203. What Medical School Doesn’t Teach About Health, Fulfillment, and Finding Your Why | Brian Devorkin

Welcome to Medicine Redefined. I'm Dr. Ultima Sharajah. And I'm Dr. Darsha. Let's put the hell back in healthcare. Today's guest is Brian DeBorkin, who at the time of this recording is a third year medical student at Case Western Reserve University, host of the Back to Bri Science podcast and creator of Back to BriScience.com. During his gap year, he worked alongside renowned longevity researcher Dr. David Sinclair, immersing himself in the science of longevity, healthspan, and preventative medicine. But what makes this conversation compelling isn't just his resume, it's his perspective. Brian shares how his own experience with chronic illness forced him to rethink the traditional definition of success and led him to a philosophy centered on health, purpose, and fulfillment. We discuss the difference between lifespan and healthspan, why optimizing every biomarker can distract us from what actually matters, how identity shapes our habits, and why happiness may be a better goal than achievement alone. What struck us most, though, wasn't simply what Brian had to say. It was when he arrived at these conclusions. At just 26 years old, he articulates ideas about health, ambition, and meaning that many physicians, entrepreneurs, and high performers spend decades trying to figure out. Whether you agree with this philosophy or not, this conversation will challenge the way you think about success, longevity, and the life you're ultimately trying to build. Let's dive in. If you're a high performer who wants a clear plan for longevity, performance, and staying active with fewer setbacks, I'm now seeing patients through my telemedicine practice who are finding health and performance. I'm opening a limited number of founding member spots at refininghealthrx.com. All right, let's jump in. Brian Dvorakian, what's up, man? Welcome to the show. It's great to be here with you guys. It's a pleasure. Thanks for having me. Awesome, man. No, the pleasure is ours. You have a really interesting background. When we first chatted and I kind of got to look at your own podcast and the things that you've been up to. Yeah, really excited to have you on here. You're now in medical school. You're a third year medical student. You're at Case Western, correct? I am. Yes. Awesome. Cool. What made you choose medical school? What is the problem that you are trying to solve? Because I know you did a lot in your gap year, which we can get into. What is it that interests you? And what is it that you're passionate about? The problem I am hoping to solve is perspective. And I know there's so many ways and avenues my life could have went to treat this perspective problem. But I think that we have it all wrong. And I think especially when I say we, I mean America and our culture is that we live a life towards success. But success is not fulfillment and fulfillment is what drives happiness. And my perspective is, can we change culture to understand what it would be like to live in a world where we truly pursue happiness? We truly find fulfillment. And I chose medicine because I believe the perspective that it allows me to provide others is health has to be at the center of that. Because there's so many famous quotes and one that really resonated with me because I have faith. dealt with, you know, chronic illness or just fatigue is that a healthy man has a thousand wishes and a sick man has one. And so truly like taking care of your health, paying yourself now and doing what's hard now so that every day later is easier. It's an ever piling mountain of hardness now, but it's always just easier and easier and easier later. Wow. Love that. We might just have to pivot this to a completely philosophical episode. Now that Altamash is reading. I'm just going to take a backseat here because this is not my area of expertise. Well, you're even reading a lot of happiness, right, Altamash, and things like that. And it's awesome to hear that, Brian. I mean, you don't often hear that, right, from medical students that are trying to say, hey, I'm trying to understand perspective. Take me through a little bit, though, what you mean about fulfillment. What are those things, in your perspective, that people need to live a fulfilled life, aside from health? I can't list what matters to other people. What I can list are things that matter to me and examples of what commonly comes up in other people's lives. And that's usually going to be things like socialization. So things that really matter to me are having a community, having family. Having people that are loyal and respect you and allow you to see yourself and respect yourself in a light that isn't always easy. Sometimes when things get difficult or you need to be reminded of who you are, it's having some sort of food culture. That's a really important to me. I really love things like sushi, eating out healthy meals, having access to that, having people around you in your life and having opportunities and finances that allow you to do things like that, go get dinner with family, with friends, whatever it is. And then really, again, just having the freedom of pursuit of passion. Do you have the support to actually do what you want to do? And that's, again, a whole other topic of, are you in medicine for the right reason? Are you doing medicine because it speaks to you, because you love it? Or is it one of those things where it's like, hey, I'm checking boxes because I have parents or I have this pressure, I want to impress people or it's safe or all the things. There's so many things that can bring you fulfillment, but really at the base of it, it's like what makes you happy and how can you live a life that allows you to do the most of that with the most things that allow you to feel that? Brian, how old were you when you got this perspective? That's a really good question. I really think that part of me my whole life felt a little different. Like there was this nagging feeling at me. And that kind of goes back to like why I even chose medicine. I think why I so cling so strongly to these values and these ideas is because I kind of was that person. And it was by no fault of my parents who like all they said is work hard, do what you want, we support you. But at the same time, like they were both lawyers. And then I had my siblings who were going to, you know, secondary school and graduate school. And it always felt like, yeah, like I can do whatever I want. But like, really, that means like life's hard. Like choose something that allows you to be good at what you are good at and be sought after and respected. And so medicine, like from an early on was like, I like science and it makes sense. And so I kind of blindlessly followed that. And I would say now to directly answer your question, in my gap year, COVID hit and I was undergrad still. I was like a sophomore going into junior year. And you guys remember like undergrad, sophomore to junior year, you start taking some higher level classes. It gets pretty hard and you're like, man, COVID hits. And now things are online. Like I'm really asking myself, like, why am I doing what I'm doing? Because learning is not as fun as it used to be. So to do what I was doing before so blindly like was easy, even though it's hard. Now it's like, it's difficult because like, why am I doing what I'm doing? Where's the passion coming from? So it had me ask those tough questions. And I think that's when it started to form. That's when COVID hit. And it was like 2020 was a pivotal year of like seeing the light at the end of the tunnel of that light being like fulfillment is really important. important and what does fulfillment look like? And then I started doing some leadership conferences and all these different things. And that's when it really occurred to me. In my gap year going to medical school, I started asking myself, like, really, I'd like to try and be as self-aware as possible so that no one can ask a question I don't already know the answer to. And it was like, okay, now I know I'm doing it. And now I can kind of see that the end game really is no end game. It's just living the life and the whole game is about fulfillment. And like every step of the way, just doing what I can to you ask the question, like, what does that mean? And continuously asking myself that, like, what makes me fulfilled now might be different later, but it's really just continue to follow that. And so there's no chase. It's just kind of staying on that path and allowing the pursuit of passion to really just be happiness along the whole route. You know, what's funny is, Darshan, I think two days ago, we were just talking about the self-awareness. Most folks, if not all, I'll say, when they're at the stage that you're in, 30-year, it's just about putting your head down and going hurdle after hurdle after hurdle. At this point, most students are thinking about, oh... I don't know, you call it V-SLO or whatever it is. When you're applying for your audition rotations or sub-internships, selecting a residency that you might want to go into. And really medical school is kind of laid out for you like that. We just talk about it. It's really not complicated. It's hard. It's not complicated. Your steps are laid out for you and you just got to grind, grind, grind, grind, grind, grind. And then you keep telling yourself throughout the pathway. It's like, yeah, I will be happy when I match. I will be happy when... I match fellowship. I will be happy when I finish. I'll be happy when I become associate professor, blah, blah, blah. And then you get to the end, you're like, oh, shit. Okay, what's next? The idea we've talked about, right? It's just the arrival fallacy that you're never going to truly arrive. And so you have to recognize, and we talked about this before, I think I had mentioned that maybe there really isn't a light at the end of the tunnel. Maybe we actually have to light that tunnel yourself. Even though I came to that realization a year after being an attending, right? Right, Darsha? I think that's kind of when we did that episode. You have this much earlier on. If you don't mind me asking, how old are you? I'm currently 26. That's amazing. Yeah. I'm really interested in how a 26-year-old, we have a decade of gap between us, arrives at this. I've got 10 years of reading Mogadad and Happiness and this all night. I was reading Darsha's The Monster You'll Create Again last night. I've got that pinned on my sub stack now. And I'm interested in how a 26-year-old arrives at this perspective, so to speak. So you mentioned siblings. How many and where are you in that order? I am a middle child, two older twin siblings, guy, girl, 29, and then one younger sister, who definitely is a younger sister, and she's 21. Wow. or 22. So you're like dead smack in the middle. One of four, so big family. And you also pointed to something earlier. You said, hey, like I've kind of battled some chronic stuff myself. You've been a patient. I think that that's a really interesting thing. I was telling my physical therapist the other day, I think it's almost, I feel that it's almost necessary for physicians to be patients and actually have to go through the ringer and deal with something difficult, not just themselves directly, but maybe even as a caregiver, like having to take care of your older parents, seeing the bullshit that you have to deal with, maybe like some difficulty fighting some insurance battles. I've talked about that on here. If you don't mind sharing, I'm curious to hear a little bit about that journey and how that affected this perspective that... you've eloquently spoken on earlier today. I definitely will resonate before I go into the story itself that like, you know, with the leadership conferences and just reflection, you really do realize. And as you talk to more people, get other people's perspectives, you only really understand what you understand already. So when you share something, the only way I can understand it is by going based off what I already know. So the power to experience something really does allow you to understand it from a whole different arena and really like feel and feel invigorated and motivated by it. So I agree. You can really treat and understand patients at a very different level when you've gone through it. And a really easy example for the listeners, because maybe they haven't struggled with certain diseases or whatever it is, but anxiety. Like there's some people that might be listening that say, I've never actually felt that. Or if like I have, I don't know if I like truly have, I'll say I have anxiety before an exam, whatever. But when you have anxiety, when you felt panic, it consume you. you can truly understand. And that doesn't mean you have to have a disorder, but just like some people who really haven't ever experienced it. And you'll know when you talk to people and it's like, whoa, again, the power to have the relatability, that empathy to truly understand when someone says I'm struggling, some people want to say like, oh, okay. Yeah, but you can get over it. It can be very difficult. So again, just resonating on that idea that you shared in terms of my story. So it was a little bit about the time of COVID again, like, Just before that hit, I had been dealing with this chronic fatigue for probably two or three years. And I didn't really know it. I'm an undergrad. Like, you're a workhorse. I'm going to med school. Like, I'm just doing everything. I'm checking all the boxes. I'm studying. I'm doing volunteering. I'm presidents of clubs, whatever it is. You're just trying to build your resume, do what speaks to you. And you're moving. You're having experiences, memories. So I just put it off. I probably am not sleeping enough. I am exercising like I did take care of myself. I don't drink alcohol and I don't do drugs. So this was like, something's probably wrong, but maybe I'm just getting older. It just got to a point where my friends, we'd be going out and it would be like 9 p.m. And they'd be like, all right, you ready to go out? And I would be on the couch and I would be thinking to myself, like, honestly, I feel like I'm going to die. I never told anyone, but I was like, like truly to move right now. I'd get up, feel lightheaded, feel like I was going to pass. Like, and I was just like, maybe this is normal. It ended up I did test positive for Lyme's disease. And so I was struggling with what I believe to have been chronic Lyme. And so there really was some satisfaction in knowing like this wasn't how I was supposed to feel. And that kind of motivated me to get into this health performance optimization. Like how can you feel at your best all the time? And it kind of started before that because I'm like, I feel so terrible. Like what can I do? And trying to optimize and play with that. But then it was after that of like, okay, medicine plays a role. And like, how can now I use that, leverage that? And when I tell you, when I got treatment and I remember specific times of like reading through comments, I've never looked at reviews of like products, whatever, you know, I would try some herbal supplements, whatever. Most of them didn't work. But what did resonate was when it finally worked and I remember the reviews, I feel like I got my life back. I've never felt so tightly related to something in my life. Because I was like, I know exactly what that person's saying. And it's crazy. Like you feel like your life was stripped away from you. Because you became a different person. The energy. Every day, like showing up, I didn't feel like myself. And what's crazy is like all these other people, I would tell them like, I just don't feel like me. And they'd be like, I see you. Like I understand. I understand. But I was like, I don't know if they do, because I haven't felt for years like I've shown up as myself. So to have that reclaimed, man, it was a really powerful moment. And I'll never forget that. Yeah. We're speaking about his agency, right? I think I try to explain this to the trainees that I work with, especially because we see a lot of patients with chronic pain. That's my number one thing I do, musculoskeletal medicine. And so. Patients would come in with an injury that's just converted into something that's been lingering forever. And before you know, you've got one thing, nagging thing. You talked about that high performer who has a lot of anxiety, maybe a little central sensitization. And they can't do or they can't perform the way that they could before. I was talking, I forget who I was talking to. Oh yeah, a previous colleague who is now turning 43. We were just talking about managing his symptoms, whether or not we should think about doing TRT at this stage in the game. And we were talking about, hey, are you comparing yourself to your 23 year old self? And that's what high performers do. They're always like, yeah, but 20 years ago, I could do X, Y, and Z. And it's like, okay, that's how life works. So I love that, man. I think that really is interesting. And so I guess that begs the question. So this is undergrad, you took one gap year, right? Correct. Yeah. One gap year. And at that point you decided you're going to go do research. Talk to us a little bit about that process. How did you arrive there? You worked with somebody who's really well known in the world of quote unquote longevity and just extending lifespan and healthspan. And so walk me through that process a little bit. I would actually correct you only in that most people assume because of who I worked with. And I'll be like, yeah, I worked with this PhD at Harvard. His name was Harvard math. His name was David Sinclair. And so he did research. I told myself going into my gap year, I'm like, I want to find something meaningful. Like this gap year, I want it to be a year where I can truly say I did exactly what resonated with me and allowed me to feel like that year off was a year well spent. And so it wasn't research. It was actually starting a longevity coaching company with David Sinclair online. who is a researcher known for his research, famous for longevity research, but he also has so many different health ventures and different companies and all the such. But so I started a company with him when I was at Michigan still, and then went to Boston to basically go full time and do that with him and kind of boost it. And it was an amazing experience. So I was really thankful to be exposed to that world. It showed me things that resonated with me, things that didn't that I'll take into my practice, other things that I won't. It was a really privileged experience to, again, just be in the world of an influencer and kind of see what that looks like and really allow an idea of what my future could look like. And again, things that maybe I know wouldn't work well for me in terms of chasing fulfillment in a career. What were some of the key things that you learned for somebody who's, I guess I'll use the word prolific, or who's further ahead, who's so well known, who understands, who's been in the game for a very long time, and you're just this young, excited person. You don't really have any experience. You've got the passion. You've got the energy. What are some key things that you learned there that you are still holding on to today? I think, and this is a kind of, again, what I embody. And so like people that know me, I try and live what I preach. And that is really just like wellness. And that's exercise, nutrition, sleep, socialization. I just had to ask you to get off the treadmill. So that's for sure. The walking desk. I do use a walking pad quite religiously. That's for sure. But yeah, it really does come down to a golden bullet, silver bullet. And they're like, just tell me what to do, what to take. less what to do, more what to take. Of like, that'll make me live longer. Like, I just, I don't want to think about it. Just like, tell me something really simple and there's going to be this solution and I just must not have known it. If it were that simple, everyone would be taking it. Everyone would be doing that really simple thing. And so that really frustrated me and just was a reminder of like the pervasive nature of culture that we just want easy. We want what's easy right now and we'll deal with the repercussions later. And so again, there's this quote, and I think I got it from... social media i'll have to look who exactly it was but it's basically do what's easy now and life will be hard later do what's hard now and life will be easy later and that's funny because it's like well then when does life get easy right like if you're always doing hard that sounds like But like if you think about it truly like you wake up and you get up at 5 a.m. and you get your workout in and every morning it's like man it would be so much easier to sleep in and every morning you choose to sleep in I promise you're gonna look back and say that was easy. I guess sleep did feel good and now all day I feel bad. Every morning you get up and you work out and you get through it and you look and you say, oh, that was an hour of suck for 15 hours of clarity. That really resonated with me. So truly what I kind of took away is just how can we change the culture and truly motivate people? and show them how to build their life and create an identity that allows them to live that. And if I can just provide as many more healthy years for loved ones to spend with loved ones, that's really where my passion comes. Love that. It reminds me of Jocko, Will Nick as well, right? Where he says discipline equals freedom. And so the hard work is the discipline. And through that, you actually, life becomes easy because not necessarily that you're on repeat, but you know that you've created a quote unquote, an easy life as you're doing the hard thing. So definitely, definitely love that. Awesome. So actually I'm curious because you're somebody with very high agency. How do you even get to work with Davis and Claire? Like how did that process even happen? Did you hit them up or was there an opportunity? Yeah, I'm very relentless. Like if I want to speak to someone, I will be as respectful as I can, but that does require a response. So like there are a lot of people that are very busy that I've been told before, like, hey, this is coming off as if like you're the most important person in the world. And it's like, I'm not trying to come off that way. All I'm trying to come off is in like, it's a yes until you tell me no. At least respond to me. You don't have to give me the daylight of time. Like if you choose not to, but at least... acknowledge so that I know that I did everything in my power to get across your table so that you gave me a shot. And so with Dr. Sinclair, it was when, you know, I decided, okay, I'm going to take a gap year. I want this to be meaningful. I found my passion in longevity, giving people more healthy years to spend with loved ones. And I was like, I want to explore that. I think it's really cool. I want to work with people I really respect. At that time, he was one of them. So I probably emailed him 15 times and I didn't get a response to get a response. And then when he finally responded, it was as if he didn't see all 15 emails. He saw one and he just said, hey, tell me more. And I basically sent my resume and I am just confident in what I do know. I have put a lot of time in to certain things. And I said, I know I can provide value. So just give me an opportunity to provide value. And I spoke with conviction and he gave me an opportunity. We got on a phone call and he believed me. He said like, oh, I kind of like this. And he gave me an opportunity. We started small and then he was like, hey, all right, if you want to come, you know, I know you're going to med school in a gap year. Then yeah. And then we had work cut out for us and everything, you know, the rest was history. That's awesome. That's amazing. I love that man. 15 emails. Relentless is the appropriate word. I was thinking about that. As you get a little bit more seasoned, you start thinking about how to protect your own time. And there's this saying that your inbox is somebody else's priority list or some version of that. And so you don't always have to respond. And sometimes you can. Sometimes actually, in fact, I was looking at Jefferson Fisher yesterday talk about rather than saying, no, I'm busy find other words to say, hey, I'm either at my capacity or it's not in the cards for me or my attention is somewhere else. I even actually arrived at this conclusion maybe a year ago. It's like not everything needs a response. And if you don't respond, most of the things that actually tend to take care of themselves. But the fact of the matter is, I think we've heard a lot of people who are really successful in life will say. Yeah, they don't respond. They don't respond. And what happens is people give up. And it's the person who keeps pushing through, such as yourself, who gets that opportunity. I think, Darsh, correct me if I'm wrong. Like, that's how you ask that question. It's like, how do you even go about getting somebody's email like that? I'm sure there's some people listening who have no idea who the hell we're talking about. But I think that if you do, then you recognize that there is some credibility there. And more importantly, it's an opportunity. And so the next thing I'm thinking about, all right, so you go do that and you probably are exposed to progressive thoughts is what I'm going to say with respect to health, just to keep this apolitical. And then you go back to medical school where it's unfortunately oftentimes still very antiquated in terms of, hey, what? memorize a cycle, learn these drugs, blah, blah, blah. And you're inundated with this stuff. And you kind of just, again, lose agency, lose your time. At least I did, right? I was just trying to figure it out. I was barely passing that first semester. Did you have some struggle where you didn't have the time to kind of entertain the things and scratch that itch and learn about some of the stuff that you're passionate about, podcasts, that kind of stuff? If so, how'd you handle it? So even in those times I told you I struggled when COVID hit and I was like, I got to rethink this. Like, what do I want? I never wavered. I've never in my life to the point of medical school, we're going to say to the point of that first year of medical school, had any doubts. And if there was some doubts, it wasn't like hesitancy. It wasn't like I'm doing this, but I don't know if I should. It was like, let me think about it. Let me think about it. I'm set. I was always confident in what I was choosing. And so the reason I start with that is because it shook me. my first year, I would say halfway through the first year, was when I finally started to say, it was probably some of the post travel blues coming down from winter break, coming back with family, a little bit even before of like going into it of like, again, what am I doing and why? Could I do this without getting an MD? And what was this? What did I want my future to look like? And it was difficult because I think a lot of happiness boils down to not looking at all the opportunities because there's a billion. There's so many different ways we can go about life. And when you open your mind and you tell yourself you have all these different doors, which theoretically I did, like I could go back to work in Boston with David. I could go back and work at home. I could start my own podcast or company now or whatever. So why medicine? And so it really drove me nuts. And it was like, Like you said, it was really difficult because yeah, it was the first time where I'm like, I don't have time to be creative to do things like I feel like I am giving where I was giving my whole gap year now it's like I'm just retaining and I don't feel like I'm making any impact like when does that come? How is this helping me make impact? I really struggled. I really, for the first time in my life, questioned doing something as I was doing it, which made it even scarier. Cause you're like, I don't even really have time to think about it. I gotta be doing it. You can imagine how, for all the people that are relating, like, yeah, I went through med school, I'm in med school now. And it's like, it sucks when you're like questioning something as you have to somehow motivate yourself to do it and it's not easy. It was really difficult and it was a struggle. And I just really leveraged my support system. And I'm just someone, as you guys probably can see, like I need to communicate. I need my feelings to be heard, to be shared. I need to voice things out because I as I talk, as I speak, as I get challenged, challenged myself by others is when I really realize like where the source is coming from and can come to new conclusions and really get through things. That's kind of what I did. It was just like, okay, drawing board. Like, what does my life look like in two years, five years, 10 years, 20? Like, what are my goals? How is this helping me get there? How can I reground myself, root myself and remind myself of what I'm doing it? Why am I doing it? What's the purpose it's serving? And then once you do that, and you can kind of just, you know, take away all the cloudiness surrounding that decision and looking at all the options, all the doors that are open to you, because there are many. it was really helpful to dial back in and realize the opportunities available that come from medicine and my passion in it. Why is the impact important to you? I would say again, with my story of chronic fatigue and for a really long time suffering alone and not sharing that with anyone, And then seeing others go through it, knowing people personally, seeing my parents who are health optimizers themselves. And if you look at them, they're very healthy on the surface, but everyone has something going on underneath. And feeling like people's loved ones are struggling, my loved ones are struggling. I feel like I truly can make a difference and be that person that reaches out, speaks out for them, and finds a whole new perspective that allows them to feel hope. and feel like there truly is more to life that they can tap into. I guess maybe you having worked with starting a company, you said a longevity coaching company, maybe we should define, I'm actually curious to hear your thoughts or your definition of it. How do you define longevity to people? How do you explain it to somebody who's never heard of it? I'll explain it two ways. I'll start with what I think most people would explain longevity as, and then I'll explain it how I viewed it as, because it's more aligned with my passion and what I was trying to get out of it and provide in the role. I would say in general, when you think of longevity, it's optimizing your health to provide more years on this planet. Yeah. And in general, you could argue that within longevity, there's inherently a health span, which is just you feel better with the years that you're given that are also extended. Depending on who you're working with, I was working with David Sinclair. He also would definitely lean a little bit more towards like we're looking for Healthy aging, yes, but also life extension, like truly remarkable, pivotal, like, you know, the longest person's lived or whatever, 120 or something. Maybe we've calculated based on science, 150 would be the max possible life. How do we go beyond that? My passion, how I define longevity is really going to be having as many healthy possible years on this planet that you want to be here feeling at your absolute best so that when it is your time, you're completely content and you're carrying your luggage, putting your luggage on overheads and planes, playing with your grand, great, great, great grandkids, whatever it is. And so I really do emphasize healthspan because for me, it really just is whatever is written in our cards for how long we're going to live. We do have some impact on that. But I just want those to be good years, healthy years that you are able to do everything you want to do and aren't limited. It's funny, I, of course I'm biased when I say this and it was that I think that PM and R docs are the first longevity docs, because if you think about the entire specialty is based off of health span, that's really kind of what you're looking at, right? Somebody has a spinal cord injury, stroke after the fact, and people who don't know physiatrist, that's some of the buzzwords we talked about function, improving quality of life. Somebody's experiencing disability and you want to help them regain function. And When we hear the word disability, you're thinking something catastrophic, stroke, spinal cord injury, Parkinson's, that kind of stuff. But they talk about this often, you know, to the baseball player who's throwing 100 miles an hour and now maybe has, you know, maybe a labral tear is now throwing 92 miles an hour. Like that's a disability. In fact, from a workers' comp perspective, that is a disability, right? If you can't do your job. I think improving quality of life was the number one reason I got interested in this as well. and healthspin, kind of we talked about. It's like, okay, how robust could those last 10, 20, 15 years be? Of course, if you do that and you get a couple extra years, that's nice too, but it's really adding life to those years rather than adding years to life. I couldn't agree with you more, man, but I think that actually answers my question of why you chose PM&R above else. Is that why? Yeah, it's funny you say that, because I always, Every time I try and describe what my passions are, what the kind of impact I want to leave in as medicine, what I maybe see as my future career, there's like, oh, functional medicine or lifestyle medicine. And you know what's funny is that PM&R is functional medicine. It may be in a little bit different way than functional medicine is actually carried out or like the term is used in that. But when you talk about functional medicine and restoring function, providing function, yeah, that's literally the basis of PM&R. And I couldn't agree more that I think it's such an amazing and expanding field that provides the opportunity to do exactly what we're talking about. Let me ask you another question, man. I think the semantics are really important with this stuff because it's shorthand for us to be able to communicate, hey, here's what I'm doing. And I imagine 20 years ago, I mean, Darcy, you'll know this better because one of your mentors, Dr. Crocetti, was in this, right? He's like one of the pioneers. Functional medicine didn't have a bad rap. And people would say like, oh, you know, I want to be able to communicate looking at the big picture and practicing good quality medicine, not being dismissive, being open minded, everything that we'd like to talk about on the show. And what am I going to call it? Oh, I'm going to call it functional medicine. Now, when you go out and try to say a functional medicine, quite honestly, like I have paused when somebody says, oh, so you're interested in functional medicine. I say, well, just because there are enough people out there who are going to just say, oh, that means you're a quote unquote quack. I hate that term, but that's what they'll say. And then, so I think a lot of people started pivoting to saying, oh, I do longevity. And longevity was still somewhat quote unquote pure in that regard. And now that's for a variety of reasons. That's somewhat tainted as well. Some very recent reasons. Yeah. Maybe we won't get into that today. And it just gives me concern. I think that we've talked about this before. Darsh is like, I mean, we just look at it as, hey, man, there's good medicine and there's not so good medicine. And so I think we're probably going to take full circle in this where people are just going to come back and start identifying with your core specialty again. So I think I'm looking forward to that day. I'll give my perspective and then I'm curious what you guys say to this, but I resonate with that a lot. And that's kind of the reason where it's like, I really like the longevity experience I had, but why I'm not going into longevity medicine is for this kind of similar reason. And I feel like you just see like, for example, we'll just use this kind of made up example of like vitamin D. A paper comes out and it says like reduces cancer by 50%. And all of a sudden, you'll just have one paper and then you'll have this functional medicine doctor. And not to say it's the whole field, not to say it's everyone, and maybe it's not even functional medicine. But I just feel like there's this idea that one flashy tip of the iceberg paper comes out, which maybe isn't the best example or doesn't really look at high quality evidence. And then we just say, okay, your cancer risk decreased by 50%, just go take vitamin D. And it's like all of a sudden they're real coworkers. You guys are a little bit further out of medicine. So I'm curious what you're going to say to this question. The question being, how does this happen? Because like I'm in medical school now and I'm like, they teach us enough to know like the body of literature to really understand like we shouldn't just draw these. That's a crazy conclusion. I'm sorry. In almost every case, like nothing is that impactful. Almost nothing. So I like look around at my peers, like which one of us is, or maybe me, like are going to be the people that start doing that. I don't really understand how that happens so pervasively. I mean, I'll speak from the community setting. Again, I think a lot of medicine has turned into a game with financials and how to make money. You have your PCP, then you have referrals, and then you'll, let's say you're Parkinson's. So neurological specialist, they have autonomic dysfunction, you have your cardiologist. There are people out there though, who are saying, well, I can treat Parkinson's, but wait, I can do all of that. So why don't you actually come to me? But in order for me to have an umbrella term, I'm going to call it longevity, or I'm going to call it neuro rehab or whatever it might be. But in order to differentiate now, well, what can I do different than a combination of a neurologist and a cardiologist? Well, they might not know supplements, right? Oh, but there's this paper. And then you kind of, it's almost like audience capture, I feel. In order for you to become validated as that physician that takes care of whatever that patient may have, you almost have to trick yourself into believing that you are providing the best type of care. Because you might not be doing harm by giving the vitamin D, but you sure as hell aren't doing as much benefit as you think you are. And people can go to sleep at night knowing that, that hey, at least I'm not causing harm. But the patient may have gotten 2% better and I'm making money in the end, And now I get an word of mouth referral, you know, et cetera, et cetera. So that's how I typically see it, especially here in Tampa, because it's a huge wellness community. I mean, med spas are popping up, bath houses are popping up. It's left and right aesthetics, whatever it is. But that's kind of what I'm looking at is like, what is the game that they're playing? How are they marketing it? More and more are to come. So it's gonna be interesting to see. I guess I'll add to that. It's interesting because it could be a really slippery slope, right? So if you are that person who is interested in thriving instead of just surviving. So medicine, we talk about sick care, right? We're going to ask you that question at the end. You talked about optimizing, use that word, again, feeling your absolute best. And if you talk about those high performers that we were referencing earlier, like they're comparing themselves to maybe five, 10 years ago. And they're like, no, I do think this is achievable. In fact, I was talking to a friend today who was like, yeah, I'm not scared of 30. He's 20. He turned 26 this week. He's like, I'm not scared of 30. Yeah, I'm going to get better and better. I was like, all right, we'll talk to you in four years. But I think that it's all about signals and noise ratio, right? And so I think the astute clinician, one who is not lazy, one who is going to do the due diligence, is going to look at that paper, maybe tear it apart, or at the very least, like read more than the abstract or just the headline. The reality is that we're getting lazier and lazier. We'll talk a little bit about artificial intelligence. We were talking about that earlier. We just want to be able to say something, put a little quick prompt in, and we want the information served up to us. We don't want to do the work. And so that's only training us to do less work than we had to before. Like, shit, like nobody does Google searches anymore. Right. We're just putting it in a chat GPT, asking that question, and you want that to go fetch the information for you, perplexity. And so the number one is like when you're asking about, hey, which one of these people are going to do that? Probably anyone is susceptible to it who's not going to read the paper, which is probably going to be a large number of them. Now we're talking about intelligent people. I'm not even considering just APPs and PAs and functional medical practitioners, where you don't even have to be a physician and go through four years of schooling and that kind of stuff. But even within, let's just say, the folks who've gone through the rigorous training and residency training, Yeah, to Darsh's point, man, it is a business. And it gets really interesting. It's like, it's a two by two framework. And you're like, hey, if I really want to help somebody get that extra 1%, get that extra 2%. And the harm is potentially low. I mean, there's maybe some financial harm, but the patient gets to make that decision. right? The consumer, I'll call them, they are an informed consumer. They're going to make that decision. Who am I to kind of tell them what they can't do, what cannot do, right? I mean, patient autonomy is big. Some of those, what is it? Beneficence, like I forget what those things are called. Like that, that's gone, right? Like you have to let the patient make that decision. And so if that's happening and you're not even considering the business aspect of it, then that's one way you can convince yourself. Oh, okay. Maybe they're 2%. I'm actually doing good. I asked you earlier, why is impact important? And you answered me by saying, Hey, like I've been through this. I've seen this. I know I can make a difference. You want to help people. I think most people who go into this field at some level, and there's a spectrum to that, have that desire to make a difference in somebody's life, maybe not large scale, maybe at one person's life and help in some, some altruistic motives. Yeah. And so that's a story you can tell yourself. And then if you stack on top of that, now you are getting paid, like Darcy said. It makes it even easier and easier. Where it gets really scary for me is when, you know, Darcy, you and I were talking about NAD this morning, is, you know, when people start engaging in some of these practices just because the harm is low. And the primary reason is because it's a lucrative practice. I'm not here to judge anybody because the reality is it is a business. I was just looking at my debts yesterday. My student loans are over 400,000 now. So yay. Yeah. Yeah. Congrats. Yeah. Thank you so much. I break that mark. Super excited. So I'm not here to judge anybody for that. I'm just a bit more conservative. I think helping frameworks is really important. I get a lot of questions about patients and this is relevant here is talking about peptides, right? That's like the thing now. But patients will come to me and we'll do PRP, we'll talk biologics and be like, well, what about BPC? What about these peptides? What about that stuff? And so that's when I'll discuss the two by two framework and I'm gonna refer out, could we prescribe that? Yeah, I'm not seeing the data that would suggest that that's gonna be helpful. It can be really, really harmful. I think we've all heard this one person talk about like, what is it? Stepping in front of a tricycle to pick up a penny, like that two by two framework. Some version of that, like, hey, are you stepping in front of a, like stepping in front of a highway to get a hundred dollar bill? Or are you stepping like in front of, you know, just like a sidewalk to get a hundred dollar bill? Like that's kind of the thing is. And the idea is if it's low risk, high reward, those are absolutely no brainers. We all know what those things are. Like you said, exercise, get good sleep. That shit is boring. Nobody wants that. Everybody wants like the really high risk and they think it's high reward. And somebody just has to tell them with a potentially degree that it's high reward. And they'll say, yeah, yeah, I'll buy that. It's the people that came to you when you're during your gap year, right? They're like, just tell me the thing to do. Give me that silver bullet. We can never, ever, I don't think we actually potentially can judge somebody's motives. Like unless they explicitly tell you I'm being nefarious here. It gets really, really tricky in this space and it can get really, really muddy. And I think for those of us who are trying to tread carefully, sometimes you get washed up. You will get washed up in the mess. I was just going to say I really resonate with a lot of what you said, and I think that's why PM&R, you know, it's just it's really speaks to me. And there's two big populations that, like you said, in my gap year, I got a little burnt out of people like not seeing the sexiness of just the simple things of like exercise. And what like really what is important? Like, sorry, but that answer isn't sexy. It's simple. But the two populations that really resonate with me are people looking for rehabilitation and athletes. Because now where you're talking about people that are exceptionally motivated and at a vulnerable point in their lives that are saying like, it doesn't have to be sexy. It can be simple. It can be anything. I just want to be better. And those are the people that really motivate me to be my best for them and to really show up and how I think I'm going to make an impact. And that's why, again, another reason PM&R speaks to me and it's a great population to work with. And I really admire what you guys are doing. Yeah, man, I love that. Like you said, I think the patients we see in rehab, especially as me with acute inpatient they're sick, man. It's black and white. They're not high performers. They're not looking to extend life by 30 years. They're looking to get better in two weeks. And so that in itself really just grounds your principles to really just siloing it to what do I have to do now? I explained this on Instagram, actually, in one of my videos in terms of how I think of PM&R. It's the past, present, and future. And that artwork, that timeframe. Yeah. So I totally agree with you. I was just going to add to Altamash's point when it comes to business. Because I mean, I think that's the biggest thing I've learned now a year and a half as an attending is the business In the US, we're just a capitalistic society. Not a bad thing. Maybe it's gone a little rampant, people argue. But healthcare is also under that umbrella of capitalism. And so when people look at how to build out their businesses, they want to work and collaborate with people because capitalism will oftentimes benefit those who collaborate with higher networks, right? And that network effect is really important. So when you see people who are now working with high profile athletes and doing IV drips or whatever other medication, well, now the question is how do I capture that audience as well? How do I get involved into that? Because in the end, Even if it comes to corporations, you know, healthcare corporations or even hospitals, they want to hire doctors who also have that network effect, who have that reputation, who can now in today's world, build a brand on social media and get more patients to come in through that hamster wheel. Or not through that hamster wheel, but at least through that funnel. So yeah, I don't know, I just kind of thought of that too. It is an interesting thing. I am curious though, I know functional medicine's worldwide, right, we often talk about it in the lens of the US, but I mean, Germany, a lot of Europe does it, also with prominent leaders, but I'm curious to see how it's done there. You know, cause we had Nisha Chellum come on to our podcast, who's a functional medicine physician. She talks about the dark side of functional medicine and how it becomes so salesy and how she doesn't like to go to conferences anymore because so much of the patients dictate the protocols. And now again, back to audience capture, well, if the patient's coming to a protocol, let me find what best suits their lifestyle so that they can take one, two, three pills instead of doing the hard work. It just reminds me of like another good example of what we're talking about is like the food wars. I love nutrition science and I got burnt out on that too because it's like, man, there's just people that it's like, be a vegan, be a carnivore. And it's just confusing people. And I feel like it's now it's just in more harm than good There's either people that just join these boats and they're like, oh, this all the way, this all the way. Or there's people that get so turned off and they're like, well, I don't even understand. You do. People create this excuse for themselves like, I don't get it. I don't understand. You do. Like if I asked any individual, regardless of the level, like what would it mean to be healthy, like a healthy diet? Yeah. Everyone, regardless of the answer, is probably going to be 90% right. It'll probably be infinitely better than the diet they're eating. So it's not like we have these tools, but it's like all this, the mist that's covering all the different perfect diets or whatever it is, is like distracting people from the truth that like, it's just, again, what's sustainable and like, what are you willing to do? Like, just do that. Just do that. Yeah, man, this is why I love our friend, E.C. Sinkowski. I mean, she talks about, you know, her podcast called The Consistency Project. You should check that out. That's what it is. It's just like the basics, not sexy, just over and over, dial it in. All right, so let's maybe let's get a little tactical, right? So I'm curious to get your idea, like maybe we could think about frameworks. So we've alluded to some of the basics and non-sexy things. Let's see if we can make them sexy for people. or at least simple, maybe let's do that, I don't know about sexy. Where would you start? If somebody was coming to you, you're like, you know what, Brian, I'm buying into this health spend nonsense you're speaking about, all right? Sign me up, where do I start? Beautiful, you asked the perfect question and you're gonna get a good question to return. What's your biggest limiting factor? I need you to tell me where the time needs to be focused. Because I could tell you what's important. We've listed it 100 times now, right? Like, are you socializing? Are you stressing? Are you sleeping? Are you eating properly to fuel yourself and feel good about yourself? Are you exercising? All these things. And the answer might be yes, maybe. It might be no to all of them. But like, what are you willing to do? What are you motivated to do or how can I help motivate you to do it? And how can we sustainably implement that? Because I don't really care what you do. Like, honestly, I don't. I care the impact I can make because of what you choose to do. And you have to be the person, you have to be your own advocate, what that's going to look like. So you have to tell me what plan that I can help you build. Like, you really do have to be your own advocate. And if you go to someone that's trying to tell you what you need to do, it's just not setting you up for success. God, man, I love that answer so much. It's so funny because everybody is looking for the keystone habit to take something from Charles Duhigg. And people will argue, hey, sleep is the most important thing, right? Just listen to Brian Johnson the other day talking about that. Yeah, you get your sleep right. Everything else is trickled downstream. Others will say, look, exercise, right? We know that there's literature out there that suggests that if you get poor quality sleep and you get a good workout the next day. it's going to make you smarter. BDNF, all these kind of people throw some words out. Others will say, well, nutrition, you're only exercising one hour a day. That's, you know, seven hours a week, but you're eating three times. You know what I mean? You'll have all these things that people will say. And the reality is that every single one of those could be the most important thing by orders of magnitude for the person, depending on what they're struggling with. For the person working two jobs and who has a newborn, who's been sleeping three and a half to five hours a night, sleep is the most important thing. Forget exercise, forget. Like that is the most important thing. For the person who hasn't gone to the gym in like two years and hasn't worked out, okay, any type of movement is going to be the greatest medicine they can possibly take. So it's just context is the most important thing. I gotta ask you this question because I wonder if you struggle with this like I do. I always find myself, I do the same thing, right? Somebody will say something, well, like, can you give me... two things and i'm like no i can't do that i can't do two things or somebody will come to me and ask me a very complex question for instance i walked in the door the other day and my wife was hanging out with her friend and they turned to me she goes oh perfect you're here she has a question for you her friend looks at me she goes what are your thoughts about glp ones i just took a big sigh Yeah, I don't know. I was like, I've decided, here's my new approach to this. I asked my wife, I was like, now when somebody asks me this question that I could go to a dissertation on, I'm going to ask them, would you like the 30 minute answer? Would you like the five minute answer? Or would you like the 30 second answer? And then I can kind of curate the response because when somebody asks me like a general question, be like... Hey, is, I don't know, is carnivore healthy? Like that's very difficult for me to answer like without providing nuance, maybe for the right person. Like it is, I don't know, probably not, but maybe, maybe, I don't know. And so I think like we talk about this, I forget who I stole this, is this Tim Grover that I got context over content from? Darsh says, it's like my favorite quote of all time. I think so. I think it's Kobe's coach, Jordan's coach. Yeah, like that is the most important thing, man. So I love that. I actually do want to say something that I don't usually do because you did ask a question and I basically threw it back at you. I'm going to answer it. And it kind of depends what stage of my life I'm in. Like I was involved with the sleep company that was really cool. And so people used to ask like, okay, but you have one thing. What's the one lever you'd pull? Sometimes I'd say nutrition. Sometimes I'd say exercise. Sometimes I'd say sleep. Right now, I actually want to answer that question. And I'm going to do it a little differently than I usually do. The way I'm going to answer that is the one thing is going to be the thing that allows you to maintain your weight. And now, like you said, there might be an individual who just had a kid and they're not sleeping. And because they're not sleeping, they feel ravenously hungry all the time. They're not regulating themselves. There might be people that if they just exercise, they know that that takes away their hunger. It really helps regulate them. There might be people that say nutrition. Like if I just intermittent fast, like I'll be able to maintain my weight. I'm good. Whatever that allows you to maintain your weight and maybe it's stress, right? Like it could also be, let's not underestimate like stress, socialization, whatever. That's probably the number one thing that you need to work on. And so maybe that's a few things in your life, but whatever factor is going to help contribute to maintaining that weight. Some people, maybe you need to lose it. Maybe start by getting healthy to lose weight. Don't lose weight to get healthy. But regardless, I guess my answer at this moment in time is what's going to allow you to maintain a healthy weight? Because that will provide a lot of healthy years compared to really any intervention I could tell you is going to be the biggest impact. What do you struggle with the most? When we talk about like the pillars? I would say, again, even personally, it'll vary mostly in my life. I can tell you what I don't. I'll start with what I don't struggle with. That's exercise. That's my identity. I exercise no matter what. I get up every morning. If I was on surgery elective, I got up before surgery. I'm going to get the workout in because my whole day is surrounding around that. Tell me what your weekly regimen looks like exercise wise. I would admit it's probably suboptimal in the sense that I probably overdo it. So if I were to talk to other people, like, is this the healthiest? No. But for me, as someone who likes to perform, someone who likes to like get after all the time, who it's a really big stress reliever, I work out seven days a week. I do. I study while I work out. So I do cardio every day for 45 minutes. And then I do strength training about five to six days a week. Awesome. So exercise is the easiest. You still haven't told me what's the hardest. Nutrition is also easy because I love healthy food. Like I don't really do cheat meals, like in this mindset of like, I don't do dessert. It's part of my identity. Again, when you make something your identity, it's really easy to do. What does that even mean? I don't eat dessert. Like it's just, imagine if it was just in front of you and you didn't really see it. Like it's just not something I do. So there's no longing for it. Like it's just like, I'd rather eat more food, healthier food. And like, I get so much joy from that. How did you make this a part of your identity? Because I'm guessing you had it when you were a child. Like you might not be a sweet tooth, but like for me, I will never do soda with sugar. Like if there's diet or Coke zero options, always. That's my identity. But I'm a sweet tooth. But how did you actually make that part of your identity? That's something I struggle with. through both healthy and unhealthy coping mechanisms. And I would say that doesn't have to be everyone's story, but for me, it's like, I'm like an all in or all out guy. So like it started with way back in high school, I gained weight and it was like my trainer every day was like, eat a lot, eat a lot, eat a lot. And so I was eating, you know, pounds of meat a day and whatever vegetables just, he's like, put pounds on, get stronger. I played baseball. I was like, I just want to get, I'm going to do whatever you say. And so again, I got super into it, gained in like two years, 40 pounds was the strongest I've ever been. And I told myself, like, this is a lot of weight. Like, I probably don't need this weight. So I stopped playing sports, went to college. And, you know, after my freshman year, I'm like, let's lose it. When I started that journey of like, and weight loss is hard. I was rigid. And I said, I'm going to follow it to the T. Like, I want to do this right. Like, I want to experiment. I want to try these things. So I tried all different things. And I said... That's when it started to form. It's just like one habit after another and habit stacking and then saying like, I'm choosing this relentlessly. And then all of a sudden you look back and you look years later and you're like, it just happens. Like when you choose something and you say, I'm not steering a veering from this, like this is my path. steadfast, like that's how you make something your identity. That's how something sticks. And that's the easiest way to go about living because then it just takes away any choice. We talked about, you know, this choice frustration of like, if I was sitting in an ice cream store or if I was at whatever, like it's hard. There's so many flavors. There's so what restaurant, what ice cream parlor do I even go to? Like there's so many options. Not when you just eliminate that and you just take what's in front of you and you really boil it down to like, this is who I am. This is what I'm going to do. This is what makes me feel good. And then it gets rid of all the distractions. I think you mentioned that your parents were into kind of the health and wellness stuff as well. So did you guys have discussion around good nutrition principles growing up? Yeah, definitely. I did not eat that healthy of a diet growing up. I was pretty restricted. Like, as a kid, I was very classic. Like, I was like noodles, hot dogs, like, that's all I eat, right? Like pancakes for breakfast with chocolate chips or whatever. Like, I was decent. It was decent. But like, I was a very normal kid. I ate a lot of desserts, you know, all the time on weekends, whatever. And I think and I talk about this with my partner all the time. And this is just one opinion and I am no parenting expert. You guys are definitely in the realm of that. Like this, I know I might be overstepping here, but I tell her like, this is how we're going to raise our kids. We lead by example and we lead with actually by letting them lead. Cause she's always like, are you really going to feed our kids like this? No. What do they want? Like we'll give them opportunities and in general we'll like provide, you know, a healthy diet. But when they're old enough to make choices, they'll make their choice. And by showing them leading as an example, setting from the basis of respect. If they respect us, we respect ourselves, the way we show up, not fake, but real ourselves, authentic. I think that's how they make the best decisions. And my parents never pushed me to do anything, but I respected them a lot. And so when it was like, hey, I'm 12 years old, I'm training for baseball for the first time, like... Why am I eating like this? Dad, why did you let me eat like this? Like, I see what you're doing. Like, why are you doing it? Like, what is help? Like, I want that. I want to do that. And that's honestly how it started. It's just like respect and realization and then just taking it into my own hands. Yeah, I mean, modeling is the best way to teach anything if you're trying to impart. I've learned that. It's crazy because like my daughter will sometimes, you know, she'll see me making up this like weird protein chick. She was like, oh, I want some. And then she'll drink it. And you can tell by her face that it's horrible, that she hates it. And I ask, do you like it? And she'll go, uh-huh. It's okay. You don't have to. You don't have to drink this, sweetie. It's all good. One day it'll be heaven. She'll know one day. I love that, man. I think that really is good perspective. I still didn't answer your question and I realized that. So just going back, the answer to your question, currently what I struggle with the most is probably healthy relationships. We've talked a lot about things that aren't super common in the medical school world. And I feel very frequently the effects of that and feeling like it's really hard to find community here. And I'm someone that's very forthright. I try and network with anyone, everyone. And it can be really hard. Like a lot of people don't want to change. A lot of people are really comfortable with what they got. Yeah. And so it just feels like a lot of times I'm on the outside. And so I've definitely struggled with that. Again, I, to anyone else who's struggling, applaud you. Keep moving forward. I know you're not alone. It is difficult and it's real. So I get it. Yeah. I was going to tell my lonely chapter, but go ahead. Cause I definitely think, well, I was going to ask him because you brought up your partner. Does she resonate with some of this stuff or is it a little bit of a tension between you guys on this? Definitely not attention. I'm very lucky. And we have a very open, communicative relationship. And we go back and forth about a lot of things. We really understand each other. She really understands me. So she understands where I'm coming from, what I'm saying, what I'm saying. She's seen a lot of this. She gets and can kind of support me through it. And she is just, again, very lucky. She's a supportive partner in that sense. But she's also very lucky and she's on a more traditional path. And so she does have really close supportive friends that are very loyal and everything she's looking for and couldn't make me happier. It's been harder for me to come by and so I've definitely needed some more support at times for that. Would you describe yourself as somewhat an intense person? When I hear intense, I feel like there's an undertone of scary. And so I prefer passionate. So I would have to answer yes with intense. I would say probably from other people's perspectives, I would probably say that they would describe me as maybe intense sometimes, but I think passionate would be the better word. I'll tell you why I'm asking. I agree with you. I'll share a little anecdote. Earlier on in my relationship, I think my wife, well, I'll say this, right? So what I struggle with the most is nutrition, especially now you got a toddler at home. Sometimes, you know, she's got snacks. And if I've just woken up from like a little nap and it's just like, Hungry Ultimush comes in and he's just, he could down an entire bag of veggie straws. Like you wouldn't be able to like believe, you know? Stay out of his way. Yeah. Yeah. You got to get out of his way or you got to knock him out because he could do a lot of damage. But so the only approach that really works for me is meticulous calorie tracking and like weighing your food. Like I have a scale to this day. It works for me at this point. I'm pretty intuitive of like how much, but. It gives me a sense of direction on a day-to-day basis, but also like, you know, I'm trying to, it works for me, right? That's kind of what you talked about. Anyways, when my partner initially saw me do that, I think she kind of freaked out. And she told me later on, she admitted, she was like, oh my God, am I going to have to live like this for the rest of my life? Do I have to weigh my food? Yeah. And I think she finally, when she got the courage and she said, hey, listen, I can't do this. Like, I don't know. I said, nobody's expecting to do this. In fact, I don't want that. Like, we don't need two of me's walking around here. Like, this world would be horrible. Like, we need the exact opposite to kind of bounce off that energy. That being said, though, I mean, certainly there are some points, right? Especially when you get kids, right? Because I think that we talked about. or at least Darshan, you and I have talked about, is like the best way to make a change is to kind of curate your environment in such a way that you don't have to have a lot of friction. Sometimes it's hard, but I think that you use an important word. Support is really important. Understanding is like, okay, that's your path. You like that, that worked for you. Maybe you struggle with those things. I don't struggle with that, so I don't need that strategy. But how can we support so you can be successful and I can be successful? And then hopefully if you do have kids in your future, all that shit's going to go out the window and you're going to have to figure out a new way out of how to do it. But that's cool, man. I really like that. Appreciate it. Yeah, and your story is very relatable and kind of a different sidetrack. But I'm just curious if you have struggled at all with – because I've done calorie tracking before. And I'll be the first to admit, again, as someone who gets super fixated on things, it can be difficult. It's an enlightening opportunity to really see, oh, what is a calorie? But it can also be very consuming. Were you able to do that in a healthy way? Or has it gotten difficult to coexist and live functionally now that you've gone down the tracking route? There certainly was a period where I think it had become unhealthy and it was too rigid. Yeah. I guess speaking frankly, probably the moment that the time that she saw me doing it, it was a little too meticulous, too hard and fast with those rules. But now I'm at the point where it's not like, like if I'm traveling on the weekends, which I do almost every weekend to go see my parents, I don't take the scale with me. I'm not. I have a sense. And I'm like, listen, if I overeat by two or 300 calories, that's fine. If I under eat, that's fine. It's all good. you do get to like, I think a point where, again, you have an intuitive of idea of like how you're eating, you can tap into some other signals, you don't have to actually have that. I think one thing that I struggle with, like, again, just growing up is just that eating thing was really, really difficult for me. And there were some psychosocial things probably there as well. Like, I'm being bullied as a young kid a lot with my weight and stuff. That was a real challenge for me. And so that probably made things harder. But I think once you develop those skills and you also recognize that you're resilient, you also recognize that, hey, Being so rigid is probably ironically actually robbing you of that health span that we're talking about. Like that's more detrimental to your longevity than, I don't know, getting your macros right or staying underneath that calorie threshold. So you're maintaining the weight like you spoke about, you know what I'm saying? So I think I'm in a good place now for sure. It's great to hear. And yeah, I would just, cause we could go, this could be a whole nother podcast on its own. We could, I mean, it's so many podcasts, but I would just say to the listener, like if you resonate with this and like, I totally do. I've been there. Just be careful hiding behind the blanket of health. Cause for a long time I feel like it was like, what's wrong with this, right? Like I'm calorie tracking, but that's healthy. Like, because I can maintain a weight, like it is causing me to eat healthier. Like, so what's unhealthy about that? And my simple answer is just like, look at what it's doing to you. Look at the rigidity, look at the stress, look at the underlying anxiety, look at the inability to adapt, to be flexible, to go out to dinner with your loved ones. Just travel without even having to be able to not think about certain things, repair. So if you need help or just acknowledge what's going on, just again, awareness is critical and know that it's not easy. And, you know, there are people that have been there and I'm part of one of those. And it sounds like, Otamashi, your story is very relatable. You've been there. So you're not alone if you're listening. Love that, man. It gets better. It gets better. It sounds like you're in a lonely chapter, what Chris Williamson would call happens when you're pretty wise at 26 and other people at 26 are not thinking about parenting and are probably eating dessert or partying, drinking after exams. I could tell you because I was one of them, but it does get better. It does get better as you get more into your niche and you start to connect with like-minded people and that network effect grows. Yeah. It's always going to get better. Okay, speaking about longevity though, I have a question for you. Would you want to live forever if you could? No. Simple answer, just no. Because it's kind of like, and this isn't a great example, but it's like one example is me and my partner have talked about moving to warm weather and it's like part of the nice thing about not always having year-round warm weather is like you gain an appreciation so much for the warm weather when it's gone. And again, there are definitely times where I'm like, no, no, I just want warm weather. So that's what I'm saying. It's not the greatest example. But it really just is like, it's like infinity. What does that mean? Like, what is there to look forward to if not to live my best today? Because there might not be tomorrow. Like when tomorrow's not guaranteed, it really does change everything. Now, would I want to live longer? Again, we mentioned AI before. As of right now, yes. But like, could that change? Yes. So again, the simple answer is like, you can only be happy because you understand what being sad is, right? What would happiness mean? Right. So again, really is like, what is life if not based on the fact that it's not for forever? Right. Absolutely. You know, I actually wrote a Substack article on this, right? Given the concept of longevity escape velocity, right? So for the listeners, longevity escape velocity is basically a point in time that comes, right? where for every year that you're living, you're actually, how do I word this? I guess you're surviving a year longer. So by 1.1 year, every year you go on or every day you go on, you're actually reversing your age by more than that. So by definition, you are living to infinity unless of course something tragic happens. But people think that there's a point in time where that will come, where medications are going to be so good, where AI and protein folding are already at we might have discoveries with cancer treatments and taking out a lot of the chronic diseases. What are your thoughts on longevity escape velocity, given your expertise? Is that something that you know is currently being researched? Tell us a little bit about that if you have anything. Yeah, I mean, I definitely, so there are definitely different perspectives on this. And when it comes to longevity and where we're going, I truly don't see a world where we can't live for a very long time. I don't know how to define that. I don't know what it would have looked like, but eventually, like you're telling me, look at where medicine is now. And I know that, again, you can argue like certain cancers, certain treatments, like why have you really moved the needle? But with AI, with the different advancements, with things that are coming, I truly don't understand how we wouldn't be able to 10x our lifespan eventually. Is that in 2050? Probably not. But like when I'm gone, you know, whatever, 30, 50, the next many generations. Yeah, I'm very confident that we'll be here. I just don't know when, but it's coming. Love it. I think I can agree that none of us are going to be here for that. And I'm not really sure I want to. I'm in the same camp as you, man. I can't imagine a world living or outliving those you love. And if there's nobody there, like, it's like, what's kind of the point? So here's my, here's my question. What if it's you and your significant other that both pass the escape velocity? No. Still no. Yeah. I, I, I love her. She's not listening here. So she's not listening. So I'm going to say no. But if she was listening, the answer would be yes. No, no, no. I think it's more than that though, man. You know, like, so kind of like Brian talked about relationships, right? I think what you were alluding to is relationships beyond your partner. It's much more than that. Like Darsha, you and I talk about this offline a lot. It's the community, parents, siblings. Now if you're saying your entire community, maybe it does take away from this life again, it's a very Mo Godot thing of him to say kind of here. It's like, yeah, happiness is only there because there's sadness and you know, it's, you got to experience the whole breadth of emotions and, And life is only beautiful because you know there's death and it's finite. If it is not finite, then I don't know. I mean, is it as beautiful? And again, I mean, to land this plane, it's really just like I'm big on expectation. Like I random, I eat dinner very early. And it's like my partner makes fun of me all the time of like, If we try and eat at 8 p.m., you're going to die. And it's like, it's all expectation. If someone tells me we're eating at 8, then I'm good. If someone says 7, I'll make it. But the second it hits 7 and I'm starving and the expectation is, how does it relate? I came into this planet not thinking anything else was possible. Then I hope I live 90 good years. I hope I live 90 functional years and probably keel over one day, still ahead. The expectation of 150, like what do I do with those? I'm expecting to work this many years, expecting to be with my partner and my grand, whatever. What do you do with that much extra time? The expectation, I don't think it's desirable, personally. I feel like, oh, you're in an apology for being late because I know you're expecting to start sharp. And I'm kidding. Absolutely, absolutely. Yes, I almost left. I told Darsh, yeah, I almost refused to do this episode. That's not happening. I appreciate you sticking around, dude. Brian, this has been amazing, man. I've got to say I'm really impressed. I wasn't partying at 26 and stuff, but I certainly wasn't having the type of introspection and insight that you've shared with us today. And then I'm sure that you have quite a bit, but I agree with Darsh. I mean, I think that the lonely chapter is tough. I mean, in some ways we're kind of going through that. I'm glad that you were able to connect and- I'm super excited to do this again with you, man. I'm kind of excited to follow your journey and see where you are. And we'll certainly do this again. Tell the people where they can connect with you, where they can follow you, social medias, all that kind of good stuff. Yeah, perfect. I appreciate the plug. I do have a podcast. It's at backed Bry science. My name is Brian. So back by science. Yes. It's backed by science.com is the website. If you have any questions, want to reach out, if you're interesting, an interesting person, which I feel like a lot of people, a lot of your listeners would be reach out. I love connecting with cool people. And then my Instagram is Brian Dvorkin. So just my first name, last name, and I'm not super active in posting, but I check frequently if you message me. So happy to have conversations or go back and forth. So yeah, I had a really good time. You guys have a great, great podcast, cool thing that you guys are doing. And I really respect the work you guys are doing as well. Awesome. Thank you, man. We definitely appreciate it. Before we let you go, one last question. Throughout this episode, you've had a couple pithy statements. And I know this question probably we can go on again, like you said, another podcast. But if you could concisely say, how do we put the health back in healthcare? I would say that it all centers around the ship of society. So can we actually change how society functions to support and advance healthy motive? So cultural norms just changing. Like it really just will center around that. Like, do we all have to eat fast food, right? Like look at, look at, you go around, look at advertisements, look at how the sit, the foundation of America is built, where the money's going. It's just, it's not conducive or supportive to a healthy world or for people to live in a healthy world, live a healthy lifestyle. I think it all boils down to that. It boils down to we need to provide opportunities and make it easier for people to be raised with those values to carry them out for their lives. Nailed it. Love it, man. Thank you. You bet. Thank you, guys. Thanks for listening to another episode of Medicine Redefined. If you enjoyed this episode, please be sure to check out some of the additional resources in the show notes. Please also check out our social media platforms where you can find more content like this. You can follow us on Instagram, Twitter, and TikTok at medredefined. We also want to thank our team for the production of this podcast, specifically Ethan Ju on video, Harita Yekori on social media, Zainab Lugmani on research, and Saira Khan for newsletter. Oh, and if you want to get similar bite-sized information delivered to your inbox every Sunday, please be sure to sign up for our newsletter. Also, if you enjoy this show, please be sure to subscribe, review, and share with anyone who you think will gain value from this as well. Now, time for the ever-so-important disclaimers. This podcast is intended for general public use and is for educational purposes only. It does not constitute the practice of medicine, nor should be construed as medical advice. No physician-patient relationship is formed, and anything discussed in this podcast does not represent the views of our employers. We recommend that you seek the guidance of your personal physician regarding any specific health-related issues.