EFR 749: MEDICINE 3.0: Battling Obesity, The Truth About Cholesterol, Extended vs Intermittent Fasting Fasting, and Science-Based Ways to Beat Chronic Diseases with Dr. Kurt Hong

0:00:00 - Speaker 1 So all the bad genes that turn on. Now you've followed this new diet, I'm able to turn those genes off. That changes everything that's right and you can now do these chips for about 120 bucks per test. No way, yeah, and the price is going to continue to drop.

0:00:15 - Speaker 2 We can manipulate which genes are turned on and off for about the cost of a hundred bucks.

0:00:20 - Speaker 1 Yeah, well, so so what we want to do is right. So it goes beyond just that, while you're screwed because you have all these bad genes, right, it's more okay. Well, what can we do about it? No way yeah.

0:00:30 - Speaker 2 Yeah, so it's, it's. I don't know if we're ready for that.

0:00:32 - Speaker 1 Yeah, well, and that's the thing is, I mean, it's great to have all these data, but data comes with responsibility. I mean, what do you do with them? And if it's just going to bring more, some of the more stress, what is that unnecessary good thing? Because people can get so fixated on just fixing one number but they lose the big picture.

0:00:51 - Speaker 2 That's kind of the catch 22 is, you know, especially when, where we are now in the world having access, and especially lowered cost access, for key biomarkers. It's a wealth of information and it can be very overwhelming. Some of us can do very well with it in terms of okay, I don't need to get stressed out and understand that this is just, you know, a bunch of individual silos for me to kind of conquer individually or understand individually.

But yeah, I think for and that's kind of where I definitely want to go later on is for most people, is this too much information and is it, are we having like a diminishing return in terms of, hey, here's something to work on, here are a lot of things to work on, but now I'm stressed out about it. I think I'm dying or I'm going to like go down a rabbit hole and spend all my money. I'm going to go over, you know, my budget and try to like fix myself and it caused a whole nother world of problems financially and stress and relationships. It's crazy. Did you see the?

0:01:45 - Speaker 1 Times article about this guy who's trying to live forever.

0:01:49 - Speaker 2 Oh, Brian, Brian, he's like cycling his 18 year old son's blood or something? No, yeah.

0:01:55 - Speaker 1 And then he does these crazy, crazy diet.

0:01:58 - Speaker 2 Yeah, yeah, yeah yeah.

0:02:02 - Speaker 1 He even has sensors to make sure that he has his morning erections properly to maintain his youth.

0:02:06 - Speaker 2 I feel like you don't need a sensor for that.

0:02:09 - Speaker 1 Measure is, I guess, the force of it yes or no? No, I mean there's go to timescom Amazing.

0:02:16 - Speaker 2 Okay.

0:02:17 - Speaker 1 Big feature article because he's convinced you can reverse aging. Of course, the interview all these other guys just disguise.

0:02:25 - Speaker 2 I'm going to check that out. Thank you for that. Uh, JB. Good, I meant well, Dr Hong. Welcome to the show officially, Absolutely.

0:02:32 - Speaker 1 My pleasure.

0:02:33 - Speaker 2 Thank you for being here out of the gate, somebody like yourself who has had so much experience in academia and medicine and life. What is the biggest concern facing Americans right now in terms of nutrition that you don't feel is being taken seriously enough right now?

0:02:56 - Speaker 1 So I think the focus has been on over nutrition, but I think more and more we're really focusing more on also the quality of food. You know, if you look at kind of where a lot of kind of certain areas where you know longevity, you know we often talk about the blue zones. Um, it's really about kind of how they approach food. You know food is really part of their culture, it's part of their lifestyle. It's not just the calories they consume during their meals.

0:03:23 - Speaker 2 It's not just one food group or one vegetable one thing, it's the whole picture.

0:03:27 - Speaker 1 You're saying Exactly, and you know you have to kind of go into it with the right kind of framework in terms of kind of how you approach not just a diet but really kind of the food selection. You know how food can potentially influence how you feel, how you think. Uh, more and more we recognize that food. Yes, it can influence your weight, but it can also influence, you know, the quality of your sleep. You know emotional state and so forth.

0:03:53 - Speaker 2 Food and sleep. Uh, I'm so glad you bring that up because, as someone who is very uh, aware of a lot of things in his life and I know my audience is with me you know we were. Maybe we're following a food plan, we're tracking on a wearable, I'm rocking two here. We have a food log or um, we are aware of certain variables that move the needle for us or ones that maybe have room for improvement. The biggest thing for me when it comes to nutrition and sleep, I was amazed at how close these two work together. Um, on my whoop data, when I eat late, when I eat within a one to two hour window of going to bed, the the way that my sleep diminishes. It's as if I had a couple of glasses of wine or alcohol it it. It almost does the exact same damage, in terms of my sleep quality and quantity, eating close to bedtime as consuming alcohol does.

0:04:45 - Speaker 1 So if you look at kind of our circadian rhythm, you know how our metabolism changes when we first wake up in the morning in terms of how our body's metabolism generally will slow down toward the end of the day.

You know our body's ability to metabolize carbohydrate, our body's ability to metabolize a high fat diet which unfortunately we frequently will treat our dinner as the biggest meal of the day. It kind of works backwards. If you look at a lot of other parts of the world or pay our people who practice fasting, they frequently will value, you know, the breakfast or even lunch as their bigger meal and only a smaller snack, particularly toward the ends of the day. And a lot of people they will actually purposely grab an early dinner and just don't eat anything at least three, four hours before their bedtime. Because kind of going back to where you're going in terms of kind of understanding our body's ability to overcome particularly some of the insulin resistance we see in a lot of our overweight and obese patients really eating a high carbohydrate, particularly processed carbohydrate or high fat diet, it's just not optimal.

0:05:46 - Speaker 2 So am I hearing you correctly that it might not be as, when we're looking at what might be diminishing our sleep quality within that time window, it's more so related to the macro nutrient profile, not as much maybe the quantity of calories or even that time window.

0:06:02 - Speaker 1 Absolutely, even though the two probably will go hand in hand.

0:06:05 - Speaker 2 Yeah, yeah.

0:06:06 - Speaker 1 High carbohydrate, high fat diet. Probably calorically it's going to be a little bit higher as well. But you're absolutely right, quantity is not the only part of the equation, it's also the quality.

0:06:17 - Speaker 2 What about when it comes to somebody and I don't really want to get in, you know more in depth to intermittent fasting versus periodic fasting in a little bit. But while we're here, what about someone who is intermittent fasting? Or just whether that's intentional or just where their life is, they're getting all of, or the bolus of, their calories. At the end of the day that's their dinner. So it's either I got to get all this food in or else I'm going to have. You know, weight gain issues, weight loss issues, body composition it's going to, it's it's not going to work with my body composition goals. Basically because at the end of the day, we, we all need sufficient calories to exist, to have energy, to build muscle, to do all these things. What about somebody in that window? Is it better to still get in your bolus, the majority, all of your calories, even if it is late at night, or should we be tailoring that back into a certain time window?

0:07:08 - Speaker 1 So when a lot of the initial studies got published in terms of looking at the various forms of intermittent fasting whether it's the five to plan, where again you fast for two days out of the seven days, or the more popular plan, which is a 16 a diet, where you try to consume all your calories within that a window it was really not designed for people to try to play catch up at the end of the day, really.

And remember there are lots and lots of studies that's really been published over many years showing that. You know, breakfast is actually an important part of the day. For people who consume breakfast, they are more likely to maintain a healthier way. If you look at the risk for diabetes and metabolic syndrome people who actually consume breakfast, they actually do better. I think it's just more from our kind of busy lifestyle standpoint.

It's much easier just to grab a cup of coffee and not eat anything in the morning, right, and then you get really busy and then you get really hungry. Other than that, then you realize, wait a second, I still need to eat. Yeah, but going back to kind of what I was saying, if your body's metabolic efficiency is slowing down at the end of the day, that's about the worst time. You should be consuming a 1200 or 1500 calorie meal just because that's kind of your caloric goal Interesting. So I actually would suggest you know what? Yes, you can still fit that AR window, but shift that window earlier, okay, and try to again wrap up most of your meals, hopefully no later than about 530 or 6pm, yeah.

0:08:27 - Speaker 2 Again, I've been floored of the data. When I look at my personal whoop data here I wear a whoop physical activity tracker and the days that I wake up that I genuinely do not feel my best. I don't feel I got the best sleep. I don't feel as energized. Usually for me I need about three seconds and then I'm up, I'm ready to go. So when I look at my dad and I look at my sleep, I look at lowered REM sleep, I look at lowered sleep quality, sweet sleep quantity, and I go back and the food log is like yeah, I had a meal close to bedtime and it pretty much damn near every time does the same thing as as if I have, you know, any alcohol.

0:09:03 - Speaker 1 Yeah, and I think what people don't realize is you know, in your 20s your body may have the adaptive mechanism to recover as we all get older you know, with a lot of the hormonal changes you know, loss of lean muscle mass, which is fully expect. Basically, again, you know, your risk for developing kind of excess body weight, particularly in the abdominal visceral fat becomes more problematic, particularly late.

0:09:28 - Speaker 2 A lot of your work centers around nutrition, like we've been kind of already talking about, as well as you know, understanding obesity, and we can't talk about obesity and we can't talk about nutrition without the standard American diet. And so my question for you around that is Can this realistically change? Can we realistically improve the standard American diet? What changes need to happen at the macro level in terms of maybe you know, government, community, you know public health and things like that, but also at the micro level, or do you think this is something that just is a lost cause?

0:10:00 - Speaker 1 I definitely think we have to start somewhere, because what are we've been doing the past 20, 30 years? That's what I'm saying. What have we been doing?

0:10:07 - Speaker 2 So I think we're going to have to start with the new one, so not a lot.

0:10:11 - Speaker 1 But I also think you know, while there's what's idealistic, you know, there's also kind of what can we do practically to get the ball rolling? And I think, as a first step, we need to recognize you know what in terms of some of the original ideas. You know back in the 80s, you know we're talking about. Basically, you know different food groups. You need to have X servings of, basically, you know, red meats.

0:10:32 - Speaker 2 You know starches, sugar, fats, grains, things like that, and that's been really thrown out the window.

0:10:38 - Speaker 1 If you really look at some of the newest recommendation that's been put out by the USDA, it's really looking at kind of how can we put together the food groups as a whole to really kind of focus on kind of minimizing the risk for developing age-related chronic diseases and hopefully also improve health span and longevity.

But I think, just even taking a step back even further, you know, I think over nutrition obviously still a big problem and at the end of the day probably all of us, you know, can figure out ways to cut out particularly some of the calories we probably don't need and if we are noticing that we are gaining weight, definitely more the priority to try to do so. But once we kind of have that in place, I think one of the things probably most people can agree on is most of us were probably not doing enough plant-based regimens and whether it's the, you know, the healthy fruits, the healthy vegetables. So there are actually some wonderful studies showing that if you look at the recommendations for healthy hard diets, we recommend anywhere between about 30 to 35 grams of fiber daily.

0:11:39 - Speaker 2 Which most people, even when you're trying they are not hitting. It's hard to do that.

0:11:44 - Speaker 1 You'll be surprised how many patients they barely are able to hit 15 grams a day, and I think it goes back to you know we're all about what can we do right now? Can we grab a fast food? And even when we're not buying stuff from restaurants, we're getting stuff from grocery stores that are pre-packaged, and it goes against, you know, our whole concept of you know, trying to prepare something from scratch if at all possible, even if you can't do it daily.

0:12:10 - Speaker 2 So I heard you say plant-based in there and I personally do not abide by any particular diet. At this point, kind of being in the profession and also just a curious person trying to optimize his health, for about 20 years now I've kind of dialed in what works best for me. I'd say if I had to pick it would be like the 80, 20, 80% of the time I'm really on top 15, 20% of the time I'm kind of, you know, wild and out. My question is oh my gosh, it just, it just left me. Oh, excuse me, that's an American diet. Oh, excuse me. Okay, I'm bringing back to the plant base. Yes, there we go.

So I heard you mentioned plant base in there and again, as someone who does not abide by a particular diet, I will say that over the years, when I come back to center and I focus more on increasing and keeping more vegetables, more fruits in my diet, I definitely feel my best. I feel like I have healthier eliminations, I feel like and I know it's serving my overall health. Do you feel like plant based is the best way to go for most Americans, most humans, getting away from plant based protein, plant based foods, or is it just kind of finding that right dynamic for humans, because then there's a lot of controversy out there. Now you know, we all need to be more meat, we need to be more animal protein, we need to be less. This that the diet culture is usually at each other's throats. But I'm curious what's your take on it?

0:13:50 - Speaker 1 Yeah, so you know, protein's been a sexy word that's been thrown around really a lot.

You know everything is about keto. Everything is about can we do something that's high protein, whether our beverages out there, you know protein shakes, protein bars but I think if you look at, you know again, pockets of the world where longevity is something where they've been able to achieve, it's really kind of they consume a huge amount of plants, basically, whether it's coming from fruits or vegetables, and definitely a lot of whole grape and obviously, you know, with that kind of comes with a much higher consumption of the fiber. Okay, so if you look at some of the really well stabs diet I'm going to kind of just pick one as an example Mediterranean diet. It's really focused on again picking out basically fruits and vegetables you can prepare, simply, you can eat naturally, and definitely you want to be able to kind of consume them as much as possible on a daily basis. Right, choose the right variety and you know, frequently I actually will tell my patient, you know, just at least pick two, three colors a day.

You know, don't go all brown there you go, yep, and even if you have basically green, pick different shades of green, try to throw in the purple in there, try to throw in orange in there sometimes, and I didn't want the hardest part with any type of kind of dietary change or lifestyle changes. It's that initial momentum. How do you get into that pattern where you realize, wait a second, I'm eating out seven, eight times per week. Can I cut that back down to three, four times a week? And once you're able to achieve that, then take it one step even further.

0:15:20 - Speaker 2 For individuals who really struggle with this, and that could be an underconsumption of calories and underconsumption of nutrients and overconsumption of calories and even an overconsumption of nutrients. For many people who go down that path for whatever reason, that turns into obesity, becoming severely overweight, severely high VMI, very imbalanced body composition in terms of lean muscle mass and body fat mass I've heard this throwing around a lot over the years. Whether obesity is an actual disease or it's just poor choices. Someone who works in medicine and in understanding obesity, what's your take on that?

0:16:06 - Speaker 1 So it's interesting if you look at the term malnutrition. Maljust means bad nutrition, so we are beginning to really think of obesity as a form of malnutrition.

0:16:16 - Speaker 2 Really.

0:16:16 - Speaker 1 Because when we typically think of malnutrition, you think of somebody with low BMI who may look anorexic, who may basically have trouble absorbing nutrients.

0:16:23 - Speaker 2 I think of all those underprivileged children, like in Africa, malnutrition sponsor a child kind of thing. It looks very undernourished.

0:16:31 - Speaker 1 Correct, but remember, you can overconsume calories but yet still be malnourished, exactly Because you're consuming the wrong type of nutrition. And this kind of goes in not only in terms of impact on the macros, but also on the microbes as well. So if you are consuming a lot of processed food, you're not eating the right balanced diet. Not surprising, you may actually see patients who may actually still run into issues in terms of nutritional deficiency and other type of metabolic imbalances.

0:16:59 - Speaker 2 So to really understand, there it could be obesity. The disease of obesity could be a consequence of malnutrition, even in pursuit of healthier choices. Correct or what we deem to believe to be true, healthier choices.

0:17:18 - Speaker 1 Correct and unfortunately what we see is that when you gain more of the adipose tissue and this is something obviously we see being more problematic as we all get older, that is our product brigade also kind of inflammatory microenvironment which makes it sometimes even more difficult to kind of overcome that. So you know, I would often tell my patients, you know you have a wheel that's spinning in the wrong way.

I need to stop it get it spinning in the right direction and sometimes and you know, we see patients where you know if they're able to lose that first five to 10 pounds because they're obese, sometimes the next five to 10 pounds may actually be a little easier.

0:17:56 - Speaker 2 Is there a difference when you're looking at obesity, when you're with a patient in clinic, versus what you see in a clinical study, so to speak? You know scientific world versus real world.

0:18:10 - Speaker 1 I think in the real world it's all about keeping it real, meaning that, again, you know you will love for the patients who's consuming 2,500 calories to cut down to 1,400 calories because that's going to allow them to lose weight. But we realize, you know, to deprive somebody of 1,000 calories overnight, they're going to be grouchy.

0:18:27 - Speaker 2 It's a big jump.

0:18:28 - Speaker 1 It's a big jump, Yep they're not going to feel well. And guess what? After probably about two weeks, they're just not going to come back and here it's just going to tank yeah.

Exactly so. We actually tell patients look, you know what, let's see whether or not you know, cut out basically just a couple of things. We'll check in with you again basically in a month or two, see how you're doing. If something's working, we'll continue with it. If something's not working, we'll make the adjustments. And patients like that and you know. Another example is for somebody who just does not exercise. You know you don't tell them to say, well, you have to hit the gym four times a week. Yeah, let's see, you know, can you, from Monday through Friday, get one day in? When are you able to do that? Between Saturday and Sunday, get one day in. Start small build.

Exactly, and you know, patients appreciate that because they feel like you're working with them, you're not preaching to them, and I think that's kind of where the problem is. You know, when it comes to a lot of the approach to nutritional obesity in the healthcare circles is there's almost still a sense of shame.

0:19:22 - Speaker 2 Oh, yeah, yeah.

0:19:23 - Speaker 1 Yeah, and I think you know sometimes, and even from a physician standpoint, they also almost don't feel like they can be comfortable in terms of bring up. You know somebody is overweight and because of their way they have diabetes or hypertension. But I think most of the overweight and obese patients they realize they have to lose weight. How do you bring up that topic in a non-judgmental way?

0:19:44 - Speaker 2 I want to share a little story with you from my time in clinic actually, and there's a question I want to tie in with it. The question is have you ever experienced this, or what is your take on the mental and emotional component to obesity?

I was sharing with you earlier that you know, I used to see patients every day as a clinical health coach and a lot of my patients were in weight loss programs and I had one patient client who we worked together for about a year and within that year, for the first time in over a decade we got her under 300 pounds and it was amazing. But then all of a sudden she stopped showing up for our coaching sessions, she stopped showing up to the group, she was dodging phone calls and emails. So I kind of called her out in a respectful way, of course, and the shame component again kind of came to light here, but in a really unique way that this was my first time ever experiencing the mental and emotional component to behavior change and especially weight loss. She said, chase, I stopped feeling safe in my body and as we began to unpack that, she shared with me in a very emotional state that she was feeling the same way she did as a young adolescent, early teen, because she shared with me that the guy that her mother was dating was physically, emotionally and even sexually abusive to her mother and her younger sisters who were smaller than her.

And so what she did? The only way she could avoid him touching her and to be protective of her family? She got bigger and she became her words, not mine less attractive, but also more capable of protecting her family. And so it came down to this component that her body and mind were being triggered, that, hey, there's a past experience of mental, emotional, physical sexual abuse. If we get any smaller, this is going to happen again. Have you ever seen this in patients or in clinic? Or what is the correlation of mental and emotional self to the physical self when we're looking at obesity and really finally letting weight go and keep it off?

0:21:57 - Speaker 1 You know you brought up a really interesting point and if you look at a lot of the science that's kind of now centered around, you know why we gain weight. It's really moved beyond. Well, you know, if you're overweight it's an issue with self control. We know that's just not true. You know a?

0:22:13 - Speaker 2 lot of a little bit, but it's not the only reason.

0:22:15 - Speaker 1 Yes, you know, people still need to kind of take charge and want to actually kind of get healthier. But we see a lot of patients where they really work at it and it's still a struggle. So, you know, back in the fifties and sixties you know they identify a part of the hypothalamus in the brain that will trigger, basically hunger. But in the eighties and nineties they recognize there is another part of the hypothalamus of the brain that actually are response to our emotional side of eating. Really these are the things that triggers cravings. So one of the things that one of the questions I will ask all my patients you know who have really struggled the way and they realize, yes, you know, calorically they probably could be eating less is it's not just whether or not you get hungry, because a lot of people they don't necessarily experience hunger.

Right, I would actually ask craving, craving, craving and you know, and people sometimes will give me a blank look and that's just say, well, I don't understand. What do you mean by cravings? And I'll actually have to define are there certain triggers? That basically, is there a component of emotional eating? Is there a component of stress eating? You know, and I actually will share my experience, I usually always just say look, you know, I have three kids and no one. They go to bed around 1030 or 11,. You know, my wife will see me in the kitchen. I'm just looking and she would say are you hungry? I'm like this is not hungry, I just want something.

0:23:29 - Speaker 2 I don't know how I got it, I just blacked out wound up in the kitchen. Sounds like me sometimes.

0:23:34 - Speaker 1 For me it's just boredom and to say, okay, well, this is what I do for a living, and there's certain days where you know I would still give it turns out, dr Hong's human as well.

All right. So you know, I think when you really ask those type of questions, you know the patients are more likely to kind of share with you their experiences and they will tell you, like you know what for me it may be more related to certain stressors, a job, or it could be some of the other issues that may be going on.

0:24:02 - Speaker 2 Yeah, this was a tactic I use in clinic as well when really looking at trying to introduce new or reduce certain behaviors. It was very rarely the thing or the food or the action. It was all right, walk me back. Like you're in your kitchen, you're making not the best choice or not the choice you want in terms of what you're eating. What were you thinking doing? Who are you around? Where were you in the 30 minutes hour before that? Right, that, all those are little bits of clues to the amount of willpower or self control that you think you do or do not.

Have Another quick little story I'll share with you. I think it's just an example that comes to mind a lot Another patient of mine, for some reason super high performing lawyer in DC, and for some reason she's like I don't know where recently, around 7, 7, 30pm, I've got this sweet tooth and I never had it before and I don't know why, and I'm gaining weight, I'm eating ice cream, I'm keeping Ben and Jerry's in business, and we began to kind of unpack Okay again, what's the time, what's the activity.

And she shared with me that about six months before that she kind of took a little mini sabbatical, spent time with her sister and her two young nieces and she was the cool aunt for a couple weeks. Every night around that same time she would take them out for ice cream. And it was just a few weeks, but long enough to build that emotional trigger in her. So what we? What do we do instead around that time it gives me goosebumps talking about the story she would put down the ice cream or not even go there and she would FaceTime her nieces. So she would get that emotional craving, happiness satisfied and she's like, yeah, and then eventually the sweet tooth went away.

0:25:38 - Speaker 1 And I should share. Kind of related to that and going back to what you were saying about food as an addiction, one of the medications out there we use to treat obesity is actually a combination of two medications. One is the same one that we used to help patients quit tobacco addiction and the other ones the one that we use to help people quit narcotic and alcohol addiction. Cravings and addictions craving addiction they're all time related and you know, for some people, you know when someone's stressed they want to light up a cigarette. For other people to turn to food.

0:26:09 - Speaker 2 They knew that release Exactly. Wow, just any other kind of emotional state. Wow, that's fascinating. Man. Humans, we are weird, we are wild.

0:26:16 - Speaker 1 We are wired so weirdly. I say at the end of all day, we all like to eat.

0:26:20 - Speaker 2 Yeah. So, having an expert such as yourself and I kind of have just a few more kind of rapid fire questions, if you will, around nutrition, but also what I think are a lot of hot topics in the nutritional and even metabolic health space cholesterol I don't know how many times I'm going to open up, you know, instagram or watch a nutrition video and it's like it's bad today, good tomorrow. So many people are at war around cholesterol, dietary cholesterol affecting your cholesterol panels. You know how much we actually need more cholesterol for hormone health. I recently just learned that cholesterol actually is, in fact, a hormone. And so what? What's going on in the world of cholesterol? Is cholesterol as bad for our health as we have been led to believe, and what role does it really play in our overall quality or overall well being?

0:27:08 - Speaker 1 So it's interesting Again going back to 80s, when they originally put out the food pyramid. You know, one of the recommendation is that your dietary cholesterol intake per day should be less than 200 milligrams per day. Okay, now I will tell you. You can ask 100 physicians if they can tell you what 200 milligrams of dietary cholesterol. Nobody knows exactly what that means. So it was basically scientists who determined that, based on older epidemiologic studies, you shouldn't cross that threshold.

0:27:32 - Speaker 2 So like in the lab. This is ideal, Exactly.

0:27:34 - Speaker 1 So since then they realized, like you know, we obviously want people to stay away from, you know, foods that are high in saturated fat, because there's like good correlation between, you know, consumption, high saturated fat or trans fat as well as early kind of risk for heart disease.

But they've kind of gotten away from basically the dietary cholesterol, you know. But you know, you do realize you know some of the very highly processed food that mean high in fat. They also tend to be high in cholesterol, but they're not taking such a hard stance saying what you have to avoid any food that contains any type of cholesterol, because you know it is conflicting. You know it's like seems like every other month somebody said, well, you can eat eggs and then the money you like you should avoid eggs. So what we do know in terms of kind of your liver profile, which is a predictor for your future heart disease, is, yes, diet plays an important role, yes, your weight can play an important role, but there are also other factors or physiologic influences that can also trigger why we see kind of increase, particularly in the LDL levels, as we get older.

0:28:33 - Speaker 2 Which is the air court here. Bad, Bad cholesterol.

0:28:35 - Speaker 1 So these are the kind of the low density lipoproteins and you know, we do know, once that number starts to get over 100 into the 130, 160 range, there seems to be a pretty strong correlation for early heart disease. It's a negative trajectory for quality of life, exactly. But we also seen patients where you know they are very healthy, they eat a very good diet, but if you look at their family history, there's such a strong genetic component and for those patients, you know, then the question becomes well, my cardiologist, my primary care doctor, all of them wants to put me on the stand. Do I go on the stand? And again, you know, I think, from patient to patient, then you know that's going to be a very individualized choice. But we recognize, yes, while diet plays a role, it's not the only thing that plays a role.

0:29:19 - Speaker 2 What role does dietary cholesterol play in directly influencing or not influencing our cholesterol when it comes time to get a lipid panel done?

0:29:28 - Speaker 1 So you know you actually need some cholesterol in your diet for a lot of the metabolic functions. So you know we tell patients luck. You know what. As long as you're eating a balanced diet, don't worry about basically your dietary cholesterol. Now that's meaning what meaning that again, you're eating mainly a lot of plant based regimen, particularly, basically, if you're preparing food without adding a lot of excess oil and, like you were saying earlier, that higher fiber component as well.

Exactly, or basically, you know and a lot of things could be things that most people probably would agree with you know you probably shouldn't be eating fried food two, three times a day. Sure, exactly. So the food preparation kind of goes into it. But I think, you know, what we need to get away with is basically some of the minuscule details in terms that, well, I can never have this or I can never have that. I think, you know, there are certain things you may be able to enjoy a couple times a month. There are certain things that you can enjoy more frequently.

0:30:15 - Speaker 2 I love it. I love it Anything, anything I can get from a doctor that tells me oh yeah, you can enjoy that more often. I'm here for it. I'm here for it To backtrack a little bit, to go back to kind of obesity. We definitely define our terms there and, I think, really shine a great light on what can lead to obesity, what people might be dealing with more than just the seemingly obvious I'm eating too much and moving too little.

What about just being overweight? When we look at, maybe, bmi which I think in my personal opinion, in professional opinion, I think really only needs to be of concern when it's very, very low or very, very high For example, I have been overweight by BMI standards for 15 years just because of my body composition. But when we're looking at someone who is just overweight let's say we're less than 30 pounds overweight what ranges are causes for concern? When left unchecked for too long with just oh, you know, like I know, I got a few pounds to lose, I'll get to it, you know, do we really have as much time as we think when being overweight?

0:31:19 - Speaker 1 so there was actually a study that came out Harvard about 10 years ago showing that is there a Subpopulation of a patient who can actually be healthy obese, okay, or healthy overweight? Really and where we are beginning to Recognize the problem with using body mass index, which is really just a calculation of your weight height and weight Exactly it really doesn't take into consideration really how healthy you are, and what I mean by that is you can have somebody who's a bodybuilder.

You know they may be 30 pounds overweight, but they're 10% body fat if that yeah.

Yeah, and then, or you can actually have. There's another term called sarcopenic obese, which means that you're not. You could be normal way or even just slightly overweight, but you have 40% body fat because you're not exercising, you're not eating right. If you look at that sarcopenic obese patient, that particular patients for risk or diabetes Is actually much higher than somebody who has 10% body fat. And so, while you know, for some people you know it's a quick screen it really can miss the big picture. So you know more and more we're recognizing Okay, you know you have access to do a body composition you know, looking at that Scan or in body exactly where you can look at body percentage changes.

You know, even if you're maintaining a same way over a period of a decade, you could potentially be swapping out muscle for fat or hopefully vice versa, the other direction. And this is where you know I often will ask the patient Well, yes, you weigh the same as 10 years ago, that's your pen size fit the same to say and this is where we also start to understand.

You know, particularly in men and women's in their 40s and 50s, they're hormonal changes it's not all down in common where we see it's much more difficult to lose the weight. You know, as you know, particularly in perin, menopausal, menopausal woman, and definitely with men, when there's also an obvious drop in the testosterone level.

0:33:07 - Speaker 2 Hormones are the wild wild west.

We won't even go down that level right now, because that could be a two, three hour episode in of itself. You clearly are someone, though, that has a lot of knowledge around nutrition In in clinic and in the real world, but, in my experience at least, we don't always get you as our primary care provider or have access to someone such as yourself in traditional allopathic care who has the formal training, the clinical training, but is aware of real nutrition, not maybe just an elective they had in med school. What can us, the individual, the you know Every day person who is seeking medical care, what can we be looking for? What questions Can we be asking of our care provider to really make sure that they have this knowledge base? Because Getting labs read is one thing, but really being with the patient and the human to understand real world application is another.

0:34:11 - Speaker 1 And you know I often like to term kind of the progression of medicine. You know, when I was in training, it's what we call medicine 1.0. You know it's about being able to spend 60 minutes with the patient because we have the time. At that time we we did not have electronic medical records system and now kind of transition over the past 20 plus years to medicine 2.0. We now have the EHR, we now have a lot of data available, but if you look at the way we actually kind of have the interaction with the patient, it's still very much the same, except for now we have to see more patients.

0:34:42 - Speaker 2 What's the national average visit time primary care provider? Like 11 minutes or something?

0:34:45 - Speaker 1 Yeah and that's basically not counting in. Basically, by the time you check in, they get your vitals, they get your prescription. You know, most physicians may spend five minutes with a patient and you know, within that five minutes they have to ask you whether you have any IQ issues. You know, are you up to date in terms of kind of your, your labs? And then they haven't really talked to you. They're talking to you. So this is where I really want to see whether or not you know the society is whole can transition to what I call medicine 3.0 and this is really now shifting the focus. You know I'm not working basically for you. Let me work with you.

0:35:19 - Speaker 2 I like that, I like that and meaning that you know.

0:35:21 - Speaker 1 My first question when I kind of see a patient is what can I do for you today? Is there something you like to discuss with you?

before, even though I may have 10 things, I want to discuss the patient because I already has left you know, and you know it may take our visit in a complete different direction and it may be important for that patient. So you know, frequently when we look at, you know the pillars in terms of the kind of what we can do better in terms of health, span and as well as longevity. It's not just focusing on the number, because we have all the numbers in the world and you know, pretty soon the machines will be able to analyze the numbers, I mean with all the AI. It's about how do we improve the quality of life. Going back to the similar questions Are you sleeping Well? Are you feeling Well? Are you noticing any fatigue? Are you able to think clearly? I can guarantee you a lot of physicians, unfortunately because of how quick the visits are. Then I ask those questions.

0:36:09 - Speaker 2 Yeah, I mean, thank you so much for doing that. I mean that I I've seen a lot of doctors over the years and I can imagine Me stepping into an appointment now In for anybody else out there. That would, I think, one catch you off guard in the best way possible To have someone whom we are going to thinking, okay, they know everything, they know what's best for me. But to actually sit down and want to navigate this with you is so empowering and, I think, in many ways Shows us how much power we actually have over our health that we maybe have been giving away Unnecessarily to these healthcare providers that of course serve a great purpose, especially in acute care. But when we're talking about you know what I just you know. Actually, now that you mentioned it, I haven't been thinking clearly. You know my sleep has been mad, but to hear my doctor ask me about it, I'm gonna take it more seriously now.

0:37:06 - Speaker 1 Right. Well, because I think a lot of times that patient may either feel uncomfortable or they won't necessarily feel like that's Perning. Enough information to often is sometimes that could be the earliest sign of a disease that we just don't know about. Yeah, quite yet.

0:37:20 - Speaker 2 So we were kind of talking about this I don't know if we actually were recording just yet but let me unpack it a little bit more with you. Nowadays, whether that's through our primary care provider or so many other new telehealth companies and wellness companies, we have access and Also a reduction in cost of what we didn't have access to five, ten years ago and would have cost thousands, tens of thousands of dollars in terms of advanced metabolic panels. Are they for everyone or are we giving too much information to the masses and causing more problems, doing more harm?

0:37:55 - Speaker 1 than good. You know I always say information can be powerful but it can also Create stress. Okay, I mean, it's what you do with information that's going to be the most useful. So, yes, there are certain recommendations, you know from coming from US preventive task force, in terms of screening things. We need to do our front patient, you know. For instance, people over the age of 40, they need to at least get a baseline lipid panel making sure that their sugar numbers are normal, their blood pressure is within normal. But there are going to be certain population of patients where, because of their strong family history, because of their other metabolic risk, you know, it goes beyond basically kind of just those simple screening. And so for those population of patients being able to identify those risk factors or diseases early with Biomarkers, now that's available to us. And again, the beauty is that some of those tests may have been very inexpensive or basically really not accessible 10 years ago. People can actually get them. It's again making sure that basically it's easy to access for people who really need, said, the most.

0:38:57 - Speaker 2 Are you familiar with the show limitless? The documentary came out, I think, on Disney or Nat Geo with Chris Hemsworth and there was a portion in there with Dr Peter Atia. Basically it might be butchering this, but basically Chris Hemsworth went through this very advanced panel, metabolic health and genetic testing and I believe it was his APO, e2 Mm-hmm marker. They came back, you know, and having that Typically put someone at a higher risk for Alzheimer's dementia, kind of going down that route and His response. Now of course this is produced Hollywood clips and stuff.

So what I saw was someone that took that news pretty Seriously, of course, but I wonder if he took it too far in terms of just because there was a marker for something and statistically it might put you in a higher bracket for this, I Wondered if that knowledge actually sent him too far down the rabbit hole and now is really gonna push him on the higher end of that percentage versus If he didn't know it. And I think, objectively we could all say Chris Hemsworth is doing great things for his health, physical body composition and all that. So someone I think could argue that if he kept that up, that even being aware of that wouldn't really matter. I guess we'll never really know. But I guess my question there to kind of expand on, you know, is too much information a bad thing? Let's say we do get this metabolic test, let's say we do get this, this biomarker, this genetic marker back. Is that set in stone?

0:40:27 - Speaker 1 So I think it's all about again taking a step back and looking at the big picture. Yes, we have the lab biomarkers, but more and more we are actually now having data in terms of coming from analyzing somebody's stool, looking at the microbiome, looking at also genetic profile. And you know, traditionally we're talking about basically just looking at genetic markers that can predispose somebody that's just a certain type of cancers. You know your cognitive diseases, you know diabetes and so forth. But we now even have the technology to say, okay, well, even we have these markers, what can we do from a lifestyle, dietary standpoint that can actually kind of lower those risks? And so, going back to kind of your question, yes, it's great to have that data, but I think before we actually offer the testing, we need to understand what we're going to do with the information, because by offering the test, if the data is not going to change our management, then doesn't really offer anything.

But in some cases where the data can actually offer important information, and then again, just because you may have multiple risk factors, whether it's for dementia or for diabetes, there are actually things you can do, naturally, you know, without necessarily just going on medication, to potentially lower those risks, and I'm going to use kind of one example. So, going back to kind of what I was saying in terms of being able to turn genes on and off, there are actually now something called epigenetic chips where you can just collect a small sample of your saliva and you can actually say look, you know, I guess unfortunately I have all these bad genes ABC. But let's see, if I kind of go on a Mediterranean diet, you know, I pick up my exercise, then basically, if you wait six months or sit 12 months downline, you can actually see some of those genes actually being shut up, as if you were not born with those genes. Wow, yep, wow.

0:42:06 - Speaker 2 I want you to go back and say that last part again, as if we were not born with these genes.

0:42:10 - Speaker 1 Absolutely, and it is definitely not a doomsday scenario. You absolutely hold the power to be able to make a big kind of change in terms of lowering those lifetime risks.

0:42:20 - Speaker 2 I mean, there's so much there, but that not only is profound information in terms of what lifestyle, what exercise, what nutrition can do for us beyond any external goal, and even internal in terms of improving our metabolic panel, lipid panel, blood glucose, metabolic health. All this stuff, but at the genetic level, having dominion over what is on and off is so empowering for us here and now. But also imagine we do that. What are we doing for the next generation?

0:42:56 - Speaker 1 Absolutely. I think it's wonderful, I'm excited and that's part of why, you know, I share a lot of these informations with my patients.

I just say you're not just going to be working with me. You're going to be working with a life coach. You may be working with a dietitian, you know, for some people they may be working with a trainer, just to really optimize your health. And again, one of the words I often like to do is be proactive. You know, it's all about kind of optimizing your health early. Don't wait until you have the disease when you're in your 60s and 70s. You can do something about it in your 30s and 40s and 50s.

0:43:28 - Speaker 2 I know my audience is. Nobody out here is not doing that, or if you're new then you won't after this episode. So, beyond lifestyle and beyond nutrition and beyond labs, a lot of us reach to supplementation for optimization, for lack of nutritional quality and nutritional value. Particularly, I want to kind of highlight something, I think, that is very trending right now. But for anybody, and especially the physical fitness space, this is not news. That's creatine. But now I'm seeing a lot of new trials and you know science come out supporting creatine beyond the typical application and use of muscle mass, of muscle saturation, of boosting ATP, getting that extra rep or two in. I'm talking mental health, brain health, you know, and I think a lot of women now are gravitating towards creatine when maybe before they were thrown off because of the assumption that I'm going to get too big or I'm going to be bloated. So what is going on now in the world of creatine as a supplement, maybe that you would recommend for general health?

0:44:31 - Speaker 1 So let me answer the question first by saying you know, if you look at some of the supplement data, you know some of the vitamin and mineral supplementation or even kind of beyond that. You look at some of the functional herbs and so forth. Unfortunately it is a little bit of YYWES out there, so absolutely make sure you get quality stuff. But if you are able to supplement properly, there are definitely some potential benefits there. However, you know it doesn't take place of basically eating properly. You know you're eating basically a lot of fast food. You're eating high fat food you can take a lot of supplements.

And sometimes people get this false sense of security. They say, well, as long as I pop a multivitamin you know what?

0:45:07 - Speaker 2 Everything is covered.

0:45:07 - Speaker 1 All the multivitamins in the world aren't going to undo all the KFC, exactly so but you know you do have also a lot of people who are really trying to really out, making a lot of great dietary changes. And then we're kind of looking to that next step. And you know there's supplementation when it comes to basically just, you know, for certain patients at risk, you know, during pregnancy there's a reason why you know you kind of add additional folic acid and potentially iron for patients with certain metabolic diseases. You know they may benefit from vitamin D. And, going back to kind of what you're saying, with the creatine, it can be helpful.

Now I often will tell patients not lucky, you know, you're just taking creatine, you're not exercising, don't expect to just bulk up. But you'll be surprised how often people assume well, if I just take a lot of it, maybe it's just work magically. But for patients where they are trying to improve on their lean muscle mass, because you know functionally they like to get stronger, then I think creatine can play a role. And you know one of the questions we get off and as well should I just take creatine? Should I improve my dietary protein quality? You know how many grams of protein should I be getting? And this is where, if you look at being able to access the data from a body composition you know, instead of guessing based off of the way you can look at the lean muscle mass and then there are specific equations.

There's a little formula there formula there you can actually follow. And then you know there are also patients where you actually will combine basically creatine with BCAAs and there even other specific amino acids out there that's designed specifically for the elderly. So there is, for instance, one called HMB, which is basically hydroxy methyl butyroid where, particularly in patients in their 60s and 70s, it's actually been shown to improve muscle mass even quicker. Wow, wow. Then some of the other supplements out there. So bottom line is, if you kind of really take a look at and look at the signs, that's been exploding just within the past five, 10 years. We didn't have that data 20 years ago, oh, no, right. But I will also caution this you know definitely if you're going to go on a creatine supplement, which for some patients can be very useful, definitely make sure that you're working with somebody who understands your physiology. You know, make sure your doctor is aware of it, just so that if they see any changes on your blood test, at least they know you're on a particular supplement.

0:47:15 - Speaker 2 Right, you mentioned the word multivitamin earlier and I think that's one that typically I would say honestly, without knowing you from Adam. Anybody asked me a question what supplement should I get on? I typically would say, especially in my health coaching days, a good multivitamin, you know. A good multivitamin, supplemented with, you know, nutritional awareness can really go a long way because even if you are air court here eating all the right things, depending on if you know the source of all the foods you know you're probably wearing, like mineral depletion I'm forgetting a term here but basically just the bioavailability of a lot of these nutrients. It's just, it's just not there like it used to be. Would you agree that general blanket statement here majority of humans could benefit from a multivitamin? Or what supplementation would you recommend in general, someone at least look at to consider to improve their nutrition, to improve metabolic panels and health?

0:48:08 - Speaker 1 panels. Even so, it depends on who you ask. If you ask the epidemiologists, if you look kind of a lot of publications out there, looking at the physician health study that was published about 20 years ago. According to that study, basically there's absolutely no benefits to multivitamin Really Nothing.

0:48:23 - Speaker 2 But nothing.

0:48:24 - Speaker 1 But remember, this is basically a retrospective epidemiologic look and the way they did these analysis is basically they just said well, if we kind of follow a lot of these patients over 20, 30 years and we actually see which of those patients are taking multivitamin versus not, are there differences in terms of their cancer risk, cardiovascular risk or even morbidity and mortality?

Now there are some prospective studies that's been done. Some of those studies also did not show a benefit, but you can also make the argument that basically, if you look at that specific subset of population, they tend to be older. So the question is that are you supplementing later in life where you may not already gotten the benefit because the disease already has progress in such a state because of potential deficiencies? So I think, going back to your question with a 20-year-old that basically want to go on the supplement, benefit from it we really don't know, but I do think basically, as long as they're coming from reputable source, it is definitely something where, again, this is in addition to eating healthy, probably from a safety-serve profile, it probably will do okay with it. I think where we get concern is sometimes people will take it one step too far. They say something is good, more better.

0:49:39 - Speaker 2 So I have seen patients where they come in with 20-30 supplements.

0:49:43 - Speaker 1 Now, if you're taking 5, 6, 7, and then there are different types of supplements you know vitamin D, omega-3s, b, complex. That's all understandable, but I see people load up on just different things, and the concern there is number one how do all the supplements interact with each other?

0:49:57 - Speaker 2 That's a crucial component a lot of people don't know about and many people overlook.

0:50:01 - Speaker 1 Yeah, I mean, for instance, if you're taking your iron with your calcium you know a lot of them they can interfere with kind of how they are being absorbed. But also, once you start to take a lot of supplement, particularly some of the potential fast-serve environment, there are actually real risk when it comes to toxicity. And so I always I think goes back to what I was saying you know it's more about optimizing the dose, not just mega-dosing.

0:50:22 - Speaker 2 Exactly. Are you familiar with yourlithin A? Yes, can you describe what yourlithin A is and I'm the reason I'm bringing it up? You know we've talked about supplementation and longevity. I have been rotating this into my supplementation for about the past year and I'm just amazed. I do like the benefits that I get from it, but personally I'm just amazed at the research behind this compound, yourlithin A, especially for longevity and muscle maintaining body composition and muscle mass and strength as well.

0:50:52 - Speaker 1 Yeah, I don't know of as many studies specifically in clinical trials. I think most of the studies there were in animal studies. So I think, with any type of supplement, one of the things I'm always waiting for are the clinical studies. And part of the reason why and now the challenge is going to be anytime you're looking at longevity, you know clinical studies are always challenging because you know obviously we can't be tracking these patients for 20, 30 years are there kind of surrogate markers you can actually track. So, like, for instance, when they did a lot of the original studies looking at intermittent fasting, they were looking at one particular marker called IGF1 okay, or insulin growth factor, one which we know basically, if it's activated it tends to actually turn off some of the longevity genes. Wow, okay, so, but for some of this? So they've done that, basically comparing different type of diet, but I am not aware whether or not they're also studies again, whether they specifically look at some of these known surrogate kind of markers.

0:51:47 - Speaker 2 Interesting. I would love to share with you offline the research from timeline nutrition on mesentus they've got a 10-year clinical study. Okay, around urolithin A. That to me is very, very profound, so I'll show that with you.

0:52:00 - Speaker 1 Let's look at that One other question.

0:52:01 - Speaker 2 I'm going to get kind of getting towards the end here. I want to get to. We talked about it before we started and that's around fasting. You talk about intermittent fasting a second ago.

Intermittent fasting, I think for my audience is not something new it's been around for many, many years in diet, culture and especially bodybuilding, as a way to, you know, condense your feeding window, as a way to get to autophagy. You know. Now, in like the biohacker and human optimization realm, intermittent fasting compared to periodic fasting. There seems to be a lot of confusion and overlap in terms of you can get all the benefits of one by doing the other. Can you set the record straight for us in terms of intermittent fasting and periodic fasting? What are the differences and why? Should we maybe consider one over the other? What really has the most bang for the buck here?

0:52:46 - Speaker 1 Yeah. So if you look way back, I mean, people have been fasting for years, probably thousands of years I mean most people.

Basically, you know, back then you know they were fasting for religious reason, for holistic reasons, or you just didn't have access to food exactly. And so you know, if you look at kind of how our bodies wire, we do know that basically a little bit stress through your body is a good thing, okay, because they kind of really kind of target, actually augment some of your survival genes. So you know, if you look at basically some of the original studies designed around intermittent fasting, these are basically, you know, kind of short-term fasting typically is 12 to 24 hours and they have all sorts of various formats of this. Some of the actually fasting regimen actually allow you to eat a little bit, as long as you keep it to five. Come on.

I know so so they, they exist well as fasting ish well, they just realize. You know, as long as you keep it less than 500 calories, you're still kind of fasting, okay, okay so.

But where basically are concerning is you know people realize okay, well, any type of fasting we do know that yes, it leads to a little bit weight loss and you kind of look at basically improvements in terms of blood sugar, blood pressure and even some of the cholesterol panel. I think all of the different type of fasting will allow you to achieve that. Where there are a little bit of confusion or basically conflict, is okay. Well, if I fast for 12 to 24 hours versus if I take it a little bit further 24 hours to 48 or even up to 72, even if I just do that basically a couple times a month, do I get additional benefits?

0:54:08 - Speaker 2 so they wouldn't. More is more is better.

0:54:10 - Speaker 1 More is better in this case so they've actually done some studies where there are people on water based fasts for all the way up to five days and beyond. Now I first say you know I wouldn't be able to do it. But there are some people who can't do it and there are even some diets out there that are trying to mimic fasting. There's even something called fast mnemonic regimen where basically you're supposed to be able to eat certain foods but at the molecular cellular level some of those fasting pathways are still being basically properly regulated interesting. But going back to kind of your question, yes, there are certain things that will happen within the first 20, 12 to 24 hours. You know, if you look at kind of our energy utilization, you know we start to go into ketosis. Your glycogen storage is going to run out. Probably by about that 24 hour mark. Our body starts to basically turn to either amino acid or basically break down of the fatty acid.

And if you just convert fuel source where we're getting exactly and if you look at basically kind of just measurement of ketone bodies, it definitely starts to rise probably as early as 12 hours, but definitely starts to peak once you get into that 24 to 36 hour mark. Okay, and ketone is actually a good thing in this sense because if you actually look at some of the things that can augment neural transmitters, ketone actually can bypass and get inf, get across the blood brain barriers and there's actually something called BDNF or brain drive neural trap factors and they've been able to show this perfect.

So one of the things then becomes okay. Well, I would love to be able to have this really apply to longevity. So some of the terms that's been thrown out there you know cellular regeneration, autophagy. You know cellular senescence, stem cell mobilization what does that all mean?

sounds pretty pretty fancy, a big terms that people can throw out to sound like this is the solution, right exactly, and part of where they are looking at all of this is they realize basically, you know, part of why our organs starts to break down is, you know, think about you have a car for 70 years. You know things are just not going to last that long. Now in your 20s, you know you can drink a little bit more, but your liver can probably regenerate right away. If you do similar type of damage, you know your body just won't be able to completely recover. And part of what allows your body to recover is, for instance, if some of the cells in your tissue dies, your body should be able to send a signal to your bone marrow and they're actually what we call mesenchymal stem cells. That gets a signal to then basically get traffic to that target tissue and then replenish.

Well, we know, basically in your teens and 20s that makes up about two to three percent of your cell cells in the circulation. When you're in your 50s, 60s that drops by 10 full you have only about 0.2 to 0.3 percent that's huge of those mesenchymal progenitor cells. Okay, wow, what we found out is actually only through extended, periodical, prolonged fasting can you start to mobilize really those cells. So that's just one example how it's huge same thing is yes, you may start to see some autophagy pretty early on, but you really don't get the full benefit of the autophagy in terms of the cellular cleaning until you basically get to that 36 or 48 hour mark. And I think this is where kind of the science is really fascinating, because you're trying to basically balance, you know, all those additional kind of longevity benefit to kind of creating something yet practical enough most of the consumers can do.

0:57:26 - Speaker 2 That's such a such a clear understanding. Thank you for that, dr Hong. I want to be mindful of our time here and this has been a wealth of information for me in my audience, so thank you. What? What does it mean to you to live a life ever forward? When you hear those words through what you do and helping people understand nutrition, obesity, metabolic health, all these things we've been talking about, how do you live a life ever?

0:57:49 - Speaker 1 forward. I think it starts with the mind. I think you know people don't realize you know right how you feel your physical health. It starts with basically having good emotional health, good mental health. I always say you know it's easy to be worried. I mean I actually will restrict how many hours in news I read it because you know it could be just down right depressing, but I also realize, you know I look around.

I have a beautiful family, I have generally pretty good health, you know. So I count my blessing and I realize you know what. What can I do? You know, yes, there are definitely things that I've noticed. You know I'm slowing down, you know, when I try to basically play sports with my kids, you know I have to warm up. I can't just get up and run. But I also realize, you know, if I'm, it's not about working harder, it's about working smarter, and this is where I'm always looking forward. It's not about what. You know, what could I've done differently? And I always say look at baby steps, don't feel like you know what I have to achieve everything on once sitting.

0:58:40 - Speaker 2 So there's never a right or a wrong answer, so thank you for your interpretation. Where can my audience go to connect with you or learn more about the work that you do? We'll, of course, have everything down the show notes for everybody, but where can we send them?