10. Dr. Andy Galpin: Debunking One-Size-Fits-All Approach with Fitness and Health, Importance of Muscle Building + Personalized Approach to Wellness

What if you could customize your health like a pro athlete? Imagine having a health and fitness routine tailored to your unique needs, just like a world-class athlete?! In this episode of Extend with Dr. Shah, we sit down with Dr. Andy Galpin, a leading expert in health and fitness technology, to explore the game-changing innovations that are transforming the industry. Andy shares insights on how personalized wellness techniques and understanding your individual response to health interventions can take your routine to the next level. From self-experimentation to the power of personalized coaching, we dive into how modern tools are enabling a new era of individualized health and so much more! Dr. Andy Galpin is a tenured Professor at California State University, Fullerton. He is the Co-Director of the Center for Sport Performance and Founder/Director of the Biochemistry and Molecular Exercise Physiology Laboratory. He is a Human Performance scientist with a PhD in Human Bioenergetics and over 100 peer-reviewed publications and presentations. We also discuss: (00:40) Precision Health and Fitness Innovations (12:42) Physical Activity and Exercise Habits (18:20) Balancing Consistency, Progress, and Recovery (27:34) Optimizing Performance Through Comprehensive Testing (32:17) Comprehensive Health and Performance Program (42:12) Body Composition Testing Recommendations (47:50) Importance of Muscle and Cardiovascular Health (01:00:25) Importance of Muscle Function and Testing (01:06:44) Importance of Exercise at Any Age (01:18:46) Strategic Progression in Exercise Programming (01:23:56) Developing Customized Training Programs (01:34:55) Balanced Exercise Regimen for Optimal Fitness (01:42:27) Training Program Flexibility and Adaptation (01:54:53) Interpreting Blood Chemistry Markers in Performance (02:06:05) Blood Biomarker Interpretation for Health (02:14:41) Assessing Physical Readiness and Hydration (02:20:56) Maximizing Nutritional Supplements for Health (02:28:09) Revolutionizing Sleep Testing for Athletes (02:39:36) Advancements in Health Technology (02:42:29) Revolutionizing Digital Training Programs Thank you to our sponsors: Timeline: https://www.timeline.com/ TruNiagen: https://www.truniagen.com/ IFit: https://www.ifit.com/ To learn more about Dr. Darshan Shah: Website: https://www.drshah.com/ Clinic: https://www.next-health.com/ Instagram: https://www.instagram.com/darshanshahmd/ To learn more about Andy Galpin: Website: https://www.andygalpin.com/ Instagram: https://www.instagram.com/drandygalpin/

Speaker names marked ? are inferred from speaking time and the show’s known hosts — they are not voice-verified.

• 0:03Dr. Darshan Shah?

  Welcome to Extend with me, Dr. Darshan Shah, a podcast dedicated to cutting-edge science, research, tools, and protocols designed to help you extend your health span. Having become one of the youngest doctors in the country at the age of 21 and trained and board certified at the Mayo Clinic, I've accumulated three decades of practice as a board-certified surgeon and longevity expert. Over that time, I've discovered that a mere 20% of health knowledge yields 80% of the results when it comes to your health span. We're living in a new era where we are creating a new healthcare system, no longer focused on disease management, but achieving optimal health and vitality. Join me as I interview world-renowned experts, offering you a step-by-step guide to proactively avoid disease and, most importantly, extend your health span.

• 0:49Dr. Darshan Shah?

  Imagine having a health and fitness routine tailored to your unique needs, just like a world-class athlete. In this episode of Extend with Dr. Shah, me, we sit down with Dr. Andy Galpin, a leading expert in health and fitness technology to explore the game-changing innovations that are transforming this industry. Andy is one of the most knowledgeable experts in the field of fitness and health. Andy also has a top podcast called Perform, of which I've listened to every single episode. Andy shares insights on our personalized wellness techniques and understanding your individual response to health interventions can take your health routine to the next level. From self-experimentation to the power of personalized coaching, we dive into how modern tools are enabling a new era of individualized health and so much more.

• 1:33Dr. Darshan Shah?

  Dr. Andy Galpin is a tenured professor at the California State University Fulton. He's also the co-director and center of sports performance and founder and director of the Biochemistry Molecular Exercise Physiology Laboratory. He's a human performance scientist with a PhD in human bioenergetics and over 100 peer-reviewed publications and presentations.

• 1:58Dr. Darshan Shah?

  Andy, I cannot believe you're here. I mean, this is just such an honor to have you here. I've listened to you for years, your YouTube videos, you know, basically it was my guidebook for how to use the gym, how to use weights, how to run on the treadmill for so long. And it's just so incredible to be here talking to you. So thank you so much for joining us.

• 2:17Speaker 01

  Oh man, that's quite the compliment. I'm very excited to be here. I'm honored to be here and looking forward to it.

• 2:23Dr. Darshan Shah?

  That's fantastic. So Andy, I'm going to start off with just a few rapid fire questions for you, just so we can kind of frame up the conversation. So what's your favorite thing to talk about in the whole world of like health, wellness, longevity, health span?

• 2:34Speaker 01

  What I'd probably say would be either a combination of the projects we're working on for the, I'll say advancement of human performance. So what are some of the next level technologies and where I think this stuff is going? The other part of that answer would be similar to you guys' work in the sense of, we'll call it precision.

• 2:51Dr. Darshan Shah?

  Right.

• 2:52Speaker 01

  So precision training, precision attrition, precision, really understanding this idea we've said a lot to the public, which is, you know, figure out what works for you, but how? And now we can actually have tools and ways to solve that problem. And so I think we did a good job for years telling people, do you know, figure out what works best for you, but we didn't tell them how to do that. And now we have the ability. So those two topics, the highest level are the most interesting.

• 3:14Dr. Darshan Shah?

  Those are two of my favorite topics. I'm going to dive into specifically the second one too, because what I find seeing people in next health, I have, you know, a few hundred patients here, is everyone is a completely different individual biology.

• 3:26Speaker 01

  Man.

• 3:27Dr. Darshan Shah?

  Right? And like what works for one person, like, like you can, I'm sure you see this a lot. You send one person to the gym to do one set of exercises and someone that looks exactly like that person, it just doesn't work at all, right?

• 3:38Speaker 01

  Yeah. And I mean, I can go a long ways in this because this is everything from when we do studies in our laboratory.

• 3:45Dr. Darshan Shah?

  Right.

• 3:45Speaker 01

  And we have left the model many, many years ago. That is, we take everyone in the study, we combine all the results together and report a group average. That is fine at the population level. That is fine to get rough ideas, but at the individual level, what happens to the person on this end of the spectrum and that end of the spectrum, right? Somebody was a hyper responder. Somebody was a low responder and scientifically not a big deal. It's averaged out, but when you actually start coaching, when you start working with people, when you start trying to change your own individual health, whether or not you're on this end of the spectrum or that end or that bell curve in the middle, that is everything. And so I think my experience, both running my research labs, as well as coaching the thousands of people we have coached,

• 4:28Speaker 01

  left me going, well, wait a minute, like scientifically, that's okay. Coaching wise, that's not. Coaching wise anecdote one by one is not good enough. We need to know real objective. So how do we actually blend this field together? And so our studies always report group averages as well as individual data. And so people can parse that out. So in general, I feel like that's what I've been going after for a long time, because it's the only way we can get real answers. Science can do some things, but it's limited. Practical coaching, clinical experience is the same. Now, how do we combine the strengths of both of those to give people the best possible answers in their own individual journeys?

• 5:04Dr. Darshan Shah?

  That speaks to exactly, you know, I do a lot of speaking engagements as well. And one of the first things I show is one of my first slides is that bell shaped curve, right?

• 5:13Speaker 01

  Yeah.

• 5:13Dr. Darshan Shah?

  You need to know where you are in the bell shaped curve. You need to run a randomized controlled trial on yourself.

• 5:18Speaker 01

  Yeah.

• 5:18Dr. Darshan Shah?

  So you know, and exactly what you were saying is how do you do that with precision? Without the data, there's no way to know where you fit on that bell shaped curve. So let's, I'm going to get into that with you here in a bit. But what's one thing that you wish everyone knew? All the listeners of this podcast, your podcast knew about, let's just say, exercise physiology in general.

• 5:40Speaker 01

  I would say you have more control than you realize. And that is a fundamental theme across nutrition, across sleep, across your mental health, anything. There's plenty of factors that are out of your control. Great. If you look at the progression of science in the field of human performance, exercise physiology, call it what you want, more and more of it just continues to suggest that you have more control. Whether you're looking at all cause mortality risks, whether you're looking at obese. You name the factor that is of most interest to you and what you're going to find is your individual. Regulation is higher than you think. That doesn't mean you're completely at fault. It's your, it's shame on you. How dare you. That's not what we're getting at.

• 6:24Speaker 01

  It is really suggesting saying, there's actually a path here. And so as we get into some of these details later, and we'll probably at some point talk about the advanced ways we work with people, and I know you do as well, fine. And we do that, and that's what I love. That's my passion. So I said a second ago, but I always, always, always want to make sure people really understand. You do not need any of that stuff. You can have a ton of success. You can look great. You can feel great. You can perform great with just the basics.

• 6:52Dr. Darshan Shah?

  Right.

• 6:52Speaker 01

  Everyone can. Lifestyle, great relationships, high quality foods, so on and so forth. That's as complicated as it ever has to be. And so I really don't ever want anyone to the level of thinking, unless I can afford X amount of dollars or services, then therefore I can have no control of my health. And I never, ever want people to be in that position. So that is the thing I think is most important for people to understand. You do not need my services. You don't need your services. Nobody ever has to pay a dollar to live reasonably well. That said, the world is a lot easier now with some of the services that are available for people to get really high, high quality answers if they struggled to get them in the past. So I know that's a bit of a juxtaposition. But I really don't want to ever make people feel like they're trapped into thinking, if I don't have this

• 7:36Speaker 01

  ultra-high-precision physiology testing, then therefore I'll never know what to do. And that's not, that's not the case.

• 7:42Dr. Darshan Shah?

  Yeah. I mean, that's such a great point because I feel like people get a lot of paralysis by over-analyses. Like they, they'll listen to like 30 podcasts, follow 10 influencers, and they hear all this stuff about lactate threshold testing and VO2 max. And there's like, I can't even, I don't even know where to buy a lactate meter at. How am I gonna, I should, I'm not even go to gym and run at all. Or I'm not gonna go out for a walk, right? And I run into that a lot with my patients. Like, look, let's just take it back a step. Just go for a walk today, you know?

• 8:10Speaker 01

  Totally. So that's actually, okay, so I want to say this a little bit more directly because you brought up a fantastic point. If you're at the start

• 8:17Dr. Darshan Shah?

  Right.

• 8:18Speaker 01

  of this journey.

• 8:18Dr. Darshan Shah?

  Right.

• 8:19Speaker 01

  And you're going, I got 300 bucks. I got $1,200. I got some, I got 6,000. Okay, fine. A lot of people really struggle to go, well, do I buy the watch then? Do I hire the trainer? Do I get the sleep study done? Like where is, which thing do I pick? And I really want to make people understand, you don't have to make a selection there. You can get going on walking. You can get going on eating high quality, high carb. No, no, don't worry. That's not the biggest factor you have, right? Can you get routine and patterns and habits? And I'll give you, this is one of our like secret hacks here. All the people that I've coached and we continue to coach. And you're talking about professionals in every major sport.

• 9:01Speaker 01

  Cy Young winners, world champions, MVPs, all pros, the highest contracts in the NFL, Major League Baseball's executives, hundred million dollar, billion, like all these people we've coached. All of them have one thing that we do no matter what. And that is step number one, you have to establish patterns. I don't care, am I on the best diet that is specific to my physique? No, no, no, no, no, don't care. I'm a macronutrient, no, don't care. So don't, don't, don't care. Quiet the system first, like we would run any study. Control as many of the variables as you can. Whatever ones they are, you pick them. If that means you're only controlling one thing, fine. If all you can manage because of your financial limitations or your technical limitations or your just mental resources going, ah, man, I'm so overwhelmed.

• 9:44Speaker 01

  Great, pick one thing and make that consistent. Your physiology will quiet down and then you'll start to see signals versus noise really easily. And we can worry about optimization, which is what you and I like specialize in later. Just start with the basics and we'll figure out even disagreeing on the basics later. But step number one is find something that you're going to stick with and repeat. And then we'll dial things in later.

• 10:10Dr. Darshan Shah?

  Right. You know, whenever I see patients here in the clinic, before we even launch into any health advice, the first thing I want them to do is to become a habit-forming expert. Become an expert at forming habits. And I find that more than, I would say 70% of people, somewhere between 60 to 70% of people, don't even have a single consistent good habit in their life.

• 10:31Speaker 01

  Yeah. I do not care about the microplastics, the toxins coming off your frying pan. It's like, what time you go to bed? I don't know. Great, when are you eating throughout the day? We don't know. Okay, like, we have things to get to, for sure.

• 10:45Dr. Darshan Shah?

  Yeah.

• 10:46Speaker 01

  But I'm not putting an environmental scanner in your bedroom and scanning for toxins if we can't even agree upon, do you work out or not?

• 10:52Dr. Darshan Shah?

  Right.

• 10:52Speaker 01

  Like, like, those are way, way, way, and that's, that's the, I think that is a good use of majoring in the minors.

• 10:58Dr. Darshan Shah?

  Exactly.

• 10:59Speaker 01

  Right, you're, you, those things are real.

• 11:01Dr. Darshan Shah?

  Yeah.

• 11:01Speaker 01

  They are factors, we do account for them, you account for them, but those are steps.

• 11:06Dr. Darshan Shah?

  Way down the line.

• 11:07Speaker 01

  Way, way, way, way, way down the line.

• 11:08Dr. Darshan Shah?

  Right.

• 11:09Speaker 01

  Long tail, for sure.

• 11:10Dr. Darshan Shah?

  Yeah, it's, you know, getting people to really hone in on the concept of the Pareto Principle.

• 11:14Speaker 01

  Yeah.

• 11:14Dr. Darshan Shah?

  Spend, where's the 20% of the information when you need to spend 80% of your energy? I think that should be a theme of this podcast talk today. Let's, let's make that a theme too.

• 11:24Speaker 01

  Perfect.

• 11:24Dr. Darshan Shah?

  Because I think, that way, you know, I think people, like, they get that paralysis by too much information, and they really don't know what that 20% of that information is. So I think if we can, kind of hone in on that today, that would be awesome.

• 11:36Speaker 01

  Great.

• 11:37Dr. Darshan Shah?

  Great, awesome, okay. So, speaking of habits, what is one or two or three habits that you try to instill in many of your clients, or you think most people should do?

• 11:48Speaker 01

  Sure.

• 11:48Dr. Darshan Shah?

  In their health and wellness journey?

• 11:50Speaker 01

  Yeah, yeah, of course. It's gonna sound like the basic life pyramids, if you will, right? So habit number one, there has to be some sort of physical practice.

• 11:57Dr. Darshan Shah?

  Right.

• 11:58Speaker 01

  Now, we will differentiate almost always between physical activity and structured exercise. This is as simple as, what we don't want is somebody who sits all day in a chair, they go to the gym, they work really hard for 45 minutes, and then they remain in a chair. You knock the exercise part out, but the physical activity, your movement throughout the day, you're walking very low. The opposite, okay, I, I walk, I take the stairs, but I never exercise. Okay, great. Neither one of those are the place to be in, and so we want basic movement. This can be a step count. This can be, you know, are you taking more meetings, standing, up and down? Who knows, right? This is all the great work that, I'm blanking on the name, but Kelly Starrett and Juliet's, they're, they're, yeah, they're, the studies they've done with the kids and things like that they've been a part of. Can you just move around a little bit?

• 12:43Speaker 01

  Right? And then at the same time, now when we get to our exercise, there's gotta be some structure there, progressive overload, some intentionality, what are we doing? So physical activity exercise would be pillar number one and those habits are going to be set, right? So how are we habit making a habit so that we're moving and how do we make it a habit so we're getting our structured exercise in?

• 13:01Dr. Darshan Shah?

  Great. So on that, I mean, what you're really doing is talking about separating physical activity into these two kind of buckets. One is the elimination of just sedentary behavior, right? That's what you're referring to, moving throughout the day. And then the other bucket is the intentional physical activity of actually exercise.

• 13:19Speaker 01

  Yep.

• 13:20Dr. Darshan Shah?

  Right? And so everyone needs, what you're saying is everyone needs both.

• 13:23Speaker 01

  Yes, sir.

• 13:23Dr. Darshan Shah?

  Okay, got it.

• 13:24Speaker 01

  And this can be in every flavor that you could possibly imagine, right? This can be, okay, your current theme of mine, like my wife at home, we have two little kids. Great. Her physical activity is just keeping children alive. She's getting countless steps, running them up and down. Okay, I mean, so she just really has to pay attention to her structured exercise because the physical activity is going to account for itself. I am almost the opposite because most of my day when I'm not, I'm wrangling my kids plenty of times too, but not nearly to the extent she is, I'm going to be sitting. I'm sitting in front of a computer for the most part. I have to go out of my way to make sure I'm moving. That is a habit I have to do. That's not a habit she has to do because

• 14:07Speaker 01

  it's going to get taken care of. Okay. So I am also much more likely to get a Saturday night lift and to do where she's like, Saturday night, she's like, I ain't lifting weights. Like, no way, right? Okay. But I'm like, I'm free, kids are whatever, like, I'm gonna go lift weights. Okay. So we have different problems. This is the point I'm getting at. And so where I need to make habits and where she needs to make her habits are different for them. Depending on your age, demographics, our goals, our past histories, what part of our training phase, all of these flavors can be different, but there has to be some account from both ends of the spectrum. And I don't think we really have anybody, with the exception of maybe some of our professional athletes, who are only focusing on training, which does happen pretty consistently. But most people are going to want both.

• 14:53Dr. Darshan Shah?

  Right, right, absolutely. And to that point, you know, getting people moving, that's one thing. But let's talk about like going to the gym, exercise. It doesn't have to even mean going to the gym. Just getting an exercise routine in. I have a lot of patients that haven't exercised either their entire life or they've, you know, had a gym routine, maybe when they're in college and it's fallen off. And I think the general kind of way that they've been spoken to by their primary care physicians is you need to go to the gym. So they'll go to the gym and just show up there one day, right? So I see a lot of mistakes being made there. So what is your feeling like that type of person I just talked about? They haven't exercised in a long time. They first get into a program.

• 15:38Dr. Darshan Shah?

  Top one or two or three things, what mistakes are these people making?

• 15:41Speaker 01

  Sure. Number one, I will always take a poorly designed exercise program over no exercise at all. Don't let perfect be the enemy of good here. Just get going, just get trying, okay? If that means you have to show up to the gym, you don't know what you're doing and you sit on some machines and you just use the machines, fine, I will take that as a better alternative to sitting at home. I never want to make exercise feel like it is so complicated that we are dissuading people from even going because they're just like, wow, no way. It's, it's like if you said you have to run all your finances by yourself, good luck with your taxes. You'd be like, ah, I'm just not starting. Like, there's just no way. It's too overwhelming, right? Great. Just get something done and I'm not happier there.

• 16:23Speaker 01

  Now, once that part is, is handled, I also want people to remember, if you're going to the gym or working out or going to Pilates class or spin class or whatever it is, right? Gym is not even maybe a great example of it. Jiu Jitsu class for the first time, who cares? You have to remember the overwhelming majority of the people that work there see people like you every day. You are the norm. You are not abnormal. You are the most common thing they see. So when you walk in that day and you feel horrifically embarrassed and ashamed because you haven't worked out in 20 years and you don't know what you're doing and you feel like, oh my gosh, everyone there is going to ridicule me either directly or they're going to look down, they have to realize you are the actual norm of things. That they see the most common thing that they see.

• 17:05Dr. Darshan Shah?

  Wow.

• 17:06Speaker 01

  Is you.

• 17:07Dr. Darshan Shah?

  So true.

• 17:08Speaker 01

  So, cause someone coming in super jacked or trained really hard is the uncommon.

• 17:12Dr. Darshan Shah?

  Is the uncommon thing.

• 17:13Speaker 01

  Thing, right? So you're the norm. They have seen you 15 times today, 50 times this week and 3,000 over their year. Okay, this is what they've seen. So I would not hesitate to go up to the person working there the first time and just give them the honest, I have not worked out in 10 years. I don't know what I'm doing. Can you help me please get started? Everyone who works at a gym or spin class, they're gonna be like, oh, I got you. I got you. Don't worry about it. Like, we'll get you sort of cruising. So that's my top piece of like what to do, cause people want.

• 17:41Dr. Darshan Shah?

  I love that.

• 17:42Speaker 01

  To sort of help.

• 17:43Dr. Darshan Shah?

  Yeah.

• 17:44Speaker 01

  Now, if you're maybe a level above that, okay, and you're like, what are the kind of common mistakes? Well, we need to think less about specific protocols, exact rep ranges and restribles. We can cover some examples. And you wanna think more categorically. What am I trying to do today? Am I trying to simply burn calories cause I'm primarily interested in fat loss? Okay, in that case, your options are really, really high in terms of what do you do? What can you do that keeps you healthy and motivated to progress? So mistake number one, I would say is people doing things that result in them getting hurt. Okay, do not get hurt. If you look at long-term research on physical activity, by far, the most progress will be made from people who are simply the most consistent.

• 18:29Dr. Darshan Shah?

  Right.

• 18:29Speaker 01

  Doesn't mean you can't take a week off and go on vacation. You got sick, you got lazy and you, that, that happens. But if you look at this over the course of not this week, this month, but what happened over these 20 years? Don't, you don't want a month gone here, four months gone there, cause you tore an Achilles. Back got thrown out. Like, that's what you have to avoid for the long-term success. So your ability to keep that weight off for 20 years, to keep that muscle around for 50, this is, the central driver there is going to be, can you just maintain yearly consistently? Not daily, weekly, but over the years, can you be consistent? So do not get major injuries. Number two, you wanna have some intention of what you're doing. In other words, this in.

• 19:13Speaker 01

  Exercise science speak, this would be progressive overload. So are we doing the same workout with the same reps, same intensity every day for years? And then we're wondering why we're not progressing. Okay, like you, I don't even need to run the analogies there. You know why that's not going to work. So there has to be some judicious intentional progress in progression of volume, duration, length, intensity, tons of ways we can play that game. But there's got to be some sort of movement forward if we want to continue to to sort of move forward. So if I had to give you my my top sort of two, those would be it. Making sure we stay injury free and then two, having some intentional progression.

• 19:48Dr. Darshan Shah?

  That's great. Absolute great advice. Would you add to that for the person that does have a consistent routine? Pretty good at the gym, not going to get injured. Would you add some kind of focus on recovery too? Because I see a lot of people not really doing any type of recovery at all. They go straight from the gym right to work. Is is there some recovery that you recommend?

• 20:10Speaker 01

  Yeah, we can get into some tactics, like specific tools and things like that in a second. But what we generally do is we put everyone through what we call a quadrant system.

• 20:19Dr. Darshan Shah?

  Okay.

• 20:20Speaker 01

  So imagine you have four quads and I give you 10 points total. Okay, and you get to split these 10 points up across those four quadrant areas, however you'd like. So you can put 10 in one and zero and zero and zero, you can put three, you get the example, okay? Now, those four quadrants are going to be quadrant one is your physical activity practice. Maybe that's your walking, maybe that's your lifting, your surfing, whatever it is you do for physical activity and exercise, which is throwing it all together. And however you define those terms is quadrant one. Quadrant two is going to be your, what we call business. Your finance, your resources, your profession, whatever you do, okay? Quadrant three is going to be your relationships.

• 21:03Speaker 01

  Could be love interests, could be friends, could be you want, you like to go out. Whatever it is you define relationships to be, and then your fourth is recovery. And again, recovery could be mental recovery. So for an introvert, that might just mean I need alone time. It could be physical actual recovery, my legs are sore, could be sleep, could be whatever are things, right? So you got 10 points, you get to spread across those four categories in total. Well, it's hard to be at less than two or so in business, right? Like you have to, most people have to.

• 21:32Dr. Darshan Shah?

  Pay your bills.

• 21:34Speaker 01

  Okay, honest reality is that tends to be somewhere between three to five. Okay, we'll say it is three, just to make an example. That's about the lowest unless you've exited a company.

• 21:45Dr. Darshan Shah?

  Yeah.

• 21:46Speaker 01

  You got it. So let's say three, we got seven left. Now, you love to work out, you train hard, okay. Do you put as much into that as you put in your business? Probably not. Let's say two. Okay, great. And then what about relationships? Well, yeah, I like to go out. Okay, great. And I put three there. Well, I got three, three and two. Now all of a sudden I'm up to eight. That means I would have two left for recovery. Nobody does that. Nobody does that. So what ends up happening is business ends up being five.

• 22:12Dr. Darshan Shah?

  Right.

• 22:13Speaker 01

  Or so. Relationships are like, I got kids or whatever. That's going to be another two or so. Training is two or so. And now we're up to nine, 10, right out the gates, right? The rule we have on that is recovery can never be less than half of your exercise and training. So if you put three into recovery or into exercise, we cannot put one into recovery. If we put four into exercise, we have no less than two to place in recovery. If you do that, you're not going to survive. It's very unlikely. And so what that means is we say, okay, great. Maybe this is simply a function of your recovery is not getting enough time. You just aren't giving enough hours to sleep. That's all we have to do. And so I don't need to, you don't need to go buy a $3,000 light therapy thing.

• 22:58Speaker 01

  You simply need to give yourself 45 more minutes to sleep. You're in the minors, right? Or we need to not go from arguing on Wall Street all day, leaving that, driving straight home, doing a maximum heart rate 45 minute session, coming home, dealing with our kid, and then trying to fall asleep and wondering why we have trouble falling asleep. So we're talking nonsense here. That's one example of going, hey, we have got to have some intentional down regulation. But another example would be the opposite. Very low stress life, my physical activity is restorative. I like to do yoga. I like to do breath work. That person doesn't need any additional down regulation. When they're sore from exercise, I don't need you to down regulate nor. I need you to actually build up more resilience.

• 23:41Speaker 01

  Your problem is you're not actually stressing the system enough. Frequently enough and you're getting more sore than you need to be because you're not resilient enough. Or we actually need to bring in exercise tools or we most likely at that case, honestly, you've got some suboptimal thing happening physiologically. That's that's compromising recovery. Those shouldn't be happening at that point. So we would look at recovery from that entire perspective, saying, what is the overall physiological, psychological balance? What's the allostatic load? Right. Exactly. You know, you know, I mean, it's the it's the science word for the fact that all stressors are kind of traded created equal, right? So you got to bring them all in, add them all up together. And then we're going to look at how many of those stressors are what we call visible or versus hidden?

• 24:24Speaker 01

  And make sure your equation is not overfilled. That's the key to recovery, honestly.

• 24:28Dr. Darshan Shah?

  Man, that's such a powerful way of thinking about it, such a powerful model to really get into people's head. For you as a trainer, but also for them to have the realization like, I'm not putting anything into recovery or just, maybe there's, it's all recovery.

• 24:41Speaker 01

  We get this all the time.

• 24:42Dr. Darshan Shah?

  Yeah.

• 24:43Speaker 01

  And we looked at it and we're like, what are you doing for recovery? And they're just like, ah, and then we're like, then why did you pay me all this money? What are you doing? You're not even trying. I guess like, we'll go try something. How great it worked. Shocking.

• 24:56Dr. Darshan Shah?

  That's, that's so amazing.

• 24:58Speaker 01

  Like really commonly, you're like not even attempting to do it. So.

• 25:01Dr. Darshan Shah?

  Wow. That's a great way to look at it. I'm going to start using that as well with your permission, of course.

• 25:06Speaker 01

  Yeah, yeah. Well, the quadrant in fairness, I sold for my friend Kenny Kane up here in Santa Monica. So I sold it from him. You're welcome to sell it for me.

• 25:15Dr. Darshan Shah?

  Love it. All right. So that was fantastic. Great way to kick this thing off. So let's do this. Let's look at that bell shaped curve of people just in general. Okay. And I see this in my practice and I think you're probably seeing a lot more on the performance side, right? Of people, but what I would say, if you look at the bell shaped curve, kind of on the left, you have the people that are completely sedentary, probably about 16% of the population, totally sedentary. Haven't worked out, I would say 10, 15 years. They might be obese. That is also playing into their psychology of of exercise and movement. And yeah, that is group one. Group two, I would say is you have the people that. Are maybe doing a class once or twice a week.

• 25:57Dr. Darshan Shah?

  They fall off when they go to vacation and they take a long time to get back into it. And you know, they're pretty much new to the to the gym. Okay. Group three being the, I would put myself in this group, which is I have a regular routine at the gym. Okay. And I, well, through listening to you, I have a very varied exercise routine, but I find most of my patients are either, you know, like Peter Tia describes them as either muscle heads, I think, or cardio fiends, right? They're either like one or the other. So I want to get into a little bit about like exercise diversity for longevity and health span. And then group four is like more of the more of the athletes, like the the people that are running marathons three, four times a year, maybe they're doing triathlons, et cetera.

• 26:41Dr. Darshan Shah?

  I see those as well. And and I want to, I have different questions about each group for you.

• 26:45Speaker 01

  Killer. That was nice.

• 26:47Dr. Darshan Shah?

  And so I think I think we can just kind of like get into a lot of, a lot of these different groups. Cause I think almost everyone can put themselves into one of these groups. And so we can go down the rabbit hole on these. So first I want to talk about just testing. I am a huge fan of doing some testing for on my patients, just because I feel like number one, it establishes kind of what where you're at right now, but also helps you kind of plan where you need to be and what direction you need to take. And so in the world of physical activity and exercise, what are some like the basics tests? That if someone wants to invest maybe a few hundred bucks, they can go get some basic tests that you could look at and help them kind of directionality wise, figure out like where they need to go and where they're at right now.

• 27:29Speaker 01

  Yeah. Okay. Sorry, but a little caveat before we get going on this one. I have been a part of many world championships in many sports without spending a dollar on testing.

• 27:39Dr. Darshan Shah?

  Amazing.

• 27:40Speaker 01

  Right? Olympic gold medalists, world champions in many, many sports without a drop of blood taken, without a single technology bought. Okay.

• 27:48Dr. Darshan Shah?

  Right.

• 27:48Speaker 01

  That said, I don't do any coaching of any kind anymore without extensive and comprehensive testing. That's how I rule, but I do want to make sure I can people understand. I've won world championships without a dollar being spent in these areas. Okay. So you do not need this stuff. You and I argue, though, that life gets a lot easier once you have this. So, okay. If you want to play in that low end of the spectrum, what we would generally say, because you have these big buckets that go into what I will continue to call human performance. But I want to clarify, when I say that, I'm not talking about sports. I believe if you have a body or an athlete, which is my fancy way of saying you all want to look a certain way. It's different for you and I. Some want to get big and small. Okay, fine. You all want to feel a certain way.

• 28:31Speaker 01

  You define that differently than I do and you do and you do. Great. You want to perform certain ways. Great. You still want then your body to perform. We're after the same game. When I am working with somebody in our coaching practice, whether they are one of our competitive, actually, in any of those four areas, because we have coached, and it's funny, those numbers you mentioned, because of the people that we've worked with, it's probably about that same thing. Probably 15 to 20% of our people that we've coached, like, do not exercise, do not do anything. And then that bell curve runs up and probably 15 to 20% are the 40 to 70-year-olds who are running triathlons, Ironmans, and...

• 29:03Dr. Darshan Shah?

  It's a very similar patient population.

• 29:04Speaker 01

  Super common, right? Really, really common. So, within that bell curve, you're still wanting to perform, though. Everyone wants to feel the best, most energy. You want to have the most mental focus. You want to have the least amount of GI distress. Like, that's all asking your body to perform. Whether the person on the right side of the bell curve uses that ability to run a race, or the person on the left uses that ability to just feel better all day, it's the same physiology. You and I are taking people in the same exact direction. So, I always want to make a point of that because people send it, they kind of hear some stuff from there. They think if they're not in category four, that this advice doesn't apply.

• 29:37Dr. Darshan Shah?

  Right.

• 29:37Speaker 01

  And it does. It is the same physiology, okay? So, how, number one, we never, ever take somebody through a minimal amount of testing. I would never, like, this is not the

• 29:47Dr. Darshan Shah?

  Sure.

• 29:48Speaker 01

  found what we've had. But that said, I would look at all these buckets that go into performance. Your sleep, your stress management, your nutrition, your exercise, whatever else we could come up with. And we could split hairs on how we make extra categories. And I would ask you intuitively, what do you think is the biggest, what we'll call, performance anchor? What's the area that's holding you back the most? And then give your 300 to 400 bucks to testing in that area. If you think you're eating well... And you're sleeping well and your training is good and your mental health is great, but somehow you're still not getting any progress in the gym. You're still feeling low energy throughout the day. You're still, whatever it is, right? Then maybe that's time to spend those three or 400 bucks on a micronutrient test.

• 30:29Speaker 01

  On some like next level thing. This is not our first line of thing I would do with the average person. Maybe this is one of your toxin tests. Like this could be some other thing there. Like maybe there's something going on. Great. Okay. Another scenario would be maybe something like, everything is great. I'm dialed, but my sleep isn't there. There are plug, conflict of interest here. My sleep company, we do this, right? For a couple of hundred dollars, you can run a full FDA approved clinical sleep study from your bedroom for a few hundred dollars. Put your money there, right? But the same token, if someone's like, no, I sleep, my energy's phenomenal. I sleep all night. Then maybe that's not the place to spend your $400 if that's the cap.

• 31:11Speaker 01

  Maybe, and I'm using you doc as an example, maybe you got all that checked off, but you're not making progress in the gym. Your 400 bucks might be better spent hiring consult from a high level strength and conditioning coach. You can go, let's take your really good training program and let's make it great. Cause it was good enough to get you here. It's not good enough to get you to that next level. And so my advice would be if you're at that kind of price point limitation, think about what is that most severe anchor you've got? As best as you can tell. And then put your money into the things with the highest fidelity and the most feedback that that can help you move forward. So that would be my recommendation, regardless of which one of those four buckets of people you've talked about. Yeah, by the way.

• 31:52Dr. Darshan Shah?

  Yeah, that makes total sense actually, because you know, obviously a lot of this stuff costs some money. And you would definitely want to spend it on the right things. And it's different for every person. Once again, we keep talking about how everyone's so different.

• 32:02Speaker 01

  Yeah.

• 32:02Dr. Darshan Shah?

  Focusing on that is is super important. So what if you did just come to you as a client? You know, and what's your base level testing package kind of include to get a good sense of where this person is?

• 32:14Speaker 01

  Yeah. So we, we do a couple of different things. So our coaching program is called Rapid Health and Performance. And we don't offer baseline. There is one, there's one. One package there and it is everything. Right. And the reason we do that is we we've done this enough and and the model honestly was built on many, many, many, many years of us working with athletes and going, okay, you're gonna do one or two tests. And then six weeks from now, you're gonna come back and add another one. And then six weeks from now, we're gonna add another one. And we're gonna add another one anyways. And we don't have two chances at the Olympics. We have, you got one chance to make that NFL roster the first time, right? We have one contract year, whatever. And do you really want? No, you know what I'm going here. Yeah. It's not worth it. No.

• 32:59Speaker 01

  It's never is. And so we are always going to say, look, if you have more money than you have time, or you have, you cannot afford to miss, what would that look like? And so that's the program we built. And we said, either one of those two cases exists where somebody has to get it right. And so we end up saying, look, I want to collect obnoxiously comprehensive data. Some of it will be unnecessary. But the problem is, I don't know what part is unnecessary. Yeah. Yeah, right? By doing that, we're then able to give very high precision simplified plans. Because we confirm, you know what, it wasn't this. We never get in a situation where like, well, we're seeing signs of A, B, and C. Well, we'd have to go confirm. We don't want to be in that situation. We don't have time to then come back 30 days later and do another draw, right? Our NFL off seasons are short.

• 33:44Speaker 01

  NBA, Major League Baseball off seasons are, we don't have time to 60 days later. Well, let's try and see, right? Let's see what happens with this protocol and come back like, we don't have those. Even our, I keep using athlete examples, but I I shouldn't have to, are non-athlete ones. It's the same thing. It's like, I gotta close this business deal. I gotta do this. Like, I have to be, I'm in pain, I'm in fatigue, like, I can't, I'm losing money. Great, like, we have to solve this problem now. So what we do is all of those areas. Our process actually takes about two months to collect the data. Some people go a little bit faster, but it's very similar, right? We're doing insanely comprehensive sleep testing. It's the in-home sleep stuff. It is environmental scanning, a ton of blood work specific to sleep-related variables, so on and so forth, right?

• 34:29Speaker 01

  Mental health for sleep, all that. It is urine, stool, saliva. I have a hair if necessary, sweat testing for performance and hydration. We're looking at hundreds of individual blood biomarkers. But in addition to that, as you know, you can make hundreds of thousands of calculations and imprints on top of all those things. It is performance testing. It is strength testing. It is VO2 max testing, depending on the, what's going on with the person. It is full body muscle analysis. So we're using a technology called Springbach.

• 35:03Dr. Darshan Shah?

  Hmm.

• 35:03Speaker 01

  Analytics. Yeah, we can get a three D, a volumetric image of every individual muscle in your body.

• 35:09Dr. Darshan Shah?

  Wow.

• 35:10Speaker 01

  With a 20 minute MRI scan that can be done anywhere in the country.

• 35:13Dr. Darshan Shah?

  Incredible.

• 35:14Speaker 01

  So we're getting, we're not looking at, like, we don't, we're not medical, right? So we're not like you, we're not looking for precancers and stuff, right? So when we have people that want that stuff, we send them to people like you.

• 35:23Dr. Darshan Shah?

  Right.

• 35:24Speaker 01

  We're not the medical side. But we want to see, like, why are you keep having that knee pain? Well, let's look at, I want to know the individual size of your biceps laterals on your left and your right. And so you get the idea, right? We're running this entire gamut up and down. Then we have, of course, things like respiratory tracking, breath work testing. You're going to work with our team of psychologists and mental health experts. And this is, I could keep going, but you're getting the point. It is all of this stuff and more and more and more. And then all those data get filtered through and they come back. And then we will analyze everything and figure out what are those one to eight most severe performance anchors and then give you a very specific program. And so it's not just like, hey, take these supplements and good luck.

• 36:05Speaker 01

  It is typically six or eight months or so of guided, we're going to get to A to B to C to D with your physiology. So that we get a known outcome. So just like I would design a training program, that's not just like, do this workout every day?

• 36:18Dr. Darshan Shah?

  Yeah.

• 36:18Speaker 01

  See ya? We're not doing that with your nutrition. We're not doing that with your breath work. We're not doing that with your recovery or your sleep. Like, everything is built together so that our sleep program is not interfering with our training. Or our training is not messing with the nutrition we're trying to get. Or that's not messing with our down regulation. It's cohesively built so that we can get to a very direct and specific outcome. So because that is the goal, we don't do like à la carte, oh, add this and kind of add this or whatever it is. We like to solve problems. This is the only way we can guarantee it as much as possible. So that's really sort of all we offer for the most part at that company anyways.

• 36:51Dr. Darshan Shah?

  I mean, that makes total sense, actually, because like you said, these are athletes or maybe business people that have a little bit of time and then you can't afford the time to do investigation to make mistakes.

• 37:02Speaker 01

  Yeah, we can't wait a year to start feeling better.

• 37:04Dr. Darshan Shah?

  Right.

• 37:05Speaker 01

  We have to get going now. So I mean, that said, our sleep company, Absol Rest, does have those, hey, if you just need a target sleep,

• 37:13Dr. Darshan Shah?

  Sure.

• 37:14Speaker 01

  You can go after those programs. Our blood work companies is like, if you just need to get the high performance blood work at Vitality, you can go to that. So we do offer those things at, you know, much more equivalent price points, depending on what you're looking for. But like my personal coaching services, when you want like to work with me directly, that's, that's what you're getting is the full kit and kaboodle and there's no like all the cart there at all. It's, I don't want to miss anything. I want to give you the highest chance of success and it is not for the faint of heart.

• 37:43Dr. Darshan Shah?

  Right, right, right. So in that, is there any DEXA scanning or using the, yeah, so the DEXA scan is a big part of this?

• 37:49Speaker 01

  Yeah, we can get, so you're going to get, of course, body composition, hydration testing, all those things. We're going to be able to get bone mineral density. We can get a lot of that on Springbok anyways.

• 37:58Dr. Darshan Shah?

  Oh, okay.

• 37:58Speaker 01

  So we're going to be able to get, so as opposed to only getting like total body composition and fat free mass index throughout the whole body. Since we're getting volume of every individual muscle, we can see exactly where that's being distributed and how and what that looks like. So.

• 38:12Dr. Darshan Shah?

  Are you getting bone density on Springbok as well?

• 38:13Speaker 01

  Yeah, totally.

• 38:14Dr. Darshan Shah?

  Oh, so it's like a super upgraded DEXA?

• 38:17Speaker 01

  Yeah, yeah.

• 38:17Dr. Darshan Shah?

  Yeah, with much higher precision.

• 38:19Speaker 01

  Totally. And sometimes we do both depending like on logistics. It's not always possible to get that on Springbok, but it will be soon. So sometimes we have to do both, but yeah, as you know, like a DEXA is pretty easy.

• 38:30Dr. Darshan Shah?

  Sure, absolutely.

• 38:31Speaker 01

  But really informative.

• 38:33Dr. Darshan Shah?

  Yeah. And then for your strength assessments, you're having someone actually test somebody with multiple different strength variables?

• 38:39Speaker 01

  Yep.

• 38:40Dr. Darshan Shah?

  Yep, okay.

• 38:40Speaker 01

  Yeah, and it kind of just depends. So I mean, globally, we're going to look at something related to grip strength. We're going to look at something related to upper body strength. We're looking at something related to lower body strength. And then obviously our athletes directly are getting different things, but the overwhelming majority of our people are not athletes in that program. That said, then they're getting a very comprehensive movement analysis. So we have folks on our team that are the highest level movement specialists, physical therapists in the world. And that's, that's kind of our model is. Everyone in our team is world-class in their area. And so we kind of do this like what I call Voltron. But nobody knows what that means.

• 39:13Dr. Darshan Shah?

  I know Voltron. I used to love that show.

• 39:15Speaker 01

  Thank you. Like everyone's like, I'm not 40 years old. I don't know what that stupid cartoon is. But we want a super team, right? Like, you know, you do the same thing with your team, right? Like you want every person in their individual specialty. So they're getting a movement assessment, movement analysis. Like, how are you moving? Not just how much can you lift or what's your VO2 max? But what's your position look like? Anything hurt? Why? How are you moving? And so that part of it is very well incorporated as well. So it's how well you're moving, why you're moving that way? What can you do? What are your limitations? All the metabolic data we're getting. Caloric expenditure, resting metabolic, like all those data are coming in as well.

• 39:48Dr. Darshan Shah?

  Amazing. Yeah, and I think, you know, one thing, you mentioned this Starrett's already. I have patients that, you know, can't really afford to get a movement analysis. It's an expensive, long test. And like you said, you need a professional to do this for you. And I really like this Starrett's app, actually, that they have.

• 40:03Speaker 01

  Oh, yeah, yeah, yeah.

• 40:04Dr. Darshan Shah?

  They're built to move.

• 40:04Speaker 01

  So all of our people get that app.

• 40:05Dr. Darshan Shah?

  They do.

• 40:06Speaker 01

  Yeah, yeah, we use ReadyState.

• 40:07Dr. Darshan Shah?

  I love it. The ReadyState app is a great proxy for this, for testing yourself at home.

• 40:11Speaker 01

  Yeah, no.

• 40:12Dr. Darshan Shah?

  If you can't do the full movement analysis.

• 40:13Speaker 01

  We actually were so stoked to get that on board earlier this year. It's not only like a diagnostic, but then it is an actual coaching.

• 40:20Dr. Darshan Shah?

  Right.

• 40:20Speaker 01

  Tool, like phenomenal.

• 40:22Dr. Darshan Shah?

  It's so comprehensive. And I think, you know, just double click on that a little bit. Almost everyone I meet ignores mobility as part of their overall routine, right? And you're laughing because you probably see the same thing.

• 40:34Speaker 01

  Like, again, we see the, you know, advanced cases. My shoulder hurts, my neck, my back, whatever. And you're just like, all right, have you done anything? Like, well, I went to chiropractor a couple of times. You're like, all right, okay, nothing against chiropractic, you know what I mean? Like, that's not an active solution. Like, you've been in pain for how many years? And all you've done was these four chiropractic visits? Like, there are better options. So, yeah, yeah, we have seen a lot of, um, we have, I'm sort of joking because we, I can't even tell you how many times we've seen the, I've been dealing with this for so many years. I've been to so many surgeons and doctors. And then, like, within a session.

• 41:07Dr. Darshan Shah?

  Right.

• 41:07Speaker 01

  Or like, we're done. And they're just like, what? Like, this is not even that advanced. This is like really, whether it's with Kelly Starrett's stuff or Dr. Charlie Weingraff, we work with a lot, or other people, like. I mean, we're not, we're not perfect. I'm not gonna give you a false sense of we've cured everything in the world, but man, like a lot of that stuff can go away pretty quickly if you just have somebody that actually knows what they're doing.

• 41:28Dr. Darshan Shah?

  Exactly. And it's incredible to me that when people come in with like some low back pain, the first thing they go to is, man, I want to see if I can avoid surgery. And it's like, there's so many steps in between experiencing back pain and then having surgery, right? And mobility is a huge part of it, just getting more. And I ask them like, so tell me about your day. Oh, I sit at a desk eight hours a day. That's where it's coming from. And like you said, a little bit of mobility work and the back pain is miraculously gone.

• 41:53Speaker 01

  Totally.

• 41:53Dr. Darshan Shah?

  And meanwhile, they've got 30 chiropractor visits.

• 41:55Speaker 01

  Yeah, for sure. For sure. There's all your money right there.

• 41:58Dr. Darshan Shah?

  Right, right. Absolutely. So yeah, that mobility piece is super important for our listeners. And the app is amazing. Their book is amazing as well. I'm gonna have them on as well.

• 42:08Speaker 01

  Oh, great.

• 42:08Dr. Darshan Shah?

  Yeah, they're fantastic. So on markers as well, just one more thing, for people to kind of follow along at home with their body composition, do you recommend bioimpedance scales? Or do you at least check like directionality?

• 42:23Speaker 01

  Yeah. So you can do this a handful of ways, depending on what you're available to. Something like a DEXA scan, of course, is gonna get you bone mineral density, body composition. So how much muscle you have as well as body fat, the three big variables. How much bone mineral density, how much body fat, how much muscle? Okay, that's great. You gotta treat those with a little bit of a grain of sugar, as I call it, because they are very subject, specifically the body composition, to acute changes in hydration. So if you didn't standardize that, and this is one of the other things we spend an enormous amount of time on, why our data collection takes so long. Data collected improperly are not only useless, they are oftentimes extremely harmful.

• 43:00Dr. Darshan Shah?

  Right.

• 43:01Speaker 01

  And so if you're not gonna collect things well, then I would strongly encourage you to not collect them at all.

• 43:06Dr. Darshan Shah?

  At all, right.

• 43:06Speaker 01

  Right? You can really get false senses. I mean, we could, you and I could probably have an hours, an hours long conversation with blood work. If you really don't know what you're doing in that area, you should absolutely just stay the heck out of it. And if you're not gonna collect it correctly, just get out of there, right? Standardization is, it's actually one of the tips that nobody talks about with blood work.

• 43:25Dr. Darshan Shah?

  Absolutely.

• 43:26Speaker 01

  And it is everything. It will change your entire Interpretation if you don't standardize your pre blood work. Exactly. Activities. But with with hydration and body composition testing, it's actually not as extreme, but it is is large enough such that you will, any amount of change you would actually realistically see in, say, three months can be masked or completely exaggerated by a hydration change prior to testing. So make sure that that is really dialed as a word of caution. That said, once a year, right? That's a probably maybe twice a year if you're really into this stuff, but once a year is fine for a DEXA. Although at the end of the spectrum, if you want to do something like just testing your body weight every day, fine, because that is, as you said, going to give you directionality, right? Rough, rough, rough ideas. Now, we never necessarily

• 44:11Speaker 01

  worry about day to day changes. We should more pay attention to, for most people, is the same day over the next and following weeks, such as to say, don't ever compare Monday to Tuesday. Compare Monday to next Monday. And the reason I'm saying that is because people tend to have a roughly similar schedule throughout the week. Okay, which is to say, most people are going to be off on Sunday, as an example. Most people are probably not going to be, it's the least physical activity they're going to have throughout the day. They tend to relax the most, go to brunch, so on and so forth, right? And then Monday tends to be a very active day because you're right back in at your work. Okay, so if you compared your weight Sunday to Monday, you're going to see those things as a result of very, very, very different patterns the day before. Your hydration status

• 44:54Speaker 01

  will be different, your fiber intake will be different, so your gut composition will be different, and your numbers will often. However, your Sunday to Sundays tend to be more similar than your Sunday to Monday. And your Monday to Monday to Monday tend to be really similar. So if you're looking at Sundays versus Sundays versus Sundays versus Sundays or Mondays versus Mondays, you get the idea here, you'll see really consistent patterns in your body weight on those days. And so if you're wondering how do you deal with this fluctuation, stack them vertically, if you're looking at a calendar, rather than horizontally day by days, right? Because you'll see these wild changes. So we look at it always vertically that way. So that is kind of like a daily metric one can do. If you want to actually get a scale that incorporates some sort of BIA

• 45:34Speaker 01

  into it, so you can get a rough idea of body composition, that's fine. But again, now you're really subject to hydration changes. So you want to make sure you're not, body composition will not meaningfully change for most people for weeks. So you really want to make sure you're tempering those adaptations. If you want to meet somewhere in the middle and you have access to a place that has a little bit more of an upscale BIA device, so the ones at home, most scales 20 to 100 dollars, and they have some BIA in it. However, more advanced systems like an InBody are going to be several thousand dollars, and we've actually done some validation research in my lab on that one specifically. And you probably aren't going to have that, but your fancy gyms, your health clinics probably do that. And so that might be something you could do once a month

• 46:19Speaker 01

  or whatever your routine is, and that gets you there. So a combination of those would be, would be my recommendation. Dexa once or so a year, a more advanced InBody once a month, or once a quarter, something like that would be reasonable if it's, you know, something you have to pay for. And then simply checking your body weight, even like sometimes daily at home. And if some people have a problem with that, which that can be a negative thing a lot of times, maybe once a week, or once every other week, or whatever, we want to be careful of not causing issues there. But that's how I would kind of lay that spectrum out for body composition testing.

• 46:51Dr. Darshan Shah?

  Yeah, no, that is perfect. And that's really along the lines of what I recommend for my patients. We do have the InBody at our clinic.

• 46:57Speaker 01

  Oh, great.

• 46:58Dr. Darshan Shah?

  Yeah, I love that machine. It does, it does a pretty good job. It's not exactly on point with the Dexa, but like I said, directionality is what we really care about here.

• 47:06Speaker 01

  Yeah.

• 47:07Dr. Darshan Shah?

  There's that InBody H20N, which has the handlebar for home use. Have you ever evaluated that?

• 47:11Speaker 01

  We did. We actually looked at, I think it was that one, the 720.

• 47:15Dr. Darshan Shah?

  Yes, the 720.

• 47:16Speaker 01

  Um, and then there was maybe another model, and we compared that to probably three or four other equivalent devices. And we ran that against Dexa and the BodPod. For the most part, for the people we're talking about here.

• 47:29Dr. Darshan Shah?

  Yeah.

• 47:30Speaker 01

  Oh, gonna be just fine.

• 47:31Dr. Darshan Shah?

  Gonna be just fine, right?

• 47:32Speaker 01

  All those things. Now, when we have to have our athletes, whether they're Olympic weightlifters, or powerlifters, or UFC fighters, and they have to make a certain weight on a certain day, level of scrutiny goes up.

• 47:42Dr. Darshan Shah?

  Of course.

• 47:43Speaker 01

  But for the vast majority of us, myself included, those products are going to be just fine.

• 47:47Dr. Darshan Shah?

  Yeah, fantastic. Okay, so let's dive into a little bit before we start talking about individual patient protocols. Just some quick thoughts about two things. We talked about the importance of mobility. The, let's talk about the importance of muscle and the importance of Cardiovascular fitness, things like VO2 max zone two, we can dive in a little bit deeper into what those mean later, but let's talk about muscle health. Give us some high pointers on the importance of muscle health, why people need to come think about it, and what are people doing right and wrong regarding muscle mass?

• 48:17Speaker 01

  Well, I am a muscle physiologist at heart, so I will admit my massive conflict of interest in this particular answer. I always bias muscle being more important than anything else.

• 48:29Dr. Darshan Shah?

  You and many of our friends.

• 48:30Speaker 01

  Yeah.

• 48:33Speaker 01

  Okay, so one of the things you want to consider here, a couple of things. In terms of, if you want to look at the things that are going to predict how long and how well you're going to live, you're not going to find anything that trumps VO2 max and high quality muscle. Depending on the study, you'll find muscle to outperform VO2 max or the opposite, but globally, those two things are going to reign supreme.

• 48:54Dr. Darshan Shah?

  And it's kind of like, just sorry to interrupt you there, but it's kind of, it's kind of counterproductive to compare muscle versus VO2 max. You really need both, right?

• 49:03Speaker 01

  There's no, it's kind of like saying, what's more important, my, my front wheel in my car or my back wheel?

• 49:07Dr. Darshan Shah?

  Exactly.

• 49:08Speaker 01

  No, no, no, no.

• 49:09Dr. Darshan Shah?

  It's a great analogy.

• 49:09Speaker 01

  This is not an either or thing.

• 49:11Dr. Darshan Shah?

  Right.

• 49:11Speaker 01

  Like this is a, you're not going to drive well without both of these things.

• 49:14Dr. Darshan Shah?

  Exactly.

• 49:15Speaker 01

  And I know, we've done longevity research, we've done studies on lifelong exercisers in many of these things. So we've done things on, we did actually a twin study on monozygous.

• 49:26Dr. Darshan Shah?

  Oh, wow.

• 49:26Speaker 01

  Yeah. So this is great for translation. That means you have the exact same DNA, right? So egg is fertilized and split into two, you get to clone. Okay. And so we don't no longer have the, well, what if their genetics was different question? We know that they are identical. However, they had 30, 30 to 35 years of discordant physical activity patterns. So this is the ideal scientific study, right?

• 49:48Dr. Darshan Shah?

  Awesome.

• 49:48Speaker 01

  Complete genetic control of that. Well, the exercisers in this particular case were mostly steady state endurance type of exercises with no lifting compared to sedentary twin. And most of the things that you would predict were improved in the exercising twin. Cardiovascular health, blood lipid markers, VO2 max, body composition, all of it better. However, Muscle strength, muscle functionality, performance, muscle quality as identified via imaging, all not any better or worse than other exercisers.

• 50:20Dr. Darshan Shah?

  Wow, that's incredible.

• 50:21Speaker 01

  And so, I mean, there's a number of conclusions to that paper, but one of them was simply that endurance exercise is phenomenally good for your health. It's tremendous. But if you don't also do strength training, you're leaving many physiological adaptations on the table. There have been many studies, again, on lifelong strength trainers, and you see the same thing. Great in a number of areas and limited in other areas. There's been lifelong endurance exercisers. We've done other work. I went to Stockholm, Sweden, years ago, did research on cross-country skiers who have been training and competing in skiing since the 1940s and 50s and compared them to 80, these are all 80 to 90-year-olds, by the way, compared them to aged and matched individuals who didn't compete in sports.

• 51:05Speaker 01

  Lots of improvements in VO2 max and other markers, equal if not worse muscle function.

• 51:10Dr. Darshan Shah?

  Wow.

• 51:11Speaker 01

  So, the story is very, very, very clear here. You're gonna want both of these two things on board. And so, if we look at what's going to determine the most about how people look, feel, and perform throughout their life, give you the longest life, the most high-quality life, health span, you know, all this stuff. Number one is staying out of disease, right? So, don't get cancer. Great, okay. I'm gonna leave all that off the table. That's doc. You're part of the equation. I'm not an MD. Okay. So, from this side of the equation, what we're left with now is things like, okay, do we have an appropriate metabolic function, right? Is our metabolism running without major cause, major problems, right? What's that mean?

• 51:51Speaker 01

  Either completely compromised thyroid function, very low metabolic rate, extremely high fat utilization, or extremely high, some dysfunctional thing, right? Can it just be like, don't be terrible. Give me the bell curve here, right? That's all we have to be in this one. Can we have a functioning immune system, right? And then, we can, we get ourselves through the world, right? And that, really, all three of those are gonna be regulated by skeletal muscle. Skeletal muscle is what's going to determine your ability to move throughout the world and to not get hurt. If your VO2 max, half that is skeletal muscle, right? There's a central and there's a peripheral component to that. Your VO2 max in general, we already talked about. If you don't have enough muscle, we're going to struggle to support the immune system. We're going to struggle to support recovery, metabolism is going to be compromised.

• 52:35Speaker 01

  And so I mean, I could go on and on about these things, but globally, you don't have to have any specific phenotype from a muscle perspective. You don't have to look a certain way. You don't have to have enormous muscle or be a professional powerlifter or weightlifter. But you just can't be in the bottom 25th percentile in terms of muscle size. In fact, one more, I know I'm going on for a while here. I could keep going, but this is a big question. One of the things that you'll see sometimes in kind of like longevity spheres, no offense on these things is people will say, okay, great. The data are really clear. If you have insufficient muscle on a male, you're typically looking at something like a fat free mass index of like below 16. Okay. In females, it's a little bit lower, below 15, 14, but you're going to see hazard ratios.

• 53:17Speaker 01

  So likelihood of experiencing poor health event or actual dying for any reason. Okay. If you go from those numbers and you go lower, then your risk of that hazard ratio, those odds ratios just start going increasing, like really high. So you're talking two, three, four, 500 fold increases of risk. Okay. If you go from, we'll just use the female example, FFM I of 14 and you go to 15, 16, 17, those risks just continue to go down. There's no step function here. It's not like down and it's even, it is just down, down, down, down, down, down, down. Okay. Now, some people argue based on very flawed interpretation of research that if you get too much muscle, that that curve turns into a U.

• 53:58Speaker 01

  And it starts going back up. And that's some people who know, again, no offense, but like really did not understand, in my opinion, basic physiology or nor statistical interpretation. But you'll see these published in medical journals and this is really pervasive in the medical community. It's why I'm so adamant about this one and I'm not trying to offend, but this is a really important point that. People as well as medical professionals need to understand. Now, we actually, we went back and myself and Tommy Wood, this is my colleague at the University of Washington, neuroscientist. He and his graduate student Christie led a project and we said, hey, okay, let's go look at these large databases and really see what's going on with this because like those data didn't make any sense. Those publications came out. So we published this paper last year, 2023, I think it is.

• 54:41Speaker 01

  And one of the things we looked at was we looked at NHANES, which you're familiar with, right? So it's this national database of, I don't know, it's probably a 40 year long study. People from all over, different facilities across the country and they're done so that scientists can have access to big data sets and we can all share the data. That's a quick

• 54:58Dr. Darshan Shah?

  Massive data dump, right?

• 54:59Speaker 01

  Totally, right? And it's everything from IQ to food recalls to genetic testing to, and it's not a perfect data set by any means. It's just meant to be a starting place to help people get, you know, 3,000 people databases or 30,000 or whatever the case may be. Now, the UK the UK did a similar thing a number of years ago and just finished it. It's called the UK Biobank.

• 55:21Dr. Darshan Shah?

  Yeah.

• 55:21Speaker 01

  They got about a half a million people in that, right? And more and more of these are coming.

• 55:25Dr. Darshan Shah?

  Yep.

• 55:25Speaker 01

  I know friends, I'm getting very like technical into the science here, but the reason why I'm explaining this is we went into that NHANES database and we looked at the people that had high muscle mass that was associated with advanced mortality, right? So what do you like, got too much muscle?

• 55:42Dr. Darshan Shah?

  Happened, right?

• 55:43Speaker 01

  Right. And you know what we found in that group? You know what their relationship was between the amount of muscle they had and their physical activity?

• 55:49Dr. Darshan Shah?

  Ah, yeah, they

• 55:51Speaker 01

  It didn't exist.

• 55:51Dr. Darshan Shah?

  Didn't exist, right?

• 55:52Speaker 01

  Zero.

• 55:53Dr. Darshan Shah?

  No physical activity, but still a lot of muscle.

• 55:55Speaker 01

  Totally. Which says, okay, you know what you really found? You found people who get a bunch of muscle, not from exercise, tend to die earlier. And you can figure out pretty clearly what that additional muscle came from. And so we were able to look at that and say, hey, number one, by the way, we found that muscle quality, muscle strength predicted 5% of cognitive variance.

• 56:16Dr. Darshan Shah?

  Wow.

• 56:17Speaker 01

  So I think that was a leg extension test and IQ. Can't remember exactly if it was IQ, but he was nonetheless, 5% of cognitive variance was determined by leg strength.

• 56:25Dr. Darshan Shah?

  Makes sense, right.

• 56:26Speaker 01

  And there was direct and indirect causes of that. So it's not just correlation, it was correlation and causation there. And so nonetheless, though, there was no association there between the higher amount of muscle mass and physical activity. Which is to say that database is full of a bunch of people who I'd just say is not the avatar I'd like to be compared against.

• 56:44Dr. Darshan Shah?

  Exactly.

• 56:45Speaker 01

  And I mean, we could talk about the implications of that with things like interpreting blood work and

• 56:50Dr. Darshan Shah?

  For sure.

• 56:51Speaker 01

  Other massive problems, but that is a, that is not an issue to be concerned with. So to getting back to your point of muscle in general, you do not want to be under muscled. And that is clear from a longevity perspective, that is clear from a right now perspective, your immune function, metabolic function, blood glucose regulation, recovery, energy throughout the day, perceived energy. All these things are going to be compromised by insufficient muscle.

• 57:15Dr. Darshan Shah?

  Risk of frailty, fractures in the future.

• 57:18Speaker 01

  Huge.

• 57:19Dr. Darshan Shah?

  Quality of life in general.

• 57:20Speaker 01

  All of it. And the things you care about now, like I said, the things that are making you have low energy, low recovery are going to be affected by you, by those things right now. So you don't want to be significantly and seriously under muscled. I can't make a strong argument that you need to be super jacked. Like I would love to be able to make that argument, but I can't, okay? And so in this particular cases, there's a little bit of a diminishing returns. Once you get to a certain point, that number tends to look like something like 20, 21 in terms of fat free mass index. By the way, that's easy to calculate. If you know your height and weight, you can go online and get your fat free mass index calculator. Like if you want to know what this number is, not body composition, rather, you have to know that.

• 58:02Speaker 01

  And for women, that number is a little bit lower, like 18 ish, starts to break. And then from there, when you add more muscle mass, you don't increase your risk, it just sort of stays about the same, right? So that is one thing to consider. VO2 max though, is not that way. There is a lot of research going all the way back to Stephen Blair's work at South Carolina in the 1980s, Jonathan Myers's work at Stanford in the early 2000s and 1990s. Extensive data suggests that there appears to be no upward limit to the benefit of VO2 max on longevity, which is a scientific way of saying as you continue to increase your VO2 max, you continue to reduce the hazard ratio or odds ratios of dying for all cause mortality.

• 58:47Speaker 01

  Benefits taper a little bit, but they don't stop like they do with skeletal muscle. So if we had to stack all these things up, the way that I would generally say it is this, muscle mass is kind of number three. You have to have some muscle mass, mostly just don't be under muscled. And I gave you those numbers and values a second ago.

• 59:03Dr. Darshan Shah?

  Right. 18 for females and 21 or so for men.

• 59:06Speaker 01

  Yeah.

• 59:07Dr. Darshan Shah?

  Fat free mass index.

• 59:08Speaker 01

  After that, there's no additional benefit. Kind of like if you slide down, what I'd say for females is you do not want to be below like 14, like you really, really don't want to be below that. If you can get yourself up to 15, 16, that that's sort of better. 18 would probably be the spot where I'd say, okay, if you don't want to work on this anymore, we don't have to.

• 59:26Dr. Darshan Shah?

  Right. But you have to maintain.

• 59:28Speaker 01

  You've got to.

• 59:29Dr. Darshan Shah?

  Got to maintain.

• 59:30Speaker 01

  You don't want to keep going backwards.

• 59:31Dr. Darshan Shah?

  Right. Absolutely.

• 59:33Speaker 01

  Which you know is going to happen with aging.

• 59:34Dr. Darshan Shah?

  Right. It's going to happen.

• 59:36Speaker 01

  For sure it's going to happen, right? At a pretty predictable rate. So actually, one of the things that we do with our people is we actually not only measure those things, but then we can actually run prediction equations and tell them exactly where they're going to be when they're 60, 70, 80, 90, 100, 110, 120, however long we want to run that thing out. On top of muscle mass, the next one then would be muscle function.

• 59:52Dr. Darshan Shah?

  Before you move on to that, I'm so sorry. I just want to get the numbers down for males too. Where do you like to see?

• 59:57Speaker 01

  Oh, yeah.

• 59:58Dr. Darshan Shah?

  Fat free index for males.

• 59:59Speaker 01

  Yeah, same thing. I'm doing this a little bit off the cuff here. So again, for a male, like I'm honestly really paying attention. If they're below like 17, I'm raising flags. I'm like, what, what's going on? If they're certainly below 16, this is going to be a very, very high priority for them. If they get above 21, 22, that's when I say, all right, if you don't want to work on this anymore, you can. But if it's below 21, you're going to be working on it.

• 1:00:20Dr. Darshan Shah?

  Going to be working on it.

• 1:00:21Speaker 01

  One way or the other. Right? I'm sorry. Thank you for letting me finish that loop out. That said, muscle function. is far more important than muscle size for the average person. And so what that means is if you look at things like, okay, how much risk reduction comes with muscle? A lot. How much comes with high strength, though? Double, triple, quadruple that amount. So if you have to choose between enough muscle and enough strength, always choose functionality over pure size. And that makes sense. There is a relationship between muscle size and muscle function, but it's not overlapped.

• 1:00:54Dr. Darshan Shah?

  Right.

• 1:00:54Speaker 01

  It's not a perfect relationship either. So, performance and size are disentangled at some end of the spectrum. Grip strength, leg strength, upper body strength, core strength, all those things really, really matter. And then we haven't even gotten into things like actual power, balance, which is a part of strength, stability. People always hammer me because I never talk about that. Well, I am talking about that. Part of strength is being stable. You cannot be strong and unstable. That's not how it works, right? To a point. So, said differently, stability is strength.

• 1:01:27Dr. Darshan Shah?

  Yes.

• 1:01:27Speaker 01

  That means you're not moving when you don't want to move. You're stable. That's strength. So all this stuff factors in, and that is more important than simple size. So you can run a bunch of metrics on all that stuff. And depending on kind of the person, the population you're looking at, you might want to run different performance tests. But I would do those, and I wouldn't call VO2 max necessarily number one. I probably should have said this as muscle size is kind of like, or body composition in general is the baseline. And then VO2 max and muscle function are kind of 1A, 1B.

• 1:01:54Dr. Darshan Shah?

  Right.

• 1:01:55Speaker 01

  Right? Because you have to have both of those two things. So you would want to run some diagnostic on that. If you were to run like a springbok analysis once a year, or a DEXA scan, or whatever you're doing, gets you in a rough spot. If you want to do some sort of performance test at least once a year, I would recommend probably twice a year, but once a year I can get away with. The same thing with your metabolic test, VO2 max test. You could probably get away with that every two years if you needed to. Honestly, if you had to do it every five years, fine, I would love once a year. But you could go a little bit longer on that one if you needed to. So that's how I generally break those up.

• 1:02:30Dr. Darshan Shah?

  Now, that's such a great summary, and I think it really encapsulates for people just listening to this and doing this at home for themselves to do some sort of test where they can figure out their free fat mass.

• 1:02:41Speaker 01

  Fat free mass index.

• 1:02:42Dr. Darshan Shah?

  Fat free mass index, and they can do that for free, just with online calculators as well.

• 1:02:46Speaker 01

  If they have a body composition.

• 1:02:47Dr. Darshan Shah?

  If they have a body composition test, and then, or get a DEXA. But that muscle size, you have a certain baseline amount you need to get to.

• 1:02:53Speaker 01

  Yep.

• 1:02:54Dr. Darshan Shah?

  But that does decouple at some point from muscle strength.

• 1:02:56Speaker 01

  Yep.

• 1:02:57Dr. Darshan Shah?

  And the muscle strength also needs to be tested with using things like grip strength.

• 1:03:01Speaker 01

  Yep.

• 1:03:02Dr. Darshan Shah?

  Maybe you can get online and find out what the standard is for your bench press, your leg press.

• 1:03:06Speaker 01

  Yep.

• 1:03:07Dr. Darshan Shah?

  And at least you know directionality where to aim for.

• 1:03:09Speaker 01

  Yep.

• 1:03:10Dr. Darshan Shah?

  And that's, that's also super important.

• 1:03:11Speaker 01

  Yep.

• 1:03:12Dr. Darshan Shah?

  And then the last thing is VO2 max. And VO2 max, there's like metabolic testing you can do, you can, you can approximate it with things like the, there's a Cooper's test.

• 1:03:22Speaker 01

  Sure.

• 1:03:23Dr. Darshan Shah?

  Yeah, there's ways, other ways of getting your VO2 max.

• 1:03:24Speaker 01

  Yeah, for all these things. There are surrogates, there are proxies, there are submaximal tests that can be done for all of it. And so depending on your limitation, I have a bad knee, or I don't know how to do a leg press, okay, fine. We can do that. If you can't get yourself up to a maximum heart rate, great, we can do a submaximal VO2 max test, we can do an estimator. The gold standard will always be the gold standard. If you have the option, do the gold standard. If you don't, though, that's when some of these other metrics can, can get you in the stratosphere, right? That can get you somewhat close. We have honestly seen a lot of chicanery with metabolic testing recently. So be really careful with where you get these things done. Make sure the facility really knows what they're doing, they're calibrating the machines,

• 1:04:08Speaker 01

  and hopefully you can have conversations with the technician. They, they should know a little bit. They don't need to have a PhD in exercise physiology to run a metabolic cart. But we've seen a lot of data come back, and I'm like, nope, no way. Like zero chance that's real. We have to do it again, and the numbers are 20, 30 milliliters per kilogram different. And you're like, yeah. Okay. So really make sure, if you want to look since we're on this point, some research laboratories and universities offer this kind of fee for service, typically somewhere between 50 to 250 bucks. Many don't, most don't. But then there's a lot of clinics that are popping up, and it's, it's those facilities you need to be really, really careful of. It's, it's buyer beware.

• 1:04:47Dr. Darshan Shah?

  Right. Absolutely. Yeah, I mean, the test is only as good as the person administering it, with this one especially.

• 1:04:53Speaker 01

  Yeah. So if you're thinking like, Yeah, I haven't really worked out in a while. I don't really train that much. Then I got a VO2 max test done and I was in the 99th percentile. Maybe it's possible.

• 1:05:03Dr. Darshan Shah?

  Probably not.

• 1:05:04Speaker 01

  Probably not.

• 1:05:05Dr. Darshan Shah?

  Absolutely.

• 1:05:10Dr. Darshan Shah?

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• 1:06:41Dr. Darshan Shah?

  Yeah, and so on that point with VO2 max too, I just want to make one more thing clear. There's no endpoint to where VO2 max improvement doesn't lead to decreased mortality. So just keep working on it, right?

• 1:06:53Speaker 01

  There's no, like, we never take that off our list unless we have, we might oftentimes will deprioritize it if we're like, we've got two, four, six other things that are really substantial for you. The way that we kind of phrase it oftentimes is we talk about, do we need to rebuild? Or do we need to upgrade? Right? And if we are looking across the entire analysis and we don't see any areas of rebuild? And they have a particular reason or desire or joy of improvement, then we might say, okay, let's go for an upgrade in your VO2 max. But if we got seven things that need to rebuild and they want to improve their VO2 max, we might actively tell them no. No, especially if it's things like, hey, the type of training you're doing for your VO2 max is digging you further into a physiological hole.

• 1:07:34Speaker 01

  Or our recovery metrics, our autonomic nervous system testing stuff, our respiratory rate, our sleep, whatever is tanked. And we need you to back down. I would probably say 10 to 15% of our clients, we end up having to throttle back. And it's not even necessarily like those category four people you talked about. Sometimes it's categories one or two or three and we're like, hey, what you need right now? Is a 25% reduction of sympathetic drive and we're going to do that for a month or six weeks. We got to get you reset. To even get back into it. So it's not necessarily just the heart charging, high exercising folks. So yeah, if we have major rebuild stuff, we're going to prioritize those first. If not, we're going to go for some upgrades.

• 1:08:13Dr. Darshan Shah?

  It brings me to even just this morning, I was in the gym and I saw this woman on the treadmill running at 10 miles per hour for literally an hour and a half. I was like, she's burning herself out. This is nuts. And so I, I wonder about things like that, like people overdoing it sometimes.

• 1:08:28Speaker 01

  Depends. Yeah. I mean, sometimes that can happen in 20 minutes. Sometimes hour and a half is fine for, for some people. I mean, some of the high level endurance athletes we've worked with, you know, 100 miles per week is not.

• 1:08:39Dr. Darshan Shah?

  Yeah.

• 1:08:39Speaker 01

  An abnormal week at all. And then others, five miles is, is a lot.

• 1:08:45Dr. Darshan Shah?

  It's a lot, right? You know, I'm seeing a lot of these biometric test devices like the Oura Ring and the watches now. An approximation of VO2 max. Have you looked into how close to accurate that might be or not accurate?

• 1:08:56Speaker 01

  They, it, it depends on what question we're trying to answer because the reality of it is they, where they tend to get lost. Is when your numbers tend to be good to great. And so if, if you are fairly poor in your VO2 max, the number is going to get okay. Um, but at high heart rates, they tend to get screwy. And at high VO2 maxes, they tend to get screwy.

• 1:09:17Dr. Darshan Shah?

  Got it.

• 1:09:18Speaker 01

  I get asked this question 50 times a day and I always don't answer it. Cause I'm like, again, I don't want to actually make things like this. I don't want to make the barriers so high people are just, I don't want to do.

• 1:09:29Dr. Darshan Shah?

  I'm sorry.

• 1:09:29Speaker 01

  But the reality of it is that those technologies are going to get better.

• 1:09:33Dr. Darshan Shah?

  Yeah.

• 1:09:34Speaker 01

  For sure. They're going to get better. They have just continually done that for many, many years. I have full faith that they're going to get better. But right now, here's how I'll say it. We don't do that in my practice.

• 1:09:45Dr. Darshan Shah?

  But at least directionality for people that are in the poor or to the, you know, average VO2 max, if they're trying to improve it. At least directionally, it can be helpful? No? Not even?

• 1:09:55Speaker 01

  Well, no, I mean, yeah, it can. But, but like what it is, is I'm getting really technical with the technology because it's things like if they tend to start sliding on your wrist during a test and they get off to a slightly different angle, you start seeing wildly different numbers. So even directionality is like, if it slid there, but that doesn't always happen. So when any of our clients have those things and like, we're not going to give them to them, but they, they already have it already, we'll kind of look at it and be like, oh, cool. Like, okay, but I'm just not like, I'm never going to be changing programs based upon the data from those things. Yeah. So nothing against those companies at all or those technologies. But if it's helping you, do it.

• 1:10:32Dr. Darshan Shah?

  Right.

• 1:10:32Speaker 01

  If it's not though, then don't. That's probably the lazy answer for it.

• 1:10:36Dr. Darshan Shah?

  Exactly. Well, and I think also like, you know, doing some of these surrogate tests is a good way to kind of, if you can really go to a VO2 max laboratory, getting a surrogate test on yourself is also another good way.

• 1:10:47Speaker 01

  Here's, maybe here's like a, a better halfway house here. If you can wear one of those devices that you already have while you're getting an actual metabolic test done and they come back and they're pretty similar, then maybe you can go home and use all your training and all that on your wearable. And then you're once a year, once every two or three years, you go back in the lab and it still keeps syncing up, then hey, perfect world.

• 1:11:09Dr. Darshan Shah?

  There you go. Right. Absolutely. So just a little bit more on the strength training pieces. Is it ever too late to start strength training?

• 1:11:17Speaker 01

  It's never, never, never too late to start any form of exercise, any habit change, any health change. But very specifically, I can answer this empirically because we have done studies, I've been involved in where we are doing training studies on 70 plus year olds, on 80 plus year olds. There's a lot of literature. These studies have been done many, many, many times. And the things you're going to find, and what I'm representing here is not one particular study. I'm representing multiple studies across multiple laboratories, different teams of scientists, men, women, Finland, Denmark, the UK, Germany, Japan, Brazil, America. For this question, they're all giving you the same answer.

• 1:11:58Speaker 01

  We see no particular line of age that says you can no longer grow muscle mass. We don't see that. We don't see any line of age that says you can no longer develop strength. We don't see, and for the record, none of these studies report any increased risk of injury. Adverse events tend to be extremely low, if not nonexistent, in most of these types of studies. Way lower than you would think. In fact, almost always lower than when we do those studies. And our dropout rates in college kids is way higher than 70, 80 year olds. Like, we always joke, like, in the lab as a graduate student, because if you're doing a training study with 70 year olds, like, you better be ready 20 minutes before the appointment. Because they're never not, like, late?

• 1:12:40Speaker 01

  Zero chance they're late. Miss a session? No chance. You do that study with college kids? You better have a four hour window, right? And you're gonna get half paying attention. People who are retired, like, this is their coolest thing of the day, no offense, but they're showing up. They don't miss sessions. They don't complain. One of my favorite stories ever, I wasn't there for this one, but it was, sort of got passed down over the years in the lab, of one of the training studies they did in 70 year old women. And they were kind of like, I think they were actually doing a biopsy. And they were just asking, like, "How you doing? How you doing?", like, whatever. And, you know, took the biopsy from her leg, and she kind of got annoyed. It was just like, "Honey, I've had seven kids."

• 1:13:16Dr. Darshan Shah?

  There you go.

• 1:13:17Speaker 01

  He's like, "All right, okay." Maybe this little thigh bruise is like, maybe, all right. So, they tend to be super, super, super resilient, so.

• 1:13:24Dr. Darshan Shah?

  Right.

• 1:13:25Speaker 01

  Yeah, you gotta be a little bit more conservative.

• 1:13:27Dr. Darshan Shah?

  Yeah.

• 1:13:28Speaker 01

  Okay, maybe we're not doing a one rep max test day one, or a three rep max, or a five rep max, for that matter, right? We're not gonna progressively overload as fast. We're not gonna take as many risks. We're gonna be a little more conservative. But we also don't need to treat them like they're frail either. They're gonna be just fine, right? You don't, the volumes doesn't have to be the same. You can train them. One of my favorite studies ever was a giant plyometric study in older men and women.

• 1:13:51Dr. Darshan Shah?

  Oh, yeah.

• 1:13:52Speaker 01

  No adverse event, like, no injuries, no problems, tolerated well, and massive improvements in muscle size, balance, stand, what are called, like, very standard activities, the daily living tests, where they sit them in a chair and literally time them, how long it takes them to stand up and walk across the hallway, right? These are really common tests in these areas, yeah. All these things are right, you're 10, 20, 30, I don't remember the exact date, but 40% improvements in everything, and no dropout, no injuries.

• 1:14:17Dr. Darshan Shah?

  What ages?

• 1:14:18Speaker 01

  That was 70 plus.

• 1:14:19Dr. Darshan Shah?

  70 plus, huh?

• 1:14:20Speaker 01

  Yeah. So, like, even then, like, jumping and landing's not a big deal.

• 1:14:23Dr. Darshan Shah?

  Incredible.

• 1:14:23Speaker 01

  You just... Again, be intelligent about how you progress it. So the way that I will teach this is, and by the way, the same research will hold up in children for the most part.

• 1:14:33Dr. Darshan Shah?

  Yes.

• 1:14:34Speaker 01

  This is not an age or a sex issue. This is a quality of movement issue. This is a quality of programming issue. If you give anybody, I don't care if they're six, 26, or 66. If you give them too much volume, bad things can happen. If you give them too much intensity, bad things can happen. If you progress them inappropriately, bad things can happen. If they move poorly, bad things can happen. If you do all that stuff combined, bad things will happen. Right? But that's not, that's not an age thing. And by the way, when I say too much intensity or too much volume, there's no numbers I can give you there because it is relative to that person, right? Here's the example. Do you run much? Are you, would you consider yourself a runner?

• 1:15:18Dr. Darshan Shah?

  Myself, yes.

• 1:15:19Speaker 01

  Yes, you, okay. How many miles a week do you run-ish?

• 1:15:22Dr. Darshan Shah?

  I would say I'll run anywhere between three to five miles, three times a week.

• 1:15:28Speaker 01

  Okay, so you're running 10 to 15

• 1:15:30Dr. Darshan Shah?

  Yes.

• 1:15:31Speaker 01

  miles per week. Great. Let's just say 10. We'll make the number up, okay? Now, if I took you, I'll do the, your range is 10 to 15. If I said, hey, next week, doc, let's get to 17 miles, it'd be fine. All I did is I increased your upper range by two miles.

• 1:15:46Dr. Darshan Shah?

  Right.

• 1:15:46Speaker 01

  Okay? If I took somebody who doesn't run, and I said, we're gonna go run two miles right now, and they're your age, your body weight, but they have not run in 10 years, I promise you the next day they're gonna wake up and their quads or hamstrings are going to be destroyed. It's not the two miles.

• 1:16:02Dr. Darshan Shah?

  No.

• 1:16:02Speaker 01

  It's the progression.

• 1:16:03Dr. Darshan Shah?

  It's the progression.

• 1:16:03Speaker 01

  From zero to two is much different than 15, even though 15's up to

• 1:16:07Dr. Darshan Shah?

  Great analogy, yeah, absolutely.

• 1:16:09Speaker 01

  It's not the weight you lifted. It's not the percent of heart rate you're at. It is the change from baseline, right? It is, the general number we give is 10%. You don't want to accelerate more than 10% per week from your standard. If your standard is zero, then we're gonna make up 10%, right?

• 1:16:25Dr. Darshan Shah?

  Right.

• 1:16:26Speaker 01

  But 10% might be, we're gonna walk 800 meters, three times per week, and like, we'll see what happens, right? For you, I would not hesitate to take you up two miles.

• 1:16:36Dr. Darshan Shah?

  Right.

• 1:16:37Speaker 01

  Right? Now, that's 20% if you're at 10 miles. Okay, you're probably gonna handle that just fine, but I wouldn't take you from 15 to 20.

• 1:16:44Dr. Darshan Shah?

  Right.

• 1:16:44Speaker 01

  That's too big of a jump. That's almost doubling at your low end. It's 50% increase to your high end. Way too much. You'd be fine for one week. But could you do that for six weeks? Something was gonna happen. Knees, knees gonna start acting up. Back's gonna start. Who knows what's gonna start happening, right? No guarantee, but very, very likely, if it's not one weekend, it's gonna be somewhere between one and four. Things will start creeping up, right? We need to have progressed that thing slowly and intentionally. And so I, I know people want numbers, but you genuinely cannot give them weight or days per week, whatever. It is always relative to that person's baseline, because those numbers are irrelevant. That's the same for a six, 26 or 66 year old.

• 1:17:19Dr. Darshan Shah?

  Right.

• 1:17:20Speaker 01

  Kids can handle anything if they are brought along appropriately. A 26 year old who's in the gym five days a week can still get overuse injuries really quickly if they put on 50 extra pounds. And that might be the same relative percentage as you putting on four extra pounds. It's not the numbers that matter. I know that because I've coached people. I coached just a little bit. A girl named Steffi Cohen. She's a doctor of physical therapy. Um, one of the meets I coached her for, she was 119 pounds and I think she deadlifted 550, 520. Right? Like for her to increase her training load by 50 pounds in a week is nothing. But she's a, at the time, 120 pound girl. So it's not, the number is irrelevant.

• 1:18:02Dr. Darshan Shah?

  Yes.

• 1:18:03Speaker 01

  Right? It is completely irrelevant. It is always relative to your body weight, your, or not body weight, but your past history and background. That's the way to think about those things.

• 1:18:11Dr. Darshan Shah?

  Yeah. I mean, I, I really like that 10% rule because people always wonder like, how much should I be progressing? Some people, you know, on the other side of that too, let's talk about a little bit of exercise progression, because you had a great podcast on this. And one of the protocols you had talked about progressing based on your own ability. Some people never really progress. They just stay at the same

• 1:18:29Speaker 01

  Yeah.

• 1:18:29Dr. Darshan Shah?

  rate of exercise or the same weight or the same number of reps for years sometimes. And it's not because they don't want, it's just because they haven't tried. And so there needs to be a certain level, like you were saying earlier, the beginning of the podcast.

• 1:18:42Speaker 01

  Yeah.

• 1:18:43Dr. Darshan Shah?

  Also trying to make some progression in the gym as well. So.

• 1:18:46Speaker 01

  I would, I would suggest people stick to the same skeleton structure, four to 12 weeks.

• 1:18:54Speaker 01

  Okay, at that point, you need to make some sort of very noticeable change. This could be your exercise selection. This could be the repetition range, the amount of sets that you're in, if we're talking about lifting. Okay, every sort of maximum 12 weeks, you probably should have a very noticeable change in your approach. What this allows you to do is make very, very small progressions for those 10 to sort of 12 weeks, right? And so a very easy, easy, classic strength and conditioning example. Let's just say you're gonna go eight to 10 weeks, or whatever you're gonna be. You might do something like a very, very slow increase in weight, you know, 5% at most, combined with a slow decrease in volume.

• 1:19:37Speaker 01

  And so you might go something like, hey, for the first couple of weeks, I'll do three sets of eight to 12 reps at 100 pounds. Every week, I'm gonna go from 100, next week, I'll go to 105. And then maybe I'll stick the next week at 105 again, cuz, and then I'll go to 110. Very slow progression in your weight, now over the course of four weeks, I just gave you, right? And now the fifth week, maybe we take a 20% deload. So now we take it down to 90 pounds, whatever, right? Still gonna work, we're not off that week, we're not sipping Mai Tais in Cancun. But we're not like really pushing it either. It's enough to stimulate maintenance, but a lot of recovery. And then the week you come back, now you go to 110, right, or 105. And so we can kind of, we do this stairwise, up, up, up, down, up, up, up, down.

• 1:20:20Speaker 01

  Every four to six weeks, we take a little bit of a back off and then back up. In that example I gave you, if we did 12 weeks, we could do four weeks on, one week deload, four weeks on, one week deload, that took us 10 weeks, right? We're in that grade. Now, since we were increasing our load, that's one example. You could also do that while decreasing your volume a little bit. So instead of doing sets of eight to 12, as I increased my weight a little bit, I also started backing down to sets of seven to eight. And then that next four to five week training block, I get down to sets of five to six. So I've steadily brought down my low or my volume, which allowed me to put more weight on the bar. That's how I got to 110. That's how I got to 115 or wherever I'm going to go, right?

• 1:21:05Speaker 01

  So now I've progressed. I've matched volume by bringing that down. So that allowed my load to go up. Now, I finished my 10 week cycle and by the time I finished, I'm doing maybe sets of four, or five, or six. And I'm getting pretty heavy. Finished that and then now maybe I switch into another cycle. I go back to the beginning. Or I go to sets of 15. Or I do some other thing. Maybe I stay there, but then I switch my exercises up just a little bit or something like that. So kind of playing volume and intensity against each other. And I apologize, I keep exchanging intensity and load. For lifting weights, that's the same thing.

• 1:21:40Dr. Darshan Shah?

  Yeah.

• 1:21:41Speaker 01

  Right? It's not the same on like cardiovascular intensity, perceived effort. That's not what I'm saying here, right? It is how much weight's on the bar. All right. So I'm sorry if I made that confusing. But you're always, you can, with, with weightlifting related things, and I, I know I'm also being very myopic. Just only talking about weightlifting. There's lots of other ways to exercise. But that's just as a, as a conceptual practice here. We can do the same thing for endurance related events, right? If you're going to increase your mileage, right? So maybe you will increase your speed of your swimming or your cycling speed. If you tone down the mileage. Typically endurance work tends to like to ratchet up mileage as their progression strategy. Fine, but you do that, you up your mileage. But don't do the like, I did one mile today. Therefore next week I'll do two miles and then I'll go three miles.

• 1:22:25Speaker 01

  That's a recipe for pain like we talked about, right? 10%.

• 1:22:29Dr. Darshan Shah?

  10%.

• 1:22:30Speaker 01

  Weekly, 10% weekly volume. Add up how much hours you were in the pool. How many laps you did, the yardage or whatever it is you did, you know, on distance around the bike. Add that up for the week. And then say, okay, next week my plan, put it together. Make sure that total weekly number is not more than about 10% or so higher. Cause what ends up happening is you go, I'll just do 50 extra meters on Monday and I'll do 200 extra meters on Tuesday. And all of a sudden you're like, damn, that's a 35% increase. That'll get you real fast. But the same principles would apply. Four, five, six weeks. Have a deload. Start back to beginning, change it up a little bit. Now move to more intervals. Now move to more, something like that. So if you're kind of just constructing this thing on your own, that's just a really, really good template. 10 to 12 weeks with a couple of little mini-cycles

• 1:23:14Speaker 01

  in between that. And then at the end of that 12-week, you don't want a drastic overhaul, but you could have a pretty good change in, in kind of what you're doing. And that will allow you to continue to work really hard, for people who like to work hard, without getting the, the consequences of overuse from the same stimulus all the time, as well as plateauing and peaking.

• 1:23:34Dr. Darshan Shah?

  That's such a great, simple model to continue to progress without hurting yourself in, in whatever you're doing, whether it's weight training, or, or like you said, swimming. It just kind of keeps you moving forward.

• 1:23:45Speaker 01

  Yep.

• 1:23:46Dr. Darshan Shah?

  I love that. I love it. Yeah, because you find a lot of people, they're like, I'm just not progressing. Like six months later, and then you find out why. It's like, there's no variation at all. This is always the same thing.

• 1:23:54Speaker 01

  Yeah.

• 1:23:54Dr. Darshan Shah?

  Every single time. I see that a lot.

• 1:23:56Speaker 01

  One of the episodes that has yet to come out is on peaking, plateauing, and, and overtraining.

• 1:24:01Dr. Darshan Shah?

  No, I can't wait for that one.

• 1:24:03Speaker 01

  We'll talk in, in detail about these things. But this is one of the primary causes of it. It's been our experience, everyone that has come in, that's like, I'm plateauing, I can't get past this, where you yet to find someone who didn't have a reason for that.

• 1:24:13Dr. Darshan Shah?

  Right, right. No.

• 1:24:14Speaker 01

  It's not your genetics, by the way.

• 1:24:16Dr. Darshan Shah?

  And your first couple of episodes too, or your second one and your third one, you had some great protocols. For those of you listening, you want some really specific protocols on those episodes for strength training and VO2 max training.

• 1:24:26Speaker 01

  Yeah, we actually spent, and it was episode two, I spent the entire one just going through two different endurance training programs. One of them was by a guy named Joel Jamison, and it is a general VO2 max and conditioning program. And then he made the first, I think, four weeks of it free in the show notes. And then I also went through another program that was designed by my friend, colleague, Dan Garner. And he wrote this program for a guy named Mark Bell. Mark Bell is a law, lifelong powerlifter, sweetheart of a human. And Mark went from lifting weights and powerlifting and bodybuilding his entire life to running his first ever marathon. And this happened to be Boston, by the way. And so this is called Faster Than 50. It was a marathon program in 50 days. He obviously took more than 50 days to prepare, but it's the

• 1:25:11Speaker 01

  Final 50 days and they made that entire program free. So I went through it in the podcast and then you can get the whole thing. I think it's faster and 50.com or something like that. If you Google that and Mark will come up and you can see the full nutrition program, the supplement program, the drug program. Mark's very open about his, you know, drug use, the, the stretching, the lifting, the training program, all those things. And they, Dan and Mark just, I don't know why they did it. They just gave the whole thing away.

• 1:25:37Dr. Darshan Shah?

  That's amazing.

• 1:25:37Speaker 01

  Yeah. So if you want an actual like program to follow, depending on your flavor, you could pick Joel's program or Dan and Mark's.

• 1:25:43Dr. Darshan Shah?

  Yeah, yeah. Those, and I, I looked them all up and they're, they're fantastic programs for someone just getting started.

• 1:25:48Speaker 01

  Yeah.

• 1:25:48Dr. Darshan Shah?

  Or you're doing something for a long time and you're just plateaued. They're great programs that can take you to that next level as well.

• 1:25:53Speaker 01

  Especially if you don't want to think about it. You just kind of want to follow a program.

• 1:25:56Dr. Darshan Shah?

  Right, absolutely.

• 1:25:57Speaker 01

  And then in episode four, we did a similar thing, but for the strength training.

• 1:26:00Dr. Darshan Shah?

  The strength training, right.

• 1:26:01Speaker 01

  Yeah. So we did a hypertrophy program, muscle growth program. And then we did a more of like a sport performance, power and strength program. Travis Mash, who himself is a multiple time world record holding power lifter.

• 1:26:13Dr. Darshan Shah?

  Right.

• 1:26:13Speaker 01

  And coached a ton of national, international level weightlifters, NFL guys, things like that. So he put that program together. It was actually a real program. It was, I think, his, this year's preseason training program for, I think it was his, his NCAA's football team. Uh, that, so he literally just gave you the, the actual program and I went through it in the podcast, the same thing. And he was like, dude, here you go. And you can just go get the program. I don't remember if the whole program is free or part of it. I think the whole thing is.

• 1:26:37Dr. Darshan Shah?

  Perfect.

• 1:26:38Speaker 01

  But it is like a speed one, there's a strength one or whatever. So, um, yeah, and the goal was to just like go straight into, uh, there's not a lot of physiology there. There's no background. It is a, here, if you want to hear what a program looks like. And then in both of those, I walk people through, hey, how, how are they progressing? Why are they doing this? Why are they doing that? So you can kind of understand a little bit of what's going on, but you can also just go straight to the programs.

• 1:26:59Dr. Darshan Shah?

  Yeah. No, that, that's, that's very generous of all of them and for you to put, put these out there because these are.

• 1:27:04Speaker 01

  That was Rob's idea, both of those.

• 1:27:07Dr. Darshan Shah?

  That's great. Thank you, Rob. But, uh, yeah, I mean, I think these professionally developed programs are great places to start. And obviously like, you know, everyone's different. Like we keep talking about, you gotta find what works for you. And maybe none of these will work for you, but you can create something on your own, just knowing some of these. Basics, how to improve, how much to increase your volume or your intensity. 10% being kind of the max number per week. I love those. I love those tips.

• 1:27:32Speaker 01

  Yeah.

• 1:27:32Dr. Darshan Shah?

  So.

• 1:27:33Speaker 01

  Do you, sorry, do you have, um, in your guys' practice, do you guys have a, like a training program and stuff that you're able to put people on as well?

• 1:27:41Dr. Darshan Shah?

  We're actually developing one right now.

• 1:27:43Speaker 01

  Okay.

• 1:27:43Dr. Darshan Shah?

  And we're really trying to customize it. You know, I'm all about N of one, right? I mean, we gotta really find something that works for each individual person. And I want to talk more about that with you right now. That was my next question for you, actually, because we put together different programs for people based on their amount of time, where they are, their training age. So it's really just kind of matching the program to the person mainly. And, you know, one of the questions I have on that for you is, I would say 15, 16% of people, somewhere in there, less than 20 probably, come in with no training, maybe forever in their life or not the last 10 years, right? And so I think where we struggle sometimes is what's the best way to ease those people back into a training program? Or what would that training program kind of look like?

• 1:28:25Speaker 01

  Yeah. Okay. So you can look at this a couple of different ways. We, I, we just gave the example of, hey, you know, download one of these programs that weren't built for you and go after it. If you want to do your own thing, what I would like to answer this question with is kind of like we've been doing today. What's the spectrum across like your interest level and your income or resources? Okay? So that everyone has an option. Add kind of one in the spectrum. If you're the person who wants to learn to write your own training programs. We actually have a whole course for that. It's in our Bio-Molecular Athlete.

• 1:28:55Dr. Darshan Shah?

  Okay.

• 1:28:56Speaker 01

  It's called the, we actually made a, it's a toolkit. So it's a course and all of the tools, the Excel files, all those things for people to develop their own training and nutrition programs for longevity, for fat loss, for strength gains, for performance. Depending on your goal, it is the actual, again, like Excel file, the numbers to calculate, enter in your stuff, and then you can build your own training programs.

• 1:29:18Dr. Darshan Shah?

  So we'll look to the show notes. That's on your website or?

• 1:29:21Speaker 01

  That's Bio-Molecular Athlete.

• 1:29:23Dr. Darshan Shah?

  Bio-Molecular Athlete.

• 1:29:23Speaker 01

  It's my education company.

• 1:29:25Dr. Darshan Shah?

  Amazing. So we'll link to that in the show notes.

• 1:29:26Speaker 01

  So we did seminars on that and we're like, dude, just put this out. I don't remember exactly how much that cost. That, there's a little bit more, the medium kind of, it's educational course. You guys know how much it costs. Cheaper than that, if you wanted to go with something like a virtual coach, Renaissance Periodization is fantastic. Nick Shaw and Mike Isertel are amazing. I don't know what their programs cost, but it's an app. It is an artificial intelligence backed app. It learns you and your progression. I think it's specific to pretty much hypertrophy. Sorry, guys, if it's not. But the RP hypertrophy app, if that is a goal, would be a great way. If you're coaching yourself, you don't want to write the program yourself. You don't want to learn. You just like, kind of want to follow something, then I would recommend that. If that's none of the case, and you're like, I don't have a dollar to spend, where do I get started?

• 1:30:11Speaker 01

  Okay, well, let's answer that one. You're gonna have to do some work, but let's get this figured out. We would generally say, okay, let's figure out what you're willing and able to be consistent with. Step one. Okay, if that's two days a week, don't put three. If that is two days a week, let's put three, because it's gonna mess up the program. Right? Let's be realistic. If we could do it, I'd do World 3 would be the case. Okay, I would love 4. I'll settle with 3. I will work with 2. Okay, but if you let me pick, I'm gonna pick 3. I am generally gonna want to have people to do mostly whole body workouts. Okay? This means whole body exercises, as well as covering multiple body parts within the workout. Okay, so very rarely do we do body part split training. Occasionally, this would be that bell curve at the end of it.

• 1:30:57Speaker 01

  Overwhelming majority of our people are going to get full body training.

• 1:31:01Dr. Darshan Shah?

  That's good information.

• 1:31:02Speaker 01

  This is equally equivalent for hypertrophy, and the research behind that is is pretty stout at this point, and it's way more time efficient. The other thing it guards against, and this is just a practical Andy coming out, because I am a human too, right? If you do body part split training, and by that, what I mean is, you know, arms on Monday, biceps on Tuesday, that kind of thing. If something happens on that Tuesday, that whole body part got missed.

• 1:31:27Dr. Darshan Shah?

  Missed, right.

• 1:31:28Speaker 01

  Your kid got sick, business meetings ran late. Our podcast went four and a half hours instead of an hour and a half, like... Now you're not gonna get to work. You skipped it. If it's whole body, then you're not out anything. Right? So nothing goes really long without getting trained. And that is a huge issue. One of the main drivers of hypertrophy is making sure you can have continuous muscle tension at enough volume. You have to be able to just not go. Now, you don't need that much to maintain where you're at. But if you're really trying to make progress, you don't want touch points that are missed. You just can't have big lapses. And one of the big causes of lapses is gonna be things like I missed a session because of life. Right? Now, if you're a 24-year-old kid and you don't have kids and you don't run like, you never miss your workouts. I get it.

• 1:32:12Speaker 01

  But for the rest of us, I don't know. 25% of my workouts get missed?

• 1:32:17Dr. Darshan Shah?

  Yeah.

• 1:32:17Speaker 01

  More maybe?

• 1:32:18Dr. Darshan Shah?

  It's just life.

• 1:32:18Speaker 01

  It's like, there's no chance, right? Flights get delayed.

• 1:32:21Dr. Darshan Shah?

  Exactly.

• 1:32:21Speaker 01

  Traffic happen. Like, it's all the stuff that you can't control, right? Kids, all that stuff. Alright, awesome. So I want more, uh, full-body exercises as well as workouts themselves. What we're generally going to do is each day, pick what is the most important thing we've gotta get done. Uh, and that's gonna be our whole-body exercise stuff. And then that's going to be very general. By general, I mean, we're gonna look to do something that is a lower-body press and a lower-body pull. We're gonna do something that is an upper-body press and an upper-body pull. Right? Now, I can explain what those are in a second. After that, though, at the end of the workout, is where I can allow isolation work.

• 1:33:00Dr. Darshan Shah?

  Right.

• 1:33:01Speaker 01

  Okay, you have a particular injury we're trying to work through. You have a particular body part you just like to train more. Or you want your calves to get bigger. Or you love doing shoulder work. Great. But that's at the end of the workout. So when the time got shorter, or whatever, and something got skipped, it's that isolation work, and we got our big work done. So we're doing it three days a week. We're gonna do multiple, uh, full-body exercises. And we're doing something in those four categories. Pushes are, tends to be literally things that where you're pushing away from your body. So for upper body, this is a horizontal push. Could be a bench press, could be a push-up, something like that. Could be a vertical one, pressing over your head. Handstand pushups, you know, whatever you want to do.

• 1:33:42Speaker 01

  Same thing with pulls, horizontal roll, pull up, lat pull down, you know, so on and so forth. Lower body pressing away from you could be a leg extension, could be a squat, could be a split squat, could be a lunge, variations of that. Pullings are the opposite. It's a hinge, it's a deadlift, it's Romanian deadlift, it's a hamstring curl, something like that. So we're looking for multiple joints to be moving at the same time. It is really what we're after. And if we can do that, we're going to get most of our stuff. If we're making sure that we're in good positions, that's going to get a lot of our core and our torso handled along the way. If we have to do some isolation work on top of that for our core or torso, we will. Almost surely though, we're going to incorporate that into our warmups as well as our cooldown to get that volume, to make sure we get touchpoints there.

• 1:34:26Speaker 01

  And that tends to get us in a pretty good spot. So categorically, that's how we're going to structure it.

• 1:34:30Dr. Darshan Shah?

  Yeah, I love that. It's just, you know, so simple for people, as a starting point for people.

• 1:34:36Speaker 01

  Yeah.

• 1:34:36Dr. Darshan Shah?

  To at least get into the gym and just do, you mentioned four main exercises and maybe a fifth added on top of that.

• 1:34:42Speaker 01

  Yep.

• 1:34:42Dr. Darshan Shah?

  Some core work. And that's on the muscular strength portion of things. And what about on the cardiovascular training part of things?

• 1:34:49Speaker 01

  So we want to think about VO2 Max as having two minimum, I prefer three components. Component one is going to be abilities to sustain work over a long duration. Call this steady state cardio, whatever, call it aerobic exercise, call it zone one, two, three, I don't care, does not matter to me at all what zone you're in. This is 20 plus minutes, this is no intervals, this is no breaks whatsoever, this is something where you're sustaining work. Okay, if you want to hike, if you want to ruck, if you want to swim, or stand on paddleboard, or kayak, or skateboard, I do not care at this level, right? We'll care later, right now, give me something where you're not going to stop.

• 1:35:32Speaker 01

  And almost always, we're going to want this to be nasal only breathing. All right, so we're intentionally doing that because we need to work on that physiological aspect, almost everybody does anyways. Brian McKenzie and Emily Hightower, I don't know if you know Brian.

• 1:35:45Dr. Darshan Shah?

  I don't know.

• 1:35:46Speaker 01

  You guys have so many mutual friends, I'm surprised you haven't. His company, Shift Adapt. So much research, so, or so much information, rather, in this area. Um, you can lay out all the reasons why you want to do these things, but so something in that area.

• 1:35:59Dr. Darshan Shah?

  Okay.

• 1:35:59Speaker 01

  Okay, again, this can be, if you had to get this done, this could be done walking, this could be whatever needs to be done. We're gonna check that box off.

• 1:36:06Dr. Darshan Shah?

  So 20 minutes on the minimum.

• 1:36:07Speaker 01

  Minimum, no maximum.

• 1:36:09Dr. Darshan Shah?

  No maximum, right, exactly.

• 1:36:11Speaker 01

  And minimum twice a week. Once a week I will live with, but like really two times would be good here if we can. Other into the spectrum is we have to do something that touches maximum heart rate ish. I don't literally mean maximum, like we gotta be close ish to there. If you want that to be a circuit with, with dumbbells and, oh, great. If you want that to be a group activity class, a jujitsu class, you want it to be cardio kickboxing. You want to do, you know, sprint the straightaways, walk the corners. Fine, fine, fine. If you want to do 30 on, 30 off, you want to do four minutes on, four minutes, like those don't actually matter at this level. You gotta do, when I'm looking at somebody's program, I'm going, do you have something that's gonna hit that?

• 1:36:57Speaker 01

  Right? Um, maybe that's your sport or your practice or whatever it is you're doing. You're, okay, great. And if we're hitting there over there, then I'm like, okay, that box is checked off. But we have to get up to some sort of maximal, and in this case, literally, it's, it's anaerobically. So we're going past VO2 max, we're going to 110, 20, 30% of VO2 max. Ideally, I would love to get part three, which is the middle ground. This is eight to 15 minutes of sustained work, not at max heart rate, because that's not gonna be possible. But it's 80 plus percent heart rate, right? This is not, you're not having a conversation, you're not enjoying your life at all, but it's not so low you could be answering texts. We're not doing any of those things. That is the most equivalent one basically to VO2 max, so.

• 1:37:41Speaker 01

  For those two aspects, the maximum heart rate and this kind of third category, once a week is enough.

• 1:37:46Dr. Darshan Shah?

  Okay.

• 1:37:47Speaker 01

  Right? If you look at actually Joel Jamison's work in this area, he's going to tell you that maximum heart rate stuff more than once a week is, some people can get away with it, but many can't. Where you live, do well is you gotta accumulate your volume. And that middle area, by the way, that eight to 12 minute one, it doesn't have to be that hard. But it's not walking either, right? So you just gotta put in work, right? You gotta really put in work there, accumulate some miles, accumulate some yards or whatever the case is, and you gotta put some work on the system. So if you were to build this whole week out, if you want me to do that, it would be something like this. I'm literally making this up on the spot, but it could be something like this.

• 1:38:24Dr. Darshan Shah?

  It's perfect.

• 1:38:25Speaker 01

  Maybe Monday, we do a lift. Okay, great. We're gonna do a 10 minute walk in the morning, nasal only. We're gonna lift in the early afternoon or right after work, and then we're gonna do a 10 minute walk in the evening before bed, after dinner. That 10 minute walk, by the way, especially the night one, there's gonna be no ear funds in. We're not listening to podcasts. We have to take arousal out of the system. It is down regulation, it is nasal only. If it's dogs, if it's family time, if it's whatever, but it is not any more up regulation than the vast majority of people. Okay, and we got that lift in. We came in and we did maybe something like two to three sets of four exercises, right?

• 1:39:06Speaker 01

  We did kind of one each, and maybe this is the leg press, maybe this is pushups, some bent row with the dumbbell, and then maybe some hamstring curls. Okay, great. And then we finished that with, you love to do more glute work, so you did some hip thrusts and you built your butt muscles up nice, like fantastic. And you did a set of 30. You did a set of 100. I don't care. You went as hard as you could till you got a giant pump, and then you rolled on the floor for a minute because it was in screaming pain. Fine. I'm good there, right? Maybe you did some sort of extra ab work. Cool, whatever. That's a 30 minute workout. Good solid warm up. We're there for 40 minutes total. Okay, we're out of there. Tuesday now, we put in a little bit of work on Monday, so Tuesday is probably gonna be one of our longer duration days.

• 1:39:50Speaker 01

  So maybe we're now going stand up paddle boarding for an hour, right? We're gonna go do something like that. We don't need to do our walks per se, although we'll keep them, but we're gonna do that longer duration thing. We're gonna be plenty recovered by Wednesday. So now Wednesday, we come in and we do, uh, maybe we do our, well, our VO2 max day. And we're gonna get a thorough warm up in, we're gonna feel really good, and we're gonna run a mile as fast as we can. And that's gonna take most people eight to 12 minutes, and that's all we're gonna do. This is also a 30 minute workout. It's gonna be 10 minute warm up, 10 minute run, 10 minutes laying on the ground. And like, we slowly make our, make our way out of there. Hopefully some down regulation stuff. I still want a night walk. Like, I really want, because remember, you ran a mile. That's not very much work.

• 1:40:36Speaker 01

  It's really, really hard. It's cardiovascular intensity, but you actually didn't do that much work. The running a mile and walking a mile is the same amount of calories. Still a mile, right? That's work. That's what calories are. So there's not extra work there. It hurt more. You got it done faster, but it's, it's not that much different. So we still need to move some calories and we need to move, so I still want my morning and afternoon walk on that one. Okay, now we're into Thursday. We're lifting again. Okay, similar, you can, if you wanna do the exact same workout for Monday, do it. If you wanna switch the movement patterns up a little bit, great. If you wanna switch the rep ranges. So Monday, we did two to three sets of eight to 12 reps. Maybe what, Thursday now, we lower the rep range to five to seven reps per set.

• 1:41:17Speaker 01

  And maybe we either do one more set, so now we do three sets instead of two sets, or we lift the load. We go a little heavier. So we got our kinda hypertrophy day on Monday. Thursday, we got our strength kinda emphasis, right? Same thing. You can finish with glutes. You can finish with a different one. Now you're gonna do forearms and, and posterior shoulders for your posture, neck, calves, toes, whatever you wanna do, right? So we're gonna do our down regulation work. Okay, now we've checked off two lifts, one long duration, one high intensity, and we're only at Thursday.

• 1:41:45Dr. Darshan Shah?

  Yeah.

• 1:41:46Speaker 01

  Maybe Friday, we do three 10 minute walks. We're gonna go, we're chilling, right? We're gonna go out, we're gonna have fun, and we're gonna take that sort of day, and we're enjoying it. We got our basic movement in. Now all of a sudden, we come back Saturday and we can add in intervals. We can add a lift. We can combine them. Let's do our lift and now let's finish our lift with 30 second burst on an assault bike. As hard as we possibly can, take a 90 second break and we do four rounds of that. We got our lift. We got our thing in it. No one ever said I couldn't do them the same day. Still talking a 45 minute workout. And now we're out of there. Sunday, we're, we're off entirely or we're doing more of our lower intensity stuff. If you wanted to get two days a weekend.

• 1:42:28Speaker 01

  Or we're doing hot yoga or sauna and ice. Or you're playing video games all day. I don't care. Right? Like you've gotten a pretty good balance of all those things in there.

• 1:42:39Dr. Darshan Shah?

  That's a great workout program. I'm, I'm going to type that out for all the listeners and put in the show notes because it's like a perfect place to start for people. And it, like you said, it checks off all the boxes and it's pretty easy. Like it's 45 minutes a day for five, five, six days a week and you're done. And also it's varied enough. So if you end up skipping a day accidentally, you've still got the full body work in. You've still got most of it.

• 1:43:02Speaker 01

  What I would recommend doing if you're in a situation like that is not necessarily holding those workouts to the day. So don't do that lift on Monday, every Monday. Just do those in order. And if you get, if you're feeling tired, take a day. Okay. But that way, if you're like, oh, something came up on Monday, now you do Monday's lift on Tuesday. And you just shift everything back one day. That's honestly how I train because I'll go sometimes 14, 16 days and not take a day off of working out. But then also life gets in the way a lot. And all of a sudden it's like, man, I got three workouts in this week because blah, blah, blah, blah. And so if you, if you do that, you're going to end up, it's really, really hard. So I have personally just said, okay. I have 30 workouts to do and my goal is to get these 30 workouts done in the next 60 days.

• 1:43:47Speaker 01

  Whatever the case is, right? So I actually program it that way. Typically I'm looking for more like 40 and 60. Can I get 40 workouts done in two months? And when I get that done, sometimes it takes 55 days. Sometimes it takes 70 days. Then we stop, reassess and my coach writes me a new program and we, we go on to the next one. That's how I do it. I do not do the kind of structured. We tweet because my, my, it's just too challenging.

• 1:44:09Dr. Darshan Shah?

  And also that way is like. A week is a human defined amount of time. And so it doesn't really exist. So at least you're staying on the schedule and not skipping certain days.

• 1:44:22Speaker 01

  So what you want to do in that case, though, is you need to give it an end time number.

• 1:44:26Dr. Darshan Shah?

  Right.

• 1:44:26Speaker 01

  And a number of tries, because if not, you just lose control.

• 1:44:30Dr. Darshan Shah?

  Lose control of it. Yeah, that's great advice.

• 1:44:32Speaker 01

  So 60 days, 90 days, whatever it's going to be, and then say, we're going to do X amount of workouts done. And then fill in as much as you can and get it close.

• 1:44:39Dr. Darshan Shah?

  Yeah, and that that works pretty much even for the people that have a good gym routine as well. This this this will work. And then we so that takes care of that group one. Group two and three, we talked about a lot already about how you kind of step up your workout without injuring yourself. I think also, and this is for me, like, I'm in that group three where I have a really good gym routine. Five days a week, I'm in the gym. Every once in a while, just like most people, I end up missing a day, but I'll make it up the next week or the next the next day. And struggling sometimes with making progression. And I like your advice on that, the way you said, you go up and take it a step down, go up and take it a step down. I do see a lot of people that are hyper focused on, you know, just that steady state cardio. Some people that don't do any cardio and they're just they're lifting weights.

• 1:45:24Dr. Darshan Shah?

  And I counsel my patients, my clients to mix it up, especially as we get older. We do need to have that variety, right? And then I also like to add, and I'd love to know your feeling on this, is some sort of like functional stability work as well. At some at some point to those people that have got their routine down. And so I'm curious as to how you put some work into that for your clients.

• 1:45:48Speaker 01

  So we actually do not address it specifically because when you are moving anyway, we should be addressing movement quality.

• 1:45:56Dr. Darshan Shah?

  Got it.

• 1:45:57Speaker 01

  So we don't have a like when we're coaching people in person, every step you take, every repetition you do is an assessment. We're watching everything. And when we consider things to be failure, it is when you have a technical breakdown. We're not looking for, did you run the time? Right? Did you complete the lap in time? It is, when did you break position? Right? This isn't stop keeping bringing them up, but this is a Brian McKenzie Kelly. Star Red thing from many, many years ago, right? Watch yourself in the aerodyne. You're not done when the clock hits. You're done when the position is broke. Okay, so that is how we're defining technical. This is also, I've heard Lauren Landau, strength coach for the Denver Broncos for many, many years now at Notre Dame. He would always test this stuff, right? When you lose position, the clock stops. That's the drill of failure.

• 1:46:42Speaker 01

  So we are always coaching position, stability, balance, however you want to define it. In terms of actual balance, this is why you don't want to have all of your physical practice in a gym.

• 1:46:55Dr. Darshan Shah?

  Absolutely.

• 1:46:55Speaker 01

  Right? If you look at actually, even to go a little more esoteric, research on late onset dementia and Alzheimer's. One of the key factors is lack of proprioception, which is say, you do not want to lose your senses. Your senses being your smell, your taste, your hearing, your sight. And proprioception, that's your body's internal understanding of where it is in space. Okay, so you don't want to lose that. One of the primary ways to not lose that is to make sure that you are constantly in different environments. This is where, and you know, those just listening, I'm pointing outside right now to the beautiful landscape. But this is why having some of your practice outdoors is incredibly important because if you and I were to go on a treadmill

• 1:47:36Speaker 01

  and do a 60 minute, that 90 minute routine or whatever that that person was doing, great. Awesome. I'll use treadmill, no problem. I have a salt bike in the house. I got, I have no issue with a skier, rower, good with all of it, right? If we can do that same work though, out there. And now our vision is instead of being 18 inches in front of us, is 18 to eight miles out, right? We're hearing different things, we're smelling different things. And as we're walking, our feet are going through proprioception. Balance, it's gravel, it's avoiding the dog, it's moving up and down on the thing. That will handle much of our loss of proprioception. Last component here is you're, we're never going, I mentioned earlier, we want to do sort of four components. Press, pull, upper, lower.

• 1:48:17Speaker 01

  What I skipped, what we would always do is you also want to work on things like single support, double support. Which is to say, you're never going to do all your workouts on two legs support unless you're a powerlifter, weightlifter, but even them. So we're going to have something where we are challenging and limiting balance, limiting stability, like you can phrase these things different ways, but we're not only going to do, say, for example, a rear foot or a Romanian deadlift, like a hinge bending over to pick something up, okay, like picking up your kid kind of movement. Sometimes we'll do that on one leg. So now, actually, because you're doing that on one leg, balance is so challenging, you don't actually strengthen the hamstrings and the glutes that much because the load has to go so low. However, the demand for stability gets really, really high.

• 1:49:01Speaker 01

  So it's not better to do things on one leg, it's not better to do them on a stability ball, or better on, you know, unstable surfaces. It's different. Both of those have pros and cons, and so we would actually blend both of those aspects into all of our training, and that's how we handle it. So as we're putting somebody on a rear foot elevated split squat, one of the things we're paying attention to is, again, are we losing to one side always? Are we leaning more forward on one side than the other one? It's not that leaning forward is bad, but are we shaking on one knee versus the other one? All of that stuff is going to tell us those internal diagnostics, proprioception, and balance and stability. So that's being incorporated into everything, every exercise, every rep, every set, while you're swimming, while you're...

• 1:49:46Speaker 01

  One example of this, I can tell you, we had a distance runner, girl, one time, and I was watching her run from the back, and I could always see her right trap was higher than her left trap, right? So now, we ran movement testing, restriction stuff, and she didn't actually have any mobility or restriction issues. It was simply a learned pattern, probably an old injury, could have been a hip injury or toe injury. And so all I did is I took a tennis ball, and I put it in her right pocket, which is to say, I want you to feel your elbow go past your tennis ball every time. And she just had to learn that she was hunching her right shoulder to her ear. She put that down, and she's like, okay. I didn't need a corrective exercise, I didn't need an ERT, I didn't need needling in there to release it. She was just pulling her shoulder up. So it's in a part of every movement we're doing is that this is what coaching is, in our opinion.

• 1:50:30Dr. Darshan Shah?

  It's muscle memory, and you just forget it's even happening until someone points it out to you.

• 1:50:34Speaker 01

  Yeah, when we break out muscle quality, we look at range of motion, we look at stability, but one of the other things we look at is awareness. Do you even realize what you're doing? I've taught this for so many years. I've had like hundreds of kids. Oh, I can't squat the full depth. I can't. I'm like, really, really? Like, okay, do you realize that your foot's going this way?

• 1:50:53Dr. Darshan Shah?

  What?

• 1:50:54Speaker 01

  And like they thought they had some sort of mobility restriction or whatever. I'm like, no, no, no. You just didn't even know your arm is in the wrong spot.

• 1:50:59Dr. Darshan Shah?

  Sure.

• 1:51:00Speaker 01

  It's just an awareness issue. So it's not always the case, but a lot of times it's just not even knowing where things are supposed to be.

• 1:51:06Dr. Darshan Shah?

  Yeah. And, and one of the things I talked with some of my clients about is this, you know, do, do a few workouts without any headphones in. Just focus on the movements, focus on where you're standing, what you're doing. I think people are so used to just like putting their, putting their AirPods in, being at the gym for that hour. That they forget that every once in a while, they need to do it without it to make sure they're moving right, right? And having that awareness.

• 1:51:26Speaker 01

  Like, God forbid a podcast.

• 1:51:29Dr. Darshan Shah?

  God forbid.

• 1:51:30Speaker 01

  Like, that's, that's just a bad, for a lot of people, it's a bad setup, right? Um, there's so much going on, your, your ability to change what you're doing, even something as simple as, there's enough research on mind-body connection.

• 1:51:44Dr. Darshan Shah?

  Right.

• 1:51:44Speaker 01

  Which is to say, if you think about a body part, when you're lifting, you can have enhanced results.

• 1:51:49Dr. Darshan Shah?

  Absolutely.

• 1:51:51Speaker 01

  Whether it's strength or hypertrophy. So if you're thinking about, you know, your next podcast that you did on phenomenal blood work and biometrics you're looking at for, and you're trying to really think about interesting stuff and, and you're just like kind of cruising through your workout, like what, what are we doing here? You would actually be more time efficient, taking the headphones out, getting the great workout in, and then paying attention at your desk, listening to the podcast and taking real notes. Like, that's a far better way. When you're doing them both at the same time, you get benefits in neither.

• 1:52:18Dr. Darshan Shah?

  Absolutely. Yeah. And I remember there was one time that I wasn't making any progress in the gym. And I just decided, I heard a podcast about this actually, not while I was working out, but at another time of just visualizing the motion before you do it.

• 1:52:30Speaker 01

  Oh, yeah.

• 1:52:31Dr. Darshan Shah?

  While you're doing, feeling the entire motion.

• 1:52:33Speaker 01

  Yeah.

• 1:52:33Dr. Darshan Shah?

  And just that broke through that barrier.

• 1:52:35Speaker 01

  Yeah.

• 1:52:35Dr. Darshan Shah?

  Just the visualization and the, and the focus on the movement and the muscle and what's happening in it broke through that barrier.

• 1:52:41Speaker 01

  Yep.

• 1:52:41Dr. Darshan Shah?

  And made strength improvements.

• 1:52:43Speaker 01

  Yeah, that's a real thing.

• 1:52:44Dr. Darshan Shah?

  It's really powerful. Mind-body connection is super powerful.

• 1:52:46Speaker 01

  Yep.

• 1:52:51Dr. Darshan Shah?

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• 1:53:32Dr. Darshan Shah?

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• 1:55:24Dr. Darshan Shah?

  So let's move on a little bit to that fourth category, people. Your, you know, your weekend athletes that are running marathons, triathlons, et cetera. And a lot of these, you know, the, I find that as we age, as we get into our 40s and 50s, there, there does seem to be some degradation of biomarkers, specifically around inflammation that I see, I see some metabolic disease developing in some of these people. And I just wanted to get your take on, you know, exercise volume as we age, specifically related to those people that are in that higher volume category? And how you can kind of notice if this is causing some impairment and where we should go?

• 1:56:05Speaker 01

  So this is actually a really, really, really interesting question. Man, I have actually some ideas we could, we could talk about afterwards. But when I was a doctoral student.

• 1:56:14Dr. Darshan Shah?

  Right.

• 1:56:15Speaker 01

  So again, I'm a, I'm a PhD, not an MD. So we're, we're doing our, our, our stuff in our lab and all that. However, we took one course, our physiology course in medical school. So I'm the only non-MD in that, the person teaching it was a PhD. So there's, there's two of us and the rest are MDs. And that class frustrated me beyond all imagination.

• 1:56:36Dr. Darshan Shah?

  Wrecked my entire medical school career.

• 1:56:39Speaker 01

  Well, what killed me was I couldn't get anything correct because when you look at the exact same metrics from a medical perspective versus a performance perspective, it's ultra confusing. So, I mean, I could, albumin, hematocrit, hemoglobin, total blood volume.

• 1:56:56Dr. Darshan Shah?

  Sure.

• 1:56:57Speaker 01

  If you put these things on a chart and you gave us no context and I looked at numbers, I would go, all right, let's see hematocrit 51%, hemoglobin in a male 16.3. Okay, that's pretty good. Albumin 5. Okay, all right, like we're in a good spot here. And total blood volume, six and a half liters. I'd go, that is a really fit.

• 1:57:21Dr. Darshan Shah?

  Yeah, I want to be that guy.

• 1:57:22Speaker 01

  Yeah. And a medical doctor would look at that and go, get that person on a diuretic right now. If that person is overweight and unhealthy, that person's about to die. If that person's healthy, that is peak physiology. So it was so confusing for me. I'm like, oh my God, I can't get these questions right on these medical exams because it's the same thing, right? So when we're starting to look into that, we really have to look at markers and have a, if you're gonna work with somebody on this, you have to understand your person interpreting your blood work. I'll say it this way. The value in any sort of molecular biomarker is not in the marker. It is all in the interpretation. And someone who's looking at numbers and going, that number is high based on the reference range, therefore

• 1:58:07Speaker 01

  we want it lower, run to the hills. Run to the hills, right? Because there's, that is a, for so many reasons, this is a very poor way to handle blood chemistry. These markers are some of the ones. And I bring this up because you're saying level four, we deal with this on a daily basis. Really? Yeah, of course, right? Because if you pull any of these people you talked about, somebody who's 40 to 70 years old, and they're a category four person, I promise you, you take their blood work, put it in front of an M D, not an M D like you, right? Other ones, they're gonna scream, like, they're gonna see markers, they're gonna look at AST, they're gonna look at ALT, they're gonna see creatinine levels, and they're gonna start, they're gonna see hematocrit levels, they're gonna see albumin levels, they're gonna see other inflammatory markers, and they're gonna be like, whoa, whoa, whoa, whoa, what's going on? And we're gonna look at this and go, no, no, no, what you don't

• 1:58:50Speaker 01

  understand is AST and ALT are not just liver and muscle damage markers, right? There are no association, you scale those things up, right? You can see what's gonna happen with AST and ALT with muscle mass. So if you are not accounting for total amount of muscle mass, you can't interpret those numbers properly. You don't know what you're doing, right? Like, there's a big difference there. If we don't know what's happening with creatine supplementation and/or contraction, if you look at markers like CRP, and you're able to balance that out with creatinine, now you can actually understand what's going on. But if you're not paying attention to both these things, you're gonna get wildly, your day is gonna be crazy. If you can't look at albumin, measure that against sodium potassium ratios, understand that against other hydration markers like blood glucose and blood urine nitrogen, like, you have no idea what you're looking at. You know this

• 1:59:35Speaker 01

  one, for the audience. Give you like a direct example. I know you're all over this one though. Albumin is probably the the most valuable blood marker in the entire world. Like point blank period. It is an acute phase reactant, right? So you've you've maybe you've talked about these in the past a bunch, but that means it's going to be reduced in the presence of inflammation. It is also directly because the way it's calculated in the lab, it is directly influenced by hydration status. So if somebody comes into you in the sense that it goes up and our dehydration, right? It only goes up on our dehydration, basically. Many things will pull albumin down, but nothing takes it up besides dehydration, right? So if you see reduced albumin, you have to run three or four of the things to know what's going on. If you see elevated albumin, like you pretty much know what's going on.

• 2:00:17Speaker 01

  You take that, look at at osmolality concentrations. You look at other things. You're gonna know what's actually happening there. Okay. So if you were slightly inflamed, albumin is down. And slightly dehydrated, albumin is up.

• 2:00:30Dr. Darshan Shah?

  Sure.

• 2:00:30Speaker 01

  What's gonna happen to your albumin?

• 2:00:32Dr. Darshan Shah?

  It's gonna look normal.

• 2:00:33Speaker 01

  It's gonna be dead in the middle.

• 2:00:33Dr. Darshan Shah?

  Exactly.

• 2:00:34Speaker 01

  And you'll be like, well, like, I don't feel great. I have some little headaches going on, brain fog thing, my recovery is going down, blah, blah, blah. You fill in the blanks. So these category four people, right? And if if someone doesn't know what they're doing with, can't look at AST, ALT, can't look at GGT, can't look at other additional markers here, you're gonna go, oh, I guess you're fine here. It's, you know, your testosterone is low. We're like some other asinine comment, right? This is not what's going on here. Like, we're seeing clear signs of here. So you have to be able to differentiate that. You have to be able to look at and and pull apart acute versus chronic dehydration. Like, we have to be able to do that. This is where all those markers we just walked through will tell you that. Because if we see this situation going on, we have to be able to look back and go, oh, you know what? Actually, I don't think we're in a problem here because that person was maybe just a little bit dehydrated that day.

• 2:01:18Speaker 01

  This is, this is, these are false flagged right here. You have to understand what are actual direct markers in blood chemistry versus what are calculations, right? Because if this is a calculation, free testosterone, that's not a real thing, right? Like, it's not actually being measured. Depending on the lab you're pulling it from, they're literally using different calculations. So this stuff has to be accounted for in these category four people because a lot of the stuff that's going on is not actually a problem. It actually is fine. These are normal physiological responses. And the last thing I'll say about this, sorry, this this topic gets me fired up.

• 2:01:51Dr. Darshan Shah?

  Right, I love it.

• 2:01:54Speaker 01

  You can't simply be judging positive or negative in these folks unless you understand what a true reference range, what a bell curve looks like in that population. Right? We've done thousands of these in these people. And so I know, um, one last point I'll back up on, then I'll pause and let you react. I'm sure you have a billion things to say on this topic too. You're foaming at the mouth, like I can see. We've been talking about bell curve, but the way that reference ranges on blood work work is a bell curve. It's a 95%. So what they're going to say is if you're looking at a blood report, and I'm sure you counsel everyone that you go through on this stuff. What they're going to say is if you're, you know, above or below the reference range, what that means is 95% of people were in here. Two and a half percent on the bottom, two and a half percent on the right. Right? And even

• 2:02:38Speaker 01

  if you're in that two and a half percent top or bottom, most people are going to look at that and go, well, you're just a little bit high, a little bit low, not a big deal. Like for most blood chemistry markers, right? It's like, oh, you're just a little bit diabetic. I'm like, no, I don't want to be a little bit diabetic. Like it's not, I don't want to be a little bit inflamed. I'm trying to do what a level four person is trying to do. A little bit inflamed is not okay here, right? We need to get this thing dialed in. In addition, that reference range is built on NHANES. It's built on male, like, these are not people, these are not your equivalents. So you don't, you don't want to look at the report yourself and go, oh, the report said this number is H or L for low. Throw all that out. You have to understand the database you're looking at. So a lot of those markers that will come

• 2:03:20Speaker 01

  back, we'll look at and go, no, no, no, that is actually dead on for high performance for a 55 year old. This is dead on for a 38 year old female. Like this is where we want you to be for high performance in those ranges. So you have to be able to calculate that. Last thing I'll say is, since you brought up inflammation, you have to understand what we're trying to do from a training perspective. If we are a category four person, we're trying to push the pace on performance adaptations, right? Which means I am trying to cause physiological stress. That's the only way I cause adaptation. If you blunt reduce diminish inflammation, I am blocking the signal for mitochondrial biogenesis. I am blocking the signal for muscle growth. I am blocking the signal for connective tissue development. Though I don't

• 2:04:03Speaker 01

  Want those there. If I'm running around at an inflamed state based on a whole cascade of markers for a year, that's a problem. But if I'm in the preseason phase, if I'm in a developmental phase, if I've been in overload phase, I want those numbers. In fact, if I'm not seeing those numbers move up, I know I'm not, we have more to push on this person. If we're peaking though, then we want the opposite. We want that stuff dialed in. And so the context of going category one person, easy, right? Keep them out of metabolic disease. Hey, like I'm telling you, you're really running your risk of a heart disease, category one. Category two, little more, hey, okay, I know technically diabetes starts at X, but you're prediabetic. We don't want you to be prediabetic, right?

• 2:04:47Speaker 01

  This is whatever. Okay. Category three, a little bit different, more like you. Now we can start picking apart some things that are, you're not going to find on medical testing interpretation, right? And going, hey, this is actually a marker of whatever we're seeing. Category four, same thing. Now you need performance evaluation. You have to have blood evaluation from the perspective of high performance. What are the reference ranges? What are the markers? And then how do we actually understand how these things are a part of your training program based on your phase? Are your calories going up, going down? What are we doing in these areas? That's the proper context. And so you simply can't take the same markers, evaluation steps and analysis in all four of these categories in blood. You're going to run yourself

• 2:05:29Speaker 01

  into a circle of mind death because you're going to be thinking, you're going to be thinking these people have kidney failure constantly.

• 2:05:35Dr. Darshan Shah?

  Constantly.

• 2:05:36Speaker 01

  Because you're like, no, because I mean, look at creatine kinase, you know, creatine kinase in a normal person after, in fact, there's data, I think it was from, I don't know if it's officially, I'm not going to say. It was a competition in which people do multiple workouts in a day with kettlebells and things like that, right? It's not against them. But this was a case study I'm thinking about. That person's creatine kinase was like 200,000. Okay, RABDO is considered to be, I don't know what, I actually don't know what RABDO is, maybe 20,000?

• 2:06:06Dr. Darshan Shah?

  I think it's a lot lower than 200,000.

• 2:06:08Speaker 01

  Well, it is a lot lower, for sure. After a football game, like we play a football game on Sunday, on Monday, oftentimes creatine kinase 10,000.

• 2:06:15Dr. Darshan Shah?

  Right.

• 2:06:16Speaker 01

  If you go from normal like baseline of 100 and you go to 1,000, you're probably really racked and sore.

• 2:06:22Dr. Darshan Shah?

  Right.

• 2:06:22Speaker 01

  Right? So really hard workout, you'll be up to 1,000. So if you're looking at like a single creatine kinase marker and you're like, oh my gosh, you're at 1,200, I'm looking at and going.

• 2:06:31Dr. Darshan Shah?

  Yeah.

• 2:06:32Speaker 01

  That's nothing. Like, that is absolutely nothing.

• 2:06:34Dr. Darshan Shah?

  Right.

• 2:06:34Speaker 01

  Now, if you're looking at CRP and ESR and a whole bunch of other markers and you're seeing that, then it's like, okay, we have acute and chronic inflammation.

• 2:06:41Dr. Darshan Shah?

  Right.

• 2:06:42Speaker 01

  But we can differentiate that, right? We know how to cross-reference these markers. So I just onslaughted you there. I'll pause for a break.

• 2:06:48Dr. Darshan Shah?

  No.

• 2:06:49Speaker 01

  There's a lot here. This is, we spent an enormous amount of time in this area for category four. That's really what we do.

• 2:06:54Dr. Darshan Shah?

  Right, right. I mean, and this is, this is so, this is such a great conversation around this category four because it is different. And it just highlights the fact that every person that we see is an individual.

• 2:07:07Speaker 01

  Yeah.

• 2:07:07Dr. Darshan Shah?

  And not only do you have to individualize the training programs, but you individualize your interpretation of the biomarkers for where they are.

• 2:07:14Speaker 01

  You have to.

• 2:07:14Dr. Darshan Shah?

  And if you're, if you have someone that's just looking at biomarkers and not looking at you as a person or talking to you as a person, which there's a lot of, as you know, this is happening all the time.

• 2:07:26Speaker 01

  It's fine for one. For category one, it's fine. It is, you know, I'm not even health-conscious.

• 2:07:31Dr. Darshan Shah?

  Right.

• 2:07:32Speaker 01

  I'm looking for a high-level overview of my overall metabolic cardiovascular health. Like, great. Absolutely great. If you're in category three, four, though, this stuff does, and this is why people end up going, I got my stuff checked. I'll put it this way. I ask a question all the time. How many of you have ever gotten blood work done? Like, almost every hand goes up, right? If you're in category three or four, watch this one. How many of you felt like you got tremendous benefit from it and came? And then all the hands go down, right? If you're in category one or two, you probably got some big stuff. But if you don't have a medically diagnosed disease, then you end up going, well, they said everything was like, kind of fine. And you're like, oh, there's a lot more in there that we can see that is kind of fine. We can see markers, tons, from basic blood chemistry. I'm talking like CBC, CMP stuff, right?

• 2:08:16Speaker 01

  You can see a ton about, about gut health.

• 2:08:19Dr. Darshan Shah?

  Sure.

• 2:08:19Speaker 01

  Signals going on. We can see a ton of inflammatory markers and immune markers that are right there in front of people. Like, I'll be on this one. Like, tell me, find a person out there listening. I'll give you a challenge. Find a person who's been told that their albumin's off.

• 2:08:32Dr. Darshan Shah?

  Right.

• 2:08:33Speaker 01

  You'll never see it. Like you almost never see it and we will look at it and go, okay, that is within a medical range, that is not in a performance range.

• 2:08:40Dr. Darshan Shah?

  Sure.

• 2:08:41Speaker 01

  And we're just gonna see that thing constantly light up.

• 2:08:43Dr. Darshan Shah?

  Yeah, absolutely. And then this is what also drives me crazy about people that get, you know, those home testing kits and just getting their own biomarkers done. And you know, those are usually some of those people that are like actually cognizant about their health. So they're checking.

• 2:08:56Speaker 01

  I know.

• 2:08:57Dr. Darshan Shah?

  And, and they have no one to interpret it for them and come in freaking out or they have no idea what those results were.

• 2:09:01Speaker 01

  Yeah, don't, don't like, like citizen scientists, I'm all about, like I'm, I'm super all about it. But one more time, I'll reiterate, I think the general point we're both making here is when it comes to blood markers, specifically or related urine, saliva, these types of molecular markers, the value is not the number.

• 2:09:20Dr. Darshan Shah?

  Right.

• 2:09:20Speaker 01

  It is the interpretation, the context, that is what separates. Look, if, if you're looking, if you're looking for telehealth and you want to just get something like that done, so that you can get growth hormone, great. Or you wanna, you wanna get tested out, like, fine, I'm not against that at all, do, do you. But if you're really wanting to get someone to go break down, why am I having these issues with focus? Why is my energy the way it is or whatever thing? Why am I having these plateaus? Why am I getting hurt all the time? Why are my joints always in pain? This is not going to be a marker. This is, you can look, if you look at your printout and someone's a medical doctor, not, I don't mean to at all, saying that about medical doctors, whoever, you're doing it or an online service you purchased it from, and they're, all they're telling you is numbers that are high versus numbers that are low. You got nothing.

• 2:10:05Dr. Darshan Shah?

  Right.

• 2:10:05Speaker 01

  You got absolutely nothing out of that because the, the end step here is what do I do about it? The answer is not take the numbers that are low and make them high and take them numbers that are higher and make them low. That is a terrible, terrible idea.

• 2:10:18Dr. Darshan Shah?

  That's a bad idea.

• 2:10:18Speaker 01

  It works for a couple of markers, like vitamin D. Okay, fine. If that's low, most likely you want to take vitamin D or get more sunshine and take it. But almost every other marker past that, including things like testosterone. The answer is not just take the thing and make the number go up. That is a, that is a, you're going to run yourself into a very quick problem. If not big, big problems for a long time. That's not how physiology works. It is a mosaic. You have to understand a little bit of the picture there and understand how to play that accordion. So that we get the right sound out of it. Those services are just, it's, hmm.

• 2:10:51Dr. Darshan Shah?

  Right.

• 2:10:52Speaker 01

  Don't do them. This is why I said earlier, if you're gonna use these things, just don't. You're, you're better off because you can get false information, false flags, things you think are high that they're not. Uh, iron is the easiest one.

• 2:11:04Dr. Darshan Shah?

  Sure.

• 2:11:04Speaker 01

  Massive, you can get a blood test on, on back to back days. One day will tell you, iron can be 20, 30% in a day. So you're gonna have one test on, says you're super low and you're gonna take a bunch of iron. The next day after you died the day before, it told you you're super, super high. That can change because of night's sleep, right? Your spleen will automatically alter what's happening.

• 2:11:22Dr. Darshan Shah?

  Absolutely.

• 2:11:23Speaker 01

  Okay, great. You have to have somebody that can just go, look, no, no, hey, great. Tell me, you're, you're, you're asleep the night before. Oh yeah, it was terrible. I hate needles. So great. We're not taking action on this.

• 2:11:34Dr. Darshan Shah?

  No.

• 2:11:35Speaker 01

  Why? Well, because here's the physiology of that. Awesome. Is it ferritin? Do we have T A B C? Do we have, we have to be able to fully evaluate the whole picture. In addition to your context and your sleep and your hydration and mental health and where are you just traveling? And what's your water quality? Like all these things go into really truly interpreting it. And that's why people can get real results from blood work. A ton of real results from it. If you really know what you're doing, especially if it's not our category one, category two people. If it's certainly three or four. This, this is, this is where we make our money for sure.

• 2:12:06Dr. Darshan Shah?

  This is, this is where you really need someone who understands biomarkers, understands what the range is for you.

• 2:12:12Speaker 01

  Yep.

• 2:12:12Dr. Darshan Shah?

  And interprets it correctly. And so, and like you said, so many of these, you don't just treat on one biomarker test.

• 2:12:18Speaker 01

  Never.

• 2:12:19Dr. Darshan Shah?

  You need, you have to repeat. You have to, you have to be able to see this longitudinally. What are the other confounding factors, et cetera?

• 2:12:26Speaker 01

  This is actually the argument I'll make for people who feel good or great. I don't need, I feel good. No, you should still get it. Why? Because you do feel good now. But when we go, when you, when you show up at our, at your door, or you, you know, show up in one of my companies 10 years from now, when you don't feel good. If you have these 10 years of past data. It's a it's a world of difference of what we can do.

• 2:12:49Dr. Darshan Shah?

  Game changer.

• 2:12:50Speaker 01

  The easiest example I'll give you here is the easiest one to pick on is testosterone. Okay, if you're concerned that your testosterone is low because of any number of reasons, you have symptomology, or maybe you don't have symptomology, but you've heard all these people talking about how testosterone is low and whatever. Okay, awesome, fine. I don't know if it's low. You don't know if it's low because some people are fine at 250. Some people feel terrible at 1,000. Too many factors go into it, let alone it's not the only thing controlling how you feel. It's not accounting for 1,000 other things that go into your whole phenotype and your experience in the world. Okay, great. However, if you could look at their medical records and go, okay, well, you had a blood test done once a year and you're 44 and now your libido is not great and your recovery is kind of going down, you're sleeping, great.

• 2:13:34Speaker 01

  And your and your testosterone is 350, total testosterone, of course, right? Okay, great. Might be low. Might be normal for you. I don't know. And let me look back. Well, actually, it's been 350 for the last 10 years. When did your symptoms start? Oh, two years ago. Right. Well, then we know it's not that.

• 2:13:49Dr. Darshan Shah?

  Exactly. It's something else.

• 2:13:51Speaker 01

  Or the opposite. Well, Jack, you actually 10 years of historical records, you've been at 650. And the last year you did, you've gone in half. Now you've got to go on a whole journey of figuring out why and not just give them testosterone. But nonetheless, if I don't have that, you as their doctor is going to sit there and go, I mean, it certainly could be 350. That's not huge, but that's, I don't know, that's kind of borderline.

• 2:14:09Dr. Darshan Shah?

  But you don't know it's related to the symptoms. You have no clue, right?

• 2:14:12Speaker 01

  You have no clue.

• 2:14:13Dr. Darshan Shah?

  My dream is that, you know, somehow there's a law passed that everyone gets their hormone levels measured when they're 25 years old. So we at least have that data point that we can compare to. Like, these were the levels when you were 25 and we have, but no one has that, you know? And so

• 2:14:28Speaker 01

  I mean, imagine you have some sort of brain injury as well.

• 2:14:30Dr. Darshan Shah?

  Right.

• 2:14:31Speaker 01

  Okay, great. Are you really back? We don't know. We actually don't know if your endocrine system is back online. We don't know what was before. Brain injury is one example, but you get the idea. Pregnancies.

• 2:14:40Dr. Darshan Shah?

  Sure.

• 2:14:41Speaker 01

  For the female stuff, okay, we, I don't know what you were before you were pregnant.

• 2:14:45Dr. Darshan Shah?

  Right.

• 2:14:46Speaker 01

  Now we have nothing to go off of. So having that baseline data is massively, it's an investment.

• 2:14:50Dr. Darshan Shah?

  It's an investment.

• 2:14:51Speaker 01

  Even if it's not mattering now and you and I are, obviously, we have conflicts of interest here. Have companies that sell these products.

• 2:14:57Dr. Darshan Shah?

  Sure.

• 2:14:58Speaker 01

  But it's, it really, I mean.

• 2:15:01Dr. Darshan Shah?

  It's really, really important. It's super important that you at least get your baseline down at one point in your life as early as you can.

• 2:15:07Speaker 01

  Yeah.

• 2:15:08Dr. Darshan Shah?

  You know, in your twenties is if you can do it, but if you've, if you're past your twenties, just get it done as early as you can. So you have some level of baseline that.

• 2:15:16Speaker 01

  Yeah.

• 2:15:16Dr. Darshan Shah?

  Professionals can refer to.

• 2:15:18Speaker 01

  Yeah.

• 2:15:18Dr. Darshan Shah?

  Future. I think we're both saying the same, the same thing. Wow. So much great information. I think, I feel like you and I could probably talk for four days in a row.

• 2:15:26Speaker 01

  I feel like we're on top of one.

• 2:15:27Dr. Darshan Shah?

  Exactly. Right. I want to touch base with you on a few other things that a few people asked me to ask you, and I think they're important questions. One is for someone in their forties, fifties, is, and you're training hard, you're strength training hard. And is there really like an upper limit to where you can strength train, knowing that you're increasing volume and increasing intensity mindfully? Like you said, maybe 10% a week or something. Is there a point where you're, you should maybe just take it easy so that you don't hurt yourself? If you have good, say you have good awareness of your body and the signals in your muscle is how your muscles are feeling.

• 2:16:03Speaker 01

  There's no inherent reason.

• 2:16:04Dr. Darshan Shah?

  Right. That's what I would think too.

• 2:16:06Speaker 01

  There's no physiological rationale to suggest that you, if you're starting to see more aches and pains and the injuries are becoming more frequently, then, then that's what I'd say. But.

• 2:16:15Dr. Darshan Shah?

  Right.

• 2:16:15Speaker 01

  If you're tolerating it well, there's no reason to.

• 2:16:18Dr. Darshan Shah?

  Stop.

• 2:16:18Speaker 01

  Think you're going to have some sort of problem.

• 2:16:20Dr. Darshan Shah?

  Exactly. Okay. And on the correlate to that question, I think a lot of people had as well is how do you know if you're overtraining? And I think you just kind of answered that, but I, I want to expand on that.

• 2:16:30Speaker 01

  Yeah, I know. Okay. So I did, that's why I did a whole episode on this. This is a really fun question. How do you know if you're taking the day off because you're just being a wuss?

• 2:16:40Dr. Darshan Shah?

  Yes.

• 2:16:42Speaker 01

  Or you're actually listening to your body, right? We tell people the same, the both, the same advice comes out of both sides of our mouth.

• 2:16:48Dr. Darshan Shah?

  Sure.

• 2:16:49Speaker 01

  Be smart, be smart, especially as you get older. Same time, you're not always going to feel great. Push through it. It's like, how do I know?

• 2:16:55Dr. Darshan Shah?

  How do you know?

• 2:16:56Speaker 01

  Okay. This took me a full podcast to unravel. I'll, I'll try to give you some of the Cliff Notes right now, but I can't do the whole thing justice in this case. This is where historical data will be. Really helpful, whether it's blood work, whether it's training logs, whether it's, are you doing some sleep tracking? Do we have heart rate recovery? Do we heart rate variability? Do we have respiratory rate? Do you have appetite? Like, is something else changing? Okay, is there an explainer? You've been sick. You've had a lot of extra work stress. You're just bought a house. Okay, then like we might have, all right, if there's nothing else going on, it's like, no, nothing's changed. Okay, interesting. What have we checked off nutrition? Have you made substantial changes or not? Have we, are we really sure we're fueling properly?

• 2:17:41Speaker 01

  Have we done anything? Like, we're gonna run through all these variables. Any data we have, we're gonna be able to know, right? If we have actual tracking data like we would have on people, I will know these answers before they happen. We will see them coming. We will actually, I have some of the athletes where we've taken urine, saliva and blood daily for years.

• 2:17:59Dr. Darshan Shah?

  Amazing.

• 2:18:00Speaker 01

  So we, we will know very clearly what's happening. You can get some of this stuff from, like our sleep tracking data will actually give us a ton of physiological information. Way past a consumer sleep tracker. So we will have some data. If you don't have any of that, then you're thinking the other stuff. To really have to think through, is anything else really substantially changed? Okay, then our next criteria is if you think no, what happens when you went warmed up? When you went warmed up in the gym, how'd you feel? Uh, once I got going, I felt fine. Okay, you were probably fine then. Once I got warmed up, I was till I got halfway through the workout and I was just, boom, performance is down, couldn't. Okay, little bit of a different answer. Most of the time, once people get warmed up and get going, you feel it better. This was probably an acute fatigue, right?

• 2:18:43Speaker 01

  We actually do have a whole course coming out on this, on fatigue management too. You go all this, there's, there's a ton of stuff to look at, but this, this is what we are a rough criteria. You're sure, like, funny enough, this sounds stupid. No one will do this. No one will listen. I guarantee it. But I've seen it more times than I can count. Did you think about your hydration today? Hydration is something we never pay attention to do and it has massive acute changes, right? Small as 1.8% dehydration can affect mood, concentration, focus, accuracy, muscular endurance, physical strength. 1.8%. You get past 2%, you start seeing actual pretty legitimate decriments. So a lot of times we're just like, yo, let's go chug a bunch of water right now. Give it 30 minutes, see what happens. And sometimes like, I still feel terrible. Okay, sometimes like, actually, damn, feel better.

• 2:19:27Speaker 01

  Just got a little dehydrated.

• 2:19:29Dr. Darshan Shah?

  There you go.

• 2:19:29Speaker 01

  That could be, you'd be really surprised how often that can happen. So we're gonna run that one. If it's the case and it was one day, fine. If you skipped a day, I don't really care. How long is this going on? Okay, if this is a day or a couple of days, this is acute fatigue. Not a big deal. If this is persisting for weeks, we've got different scenario on. So that's a rough idea of some of the things we're thinking through. Did we ensure we didn't do something silly and stupid? Went out, either that is a visible stressor, that's what we call them. So visible stressors are things that you can see and feel. I didn't sleep well last night. Hydration, I only have food, things like that. Stress in my life. Okay, all this stuff gets treated equally. Hidden stressors are things that you won't feel. This is a micronutrient deficiency.

• 2:20:13Speaker 01

  This is a potential pathogen. This is a toxin. This is some other thing like that going on. We're running a quick game on that. If it goes away with the warm up, fine. If it doesn't, maybe we take the day off or we throw it all the way down. If it's persisting for weeks, now we're stepping in. Now we're having real intervention, but at minimum three days before I'd care. If you feel junky two, three days in a row, I'm fine. You're probably fine. We will see this a lot. People will say, man, like I overtrained, overtrained, overtrained. Like, oh, how'd you get out of it? Oh, I took three days off and I felt great. Okay, that's overreached. That's a technical, that's not overtrained. Overtrained takes weeks to months to recover from.

• 2:20:50Dr. Darshan Shah?

  Got it.

• 2:20:50Speaker 01

  That's our distinction definition. So if you're like, yo, I took Saturday off and I just Netflixed and chilled. Awesome. We were just acutely overloaded a little bit. So those are some of the things we could think about in terms of like, how do I know whether I'm in or out?

• 2:21:05Dr. Darshan Shah?

  Yeah.

• 2:21:05Speaker 01

  If you have any data at all on yourself that's objective, then we can look at those metrics. One of the ones I'll look at the fastest and most is respiratory rate. If your respiratory rate is up, something for sure is happening. You're getting sick. There's a stressor that's weighing on you that may be a hidden stressor that you don't realize. We tend to not see that. If it is normal, then we might just be a little bit tired. But respiratory rates, HRV, of course, are key ones, but those ones really to pay attention to.

• 2:21:33Dr. Darshan Shah?

  Yeah, those are two great biomarkers and most wearables will give you those biomarkers. Out to for recovery and I always tell people you absolutely go by how you feel, but along the lines you're saying, you need a little bit more data as well. And the length of time this has been a problem is very helpful.

• 2:21:48Speaker 01

  And then the thing to think about Sue on this is, are you a normal caffeine and or stimulant user?

• 2:21:53Dr. Darshan Shah?

  That's true too.

• 2:21:53Speaker 01

  And they don't have an effect?

• 2:21:54Dr. Darshan Shah?

  Right.

• 2:21:54Speaker 01

  You're like, man, I took my caffeine and I still feel awful. Okay, even when you're habituated caffeine, it still should have a ergogenic effect. And if it's not, then it's like, oh, okay, maybe maybe you wanted something, but other times you take it and you're like, all right. Okay, all right, I can go do this. And then you get going a little bit and you're like, all right, I felt okay. You kind of got to the hump. So hopefully that helps a little bit.

• 2:22:15Dr. Darshan Shah?

  That's super helpful. Absolutely. And then another question on the docket here too is your view on supplementation. Are there any ones that you feel are absolutely necessary or absolutely critical for us to think about?

• 2:22:26Speaker 01

  Yeah.

• 2:22:27Dr. Darshan Shah?

  And and can you talk a little bit about that? Just high level points on supplementation?

• 2:22:32Speaker 01

  Yep. Again, no one has to ever have supplements. Whole food is the win.

• 2:22:35Dr. Darshan Shah?

  Yep, all the time.

• 2:22:37Speaker 01

  Repeat that sentence 50 times, 100 times. Okay, that's the truth. That's how I coach and that's how I believe it. No question. Additionally, I actually work with and partner with Momentus.

• 2:22:48Dr. Darshan Shah?

  Sure.

• 2:22:48Speaker 01

  So conflict of interest to disclose there for you all there. That said, your answer. There's a handful that we would kind of call like the big three or the big four, and these are ones that have a very high safety profile. Which means you you can't really overdose on them. They're not going to pick up liver issues or kidney or brain or problems like that. Biggest side effects you're generally talking about are like maybe some GI distress, some people and them like that. So big safety profiles. In addition, they have a large evidence base, which means many studies, placebo controlled trials, men, women, young, old, clinical populations, young populations.

• 2:23:24Speaker 01

  So on and so forth. The number three, they generally work, which means they show a positive benefit in a range of things from performance markers to molecular markers. To whole body outcomes. All right. That's pretty strong, right? When you're like, it's safe, it's been done a lot of different people. It has multiple mechanisms of effect and the data are well rounded from multiple scientists and multiple labs. That's a really strong evidence base. What are those? Creatine monohydrate. Fish oil, protein, whey protein, potentially, and a little bit less strength here, but a multivitamin. If needed, magnesium, lower on that chain, but that would be pretty close to on that list, especially if you exercise

• 2:24:07Speaker 01

  and sweat a lot. But those big three would, would probably be the jump. Um, vitamin D would also probably be on that.

• 2:24:14Dr. Darshan Shah?

  Yeah.

• 2:24:15Speaker 01

  I call it like tier two, maybe.

• 2:24:16Dr. Darshan Shah?

  Yeah, especially if you have levels as more compelling.

• 2:24:19Speaker 01

  A hundred percent.

• 2:24:19Dr. Darshan Shah?

  Right.

• 2:24:20Speaker 01

  But those are the ones, if you had no testing at all, and you either felt like you didn't have access to food, or your food was dialed, but you wanted to do more stuff, and you didn't know any marker about yourself, I would feel very comfortable with people taking fish oil, magnesium, and making sure their protein intake is sufficient, whether they want to do that whole food, or a protein powder for convenience, then those would probably be the top three places.

• 2:24:43Dr. Darshan Shah?

  Yeah, that is exactly my list, and I, I love that as a starting point for people. And everything else after that is just, you know, you have to really look at the data.

• 2:24:49Speaker 01

  It's precision now.

• 2:24:50Dr. Darshan Shah?

  It's precision now, exactly. And a lot of people take a lot of supplements they absolutely don't even need, and they're, and they might actually be causing themselves harm.

• 2:24:58Speaker 01

  I wouldn't do it.

• 2:24:59Dr. Darshan Shah?

  Exactly.

• 2:24:59Speaker 01

  I, I honestly tell people, like, take those big three, I'm fine with, maybe the big four in terms of vitamin D, especially if you're taking vitamin D at a, at a reasonable dosage, it's very unlikely you're causing problems. If you're already like moderate to high, and you go a little bit higher, fine. Past that, I wouldn't take anything without specific rationale. You can run into problems. We talked a little bit about inflammation, but if you take things at lower inflammation, that's not a good thing, per se. If you don't have inflammatory problems, taking anti-inflammatories blocks adaptations.

• 2:25:30Dr. Darshan Shah?

  Sure.

• 2:25:30Speaker 01

  This is, this is not a good thing, right?

• 2:25:32Dr. Darshan Shah?

  Right.

• 2:25:32Speaker 01

  Micronutrients and minerals, don't play with. If you want to play with macronutrients, carbohydrate supplements, fine, fine, right? But when you start playing with, vitamins are, are okay, but minerals in particular, irons, rocks, things like that, those have real physiological consequences at small dosages. Yeah, in, in ways that matter a lot. So really be careful with minerals.

• 2:25:56Dr. Darshan Shah?

  I can't tell you that many people I see on multivitamin with iron. I'm like, why are you taking iron? And they have no idea. This is what I've bought from CVS.

• 2:26:04Speaker 01

  Yeah, yeah, yeah, yeah, yeah. Like, don't, that's why I even said like multivitamin, like, okay, that's a, like, it's a layer down a little bit.

• 2:26:10Dr. Darshan Shah?

  Yeah.

• 2:26:11Speaker 01

  Yeah, especially men. You want to be very careful about the multivitamin with iron, for sure. But women as well. Like, precision matters with minerals.

• 2:26:18Dr. Darshan Shah?

  Absolutely. The precision is key there. And then on the protein front-

• 2:26:22Speaker 01

  Sorry. Inflammatory regulators-

• 2:26:24Dr. Darshan Shah?

  Yes.

• 2:26:24Speaker 01

  And cortisol regulators as well.

• 2:26:26Dr. Darshan Shah?

  Right.

• 2:26:26Speaker 01

  Because I see those things massively over consumed with no rationale. You don't want to take inflammatory supplements with no cost. You don't want to take minerals, and you definitely don't want to take cortisol modulators.

• 2:26:36Dr. Darshan Shah?

  Absolutely.

• 2:26:36Speaker 01

  Adapting is that that lower cortisol very specifically. If you have low energy and you smash cortisol to the bottom, you're gonna feel horrible. So you don't want, like, don't do that stuff at all.

• 2:26:48Dr. Darshan Shah?

  Yeah, that is, that is great advice. Yeah, without very specific rationale, those will actually, on the worst case, cause you massive health problems, but also-

• 2:26:57Speaker 01

  Most definitely.

• 2:26:57Dr. Darshan Shah?

  Just, it'll blunt your gains in the gym, too.

• 2:26:59Speaker 01

  Totally.

• 2:27:00Dr. Darshan Shah?

  Yeah, absolutely. So, really good point there. On the protein front, do you have a favorite protein powder that you use, or just any type of good, well-sourced whey protein, or?

• 2:27:09Speaker 01

  Yeah. The highest level, if it is, if you know that it is clean-

• 2:27:14Dr. Darshan Shah?

  Yes.

• 2:27:14Speaker 01

  Fine. Whey protein is awesome. There's a lot of good companies that make it. Obviously, I got, you know, I love Momentous, but you can get it from plenty of other places. Just make sure that it has a handful of things. Number one, I, for the athletes we work with, of course, everything has to be either NSF or informed choice certified. If you're not an athlete, you don't have to have that standard. But what you do need to make sure is that they're getting it from a place that has been tested to not have contaminants. Now, I've actually published research in this area. The amount of adulterations, mislabeling, and contaminants in dietary supplements is astronomical. It's a lot better than it used to be, especially in America. It's, it's pretty safe, right? Any of the bigger brands are generally going to be safe.

• 2:27:56Speaker 01

  If you leave America, some countries get really, really screwy. You also don't know if you can trust the data, and things get sort of off of there, okay? So that said, you need to make sure that it is tested for contaminants, heavy metals, LEDs, cadmiums, mercury. All these things can, can be really, really alarmingly high. In addition, whey proteins have historically, and anyone who's been in the whey protein game, knows that, like, in the 2000s- In the nineties, this was constant. They did what they called amino acid or protein spiking.

• 2:28:24Dr. Darshan Shah?

  Right.

• 2:28:25Speaker 01

  Which is to say they're putting a whole bunch of amino acids in that are way cheaper, that have little effect on muscle protein synthesis, right? And so this is where you would like, you get what you're paying for. Like you found the cheaper version at the big retail store and it was half the price of the higher qual- but it's not, because you're not getting any of the active ingredients or getting a much smaller dose is the more appropriate thing to say. So when it comes to protein, yeah, pick wherever you want. I've worked with tons of different companies in this area and a lot of them, but just make sure the labeling is on there. Make sure that like, show me the data. Do they, are they transparent with how they sourced it? Like Momentus does grass free, GMO free antibiotic free stuff. Okay. If you don't care about that, fine, but are they at least telling you where they got it from?

• 2:29:08Speaker 01

  Can you track back to the manufacturer and show the verification of testing for contaminants, toxins, spikings, things like that? That's all I'll care about. That is actually especially true for fish oil.

• 2:29:17Dr. Darshan Shah?

  Absolutely.

• 2:29:18Speaker 01

  Like really making sure they can show you that there's no mercury in there is a really good thing. But the one I'd say about protein would be spiking quality in there. And so I just, I'd rather you not take it if you're not going to get a higher quality brand.

• 2:29:31Dr. Darshan Shah?

  That's absolutely true.

• 2:29:32Speaker 01

  And just don't take with anything else. You want whey protein. Don't take it with whey protein plus stimulants or pre workouts or like you, you want that pure whey protein by itself.

• 2:29:42Dr. Darshan Shah?

  Absolutely. You mentioned this last question because I know you've spent, you've been so generous with your time.

• 2:29:47Speaker 01

  I'm good, brother. Keep going.

• 2:29:49Dr. Darshan Shah?

  You're awesome. I want to talk to you a little bit about the environmental testing that you do because I found that really interesting. I didn't know you were doing that for all your prior clients and that's super interesting to me. So talk to me a little bit about what you do there and the rationale.

• 2:30:01Speaker 01

  So three years ago or so, I was at this kind of off-label human performance summit. And I got talking to a guy and he was actually working, he had a company that built eye tracking, ocular testing for SpaceX, International Space Station, naval, one of the naval groups, I can't remember exactly. And one of the big things you can do with eye tracking is you can get in very high resolution sleep testing. And so he started going and he was kind of like talking about how he wanted to do some sleep testing stuff. And I started talking about athletes and he was kind of like, what do you guys do for your, you know, $400 million athletes for sleep? And I was like, send them to a sleep clinic? And he's like, what? I'm like, there's nothing, we have no other options, right?

• 2:30:44Speaker 01

  We have a consumer grade wearable, or we could send them to a medical sleep. And he's like, there's nothing else. Well, probably two months later, we built Absolute Rest, our sleep company. Cause he's like, dude, this is enormous. And he showed me his technology he had for the International Space Station. And part of that, he had that they were again focused on ocular tracking stuff. One of the things he said is like, hey, man, you want to solve the problem? How do you do it? I said, well, we have to know how somebody's sleeping, number one. And then why they're sleeping that way. The overwhelming majority of trackers will maybe at best tell you how you're sleeping, but they don't tell you information about why you're sleeping that way. All the stuff we would talk about is both that, right? What's it look like? And then why is it there? And now we can solve the problem. Okay. So it's very easy to quickly figure out that the sleep testing that's being done is not actually in depth at all.

• 2:31:29Speaker 01

  So step number one is we built that. And so we built by far the world's most advanced sleep testing thing. Again, we can build a full clinical grade sleep study anywhere. Take it with you and you can do it every single night.

• 2:31:40Dr. Darshan Shah?

  And this is using eye tracking?

• 2:31:41Speaker 01

  We, this is a bunch of different things. So I'm getting to this part of the story. So we're like, great. What if we took a clinical sleep lab and we have the technology? We're already using it for these groups and build that into a consumer available model, right? So we built Absolute Rest, which means we can do that in the comfort of your own room. And again, you don't have to worry about wires everywhere, like you would see kind of hooked up all over the place. And we don't have to worry about going like, well, I got it done, but it was in this creepy sleep lab and I did one night and I, or two nights. Do it 50 nights in a row. I don't care, right? Like it's very easy for you to put on and do. That's going to tell us now the most high fidelity analysis of how you're sleeping.

• 2:32:22Dr. Darshan Shah?

  Wow.

• 2:32:22Speaker 01

  The question then becomes when we see a clinical sleep disorder, by the way, they're incredibly prevalent. 80 or so percent of sleep disorders are going to go undiagnosed, affects everybody, athletes, non-athletes, right?

• 2:32:35Dr. Darshan Shah?

  Absolutely.

• 2:32:36Speaker 01

  Well, I can't solve it unless I know why you're sleeping that way. And so we said, it's not good enough to just have the best sleep testing. We have to, part of this package, understand why you're sleeping that way. So one of the things that we do is positional analysis. So in your sleep evaluation, we see by position, when you're on your back, on your right side, your left side. What most people don't realize is the overwhelming majority of sleep issues someone has comes in a very specific position. Once we identify that, now we know exactly where to solve. That's if you have a sleep disorder or position. We have a scanner for your face, actually, on a very easy technology. We can look at anatomical structural difference, like is there a pathway issue? Is it? And that happens, it happens, right? So is the problem your position? Is the problem some anatomical thing?

• 2:33:20Speaker 01

  And then we said, okay, what are the other factors that go into it? Well, one of the things that they have to work hard at the International Space Station on is regulating the temperature. Easy. Regulating pressure, easy. Humidity, easy. Also CO2 concentrations. Also mold, toxins, pollen, danders, allergens, all this stuff. And so we said, we have to be running a full environmental analysis of these people to understand, is it something in the environment that's causing the dysfunction? So we have a very small device, like the size of a phone, that can be placed in a room, and you can take it anywhere. I take it on airplanes with me all the time. Actually, when I was buying a house, I took it with me. I'm like, I'm testing the air at 100% all times with me on my phone. It's funny, because the realtor came in, she's like, what the hell? And I was like, oh, yeah. Yeah, pollen in here, dander. They're like, what? Wow.

• 2:34:05Speaker 01

  Like, are you able to go, CO2 concentrations are too high in your house? Like, we took it outside, we can measure the area, like, we can do all this stuff, right? You can't buy that. Like, that's, that's, you know, that's what we have, right? So, we're gonna put that in, and we're gonna look at a second-by-second breakdown of your sleep. And by that, I mean, we're taking over 150 measures per second. We're not doing one measure every five minutes, like a tracker would do, right? And so we will know, within the, literally, millisecond, if something happened in your oxygenation concentration, in your position, in your breathing, in your chest expansion, all these things we're directly measuring, leg movement. And then if we see anything synced up with the environment at the same timestamp, we can go, ah. Once your room crossed this threshold of CO2, we started seeing a 20% increase in movement patterns.

• 2:34:50Speaker 01

  You started rolling around a bunch. Maybe it was a temperature, maybe it was a light issue, maybe it was a sound issue, maybe your white noise machine got a little bit too high, or whatever the case is, right? Again, was it something environmental? Was it the sound, the temperature? Was it something in there, actually, accumulation of dander from your dog? And all of a sudden, your nose got plogged up, and right around that time, you started mouth breathing, and then this is what happened, right? Then, if it's not environmental, we're looking at behavioral, right? So this is a, are you doing something? This is light exposure, this is exercise activity, this is like, all the, the standard hygiene stuff is gonna get measured. We developed the first and only blood test specifically for sleep-related physiology. So we're looking at a whole bunch of micronutrients, vitamins, minerals, melatonin,

• 2:35:34Speaker 01

  serotonin, things like that to see like, is this a physiological problem? And then one of our co-founders was a Harvard trade MD in sleep psychology. And so we're running through a psychological evaluation for anxiety, depression, all related to sleep, not just like general stuff there. And so by doing all that, we've got now an understanding of how you're sleeping. And again, we can do that at high fidelity for 50 nights in a row, if you want, to get a real good baseline. We do that in your vacation house, we do that in your other house, right? And now underneath that, we go, okay, well, why are you sleeping that way? Was it physiological? Was it environmental? Was it behavioral? Was it psychological? Or was it pathological? Do you have a clinical sleep disorder or even a subclinical thing? And so now all those data then come back to our sleep scientists, who are some of the

• 2:36:19Speaker 01

  most published MD, PhD sleep scientists in the world, go through that stuff, create coaching programs, and then you're coached through that sleep program to get improvements in sleep. So we're not just going to hand you a report and be like, your sleep sucks, good luck, here's a CPAP. Not against CPAPs, but like, that's not, that's not the best we can do. We're going to work through these problems, we're going to track and monitor, we're going to try things and give you reports back of what's going on, this is working, this is not, and there. So that is the, the environmental scanner is a part of that absolute rest elite sleep program that we do.

• 2:36:52Dr. Darshan Shah?

  That is the most comprehensive sleep program I've ever heard of, ever.

• 2:36:57Speaker 01

  That's why the waitlist is enormous.

• 2:36:59Dr. Darshan Shah?

  That's incredible. And so I can't even imagine, like, it's, it sounds like you're sending a blood test, you send a device to their home and...

• 2:37:07Speaker 01

  Yep. So all this stuff gets sent to their house.

• 2:37:10Dr. Darshan Shah?

  Yep.

• 2:37:10Speaker 01

  They get, handle the blood work, we do sort of all those things, send somebody to your house, whatever needs to be done, go to LabCorp, you know, Quest, whatever you want to get done there. But it's all done from your own house and it's on the, all the data comes back and then you've got a central app and a hub to work through and you meet directly with our, you know, our professional scientists. It's not like a telehealth sort of, you know, 10 minute thing. It's, they're, they're gonna...

• 2:37:32Dr. Darshan Shah?

  It's a real...

• 2:37:33Speaker 01

  They're gonna rigorously debate the data there and, and come up with stuff and then... I mean, our team is solid. Jeffrey and Amy, like, they've been in the game for a very, very long time. They've published, they're still publishing, they're treating people, and they've built technologies, built these companies. So our team there is very, very solid. In fact, depending on the day, about two weeks ago, we just released what's called Sleep Lens. And that's our consumer-grade version of that. So it isn't, this is the, I can't afford the big elite program. That's, it's not a cheap program. But the Sleep Lens program is, you know, in the, in the three-digit price point, plus or minus. It's not all the bells and whistles. It's not all the blood. You're not meeting with, you know, Dr. Bender and

• 2:38:17Speaker 01

  all that stuff. But you're gonna get a full FDA-approved clinical sleep study done, any nights as you want, and you're gonna get coached for several months on your sleep.

• 2:38:25Dr. Darshan Shah?

  Wow, I can't wait to check this out.

• 2:38:26Speaker 01

  There's nothing like it in the world.

• 2:38:27Dr. Darshan Shah?

  Yeah, this is, this sounds just revolutionary as far as, I mean, so many people struggle with their sleep. I mean, I would say, I would say it's about 90% of people I know that are not getting perfect sleep.

• 2:38:38Speaker 01

  You know what's actually crazy? I don't know if you've ever looked at the data. You have, it's kind of like all this we've been talking about, but there is, yeah, there's long-term medical consequences of bad sleep. And, you know, people have talked about that ad nauseam. That's true. People do not realize the performance-enhancing aspects of going from even good or okay to great sleep. I cover, actually, I think the episode just came out, yeah, just, I think it was last week's episode on-

• 2:39:02Dr. Darshan Shah?

  Last week was sleep.

• 2:39:03Speaker 01

  The sleep extension research is so compelling for decision-making, executive function, word recall, memory, VO2 max, body composition, so on and so forth. So making sure that even if you're like, I don't have a disorder, fine. We say the same thing for, yeah, you don't have a clinical pathology in your muscle. It's not functioning great. Your blood, like, we wouldn't treat, it would not be acceptable in any other aspect of our physiology, and we shouldn't do that with sleep. So it is a, it is a hammer that you can swing, that is ubiquitous across your physiology, that, you know, all it requires is a little more precision, and the metric you care about, your sexual function, your brain capacity,

• 2:39:45Dr. Darshan Shah?

  What have you?

• 2:39:46Speaker 01

  It goes up.

• 2:39:46Dr. Darshan Shah?

  It does.

• 2:39:47Speaker 01

  It just improves. So it's been so, so fun in that. Just the amount of people who are just like, I've been to five sleep clinics. I've been on this before. I've tried. And you're like, oh, gosh. And then just to see those stories come in and be like, well, it's this. They're like, jeez.

• 2:40:04Dr. Darshan Shah?

  Wow.

• 2:40:06Speaker 01

  It's been, it's been very remarkable. Sleep hurts.

• 2:40:09Dr. Darshan Shah?

  Yeah.

• 2:40:10Speaker 01

  Like, if you're not getting as strong as you want in the gym. Yeah, whatever. If you're not losing those last 10 pounds, like, okay. But when you don't sleep.

• 2:40:17Dr. Darshan Shah?

  You, you feel it.

• 2:40:19Speaker 01

  It hurts bad. So.

• 2:40:21Dr. Darshan Shah?

  I can't wait to do this. I'm gonna do it. Even though I think my sleep is pretty good, it's not awesome, but.

• 2:40:25Speaker 01

  You know what's funny about that? I have to say this carefully. I'll tell you two stories. One, we legitimately saved somebody's life that said that exactly. He signed his wife up. He was probably 60 or so years old, had exited a company. You know, plenty of funds, whatever. It was like, whatever. I want my wife to do it just in case. I sleep fine. He's like, I'll pay. I'm not gonna do it. I'm not gonna do it. So I went fine. And eventually he's like, I'll do it. And I don't remember exactly what it was, but our team saw stuff and was like, yo, you need to go to the hospital right now.

• 2:40:56Dr. Darshan Shah?

  Really?

• 2:40:56Speaker 01

  Yeah. I don't remember. I wish I knew exactly what it was.

• 2:40:59Dr. Darshan Shah?

  Wow.

• 2:41:00Speaker 01

  Oh, they're gonna kick me for not knowing this. But they effectively sent it. Like, it was almost overnight and they ran him into, I think he was in Vail. Got him into a place down there and they're like, the medical doctors were like, yeah, you're, you're a walk, you're, you're like any second heart. I don't know if he was infarction or what the exact problem was. And they're like bam. And then he had to go through, it was years of stuff, but it legitimately was like, holy. And he felt like he was sleeping very, very well. And it was not. That's not common. If you feel like you sleep well, you probably sleep fine. I don't, I don't like overly scale, scare people into it. But, but that has happened multiple times. And that also happened with one of our high performing athletes. Not the death thing, but the, was using a tracker and was like, oh, I'm getting 90 plus percent scores every time.

• 2:41:43Speaker 01

  But then it was like, man, recovery is just stuff for slowing down. It's not that. It's something else. And then we ran him through our system. We're like, oh, no. It's a little bit technical, but one of the things that can happen with like a tracker. They're going to tell you things like sleep staging.

• 2:41:57Dr. Darshan Shah?

  Sure.

• 2:41:57Speaker 01

  How much time you spent in deep or whatever, and those numbers are almost entirely garbage. The amount of time you send in those stages is arbitrary. They can't correctly measure them. But it's not the time that matters. It's the amplitude within them.

• 2:42:08Dr. Darshan Shah?

  Right.

• 2:42:09Speaker 01

  And so we were able to actually see that. And we're like, no, no, no, you're actually, you know, you're very shallow in this. And so we were able to make a bunch of improvements in that individual. And that that person's a world champion. So it was like in the spectrum here, sixty year old executive person was life saving. This person was like, yo, you're world champion and you're not sleeping as good. And that story of athletes has happened multiple times with very, very high profile peoples, like athletes who every one of you, not even sports fans would be like, oh, I know that name. Um, or like thought they were sleeping well and and we're not. So.

• 2:42:40Dr. Darshan Shah?

  Just, I mean, the the power of sleep to improve or affect every aspect of your biology is just, it you cannot be overstated as as we know. But um, it just goes to show you too, like just the value of doing intense studies into some of this stuff is is just, it can be a game changer for people.

• 2:42:57Speaker 01

  And it's just so awesome that we're in a time now where these things are real.

• 2:43:02Dr. Darshan Shah?

  Right.

• 2:43:03Speaker 01

  They're available. I mean, services are remote. And some of them are way past your budget point. But give it a year, give it five years. Like it's it's coming, right?

• 2:43:14Dr. Darshan Shah?

  That's what I tell people all the time.

• 2:43:15Speaker 01

  Our company, your company, other people, I don't care. It's clearly getting to a spot where it's going to be democratized or really, really, really close. So if you can't afford it, fine, keep paying attention. It it's gonna get there.

• 2:43:25Dr. Darshan Shah?

  Yeah. I feel like you and I are the same on that. We want everyone to do it.

• 2:43:29Speaker 01

  Oh, yeah.

• 2:43:29Dr. Darshan Shah?

  And as things get less expensive, we can make it less expensive ourselves too.

• 2:43:34Speaker 01

  Hundred percent.

• 2:43:35Dr. Darshan Shah?

  It's we want it to be less expensive. Like, we don't want people paying four to five thousand dollars for an MRI.

• 2:43:39Speaker 01

  No.

• 2:43:40Dr. Darshan Shah?

  It'd be great if you can get it for a hundred, two hundred bucks. I think one day it will be a hundred dollars for an MRI.

• 2:43:44Speaker 01

  Most definitely will be.

• 2:43:45Dr. Darshan Shah?

  Absolutely. They'll be all over the place.

• 2:43:46Speaker 01

  I mean, the cost of MRIs alone have gone down almost magnitude of, like an order of magnitude in the last few years. They're going down like seven figures per year, depending on like to get into them.

• 2:43:57Dr. Darshan Shah?

  It's like genetic testing, right? It was hundreds of thousands of dollars. Now it's a hundred bucks.

• 2:44:01Speaker 01

  Oh, it was hundreds of millions.

• 2:44:02Dr. Darshan Shah?

  Yeah, the first one.

• 2:44:04Speaker 01

  Yeah, for sure. And the billions. Twins, actually, and then now it's like for sure.

• 2:44:07Dr. Darshan Shah?

  Yeah.

• 2:44:08Speaker 01

  Couple of hundreds of things.

• 2:44:09Dr. Darshan Shah?

  Exciting time to be alive.

• 2:44:10Speaker 01

  Yeah, man. That is, that is really, and then the fun part really that we'll, we'll leave little teaser on is the stuff that we can actually do with prediction models now.

• 2:44:20Dr. Darshan Shah?

  I want to hear more about that.

• 2:44:21Speaker 01

  So we actually finished a project called the Human Digital Twin. And we did this in collaboration with a bunch of different companies. My friend Cody Burkhart, who runs Human Works at a NASA, led the charge of this. And so he brought together a bunch of companies and said, can we take a bunch of companies and run full analysis of them? So we did Absolute Rest, we did Vitality, our, our blood work stuff. We put them through force plate testing, motion capture, movement analysis. We put them through a whole bunch of, tons of companies came together on this. And then we took all those data and we made a digital twin.

• 2:44:57Dr. Darshan Shah?

  Wow.

• 2:44:57Speaker 01

  Of them. And then we're able to run simulations on them millions at a time. Combinations of training, recovery, supplements to say like, what, what responses are we going to get out of your physiology?

• 2:45:08Dr. Darshan Shah?

  That's mind blowing.

• 2:45:09Speaker 01

  Yeah, yeah, and we, we did this and we presented, we, we, we put four people through it.

• 2:45:15Speaker 01

  As our, kind of like our, our proof of concept pilot thing. And then we're able to come back and then run them through an intervention and then actually test them post, right? As, as a proof of concept. So we did that thing and then sort of showed the world that a couple of months ago and said, it wasn't perfect, like by any stretch of the imagination, but we did it.

• 2:45:32Dr. Darshan Shah?

  And correlated pretty well?

• 2:45:33Speaker 01

  Yeah, yeah, like.

• 2:45:34Dr. Darshan Shah?

  That's incredible.

• 2:45:34Speaker 01

  It's not even that hard at all. There's, there's a company called, um, called SVEKSA. It's kind of under the radar. It stands for like Silicon Valley exercise, something or other, whatever. But their, their ability to run digital twins is insane right now. And so they, they can do a ton of cool stuff with that. You can't go buy it as a consumer, but we use it a lot in a lot of different areas. And so those things where you can come in and say, hey, look, what do you have for wearable or whatever? Okay, you've got this, you've got this, you've got this. It can all link up to their system and their system can use it. They were actually, SVEKSA was able to predict, I think it was, don't quote me exactly here, but I'm pretty sure it was Swedish National Championships in swimming within one and a half percent.

• 2:46:15Dr. Darshan Shah?

  Mind blowing.

• 2:46:15Speaker 01

  They did, I think, within like, sorry, Specks, the guys, they told me before, don't quote me, but you're getting the concept here. I think it was within 40 seconds of the Chicago Marathon performance.

• 2:46:24Dr. Darshan Shah?

  That's incredible.

• 2:46:25Speaker 01

  And all they used for that is they, they actually did, I'm jumbling the story just a little bit, but I'm getting the right point here. I hate, I don't want to sound untruthful, so I'm aware of that, but it's the same concept here. They handed their coach note cards six weeks before the race and said, this is the time all your people are going to run. And then when they actually looked at the numbers, they were within 40 seconds of the marathon performance of, of all of them.

• 2:46:48Dr. Darshan Shah?

  Just using the digital twins.

• 2:46:49Speaker 01

  In that case, all they used were training logs.

• 2:46:51Dr. Darshan Shah?

  Ah.

• 2:46:52Speaker 01

  They used training logs, built that into their digital twin, ran it and said, this is the times they're going to run. They can actually take that and then tell you, like, if you have a goal in mind, they can say, hey, look, it's going to take you this many months to hit that number. So you want to squat 300 pounds or you want to run, or whatever, they can say, okay, here's your data, let's track your physiology, whatever, it's going to take you this many months to get there and tell you the day that you're going to break that number on.

• 2:47:13Dr. Darshan Shah?

  So, so there's a world where you can like create, run hundreds of simulations and create the perfect training program for somebody.

• 2:47:20Speaker 01

  Millions. Yeah.

• 2:47:20Dr. Darshan Shah?

  Like to the rep count, maybe.

• 2:47:22Speaker 01

  Yeah. So actually what Specks does is they have a coach, a running coach, I forget his name, but yeah, I think he won Chicago Marathon a bunch of times. And they said, give us all your training programs and we will build a digital you. So you can hire him as your coach for pennies on the dollar and he'll like, and he'll, you know, he went back and verified that. So your ability to get coaching from people like that or people like me or whoever else, if that person is willing to be able to run that and make digital coaches, coaches of us.

• 2:47:53Dr. Darshan Shah?

  Yeah.

• 2:47:54Speaker 01

  And now you're, instead of having to pay, you know, six figures to like me or you directly coach you.

• 2:48:01Dr. Darshan Shah?

  You got it all in the palm of your hand in your phone, even. And it's doing it in real time, interacting with your physiological data.

• 2:48:07Speaker 01

  Exactly right. So it's adaptive training.

• 2:48:09Dr. Darshan Shah?

  Adaptive.

• 2:48:09Speaker 01

  Based on how your body's responding. Now, there's a lot, a lot of people sell things like that while I'm here and they're, they're terrible. They're not good at all, but some people do it very, very, very well.

• 2:48:20Dr. Darshan Shah?

  And is this using artificial intelligence, machine learning?

• 2:48:23Speaker 01

  It's all those things. It's historical data, it's machine learning, it's artificial intelligence. Like, when people throw out things like AI and machine learning, like, it can be a whole mess of nothing.

• 2:48:31Dr. Darshan Shah?

  Yeah.

• 2:48:32Speaker 01

  Because those data are only as good as the data in it.

• 2:48:34Dr. Darshan Shah?

  Right, right.

• 2:48:35Speaker 01

  So like, if you were to use, for example, and I've seen people do this. Like, oh, we're gonna jump all these floodwater companies because we're using AI and machine learning. And I'm like, okay, that's great, but if they're all based on poor reference ranges.

• 2:48:48Dr. Darshan Shah?

  Back to reference ranges, exactly.

• 2:48:51Speaker 01

  You don't know what good is.

• 2:48:52Dr. Darshan Shah?

  Exactly.

• 2:48:52Speaker 01

  So, like, until you get that secret from my lockbox, like, you still don't have any good data to work off of. So, so good luck. So a lot of those programs are that. Like, if they're based on poor information, if the coach doesn't really know how to coach, they don't have lots of really good data on you, then you're gonna get, like, you're just gonna get the noise, the loudest noise in the room.

• 2:49:13Dr. Darshan Shah?

  Sure.

• 2:49:13Speaker 01

  Which is not a good thing. So most of that stuff sucks right now, to be totally honest with you. But there are other groups, like Spex, who are real excellence physiologists, from real scientists, real coaches, built into programs, so. Whether it's them, or another group, or anyone else, the point is, these things are going to be online really, really, really, really soon. That'll allow people to do a lot better with exercise.

• 2:49:36Dr. Darshan Shah?

  Yeah. And I think, feel like in the next five years, things will be completely different, right, right of this exponential change that we're seeing.

• 2:49:43Speaker 01

  Totally.

• 2:49:43Dr. Darshan Shah?

  It's just, it's just growing and getting so much better. At an accelerated pace, year to year, so.

• 2:49:48Speaker 01

  Yeah. I mean, this is why, like, companies like Renaissance, Periodization are crushing so much. Because they have so much data of real people who've had real progress. So now it's like, okay, how do you know that I should take this little deload or whatever, it's like, well, we have 10,000 people in the database, in your age range, at your body composite, and you're like, oh. Okay, like that, that, pretty good chance it's gonna work.

• 2:50:11Dr. Darshan Shah?

  Exactly.

• 2:50:12Speaker 01

  Whatever. I don't know how many they have, but it's an enormous number of people in those databases. So, um, Precision Nutrition, if you're familiar with that company, they have a similar thing from the nutrition.

• 2:50:20Dr. Darshan Shah?

  Sure.

• 2:50:21Speaker 01

  So, there's just a lot of companies coming on board with, with really cool things. Um, but we gotta have the good data first.

• 2:50:27Dr. Darshan Shah?

  Exactly. Wow. Well, with that, Andy, I just want to thank you from the bottom of my heart for making this such an incredible discussion. I learned a tremendous amount. You're a massive wealth of knowledge. I just love it. I can't wait to have another conversation with you one of these days. And where can people find you? I mean, you have, it sounds like you have a few companies and lots of great resources available for people. Can you give us a rundown of some of those?

• 2:50:48Speaker 01

  Yeah, honestly, what I've tried to do my entire career is make things available for anyone regardless of situation. So where I started and my home base is always free education. What that means, like my podcast, of course, is called Perform. That's 10 episodes in season one. And it's not a weekly podcast. Like it's just get in, get out. Um, my YouTube channel, there's no paywalls. There's no newsletter to sign up. That is always and always will be free. And I got 10 years or more of videos from exercise, nutrition, to workouts, to samples on there. That's always gonna be my baby. Like those will be my course for sure.

• 2:51:27Speaker 01

  Then from there, as step ups, I mentioned the biomolecular athlete. That is the, okay, if you wanna use our tools, you want me to actually teach you, like there's a fee behind that. That's where our, on our in-person seminars are at. So we have one coming up on blood work and genetic testing for performance in Dallas and in, uh, in August. I'm not sure when, when this is gonna air, but.

• 2:51:51Dr. Darshan Shah?

  I, I think it's after that, but that's okay. I'm sure you're gonna do this on a yearly basis.

• 2:51:54Speaker 01

  But then that'll be up on there.

• 2:51:56Dr. Darshan Shah?

  Okay.

• 2:51:56Speaker 01

  Available. Little bit more expensive, right? Those courses are a little bit, but not a ton. Then you have things like absolute rest where, okay, a couple hundred dollar, maybe a thousand dollar version to, to much more than that. Our blood work company, Vitality Blueprint, same thing, right? Like you want performance, blood work, performance analysis, performance plans from that side of the equation. That's. Available. These things are in the thousands. And then we have rapid health and performance, which is our, our full immersion coaching programs. Right. This is where, hey, that's not cheap. And I will never, ever feel bad about that because now you're getting my personal time. And I can only do a few of those at a time. So the other ones are available.

• 2:52:39Speaker 01

  You know, for a thousand bucks, for 500 bucks, all the way down to free. And, and their goal is to give, again, everyone a chance. If they find anything I say interesting or helpful, I don't want it to be behind paywalls. If you want my time, that's behind a paywall. But if you want my information, that, you know, try to make that as free and accessible to anybody as, as I possibly can.

• 2:53:00Dr. Darshan Shah?

  Yeah. And, and I learned pretty much everything about exercise, not from medical school at all.

• 2:53:05Speaker 01

  Yeah.

• 2:53:06Dr. Darshan Shah?

  I learned it from your YouTube videos.

• 2:53:07Speaker 01

  Oh, amazing.

• 2:53:08Dr. Darshan Shah?

  So I highly respect your content. It's very scientifically based. And, you know, the regular person can use it. It's, it's like made for the regular person, which I love. Even though you're a performance coach, you train world famous athletes.

• 2:53:21Speaker 01

  Yeah.

• 2:53:21Dr. Darshan Shah?

  Regular people can use your information very effectively. So, hey, thank you so much for doing this. This is an incredible conversation and look forward to many more.

• 2:53:29Speaker 01

  I really appreciate it, man. It's been a blast.

• 2:53:31Dr. Darshan Shah?

  Awesome. Thank you so much.

• 2:53:36Dr. Darshan Shah?

  Thank you so much for listening to the podcast today. Please remember to subscribe if you liked this episode and give us a good review and share a link with your friends. It really helps to support all of our efforts. I also want to remind you that the information shared on this podcast is for educational purposes only and is not intended to replace professional medical advice, diagnosis, or treatment. Please consult with your healthcare provider or physician before making any decisions or taking any action based on what you hear today, especially if you have any underlying health conditions or on any medications. Your doctor knows your personal health situation the best and it's always important to seek their guidance.