Hi everyone, my name is David Vernet. I'm joined by Song Liu. Today we're going to be talking about kernel live patching at Meta. So basically what is this awesome feature kernel live patching that's available in the Linux kernel? And then how and why do we use it at a company like Meta? So let's go ahead and get started. The talk will be roughly this. We're gonna start by giving a history of how fixes have been applied to the kernel in the past. What's been the evolution essentially of how this this has happened over over the course of the lifetime of the kernel? We'll talk about KLP of course, describe how it works, what its pros and cons are. Then we're going to move into talking about the ecosystem around live patch. So what sorts of tools are available in industry to make live patch easier? And to kind of assist you as a developer and creating live patch and using it. We'll talk about our experience with using live patch at scale at Meta. That'll include how we use it, what it's enabled for us. We'll then go on to talking about some of the challenges we've encountered with it and some of the fixes that we've added in upstream to live patch. And then finally we'll talk about some ongoing work with live patch and some future work that we're working on and that of course anybody else can join in on to help with as well. So with that said, let's go ahead and get started. Now, of course, the canonical way to apply a fix or upgrade the kernel in general is with a full reboot. So we've all done this, of course, you install a new kernel, you do a full reboot of your machine. The kernel is then loaded via the bootloader, UEFI firmware, whatever. The kernel itself then does a full boot, initializes all of its subsystems, powers on the devices on the host, allocates memory, does whatever it needs to. And then the system starts to run at that point. Okay, so obviously there are pros and cons to this. On the pro side, doing a full reboot is simple. The system is shut down. And when you're rebooting, everything is starting out from a fresh state. So there's no possible memory corruption. There's no running tasks or concurrency issues that you have to worry about. All the devices are starting from a powered off state. And then also the hardware does post checks, power on self test checks. So your hardware is validated before the kernel starts to run, at least at some level to verify that there's no issues, that memory isn't corrupted or something like that. Now, while this is simple and it's the safest method, so to speak, of applying fixes or upgrading your kernel, the cons are that it's really, really slow. You have to migrate all workloads off of the host. Obviously it's going down so you can't have any traffic going to those hosts. This requires downtime. Post checks can be really slow, especially in large machines with like tons of memory. And then eventually once the machine is booted and the kernels booted and everything like that, you have to re-warm your caches and start to send traffic again and ramp it up slowly but surely. It's slow and it requires a lot of time. So to address the slowness of things like power on self test checks, post checks, Kexec was added to the kernel. And the way that Kexec works is just like with any other kernel, you install a new kernel and then rather than rebooting your host, you Kexec into the new kernel.  That new kernel starts executing and then boots as though it had done a full boot from the host itself being rebooted. Devices are powered back on, the kernel allocates memory, it does everything it would do in a normal boot cycle. But you skip the power on self test checks and just in general the latency of rebooting. Now of course this is faster than reboots, that's a big plus. Like I said, you skip the post checks and it's still relatively simple. The kernel is doing a full reboot, there's no tasks running while you're doing this boot. But of course the cons are that it is still a lot more complicated than doing a full reboot. You have to make sure that the devices on the system support going through a full lifecycle, power running off, powering back on. That can require a lot of work with vendors to make sure that it's supported and that it's being done correctly. There is still downtime as well with Kexec, the host isn't going down but obviously the kernel is shutting down. So you have to migrate your workloads off and you still have the same latencies in that regard as you did when you were doing the full upgrade and the full reboot. Okay so this is great, these work but they're slow and what can we do to try to improve the slowness? Well we can use KLP. So what exactly is KLP? Let's talk about that before we talk about the advantages and disadvantages. So if you have a kernel function, the first instruction in that function is going to be a no op, a no op instruction. And so when the CPU encounters a no op instruction it just skips over it, looks for the next one. It's totally useless, it's just a placeholder for doing things like this. Where using Ftrace you could have that first instruction actually be a callout to an Ftrace handler and then that Ftrace handler can call out to a replacement function that you implement as a live patch. So basically you do a jump over to an Ftrace handler and then after it's safe to transition to the new function which we'll talk about a little bit more in a second. Ftrace will itself call out to your replacement function and you'll totally circumvent calling the original logic in the first function. So you've patched the kernel by having a new function that you call out to you with Ftrace. Great. So this is obviously a totally different paradigm for kernel upgrades compared to kexec or rebooting. This is happening at runtime in place, no tasks are being shut down, no rebooting has to happen. It just happens at runtime. What are live patches? Well they're actually technically special types of kernel modules so when you're applying the live patch what you're really doing is loading a kernel module and then the init hook is where the patch is applied. And we've mentioned Ftrace, well this is actually how it's done. You use the ipmodify flag to replace the existing kernel function in the way that we just showed. Okay let's talk about the pros and the cons. So obviously the pros are that it's super fast. At meta when we apply a live patch it usually takes on the order of one to two seconds to apply the patch to the host. That's to a single host, obviously not to the whole fleet of servers. But one to two seconds for a host is really really fast compared to even kexec. It doesn't require any downtime or workload migration. You just apply the live patch and it's low. It's lightweight enough where no perturbance is detected on the system. We'll talk in a little bit about how there actually can be some perturbance but those are bugs that need to be fixed. So on the cons side there are limitations to what can be patched with live patch. Live patching patches texts, executable instructions in the kernel. You cannot patch data so if a fix requires you to change the layout of a struct or something like that you can't live patch that. What you would have to do is something like jump to a different function that does like a lazy allocation maybe of a different type of struct and then have people use that pointer. So something that you wouldn't upstream but you can still sometimes get creative with how you apply live patches. Or if it's just like you're missing a null check or something then that's purely live patchable. That's like the canonical use case and that you can do. Or like mem setting or something like that if you forget to like zero out some stack variable. Another con is that in addition to the limitations of live patching extra engineering work is usually required to do this. It's not just as simple as compiling a live patch and knowing it'll be safe and applying it. These are kernel modules. You can break things if you're not careful. There are no guarantees provided on the fact on whether the patch itself is correct. So as we'll talk about later we'll talk about the ecosystem for live patch a bit later. You have to have a kernel professional that understands everything very well. Look at the patch. Look at the instructions and really verify that this is correct and nothing is going to break. So it is a lot of overhead but the pros are significant as well. So we already looked at this. This is the knob instruction that we patch and we call out to you with F trace. This is just showing you the instructions without live patch. We have this knob instruction here. We can overwrite that with live patch to a call instruction which calls out to the F trace handler. So pretty simple, super useful stuff. Live patch can also patch multiple functions atomically per task. So each task has a state that shows whether it has been patched or not for some instance of applying a live patch. And essentially what this means is that when you're applying a live patch the live patch subsystem will guarantee that it's applied atomically to tasks. So for example you don't have one task that's calling the patched function and then another task that's using the unpatched function that's not safe because maybe you're changing like how locks are acquired or something like that. And you could break things if it's not atomic. And so live patch will iterate over every task in the system and lock its call stack to detect if it's safe to transition the task or not. And if it fails to transition the task the live patch subsystem like any good kernel subsystem would rolls everything back and guarantees that the state is maintained from before the patch was applied. Which is pretty cool because it's a pretty complex operation. Okay so that's KLP. Now that we've spoken about that I will hand it off to Song and he can talk about the ecosystem around live patch. Thanks Davy. KLP is actually pretty common among enterprise distros. The primary goal for enterprise users is to fix kernel bugs without rebooting the system. The most popular solutions are Kpatch from Red Hat, Kgraph from Suzy, and Ksplice from Oracle. Here I want to thank Red Hat folks for sharing and supporting the Kpatch tools which are great. There are also third party solution providers who build patches for CVEs. Based on our knowledge all these solutions have similar internal mechanism but different two genes. So how do we use KLP at scale? First, why? As a matter we don't have a problem rebooting a specific system but we have a problem that kernel upgrade is not fast enough. Typically it takes us a month to upgrade the compute tiers and potentially much longer for the storage tiers. As a result we cannot rely on rebooting for urgent kernel fixes. And this means sometimes we have to run kernels with known bugs. And sometimes we have to debug the same issue multiple times because they may not hit the different tiers at the same time. Occasionally we have to have a fixed only kernel release just to fix a bug. And such releases will delay the actual feature release. The solution use KLP which can rule fixes much faster. Another case we found KLP helpful is when we debug tricky issues. Modern kernel provide a lot of tracing tools but there are still cases where tracing is not straightforward. For example if we want to trace the exact condition at the middle of a function it's not easy. KLP on the other hand can add a printk or maybe a traceable function to the exact location we want to trace and make tracing much easier. The other case we found KLP very helpful is when the issue is hard to reproduce. When we finally get a live reproduce of this issue we can use KLP to make smaller changes without resizing the system state. This will make more debugging much more efficient. So how do we do KLP at meta? We push for homogeneous configuration which means the kernel team owns the KLP and the user cannot decide which fixes you want or not. The other side of this is that we need to make sure the KLP do not introduce any new problems. homogeneous configuration allows us to do something called cobalative patch which means we combine all the fixes we need for a kernel in one KLP module. This greatly reduces the test metrics we need to cover. Kernel provide a replace flag which allow we attach the new KLP and detach the old KLP in one atomic KLP transition. This eliminates the vulnerable window between we load unloading the old KLP and we load the new KLP. At meta, KLP rule out is 100% managed by automations. We package KLP module in an RPM file, something like KLP for kernel X, hotfix Y, and we manage these RPMs just like any other RPMs. When we load the KLP, we use health check to detect any issues. Specifically, we compare the kernel with the new KLP and with the same kernel with old KLP. We check for issues like new crashes, increased error rate, or KLP transition failures. If any of these metrics looks bad, the automation will stop the rule out and bring this to the attention of the engineer. This figure demonstrates when we draw a new kernel. When we start a new kernel, we always start small with the release candidate and we gradually increase the deployment of the kernel. Before we have KLP if we get any bug, we have to go back to the first release candidate. With KLP, on the other hand, we don't have to do that. If there's a bug, we load the KLP and move on. This gives us a much more predictable kernel release cadence. To read out, KLP helped a lot. Right now, we have millions of servers running with KLP. And typically, it takes us a week to rule out a new KLP. In the extreme case, we can patch the whole fleet in hours. And we found KLP is essential to keep the fleet healthy. We have eliminated the most fixed only kernel releases. And we don't have to debug the same issues again. OK, so Song just spoke about the live patch ecosystem, how we use KLP and meta at a large scale. So now let's talk about some of the challenges that we've encountered when using live patch and some of the things that we fixed and upstreamed as part of doing that. So, yeah, live patch is awesome, as I said, but it still has some sharp edges. There are small performance issues, which independently or on a small scale may not be a huge problem. But then at a larger scale with a ton of hosts, it becomes serious performance problems. We've encountered some conflicts with the tracing subsystem due to the use of F-Trace and the IP Modify flag. And we've also observed that KLP sometimes fails to transition tasks due to things like not yielding the CPU, which we'll talk about in a second. We'll look at it in a second. So to start with, I want to talk about a bug where we noticed that we were applying a live patch to the meta fleet. We saw a short uptick and missed IO, and this would set off alarms all across the company. For example, one of the alarms was a higher TCP retransmit rate, which indicates that TCP packets are being dropped. The other one is a higher IO and F-sync latency, so we were getting alarms for some of our database workloads and stuff like that. Now, these spikes in retransmits and F-sync latencies were only lasting for one to two seconds, but then across millions of hosts, it results in alarms going off all over the place and people freaking out and it causes problems. So what was the problem? Well, it turned out that the INSMOD task, so the task in Linux that inserts a module and adds it to the system, and as we know, kernel live patches are modules, so INSMOD is applying the patch. It turned out that that task was hogging the CPU and starving KSoft IRQD from being able to run. So the kernel that we were using was compiled without preemption, which means that a long-running task in the kernel, unless it yields the CPU, will not be preempted by another task. So we would load the KLP module, we would be doing relocations. For relocations, you have to look up symbols to figure out what the address should be of the relocation, and because there's a lot of symbols in the kernel, this would start with KSoft IRQD. For anybody who's not aware, KSoft IRQD is a kernel task that is used to service interrupts when there's a lot of interrupts in the system and they're not all serviced. In a bottom half handler, they can be serviced later on by a kernel task called KSoft IRQD, and that's done to avoid starving user space and only handling interrupts and not letting any other work get done. So if KSoft IRQD doesn't get scheduled, then networking packets may not get serviced. IO, when it's completed, interrupts from like a storage devices may not get serviced. So the system slows down. Essentially interrupts aren't serviced and the system can experience all sorts of problems. So the fix was a very simple one. It's adding a cond resched call on the symbol lookup path. This is pretty common in the kernel. Any place where you're doing something in a loop and it could take a long time, you have to add a cond resched for this exact thing. That fix was upstreamed. And then one fun fact is that we didn't want to have to wait for the fix to be applied through real kernel upgrades as we were upgrading the fleet because we wanted to be able to apply more kernel fixes via live patch before that happened. So we decided to roll the fix out as a KLP. So we actually patched the live patch subsystem with a live patch. And we experienced the same like retransmit bumps and like the KSoft IRQD starvation during this rollout. But then for subsequent rollouts, we didn't observe it. So KLP can patch itself even, which is pretty cool. Okay, so now I will let Son take over to talk about tracing in data centers. Thanks, Devin. Tracing is first class citizen in the data centers. In other words, monitoring and tracing are as important as the main service. If the main service goes down, Uncle will come up at night and fix it. If monitoring goes down, Uncle also wakes up at night and fix it. So yeah, they are as important. As a result, KLP should not break any tracing users. However, there were issues. First, sometimes KLP may break trace point. This is because KLP function cannot have jump labels and trace point use jump labels. As a result, if there is a trace point call in a function that is patched, the trace point call is removed. This issue hit us as block trace start missing event. Fortunately, this is partially fixed in 5.8 on neural kernels by Josh. Specifically, trace point in the VM Linux will not be removed by KLP. However, trace point in the kernel modules still have this issue. Second, KLP may conflict with tracing tools. Specifically, both KLP and BPF coupling use the ftrace flag IP modify, which means we can modify the IP of this function. As a result, only one of the two can apply the same kernel function because we cannot modify the IP of one function to two different targets. And whichever comes later fails. This is fixed in 6.0 kernels. ftrace direct function, which is used by BPF coupling, no longer set IP modify. And BPF coupling is trained to share the same function with KLP. Next, KLP transition failures can be problematic at scale. Recall that to finish the transition, each task needs to start from KLP unpatched to KLP patched. And such transition happens at a specific point. The common point are first, when the task access kernel space and returns to user space. And second, when the task goes to sleep without any being patched function in the stack. This means kernel threads sometimes fail the transition because they never go out of the kernel space. This usually happens at a very low rate. However, unfortunately, low rate times a big fleet sometimes means many, many failures. So here's an example. The BPFS reclaim work may run for many seconds. However, it costs conditional reschedule many times per second, so technically it's not a bad behaving thread. However, this means we were seeing 10 times increase in KLP transition failure rate because the events on the kernel thread doesn't go to sleep often enough. Unfortunately, this issue cannot be fixed with KLP. And KLP with this fix has 100 times more transition failure rate because now the thread sleeps with a to be patched function in the stack. We have a temporal fix for this by adding KLP try switch tasks to the kernel thread. And now we're also working with upstream community for better fix and we'll give more information about this in the later slides. Next are ongoing and future work. First, we are proactively identify and fix corner cases because real corner cases in a big fleet can be a serious problem. Here's one example. If our kernel module with a patched function and you unload it and try to reload it, it fails. Why? Because when you load the kernel module, there are some sanity checks for the relocation addresses and KLP breaks it. This has to be a non-issue for years, but it hasn't been a priority for enterprise users because unload and reload the kernel module is not a common use case. However, it's potentially a big bazooka for a fleet managed by automations like MEDAS. Besides fixing corner cases, we're also adding new features to the toolchain. First, we add a toolchain support to build KLP for kernels compiled with ClimbPGO support. In this case, we need the profile data to build the kernel. We also need the profile data to build the KLP. This work is mostly down, but it's not yet upstream because the kernel support is not upstream. We're also looking at a case to have one KLP built for both intree and autotree fixes. We have this requirement because we need the replace flag and cannot have two KLP, one for intree fixes, one for autotree fixes. Thirdly, we're actively looking for solutions to reduce KLP transition failures. There's an interesting idea by Peter. Specifically, we can use F-trace to attach KLP tri-switch task to specific functions. As a result, pending tasks can finish the transition without going to sleep. Okay, that's all we have for KLP at Meta. Thanks for your attention. Any questions?


Well, hello again and welcome to this episode of Anabaptist Respectives. I'm here again with John Mark Koons at Faith Builders Christian School. And John Mark, I want to talk to you today about science and being Christians and science and scientists. And a lot of people don't think those two things go together. So I want to talk to you about that today, but before you do that, can you just give us a little bit of your background with science? One of my earliest memories related to science is in grade school. I don't remember what grade I was in, but I had to do this experiment where I took two balloons and put them on a balance beam scale, showed that they were the same weight, and then I was supposed to predict what happens if I blow one of the balloons up and then compare the weights. And I thought, well, obviously, they're still going to be the same weight. I mean, yeah, I put air in it, but it's just air. Air is nothing. And so I blew the balloon up and put it on the balance beam. And wouldn't you know the one with air and it went down? And I was like, what in the world? I'd like to say that that sparked my interest in science, and then I was always a scientist ever after that. I don't know that that's the case. I don't remember the surrounding context, but I remember that discrepant event as the kind of thing that science can do for you is just shatter your expectations. So anyway, I decided to pursue medicine when I was in high school. My goal was to be, I think first a heart surgeon, and then I found out that being a heart surgeon was really hard.  By the time I went to college, I had switched to pediatrics as my target. And so I went to college, got a bachelor's degree, a bachelor of arts and biomedical humanities, which is basically a pre-med degree. I took some time off of school and fell into teaching and have been pursuing the sciences since then, just kind of an informal way, reading whatever comes to hand and staying up to date on medical news and such. But yeah, science has been a growing passion for me over time. And a lot of the science that you read, you know, scientific magazines and all of that are coming at science from the worldview of evolution, and you're coming at it from the worldview of being a Christian. How do you see that working together or how did those things coexist? Because a lot of people would say, maybe especially outside our circles, would say, the Christians are over here and science is over here. How do you bring those together? I think that the mistake that Christians made during the scientific revolution was that they kept retreating behind a lack of knowledge. They said, well, but God still exists because you see, you can't explain this phenomenon and then science would explain that phenomenon and then Christians would retreat.  They were arguing for the existence of God based on the lack of knowledge in science. But that was a huge mistake that Christians made during the scientific revolution. And one of the last places that they have kind of stood their ground was in relation to life, the life sciences. And you still actually hear Christians saying, but God must exist because science can't explain where life came from. How did life start? I want to say, no, that's a mistake. Because what that does is it puts God off to the side and he only works through miracles with that viewpoint. Instead, I want to say that what science does is demonstrates to us or reveals to us how God works. During normal times, Jesus made wine at Cana and it was a miracle and it was an incredible miracle. You know, there's a lot going on there. Vintners make wine all the time and we don't raise an eyebrow about that. That doesn't make any news because they do it over a long period of time. But they do it with natural processes. Jesus did it by a miracle. We see those as two separate things. God is working in the one and he's not working in the other one and that's a huge mistake. We see science as revealing things about how the Creator works right now, in the here and now, outside of miracles. He works in miracles. I don't want to deny that, but he also works through natural processes. He also works in natural law. So coming back to evolution, one of the things that people really misunderstand about evolution is they think that Charles Darwin is the guy who came up with the idea and that he did it to disprove God. That's not quite how it happened. There were many theories of evolution before Darwin and in fact, some of them were pretty close to what he said. What Darwin did is came up for a mechanism for things to evolve over time that does not require an outside influence and so it's descent with modification or we call it natural selection.  It works. You see populations changing to fit the environment that they're in. Christians thought that by coming up with a mechanism where God wasn't required for things to evolve that Darwin was denying God. That's not necessarily the case. Just having a mechanism for populations to change over time that doesn't require God's miraculous intervention, does not actually remove God from the process. It's a natural process that he has set up. Now, that sounds as though I'm defending evolution. It sounds a bit like theistic evolution at least. So I want to back up and say we don't have to deny every tenet of evolution to maintain a Christian and even a straightforward reading of the Bible Christian approach to science. We do have to recognize that the mechanisms of the natural world were written into the universe by God and that there are gifts from him. So let me just clarify that a little bit for myself and for our audience. So you're saying and I think a lot of Christians would agree that since the time of the flood there have been what we call micro evolution where species do slowly adapt and there are more breeds of dogs and things like that. You're saying God is working through that. He's still part of that process. It's not devoid of God. Well it's actually a gift from God to populations and here's what I mean. During the Industrial Revolution there was a lot of particulate matter put into the air that killed lichen on trees. When they put particulate matter into the atmosphere the lichen on trees died and the spot of pepper moth went from being a mostly light colored species to being mostly dark colored. In the light colored population there were a few dark colored individuals who were able then to reproduce more quickly than the light colored ones once the lichen was gone. So the population had some variability in it and then the percent of the population that was dark changed over time to fit the changing environment. This is the process of evolution in a nutshell micro evolution is that populations adapt to the environment that they are a part of. The environment is always going to be changing and so it's a gift from God to the population to let it change. In contrast the Cavendish banana is basically a genetic clone. All the bananas we eat here in America are Cavendish bananas except for the little dinky ones. They are genetic clones of each other and what that means is that if the environment changes those bananas will no longer be viable in the place in which they are.  Okay it was big, it was tasty, it was it shipped well, it produced well, it was the perfect banana until a tropical fungus developed the ability to attack that variety of banana and since there was no variation in the population they were all genetic clones of each other as soon as one was vulnerable to that new disease all of them were vulnerable to the new disease so it wiped them all out. There wasn't the variation because people took the variation out that's what happens when you have a strictly static kind of population but God's gift is that we have a variety in the population and the population can shift its frequency, the frequency of certain types of individuals over time to fit the changing environmental surroundings. Let's circle back just a little bit then. I like what you said about how for a lot of Christians the lack of scientific explanation for something was really their proof for God because science couldn't explain it. God exists here at least and then as science debunked that and there was scientific evidence then maybe that was an area where God wasn't at work. According to the miracles and God and what we're just talking about with evolution are you saying that because in my mind it still hasn't answered where you're coming out on with macro evolution I don't feel like you've really really defined that part yet so I want to just push in a little bit more on that. Are you saying that God created the world in six literal days as a miracle and then we've had micro evolution since that time or can you just expand a little bit where you're coming at with the macro evolution side? So Genesis clearly indicates God's involvement in creation and I would say his miraculous involvement. The natural laws that we're familiar with now were clearly not at play in the description of God's creation. There are obviously lots of different ways that people read Genesis and I tend to think that when God says he did something I should believe that he did it that way. I also have to recognize that I may have misunderstood what he's saying with his account in Genesis. So I'm not going to attack or disfellowship somebody who reads Genesis differently from how I do. I think that if God wanted to he could have created the world last Thursday and given me all the memories that I have and everything and he has the right to do that. I don't think he did. He said he did it a certain way and I take it as a matter of faith that he did it that way. That being said I don't think that that's actually the most important way in which science and Christianity interplay with each other. One of the first things that God did after he created man in his image was that he said to dress and keep the garden and that task has not been eliminated. It's still our task and so I don't like to get into extended arguments about exactly how it started. I'm not going to stand up to God and say no you couldn't have created it that way. You couldn't have done it that way because it doesn't make sense to me. That's just not a that's that's hubris on my part and so I have to take the humble approach to recognize that I may not know everything. You've talked about this interplay of science and faith a little bit. Can you speak a little bit more to that? How does our faith as Christians and science and new discoveries, can you just speak a little bit more to that interplay and how we can reconcile the two or marry the two? I know that there are probably problems with the quote all truth is God's truth. I don't know what those problems are but I'm sure somebody has an issue with that. I kind of take that approach that all truth is God's truth. And so I see the scripture as telling me things about God that I couldn't know otherwise. I would not know about God's Trinitarian nature without reading the scriptures. I wouldn't know about Jesus without reading the scripture or the whole plan around Jesus. At the same time I wouldn't know the expanse of the heavens without science. I wouldn't know the size of the earth without science. I wouldn't know so much about what the universe is actually like if all I did was read the Bible. Many of those misstatements that atheists like to throw at scripture are not misstatements at all. They're metaphorical language and clearly metaphorical in the context. If you don't have science and don't have any way of studying the physical world, you don't have any other description of what the universe is like. And so you're going to get a very, very skewed picture. I see both as being ways that God reveals himself. Creativity and the power and complexity of God shows up in creation and his love and his grace and his jealousy and these other characteristics show up in scripture. If I reject either one of those, I'm going to miss something about who God is. Clearly for salvation purposes, scripture is primary, but as a Christian who wants to be fully formed into God's image, I ought to be studying what the world is like. I think everyone ought to be interested in science because it's a powerful tool for getting to know something about what the universe is like. And really doesn't it give us a deeper picture of just the awesomeness of God? You really can't help but look at something from the Hubble telescope or even look through a normal telescope from down here or read about these just intriguing scientific facts or how this animal does this under these circumstances or as a matter of fight or flight or there's so many things that's just like, wow, isn't God good? That's just kind of my response sometimes when I look at things and I think having a fascination with science really can point us to God more and help us worship him in deeper ways. One of the ways that this should work out in us as Christians is that we ought to be taking a creation care approach to the whole environmental question. So I grew up as an anti-environmentalist.  I mean, who cares about a moth, right? We were people and people clearly trump any kind of animal that's out there or plant or what have you. I've come to recognize that the anti-environmental movement, I could say, is every bit as dangerous as the environmental movement for our Christian witness and so I've started using the term creation care because when we go out and just wantonly destroy what God has made, we trample on things, on beauty that he has put there for us to take care of. But how do you develop human ingenuity or allow human ingenuity to flourish, allow human populations to grow without destroying the environment? I mean, there are Christians who are starting to work on this and unfortunately, far too often the loudest voices among Christians are those who are arguing about how we got here and very few people, very few Christians are taking seriously our task to take care of the earth that God has given us and there are lots and lots of reasons for that. Among them being that we don't trust science very much. We don't trust scientists because of the whole evolution question, that's one of them. As conservative anabaptists, we have often aligned ourselves with certain political movements that have set themselves up against environmentalism and again, environmentalism can go way too far. But as Christians, we need to take seriously our creation care responsibility. That's actually where my passion lies, that we don't get so caught up in the question of evolution that we forget to do what we ought to be doing right now. I said earlier, there are certain things I know to be true. I know God was involved in the process. I know that He upholds the universe. These are among the things I know, but the most important thing I know is what I ought to be doing now, which is to be learning what I can about the universe so that I can act responsibly. Just one example of thoughtless irresponsibility that led to significant damage. The Atlantic used to have a lot of salmon, Atlantic salmon, and they would go up the eastern rivers and spawn just like they do in the west now. When settlers came from Europe, they put in water wheels on these rivers and accidentally blocked the salmon from coming up the river. Without meaning to, they collapsed the Atlantic salmon population. They didn't overfish them. They were doing what made sense. You need power. You've got power right here. You build a dam and a water wheel. In so doing, you have this huge chain of effects that leads to really a beautiful fish and a productive fish, one that could have fed lots of people collapsing in its population. My point is that it was a lack of knowledge on their part. They didn't mean to. They didn't want to do this. They just didn't know. Had they known, I think they would have taken appropriate precautions. Early settlers cared, but they had other things. They didn't know enough on the one hand, and they also had certain needs right then. They needed power. They did the sensible thing, and in so doing, did tremendous damage. We can tend to do that if we ignore what science is telling us.  If we have often done things out of ignorance or maybe scorned or ignored science and gone ahead with a housing development or whatever that endangers some plant or animal in some way, if a Christian is truly caring about caring for God's world, what should that look like? Maybe let's just use the example of the power for the early settlers and the salmon. If we were just coming to America, we knew that the salmon go upstream to spawn, and we needed power on an east coast river. What should the Christian's thought process be in creating a sustainable solution for both human and animal? That's where I can diverge from a lot of environmentalists, the really extreme environmentalists, would say, well, you don't develop that river. It's important for those salmon so you don't develop the river. There are design solutions that can allow the salmon to spawn while still giving you the power you need in the west coast that have dammed some of those rivers, and they've built a series of steps that salmon could still get up past the dam to get to their spawning beds. But you have to think about how you can get what you want while still allowing for the things to take place that are taking place or that need to take place. If we don't, there are always these unintended consequences, and even if we do, even when we take things seriously and try to do it in an environmentally responsible manner, we are going to have downstream effects that we don't intend. That's just the nature of life. But as we learn more, we ought to be changing our behavior based on that. As an example for me right now, Roundup is a wonderful invention. But more recently, we're learning about the ways that Roundup actually damages the soil. And so I've stopped using it at my house, which makes things harder. So I have weeds growing in my driveway. How do I kill my weeds without Roundup? Well, I tried pulling them too many. I'm not going to do that. But I discovered that if I take a blowtorch and blowtorch them, they die. And so I can still kill my weeds while not destroying the soil with Roundup. Now, there might be a better solution yet, and I'm going to keep iterating until I find a solution that works well for me. That solution, for example, doesn't work under my spruce trees because I'll set all the spruce needles on fire. And that would be a bad thing. So I'm still trying to figure out how I'm going to kill the weeds under my spruce trees. But just knowing that glyphosate is off the table means that I have to get creative with my other solutions. And I wonder sometimes if maybe what's happened is, and I think this is true for pretty much everybody in Western civilization. Maybe that's a little too broad of a stroke, but we're capitalists. We live in a capitalistic society and efficiency and time are just really, really high priorities. Designing a dam that has a fish ladder in place is not the cheapest way to do things. It's not the shortest, most efficient way to do things. But I think as Christians, we need to check ourselves on those capitalistic pressures that we grow up in and we're surrounded by. Somewhere we need to find the balance of stewarding the earth and stewarding the other resources. And we really need to take into account all the resources God has given to us, not just the ones that society says matters, such as time and money, but that the earth also matters. And I think that's a really good balanced approach where you are caring for the environment, but you're not the one out there hugging the tree, so the bulldozer doesn't push it over either. Another big mistake that I think a lot of environmentalists make is that they see business as a problem with this. The ways that some businesses approach the environment are problematic. That's undeniable. But that doesn't mean that business itself or capitalism itself is necessarily going to be the problem. The Clean Air Act in the early 90s worked phenomenally well at motivating businesses to clean up the air. The program worked better than predicted. It was cheaper than predicted and it worked faster than predicted simply because businesses got on board with it and said, we're going to do this. They gave a business incentive for power plants to clean up their power stacks. And then you got the creativity that people put forth when there's money at stake. When you can make money at this, you tend to get more creative. You don't give up as quickly. Now, that's not to say the Clean Air Act was perfect, but it gives us an indication at least that if you get businesses motivated, they can do phenomenal things. And now, I don't actually think that the best approach is to have government legislate that businesses do this. The Clean Air Act gave a motivation for businesses, kind of a business motivation. I don't think it would work with other challenges that face us right now, but I think that there are other ways to get businesses motivated to clean up their act. And maybe you mentioned money as being a motivator, and I agree with that wholeheartedly. Should we as Christians and especially as Christian business owners who care about caring for God's world, should the motivation to be a good steward of God's earth, is that a good enough motivation instead of money?  And should Christians be more self-motivated, maybe is the question? I think we should, but we have to recognize that we still have to put food on the table. And our daily interactions are often around acquiring money in order to survive. And as a business, you are competing with other businesses. So you can't just care about the environment because of God's creation, and that's going to be enough. It ought to be the thing that motivates us. It ought to be an extra incentive for us. But the truth is that no matter how much I care about something, if it isn't sustainable for me, I'm not going to do it. I've talked to many teachers who love teaching, but they're quitting because they're not getting paid well enough. They care about it tremendously, but it's not sustainable so they can't do it. In the same way, I can care as much as I want about plastics, but it's not sustainable to live a plastic free life, so I'm not going to do it. And yeah, you're right that Christians and Christian business owners ought to have as part of their motivation to take care of creation, but that's not going to be enough to actually change practices in a sustainable way. And what I mean by sustainable is sustainable for you as a person or as a business owner.


Hi everyone, Joe for jaskiescasewrakes.com, coming at you with a random number block randomizer for this big group of teams right here, which will unlock Panini 1 football coming up in the next video. Also a full spot giveaway. If you bought a full spot, you got a chance to win a full spot. And guess what? Carl was the only one who got full spots. We even canceled the filler and made full spots available again. No dice. So then we turned it back into a filler. Anyway, Carl, thank you very much for grabbing those full spots. Let's get all your names in here and we'll randomize you a number. Let's roll it and randomize it three and a two, five times for names and numbers. One, two, three, four, and five. After five times, we got Barry down to Jose, delete this list now. And three and a two, five times for the numbers. One, two, three, four, and fifth and final time. We got four down to two. All right, Barry with four, Allen with five, Carl with zero. So remember Carl, zero gets you any and all redemption for that big group of teams down there where my mouse is hovering, including one of one redemptions. Scott, you'll still get live one of ones. Carl with three, nine, six, Jose with seven, Steve Locke with eight, and Jose with two. Now if there are any non-numbered cards that pop out of here for any of these teams, it'll be randomized to one person on this list. So there you go. I'll see you in the next video for the break, jaspyscasewrakes.com. Bye-bye.


We came here today to find out more about the, yeah, it's just the general trends for red because Caltang is now a pilot demonstration province and there's a lot of projects happening and because we work with communities of course we're interested in the interface between red and communities and how the benefits blow down. So a lot to learn and I'm very happy to be here. Coruscita red, I think at the moment it's suffering, it's suffering from some bad decision-making at the provincial or district level say. I think there's still lack of buy-in and participation at the district level, which is really crucial. It's not enough for national level to make announcements or proclamations if the district isn't really willing to surrender land or surrender forest area. So I think these things have to be ironed out obviously as a matter of priority before we can really hope for an optimistic future for red.


Okay, so city zero how markets and evolution can save lives and money gave you a little bit of a background on this I Wait one other Thought on the bacon piece. I had to live for almost 48 hours knowing that bacon was the most nutritious pork product on the planet sworn under Penalty of being dissolved in a hydrochloric acid bath if I gave it up. So That stuff's pretty cool. So So Moore's law any tech-oriented folks in here So Moore's law is a concept that was developed in the late 60s early 70s It was this observation that transistor speed tended to double at about a rate of every every 18 months So there was this kind of observation that computing power basically doubled about every 18 months and Guy named more kind of figured this out And so it's called Moore's law and this is held pretty consistent throughout the the recent history There's some thoughts that maybe at some point This is going to plateau out who knows quantum computing and stuff like that may keep driving this forward but in addition to this notion that computers get faster and they you know our ability to do Processing of information gets faster things also tend to get cheaper and shockingly so and so we see that as Cost per unit of computing drops the computing power goes up There are a ton of different observations or Market-based analyses that we can apply the same Investigation to even getting things out of the ground like natural resources mining and stuff like that tends to follow Moore's law We have a market-based intervention where we have innovation being applied to a tech to a problem Then typically we do things better faster and at less cost and and this is just a ubiquitous in various markets This is a hard drive cost Gigabyte of hard drive 1998 or 1980. It was about a million dollars to get your average Gigabyte of processing power today. It's less than ten cents a Gigabyte of processing is now so cheap that it's more valuable as a means of advertising than it is as the original artifact Intention, which is just amazing. I remember 1980. I remember you know wearing parachute pants and stuff And so at a time when when something was a value of a million dollars one million dollars We you know we have something that is now a Keychain trinket and so it's it's just an amazing change and it doesn't just apply to Let's say like hard drives and stuff like that like I said these these things apply to mining and a variety of other Activities, but the cost to to sequence a megabase of DNA back around 2001 was was again Enormously costly relative to what we can we can apply this problem today This this graph to two important things the first is that this is a logarithmic graph And so this drop is artificially stretched out It should look like a clip like a sheer face of a cliff for for one thing the other part That's interesting to point out with this. Is it the first phase of this? Decreasing costs of sequence in DNA was largely an outgrowth of the government Undertaking the human genome project and starting to sequence large amounts of human DNA Trying to to you know get a handle on what the human genome is Where the precipitous drop occurs who knows what caused that? Yeah, private enterprise intervened in the process and the whole the whole thing became it diverged away from Moore's law at a shocking rate It wasn't just a doubling of the information again It became a logarithmic change in the way that said this innovation occurred so today Let's say let's ask the question to the audience Do we know more today about genetics than we did 30 years ago? Yeah, how about pathology? Biochemistry epigenetics. I don't even know if epigenetics was a term 30 years ago So we know more about damn near everything that there is to know but yet costs of medicine this is a from the Congressional budgetary office. It says orthodox government as you could get there's nothing controversial No, tinfoil hats. Nothing weird about this at all and the projection is that by 2050 we will be spending We will be in debt 300% of GDP a massive allocation of that is going to go to health care costs Why is that how can that be? We know more about all of these problems Every other thing that we experience in our life gets cheaper and better With regards to technology we understand pathophysiology of any disease that you want to talk about Better than we've ever known at any time and tomorrow we're going to know it even better But yet every projection that we have is that costs are going to go up and they're going to go up in a way that is non-linear it's exponential and Another graph from the Congressional budgetary office. We cannot hang this on demographics We cannot simply hang this on an aging population It is clear that the bulk of these costs are related to health care and the bulk of the problems related to health care is Tied into diabetes, you know anything that you want to talk about that. I wanted to Bring in some information. Well quickly this graph it ranges the This is from Manage Care magazine in the middle bound. We're talking about one in three Americans being Officially type 2 diabetic the upper bound were basically between 1.5 and 1.2 I don't know how you get a half a person being Diabetic, maybe a leg falls off and it becomes like a zombie entity and goes on or something But again, this is following like a reverse Moore's law pattern. We are doing exactly the opposite of what every other industry or technological endeavor does You pick a thing I can Google it and find that some sort of innovation some sort of discovery is driving the prices down on something except medicine and Why the hell is that and can we sustain paying that and the answer to that is absolutely not People talk about national defense and all kinds of other stuff if you want to bankrupt this economy and there are several other Economies around the world that are relatively wealthy that have been Beneficiaries of a demographic bump when you have a small aged population a large youthful population that is very productive And they have very giving social welfare programs and whatnot Those things are changing because our costs for dealing with illness are increasing at exponential rates So my my I just generally asked this question. What the heck is it that we are doing that's so wrong And I would make the argument that we are not practicing Darwinian medicine that as Matt alluded in the beginning of his talk If we have a fleet of health care providers that don't really buy into or or use Darwinian medicine is kind of the beginning of their Hypothesis generation. We're really behind the eight ball with that This is like trying to do physics without an understanding of quantum mechanics, but that's a whole other whole other topic for a different day It would be nice if we had an example of something that actually does follow Moore's law type type patterns in medicine And in fact Lasix is a beautiful illustration of this even in non inflation adjusted dollars Lasix has plummeted in price and this this graph is out of date It's in 2004 current average Lasix prices are about six four hundred to six hundred dollars per eye And so what you have here is a situation in which you have a problem people with bad eyesight You have technological innovation that can deal with that problem because we have markets and a lack of third-party payers Which is the the definition of the the situation that we typically face Then we see a Moore's law type handling of this problem So as long as we maintain a third-party payer system as long as people think that Medicine is going to be free that they can have zero co-pay for everything which in basic economics means that everything becomes You try to take a limited resource and make it infinite then what you do is you make the price become infinite So we we've got some serious problems there, but we have obvious solutions in my mind to where we go with this So this is kind of part one part two or I guess I've got a little recap on it Technology in advances goods and services improve cost decrease We know more about pretty much everything under the sun. How can all this stuff be happening? So So I'm hoping that this next piece of the story is a little bit of the solution Hopefully it's the beginning of something that we as an organization as a movement can embrace if I if if what is happening here? Is legit what I think is occurring that it may again be the skinny end of the wedge towards an opportunity to change things in a really profound way so back around 2001 3 University of Nevada, Las Vegas police officers succain to cardiac events within a year's time less than a year's time The cost to retire an officer in the state of Nevada and different state a lot of states view police military and fire Anybody in that profession if they have a stroke a heart attack and autoimmune disease a host of different conditions If they develop that condition whether they are on the job or off the job It's assumed to be an on-the-job workman's comp L&I issue So not all states are like that but many states are like that Nevada happens to be one of them So the cost to retire an offer the officer when they suffer a heart attack or a stroke is about 1.2 million dollars That's the initial on the books number that people write down when they're trying to do their budgeting and when they do risk Assessment and whatnot the real costs are actually about ten times this amount and this is part of the reason why municipalities all over the country are going bankrupt because they are Reporting that they are going to spend one dollar amount on things and then they're spending ten times more on a variety of issues And this is a perfect illustration of this so this this situation with these doctors or with the Officers getting sick having cardiovascular disease costing the the state and the university huge sums of money to say nothing about the I Hope it's implicit that there's also the human life cost here when you have people dying on the job There's the you know the loss of human beings the loss of fathers the loss of mothers You know all the rest of that stuff I'm gonna focus on kind of the the hard real cost But the human cost are obviously enormous here brain drain and all the rest of that so especially health is a Health maintenance risk assessment program that was founded in 1993 there in Reno, Nevada I just moved to Reno back in November Kind of interesting backstory, which I'll try to weave into this here in a bit Initially these folks were an orthopedic risk assessment program So they worked with labor and industry claims workmen comp claims trying to figure out effective preventative measures for orthopedic issues, you know like a carpal tunnel C spine low back issues and stuff like that and then trying to recommend successful physical therapy medical procedures to offset costs so that these guys have been around since 1993 one of the folks at the University of Nevada Reno and Who was in the police department heard about the folks at UNLV and then they knew the the people at specialty health and they said hey Do you think you guys could develop some sort of a risk assessment program? We had three three officers almost died due to cardiovascular events down in Las Vegas We have a similar problem here in Reno for both the police and the fire. Could you guys? Possibly develop a risk assessment program and they said well We can certainly look into this and so they started putting the pieces together on a risk assessment program They did standard blood work HDL LDL total cholesterol triglycerides kind of the standard boilerplate blood work They did framing ham scores, which if you want to blow your brains out just try to figure out what the hella framing ham score is It's both worthless and Induces about a 50% suicide rate and those who study it Um They implemented it a when they put people through the blood work and they were found to have a High risk of say metabolic issues based off the blood work that they were looking at which at that time They were missing a ton of stuff They would recommend a high carb low fat American Heart Association diet and their results were absolutely dismal They were frequently Worse than the groups that did not receive intervention Let that one sink in These guys are getting paid by the city of Reno to do a risk assessment program trying to mitigate cardiovascular disease and the people Going through their high carb low fat framing ham score oriented program were typically developing type 2 diabetes at a higher rate triglycerides going up cholesterol going south and They were kind of like what the hell is going on. I mean they were following the American Heart Association guidelines They were doing the due diligence that physicians are supposed to do and follow the rules of the consensus And the results that they were seeing were obviously sub par It was not addressing the issues that these people suffered from at all So Luckily they kept looking and eventually the whole low carb concept got on their radar They found some work from gary tobs from mike eads and some other folks And they started doing a little bit of work around low carb intervention Uh, they got in contact with the national lipid association, which these guys are pretty cool. They they are far more sophisticated than the american heart association and Uh, they they will even openly endorse a ketogenic diet for high cholesterol issues elevated Ldlp and stuff like that. So they're they're pretty solid There's still some things that I would like to mold and change in the way that they they look at things But they're they're pretty solid They do nmr testing via liposcience labs, which I'll talk a little bit about what that is It's advanced testing look at looking at different lipoprotein fractions that seem to have A better correlate with actual cardiovascular events and I'm have some commentary on all that stuff too, but The current program they do a yearly risk screening So they pump all the the police and fire through a yearly risk screening now They they do all of them. I'll tell you about the pilot program here in a second Folks that are flagged as high risk either because of specific lipoproteins or because of overt insulin resistance Those folks receive a low carb slash paleo diet The paleo thing is kind of a newer addition the orientation towards gut health and what what not which I'll I'll get to here And just a bit they do some targeted pharmaceuticals some statins and some metformin which I'm going to comment on that They do sleep counseling They used to do it a bit since I've come on the scene They do it aggressively because it clearly like the paper that pedrobastos was was a part of talking about the ancestral biomedical environment and the changes in metabolic health associated with sleep I think if people are sleeping well, it's very difficult to kill them if they're not sleeping well It's hard to keep them alive So this is a a huge problem in police military fire and medical situations in which these people are forced to be in Suboptimum sleep conditions almost constantly and so we need to figure out strategies for mitigating those those effects And so we do sleep counseling and a variety of Kind of support material with that we recommend metabolic type conditioning circuit type conditioning to help reverse Insulin resistance and and whatnot, but that we are trying to emphasize an appropriate dose and and not kill folks with it So here's a a standard good Blood work They call it the big five. We we've got a Body mass index, which is kind of like eh, whatever blood pressure breathing is actually cardiac output and Whether or not the person's smoker Lipid profile and then blood sugar This person is is pretty solid I'm only going to show you the front page of this this NMR this advanced testing But this person has a this is nice also For police military fire because it's like red light green light yellow light kind of gay It's real real easy to get it's kind of like a bunch of red lights your fubard, you know And and a bunch of green lights are pretty good but the this first one when you look at the advanced testing the The further analysis of the lipoproteins also look good But I'm going to show you one that really Qualitatively is not that much different and this is what we call the discordance model This is the person that typically their doctor Doesn't really notice they If you can't see the numbers there's I have a chart at the end Which we will we'll be able to look at all of the the numbers But the concerning things here we we see an LDL cholesterol of only 117 And so for most physicians that wouldn't be particularly concerning That triglyceride that I think is in the 300s would cause me to probably wet my pants If I were the person's doctor a lot of docs, this is not a flag for them though They look at HDL LDL His his HDL is okay. It's a little on the low side And again, I've got a chart here and just a little bit to to show you what those are exactly The upper right, I guess your left hand corner LDLP It's above 2000 we want that number ideally to be below a thousand typically There's some contention with that like a dr. Atiya and myself and chris crescer We've been talking about this a little bit if you have somebody who has LDLP that's quite elevated like this, but they're eating a low-carb non-inflammatory diet doesn't matter We don't know the folks at the national ellipid association think that it does matter But it's an opinion because we don't have data to really support it at this point Uh, I'm kind of of the opinion that the elevated LDLP unless it's familial hypercholesterolemia is actually A symptom of something else going on. It's not the problem. It's actually a symptom of systemic inflammation I'll try to build my case on that a little bit But this is what they're looking at with this guy And so his triglycerides were 362 Total cholesterol was not super high But normally this guy would fly under the radar They'd send them back out at work and he's This guy looked like Off of a wheatie's box. He's a triathlete and ended up having a heart attack while giving a What's the you know the Neighborhood watch is given a neighborhood watch talk to a bunch of like You know 80 year old women and he collapses on their coffee table and they barely save his life But they they so the the importance here the the idea that's going on We could have equal amounts of total cholesterol When we're talking about these different cholesterol fractions and folks like christmaster john and a lot of other people are much more knowledgeable on it than I am but the uh You have lipoproteins and those lipoproteins are trying to carry lipid type fragments around our body Either carrying it from the body back to our our liver in the case of hdl Carrying it from the liver out to the body in the case of ldl And depending on the composition of these particles if they are small and dense Then they could be carrying the same total amount of cholesterol But we have more particles and the more particles we have the higher likelihood We have of these things associating poorly with the vascular endothelium and causing some sort of damage and in promoting atherosclerosis Or a plaque or something like that So the takeaway is that if we could have the equal amount of ldl cholesterol But yet different ldl particles ldlp and the higher the particle the supposition is that we have a higher Statistical probability of something going wrong. It's kind of the the basic idea on that So this is an after and I believe that these guys let me back up This was a four month intervention. I believe and so afterwards We've we've shifted things around pretty nicely The ldlp is now almost below a thousand and then this this chart kind of summarizes things pretty nicely The dude's like a mesomorph like he's he's just kind of brick poop house kind of kind of build on him and So he dropped some weight, but he's really thick meaty dude ldlp went from 2200 down to a thousand The other notables the triglycerides are still for me way too high Like in in this scene I would really like to see those more long like 50 to 70 or something like that Like I I still think that that's too high and it's showing some like that insulin resistant score I would like to see lower, but obviously a good improvement So another person here, this is what they call dead man walking and This dude when he came in it was it was you know a nightmare right from the beginning This is his after and you know what this was a 10-year intervention So it shows that with a Modification in his nutrition, which was primarily just low carb not even the the paleo orientation And a little bit of of a metformin and whatnot Then he had a pretty remarkable change and Yeah, like the uh Do we have the Oh, we don't yeah the triglycerides are better in this one than than what the other one was So we have one more and this I believe is a six year change and similar kind of dead man walking and in the The summary chart is I think really valuable. So over 2200 in the LDLP about a thousand at the end Really really remarkable triglyceride change. So I I like seeing numbers like that What it tells me is a person is very very insulin sensitive So we're getting no collateral damage with up your regulation of pro inflammatory pathways with with this person So that that still is kind of a question, you know, like can you get LDL or a Insulin sensitivity in this range, but then potentially have a higher LDLP Would that still be as problematic as somebody who has high oxidative stress and an insulin resistant profile? I don't I don't think the two are equal, but that stuff will have to figure out So this stuff does some pretty remarkable work Especially health They I think they have 1.5 million people in their database And so they have an enormous pool of data that they've been accumulating since 1993 So they're able to do some really nice statistical Kind of forecasting on, you know, if we have a white male 45 years old five foot nine Blah blah blah, you know and extrapolate all of the data They can do some pretty nice forecasting about disease rates And so the pilot study that was performed there were 33 participants at a cost of about $1,000 per person Based on the metabolic changes that we see in these 33 people and the 33 were the the There were 200 cops and firefighters that were screened 33 of them were found to be at high risk So these are the people that were the likely very high likelihood of a stroke or heart attack within the next five years So they did these in Yeah, and this is part of the cool thing which is is really important to point out the chief of police Had his life saved with this program chief of fire had his life saved with this program Six of the city council members had their lives saved with this program The cfo of the three largest uh casinos in town had his life saved with this program So this is an example of the old boys club actually doing something right They got together and these people who have significant power and significant sway Saw a problem. They saw that their police and firefighters were dying They saw a huge cost in regards to life And and the the cost of retirement and they actually got in and did the right thing And so the reason why this is working in part is because the chief of police chief of fire This is mandated stuff when they tell you to do this. This is your job to eat this way This is your job to exercise So it's not a compulsory, you know, like you do it and that's part of the reason why this stuff has worked Are they seeing a reduction in cardiac Well, we're seeing all of the markers that should indicate that and given that it's been running This this part of the program has been running five years Then we're we are starting to accumulate enough time on a large enough data set that it's favorable But we need some more time to run to be able to Fully fully address that the estimated return on investment is 20 to 1 ROI and about a 22 million dollar return on investment with that pilot study alone So I'll I'll talk about the the overall program at the end But I I'm still as cool as all this stuff is I'm still really Unimpressed with pieces of it. I still think we're treating symptoms I still think the elevated LDLP is is symptomatic of other things or It based on the metabolic profile. It may not be that big of a problem at all I think that it may be a sign of intestinal permeability systemic inflammation, etc I I'm really curious I I got thinking about the mechanism of action like the the national lipid association folks use Metformin and use statins Significantly they use very low doses, but they use them consistently But one day I started thinking about metformin And what metformin does it's actually a pretty cool little drug It improves insulin sensitivity both at the liver and at the muscle level And it just seems to do amazing things like the when folks are Going in for Reproductive medicine, you know, typically they'll look at the look of the male look the female and everything But typically the first line of intervention for females is they put them on metformin Which is an insulin sensitizer because insulin and estrogen and in progesterone and everything are very tightly lined up But I was thinking about all the benefits that we seem to get empirically Observationally from metformin. I was thinking I wonder if metformin actually has effect on LPS lipopolysaccharide lipopolysaccharide is the the part of the exo the outside coat of bacteria And mammals basically any vertebrate that gets bacteria into its system has a huge inflammatory response An interesting thing. I think I mentioned last year in my talk. It's physiologically Indistinguishable type 2 diabetes from acute sepsis Acute sepsis is when you have a high very high blood titer of bacteria or or lipopolysaccharide endotoxins and it dysregulates the the normal Glucose home of homeostasis coming out of the liver. Yeah, I've elevated blood glucose Yeah, I've elevated gluconeogenesis everything that you see in type 2 diabetes you see in sepsis And so I've been wondering is a bunch of you know, what we're seeing With systemic inflammation and the beginnings of insulin resistance leptin resistance Is this all related to low-grade sepsis? And so part of part of this thing that I started kind of putting together is that LDL particles are critical. They're part of the innate immune system So we have the adaptive immune system makes antibodies. We have the innate immune system macrophages and other white blood cells They act in an immediate kind of first responder Kind of fashion But they seem to be tied in really really tightly with a lot of systemic inflammatory diseases So lps binding protein circulates in association with apoby containing lipoproteins Enhances LDL and VLDL interaction What all that stuff means is that when we have an infection or some sort of septic event I would make it an analogy here of gut permeability Ciliac non-ciliac gut permeability a variety of issues that go into that Lipopolysaccharide makes its way into our system It is very very toxic to us and causes profound metabolic changes So our body really is highly motivated to deal with it You have lipopolysaccharide binding protein, which can then associate the lps with our our endogenous lipoproteins HDL LDL etc And if it goes through that route then we can neutralize the lps in a fairly non-toxic fashion If it goes the other way though if this lps associated with the cd14 protein on macrophages and and other white blood cells We then pump that through into the liver and we have a highly toxic response Basically akin to type 2 diabetes. This is that beginning of systemic inflammation Possibly this leads into leptin resistance a whole host of stuff so And this is also just a backup like A normal response that the body would have to chronic infection is to upregulate Cholesterol production because the cholesterol is attempting to remove these lps particles. So that that's some of my thought about Lps and and systemic inflammation But I started thinking about metformin as it relates to all this stuff And one day I was thinking I wonder if metformin has some effects on mitigating Lps lipopolysaccharide induced Hepato toxicity and so I opted into pub med and sure enough we found Several papers that seemed to indicate that metformin had potent anti Hepatic toxicity effects with regards to lps, which I thought was pretty cool And then I had another thought I wonder if Metformin has effect on gut permeability and sure enough it does and there's a pretty cool The I pulled a couple of things out of the paper The protective effects of metformin treatment on the onset of fructose induced non-alcoholic fatty liver disease Were associated with protection against the loss of tight junction proteins The the tight junction proteins occludin and zonula occludin is one and the duodenum of fructose fed mice And the increased translocation of bacterial endotoxin found in mice only fed with fructose Taken together these data suggest that metformin not only protects the liver from the onset of fructose induced non-alcoholic fatty liver disease Through mechanisms involving its direct effects on hepatic insulin sensitivity But rather through the altering of intestinal permeability and subsequent the subsequently the endotoxin dependent activation of hepatic coup fur cells So metformin is a really cool little drug. It improves insulin sensitivity in a variety of ways and it seems to prevent Lipopolysaccharide induced systemic inflammation And it seems to improve intestinal permeability or at least prevent the the normal signs and symptoms of intestinal permeability This is almost like a mirror image It's a drug that treats all of the problems that we're basically addressing in this kind of ancestral health Framework. It's pretty pretty cool stuff so I'll just really briefly talk about statins for a long long time The main mode of action in statins has been suspected or largely known to be the anti-inflammatory effects So again when we're talking about modifying Cholesterol levels and risk factors I don't really think that it has that much to do with the cholesterol modification numbers It has to do with the systemic anti-inflammatory effects that statins carry And this is an old paper. I think it's 2002 Yeah, so it's a pretty old paper. We have way more data on this now So when I came on the scene with the the specialty health folks I moved to Reno and about three weeks after being there a dr. Greenwald shot me an email and he said Hey, we really like your work We'd like to do some lunch with you and I sat down and these folks showed me all this stuff And I was like holy cats man. This is this is super cool And I started looking at what they were they were tracking. They were doing a low-carb intervention I said hey, have you guys started tracking auto immunity or intestinal permeability or any of that stuff? And they're like no and it turned out that both dr. Greenwald and Dr. Cox Jackie Cox who is kind of the statistical Brain behind this whole thing both of them have autoimmune conditions neither one of them really knew it But we kind of dug that up via Via blood work and where they were eating a low-carb diet previously And their their carb would inevitably be like a piece of toast and stuff like that We ended up doing an autoimmune protocol, which we've talked about quite a bit for I don't know maybe five five years now We've had some inkling of an autoimmune protocol variety of paleo both of them have responded remarkably well And we've started going back and looking at the data that they've had on their their police and fire that they've tracked And we've dug up some some kind of below the surface auto immunity in these folks So this is what we're looking at now screening for intestinal permeability also for overt auto immunity The stuff that we have cooking next We have a program that's been running now for three months four months that encompasses all of Reno police and fire The estimated savings on these folks based off the numbers that we have had currently Over a 30 year period is about 1.2 billion dollars Yeah, amazing amazing and at a time when it If you look at almost any corporation any municipality typically the greatest increasing cost that they are facing is health care costs It's going up at between 10 and 15 percent a year. So the this is Absolutely gutting the costs and the spending that they were they were putting into health care potentially. We'll see how it goes This is you know the low-carb intervention with the addition of this kind of paleo Gut permeability systemic inflammation mindset lots of sleep counseling We're going to spread this program to a global audience. We've been contacted by 45 municipalities globally thus far We have Scandinavia, Australia, New Zealand the uk all over the united states Especially health already had a very robust database and and networked Health maintenance program. So we're able to collect data on all these folks So basically these folks are going to be given the tools to implement these programs locally We will do the data collection and then we're we're going to kind of roll from there We're going to data consolidate that data with those folks The next step also we're working on a health care provider education covering Trainers coaches allied health professionals mds so that we can get folks up to speed in this ancestral health model And then the big goal is that we're going to develop a health insurance company pushing hsa's And referrals back to these gyms. I've said for a long time. Some of you folks may know that I've had On and off stuff with the crossfit entity and whatnot, but I think gyms like that Literally should be our primary care medicine We shouldn't go to the dock in the box for primary care We should go to a local Decentralized gym where we do functional training and we get sunlight and we have community and we have csa's in there So the development of stable well run gyms is actually a huge part of what i'm going to be up to And educating those people and then creating networks with allied health care providers Physicians etc and then providing Direct to consumer blood testing so that we can help those folks whether they're at high risk or low risk But the whole thing also is if we can develop a health care model That is based on darwinian medicine in the ancestral health model It is going to be so much more cost effective than anything else out there. I think it will crush things And there was a couple of people mentioned that we need to get more science coming out of the back end of this stuff I agree But the academics take a goddamn long time to get anything done And and I say that with respect being at harvard and all the rest of that We cannot wait for that to happen We need to bootstrap this and we need to take responsibility and we need to help each other do this Or it won't happen if we wait for the academic process to occur It'll be 20 years before we validate the things that we're suspecting today So we need to do this on our own and and make it it's still outcome based We're not just making stuff up We still are hanging our hat on the results that we get But the economics need to drive this thing and that's the in my opinion the the direction that we need to drive that boat As a closer Really interesting how the world works in small circles So the the gentleman on the far right is egg greenwald He is dr. Greenwald's father. He became a high ranking person at the fbi The gentleman next to him with the mustache Does anybody know who he is? Anybody particularly in the anthropology realm? His name is robert bravewood Does anybody know that name? We should all I I didn't know so i'm not gonna gonna hang you guys out to But robert bravewood was One of the first people to study the transition from the hunter-gatherer life way to the the settled Agriculturalist life way He wrote some of the very first papers detailing the changes in stature the changes in dentition The changes in health status of hunter-gatherers as they transitioned into agricultural is so he literally is one of the first people to ever Study this topic that we are now Amashed in right right in the the middle ground part of the significance is that he was a Super tight friend of the greenwald family and dr. Greenwald the co-founder especially health The reason why he went into medicine is because of this man and he's had a lifelong fascination of genetics evolution And and everything obviously health related and so this guy is the guy that contacted me after I was in reno for three Three weeks and he's the one that's been running this uh this Risk assessment program and it all largely is an outgrowth of this man that it's somewhere in the you know The history of all the anthropology side of this we can largely attribute his work as being foundational to it So it's really really amazing And so we'll dedicate this to the next generation That's zoe and that's uh sophie the giraffe so Um, I'm not sure. I think I was at 38 minutes. We were a little late if I need to to pull up I can definitely split if folks have questions. I can answer that later I really thank you guys though, but I are we good for a couple of questions I I just can't emphasize enough though that I feel like we are at a Both a precarious but also an amazing moment in history. I think we can change this all I really do 15 years ago None of this existed Is a couple of crazy, you know me talking to lauren cordain on on via email and and I mean none of this existed So this is uh an amazing time that we Are in and I think we have an amazing opportunity So we'll see how this goes for a year. We'll see if we can get these other programs off the ground We'll see what type of savings we can get out of it. Maybe the program doesn't work Maybe it does. I think it will time will kind of bear that out But I think that something like this and us taking responsibility for the way our food is produced for our own health Somebody needs to start this and it's got to be us and then we will drag the rest of the people along kicking and streaming So thank you Thank you. So we have about five minutes for questions Hi, very good talk. I was just wondering with the metformin data that you were Showing us. Uh, does that permanently affect how the body functions or is it only while people are taking metformin? It's only while they are taking metformin, but you do It's both to some degree because you are changing certain parameters of inflammation That if the person goes off metformin, they tend to get a long lag period with it And I think that if you use it as an intervention Like I think for like police military fire and and medical workers who are facing constant sleep deprivation and have an Sleep-induced metabolic arrangement. I think that those folks should be on low dose metformin across the board Like it is so safe But yet so efficacious in mitigating the effects of insulin resistance that for that population I would argue they they should be on a low dose like half what they would normally do But just a baseline dose and it's going to help undo the sleep-induced metabolic arrangement that is unavoidable from their life Yeah Yeah, great talk. Thanks for for giving it How is this changing your the training curriculum that you mentioned that we're all dying to know about And say the evos program that you had with uh, s1y new pulse. Is this changing some of the content that's going on there? Not really. I mean we it is in that way. It's very clear that My background is obviously more gem related, but we obviously need to get Sophisticated in how we educate allied healthcare providers and also physicians So that we can refer people to this program and like what blood work we're going to track and stuff like that An interesting backstory with this is dr Tara doll who is one of the folks at the national lipid association She and her husband were given a huge grant by the world health organization To provide a website where barefoot doctors in developing countries can do their whole medical school curriculum online And then the people will show up in the uk or australia do some clinical work But otherwise they're they're anointed and often running. So it's a huge Fully accredited medical school curriculum online These people have offered to host our our education material So we basically right out of the gate get a ccme accreditation, which is gold stattered AMA accreditation and peripherally. We're basically getting a nod from the who on this So we're basically just like need to bum rush this thing and make it happen. So yeah, thank you Awesome talk. Thank you so much. Um on a personal note, I'm one of those people my ldlp of 22 40 Um triglycerides of 40, uh insulin resistance score of four. So I've got this weird Sort of schizophrenic numbers Maybe it's time to get like this get folks like us Together and and watch us and and and and maybe we need like a forum or some kind of Way that those of us that are in that situation because it isn't it is kind of seemed like it is a gray area We don't know everything we need to know about this yet. Absolutely. I totally agree and how many of y'all know chris chresser chris can you rate So the one person in the room raises his hand everybody knows chris Okay, chris has some really amazing material coming out and looking at high cholesterol in the the paleo scene And so I think that we need to organize ourselves do some advanced testing and then consolidate this Especially health is is trying to work with me so that we can do some direct to consumer Blood work and they will be able to provide an analysis on this So then that way you guys will get you know, if you want to do advanced testing They'll be able to to send it right to you and you can do it and you wouldn't Very few doctors are even aware of this stuff. So it's hard to get them to order this whereas you'd be able to order it through Especially health Yeah, hey, Rob. Uh rick henricks. I'm a family physician and before everybody goes and runs and buys metformin or recommends it for everybody I just wanted to Hold the horses a bit. So there are some bad side effects right nausea diarrhea So it's not the wonder drug, but it is a fantastic medication and does work really well And I would just like to say I mean, this is great stuff and there are physicians that are doing Similar things like that that are here and and look for Good physicians to help you out with that. Awesome. Are you signed up on the physicians network? Sure are and I get The other day I had like five of my 7 a.m. Morning patients that were that were from the network. So it's actually working It's actually work. Cool. Thank you. Thanks. Thank you everybody We're gonna cut off questions right now If you have questions later, maybe Rob will answer them His answers will be much more colorful then