Dr. Rhonda Patrick: Maximizing Healthspan with Exercise, Sauna, & Cold Exposure

0:00 If you could pill up what vigorous intensity exercise does,

0:05 it would be the biggest anti-aging blockbuster out there.

0:08 After these 2 years of exercise, they measured their hearts, you know,

0:12 of course they measured at baseline,

0:14 and their hearts grew and become and became more flexible.

0:18 So much that was reversed about 20 years of aging.

0:22 So, their hearts actually looked like

0:25 a 30-year-old heart rather than a 50-year-old heart.

0:28 This was after 2 years of this intense exercise training protocol.

0:32 There's no reason to go in a 212° F sauna.

0:36 I think, you know, 190 max.

0:38 Like, that's that's that's hard.

0:39 190 is hot.

0:40 I go I do 180 personally.

0:42 Um but, I think that's important because I know if you go on Instagram,

0:46 there's a lot of influencers that are going really really hot,

0:49 and I just don't think that's a great idea.

0:51 So excited to be here.

0:52 Um boy, it was great.

0:54 I woke up this morning, bright light exposure first thing in the morning.

0:58 We set my circadian rhythm, elicit the cortisol response, right?

1:02 Get that serotonin, inhibit melatonin.

1:05 Um what a great place to have a conference.

1:07 So, thank you to the organizers for inviting me.

1:10 Excited to be here.

1:11 Uh today, we're going to talk about some behavioral strategies that I think

1:18 are very important for improving the way we age and the way we feel.

1:23 I mean, these things go hand in hand, right?

1:25 So, we're going to talk about the power of vigorous intensity exercise.

1:30 We're going to talk about using thermal

1:34 [snorts] stress in the form of deliberate

1:36 heat exposure and deliberate cold exposure to really improve the way we age.

1:42 And so, just to give you a heads-up of what we're going to discuss,

1:46 we're going to get into exercise and particularly a vigorous type of exercise,

1:50 and we're going to talk about cardiorespiratory fitness.

1:52 We're going to talk about brain aging, reversing heart aging.

1:55 And then, we're going to talk about exercise snacks.

1:58 Then, we're going to get into deliberate heat

2:00 exposure with a big focus on regular hot saunas.

2:03 We're going to talk about being, you know, it being an exercise mimetic.

2:07 We're going to talk about heat shock proteins, Alzheimer's disease.

2:10 We're going to talk about infrared saunas versus

2:12 hot baths versus regular hot sauna saunas as well.

2:16 And then, we're going to get into some of the cold exposure data,

2:18 and we're going to talk a lot about some of the hormonal responses,

2:21 some of the effects on the brain, on metabolism and muscle.

2:25 And then, we'll get into some protocols as well.

2:29 So, let's get started, and I like to start with this slide because

2:34 if you could pill up what vigorous intensity exercise does,

2:40 it would be the biggest anti-aging blockbuster out there.

2:43 So, when I say vigorous intensity exercise,

2:47 what I'm talking about here is the kind of exercise that you

2:49 do and you can't really have a conversation while you're doing it.

2:54 You're really putting in some hard effort.

2:56 So, you just you're really not able

2:58 to talk while you're doing that kind of exercise.

3:00 If you wear a heart rate monitor,

3:02 it's the kind of exercise where you're about 80% your max heart rate or greater.

3:07 That's the kind of exercise that when I say vigorous intensity,

3:11 that's what I'm talking about today.

3:14 And I want to start by talking about cardiorespiratory fitness.

3:18 So, cardiorespiratory fitness is often measured by something called a VO2 max.

3:24 You've probably heard of this.

3:25 VO2 max is really just the maximal amount

3:27 of oxygen that you can take up during maximal exercise.

3:32 Cardiorespiratory fitness has really become a very

3:35 very important biomarker of our healthspan and lifespan.

3:42 So, there've been countless studies now,

3:43 and this study I'm showing you here is showing it's

3:46 stratifying people based on their cardiorespiratory

3:49 fitness and their life expectancy.

3:52 And what they did it shows is

3:53 that people that have a low cardiorespiratory fitness,

3:57 if they can move anywhere above that low,

4:00 even to a low normal, they're still low, but they're on a nor low normal range,

4:05 that's associated with a 2-year increase in life expectancy.

4:08 And if you compare people from the low to the high,

4:12 that's about a 5-year increase in life expectancy.

4:16 And there've been other studies that have actually

4:18 analyzed if you can improve your VO2 max, your cardiorespiratory fitness,

4:24 from what each for each unit that you improve it,

4:26 so a unit is actually 1 ml per kilogram per minute,

4:31 that is associated with a 45-day extension in life expectancy.

4:35 So, for each unit you go up and you increase it,

4:38 that's 45 days added to your lifespan.

4:42 Why is VO2 max important?

4:44 I mean, if you think about VO2 max, your cardiorespiratory fitness,

4:48 it's you know, we're talking about

4:50 measuring it when we're doing maximal exercise, but really, you know,

4:54 everything we do relies on our cardiorespiratory fitness,

4:56 even just sitting still.

4:58 Just to sit still and breathe,

5:00 it takes about 3 ml per kilogram per minute of oxygen.

5:05 When I'm just having a conversation,

5:07 like me up here on stage talking to you guys, that takes about 11 ml of um per

5:13 kilogram body weight per minute of oxygen, right?

5:15 So, as we're aging, we we we start with our with our cardiorespiratory fitness,

5:21 and there's things we can do to get high, right?

5:23 And that's where we want to be.

5:24 But, as we're aging, we kind of head towards this cliff.

5:28 We're going down.

5:28 Our cardiorespiratory fitness declines with age.

5:31 And so, you want to really bank

5:34 in all you can and improve your cardiorespiratory

5:37 fitness early on because you want to be

5:38 higher up because you will reach that cliff.

5:41 You just want to reach it at a later time point, right?

5:45 There was a study that was published a few years back in JAMA,

5:49 and I really like this study because it showed that there really didn't

5:52 seem to be an upper limit

5:53 in the benefits for improving cardiorespiratory fitness.

5:56 So, people that were at like the elite,

5:58 the top 2% the elite level for their cardiorespiratory fitness,

6:03 they had a 80% lower all-cause mortality

6:06 than people that were low cardiorespiratory fitness.

6:09 Not a big surprise.

6:10 But, even people that had a high cardiorespiratory fitness,

6:13 we're talking like the top quarter percent of the of the participants,

6:17 the [snorts] elite people still had a 20% lower

6:20 all-cause mortality compared to those people with a high.

6:23 I mean, these are healthy people, a high cardiorespiratory fitness.

6:27 But, what was so fascinating about this study was

6:30 that researchers looked at biomarkers that could predict mortality.

6:35 And so, they looked at things like type 2 diabetes,

6:39 smoking, cardiovascular disease.

6:41 These things, of course, pre- predicted a lower life expectancy, right?

6:46 A higher all-cause mortality.

6:48 However, a low cardiorespiratory fitness actually predicted better.

6:53 So, in fact, people with a low cardiorespiratory fitness had a lower

6:57 life expectancy than even people with type 2 diabetes or even people smoking.

7:02 So, in other words, having a low cardiorespiratory

7:04 fitness was like smoking in terms of life expectancy.

7:09 And people don't think about that.

7:10 We think about all these diseases.

7:12 We talk a lot about type 2 diabetes.

7:13 We talk a lot about, you know,

7:14 cardiovascular disease, how terrible it is for your health,

7:17 how bad smoking is, but nobody's talking about how terrible being sedentary is,

7:22 not being physically active.

7:23 It is a disease, and it should be treated as a disease.

7:27 We really need to think about our cardiorespiratory fitness.

7:30 We need to think about how important it is.

7:32 We're supposed to be moving and improving that cardiorespiratory fitness.

7:36 So, how do we improve it?

7:38 Endurance aerobic exercise is one

7:40 of the best ways to improve cardiorespiratory fitness.

7:44 However, vigorous intensity exercise is actually better.

7:49 And we know this because there have been multiple studies,

7:51 and there've been meta-analyses of these studies looking

7:55 at people that actually do the physical activity requirements,

8:00 the guidelines that are out there.

8:01 So, this is about 2 and 1/2

8:03 hours per week of moderate intensity physical activity.

8:07 So, this is the type of exercise that you do that's aerobic,

8:11 and [snorts] you can kind of have a you can talk while you're doing it,

8:14 but you're very breathy.

8:15 So, you're really not at that intense level where you're pushing really hard,

8:19 but you're you're getting physical activity.

8:21 About 40% of people doing that 2 and 1/2

8:23 hours per week cannot improve their cardiorespiratory fitness.

8:27 They're so-called non-responders,

8:30 unless they engage in vigorous intensity exercise,

8:34 particularly high-intensity interval training.

8:37 So, that's the kind of exercise where you're doing short bouts,

8:40 intervals of high intensity.

8:42 So, it could be anywhere from 20 seconds long to 30,

8:45 maybe a minute long interval where you're going hard,

8:48 and then you have a period of recovery.

8:50 When those individuals that did not respond to just

8:52 normal moderate intensity exercise engage in high-intensity interval training,

8:56 they're able to improve their cardiorespiratory fitness.

8:59 And it's thought the reason for that is because,

9:03 you know, cardiorespiratory fitness,

9:04 you're you're you're transport- porting um oxygen.

9:07 You're breathing it in, your lungs are taking it in, and then

9:10 your vascular system is transporting it to other tissues like the muscle,

9:13 um the brain, right?

9:15 It's [snorts] It's thought that the harder the stress that you're putting,

9:19 the greater the ad- adaptation.

9:21 So, your body is responding to a greater

9:23 amount of stress when you're going harder, when you're working out harder.

9:27 There's a variety of protocols out there

9:29 that have been shown to actually improve cardiorespiratory fitness.

9:33 I like to talk about probably one of the hardest ones.

9:35 Uh it's called the Norwegian 4 by 4.

9:38 This The reason it's called that is because the Norwegian

9:41 ski team uses it as part of their training protocol.

9:45 And what it is is you for 4 minutes,

9:48 this is a 4-minute interval where you're going as hard as you can,

9:52 not all out, as hard as you can and maintain for that entire 4 minutes.

9:56 And it takes a little bit of try and trial

9:58 and error to figure out what that intensity is.

10:01 It's going to be you're going to be it's going to be hard,

10:03 but you're not going all out.

10:04 That would be impossible.

10:06 And then you and then you do light exercise, very very light exercise.

10:09 You let your heart rate go down and recover for 3 minutes.

10:12 And you do that four times.

10:14 So it's 4 by 4.

10:16 And um this protocol has been shown in countless studies to improve the VO2 max.

10:21 Now there's other ways to improve your cardiorespiratory fitness.

10:25 You can do a 1-minute on, 1-minute off, even 20 seconds on, 10 seconds off.

10:29 I mean, whatever works for you.

10:31 I think the most important thing here is what are you going to do?

10:35 What are you going to do on a weekly basis?

10:37 What are you going to be able to do?

10:39 What do you like to do?

10:40 That's the most important.

10:41 You don't necessarily have to do the 4 by 4.

10:44 I do this once a week.

10:45 Um I think it's great if you can, but you don't necessarily have to.

10:50 Um [snorts] if you haven't gotten a VO2 max test,

10:53 like that's where you go into a lab and you wear one of those masks,

10:56 you get on treadmill or on a stationary bike and you're doing like, you know,

10:59 15 minutes of running as fast as you can for the entire 15 minutes.

11:03 Pretty brutal if anyone's done it.

11:05 Um you can you can estimate your own VO2 max actually by by using

11:09 any type of a wearable device that tracks your distance and your heart rate.

11:14 And so it's called the 12-minute uh run test.

11:17 And basically what you're doing is you're

11:19 running for 12 minutes on a flat surface.

11:21 It has to be flat.

11:23 And you're you're you're calculating your distance.

11:25 And there's an equation you can look up called the Cooper test,

11:28 the Cooper equation,

11:29 and it'll help you convert your it'll estimate your VO2 max essentially.

11:33 And that's a pretty good way to do that.

11:37 I like I want to take a minute here.

11:39 We're going to talk about that Norwegian 4 by 4 again

11:41 as part of this this protocol that was done by a Dr.

11:45 Ben Levine at UT Southwestern in Dallas.

11:48 Um he's probably one of the world's

11:50 leading experts in cardio cardiovascular exercise,

11:54 cardiologist, exercise physiology.

11:56 He studies how the heart ages and how we can reverse that aging

12:00 through different lifestyle strategies and also

12:04 what accelerates that aging as well.

12:06 So he's looking at both ends of the spectrum.

12:08 And um just generally speaking, what what happens to our heart with as we age?

12:13 Well, a lot of things.

12:14 I'm not going to spend hours discussing that.

12:16 You probably have other people here talking about that.

12:19 But generally speaking, as we age, our heart shrinks and it gets stiffer.

12:23 It's stiffer with age.

12:25 Um and that's not a very good thing for cardiovascular health.

12:28 You want your heart to be flexible.

12:30 You want to be able to respond to stressful situation situations.

12:33 You don't want your heart to be stiffer.

12:35 And so what Ben um set out to do was try to see if he

12:39 could reverse some of this shrinking and stiffening

12:42 of the heart in people that are middle-aged.

12:45 They're 50-year-olds that didn't have any identifiable diseases

12:49 other than the fact that they were sedentary.

12:51 So they had one disease, as I just mentioned.

12:53 Sedentary being sedentary is a disease.

12:55 Um but they didn't have any other diseases.

12:57 They just weren't physically active.

13:00 And [snorts] he separated these 50-year-olds into two groups,

13:02 one with the treatment group, one with the sham control group.

13:05 The treatment group underwent a 2-year

13:07 pretty intense exercise training protocol.

13:10 Where at the end of the 2 years, they were exercising for about 5 hours a week.

13:15 A large portion of that was vigorous intensity exercise.

13:17 They were doing the Norwegian 4 by 4 once a week.

13:20 But they didn't start out there.

13:22 It was a progressive workup, right?

13:23 You can't just take someone that's not ever worked out in the gym and then

13:28 start them on the 4 by 4 and doing 5 hours a week, right?

13:30 So they progressively worked up to that point.

13:33 The sham control was kind of like yoga-ish stretching, you know,

13:37 enough where they thought they were getting a treatment,

13:39 but it wasn't actually the treatment.

13:41 After these 2 years of exercise, they measured their hearts, you know,

13:45 of course they measured at baseline,

13:47 and their hearts grew and become and became more flexible.

13:51 So much that it was reversed about 20 years of aging.

13:55 So their hearts actually looked like

13:58 a 30-year-old heart rather than a 50-year-old heart.

14:00 This was after 2 years of this intense exercise training protocol.

14:05 And I love this study uh because it really shows one that it's never too late,

14:11 and these were 50-year-olds, they're in middle middle age, and two,

14:14 that you really have control of the way your heart ages, right?

14:18 I mean, this is pretty I would say unbelievable that you

14:22 can actually after just 2 years of really putting in effort,

14:25 reverse the aging of your heart by about 20 years.

14:30 The control group, I mean, they they didn't have any of this, by the way.

14:33 And yoga's great, but it just isn't going

14:35 to reverse the structural aging changes in your heart.

14:39 We also know that exercise has massive effects on the brain.

14:42 So it's an immediate cognitive enhancer.

14:44 So you can just do a 10-minute bout of vigorous intensity exercise.

14:48 Again, you're getting that you're putting in that effort,

14:50 and you can improve reaction time, executive function.

14:54 I mean, there was actually a 14% increase in cognitive

14:56 performance in this cohort that just did 10 minutes.

14:59 I do 10 minutes of exercise like before almost any talk I give,

15:04 anything anything I'm doing that requires my brain to be working.

15:07 10 minutes, everybody has 10 minutes, right?

15:09 And it's amazing how you feel after that.

15:13 We know that vigorous intensity exercise rewires the brain almost immediately.

15:18 So it actually, like I said,

15:19 it speeds up reaction time, especially on executive function tasks.

15:22 It improves working memory.

15:23 It improves impulse control.

15:26 So, you know, if you have a lot of tabs open,

15:28 you're not going to be going to the social media or you're

15:29 not going to be getting on X or Instagram or whatever.

15:32 You know, so it helps you with that impulse control.

15:34 I mean, these are all I would say little hacks that most

15:38 of most of us in here that are also high performers,

15:40 you know, you're taking care of yourself and your patients,

15:42 but we're also high performers.

15:44 So it's it's kind of really important to kind of use some of these tools

15:47 that we can to just improve our impulse

15:49 control and our cognitive function as well.

15:53 Why is vigorous intensity exercise so good for the brain?

15:56 And I keep saying vigorous because when you are working really hard,

16:01 you're forcing your energy system

16:04 to produce energy quicker than your mitochondria,

16:08 which are the little organelles inside of your cells

16:11 that are essentially mostly responsible for producing energy,

16:15 can can can keep up with.

16:16 And so essentially you can't get oxygen to your cells quick enough to make

16:20 energy because mitochondria need oxygen to make energy in the form of ATP.

16:25 And so you're forced to do that outside

16:28 of your mitochondria using um glucose as a source of energy.

16:32 And that glucose gets converted into energy, but also lactate.

16:37 And for a long time,

16:38 lactate was thought to be this just

16:39 metabolic byproduct of glucose metabolism, glycolysis.

16:44 Turns out, Dr.

16:45 George Brooks at uh UC Berkeley decades

16:47 ago came up with this lactate shuttle theory.

16:49 It's no longer a theory.

16:51 It's been proven many many many times.

16:53 Um lactate is not only an energetic molecule,

16:58 so it gets shuttled back into cells,

17:01 including the muscle, and is used to make energy like glucose, like fatty acids.

17:06 In fact, it's more energetically favorable than glucose.

17:09 You can actually make more It takes less energy

17:12 to make energy from lactate than it does from glucose.

17:15 But even more importantly, lactate is actually a signaling molecule.

17:20 So when you're forcing your muscles to work really hard,

17:23 you're generating that lactate.

17:24 A lot of people associate that burn you

17:26 feel in your muscles with the lactate generation.

17:29 I mean, that's kind of a okay association, I guess.

17:31 Lactate itself is not responsible for the burn.

17:34 Um it's the hydrogen ions, but that's a whole other story.

17:38 The lactate then goes into your circulation

17:41 and it gets transported to other organs, especially the brain.

17:45 And it acts as a messenger.

17:47 It's a way for your muscles to communicate with other organs and say,

17:50 "Hey, I'm working really hard.

17:52 We got to respond to this, like otherwise we're not going to be able to like

17:55 survive." And so what happens is it

17:58 is communicating with the brain and the heart and the liver and all these other

18:01 organs where the lactate's going into, and it's

18:03 activating a variety of stress response pathways

18:06 so that you can deal with stress.

18:08 And in the brain, lactate increases brain-derived neurotrophic factor.

18:12 In fact, it is the molecule that is

18:15 signaling to the brain to increase brain-derived neurotrophic factor.

18:20 So this is a growth factor in the brain

18:22 that is responsible for the growth of new neurons,

18:25 um particularly in the hippocampus.

18:26 We'll get to that in a minute.

18:27 It's also important for learning, for memory, and neuroplasticity, right?

18:32 That's important for your brain's ability to adapt to the changing environment.

18:37 It plays a very important role in not only brain aging, but also mental health.

18:42 So people with depression, for example,

18:44 major depressive disorder, they have problems with neuroplasticity.

18:48 Their brain is not adapting to a changing envi- environment.

18:51 And so they're unable to adapt, and that is uh plays a role in depression.

18:59 We also know that lactate itself signals to the brain to make neurotransmitters.

19:04 We have human data on this, both serotonin,

19:07 most people think about serotonin as that neurotransmitter involved in mood,

19:11 makes you feel good.

19:12 It's also involved in executive function, and more importantly, impulse control.

19:16 Um and I talked about all those studies showing that vigorous

19:18 intensity exercise has a pretty profound effect on impulse control.

19:23 Well, there have been human studies that have done

19:24 dose-dependent um exercise protocols where people do light exercise,

19:29 moderate intensity, or they do vigorous intensity exercise,

19:32 and it's the vigorous intensity exercise that increases lactate the most,

19:36 and that's also associate associated with the most impulse control.

19:39 We want impulse control.

19:40 We want to be able to be focused.

19:42 And norepinephrine as well.

19:43 So our brain also is working very

19:45 hard when we're doing vigorous intensity exercise.

19:47 It's not just our muscles that are working hard.

19:49 It's not just our and that are working hard.

19:51 It's not just our cardiovascular system that working hard.

19:53 Everything is working hard including our brain.

19:56 And and and like I said, lactate is the way is the communication

20:00 is the communicating factor there, right?

20:02 And so, norepinephrine is increased also human studies showing this as well.

20:06 That's involved with focus and attention and improved um memory as well.

20:12 So, lactate's responsible for doing all these things.

20:15 There are many different protocols out there, human protocols,

20:17 human data showing uh different type of exercise intensities can

20:21 increase brain-derived neurotrophic factor in the plasma where it's measured,

20:25 which correlates with brain levels as well.

20:27 Um the more intense the exercise, the more BDNF that you're going to make.

20:32 It's definitely a dose and duration-dependent process.

20:37 So, if someone that's doing like a pretty

20:38 hard 30-minute run really gets a lot of BDNF,

20:43 but you can also do these these hit protocols, right?

20:45 The 1-minute on, 1-minute off, even doing that for you know,

20:48 six times um has been shown

20:50 to really massively increase brain-derived neurotrophic factor.

20:52 So, the key here is just get those hard intervals in whatever

20:57 your favorite protocol is and you'll be getting that BDNF boost.

21:03 I like to talk about this study even though it's about gosh,

21:06 it's a 2011 it was published I think PNAS.

21:09 Um I love this study because it showed that exercise

21:13 can reverse the brain the the the aging brain.

21:16 Um and this was this study was in an older adult.

21:19 They were doing more like 70 75% max heart rate, so not quite as vigorous,

21:25 but pretty vigorous for this cohort cuz they're older adults.

21:28 Uh they did this for about 1 year

21:31 and it was incredible what happened to their brains.

21:35 So, typically when you hit about 65

21:39 brain atrophy really starts to accelerate and people

21:41 start to lose about on average 1

21:44 to 2% of their hippocampal brain volume per year.

21:48 Well, these older adults that engaged in this type of exercise,

21:52 they were doing like three times a week

21:53 about 30 minutes of this type of exercise.

21:56 Not only did they not experience that brain atrophy over that year,

22:00 they gained brain atrophy.

22:02 So, they gained about 1 to 2% in their hippocampal region.

22:05 So, again, brain-derived neurotrophic factor is

22:07 responsible for the growth of new neurons.

22:09 They were able to actually grow new neurons in their hippocampal brain region.

22:15 The control group, again, the stretching group didn't experience that either.

22:19 So, I think this is a nice way to kind

22:21 of wrap up the brain section here showing that vigorous intensity exercise,

22:25 putting in that effort, really is good for the brain and improving brain aging.

22:31 But, what if you don't have a lot of time and you know,

22:34 you still want to get some improvements to the brain,

22:37 to the heart, um cancer risk.

22:40 There's something called exercise snacks.

22:42 Uh these are really short bursts of vigorous intensity exercise.

22:47 Again, you're going to that 80% or more max heart

22:51 rate range and it could be 1 to 3 minutes long.

22:55 These are any any type of exercise you like to do.

22:58 You could do, you know, body weight squats, burpees, high knees,

23:01 jumping jacks, you know, there's lots of different ways to do exercise snacks.

23:07 [snorts] Um but there's now a lot of evidence

23:07 out there that they're highly highly beneficial.

23:10 In fact, there have been about three very large studies.

23:13 They're called vigorous intermittent lifestyle activity studies, Vilpa, VILPA.

23:19 Um these [snorts] studies have been done

23:20 in people that have been wearing accelerometers,

23:22 so researchers can measure their heart rate

23:25 and they can measure, you know, distance [snorts] that people are moving.

23:29 And what has been found is that people that are wearing these accelerometers,

23:33 if they get their heart rate up 1 to 2 minutes

23:36 three times a day they have a 40% lower cancer-related mortality,

23:42 a 40% lower all-cause mortality,

23:44 and a 50% lower cardiovascular-related mortality than people that are not

23:48 doing these types of short bursts of exercise throughout the day.

23:52 And this is even in people that identify themselves as non-exercisers.

23:57 In other words, people that are like, "No, I don't go to the gym.

24:00 I don't take time to like out of my day to like actually try to exercise." Yet,

24:03 they were doing these types of like exercise snacks.

24:06 In many cases, it was it's not the structured type of snack I

24:09 told you about where you kind of like get up and do some, you know, air squats.

24:13 It's more like taking advantage of everyday situations.

24:16 Like, "I'm not going to use the elevator ever.

24:19 I'm going to sprint up the stairs, not just walk.

24:21 I'm going to go fast, right?

24:22 Or I'm going to vigorously or briskly walk to the office or whatever." So,

24:28 they're taking advantage of everyday situations to get

24:30 their heart rate up and it really does pay off.

24:35 So, there's a lot of ways that you

24:36 can actually implement exercise snacks throughout your day.

24:39 Um there was this recent study that came out

24:41 showing that doing about 30 body weight squats every 45

24:44 minutes for like a 7 and 1/2-hour work week

24:46 was better at improving glucose metabolism than a 30-minute walk.

24:50 I love doing exercise snacks.

24:52 We're actually all going to get up right now and we're

24:54 going to do just 1 minute of body weight squats.

24:57 What do you think?

24:57 1 minute of body weight squats.

24:58 Everyone turn to the side.

25:01 Kind of like I'm going to set my timer.

25:05 Okay, is everyone up?

25:06 Up?

25:07 You ready?

25:07 Okay.

25:08 You ready?

25:08 So, we're going to do body weight squats.

25:10 Put in the effort.

25:11 Don't just like go through the motions, but like try to like go fast.

25:15 Try to squat as low as you can.

25:16 All right, here we go.

25:17 1 2 3.

25:20 So, we're going to do 1 minute of this.

25:22 Really like try to get your heart rate up.

25:24 Feel the burn.

25:25 Feel uncomfortable.

25:27 Feel uncomfortable.

25:34 Okay, we got 45 seconds left.

25:40 [snorts] Now, I'm not going as fast because I want to like be able to talk.

25:44 But, usually I'd be going a lot faster.

25:51 We got 30 seconds left, guys.

25:54 I know, you guys are like, "What?

25:57 This is the longest minute of my life." [laughter]

26:02 Okay, we only got about 15 seconds left.

26:04 COME ON, DON'T STOP NOW.

26:06 Keep going.

26:09 10 9 8 7 6 5 4 3 2 1.

26:19 All right, everyone.

26:21 Amazing.

26:26 If you don't feel great right now, there's something wrong with you.

26:32 [laughter] So, [sighs] set your timer for 45 minutes.

26:37 [gasps] Do it again.

26:38 No, but like seriously,

26:40 when you're sitting you can you can take you can take 1 minute.

26:44 I don't care if you're in your office with a patient.

26:47 Do do it with your patient.

26:49 You can take 1 minute if you're at your desk.

26:51 I I'm serious.

26:52 I challenge you.

26:54 Try to find a way to implement exercise snacks.

26:58 It'll change your life.

27:00 All right.

27:01 We're going to switch gears and we're

27:03 going to talk about another type of stress.

27:06 Exercise is one type of stress.

27:09 We're going to talk about thermal stress from deliberate heat exposure.

27:15 [gasps]

27:16 And if you think if you anyone in here that's

27:18 done a hot tub or a sauna um a steam shower, hot yoga you know that a lot

27:28 of the physiological responses are very similar to moderate-intensity exercise.

27:33 So, as you're sitting in a hot tub,

27:34 as you're sitting in a hot sauna your heart rate starts to go up.

27:38 You start to feel hot.

27:40 You start to feel uncomfortable.

27:41 You start to sweat.

27:43 A lot of the same physiological processes

27:45 that happen when you're doing moderate-intensity exercise,

27:49 not vigorous, but moderate happen when you expose yourself deliberately to heat.

27:54 Increase heart rate.

27:56 Uh your your stroke volume goes up.

27:58 You have increased cardiac cardiac output.

28:01 In fact, there's been a head-to-head comparison

28:04 looking at sauna versus a stationary bike.

28:08 So, individuals did about 100 watts on a stationary bike for about

28:11 15 minutes or they were in a hot sauna for about 15 minutes.

28:15 And the physiological responses that were measured were identical.

28:19 So, during the activity, heart rate went up, blood pressure went up.

28:24 After the activity, whether it was sauna or stationary

28:28 cycling blood pressure was improved compared to baseline.

28:32 The uh resting heart rate was improved, was lower.

28:35 So, head-to-head comparison,

28:38 sauna is mimicking moderate-intensity physical activity.

28:43 There have also been studies looking

28:45 at exercise alone plus or exercise plus sauna.

28:50 And observational data shows that people in Finland

28:54 that exercise they have a longer life expectancy than not.

28:59 But, people that exercise and sauna have a longer

29:03 a life expectancy than people that only just exercise.

29:06 So, in other words, there seem to be

29:07 an additive effect on improving life expectancy.

29:11 And there's been intervention trials that have again, Finland, uh Dr.

29:15 Dr.

29:16 Jari Laukkanen, friend of mine.

29:18 Um he's probably the the one of the world's leading experts on sauna research.

29:24 He took a cohort of participants split them into two groups.

29:28 One group is doing stationary bike.

29:30 The other group is doing stationary bike bike and then getting into a hot sauna.

29:34 In this case, it was only about 15 minutes.

29:37 175 179° F sauna.

29:40 And then he measured their cardiorespiratory fitness, you know,

29:42 at baseline and after the intervention

29:45 and a variety of other biomarkers as well.

29:47 And what he found is that exercise plus sauna

29:50 improved cardiorespiratory fitness better higher than just exercise alone.

29:56 Which isn't that hard to believe considering I just

29:59 told you that sauna is like an exercise mimetic.

30:01 So you're essentially extending the time of your workout.

30:05 There was also better improvements in blood pressure,

30:08 in lipid biomarkers as well compared to just exercise alone.

30:14 Also data from Yari's Dr.

30:16 Jari Laukkanen's lab has shown that men that use

30:19 the sauna two to three times a week have

30:22 about a 22% lower sudden cardiac death than men

30:26 that only use the sauna one time a week.

30:29 Men that use the sauna four to seven times a week have about

30:32 a 63% lower sudden cardiac death than men that use it one time a week.

30:36 Now, sudden cardiac death, you know, if you think about heart attacks,

30:40 if you have a heart attack, you want to survive it.

30:41 First of all, you don't want to have the heart attack,

30:43 but if you have it, you want to survive it.

30:45 And in the US, a heart attack,

30:47 someone's having a heart attack like every 30 seconds.

30:50 So if you can survive that heart attack, it's pretty big.

30:52 63% less likely to die from sudden cardiac death if

30:55 they were doing the sauna four to seven times a week.

30:57 And by the way, saunas in Finland are very ubiquitous.

31:00 There's also a lot of public saunas as they call it that are free as well.

31:05 So a lot of people have access to saunas.

31:10 His data also showed that in a dose-dependent manner,

31:14 sauna use was also associated with lower all-cause mortality.

31:17 So people So this in this case it was men that use the sauna

31:21 two to three times a per week had about a 24% lower all-cause mortality.

31:25 If they boosted that up to four to seven times a week,

31:28 they had a 40% lower all-cause mortality than men

31:30 that only use the sauna one time a week.

31:32 They also had a lower cardiovascular related mortality.

31:35 Again, in a dose-dependent manner.

31:37 If they went up to four to seven times a week,

31:38 that was a 50% lower cardiovascular related mortality than

31:42 men that only used it one time per week.

31:44 So we're seeing this clear dose response here.

31:48 This data was adjusted for many many different types of confounding factors.

31:52 So you know, physical activity, lipid, you know,

31:55 type two diabetes, diet, all these things were looked at.

31:59 In addition to that, Yari took

32:01 a cohort of individuals that actually were unhealthy.

32:04 So they did have type two diabetes.

32:06 And even in those cohorts,

32:09 sauna use was associated with lower all-cause mortality,

32:12 lower cardiovascular related mortality as well.

32:15 So it really seems to be a true phenomenon that's being observed.

32:21 And we'll get to some of the intervention data that kind of corroborates it.

32:25 But we also know that sauna lowers stroke risk in a dose-dependent manner.

32:28 Again, two to three times per week, 14% lower stroke risk.

32:32 This was in both men and women compared to just one time a week.

32:36 Four to seven times a week, 61% lower stroke risk.

32:39 I mean, these are pretty phenomenal numbers we're talking about here.

32:43 And I know I spent like the first 30

32:46 minutes of my talk talking about vigorous intensity exercise.

32:49 But I mean, we all are in the real world here

32:52 and there's a lot of people that just won't put that effort in.

32:58 And it's a lot easier to get some people to sit in what they think is a spa,

33:02 hot tub, hot sauna, than it is to get

33:05 them to go and do a Peloton 10-minute interval, right?

33:09 Maybe you can get the exercise snack in.

33:10 I think that that that definitely is something that's doable.

33:13 But it's it is it is really kind

33:15 of relevant to a lot a big percentage of population

33:17 that is really not going to engage in physical

33:20 activity or perhaps they're even injured and they can't, right?

33:23 So I think it it opens a lot of doors.

33:27 Sauna use is also linked to lower hypertension in a dose-dependent manner.

33:30 And this goes across not just sauna use.

33:33 There was actually a lot of really early, I mean, this data dates back decades,

33:37 data showing that hot baths, like hot tubs, lower blood pressure as well.

33:42 So again, dose-dependent manner, two to three times per week,

33:45 you get about 24% lower risk of hypertension.

33:47 Go that you go up to 47 times per week,

33:50 you get a 46% lower risk of hypertension.

33:52 You really want to see this dose dependence when you are looking

33:55 at any types of observational data

33:57 because you can never really establish causation.

33:59 And so it really helps strengthen the data

34:01 if it's actually showing you that it's dose-dependent.

34:05 There have been intervention trials as well showing that if

34:08 you expose people to even just a single sauna session,

34:11 but multiple sauna sessions,

34:13 they improve their blood pressure after using the sauna,

34:16 even after a single sauna session.

34:18 So I you know, the sauna is causing vasodilation.

34:21 It's doing a lot of the same, like I said,

34:23 it's increasing cardiac output while you're doing it.

34:25 A lot of the same things that's happening

34:27 when you're engaging in moderate intensity physical activity.

34:33 [snorts] Most of the parameters used in those studies were out of Finland.

34:36 In Finland, they do typically their sauna

34:40 temperatures around 174 to 179° Fahrenheit.

34:46 They also often will put water on hot rocks to create humidity,

34:51 about 20 to 30% humidity.

34:53 And that does make it feel hotter as well.

34:57 The duration spent in the sauna is very important.

35:01 So with those studies, for example,

35:02 like the sudden cardiac death study I was talking about,

35:05 if those men only stayed in the sauna for 10 minutes,

35:09 the effect was very much dampened.

35:11 So it was like they only had an 8% lower risk of sudden

35:14 cardiac death two to three times per week versus like the, you know,

35:18 25% lower risk of sudden cardiac death.

35:21 So it was really the sweet spot was they

35:23 had to stay in the sauna greater than 19 minutes.

35:26 So I like to say 20 minutes is

35:28 the sweet spot because once they hit that 20-minute mark,

35:31 then they were getting the most robust effect.

35:33 So really duration is important.

35:36 Frequency as well.

35:36 We already talked a lot about that.

35:38 It was dose-dependent.

35:39 The minimum effective dose, two times a week,

35:41 you're going to at least get some benefits.

35:43 The maximum, you know, dose, 47, right?

35:47 Four if you're really kind of trying to be time efficient.

35:52 [snorts] But a big question that everyone always wants to know is,

35:56 what about infrared saunas?

35:58 What about hot baths?

36:00 Do they have the same effects?

36:02 Well, let's start with hot baths because they they seem

36:07 to really mimic a lot of the same effects as hot saunas.

36:12 And and we'll talk about some data there with blood pressure,

36:15 but they also increase brain-derived neurotrophic factor.

36:17 There have been studies showing that sitting in a hot bath,

36:20 104° Fahrenheit is the is the temperature most of the studies.

36:24 People have their shoulders submerged down and they're in there for 20 minutes.

36:27 It's hard to do.

36:29 I I mean, if you sit down and try it, it's hard.

36:31 You want to always put your arms out.

36:32 You get hot.

36:33 But that's the the protocol there and brain-derived neurotrophic factor goes up.

36:38 Blood pressure improves and we're going to talk about heat shock proteins.

36:41 When it comes to infrared saunas,

36:44 there was a head-to-head of moderate intensity exercise,

36:48 hot sauna, and infrared sauna.

36:51 Unlike the data I started out with telling you

36:54 about how hot saunas do mimic moderate intensity cardiovascular exercise,

36:59 for the same amount of time, infrared saunas do not do that.

37:03 And it's not that big of a surprise because

37:06 infrared saunas are going up to maybe 145° Fahrenheit max.

37:11 They're not getting quite as hot.

37:12 They're working through a very different mechanism, right?

37:14 So they're using infrared radiation to kind of move

37:17 molecules around to make you hotter, to make you sweat.

37:21 So it's not the same at the same duration amount of time spent in the sauna.

37:28 That doesn't mean that you can't double the amount of time you spend

37:31 in infrared sauna and actually start to get those effects because you can.

37:34 If you stay in an infrared sauna for 20 minutes,

37:36 it's not going to be much of anything with respect

37:39 to increasing cardiac output and all these things I talked about.

37:42 If you stay in there for 40 minutes,

37:43 you're going to get you're going to get those effects.

37:46 So it all depends on how much time

37:48 you're willing to spend in the infrared sauna.

37:50 That also doesn't mean that there aren't benefits to infrared sauna.

37:53 There's a lot of thermoregulatory mechanisms that are

37:56 going on as well and you're sweating a lot.

37:58 You are excreting some heavy metals and things that you're exposed to.

38:02 But if you're looking for these effects that I'm talking about here in today,

38:06 you're going to probably have to double your time or maybe two and a half it.

38:10 And it's still we don't have a lot of data to show that it has the same effects,

38:14 but I think it likely does if you if you get to that right duration spot,

38:20 which I think is about 45 minutes to 60 minutes.

38:25 I already mentioned that hot baths do improve blood pressure.

38:28 Countless studies on that.

38:30 But I want to shift gears and talk about this adaptive response that happens.

38:34 So you know, we are stressing our bodies when we are exposing it to heat,

38:38 whether that's hot air or hot water.

38:41 Part of the adaptive response is

38:43 an increase in something called heat shock proteins.

38:45 As their name implies, they respond to heat,

38:47 but they also actually are increased um when

38:50 we're exposed to other types of stressors like exercise,

38:53 um like eating a phytochemical like sulforaphane, for example.

38:57 These heat shock proteins,

38:59 um what they do primarily is they prevent proteins inside of our cells,

39:04 inside of our vascular system, inside of the you know,

39:07 extra inside of the extracellular space in our brains

39:10 from aggregating and forming these protein aggregates.

39:14 So heat shock proteins help keep

39:15 proteins folded in their right three-dimensional structure.

39:19 That way they can do their function properly and that way they get degraded.

39:23 They, you know, when the when their time when the protein's time is up,

39:25 then a new protein is made.

39:26 It's properly folded.

39:27 So heat shock proteins play a very important role in that full process.

39:31 And so there've been studies that have shown, for example,

39:35 in animal models, if you expose them to amyloid beta 42,

39:39 the toxic protein that aggregates and is associated

39:42 with the pathology of Alzheimer's disease and you give these mice,

39:46 you know, heat shock you make them express a lot of heat shock proteins,

39:49 it actually protects against the aggregation of this amyloid beta 42.

39:53 So, it protects against Alzheimer's disease.

39:55 The same goes for some of the cardiovascular

39:57 aggregates that happen in the vascular system as well.

40:01 [snorts] Um, heat shock proteins also slow muscle atrophy.

40:03 There have been studies that have exposed individuals locally

40:06 to heat on one leg and they're they're disuse they're

40:10 disusing that leg so they have like a cast

40:12 or something they're not they're not exercising or using that leg.

40:15 Um, and the heat shock proteins as well as the heat

40:19 local heat prevent about 40% less uh muscle atrophy.

40:24 So, they play a role in preventing muscle atrophy.

40:26 But, they're also associated with longevity.

40:29 Human longevity.

40:31 So, individuals have variations in the heat shock 70

40:35 gene that make them have a more active heat shock

40:39 70 gene so they're making more heat shock protein

40:42 70 which is one of the major heat shock proteins.

40:45 If those individuals have one copy from either mom or dad,

40:48 that's associated with a one-year increase in life expectancy

40:51 compared to people that don't have any of those copies.

40:53 They're just making normal amounts of heat shock proteins.

40:56 People that have two copies so they're homozygous,

40:59 those individuals have a two-year increased life expectancy

41:02 compared to people that don't have any copies.

41:04 So, again we're seeing a dose-dependent effect here with um with those alleles.

41:09 And this extends to lower organisms as well.

41:12 I I've done these experiments with my own hands um in worms and in flies.

41:16 If you expose them to a really short burst burst of heat,

41:20 it'll extend their life expectancy by like 20%.

41:23 So, it seems to be an evolutionary conserved mechanism as well.

41:27 And we know that people that sit in a relatively hot sauna,

41:31 actually not even that hot, 163°F sauna for about 30 minutes,

41:36 they can increase their heat shock proteins by 50% over baseline.

41:40 Heat shock proteins again this is another

41:42 sort of dose dose and duration-dependent response.

41:47 I mentioned 20 minutes in a 104° bath for you know,

41:52 shoulders down also increases heat shock proteins.

41:56 Sauna also lowers inflammation so there have been a variety of studies

42:00 um initially it has the same response as exercise where you're increasing IL-6.

42:04 This is kind of this kind of funny

42:06 cytokine because oftentimes it's associated with inflammation,

42:09 but IL-6 is also kind of like a signaling mechanism because when you put

42:14 the right the good type of stress on your body like exercise or heat stress,

42:19 the IL-6 that's produced is actually signaling and you

42:22 make something called IL-10 the anti-inflammatory cytokine and so

42:25 you end up having this net anti-inflammatory response

42:28 which is the same thing that happens with exercise.

42:31 Yes, you're generating inflammation while you're doing that exercise,

42:34 but the response the adaptation that your body is um you know,

42:37 undergoing to respond to that inflammation is to make a lot

42:40 of anti-inflammatory cytokines to deal not only with that acute inflammation,

42:45 but that response is long-lasting.

42:48 So, essentially like days later you're

42:50 still having an anti-inflammatory response which means

42:52 all the other stresses of aging you're

42:54 kind of combating combating that better, right?

42:57 So, this is that so-called hormetic effect where you're

42:59 giving the little dose of a a good type

43:02 of stress and the response that stress is so robust

43:05 that it really is just improving the way you age.

43:07 It's resilience.

43:08 It's building resilience and that's really what we're talking about today.

43:13 [snorts] Sauna use is also associated

43:14 with a decrease in dementia and Alzheimer's disease.

43:17 In this study here this was out of again Dr.

43:19 Laukkanen's lab.

43:20 He showed that people that use the sauna four to six times per four to seven

43:24 times per week had a 65% lower

43:28 Alzheimer's disease risk as well as dementia risk.

43:31 Um I want to take a moment here to talk

43:33 about another study out of Finland that showed the same thing.

43:36 It was about a 60% lower dementia risk if people used the sauna um frequently.

43:42 However, that study looked at temperature so

43:45 they they they basically [clears throat] looked

43:47 at different types of temperatures that people

43:49 were using and they found something very interesting.

43:52 And that is is that when people started to go

43:54 to the really extreme hot level so they were going

43:57 above 200°F they were getting like 200 to 210 212°F

44:04 that sort of like that go hard go home mentality,

44:07 they actually had a higher two times higher risk of Alzheimer's disease.

44:11 I think that's important because you know,

44:14 often times there is this go hard go home,

44:17 but when we're talking about stress, you know,

44:19 we're giving we're we're the whole point is

44:21 we want to give ourselves the right dose

44:24 the right amount of stress to have

44:26 that really important anti-inflammatory antioxidant you know, adaptive response.

44:32 But, like heat is it's a hard stress and you don't necessarily want to be

44:36 going in 212°F sauna that's very hot and your head is exposed to that heat, too.

44:43 It's not really understood what the mechanisms are there,

44:46 but there's no reason to go in a 212°F sauna.

44:50 I think you know, 190 max like that's that's that's hard.

44:53 190 is hot.

44:54 I go I do 180 personally, um but I think that's important because I

44:58 know if you go on Instagram there's a lot

45:00 of influencers that are going really really hot

45:03 and I just don't think that's a great idea.

45:05 Um, we don't have any evidence that going that hot is beneficial

45:09 and if anything we have evidence that it potentially might be harmful, right?

45:16 [clears throat] So, overall this is a from a paper I published in 2018.

45:20 Um or sorry 2021.

45:23 I think you know, it's pretty clear sauna improves

45:25 health span deliberate heat exposure through sauna through hot baths.

45:29 We are you're mimicking car modern physical exercise.

45:32 Doing in conjunction with exercise is better than exercise alone.

45:36 You're improving your cardiovascular health.

45:39 It improves endothelial function and it it improves arterial

45:42 compliance and you're getting that heat shock protein response.

45:45 By the way, the heat shock proteins stay activated for about 48 hours.

45:49 So, the more frequently that you're exposing yourself to heat

45:52 or exercise which also raises your core body temperature,

45:55 you're getting that heat shock protein response, right?

45:57 So, that's good especially if you don't have those alleles

45:59 where you're having an overactive heat shock protein 70.

46:03 Okay, the last fourth of the talk I'm going to talk about cold stress.

46:06 I'm in my cold plunge smiling.

46:07 I usually don't smile and I often say prof pain words,

46:11 but um we're going to totally talk

46:13 about a different type of thermal stress here.

46:15 Um, we're going to talk about deliberate cold exposure.

46:18 There's a lot of things that we could talk about,

46:20 but because of time we're going to just talk about a few.

46:23 Um, I'm going to focus on increased brown adipose tissue.

46:28 Um, this is the thermogenic type of adipose tissue.

46:32 We're going to talk about the effects

46:33 on mood and cognition that's like my favorite.

46:35 We're going to talk about the effects

46:36 on mitochondrial biogenesis the growth of new mitochondria both

46:40 in adipose tissue and what that means

46:42 and also in muscle tissue and what that means.

46:45 And then [snorts] we're going to talk

46:45 about some precautions because depending on the protocol,

46:50 the timing of the protocol um and other things that you're doing it may blunt

46:54 some muscle hypertrophy from your resistance training

46:57 and that's something to keep in mind as well.

47:01 So, cold stress much like heat stress causes

47:04 adaptations and these adaptations are also dose and duration-dependent.

47:09 So, for example people that spent one hour

47:12 in 57°F water had a fivefold increase in norepinephrine, right?

47:18 That's uh it's norepinephrine is both a hormone and a neurotransmitter.

47:23 As a hormone it causes vasoconstriction and that's what's

47:26 happening when you get into the cold it's causing vasoconstriction,

47:29 but also when you get into the cold it's increasing norepinephrine

47:33 in the brain in the locus coeruleus region of the brain.

47:36 Those studies have also been done.

47:38 But, who wants [snorts] to go into 57 by the way is not warm.

47:41 I mean if you've anyone's done 57 it feels pretty darn cold.

47:45 Um, who wants to do that for one hour?

47:47 Um, luckily two minutes at raises norepinephrine by twofold.

47:54 This is my favorite thing.

47:56 This is my spot.

47:56 I I do about 49°F for two minutes.

47:58 I like to get that little norepinephrine pump cuz I'm

48:01 it really helps with the focus and the attention improving mood.

48:05 Sort of it has a little bit of an anxiolytic

48:07 effect where anxiety is a little bit lowered as well.

48:10 And two minutes is way easier than one hour, right?

48:15 [snorts] And then 35°F that's really cold.

48:16 Um, not a huge fan of that, but if you just go

48:18 in there for 20 seconds if you really want to be efficient,

48:21 that also is associated with a twofold increase in norepinephrine.

48:24 Now, if you stayed in there for two minutes versus 20 seconds you're probably

48:27 going to go up a little bit more in terms of your norepinephrine response,

48:31 but the bottom line here is dose and duration-dependent.

48:34 You kind of get the point.

48:37 And I this is just to show you guys there's evidence that yes,

48:40 cold does increase norepinephrine in the brain.

48:43 It's not just the hormonal response that's occurring.

48:46 It's the brain as well and anyone that's

48:48 done deliberate cold exposure knows this is true.

48:51 You feel it immediately.

48:54 There have been some studies.

48:56 Um, this was a very small cohort study that was done

49:00 in people with major depressive disorder and they were exposed to cryotherapy.

49:04 So, not cold water immersion,

49:06 but they were going into those cryo chambers with a very very cold air.

49:10 And um researchers wanted to look at how it affected their mood.

49:14 And so, there was a treatment group and then there was the sham control.

49:16 The treatment group they were getting about minus 256°F.

49:20 I've done cryotherapy several times.

49:22 I much prefer cold water immersion.

49:25 Um, there's something about the water contacting your skin where it just

49:28 makes it much more robust of a effect at least for me.

49:32 Um, however, it's a lot easier to have this this sham control here.

49:36 They had a minus 58° F sham control,

49:39 which does people going in that feel like they're totally getting a a response.

49:43 A placebo group is very obviously very

49:45 important when you're studying any kind of depressed

49:47 depression because the placebo effect is very

49:49 real and you'll get an antidepressant effect.

49:51 And so the people that did the 2 minutes at that minus 236° F

49:55 five times a week for 2 weeks did have a pretty major anti sorry,

50:02 antidepressant effect.

50:03 In fact, in fact, the Hamilton scale they improved by about 17 points,

50:07 which is kind of phenomenal.

50:10 Just to give you reference basis,

50:12 I think if you have like a 2.5 change in that scale,

50:16 it's considered to be clinically relevant and they had 17.

50:19 So.

50:21 Um let's shift gears and talk about the effect

50:24 of deliberate cold exposure on thermogenesis on brown brown adipose tissue.

50:30 So, one of the regulating responses here is the norepinephrine response.

50:35 When you are making norepinephrine,

50:38 when you're making it in your vascular system, the hormonal effects,

50:42 it is a signaling mechanism much like we talked about with the lactate.

50:45 Well, the norepinephrine is increasing a protein called UCP1,

50:49 which then signals to your adipose tissue to make more mitochondria.

50:53 So, it's an adaptation because the more

50:56 mitochondria you have in your adipose tissue,

50:59 the more energy that you can burn and the more heat as a byproduct is made

51:04 and so your body is finding a way to stay alive when you're sitting in the cold.

51:08 And the way that it's adapted to do that is to make more mitochondria.

51:13 Therefore, you can burn more energy in your adipose tissue.

51:16 So, your your stored fatty acids undergo lipolysis.

51:19 You start to metabolize those, right?

51:21 And therefore, you're making energy and then heat is dissipating, right?

51:25 And so you're warming yourself up.

51:26 And this is an adaptation that happens the more you expose yourself to the cold,

51:32 the more you start to make brown fat.

51:35 And so that that is something that is

51:37 a therapeutic target for many many different researchers out there.

51:40 They're trying to find a way to make a pill to increase brown adipose tissue,

51:44 to increase mitochondrial biogenesis in brown adipose

51:46 tissue because that would be a you know, weight loss mechanism, right?

51:49 Because you're burning more fat.

51:51 It's also it's it's also associated with improving metabolic health as well.

51:56 We know from studies that young healthy people, this in this case they were men,

52:01 if they walked around with a cooling suit that was

52:03 cooling their body to about 50° F for 2 hours daily,

52:08 after 1 month, they had about a almost 50% crease in brown adipose tissue.

52:14 That's really a lot.

52:16 That's a lot.

52:17 I've seen other studies where 15 minutes, do I have that slide?

52:21 No.

52:22 I've seen other studies where 15 minutes in 50° F cold water

52:27 can also increase the bio the mitochondrial biogenesis in your adipose tissue.

52:31 So, if you if anyone's in here has done deliberate cold exposure,

52:35 you know that 15 minutes is hard.

52:37 In fact, the sauna, it gets harder the longer

52:40 you stay in cuz you're getting hot and you're uncomfortable.

52:43 The cold gets easier the longer you stay in.

52:45 So, if you can get past about 4 minutes,

52:48 you can you can actually do 15 minutes at 50° F.

52:52 But, adipose tissue is not the only tissue where

52:57 mitochondrial biogenesis occurs in response to deliberate cold exposure.

53:01 Muscle also is increased.

53:03 So, um this there there's been a few studies that have shown again,

53:10 what's happening is when you're getting yourself exposed to the cold,

53:13 norepinephrine goes up.

53:15 That increases a protein called PGC1 alpha,

53:19 which then increases mitochondrial content in muscle tissue.

53:23 That is associated with decreased muscle atrophy.

53:27 It's associated with improved endurance performance.

53:30 In fact, there's actually been several

53:31 studies that have shown elite tennis players, rowers, let's see, what else?

53:38 There've been a variety of different endurance runners that in between

53:42 their their their sort of sets that they're doing,

53:46 if they engage in deliberate cold exposure,

53:48 they actually improve their running time

53:51 or their reaction time, whatever you know, metrics being measured,

53:53 but it's essentially increase or improving their athletic performance.

53:58 This is very specific to endurance type of activities only.

54:03 And I'll talk about that probably in the next slide,

54:07 but it it's really important that I also just want to point out the best

54:11 way to increase mitochondrial biogenesis in muscle

54:14 tissue is actually high intensity interval training,

54:17 way more robust than deliberate cold exposure.

54:20 With that said, deliberate cold

54:22 exposure does also increase mitochondrial biogenesis.

54:25 It's an adaptive response again.

54:27 In fact, individuals that spend about 15 minutes again at 50 So,

54:32 if you're I think that the sweet spot here is 50° F, 15 minutes.

54:38 That's the number for increased mitochondrial biogenesis in muscle

54:42 and increased myo mitochondrial biogenesis in adipose tissue,

54:46 which then is translating to brown adipose adipose tissue, right?

54:50 The reason it's brown adipose tissue is if you

54:52 look at a little fat droplet under a microscope,

54:55 the more mitochondria it has in it,

54:57 the browner it looks under the microscope and that's where it got its name from.

55:02 Very important to point this out and that is deliberate cold exposure

55:09 after any kind of resistance strength training type of exercise where you're

55:14 trying to put mechanical force in your muscle to increase muscle protein

55:19 synthesis to cause muscle hypertrophy can blunt some of those anabolic effects.

55:24 For a variety of reasons, there have been multiple studies now,

55:28 the most recent one by Luke van Loon.

55:30 Um He showed that essentially because

55:33 the the cold exposure is causing vasoconstriction,

55:37 you're basically for a period of time,

55:40 you're not getting as much amino acids to muscle,

55:43 you're not getting as much of the inflammatory and growth

55:47 factors to the anabolic signaling to the muscle tissue.

55:49 You end up having a blunted hypertrophy hypertrophy effect.

55:54 That's not to say you don't experience some muscle hypertrophy, you do.

55:58 It's just if you compare it to a sham control group, it's blunted.

56:03 And so if you're really trying to maximize your muscle gains,

56:06 it's a good idea to not engage in deliberate cold exposure,

56:09 cold water immersion, cryotherapy, whatever fill in the blank your favorite

56:13 cold exposure method is anytime around resistance training.

56:17 And you may go, "Well,

56:18 when do I do it?" Um I think it's the safest if you're doing

56:23 it on recovery days or days where

56:25 you're doing more endurance training like a run,

56:28 more of a like a zone two moderate intensity training kind of day.

56:32 Those are the best days to do it

56:34 or perhaps like many many many hours after or before

56:38 you're going to do your training because you do

56:40 run the risk of blunting your muscle protein synthesis.

56:48 So, to sum that up, we talked about some protocols.

56:51 If you're really just wanting a little brain pop,

56:53 if you're wanting to get that norepinephrine response,

56:56 if you're wanting to perk up before you sit down at your desk

56:58 or before you're giving a talk

56:59 or before you're doing something cognitively demanding,

57:04 you can you can do your hit protocol, which is my fav,

57:06 or you can do your your 2 minutes at 50° F and get that norepinephrine boost.

57:13 You can also do 35° F for 20 seconds if you really can't stand the 2 minutes.

57:17 That's another option.

57:18 For mitochondrial biogenesis, whether it's in adipose tissue or in muscle,

57:24 the key here is 50° F for 15 minutes.

57:28 And actually like once you work your way up to that point,

57:32 it becomes easier because you have more brown adipose tissue,

57:35 it doesn't feel as cold.

57:36 And so after like a couple of weeks,

57:39 you'll actually notice that it doesn't feel as cold,

57:43 but it goes away very quick.

57:44 If you stop doing it, it's gone.

57:46 You'll you'll have to readapt.

57:49 So, with that said, I'm going to conclude

57:51 the three habits that we talked about today.

57:53 Vigorous intensity exercise, really, you know,

57:56 there's a variety of protocols out there.

57:58 Whether you're doing the Norwegian 4 by 4 or you're doing

58:01 the 1 minute on, 1 minute off 10 times or you're doing Tabata's,

58:04 20 seconds on, 10 seconds off, find a way to make it frequent.

58:08 Or you're doing your exercise snacks.

58:10 Find a way to just start doing them throughout the day.

58:13 If it's three times throughout the day, great.

58:15 If it's six times, even better.

58:17 Find a way to just get up and do 1 minute.

58:19 1 minute.

58:20 You feel great after that minute, right?

58:21 If you do that about six times a day, it's amazing.

58:24 Um you want to try to incorporate some deliberate heat exposure.

58:27 If you don't have access to a sauna, hot baths are great.

58:30 If you don't have a hot tub or a jacuzzi, get a pool thermometer,

58:33 stick it in your bathtub and make sure you keep refilling the hot

58:36 water so that it stays about 104° F or close to that.

58:39 Very easy, very accessible for many people that don't have saunas as well.

58:43 If you have an infrared sauna,

58:45 you probably going to have to double your time to about 45 minutes or more.

58:48 And then deliberate cold exposure,

58:51 hard to do if you don't have your own cold plunge,

58:53 although depending on where you live in the US in the in the winter,

58:57 cold showers can do wonders as well.

59:00 If you're in Florida, not so much all all times of the year.

59:02 I've gone to Florida in the in in the winter where I'm like,

59:05 "This isn't cold at all." So, you know,

59:09 the the benefits are also dose and duration dependent.

59:12 50° F, 15 minutes if you want that mitochondrial biogenesis boost.

59:16 And with that, thank you so much.

59:18 I think we're going to take some questions.

59:20 I'm looking forward to those.

59:26 Thank you so much, Rhonda.

59:28 So, who loved that?

59:30 [laughter] I mean, Yeah.

59:32 Yeah.

59:34 I literally have chills right now.

59:36 So, she is a if not the powerhouse on all of those subjects in the entire world.

59:41 So, the fact she's on our stage and I'm

59:44 actually up here is literally a bucket list item.

59:46 So, I'm going to dive in.

59:47 I mean, we've been doing this, you know,

59:49 now for a day plus and the amount of questions,

59:53 I mean, you obviously have very, very hot, pun intended, topics.

59:57 Um the amount of questions coming in around

59:59 all the subject matter is is is literally mind-boggling.

1:00:01 So, I'm going to dive in.

1:00:02 First off, a personal thank you.

1:00:04 I learned everything I do I do sauna every single day.

1:00:06 You guys know I talk about resilient

1:00:08 behaviors and sauna and all sorts of things,

1:00:10 but it's for you that I learned all of that.

1:00:11 So, thank you cuz your contributions are literally I don't

1:00:13 think you understand what you're what you're contributing to this space.

1:00:16 It's it's truly incredible.

1:00:17 Thank you.

1:00:18 So, So, I'm going to do my best

1:00:22 to categorize these because there's a lot and there's

1:00:24 a lot of overlap and you may have

1:00:26 actually just answered some things that I didn't hear.

1:00:28 So, um repetition is the mother of learning.

1:00:31 So, we'll just sort of dive into some of this.

1:00:33 So, I'm going to hit at some point micronutrients.

1:00:36 I know that's a big passion of yours.

1:00:37 I'll hit the top three that I know you always educate

1:00:39 on cuz I think our audience is going to want to hear that.

1:00:41 I'll get into some more stuff about exercise, hot, cold, I mean, all the things.

1:00:45 Let me just sort of lead off with Okay.

1:00:51 There was a whole category that came in around cycling women.

1:00:54 So, women who have menstrual cycles and exercising and hot and cold

1:00:59 and I know this is going to be kind of a all-encompassing discussion,

1:01:02 but even just pre-menopause, perimenopause, menopause,

1:01:07 and exercise recommendations, do they change?

1:01:09 Does your heat schedule change?

1:01:11 Does your cold Does anything change relative to the menstrual cycle?

1:01:15 If we can start there.

1:01:16 Okay.

1:01:16 Um I have some pretty strong thoughts on this and it

1:01:21 it's probably not what you're going to expect.

1:01:23 I do think there's a lot of hype out there on inducing fear around this topic.

1:01:30 I think if a woman listens to her body,

1:01:34 I mean, that's all you really have to do, honestly.

1:01:37 If you're on your cycle, I mean, you're not going to go as hard, right?

1:01:43 I mean, there's times that you're just it's pretty clear.

1:01:46 Um when it comes to like the hormonal responses

1:01:48 that are happening from some of these, you know,

1:01:51 types of exercise that people are so

1:01:53 worried about high-intensity exercise being bad for women.

1:01:55 Like the problem with that statement is it doesn't encompass the nuance there,

1:02:02 which is essentially that all stems from data showing that women

1:02:07 in a calorically deficit state that are doing extreme types of exercise,

1:02:13 whether it's very long duration endurance or very high volume,

1:02:18 high intensity training.

1:02:20 That, you know, is kind of like if you're in this calorie deficit,

1:02:24 then you can you can have a pretty strong

1:02:26 effect on hormones and that's the problem, I think.

1:02:30 So, if you're not in a calorie deficit

1:02:33 and you're not really I don't know that there's anything

1:02:35 to worry about other than the fact that you

1:02:37 probably should making be making sure you're getting enough iron,

1:02:39 to be honest, if you're menstruating.

1:02:41 Um if you're postmenopausal, I mean, again,

1:02:45 I think that you should just be probably working out harder.

1:02:48 Um so, yeah, I I my my thoughts are don't sweat that topic so much.

1:02:54 Please, listen to your body and it's really not a huge issue for most people.

1:02:59 Thank you for that.

1:03:00 How do you see intermittent fasting and time-restricted feeding

1:03:03 or eating intersecting with exercise timing for optimizing metabolic health?

1:03:08 For metabolic health?

1:03:09 Okay.

1:03:09 Yeah, that's important.

1:03:10 So, I think that if you're doing any kind of intermittent fasting protocol,

1:03:14 whether that's time-restricted eating and you're eating

1:03:17 all your food within like an 8-hour window,

1:03:20 what you really, really need to keep in mind

1:03:22 is making sure you're getting enough protein, right?

1:03:25 Because that's that's the key for preventing

1:03:29 Anytime you're in a caloric deficit, if you're skipping meals,

1:03:32 you have to make sure you're going higher on the protein,

1:03:34 even higher than you would if you weren't in a you know, caloric deficit.

1:03:38 So, you want to make sure you're getting enough protein.

1:03:41 I would say at least 1.6 um grams per kilogram body weight per day,

1:03:46 probably closer to two, to be honest, if you're actually skipping meals.

1:03:50 Um [snorts] If you're engaging in exercise,

1:03:54 you probably, depending on the type of exercise,

1:03:57 so if you're doing high-intensity exercise or resistance training,

1:04:00 you don't really want to do that in a fasted state.

1:04:02 So, you want to time those types of exercises closer to like a meal.

1:04:06 If you're doing more of an endurance type of training,

1:04:08 as long as it's less than an hour,

1:04:09 you can actually enhance some of the metabolic

1:04:13 adaptations and maybe that's the question you're asking.

1:04:16 If you're wanting to increase more things like autophagy,

1:04:19 so this is what a lot of people are doing They're aiming to increase autophagy

1:04:24 and that's why they're intermittent fasting, among other reasons,

1:04:27 but autophagy is when you're in in that fasted state and essentially

1:04:32 you're clearing out a lot of the the damage that's accumulated within cells,

1:04:35 whether it's protein aggregates or pieces of DNA, just all the gunk.

1:04:39 Um Caloric restriction and being in an energy

1:04:42 deficit does that, but so does exercise.

1:04:45 And when you pair the two together,

1:04:47 you can kind of enhance that process even more.

1:04:49 So, also some of the mitochondrial adaptations

1:04:52 that you're going to experience from your endurance

1:04:54 training will also be enhanced somewhat if you do them in a fasted state.

1:04:59 I don't know that it makes that big of a difference, but if you really,

1:05:01 really like trying to dial in every single thing,

1:05:04 um I think that that's also key.

1:05:06 When it comes to metabolic health,

1:05:08 also high-intensity vigorous exercise is the most important because

1:05:12 it's that it's causing an intense stress on your muscles,

1:05:15 which are increasing glucose transporters to come up to the cell surface,

1:05:19 bring glucose in better.

1:05:21 That's even It lactate is the molecule that's actually signaling to do that.

1:05:24 So, you really have to go harder to get that response.

1:05:28 Timing that with um time-restricted eating is great if you

1:05:32 can try to eat your your meal earlier in the day,

1:05:34 you're going to get like a double hit, right?

1:05:36 Because as we're getting as we throughout the day,

1:05:41 our metabolic I would say health, our glucose metabolism, fatty acid metabolism,

1:05:46 all these things aren't as efficient as they are earlier in the day.

1:05:50 And so, if you're timing if you're doing both of those things,

1:05:53 then you're really optimizing for metabolic health in both both directions.

1:05:57 Great, thank you.

1:05:58 This next series of questions is sort of around the same topic.

1:06:02 The high-level one is,

1:06:04 how do you if someone doesn't exercise and they're sedentary,

1:06:09 what are you How do you discuss just initiating exercise?

1:06:12 One, two, these are all prescribers in the room and we treat a lot of pathology.

1:06:17 So, we see autoimmune disease, we see cancer, we see people fibromyalgia,

1:06:20 things that are just like lots of metabolically

1:06:22 a lot of inflamed sort of metabolic derangement going on.

1:06:26 How do you plan and I know it's also individual It's based on the person,

1:06:31 but generally speaking,

1:06:32 how do you plan or or educate or at least recommend exercise regimens,

1:06:37 hit or otherwise, for someone, let's say, with autoimmune disease,

1:06:41 which is so prevalent, or or fibromyalgia, any of these chronic conditions?

1:06:44 What would you say to both the sedentary person who never exercises?

1:06:47 How would you introduce them to it?

1:06:48 Secondly, the person who's highly inflamed, but also needs to do it?

1:06:52 Yeah.

1:06:52 Um I'm going to try to answer that question the best

1:06:55 I can in a short period of time without all the nuance.

1:06:58 Um So, first and foremost, I like to turn to the exercise snacks because we all

1:07:03 did them together for 1 minute and you can introduce that.

1:07:08 You can like in your office or wherever you're seeing your patient,

1:07:11 you can actually just we're going to do this together

1:07:13 for 1 minute and it they don't have you know,

1:07:15 just as hard as they can and whatever they can do.

1:07:18 What what they need to get is that dopamine response, right?

1:07:20 They need to feel that dopamine themselves because you

1:07:23 can tell them all the things you all the benefits,

1:07:26 you can give them all the science.

1:07:27 I mean, you can lecture them, just throw it all at them,

1:07:29 but at the end of the day, like they need to have they need to have

1:07:33 something that makes them want to do it, right?

1:07:36 And so, if you do that short exercise snack with them,

1:07:39 they're going to get that dopamine response and they're

1:07:41 going to feel it and they're going to be like,

1:07:42 "Wow, this is how I feel after just this one little short minute of, you know,

1:07:47 whatever it is you do with them, jumping jacks, high knees, whatever.

1:07:50 You chair squats, right?

1:07:51 For like older adults.

1:07:52 Um I think that's a great place to start.

1:07:54 I've done it with my mom.

1:07:56 Um the other place is group exercises.

1:08:00 Huge.

1:08:01 Like there's a social component.

1:08:03 Um there's a component of like you have to show up, right?

1:08:06 Accountability is there.

1:08:08 And so, like if you kind of can find any type of group exercise,

1:08:13 you know, whether So, for example, just I got my mom in a seniors CrossFit.

1:08:17 You know, she's 70 years old and she's now

1:08:18 going to a seniors CrossFit class three times a week.

1:08:21 She's been sedentary her whole life and she's been doing this CrossFit now

1:08:25 for the past 9 months and she goes three times a week and she loves it.

1:08:29 It blew my mind that I never thought I'd be able to get

1:08:32 her to do that, but it it happened and how and how did it happen?

1:08:36 Well, one, uh the friends that she's made there.

1:08:39 So, I did there there's a real power in these group exercises.

1:08:43 So, if you you can find something where people can go and like have a community,

1:08:48 it really it's not just like going to the gym by yourself and yeah,

1:08:51 you can do that and make friends, but like a class, you know,

1:08:53 where they actually have to show up and they make friends and it really helps.

1:08:58 Um with respect to like fibromyalgia and all those things,

1:09:02 um people will start to notice as they start to work out,

1:09:05 it's like the opposite of what they think.

1:09:06 They think they have to rest and not move,

1:09:08 but it turns out that's like the worst thing they can do.

1:09:10 And if they start moving, all these anti-inflammatory mechanisms kick in.

1:09:15 They actually start feeling better.

1:09:16 And so, even just getting them again to the short burst of exercise

1:09:19 snacks or starting out with the class

1:09:21 that it's not necessarily vigorous intensity,

1:09:23 but it's like it's something that's that they can do.

1:09:26 And again, they get the dopamine,

1:09:28 they start to notice they have to feel these effects and that's

1:09:30 when it get what's going to get them going back to it.

1:09:32 And then with the sauna,

1:09:34 um that's also a really good place to start and to bring it in, you know,

1:09:37 combination as well because it is easier to go sit in a sauna and they do kind

1:09:42 of feel like they're getting a spa treatment

1:09:44 and there are beneficial effects from that as well,

1:09:46 but I really think it should be

1:09:47 paired with exercise because exercise is the king.

1:09:50 There's nothing that compares to getting getting physically active.

1:09:53 Awesome.

1:09:54 Um maybe easy one.

1:09:56 What is your favorite wearable?

1:09:58 Um well, right now my favorite wearable only is it's

1:10:01 my Apple Watch because of all the other not just fitness reasons.

1:10:05 Um I do like the Whoop as well.

1:10:07 And then I'm I'm actually uh diving into Google's Pixel.

1:10:12 I'm actually on their uh scientific advisory board uh for Pixel and there's

1:10:15 like a new AI assistant coming with that that is really cool.

1:10:20 Very cool.

1:10:21 Very cool.

1:10:22 Personal question I've wanted to ask you.

1:10:23 I am into the Carol bike.

1:10:25 Are you familiar?

1:10:26 I have one.

1:10:27 You have one.

1:10:28 Okay, I didn't know that.

1:10:29 So, um a lot of people don't know what that is.

1:10:31 Can you just explain what it is and then

1:10:33 I love to just hear your thoughts on that.

1:10:34 I'm about 6 weeks in to mine and there's a Norwegian 4x4 on there that I'll do.

1:10:40 And so when I when I knew you were

1:10:41 going to be talking about that, I mean again, chills.

1:10:43 So, can you just tell people what that is

1:10:44 and kind of what it's claiming that you'll

1:10:48 get cuz I mean it kind of blew me away when I started like doing it,

1:10:51 but also reading what they're claiming and the research around it.

1:10:55 So, I'm just curious.

1:10:55 Yeah, I mean uh full disclaimer, I have a Carol bike,

1:10:58 but I've only used it a handful of times because um I've got my routine

1:11:02 down on my Peloton and I'm mostly not

1:11:04 doing I'm doing other stuff types of training,

1:11:06 but to essentially the Carol bike,

1:11:09 you know, it's is it's kind of forcing you to do

1:11:11 it's like a protocol where it's forcing you to do

1:11:13 it in a in a way where it's not like you

1:11:16 you kind of have to go with it in a way.

1:11:17 So, it's like it it changes the intensity,

1:11:19 you have to keep up with that change in intensity.

1:11:22 Um they added the 4x4 because of me.

1:11:24 Um I had Really?

1:11:25 since with them on that.

1:11:26 That's hilarious.

1:11:26 And I was like, I hate how the Peloton has no 4x4.

1:11:29 Oh my Um and so they they added the 4x4 and that for that reason alone,

1:11:34 I like the Carol bike.

1:11:36 Okay.

1:11:36 Um but I you probably can describe it better than I have

1:11:39 because I have used it so infrequently and only for the Norwegian 4x4.

1:11:42 Well, the way that I discussed it Carol bike's an AI

1:11:45 sort of generated stationary bike that you you bring home,

1:11:48 you order it, 5 weeks later you build it.

1:11:50 It's easy to build and you start doing it.

1:11:52 Their whole claim is literally 3 days a week,

1:11:55 a 5-minute exercise, 15 minutes, 15 minutes.

1:11:59 After 8 weeks, your VO2 max goes up 12 to 15%.

1:12:05 15 minutes a week and that's doing their classic what they call rehit,

1:12:11 reduced high-intensity interval.

1:12:13 And that's it.

1:12:14 So, what I have in my practice and you may as well,

1:12:16 I have cyclists that do triathlons, Iron Mans, what have you.

1:12:19 These are very very fit people.

1:12:21 They love the Carol bike as an augment

1:12:24 to what they already do in their normal training regimen.

1:12:26 They just swear that it helps sort of what they feel is this margin,

1:12:30 this very slim margin to improve their cardiorespiratory fitness.

1:12:33 So, anyways, I was just intrigued about your thoughts on that because

1:12:36 there's a bunch of other things like different exercises in it,

1:12:38 but who can't do 5 minutes 3 days a week?

1:12:41 That was the other thing that really appealed

1:12:43 to me and they have a 100-day uh money-back guarantee.

1:12:46 So, if you get it and you do, oh I don't know,

1:12:49 four times a week and you feel like it's not doing it, um you can send it back.

1:12:53 So, anyways, have you I was just curious about what your thoughts were.

1:12:57 to the whole like hit protocols improve cardiorespiratory fitness and like,

1:13:00 you know, 15 minutes a week absolutely is going to do that.

1:13:03 Yeah.

1:13:04 And improve it.

1:13:04 And I mean again, stationary bike, right?

1:13:06 It's so great on the joints.

1:13:06 You're in the AC.

1:13:07 It's not like you have to drive or go or or put stress on.

1:13:10 So, it just made a lot of sense to me.

1:13:12 So, I appreciate that.

1:13:14 I'm going to switch now into um the micronutrient category

1:13:18 and and I'm going to leave this off with one that that may

1:13:20 not be familiar with the audience and I'd love for you

1:13:22 to explain this, but this this idea of omega-3s and fatty 15.

1:13:30 Are you familiar?

1:13:31 Yeah.

1:13:32 So, so pentadecanoic acid, I believe, but but what we we teach on EPA DHA

1:13:41 and the importance of those and why systemically they're important,

1:13:43 but as compared to Can you Can we at least describe what fatty

1:13:47 15 is and is there I have a conceptual idea of the two differences,

1:13:51 but I'm curious about your thoughts on this since you love that space.

1:13:54 I Well, let me just say looking at the data on, you know,

1:14:00 fatty 15, it's very weak.

1:14:03 It's very observational.

1:14:05 It's very I it's it's just I don't I don't know that there's enough there.

1:14:10 It's kind of like, are we looking at the foods

1:14:12 that it's in and that's what's happening um versus,

1:14:15 you know, if you're if you're comparing it to like EPA DHA,

1:14:19 I mean there's just decades and decades.

1:14:20 It's probably the most well-studied fatty acid

1:14:22 like molecule one most most well-studied molecules.

1:14:25 Tons of evidence on actually supplementing with it, right?

1:14:28 Where we know it's actually due to this molecule versus like

1:14:32 the fatty 15 where there's a lot of observational evidence in like,

1:14:35 okay, this is found in these types of meats, these types of foods.

1:14:38 There's a little bit of supplements that it's like the supplement studies are

1:14:42 so far and few where it's like by a company that's making that molecule.

1:14:47 So, there's a little bit of a conflict of interest

1:14:50 and they're very very small studies with all sorts of problems.

1:14:54 So, um from an evidence-based approach, I find it interesting.

1:14:59 I don't quite know what to make of it yet,

1:15:02 but I will say that with the omega-3s, I am confident Yeah.

1:15:06 that those are highly beneficial and that most people are

1:15:10 in fact 80 to 90% of the population is deficient in omega-3.

1:15:15 They're not getting enough.

1:15:16 Yeah.

1:15:16 And that you can essentially increase someone's life expectancy

1:15:19 by 5 years by bringing them from a, you know,

1:15:21 low omega-3 index, which is 4%, to a high index, which is 8%.

1:15:26 Um so, to me um probably not the answer you want to hear.

1:15:30 [snorts] I do I do think it's an interesting

1:15:33 area to keep keep my finger on the pulse,

1:15:35 but um because I'm so critical and evidence-based,

1:15:39 I still I I have to be like very balanced Absolutely.

1:15:42 talk about it.

1:15:43 And there's definitely no answer I want to hear.

1:15:45 So, you basically just verbatim said what I thought you would

1:15:47 because you're a researcher and I already knew sort of the answer,

1:15:50 but I was asked to ask.

1:15:51 So, so that that's got to do Hey, I'm waiting.

1:15:54 I'm waiting for the cool study.

1:15:56 I'm like, I'll be the first to talk about it.

1:15:58 So, on the ratio of EPA to DHA,

1:16:01 I assume it depends on what you're going for and what you're treating,

1:16:04 but generally speaking, can you just talk to that to the audience?

1:16:07 Yeah, the ratio to EPA to DHA.

1:16:09 So, first of all, let's talk about like, you know, these these fatty acids.

1:16:13 Um DHA is predominantly found in our cell membranes.

1:16:19 It plays a role in the fluidity of our membrane.

1:16:22 So, it does kind of the opposite of what trans fats do.

1:16:25 Trans fats will stiffen,

1:16:26 they get incorporated into the cell membrane in endothelial

1:16:29 cells lining the lining our vascular system, our arteries.

1:16:32 They'll stiffen it and cause cardiovascular disease.

1:16:34 Well, DHA does the opposite.

1:16:36 It makes it more flexible.

1:16:38 It makes it more fluid.

1:16:40 And so, um it's very important component

1:16:42 of our cell membranes including in our neurons.

1:16:44 In fact, if you're not getting enough DHA,

1:16:47 what happens is transporters and receptors

1:16:49 like neurotransmitter receptors like serotonin,

1:16:53 like dopamine, they're structurally not uh optimal because the membrane

1:16:58 stiffen and so neurotransmitters can't bind them as well.

1:17:01 And so, you'll find that transport of nutrients,

1:17:05 even glucose has been studied showing that glucose

1:17:07 transport into the brain across the blood-brain barrier

1:17:10 because the glucose transporters are they're they're they're

1:17:13 structurally not optimal when you don't have enough DHA,

1:17:16 which accumulates at the blood-brain barrier.

1:17:19 Then you're not getting enough glucose into the brain.

1:17:20 You're not You're not You You get the idea.

1:17:22 You're not binding, you know, the serotonin receptors are not binding serotonin,

1:17:26 so you don't get the effect.

1:17:27 Same with dopamine.

1:17:28 So, the So, DHA plays a very important role in a lot of functions.

1:17:32 Also, muscle tissue.

1:17:34 So, there's studies now by Chris McGlory um

1:17:36 showing that DHA actually having high levels super

1:17:41 high levels of DHA in the muscle can make it can sensitize it to amino acids.

1:17:46 So, that plays a role in obviously muscle protein synthesis

1:17:49 and um preventing muscle atrophy as a um function of disuse.

1:17:53 Um EPA on the other hand is also incorporated into cell membranes,

1:17:57 but doesn't have as big of a role as DHA.

1:18:00 It has a very important anti-inflammatory role as well.

1:18:03 And so, um it's playing a big role in cardiovascular health.

1:18:08 I think if you're wanting if you're

1:18:09 someone that's really got like cardiovascular disease,

1:18:12 then like you're focusing more on a higher EPA.

1:18:15 You want higher EPA.

1:18:16 If you're someone that's really you've you've got a familial

1:18:18 history of Alzheimer's disease or dementia or Parkinson's disease,

1:18:21 brain neurodegenerative disorders, really focus is DHA.

1:18:26 So, I think it depends on what outcome we're looking at.

1:18:29 I like to get both, but really uh depression is

1:18:33 interestingly um EPA because of the anti-inflammatory effect as well.

1:18:37 But um so, my thoughts are here.

1:18:38 It's not just a one-size-fits-all.

1:18:40 It's like, what endpoint are we looking at here, right?

1:18:42 Cardiovascular disease or brain brain dysfunction.

1:18:45 So, we would hear checks omega checks omega quant omega indexes.

1:18:48 Yeah, okay.

1:18:49 Not enough.

1:18:50 Few hands.

1:18:50 So, um yeah, something I've been doing for years and yeah,

1:18:53 just glad you're on stage cuz I want to ask you that.

1:18:57 Nice.

1:18:57 There's something supplements They're rancid.

1:19:03 Okay, let me talk Can I talk to that question?

1:19:05 So, the question is,

1:19:06 oh you shouldn't be taking fish oil supplements because um you know,

1:19:09 fish oil is a polyunsaturated fatty acid.

1:19:11 Polyunsaturated fatty acids are very prone to oxidation.

1:19:14 Um I will say this, I there's not a single study.

1:19:20 In fact, there were studies that were deliberately fed

1:19:22 people oxidized fatty acids and they had no negative effects.

1:19:27 And that was already like I still think you

1:19:29 should get a quality fish oil supplement for sure.

1:19:31 Like don't get me wrong.

1:19:33 But there's more than one study and and the only reason I

1:19:35 know about this is because when I submitted an article for peer review,

1:19:38 reviewers were jumping on my case about.

1:19:40 I was like the opposite.

1:19:41 I was like, oh, it's oxidized.

1:19:42 You have to and they were like, three studies right here.

1:19:45 They gave them they fed people oxidized fish oil.

1:19:49 And guess what?

1:19:50 Markers were still improving and things were not going bad.

1:19:53 So I was like after that I was like, okay, I can't I'm I'm sold, you know.

1:19:57 Show me the data.

1:19:58 I will change my mind on something, right?

1:20:00 It's all about following the data.

1:20:01 So the bottom line here is that you know,

1:20:05 even even a sub-optimal fish oil supplement is beneficial.

1:20:10 And I think there's there's a lot of perverse incentive in some

1:20:14 of these influencers saying these things

1:20:15 because if you create that fear response, people will listen to you.

1:20:19 They get more followers.

1:20:20 They get, you know, so you have to really

1:20:21 be careful with that effect because it's a real effect.

1:20:26 And at the end of the day, you know,

1:20:28 I'm an associate scientist at the Fatty Acid Research Institute.

1:20:31 I've published I've two publications with omega-3 fatty acids.

1:20:34 I'm involved in clinical trials right now.

1:20:36 I mean, I I I can't tell you enough like omega-3 fatty acids,

1:20:41 it's like one of the easiest things that we can do,

1:20:44 you know, it's supplementing with the fish oil.

1:20:46 About 2 g a day will get most people

1:20:48 from a low index of 4% to a high omega-3 index.

1:20:51 By the way, we're talking about omega-3 fatty acids in red blood cells.

1:20:55 That's the omega-3 index.

1:20:56 And and it has a huge impact on 90% lower sudden cardiac death,

1:21:01 5-year increased life expectancy, a just a whole host of benefits,

1:21:04 neurodegenerative disease as well, dementia risk is lowered.

1:21:07 Um we have all these randomized controlled trials now.

1:21:10 We have the reduce it trial with Vascepa high EPA showing 25%

1:21:14 lower adverse cardiac events including stroke

1:21:17 and heart attack compared to placebo.

1:21:19 We have the vital study where people were actually given a low dose.

1:21:21 They were given like 800 mg of Lovaza.

1:21:24 So that's the prescription form of omega-3 that's EPA and DHA.

1:21:29 If we look at secondary outcomes,

1:21:30 these individuals had about a 30% lower heart attack risk compared to placebo.

1:21:35 This was a 5-year study.

1:21:36 These are large randomized controlled trials.

1:21:39 This is causation, not just observational data,

1:21:42 which all points in that direction as well.

1:21:44 So I don't think there's an argument that people can make when

1:21:47 it comes to supplementing with fish oil is bad when we're seeing,

1:21:51 you know, 30% reduced heart attack and death from heart attacks.

1:21:54 Yeah.

1:21:55 Compared to placebo.

1:21:55 100%.

1:21:56 For the timekeepers, I apologize, but I'm next to a power house.

1:21:59 I've got three more and then I'll be done.

1:22:02 Magnesium, you know, huge, right?

1:22:05 It's a big micronutrient you talk about a lot.

1:22:07 Can you just break down how you think through the different forms of it

1:22:10 and when you choose to use what you choose to use based on what?

1:22:13 Yeah, so magnesium's an essential micronutrient.

1:22:16 We can't make it in our body.

1:22:17 We have to get it from our diet, right?

1:22:20 Half the population's not doing that because

1:22:21 it's essentially found in dark leafy greens.

1:22:24 So supplementation is another way to get it.

1:22:27 The RDA for magnesium for women is about 300 to 350 mg a day.

1:22:32 For men, it's about 350 to 400 mg a day.

1:22:35 If you're sweating a lot, you're using the sauna,

1:22:37 you're physically active, those requirements can go up between 10 to 20%.

1:22:41 If you're a high-level athlete, again, those levels can go up.

1:22:45 And most people [clears throat] aren't even meeting that.

1:22:47 So imagine, you know, how deficient people are in magnesium.

1:22:52 [snorts] It is a cofactor for over 300 enzymes.

1:22:54 Important to make energy.

1:22:55 You can't make ATP without magnesium.

1:22:58 You also need it to repair damage to your DNA.

1:23:01 So it plays a very important role in preventing age-related cancer.

1:23:04 That's not something that's going to show up in your 30s or 40s, maybe 50s.

1:23:08 As you get to your sixth, seventh,

1:23:09 eighth decade of life, you know, cancer start to show up.

1:23:12 And if you've been a lifetime of magnesium deficiency,

1:23:15 you're not repairing that damage to your DNA as well.

1:23:17 That can lead to oncogenic mutations.

1:23:20 Also, magnesium stored in bones.

1:23:22 And so anytime you're in a magnesium deficient state,

1:23:24 you pull it out of your bones because

1:23:25 you have to maintain plasma levels of magnesium.

1:23:28 And so a plasma magnesium test isn't necessarily going to show someone's

1:23:32 getting insufficient magnesium because you're going

1:23:34 to pull it out of your bones.

1:23:35 So it also plays a role in osteoporosis.

1:23:38 What what forms of magnesium can people take?

1:23:41 That's like the big question.

1:23:42 So there's a lot of forms out there.

1:23:44 The classic one that people used to take, magnesium dioxide, terrible.

1:23:50 It's just not bioavailable at all.

1:23:52 Um so forget that form.

1:23:54 When it comes to supplementation,

1:23:56 some of the best and most bioavailable forms are the the organic salts.

1:24:01 So you're getting magnesium citrate, magnesium malate, magnesium taurate.

1:24:07 And then magnesium glycinate is a really good one.

1:24:10 So those are some of the most bioavailable forms.

1:24:13 Magnesium glycinate I like to take because at night especially because glycine,

1:24:19 so it's it's attached to a glycine molecule.

1:24:21 And so if you're taking glycinate or bisglycinate, that's two glycines,

1:24:25 you end up you end up getting glycine as well,

1:24:27 which is also seems to help with sleep a little bit.

1:24:29 So magnesium glycinate is a very bioavailable form.

1:24:32 I think that's a great form to take.

1:24:33 There's also magnesium threonate.

1:24:35 Magnesium threonate is a form of magnesium that was developed by a group

1:24:42 of researchers to look at the effects

1:24:44 of getting magnesium into the brain more readily.

1:24:46 And so animal studies show that it can actually

1:24:49 more readily cross the blood-brain get into the brain.

1:24:52 There's two small human cohort studies looking

1:24:55 at magnesium threonate and its effect on cognition.

1:24:59 It seems to improve cognition.

1:25:01 I'll say this, take it with a grain of salt.

1:25:03 We do need more evidence, but it is looking promising.

1:25:05 Um that data had to be pulled together just because

1:25:09 I think there wasn't enough sample size to power the study.

1:25:12 Often times you'll have to do that if you don't have a large enough sample size.

1:25:15 So the thing with magnesium threonate is

1:25:17 if if you're looking for the brain effects, so improved cognition,

1:25:22 just consider that magnesium is potentially going to the brain more.

1:25:26 And so you want to get the other form as well

1:25:28 to like be in this in your circulation to help repair damage,

1:25:32 to help with energy as well.

1:25:33 So I think that people that are only taking magnesium threonate are missing

1:25:37 out and should be taking also maybe

1:25:38 magnesium glycinate or magnesium malate or citrate,

1:25:41 whatever whatever form you like.

1:25:43 Like I said, I like the glycinate.

1:25:44 Perfect.

1:25:45 Thank you.

1:25:46 Um maybe an easy one.

1:25:47 What's one area of your research you feel providers underutilize

1:25:51 in everyday patient care and how could we integrate it more effectively?

1:25:55 Well, I would say the omega-3 index.

1:25:56 I only saw a couple of hands and I think that's like it's one of the it's one

1:26:00 of the easiest things and you get a very

1:26:03 robust effect in terms of the way you age,

1:26:05 cardiovascular, brain, mood, muscle, endless, right?

1:26:09 And life life expectancy.

1:26:10 Super easy.

1:26:11 You can get someone to take 1.5 to 2 g a day.

1:26:14 It's well below the 4 g that is prescribed to patients with, you know,

1:26:18 high triglycerides or cardiovascular disease.

1:26:20 Um so I would say that was that would be the the the biggest thing.

1:26:23 Also a multivitamin, honestly.

1:26:25 Um simple simple multivitamin.

1:26:27 Yeah, omega's a huge passion of mine as well.

1:26:29 So last one, always like to conclude with these types

1:26:31 of questions cuz I think the audience is very curious.

1:26:33 What is September 2025?

1:26:36 What is Rhonda Patrick's weekly resiliency behavior schedule?

1:26:40 What do you do?

1:26:41 Uh weekly?

1:26:42 Weekly.

1:26:43 Okay.

1:26:44 So I probably work out about usually [snorts] 5

1:26:49 hours a week when I'm at home and not traveling.

1:26:52 That's one of the most important things I focus on.

1:26:55 I have to get my high-intensity exercise and my resistance training.

1:26:59 I do it like it's like I it's like you

1:27:02 can't miss brushing your teeth and that's how I view this.

1:27:04 I have to do it.

1:27:05 Someone asked me at the last event like, well, you talked all about

1:27:07 this cardiorespiratory fitness and vigorous-intensity exercise.

1:27:10 What about the muscle?

1:27:11 And I'm like, yeah, you got to do resistance training.

1:27:12 I just didn't talk about it today.

1:27:14 Like you have to do it.

1:27:15 So I like to do a lot I do CrossFit training.

1:27:17 I do that 3 hours a week.

1:27:19 Um that I like it because it incorporates both

1:27:22 the high-intensity and it incorporates

1:27:24 resistance training and strength training.

1:27:25 So I starts out with strength training and resistance training and then it

1:27:28 like incorporates the the hit stuff

1:27:30 and cardiovascular and the rowing and the biking, sprinting and stuff.

1:27:33 So I really like doing that because I'm

1:27:35 getting all of the resistance training that I need.

1:27:38 I'm getting the hit.

1:27:39 And then my additional hours of working out are running.

1:27:43 And sometimes I'll do as my exercise snacks.

1:27:45 But the the running I also like for other reasons.

1:27:48 It's kind of my you know, it's recovery days where I run.

1:27:52 And it's also really just when my brain kind of like

1:27:55 cleans out and I like go through all the stuff

1:27:57 that is like in my head and it like is a very

1:28:00 it's like this mental cleaning out for me that I love.

1:28:04 And I also get ideas.

1:28:05 So it's like a daydreaming kind of effect as well.

1:28:08 [laughter] Um on top of that, I like to do my nightly sauna.

1:28:10 So I used to be I was I would do a couple

1:28:13 of them after my exercise to kind of lengthen the workout,

1:28:15 but like I got to get work done before school pick up and all that, right?

1:28:18 So now I do saunas at night.

1:28:20 My husband and I have this ritual we like to do it before bed.

1:28:24 I put a video on how heat stress also can improve sleep.

1:28:28 So that is something that I do a couple of hours before bed.

1:28:31 These days I've been doing I switch between the sauna.

1:28:34 We also have a hot tub.

1:28:35 I like I like being outside at night and looking at the stars.

1:28:38 And so I I probably do that like five times times

1:28:42 a week where I'm getting the heat stress before before bed.

1:28:45 Um so that's my exercise.

1:28:47 I don't really the cold exposure I'm

1:28:49 I'm really just a seasonal cold exposure person.

1:28:52 I do it in the summer.

1:28:53 Um I I don't really keep it up in the winter.

1:28:56 I'll totally admit it.

1:28:57 I'll talk all about the science behind it,

1:28:58 but like at the end of the day if I get my my hit

1:29:00 and my my training is I know I'm that's the most important for me.

1:29:04 Um when it comes to my my diet, you know,

1:29:08 I've really increased my protein intake to meet my my exercise needs.

1:29:15 So I used to really not work out like lifting,

1:29:17 you know and now I'm I'm doing a lot of lifting and so I'm trying to aim for it.

1:29:20 I do about 1.6 g per kilogram body weight per day.

1:29:24 Most of my meals like I'll have you

1:29:26 know for breakfast it'll be just just some eggs.

1:29:29 Maybe maybe I'll have like an avocado and then I

1:29:33 do a green kale blueberry smoothie as well and then I

1:29:41 take my vitamin let's see for lunch sometimes I'll just have

1:29:44 like a salmon it's like salmon not salmon a turkey burger

1:29:47 that's homemade so I do like more protein and then

1:29:50 for dinner I'll have like a big salad or a lot

1:29:51 of vegetables along with my protein chicken or salmon or turkey

1:29:56 or red meat and then I take a lot of vitamins.

1:29:59 Oh, I also take a lot of creatine in the morning

1:30:01 so I do 10 g a day in the morning.

1:30:03 And um and then in the morning my other

1:30:07 vitamin is a multivitamin I do in the morning.

1:30:09 I do my creatine and then I do some omega-3s in the morning

1:30:13 as well and then at night I'm doing a lot of stuff.

1:30:16 I mean I'm doing the magnesium.

1:30:18 I'm doing more omega-3.

1:30:22 I do the vitamin D vitamin K2.

1:30:25 I'm doing niagen true niagen for the NAD.

1:30:28 I'm doing gosh like what else am I doing?

1:30:32 Oh, I do cocoa via in the morning which is like

1:30:35 you know cacao one and I'm there's these are these are

1:30:40 the core ones that magnesium I do I mentioned that at night

1:30:43 but yeah I think there's like more that I'm missing.

1:30:45 I do um Oh gosh PQQ um Yeah.

1:30:52 Yeah.

1:30:52 Like what else?

1:30:53 Anyone seen my supplement list?

1:30:54 There's like there's ones that I'm missing

1:30:56 but melatonin right now cuz I'm jet lagged.

1:30:58 Got back from China a couple days ago.

1:31:00 But that's that's that's pretty much my nutrition supplement exercise.

1:31:08 One interesting thing I learned about Ronda is

1:31:09 her idea of a stack is much different than mine.

1:31:12 So I'm going to use exercise next I think that's that's I do I do those.

1:31:18 I like sit up and I'll I'll get up and I'll do

1:31:20 my my my one minute like usually I do squats or I'll do burpees.

1:31:24 Burpees like gets my heart rate up more than than just squats.

1:31:27 I would if you were up to me we do burpees but there's no space.

1:31:32 [laughter] Burpees everyone would hate me.

1:31:33 Well, so Ronda just like all the speakers I didn't

1:31:36 say this earlier but they're going to be here today.

1:31:38 They're going to be around so if I sincerely apologize there were so

1:31:41 many questions that came out I could not get to all of them.

1:31:43 If you have questions she's available and again all the speakers will

1:31:46 be so just one more round of applause please for Ronda Patrick.

1:31:49 Thank you.