Five nights in a row of less than your requisite seven to nine hours, whatever it is, you can lower your instant sensitivity by as much as 50%. Yeah. Wow. And for most people that worry about body composition, that's all they need to hear. Although there's a myriad of reasons why you should get enough sleep, but that will get their attention. Yeah. They've heard that testosterone can get their energy back, their libido back, help with body composition. And in the 90 day follow up, they say, and by the way, doc, I'm sleeping so much better. Yeah. And you go, yeah. When you used to wake up when you're 20 years old and think about some of these things.  I'll hail it when I wake up in the morning.  Well, 14 days later, you feel better. The world hasn't changed, but the world's great again. Yeah. No, it was you. With the hormones being off is my point, particularly testosterone, what you get is that feel good and confidence hormone. You can have trouble sleeping. And so you fix that and bingo, you know, everything works again. One thing can lead to another, as I said earlier, and vice versa. If you regulate your testosterone, if it's dysregulated, then sometimes that can solve all your sleep problems. And if you're not getting enough sleep and you thereby dysregulate your thyroid, your testosterone, your cortisol, well, then you can have more issues and, you know, that snowball effect. So you're watching Dr. Rand McClain, author of Cheating Death.  So the rest of the episode is pretty awesome. Can't wait for you to hear it. Also, we're going to give away a program right now. Maps and a Bollock is the giveaway. And if you want to win, here's what you do. Leave a comment below this video in the first 24 hours that we drop it, subscribe to this channel, turn on notifications. If we declare the winner, we'll let you know in the comment section. We're also running a sale on some programs right now. These are correctional exercise pain relieving pro mobility workout programs. Maps Prime, Maps Prime Pro and the Prime Bundle, all 50% off. If you're interested, just click on the link at the top of the description below. All right, back to the show. Dr. Rand, welcome back to the show. Always great having you on. You're definitely one of our favorite, if not absolute favorite people to talk to you when it comes to hormones, longevity, health. You know, we respect the hell out of you and you wrote a book and we want you to talk about this book because it's pretty awesome. The title of it is awesome. It gets your attention. It gets your attention. Cheating death. Let's talk. So who's this book written for? Why did you write this book? And then we can kind of get into some of the stuff that you've learned and the research that you cite and talk about in the book. First question I haven't really answered yet before, but who's it written for? It's written for anyone who wants to take control of their health. So the message of the book is really letting people know what's out there so that you can take advantage of your health. I use the example of myself in the book in that, you know, medicine was advancing so quickly that when I had some of my medical challenges, for example, with the spine and they offered me really the option between a fusion and what amounted to kind of an advanced door hinge as a replacement for the disc. I said, no way, man, I'm not doing it. And, you know, 33 years later, I had a pretty serious result from not doing anything about it. And in between there, if I had paid more attention and known how quickly we were advancing, I would have had a lot more well, opportunities to fix it and be better off than I am today. I'm not complaining where I am today, but I had other options that I had no idea about. So the idea of the book is to let people know that there are so many options for increasing health span, we call it, right? Not just longevity, but the quality of life while we're living. And so the purpose is to spread the word in that regard. And then obviously as part of that, give people the sense that, well, first of all, you should be your own best advocate for your health, but that you have the ability to control it. And there's some ideas in the book as to how you can do it, not just theoretically, but some practical information there, too. I hope that people take advantage of it.  And it seems to me, I have a lot of friends in the field. I have a lot of clients that were doctors. And I noticed that, especially more recently, maybe over the last two, maybe two and a half decades where Western medicine, which gets a lot, they get a lot of heat, but a lot of credit for this. They do a good job of treating symptoms. Not a lot of not a great job at looking at kind of chronic issues or looking at things like longevity or quality of life necessarily. Seems like we're starting to see advancements in that space, where it's like, OK, yeah, we have these great ways to kind of make you feel better right now, but there seems to be a lot of research going into now longevity or health span. First of all, how do we define the two? What do you mean by longevity versus health span? Because you said those two. Well, health span combines the idea of longevity with quality of life. No one wants to go into their older age spiraling down the, you know, proverbial toilet, just hanging in there to last moment.  And that's that's doable to date. We're looking at old news where you see the, you know, your best time, let's say, is here when you're 20 and then it creeps up a little bit until you get to 70 and then hockey sticks. But I think that's moving. I think if you looked at data today, it'd probably be closer to 85. And you see the examples in the in the press now where, you know, people are doing some pretty amazing stuff, whether it's on the the the gymnast bar of some sort or on the track, you know. So again, the idea is to well, I hopefully defined health span, right? So it's not just being alive. It's actually being functional and dependent. Yeah. And being able to function, enjoy life. I've never met a patient who says, yeah, let me trade one for the other in terms of longevity for quality of life. It's usually the other way around. They'll come in and asking for, hey, what do you got? I'll take 10 off the back end. If you can give me three more before I go, you know, no. And that's the beauty of this is and I try and make it clear in the book. It's really it's definitely not a Rob Peter to pay a Paul situation. It's really one is advancing the other. Certainly if you're in better health, you're expected to live longer, right? If you don't have uncontrolled type two diabetes, not only will your life be better, but it shouldn't last longer too. So that's pretty exciting. I mean, from I think anyone in this room standpoint, how valuable or how accurate I should say, do you think the the tests are that give us our, you know, biological and chronicle age? Are those pretty accurate? Or is that a pre-planned question? Because yeah, well, I'm a lot of people are working on that. I've got an app, which is up in its first iteration that gives people based on the, you know, the in Hanes database that we have, which is pretty huge anyway. Correlation between some of these markers in biological age, what we're estimating is biological age is always going to be an estimate until many, many generations, because we got to live through those to be able to verify the data, right? But we're doing a pretty good job. It's certainly at advanced levels, an advanced level with things like DNA methylation, that comes up pretty accurately to measure chronological age. And then of course we associate the two and we can come up with a biological age estimate. Telemere length probably comes in second place, depending on how you measure it. Something called HQ Fish is I think the only way it's worth measuring if you're trying to get a decent estimate of biological age, but the point being we can come up with it and even if we're not accurate, you know, the idea, especially with what you guys are doing, think about what we're all trying to do. If I'm 60 and it says I'm 62, but then we can implement an exercise program that rashes things up and knowing what we know about, you know, down-regulating mTOR and up-regulating autophagy, if we can measure again in six months to a year and go, hey, now it says you're 61, I don't care so much about the ages I do. Hey, I'm doing the right things and I'm moving in the right direction. This is how we explain to people not to get so hung up on some of these tools or let's say body fat measurement readings where they're like, oh, I heard that's off by 4% or this one's better than that one. It's like none of it really matters that much.  And then the things that you put into place, did you go up? Did you go down? And so I think the same thing would probably be true with this. It's like getting that reading so you at least have an idea that, okay, I'm now going to go out and implement these new behaviors or supplementation or exercise regimen and then I'm going to come back and retest and say six months a year. And hopefully I'm in trending in the right direction. And if I'm not, I probably need to correct something. And think about what a great motivator that is. I mean, it's not to say that people don't trust you or us in what we're saying or grandma, eat plenty of colors, you know, put plenty of colors on your plate when you eat. Like it's now beyond trust, it's happening. I can measure it and it just leads to I'm telling you guys of charting, all right, compliance. They see it happening, they're much more likely to follow through rather than just go, yeah, well, he told me so. Again, even if it's subconscious, people who are coming to you for advice, they trust you to begin with, but this really drives it home, right? Yeah, I think like a simplistic way for me, look guys, when I go to like a reunion and you notice like everybody there is the same age, but you can see like a drastic difference, especially over the years, how their health has diminished on one end versus like people that are really like humming right now in terms of the quality of life and hitting all those markers, but now to have something to sort of quantify that, I think that's interesting for people to look into that further and like how we can kind of base that off of like some of those markers that you're mentioning and so to test that.  And then we all know that 50 year old, you're like, oh, it's like they're 90 years old, they can barely function. So it's really biological age is like how young your body is on a cellular level, essentially, right, to find it loosely, how well things are working and moving versus just on the calendar, how old you are, right? Would you say that? Yeah, and arguably it's for everybody, but for the person you're talking about, who's 70 but working like he or she's 50, it's out of motivation. If you think about it, you need a biological age to motivate somebody like that, or if I'm that person, if you're 70 but moving like you're 50, it's the functional day-to-day that makes all the difference to you. So do I need a number? But for those people arguably, yes, because it gives them that much more drive. They're already doing well, but for someone who, I don't wanna say might be more likely to take advantage of it, but for someone who's obviously doing it right to begin with, if they're trying to squeeze that last percentage out, it gives them even more feedback, I guess. Well too, and the person that maybe is a little bit more on the less able-bodied, like less healthy versions of, they're always out there trying to ask them what they're doing. Like what are you doing? How are you so vibrant? How are you so healthy? And to be able to then kind of go in and test and figure out ways that they can improve their health and their quality of their health and like sort of reduce that biological number, I guess, down would be something I could see people wanting to get into that. Now as a fitness professional, I'm gonna make a couple assumptions and I'd love your input. I would assume that the most impactful things on chronological, excuse me, biological age have to do with exercise, diet, and sleep. Those are the most important ones. Yeah, and we go back to your question about the purpose behind the book and what's in there. We've all heard that forever, right? Those three pillars are huge and you could throw in- Three lifestyles of stress or whatever. Yeah, and part of that is humans. So bonding and interaction with people and relationships and that gets kind of woo-woo, but not so much anymore if you look at the research. The data's clear. Yeah, it's true. So you could throw that in as a fourth pillar for sure. But we've all heard the other three forever and it gets kind of old to, I mean, you see your clients out there, right? My patients, yeah, yeah, yeah, yeah. Okay, what else you got? Talk to me about peptides. What kind of pill? What kind of other thing? What's the cool latest? Well, the purpose of the book was to go into the research like there's plenty of with relationships and stuff, but to show, look, sleep, it's not just what great grandma said, you know, nutrition ditto and exercise ditto. Let me explain some of the research or present it to you and explain it as much as you need it to explain to show you that it's not just, you know, a legend, a myth, whatever you want to call it, it's real. And I think that makes it more interesting, particularly in this day and age with the people we're dealing with that are much more interested and want, hey, I want to see just like, hey, show me the research on the peptides. Okay, I want to see evidence. And it makes it easier to circle back, I've found and say, before we start talking about fine tuning or sniping with the peptides, let's get back to the basics because, you know, I remember seeing guys in my office with the cooler of food, the jug of distilled water ran, I'm doing everything right, you know, but I can't get leaner, I can't put on more muscle. And I'm going, okay, talk to me. We find out that, yeah, their exercise routine looks brilliant. They got that wired. They're carrying the nutrition with them.  What else? Well, I work for UPS and two other things, you know, and where I come from, we say working like a Jamaican, you know, hardworking, so it's a 16 hour day just with work and then they're getting four hour sleep. Hello, you know, and they're wondering because they don't understand. They go, yeah, but I've gotten away with this for years. That's probably something you guys see a lot of. So yeah, that can't be it. No, it is it.  And it's that simple. Now those categories are broad, right? I mean, we spent our entire careers talking about those categories. So what does the data say on nutrition? Let's get nutrition, because there's so many different ways you can eat. There's so many different diets that are out there. This one's better than that one or whatever. What does the data show with diet in terms of longevity or health span? What is it saying? The data shows you can't rely on the data. No, seriously, this is part of what I present in the book and it's no new news to most guys that are out there doing like you do. One of my favorites came out recently. Have you guys heard of this guy, Ross Edgeley? No, I don't know. I have. Yeah, I have. So I ran into him just fairly recently, but I've already read two of his books because what I like about his approach as a doer, not just somebody standing here talking about it, is the guy swim around Britain. Right. He climbed via rope the height of Everest. So he's clearly a doer, right? There is no one diet that fits all. Okay. And that's the point. Most of the research that we see is epidemiological in nature. It's observational and retrospective. For example, it's based on forms you fill out that, no, no, I'm serious. I know, I know this. What have you eaten over the last year? Yeah. Do you remember what you ate? I can't tell you. Forget about the last Thursday. Yesterday? Yeah, yesterday, right? Not the week before. Forget about it. It creates a lot of problems and a lot of data that comes out false because it can be so easily manipulated with bias. I never did well at statistics because, well, long story, but it really does come down to that. And there's so many flaws that you wouldn't think about intuitively, but that come up when you look at the research.  One of my favorites, again, is Peter Atia and then Dr. Ioannidis, who really first spoke out and said, hey guys, most of the info we have here is garbage. I think he's quoted as over 90%. So to answer your question, first of all, throw out the data. You can use some of the diets. Like we all, you know, so many of them now. Ketogenic diet, you know, the carnivore diet, the Mediterranean diet. Start with one as a basis to figure out what works for you and tweak it as necessary. You may throw it completely out. Carnivore doesn't work for a lot of people. My wife would be one. I mean, she's one of those freaks of nature that lives on carbohydrates. I mean, she could probably survive and still perform well on twizzlers from what I've seen, right?  But that's to the point that you can't just say, okay, this is what works for everybody. Now there are some that do have some decent science behind it, like the Mediterranean diet. And God, I always forgot his name. I don't mean to be disrespectful, but there's a doctor out there that promotes it really well, or his version of it. And we know that lowers LDL and can help with people that have extant coronary artery disease. Well, but that applies to certain individuals. It doesn't mean that everybody needs to be on that diet because everybody didn't have coronary artery disease.  I mean, in terms of what you're saying with the data, doctor, I think Ansel Keys was his name came up with the Seven Nations study where we based our nutrition, our government nutritional advice that demonized fat, right? So he took a bunch of data from all these countries, literally took out the three countries that didn't fit the data and said it's fat, right? Took the countries out that lived a long time that ate a lot of fat. That's a classic example. Classic, and it became like this anti-fat campaign. Obviously we got fatter and sicker, so it didn't help anybody. We noticed as trainers and coaches that there's this huge individuality when it comes to diets. We're now seeing this with CGMs, right?  I've seen people get glucose spikes from foods. I don't even have sugars and carbohydrates to add some kind of immune response. So to kind of back you up, that's absolutely true. Are there general truths though that you're seeing? Like, don't overeat, avoid? Don't eat large quantities of arsenic. Okay. Solid. There's some obvious ones. I mean, a whole food site. But there's also some ones that you go, man, I wouldn't think that's obvious or vice versa. You know, you really just have to experiment within reason to see what works best for you. And then you have to also throw in there, what works for me while I'm training for endurance versus while I'm training for muscle mass or leaning out. If it's winter versus summer, if I'm on the equator and it sounds kind of esoteric, but it's true. No, very true.  Winter or summer, you know? So, and then you got it all figured out, right? For each individual. And then you age another couple of years and you go, okay, my body's not working the same anymore. So you really just have to go back to, okay, be your best advocate and observe, observe, observe. And be aware of all these factors that come in to play and maybe some that don't, you know, like whether I wear a blue in the morning for my t-shirt, I don't think that has anything to do with my diet. So just making the point that, you know, you got to also exclude some of the stuff that a lot of people are touting this. This is very, very important, not really. Dr. Rand, again, to back you up, people in cold, traditional cold freezing climates, if you look at the traditional diets, high in things like cod liver. Yeah, I'll make it. The innuits. Very high in vitamin D. Gotta get that vitamin D. Where they're not getting it from the sun, right? And people who live at the equator, the traditional diets are very different as well. So what you're saying is, I love that you're saying this. I'd like to ask you then personal with diet because you're super active. You do the strength training. You also do the long endurance training. You also need to have a lot of cognitive performance, obviously with your job and presenting yourself on podcasts and stuff. Does your diet vary between those? Have you found for yourself that you eat, like to eat for maximum performance with stamina versus muscle mass versus cognitive performance? Or is it all generally the same for you? That's a tough one to answer because I was blessed with a mom who got interested in nutrition very, very early. So I grew up on, I always joke on wheat germ pancakes. And we were allowed candy on Halloween. That was it, you know, that kind of thing. So I'm not sure if it was something I just got lucky and paid attention to early. One of the first books I ever read, I was 11 years old, meaning not mandatory, you know, see Jane Run and all that kind of stuff was a nutrition book. Adele Davis is one of her books. And I was fascinated by the fact that you could affect yourself with nutrition. So I don't know if I glommed onto that or not, but I really just kind of go on gut is what I'm saying. So, you know, did I purposely study it? Yeah, is that now sort of ingrained and I don't even think about it. But to answer your question, not so technically, I eat whatever I want, but it's definitely based upon how I'm feeling. And typically, for example, I'll eat more vegetables and even starchy carbs in the summer months where it's hot. And I tend to burn more fuel just, you know, because it's hot. It's not different. And whatever I'm doing, maybe burning more calories. Although you could argue, what about in the cold? Well, yeah, if I live in Chicago again, nothing against Chicagoans, I love it up there, but you know, I don't, I live in Malibu. So I'm not dealing with super cold weather. So I don't have to change my diet to compensate for the cold like some of Chicagoan would. So I'm not going to be eating a lot of calorie dense foods, but I will adjust. I'll be eating more protein depending on what I'm doing.  And if you don't eat really carefully with that, you're in trouble. So I listen and I go, okay, boy, I can just, I crave that steak, which is most times anyway, but you know, and I'll eat it. So God, I'm giving you a long way to answer. That's not really good. But I think with enough time, if you do what we're talking about where you pay attention to what you're eating and what it does for you, you'll just get that sort of innate sense of what's eat and when. And we all do that to some degree when you're in the pink, right? Meaning when you're in good shape, there's no question what your next meal is gonna be. If you have any control, right? You don't look at that chocolate cake and go, wow, that looks great.  Because you already feel good and you know that you're in tune with it, right? I know it sounds kind of woo woo, but we all sense that, right? No, what you're alluding to right now is the area that we're always trying to guide our clients to, which is becoming more aware of the natural signals that your body tells you. Unfortunately, I think most people are so disconnected to that because we're so distracted and we're so out of our bodies that we don't. But when you get to a place where you have practices, you've measured it, you've tried different things diet and you start to piece together, oh wow, when I eat like this, I sleep really well. Oh wow, when I eat like this, my training session is really well. When you start to make those connections and you do it for long enough like you have, it becomes intuitive. It comes to a point where it's like you say- You crave what you need. Yeah, you crave what you need and you don't deny that. Or you look at a food like a chocolate cake and go, oh yeah, it smells good, it looks nice with that, but I also know how that will make me feel and as much as that sounds tempting right now to do that, I know how my body will react to it, so it's not worth it. So it's easier to pass on it when you've learned that. I think the challenge that a lot of people have today is being in themselves, being connected to their body and actually paying attention to those signals. To drive that point home, to go back to this fellow I was mentioning earlier, Ross Edgley, I think he loves cheesecake, if I remember correctly, so he eats tons of cheesecake, but he's also swimming around Britain in five degrees centigrade water, right? Swimming 12 hours a day, demanding 10 to 15,000 calories a day, so that's not messing with him. So that cheesecake is actually going, ding, ding, ding, ding, ding, dense calories, I need it. I don't need my alfalfa sprouts and broccoli right now, right? It's a waste of my GI space, so you can take that to the extreme, but it just, I think, drives your point home even further that it is all relative and you just have to pay attention. And there are studies talking about being in tune or not. When you're out of tune because of like allergies, no matter how hard you try sometimes, can throw you off. A lot of times, particularly food allergies, you will choose the food that you're allergic to over something you're not. And is that driven by the allergy or what happens as a result of the allergy, the change in your gut microbiome or whatever? We're not sure yet, but all the more reason to stay on track and be in the pink so your body's working properly than when you get out of sync and you're making wrong choices because you're out of sync. There's two theories behind that, by the way. You just said, I just actually literally last week read about that. They think it's either A, you're more likely to develop an intolerance to foods that you repeatedly eat because maybe you have a damaged gut. So it's like, why am I attracted to this food that's making me say, well, I've always been eating it and because I have a damaged gut, my body's now developed an immune response to it. Then the other theory was the cortisol spike, people get addicted to. It's like that stress, the stress junkie. So they get that stress response and for some reason it develops this kind of. Or even a histamine reaction which will pump you up too. That's right, Hissy will do that, absolutely. All right, so let's talk about exercise. What about the data on exercise and health span and longevity? Obviously being active is better than not being active but when we get more of the specifics, what does it say about strength training, cardiovascular or extreme exercise versus moderate exercise? What do you see in that regard? Lot in that question, but exercise is definitely key. The very definition of life includes, you know, the word movement, right? By just about any definition of life itself. So we know the movement's important, exercise is important, it starts the process that I get into in much more detail in the book whether it's with regard to M-torque, one or two complex, the sertuin genes, autophagy. So exercise what I call the great equalizer because it can make up for a lot. For example, in med school, you know, you'd be pulling 36 hours at a time back in those days you could.  They put limits on that now, right? You can't, they won't, I'll overwork their students like they used to. Of course, I'm gonna say it this way because I did it before.  It's still nuts the way they do it. Okay, really, it's counter to what we know in medicine is the proper way to do things and we still do it wrongly. But anyway, you know, I'd still grab a workout because if nothing else, it helps with metabolic dysfunction. That's the linchpin for, you know, the four horsemen of disease these days, arguably. And again, I call it the great equalizer because it does so much for you when done properly. Now you can over train and that hormesis curve comes into play. Some people go out of J-curve where, you know, a little bit is good or not good, you know, the medium amount is great and too much is not good again. I think we tease it into different categories. Pretty much the research tends to point to you got to do a little bit of zone two and below. Okay, the gardening, the stuff they talk about where you can talk to a friend comfortably. It's the exact services, right? And then you have to do some hit, you know, zone five, high zone four, low or mid zone five, right? Or maxed out. And the two of those are the combination you need because they both are different kinds, obviously, of exercise, they do different things for you. And then when it comes down to measurement again, we can correlate muscle strength and VO2 max with longevity and health span as well as muscle mass.  It's a proxy for strength, typically, right? I think it's more than that because, you know, muscle, for example, I call it a metabolic liability. You know, it's a sugar sink, we can call it. It helps with that metabolic dysfunction. If you're carrying that extra muscle mass and you do go off and indulge in that chocolate cake, which by the way, we should every once in a while for the other part of it, just the mental part, right? We should have got a chocolate cake, he brought up it. We will after this. Actually, I skipped it last night for some reason. But maybe because I was waiting for it today. There are divisions that we can look to and whether you're above the anaerobic threshold or not that contribute to your health in different ways. And so we need a little bit of both. I would say, arguably, if you were forced to choose between the two, which I hope no one is, that the long slow distance is gonna be considered more important just getting around and even if it's just gardening or going for a walk. But if you can do the hit as well, I think the combination, you know, the science bears out on who cares what I think. You know, the science shows that you're gonna be best off. And it's gonna hit those three, mass, strength and VO2 max. When I did the research for my book, I was actually, I knew the benefits of exercise, but in particular, I wrote about strength training. And I was shocked at the impact that strength training and muscle mass had on blood glucose and insulin sensitivity. By itself, the most effective way of helping to modulate how your body uses insulin and glucose, which is a huge problem in modern societies. I mean, there's, you know, now they're finding, even Alzheimer's are starting to say, hey, maybe that type three diabetes theory is true that the brain is not able to utilize glucose properly. Definitely comes into play. The more we dig into Alzheimer's research or any neurological disorder, absolutely. And you've got, what, 100 million Americans, they estimate have fatty liver now whether it's diagnosed or not. So yeah, and I've got, I remember 15 years ago, one of the first times I put two and two together, and I can tell he's on the internet, made his probably his name is Jim DeMetz. I remember he was on insulin, he was about 360, you know, 63, 64, 360, overweight, clearly.   That's awesome. God bless him, wherever he is now.  But we need to focus on this first. Thank you, thank you. All right, so sleep, what about, what does the data say on sleep? We all hear the whole seven to eight hours a night, and there needs to be a certain percentage in this REM stage of sleep or whatever. What does the data say in terms of health span in sleep? It's very easy for me to dish to the guys who are the experts, Dr. Bruce and Dr. Walker. You know, one's called the Sleep Doctor, the other one is, now he heads up Berkeley, we stole him from the UK and he's written a book, both Dr. Bruce and Dr. Walker have written extensively on sleep, but the science is extremely clear, seven to nine hours, by the way, somewhere you fit in there, unless you have, I think it's one of three very rare gene mutations that allows you to get away with like five because you can drop into deep sleep pretty well, but yeah, it's not just about deep sleep, you need your REM and you need your light sleep, and there are further divisions within those and how you control those is difficult. Some of it's genetic, some of it gets into a lot of different nuances, but the basics, as you can break it down in terms of like an oer ring, I think is the best, proven the best in terms of the ability to pick up as closely as you could with an EEG, more of the gold standard of, you know, determining what levels of sleep you're in, but yeah, if you're not getting seven and nine, and that's gonna vary too, by the way, again, like the diet, depending upon what time of year, how hard you're training, so maybe your average is seven and a half, but there may be nights where you go, no, I need eight, even eight and a half, and you may need seven and seven and a half, and you might need the full nine every night, right?  I'm so glad you said that. I mean, we all did that, right? All of us in here. Probably everyone in this room, right? Yeah, good to me. You could get away with, right? I remember as a young trainer, thinking sleep was like whatever, then I got older and I worked with these functional medicine practitioners, I'd hear them talk about sleep, and I'd see the results of their clients, and at least that my ego wasn't big enough to so big that I didn't, you know, absorb other information, right? So I remember one of the first clients that I addressed us with, and all we did was work on her sleep and she lost seven pounds. Nothing else, she did nothing else, but fix her, now of course that affects everything else, right, her eating probably changed her activity, but just working on her sleep, seven pounds of body fat was gone, and from then on I was totally sold. How about muscle? Did she gain some muscle? Oh yeah, she gained muscle and strength before. Because I would argue that contributes to it, right? 100%, 100%, so it's a huge, huge deal. I think we've all experienced that ourselves as dads and, you know, you get no sleep with the little ones and they just get older. Well, I think that going back to what we talked about earlier about people being aware of their, I think just a lot of people aren't aware of it. For some weird reason, there's hundreds of books, maybe thousands of books written about morning routines, but very few people focus on evening routines. There's just kind of, we just regard it. But yet ironically, everybody's pretty aware that sleep is important, like that's been touted for a long time now. Most everybody is familiar with hearing that, yet there's just not a lot of energy and effort put towards how you set that night to be successful. It's just this idea of like, oh yeah, I'm supposed to get seven to nine and so, okay, I'm gonna try and go to bed whenever and fall asleep and only get up at this time. But it's like, man, how you get prepared for bed, I think really makes a dramatic difference in the quality. They call it sleep hygiene now. Yeah, yeah. So talk a little bit about that. Like are there things? Like should you have an argument with your wife right before going to bed? No, are there- That's pretty much always a no, any time, anywhere. Is there, are there some things that you, either you personally practice or things that you encourage people to do to set them up for success to have that seven to nine hours, because simply just saying, oh, seven to nine hours, but you know, if you're one week, you're getting to bed at nine o'clock, another week, you're getting to bed at 11 p.m., like one time you're watching T, like what are some good behaviors?   We're designed for to be day creatures. So you're messing with some of your neuroendocrine system for sure, when you're working graveyard. Melatonin doesn't work during the day. It works when it starts getting dark and if you're living like a vampire, that's gonna hinder you, but again, going back and forth, mixing it up is the worst. And I'm going back to what you referenced about, you know, going to bed at the same time, waking up at the same time, your body loves that kind of regularity.  On the weekends, you're like, five o'clock, what am I doing here? And that's actually a good thing. And by the way on weekends, they say, as much as you don't want to, you're better off getting up at five o'clock, seven days a week because of that regularity that's needed. But the hard part is, you know, turning off the tube and watching one more of the series, right, to adjust that go into bedtime, which is what you should work on. In terms of the falling asleep, you're trying to work on something called sleep pressure. For me and I think everyone in this room, what's the best one for that? Working your butt hard in the gym, or wherever you're working out, right? Cause that is great. Relieving that pressure is a mistake that some people make by trying to get a nap in. Now I'm not saying avoid naps. The body's actually designed for this from the research. We're made for that siesta, okay, afternoon. We don't do that anymore in the industrial ages for the most part. But if you can get away with it, great if you're having trouble falling asleep, which is not typically the issue. Most people have problems staying asleep. They wake up after four hours, thinking about the 2.3 kids in a mortgage, and they ruminate about things that's much more difficult to deal with. But I argue, again, going back to sleep hygiene, one of the best ways to deal with that is to come in to bedtime with as much sleep pressure as possible.  There aren't a whole lot of tricks to staying asleep. And one of the things I would say that is a trick you should absolutely avoid at all costs is the use of benzodiazepines, valiums, Xanaxes and stuff. That can lead to a major disaster real quick. I think it's gonna be worse than the opiate scourge. Yeah, way worse. Because it sneaks up on you, the withdrawal symptoms sneak up on you, whether you're taking it or you've stopped taking it, still taking it withdrawal, you can accommodate to these dosages. Anyway, pills in general are not a good idea. There are no great sleep aids out there where you're not Robin Peter to pay Paul.  And then just doing the best.  I think it was he who said, look, if you wake up and you're tossing and turning for more than a half an hour, there's some people I'm convinced that are just goal oriented, well, get up out of bed and go do what's on your mind, go work on something and then go back to bed and that sleep pressure will build again. It's not the answer everyone wants to hear, but the body's pretty cool in the way it works in that without a pill, if you do that a certain number of nights in a row, typically, not always, but typically, you will go to sleep that one night and then stay asleep and it'll happen for a few nights before it starts happening again. And I would argue that you guys are probably thinking in your back head, well, that doesn't work for me necessarily. There are personality types and this is just my observation that your goal oriented, the best thing to help you stay asleep at night is accomplishing your goal. Yeah. And for some of us, that might be the only way you're gonna get that sleep and- I have to do that. I wish I had better news. If I have something and it's always business related, right? If Katrina asked me a question and I started thinking about the business at seven, eight, nine o'clock at night, I've got to go write notes down or solve that problem before I go to bed or else it'll disrupt the entire night. That's actually a great idea and it's not to play junior shrink here because I'm not a psychiatrist, but that's the one thing I'll jump in with patience. I'll say, if you do have this issue, write it down at night, whether it's on your iPhone or a pad of paper or whatever, because two things will happen in the light of day.  I already wrote that down. So I don't need to juggle in what I call the RAM memory. We do this all the time. Hey, remember to pay the car payment and then you go through the day and then you wake up and then I forgot to do that. Okay. Two, in the light of day, you wake up and you go, make the car payment? Really? That was what I was juggling all day and I woke myself up about? I'm gonna, it's not gonna be a problem. They're not gonna come repo the car. Typically I'll get several love letters from the car or the bank before they take my repossess my car. So you realize, okay, I don't need to do this stuff and you can put it to bed with something that sounds kind of simple or overly simplified, but sometimes it works. Yeah, can you speak a little bit more and because it's your background is hormones? I'm always curious because you've always heard that like getting good sleep and all this helps to kind of balance out the hormones and vice versa. No, if you don't get it, it ruins your hormones sometimes, yeah. Right. So can you speak a little bit more to like, especially the stress hormones and then how that impacts that and then also to like, you know, how you can better improve that whole process and what's happening as you're sleeping with your hormones. A lot of times patients come to my office and make no mention of having trouble sleeping. They've heard that testosterone can get their energy back, their libido back, help with body composition. And in the 90 day follow-up, they say, and by the way, doc, I'm sleeping so much better. And you go, yeah, because to the point that we were making earlier, you wake up in the middle of the night. When you used to wake up when you were 20 years old and think about some of these things, it wasn't the 2.3 kids in the mortgage most likely, but it was something that meant something to you, nevertheless, back then, it's all relative. What would you do?  I'll hail it when I wake up in the morning.  Well, 14 days later, you feel better, the world hasn't changed, but the world's great again. Yeah. No, it's you. With the hormones being off is my point, particularly testosterone, what you get is that feel good and confidence hormone. You can have trouble sleeping. And so you fix that and bingo, you know, everything works again. Now, cortisol levels can rise, and here's one that comes up with people that are into the fasting.  Have you ever tried? It might be a silly question. You've tried some serious fasting, right? Yeah, I have, yeah. Did you have problems sleeping after a couple, three nights of fasting? See, so you must have a pretty good job, a pretty good time of keeping muscle on your frame or regulating your sugars. When I've fasted, which I've done probably twice in my life, you know, I don't like missing meals. That's one of the things I noticed after probably the third day.  I couldn't sleep. My cortisol levels had to have been off the charts. And I had, you know, palpitations and arrhythmias and other arrhythmias. So what's my point? You gotta pay attention to what works for you. Again, that theme keeps popping up. And, you know, one thing can lead to another, as I said earlier, and vice versa. If you regulate your testosterone, if it's dysregulated, then sometimes that can solve all your sleep problems. And if you're not getting enough sleep and you thereby dysregulate your thyroid, your testosterone, your cortisol, well then you can have more issues and, you know, that the snowball effect. And by the way, coming back to just reminding me, one of the great motivators for getting enough sleep for probably a lot of all of our patients, clientele, five nights in a row of less than your requisite seven to nine hours, whatever it is, you can lower your insulin sensitivity by as much as 50%. Wow. And for most people that worry about body composition, that's all they need to hear, although there's a myriad of reasons why you should get enough sleep, but that will get their attention. Yeah, make me feel. I think I know why too, because like in terms of like, I have like digestive, like gastrointestinal issues. And so for me to like step away from eating for a bit, I actually helped and enhanced my sleep a bit because of that's like, that was usually a thing I had to figure that out so to stop eating at a certain time during the day because that really impacted my sleep. So there was a whole, there was a segment in your book that you wrote about a compound called metformin, which I keep hearing about metformin, metformin. I've always heard this in the biohacking space, the health space, why is this included in your book? And well, first off, what is it and what's the deal with metformin? What does it do? And then why is it in the book, you know, that you're talking about with longevity and health span. Now we're getting to some of the nitty gritty beyond the basics. So there are processes in the body that help reset things we can call it for lack of a better word, whether it's through a mechanism called autophagy, whether it's through down regulation of mTOR1 complex, whether it's through activation of AMPK, these are all avenues by which the body can regenerate itself and recycle things. So metformin is great because first and foremost, it lowers blood sugar. It's an old, very old diabetic drug derived from a plant. I don't know, as old, how long has it been around? You know what, I don't know the exact date, but I mean, it's age old, and that's why it's cheap as dirt, which is another benefit. Well, that's good because if it's been around for a while, we know we have at least some long-term data showing us. Oh, the safety, I mean, the biggest risk with it, and I've never had an issue with any of my patients is if you have chronic kidney disease, you gotta work, worry about lactic acidosis. Oh, okay, thank you. 1922. It was discovered, interesting. So metformin has been used by anti-agers more recently to lower blood sugar, which we know comes with all kinds of positives, right?  Sure. That's why I was cautioned bodybuilders against, I would never use insulin. That'd be the most dangerous hormone they use. You know what? I just, I don't even know how they rationalize it, but I would never touch it. Okay, if I were a bodybuilder or anybody unless you needed it, right? But metformin is very safe in that regard. The only potential drawback with metformin is there's some evidence that shows it affects one of the mitochondrial, well, it affects the mitochondria in one of the complexes, I think it's C2. And yet I've talked to athletes to say, no, it hasn't affected my ability to work out at all.  So how much of that is actually real or not or how much it affects people, I don't see any evidence for it, but metformin can activate AMPK, which they, all these, the things I mentioned just now seem to be very interrelated. I forgot to mention the CER2 engines. We heard about that, right? Activating CER1 and CER2 for these processes that again, the bottom line is they help regenerate the tissue, they help, for example, autophagy takes cellular waste and recycles it. It cleans up the mess we talked about earlier at cellular level. So I use the analogy of a kitchen, right? You're slinging food all day. And if all you do is keep cooking and slinging food, you're gonna have a messy kitchen. You gotta stop, wash the dishes, wash the pans.  Rancid oil, for example. Well, the same thing happens. You start misfolding the proteins that have one job in mind. Now they're misfolded a little bit and they do something that they're not supposed to do. Or, you know, to further the analogy, you spilled spaghetti sauce on the recipe book. So you go, is that three ounces or eight ounces? Can't read that. So the DNA, the recipe gets ruined and then it's making the wrong things because the DNA, the instruction is corrupted. So the process of autophagy cleans up the mess. The process of DNA repair is fixing the recipe book and all this is happening at a cellular level and keeping us from degrading. And this is a major cause of aging. It's keeping us from aging. How much of a difference do you see typically in patients when they add metformin to fasting glucose or? Well, typically you're gonna lower your A1C, which is a measure, hemoglobin A1C, by no less than about 0.3% I've observed. And that's just me observing. That's not a study or whatever. And that's fantastic. I mean, no matter how you're slicing it, that's a great start in the right direction. Right. In terms of feeling better, yeah, most patients who need it are gonna notice it. If you're already at a 4.8, which is relatively low and you go on metformin and drop it to 4.5, which is pretty much ridiculously low, the juices are gonna be worth a squeeze. Save your money and do something else. Okay, but metformin for somebody who might be in the normal range of say 5.5% and you bring it down to 5.2 or 5.0. That's fantastic. What do they notice? You know, most people will say they feel better, but honestly, you may not necessarily notice anything, but you know that you are protected more so in almost all cases against most forms of cancer, inflammation, remember sugar is the right hand man of what we now call inflammation. Have an excess sugar is no bueno. You need enough and no more than that. So regulating sugar in and of itself does the trick, but again, modulating this process in the liver called AMPK, you're activating it, that's regenerative tool in and of itself. So it's another mechanism just like exercise is to say, hey, body, set these wheels in motion. And for some people who, whether they don't like exercise or they can't, okay, can use metformin not as a replacement 100% but to get some of the same benefit without having to do the exercise. Now, if they may not feel it, is this taking an account when we measure biological age? So let's say they don't feel it, but yet because they start taking this, they could see an improvement on their biological age. Was this, is this taking an account when we measure that? Yeah, and of course, when I say you can't feel it, I mean, I'm dealing with a patient population that's normally very healthy to begin with. If you're diabetic and you get on metformin, you're probably gonna notice a big difference. No, but I like you saying that I appreciate it because a lot of times people just disregard something because they don't have this feeling, you know? Which is why I think things like pre-workout are so oversold because it's something that people feel and so they just assume it's this great thing it's just like, listen. I'm gonna pull a nice and you'll feel this. Yeah, they'll take a pre-workout, but then they're low on vitamin D, they don't get enough magnesium, they're missing all these things that are way more essential, but they're pumping the pre-workout because they can feel it. When I take vitamin D, I don't really feel anything. When I take magnesium, I don't really feel anything so they don't take those things and it's just like, you're missing that. So that's why I like that you say, that you may not feel it, but hey, if it's improving your biological age, it's improving. That's part of the reason behind the book is to show, hey, look, if you don't see a benefit like you're describing without looking at, say the assays of your blood, biological markers for aging inflammatory markers, here's the science behind it. So even if you don't feel like, obviously testosterone, if you're low on it, if you replace it, that's a sexy hormone, literally and figuratively in a lot of ways, right? You feel the difference with that, but if you were to pump up your pregnant loan, are you gonna appreciate a difference in color perception necessarily? No, are you gonna notice your cognition bouncing up? Not necessarily. I would argue not even close to just having the energy for the brain work that you're gonna get with the restoration of your testosterone level. So you do have to rely on the science and go, okay, but here's what the studies show and trust that, yeah, this is helping me in the long haul over the next 20 years or literally the rest of my life, which we hope is gonna be a lot longer than that. And that's important, right? I think you guys probably experienced the same frustration I do because of just what you're saying. Oh, I don't notice anything with that extra magnesium, except I have an explosive stool the next morning. Okay, well, first of all, let's modulate the toes, but second of all, it's a long-term play here, guys. Yeah, let's talk about hormone therapy. This is obviously the field that you're most active in. And hormone therapy has been relegated for a long time. I guess, if you consider what the public perception to be, to be kind of like this cosmetic part of health, like hormone therapy, just to make you look better, make your skin look better. This is what Hollywood actors do, what celebrities do, but you put it in your book in regards to health span and longevity. So let's talk about that with hormone therapy. How can hormone therapy improve those in people? Well, if we skip the, I don't know if you wanna refer to it as the hedonistic aspects of it, which, hey, what's wrong with that? Who doesn't wanna look better, feel better, perform better? But, and I think I make it in reference to, you know, controversial topic that includes anabolic steroids, right? I believe it's the fourth leading cause of death currently falls, right? In the elderly, people that are infirm for whatever reason, right?  Dr. Rand, let me stop you right there. I train a lot of surgeons, and I'll never forget this, that I heard from at least four of them the following statement. They would say, yeah, you break a hip and then you dive pneumonia. They would say that all the time. So you could see the direct deaths from falls, but they would tell me all the time, oh, when you're at that age and you don't have good mobility and strength to begin with, and then you break a bone, your lifespan is dramatically shortened because of all the potential stuff that happens. Absolutely, and you know how, I think it's still the same way, but after they surgically correct that broken hip, I think it's three days. If you don't die within those three days, then it doesn't count as you died of that broken hip. Oh, interesting. Think about that for a second. If it's still the way they keep tallies. So yeah, you might argue it's closer to number two or a close third leading cause of death. Well, it makes no, well, let's put it positively. It makes sense then that you wanna make those infirm people firm enough, as it were, so they don't fall as easily. You still have to get out there and do the work, but why don't a lot of patients' clients do the work? They're not seeing results. And if you're 80 years old and you pick up a weight program, you're less likely to see results than some of our 30-year-olds, they're already complaining that they're not seeing the results enough. Well, you give them the ability to leverage all the good work they're doing, which goes into more than just the exercise, the sleep and the eating right and everything. And they get the results and they're less likely to fall. I mean, to me, it's out of the park home run. You guys agree? Oh, 100% you're preaching the choir. Yeah, so I mean, optimizing hormones through working with a doctor in combination with all those other things we talked about. It's like night and day in terms of the types of results and progress and strengthening that someone's gonna get. Is that a fair statement? Yeah, and the horses out of the barn in this one, there's so much research out there. It boggles my mind, I hate to say it, but almost on a daily basis when I hear patients referring to other physicians, and I can say this because I'm a fellow physician, right? So I can bag on my own profession to some degree that haven't done the research on this because even if it's the first time a patient is mentioning it, well, don't just poo-poo it out of hand, go back and do the research, because it's out there. There's plenty out there. Start with the publication in the Mayo Clinical Proceedings in 2016 from the International Consensus from 2015 that was headed by Abraham Morgantiler. You know, he's with Harvard and he wrote Testosterone for Life, but he got together over 20 of the leading urologists, I think all of them, in the world and came up with nine resolutions. Just start there, I'll leave it at that so audience can go out there and look it up themselves. But just so that you go, oh, coronary artery disease, that's out, it actually is correlated, meaning low testosterone with coronary artery disease, not the other way around. Type 2 diabetes, out, cancer out. These rumors are very easily dispelled and so physicians nowadays have no excuse. And I think that's turning around so that more and more people are gonna get access to what should be basic, right? I feel it's one of those, you know, the dose determines the poison type of deal where, you know, the few anomalies that have been highlighted in the news or what are that of, oh, so and so, and then they try and pin it to, he was taking all these anabolic steroids, therefore they're bad, like they try and correlate things like that that happen all the time. And it's like- That's huge. I can't name names, but, you know, I'm in Los Angeles. I work out at the Mecca and, you know, in Venice. And so I see and know a lot of these stories and what they don't include because it takes away from the sensationalization of the story is that, first of all, unfortunately, and I'm not saying this is the case for all bodybuilders, certainly or anything, but look, if all, I say, oh, I don't mean to sound that way either because a lot of these guys hold regular jobs and still do it, but certainly in the old days, the job was just being a bodybuilder, right?  So a lot of these guys point is taking recreational drugs that led to their death. A lot of these guys also had things that you don't hear about where, for a lot of reasons, they're scared to go to the doctor because they don't want to get a lecture about all the stuff they're taking or they're just scared of physicians or they're just scared overall about, oh, I have this chest pain now for three years that I haven't seen the doctor about and that can happen to anybody. It's magnified, it's leveraged, however, by anabolic steroids, which are different than testosterone, regular, endodically produced steroids, right? In that it furthers the production of cholesterol, particularly the so-called bad cholesterol, the LDL, that if you have extant coronary artery disease, it's only gonna make it a heck of a lot worse. So was it the anabolic steroids or was it the person, right? Yeah, you know what's funny? I just looked this up the other day in preparation for this. I went down a rabbit hole and I looked at the pro bodybuilders, which is in extreme, by the way, just for the audience, all extreme sports, you're gonna see a, there's always a, there's a trade-off at that level with longevity and performance at the extreme levels. Great point. So if you look at like the top, top, top endurance athletes, you'll see them, they don't live very long in comparison to healthy, normal people. Especially if they try and stay in it for too long and we go back to that whole idea of the J curve or amesis, too much.  But what's interesting is you do see a higher rate among them with coronary artery type diseases and heart issues, they have a much lower than average rate of cancer, which is cool because this peeks into the potential value of just simply building muscle. And studies will show muscle is actually, or building muscle is a wonderful protection against cancer. So I'm not saying it'll be a pro bodybuilder because you do raise the risk of, you know, if you live like them of dying of heart issues, but even at that extreme level, their muscle, even with their crazy lifestyle, they have a half the rate of cancers than the average person, which is, I think, kind of interesting. That's huge. And again, you don't have to be, you know, matter of fact, you are not as healthy to pack on excess muscle. Muscle that I would argue is non-functional because as a bodybuilder, you're not building the sarcomeres perpendicular to resistance, right? You don't care if they go this way, this way. You're just trying to build mass. And that extra is actually a liability as opposed to functional muscle. And I was making this point recently too. So yeah, you're spot on as usual.  One point I want to make about that too is that with heart, okay, atrial fibrillation, very common, much more so than certainly you would expect, right, I'm running every day or I'm rowing every day, biking every day. Athletes like that have a greater instance than the norm of atrial fibrillation, which is an irregular heartbeat, very common. However, and first of all, let's absorb that for a second. That's a jib, right? I'm not supposed to do stuff that's supposed to be good for me. Complications from it though are way, way lower, fewer than the normal average person. So okay, you get this and it has to do with just, you know, you get a larger heart as closer to the pulmonary vein. There could be an adaptation there, we're just not quite, we don't really know all about. Yeah, it's kind of like, it's a jib. It's like, well, you know, the formation of plaques and adaptation that 300 years ago was great. Yeah, patch off the artery because you were dead by 30, 35 on average. So it didn't matter if you patched it too much, right? But now we're living longer, it's an adaptation that didn't service well. So in this case, you know, I still, are you keep going with your endurance training because at the end of the day, even though you're more likely to develop a fib than the average person, you are still better off from it.  Now, I know that hormone therapy can be appropriate for almost anybody, depending on the situation. I mean, you could have children who are growth hormone deficient or have issues with their hormones, but generally speaking with healthy people, when does hormone therapy become something that's like, okay, this is around the age where you should look into this because you're probably gonna start to really derive some value from moving in this direction. Great question. And one that gets not enough attention, although Abraham Morgantailer, who used to frustrate me because he would use a number and he was considered one of the leading experts along with guys like Dr. Lipschold's pioneers like Lee and Wright. But you know, it used to be for men, it used to be a total testosterone of 450 or below 450 nanograms per deciliter. Now to answer your question, it is not a number, it's when you start having symptoms, duh, right? Everyone's different and what are you gonna do? If someone comes up and forget about laboratory assays being not necessarily precise all the time and therefore accurate all the time, but if you came up for the old standard at 451, does that mean you're not gonna treat? You know, and no, it gets crazy in a lot of this with medicine, like the new weight loss drugs. Do you stop giving the new weight loss drugs when they're no longer at a BMI that suggests they're overweight and then we're gonna go like this the rest of our life or do you say, okay, this person has an issue, let's continue. So anyway, to answer your question, but again, along with an answer, when someone comes up with what are standard or not, but which implicates low testosterone, well, that's when you start to look into it anyway. Now, of course, you look up and you go, wow, you've got 1,000 nanograms per deciliter of total testosterone, we should probably look somewhere else for the reasons why you have low energy and erectile dysfunction or something like that. But if it comes to instead of 450, 550, you go, yeah, let's give this a whirl, or at least retest. When does that commonly start to pop up in most people like in their 40s, would you say? I think by definition it's still age 35, whether it's for para menopause or para andropause, we call it, or manopause, I guess. I don't know, that was the thing. Yeah, by the way, just to back you up, there was a study done on testosterone and the ability to build muscle and strength, and they were trying to see if there was a relationship between total testosterone, free testosterone and muscle and strength, and what they found that was a better indicator or correlate for strength in muscle was androgen receptor density. So back to what you were saying, someone could have testosterone up here, someone can have it kind of below, but the guy with the lower testosterone has more androgen receptors, feels great. The guy over here has got low density of androgen receptors, doesn't feel so great. So this is why those ranges can be so wildly different. And that does happen, and that's one of the cool things about Mother Nature too, is that's gonna vary not just by genetics, but well, to some degree, your ability to adapt is obviously based upon your Dinex too, but I always explain to patients, what's cool is if your body can't make more keys, more testosterone for the locks, it'll make more locks for the same keys. That's up-regulating the receptors, the density as you put it, the androgen receptors. How cool is that? And then that's why when people first start on TRT, oftentimes I get the, wow, if I could just feel the same way I did after the first six weeks, you're getting started, you don't want to keep taking the first six weeks, because after that six weeks, and it kicks in, you've got a month where your body still got those androgen receptors up-regulated, and you feel better than you might ever feel, and then they down-regulate to what is more normal, right? Is that why for the first three months, my libido was rid, I- Most likely so, yeah. I was driving my wife crazy, it was too much. I didn't regulate it out. You know, what do you think, so my mother-in-law does this, and I wish I had met her when I was a young trainer, and I thought that was very interesting and smart that she would told her kids to do this. When they were in their late 20s, and by 30 it was like her thing, like make sure you go get your blood work done by 30, and she would tell them to get all your hormones checked when you're in a state of failure, because I know there's people listening right now that are like, oh, I feel good. I don't need any hormones, or I'm young, right? And she would say, what you should do is get it checked then, so you know your baseline, so then when you do hit 35, 40, or 50 years old, and you don't feel good, you have a reference point to go like, and to add to your point of like how, you know, you could be a 450 person and feel amazing on 450, or you could be a 900 person and feel amazing, or terrible and vice versa. It's absolutely true, and most of the people who come see me in my practice are in need of testosterone replacement therapy, but I get people that say, hey, I'm just here to be proactive, I wanna know, and gosh, I've had two in the last two weeks whose levels weren't necessarily great, but said, yeah, I don't have any complaints. I said, well, great. Then we don't have to talk about testosterone. Some other things you can do to be proactive when we had discussion about sleep, and a lot of other things, but that is again the key per your question. Do you have the symptoms or not? You don't treat what doesn't exist, right? So, and you know, you don't fix what's not broken. Now, the other parts of that though is, again, we do have, and gotta be careful here, correlation between low testosterone, things like coronary artery disease, type two diabetes, colon cancer, prostate cancer, and osteoporosis, but anyone in this room, if you were not on T, I would say so. What are the odds that you're gonna get any of those, right? With the exception of prostate cancer and coronary artery disease, which can be driven by genetics and some other factors, and we can screen for those. And again, if you say, yeah, I'm good, then I wouldn't necessarily do it because it's correlated with things that are associated with dysfunction and aging. You with me? Absolutely. All right, let's talk about peptides. The peptide space is fascinating to me. This is like a whole, it's exploding, by the way. Obviously in our space, people are talking about peptides left and right. What peptides would you say are in the context of longevity and health span? Would you say, and I know it's up to the individual, right? Some are gonna be better for some people than others, but which ones do you like to work with the most in that category for improving those things? The most popular are the growth hormone-releasing secretogogs that are peptides, although I have to throw in there one that's not a peptide. It's a peptide of a medic, which is just a fancy way of saying it looks and acts like one, but it's not. It's Ibute Morin, but they help the body's own ability to produce more growth hormone. And of course then eventually some IGF-1, which does most of the humans work, but doesn't get the credit for what GH does, which only lasts for about 30 minutes anyway in the body. That's probably the most popular because it helps regenerate tissue organs, particularly ligaments and tendons for the athlete. And I'd say again, that's the most popular. It's not well-known, but we cannot, as doctors, prescribe growth hormone, except for seven what are considered wasting disorders. It's actually illegal. It's just hormone- It's crazy because it's like the fountain of youth. That's crazy. Well, it's been touted as a fountain of youth. I would say not necessarily. And there's arguments, of course, about IGF-1 being higher or lower. We can do that if you want because I definitely have my own opinion about it seeing patients over the years. But it's the only FDA approved drug that's not approved for off-label use. I would argue, though, that you don't need it. First of all, it's ridiculously expensive. And the levels that you're looking for, that you want to approximate, and we use IGF-1 as a circuit marker for GH, are the levels you had, say, when you were 20, if you're using it to help regenerate organs, and I said I wasn't gonna go off on this, but just very briefly as a side tangent, if you're riding a desk all day, do you really need a lot of growth hormone slash IGF-1? Probably not as much as if you're working an oil rig. Got it. Okay, you're working like you guys are every day with patients and working out yourselves and that sort of thing. But to get the level you had when you were 20, which would amount to, say, 350, I think it's a milligrams per deciliter of IGF-1, you only need a GH sacretogoc, because you'll get there with it. And then you're called, you're recredesting the gland, you're getting it running like it used to when you were 20, and you're not suppressing its own use.  Where you're not gonna be tanked all of a sudden, you'll just slowly come back down to your prior level of natural production, right? And again, if you can keep it going, which we can't do with testosterone at later ages, that's why we use TRT, then why not keep it going with something that gets your own GH producing itself? How effective are they at raising, because you guys will measure IGF-1, that's kind of the surrogate, right? So you'll put them on a sacretogoc, type of Merlin, or CJC, or Ibutomorin, and you'll look at the IGF-1, and how effective is it with each patient when you have them taken? Do you always see, or do you sometimes see not sometimes? Unfortunately, not always, no. It's funny to see how people will or will not react to certain ones. There's an issue involved where you don't want to be suppressing your own production by eating late at night, and therefore spiking your own insulin production, which will counter the effects, they oppose the effects of endogenous production of GH. So that's one thing you gotta avoid, and that can confound the results. If a patient's not compliant with that, or they're sensitive to it, or they're insulin insensitive, and their insulin's always kind of high anyway. But yeah, for the most part, though, I will say, not just in studies I've read in the last six months, but over the course of my use of Ibutomorin for at least a decade, definitely see the best results with Ibutomorin. What is it about Ibutomorin that makes me sleep like a baby? I mean, I get some of the most amazing sleep. I wish I knew because you're not necessarily the rule. Some people actually will wake up hungry. It's not the norm, but it's the flip side where the ghrelin that's activated, the whole mechanism is through ghrelin, which is the same mechanism that you get the munchies from if you smoke dope. It's a ghrelin agonist, is that what it is? It's a ghrelin agonist, yes. That can make you hungry. That's why you should take these at bedtime. Don't go channel surfing, or you'll wake up and it'll look like a bomb when off in your kitchen. But some people get the somnolence from Ibutomorin. Most people get some form of somnolence if they're gonna get any from S'morlin. One of the original ones used to be called Jarev. Dr. Walker was involved in all that research. What's the half-life for Ibutomorin's, 24 hours? Oh boy, you put me on this spot. I'm sorry, I think it might be about 24 hours. That's why you take it daily, if I'm not mistaken. Oh yeah, you definitely wanna take it nightly, and yeah, I mean like S'morlin, I think it's like max 15 minutes is the half-life. So I've tried the CJC 12.95 with the S'morlin combination. Then I did the Ibutomorin, very different results from each one of them. The Ibutomorin, like, man, first of all, my appetite goes up all day long. So I would say when I've talked about it, yeah, it's just 24 hours. When I talk about it to our audience, I say, if you're trying to gain muscle and you need to feed yourself, for me at least, this is great, because it makes me wanna eat.  I feel like I'm on something. The other combination is much more subtle. I just kind of feel better, but it doesn't, it's not like a, like the Ibutomorin's like, holy crap, I'm on something I can feel. You're probably experiencing a little bit of water retention too, which is about 20, 25% of users. That's where the pumps come from. Yeah, exactly. And you feel like the joints are hydraulic now. Probably literally in some cases, right, with the Ibutomorin. I love to sleep from it. I mean, I noticed a huge difference of just like crash. Then there you go.  And if we start having issues with people staying asleep like we talked about earlier, those are the things that as a physician and hopefully just cause it's out there now, you gotta think about and maybe bring it up with your own physician.  So Ambien, Lunesta, what we call the Z-drugs, they have a Z in them, including the benzo-dazepines, are for falling asleep. Although as I say that, the benzos are actually to help you stay asleep, but I don't recommend you use them. But again, something like this, it's a win-win. Well, so I have this, I swear, I have like the words of my family, my uncle, my whatever, everybody in it, we've all been this way. I've been this way since I was a child. It's like, I'm so sensitive to having to go pee that even if I don't have to go pee bad, just a little bit, I wake up and the only thing that's made me sleep through that is the Ibutomorin. It'll make me sleep through. Makes you sleep heavier. Yeah, I sleep heavier through the night and I'm totally fine. If not, I'm like so sensitive that I'll wake up two or three times, have to go pee. Yeah, but who isn't, man?  Yeah, right. The idea, like I think you're suggesting, you don't want to not wake up for any reasons until it's time to wake up, especially in the morning. I, as I've gotten older over the last maybe 10 years, I have to wake up to go pee at once, but I stopped drinking water like two hours, make sure I get all my water, but then stop about two hours before that made a big difference for me. Yeah, that'll take me from like three down to two, right? So that's like, that's kind of what happens when, but the Ibutomorin has been one of the few things that I've been able to take that actually will get me through the night sometimes, which is amazing. I would stay with it then. Yeah, because of the reason of how important sleep is uninterrupted sleep. Yeah, no. There was a segment in your book about some like kind of stuff that's happening on the, I don't know if it's, you know, in the future, like gene editing and like kind of looking forward stem cell type of stuff. Like where's that fall in this category of longevity? This is where it gets really exciting because now we're talking about really doing some sharp shooting that can make a big difference in life. With gene editing, I'll start there. You know, it's actually pretty easy to do compared to a lot of things that we can do, but we don't have enough testing yet. And it's politically charged too because you're really changing the cars you were dealt with. So there's a lot of, okay, well, you know, we're manipulating what God did and that sort of thing out there. We're testing a lot of, in my opinion, we're testing a lot of the rare disorders first. I think consciously we're doing this on purpose. And we're getting a lot of good results. We've had some failures. And I'm not sure it's for the gene editing per se if this makes sense, but perhaps the way we're trying, what we're splicing in there, I don't think we have it necessarily right. So we've had some deaths, but when you're dealing with rare disorders or really serious ones, it makes the stakes a little bit lower in the sense that, hey, well, I was gonna live with, say, Huntington's Korea, which is miserable. God forbid anyone has it, because in your 30s it's a horrible disease to get. Anyone would take the chance to get rid of that disease if they knew it was coming, right? So I think we're... Do you think in the next decade or two that this is gonna just revolutionize? Yeah, we have to. Okay, okay. Because here now with gene editing, you're changing the genome, okay, your genome sequencing, not the epigenome, which would then of course be the effect you're having on the DNA. This goes back to something that changes the entire window with which you have to work. So some people have a window that they're more predisposed to diabetes than if they eat a ketogenic diet, for example, and fast and do a lot of exercise, will never face anything close to diabetes. But if they don't, boy, are they likely to get it. This makes it so, it shifts over like this so that, yeah, the odds are you're getting diabetes, I mean, you just don't really screw up. Okay. You follow? And then of course with major diseases, I mean, that's a game changer. Forget about some of these things that we can already control with what we call our activities of daily living that just turns off that gene, which is somewhat minor, okay, which puts you over here, like I say with the ketogenic diet, doesn't activate those genes. So yeah, that was a game changer. And if you take it to its ultimate, then we change our genes that allow us to, like lizards, regrow a tail, we can regrow organs conceivably down the road, we can extend our predetermined lifespan. And then you combine that with, talking about regrow on tails and whatnot, with stem cells, okay, and gene editing, or just with stem cells alone conceivably, we can generate new organs that can then be transplanted.  No need to take a mean suppressing drug. It's like your own organ. It just goes right in, your body accepts it. That's the ideal, right? Yeah, excellent. Have we been measuring people's biological age long enough to see some interesting, like what are the most like dramatic swings you've seen? Like someone comes in the first time you do biological age, it says, you know, and their chronological age is actually 50, and it says they're 70 or whatever, you start to dial some things in, get them on hormone, and they're doing all these great, and then all of a sudden it goes from 70, all the way down to say 50. What are some of, are we? Yeah, not to be... How much are we moving the needle, I guess? Yeah, I mean, it's hard to answer because of the testing. How confident are we with the testing? Like if you look at my first generation of the biological age and clock, you might see a difference of 20 years, and you go, okay, that might represent five, you know, ideally, you know, maximally, but it means we're in the right direction. It goes back to that precision and accuracy thing. But again, it has to do with the faith that you have or don't have in the markers we're using. I don't think we can quantify it as much as we want to right now. I think most of what we go back to is what any layman can do for the most part, and look at somebody and go, ooh, you say you're 50, huh?  Or God, dog, you're 70? No way, dude, that's your best gauge. And this is where we'll go back to the gene editing though, I think, because we're finding, there are definitely some advantages that centenarians have genetically speaking and to delve into that just to smidge. What's happening is they're, and I think we're gonna focus a lot more on immune system and changing the immune function through gene editing, they're getting the same disease as we are. They're just postponing it a decade or more, and then they come up with Alzheimer's, heart disease or whatever, but it's not until they're 100 or 90 or whatever. So that's the key right now, but with gene editing, I think we can change that certainly, but I think we'll also extend, the estimates are right now, we can make it to 120 based upon the limits of our genes, but we'll be able to extend that as we learn more and more about what we can do with the genes and which ones do which. Wow, what about currents, like available stem cell therapies? Like I had a friend who's like, oh man, I went to this doctor in Mexico and they did the stem cell therapy, my knee pain was totally gone or, and I hear stories like this, I don't know much about it. And just to, as someone who's always skeptical, I'm always like, well, okay, but what's going on there? Yeah, the body was gonna do that anyway. Yeah, what have you seen with stem cell therapy now? Like let's talk about, not maybe not the future, but what does it do now? What do we know that it can do now for people? Picking one of my favorites because I've experienced the results of that myself as I document in the book. The stem cell knows what to do and now we've identified another cell called a mu cell, which is even arguably more effective and with no risk of cancer development, which is a minor risk with stem cells anyway, but I have to say that because it is a difference. The stem cell can, I mean, I argue a monkey could do it because a stem cell knows where to go to get the work done. It knows where to find the work and then once it gets there, knows what to do. So you can inject it intravenously, a very large percentage goes through the lungs and may stay there, but the rest of it goes to the rest of the body and we'll find say damaged heart tissue and if it's your own stem cell derived from your own bone marrow or collected through aphoresis or whatever it might be, your stem cells will find that and actually in graft and replace that damaged heart tissue cell, a myocyte we call it, right? So to me, that's just fascinating. And that we can do right now where we have more room to improve is with nerve tissue repair because that's the one where, like for example, we've had, and you can imagine where this would be really good to with spinal cord injuries, right? Unfortunately, a goodly amount, I think is 25% of the time and it's mainly because we haven't what we call pre-differentiated. We haven't started the stem cell in the right direction toward a nerve tissue, 25% of the time you'll start to develop a tumor. That's no bueno, right? So we're advancing there, but here's another area that we can do, work with right now that I think is exciting, where we use stem cells to create organ tissue. So we can start with harvested tissue from a liver and use that to create a bunch of petri dishes as it were with liver tissue and test various therapies, whether it's drug therapy or not. So we don't have to go through human trials right away or even animal trials. We're skipping to human tissue right away and think about it, we replicate human livers and we say, okay, this drug works to get rid of fatty liver or not. Oh, I see, wow. The development process. Fascinating. And you combine that with- AI. To skip ahead with AI.  This is where I'm getting really excited where, and to borrow from Ray Kurzweil, live long enough to live forever or live long enough to live longer, right? Stick with the basics, stay in the game while we develop these over the next decade or so so we can take advantage of them and then extend our health and longevity even further. Wow, a lot of the advancements in, for example, cancer treatments or other types of treatments where we see people are living longer or surviving has to do with early detection and technologies that are able to detect things. But when they're treatable, you have a segment in the book talking about this. Are there advancements or new ways that you could detect? You know, like I heard about people getting these like full body scans where they're going, oh, you know, looks like we're early, we have a super early case of this type of cancer. You wouldn't have seen this unless it got to stage four. Now we could treat it in your fine type of deal. Are there new technologies with early detection now that people can look into? Yeah. And that's huge because I would argue there's very little if any excuse to die from breast cancer, prostate cancer, heart disease or colon cancer now if you make use of the early detection tools we have. Imaging, like you suggest, MRI imaging is very useful because you can see a tumor. For example, for prostate, there's nothing better than something called a multi-parametric MRI of the prostate where we can see a lesion in something that's typically walnut sized or larger as small as three millimeters. And I think the cure rate for cancer stage, I wanna say two or below, I might be wrong on that, is like 97%, okay, with what we call it pyrads two or lower, that's just a staging. That's for prostate. It's not the standard staging, but it's something you pick up per imaging. That's where you have that early detection of prostate cancer. That's before you've biopsied it, yeah. Wow. Is that what we'll put like radioactive pellets or whatever there? Well, that's one option of treatment for the idea is you have, well, you've identified it. So now you know what your options are. That's right. The first thing is to identify it. You know, I went through it, I document that in the book. Maybe I don't document it to a large degree, but I caught it at what we would call stage zero. And I think I'm six years now cancer free without a biopsy. We found it with imaging and to go further than what you're saying with a liquid biopsy test. Back then it was called Oncoblot, but it's similar to a lot of these new ones. The most famous is the Galeri from Grail, which can detect, I think over 50 different cancers. Prostate's not one of their biggest one. I think they have like a 37% sensitivity, but these are all tools that should be utilized together. Okay, and you know, in medicine, we don't like to shotgun things necessarily and you don't want to open up a Pandora's box. I was always taught you do test based upon what you pick up in history and physical and complaints and stuff. You don't just treat it like a car and have a typical maintenance plan that you, okay, let's test all these things and tweak that and tweak that based on the testing. But here I think it's definitely different where you want to use every screening tool possible because you do want to open up that can if it's appropriate. Okay, so if you can detect that prostate cancer and I'm harping in that one because think about it. We're all athletes here, right? How many times do you have to take a swing at a baseball before you're good at it? They say 10,000 swings. Do you think that proctologist has done this 10,000 times and with proficiency, the tip of the finger against something kind of mushy the size of a walnut? Come on guys, I mean, really. What made you get that, the imaging, was it, did you get a PSA test that came back? Well, this Oncolblot, this liquid biopsy, which is no longer available in the United States, picked up on something called an ENOX2 protein, which is only, it's only found in fetal tissue or cancer. Wow. Period. So you weren't pregnant? Nope.  I'm not gonna say that it was an error but it may not actually be, it's associated may not be the actual ENOX2 protein but the point being very accurate. Everybody I ever used the test on, except for one instance, we had a GI cancer that we couldn't find. Now, you know, you know how long the GI tract is and how hard it might be to find that on imaging or any other kind of testing. But in the studies with Moray, if they couldn't find the cancer initially that was picked up with the ENOX2 protein test, which will pick up the test and based upon the the weight, okay, and the pH, we can find the tissue of origin. We later found the cancer, okay. So there's a hundred percent correlation with the early test and a significant number of people where it's not like, okay, this is not a powerful enough study but we have other ones now. There's ways to pick up on certain forms of prostate cancer, PCA3, again, the liquid biopsy and there are so many coming down. There's a, I want to say C2N is the company that has a test for Alzheimer's now. Oh, wow. Yeah. And it's early detection. Yeah. Wow. Yeah, I've read that Alzheimer's starts decades before somebody has like really- Signs of it, yeah, which you want to jump on if you can. If there's anything you can do about that one, I mean, I feel for it's in my family not by gene, but by expression. And so it's a sensitive topic for me too. But yeah, I mean, who wants to go that way if you can avoid it? And that's the point of all this, whether it's colon cancer, which again, come on. I mean, the testing for that now, we've got some liquid biopsies, we've got some virtual testing. The standard is still something which, I mean, the most hateful part of the process is the prep, basically you spend all night with a pill in the toilet after drinking something that makes you go to clear out the- The orange fluid or whatever it is. But come on, is this worth it? Because that's a great way to go. Should we beat, so we're all 40 now, should we go get the colon? Statistics show that if you have a first degree relative that has one of these cancers in your family go early, like 45, otherwise 50 seems to be the magic number at which there's more yield for these tests because we're more likely to find something. That said, if you're a little high strung, like maybe all of us in this room, and it's keeping you up at night, which is what it was for me and like get tested earlier, you know, whether it's a coronary CT angiogram, which goes to testing, that one is also misunderstood even by cardiologists because the idea is, oh, we don't want you to get irradiated. You guys might all be too young, but when I used to go to the dentist, okay, dental x-rays were limited to every five years. So they would ask you, well, Mr. McLean, have you had dental x-rays in the last five years? Yeah, I think it was about three years. Okay, never mind, come on back, we're going to clean your teeth. Nowadays, when you go to the dentist for your annual, they take you back, they didn't ask you a question, they go back and they chuching you for the x-rays, because why? There's not that much of an issue with irradiation like there used to be. And with a coronary CT angiogram, you know, they're doing these calcium scores, which is one pass, about six to eight seconds through the CT and you're getting maybe, all you guys are probably getting six millisieverts of irradiation, right? Max, actually less than that, because that's just one pass, so maybe half that. To make another pass, you're getting to six. Another six to eight seconds, you're getting six millisieverts of irradiation. The maximum recommended annually is 50.50, where we live here, you guys, San Jose, you're getting maybe 3.5 millisieverts per year, just being on the planet. And if you take an overseas trip, you're getting more than- On the plane, right? Yeah, on the plane, right. So why would we not want to use that if something could save your life? Particularly, and I know this sounds backwards, but with athletes, I've had athletes that had 99, 98% blockage in their widowmaker, the left anterior descending, they were going fine. Ah, you know what, God, I ate something bad last night. The wife, thank God, says go to the ER and they whisk them into the OR and they're getting stents. They're athletes, they can get away with it. Not everyone's that well-conditioned and can get away with it like that. It's a no-brainer. And I go back to the way we think. If it's keeping you up at night, get it done. And it's an extra pass compared to what they call the coronary calcium score, which is worthless. Why? Because a calcium score, first of all, it's not that well-correlated. I've had people that had zero calcium score, okay, but recently happened to be about 89% blockage in the left anterior descending because it's a soft or fibrous plaque, which will kill you. That's the dangerous stuff. The calcified plaque is old news. The body says, okay, we've dealt with the inflammation, we walled it off, the immune system came, macrophages, cholesterol to the rescue. Now we're gonna calcify it. Okay, we're done there. And you're not gonna reverse it. So it's old news. And again, it's not correlated one way or the other. I had a coronary calcium score, I think it was like 32, okay? What? I've done everything right. This is impossible. This is not rage, right? And yet, again, because my brain was working over time, worried about it. When I did a coronary CT angiogram, squeaky clean otherwise, thank goodness. But the point is, and we forget this, the screening is so important because you can get these things despite what you think you're doing right from A to Z because something as simple as, say, an abscess tooth, okay, that goes unrecognized for a year or more, or a GI bug, some of you don't have much control over, right, unless you want to live in a bubble. It's an infection. It goes throughout the blood. It could seed somewhere in the coronary areas of the heart. You got inflammation and bingo. You've done everything right. And yet here you have this problem. As a matter of fact, for the three people I mentioned that I was thinking of, two of them had 98%, one had 99. I went back and looked at their labs. All three patients of mine. I was like, okay, how can this happen? On my watch, what's going on here? What did I do wrong? And I told you I'm a CPA before I'm a doctor, right? So I'm presumably honest and conservative. Every single one of their labs, LDL of 80, HDL of 60, plus or minus two points on either of those numbers for all three people. That's a cardiologist's dream.  Well, first, I'm gonna go into a whole other subject about cholesterol and its effects or not, but yeah, it had to be something different. And in my case, again, I lived a pretty good life. I went back and I remember when I was too broke to be able to fix a tooth, where the filling had fallen out and it started rotting away. I think it sounds gross. I know, but I was too broke to fix it. And all I could do was figure, yeah, I was in my 30s, must've been what seeded that little piece in my heart that finally, when I got the tooth fixed, my body got the upper hand on it, that was that. Just to back you up, by the way, studies are pretty clear on this, that flossing reduces your risk of heart disease, probably because of that. Well, you pick up on a, I don't know if I devoted an entire chapter to it, but why we separate dental health from all the other healths? I mean, it's a specialty just like anything else and it's huge for that reason. We all know, okay, you've heard of friends, if not you. Oh yeah, he had a heart murmur, so he has to get prophylactic antibiotics before he has any dental work. Okay, there's a connection there. We gotta take great care of our mouth as well as our feet, our genitals, our heart, our liver, right? Otherwise, it can be a problem for that reason. Interesting. Well, Dr. Rand, always awesome talking to you. I think, again, you're like the, you're our favorite person in this space, the person I think we will recommend the most, so for anybody listening who wants to- The only one too, but that's okay. Yeah. For anybody who wants to learn about longevity and being active and fit for the rest of your life, this is the guy to go to, and your book is great, so. Well, thanks a lot. Thanks for coming on the show. No, thanks for having me as always, guys. Thanks, guys. Thank you. Today, we're gonna teach you everything you need to know to build a strong, well-developed chest. When I think of weak points and areas that I struggled with developing for a really long time, chest was up there with the- Yeah, it was for me. It was for me for sure. I got more caught up in the weight I could lift versus how I was developing my body. I think it's one of the most challenging muscles to develop for most people because the form and technique.