Lessons Learned: Shawn Arent, PhD, CSCS*D

Hello everyone, I'm Dr. Darsha Shah, 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. Before we get into the show, here's a quick message from MedEvolve, a company that empowers physician practices to work smarter with data-driven services. Are you tired of dealing with headaches like finding and retaining quality billing staff, high turnover and limited resources? Many practices are opting to outsource all or part of their billing processes to help relieve the burden on internal staff, free up resources and reduce overhead costs. For those who wish to keep billing in-house, it's critical to have solutions that provide automation and give you the ability to monitor staff productivity and effectiveness, especially for remote employees. MedEvolve can help you leverage data and AI solutions that bring answers to the forefront and take the guesswork out of revenue cycle management. Let them show you how. To have this great company help you work smarter, reduce your cost to collect and get paid on time, find them at drpodgastnetwork.com slash medEvolve. The link is also in the description of this show. Our discussion with Dr. Sean Art last week was such an informative and knowledge-packed episode. If you had a chance to tune in, it was pretty evident that Darshan and I had such a fun time nerding out and we learned so much from Dr. Art. In this episode, we discussed some of the key takeaways from our discussion with him and things that you might be able to learn as well. With that further delay, enjoy this recap episode. What's up everyone. Welcome back to another Lessons Learned. This time we will be chatting about our episode with Dr. Sean Art. Man, this episode was long, right, it was our 50, but full of dense information. This is an episode where people might have to go back and just listen to or save and come back to it in the future because there's just so much gold in this episode that I learned and that I just loved because it opened up my mind and changed my perspective about a lot of different things. Yeah, no, I'm not surprised. Actually, in fact, I probably expected it to be honest with you, man. Just because Dr. Art is one of those people, when we talk about looking at the literature, looking at the data, most of the stuff when it comes into sports science, or I should say a lot of the stuff, he's the one producing all that, right, when it comes to nutrition. It's so funny because when we asked him, hey, what's your current area, what are you researching? He barely touched on nutrition. I think it's so funny because that's where we wanted to start off our conversation with and as I mentioned, he's all over the place. I spent my time at Rutgers with him where he created the Center for Health and Human Performance and has a history of playing Division I athletics. He's definitely walked the walk as he was. He has experience from his own personal background as an athlete. But now as a sports scientist, exercise physiologist, continuing to see athletes at a high performance level, but also individual, quote unquote, the lay population. It was fun and very informative for sure. Yeah, absolutely. The first thing we touched on with him was nutrient timing and talking about pre-workout, post-workout, protein carbs, when do we eat? When is the best time to optimize our bodies to put it in this anabolic state? Frequently, in the last 10, 20 years, a lot of people mentioned, especially body builders, people who wait-lift about the anabolic window, about how we only have 30 minutes after a weight lifting session to chug that protein shake just so we can start building that muscle. We asked them, hey, is this true? What do you think about it? He's done extensive research and he likes to talk about the garage door rather than an anabolic window and really say that the feeding period is actually much longer than we think. Too often, we're too hyper-focused on nutrient timing and what I love, he started talking about the layers of the cake. That's why I love. He said, nutrient timing is more of the icing and before that, you need to build the foundations of the cake and that just comes down to quality and quantity of the protein or of the food. Yeah. No, I love that. And again, we kind of took a backwards approach to the whole nutrition thing, honestly, because typically when somebody comes to me and whether it's a family member patient, whatever it might be, we start with quality and I think any good coach, nutritionist, a dietitian that you'll talk to, that's where they want to start, right? That's your low-hanging fruit, no pun intended there, but because that's what most people are missing the boat on, but we wanted to take the new timing approach because it's the most popular question you get. People are concerned about that last 10-20% where they should be focusing on the big 80%. Nevertheless, it was an exciting conversation and yeah, I think that recently he actually published the same paper, I think they actually had a very similar title of the paper talking about the garage door opportunity. So I agree with you, it was good to know that this opportunity, the feeding garage door is much longer, but essentially that's what a lot of other experts, I mean, that's what the consensus is, right, that your peri-workout window is going to be, your body is going to be primed to absorb all these nutrients and we got into the science of it, a little bit nitty-gritty, particularly talking about the up-regulation of glute four and, you know, without diving back into it if you want to go listen to, I highly recommend that you do, but basically exercise makes your body much more insulin sensitive, right, and it makes your muscles more glucose sensitive, if you will. And the only thing that does that for these receptors is insulin. So insulin, they're insulin dependent and they allow all this sugar to be pulled into your muscle, but so does exercise. This is why exercise is so great for diabetes, you know, as a lifestyle management. So that was good to learn about that, just at least the biochemistry behind it. Yeah, absolutely. I mean, you know, for me, I've really been getting into biohacking lately and so it's, you know, it's the new hot topic, everyone's blowing up on Instagram about biohacking. But what I've come to realize, just talking to Dr. Arne, is how much, you know, and looking into my own life, how much I'm a little too focused in on the things that might not really matter as much and kind of taking an overall big picture approach, right, looking at timing doesn't necessarily have to be just the workout. It's from the moment you wake up to the moment you sleep and even through sleep. So he really just opened my eyes to that and just looking at my own life and saying, hey, what can I do better? And a lot of it actually does even come to that 5, 10% that could, you know, like the cherry on the top. So the other thing, definitely, yeah, exactly, yeah, I know this. So the other thing I loved that he talked about was calories in versus calories out, right? Huge, huge polarizing topic on Instagram, at least or wherever you kind of get this nutrition information from. And you know, the way I used to approach it with people is, you know, calories in calories out definitely matters. And of course, it's not going to be like the perfect science, right? A lot of people are stuck on, no, what you put in your mouth. And if it exceeds your basal metabolic rate, you're going to gain weight or if you have less than what your basal metabolic rate and what you're supposed to do have in, you're going to lose weight. But can you kind of just explain why it's not that easy? Yeah, no, I mean, so I don't know why this is such a debate. I mean, I think that part of this has to do with the new, the insulin model that we talk about. And I think there's definitely some merit to that. I mean, I don't know who the first person let's talk about it. But I think that withhold the fasting approach in Jason Fung, who's a brilliant nephrologist, I think that his, his book, the obesity code, I highly recommend that to check that out. He really dives into how fasting is a great, great, you know, management strategy for diabetes, but for a lot of other ailments as well. I think that that's like anything else here, we come back to the pendulum again, right? We tend to people tend to take it to the extreme and then we forget just simple loss of thermodynamics that it does matter at the end of the day. You know, if, if you're intake and not, and to his point, the absorption, the true absorption rather than just the consumption, that is the most critical point. If that outweighs, it means just like a, it's like a seesaw, right? If, in one side, if you're intake and the absorption, I should say, it's heavier, then, you know what I mean? Like at the end of the day, the pounds off the scale or the body fat percentage is, is not going to go. And by the same token, if you're trying to put weight on, you need to be, quote, unquote, anabolic. You need to be consuming more than you're actually burning. It is very simple. I think that most of the people, unfortunately, who are arguing about these topics have little knowledge about it. I wouldn't say all of them, but I don't know why things have to be mutually exclusive. You know what I mean? Both can be true. Both can be absolutely true. I think that AC's in Kowski recently posted something to that respect about it. Yeah. Go for it. Go for it. She said, calories in, calories out is basically saying that, you know, we're talking about weight. And then calories matter is, of course, also true, and that's talking about health and that health can definitely affect the weight, right? So all these variables matter, but we also have to learn how to separate them at the same time. So it's as beautifully simple, but yet it can be complex if we choose to make it complex. But at least for the listeners out there, you know, I think Dr. Sean Arden does a beautiful job, like you said, talking about absorption and how the gut can really play a role in this whole calories and calories out model. Yeah. Absolutely. And I think another point that we had kind of, before we even got into the interim and fasting topic, just because we were learning so much, we touched on all these different diets and what tends to work. And again, going back about why nutrition tends to be so confusing. I think for the average population who aren't as informed as, as maybe you and I are, or maybe even somebody like Dr. Arden who aren't just diving deep into the literature on a daily basis, you know, you get most of your information from websites or other people that it tends to work for. And then again, it goes to that approach for individualization. If it worked for you, it doesn't necessarily mean it's going to work for me. But I kind of loved his new diet that he talked about, if it fits your lifestyle. Right. And as I've learned more and more, again, I don't know why people will find it so frustrating. As long as you have the similar principles, and when you really get into the nitty-gritty of it, most of these diets, you'll find have a lot of common denominators. Right. And that's what you tend to focus on. If you tend to focus on those basic, the foundations of what it is, then again, the icing on the cake, as we said before, you know, the last 10, 20, 30 percent, the differences between, they don't matter as much. Then you need to kind of figure out what tends to work for you. And so, yeah, I mean, that's essentially what it is. And I think that it just to kind of summarize what his, if it fits your lifestyle is basically again, going back to the foundation, eat mostly whole foods, right? Don't die to wait your time with people. Eat things in moderation, start with protein, and fill in around depending on your energetic demands. So if you're a high-intensely athlete, like if you're a professional soccer player, which was considered a power aerobic sport, where I think at one point, he referenced a study where some work that some athletes had a 95 to 97 percent, 97 percent of glycogen depleted. Well, then you better be consuming lots of carbohydrates if you want to have optimal performance. But if you're a relatively sedentary individual, or again, you and I are now residents and we're working a lot of time, so we're not training as hard as we did, we don't need to consume as much carbohydrates, right? Right. So that's kind of what you need to figure out for yourself. Like, does your absorption or intake in that regard match your energetic demands? Absolutely. I think what people need to realize again, a lot of these people are going to Instagram, finding a plant-based, finding a carnivore diet, finding paleo, finding keto, whatever it may be. And a lot of the information out there is focusing on that, you know, 5 percent, 10 percent of, oh, well, the zinc and the magnesium and it's like, okay, okay, okay, like, let's back off a little bit and talk about the quality and quantity. And like you said, like, everyone's looking for this one quick fix and there, and a lot of people are just looking for the one thing that will help them, right? Just the one diet rather than taking the strengths of all these different diets and combining them. And when you look at the research, I think a lot of these diets, the reason they work is because people previously were on the sad diet, right? The standard American diet. So like, any diet is going to be better than that. And usually when somebody starts a new diet, they're going to be a lot more hyperware of the quality of food that they're buying. They're going to be more aware of, they're hitting those 10,000 steps. Their whole lifestyle changes, usually, right? And now it's about consistency, right? I think you, you put up a great tweet today by Eric Cressy about showing up. It's about showing up every single day. That's what's going to be the best thing and it's not your aunt says the best diet is one that you'll do. And the best workout is one that you'll do. And again, if it fits your lifestyle, I might have to put that in my Instagram bio, ii, fyl with little plant, just so I can let people know that that is how I identify myself with the diet. So yeah. Yeah. Yeah. I mean, I think we just make it more complicated. It just going back to simple as in sexy and I think like Dave Talker, he's making foam rolling sexy again. I think we're going to make simple sexy again. Hopefully, if people want to take away one tag line, then maybe that's the, those are the two. If it fits your lifestyle and make simple sexy again, I don't feel like it. Anything else on that front before we switch over to like time, we should be eating and intermittent fasting. Down. Let's go into it. Let's go into it. Yeah. Yeah. So I have, I mean, again, that's interesting for me. So what I'll tell you is, you know, again, being kind of getting my start in the fitness industry, this was like many other fat diets. I think most of the things diets, I should say, or a lot of nutritional protocols kind of start in the realm of bodybuilding fitness because people are trying to figure out what the best thing is for physique or for aesthetic purposes, right? For a physical modification, things of that nature. And so I think most of the research or at least the most robust research that's done in this regard is looking at a lot of the weight loss type stuff. So, and that's why that has so many confounding variables. To me, for that purpose, I don't care as much. I kind of shared my story about, you know, trying to cut body fat percentage when I'm trying to get as easy as possible. Don't ask me why I was just, it wasn't a stretched out in medical school yet. So those are the things I could do. You know, that was less interesting to me. The thing that's really peaked my interest as a late is, again, the idea of longevity, right? When we're looking about being set in the area, like you, you, you, you great grandmother, I believe you were paternal and great grandma. Grandma, yeah, yeah. Grandma, excuse me. Yeah. I'm trying to get there, right? And so that's what was interesting to me. And so I want, it was good to kind of pick his brain in that regard. But I think that for most people, one of the reasons they, they do tend to be attracted to this is because physiologically and psychologically, it's to be easier. It's kind of just easier to skip the meal rather than think about that's another decision that you have to make, how to make healthy versus unhealthy, or, you know, how to identify healthy versus unhealthy foods. So I get it from that perspective. Yeah. Yeah. The one that I'm more interested in on and I need to continue looking at the literature is, again, where the stress resistance and glucose regulation type stuff comes in. And this is where Jason Fung's book is good. I got it. I've been over a year and a half that I read it. So I wish I had taken more notes. But, you know, that's kind of where I want to dive into. But what are your, what are your preliminary thoughts before we talk a little bit about the metabolic flexibility in those types of things? Yeah. I think, you know, I, if I think has its advantages, I don't think it's for everyone. I really don't. I think people try to force it at times, especially when they're trying to lose weight. And sometimes people need to realize that you want to overshoot your calories at times, maybe, you know, just if you're, if you're working out heavy and stuff, you need those calories. So I think it's a great way to face things in and out, you know, I was intermittent fasting for about two years. I just found myself super bloated. The great thing about it, you know, and why I skipped breakfast was the mental clarity. You know, I was no longer bogged down after these meals, not really having to food coma. But yeah, Jason Fung's work is where actually I've kind of first got introduced to it. He has a great interview with Mike Mutzel, metabolic Mike, or he also has a podcast shout out to him, high intensity health. But I do need to read obesity code and hopefully soon we'll get a Dr. Fung on our, on our podcast. That would be awesome. Yeah. That would be awesome. For you, man, is maybe as, you know, a prerequisite or afterwards would be the circadian code. I kind of talked about such and pandas work. It's a shorter read. There are some similarities when we're talking about nutrition and fasting in that. But he does have an interesting thought about just how every single organ in the body has its own circadian rhythm. So I would highly recommend that. I'm going to have to check it out. Yeah. But what I did like the doctor on reference that, hey, metabolic switching, not so much, but metabolic flexibility is pretty important. I do like that concept. I do think that that is an important concept that we have to kind of, kind of pay attention to it because in today's day and age, you know, maybe two, 500 years ago when you had to kind of find whatever and then eat any kind of food, whether it was berries or verses just, you know, eating a deer, right, that you could kill with your own hands. Today, you can find the same foods on a daily basis, right? We're most folks. I don't want to be insensitive and say that all folks, but most folks can afford a lot of the things and they can just be on the same exact diet, the same components of the sad diet, if you will. But essentially with the term for those who don't know metabolic flexibility, basically what's talking about is, you know, the preferential shift of your body from the use of glucose as a fuel source sugar to the use of fatty acids and ketone bodies, right? So it's basically your body's ability to toggle back and forth between these two metabolic states and that's going to be an indicator of metabolic flexibility. You know, Peter Tio from the drive, we're both huge fans of him. He did give this account, account a point to this. You know, actually recently I want to say in 2019 the New England Journal of Medicine, which is what our parent journal in medicine, they published an extremely popular article of the effects of intermittent fasting on health. I would recommend check that out if you haven't read it yet and it's like a very comprehensive overview of it. But in that paper, the author's kind of talked about how at 24 hours of fasting your plasma ketones measure, you know, up to at max 0.5 millimoles, right? But when you look at the literature and at the at what state of ketosis you will benefit in terms of the cognitive health and a lot of the benefits you get from ketosis, it's one millimole and beyond, right? So again, so this goes back to what are you doing it for? Right? So if you're fasting for 12 hours or 14 hours and 18 hours, I mean, I think that you still have benefit. Again, every individual like I might achieve ketosis much faster whereas you might achieve it lower or you know, later on or vice versa. So I think that's an important thing to understand. I think this is one of the reasons he's not a huge fan of the time we're sure to eating has been called intermittent fasting. And the same point that Dr. Arndt was making goes, okay, when you have intermittent fasting, which protocol are you doing? You know, you kind of need to identify why you're doing it, what it is that you're actually even talking about, and then how you're going to implement that practice for your goals. Yeah, no, I love that. I love how he said it's you've got to figure out your why and essentially what are you doing it for, right? You have to have a goal. You can't just nilly, willy kind of, hey, I'm just going to fast for 16 hours. Sure, you can, but in the end, are you just kind of wasting that fast or what's the point behind it? And that's where I was honestly, you know, like a couple years ago, and yeah, I've kind of heard the research like, you know, in order to achieve a top of the G, it has to be at least like 48 hours, 48 to 72 hours for like full benefit. And so that's where I kind of am now in my personal journey with intermittent fasting is I'll just do like a 48 hour once, once a month, actually I'll do one tomorrow in the next day because I'll, I'll have my board exams level three. So figured why not just do it when I'm going to be doing 400 questions a day anyways. But yeah, for me, it's like, you know, it goes back to that hunger drive, that animalistic tendency that we might have, you know, getting in tune with yourself. I've noticed that my meditations are a lot more transcendental when I fast. So for me, I've definitely shifted the focus for more of a lose way, calorie standpoint to more of a spiritual one with fasting. That's interesting. Now are you drinking black coffee at all? No, you don't drink coffee. I, I rarely do. Sometimes I will just suppress the appetite, you know, I'll do it around like, you know, 12 p.m. One one day, or I'll do, I do a lot of seltzer water, um, okay, I'll have with a carbon agent. Yeah. Yeah. Yeah, that's actually a good point. So, you know, so just to give you back are interestingly, I think that for me, 20 hours is about the max, and I'll tell you why my extremities typically run so cold. Well, yeah. And like, my wife, I mean, she, Amelia will tell me, I don't know what's, what is wrong with you. But, um, so the longer I go on my fast, um, like I am freezing, and I mean, I suspect some of it has to do with like my heart rate. I mean, typically my heart rates in the low 40s or around 40, that's kind of where I hang and maybe that has to do something with my circulation. But yeah, if I go beyond 20 hours, man, it's untolerable how cold my hands get. Yeah. So that's interesting. My other thing is like, again, trying to shift it to have more breakfast. Like, you know, if I'm doing the TRE, um, it's hard for me to sleep if I stop eating it for p.m. I don't know. Do you ever find, uh, that's an issue for you or no? Yeah. I find it, I find it very tough to sleep, um, especially when I'm hungry, and I think, you know, when I look back at why it just comes down to back in the day when we're hunter gathers, we would stay awake just to get that food. Um, so I guess there has to be some sort of connection with, you know, sleep drive and fasting. And just for the listeners out there, um, I F versus TRE, what are we kind of meeting by this TRE time restricted eating is probably what most people mean by intermittent fasting. It's how many hours you're not eating in a day, right? Whereas intermittent fasting is intermittently doing periods of fasting. So maybe like once a week, you're doing, you know, two days, I'm not eating or quarterly, you're going to do a seven day fast. That's essentially intermittently, um, you know, that's intermittent fasting versus what mean by TRE is more of a daily kind of thing. Yeah. Yeah. And, uh, so my old boss, um, Jason Ferragia, that I work for over the renegade, um, you know, he, he created the renegade diet. I think this again, back was 2012. It's a quick short read, um, but the idea essentially was, he, he talked a lot about the benefits from the fitness side of intermittent fasting, uh, but he's, that's when I started doing it as well. It was a lot about, uh, just, you know, skipping breakfast and kind of, again, in the morning, most people are going to work. It's easy. You get them mental clarity benefit. It is harder to sleep or focus less, probably dependent on caffeine. Um, so maybe that's, that's one of the reasons why I was doing it, and it's much harder for me to sleep. And he's recommendations used to be that you either have your carb meal because, you know, typically people will get sleepy after a carb meal at nighttime. But again, it's, it's a very, very, has to be individualized because if you're going to eat a heavier carb meal, we just talked about how you're going to be much more, you know, glucose sensitive or insulin says that it was post exercise and that, that's why, um, but, you know, as we're getting more information about insulin sensitivity tends to be better in the morning, um, so maybe early eating might be better, uh, but again, that type of defense. So I'll give you an example, you know, one of my, uh, attendings was awesome. I would recommend that people start doing TRE, um, and cut their evening meals further back. But at the same time, um, I typically train in the evenings, what, what, what, 90 more now I'm trying to train in the mornings, but I used to, I was, when I have to be at work at six, seven o'clock, I'm not training at four, 30 in the morning, I'm sorry, I'm not the rock. Uh, so, so I would typically do any of the evenings and if I'm going to train in the evenings, I want to have my carbohydrates around that. I think that ultimately makes more sense than despite that if you are a little bit more insulin, quote unquote, resistant, not necessarily, um, also then there's a social component of it, right? Like, uh, Ben Greenberg talks about this when he's not fasting at night, um, and he wants to have dinner with his kids and his family, right? Most people tend to have dinner on the family table. Um, so that, that's another, so I mean, you really have to kind of do the pros and cons for you. Um, I do want to talk about what, when we're talking about the evidence and looking at the literature, there was a meta analysis, uh, published in the international journal of obesity in 2019, um, and essentially they were looking at, they had three separate things. They looked at continuous energy restriction versus intermittent energy restriction, which is kind of like IF, uh, and then they had intense, um, energy restriction and basically the, the difference between intermittent and intense was that you, in the intense one, you never made it back to baseline, right? To overall, you were in a deficit, um, and essentially what they found in the results were that intermittent energy restriction might produce a larger loss of lean mass compared to continuous energy restriction. And again, the purpose of the study was to look at just the body composition, right? All right. It was small, small and it's clinically not even significant. However, previously, I think a few months before there was systematic review that, that talked about how these effects could be mitigated by performing resistance training and consuming enough dietary protein. Now, Dr. Aaron did talk about that, right? Protein tends to be the foundation. And if you ever talk to a bodybuilder, if you ever, uh, have been around bodybuilder, that's where they start. When they, you know, again, we're not diving into macronutrients today, but when they try to figure out what macronutrients are going to fit their, you know, their daily energy intake and expenditure, you always start with protein. This is how much protein I'm going to do and then you fill fats and carbs around that. Um, so, so I think that that's also important to understand is, hey, ultimately, and I think we've talked about how protein is probably the most satiating one, right? And that's going to fill, um, full longer as well, so that's why it's important. Yeah. Um, what were your thoughts about just him talking about, you know, good foods and bad foods? I think that that's an important point to touch on really quickly. Yeah. It's all about in terms of like clean eating, like he says, like, quote, clean, cheating, that really, quote, cheating. Yeah. I completely agree. I mean, you know, I want to first say, like, a lot of this comes down to self experimentation, right? For people listening to these things, people doing their research, people trying to figure out what works best for them. You got to experiment. Like, you're not going to know until you try it, try a five to intermittent fasting, try a 24, you know, try keto, try vegan, you know, you just got to get into these things. See what works for you? Where are the best things you can, you know, get out of that? And then, yeah, don't be so hard on yourself. You know, I was looking at Dr. Chatterjee, Rungan Chatterjee is a general practitioner in the UK, you know, talks about obesity and weight loss and eating. And he just says, we have to have cell compassion, right? It starts with that. In order for you to transform your life in a positive way, you have to be compassionate towards yourself. So when you do have a cheat meal or when you have that donut that you really wanted, not to feel guilty, but to just enjoy that pleasure of life for what it is, you know? And the way I look at it too from very philosophical standpoint is, sure, I can optimize all I want every single day. I'm going to die one day, you know, like, I also want to enjoy. I also want my cheese, which I try to come back on dairy personally, but, you know, there are times where I love goota, and I'm going to go all in. So I love that point of, you know, that he made about just having compassion towards ourselves and in terms of food with good food and bad food and stuff. That's awesome, man. Yeah, you know, my regret is yesterday I went grocery shopping and love waggments. I don't know if I told you my new favorite store, but, um, so, and I posted a picture on social of my cart, which was primarily vegetable. In fact, obviously. Other than the protein that I got, what I didn't post and I wish I had is the pizza that I got. Uh, and, and I felt guilty afterwards because I didn't post it because I came home and ate it so fast, um, you know, because, oh, man, their pizza is amazing, but, uh, but I wish I had done that. And then I thought, oh, man, this is exactly what he was talking about is I used to be one of those people. Um, that doctor, you know, we were just like, oh, that's bad food. That's you're going to say, it's like a hundred percent all in or, or not all in. And especially when, you know, people, uh, maybe they'll mess up. I mean, I could have, you know, again, it was just two slices of pizza. It wasn't like, I could have, you said, oh, it's two slices. Let me just go to, let me go to another pie after that and an ice cream after that because the day is all ruined. Um, you know, this is such an important point for people to understand that like, again, if you're having three meals a day, let's say you're not doing IF, uh, or teary and you're having three meals a day or maybe even four meals a day, whatever it is, uh, 21 meals if one or two are bad, like you're still going to be fine. You know, again, um, extrapolate that out to a year, two years, again, going back to consistency. Um, you, you got to enjoy it and you got to be kind to yourself. So, um, I will, I promise I will try to post the next piece of it, but I get full disclosure. I had a whole box of dominoes yesterday, man. It was, I had a guys night, um, with some reps and I'm really not a fan. I got a set. I'm really not a fan. I think it was just like, we needed some quick fix, you know, started it. I got a pineapple pineapple jalapeno solid toppings. Okay. See, I'm not, man. And you're one of the people who can't do that. I'm not convinced. Uh, uh, let's get there by the end of, um, sweet, um, all right. So a quick point that when you asked him what performance is, this was music to my ears. You know, do you remember what he said about performance? I, what he said, so it's, it's about function, right? It's about the daily function that you can do. He's, uh, he's an honorary physiatrist, man. That's right. Right. Right. We recruited him on the club. Yeah. He did deal with, right? As a physiatrist, um, you know, seeing our patients, just trying to get up and leave back to the way they were living, right? So somebody with an amputation or somebody, you know, with nerve, nerve damage, can't really walk anymore. And they got us slowly get back to how they were. That's a struggle. And that's going to be performance. Then I'm going to the gym working, you know, what they're going to eat is going to matter all these things. It's, it's all performance driven 100 percent. Uh, I mean, again, I love that he made that statement because that's what we're all about. I mean, as clichés, some people might say it sounds, it's about quality of life. It's about getting up, you know, when you're 80, 90, 100 and still being able to play with your kids. Oh, that reminds me. I got to check out that ad that he told us about with the German, yeah, yeah, yeah. So I'm going to Google that. Uh, but you know what was funny to me is, uh, again, he said he started training when he was like 11 years old. I mean, for me, it was around the same time I started working out when I was about 12. So that I'm a little over 19 years now lifting. And yeah, just training for the sake of training gets to be hard. Uh, and so I really resonated with that ad thing that he talked about is because I, I like to go hard, like I like to go very, very hard and the people like, Oh, what are you training for? And so I'm just training for life and they just look at me like, what are you talking about? Like, but that's, that's what it is. And, uh, it's funny that he mentioned with his own life, he, he starts to do imperialization is because he still likes to surf and he still likes to ski and do all those things. So, so, you know, when, when he's coming around the corner, he'll start adjusting his training accordingly, uh, to get prepared and I do that. I mean, I, I love playing black football. Uh, and so, you know, as March, April starts rolling around when I'm going to play spring ball two, three months before that, I got to start training. Not only is that smart, is it, is it fun? But it's, it's also smart because it's going to prevent injuries from happening. So it's like, if I don't do explosive stuff, I don't get out there, do some sprints and then all of a sudden I go and, and try to play football, uh, that's nothing good. It's going to come out of that, right? And I like my Achilles both of, uh, both of them, and I'm trying to keep those, um, so, so yeah, I mean, ultimately whatever it is, whether it's being able to pick your kids up or, or, or, or, you know, go up a mountain with them, uh, because they like, live hiking or, again, being able to go on a run, um, performance is just function for your every single day life. So hopefully people can take something away from that. Um, yeah. It's what, uh, Peter, Tia kind of says, right? We, we got a prep for the Centenary Olympics, um, and, and we're all 100. So it's kind of, kind of goes along that, are you playing the long game or are you playing the short game? And that's important. You got to know what you're playing. Got to know what you're playing. So, and it's hard. I, I wish that wisdom came earlier for me in my life when I was maybe 18, 19, 20, um, even 23, 24 rather than at, at the age of 29, 30, you know, because I, I could have saved a lot of chronic stuff from happening. And the hope is that maybe some of the, the primeds and medical students that are maybe earlier in their, in their career can appreciate this, not only for themselves, but also for their patient. Um, and, you know, they can kind of convey that, um, speaking of injuries, um, what did you learn about nutritional interventions for injuries? Yeah. Um, you know, I think it comes down to being more aware. I think, you know, when you have an injury and I think again, for me, a lot of my life comes from perspective and philosophy. And it's when you are injured or when you are in this down state, it's not looking at it in the way of saying, okay, like I'm doomed, my, like you said, I just had a pizza my day's gone. No, it's, how do I get back from this? How do I optimally get back to my function? Um, and so yeah, I just think, you know, being more, a little more hyper aware in terms of what's going in your body, how you're going to get back, um, doing it safely, following almost a protocol and doing your own research, um, in terms of seeing what, what works for you. Yeah. Again, I think that more so than ever, kind of what I'm getting from you is, again, going back to the quality part and we got to get somebody on here who can hopefully, we can really dive into the quality and I think we plan on doing that, um, pretty soon. But to me, man, I'm going to send you this, um, it's like a four part series by precision nutrition. I've mentioned them a couple of times because I respect them so much they kind of have a whole nutritional, um, you know, we're recovering from an injury that one of the cool things about them is they have these really nice infographics that are just, you know, a picture speaks a thousand words. But essentially my car process on injury recovery and nutrition around that is you and I understand the body's healing response, but for it can typically be broken down into, um, a couple of phases, right? You have the first phase, the inflammation phase, right, which is necessary, uh, acute inflammation is necessary. Chrotic inflammation is what's bad. That's kind of what Dr. Joseph was talking about as well, right? That's what things are always simmering and things go on. Um, and so being able to manage inflammation in the acute phase, allowing it to happen, but not icing three, like three weeks after an injury, like if you're doing that, then something is wrong. Mm-hmm. Um, that reminds me, we're going to have to kind of talk about icing versus, uh, meat and all those, the new protocols as well, um, but, you know, in, in their, in their precision nutrition, Dr. Arden specifically talked about that he did mention Omega 3s and, in losing and, uh, and I think he said, um, El glutamine as well, uh, about how they can help recover a little bit better. Uh, but I think ultimately protein, I mean, if you, if you're getting good proteins, you're going to get all your branching amino acids, um, you're going to get glutamine in there. Uh, Omega 3 fatty acids, what's more important though is the ratio of Omega 6 to Omega 3 fatty acids. Uh, most people have heard Omega 3 fatty acids in fish oil and, uh, sometimes walnuts will have that, um, although plant Omega 3 fatty acids aren't converted to EPA and DHA. Um, I don't want to dive too much into that, but yeah. Essentially, most of our art, sad or American diet is high in Omega 6, particularly with the vegetable oils. Again, Ben Greenfield hates these, um, I'm actually into so much of this stuff. Uh, but so the ratio is kind of really important, um, curcumin, uh, that's pretty well studying literature in our world for osteoarthritis, knee type stuff. There's a myriad of other benefits for curcumin as well, uh, but I think for pain related to have an injury, um, bromelain, which you can find pineapples. There's your pineapple that you got yesterday, um, uh, flavonoids, which are, you're going to find in teas and, and garlic, garlic is, again, I'm going back to what Dr. Jody Patel said about us. South Asians love in that. Um, so I think there's managing the inflammation is going to, you know, set you up right, um, and then after that, you have the proliferation phase where all these collagens are trying to be laid down when you have, like, let's say you have a tendon or a muscle injury, and you want to make sure they're not irregularly laid down. And that's where we have a so critical hashtag PM and R, um, that's what therapy is going to be so important. And that, like proliferation remodeling phase, um, and the one thing that he did harp on was making sure that your, your calories aren't completely dropped down because your body is in this energy consumption phase to in order for it to heal. The healing process does take, does require a lot of energy. Now one thing to, to point out though is like if you are an athlete or if you're in competition or not even at the, let's just say a lot of people do crossfit, right? Crossfit can be pretty challenging, taxing on the body and let's say you're going to the box four to five times a week and you're training four to five, uh, good resistance training sessions. And then now, hopefully not, but, uh, you hurt yourself and now you're not training. You need more calories than you're basically resting level if you were a sedentary, but not as much as you were training before. So somewhere in the middle, and I think this thing, actually, we'll post it in our show notes when people can see, um, from PN, uh, really talks about that, um, does that make sense? Yeah. Yeah. Absolutely. Cool. All right, man. Um, I, before we close it out, we got to touch on the, uh, the supplementation because, again, uh, like I said, two to three times a week, somebody's hitting me up to ask me about something for sure, um, what, what did you take away from that? And then I'm, I'm actually curious if you're taking any supplements right now. Yeah. So let me first start off with creatine, right? Because that's the one he's like, there's so much research. And I remember I started creatine about maybe like six, seven years ago. And at first, I was never a big supplement guy. I was like, what the research shows is this good for the body, the kidneys, right? Just creatinine that we always hear about. So people get that confused. Um, so creatine for sure, right? Is one of them that I'll take post workout, I believe he said more so because you're insulin sensitive and stuff. And so, you know, it can shuttle straight to the muscle. Um, so that's an easy one, uh, caffeine, right? And coffee, um, great, you know, for alertness, performance, uh, just elevating your heart rate, getting you ready. Um, so that's definitely one that, you know, I'm not the biggest, biggest fan of, um, you know, I'll rarely do coffee. I'll do a green tea, maybe if anything. Um, and then what else do I take? Let's see. So I take magnesium, um, I take like a, so I am vegetarian. So I do plant-based protein, like a protein shake, um, and then I was taking ashwagandha for a little bit, just for like the stress response, especially with residency. Um, and then I take B12 and I stopped taking a multivitamin. I actually heard Peter Tia talks about this. He doesn't think there's much utility, um, for multivitamin, as long as you're having a pretty complete, you know, healthy diet, uh, which, you know, I, I think I agree with, um, with him as a key phrase though. Exactly. Yeah. That is the key phase you gotta be having that quality key diet in there. Um, that's all I take because, you know, sometimes I'll take like a biotin or a collagen or something. I scarred pretty easily. So I don't know if I play some deficiency in that, but yeah, I gotta, I gotta look into this more about collagen type stuff. Um, I mean, it's definitely, yeah, oh, vitamin D, yeah, yeah, definitely. Um, yeah, I mean, that's been more popular than ever nowadays. Um, yeah, the collagen stuff, uh, I gotta look into it. I don't know too much about it. But yeah, again, creating is again, besides caffeine, the most widely studied one. And it's gonna just, there's no almost, um, I shouldn't say no. But yeah, most people are going to respond well to creatine in terms of performance or hypertrophy. And you really have to kind of measure, uh, it might not be noticeable effect. One of the main side effects is two main side effects is people get some GI distress and then obviously some water retention. But guess what? Gligation, uh, is mostly muscle is mostly water. You're mostly water. So that didn't this to make sense. Um, it's simply protein. Uh, I think that he did emphasize that as well. And one of the points that I wanted to make is he touched on, you know, protein being um, uh, again, most physicians and I think our colleagues, even myself to some degree, um, used to think that it's detrimental in patients with kidney disease and he, he said how the preponderance of research is, is not panning out to show that. And you know, you don't necessarily want to be on a high protein diet. But at the same time, you don't need to be protein diverse, right? In fact, that might be more detrimental because most of these individuals, not all, but most of these individuals might be elderly, they might be frail. They already might have significant muscle loss and atrophy and, um, if you put them on, you know, a low protein diet, then that's going to only exacerbate the ability and then what are we doing, right? So I think that often you and I, we see it in the hospital when they're on a renal diet or protein diet and it's like cut the protein off to 60 grams a day or if even 40, 30 grams a day and it's like, what the hell? Uh, and for those who don't know, uh, you know, a renal diet is typically low in potassium, which I, again, uh, we're not suggesting that anybody put a homemade new, anybody on a high protein diet, but you'd be surprised meant when I was trying to get super lean, like, I mean, I was consuming upwards of 250 grams of protein a day. Uh, it's hard to do, don't get me wrong, it's insane to do. And I was a healthy individual and I'm not suggesting that anybody does that. Uh, but I think that I would caution our, our colleagues to say, okay, protein is toxic for the kidneys. I don't think that the literature is supporting this. So definitely be familiar with that. Uh, the one thing I do want to emphasize, the, the biggest thing I took away from a supplement conversation with him is that the FDA does actually, yeah, 100% blew my mind. I had no idea. Yeah. I am actually so guilty of, uh, of telling people that, but I actually went to go look this up and, uh, we're going to post exactly the FDA 101 page for supplements, but just a couple of points to point out that it, that I took away, which we're terrifying. Um, and this is straight from their website. The federal law does not require dietary supplements to be proven safe to FDA satisfaction before they are marketed. Okay. Great. Um, also the federal law doesn't require them in fact or a seller to prove to FDA satisfaction that the claim is accurate or truthful before it appears on the product. Okay. So it doesn't have to be safe and it doesn't even have to be truthful. Uh, and in general, FDA's role basically with these supplements begins after it gets to the market. All they're really checking for is the serious side effects that are, that are reported by the company. Um, and so that he, he had mentioned really the FTC, which is like the, uh, federal trade commission kind of doxam, the FDA doesn't even do that. So, you know, the dietary supplement manufacturers, they don't even need to get the agencies approval before producing or selling these, uh, it's just like they have to let the FDA know courtesy, hey, we're doing this kind of apply this. So it, it, it, it's kind of terrifying, um, but you might wonder, okay, so, so what the hell do we do, right? People ask me about supplements. So I used to say, hey, they're not regulated. Now I know better. Now it's just quality control, right? Right. So that's kind of what it is. I mean, I guess they're regulating birth or they're really regulating, regulating is a, uh, uh, loosely say that here. Um, so I think when I tell people to recommend is this is why when I buy my protein creatine, like I'm paying double or triple, what most people end up paying is that you want to get products that have a CGMP, uh, label under FDA. And what that is that they're certified with, you know, good manufacturer practices. This is compliance by the FDA that a lot of the quality control issues will be, will be taken care of. So the, um, the facilities that they're, they're making the products, they'll be inspected periodically. And, and so at least that's something, um, then the other one is the label that folks might want to look for is NSF, right, which is the National Sanitation Foundation. So anything that's NSF certified for sport or informed sport, those words are on the label. You know, again, that this is being held to a higher standard. And then lastly, just flip it over and look at frigging ingredients, right, uh, don't be buying stuff that says proprietary blend because you don't know what the hell that it even means. So, like, uh, that's all that stuff, yeah, yeah, that's my, uh, that's my last bit from today, man, or from, from his conversation, you know, love it. Let me just add real quick, people ask me the same question, labdoor.com is one that I love. Um, you know, so he's looking at these, looking at these websites that do outsourcing. So they'll actually test the quality of different supplements, they'll rank them from like, which is the best to worse, also price wise, or labdoor.com is one of my go-to's. Um, and then got this from Dr. Christian Gonzalez, uh, who one day hopefully get on this podcast as well. He'll reach out to companies specifically and say, hey, can I get the certificate of analysis? Just so he knows how much heavy metal is in here, um, what ingredients are they using? So he'll, he won't be afraid. He'll call up. And then if the company says, hey, we don't really give it out, it's a little fishy. Um, so just be aware of those types of things. Those are great calls. We'll link those two so people can easily access that. Awesome. And well, this is definitely a little bit on the length of a recap. But again, this was such a powerful episode. So hopefully people can get something, uh, you know, actionable from this and, uh, enjoy it. Yeah, absolutely. Can you agree more, man? So wait, all right. Later. Thanks. Well, that's a wrap on the show. But before we end, don't forget to reach out to Medevolve. For those of us who know how hard it is to build and maintain a sustainable business, we understand that bringing the right help to achieve our goals is really important. Get in touch with them for data-driven analytics, workflow automation, and medical billing technology and services by going to www.doctoralpodcastnetwork.com slash Medevolve and get going on the right path. As always, guys, remember everything in this podcast is for educational purposes only. It does not cost you to practice a 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. If you find the content valuable, please be sure to subscribe and share it with someone else who you think will also benefit from this podcast. Thank you so much for your time.