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When you reintroduce the hometic nature of these environmental signals, when you reestablish amplitudes, circadian amplitude, you re-establish the feeding and fasting amplitude, when you reintroduce exercise, rest and intense exercise amplitude, that contrast seems to be the most effective way to put this metabolic system back into gear and start healing.
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That's actually that's a very interesting question.
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And I think probably the most influential book for me with respect to these ideas and the intellectual journey is actually has nothing to do with health or medicine.
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A little bit of stress is what keeps the mitochondria functioning properly and it keeps the body functioning properly, and it makes sense of these environments where human health falls apart, whether that's the submariners, astronauts in the International Space Station, or the typical office worker sitting in a windowless room under LED lighting and three monitors.
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Welcome to the Ritchie Flow Nutrition Podcast.
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My name is Cameron Borg.
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On this episode, I had the pleasure of speaking with Max Gulhain.
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Max is an Australian medical doctor and educator specializing in metabolic health.
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He's a central figure in the movement to decentralize medicine and empower individuals through education and preventative medicine.
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Max's expertise extends far beyond the bounds of conventional medicine, incorporating an evolutionary lens on health to emphasize the critical importance of natural life, circadian principles, and ancestrally consistent dietary patterns.
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His podcast, The Regenerative Health Podcast, explores a foundational approach to health, featuring incredible conversations with world-renowned experts.
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Max is currently setting up a bespoke clinic in Byron Bay where he hopes to integrate diet, lifestyle, and environmental changes to help people get control of their health.
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Before we start, please consider subscribing to my Substack where I share information that goes well beyond the scope of this podcast.
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Becoming a subscriber is the best way to support my work and this podcast.
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With all that being said, I hope you enjoy the conversation.
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Alright, Max, I feel like this has been long overdue.
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You've been uh someone I've looked up to for a very long time now.
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And um, you know, we've we've uh been together a few times when you've set up Regenerate, which has been an absolutely fantastic thing to bring these uh this community in Australia together.
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So uh I very much look up look up to what you're doing, and uh I'm very glad you've given me some of your time.
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It's nice to be back on the same time zone for once.
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Yeah, thanks, Cameron.
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It's I think we first connected maybe what at least three, two, two or three years ago.
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And when I was getting around to make a podcast, I I stumbled upon your work and I realized that you'd interviewed, you know, probably six months or eight months earlier, the exact guest list that I myself um was hoping to talk to.
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So I think uh we've been thinking about very similar problems and the solutions to those problems at you know almost in parallel.
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So it's always great to uh to to touch base and riff with uh someone so like-minded.
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Yeah, it's uh it's very good, particularly for me uh to have uh some people around to discuss all of this with.
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Um and I think much like me, you probably have uh a moment or maybe a few moments that were very um that were a catalyst for you, sort of opening your mind to seeing health uh and and medicine in a different way.
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I'm curious because I I've never asked you this.
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What what were the what was the moment or maybe some of the moments that were really important in getting you to start thinking sort of against the grain when it comes to health?
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Yeah, I I would say there were two distinct epochs of of major relief uh revision of belief.
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And the first the first era was probably around 2016-17 when I had to solve my own acne problem and somehow found my way onto low-carb down under his YouTube channel and just listened to a bunch of medical doctors talk about the benefits of therapeutic carbohydrate restriction on a range of conditions.
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And you know, you the the name of the channel says a lot, which is it's various interpretations of of how that single approach can have benefit.
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And to some degree it it is, you know, one-sided, but it is extremely useful and extremely um therapeutic therapeutically effective.
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So, you know, I I really thank Dr.
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Rod Taylor and and the team behind that for providing such an amazing resource for patients.
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And that really helped me solve a problem that had been had run up against uh dermatologists and other G and GPs and really come up empty-handed and you know went through the whole theetrogenic harm process of of dealing with estrogenol and the roacutane medication.
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And so that kind of started the the process of thinking, I guess, in this heterodox way.
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And then the the other one, the other kind of epoch or era was in the early 20, probably just after COVID, 20, early 2020s, when I some somehow found Dr.
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Jack Cruz as an extension of of explorations on on YouTube and podcasts.
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And I think it's almost an inevitable path, if we're being curious, that you don't stop asking a question that will take you to the next spot.
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And I feel like some people, and maybe in in all domains, they they get to a certain level or a certain door, and then it's like, okay, we're not gonna ask more questions than that.
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Um, but there there's there's always more doors, so it's however whatever your appetite is for curiosity and your scope is, you can keep going, but it's it's kind of up to you.
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Um, and by no means am I anywhere near the end of that process.
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But uh at the moment, I'm kind of I guess uh integrating a lot of what I've learned um in on my own parallel education journey, private, private education journey with what I've learned clinically as a a medical doctor, uh now um fully qualified general practitioner or family medicine physician, and pulling pulling those threads all together into a a pro a project or an offering or product where I feel like I can help patients, you know, in in one of the most brute cause or kind of fundamentally addressing their disease process.
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Um yeah, so that's kind of what I'm working on and what I've been working towards.
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We have hilariously similar origin stories in that regard, um, with acne being the catalyst.
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So that's quite funny.
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Um, I was gonna save this question for the end, but I thought it was probably a good place to ask you now.
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I'm interested in um maybe a couple of your favorite books um that have been uh particularly influential since you started to see things in this way.
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Yeah, it's that that's actually that's a very interesting question.
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And I think probably the most influential book for me with respect to these ideas and and the intellectual journey is actually has nothing to do with health or medicine.
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It would be Nassim Nicholas Taleb's Incerto series and probably anti-fragile.
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Um, I think I've got a copy of it right in front of me.
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So here you go.
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Anti-fragile mind by Nassim Nicholas Taleb.
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This this is uh Nassim Taleb was uh originally a an options trader.
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So he he's a he's a Lebanese Christian of um who grew up in around the time of the Lebanese war, moved to educated in a French school, moved to the US and you know, did finance and options, but came from a history and a family environment of what where they they prized this quality of erudition above all else.
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And erudition is this this quality of being well read, and uh more it's more than that.
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It's it's being extremely knowledgeable in a vast different array of fields, and it's a very interesting um, I guess, value to prize as a as a family or in a culture, because obviously this was his father's values that he espoused to Talib.
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But they the what it brings out is an immediate or a sense of multidisciplinarity in one's endeavors.
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So for him, he was he's tying together philosophy with uh ancient history, with mathematics, with language, and uh what what what you can gain or what uh intellectual ground one can can break by bringing together all these seemingly disparate fields, it's incredible.
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It's honestly how it's exactly how Da Vinci made some of all his breakthroughs, is because when you assess or you look at fields in from a completely novel perspective, just as an engineer might approach it, approach health, or um someone without medical training approaches a clinical problem, you you see solutions that people who are anchored to the existing paradigms, the existing thought structures, they can't see.
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It's an incredible, incredibly powerful um intellectual position to occupy.
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So Kaleb wrote this series called The Black Swan, which I mean you this ties this ties deeply into the philosophy of science.
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And I don't know how much you've looked into Karl Popper, but um Popper was one of the first to he wasn't the first, it goes, it went back to a guy called Hume, um, who is a philosopher, a Scottish philosopher, but Karl Popper um formulated and phrased the problem of induction, which was how how are we making like uh scientific claims or scientific um, yeah, I guess you could say uh claims from observed phenomena.
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And the black swan problem was this idea that you can you can have a theory or a proposition that all swans are white.
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But the the it would it only takes the citing of a single black swan to completely nullify and nullify your your hypothesis.
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So um the this out of this idea comes the foundation of of proper scientific rigorous practice, which is um we we have a hypothesis, but we're uh if we're doing science properly, then what rather than seek confirmatory uh findings or evidence that support our hypothesis, i.e., you know, go out and look out more more white swans, look at different environments where white swans look.
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If we're being really uh thorough and rigorous in truth seeking, then we actually should be looking for the black swans.
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We should be actively trying to disprove our hypotheses rather than just simply collect more confirmatory evidence.
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And it's like the book, The Black Swan, is all about that, is all literally about that, and how um another form of this problem is is the Turkey problem.
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They use it in in finance more than they perhaps in medicine, but is relevant to health and medicine because the and briefly explained it's this idea that the Turkey is there's an American, obviously American framing.
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The Turkey is being fed every single day um prior to Thanksgiving.
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And the day before Thanksgiving, his report, uh the Turkey's reports, uh the missives, the um newspaper dictum, whatever, they say human human and turkey relationships relations are at their peak.
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We have never had better relations between the turkeys and the humans.
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And obviously the fight the next day the turkey gets killed because it's Thanksgiving.
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Um so the the this this they're they're related problems because it's this idea of um that you you you really need to uh try and avoid to be being a turkey, and you there can be situations where um you get closer and closer and closer, you're getting more and more confirmatory evidence of of XYZ, and then you know things can change rapidly.
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But as it as it relates to health, um the second book, or it's probably it's his third book, anti-fragile, basically has this thesis, which is essentially hormetic benefit and hormesis.
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And anti-fragility is this quality where we don't only um we're not robust to uh disorder, we're actually we improve from disorder.
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And he actually mentions in that book uh dissipative systems and illio pure gene, like in a footnote of that book, which was published in 2016, you know, well before I probably even you know someone Dr.
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Drakkruz even mentioned it.
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So it that's a very interesting uh uh thing.
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But essentially, Taleb talks about this idea of anti-fragility and it maps exactly to uh biology, it maps to mitochondrial function, because if we fundamentally benefit from hormesis, mitohomesis, mitochondrial hormesis, uh the organism is anti-fragile to a point, mean meaning that a small dose will of stress or you know, and he calls it in in his book stress, entropy, disorder, chaos, small degree it's beneficial, and there's this a limit beyond which it's no longer beneficial.
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And you think about it as anything like uh exercise, cold exposures.
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You know, you can sun exposure, you lie if you lie in you know, UV index of of of 11 for six hours, unless you've got the darkest physic spin type, you're gonna overdo it.
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So um it maps amazingly to human health.
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And and it and it really also extends to how I heal people or how I guide people to say reversing their metabolic dysfunction.
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Because I see metabolic disease, metabolic dysfunction, instant resistance is fundamentally you know mitochondrial maladaption to an set of environmental conditions that has stripped away the uh you could say chaos, intermittency, um, hometic exposure that a natural environment, which was our evolutionary environment for the duration of our evolutionary period, had provided.
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So when you strip that away, the mitochondria has to make a series of inconvenient but ultimately adaptive choices about energy handling, disposal, and um uh storage that push you uh that that postpone postpone the organism breaking uh a bit a bit more than it otherwise would.
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So when when when you promote anti-fragility in a lifestyle, the ultimate anti-fragile fragile lifestyle is similar to what we observed when those Peruvian Amazon uh Amazonians got witnessed, you know, in the in the that uncontacted tribe.
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Like hunter-gatherer culture is fundamentally anti-fragile because you don't know when your next meal is coming from.
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There's intermittency of nutrient supply, this intermittency in many regards of of exercise patterns, but in it's also uh you know quite periods of intense rest followed by intense periods of exercise, etc.
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etc.
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And all these all these um environmental exposures provide this you know fluctuating um amplitude where there's a contrast between uh between the the height of these inputs.
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So long-winded answer, but uh anti-fragile is a book that I would highly recommend and the whole Taleb series to to someone who wants to delve into the theory of science, the theory of of essentially how the world works.
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I think they're fundamentally very useful mental models for how how health and and the world work.
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I'm intensely interested by that answer, and I'm really glad I asked that off uh off the bat.
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Um, I uh I have a similar uh sort of idea when people ask me about my favorite book, it's uh it's like, well, it's the only really one of the only books I've read that's not really about health.
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It's a fiction book.
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Uh Siddhartha by Herman Hess.
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It's the book that's taught me the most.
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Um, and it's interesting to hear you've had a similar experience.
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And I love this idea that um by gaining experiences that are actually uh adjacent or or not even not even remotely related, actually help your ability to understand the things that you really want to understand.
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Um, there was a post last week, I think, by Paul Czech, who was originally one of the people who um I looked up to very early on in my health journey.
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And um, it was going over all of the careers he's had.
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He was a tree lopper, he was a boxing coach, he was in the army, he's done like he's had like 10 careers.
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And I remember him talking about how all of that was very, very important in helping him really understand how to uh uh how to grasp and explain these uh uh these very complicated topics.
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Uh and I find that very, very um fascinating that you brought that up.
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I'm really glad I asked that um right off the bat.
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Um and it reminds me of uh how um Bob Fosbury helped Glenn Jeffrey figure out how reindeer eyes work.
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Uh Glenn would have never figured that out was it not for if it was not for Bob's um Bob's expertise as an actual astrophysicist.
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Um I just find that fascinating that um uh people's uh experiences that are outside the realm of of what you would expect to help them play such a critical role um in in what they're doing.
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Um now I'm I'm I've been caught off.
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Yes, I wanted to I I would just make a comment on that.
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I I think that is so true, and especially when it comes to health and and medicine, there's there's no area of of medicine that you can practice that doesn't in some way help you later on in in some other way, and it's some knowledge that you might pick up or some experience or a patient you might see.
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Uh everything, every none of it is wasted.
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And maybe not even medicine, maybe life itself, except it doesn't make sense at the time.
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It only makes sense, you know, with five, ten years hindsight, and then you can see how how the pieces all like brought you to the place that you are now.
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And that's that's the kind of a piece of advice that I sometimes have to sometimes give people, which and and kind of reassure and emphasize if if you feel like you're lost at the moment, then that's what it might feel again right now.
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But it will make sense in hindsight because who you meet, who you talk to along that way in that journey is going to set you up for what you're eventually gonna do and do do well and do even better, having having walked that path.
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Absolutely.
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It's very hard to tell uh what the context of the present moment is going to be five, 10 years, even longer down the track.
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And there has to be some level of belief um that things are going to work out for the best.
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Um, and I I'm curious, I'm curious as to your um clinical experience as a as a practitioner.
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Uh, I've for the longest time thought that there is a real difference between things you learn by reading or or being taught and things you learn by interacting with other people.
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Um, and this is why becoming a practitioner in some uh in some level has been a real goal of mine because I think there are absolutely things that you cannot learn unless you are dealing with people one-on-one.
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And there's there's absolutely no way around that.
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And uh I I wanna I want to delve into a little bit about your personal experience as a practitioner, um, someone who is there, like you said before, as a guide to help someone heal themselves.
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Um, are there any particular lessons?
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I know this is probably rather difficult to put into words because um they're not exactly tangible, like you said, particularly in the moment.
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But are there any lessons you've learned from your patients that help you uh figure out what you know what the right things to do in particular situations would be as a doctor, as someone who's being a guide, like you said?
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Yeah, so medicine was is one of those interesting uh I would say careers or fields of endeavor where it it I feel like it equally does rest on both theoretical and practical knowledge in in that the basis of of understanding is uh yes, yes, you could call it incomplete, but it is physiology and it is does relate rest on bio biochemistry and yes, ultimately or biophysics.
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So the the theory does matter, and if if people could go through um without spending four, five, six years at medical school and then simply be doctors, then they probably would, but they but they can't, um, because you wouldn't have that.
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That foundational theoretical knowledge.
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But by no means does that suffice in order to become a practitioner and an effective clinician, because you absolutely need experience.
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And when we get taught in medical school, and then you get mentored through hospital rotations and clinical placements, you know, the most most some of the wisest clinical mentors that I ever had, they give you the real lowdown about how a patient might presume present that is is nothing like a nothing like the textbook.
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And the smart, you know, the smart student, like they they listen when someone with such deep ex uh experience as some of these old doctors talk, because their practitioner knowledge is absolutely immense.
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And it's it's it can't be replicated in the textbook.
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It's just adding color and and um nuance and depth to to those textbook representations.
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So but to answer your question, the my perspective on this is that every time you you see a clinical case present in a unique way, or you see a disease syndrome or a uh an illness or something that's novel, then it kind of gets put into the back of your of a mind such that it becomes an intellectual touch point whenever I see a certain circum circumstance returning.
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So um I'll give you an example because this is probably one of them that stuck with me the most.
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You you you we have a lady who's um developed type 2 diabetes in quite a quote quite a short amount of time.
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So she was maybe in her late 40s or mid-50s, um, was not not really diabetic, and then maybe 12 months was forwardly diabetic.
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And she, you know, she mentioned to me, oh, you know, I ate ate really poorly over during the COVID period.
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And yeah, she wasn't she was overweight, but she wasn't massively overweight.
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And um she, you know, was being treated as a type 2 diabetic.
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So for your patients, there's obviously um the diabetes tells us about the problem, which is that you you've you've got a complete inability to handle glucose properly, but it doesn't tell us the the etiology, and it doesn't tell us whether that's an insulin-deficient process or an insulin-resistant process.
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Most people are insulin-resistant, type twos and diabetics, because their their insulin secreting capacity is intact, i.e., their pancreas and their beta-is cells work fine.
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Um, but their tissues, the liver, the skeletal muscle, the adipose is um essentially blocking entry to any more glucose substrate because their mitochondria and their uh are are uh full.
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They can't oxidize, they can't burn more substrate, so it's it eventually gets spilled out into the blood.
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Insulin deficient states is when we have loss of insulin production.
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So there's simply a lack of insulin, so that the the body essentially can't um put it away anywhere.
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The cells are starving for energy, but the the they can't get it because insulin's not there to allow the glucose to enter their cells.
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So um as as I mentioned, most people are type twos, but this lady's situation was slightly different.
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She um it turned out later um that she'd had some some back pain, just very, very vague, you know, discomfort.
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Nothing that was so severe that would you know even warrant a specific visit to the to the doctor for that problem, even.
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But apparently it had been something that was mentioned in passing multiple times.
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It turned out that the reason that patient was diabetic was because she had a pancreatic tumor that was growing and therefore obliterating her beat it her endogenous insulin production process.
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So she it was a form of acquired insulin deficiency, not from type one diabetes, not from her own body attacking her immune cells, but because there was a a tumor like a pancreatic adenocarcinoma eventually growing and then reducing her ability of the pancreas to work.
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So these types of presentations, when you when you actually are the doctor treating doctor, you know, you can read a case vignette about that, but it won't it won't enter your repertoire until you're actually dealing with it.
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So, you know, if the if you do have a patient with and and this lady had no symptoms of pancreatic cancer otherwise.
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So you can't, and that's why pancreatic cancer is a difficult uh disease, because it's often very late presenting, and by the time a patient presents with biliar obstruction and jaundice, it's you know very much game over.
00:27:39.680 --> 00:27:57.440
So the the takeaway or the learning point is that for me is that if you have a precipitous onset of type type 2 diabetes or or what you think is type 2 diabetes, then you you really have to be absolutely sure that that's what you're treating.
00:27:57.519 --> 00:28:04.080
Um, you know, is it really a tiger or is it um, you know, is it another form of a cat altogether?
00:28:04.240 --> 00:28:17.519
And it, depending on the clinical situation, then checking their insulin secreting ability in the form of this the C peptide alongside your insulin, checking things like uh pancreatic autoantibodies.
00:28:17.680 --> 00:28:25.519
And in some cases, if there's any hint of it or concern, then doing a CT abdomen uh is indicated.
00:28:25.600 --> 00:28:37.600
And and that's again, this is a difficult diagnosis because no one wants to give a year's worth of background radiation to a patient in one go with IV contrast to make this diagnosis.
00:28:37.840 --> 00:28:44.480
So the people people the scan doesn't often get done because it's it's a very it's it's not clear-cut.
00:28:45.120 --> 00:28:51.120
So again, it's a it's a very difficult diagnosis to make, but in this lady's situation, there was a clue.
00:28:51.360 --> 00:29:16.320
Um I I use that example as a as one to say that that's one that stuck with me, but this there's obviously hundreds of others in different forms that the body that the brain goes to in uh I guess type one type thinking, if you you know, Daniel Kahneman's work, it becomes type one thinking that you run through when you hear a case series or what we call illness script.
00:29:16.480 --> 00:29:24.880
Um, so yeah, it's a it's a and and the more patients you see and the more you listen to your patients, I think that's the key part.
00:29:25.039 --> 00:29:39.440
The more that you hear people's accounts and stories and and their lived experience of these diseases, the the quicker you build a mental model and a mental bank of disease presentations and possible solutions.
00:29:39.680 --> 00:29:51.920
Because we're just we're just we're just trying different combinations of therapies and lifestyle interventions that may or may not work for each of these people who are themselves an end of one experiment.
00:29:52.240 --> 00:30:10.960
So we have to have my particular my take on this is we we have to be open-minded, we have to be curious, we have to be fundamentally an experimenter who's happy to work with someone until we ideally find a combination or a thing or combination of inputs that um solves that person's problem.
00:30:11.759 --> 00:30:19.680
It's always fascinated me uh uh over the years as I've worked in a hospital seeing, you know, by at this stage thousands of patients.
00:30:19.840 --> 00:30:23.840
Uh, and I see them for longer than the doctors do as a respiratory scientist.
00:30:23.920 --> 00:30:28.160
So I get to chat with them and talk to them about a lot of stuff, and I see all their labs and whatnot.
00:30:28.320 --> 00:30:36.720
It's amazing how unique every single patient is, uh, even though they're all coming to a respiratory clinic for respiratory issues of some description.
00:30:36.960 --> 00:30:42.640
Everyone is so unbelievably different and presents in a slightly different way every single time.
00:30:42.720 --> 00:30:45.920
Um and it's just an incredible experience to just talk to people.
00:30:46.000 --> 00:30:50.000
And like you said, when you listen to them, I can't remember who said it.
00:30:50.160 --> 00:30:57.680
Uh maybe it was uh Freud or something who said, if you listen closely enough, your patient will tell you exactly what's wrong with them.
00:30:57.920 --> 00:31:06.400
And uh I've had that experience um of you know plenty of times just talking to people about you know when their symptoms started and all that kind of stuff.
00:31:06.560 --> 00:31:26.320
Um and I find it interesting that you know when we look at epidemiology or population um, you know, uh publications on populations, it's easy to forget that that data is only applicable to populations, like epidemiology, you know, you can't just place that uh on on recommendations for individuals.
00:31:26.480 --> 00:31:29.600
Those those are models only applied to populations.
00:31:30.240 --> 00:31:41.759
Um and I wonder sometimes because uh of the degree of heterogeny in populations, uh, how do you read a lot of this literature?
00:31:41.920 --> 00:32:05.039
Because I find myself really questioning a lot of the conclusions that one might be able to come to when reading literature, because maybe the things that you and I might do uh with regard to circadian rhythm, with regard to our food choices and all of that kind of stuff, may make us uh completely different to the person that the epidemiology uh epidemiology is modeling.
00:32:05.360 --> 00:32:16.160
And I wonder how you sort of bridge that gap between the things that are exist in the published literature and how you look at people who might be doing things very, very differently.
00:32:16.320 --> 00:32:22.640
I I often find it difficult to square or difficult to know where to draw the line between those two things.
00:32:23.360 --> 00:32:26.240
Yeah, it's it's a very interesting question.
00:32:26.320 --> 00:32:35.360
And I think we can like even break it down one more level, which is response to treatments and response to drug and therapeutic interventions.
00:32:35.600 --> 00:32:49.840
So what the what what modern science is built upon, and what I would call what they called evidence-based medicine, um was came up, I believe it was maybe the late 90s or the early 90s, perhaps.
00:32:50.000 --> 00:33:03.519
This idea of blending the best available evidence with practitioner knowledge and nuance to get to what could be seen as the best gold standard of patient care.
00:33:04.240 --> 00:33:07.759
A noble undertaking and very noble intention.
00:33:07.920 --> 00:33:33.920
But what essentially had happened is that it put this it it built and then kind of sanctified a hierarchy of evidence, which put the double-blinded placebo-controlled randomized control trial close to the top of this pyramid, and then you know, the meta-analysis or systematic review of randomized control trials, uh, you know, even even higher up.
00:33:34.160 --> 00:33:52.480
So what it happened, what has happened over the course of years, is that unless evidence has been in this form, in this format, then it's not going to be we're not going to look at any other forms of evidence.
00:33:52.640 --> 00:34:08.239
Um what what that means is that it favors clinical trials that are being designed, funded, and conducted by the pharmaceutical industry of drug therapies that they are able to patent and therefore profit from.
00:34:08.559 --> 00:34:25.199
So the the the whole paradigm is therefore being aligned towards um whether we get an averaged-out treatment effect across a group of patients, which may or may not be representative of the patient sitting in front of you.
00:34:25.440 --> 00:34:29.840
So as you can see, that there's multiple problems at each one of these levels.
00:34:30.000 --> 00:34:33.920
One is the trial study group representative.
00:34:34.079 --> 00:34:40.639
That's uh, you know, that's what we call external validity in terms of um of epidemiology.
00:34:40.719 --> 00:34:45.360
And then is the trial itself, was it a robust trial?
00:34:45.440 --> 00:34:52.320
You know, that's the that's the internal validity, you know, with was the randomization process done properly, et cetera, et cetera.
00:34:52.400 --> 00:34:54.320
You know, are they even asking the right question?
00:34:54.720 --> 00:35:01.920
Are they compare comparing this drug against a non-inferiority trial against one that has already been in use?
00:35:02.400 --> 00:35:14.480
So, you know, there's all these these uh questions, and then when you get the results of the trial, uh, were there some who responded uh very well and some who hardly responded at all?
00:35:14.639 --> 00:35:18.960
And if you take an averaged-out effect, are you gonna miss the signal?
00:35:19.360 --> 00:35:49.599
So all this to say, in this day and age, medical practice and clinical practice is overwhelmingly influenced by the ev this evidence base that's actually generated through one, a biased funnel because it's it's inherently uh geared towards finding favor for a patentable drug as in opposition to non-patentable drugs which aren't even going to be examined because there was there's no potential profit in a pipeline.
00:35:49.920 --> 00:36:19.280
So we're we we're just looking at a uh group of possible treatments that doesn't encompass all possible treatments, and then inevitably there's a favorable finding found, and and other mechanisms of of regulatory intervention get um, I would say, manipulated to to pass that XYZ treatment and which is worth a lot of money, and eventually the taxpayer fits the bill, foots the bill.
00:36:19.440 --> 00:36:21.920
Um they that's that's what gets passed in.
00:36:22.079 --> 00:36:25.440
So yeah, absolutely, that's a it's a massive problem.
00:36:25.760 --> 00:36:30.079
And um, I'm just speaking with respect to essentially drugs.
00:36:30.240 --> 00:36:36.320
I mean, you can you can you can enter whatever new drugs come out and it kind of will fit into this, I think.
00:36:36.400 --> 00:36:39.680
And not to say that some aren't useful and they s they serve a role.
00:36:39.760 --> 00:36:58.639
I use them in clinical practice daily, but it's a big distraction away from what actually fundamentally root cause is going to turn that person's biology around or remove the in initial offending insult or combination of insults that got that patient into the into their problem in the first place.
00:36:58.880 --> 00:37:02.320
But you know, as it relates to observational data, I agree.
00:37:02.480 --> 00:37:12.079
I think we have a similar problem, which is if we look at a big observational cohort of people, uh, again, to what to what degree is that averaged out finding relevant to the patient in front of us?
00:37:12.240 --> 00:37:26.639
And I think maybe the most important one to mention that I find myself talking about is say something like the melanoma in southern Sweden cohort studies or or Richard Weller's Professor Weller's studies of UV light exposure and health.
00:37:26.800 --> 00:37:41.119
And you know, the outcome of of all of these cohort studies is that at a population level, the more UV light someone gets, the longer they live, the less their all-cause mortality, but the higher their chance of getting a skin cancer diagnosis.
00:37:41.360 --> 00:37:45.280
So I have I explained that that this is a population effect.
00:37:45.519 --> 00:37:53.920
And this is a difficult thing to say to someone whose mom got or you know, sister got a malignant melanoma at the age of 36.
00:37:54.480 --> 00:38:01.360
Um we can go into the nuances of causes of nuances of potentially why that happened in that patient's N equals one.
00:38:01.680 --> 00:38:11.360
But yes, it's a difficult to bridge that gap between averaged-out epidemiological and observational findings and and the patient in front of you.
00:38:11.920 --> 00:38:17.280
That was an incredibly cognizant and succinct answer that clarified things for me.
00:38:17.360 --> 00:38:19.680
I'm I'm very glad I asked that question.
00:38:19.840 --> 00:38:27.840
Um, I I want to know because someone asked me this uh a week or two ago, and I was very disappointed with how much I fumbled the answer.
00:38:28.000 --> 00:38:36.639
Um, I I'd I'm very interested in understanding your elevator pitch for why light is important and what light does for your health.
00:38:36.800 --> 00:38:38.000
Um, someone asked me that.
00:38:38.079 --> 00:38:39.760
They're like, can you explain in a minute?
00:38:39.840 --> 00:38:41.200
Uh, you know, what do you tell people?
00:38:41.360 --> 00:38:42.800
And I was like, you know what?
00:38:42.880 --> 00:38:45.680
I really don't know how to explain it succinctly yet.
00:38:45.760 --> 00:38:56.320
Um, I'm interested in how you sort of convey this message to um patients that you might see that have absolutely no idea that light impacts their health whatsoever.
00:38:56.960 --> 00:39:07.360
Yeah, I mean, I I would say that it was an ever-present factor in the development of your body and your ancestors' bodies and biology, you know, full stop.
00:39:08.320 --> 00:39:12.800
So without it, we we wouldn't exist as life does today.
00:39:13.119 --> 00:39:38.000
And the things that it offers to you is can be thought of as an as nutrients, as timing signals, as um coordination, uh coordination signals, and um basically all of all of those together enable the cell to and your body to actually work in the way it was it it most properly is able to.
00:39:38.240 --> 00:40:00.320
So um without getting too deeply into what light is itself, but fundamentally there's a smoggus board of uh nutrients that are in the forms of different light wavelengths that are providing a unique role and a new unique um necessary role for the cells and your body's health.
00:40:00.559 --> 00:40:19.280
And we just need to understand, or it helps to understand what each one does and how we naturally would have got them, which is in the package of full spectrum sunlight, um while and and also avoiding using something like artificial light at the wrong time.
00:40:19.519 --> 00:40:28.880
So when you understand how critical it is as a nutrient and a timing signal, then you you try and avoid using artificial light at night time.
00:40:28.960 --> 00:40:35.840
You try and get full spectrum sunlight during the day um and you time that relative to your skin type and your latitude and your ancestry.
00:40:36.000 --> 00:40:43.599
Um, and then the body works properly because it's uh, like we said, such a fundamental uh environmental signal.
00:40:44.000 --> 00:40:49.760
How do you implement this with the patients that you see with regard to their light environments?
00:40:49.920 --> 00:41:00.240
Because uh, for a lot of people, I imagine it's rather difficult to curate their light environments, you know, as as precisely as you might like them to be able to do.
00:41:00.400 --> 00:41:04.480
Uh, what what are the workarounds that that you're able to come up with at the moment?
00:41:04.559 --> 00:41:06.159
Because it's very difficult.
00:41:06.960 --> 00:41:08.400
It's extremely difficult.
00:41:08.639 --> 00:41:26.240
And yeah, it's it's difficult because in the scope of a 20 or even 30-minute or even 14-minute console in the clinic, I feel like I cannot give enough uh time and and attention to really make sure people get this.
00:41:26.480 --> 00:41:32.159
And I think that 99.99% of people aren't doing the light thing correctly.
00:41:32.400 --> 00:41:39.840
There's a very small minority who are truly understanding what we're talking about because it's actually quite complicated.
00:41:40.079 --> 00:41:51.760
And without telling people to live in a hut with a set of candles, that's a very intuitive way to do it without needing a debt deep explanation.
00:41:51.840 --> 00:41:52.880
But it's not going to happen.
00:41:53.119 --> 00:42:04.960
So, you know, the type of concepts that you we're trying to convey, let me just talk about the nighttime first, is that we're trying to convey one, an absence of daytime wavelength.
00:42:05.360 --> 00:42:14.079
So we're trying to tell them that they shouldn't have blue and green light particularly for its melan melanopsin activating and melatonin-suppressing effect.
00:42:14.320 --> 00:42:25.840
We're trying to tell them avoid the positioning of overhead light, which in and of itself is stimulatory because above head light was the only daytime was a daytime signal.
00:42:26.000 --> 00:42:30.159
We never never had above head light that was otherwise at another time of day.
00:42:30.400 --> 00:42:33.440
It has to be of a low enough intensity.
00:42:33.599 --> 00:42:39.519
And we're, you know, I'd I in the hour before sleep, like trying to get the light under five lux.
00:42:40.720 --> 00:42:41.760
You don't have time to explain.
00:42:41.840 --> 00:42:44.639
You could there's so many concepts you have to explain to get that far.
00:42:44.880 --> 00:42:53.119
Um and then trying to avoid other things like uh, you know, a flicker and and beneficial spectrum and and the rest of this.
00:42:53.360 --> 00:42:55.119
So it's it's it's a challenge.
00:42:55.360 --> 00:43:07.440
I think what what I'm trying to do at the moment is get everyone on a pair of blue-like blocking glasses because everyone is going to have some form of blue and green wavelength containing light in their nighttime environment.
00:43:07.599 --> 00:43:10.960
So they become a must to at least mitigate that effect.
00:43:11.200 --> 00:43:20.880
And then what I've been doing lately is saying, look, why don't you use a single incandescent light in your work and living and kitchen area and then switch it off.
00:43:20.960 --> 00:43:28.240
It comes 7, 7:30 p.m., switch that light off and only use some visible red LEDs.
00:43:28.559 --> 00:43:40.960
That way we are eliminating this melanoxin-suppressing light, and we are promoting a very low light environment without having too many uh disruptive or overhead signals.
00:43:41.200 --> 00:43:45.440
So it's hard, but that's kind of what I point to for nighttime.
00:43:45.519 --> 00:43:58.880
And then for daytime, I I basically say you you need to get out as soon as possible and you need to expose your skin and your eyes without filtration through lenses, through eyeglasses, through windows, through car windows, through anything.
00:43:59.039 --> 00:44:18.800
And the more sun you get, the the better, because the more your skin and eyes are able to congruently use that light information to coordinate your body processes and run your metabolism, run your immune system, um, run run your your essential hormonal processes.
00:44:18.960 --> 00:44:28.240
Um, and then you do need some midday light additionally, and that is how the body makes vitamin D because it's irrepro it's not replaceable by a tablet.
00:44:29.200 --> 00:44:34.480
Some combination of those things is what I'm working with now, but um, it's difficult to cover it all.
00:44:34.559 --> 00:44:37.200
And and yes, we can't you can't do it in one console.
00:44:37.840 --> 00:44:48.960
Yeah, it's it's uh it's definitely something that even Even myself, I've been trying to do this properly for myself and my family for, you know, coming up to 10 years now.
00:44:49.119 --> 00:44:51.039
I still don't know what the right answer is.
00:44:51.200 --> 00:44:55.680
You know, I'm carrying around, you know, assault lamps with me everywhere at the moment.
00:44:55.840 --> 00:45:05.200
Um, it was funny because I I got back to Sydney and I had to fix all my parents moved to a new place and they've, of course, they're all LED down lights.
00:45:05.360 --> 00:45:08.800
Um, so I had to fix everything up and they're complaining it's too dark.
00:45:08.960 --> 00:45:10.559
I've put incandescence everywhere.
00:45:10.720 --> 00:45:13.920
And uh it's just a bit of a bit of a nightmare, isn't it?
00:45:14.079 --> 00:45:41.840
Um, but it was interesting uh in Sweden because of the how far uh off the equator you are, the swings between short day lengths and long day lengths is is so significant uh and so different to what I spent most of my life doing, um, that uh it's very difficult to figure out what the right thing to do is when you're in a place where the sun basically doesn't set or the sun sets at 2:30 p.m.
00:45:42.320 --> 00:45:47.519
Um and uh I'd love to hear your thoughts on this.
00:45:47.680 --> 00:45:51.119
I didn't take a vitamin D supplement the whole time I was there.
00:45:51.280 --> 00:45:56.960
I did a little bit of cod liver oil the first winter, and then I didn't know cod liver oil the next winter.
00:45:57.440 --> 00:46:00.000
And basically I was fine.
00:46:00.159 --> 00:46:06.639
Um, but you know, we were going seven, maybe eight months of no UVB.
00:46:07.039 --> 00:46:09.519
Um, I'm curious what you think.
00:46:09.920 --> 00:46:17.440
Uh in a situation like that, would it have been better for me to mess around with taking some vitamin D?
00:46:17.599 --> 00:46:24.960
Uh, I know I know that's an impossible question to answer, but um, I was okay, which uh I wasn't sure what I was expecting.
00:46:25.039 --> 00:46:29.519
Maybe it was a stupid thing for me to do, but yeah, it's a whole different world over there.
00:46:29.920 --> 00:46:37.519
I it's fascinating to experiment with those radical changing photo periods and and what that does to your biology.
00:46:37.760 --> 00:46:42.800
I think there's two two ways to approach this question: one theoretically and one maybe more clinically.
00:46:43.039 --> 00:46:49.680
Theoretically, the answers is gonna massively depend on the individual and their and their background.
00:46:49.840 --> 00:47:07.920
And it it reminds me of a paper that, medical hypothesis paper that um that came out maybe a couple months ago, that was investigating the possibility of male androgenic alopecia, so male pattern balding, as an adaption to low solar conditions.
00:47:08.240 --> 00:47:12.159
And what it was in in vitamin D um receptor variants.
00:47:12.320 --> 00:47:36.639
So what it what it was possibly hypothesizing that was that the loss of hair on on the in the male head, the vertex, and the front, all these frontal areas, depending on I mean the exact pattern is going to vary individually, but that coincides to the position where the sun is going to be maximally overhead and therefore maximally able to generate vitamin D.
00:47:36.960 --> 00:48:09.039
And so it's it was hypothesizing that in northern European people who probably had some adaptations to cold and um would have been clothed, that suddenly the small amount of area on the scalp could become a potentially significant percentage of exposed body surface area enough to generate a meaningful amount of vitamin D that might potentially become a selective pressure to avoid osteoporosis in in that man.
00:48:09.599 --> 00:48:21.920
So it's it's a hypothesis and it's been driven by probably one of the most strongest associations, which is vitamin D insufficiency and deficiency in in androgenic alopecia.
00:48:22.480 --> 00:48:37.280
So I mean we could talk a lot about I've been thinking a lot about that that problem, and I um and I think I think it it it is uh I think it's a sign of of I mean I think it's a sign of aging.
00:48:37.360 --> 00:48:45.760
I think it's it's it's it's a maladaptive response to suboptimal conditions, where the what I don't think sunlight's not the only factor by by any means.
00:48:45.840 --> 00:48:47.920
There's there's obviously multiple things going on here.
00:48:48.159 --> 00:49:02.400
But the reason I bring it up is because you had there's people, and and when I did a reel recently, it it went a little bit viral, and you had all the reply people saying how they know all these tradies who've been in the sun who are very bald.
00:49:02.800 --> 00:49:23.280
And I agree with them, and I wasn't meaning to try and convey this complex conversation in in one minute on a reel, but for some people, and I and whether it's their vitamin D receptor status or some other genetic variant, are gonna are potentially gonna be very susceptible to drops in serum vitamin D levels.
00:49:23.599 --> 00:49:34.559
And I'm not sure who those people necessarily are and um you know what what either is the ideal combination of exposure versus lack of exposure.
00:49:34.720 --> 00:49:55.519
But my presumption is that if any population is adapted or evolved to one depigment and two, you know, cold adapt through the uncoupling proteins and the rest to live at such a high latitude, then they're probably adapted to have an absence of sunlight and UVB throughout several months of the year.
00:49:55.599 --> 00:49:57.200
That that makes sense to me.
00:49:57.440 --> 00:50:10.320
Um what about someone who is a Fitzpatrick 5 or you know they've their ancestors are from the Pacific Islands in Fiji, where it's a it's really hot and and high UV all year round.
00:50:10.559 --> 00:50:14.960
Well, there wouldn't, I was there recently, there was no very little androgenic alopecia.
00:50:15.280 --> 00:50:17.280
There was none uh to make of.
00:50:17.440 --> 00:50:33.360
And it coincides with the findings that this is a this that condition seems to uh mostly affect northern European people uh with I think rates approaching uh you know prevalence associating uh approaching 90% by the age of 80.
00:50:33.440 --> 00:50:38.079
Um, not so in in African populations, not so in these equatorial populations.
00:50:38.240 --> 00:50:54.159
And it would kind of make more sense because if you are if the head is supposed to cop uh UV high UV indexes all year round, then you actually need a thick amount of heavily U melanated hair follicles to protect that dome.
00:50:54.240 --> 00:51:09.760
Um, and there wasn't a need to evolve an adaptive shedding of hair, if this solar hypothesis turns out to be you know reasonably valid uh uh in certain people that that to account for that phenomenon.
00:51:10.000 --> 00:51:13.760
So I think to answer your question, it's gonna be dependent.
00:51:13.840 --> 00:51:32.960
And if people have northern European ancestry, then to me it makes more sense that they are would be able to go winter without generating vitamin D compared to someone who's darker who I think needs a constant drip of it because that's what their ancestors, um, their ancestry has developed.
00:51:33.200 --> 00:51:43.840
Now, when it comes to the clinical question, that's a different that's a different question, which is should we supplement vitamin D in people who are insufficient or deficient?
00:51:44.159 --> 00:51:56.639
Um and I have a depending on what condition they're suffering from, and depending on how low their level is, then I will recommend them that they should should should take an oral vitamin D supplement.
00:51:56.880 --> 00:52:03.840
Um, you know, if you have someone who's got thinking for an example, again, we're using in extreme examples.
00:52:04.159 --> 00:52:14.639
Patient who's been on carbamazepine, tegritol, which is an anti-epileptic medication, for years, and it in it massively interferes with vitamin D effects and and and generation.
00:52:14.880 --> 00:52:28.720
Um and that person was has developed severe osteoporosis because they're unable to absorb and utilize calcium and phosphate um efficiently because of that that low level.
00:52:28.880 --> 00:52:52.400
So, you know, if you're trying to build someone's vitamin T level up who's symptomatic of or it's experiencing osteoporotic crush fractures, you I'm not gonna just say, okay, you know, now now you lie in the sun in uh at a very um southern latitude where there's not enough uh sunlight to and wait and hope that their their level climbs.
00:52:52.559 --> 00:52:53.920
Like we're not gonna do that.
00:52:54.079 --> 00:53:09.920
We're gonna therapeutically boost it up and then hopefully keep it there with sun habits after we've you know got them beyond the the minimum uh threshold for for you know re-establishing proper calcium and phosphate um homeostasis.
00:53:10.960 --> 00:53:11.599
Absolutely.
00:53:11.760 --> 00:53:24.079
I think um I think the nuance is hard to grasp and and interest interestingly, uh when summer does roll around, it's incredible in Scandinavia how dark the the the natives get.
00:53:24.240 --> 00:53:28.880
Like they get darker than me, um darker than I would ever get here.
00:53:29.280 --> 00:53:35.119
And um, I never got burnt in Sydney and I was I was I was sunbathing every day.
00:53:35.280 --> 00:53:46.720
Um, but I burnt several times in Sweden because you know you go such an extended period of time with nothing, and then you get the first day of like 10 degrees, and you're like, oh my god, it's time to get naked outside.
00:53:47.039 --> 00:53:54.960
Uh and uh yeah, I was getting erythemas that I would never get in Australia, so it just it there's so much more going on.
00:53:55.119 --> 00:54:03.519
Uh and that probably had to do with the fact that my circadian signaling was was not so great because it's actually quite hard to do in those parts of the world.
00:54:03.760 --> 00:54:09.360
Um, and it's not easy to get outside at the right times because it's bloody freezing.
00:54:09.519 --> 00:54:24.480
Um, but yeah, there's yeah, it gets to the idea of why you know it's sometimes it's you give it away as like a gimmick and a shortcut in terms of lifestyle advice in in these kind of niche health circles, or just move to the equator.
00:54:24.720 --> 00:54:46.880
But the the explanation is because in the equator, you there's a there's a predictable, stable photo period of 12 hours with a predictable year-round amount of ultraviolet light um and a stable temperature and that allows or makes these habits, these circadian habits, much more easy to implement and maintain.
00:54:47.200 --> 00:54:51.680
So um that there's a case for it absolutely to be made.
00:54:52.000 --> 00:54:53.360
Yeah, I I couldn't agree more.
00:54:53.440 --> 00:54:57.119
I hadn't considered it from that perspective before, but that's absolutely right.
00:54:57.280 --> 00:55:06.559
It does it has been so much easier being back in Sydney because you know the sun is rising and setting at reasonable hours, and I haven't even an alarm clock.
00:55:06.720 --> 00:55:08.960
Everything I'm waking up at the same time every day.
00:55:09.039 --> 00:55:10.159
It's it's really magic.
00:55:10.240 --> 00:55:13.039
I wasn't able to do that for two years, basically.
00:55:13.280 --> 00:55:18.159
Um I'm very interested in the visceral fat story.
00:55:18.240 --> 00:55:22.079
It's something I I'm uh very poorly educated on.
00:55:22.159 --> 00:55:24.079
I don't know a whole lot about it.
00:55:24.320 --> 00:55:35.680
I I guess, and I don't know if there's a an answer to this question, um, but evolutionarily we probably have evolved to preferentially store fat subcutaneously.
00:55:35.840 --> 00:55:44.079
Um, and and and that's that's very obvious, particularly in women, we see where subcutaneous fat is um preferentially stored.
00:55:44.960 --> 00:55:52.159
What is the cause uh of the fat being stored around the organs?
00:55:52.400 --> 00:55:57.920
What is causing the fat to be deposited there rather than in subcutaneous fat deposits?
00:55:58.400 --> 00:56:02.320
I mean, the the the this is the million-dollar question, really, isn't it?
00:56:02.480 --> 00:56:11.840
Um the the the answer is that there's multiple re there's multiple contributing factors that I think are different for each individual person.
00:56:12.800 --> 00:56:24.880
And I I I the I think the big picture is that the body wants to physically use the physiological fat depots as much as it can.
00:56:25.119 --> 00:56:38.480
It wants to store excess energy under the skin in these white adipocytes that are that provide an easily accessible um source of of stored energy.
00:56:38.639 --> 00:56:46.880
Like that that is completely healthy fat storage is in these cells that are actually going to be seeing the sun.
00:56:47.039 --> 00:56:48.000
That's a key point.
00:56:48.159 --> 00:56:54.639
The physiology of the white cells under the skin is that they have this melanopsin uh OPN uh OPN4.
00:56:54.880 --> 00:56:57.280
They can they actually detect blue light detectors.
00:56:57.519 --> 00:57:03.760
And on blue light, they actually increase their lipolysis or their fat um mobilization.
00:57:03.920 --> 00:57:08.159
Um they are this an endocrine organ, this this adipose tissue.
00:57:08.240 --> 00:57:15.280
It's it releases leptin, it releases adiponectin, it releases factors that are actually health promoting.
00:57:15.680 --> 00:57:31.519
And the most healthy phenotype, I think, for optimal longevity is actually some degree of increased uh fat store with subcutaneous but not visceral fat.
00:57:31.599 --> 00:57:49.599
And the reason is because when you talk to uh Nir Barzalai, who is the longevity researcher who uh looked at a cohort of long-lived people in New York, he he landed or he observed a BMI of 26 as to be a commonality amongst these supercentenarians.
00:57:49.840 --> 00:57:58.960
So it wasn't people that that looked like um, you know, Ziz Ziz Shavashian or uh or some other form of bodybuilder.
00:57:59.039 --> 00:57:59.760
It wasn't that.
00:57:59.840 --> 00:58:03.519
It was some it was some people that had an extra amount of weight on.
00:58:03.680 --> 00:58:06.240
But the the nuance is where was that weight?
00:58:06.400 --> 00:58:11.119
And because we don't have MRIs for those gentlemen, we can't tell we can't tell you.
00:58:11.200 --> 00:58:14.960
I'm hypothesizing, but I'll explain my reasoning.
00:58:15.280 --> 00:58:28.800
Because when the body stores energy in the subcutaneous depots under the skin, then that that doesn't come with a corresponding negative inflammatory and cytokine profile.
00:58:29.440 --> 00:59:09.760
Whereas when the fat seems to be exceeding safe storage, or for some other reason unable to be further loaded into safe subcutaneous storage for a variety of reasons: genetic, uh, metabolic, circadian, related to a bunch of facts we can go into as well, then the body is making this trade-off, which is we we're gonna have to store it in this ectopic deposit, which is inside inside the abdominal cavity around the organs and around the heart, pericardial, visceral fat, and epicardial fat around in in the liver, in the muscles eventually.
00:59:10.000 --> 00:59:23.360
But the characteristics of that, those fat tissues is they they they actually become um so hypertrophied that they they expand and they exceed the perfusion in the in the blood supply.
00:59:23.519 --> 00:59:25.119
So it's almost like a tumor.
00:59:25.280 --> 00:59:26.480
That's what a tumor does.
00:59:27.039 --> 00:59:37.200
A tumor can grow so fast that it um exceeds the the ability to perfuse it with with the blood vessels and therefore you know becomes necrotic.
00:59:37.280 --> 00:59:39.920
That's that's a characteristic of a of a cancerous tumor.
00:59:40.079 --> 00:59:42.880
That's what the same thing that's happens with visceral fat depots.
00:59:43.039 --> 00:59:47.760
The cell will rather than replicate, the cell has to grow.
00:59:48.000 --> 00:59:58.240
Um, you know, we it's it's a common saying, you know, what happens when when uh an a system is losing energy or is is uh you know grows bigger in in a half hour it grows bigger.
00:59:58.480 --> 01:00:01.039
Um it's a maladaptive response.
01:00:01.200 --> 01:00:03.440
And the adipocite is doing the same thing.
01:00:03.519 --> 01:00:16.240
It's it's hypertrophrophing to the extent that it becomes inflamed and infiltrated with immune cells and and broadcasting inflammatory pro-inflammatory cytokines.
01:00:16.880 --> 01:00:20.159
Um and because it's it's you know it's hypoxic.
01:00:20.320 --> 01:00:23.760
So the body doesn't want to have to put energy there, but it but eventually does.
01:00:23.840 --> 01:00:27.119
So what are the factors that are gonna exacerbate this?
01:00:27.440 --> 01:00:38.559
I think, like I said, I think partially genetic and genetic, there seems to be a genetic predisposition to subcutaneous versus um visceral fat deposition.
01:00:38.720 --> 01:00:41.840
And it's again related, seems to be related to latitude.
01:00:42.159 --> 01:01:04.720
Northern European people seem to be able to put down massive amounts of energy in subcutaneous stores and be relatively protected from insulin resistance and metabolic dysfunction um compared to, say, South Asians, Indians, even you know, Africans, Australian Aboriginals, uh, Pacific Islanders.
01:01:04.960 --> 01:01:12.559
And maybe it's because with that amount of solar exposure, there wasn't a need to actually store lots of energy.
01:01:12.800 --> 01:01:29.840
And what we know about how energy homeostasis as it relates to the light exposures, we know that um, you know, this these alpha MSH uh melanocorn peptides, which are going to be made on UV light exposure, are negatively feeding back onto polycene neurons to suppress appetite.
01:01:30.000 --> 01:01:45.840
We know that um the like like we talked about, the the fat cells have these melanopic sensitive elements so that they essentially wouldn't want to store uh energy if there's an abundant energy source that they're plugging into.
01:01:46.000 --> 01:01:56.960
So I think people uh already with lots of melanin are probably less programmed to store fat, and they're probably less programmed to have expandable subcutaneous fat stores.
01:01:57.280 --> 01:02:05.039
Um I'm hypothesizing, and obviously there's uh lots of heterogeneity and variation within pigmented people about this.
01:02:05.200 --> 01:02:07.760
Um, and then there's there's some environment this factor.
01:02:08.000 --> 01:02:32.559
So we know that if you if you and this is mouse tartar, you can simulate circadian disruption in a mouse cohort with mistimed um lighting and feeding, and those m m mice get um visceral fat expansion, they get a necrotic macrophage infiltration into their adipocytes, and with the same diet, they become you know metabolically compromised.
01:02:32.720 --> 01:02:38.880
So I think circadian signals matter the time, and that it that means the timing of eating.
01:02:39.039 --> 01:02:48.480
I think consuming food preferentially at nighttime is gonna get into visceral deposits, then it's what the food itself.
01:02:48.639 --> 01:03:01.039
I think there is some evidence that poly on these polyunsaturated seed oils preferentially um interfere with correct oxidation of substrates such that they will get into this um depot more.
01:03:01.360 --> 01:03:10.000
Alcohol um and carbs, because there's this oxidative priority, and and the body's gonna attempt to burn those food those first.
01:03:10.159 --> 01:03:19.440
If they can't, um it's the metabolism is is in my uh estimation is breaking such that uh that they're probably getting deposited.
01:03:19.519 --> 01:03:25.360
And what I see in reality in clinical practice is if someone's drinking a bottle of wine at 9 p.m.
01:03:25.440 --> 01:03:31.039
at night with some sweet food, and then you bet they're gonna be laying down visceral fat.
01:03:31.280 --> 01:03:34.000
So, you know, those are the those, and then stress.
01:03:34.159 --> 01:03:43.119
Cortisol seems to disproportionate and testosterone disproportionately uh assists in visceral fat um deposition.
01:03:43.360 --> 01:03:48.400
Stress, people who are stressed get visceral fat with very little else.
01:03:48.559 --> 01:03:50.480
Um it's enough to put it in there.
01:03:50.720 --> 01:03:51.039
Dr.
01:03:51.200 --> 01:03:54.559
Omar in in the US notices in long distance runners.
01:03:54.720 --> 01:04:03.360
They'll they'll be doing everything else right, but if they're jogging for a hundred and kilometers a week, they will be having visceral fat being deposited.
01:04:03.599 --> 01:04:13.280
Um, and then uh you know, additionally to that, probably the the um this this male male hormones.
01:04:13.440 --> 01:04:23.680
Um again, it's it's I've heard from other clinicians that men who are using anabolic steroids, they get they have extremely strong musculature.
01:04:23.760 --> 01:04:25.119
I haven't seen these MRIs myself.
01:04:25.200 --> 01:04:26.720
I'm looking forward to doing them.
01:04:26.880 --> 01:04:30.480
Um, but they they've they're carrying visceral fat in their abdominal cavity.
01:04:30.559 --> 01:04:50.559
So, and then the radiologist will also tell you there's uh you can see a couple who live the same presumable lifestyle, the same diet, and the lady has just complete um fat storage in in around the buttocks and legs and and under the skin, and her husband, it's it's all in the abdominal cavity.
01:04:50.800 --> 01:04:53.680
So there's there's a lot to say here.
01:04:53.840 --> 01:04:58.079
Um I have I that that's kind of my thinking at the moment.
01:04:58.320 --> 01:05:28.480
Um, but if you if someone is experiencing this or they're having visceral fat um deposit, and obviously carbohydrates in and of themselves, because when the mitochondria are spilling out of energy and they can't fit anything more in, then carbohydrates, even from benign, benign sources like fermented sourdough or sweet potato, it's gonna go into storage until you can fit that gear stick back into ketogenic metabolism and and start burning this excess substrate off.
01:05:28.639 --> 01:05:34.240
Um, so you know, those are the probably the main factors that I think drive visceral fat deposition.
01:05:34.639 --> 01:05:49.680
I'm curious as to how I mean, I'm I know there's a little bit of research, I'm not sure how much, but how to specifically target uh the removal or the or the uh correction of the storage of this visceral adipose tissue.
01:05:49.840 --> 01:06:02.320
I think there's been some work on some plant hormetic compounds like EGCG from green tea and things like that, being able to um uh upregulate the amount of fat that's being used from visceral stores.
01:06:02.480 --> 01:06:11.680
Um, but uh where what is the state of your understanding at the moment with regard to people that are coming into you with visceral fat going, what do I need to do?
01:06:12.159 --> 01:06:16.079
Yeah, it's I think it's an academically extremely interesting question.
01:06:16.320 --> 01:06:37.840
But for the patient in front of us, we're gonna implement a range of strategies that I think seem to preferentially or uh get this f fat tissue off, but not necessarily because of w what they're doing in that the body itself wants to get rid of this fat.
01:06:38.000 --> 01:06:41.760
So uh it will preferentially to some degree burn burn this off.
01:06:42.320 --> 01:06:55.280
Um so I th I I personally don't make too many distinctions and or promises about, you know, this is what is going to, you know, get rid of your abdominal fat preferentially.
01:06:55.599 --> 01:07:04.480
But when, you know, my my suite of approaches seems to over time uh you know get work to reduce it.
01:07:04.720 --> 01:07:06.639
It's it's a work in progress.
01:07:06.800 --> 01:07:13.440
It doesn't, depending on how long the patient's got has had visceral storage, it's gonna take a while to get off it.
01:07:13.599 --> 01:07:28.400
And um, it's a it's an opportune time to discuss this because I'm as we're talking off air, I'm literally just about to launch uh my own MRI product that is gonna allow us to scan you without ionizing radiation.
01:07:28.639 --> 01:07:52.800
Look to see what's going on inside, look to see whether your fat is in this safe subcutaneous depot, um, and you're and and potentially the BMI is uh calling you less healthy than you are, or it's in this visceral depot and around your heart, and then in which case, you know, you're in trouble and and the BMI hasn't told you anywhere near as uh how worried you should be.
01:07:53.039 --> 01:08:03.360
But um in in practice, it's going to be a a series of things that we do, which relates to the beginning of our conversation in terms of environmental signals and hormesis.
01:08:03.519 --> 01:08:34.319
When you reintroduce the hometic uh nature of these environmental signals, when you reintroduce the amplitude, when you re-establish amplitude, circadian amplitude, you re-establish um the the the feeding and fasting amplitude, when you reintroduce exercise, rest and rest and intense exercise amplitude, that contrast, that seems to be the most effective way to um you know the amplitude between carbohydrate, glucose metabolism, and ketosis.
01:08:34.639 --> 01:08:42.159
And then you can you can re you can put this metabolic system back into gear and and start the uh healing right.
01:08:43.359 --> 01:08:46.159
How often are you in ketosis out of curiosity?
01:08:47.359 --> 01:09:16.159
I would I would probably flip in two ketosis maybe uh weekly, but I would spend maybe maybe 24 hour period in 24 to 36 hour period every week in ketosis, mostly through um not through reduction in feeding um instances, but simply weekly carbohydrate restriction.
01:09:16.800 --> 01:09:17.440
Interesting.
01:09:17.600 --> 01:09:35.520
Uh I'm I'm curious as to uh your perspectives on deuterium depletion protocols as well, uh whether you have any experience with them and and what from your clinical experience uh deuterium depletion is is contributing to with regard to the health of the patient.
01:09:36.000 --> 01:09:45.600
Yeah, I I mean that that is an extremely interesting question and one that I can't say I have had a lot in terms of implementing.
01:09:46.560 --> 01:09:55.119
The I mean the main condition which is indicated for deuterium depletion in my mind is is any is cancer.
01:09:55.279 --> 01:10:02.239
Um and I think a severe type type 2 diabetic, you know, very poorly controlled type 2 diabetic also fits that criteria.
01:10:02.480 --> 01:10:10.319
And because of it's of the access, you know, that obviously in the cost, it's not something that I routinely recommend.
01:10:10.640 --> 01:10:19.760
But one that I'd be really I'm really interested to use, especially in the context of MRI, where we can really get a before and after.
01:10:20.000 --> 01:10:23.440
I mean, the thing is that when we're very rarely changing one factor.
01:10:23.680 --> 01:10:41.520
So to what degree that's gonna be moving the needle versus uh again, carbohydrate restriction, eating deuterium-depleted uh animal fats, grass-fed animal fats, um, introducing time-restricted eating windows, it's it's very difficult to say.
01:10:41.840 --> 01:10:53.600
But um it it I think the angle of the question also invites this idea of to what degree is the this visceral fat problem a problem of of deuterium and deuterium overload.
01:10:53.840 --> 01:10:58.800
And um it's a question I asked Laszlo Boros three years ago when I interviewed him.
01:10:59.039 --> 01:11:14.640
Um and the way he framed it, which I I really like and I I kind of use, is more of this idea of uh visceral fat as a kind of as what he called metabolic crowding.
01:11:14.800 --> 01:11:21.760
And metabolic crowding is when you get a build-up of partially combusted energy substrate.
01:11:22.079 --> 01:11:28.000
And again, because it can't be fed through the mitochondrion for whatever reason, because it's 9 p.m.
01:11:28.159 --> 01:11:36.399
at night, there's no red infrared spectrum turning the the the hitting cytochrome um for or or spinning the ATPAs.
01:11:36.800 --> 01:11:53.039
Um for all these reasons, because you're you're sedentary, you're not doing any forms of exercises, you're not maintaining lean muscle mass that again provides a a sink to some degree for excess energy substrate because you haven't developed a brown adipose tissue.
01:11:53.119 --> 01:11:58.159
You know, you're not someone isn't uh living congruent to their environmental signals.
01:11:58.399 --> 01:12:15.920
To all these reasons, you get unburnt substrate, and really it's it's it's it's can be thought of as unburnt fuel coming out of the back of a of an engine that's not tuned properly, and because it's that that engine's lacked these environmental inputs like that we discussed.
01:12:16.079 --> 01:12:18.079
Um, and he calls that metabolic crowding.
01:12:18.159 --> 01:12:21.039
And you know, to what degree is that deuterium itself?
01:12:21.199 --> 01:12:29.520
I mean, there are certain MRI modes that visualize deuterium, but they need uh they they they actually look at traces.
01:12:29.600 --> 01:12:35.920
They it's MRI spectroscopy that is actually looking for a deuterated spectrum tracer.
01:12:36.159 --> 01:12:43.119
So it's it's not you can't, as far as I interpret the MRI images, it's not something you're using on a standard standard sequence.
01:12:43.440 --> 01:13:02.000
Uh to a certain degree, I think it's moot, and I and I don't think it's useful in explaining to patients because um what what does a patient really care about whether what what this heavy hydrogen isotope means for them, uh if everything that we're doing is going to help in aid in deuterium depletion.
01:13:02.319 --> 01:13:16.880
So to me, it doesn't really add anything, and if anything, it it complicates things and it unnecessarily puts uh put put put puts you know things in a in a in in a difficult to um relate terms.
01:13:17.199 --> 01:13:24.480
But if they understand that the visceral fat is simply a maladaptive, the body's not trying to kill them, it's just doing the best given the situation.
01:13:24.640 --> 01:13:43.359
It's a maladaptive situation, and if we do time restricted eating, we do carbohydrate restricted, um, I call it an epicarnival diet, which is it's just a time-restricted carnivore with uh abundant seafood and fermented uh foods, then you know this that is deuterium depletion.
01:13:43.680 --> 01:13:50.960
You will deuterium deplete yourself um along with full spectrum sunlight and whether or not you're on a deuterium depleted water protocol.
01:13:51.039 --> 01:13:53.279
If you add that in, it'll happen even quicker.
01:13:54.399 --> 01:14:06.640
What where do you draw the line between uh lower it lowering someone's carbohydrate intake and going onto a proper ketogenic style regime?
01:14:06.960 --> 01:14:09.920
Um, and how do you tell if someone's going into ketosis?
01:14:10.000 --> 01:14:15.520
I I know that there's quite a bit of variability between people's abilities to go into ketosis.
01:14:15.600 --> 01:14:17.600
Some people go into it very, very easily.
01:14:17.760 --> 01:14:22.399
Some people's bodies seem to be extremely resistant to the ketogenic state.
01:14:22.640 --> 01:14:29.520
Um, I'm wondering where uh when is it indicated to go really deep into that ketogenic state?
01:14:29.920 --> 01:14:56.480
Yeah, I mean the the the classical deep ketos key indications for deep ketosis are uh essentially brain conditions like severe refractory epilepsy and essentially conditions where you need a hyper a high new level of ketonemia to uh essentially trying to maintain a uh more desirable uh physiological state of brain exit uh metabolism.
01:14:56.720 --> 01:15:03.199
So, you know, that those are the most common ones, and then you know, some of these cancer protocols that are using deep deep ketosis.
01:15:03.840 --> 01:15:25.920
My experience and my interest is at the moment is in metabolic diseases, and if in into some some degree, uh the this the depth of ketosis is less important than um the fact that that person is getting essentially a high amount of nutrient flux through their mitochondria.
01:15:26.239 --> 01:15:30.560
So does it matter if they're sitting at four millimoles per liter?
01:15:31.039 --> 01:15:39.440
Not as much as if they are you know implementing this protocol of intermittent um high-intensity exercise.
01:15:39.600 --> 01:15:47.039
They're not eating large amounts of carbohydrates, they're probably having fiber in the form of some forms of sauerkrauts.
01:15:47.680 --> 01:16:03.199
But um the combination of factors, rather than the ketonemia itself, is mobilizing stored energy from adipocytes from visceral fat stores and essentially burning it, and they're they're blowing it out.
01:16:03.440 --> 01:16:06.000
That's how that's how it how how it leaves the body.
01:16:06.079 --> 01:16:08.800
It's it literally exhaled as carbon dioxide.
01:16:09.039 --> 01:16:13.520
Um so yeah, I'm not a nice uh I'm not an artsy about it by any means.
01:16:13.600 --> 01:16:19.199
Um, and I don't necessarily need people to measure ketones unless they want to.
01:16:19.440 --> 01:16:37.199
Um but I agree, there's massive variation and in in in metabolisms, just like there's variation in you know stomach anatomy, or you're circling back to the beginning of the conversation, and it's very hard to know that um from the beginning.
01:16:37.440 --> 01:16:43.039
But yeah, it's it's it all depends, and it depends on how strict we need to be, is how bad someone's problem is.
01:16:43.199 --> 01:16:50.960
I mean, you know, I had a guy the other day whose whose HPA1C is glycated hemoglobin was above 14.
01:16:51.279 --> 01:17:06.239
Like this is someone who's, you know, and he's 120 kilograms, who's actively neglected his health for you know many, many years, and is you know, probably in the stage of pancreatic burnout of type 2 diabetes.
01:17:06.480 --> 01:17:21.279
Um, so the impetus for someone to kind of be strict in their lifestyle habits is much higher than someone who's maybe got a fasting incident of 12 but normal HBA1Cs and you know, etc.
01:17:21.680 --> 01:17:43.279
So it it all kind of depends, but you know, the the saying that you can't get better in the same environment where you fell sick, you you know, you can't get metabolically healthy with the same amount of carbohydrate intake and the same amount of sugar intake and alcohol intake and uh nocturnal food consumption as when you when you felt when you got metabolically sick in the first place.
01:17:43.920 --> 01:17:44.800
I find it funny.
01:17:44.880 --> 01:17:52.079
I don't want to keep you too long, but I find it funny that we uh we always come back to just talking about the same stuff all the time.
01:17:52.159 --> 01:18:03.119
It makes me uh feel very much uh in uh imposter syndrome all the time because uh you know when people ask me advice, it's always the same, it's always the same thing.
01:18:03.279 --> 01:18:07.359
It doesn't really evolve because what we need doesn't evolve, it's it's the same.
01:18:07.600 --> 01:18:11.680
Um, and that's to basically get outside as much as possible.
01:18:11.920 --> 01:18:18.159
Um and uh and beyond that, you know, you're really looking at very minor things.
01:18:18.480 --> 01:18:23.039
Um I I won't ask you, yeah, you can you can go.
01:18:23.520 --> 01:18:40.960
I would just yeah, I would I would just say that the person that's that I've really enjoyed his perspective on this lately has been Alistair Nunn from the Guy Foundation, and really framing this problem of human physiological and biological need in the terms of engineering.
01:18:41.199 --> 01:19:11.039
And again, it's the engineers who bring more than anyone else a rigorous view to health and and medicine and biology in a way that we most doctors will never do because again, they're they're too inculcated into this uh you know, prescribing pharmaceutical-based uh paradigm that's preoccupied with pathology without looking into as Abu Dud Bakri calls celluenesis or health promotion.
01:19:11.359 --> 01:19:18.000
So the way that None frames it is a flight envelope, it's like a metabolic adaptive metabolic envelope.
01:19:18.159 --> 01:19:24.560
So just like a Cessna plane has a certain set of conditions by which it can fly.
01:19:24.720 --> 01:19:38.960
So airspeed, payload, uh, you know, runway, takeoff speed, uh, engine maintenance periods, the that that flight envelope for a Cessna is going to be completely different to a Boeing 747.
01:19:39.279 --> 01:19:46.000
It's gonna be completely different to a you know uh Hercules C 130 Globemaster.
01:19:46.319 --> 01:20:00.560
So the question is, what conditions as we apply the analogy to a biological system, what conditions or what um set of dictates influence our biological envelope?
01:20:00.640 --> 01:20:11.279
Because we obviously have one, um, and it's you know to go all the way back to the most foundational inputs, it's it's an atmospheric oxygen of 21%.
01:20:11.920 --> 01:20:14.239
It's a gravitational field.
01:20:14.560 --> 01:20:17.920
And you know, when when when uh Dr.
01:20:18.079 --> 01:20:28.000
Cruz says uh, you know, light water magnetism, I'm like, okay, well, why not light water magnetism, gravity, um, you know, and oxygenation, because they're just as fundamental.
01:20:28.159 --> 01:20:50.000
Um the gravit geomagnetic field, which is you know seems to be shifting over the South Atlantic right now, and the this light dark cycle, the fact of full spectrum, sunlight during the day and complete darkness at nighttime, or relative compared to um uh relative compared to what we're doing now.
01:20:50.239 --> 01:20:58.319
And and then you you you plug all these um facets of uh inputs in, and then you get a human metabolic envelope.
01:20:58.560 --> 01:21:03.359
And that is the evolutionary niche with with respect to these fundamental inputs.
01:21:03.600 --> 01:21:21.199
So that's another way of of talking about it, and it comes back to antifragility, it comes back to um hormesis because a little bit of stress is what keeps the mitochondria functioning properly, and it keeps the body and and functioning properly.
01:21:21.440 --> 01:21:24.000
So yeah, I uh I like that framing.
01:21:24.079 --> 01:21:57.279
I think it's it's a really useful one, and it and it makes sense of these environments where human health falls apart, whether that's the submariners in submariners on under the ocean for 90 days at a time, astronauts in the International Space Station, um, or the off typical office worker sitting in a in a windowless room under LED lighting and three monitors and a and a Wi-Fi router emitting you know dual band um gigahertz, 5.4 and 2.
01:21:58.079 --> 01:22:00.640
whatever, 8 gigahertz right next to them.
01:22:01.760 --> 01:22:09.119
I I think that's a fantastic way to uh wrap this up with that full circle moment back to anti-fragility.
01:22:09.279 --> 01:22:17.279
You've just added a few books to my extremely long reading list, and I'm sure you've added a couple of books onto a lot of other people's as well.
01:22:17.520 --> 01:22:31.840
Um, I've learned a lot just by listening to you speaking, I think there's so much to be gained um by hearing people who have clinical experience talk, and that's why I was really looking forward to talking to you finally on the podcast.
01:22:32.079 --> 01:22:43.199
Um I will make sure to leave all of your details uh in the description so people can check out your podcast and and find you on all of your platforms.
01:22:43.359 --> 01:22:50.480
Um, but yes, do you do you want to give any more information about this this clinic that you're setting up and and what you'll be offering?
01:22:50.560 --> 01:22:54.720
Because I think it'll be um it'll be you're you're on the cutting edge.
01:22:54.800 --> 01:23:00.000
You're doing the stuff that I I think will become popular in the next uh coming decades, hopefully.
01:23:00.319 --> 01:23:01.520
Yeah, thanks, Cameron.
01:23:01.600 --> 01:23:03.440
Thanks for your your your kind words.
01:23:03.520 --> 01:23:05.520
It's always a pleasure to to speak with you.
01:23:05.760 --> 01:23:23.359
So, yeah, for anyone who's interested, um the my what I've as a as we discuss, I'll be offering a a non-contrast abdominal MRI to really give people true insight into their their metabolic health and their the presence of structural metabolic disease.
01:23:23.520 --> 01:23:30.800
So, you know, you can you can go into your doctor, you can you can measure, you can even measure your fasting incident and you measure your fasting leptin.
01:23:30.960 --> 01:23:32.239
I mean, it's a good start.
01:23:32.480 --> 01:23:37.359
But um what shows up on the MRI is prodromal, even before that.
01:23:37.520 --> 01:23:48.720
And it's before you get even endocrine or um derangement, you're gonna you're gonna start seeing deposition of of of this type of fat.
01:23:49.039 --> 01:23:54.800
So MRI, the MRI don't lie, uh is what is uh what what gets said.
01:23:54.960 --> 01:24:01.199
So we can just see what's going on, and then you can make choices about what you want to do based on that.
01:24:01.279 --> 01:24:14.079
And inevitably, the the closer we implement lifestyle factors that that we've discussed, closer to this flat envelope, the less the visceral fat is carried and the quicker it goes away.
01:24:14.319 --> 01:24:23.359
And again, if we look at those Peruvian um Amazonians who were in that under undiscovered tribe, they're thin.
01:24:23.680 --> 01:24:29.119
They uh, you know, they're they're probably, if anything, protein deficient, but they didn't have any visceral fat.
01:24:29.279 --> 01:24:40.319
So, you know, the vis the visceral fat is a problem of modernity, it's a problem of this indoor domesticated lifestyle, and it's a problem of deprivation from natural environmental exposures.
01:24:40.480 --> 01:24:50.800
Um and it's the main root cause behind chronic diseases, or it's it's it's the key um structural evidence that someone's going down the wrong path.
01:24:51.039 --> 01:25:08.800
Um so yeah, if you're interested in that, then you know go onto my website and we're gonna be really it's all on a very kind of it's all embryonic at this stage, but uh it will be offered at in certain locations and then we'll be able to follow you up and we'll be able to walk you through and show you the images of your own abdomen.
01:25:08.880 --> 01:25:15.920
And just like a tree trunk, we can see the different slices and we'll we'll we'll let you know what what you what's going on.
01:25:16.079 --> 01:25:20.159
This is part of doing health due diligence as far as I'm I'm concerned.
01:25:20.399 --> 01:25:29.279
Um because really, if unless you know what's what what is actually inside you, you you haven't you're not really given a complete picture of your health.
01:25:29.520 --> 01:25:43.520
And the corollary to that, and we didn't talk about things like veg, you know, different health practices or different health schools of thought, but something like this abdominal MRI, it's it's really the final referendum on a lifestyle.
01:25:43.760 --> 01:26:03.279
Um, because whatever we uh protocol any health um influencer or doctor would um promote, you if if that were truly healthful, then they would it would not contain structural metabolic disease, it would not have visceral fat.
01:26:03.440 --> 01:26:06.159
So it's really it's really an arbiter of that.
01:26:06.319 --> 01:26:18.880
Um you know, give give me 10 people who are each following the different protocol, whether it's a vegan, you know, on plant-based diet, uh, fruitarians, you know, the the crossfitters, people who are working out at 6 a.m.
01:26:19.039 --> 01:26:20.960
and doing bulletproof coffees.
01:26:21.119 --> 01:26:24.560
Uh, you know, whatever the whatever the different schools of thought are.
01:26:24.640 --> 01:26:29.199
It's like um, you know, Anchorman, where the different news teams are like uh fighting out.
01:26:29.359 --> 01:26:30.880
I don't know if you've seen that movie.
01:26:31.039 --> 01:26:39.199
But uh look, get them all together and we'll scan them and we'll see who's who's living the correct approach and who isn't.
01:26:39.440 --> 01:26:48.560
So that in that regard, I'm excited to be bringing this um this research tool to to people into demo democratization.
01:26:48.720 --> 01:26:53.359
Um so yeah, go onto my website if you want to listen to what I have to say.
01:26:53.920 --> 01:27:03.760
Sometimes it's on the Regenerative Health Podcast, which Cameron's been on uh twice already, or and and yeah, we'll we'll we'll definitely be continuing that conversation.
01:27:04.000 --> 01:27:06.960
And yeah, that's uh that's basically where you can find me.
01:27:07.119 --> 01:27:18.239
And um, I'll be expanding my you know private consulting around health optimization um in in the in the next yeah six months to to one year for sure.
01:27:18.720 --> 01:27:21.359
Max, I'm I'm so grateful for everything you're doing.
01:27:21.440 --> 01:27:35.680
You really are sort of the lightning rod of uh you know uh the health movement in Australia, and um, you know, there is a massive, massive um desire for this type of um uh content in Australia.
01:27:35.840 --> 01:27:39.119
For some reason, Australia we're we're very passionate about this.
01:27:39.199 --> 01:27:43.440
We have a massive community here, and you're at the absolute forefront of it.
01:27:43.520 --> 01:27:50.640
Uh and I'm I'm just so grateful to have you uh leading the way uh and um you know showing everyone the right way to do it.
01:27:50.720 --> 01:27:54.079
You're you're a real leader, so I'm very happy to have you around.
01:27:54.319 --> 01:27:56.880
Thank you for um giving me some time.
01:27:57.199 --> 01:27:58.560
Yeah, okay, pleasure.
01:27:58.720 --> 01:28:01.600
Thanks for for the questions, and yeah, we'll we'll talk soon.
01:28:01.920 --> 01:28:03.119
Thank you so much for listening.
01:28:03.199 --> 01:28:04.800
I really hope you enjoyed this episode.
01:28:04.880 --> 01:28:09.760
I've left links to all of Max's social media in the episode notes, so please go follow his amazing work.
01:28:09.920 --> 01:28:17.680
If you'd like to keep up to date with my work, please follow my social media and subscribe to my substack for even more in-depth information about science and health.
01:28:17.760 --> 01:28:19.680
Your support keeps this podcast going.
01:28:19.840 --> 01:28:21.119
Thanks again for listening, everyone.
01:28:21.199 --> 01:28:22.079
Take care.
00:00:43.440 --> 00:01:06.319
When you reintroduce the hometic nature of these environmental signals, when you reestablish amplitudes, circadian amplitude, you re-establish the feeding and fasting amplitude, when you reintroduce exercise, rest and intense exercise amplitude, that contrast seems to be the most effective way to put this metabolic system back into gear and start healing.
00:01:06.640 --> 00:01:08.879
That's actually that's a very interesting question.
00:01:09.040 --> 00:01:18.560
And I think probably the most influential book for me with respect to these ideas and the intellectual journey is actually has nothing to do with health or medicine.
00:01:19.039 --> 00:01:40.319
A little bit of stress is what keeps the mitochondria functioning properly and it keeps the body functioning properly, and it makes sense of these environments where human health falls apart, whether that's the submariners, astronauts in the International Space Station, or the typical office worker sitting in a windowless room under LED lighting and three monitors.
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Welcome to the Ritchie Flow Nutrition Podcast.
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My name is Cameron Borg.
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On this episode, I had the pleasure of speaking with Max Gulhain.
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Max is an Australian medical doctor and educator specializing in metabolic health.
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He's a central figure in the movement to decentralize medicine and empower individuals through education and preventative medicine.
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Max's expertise extends far beyond the bounds of conventional medicine, incorporating an evolutionary lens on health to emphasize the critical importance of natural life, circadian principles, and ancestrally consistent dietary patterns.
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His podcast, The Regenerative Health Podcast, explores a foundational approach to health, featuring incredible conversations with world-renowned experts.
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Max is currently setting up a bespoke clinic in Byron Bay where he hopes to integrate diet, lifestyle, and environmental changes to help people get control of their health.
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Before we start, please consider subscribing to my Substack where I share information that goes well beyond the scope of this podcast.
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Becoming a subscriber is the best way to support my work and this podcast.
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With all that being said, I hope you enjoy the conversation.
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Alright, Max, I feel like this has been long overdue.
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You've been uh someone I've looked up to for a very long time now.
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And um, you know, we've we've uh been together a few times when you've set up Regenerate, which has been an absolutely fantastic thing to bring these uh this community in Australia together.
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So uh I very much look up look up to what you're doing, and uh I'm very glad you've given me some of your time.
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It's nice to be back on the same time zone for once.
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Yeah, thanks, Cameron.
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It's I think we first connected maybe what at least three, two, two or three years ago.
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And when I was getting around to make a podcast, I I stumbled upon your work and I realized that you'd interviewed, you know, probably six months or eight months earlier, the exact guest list that I myself um was hoping to talk to.
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So I think uh we've been thinking about very similar problems and the solutions to those problems at you know almost in parallel.
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So it's always great to uh to to touch base and riff with uh someone so like-minded.
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Yeah, it's uh it's very good, particularly for me uh to have uh some people around to discuss all of this with.
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Um and I think much like me, you probably have uh a moment or maybe a few moments that were very um that were a catalyst for you, sort of opening your mind to seeing health uh and and medicine in a different way.
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I'm curious because I I've never asked you this.
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What what were the what was the moment or maybe some of the moments that were really important in getting you to start thinking sort of against the grain when it comes to health?
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Yeah, I I would say there were two distinct epochs of of major relief uh revision of belief.
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And the first the first era was probably around 2016-17 when I had to solve my own acne problem and somehow found my way onto low-carb down under his YouTube channel and just listened to a bunch of medical doctors talk about the benefits of therapeutic carbohydrate restriction on a range of conditions.
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And you know, you the the name of the channel says a lot, which is it's various interpretations of of how that single approach can have benefit.
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And to some degree it it is, you know, one-sided, but it is extremely useful and extremely um therapeutic therapeutically effective.
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So, you know, I I really thank Dr.
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Rod Taylor and and the team behind that for providing such an amazing resource for patients.
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And that really helped me solve a problem that had been had run up against uh dermatologists and other G and GPs and really come up empty-handed and you know went through the whole theetrogenic harm process of of dealing with estrogenol and the roacutane medication.
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And so that kind of started the the process of thinking, I guess, in this heterodox way.
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And then the the other one, the other kind of epoch or era was in the early 20, probably just after COVID, 20, early 2020s, when I some somehow found Dr.
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Jack Cruz as an extension of of explorations on on YouTube and podcasts.
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And I think it's almost an inevitable path, if we're being curious, that you don't stop asking a question that will take you to the next spot.
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And I feel like some people, and maybe in in all domains, they they get to a certain level or a certain door, and then it's like, okay, we're not gonna ask more questions than that.
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Um, but there there's there's always more doors, so it's however whatever your appetite is for curiosity and your scope is, you can keep going, but it's it's kind of up to you.
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Um, and by no means am I anywhere near the end of that process.
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But uh at the moment, I'm kind of I guess uh integrating a lot of what I've learned um in on my own parallel education journey, private, private education journey with what I've learned clinically as a a medical doctor, uh now um fully qualified general practitioner or family medicine physician, and pulling pulling those threads all together into a a pro a project or an offering or product where I feel like I can help patients, you know, in in one of the most brute cause or kind of fundamentally addressing their disease process.
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Um yeah, so that's kind of what I'm working on and what I've been working towards.
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We have hilariously similar origin stories in that regard, um, with acne being the catalyst.
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So that's quite funny.
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Um, I was gonna save this question for the end, but I thought it was probably a good place to ask you now.
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I'm interested in um maybe a couple of your favorite books um that have been uh particularly influential since you started to see things in this way.
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Yeah, it's that that's actually that's a very interesting question.
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And I think probably the most influential book for me with respect to these ideas and and the intellectual journey is actually has nothing to do with health or medicine.
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It would be Nassim Nicholas Taleb's Incerto series and probably anti-fragile.
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Um, I think I've got a copy of it right in front of me.
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So here you go.
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Anti-fragile mind by Nassim Nicholas Taleb.
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This this is uh Nassim Taleb was uh originally a an options trader.
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So he he's a he's a Lebanese Christian of um who grew up in around the time of the Lebanese war, moved to educated in a French school, moved to the US and you know, did finance and options, but came from a history and a family environment of what where they they prized this quality of erudition above all else.
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And erudition is this this quality of being well read, and uh more it's more than that.
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It's it's being extremely knowledgeable in a vast different array of fields, and it's a very interesting um, I guess, value to prize as a as a family or in a culture, because obviously this was his father's values that he espoused to Talib.
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But they the what it brings out is an immediate or a sense of multidisciplinarity in one's endeavors.
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So for him, he was he's tying together philosophy with uh ancient history, with mathematics, with language, and uh what what what you can gain or what uh intellectual ground one can can break by bringing together all these seemingly disparate fields, it's incredible.
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It's honestly how it's exactly how Da Vinci made some of all his breakthroughs, is because when you assess or you look at fields in from a completely novel perspective, just as an engineer might approach it, approach health, or um someone without medical training approaches a clinical problem, you you see solutions that people who are anchored to the existing paradigms, the existing thought structures, they can't see.
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It's an incredible, incredibly powerful um intellectual position to occupy.
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So Kaleb wrote this series called The Black Swan, which I mean you this ties this ties deeply into the philosophy of science.
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And I don't know how much you've looked into Karl Popper, but um Popper was one of the first to he wasn't the first, it goes, it went back to a guy called Hume, um, who is a philosopher, a Scottish philosopher, but Karl Popper um formulated and phrased the problem of induction, which was how how are we making like uh scientific claims or scientific um, yeah, I guess you could say uh claims from observed phenomena.
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And the black swan problem was this idea that you can you can have a theory or a proposition that all swans are white.
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But the the it would it only takes the citing of a single black swan to completely nullify and nullify your your hypothesis.
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So um the this out of this idea comes the foundation of of proper scientific rigorous practice, which is um we we have a hypothesis, but we're uh if we're doing science properly, then what rather than seek confirmatory uh findings or evidence that support our hypothesis, i.e., you know, go out and look out more more white swans, look at different environments where white swans look.
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If we're being really uh thorough and rigorous in truth seeking, then we actually should be looking for the black swans.
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We should be actively trying to disprove our hypotheses rather than just simply collect more confirmatory evidence.
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And it's like the book, The Black Swan, is all about that, is all literally about that, and how um another form of this problem is is the Turkey problem.
00:12:15.279 --> 00:12:30.639
They use it in in finance more than they perhaps in medicine, but is relevant to health and medicine because the and briefly explained it's this idea that the Turkey is there's an American, obviously American framing.
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The Turkey is being fed every single day um prior to Thanksgiving.
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And the day before Thanksgiving, his report, uh the Turkey's reports, uh the missives, the um newspaper dictum, whatever, they say human human and turkey relationships relations are at their peak.
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We have never had better relations between the turkeys and the humans.
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And obviously the fight the next day the turkey gets killed because it's Thanksgiving.
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Um so the the this this they're they're related problems because it's this idea of um that you you you really need to uh try and avoid to be being a turkey, and you there can be situations where um you get closer and closer and closer, you're getting more and more confirmatory evidence of of XYZ, and then you know things can change rapidly.
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But as it as it relates to health, um the second book, or it's probably it's his third book, anti-fragile, basically has this thesis, which is essentially hormetic benefit and hormesis.
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And anti-fragility is this quality where we don't only um we're not robust to uh disorder, we're actually we improve from disorder.
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And he actually mentions in that book uh dissipative systems and illio pure gene, like in a footnote of that book, which was published in 2016, you know, well before I probably even you know someone Dr.
00:14:04.719 --> 00:14:06.159
Drakkruz even mentioned it.
00:14:06.319 --> 00:14:09.519
So it that's a very interesting uh uh thing.
00:14:09.679 --> 00:14:46.319
But essentially, Taleb talks about this idea of anti-fragility and it maps exactly to uh biology, it maps to mitochondrial function, because if we fundamentally benefit from hormesis, mitohomesis, mitochondrial hormesis, uh the organism is anti-fragile to a point, mean meaning that a small dose will of stress or you know, and he calls it in in his book stress, entropy, disorder, chaos, small degree it's beneficial, and there's this a limit beyond which it's no longer beneficial.
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And you think about it as anything like uh exercise, cold exposures.
00:14:51.439 --> 00:15:02.799
You know, you can sun exposure, you lie if you lie in you know, UV index of of of 11 for six hours, unless you've got the darkest physic spin type, you're gonna overdo it.
00:15:03.120 --> 00:15:06.079
So um it maps amazingly to human health.
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And and it and it really also extends to how I heal people or how I guide people to say reversing their metabolic dysfunction.
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Because I see metabolic disease, metabolic dysfunction, instant resistance is fundamentally you know mitochondrial maladaption to an set of environmental conditions that has stripped away the uh you could say chaos, intermittency, um, hometic exposure that a natural environment, which was our evolutionary environment for the duration of our evolutionary period, had provided.
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So when you strip that away, the mitochondria has to make a series of inconvenient but ultimately adaptive choices about energy handling, disposal, and um uh storage that push you uh that that postpone postpone the organism breaking uh a bit a bit more than it otherwise would.
00:16:06.799 --> 00:16:22.799
So when when when you promote anti-fragility in a lifestyle, the ultimate anti-fragile fragile lifestyle is similar to what we observed when those Peruvian Amazon uh Amazonians got witnessed, you know, in the in the that uncontacted tribe.
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Like hunter-gatherer culture is fundamentally anti-fragile because you don't know when your next meal is coming from.
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There's intermittency of nutrient supply, this intermittency in many regards of of exercise patterns, but in it's also uh you know quite periods of intense rest followed by intense periods of exercise, etc.
00:16:44.639 --> 00:16:44.879
etc.
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And all these all these um environmental exposures provide this you know fluctuating um amplitude where there's a contrast between uh between the the height of these inputs.
00:16:59.199 --> 00:17:14.640
So long-winded answer, but uh anti-fragile is a book that I would highly recommend and the whole Taleb series to to someone who wants to delve into the theory of science, the theory of of essentially how the world works.
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I think they're fundamentally very useful mental models for how how health and and the world work.
00:17:21.279 --> 00:17:26.559
I'm intensely interested by that answer, and I'm really glad I asked that off uh off the bat.
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Um, I uh I have a similar uh sort of idea when people ask me about my favorite book, it's uh it's like, well, it's the only really one of the only books I've read that's not really about health.
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It's a fiction book.
00:17:38.640 --> 00:17:40.400
Uh Siddhartha by Herman Hess.
00:17:40.559 --> 00:17:42.960
It's the book that's taught me the most.
00:17:43.039 --> 00:17:46.400
Um, and it's interesting to hear you've had a similar experience.
00:17:46.640 --> 00:18:00.640
And I love this idea that um by gaining experiences that are actually uh adjacent or or not even not even remotely related, actually help your ability to understand the things that you really want to understand.
00:18:00.880 --> 00:18:10.560
Um, there was a post last week, I think, by Paul Czech, who was originally one of the people who um I looked up to very early on in my health journey.
00:18:10.720 --> 00:18:13.920
And um, it was going over all of the careers he's had.
00:18:14.160 --> 00:18:19.360
He was a tree lopper, he was a boxing coach, he was in the army, he's done like he's had like 10 careers.
00:18:19.600 --> 00:18:33.120
And I remember him talking about how all of that was very, very important in helping him really understand how to uh uh how to grasp and explain these uh uh these very complicated topics.
00:18:33.279 --> 00:18:37.120
Uh and I find that very, very um fascinating that you brought that up.
00:18:37.200 --> 00:18:40.240
I'm really glad I asked that um right off the bat.
00:18:40.400 --> 00:18:47.600
Um and it reminds me of uh how um Bob Fosbury helped Glenn Jeffrey figure out how reindeer eyes work.
00:18:47.759 --> 00:18:57.840
Uh Glenn would have never figured that out was it not for if it was not for Bob's um Bob's expertise as an actual astrophysicist.
00:18:58.000 --> 00:19:11.920
Um I just find that fascinating that um uh people's uh experiences that are outside the realm of of what you would expect to help them play such a critical role um in in what they're doing.
00:19:12.400 --> 00:19:15.200
Um now I'm I'm I've been caught off.
00:19:15.440 --> 00:19:18.800
Yes, I wanted to I I would just make a comment on that.
00:19:19.039 --> 00:19:39.759
I I think that is so true, and especially when it comes to health and and medicine, there's there's no area of of medicine that you can practice that doesn't in some way help you later on in in some other way, and it's some knowledge that you might pick up or some experience or a patient you might see.
00:19:40.000 --> 00:19:42.720
Uh everything, every none of it is wasted.
00:19:42.960 --> 00:19:49.360
And maybe not even medicine, maybe life itself, except it doesn't make sense at the time.
00:19:50.400 --> 00:19:59.120
It only makes sense, you know, with five, ten years hindsight, and then you can see how how the pieces all like brought you to the place that you are now.
00:19:59.360 --> 00:20:14.320
And that's that's the kind of a piece of advice that I sometimes have to sometimes give people, which and and kind of reassure and emphasize if if you feel like you're lost at the moment, then that's what it might feel again right now.
00:20:14.640 --> 00:20:28.960
But it will make sense in hindsight because who you meet, who you talk to along that way in that journey is going to set you up for what you're eventually gonna do and do do well and do even better, having having walked that path.
00:20:29.279 --> 00:20:29.920
Absolutely.
00:20:30.000 --> 00:20:37.039
It's very hard to tell uh what the context of the present moment is going to be five, 10 years, even longer down the track.
00:20:37.279 --> 00:20:42.640
And there has to be some level of belief um that things are going to work out for the best.
00:20:42.960 --> 00:20:51.920
Um, and I I'm curious, I'm curious as to your um clinical experience as a as a practitioner.
00:20:52.080 --> 00:21:02.640
Uh, I've for the longest time thought that there is a real difference between things you learn by reading or or being taught and things you learn by interacting with other people.
00:21:02.960 --> 00:21:16.400
Um, and this is why becoming a practitioner in some uh in some level has been a real goal of mine because I think there are absolutely things that you cannot learn unless you are dealing with people one-on-one.
00:21:16.880 --> 00:21:20.080
And there's there's absolutely no way around that.
00:21:20.320 --> 00:21:33.440
And uh I I wanna I want to delve into a little bit about your personal experience as a practitioner, um, someone who is there, like you said before, as a guide to help someone heal themselves.
00:21:33.680 --> 00:21:36.240
Um, are there any particular lessons?
00:21:36.400 --> 00:21:44.640
I know this is probably rather difficult to put into words because um they're not exactly tangible, like you said, particularly in the moment.
00:21:44.800 --> 00:21:59.200
But are there any lessons you've learned from your patients that help you uh figure out what you know what the right things to do in particular situations would be as a doctor, as someone who's being a guide, like you said?
00:21:59.519 --> 00:22:28.000
Yeah, so medicine was is one of those interesting uh I would say careers or fields of endeavor where it it I feel like it equally does rest on both theoretical and practical knowledge in in that the basis of of understanding is uh yes, yes, you could call it incomplete, but it is physiology and it is does relate rest on bio biochemistry and yes, ultimately or biophysics.
00:22:28.240 --> 00:22:41.680
So the the theory does matter, and if if people could go through um without spending four, five, six years at medical school and then simply be doctors, then they probably would, but they but they can't, um, because you wouldn't have that.
00:22:42.080 --> 00:22:44.400
That foundational theoretical knowledge.
00:22:44.560 --> 00:22:54.320
But by no means does that suffice in order to become a practitioner and an effective clinician, because you absolutely need experience.
00:22:54.480 --> 00:23:16.240
And when we get taught in medical school, and then you get mentored through hospital rotations and clinical placements, you know, the most most some of the wisest clinical mentors that I ever had, they give you the real lowdown about how a patient might presume present that is is nothing like a nothing like the textbook.
00:23:16.480 --> 00:23:30.000
And the smart, you know, the smart student, like they they listen when someone with such deep ex uh experience as some of these old doctors talk, because their practitioner knowledge is absolutely immense.
00:23:30.080 --> 00:23:34.560
And it's it's it can't be replicated in the textbook.
00:23:34.960 --> 00:23:43.200
It's just adding color and and um nuance and depth to to those textbook representations.
00:23:43.440 --> 00:24:14.000
So but to answer your question, the my perspective on this is that every time you you see a clinical case present in a unique way, or you see a disease syndrome or a uh an illness or something that's novel, then it kind of gets put into the back of your of a mind such that it becomes an intellectual touch point whenever I see a certain circum circumstance returning.
00:24:14.320 --> 00:24:19.600
So um I'll give you an example because this is probably one of them that stuck with me the most.
00:24:19.920 --> 00:24:27.680
You you you we have a lady who's um developed type 2 diabetes in quite a quote quite a short amount of time.
00:24:27.759 --> 00:24:38.240
So she was maybe in her late 40s or mid-50s, um, was not not really diabetic, and then maybe 12 months was forwardly diabetic.
00:24:38.480 --> 00:24:44.800
And she, you know, she mentioned to me, oh, you know, I ate ate really poorly over during the COVID period.
00:24:44.880 --> 00:24:49.039
And yeah, she wasn't she was overweight, but she wasn't massively overweight.
00:24:49.360 --> 00:24:54.640
And um she, you know, was being treated as a type 2 diabetic.
00:24:54.880 --> 00:25:12.880
So for your patients, there's obviously um the diabetes tells us about the problem, which is that you you've you've got a complete inability to handle glucose properly, but it doesn't tell us the the etiology, and it doesn't tell us whether that's an insulin-deficient process or an insulin-resistant process.
00:25:13.120 --> 00:25:25.200
Most people are insulin-resistant, type twos and diabetics, because their their insulin secreting capacity is intact, i.e., their pancreas and their beta-is cells work fine.
00:25:25.360 --> 00:25:38.320
Um, but their tissues, the liver, the skeletal muscle, the adipose is um essentially blocking entry to any more glucose substrate because their mitochondria and their uh are are uh full.
00:25:38.480 --> 00:25:44.240
They can't oxidize, they can't burn more substrate, so it's it eventually gets spilled out into the blood.
00:25:44.560 --> 00:25:49.039
Insulin deficient states is when we have loss of insulin production.
00:25:49.279 --> 00:25:55.759
So there's simply a lack of insulin, so that the the body essentially can't um put it away anywhere.
00:25:55.840 --> 00:26:02.720
The cells are starving for energy, but the the they can't get it because insulin's not there to allow the glucose to enter their cells.
00:26:02.960 --> 00:26:09.200
So um as as I mentioned, most people are type twos, but this lady's situation was slightly different.
00:26:09.440 --> 00:26:20.080
She um it turned out later um that she'd had some some back pain, just very, very vague, you know, discomfort.
00:26:20.320 --> 00:26:28.240
Nothing that was so severe that would you know even warrant a specific visit to the to the doctor for that problem, even.
00:26:28.400 --> 00:26:32.720
But apparently it had been something that was mentioned in passing multiple times.
00:26:33.039 --> 00:26:46.400
It turned out that the reason that patient was diabetic was because she had a pancreatic tumor that was growing and therefore obliterating her beat it her endogenous insulin production process.
00:26:46.720 --> 00:27:07.200
So she it was a form of acquired insulin deficiency, not from type one diabetes, not from her own body attacking her immune cells, but because there was a a tumor like a pancreatic adenocarcinoma eventually growing and then reducing her ability of the pancreas to work.
00:27:07.519 --> 00:27:21.519
So these types of presentations, when you when you actually are the doctor treating doctor, you know, you can read a case vignette about that, but it won't it won't enter your repertoire until you're actually dealing with it.
00:27:21.680 --> 00:27:28.080
So, you know, if the if you do have a patient with and and this lady had no symptoms of pancreatic cancer otherwise.
00:27:28.240 --> 00:27:39.440
So you can't, and that's why pancreatic cancer is a difficult uh disease, because it's often very late presenting, and by the time a patient presents with biliar obstruction and jaundice, it's you know very much game over.
00:27:39.680 --> 00:27:57.440
So the the takeaway or the learning point is that for me is that if you have a precipitous onset of type type 2 diabetes or or what you think is type 2 diabetes, then you you really have to be absolutely sure that that's what you're treating.
00:27:57.519 --> 00:28:04.080
Um, you know, is it really a tiger or is it um, you know, is it another form of a cat altogether?
00:28:04.240 --> 00:28:17.519
And it, depending on the clinical situation, then checking their insulin secreting ability in the form of this the C peptide alongside your insulin, checking things like uh pancreatic autoantibodies.
00:28:17.680 --> 00:28:25.519
And in some cases, if there's any hint of it or concern, then doing a CT abdomen uh is indicated.
00:28:25.600 --> 00:28:37.600
And and that's again, this is a difficult diagnosis because no one wants to give a year's worth of background radiation to a patient in one go with IV contrast to make this diagnosis.
00:28:37.840 --> 00:28:44.480
So the people people the scan doesn't often get done because it's it's a very it's it's not clear-cut.
00:28:45.120 --> 00:28:51.120
So again, it's a it's a very difficult diagnosis to make, but in this lady's situation, there was a clue.
00:28:51.360 --> 00:29:16.320
Um I I use that example as a as one to say that that's one that stuck with me, but this there's obviously hundreds of others in different forms that the body that the brain goes to in uh I guess type one type thinking, if you you know, Daniel Kahneman's work, it becomes type one thinking that you run through when you hear a case series or what we call illness script.
00:29:16.480 --> 00:29:24.880
Um, so yeah, it's a it's a and and the more patients you see and the more you listen to your patients, I think that's the key part.
00:29:25.039 --> 00:29:39.440
The more that you hear people's accounts and stories and and their lived experience of these diseases, the the quicker you build a mental model and a mental bank of disease presentations and possible solutions.
00:29:39.680 --> 00:29:51.920
Because we're just we're just we're just trying different combinations of therapies and lifestyle interventions that may or may not work for each of these people who are themselves an end of one experiment.
00:29:52.240 --> 00:30:10.960
So we have to have my particular my take on this is we we have to be open-minded, we have to be curious, we have to be fundamentally an experimenter who's happy to work with someone until we ideally find a combination or a thing or combination of inputs that um solves that person's problem.
00:30:11.759 --> 00:30:19.680
It's always fascinated me uh uh over the years as I've worked in a hospital seeing, you know, by at this stage thousands of patients.
00:30:19.840 --> 00:30:23.840
Uh, and I see them for longer than the doctors do as a respiratory scientist.
00:30:23.920 --> 00:30:28.160
So I get to chat with them and talk to them about a lot of stuff, and I see all their labs and whatnot.
00:30:28.320 --> 00:30:36.720
It's amazing how unique every single patient is, uh, even though they're all coming to a respiratory clinic for respiratory issues of some description.
00:30:36.960 --> 00:30:42.640
Everyone is so unbelievably different and presents in a slightly different way every single time.
00:30:42.720 --> 00:30:45.920
Um and it's just an incredible experience to just talk to people.
00:30:46.000 --> 00:30:50.000
And like you said, when you listen to them, I can't remember who said it.
00:30:50.160 --> 00:30:57.680
Uh maybe it was uh Freud or something who said, if you listen closely enough, your patient will tell you exactly what's wrong with them.
00:30:57.920 --> 00:31:06.400
And uh I've had that experience um of you know plenty of times just talking to people about you know when their symptoms started and all that kind of stuff.
00:31:06.560 --> 00:31:26.320
Um and I find it interesting that you know when we look at epidemiology or population um, you know, uh publications on populations, it's easy to forget that that data is only applicable to populations, like epidemiology, you know, you can't just place that uh on on recommendations for individuals.
00:31:26.480 --> 00:31:29.600
Those those are models only applied to populations.
00:31:30.240 --> 00:31:41.759
Um and I wonder sometimes because uh of the degree of heterogeny in populations, uh, how do you read a lot of this literature?
00:31:41.920 --> 00:32:05.039
Because I find myself really questioning a lot of the conclusions that one might be able to come to when reading literature, because maybe the things that you and I might do uh with regard to circadian rhythm, with regard to our food choices and all of that kind of stuff, may make us uh completely different to the person that the epidemiology uh epidemiology is modeling.
00:32:05.360 --> 00:32:16.160
And I wonder how you sort of bridge that gap between the things that are exist in the published literature and how you look at people who might be doing things very, very differently.
00:32:16.320 --> 00:32:22.640
I I often find it difficult to square or difficult to know where to draw the line between those two things.
00:32:23.360 --> 00:32:26.240
Yeah, it's it's a very interesting question.
00:32:26.320 --> 00:32:35.360
And I think we can like even break it down one more level, which is response to treatments and response to drug and therapeutic interventions.
00:32:35.600 --> 00:32:49.840
So what the what what modern science is built upon, and what I would call what they called evidence-based medicine, um was came up, I believe it was maybe the late 90s or the early 90s, perhaps.
00:32:50.000 --> 00:33:03.519
This idea of blending the best available evidence with practitioner knowledge and nuance to get to what could be seen as the best gold standard of patient care.
00:33:04.240 --> 00:33:07.759
A noble undertaking and very noble intention.
00:33:07.920 --> 00:33:33.920
But what essentially had happened is that it put this it it built and then kind of sanctified a hierarchy of evidence, which put the double-blinded placebo-controlled randomized control trial close to the top of this pyramid, and then you know, the meta-analysis or systematic review of randomized control trials, uh, you know, even even higher up.
00:33:34.160 --> 00:33:52.480
So what it happened, what has happened over the course of years, is that unless evidence has been in this form, in this format, then it's not going to be we're not going to look at any other forms of evidence.
00:33:52.640 --> 00:34:08.239
Um what what that means is that it favors clinical trials that are being designed, funded, and conducted by the pharmaceutical industry of drug therapies that they are able to patent and therefore profit from.
00:34:08.559 --> 00:34:25.199
So the the the whole paradigm is therefore being aligned towards um whether we get an averaged-out treatment effect across a group of patients, which may or may not be representative of the patient sitting in front of you.
00:34:25.440 --> 00:34:29.840
So as you can see, that there's multiple problems at each one of these levels.
00:34:30.000 --> 00:34:33.920
One is the trial study group representative.
00:34:34.079 --> 00:34:40.639
That's uh, you know, that's what we call external validity in terms of um of epidemiology.
00:34:40.719 --> 00:34:45.360
And then is the trial itself, was it a robust trial?
00:34:45.440 --> 00:34:52.320
You know, that's the that's the internal validity, you know, with was the randomization process done properly, et cetera, et cetera.
00:34:52.400 --> 00:34:54.320
You know, are they even asking the right question?
00:34:54.720 --> 00:35:01.920
Are they compare comparing this drug against a non-inferiority trial against one that has already been in use?
00:35:02.400 --> 00:35:14.480
So, you know, there's all these these uh questions, and then when you get the results of the trial, uh, were there some who responded uh very well and some who hardly responded at all?
00:35:14.639 --> 00:35:18.960
And if you take an averaged-out effect, are you gonna miss the signal?
00:35:19.360 --> 00:35:49.599
So all this to say, in this day and age, medical practice and clinical practice is overwhelmingly influenced by the ev this evidence base that's actually generated through one, a biased funnel because it's it's inherently uh geared towards finding favor for a patentable drug as in opposition to non-patentable drugs which aren't even going to be examined because there was there's no potential profit in a pipeline.
00:35:49.920 --> 00:36:19.280
So we're we we're just looking at a uh group of possible treatments that doesn't encompass all possible treatments, and then inevitably there's a favorable finding found, and and other mechanisms of of regulatory intervention get um, I would say, manipulated to to pass that XYZ treatment and which is worth a lot of money, and eventually the taxpayer fits the bill, foots the bill.
00:36:19.440 --> 00:36:21.920
Um they that's that's what gets passed in.
00:36:22.079 --> 00:36:25.440
So yeah, absolutely, that's a it's a massive problem.
00:36:25.760 --> 00:36:30.079
And um, I'm just speaking with respect to essentially drugs.
00:36:30.240 --> 00:36:36.320
I mean, you can you can you can enter whatever new drugs come out and it kind of will fit into this, I think.
00:36:36.400 --> 00:36:39.680
And not to say that some aren't useful and they s they serve a role.
00:36:39.760 --> 00:36:58.639
I use them in clinical practice daily, but it's a big distraction away from what actually fundamentally root cause is going to turn that person's biology around or remove the in initial offending insult or combination of insults that got that patient into the into their problem in the first place.
00:36:58.880 --> 00:37:02.320
But you know, as it relates to observational data, I agree.
00:37:02.480 --> 00:37:12.079
I think we have a similar problem, which is if we look at a big observational cohort of people, uh, again, to what to what degree is that averaged out finding relevant to the patient in front of us?
00:37:12.240 --> 00:37:26.639
And I think maybe the most important one to mention that I find myself talking about is say something like the melanoma in southern Sweden cohort studies or or Richard Weller's Professor Weller's studies of UV light exposure and health.
00:37:26.800 --> 00:37:41.119
And you know, the outcome of of all of these cohort studies is that at a population level, the more UV light someone gets, the longer they live, the less their all-cause mortality, but the higher their chance of getting a skin cancer diagnosis.
00:37:41.360 --> 00:37:45.280
So I have I explained that that this is a population effect.
00:37:45.519 --> 00:37:53.920
And this is a difficult thing to say to someone whose mom got or you know, sister got a malignant melanoma at the age of 36.
00:37:54.480 --> 00:38:01.360
Um we can go into the nuances of causes of nuances of potentially why that happened in that patient's N equals one.
00:38:01.680 --> 00:38:11.360
But yes, it's a difficult to bridge that gap between averaged-out epidemiological and observational findings and and the patient in front of you.
00:38:11.920 --> 00:38:17.280
That was an incredibly cognizant and succinct answer that clarified things for me.
00:38:17.360 --> 00:38:19.680
I'm I'm very glad I asked that question.
00:38:19.840 --> 00:38:27.840
Um, I I want to know because someone asked me this uh a week or two ago, and I was very disappointed with how much I fumbled the answer.
00:38:28.000 --> 00:38:36.639
Um, I I'd I'm very interested in understanding your elevator pitch for why light is important and what light does for your health.
00:38:36.800 --> 00:38:38.000
Um, someone asked me that.
00:38:38.079 --> 00:38:39.760
They're like, can you explain in a minute?
00:38:39.840 --> 00:38:41.200
Uh, you know, what do you tell people?
00:38:41.360 --> 00:38:42.800
And I was like, you know what?
00:38:42.880 --> 00:38:45.680
I really don't know how to explain it succinctly yet.
00:38:45.760 --> 00:38:56.320
Um, I'm interested in how you sort of convey this message to um patients that you might see that have absolutely no idea that light impacts their health whatsoever.
00:38:56.960 --> 00:39:07.360
Yeah, I mean, I I would say that it was an ever-present factor in the development of your body and your ancestors' bodies and biology, you know, full stop.
00:39:08.320 --> 00:39:12.800
So without it, we we wouldn't exist as life does today.
00:39:13.119 --> 00:39:38.000
And the things that it offers to you is can be thought of as an as nutrients, as timing signals, as um coordination, uh coordination signals, and um basically all of all of those together enable the cell to and your body to actually work in the way it was it it most properly is able to.
00:39:38.240 --> 00:40:00.320
So um without getting too deeply into what light is itself, but fundamentally there's a smoggus board of uh nutrients that are in the forms of different light wavelengths that are providing a unique role and a new unique um necessary role for the cells and your body's health.
00:40:00.559 --> 00:40:19.280
And we just need to understand, or it helps to understand what each one does and how we naturally would have got them, which is in the package of full spectrum sunlight, um while and and also avoiding using something like artificial light at the wrong time.
00:40:19.519 --> 00:40:28.880
So when you understand how critical it is as a nutrient and a timing signal, then you you try and avoid using artificial light at night time.
00:40:28.960 --> 00:40:35.840
You try and get full spectrum sunlight during the day um and you time that relative to your skin type and your latitude and your ancestry.
00:40:36.000 --> 00:40:43.599
Um, and then the body works properly because it's uh, like we said, such a fundamental uh environmental signal.
00:40:44.000 --> 00:40:49.760
How do you implement this with the patients that you see with regard to their light environments?
00:40:49.920 --> 00:41:00.240
Because uh, for a lot of people, I imagine it's rather difficult to curate their light environments, you know, as as precisely as you might like them to be able to do.
00:41:00.400 --> 00:41:04.480
Uh, what what are the workarounds that that you're able to come up with at the moment?
00:41:04.559 --> 00:41:06.159
Because it's very difficult.
00:41:06.960 --> 00:41:08.400
It's extremely difficult.
00:41:08.639 --> 00:41:26.240
And yeah, it's it's difficult because in the scope of a 20 or even 30-minute or even 14-minute console in the clinic, I feel like I cannot give enough uh time and and attention to really make sure people get this.
00:41:26.480 --> 00:41:32.159
And I think that 99.99% of people aren't doing the light thing correctly.
00:41:32.400 --> 00:41:39.840
There's a very small minority who are truly understanding what we're talking about because it's actually quite complicated.
00:41:40.079 --> 00:41:51.760
And without telling people to live in a hut with a set of candles, that's a very intuitive way to do it without needing a debt deep explanation.
00:41:51.840 --> 00:41:52.880
But it's not going to happen.
00:41:53.119 --> 00:42:04.960
So, you know, the type of concepts that you we're trying to convey, let me just talk about the nighttime first, is that we're trying to convey one, an absence of daytime wavelength.
00:42:05.360 --> 00:42:14.079
So we're trying to tell them that they shouldn't have blue and green light particularly for its melan melanopsin activating and melatonin-suppressing effect.
00:42:14.320 --> 00:42:25.840
We're trying to tell them avoid the positioning of overhead light, which in and of itself is stimulatory because above head light was the only daytime was a daytime signal.
00:42:26.000 --> 00:42:30.159
We never never had above head light that was otherwise at another time of day.
00:42:30.400 --> 00:42:33.440
It has to be of a low enough intensity.
00:42:33.599 --> 00:42:39.519
And we're, you know, I'd I in the hour before sleep, like trying to get the light under five lux.
00:42:40.720 --> 00:42:41.760
You don't have time to explain.
00:42:41.840 --> 00:42:44.639
You could there's so many concepts you have to explain to get that far.
00:42:44.880 --> 00:42:53.119
Um and then trying to avoid other things like uh, you know, a flicker and and beneficial spectrum and and the rest of this.
00:42:53.360 --> 00:42:55.119
So it's it's it's a challenge.
00:42:55.360 --> 00:43:07.440
I think what what I'm trying to do at the moment is get everyone on a pair of blue-like blocking glasses because everyone is going to have some form of blue and green wavelength containing light in their nighttime environment.
00:43:07.599 --> 00:43:10.960
So they become a must to at least mitigate that effect.
00:43:11.200 --> 00:43:20.880
And then what I've been doing lately is saying, look, why don't you use a single incandescent light in your work and living and kitchen area and then switch it off.
00:43:20.960 --> 00:43:28.240
It comes 7, 7:30 p.m., switch that light off and only use some visible red LEDs.
00:43:28.559 --> 00:43:40.960
That way we are eliminating this melanoxin-suppressing light, and we are promoting a very low light environment without having too many uh disruptive or overhead signals.
00:43:41.200 --> 00:43:45.440
So it's hard, but that's kind of what I point to for nighttime.
00:43:45.519 --> 00:43:58.880
And then for daytime, I I basically say you you need to get out as soon as possible and you need to expose your skin and your eyes without filtration through lenses, through eyeglasses, through windows, through car windows, through anything.
00:43:59.039 --> 00:44:18.800
And the more sun you get, the the better, because the more your skin and eyes are able to congruently use that light information to coordinate your body processes and run your metabolism, run your immune system, um, run run your your essential hormonal processes.
00:44:18.960 --> 00:44:28.240
Um, and then you do need some midday light additionally, and that is how the body makes vitamin D because it's irrepro it's not replaceable by a tablet.
00:44:29.200 --> 00:44:34.480
Some combination of those things is what I'm working with now, but um, it's difficult to cover it all.
00:44:34.559 --> 00:44:37.200
And and yes, we can't you can't do it in one console.
00:44:37.840 --> 00:44:48.960
Yeah, it's it's uh it's definitely something that even Even myself, I've been trying to do this properly for myself and my family for, you know, coming up to 10 years now.
00:44:49.119 --> 00:44:51.039
I still don't know what the right answer is.
00:44:51.200 --> 00:44:55.680
You know, I'm carrying around, you know, assault lamps with me everywhere at the moment.
00:44:55.840 --> 00:45:05.200
Um, it was funny because I I got back to Sydney and I had to fix all my parents moved to a new place and they've, of course, they're all LED down lights.
00:45:05.360 --> 00:45:08.800
Um, so I had to fix everything up and they're complaining it's too dark.
00:45:08.960 --> 00:45:10.559
I've put incandescence everywhere.
00:45:10.720 --> 00:45:13.920
And uh it's just a bit of a bit of a nightmare, isn't it?
00:45:14.079 --> 00:45:41.840
Um, but it was interesting uh in Sweden because of the how far uh off the equator you are, the swings between short day lengths and long day lengths is is so significant uh and so different to what I spent most of my life doing, um, that uh it's very difficult to figure out what the right thing to do is when you're in a place where the sun basically doesn't set or the sun sets at 2:30 p.m.
00:45:42.320 --> 00:45:47.519
Um and uh I'd love to hear your thoughts on this.
00:45:47.680 --> 00:45:51.119
I didn't take a vitamin D supplement the whole time I was there.
00:45:51.280 --> 00:45:56.960
I did a little bit of cod liver oil the first winter, and then I didn't know cod liver oil the next winter.
00:45:57.440 --> 00:46:00.000
And basically I was fine.
00:46:00.159 --> 00:46:06.639
Um, but you know, we were going seven, maybe eight months of no UVB.
00:46:07.039 --> 00:46:09.519
Um, I'm curious what you think.
00:46:09.920 --> 00:46:17.440
Uh in a situation like that, would it have been better for me to mess around with taking some vitamin D?
00:46:17.599 --> 00:46:24.960
Uh, I know I know that's an impossible question to answer, but um, I was okay, which uh I wasn't sure what I was expecting.
00:46:25.039 --> 00:46:29.519
Maybe it was a stupid thing for me to do, but yeah, it's a whole different world over there.
00:46:29.920 --> 00:46:37.519
I it's fascinating to experiment with those radical changing photo periods and and what that does to your biology.
00:46:37.760 --> 00:46:42.800
I think there's two two ways to approach this question: one theoretically and one maybe more clinically.
00:46:43.039 --> 00:46:49.680
Theoretically, the answers is gonna massively depend on the individual and their and their background.
00:46:49.840 --> 00:47:07.920
And it it reminds me of a paper that, medical hypothesis paper that um that came out maybe a couple months ago, that was investigating the possibility of male androgenic alopecia, so male pattern balding, as an adaption to low solar conditions.
00:47:08.240 --> 00:47:12.159
And what it was in in vitamin D um receptor variants.
00:47:12.320 --> 00:47:36.639
So what it what it was possibly hypothesizing that was that the loss of hair on on the in the male head, the vertex, and the front, all these frontal areas, depending on I mean the exact pattern is going to vary individually, but that coincides to the position where the sun is going to be maximally overhead and therefore maximally able to generate vitamin D.
00:47:36.960 --> 00:48:09.039
And so it's it was hypothesizing that in northern European people who probably had some adaptations to cold and um would have been clothed, that suddenly the small amount of area on the scalp could become a potentially significant percentage of exposed body surface area enough to generate a meaningful amount of vitamin D that might potentially become a selective pressure to avoid osteoporosis in in that man.
00:48:09.599 --> 00:48:21.920
So it's it's a hypothesis and it's been driven by probably one of the most strongest associations, which is vitamin D insufficiency and deficiency in in androgenic alopecia.
00:48:22.480 --> 00:48:37.280
So I mean we could talk a lot about I've been thinking a lot about that that problem, and I um and I think I think it it it is uh I think it's a sign of of I mean I think it's a sign of aging.
00:48:37.360 --> 00:48:45.760
I think it's it's it's it's a maladaptive response to suboptimal conditions, where the what I don't think sunlight's not the only factor by by any means.
00:48:45.840 --> 00:48:47.920
There's there's obviously multiple things going on here.
00:48:48.159 --> 00:49:02.400
But the reason I bring it up is because you had there's people, and and when I did a reel recently, it it went a little bit viral, and you had all the reply people saying how they know all these tradies who've been in the sun who are very bald.
00:49:02.800 --> 00:49:23.280
And I agree with them, and I wasn't meaning to try and convey this complex conversation in in one minute on a reel, but for some people, and I and whether it's their vitamin D receptor status or some other genetic variant, are gonna are potentially gonna be very susceptible to drops in serum vitamin D levels.
00:49:23.599 --> 00:49:34.559
And I'm not sure who those people necessarily are and um you know what what either is the ideal combination of exposure versus lack of exposure.
00:49:34.720 --> 00:49:55.519
But my presumption is that if any population is adapted or evolved to one depigment and two, you know, cold adapt through the uncoupling proteins and the rest to live at such a high latitude, then they're probably adapted to have an absence of sunlight and UVB throughout several months of the year.
00:49:55.599 --> 00:49:57.200
That that makes sense to me.
00:49:57.440 --> 00:50:10.320
Um what about someone who is a Fitzpatrick 5 or you know they've their ancestors are from the Pacific Islands in Fiji, where it's a it's really hot and and high UV all year round.
00:50:10.559 --> 00:50:14.960
Well, there wouldn't, I was there recently, there was no very little androgenic alopecia.
00:50:15.280 --> 00:50:17.280
There was none uh to make of.
00:50:17.440 --> 00:50:33.360
And it coincides with the findings that this is a this that condition seems to uh mostly affect northern European people uh with I think rates approaching uh you know prevalence associating uh approaching 90% by the age of 80.
00:50:33.440 --> 00:50:38.079
Um, not so in in African populations, not so in these equatorial populations.
00:50:38.240 --> 00:50:54.159
And it would kind of make more sense because if you are if the head is supposed to cop uh UV high UV indexes all year round, then you actually need a thick amount of heavily U melanated hair follicles to protect that dome.
00:50:54.240 --> 00:51:09.760
Um, and there wasn't a need to evolve an adaptive shedding of hair, if this solar hypothesis turns out to be you know reasonably valid uh uh in certain people that that to account for that phenomenon.
00:51:10.000 --> 00:51:13.760
So I think to answer your question, it's gonna be dependent.
00:51:13.840 --> 00:51:32.960
And if people have northern European ancestry, then to me it makes more sense that they are would be able to go winter without generating vitamin D compared to someone who's darker who I think needs a constant drip of it because that's what their ancestors, um, their ancestry has developed.
00:51:33.200 --> 00:51:43.840
Now, when it comes to the clinical question, that's a different that's a different question, which is should we supplement vitamin D in people who are insufficient or deficient?
00:51:44.159 --> 00:51:56.639
Um and I have a depending on what condition they're suffering from, and depending on how low their level is, then I will recommend them that they should should should take an oral vitamin D supplement.
00:51:56.880 --> 00:52:03.840
Um, you know, if you have someone who's got thinking for an example, again, we're using in extreme examples.
00:52:04.159 --> 00:52:14.639
Patient who's been on carbamazepine, tegritol, which is an anti-epileptic medication, for years, and it in it massively interferes with vitamin D effects and and and generation.
00:52:14.880 --> 00:52:28.720
Um and that person was has developed severe osteoporosis because they're unable to absorb and utilize calcium and phosphate um efficiently because of that that low level.
00:52:28.880 --> 00:52:52.400
So, you know, if you're trying to build someone's vitamin T level up who's symptomatic of or it's experiencing osteoporotic crush fractures, you I'm not gonna just say, okay, you know, now now you lie in the sun in uh at a very um southern latitude where there's not enough uh sunlight to and wait and hope that their their level climbs.
00:52:52.559 --> 00:52:53.920
Like we're not gonna do that.
00:52:54.079 --> 00:53:09.920
We're gonna therapeutically boost it up and then hopefully keep it there with sun habits after we've you know got them beyond the the minimum uh threshold for for you know re-establishing proper calcium and phosphate um homeostasis.
00:53:10.960 --> 00:53:11.599
Absolutely.
00:53:11.760 --> 00:53:24.079
I think um I think the nuance is hard to grasp and and interest interestingly, uh when summer does roll around, it's incredible in Scandinavia how dark the the the natives get.
00:53:24.240 --> 00:53:28.880
Like they get darker than me, um darker than I would ever get here.
00:53:29.280 --> 00:53:35.119
And um, I never got burnt in Sydney and I was I was I was sunbathing every day.
00:53:35.280 --> 00:53:46.720
Um, but I burnt several times in Sweden because you know you go such an extended period of time with nothing, and then you get the first day of like 10 degrees, and you're like, oh my god, it's time to get naked outside.
00:53:47.039 --> 00:53:54.960
Uh and uh yeah, I was getting erythemas that I would never get in Australia, so it just it there's so much more going on.
00:53:55.119 --> 00:54:03.519
Uh and that probably had to do with the fact that my circadian signaling was was not so great because it's actually quite hard to do in those parts of the world.
00:54:03.760 --> 00:54:09.360
Um, and it's not easy to get outside at the right times because it's bloody freezing.
00:54:09.519 --> 00:54:24.480
Um, but yeah, there's yeah, it gets to the idea of why you know it's sometimes it's you give it away as like a gimmick and a shortcut in terms of lifestyle advice in in these kind of niche health circles, or just move to the equator.
00:54:24.720 --> 00:54:46.880
But the the explanation is because in the equator, you there's a there's a predictable, stable photo period of 12 hours with a predictable year-round amount of ultraviolet light um and a stable temperature and that allows or makes these habits, these circadian habits, much more easy to implement and maintain.
00:54:47.200 --> 00:54:51.680
So um that there's a case for it absolutely to be made.
00:54:52.000 --> 00:54:53.360
Yeah, I I couldn't agree more.
00:54:53.440 --> 00:54:57.119
I hadn't considered it from that perspective before, but that's absolutely right.
00:54:57.280 --> 00:55:06.559
It does it has been so much easier being back in Sydney because you know the sun is rising and setting at reasonable hours, and I haven't even an alarm clock.
00:55:06.720 --> 00:55:08.960
Everything I'm waking up at the same time every day.
00:55:09.039 --> 00:55:10.159
It's it's really magic.
00:55:10.240 --> 00:55:13.039
I wasn't able to do that for two years, basically.
00:55:13.280 --> 00:55:18.159
Um I'm very interested in the visceral fat story.
00:55:18.240 --> 00:55:22.079
It's something I I'm uh very poorly educated on.
00:55:22.159 --> 00:55:24.079
I don't know a whole lot about it.
00:55:24.320 --> 00:55:35.680
I I guess, and I don't know if there's a an answer to this question, um, but evolutionarily we probably have evolved to preferentially store fat subcutaneously.
00:55:35.840 --> 00:55:44.079
Um, and and and that's that's very obvious, particularly in women, we see where subcutaneous fat is um preferentially stored.
00:55:44.960 --> 00:55:52.159
What is the cause uh of the fat being stored around the organs?
00:55:52.400 --> 00:55:57.920
What is causing the fat to be deposited there rather than in subcutaneous fat deposits?
00:55:58.400 --> 00:56:02.320
I mean, the the the this is the million-dollar question, really, isn't it?
00:56:02.480 --> 00:56:11.840
Um the the the answer is that there's multiple re there's multiple contributing factors that I think are different for each individual person.
00:56:12.800 --> 00:56:24.880
And I I I the I think the big picture is that the body wants to physically use the physiological fat depots as much as it can.
00:56:25.119 --> 00:56:38.480
It wants to store excess energy under the skin in these white adipocytes that are that provide an easily accessible um source of of stored energy.
00:56:38.639 --> 00:56:46.880
Like that that is completely healthy fat storage is in these cells that are actually going to be seeing the sun.
00:56:47.039 --> 00:56:48.000
That's a key point.
00:56:48.159 --> 00:56:54.639
The physiology of the white cells under the skin is that they have this melanopsin uh OPN uh OPN4.
00:56:54.880 --> 00:56:57.280
They can they actually detect blue light detectors.
00:56:57.519 --> 00:57:03.760
And on blue light, they actually increase their lipolysis or their fat um mobilization.
00:57:03.920 --> 00:57:08.159
Um they are this an endocrine organ, this this adipose tissue.
00:57:08.240 --> 00:57:15.280
It's it releases leptin, it releases adiponectin, it releases factors that are actually health promoting.
00:57:15.680 --> 00:57:31.519
And the most healthy phenotype, I think, for optimal longevity is actually some degree of increased uh fat store with subcutaneous but not visceral fat.
00:57:31.599 --> 00:57:49.599
And the reason is because when you talk to uh Nir Barzalai, who is the longevity researcher who uh looked at a cohort of long-lived people in New York, he he landed or he observed a BMI of 26 as to be a commonality amongst these supercentenarians.
00:57:49.840 --> 00:57:58.960
So it wasn't people that that looked like um, you know, Ziz Ziz Shavashian or uh or some other form of bodybuilder.
00:57:59.039 --> 00:57:59.760
It wasn't that.
00:57:59.840 --> 00:58:03.519
It was some it was some people that had an extra amount of weight on.
00:58:03.680 --> 00:58:06.240
But the the nuance is where was that weight?
00:58:06.400 --> 00:58:11.119
And because we don't have MRIs for those gentlemen, we can't tell we can't tell you.
00:58:11.200 --> 00:58:14.960
I'm hypothesizing, but I'll explain my reasoning.
00:58:15.280 --> 00:58:28.800
Because when the body stores energy in the subcutaneous depots under the skin, then that that doesn't come with a corresponding negative inflammatory and cytokine profile.
00:58:29.440 --> 00:59:09.760
Whereas when the fat seems to be exceeding safe storage, or for some other reason unable to be further loaded into safe subcutaneous storage for a variety of reasons: genetic, uh, metabolic, circadian, related to a bunch of facts we can go into as well, then the body is making this trade-off, which is we we're gonna have to store it in this ectopic deposit, which is inside inside the abdominal cavity around the organs and around the heart, pericardial, visceral fat, and epicardial fat around in in the liver, in the muscles eventually.
00:59:10.000 --> 00:59:23.360
But the characteristics of that, those fat tissues is they they they actually become um so hypertrophied that they they expand and they exceed the perfusion in the in the blood supply.
00:59:23.519 --> 00:59:25.119
So it's almost like a tumor.
00:59:25.280 --> 00:59:26.480
That's what a tumor does.
00:59:27.039 --> 00:59:37.200
A tumor can grow so fast that it um exceeds the the ability to perfuse it with with the blood vessels and therefore you know becomes necrotic.
00:59:37.280 --> 00:59:39.920
That's that's a characteristic of a of a cancerous tumor.
00:59:40.079 --> 00:59:42.880
That's what the same thing that's happens with visceral fat depots.
00:59:43.039 --> 00:59:47.760
The cell will rather than replicate, the cell has to grow.
00:59:48.000 --> 00:59:58.240
Um, you know, we it's it's a common saying, you know, what happens when when uh an a system is losing energy or is is uh you know grows bigger in in a half hour it grows bigger.
00:59:58.480 --> 01:00:01.039
Um it's a maladaptive response.
01:00:01.200 --> 01:00:03.440
And the adipocite is doing the same thing.
01:00:03.519 --> 01:00:16.240
It's it's hypertrophrophing to the extent that it becomes inflamed and infiltrated with immune cells and and broadcasting inflammatory pro-inflammatory cytokines.
01:00:16.880 --> 01:00:20.159
Um and because it's it's you know it's hypoxic.
01:00:20.320 --> 01:00:23.760
So the body doesn't want to have to put energy there, but it but eventually does.
01:00:23.840 --> 01:00:27.119
So what are the factors that are gonna exacerbate this?
01:00:27.440 --> 01:00:38.559
I think, like I said, I think partially genetic and genetic, there seems to be a genetic predisposition to subcutaneous versus um visceral fat deposition.
01:00:38.720 --> 01:00:41.840
And it's again related, seems to be related to latitude.
01:00:42.159 --> 01:01:04.720
Northern European people seem to be able to put down massive amounts of energy in subcutaneous stores and be relatively protected from insulin resistance and metabolic dysfunction um compared to, say, South Asians, Indians, even you know, Africans, Australian Aboriginals, uh, Pacific Islanders.
01:01:04.960 --> 01:01:12.559
And maybe it's because with that amount of solar exposure, there wasn't a need to actually store lots of energy.
01:01:12.800 --> 01:01:29.840
And what we know about how energy homeostasis as it relates to the light exposures, we know that um, you know, this these alpha MSH uh melanocorn peptides, which are going to be made on UV light exposure, are negatively feeding back onto polycene neurons to suppress appetite.
01:01:30.000 --> 01:01:45.840
We know that um the like like we talked about, the the fat cells have these melanopic sensitive elements so that they essentially wouldn't want to store uh energy if there's an abundant energy source that they're plugging into.
01:01:46.000 --> 01:01:56.960
So I think people uh already with lots of melanin are probably less programmed to store fat, and they're probably less programmed to have expandable subcutaneous fat stores.
01:01:57.280 --> 01:02:05.039
Um I'm hypothesizing, and obviously there's uh lots of heterogeneity and variation within pigmented people about this.
01:02:05.200 --> 01:02:07.760
Um, and then there's there's some environment this factor.
01:02:08.000 --> 01:02:32.559
So we know that if you if you and this is mouse tartar, you can simulate circadian disruption in a mouse cohort with mistimed um lighting and feeding, and those m m mice get um visceral fat expansion, they get a necrotic macrophage infiltration into their adipocytes, and with the same diet, they become you know metabolically compromised.
01:02:32.720 --> 01:02:38.880
So I think circadian signals matter the time, and that it that means the timing of eating.
01:02:39.039 --> 01:02:48.480
I think consuming food preferentially at nighttime is gonna get into visceral deposits, then it's what the food itself.
01:02:48.639 --> 01:03:01.039
I think there is some evidence that poly on these polyunsaturated seed oils preferentially um interfere with correct oxidation of substrates such that they will get into this um depot more.
01:03:01.360 --> 01:03:10.000
Alcohol um and carbs, because there's this oxidative priority, and and the body's gonna attempt to burn those food those first.
01:03:10.159 --> 01:03:19.440
If they can't, um it's the metabolism is is in my uh estimation is breaking such that uh that they're probably getting deposited.
01:03:19.519 --> 01:03:25.360
And what I see in reality in clinical practice is if someone's drinking a bottle of wine at 9 p.m.
01:03:25.440 --> 01:03:31.039
at night with some sweet food, and then you bet they're gonna be laying down visceral fat.
01:03:31.280 --> 01:03:34.000
So, you know, those are the those, and then stress.
01:03:34.159 --> 01:03:43.119
Cortisol seems to disproportionate and testosterone disproportionately uh assists in visceral fat um deposition.
01:03:43.360 --> 01:03:48.400
Stress, people who are stressed get visceral fat with very little else.
01:03:48.559 --> 01:03:50.480
Um it's enough to put it in there.
01:03:50.720 --> 01:03:51.039
Dr.
01:03:51.200 --> 01:03:54.559
Omar in in the US notices in long distance runners.
01:03:54.720 --> 01:04:03.360
They'll they'll be doing everything else right, but if they're jogging for a hundred and kilometers a week, they will be having visceral fat being deposited.
01:04:03.599 --> 01:04:13.280
Um, and then uh you know, additionally to that, probably the the um this this male male hormones.
01:04:13.440 --> 01:04:23.680
Um again, it's it's I've heard from other clinicians that men who are using anabolic steroids, they get they have extremely strong musculature.
01:04:23.760 --> 01:04:25.119
I haven't seen these MRIs myself.
01:04:25.200 --> 01:04:26.720
I'm looking forward to doing them.
01:04:26.880 --> 01:04:30.480
Um, but they they've they're carrying visceral fat in their abdominal cavity.
01:04:30.559 --> 01:04:50.559
So, and then the radiologist will also tell you there's uh you can see a couple who live the same presumable lifestyle, the same diet, and the lady has just complete um fat storage in in around the buttocks and legs and and under the skin, and her husband, it's it's all in the abdominal cavity.
01:04:50.800 --> 01:04:53.680
So there's there's a lot to say here.
01:04:53.840 --> 01:04:58.079
Um I have I that that's kind of my thinking at the moment.
01:04:58.320 --> 01:05:28.480
Um, but if you if someone is experiencing this or they're having visceral fat um deposit, and obviously carbohydrates in and of themselves, because when the mitochondria are spilling out of energy and they can't fit anything more in, then carbohydrates, even from benign, benign sources like fermented sourdough or sweet potato, it's gonna go into storage until you can fit that gear stick back into ketogenic metabolism and and start burning this excess substrate off.
01:05:28.639 --> 01:05:34.240
Um, so you know, those are the probably the main factors that I think drive visceral fat deposition.
01:05:34.639 --> 01:05:49.680
I'm curious as to how I mean, I'm I know there's a little bit of research, I'm not sure how much, but how to specifically target uh the removal or the or the uh correction of the storage of this visceral adipose tissue.
01:05:49.840 --> 01:06:02.320
I think there's been some work on some plant hormetic compounds like EGCG from green tea and things like that, being able to um uh upregulate the amount of fat that's being used from visceral stores.
01:06:02.480 --> 01:06:11.680
Um, but uh where what is the state of your understanding at the moment with regard to people that are coming into you with visceral fat going, what do I need to do?
01:06:12.159 --> 01:06:16.079
Yeah, it's I think it's an academically extremely interesting question.
01:06:16.320 --> 01:06:37.840
But for the patient in front of us, we're gonna implement a range of strategies that I think seem to preferentially or uh get this f fat tissue off, but not necessarily because of w what they're doing in that the body itself wants to get rid of this fat.
01:06:38.000 --> 01:06:41.760
So uh it will preferentially to some degree burn burn this off.
01:06:42.320 --> 01:06:55.280
Um so I th I I personally don't make too many distinctions and or promises about, you know, this is what is going to, you know, get rid of your abdominal fat preferentially.
01:06:55.599 --> 01:07:04.480
But when, you know, my my suite of approaches seems to over time uh you know get work to reduce it.
01:07:04.720 --> 01:07:06.639
It's it's a work in progress.
01:07:06.800 --> 01:07:13.440
It doesn't, depending on how long the patient's got has had visceral storage, it's gonna take a while to get off it.
01:07:13.599 --> 01:07:28.400
And um, it's a it's an opportune time to discuss this because I'm as we're talking off air, I'm literally just about to launch uh my own MRI product that is gonna allow us to scan you without ionizing radiation.
01:07:28.639 --> 01:07:52.800
Look to see what's going on inside, look to see whether your fat is in this safe subcutaneous depot, um, and you're and and potentially the BMI is uh calling you less healthy than you are, or it's in this visceral depot and around your heart, and then in which case, you know, you're in trouble and and the BMI hasn't told you anywhere near as uh how worried you should be.
01:07:53.039 --> 01:08:03.360
But um in in practice, it's going to be a a series of things that we do, which relates to the beginning of our conversation in terms of environmental signals and hormesis.
01:08:03.519 --> 01:08:34.319
When you reintroduce the hometic uh nature of these environmental signals, when you reintroduce the amplitude, when you re-establish amplitude, circadian amplitude, you re-establish um the the the feeding and fasting amplitude, when you reintroduce exercise, rest and rest and intense exercise amplitude, that contrast, that seems to be the most effective way to um you know the amplitude between carbohydrate, glucose metabolism, and ketosis.
01:08:34.639 --> 01:08:42.159
And then you can you can re you can put this metabolic system back into gear and and start the uh healing right.
01:08:43.359 --> 01:08:46.159
How often are you in ketosis out of curiosity?
01:08:47.359 --> 01:09:16.159
I would I would probably flip in two ketosis maybe uh weekly, but I would spend maybe maybe 24 hour period in 24 to 36 hour period every week in ketosis, mostly through um not through reduction in feeding um instances, but simply weekly carbohydrate restriction.
01:09:16.800 --> 01:09:17.440
Interesting.
01:09:17.600 --> 01:09:35.520
Uh I'm I'm curious as to uh your perspectives on deuterium depletion protocols as well, uh whether you have any experience with them and and what from your clinical experience uh deuterium depletion is is contributing to with regard to the health of the patient.
01:09:36.000 --> 01:09:45.600
Yeah, I I mean that that is an extremely interesting question and one that I can't say I have had a lot in terms of implementing.
01:09:46.560 --> 01:09:55.119
The I mean the main condition which is indicated for deuterium depletion in my mind is is any is cancer.
01:09:55.279 --> 01:10:02.239
Um and I think a severe type type 2 diabetic, you know, very poorly controlled type 2 diabetic also fits that criteria.
01:10:02.480 --> 01:10:10.319
And because of it's of the access, you know, that obviously in the cost, it's not something that I routinely recommend.
01:10:10.640 --> 01:10:19.760
But one that I'd be really I'm really interested to use, especially in the context of MRI, where we can really get a before and after.
01:10:20.000 --> 01:10:23.440
I mean, the thing is that when we're very rarely changing one factor.
01:10:23.680 --> 01:10:41.520
So to what degree that's gonna be moving the needle versus uh again, carbohydrate restriction, eating deuterium-depleted uh animal fats, grass-fed animal fats, um, introducing time-restricted eating windows, it's it's very difficult to say.
01:10:41.840 --> 01:10:53.600
But um it it I think the angle of the question also invites this idea of to what degree is the this visceral fat problem a problem of of deuterium and deuterium overload.
01:10:53.840 --> 01:10:58.800
And um it's a question I asked Laszlo Boros three years ago when I interviewed him.
01:10:59.039 --> 01:11:14.640
Um and the way he framed it, which I I really like and I I kind of use, is more of this idea of uh visceral fat as a kind of as what he called metabolic crowding.
01:11:14.800 --> 01:11:21.760
And metabolic crowding is when you get a build-up of partially combusted energy substrate.
01:11:22.079 --> 01:11:28.000
And again, because it can't be fed through the mitochondrion for whatever reason, because it's 9 p.m.
01:11:28.159 --> 01:11:36.399
at night, there's no red infrared spectrum turning the the the hitting cytochrome um for or or spinning the ATPAs.
01:11:36.800 --> 01:11:53.039
Um for all these reasons, because you're you're sedentary, you're not doing any forms of exercises, you're not maintaining lean muscle mass that again provides a a sink to some degree for excess energy substrate because you haven't developed a brown adipose tissue.
01:11:53.119 --> 01:11:58.159
You know, you're not someone isn't uh living congruent to their environmental signals.
01:11:58.399 --> 01:12:15.920
To all these reasons, you get unburnt substrate, and really it's it's it's it's can be thought of as unburnt fuel coming out of the back of a of an engine that's not tuned properly, and because it's that that engine's lacked these environmental inputs like that we discussed.
01:12:16.079 --> 01:12:18.079
Um, and he calls that metabolic crowding.
01:12:18.159 --> 01:12:21.039
And you know, to what degree is that deuterium itself?
01:12:21.199 --> 01:12:29.520
I mean, there are certain MRI modes that visualize deuterium, but they need uh they they they actually look at traces.
01:12:29.600 --> 01:12:35.920
They it's MRI spectroscopy that is actually looking for a deuterated spectrum tracer.
01:12:36.159 --> 01:12:43.119
So it's it's not you can't, as far as I interpret the MRI images, it's not something you're using on a standard standard sequence.
01:12:43.440 --> 01:13:02.000
Uh to a certain degree, I think it's moot, and I and I don't think it's useful in explaining to patients because um what what does a patient really care about whether what what this heavy hydrogen isotope means for them, uh if everything that we're doing is going to help in aid in deuterium depletion.
01:13:02.319 --> 01:13:16.880
So to me, it doesn't really add anything, and if anything, it it complicates things and it unnecessarily puts uh put put put puts you know things in a in a in in a difficult to um relate terms.
01:13:17.199 --> 01:13:24.480
But if they understand that the visceral fat is simply a maladaptive, the body's not trying to kill them, it's just doing the best given the situation.
01:13:24.640 --> 01:13:43.359
It's a maladaptive situation, and if we do time restricted eating, we do carbohydrate restricted, um, I call it an epicarnival diet, which is it's just a time-restricted carnivore with uh abundant seafood and fermented uh foods, then you know this that is deuterium depletion.
01:13:43.680 --> 01:13:50.960
You will deuterium deplete yourself um along with full spectrum sunlight and whether or not you're on a deuterium depleted water protocol.
01:13:51.039 --> 01:13:53.279
If you add that in, it'll happen even quicker.
01:13:54.399 --> 01:14:06.640
What where do you draw the line between uh lower it lowering someone's carbohydrate intake and going onto a proper ketogenic style regime?
01:14:06.960 --> 01:14:09.920
Um, and how do you tell if someone's going into ketosis?
01:14:10.000 --> 01:14:15.520
I I know that there's quite a bit of variability between people's abilities to go into ketosis.
01:14:15.600 --> 01:14:17.600
Some people go into it very, very easily.
01:14:17.760 --> 01:14:22.399
Some people's bodies seem to be extremely resistant to the ketogenic state.
01:14:22.640 --> 01:14:29.520
Um, I'm wondering where uh when is it indicated to go really deep into that ketogenic state?
01:14:29.920 --> 01:14:56.480
Yeah, I mean the the the classical deep ketos key indications for deep ketosis are uh essentially brain conditions like severe refractory epilepsy and essentially conditions where you need a hyper a high new level of ketonemia to uh essentially trying to maintain a uh more desirable uh physiological state of brain exit uh metabolism.
01:14:56.720 --> 01:15:03.199
So, you know, that those are the most common ones, and then you know, some of these cancer protocols that are using deep deep ketosis.
01:15:03.840 --> 01:15:25.920
My experience and my interest is at the moment is in metabolic diseases, and if in into some some degree, uh the this the depth of ketosis is less important than um the fact that that person is getting essentially a high amount of nutrient flux through their mitochondria.
01:15:26.239 --> 01:15:30.560
So does it matter if they're sitting at four millimoles per liter?
01:15:31.039 --> 01:15:39.440
Not as much as if they are you know implementing this protocol of intermittent um high-intensity exercise.
01:15:39.600 --> 01:15:47.039
They're not eating large amounts of carbohydrates, they're probably having fiber in the form of some forms of sauerkrauts.
01:15:47.680 --> 01:16:03.199
But um the combination of factors, rather than the ketonemia itself, is mobilizing stored energy from adipocytes from visceral fat stores and essentially burning it, and they're they're blowing it out.
01:16:03.440 --> 01:16:06.000
That's how that's how it how how it leaves the body.
01:16:06.079 --> 01:16:08.800
It's it literally exhaled as carbon dioxide.
01:16:09.039 --> 01:16:13.520
Um so yeah, I'm not a nice uh I'm not an artsy about it by any means.
01:16:13.600 --> 01:16:19.199
Um, and I don't necessarily need people to measure ketones unless they want to.
01:16:19.440 --> 01:16:37.199
Um but I agree, there's massive variation and in in in metabolisms, just like there's variation in you know stomach anatomy, or you're circling back to the beginning of the conversation, and it's very hard to know that um from the beginning.
01:16:37.440 --> 01:16:43.039
But yeah, it's it's it all depends, and it depends on how strict we need to be, is how bad someone's problem is.
01:16:43.199 --> 01:16:50.960
I mean, you know, I had a guy the other day whose whose HPA1C is glycated hemoglobin was above 14.
01:16:51.279 --> 01:17:06.239
Like this is someone who's, you know, and he's 120 kilograms, who's actively neglected his health for you know many, many years, and is you know, probably in the stage of pancreatic burnout of type 2 diabetes.
01:17:06.480 --> 01:17:21.279
Um, so the impetus for someone to kind of be strict in their lifestyle habits is much higher than someone who's maybe got a fasting incident of 12 but normal HBA1Cs and you know, etc.
01:17:21.680 --> 01:17:43.279
So it it all kind of depends, but you know, the the saying that you can't get better in the same environment where you fell sick, you you know, you can't get metabolically healthy with the same amount of carbohydrate intake and the same amount of sugar intake and alcohol intake and uh nocturnal food consumption as when you when you felt when you got metabolically sick in the first place.
01:17:43.920 --> 01:17:44.800
I find it funny.
01:17:44.880 --> 01:17:52.079
I don't want to keep you too long, but I find it funny that we uh we always come back to just talking about the same stuff all the time.
01:17:52.159 --> 01:18:03.119
It makes me uh feel very much uh in uh imposter syndrome all the time because uh you know when people ask me advice, it's always the same, it's always the same thing.
01:18:03.279 --> 01:18:07.359
It doesn't really evolve because what we need doesn't evolve, it's it's the same.
01:18:07.600 --> 01:18:11.680
Um, and that's to basically get outside as much as possible.
01:18:11.920 --> 01:18:18.159
Um and uh and beyond that, you know, you're really looking at very minor things.
01:18:18.480 --> 01:18:23.039
Um I I won't ask you, yeah, you can you can go.
01:18:23.520 --> 01:18:40.960
I would just yeah, I would I would just say that the person that's that I've really enjoyed his perspective on this lately has been Alistair Nunn from the Guy Foundation, and really framing this problem of human physiological and biological need in the terms of engineering.
01:18:41.199 --> 01:19:11.039
And again, it's the engineers who bring more than anyone else a rigorous view to health and and medicine and biology in a way that we most doctors will never do because again, they're they're too inculcated into this uh you know, prescribing pharmaceutical-based uh paradigm that's preoccupied with pathology without looking into as Abu Dud Bakri calls celluenesis or health promotion.
01:19:11.359 --> 01:19:18.000
So the way that None frames it is a flight envelope, it's like a metabolic adaptive metabolic envelope.
01:19:18.159 --> 01:19:24.560
So just like a Cessna plane has a certain set of conditions by which it can fly.
01:19:24.720 --> 01:19:38.960
So airspeed, payload, uh, you know, runway, takeoff speed, uh, engine maintenance periods, the that that flight envelope for a Cessna is going to be completely different to a Boeing 747.
01:19:39.279 --> 01:19:46.000
It's gonna be completely different to a you know uh Hercules C 130 Globemaster.
01:19:46.319 --> 01:20:00.560
So the question is, what conditions as we apply the analogy to a biological system, what conditions or what um set of dictates influence our biological envelope?
01:20:00.640 --> 01:20:11.279
Because we obviously have one, um, and it's you know to go all the way back to the most foundational inputs, it's it's an atmospheric oxygen of 21%.
01:20:11.920 --> 01:20:14.239
It's a gravitational field.
01:20:14.560 --> 01:20:17.920
And you know, when when when uh Dr.
01:20:18.079 --> 01:20:28.000
Cruz says uh, you know, light water magnetism, I'm like, okay, well, why not light water magnetism, gravity, um, you know, and oxygenation, because they're just as fundamental.
01:20:28.159 --> 01:20:50.000
Um the gravit geomagnetic field, which is you know seems to be shifting over the South Atlantic right now, and the this light dark cycle, the fact of full spectrum, sunlight during the day and complete darkness at nighttime, or relative compared to um uh relative compared to what we're doing now.
01:20:50.239 --> 01:20:58.319
And and then you you you plug all these um facets of uh inputs in, and then you get a human metabolic envelope.
01:20:58.560 --> 01:21:03.359
And that is the evolutionary niche with with respect to these fundamental inputs.
01:21:03.600 --> 01:21:21.199
So that's another way of of talking about it, and it comes back to antifragility, it comes back to um hormesis because a little bit of stress is what keeps the mitochondria functioning properly, and it keeps the body and and functioning properly.
01:21:21.440 --> 01:21:24.000
So yeah, I uh I like that framing.
01:21:24.079 --> 01:21:57.279
I think it's it's a really useful one, and it and it makes sense of these environments where human health falls apart, whether that's the submariners in submariners on under the ocean for 90 days at a time, astronauts in the International Space Station, um, or the off typical office worker sitting in a in a windowless room under LED lighting and three monitors and a and a Wi-Fi router emitting you know dual band um gigahertz, 5.4 and 2.
01:21:58.079 --> 01:22:00.640
whatever, 8 gigahertz right next to them.
01:22:01.760 --> 01:22:09.119
I I think that's a fantastic way to uh wrap this up with that full circle moment back to anti-fragility.
01:22:09.279 --> 01:22:17.279
You've just added a few books to my extremely long reading list, and I'm sure you've added a couple of books onto a lot of other people's as well.
01:22:17.520 --> 01:22:31.840
Um, I've learned a lot just by listening to you speaking, I think there's so much to be gained um by hearing people who have clinical experience talk, and that's why I was really looking forward to talking to you finally on the podcast.
01:22:32.079 --> 01:22:43.199
Um I will make sure to leave all of your details uh in the description so people can check out your podcast and and find you on all of your platforms.
01:22:43.359 --> 01:22:50.480
Um, but yes, do you do you want to give any more information about this this clinic that you're setting up and and what you'll be offering?
01:22:50.560 --> 01:22:54.720
Because I think it'll be um it'll be you're you're on the cutting edge.
01:22:54.800 --> 01:23:00.000
You're doing the stuff that I I think will become popular in the next uh coming decades, hopefully.
01:23:00.319 --> 01:23:01.520
Yeah, thanks, Cameron.
01:23:01.600 --> 01:23:03.440
Thanks for your your your kind words.
01:23:03.520 --> 01:23:05.520
It's always a pleasure to to speak with you.
01:23:05.760 --> 01:23:23.359
So, yeah, for anyone who's interested, um the my what I've as a as we discuss, I'll be offering a a non-contrast abdominal MRI to really give people true insight into their their metabolic health and their the presence of structural metabolic disease.
01:23:23.520 --> 01:23:30.800
So, you know, you can you can go into your doctor, you can you can measure, you can even measure your fasting incident and you measure your fasting leptin.
01:23:30.960 --> 01:23:32.239
I mean, it's a good start.
01:23:32.480 --> 01:23:37.359
But um what shows up on the MRI is prodromal, even before that.
01:23:37.520 --> 01:23:48.720
And it's before you get even endocrine or um derangement, you're gonna you're gonna start seeing deposition of of of this type of fat.
01:23:49.039 --> 01:23:54.800
So MRI, the MRI don't lie, uh is what is uh what what gets said.
01:23:54.960 --> 01:24:01.199
So we can just see what's going on, and then you can make choices about what you want to do based on that.
01:24:01.279 --> 01:24:14.079
And inevitably, the the closer we implement lifestyle factors that that we've discussed, closer to this flat envelope, the less the visceral fat is carried and the quicker it goes away.
01:24:14.319 --> 01:24:23.359
And again, if we look at those Peruvian um Amazonians who were in that under undiscovered tribe, they're thin.
01:24:23.680 --> 01:24:29.119
They uh, you know, they're they're probably, if anything, protein deficient, but they didn't have any visceral fat.
01:24:29.279 --> 01:24:40.319
So, you know, the vis the visceral fat is a problem of modernity, it's a problem of this indoor domesticated lifestyle, and it's a problem of deprivation from natural environmental exposures.
01:24:40.480 --> 01:24:50.800
Um and it's the main root cause behind chronic diseases, or it's it's it's the key um structural evidence that someone's going down the wrong path.
01:24:51.039 --> 01:25:08.800
Um so yeah, if you're interested in that, then you know go onto my website and we're gonna be really it's all on a very kind of it's all embryonic at this stage, but uh it will be offered at in certain locations and then we'll be able to follow you up and we'll be able to walk you through and show you the images of your own abdomen.
01:25:08.880 --> 01:25:15.920
And just like a tree trunk, we can see the different slices and we'll we'll we'll let you know what what you what's going on.
01:25:16.079 --> 01:25:20.159
This is part of doing health due diligence as far as I'm I'm concerned.
01:25:20.399 --> 01:25:29.279
Um because really, if unless you know what's what what is actually inside you, you you haven't you're not really given a complete picture of your health.
01:25:29.520 --> 01:25:43.520
And the corollary to that, and we didn't talk about things like veg, you know, different health practices or different health schools of thought, but something like this abdominal MRI, it's it's really the final referendum on a lifestyle.
01:25:43.760 --> 01:26:03.279
Um, because whatever we uh protocol any health um influencer or doctor would um promote, you if if that were truly healthful, then they would it would not contain structural metabolic disease, it would not have visceral fat.
01:26:03.440 --> 01:26:06.159
So it's really it's really an arbiter of that.
01:26:06.319 --> 01:26:18.880
Um you know, give give me 10 people who are each following the different protocol, whether it's a vegan, you know, on plant-based diet, uh, fruitarians, you know, the the crossfitters, people who are working out at 6 a.m.
01:26:19.039 --> 01:26:20.960
and doing bulletproof coffees.
01:26:21.119 --> 01:26:24.560
Uh, you know, whatever the whatever the different schools of thought are.
01:26:24.640 --> 01:26:29.199
It's like um, you know, Anchorman, where the different news teams are like uh fighting out.
01:26:29.359 --> 01:26:30.880
I don't know if you've seen that movie.
01:26:31.039 --> 01:26:39.199
But uh look, get them all together and we'll scan them and we'll see who's who's living the correct approach and who isn't.
01:26:39.440 --> 01:26:48.560
So that in that regard, I'm excited to be bringing this um this research tool to to people into demo democratization.
01:26:48.720 --> 01:26:53.359
Um so yeah, go onto my website if you want to listen to what I have to say.
01:26:53.920 --> 01:27:03.760
Sometimes it's on the Regenerative Health Podcast, which Cameron's been on uh twice already, or and and yeah, we'll we'll we'll definitely be continuing that conversation.
01:27:04.000 --> 01:27:06.960
And yeah, that's uh that's basically where you can find me.
01:27:07.119 --> 01:27:18.239
And um, I'll be expanding my you know private consulting around health optimization um in in the in the next yeah six months to to one year for sure.
01:27:18.720 --> 01:27:21.359
Max, I'm I'm so grateful for everything you're doing.
01:27:21.440 --> 01:27:35.680
You really are sort of the lightning rod of uh you know uh the health movement in Australia, and um, you know, there is a massive, massive um desire for this type of um uh content in Australia.
01:27:35.840 --> 01:27:39.119
For some reason, Australia we're we're very passionate about this.
01:27:39.199 --> 01:27:43.440
We have a massive community here, and you're at the absolute forefront of it.
01:27:43.520 --> 01:27:50.640
Uh and I'm I'm just so grateful to have you uh leading the way uh and um you know showing everyone the right way to do it.
01:27:50.720 --> 01:27:54.079
You're you're a real leader, so I'm very happy to have you around.
01:27:54.319 --> 01:27:56.880
Thank you for um giving me some time.
01:27:57.199 --> 01:27:58.560
Yeah, okay, pleasure.
01:27:58.720 --> 01:28:01.600
Thanks for for the questions, and yeah, we'll we'll talk soon.
01:28:01.920 --> 01:28:03.119
Thank you so much for listening.
01:28:03.199 --> 01:28:04.800
I really hope you enjoyed this episode.
01:28:04.880 --> 01:28:09.760
I've left links to all of Max's social media in the episode notes, so please go follow his amazing work.
01:28:09.920 --> 01:28:17.680
If you'd like to keep up to date with my work, please follow my social media and subscribe to my substack for even more in-depth information about science and health.
01:28:17.760 --> 01:28:19.680
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01:28:19.840 --> 01:28:21.119
Thanks again for listening, everyone.
01:28:21.199 --> 01:28:22.079
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