40. Lessons Learned: Kelly Starrett, Janeeka Benoit & Neil Paulvin

Hello everyone, I'm Dr. Darsha, and I'm Dr. Altamash Raja, and welcome to Medicine Redefined. A podcast where we will explore the often overlooked but necessary components of health, what we consider to be the fundamentals. We will investigate topics and practices that can give you and your patients the best chance to optimize a healthy lifestyle. It's time to move the needle forward and put the health back in healthcare. We're back with another Lawson's learned here. It is a frigid winter right now. Actually it's supposed to be a pretty warm winter, but you're a strand, so it's definitely going to be a little colder for you up there. It is. It's funny. I was in South Jersey yesterday and it was high of 70, and I drove, so I left and when I left the drive at 67, and an hour, and when I got here, all of a sudden dropped at 51, and I was like, oh, yeah, I'm home. Not in the mountains. Up in the mountains. But here's the best part though. I got home and we have no hot water this weekend in my apartment, so that's why I came out here. Well, cold showers, man. We got to do an episode on cold plunge, eventually, right? So cold showers. Everyone's doing them. Everyone is doing them. I am. Maybe. Go go for it. Two hours ago, I was like, yeah, I'll just go home and do like a really cold shower, but then I was just on the ice for the last three hours, and I was like, I'm not doing this one. The coverage, yeah. Yeah. Yeah, today I actually had to stand in the tunnel and whatnot, and I was like, I'm not doing this. This is stupid. It's cold. It's already got here. It's already got cold in. Nice. Well, first off, I guess, you know, toward listeners, you are now a father, man. So congratulations. Thank you. Thank you. How does fatherhood feel? Feels good. I think this is going to be an awesome learning experience and for me to be able to appreciate a lot of what folks go through. It's interesting because, you know, of course, training and sleep and all these things that we routinely talk about how important they are. So I'm going to have to figure out my strategies like today is the first day, after like seven days, like I walked, like we're just over the last couple, that's not what we're talking about today. But again, for the last couple of days, from exercise, it was just kind of just maintenance mode and stuff. So yeah, I'm going to figure these strategies out and be able to have, you know, deeper meaningful conversations with folks and see what they're struggling with. So we'll see. It'll be fun. Absolutely. Right? Yeah, I think that's the toughest part, right? I mean, obviously I'm not a father yet, but I looked forward to that opportunity, but comes with the idea of knowing when to sacrifice, right? And I think that's very hard, probably for both of us, is like, yeah, knowing you have to sacrifice. It's not an option. It's something you have to do. So, well, it's still an option. It could be. It's a bad option for somebody. You know, and I think there are people who definitely do it. Not there. So I don't think it aligns with our values, but yeah, for sure. Cool. All right. Well, let's get started here. So our first guest was none other than Kelly Starrett. So what a privilege to have him come on. Take it away, man. Yeah, a special person for sure, right? He's kind of been a legend in the, in the physio world for quite some time and doing some amazing things. So we're very lucky to kind of pick his brain, limited on time, of course. But, you know, we talked about a lot of things and, you know, I was, there were a lot of things. I've been following him for maybe the better part of a decade, but there were still a lot of things that I learned, you know, just initially him talking about his own experience and how he was what he called the user, right? And just the emergency athlete model that he talked about, hey, like, you know, or this is, I'll do all kinds of cry therapy in this and just kind of bounce back and get back to doing, I think paddle boarding of some type of, or he was a, he wasn't a rover. I think he was paddle boarding. But basically his own experience, his own injuries, how that informed him to take ownership and how critical that was to his success, right? And I think that even though we spent a great deal of that episode kind of trying to dissect the various issues with the healthcare model, when I was thinking back and reflecting on it, I was thinking, you know, we've come, we still come a long way, right? The fact that we even sit here for the last year, we've been having these conversations in the forefront, the people that we fall in social media and, you know, that the dial, the volume of these conversations, at least in the healthcare industry, in the physician's offices, among physician colleagues is getting louder and louder. So I think that that's pretty cool about that. Yeah, you know, it's funny, I think going into this episode, we both had a different idea kind of where we take it and the conversation went another direction just because Kelly's such an expert, you know, he has his gift of gab and he, he's now someone who can talk from a deeper perspective, right? And somebody who, as he says, we should all get to base camp and then we climb out Everest, well, he's kind of at the tip, right, talking about the different things. And you know, one of the biggest things is self-care and why we have such problems with that, right, as humans and creating those habits. And I think the biggest thing I took away is, is his own journey, his personal experience and what it actually means to, to prioritize yourself, right, and I'm currently reading 12 rules for life by Jordan Peterson, you know, and again, that, that second rule of his is take care of yourself, like you were somebody, like you're somebody else that you are responsible for taking care of, right, a dog, a plant, whatever, we treat these people better than we treat ourselves. And we have to try to understand why that is. I think Kelly really honed it on that episode as to how we can start to change, especially in the world of movement, right? Yeah, I love that he said, you know, we need to do a better job at empowering people to understand their own role, right? And that's what he's all about. I think that's why, that's one of the main reasons why they've been so successful. I think for a long time, right, us in the healthcare industry, us physicians, we did mention it's a paternalistic point of view. I think less so today, but I still think that a little bit of that's there. But, you know, one of the things I think they had been exceptional at is just telling people, hey, like you take ownership of your own, right? I think one of our later guests, I can talk about today, it's really not about the doctor controlling your healthcare. It's really a consumer, right? That's kind of the model it is. And one of the, some of the things that we talked about, how do we help people empower, or how do we help empower people is, it comes down to coaching, right? Letting people understand that, hey, we cannot get you from point A to point B, right? Whatever point B is, if that's the destination that you want to get to, you can define that. And maybe we can't even show you the path. Maybe it's just about educating and forming with suggestions and strategies to allow people to find the path themselves, really. And that's probably the most likely recipe that's going to be for success. I think the other thing he mentioned is, you know, we also need to start thinking about this problem in a different way. Like we've talked about this at length several times is the obesity epidemic is consistently, despite education, right? It's getting worse, ACL injuries is like, are we doing the ACL front, not getting better, right? It's people are getting injured at a younger age, all those kinds of stuff. And it's a host of variables that contribute to that. But he mentioned that when you start thinking about a different way, and you know, for instance, I think he, I don't know if he actually gave this example, but they're initiative that they took a stand of kids, right, getting people to encourage mobility, just throughout the day, stand of best, that kind of stuff that they're doing out in, I know the California, I think that's, that's really cool. And a lot of these issues, a lot of the struggles that we have with these elements, the chronic ailments, musculoskeletal, whether it's metabolic, whatever it are, there are because of environmental issues, right? I'll give a personal anecdote, right? So since we were celebrating last weekend because my family grew, of course, lots of people, my loved ones are bringing cakes to celebrate birthdays. My parents brought this massive Costco cheesecake, absolutely delicious. I love sweet tooth, and I think those who know, you know, me, or, you know, know me well, the home and your incredibly disciplined and snob, just like I tried to strategize and not bring these things inside the house because just like any other mortal, I also went to open their refrigerator, if I see a cheesecake there, I won't have some. And I did not win that battle, Darsh, is what I'll tell you, you know what I mean? I lost a several times, in fact, especially because, again, sleep deprived, right? I mean, you're much more susceptible, I think Dr. B's actually sent a study in his newslet item, if you got a chance to look at that, something with, you know, sleep deprivation and metabolically how glucose is supposed to all that, anyways, I'm getting off in tangent, but I think that that's a really important I understand. And I think about when people go to the hospitals, right, we work in the hospital or you're in there and you go to the vending machine, it's just like, like environmentally, you know, at hospital people are going to get healthy, and this is kind of the environment that we're surrounding with. Like how do you expect, right? Like when I was up in the middle of the night, when I was in the hospital and I was hungry, I don't know, I'm gonna go get a snack and the cafeteria was closed, right? The cafeteria was closed, so the only options of vending machine, you go to the vending machine, it's like, are you kidding me? Like, what am I gonna do? You know what I mean? It's just, that's disaster right there. Absolutely. Yeah, man. I asked him near the end of the conversation about like, hey, what do you think about the future, right? Especially with tech, right? Amazon, Facebook, all these people are just going to start ruling our lives essentially in some way or another. And I think again, we're going to see a schism. There's a lot of companies out there that are really trying to get into the consumer market about patients and trying to make them healthy with wearables and tech and even a big pharma, right? We listen to Peter at the end looking at the glyph ones, right? And that kind of scares me a little bit too, right? It gives almost people a reason to be obese when you have a quick fix like that. But you look at Facebook, you know, I was reading up on like the Metaverse and went through the O and it's insane what's gonna happen. And I tend to think people are gonna be sitting on their butts even more and being in this virtual reality space, enjoying another country through goggles, right? I mean, where's our primal instinct going to be anymore? We take that 10 minute walk, 20 minute walk. And again, I see it going both ways. I think fitness companies are going to have a great, you know, you can now do virtual classes, fitness classes through the Metaverse. But there's also going to be this aspect of gaming and a whole different branch where people are just going to, we're going to see that obesity number rise most likely, I think, too. So I don't know. It's going to be very interesting to see, but it just, it definitely gets me thinking about that. Yeah. And I think that just reinforces the importance of why we need to think about the problem a different way, right? I mean, and it's a multi-pronged approach, I think. So something you hit on there is really important to highlight is that, and Kelly mentioned this, is we've gotten extremely well at talking with the people who already have a bias towards this stuff. Like the people who are the worried well, right? They're already taken and they're coming to you and they're already open-minded. And then you give them, like, hey, listen, oh, you're interested in exercises. Like for instance, EC's and Kowski recently had an episode about, you know, offering nutrition in the crossfit space. I don't know if you had a chance. Listen to it. Yeah, yeah, yeah, yeah. And that one of the things they were talking about, I think, at least Patrick mentioned that, you know, these people are already coming to the gym, and so they're already primed to be receptive to stuff about fitness. And therefore, it's going to be easy to talk about nutrition. But then there's the other side of it, people who are not thinking about this, who are climbing on a hike to VR and you and I were talking about mission trips offline. And I would, it wouldn't be a far-fetched to think this somewhere, somebody was doing the mission trip to VR, you know, I mean, like, what do you need to do? Right. Right. So it's scary, but I think that, I mean, it could be potentially scary, and it probably will be scary. But I think that's all, that's exactly why it's so important to why the people who, it starts with the healthcare providers who are producing that information, who are supposed to be guarding health, right, and being averse, and protecting people from sickness and illness, that they need to kind of look at it in a different way. Yeah, absolutely, man, I can't agree more. Anything else you took away from this episode, or do you want to go on to the next? I just, I think last actionable tip that I think that we talked about something he mentioned about expanding people's movement language, right? And what that means is it's maybe, you know, kind of seem like, oh, well, what the hell does that mean? That's kind of like a fancy way of saying, basically, it's just, hey, try something new, right? We talked about cash and the credits. I mean, hopefully people will get a chance to go listen to it, because he's very eloquent in how he describes it. But, you know, simply just, rather than, if you're watching and bingeing on Netflix, Squid games, or whatever you're watching, rather than sitting and watching it on the couch, we're super comfortable, and you can sit there for four hours straight. Maybe just sit on the ground. And you'd be surprised how many times while you're sitting on the ground, you're going to change position. You might go from, like, cross-legged to frog-legged to roll over in stomach, you know what I mean? And there's somebody, Dean Somerset, who talked about this long time ago. So it says something new, try a new position, right? Go to end range, normative ranges, and challenge that. Oh, which, maybe this might be a good time for you to talk about. You've been doing the virtual mobility coach for a couple of months now, right? Yeah. What's your feedback? Just going to touch on that. Yeah. I absolutely love it. Kelly's app is great. The program's great. Any, all the drills, or I want to say drills, all the programs in the morning, I do it. So I wake up at five in the morning. First thing I do is go to the gym, and I do whatever he has worked out. So it's anywhere from 10 to 30 minutes. And I mean, a lot of it focuses on the legs and opening up the hips, but they'll go into the rotator cuff and things. You're just really using a foam roller and a cross ball. I mean, these are not like crazy movements that we're doing. They're very basic. The thing that I realize is when you go on YouTube and you look up full body stretch, right, you'll see videos for like 10 minutes. And Kelly's whole idea is you cannot exact change in 10 minutes, not full body, at least. Maybe like the lower one third of your rectus femoris, right? That's kind of his thing that he says. He's like, you give that five minutes shirt over, you know, every day, you'll see a difference. So just doing a little bit every day, these 10 to 30 minute sessions. I mean, it's been incredible for me. I range of motion is definitely improved. I can see a noticeable difference too when from one side to the other, right? So I'll foam roll my lads, do kind of what he says. And you're like, oh my gosh, like my right shoulder is actually four inches lower than my left. And then move on to the left. But highlight your point about expanding your movement language. I mean, one of the things that I've been trying to do now is walk more barefoot, you know, even in just like, even in the gym when I'm squatting and deadlifting, like usually I'll have socks when I'm like, you know what, this might even restrict my toes a little bit in terms of flattening out more. So I should go barefoot during those. And just, you know, Kelly Colchews, a sensory deprivation, essentially. So which, you know, it really is. And I definitely have ankle issues in terms of door selection. So that's something I'm definitely starting to work on a little bit more and I've definitely seen some improvement. So I couldn't, I couldn't recommend it enough to people who definitely want to put mobility into their lives. I love that. You typically just train right after or it's just kind of a separate session. Yeah. So mornings for me are just mobility work and insana and then later the day I'll do a full workout. Yeah. That's amazing. To that point about the barefoot just getting to spend some more time barefoot. And you know what's interesting? I don't know if you at home, because a lot of people even at home wear shoes and stuff like that. So they're just kind of locked up all the time. Let me ask you something, right? This is going to be my put you on the spot here is, can you dissociate your toes? Like what I mean is, can you just isolate your big toe and flex and extend and then the other toes? You know what I mean? Yeah, I'm trying to now. I can a little bit. It's getting better now. I'll tell you that. But so it's weird from, so we, we both ran track. I don't know about you, but my shoes are tight. Like I've loved my shoes because, yeah, especially with track, right? You need that tight shoes and you're always on your toes running and you kind of mess with your feet. You have tennis for me. I mean, I need tight shoes and, I mean, I haven't gone this far in Cucarillo yet, but apparently you're supposed to wear like one size higher, like, you know, the shoe box. That's what you should be wearing, you know, when I was talking to my program director about this actually. And I'm just, for one, you're like, that would be so uncomfortable for every day walking kind of. You should have at least like, I'm a size 10, I, right now I'm a size 10, I should get to a 10 and a half, 11 and actually have enough room, like in my toe box is what she's saying is, what's the logic behind that? It's just to give your feet enough space actually to like work. Interesting. For me, it's all curled up, like my fourth like digital, my toe is like hammer toe already. It's just, it's pretty bad. So, but it's from, you know, being an athlete very young and just always having tight shoes, but I've been used to. So. Yeah. This, I mean, this has been going on for such a long time, right? The whole barefoot running craze came out by 10 years ago. I think that there were some good research that came out from Harvard. Then it was later on it was debunked, maybe not debunked, but, you know, the research arguing against the benefits of it. I mean, I think being obviously like most things as the folks on VPCD say, all middle is the way to be, right? Yeah. And, but, but ultimately, I think that the point is that, you know, you got to have some mobility in not only the feet and the intrinsic muscles and the bones, but also within the toes, right? I mean, you got to have some mobility. I think it's super important. Something for you to check out. Yeah. Yeah. Yeah. Yeah. Yeah. Yeah. Yeah. Yeah. Yeah. Yeah. Yeah. Yeah. Yeah. Yeah. Yeah. Yeah. Yeah. Yeah. Yeah. Yeah. Yeah. Yeah. Yeah. Yeah. Yeah. Yeah. Yeah. Yeah. Yeah. Yeah. Yeah. Yeah. Yeah. Yeah. Yeah. Yeah. You use them overnight. Yeah. I mean, you see them overnight. You wake up painful. I'd be like, oh, okay. And this is like way too painful. That seems like a lot. Yeah. Wake up in the middle of the night. I'd be like, I got to take these off. I got to send you. There's a company called Bevo Barefoot. And they actually just specialized in Barefoot shoes now. Yeah. A lot of people. So they actually on their website have a whole, like, extensive science page as to why you need Barefoot. They talk about running and proper running form and how. They actually translate. So it's, it's pretty fascinating. So. Yeah. I mean, so I can't, I can't, I can't go into completely zero heel type stuff. Right. Like I, I have for a long time, I had the vibe and stuff like that. But I, I've got a big toe injury. Where basically it's like a sesame night. It is. So now, so this is kind of the issue. Right. So if people like, oh, the folks who are like barefoot training is great, blah, blah, blah. That kind of stuff. It can be good. But if you have an injury and stuff like that, or if you had some issues like that, it's because the problem is it's extremely stressful to, right? So like, for instance, the sesame bones underneath the foot, they're like going to be right underneath your big toe. There's two little bones and they can be inflamed, right? Depending on type. And so for me, I've also got a little bit of arthritis in that big toe as well. So if I'm going big toe, it puts a lot of flexion, right? Or extension of the big toe. That's quite painful. I like it's funny that you say this for like for Black Friday. Yeah. I'm like always looking for kinds of the shoes are like really, really, we could talk about this offline a lot. But I would like 14 pairs of shoes. And I just return like keep pairs of shoes. Because I got to find the right ones, man. It's an instant issue. I digress. Anyways, let's go. Let's get back to. Yeah. Well, we will find a shoe expert and bring them on to the podcast. But we definitely can have make that happen. So we'll have to meet some love. Yeah. All right. And then we'll talk to episode 38, then, Dr. Tanika, then what, Dr. J? Dr. J, man. Love having our own so much energy. So awesome. I truly was fired up. It was like 930. I was late. But talking to her, it kind of got me inspired. You know, and I think some of it was of course confirmation by it. Right. You know, we shared a lot of common interest. But but the main one, I think it was an important discussion that we had. And we got to pick our brain is, you know, we spent a great deal of time talking about. How can we help individuals on the journey of self discovery and finding their why. You know, she talked about her acronym, which I think is really cool. If people get a chance to listen to it, but if not, we can kind of go through it. I do remember most of it. But I, you know, I was, I left kind of pretty fired up after that. Yeah, for sure. Definitely high energy. What you said. Yeah. I mean, we can definitely go through the acronym, right? Because I think habits are important. And it's funny. I go IG live a lot. And one of the questions I get is, how do you deal with, like, how do you get motivated? Right. This one of my former students was doing the MCAT like for the third time. And he's like, hey, man, I'm trying to get motivated. How do I do this? Motivation is BS. Like, you know, it's kind of like that David Goggins rule, right? So when, when you're trying to run a marathon, motivation is a sprint. That's all it is. It's a quick burst of energy. You're never going to finish the marathon, right? You're never going to finish the marathon at 30 miles per hour running. And what happens is you get disappointed, right? Because you're never, you're going to fail. And then you say, man, how am I ever going to reach that again, right? You kind of get into this negative feedback loop. Whereas habits, small habits every day, and I told him just focus on a habit, focus on completing one passage a day or whatever it might be, over time, you'll see those results come along, right? And that's what's going to motivate you in the end, right? If we're talking about overall motivation, it's going to see those results. And those results results only come from small, tiny habits that make change, right? So to break down the acronym, right? Habit is the acronym H for healthy mindset, which I think is self-explanatory, right? We got to have a growth mindset. I think we talked about a lot of books, but Carol Dweck's mindset is essential with that book, is about a affirming belief, right? So this is self-belief, knowing that you can reach that end goal. Also the beat, believing in greater, right? So assuming yourself as a greater role in this world, a greater purpose, a greater passion, and actualizing that, right? Every morning. The eye was it for incorporating change. So I guess now we're getting more to those actionable steps. How are we going to do it? Are we going to run outside? Are we actually going to go to the gym? Are we going to get accountability partner? What's the change that we want to monitor over time? Right? And then Tee was transforming lives, right? I think she was talking personally for her also to transform lives, but I think for anyone going on a journey of personal development, it will be surprised by how many lives you can touch. Even though people that you don't know, right? I was talking about in the episode, I go to the gym, man, and I see people who are really struggling with their weight, right? Pretty, pretty obese, even morbidly obese. But they're in there, you know? They're probably on their mind thinking, hey, I might be getting judged or whatever, but they're in there, lifting the weights. And for me, that's super inspiring to see, right? Because that makes me want to go to something else and be like, you know, I'm uncomfortable with this too, maybe, or I need to make sure that I can see that change myself and it'll quote unquote motivate me to do better. Yeah, that's well said, man. I think the point you made about motivation is such an important one for people to understand. And then they don't get it. This comes back to kind of like the cheesecake thing that I was talking about, right? Again, folks will say, well, you know, aren't you a disciplined person like, well, no. Like, yes, to a certain level, but if you're going to rely on motivation to be successful towards your goals, like that's just a failure right there. Like that you're, that's a disaster. And like again, it goes back to kind of both all the, the habit folks talking about, you know, if you're trying to get rid of a bad habit, you got to create friction. So you don't do that. So for instance, let's just stay on the sweet thing because a lot of people struggle with this, right? Sure. So if you don't want to eat cheesecake, don't bring cheesecake in the house. But then if someday maybe you do want cheesecake, and then you're like, you know what? I got to go to the store and get cheesecake. You're going to be less likely to do it. Yeah. Maybe one day you will. And that's cool. Like that's fine too. That can be part of a healthy diet. But overall, like if you don't want to have it every single day, you don't bring it in the house instead. You bring apples. And if you have a sweet craving, post meal or whatever, and you want some dessert, you're like, oh, you know, I'm going to grab an apple. And that might suffice until, you know, especially if you're trying to, you know, adapt your palate right off the bat. Like that's going to be super critical, not to have that kind of stuff. So putting those habits or getting rid of bad habits, it's going to be clutch. And that's how people are going to meet their goals. So I mean, that you can use that example pretty much in anything. So I think that's really important. Yeah. Yeah. Absolutely. I loved how she said this to several times. You know, she said that you have to do something different in order to be someone different. Yeah. I don't know. Maybe it was Jim Rome. If she got it from a book or where she mentioned it, but I think it was Jim. Yeah. But but I love that because. You know, it's all about the part of the incorporating changes, like an identity change. Right. We talked about the smoking example, which I forget if it's from the book. Jim's third book or not, but you know, again, the identity is like, hey, like I'm, I'm not going to smoke today or I'm not going to drink today. Whereas saying, hey, I'm not a smoker. I'm not a drinker. I mean, that's, that's a complete different mindset. Right. If you want to be a not smoker, then that's how you do it. You know, you change your identity in that respect. That's huge. Man, I think that's probably the biggest takeaway I would say for a lot of people to take is you have to identify with who you want to be. Right. They have done studies with this in children, and I brought up in the episode that if you want a child to clean, you don't just ask them to clean or sing a song. You ask them, hey, are you a cleaner? Right. And kids usually are like, yeah, I want to be that. I'll do that. And they're like, all right. What does a cleaner do? And they're more likely to just kind of pick up their toys. And you put those good habits in there. Yeah. Yeah, I mean, it was, yeah. And the other point that I think is worth mentioning for folks as well. And this has been talked about in the books by the Heath Brothers. Switch, you know, how to make change and change and change is hard. That's one of the books that I'm reading right now. You know, they talk about how will power is an exhaustible muscle essentially. Yes. It's like, if you, if I run a marathon and then I go try to do deadlifts afterwards, it's not going to work out too well. Right. It's the same idea. And not only that, so you have evidence to support that if you exhaust your willpower in one aspect of your life, it's going to be more challenging to use it in other place. So for instance, if I have been, if I've been busting my butt and trying to put off squid games, which I really, really want to watch. I can read a review paper. That's a lot of willpower right there. So if I exhaust that for over several days or maybe several hours, it's going to be more challenging to, you know, use that willpower when it comes to giving off that candy or cheesecake, or whatever. I keep coming back to that because that's fresh in my mind. It was so delicious. But that's also an important people. And we have evidence to support that time and time again. So, yeah, can't stress habits enough. A couple of great books that we talked about. You know, James clear, atomic habits. Awesome. What was the other one or Charles du Hick, the power habits. You had a couple of two, right? We talked about tiny habits, B.J. Fog. Yep. How to think and grow rich. Yeah. Yeah. Switch like, yeah, switch it with a heat brother. This is a really good one. Yeah. Yeah. Did you like it? I thought it was okay. I think they're writing the heat brothers a little elementary for me. Okay. You know, I mean, like it's to the point. I think it's very for the lay person. It's fine. I think if you're already in that personal development kind of stuff, it's like redundant. But for somebody who's just starting out, I think I think it's a great book, right? Yeah. And it's very important that you mention that because a lot of people ask me on how did you have a work like balance in med school? And I used that exact principle about willpower. And so the first thing, you know, after mandatory class and stuff, I would not study. I would go to the gym. I would meditate. I would make sure I meal prep. I would learn Spanish. I would do the things that I knew that I wouldn't otherwise do if I studied for four to five hours. You know what I mean? Like, that willpower is gone. But I also knew that if I did that, my ass was sure I'm going to study because if I want to stay in med school, you have to study, right? Interesting. It was all, it was essentially tricking your brain. So I essentially got done everything I needed to and then it was like, all right, well, if I want to stay in med school, I have to study. So that's kind of how I made pretty good progress in med school just by that principle. For any medical students out there, I would be cautious before you have them at them to your life, though, because that could be a risky proposition. If you spend three hours doing all those things and you're like, ah, screw it. I'm not going to study. I don't want you to fill in. So just know yourself before you do that. Here's a quick message from our sponsor, Comp Health. There are a lot of podcasts out there. Murder mysteries, breaking news. There's even a podcast about garden notes. But instead, you're here learning how to be the best version of yourself. Smart move. Do you know what else is a smart move? Working a local tenant assignment with Comp Health. Now, I know what you're thinking. If you are a physician, you already have a job. That's the best part. You can work flexible local assignments on the side for extra income. Or you can work lokomps full time too. And to top it all off, lokomps almost always pays more on average. Just head to financialresidency.com for slash Comp Health. And see what lokomps can do for you financially. And now back to the show. All right. All right. Well, let's go on to the third episode here with Dr. Neal Paulvin. I'm talking about, so I mean, this guy is a jack of all trades. But in this episode, we talked about mitochondrial health, longevity, anti-aging, and in specific NAD peptides and spermedine. So this was so episode with me, but I know you heard it. So what did you, what did you think? I thought it was awesome. But, you know, so I think it's important to understand. I think first let's lay out, right? I know some people are going to listen to this and like anti-aging, like that's not a thing. Like, all right, listen, you know, I think what we're talking about is, you know, how can we maybe delay the healthy aging? How about that? Maybe that's a better way to say it, right? And I think that's generally the idea. So if we can just kind of not focus too much on the semantic, I think it's important. One thing I think it's important, you know, I know we talked about a lot of different things that actually I hadn't even heard about. Like I think, you know, spermedine, you're the first person to mention that to me that hasn't been on my reader. Some of the things that I had heard about, I've looked into it, I've learned a little bit about. But I do want to put this disclaimer out front. You know, he said this, I think in the beginning towards the end, maybe even in the middle, that these are basically supplemental methods. And right there adjuncts to helping improve mitochondria health. You know, we still want to reiterate that nutrition, exercise, maybe zone two in particular, or you know, moderate intensity, continuous activity is a core component of augmenting mitochondrial efficiency. And the literature is probably better supporting those than it does for these. This is probably that last, not even 20% of the last 10%, and I think that you did mention that. But that being said, I mean, there were a lot of great things. I think that at least my understanding of it, you correct me. You know a little bit more about some of these things. I would say probably the most robust data that we have, that's been around longest, is probably looking at NAD, photo biomodulation that you talked about. Then maybe spermidine and peptides are probably the last one. Is that fair? Yeah, I'd say that's fair enough in terms of data. I think in popularity, I would put peptides maybe a head of spermidine. Okay. Like in terms of mainstream. In terms of mainstream people using it. I see. Yeah. But yeah, I think it's important. Like you said, for the viewers to understand that the foundations are important. I think one of the reasons why I wanted to talk about this with Dr. Paul bin, is that he's kind of at the forefront of these things. And as more and more research comes on, I think these things will become even more mainstream. And put into practices more so for health span and lifespan longevity, essentially. But it was interesting, right? I asked him, you know, with quote unquote anti-aging. Why, you know, what is it that we target? And he said mitochondrial first, second, and third. I mean, the mitochondria is what we are going after with this. And it's interesting, right? The mitochondria has its own DNA and there's theories. Estetino is probably its own living cell and kind of got incorporated into the human body. But it's the powerhouse of the cell, right? It's kind of where the magic happens in terms of circadian rhythm and a lot of things. Yeah. Yeah. No, right on. I mean, for sure, it's important. And I think that it's just most folks are like, oh, yeah, learn about that biology. And then I forgot it all because clinically, unless you study a lot of these mitochondrial diseases or geneticists and those kinds of things, like for most folks, not something that you and I do. Although we got to know some of the mitochondrial diseases for our boards. But I think, so yeah, I think we could probably agree this is more of an exploratory episode. But definitely putting things on our radar. So just starting with maybe identifying some of those things, right? So NAD. So what is NAD? So this is nicotine in my adenine, adenine dinucleotide? Yes, I think that's right. I have to use this. I'm so hard on this. Yeah. So NAD, NAD plus is probably a little bit easier to say. And what it is, it's a crucial molecule in cells responsible for maintaining the DNA integrity and this ensures proper functioning and regulating the normal aging process, right? As we talked about. So it's basically a shuttle bus, right? It's carrying electrons to various reactions can take place. It's counterpart NADH. This is where the redact reactions are happening. They work together to generate the cell's energy. Another role NAD serves is to function as a co-factor for various reactions. So, you know, without sufficient NAD plus, these functions would be compromised. So it's safe to say that it's pretty damn important, right? Now, with the natural aging process, these levels tend to drop. And so, you know, I suppose one could say there's a finite level. And the question that I always have is it's kind of a chicken or egg situation. Are we aging because these levels dropping? Or are these levels dropping because they're aging? I think that's kind of the part that's one of a harder. I'm sure people like David Sinclairick, it probably tell you a lot more. If you want to, I think he has a book, right? Isn't it a book about lifespan? Yeah, it was. Oh, that's what it's called. But then the important question becomes, which is what we're wondering is, Hey, it's replacing it beneficial, right? I think that's kind of the theory is if you replace it, that this is more causative. But I think I'm not really sure that we've proven that. I think it's maybe correlated as what we know. Yeah. So I think Dr. Pom was saying there's tests coming out now where you can actually measure these things. And they're not like hot on the market, but they're starting to come out. And I think to answer your question, once we get a trend of, you know, different age groups and seeing their NAD levels and supplementing and how much it helps, we'll kind of be able to see that. But I don't know of any data out yet that at least shows that, you know, there is a lot of correlation. Or even causers. Yeah. So and certainly not human models. I think most of the study in road models has been very, it's been pretty good. And I think that's where the most of the studies have been done. But the issue for supplementation, at least from my rating is that bioavailability hasn't shown to be very good orally, right? I'm not interested cellular at least. I remember Peter T talking about this for 2018 paper that showed that most of it's being, at least the oral is being absorbed by the liver and start actually getting into the cell. And if it's not getting into the cell, then okay, well, what function is it serving? Except you're paying a lot of money, right? And I think IV administration hasn't been shown to be inclusive either. So the solution, which a lot of people talk about. And I think Dr. Paulman also mentioned is precursors. And that's where NMN comes in. And this is, this is. Negotiating my modern nucleotide, right? Basically, NMN has shown that it can boost entity levels in rodents and some evidence supporting that mice have a transporter in their gut for this. Now humans have a gene. Or the gene has been identified in human, but we're not, we're not sure about the expression of it. It's still very, very early when it comes to NMN, which is a precursor for this. But the, you know, the good news is if people are interested in this. Well, first, what I'd say, if you're more interested in this, I don't want to, like, make this a whole educational topic about this. But there is actually a website. It's www.NMN.com. And, you know, what is entity? If you want to, and we'll link in a show notes and people can go learn a little bit about this. There's studies are in there. The basic science research clinical research, all that kind of stuff. If you're interested, you can learn more about that. But what I was excited to learn about that supplementation isn't the only way to boost this. If you think this is worth boosting, there are other potential ways to leverage it. To implement physical stress via exercise and clerk restriction. So look at, look at, look at how it always comes back. And so the funny thing is we're always trying to shortcut those things that we know work. And so it's interesting, but it's exciting. Like I said, exploratory, good to know. Hopefully you guys learn something about that. Yeah, absolutely. So the next compound, I mean, we can briefly go over as well as peptides. BPC 157 is probably the one peptide that is the most research. And this is actually on examine. They kind of go through a lot of it, and they specifically say there is no evidence for humans as of yet. But it has shown a lot of great benefits in rat models, mice models. But essentially what are peptides, right? So these are amino acids. And they're synthetic essentially, especially BPC 157. So they don't get degraded by the stomach, right? Because the stomach is where protein digestion happens. And so essentially these peptides have specific receptors, right? So you can think of this almost as epigenetics where it goes to a target receptor and it'll either turn on or off certain genes. And then these genes will go on to perform whatever the benefit might be. And this is where it kind of gets a little confusing because there's so many peptides out there. And we don't have all the data to understand what targets are, what targets are reaching and exactly what the benefits are specifically. But we have a wide array of them, right? So some of them are used for cancer therapy, essentially, right? Some of them increase veg F, increase blood flow. Some of them are known to help with IVD and IVS, probably just by reducing dot inflammation. But you can go on and on kind of about what specific things people have seen. Even neurotransmitters actually, they're showing out with some effect on serotonin dopamine. I can't remember if they're increasing or decreasing, but at least there's some neuromodulation effect. So how do we give these, right? So before it was kind of just oral or IV. But now Dr. Paulvin is talking about giving it intraarticularly, right? So with all arthritis, you're going to inject this in there. He's seen some people with a lot of benefit. He gives a story about, I believe a young patient who came in after a crash and that had some knee pain and then got some peptides and three to four months later really felt a lot better. So again, it's very new and it's expensive. So this is not a first line kind of treatment. This is very kind of experimental, but we'll see what the research shows down the line. I think it's a very promising thing. If you go down PubMed, it shows a lot of cool data on there with mice models. Yeah, yeah, and that's the point to highlight. But you know, this is the one that I had heard about. At least I know you mentioned there are other applications in terms of systems. But for musculoskeletal system, the main mechanism that was focused on, right? Like you said, but arthritis was angiogenesis, right? And that's what largely people talk about. And so for me, it kind of falls in the orthobiologic category, right? Now, these are synthetic. So important understand it's not autologous. So from the legality perspective, I'm not really sure the FDA is cranked, you know, cracked down pretty hard effective 2021 on orthobiologics and what you can and cannot offer. So, you know, I wonder what some of those conversations are like. You know, we didn't get to ask him that. But, you know, that's pretty interesting to kind of keep in the back of our mind as well. Yeah, absolutely. And growth factor, right? That was the one thing when you said musculoskeletal, I think they showed a lot of things with that with muscle hypertrophy and just muscle development. So cool. They were compounded. You ready? Spurmedine. Yeah. Spurmedine is interesting, right? So this is, they're actually found a really cool review article, which will link into this was published in 2018 in science, discussing the benefits. I think it's kind of just called spurmedine, like role in health and disease or something like that. But basically, it's actually, it's, it's, it's, it's pretty neat. But the premise is that, you know, spurmedine, there isn't anything, or I shouldn't say anything, there isn't much novel behind the theory is that it seems to act as a cloric restriction mimetic, right? I don't know if you know, but cloric restriction is hard. Which is why there's an epidemic. And, you know, I think that when we keep coming back to the fasting thing, a lot of, a lot of folks will argue that benefits of fasting have been for extent, you know, extended cloric restriction. Actually, David Sinclair is works largely hinged upon that too, right? Cloric restriction, first and a period of time, however you achieve it seems to be beneficial when it comes to extending lifespan that we, I think that most people will agree on that. But spurmedine, I mean, what is it? It's a, it's a polyamine, right? It's a compound with two amino groups coming back to amino acids. Well, the one thing that was interesting, you know, they didn't specify the sources, but it is available in our diets according to this paper. Do you have any, what kind of foods? Wheat germ. So a lot of tofu, natto. Yeah, a lot of a lot of those type of soy products will contain it. Yeah. And of course, sperm. That's where the name came from. But I mean, I don't know why they chose the name of sperm and need, but. But, oh boy, those are kind of sources. I, I'm going to refrain from making a comment on that. No, so, so, so another interesting one for sure. I think that there is. There's some promise to this one as well, but it's certainly interesting. I think, again, talk about. Really focusing on the details are in the minutia in terms of overall health and longevity and durability. As Kelly and Julia talk about, you know, being healthy or coming back to health span. You know, we're both interested in deeply. But, uh, but yeah, I mean, we'll link this paper. If anybody's interested in, they can check this out. I think it's a pretty easy read. The cool thing is it's got a review. It's got a one page review in the beginning of the paper too. So if you're not interested in reading the other 10 pages, you read like a thousand words per minute. So it won't matter for you, but. I'm pretty slow reading. You say that, but you texted me about that one book yesterday. You're like quick 200 pages. I'm not really quick. Cool. Anyways, what do you got next, man? I think yeah, it's very cool, right? 13,000 articles. Apparently, if you go to Sermony Life.com and talk about Davidson Claire, he's on the board. Where all this research is happening in Austria, which is actually what I'm supposed to go in January. Hopefully, you know, lockdowns and things are gone. But yeah, I think this is something that there's two main companies out there. Prime of Dean and actually prime of life and sperm, sperm of life or something, sperm of life. Don't quote me, but it's something like that. But these are kind of two companies that really take research seriously. They take customer service seriously. So if anyone's actually interested in kind of ordering these things. I mean, from when I've heard podcasts of these founders talk about Sermony, they say you have to take it for about two to three months. And that's when you'll kind of see change. And you really will see more change in people over 50, which is interesting. And again, more research kind of coming across as the why that is. But they think cognitively, it really helps cognitively, especially with the Chloric Restriction. But my main thing is, you know, are you supposed to take this fast data? You're supposed to take this while eating. So I asked Dr. Paul, and he said you're actually supposed to take it kind of in the morning. But you're supposed to eat on the day of. And so my issue, I guess it's kind of an issue is just is I'm thinking. We obviously were in a fed state, facet state, and it's not one or the other. Both are kind of working at the same time. But when you talk about, you know, an antibiotic or catabolic process in terms of autophagy. How was that working when you're eating, but then taking this? You know, that's where I kind of want to see the biochemical pathways about how Sermony works. Yeah. And that's the interesting part, right? I mean, there are so many questions. It's what's best about. I think it was Peter T is a newsletter today talking about how, you know, we lose our curiosity as you get older. But the premise of it was that every time you read a paper, you should have more questions, right? And that's kind of what I'm seeing from you right now. So you have so many more questions as we're learning about this and so did I, right? I was like, the first time I heard about Sermon Dean was maybe a couple of weeks before you mentioned that we're going to be having this guest. And this is something interesting. And as I started reading, I'm like, but what about this? But how does this make sense? And that's exactly what you're talking about here. So I think ultimately that's, you know, we've mentioned this a couple of times. But one more time, one heard is super new super novel preliminary is the word probably for this. Just kind of bringing it a whole together, you know, a couple of awesome guests. Very lucky to have them. Some great conversations, some great topics. And we talked about the tried and true methods in musculoskeletal medicine. We talked about the philosophical approach on how we're going to make the system better. We talked about at the individual level, how we can empower people with Janika. We talked about, you know, habit and implementing some actionable things and how people can be successful and why even it's important. And then lastly, just to kind of to close it in, you know, some supplemental preliminary evidence to kind of explore, hey, what else is out there? But or quote-unquote outside the box type thinking. But, you know, maybe make sure you're curious and really that's what it's all about. Absolutely, man. Well said. Good summary. Cool. All right. We'll see you guys next week. See you later, man. Thanks so much for tuning into another episode of Lessons Learn. Now, if you found any of the topics we discussed today interesting, be sure to check out the full length episodes. That's episode 37 all the way up to episode 39. And be sure to subscribe to keep up with the latest guests that we bring on to this podcast. And as always, everything in this podcast is for educational purposes only. It does not constitute the practice of medicine and we are not providing 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 see the guidance of your personal physician regarding any specific health related issues. We'll see you next week. You