Kind: captions
Language: en
the higher that level the longer you're
going to live there is no number there
is no biomarker there's no finding in
all of biology that is more predictive
of a person's length of life than that
specific number
you have a quote in the book that goes
something like I used to think that diet
and nutrition were the cure-alls and now
I'm not so sure
how is it possible that diet and
nutrition which would have been the
thing and I've said many times in the
show if if you just let me
control a hundred percent what people
eat
I I've got them covered I'll control
their body composition but the one thing
I always caveated was I don't know that
I'll keep them alive longer because I'm
running an NF1 experiment so what made
you start to lose faith that diet and
nutrition were the answer well I think
it's important to differentiate between
a couple of things so I definitely don't
want
um what I've written or what you've
correctly interpreted to imply to people
that I don't think nutrition is
important right what I'm really saying
is nutrition is an asymmetric input to
the equation if we want to think about
it technically meaning it has far more
downside if you get it wrong than it has
upside if you get it right that's
interesting does that make sense yeah so
getting it wrong will really hurt you
getting it right man it's not going to
make you live to 200. that's right I
mean first of all I don't think anything
will but yes that's the right idea no
absolutely not so so if you get it wrong
and let's be clear we are living in a
case study of getting it wrong right MO
the standard American diet is all about
getting it wrong for virtually everybody
so we're we're watching proof positive
what it means to get it wrong but what I
want people to understand is
it's very easy to get to that point
where you think okay I'm going to fixate
on this thing and it's going to get
better and that's wonderful by the way
if you do
but you're if you do that at the
exclusion of some of the other things
namely exercise
um you're really leaving an opportunity
on the table an exercise has more of a
symmetric upside and downside in other
words if you
are not exercising or you're not
exercising sufficiently there's a huge
downside but unlike nutrition if you get
exercise right there's enormous upside
there is true life extension and
Remarkable Health span extension which
might be even more important I'm really
I'm bothered by that and it's bothered
by that because I hate exercise dude in
a way that you can't imagine so
literally while while I was reading your
book which I always do as an audio
format I was doing
um air squats and sit-ups and stuff
because just hearing you talk about the
importance of exercise it really is the
thing that I have always done out of
obligation and never out of Joy so I
always thought again literally until
reading your book that I was way better
off controlling diet and you get this
the classic phrase you can't outrun a
bad diet
can you like are you saying you can well
again we wanted so that's a complicated
answer which we'll take in steps so
there's probably a season in your life
when you can generally when you're young
and if that exercise is at a high enough
level you can so just using my own
personal example absolutely when I was
growing up so in my teenage years right
13 to 19 I didn't pay any attention to
what I ate other than I was always
eating
and when I say I was always eating I'm
not exaggerating right like I every
morning breakfast was a box of Froot
Loops or Captain Crunch or some
unbelievable crap that could only be
consumed in a tupperware bowl bigger
than my head nice and you know with a
liter of milk lunch was usually seven
sandwiches oh my God it's a full loaf of
bread what were you doing I was
exercising six hours a day Jesus were
you a wrestler or something boxer oh yes
so you know running minimum five
typically closer to 10 miles every
morning 25 minutes of rope jump two and
a half hours of weight training sparring
bag work every single day 400 push-ups
before bed every single night with one
exception One Night in high school I
didn't make it happen wow you actually
remember that it was only one time one
night I was so goddamn sick that I
couldn't get out of bed for a whole day
and that was the only night in all of
high school I didn't do my 400 push-ups
before but I was so pissed off that even
now you remember that there was one day
I love it but my point is I didn't stop
eating I was eating french fries crap
all day every day I couldn't gain weight
I was trying to move up a weight class I
couldn't because of the exercise or your
genetic Proclaim oh I just think I mean
that that much exercise you're you can
eat whatever you want
um now could I exercise that much today
could I exercise could I out exercise a
bad diet today no at 50 I can't do what
I could do when I was 15. right I want
to get into the mechanisms of that so
here's another one of my ignorant
statements that I live by uh this is all
a game of controlling your glucose and
that if you let me control your glucose
levels then I basically control your
destiny and I want everybody listening
to know that after reading this book I
know this is probably not only overly
simplistic but maybe even just wrong
correct but uh
in exercising like that it feels like
okay well you're burning all that
glucose so the glucose isn't going in
and wreaking havoc on your system
um are you saying now mechanistically
that
at this age I guess like you either
I think there's two things going on
right one I simply couldn't do
I I don't think I could do in one I
don't think I could do four one day what
I did for five years
every day just two taxing on the system
it's just too difficult like I don't
have the physical capacity to go like
today if I went out and ran 10 miles I'd
be beat for the rest of the day like
that would be my day whereas I had done
that before six in the morning every day
and I was just getting started so I
simply can't do what I used to be able
to do
so I think that's just a big part of it
but also as we age for reasons that are
not entirely clear we do become less
metabolically healthy our mitochondria
become less efficient our muscles become
more insulin resistant part of that's
driven by hormones part of that's driven
by enzymes I mean we know that
testosterone is going down my
testosterone is actually quite low you
know I'm sitting here kind of on the
fence contemplating should I really
start testosterone replacement therapy
because my testosterone has kind of been
in the crapper for a few years but I
know me crap or what what number oh I
sort of hover in the 400 nanogram per
deciliter range and I've kind of been
there for a few years and you've tried
to elevate it naturally and can't
um I mean only in that I'm doing all the
right stuff like I sleep incredibly well
but my FSH and LH are really at the
upper end of normal in other words like
everything from my brain is doing the
right thing my brain is telling my body
to make testosterone but you know I'm
sort of at the limits of what my body's
willing to make right now which is you
know probably I'm at about the 20th
percent tile now one time you and I had
spoken about testosterone replacement
therapy and you said you prefer to do
precursors and not so would you still do
the precursors if you do it I'd probably
start with a precursor or a pre-hormone
like HCG
um I wouldn't use Clomid which is
another one
um and give it a shot and see if that
could really wake things up but you know
eventually you know I'd probably need
testosterone
um but even that like even if you
restored my testosterone levels to what
they were in my 18s or 20s I'm not sure
that that would be remotely sufficient
to address the metabolic changes that
have occurred in me
um you know I probably have less hormone
sensitive lipase or or lipoprotein
lipase rather on my muscle cells and
more of it on my fat cells in other
words my body is probably more inclined
to fuel Partition unfavorably meaning
it's probably more inclined to take
energy and put it into fat cells as
opposed to direct it towards muscle
cells so all of that is to say there's
no way today I could out exercise a bad
diet and as a general rule
again at least if using uh body
composition is the metric yeah it's a
pretty good
um you know rule of thumb that you're
not going to out exercise a bad diet but
there are exceptions clearly
okay so I want to linger on this idea
for a second that because this the
reason that I am really I've always
steered myself towards things that you
say is because you have a really deep
ability to get to the mechanism of
action
and so this idea that a diet is
incredibly important in terms of you
have to do the right thing to avoid
downside but it's not really going to
elevate you now we hand over to exercise
and exercise
is potentially going to now pull you
farther forward but I want to understand
why so is it you talk a lot about in the
book stability is it just that I'm not
going to fall or is there something
going on at the cellular level that
becomes important it's all of the above
so
um
you know generally speaking we think
about this through the lens of Health
span and lifespan so let's just start
with the lifespan side of that and we
can even go back and talk about the
nutrition piece right so if your
nutrition is sub-optimal what does that
mean there are lots of ways your
nutrition can be sub-optimal it can have
too many calories in it it can have too
few calories in it it can have too
little protein in it it can have
deficient micronutrients in it I mean
those would kind of be some of the big
examples of where nutrition can be off
and those will produce different
phenotypes you could be underweight you
can be overweight you can be insulin
resistant which comes hand in hand with
excess nutrition you can be under
muscled which would be a result of low
protein intake so and then you can have
a whole bunch of sort of deficiencies
like B vitamin deficiencies and vitamin
D all sorts of nutritional deficiencies
that come from not getting the right
vitamins and micronutrients on the
exercise side we can go through the same
exercise by the way on on the nutrition
side that mostly impacts lifespan those
deficiencies disproportionately Point
towards a shorter lifespan so as you
increase adiposity you increase meaning
as you get fatter
um you increase the odds that you're
going to start spilling that excess fat
from the safe place that you can store
it which is in your subcutaneous fat
cells as athletic as aesthetically
unappealing as that is but otherwise
metabolically quite inert you start
spilling that into places where fat
shouldn't be
inside the liver inside the muscle
itself meaning right inside the muscle
cell
around the pancreas around the heart
around the kidneys around the organs
itself is visceral fat once you start
spilling fat there all of a sudden your
risk of every disease every chronic
disease goes up and it goes up a lot
right I mean we're talking about a
doubling of risk of cardiovascular
disease cancer and neurodegenerative
disease especially Alzheimer's disease
don't pull past that so I need to
understand this mechanism so it's um
you're filling the fat cells you're also
making new fat cells some not so much
you basically I'm talking about when
it's working well oh no no you're just
filling the fat cells yep and the
subcutaneous fat cells are accommodating
the increase in energy storage so again
even though you know culturally we don't
like that that means you're getting
fatter yeah evolutionarily that's an
enormous leap step forward right this is
what allowed us to basically develop
monstrous brains is the ability to store
lots of energy so we weren't dependent
on meal to meal because our brain is by
far the most energy hungry part of our
body so you have this organ waste two
percent of your body weight consumes 20
to 25 percent of your energy any
interruption in energy is going to
prevent the brain from working so in
order to evolve very quickly and
basically hit escape velocity on all
other species this was our trick how
could we become efficient at storing
energy and fat is by far the most
efficient way to store energy so this is
all very good it only becomes
problematic when you live in an
environment where there is so much
abundant energy that you exceed the
capacity of this system to safely store
it right so the way you can think of it
I think I described it the way the book
is a bathtub
the bathtub that is your the total Depot
of all your fat cells water is energy is
flowing in there's a little drain that
safely drains water out that's your
expenditure of energy the balance
between those two things determines the
water level at some point if the input
is so much greater than the output you
will not only raise the level of water
to the point where it's getting bigger
you'll start to overflow it's that
overflow that's destructive right right
so does your body store visceral fat
without overflow no visceral fat is part
of the Overflow okay so is visceral fat
made up of the same sacs that I would
find in my subcutaneous fat
um it's uh no it's it's actually kind of
a different location altogether and it's
it's it behaves very differently so
visceral fat is far more inflammatory in
fact that's part of the problem you know
if we do a dexa scan on a person which
is how you can measure some of this
stuff
you do a dexa scan on a person that
weighs 200 pounds that has 25 body fat
so by definition based on those numbers
they have 50 pounds of fat
but let's assume that of that 50 pounds
of fat the visceral fat is five pounds
so ten percent of their fat is visceral
that five pounds of visceral fat is
wreaking all the damage in their body
the 45 pounds of fat that is not
visceral
totally inert okay let me describe it in
a lay person's way so subcutaneous fat
is water inside of a water balloon
visceral fat is water on your sweatshirt
yeah and your sweatshirt now is just
[ __ ] wet and nasty yeah think about
the bathtub analogy right the the
subcutaneous fat is the water in the
bathtub is totally fine the visceral fat
or peripancreatic or intramuscular or
intrapatic fat is when it gets out and
starts leaking through your floor it's
the same stuff it's the same just one is
in its rifle container and the other
it's just glommed on to something that's
right
that is really interesting so for
example in the muscle what does that fat
do that's so destructive it impairs the
signal of insulin not to get terribly
detailed but you like the mechanism
right insulin hits a receptor called the
insulin receptor that insulin receptor
triggers a Cascade a chemical Cascade in
a muscle cell that tells a glucose
transporter to move up to the cell and
allow glucose to come in that's the way
it's supposed to work when you have fat
inside the muscle cell that signal gets
broken so that's what the that's the
first sign of insulin resistance
and the body says hey I need to get rid
of this glucose I need to get this
glucose into the muscle that's where we
store glucose I can't I need more and
more insulin to do this and eventually
you run out of ways to do that so
initially you can make the glucose go
away but you need more insulin
eventually all the insulin in the world
doesn't do it the glucose goes up that's
called type 2 diabetes okay so how do I
overwhelm that system if I have a binge
night on a Saturday and I'm going ham on
the ice cream am I going to overwhelm
the system or do I have to fill the fat
cells first is it basically speed or
quantity so two separate things there so
if you're just having one binge night
eating ice cream and stuff you're you're
binging you know you've got glucose and
fat and you may you may well dispose of
those things fine it depends on your
incoming state so if you're a relatively
healthy person an insulin sensitive
person a night of binging really isn't
going to cause any trouble certainly
nothing long term right what we're
really talking about is The Chronic
result of doing that and so the the
glucose these and the fat piece are
slightly different the the glucose piece
is very tightly regulated
um you know if you consider the
difference between a person who doesn't
have type 2 diabetes and someone who
does it's literally only the difference
of one teaspoon of sugar in the blood
that's the I mean it's a remarkable
difference in terms of how subtle it is
that's how tightly the body wants to
regulate glucose so when the body can't
do when the body can't regulate glucose
that becomes type 2 diabetes
long before that's happened you've
usually started exceeding your storage
of fat and it's that excess fat that
spills out of the bathtub that is making
the body dysfunction around glucose
regulation I've recently heard that it's
more dangerous to be a lean diabetic
than to be an obese diabetic do you
agree with that the data absolutely
suggests that that is the case
okay so if I'm a lean diabetic then what
that predicts is that my water balloons
are very small and they just can't take
much water and so they keep spilling
back out spilling back out spilling back
out so if I'm a lean diabetic I probably
have a ton of fat around my viscera yeah
and that doesn't translate to much
weight on the scale because you don't
need much of that visceral fat
peripancreatic fat intra hepatic fat you
don't need much of it in total mass to
cause absolute metabolic destruction
okay and so that's why the lean insulin
resistant the lean person who's
metabolically unhealthy has the worst
outcome
so interesting man so okay before
reading your book I would have come in
uh and said all right let me just look
at the person I'll ballpark you if they
are lean they're almost certainly fine
and if they are obese they for sure no
question they have a problem metabolic
disorder they're in danger uh I get the
feeling from reading your book while
that may sometimes be correct and maybe
directionally at the population level
it's fine but that an individual
actually can be fat and healthy and that
a lean person can effectively have the
blood if somebody is morbidly obese yeah
you're absolutely right at the
population level
we can look at things like BMI and make
General broad statements but at the
individual level to do anything other
than ask the question specifically about
that person is to do a disservice and
you're right up to a third of people who
meet the BMI criteria for obesity
they are metabolically healthy and their
life expectancy is the same as a lean
person Jesus okay so when I read that in
your book I actually had this impulse
I'm ashamed and I would never act on it
but I had the mask mandate impulse of
like you can't tell people that like you
you're just better off telling them that
being fat is going to kill you don't be
fat well so this is where Nuance comes
into uh consideration
everything I just said is more about
lifespan but let's talk about health
span okay there are reasons to not be
obese that go beyond you know premature
cardiovascular disease cancer Etc
think about the impact it has on joints
so it's not necessarily going to shorten
your life if you're metabolically
healthy but there are still other
consequences that's right got it okay
joints just because I'm carrying so much
weight yes every time you take a step
while walking your knees are
experiencing approximately three times
your body weight in terms of force Jesus
when you're running it's about eight
times your body weight
so losing weight has a very non-linear
effect on your joints and similarly
gaining weight in the negative Direction
has a very non-linear effect on joints
there's a reason that now I'm not that
psyched about running the way I was when
I was 25 pounds lighter I was 25 pounds
lighter my joints handled it
effortlessly today
I don't know I'd probably get away with
it but I'd have to really reduce my
volume and frankly I just choose not to
I much prefer to get my cardio doing
things that aren't having impact on my
joints what's up everybody Tom bilyu
here and I am very excited to share some
news with you that's going to help you
be legendary in honor of mental health
awareness month this may I'm teaming up
with better help to bring you an
exclusive video miniseries available
only on Spotify every week in May I'll
be sitting down with some of the most
inspiring insightful people in the world
of mental health and personal
development we're talking about people
like Mo Gadot and Emily Morse who will
share their wisdom and strategies for
overcoming challenges building
resilience and tapping into your full
potential each video will be packed with
practical advice powerful insights and
actionable steps you can take to
transform your mindset and take back
control of your life so if you're ready
to take your mind and body to the next
level tune into this all new mini series
exclusively on spot modify sponsored by
betterhelp check out betterhelp.com
impact Theory to get 10 off your first
month yeah we don't want to dismiss the
orthopedic causes of you know reduced
reduce more reduced Mobility
um and weight plays an absolute role on
that furthermore I don't want to suggest
that body composition doesn't matter
lean mass absolutely does matter and
it's really what people should be
focusing on so this gets back to the
point of
you know the reason I'm not a huge fan
of sort of population-based metrics like
BMI is they just don't contain enough
information right like a very very
muscular individual will could have a
BMI of an obese person so obese is
defined as a BMI of 20 a pardon me of 30
overweight is a BMI between 25 and 30 is
overweight I think my BMI is like 28. so
I'm I'm closer to obesity than normal
weight but I'm not based on body
composition yeah so body compositions
we're really not watching he's he's got
some muscle on him this kid no I mean
I'm like just I'm a relatively normal
healthy guy and that's what by what
metric do you consider your physique
normal
like the normal person in America yeah
maybe not maybe not heavy yeah sure
um
so anyway my point being
when we look at our patients we I don't
know my patients bmis I couldn't care
less I want to know how much visceral
fat they have
I want to know how much total body fat
they have I want to know their bone
mineral density and the metric I
probably care most about or at least as
much as bone density and visceral fat is
something called appendicular lean mass
index and fat-free mass index what is
that so appendicular lean mass index is
take the total amount of muscle mass in
both arms both legs in kilograms divide
it by your height in meters squared you
get a number that number we rank on a
nomogram and we care what that
percentile is why arms and legs arms and
legs well we do too so you do
appendicular lean mass index which is
arm's legs and then we do fat free mass
index which is all non-fat mass of the
body and you do the same calculation
each has a pro and con the fat free mass
index has the advantage of including all
the muscle in the body but unfortunately
it includes stuff that's not muscle it
includes organs
the appendicular lean mass index has the
advantage of being a very good proxy for
muscle mass in those locations because
they don't have organs in your arms and
legs so we do both and they usually give
concordant answers but sometimes they're
a little discordant and we have to
evaluate them discordant meaning they
have different percentile predictions
but we want to see people at or above
the 75th percentile for those two muscle
mass metrics and again
you don't have to be super that doesn't
mean you're super jacked right like you
know a super jacked person is off the
chart on those things but again no one
would accuse me of being super jacked I
think I'm at the 95th percentile so
we're this is not a this is not a
standard that is unreasonable and the
reason we care about that is the the
evidence that if you look at a person
whose almi is greater than the 75th
percentile that's one of the ones you're
just describing that's the appendicular
lean mass index and you compare them to
people below the 75th percentile
the mortality difference in those people
once they reach their mid 70s is a
staggering difference so in one study if
you looked at people who were 75th
percentile or higher
their 10-year survival from the age of
72 was 80 percent
if you looked at people who were below
that their 10-year survival was 50
percent
that's a pretty big difference
when you take on a new client that is
coming to you specifically for longevity
reasons
do you start with looking for signs of
degradation the damage that they've done
or are you prescribing the things that
they ought to do no we start we want to
we want to get as much Baseline
information as possible so everything
from your family history in excoriating
detail because it's going to tell you
about the what you call the horsemen in
the book yeah what are your legion of
death that's right what are your what
are your risks at least as your genes
would set us up to believe obviously
lots of blood work body composition
information functional testing so
mitochondrial function VO2 max which is
Peak aerobic strength and movement those
are really big big buckets and we have
very specific tests that we use for each
of those things the strength and
movement tests are tests we've designed
over the past several years
um and and they're I think in many ways
some of our best work really because
they're you know we had to come up with
this stuff on our own because nobody
else really had a test that we felt was
as predictive of you know what we wanted
to believe so it's doing a whole bunch
of that type of testing and and using
all of that to basically come up with
something we called the longevity risk
assessment the lra which is a rank order
of all the things that are a threat to
their longevity there's basically seven
things that are a threat to how long you
live and how well you live yeah and we
just sort of rank them out and get to
work and that's when you start to get to
prescriptive what are the seven uh
cardiovascular disease or the diseases
of atherosclerosis so cardiovascular and
cerebrovascular disease cancer
neurodegenerative diseases inclusive of
all dementias
um accidental deaths including
Automotive accident
uh what do you look at for that fall
risk as you get older yes so it's
basically Falls automotive and overdose
so that would by the way include people
who are using illicit drugs right if
you're using list of drugs nowadays
there's a very good chance you're
running the risk of getting spiked by
fentanyl right last year over 100 000
people died by accidentally ingesting
fentanyl because it's so cheap and so
people are putting it into other drugs
yeah basically drug cartels are now
using synthetic fentanyl as a filler in
drugs because it's insanely cheap okay
um then you get into uh sort of physical
decline so Orthopedic injury and
physical Decline and then there's
usually some special one that'll show up
that's specific to an individual so for
example you know someone might have
hemochromatosis or something like that
or something like that yeah just a
genetic disorder of like iron uh
metabolism or someone might have you
know low kidney function or something
like that once you kind of rank order
those
risks that's what determines the getting
to work part so now you start to get
prescriptive how do you go about
mitigating those risks so then you'll
take on a period of time what are the
things that you start looking at so if I
said hey I the person you want to talk
to you can't ask them any questions but
I can give you any reading you want
would you go immediately there's seven
things we look for in the blood or
um yeah blood testing is very helpful
but it has lots of blind spots there's
no one test that offers us everything so
blood testing for example will give us
great insight into your risk of
cardiovascular disease uh pretty good
insight into your risk of dementia what
are you looking for there I'm gonna
guess glucose yep you're certainly
looking for all things that pertain to
metabolic Health all things that pertain
to lipids and lipoproteins inflammation
things like homocysteine what would you
look for for inflammation C-reactive
protein yeah c-rective protein
interleukins things like that
um you also look for again all the
lipoproteins factor into both
cardiovascular disease and dementia
really fast I want to go back to
inflammation this is the one that scares
me the most when I was a kid you could
write on my skin just by scratching me
and it would welt up
um I ice my wrist in fact this is where
you and I first cross paths I was icing
my wrist for 15 years you had me try
keto which will definitely talk about
your change of perspective on that uh
that changed my life and by introducing
healthy fats my inflammation plummeted
but I still I've not ever done a
C-reactive protein test if you see
C-reactive protein in the blood do you
know that oh that's coming from or is it
just like okay it's very non-specific
yeah yeah so very very high levels of
C-reactive protein which we often see
almost assuredly don't constitute
pathology of concern it's usually an
acute illness
really yeah so normalcy record protein
level is less than one if if I get a
patient's blood back and it's 12 I'm
calling them and I'm saying hey were you
sick around the time we do this blood
and they're almost always saying no but
I got sick the next day or yeah I'm just
I was just coming off a bad cold so
somebody on a standard American diet
won't have spikes not not to that high
usually what I'm more concerned with is
the person who's got a C-reactive
protein of two and a half that never
goes away there's something going on
there
and it could be diet related it could be
autoimmune it could be cardiovascular
it's very difficult to know so again the
problem with most of the biomarkers
around inflammation is the profound
non-uh specificity of them when did your
uh so if my arrogance around diet
started to dwindle uh with your book
when when did your conviction around
diet is is going to be the answer to
everything when did what what began to
shake that
I think just kind of in the process of
writing this book and getting deeper and
deeper into the data I don't know tooth
Circa 2011 to 2012 where I even went on
a whole rant about the non-importance of
exercise relative to nutrition and by
the way I acknowledge up front the irony
of me writing this because this was
still back in the days when I was
exercising three or four hours a day but
I sort of chalk that up to look I have
an addiction and I do this and I love it
and it's like a hobby it's like a
passion like I would do this if it were
harmful
but like don't look at me and think you
need to be doing this right all you need
to be doing is you know controlling your
diet
um so so
it just became impossible for me to
ignore the the literature on exercise
and what what's the thing like you saw
grip strength is tied to a massive
decrease in all-cause mortality stuff
like that like what are the biggest it's
the entire spectrum of it right so it's
the experimental literature the
epidemiologic literature the mechanistic
literature but what's it all saying
Muscle Matters like if we had I know you
[ __ ] hate the I did this whole
note-taking session about how you hate
like people that don't get into the
nuance and then I was like my
Counterpoint to that is if you can't
distill this stuff no look I would say
high cardiorespiratory Fitness and high
muscle mass and strength are more
predictive of a long life than anything
else we know say those again High cardio
respiratory Fitness yes it's measured by
VO2 max okay
High muscle mass high strength the
amount of muscle the amount of muscle
although I would argue it's more
strength and we just see a very tight
correlation between strength and muscle
mass okay within reason interesting that
is more predictive of a long life
than any other metric we have okay so
now we're going to get to I'm going to
test this at the fringes I don't know if
you know who Dr William Lee is but I
just had him on the show and I was
barraging him with questions about sumo
wrestlers
and he made an assertion that I found
just impossible to wrap my head around
which is that a Sumer wrestler may be
perfectly healthy and I was just like
how the [ __ ] is that what that tells me
is that I could ask you and get a
prescriptive answer to the question how
do I get obese in a healthy fashion
so I can't speak to sumo wrestlers I
don't understand anything about them I
don't know but but on its face it's
possible Right In based on what we just
talked about they can as long as they're
hella strong as long well no as long as
they are metabolically healthy in their
obesity there's no question okay
consumer wrestler is profoundly obese
right and it's not like just muscle mass
so a sumo wrestler is extremely high in
muscle mass is extremely high in
strength is also extremely high in fat
if they also happen to have high cardio
respiratory Fitness which I'm guessing
they do to do what they do provided all
that extra fat isn't creating a
metabolic problem okay let's let's
define that so they're not leaking out
so they don't have they don't have
insulin resistance they're able to
uptake their diapers of glucose just
fine they're
um and the reason that matters so much
is because if you don't you're getting
uh the so two-ish glucose is sticking to
things yes so that's that's half of the
equation so half of the damage this is a
bit of an oversimplification but half of
the damage is the excess glucose is
causing a lot of sticking around and
it's damaging small blood vessels the
other half of the problem may be even a
bigger half of the problem is the excess
insulin that is trying to put that
glucose away is causing damage to larger
blood vessels and also it's a growth
factor that is constantly in the on
switch feeding tumors cancer would
certainly be the biggest concern you
would have there and that's probably why
after smoking obesity is the second most
prevalent environmental trigger of
cancer because obesity is a signal that
you've got your body in grow grow mode
well obesity is often though not always
accompanied by high signals of growth
and inflammation which gets back to you
know are you a metabolically healthy or
unhealthy obese person if you're
metabolically unhealthy and obese that
means it's by definition accompanied by
high growth factor High inflammation
high glucose and all of those things are
destructive to your health so is the fat
becoming inflammatory because it sends
out a hormonal signal or it sends out
inflammatory signals when it's not in
the fat cell when it's not in the right
fat cell when it's not in the
subcutaneous fat cell got it so those
visceral those fat droplets that are
around the organs are sending out
inflammatory signals so when we're
looking at an obese person just to beat
this point to death
really the we're just concerned about
I'm going to guess given that you're
obese so you're probably leaking fat
into the system that is becoming
visceral fat which is just loose using
the water balloon analogy it's just
loose fat and sticking to things that
it's not supposed to causing distress
and the liver I know can cause scarring
absolutely causing damage in the liver
then yes can absolutely lead to scarring
and ultimately cirrhosis if it doesn't
goes or go away which is the leading
cause of liver transplantation is fat
accumulation in the liver not related to
alcohol ingestion yeah
um and getting into the pancreas
poisoning the beta cells making it
harder for them to even make insulin so
further exacerbating the problem of high
levels of glucose
um so yeah but the problem is when
you're looking at that person with your
naked eye you don't really know it
okay very interesting all right so back
to strength
um getting back to our sumo wrestler so
we
we would have to look for things to see
if this is fat in a healthy way and it
oh can I say protective instead of
healthy sure maybe I just have something
emotional I still need to work through
with obesity uh but it feels like uh the
reason that a lean diabetic is in a far
more problematic state is it does not
have the defensive mechanism of hey this
terrible diet that you're eating is
causing the leakage of fat uh and when
you're obese it's like hey we got you
you can pump the system full of fat we
can store it appropriately all as well
so
the Obesity then to a point will be
protective
it seems that obesity to a point
is the safest place to put excess energy
which you're better off not consuming
yes but if you are consuming it you're
way better off storing it in
subcutaneous fat cells and getting
bigger than you are just letting it
dissipate into in other words you're
better off having a bigger bathtub
that's full than having a smaller
bathtub that's draining water onto your
floor and down your heat ducts okay let
me ask you another question while I get
as we age we're probably not going to be
able to do it
is there any damage being accumulated to
a Michael Phelps in his early 20s eating
10 000 calories but burning 10 000
calories through exercise yeah great
question
um
probably not in the short run
um and probably not if upon ceasing all
of that activity the energy expenditure
returns back to an appropriate level so
as long as the body's using it you're
fine yeah now again
um there might be a behavioral challenge
there it might not be an accident that a
lot of former athletes who are you know
basically eating as much as is humanly
possible to support their energetic
needs when they're young struggle to
maintain Health when they get older
because the habit of still I mean I
truthfully Tom I think I still struggle
with this like I mean I'm not in a
position now where I can just eat all
the time and yet I think there's a part
of me that's still kind of wired to want
to right but again when you're not
exercising six hours a day you can't so
and I remember you know even when I was
young my parents just watching with
complete befuddlement as I would I was
just constantly eating and it didn't
like I would tear through ice cream I
was just always like it didn't matter it
just didn't matter I was an eating
machine and it was freakish for people
to watch they couldn't believe it and
yet I was rail lean right and they said
I remember my parents saying is like you
know they're like you better be careful
like one day you're not going to be able
to eat like this um
yeah that is uh the Lamentations of the
old looking at the Young yeah no I
definitely get it uh okay so if you
maybe the data already shows us but if
you had to guess or base it on the data
why is why does strength matter so much
is it that cardio Fitness uh means your
heartbeat slower when you're not
exercising and and the differential
between how much you exercise and thus
speed it up but that the amount of time
you spend in that really slow resting
heart rate like that's the deal is it um
you're gonna say all the above but like
grip string so I'm not falling uh I
don't know what else well I'm storing
amino acids in muscle yeah so I think
there's several things going on so let's
talk about the limitations of the
exercise so the limitations of the data
are
your their data are only as good as
things that we can measure
so you know what hemoglobin A1c is yes
okay so hemoglobin A1C for people
listening is a blood test you get that
in a snapshot
gives some prediction over what your
blood glucose has been doing for the
past few months
so in that sense it's what is called an
integrator
right if you think back to calculus for
people who took calculus the integral is
the area under the curve it's the total
ups and downs it incorporates everything
that's happened and so in this case
hemoglobin A1c is an integral function
of the last three months of your eating
at least as it pertains to glucose
doesn't tell you anything about fat
protein overall calories doesn't tell
you any of that stuff but gives you a
pretty good indication of how your body
regulated glucose
okay
integral functions are not common in
biology unfortunately
uh I had a recently a very interesting
guest on my podcast and we talked about
how HDL cholesterol may be an integral
function for recent triglyceride levels
so the fluctuations in your
triglycerides and we know that lower is
definitely better becomes an inverse
correlate with HDL cholesterol so the
higher your ratio cholesterol might
suggest lower previous levels of
triglycerides so that's kind of
interesting that has not been validated
but it's an interesting hypothesis
but for the most part we just don't get
great integral functions
it turns out VO2 max is a really good
integral function of how much cardio
training you do um
so VO2 max have you ever had a test done
I have not but do you know how it works
uh I think so so you run uh all out and
then you go slow get your heart rate
back to 100 run all out again well
that's how you would train for it but
the test is done uh on either on a
treadmill or a bike those are pretty
much the only two ways to do it you have
a mask on and you're pushed so you get a
warm up and stuff but then you're
basically pushed until you fail where
you're like I have to jump off the
treadmill yes got it um and what's hap
what they're sprinting so they're trying
to no no no it's not it's it's
um at the end it feels like you're
sprinting but they'll you know if your
two Max test might take 10 minutes
they're gradually working you up and
watching your consumption of oxygen rise
so this mask is measuring how much
oxygen you consume because it has a
little oxygen sensor on it so it knows
the flow rate of oxygen that you're
putting in and it's measuring the
concentration coming out and it's it
says okay right now you're consuming one
liter of oxygen so you and I sitting
here right now are consuming three or
four hundred milliliters of oxygen per
minute very little
if pushed to your max you might be 10
times that whoa the fittest athletes in
the world you know will get to 20 times
that at they have the capacity to use so
much oxygen so that's what the VO2 max
test is it is measuring your maximum
consumption of oxygen
the higher that level the longer you're
going to live
there is no number there is no biomarker
there's no finding in all of biology
that is more predictive of a person's
length of life than that specific number
and the question is why
and I believe the reason is VO2 max is
such a potent integrator for what you
have to do to have that number you
aren't born with that number being high
there's clearly a genetic component to
that number you know the the highest
people in the world ever measured are
born with a great potential for it but
they won't get that potential without
training and the training you have to do
to get that is pretty hard
so
what the what this tells you is that
that type of training is what's really
valuable
the same is true with strength when you
compare
very strong people to very weak people
you see almost as high a prediction of
longevity as you do with high VO2 max to
low VO2 max
and again
it's important that we are strong for
all the reasons you said it helps you
prevent falling it helps you stand up it
helps you do all of these things that
matter
but I think the reason it's telling us
you're also going to live a long time is
because it tells us what you had to do
to get there when we see that the top 10
percent of people with grip strength
compared to the bottom 10 of people with
grip strength have a 70 percent less
chance of getting Alzheimer's disease
and a 70 chance of dying from
Alzheimer's disease it's not because
grip strength by itself protects your
brain right it's because those people by
definition are doing so much more
physically and it's the doing part that
is protecting their brain
man this is uh very interesting so let
uh I'm gonna ask it so let's imagine a
world where we have uh just insane AI
with VR do you think that I would be
able to stimulate my brain
in a way that because people talk about
for staving off dementia like dancing is
nothing anything so
can I obfuscate the need for the
physical part if I'm stimulating the
brain or is it like nope like you're not
doing the things you would need to do to
make your heart uh and again I don't
know if it's resting heart rate becomes
the thing that's good or because if it
really is just the thing you have to do
and not the outcome of the thing right
right uh how can I fake it uh probably
you would get some benefit in a if you
did this as a thought experiment where
let's assume we can truly above your
neck replicate The Experience that's
probably giving you some of the benefit
but I don't think it's giving you the
majority of the benefits so the muscle
acts like an endocrine organ so when it
is put under the appropriate stress it
is releasing myokines right it is
releasing hormones that are having a
beneficial value for example bdnf brain
derived neurotropic factor is being
released and providing effectively
nutrition to neurons so you actually
have to do the thing to get it not just
thinking you're doing the thing also
let's not forget all of the other
benefits of exercise such as the
metabolic benefits so we talked about
all of this business around insulin
resistance well the number one cure for
insulin resistance is exercise that's
why those sumo wrestlers can be morbidly
obese by most definitions and still
potentially be quite insulin sensitive
because of how active they are and then
of course we get into the structural
piece of this right which is what good
is it to have a brain that works if your
body actually does not
yeah or vice versa yep for that matter
uh okay so
ketogenics was something it really was
transformational and as I discovered
ketogenics through you I'm very curious
to hear
um you no longer feel
the same that you did what changed
well it's a broader topic I think around
that of dietary restriction so I think
my aperture has just widened
significantly
so you have to take a step way back and
ask the question how does one what are
the ways in which one can change their
diet so
let's come back to your example in a
moment because
I think if I recall when you went on a
ketogenic diet it wasn't in an effort to
lose weight no yeah so let's put your
case aside for a moment and instead
discuss it through the lens of how most
people think about ketogenic diets vegan
diets pick your diets it's it's usually
some form of energy restriction
so
I think initially I was like most people
are pretty myopic about my views of
energy restriction
and over time that thinking evolved into
saying look there are really broadly
speaking three strategies to reduce
intake
one strategy is to just directly fixate
on the reduction of energy intake that's
called caloric restriction so
bodybuilders are a great example of this
right like they really know how to weigh
and measure every single thing they're
eating and they certainly understand
during an anabolic phase this is how
much energy I need during a catabolic
phase or cutting phase I need this much
and they've got this down to a science
and it's really remarkable I mean it's a
science optimized for the reduction of
fat that's right that's right and
maintenance of muscle that's exactly
right so longevity that's right
absolutely right so so but but let's be
clear like I don't think there's a
better example of any type of person on
the planet that's figured out how to
control intake up and down and to
produce a perfect result with respect to
that aesthetic well said and for most
people that's really hard to do
um it's hard to do because you can't
really ignore it like you can't just eat
without thinking you always have to be
paying attention to what you're doing
but it is the most direct way to go
about getting the results you want
so that's method one
method two says how about I don't pay
attention to what I'm eating
or when I'm eating
um but I pay attention apparently I
don't pay attention to what I'm eating
or how much I'm eating but I just pay
attention to when I eat
so that's called time restriction people
call that intermittent fasting and if I
make the window in which I eat small
enough
I will reduce energy and take in total
so if I said to you you know you can
only have one meal a day chances are you
are going to lose weight
now people thought that well there must
be something magical about intermittent
fasting beyond the caloric reduction but
that turns out to not be the case it's
been tested in several studies now and
it's clear that if you eat 2 000
calories in one sitting
it's no better or worse for you at least
from a weight perspective than if you
eat 2 000 calories spread out of the
course of a day it's probably worse for
you in another way though which is
you're a little more likely to lose
muscle mass because you won't be able to
get the right amount of amino acids I
don't want to derail your point but we
are going to have to talk about
autophagy because I intermittent fast
like a fiend great 365. yeah okay so
then we get to the third method of
caloric reduction which is the use of
what's called dietary restriction
so here we pick things within the diet
and we cut them out
and the more restrictive that is the
more likely it is to produce an energy
reduction and therefore the more likely
you are to achieve the goal of weight
loss so the glib example I always give
is if you went on the no lettuce diet
you would not lose an ounce right right
it's simply not restrictive enough if
you went on the only potato diet you
would lose an insane amount of weight
you simply couldn't eat enough potatoes
to maintain now the that's not a healthy
diet right no one would think that the
all potato diet is going to produce an
ideal Health outcome but you will lose a
lot of weight