Dr. Paul: Fat loss drugs, fitness, nutrition, & longevity.

The content of this podcast is not intended to be a substitute for professional medical advice, diagnosis, or treatment. The use of information on this podcast or materials linked from this podcast is at the user's own risk. I'm here today with Paul Rodenberg, ER doctor for 11 years. He trained at UCLA and UCI. He's also got a passion for personalized medicine, longevity, and personal health. We're going to spend some time talking about steps we can all take to live longer, healthier, and feel better. But first, Dr. Rodenberg, I really want to know about this fat loss drug. Dr. Paul Rodenberg, how are you this morning?

Nicholas Stanley, I'm doing great, bud. Excited to be here. Being part of your amazing podcast. Glad to be hanging out with one of the best guys I've ever met in my life. So I'm excited. What a compliment. I know a lot of guys too, but you're up there, my friend. I'm going to get you right up on this mic. Make it uncomfortable. It is uncomfortable, actually. I didn't mean to interrupt you. Please continue. Thank you for those kind words. I'm feeling great this morning. I was reading over some of your notes for the show and I got so engrossed in reading about the mechanisms of fat loss and exercise and how those two things work together.

All of it towards this goal of longevity. I mean, I was just fired up on it and I was actually sitting in the cold plunge when I started reading 11 minutes later. It hit me how long I had been in there and checked the clock. I got out. I am frozen solid today. I could not even get my pants on because my legs were so numb. I just it's like I couldn't I couldn't feel anything. I had to sit on the ground to pull them up and get them on. But I feel fantastic this morning. Yeah. Ladies and gentlemen, this man showed up in a snow parka and boots and we're in Southern California and it's like 90 degrees outside.

So he's telling you the truth. It was actually pretty comical. I'm hearing, you know, shorts and a T shirt and Nick is ready to hit the slopes. I had it down here. 40 degrees. I was just trying to get two, maybe three minutes in. Is 11 the longest you've gone now? No. I think I did 15 once. That was a Wim Hof challenge that he had online. This guy didn't think he could do it and he goes in a barrel of ice with him like they jam themselves in together. Wim Hof is like coaching him through it the whole time like they're in there together. You've gone. If anyone could make you stay and be Wim, you're not getting out if he's in the barrel with you.

Yeah. So I one. 15 minutes. That's a long time, man. It's long after about five. You can't believe you've got 10 minutes to go. Yeah. I think they recommend about 10 minutes per week on that stuff. So I got in almost a week's worth this morning. You got a week and a half. Yeah. Well, I guess the 15 minutes would be a week and a half. Yeah. This morning would be about a week. I really want to know about this fat loss drug. What is it? Is this real? Does it work? Sounds too good to be true. 100% works. Some are glutide or a Zempic. It's a GLP1 agonist, which basically means that it's a hormone that's going to be secreted by the gut that basically tells your brain, let you don't need to eat anymore.

It slows your gut's ability to digest food and then it also increases your insulin sensitivity. And so with those three things combined, basically it causes you to eat less overall and then also become more metabolically healthy, which then in turn will lead to fat loss. This is a pill I take or is it an injectable? So it's an injection. It's a once a week injection. I think you start at 0.25 milligrams and then you can increase up to 2.4 milligrams, I believe. You sort of go in a stepwise fashion. You'll do like 0.25 for a month and then you can go up to 0.4 another month and you keep on increasing and up until the max of 2.4, which will then get you to the maximum amount of fat loss, satiety, meaning that you're not going to be hungry and also metabolic health through insulin sensitivity.

So I inject this and I will lose weight. Does this apply to only people that are extra heavy or this works for anybody? Now this is a drug that will work for pretty much anybody. It's pretty amazing. And it will just bring you down to your essentially ideal weight for lack of a better phrase. Yeah, it'll bring you down to your to a healthy weight and bring your metabolic markers and to healthy ranges. It sounds too good to be true that I could just inject myself and solve weight loss. What's the downside? Well, you'll be injecting yourself once a week, four times a month and you can titrate your dose.

That will be helped by your prescribing doctor. But I mean, it definitely works. If you look at the studies, 50% of people will lose like 15% of their body weight, which is insane. Right. Third of people will lose, I believe 20% of their body weight, which is incredible. I mean, there's no weight loss drug that we've had that's as potentially safe as this one that has had the results that this medication has. Down sides are really pretty minimal that we know of. The main one being nausea. And that's really probably because it's slowing down your gut from moving so much causing that feeling of fullness that you may feel some nausea.

And then some people get some diarrhea as well, but those are really the two main downsides. So very little. Long-term side effects. Does anyone have any ideas? That's one thing I don't think we really know too much about. All of the studies have been over months to a few years at a time. So to know if you inject this thing for 50 years, what would happen down the line, I don't think we know. I think it's been shown though that if you want to continue to lose weight or stay at that weight that you're at, you'll need either keep on injecting or you'll have to change your diet and increase your exercise to keep the weight off.

How much does it cost? That's about a thousand dollars a month for those that wouldn't be covered by insurance, which would be the majority of people that are going to use it for weight loss. I think the only people that will be covered now are those with pretty bad diabetes because of its help with the insulin issue. But for obesity per se, I don't think many insurance companies are covering it. So it's going to be about a thousand a month. I've heard there have been shortages of the drug for people who need it for diabetes. Oh, it's 100% true. Yeah. So I've prescribed it for a few people and I know that if I'm not on the refills, they may go another month or two even without being able to get to be able to get their prescription.

So yeah, there's a definite shortage now. But I think that other companies are coming out with similar drugs should be out within the next year, I believe that we'll be doing very similar things. And so hopefully that shortage will no longer be an issue. Okay. So you've got a lot of, if I'm guessing, movie stars, people in entertainment, people who want to be movie stars and people just with money that can afford to spend a thousand dollars a month on a drug like this. I mean, is that who's out there seeking it for weight loss purposes at this time? Well, I think those are the only people that can really afford it.

That's a lot of money to be spending range over payment right there. So other companies are coming out with similar drugs. Is that because they see an opportunity in terms of they can basically like copy the drug and then they want to get in on that thousand dollars a month action? 100%. They see that the potential to make money for them is massive, right? I mean, everybody wants an easy way to lose weight, no matter the cost. So this really allows people to do that. It's like, wow, I don't have to try to diet. I don't have to exercise more and I get to lose weight. That's amazing. I mean, it's pretty incredible though.

And when you look at the studies that have come out that have shown these great results, all those people were encouraged to decrease their caloric intake by 500 calories per day and also to increase their exercise or try to exercise 150 minutes per day. So I mean, that's part of those results there. So you're telling me pharmaceutical companies are mostly motivated by money? Shocker. Yes. Yes. Okay, let's go back to the exercise. So 150 minutes a day. I mean, that's quite a bit of exercise per week. Still, that's a lot of exercise. I would say the majority of people are not exercising that much.

Right. So the people who are using this for weight loss purposes, let's break them into two groups. We've got obese and then we have people who are just trying to lose a little bit of weight. How critical is the exercise piece in conjunction with the drug and the diet piece as well? When you come to health and longevity and all these things, I think it really just depends what you want out of it. Is your goal just to lose weight? Is your goal to be healthy and live longer? Right. So if your goal is to be healthy and live longer, diet and exercise can be a massive part of it, right? Because that's going to allow you to live longer to be able to function well in your 80s and 90s.

What is your gut instinct about this drug? Is this a good development for society? Well, the downside is that you have to inject it potentially forever if you want to maintain that weight. If you don't make actual changes to diet and exercise, which are the things that need to happen. I think regardless. The way that I think about dieting, losing weight, trying to be healthy, it's really like a two stage type process. So initially you need to have something where you have this buy in, you have this belief where you see the weight come off and then next you have to do something where you can basically sustain it for the rest of your life.

You're going to have to restrict something forever and you're going to have to exercise during that time to allow yourself to stay at that healthy weight forever. So I think that you could go about looking at this in one of two ways. It's either something I inject forever and I'm just going to inject and keep my life sell the way it is or you inject for let's say six months until you get to be metabolically healthy and then you can try to decrease your food intake or decrease your sugar intake or whatever that may be and exercise a little bit more and try to maintain. I think the problem with diets is that people just basically once they get to their goal weight, they don't have a plan for after that.

So they are 250 pounds and you want to be 185 pounds and you lose all that weight and you get to be 185 pounds and you're like, yes, I'm here. And then you stop dieting and then you just revert back to where you were before six out of seven people that are obese have lost a significant amount of weight. But they all revert back because they don't have that secondary plan in place. If this drug was $10 a month, would you take it? If it was $10 a month, most definitely I would take it 100%. But I don't think I would do it long term. I think that I would inject for a time until I felt like I was as metabolically healthy as possible and then try to go to my like phase two where I'm good at my diet, good at my exercise and then try to live that way just because we don't know the potential long term effects of injecting long term.

If I don't have access to this drug, I can't afford it. Whatever that place is that you desire to be, right? Whether that's a certain weight you want to hit, a certain health level, you just want to feel good, look good, whatever that person's goal might be. How can you get there without the drug? Yeah. I mean, there's a lot of ways to get there. If we look at the world today, I mean, we're getting to a pretty scary place. I'm an ER doctor and I just see so many people come in the ER for things that are potentially preventable and we're just getting busier and busier and busier with all these ailments that don't need to be happening.

And I think we're in a very interesting place because with COVID, the ERs were packed because people were sick with pneumonia and there weren't ventilators. And after COVID stopped, people were out of isolation, everyone was partying. And then the ERs were super busy because of accidents involving alcohol and methamphetamine and cocaine and whatever. And now we're seeing this next hump where I feel like staying home, not exercising, eating poorly is now causing this next bump in the ER where we are just so busy with all these other ailments that are 100% preventable. We look at the data and 50% of people have some form of insulin resistance.

So they have some form of high blood sugar or early diabetes or even diabetes. And you look at other data and there's like 90% of people have some part of metabolic syndrome, meaning that they have a large waste. Their triglycerides are high, their HDL is high, their blood sugar is out of whack or they have high blood pressure. And that's just crazy. 90% of people. So is there other things that we can do? 100%. When you start a diet, I mean, I being a person that have fluctuated in weight so much. So I'm pretty masterful at dieting at this point. I mean, I played college football. I weighed as much as 340 pounds and I've lost a lot of that weight.

But I think the key to diets, especially in the beginning, are just going to be to believe in it. And there has to be this buy-in, right? So I think that initially the greatest way to lose a pretty substantial amount of weight early is to really restrict carbohydrates. Now do you need to restrict carbohydrates forever? No. But I think initially restricting those carbohydrates really allow you to lose a lot of water weight and then it also allows you to then, once you get your glucose under control and your insulin sensitivity under control, you're then able to really pull a lot of the fat from your fat stores and lose a tremendous amount of weight that way.

But I think that you really need to do it by limiting your carbohydrates, carbohydrate intake. And there's a lot of interesting ways that we can do this. I mean, I wear a CGM now, a continuous glucose monitor and it lets me know exactly what's going on with my glucose at all times. It lets me know if I eat this certain food, does that cause my blood sugar to spike? If I exercise after I eat, what does that do to my blood sugar? It typically causes it to stabilize or come down nicely. It's taught me that eating earlier in the day, I can eat earlier foods that are higher in sugar or glucose and it's not going to affect my blood glucose levels as much.

So I think there's a lot that we can learn from these things and using that as a tool for being accountable and actually seeing real time what our glucose levels are is just massive. You limit your carbohydrates early, you lose a lot of this weight and you can then start pulling stuff from your fat stores, becoming metabolically healthy. I think that's really sort of the phase one that will get the best buy-in that will show people that they're going to lose the greatest amount of weight. And then once you get to be quote unquote metabolically healthy, you can then change it up a little bit to restrict whatever you want, whether it being just straight caloric restriction, time restriction, fat restriction, carbohydrate restriction, whatever you like.

So the CGM, it's like a little piece that you wear on the arm and it actually goes into the skin with a tiny little needle, right? So it can measure your glucose levels, your blood sugar and allows you on your phone to see the spikes in your blood sugar and what it's doing to you over an extended period of time. Exactly. 100% is something that basically you just apply it and you can either do it on your belly or your arm. I think most people typically put it on your arm and there's a device that applies it, you just push a little button and it goes right in. You hardly feel it at all. It's virtually painless.

You sink it with your phone. You get blood glucose readings 24 hours a day. We'll let you know. If your blood sugar is shooting up, if it's coming down, if I eat this ice cream, what is it due to my blood sugar? If I eat this salad, what is it due to this blood sugar? If I happen to eat some fats and fiber first and then have the ice cream, what would happen to my blood sugar? If I eat ice cream and then go out to exercise, what would that do to my blood sugar? It allows you to really just have a tool to understand your personalized biology and how to become truly metabolically healthy. What I'm going to see on my monitor is different from what you are going to see or somebody else.

It's very personalized. We're going to react differently to different foods. Yeah, 100%. All of our biologies are different. If I'm going to eat a food that's high in sugar, I should really do it after eating foods that are high in fat or fiber and that will really blunt my response. If I'm going to eat something that's high in sugar, I should really exercise or go on a walk afterwards and that will blunt my glucose response. If I tend to eat foods that are high in sugar earlier in the day, I tend to have much less of a glucose spike or a glucose response. I've even noticed things with sleep. If I don't sleep as well, my blood sugars tend to be higher throughout the day, probably because I'm not getting enough deep sleep and that really affects you directly, metabolically, as well.

I think it's amazing. Then it also just keeps you accountable. I don't know. For me, I hate to see those spikes when I look at my phone or I hate to see those alerts. For me, it makes me think twice about having the cookies and cream ice cream or whatever. How did the spikes lead to bad metabolic health? Why are the spikes bad? What you want is you want your glucose level to be relatively stable and it would be great if you're your average below glucose was, let's say, less than 90. Then you want to limit those spikes because basically the more spikes you have, the more likely you are to become insulin resistant.

Insulin resistance leads to diabetes. Diabetes leads to disease from your eyes to your toes, it leads to blindness. It leads to dementia. It leads to heart attacks. It leads to renal failure. It leads to amputation of your feet and your limbs. It leads to infections. It also amplifies the three major killers that we see today, cardiovascular disease, neurodegenerative disease and cancer. If you can decrease your overall levels of glucose, you're going to live a much metabolically healthier life and really limit your exposure to those three main killers, which will allow you to live a much more productive, healthy, longer.

These are the main killers based on data across the country and what you see in the ER. You see this CGM as a real benefit to anybody that wants to take control of their health to live longer and healthier. Yeah, 100%. For me, accountability is just so important. It really helps with the buy-in. I don't like to see those spikes. It's been effective for you because you said you were at 1.340 pounds when you were playing college football. You look like a David sculpture today. You are in incredible rock solid shape right now for those who can't see the video of this because we're not shooting any video today.

Dr. Paul is in phenomenal shape at this moment in his life and has been so for quite some time. The CGM has been key to you for achieving that. Instrument. Okay, if I want to get one or somebody listening wants to get one, how do you go about doing that? You can either go to a physician and they can have it for you. I get mine through an app called levels.com. You can just log in there and it's like $200 for a month's supply of a CGM. Through a company like levels, you can get one without going to see a doctor. Yeah, they have doctors and staff that will then, I guess, write the prescription and they just come in the mail and you put them on and you're on your way to living a longer, healthier life.

This is something that you could order them forever if you wanted to monitor this on an indefinite basis. But it sounds like you could also order it for a limited period of time, learn what works and what doesn't work for your particular biology, and then make decisions off of that. And you're not stuck having to pay for this for the rest of your life, unlike that the fat loss drug. I agree with you 100%. Are there any other wearables or devices that you really like to improve your health? The other wearable I wear is aura ring. It'll differentiate your different stages of sleep, your light sleep, your deep sleep, your REM sleep, your step counts, your resting heart rate.

The aura ring has really helped me become a better sleeper and I think it's shown me how important getting good sleep is. Up until maybe a year ago, I was sort of in the camp of I'll just sleep when I'm dead and I would sleep four or five hours a night. Deep sleep is super important for your metabolic health as well. It's basically like overnight blood pressure medication. It also helps with controlling your glucose. Your deep sleep also helps with brain health. You've probably heard about like how proteins and things like that that are involved in dementia. It helps filter those out. And then your REM sleep is super important for your mental health.

And so it's like an overnight therapy session. It's really helped me focus on making sure I get enough sleep. Now I'm sleeping much more than four or five hours. I try to get seven hours a night and then I try to nap every day. I think that's really assisted not only my metabolic health, but my mental health tremendously getting that extra REM sleep. So you would agree with that, Navall-Ravakant equation that health equals exercise plus diet plus sleep. Health equals exercise plus diet plus sleep. Yes, I would agree with that. But I think the other factor would be mental health too. So I think that really your four pillars of health are going to be nutrition, exercise, sleep, and then also like mental health and stress resilience.

I think those are really the four pillars. Well, let's dive into the mental health a little bit and building up some of that mental resilience. What do you recommend to improve that part of your health? It's a good question. So mental health is something I've definitely struggled with when I was a kid. I've been overweight my entire life. And so I was made fun of tremendously as a child. That coupled with some other things like my dad was a pastor and growing up in a church, I always felt like I had to be perfect. Also other struggles at home where times I would get ridiculed for not performing well at sports.

I think all of those things coupled together really led me down a path of not being that confident and it led to me having pretty severe anxiety at times. And so I've had to deal with these things sort of over the years. And I've definitely at times not dealt with it in the healthiest fashion. At times to battle the anxiety, I would drink too much because that would sort of make me feel okay or not anxious. And I've recently got away from all of that and I feel like I finally have my mental health someone under control. And I think a big part of that has been meditation and just taking time out and being present and focusing on things that are truly important to me and making those the pillars that I just make the most important things in my life.

Being a loving, happy person, being a good husband, being a good father. And I feel like if I can be present and do those things, it's really improved my mental health. And I think that's what you say in that being vulnerable and honest about your past struggles with mental health because it would be very easy for a uber successful doctor to put up the standard facade of semi perfection that most adults, especially those who do well in their professions, feel the need to put forth. So I just want to say I really appreciated that you are honest and willing to share that that you're not perfect, that you have struggled with this stuff because everyone does to one level or another.

But very few people will cop to that. I think everybody struggles with mental health and it's unfortunate that we can't be more open about it and talk about it because I think that if we did, people would be in much better places. How do you feel about cold plunging as a tool to improve mental health resilience to stress? I'm already a big proponent of it, but I'd like to hear your thoughts on it. Yeah, I mean, cold plunging is amazing. So I think there's a couple benefits that you can get from cold plunging. One is going to be recovery, decrease the inflammation. Another could be weight loss as well, especially if you get cold enough where you start shivering that's going to aid in fat loss.

And the next would be sort of mood elevation through the famous dopamine molecule. So it will definitely increase your mood, motivation, desire and drive afterwards 100%. I think it does those three things beautifully. What did you notice on the CGM after doing a plunge? Did that have an effect on blood sugar levels? Yeah, I typically do a hot cold contrast. So I'll go in the sauna first anywhere from 25 to 45 minutes. Sauna is a great use because it's actually sort of like doing like a mild aerobic exercise, right? It increases your heart rate, causes your blood vessels to dilate. And I think that sauna could be a really interesting tool for people that aren't in very good shape that they can't go out and do a lot of exercise.

If they could get in a sauna and allow their heart to start beating and get healthier that way, so it could be an interesting way to get them to exercise a little bit more by getting them more cardiovascular health early. But with the cold, my blood sugar plummets. So I'll often come out of the cold and I'll look at my CGM and it's under 70. So yeah, it goes down dramatically. And if I get real cold and I'm shivering and I don't like to put on a lot of clothes and I'll walk around without much and I'll stay cold for a few hours, my blood sugar will stay low and stable for a long time. Even if you're eating.

Yeah, even if I'm eating. And for the sauna, for anybody listening, Dr. Paul here recommended to me, it's a wet sauna that is available on Amazon for less than $300 because I really like the health benefits of sauna as well, but it's not accessible to everybody. You're going to pay anywhere from five to $10,000 for a large, dry, Swedish style sauna, which is the best and they're really nice and I love them when I get access to them. But I thought this was a great tip that this model, it looks like a phone booth and then it's got like the spaceship style foil on the inside, which keeps the heat in there.

And then it just pumps hot steam into this phone booth that you sit in and you can reap all these health benefits at a price that your average person could definitely afford. It's only 300 bucks. It's very high tech and very luxurious. There's not much to it. It looks great. My wife loves it. Yeah, it's it's not very easy on the eyes, but it gets the job done. Yeah, and it's portable, which is awesome. I think it's amazing. It doesn't get as hot as the Swedish saunas, but it makes me feel hot enough where I want to get out. And I think that's really where you want to be, just like with a cold plunge, you want to be cold enough where you just don't feel comfortable and you don't want to be in there anymore.

And that's those are really the sweet spots, I think. So you get the the endorphin release to make you feel great or the dopamine release to make you feel great all day long. So if I want to maximize my health so I can look like you, sauna, cold plunge, CGM, that's a glucose monitor, control my nutrition, get lots of exercise. These are the ways to do it in an affordable manner. Obviously, you can spend all kinds of money on those things to get the best of all those versions, but it sounds like this is something that's under our control. If we look for the right things and then put in enough time and energy into that aspect of our lives.

Yeah, I mean, 100% it's under our control and it's not easy. It takes some dedication, but you can definitely do it. I think you'll reap the benefits and rewards later on in life if you put the time in. I mean, I think the question just really is what do you want out of your life? Do you want to be a bedridden at 70 and not able to hang out with your grandkids or do you want to be a 90 year old that's traveling to Italy and carrying your wife's 45 pound luggage? Like, what do you want? Like I want to be a kick ass 90 year old and there's certain steps that we have to take now to make sure that happens.

And if you don't start now, it's just not going to happen. Unfortunately. Yeah, I saw Wim Hof the other day. He's 80 years old now and he was in the snow, just got out of a cold plunge. He's on one hand in a pushup position, balancing his entire body on the one arm and he was like, Hey, 80 years old can still do this. I thought, that's where I want to be someday. That would be awesome. That's bad ass. That's where I want to be. So it's possible. It's possible for your average human. Of course it is, but you just, it takes work. Once you hit 50, you start losing at least 1% of your muscle mass per year, right?

So you're going the wrong direction. So unless you're 40 and building up muscle, like you're going to be in a tough spot when you're 60 and no longer lifting weights, you're just going to keep on, you know, losing muscle masking weaker and weaker and weaker. And muscle mass you lose at 1%, but power and speed. Those are exponentially more. And so unless you're really focusing on these things now, but it's also never too late. I mean, if you're 55, you can definitely start lifting weights and building up the strength and make sure that you don't lose any more muscle mass 100%. But I think there's a lot that of people that are in the 30 to 40 year old range that need to start building up and thinking about, gosh, if I want to be 90, then maybe I should start lifting some weights, trying to build strength, trying to build some muscle mass.

So I'm working on zone two cardio type stuff to make sure that my mitochondria are healthy, that I can be metabolically flexible and use fats and sugars and make sure that you can do maximal intensity stuff with like B02 max type training. And also just make sure that you're stable and flexible with like yoga or what I like to do with rucking. I just throw a bunch of heavy stuff on my back and take the dogs for a walk. What kind of exercise should people be doing to get in shape now in the 30s and 40s, specifically what type of weightlifting and other exercise so that you can be that awesome 90 year old trucking your grandkids around.

There's really four different things that you need to work on. One being strength, one being sort of zone two exercise where you're really maximizing your mitochondrial efficiency, the other being like maximal effort type exercise. You probably heard of like the O2 max type training and then the last being, you know, stability and flexibility. So for strength, it just depends on how trained you are. I've been lifting weights since I was 14 years old. And so I'm pretty confident around the weight room and I feel like I have decent form. So I'd like to deadlift and squat and do bench press and do sort of the power Olympic lifts type stuff.

But if you're not as well trained, we can just pick a few arm exercises. We can get on some of the machines and do some pushes, some controlled bench press. You can do some leg extensions or leg press. That's a lot more controlled, but really just doing something to try to build your arm strength and leg strength. Additionally, something else I want to touch on is that for women after they go into menopause, their estrogen starts decreasing so much that their bone density really falls off the charts. So unless women are really maximizing their bone density earlier on in life, they really put themselves at risk for falls and fractures and things much more than men early on.

For you know, zone two cardio type stuff, I mean, it's really whatever you're comfortable with. You could bike on a peloton. That's typically what I do. You can go for a run. I mean, you could do a rower. And so there's a couple of ways to know that you're in that zone. So people typically say it's like 60 to 70% of your maximum heart rate. So you can take your heart rate minus your age. That will give you your maximum heart rate. And then you can take like 60 or 70% of that and that could be, you know, where you fall. So for me, that's about 125 beats per minute. Most people have watches or things that can tell you where you are.

And so you can do it by that or you can do it by perceived exertion. At that point where it's sort of difficult to carry on a conversation, that would be sort of like where zone two is. And so recommendations are typically about 150 to 180 minutes per week to do that. For high intensity sprints, VO, two max type stuff, you really don't have to do too much of that at all. It's probably six, seven minutes a week, something like that. But I typically do to bot a type stuff on the peloton. So you go 20 seconds hard, 10 seconds off and you do that for four minutes. You can just go two minutes hard. You can go one minute hard, five minute hard, something in that range.

So five, six, seven minutes a week doing that. A four stability, flexibility. Yoga is great. How about protein? How important is protein in the diet and protein supplements? Well, I think protein for nutrition really needs to be the foundation. So if you're going to diet, you can caloric restrict, you can carb restrict, you can fat restrict, but no matter what, your protein has to stay the same. You can't restrict your protein. I think the golden number is probably one gram per pound of body weight. So I try to get in approximately 180 to 200 grams of protein a day and that's really non-negotiable.

If you're able to get that total number, how you disperse that protein throughout the day matters a little bit less, but you probably should try to get that in three or four meals spread out by three or four hours to really maximize your protein synthesis. If you can't get it in real foods, if you're not going to eat for chicken breasts a day, which a lot of people don't, then I think protein powders are wonderful and I have a protein shake every morning and sometimes I'll have one in the afternoon for a snack. How do you feel about creatine? Creatine is something that a lot of people should consider to take.

I think there's very little downsides, maybe just a little bit of GI upset, but it's something that is going to aid in recovery, aid in strength, aid in mental performance. I mean, the data that's coming out on creatine is just getting better and better and better and it's just showing more and more benefit. People that are 160 pounds or less should be on about five grams of creatine a day and those that are above that should be on about 10. You can take that anytime during the day. It doesn't matter. We used to, when I was back playing football, we would load creatine and you don't have to do that anymore.

You can just take it daily, but it really is a massive aid to strengthen muscle gain performance, recovery and mental health. And protein and creatine, I mean, these supplements have been around for more than 20 years. So we do have some long term data and would know it if there were some hidden negative side effects and what I'm getting from you is you're not seeing many, if any. No, definitely not with creatine and definitely not with protein. I think that as we get older, we tend to metabolize protein a little bit worse. So we actually need more and more and more to make sure that we're keeping up our muscle mass.

And so it's something that you've really got to focus on. If you eat, if you mainly have a plant based diet, I think it's something that you really need a supplement to keep your muscle mass up to so that when you're 50 or not losing a ton of muscle mass and becoming weaker and falling and breaking a hip and creatine is produced naturally in the body. Is that right? Yes. It's the quickest way for us to create ATP, sort of the energy of life, if you will, then you can use glucose after that than fat. But yes, it's a natural occurring substance. They did have a discussion with somebody recently and I didn't know how to answer their question, but they thought creatine was more of a synthetic substance that had been cooked up in a lab that might not be good for you.

And this somebody that takes their health really seriously and tries to eat very natural foods without a lot of preservatives and does exercise a whole lot. Any concerns on creatine being foreign to the human body? It's not foreign. No, it's a naturally occurring substance. You look at these guys that do CrossFit and they get Rhabdo and you maybe have heard of like CK elevations because of that. It's creatine kinase. Sorry, what's Rhabdo? Rhabdo? It's basically when your muscles get overused, they get very swollen and inflamed and basically it causes injury to the muscle. But there's a substance that's released.

That's how we measure it. If I'm doing a blood test, it's a CK level, but it's a creatine kinase level. And that's one of the markers or one of the enzymes that actually helps break down creatine and create the energy needed to do the short term bouts of exercise. So you're saying some of this negative perception on creatine, like so many things in the world today might be spurred by these warped impressions that people get from looking at social media and bad examples? Oh, yeah. You can find negativity regarding anything you want in life. But the thing is, if you look at the data, there's no negativity.

The math doesn't lie. Math doesn't lie. It's the one thing on this planet, it doesn't. Yeah, cold plunges in math. That's what I keep coming back to in every episode. Are any of these recommendations different for women, some females that I've discussed some of these subjects with, they're worried about taking on too much protein, too much creatine and weightlifting because they don't want to bulk up? Gaining muscle is difficult, right? I mean, I wish it was that easy. If I could just eat more protein and have some creatine and bulk up, that'd be amazing, right? It just doesn't work that way. There's definite ways that you can train for strength versus hypertrophy, meaning like gaining of muscle mass.

So if you want to do more strength type training, you need to do like three to five sets at very heavy, at heavy loads. If you want hypertrophy to gain muscle, you need to do much more volume. Like that's the way that you gain muscle mass. You need to do sets between 10 and 30 reps and you probably need to do like 20 sets a week involving that muscle group to really maximize hypertrophy. And that's a lot of work. So I mean, to really get massive in hypertrophy, do you have to train in that fashion? And I just don't really see that happening to many people unless you're really training for hypertrophy, which is a, it's a different beast.

I think most people train for strength. They do their three or five sets. They try to go relatively heavy. And that's the way that you gain strength versus hypertrophy. So for these nice women that asked me to ask you that question, you would say they'd have to be intentionally trying to bulk up in order to bulk up. And even then it's going to be extremely difficult for them to do so. So they don't need to be afraid that using protein, creatine and weightlifting is going to lead to weight gain. Yeah. I mean, unless you are doing sets of 30 to maximal exertion and you're doing 20 of those a week, you're not going to be gaining much muscle.

And that's a lot of work. Okay. Let's flip that around because there's another gentleman who works at test prep gurus where we are recording this right now. And he wants to bulk up, wants to put on a lot of muscle mass, wants to do so without gaining fat. What sort of exercise regimen should he be on in order to maximize muscle growth? So again, I mean, he needs to make sure that his protein intake is at one gram per pound of body weight. I would definitely focus on the creatine. And then for hypertrophy, it's going to be a little bit different than strength training. So for strength training, you can do more complex movements.

You're going to do your bench press. You're going to do your deadlift. You're going to do your squat. But for hypertrophy, it's really more muscle focused, right? So you're going to be doing the famous bicep curls or whatever. And so you're actually focusing and concentrating on contracting the muscle. You're doing this intensely with a moderate load with a high rep range to near failure. And you're doing 10 to 20 sets of those per week, whether it's a calf raise or a leg extension or a bicep curl or tricep pushdown. I mean, that's really the recipe for gaining hypertrophy in those muscle groups.

So to put on a lot of muscle, I'm looking at a lot of isolation exercises. You're looking at volume versus intensity. So intensity gets you strength, right? Because exercise is all about specificity. Like if you want to get faster, you need to train being faster. If you want to get stronger, you need to train being stronger. If you want to gain muscle mass, it's all about volume. So you have to do a ton of work to grow the muscle. This episode is brought to you by the gin Rodenberg real estate group. They are the top producing real estate firm in Seal Beach, California, and are a trusted partner in all facets of real estate transactions in Seal Beach, Rossmore, Long Beach, Huntington Beach, Laguna Beach, Ladair Ranch, and all surrounding areas.

Follow them on Instagram to see active listings and more at JEN, ROH, DEN, B-U-R-G group. That's at gin Rodenberg group. This episode is brought to you by Test Prep Guru's. Test Prep Guru's helps students raise their ACT and SAT scores so they can achieve their goals for college and beyond. ACT and SAT scores are optional at many colleges. However, submitting a strong score can often double a student's chances of admission. ACT and SAT scores are strongly recommended or required for many college scholarships, including $30,000 per year at USC, $25,000 per year at Notre Dame, or Texas Christian University's $57,000 scholarship among many others.

Visit www.prepgurus.com to take a free ACT or SAT exam and learn more about how your son or daughter can boost their chances of admission to selective colleges by raising his or her standardized test scores. And now, back to the show. So you're talking about if I'm 50 years old and I have a heart attack and I recover from it, my trajectory is still altered from having that heart attack in a very negative way. I saw a gentleman, he was a 46 year old lawyer and he was moving here from Texas. And during the move, he started to develop chest pain. Didn't really think much about it. Then five or six hours later, he started to develop shortness of breath and got sweaty and became nauseated and started vomiting.

So then he called 911. By the time he got to me, he was having a massive heart attack, got him to the cath lab and they were able to deploy a stent and open up the vessel that had been clogged with the atherosclerotic plaque. And the procedure went great. But once he got out of the procedure and he was in rehab, he could only walk the step or two without becoming severely short of breath. And the treatment for heart disease can't happen when we get a heart attack. It has to start much, much earlier. So now this gentleman is on a list trying to get something called an olefin trichular assist device, which is basically like this electronic heart on the outside of his body to try to bridge him to get a transplant.

So if we wait until we get a heart attack to start the treatment for all these things, it's just too late. And that's what our system is really based upon. Our current health system is based upon really acute care medicine. It's based on being reactive instead of proactive. It's based on looking at consensus data rather than looking at individualized or personalized care. And I think if we go more down that route, we can achieve these goals of living longer and living healthier. And I think we're starting to see this transition in our health care system. And I'm hopeful that we are, but it's going to take a lot of work and it's going to take a lot of people buying in saying this life that I'm leading could be better.

I could be healthier. I could be stronger. I could live an excellent life in my 80s and 90s. Those don't have to be years that you're stuck in a nursing home contracted bedbound with tubes coming out of you. It doesn't have to be that way. You see how popular Huberman is. Atia is regular people in the world want to be proactive about their health. Is the system moving towards them? I think it is slowly, very, very slowly. I think a lot of the problems is is that if people want to truly go after care like this or try to improve their health in this manner, unfortunately, a lot of it might have to come out of your own pocket because insurance companies just won't cover it.

And that's a main problem, right? I mean, we should be starting the treatment of heart disease much, much earlier. But the way that cardiologists risk stratify now, they look at like a 10 year model to look at risk. And the way that these stratification schemes come about is that the way that the algorithm works is that age and sex plays the biggest part of these things. The way that things are currently done, prevention doesn't really even start occurring in our current system until you're 55 or 60. But what's crazy is that most of the heart attacks that happen happen before that. I mean, the reason for that is obvious is that there's more people that are younger.

So the rates of heart attacks are less, but there are a lot of heart attacks that are happening in that younger population. And I think we got to focus on trying to treat those people. There's a story in Gulliver's travels where he ends up on this island where all these people can live forever. And it seems amazing when he first gets there. He's, wow, you have the greatest gift of all. You have immortality. But as he slowly discovers in talking to these people, they still suffer from all the same physical ailments that everyone else does. And so as they get older, they, again, they live forever, but their quality of life goes down, down, down, down until all of them end up blind.

They have no idea who they are, where they are crippled, the body pretty much ceases to function. And then they just put them into these places where there are wards of the state. And I thought that was a great metaphor for this lifespan versus health span, because none of us want to end up physically impaired and or mentally impaired. And that just sounds like the worst ending possible. Yeah. I mean, I think the goal is not to live as long as possible because our bodies are eventually going to give out, right? It's just to be as healthy as long as possible. And that takes work. I liked one of the things you wrote in when you were putting this all together, you said, if your goal is to increase your health span as much as you can and your goals are to feel healthy and strong when you're older, then this is good information for you.

If you're just going to ride this thing out and not care about that stuff and see what happens and hey, if I die at 65 or end up impaired at 55, I don't care. Like this isn't the message for you. Yeah. 100%. This has to be an individualized question, right? You need to ask yourself what you want your life to be like in your 70s, 80s and 90s. And if you want to be vibrant and healthy and doing all the things that you love doing now in your, let's say 40s and 50s, then you're going to have to put in some work. But if you're okay being in a nursing home, which is becoming all too common, I mean, as an ER doc, I see nursing home patients all the time.

And let me tell you, they're not happy being bed-bed-bound and contracted and being fed by tubes and having IV lines coming out of them. But these people weren't aware of the things that are potentially available to them to help improve the time in their lives that could be healthy to help to lay the onset of these chronic diseases. And so I think if you were to ask them, they would be all aboard and say, if I could go back in time, I'd be all in. But yeah, it comes down to an individual question. And if you want to be vibrant and strong and in shape and healthy and have great metabolic health, then let's chat.

We had another question from a listener who asks, what's the best way to lose weight? So, Nick, how do we actually lose weight? Well, I'm going to go with my original answer because we discussed this once and this one blew my mind. But I think what most people say, they give the same answer as me, is that you burn energy and you excrete it through waste products. Where all the stuff you don't need goes. And I assumed actual weight loss was linked somehow to that system. So our body weight actually leaves our body through exhalation, which I think is pretty awesome. So what we have to realize is that we breathe in oxygen, which is O2, and we breathe out CO2 or carbon dioxide.

And what's the difference there? The difference there is that carbon molecule, right? glucose is simply the six carbon ring and fatty acids are just long strings of carbon. And so all of metabolism really is is trying to break these carbon bonds, harness that energy, form ATP, and then use that as basically our energy currency that fuels all of our metabolic reactions. So then the question is then why do we actually breathe? We really breathe in oxygen to get rid of the carbon dioxide. We break these carbon bonds, we harness that energy, form ATP, but now we have this free floating carbon atom.

And this carbon is a problem because it causes the pH in our blood to decrease. And the body likes to regulate many things. The top four probably are the blood pH, our blood glucose, blood electrolytes, or salts, and also our blood pressure. So the body has to figure out what the heck it's going to do with this carbon molecule. So what do we do? We take a breath in, we bind that free floating carbon molecule to the oxygen, and we breathe it out. Let me make sure I understand to this point. We're taking in the carbon through food. We take it in through food, yes. Then we're breaking the carbon bond initially to release energy.

That's how we form ATP, which is what fuels the energy. Then we have the extra carbon floating around from breaking the initial bond. And that's what we have to get rid of. And we expel that out through exhalation. That's where we get rid of this excess carbon. Very well said. So if we're gained too much weight, all that means basically is we have too much carbon in our body. So then the next question would be, can we just breathe faster to lose weight? Right? So I mean, the answer is yes. So there's really two ways to lose weight, right? Either take in less carbon or we exhale more carbon. And it's just based on carbon.

This is why any type of diet or caloric restriction will work. You can do basic caloric restriction. You can do time restricted feeding. You can do dietary restriction where you limit either your carbohydrates or your fats. When they've looked at meta-analyses that have compared low fat to low carb diets, when it's equated for calories and protein intake. They all work the same. It all just comes down to total caloric intake or carbon intake. So can we just breathe faster then and breathe off this CO2 and just lose weight through breathing exercises? Unfortunately, that's not the case. I see people come in the emergency room all the time when they're hyperventilating.

Their arms and legs are getting tingly. Their hands and feet are starting to contract. They're getting something called carpal peel spasms and sometimes they'll even pass out or what we call a syncable episode. And that's because you're breathing off way too much CO2, which again is messing up with that acid-bh balance or your pH. And so it's causing you to become much too basic. So that doesn't work. But the one way that we can increase our respiratory rate without passing out is something that's well known to us all. And that's just exercise, right? It's a beautifully balanced system once again.

The metabolic reactions that fuel exercise will lower our pH. The breathing off the CO2 will increase it. It's all about breaking those carbon bonds and harnessing that energy and using it. And this is why any type of exercise modality can work. You can do high intensity interval training. You can do zone two endurance training. You can lift weights. They all increase your respiratory rate so they can all result in weight loss. And again, there's been studies that have compared all of these things. And when work is equated, weight loss is the same. But the key is going to be really adherence. It's sticking to it.

That's going to be the key to everything. If you burn fats or carbs during your exercise, it's absolutely irrelevant. This should make people so happy because it just basically depends on what you like to do. You get to choose the exercise you want to do. You get to choose the diet that's easiest for you because they all can work. Okay, let's check in again. We're going to say that it comes down to the math of calories in versus calories out. Or another way to put that would be carbon in carbon out. And for that reason, because it's really just a matter of math, any version of exercise can work because that is carbon out.

And then any version of diet can also work when we're regulating the amount of carbon coming in. Spot on the sort of next fundamental piece is does training fasted lead to more weight loss, which is definitely another fundamental piece in this all to help us understand metabolism as a whole. And so most people would say 100% it should, right? If I don't have any calories in my body, then we're going to have to start burning fat. And so that's what I want to do. So a lot of people love to exercise fasted, which is great. If you love it, great. But that's not exactly how it works. It's just a misunderstanding and metabolism because at any one time after an overnight fast, you're going to have about two hours worth of carbohydrates stored up or 1,500 calories.

And you have 25% in your liver and 75% in your muscle. And when those things wear out, when you've burned all those up, let's say like you're running a marathon for a first time and you hit mile 20 and you see these people and it looks like they just can't even move any longer and you're like, what's going on? You just ran 20 miles. You can't do another six. And it's because they've bonked. They've run out of all of those stores. There's actually been a signal sent from their liver to their brain telling them no more. You just can't work anymore until you get more fuel in your body. So the idea of burning more fat at an exercise intensity that uses more fat is also unfortunately sort of a misunderstanding of things.

And that's part of what you hear with the seems to float around a lot with people that are into the keto diet. This idea that if you don't eat before you train, you're training fasted as you put it, that you're automatically just going to start burning fat off because that's all you have to burn off at that point. You don't have the food that you just took in to use as energy. And so you're just going to run through your fat stores when you train and you were saying that is unfortunately untrue. Right. I mean, you have two hours of sugar, two hours of glucose stores in your body at any one time.

So that's just not the way it works, unfortunately. So when we're just resting, when we're sitting here, we're burning like 60% of our calories are coming from fat, 40%. Let's say from carbohydrates, when we sleep, it goes down. So it's mainly fat that we're burning. It's like 70% fat, 30% carbohydrates. We can't get to a point to where we are burning only fat. It's physiologically impossible, but we can get to a point at very high exercise intensities where we burn only carbohydrates. Let me pause you there for a second. You said we're burning the most fat when we're sleeping. I did say that. I was trying to prime you for an interesting question.

Explain that. Well, I mean, that sort of comes back to this whole fat loss thing, a percentage trick, right? I mean, people say, I want to burn fat, so I want to lose fat. People think that I need to do zone two training to burn fat. So I mean, if you think of burning fat equals fat loss, then the best way to lose fat would then be to sleep. Does that make any sense? That doesn't sound right. That doesn't sound right. People say, I don't want to burn carbs. I want to burn fat. So then what does burning carbs mean? Does that just mean that you're, since you store it all and you're liver and your muscles, that those just shrink?

After you do high intensity interval training, your muscles just don't shrink, do they? That doesn't sound right either. That doesn't make any sense either. So it's really all a percentage trick, right? It's all about the total number of calories that are burned. So say I do high intensity interval training, right? And you're going to a CrossFit gym and you look back and you're like, gosh, I've been doing all this high intensity interval training. How is it that I've lost this gut and my love handles are gone and my man boobs are gone? Like how did this work? Well, again, it's all a percentage trick.

So you do this high intensity interval training. You ramp your carb usage way up probably to a point where you're only burning carbs. But after you stop, then what happens? So you intake some food. All of the carbohydrates you take are then biased towards storage. They're all going to go towards storage. But at that same time, you're not going to be burning those carbs. You're going to ramp up your fat usage. And that's going to be your predominant caloric expenditure. So it's just a percentage trick. It's just relative versus absolute where it's all about absolute burn, the total burn. It really just comes down to a carbon game.

I think I see what you're saying here. So since we're talking about burning carbon instead of fat versus carbs, and this is where a lot of people get mixed up, if I'm doing a hit workout, I might be burning a lot of carbs during the workout. But because I went through so many of those carbs, a high percentage of them were burned during the workout versus fat. Afterwords, my body is then burning fat as opposed to carbs, almost like a rebalancing. Exactly. So it's like your body, after you burn all those carbs, your body is sort of freaking out. And it's saying, we need to replenish all of these stores.

We need to make sure we have these stores in case we have to do anything in the future. So it's not going to burn any of those up for energy, right? It's just going to store them all. Your liver is going to be selfish. Your muscles are going to be selfish. They're going to intake all that glucose. And then since your body isn't able to use the glucose or sugars for energy, it then transitions to using fat for energy. So even though you're doing this hit workout, it burns a lot of carbs, it's going to result in a lot of fat burnage in the end, if that makes sense. That does. Okay. So ultimately, we want exercise and high intensity exercise in order to expel the carbon.

And then we want some sort of restriction, intention, mindfulness around what we're eating, but that can come in a lot of different forms as well to restrict the amount of carbon that's coming in. Those two things together should lead to better metabolic health. Exactly. So these are really just more examples to help us understand how metabolism sort of works. It all depends on what your question is and what your objective is, right? If your question is, how do I lose the most amount of weight possible? That's really going to come down to mainly a dietary question on what you eat. If you want to be as healthy as possible, it's probably a combination of both.

But there is no magic bullet like exercise that will work to improve all of your metabolic parameters. So if you're looking to be as healthy as possible, exercise has to be a component, right? And then diet will feed into that. But if you're looking to lose weight, diet is really going to be where that comes in. Because it's really easy to out eat exercise, right? I mean, you can eat a bag and a half of chips and that equals a mile run. I mean, 350 calories is a pound of fat. So it really comes down to diet when you're dealing with weight loss. But if you want to be as healthy as possible, there's nothing better than exercise.

A question on the sleeping and burning fat, is that just the highest percentage of burning fat, but you're not burning the highest amount of carbon. Exactly. It's just a percentage trick, right? I mean, that's why I was saying you can equate it to the zone two, right? You are burning much, much more fat than you would at high intensity interval training. But the total caloric burn is much, much less, even though percentage wise of fat burning is greater. Yes. It's all about total caloric expenditure, where the percentages don't really matter. Sure, this is a complicated topic. And I know we're going deep into the weeds on this one.

But here's why I think it's important to go deep on this topic, especially if you want to be healthier now and into your later years. If you understand how all of these bodily systems work together and integrate with each other, you'll be able to filter good information from bad. This is important because it seems everyone has an opinion on these topics, but not everyone knows what they're actually talking about. This understanding will also put you in a position where you're better able to stick with your plan based on your goals and intentions, if you understand what works and why it works. So that's where we're going deep on this.

Gosh, that was well said. Dr. Paul, where do you want to go next? Well, let's keep on diving deep. Teach away. It's really just based on this carbon game. You can go through the Crib cycle and TCA cycle and glycolysis and Cori cycle and all these complicated things. But when it comes down to it, it's really just a carbon game. All that matters is total caloric burn. If you are metabolically unhealthy, let's say you have diabetes, it's probably better to bias the fat burning system because your cells have basically been programmed not to be able to use fat. And so that's why you see all these homeless people that are morbidly obese.

It's not because they're eating nonstop. It's because their bodies have actually been reprogrammed. So they actually can't use that fat. So what you can do is put pressure on that system, both through taking a low carbohydrate and sub would say, going ketogenic or a little bit higher fat diet. You can do that or you can put stress on the mitochondria to burn the fat through those low intensity or zone two type exercise programs. Both will then bias fat for for utilization and hopes of making someone more metabolically healthy, if that makes sense. So zone two long distance endurance related training is going to be better if you are pre diabetic, diabetic or obese.

I think that it is better for those people in hopes of achieving metabolic health. Basically when someone has diabetes, there's a bunch of issues. We'll talk about diabetes type two here. And so on basically doesn't work as well at pushing glucose into the cell. So say you eat a lot of carbohydrates, you get a lot of blood sugar in your blood, your pancreas, the beta islet cells, the pancreas then release a lot of insulin, trying to try to regulate that blood sugar level, trying to push it into all these muscle cells to lower your glucose levels. Because the body knows that glucose is toxic, right?

Glucose is toxic from everything from your eyes to your toes. It'll lead to blindness and heart attacks and can make you go on dialysis and kill your kidneys. Because peripheral vascular disease where you get these wounds on your feet and will lead to gangrene where you actually don't have any blood circulation to your toes. I mean, when I was a resident at the VA, I was checking on this dude that had gangrene of his toes and he was going to have these things amputated. I don't know if I've told you this story before, but so I went to go check on him. He was going to have an operation and I went to go examine him and I lift his sheet up and I looked underneath and his toes were gone.

I was like, did you already have surgery? And he's like, no, no, I've just been sleeping and I look at his bed and I found his dead toes in his bed. Whoa. They were like charcoal. It was unbelievable. So I mean, you really don't want to have diabetes, right? It's just, it's toxic to you. So you have this high blood sugar levels. Your body's creating more and more insulin, trying to push this into cells and eventually your body becomes resistant to it. And it's sort of like equated to drinking alcohol, right? It's like you want to get that same head change. You want to get that same buzz. You want to get hammered, if you will, but the longer time span you drink over, the more and more you need to drink to be able to make that happen.

And you're talking about the same relationship with food. With food. Yeah. Yeah. So this just means this tolerance to the insulin. So it takes more and more and more to try to push this blood sugar into the cells and eventually the body just can't keep up and your blood sugar ends up rising and all of these toxic issues happen. And then your toes fall off. Right. So the goal really is avoid diabetes or type two diabetes at all costs and to maintain energy balance. Hold up of lactate in the cells relate to soreness. Lactate is not the actual cause of soreness or the burn that you feel. It actually buffers you from it.

But let's just take a step back real quick and we can sort of get there in a second. When we're breaking down ATP, it's something called ATP hydrolysis. And then we end up getting ADP plus a high energy phosphate plus a hydrogen ion. And hydrogen is really what the whole system is based upon. So that's going to make our blood pH go down. And as we've talked about, the body doesn't like that at all. So what is what does the body do? It actually ships that hydrogen, sticks it on the pyruvate and then you have lactate. So it's actually that hydrogen ion that's created from that ADP hydrolysis that is causing that burn that is causing that fatigue in your cells.

The lactate is actually buffering you from it. It's just everyone thought that it was lactate because if you measure someone and they're doing higher intensity interval training, their lactate is super high. So it must be the cause. But it's the difference between, I guess, correlation and causation. It's sort of just like HDL cholesterol. So HDL cholesterol is associated with being metabolically healthy. It's correlated with that. For a long time, all these pharmaceutical industries tried to make drugs that actually could sort of increase your HDL level. But in doing that, they actually didn't improve any health parameters as well because it's correlated with health.

The HDL molecule itself is not the causative agent. Just like high intensity training is going to be correlated with a high lactate level. It's not the causing, it's not the causative agent of the burn. It's actually that free hydrogen ion. I am amazed at how little I understand about my own biology. Your comment about the hydrogen ion makes me want to ask this. Are you often in awe of how the human body functions? I mean, there are amazing things going on nonstop that we have no idea about. Does that blow your mind? Every single day, man, I think that the human body is just absolutely fascinating.

Going through biology and med school, I was just so into it, just mesmerized every day that all of these things were going on inside of me that I had no idea about. That this, like you said, this little hydrogen ion can cause all this burning in your muscles and make you stop or just these little transporter straw-like things that go across cell walls can be responsible for diabetes or being metabolically healthy. It's mind blowing all these minuscule things that are going on not only day to day, but millisecond to millisecond. It's incredible that every time I take a breath, my body is taking an excess carbon molecule and binding it to two oxygen to get rid of it.

Every breath, my breath in our minute, do we take? 12, 14, 20? So between 10 and 20 times a minute, our body is performing a function that is kind of a chemical miracle. Every single second is a chemical miracle. I mean, it's unbelievable. I mean, just stop and think about like how the heck did we evolve that plants pretty much do the opposite thing that we do. And we do the opposite things that plants do. And somehow we have this beautiful balanced atmosphere. I mean, it's absolutely nuts. Like all of the things that must have happened over time to allow this life to be possible. It's mind blowing.

I just love biology and biochemistry of medicine so much. It's just this world of never-ending knowledge that just blows me away day to day. Seeing patients and trying to manipulate their own physiology or illnesses with different medications, trying to save their lives. I mean, the fact that someone come come in with a fentanyl overdose, they smoke too much fentanyl. They stop breathing. I give them a medicine called Narcan and they wake up and they start breathing again. I mean, it's crazy. The stuff that we can do, the GLP1 inhibitors are like the coolest thing on the block. Semicluetide and tersepetide and fleek came out for diabetics and now it's used for weight loss.

But they've known that these GLP1 agonists have, they've been, people have been looking at and researching these for a long, long time. But it wasn't until they found a similar molecule in the saliva of gila monsters that then could survive a long time that they were able to bring this to market. I mean, that's crazy. It is. Right? No gila monster like they look like those big ass lizards that look like dinosaurs. My biologist friend always makes fun of me when I call them gila monsters. What the hell are they called gila? Gila monsters. No, they're not. It's silent. That's what he told me. Gila?

Gila. Gila. Yeah. But it's spelled G-I-L-A? Correct. Eric. Yeah. He's coming on very soon actually to educate all of us about gila monsters. Gila monsters. Snakes, hawks, finding poisonous vipers in Malaysia. Yeah. God, it sounds a lot more interesting than medicine. Okay, let's talk about metabolism. My favorite subject. Why does one person gain weight when they eat half a bag of chips and another person doesn't? Well, I think with like all things in biology or biochemistry or medicine, like it's not as simple. This is why, right? I mean, it's multi-factorial. So when you look at the equation that sort of dictates weight loss, there's multiple components to it.

It's like basal metabolic rate. You have your physical activity. You have their thermal effects of food. And another, and a portion of the physical activity can be broken down into exercise and something called neat and a non-exercise activity thermogenesis. So some people just have this obese resistant phenotype where they eat food and they just spontaneously start moving. They start twitching their legs. They get up, walk around. They start talking a lot. Like they just start burning those calories up where some people just are predisposed to sitting more. And it probably also has to do with just genetically how insulin sensitive your cells are.

So some people are going to be more biased or just taking all that glucose in and storing it all up in your muscles and all up in your liver where some people might have a propensity towards letting that sugar go to their fat cells and then it gets transformed into fat and they get much more obese. So I think it's likely just multi-factorial. More genetics and more environment on that. Is that a matter of getting lucky with your genetics or is a combination of the two? No, I think it's probably mainly genetically based. Again, I mean, these are things that you can be aware of and try to modify your behaviors and try to capitalize on those things.

But if you're just taking two individuals that just have them act as they would typically, then I think it's mainly genetic. Yeah. Another listener question here. Can you provide me some concrete steps to help me maintain a healthy approach to what I eat and how much of it I eat? When you look at studies and you want to look at healthy weight loss maintainers, a few things always come up, right? It's self-restraint, it's self-monitoring. Another interesting one is actually creating a new identity. You have to have a belief in what you're doing. There has to be, you have to restrict something and then you also need to have a plan for once you've lost this weight with what you're going to do.

I think one of the main issues with weight loss is if you think about blood pressure, right? You have elevated blood pressure, you get started on blood pressure medication and let's say your blood pressure is initially like, I don't know, 180 over 90. You get on a couple of blood pressure pills and you get it down to our goal of 120 over 80. Once you get to that goal, you don't just stop the medication because you got to that goal, right? But I think a lot of people when they practice weight loss, they just want to get to that goal and there's no thought for what they're going to do once they actually get there.

I mean, if you look at the statistics, I mean, six out of every seven obese people have lost a significant amount of weight during their lifetime, but they all regain it. It's because you can do that first step. You can restrict. You can exercise. You can do all the right things, but adherence is the most important thing, right? This is a lifetime commitment to changing your habits. Once you get to that goal weight, you can't. Simply just throw up your arms and say and celebrate and go out. Like I used to do when I played football, go eat two double quarter pounders with cheese, two large fries, two apple pies and a Coke.

You know, that just doesn't work. Because then you're going to put it right back on. You're just going to put it right back on. What was that you mentioned about forming a new identity and it's linked to adherence? A new identity is fascinating, right? So I guess this opens me up to be a little bit vulnerable. When I was younger, I was severely overweight. When I was in the third grade, I don't know, I weighed 140, 150 pounds. I would be made fun of constantly. My nickname at school was Supreme Chubs. I remember coming home and I would just cry in my bedroom just because I'd get made fun of so severely.

I remember we had this one room in our house. It was like this nice sort of ornate dining room that we didn't use too much. But I would go to the blinds there and look and I could see the street from there. And I would check to see if any kids were outside. And if there were any kids, I wouldn't go outside. But if no one was there, then I'd go outside and ride my bike or play or whatever. And so this led down basically to a long road of me just believing through all this being made fun of. And there was other things in my life. My dad was a minister and we grew up in a community that was quite affluent.

We had no money. So I always felt like we were always trying. I was always trying to live up to what everyone else had. And I was never enough. And that was really the same thing with being overweight. It's just like I wasn't enough to be to be cool or liked or accepted. And I wasn't able to read until the third grade. And my parents would do my homework for me. And because of that, I really never felt like I was enough either. I don't know. There was a lot of these micro-traumas that basically led to me having some issues with just feeling like I was never enough. I'd go through periods of life where things would be fine and I'd feel great and wouldn't have any issues.

Like in high school was an amazing time for me. I played football and did well in school and had lots of friends. And then I went off to play college football and it was just a really stressful time for me and a lot of these insecurities came out. And I'd always feel anxious and have the social anxiety in classes. And so that was a tough time. And what really came out was when I went to med school, like I just had this imposter-type syndrome where I just didn't feel like I belonged. I didn't feel like I was enough. Even though I scored in like the top 1 percentile on the test to get in there and I was top of my class in med school, I always just felt like almost like an imposter.

People would ask me, you know, like, what I did or what I was going to school for. And I would just say, oh, I work in a hospital or, you know, I work. I work, I don't know, I'm just going to school. I would never say, oh, I'm a physician or I'm a doctor. So it was almost weirdly, I don't know, just felt like I wasn't good enough to do those things. It was it almost like if you told them you were studying to be a doctor or you were a doctor, they might figure out you were faking it. Yeah, they would figure out that I just wasn't enough. Like, how are you doing that? You shouldn't be doing that.

And it would come out a little bit like in social situations too. I'd get social anxiety and just feel like I wasn't enough for the situation. I remember the first time I met my wife's parents, we sat down at a, at a restaurant and I just started sweating profusely. I was just like so anxious, so insecure and it was just crazy. But the point of all this is basically I've gone through therapy, I've worked on myself. Now I meditate all the time in a much, much better place. I've had to come to a point where I've actually created this new identity where I actually believe now that I am enough. And I had to realize that all of those things in my past and all of those feelings were just defense mechanisms as me as a child trying to protect me from getting hurt.

But I just don't need those things anymore. They're no longer beneficial. So I've had to create this new identity where I am confident and I do believe in myself. And I do believe that I'm enough, but it's been a long road. The same thing with dieting. It's like you've got to actually change almost this perspective of who you are. I'm no longer that guy that plays college football and weighs 340 pounds and eats two quarter pounders. Two quarter pounders and all this other crap that's just killing you slowly. I've just come to a place where that's no longer me. No, I don't really eat that way. I mean, do I eat poorly sometimes?

Sure. A birthday or a special night out or whatever. I'll splurge and I'll have an Oreo cookies and cream based treat, which is my Kryptonite. Yes. Now we're talking, right? Oh, wasn't it? You're I think it was your daughter was talking about recently. It was a vanilla ice cream with Oreo dust. The dust. Oh, that actually gave me tingles inside. That's how strongly that still affects me. I mean, when I was a kid, my mom would buy Oreos like by the pound, right? And the only thing that would make me happy or calm me from crying was to eat Oreos. I'd like hide away. I still remember this nook underneath our stairs and I'd eat, you know, a whole thing of Oreos and I'd feel great.

Full bag like all the rows. All the rows. Not one or two. We're talking all the roads. So if you want to die and to be successful, you've got to disassociate from the identity of being an overweight person and form a new identity as a healthy fit person and see yourself that way. Yeah. Like it's that. And then also believing in what you're doing is actually going to work and be healthy and be beneficial. Like people think of placebo effects. I'm too mentally strong to fall for that. But people fail to realize that psychology is physiology. Like the way you think and feel affects your metabolic processes, it affects your physiology.

Like they did a study on these on these ladies that clean hotel rooms, right? Half of them, they told them, oh, wow, by cleaning these hotel rooms, you're actually, you know, far exceeding the daily recommended dose for exercise and that this is really going to help you become healthier. It's going to decrease your blood pressure, decrease your fasting blood glucose, improve your lipid profiles, all these things. And the other half of people, they just let them do their normal job. They ended up doing the exact same amount of work. They did their jobs as they did before. But the people who were told that they were doing something and was beneficial for them, they lost weight.

Their lipid parameters got better. Their blood pressure got better. Their fasting glucose got better by changing nothing except for what they thought about the situation. So I believe some major part two, which is fascinating. Yeah, there are all these studies now around girls and math simply by showing girls a study that they're just as good as boys at math or even just reading that that statement that girls are just as good as boys at math. Before they go take a math exam improves their results. They perform better mathematically if they believe they are capable of performing better mathematically.

And the drastic differences in their scores blows my mind because you would think, well, they either know the stuff or they don't, what they believe about it isn't going to change anything. And yet it absolutely changes their performance. Psychology, the way that you view yourself, the way that you view your habits, I mean, it is incredibly important. You mentioned monitoring too. How does monitoring figure into the dieting, the weight loss and being successful with that process? I mean, there's there's multiple different ways that you can implement monitoring, right? I mean, you can just go on the internet.

There is a like a calorie calculator that the NIH puts out that you can just enter in your goal weight, you enter in your age and your sex and your physical activity level. And it will tell you how many calories you need to intake in order to reach your goal weight. And then it will also give you the calories that you need for maintenance after that. So it gives you a plan for after. What about steroids? They actually bad for you? That's a great question. So if you're talking about testosterone replacement, I think as long as it's within your physiologic parameters, it's not bad for you at all.

If you're someone that's deficient in your androgens, if you have low testosterone, if you have more importantly, low free testosterone, and you either take pellets or injections or creams to boost up your testosterone levels to within normal physiologic parameters. I don't think there's any downside to that. Testosterone is known to elevate mood to elevate energy. It actually makes you much more insulin sensitive. Then a lot of talk about testosterone increasing your risk of prostate cancer. I think a lot of that has been debunked. There's some data suggesting that if you are very metabolically unhealthy, for some people, it might increase your risk of heart disease during the first year of being on testosterone.

But if you're going within your physiologic parameters, I don't see a downside to testosterone at all. I think that it can increase mood, increase energy, give you a chance to recover better from workout so you can work harder and gain more muscle mass. I really see a lot of positives. But you can't abuse it and you can't do it like the bodybuilders do. You go beyond those physiologic parameters and bad things are going to happen. It causes something called the rithrocytosis where you actually gain many more red blood cells in your blood. That's going to lead to strokes and heart attacks and high blood pressure and all these other things.

That's why so many people in the bodybuilding world are unfortunately passing away. So it sounds like to take testosterone in a healthy way, you need to wait until you're at a point where it's justified by taking measurements that your testosterone levels are low. Yeah, 100%. When your free testosterone is low, when it's below the 25th percentile or whatever, I think it's justifiable then to potentially go on testosterone replacement. But like with all things, what are your goals in life? How old are you? I mean, if you're a 30 year old guy, should you go on testosterone replacement? No, you should not if you want to have kids in the future because it's going to kill your ability to be able to produce sperm.

And that might be a consequence that's irreversible. I mean, there are some protocols that you can do with ECG and FSA to try to reboot your testicles, if you will, to producing more sperm. But it's not always foolproof. So I think there are other ways to modulate your testosterone levels other than injecting testosterone. You can take beta 8Cg or you can take chlamid, which actually just stimulates your testicles to produce more of the natural testosterone. Rather than supplementing with it. I read an article in I believe it was Sports Illustrated. It was about a minor league baseball player and how prevalent steroids were in the minor leagues because these guys are trying to break through and get their chance in the majors.

And it was written anonymously because the conclusion this guy had come to was that his only regret was that he didn't start taking steroids earlier. It was once his career started to dip and they were about to throw him out. That's when he started taking the steroids and it kept him around for a while longer. But he'd already declined so much that it wasn't quite enough, even though he saw all these benefits. And he said, yeah, I just wish I had started taking it at an earlier stage because then I would have popped through for sure. If I'd started taking it when I was 20 years old, I would have had my five, six years in the majors and then I would have had that decline.

What do you think about that other than the not being able to have kids say you put that at risk, which is obviously massive, but other drawbacks from that? He really didn't think they're worry. Yeah, I mean, if you're not worried about the kids issue and you're going to do it within physiologic parameters, there probably isn't much danger to it. Other than the fact that there's so much drug testing now that I don't think it would fly. When I was playing football, I never got drug tested one time. I mean, I've never used testosterone, but never once. And now it's much more prevalent. Everyone's getting drug tested all the time.

They drug test in high school. There's obviously some tricks of the trade to avoid popping up positive on the test, but yeah, I just don't. I don't really see how professional athletes can do it now. He eventually did get caught, but he said he was at the end of his career anyways. And so it didn't really matter. And then he wouldn't reveal what his tricks were for getting around the drug testing earlier because he said, right. But that might not necessarily be horrible for him. No, you're just going to have to be on if you actually take testosterone itself, you're going to have to be on the rest of your life.

So from 20 on out, unless you try to get things rebooted and maybe it'll work, maybe it won't, but it's a it's a lifelong decision. It's a big decision to make injecting. And you may pay the price that you're never able to have children, which I would say is a price too high. For me, it would be too high. I guess for some people, it wouldn't matter. How does cold exposure tie in to all of what we're talking about here? Your favorite subject? My favorite topic. You're just wondering why you're freezing and trying to warm up as we speak. Why did I go in for 11 minutes today? That's a good question.

So as we all know, we have like a 24 hour circadian rhythm, but our bodies also have this like 24 hour temperature rhythm as well. Right. So two hours before we wake up, our bodies at this temperature minimum, and then it starts to rise throughout the day until evening where it starts to decline. And then when we go to bed, it actually declines a couple more degrees that allows us to aid in deep and quality sleep. And throughout the night, it stays low. And then it'll start to rise again. All this is sort of dictated by the hypothalamus, which is just a structure in the brain. But cold immersion can really help our metabolism because as we get cold, we want to warm up.

So our metabolism will increase. It'll start burning energy, trying to increase our temperature. It's sort of like putting on muscles. Like if you put on a pound of muscle, you might get an extra 10 calories burned today in caloric expenditure because of that extra pound of muscle mass. So in one day, it might not matter. But if you're looking over the long term, over a thousand days, will it matter? It definitely could. There's also these transition of what we call white fat to brown fat. So while white fat isn't inert, it really doesn't have many mitochondria, but brown fat does. And so consistent cold exposure can convert some of our white fat to brown fat.

So then this fat is actually metabolically active and can burn many more calories than the white fat. And so kids have a lot more brown fat, right? When babies are born, they actually can't shiver. And so they have a lot of brown fat on them to keep them warm. And this is why you see kids running around in the snow or ice cold water without shirts on. And it doesn't seem to bother them because they have a lot of brown fat that just keeps them warm. So we lose a lot of that brown fat as we get older, but it's a plastic process, meaning that we can actually gain it back if we work at it. And it's also great for our mental health.

So when we undergo typical stress responses, we have an increase in these neurotransmitters, like norepinephrine and epinephrine. They go way up and go down. And there's another one that it affects during stressful responses, something called dopamine, which is like the most famous neuromodulator right now where dopamine will go up. And then it acts like a sine wave that will go back down beneath baseline and then go back up. And then during a stress response, you'll also have this increase in cortisol where it will go up and then come back down. When you do cold exposure, you get this big spike in dopamine, but instead of acting like a sine wave and going back below baseline, it actually causes dopamine to go up and stay up for hours at a time.

And when it actually comes back down, it just goes back to baseline. And it doesn't affect cortisol at all. So it doesn't affect that sort of chronic stress hormone whatsoever. So that elevation and dopamine that stays high for a long period of time, dopamine is known for increasing mood, motivation, drive and desire. And so all of these things are just flourishing after the cold. You're saying that medicine is worth the payoff. 100% it is. Yeah. Paul, what's gut health all about? Gut health. There's really a few things that you can do to increase or improve your gut microbiome. One has been shown to be exercise.

One is shown to restrict calories. And the third is to increase your fiber intake. So fiber is really a prebiotic. Prebiotic basically just means that that is food for the bacteria to digest. OK, so the fiber makes it down to the gut, the microbiome or the bacteria inside of your gut. These all these bacteria basically live in the small intestine. There's three different parts of the small intestine, the duodenum, the jejunum, the ileum. They live in the second and third. The jejunum and the ileum. And they feed on this fiber. Some of them will make like these short chain fatty acids. One of the ones that everyone talks about now is butyrate.

What that can do is actually increase your insulin sensitivity and actually increase satiety signals, meaning it'll make you feel more full in the long run. Another thing that fiber does is it basically creates this mesh-like network inside the duodenum which sort of blocks a lot of nutrients from being absorbed quickly. So let's say you eat real food. When I say real food, we're talking about like stuff without nutrition labels, fruit, vegetables, nuts, seeds, all of those have fiber with anum, right? So you consume those. This fiber creates this mesh-like network in the duodenum which basically slows the transport of food and so it's not rapidly uptake in the gut.

This allows all this food to go down to the small intestine and the bacteria can feed on it. It can be absorbed slowly and all sort of goes to plan. I'll come back in one second to the standard American diet, what happens when we intake that food. But fiber has also been shown that for every 10 grams that you increase in fiber intake, it will actually decrease your all-cause mortality by 10%. Like that's a crazy number. If you look at diabetes and high blood pressure, those increase your all-cause mortality by 25% each. Smoking is like 40% in stage renal disease being on dialysis. It's like 150%.

So to decrease it by 10% by taking in 10 grams of fiber, that's nuts. I think the recommended is about 15 grams of fiber for every 1,000 calories. Now there really isn't a top end to that. The only top end would be how much you can basically handle because it's going to make you feel full and maybe a little sluggish and uncomfortable if you eat too much fiber. Let's talk about the standard American diet quickly. So the standard American diet is this food experiment that unfortunately has gone wrong. It's a diet that has been made to increase taste, but decreased cost. Also increased portability.

So all of these foods have lots of refined sugars. They have lots of omega-6 fatty acids. They don't have enough protein. They don't have enough fiber because you can't freeze fiber or everything turns to mush. They don't have enough micronutrients. These foods also have something called the mulsifiers in them, which is basically like these detergents or soaps. And they have too much salt. So we talked about when you eat regular food, you create this mesh like network in the duodenum and the food goes through and gets eaten by the bacteria and gets absorbed. If you don't have all of this fiber and you're eating the standard American diet with all this processed food, what happens is that all of this food and specifically all this added sugar gets taken up quickly through the duodenum.

And what this actually does is this activates the vagus nerve. And this nerve is sort of famous for the gut brain connection. And through this connection, what actually gets stimulated is dopamine. What we were talking about before, so it increases your mood, motivation, desire when you eat this sugar. And this can be stronger than all of the satiety singles you have, like CCK or leptin, all these things that basically cause you to feel full. So you intake this processed food. It takes away the feeling of satiety because it's overwhelmed by dopamine and you really never feel hungry. Never, never feel associated.

So if these over processed foods are basically hijacking the dopamine circuit to override our natural bodies mechanism for feeling satiated. And so we're driven to eat a lot more of these over processed foods, which make us feel worse. Yes, but there's other ways that it does it as well. So it has these emulsifiers in it. And these emulsifiers will actually go in and they digest the inner part of the gut. They'll actually degrade it. And these are the cells that actually produce some of these satiety type signals. So it digest these cells that produce CCK, which is a satiety producing signal. So then you don't have that signal at all either, which is crazy.

So then you don't feel full because of that. And then to make matters worse, without this mesh like network from the fiber, if you eat real food, if you don't have that, everything is taken up quickly by the duodenum and then what happens to the gut microbiome? They're just there not eating anything. They have to eat something. So what do they start doing? They actually digest the inside of your gut as well because they're not being fed. So some people think that this is leading to leaky gut or IBS or stuff like that. These processed foods, they've been weaponized against us. These people are brilliant for creating them, but it's just wrecking havoc on our metabolism and health in general.

It's a combination of science and profit motives combining into something that's really net negative for society. Yeah. And the fact that it's so cheap, it's just all that some people can afford. And you wonder again, why you see this homeless person on the side of the street and they're obese and you're like, well, if you're obese, you should be able to afford rent or whatever. It's like, no, like the whole system has been hijacked. It's all been weaponized against them. And it's really unfortunate. So to go down a checklist here of all the things we want to do to feel and be healthy, fit, strong, especially into long age, I've got take protein and creatine supplements, get enough sleep, build an identity of seeing yourself and believing in yourself as a fit and healthy person.

Keep management through diet and exercise. Put on some muscle, work that into the exercise routine to have enough muscle mass to last you into your later years, especially if you're in your 40s and 50s now. Very important to get on the weight lifting so that you can carry that with you into the golden years when it really starts to drop off. Cold exposure, sauna heat, also very helpful, good for the whole bodily system. Blue Coast Monitor can be a great way to see what foods are affecting you personally and then eat a lot fewer of these processed foods. So you can have increased fiber and avoid all these massive negative effects from eating too many processed foods.

And if you do these things, we're going to feel better and we're actually going to be metabolically healthier and have a chance to delay or evade these chronic diseases and increase our health span. Not just increase our lifespan, but increase our health span. That's the most important. Well, thank you so much, Paul. It is always a pleasure getting to sit down and chat a bit. And I think we should make this a recurring segment where we dissect medical issues with Dr. Paul. I'd love to come back, bud. All right. What are we doing for the rest of the day, Paul? I think we're going to go deadlift.

I think that's going to go hit some deadlifts. That's a great idea. Yeah. Yeah. That'll help our strength, our stability. I love it. All right. Let's get the gym and can we to record another one? All right, bud. The content of this podcast is not intended to be a substitute for professional medical advice, diagnosis or treatment. The use of information on this podcast or materials linked from this podcast is at the user's own risk. Thank you for listening to the Nick Standlea podcast. If you enjoyed this episode, please subscribe, rate five stars and leave a review. The best way to support this podcast is to visit our sponsors in the description.

Have an excellent day.