112: Understanding Blood Work, Nutrition Myths, and Fertility with Dr. Kyle Gillett

Dr. Kyle Gillett returns to discuss a variety of health topics, including the impact of plastics on health, lab testing for athletes, and the rising concerns around fertility. We spend time in the real issues behind common health narratives, offering practical advice for optimizing lab results and exploring effective treatments for infertility. The episode also highlights the importance of diet, exercise, and sleep, particularly for parents managing busy lives. CHAPTERS: 01:51 Dr. Gillette's Background and Motivation 04:33 Importance of Primary Care Physicians 07:50 Challenges with Blood Work and Lab Tests 18:18 Mobile Blood Draws and Lab Testing Insights 25:26 Interpreting Lab Results and AI in Healthcare 34:23 Overhyped Health and Fitness Narratives 41:17 Understanding Orthorexia 49:22 Overhyped Health Narratives 01:12:12 Nutrient Deficiencies in Athletes 01:18:49 Iron Deficiency in Female Athletes 01:27:03 Impact of Microplastics on Health 01:29:09 Chelation Therapy and Detoxification 01:48:39 Fertility Treatments for Men and Women 01:58:02 Balancing Health and Family Life 02:02:46 Conclusion and Final Thoughts Become a BPN member FOR FREE - Unlock 20% off FOR LIFE https://www.bareperformancenutrition.com/pages/bpn-membership?srsltid=AfmBOorlpjVeag2kkt3eZ5UpWcFA5Bb2v5V_93lmO47Vn_Y8DRdLwDLL Your trusted partner for Concierge Medicine & Aesthetics https://gilletthealth.com/ FOLLOW: IG: instagram.com/nickbarefitness/ http://instagram.com/nickbarefitness/ YT: youtube.com/@nickbarefitness http://youtube.com/@nickbarefitness KEEP UP WITH DR. GILLETT IG: instagram.com/kylegillettmd/ http://instagram.com/kylegillettmd/

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

• 0:05Nick Bare?

  All right, ladies and gentlemen, back on the podcast, second time, Dr. Kyle Gillette. Dr. Gillette, welcome. Welcome back.

• 0:18Speaker 01

  Thank you, Nick. It's my pleasure.

• 0:20Nick Bare?

  So before we dive in to a lot of things, and I want to cover a lot of topics that we've been discussing the last couple of days in preparation for this conversation, I think it's worth resharing your background, providing the audience the intro of where you're coming from, what you specialize in, your practice in Kansas. Just provide some, some background into some of the topics we'll be diving into today.

• 0:47Speaker 01

  Yeah, I'm from Kansas, as you mentioned, and I'm a board certified family medicine and obesity medicine physician. And I'm pretty much your stereotypical Kansan. I'm a dad, I have three kids, I love health optimization, I like staying healthy myself. But the reason why I got into health optimization is it's how you help most people. We have a very sick population. And as I went through my education, I watched my father who had a pretty large faith-based Christian practice with, I think, almost 100 nurse practitioners and physicians. And I saw how they really cared for their patients. But a lot of times, people still got really sick. They got diabetes, they got obesity, they stopped exercising, they

• 1:32Speaker 01

  stopped eating healthy. So I wanted to tailor my education in order to help people the most.

• 1:38Nick Bare?

  When you were pursuing being a board certified family doctor and specializing in obesity, were there other areas of medicine that you were being drawn towards? How did you end up in this area of expertise as opposed to others?

• 1:57Speaker 01

  Yeah, I'm really glad that I did. I've known that I wanted to be a full-spectrum family practice doctor. In the Midwest, family practice doctors still kind of do it all. I know I wanted to deliver babies, take care of newborns, take care of people in end-of-life care, all the above, do procedures, you know, work on skin, do aesthetics. But during medical education, I went to med school at the University of Kansas, which I think is an excellent med school. But it was very tempting to do another specialty because,

• 2:32Speaker 01

  for better or for worse, mostly for worse, people want to do a specialty that they think has high status and makes a lot of money. And generally, the most difficult specialty, which is family practice, you do literally everything. So you have to know more. And yes, I understand an inch deep, a mile wide, et cetera, et cetera. But you literally have to know more, and we put our worst applicants into that. So hundreds of people told me that I was throwing away my education because I was a strong applicant, I was good at taking tests, and that it would be a waste to be a family practice doctor, and it can't be fun. But I'm very glad I did not listen to them.

• 3:08Nick Bare?

  That's interesting. Steph and I have had an amazing experience working with you and your team. So after you were on the podcast last time, obviously, we started talking more about the opportunity to work together. And it's one of those things where I'm going for routine blood work or a checkup prior to working with you, and someone asks the question, "Who's your primary care physician?" My answer was always, "I don't have one."

• 3:40Speaker 01

  Urgent care.

• 3:41Nick Bare?

  Urgent care, yes.

• 3:42Speaker 01

  Yeah.

• 3:42Nick Bare?

  Because when I was in the military, like my primary care physician was just going to, you know, down the road to whoever was closest for med call when I was on active-duty military service. And when I transitioned down, I didn't go and try to find a primary care physician, which I actually think a lot of people, at least in my circle, in my age, are in a same or similar situation where they don't have a primary care physician.

• 4:12Nick Bare?

  So after you were on the podcast last time, we were talking, you are now our family's doctor. And that's been hugely beneficial just in terms of...

• 4:23Nick Bare?

  Having a resource, questions answered, instead of us going to Google, or in an emergency, trying to find some sort of answer for a problem we're experiencing, having a source of truth that can help us and our family. Do you find, and maybe I'm just in a rare situation, but do you find that a lot of people don't actually have primary care physicians?

• 4:52Speaker 01

  Yeah, it's very common. In fact, most people get a PCP when they need one for a specific reason. For example, a referral. Occasionally, people will refer to family practice doctors as algorithm robots, or referral primates, referral apes. Because they're just clicking the refer button and then following the algorithm. And they do nothing specialized and they do almost no thinking, but it should be the opposite. And thank you for your kind words, by the way. Many people say, well, you shouldn't Google it, just go on AI. And we could talk about AI some too, but people understand the importance of a coach, or even a nutritionist for whatever sport they're doing.

• 5:34Speaker 01

  And at the end of the day, a physician should be more similar to a coach. We should explain all the upsides and downsides of every intervention, and then come to a decision together.

• 5:45Nick Bare?

  I mean, it's how our working relationship has been. It's just like that. We have questions, we set up a call, we address those questions, you provide solutions, and then we weigh the pros and cons, and which options do we want to pursue? So it's been extremely beneficial for our entire family since we started working with you and your team. So I appreciate it.

• 6:08Speaker 01

  Absolutely, yeah. Hopefully, this will help people, including nurse practitioners and physicians. Shared decision making is what we're talking about, and everybody is taught this in med school. So everyone can do that. They just have to learn the upsides and downsides, rather than following an algorithm.

• 6:27Nick Bare?

  Right. So one of the first things I want to talk about, which kind of leads naturally into...

• 6:35Nick Bare?

  When I talk about getting blood work done, especially in the business here,

• 6:40Nick Bare?

  employees have come up to me after speaking out wanting to get blood work done and they say, "How do I get blood work done?" And I typically say, "Well, go to your primary care physician." They say, "I don't have a primary care physician," or if they do, their primary care physician won't order them the blood work that they're trying to get.

• 6:59Nick Bare?

  So with that kind of aside, I'd love to talk about what labs should people be getting done on a regular basis and what questions should they be asking their PCP? Because I think based off some of the things we've talked about, if you just go to your PCP and say, "I want to get blood work done, routine blood work done," they might not order the right labs to actually be done.

• 7:27Speaker 01

  Yeah, there's almost no chance that they will.

• 7:29Nick Bare?

  And the last time I got blood work with you, we got like 14 miles of blood drawn. It was a pretty extensive, comprehensive panel. So where do people start with how often, what blood work to be getting done, like why, what, everything around labs?

• 7:46Speaker 01

  Yeah, and this obviously depends to some degree on the person, but a good place that everyone should start is I think everyone, whether they're 20 or 50 or 90, should check their hormones, their inflammatory markers, their vitamins and nutrients, and then their organ system tests. And very few of these labs are on a normal panel, and I've been podcasting it enough, I can speak pretty bluntly. Going to your doctor through insurance and getting labs, they will cover some labs. They'll cover probably $10 worth of labs. The average markup on say a LabCorp or Quest panel of what you would pay if your insurance doesn't cover it is 10x.

• 8:25Speaker 01

  So let's say you get a $200 lab panel through Gillette Health or my lab company Sage Bio or whatever other company, probably going to be twice as much or just have worse labs that are not accurate. But if you try to run that through insurance and your insurance does not cover it, they will send you a bill for $2,000 on average, if not more, and I see this very frequently. And obviously, it's the person's decision at the end of the day. And for some labs that I think... Can and or should be covered. I do fight for those to be covered and do appeals. And, you know, I speak to the insurance companies to try to cover them. But it's usually not worth the effort because they usually end up just not covering them.

• 9:09Speaker 01

  And there's no way to know. So with a medication, you can go see, yes, this is on your formulary. With a lab, you have no way of knowing that. But I have a pretty good idea of what's covered and not covered.

• 9:20Nick Bare?

  Why is the markup so ridiculous?

• 9:23Speaker 01

  It's actually the same way with medications and imaging tests too. Just not quite 10 times. It's because when you negotiate with some insurance companies, including the government's insurance company, Medicare and Medicaid, you start off with a higher asking price. Because you know Medicare and Medicaid wants to pay, you know, about 10 to 20% of the price. So you just increase your initial offer. And this is why a lot of specialty tests are high cost too, like the Grail Gallery Liquid Biopsy Cancer Screening.

• 9:58Speaker 01

  That would be one eighth the price of what it is right now if they weren't trying to get it paid for from insurance.

• 10:06Nick Bare?

  So it's pretty much a way to maximize money from the insurance companies?

• 10:11Speaker 01

  Correct.

• 10:12Nick Bare?

  I saw this saw this video on on social media yesterday. It was this guy calling his insurance company to talk about a bill that he got. So he got this bill. It was higher than he thought it was supposed to be. He called back in to to check on it. He got a new bill. The new bill was more expensive than the previous one. So he's recording this conversation with the insurance company. And it was the fact that because he had insurance, it was at a a set rate. But if he did not have insurance, there was a discount for not having insurance. So if he didn't have insurance, it was actually cheaper.

• 10:56Nick Bare?

  So he was asking if he could call in and cancel his insurance to get the cheaper rate. Doesn't that seem backwards?

• 11:03Speaker 01

  Yeah, it's very backwards, especially now that we have options like Christian health sharing. That's what my wife and kids are on. And it's been pretty good for us because we're quite healthy and they cover things like midwife services and a lot of other things that insurance companies cover. They don't cover immunizations, which we could also talk about. You know, my oldest just turned five and I know immunizations cost, again, $5 to make or $2 or $3 to make. So if you want to go get a MMR, measles, mumps, rubella immunization, and you don't have insurance, then it's extremely expensive. That doesn't seem like something that a system that wants to

• 11:45Speaker 01

  optimize and increase immunization rates would do. It's extremely difficult and almost cost prohibitive from my perspective to, I guess, fully immunize my children. You know, it doesn't necessarily have to be that. The way that I look at immunizations and peptides and medications and supplements, is they're all just compounds? And I believe that God has made us to be in control of our organic machines that are our bodies. And you're thinking about whether or not that is a, like, what's the good thing about putting that into your body? And what's the bad thing about putting that into your body?

• 12:25Speaker 01

  So I think that's a, it's a pretty personal decision that I think everyone should have a discussion with their doctor about. But the, the problem is, a lot of times, that's dictated by what the price is.

• 12:38Nick Bare?

  Hmm. Is this one of the reasons that you decided to start your own lab testing company? And is that newer?

• 12:46Speaker 01

  Yeah, it's brand new. In fact, we, the website's still kind of in beta version, but it's sagebio.com. And whenever I see something that's wrong in the healthcare field, there's usually many companies that have tried to Rectify this, or if you're a little cynical and glass half full like me, to try to take advantage of it. And just because the thesis is true on something does not mean that the antithesis is also true. So a lot of what I call self-service lab companies, one of the first one was private MD labs. And then you had, most people are familiar with Inside Tracker. And of course, they have different strengths and weaknesses. But at the end

• 13:27Speaker 01

  of the day, they're big companies that want to make a ton of profit. And I know exactly what the margins are on labs. So if there's a big company that offers a panel for $500, I offer it for $300. And if there's a big company that offers a panel for $800, I order a panel, not necessarily an identical panel, but a similar but better panel, that does not have lab tests that you shouldn't order without a discussion with the physician first, for lower cost. And of course, I have to mark up those to some degree, and I have a lot of help from people who basically develop the software program in order to run it, and the AI doctor that we train, because I do think that that's the way of the future,

• 14:09Speaker 01

  that people can use to help understand, wouldn't say interpret, but understand their lab panels. But yeah, it's certainly not a particularly profitable venture, given that I have not gotten any venture capital funding. So I don't have tens, or even hundreds of millions of venture capitalists that have invested in this, that basically tell me what I have to do. But the good thing about that is, I can do whatever I want. So if there is a sensitive estradiol panel that costs $40 wholesale, and we have to sell it for 50 or 60, and everybody else is selling the $4 estradiol panel that I know is not accurate, then I can sleep well at night, knowing that I ordered the test that is going to give the patient the best information.

• 14:53Nick Bare?

  So how does, how does starting a lab testing company work? So who is, who's doing the draws? Who's doing the actual testing? And like, what is your company then do? Are you guys the glue that brings it all together? Or do you, do you own the?

• 15:13Nick Bare?

  The I guess, operations side of the business that does the draws and the testing itself?

• 15:17Speaker 01

  Yeah, right now, we don't own any sort of lab drawing company. It's pretty interesting. Right now, we use LabCorp, but some of the big companies use Quest, some big companies use Vibrant or Access or BioReference, but they switch quite a bit. So InsideTracker, I think, used to use BioReference with a company called Scarlet, which is mobile phlebotomy, but almost all this is middlemen, kind of like Amazon. Think of LabCorp as Amazon, and we're a seller on Amazon. That's why you had to get 14 vials of blood drawn, because LabCorp actually doesn't own the assays and tests either. They send it off to a completely separate business, but they're just such a giant in the space, just like Amazon is, and they get the best prices on everything. But when they

• 16:02Speaker 01

  take four different quote unquote "purple tops" or "red tops," if they owned all their own assays, they would just need one of each of those tubes. But they're sending that to four different labs, because each one, you know, they kind of go with the price of the lowest bidder, as long as it's a quality lab. So there's a lot of middlemen in between, but it's still at a very low cost in order to do that. But eventually, of course, we'd love to reinvest in the business and own as many of our assays as possible. And we'd also love to have a, basically, an analytical chemistry lab. I've talked to many people about this. Analytical chemistry lab, maybe even a

• 16:43Speaker 01

  nonprofit company, because Consumer Labs and Consumer Reports is not completely unbiased, where it can actually test supplements and compounded medications, which I think are going to be bigger and bigger.

• 16:54Nick Bare?

  Interesting. I think one of the greatest hacks of all time in terms of getting lab tests done is the mobile blood draws.

• 17:05Speaker 01

  It's great.

• 17:06Nick Bare?

  That was game changing for me, because one of the most inconvenient parts of my day, when I was getting routine blood work done. Was trying to get one lab work scheduled at a time that worked for me. Cause I, you know, you have to fast lead into your, your labs. And I'm starving when I wake up. I like training when I wake up.

• 17:26Speaker 01

  Yeah.

• 17:27Nick Bare?

  So trying to fast and then finding an appointment to go to the facility, get blood drawn, go back to work. I mean, now I book my mobile blood draws well in advance. I get the first time available. Me and Steph both do. Like I'll walk in the garage sometimes. It's like 5:00 AM and Steph's getting blood drawn in the home gym. And it's just so, it's so convenient. Now they don't have to come in your house. I literally just do it in the garage. And I'm sure if someone drove by garage doors up, there's a lady like pouring blood, 14 vials of blood out of my arm. Like what is going on? But I, for a lot of people, you know, especially people who have lots of responsibilities, kids, a job, all of these things.

• 18:10Nick Bare?

  Like go with the, just pay the, the little extra money. It's not that much to have someone drive to your house, take your blood and then send it into the labs. Which it sounds like now you don't know where that blood's going. It's going all over the place.

• 18:24Speaker 01

  Yeah, it is going all over the place. And in general, mobile lobotomy is fantastic. If you're getting a hyper specialized lab, especially one that has specific handling necessities, like an APTT, which is a blood clotting marker, then depending on where you live in the country, if you live on the coasts, you might want to go into a lab corps because mobile lobotomist might be at high risk of mishandling the specimen.

• 18:52Nick Bare?

  Hmm. It's interesting.

• 18:53Speaker 01

  Yeah. So there, there's certainly things to consider, but yeah, if you're just getting your routine labs, for most people I recommend twice a year, even if you're not, you know, hyper focusing on it, just get your baseline things twice a year. You, it's a, there's enough things that you almost always find something, whether it's low iron status, low vitamin D, your B12 could be improved. You almost always find something.

• 19:15Nick Bare?

  So if someone's for the first time has never gotten blood work done before, they go to their doctor or they want to go order labs with say your company, you want to get like a comprehensive panel done, you want to home run everything, like go all out. What are some of those things people should be adding or looking out for to make sure they're getting everything they need done within that test?

• 19:41Speaker 01

  If they're listening to this panel, then certainly they want the things that I mentioned before, your hormones, your testosterone, your estrogen, your progesterone, your cortisol, even your IGF-1, which is kind of a marker of your growth hormone. Cause part of that is it tells you how you sleep. You make growth hormone as you sleep. You want your insulin as well and your A1C. Although interestingly in some runners, A1C is not as accurate because the red blood cell turnover is a bit faster. But if they're listening to this podcast, they probably want what I call the athlete panel. Maybe I could call it the Nick Bear panel. But you, you want to get your CoQ10, which converts NAD plus to ATP. Even if you're not taking any D plus, your body makes that as a natural part of the cellular mechanism.

• 20:27Speaker 01

  And then you also want things like glutathione, which is the master antioxidant.

• 20:32Speaker 01

  We give people that have Tylenol overdoses NAC. That is one of the three amino acids that helps make glutathione, but you can actually check it too. It's just not very common to, and then you can check things like carnitine, which is like a fuel pump that pushes energy fatty acids into your mitochondria.

• 20:50Nick Bare?

  Awesome. What about in terms of like age groups? Is there something people should specifically look, be looking for in labs in their twenties compared to their thirties, compared to their forties and beyond?

• 21:06Speaker 01

  Yeah, in general, as you age, it's more important to look at intracellular micronutrients. For example, how much magnesium is in the cell? How much zinc is inside the cell? As it becomes slightly more difficult to push nutrients intracellularly as age progresses. And then in both males and females, as you age, it's more and more important to check your hormones for perimenopause or all andropause is periandropause. You don't really have a precipitous drop off, but it does get more and more important. But even for someone who is 20 years old, I think it's important to get a baseline hormone status. For males, you want to be ideally relatively well slept so you get an accurate reading.

• 21:50Speaker 01

  Lots of young males try to get lower testosterones to, you know, incentivize maybe doing something or taking Clomid, but that's kind of another topic. And for females, I'm actually a fan of them getting mid-cycle labs. That way they have relatively high testosterone and estrogen. They can get late cycle if they want to see their progesterone spike, but it doesn't matter as much. The estrogen to androgen ratio mid-cycle is more important. However, if female athletes are having some skipping of periods, which is very common, then it's even more important to check. You're always going to check your hemoglobin, your hematocrit, your ferritin, but you want

• 22:34Speaker 01

  to add full iron studies and you probably want to see what's happening with your estrogen during the cycle as well. So sometimes I have them do urine tests after the blood test, like a MIRA, M-I-R-A test that looks at estrogen metabolites or progesterone metabolites.

• 22:52Nick Bare?

  So for women, mid-cycle is when you should be doing your blood test?

• 22:57Speaker 01

  Or late cycle, which is day 21 or shortly thereafter, if you're trying to see if you ovulated that month. And then if you're looking for basically how many eggs you have in reserve, you do day three or day four.

• 23:10Nick Bare?

  That's a really interesting or very important thing to bring up because before we started working with you, when Steph would get blood work done. The doctors never asked where in cycle she was. They would just schedule blood to be drawn at the earliest convenience. And then we started working with you. You were making sure she was in the right timeframe within her cycle to get the most accurate readings. And it was a great thing to bring up that I remember now as staff's beginning blood work done, there's, she has less flexibility compared to me.

• 23:47Speaker 01

  Yeah.

• 23:47Nick Bare?

  When she get hers done. So this is all great information, but I think what a lot of people are, or might be asking themselves is, can I have all this data now? What do I do with it?

• 23:59Speaker 01

  Yeah.

• 24:00Nick Bare?

  How do, how do people figure out what to do with the data they get from all the results?

• 24:04Speaker 01

  Yeah, you, you have a couple of options. Generally, even if you're going to what I call a self-service lab company that orders your own labs, a lot of times they offer a consult with independently contracted healthcare providers. So of course, that's always an option is to talk to a doctor or a nurse practitioner about it. But what most people do is now they just ask ChatGPT or some other sort of AI robot, which are very knowledgeable about health, but they've learned from the internet. So they might over diagnose. And I do have patients with these conditions, but you know, a chatbot will likely over diagnose mold toxicity or heavy metal toxicity or Lyme disease. But it's important things to keep on your differential depending on your symptoms. But the input

• 24:49Speaker 01

  is very closely coordinated with the output. However, they are pretty good at interpreting labs as well. So my trained doctor is going to be called Noctur AI. If people have gone to Reddit and looked up what a Noctur is, it means not doctor.

• 25:05Nick Bare?

  Interesting.

• 25:06Speaker 01

  So it's not meant to replace the doctor, but it is more helpful than Googling your results. And a lot of times I will discuss, you know, whether like this thing that AI suggested, is that a good idea? Is that a bad idea? Is this just completely irrelevant? Sometimes it is. But I do think that in the next five to 10 years, the algorithm following that most general practitioners are doing, I think that that can be replaced by some sort of AI doctor.

• 25:41Nick Bare?

  That's crazy to think about.

• 25:44Nick Bare?

  I don't know if I have fully accepted the fact that AI is here and it can be trusted, but I guess it's just getting smarter and smarter.

• 25:53Speaker 01

  Yeah, it's here and it's smart.

• 25:55Nick Bare?

  Is it smarter than us?

• 25:56Speaker 01

  Yeah. In most scenarios, no, but it certainly has a larger database to pull from.

• 26:07Nick Bare?

  Scary.

• 26:08Speaker 01

  Yeah, I can't memorize, you know, I can't instantly have most of the internet at my fingertips unless I use an AI robot.

• 26:15Nick Bare?

  Right.

• 26:15Speaker 01

  To do so. Yeah, but I won't say anything too negative about it because, you know, at some point it might take over. Hopefully evil forces do not, you know, take over these AI robots. That's something that could happen.

• 26:29Nick Bare?

  I think that's my, that's my fear with AI is that it's, it's used for evil as opposed to good.

• 26:37Speaker 01

  I agree. I, I have added that as part of my prayers is that God does not let the forces of evil. I mean, it sounds ridiculous to say, but it's true. You don't want that to be, I don't know if possessed is the right word, but you not want an evil force in control of an extremely powerful AI robot.

• 27:01Nick Bare?

  Right.

• 27:02Speaker 01

  Whether it's a health one or a military one or whatever else.

• 27:06Nick Bare?

  So when I get my results back after I do my routine blood work, I typically just go down the line and I look for what's out of range, if anything is out of range. How accurate are those ranges? Like, how are those ranges being established? And, you know, comparing general population to athletes, I put myself in like the athlete category. How relevant or applicable are the general population standards for athletic individuals?

• 27:44Speaker 01

  The analogy I'd make is if you take your car into the mechanic and they hook it up to one of their computers and it shows if something is drastically wrong. You have a flat tire. You can tell if your tire is flat, but if you're racing a car at the drag strip, then having normal air in your tires might not be what you want. So it's not a perfect analogy, but it prevents your body from falling apart because at the end of the day, we're made to be organic machines, but it does not tell you much about what you can optimize. So if you're trying to improve your athletic performance, then going far beyond what the reference range

• 28:26Speaker 01

  is, whether it's for your ferritin, which is your iron stockpile, or even your vitamin D, or even your hemoglobin, it's important to keep all those things in mind.

• 28:36Nick Bare?

  So it's probably smart for people outside of the general population category, say athletes, elite athletes, anyone who wants to improve performance, optimize health, to find some sort of coach, doctor, or mentor to help analyze these results and then establish a plan to further optimize.

• 29:00Speaker 01

  Yeah, absolutely. And even for people that aren't at a place where they can afford a service like our clinic, often it's cheaper to get labs through our Sage Bio service. That's, again, part of the reason why we made it. And we also post all the reference ranges of what is optimal and not optimal, even for people that have the free version. So they can take that information with whatever labs they have. And then they don't even have to get labs through us. We have an AI robot that can just automatically scan any sort of PDF. You can write your labs by hand, as long as it knows that it was this assay, it can put it in, tell you if the assay

• 29:43Speaker 01

  is accurate, compare it to your other ones longitudinally. And then tell you what's a normal range and an optimal range depending on what your goals are. And of course, we're going to continue to fine tune this. But this is hopefully something that can provide information to the public that they can use a lot of it free of cost. I've always said for years, I post all of my ideal lab panels on my website, and people can go look it up and take it wherever they like and get those labs ordered if they have a better way to do that.

• 30:15Nick Bare?

  So I could go to the Sage website, order my labs, not having to be a patient of yours. Go get that blood work done. And then through Sage, I get the results back. And it provides all the reference ranges based off of your guys' standards. But I don't have to be a patient of yours to do that with Sage.

• 30:41Speaker 01

  Correct. Yeah, it's not a clinic. It's a service that people can use to get their labs drawn. Now, we don't have it tuned to where we can take a slider and put, you know, endurance runner, or, you know, jump roper or whatnot. And then the references change, but that'd be relatively easy to add in the future.

• 31:03Nick Bare?

  And then if you go to the Sage website, how do you know what panel to order? Are there categories?

• 31:10Speaker 01

  Yeah, there's categories. So again, if people are listening to this podcast, something like an athlete's panel, some people that are interested in hair loss prevention, like myself, probably interested in a more hair specific panel.

• 31:23Nick Bare?

  I think this is a great business that you started, because before I started working with you, I'd go on these, these websites, like I used, what would you say, was private MD labs?

• 31:36Speaker 01

  Yep.

• 31:36Nick Bare?

  I've used them before. There's another service that I was using.

• 31:42Nick Bare?

  Can't think of the name off the top of my head a few years ago. But they're they're outdated. They're dinosaur models. You don't really have these well established categories. It's individual test, individual

• 31:59Nick Bare?

  biomarkers you're looking to add. And by the time you add up all these biomarkers into this lab kit that you want to get, it's like a thousand dollars. Hey, what do I pull from? What do I actually need? So I think this is a great service that you're building out. Great new business.

• 32:13Speaker 01

  Thank you. Yeah, like I mentioned, there's very popular services that have panels for, say, $500 and ours is very similar to that, except even better labs and it's just over $300. And I think that eventually we want to promote our service as just being a better quality and having less labs that cause people stress and harm like cancer tests. I think you should talk to a doctor before getting a cancer test. You shouldn't just get that result back. Some people disagree, but that's my thought because you can have a two minute or five minute or 10 minute conversation about whether or not you really want that test. If you're in your twenties, do you really need that? Your chance of false positive is probably too high.

• 32:58Nick Bare?

  That's interesting.

• 33:01Nick Bare?

  All right, so the next thing I want to talk about is some of the most overhyped health and fitness narratives that are being pushed right now. When I brought this up to you yesterday, you seemed like you were pretty passionate about it. I'm pretty passionate about it because it feels like you go online, you go on social media every day. And if you just consume an hour's worth of the Instagram algorithm, you're gonna arrive to your dinner table that night and you're going to end up with a glass of water thinking, I can't eat or look at anything else. So I don't even know where we get started on this one. I like to throw one out there before

• 33:44Nick Bare?

  we dive into some of the things you want to bring up. You previously brought up mold. How big of an issue is mold in terms of our exposure on a daily basis?

• 33:57Speaker 01

  Yeah, for most of us, it's not a huge issue. I am sensitive to mold myself, but I'm also very sensitive to things like ragweed. In fact, I'm more sensitive to ragweed. And if there is a ragweed plant growing in my house and circulating through the HVAC system, then I would absolutely remove the ragweed. But I wouldn't take thousands of dollars of supplements in order to recover from that. I'd let it wash out of my system naturally, which usually mold can do. The problem is that people go to a functional medicine clinic. And I practice root cause functional medicine. That's what it's supposed to be, is you find the root cause and you address it. But the problem is people go in, and a lot of people listening will have this story, the NP or doctor

• 34:40Speaker 01

  will tell them, well, without even doing blood tests, just looking at you and hearing your story, I can tell it's one of three things. Mold toxicity, heavy metal toxicity, or tick-borne illness, probably Lyme disease. And it is, I've heard this story so many times, I don't think it's just a couple clinics that are propagating it.

• 35:00Nick Bare?

  Oh, I've talked to functional medicine doctors. That was the exact scenario I was in in the past. Like, those three things were brought up. It's funny.

• 35:14Speaker 01

  Yeah. And like I said, I do have patients that have all of those, well, not all three of them, I don't think. But I have patients that have had, that are extremely sensitive to mold, and things like orca toxin can be, you know, can have a lot of deleterious health sequelae. But they're very rare. And most of the testing that is used to evaluate these things is not accurate. So I've had patients that are very health focused and are very open minded, as I am, and they're concerned for heavy metal toxicity. So they go and order a heavy metal test from a popular website for a lab, and they've been eating a whole bunch of tuna. And of course,

• 35:58Speaker 01

  their mercury comes back high. And they're very stressed about it. So I reassure them, but... Between them getting the test and me being reassured, multiple other functional medicine clinics have offered them plasma exchange, which is called plasma pharesis, or chelation therapy, or a whole bunch of other things, which they say these have no downside. But those do have risks, actually. They're just not hugely significant risks. And one of the other downsides is they're very expensive to do. And it delays, presumably they're doing this for a symptom. If that person is not actually heavy metal toxic, it delays the diagnosis of what's actually happening.

• 36:40Nick Bare?

  So if you are exposed to mold, I'm interested in this now because the people who are on this narrative, push it like it's taking over your entire life. It is like you are possessed by the devil and you need an exorcism to get rid of it, essentially. So say, for example, I live in an old house that has carpet throughout, and that carpet has mold in it. So I'm exposed to mold. And I've been exposed to this mold for five years. Does that mold, or can that mold take over my body? Can it fill my body and cause all of these symptoms?

• 37:23Speaker 01

  Like the Last of Us game?

• 37:25Nick Bare?

  Yes.

• 37:25Speaker 01

  Yeah. It's not going to take over your body, but there is a lot of truth to leaky guts. Tight junctions in the gut can be more leaky. Leaky blood-brain barrier. So a lot of times, people have heard of meningitis. There's bacterial meningitis, which is life threatening. There's some milder viral slash aseptic meningitis. But you can also have irritation of the blood-brain barrier in general. And mold can increase the irritation of that. But even severe allergies can do the same. A lot of autoimmune conditions can do the same as well. And there is a healthy microbiome that interplays with fungus.

• 38:09Speaker 01

  And there's actually probiotics that are fungal probiotics that you can take of many types, different species of Saccharomyces genus. But it's not going to take over your mind and possess you, like in that video game.

• 38:26Nick Bare?

  So does our body do a much better job than we give it credit to?

• 38:33Nick Bare?

  Maintain homeostasis and clear out the bad on a regular basis?

• 38:38Speaker 01

  Yeah, in most cases. And just like I see with training, most guys in general need to do more cardio. Most women need to do more resistance training. A lot of times, people that are seeking out these functional medicine clinics because of a mold toxicity or whatever else, or to change their diet, a lot of them have really healthy diets that are almost all whole foods, and then they're just over restricting the orthorexia that people are familiar with. It's not anorexia, but it's orthorexia because they're scared of unhealthy things. And then conversely, people who just 100% trust conventional medicine, they see this dichotomy that's a false dichotomy,

• 39:16Speaker 01

  and they say, "Yeah, this is just completely unscientific, so we should never consider mold as something that is playing a part." But perhaps they've had a bunch of antibiotic courses, and they're particularly susceptible to a significant fungal bloom. And we do see an increased incidence of candidiasis, which is a type of basically fungal or yeast infection. That's not just in mucosa, that's also through the GI tract as well, or like the esophagus. So people can be prone to things like this.

• 39:49Nick Bare?

  I want to explore this route really quick, but then come back to the overhyped health and fitness narratives.

• 39:56Nick Bare?

  Orthorexia, I'd like to hang out there for a little bit because I believe that's an even bigger issue than, say, an eating disorder like anorexia is right now. Can you briefly explain what orthorexia is in more detail? And then the negative consequences of that level of restriction and fear?

• 40:23Speaker 01

  Yeah, so orthorexia is being terrified of not just eating or eating too many calories, but eating something that might not be healthy. So a classic presentation would be, "Well, I don't want to eat anything with lectins or oxalates. So I avoid all fruits and vegetables that have lectins or oxalates, and I don't want to eat any phytoestrogens. So I avoid anything that might have a phytoestrogen, which is basically a plant-based estrogen. Think of soy and genestatin as the classic example. And unless you drink three quarts of soy milk per day, I'm not hugely concerned with phytoestrogens.

• 41:03Speaker 01

  And then they want to avoid meat because they're scared of heart disease. And then they want to avoid dairy because casein can bind the mu opioid receptor like gluten can. So they don't have any dairy or gluten and then there's nothing left to eat.

• 41:21Nick Bare?

  And seed oils is probably one of the most recent where, you know, obviously I try to

• 41:30Nick Bare?

  minimize my seed oil intake as much as possible. But if I were to try to completely eliminate it, it ends up having a negative effect on life. Going to dinner, going to family gatherings, barbecues, all of these things. And I've seen people have this fear from an ingredient, a source, a type of food. And it's meant to be from a, a source or root of healthy behavior, but turns into this completely unhealthy behavior because of the fear and restriction of that one ingredient. But I believe, I believe the, the mental and emotional toll of

• 42:15Nick Bare?

  have that mindset around that ingredient does far more harm than good from removing it.

• 42:23Speaker 01

  Definitely. Yeah. The, the concept of orthorexia, I believe is something that everyone struggles with.

• 42:33Speaker 01

  And you have to find the balance between coming up with habits to develop a diet that you can adhere to. Cause the best diet's a mostly whole food diet that you can adhere to. That's what people should do. I want to give actionable items. But just like everyone has some degree of body dysmorphia, body, body image issues, everyone also has some degree of orthorexia.

• 43:01Nick Bare?

  I don't want to put you on the spot right now, but if you had to identify a a trigger food for you that you could say is your small part of orthorexia, what would you say it is?

• 43:16Speaker 01

  Cheese. I particularly love cheese and any sort of pizza.

• 43:21Nick Bare?

  But do you feel guilty eating it then?

• 43:24Speaker 01

  At times, yeah.

• 43:27Nick Bare?

  Yeah, for me, I'd say it's

• 43:32Nick Bare?

  items that are fried. If I go to dinner and it comes down and I know it's been fried and there's all these oils and sauces added on to it. I'm, I'm not thinking how good is this going to taste? I'm thinking, how am I going to feel after eating this? How is this going to affect my training in the next day?

• 43:53Speaker 01

  Yeah.

• 43:54Nick Bare?

  So I'd say that is my like, one of my triggers for orthorexia.

• 43:59Speaker 01

  Yeah. With cheese, I don't want like too much cheese or even fair life milk. Um, I don't want it to affect my skin because I'm really prone to breakouts or oily skin.

• 44:10Nick Bare?

  So if you have dairy, all things dairy?

• 44:13Speaker 01

  Um, most things dairy. To some degree meat as well. I think anything that, I think I'm just very prone to things that drive up IGF-1 in my case.

• 44:22Nick Bare?

  Is it more so soft cheeses than hard cheeses? Do you find a difference between the two?

• 44:27Speaker 01

  Not particularly. I do okay with soft cheeses, even though they have more carbohydrate in them.

• 44:34Nick Bare?

  I could eat hard cheeses. Like if you give me a block of Parmesan, dude, I could eat a block of Parmesan daily.

• 44:41Speaker 01

  I do love hard cheeses.

• 44:42Nick Bare?

  Oh my gosh. We were, uh, we were just like shaving some cheese, some Parmesan cheese for top of pasta and salad last week and just cut off a little block of it. I'm like, I don't. I don't think I appreciated how good Parmesan cheese was.

• 44:58Speaker 01

  Yeah.

• 44:58Nick Bare?

  Growing up. Cause when we bought Parmesan cheese when we were younger, in our family, we'd have like spaghetti night. My mom would buy the jar of already shaved grated Parmesan cheese. You pop the top, it has like little circles on top. You just throw all of that on top of your spaghetti. We would never buy a block of Parmesan cheese and grated ourself.

• 45:19Speaker 01

  Yeah. Last night, the go to bed snack for my two oldest kids, I gave them each chunks of the block of Parmesan cheese and just cut off. Yeah. Unfortunately, it's a little bit more expensive than other cheeses, but they particularly like it. And I do have orthorexia for my kids, but usually not for cheese or dairy. Cause I know it helps with growth and I know that there's, you know, there's a little downside because they're very lean. So I'm not worried about the calories, but if I give them, you know, too much processed food or too much sugar, then I do start to have a little bit of

• 46:02Speaker 01

  orthorexia for them.

• 46:04Nick Bare?

  I get that way too.

• 46:07Nick Bare?

  I think it's tough, you know, raising children because

• 46:11Nick Bare?

  for me, previously having an eating disorder, I don't want them to be afraid of unhealthy foods. And then I make these, these foods, bad foods. So as they grow up, there's bad foods and there's good foods. I want them to have this balance and be able to make healthy food choices on their own.

• 46:34Speaker 01

  Definitely.

• 46:35Nick Bare?

  But when I give that, like when I give Charlie, Nico's not eating Whole Foods yet. When I give Charlie, say like a sweet treat or something processed, I do have this, this sense of guilt.

• 46:49Nick Bare?

  Even as much as I see her, enjoy it. So I can, I can relate to that.

• 46:55Speaker 01

  Yeah, it's interesting to see the kids' different preferences change. And they'll have a preference and you're really scared about it. For example, they won't want to eat meat one day. And I start to have this inner anxiousness that, oh no, they're not going to like meat. But it just turns out to be another one of the fleeting, you know, kids will like something one day and not like it the next day. Eggs. I love having eggs every, every morning and sometimes they just don't like their eggs one morning. And almost every single time I get concerned about it.

• 47:30Nick Bare?

  And Charlie's in a phase right now where she doesn't make breakfast at all. So what I've been doing is she drinks milk every morning. I've been putting a half scoop of whey protein in her milk. So she gets like 15 grams of protein.

• 47:44Speaker 01

  Yeah.

• 47:45Nick Bare?

  To start the morning off every, every day.

• 47:47Speaker 01

  You could do albumin and protein if you wanted. Egg white protein.

• 47:50Nick Bare?

  Oh, that's, that's a good point.

• 47:51Speaker 01

  Yeah. Not that whey is bad. It's just a little bit faster digested than albumin or egg white protein.

• 47:57Nick Bare?

  Yeah, it's a good point.

• 47:58Speaker 01

  Yeah.

• 48:00Nick Bare?

  So from your perspective, what are some of the most overhyped health and fitness narratives being pushed right now?

• 48:07Speaker 01

  Yeah, avoiding dairy, I suppose, would be one of them. And, you know, some people are legitimately allergic to dairy. My dad's actually like anaphylactically allergic to eggs.

• 48:20Speaker 01

  So, you know, there, there's exceptions, but in general, if you have sensitivity to gluten or sensitivity to dairy, or just in general histamine intolerance, people call it mast cell. 99% of the time plus, there's another root cause pathology that's leading up to this secondary diagnosis. So instead of doing, you know, your full mast cell histamine protocol and, you know, taking M. lecinox and this and that, not that I'm against those, I do use them situationally into various stages.

• 48:57Speaker 01

  But instead of doing that, then finding out what's happening with your gut, or even, you know, what's, what's happening in another system of your body in order for you not to be able to tolerate that. And there's a lot of actionable tips and strategies that you can give people too. A lot of times I use colostrum or transfer factor that comes from colostrum. Some people say they can't tolerate any casein protein or any dairy protein at all. Casein is one of the two proteins in milk. There's whey and casein. And colostrum is almost half casein protein and they do completely fine taking four grams of that per day. So you can up titrate that in order for them to tolerate it. Kaffir is another good one.

• 49:38Speaker 01

  There's different probiotics, I think, bifidobacterium or lacto, bifidobacterium lactis and lactococcus lactis. There's a various good bacteria that can help your gut learn how to digest both the carbohydrates and the proteins in dairy. So instead of just telling people to avoid gluten and avoid dairy, like unfortunately, a lot of registered dietitians do. Myself and my team of sports dietitians like to give them the tools in order for them to actually tolerate those things again.

• 50:13Nick Bare?

  Why do you think so many people fear? We could probably say gluten and dairy, but focus on dairy now. Why do people fear dairy? Is it because they're being told to fear and eliminate dairy? Or is it something they think they're experiencing that they just intuitively attach to, well, I'm consuming dairy. That's why I feel this way.

• 50:39Speaker 01

  Partly, and a lot of people do feel significantly better when they cut it out. So it does bind that mu, which is the Greek letter for you. It does bind that type of opioid receptor in the gut. And another thing that binds it and activates it is Imodium or loperamide. So just like a tube of toothpaste, your gut's not going to work particularly well if you're squeezing in random places and not very strongly. So that can be the case when people have gluten and dairy and people notice their bowels change afterwards. So there's, it seems like there's very direct a cause and effect, but the dose makes the poison. So perhaps not eating, you know, three different sandwiches per day, high in gluten,

• 51:23Speaker 01

  and then a whole bunch of glasses of milk. Work your way up to that slowly. And there is things like low dose naltrexone or LDN, which is actually a prescribed medication. A very low dose of that can block some of those receptors and attenuate a lot of that effect. That way, you're having that more organized squeezing of your tube of toothpaste and your digestion's a bit better.

• 51:47Nick Bare?

  What are your opinions on raw milk as opposed to your typical store-bought pasteurized milk? Are there actual benefits to raw milk? Do people, I've heard people say, I mean, we buy raw milk at the farmer's market because it's delicious. I mean, you get the cream on top. It tastes like a milkshake. It's phenomenal. Some people will say they can drink raw milk, but they can't drink regular store-bought pasteurized milk. Is there validity to that?

• 52:15Speaker 01

  There is. So it's kind of a different version of Kaffir, which is the probiotic yogurt drink, basically. Or, you know, it has similar digestion benefits. So it's absolutely true. Some people do better with the non-homogenized, low-tempe pasteurized milk that you can get. I think Kelona is one of the brands. But I'm not totally against raw milk. There, of course, is an infection risk, since it's not even low-tempe pasteurized. But I think it's reasonable to drink that for people that choose to. I don't think that it's particularly more dangerous than a lot of the other things in our diet, if that makes sense.

• 52:54Nick Bare?

  Have you ever heard of the book called Supergut?

• 52:58Speaker 01

  I think I have. I can't remember if you mentioned that.

• 53:00Nick Bare?

  I might have brought it up to you.

• 53:02Speaker 01

  Yeah, I think you did.

• 53:03Nick Bare?

  I might have told this story before, so forgive me if I have. I read this book a few years ago, and I was really into probiotics at the time and Kaffir. I was drinking goat's milk Kaffir every day, which I actually love.

• 53:20Speaker 01

  Interesting.

• 53:20Nick Bare?

  Goat's milk, and I love goat cheese. Steph, when I first started dating Steph, she hated goat's cheese. Now she loves it. But in this book, it provided this recipe to make your own like super colonized yogurt kefir. So I bought these probiotic strains online and I had to put it in milk and then we put it in the one of those Instapot pressure cookers. It's like, like a hundred degrees. Don't quote me on this, like a hundred degrees for like 72 to 100 hours, something

• 54:02Nick Bare?

  of that. And it multiplied these bacteria strains to ridiculous levels. So I experimented with this and it was disgusting, disgusting, like what came out from it.

• 54:18Speaker 01

  This was from goat's milk?

• 54:19Nick Bare?

  This was from regular milk, but it was at a time where I was drinking goat's milk kefir. I also during this time got hit with this ad for camel's milk. I bought like a hundred bottles of camel's milk online. But to wrap up the story, I consumed this yogurt that I made and colonized. I didn't go to the bathroom for like 10 days. So I gave up on that. It backed me up to the most uncomfortable extremes of my life. So part of the reason I share that story is the power of dairy and probiotics and the impact on the gut for better or for worse.

• 55:03Speaker 01

  Definitely.

• 55:05Nick Bare?

  What other overhyped health and fitness narratives are, are you passionate about right now, if any?

• 55:11Speaker 01

  Yeah, fructose is a particularly interesting conversation because there is decent scientific data that's preclinical, animal data, to where fructose makes you very obese and makes you gain a whole bunch of body fat.

• 55:27Speaker 01

  However, you know, most people listening to this podcast are probably familiar with the fact that fructose is a great intra-workout carbohydrate source and has a lot of benefits for the active individual. And some of my favorite foods like blueberries are high in fructose. So if blueberries are not right, then I'm just choosing to be wrong, I guess. But in all seriousness, if you're going to do a very dirty bulk, I do think that fructose has the potential to put more visceral adipose on you. So fat in and around your liver. So my main advice is unless you're one of the world's strongest men and you

• 56:11Speaker 01

  need to do dirty bulking and get to, you know, huge amounts of calories for basically your career, then just don't dirty bulk and then fructose is completely fine.

• 56:22Nick Bare?

  So are people afraid of fructose right now because of the potential of adding on unwanted visceral fat? And is it actually a concern?

• 56:32Speaker 01

  Yeah. If you're going to do a bulk phase where you gain a lot of fat, if you gain, if you consume a very high percentage of fructose as your calorie source.

• 56:45Nick Bare?

  What would you say a high percentage is? Over 50?

• 56:50Speaker 01

  I wouldn't say 50. I'd say if you have, I'd say 20% of your diet is fructose or 20% of your carbohydrates are fructose, then you'll probably gain a little bit more visceral adipose. If you start having, if you start your caloric surplus, because I have gone in caloric surpluses in the past, I think I mentioned I did it to keep up with my wife for our CrossFit competitions. But, um, you know, I, I've gained 15 or 20 pounds and I do try to avoid high fructose and just generally fructose corn syrup during that time. But I, I always have less than one pound of visceral adipose when I get my DEXIS.

• 57:32Speaker 01

  I usually have less than half a pound, if not 0.1. So if there's somebody that is an average American, then first their job is to go into a caloric deficit and a great way to get healthy sources of fiber and polyphenols and anthocyanins and other good things is to consume berries, which often have fructose. Even even apples have fructose and apples are one of my favorite diet foods. So on a diet, I think fructose is fantastic.

• 58:03Nick Bare?

  Berries are one of those things that I have. It's one of my non-negotiables every day. It's one of the easiest ways for me to get polyphenols, fiber. I have like a whole carton of raspberries every morning. I have some blueberries, typically with my pre-workout overnight oats.

• 58:22Nick Bare?

  There's a lot of fruits that I I used to consume that I don't consume as much anymore. I experimented with a little bit of a low FODMAP diet a few months ago. So I minimized my banana intake, which I used to always have at least one banana a day. So I don't eat as many bananas anymore or as many apples, but I consume more berries now. I actually have found that my stomach handles berries better than apples and bananas.

• 58:53Speaker 01

  Interesting. Yeah, a lot of times bananas lead to significant constipation, especially in children that overconsume bananas.

• 59:00Nick Bare?

  Why is that?

• 59:03Speaker 01

  I'm not sure. It's pretty low fiber and I could see it gumming up the bolus in your gut. But I don't know why bananas are particularly bad for constipation. Banana is kind of a fake fruit. So I think bananas are wildly overrated. They're pretty sugary. There's not as much fiber as you think. Even the potassium content of bananas is kind of, it has a lot of potassium, but not that much more than a potato. That makes sense? Like if you're gonna eat a full serving of potatoes, it's actually a pretty good source of potassium. And also, it's not a propagating plant. It can't reproduce. It's just grafts taken of each other like a clone.

• 59:42Nick Bare?

  They are delicious, though.

• 59:44Speaker 01

  They are good, but I think in my mind, I just think they're so overrated that it's almost never, I would, I would usually rather have a Butterfingers or a Reese's than a banana. I kind of put them in the same category.

• 59:57Nick Bare?

  What about like a, what are your thoughts on green bananas or cold potatoes because of the high resistant starch? Is that an actual benefit?

• 1:00:06Speaker 01

  Yeah, it is. The resistant starch is basically a starch that can only be digested in the large intestine. So if you're not digesting it in the small intestine, you're not going to get small intestine bacterial overgrowth. So it has a lot of benefits acting as kind of a tonic for the bolus of food, if you will. So in some patients, I do recommend resistant starch. And plantains don't bother me as much as bananas. But I also have a bit of a bias because I tend to like savory things instead of sweet things anyway. So I also think that melons and pineapple are also very overrated foods, which should be more in the candy area.

• 1:00:45Nick Bare?

  Do you like papaya?

• 1:00:48Speaker 01

  I like papaya, but it's also somewhat overrated. And unfortunately, even mango, which I do particularly like mango. I would eat mango instead of most candy bars.

• 1:00:57Nick Bare?

  Mango, I can't say mango is overrated. Now that we have kids, the amount of dried mango that we have in the house. My daughter loves dried mango. But I mean, the, the, the problem with dried mango is that you can eat like eight mangoes and not feel like you've eaten anything.

• 1:01:18Speaker 01

  Yeah, which can be good if you're trying to put on a ton of weight. So for a really lean kid, it might not be bad.

• 1:01:24Nick Bare?

  Yeah, for me, my wife, it's not the preferred right now.

• 1:01:27Speaker 01

  Yeah, that's true. Same thing for macadamia nuts. Macadamia nut butter and then macadamia oil. I love the fat content of it and I actually have a full bulk, bulking protocol. I'll post it on my website if people are interested. But my middle child was, is very tall and skinny, kind of like I was as a kid. Maybe still now, depending on your definition of tall and skinny. But he was first percentile for BMI.

• 1:01:54Nick Bare?

  Oh, wow.

• 1:01:54Speaker 01

  And I think he was maybe 30 or 40th percentile for weight. And I thought, all right, I remember being just like extremely skinny. So let's bulk this guy up and got him on a good diet. Got him increased in his dairy content. So I'd mix even some like triple cream Icelandic yogurt or triple cream Greek yogurt. He particularly likes that. I got him fortified egg yolk protein called yolked, which I think was very helpful as well. And then, and I always make the joke, that's why Mike O'Hearn's kids are so jacked is because they eat all of his duck egg yolks. And then.

• 1:02:36Speaker 01

  Things like macadamia nut butter, macadamia oil. And he's, I believe, over 50th percentile BMI and still 99th percentile, something height. So worked quite well.

• 1:02:46Nick Bare?

  So you just mix all of this up in a bowl and kind of just feed it to him?

• 1:02:49Speaker 01

  Yeah, kind of randomly. I didn't have a specific. I didn't mix all of it every single time, but he does particularly like it, fortunately.

• 1:02:58Nick Bare?

  I want to take a quick break in this episode to talk to you guys about how I use our products around my endurance training and how you can as well. Now here at BPN, we've created products to fuel your performance and optimize your recovery. But I want to talk specifically around how I use these products in my morning run. Before my morning run, every morning, I'm not training fasted. I want carbohydrates and I want electrolytes. So I consume two scoops of G1M Sport, which is our carbohydrate and electrolyte powder. And one go bar, which is our lightweight oat-based bar.

• 1:03:40Nick Bare?

  With this combination, I'm getting about 800 milligrams of sodium and 76 grams of carbohydrates total. Carbohydrates for the fuel, electrolytes for the hydration. This is going to set me up to have the best run possible. Fuel and hydration. Now, based off of the distance, duration and intensity of that run, I will add in go gels during the workout. And the go gel is our simple ingredient.

• 1:04:13Nick Bare?

  Endurance gel, 24 grams of carbohydrates in each gel and 110 milligrams of sodium. We have a non-caffeinated version and a caffeinated version. The caffeinated version has 75 milligrams of caffeine per gel. And I will have one go gel every 30 to 45 minutes or every four to five miles. And we really created the go gel. For these bigger effort runs or endurance training sessions and races, they are extremely useful during races because you get a quick hit of energy from the fuel, the carbohydrates, some hydration from the electrolytes, the sodium,

• 1:04:56Nick Bare?

  but they also digest very easily. So you're not going to have stomach discomfort and GI distress. And then after my run, I want to rehydrate. So I'm always adding in our electrolyte powder, one to two scoops. Each scoop has 500 milligrams of sodium, full electrolyte profile. So I'm using our products to fuel training, enhance hydration,

• 1:05:23Nick Bare?

  maintain effort intensity during training sessions with the Go Gel, and then rehydrating immediately after. So that's how I use our products around my early morning runs and all my endurance training and how you can as well. So go to bpnsubs.com, check out all of our endurance products to fuel your performance. And now, back to the episode. Hey, going back to resistance starches.

• 1:05:52Nick Bare?

  I love cold potatoes. I do find that they digest very easily for me. You have to cook the potato first and let it cool. That's one of my travel hacks though, is if I'm having a long travel day, I always travel with food. So I'll cook some potatoes the night before, put them in the fridge, let them cool down, throw them in a Ziploc bag and carry them with me. So I'll be standing in the line to go through TSA, eating a potato. Yeah. And we were traveling with my wife's family a few years ago, and I was standing in TSA line eating a potato. They thought I was eating an apple. They're, what is that? Oh, it's a roasted potato. It's cold.

• 1:06:34Nick Bare?

  I'll take potatoes when you're traveling, cold steak, cold meat. Like I always have food with me, but I think cold potatoes are a hack, not just for the convenience, but the resistance starches from heating and then cooling those foods.

• 1:06:49Speaker 01

  Yeah, definitely. That's kind of a stereotypical ultra marathoner thing, too. I get the baked potato, maybe even put it in a tube of toothpaste or something, you know? The tubes or peanut butter and you squeeze it out and eat it.

• 1:07:02Nick Bare?

  Yeah, I remember my first marathon ever. Yeah, I was like mile marker sixteen, seventeen. I was sucking at that point. People were handing food on the course, you know, there's bacon, there's pure penny alcohol, pickle juice, all these things. And I just grabbed something from someone. I just needed, I knew I needed some sort of fuel in my body. And it was a potato. They were cold potatoes covered in salt. And it was the saltiest thing I've ever had. It was, it almost burned my mouth. It was so much salt.

• 1:07:34Speaker 01

  Wow.

• 1:07:36Nick Bare?

  But you just sharing that takes me back to that, that one moment. I remember just being scarred by the, the salty potato at mile marker sixteen at the Austin Marathon in two thousand and eighteen.

• 1:07:46Speaker 01

  Yeah. What do you think about,

• 1:07:51Speaker 01

  the, you know, the various companies, including yours, that make electrolyte-rich things or just packets of electrolytes or jars of electrolytes? Why do some people like them so much more salty? And then some people like to taste almost no salt at all? Cause there's, there's a couple of different groups of people.

• 1:08:10Nick Bare?

  Mm hmm. For me personally, and the way that we formulate our products, I want you to taste some of the salt. One, it's like this, this mental acknowledgement that the things that I'm consuming are salty and they're replenishing what I'm losing. So I want that, that feedback loop of I'm looking for something with electrolytes to replenish and rehydrate. I want to know that I'm drinking something salty. I think some people just don't like that experience. They want, they want to drink something that.

• 1:08:46Nick Bare?

  I think a good example, people ask us sometimes to create products that are unflavored. And the reality is if I create a whey protein powder, but we don't add any flavor or any sweetener to it, there's still going to be a flavor. People assume that when we don't add flavor or sweetness, it's just going to taste like water.

• 1:09:07Speaker 01

  Yeah.

• 1:09:08Nick Bare?

  But that's not the case. So for me, it's the same way with like an electrolyte powder is, one, I want people to know that when they're drinking it, there are, there is significant sodium content in that product to replenish and improve the performance. And you don't accidentally mistake it for, am I drinking Crystal Light? Or am I drinking an actual performance beverage? But I think some people just don't want that or care about that positive feedback loop.

• 1:09:43Speaker 01

  Yeah, that's a good way to approach it, I think. I've also been interested how common slightly low iodine levels are. And I think partly because it's skewed to people of generally higher, not even socioeconomic status, but higher health care. They care about their health more, they're conscious. And then they just avoid any sort of iodized salt because that's not the perfect form of nascent iodine. But then they also don't consume sources of iodine from the sea. So I'm interested to see how many more companies start incorporating iodine as a ingredient? And if nothing else, a multivitamin.

• 1:10:27Nick Bare?

  What are the symptoms of deficiency of iodine?

• 1:10:31Speaker 01

  Generally thyroid dysregulation. Iodine is used to make thyroid hormone. Thyroid hormone has either like two or three iodines that are made. And as your body activates thyroid hormone, it cleaves off one of those iodines with a deiodinase enzyme.

• 1:10:48Speaker 01

  So they can actually be somewhat similar to mercury toxicity. Because mercury interferes with enzymes that are cofactor with selenium. And one of the main ones is enzyme that your thyroid uses to make more thyroid hormone. So if you have slightly low iodine, slightly low selenium, which is what people classically think of Brazil nuts for, and then slightly higher mercury status, you likely are going to develop some degree of thyroid issue.

• 1:11:23Nick Bare?

  Just going back a little bit on that note, talking about orthorexia. And this is probably a really broad question because there's so many different categories and types of orthorexia of what people are trying to minimize, eliminate, or remove. Are there common deficiencies you see, general population, that people are experiencing due to the restriction of certain foods or ingredients?

• 1:11:58Speaker 01

  Yeah. Vitamin D is a big one, not just because of dairy restriction, but because of restriction of being outside, we're meant to be outdoors more often. Iron deficiency is another one, partly just because people supplement with calcium so often. If you're consuming a lot of calcium, you're not going to absorb iron as well. It significantly decreases iron absorption. And then if you're not consuming fruits and vegetables with more vitamin C, you're not going to absorb iron as well. Because most people eat plenty of iron-containing foods that, at least that eat animal-based products. Iron's generally pretty bioavailable, but you need vitamin C to have optimal absorption.

• 1:12:42Speaker 01

  So that's another one. And of course, that's more common in females because they have menses. But you do see it. It's more common in runners as well. And then vitamin B12 is not as common, but it's absorbed in a very specific spot in your small intestine called the terminal ileum. And basically, if that area is inflamed for whatever reason, for example, inflammatory bowel disease, you're not going to absorb it as well. Or if your stomach acid is not acidic enough, you're also not going to absorb vitamin B12 as well. So if you've been on something like Nexium for years and years, then you're at higher risk of vitamin B12 insufficiency. Or if you're just at very advanced age. That's especially if someone is 60 plus, extremely important to check a vitamin B12 and a homocysteine,

• 1:13:28Speaker 01

  which gives you an idea of how much you can activate your vitamin B12.

• 1:13:32Nick Bare?

  This kind of naturally takes me into a question I wanted to discuss. Talking about nutrient deficiencies. What nutrient deficiencies do you commonly see in endurance athletes? But I would even say in particular runners. And we've talked about this before on one of our, our calls, your private calls.

• 1:14:01Nick Bare?

  And you explained it in terms of the way that the red blood cells are affected with the striking of the foot on the ground. So I just wanted to bring that up to make sure we touch on that. But broad question, nutrient deficiencies in endurance athletes, specifically runners.

• 1:14:19Speaker 01

  Yeah. So there's a couple of reasons why runners are more prone to anemia and also more prone to iron deficiency. And you don't necessarily have to be anemic to have iron deficiency. That's something that a lot of people don't understand because they'll go to their regular doctor. They get something called a hemoglobin checked or a CBC and it will be normal. Or maybe their hemoglobin is just barely over normal. But their ferritin, which is their iron stockpile is low. Runners are at risk of this for a couple of reasons. One is, this is probably the main reason, their red blood cell turnover is faster. As their foot strikes the ground, it will deform or even explode red blood cells.

• 1:15:04Speaker 01

  You don't necessarily have to run to do this. You can jump, you can jump rope. A lot of CrossFitters doing a lot of box jumps, this can happen too. Or even soldiers marching. In fact, I think it used to be called marchers or anemia. They used to send people off to basic training or something like that. You'd probably know better than me. But basically, they marched to where the boots would hit the hard ground so much that would cause the same phenomenon.

• 1:15:31Nick Bare?

  So what's happening with that foot strike? What's exactly happening to the red blood cells?

• 1:15:39Speaker 01

  Yeah, so it deforms and actually gets larger. For example, there's something called the MCV, which means mean corpuscular volume. That's your average red blood cell size. And generally, it's around 90. If you have an athlete or a runner, doesn't matter, anybody, take it easy and not do any hard runs, then let's say it's 90, 90, 90. And then you tell them, go run a marathon. They can go run a marathon and then, you know, and it's just the red blood cells in your feet. But after they run the marathon, you draw their blood and it goes from 90 to 94. So there's a significant increase just from one single run.

• 1:16:22Speaker 01

  And it's somewhat temporary because it, you know, it deforms the red blood cell and it eventually somewhat goes back to normal. But that's called macrocytosis when those red blood cells get larger and larger. And in general, a runner's anemia is a macrocytic anemia. Or the red blood cells tend to be larger. And they don't always have to explode, but you're going to have a faster turnover. So there's been several studies where they basically tag a red blood cell with a specific tag or label. And then they watch to see how long they last in the body. And generally, it's three to four months for the average person.

• 1:17:04Speaker 01

  Or for a runner, especially one that's having higher volume, that might be two months or even less.

• 1:17:12Nick Bare?

  So what are the symptoms of?

• 1:17:16Nick Bare?

  Iron deficiency. If I'm a runner, as I am,

• 1:17:23Nick Bare?

  what might I be experiencing if I actually have iron deficiency?

• 1:17:28Speaker 01

  Yeah, that's where it's kind of difficult because it's pretty similar to sleep deprivation, fatigue, tiredness, low energy.

• 1:17:37Nick Bare?

  I felt that.

• 1:17:38Speaker 01

  I felt that as well. Yeah, that's why I had to check my ferritons.

• 1:17:43Speaker 01

  Yeah, I remember Thomas Delauer did a post one time and he looked maybe a touch more pale and a touch more fatigued than usual. Maybe I do as well. Maybe I don't. I don't know. It's hard to tell. But I remember someone said, what, what happened? Like, did you, did you smoke something? Did you, did you like go out and party or whatnot? And he's like, nope, kids happens because, you know, he's a, for the people who don't know, he's a, a good father and a good family person and he's obviously involved in his kid's life. So, you know, if you're, if you're a busy person, regardless of what the cause is, or if you just have a night of low sleep because a kid keeps you up, which can happen,

• 1:18:24Speaker 01

  then at the end of the day, you like, even if you don't have pale eyes, you can have pale sclera. That's another sign of iron deficiency and then your whole skin can look pale. But you can be iron deficient without having those symptoms. You can just feel a bit off.

• 1:18:39Nick Bare?

  So how do you counteract the deficiency? Is it just taking an iron supplement? Is it eating iron-rich foods? Will your body actually convert that iron into something that is usable and stored?

• 1:18:54Speaker 01

  Yeah, it will. Testosterone helps you do that, too, in males and in females. And estrogen can also help with that. Estrogen inhibits something called hepcidin and hepcidin inhibits something that, well, hepcidin inhibits you from absorbing iron. So basically more estrogen helps you absorb iron, which makes sense during pregnancy. Estrogen is very high and you want to absorb a ton of estrogen because you have essentially a tumor growing, fetus growing. But you also want to avoid calcium within a couple hours of consuming iron and take vitamin C with it if you want to and make sure there's not something else that's inhibiting the production of red blood cells.

• 1:19:35Nick Bare?

  I know a lot of female runners who are always anemic and to the point where they have to get iron infusions.

• 1:19:45Nick Bare?

  So my, one of my questions around that is, is it because they are a runner and they have menstrual cycles and those two in combination are just creating the iron deficiency? Or, maybe it's an and/or, is it those two on top of orthorexia and reducing food intake to stay lean, to stay fast? You know, what have you seen in your experience? Cause I feel like every female runner I know is anemic and they're getting iron infusions.

• 1:20:23Speaker 01

  Yeah, I've heard more than 50% of female runners are anemic. And my wife is not a runner. She likes rowing and throwing weights. She does, she used to do throwing javelin and throwing discus. And she was extremely anemic all throughout college at University of Nebraska. They sent her to a sports psychologist because she threw like one of the farthest in the nation as a high schooler and whatnot. And then after college, of course, she figures out, oh, I'm just anemic or sorry, iron deficient. But she had just high enough of a hemoglobin to where she wasn't extremely anemic. But she was profoundly iron deficient and she's gotten iron infusions one of her pregnancies. But, so you don't necessarily have to be a runner, but of course throwing javelin and discus and doing CrossFit, you foot strike a lot.

• 1:21:08Speaker 01

  So you kind of get that same scenario. One of the things that helps some females, if they're a lighter body weight, then their metabolism is slower and they just don't consume as many calories. So even if they consume a decent relative proportion of iron-rich foods, just because they're consuming less, you know, if they have the same diet as you or I, and you or I consume 4,000 calories and they consume 2,000, then they're not consuming as much iron. So that's something else that plays a part. And then the other reason is runners are generally pretty lean and low body fat. And that tends to lead to lower area under the curve estrogen levels. So you have less iron absorption because of that too.

• 1:21:51Nick Bare?

  So what did your wife do to combat that anemia? Did she start taking iron supplements, eating a diet rich in, you know, iron-dense foods?

• 1:22:03Speaker 01

  Yeah, during pregnancy, when it got low enough, she got the infusion. But in general, she just eats lots of iron-rich foods. She cooks with lots of raw cast iron, especially when we're cooking like acidic meals, like if we're doing a pasta sauce or whatnot, because that helps purposely leach iron into your food if you cook with the raw cast iron. And then she just eats a lot of good heme iron sources and other iron sources as well. And surprisingly, she's not completely against supplementation, but she's not nearly as for supplementation as I am. And part of the reason I like it is just convenience, but she tries to get it from her diet and then occasionally she'll supplement with iron. If I put the pill into her hand and tell her to take it.

• 1:22:47Nick Bare?

  Yeah. But what would you say to a female endurance athlete who has to get regular iron infusions, say every couple of weeks, every couple of months? And they just accept the fact that this is what I have to do? Is that acceptable? Or is there another course of action they should be taking or exploring?

• 1:23:10Speaker 01

  It's not, it's not completely unacceptable, but it's very likely that they could decrease the amount of infusions that they need, whether it's timing of supplement when they take their calcium or even when they take dairy. You can supplement with iron multiple times a day. And for people in that situation, I try to use multiple types. So there's two main types of iron supplements. Your iron salts and your iron polypeptides. And in general, iron salts are actually better absorbed and better tolerated. We found that out later because the iron polypeptides were kind of the second ones to come around. However, the iron polypeptides do not make the little hairs in the gut called cilia. They don't affect them as much.

• 1:23:53Speaker 01

  So there might be a benefit of doing some of both, but I usually pick two different types of iron salts, like an iron bisglycinate and, sorry, ferrous bisglycinate. And then another one, whether it's ferrous fumarate or there are several types. And then at different times of the day, you take those and just make sure you're not taking anything else at the same time that's going to inhibit the absorption of those.

• 1:24:16Nick Bare?

  So outside of iron deficiencies, on the topic of endurance athletes, specifically runners, are there other nutrients, vitamins, minerals that?

• 1:24:26Nick Bare?

  These individuals are typically deficient in that you see?

• 1:24:31Speaker 01

  Yeah, one surprising one is vitamin D. You'd think if they're outside quite often that they would not be as deficient, but it is very common to see someone that's at least insufficient of vitamin D. So I do like to check vitamin D. And then if they supplement, most often I like a soft gel of vitamin D three K two. And there's of course ways to get that from sun and in your diet if you're able to. And then another, I guess, sort of nutrient that many runners are insufficient in. Most people do not get enough magnesium and potassium in the diet. So those

• 1:25:10Speaker 01

  are relatively easy things to check. But you know, you can increase your dietary sources of magnesium and potassium. But there's a lot of benefits to making sure that you're not insufficient in those.

• 1:25:25Nick Bare?

  If someone is supplementing with potassium, what kind of regimen do you put them on?

• 1:25:32Speaker 01

  Yeah. The most important thing is don't take it right as you're beginning a workout or a really hard workout, especially if we're on anything else that could increase potassium. Because as you exercise, you release a bunch of potassium into your bloodstream temporarily, mostly during the workout and a few minutes after. And you don't want to cause your heart to have an arrhythmia from too much potassium. So it's fine to have some potassium, you know, I wouldn't worry about the potassium in an electrolyte packet. And occasionally, if I don't have an electrolyte packet around, I actually get a tiny bit of what's called Morton's light salt, which is basically half potassium chloride, half sodium chloride, and put a little bit of that into my pre-workout or protein shake. So that's also reasonable to do in small enough

• 1:26:17Speaker 01

  quantities. But the easiest thing that I add in is I just tell people to use Morton's light salt because it doesn't taste disgusting like pure potassium chloride and use that used to taste.

• 1:26:29Nick Bare?

  It's good to know. So kind of moving on to a completely different topic that I believe is very important and applicable to what we as the world is experiencing right now is fertility issues. I'm curious from your perspective.

• 1:26:49Nick Bare?

  Are fertility issues becoming more of an issue? Or is it just that people are more so speaking about them more openly than they were in the past?

• 1:27:01Speaker 01

  Yeah, they're definitely becoming more of an issue. There's a couple main drivers of this. One of them is that both males and females are less fertile. A lot of it is because they have poor metabolic health and they don't exercise frequently. But from the male standpoint, sperm counts are lower than ever. They've decreased pretty steadily in a somewhat linear pattern. And females have more anovulatory cycles than ever, whether it's hypothalamic amenorrhea, which is common in runners, or whether it is PCOS, which is very common in general.

• 1:27:40Speaker 01

  And yes, there's a lot of embryological causes and medications. Potentially even hormonal contraceptives may have combined, may have like partly contributed. But the main drivers, I think, is metabolic syndrome and lack of good exercise and sleep. Even something like sleep apnea can can worsen outcomes with that. Microplastics do play a role and microplastics are all throughout the body, including in the gonads. So you try to minimize those. But again, many types of microplastics you can sweat out. So if people exercised more, they'd have more out.

• 1:28:25Speaker 01

  And then they can also decrease the amount that's coming in at the same time.

• 1:28:29Nick Bare?

  I have a hard time conceptualizing what it looks like from, say, plastics in our environment. How they get into our body? Like, do you have a good way to describe how we have? Hey, how are these microplastics getting in? Where are they stored? And then what? What are they necessarily doing to impact and create all of these? Consequences that we are experiencing like infertility.

• 1:29:03Speaker 01

  Yeah, the best analogy I've thought to tell a layman is metals can leach and plastics can leach as well. And that basically means a tiny little bit of it breaks off and combines with something. And then those particles are kind of delivered together into the body.

• 1:29:21Nick Bare?

  And they're like naked to the eye. You cannot see that these particles.

• 1:29:25Speaker 01

  Correct. Yes. Although it is possible to, you know, swallow something that has plastic in it. And then it to continually leach off in the gut as well, or even get stuck in the gut. Something called a beesore is where a bunch of, you know, supplements or plastic bits or whatever else can get caught in the lining of the gut. But most often than not, it's invisible to the naked eye. And think of it as a tiny little piece of trash essentially because we don't need that for a lot of metals, including mercury and I believe cadmium, and also microplastics. We don't have any use for them in the body. We didn't have these plastics hundreds of years ago. So this is a new phenomenon. However, we did have metals

• 1:30:07Speaker 01

  hundreds of years ago. And in the body, there's little basically trash cans within each cell. And we can fill up these trash cans. And a lot of times, people feel worse when they do something like a chelation therapy, because it releases a whole bunch of metal into the system that's previously in the trash can. Think of your body like a room and as a thousand trash cans and you take some of the trash out of every trash can. And it's just going through the hallways until it is eventually excreted in the urine and or stool.

• 1:30:36Nick Bare?

  How are these therapies done?

• 1:30:38Speaker 01

  You can do IV therapies. You can take oral things that are chelators. And you can even do them for things that we need, like iron. So someone who has iron overload, you can do iron chelation. You can do copper chelation. And in general, it's not worth it because your body has ways to excrete this naturally. Like sweat and urine and stool. And you want to make sure that your trash cans don't get to a point where they're overfull. And you want to have the amount in roughly equal to the amount out. And then you're not going to overflow and have organ dysfunction downstream to that.

• 1:31:22Nick Bare?

  Is there any negatives to?

• 1:31:26Nick Bare?

  It was called chelation therapy, you said? Is there any negative to us facilitating this type of body cleaning? So that our bodies don't naturally have to do it? So if we keep doing these things to help our body rid of what they are already are trying to get rid of? Does our body become trained to not even remove them at all? Because we are manually incorporating these processes and therapies to facilitate?

• 1:31:59Speaker 01

  Not that I know of. I don't think that it downregulates the natural detoxification measures within the body. In fact, a lot of different therapies. I actually have a toxin cleanse protocol. I'll post it on my website that I think has little to no downside. Because you want to make sure your, you know, your glutathione is optimal. For example, I think that makes a lot of sense. But as far as, you know, an IV chelation therapy? One is for plastics, whether it's like taking IV of a chelator or even just plasma for resuscitation, which is plasma exchange. How do you really know that that's necessary? And is, are the metals and plastics that are really causing the dysfunction? For example, the ones in your brain?

• 1:32:44Speaker 01

  Are they really going to be able to like go through the bloodstream as you're getting plasma exchange? Are you going to have your plasma being exchanged 24/7? Probably not. And in general, if you're provoking metals, and then in the future, we'll be able to like provoke plastics and test them. Although the tests right now for microplastics, I believe, are very invalidated. I have not seen any like good validity corroboration for those tests. Usually it's about five times higher. So you have to test before the provoking and then after the provoking and you expect it to be at least five times higher. And that's kind of a pain to do. I have occasionally done it in patients.

• 1:33:24Speaker 01

  But the plastics that are coming in are the most important thing to assess, in my opinion. For example, plastics coming in from water, like almost every can, they don't leach very well. There is a paper that we pulled up, we talked about it on the Gillette Health Podcast, that showed plastics from a plastic bottle of extra virgin olive oil had a million times as many microplastics as a plastic water bottle. Because the oil is more lipophilic and presumably some sorts of plastics are leached into that

• 1:34:02Speaker 01

  oil-based substance much better than the water-based or aqueous solution. And I don't know if we can extrapolate that to every single oil-based solution or water-based solution, but personally, I am more careful. You know, I used to have bottles of extra virgin olive oil that were plastic, probably got it from Aldi, and now I try to switch to all glass bottles for that. But for aqueous solutions, I don't worry about plastic.

• 1:34:32Nick Bare?

  Yeah, I was just thinking about the olive oil we buy. And it's either in a tin can typically.

• 1:34:40Speaker 01

  Oh, nice.

• 1:34:40Nick Bare?

  Or a glass bottle. But there's this new olive oil that came on the market this past couple of years. It's in a squeeze bottle. It's a Graza or something. It's in a plastic bottle and we buy that. And now I'm thinking, okay, let's go back to the old school glass, uncool looking bottles.

• 1:35:06Nick Bare?

  What are other ways that you personally try to minimize your exposure to microplastics?

• 1:35:13Speaker 01

  Yeah, one thing that I use mostly for my kids, but not as much for myself is something called a Berkey filter. So you can test your tap water and there is not any significant concerning microplastics in it. There is a tiny bit. And the younger you are and the more material you're incorporating into your body, I think the more reasonable it is to avoid microplastics from other sources too. So I try to mostly get my kids' water from Berkey filtered water. Ironically, it gives them a tiny bit of silver because the filter has silver in it. So somebody tested that too. So everything within reason. But yeah,

• 1:35:53Speaker 01

  past that, I try not to consume food that's in plastic wrappers that has been reheated or deheated over and over again. And then I don't get hot, warm receipts and then smear them all over my hands before I eat. I wash my hands before I eat. So nothing particularly crazy.

• 1:36:13Nick Bare?

  Do you think that goes back to one of the things that is blown out of proportion of these common health and fitness narratives that's pushed?

• 1:36:23Speaker 01

  A little bit, but I think microplastics is a pretty big concern for the majority of the population, partly just because people don't sweat and move enough.

• 1:36:34Nick Bare?

  So, you know, in the summer, for example, here in Texas, I'm going through a workout, I'm sweating like crazy. I'm running, I'm sweating like crazy. In the winter, it's not the case. I'm using the sauna more.

• 1:36:47Speaker 01

  Yeah.

• 1:36:48Nick Bare?

  So we can excrete some of these microplastics in sweat, either through training or, say, a sauna?

• 1:36:57Speaker 01

  That's likely the case. I don't, I don't think we can say for sure at this point, but that is likely the case. A lot of the studies on this are called cohort studies. So you're basically taking two groups of people and then comparing them. For example, a group of people that have passed away that had dementia versus don't have dementia. The ones that had dementia had way more microplastics in their brain. Is that because the higher amount of microplastics in their brain caused them to have dementia? Or is it because they ate a ton of processed foods that just happened to be in plastic wrapping? And lots of sugary beverages that happened to be in plastic containers?

• 1:37:38Speaker 01

  And they also did not sweat and exercise and move enough because all of those things are also much more likely to lead to dementia or type three diabetes. So we don't really know the causation or correlation of that. But I think it's safe to say that incorporating sauna into your protocol is a reasonable way to attenuate negatives of plastics.

• 1:38:00Nick Bare?

  I remember back in the day, we'd have like our Tupperware drawers in the house and it was all plastic stuff. And growing up is all

• 1:38:08Speaker 01

  We did too.

• 1:38:08Nick Bare?

  Plastic Tupperware. Now all of our meal prep containers are glass, which I will say makes it a whole lot harder to store. You can't stack metal or glass, I should say. But we stopped using, you know, like those typical traditional black meal prep containers with the plastic clear lid on top. So I used to always prep all my, all my food. Now if we've moved to glass and that's one of the, the changes we've, we've made in our household. So outside of lack of sleep, microplastics, what else is affecting fertility? I heard

• 1:38:51Nick Bare?

  this, uh, this stat, and I might be way off, but it was something like in the next 50 years, the fertility rates are going to be, or actually infertility rates are going to be skyrocketed where essentially we can't reproduce in, in the next 50 to 100 years. How accurate would you say that is?

• 1:39:19Speaker 01

  I don't think that's extremely accurate, but I do think that the continuing trend of lower fecundity rates will happen. So fecundity rates are just, you know, um, not just how many kids you have, but how early you can have them. Think of the movie Idiocracy, where someone with a very low IQ starts having kids when they're, um, you know, 18 and then the people with very high IQ, they don't have kids till they're in their 40s or they try to have kids, but then they're infertile by that time. And age is a huge thing that affects fertility, not just chronological age, but biologic age.

• 1:40:00Speaker 01

  So you see a lot of people that might be 20 years old, but they look like they're in their 30s. And it's not just from steroid use. That is actually one of the causes why a lot of younger males look very, very old is because of very large amounts of steroid use and sun damage is another one and lack of sleep. But generally for people who are metabolically healthy and that usually means they have a good diet and they're pretty active and they're relatively young, under the age of 35, almost all of those individuals have very good rates of fertility.

• 1:40:39Nick Bare?

  So what other environmental factors can we kind of be aware of and try to reduce or minimize that we're currently being exposed to that could kind of influence some of these fertility rates?

• 1:40:59Speaker 01

  Heat damage to the testes is an important one. So the testicles are obviously not in the body like the ovaries. They can be damaged by heat. And on the Gillette Health Podcast, I've talked about my varicoseal and kind of my journey looking into that. I basically didn't do anything for it, even though I could tell my testicles were atrophying until after I had a couple of kids and I was already in my, I guess, mid 30s, early to mid 30s. And then finally I decided to do HCG, which I was very happy about. But you know, they tell you if you have one varicoseal and atrophied testy, if not two of them, then your fertility is terrible.

• 1:41:39Nick Bare?

  What is a varicoseal?

• 1:41:41Speaker 01

  Varicoseal is varicose veins that basically cause heat damage to the testicles. About one third of males have them. I'm working on a podcast specifically on varicoseal. Most people just have a very mild one on the left side that have it. And about one in three males does have a varicose vein. It kind of feels like a, like if you're bearing down, like, let's say you've had a hard workout and you've been standing up all day, it kind of feels like excess veins, worm-like veins on the scrotum.

• 1:42:11Speaker 01

  But that's definitely associated with infertility. A lot of people get them fixed, either a coil or ligation, which is like a suture from a urologist in order to regain fertility. And fortunately, I didn't have to do that. But I remember before our first kid saying, oh yeah, there's, you know, I not just have one varicose seal, like it's affecting both sides. It's a pretty significant amount of heat damage. I did everything that I could to avoid it. Like hot tubs and jacuzzis, and I didn't wear any tight clothing. So I wore nice loose fitting clothing, especially at night. And I've tried every single ones of the varicose seal underwears

• 1:42:51Speaker 01

  that basically have cooling built in. Haven't liked any of them so far. So, but I could be wrong. Maybe I haven't. I haven't tried them in a couple of years. But anyway, fortunately, you know, I was healthy and I don't know if I was young. I was in my, you know, my 30s. But fortunately, no issues conceiving. But after the second one, I noticed that I was also sleeping worse. And I don't think I ever had a testosterone above 400, other than while I was on finasteride. But not to go too deep into my health. I've talked about that on my podcast quite a bit.

• 1:43:31Speaker 01

  But basically, I was glad that I did HCG, even though it was not needed for fertility. And a lot of people, regardless of what their like, you know, ability to be fertile is, I think if they are worried about it, just like checking a testosterone and your vitamins, nutrients in your 20s. I wish I had checked my sperm count in my 20s. Maybe my early 20s, but later 20s is better than nothing. So yeah, even from my perspective, as someone super interested in health optimization, I could have been much more proactive looking into this.

• 1:44:10Nick Bare?

  And it took Steph and I a full year to get pregnant with our first, Charlie. And we both did all the testing and both came back clear. If anything, my sperm had lower motility than they would have hoped for. Took us a year, finally got pregnant with Charlie. And then with our second, it took us like no time, which we were not prepared for. We thought it was going to be like another year journey.

• 1:44:42Speaker 01

  Yeah.

• 1:44:43Nick Bare?

  But there's so many people in my life that I know who are going through similar experiences where it's a year, a year plus, they're going on two years of not being able to get pregnant. And it seems like there's less and less people you come across today who decide they want to have a baby. They start trying, they get pregnant right away. So it feels like all of the, for me, it's a lot of just subjective cohort data.

• 1:45:15Speaker 01

  Yeah.

• 1:45:16Nick Bare?

  But it feels like it's trending in that, that direction.

• 1:45:19Speaker 01

  Yeah. A lot of times people don't realize how much more fertile someone who is 20 is than someone who is 30. Even from 20 to 30, and especially from 25 to 35, fertility, chance of success is hugely affected. So there's certainly that to consider, but yeah, I'm a fan of testing. For example, for low motility, I like to recommend L-carnitine, which I guess is technically a peptide, but it's just a two amino acid peptide and has, you know, decent evidence, especially anecdotally, but it has decent evidence that it improves motility of sperm.

• 1:46:01Speaker 01

  So small adjustments like that can make a decent difference, but I don't really see infertility specialists, other than rare exceptions like Dr. Fantas, who we've had on the podcast, dive into things that you can do other than IVF. People just skip to IVF. And frankly, you know, I wish that they didn't because it was very, it's very expensive. And I know that the government has said that they're going to improve affordable access to IVF soon, but usually IVF isn't needed. I have helped feed my family in large part due to patients seeking out my care for fertility and have helped a lot of people, males and females with infertility.

• 1:46:46Nick Bare?

  I've learned a lot about the female body and hormone system by being married to Steph and then going through our journey of, well, not just being married, but having kids. And the one thing she's done a really good job at is just educating herself and then working with professionals like yourself to, to learn more. When we first started trying to have kids and we were unsuccessful for those first couple of months, I mean, she really did the research and I think one of the things that we've realized after talking to other couples is like some women just don't track their cycle

• 1:47:31Nick Bare?

  as closely as Steph tracked hers, where she knew exactly when she was ovulating, when we had to try, she had it dialed in to the day. So it wasn't just throwing a dart at a dartboard hoping that she was ovulating in that period. Like Steph knew exactly when. So she, she did a really good job at removing all of the variables that we could control prior to exploring other options.

• 1:47:57Speaker 01

  Yeah, that's a good point. You know, a lot of people will do just something as simple as a urine LH tests.

• 1:48:03Nick Bare?

  That's what she was doing.

• 1:48:04Speaker 01

  Yeah. Some people will do basal body temperature, which is also decent. Some people will even do cervical mucus monitoring, which I don't think is really necessary with modern options like urine LH tests, first thing in the morning or twice a day. But there's always more and more levels. So, you know, depending on the male's sperm count, there might be better intervals to do because some people just say, oh yeah, every other day. That's what you should do when you're looking at fertility and it's not necessarily the case. If there's a slightly lower sperm count, maybe every third day would be reasonable. And even several days before ovulation, that can be a fertile window, which I think most people understand.

• 1:48:49Speaker 01

  But past that, there's also a level of, you know, what if you have two boys like I did? And you wouldn't mind having a girl? Then you can get an idea even just from your labs. There's actually three labs that can skew your chance of is it more likely to be a boy or a girl? And this is theoretical, but at least in my case, it turned out to be very true. And you can try at different times when you might have more or less Y chromosome versus X chromosome survive. And there's even levels and layers beneath that of what if you do IVF? What sort of embryo genetic testing should you do or pre-implantation genetic diagnosis? And for the average person, this doesn't necessarily matter.

• 1:49:34Speaker 01

  But I just kind of find that it's interesting that someone like myself that does see a lot of fertility patients, but I'm not an OB-GYN or a urologist, is very familiar with this. But if you go to big academic centers, even like KU, I'm friends with some of the infertility specialists at KU like Dr. Fantas. This is not something that they regularly incorporate into their practice.

• 1:50:00Nick Bare?

  This is probably a really broad question. So if you can't answer it, let me know.

• 1:50:06Nick Bare?

  But say a couple comes to you, they're having trouble getting pregnant.

• 1:50:11Nick Bare?

  They don't want to go to IVF yet.

• 1:50:14Nick Bare?

  If it's a problem with the males sperm, what is a typical treatment protocol you might put him on to help get pregnant?

• 1:50:27Speaker 01

  Yeah, it's a good question. Part of it depends on the problem. For example, I mentioned L-carnitine or even injectable L-carnitine if it's a big motility problem. If it has to do with low LH or FSH, so that's a pituitary issue, actually regardless of if it is related to they're on TRT previously or they have a pituitary adenoma, then HCG, FSH, and sometimes SERMs, which are selective estrogen receptor modulators, can be helpful. So occasionally I use the HCG, which basically binds the LH receptor and causes hypertrophy of the testicles. FSH binds the FSH receptors.

• 1:51:13Speaker 01

  And they have a lot of crosstalk within the testes. The combination of the two does seem to be better. But then after you have kind of one, let's say you take an infertile male. And this is partly based off my conversation with Dr. Fantas. Then one course of FSH kind of resets things and then you can keep them on just HCG. And they seem to do well. He tried to study a group of men with something called idiopathic infertility. So they couldn't find out why it wasn't because of something that they took. It wasn't because of, you know, some sort of cell aplesia or a specific type of cell in the test. He just never formed. In cases of those, a lot of times I do refer to the urologist and they just physically go in and try to extract

• 1:51:55Speaker 01

  the sperm that is not coming out. Like a sertoli cell aplesia, these are pretty rare. But they actually couldn't recruit enough people with idiopathic infertility because they would always find a cause of why they had it. But I think that they were just too strict in their definition of idiopathic. Because if someone has, you know, a slight cause, then not everyone with that has infertility. For example, if you have someone that has a varicose eel and also not too much else wrong, but has zero sperm, I think that's kind of strange. So a lot of times I use FSH, HCG, and then serums like Clomid. But not all together.

• 1:52:40Speaker 01

  It's either HCG plus or minus FSH or something like Clomiphene or Inclomiphene, but not both.

• 1:52:49Nick Bare?

  And on the flip side of that, what kind of treatment protocol would you do for a female? If that's the approach that you were going to take?

• 1:52:58Speaker 01

  Yeah, this tends to be more variable. But I use a combination of several things depending on if it's PCOS related, depending on if it is hypothalamic amenorrhea related. Or whatever, whatever else the case may be. But a lot of times I do use LDN, especially if it's not related to any of those. It kind of seems idiopathic. We can't find an obvious reason. Just in case there's some degree of autoimmune component. I've had patients that have extremely high natural killer cell levels, which is NK cells. And they've had, you know, six miscarriages and.

• 1:53:37Speaker 01

  You start them on some LDN and maybe some other immunomodulators, even kind of sort of autoimmune medications. And they do not have a miscarriage again. So I've seen that in the practice. It's not as common. But for more common things, a lot of times I use GLP-1s as well, especially if there's significant insulin resistance. Or even if they're not a very high body fat, but if their insulin is high, then I like a GLP-1 to decrease that area under the curve insulin. Those are like Ozempic or Mounjaro or generic versions of those if they need to start less than the starting dose. And with good success.

• 1:54:22Speaker 01

  I'm not against things like Letrozole. I usually like, if someone has PCOS, Letrozole is Famara. And basically, they take it just a couple of days right at the start of their cycle. For example, days three to seven or five to seven.

• 1:54:36Nick Bare?

  So they call the trigger shot?

• 1:54:39Speaker 01

  They're pills, but it's kind of like a trigger. But yeah, a lot of times they'll do a trigger that'll just be HCG or a form of FSH like Gonalf or Folatopen Alpha or Folatopen Beta, which is a Folostem. But that's usually just in the context of either egg harvesting or doing IVF cycles. And then sometimes if it doesn't look quite right, they'll do IUI.

• 1:55:05Nick Bare?

  We did IUI.

• 1:55:06Speaker 01

  Intruder and insemination. Yep. Which does increase the chance. But you know, as you've seen, it's often not necessary. Just because you've tried that once, you don't necessarily have to continue on in the future. But yeah, they're Letrozole and Clomid are pills that you take early in the cycle. Generally, in the case of PCOS, but both of them have the risk of multiple gestations, like twins or triplets, which if you've delivered a couple hundred babies like I have, including multiple twin pregnancies, both vaginally and C-sections and twin pregnancies where one is head down and one's not, then I would certainly not want a twin pregnancy, especially not my first pregnancy,

• 1:55:51Speaker 01

  just because there's such a higher risk of adverse effects.

• 1:55:56Nick Bare?

  We were just talking about in the brand office with some of the team members, the surprise of what twins would be.

• 1:56:06Nick Bare?

  My dad, actually, he uh, he saw a um,

• 1:56:15Nick Bare?

  what's one of those people who you come and you ask him questions, what's my future look like? And they tell you, oh, you're gonna.

• 1:56:21Speaker 01

  Fortune teller?

• 1:56:22Nick Bare?

  It was a fortune teller, yeah. My dad went and saw this fortune teller as like a, an event with friends a few years ago. And this is before we had kids. And this fortune teller told my dad, or psychic, I guess you would say, told my dad that I, his oldest son, would have a daughter first, a son second, and then we'd go for our third and we'd have twins.

• 1:56:47Speaker 01

  Ooh.

• 1:56:48Nick Bare?

  So far, it's, it's two for three.

• 1:56:51Speaker 01

  Yeah.

• 1:56:51Nick Bare?

  So I'm.

• 1:56:52Speaker 01

  That's pretty good.

• 1:56:53Nick Bare?

  I'm very nervous for the potential of twins going for a third.

• 1:57:00Speaker 01

  Yeah, that could definitely be a bit of a self fulfilling prophecy.

• 1:57:03Nick Bare?

  Yeah.

• 1:57:04Speaker 01

  Yeah, um, fraternal twins do seem to be related to maternal inheritance. So, passing down the female line, if people tend to have fraternal twins, not identical, then there's a slightly higher risk. There's also a higher risk of twins as age increases. So, you are, you are technically at a higher risk of twins now than before.

• 1:57:30Nick Bare?

  It's a double edged sword, like have kids later on and have twins on top of it. How old are you right now?

• 1:57:37Speaker 01

  Thirty four.

• 1:57:38Nick Bare?

  Thirty four. I turned thirty five, I'm thirty four too, I turned thirty five this summer.

• 1:57:43Speaker 01

  Yep.

• 1:57:44Nick Bare?

  And that, that just, are you on August birthday by chance?

• 1:57:46Speaker 01

  July.

• 1:57:47Nick Bare?

  July.

• 1:57:48Speaker 01

  Yep.

• 1:57:49Nick Bare?

  Yeah, I'm August first, and thirty five just feels like, I mean, I'm on my way to forty at that point. We're getting there.

• 1:57:57Speaker 01

  Yeah, I tell Maddie that I'm, I'm getting gray hairs and a little bit more creaky when I get out of bed, but I have more energy than ever. Maybe it's from taking nootropics or modafinil from time to time. And I think I'm in better shape than ever, too.

• 1:58:10Nick Bare?

  That's great.

• 1:58:11Speaker 01

  It's a.

• 1:58:14Speaker 01

  Everyone ages and at some point, everyone will go meet our maker. But there's certainly, it's certainly easier to age gracefully and then prevent age-related decline than to age a whole bunch and then try to get back by reverse aging. It doesn't really work that well, other than just manipulating your lab tests to make your biologic age look lower.

• 1:58:39Nick Bare?

  So really, you gotta think about longevity and you gotta think about aging earlier than you initially would think. It starts in your twenties, in your thirties to prepare for sixties, seventies, eighties.

• 1:58:54Speaker 01

  Have you seen the studies on how many brain cells a parent loses each kid they have?

• 1:58:58Nick Bare?

  No, but I believe it's significant.

• 1:59:00Speaker 01

  Having a kid, yeah.

• 1:59:01Nick Bare?

  I believe it.

• 1:59:02Speaker 01

  Unfortunately, it is. So yeah, it's a particularly important time. That's one of the topics that I was trying to think on how to make a video or a discussion about this. Is you think about your biohackers, they're almost all young people that don't have kids or people who are, their kids are grown and, you know, they've done well in business or whatnot. And they have excess funds and, you know, people like nice things. And even my clinic is considered a luxury good or service, you know? It, uh, it just is. But you, the most important time to biohack is when you have no time to biohack.

• 1:59:45Speaker 01

  So actual biohacking is doing your lifestyle pillars, your diet, your exercise and your sleep. And you're not taking it from 95% to 130%. You're just getting by on 90% or even 80% when it would be 40% otherwise. Because it'd be very easy for me, right now, I'd probably consider myself to be 80% or 90%. But it'd be very easy to be at even 30 or 20 and just be absolutely drowning.

• 2:00:13Nick Bare?

  You see, I mean, I see people do that all the time where they go into this chapter of life like we're in right now with young kids and growing businesses. And it's very easy to stop doing the things that make us feel better because they feel like it's extra or it is luxury. So while we throw all that out the window, we go down to operating at 20, 30%. And of course, we feel horrible. Of course, we're tired. Of course, we don't have the energy to go and train. But I take the time, and I'm sure you do as well, to even when I don't feel like I have the time to prep my meals, to train, to do my sauna sessions, to stay hydrated throughout the

• 2:00:54Nick Bare?

  day, to take some time for myself. Like the things that I'm doing and making time for allow me to operate at a higher optimization. And it might feel like unnecessary work, but it actually has this compounding ability to allow us to achieve more and then have greater outcomes in the future.

• 2:01:19Speaker 01

  Yeah, the social health component is difficult too, especially with your spouse. It's like just having three kids under the age of five and both of us trying to emphasize healthy diet and exercise and sleep, well, less unhealthy sleep. It's easy to kind of friendly fire with each other to where, you know, it's not, it's your collective well-being. It's not necessarily one person has to get the, and maybe with you, it's a bit different since you're kind of a professional athlete, but it, you want you and your spouse both

• 2:01:58Speaker 01

  to have a somewhat good lifestyle habit because that sets in. And at least for us, that's one of the few things that we share in common. Men and women usually have different hobbies, if people haven't realized that.

• 2:02:12Nick Bare?

  Yeah.

• 2:02:13Speaker 01

  Other than raising kids, I think it's really important to have at least one thing, whether that's your fitness and training or your love of the, like a good diet in common.

• 2:02:24Nick Bare?

  Yeah, I mean, Steph and I split everything 50/50 in terms like we both are super passionate about healthy eating and working out daily, moving our bodies, but also being involved with the kids.

• 2:02:37Speaker 01

  Yep.

• 2:02:38Nick Bare?

  So like the other night, we just got through this, we're still kind of in it, this sleep regression with our oldest Charlie. And she's having trouble going to sleep and then in the middle of the night. She'll wake up screaming for one of us, like one of us ends up sleeping on the floor next to her crib. It's been like this for the last couple of weeks. I'm hoping we're out of it soon. But the other morning I was walking into the kitchen from Charlie's room. Steph was walking into the kitchen from our room. Cause that was one of the nights I slept on the floor. And we just stopped and we shook hands. We said, hi, nice to meet you. When have we seen each other last?

• 2:03:20Speaker 01

  Yeah, that's hilarious. Yeah, I love that. It is important to split things up like that. And we certainly did that more often with our first, where I also did a lot of the nighttime bottle feeds. But with these last two, I have, I don't think I've done a single nighttime bottle feed.

• 2:03:36Nick Bare?

  It's tough.

• 2:03:37Speaker 01

  Yeah, no. And with sleep stuff, we've tried many different methods and actually for, for different kids, different methods worked better. Because there's definitely going to be commenters that are telling you like how you should tweak your method or whatnot.

• 2:03:52Nick Bare?

  Oh, I've gotten all the advice. That's why I'm very cautious to share anything we're going through with our kids because there's always a good answer.

• 2:04:02Speaker 01

  That being said, please comment below. It's good for the algorithm. We should be doing with our kids.

• 2:04:06Nick Bare?

  Absolutely. Yeah. And we've tried it. We've tried it. Uh, and we're still searching for the answer. But Dr. Gillette, really appreciate you coming on and sharing all the insights. Really appreciate the help that you provide me and my family. It's, it's a tremendous reassurance that we're just doing the best we can to optimize our health, our performance, take care of our families. And we're very grateful for you and your team.

• 2:04:34Speaker 01

  Thank you.