great way to follow amazing content also great way to follow amazing content also great way to follow amazing content also you put up a lot of content I think you put up a lot of content I think you put up a lot of content I think Instagram is probably where you're Instagram is probably where you're Instagram is probably where you're putting up most of your content right is putting up most of your content right is putting up most of your content right is that is that safe to say that if folks that is that safe to say that if folks that is that safe to say that if folks reach if folks follow you on Instagram reach if folks follow you on Instagram reach if folks follow you on Instagram that's where you're doing kind of really that's where you're doing kind of really that's where you're doing kind of really sort of thorough analyzes and stuff like sort of thorough analyzes and stuff like sort of thorough analyzes and stuff like that would you recommend people also that would you recommend people also that would you recommend people also check out Twitter where should people be check out Twitter where should people be check out Twitter where should people be going to see your thinking on a frequent going to see your thinking on a frequent going to see your thinking on a frequent basis well it depends on what they like basis well it depends on what they like basis well it depends on what they like to consume so if they like to consume to consume so if they like to consume to consume so if they like to consume like in-depth articles we publish them like in-depth articles we publish them like in-depth articles we publish them on my website foundmyfitness.com we have on my website foundmyfitness.com we have on my website foundmyfitness.com we have like topic articles that we cover we like topic articles that we cover we like topic articles that we cover we cover blood brain barrier for one is one

2:47cover blood brain barrier for one is one cover blood brain barrier for one is one um you know like so we cover that more um you know like so we cover that more um you know like so we cover that more in depth some people like to read they in depth some people like to read they in depth some people like to read they like to like nerd out on that like to like nerd out on that like to like nerd out on that um so that would be the place for that um so that would be the place for that um so that would be the place for that and then some people just like short and then some people just like short and then some people just like short little to the point like what you know little to the point like what you know little to the point like what you know and that is where if they want like the and that is where if they want like the and that is where if they want like the sort of uh quick thing like the sort of uh quick thing like the sort of uh quick thing like the Instagram Instagram Instagram um would be you know so found my Fitness um would be you know so found my Fitness um would be you know so found my Fitness on Instagram and also Twitter as well I on Instagram and also Twitter as well I on Instagram and also Twitter as well I do like a lot of it's it's kind of like do like a lot of it's it's kind of like do like a lot of it's it's kind of like a short I mean you only get so much time a short I mean you only get so much time a short I mean you only get so much time on Twitter and on Twitter and on Twitter and um you know you can't go into in depth um you know you can't go into in depth um you know you can't go into in depth and nuance and then I sort of have a and nuance and then I sort of have a and nuance and then I sort of have a love-hate relationship on Twitter but um love-hate relationship on Twitter but um love-hate relationship on Twitter but um but it is kind of a fun a fun place to but it is kind of a fun a fun place to but it is kind of a fun a fun place to also like there's other scientists on also like there's other scientists on also like there's other scientists on there as well and so yeah I'm I'm on there as well and so yeah I'm I'm on there as well and so yeah I'm I'm on Twitter and Instagram but and it's all Twitter and Instagram but and it's all Twitter and Instagram but and it's all the same handle right it's awesome yeah the same handle right it's awesome yeah the same handle right it's awesome yeah I found my fitness and then in the I found my fitness and then in the I found my fitness and then in the podcast as well which is podcast as well which is podcast as well which is Andrew Andrew huberman and I were Andrew Andrew huberman and I were Andrew Andrew huberman and I were talking a little while ago and we were talking a little while ago and we were talking a little while ago and we were sort of singing your Praises as as truly sort of singing your Praises as as truly sort of singing your Praises as as truly the the OG Health podcaster when did you the the OG Health podcaster when did you the the OG Health podcaster when did you start was it 2014

2:48start was it 2014 start was it 2014 yeah I start that was when I started the yeah I start that was when I started the yeah I start that was when I started the podcast when I it was a weekend podcast when I it was a weekend podcast when I it was a weekend um I was doing my post-doc in in Oakland um I was doing my post-doc in in Oakland um I was doing my post-doc in in Oakland and I just started like Ron Krauss down and I just started like Ron Krauss down and I just started like Ron Krauss down the hall the hall the hall um George Brooks so I have a podcast um George Brooks so I have a podcast um George Brooks so I have a podcast with George Brooks on lactate like he with George Brooks on lactate like he with George Brooks on lactate like he was like I don't think I've heard that I was like I don't think I've heard that I was like I don't think I've heard that I need to go and listen to that one yeah need to go and listen to that one yeah need to go and listen to that one yeah we went all into that I've been into we went all into that I've been into we went all into that I've been into that like that whole podcast like kind that like that whole podcast like kind that like that whole podcast like kind of shifted my thinking of like intensity of shifted my thinking of like intensity of shifted my thinking of like intensity of exercise and the importance of of exercise and the importance of of exercise and the importance of lactate because you know I don't know if lactate because you know I don't know if lactate because you know I don't know if you know this but like I trained I you know this but like I trained I you know this but like I trained I probably shouldn't like we already probably shouldn't like we already probably shouldn't like we already talked about where people should go find talked about where people should go find talked about where people should go find me but like I I was a mitochondrial me but like I I was a mitochondrial me but like I I was a mitochondrial metabolism you know researcher in grad metabolism you know researcher in grad metabolism you know researcher in grad school you know and so I was looking at school you know and so I was looking at school you know and so I was looking at my the role of mitochondria in cancer my the role of mitochondria in cancer my the role of mitochondria in cancer um and so of course like lactate I mean um and so of course like lactate I mean um and so of course like lactate I mean I was thinking about it in a completely I was thinking about it in a completely I was thinking about it in a completely different frame of mind right as opposed different frame of mind right as opposed different frame of mind right as opposed to I mean we now know it's such an to I mean we now know it's such an to I mean we now know it's such an important signaling molecule in addition important signaling molecule in addition important signaling molecule in addition to all those other things we we talked to all those other things we we talked to all those other things we we talked about about about um it is you know we've had at least one

2:49um it is you know we've had at least one um it is you know we've had at least one guest suggest that George Brooks uh is guest suggest that George Brooks uh is guest suggest that George Brooks uh is deserving of a Nobel Prize deserving of a Nobel Prize deserving of a Nobel Prize I mean I think you know he his lactate I mean I think you know he his lactate I mean I think you know he his lactate shuttle Theory it's called a theory and shuttle Theory it's called a theory and shuttle Theory it's called a theory and I kind of hate that it's called that I kind of hate that it's called that I kind of hate that it's called that because people hear that and they're because people hear that and they're because people hear that and they're like oh it's not proven yeah yeah but it like oh it's not proven yeah yeah but it like oh it's not proven yeah yeah but it but it's been but it's been proven um but it's been but it's been proven um but it's been but it's been proven um and in fact there's like studies like and in fact there's like studies like and in fact there's like studies like even like there were people looking at even like there were people looking at even like there were people looking at this like even before he proposed like this like even before he proposed like this like even before he proposed like they were looking at lactate in the they were looking at lactate in the they were looking at lactate in the getting in the brain uh in response to getting in the brain uh in response to getting in the brain uh in response to physical activity and um and and it's physical activity and um and and it's physical activity and um and and it's like beta hydroxybutyrate it's a like beta hydroxybutyrate it's a like beta hydroxybutyrate it's a signaling molecule it activates bdnf signaling molecule it activates bdnf signaling molecule it activates bdnf like beta hydroxybutyrate they go like beta hydroxybutyrate they go like beta hydroxybutyrate they go through the same transporter through the same transporter through the same transporter monocarboxylate transport of the MCT monocarboxylate transport of the MCT monocarboxylate transport of the MCT transporter to get into the brain transporter to get into the brain transporter to get into the brain um and there's also those in um and there's also those in um and there's also those in mitochondria but it's so funny because mitochondria but it's so funny because mitochondria but it's so funny because there's a lot of similarities the there's a lot of similarities the there's a lot of similarities the effects on TBI so you know George Brooks effects on TBI so you know George Brooks effects on TBI so you know George Brooks has done some studies has done some studies has done some studies um USC looking at you know some of these um USC looking at you know some of these um USC looking at you know some of these victims of TBI and I'm giving them victims of TBI and I'm giving them victims of TBI and I'm giving them lactate and it's like improving whatever lactate and it's like improving whatever lactate and it's like improving whatever their Glasgow rating scores yeah their Glasgow rating scores yeah their Glasgow rating scores yeah whatever the things that they're looking

2:50whatever the things that they're looking whatever the things that they're looking at but like I think beta hydroxybutyrate at but like I think beta hydroxybutyrate at but like I think beta hydroxybutyrate there's some wasn't there some evidence there's some wasn't there some evidence there's some wasn't there some evidence I think we with TBI I remember Dom I think we with TBI I remember Dom I think we with TBI I remember Dom talking yeah Thomas talked about this talking yeah Thomas talked about this talking yeah Thomas talked about this yeah yeah so it's like it's so yeah yeah so it's like it's so yeah yeah so it's like it's so interesting because also interesting because also interesting because also you know with respect to like you know with respect to like you know with respect to like Alzheimer's disease and like through Alzheimer's disease and like through Alzheimer's disease and like through some really preliminary data that of some really preliminary data that of some really preliminary data that of course needs to be repeated probably course needs to be repeated probably course needs to be repeated probably won't because you can't get funding but won't because you can't get funding but won't because you can't get funding but like giving beta hydroxybutyrate BHB to like giving beta hydroxybutyrate BHB to like giving beta hydroxybutyrate BHB to people with Alzheimer's disease people with Alzheimer's disease people with Alzheimer's disease um can like help improve like there's um can like help improve like there's um can like help improve like there's some small clinical studies looking at some small clinical studies looking at some small clinical studies looking at improve Improvement in like cognition improve Improvement in like cognition improve Improvement in like cognition and um you know so lactate lactate's and um you know so lactate lactate's and um you know so lactate lactate's like I think similar so there's a lot of like I think similar so there's a lot of like I think similar so there's a lot of overlap there now lactate you can make overlap there now lactate you can make overlap there now lactate you can make beta hydroxybutyrate you make from beta hydroxybutyrate you make from beta hydroxybutyrate you make from exercise as well you like push yourself exercise as well you like push yourself exercise as well you like push yourself into ketosis right so it'd be into ketosis right so it'd be into ketosis right so it'd be interesting like there's you know if interesting like there's you know if interesting like there's you know if there's Synergy there uh but like the there's Synergy there uh but like the there's Synergy there uh but like the the the trying to get the lactate and the the trying to get the lactate and the the trying to get the lactate and the beta hydroxybutyrate the the beta hydroxybutyrate the the beta hydroxybutyrate the neurobiological effects of them to me is neurobiological effects of them to me is neurobiological effects of them to me is is like it's so important it's so

2:51is like it's so important it's so is like it's so important it's so interesting and I just I kind of want interesting and I just I kind of want interesting and I just I kind of want more research in that area and so I like more research in that area and so I like more research in that area and so I like talking about it because I know talking about it because I know talking about it because I know scientists listen to your podcast scientists listen to your podcast scientists listen to your podcast researchers Physicians so it's it's it's researchers Physicians so it's it's it's researchers Physicians so it's it's it's good to kind of like spread ideas I mean good to kind of like spread ideas I mean good to kind of like spread ideas I mean that's part of what the podcast does that's part of what the podcast does that's part of what the podcast does right right spreading ideas it's not it's not just spreading ideas it's not it's not just spreading ideas it's not it's not just like I'm a communicating you know the like I'm a communicating you know the like I'm a communicating you know the the health ideas inside it's like the health ideas inside it's like the health ideas inside it's like scientists are listening to this and scientists are listening to this and scientists are listening to this and they're they're outside of their like they're they're outside of their like they're they're outside of their like you know lens where they're only you know lens where they're only you know lens where they're only thinking about the thing that they thinking about the thing that they thinking about the thing that they research and they hear this and it's research and they hear this and it's research and they hear this and it's like creativity right they start to go like creativity right they start to go like creativity right they start to go oh like and I've I've seen that happen oh like and I've I've seen that happen oh like and I've I've seen that happen like that like scientists like doing like that like scientists like doing like that like scientists like doing experiments you know based off of like experiments you know based off of like experiments you know based off of like listening to podcasts and stuff and so I listening to podcasts and stuff and so I listening to podcasts and stuff and so I think it's really I think it's really think it's really I think it's really think it's really I think it's really great great great um but thank you for the OG yeah I did um but thank you for the OG yeah I did um but thank you for the OG yeah I did that and it was a it was a weekend thing that and it was a it was a weekend thing that and it was a it was a weekend thing for me and for me and for me and um I loved it it took off I just I love um I loved it it took off I just I love um I loved it it took off I just I love it so much like I know you do as well I it so much like I know you do as well I it so much like I know you do as well I mean it's like and by the way mean it's like and by the way mean it's like and by the way um phenomenal podcast like it's funny um phenomenal podcast like it's funny um phenomenal podcast like it's funny um I don't listen to podcasts much at

2:52um I don't listen to podcasts much at um I don't listen to podcasts much at all as I mentioned but there's there's a all as I mentioned but there's there's a all as I mentioned but there's there's a few people that I trust few people that I trust few people that I trust to really be vigorous in their you know to really be vigorous in their you know to really be vigorous in their you know research and to be critical to really research and to be critical to really research and to be critical to really like dive down and like get into the like dive down and like get into the like dive down and like get into the root of things and and you are like one root of things and and you are like one root of things and and you are like one of those people and so like people will of those people and so like people will of those people and so like people will come to me you know and say oh Peter come to me you know and say oh Peter come to me you know and say oh Peter ortia said this I'm like oh okay I ortia said this I'm like oh okay I ortia said this I'm like oh okay I should like this is like like you know should like this is like like you know should like this is like like you know this is something I should consider or this is something I should consider or this is something I should consider or you know oftentimes it'll be oh yeah you know oftentimes it'll be oh yeah you know oftentimes it'll be oh yeah Peter also said that and so I'm like oh Peter also said that and so I'm like oh Peter also said that and so I'm like oh good you know so so I'm always like I'm good you know so so I'm always like I'm good you know so so I'm always like I'm always like okay what is Peter thinking always like okay what is Peter thinking always like okay what is Peter thinking what is Peter what is Peter thinking so what is Peter what is Peter thinking so what is Peter what is Peter thinking so um it's nice to have you as a colleague um it's nice to have you as a colleague um it's nice to have you as a colleague as a friend request I'm glad we've as a friend request I'm glad we've as a friend request I'm glad we've reconnected um thank you so much for reconnected um thank you so much for reconnected um thank you so much for inviting me on your podcast can't wait inviting me on your podcast can't wait inviting me on your podcast can't wait to to speak with you again uh soon on to to speak with you again uh soon on to to speak with you again uh soon on your amazing book which I can't wait to your amazing book which I can't wait to your amazing book which I can't wait to read and uh discuss as well in a couple read and uh discuss as well in a couple read and uh discuss as well in a couple of months of months of months well thank you very much Rhonda I can't well thank you very much Rhonda I can't well thank you very much Rhonda I can't wait to uh to see you in person even

2:53wait to uh to see you in person even wait to uh to see you in person even though it's been pretty awesome to see though it's been pretty awesome to see though it's been pretty awesome to see you in video your setup is as I said you in video your setup is as I said you in video your setup is as I said exceptional so we've we've treated the exceptional so we've we've treated the exceptional so we've we've treated the people who are watching this to a people who are watching this to a people who are watching this to a world-class view of what a home podcast world-class view of what a home podcast world-class view of what a home podcast setup can look like setup can look like setup can look like amazing thanks Peter all right see you amazing thanks Peter all right see you amazing thanks Peter all right see you around around around [Music]

252 Latest insights on Alzheimer s disease cancer exercise nutrition and fasting