Hormesis, Circadian Rhythms & Visceral Fat | Dr Max on Cameron Borg Podcast 的完整文字稿

way. 00:05:40.800 --> 00:05:54.000 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. 00:05:54.080 --> 00:06:00.080 Jack Cruz as an extension of of explorations on on YouTube and podcasts. 00:06:00.240 --> 00:06:08.000 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. 00:06:08.240 --> 00:06:19.040 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. 00:06:19.280 --> 00:06:29.600 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. 00:06:29.759 --> 00:06:34.000 Um, and by no means am I anywhere near the end of that process. 00:06:34.240 --> 00:07:16.400 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. 00:07:16.640 --> 00:07:21.600 Um yeah, so that's kind of what I'm working on and what I've been working towards. 00:07:22.000 --> 00:07:27.520 We have hilariously similar origin stories in that regard, um, with acne being the catalyst. 00:07:27.680 --> 00:07:28.800 So that's quite funny. 00:07:28.879 --> 00:07:33.120 Um, I was gonna save this question for the end, but I thought it was probably a good place to ask you now. 00:07:33.199 --> 00:07:44.400 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. 00:07:46.160 --> 00:07:49.759 Yeah, it's that that's actually that's a very interesting question. 00:07:49.920 --> 00:08:00.879 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. 00:08:01.120 --> 00:08:07.360 It would be Nassim Nicholas Taleb's Incerto series and probably anti-fragile. 00:08:07.600 --> 00:08:10.160 Um, I think I've got a copy of it right in front of me. 00:08:11.280 --> 00:08:12.720 So here you go. 00:08:13.040 --> 00:08:15.680 Anti-fragile mind by Nassim Nicholas Taleb. 00:08:16.480 --> 00:08:24.720 This this is uh Nassim Taleb was uh originally a an options trader. 00:08:25.040 --> 00:08:45.919 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. 00:08:46.080 --> 00:08:51.919 And erudition is this this quality of being well read, and uh more it's more than that. 00:08:52.000 --> 00:09:10.480 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. 00:09:10.879 --> 00:09:20.319 But they the what it brings out is an immediate or a sense of multidisciplinarity in one's endeavors. 00:09:20.559 --> 00:09:40.240 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. 00:09:40.399 --> 00:10:09.599 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. 00:10:10.000 --> 00:10:15.039 It's an incredible, incredibly powerful um intellectual position to occupy. 00:10:15.199 --> 00:10:24.240 So Kaleb wrote this series called The Black Swan, which I mean you this ties this ties deeply into the philosophy of science. 00:10:24.319 --> 00:10:57.039 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. 00:10:57.199 --> 00:11:07.360 And the black swan problem was this idea that you can you can have a theory or a proposition that all swans are white. 00:11:07.759 --> 00:11:17.679 But the the it would it only takes the citing of a single black swan to completely nullify and nullify your your hypothesis. 00:11:18.159 --> 00:11:48.079 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. 00:11:48.319 --> 00:11:55.039 If we're being really uh thorough and rigorous in truth

seeking, then we actually should be looking for the black swans. 00:11:55.439 --> 00:12:04.079 We should be actively trying to disprove our hypotheses rather than just simply collect more confirmatory evidence. 00:12:04.399 --> 00:12:15.199 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. 00:12:30.799 --> 00:12:35.360 The Turkey is being fed every single day um prior to Thanksgiving. 00:12:35.519 --> 00:12:52.079 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. 00:12:52.319 --> 00:12:56.399 We have never had better relations between the turkeys and the humans. 00:12:56.559 --> 00:13:00.719 And obviously the fight the next day the turkey gets killed because it's Thanksgiving. 00:13:01.120 --> 00:13:24.959 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. 00:13:25.199 --> 00:13:38.799 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. 00:13:39.199 --> 00:13:49.519 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. 00:13:49.839 --> 00:14:04.319 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. 00:14:46.479 --> 00:14:51.199 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. 00:15:06.159 --> 00:15:16.319 And and it and it really also extends to how I heal people or how I guide people to say reversing their metabolic dysfunction. 00:15:16.559 --> 00:15:44.000 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. 00:15:44.159 --> 00:16:06.559 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. 00:16:22.959 --> 00:16:28.719 Like hunter-gatherer culture is fundamentally anti-fragile because you don't know when your next meal is coming from. 00:16:28.879 --> 00:16:44.399 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. 00:16:45.039 --> 00:16:58.879 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. 00:17:14.799 --> 00:17:20.559 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. 00:17:26.799 --> 00:17:37.519 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. 00:17:37.599 --> 00:17:38.559 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 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.