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As a physiologist and a physician, I firmly believe that it is what makes people who survive and thrive in extremes and taking that and combining that with brilliant medicine, that is where the future of medicine is going.
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If you're not doing the work from a physiological level, everything else just is like pouring good water into a into a bucket with holes.
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So we try to fill the holes and give you a give you the base.
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Be very humble about the use of the word longevity.
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Define it as not living forever, but having the vitality, the mobility, the independence and the and the cognition that you want so that you're not a burden on other people and you can still enjoy life till the very, very end.
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Hello and welcome to the Vibrant Wellness Longevity Podcast.
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I'm your host, Dr.
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Alex Carrasco, and we are live from the Omnibarton Creek Resort in Austin, Texas.
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Today in the podcast, our guest is Dr.
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Jack Krinler.
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Dr.
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Jack's medical career spans 25 years as a physician and extreme environments researcher.
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Dr.
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Jack, thank you so much for being here.
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Thank you, Alex.
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Thank you.
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Very happy to speak with you.
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So I would love to learn more about your view on longevity.
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It sounds like you've done some really amazing thinking and work within the field.
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And it sounds like it's very different than what most people think about or attribute to longevity medicine.
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The word longevity for me is super interesting because it always meant for me extending human lifespan.
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So the fact that it now encompasses a whole bunch of different things is kind of difficult sometimes to reconcile.
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Obviously, there's health span, there's folk that are really trying to extend the number of years that uh human beings can live for, uh, and and some in between.
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Uh, but for me, um, being very, very clear about uh what medicine should be uh from uh the time I qualified 20, 25, 26 years ago, and that is that as a physiologist and a physician, uh I firmly believe that it is what makes people who survive and thrive in extremes, um, and taking that and combining that with brilliant medicine, um, that is where the future of medicine is going.
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So the things that we see in elite human performance science and sports science and the kind of training that we give folk in special forces or expedition leaders and excellent medicine combined, that is where longevity, if you want to call it that, will uh will emerge.
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Um, the our application of combining um extreme environments medicine um with sports science and so forth is threefold.
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One, we can work with very, very sick patients who otherwise might not have 150 days to live.
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Right.
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And longevity for them is seeing three or four more birthdays.
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Right.
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Okay.
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Uh on the other end, it's how do you get folk up Everest without oxygen?
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Uh how do you get people to achieve things they never thought were possible?
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And the third area is kind of folk like you and me, probably.
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The common people.
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The people for whom they don't even realize what the human being is capable of.
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And can we create a physiology of a 60-year-old when we're 90?
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Wow.
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And that has been our North Star for the last 20 years, and a lot of what we see in the longevity space is that playing out.
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So, how do you apply that in clinical practice?
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Uh practice is very simple.
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We never look at a person from an avoidance of disease perspective.
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It is always uh looking at that.
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Well, of course, that's one part of it.
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So I would say that screening is essential.
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You do not want to have an avoidable asteroid hitting you.
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Uh if you have a small bunch of cells that could be quickly whipped out and that could save your life, of course.
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So, but that's bread and butter, I would probably um say.
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We started testing, not in my own practice, but uh in my first startup, which is a bit of a bigger thing uh than a clinic.
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Uh, we first started testing uh high-performing people for their health and performance using uh cardiopulmonary exercise testing as one of the measures, CPET testing.
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People know what VO2max is, but it's one of the 150 odd biomarkers that come out of a uh of a research grade, clinical grade research um uh VO2 Max test.
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We started doing that in 1999.
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Wow.
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Um then uh when I founded the Centre for Health and Human Performance, which has now been rebranded to well-founded, but uh the original centre in London, uh, we were probably the first folk who said everyone every year should have a clinical grade VO2 max test.
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Oh, that's so interesting.
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So whatever your screening is, yeah, that's all cool.
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Yeah, but what is your response, your metabolic response to exercise stress, to complete maximal cardiorespiratory stress?
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Um, and we've I I would estimate uh have done something in the region of 17,000 of those tests.
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Wow.
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In people who are young, old, sick, elite performing uh, and and seen what importance those measures that you get, including VO2, um, how important they really are.
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And and optimizing those numbers, uh, those things that are a hallmark of youth as opposed to a hallmark of aging is the bedrock of our practice.
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It is the combination of uh applied clinical physiology and medicine, um, treating people like athletes no matter where they are in their journey.
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So then for someone that is, you know, maybe not an elite athlete but not someone that's on their sick bed, how would you structure a program to really help them increase their VO2 max to move those markers?
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Yeah.
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And how rigorous is it?
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And do you have to really want it?
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Well, yeah.
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I mean, so so first of all, doing a VO2 max test is unpleasant.
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Right.
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Uh max really means that you cannot possibly do a single bit more work.
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Most people do VO2 peaks, which is where your body has basically said, I think you better stop now, and you haven't broken through that barrier.
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So real VO2 max tests are hard.
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Um, so it's not for everybody.
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Uh we are are okay with people who are not athletes saying, Oh, I'd rather not, I'd rather not do that.
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But but most people do in the end because the because the data are beautiful and people can see, oh my gosh, I I can really make improvements to this by doing different types of physiological intervention exercise.
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Right.
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Um but it's never done on its own.
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You we measure, um, well, first of all, before we do any of that, we ask about goals.
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Yeah.
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I mean, where do you Alex, where do you want to be when you're when you're 90?
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What do you want to be doing?
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Right.
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I'd love to play with my grandkids and be able to, you know, walk around and not feel like I need help getting up and just be vital and vibrant.
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Vitality, independence, mobility, yeah, and being able to still have a decent sense of humor.
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Yes, and uh in a healthy mind.
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That is that those are people's goals.
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But then when you map back, okay, where are you now and where were you five years ago, and what is the trajectory, though that's the first set of biomarkers.
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Yeah.
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And usually people are quite scared about the the downward trajectory of that.
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Right.
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I'm sure in in in in your practice and in your life, you would said, well, maybe five, ten years ago, I was, I swore I could remember being able to ski modules better.
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So if you think about where that plots you, you're not going to be 60 at 90.
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You're not gonna have a physiology of a six-year-old at 90 if you don't address that downward curve.
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So the first thing is like simply ask goals, and it turns out that unless you're super sick, um, everyone's goals are pretty well the same.
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Yeah.
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And we're very lucky because assuming we're not super sick, uh, we don't have to worry about where our whether we're gonna celebrate our next birthday.
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But let's say it's that second group of people, folk like you and me, like most of our patients.
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Um how do we get you to there?
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Is a mixture of knowing your um CPET data, uh, body composition, bone density, really super important.
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We do um without fail, um, a an elite physio, you call it physical therapist, we call it physiotherapy physiotherapist um assessment of uh bone joint muscle um integrity, so whole musculoskeletal uh review, uh, which is very functional.
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Um, and you know, people can do little things like grip strength, which form part of it, but uh that that's ultra important um for the whole 60 at 90 um goals and uh blood work is uh it forms a part of it too.
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And then of course uh the the asteroid avoidance stuff, right?
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Yeah, colonoscopy if you need it, preventative you know, that that that that kind of thing.
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But let's concentrate not on the table stake stuff, let's talk about the physiological optimization.
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If there's something that really is going to doesn't matter what um exercise you do, going to stop you from doing it because you've got catastrophically low hemoglobin, your ferritin's through the floor, your your iron's so low.
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I'm just giving one of a million examples.
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Right.
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Um your hormones are um or you've or you've just got unexplained fatigue.
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And and every time you go to the gym or go for a long walk, uh you feel worse than you did before.
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Uh so you you've lost the ability to do superadaptation, which is the heart of performance physiology.
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Nothing is gonna help if you just give somebody an exercise prescription.
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You've got to get to the uh the underpinnings um of why that might be a blocker.
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Um, but once you've fixed the hormones, got the thyroid function right, and and all of the rest of it, um then you can use your physiology again to uh essentially retrain your body to be what it was like when it was in a state of youth.
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And so then the behavioral training programs, nutritional coaching, um all of the things that we call lifestyle in general, but are real the it's the science of physiology uh we put into play, and it's an ongoing, iterative process trying to bang that bang the door down when they've said, Oh, yeah, no, I can't be bothered to do this for another couple of months, um, and bringing joy back into it so people start doing that that stuff for themselves without coaching.
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And so, within that within your practice, do you also use technologies like peptides or the more kind of you know fancy longevity uh tech that everyone is using?
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Or are you really just trying to recomposition people's bodies with just macros and with movement?
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Well Founded is founded on fund foundational fundamental physiology.
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Yeah.
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Okay.
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And and uh there is pharmaceutical medicine, uh, there's psychological medicine, and then there is physiological medicine.
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And we are very much a group of geeky uh physician scientists who really do understand that world very well, upon which you can then build other things.
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But without the base of the cake, there's nothing.
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Um, and and whether you're Peter Tear or someone far less evidence-based, everyone will always tell you that if if you're not doing the work from a physiological level, everything else just is like pouring good water into a into a bucket with holes.
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So we try to fill the holes and give you a give you the base.
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Um, that said, uh, a lot of our clients uh are experimental, yeah, and they are highly successful people, some of them, um uh very well resourced.
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That's not all, but the majority.
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And of course, they're reading about everything that every everyone is doing.
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But I would say cutting edge.
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Uh there's a difference between cutting to the truth and just slicing you and wounding you.
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So uh those sorts of things that you mentioned.
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I mean, question is what is a peptide?
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Is insulin a peptide?
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Is is it is a GLP1 a peptide?
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Um are the other things that we have seen in elite sports doping for decades are are they medicines or are they just experimental chemicals?
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They generally are experimental chemicals, and if people are absolutely dead set on using them, we will absolutely make sure that they have the tools to know whether they're doing harm, nothing, or good.
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Right.
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Um and and that's the science basis of what we do rather than the interventional medicine basis of what we do, which is uh let people, if it's right and safe, try things, uh, but we don't prescribe them.
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Yeah, I I think I think something that has I've come away with from a lot of the people I've spoken with is that we can't get away from the foundational things.
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As much as we want um quick fixes and things that solve our problems, you know, that don't take a lot of effort.
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I I don't know if that is accurate.
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I don't know if we can do that.
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As I said, if you haven't got the base of the cake, you can't can't put the icing on it.
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That said, for instance, uh I I think I have to get this right.
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Ten years ago, we first prescribed GLP1s, which is way earlier than other folks.
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Right.
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Uh since then, probably in our entire patient base, I think we prescribed it 12 to 12 patients out of our entire, maybe less than maybe less than three or four percent.
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Uh like a small number.
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Right.
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And so we are like ahead of the curve for things that really do look amazingly promising.
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Um, and why did we do that?
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It's because the physiology is so broken that you you have to move from our founding principle is endogenous before exogenous.
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I love that.
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And uh if endogenous is broken, you need help.
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Peter O'Teer talked about it in his talk.
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You don't ask a builder to come along who's only got one tool.
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Right.
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You use multiple tools for different things.
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And uh we've had people with uh injuries that A make them uh unable to do the sport they absolutely love, uh, and B, um, if they don't do that sport, we know that they will go into that cycle of losing the base of the cake.
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Right.
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And have had in very controlled, very thoughtful, risk-managed conditions uh all the things, if you want to call that, uh call it that, uh by people who uh are the least risky that you could choose and seen great results.
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But interestingly, those uh practitioners uh um have always said that the results they see with people who have a really great physiological base always do better.
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Always right.
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Yeah, so I think that then it becomes tricky because you're like you said, your patient populations can be stratified into three groups, and um you know, for some patients, you know, to your point about GLP1s, it's not something that I prescribe very much either.
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I think that there's a a benefit to them, but there's also a very potential huge downside, and I think we're gonna probably see that in the next 10 years.
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Yeah, look, muscle mass is uh is of is of concern.
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I have to admit, we have never seen anyone lose muscle mass, but maybe that's because we are.
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Yeah, with their macros and their movement, right?
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Yeah, that that's because the physiological medicine we do is is so much our core.
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Yeah.
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Um, but I suppose for people that are just saying, I've heard this makes me live longer, has not been proven.
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Uh, I've heard that it reduces Alzheimer's risk.
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I've I've heard that it will give me a six-pack when I've already got a four, but I just can't get it to six, but they're not putting in the work, then I think you've got issues.
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Right.
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Yeah.
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Yeah, and I think I think unfortunately in with social media and the way that we things are glamorized so much, uh, especially in social media.
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I think people are quick to want those fixes, right?
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Because their influencer looks amazing and they don't see the downside of it.
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Yeah.
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So I think it can be can be dangerous for the general population unless they're really guided by doctors that know what they're talking about.
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I believe that the world should be should be allowed to run lots of experiments.
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I I don't believe in regulation that inhibits free will.
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Right.
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I I do, however, feel that where those experiments go wrong, we're not as vocal about them, so we don't learn as quickly as we could.
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And it would be handy if when things don't work out from weird, wild, and wonderful things that people choose to do to themselves uh don't get um uh don't get out there too.
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Uh and it's just the the hype and the and the cool stuff that um is is is advertised.
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A lot in medicine, including antibiotics for uh gastritis, uh including radiotherapy, including vaccines, yeah, uh, have all been as a result of zero evidence hunches by very, very uh albeit intelligent, right, uh brave people that did things to themselves.
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You could call that the ultimate biohacking.
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Of course, it's very there's a there's a lot of selection bias there because the people that didn't make it never became famous, so yeah.
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You've got all of your early adopters.
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Yeah, exactly.
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Exactly.
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Well, let me ask you this because our audience is largely clinician-based.
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Um so what would you be telling someone that is dipping their toe into longevity medicine for the first time?
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Maybe they've been in a general practice for a while or within their specialty and they think this is the new frontier.
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What would you suggest for them?
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First, be very humble about the use of the word longevity.
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People who've only got a short time to live have a real issue with us using this word.
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But um, so be humble with it.
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Um define it as not living forever, but having the vitality, the mobility, the independence, and the and the cognition that you want so that you're not a burden on other people and you can still enjoy life till the very, very end.
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And then fall off a physiological cliff when you're dancing on your 90th birthday.
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Um so that that's number one.
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Number two is physiological medicine, performance science, you just have to learn it.
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Yeah.
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And if all you're doing is being an expert at putting icing on the cake, I will eat my hat if that results in better outcomes for and more economical outcomes for anyone versus getting the base of the cake right.
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So really understand what that means.
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When you say VO2 Max, what does that actually mean?
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Learn it.
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It's hard, do the work.
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And the third piece of advice is publish.
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This is an health span uh research, geromedicine, longevity.
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It doesn't matter what your word for it is, the the art of long-term preservation of a person's physiological, immunological, uh, and every other logical part of themselves is still experimental.
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And if you are true to your profession, publish, be open about what works uh and as well as lauding um uh what doesn't.
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Be honest about all of it, right?
00:20:59.119 --> 00:21:03.359
People will learn quicker and we'll get to the ground truth faster if we do that.
00:21:03.839 --> 00:21:04.720
That's great advice.
00:21:04.720 --> 00:21:05.920
That's really wonderful.
00:21:05.920 --> 00:21:07.119
Now, uh Dr.
00:21:07.119 --> 00:21:10.400
Jack, where can people find you if they want to learn more about you and your work?
00:21:10.720 --> 00:21:14.559
Uh we do very little in the way of uh very little in the way of marketing.
00:21:14.559 --> 00:21:19.839
Uh we have been very, very fortunate to just have uh great word of mouth.
00:21:19.839 --> 00:21:23.759
Yeah, uh I I I guess, and known to those who need to know us.
00:21:23.759 --> 00:21:26.480
Uh but uh I'm Jack Krindler on LinkedIn.
00:21:26.480 --> 00:21:28.240
I'm the only Jack Krindler in the world, I think.
00:21:28.240 --> 00:21:39.200
Um Jack Krinder on LinkedIn and uh well founded uh on wellfounded.health as a website and well founded health on LinkedIn as well.
00:21:39.200 --> 00:21:42.079
Um or just pop over to Highgate in London.
00:21:42.079 --> 00:21:44.799
You'll find me walking around the Heath every day taking my meetings.
00:21:45.039 --> 00:21:45.680
That's amazing.
00:21:45.680 --> 00:21:47.759
Oh well, thank you so much for coming under the show.
00:21:47.920 --> 00:21:48.400
You're very welcome.
00:21:48.400 --> 00:21:49.279
Thank you very much.
00:21:49.279 --> 00:21:49.839
Thank you.
00:21:50.000 --> 00:21:50.720
Thank you.
00:00:00.080 --> 00:00:15.119
As a physiologist and a physician, I firmly believe that it is what makes people who survive and thrive in extremes and taking that and combining that with brilliant medicine, that is where the future of medicine is going.
00:00:15.119 --> 00:00:24.320
If you're not doing the work from a physiological level, everything else just is like pouring good water into a into a bucket with holes.
00:00:24.320 --> 00:00:27.679
So we try to fill the holes and give you a give you the base.
00:00:27.679 --> 00:00:30.559
Be very humble about the use of the word longevity.
00:00:30.559 --> 00:00:43.359
Define it as not living forever, but having the vitality, the mobility, the independence and the and the cognition that you want so that you're not a burden on other people and you can still enjoy life till the very, very end.
00:00:53.679 --> 00:00:56.960
Hello and welcome to the Vibrant Wellness Longevity Podcast.
00:00:56.960 --> 00:00:57.920
I'm your host, Dr.
00:00:57.920 --> 00:01:02.159
Alex Carrasco, and we are live from the Omnibarton Creek Resort in Austin, Texas.
00:01:02.159 --> 00:01:04.079
Today in the podcast, our guest is Dr.
00:01:04.079 --> 00:01:05.120
Jack Krinler.
00:01:05.120 --> 00:01:05.439
Dr.
00:01:05.439 --> 00:01:10.560
Jack's medical career spans 25 years as a physician and extreme environments researcher.
00:01:10.560 --> 00:01:11.040
Dr.
00:01:11.040 --> 00:01:13.040
Jack, thank you so much for being here.
00:01:13.359 --> 00:01:13.920
Thank you, Alex.
00:01:13.920 --> 00:01:14.239
Thank you.
00:01:14.719 --> 00:01:16.079
Very happy to speak with you.
00:01:16.079 --> 00:01:19.760
So I would love to learn more about your view on longevity.
00:01:19.760 --> 00:01:26.159
It sounds like you've done some really amazing thinking and work within the field.
00:01:26.159 --> 00:01:31.359
And it sounds like it's very different than what most people think about or attribute to longevity medicine.
00:01:31.680 --> 00:01:39.760
The word longevity for me is super interesting because it always meant for me extending human lifespan.
00:01:39.760 --> 00:01:49.200
So the fact that it now encompasses a whole bunch of different things is kind of difficult sometimes to reconcile.
00:01:49.200 --> 00:01:58.879
Obviously, there's health span, there's folk that are really trying to extend the number of years that uh human beings can live for, uh, and and some in between.
00:01:58.879 --> 00:02:27.680
Uh, but for me, um, being very, very clear about uh what medicine should be uh from uh the time I qualified 20, 25, 26 years ago, and that is that as a physiologist and a physician, uh I firmly believe that it is what makes people who survive and thrive in extremes, um, and taking that and combining that with brilliant medicine, um, that is where the future of medicine is going.
00:02:27.680 --> 00:02:43.599
So the things that we see in elite human performance science and sports science and the kind of training that we give folk in special forces or expedition leaders and excellent medicine combined, that is where longevity, if you want to call it that, will uh will emerge.
00:02:43.599 --> 00:02:55.520
Um, the our application of combining um extreme environments medicine um with sports science and so forth is threefold.
00:02:55.520 --> 00:03:02.080
One, we can work with very, very sick patients who otherwise might not have 150 days to live.
00:03:02.080 --> 00:03:02.240
Right.
00:03:02.240 --> 00:03:05.360
And longevity for them is seeing three or four more birthdays.
00:03:05.520 --> 00:03:05.759
Right.
00:03:05.919 --> 00:03:06.240
Okay.
00:03:06.240 --> 00:03:11.599
Uh on the other end, it's how do you get folk up Everest without oxygen?
00:03:11.599 --> 00:03:15.520
Uh how do you get people to achieve things they never thought were possible?
00:03:15.520 --> 00:03:19.280
And the third area is kind of folk like you and me, probably.
00:03:19.280 --> 00:03:20.479
The common people.
00:03:20.479 --> 00:03:26.240
The people for whom they don't even realize what the human being is capable of.
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And can we create a physiology of a 60-year-old when we're 90?
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Wow.
00:03:34.159 --> 00:03:41.520
And that has been our North Star for the last 20 years, and a lot of what we see in the longevity space is that playing out.
00:03:41.919 --> 00:03:44.879
So, how do you apply that in clinical practice?
00:03:45.199 --> 00:03:47.280
Uh practice is very simple.
00:03:47.280 --> 00:03:51.520
We never look at a person from an avoidance of disease perspective.
00:03:51.520 --> 00:03:55.199
It is always uh looking at that.
00:03:55.199 --> 00:03:56.800
Well, of course, that's one part of it.
00:03:56.800 --> 00:04:00.000
So I would say that screening is essential.
00:04:00.000 --> 00:04:04.000
You do not want to have an avoidable asteroid hitting you.
00:04:04.000 --> 00:04:10.560
Uh if you have a small bunch of cells that could be quickly whipped out and that could save your life, of course.
00:04:10.560 --> 00:04:14.960
So, but that's bread and butter, I would probably um say.
00:04:14.960 --> 00:04:23.839
We started testing, not in my own practice, but uh in my first startup, which is a bit of a bigger thing uh than a clinic.
00:04:23.839 --> 00:04:34.160
Uh, we first started testing uh high-performing people for their health and performance using uh cardiopulmonary exercise testing as one of the measures, CPET testing.
00:04:34.160 --> 00:04:44.399
People know what VO2max is, but it's one of the 150 odd biomarkers that come out of a uh of a research grade, clinical grade research um uh VO2 Max test.
00:04:44.399 --> 00:04:47.600
We started doing that in 1999.
00:04:47.839 --> 00:04:48.240
Wow.
00:04:48.480 --> 00:05:07.600
Um then uh when I founded the Centre for Health and Human Performance, which has now been rebranded to well-founded, but uh the original centre in London, uh, we were probably the first folk who said everyone every year should have a clinical grade VO2 max test.
00:05:07.839 --> 00:05:08.720
Oh, that's so interesting.
00:05:08.959 --> 00:05:10.959
So whatever your screening is, yeah, that's all cool.
00:05:10.959 --> 00:05:20.319
Yeah, but what is your response, your metabolic response to exercise stress, to complete maximal cardiorespiratory stress?
00:05:20.319 --> 00:05:27.920
Um, and we've I I would estimate uh have done something in the region of 17,000 of those tests.
00:05:28.079 --> 00:05:28.560
Wow.
00:05:28.879 --> 00:05:42.560
In people who are young, old, sick, elite performing uh, and and seen what importance those measures that you get, including VO2, um, how important they really are.
00:05:42.560 --> 00:05:54.399
And and optimizing those numbers, uh, those things that are a hallmark of youth as opposed to a hallmark of aging is the bedrock of our practice.
00:05:54.399 --> 00:06:03.360
It is the combination of uh applied clinical physiology and medicine, um, treating people like athletes no matter where they are in their journey.
00:06:03.759 --> 00:06:15.680
So then for someone that is, you know, maybe not an elite athlete but not someone that's on their sick bed, how would you structure a program to really help them increase their VO2 max to move those markers?
00:06:15.839 --> 00:06:16.000
Yeah.
00:06:16.160 --> 00:06:17.279
And how rigorous is it?
00:06:17.279 --> 00:06:18.560
And do you have to really want it?
00:06:18.959 --> 00:06:19.360
Well, yeah.
00:06:19.360 --> 00:06:23.519
I mean, so so first of all, doing a VO2 max test is unpleasant.
00:06:23.519 --> 00:06:24.000
Right.
00:06:24.000 --> 00:06:32.720
Uh max really means that you cannot possibly do a single bit more work.
00:06:32.720 --> 00:06:42.560
Most people do VO2 peaks, which is where your body has basically said, I think you better stop now, and you haven't broken through that barrier.
00:06:42.560 --> 00:06:45.600
So real VO2 max tests are hard.
00:06:45.600 --> 00:06:47.920
Um, so it's not for everybody.
00:06:47.920 --> 00:06:56.160
Uh we are are okay with people who are not athletes saying, Oh, I'd rather not, I'd rather not do that.
00:06:56.160 --> 00:07:11.279
But but most people do in the end because the because the data are beautiful and people can see, oh my gosh, I I can really make improvements to this by doing different types of physiological intervention exercise.
00:07:11.439 --> 00:07:11.600
Right.
00:07:11.839 --> 00:07:13.519
Um but it's never done on its own.
00:07:13.519 --> 00:07:19.680
You we measure, um, well, first of all, before we do any of that, we ask about goals.
00:07:19.839 --> 00:07:20.240
Yeah.
00:07:20.480 --> 00:07:24.480
I mean, where do you Alex, where do you want to be when you're when you're 90?
00:07:24.480 --> 00:07:25.680
What do you want to be doing?
00:07:26.000 --> 00:07:26.079
Right.
00:07:26.079 --> 00:07:34.959
I'd love to play with my grandkids and be able to, you know, walk around and not feel like I need help getting up and just be vital and vibrant.
00:07:35.519 --> 00:07:42.079
Vitality, independence, mobility, yeah, and being able to still have a decent sense of humor.
00:07:42.399 --> 00:07:44.160
Yes, and uh in a healthy mind.
00:07:44.560 --> 00:07:46.480
That is that those are people's goals.
00:07:46.480 --> 00:07:55.199
But then when you map back, okay, where are you now and where were you five years ago, and what is the trajectory, though that's the first set of biomarkers.
00:07:55.279 --> 00:07:55.680
Yeah.
00:07:56.079 --> 00:08:00.879
And usually people are quite scared about the the downward trajectory of that.
00:08:01.120 --> 00:08:01.279
Right.
00:08:01.600 --> 00:08:10.560
I'm sure in in in in your practice and in your life, you would said, well, maybe five, ten years ago, I was, I swore I could remember being able to ski modules better.
00:08:10.560 --> 00:08:16.639
So if you think about where that plots you, you're not going to be 60 at 90.
00:08:16.639 --> 00:08:20.399
You're not gonna have a physiology of a six-year-old at 90 if you don't address that downward curve.
00:08:20.399 --> 00:08:29.360
So the first thing is like simply ask goals, and it turns out that unless you're super sick, um, everyone's goals are pretty well the same.
00:08:29.600 --> 00:08:29.920
Yeah.
00:08:30.480 --> 00:08:38.879
And we're very lucky because assuming we're not super sick, uh, we don't have to worry about where our whether we're gonna celebrate our next birthday.
00:08:38.879 --> 00:08:44.000
But let's say it's that second group of people, folk like you and me, like most of our patients.
00:08:44.000 --> 00:08:47.519
Um how do we get you to there?
00:08:47.519 --> 00:08:55.039
Is a mixture of knowing your um CPET data, uh, body composition, bone density, really super important.
00:08:55.039 --> 00:09:13.919
We do um without fail, um, a an elite physio, you call it physical therapist, we call it physiotherapy physiotherapist um assessment of uh bone joint muscle um integrity, so whole musculoskeletal uh review, uh, which is very functional.
00:09:13.919 --> 00:09:28.159
Um, and you know, people can do little things like grip strength, which form part of it, but uh that that's ultra important um for the whole 60 at 90 um goals and uh blood work is uh it forms a part of it too.
00:09:28.159 --> 00:09:31.360
And then of course uh the the asteroid avoidance stuff, right?
00:09:31.360 --> 00:09:34.960
Yeah, colonoscopy if you need it, preventative you know, that that that that kind of thing.
00:09:34.960 --> 00:09:40.240
But let's concentrate not on the table stake stuff, let's talk about the physiological optimization.
00:09:40.240 --> 00:09:53.200
If there's something that really is going to doesn't matter what um exercise you do, going to stop you from doing it because you've got catastrophically low hemoglobin, your ferritin's through the floor, your your iron's so low.
00:09:53.200 --> 00:09:55.600
I'm just giving one of a million examples.
00:09:55.600 --> 00:09:55.919
Right.
00:09:55.919 --> 00:10:04.799
Um your hormones are um or you've or you've just got unexplained fatigue.
00:10:04.799 --> 00:10:11.039
And and every time you go to the gym or go for a long walk, uh you feel worse than you did before.
00:10:11.039 --> 00:10:18.080
Uh so you you've lost the ability to do superadaptation, which is the heart of performance physiology.
00:10:18.080 --> 00:10:21.600
Nothing is gonna help if you just give somebody an exercise prescription.
00:10:21.600 --> 00:10:26.799
You've got to get to the uh the underpinnings um of why that might be a blocker.
00:10:26.799 --> 00:10:42.639
Um, but once you've fixed the hormones, got the thyroid function right, and and all of the rest of it, um then you can use your physiology again to uh essentially retrain your body to be what it was like when it was in a state of youth.
00:10:42.639 --> 00:11:14.320
And so then the behavioral training programs, nutritional coaching, um all of the things that we call lifestyle in general, but are real the it's the science of physiology uh we put into play, and it's an ongoing, iterative process trying to bang that bang the door down when they've said, Oh, yeah, no, I can't be bothered to do this for another couple of months, um, and bringing joy back into it so people start doing that that stuff for themselves without coaching.
00:11:14.799 --> 00:11:24.559
And so, within that within your practice, do you also use technologies like peptides or the more kind of you know fancy longevity uh tech that everyone is using?
00:11:24.559 --> 00:11:31.039
Or are you really just trying to recomposition people's bodies with just macros and with movement?
00:11:32.000 --> 00:11:38.080
Well Founded is founded on fund foundational fundamental physiology.
00:11:38.080 --> 00:11:38.320
Yeah.
00:11:38.320 --> 00:11:38.799
Okay.
00:11:38.799 --> 00:11:45.519
And and uh there is pharmaceutical medicine, uh, there's psychological medicine, and then there is physiological medicine.
00:11:45.519 --> 00:11:57.679
And we are very much a group of geeky uh physician scientists who really do understand that world very well, upon which you can then build other things.
00:11:57.679 --> 00:11:59.840
But without the base of the cake, there's nothing.
00:11:59.840 --> 00:12:20.000
Um, and and whether you're Peter Tear or someone far less evidence-based, everyone will always tell you that if if you're not doing the work from a physiological level, everything else just is like pouring good water into a into a bucket with holes.
00:12:20.000 --> 00:12:23.600
So we try to fill the holes and give you a give you the base.
00:12:23.600 --> 00:12:37.120
Um, that said, uh, a lot of our clients uh are experimental, yeah, and they are highly successful people, some of them, um uh very well resourced.
00:12:37.120 --> 00:12:39.759
That's not all, but the majority.
00:12:39.759 --> 00:12:44.799
And of course, they're reading about everything that every everyone is doing.
00:12:44.799 --> 00:12:46.559
But I would say cutting edge.
00:12:46.559 --> 00:12:53.840
Uh there's a difference between cutting to the truth and just slicing you and wounding you.
00:12:53.840 --> 00:12:57.679
So uh those sorts of things that you mentioned.
00:12:57.679 --> 00:13:00.000
I mean, question is what is a peptide?
00:13:00.000 --> 00:13:01.440
Is insulin a peptide?
00:13:01.440 --> 00:13:04.399
Is is it is a GLP1 a peptide?
00:13:04.399 --> 00:13:17.120
Um are the other things that we have seen in elite sports doping for decades are are they medicines or are they just experimental chemicals?
00:13:17.120 --> 00:13:28.799
They generally are experimental chemicals, and if people are absolutely dead set on using them, we will absolutely make sure that they have the tools to know whether they're doing harm, nothing, or good.
00:13:29.039 --> 00:13:29.519
Right.
00:13:29.840 --> 00:13:44.240
Um and and that's the science basis of what we do rather than the interventional medicine basis of what we do, which is uh let people, if it's right and safe, try things, uh, but we don't prescribe them.
00:13:44.559 --> 00:13:51.360
Yeah, I I think I think something that has I've come away with from a lot of the people I've spoken with is that we can't get away from the foundational things.
00:13:51.360 --> 00:13:58.320
As much as we want um quick fixes and things that solve our problems, you know, that don't take a lot of effort.
00:13:58.320 --> 00:14:01.120
I I don't know if that is accurate.
00:14:01.120 --> 00:14:02.159
I don't know if we can do that.
00:14:02.799 --> 00:14:06.000
As I said, if you haven't got the base of the cake, you can't can't put the icing on it.
00:14:06.000 --> 00:14:12.320
That said, for instance, uh I I think I have to get this right.
00:14:12.320 --> 00:14:19.039
Ten years ago, we first prescribed GLP1s, which is way earlier than other folks.
00:14:19.039 --> 00:14:19.279
Right.
00:14:19.279 --> 00:14:31.519
Uh since then, probably in our entire patient base, I think we prescribed it 12 to 12 patients out of our entire, maybe less than maybe less than three or four percent.
00:14:31.519 --> 00:14:33.600
Uh like a small number.
00:14:33.600 --> 00:14:34.000
Right.
00:14:34.000 --> 00:14:41.600
And so we are like ahead of the curve for things that really do look amazingly promising.
00:14:41.600 --> 00:14:43.519
Um, and why did we do that?
00:14:43.519 --> 00:14:55.519
It's because the physiology is so broken that you you have to move from our founding principle is endogenous before exogenous.
00:14:55.519 --> 00:14:56.240
I love that.
00:14:56.240 --> 00:15:00.399
And uh if endogenous is broken, you need help.
00:15:00.399 --> 00:15:02.799
Peter O'Teer talked about it in his talk.
00:15:02.799 --> 00:15:07.360
You don't ask a builder to come along who's only got one tool.
00:15:07.360 --> 00:15:07.600
Right.
00:15:07.600 --> 00:15:10.080
You use multiple tools for different things.
00:15:10.080 --> 00:15:25.279
And uh we've had people with uh injuries that A make them uh unable to do the sport they absolutely love, uh, and B, um, if they don't do that sport, we know that they will go into that cycle of losing the base of the cake.
00:15:25.279 --> 00:15:25.679
Right.
00:15:25.679 --> 00:15:43.279
And have had in very controlled, very thoughtful, risk-managed conditions uh all the things, if you want to call that, uh call it that, uh by people who uh are the least risky that you could choose and seen great results.
00:15:43.279 --> 00:15:56.000
But interestingly, those uh practitioners uh um have always said that the results they see with people who have a really great physiological base always do better.
00:15:56.399 --> 00:15:57.200
Always right.
00:15:57.200 --> 00:16:12.240
Yeah, so I think that then it becomes tricky because you're like you said, your patient populations can be stratified into three groups, and um you know, for some patients, you know, to your point about GLP1s, it's not something that I prescribe very much either.
00:16:12.240 --> 00:16:21.440
I think that there's a a benefit to them, but there's also a very potential huge downside, and I think we're gonna probably see that in the next 10 years.
00:16:21.759 --> 00:16:25.519
Yeah, look, muscle mass is uh is of is of concern.
00:16:25.519 --> 00:16:32.000
I have to admit, we have never seen anyone lose muscle mass, but maybe that's because we are.
00:16:33.600 --> 00:16:35.519
Yeah, with their macros and their movement, right?
00:16:35.679 --> 00:16:41.200
Yeah, that that's because the physiological medicine we do is is so much our core.
00:16:41.200 --> 00:16:41.519
Yeah.
00:16:41.519 --> 00:16:48.399
Um, but I suppose for people that are just saying, I've heard this makes me live longer, has not been proven.
00:16:48.399 --> 00:16:51.039
Uh, I've heard that it reduces Alzheimer's risk.
00:16:51.039 --> 00:17:00.000
I've I've heard that it will give me a six-pack when I've already got a four, but I just can't get it to six, but they're not putting in the work, then I think you've got issues.
00:17:00.000 --> 00:17:00.480
Right.
00:17:00.480 --> 00:17:00.879
Yeah.
00:17:01.200 --> 00:17:11.200
Yeah, and I think I think unfortunately in with social media and the way that we things are glamorized so much, uh, especially in social media.
00:17:11.200 --> 00:17:13.519
I think people are quick to want those fixes, right?
00:17:13.519 --> 00:17:17.279
Because their influencer looks amazing and they don't see the downside of it.
00:17:17.279 --> 00:17:17.519
Yeah.
00:17:17.519 --> 00:17:23.440
So I think it can be can be dangerous for the general population unless they're really guided by doctors that know what they're talking about.
00:17:23.759 --> 00:17:28.000
I believe that the world should be should be allowed to run lots of experiments.
00:17:28.000 --> 00:17:32.160
I I don't believe in regulation that inhibits free will.
00:17:32.160 --> 00:17:33.119
Right.
00:17:33.119 --> 00:17:44.000
I I do, however, feel that where those experiments go wrong, we're not as vocal about them, so we don't learn as quickly as we could.
00:17:44.000 --> 00:17:54.799
And it would be handy if when things don't work out from weird, wild, and wonderful things that people choose to do to themselves uh don't get um uh don't get out there too.
00:17:54.799 --> 00:18:02.640
Uh and it's just the the hype and the and the cool stuff that um is is is advertised.
00:18:02.640 --> 00:18:28.720
A lot in medicine, including antibiotics for uh gastritis, uh including radiotherapy, including vaccines, yeah, uh, have all been as a result of zero evidence hunches by very, very uh albeit intelligent, right, uh brave people that did things to themselves.
00:18:28.720 --> 00:18:30.640
You could call that the ultimate biohacking.
00:18:30.640 --> 00:18:36.559
Of course, it's very there's a there's a lot of selection bias there because the people that didn't make it never became famous, so yeah.
00:18:36.559 --> 00:18:38.319
You've got all of your early adopters.
00:18:38.319 --> 00:18:39.440
Yeah, exactly.
00:18:39.440 --> 00:18:40.079
Exactly.
00:18:40.480 --> 00:18:43.839
Well, let me ask you this because our audience is largely clinician-based.
00:18:43.839 --> 00:18:49.279
Um so what would you be telling someone that is dipping their toe into longevity medicine for the first time?
00:18:49.279 --> 00:18:54.960
Maybe they've been in a general practice for a while or within their specialty and they think this is the new frontier.
00:18:54.960 --> 00:18:57.200
What would you suggest for them?
00:18:57.599 --> 00:19:00.960
First, be very humble about the use of the word longevity.
00:19:00.960 --> 00:19:08.000
People who've only got a short time to live have a real issue with us using this word.
00:19:08.000 --> 00:19:10.160
But um, so be humble with it.
00:19:10.160 --> 00:19:25.200
Um define it as not living forever, but having the vitality, the mobility, the independence, and the and the cognition that you want so that you're not a burden on other people and you can still enjoy life till the very, very end.
00:19:25.200 --> 00:19:29.119
And then fall off a physiological cliff when you're dancing on your 90th birthday.
00:19:29.119 --> 00:19:31.440
Um so that that's number one.
00:19:31.440 --> 00:19:40.319
Number two is physiological medicine, performance science, you just have to learn it.
00:19:40.319 --> 00:19:40.559
Yeah.
00:19:40.559 --> 00:20:00.799
And if all you're doing is being an expert at putting icing on the cake, I will eat my hat if that results in better outcomes for and more economical outcomes for anyone versus getting the base of the cake right.
00:20:00.799 --> 00:20:02.400
So really understand what that means.
00:20:02.400 --> 00:20:05.759
When you say VO2 Max, what does that actually mean?
00:20:05.759 --> 00:20:06.799
Learn it.
00:20:06.799 --> 00:20:08.480
It's hard, do the work.
00:20:08.480 --> 00:20:12.400
And the third piece of advice is publish.
00:20:12.400 --> 00:20:22.480
This is an health span uh research, geromedicine, longevity.
00:20:22.480 --> 00:20:43.119
It doesn't matter what your word for it is, the the art of long-term preservation of a person's physiological, immunological, uh, and every other logical part of themselves is still experimental.
00:20:43.119 --> 00:20:55.680
And if you are true to your profession, publish, be open about what works uh and as well as lauding um uh what doesn't.
00:20:56.480 --> 00:20:58.400
Be honest about all of it, right?
00:20:59.119 --> 00:21:03.359
People will learn quicker and we'll get to the ground truth faster if we do that.
00:21:03.839 --> 00:21:04.720
That's great advice.
00:21:04.720 --> 00:21:05.920
That's really wonderful.
00:21:05.920 --> 00:21:07.119
Now, uh Dr.
00:21:07.119 --> 00:21:10.400
Jack, where can people find you if they want to learn more about you and your work?
00:21:10.720 --> 00:21:14.559
Uh we do very little in the way of uh very little in the way of marketing.
00:21:14.559 --> 00:21:19.839
Uh we have been very, very fortunate to just have uh great word of mouth.
00:21:19.839 --> 00:21:23.759
Yeah, uh I I I guess, and known to those who need to know us.
00:21:23.759 --> 00:21:26.480
Uh but uh I'm Jack Krindler on LinkedIn.
00:21:26.480 --> 00:21:28.240
I'm the only Jack Krindler in the world, I think.
00:21:28.240 --> 00:21:39.200
Um Jack Krinder on LinkedIn and uh well founded uh on wellfounded.health as a website and well founded health on LinkedIn as well.
00:21:39.200 --> 00:21:42.079
Um or just pop over to Highgate in London.
00:21:42.079 --> 00:21:44.799
You'll find me walking around the Heath every day taking my meetings.
00:21:45.039 --> 00:21:45.680
That's amazing.
00:21:45.680 --> 00:21:47.759
Oh well, thank you so much for coming under the show.
00:21:47.920 --> 00:21:48.400
You're very welcome.
00:21:48.400 --> 00:21:49.279
Thank you very much.
00:21:49.279 --> 00:21:49.839
Thank you.
00:21:50.000 --> 00:21:50.720
Thank you.
