183. Tech Tools, Living Pro-Analog, Ketones, and Finding Preventive Healthcare

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Welcome to Medicine Redefined, a
podcast focusing on helping you

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reclaim ownership of your
health.

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I'm Doctor Darsha.
And I'm Doctor Ultima Shraja,

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we're your hosts here to
challenge conventional practices

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and uncover the stories behind
pioneers shaping the future of

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medicine.
Our conversations not only focus

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on the individual level to
dissect common practices for

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health optimization, but also
zoom out to.

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Enhance systemic change Join us
as we look to break the status

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quo, move the needle forward and
put the help back in healthcare.

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Doctor Darsh, welcome back to
Medicine Really Fine.

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What's up?
What is up?

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We're talking in our chat with
the shit that's been going on,

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the political landscape.
So that's a little scary.

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I know that's why I wasn't
really on the agenda.

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But yeah.
So I guess the listeners were

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recording this as we found out
about Charlie Kirk and getting

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shot at, I want to say Utah, the
University of Utah.

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Yeah, Which is surprising given
everything.

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I feel like these events, these
political unrests happen.

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It's still surprising in the
sense that he did die and passed

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away and I guess he got shot in
the neck and just heartbreaking

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overall. 31 years old, wife, two
kids for people.

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I mean, I hate him or love him.
He was somebody that kept the

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open discussion, willing to
debate people and just kind of

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talk about politics and make the
USA better place, I think.

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What's sad is somebody sent me a
video of I think it's on X some

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looks like a young person who it
sounds like he was asking a

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question about mass shootings in
the Second Amendment.

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And there's a clip where he
talks about there is a cost and

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the cost is worth it.
And the caption of the clip is

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you still think it's worth it
once, Charlie.

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And it reminds me of Brian
Thompson.

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The empathy is it's rare and
rare every single day, huh?

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Yeah, for sure, especially with,
like you said, a younger person.

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Again, this is not to exclude
Gen.

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Z or anything.
His opponents, quote UN quote.

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On the Democratic side would be
Dean Withers, 21 years old.

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There's a big following in the
younger group, obviously from

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the woke side, the Democrat
side, these different tribes.

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So it doesn't surprise me that
it's a younger person.

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But it's tough, right?
Because there's not enough lived

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experience yet to try to
understand all the different

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sides to someone's story and why
they might be sharing whatever

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they're sharing, what they're
pulling for, and what they're

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becoming an activist for.
Let's turn from that song,

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right?
There's a bit of a hodgepodge

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random show.
Talk about what's top of mind

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for us, top of mind for you.
I'll give you the floor to start

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off because that's kind of your
idea and I like it.

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So 100% random show, random show
it is so people have for people

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to understand.
Tim Ferriss is probably my

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favorite podcaster and he does
this with his good friend Kevin

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Rose.
They call it the random show and

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probably once a month.
And they just go over things,

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current events, things that
they're finding, things that

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have brought value to them and
they try to share that with the

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audience and just shoot the
shit, so to speak.

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So I guess one of the things,
and I'm going to try to make us

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all full circle.
Let's see what has been recent

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for me.
So I got back into writing.

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I used to have a blog in college
and then I found myself not

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writing after graduated, you
know, with medical school

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residency, it was hard to do
that writing poetry, writing

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creatively.
And now I found myself on sub

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stacks.
So the way this happened was

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there's an app called Matter.
And the way I got hooked up to

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that was I've always got in
newsletters.

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So Tim Ferriss's deals letter,
James Clear's newsletter as

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well.
They shared Tim Ferriss shared a

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quote from David Foster Wallace
from another article called The

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Memes and Meaning by Paki
McCormick.

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So he's like a tech Blogger, but
red means and meaning and took

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us like a 20 minute read.
Absolutely fascinating.

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I especially think for us and
like where we are in life and

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trying to find purpose.
It's all about so cool.

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Now what?
Right?

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If you hit, you get gold, you
hit your successful goals.

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Now what?
So he really just delves into

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that.
And that got me thinking even

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more.
And then I found his article on

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this app called Matter, which
basically shares a bunch of

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different perspective articles.
So that inspired me now to get

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back into writing because I
realized, man, when I was like

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23 writing, it's just different.
Like I talked about the frontal

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lobe wasn't developed, didn't
have enough lived experience.

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But now with being attending.
So when you get that gold medal

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syndrome and you reach the top
to reach the pinnacle, often ask

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ourselves, what what do we do
now, right?

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We actually enjoy the journey.
So that had influenced me to

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start writing because now that
I'm at the right age of 33,

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rather than writing ten years
ago.

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But now, you know, with medicine
practicing.

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And it's been such a blessing
for me to kind of get back to

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writing because it's allowed my
thinking to be more clear.

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And now I understand why people
say when you want to understand

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what you actually know, if you
want to brand yourself, if you

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want to have an opinion or a
thought, write it out and make

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it your thesis in a way.
So now when I'm writing, it's

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really about what's my thesis,
and it's not even for education

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really, it's for my own self.
Why sub stack?

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I think it's the easiest
platform now.

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Everyone's kind of on there.
It has a good algorithm, so you

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can go in and talk, hit whatever
topics you're interested,

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business, tech, space, medicine,
and then it'll link you to those

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people.
So it's almost like X or Twitter

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now, really just for articles
and newsletters.

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So that's like the new format
that a lot of people are using.

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Yeah, good piece and I think we
shared it on social, so

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hopefully people will check it
out, particularly if you are a

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undergrad considering a career
in healthcare and especially in

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medicine.
I think my favorite was, I don't

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remember which one, it might
have been 10 or 11, where you

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talk about the question that's
asked of just go to medical

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school.
What do you see as your

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specialty being right?
I asked this question as well.

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I'm guilty of doing this
yesterday actually.

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And instead I think you propose
ask what kind of life you want

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to live, right?
It's interesting because it

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applies to so many things that
applies to, you know, when my

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the residents I work with, they
ask me about different

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fellowship and that's the
question I asked, you know, ask

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yourself what life you want to
live in 15 years.

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What is that like?
What is your practice like?

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And then you know, their back
cast or reverse engineer from

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that.
And I know you've talked about

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that.
I think that is an exponentially

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better question.
Where do you see yourself in

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five years?
Where do you see yourself in 10

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years?
It's getting at that question.

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But I think if you reframe it in
this sense, then you can think

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about, OK, what are my next
steps especially, and you have

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to do that Part 2 if you want to
make it more actionable in the

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immediate future.
I love that one man.

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No, I totally agree, right?
Because when if you ask yourself

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too far in the future, then
you're just looking for that one

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opportunity that can launch you,
right?

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But when you go look at yourself
just in the near future week or

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two weeks, so many opportunities
are coming to us now, right?

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With social media and
collaboration, whatever might be

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that, if you have the vision in
your mind for what type of life

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you want to live, you can then
filter out and choose the better

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option that's right in front of
you that's going to get you

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closer to that life that you
want to live.

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Yeah, Matter's a cool app.
Thank you for sharing that.

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I'm using the free version.
I read newsletters.

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My primary wants, it's going to
be Modern Wisdom, James Clear,

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Tim Ferriss.
I like the layout.

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The UI of it I think is quite
cool.

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Speaking of apps, Alfred, you
familiar with?

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No.
You said Alfred, what the hell

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is that?
So I got this from Chris

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Williamson.
Alfred is an app.

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I think it's exclusively for Mac
for those who don't know.

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Have been PC in my entire life.
Fight the fight.

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Steve Jobs has won, and I gotta
say, I'm not fully transitioned

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over, but there's no turning
back for me.

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I do love it.
The seamless transition is just

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absolute game changer.
But Alfred is this super cool

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thing, man.
And it's actually very

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reasonably priced too, like if
you get the lifestyle

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prescription.
But I have to say, I haven't

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quite figured out the
capabilities of it.

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But you know how you have the
Finder on Mac when you're

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searching for something?
Well, Alpha could do that for

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you in a much more efficient
manner.

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So it's a place where you can
find different files, find

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thoughts in different files,
find just little phrases in

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different files.
If you want to copy something,

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you know, something that used to
be really annoying is if you

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copy, you can only retain the
very last thing that you had

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copied.
With this, it allows you to copy

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20 things and you can just go
through this little snippets

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thing.
It's been really freaking

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awesome.
And I think it ended up costing,

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I don't know, maybe 80 bucks or
something like that for a

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lifetime prescription.
So big fan not getting paid by

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them, but you gotta check it
out.

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You have Alfred, probably.
It's a British product, so maybe

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there's lots of offers out
there.

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Yeah, Alfred.
I was a big fan of Michael

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Caine's version.
That's not Michael Keaton.

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Keaton.
Can't get it right.

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You know me.
Alfred, y'all have to check that

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out.
So we talked about tech, we

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talked about what you're at, any
other products, any other things

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that you think have improved
workflow?

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Yeah, for all the physicians out
there.

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So we use Dragon a lot of the
times, but if you're like I use

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point click care for my skilled
nursing facilities.

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So the best speech to text app I
found is called Whisper WISPR.

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So it's Whisper dot AI.
This is in a game changer for me

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too.
Like when I don't have to use

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Dragon and then copy and paste
it over at this, you basically

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do speech to text and it can
work in any text box that you

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have open.
So that is what I like spread

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the gospel to, to a lot of the
newer physicians out there who

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are struggling with
documentation or they don't have

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a scribe themselves and they
don't have access to Dragon or

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any other device.
Whispers definitely what I've

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been using.
Now do you dictate on your phone

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and then transfer it over?
Or it's on the laptop itself and

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it's super clear.
It's almost nuanced that like

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Dragon is.
So it picks up full sentences,

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the periods, everything.
Is it built for medical lingo

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like specific terminology?
I heard it from my first million

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podcast, right?
So these, if you're using

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ChatGPT instead of actually
speaking to ChatGPT or having to

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type, you just say your prompt
rather than doing anything else.

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And so it's just been saving a
lot of time for people that are

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really heavy AI users.
Yeah, I think you know this.

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I'm a big speech to text and I'm
talking just a regular SMSI

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message.
I will hit that speech to text

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back and forth and maybe
sometimes it'll come across as

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during my dictation, you know,
words that it doesn't pick up.

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That's actually one of the
reasons Chachi PT.

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Chachi PT, to my knowledge, is
the only current LLM out there

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that allows you to do that both
on the computer and the app.

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Claude, you can only do in the
app.

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I think perplexity might only be
in the app if I'm not mistaken,

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but Apple, what'd you say?
I'm sure when you're using your

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iPhone trying to do it, it
doesn't capture, it's not great

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like 70%.
Yeah, it's not great.

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It is getting better.
It does learn some like specific

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names, you know, it'll learn my
sister's name or some other

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words that just are not in the
English language over time and

227
00:10:15,480 --> 00:10:17,240
it will learn that.
But yeah, it's not nearly as

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00:10:17,240 --> 00:10:17,800
good.
Big.

229
00:10:17,800 --> 00:10:19,400
So Whisper, I got to check that
out.

230
00:10:19,400 --> 00:10:21,720
What's big fan of that?
Cool, see what other apps are

231
00:10:21,720 --> 00:10:24,040
out there that I'm using.
Whisper I'm not even paying for.

232
00:10:24,040 --> 00:10:26,440
I only use it for my skilled
nursing facilities so it's not

233
00:10:26,440 --> 00:10:29,160
much but I think it's certain
words per month or something

234
00:10:29,520 --> 00:10:31,240
that you can get away with.
OK, cool.

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00:10:31,760 --> 00:10:32,880
Yeah.
Yeah, you.

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00:10:32,880 --> 00:10:33,240
Did.
You ever?

237
00:10:33,640 --> 00:10:36,440
I think you told me about that
episode of Tim Ferriss about the

238
00:10:36,440 --> 00:10:38,120
vagus nerve.
Right, interesting stuff.

239
00:10:38,320 --> 00:10:42,240
Bioelectric medicine coming out.
Yes, interesting stuff.

240
00:10:42,440 --> 00:10:45,680
I came across a post on LinkedIn
by Doctor Chris Centeno.

241
00:10:45,680 --> 00:10:49,720
He's over in Colorado, a big
name in the ortho biologic

242
00:10:49,720 --> 00:10:54,040
space, him talking about hydro
dissecting the vagus nerve with

243
00:10:54,120 --> 00:10:56,560
PRP products for a long time for
different things.

244
00:10:56,560 --> 00:10:59,280
So that got me thinking, wow,
this is actually interesting.

245
00:10:59,520 --> 00:11:03,240
What does that mean?
Hydro dissection is a type of

246
00:11:03,240 --> 00:11:06,280
procedure and really what that
means, the term dissection is

247
00:11:06,280 --> 00:11:08,920
you're separating from the
surrounding structures and you

248
00:11:08,920 --> 00:11:11,920
can do a mechanical dissection
like most people would think

249
00:11:11,920 --> 00:11:14,400
about.
If you are a medical student and

250
00:11:14,400 --> 00:11:17,480
you've had an anatomy lab where
you're actually have a cadaver

251
00:11:17,480 --> 00:11:21,760
or donor recall, you're using
tools to dissect fascia away

252
00:11:21,760 --> 00:11:23,800
from nerves and muscles.
Surgeons do that during

253
00:11:23,800 --> 00:11:27,200
surgical, etcetera.
Hydro just suggests you're using

254
00:11:27,200 --> 00:11:30,320
some type of fluid to do that.
So it is a dissection.

255
00:11:30,360 --> 00:11:33,160
Often times we'll do this for
nerve related procedures and it

256
00:11:33,760 --> 00:11:37,000
works quite well.
And so he was just talking about

257
00:11:37,040 --> 00:11:39,320
using platelet products to do
that.

258
00:11:39,320 --> 00:11:42,400
But it got me thinking are is
there a role for other things

259
00:11:42,480 --> 00:11:45,400
out there?
Turns out there is a little bit.

260
00:11:45,480 --> 00:11:50,040
I'm excited to explore this as
an opportunity as well.

261
00:11:50,440 --> 00:11:52,280
But maybe let me take a step
back and tell people about the

262
00:11:52,280 --> 00:11:53,920
vagus nerve, unless you have a
question.

263
00:11:53,920 --> 00:11:56,360
There I was going to ask why
platelet products to do the

264
00:11:56,920 --> 00:11:59,000
hydrogen section?
Why not just normal saline or

265
00:11:59,000 --> 00:12:00,520
whatever else it's typically
used?

266
00:12:01,040 --> 00:12:03,160
Let me kind of set the stage for
those who don't know, you know

267
00:12:03,160 --> 00:12:05,400
this cause the vagus nerve.
So for those who don't know,

268
00:12:05,640 --> 00:12:07,360
it's a cranial nerve.
It's the 10th cranial nerve and

269
00:12:07,360 --> 00:12:09,680
I think it's the longest nerve
in the body.

270
00:12:09,680 --> 00:12:12,960
Apparently it has thousands of
branches off of just the vagus

271
00:12:12,960 --> 00:12:15,360
nerve and there's some key
branches that we learn about,

272
00:12:15,360 --> 00:12:17,160
but I didn't know there were so
many off of them.

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00:12:17,720 --> 00:12:20,680
It's what we call a mixed nerve.
So what that means is there's a

274
00:12:20,680 --> 00:12:23,040
sensory component to the nerve,
which is the primary function

275
00:12:23,040 --> 00:12:25,160
and but there are motor
components to the nerve as well.

276
00:12:25,760 --> 00:12:30,600
It's the main parasympathetic
outflow, parasympathetic driver

277
00:12:31,040 --> 00:12:34,520
to your heart, your lungs, your
gastrointestinal tract and all

278
00:12:34,520 --> 00:12:37,240
other visceral organs.
So I think people have heard

279
00:12:37,240 --> 00:12:38,880
about the autonomic nervous
system, right?

280
00:12:38,880 --> 00:12:42,200
You've got the sympathetic
parasympathetic, In fact, most

281
00:12:42,200 --> 00:12:45,160
of the breathing protocols that
we talk about, and maybe you can

282
00:12:45,200 --> 00:12:48,080
comment on this, some of the
like what you're trying to do is

283
00:12:48,080 --> 00:12:50,280
you're trying to modulate that
vagus nerve in some sense,

284
00:12:50,280 --> 00:12:51,240
right?
You're trying to use your

285
00:12:51,240 --> 00:12:55,480
respiratory diaphragm because
breathing being one of the only

286
00:12:55,480 --> 00:12:59,320
autonomic things that we have
control over to get this reflex

287
00:12:59,800 --> 00:13:02,880
stretch going up to the vagus
nerve and get a response.

288
00:13:03,480 --> 00:13:05,760
So I think you know what people
started thinking, and this is

289
00:13:05,760 --> 00:13:08,080
probably where vagus nerve
stimulators came into the

290
00:13:08,080 --> 00:13:11,320
picture.
Vagus nerve stimulators came in

291
00:13:11,320 --> 00:13:14,080
because what we recognized is
there are a lot of conditions

292
00:13:14,080 --> 00:13:17,640
out there that might have
dysfunction of the autonomic

293
00:13:17,640 --> 00:13:20,560
nervous system that could be an
imbalance in the body's

294
00:13:20,560 --> 00:13:23,360
sympathetic fight or flight
system and the parasympathetic.

295
00:13:23,360 --> 00:13:28,160
You could have just these vague
varied symptoms like dizziness,

296
00:13:28,160 --> 00:13:30,640
blood pressure fluctuations,
digestive problems.

297
00:13:30,640 --> 00:13:32,960
As I mentioned, you have a
variety of organs that it

298
00:13:32,960 --> 00:13:36,120
effects.
Other things that can be

299
00:13:36,120 --> 00:13:39,800
influenced by that are your
response to pain, anxiety, it's

300
00:13:39,840 --> 00:13:41,840
implicated in mood disorders,
depression.

301
00:13:42,680 --> 00:13:46,560
And So what we realize is, OK,
let's modulate this nerve and

302
00:13:46,560 --> 00:13:49,240
see if we can have an effect on
some of these clinical

303
00:13:49,240 --> 00:13:51,760
indications.
And you know, people have been

304
00:13:51,760 --> 00:13:53,920
using it for, again,
dysautonomia, chronic pain

305
00:13:53,920 --> 00:13:58,360
syndromes, PTSD, insomnia.
And the FDA approved this device

306
00:13:58,360 --> 00:13:59,680
called the vagus nerve
stimulator.

307
00:13:59,840 --> 00:14:04,000
I think it's been over 20 years
now where the surgeons will go

308
00:14:04,040 --> 00:14:08,760
and implant a tiny little chip
near this nerve into your neck

309
00:14:09,240 --> 00:14:11,640
in the carotid sheath.
Rather it actually runs with

310
00:14:11,640 --> 00:14:15,120
your carotid, which is the big
pulsing artery in your neck and

311
00:14:15,200 --> 00:14:17,960
you implant that.
And this has, this is FDA

312
00:14:17,960 --> 00:14:21,080
approved for a drug resistant
epilepsy treatment, resistant

313
00:14:21,080 --> 00:14:24,320
depression and even some type of
these cluster headaches and

314
00:14:24,360 --> 00:14:26,120
different difficult to treat
headache conditions.

315
00:14:26,920 --> 00:14:29,960
And the idea is you are
decreasing that sympathetic

316
00:14:29,960 --> 00:14:32,440
arousal and increasing
parasympathetic tone.

317
00:14:32,800 --> 00:14:36,200
Again, as we talked about
breathing helps us do that as

318
00:14:36,200 --> 00:14:37,560
well.
It's an easier way to do that.

319
00:14:38,200 --> 00:14:40,240
But as you know, if you've taken
some deep breaths when you're

320
00:14:40,240 --> 00:14:42,560
stressed, you feel more in
control.

321
00:14:42,720 --> 00:14:46,920
You are emotionally regulated.
So to your question, why use

322
00:14:46,920 --> 00:14:50,320
PRP?
How else can we help, you know,

323
00:14:50,400 --> 00:14:53,360
affect it in the sense?
So some people out there will

324
00:14:53,360 --> 00:14:56,760
argue that, OK, maybe it's what
we call a mechanical issue as

325
00:14:56,760 --> 00:14:59,520
well.
So modulation is, you know,

326
00:14:59,640 --> 00:15:01,680
gonna be more of an electrical
signal, right?

327
00:15:01,760 --> 00:15:04,080
But maybe there's a mechanical
compression to the nerve.

328
00:15:04,600 --> 00:15:07,840
Think of the classic nerve
compression would be carpal

329
00:15:07,840 --> 00:15:11,120
tunnel syndrome.
It's the most common upper

330
00:15:11,120 --> 00:15:13,600
extremity, what we call
neuropathy, nerve related entry.

331
00:15:13,920 --> 00:15:16,840
And that's because you have that
nerve being pressed underneath

332
00:15:16,840 --> 00:15:19,000
this ligament.
If we know that nerves don't

333
00:15:19,000 --> 00:15:22,200
like compression, they like
space, why can't that happen in

334
00:15:22,200 --> 00:15:24,000
the vagus nerve?
Because of nerves being

335
00:15:24,000 --> 00:15:27,280
compressed, it's not getting
good mobility.

336
00:15:27,720 --> 00:15:29,600
And if it's not getting good
mobility, it likely isn't

337
00:15:29,600 --> 00:15:32,760
getting good blood flow.
Blood flow tends to be a usually

338
00:15:32,840 --> 00:15:36,680
a good thing in in the body.
So a hydro dissection procedure

339
00:15:36,680 --> 00:15:38,840
or any type of dissection
procedure using fluid, you can

340
00:15:38,840 --> 00:15:41,880
separate it from the surrounding
tissue, allow that to move a

341
00:15:41,880 --> 00:15:44,840
little bit better.
Why might you use PRP, these

342
00:15:44,840 --> 00:15:48,000
platelet products?
We know we've talked about this

343
00:15:48,000 --> 00:15:50,800
with a doctor Malenga, we've
talked about this Robbie Bowers,

344
00:15:51,200 --> 00:15:52,720
right?
They inherently have this

345
00:15:52,720 --> 00:15:55,840
therapeutic potential, right?
They have healing properties,

346
00:15:56,080 --> 00:15:59,520
whether it's various growth
factors, whether it's different

347
00:15:59,520 --> 00:16:01,440
cytokines and proteins and
healing potential.

348
00:16:01,800 --> 00:16:04,240
So you might be able to help
modulate from a chemical

349
00:16:04,240 --> 00:16:06,720
perspective in that sense.
I think that's one of the

350
00:16:06,720 --> 00:16:10,480
reasons they're doing that.
I was personally interested to

351
00:16:10,480 --> 00:16:13,800
see, OK, one of my main go TOS
to do these hydro dissection

352
00:16:13,800 --> 00:16:17,080
procedures, I don't have a lot
of patients who pay for PRP is

353
00:16:17,080 --> 00:16:20,440
to do good old dextrous 5%,
right?

354
00:16:20,480 --> 00:16:23,160
So that's, that's the sugar
water concentrated with 5%.

355
00:16:23,160 --> 00:16:25,840
Did you ever do these procedures
in residency training?

356
00:16:26,200 --> 00:16:28,720
We didn't have many patients
that came in to do the

357
00:16:28,720 --> 00:16:30,360
outpatient stuff.
Yeah, I think they went to the

358
00:16:30,360 --> 00:16:33,280
pain medicine clinic rather and
they were three anesthesia, not

359
00:16:33,280 --> 00:16:35,720
DMRS.
Yeah, I'm probably the most

360
00:16:35,720 --> 00:16:38,200
popular thing that I do.
And it's just one of those

361
00:16:38,200 --> 00:16:40,120
things, right, that they tend to
find you after you do a lot of

362
00:16:40,120 --> 00:16:41,160
that, you get the right
referrals.

363
00:16:41,840 --> 00:16:44,960
And dextrose is interesting more
so than normal saline.

364
00:16:44,960 --> 00:16:48,160
Normal saline is completely
neutral, but D5 dextrose in 5%

365
00:16:48,160 --> 00:16:52,400
water has shown to of course you
have the mechanical component to

366
00:16:52,400 --> 00:16:55,200
that, but there's a chemical
component because they can help

367
00:16:55,200 --> 00:16:58,280
down regulate some of those PN
receptors as well, the TRYP V1

368
00:16:58,280 --> 00:17:02,360
receptors, which are
particularly important to

369
00:17:02,360 --> 00:17:04,720
modulate in neuropathic pain,
nerve related pain.

370
00:17:05,440 --> 00:17:08,040
So I went down this rabbit hole
this weekend, really not a lot

371
00:17:08,040 --> 00:17:11,280
out there, but anecdotally there
are a lot of people, some

372
00:17:11,280 --> 00:17:12,680
conversations being had a
LinkedIn.

373
00:17:12,680 --> 00:17:14,720
Yeah, that's really interesting
to me.

374
00:17:15,000 --> 00:17:17,680
I'm excited to learn about that,
particularly because we got

375
00:17:17,680 --> 00:17:19,960
vagus nerve stimulators that are
tried and true.

376
00:17:20,160 --> 00:17:23,680
And so I'm just thinking about
who might be the person as as it

377
00:17:23,680 --> 00:17:25,680
stands today from my
conversations with people,

378
00:17:25,960 --> 00:17:29,200
they're using it for people with
CRPS, any type of central

379
00:17:29,200 --> 00:17:33,960
mediated syndrome, fibromyalgia,
long COVID, dysautonomia, right?

380
00:17:33,960 --> 00:17:36,360
So stroke, yeah, I can
completely mess up your chronic

381
00:17:36,360 --> 00:17:40,600
migraines, anxiety, PTSDA, lot
of folks who are military

382
00:17:40,600 --> 00:17:43,400
veterans who have and they're
getting bilateral.

383
00:17:44,000 --> 00:17:46,080
I'll link this case report that
was published last year.

384
00:17:46,120 --> 00:17:48,520
It's the only one that I was
able to find where they did

385
00:17:48,520 --> 00:17:51,240
bilateral vagus nerve hydro
dissection in a 49 year old and

386
00:17:51,600 --> 00:17:54,720
showed significant improvement
both in anxiety, PTSD, all these

387
00:17:54,720 --> 00:17:56,560
symptoms.
Actually, I should mention this.

388
00:17:56,600 --> 00:17:59,200
What's his name?
Oh, my God.

389
00:17:59,320 --> 00:18:03,200
He we talked about Doctor Khan.
I forget his first name, Adil

390
00:18:03,200 --> 00:18:06,280
back on Adil Khan.
Yeah, I had seen him on social

391
00:18:06,280 --> 00:18:08,040
media talk about doing that as
well.

392
00:18:08,240 --> 00:18:09,400
So I might reach out to him
actually.

393
00:18:10,560 --> 00:18:12,480
Nice day.
Yeah, the first time I heard

394
00:18:12,480 --> 00:18:14,240
about Vegas nurse stimulators
toward the end of my

395
00:18:14,240 --> 00:18:17,240
residencies, a lot of these Med
device companies are starting to

396
00:18:17,240 --> 00:18:19,960
do BNS.
And so they would come to our

397
00:18:19,960 --> 00:18:22,880
stroke clinics and talk to the
patients and try to offer that

398
00:18:22,880 --> 00:18:26,400
too, just to restore that upper
limb function by all the

399
00:18:26,400 --> 00:18:29,680
mechanisms that you touched on.
But I think what was very

400
00:18:29,680 --> 00:18:33,200
interesting about that podcast
was what they said is this new

401
00:18:33,200 --> 00:18:36,120
creation in medicine, this new
field called bioelectric

402
00:18:36,120 --> 00:18:39,000
medicine.
And you know, we talked to Rocky

403
00:18:39,000 --> 00:18:41,480
Sullivan and we should probably
get him back at some point and

404
00:18:41,480 --> 00:18:44,440
talk about transcranial magnetic
stimulation, right?

405
00:18:44,440 --> 00:18:48,400
And so learning about the
electrical properties of the

406
00:18:48,400 --> 00:18:51,040
human body, I think it's going
to be kind of that next unlock

407
00:18:51,040 --> 00:18:54,520
when you have AI, you have
biotech, and then we start to

408
00:18:54,520 --> 00:18:56,800
understand some of the quantum
stuff, maybe that's going on.

409
00:18:56,880 --> 00:18:58,480
We talked about acupuncture,
right?

410
00:18:58,520 --> 00:19:02,200
So there's a lot of stuff that
goes on that is electrically

411
00:19:03,200 --> 00:19:06,040
charged.
Yeah, we got this podcast coming

412
00:19:06,040 --> 00:19:07,720
out with, you know,
documentation not too far.

413
00:19:07,760 --> 00:19:10,760
It's an exciting time, I think,
particularly with AI getting

414
00:19:10,760 --> 00:19:13,360
better and better, how it's
going to help us acquire that

415
00:19:13,360 --> 00:19:16,520
knowledge and make sense of
things that I think we couldn't

416
00:19:16,520 --> 00:19:21,680
have made sense of just because
you have something that has all

417
00:19:21,680 --> 00:19:24,560
the world's knowledge available
to it at all times.

418
00:19:25,040 --> 00:19:27,560
And right now, I think, you
know, we talked about dismissing

419
00:19:27,560 --> 00:19:29,800
the nuance.
It's missing the wisdom to

420
00:19:29,800 --> 00:19:33,200
interpret what's good from bad.
I see that on a daily basis

421
00:19:33,200 --> 00:19:36,920
despite these clot or whatever
the highest reasoning model, I'm

422
00:19:36,920 --> 00:19:39,080
like, yeah, that doesn't quite
make sense You you wouldn't do

423
00:19:39,080 --> 00:19:41,000
this in a clinical and that's
just experience.

424
00:19:41,520 --> 00:19:44,440
The more feedback we give it as
clinicians, the better these

425
00:19:44,440 --> 00:19:45,920
things are going to get.
Anything else?

426
00:19:46,480 --> 00:19:48,080
No, that was just exciting
stuff.

427
00:19:48,080 --> 00:19:51,280
Speaking of, I want to ask you
because I know a long time, but

428
00:19:51,280 --> 00:19:53,960
we had to talk about breath work
is a big thing on your part.

429
00:19:54,440 --> 00:19:58,160
Alternate nostril breathing.
Talk to me a little bit about

430
00:19:58,360 --> 00:20:01,560
your current breath work pattern
strategy.

431
00:20:01,880 --> 00:20:04,120
Protocol if you have anything.
When I was in Harrisburg,

432
00:20:04,160 --> 00:20:05,480
residency was a little bit
better.

433
00:20:05,520 --> 00:20:07,280
I am actually trying to get back
onto it.

434
00:20:07,280 --> 00:20:11,600
So Soma Breath is, I think in my
opinion, by far like the best

435
00:20:11,880 --> 00:20:14,920
breath work app and breath work
course that you can take.

436
00:20:14,920 --> 00:20:18,440
Bridge, forget his last name,
but Niraj is pretty much the guy

437
00:20:18,480 --> 00:20:19,960
who runs that.
I really want to bring one to

438
00:20:19,960 --> 00:20:22,360
the podcast at some point too,
just to talk about breath work.

439
00:20:22,680 --> 00:20:27,120
But what they do is breath
training, so learning to exhale

440
00:20:27,120 --> 00:20:29,800
more than you inhale.
So 2 second inhale, 4 second

441
00:20:29,800 --> 00:20:31,880
exhale.
But what they say is it's more

442
00:20:31,880 --> 00:20:34,120
about the cadence.
The cadence is what's important,

443
00:20:34,120 --> 00:20:35,640
not the amount of air that you
take in.

444
00:20:36,160 --> 00:20:37,800
But eventually you get to the
point where in those two

445
00:20:37,800 --> 00:20:40,920
seconds, you're taking in a lot
more air as time goes on because

446
00:20:40,920 --> 00:20:42,800
your body is just used to
expanding.

447
00:20:43,320 --> 00:20:46,520
So similar to Wim Hof, if
anyone's ever done Wim Hof, it's

448
00:20:46,520 --> 00:20:49,200
very similar where it's more
exhalation than inhalation.

449
00:20:49,520 --> 00:20:51,320
So you're really getting a lot
of it out.

450
00:20:51,320 --> 00:20:54,360
You're driving out the CO2 and
so you have a lot of

451
00:20:54,360 --> 00:20:56,000
oxygenation.
You can hold your breath for

452
00:20:56,000 --> 00:20:59,280
longer, and then you really
start to get in a meditative

453
00:20:59,280 --> 00:21:01,520
state with that.
But what's cool about solar

454
00:21:01,520 --> 00:21:05,120
breath is if you use headphones,
they have these binaural beats

455
00:21:05,160 --> 00:21:07,280
that go with it.
And you can do this for 20

456
00:21:07,280 --> 00:21:08,280
minutes.
And it's almost like a

457
00:21:08,280 --> 00:21:12,040
psychedelic experience where you
will feel some sort of energy,

458
00:21:12,600 --> 00:21:14,760
just not your regular state of
walking around, but you will

459
00:21:14,760 --> 00:21:17,680
feel different.
So it's 20 minutes, it's tough

460
00:21:17,760 --> 00:21:20,760
for me to incorporate right now,
but even the app will have 6

461
00:21:20,760 --> 00:21:23,800
minute sessions that you can do.
So I'll do that once in a while.

462
00:21:23,880 --> 00:21:25,480
But really right now what I've
been doing is a lot of the

463
00:21:25,480 --> 00:21:28,160
Buddhists and meditation with
Henry Schuchman's app.

464
00:21:28,680 --> 00:21:30,960
But yeah, alternate, there's so
many different pranayamas you

465
00:21:30,960 --> 00:21:33,480
can do.
Alternating nostril breathing is

466
00:21:33,480 --> 00:21:35,200
one of them.
So a lot of people say if you're

467
00:21:35,200 --> 00:21:37,280
alternating nostril breathing,
like it's still going down the

468
00:21:37,280 --> 00:21:40,000
same throat, right?
But it's actually dated to show

469
00:21:40,000 --> 00:21:42,960
like going, you know, our even
with our circadian rhythm, our

470
00:21:42,960 --> 00:21:46,320
nostrils will change and close
up depending on time of day and

471
00:21:46,320 --> 00:21:49,200
things like that.
So there is data to show that if

472
00:21:49,200 --> 00:21:52,440
you alternate your nostril
breathing purposefully, it can

473
00:21:52,440 --> 00:21:54,880
have more benefits.
But there's so many different

474
00:21:54,880 --> 00:21:56,960
types of breathing.
I think one of the things that

475
00:21:56,960 --> 00:21:59,440
came to mind when you were
talking about hydro dissection

476
00:21:59,440 --> 00:22:02,680
is how most of us are really
tight around the scalenes in the

477
00:22:02,680 --> 00:22:04,520
neck.
And we learned this osteopathic

478
00:22:04,520 --> 00:22:06,160
school, right?
Like the rest, there's different

479
00:22:06,240 --> 00:22:08,720
diaphragmatic points.
It's not even all a diaphragm,

480
00:22:08,720 --> 00:22:11,040
but we have a diaphragm up here
in our neck down near the

481
00:22:11,040 --> 00:22:13,280
pelvis.
I can see his face, but I can't.

482
00:22:13,640 --> 00:22:17,680
Oh man, so he did a lot of.
Is it a fitness guy or a Harvard

483
00:22:17,680 --> 00:22:18,760
physician who does a
performance?

484
00:22:18,760 --> 00:22:21,280
This guy's a fitness guy and now
he's gone like political.

485
00:22:21,480 --> 00:22:24,480
But anyways, people might know
him, he's an OG YouTube, but he

486
00:22:24,480 --> 00:22:26,960
does a lot of bioenergetics.
And So what are the things he

487
00:22:26,960 --> 00:22:29,360
used to do before a big heavy
lift.

488
00:22:29,640 --> 00:22:31,080
And if anyone's watching me,
they can see this.

489
00:22:31,080 --> 00:22:34,000
But he would put his hand like
backwards kidney czar, open up

490
00:22:34,000 --> 00:22:37,880
his chest, look up to the sky,
open up his mouth and he would

491
00:22:38,000 --> 00:22:41,640
try to breathe through his mouth
like and it's really hard to do

492
00:22:41,840 --> 00:22:44,520
'cause there's this restriction
here and you cough and you gag.

493
00:22:44,800 --> 00:22:47,800
But over time if you cards start
to do that, it's like, again,

494
00:22:47,800 --> 00:22:50,600
it's a different type breathing.
And it's interesting because the

495
00:22:50,600 --> 00:22:53,560
more you take these inhalations
and try to breathe to that

496
00:22:53,560 --> 00:22:56,600
diaphragm, you'll start to feel
like a release around that neck

497
00:22:56,600 --> 00:23:00,640
and scaling area.
Yeah, I know box breathing was

498
00:23:00,640 --> 00:23:03,440
something that's most people at
this point recognize just

499
00:23:03,440 --> 00:23:07,200
because it's easy to do.
I've actually found personally,

500
00:23:07,200 --> 00:23:10,240
I'm not a fan that 4 seconds of
just hold and stuff.

501
00:23:10,240 --> 00:23:12,800
I think that my CO2 tolerance is
really low.

502
00:23:13,240 --> 00:23:16,440
The alternate nasal part is
interesting because I think it

503
00:23:16,440 --> 00:23:18,680
really helps with you have to
focus, right?

504
00:23:18,840 --> 00:23:22,560
And if you have a monkey mind,
you lose track of thinking of

505
00:23:22,560 --> 00:23:24,240
anything else except what it is
that you're doing.

506
00:23:24,800 --> 00:23:27,720
Physiological sigh.
Tried and true, very popular.

507
00:23:27,800 --> 00:23:31,320
Huberman comes out of his lab, I
think published in, was it

508
00:23:31,320 --> 00:23:34,520
published in Cell or something
big 2023.

509
00:23:34,600 --> 00:23:37,520
So that's an easy one to do more
for those acute stress immediate

510
00:23:37,520 --> 00:23:39,640
reset stuff.
But it's just going to good old

511
00:23:39,640 --> 00:23:42,200
resonance frequency breathing.
But I was looking into the

512
00:23:42,200 --> 00:23:44,360
different conditions to do that
for you.

513
00:23:44,680 --> 00:23:47,480
What else we got?
I got another deep topic, but

514
00:23:47,480 --> 00:23:50,200
tell me what tone you want to go
exogenous ketones.

515
00:23:50,360 --> 00:23:54,320
Does it it?
Might just be from listen to a

516
00:23:54,320 --> 00:23:57,520
couple of podcasts close
together right between on

517
00:23:57,520 --> 00:24:00,720
Stephen Bartlett and talking to
and Dom D'agostino on Tim

518
00:24:00,720 --> 00:24:03,440
Ferriss talking about ketones.
I think most people have heard

519
00:24:03,440 --> 00:24:05,640
at this point about a ketogenic
diet and the value of a

520
00:24:05,640 --> 00:24:09,520
ketogenic diet.
I'm particularly interested in

521
00:24:09,520 --> 00:24:14,160
ketones as a cognitive enhancer
for my cognitive performance.

522
00:24:14,640 --> 00:24:16,760
I'm not interested in going on a
ketogenic diet.

523
00:24:16,880 --> 00:24:19,800
I just not.
But I am interested in the

524
00:24:21,040 --> 00:24:23,560
ergogenic aid that I might be
able to use it for or the

525
00:24:23,560 --> 00:24:25,920
therapeutic potential of
exogenous ketone.

526
00:24:25,920 --> 00:24:28,280
So it's just going down into how
you could do that.

527
00:24:28,280 --> 00:24:31,600
And so for those who don't know,
there are multiple fuels in the

528
00:24:31,600 --> 00:24:34,520
body.
Ketones are one of those, right?

529
00:24:34,560 --> 00:24:37,080
The interesting thing about
ketones is they can cross a

530
00:24:37,080 --> 00:24:41,840
blood brain barrier and they can
be a really strong fuel source

531
00:24:41,840 --> 00:24:45,280
for your brain in particular.
You know, it's an alternative

532
00:24:45,280 --> 00:24:47,400
fuel source for neurons, but
muscle can use it.

533
00:24:47,480 --> 00:24:51,200
And the specific thing within
ketones or something called beta

534
00:24:51,200 --> 00:24:55,720
hydroxybutyrate, this can be
produced naturally if you stop

535
00:24:55,720 --> 00:24:59,800
eating right.
Probably have to go, depends on

536
00:24:59,800 --> 00:25:01,200
your health levels.
But if you're a generally

537
00:25:01,200 --> 00:25:05,280
healthy person, in order for you
to be in a ketogenic diet, it's

538
00:25:05,280 --> 00:25:08,680
got to be probably around less
than 50 grams of carbs a day,

539
00:25:09,280 --> 00:25:12,320
which I don't think most people
understand what that means.

540
00:25:12,880 --> 00:25:15,280
Or you have to do some type of
extended fasting.

541
00:25:15,520 --> 00:25:18,200
And I think the the numbers
could be off.

542
00:25:18,200 --> 00:25:22,320
Like you have to have levels of
greater than one, minimum one

543
00:25:22,320 --> 00:25:25,320
millimolars of beta hydroxy
butyrate in your blood levels.

544
00:25:26,000 --> 00:25:28,760
But the other way you could do
it is you could exogenously take

545
00:25:28,840 --> 00:25:33,160
ketones and they really come in
two forms, as I learned.

546
00:25:33,160 --> 00:25:36,200
So you have ketone mono esters,
which are much more potent.

547
00:25:36,480 --> 00:25:39,080
They raise your beta hydroxy
butyrate very quickly.

548
00:25:39,680 --> 00:25:41,880
They taste horrible.
Actually all of them supposedly

549
00:25:41,880 --> 00:25:44,160
taste horrible, but they tend to
have, because they're more

550
00:25:44,160 --> 00:25:46,520
potent, they tend to have more
side effects and GI issues are

551
00:25:46,520 --> 00:25:49,120
the bigger ones.
Then you have ketone salts,

552
00:25:49,280 --> 00:25:51,440
which are these, the beta
hydroxy butyridine is bound to

553
00:25:51,440 --> 00:25:53,840
minerals.
So sodium magnesium is less

554
00:25:53,840 --> 00:25:56,840
potent, easier to consume.
Typically people will add some

555
00:25:56,840 --> 00:26:00,240
type of flavor to that It'll so
it's milder and it'll have a

556
00:26:00,240 --> 00:26:04,640
longer effect in what you're
going for and you know, all of

557
00:26:04,640 --> 00:26:07,880
these things, it'll get you your
levels to rise up and it'll

558
00:26:07,880 --> 00:26:10,560
provide that source.
So it's maybe a quote UN quote

559
00:26:10,600 --> 00:26:12,560
hack.
Here's what we know about the

560
00:26:12,560 --> 00:26:15,040
cognitive benefits, right?
So you have both acute benefits

561
00:26:15,040 --> 00:26:17,080
and neuroprotective.
And interestingly, there is

562
00:26:17,080 --> 00:26:19,560
actually really good quality
evidence about this.

563
00:26:19,920 --> 00:26:23,120
Is this benefits of a ketogenic
state or just?

564
00:26:23,120 --> 00:26:25,320
Ketogenic states, yeah.
Ketogenic state, yeah.

565
00:26:25,320 --> 00:26:28,760
So these studies, at least that
I looked into, both had people

566
00:26:28,760 --> 00:26:31,840
either on a ketogenic diet and
assessed them from a performance

567
00:26:31,840 --> 00:26:34,520
standpoint for cognition.
Also, ketogenic diet for

568
00:26:34,520 --> 00:26:37,800
epilepsy, that's really well
known it, it works extremely

569
00:26:37,800 --> 00:26:39,360
well.
My wife's an epileptologist and

570
00:26:39,480 --> 00:26:43,120
this will like the first thing
you learn in epilepsy school.

571
00:26:43,720 --> 00:26:44,800
I'm just kidding.
It's a fellowship.

572
00:26:44,800 --> 00:26:46,640
But I mean, she's not listening
anyway.

573
00:26:47,200 --> 00:26:48,800
And you have these acute
effects, right?

574
00:26:48,800 --> 00:26:51,520
So as long as you get those
levels up, which, you know, the

575
00:26:51,520 --> 00:26:54,000
hack is to take exogenous, which
is going to be like a little

576
00:26:54,160 --> 00:26:56,800
drink or a shake, you're going
to improve, you know, working

577
00:26:56,800 --> 00:27:00,520
memory, attention, process
speed, especially in sleep

578
00:27:00,520 --> 00:27:03,400
deprived individuals.
That's your mate, right?

579
00:27:03,960 --> 00:27:06,560
Reduce your cognitive fatigue,
potentially enhance motor

580
00:27:06,560 --> 00:27:09,120
learning, although that evidence
is really early and that's the

581
00:27:09,160 --> 00:27:12,080
evidence that's becoming really
promising for some of the

582
00:27:12,080 --> 00:27:14,680
neurodegenerative conditions.
I'm talking Parkinson's, I'm

583
00:27:14,680 --> 00:27:17,760
talking Alzheimer's, I'm talking
patients with TB is where you

584
00:27:17,760 --> 00:27:19,920
have some of this motor learning
issues that you know, things

585
00:27:19,920 --> 00:27:21,640
that we lost.
Let's even include stroke in

586
00:27:21,640 --> 00:27:23,560
there, although I don't think
that's being studied yet.

587
00:27:24,360 --> 00:27:26,640
But the neurodegenerative ones,
because the other way that it

588
00:27:26,640 --> 00:27:29,400
might work is actually can
stabilize some of those neurons

589
00:27:29,640 --> 00:27:33,480
and the neural in a networks,
right, by modulating GABA, which

590
00:27:33,480 --> 00:27:35,960
is a neurotransmitter.
You know, just it could be

591
00:27:35,960 --> 00:27:39,080
healthy aging or every adult as
you get to a certain age, you

592
00:27:39,080 --> 00:27:42,440
develop some type of dementia.
The most common probably, I

593
00:27:42,440 --> 00:27:44,080
think is gonna be vascular
dementia.

594
00:27:44,080 --> 00:27:46,760
And that just means, look, if
you have your pipes aren't clean

595
00:27:46,760 --> 00:27:48,880
and your arteries and you're
getting some plaque buildup, you

596
00:27:48,880 --> 00:27:50,600
could have minor strokes and
never even know that.

597
00:27:50,960 --> 00:27:53,320
And you know, that's why people
say, oh, you're getting senile

598
00:27:53,320 --> 00:27:56,520
in your 70s and 80s.
But the clinical use cases for

599
00:27:56,520 --> 00:27:58,800
this where it's been studied
really well is, you know, been

600
00:27:58,800 --> 00:28:02,160
military shift workers,
emergency responders, again,

601
00:28:02,240 --> 00:28:05,480
those high stress states where
you need alternative fuel

602
00:28:05,480 --> 00:28:08,200
sources and you need to be
really sharp in.

603
00:28:08,200 --> 00:28:11,800
So again, PVR, you know, take
that with a grain of salt, but

604
00:28:11,800 --> 00:28:13,960
I'm thinking about neurosurgery
residents and thinking about

605
00:28:13,960 --> 00:28:17,520
other surgical colleagues of US
where some people are now

606
00:28:17,520 --> 00:28:19,440
exploring this potential.
And I think it's getting popular

607
00:28:19,440 --> 00:28:22,640
in conversation is a lot of the
post COVID era because you have

608
00:28:22,640 --> 00:28:26,880
these brain fog symptoms where
really nobody can put a finger

609
00:28:26,880 --> 00:28:28,840
on it.
Neurology can't figure out,

610
00:28:28,840 --> 00:28:31,040
there's no structural stuff that
you can identify.

611
00:28:31,040 --> 00:28:32,560
It's like, how do we sharpen
your brain?

612
00:28:33,160 --> 00:28:35,080
We know when you have autonomic
dysfunction, when you have

613
00:28:35,080 --> 00:28:37,400
central pain sensitization, when
you have mood related stuff.

614
00:28:37,400 --> 00:28:41,160
It's like, how much is mood, how
much is an actual structural

615
00:28:41,280 --> 00:28:44,400
problem?
I probably wouldn't overall

616
00:28:44,400 --> 00:28:47,520
characterize the body of
evidence as strong.

617
00:28:47,960 --> 00:28:49,960
Maybe it would be in the
moderate category 'cause we

618
00:28:49,960 --> 00:28:52,040
don't have a lot of randomized
controlled trials, we don't have

619
00:28:52,040 --> 00:28:55,200
a lot of human studies.
If we do have a good amount of

620
00:28:55,240 --> 00:28:58,360
animal studies on at least the
neurodegenerative stuff, the

621
00:28:58,360 --> 00:29:01,000
TBI, because it could do this
interesting thing to animals

622
00:29:01,000 --> 00:29:02,800
where you can bang them on the
head and then you can treat them

623
00:29:02,800 --> 00:29:04,280
afterwards.
You can't do that with humans.

624
00:29:04,880 --> 00:29:06,560
Really interested.
Here's the downside though,

625
00:29:06,560 --> 00:29:09,280
freaking expensive.
At least when you're trying to

626
00:29:09,280 --> 00:29:12,760
get a a good product.
There are a couple of products

627
00:29:12,760 --> 00:29:16,320
on the market that are
pharmaceutical great, but there

628
00:29:16,320 --> 00:29:19,920
are really expensive.
I have read that it's not

629
00:29:19,920 --> 00:29:22,840
something to be messed with if
you do have tend to have GI

630
00:29:22,840 --> 00:29:25,360
related issues.
And if you want to dabble into

631
00:29:25,360 --> 00:29:28,320
this, you want to really start
low and go slow.

632
00:29:28,320 --> 00:29:30,760
Take that approach because you
could have some messy pants.

633
00:29:30,760 --> 00:29:33,200
I think I'm going to try it.
I am going to try it.

634
00:29:33,200 --> 00:29:37,440
I want to see if I can dial back
my caffeine intake, particularly

635
00:29:37,440 --> 00:29:40,160
in the afternoon.
I find myself in this vicious

636
00:29:40,160 --> 00:29:43,080
cycle where I always need that
little afternoon pick me up and

637
00:29:43,080 --> 00:29:45,280
maybe if I could replace it with
a little ketone shot and see

638
00:29:45,280 --> 00:29:47,800
what happens.
Do you, are you going to try to

639
00:29:47,800 --> 00:29:49,640
be in a ketogenic state then?
Or are you just going to use

640
00:29:49,640 --> 00:29:53,160
this as a way to feel?
Like how many cars do you have

641
00:29:53,160 --> 00:29:55,880
to limit, do you feel in order
for this to take effect?

642
00:29:56,160 --> 00:29:59,000
My understanding is that's a
great question.

643
00:29:59,000 --> 00:30:03,800
I think could there be a certain
amount of carb intake where that

644
00:30:03,800 --> 00:30:07,360
that blocks it or you have to
take a higher amount?

645
00:30:07,760 --> 00:30:09,960
That's an answer that I haven't
come across yet.

646
00:30:10,480 --> 00:30:14,040
I'll average anywhere from 100
to 200 grams a day of carbs.

647
00:30:14,080 --> 00:30:16,800
I find that's the diet that
works best for me, which I don't

648
00:30:16,800 --> 00:30:18,880
think it's a crazy amount in all
honesty.

649
00:30:18,880 --> 00:30:21,600
I think that if you probably
aren't 300, four, 100 milligrams

650
00:30:21,600 --> 00:30:24,360
of daily carbs when you're not a
bodybuilder or a high

651
00:30:24,360 --> 00:30:27,360
performance athlete, then that's
probably a little bit too much.

652
00:30:27,360 --> 00:30:30,080
But that's a great question.
I suspect that if I'm going to

653
00:30:30,080 --> 00:30:32,320
do it and if I want to be
experimental about it, then

654
00:30:32,320 --> 00:30:35,960
maybe I should get something to
actually measure.

655
00:30:36,560 --> 00:30:38,800
You know, there's the glucose
ketone index.

656
00:30:39,000 --> 00:30:40,360
Then that's really what you want
to check.

657
00:30:40,360 --> 00:30:42,800
I mean, it's a good marker for
metabolic health and you can see

658
00:30:42,800 --> 00:30:45,080
what your body's processing in
terms of fuel sources.

659
00:30:45,520 --> 00:30:47,800
I think these ketone testers,
they're really not that

660
00:30:47,800 --> 00:30:49,320
expensive.
So I might do that.

661
00:30:49,560 --> 00:30:52,040
But how I'm going to use it?
Maybe take a shot 30 minutes

662
00:30:52,040 --> 00:30:53,760
before a podcast.
What are your thoughts playing?

663
00:30:53,760 --> 00:30:56,200
Nonsense on here.
What are your thoughts on just

664
00:30:56,200 --> 00:30:57,560
Regular?
Are we?

665
00:30:57,640 --> 00:31:01,480
Talking about alpha GPC,
caffeine, yeah.

666
00:31:02,600 --> 00:31:05,080
Oh, nicotine, yeah.
Nicotine something, yeah.

667
00:31:05,080 --> 00:31:07,840
So alpha GPC, I've looked into
this examine actually has a lot

668
00:31:07,840 --> 00:31:12,440
of really interesting.
I think the evidence is it's a

669
00:31:12,440 --> 00:31:14,600
meager.
I, I, I don't think the evidence

670
00:31:14,600 --> 00:31:16,520
is strong.
Most of these states for alpha

671
00:31:16,520 --> 00:31:19,960
GPC, like the data that we have
coming from, is going to be from

672
00:31:19,960 --> 00:31:24,440
people who have deficiencies in
choline, who are older, who have

673
00:31:24,440 --> 00:31:26,920
some type of neurodegenerative
disease already going on.

674
00:31:27,680 --> 00:31:29,680
I'm again, particularly
interested in healthy folks.

675
00:31:29,920 --> 00:31:32,320
The good news about some of the
ketogenic diet, it has been

676
00:31:32,400 --> 00:31:34,840
assessed in athletes for
performance specifically.

677
00:31:34,840 --> 00:31:37,560
It has been checked in healthy
individuals.

678
00:31:38,160 --> 00:31:41,680
I'm a big ROI guy.
I just don't see the ROI there.

679
00:31:43,240 --> 00:31:45,640
I think what really convinced me
honestly is I can't remember

680
00:31:45,640 --> 00:31:47,440
that guy's name.
He's PhD, the ketone person.

681
00:31:48,040 --> 00:31:50,040
Remember him talking about how
these graphs, when they're

682
00:31:50,040 --> 00:31:52,040
looking at those give you
averages or they'll give you the

683
00:31:52,040 --> 00:31:54,920
medians on a bar graph.
This is the range that, you

684
00:31:54,920 --> 00:31:57,440
know, if you're a non responder,
you're on the bottom, or if

685
00:31:57,440 --> 00:31:58,920
you're a hyper responder, you're
on the top.

686
00:31:59,600 --> 00:32:02,280
You could be either one of those
individuals and you won't know

687
00:32:02,280 --> 00:32:04,320
until you try.
I think we believe that, right?

688
00:32:04,320 --> 00:32:06,480
That's why there's the end of
one medicine that we talk about.

689
00:32:07,040 --> 00:32:08,880
So yeah, you know, that makes a
lot of sense.

690
00:32:08,880 --> 00:32:11,520
I think the evidence is stronger
for me to try this, but I'm not

691
00:32:11,520 --> 00:32:13,520
opposed to those.
I think our money's probably

692
00:32:13,520 --> 00:32:15,400
better spent.
I don't have a lot of money to

693
00:32:15,400 --> 00:32:17,560
spare yet.
I hear you, I hear you.

694
00:32:17,800 --> 00:32:19,680
I've been getting, I don't know
if you heard a breadwinner, but

695
00:32:19,680 --> 00:32:22,520
they're a neotropic company that
has partnered up with me.

696
00:32:22,520 --> 00:32:23,760
So I've been trying out their
stuff.

697
00:32:24,160 --> 00:32:25,960
It's not caffeine.
Yeah, evaluate.

698
00:32:25,960 --> 00:32:27,960
Right, Because it's it's just
the caffeine that's making me a

699
00:32:27,960 --> 00:32:30,760
little bit more awake and alert.
Or is it the lion's vein and all

700
00:32:30,760 --> 00:32:32,640
that stuff?
Alpha GPC and everything else in

701
00:32:32,640 --> 00:32:33,960
it.
What is this supplement?

702
00:32:33,960 --> 00:32:35,240
Is it a drink?
There are capsules.

703
00:32:35,480 --> 00:32:38,160
OK, well, what's interesting is
like, ever since I found out my

704
00:32:38,160 --> 00:32:41,040
ferritin was low by doing
function labs, I started

705
00:32:41,040 --> 00:32:44,440
supplementing with iron and my
Afrin slumps are pretty much

706
00:32:44,440 --> 00:32:47,920
gone.
Yeah, cool.

707
00:32:48,560 --> 00:32:50,600
What else you got is something
completely unrelated to keto.

708
00:32:50,680 --> 00:32:52,600
Back to more of the philosophy
and future.

709
00:32:52,640 --> 00:32:55,360
So what I've been really been
thinking about is just the

710
00:32:55,360 --> 00:32:57,720
future of the world, right?
I think a lot of us are having

711
00:32:58,000 --> 00:33:00,440
those discussions and thoughts
now being where we are in our

712
00:33:00,440 --> 00:33:04,640
30s and you know, you have a
kid, me not having kids yet,

713
00:33:04,640 --> 00:33:06,920
maybe never, I don't know,
thinking about like where is the

714
00:33:06,920 --> 00:33:09,360
world heading?
And so what's interesting that

715
00:33:09,360 --> 00:33:11,840
I've been hearing just a lot of
through these articles I've been

716
00:33:11,840 --> 00:33:13,800
reading Tim Ferriss, my first
million.

717
00:33:13,800 --> 00:33:15,840
It's the thoughts have to be pro
analog.

718
00:33:16,120 --> 00:33:19,920
And I actually just read it
again today by a guy named Dan

719
00:33:19,920 --> 00:33:24,320
Koh who amazing sub stack about
it's called future proof and he

720
00:33:24,320 --> 00:33:26,160
just talks about how it like
we're getting sick of social

721
00:33:26,160 --> 00:33:27,680
media.
Like honestly, I haven't posted

722
00:33:27,680 --> 00:33:31,480
on social media just because I
don't find it like any valuable

723
00:33:31,480 --> 00:33:33,560
anymore, right?
Like the number of followers you

724
00:33:33,560 --> 00:33:37,600
have doesn't indicate the value
or education that you're

725
00:33:37,600 --> 00:33:38,960
providing.
And I think people are starting

726
00:33:38,960 --> 00:33:41,920
to realize that.
So I think a lot of people are

727
00:33:41,920 --> 00:33:45,480
just coming pro analog.
They miss having hard copies of

728
00:33:45,480 --> 00:33:48,720
books or a newspaper.
There was a photo posted in New

729
00:33:48,720 --> 00:33:51,800
York City across a bridge at
10:00 PM last week and was like,

730
00:33:51,960 --> 00:33:53,680
this is what people are doing
now on Friday nights.

731
00:33:53,680 --> 00:33:55,120
They're like running and run
clubs.

732
00:33:55,440 --> 00:33:58,000
So this lack of social
connection that we've had since

733
00:33:58,000 --> 00:34:00,480
COVID, people are now trying to
find ways, right?

734
00:34:00,480 --> 00:34:04,720
So ice, ice baths with coffee,
sauna clubs, more Wellness

735
00:34:04,720 --> 00:34:07,560
orientation, honestly, even
alcohol.

736
00:34:07,560 --> 00:34:10,280
I enjoy drinking.
We me and Mira don't drink

737
00:34:10,280 --> 00:34:12,679
honestly that much, but we'll
have a good time whenever we go

738
00:34:12,679 --> 00:34:15,080
out.
And like Tom Holland started

739
00:34:15,080 --> 00:34:18,520
this beer company called Bureau.
So it's not alcohol here and

740
00:34:18,520 --> 00:34:20,880
it's absolutely F it.
Awesome dude.

741
00:34:20,920 --> 00:34:22,920
I actually like it more than
regular beer.

742
00:34:23,080 --> 00:34:24,719
And actually the last two
podcast, that's what I've been

743
00:34:24,719 --> 00:34:26,440
drinking.
It looks like real beer.

744
00:34:26,800 --> 00:34:28,719
So the guests are probably like,
dude, this guy's turned.

745
00:34:29,000 --> 00:34:31,040
Not very professional.
Yeah, just your thoughts.

746
00:34:31,040 --> 00:34:32,520
How do you think about the
future?

747
00:34:32,639 --> 00:34:37,719
Are you craving this nostalgic
way of the past of communication

748
00:34:37,719 --> 00:34:41,679
or the way of just doing things?
Are you getting sick of the AI

749
00:34:41,679 --> 00:34:45,920
social media yet?
I'm not sick of AI, but I told

750
00:34:45,920 --> 00:34:47,360
you I deleted Instagram off my
phone, right?

751
00:34:47,760 --> 00:34:49,480
But yeah, yeah, phenomenal
decision.

752
00:34:49,600 --> 00:34:51,880
I don't regret it.
I'm not interested in getting

753
00:34:51,880 --> 00:34:53,360
back.
It is a little annoying because

754
00:34:53,719 --> 00:34:56,159
I put it on my iPad.
So if I have to go back for

755
00:34:56,440 --> 00:34:57,720
just, you know, that's what I'll
do it.

756
00:34:58,160 --> 00:35:00,440
I like that.
I have interestingly found

757
00:35:00,440 --> 00:35:02,320
myself to bought.
I bought back time.

758
00:35:03,080 --> 00:35:04,800
Isn't that interesting 'cause I
think, I think I've mentioned

759
00:35:04,800 --> 00:35:06,680
here before, it's just being in
these rabbit holes.

760
00:35:06,800 --> 00:35:10,280
Were you doom scrolling or?
Yeah, and you pick up your phone

761
00:35:10,280 --> 00:35:12,960
and you just end up on the app,
you know, it's 3 clicks over.

762
00:35:12,960 --> 00:35:15,640
I tried to hide it.
You put the filters to log out a

763
00:35:15,640 --> 00:35:17,280
certain time and it just didn't
work.

764
00:35:17,320 --> 00:35:20,280
And I think getting rid of it
was actually really good.

765
00:35:20,840 --> 00:35:23,400
I think we had talked to Robin
Tiger about this, the importance

766
00:35:23,400 --> 00:35:27,360
of being present in that moment.
And this is interesting.

767
00:35:27,360 --> 00:35:29,120
I'm thinking about a
conversation I heard Michael

768
00:35:29,120 --> 00:35:32,720
Easter have not too long ago.
I've heard Saul Blue and Ryan

769
00:35:32,720 --> 00:35:34,240
Holiday talk about so many of
these things, about the

770
00:35:34,240 --> 00:35:38,000
importance of presence.
And you know, I just got one kid

771
00:35:38,000 --> 00:35:40,320
right now and it's crazy 'cause
she's 3 1/2.

772
00:35:40,520 --> 00:35:43,840
I don't remember what the hell
happened in that first year.

773
00:35:44,000 --> 00:35:46,240
So you asked me if I'm craving
it.

774
00:35:46,480 --> 00:35:49,520
I always found myself to be the
person who preferred to pick up

775
00:35:49,520 --> 00:35:51,520
the phone and call rather than
text.

776
00:35:51,880 --> 00:35:55,000
This is why I I speech to text
'cause I hate actually typing

777
00:35:55,000 --> 00:35:58,440
stuff out.
So I would rather like just pick

778
00:35:58,440 --> 00:36:00,200
up the phone and just have that
conversation.

779
00:36:00,240 --> 00:36:03,920
I'm known to be that guy, you
know, in my at least college

780
00:36:03,920 --> 00:36:06,040
buddies at the I'll call
somebody from time to time.

781
00:36:06,640 --> 00:36:08,960
You know, I'm always talking to
my parents or somebody.

782
00:36:09,400 --> 00:36:11,640
You and I are are doing this
enough that we're chatting, but

783
00:36:11,680 --> 00:36:15,320
prefer that I also send voice
notes to people like through

784
00:36:15,320 --> 00:36:18,360
WhatsApp and stuff.
Tone is so important if you're

785
00:36:18,360 --> 00:36:20,760
having any type of sensitive
conversation.

786
00:36:21,400 --> 00:36:24,440
So I've always been more
attracted to that.

787
00:36:25,400 --> 00:36:27,400
So I'm excited that we're headed
back to that man.

788
00:36:27,440 --> 00:36:30,560
I really am.
Jonathan Height posts and talks

789
00:36:30,560 --> 00:36:32,880
about this a lot, right?
The anxious generation.

790
00:36:32,880 --> 00:36:34,640
I think that's his newest book.
Maybe I think he might have

791
00:36:34,640 --> 00:36:38,640
posted this on social media.
What schools look like that are

792
00:36:38,880 --> 00:36:41,080
phone free or just for a little
time?

793
00:36:41,120 --> 00:36:46,120
And it really is freaking
amazing to see that, you know,

794
00:36:46,600 --> 00:36:51,040
like cafeterias where people are
having conversations and

795
00:36:51,040 --> 00:36:54,640
laughter and that kind of stuff.
Did you have a cell phone in

796
00:36:54,640 --> 00:36:56,600
high school?
Yeah, middle school is when it

797
00:36:56,600 --> 00:36:58,920
started.
Yeah, no smartphone, I think

798
00:36:58,920 --> 00:37:00,800
10th grade for.
Yeah, I don't think I got my

799
00:37:00,800 --> 00:37:04,040
first smartphone until I was in
college and like towards the end

800
00:37:04,040 --> 00:37:06,120
of college, I think I had a
BlackBerry my senior in college.

801
00:37:06,120 --> 00:37:08,040
So that's a different
experience.

802
00:37:08,040 --> 00:37:10,720
Man, I I don't know what an
experience in high school would

803
00:37:10,720 --> 00:37:13,680
be like now, but when I think
about my high school time, it

804
00:37:13,680 --> 00:37:17,480
was an amazing experience.
I see people, if I'm at a

805
00:37:17,480 --> 00:37:21,400
restaurant now with a group of
folks who look like they might

806
00:37:21,400 --> 00:37:24,040
be in their teens or 20s or, or.
I can't imagine a cafeteria

807
00:37:24,040 --> 00:37:26,160
being any different.
It has to be the same.

808
00:37:27,560 --> 00:37:30,360
Yeah, no, I agree, man.
Hijacking the dopamine and the

809
00:37:30,360 --> 00:37:32,920
circuitry, it's.
Yeah, I couldn't imagine a world

810
00:37:32,920 --> 00:37:34,600
like that now.
I mean, I know there's a big

811
00:37:34,600 --> 00:37:38,040
push for getting students to
learn how to code and be on

812
00:37:38,040 --> 00:37:39,960
computers because that's where
the future is going.

813
00:37:39,960 --> 00:37:41,680
So it's like, why waste our time
without it?

814
00:37:42,000 --> 00:37:47,200
But I do agree, I think there
has to be this education on not

815
00:37:47,200 --> 00:37:50,400
being dependent on it.
And so I've always kind of told

816
00:37:50,400 --> 00:37:52,840
myself, like, when I walk into a
restaurant, be the observer,

817
00:37:52,960 --> 00:37:54,680
right?
Because it's so much fun when

818
00:37:54,680 --> 00:37:56,520
you get to look around and
you're not the one on your phone

819
00:37:56,520 --> 00:37:59,600
and be like, holy crap, man.
It's like the world we live in.

820
00:37:59,840 --> 00:38:02,200
You know, you see it all and you
start to notice other things.

821
00:38:02,200 --> 00:38:04,880
You start to make associations.
You start to see how is it a

822
00:38:04,880 --> 00:38:07,560
generational thing?
Is it a health status thing?

823
00:38:07,880 --> 00:38:10,560
You know, the people who are
healthier tend to be eating

824
00:38:10,560 --> 00:38:12,920
better or not smoking or not
doing these things.

825
00:38:12,920 --> 00:38:15,160
But you can actually see that
out in the real world too play

826
00:38:15,160 --> 00:38:17,560
out if you choose to not be on
your phone and actually put it

827
00:38:17,560 --> 00:38:19,560
away and just start to observe
and watch other people.

828
00:38:20,000 --> 00:38:22,520
I've always found that aspect of
it very fascinating.

829
00:38:23,560 --> 00:38:25,480
Speaking of being the observer,
the one thing that would always

830
00:38:25,480 --> 00:38:28,960
fascinated me is when I go on
vacation, it was just like the

831
00:38:28,960 --> 00:38:30,720
most awesome, beautiful tourist
spot.

832
00:38:31,280 --> 00:38:33,000
Everybody there is trying to
take pictures.

833
00:38:33,000 --> 00:38:34,360
They're trying to capture that
moment.

834
00:38:34,920 --> 00:38:39,960
I always find interesting is a
lot of people are capturing that

835
00:38:39,960 --> 00:38:43,280
moment or living that moment
through the lens.

836
00:38:43,480 --> 00:38:46,840
It can sometimes create tension
with whoever I'm doing that

837
00:38:46,960 --> 00:38:48,080
vacation with.
They're like, let's take a

838
00:38:48,080 --> 00:38:50,200
picture.
I'm like, no, like I, you know,

839
00:38:50,200 --> 00:38:52,960
my principles do that.
I have open to it because it is

840
00:38:52,960 --> 00:38:55,520
nice, especially when you have
younger kids to go back and look

841
00:38:55,520 --> 00:38:57,320
through that and relive the
experience.

842
00:38:57,320 --> 00:38:58,840
So I think there there certainly
is.

843
00:38:59,480 --> 00:39:02,600
But you always also got me think
about the pro analog concept.

844
00:39:02,600 --> 00:39:04,640
Right.
So you read the comfort crisis.

845
00:39:04,880 --> 00:39:07,400
Yeah, OK, still my agenda.
But I've listened to him.

846
00:39:07,400 --> 00:39:11,000
So I listened to him on Huber
not too long ago.

847
00:39:11,040 --> 00:39:13,320
I think he was on there a while
back, but I just listened to him

848
00:39:13,800 --> 00:39:16,520
caught up with that one.
And you know, he talks about

849
00:39:16,520 --> 00:39:18,080
this, right?
Was it the Alaska trip?

850
00:39:18,520 --> 00:39:22,800
Also funny when he talks about
he's trying to get to Alaska for

851
00:39:22,800 --> 00:39:25,880
this month long trip and he's
just like on a tiny little

852
00:39:25,880 --> 00:39:27,360
flight.
You know the story.

853
00:39:27,360 --> 00:39:28,840
Have you heard the story?
He writes about the book?

854
00:39:28,840 --> 00:39:30,720
Yeah.
So the the story goes and people

855
00:39:30,720 --> 00:39:33,040
can check this out.
He talks about it, but he's got

856
00:39:33,040 --> 00:39:36,240
to get like 2 planes to get to
Alaska for this trip that he's

857
00:39:36,240 --> 00:39:38,400
doing.
And he's so uncomfortable and

858
00:39:38,400 --> 00:39:41,480
the bathroom is tiny and the
seats tiny and he has no light

859
00:39:41,480 --> 00:39:43,080
and the food is cold and blah,
blah.

860
00:39:43,080 --> 00:39:46,120
And then he goes to Alaska
without electricity, without

861
00:39:46,120 --> 00:39:49,240
warm water and decides to live
out there for a month where he

862
00:39:49,240 --> 00:39:52,120
has to put their own fire.
Basically live how they used to

863
00:39:52,120 --> 00:39:54,520
100 years ago and really connect
with nature.

864
00:39:54,560 --> 00:39:57,680
Then live with the sun comes up
and which it doesn't a lot hunt

865
00:39:57,680 --> 00:40:00,720
for their game and, you know,
get that experience and be

866
00:40:00,720 --> 00:40:04,000
outdoors and also pushed himself
through something really hard.

867
00:40:04,600 --> 00:40:07,800
And then on the way back when
he's on the same flight, it just

868
00:40:07,800 --> 00:40:10,680
it feels like a five star luxury
experience.

869
00:40:11,200 --> 00:40:12,600
And Michael Easter he talks
about.

870
00:40:13,120 --> 00:40:15,000
I don't know if that's also what
he talks about.

871
00:40:15,000 --> 00:40:17,640
Misogi experience.
You familiar with that concept?

872
00:40:17,720 --> 00:40:19,640
Misogi.
Yeah.

873
00:40:19,640 --> 00:40:24,120
So he talks about having to
basically reset your expectation

874
00:40:24,120 --> 00:40:26,400
to recalibrate once a year or
something like that, where you

875
00:40:26,400 --> 00:40:29,720
do something really hard and you
don't know if you're gonna make

876
00:40:29,720 --> 00:40:35,040
it out on the other end and how
that prepares you to perhaps

877
00:40:35,040 --> 00:40:40,080
enjoy, perhaps slow down,
perhaps disconnect from things

878
00:40:40,080 --> 00:40:42,280
that don't matter.
I get the sense of what you're

879
00:40:42,280 --> 00:40:44,000
talking about is aligned with
that too.

880
00:40:44,240 --> 00:40:47,000
What do you think?
Yeah, no, I love the concept of

881
00:40:47,000 --> 00:40:49,840
Nisogi, honestly kind of want to
get back to doing a couple of

882
00:40:49,840 --> 00:40:51,960
them.
So yeah, I think it's a great

883
00:40:51,960 --> 00:40:55,320
way to learn how to detach.
And it also builds your mental

884
00:40:55,320 --> 00:40:58,320
fortitude.
So when you realize, hey, you

885
00:40:58,320 --> 00:41:00,160
got to save something for a
rainy day, or when that rainy

886
00:41:00,160 --> 00:41:02,280
day comes, you're able to say,
OK, I can do this.

887
00:41:02,600 --> 00:41:06,480
So I drove from Philadelphia to
North Carolina, 7 hours without

888
00:41:06,480 --> 00:41:08,800
any music, any talk, just
silence, you know?

889
00:41:08,800 --> 00:41:10,800
And that was like Nisogi that
time I was like, I just want to

890
00:41:10,800 --> 00:41:12,760
see if I can do it.
So now when it comes to

891
00:41:12,760 --> 00:41:16,240
meditation or just, you know, be
by myself and not having

892
00:41:16,240 --> 00:41:18,840
anything, I did it for seven
hours, you know, just being my

893
00:41:18,840 --> 00:41:20,440
thoughts more than capable of
doing that.

894
00:41:20,640 --> 00:41:23,160
Fasting is another reason why,
you know, all fast here and

895
00:41:23,160 --> 00:41:26,480
there is really just get back to
what it's like to just be

896
00:41:26,920 --> 00:41:29,240
grateful for food.
Not only health benefits of it,

897
00:41:29,240 --> 00:41:32,360
but also just realizing when
you're driving on the street and

898
00:41:32,360 --> 00:41:34,720
you see a homeless person that's
just asking for food, you know,

899
00:41:34,720 --> 00:41:36,800
I'll try to make sure I stop by
and try to get them something

900
00:41:36,800 --> 00:41:38,960
because I now know that feeling
that they might be going

901
00:41:38,960 --> 00:41:40,720
through.
So it really just helps you

902
00:41:40,720 --> 00:41:42,640
connect with the world around
you in different ways.

903
00:41:43,800 --> 00:41:45,120
I'll push back though.
I don't think you know that

904
00:41:45,120 --> 00:41:47,400
feeling, right?
Because I think when you're

905
00:41:47,400 --> 00:41:50,080
fasting, you're doing a
voluntary thing, food, it's

906
00:41:50,080 --> 00:41:52,120
available to you, whereas that
homeless person, it's not.

907
00:41:52,440 --> 00:41:55,240
And I get the sense, right, The
purpose is like you're trying to

908
00:41:56,240 --> 00:41:58,640
experience the physical aspect
of hunger.

909
00:41:59,640 --> 00:42:01,360
Yeah, I think it's a die.
There's been many times where

910
00:42:01,440 --> 00:42:03,480
I've I've broken it right,
because I'm like, oh, I got food

911
00:42:03,480 --> 00:42:04,920
in the fridge, let's do it.
I'll just cheat a little.

912
00:42:04,920 --> 00:42:08,040
But I did 18 hours, Yeah, that
pushing back, right?

913
00:42:08,040 --> 00:42:10,840
But hating that feeling, I think
is the relatable part is God, I

914
00:42:10,840 --> 00:42:12,520
hate this.
Like, why would I ever put

915
00:42:12,520 --> 00:42:15,200
myself through this and try to
relate on that aspect of it of

916
00:42:15,200 --> 00:42:17,440
just a great feeling right when
you're unfed.

917
00:42:17,760 --> 00:42:20,360
I was laughing to myself and he
was like, yeah, Misoki's like a

918
00:42:20,360 --> 00:42:21,800
concept.
You pick something that you

919
00:42:21,800 --> 00:42:24,120
don't know if you're gonna be
able to make it through this, if

920
00:42:24,120 --> 00:42:25,280
you're gonna come out the other
side.

921
00:42:25,800 --> 00:42:27,880
I was just thinking half case,
man.

922
00:42:28,040 --> 00:42:31,320
That's Misoki.
But yeah, yeah, the 50% chance

923
00:42:31,320 --> 00:42:32,240
is the way he defines.
It.

924
00:42:32,240 --> 00:42:33,880
No, I love it.
What else you got?

925
00:42:33,960 --> 00:42:36,920
Anything else?
Last thing for me was really GLP

926
00:42:36,920 --> 00:42:38,360
ones.
So I know we've been talking

927
00:42:38,360 --> 00:42:40,280
about this here and there on a
lot of episodes.

928
00:42:40,320 --> 00:42:42,360
Did you see how Serena is now an
ambassador?

929
00:42:42,560 --> 00:42:45,720
Serena Williams an ad for that?
What are your thoughts on that?

930
00:42:46,280 --> 00:42:50,120
I think it's for one of those
companies who will give

931
00:42:50,120 --> 00:42:55,120
compounded medication.
I saw people on a Sports Center,

932
00:42:55,120 --> 00:42:58,680
people on ESPN talk about that.
I don't really have any strong

933
00:42:58,680 --> 00:43:01,920
points of view on it.
You know, I think she, I don't

934
00:43:01,920 --> 00:43:03,720
know too much about her
reasoning behind it.

935
00:43:03,720 --> 00:43:06,360
I know she talked about
struggling to lose weight

936
00:43:06,360 --> 00:43:08,720
throughout the whole thing and
after pregnancy getting back to

937
00:43:08,720 --> 00:43:10,320
it.
Didn't she win the US Open while

938
00:43:10,320 --> 00:43:12,160
she was pregnant?
I think right after she came

939
00:43:12,160 --> 00:43:14,160
back or something.
Right after she came back like

940
00:43:14,160 --> 00:43:17,240
that.
Pray pardon, but tool, go ahead.

941
00:43:17,240 --> 00:43:19,600
Yeah, I was going to say what
the marketing behind it too, I

942
00:43:19,600 --> 00:43:22,800
guess said this is healthcare.
And I think a lot of people that

943
00:43:22,800 --> 00:43:24,760
struck A chord with people.
I've seen some of our recent

944
00:43:24,760 --> 00:43:27,480
guests go on LinkedIn and be
like, this is not healthcare.

945
00:43:27,480 --> 00:43:32,000
This is just a way to, you know,
skirt around chronic disease

946
00:43:32,000 --> 00:43:33,960
still.
And so that's where I think the

947
00:43:33,960 --> 00:43:35,480
conversation gets very
interesting.

948
00:43:35,880 --> 00:43:37,080
I don't know if he's skirting
around.

949
00:43:37,080 --> 00:43:40,360
It's it is because that would
suggest that like you are

950
00:43:40,360 --> 00:43:43,120
hacking chronic disease.
But if you're calling obesity

951
00:43:43,640 --> 00:43:48,400
and this is a treatment for
obesity, then and she I don't

952
00:43:48,400 --> 00:43:49,760
know what her medical condition
is right.

953
00:43:49,760 --> 00:43:53,520
I have no idea if she has some
truth related difficulty with

954
00:43:53,520 --> 00:43:55,720
this.
She's always been somebody who's

955
00:43:55,920 --> 00:43:57,680
probably been a little bit on
the heavier side.

956
00:43:57,680 --> 00:44:00,520
Not I'm sure she has a ton of
muscle, like I have no idea what

957
00:44:00,520 --> 00:44:04,040
her body composition is, but
just comparatively to her peers,

958
00:44:04,560 --> 00:44:06,960
I have no idea what her struggle
had been behind the scene.

959
00:44:07,080 --> 00:44:08,960
So that could be a really viable
option for her.

960
00:44:09,320 --> 00:44:12,320
The people that I, the area
where I do have a problem with

961
00:44:12,320 --> 00:44:17,000
this is when, I guess I will say
this, if it is a company that's

962
00:44:17,000 --> 00:44:20,360
giving competitive medication, I
think Hims tried to do this and

963
00:44:20,360 --> 00:44:22,040
Hims and hers, whatever tried to
do this as well.

964
00:44:22,480 --> 00:44:25,640
It suggests that a lot of people
can reach out.

965
00:44:26,040 --> 00:44:28,080
This is promoting health and
it's not necessarily promoting

966
00:44:28,080 --> 00:44:29,680
health.
It might be promoting health if

967
00:44:29,680 --> 00:44:31,440
you are actually a good
candidate.

968
00:44:31,960 --> 00:44:34,640
And in order for somebody to be
a good candidate, I would really

969
00:44:34,640 --> 00:44:36,760
want to know what they've tried,
what their journey has been

970
00:44:36,760 --> 00:44:39,520
getting up there.
Obesity is such a complicated

971
00:44:39,560 --> 00:44:42,440
and complex thing and that's why
I'm so excited and I really want

972
00:44:42,440 --> 00:44:43,880
to.
I could talk about it here, we

973
00:44:43,880 --> 00:44:45,720
could talk about it, but I
really want to get somebody who

974
00:44:45,720 --> 00:44:48,920
is a little bit more, has deeper
expertise in this than we do.

975
00:44:49,560 --> 00:44:52,080
And then when you actually get
into the weeds of what their

976
00:44:52,320 --> 00:44:55,240
regimen has been like, what that
struggle is to really, truly

977
00:44:55,240 --> 00:44:59,280
define that, to really put that
on paper, you realize it's, Oh

978
00:44:59,280 --> 00:45:00,800
no, you just can't get out of
your own way.

979
00:45:01,160 --> 00:45:04,880
And it's not a matter of simply
actual physiological

980
00:45:04,880 --> 00:45:07,520
limitations.
It's more of a matter of you

981
00:45:07,520 --> 00:45:11,320
want to take the path of least
resistance, which I don't know

982
00:45:11,320 --> 00:45:14,000
how I feel about that part.
Probably in the not mega fan

983
00:45:14,000 --> 00:45:17,000
camp.
Yeah, What really struck a chord

984
00:45:17,000 --> 00:45:20,240
of me or what I really flipped a
switch, I should say for me is

985
00:45:20,280 --> 00:45:22,840
we had a episode yesterday with
Doctor Nisa Chellam.

986
00:45:22,840 --> 00:45:26,240
And so just to preview it for
the guests, that'll be a future

987
00:45:26,240 --> 00:45:28,120
episode.
It's when she talked about food

988
00:45:28,120 --> 00:45:32,120
noise, like when she used those
words and how GLB ones can help

989
00:45:32,120 --> 00:45:34,800
with the food noise.
That's where I was like, man,

990
00:45:34,800 --> 00:45:37,040
this is like neuotropics I feel
in a way, right?

991
00:45:37,160 --> 00:45:40,000
There's this distraction noise
that we now use a supplement or

992
00:45:40,000 --> 00:45:42,160
something to get us focused role
and goal.

993
00:45:42,520 --> 00:45:44,880
So I definitely see those.
But I think that's where I was

994
00:45:44,880 --> 00:45:48,240
really like, OK, I'm more open
to the concept of GLP.

995
00:45:48,240 --> 00:45:51,680
One, I think before, when I
first heard of it, I'm biased,

996
00:45:51,680 --> 00:45:52,800
probably was more than that.
Capable.

997
00:45:52,800 --> 00:45:54,640
This is cheating.
We could probably use lifestyle

998
00:45:54,640 --> 00:45:57,440
modification to get you to lose
weight and whatnot.

999
00:45:57,440 --> 00:46:00,720
But when you live in a world
where everyone's trying to sell

1000
00:46:00,720 --> 00:46:03,760
you their next greatest product.
And it's what I really want to

1001
00:46:03,760 --> 00:46:05,320
bring on.
Doctor Judd Brewer because he's

1002
00:46:05,320 --> 00:46:07,160
a psychiatrist.
He talks about willpower and how

1003
00:46:07,160 --> 00:46:09,120
willpower is actually not a
thing.

1004
00:46:09,520 --> 00:46:11,720
Talking about that and
understand the mental fatigue

1005
00:46:11,720 --> 00:46:13,720
that people go through when they
have this noise and these

1006
00:46:13,720 --> 00:46:17,040
distractions isn't really just
shutting off your hunger.

1007
00:46:17,040 --> 00:46:19,040
Than you don't even care about
these distractions.

1008
00:46:19,280 --> 00:46:21,280
Is it deleting Instagram off
your phone where you don't have

1009
00:46:21,280 --> 00:46:23,600
a choice to really click it?
We've heard about that, right?

1010
00:46:23,600 --> 00:46:25,840
People have had gotten off other
addictions and stuff.

1011
00:46:26,080 --> 00:46:27,960
Food noise is a really
interesting phrase though, and

1012
00:46:27,960 --> 00:46:31,280
the more people talk about it in
the media, I think the more

1013
00:46:31,280 --> 00:46:34,960
people can use that because the
reality is you and I can't.

1014
00:46:35,200 --> 00:46:38,400
We can't prove whether somebody
has excessive food noise or not.

1015
00:46:38,760 --> 00:46:40,920
If somebody tells me they have
this excessive food noise and

1016
00:46:40,920 --> 00:46:42,760
they've struggled their entire
life and I have no idea what

1017
00:46:42,760 --> 00:46:45,360
they are going through, I'll
have to take them at their word.

1018
00:46:45,360 --> 00:46:50,760
For I do think this is it can be
a crutch for some people 'cause

1019
00:46:50,760 --> 00:46:54,120
they'll drop that bomb and it's
OK Hard to argue against that.

1020
00:46:54,840 --> 00:46:58,480
This is where expertise and
dealing with a lot of people,

1021
00:46:58,480 --> 00:47:03,840
you get a sense of who's truly
struggling versus who's using

1022
00:47:03,840 --> 00:47:07,880
that as a crutch to get the drug
right to go back to the

1023
00:47:07,880 --> 00:47:11,240
treatment.
I think people who truly

1024
00:47:11,240 --> 00:47:15,840
struggle with obesity and food
noise, I should define, I think

1025
00:47:15,840 --> 00:47:18,840
most people in the obesity space
will define it as like you are

1026
00:47:18,840 --> 00:47:23,080
constantly thinking about food.
So what that means is if you

1027
00:47:23,080 --> 00:47:26,200
would, let's say you wake up at
8:00 AM in the morning, you're

1028
00:47:26,200 --> 00:47:28,480
waking up hungry and you're
thinking about what you're going

1029
00:47:28,480 --> 00:47:31,560
to eat.
And not only just about eating

1030
00:47:31,560 --> 00:47:35,880
food, but it can also revolve
around all types of context in

1031
00:47:35,880 --> 00:47:38,680
food.
So it could be this internal

1032
00:47:38,680 --> 00:47:42,400
struggle of not fighting to eat
that bagel and cream cheese or

1033
00:47:42,400 --> 00:47:45,400
Dunkin' Donuts in the morning
and instead just having this

1034
00:47:45,400 --> 00:47:47,720
internal dialogue that you
should be having eggs and, I

1035
00:47:48,120 --> 00:47:50,920
don't know, Turkey or whatever.
So that conversation is

1036
00:47:50,920 --> 00:47:54,280
basically these pervasive
thoughts about food.

1037
00:47:54,320 --> 00:47:57,400
And then when you're done
eating, now you're also having

1038
00:47:57,400 --> 00:48:01,320
additional thoughts about either
how you quote, UN quote, failed

1039
00:48:01,320 --> 00:48:03,880
and put something in your body
that you shouldn't have if you

1040
00:48:03,880 --> 00:48:09,720
did crumble, quote, UN quote and
have that doughnut or thinking

1041
00:48:09,720 --> 00:48:13,760
about the next meal, right?
Mind is distracted, as you said,

1042
00:48:14,000 --> 00:48:18,120
with some thoughts of food.
It could also present in the

1043
00:48:18,120 --> 00:48:23,880
fashion where somebody is just
crazy, persistently logging and

1044
00:48:23,880 --> 00:48:27,280
calculating and just being
obsessive about that because

1045
00:48:27,280 --> 00:48:28,560
they don't want to make these
mistakes.

1046
00:48:28,560 --> 00:48:32,720
So it comes in many forms.
But yeah, a lot to unpack on

1047
00:48:32,720 --> 00:48:33,960
that.
That's a sweet tooth.

1048
00:48:34,440 --> 00:48:36,680
I skipped lunch, for example,
because I'm rounding and then

1049
00:48:36,680 --> 00:48:38,760
I'm like, oh God, I'm just, you
know, stressful day.

1050
00:48:38,760 --> 00:48:39,880
Like today.
I really just want to get the

1051
00:48:39,880 --> 00:48:41,120
vending machine and get like
gushers.

1052
00:48:41,280 --> 00:48:43,120
Thank God the vending machine
didn't work because I had to

1053
00:48:43,280 --> 00:48:45,680
have to have that internal
dialogue with myself and say, I

1054
00:48:45,680 --> 00:48:47,680
know exactly how I feel Gushers
anymore.

1055
00:48:47,920 --> 00:48:50,640
Oh yeah, dude, they do.
But yeah, that internal dialogue

1056
00:48:50,640 --> 00:48:53,520
of once you once you have it, I
know how I'm going to feel.

1057
00:48:53,920 --> 00:48:56,440
And then I try to get the
Gatorade protein bar wasn't

1058
00:48:56,440 --> 00:48:57,800
working.
I was like, you know what?

1059
00:48:57,800 --> 00:48:59,360
Let me just go home and figure
it out.

1060
00:48:59,360 --> 00:49:00,480
So I've been doing a better job
at that.

1061
00:49:00,480 --> 00:49:03,000
But I get that same feeling
where I know if I mess up, I'm

1062
00:49:03,000 --> 00:49:04,880
then blaming myself and saying
why did I do that?

1063
00:49:04,880 --> 00:49:06,680
You know, now I'm going to have
to work three times as hard in

1064
00:49:06,680 --> 00:49:09,240
the gym and whatnot to fight
that off do.

1065
00:49:09,440 --> 00:49:12,520
You want to know what's a really
good strategy for appetite

1066
00:49:12,520 --> 00:49:13,840
control?
What drinking?

1067
00:49:14,360 --> 00:49:17,080
Ketogenic State.
Baby, it's true.

1068
00:49:17,760 --> 00:49:19,880
That is true.
I was going to say a really good

1069
00:49:19,880 --> 00:49:22,600
book on this, though, is Adam
Bornstein's You Can't really

1070
00:49:22,600 --> 00:49:24,640
Screw this Up.
I think it's a phenomenal book

1071
00:49:24,640 --> 00:49:27,000
on the internal dialogue of
you're going to mess up and

1072
00:49:27,040 --> 00:49:29,160
quote UN quote mess up, but it's
not really messing up because

1073
00:49:29,160 --> 00:49:32,040
you can't screw it up.
So get back on track next meal,

1074
00:49:32,040 --> 00:49:34,600
the only thing that matters.
So yeah, I really like that book

1075
00:49:34,600 --> 00:49:37,440
on it.
Oh man, last thing here, if

1076
00:49:37,440 --> 00:49:39,400
you're cool with that, if you
want to go a little bit more, I

1077
00:49:39,400 --> 00:49:40,440
have.
I think I could use your

1078
00:49:40,440 --> 00:49:43,440
expertise here too.
So talking about, we talked a

1079
00:49:43,440 --> 00:49:45,960
lot about DPC model, we talked a
lot about cash based on this

1080
00:49:45,960 --> 00:49:48,280
practice, right?
But I think a lot of people

1081
00:49:48,280 --> 00:49:50,240
might have the questions like
how do you find these providers?

1082
00:49:50,240 --> 00:49:53,160
Like how do you go about
thinking about what labs you

1083
00:49:53,160 --> 00:49:55,640
need to get, who you should get,
how much money you should pay?

1084
00:49:56,040 --> 00:49:58,080
Do you get APCP?
Do you keep insurance or do you

1085
00:49:58,080 --> 00:50:00,040
just see some specialist one
off?

1086
00:50:00,120 --> 00:50:02,920
To recap the listeners, I used
Function Health, which is a

1087
00:50:03,120 --> 00:50:06,160
panel of blood tests that you
know, spend $500 to get twice a

1088
00:50:06,160 --> 00:50:07,480
year.
So I got that.

1089
00:50:08,160 --> 00:50:09,920
I have a history of high
cholesterol.

1090
00:50:09,920 --> 00:50:12,880
It runs in my family.
And so that is something that I

1091
00:50:12,880 --> 00:50:14,720
am actively trying to tackle
down, right?

1092
00:50:14,720 --> 00:50:17,320
And so we've talked about where
getting on statin, do I need to

1093
00:50:17,320 --> 00:50:20,240
get a CAC versus a CTA?
And then which provider, right?

1094
00:50:20,240 --> 00:50:23,120
Does it make sense to just see a
cardiologist like via telehealth

1095
00:50:23,120 --> 00:50:27,040
that is more like a functional
cash based provider or is it

1096
00:50:27,040 --> 00:50:30,520
better to go through and pay my
own for CTA or go through

1097
00:50:30,520 --> 00:50:33,320
insurance versus a provider?
The way I'm thinking about this

1098
00:50:33,320 --> 00:50:36,080
right now is, OK, let me, I'm
taking some supplements, I'm

1099
00:50:36,080 --> 00:50:38,120
doing psyllium husk.
I'm actively trying to lose

1100
00:50:38,120 --> 00:50:39,920
weight as well and get back to a
better shape.

1101
00:50:40,560 --> 00:50:44,560
Do my repeat labs with function,
see where I am at that point.

1102
00:50:44,680 --> 00:50:47,160
And then next year onwards we
talked about rhythm health.

1103
00:50:47,280 --> 00:50:50,720
Rhythm health is a monthly lab
check where it's A at home test

1104
00:50:50,720 --> 00:50:52,720
and you get certain number of
biomarkers.

1105
00:50:52,720 --> 00:50:54,560
But that way you can at least
check monthly.

1106
00:50:54,880 --> 00:50:58,160
Me, I'm a data nut, and I know
if I can keep track and try to

1107
00:50:58,160 --> 00:51:01,400
do better every month, I'm going
to be more consistent with my

1108
00:51:01,400 --> 00:51:03,640
diet, with my workout, stress,
all that stuff.

1109
00:51:04,120 --> 00:51:07,120
I think the thing I'm hung up
on, though, is like, how do I go

1110
00:51:07,120 --> 00:51:10,120
about this cardiologist?
Do I go through my PCP?

1111
00:51:10,120 --> 00:51:13,320
Do I just find someone like
Doctor Harkin, find someone like

1112
00:51:13,320 --> 00:51:19,080
her to get better guidance as
far as medications and lifestyle

1113
00:51:19,080 --> 00:51:20,160
treatment?
What are your thoughts?

1114
00:51:20,480 --> 00:51:23,240
Yeah.
I think in your specific case,

1115
00:51:23,240 --> 00:51:26,240
yeah, certainly Doctor Nicole
Harkin, awesome docs.

1116
00:51:26,240 --> 00:51:27,960
I think she's still practicing
out in West Coast.

1117
00:51:28,400 --> 00:51:34,000
But I would say find anybody for
your particular case who is

1118
00:51:34,000 --> 00:51:38,360
interested in that health.
Like I feel relatively confident

1119
00:51:38,360 --> 00:51:41,080
that I can manage certain lipid
disorders.

1120
00:51:41,400 --> 00:51:44,680
And certainly from a, you know,
your perspective, I know you and

1121
00:51:44,680 --> 00:51:46,480
I have talked about this online,
a primary care doctor.

1122
00:51:46,480 --> 00:51:48,480
So Doctor Nisha Chillin last
night, you know, we were talking

1123
00:51:48,480 --> 00:51:50,720
about this, she had talked about
checking the APOBE, checking the

1124
00:51:50,720 --> 00:51:53,480
LPLA.
There's no reason why a primary

1125
00:51:53,480 --> 00:51:57,120
care provider who knows how to
make sense of the data can't do

1126
00:51:57,120 --> 00:51:59,360
that stuff.
You know, from a cost efficiency

1127
00:51:59,360 --> 00:52:02,600
standpoint, maybe that's better.
I think that if you probably

1128
00:52:02,600 --> 00:52:05,040
find somebody more local that
might work out.

1129
00:52:05,040 --> 00:52:08,040
You just need somebody who can
make sense of the data for you

1130
00:52:08,400 --> 00:52:09,760
and is willing to write you the
prescription.

1131
00:52:09,760 --> 00:52:14,200
Because even I don't think those
advanced diagnostics, you still

1132
00:52:14,200 --> 00:52:17,120
need a prescription to be able
to get that, even if you choose

1133
00:52:17,120 --> 00:52:19,920
to pay for it out of pocket.
That's a tougher like how do you

1134
00:52:19,920 --> 00:52:23,240
find a provider in our insurance
model that you can go into

1135
00:52:23,240 --> 00:52:27,160
knowing beforehand, hey, this is
a provider that is more forward

1136
00:52:27,160 --> 00:52:29,280
with the research and kind of
understands that it's not just

1137
00:52:29,280 --> 00:52:32,840
good versus bad cholesterol.
That's a very difficult thing.

1138
00:52:32,840 --> 00:52:36,640
I had a consultation with three
cardiologists and the 4th

1139
00:52:36,640 --> 00:52:38,920
cardiologist I found was the one
that works.

1140
00:52:38,920 --> 00:52:41,840
I have hyperlipidemia, coronary
disease rampant in my family.

1141
00:52:42,160 --> 00:52:46,240
I take a PCSKNI now because of
my dyslipidemia.

1142
00:52:46,840 --> 00:52:48,520
Most of the cardiologists are
not interested in that.

1143
00:52:48,520 --> 00:52:50,600
Even the preventative
cardiologists who market

1144
00:52:50,600 --> 00:52:53,800
themselves as such will give you
that push back because when

1145
00:52:53,800 --> 00:52:55,240
you're 33, they're going to look
at you.

1146
00:52:55,240 --> 00:52:57,240
They're going to literally
assess you by your looks.

1147
00:52:57,240 --> 00:52:59,160
You're like you're fine.
You don't need to do this this

1148
00:52:59,600 --> 00:53:04,840
and the way that I initially did
that is I looked up to see what

1149
00:53:04,840 --> 00:53:08,160
people are talking about and
what are the publications that

1150
00:53:08,160 --> 00:53:09,880
they're interested in.
So you get a sense of, OK,

1151
00:53:09,880 --> 00:53:12,440
what's their level of expertise
in this specific matter.

1152
00:53:13,080 --> 00:53:18,640
Not all cardiology is lipidology
is a field within itself, right?

1153
00:53:18,640 --> 00:53:20,880
And you could be a lipidologist
and not be a cardiologist.

1154
00:53:20,880 --> 00:53:24,080
And so if that's the area that
you're looking at, probably that

1155
00:53:24,080 --> 00:53:27,080
somebody better suited for you
or really anybody who's

1156
00:53:27,080 --> 00:53:30,440
interested in that aspect of it.
But cardiology is so broad.

1157
00:53:30,920 --> 00:53:36,000
But honestly, it's, there's no,
nothing better than actually

1158
00:53:36,040 --> 00:53:39,560
having that interview and having
that sense, I think within a few

1159
00:53:39,560 --> 00:53:41,400
minutes.
And it's not even just you, the

1160
00:53:41,400 --> 00:53:44,880
layperson, when you have that
discussion with a person and you

1161
00:53:44,880 --> 00:53:49,240
tell them, these are my goals,
My goals are to prevent the

1162
00:53:49,800 --> 00:53:52,120
second or third heart attack
because that's what they're

1163
00:53:52,120 --> 00:53:53,640
really good at.
That's what the medical system,

1164
00:53:53,640 --> 00:53:56,400
right?
My goals are to limit my chances

1165
00:53:56,440 --> 00:53:59,600
of you can't really truly
prevent, but mitigate the risk

1166
00:53:59,600 --> 00:54:01,640
of having a heart attack 25
years from now.

1167
00:54:02,000 --> 00:54:05,160
And if they don't look at you
like you're a crazy person, then

1168
00:54:05,160 --> 00:54:06,440
maybe there's some potential
there.

1169
00:54:06,440 --> 00:54:09,160
But they look at you like you're
ridiculous with your demands or

1170
00:54:09,160 --> 00:54:10,800
your questions or your
aspirations.

1171
00:54:11,400 --> 00:54:13,600
Then you just gotta, you're best
off to just cut that as soon as

1172
00:54:13,600 --> 00:54:15,480
possible because it's going to
be fighting an uphill battle.

1173
00:54:16,280 --> 00:54:19,760
Well, honestly, this would be
like you had asked, like how do

1174
00:54:19,760 --> 00:54:21,000
we figure that out in the
insurance model?

1175
00:54:21,240 --> 00:54:24,200
The challenge with that is in
order to be able to see three

1176
00:54:24,200 --> 00:54:26,360
different cardiologist,
lipidologist, that's a six month

1177
00:54:26,360 --> 00:54:29,280
process.
The direct pay industry is going

1178
00:54:29,280 --> 00:54:33,200
to be much more accessible.
I understand not everybody's

1179
00:54:33,200 --> 00:54:34,480
privileged enough to be able to
do that.

1180
00:54:34,560 --> 00:54:36,920
I'll plug Parsley Health.
Yeah, she talked about the works

1181
00:54:36,920 --> 00:54:38,760
for Parsley Health, and it's
awesome that they're doing this.

1182
00:54:38,760 --> 00:54:39,840
Hybrid models.
And that's it.

1183
00:54:39,840 --> 00:54:40,760
And that's what I was looking
at.

1184
00:54:40,760 --> 00:54:43,480
But now that goes back to my
question, is it worth me doing a

1185
00:54:43,480 --> 00:54:45,440
subscription model?
I think Parsley Health's like

1186
00:54:45,560 --> 00:54:50,560
250 or 270 bucks a month where
my true only real thing I need

1187
00:54:50,560 --> 00:54:53,080
to focus on is just the limpet
stuff and it's just get a

1188
00:54:53,080 --> 00:54:56,480
cardiologist and just do A1
tower place a year type visit

1189
00:54:56,800 --> 00:54:59,040
where I can really take care of
a lot of the other stuff and I

1190
00:54:59,040 --> 00:55:00,880
feel healthy with everything
else I think.

1191
00:55:01,080 --> 00:55:03,280
You and I, we have the advantage
that we have a network, so we

1192
00:55:03,280 --> 00:55:04,480
could probably reach out to
people.

1193
00:55:04,480 --> 00:55:07,320
My current cardiologist, I ended
up connecting with him because I

1194
00:55:07,320 --> 00:55:10,440
had asked some residents who are
interested and I was like, hey,

1195
00:55:10,440 --> 00:55:12,160
who's a good cardiologist that
you've worked with?

1196
00:55:12,760 --> 00:55:14,600
And his name came up multiple
times.

1197
00:55:14,600 --> 00:55:17,120
This person, they get it and
they understand my goals.

1198
00:55:17,120 --> 00:55:20,960
I would probably start there to
see if you have a network, you

1199
00:55:20,960 --> 00:55:22,920
know who we could probably talk
from Persistent Health.

1200
00:55:23,080 --> 00:55:25,360
We could ask Doctor Cromwell
again.

1201
00:55:25,520 --> 00:55:28,200
I wonder what their system is.
Absolutely good idea.

1202
00:55:29,560 --> 00:55:31,280
We'll see how it'll be the end
of the year thing that I'll be

1203
00:55:31,280 --> 00:55:33,960
researching and looking into,
but I'm excited to try Rhythm

1204
00:55:33,960 --> 00:55:36,560
Health and there's super power.
That's the other thing was man,

1205
00:55:36,560 --> 00:55:39,640
where all this consumerism with
blood testing is going is pretty

1206
00:55:39,640 --> 00:55:41,080
insane.
You need to stop drinking on the

1207
00:55:41,080 --> 00:55:43,000
show.
That's forget about lipids.

1208
00:55:44,040 --> 00:55:46,800
Drinking non alcoholic beer.
Yeah, I've always start with

1209
00:55:46,800 --> 00:55:48,720
step one.
Stop showing up drunk to the

1210
00:55:48,720 --> 00:55:50,680
podcast.
People gotta try Bureau.

1211
00:55:51,000 --> 00:55:52,160
No?
I still can't believe there's no

1212
00:55:52,160 --> 00:55:53,280
alcohol.
Yeah, absolutely didn't.

1213
00:55:53,440 --> 00:55:54,720
Say it all right man, this was
fun.

1214
00:55:54,880 --> 00:55:56,400
Sounds good man.
Thanks for listening to the

1215
00:55:56,400 --> 00:55:58,000
other episode of Medicine
Redefined.

1216
00:55:58,440 --> 00:56:00,640
If you enjoyed this episode,
please be sure to check out some

1217
00:56:00,640 --> 00:56:02,400
of the additional resources in
the show notes.

1218
00:56:03,000 --> 00:56:06,040
Please also check out our social
media platforms where you can

1219
00:56:06,040 --> 00:56:09,520
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1220
00:56:09,760 --> 00:56:12,240
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Redefined.

1221
00:56:12,960 --> 00:56:14,920
We also want to thank our team
for the production of this

1222
00:56:14,920 --> 00:56:18,560
podcast, specifically Ethan Jill
on video, Harita Yapuri on

1223
00:56:18,560 --> 00:56:21,560
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1224
00:56:21,560 --> 00:56:23,760
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00:56:23,760 --> 00:56:26,560
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1226
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1227
00:56:29,440 --> 00:56:32,360
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00:56:32,360 --> 00:56:34,680
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1229
00:56:34,680 --> 00:56:38,200
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Now time for the ever so

1230
00:56:38,200 --> 00:56:41,520
important disclaimers.
This podcast is intended for

1231
00:56:41,520 --> 00:56:44,200
general public use and is for
educational purposes only.

1232
00:56:44,680 --> 00:56:46,800
It does not cost you the
practice of medicine nor should

1233
00:56:46,800 --> 00:56:48,160
it be construed as medical
advice.

1234
00:56:48,520 --> 00:56:50,560
No physician patient
relationship is formed and

1235
00:56:50,560 --> 00:56:53,320
anything discussed in this
podcast does not represent the

1236
00:56:53,320 --> 00:56:56,000
views of our employers.
We recommend that you seek the

1237
00:56:56,000 --> 00:56:58,600
guidance of your personal
physician regarding any specific

1238
00:56:58,600 --> 00:56:59,640
health related issues.