19 Episode results for "AMA"
#73 - AMA #9: NAD & metformin, fat-burning zone, creatine, estrogenization of men, emergency kit for cold & flu, and more
"Hey everyone welcome to the Peter Attiyah drive. I'm your host Peter Drive as a result of my hunger for optimizing performance health on jeopardy critical thinking along with a few other obsessions along the way I've spent the last several years working with some of a successful top performing individuals in the world and this podcast is my attempt to synthesize what I've learned along the way to help you live a higher quality more fulfilling life. If you enjoy enjoy this podcast you can find more information today's episode and other topics at Peter at md dot com and everyone. I'd like to take a couple of minutes to talk about why we don't run ads on this podcast and instead. We've chosen to rely entirely on listeners support. If you're listening to this you probably already know but the two things I care. Most about professionally are how to live longer and how to live better. I have a complete fascination and obsession with this topic. I practice a professionally and I've seen first hand. How access to information is basically all people need to make better decisions and improve the quality of their lives curing and sharing this knowledge is not easy and even before starting the podcast that became clear me. The sheer volume of material published in this space is is overwhelming. I'm fortunate to have a great team that helps me continue learning and sharing this information with you to take one example are shown outs are in a League of their around in fact. We now have a full time person that is dedicated to producing those and the feedback has mirrored this so all of his races and natural question. How will we continue to fund the work necessary to support this as you probably know. The tried and true way to do this is to sell ads but after a lot of contemplation that model just doesn't feel right to me for a few reasons now the first and most important of these is trust. I'm not sure how you can trust me if I'm telling you about something when you know now. I'm being paid by the company that makes it to tell you about it. Another reason selling ads doesn't feel right to me is because I I just know myself. I have a really hard time advocating advocating for something that I'm not absolutely nuts for so if I don't feel that way about something. I don't know how I can talk about enthusiastically so instead of selling ads. I've chosen listen to do what a handful of others have proved can work overtime and that is to create a subscriber support model for my audience. This keeps my relationship with you new both simple and honest. If you value what I'm doing you can become a member and support us. At whatever level works for you an exchange he'll get the benefits fits above and beyond what's available for free. It's that simple. It's my goal to ensure that no matter what level you choose to support us at you will get back more than you give so for example members will receive full access to the exclusive shouts including other things that we plan to build upon on such as the downloadable transcripts for each episode these are useful beyond just podcast especially given the technical nature of many of our shows members also get exclusive access to listen to and participate in the regular ask me anything episodes that means asking questions directly into the Ama Ama portal and also getting to hear these podcasts when they come out lastly and this is something I'm really excited about. I want my supporters to get the best deal possible on the products addicts that love and as I said we're not taking dollars from anyone but instead what I'd like to do is work with companies who make the products that I already love and would already talk about for free and have them pass savings onto you again. The podcast will remain free to all but my hope is that many of you will find enough value in one the podcast itself and to the additional content exclusive for members to support us at a level that makes sense for you. I want to thank thank you for taking a moment to listen to this if you learn from and find value in the content I produce please consider supporting directly by signing up for a monthly subscription another month another Ama welcome to Ama number nine. I am again joined by the incredibly handsome Bob Kaplan in this episode. We talk about my history with Theranos. This is Kinda funny sort of sad story the estrogen nation of men conversation around plastics and glass containers. There's takeaways from my recent hunting trips what books I'm reading and listening to at the moment what advice I would give my twenty five year old self relating to mental health my emergency protocol for when I get sick as a dog things that I used to be bearish about that. I'm now bullish about or or vice versa. Bob And I talk about exercise in the quote Unquote Fat Burning Zone Hint that's a term I can't stand and we end with a little. It'll creatine supplementation conversation as reminder. Ama's are four subscribers only if you're not a subscriber you'll only be able to hear a preview of the AMA here. If you are a subscriber and hearing this means you have yet to download our members only podcast feed with this members only feed you'll be able to subscribe to the drive in your podcast player player to get every episode of the drive without the subscriber callout plus full episodes of the AMA podcast directly along with other exclusive content. You can learn more about it. Peter D M D dot Com forward slash members to become a subscriber to have access to the members only podcast feed as well as other benefits such as detailed show notes and member Burnley discount codes and the products. I believe in you can visit Peter Tia. MD DOT COM forward slash subscribe we'll continue to police questions from the AMA forum and we encourage all subscribers to participate ask questions as we hope to get to all of your questions in time through Future Ama's so without further delay welcome to Ama number nine. They find hello again. podcasters subscribers. Bob Kaplan here Peter t here or I didn't see. I know it's hard. It's hard to see me in the ghetto. I can see the soil and green all right. Let's jump right into it. Two minute drills should even say two minute drill. It's a two minute drill. That might take longer not not exactly Tom. Brady on these fair drives bail but who's counting. Will you talk about your history with Theranos. You alluded to this in that tweet yeah so in two thousand six. I was working in Palo Alto at consulting firm and a good friend of mine he had a connection connection to Theranos and at the time both he and I were considering jobs. They're in their role of chief financial officer and me in the role of chief medical officer. This was very early days. I don't recall what year Theranos has found that I want to say oh three but it was it's still very small and I remember their office was next to ours and we were actually both on California Avenue in Palo Alto. So the first time my went over there to meet with Elizabeth homes I remember it was just a tiny place think there were maybe twenty or thirty employees and we sat down and looked at this black box that they a hat and talked about a bunch of things that had to do with the business and the technology and we met again and ultimately decided not to take the job for for several reasons. One of the reasons was when I did my due diligence on their investors. Something came up on one of the investors that that someone I knew entrusted. A lot didn't have a lot of great things to say about one of their investors and when you're thinking about joining a startup company that kind of stuff matters the other thing is I really loved loved. I was actually doing so the hurdle rate for me to leave. What I was doing had to be very high because I was super happy at McKinsey and really really loving the work work I was doing and then the third thing was. I wasn't convinced that what you could test in a box. That size was interesting so although Elizabeth was incredibly secretive about what they were doing and I was not allowed to look in the box. Which of course I and I'm sure every other person that showed up I would ask that question of faith what's actually what's in the box that was a no go even under an NDA if people wanNA primer on their noses a documentary right on HBO if they don't know you know the story behind it? That's right nothing. I'm saying that we'll be even remotely interesting. If you don't understand why in the end this is an interesting story. I knew enough about Diagnostics and I knew enough about the chemistry of it that I knew knew that there was pretty much not going to be anything you could do on a drop of blood in a box that size that was clinically interesting and so in the and the reason I did not go forward was. I just didn't think it was medically interesting enough. I thought Lucky you'll figure out way to do a chem twenty and a CBC and a few other things but I don't care like you're not moving the needle in terms of clinical medicine so that was at the end of that so that was two thousand and six now fast forward to two thousand fourteen his eight years later. Elizabeth is on the cover of Forbes. The most recent isn't valuation of Theranos is nine billion dollars and I remember coming home and saying to my wife that company I almost joined eight years ago and she didn't remember number and I told her the whole story and she's like. Oh yeah and I said this is how much money we'd be worth today. If I had taken that job based on my estimation of how much dilution would have occurred in the Cap Table Etc etc and it was a big number like a life changing number and she was just like Oh wow you he win some you lose some yeah so kind of never really thought about it again and then fast forward to the beginning of October two thousand fifteen there is an event in in San Francisco called the vanity fair something Vanity Fair Event and this was back in the day when I was a lot of my life revolved around fundraising and having to be at events like this so I was at this event and Elizabeth was the main attraction of the event actually so much so that Mark Zuckerberg Berg also spoke but he was at one of the smaller breakouts so elizabeth was really the main attraction and the night either of or before her big big Talk Hawk there was a cocktail party and I actually wasn't invited to the cocktail party because it was really only for the important people but I was there with Tim Ferriss and he was invited to it so got to be Tim's date so tim and I went to the cocktail party together and we just sort of playing patty cake and in walks Elizabeth and of course she's just swarmed by people people but somehow over the course of the next twenty or thirty minutes. She ends up standing kind of right next to me. I'm thinking to myself. There's no way she's GonNa. Remember me because of course by this point. It's it's been nine years but anyway I said. I said Hey Elizabeth. You're probably not going to remember me but we matt and she goes on and I remember you. You're name's Peter. She didn't remember my last name. I barely remember my the last name your name's Peter and we met in two thousand six and you're a friend of so-and-so who is the person and she knew everything. I was really really surprised and I said little bit. That's unforgiving believable. How could you possibly remember that and she's like I totally remember Bobo on. I was like hey well congratulations on your success just amazing and she gave me her card hard. She's like look. Let's stay in touch. I'd love to talk with you again. Blah Blah Blah Blah to this. was that the first week of October two thousand fifteen and I want to say that was like a Thursday night. I think it was like a couple of days as later early in the next week when the John Kerio story in the Wall Street Journal hit and in retrospect now of course you realize that all of that stuff had been brewing long before and obviously Elizabeth knew this was coming in you know I gotta say like I think you don't come away from that documentary with a lot of empathy for Elizabeth. I don't think that's the purpose of the documentary at all but in retrospect if you're going to try to just if do nothing else but practice the art of having empathy for people who don't think deserve any it's hard for me to imagine the cognitive dissonance she would have been experiencing when on the one hand she is at this event which is a huge event by the way these sort of people who were there. I mean it was the a WHO's who of everything I remember walking out of one of the sessions and literally almost bumping into Bradley Cooper who by the way his incredibly good looking. It's worth pointing this out by the way in realized how good looking Bradley Cooper is. I just want to state that for the record. It's almost upsetting how good looking he is because you sort of think person's not supposed to be that good looking but anyway and here she was as the headliner of this event and yet in her mind she has to know her. World is about to get really messy now. The flip side of that from psychology standpoint is. I don't believe that Elizabeth ever thought she was doing anything wrong which is not for a moment to say. She shouldn't be held accountable for what happened. I think you can be so delusional that I mean. I don't think Hitler believed he was doing anything wrong either so the fact that you don't believe you're doing something wrong doesn't in any way absolve you over the responsibility of what you've done but it's a very important distinction. I think which is as you are so delusional that you really believe that the lies you're telling our for the better good and therefore I think Elizabeth felt that this was just a temporary prairie speed bump along the way but anyway. It's sort of interesting. We stayed in touch over email a couple of times in the ensuing months and then obviously lost track but that's my little history of almost having gone to work at Theranos. I think another thing that I thought about that watching. The documentary is the people that were on board. How could these people be so foolish and be duped and everything. I think hindsight bias really plays a role there that after the fact when everybody's looking at where all the chips have fallen simple thank and to be clear. I WANNA make sure that nobody ever assumes I'm. I'm trying to take credit for knowing the whole thing was a fraud that I never suspected not for a second to that ever cross my mind either at the time or in the years that followed I just thought it was the world's most uninteresting business in the history of civilization like point of care testing in a drugstore for chem seven. CBC I mean I would would have more interest in a business that specialized in removing hangnails knows that to me is more interesting than just being able to get a CVC chem seven at rite. I gave my opposition to it was never suspected there was fraud. Going on in opportunity costs gig going to yeah. I mean in the end. Our Pads are past. You have reference prince to the Estrogen Nation of man as one of the most important yet largely uncovered trends. What is this what causes it. What can be done to fix it. Talk you can find all of this information and more appear via. MD DOT com forward slash podcast there you'll find the show notes readings and links related to this episode also find my blog at Peter Attiyah. MD DOT COM. Maybe the simplest thing to do is to sign up for my subjectively non lame once a week email where update you on what I've been up to the most interesting papers I've read and all things related to longevity science performance sleep etc on social you can find the on twitter instagram. Emma facebook all with the ID Peter Attiyah md but usually twitter is the best way to reach me to share your questions and comments now for the obligatory disclaimer. This podcast is for general informational purposes only and does not constitute the practice of medicine nursing or other professional healthcare services including giving of medical advice and note no doctor doctor-patient relationship is for the use of this information and the materials linked to the podcast is at the user's own risk. The content of this podcast is not intended to substitute for professional medical advice diagnoses or treat users should not disregard or delay in obtaining medical advice for any medical condition they have and should seek the assistance of their healthcare care professionals for any such conditions lastly and perhaps most importantly. I take conflicts of interest very seriously for all of my disclosures companies. I invest in and indoor advise. Please visit Peter Attiyah M._d. Dot Com forward slash about.
#111 - AMA #14: What lab tests can (and cannot) inform us about our overall objective of longevity
"Lou everyone welcome to a sneak. Peek asked me anything or AMA episode of the drive podcast. I'm your host Peter. At at the end of this short episode I'll explain how you can access the Ama episodes full along with a ton of other membership benefits. We've created or you can learn more now by going to Peter Tia. Md DOT COM FORWARD SLASH. Subscribe so without further delay. Here's Today's sneak peek of the. Ask Me Anything episode into their. Ask Me Anything or AMA episode. This is number fourteen. One of our previous. Ama's I mentioned how I like to think about lab ranges and I might look at them in a way that it's not necessarily congruent with the way the themselves talk about them and I talked about doing potentially an episode about looking at labs and such so. This is that episode so this is pretty big topic and we actually didn't cover as much as I thought we would before we ran out of time on this episode so in this episode. I talk very broadly but I think comprehensively and in a manner. That's helpful to think about labs about my framework four. What labs can inform and what they can't inform and again even though that took longer than I thought it would take. I don't think it makes sense to get into this discussion without starting with a foundation. And so I think you'll find that interesting and hopefully it's the type of thing you don't have to go back and revisit over and over again but sitting through at once is a really good way to say okay if I'M GONNA go to the trouble of doing advanced testing what am I learning. And just as importantly what am I not learning? We then go into a couple of cases around cardiovascular disease and that's pretty much where we run out of time on this episode goes by really quick. And we're going to do is come back and just pick it up on the same thread going into other sorts of cases so at the end of this episode. I talk about what we're going to come back and visit and of course if based on this episode you have specific types of lab questions or scenarios. Maybe as a more important I think about it that you want to dive into. Please let us know. And we can obviously add that to subsequent episodes so before I started have to obviously give the obligatory disclaimer. Which is at this. Podcast is for informational. Purposes only does not constitute the practice of medicine including the giving of medical advice the use of this information the materials linked to it in the podcast are the users own risk of the content of this. Podcast is not intended to be a substitute for professional medical advice. Diagnosis or treatment users should not disregard or delay in obtaining medical advice for any medical condition. They have so with that. Said and without further lay. I hope you enjoy AMA number. Fourteen role podcasters. Welcome to another. Ask Me Anything with Peter. Attiyah this is your host. Bob Kaplan asking your burning questions. This time around. We've compiled the many questions you have on the topic of lab tests. I know Peter answered a few questions here and there and actually her first day. He discussed some of the best lab tests for overall longevity. We can possibly revisit some of those. But either way we'll be sure to include that information in the show notes. Peter is also left a lot of breadcrumbs in podcast interviews. Where he'll discuss ranges and cutoffs? He likes to see on a given test. And those values might not always reflect the ones you might see on the report that you get back from the lab. So I've actually gathered a bunch of those ranges. So one thing we can do is throw those into the show episodes. They're all in one place. If you put those two topics together many people essentially WanNa know what are the tests that I should be getting? And what to the specific results of those tests? Tell me a number of the questions we've received really fit into the broader question of. How Does Peter? Think about labs both as a patient himself and as a doctor who treats patients. What DOES THE LAB test? Actually tell you. What does it not tell you? Where can you be fooled? How often should I get a particular test? How can one lab test and form another lab test? What's the difference between normal and optimal what tests are most useful? What tests are useless? Why are we doing these tests in the first place so those are all listener questions and so instead of just taking these questions in isolation one by one we thought it would make for much more useful podcast for Peter to actually walk us through his stick on labs that he gives to patients and secondly for Peter to share some really interesting cases? He's experienced with patients that can give us real world examples of how Peter Thinks about labs and how it might inform decision making so I guess Peter. The first question goes to you. Which is if I'm a patient of yours and you. WanNa take a bunch of of my bodily fluids. I guess my question is A. Why do you want to do that and be what information are you trying to extract from that? So I think every time I sit down to review labs of the patient for the first time I usually take a step back and try to put the labs in the context of how they fit into our overall objectives with respect to longevity and do this through the Lens of the way. I've spoken about this before. Which is longevity. Has these two lifespan and health span by identifying the components of each of those and then looking at where labs have information or can shed light on those things versus where they can't you start to get a sense of where the labs are adding value and of equal importance where you have blind spots so? I do think it is important to have this discussion before we jump into the examples that we pull the side. So what is longevity again? Longevity is a function of two things. It's how long you live. And that's the part that's called lifespan. And how well you live. That's the part that's called health span. The life span part is easier to explain because it's binary person is either alive or they're dead health span. Part which will save for second is a little harder to understand maybe harder to quantify is his head. I think it's relatively straightforward to understand. Okay so living longer is effectively. Going to boil down. To how long can you delay the onset of chronic disease? How many people probably heard me say that before but I I want to unpack that a little bit more if we look at the centenarian literature as you know we have devoured that literature. The process writing the book in fact. One chapter of the book is entirely dedicated to centenarians. I think it's chapter four. They've taught us a lot so even though they turn out to be sort of genetic lottery winners people who almost through no action that they've taken are gonna live to be one hundred or beyond and instead through some amazing luck that they've inherited a set of genes are still a very illustrative population to study and we learned a lot from them. But I think the single most important thing we learned from them is they don't live longer. Once they get a disease they just take longer to get a disease. And that's really important. That's not obvious. If you haven't sort of dug into it it could easily be the case that centenarians acquire disease at the same rate and at the same time as non centenarians but they're superpower is living longer with the disease being more resilient to a disease wants it sets in but as you know Bob that turned out to not be the case so when we passed that question directly the answer was overwhelmingly in the opposite direction and indeed there superpower is how long they can go before they get the first chink in their armor but once that disease sets in they've basically been exposed to Kryptonite and they are now just mere mortals. Like the rest of us are the way I describe this in the book. Is They have a phase shift so they have a phase shift in time. That delays the onset of disease. So if you want to live longer. The mathematical equivalent function is delay. The onset of chronic disease not figure out ways to live longer once you have chronic disease worth noting that unfortunately the entire healthcare system is mostly geared towards the opposite. Prevention is not really the mainstay of medicine. Medicine has had its greatest impact. Its greatest efforts basically on what to do once. You have a disease. How do you live longer so once? You have Alzheimer's disease what drug might reverse the dementia or slow its progression. Of course the sad reality of that is none. We've spent billions of dollars trying to answer that question and come up empty handed similarly when we look at cancer treatment once you have cancer. What can you do well? Unfortunately we haven't made a lot of progress in fifty years so if you go back to nineteen seventy you look at what the long term. Survival was of a patient with metastatic cancer. And you compare that to today. The answer is almost the same. It's roughly about a five percent improvement. We've made in fifty years again. Not Great and probably speaks to the challenge of treating disease like cancer or Alzheimer's disease. Where once you have it. Modern medicine doesn't seem to be able to do that much more today than it could fifty years ago to erase it. So I think one place where we've seen the most progress on managing disease. Once it sets in is cardiovascular disease and I could do spend an entire Ama just discussing the differences between cardiovascular disease and cancer and dementia but part of it has to do with the fact that Atherosclerosis is much more of a continuum and dementia and cancer and therefore that coupled with the fact that we have a far better understanding of atherosclerosis. I think is complicated as diseases. This is and I don't mean to undermine people who studied for a living. It is far and away. A simpler disease process to understand than the other. Two major pillars of mortality. So a long winded way of saying. I hope I can convince a person that if you WANNA live longer. You've got to figure out how to delay. The onset of these chronic diseases not live longer once you have them. I think it's a study by the group Thomas Pearls which is I think he's at Bu. The New England Centenarian Study. We're looking a lot at a nearby allies blunk jeopardy jeans project but pearls has an interesting article where he talks about. Exactly what you're you just frame-they're where there are three groups. There's delays escapers and survivors. And so you have the people. So how many of these centenarians are delaying disease? How many are completely escaping? Some of these chronic disease and then how many are just living with it and have superpowers and the majority of the cases were probably no surprise. They were the delays and so they're delaying disease which fits exactly with what you're talking about. Yeah and again. It's important for me to explain to patients that phenomenon and you actually just stated in about thirty one seconds. Would it took me probably five minutes to explain so might have to start bringing you in on these meetings and then secondly it's important to explain to them that this approach while conceptually logical and. I think once most people here at they're like etta totally make sense is not congruent with how most people go to the doctor and again it's been stated a million times before we don't really function in a system of healthcare. We function system of SICK CARE. Meaning we interact with our healthcare system in a manner that is once there is a problem we seek help and again you know. I'm not one of these guys who likes to rail against health care and it's just not true. Look that's just the nature of the way the system works. The system works by identifying a disease and then label basically the more clearly you can identify and label a condition the more accurately. You can provide a treatment for it and so that's the way we were educated so medical education is predicated on this idea that you put a label on a disease and by the way. The entire financial system rounded is predicated the same way you have to come up with a billing code. That explains what a person has. This person has hypertension person as Lipa -demia this person has fill in the blank so we have a code. The code allows us to bill an Insurance Company for it we peg treatments to these things. And that's the way we go so everything that we learned in our medical training was based on this and it's not surprising then that when patients go to their doctors and say hey can perfectly healthy but whatever forty years old but I I really Wanna do everything I can to live to be one hundred. Most doctors would look at you like you had three heads they can offer you sort of glib insight like don't smoke and quote unquote eat well and exercise in those things. But how would we go further? We have to sort of change the way we think about risk which will come to a second. Can I ask one question? This is maybe a silly question or uninformed question on those codes are their codes for prediabetes or pre hypertension or on the road to Metabolic Syndrome or even metabolic syndrome. Where you're essentially saying we need to do something so that this person doesn't develop one of those diseases or chronic conditions. There's not a silly question indefinite. Leave things are changing. Thank you for listening to today's sneak. Peek Ama episode of the drive. If you're interested in hearing the complete version of this ama you'll want to become a member. We created the membership program to bring you more. Indepth exclusive content without relying on pats membership benefits are many and beyond the complete episodes of the AMA each month. They include the following ridiculously comprehensive. Podcast show notes detail every topic paper person and thing we discussed on each episode of the access to our private podcast feed quality is which were a super short podcast. Typically less than five minutes released every Tuesday through Friday which the best questions topics and tactics discussed on previous episodes of the drive. This particularly important for those of you who haven't heard all of the back episodes becomes a great way to go back and filter and decide. Which ones you WANNA listen to in detail? Really steep discount codes for products. I use and believe in book for which I don't get paid to endorse and benefits that we continue to add over time. If you want to learn more and access these member only benefits head over to Peter. Attiyah d dot Com forward slash. Subscribe last week. If you're already a member you're hearing this means you haven't downloaded are member. Only podcast feed where you can get the full access to the AMA and you'll have to listen to this. You can download that at Peter Attiyah. Md DOT COM forward slash members? You can find me on twitter. Instagram facebook all the ID Peter. Attiyah md you can also leave us a review on Apple podcast or whatever podcast player. You listen on this. Podcast is for general. Informational purposes only does not constitute the practice of medicine nursing or other professional healthcare services including the giving of medical advice. No doctor patient relationship is formed. The use of this information and materials linked to this podcast is at the user's own risk. The content on this podcast is not intended to be a substitute for professional medical advice. Diagnosis or treatment users should not disregard or delay in obtaining medical advice from any medical condition they have and they should seek the assistance of their healthcare professionals for any such conditions finally take conflicts of interest very seriously for all of my disclosures and the companies. I invest in or adviser. Please visit Peter Attiyah. Md DOT COM forward slash? About where I keep an up to date and active list of such companies.
#48 AMA Discharges: At the Bedside Segment
"I wanted to start off the episode by telling you about the very first patient that i discharged against medical advice. This was a young man who had been admitted overnight. <hes> had a history of i._v. Drug use parents specifically and came in just looking really lousy febrile shaking they it drew blood cultures the emergency room and started him on broad spectrum antibiotics and i met him first thing in the morning. I saw him i for two reasons. One of them was that i was paged by the micro lab that he was growing four out of four bottles <hes> with a gram positive bacteria and second because i it also gotten paged from the nurse <hes> who was telling me that the patient it was dressed and ready to go. I walked into his room and essentially explained my concerns. <hes> saying that i was was very worried that he might have decried itis might be growing bacteria in his bloodstream that were seating his heart valves but he told me quite calmly that he had to go. I asked why he said that his mother had gotten into legal trouble and he needed to go take care of her but but i kind of suspected from the yawning from the pilot erection that he was withdrawing from heroin i offered him some methadone <hes> <hes> try to see if that would convince him to stay but he declined my offer he left against medical advice and i don't know what happened to come back at the bedside the segment of cory m. that that discusses common ethical issues and clinical care and questions that fall outside the traditional realm of evidence based medicine. I'm margo a third year internal medicine resident at n._y._u. In my you i'm jennifer a hematologist oncology fellow at u._c._l._a. and i'm tomorrow currently pursuing research in bioethics on today's episode. We're going to discuss a topic that comes up frequently early in our practice discharges against medical advice or ama many of you listening had the discharge a patient against medical advice and bike us. You've probably come away from his conversations with tomorrow more discomfort or at least frustration and we wanted to quickly acknowledge here that questions of capacity often weigh heavily on if and how a patient leaves the the hospital against medical advice recognizing that it's a sometimes complicated topic we're hoping to dedicate an upcoming episode to discussing capacity assessment for today's discussion will focus on patients who have demonstrated capacity and making their own decisions so we're speaking to dr david wolfe andre whose research largely focuses on ama discharges is he's an associate professor and as departments of medicine and public health and healthcare ethicist with the v._a.'s national center for ethics and healthcare. We'll talk to him about different approaches approach in these situations and then discuss some truths and myths about discharge against medical advice. Let's let's begin with some of the statistics. Amy discharges only make up about one to two percent of all hospital discharges but these patients are particularly likely to be for more vulnerable populations john's right so <hes> one interesting <hes> study suggested that the same factors that are associated with amy discharge associated with people while having difficulty accessing care so you know we see patients who are poor who warn insured <hes> those factors are a risk factor for mm for being discharged ama but it's also respect for actually being able to engage in care and be able to access care on a regular basis yeah exactly as i was is reviewing this topic. I found a great paper. It was a retrospective study of over three hundred thousand discharges from two thousand and two two thousand eleven at found that ama discharges were highest biased among patients who were young male had medicare or medicaid or who are uninsured and also specifically people being admitted to the hospital for reasons relating to mental health. There's substance use disorder and this for me is this is such a large part of the frustration with ama discharges by definition. These are the patients that we don't think ready to walk out the door. It's really not surprising then that they do in fact have outcomes. There are less likely to attend follow appointments and study showed that their thirty the day readmission and mortality rates can be twice as high as patients who stay in the hospital. It's easy to make generalizations when i hear this kind of demographic information but i always wonder how do these statistics apply if the patient in front of me what an individual patient is going to be interested in as far as needing to leave the hospital you you really have to individualize so you have to talk to the patient for some patients it it might be that there's a social service payment but others are maybe a pet in the home. There may be competing eating <hes> priorities that they have and that could be anything. It could be a child in the home. It could be an older parent in the home whatever it is. It's a competing priority and so that's really <hes> what you're trying to uncover when you talk to patients as what else is going on. That's competing for their needs to be in hospital so thinking about some of the groups mentioned mentioned in that study for example. Let's take people in their thirties and forties who have higher rates of ama discharges than other age groups. It makes sense. These are ages where people people are very likely to have important obligations to others in their lives children a parent a partner so they choose to prioritize these obligations over the hospitalization similarly unfair stigmatization or biopsies are applied to people admitted for reasons relating to mental health or substance use. Sometimes these patients have faced difficult interactions with clinicians in the past. This is all really important context when we consider why someone may then be more likely to decide to to leave the hospital early okay so we've got a pretty clear sense of why these statistics are important to talk about about understanding which patients leave a._m._a. Helps us understand why they leave a._m._a. And hopefully down the line that'll help us find ways to address the needs of these more vulnerable populations but there's a whole other category that i wanna make sure we touch on. It's not just patient specific factors that are causing ama discharges charges. We work within a complex healthcare system. Were starting to gather more information about that. But what we're finding is urban hospitals hospitals that are non teaching hospitals. Those tend to have more ama discharges which is an important point when you think about that it's not simply related just to patient factors actors but there are other what we call sort of non patient health system provider factors that may contribute to the amy district so we as clinicians have a large role on us to that's important information to consider right <hes> is it the <hes> the gender of the healthcare provider the age of the healthcare provider the number number of years out of practice this specialty of i mean there's a lot of things that may be again just associated with it but those are important questions to ask <hes> because if there are related to healthcare providers then that's where we intervene right we talked about the patient related factors that are associated but what if there are healthcare provider factors that are associated because those would be important to find out about and intervene to try and mitigate the adverse outcomes. These factors are really interesting to consider and again again. It's a topic that we don't think about quite as often. There's a bit of a gap in the literature here but there are a few small qualitative studies on the topic. One of these studies was back in twenty ten. The authors reached out to patients who had left the hospital ama and talked with them about the reasons for leaving for some patients. It was a breakdown in communication which has absolutely happened with some of the patients that i have taken care of the intern tells the patient one thing and the consultant comes by and says something else and then by the time the attending rounds the whole plan has changed again other patients felt dissatisfied with doctor's bedside manner or felt their pain was being under treated or they felt stigmatized because they had a history of drug use again. All all of these reasons really resonate with my experience a study in two thousand sixteen that dr l. fundraise was a part of also found that patients often wanted to leave a._m._a. Because they disagreed with the discharge plan they didn't want to be discharged to a skilled nursing facility for example other patients left a._m._a. Because they were frustrated by certain aspects of their medical care like being kept n. p. o. for procedure or being kept in contact or an isolation room margot all all these situations. You're describing sounds super familiar to me as well and i guess this highlights another reason why it's so important to communicate clearly with our patients <unk> additional. That's a silly thing to say. I mean we all try to be clear but it's interesting to think of this as a kind of small possible intervention for making amy discharges just a bit less than easy it of course won't come close to solving every difficulty but for some patients. Maybe if i push myself to be more clear or more explicit said about why i'm doing what i'm doing the medical plan. Maybe i can prevent even just a few misunderstandings that would have led to premature discharges. Yeah absolutely absolutely and you know with that in mind we need to figure out how to move forward towards a good or at least better way to have these conversations with patients in these these situations. I feel like we have to start by admitting that we can be exceptionally frustrating when a patient insists on leaving a._m._a. Remember there's the socially sanctioned role of a physician is to provide care for patients. You know regardless right so you know ama discharges sort of push up against that there. It's it's not uncommon <hes> to find practitioners frustrated sometimes even angry with patients that choose to leave the hospital over the recommendation of the providers. How else do you think about this. I mean i think most of the time patients just want to be heard. They want to have a conversation with their healthcare provider. They want to have their concerns answer. Their needs addressed <hes> and sometimes sometimes that's the only way for them to have that conversation is to is to assert that they're leaving the hospital so it's it can be inconvenient. The often say that it's an opportunity often when i say that how my trainees often sorta roll their eyes and say oh great another opportunity to have a conversation versions about ama discharges but that's really what it is right the patient in the only way they know how is trying to say. I have something really important that i need to do or i have something really important to tell my healthcare provider and this is how i'm saying so one sort of cognitive restructuring is to think about when a patient is asking to leave a._m._a. It's an opportunity to better connect with the patient about their their needs. What's important to them and often to convince them to stay because that's often the case. That's a really helpful a way of thinking about it here. We've got a conflict but conflict ends up being away for both sides to talk about what really matters to them. It ends up being away for both sides to understand understand each other better and hopefully improve care. I really enjoy these conversations. I i truly see them. As opportunities. I really find the ability to work with patients nations who were frustrated and concerned and wishing to decline recommended care i find those interesting clinical challenges and i hope i can convince other physicians nations that if they see it that way as well. They may be just like interesting e._k._g. Or an interesting chest x-ray easier to sort of engage with the process. So where do we start these conversations really it comes down to having that shared decision making conversation with the patient and that means finding <music> out what's important to them what their competing priorities are what else they're concerned about in their life and that means quite honestly just empathizing with the position that they're in <hes>. It's not easy to understand necessarily <hes> the financial and social and emotional pressures that some patients are undergoing <hes> but that's really what this process requires <hes>. It's about sitting down with the patient and finding out what is of concern. It's interfering with their ability to make decisions that we're going to promote their health. If the beginning medical student they'll say yeah. I understand amy. Discharges patients have the right to make bad decisions and i'll say well. That's not quite how how i would describe that they the competent patients have the right to decline recommended treatment and sometimes that means not promoting their health but it's not bad <hes> necessarily early because it's meeting some other need that they have and the more open you are non-judgmental to what those needs might be for swale the more likely you already hear it from the patient. The more likely they are to trust you and be able to confide in you about what those concerns are and then the more likely you are able to identify the resources that are directed towards meeting those needs you know the way he describes it sounds wonderful but i feel like it so much easier said than done if you go in and you're angry and frustrated and overworked at least the last two variables probably accurately described most night floats right. They're getting day j- you know every couple of minutes. They're running around the caring for a lot of patients <hes> and it's easy to feel overwhelmed in those situations so it's hard to to have these conversations and and <hes> take the time to make sure that they're getting the information they need from patients but often a short amount of time invested at the beginning. We'll save save a lot of time later on in the course of the patient's care a by developing that relationship creating treatment alliance <hes> developing trust <hes> <hes> getting good information from the patient so that you can <hes> develop a care plan actually meets their needs the one interesting study from oh probably thirty or forty years ago showed that the more likely clinicians word establish expectations early in the hospitalization the lower the likelihood of ama. You may discharge so this totally gets back into what we were talking about earlier at the critical role of communication of being connected and transparent with our patients but honestly i know that when i get busier frustrated and being an intern on nightfall was the perfect example of that when i'm frustrated and busy all one of them to say is i know i can die and then signed on my piece of paper so it can move on to my next planner crisis of the night when i come on service and go over very clearly that really our primary ethical and legal obligation is to ensure ensure that the patient is making informed refusal of care right or there's an informed consent discussion about the patient choosing decline recommended treatment and and that's all they need to do once they do that then they need to document that process within the record but as soon as i tell house officers that uniformly sort of their shoulders relax a little bit and they nod in agreement and they say oh okay that's really easy. I say you don't need to have them. Fill out the discharge discharge warm as a matter of fact. That's probably just going to antagonize the patient. It's extra work for you. It's never been shown to actually promote higher. Quality risk communication and often patients feel like the process is more stigmatized when there's an ama discharge form so there's another holdover from a more paternalistic era but we see it in lots of different different health systems and that's so important to remember. It's really not about the form at all. It's not some golden document that keeps me out of jail. You just do your best. You know you have a real talk skin documented somewhere. Let's take a second here to talk about the form because i know at least for me. That piece of paper feels like the symbol of an ama discharge doctor off andre outlines our ethical obligations to the patient which is a thorough an empathetic informed mm consent discussion the a._m._a. Form on the other hand addresses the legal aspects of the case. It's essentially an attempt to make sure the discussion includes the the information that the clinician would need to protect themselves legally if the case should ever go to court. Amy forms are different in every hospital but generally involve off three parts. The first part says that the patient has demonstrated capacity to leave a._m._a. The second part records the key pieces of the informed informed consent discussion which is what dr dre has been walking us through the clinician needs to communicate her concerns the intended workup and potential treatments and all of the potential risks six of leaving and the patient needs to understand what was explained the third part of an a._m._a. Is that discussion is documented in the chart which which for many people means the a._m._a. Form itself but dr off andre is discussing the alternative which is documenting in the our this form can be helpful a study of emergency room physicians found that introducing an ama form improved quality of physician documentation of ama discharges but the a form isn't a get out of jail free card. It can't replace the conversation. There was a lawsuit about this nineteen ninety one called battlefield versus gregory in which a patient sued to doctors for delay in the treatment of a ruptured appendix. Essentially the patient had just given birth and had a fever elevated heart rate and high white blood cell count concerning for an infection but she wanted to return home to be with her family. She was advised that while all the doctors recommended staying until she invest she could go home. If she signed an ama form. The jury argued against the doctors involved saying that the first doctors hadn't really explained the risks that the patient was taking by leaving early. The form wasn't enough at the end of the day both ethically and legally the conversation precision is key as for whether you document that with an ama form or a note in the patient's chart check with your local hospitals policy and so again like so many other parts of the treatment plan. It's all about the conversation chair decision making still still when a patient leaves the hospital a wide is it often feel uncomfortable or difficult. I think the concept of harm reduction is sometimes challenging challenging to accept. I hear from a lot of providers well if i don't discharged patient ama they're not getting the right message. They're getting the message that it's okay to to use drugs or it's okay to forgo their health. <hes> and that's not really the primary philosophy behind harm reduction patients it can get really frustrated in the hospital but when you sort of think about the arc of their provision of care <hes> the goal is to keep them engaged with the healthcare system and so if they choose to leave the hospital now that doesn't mean that they won't come back sooner answer your goal is to give them as best care that you can and care that they're willing to accept talk. This is really helpful to hear it makes me think of when i come up with what feels like the perfect discharge plan. Medically you know this patient. She's going to finish her i._v. V antibiotics and then leave the hospital on tuesday to a skilled nursing facility but if that plan doesn't work in her life then i was misunderstanding what would be perfect instead. I need to find some sort of compromise between what the patient needs medically and what actually fits with her motivations and priorities so it's not a failure. Oh you're a breakdown. It's helping someone get to a goal that works for them. We don't have to throw the baby out with the bathwater on this. You know just keep them. Engaged in this person has a chance to pick up where they left off on that hospitalization will next time and you know to that end just because someone is leaving a._m._a. Doesn't mean we should forego making some kind of discharge plan for them for example. We may want them to stay on i._v. Antibiotics for four weeks but if they're not willing to do that we're obligated to find some kind of oral regimen that can help treat their condition even if we don't think it's ideal and give them follow appointments with primary care infectious disease specialists just because they're not conforming to the best medical evidence doesn't mean that we turn turn our backs on them and to the extent that we do that. We should be careful to look at how we might actually be trying to punish that patient for not agreeing with their plans of course course we always need to think about safety of compromise discharge plans for instance. I wouldn't be willing to give benzoate perpetuates to someone leaving a._m._a. During alcohol withdrawal just given the risks of combining substance abuse with continued drinking but it's still our ethical obligation to try and offer what we can where we can one of the the most dangerous pitfalls is when we let ama designations itself get in the way of this and use it as an easy. Excuse not working with that patient to find other solutions. General premise of the argument is is that we're finding that amy discharges don't haven't been demonstrated to advance a patient's care in any in <hes> and in any evidence based way and we know that there's evidence of stigmatization and reduced access to care for these patients so from an ethics ethics perspective. There's really minimal benefit or no identified benefit and there's emerging evidence of harm so these situations don't need to put a stop dr trying to to provide the best possible care. It's just redefining it and asking what's the next best way to take care of this patient now right and that also leads us just to addressing an important myth about ama discharges. I've heard this and i know my colleagues have as well. Is it true that if a patient leaves ama his insurance won't cover the hospitalization can sometimes this is use the rationale for convincing someone to remain in patient we dug into the data on this and there's a great study from twenty twelve that combed through the records of over forty six thousand admissions about one percent of those admissions ended in an ama discharge and when they looked through those records they found a total title of about four hundred fifty three patients who left a._m._a. Who had some form of health insurance while some of the claims ended up being rejected for administrative reasons such as submitting the bill too late not a single one was rejected because the patient left a._m._a. While i've been lying to people about this for a long time time and to be honest. I've tried to leverage to keep people in the hospital. I almost want to be true but that's just me trying to financially bully the patient into doing what i i want them to do with their hospitalization but that's you know that's a really helpful for us to debunk because i think he gets thrown around a lot so i i really look forward or sounding smart. The next time this comes up. We're very thankful to dr j. for taking us through trying to reframe discharges charges against medical advice as opportunities to discuss our patients competing priorities and away to focus on harm reduction and shared decision making king. We hopefully also debunked a couple of the larger myths that loom over in the discharges with that will turn it back to dr l. j. force and take home points on the strategies for doing all this effectively. Hopefully i can provide sort of a general framework to think about the problem again. Given some of the values values that we've talked about a promoting shared decision making and harm reducing alternative sell <hes> like you said the first thing i divide them up into behavioral and in cognitive strategies the first thing is from a behavioral standpoint is involve others right and that means the patients family the patient's friends the patient's healthcare provider the patient's primary care doctor involve other people who the patient knows and trusts because if this is the first time you're meeting the patient. They're unlikely to trust you you or necessarily want to agree with what you're saying. The second thing is to maximize the amount of decisions. The patient can control. I had an interesting conversation with a psychiatrist about this and he talked talked about making the unconscious. No conscious so patients may be just saying no because i want out of here. They haven't thought through the consequences like the case you described. They haven't thought through all the tournaments. They're just like. I'm done with being here. I've spent x. Number of nights not sleeping getting woken up every couple of hours that person in my room screaming. I'm uncomfortable right. They're not necessarily thinking through all the risks associated with leaving. They're just thinking i'll be more comfortable at home and so you want to slow down that process but also help help the patient control whatever they can within the hospital environment so sometimes when you go to the bedside and the patient says i'm ready to leave. He find out what's on their mind. What their concerns are her and you find out that they don't wanna get their vitals. Check did two in the morning so you you give them that. Opportunity control that about their healthcare environments he maximize anything you can about the patients experience in the hospital the third i think we talked about his empathizing and that requires practice so as you're walking into the room yes so you're getting you have four pages backed up and now you're running to the bedside to talk to this patient. Remind yourself all right. I'm not gonna argue. The patient patients wanna be heard right. They don't necessarily want. We'll be right if you remind yourself and i'm going to empathize with this patient. I'm not gonna argue. You'll often find out what's going on with the patient what the patients concerned about. It'll also calm you down down a little bit. You won't feel as activated and <hes> antagonistic <hes> so that's that's third point. The last one is as we said before rely on untrusted legal advice so if you don't know ask your tending hey what what's what are my legal obligations here once you know what those are it's easier to relax. It's easier to focus focus on the care of the patient and then the cognitive strategies. I is conflict as opportunity which we talked about. Seeing patients desire to leave a._m._a. Is an opportunity to you. Have a conversation about what's important to the patient. What's on the patient's mind. What's concerning to the patient right. I mean much of the work of interacting and and aligning with patients is finding out what's important to them and sometimes that's how <hes> that's how they tell us. They tell us that they're ready to leave so see that again as an opportunity he rather than as a challenge cheer authority. The second is understanding and accepting patients with substitutes disorder. I bring that up specifically because so many more patients with substance use disorders are likely to leave against medical by south and we're training you have more comfort you have in caring for patients like this the easier it is for you to get to to provide high quality care and focus on their needs and then the last part is decide for yourself whether or not you want to discharge the patient ama. That's a choice <music> that i leave to the individual healthcare provider. I'm not here to say you should never discharge a patient ama. I'm simply saying think about whether or not it's going to advance the patient's care you're thinking about the harms associated with the designation again this isn't this is about the designation of discharge both in the record and discussing with the patient. I always tell trainees and other physicians. This isn't about not recommending that the patient remain hospitalized. This is about letting them know their their options letting them know the risks the benefits and if so recommending that they stay in the hospital because that would promote their health but taking it that next step farther and formalising the decision documenting into the record using a discharge form those have never been shown to advance patient care so think consider for yourself like other or high value care decisions is what i'm doing actually advancing the patient's care or is it actually harming the patient potentially. Those are the main strategies at big. Thank you to who dr off andrei for those taken points we have covered a lot in this episode are ethical and legal obligations to our patients some strategies for meeting them halfway and a framework for structuring a conversation that can help mitigate some of the conflicts that often come up when a patient has one foot out the door. We're planning an episode to explore an issue that many of us find challenging the capacity assessment. It is such a nuance topic that it really needed a whole episode to itself itself so stay tuned. We also wanted to acknowledge that. Even in the best of circumstances ama discussions don't always go according to plan. We think that the framework outlined in this episode is really helpful and has the potential to improve the therapeutic relationship for the safety of an a discharge or even convince a patient to stay but sometimes in the face of it all. You're gonna strike out while i was researching and recording this episode on how to have a good ama conversation i ahead several patients leave and that was pretty humbling so clinical medicine can be challenging wonderful in all of these. It's kind of difficult ways and at the end of the day just keep on trying your best. Thanks to everyone for tuning in we know these topics more questions than answers and we look forward to hearing more about your experiences and reflections on ama discharges. Please continue the conversation with us online at our facebook facebook page on twitter or email directly find show notes and contact information for us on our website. I am podcast dot com slash contact. If you enjoyed listening to our show give review on itunes or whichever podcast app to use it helps other people find us. We work really hard on these podcasts. We'd love to hear from you. Let us know what we're doing right and how we can improve and as always u._p._s. Expressed in this podcast our own do not represent the opinions of any affiliated institutions solutions finally special thanks to all our collaborators in this episode are wonderful editor. Julius q._b.'s are illustrator. Michael shannon are music composers gave external peter ken doll of hickory collective and less technical support from horita most importantly thanks to you our listeners now.
Thursday, January 7th, 2021
"Good morning sagittarius. Today is thursday january. Seven two thousand and twenty one. The moon enter scorpio inviting us to go inward and recalibrate with the new year comes new opportunities and ways of being but there may be some old emotional patterns we still must confront this is sagittarius today. A spotify original from podcast. If you're feeling anxious depressed or overwhelmed better help offer licensed online counselors who are trained to listen and help connect with your counselor through secure video phone chat or text. Join the one million. Plus people getting help with better help and horoscope today. Listeners get ten percent off your first month at better help dot com slash horoscope today. That's better h e l p dot com slash horoscope today Let's begin your day. Lunar energy in your house of the unconscious underscores emotional matters. You're only just now confronting a sense of renewal may be lingering. Try not to get overwhelmed by the desire for newness changes rooted and what we're already dealing with now. Take a moment to reflect on your relationships mars and torres as you yearning to improve the way you relate to others. Are you doing mental acrobatics. To make a romantic fling worth your while. If so reconsider. Contemplate the work you do and your career. The moon squares jupiter and saturn making productivity complicated. Ama also find that those around you are equally distracted go with the flow and get as much done as you can sagittarius. Today is daily. Podcast follow on spotify to make it part of your morning routine if you're in learning more about your sign. Download the sanctuary app from the apple app and google play stores. Get your astrology. Tarot or psychic readings today and follow sanctuary world on instagram. that's s. anc t. u. a. r. y. w. r. l. horoscope. Today is a spotify original from podcast.
#89 - AMA #11: All things fasting
"Hey everyone welcome to a sneak. Peek asked me anything or AMA episode of the drive podcast. I'm your host Peter at at the end of this short episode. I'll explain and how you can access the Ama episodes full along with a ton of other membership benefits. We've created or you can learn more now by going to Peter Tia. MD DOT COM forward slash slash. Subscribe so without further delay. Here's Today's sneak peek of the. Ask Me Anything episode. Welcome to a special AMA episode focusing on my recent seven day fast. In addition to a deep dive on fasting. In general as this is a topic we get so many questions Russians on we figured dedicating an entire. Ama to it would be a value so we hope you enjoy. I'm once again. Joined by my head of research. Bob Kaplan so without further delay. Here's Today's special. Ama focusing on fast low and welcome to A.. We've fasting edition of ask. Peter Anything Peter how you doing doing all right. And this is Bob Kaplan. So let's just jump right into the questions around fasting. You obviously get a lot of questions on fasting and I thought before we get into fasting. Maybe you could discuss what what. Fasting is a definition of fasting. So we get a lot of questions around what is I F. What is T. R. F. What is ADF? What's a fasting mimicking diet and what is prolonged fasting? Even what's an overnight fast so I can remind you of all those okay. Why don't you give them to me one at a time? Okay so I think maybe the first one is overnight fast when somebody refers to an overnight fast. What does that so that as its name suggests is sort of a standard fast that almost by definition finish? Everybody does between dinner and breakfast. So if you finished dinner at seven o'clock in the evening rather than you had breakfast at seven o'clock the next morning you would have you've just undergone a twelve hour overnight fast. Okay and T R F time restricted feeding. Some people call T. R. E. Time restricted eating. That is is an idea where you increase that window from just an overnight fast into a slightly longer window so if the overnight fast I used a moment ago were to be put into time restricted feeding nomenclature. You would call it a twelve twelve. You've meaning twelve hours of fasting followed by twelve hour window sale seven. Am to seven PM. In which one would eat you can extend that and you could say a fourteen ten window or a sixteen eight window or an eighteen six window. Where the first number generally refers to the period of time that has is no nutrient exposure and then followed by the window and time in which one would be able to consume food? Typically ad Lib Dem meaning without restriction. Okay Okay so rolling into the next one. Alternate Day fasting so again as the name suggests alternate day. Fasting is when every other day a person does something other than their traditional ad. libbed him eating now. The most strict way that one could do an alternate day fast which would be quite difficult to do over the long haul would be to literally consumed nothing every other day more commonly when people do alternate day fasting. They have a hypo caloric orrick day so they might alternate days consume. Say a thousand calories and on the Non Fasting Day they would consume whatever they consume ad Lib. Yeah that might be say twenty five hundred three thousand calories so that your somewhat of a stickler on the definition so in that case it's almost like alternate day calorie restriction on the opposite day. One Way to think about that actually a couple of days that I think about it. As if you're looking at a calendar for a strict alternate day fast. If you're going to start in January January one let's say you're going to eat in January second. You'RE GONNA fast. You can mark off every even day of that month and you know that you're fasting passing on that day. And then on the the alternate days you're eating and I sometimes think about it in terms of when you talked about Kiara for time restricted feeding time restricted. Eating you think about it in the context of a twenty four hour clock with alternate day fasting. It's almost like a forty eight hour clock on the alternate days. I think it can. Actually it can vary quite a bit on your. You're feeding days that you might do a one meal a day which would be like a almost like a forty seven one. That's right one hour of the day you're feeding and in the forty seven hours. You're not. I don't suspect that people are eating between midnight and eleven fifty nine on the feeding days. There's probably a a bigger window than just twenty four hours when you think of an alternate day fast. Next definition is intermittent fasting so this is a term that unfortunately has gained a lot of popularity. I guess I say unfortunately because I don't find find it to be that helpful. I think what people generally mean when they say. Intermittent fasting is time restricted feeding and in the end. Who cares what people say? It's long as they know what they're talking talking about it and know what they're referring to but I personally don't find the term intermittent fasting to be very accurate because I don't think that not eating for sixteen Hours really constitutes a fast per se. And that's why I do prefer the terminology time restricted feeding or time restricted eating to describe the the extension of the overnight fast. I think if you were going to give a true meaning to the word intermittent fasting. You would describe. I bet sort of the way I describe periodic fasting which is at some frequency. You actually undergo fast and that might mean every month or every quarter or every six months or every year you undergo a fast. That is intermittent and again that gets into probably another one of the definitions. You'RE GONNA ask about which is what does fasting mean. Does fasting necessitate a complete elimination of calories or could it also be done through reduced used calories. Maybe one other bucket popular diet as the five to fast which is instead of looking at a twenty four hour window or a forty eight hour window. You're you're looking at the calendar week and you're selecting a couple of days where it's actually. I think it's calorie restricted. Like you said with the alternate day fasting so in two days so eating five days out of the the seven day week. You're eating normally today's out of the seven day week. I'm not sure if you can pick them whatever days you WanNa pick him the usual version. That protocol is that they are not successive but otherwise is it's sort of up to you. Okay yeah in that case it'll be typically hypo caloric four hundred to six hundred calories. I think on your quote unquote fasting days. Yep fasting mimicking. What does mimicking fasting? Well I think of term fast mimicking diet or fasting mimicking Diet F. M.. Mm D is actually a trademark that belongs to a company that sells a product. That is a prepackaged five day. A fast I believe the company is called L. New Terra minutes based on the work of a guy by the name of Valter Longo and it has a very clear clear prescription around its macronutrients. And it's total caloric balance so in other words to be very clear. The term fast mimicking being diet is to that what the term Kleenex is to the actual tissue. That is branded Kleenex. So there are an infinite number of tissues that you can blow your nose into. There's only one Kleenex. There are an infinite number of ways that one can do a reduced calorie fast. I that approximates some of the metabolic benefits of fasting but there is only one fast mimicking diet or FMD for what it's worth. That's approximately awesome at least nine hundred to one thousand calories on the first day and I believe it's approximately seven hundred to seven hundred fifty calories for days two through do five but I could be off a little bit on that okay and then last but not least prolonged fasting or multiple day fasting so so again if we're now talking about absolute fasting as opposed to reduced calorie fasting of which fast mimicking diets are a subset so again a reduced calorie fast would be typically from a clinical perspective using our patients as an example. We do anywhere from three to seven days. Typically at about five hundred to seven hundred calories a day we also have very different macro that we prescribe than some of the commercial applications nations. But again we call that a reduced calorie fast. So then what you're talking about of course says it's the simplest way to explain. Actually it's just water only and I say water also so includes tea and some minerals. But it's no calories for a period of time and again it's typically done for three to seven days at a time. I can't believe I'm GonNa give you the one about S- so what about coffee coffee and tea and water or just water. Is there a difference. There probably is but again. It probably isn't as much which of an issue as people want to make it out to be when we have patients who are quite caffeine dependent. We don't like to see them eliminate caffeine during a fast because fast and can be challenging enough on its own and I don't really think it benefits someone to also go through caffeine withdrawal during that period of fasting. So I'm sort of fortunate in this regard in that I drink coffee every day but I don't seem to have any dependency on. Its when I fast. I don't drink coffee at least for the first five days. Sometimes as a treat on days five six seven those longer fast I'll drink black coffee. Some observers have suggested that enhances Tafkaji late enough in a fast. I'm not necessarily convinced that that's the case. And truthfully I think I do it just to sort of break up the board. A black coffee has I've never tasted so good as it does on day. Five of water only fast but for most of the time. I don't consume coffee even black during a fast and again and we make a decision very clinically with patient. There are some patients in a big part of the fasting protocol is gut rest in those patients. We definitely want to avoid coffee. offi not so much for the caffeine but more for some of the other phytochemicals that are in. T- seems to be a little bit more forgiving. And obviously there's plenty of caffeine in enough F- types of tea so again. The Caffeine is probably less the issue but I do think that for most patients the sort of bread and butter no pun intended of a fast is water and that can be bubbly water stillwater. Bubbly waters a nice way to sort of mix it up and you know I have a particular brand of bubbly water that I fancy the most. So go through those at a geometric rate during my fasting weeks. Okay so obviously you alluded to the next question which is at least one of the types. So what type of fasting do. Oh you personally engage in and why so why do you fast. And what types of fast of all those fast. We just talked about T. R. F.. ATF IFM D. and the prolonged fast asked which ones are you engaging in and why thank you for listening to. Today's sneak peek. Ama episode of the drive. If you're interested in hearing the complete version of this AMA damning you'll want to become a member. We created the membership program to bring you more. Indepth exclusive content without relying on paid ads. Membership benefits are many and beyond the complete episodes of the AMA each month. They include the following ridiculously comprehensive. PODCAST show notes that detail every topic pay per person and thing we discuss on each episode of the drive access to our private podcast feed the quality which are Super Short. podcast typically less than five minutes. Mets released every Tuesday through Friday which highlight the best questions topics and tactics discussed on previous episodes of the drive. This particularly important for those of you haven't heard all of the back. Episodes becomes a great way to go back and filter and decide which ones you wanNA listen to in detail really steep discount codes for products. I A US and believe in book for which I don't get paid to endorse and benefits that we continue to add over time if you WANNA learn more and access these member only benefits head over to repeater at MD dot com forward slash subscribe. Lastly if you're already a member but you're hearing this means you haven't downloaded are member. Only podcast feed. Were you can get the full access to the AMA and you'll have to listen to this. You can download that Peter Attiyah. MD DOT COM forward slash members. You can find me on twitter. Instagram facebook all with the. Id Peter Attiyah md.. You can also leave us a review on apple podcasts. Or whatever podcast player you listen on. This podcast is general. Informational purposes only does not constitute the practice of medicine nursing or other professional healthcare services including the giving giving of medical advice. No doctor patient relationship is formed. The use of this information and the materials linked to this podcast is at the user's own risk. The content on this podcast is not intended to be a substitute for professional medical advice. Diagnosis or treatment users should not disregard or delay in obtaining medical advice from any medical condition they have and they should seek the assistance of their healthcare professionals for any such conditions finally take take conflicts of interest very seriously for all of my disclosures in the companies. I invest in or advise. Please visit Peter. MD DOT COM forward slash. About where I keep an up to date an active list of such companies yeah yeah.
#108 - AMA #13: 3-day fasting, exogenous ketones, autophagy, and exercise for longevity
"Lou everyone welcome to a sneak. Peek asked me anything or AMA episode of the drive podcast. I'm your host Peter. At at the end of this short episode. I'll explain how you can access the Ama full along with a ton of other membership benefits we've created or you can learn more now by going to Peter. Md DOT COM FORWARD SLASH. Subscribe so without further delay. Here's Today's sneak peek of the. Ask Me Anything episode. Welcome to another edition of. Ask Me Anything Ama episode thirteen. I'm joined again today by my head of research. Bob Kaplan in this episode we talk about a bunch of things it was supposed to be rapid fire but we on the first question got so far off the rails and I think it literally took half the time but it was basically a question about seven. Davis is three day. Water fasts and that evolved or devolved depending on how you think of it into all things related to fasting how you cope with them all the things that you would measure. What's happening physiologically? The use of exotic kitone CETERA. We- then pivoted off to some other topics such as favourite resources that I have for staying to date on information as it relates to medicine health longevity. We talked a little bit about exercise and specifically how one might craft an exercise program around longevity. I hope you enjoy this episode of Ama Thirteen. Everyone welcome to another. Ask Me Anything. Ama with Peter. Attiyah Peter how you doing doing well Bob. How are you living the dream ready to ask you some questions? I'm nervous man. You got that look in your eye. That says you've got questions to make fooling me or something while we're just GonNa do a rapid fire and see which ones stick. Okay rapid fire meeting. You're going to be on the Stop. Watch or yeah. We could do a two minute drill if you want. And then we'll just go over if we need to defeats the purpose. Okay go for it all right first question any early observations from your new three day per month fasting regimen. So I guess for folks who may be aren't familiar. I'll give a bit of background for a great deal of time. I would do a seven day fast. Once a quarter and around Thanksgiving last year I decided to try something different. Which was more frequent fasts that were shorter and so being completely arbitrary. I was like well if I was fasting. Seven days every quarter three days a month is almost the same in terms of total aggregate. Fast time by Bob. This is not going to be a two minute. Answer just FYI. So I decided will what if I could do three days a month and I think part of the rationale was twofold one. The seven day fasts are quite intrusive just in life in general. I've done enough for them. That I can pretty much sail through them but it's seven days of not eating not drinking and I just thought well. Every time I do one of those I noticed that Bhai about the second day of the fast. My glucose levels really start to normalize as in low levels of glucose. Mikey tone levels. Really start to rise. I started to suspect that maybe around day to day three is when some really interesting metabolic stuff is going on and basically figured well. What if we just did a slightly less extreme version where we got some of the benefit that we got from the seven day fast but maybe not all of it but revisited that more quickly so anyway. That was the rationale for it. So actually by total coincidence. I'm on day one of this month's fast and we're recording this UN. What is it March? Second today so this is the march fast. And when was your last meal? My last meal was Sunday evening so I will break the fast Wednesday evening so now having done one. Two three four five of these shorter fasts. They're definitely easier and that's saying even though the longer fasts you get more and more used to them. You have periods during those longer fasts. Where you're at least for me. I'm just sort of dragging I'm kinda wearing. I'm just not my normal self for the three day. Fast sites seemed to skate through them a little bit easier. That's one thing I think the other thing is my exercise. Tolerance seems higher because obviously I'm not subjected to the same degree of glycogen depletion so today for example not the. Today's workout counts because it was the first day after having a dinner so this doesn't really fasted workout but I suspect I could do the type of work that I did today. Which was two hours and superintendents lots of sled work? Lots of dead lifts lots of compound movements. I could do that easily through a three day. Whereas in the longer fast I still try to do those activities each day but I really have to reduce the volume and I just find that during three thousand. Nothing really seems to happen. I will say this Bob. I have not done a lab test on myself at the end of a three day. So that's kind of an important thing I still need to do is do a blood test. I have done a blood test on myself after a four-day fast and I was very surprised to see it looked almost identical to the stuff you and I discussed at the end of a seven or eight day fast and again to reiterate for folks what that was insulin. Of course. Basically UNMEASURABLE glucose has very low triglycerides. Not that low again. Because you're probably you've got so much flocks of triglycerides to free fatty acid going through that. That's basically you're substrate for making all those key tones so not like my triglycerides were high. But they were about the same as they are. When I'm fed uric acid very high free. T three very low reversed. He three very high testosterone. Very low those are sort of signature findings. I see after a long fast. Oh I G F also very low and again. After a four day fast. They looked almost the same so I really do. Need to get around to doing a three day post lab. Maybe I'll do it this time. Now look at my schedule and see if it makes sense but that would be kind of an interesting thing so kind of a long answer to a simple question and I hope that suffices the seven day fast that you were doing before you were doing nothing burger or the KPFK. So you're doing a week of Akita. Genyk diet going into the fasten a week coming out. Are you doing anything different or similar with the three day fast since January so for the last two months I have not been on a full Ketogenic Diet? But I've been much more low carb than I normally have been at least for the previous four five years so. I'm not doing a very strict. Kito but I'm really not eating any sugar. I'm not eating the hardly any starch. The only carbs. I'm eating or sort of vegetables and my one. Little Vice is fiber one cereal with twenty seven pounds of fiber in it. Which is it's amazing. How it does not spike my blood sugar and I mix it in with like some cashew milk and some yogurt but that's probably sufficient to exclude me for making too many key tones but just sort of a slightly more strict dietary restriction. Probably makes it also easier for me to slip in and out of this fast see started last night? Sunday night to get glucose in PHP on Monday morning. And what does that look like? And maybe relative to what you're doing when you're full Kito not half Kito right. I didn't today. I'll probably do my first check tonight. I would expect key turns tonight to be in the neighborhood of point. Five to one and you may recall. I use these two devices. One of them seems I think a little bit more accurate at lower levels which is the precision Xtra. The Kito Mojo seems to run very high low levels. I'm also GONNA be testing out a new breath device for measuring acetone. I don't think it's commercially available yet. But Dom Dagestani know who many listeners will recall having been on the podcast and I might add. We're going to have dom back on to do a follow up because there's been so many great questions for Dom who is one of the most knowledgeable people on this topic but anyway I'll be testing a breath. Acetone device that I think is still sort of in the research phase and looking to see if there's any correlation between that and be. Hp historically the answer is no historically breath. Acetone testing is not very well. Correlated with blood testing so for that test. I've got a breathalyzer here at home. I think it's called a key tonics and it basically it's acetone and I think it gives you red yellow and green and green means. You're in. Let's say it's probably like the peace drips of the urine strips. It's not giving me an output of a number it's just basically saying you're in deep ketosis urine moderate or probably undetectable. Does this new device. Have anything that's a little more accurate than the stoplight. Or the traffic light. It's sitting in the box. And one of the people who works with me in the practice has done all the vetting on it including talking with the company so I have to talk with her today to actually get the tutorial on it so I don't know how quantitative versus qualitative. It is but based on an email. She sent me last week after she did a pretty deep dive into it. I'm going to guess that it's actually somewhat quantitative and hopefully pretty impressive. Look for me personally. I just like checking my blood. I don't really some great advantage in in checking breath ketones but I can understand that there are advantages to at one. It's going to be a heck of a lot cheaper. Because when you're checking in the blood those strips really do get expensive and to there are people who don't like to poke their fingers so it's probably more accessible so and we shouldn't lose sight of what the purpose of this type of testing is which I think is easy to do. It's basically there is a guidepost and I think frankly it's more helpful during f.a.s.t. When someone is trying to go through nutritional says than it is during fasting during fasting. It's just kind of a way to fight a little bit and look. I'm as guilty as the next person. 'cause I'm always checking my key tones three times a day when I'm fasting but I truthfully don't know that that's that relevant. There's nothing I can do about it per se. I will say this one interesting observation that I learned in fast. Maybe two years ago was I decided to experiment and consume Diet Steph Diet Cokes and Trident sugarless gum and stuff like that. So I wasn't adding any calories to the fast and it could be true true and unrelated but I'll tell you I never forgot the lesson which was I've never had lower key tones and I've never felt more miserable during fast and that by the way can be sort of the power of suggestion. I think sometimes when you're ketones are low you think you feel crappy. Maybe you don't but the numbers clearly were low that is not subject to a placebo effect whether I felt good or bad might be but that was a sort of an interesting lesson that came from checking those key tone levels during the fast was I realized. Hey there's something about these non nutritive sweeteners that might be impairing Ketosis or at least impairing some aspect of the fast that is increasing kitone production so for people who are trying to get into nutritional ketosis. I think these devices are probably helpful and who knows I mean? I think we're probably within the next few years we'll see continuous kitone meters. Just as we have continuous glucose meters dethrone an insulin to meaning continuous. One Monitor. Well that's an interesting topic. Thank you for listening to today's sneak. Peek Ama episode of the drive. If you're interested in hearing the complete version of this ama you'll want to become a member. We created the membership program to bring you more in depth exclusive content without relying on paid ads. Some membership benefits are many and beyond the complete episodes of the AMA each month. They include the following ridiculously comprehensive. Podcast show notes the detail every topic pay per person and thing we discuss on each episode of the drive access to our private podcast feed the qualities which were a super short podcast. Typically less than five minutes released every Tuesday through Friday which highlight the best questions topics and tactics discussed on previous episodes of the drive. This particularly important for those of you who haven't heard all of the back episodes becomes a great way to go back and filter decide which ones you wanna listen to in detail. Really steep discount codes for products. I use and believe in book for which I don't get paid to endorse and benefits that we continue to add overtime if you WANNA learn more access. These member only benefits head over to Peter Tia. Md DOT COM forward slash? Subscribe last week. If you're already a member but you're hearing this it means you haven't downloaded member. Only podcast feed. You can get the full access to the AMA and you don't have to listen to this. You can download that Peter Attiyah. Md DOT COM forward slash members? You can find me on twitter. Instagram facebook all with the. Id Peter Attiyah md. You can also leave us a review on Apple podcast or whatever podcast player. You listen on this. Podcast is for general. Informational purposes only does not constitute the practice of medicine nursing or other professional healthcare services including the giving of medical advice. No doctor patient relationship is formed. The use of this information and materials linked to this podcast is at the user's own risk. The content on this podcast is not intended to be a substitute for professional medical advice. Diagnosis or treatment users should not disregard or delay in obtaining medical advice from any medical condition they have and they should seek the assistance of their healthcare professionals for any such conditions finally take conflicts of interest very seriously for all of my disclosures in the companies. I invest in or advise. Please visit Peter Attiyah. Md DOT COM forward slash? About where I keep an up-to-date an active list of such companies.
The Porn Reboot Podcast Episode 239: Why Your Relationship Should Have a System
"Welcome to porn reboot podcast where you get practical tips gaining control over your porn or sex addiction. We help ambitious men. And they're out of control sexual behavior with pornography sex and masturbation so that you can maximize your life perform at your potential and remain in control in the driver seat. Which is where you have to be in order to gain. Maintain the success. You want in life. I'm your host. Jk ama's he said a fight sex and porn addiction recovery coach. Welcome to the episode. Today's episode is a response to a brother who listen sit upon reboots podcast and he has a question regarding one of my podcast episodes on relationships. His question is i heard in europe. Ornery would podcast episode about systematising relationships. Or even your single life. How can you system. I something personal which you share with someone else that would mean that you were system is in her life as well right. The reason i'm responding to this is because i can understand how some brothers would see it that way like. Why would you want to make your relationship a system. Why would you want your dating life to be a system as well. Let's start with this. Everybody needs to have the dating life. Be assistant not. Everybody needs to have their relationship. Their long-term relationship their marriage not everyone needs to have a system. The vast majority of men will never have a system. They'll just wing it or a lot of men will just sometimes relationship with somebody where things just work. The truth is you may have a system. You just haven't acknowledged it. My point was that many men need a system because assist the missed something which allows you to have reliable predictable and consistent results out of everything that you do. And i'm a big proponent of systems but you don't have to just go along with it. Because i say so. The purpose of systems is to basically maximize in this case a relationship is to maximize the best aspects and minimize its worst aspects. So we'll system in your relationship maximizes the things which you value and usually men in relationship value things like intimacy. The quality of time spent together while actually both men and women growth increased self worth challenging home supporting each other's limits and so on right. Assist them also limits drama and by drama. I mean negative emotional validation right limits taking each other for granted limits feeling stifled into relationship limits arguments over boundaries and poor communication and expectations as you both grow older in your relationship and change among other things. So if you're one of those brothers who feel like oh man. Sounds like a turnoff. It sounds like i'm being predictable into like i'm you know systematising her life right then. That would imply that her entire life was your relationship and the truth is probably isn't while the as a life outside of your relationship right so your partner may or may not have systems for her life but i believe that it is your obligation as a man and the leader in the relationship to create systems which ensure both of your continued happiness. Now i do use the term partner. Sometimes when i'm speaking about relationships but i wanna make one thing clear when i use that term. It doesn't necessarily mean that every single decision is made in a fifty fifty split. I still believe that men lead relationships even if you are in a relationship with a mall dominant woman a woman who has a dominant personality right. Both of you might make certain decisions but you lead and if the relationship ends. It's still your responsibility. So i just wanted to address that real quick gentleman. In the porn reboot system we teach and breakdown different systems for casual dating for dating multiple people for long term committed marriage relationships as well. I'm jay your brother in the struggle. Thank you so much for listening to this. Episode of the porn reboot podcast. I'll speak to you later on in the week. If you found this episode helpful hero full ways. I can help you with your out of control sexual behavior for free. The first ways to grab a free copy of my book. Confessions of a porn addict. Seven secrets of born free men at elevated recovery dot. Org or visit the link in the description below this episode. The second way is if you're not sure where to start but you'd like to learn more about my team and i if you'd like to spend time with like minded professionals and business owners who are controlling behavior then join free and confidential group porn reboot group on facebook as linked to join in the description below this episode. The third way is if you need help right now because you have a burning issue yobe gave you pornography is hurting you mentally or emotionally. You're about to lose your relationship. You want to live up to your potential be an authentic man and free yourself from shame guilt and underachieving and click on the link in the description below this episode. That says free. Coaching call and a fourth way is the leave us a five star review. If you enjoy this podcast so that we can reach more men who are struggling in silence and bring back the lessons. We learn from coaching them to freedom.
92 - AMA #12: Strategies for longevity (which don't require a doctor)
"Lou Hey everyone welcome to a sneak. Peek asked me anything or AMA episode of the drive podcast. I'm your host Peter at at the end of this short episode. I'll explain and how you can access the Ama episodes full along with a ton of other membership benefits. We've created or you can learn more now by going to Peter Tia. MD DOT COM forward slash slash. Subscribe so without further delay. Here's Today's sneak peek of the. Ask Me Anything episode. Welcome to WHO. Ama Episode Number Twelve in this episode. We discuss all things related to longevity. That you don't need a doctor form. This actually came out of a discussion. I was having with Bob and nick. About how much of the stuff that I do with patients I think people could do on their own if they had sort of the right guidance. So we focused by looking at nutrition exercise physiology and sleep physiology for the most part. If you enjoy this conversation Shen were happy to have a follow up ama based on any more questions that come out of it and of course if the reception to this is positive we can certainly go into other other things that we didn't have time for in this episode which would include for example things around supplements techniques round distress tolerance things like that and once again joined in hosted right by my head of research. Bob Kaplan so without further delay here is today's Ama up Welcome to another episode. I'm Bob Kaplan and with me as full-time shepherd and part time race car driver Peter Attiyah Peter how are you doing. I'm good. I was thinking today. I've never done anything as bad as I do. Driving it is actually the worst thing thing. I do a much better everything than I am driver. That's why our full-time shepherd. In part time racecar driver. We wouldn't want to switch those. Yeah and today I just was really frustrated in the simulator later at how bad I was. It is definitely the hardest activity I've ever tried. And another life. You know a thing or two are about longevity longevity and lifespan and health span so we might get to a few questions on those and not just shepherd related topics today so despite all the questions we do get around shepherds and Racecar racecar driving which we actually do the latter. We thought great theme for Today's Ama as all things related to longevity that you don't need a doctor for with a focus on the five tactics of longevity which covers a huge range of questions that come from the listeners and to remind the listeners what those five levers are or five tactics are nutritional biochemistry exercise physiology sleep physiology distress tolerance. And -til Amir's wait sorry exogenous molecules which includes drugs hormones and supplements and maybe telomeres telomeres. So I thought we would just go down the list and start with nutritional biochemistry. We get a lot of questions around these and if we you just start with nutrition I would say that people are asking a lot of different questions. Should I eat this. Should I not eat that but I think in some ways. They're asking the same thing which is what. or how should I be eating or not eating in order to live better now and or in the long run so Peter. How do you approach this question? Maybe have a personally and what do you think is the answer to that question. Or how do you even approach that question. Well before even getting into that I would say that this is a great place to start art for the theme as you've laid it out. which is we're really going to focus today on things that one can do? That specifically does not require the help of a physician. Because I know that it's just difficult for people depending on where they are geographically or otherwise to find physicians additions. Who are thinking about the problem this way so I think there are lots of physicians who do think about the problems this way? Meaning they think long and hard about the long tail of longevity seventy and what the long arc of prevention needs to look like but I also realize that a lot of people don't happen to be in an area where they're gonna be able to find a doctor that can help them with that and so what I've been thinking about and what I will talk about today is okay imagine for a moment you absolutely have no access to medical care. You have no access to a physician who can help navigate through this. What could you do on your own and I think the good news is you can do more on your own then? You require the help of a physician for so to your question. I think of all of these tactical domains scenes. I think in some ways nutrition is the most complicated and I think it might be the most complicated because I think it has the most variable response for a given individual to a given stimulus so if the things that you put in your mouth to eat the molecules you put in your mouth to eat are the inputs or the stimuli. The responses responses can be totally variable. So you and I bob could eat the same thing at the same time under the otherwise same conditions and it produces a very different output. Put One of US might have a favourable response to that. The other one might have a lukewarm or even an unfavourable response to that and I think that's where a lot of frustration comes from. I can sense that frustration Asian in people's questions at times I feel myself I feel it in my patients. It can be infuriating when you are doing everything quote unquote right. Because you're listening to someone who sounds like they know what they're talking about. You're reading something that seems reasonable. You try to adhere to that prescription dietary prescription. And you don't get a result and you don't get the result that you were promised or you think you should get so. We think the overarching principle of nutritional biochemistry. Is You have to be malleable. You have have to be empirical and you have to assume that if it doesn't work and you've tried it correctly but that's okay and there's another approach so I don't want to harp arpanet framework because I think we've talked about quite a few times. But the framework that I find helpful is to be thinking about the three things that you can restrict picked within nutrition you can do. What's called dietary restriction which is restricting some type of macromolecules so examples of dietary very restriction? would be something quote unquote as simple as restricting sugar. Michigan carbohydrates restricting animal protein animal product. Jen Enroll fat one type of fat like polyunsaturated fat. It's basically anytime you're saying. I'm not going to eat from certain food groups or certain macro or certain subsets subsets of food. The second type of restriction is time restriction. This says. I'm going to limit the window during which I eat again. You and I have talked about this a lot written about it. Recently this gets lumped into the broader terminology of intermittent fasting. I've never liked that term arm and so I try to steer people away from the term intermittent fasting towards time restricted feeding or time restricted eating. But I think this is an idea. A lot of people are familiar with so sixteen. Eight as an example means a sixteen hour window when you are not eating anything or being exposed to nutrients other than water tea and then an eight hour window in which you're consuming food and that number tends to shrink as you become more extreme so sixteen eight is less extreme than eighteen. Six which is less extreme than twenty one three as you open the non feeding window enclosed the feeding window the third and final lever. That I you think of in nutrition is caloric restriction. This is when you actually reduce the input. Obviously these three can be combined but they don't have to be so as an example. Since my last fast now ended about two weeks ago I have been only utilizing in one of these levers I have been exclusively going down the rabbit hole of dietary restriction with absolutely no caloric restriction and absolutely no time restriction fiction. So what that translates to is. I'm pretty much eating. Whenever the Hell I want? In fact I seem to be eating constantly. The first thing that goes in my mouth five in the morning and the last thing that goes into my mouth is is like seven at night. That's like a fourteen hour window in which I'm feeding. I'm also making no effort whatsoever to restrict how much I'm eating but where I'm I'm really strict. In fact at this point maniacally strict is what I'm eating. I hate using the word clean but people would understand what that means. I'm basically completely restricting. Carbohydrates outside of vegetables. I think I had three berries the other day. But I'm pretty much having no fruit I'm having no starch whatsoever. I'm eating not a single Krumlov. My kids plates which is Kinda my New Year's resolution. I'm eating vegetables like my life. Depends on it meat. Eggs and things like that avocado nuts but otherwise quite restricted when it comes to most carbohydrates so another point point I want to make here is. I've learned over many years that that approach works very well for me when I want to lose a few pounds and a wrote what about this earlier in the year. One of my goals. Here's to lose about seven pounds. which sort of an arbitrary number? But there's actually a a reason behind that and I just know I know that dietary restriction is the lever for me the tends to result in weight loss provided it's this form of dietary restriction. I'm positive ositive that I could prescribe the same dietary intervention to another person and it would not produce the effect in fact I have many patients for whom they say. The only thing that really results results in weight loss for them is time restriction. It's making that feeding window narrower and narrower and narrower and so it's neither good nor bad one isn't right light one isn't wrong. The idea is approaching this problem through the Lens of being malleable. Enough to a know what it is. You're trying to address. Be figuring out how to measure. Is your that when possible in the case of something as trivial as weight. It's very easy to measure but for other things it's potentially impossible to measure sticking with a plan Dan long enough to assess it and being ready to abandon it. If it doesn't seem to work so I don't think I fully answered your question because I think there's a lot there but I'll pause for a moment and let you digestion. Ask More if you feel like I could shed more light on that. I think one of the things that you brought up is essentially a goal or some type of marker to look at in in terms of whether your diet is successful or not re say I WANNA lose seven pounds and I think that's a important question to ask when the original the question is what should I be eating. or how should I be eating in order to live better and that may mean a number of different things for somebody and I was thinking in that context. What are some of the tools that people can use to help? Guide them in answering this question for themselves. I mean I often think of like a continuous Glucose Monitor. But that might be where you're crossing that line between whether you need a doctor or not or on the flip side. Sometimes I think in medicine. We look at randomized controlled trials and wonder whether something was efficacious or not. But when you think about it in the clinic I think an important question to ask the patient or ask another doctor about the patient as well. How does the patient feel so? I think in terms of a diet. Maybe somebody just wants to feel better feel like they have more energy. Feel less lethargic or it is losing weight or lowering glucose for something like that. So how can people keep track of that. Thank you for listening. Today's sneak peek. Ama episode of the drive. If you're interested in hearing the complete version Asian of this ama you'll want to become a member. We created the membership program to bring you more. Indepth exclusive content without relying on pay. Dad's membership benefits are many and beyond the complete episodes of the AMA each month. They include the following ridiculously comprehensive. PODCAST show notes that detail every topic. The paper person and thing we discuss on each episode of the drive access to our private podcast feed the qualities which were super short. podcast typically less. Some five minutes released every Tuesday through Friday which highlight the best questions topics and tactics discussed on previous episodes of the drive is particularly important for those of you who haven't heard all of the back. Episodes becomes a great way to go back and filter and decide which ones you want to listen to in detail really steep discount codes for products products. I use and believe in book for which I don't get paid to endorse and benefits that we continue to add over time if you WANNA learn more access these member only benefits head head over to Peter Attiyah. MD DOT COM forward slash subscribe. Lastly if you're already a member but you're hearing this it means you haven't downloaded are member. Only podcast ask feed where you can get the full access to the AMA. And you don't have to listen to this. 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"Everybody Kevin Rose here. Welcome back episode of the Kevin. Rose show really excited do my second ask me anything. I want to say first of all. Thank you to everyone that submitted midday questions to my instagram account. I got probably. I'd say between five hundred and six hundred questions so I couldn't get them all but we highlighted a few of my favorites here and got through quite a few actually because we do a rapid fire at the end for this episode. I wanted to a couple of things. One tell you to call me up on at at Kevin Rose on instagram. And the second thing. I'm excited to do this episode with Jason De Filippo. I've known Jason for a very long time now and we were old school web two point. Oh geeks back in the day Jason. Also Edison's podcast and he's also a podcast host. If you haven't heard his show you want to check out grumpy the old geeks Jason is have you on the show man good to finally get together on a show at some like taking awhile. I know dude. We have been friends for. Do you remember we first met. We first met I think it was right before you got funded for dig because I you said something really nice on. TV about technology. And I was like employees eleven at technology and I saw you lucky cat or black cat. Black Cat yeah. In San Francisco came up and said Hi and then it turned out. We live like two blocks away from each other and the rest is history which was actually a bad thing yet. It was a bad as we end up becoming drinking but his back then and we were pretty young and foolish and consumed a lot of beer. Together we were pretty good drinking buddy. That's for sure that's right that's right. There's some good stories in there that we shall not talk about. Nobody will ever. We're here though that's right so yeah I'm excited to do this with you. Thanks for agreeing to come on and help me out with some of these questions because It'll be nice to have someone to chat with him about the last time I did one. That was Kinda weird when you do those. Ama's and you're the only person sitting in the room. So yeah it's a it's cool to to have you on the show to excellent excellent excellent. Well shall we get started. Let's do it. Do you have any advice for a recent college graduate stepping into the startup world. Yeah absolutely I mean this one is something that ad I you know. We all land in that. I kind of GIG straight out of school or in my case I dropped out of school. I think he dropped out to right. Yeah I I mean. I went what to school for photography. And just Kinda bounced into computers on my own. So I learned everything myself but Yeah you're all self taught on the on the coding side and remember that. Yep You know oh I think that in the early days. Don't think of this as like okay. I I'M GONNA work my way up in NBC's Eeo in in five years. I think it's more about doing excellent work. It's it's about making friends You know these friends will eventually you know go off to start other. Companies joined other businesses. And when you have those relationships ships that's going to open up opportunities future companies in really. I would say these first. Five years are all about networking and improving your worth and being take on any task so whatever you do do it at the highest level and don't have this attitude where well that's beneath me. I mean you really really have to get scrappy and to show that you're willing to take on anything and when you do that and and you do it successfully. You know the people in charge. If you're working on a good organization we'll start to hand you tasks tasks that are you know more more challenging and that will eventually lead to promotions and other things but yeah definitely making friends in in. Doing excellent work would be my by the advice. What's your take on specialization versus generalization in a start up? Well I guess it really depends on if you had gone to school for coding. When you already know I'm GonNa be in this particular department? If you're someone like me that had taken a little bit of code but also I love to do. I was Doing some early display ad stuff. When I first got started in kind of tracking down our of our conversion away from the you know the actual ad add source all the way down to the network that we purchased the ad out all way to converting to a shopping cart or cart? Abandonment rate I just loved excel and loved to jump into that so when I was at my first couple startups it was doing a little bit of everything Just kind of trying to see what what I gravitated towards and what I really loved so yeah I mean. If you're if you're a coder I would get serious about something especially given the kind of crazy demand for on the machine learning and AI side. I'm that's a no brainer to go into those very specific niche kind of industries early on because in five ten years. You'll be making some serious dollars in in those those fields. I know that when I was at Google I had heard that some of our higher end kind of AI. Folks were gosh was it was over. Four million dollars in total copy year for those types of coating positions which just insanity but it just goes to show you how few people at that time. We're actually doing that work. And it it was Is Very sought after in so they could command those salaries. But yeah I'd say if if you really don't know what's going on in any kind of like well. I think I like this but I am not sure. I mean when you're so early in your career you you can afford to go and spend three years to three years at something and in the end up bailing on saying like I just don't like this and then jump over to the the next thing so don't be afraid or feel like if you've gone down a path for years and I wouldn't say this even as an adult later on in life life you've gone down this path and you keep beating yourself up and you know it's not for you at an life's too short It's worth taking a few steps back to to move forward word. Definitely definitely and on the generalization side of things. I just want to chime in that. When I was at the companies I was always a coder but I got to know every different part of the business business? Just because it makes you a better coder because you know what the business goals are. You know what the marketing goals are and it helps you align what you're doing when you design your software and you throw out ideas for new features. It really makes you more valuable to the team. And it's not that you're GONNA have to go you know you're going to be right you know see. PHP Java script doing design work working all that stuff. Not that kind of generalization but just knowing having a working functioning knowledge of the startup that you're working in like try and get your fingers and everything because it's GonNa make you more valuable to the team in the long run. Yeah absolutely and even if like let's say you're a engineer and you eventually want to make your your way to the management track. You're going to have to have those skills anyway way right because if you're managing other engineers part of your responsibilities not only obviously managing that team but then also kind of working with other related teams you know the marketing departments the the CEO on the other organizations internally to to fulfill that vision. So you're gonNA need to have those those skills all right moving on. How often do you meditate? Yeah I mean that's changed quite a bit over the years I would say that Initially I kind of did it to on a more prescriptive kind of the thing where I was meditating to relieve anxiety and just kind of using it because I was going through something in life where I felt like meditation would help me me and then you know later I realized that that's actually the worst time to meditate. You Really WanNa have a habit and build up a practice practice so that you don't even get in those situations to begin with and so for me that that looks like at least and this will seem like a very short amount of time. Yeah but at least ten minutes Sometimes twenty minutes a day but the key here is ten minutes every single day so treating this like something that cannot be skipped tipped. Everyone can find ten minutes. I don't care how busy you are but just making sure to keep up that that daily cadence so that it is a part of your life and that yeah well those benefits will compound over time And I I think it's a it's all you really need. I I was I doing longer for meditations but then you know after when life all of a sudden it hits from a different direction you realize i. I don't have time to sit for forty minutes a day. I was doing twenty minutes in the day and tournament tonight and then all of a sudden an one one of those falls off and then all of the second one falls off you know like well I gotta go meet a friend for dinner tonight. So I can't do in. You're not meditating at all so yes sticking working with a daily practice that you you promise to yourself internally that you just will not move are sacrificing for anything else And during those ten minutes I think is the key. How is is your practice changed from when you didn't have kids too when you had kids? Is that when it started to fall off well. My practice has changed quite a bit in that of study with a bunch of different disciplines over time I was very lucky to live across the street from the San Francisco Zen Center when I moved over on page street there and I would pop in and an actually took my first training and meditation With the Zen monks there and learned about Zaza and all the proper ways proper to sit in the how you would enter the temple and like all these like very formal things that they have when you practice Zen so I was lucky in. That was an hour long meditation that I was doing there seated but thin one. The APP started coming out. So you know head. Space launched in eventually come came out. It started just practicing at home with a cushion there and I was moving to twenty minutes a day. I think is pretty much where I was at the night started. Ti studied TM Meditation which is a form of mantra meditation. They recommend that you do twenty minutes in the morning in tournaments tonight. That's very mantra. Meditations a very intense thing. It's like It's it's different than the than the zen or or more of a pasta kind of with my infamous based meditation and more recently. I've gotten serious about that. Mindfulness based style. I think Sam Harris has a fantastic course but it's the fifty day ten minutes a day course on the pasta style meditation. I fear that a lot of the meditation APPs. Oh concluded the one that I most recently worked on. They're great for an introduction and a lot of them are really great for prescriptive stuff so I have a fear of flying. I'M GONNA take a fear of flying pack and things like that but they don't go really elite really deep for people that want to take meditations seriously. So that's the one thing I really loved about Sams Course. He really is for meditation for people that want to go. Oh a little bit deeper. If you could call yourself ten years ago and talk for one minute what would you tell your younger self. Oh Gosh that's a difficult one so ten years ago for one minute. I think I would say that. Not a single person on earth. Has Everything figured out you know quote quote unquote everything figured out. And there's no such thing as figuring out life believing that you can crack the code or figure it out it's just gonNA cause anxiety because is you're constantly trying to figure out something that is just too dynamic to be solved once you surrender to that idea then you could finally just exhale a little bit and Lecco and you're actually a lot closer to peace and balance that if you're chasing something that's just impossible in Jason. I'm sure you're in. The same boat is like we've bumped into living in the bay area billionaires running very large tech companies you become friends with these people and everyone from the outside world looking in. What's it's eight man? They have it all. They've gotten assistant they've got to nannies. They've got you know all of these things. They drink. Whatever wine they won they fly on private jets? And I and you meet these folks in realized that they're in the same boat that were all in like none of us are ever going to figure this out. There's always something that what happens. That occurs that when you think you have it figured out life. Just toss the upside down. I had a buddy of mine that sold his company to fit bit and he had an offer and it is you know somewhere around thirty five or forty million dollars. And as he was going through this process inciting the docks he gets hit with stage four non Hodgkin's lymphoma cancer. And it's just like you know that that's life that's life and thankfully he's doing fine now. He's in full remission but it just goes to show you that this is to dynamic when you can release and let go of that chasing that thing that you will never obtain. It gets a lot easier. It's funny talking about the people that we used to know. That made it super big. Those people seem to be a lot more miserable now than when they when we used to hang out and have fun. It's Mo Money Mo problems really is kind of thing. So here's the thing. I've seen a handful of friends that are now billionaires that I I knew we all hang out with when we had two pennies to rub together and every the asset. You acquire everything like whether it's a new car. It doesn't matter what it is. Everything that you take on has some type of burden right so so a new car would have maintenance issues that might go along with it or it might have increased premium for insurance which means you have to make more money than to be able to cover that insurance. It's like all these material Tiriac. Things are just adding mental burden. I sat down with a this kind of Zen tea master who I was studying T. He was teaching me a lot about different types of tea and he goes. He said to me. Do you want to know the key to life and is like Ria. Like let's hear sounds great. And he goes less keys and he pulls goes out one key that he had in his pocket and he goes. This is my one key he goes. It's the key to my front door. That's all I have. And it gets that that just like simplicity of not having a second house of not having another car of not going out and acquiring all these things but just he has that one key he lived in the most humble little small dwelling that and you know just has little tea collection. It was so at peace. I think we would all. Aw Love to be in that place at some point and it just material. Things aren't GonNa get you there. You know it's not going to create that that level of happiness. It's funny. When can you and I were hanging out in San Francisco? Almost everything I owned fit in my car that was by design time to go and living in San Francisco and being around rounded rich people. Then they got me starting to collect stuff and stuff and stuff and then years later I finally purged everything again and went back to my car. I got a bigger car but it was. It was much nicer nicer much. Calmer so I had the keys to my car and I tell you what letting. Go of all of that stuff that you have to carry around as Tyler durden would say the things you own end up owning you so true through moving on to our next question did you struggle finding purpose post dig. Yeah I think I definitely did. There was a point where air when dig kind of fell apart and our offer from Google and the very last hour they pulled the plug on it and we didn't have the acquisition Happen where I just was in total shock. And that then snowballed into product decisions and other things that we did. They just didn't make a whole lot of sense for the company which let ready to overtake us is kind of you know the biggest social news site that was out there but I I would say that there is certainly a good year or so where I was trying to kind of figure things out and trying to find purpose but what this whole thing did the whole collapse of dig would it did is it forced me into a better place by kind of force me into some introspection. It really forced me to acknowledge where my deficits were. And the things things that I didn't know that I had been trying to kind of cover up which pushed me more into lifelong learning and admitting some of my faults and becoming a more open person and then eventually got me into to meditation. So I would say that had that sale to Google gone through I was living kind of the crazy lifestyle back then. Back the DIG nation days and when dig was on on top and it was the idea of like you know it was a lot of a lot of drinking king in a lot of just like I can only imagine how I had that outcome and those dollars like where I might have gone and so I really really like the fact that why. Look back on that on. My cautious really forced me into a much better place because it forced me to pause and say well wait a second. I don't know everything and and I did screw up. And why did I make the wrong decisions and when you have to re evaluate all of that and you can embrace the fact that you were wrong and you can learn from those mistakes just really puts you in a better position long-term which I'm really happy about now so when I look back on my gosh. That was probably the right thing into have happened. I missed DIG nation days. I gotta say they were fun but man yeah. If you had lots of money you would have had lots of trouble. Yeah I mean you knew me back. Then it's just think of what the Reno show would have been like to we got. We got into enough trouble with no money so it's like we. We did me that on top of things so I definitely yeah I mean. Don't get me wrong. Like I love DIG Nation having host that show with Alex and doing all of those fun times it was. It was a blast but that was great on the entertainment side and fund side. But it what you didn't see is a lot of the the mistakes made at dig because I hadn't managed people before because I hadn't you know admitted that I wasn't a good manager because they've never looked to find a coach to help me learn some of these things. I did know You know that's the stuff that that I guess I'm more more talking about their but yet ignition was a blast. Yeah there weren't a lot of tools for people like you that we're starting their first technology company company back. That not like there are today. Because you're kind of at the spearhead of that whole thing with the whole dot com generation coming through that with entrepreneurs back that I I would say that one thing. I always respected about Mark Zuckerberg. I remember when he came by the office and he was obviously quite a bit younger than I am. And when we were chatting about how he was running his business and how he was starting to scale facebook and they were still really small back then he had so many questions and he was just so transparent about what he didn't know and I always respected them. Like wow like. He's just telling me like you know. I always thought there is kind of like a little bit of shame and admitting that you didn't didn't know something and I would say that. It might twenties and early thirties. That was probably my biggest fault was just not willing to admit to others in raise my hand and say hey I need. I need some help here and he was so good at that. So that was United didn't have that image for some reason in some reason he'd been coached to to really embrace. That which I thought was awesome moving on to our next question. Would you go in depth into your suicide experience. Yes happy to do so. So suicide been is the magic component of magic mushrooms. Not to be confused with Magic Mike. That's right not net definitely not magic Mike. Little different there so suicide and I definitely I was was curious about because Tim was telling me about it and he was saying that. There is a difference between a recreational dose and a high dose experience here so just to give you some context like people do. I've been with friends that have had mushrooms before and I had eaten actually in San Francisco Cisco I'll never forget it. I had I had a chocolate that somebody gave me the go. There's just a little bit of mushrooms and there you'll have fun inside like okay so I just ate the entire chocolate to I hate. I hate when people don't tell you like that right dosing for things like I ate the entire chocolate and I was in hell for like five hours hours. I I basically know until go outside so we stuck inside. ooh And he had the sentence setting was a write in. I felt like I was like hollowed out. I couldn't feel my heartbeat repeats and I had horrible anxiety and it was the first time I tried anything like that. And everything's moving their snakes and the carpet all cut and I just had awardable time so I had a ton of exotic I am never ever ever touching that again period and then you know jump forward another another fifteen years later. I'm talking like listen like there's high-decibel Siobhan thing where people go and you work with a guide and it's not a a thing where you dislike giggle in the park Really doing deep work. And they're doing it to cancer patients and people that are experiencing You know end of life situations where they want to be a little bit more at ease and at peace and people have had. PTSD so people coming back from you know with wartime trauma and And they're having great outcomes and you can also apply this to other things like you know. Everyone has their whole onion layers of different traumatic events. That we've all all gone through and mine was my dad. My Dad passed away and a lot of stuff was unsaid between the two of us he was a very much. Do as I say not as I do type. Father very verbally just disrespectful. My mother like verbally abusive for sure. Like it was a part of my my family family life every single day of my childhood which is a given thing that my dad would blow up get upset just trash. My mom verbally never abusive in the physical physical. But you know I would argue just as damaging right and it would really where my mom down on so many fronts up my mom being the good you know Christian mom. I did not want to leave him because he wasn't he wasn't cheating on her or anything like that. So you know that was a lot of of kind of I think I got a lot of just general enroll anxiety around that stuff and I would avoid confrontation up. Just a bunch of a bunch of things that were weren't good so my dad passes away a Mike. It sounds good. I'm going to go give this a shot so I go Meet with this person husband wife team we sit down and we Kinda whiteboard out the things that I want to go into so you sit down like okay. Well I want to talk to my dad. I want to like find out why he was so angry. One find out what still I'm still holding onto Blah Blah Blah so. We whiteboard all of that out set our intentions. We burn some sage in the room. Like it's a little bit of that action and I down this like liquid liquid version of suicide in and sit down on the ground you know takes twenty to thirty minutes kick in. Nothing's really happening. I'm just kinda talking like hey. Let's do some stretching Mike okay. I'm distressed down a little bit and you know they're everyone's kind of waiting for it to happen and all of a sudden I'm just like like the room starts like popping in color and just just like getting really intense where might hearing just becomes super crisp but also overwhelming like. It's turning on all these sensory sensory things in my body that is it's too much like it's like it's like you're on a rocket ship and I don't know where the rocket ship is heading. But I've hit three. Two one has happened and we are at blastoff and so they're like okay. We'll and this is very much different than the the much experience I'd had before because it's a like a five gram does so it's like you know five plus times the normal dose or more of what someone would do a standard kind of like hang out in the park dose. That's so it's a lot lot. It's a lot it. Had you ever done acid before zone. Never done acid okay So I was like okay. We'll let's They are like let's lay down so I laid down on the couch. and they put some shades over me and like you know like asleep mask type thing and then all of a sudden I close my eyes is indices fractionals. Come at me like these like beautiful fractionals and all these like different kinds of bending kind of morphing and changing kind of PSYCHEDELIC cadel type. Classic Psychedelic type experience And then that kind of passes and then all of a sudden I guess I really. It is hard to put into words because it is such a feeling that you have that that words just wouldn't do it justice but I would say that the best way that yeah I could I I was able to Verse a little bit of my childhood and not so much the moment to moment like a memory we have something but more like the feelings that had been layered on and stored in my body and in my brain so I could feel. These emotions is really really intense emotions and I could see. It was this combination of energy. That had happened from my father being that abusive in that way and I can kind of see it in like manipulated a little bit and then just let it go in when I was able to release let it go hours just like okay. I have the power our let this go and I started to like releasing like releasing like Oh and then you come out of it so then like you know you pop out for a second. Take a sip of water and I'm like Oh my Gosh Astros happening in when I came out of it for the first time my nose is just completely fill was not I have tears just streaming like my shirt is drenched inched from tears. I'm like Whoa what is going on. And like you're sobbing. You're releasing in letting go and I'm not the first one to say this but like so many people said it's ten years of therapy and a single session and then you close your eyes and you go right back in so that the mask is back on your back in that world and then I was able to see something that forgotten that was. My mom had told me that my dad's dad was very verbally abusive and so I could kind of see and feel feel the energy of my father and how that had come down from his dad and how was passing down to me and the beauty that struck me at that time was that this doesn't have to continue. I don't have to continue and let this energy passed down to my kids into my wife and seeing that I can release my father my grandfather and take these emotions that they had put into me but not act on them and let them go and pass asked him for them was such an amazing freeing feeling and I felt like my father was so proud of me at that moment and I felt like it was. He's like this bonding. I have with my dad that I was able to like. Let his energy pass through me and we kind of merged kind of spirits. In some sense I know. Oh this is sounding crazy if you've never done this because I would have what I've heard some these stories to from friends of mine before I had done it. But it was such a great transformation nation for me and when I came out of the several hours later I felt like there had been this huge burden that was lifted from me and it was just like a fantastic tastic experience. It's fantastic. Let you break that cycle. Yeah one hundred percent and address it and really dig it up you know because it you know we we all all will experience anxieties and different things and little ticks things that happen and sometimes where they come from. God had a stressful day at work. And then other times you just. I don't know where it's coming from right. You're like why am I feeling like this. Whereas why is building up and I was able to go in and dig out a lot of that stuff that that had been this kind of little background processes that were just running? That I didn't wasn't he at the subconscious level and kind of flush those out. Let those go. Mif level just generally has dropped a ton in stayed with me in. Gosh has been four years since I had that experience and I still experience those benefits to this day. How long did the whole process take six hours or so? WHOA that's a good one? Yeah it's a it's a good. I mean it's work. It's not fun you know. When you're sitting there sobbing revisiting the stuff and having conversations their father and seeing the you know relationship with your wife and all the things you want to go into? It's a lot of work. How long did it take you to come down and recover from that? You know. There's kind of this beautiful afterglow. The last few days afterwards and you sleep really well in a AH I would say that you know there was no kind of like druggy type feeling. I was very very clear to me that this was like a natural substance that came from a mushroom. I'm and I was back doing normal things the next morning. If somebody wanted to do this how did they go about it. Well first of all I WANNA make any recommendations for people in terms of what What dosage or anything like that to do you need to work with professional and I would say Michael Pollen's latest book on Psychedelics. It really goes into this topic in depth about how he was able to find a guide. Kind of What he looked for in his guides? I I would definitely say checkup. Michael Pollen's book look how to Change Your Mind in. That will be not only. Is it just a great for that information but he also covers a wide range of different psychedelics. Minia which I've never I've of ever tried. It's definitely my favorite Goto that when people ask me about this I I was pointing in that direction. Get down to some tactical stuff would love to hear about your to-do system system and how you manage work in life. And what does a typical day look like for you. Yeah so I Typical Day for me would be waking up at seven. Am I am on Zelda baby duty until the nanny shows up at nine. I don't eat any food. Initially saw going to have a cup of tea or just plain black coffee feed. Read the Kiddo. Do a little bit of playing with the you know the little one and Doria. My wife is working on the youngest one trying to get her up and so do a bunch of that stuff and then when the nanny shows up I'm able to go to work and I have an office podcasting out of downstairs in my house here in Portland Oregon for me. Every day is a little bit different so I do receive a lot of pitches on a you know. fulltime venture capitalists adventures. We look at an early stage startups in in kind of seed and series as startups Like I mentioned before my interests are along the kind of longevity and biohacking side also consumer Internet I looked a lot of the cryptocurrency elit related stuff so deals will either get sent me. Send me internally to checkout or referred to by other entrepreneurs in its doing meetings like just before this call. I I did a meeting with the founder and We wind up about his PRI- but he's trying to do how much money is looking to raise things like that and then I would say I Stay I continue to say facet if I don't. I always try to get in some type of gym activity so I either. I don't have enough time to do like full gym. MHM sessions so for me it is cardio and Sauna most days and then I'll try and do weight training three days a week. These are kind of non-negotiable able. I don't move them. I always make time for this. And it's nice when you really don't eat breakfast at. You'll do find some extra time there so I'll go and do new cardio it's it's pretty awesome do fifteen degree incline which is really steep. Max that most treadmills go and I'll walk at one point six and then I'll have an IPAD as well so that means I can listen to an audio book or I can go and actually do some work or if I need to but after about an hour for which is what I aim for. I'm drenched drenched in sweat. Just in look my apple watch burned about three hundred and fifty calories and it's great and then I'll jump into the Sauna and do a twenty minute sauna session. Just because the all the data that around Saana usage points to twenty minutes being kind of the sweet spot at around one hundred seventy four degrees Fahrenheit ID one eighty and that'll take quick shower and then by that time it's normally like one something. I typically have hit my successor. Eighteen hour window for fasting. I'll then have a A vegetarian or Vegan lunch and then I am not vegetarian Vegan. But I was just trying to do that and then when it comes to dinner I will do. More of you. Know Meat meat-based proteins things like that and then come back to my computer and some of the work that I have to do is round either podcasting or it has to do with Research in general Paying attention all the Trans reading all the latest cryptocurrency news. And just seeing what's going on so visiting sites like tech and just I really kind of keeping a pulse on everything that kind of holistically in the tech industry what's happening so understanding all the different areas. There's some that I avoid. I don't really care a lot about the BB kind of enterprise world. So I don't track that closely but if it's consumer facing there's a good chance of you talked me in the afternoon and there was some big story. I'm pretty well read up on it so that I'm just always keeping up with that stuff and then you know when it hits five o'clock I try to bounce bounce out my daughter's up for another couple of hours and so I spent some time with her daughters and then You know we'll do bedtime routine and bath and things like that that and then yeah after that dinner with. My wife tried to do early dinner so I can start the fasting early and just the data around eating and early dinner. Leads is to better. Night's sleep is great. Try to not drink too much alcohol. You know for me. A couple of glasses of wine is plenty go above and beyond that. It's it's always a crapshoot in terms of how I'm going to sleep and the Jason you and I have traded biohacking supplements and things for for that. Oh I didn't mention any myself months. I think we have a question about someone's coming up later you too though so I can go into that later. But that's a typical day. What's your favorite T.? And would you ever go caffeine free. Favorite T I will say that. I'm drinking a lot of Japanese essentials now. I like the really grassy green teas so if you can find high quality organic Japanese censure that's probably your best bet I don't have any places to recommend in that sadly I actually go to Japan At least once a year and I always get my whole Phil when amount. They're always bring back a little miniature backpack worth of tea when I'm coming back so I don't have a push recommend that said if you want long. Tease Red Blossom T- based out of San Francisco Cisco they saw online by far the best importer of really high quality. alongs that are out there. They also do some green tea's as well mostly Chinese though which are fantastic fantastic? And they're they're sourcing really high quality in terms of Macci. I'm an investor with Dr Andrew. WEIL MACHO DOT COM. Andy is Really good friend. And and he travels out to Japan and buys the absolute best macho on earth the ceremonial grade. Masha from very very small tea. Producers and not industrial grown macho done the right way using ancient techniques like this is legit Staf it's expensive but without got a doubt much dot com. That's the Best Mata which if you want to consume the entire plant which gate has a lot of health benefits? That's the way to do do it in. I obviously get my macho from there. So how would I go caffeine free. I'm going to try it actually. I'm going to try it in January. I'm going to go completely caffeine free for one month in to see what happens to my sleep just as a little hack. I'M GONNA have to taper off though feeling. Oh Yeah because I'm worried about headaches all the other stuff so yeah it's it's easy to do you. Can you can do it like over. The course of a week is a long time to do it. I've been off a caffeine for three months and I just got back on it and it took me about a week to get off it and I skipped all of the headaches every today I would for my tea in the morning. I would just knocked down. The Caffeine Level Tiller was basically zero and then I would have some herbal tea. I still had my teague and you know just the the the physical part of making the tea and going through it so you don't lose that and then I just stuck with herbal teas for three months and just went back on it so I have faith that you can do it. I'm so so have you noticed that your sleep has improved. No so it didn't improve when you were doing. No Caffeine No. I found zero benefits for being off of cat. And Yeah get back in. That's what I mean it's like the mornings were harder. I definitely found the mornings harder. Like I like to get up and go to the gym and get all my stuff done because I get up at four in the morning and I I like to have that boost at five. He's always waiting hour before caffeine and I found when that was gone. It just made the mornings so much harder even if I woke up perfectly because I have a an H.. Sleep bed the tracks my sleep and I get sleep reports from it. I'm sleeping fine. There was no change in in my sleep whatsoever and I just found that the mornings were actually harder So so I said I said screw it went back on it. You crazy as I was I had heard recently a guest that I have my show. I'm sure remember Matt Walker. I forgot to mention that. You also editing. All My podcasts. People should know that as well so Matt Walker He he was talking recently that AH turns out obviously. Caffeine has a benefit in terms of alertness. And kind of waking up and getting you going but one of the reasons that people wake up in the morning or they have like historically has been that when the special you're sleeping outdoors when things start to warm up when your body starts to warm up you kinda naturally rise and one of the benefits of having having a hot beverage whether even if it's just decaffeinated tea in the morning is it Kinda warmed up internally which will get things kind of firing up and starting to to function and ramp back up in terms of the different like levels of form owns and a whole slew of different things so it looks to be that. Obviously Caffeine is GonNa the be the GO-TO winner in terms of Best Bang for buck in terms of getting that jolt. But if you're just looking for a little extra wake up you don't. You could just having a herbal tea in the warmth will help as well. It does do that. I I have a feeling that my sleep didn't change because like I said I have an eight sleep bed so when I go to bed at night the bed is cold and Like about an hour before I start to wake up. It actually warms the bed right and in warms my body up so when it's time to wake up I'm already warm and ready to go. Yeah I I love that. Yeah the thing is so good man. It is so have a chilly pad. The does the same thing so I am with mine. I can dial in exactly what temperature I wanted at any point in the night. Yeah so I I have it ramp up before I go to bed and like when I get in bed. It's nice and warm and then it goes all the way down to where I'm going to get the most deep sleep in the ramps me back up just before I wake up in the morning. It's pretty cool. Yeah that is the way to go. I mean you haven't lived until you have one of these they ask. If they're they're amazing they're not cheap. But it's like you know asleep. Deep is so important definitely worth the investment. Yeah just the extra productivity you get back from. Not being groggy morning you will earn it back you know in in no time and also for a lot of these things you can turn off your house. AC in the summer and you actually save electricity. Because you don't have to cool the whole house because you can just cool your bed. Yeah and just have your heater turn on like when you get up in the morning or your. AC turnouts agree point. So you can you can save. You can save a lot of money either way. That's awesome yeah these are these are awesome devices are are you. Are you a fan of that bed. Because I haven't used that that bad yet. I love it I actually have two. I would've bought another way. It's the it's the mattress right. It's a whole on fallen mattress. It's basically a memory foam mattress and the unit wraps around it. So you've got kind of this waffle coil. It is attached to the bed so it's probably like yours as well as just a lot of water tubing writing with a little unit next to it with a you know a heater in a cooler next to it and what's it called again the pod by. Ah Sleep is the one. I have. Okay sweet yeah. I'll check it out there amazing so we're talking about supplements before we have a supplement question. What lion's Mane Supplement d you use yes yes a lion's mane mushroom really good for cognition? I typically wom growing them backyard although they haven't come out yet this fall also. I'd probably be springtime when I actually get some to pop out of the logs but if I can't find them locally and oftentimes can because being in the Pacific northwest I if you do ever find lines in the grocery store you can find more that whole food style stores just cut it up in a thin like quarter-inch kind of like slices you. You can dry roasted meeting no oil and then it'll get all the you put it in a pan and it'll kind of Just shrink down a bit because although natural water evaporates rates then you can add some oil or butter and a little bit of garlic and salt and pepper and tasting lobster. It's amazing so oh man really he sounds good. Yeah it's really good really healthy mushroom for you. So if I can't do that there's a company called real mushrooms Which I communicate with the founder of a whole slew of different times and they were also analyzed? Recently at a website that I really trust called consumer lab that basically Consumer lab is a really awesome little hidden website that they are independent. Third Party lab that comes in and they look at pretty much everything in terms of like you know everything from vitamin supplements supplements to protein. Powders to you name. It mushroom supplements and then they come back and say these are the ones that are most pure these ones contain You know ladder. They don't so they are looking at all the the integrity of the product. So I've learned a lot there on which brands to avoid and which ones you know actually contain a lot of the sometimes. It's not even bad things. It's just like they're reporting five hundred milligrams in the bottle on. It's only two hundred twenty. You know like little things like that. You should be aware of Just because this is such an unregulated regulated industry but anyway real mushrooms is named the brand. They sell an Amazon. I've talked to the founder of buying cheese shared with the photos and like I said they were analyze has recently and it came out really positive. Zoe's they're using the entire mushroom so a lot of these brands that you have to be. I don't know some people claim claim that a lot of the benefits actually happened in the fruit body which is like the main sprouting piece of it and then other people claim that it's actually in the my see Liam. Am which the stuff that you really can't see where a lot of this happens like you know at the base of of the actual mushroom. And I would say that I am torn in the science. That I've looked at so for me. I I want to have something that has both an real mushrooms Does both give you the my Salem and the fruit body all combined in once you're getting the full spectrum which which is always a good thing so that's why he's them in. What other supplements are you currently taking so I take a prescription supplement called met foreman? It helps helps regulate glucose levels but it has been linked to reducing the risk of a whole slew of different cancers extending life in humans which is amazing thing so I take A gram of Metformin Day extended release. Obviously you have to get that through your doctor and talk to them about all that good stuff. I also take I know that hat because of my genetic polymorphisms I've taken my twenty-three meet stats. You can actually if you do a genetic test at twenty three me. You can export that data and you can take it into some third party tools to analyze that data and then tell you based on your genes which supplements you should potentially be trying. And so I used. He's found my fitness doctor. Rhonda Patrick Website for that. You could take your expert at twenty three may drop it in. There should run a report and then you'll understand at least what you should be paying attention to so for for me. I'm a bad a poor absorber of choline. So that means I need to eat. More things like edgy joke and sometimes supplement with choline as well and also I. I realized that I have the MTA Jaffar genetic mutation which means that I am a poor absorber of a vitamin so I need them in the methylated state which means that I use The Mega Foods Multivitamin which I love and it's formulated by. Someone called Dr Low dog and she uses Macedo vitamins in that in that food. So they're going to be more bioavailable for me the beautiful thing about this stuff though is we're getting to the point where you go in take a look at your twenty-three me and you're like okay. Well it says that I have this genetic mutation that could lead to higher homocysteine levels which is known to be a bad thing thing for cardiovascular disease and dementia and things like that then you go get your blood work drawn and you're like oh Yup sure enough. My homelessness teen is much higher than it should be eight. which is I'm telling you my exact case here and then like okay well? According to Rhonda's report I should be taking methylated full eight and and other vitamin so I go in supplement with lady full eight and B. Vitamins and after three months going gear. Blood work done again and you can see that my home assisting has gone down other things that her report uncovered me was like. I'm I most likely have low B. D. Vitamin D in. So I go and check my blood and sure Enough Avenue D okay. So it's like this kind of count cat-and-mouse game of does this actually apply to me because sometimes you can have a genetic polymorphism and it doesn't actually show up in your blood. See it's not really an issue for you even though you have it 'cause genes are turned out to be really complicated in and just because you have a polymorphism doesn't mean it's actually actually active. So what you do is you just look use it as a template then get the blood work done then supplement and then go back and kind of rinse and repeat and do that until you fix things. So Oh that's been a big big thing in a fun thing to do over the last five or so years. Is that process getting back last thing. Real quick I'll hammer out the things I I take creating everyday about a gram and a half of it not because I want to be off because of the brain benefits that it offers. I take a vitamin D. Obviously the and without a take K.. Two which is important to get with Your D. I take the Maltese. Let's see I got the metformin down there and I think that pretty much about it. I do every once in a while. Take Turmeric like a couple times a week for inflammation. I don't do it every single day and same thing with mushrooms and things like lion's mane deny pulse that stuff where I'm doing it. You know randomly like a couple of times a week so it's not something a half to have him me every single day. Those Dr Low dog. Vitamins are awesome. I take take the mega food. Multi Ferman forty plus is. I'm an old guy. Yes and that thing. That thing's great also Their tumor is really good. I think Doctor Wyle was on your show and he recommended the the the mega food. I think it's to mark for whole body. Yes yes I. I'm a fan of of mega foods. I love that they really show you all the farms that they get everything thing from. And you know a Multivitamin as good as I back in the day I don't know if you remember multivitamins but like you know you go and you buy one agitate average drugstore or they're most likely going to be ninety nine point nine percent of the time it'd be synthetic vitamins and when you take those you get that really horrible nausea give or take a vitamin on an empty stomach. Do like the the old centrum make me sad for like half the day. I know it was brutal so basically these were made from whole food ingredients and I can take them on an empty stomach with no nausea whatsoever. And they're just awesome company. I have no affiliation with vitamin companies. None of these things I mentioned today. I have any the type of financial affiliation other than that Macho Dot com which already mentioned but yes so I I just I just love that. The PRESI- quality product moving onto some some tech. Can you please explain how you go about buying bitcoin. Or other crypto in small amounts yeah. I think that there's a couple places to do it. I would say the three three that come to mind are obviously coin. Basis the biggest one out there. And they're gonNA have most of the the kind of major cryptocurrencies. Is there out there and so you can buy very small amounts of bitcoin. You know fractional coins right there and then you can send them to a vault there air which kinda takes them off line so there's no worry about being hacked or anything like that so that they were ever breached like your coins are actually start off line completely safe. I liked coin base for most things I would say the does require you know setting up an account. Then how do you get money in there and all that good stuff if you're just looking to play around square actually has a fantastic app the square cash APP and they allow you to buy bitcoin directly inside of there. So I've had some friends where you're sitting at a dinner table in your splitting putting up a bill and you're like okay. It will fifty bucks sent him square cash and they just go and just like instantly converted over to bitcoin directly inside of the square cash APP. I really I love the work that that square is doing. I think Jack is is really doing a great job embracing cryptocurrency in also kind of providing an avenue for are you know all of the unbagged people out there. That don't have bank accounts. Let's just say for example. I will every once in a while. We get a babysitter to watch the kids. We pay our babysitters Square or cash. They can then in two seconds. Just get a debit card from square and have instant access to their cash. They don't have to have a bank account or anything like that. So it's a it's a pretty cool world in in tool that at square as has built. That's pretty cool. I didn't know you could do that. Yeah it's awesome and also Another stock trading one that is free stock trades. The square is going to do that now to But Robin Hood is another one. That does a bitcoin related stuff. Next question I'm turning thirty. Yikes any advice based on how to make the most of the next decade. Yeah that's a great one. I think you've got us off to a rough start our early thirties. I wish I wish we'd that'd be listening to this. podcast like this or something. Yes stop drinking now exactly. That's a great win. There you go boom in the show. Yeah and that's that's a huge obviously. Take your health seriously seriously. Also I would say now is the time to find employees your gaps and admit to the gaps. You have if you can't out and if you can't spell were shit like now's the time to figure that stuff out of you don't know excel like now's the time to take a class on it. You know you'll know where these areas are like especially especially if you want to be an entrepreneur like never built a Peon al or you've never you don't know anything about bookkeeping like it's a great time where your brain is still really release still sponge like and you can go in and learn these things. I would say that. Obviously it's never too late for any of this stuff but in your early thirties is a great time to say okay. I'm entering the serious stage of my career. I'm kind of starting to figure things out. Let's fill those gaps and now you can step into bigger career roles whether it's starting something on your own or you know kind of working your way up a certain organization I would also say don't fall victim to the sunk cost fallacy. You're in in a place that you Kinda don't like just cut Bayton run because I stayed in tech for probably ten years longer than I should have and and it wasn't making me happy anymore and now for the past seven years I did something completely different. I'm in podcasting now. It talking to a microphone day night and day from programming and I have never have been happier and I wish I would have made that change years before I did so. Just don't hold onto things because you've got an investment in look for things that are GonNa make you happy. Yeah Jason. That's solid solid solid advice like I should have mentioned that as well. That's a there's so many people that they they get to this point in their life and the like wow. I spent all my days in college going down this path and you know I've put the last like five seven years into this career and it's like you'll know internally at this point right when you're thirty thirty you know. Is this something I want to spend the rest of my life doing. And if it's not like he said cut bait and move on it. Now's the time you know all right. We're coming to the end here so we're GONNA do some rapid fires I up. What guest has had the biggest impact on your everyday life? Yes Oh Matt Walker for sure if that is my most popular episode of the podcast. It is it's still continues to grow people passing around. It's all about sleep in the importance of sleep. And so if you don't take sleep seriously or you haven't heard this episode go back. Check out the Matt Walker podcast show. I think you'll really enjoy it. What are your current favourite biohacking tools? Sauna Cold Exposure Continuous Glucose Monitor. Honor those are the three if you WANNA learn about the benefits of Sauna and cold exposure type in Sauna Rhonda Patrick pdf and she has a great article. Michael both unsown and cold exposure to separate documents You can pull them up. She references all of the peer reviewed science. And why it's important to figure out a way incorporate into your life so those are those might go to's if you had to choose just one would it be Peleton or Sauna At the tough one I would say probably Peleton because I lost the most weight and got in better cardiovascular shape with Peleton and it's a ton of fun but that that said there are some really inexpensive ways to hack the Saunas some little single person Saunas. And these little things Kinda wrap around a chair and get you to the right temperatures. So don't think just because he draw a couple of grand on Peleton that you know you have to do the same thing for Asana. They're much more inexpensive ways. Infrared saunas things like that as well. So you know I'd I'd say to one and save up for the other. Do you still invest. I do yeah I do so. I'm pretty vanilla when it comes to public market stuff in that I do index funds all the John Bogel vanguard style stuff and then a certain percentage of my net worth is carved out to cryptocurrency Z.. So I'm really long on Bitcoin so I hold a bunch of Bitcoin and a few other. Little smaller CRYPTO projects. I know that when I say that thousand which ones and Gosh I would have to think of the ones that pulling some file coin from back in the day and in a couple of other ones that Solana's unas another one. So L. A.. Saying by these. I'm just telling you what I have Coin I don't know opera coin while we're going was the burger. Your King crypto amazing without did not. I'd never gotten to Oppor coin. Yes Oh investing wise. I tend to think go super risky with a very small percentage of your worth for me. That's Crypto in tech investing in the rest is like just not gonNA lose it. Get a nice little slow. Gains Means Year over year. How many meals a day do you eat to lunch and dinner? He's enough. How do you balance exploring your many interests with being present husband and father It's really difficult. I would say that I used to do like ten little small things that I was always fight juggling now. I pick like one thing that that I want to go and considered to be an outside of work activity and then I I just go do that. So for example. I've been spending some. I've been doing. Actually the kind of two birds wants don't want to spend time with my my mom and that gets to spend some time with her. She lives here as well. And she's getting up there. She'll be eighty next year. which is crazy So I didn't taking pottery class with my mom right now and I do that once a week and I've always wanted to take some pottery and learn in. Just try my hand at that. So it's like I get to spend time with mom and do pottery so it's awesome but yeah just picking one thing because they they kind of hit on it with a question but it is hard to juggle everything. What's your thought process? That's behind moving to Portland. Good life investment. Yeah Portland's amazing if you haven't been phenomenal place to visit hiking trails beautiful forests fantastic beer scene. It's almost too good of a beer. Seeing my my gut will tell you and you get a lot more like it like. It's a lot more space and it's actually still really affordable place The food scene is awesome. And there's so much love in terms of just like a really cool town certain areas. Are they have these like fun. Little pocket neighborhoods with all these little coffee offi shops and a Lotta rain. But you know that's why you get the beautiful forest and the amazing summers. How did you meet Dario? And when did you realize she was the one mentor on twitter after she automatically follow me because I was suggested user back in the suggested user list was hard coded so I have to thank for that one. He was. CEO CEO time and added to the suggested user list. I started getting all these followers all of a sudden and then having to be one of them and she re re tweeted something that I had tweeted. It's actually about Dr Andrew. Weil and I was like. WHO's this little hot? Little forty forty icon Suman on that and clicked on her profile and we ended up meeting beaten up for a bottle of wine and I would say I knew she was the one when I found someone that was into Zelda. That was Super Geeky. 'cause she's a neuroscientist. Scientists you know obviously really attractive and awesome in also just really willing to to work on herself and always be improving living and treating our relationship like we're in this together versus so confrontations with her as it always obviously happens with with everyone one have always been. Let's figure out a way to solve this and that we will both want the same thing. We both want healthy loving relationship and so working working on this together versus it being me versus you is such a nice refreshing way of approaching things so just finding that in someone say you hit the lottery with that one brother thank you. I appreciate that as she's awesome. She is. How do you network with people? Assuming you're starting from scratch. Oh that's a good question so for start from scratch crash I would say meet up so your friend go to where you're gonNA find like minded folks be yourself. Don't try you mean the second you try and be someone you're not it's going to be so apparent and then use Actually the workplace for a lot of this so just meeting people. The same company is a less intimidating thing to do and you know just sitting at the lunch table with a different group of people. Ask them about where they work. If you're at a big company offering assistance and how you can help out in certain ways. He's I would say that those are great places to start. What's your favorite Japanese whiskey under a hundred dollars? Okay so I was really glad to receive this question. It's a tricky question because there's no such thing. Japanese was these are just insanely overpriced right. Now I mean you can get a horrible Japanese. It is whiskey by some unknown brand. Don't do that so the one I will tell you that I think is fantastic. You like that Chocolate with Vicha Sea salt on it. Oh yeah that Kinda like savory sweet Flavor profile totally. Yeah if you're a fan of that Yoichi makes a whiskey called the PD and salty. And it's two hundred and eighty nine dollars a bottle. Oh it's Pricey I get that but you know these things are not getting cheaper. So it's like a little bit of investment in in. I know it's really pricey but you asked about Japanese whisky whiskey. So like Java's are not cheap like just give some context here you go and get a blended BIKI and it's GonNa be like eight hundred bucks a bottle plus and it just gets crazier and crazier from in there. So this is a killer bottle if you're willing to make the investment and It has that components of Ip Denison saltiness that aged aged fund fund. Nice little friend just to SIP on But I I got I by Java's whiskies from a place called D.. Kanta because you can really trust awesome You can find cheaper place to define this probably but it's like I don't know that I would fully trust all the spot so D. E. K. A. N. T. A.. Dot Com is my go to place for the great Japanese importer. What's your favorite book of two thousand? Nineteen I've got a few I would say. Ah The untethered soul by Michael Singer was fantastic. One thing that I did enjoy a was this book called Buddha by Karen Armstrong and it really is a biography of. who was the Buddha? Like you know you hear these things like okay. Buddha religion you know. There's all these books on. How to meditate eight? How the Buddha? But how about just like the human person where where did where did he come from. What kind of houseful did he grow up in? What happened when he became Kim enlightened how did he gain following like just understanding and writing? That story has been fascinating to read and so yeah. Buddha by Karen Armstrong is is definitely a good one. I've got one for you because I remember you and I both had a pretty bad fear of flying which Oh yeah. They gave into a love of bloody Marys at seven in the morning. Yeah thanks for telling everybody that. There's a great book called Cockpit confidential everything you need to know about air travel by Patrick Smith. He's he's a pilot it. It came out in twenty fifteen. I get this book on audible and I just put. Every time I go on a plane. I started listening to it on my way to the airport and can just skip around around. I feel safer in a plane now than I do standing in the airport. That's amazing. It is unbelievable. This will this will get anybody overflying tell you because he just goes through everything about what. It's like to be a pilot. How safe being on the plane is because statistically that is the safest place in the airport from from the time you're in your house to to win you're on that plane? Everything in between is more dangerous than you be actually being on that plane even when it's on the ground yeah I mean I've been walking through so those little tunnels to get the plan. You feel like those things during a collapse on you. I tell you man I will say that. I fly so much now that I've gotten over a lot of that. I think once you do once you fly like like four times a month. It doesn't really impact us much and then also do it. A lot of the surrender stuff were like There's a great by Michael Singer on surrender. That that one will really help out a lot. but yeah. I'm excited to read this. I'm definitely down but that's not that said you know if it's like six o'clock and I'm taking a later flight I no longer have to do the morning. Bloody Marys raise but definitely from later flight. I'm like yeah why not have a you know a a beer or something before I get on the plane are you doing the Wim Hof method this went am yeah. I'M GONNA start on in December so stay tuned on Instagram at Kevin Rose. And you'll see all of my crazy ice bath. Experiments also kind of outline what the methods all about do you have any falter elements like OCD. ADHD oh man. Yeah absolutely. I've always been someone that ruminates a lot on on things so I've always kind of had that that issue where if something enters my head and I I like obsess over it in a way. I've talked to people people about this. And they they won't classify as OCD but they've said that it's like a mild form of that where you like. I guess it's like the fear of flying right. I if you have a fear you're flying. You're just kind of there's no logical reason to have that you're just Kinda ruminating on this idea that something might happen on the plane that you're on and so that's that's been in issue of mine that I find that meditation helps a ton with I would say that was Kinda my my biggest one also. I've had A. I've had a really hard time mm-hmm ever since I was little with just memorizing things I had some type of learning disability when I was younger and I was horrible at memorizing things people's faces vases in names and yeah for some reason I was like the kid in class. That just could. Not You know like my alphabet telling you which letters can before and after I just remember like they're being just issues with memory and recall. I think now that I look at my genetics. I think it's tied tied to the way that I Absorbed Coleen so Anyway just a yeah. I mean we all got something right. Ain't that the truth. What years? GimMe Gimme your your thirty second version. I know you must have some. Oh well I'm dyslexic. Which is real fun? Eight that part especially when you're trying to reach scripts all day long. I recommend the open dyslexia defunte which is fantastic for people who have any kind of reading disability. It really helps form the words and you can see them. I wish you could put this on everything so between that CODEPENDENCY dependency and a lot of a little. OCD going onto everybody's got got a sprinkle of something that for sure. There's no such thing as normal man that's right there is is no such thing. Yeah it's it's always I feel like the Geeky you get to like. I'm a little bit of an introvert like the more. Some of that stuff is apparent. Yeah it's interesting that you're an introvert because when we met we both were doing a lot of stuff where we had to be around a lot of other people. I think both of us. That's why we would kind of just run often do other things because we didn't want to be around those other like that many people but I I saw you on TV. I saw you on TV your first day as I was a big tech TV fan. I was working with Chris. Pirillo Carrillo and you wouldn't think somebody who was on TV doing all the talks that you were doing and also doing dig nation and all. That stuff was an introvert but I think that happens a lot for for people like us in tech. Yeah I mean it was. I definitely remember the first time I did a cozing the show on Tech TV Liam. Liam Patrick were out. They were off doing something and it was myself Martin and I was like so nervous. He took me out you. You did a shot before the show started shot of whiskey. Oh He's a great idea for life TV good idea but it just like you know I just. I had a really tough time. I would be down with shows. I would just like be sweating like you know. It's just it's so intense to do live TV in front of that many people. It's like flying in that way. You do it enough time then all of a sudden it starts to get a lot easier for me. The hardest thing has been in something I always enjoyed about. Our friendship is like you know we go have beers and we talk about real things. It wasn't this kind of like you know party. Talk that some off so many times people get into where you like. What do you do like where you know? And and it was I I've always avoided that. What kind of like just never been good at it? I guess never been good at that. Just general like surface levels yes surface level stuff. And so I I've always wanted wanted to Kinda get deeper pretty quickly and That's why I prefer smaller more intimate groups. I think and just meeting people for the first time and you know having winded answer. All those questions is always been awkward for me at a now. Yeah I can imagine i. I've only been on live. TV Once I did my I did my stint on call for help with Chris Pirillo in in my hands were under the desk like shape air crazy as soon as the light went on. Though I got calm it was weird. It's like okay boom lights on got to perform a- as soon as as soon as the light went off I like you know had a panic attack I could. I could turn it on for that three minutes when we were on the air and then after it was done it was like this like a ton of bricks and yeah oh yeah it's crazy. The used to get these muscle twitching like in my leg Randomly after after live shows. It would just like I'd go out and have a drink afterwards and I just feel like this twitching from just like this stress like these. Little little tiny micro stress that was still in the earthquake. After it happened. All the little small you know. Like the tremors that were coming up I'm sure a lot of the adrenaline leaving your system to. Oh for sure all right getting to the end here. Have you ever considered investing in Zombie. Movie I have a script. Yeah I thought this was funny to include because it just shows you like somebody I have not considered investing and but thank you for offering should start a podcast. Nobody needs to move anymore. That's right. What are your favorite spots in Portland? Yeah so if you'RE GONNA come out to Portland deathly on the food side ox fantastic Uruguayan beef. They're amazing bone marrow like stews. WHO's in they actually have a really good beef heart dish? That is with Horace Rash on top of that is unbelievably good. All this stuff's really funky but so good for you Task is another great. One can Mediterranean inspired phenomenal. Missed really good spot Sushi wise. We have a great great great sustainable Sushi restaurant here. called bamboo also a fantastic. I would say closest to Japan experience. I've had in all the United States would be a tasting menu called not so if you are out here visiting and you WanNa make sure you get reservations a month out but not grow is is really the closest thing you'll get to an actual like Japanese binny's experience really legit chef that trained in Japan. Obviously all the breweries are great. deschutes brewery Probably my favorite. If you want to try all the crazy beers because we have more microbes I hear per capita than the United States. Good a place called Loyal Legion. They have over think ninety or one hundred local beers on tap. And so you get to do these little tasting flights that are phenomenal. That's a fun fun. Place the Japanese gardens are a great place to hang out. See some the most beautiful in in Tokyo. They call Portland their mother or their Sister City and that the Japanese Gardens By many Japan are considered to be the best in the United States are in Portland Portland Oregon so definitely check that out and of course all of the hiking trails and stuff here well. That's it for the questions on this one. This was a blast. I'M GONNA have to have you on my podcast and it was fun getting to chat again. Yeah Jason thanks much for doing this. Awesome to have someone to bounce ideas off of and and go back and forth on in your insights of of course are always awesome. So so it's great to have your commentary as well anytime brother anytime all right. Thank you all right. That's it for this show. I hope you enjoyed it but before I let you go. I want to tell you a little bit more about about the Jordan Harbinger podcast so a lot of people ask me what other podcasts. I listened to indefinitely top on my list Jordan Harbinger show Jordan. You're on with me. Thanks for joining me for this segment for sure man. Thanks for having me yet. You've had some crazy guests on your show and I know you like to go really deep like I do when when you have a guest on. It's not just bullet points in you. Know a variety show but you actually get into their psyche. Talked about one of your favorite guests recently. I had Jamie Metal Dole. And he's a tech futurist in kind of a geopolitical expert as well as an entrepreneur. But this guy wrote a book called Hacking Darwin Genetic Engineering and the future or if humanity and so yeah. A lot of people are talking about gene editing. And things like that but this is kind of what happens in one hundred years and it's humans are disease resistant. Two things that right. Now you wouldn't even think about and outlier traits inhumanities such as IQ's of several hundred or even possibly up to a thousand are things that we can then select for so we might have humans that are designer bread. Everyone's six five everyone's cancer resistant. Everyone's disease resistant. Everyone is super intelligent. Things like that super athletic things like this and he even discussed the idea that we might have certain breeds of human. That are radiation resistant. I thought well. Why do we need that? Well if we're going to go to space and it's GonNa take us years in a spaceship to get to Mars or other planets even further wither away. We need to have people that are just going to immediately be cancer ridden by the time they get there or horribly sick you can breed people that might be resistant to solar radiation and other types of radiation that are outside the atmosphere. How about just the flight attendants? Yeah I don't know if you know that zapped every time you take a flight it's it's pretty bad that's right. Yeah pilots are like. Here's a pilot that can work for another ten years and doesn't get a horrible horrible form of cancer afterwards. Because he's in the sky all the time so he's talking about these types of things but how will this affect the gene pool. Will it start an arms race with genetics. Will it change corporations governments religion crime and he explores all of his own of course sports. I mean that goes without saying sports are going to look totally different when everybody can. Just walk up to a basket you know or sprint. At twice. The speed of using Bolt Holt and just slammed the ball in everything is going to change and so he was just absolutely fascinating. We did like a solid hour. Change with Jamie Nets on the show. That's that's awesome. Well I will link up that episode in our show notes in the description of the podcast here so people can get it If people WANNA go directly I mean obviously they can search for your show their favorite podcast APP. But where else can they find you online. Sure the Jordan Harbinger show in any PODCAST APP. Like you said at Jordan Harbinger DOT COM as well and I. I would love to hear what your audience thinks is episode and the show in general because smart people are what. I'm let their what I'm looking for. Yeah I mean you've had Just like you you bounce around around in terms of like awesome guests like you can go with someone that's super obscure but really interesting and then you have people like Kobe Bryant. Not so I love the show keep up the great work. Thank thank you very much man. I appreciate it all right. That's the show. Please do me one last favor and head on over to where you found this podcast normally in your favorite podcasting APP or on the apple store and his five stars. That would really help us get recommended to more people have better guests on the show take care.
Standup Week Tuesday Night (4-14-2020)
"Welcome back it's time for Chompers your morning and night tooth brushing show brushing on the top of your mouth on one side and brushed the inside the outside Ama- showing side of each to three. It's stand up week and tonight our champion ally is opening the show with joke ally. Take it away. How do you make a hotdog? Steve How you take away. Share switch brushing to the other side of the top of your mouth but don't brush too hard and now with an encore performance. Please welcome back our comedian from this morning. Joe Oh my goodness I'm a grown up. I don't know if you've noticed but I'm grown up. In fact I got a little money got a little. I bought a new bed recently. I had to there. Were too many monsters. Under the old one switzer rushing to the bottom of your mouth making tiny circles with your brush around each tooth. Are there any grownups here? All right well I just want little ones know that just because the grownups are here. I'm not going to be doing anything to like. Kiss up to them. Don't worry it's all for you guys. It's like grown-ups aren't even here in my mind. You're just going to get the jokes. You'd be getting if there were no grownups here. So what's your rushing to the other side of the bottom of your mouth and keep on brushing ask. What did I want to talk about next so I was cleaning my room without being asked to the other day? This is of course after finishing all my green vegetables. Right relatable to you guys and I was thinking to myself. Isn't it so funny? That whenever her grandma GRANDPA send me a birthday present? I don't even WanNa play with the toy. I JUST WANNA get right on writing that thank you note. And that's chompers tonight. Come back tomorrow for more standup week. Now all you have to do is three. Two chompers is a production of Gimblett media.
15-Min Free AMA With Erik
"Go ahead ask me anything. Hey there. I'm Eric. Olson I'm heaven. Daisy join us our journey to building a one hundred million dollars company. What's happening? It's Eric J Olson. One of the things that I am doing these days is I am offering a free fifteen minute consultation to anyone about frankly almost anything. But it would be best if you had a business question for me how to start a business how to grow business or some question about digital marketing. So I'm doing this for lots of different reasons, one is because people have a lot of questions about this stuff like you know, we've been doing this for a while. As far as running our business and growing our business and digital marketing, so we get a personal lot by people asking sometimes some basic questions, sometimes some more advanced questions, but people just have a lot of questions about these things start a business how to run a business and about digital marketing. There's a lot about digital marketing social media. Seo Websites on on advertising the pros and cons of each. And, so this is people. Ask Us he's things all the time. And since we are now working remotely and I don't get the opportunity to answer these questions in person. I have a new thing that I'm trying which is basically an ama asked me anything. If you have a question about entrepreneurialism how to start a business how to run a business how to scale business, or if you have a question about digital marketing, then you can ask me whatever you want free of charge, no sales pitch and I'm just going to try to help you. So if you go to Ama with Eric's as a m a with the word with Eric Yara K.. Dot. This is array dot com. Go to are L. Ama with Eric Dot dot com. You can sign up to schedule a meeting with me and it'll be a fifteen minute. Google. Hang Out! I will record it and I'm going to then post it online for social media purposes, so I will tag you in the Post that we create and the recording that I share. It's a way for me to also create some content along the way, but honestly the real reason is I want to help. Whoever has these questions and I'm willing to provide. Fifteen twenty minutes here or there to answer these kinds of questions, so if I can help in any way hit me up so again. It's AMA with. Eric Dot this ray dot. State you for listening. Is it time for new website? It's so we'd love to help you out. Check out. Our website services at this is the Ray dot com.
#80 - Celebrity AMA #1: Fasting, rapamycin, performance vs. longevity, and more
"Hey everyone welcome to the Peter Attiyah drive. I'm your host. Peter Drive as a result of my hunger for optimizing performance health on jeopardy critical thinking along with a few other obsessions along the way I've spent the last several years working with some of a successful top performing individuals in the world. And this podcast is my attempt to synthesize what I've learned along the way to help you live a higher quality more fulfilling life if you enjoy. Enjoy this podcast. You can find more information on today's episode and other topics at Peter at MD DOT COM and to a special bonus. Ask Me Anything episode and what we are likely to call celebrity AMA number one in this and future her celebrity Ama bonuses instead of being asked questions by my head research analyst. Bob Kaplan I'll be asked questions by guests. Either future guests special guests or just other guests on the podcast so for Celebrity Ama one I'm joined by Olympians Apollo and Sasha Cohen and we talked about fasting we talk about the role of nutrition Russian during periods of study. This prompted by something that Apollo is about to embark on we talk about exercise the ultimate gorge or Feast meal and we talk about watches watches. which really I think was the question I struggled with the most from their Sasha takes over and she asks me about things that excite me the most in longevity we talk about 'em Tauran rapamycin how to measure results when you're doing a lot of interventions blood tests and supplements along with a few other things as reminder? Ama's are are for subscribers. Only if you're not a subscriber you'll only be able to hear a preview of the Ama here if you are a subscriber and hearing this it means you have yet to download our members. Only podcast feed with this member only feed. You'll be able to subscribe to the drive in your podcast player to get every episode of the drive without the subscriber callout plus full episodes loads of the AMA podcast directly along with other exclusive content. You can learn more about it appeared he. MD DOT com forward slash members to become a subscriber to have have access to the members. Only podcast feed as well as other benefits such as detailed show notes member only discount codes and the products. I believe in you can visit Peter. Tia MD DOT com forward slash subscribe. We'll continue to police questions from the AMA forum and we encourage all subscribers to participate. Ask questions as we hope to get to all your questions in time through future. Ama's so without further delay. I hope you enjoy celebrity. Ama numberof Apollo no eight eight time. Olympic medalist spent fifteen years of my life previously pursuing the sport of short-track speedskating. And I have the pleasure of doing a Ama with Peter not oh my good friend and I've got some interesting questions here and hopefully you haven't answered all of them before in the past I'd try to do as much as I could would love to expand upon on some of these further so thanks for having me on Peter to interview. You're having me on so take it away. Let's jump right in so my first question is centered around women and fasting and to give it some context my girlfriend. She has a very difficult time. Doing water only fasts gets dizzy Z.. Feels like she needs some sort of sugar. Some kind of just anything any type of caloric intake and where I can do seven plus days kind of no problem most of the the time. So what is the difference here. And is there a separate protocol that you've seen for maybe perhaps clients who are female. I definitely noticed over the past few years that even even when it comes to time restricted feeding so not even getting to the point of fast but just saying not eating for eighteen hours a day that there appears to be a gender difference I can sort of concoct a bunch of evolutionary answers that may or may not be true. Certainly one of them one's I'll come back to if we have a moment is to talk about the impact of fasting on infertility in women. So my point being is definitely appreciate what you're saying and we see it clinically with our patients. Now that said I also have seen many female patients who can fast independent pendant. Body habit is because obviously beyond tiny and maybe that plays a role. But I don't think that that's it because I think there there might be something else going on so I think I don't know the answer but what I would say is it might just mean that for some people. They need more time to work up to a fast. Which means longer stretches of time restricted feeding and then what we would typically do is progress patients through through something as follows a once a person can pretty consistently go eighteen hours with a six hour feeding window? You then moved to one meal per day. Can she do one meal per day absolutely and in the afternoon she feels totally no problem. Okay so then the next thing. I typically try a thirty six hour fast where you'll do like dinner Monday. Lunch breakfast Wednesday so so you go a night and then a full day and then into the next day is that something. She's tried. Yeah she can do the forty hour fast. Anything past I would say seventy two. It's really difficult for her. She is not able to physically basically can leave. The House is she experiencing lightheadedness cramps. No cramps but definitely headedness severe lack of energy and just doesn't have the cognitive ability to do anything that would require semi deep thought again. It's hard to know I mean. Does she check her glucose and Kito levels all the way through this now sometimes that provides a bit of an insight. I've talked about this a bunch but I find going into Kito says just the week before makes that transition a lot easier so much easier and I've sometimes done the exact opposite and gone right into a fast out of bender. And that's you mean you'll pay the fiddler all all day long. The other thing that I think is important for everybody understand is one. I'm glad to hear that when she feels that way she stops. Because I do think it's important for people to not hammer through fasts no matter what you you can quote unquote fail at a fast ninety nine times and come back on the hundred and be successful in my mind. They're all successful so so I think it's really important that people get it through their mind that hey if this isn't feeling writer going right stop and eat again. The second thing is a lot of people don't realize how much food contains water. So when you're not eating you have to make up that water that you're not getting from food in addition to what you think you normally would need to drink so if you're a person who normally gets by sort of drinking call it for leaders of water at Sa a gallon of water. You're going to need more than that for two reasons. The first is when you're fasting. Your body is typically excreting sodium at a higher rate. So that's creating what's called the diary so you have to compensate for that and then have to compensate for the fact that you're not getting the water in the food so that might be the other thing to think about and the easiest way I mean. There's some technical ways that one can sort of measure the volume balance but honestly just looking at urine output. His a great way to do it. I mean when I'm fasting. One of the things I'm thinking about is how often I go into the bathroom if I don't get up to about every ninety ninety minutes I'm not drinking enough got it. That's great the other thing by the way she a caffeine drinker. Normally she's not okay because that's the other thing that you always WanNa think about in people sometimes when they stop. Stop Caffeine as well. The one two punch of no food. No caffeine can be really devastating and in those patients I generally think it makes sense to probably allow them to continue to drink black coffee or high caffeine tea or whatever sort of pick and choose your battle. Okay thank you for that just moved number two so my question. Is You have kids. So what are your thoughts. It's on adolescent fasting. And is there a place for it routinely I E D. You think that in twenty years it'll be a regular park fifty years of a curriculum or a dietary program so I'm talking mid teen too late eighteen point. That's an interesting question and it really depends. I suspect on the health of the Child Eld so there are probably certain situations where it could make sense. Unfortunately today were in. Canada epidemic of obesity. Type two diabetes non alcoholic Fatty Liver Disease Amongst amongst kids in adolescence and certainly in kids with metabolic conditions under the right supervision. I think one could make the case that some form fasting whether it be time restriction feeding or even hypo caloric periods of time for example several days at a time with an energy input. That's below requirement choir man could have enormous medical benefit. But at the same time one has to be very careful about threading this needle. Because they're still basically supposed to be an anabolic mode. Fourteen fifteen sixteen year old adolescent is still growing and so a lot of times doctors who take care of kids that age that have obesity have a different goal which is not weight loss per se. But actually wait stability so let them grow into this wait now. That's a bit of a Sorta Hokey concept because as an athlete you'll appreciate that weight. Eight is not really the issue. The issue is fat mass versus muscle mass. And in the end what we're talking about is potentially a treatment for excessive fat mass. Ask the other thing. Of course it has to be really considered is I do believe. And I don't have great evidence to suggest this is really based on discussions with endocrinologists knowledge EST my own personal experience in interacting with patients that have had eating disorders. But I think there is a critical window during which deprivation of food can be potentially harmful and I think that's why I've certainly seen a subset of people who have had disordered eating or eating disorders during adolescence and it it has sort of imprinted their endocrine system in a way. That's come back to haunt them as an adult so kind of a long winded answer which is to say. I think we don't know the safety of that yet. My view is is that unless you're an adult really. This isn't something that should be considered as a regular part of how you eat. But that's also acknowledging the fact that I know evolutionary it's tolerated because obviously we came from our ancestors who whether they be children or adults would have gone through periods of time without food. So yeah I don't know I think think this should be studied though because it's important and I I wouldn't want to speculate from or extrapolate rather from adults okay. That's a long list man. That is a lot of questions. I'm looking at over there here. Do you went whole hog on this holy cow. You took it serious and I apologize everyone. WHO's listening to some of these are selfishly? Because I just really want for myself and speaking of that I'm going back to school. Aw this fall and I did. Yeah Yeah So. I'm doing this program at Warton is okay. That's what that's what I was asking you about because I thought you were going to be in Philly this week basically in a couple of weeks All right so in lieu of that what is your preferred diet for. Consuming large amounts of information retaining it while still being alert because is the influx of information and critical. Thinking is going to be at an all time high for me for approximately eight straight. You can find all of this information and more Peter T M D dot Com forward slash podcast. There you'll find the show notes readings and links related to this episode can also find find my blog at Peter Attiyah. MD DOT COM. Maybe the simplest thing to do is to sign up for my subjectively non lame once a week. Email where update you on. What I've been up to the most interesting papers papers I've read and all things related to longevity science performance sleep etc on social? You can find me on twitter instagram facebook all with the ID Peter at not at md but usually twitter is the best way to reach me to share your questions and comments now for the obligatory display for this podcast. For general informational purposes only does not constitute the practice of medicine nursing or other professional healthcare services including the giving side of medical advice and note. No doctor patient relationship is for the USA USA. This information and the materials linked to the podcast is at the user's own risk. The content of this podcast is not intended to be a substitute for professional medical advice. Diagnoses or treatment. Frequent users should not disregard delay in obtaining medical advice for any medical condition they have and should seek the assistance of their healthcare professionals for any such conditions lastly and perhaps most importantly I take conflicts of interest very seriously for all of my disclosures the companies I invest in and advise. Please visit Peter Tapia M._d.. Dot Com forward slash about.
The Porn Reboot Podcast Episode 230: Routine, Systems, and Accountability
"Welcome to the porn reroute podcast. Where you get practical tips to gaining control over your porn or sex addiction. I'm your host jake. Ama's certified sex and porn addiction recovery coach. Welcome to the episode. Today we are going to round up this series for high performing rebuilders. Yesterday we spoke about one of the strategies which was standard over schedule. And today i'm going to be breaking down the remaining three strategies. We're gonna be diving right into gentleman. The first one is routine now. Successor routine success ritual even though your schedule is changing all the time as a high performance professional. It's important as this type of individual that you have a routine which includes two things the first is you have a time when you set your intentions and decide on your schedule for the week. I speak about this briefly in an episode on what i call regulation and maintenance now we actually have a training for this. Within the porn reboot implementation an intensive program from going to talk about that here briefly every sunday. I look at the schedule ahead. And i figure out how. I'm going to hit my standard for that specific week now a couple of days ago. When i spoke about standards i used the reboot time as the standard. So how many times are you going to implement your reboots time for the week. Now you also want to have a standard for everything else in your life or when you go to the gym for how often you spend time with your significant other or your diet like the things that you eat. I even have a standard for how. I'll consume sugar. So that's something that's in my life. I wouldn't say i don't eat sugar at all but when i do consume sugar. It has negative impact on my life so if a standard as to how much i can have and i just don't have anything more than that right. So what does this do. This allows me to evaluate. What's going on in my work schedule. Like if i'm traveling. Or if i have a night out with my goal friend where i'll be eating at a restaurant or if i will be at a meeting or some sort of networking events where let's say alcohol will be present and i know like okay. You gotta pre prepare. Are you going to go to that. Are you going to drink. Are you going to implement your to drink. Maximum standard which i will but the important thing is i have to plan it out. I just show up to these events thinking that. Oh you know what i'm totally going to go out with my girl and we're just gonna eat and i'm just to eat whatever i want to eat or i'm just gonna go out to this meeting. Hang out with these friends and just you know just no plan for what. I'm gonna do no standard for anything into week so knowing all these things allows me to hit my standard even though my schedule might differ slightly from week to week. And it's going to do the same thing for you the second thing when it comes to your routine as half time every week in your routine where you reflect on how you did during the past week self assessment and self reflection of both the key habits of high performance every week. You want to ask yourself. What did i do well. What did i accomplish what i struggle with. Where could i improve for this upcoming week. Evaluate these things to ensure that you are making progress week after week and that you're always getting better. Now we make it. Easy in the porn reboot system. Because we already have all the worksheets that you can use to evaluate your week your month and now we have something that you can use to evaluate your behavior on a year to year basis. And finally when it comes to your routine have a daily part of your routine way you reset your intentions and make adjustments to your schedule but this is more on a day to day situation. So schedules can sometimes change last minute right. So one of your kids get sick as an emergency client cancels a meeting there's a blackout zoom. That's not working right so it's important that each day you're adjusting to make sure that you're on track to hit your standards for the week. Even if that means having to reschedule your reboot time or an accountability cole. Or a coaching call or a therapy session for later on in the week or change. When and where. Your implementing your reboot. Time always set your intentions for the next day to make sure that you stay on track to hit your standard. So that is one of the strategies on routine broken down into three parts. the next strategy brother is systems. Now you already know that. I'm big on systems. Would you want a system. is everything. Obviously your reboot should be systemized but your career your business your health your nutrition going to the gym even your relationships and if you're single you're dating life i believe they should all be systemized. This is very important if you want to be a high performance professional so truth be told when i tried to do all the things. I'm talking about right now on my own. It actually made it harder. Are you in that situation. Are you one of those guys where you're just like. Oh my god. I'm trying to implement everything on my own. You just end up confused stressed out. Maybe you're doing some things but when you look at your progress over the past couple of months like cut dammit. I haven't done anything right in business. It's common knowledge that you can go further when you build the team around you. Okay so this. Those high performance business owners delegating is one of the keys to producing more within a business while the same thing goes for your health results. This same thing goes for your reboot to the same thing goes for even your nutrition. Your workouts right. So there's a quote that says you can go fast alone but you can go far with others. One of the best things that i did for my reboot. My businesses. my physical amend mental health was systematising part of my life. I created a system for my reboot years ago. Which today is the point of view boot system. But i also created systems for my nutrition by business investments. My relationships my workouts everything. I made sure that i had coaches. Who were holding me accountable. In all these areas. So for instance. I'm able to focus fully on porn reboots while having other businesses and investments which run into background passively because i have systems for them. It wasn't easy to implement these systems. While i was doing this but i knew that i had interests i also knew that. Something like porn reboot made a huge difference in my life. And i wouldn't have any of the things i didn't have if i didn't control my sexual behavior so i felt that you know what this is my priority. This is the place. I wanna put all my energy. But how do i do all those other things. How do i manage these other businesses. I had qualified. People design these things for me so that it eliminated the thinking and planning and reading a thousand books and different systems in order to make that happen for myself. Before i got into a relationship. I had a system for online dating. I had a system of meeting women in person while being busy in my career. So i got busy started managing lodge organization and i was like. I don't have time to just take time off a dates or spend time online. I have to meet women while. I'm on business on the go in the app or at a coffee store while i'm doing my groceries on our time to specifically go out and meet women are time to go to clubs and bars and all that sorta stuff right and lastly. I made sure that i had community which was holding me accountable in all cases so that no matter how busy my schedule god i was being held to my commitments and my standards and this is how i still live today and the biggest thing i had to overcome was the ego. Was that part of me. That said you can read a book. You can take a course. That's going to teach you how to do this on your own. Yes they helped yes. I was able to make some progress. However i made the most progress. I was able to stay consistent and i was able to do so many things in my life in an organized manner and i'm still able to simply because i had systems and in some cases i had people designed systems for me and stay accountable rather keep me accountable to them. The final strategy. I'm going to share with you. Is the secret sauce so to speak to sustainable success. A high performance reboot or and it is accountability now most of my high performance clients. Tell me that accountability is the reason that they have achieved their goals in most areas of their life right and there have been certain keys that have been proven to deliver high level results and studies have shown that when people apply these three keys or we can call him these three ingredients to any routine. They make serious progress in their life. They achieve their goals at a much higher rate. Those three things are the number one. They've signed up for a program number two they have paid for it number three. They are not doing it alone. They doing it with other people and these three things are very important especially the last one they are doing it with others. There's so many people who believed that. Oh my god. I am going to make so much progress in finding the root cause of my out of control behavior. If i work with this therapist who specializes in this thing. One on one. You may make progress. You probably will to be honest but when it comes to your an out of control sexual behavior you need a community because it is unlikely that this individual who is helping you with these breakthroughs is going to be able to keep you accountable at the level you need now. We are tribal creatures. Whether you want to call yourself. Lone ranger and introverts contrarian person who does this differently when you are in a community you cannot help but compare yourself to others. You cannot help but rise to the standard of the group that you're in and this is how we've designed to porn rebooted limitation and intensive programs. It includes all three of these important ingredients when you sign up for the porn would implementation or intensive program or any other program out there for that matter. Make sure you're signing up for something that excites and challenges you with the intensive program for instance you get an individualized results coach. You get a concierge. You have someone in your corner on a daily basis that you communicate with they hold you to a high standard and you are committed to giving a high level of accountability in return. Now you're also going to receive a community of other professionals on the same mission as you are. High performance high impact entrepreneurs professionals executives and leaders all striving to woods growing a great relationship with their spouse and their kids controlling out of control behavior growing their businesses and their careers while rebooting and in our community we use a combination of different strategies. Motivation support recognition. And of course. All of this comes together. It's wrapped up our wonderful system but most importantly you become a part of our family. You become a part of our little tribe here. You will get on a mission if you aren't already to becoming a truly high performance professional in control of your sexual behavior in your own life said the end of the day brother. We believe that this mission that we're on isn't just about controlling your behavior with pornography or masturbation or having a great marriage or relationship most importantly it's about becoming the best version off yourself. I'm jay struggle. Thank you so much for joining me on this short series on becoming a high performance re booder. I'll speak to you later on into week.
#145 - AMA #19: Deep dive on Zone 2 training, magnesium supplementation, and how to engage with your doctor
"Lou everyone welcome to a sneak. Peek asked me anything or ama episode of the drive podcast. I'm your host peter. At the end of this short episode. I'll explain how you can access the ama episodes full along with a ton of other membership benefits. We've created or you can learn more now by going to peter t md dot com forward slash subscribe so without further delay. Here's today's sneak peek of the. Ask me anything episode. Welcome to ask me anything. I'm once again joined by my head of research. Bob kaplan in this episode aka ron tug nut. In today's episode we go really deep on zone to We touched one exercise a little bit more. Broadly than that. And we get into a few other tangents. Outside zone to tee pees on five you know some of the anaerobic stuff but mostly this is a super deep dive into zone two from a practical level so if you heard the ago sign milan podcast. You'll have obviously an understanding of what that is if not. Don't worry because we revisit it but more importantly i think we get into the how to do it. What's the dose. What type of exercise. What type of machines the frequency. What if your numbers look like this. You know all of that kind of stuff. So i hope by the end of this episode. You'll really understand how to bring zone to in as one of the four pillars to your exercise program. The other things we get into in this episode are low down on magnesium so we had a great question about hey. Peter keeps talking about this type of magnesium vitamin magnesium. This had been magnesium. Can you give us the skinny on that. And so we get into that and then we close it out with a short discussion on the. How do you actually talk to your doctor about some of the stuff that we're getting into here a couple of weeks ago. Actually couple months ago now we had a newsletter that talked about early screening or more aggressive screening colonoscopy which is a point of view that i have and there were many questions from listeners. Saying hey look sure. That'd be one thing if you were my doctor we could have this discussion but having this discussion. My doctor is actually much more difficult than and so. I try to offer as many insights as i can into. How one would go about doing that without being off putting and obviously trying to get the best care you can so without further delay. I hope you will enjoy theater. Run tug nut. How are you the one. And only. I'm doing pretty well. I feel like our. Ama's have turned into basically a game of hockey obscurity. Where every time we meet on video. You've got a different nineteen eighties slash nineties goalie as your id. That's right growing up. Just love the bruins and hated every other team. But i had a lot of respect for run boston. Bruins saved seventy shots in. A three tie was just absolutely unbelievable. It's on youtube. Check it out to some of the saves that he was making was just unreal. It's great m. Mr tug nut actually is from my home borough of scarborough ontario the little crappy outpost of toronto. I remember that we've got a nice easter egg if anybody cares to look in the studying studies series if you go to. I think it's studying studies part. Two and i think it's figure two. It's about chimney sweeps check out that figure caption. It's pretty impressive. I forgot about that. Thanks for reminding me you approved it. So it's there. What do we have a madaba today for. Ask me anything. We have a lot of questions. Related to exercise zone to we also have a few questions around magnesium and then we got a lot of follow up questions on a couple of weekly emails. Which were i think. The earlier one was how to find a good doctor in the questions that you should ask if a doctor and then we also had a weekly email on colorectal cancer and colonoscopy and a lot of questions that you should ask your gi doc before getting a colonoscopy and we had a lot of questions around how should. I approach my doctor with these questions. Is there a way to do that. That's most effective if we can get through all of that in one episode. I'll be delighted but let's see how far we can absolutely okay zone to an exercise questions. I type of exercise. One of the questions we received is. What is the best device to buy if you want to do zone to your home rower. Stationary bike or treadmill. Bob or should i say ron may. I take a step back from this before answering it and create a bit of a broader context. If there's a listener who's not familiar with exactly what zone to is. I'll allow it. I think it'll be helpful. Thank you as you know in our practice. We kinda framework for how we think about exercise and it has four components. Those components are stability strength aerobic efficiency and anaerobic performance. Now i will focus on one of those today. I just want people to understand that when we talk about zone to it doesn't mean that the exclusion of these other things stability strength and the anaerobic piece but it is the way in which we think through the aerobic piece. So you don't wanna table that stands on three legs or two legs or god forbid one leg anymore than you want a root canal and therefore one has to be very clear that when you think about zone to us that it is but one component in subsequent episodes of the podcast and ama is will get much deeper into these other things when you understand that you understand okay. We'll zone to. It's got a very clear definition. And this was covered in previous podcast with sean milan. I don't remember what number that is obviously will link to it. Eighty five so it is defined as basically your highest metabolic output the highest amount of work that you can sustain while keeping your lactate level below to minimal or two moles per liter. So what does that mean in english to understand that you have to think about what's happening bio chemically as you exercise or frankly do anything. The process of respiration which is central to our existence is the process of using substrate and for the purpose of this discussion. Let's just think about glucose and fatty acids and oxygen to make atp and carbon dioxide. So let's just restate that we use glucose we use fatty acids we use oxygen. We undergo a chemical process. So we take the chemical energy that is stored in the bonds of those molecules. We turn that into electrical energy. People have heard of something called the electron transport chain which it is the bulk of where that takes place and then it gets turned back into chemical energy as we borrow from that energy to make atp and then atp becomes our currency for. How do everything and just again to put this in perspective. Any interruption in that system is fatal so when you think about a toxin like cyanide what is a microscopic dose of cyanide. Kill somebody instantly. It's because it actually stops process. Now people may already appreciate that. There are a couple of different ways that we can go about making atp and it basically comes down to how quickly the body is asking for it so the first step and let's just limit ourselves to the discussion of glucose to make this really simple. The first step is turning glucose. Which has its a six carbon ring into two smaller molecules. That are each made up of three carbons called pyro. Vague and that process doesn't yield a whole heck of a lot of atp yields a little bit costs. A bit makes a bit but when you stop there. The body kind of has a choice in the choice is do. I continue this process. Outside of the mighty qendra where i make another byproduct State and i can generate a little bit more. Atp by the way or do i take that peru and shuttle it into the mighty qendra and undergo a separate chemical pathway and a separate process called the krebs cycle where i can make many many more. Atp's so well obviously linked to sort of make this much more clear graphically but if you need to make atp really really quickly you'll take that former pathway and make lactate because you don't need oxygen to do it so you're not limited by the amount of oxygen that is being taken up by the muscle. If you have time on your hands he'll take the latter pathway with means you will utilize oxygen and actually take that substrate into the mitochondria and you'll be to make tons of atp now. All people are not created equal both genetically but more importantly through training in one of the biggest things that differentiates the highly trained from the untrained. The metabolic fit from the metabolic. Unfit the flexible from the inflexible. Is that ability to under a greater and greater array of metabolic demands make that input of substrate into the mitochondria so micahel health then can be somewhat estimated and proxy d- by the ability. A person has to do this. So how would you measure this. I mean shy of doing muscle biopsies and things which obviously we're not going to do. How can we get an estimation of this and it turns out one of the most valuable ways to do. This is to measure lactate levels because we can measure this this lactate if you start producing too much of it will actually escape the muscle and get into your circulation and you can measure it very easily with a finger prick. Just as you would measure glucose or key tones or some other metabolite a healthy person. When they're sitting there at rest has a lactate level of about one mill if they get up and move about their day and walk around and have breakfast and watch. Tv and get in the car or whatever they're doing their lactate really shouldn't be changed their actually demanding more atp than if they were sleeping but a reasonably metabolic flexible person and healthy person. Those activities i just described shouldn't at all be pushing to generate higher levels of lactate so in other words. You're not accumulating lactate. Now what happens if we asked you to start doing something a little more strenuous at some point you're going to start generating lactic doesn't matter how fit a person is if you push the fittest person on the planet at some point they're going to have to start generating lactate. Because you're basically saying. I need you to make energy or atp faster than you're able to deliver oxygen to your muscles and at some point. They can't clear that lactate. So at some point the lactate begins to accumulate in excess of what is cleared and we can measure that now. It's a bit more complicated. Because the oregon that is primarily responsible for clearing lactate is the liver and does so via gluconeogenesis and that takes longer. So there's a big time lag there. The other thing is different. People have different amounts at which they clear lactate from the cells of everything i'm describing is taking place in the side of plaza of the cell. It still has to escape the cell to get into the circulation and it does so via transporters called mcat's so different people can have different levels of mc t. expression but if you put that aside for a moment it's crystal clear that the fitter a person is the healthier. A person is the more work they can do with less lactate. And therefore for a given individual we use this metric zone to as a place to say how metabolic healthier you. How good are your mitochondria. And that means how much work can be done while you keep your lactate right at about two minimal. We kind of use a slight range. We'd say about one point. Seven two two mil. So how does one do this. If i'm walking down the street. And i run into you. And i say hey bob what's your zone two and we were both in the know on this. You could literally spit out a metric on my zone to two hundred watts. That would assume that you're riding a bike and that would mean you could hold two hundred watts for a very long period of time. Because you're never really going above to minimal and to minimal is a very very sustainable level of lactate production people have probably heard the term lactate threshold. This is well below lactate threshold. I take thresholds for most people kind of in the four oil area in lactate threshold. An athlete is really only able to hold that pace for depending on their level of fitness. We're talking tens of minutes if not less and obviously peak output is going to produce lactates easily over ten and in some cases over twenty. Those are you know efforts that can be sustained for seconds. Sort of all out two minute. Effort might produce that in a very fit individual but zone two is functionally offers your all day pace but there is an enormous variability between what some can do. And what can't in the podcast with ago. We discuss one of the studies that he did. I believe with george brooks they compare people with type two diabetes to people who are normal fit people to world class people class athletes. I believe cyclist and the difference in the zone to meaning the amount of power that they could put out on a bicycle while keeping lactate at two with staggering. Especially once you normalize for weight which is really the way you want to normalize. These things is not just. How many watts. But how many watts per kilo. So i know that was a bit. Maybe more information that people wanted up front. But i don't think you can understand everything. You're probably going to ask me without that. So now your question. If i recall was if you wanted to use on to training at home. What's the best type of device to do it on. Thank you for listening to today's speech. Peak a episode of the drive. If you're interested in hearing the complete version of this ama you'll want to become a member. 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These member only benefits head over to peter at md dot com forward slash. Subscribe last week if you're already a member but you're hearing this it means you haven't downloaded are member. Only podcast feed where you can get the full access to the ama. And you don't have to listen to this. You can download that at peter. Md dot com forward slash members. You can find me on twitter. Instagram facebook all with the. Id peter md. You can also leave us a review on apple podcast or whatever podcast player. You listen on this. Podcast is for general. Informational purposes only does not constitute the practice of medicine nursing or other professional healthcare services including the giving of a medical advice. No doctor patient relationship is formed. The use of this information and materials linked to this podcast is at the user's own risk. The content on this podcast is not intended to be a substitute for professional medical advice. 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#45 - AMA #4: sleep, jet lag protocol, autophagy, metformin, and more
"Hey, everyone. Welcome to the Peter Attiyah drive. I'm your host, Peter. Drive as a result of my hunger for optimizing performance health on Javadi critical thinking along with a few other obsessions along the way. I've spent the last several years working with some of the most successful top performing individuals in the world, and this podcast is my attempt to synthesize. What I've learned along the way to help you live a higher quality more fulfilling life, if you enjoy this podcast. You can find more information on today's episode and other topics at Peter Tia, MD dot com. Everybody. Welcome to this week's episode of the drive. I'd like to take a couple minutes to talk about why we don't run ads on this podcast. And why instead we've chosen to rely entirely on listener support, if you're listening to this you probably already know, but the two things I care most about professionally are how to live longer and how to live better, I have a complete fascination and obsession with this topic. I practice it professionally and I've seen firsthand how access to information is basically all people need to make better decisions and improve the quality of their lives curing and sharing miss knowledge is not easy. And even before starting the podcast that became clear to me, the sheer volume of material published in this base is overwhelming. I'm fortunate to have a great team that helps me continue learning and sharing this information. With you to take one example are shown outs are in a league of their own. In fact, we now have a full-time person that is dedicated to producing those and the feedback has mirrored this. So all of this raises a natural question. How? How will we continue to fund the work necessary to support this as you probably know the tried and true to do this is to sell ads? But after a lot of contemplation that model just doesn't feel right to me for a few reasons. Now, the first and most important of these is trust. I'm not sure how you can trust me. If I'm telling you about something when you know and being paid by the company that makes it to tell you about it. Another reason selling ads doesn't feel right to me is because I I I just know myself. I have a really hard time advocating for something that I'm not absolutely nuts for. So if I don't feel that way about something. I don't know how I can talk about it enthusiastically. So instead of selling ads I've chosen to do what? A handful of others have proved Ken work overtime, and that is to create a subscriber support model for my audience. This keeps my relationship with you, both simple, and honest, if you value what I'm doing you can become a member and support us at whatever level works for you in exchange. He'll. Get the benefits above and beyond what's available for free. It's that simple. It's my goal to ensure that no matter what level you choose to support us at you will get back more than you give. So for example, members will receive full access to the exclusive show notes including other things that we plan to build upon such as the downloadable transcripts for each episode. These are useful beyond just podcast, especially given the technical nature of many of our shows members also get exclusive access to listen to and participate in the regular ask me, anything episodes. That means asking questions directly into the AMA portal. And also getting to hear these podcasts when they come out. Lastly, and this is something really excited about I want my supporters to get the best deal possible on the products that I love, and as I said, we're not taking dollars from anyone. But instead what I'd like to do is work with companies who make the products that I already love and would already talk about for. Free and have them pass savings onto you again, the podcast will remain free to all. But my hope is that many of you will find enough value in one the podcast itself and to the additional content exclusive for members to support us at a level. It makes sense for you. I want to thank you for taking moment to listen to this. If you learn from and find value in the content, I produce police consider supporting us directly by signing up for a monthly subscription. Welcome to AMA number four. I am joined again by Bob Kaplan, my head research. This will be our first subscriber only AMA pure subscriber, you can watch or listen to this full episode on our website. If you're listening to this on a podcast player, you'll be able to hear a preview on the AMA. And then you'll have to finish listening or watching on the website as a reminder, we pull these questions from the AMA form and any subscriber is welcome to participate in this episode. We talk about the following blue blocking glasses and lighting cortisol and sleep my jet lag. Protocol discussion about PMS and the hormones around it discussion around tough Aji, and then we close with a rapid fire which gets into some issues like CME for podcasts. How to find a good doctor interesting biomarkers to monitor if the tech was not an issue and the idea of a PHD versus an MD if you wanted to study long jabbing welcome to AMA number four. Welcome. Everyone to ask me anything before. I guess we're starting Peter what's up with those glasses the glasses? These are one of my two favorite sets of glasses that I like to wear when I'm looking at electron IX in the evening this brand which I am neither sponsored by nor received any compensation from. But I do fancy is called Gunnar G U N N A R. And I went through a bunch of these before deciding on the that these are the ones I liked more than the others. I started out with gaming glasses. I and I just didn't find that. I had enough sort of coverage. So for whatever reason these optics are the ones I like the most they have a ton of stuff on there. They're not that expensive, and they usually have sales. So when they have a sale I recommend buying like two or three pair, and then figure out which one you're gonna like the most there's another brand that I like whose name, I'm blanking. On now, that's not a gun. But it's a pretty solid brand. It's it's about twice as expensive though with these guys you're into about forty bucks. The main issue is if you can remember to do so putting these on once the sun goes down as you're looking at electron IX, huge difference, especially for computers. So I'm more of a laptop guy than I am a phone guy. And I'm usually working on a computer, I don't know till at least an hour before bed. Unfortunately. And this is key. Whereas on the phone there is a setting that like renders the phone completely read or completely gray, which is different from just the usual light setting on the phone, and that usually is more than adequate than needing, these classes and on the laptop to at least for the MAC, they had the F Lux. Yeah. Which will take the light down. And that's pretty good. I do that as well. I kind of view the glasses as an insurance policy, and I definitely notice a difference. In my sleep quality, at least, objectively and sometimes subjectively based on my remembering to do that. And there are times. I just I dunno. I space. I don't do it. And I'm going to bed having just been blasted by that light. It sorta sucks. Do we want to explain what's actually going on with when you're wearing blue blockers probably taken us back a little bit with the glasses? But what does it actually doing? It actually seems like it's one of those hacks for lack of a better term that that is affect of in terms of lighten sleep and circadian rhythms. Yeah. So I mean, I think to understand sleep. You've gotta think of three things so sleep is kind of like a balancing act of forces. Now, this is a gross oversimplification. And you know in our podcast with Matthew Walker. We're going to go into much more detail on sleep. But I like to think of sleep as a balancing act between cortisol melatonin and identifying so we'll talk about each of those for second. So. By dennison. If that sounds familiar, it's because you remember from high school biology that ATP which is the currency of energy is a Dennison Tri phosphate. So the way to think about Dennis is it something that gets built up the more energy, you've expended. So if you were to measure Dennison levels in the morning, and then dentist levels in the evening. They should be higher. If you've been doing something. And so that's the first thing you want happening when you sleep is you want denting levels to be high. And in fact, that's actually how caffeine works caffeine keeps you awake by lowering Dennison levels. The second thing you want is cortisol cortisol has to go down. And I've spoken about this little bit before. But basically you have a cycle to cortisol. So if the x axis is time, and that's the moment you wake up, and that's the moment, you go to bed, and that's your cortisol level. You wanna wake up at a low level, and you wanna go to bed at a low level, and what should be happy. As in about the first two hours. You should have a huge surge in cortisol for the listeners only Peter's, actually as luck would have it. There's an easel behind us as we're having this conversation drying this. He's assault pattern. And so you want to have this uptick gradual down nice and low at night and just as you're waking up it should be just about to kick off. So that's the second factor. So you want a dentist to be high cortisol to be low, and then the third thing you want is you want melatonin to rise and melatonin is secreted by this tiny tiny little gland called the perennial gland. And it is secreted in the absence of light, specifically blue light. And it's basically a signal to tell the brain that it's dark, so it's melatonin basically removes the brakes of staying awake. And that's where the glasses fit him. So if you're really trying to optimize. Your sleep you want high Dennison you can accomplish that by not having caffeine, and by being active you want low cortisol that's probably a lengthier topic and himself, and then you want high levels are rising levels of melatonin. So we got a bunch of questions around sleep. So while we're on the topic maybe can cover a few more of one of the questions was how to minimize jetlag and sleep disruption while traveling. Everyone enjoyed a sneak peek of this AMA AMA's along with extensive show notes and member only discounts on products that I think are awesome are available to subscribers own. So if you're interested in hearing the remainder of this AMA or want to access any other benefits that come with being described please head over to Peter at the MD dot com forward slash subscribe. Learn more and sign up if you're already a member please head over to the show notes page where you'll be able to finish listening the audio or watch the rest of this AMA on video. You can find all of this information more Peter Tia, MD dot com forward slash podcast there. You'll find the show notes readings and links related to this episode can also find my blog at Peter TMD dot com. Maybe the simplest thing to do is to sign up for my subjectively, non lame once a week Email where I'll update you on what I've been up to the most interesting papers, I've read and all things related to longevity. Science performance sleep etcetera. Unsocial you can find me on Twitter Instagram Facebook, all with the ID Peter Tia MD, but usually Twitter is the best way to reach me. Share your questions and comments now for the obligatory disclaim, this podcast is for general informational purposes. Only does not constitute the practice of medicine nursing or other professional healthcare services, including the giving of medical advice and note, no, doctor patient relationship is for the use it as information and the materials linked to the podcast at the user's own risk. The content of this podcast is not intended to be a substitute for professional medical advice. Diagnoses or treat users should not disregard delay in obtaining, medical advice for any medical condition. They have and should seek the assistance of their healthcare professionals for any such conditions. Lastly, and perhaps most importantly, I take conflicts of interest very seriously for all of my disclosures companies. I invest in end or advise, please visit Peter Attiyah MD dot com forward slash about.
#84 - AMA #10: Low testosterone, hypothyroidism, building muscle (and preserving it while fasting)
"Hey everyone welcome to the Peter Attiyah drive. I'm your host. Peter Drive as a result of my hunger for optimizing performance health on jeopardy critical thinking along with a few other obsessions along the way I've spent the last several years working with some of a successful top performing individuals in the world. And this podcast is my attempt to synthesize what I've learned along the way to help you live a higher quality more fulfilling life if you enjoy. Enjoy this podcast. You can find more information on today's episode and other topics at Peter at MD DOT com the puck into another edition of. Ask me anything once again. I'm joined by my head of research and my sidekick POB Kaplan in this episode we go really deep about three things. There's no speed round but I think we make up for it by just the depth rather than the breadth so the first thing we talk about his testosterone replacement replacement for men's specifically when it's appropriate related risks benefits the laboratory values. One should and shouldn't care about so apologies that this one is a little more gender specific Pacific. I didn't think we've also already covered this on the female side. So this is a very male centric view of testosterone replacement therapy second thing we jump into his thyroid replacement therapy and just in general thyroid hormones. How they're produced? How the diagnosis of hypothyroidism is made in my opinion how that differs from maybe the standard way the people think about it and all sorts of other tential things around that and then lastly we talk about exercise and specifically we talk about exercise and how it relates to nutrition with respect to building muscle now to be completely clear and I disclosed this fully in the episode? I don't consider myself an expert on muscle building bodybuilding. Anything like that. You certainly wouldn't want me as your coach if you were training for such things but at the general population level which is where I consider myself to be. I think I hopefully know enough to add value here so so anyway we talk a lot about the role of fasting caloric restriction up and down and muscle accumulation versus loss of muscle. We also talk about tougher G. I. G. F. OR INSULIN. Like growth factor and tour in the process so without further delay. Here's a number ten as reminder. Ama's are for subscribers. Only if you're not a subscriber you'll only be able to hear a preview of the AMA here to become a subscriber to have access to the members only podcast feed as well as other other benefits such as detailed show notes member only discount codes and the products. I believe in you can visit Peter. T. A. M D dot Com forward slash. Subscribe the podcasters. Welcome to another. Ask Me anything I am joined by. Peter Tia this is Bob Kaplan appear how you doing. I'm doing good Bob. How are you doing? Well thought we just jump right into it. Start off with some testosterone. Wow No foreplay foreplay. Go for it. Yeah a lot of questions around testosterone the essential question is are you a fan of testosterone supplementation as as men age if so to what targets. Well I mean this is sort of a tough question. It's very difficult to answer these questions in isolation because they're kinda dependent on individual patients bear with me. I suppose as I kinda give us allegedly regardless of what. You're talking about manipulating in medicine. He should ask yourself the question. What is the desired outcome M. I. manipulating this variable because I believe it improves longevity if so does it improve lifespan? Does it improve health span both neither one more than the other testosterone. Let's it's just now evaluate stoskopf replacement through that Lens. which is what are we believe it can help with well? I'm not really particularly convinced that normalization of testosterone will improve lifespan. I could be wrong on this. There are certainly associations that would suggest that that could be the case. For example low testosterone is not only associated with prostate cancer but is associated with more aggressive prostate cancer. Her by the way I think that that's probably not saying that. Low testosterone causes aggressive prostate cancer. I think it says that if you have prostate cancer and a low androgen environment it is likely to be more aggressive. We could probably spend an entire images debating the merits of Testosterone Astro replacement therapy. But I in spending a lot of time in this literature. I don't see a clear and obvious case that you one will live longer longer because of it and again living longer by definition means delay the onset of death at least as it pertains to chronic disease so then I would sort of turn the table a little bit and say well. Is there evidence. That improves health span. Well health span again. Has Three components one of them is cognition. One of them is sort of physical exoskeleton for. I still got to come up with a better name for this one Bob. I hate saying Exa so skeleton because it sounds like I'm talking about a grasshopper or something like that. I always think terminator okay. Even better and then the third one is emotional health wellbeing happiness etcetera. Now I think the testosterone can have a pretty significant impact on two of those three which was the odd man out. I'm not convinced that testosterone has an impact on cognition. This has actually been studied once. And we'll link to the study in the show notes. It was studied quite recently. Meaning the last two years is study habits limitations but it did not suggest that testosterone replacement therapy was improving cognition. Now I know there are a lot of people out there on a physicians out there who prescribed arrived here T- who would disagree with me on that and would say that empirically. It appears to maybe. That's the case. Maybe it's not but as a selling point I generally don't on say two men normalization of your testosterone is going to improve your memory again. Who knows what the placebo effect can mean in the situation? But I I I. Generally by and large. Don't think that that affect is there and if it is there. I don't think it's strong. Let's go to the area where there is absolutely no denying the benefits of testosterone replacement therapy. which is the improvement of and or maintenance of lean muscle mass strength conditioning recovery from exercise? All of these things they they all fit into this bucket of. How does your physical body work and there is no doubt the testosterone? Improves those things. The magnitude that those things are improved proved however is not obvious is not entirely predicted by the number. So let's come back to that Bob. If you can remind me 'cause I wanNA really go into that. But just for the sake of completeness. Let's turn our attention to the last piece of health span which is sort of happiness and emotional health contest Austrian improve those things. I'm a bit embarrassed to say. I don't know how rigorously this has been studied but the effects would be difficult to miss. If you've ever treated patients with low testosterone then respond favorably which is to say you know mood can get better libido tends to get better and maybe those two things alone alone are worth the price you know worth any risks that are going to be associated with testosterone because someone who's Libido is shot who now all of a sudden has desire to have sex again and intimate and be all those things that alone could be a benefit to a person's relationship and therefore to a person's life so in summary. What am I saying? Four things we think about right living longer improving cognition improving physical body improving emotional health I think to with those three probably are impacted. Positively by testosterone. I think two of those three are probably less so yes. There are lots of ways that having more muscle so mask could also delay death so notice. I said chronic death when I was talking about death but of course they might be the case that testosterone replacement therapy can improve muscle mass ass and functional strength. They can later in life prevent accidental death. Which is probably the fourth leading cause of death when somebody is old enough? Okay I said way more about that than I wanted to and I have not answered the question yet but do you bob any questions about everything I just said. Can I go to the next part of this now. That sounded good. I know that We looked into testosterone. Did some research on it and I remember seeing the the endocrine society their recommendations for TRT for symptomatic men with low T. and etta following purposes which sounds like be pretty much nailed them. All improve sexual function improves sense of wellbeing improve muscle mass and strength and increased bone mineral density. You can find all this information and more appear Attiyah. MD DOT COM forward slash. podcast there. You'll find the show notes readings links related to this episode can also find my blog at PTA MD DOT com. Maybe the simplest this thing to do is to sign up for my subjectively non lame once a week. Email where update you on. What I've been up to the most interesting papers I've read and all things related to longevity science performance sleep etc and social? You can find me on twitter. Instagram facebook all with the ID Peter at md but usually twitter is the best way to reach me to share your questions actions and comments now for the obligatory disclaimer. This podcast is for general informational purposes. Only and does not constitute the practice of medicine nursing or other professional healthcare services Mrs including the giving of medical advice and note. No doctor patient relationship is for the use of this information and the materials linked to the podcast is at the user's users own risk. The content of this podcast is not intended to be a substitute for professional medical advice. Diagnosis or treatment users should not disregard or delay in obtaining medical advice advice for any medical condition they have and should seek the assistance of their healthcare professionals any such conditions lastly and perhaps most importantly I take conflicts of interest. I very seriously for all of my disclosures companies. I invest in indoor advise. Please visit Peter Attiyah M._d.. Dot Com forward slash about.
The Porn Reboot Podcast Episode 222: Motion Over Emotion
"Welcome to the porn route. Podcast where you get practical tips to gain control over your porn or sex addiction. I'm your host shake. Ama's easy certified sex and porn addiction recovery coach. Welcome to the episode. Today we're going to be speaking about emotion and motion now back in the day. When i was doing the whole door to door thing that was a manager in our company and his nickname was spartan was guy could motivate a lot of people. He had this saying he would repeat and it was just take the e out of emotion and you get motion and just take action and what that meant. Was that instead of just talking about all the emotions that you're dealing with. How do i deal with emotions. There's a time to simply move forward. Make progress build up a mental and make even more progress. We have a free private facebook group on facebook. Obviously and right now. We have about as of december thirteen bouts just over two thousand members but we actually get thousands and thousands of applicants and we have an almost fulltime which assistants who just goes through every single application and just decide who's going to be within the group and who's not going to be in the group and one of the reasons why i do. This is because a lot of men who are looking for help with the out of control. Behavior are very attached to their emotion in our group. Go through the group once a week. And i also out men who complain a lot without offering a solution or some thing solution for themselves and then asking what other people think about it so for example could be at a very stressful day and i came back and i slipped. I feel frustrated. I it sucks. Because i have this. This'll attached to streak. So they'll had this thirty day streak or this forty day streak and i feel this way. Here's what i'm going to do to set up a boundary around this thing. Would you guys think about that. Or i thought that my boundary was going to work or i thought that myself care was good enough but it isn't and that's frustrating. What are your thoughts so when guys are just showing up to vent and to just share that emotions alone which is healthy. But if that's all they're doing they eventually get removed from the group so when you slip and you choose to focus on the shame the disappointment the frustration and so on you literally choosing the emotion over motion you are choosing the emotion over moving forward and the truth is you can only have one of those. You can either have the emotion and if you have the motion. You're not going to have the motion. it's one or the other. I've often said that you emotions have nothing to do with your obligations. And when i bring this up. I'll have the occasional person show up and say well. Jk that means that you don't really understand what you're dealing with like. What does that mean. Well you know a lot of porn addicts are they deal with. Depression and depression can stop you from doing all these different things. I'll depression as a real thing. They're men who are clinically depressed. The men who go through various bouts of depression. I am one of those men who at least i would say two times a year. I'll go through just this phase off depression. There's a heavy cloud over me. And there is often really know coping strategy that i have that can overcome that deep sadness right. I'm a human being. I'm a work in progress. But i'll tell you what that doesn't do to me. It never stops me from going through with my obligations. I may feel no need to even exist on our planet like. There's no point in me being here. But again that deep emotion that is permeating every aspect of my for those of you who have struggled with any form of depression is actually not physically holding me back from accomplishing doing what needs to be done right. I'm granted what needs to be done. Might not be done as efficiently or in the best way possible during that time but it still gets done guys say oh no. That means that you're probably not depressed. Here's his proof of that slavery at least slavery in america right now. In america slave worked ten to sixteen hours a day. Monday through saturday and the only day that they had off was sunday the sabbath and you were put to work as soon as you a three to four years old right toddlers were already weeding and picking up trash and caring drinking water and feeding livestock and helping in the kitchen now where people depressed. You bet they were. You bet. people were depressed. Not being paid being forced to work being treated like livestock a millions and millions of people with depressed but they still woke up and did what they needed to do. They did it because they had to survive. They did it for the survival of the family. It didn't matter that your family could be separated and sold off to another plantation the next day but you still went to work. Of course there were exceptions to the rule but for the most part that is a time in history that shows that something that i used personally as a motivation for myself. That people were often in circumstances where they had no choice but to do what was demanded of them would they were obligated to do by the unfortunate nature of the institution of slavery. And they did it regardless of how they felt all right so we live in a world where for the most part we are free and we are very free compared to slaves from that era and when a man tells me like yeah. I was so emotional that i just couldn't take any action or i've just been feeling down so i haven't done anything. That belief is bolstered by going online and then having other people try to relate to you by telling you like yeah. It's okay if you're not able to do anything and that's fine. Maybe you shouldn't be doing anything. The point i'm trying to make that when you struggle with an out of control behavior and you make giving into your emotions a habit and having it as an excuse for not doing certain things in your life you only have yourself to blame because of whatever it is you choose. You can only choose one. You can choose emotion or you can choose motion and the progress that comes with it. You simply cannot do both right. I'll give you a few more examples if you have marital issues right and your only focus is on the emotion coming from those marital issues right. You're focused on the fear of losing the relationship. You'll focused on the anger you feel. You're focused on the frustration of not being able to communicate the way you would prefer to with your spouse. You are not going to be able to move forward until you take that e out of the emotion until you make the decision that you know what i'm just going. I choose motion. I'm going to take action. There are many men whose partner as discovered that beta viewing pornography. And maybe you're one of those men who told you partner at some point that you had this problem. Maybe she was very upset about it and she said she was going to leave you but you reconciled with her. You apologized and he promised her that you are never going to engage in this behavior again yet. You did as most men who struggle with this behavior do and it continued and finally you get to a point where you realize that. Okay like i need help. And then you get on the phone. With one of our reboot strategists. The reboot strategist says like you know what in order to move forward and to be in our group in your situation. It is recommended that you have this conversation with your partner. I because there is if a reboot strategists discovers that you have so much shame and so much emotion that means that you desperate and if you're desperate and you're reaching out to us you're probably not going to make a good decision. Yeah we could easily have a conversation with you and your desperate and tell you this is the best program for us but the truth is ethically and for myself as the coach and for the good of all the other men in the community that is not going to serve anybody in the long run right so we prefer that men make a decision from a very logical place is still going to be emotion. But we'll tell you. Hey go back and have a conversation with your wife but many men in this situation will go back and they might have a conversation with their life and then she blows up. She's like oh my god. I can't believe that you are keeping this from me from all these years. I'm so disappointed. I can't have you under same roof with me. Is i just had no idea. Do you not find me attractive. I feel betrayed. I feel like i can't trust you anymore. Is there anything else. That's been going on and the men get caught up in these emotions. They're so caught up in it that they do not take any action they like. My priority is saving. My marriage. Like i can't i can't be in a group with other guys because my wife says she doesn't trust me to be around other guy. She doesn't think that's going to help me. She feels like we need to go to couples counseling. But they're so stuck in that that they don't take any action with ending out of control behavior. They will not go see a therapist. Who deals specifically with compulsive sexual behaviors. They will not go to a twelve step group they will try to quote unquote fix the issue with their partner. When all you're really doing is just choosing the emotion over emotion you might be struggling from the economic impact of covert on your business or on your career and then you also have a choice. There are many men who have lost jobs. There are many men who have lost their businesses or in the process of losing businesses. And we've spoken to both types of men but men at both ends of the spectrum. We still have many men in our group who are losing. Their businesses are struggling in their career. Of course we are very sensitive to that and programs adjusted to that but my point is there are men who choose the emotion and the choose to sit in the emotion not realizing that as long as they stick to that emotion and that story of all my goodness you know covert has done. This to meet has done that to me. Yes sure has right but at a certain point in order for you to move forward you must choose motion a final thing. i'll mention. is that gentleman. You should be wary of the communities that you spend your time in if you find yourself in a community where there are a lot of people sharing emotion only and they're not taking enough action. I guarantee you that the people within that community and not going to get far and there are a lot of coaches and consultants and influences out there that attract an audience based on complaining about problems and not actually giving solutions to those problems and people really like that you find that maybe large communities on facebook on social media and other places are literally made up of people who are following a group or who are following somebody because that person complaints and they complain very eloquently and you can relate to the emotions that they're complaining about and so you don't even know that you are a part of this group. You think you're there to help yourself. And they may claim that they're there to help you but actually what's happening is you're there because of the emotion when somebody's audience derives mostly from complaining about a very narrow group of problems. What happens is the people in their have less incentive to fix those problems in many cases even aknowledge the progress of other people. And what i mean by that is when somebody shares that they have made progress. You'll notice that some people cheer that but more people relate to posts and shares where somebody is complaining like. Yeah yeah yeah. I feel that way. That's one of the reasons why again the original reason that i share that the beginning of this episode why we really reject a lot of people who applied to the group and we on a consistent basis go through the group and purge it because some people come there and they have that attachments to emotion right. And that's how you end up having communities where there's no progress and these days unfortunately it's a tough gig to basically speak the truth because the truth is not sexy right the truth. It's not flavored with complaints. It's not flavored with the drama. It is what it is and a truth is either choose emotion or you can choose motion and making progress and you simply cannot have both. I hope that made sense brothers. it has jumped onto. Share that with you today. I'm jay your brother. The struggle thank you so much for taking the time to listen to this. Episode of the porn reboot podcast. Now whenever are ready they are a couple of ways that i can help you to control your out of control behavior with dog raphy. The first way is to join the group that i talked about right. Now it's called the porn reboot group. It's a private facebook group on facebook. There's a link to join it in the description below this podcast. The second way is to get on a call with one of our reboot strategists and find out if you are a good fit for our implementation program or our intensive program and if not perhaps you just are a little bit stuck in your reboots and you need some feedback on what you should be working on a reboot strategist will help you with that as well as make it very clear to them when you get on the phone with them and finally if you've been listening to this podcast but you would like to learn more about this system. I'm always droning on and on about then download a free copy of my book. It's called confessions of a porn addict. Seven secrets of porn freeman. And it's basically the roadmap to controlling your behavior with pornography using my system. It also has all the lessons that will learn by clients of mine who have been successfully off pornography and masturbation in many cases for quite a number of years. There's also a link in the description below this podcast to download it. Thank you so much for listening. And i'll speak to you later on in the week.
The Porn Reboot Podcast Episode 166: Counting Days is a Waste of Time
"Welcome to the porn reboot podcast where you get practical tips gaining control over your phone or sex addiction. I'm your host Jake Ama's. He said if I'd sex and porn addiction recovery coach. Welcome to the episode today we're going to speak briefly on time and counting in one of our groups. We often have men in off. Regroup actually to be precise. Often have men who come in from different modalities that come in from twelve steps, come in from working with a therapist. Basically they come in from a system that involves a lot of counting, and they'll often share things like I'm so happy. That I've reached ninety one days then in parentheses at put not that I'm counting and I'll see them share again months later Oh, you know I've reached this number of months I'm not really counting, but I would like to celebrate that. And I often gently remind them in the free group I don't really enforce it and implementation program and the intensive program. We just simply don't count at all. Because if you've made a significant investment, you want to follow the system, but in the free group I'm a little bit more lenient. I gently remind them why. Counting does not help when it comes to ending this behavior, and why it is actually the very thing which is holding you back. And so today I want to reiterate that in a very simple way. We, do not place. Much importance on days or months or years. We. Celebrate changes in feelings, not figures on a dial improvements in action up days on a calendar improvements in the quality of our thoughts, not the passing of time. and. Gratitude for time is good. Gratitude for change is better. See Time. Was it never within your control? But change always was so just remember. The time is going to pass anyway. It is futile to save it up. And put it on display as a win or a trophy of some sort I got to this number of days. This numbers of days of abstinence. This number of years of sobriety because time does not care. It's gone. That elation that you feel when you celebrate it, this appears. As soon as everyone has congratulated, you petted you on the back and give a new gold star. You elected only one thing and attachments to that time, which has already slipped through your fingers. When threatened by strong triggers that very time which you celebrated now becomes a burden. The more days and months you add to it the more precious it becomes to you the more beer you experience at the thought of losing it. Losing that which you cannot even keep. So the only thing that matters brother. Is the change that happens within us. The change. That affects the present moment. And it's that same change which has an impact. On your future. I'm Jay your brother indestructible? Thank you so much for taking the time to listen. To, this episode of the Porn Route podcast, we'll chat in a couple of days.
Understanding What's Going on in Your Industry
"The. Hey there I'm Eric Olsen. And I'm heaven days. Join us on our journey to building one hundred million dollars company. Hey, everybody. It's Eric when we were down in Orlando in January. We went to a American marketing association meeting in one evening, and the speaker was the CEO of the organization a self not like the wolf chapter, but the American marketing association, that's so before he actually spoke. There was a little bit of a happy hour, and it was outside. It was beautiful night. And I saw that he was talking to a couple of people, and I kind of worked my way over there. And I got into the little circle that he was talking to. And he was talking about something that's really kind of geeky when it comes to the marketing and advertising industry. It was something very specific to the advertising industry, which is large agencies. There are very big companies that are agencies that are advertising agencies. They they buy a lot of other agencies. And so the. A big agencies that really called holding companies, and he was talking about the concept of holding companies and how he was saying that there is some change happening in the industry and some clients are taking taking the work back in house. So that's a lot of detail about the conversation more detail than Asha wanted to share. But that kind of sets up the conversation what he was talking about that these holding companies are starting to fail because clash taking the work back and everyone in the circle just kind of like nodded, and because I had been reading industry magazines for a while before that event, I had a different opinion. And so even though I was the new person at this AMA meeting, the American marketing association, also Amei, it was my first one there in Orlando. And I was standing in front of the CEO of the large organization. This guy should know everything. There is no about marketing and the industry, I had a difference of opinion. And I've always my opinion. And I cited. With information that I had read about in the industry magazines. It was probably kind of a bold move to have a difference of opinion when everyone else's shaking their head. Yes. But I decided to voice the truth that I knew and won't be hold. He agreed with me. So it's not that these things are black and white sometimes there's just gray and people can interpret grey to black or white or shades of black and white. And so I had voice my opinion. He agree with me. It was interesting to me because I went to this marketing association meeting with people that are experts, and it was a Uber. Experts ending in front of me. And I had enough information to kind of counter his argument and felt pretty good. But that would have only happened if I had put in the time and effort to read these magazines and give a million with the industry myself. And I think that's what's lacking a lot not. Not only in this industry in every industry. So many people take for granted what they do Dane day out. And that they know what's going on in the industry based on what they witness in their own company and only their company, and I think it's a mistake. I think it's a mistake when people do not venture beyond their own company. They need to find out. What's happening, and you need to find out what's happening in other companies and in the industry as a whole if you don't you're really just super limited in your exposure, he to get more exposure as so that, you know, you act like an expert, and you can present yourself as an expert when you're in front of other experts like I was at this AMA meeting with the CEO of AM app. So it felt good to me that I had put the work in and it has something to contribute to the conversation. And he didn't say that. I was an idiot. He actually agree with me. So prepare for not only these meetings, but just prepare for your career. Dear don't just focus it on your company and your company loan understand what's happening and other companies and within the industry as a whole, and it will get you somewhere small steps. Thank you listening. I hope you heard something you can implement in your business right away. Vines online at journey to one hundred million dot com.