Peter Attia - Autism, Vaccinating Your Kids and the 4 Leading Causes of Death | SRS #181

Peter AA welcome to the show thank you. for having me Sean so uh I'm really. excited about this interview I've been. diving into the health space pretty hard. uh about the past month and um had a. bunch of your constituents on here and. uh it's like drinking from a fire hose.

here for me so really excited to talk to. you about about everything that we're. going to cover today but um real quick. everybody starts out with an intro. so Dr Peter Atia you're the founder of. early medical a medical practice that. applies the principles of medicine 3.0. to patients with the goal of. simultaneously lengthening their. lifespan and increasing their health. span you're the host of the drive one of. the most popular podcasts covering.

health and Medicine you frequent number. one in the category congratulations. that's awesome uh and I've like I said. I've interviewed a lot of your. constituents and that everybody has. amazing things to say about you um. you're also the author of the number one. New York Times bestseller outlive the. science and art of longevity you're also. an accomplished long-distance Open Water. swimmer including being the first male. to complete the round trip between Maui. and laai.

I've heard that the only thing you do in. moderation is moderation itself and uh. like I said I'm really excited to dive. into medicine 3.0 but we had a little uh. side conversation downstairs when we. were getting started so you're a hunter. yep how long have you been hunting uh I. about six years now what got you into. that well I got into archery first just. because I really love Precision things. uh um and I was just looking for another.

Hobby and something to do and get really. into so I'd been doing archery for a. couple of years and really enjoying it. and really just enjoying it for the art. of learning how to shoot a bow and arrow. um and then a buddy invited me on a hunt. and I I was kind of ambivalent I was. like I mean okay I get it like I think. it'd be pretty cool to kill something. that you eat um and I think we just got. lucky you know we got we went to a place. in Hawaii that was amazing and to hunt a.

type of animal that is very difficult to. hunt called called axis deer that is not. only very difficult to hunt but is very. invasive to to the state of Hawaii. incredibly destructive um and so it's uh. it's a win for the state it's a win for. the people of Hawaii um it's an. important part of population control and. it turns out that I would say along with. elk it's probably the most you know. delicious sort of wild game there is.

and then the rest is history you know. you sort of get hooked on it after that. how often do you. hunt you know I would say these days I'm. busier than I would like so I I probably. went on five probably went away for four. or five hunts this year um but luckily. in Texas we can hunt locally as well we. actually have access deer in Texas so I. can do I can do some local hunting there. as well the same deer that's in Hawaii. yeah although it's funny they're the. only two places in the US that exists is. Texas and Hawaii but it's a pretty.

different animal in Texas it's a bigger. animal based on its diet in Hawaii it's. it's it's smaller and for whatever. reason it it seems just a little more. skittish in Hawaii uh but but it's a. totally different hunting experience so. in Hawaii it's um you're hunting in the. mountains it's um it's pretty it's. pretty amazing yeah I started hunting. this year for the first time just. Firearms yeah I'm not into the bow stuff. yet but uh I love it man I think it's. just awesome being out there and um and.

then through these health interviews. been learning a lot about what are what. our proteins are eating at the market. and the hormones and the garbage food. that they I just I just had this guy on. Paul saladino and he was talking. about I asked him about wild caught. salmon versus Farm race salmon and he. started going on about the what we're. feeding the salmon holy [ __ ] man.

I mean what do you is did that play any. role into why you started hunting no I I. think it look I think it plays more of a. role today um I feel pretty lucky that I. can get away with eating mostly Wild. game. or uh animals that are eating what. they're meant to be eating so I also. have a friend in Austin who's got a a. large property and he Farms you know in. a sustainable way everything else that.

we eat so even the bacon that we're. getting is coming from pigs that are you. know that are not going through the. usual process um so so there's you know. I certainly hope that um as more and. more people are becoming aware of it's. hard to be healthier than the animal you. eat so you got to be eating an animal. that was pretty healthy to begin with um. I I hope that there are more and more. economic choices for people to to do. this because right now it's a bit Niche. right not everybody can go out and hunt. mhm um my brother grows cattle um and.

it's pretty awesome so he's you know he. lives on a farm and he basically. regeneratively Farms his cattle and you. know he and his family are only going to. eat one a year so they're selling all. the rest of them and they're just kind. of cycling through it um but there these. are animals that literally just eat. grass just run through a pasture all day. and then when their life ends it it ends. in the least stressful way possible. which is to say they don't know their. life's about to end until they get shot. in the head which I know sounds harsh to. people but it matters right it matters.

that an animal D dies in the least. stressful way why is. that um look I think that there's you. know if the end of an animal's life is. incredibly stressful there are a lot of. stress hormones that kind of go through. an animal's body and and I can't tell. you that that necessarily makes a. difference in the health of the meat but. it certainly does make a difference in. the flavor um I also think there's just. something to be said for for the. humanity of it right like um you know we. are omnivores right we do we do eat.

plants and animals um but we don't have. to be cruel about it and and I think we. should all aspire to to to to eat. animals that that have lived the best. life that they can um and when their. time comes their time comes in the in. the simplest and and cleanest way. interesting I mean I'm just it seems. like everybody's moving to the farm to. table stuff at least everybody around. here is it's like a big conversation uh. in the local area and seems like a lot. more podcasts are starting to talk about. that I mean.

how how important is it in your. opinion I mean everybody's got their. stick you know and and so and some. people really lean into. it I'm just curious you know what your. opinion is on you know on stuff like. salmon or or you know the cows eating I. think I think it's a second or third. order term I think the first order term. if you want to just take a step way back. and say okay um what do we know is is. 100% true about nutrition the answer is.

not a lot right despite what health. influencers might try to tell you. there's very little that we know is kind. of what i' call Capital T true so we. know that eating too much food. regardless of what that food is is not. healthy um so we know that once the body. is consuming calories in excess of what. it can store safely and different people. have a very different genetic capacity.

for what that means you and I could be. different in that regard in other words. you and I might have a different ability. to put fat into the subcutaneous area. around our waist which by the way is a. safe place to store excess energy um but. at some point any person will begin to. exceed that and they'll start to put fat. into places where it should not be fat. should never be in your liver it should. never be around your organs it should. never be marbling inside your muscles it. should never be interwoven in your.

pancreas around your heart or around. your kidneys those are the danger zones. and once fat starts to accumulate there. which will happen in any form of excess. energy um awful things are going to. happen and it doesn't matter if you're. eating farm to table or if you're eating. McDonald's now one could argue if you. are eating highly processed foods it's. an easier path to get there and I agree. with that I think there's reasonable. evidence to suggest that the the more.

palatable the less nutrient dense the. lower quality the food that easier it is. to overeat but we just shouldn't lose. sight of that objective which is you. don't want to eat too much and of course. you don't want to eat too little. although that's less of a problem today. it's we should acknowledge it's still a. problem I think the second order term is. you got to make sure you're getting. enough protein for adequate muscle. protein synthesis um I joke about this.

and my my my wife teases me um you just. you can't walk through the hospital. hallway and interact with people in the. final years of their life and find. anybody saying I wish I had less muscle. mass you know so so we we all have to. remember that gravity is working against. us as we age and sarcopenia which is the. loss of muscle mass osteopenia the. weaking weakening of Bones all of these. things are enormous causes of age. related morbidity and mortality and so.

adequate protein intake in addition to. adequate caloric intake are the two most. important pillars then you can start to. go okay well okay Peter I get that now. tell me what to do and then believe it. or not I think we get into a highly. variable way that the body works there. are some people who do incredibly well. on diets that are very high in. carbohydrates there are others who do. incredibly well on diets that basically. omit carbohydrates altogether I was one. of those people by the way for 3 years.

from 2011 to 2014 I was on what was. called a ketogenic diet so that meant. for 3 years I think I had carbs once. what literally one day on my wife's. birthday I had three pieces of cake and. aside from that I was the only form of. carbohydrates I had was like lettuce and. some berries but otherwise it was all uh. protein and fat I did very well on that. diet it it served me incredibly well but. for some people it did not and that's. fine um when you start to get into kind.

of some of the more minutia that people. tend to fixate on it's a little bit of. majoring in the minor and minoring in. the major um the evidence gets squishier. and squishier the arguments get more and. more mechanistic and less based on. actual data so you can make a plausible. argument that maybe you shouldn't eat. that type of fat in favor of this type. of fat but there's no actual outcome. data to the effect so maybe time will. tell um but I tell people that they.

should probably focus on the areas where. we have far more evidence of doing X is. beneficial doing Y is not for example. around exercise sleep and other things. like that why did you come off that. diet so truthfully I got a little bit of. food fatigue you know um I just and it. wasn't that I was craving to eat like. pasta and you know rice and potatoes. again but I was I was craving just a. wider variety of fruits and vegetables. and things that were were basically. going to kick me out of ketosis um and.

so I did um and you know I'm I'm super. happy to be eating what I eat today. which is basically I'm pretty much an in. the-middle eater right like I'm I. wouldn't say I'm on a high carb diet I. wouldn't say I'm on a high fat diet I'm. kind of I don't pay attention to any of. it you know what I pay attention to I. pay attention to how many calories am I. eating how much protein am I getting are. the sources of my food as good as I can. make them on a given day on average yes. okay that's and and by the way all the.

biomarkers that any human is capable of. checking they're looking fine I will use. that to make sure I'm doing it correctly. if something were to change I could. revisit it but but um I don't think that. the incremental leanness that I might. have had because that was certainly a. difference for me being on a ketogenic. diet I mean I. was probably six or s% lower in body fat. than I am today wow um do you try to do. I'm just curious you personally do you.

try to do the farm table stuff or do. you well again I look I think it's it's. it's I'm pretty privileged in that. between my access to hunting um you know. we were talking about this year very. fortunate that I had two elk tags so not. only am I going to feed my entire family. with every form of elk you can imagine. right I mean we've got elk sausage we've. got elk steaks we've got ground elk for. burgers I actually had to give away 500. pounds of meat I had so much this year. umow.

so so yeah I'm in a fortunate position. where because of my hobby I have access. to that but I don't I don't tell people. to fixate on that right I mean if you. don't have access to farm to table you. can still go and buy at your grocery. store grass-fed you can spend a little. more and go grass-fed instead of grain. Fred and I think that's a worthwhile. trade you can still spend a little bit. more and say look I'm going to opt into. something that's organic that hasn't bed. fan antibiotics um without having to go. all the way to farm the table but if you. live in area where you can find a local.

farmer and say look I'm going to commit. to half a cow this year with my family. or you know a quarter cow or whatever is. typically how they'll do it I mean I. think that's a great. option you know you we're going to. little in the weeds before we really. start here but I wanted to you brought. up studies earlier and um you know I. don't think it's any secret everybody is. the the there's been a lot of distrust. in the in the Health Care system and.

where these studies come from is Big. Pharma the only one doing the studies on. the medicine that they're producing are. the food companies corporations doing. the studies on the food that's coming. out and. so kind of want to ask you you know what. do you think about those studies are. they only is that who's conducting the. studies and and are there. Alternatives yeah so again the term. studies obviously is pretty pretty broad. so if you look at most nutrition. research that's trying to answer the. questions that I think people want to.

know they aren't actually funded by by. by industry they're they're typically. funded by uh NOS they're funded by. NIH um and you know you're the list of. people who's going to be more critical. of NIH than me is not a very long list. I've been quite critical of of things. that the NIH has done um in my view not. correctly uh also you could argue maybe. I'm conflicted I did my fellowship my. post-doctoral fellowship at the NIH so I.

spent two years there um and so I know. the I know the merits of of NIH it's a. remarkable system that gives the United. States an insane competitive advantage. in biomedical research like no other. country on the planet has what we have. access to right so we we talk about. things like what why is the US military. so far superior to every military on the. planet like is there a second place. there really like the gap between the US. and everybody else is so enormous and a. big part of it comes down to investment.

and I would say the same is true from a. biomedical research perspective like. nobody can even invest a quarter of what. we invest in. this it's seeming more and more like. we're about to hit an inflation cycle. like we saw in the 70s President Reagan. once said that inflation is as violent. as a Mugger as frightening as an armed. robber and as deadly as a Hitman and I. couldn't agree more the price of gold. during the last inflation cycle during. the 7s was a Saving Grace for a lot of.

people that were trying to protect their. savings that's why I want you to go to. shaikes gold.com to learn more about my. partners over at goldco they're a great. company impeccable customer service and. for my listeners they're going to give. you a free gold and silver kit where you. can learn about how precious medals. could help protect your money and lucky. for you you could also get up to a 10%. instant match in bonus silver on. qualified orders to learn more call A 8. 55936 gold or visit shaikes gold.com.

that's 855 936 gold or visit Sean likes. gold.com performance may vary consult. with your tax attorney or financial. professional before making an investment. decision I'm always on the lookout for. ways to get healthier especially now. that's why I'm so glad I discovered. armor colostrum armor colostrum has. thousands of people reporting absolutely. life-changing benefits tens of thousands.

of five-star reviews and. transformational stories armaro. colostrum is a proprietary concentrate. of bovine colostrum that harnesses over. 400 living bioactive nutrients that can. help strengthen the barriers of your. body and help fuel cellular health for. thousands of research-backed health. benefits armor colostrum can help. strengthen immunity and gut health help. improve Fitness and metabolism and. enhance skin in hair Radiance we've.

worked out a special offer for my. audience receive 15% off your first. order go to tr armor.com SRS or enter. SRS to get 15% off your first order. that's TR r y a r. m.com SRS these statements and products. have not been evaluated by the FDA these. products are not intended to diagnose. treat cure or prevent any disease or. condition these statements and. information are not a substitute UD for. or alternative to seeking care from your.

healthare. providers so we just have to acknowledge. that that's a good thing and yeah it. still makes some. mistakes um so the majority of people. who are conducting This research are. good people um they have varying degrees. of competence and varying blind spots um. but for the most part. when multiple different Labs over. multiple decades conduct multiple types.

of Trials and the answers largely point. in the same direction you you're sort of. inclined to think that there's probably. not much of a signal in the other. direction um now when it comes to. pharmaceutical stuff there's a there's a. different pathway right so here Pharma. does need to pay independent. investigators to do research um because. of the regul Pathway to get drugs. approved now um we might see in the new.

Administration a revision of how some of. that is done I think that um I think. that there have been mistakes that have. been made in the way drugs are approved. I don't think it's nefarious I don't. think it's a conspiracy people are very. quick to attribute conspiracy to what I. think is more readily attributable. attributable to um uh incompetence at. times truthfully um or just people. acting their own best interest right.

like you know water always follows the. path of lease resistance so just because. water goes down there doesn't mean like. oh there's a conspiracy that the water. is going down there no like that's what. gravity and less resistance means so um. as one example I think that there should. probably be fewer barriers during the. leadup to approval but more barriers. post approval in other words I'll give. you one example it's a controversial. example but I feel strongly about it um. Pax lvid was a drug that was approved to.

treat people with covid right this was a. drug I believe it's a fiser drug so if. you got covid they would give you Pax. lvid and it was approved very. quickly um but I think ask any doctor. who's been prescribing Pax lvid for. patients with covid the drug doesn't. work like it just outright doesn't work. and by the way it might even increase. your risk of getting subsequent Co and. while I can appreciate why the FDA. wanted to see that drug approved quickly.

um because of the way the world looked. then and especially if you're trying to. treat people who are uniquely vulnerable. to covid which would primarily be older. people um I think where a lot of trust. was lost in that it would have been. great if they did follow-up studies that. six months later said hey we this Drug's. been in the world today for six months. it's not working we should pull the drug. because a lot of money is getting wasted. and frankly a lot of people are being. put on a drug it's not harmful but it's. not helpful right so why would we have a. non-helpful drug out there um so so so.

again I know that that's a bit of a long. answer but I hope that I'm communicating. the Nuance of the situation which is. it's not black and white thank you for. sure then I I'm curious to you. vaccines going through all these things. are popping in my head that aren't in. the outline vaccines are are you know a. major topic of discussion in a lot of. homes right now everybody that has kids. you know is wondering be included you. know should we vaccinate our kids should.

we not what do we do you know and and me. and my wife have kind of set off on this. journey interviewing a lot of different. medical professionals and it gets it. gets hard you know it gets for for. somebody that's not a medical. professional myself it's you know what I. find is we we'll go to a practice and it. feels like it's a sales pitch it's a. sales pitch on we don't vaccinate we're. antivaxx you don't have to vaccinate.

your kids here and it's like that's. great um but we we still need a health. care professional we don't just need. somebody to tell us hey don't vaccinate. your kids at all like what if my kid. gets a broken arm what what are you. going to treat them with you know and. and it becomes like this sales pitch you. know the whole pitch is we don't vax. which like I said great you don't vax. but what what do you do here and other.

than tell me that vaccinations are. horrible for my kids and for myself and. my wife and so I'm just curious what. your thoughts are on. vaccinations if you have any what what. should we be doing what should we not be. doing well this is a topic I've put more. work into than I wish um I say that. because it's not something I'm really. interested in to be honest with you I I. don't are lots of things I'm interested. in this is not on the list right um but.

I've had to put a lot of interest into. it I've had to put a lot of time into it. uh I suppose because of the position. that I have found myself in where people. are saying hey Peter you're a very very. public-facing physician and you're not. in the quack category like there are. lots of quack Physicians out there but. but like we want to hear what you have. to say um I also have a personal. interest in it because I have three kids. um so so what what have I what if I. learned well uh I've learned that there.

are certain so first of all this is. another topic that that is not going to. be a popular topic because people don't. love gray they want black and they want. white nothing in science is absolute it. is all probabilistic so there were very. very very high probabilistic certainties. and there were very very very low. probabilistic certainties so for example. I know that if you have a certain type. of infection and I give you this type of.

antibiotic the probability that it will. cure that infection and save your life. is exceedingly high it's. 99% um but I can't say with 100%. certainty that every single person that. has this infection to whom I give this. antibiotic will be cured can't say that. that's not how biology works and biology. is the messiest of the Sciences so with. that stated I think there are some high. probabil. certainties out there with respect to.

vaccine I think there are some really. gray areas um and I think everybody. needs to ask the question what am I. optimizing for so I will start that. question with with with you right what. is it you are most afraid of as you. think about vaccinating your kids what. are you what are you what what is the. mistake you're worried about what are. you afraid of and what are you hoping to. achieve well I think I think something. that I'm afraid of and is you know. there's a lot of talk and and maybe it's.

rhetoric maybe it's not about you know. autism you know being caused by vaccines. well you know me and my wife talk about. this all the time and and there's all. the people out there that are you know. my kid took the MMR. shot hasn't been the same since and you. know and then and then there's the. studies with the rise in. autism but are we testing more. effectively for ism is you. know there's got to be some sort of a.

scale like how autistic are you are we. diagnosing more you know based off of. that scale because because more and more. symptoms or or whatever are become more. prevalent and so is is that the reason. that autism is on the rise is it's just. we didn't diagnose as many people. because the symptoms were not as. is is is prevalent or or is there. actually a rise you know and and so.

that's one thing then there's all the. you know the co stuff about the covid. vaccine um is it giving people you know. is it creating um you know hard problems. are people dying from the. vaccine I don't know you know what I. mean I don't I don't know what to so. let's just take those two examples I. think the second one's a lot easier um. because I think we I think the answer. there is I would put it a little more in. the more certainty category although I. think the previous one as well we can we.

can address so um when it comes to the. covid vaccine one of the concerns. particularly with the MRNA vaccines and. particularly more so with the madna one. than the fiser 1 was you saw an above. the Baseline increase in myocarditis in. particular in young men so myocarditis. is an inflammation of the cardiac muscle. now you always have to remember when. you're vaccinating millions of people. there's going to be background noise. people get myocarditis all the time and. you can get any sort of viral infection.

and get myocarditis I've known countless. people uh and seen in in the hospital. and been around people who have got. myocarditis for no reason other than. they got an infection so you have to. know there's a baseline level of this. going on but it really appeared that in. particular for young men teenagers and. in their 20s perhaps there was an uptick. following that particular vaccine in the. incidence of myocarditis to be clear. most of those men recovered without a. I think that the real mistake of policy.

makers at the time because this would. have been about. 2022 was not acknowledging that right. like to acknowledge that is basically to. say hey this is biomedical science. things happen and we don't always know. when we do studies on a few thousand. people what's going to happen when it. reaches a million people because if the. signal is so small that it's only 0.1. per of people you're not going to pick.

that up at a thousand you got to be able. to do a million and you're not going to. do that until it's out in the real world. so why not just acknowledge that and say. hey that's a risk we should be aware of. and we should weigh that risk against. the. benefit cuz what's the harm to a. 18-year-old healthy male when he gets. covid well we can quantify that we know. what that risk is we we've seen enough. variants of covid to know that is that. risk worth that.

tradeoff and I think reasonable people. when presented with that set of facts. can make their own decision I know my. decision for my kids in that setting. when confronted with that information. and it might not be the same as the next. person but that's okay I think that's we. just want people to be able to make. reasonable decisions based on reasonable. information but when it turned into. there's nothing wrong with it there's. nothing wrong with it you know the sort. of den buying it I think that cost a lot. of credibility and when parents got.

demonized for asking the question and. saying hey should my six-year-old who's. completely healthy really get this. vaccine and they got turned into bad. people for that I think that was a huge. mistake um and and again I I I can tell. you taking care of countless people I. have patients that ran the Spectrum. across there I had patients that said I. want me and my family to get every. single vaccine there is and I had other.

people that said we're not touching this. thing with a 10-ft pole and my job was. not to talk anybody into or out of. anything it was simply to make sure they. understand and can quantify the risk of. both decisions and to be there and help. them think through it and that's it so. um I hope that answers your question on. the myocarditis yes there was indeed a. real signal in absolute terms it wasn't. big but in my opinion it was not worth.

the risk to young males that was my it's. my personal opinion I don't think it was. worth the risk and that means as such I. did not vaccinate my kids because they. were otherwise healthy I also feel very. fortunate that we live in a state where. it was not mandated and therefore we. didn't actually have to pay a heavy. price for it so I also have empathy for. people who live in Draconian states. where these things were shoved down. their throat but you know and you when. you live in a great state like Texas um.

they they tend to defer to what the. patient what the parents think is right. at least in this regard around a covid. vaccine and we just felt like hey wasn't. necessary our kids are super young and. healthy why put anything else into them. that they don't need um that said I take. a different point of view on other. vaccines I think there are a number of. vaccines where the risk of not. vaccinating them is so much worse than. the risk of vaccinating them the one in. particular that I have looked into more.

than all others combined is indeed MMR. uh because I think every parent who has. been um and I say this word. deliberately misled by the fraud that. came out of a guy by the name of Andrew. Wakefield uh will always have in the. back of their mind the lingering concern. about autism so Andrew Wakefield was a. guy who has been more than discredited. so I say this again um with with with.

with with complete uh Clarity he has. been more than discredited for what he. did to completely and deliberately and. fraudulently manipulate data to make a. case that the MMR vaccine caused covid. um I've done autism I'm sorry caused. autism I've done a complete podcast on. this so if people are interested um they. can I interviewed the journalist who's. done great work on this and we kind of. go through all the work his name is. Brian deer not a vaccine guy by the way. doesn't care about vaccines one bit.

despite the fact that he's been people. have tried to make him the face of MMR. he's like nope I just care about science. and this guy was the worst example of. bad science um so I can tell you with a. very high degree of confidence without. wasting the next three hours why the MMR. vaccine is is safe uh and furthermore. why I think kids who don't get the MMR. vaccine are really at risk of getting. diseases that are much much too.

significant to ignore an area where I do. sorry you're going to ask a question and. I'm go to another Direction I wanted to. I mean I don't want to take you off your. train of thoughts so go ahead I was just. going to say now let's talk about an. area that I would put in the middle. because right there I'm saying on the. one. hand again I I didn't think the covid. vaccine made sense for young healthy. kids I really do think the MMR vaccine. absolutely makes sense for all kids so. here's an area where I think the system. has kind of broken a little bit and it's. the use of the he B vaccine for kids.

early in life so today if a child is. born in the United States they are going. to want to give them their first of. their Hepatitis B shots while they're in. the. hospital now that has never made sense. to me. biologically Because unless the mother. has he be in which case that makes sense. because the risk of transmission is very. high and to be clear het be is an awful. dis disease so I'm not minimizing HB at.

all we have no treatment for it we have. no cure for it if you have hepatitis be. the risk of getting curosis and needing. a liver transplant or the risk of requir. or or getting what's called. hepatocellular cancer is very high so. you don't want have B but it's a uh. bloodborne transmitted disease like. you're not going to catch it in the air. so if a child is born to a mom that. doesn't have hepb the risk that that. kid's going to get H be in the first 5.

years of their life is virtually zero. and for that reason I don't see the need. to subject them to That vaccine. immediately but I also understand where. the medical community is coming from. which is saying hey we don't want to. miss an opportunity to give a vaccine. because if we don't give it now this kid. might never get it so so there's a. policy decision that needs to be made by. people there personally if it were me i'. like to see it studied this is where I.

actually would like to see the NIH fund. and experiment because I'm genuinely. curious is it safe to give children that. many vaccines that early in life or. should we limit them to the ones that. are absolutely essential where we know. hey measles moms rebella small poox. polio these are devastating diseases and. especially if you have a kid that's. going to go to daycare where they're. going to be a around a lot of kids and. the risk of transmission if there's an.

outbreak is is non-trivial so again we. want to eradicate small pox and polio mm. probably don't get eradicated but we. want to protect kids against them and. Het B strikes me as something like H I. don't think we need to do that right. away but I'd like to see it studied so. that's kind of three extreme examples of. how to think about this but as you can. tell um given that it just took me 10. minutes to explain those three things at. a superficial level nobody wants to have. this discussion they they just want to. be black or white oh you provax or you. antiva what about neither like what.

about I have a nuanced approach to every. single one of these if you're willing to. sit down for three hours yeah yeah that. was actually that was my question is is. you know do we if we were to vaccinate. our kids do. we do we break it up you know be CU you. know we'll go to the doctor and they. want to do they want to do them all at. once and it's like you know for like I. said for somebody that's not a medical. profal it's overwhelming is it is this.

too much in too small amount of time do. we do we try to drag this out you know. so that it's one every month or or or. what I don't even know the schedule I'm. just saying do we do we prolong this so. that it's not so many vaccines in such a. short amount of time well and and the. other thing to your point is um some. kids are going to have no problem. they're going to sail right through it. but you don't know if that's your kid I. mean at the end of the you're you're. you're sort. of your goal is to figure out what's the.

best thing for your kid and whatever you. can do to kind of minimize that risk and. of course the doctor is looking back at. you and your wife. saying yeah look we're not opposed to. spreading this out but how do I know. we're going to keep you on schedule now. there's also some nefarious stuff that I. understand why it takes place but the. Optics of it are really problematic and. that is that uh Medicaid really. reimburses Physicians for.

vaccinations so you'll hear that and. people who are really in the antivaccine. camp will point at that and say that's a. a blatant conflict of interest and the. answer is it is and it isn't it's not at. all uncommon for Medicare and Medicaid. to reimburse Physicians to incentivize. them to provide good care to patients. right so just as if you have high blood. pressure and you're on medic care you. might have a physician who's being. reimbursed if they can control your.

blood pressure better that's viewed as a. win-win your life is better because when. your blood pressure is lower there's. less chance of heart attack or stroke. the medical system is better off because. you're now going to cost the system less. money by not having a heart attack or a. stroke and they want to reward The. Physician by saying here's an extra $100. because you manage to get Shawn's blood. pressure down so that's everybody agrees. that that's kind of a good system but. when you now go into Medicaid and you. apply that to doctors are getting paid.

to vaccinate. kids well a couple things change right. the first thing is we don't know the. answer to the question you asked like I. don't know I certainly don't know the. answer and I and I I say this with. humility I don't know that anybody does. I don't know that anybody knows we. should just be ramming all the vaccines. in the kids on day one to maximize them. and make sure compliance is the highest. versus can we take a more nuanced. approach and spread them out so right. out of the gate you take away some. certainty so you lose a bit of the moral.

High Ground to be able to say I should. be paying you to do this whereas in as. much as you can have certainty in. biology I have pretty high certainty. that if your blood pressure is normal. you're way better off than if your blood. pressure is high so that again becomes. problematic but you can you can see how. it can get twisted into something that. it's really. not interesting thank you for that we. talk about hunting instead yeah. uh so I want to kind of do a little bit.

of a life story with you but before we. get started I have a patreon account. there are top supporters a lot of them. have been with us since the beginning. it's grown into quite the community over. there and um without them I wouldn't be. sitting in here and neither would you so. one of the things I do is I give them. the opportunity to uh ask each and every. guest a question and so this is from. Christian in a time when information is. transmitted exponentially and health.

experts often present contradictory. contradictory views how can we. distinguish valid analysis from. discourses influenced by biased personal. agendas oh that's a very very. sophisticated aidite. question think a couple of. things um I think one. um uh look at look at people who are. comfortable talking about uncertainty so.

the the more that a person is willing to. speak in uncertainty versus certainty I. tend to believe them a little bit more. right so when a person tells you that. it's their way like you have to eat this. food and it's like it's this is anything. that's not this is going to kill you. blah blah like versus well we didn't we. you know maybe maybe not like so so so. that's one thing and then I think the. second thing is you always have to mine.

for what a person's conflicts are. Financial conflicts so um I think it. should be required that anyone who um. describes thems as you know a health. influencer slash whatever like whatever. you call people in this category they. should all have a clear page of. financial disclosures uh it should be. unambiguous um exactly what what company. have they invested in do they receive.

pay for promotion do they receive. financial Kickback or remuneration when. they talk about a product all of that. should be fully fully disclosed um just. you know there should be no ambiguity. about that so I would say those are two. really important ways to understand the. credibility of who you're listening to. okay that it's a great answer and then. last thing everybody gets a. gift I get really self-conscious about. giving these out to doctors but.

vigilance lead gummy bears you know all. kinds of stuff that's bad for you in. there but they do taste great they're. made here in the USA and uh it's kind of. a Mainstay for the show it's been going. on since since since we started thank. you very much but um all right let's. dive into your live story so I knew you. grew up in Toronto and I think your. parents came immigrated from Egypt yep. so what were you into as a.

kid um I mean the first sport I fell in. love with was hockey which is pretty um. pretty typical in Canada probably at the. time honestly there were today I'm sure. kids will have more of a well-rounded. sporting background with you know the. NBA is there but yeah I was pretty much. just hockey growing up from a very young. age until uh until until my second Love. Came which was boxing boxing MH nice. what were your parents what did they do.

um so my dad uh ran a restaurant and my. mom worked at the restaurant with him I. mean she when I when she when they came. over you know she worked at a a checkout. you know worked in a like a variety. store grocery store at the checkout um. and then by the time I was born she was. mostly working at the restaurant with my. dad any brothers sisters yep I got a. younger brother and a younger your. sister so I was to. three you guys get along very well yeah.

still close very. close what other I mean were you a good. student um were you into were you into. medical grownup nope no not at all um. yeah I think I was um I was a bright kid. when I was young I was put into um a. gifted program but my mom says when I. was in fourth grade the program lost its. funding. so I got put back into the normal.

program and she says that's when things. started to go not so well so I think. that was fourth or fifth grade um again. I don't really remember much of this to. be completely honest with you Sean but. my mom says I just got very bored in. school and my performance started to. sort of go down I started to really kind. of clash with teachers a lot and I think. by the time I got to high school um just. really had zero interest in school um. was you know you didn't have I didn't.

have a choice to but to be there but I I. had no interest in it at all by that. point getting into trouble I did but not. that much because fortunately by that. point I had gotten into boxing and. boxing. was I mean I think it saved my life. because I think it really kept me. focused on this goal I mean I wanted to. be a professional fighter and even by. the time I was 14 years old I mean I was. training 6 hours a day wow so I was you. know training in the morning training.

middle of the day at school training. when I got home and so it was my life. was basically training and working at. the. restaurant here's something I'd love to. tell us Americans to get better at this. year something that our International. Friends beat us at in Spades speaking. more than one language and you can get. fluent sooner than you think with Babel. this year find a whole new voice with. Babble the language learning app that. gets you talking learning a new language.

is one of the best ways to understand. the world around you with a focus on. conversation you'll be ready to talk. wherever you go and if you watch my show. you'll know I've spent a lot of time in. dangerous places all over the world. being able to speak the language was a. lifesaver more times than I can even. begin to count with over 16 million. subscriptions sold Babel's 14. award-winning language courses. are backed by a 20-day moneyb guarantee.

get up to 60% off at babel.com. SSRS spelled. babbel.com. SRS babel.com. SRS this year get talking with Babel. rules and restrictions May apply visit. babel.com for terms and. details I'm always looking for ways to. make sure I feel comfortable in what I. wear through the whole day that's even. more important important when the. weather is changing from Winter to. Spring and true classic helps make it.

easy their active wear is moisture. wicking in quick drying and for spring. they have short sleeve Comfort knit. button-ups that look as good at the gym. as they do in meetings true classic. makes premium clothes at an affordable. price with shirts designed for your best. features with a perfect fit their. bestselling t-shirts and more come in. three six and nine packs the more you. bundle the more you save plus you get. free shipping on all orders a 100%.

Perfect Fit guarantee and easy returns. so there's no risk whether you're. bundling up for the cold or getting. ready for spring level up your style. with the clothes that actually fit right. just go to my exclusive Link at true. classic.com SRS to save that's true. classic.com SSRS shop now and elevate. your your wardrobe.

today I mean I didn't I didn't socialize. I didn't go I didn't have time to do. anything else you know I was working at. the restaurant and I was training I mean. you say it you say it saved your life I. think so for sure why do you think that. well because I think like I look at a. lot I look at um like I don't think I I. think I had poor judgment as a young kid. which a lot of young boys have and I. look at some of the kids that I grew up. with and I see where they wound up. and um I I just don't know which side of.

that fence I would have been on right. like I I mean there kids I grew up with. that were 10 years after high school or. in jail for armed robbery you know you. make a dumb decision like you can do a. dumb thing and change your life forever. yeah and I don't have the confidence to. say I would have never been one of the. guys that made that dumb decision or. been at the wrong place at the wrong. time cuz I also don't like I don't look. at myself I certainly didn't look at. myself back then as a leader um I don't. think I was a huge follower but I was. mostly just in my own world but I think.

if I wasn't in that world I could have. easily wanted to impress one of the. older tougher kids and that's how you. get sucked into these stupid stupid. things um and it could be stupid things. like God there was a kid in my high. school and we used to play this game. which was so idiotic where we would jump. into the subway trains and play chicken. to see who could get out last and sure. enough one of the kids didn't get out oh. [ __ ] and so you you know you just like. you that uh no I wasn't there but I knew. his brother very well.

um cuz this the kid that didn't get out. was a year younger than us it was a. younger brother one of our friends and I. I just think. like man there's so much luck involved. in not um you know not not ending up in. the wrong spot so so again I think for. me boxing and martial arts as well cuz I. was doing both by the time I was in in. high school they just became an amazing. thing for me I I ended up hanging out.

with people who were older right cuz. you're you know it's not a place for a. lot of kids at the time right this was. you're I'm hanging out with grown men so. you're sort of seeing these guys who. have jobs and you you know you're you're. I think they were just a good influence. on me yeah yeah how far did you take. your boxing career well I was super. serious about it so when I finished when. I was in 12th grade was when I did make. a decision to not become a professional.

boxer um. and um you know it was really because of. this teacher I had so when I was in 12th. grade I had this teacher who really made. a big difference in my life um and again. I'm really grateful for that because. even though I was pretty good like I. statistically speaking you have to think. in terms of probabilities statistically. speaking I was going to wind up you know. brain dead right like very few people. are going to hit escape velocity in a. sport like. boxing I'm curious one you said you.

clashed with teachers so how did that. teacher make that influence on. you well you. know for reasons that I don't know I. still kept taking math um I think I deep. down kind of liked it and so he was my. math teacher Woody Sparrow and so this. is you know 12th grade I'm taking math. and I'm actually doing reasonably well. right like I'm not you know top of the.

class or anything but I'm but I'm doing. well and I just like the guy like he's. funny um but he's got like kind of an. edge to him um and in middle of the year. one day he he says hey can I can you. come in tomorrow morning before class I. said sure So I ca I came in and he said. you know Peter I heard you're not going. to University and I said that's right. and he said you know I I I think that's.

a mistake but he didn't lecture me right. he didn't give me the you know you're. crazy not to go to university he gave me. the uh he he said something else which. was very touching and he said look I. think it would be um I think it would be. a I think how did he word it I think it. would be a waste because I think you. have an unbelievable amount of potential. um and I I just think you should revisit. the decision not to go I I think you. have a real gift for mathematics um that. you don't quite see yet but I think you. know I just think you should be open to.

the idea of doing something and and. there was something about that I mean. that undoubtedly planted a seed in my. mind that over the rest of that year I. kind of changed my thinking um came back. for this fifth year of high school to. take all of my prerequisites to then. apply to go to university and actually. set out to emulate him so he was. actually an engineer before he came back. to teach math um so I I went off to the. same University he went to to study uh. both engineering and math interesting.

yeah interesting so you went in actually. before we go there I'm I'm also curious. I mean as a as a boxer as a mixed. martial arts guy you know I've. interviewed a handful of of pro Fighters. and I'm I'm always curious you know with. with the with TBI and all that kind of. stuff. um what do you think about kids and. boxing now. you know it's super tough like again I. think about how lucky I am I only really.

had one horrible. concussion um it was really bad. um and I was I was hurting for about. three months like literally my head hurt. for three months I couldn't turn my head. that even at that speed that's how badly. I was. contused um and so I feel insane. gratitude again like how many times. could my life have ended and it's really. fun I remember being in the hospital cuz. I spent two days in the hospital after.

this one. and this neurologist comes in and he's. like and by the way the worst part of. this story Sean I was already in. University at this point oh really yeah. yeah yeah like this was already after I. decided I'm not going to be a. professional boxer but I couldn't let go. of the drug like it was still I still. wanted to fight so at this point I was. like training and I was like I would. fight lots of guys in the same day so on. this particular day I had lined up three. opponents for two rounds each and I'm.

fighting them at increasing weight so. it's in the fifth round I'm fighting a. guy 25 pounds heavier than me and I just. could not get out of the way of this guy. and I mean you know and I he didn't even. knock me down it was just at the end of. five rounds I was like yeah I don't feel. right let's let's call it a day Mike um. so this this doctor comes in and he goes. he was just apoplectic he's like I heard. you're a smart kid like what are you. doing. what are you doing do you understand. what this is doing to your.

brain and I and I I never thought about. it I was like yeah I don't I never. really thought about it what is it doing. yeah that's a really interesting thought. so to answer your. question I'm torn because I think that. boxing teaches you something about. yourself and it's probably true of other. forms of fighting I just don't know and. I did a lot of boxing obviously a lot of. martial arts and a lot of tie boxing I. never did MMA I never did Jiu-Jitsu or. any of the other stuff that kind of. rolls up into to the to to to what we.

see today but I would guess it's true of. any combat sport is you learn how to. control your fear you learn what it is. like to be alone in the ring with. someone who wants to hurt you. um I think there's something really. valuable about that now my boys both do. Jiu-Jitsu they've been doing BJJ since. they could start I love that they do. that if they wanted to box I would love. it I just don't know if I'd want them to.

spar I'd love for them to learn how to. hit but I also realize if you're not. getting hit it's not you're not really. learning how to hit unless you're also. being hit you know it's it's you're. going to develop a lot of bad habits if. you're hitting W without the risk of. being hit that said I just don't think. it's worth it I think I'm happier that. they do. BJJ um and and that they're you know. that their brains are being spared if. they came to you and they wanted to.

start boxing or striking would would. that be a hard no no it wouldn't uh you. know we have a heavy bag hung up and. every once in a while they're like Dad. show us how you can hit this thing and. I'll hit it and they'll be like. whoa um which by the way I can only do. for like 30 seconds like that's how bad. I am today right I can look good for 30. seconds um so I would love it if they. would learn but do want them in the ring. taking hits I don't think so yeah it.

seems like everybody that I interviewed. that's in that space they they they want. their kids in some type of mixed martial. arts but no striking no head shots I. hear that a lot pretty much from. everybody and um yeah that's that's. interesting so you go to school when did. you become interested in the medical. field so when I finished engineering um. I was getting ready to go and do my PhD. in aerospace engineering which had. become the convergence of my interest in. math and I had done mechanical.

engineering um and then I I had a total. change of heart and decided I wanted to. do medicine and so that kind of derailed. me because then I had I didn't have any. prerequisites to apply to medical school. and you have to take this test called. the MCAT it's like the SAT but for. medical school so I hadn't done any of. that stuff so I had to take an extra. year to do it and apply to medical. school what what got your motivation. into. medical yeah so it's. um it's one of those things where there.

was an instant when it happened so there. was a single moment where I realized it. but it was predicated on a year of angst. so I don't know which it was you know. the story about the you know the the the. the the guy hitting away at the stone. and it's like on the thousandth hit the. stone splits and it you realize it. wasn't the thousandth hit it was the 999. before it it just happened so so I'd say. that the year of Ang was really um my. something I was struggling with I was.

just kind of like I felt like this tug. like I wanted to help people I wanted to. work more directly with people but I. really. loved I loved the problem solving and. and whatnot that we were doing in. engineering but I felt this tug kind of. in my heart to do something with people. and I just couldn't figure out what to. do and it's interesting like medicine. never actually crossed my mind so I was. I mean I I had crazy ideas I was like. should I be a social worker which of. course if anybody knows me they would.

laugh hysterically at the idea of me. being a social worker like you know I. thought about should I be a lawyer like. I had all of these ideas for things that. I should be doing and I went and talked. to people who did these things these. weren't like idle thoughts like I mean I. was out there talking with people of all. of these professions saying hey you know. I'm trying to figure out is I am I going. to be good at that am I going to be good. at that am I going to be good at that. and and then medicine never once entered. that calculation until one day I. happened to be in the hospital visiting.

somebody and had this. experience and I was like it just kind. of hit me in the face I was like oh my. God medicine that's the thing I should. be doing what was the. experience so at the time I was. volunteering the whole time I was in. college I volunteered um for for kids. who had been abused and I was in the. hospital visiting one of the one of the. kids and I was in the waiting room and I. was eating my lunch and another patient. an older woman came up and sat with me.

and um. I she had been shunned by a group of. patients at another table it was kind of. weird I don't know why but they wouldn't. they didn't want her to sit with them so. she came and she sat with me and we we. sat there and had a pleasant. conversation while I ate my lunch and. waited for the nurse to come out and get. me to go in and visit the kid that I was. visiting and when the when the nurse. came out to get me the woman said she I. think she assumed I was a doctor but.

then realized in that moment I wasn't. she goes oh I should have realized you. weren't a doctor no doctor would sit. here and have had this nice conversation. with me for this long and I remember. thinking boy that's sad if that's true. but it it it just all kind of clicked in. that moment which was maybe maybe. medicine maybe being a doctor would be. the right way for me to apply both my my. interest and love in problem solving and. science but but with this kind of more. human connection then fast forward a.

little bit you you left your. residency yeah 10 years later 10 years. later why did you what don't we missing. in between there well so then I went to. medical school and and then this you. know you go to medical school and you. decide what do you want to specialize in. and um you don't figure that out until. you're in your third or fourth year of. medical school and by that point I. decided I want to do surgery and then. you pick a place to go and do surgery.

and I wanted to go to the best place. that was the most hardcore place and. that was this place in Baltimore called. John's Hopkins and because one of the. things that made John's Hopkins so great. and to this day is both the combination. of having the high the high volume of. Surgeons who do really complicated. operations in this case operating on the. Li Li and the pancreas for cancer and at. the same time it's in a really really.

rough inner city area so you get a lot. of trauma and um as as perhaps grotesque. as it sounds it's really important for. surgeons to train in trauma areas. because you learn so much about how to. fix the human body when the human body. is getting shot and stabbed every day. and at a place like Hopkins I think at. the time I was there it averaged 16. penetrating traumas a day wow so if you.

m now think about that I'm on call every. third night for trauma wow so now think. about how many stab wounds and gunshot. wounds you're taken care of you're. really you you you know this is how you. learn to have ice in your veins and it. you're unemotional about it it's like. what's coming in what do we need to do. how do we stabilize this patient can we. fix them let's go and so again you don't. get that experience at all the hospitals. right that's that's there's there you.

know but but people who you know will. will pick programs that really emphasize. in that are going to go there so so so I. went there and and really honestly had. an I mean just had a very special. experience I mean really can't say. anything negative about the place I was. at right this wasn't like I mean I had. amazing mentors there the surgeons at. Hopkins were Legends um my co-residents. were incredible I. mean it I'm sure it's like what you feel. like being in the seals like you are.

with the best of the best it's the best. 1% of the best 1% that all came to this. place not because Baltimore is a pretty. city but because this is the best. training we're going to do and um but I. just I became I became really frustrated. with the fact that I did not feel like I. was moving the needle one bit and I felt. like everything I did was a day late and. a dollar short and it just didn't matter. like and that meant like I felt like it. didn't matter on the cancer side like. you could do the most perfect operation.

on somebody to remove the cancer but you. didn't get every cell out because you. couldn't you know they were still going. to die 18 months later and sometimes. even on the trauma side it would be. really tragic you would you. would you know you would use 60 units of. blood and operate for eight hours to. save somebody and then the next month. the guy would be out there and get shot. in the head geez you know you would see. this you would see this from time to. time where you know um so so so I just.

felt very frustrated and um I just. thought the system did the system didn't. make sense to me I was and my wife I was. newly married at the time uh my wife. said incredibly wisely she's like look. we've only been married for a year I've. only known you for four years but you. you don't strike me as a person who can. live in in this state meaning you only. two things are sustainable you either.

need to fix the system that we're in so. you have all these complaints and. grievances about why the medical system. isn't right you should fix it or you. should leave it but if you sit here and. just keep bitching about it like your. life is over and you know I spent the. next six months thinking about what she. said and then just decided to leave how. long did it take you to kind of cut your. emotions off from all that trauma that. you were. experiencing with your.

patients you mean the actual trauma. cases mhm I'm talking about you know. gunshot stab gunshot stab stab stab I. mean sometimes never I mean I had some I. had some pretty bad failures I mean my. I'll tell you this my one of my last. nights as trauma Chief so I left on June. 30th you um The Residency year runs July. 1st to June 30th so even though I. decided to leave by March I stuck around. for the last 3 months so I remember it. was like April 14th meaning I've got.

like 6 weeks left in all of my medical. training at that point in time and I was. the trauma chief that night for. Pediatric. trauma and we get a call it's early in. the evening it's like 7 o'clock at night. MVA a motor vehicle accident um but uh. no no vital signs in one of the two so. it's two I don't know anything other. than it's two two kids driving and one. of them seems totally fine one of them's.

got no vitals the one that's got no. vitals is coming to my trauma Bay so I. go down and this boy comes. in. and he's he's he's got maybe I convince. myself he's got a pulse he's got a. thready threy pulse and now um so so we. we run a code on him we can't get him. back I get an Ray I see that his aort is. a bit. wide you know you're running through.

your mind what's going on here what's. going on why do I not have vital signs. in this kid right is this head trauma. his pupils are a little bit big so that. means there's probably something wrong. with the head his iorta is a bit wide. though that means he could have torn the. aorta so he when you have blunt trauma. when you have massive deceleration and. in the case of this car they were they. were they had the right away going. through an intersection and some idiot. T-Bone them so massive deceleration can. Shear the aorta so he be literally. bleeding into his aorta so I have to. make a decision do I open this guy's.

chest to try to figure out what's going. on which by the way is not the answer. that that but but like I'm I'm I don't. want to let this kid die yet and it. looks like he's dead so we I keep. running the code I keep running the code. we keep pumping more epine Effron into. him we keep doing everything and. everybody's kind of like it's my job to. call the code to say time of death call. it over and I just can't bring myself to. do it I'm like. no no no we got to keep going we got to. keep going I'm just feeling this. overwhelming sense of sadness and we.

finally call the. code and I you know it's very unusual. normally you walk out as quickly as. possible because they have to get the. body out because you have to make room. for the next trauma to come in you don't. know when the next one's coming in so. you can't have that you can't have too. much time with a body just sitting there. so they have to cover the body up get it. out clean the floor off and there's a. mess everywhere there's you know we've. put aill Central lines in him at this. point there's needles blood everywhere. and I remember leaving the trauma bay.

and going into the stairwell and just. completely breaking down which was very. unusual right normally you you sort of. pro you don't you just don't even think. about it but but I was absolutely I I. couldn't I couldn't put myself together. and then the nurse came and said hey you. know can you go talk to the mom and I. was like yeah yeah so now the mom and. all the relatives are in a room they. only know that they turns out I realize. these are two brothers the victim who.

was in the passenger seat is 14 the. brother was. 17 he's fine by the way he doesn't have. a scratch on him um and the mom just. knows your boys were in a car. accident and I go and tell her what's. going on and I mean it was the most. difficult thing of my life. um I still remember um you know and when.

you're wearing scrubs they have a little. pocket on them she grabbed on to me and. tore the pocket off the. scrubs I'd never had somebody do. that. um and I. spent I probably spent two hours with. them that night and I was very fortunate. that nothing else came in that night. like I had the time to sort of be there. um. and I'm not sure why I don't I don't. know what it was his name was Malcolm I. don't know what it was about Malcolm's.

case that that devastated me I also went. to his funeral 5 days later which I'd. never gone to the funeral of a trauma. patient before I've been to the funerals. of patients but never a trauma patient. because you don't usually have a. connection to trauma patients right you. don't know them they come in and they. die you don't know them um but I got to. know a lot about Malcolm's life. um and at the. funeral when I walked past the casket I. don't think his mom expected to see me.

and when she did she lunged at me. grabbed me and I I kid you not she. grabbed me so hard she tore the pocket. off my dress shirt just as she had torn. off the scrubs 5 days. earlier um and it's it's interesting I. learned more about Malcolm at that. funeral that day than I you know. obviously would have ever imagined. knowing and it's the story is just just. even more tragic when you realize what. an amazing kid he was and what he meant.

to his family. um he it's interesting so he he you know. so a relatively poor black family and he. was this incredible student and he was. going to a a really special school. because of his exceptional abilities and. that's why his brother was actually. driving him like you know he couldn't go. to the local public school in inner city. Baltimore he was going to a school in. the in the northern part of. Baltimore um and he was you know he was.

the jewel of his mom's life man man how. do. you you know as a surgeon that that that. treats that much trauma and sees that. much death I mean how do you. disassociate I mean I could ask you the. same. question you. don't yeah how long have you been. married. uh we're 21 years now 21 years M. congratulations thank you what about you.

I've been married for 5 years M so. what's the secret to a successful. marriage pick the right person I think. is literally the single most important. thing I mean I think that's not. sufficient right you still have to do. work but but if you don't get that piece. right I think it's harder and um there's. no one right person that's obviously. sort of silly so there's like an. operating window I think in which you. can marry people um I think I just got.

really lucky like I think that's the. theme of my life is just obscene luck. but I just didn't understand at the time. how lucky I was to meet this woman. and um how much she could kind of. tolerate all of my. challenges and all of my focus and how. Relentless I could be um. and how difficult I could be um and and. so it took me a few years to figure that.

out but once I did um yeah I just I just. think. like I I get it I get I get what you you. know you see these people that are in. their 90s that have been married for 70. years and you hear them talking about. each other like I can't imagine living. without each other and you you think. really I mean is that special she's that. special but but but now I get it now I. get it now I understand you know and my. wife will tease me all the time and.

she'll say you know you know she'll say. oh you sure you don't want like some. young hot 20-year-old wife and I'm like. absolutely not you know I I you know cuz. it's I think once you get to a certain. point and you've been through enough. tough stuff together you really. understand what it's about how' you guys. meet we met at Hopkins we met uh 2 days. after 9/11 actually cuz we were still. kind of in lockdown in the hospital um. at the time it wasn't. clear what the damage was and how like.

would we still need to be on standby for. bodies and of course it turned out that. that wasn't the case at. all interesting so wow so did you treat. a lot of those victims no no that's the. point like nothing came up from the. Pentagon nothing came down from New York. I mean people were incinerated there was. nothing to treat geez. geez well Peter let's take a quick break. and then when we come back we'll pick up. with your medical.

career one of the best parts of having. my own show is getting to do what I love. with a team that I love to work with if. you're doing what you love to do there's. nothing better than being surrounded by. people who love it as much as you and if. you own your own business you want to. hire employees who love what they do to. boost the overall success of your. business plus make it a pretty great. place to work but how do you find. passionate employees who are a good fit. for all of your roles zip recruiter and. right now you can try it for free it's. ziprecruiter.com.

SSRS zip recruiter is the top rated. hiring site according to G2 and their. smart technology shows your job to. qualified candidates immediately hire. experienced people who are excited about. what they do with zip recruiter four out. of five employers who post on zip. recruiter get a quality candidate within. the first day see for yourself go to. this exclusive web address to try zi. recruiter for free ziprecruiter.com. SRS again that's ziprecruiter.com.

SRS zip recruiter the smartest way to. hire this episode is sponsored by Roa. Roka is a performance eyewear brand for. people who want to invest in themselves. Roa manufactures premium sunglasses. prescription ey glasses and readers and. cuts all of their lenses here in the US. at their headquarters and Austin Texas. Roa recently partnered with one of my. favorite guests Dr Andrew huberman to.

launch a new line of glasses called The. windown Collection guys I've tried these. you know I have problems sleeping I. absolutely love love love these frames. and lenses they're available with and. without prescription and have a. proprietary red lens that helps filter. out short wavelength light short. wavelength light is in pretty much all. artificial light and it's terrible for. your sleep Roa let me try a pair of. these things and I can feel the. difference whenever I wear them I wear.

them in the evening after the sun goes. down I pretty much started at dinner and. I wear it until bed and let me tell you. these things work with so many options. and I wear and wellness products out. there it's a relief to know the glasses. I'm wearing help two things I really. care about my vision and my sleep and as. a business owner with all the decisions. I already need to make every day wearing. a pair of of roa's glasses is one of the. best ones I've made check them out for. yourself at roka.com and use code SRS.

for 20% off sitewide at checkout that's. roka.com with code. SRS all right back to where were we we. were oh we were talking about secret to. successful marriage and you're leaving. your medical residency and you end up at. McKenzie modeling C credit risk how did. that happen um well when I wanted to. leave medicine I wanted to get as far.

away from medicine as possible and I. wanted to go uh and get an. MBA but I was in so much debt that the. thought of more debt to go to business. school for two years was not very. appealing um I met somebody actually. when I was on call One Night in the uh. er uh another Resident and they told me. about this place called McKenzie so. learned about it sounded like a great. place where basically you get paid and. you get to learn all the stuff you would. learn through an NBA and so that's what.

I that's what I did and um so I ended up. out on the west coast and um working on. sort of math problems again but in the. in the sort of financial banking. section and then you wound up back in. the medical. industry eventually yep how did that. happen uh initially just through my own. kind of Interest in trying to figure out. U my own health you know once my. daughter was born when I was.

35 um I you know thought about hey I. gota you know I've been always. interested in performance obviously and. uh you know you mention it swimming and. all sorts of crazy escapades but but had. never really thought about health per se. um and so wanted to you know just better. understand my own risk. of initially cardiovascular disease. because that's the disease that runs. most rampant in my family um and as I.

just became deeper and deeper in terms. of my interest in understanding uh. understanding that I wanted to start. applying it to help others and so you. know I began to slowly sort of um start. working with with with other patients um. because i' never I'd never let my. medical license laps so I the one thing. someone gave me advice when they when. they left they said hey I know you think. you're done with medicine for the rest. of your life just take the test every. two years keep your medical license.

you'll be grateful you did which was. Sage advice because I think if you let. the thing lapse it can be bit of a grind. to uh reacquire medical license um so. that's kind of how I kind of slowly came. back into it so and you have three kids. yeah how old are they 16 10 and seven 16. 10 and. 7 any uh well actually. was going to ask for fatherly advice but. how old are yours mine are 1 and three.

okay we're in it we're in it but um you. know being who you are and you're a. businessman you're an author you're a. podcast you're a medical professional I. mean you've got all these things going. on you got three kids successful. marriage how do you how do you balance. all that well you have to make some. sacrifices right so there are just. certain things I don't do um I. don't I don't have a lot of idle time.

and I and I think that idle time can be. beneficial like I think there's value to. doing nothing and unfortunately I don't. have a lot of nothing time I also don't. have a lot of hanging out time right and. and and you know I it sometimes means I. come across as a little bit aloof and. you know when people say hey you want to. get together my answer is usually no. no offense it's not you but like on the. hierarchy of work and family like I just.

don't have the time right I don't. everything I do has to be has to be. somewhat measured and so between the. time I make for exercise and hobbies and. spending time with my kids and like once. a month I want to have a special day. with each of my kids individually right. once a month once a month so that means. like going away for example like you. know you know take my kid to Disneyland. if that's the thing they want to do take. my daughter to La if she wants to go.

shopping or take you know my son is. really into Harry Potter so we're going. to go to Harry Potter land like I want. to have a real special day with each of. my kids once a month so when you start I. mean there's only 30 days in a month. like that's one of them gone right uh if. I want to have a date night with my wife. every single week that's one night a. week gone and I say gone not that it's a. bad thing I'm just saying like there's. only 168 hours in a week. and I'm going to sleep for this many of. them and I'm going to exercise for this. many of them and I'm going to work for. this many of them there's not a lot of.

hours left so that's probably how I get. away with it right I don't watch TV I. don't know I don't know the last time I. watched anything on TV that wasn't. Formula 1 like formula one guy formula. one's the only thing I pay attention to. I have not watched a single football. game literally not a single game of. football in I don't know how many years. now yeah me and you are very similar. with the TV aspect do you race. um I drive quite a bit on the track but. not as much as I used to or not as much.

as I would like to so in an Ideal World. I should be on the track two to four. days a month that's not happening right. now so I probably spend more time in the. simulator now um and realistically if. I'm on the. track this year I'll probably. do 16 days total and the whole year on. the track what are you. driving um my favorite cars are formula.

cars so like a like a Formula 3 car um. but also I love you know like pores and. you know all sorts of cars nice nice. well let's move into medical. 3.0 what what is. it so it's a term that I use throughout. the book to describe kind of an. evolution of medicine right so I I. contrast it with medicine 1.0 uh because. you can't have a 3.0 if you didn't have.

a 1.0 and 2.0 and um uh so so maybe it's. easier to kind of explain what 1.0 was. what 2.0 was and is because 2.0 is the. dominant system of medicine today and. then what what am I proposing as 3.0 for. where where we go so medicine 1.0 was. medicine through all of human history. basically until the end of the 19th. century. and so so for the longest period of you. know for hundreds of thousands of years. whatever we thought of as medicine this.

1.0 system wasn't a scientific thing. right it was it was ideas that were. based on um beliefs that we had at the. time that I think were understandable. given that we didn't have a scientific. process so it meant that diseases were. believed to result from the gods or from. bad humors or from these sorts of. ideas um and therefore the treatments. were usually pretty ineffective you know.

it wouldn't be uncommon for them to. blood let people if they if someone had. a fever or to bore a hole in your head. if you had a headache I mean things that. we would look back at today and say. that's crazy well yes but they didn't. know any better and that was medicine. 1.0 um and you know people lived pretty. awful lives uh you know I think if any. body if anybody's feeling sorry for. themselves uh which I think we're all. prone to myself included we should just.

remind ourselves that we weren't born a. thousand years ago you know like how. lucky to just be alive today uh if. you're still feeling sorry for. yourselves how lucky if you're listening. to this and you live in the United. States or you live in you know some part. of the world where you know you you have. the freedom we have so so um. now you think about how like people just. died all the time right they died of. infectious diseases you know there was. probably a 30% chance that a woman was.

going to die during her lifetime giving. birth um just astonishing hardship um. all of this changes about 140 years ago. with a handful of seminal improvements. one is a real codification of a. scientific method remember science is a. process so I really get frustrated when. I hear people talk about science is a. thing it's not a thing it's a process. it's a way of thinking it's a way of.

making. observations taking guesses as to what. it is that is accounting for the. observation designing a hypothesis that. can be tested in an. experiment conducting an experiment and. measuring the results of the experiment. against what would have been predicted. by the hypothesis and then if necessary. revising the hypothesis. and coming up with better and better. theories that's it that's what science. is everything I just said is all you. need to know that's the scientific.

method and that didn't exist that is a. man-made creation very important to. understand that it's a brilliant. creation I would argue it as the single. most important creation that allows us. to exist today it allowed us to figure. out that washing your hands was a way to. prevent spreading disease it allowed us. to figure out that there were organisms. that we can't see with our naked eye. like bacteria and viruses that are. killing us it allowed us to create.

medications to treat those things so. just on the basis of those few things I. said we basically doubled human. lifespan just by figuring out how. sanitation uh addressing um infant and. mother mortality treating infections you. know all of these things at a huge. difference that is what I call medicine. 2.0 medicine 2.0 was heralded in with. with that Discovery um medicine 2.0.

basically says look we treat a disease. when we see the disease and the playbook. for medicine. 2.0 um again has has been really. successful for acute conditions trauma. is another one right like think about. what think about what a soldier in. theater today. can survive relative to what they could. have survived in World War I or World. War II uh especially World War I and.

even the Civil War let's go back if you. want to make it a medicine 1.0 to. Medicine 2.0 consider a civil war versus. Soldier today totally different. experience uh in terms of what's a. survivable injury again the advances in. trauma and critical care are insane the. problem is those things have not. extended to life uh life extension Visa. chronic diseases so most people that are. listening to us right now are going to.

die from basically one of four things. cardiovascular disease including you. know heart attacks and strokes cancer. dementing diseases and metabolic. diseases type two diabetes fatty liver. disease those things like that that's. literally like 80% of people listening. to us are going to die from one of those. things DeMent and diseases being. Alzheimer's Alzheimer's vascular. dementia other neurodegenerative disas. diseases like Parkinson's disease and. things like. that so those are all chronic diseases.

and we have not made great progress on. any of them with the exception of. cardiovascular disease we're doing a. much better job on that people are. definitely getting heart attacks later. in life and you're more likely to. survive your first heart attack today. than you were 25 or 30 years ago um so. 30 years ago uh roughly 2third of people. would not survive the first heart attack. today slightly more than half will but I. would still argue that all of these.

results are kind of unacceptable right. and that we should be able to do better. and so now to your question apologies. for the ramble the first and most. important pillar of medicine 3.0 is you. have to be able to be better at treating. chronic disease because chronic disease. is what's going to kill us today and. again this is a privilege right we've. done so well at treating acute diseases. that we've now earned the right to have. to focus on chronic diseases but the.

current medical system was not designed. for it the economics of the system. aren't built around it and again this is. not a conspiracy theory you get all. these sort of Health influencers that. want to turn this into a big pharmac. conspiracy theory no it's not a. conspiracy theory it's simple economics. you have a billing system that is. predicated not on keeping people sick. but on treating people when they get get. sick I get so frustrated when I hear. people say oh big Pharma has the cure. for cancer they just don't want it out.

there they want you to be sick that is. hands down the dumbest thing I've ever. heard if big Pharma had a cure for. cancer they would happily profit on it. all day long the bottom line is cancer. is really really really hard to cure. once it's taken hold the far better. strategy to address cancer is to catch. it early or prevent it alog together and. that's not in the purview of Pharma. they're not in the business of doing. that anymore than the guy who runs the.

car wash is in the business of making me. dinner they're different businesses so. um medicine 3.0 has to come up with a. better way to treat chronic disease and. though I won't get into all the details. but I I Write About It extensively in. the book you can mathematically prove. that the way to treat chronic disease is. to delay its onset those are. mathematically equivalent so you want to. live longer without disease not live. longer with disease so medicine 2.0 aims. to keep you alive longer with chronic.

disease medicine 3.0 says that method. will fail you have to delay the period. of time before someone gets a disease. the second big principle of medicine 3.0. is you have to treat this thing called. Health span as much as you treat. lifespan so lifespan is the thing that I. think most people intuitively get is. like how long you live right are you. going to you know if your parents are. still alive you could say yeah my my. parents are 85 and 80 and hopefully. they're going to live another 5 years. and that's their lifespan um but there's.

this thing called Health span which is. not as easy to measure but is more. important which is what's the quality of. their life phys physically cognitively. and emotionally and so how do you. preserve and maximize Health span this. is another very important principle of. medicine 3.0 medicine 2.0 does not. acknowledge Health span Beyond a very. cursory way to describe it but 's a. saying which I'm sure is true in the. military just as it's true in all of. medicine and business what gets measured. gets managed and in medicine 2.0 you.

manage to lifespan that's the metric. everybody's focused on but in medicine. 3.0 you have to pay just as much. attention to quality of life and if you. manage to that how much muscle mass do. you have how strong are you what's your. V2 Max what's your reaction time what's. your cognitive performance what are the. what's the strength of your. relationships that's part of emotional. health all of those things figure into. the quality of your life and Medicine. 3.0 says we should be managing to those. just as much as we manage to life. expectancy interesting interesting so so.

it sounds like more of a. preventative it's it's preventive but. it's also very proactive and it's much. more Broad in its focus it's not just. about how long can I keep you alive it's. how long can I keep you thriving so what. are some of the let's go down each you. mentioned I believe three pillars but. you know. four did you mention four chronic. diseases that we're we're all going to. die from most people are going to die.

from let's start with. cardiovascular so it's the leading cause. of death for uh in the United States. it's the leading cause of death globally. and it's the leading cause of death for. men and the leading cause of death for. women so even though I don't think it. gets that much attention because maybe. because it's so common we just sort of. tune it out a little bit um we can't. forget you know 19 million people a year. globally are dying from cardiovascular. disease um now this is certainly tragic.

and ironic given that of the four. chronic diseases it's the one that a we. have the best understanding of and. see we probably have the best treatments. for um so uh you know we can come back. to metabolic disease because I think a. lot has changed there but we certainly. understand what the drivers of. cardiovascular disease are um and. there's several right so lipids blood.

pressure smoking poor metabolic Health. those are the big big big drivers right. so if you're insulin resistant if you. have high blood pressure if you have. high what's called apob which is a. particular measurement of lipids uh if. you smoke those things are going to. drive your risk through the roof um. there are people who can certainly get. away with having one or two of those. things uh not optimized but if you're in. the business of trying to prevent the. disease you want all four of those.

things fully optimized um some of those. are purely behavioral um some of those. are done through medications we talked. about blood pressure as an example lots. of ways to control your blood pressure. um without pharmacology but if you need. pharmacology it's also pretty easy to. manage it that way so um that you know. really it shouldn't be the leading cause. of death it just it just simply. shouldn't be um but most people don't. have the right timeline on it they don't. realize how long this disease is brewing. so how old are you 42 okay so you know.

the probability that a 42 year-old's. arteries if if let's just say tragically. you died in a car accident tomorrow if. they did an autopsy on you the. likelihood that your coronary arteries. would look perfect is very very low we. know this because during Vietnam they. did autopsies on all these young men. that were 18 19 20 years old who. obviously were killed in combat so not. had nothing to do with their hearts and. they did not have perfect coronary.

arteries they all had some evidence of. disease and um those guys were not going. to die of heart attacks for another 40. or 50 years to be clear but what it. showed us was how long it takes for this. disease to progress below the naked eye. so in the instant that a person has a. heart attack there's an enormous and. abrupt change with clotting factors and. all these sorts of things but but all of. that is precipitated by Decades of. buildup and by buildup I mean sort of. impossible to see processes that.

eventually can become visible on certain. elaborate scans so um we do want to. start preventing this stuff early by. managing those four variables uh and if. we do I think we get to take that one. off the table how do you start to manage. them yeah so you again you look at each. of those risks individually so first. someone's smoking if they are I want. them I want them to not smoke and we're. going to do whatever steps we have to do. to get them off cigarettes what's their. blood pressure again if someone's got. elevated blood pressure first line. therapy is not to turn to medication. it's actually to uh look at exercise.

sleep and weight those three things uh. can fix blood pressure in many cases but. if it can't the amount of medication we. have that can address blood pressure. without inducing symptoms um because. that's the other thing you always have. to think about right anytime you're. giving somebody a medication you have to. be able to do it in a way that it. doesn't create another problem um and a. lot of the early generations of these. drugs. they cause problems you know they would. they they' make you feel horrible in. some other way um so if your choice is.

walk around with high blood pressure. even when you've corrected for body. weight exercise and sleep or don't. you're you know you're you're better off. fixing it even if it means taking. medication metabolic health I think is. the toughest one to fix truthfully um. and it requires everything from being in. energy balance you know doing the right. kind of exercise so the right balance. between exercise that generates muscle. mass and exercise that that generates. the ability for the muscles to soak up. glucose that's kind of one of the. important functions of the muscle.

besides the obvious structural. components but the muscles are a huge. reservoir for glucose putting glucose. into muscles is a super important job. that drives so much of our health um and. then the fourth one is managing these. lipids so uh this apob marker which is a. very simple blood test measures the. total concentration of all cholesterol. carrying uh molecules in the body that. are harmful so not all the molecules. that carry cholesterol in the body are. harmful but a subset of them are and.

that's how you measure them and again. that can be addressed through through. diet but if it's not again you you want. to lower those things pharmacologically. so what are some things that people can. do just right off the bat. to better their health other than. smoking yeah so that's a great one right. so if you're if you're a smoker I think. I don't think there's anybody out there. who's smoking who thinks it's good for. the so really the challenge there is not. the what do I do it's how do I go about. doing it how do I go about a smoking. cessation plan which we could talk about.

another we could we can talk about that. as much as you want by the way because. it's a topic I'm very interested in um. we talking just cigarettes are we. talking cigarettes. cigars marijuana so cigarettes are the. Lion's Share of this problem because of. just the volume right so if you're if. you're a cigar smoker you're probably. smoking like first of all a lot of cigar. smokers aren't in in the smoke all the. way into their lung um and so it's just. generally not posing the same risk it's.

not it's still is risk but but nothing's. probably going to be the the risk of. taking 25 cigarettes a day and smoking. them right and so even people who are. smoking weed are not typically smoking. nearly enough to get there now when you. get into nicotin replacement products. you want to always be able to. differentiate them into with and without. tobacco. I know everybody out there has to. be just as frustrated as I am when it.

comes to the BS and the rhetoric that. the mainstream media continuously tries. to force feed us and I also know how. frustrating it can be to try to find. some type of a reliable news source it's. getting really hard to find the truth. and what's going on in the country and. in the world and so one thing we've done. here at sha Ryan Show is we are de. veloping our. newsletter and the first contributor to. the newsletter that we have is a woman.

former CIA targeter some of you may know. her as Sarah Adams call sign super bad. she's made two different appearances. here on the Shawn Ryan Show and some of. the stuff that she has uncovered and. broke on this show is just. absolutely. mindblowing and so I've asked her if she. would tribute to the newsletter and give. us a weekly intelligence brief so it's. going to be all things terrorists how. terrorists are coming up through the.

southern border how they're entering the. country how they're traveling what these. different terrorist organizations. throughout the world are up to and. here's the best part the newsletter is. actually free we're not going to spam. you it's about one newsletter a week. maybe two if we release two shows the. only other thing that's going to be in. there besides the Intel brief is if we. have a new product or something like. that. but like I said it's a free CIA. intelligence brief sign up links in the.

description or in the comments we'll see. you in the. newsletter so if a nicotine replacement. product is derived from tobacco like. snooze it still carries a ton of risk. nowhere near as much risk as a cigarette. so cigarette is still the A+ risk but if. you're consuming snooze. you're still getting a lot of the. carcinogenic risk it's just going to be. subject to your mouth as opposed to your. lungs um so when you want to get.

somebody off smoking you want to create. a real awareness of what they're doing. you want to understand and so typically. the first thing we'll have people do is. um just journal what when is it that you. pick up a cigarette what happened that. made you want to pick up the cigarette. this is but by the way this will work. for any habit right if you're trying to. understand why you're eating so much. junk food. let's just start with a few weeks of. noting every time you go into the pantry. for Pringles what predisposed you to do.

that was there something stressful did. you have a thought about something were. you bored were you actually hungry what. what created the urge um another one of. the things you do is you start. disconnecting the urge from the behavior. so let's say you're a smoker um we would. say hey Sean every time you you feel. this urge to go out and get a cigarette. I want you to not do it but set an alarm. for 15 minutes and then go out in 15. minutes in other words I'm not going to. stop you from smoking I'm just going to. uncouple the urge from when you do the.

thing so that that's that becomes. important nicotine replacement is a very. important part of smoking cessation. there are lots of ways to replace. nicotine right you've got little patches. I mean little um uh pouches there um. I've got my toothpick here we've got uh. Patches gum all sorts of ways to go. about doing it each of them has their. pluses and minuses I did a whole podcast. on this um that that that gets into the. itty bitty nuances of this um but the. bottom line is nicotine replacement very.

very powerful tool because nicotine if. derived from a clean Source like a. synthetic. nicotine doesn't carry any of these. cancer uh risks at least we can be very. confident that that's true certainly not. from a lung cancer perspective there may. be other risks um so we should be. mindful about how much nicotine we do. consume um but it allows you to deal. with what the addictive piece was and. then the final thing is understanding. the oral fixation that a lot of people.

have with a cigarette by the way I think. that's why kind of the nicotine. toothpicks are kind of nice is for many. people it's just it's a bit of an oral. fixation with with a with a nicotine. containing thing there are also. different classes of anti-depressants. that can be very helpful with people. that are quitting smoking so we'll put. that aside because it's self-evident. that one should not quit that one should. not smoke but the sometimes to how to do. it is is easier said than done now is is. there any way to reverse this is there. any way to to clean up your arteries you. were a smoker yep um how do you do that.

well when it comes to smoking we know. that after a certain number of years. depending on how long of a smoker you. were your risk of heart disease and. cancer will return to Baseline it will. it will yeah now again you might not get. there because depending on how long you. smoked it could be 30 years before you. return to Baseline so if you're a. 50-year-old who's quitting smoking. and you've been a pack a a smoker for 40. years or you know say 30 years um you. might not make it to 80 without some.

event so we still act with enormous. vigilance in people who are former. smokers in our practice we treat former. smokers and smokers identically when it. comes to cancer screening um because. even though we know the risk is coming. down in them we just assume it's still. quite high and so we will still screen. them very aggressively for you know. every every cancer that that we can um. even maybe against the advice of of sort. of medical authorities in terms of how.

aggressively we'd look at it um the same. is also true for cardiovascular disease. we do see that over time that risk will. return to the Baseline risk but remember. as you're aging what's happening to your. Baseline risk it's going way up age is. the single biggest predictor of risk for. both cardiovascular disease and cancer. okay yeah so so you never want to escape. the fact that even though you're. quitting and that's driving risk down. age is driving it up so you never really. want to take your pedal off the metal. when it comes to prevention so what are. some of the other things you can do to.

to get back to Baseline um exercise is. very important um again the the benefits. of exercise when it comes to brain. health metabolic Health heart health are. probably the most obvious I think when. it comes to cancer it's less obvious of. all the four diseases I call them The. Four Horsemen in the book I think cancer. is by far the one we understand the. least in terms of what's driving risk so. we know that metabolic disease drives.

risk so obesity and type 2 diabetes. clearly driving risk um we have some. ideas as to why but beyond that and. smoking we don't have a great sense and. I don't think there's anybody who's. listening to us right now who can't. relate to the idea that otherwise. completely normal healthy people still. get cancer right I'm sure you know. people who are 40 50 years old picture. of health and they still get cancer. scares the hell out of it's like every.

day a text comes in my mom's got cancer. I've got cancer my kid has cancer my. aunt has cancer so and so died of cancer. I mean it it it's it scares the hell out. of me well and and I would say this once. you've got your house in order. healthwise it's the biggest risk because. you can drive the risk down of metabolic. disease of cardiovascular disease and. even of neurodegenerative disease. especially dementing diseases we can.

drive these down when I you know people. often ask me Peter you know your your. whole life is this longevity thing how. are you going to die and I say honestly. like the it's it's going to vary by. decade but if you said to me in the next. decade if you had a crystal ball that. said Peter you're not going to make it. to I'm 52 you're not going to make it to. 62 why there's really two things it's. cancer and accidental death you know I'm. going to I mean I they going to get. cancer and succumb to it or I'm going to. die in an accident that would be that.

would be 90% of what would kill me in. the next decade okay um so so you're not. alone right in feeling that way that's a. rational uh fear fortunately given your. age you're 42 um your 10year mortality. from cancer is still very low it's. probably in the 2 to 3% range but that's. not zero like well you know it also. bothers me cuz you see all these weird. cancers you know coming up from from. being overseas I think stuff we've been. exposed to I'm sure yeah I mean I don't.

even know what I've been exposed to but. there's all these weird cancers nobody. can explain um she had this guy on Chris. fetus who we were talking about the. Jammers that used to jam the frequency. for iids and stuff and maybe sitting. under that thing he says there's been. studies out there that have said yeah. definitely increases the risk uh. by a pretty large. amount. and I mean. it's man it's just EV yeah I mean I.

think the only thing you can do is you. sort of have to decide am I willing to. trade that anxiety for another anxiety. because you're going to have to deal. with some anxiety so anxiety one is I'm. just going to worry about it but I'm not. going to go looking anxiety two is I'm. going to do everything in my power to. screen and look for this but I'm very. likely going to find a bunch of things. that aren't cancer those are called. false. positives so which of those and this is.

a very individual decision yeah but. which of those gives you more stress are. you more stressed just sitting here. worrying about it or you going to be. more stressed if we turn over every. stone screen the hell out of you and. find a bunch of things that ultimately. will not be cancer but we're going to. have to chase them down which one of. those is more anxiety-provoking I don't. know you know me I don't know me and my. wife have talked about doing the. pre-cancer stuff I've had blood work. done I know there's some kind of uh.

imagery that you can do yep you know and. and we were signed up to do it and then. my wife said hey you know what happens. what happens if something does pop up. and they say oh you've got this much. time to live then how do we treat each. other during that time and that's. something I never thought about I was. like [ __ ] you know that's it would be a. whole new Dynamic you'd be thinking.

about your future without that. person that person would think oh I'm. holding you back in life and I mean so I. don't know we we haven't done it for. that reason like I said I did do the. blood work and uh she's getting the. blood work done and so far you know so. good but I mean what what do you do do. you get well again it's a very personal. decision just like we were talking about. with the vaccines earlier I there's not. a right answer and if every P every.

single patient I'm talking to I'm not. trying to impose my will on them or my. beliefs or even what I do I want to help. them understand. probabilities this is the probability of. you getting any of these types of. cancers this is the probability of this. test that we do giving a false POS. positive this is the probability of it. giving a false negative and again we we. know all of this stuff like we know for.

every test we do uh there are these two. mathematical terms one is called. sensitivity and one is called. specificity so if we if you do that. liquid blood so you're what you're. referring to I assume is a liquid biopsy. so it's a blood test it's doing a pan. screen for. cancer that test has a sensitivity which. is the probability that if if you have. cancer it will pick it up the. sensitivity for a liquid biopsy is very. low for a stage one or stage two cancer.

it's probably on the order of 30% for an. for all can that's it that's it for all. cancers it's probably on the order of. 50%. sensitivity conversely the specificity. which is the probability that the test. comes back negative if you are free of. cancer is very high. the specificity on those tests typically. runs about. 99.5% now when you know those two.

numbers sensitivity and. specificity and you know the probability. that you have cancer out of the gate. What's called the preest probability. which says you're a 42y old man you. don't smoke but maybe you have a. slightly higher risk because of your. exposure to chemicals blah blah blah. blah blah your pre-test probability is. 3%. knowing the preest probability the. sensitivity and specificity allows us at. any point in time to calculate what's. called positive a negative predictive.

value which means if this test comes. back positive How likely is it you have. cancer and it's going to be very low. okay the whole takeaway of that whole. Spiel is the ppv or positive predictive. value is going to be like 10% so even if. that test came back positive there's 90%. chance you don't even have cancer okay. the negative ICT value is going to be. very high the negative prct value is. going to be above 99% so if it comes. back negative you can feel really. comfortable negative comes back positive.

and this is what I got to earlier I. don't even let people do these tests if. they're not willing to live with the. consequences of a false positive because. the likelihood of that happening is. actually pretty high well what if you do. get a false positive what then what. happens well I'll tell you I'll give you. a really horrible story of a false. positive um was just talking to somebody. the other day um who went and got a. whole body MRI and it found something in. his thyroid that looked a little. suspicious and to be clear the thyroid.

gland is notoriously difficult to image. notoriously difficult it is so glandular. and so prone to over representation of. cancer um that we see we see false. positives all the time in the thyroid I. just tell patients 10% 20% chance we're. going to see something in your thyroid. um in this case saw something in his. thyroid his doctors recommended a. thyroid ultrasound and a biopsy so they.

did the ultrasound they did the biopsy. now normally at that point that's the. end of the line the thyroid is really. easy to biopsy you can feel it under an. ultrasound it's like shooting fish in a. barrel pull a couple cells out no cancer. you're fine sorry for the inconvenience. we'll see you in a year but in this case. when they did the biopsy they're like it. might be cancer we can't fully tell and. they recommended removing the half of. the thyroid so they did now they did the. surgical operation they took out his. half thyroid and it came back it was. totally.

fine now is this a life-changing surgery. no can you live without half your. thyroid yes but that's an example of. what can go wrong now how do I choose to. live with that degree of uncertainty. personally because of my risk appetite I. make the decision to screen I screen. myself very aggressively so I do get a. whole body MRI every year I'm very. aggressive with the frequency with which.

I do colonoscopy I do liquid biopsies. every year you know I'm religious with. my skin exams and again some of these. things are low risk like you know the. risk of a skin exam means I'm losing a. couple moles I didn't need to lose who. cares um but a colonoscopy is a huge. risk you know I shouldn't say huge I. mean it's just a very nonzero risk but. again I consider it a bigger. shame to to get colon cancer and to miss. a colon cancer something that's you know. third leading cause of cancer death.

right I want to make sure I'm not going. to succumb to colon cancer um. so you know I don't have an answer for. you but I could walk you through every. number and let you make the best answer. for you what age should people start. getting. screened probably depends a bit on. family history which really speaks to. risk um colon cancer is an easy one to. talk about so it used to be the. traditional screening for low-risk. individuals was 50 I'm very grateful to.

see that that's been lowered to 45 so. that means now people can get insurance. to cover them 5 years earlier and I. think that matters a lot personally I. would lower it to 40 although I. understand maybe on an economic basis. why it doesn't make sense but as an. individual thinking about yourself look. I still think 3 to 4% of cancer colon. cancer deaths are in people younger than. 40 that's a staggering statistic people. just don't think of young people getting. colon cancer um and yet you know they do.

um uh so so uh I would say somewhere. between 40 and 45 is probably the right. time for a person to get their first. colonoscopy unless they're high- risk in. which case you want to be treated. earlier than that so if you person has. Al all sort of colitis or Crohn's. disease or a family history of colon. cancer things of that nature I would be. doing it even sooner okay rewind back to. cardiovascular stuff You' mentioned. getting back to Baseline how do we know. when we're back to Baseline well. unfortunately you can't and and to be. clear Baseline I said Baseline risk so.

you're never going to take your coronary. arteries back to what they looked like. when you were 10 years old right so what. we really aim to do is stabilize the. progression of. atherosclerosis um and so depending on. what sort of screening modality is used. to measure um and that the most common. one that's used is something called the. calcium score but there's a more. advanced test called a CT angiogram so. they're both CT scans but the calcium. score just runs over the body doesn't.

put any contrast in and is just looking. to pick up the light of calcium it's not. a very granular test but if you have any. calcium in your coronary arteries we. know that's bad that's not a good test. to measure progression because it's not. a very accurate test and it can easily. be over interpreted so if a person's. calcium score is 100 if if you had a. calcium score 100 at the age of 42. that's a four alarm fire even though 100. is not a very high number that number. could easily be 4,000 at the age of 42.

it should be zero all day every day but. if it was 100 and then 5 years and we. started treating the heck out of you and. 5 years later it was. 130 that would in my mind not constitute. progression because of how crude the. test is okay now if they use a more. granular version of that test called a. CTN geogr it's a more high resolution CT. scanner where they use intravenous. contrast now you get to look more at the. coronary arteries and there you can get. more subtle descriptions of what's going.

on but the truth of the matter is when. you're treating the causal risk factors. we don't tend to fixate on the Imaging. as much as we fixate on function and the. reduction of risk markers so if you. showed up at 42 with the calcium score. of 100 there's no doubt in my mind that. at least one of those four factors is. out of whack. we're going to fix it we're just going. to fix it non-negotiable and in five. years even if your calcium score has. gone up a little bit we we are still.

very confident we've halted the. progression of the disease okay okay. back to cancer. preventatives I've talked a lot about. this with with other health. professionals on the on the show and and. it seems like. Plastics sugar. what else uh single ingredient Foods I. mean do you have any do you have any we. can talk about what is absolutely known. what is unambiguous is smoking obesity.

diabetes are. driving the the majority of what we see. as preventable risk okay so that's. that's the only thing that I would say. we know with a very high degree of. certainty once again when you're smoking. smoking cigarettes cigarettes cigars. mostly cigarettes okay yeah now cigars. even if you're not inhaling you're still. increasing your risk of oral cancer and. things of that nature but yeah when we. talk about a person who smokes a. cigarette that they're inhaling that's. increasing the risk of many forms of. cancer not just lung cancer although.

it's increasing your risk of lung cancer. geometrically so if you're overweight or. obese if you have type two diabetes if. you smoke any combination of those. things is increasing your risk of. multiple forms of cancer they're not All. the Same by the way so this the the. cancers that are predisposed or the ones. that risk is going up dramatically for. typee two diabetes and obesity overlap. with some of the lung cancer but there's. some different ones as well um.

everything therea that we are at a lower. level of certainty so I did a lengthy. lengthy deepest Deep dive I've ever done. certainly top three deep Dives I've ever. done in my life into microplastics on a. podcast a few weeks ago. and I can tell you that the evidence. that. microplastics past chemicals PM 2.5S are. causing cancer PM 2.5S are sub 2.5.

Micron particles in the air that we. inhale um the evidence that they can. cause cancer is modest um it's not very. strong but it's also shouldn't be. ignored right I wouldn't I wouldn't. throw it out and say ah come on it's all. fine uh the question is what do you do. with that information like how hard hard. should one work to avoid all of these. things because it's impossible to avoid. them period that's uh it's it's actually.

we can't we couldn't imagine a scenario. whereby a person could completely be. free of microplastics even if you said. something as ridiculous as I'm going to. move to the Antarctic well you wouldn't. be able to because the protective. clothing you would need to prevent you. from dying in that environment would. expose you to microplastics so we're. going to be exposed to microplastics no. matter what um but there are a bunch of. things you can do to. like either inconvenience yourself in. time money some other variable and.

reduce it a lot so you know um actually. made a video kind of recently about this. which is like what's the what's my 8020. view of how to do this and it's. um some obvious stuff so one don't store. food in plastic containers. just so if the restaurant's trying to. give you your food in plastic container. just don't take it home um at home throw.

out your plastic storage containers. splurge on Amazon for the glass storage. containers and just use those don't heat. up anything in plastic so my kids. because they still throw cups will still. have a few plastic cups I'll put cold. milk in there but I would never put. anything hot into there and frankly I. can't wait till we're kind of done with. plastic cups in. general. um one big Splurge I did was I got rid. of my drip coffee machine which just had.

plastic all over it and I swapped it out. for a machine that is all Glass and. Metal so it still makes a drip coffee. but the water is the hot water is only. exposed to metal and glass so which. again anytime hot water was exposed to. plastic you're really increasing your. risk um so that's a that's but you know. it's an expensive coffee machine but. it's a onetime cost. um another thing was and we had already. done this before but I do think this is. a worthwhile investment for people who. can afford it is putting in a reverse. osmosis water filter in the home and.

drinking out of that um huge source of. microplastics and other chemicals that. you want to. avoid another thing that you can do. which again is a big cost and this is. not something everybody necessarily. should do but especially if you're. indoors a lot is um moving your air. filtration system up to HEPA level. okay um again that that requires that's. a that's a cost there's a real cost in. doing that not in the filters themselves. they can be relatively inexpensive but.

in the um HVAC machines that need to. blow them are pretty expensive so. standard residential HVAC units. typically aren't powered to do it so. you'll have to upgrade them. um little things like uh it sounds silly. but like I don't take a plastic bottle. into the sauna I use a glass bottle I. don't even keep a plastic lid on it I. just don't want anything heating up. plastic um those those are oh I I. switched out my water bottles in um I. used to ride my if I'm riding my bike.

Outdoors you know cyclists have plastic. water bottles I just found a company. that makes steel ones so those are those. are kind of the big things so again a. lot of it's a single upfront big cost. you know the water bottle is like 40. bucks which is a total ripoff but. whatever um so single big upfront cost. but then after that you're kind of done. thinking about it and and. probably getting rid of 2third of it now. I'm doing that out of What's called the. precautionary principle not doing that.

because I'm telling you this stuff. causes cancer and heart disease I don't. know interesting but the cost of. mitigating it is low relative to the. cost of being wrong yeah yeah what about. plastic. bottles I try to avoid them yeah I can. taste it now we have we had a filtration. system put in and and uh now if I go to. the gas station I want some more I I can. taste the plastic I couldn't before cuz. I was so used to it but I definitely.

taste it and again let's say you're on a. road trip and you're parched and you. pull over at a gas station and your. choice is to stay parched or drink the. water out of the plastic bottle drink. the water out of the plastic bottle. that's better than getting a kidney. stone okay right like again people have. to remember the dose effect of this. stuff like I get I I'm amazed at how. people completely lose the forest for. the trees sometime on this thing and. they all of a sudden become so fixated. on I can't ever touch anything that. touched plastic and yet they forget to.

work. out like remember the priority list. right okay yeah what about household. chemicals does that play a big role in. cancer um probably not as much as health. influencers want you to believe okay. yeah what about sugar does cancer feed. off sugar that's a bit of a gross. oversimplification the truth of the. matter is um cancer feeds off glucose.

glucose is the simplest breakdown. product of all carbohydrates or. virtually all. carbohydrates um the an the the uh. evidence that sugar is uniquely. carcinogenic is virtually. non-existent despite again what every. anti-sugar health fluer wants you to. believe there's the evidence is awful. for that statement um. but um sugar almost undoubtedly drives.

people to overeat and there are there. are really compelling biochemical. reasons for that and decent experimental. reasons for that especially in animals. that high sugar diets will drive. overeating and overeating certainly. drives cancer um but. sugar does not uh cancer does not have a. unique ability to consume fructose which. is the actual part of sugar that makes. it sweet so if you if you eat a bowl of.

rice that's all glucose if you eat sugar. it's half glucose half fructose well the. cancer does not have a unique ability to. consume the fructose it just consumes. the glucose so you could frankly argue. that rice is more carcinogenic than. sugar except for the fact that again as. I said maybe sugar drives people to eat. a little bit more okay but but sugar is. uh pardon me the the bigger driver of. cancer from a nutrition perspective uh. is likely the growth signals that are.

very prevalent with obesity and type 2. diabetes so it's undoubtedly much more. the high levels of insulin than the high. levels of glucose that are problematic. when you're trying to prevent or. minimize cancer risk okay let's move. into dementia. that's another thing that scares the. hell out of me more and more it seems. like people are getting dementia.

Alzheimer's how do we prevent that can. we prevent that well we can definitely. prevent some of it I don't know that. it's entirely preventable just like I. don't think any disease is entirely. preventable um the closest of the main. diseases that I think is I I think again. I think type 2 diabetes and extreme. metabolic disease and heart disease are. the most preventable I I think the other. two are less so um but we know a bunch. of things right we know that there are a.

number of behaviors that really really. reduce your risk of dementia so you can. invert that statement and say that doing. a lot of those things helps you prevent. dementia right so what are those things. so. exercise has the most potent effect on. reducing the risk of dementia I mean. it's profound actually so there are lots. of reasons that that could be the case.

it could be that when you exercise your. muscles make these hormones called. myokines and that myokines uh are pro uh. basically PR neuron right they're they. they they promote neuronal growth um. exercise produces other um hormones and. proteins um so something called brain. ntic peptide another protein called. clotho uh is made we have a spike in. clotho by about 15% right after we. exercise we know very clearly uh through.

experiments in everything from mice to. monkeys that when you inject people with. those proteins they they transiently. have an improvement in cognition and. even when you give those things to. people or to animals in the early stages. of cognitive impairment it reverses it. so so there's a whole bunch of reasons. that are profoundly beneficial of course. exercise also plays an amazing role in. metabolic health and Vascular Health. which again are two of the biggest risk. factors for dementia metabolic health. and Vascular Health um we look at other.

things that can get in the way of brain. health is disrupted sleep so person who. doesn't sleep enough or a person who. doesn't get a high enough quality of. sleep so again anything that we can do. to improve sleep duration quality. staging Etc it's going to be important. all the things that hurt the heart hurt. the brain so apob blood pressure smoking. we talked about metabolic Health those. things are bad for the heart they're bad. for the brain so reducing apob keeping.

blood pressure normal not smoking being. metabolically healthy exercising are I. mean that's the that that's the Playbook. and again people really want there to be. some special not Tropic agent out there. that you can just take that is going to. just make your brain perfect and it's. like you're rearranging the deck chairs. on the Titanic the most important thing. is not to hit the iceberg don't hit the. iceberg that's the most important step. and that those are the things that we.

just talked about everything else is I. have heard and read and you know and. like I said I don't know I don't really. know what I'm breing if if it's if it's. if it's factual or not there's a lot of. talk about psychedelics MH. and help him with ADHD help him with. anxiety help him with addiction and and. I did it uh did an Iain um treatment. about three years ago came off booze. it'll be three years this Valentine's.

Day um does that help with there's also. been talk about that helping with. demential. alimer I'm not I'm not familiar with. that I'm I'm I am familiar with a lot of. the um both the stories and and and. certainly some of the some of the. reports case reports of the benefits of. iboga and Iain um on alcohol um on. opioids even more potently um very.

difficult to ignore uh in other words I. I really think there's something going. on there actually just spoke with a. patient who came back from um a long. retreat in uh it was either Mexico or. Costa Rica I think it was in Mexico um. he was there for a week and um you know. it's interesting like I asked I always. ask people when they do this what are. you in search of like what what's the. what was the reason for it right um out. of curiosity of course not I'm not.

judging The Experience um and he he kind. of went in there without a very clear. objective like he wasn't he wasn't going. to solve a problem um but he said it's. really interesting he came out of it and. he was like yeah I just don't have any. appetite for alcohol like that's what. happened to me so you didn't go in there. specifically for that reason no I didn't. I mean uh used to used to be very heavy. drinker and then by the time which I. still was a heavy drinker. um but I IID kind of like gotten away.

from hard alcohol vodka was kind of my. poison and then kind of moved into wine. having I was probably drinking a bottle. maybe a little bit more a night uh but I. went there for more. anxieties PTSD traumatic brain injury. type stuff and the same thing I walked I. wanted to be more in the moment with my. family and um I just. interviewed former colleague after. former colleague over and over again and. and all these guys were just having.

these profound benefits that came out of. it and then when I came out that that. was one of the things that was i' kicked. caffeine for about six months I'd kicked. marijuana for close to six months I've. kicked booze uh completely I haven't had. a drop of alcohol in almost 3 years I. was more on the moment and. um and then and. then yeah so that that was all that kind. of stuff was kind of a byproduct that I.

wasn't expecting caffeine was gone for. quite a while um I only I drink tea now. instead of coffee uh sugar kick that for. probably three or four months. and and then it's interesting right this. is a an experience of 10 minutes long. right oh no I wouldn't say it's 10. minutes it's it's I think it's about a. 12-h hour experience oh really okay yeah. I think it's about I think the effects.

uh you're kind of in it for about 12. hours and then and then came out of it. and then yeah all these good things. happen I did wind up. um it's been what probably about three. months since I had any marijuana which. really decreased my sugar intake but um. and that alone should also help your. anxiety mhm I think it did I think a lot. of PE marijuana is a very interesting. drug where for a for a for a high number.

of people in the short term they think. it's giving them a reduction of anxiety. but it's actually compounding their. anxiety and I had a woman on my podcast. who who talked about this at length and. she talked about the number of patients. where if she can just get them to stop. marijuana for. a month they're going to it starts to. break the cycle of their anxiety um and. of course there are lots of people who. use marijuana quite regularly have zero.

issues with anxiety so again I think. like most things in mental health um. it's really complicated to understand. susceptibility Windows like why is it. that one person when they use this drug. something negative happens another. person can use the same drug and. actually something quite positive happen. happens what what's the susceptibility. of that like you know we're we're really. in uh our our infancy of understanding. these things to put it mildly.

um so so there is no there is nothing. thus far that that that states that. psychedelics may help with. dementia certainly nothing directly now. look you could make some indirect cases. and and by the way I don't include MDMA. as a Psy adelic because it's technically. not a psychedelic uh it's an empathogen. so it doesn't distort uh you know your. perception but as I'm sure you're aware.

from interviews you've done I mean MDMA. is is probably the more promising of all. of those agents when it comes to. treating. PTSD and it would be hard to make a case. that if you took an individual who's. suffering from. PTSD and you freed them from the grip of. that through uh MDMA guided therapy that. you aren't not just reducing the risk of. near-term issues that are associated. with PTSD but also long-term issues.

including cognitive decline so again I. think that's that I think there could be. indirect and adjacent benefits of this. um I just think with each. psychedelic um as with each drug you. have to know the operating window of the. drug right so like take something that's. really obvious and predictable like. Tylenol so when was the last time you. took Tylenol for a headache or. something it's been a long time all. right so but you know how it works your. kids get a fever you give them Tylenol.

right like it has a really predictable. operating window you're like going to. give this to you you're going to feel. better can't give you too much or I'll. hurt your liver uh if I give you too. little you're not going to feel anything. but like this is the dose at which it. works Advil took an Advil if you pulled. a muscle or something like super super. predictable um MDMA pretty predictable. drug right like for most people.

somewhere between about 75 milligrams. and 125 milligrams is going to produce a. remarkably consistent. effect now you layer that in to the. right setting with the right therapist. with the right intention you start to. get amazing clinical results with people. now when you start to look at. psilocybin. LSD oh it starts to become a lot less. predictable you can give the exact same.

dose to two different people or to the. same person in two different settings. wildly different. result now go one step further and start. talking about. iasa I mean all bets are off right like. it's not even one molecule right does. that in any way diminish that people. have life-changing effects on these. things no but it there's a real buyer. beware on on these things in my mind and. I do think that I don't I again I don't. follow the space nearly as much as I.

used to so this is you know but but like. if I think about kind of where my. interests in this space were seven or. eight years ago um I felt like there was. maybe just a little too much indexing on. these things or the Panacea everybody. needs a shaman everybody needs to be. doing iasa all the time and my view now. is that's that's just insanely irres. responsible and I think for every great. story you hear about someone uh one how. often is the change durable and B what. what is the graveyard look like of. people who have been you know kind of.

ravaged by some of these some of these. things um I think ibaa iag and iboga are. really interesting and and actually if I. could make one wish of the of the FDA. it's that I really wish that they would. um reclassify it um to permit it to be. studied uh for addiction uh because I. don't know how we can live in the world. today where we see more than a 100,000.

people in this country die from fentanyl. overdoses a year and we we aren't. interested in trying to Free People of. that addiction with and by the way some. will say well but iboga is very. dangerous and you can run into cardiac. toxicity and it's like yes all of that. is true but it can be done safely. um and the toxicity that comes with it. has to be weighed against the toxicity. of an ongoing opioid. addiction have you personally done any.

of these therapies yes I have not done. ioga but I've done most of the. others for what. reason um you know usually uh trying to. trying to solve a problem trying to. trying to address a. demon and I've had. some incredible experiences that have. changed my life forever uh have given me. compassion in areas where I never. thought I could have it um can you share.

that um yeah yeah I think um I think one. of the most powerful experiences I ever. had. um was. um uh probably U. 2017 so uh. and and it was I I didn't go into this. experience knowing what was going to. happen but but I had a remarkable vision. of something in my childhood that um was.

quite unremarkable but but it was uh and. I'm sure you've heard this from people. who have used high doses of psilocybin. but you sort of disassociate so you are. no longer experiencing this thing from. your Viewpoint as where you were and I'm. trying to think how old I was I was. probably 13 so so I was no longer 13 I. was me as an adult but I had lifted up. to the top of the room and I was now. watching me as the child with uh with my.

father and I was watching something an. interaction that we had but through a. totally different lens which was through. his eyes and I saw the world through his. eyes and I gained a compassion for him. that has endured to this day in in a in. a way that I I I'm so grateful for um. and and it was you know I mean it was um.

I I woke up I remember waking up and. thinking someone had spilled water on. the floor and realized it was my tears. wow and I couldn't understand how there. was so much water on the floor after. this many hours I mean it was such a. profound experience that said on the. opposite side of that Sean I've had. experiences with some of these agents. that have I described them as Guantanamo. Bay for my soul just horrible. experiences do you continue to do those. therapies no I I honestly think um I.

think I have I have um extracted the. value that can be extracted from them. and I'm grateful for it but I do not. believe that there's any more value to. me uh to be extracted from from those. from those agents with the exception of. MDMA I think I think I still think MDMA. um because of its very gentle forgiving. nature um offers offers a wonderful. opportunity to um to to to to to kind of.

heal oneself a little bit um but but I I. think you'll I'll Never Say Never but. but I I'm not I'm not at all eager to. re-engage with any of the. others what about. you you know I yes I do every once in a. while. um I'm. very have very clear intentions when I. do it and and have done. psilocybin 5.

Meo iboga and that's what I was. confusing sorry it's 5mo that's the. 10-minute ride yes yeah yes but what I. see especially in the veteran Community. is I I see people friends of. mine that they go and they do iig then. they do siloc cyon then they do iasa. then they're doing MDMA then they're. mixing it all together then they're. going and doing peyote and and they. start living in that space and it's like.

it's like man look what are you digging. for here like you you have to actually. take whatever you learned in. that in in in and change the habit and. carry on with your life here in the real. world otherwise it's just yeah there's. there's a book by this title that talks. about the difference between Altered. States and altered. traits and the idea here is every time.

you do one of these drugs it Alters your. state. obviously but unless it's altering a. trait I.E once the effect of the drug is. gone is it going to change the person I. am does it make me a better person if it. doesn't that's a litmus test that you. shouldn't be doing it. and so that is the standard I hold. myself to on these things I have no. interest in just having my state altered. if it's not going to address a trait I.

don't care I don't need I I actually. like the state I'm in I don't I don't. need to run from this place um unless. transiently doing so is going to help me. fix something that's a great way to put. it what's the fourth one metabol. metabolic disease so this is everything. from insulin resistance fatty liver. disease type 2 diabetes and this is in. many ways probably the one that's. growing at the fastest rate so uh in the.

year you and I well I guess I'm 10 years. older than you but roughly when you and. I were born um you know we're talking 1%. of the US population had type 2 diabetes. it's 10% today wow um you know obesity. rates have doubled in that period of. time so something's broken right. something is broken and if you have type. two diabetes your risk of all cause. mortality is 40% higher your risk of.

getting any of these other diseases is. up to 50 in some cases 100% higher um. not to mention the personal toll this. takes right that doesn't count the all. the other stuff the blindness the. impotence the uh amputations of digits. like all the other stuff that comes with. this the cost to the health system I we. could rattle off everything about this. right so so what is it that's going on. like you know CU obviously there's an. there's an association between weight.

and metabolic Health but it's not an. ironclad. Association um and we know that weight. by itself excess weight by itself is not. the problem um it really has to go back. to kind of that thing we talked about. before which is some people can store a. lot of excess energy as in the form of. fat without it becoming metabolic Ally. toxic without it kind of going into. those other parts of the body where um. where it leads to these horrible. compensations and.

um I I do think that the majority of. this problem uh stems from nutrition I. think exercise can alleviate much of it. and as people are becoming less and less. active at just kind of Baseline activity. level um they're more susceptible to to. bad nutrition um sleep factors into this. more than most people realize so if. you're sleep deprived you're you're. susceptibility for everything goes way.

up including you're I mean I'm sure you. know I know this from back when I was in. residency so every third night you're. not sleeping those that next day my. eating pattern was worse I was more I. had more Cravings I would eat more crap. um and your cortisol levels are through. the roof I mean there's just a whole. bunch of bad things that happen when. you're not sleeping. so. um something about our food system isn't. working um I don't think it's I I think. it's actually more the obvious stuff.

honestly I don't think it's I don't I. don't believe it's red dye and the foods. and I think that all that stuff is like. those are rounding errors right I think. the real issue is um we we culturally. eat too much in this country our we we. do have a lot of processed food and we. eat a ton of it and. any American who has spent time abroad. will recognize immediately the. difference in food yes the food quality. is better elsewhere but there's a. totally different culture about how much.

you eat when you eat um the size of. portions everything is you know. everything is geared and kind of rigged. against us here um and I think that's. probably the single biggest Factor. that's driving it um coupled with like. again just give you a little example. right like you don't see places like. Costco in Europe the way you would see. it here right cuz over there you're. going to go grocery shopping twice a. week and you're going to just you know. their fridges are smaller over there.

right they're not super sizing. everything. um so as much as people want to point to. seed oils and red dyes and you're eating. too many animal products you're eating. not enough animal products or what like. I that the data just don't support that. the data suggest it really comes down to. we just eat a lot. more um Nutri you know uh calorie dense. foods in way higher quantities than. other people do now of course they're.

catching up to us so In fairness the. rest of the world is doing their best to. catch up to the United States because we. certainly export the best of our food. ideas so you don't you know there's a. lot of talk about seed oils these days. oh I'm actually in the process of trying. to engage um and and I have engaged two. people on this debate so I won't name. them but but you can probably figure out. who they are um but two people on either. extreme of this debate and I'm actually. trying to bring them on my podcast for a. moderated debate um now I think podcast.

debates usually suck um and the reason. is people can make up whatever they want. and you can't fact check them in real. time so I I've never actually watched a. debate on a podcast that I didn't think. was an absolute garbage waste of time so. in going to these two guys I said look I. don't have any interest in adding to to. the uh uh to to the volume of crap out. there so if we do this we're going to do. it by my rules and my rules are as. follows the question of what is being.

debated will be very very clearly. articulated a priority all the research. that each of you will use to address the. question will be pre-submitted such that. everybody can review it so this is this. is how a court works okay um so um you. will submit all your data to you you. will submit all of your data to you and. both of you will submit it to me and my. research. team when a person is speaking in the. debate if they are citing a study they.

may only site from what was presubmit. there is none of the pulling out of. one's ass that is rampant in the podcast. space when it comes to. debates and everything you say will be. fact. checked so beware if you're making. something up we will fact check you and. we will insert fact check and correction. every time you misspeak wow when's that. coming out we haven't I mean we're still.

trying to get everybody to agree to this. and it might not happen you know I mean. I've tried to do this for vacine safety. I've tried to do it for seed oils uh I. would like to do it for sugar uh there. are lots of topics we want to do it for. um but you know when push comes to shove. it's hard to get people to commit to. that kind of rigor can I ask you who. who's apprehensive is it the anti-ed oil. guy or the I I won't say for sake of who. these folks are um but but I will say.

that even getting to agree on the. question has been difficult wow right. wow that's. interesting it's really easy to just. kind of blame your favorite Boogeyman. yeah um but but when push comes to shove. like what is the data what is the. data let's move into exercise so it. sounds like exercise helps pretty much. all of these four pillars uh that are.

these four disease types what kind of. exercise are you doing what what should. people be doing I mean do they need to. dedicate three hours a day to this does. it have to be super strenuous I mean. what what do you. recommend um I think the it's it's it's. easier to talk about it through the lens. of what is the output need to be right I. think too much of exercises talked about. the input you need to do this many hours. of this you need to do this many hours. of this and that's a obviously a very. helpful way to talk about it because. it's easier and it's actionable but but.

it's better to at least start with. what's the objective and the objective. is if you at least just look at the the. the top level of the data you you want. to have muscle mass that puts you at. about the 75th percentile of the. population or better the two easiest. ways to measure that is something called. appendicular lean mass index and. fat-free mass index these can both be. derived from a dexa scan that's a body. scan that very quickly measures how much. fat muscle and bone density you have and.

so that's one of our first optimizations. we really would love to get everybody to. be at or above the 75th percentile of. muscle mass now that's not going to be. possible for everybody there are some. people whose build is so slight I mean. we have patients that come in our. practice who are literally at the third. percentile for muscle mass I don't. expect those people to ever get to the. 75th percentile but I bet I can get them. to the 40th or 50th percentile over a. few years um second thing is you want to. hit certain metrics of.

strength and um you know so you you. should be able to carry some fraction. depending on how old you are your body. weight or some fraction of it for a. certain period of time right you should. be able to do a wall sit for a certain. period of time and again you can. discount this over time as a person ages. the stand goes down right so when you. were coming out of buds my guess is like. you could you were Superman right uh. wouldn't hold you to that standard today. but but there's a standard for a.

40-year-old a 50-year-old a 60y old a. male a female Etc and so if you rattle. off what all these standards are I would. say that becomes a very important thing. that we want to be able to hold. ourselves to and we'll come back to how. you get there um there's a a measurement. that is um the a very accurate way to. determine what a person's maximal. aerobic capacity is it's called V2 Max. um it's typically measured either on a. stationary bike or on a treadmill when. someone's hooked up to a mask that. measures oxygen.

concentration um and and a volume of of. uh air consumed and and you can. calculate how much oxygen was consumed. when you know that um you can tell a. person where they are relative to people. their age and their sex and we have a. very high standard for what we white. think you want to be you know we might. say look I want you to be at the 97th or. 98th percentile for your age and sex. with respect to E2 Max and then there. are other markers of uh Baseline aerobic.

fitness what's called zone two and we. would say we we have a standard for what. we would want you to be able to do how. many watts we would expect you to be. able to put out relative to your body. weight for an hour under these. conditions and so we can rattle off a. whole lot of these goals and then then. we can come back to your question of how. should one do that and it I don't tend. to prescribe like you got to do this. many hours of exercise what I then do is.

I say how many hours a week can you. exercise Sean you tell me what you're. willing to do not for one week when. you're being a hero like tell me what is. sustainable for you for the next year. and then if you came back and. said look man my kids are one and three. I got this podcast I'm doing 20. interviews a week I got this business. thing I got this business thing I can't. do more than six hours a week of. training right now I'd say okay we're. going to work with six hours per week. and we're GNA we might not get you to.

those goals within a year um but we're. going to put you on the right path and. this is how we're going to balance the. portfolio if you came back and said I. can only do three hours per week I'm. going to be like oh God okay we're. probably not going to make that much. progress but unless you're starting from. zero if you're starting from zero 3. weeks so three hours a week is pretty. awesome um but if you're a reasonably. you know quasi fit person who's at about. the 50th percentile we're not going to. make huge progress in three hours a week. but we're not going to take any steps. backwards and that's important um and if. you come in and say I'm going for broke.

man you got me for 12 hours a week then. it's a different then it's a totally. different training program how often do. you exercise um I mean almost every day. I didn't exercise today because I had to. you know fly in and then I'm G to fly. back tonight but I did today's workout. yesterday so I I mean my my my schedule. is set up to exercise pretty much every. day but at least twice a month there's. kind of a forced day off due to travel. okay so how how many hours a week um. right now let me.

think maybe eight hours a week eight. hours a week yeah what kind of. exercising um it these days you know. it's mostly just cycling and uh. resistance training um I'm going to. resume swimming again in a couple months. so I think I'll probably increase to. about 12 hours per week total training. Time by spring summer and I think just. brings swimming back in permanently to. my life I haven't swam in a long time um.

and I kind of miss it and I also think. it's um you know kind of going back to. something you said earlier like how do I. spend my time um swimming will be a form. of exercise where I'm killing two birds. with one stone well I'll get the. exercise but it's also a bit of a mental. health check whereas when I'm on my bike. I'm usually like I'm indoors I'm. listening to a podcast or an audio book. I'm not really turning it off I'm trying. to learn um when I'm strength training. I've got music on so I'm kind of focused.

on what I'm doing there but swimming is. as you know you probably spent a ton of. time in the water uh you only hear the. water you hear yourself breathing and. you hear the sound of the water so. that's why I'm kind of excited to get. back into swimming and that'll probably. take me up to 12 hours a week let's talk. about emotional health this is something. you talk about about kind of broached. psychedelics what what other kind of. things should people be doing for. emotional health no I mean I think just. asking themselves questions you know. like trying to trying to understand the.

root of of of what's going on like what. you know uh how can I name my emotions. right um why do I feel way why do I feel. the way I feel who am I uh who do I feel. connected to who do I not feel connected. to um so I think just being kind of. curious is a is a very important step I. think this is an area that comes a lot. easier to women than to men I think men. uh particular young men. um just don't necessarily possess the.

vocabulary sometimes to even think. through some of this stuff um and I. think you can you you just you get into. trouble for it right you you you end. up um go going down a road where you can. you know you you you can um poison. relationships because you didn't know. better right because you didn't you. didn't you didn't know how to act you. you maybe you didn't have a role model. in that way.

um and and I think there's different. there's different ways to do it I mean. you can you know I think in my in my. case the issue was you know workaholism. perfectionism anger being great tools. that were highly valuable when I was. young um that that start to become. maladaptive when you get older and then. you have kids and then you. realize um you know uh what served me. well when when I was a 16year old is not. going to serve me well when I'm a 46y.

old it's. sleep how do we improve our sleep do you. recommend everybody do a sleep study no. I don't think so um look a lot of people. if you spend two minutes with them. asking them questions you can figure out. they don't have an issue with their. sleep their sleep is great there are. there are a couple of really great. surveys you can take online there's one. called the PS QR uh which is probably. the most important one anyone should. take so if you just Google PS QR and go. and take the survey um it asks you a. bunch of questions and it'll pretty.

quickly tell you if you have a sleep. issue um and if you do then you know you. kind of want to get into the what's. going on um and just start doing some. accounting like what time do I go to bed. am I consistent in my bedtime am I. consistent in my wakeup time how many. hours am I getting in bed cuz if you're. not even spending 7 and a half to 8. hours in bed yeah you're probably going. to be short changed in sleep cuz it's. hard to sleep more than 90% of the time. you're in bed so you know I try to be in. bed for 8 to 8 and 1 half hours to get. seven and 1 half to eight hours of sleep.

um and of course nowadays you know. tracking devices are ubiquitous so you. can. measure with reasonable accuracy like. how you're sleeping what staging you're. getting and things like that and then. there's just a whole bunch of really. really um straightforward sleep uh. hygiene things that everybody I think. should be doing um and they everybody. knows what they are I could rattle them. off but I don't think anybody would be. surprised by him it's just a behavioral.

challenge right like I don't think. there's anybody who's going to listen to. us who's going to think wait I shouldn't. be looking at my phone before bed right. so everybody knows that but sometimes. it's just hard to to make the discipline. of not looking at your phone for let's. say an hour or two two hours before bed. um um having a bedtime routine um. keeping the room really dark really cold. uh not having you know Electronics in. the room um not eating before bed for.

maybe 3 hours not having alcohol before. bed all these things make such a big. difference and then when you stack them. all together it's like you're going to. you're going to sleep well and then of. course there's always a subset of people. where after doing all of that stuff. sleep is still problematic and then a. sleep test can be really help you know. you you do learn that hey a person might. have sleep apnea and even if they lose. weight it doesn't fix or maybe they're. normal weight because there are still. people who get sleep apnea that are of.

totally normal weight even though it's a. a condition that. disproportionately uh afflicts people. who are overweight and then yeah you. might you know you give that person a. CPAP machine and it changes their. life man that's a lot of it's a lot of. great information thank you uh is there. anything that we didn't cover that you'd. like to. cover no I don't think so then with this. just want to know what is you know what. is your daily routine not when you're on.

travel and going to podcast what is what. is your picture perfect daily routine. that you that you don't like to. interrupt um you know I like to get up. early make coffee um in an ideal world. have 15 minutes with my wife um where. we're s sitting in the dark having. coffee catching up um kids are up then. uh getting the kids ready for school so. making breakfast uh in a really good day.

uh get a chess game in with with one of. the boys before school um get the kids. off to school by now it's about. 7:15 um I will typically head right into. my office at that point and do my first. scan of email and then you know just. address anything that needs to be. addressed and then actually at that. moment in time as when I can turn my. attention to whatever my most important. task of the day is uh from a creative. perspective so that's when I can do my. best writing editing thinking um I've.

done my prep for the day before the. night before or for that day of so I. know which patience I'm talking to I've. already gone through all that stuff um. and then I'll uh typically go and. exercise so what time um it depends uh. but probably now it's like 8:30 so I'll. um I'll work out and I don't so I don't. schedule anything until 10: or 11 in the. morning so I just have a hard rule um. unless I have a call in Europe then I'll. typically do that at 7:15 the second the.

boys uh and my daughter leave um so but. assuming I don't have a European call. it's going to be 10 or 11 is first. scheduled um meeting and so if it's 10 I. need to be in the gym by uh uh 8 if it's. 11: I'll go 8:30 and then I like to try. to get a quick sauna in for 20 minutes. and then get ready for work and then so. work from 11: to 5. 5:30 um and then you know help with.

dinner um goof off a little bit after. dinner again play some chess just you. know kind of hang out with the kids. again depends on the season right so in. the summer you get a little more leeway. we go outside we'll play baseball or you. know do something um in the winter you. know or during school you know it's. maybe more directed towards kind of the. the the the night routine um once the. kids are down I'll typically work again. um for. another one to two hours and then kind.

of like to spend the last hour before. bed off work just you know vegging. hanging out with my wife you know watch. Netflix maybe do a sauna if we if I. didn't do one earlier in the day right. on boring life man hey that sounds that. sounds pretty good to me but uh Peter I. just want to say thank you for your time. thank you for coming I learned a ton. from you and uh I hope to see you again. well thanks for having best of.

[Music]. luck no matter where you're watching. Shan Ryan Show from if you get anything. out of this please like comment. subscribe and most importantly ly share. this everywhere you possibly can and if. you're feeling extra generous please. leave us a review on Apple and Spotify. podcasts.