286. Dr. Jordan Metzl: Why Movement Is a First-Line Drug for Depression

I sat down with Dr. Jordan Metzl, a sports-medicine physician who's convinced that the reason most of us can't stay consistent isn't discipline or knowledge, it's motivation, and he says you can actually engineer it by "lowering the cost to act." We get into exercise as a literal medicine that would beat almost any drug if it came in a pill, why fun is the real holy grail of compliance, and how movement can go head-to-head with antidepressants for everyday anxiety and depression. If you've been white-knuckling your way through willpower and losing, this one's going to change how you think about getting off the couch. CLICK HERE TO BECOME GARY’S VIP!: https://bit.ly/4ai0Xwg Get Dr. Jordan Metzl's book, “Push: Unlock the Science of Fitness Motivation to Embrace Health and Longevity”: https://bit.ly/4f28xiO Connect with Dr. Jordan Metzl Website: https://bit.ly/4gzA0tp Instagram: https://bit.ly/4aRhbhA Facebook: https://bit.ly/4fdR45E X: https://bit.ly/4aP5Mig Thank you to our partners A-GAME: “ULTIMATE15” FOR 15% OFF: http://bit.ly/4kek1ij AION: “ULTIMATE10” FOR 10% OFF: https://bit.ly/4h6KHAD AIRES: "ULTIMATE20 " FOR 20% OFF: https://bit.ly/4a3Duze BAJA GOLD: "ULTIMATE10" FOR 10% OFF: https://bit.ly/3WSBqUa BODYHEALTH: “ULTIMATE20” FOR 20% OFF: http://bit.ly/4e5IjsV COLD LIFE: THE ULTIMATE HUMAN PLUNGE: https://bit.ly/4eULUKp CYMBIOTIKA: "ULTIMATE20" FOR 20% OFF: https://bit.ly/4tjyluP GENETIC METHYLATION TEST (UK ONLY): https://bit.ly/48QJJrk GENETIC TEST (USA ONLY): ⁠https://bit.ly/3Yg1Uk9 GOPUFF: GET YOUR FAVORITE SNACK!: https://bit.ly/4obIFDC H2TAB: “ULTIMATE10” FOR 10% OFF: https://bit.ly/4hMNdgg HEALF: 10% OFF YOUR ORDER: https://bit.ly/41HJg6S PEPTUAL: “TUH10” FOR 10% OFF: https://bit.ly/4mKxgcn SNOOZE: LET’S GET TO SLEEP!: https://bit.ly/4pt1T6V WHOOP: JOIN & GET 1 FREE MONTH!: https://bit.ly/3VQ0nzW Watch the “Ultimate Human Podcast” every Tuesday & Thursday at 9AM EST: YouTube: https://bit.ly/3RPQYX8 Podcasts: https://bit.ly/3RQftU0 Connect with Gary Brecka Instagram: https://bit.ly/3RPpnFs TikTok: https://bit.ly/4coJ8fo X: https://bit.ly/3Opc8tf Facebook: https://bit.ly/464VA1H LinkedIn: https://bit.ly/4hH7Ri2 Website: https://bit.ly/4eLDbdU Merch: https://bit.ly/4aBpOM1 Newsletter: https://bit.ly/47ejrws Ask Gary: https://bit.ly/3PEAJuG Timestamps 00:00 - ​Intro of Show 02:00 - From family of doctors to sports medicine 04:00 - Prescribing the medicine of exercise 05:55 - What an exercise prescription looks like 07:41 - The 1950s London Transport study 10:22 - Cellular adaptations and mitochondria 11:52 - Inflammation and chronic disease 13:31 - Immuno-fatigue and the theory of aging 14:45 - Motivation, not discipline, is missing 18:14 - Knowledge, emotion, and belief 20:25 - Building a fitness community 24:11 - Biomarkers and the cost of chronic disease 26:23 - Lifespan vs healthspan gap 28:26 - Fun is the holy grail of compliance 34:00 - Why remote work hurts our health 39:16 - Making exercise pay for doctors 41:01 - Two minutes of vigorous activity a day 44:30 - The GLP-1 and arthritic knee study 48:49 - Exercise vs antidepressants 55:38 - Lowering the cost to act 59:42 - What it means to be an Ultimate Human 1:01:29 - Alice: a marathon at 70 Disclaimer: This podcast is for informational purposes only and does not provide medical advice. It is not intended for diagnosing or treating any health condition. Always consult a licensed healthcare professional before making health or wellness decisions. Gary Brecka is the owner of Ultimate Human, LLC which operates The Ultimate Human podcast and promotes certain third-party products used by Gary Brecka in his personal health and wellness protocols and daily life and for which Ultimate Human LLC and / or Gary Brecka directly or indirectly holds an economic interest or receives compensation. Accordingly, statements made by Gary Brecka and others (including on The Ultimate Human podcast) may be considered promotional in nature. Learn more about your ad choices. Visit megaphone.fm/adchoices

• 0:00Speaker 00

  In Western medicine, we do great at treating the problem after somebody has diabetes, where we can treat it, but why not think about preventing that from happening in the first place? And we don't spend nearly enough time thinking about that and incentivizing it.

• 0:11Speaker 01

  When you look at the broad data on the status of healthcare in America, we don't realize what portion of our tax revenue is just going to support preventable chronic disease.

• 0:19Speaker 00

  Exercise is a first-line drug. That's an exact example of the medicine of exercise. What we're really prescribing is community.

• 0:26Speaker 01

  One of the first signs of early depressive symptoms is people become more and more and more reclusive, less social interaction and less mobility.

• 0:33Speaker 00

  It's really what motivation is, which is people want to connect and they want to help other people. It's so much better to have a community. And that's what I realized early on, bringing people together was a way to harness motivation and to encourage motivation. That really made a big difference.

• 0:46Speaker 01

  When people have gotten accustomed to this sedentary lifestyle, how do you get them off their ass?

• 0:52Speaker 00

  That's the $100,000 question. And I'll give you two answers to that. Number one is.

• 1:09Speaker 01

  Hey, guys. Welcome back to the Ultimate Human Podcast. I'm your host, human biologist Gary Brecka, where we go down the road of everything, anti-aging, biohacking, longevity, and everything in between. And today's podcast is going to be one of those really interesting podcasts about the intersection of all of those. It's rare that I get a guest on this podcast that has been so woke to what we consider mainstream for 30 years and is also an allopathic, classically trained physician. And so, welcome to the podcast, Dr. Jordan Metzl.

• 1:41Speaker 00

  Thank you so much. It's really an honor to be here. I'm thrilled to be here.

• 1:43Speaker 01

  Yeah, yeah. It's an honor to have you. It really is. And two interesting stories that happened before the podcast. One, he showed up to my house panting and sweating, soaking through his shirt, which was the first time a guest came in. I was like, well, maybe he's nervous to meet me. I'm kind of a celebrity. But he was out on a run and then realized midway through his run from my house that he didn't have the time to get here. So he just ran straight here.

• 2:06Speaker 00

  I ran back to the hotel, but I didn't have time to cool off. So I showered, got on a bike and biked over here. And I was like, oh, man, I look like a mess.

• 2:13Speaker 01

  What I love is you're practicing what you preach.

• 2:15Speaker 00

  Absolutely.

• 2:16Speaker 01

  But during my house tour, you know, we're sitting in the hyperbaric chamber, and you said something that really sparked my interest. You said that I've been writing people prescriptions for the medicine of exercise for years. And you're the first classically trained physician that I've heard refer to mobility and exercise as medicine.

• 2:39Speaker 00

  Yeah.

• 2:40Speaker 01

  And I think, looking at your background, you also credit that recognition with what actually got you into medicine. So can you tell us a little bit about your journey?

• 2:50Speaker 00

  Sure.

• 2:51Speaker 01

  Into becoming a sports medicine physician?

• 2:53Speaker 00

  Absolutely. So I come from a family of doctors, both parents and three of the four brothers are doctors, the other guys are doctors too. So everybody, like dinner was, you know, Dr. Metzl.

• 3:03Speaker 01

  Lot of pressure.

• 3:03Speaker 00

  Everybody's Dr. Metzl. So my dad was the OG Dr. Metzl. Everyone else followed suit. And as I knew I was going to be a doctor since the time I was quite young, when I was like five, six, I used to go with my dad. He was a pediatrician. I had a little black, plastic doctor bag. And that was, that was my destiny. And I always really enjoyed.

• 3:19Speaker 01

  That's the best.

• 3:20Speaker 00

  You know, that role. And I knew I was going to do that forever. So I was very, that was my path. As I got into medicine, and I got in through medical school and then did residency, and I had this kind of whole life of being a doctor. And then simultaneously, I had a whole life of being an athlete. I played soccer in college and then in residency, where it really was a horrific type of schedule. You were awake like 36 hours in a row.

• 3:44Speaker 01

  Yeah, the exact opposite of what we should be doing to our doctors.

• 3:47Speaker 00

  Exactly. I used to bring a jump rope to the on-call and jump rope in the stairwell. People thought I was nuts, which maybe I was. But, but I really was recognized early on. In fact, even in med school, I recognized that my brain absorbed knowledge much better after I was, I was working out throughout med school to study. Really, my brain just worked better with exercise. But as I kind of got into my residency and then, interestingly, I'd never done a marathon. But the option in Boston, where I did my residency and internship, was that you could get the day off of internship, which was horrible, if you ran the Boston Marathon on Patriots Monday. I was like, that's the best deal in the world. Of course I'll run the marathon. So I ran my first marathon.

• 4:27Speaker 01

  Whatever motivation, man.

• 4:28Speaker 00

  100%. So that was the beginning of a love affair with the marathon. And now 40 marathons and counting later.

• 4:33Speaker 01

  And a lot of triathlons, too.

• 4:34Speaker 00

  A lot of triathlons, you know, I got a.

• 4:35Speaker 01

  31-time marathon finisher and 12-time Ironman finisher.

• 4:40Speaker 00

  Those are outdated. Now it's like 40 and 15. But, but, but if your sports medicine doctor's a slug, no one's going to listen to you. So I really have to, you know, it's part of the street cred, I guess. But, but anyhow, so as my career in medicine started to grow and I ended up in sports medicine, and I had this whole world of, you know, the idea of medicine was fix people when they are broken, if they're sick, if they're injured. And then I had my whole world of being an athlete, which was a lot about preventive health through movement. And if you go to a race, everybody's healthy, everybody's smiling, everybody's encouraging each other. And so these two separate circles of life, the doctor, fix it when it's broken, and athlete, preventive health through movement. And over time, those worlds started really coming together. So medicine and movement

• 5:25Speaker 00

  became one and the same. And, and over years, I have really morphed these into one. So if you come see me for a hurt knee, not only am I going to fix your knee, but I'm going to talk about how we use exercise as part of the medicinal part of your life. And, and that's led to really prescribing the medicine of, of exercise, which I see as a medicine. And what I tell all my patients, if we had a drug that was 100% effective for almost every single chronic disease, it was basically 100% efficacious, worked for every single person around the world, rich or poor, young or old, had zero side effects and only positive effects. Everybody should be prescribing this medicine. And in my view, physicians and the medical system should be actively prescribing this to people as part of what

• 6:08Speaker 00

  we do. And that, obviously, drug is movement. And, and so much so that about 10 years ago, we started, as I mentioned before, when we were chatting, we started a course to prescribe, teaching med students of the future, doctors of the future, how to prescribe exercise called Prescribing the Medicine of Exercise, which is a seminar at Cornell Medical School. We've been doing this now for 10 years. When we started, we were looking for a curriculum for the med students. There was none. Despite medicine, in all the centuries of medicine, they really, and people knowing exercise is quote unquote, "good for you," there was no curriculum on how to teach doctors how to prescribe exercise. So for me, the medicine of movement and prescribing the medicine movement is, is a huge piece of what I prescribe for health and for health span and for healthy longevity. And I've been at that, at that

• 6:53Speaker 00

  for a while. And I'm really glad to see, you know, the tide changing in that, in that regard.

• 6:58Speaker 01

  What is a prescription for, a medical prescription for exercise look like?

• 7:04Speaker 00

  Well, it's different for everybody. So if you're, you know, 60 and overweight and have arthritic knees, that's different. If you're 25 and you want to do a triathlon, it's different than if you're, if you have Parkinson's disease.

• 7:13Speaker 01

  But you're literally putting these, these protocols down and saying, here's, here's what I want you to do. I want you to go home and I want you to do 30 minutes on the treadmill, walking at this pace, or this incline, or I want you to do this kind of weight-bearing exercise. I mean, literally a descriptive.

• 7:28Speaker 00

  Yes.

• 7:28Speaker 01

  Set of functional movement.

• 7:29Speaker 00

  I'm lucky that I work at Hospital for Special Surgery. And so we are the world's biggest orthopedic specialty hospital and everything from orthopedic surgery to sports medicine, where I am, to rheumatology.

• 7:39Speaker 01

  Yeah.

• 7:40Speaker 00

  To exercise and physical therapy. So we have a whole team of performance specialists, exercise physiologists, nutritionists, where I will say, like, I see you as a patient, and I want you to start thinking about these things. And then I will send a note out to our performance team, and they will have that person come in for an evaluation. They'll look at his movement, they'll look at his metabolic health, they'll look at his nutrition, they'll look at all these things, and they'll put together a program for him. And we're really working on standardizing that. But it's nice because each of these things is tailored. And it's not only me. I mean, I think I'm, I'm on the musculoskeletal side, but I definitely need help in order to help enact this in a, in a more holistic way for people. But that's the idea, is that people should think about movement as part of their,

• 8:21Speaker 00

  their necessary medical intervention. And it means more coming from, from a physician, I think, are different because I think people then really internalize that message. And they realize this is not just because I feel good, but this is actually important for my health, which is what I'm really after.

• 8:35Speaker 01

  And I wonder, you know, I come from a big data background. And so what kind of data are you seeing coming out of results? Are you seeing coming out of it? I mean, what would, was there, number one, was there anything that surprised you about this and the outcomes in these patients? And what kind of outcomes are you seeing?

• 8:50Speaker 00

  Yeah. So I think the fascinating thing on that, and it's interesting, so for our course, we've looked at the history of exercise science and exercise as medicine. And you may think, like, for you and I, like, of course, why wouldn't we do that? And even for many of the people who are getting this information now, you know, many of people in this space already have kind of drunk the Kool-Aid somewhat.

• 9:08Speaker 01

  Sure.

• 9:09Speaker 00

  And so they know that. But much of the data on exercise and the effect, health effects of exercise comes from, actually, the 1950s is when we started getting the most information. There was a really interesting study set in London, the London Transport and Post Office Study, where they took people in, who, in the, in the bus industry and the post office industry in London, postal. And they had two categories of people. One had active jobs, walking up and down, collecting tickets and delivering mail. And one had sedentary, others had sedentary jobs, sorting mail and driving buses. And they looked at their cardiac and cardio, cardiac morbidity outcomes, based on if they had active versus sedentary jobs. And the people who were active basically had much less risk of cardio, cardio

• 9:52Speaker 00

  metabolic disease, even in the 1950s. So that was really the first birth of learning about the effect of exercise. And then over time, and when I, when I give talks on this, I have a wonderful slide of a woman in her 70s doing a single leg squat.

• 10:06Speaker 01

  Wow.

• 10:07Speaker 00

  And on one side.

• 10:08Speaker 01

  I don't know if I could, I used to do them in CrossFit, because they were required in CrossFit. But let me tell you something, dude, those are no joke. They call them pistols.

• 10:16Speaker 00

  Not all the way down.

• 10:17Speaker 01

  Yeah.

• 10:18Speaker 00

  Exactly right. So on one side, we have all the body systems of exercise. So this I, this slide looks at the, the body and the cellular effects of exercise. On the, on the body side, the system side, you know, metabolic and cardiac, hypertension and, and coronary disease and, and pulmonary function and muscular mass and body composition and Alzheimer's and et cetera, et cetera. All the, all the body system effects that we've known in the past 80, 90 years, we've seen a real growth and proliferation of research around the clinical effects of exercise. So a big, you may have seen a big meta-analysis came out a couple of weeks ago, looking at the effects of exercise on, on mental health and depression, anxiety, really highlighting some of these important changes as exercise as medicine.

• 11:04Speaker 00

  On the other side of her single leg squat are the cellular adaptations to exercise, things like muscle and myokines and telomeric length and some of the things we're hearing more about now, the cellular responses, which basically are the cellular manifestations of the clinical changes that we're seeing, I think is really fascinating because we're getting a better understanding on a, on a micro level. We were talking about mitochondria before. I was telling you about the Mitochondrial Society.

• 11:31Speaker 01

  I didn't even know there was a Mitochondrial Society of America, but I want to be a member. Whoever's watching and controls the membership.

• 11:36Speaker 00

  I think it's actually international.

• 11:38Speaker 01

  Can you get me in?

• 11:39Speaker 00

  International.

• 11:40Speaker 01

  Do the International Mitochondrial Society. I want to be on that. Dude, I want a T-shirt. I want some mitochondrial swag.

• 11:45Speaker 00

  A hundred percent.

• 11:46Speaker 01

  Yeah, let's get the, let's unite the nerds.

• 11:48Speaker 00

  Yeah, exactly. But anyway, so on the cellular advancements in understanding exercise, really parallel the clinical changes that we've seen over time. So why do people have more muscle? It's related to mitochondrial volume. So as we see that on a cellular level, we're really understanding the clinical changes that we're seeing. And then more information on why muscle is important to health span and the importance of functionality, things like achy knees, but also metabolic control and anti-inflammatory effects of muscle. All these things we're recognizing over this, really from this early work in the 1950s, has been really exciting to see.

• 12:22Speaker 01

  Yeah, no, it's so exciting to see. I think people, we, I think, you know, Dr. Gabrielle Lyon and some of the other big influencers in the space have really started to reframe the way that people think about muscle. You know, it's truly our metabolic currency. It's a sponge for glucose and the downstream consequences of hyperglycemia and insulinemia, hyperinsulinemia. Those are the genesis of so many pathologies down the road. It's sort of mind numbing. It's, it's, you know, one of those dominos that if it falls, the consequences are just so grave for, I feel like the Bible should say the, it's not the love of money that's a root of all evil. Blood sugar is a root of all evil.

• 13:01Speaker 00

  Yeah. Well, it's interesting. So there's a term that we teach in our course that is kind of really gaining traction in medical circles for sure. And I actually have, in my newest book, I have a whole section on this, the beginning called inflammaging or inflammaging, depending on who you read.

• 13:16Speaker 01

  Inflammaging.

• 13:17Speaker 00

  Inflammaging or inflammaging, the inflammatory basis of chronic disease. And much of this is related to sedentary behavior versus active behavior. And so muscle, we think of as important for storage, but also as an anti-inflammatory vehicle. Myokines are anti-inflammatory and that affects the, the expression of basic chronic disease. So all the major chronic diseases, you know, metabolic diseases, diabetes, neurodegenerative diseases, cardiopulmonary diseases, certain types of cancer are very much related to this chronic inflammatory state of reflected in this term inflammaging or inflammaging. And exercise is a, is a direct counterbalance to that. That's why we feel so strongly about it.

• 13:57Speaker 01

  Yeah. You know, I was asked a really interesting question about aging not too long ago, last year at a conference, and somebody said to me, if you were to put all the leading experts in the world that you know of in a room and ask them to agree on one theory of aging, what would it be? I said, you know, I think we would agree on the theory of immunofatigue. Slow, progressive, overwhelming of the immune system, degradation of the immune system, whatever you want to call it. A lot of it has to do with these low-grade fights that the immune system is in, these low-grade inflammatory cascades. They really don't really belong anywhere and, and they're not necessary and they're things that you can do something about just with lifestyle changes. Listen, there's what I share on this podcast, and then there's what I share with my inner

• 14:42Speaker 01

  circle. If you've been following me for a while, you know how I hold nothing back here. But my VIP community, that's where the real magic happens. Picture this, you're struggling with energy crashes, brain fog, or just feeling like you're not operating at your peak and you don't know where to get real answers. But here's what really sets this apart. You're not just getting my insights. When I have incredible guests on the podcast, VIP members get to submit questions for our private podcast segment. So that world-renowned expert we just interviewed, you get exclusive access to their knowledge tailored to your specific situation. This section is under the private podcast section in the Ultimate Human Community. And speaking of exclusive, you're getting my personal protocols, the exact tools I

• 15:23Speaker 01

  use for water fasting, gut optimization, and morning routines that have taken me decades to perfect. This isn't theory. This is what works in the real world. The community launches challenges throughout the year where you get direct access to me and my network of experts. It's like having a personal health advisory board for less than a hundred dollars a month. Your health is your wealth and this investment pays dividends for life. Join the VIP community at theultimatehuman.com/vip and step into your ultimate potential. Now let's get back to the Ultimate Human Podcast. And so you're doing this en masse.

• 15:55Speaker 00

  Yeah, I think that's the, that's the point. And so even some of the earlier work done, the CDC had published in the early 2000s, an estimation of what affects human health. And at that point, their comment was 20% was genetics, 20% was interface with the medical system, and 60% was lifestyle. Increasingly, some of the recent work, like Eric Topol and others published a study looking at the Welterly, people that lived 80 years, 80 to 100 with no disease, meaning they were well and they didn't have disease. The average person over 80 has two or more chronic diseases. So they were called Welterly. And so Welterly versus age match controls. And the thought was, listen, if you're 88 and you don't have chronic disease, there's something genetically different about you. But there was actually nothing. Their genomes were almost identical to people who had the chronic. So the biggest

• 16:37Speaker 00

  change, the biggest modifying factor was their habits. And so the idea that we have such a powerful influence on people's habits, and in, in Western medicine, if, you know, we do great at treating the problem. After somebody has diabetes, we're, you know, we can treat it, but why not think about preventing that from happening in the first place? And we don't spend nearly enough time, you know, thinking about that and incentivizing it. And so one of the big pieces that I'm really talking about and thinking about is how we incentivize people for the behavior that we want to see, because I think that's the piece, because people ultimately may not want to do it on their own.

• 17:09Speaker 01

  That's so true. And I think that you, you argued that it's not discipline, it's not knowledge, but it's motivation that's missing. This is, we're going to gravitate into push now and, and your, the genesis of push. And I'd really love for you to talk about that. But what do you mean by motivation is the missing component? And how do you define it? And then how do you, how do you excite that in, in somebody?

• 17:31Speaker 00

  Yeah, I mean, that's exactly right. So I've been thinking about and trying to give this message for, for decades, as many have. Some people gravitate towards it, others just don't. And so what, what do we know about the people that do? Well, some people, it's just kind of built into their DNA. Like I was born moving and I can't not move every single day. I love moving. It's a big piece of what I do. But others really struggle for that. Yet, one of the things I really have kind of noticed over time is that consistency over time is really, it's not what you do day after day, but it's week after week, year after year. What can you do to kind of master your own motivational health? And at the beginning of push, I have two quotes, one from Gandhi, which is, you must be the change you wish to see in the world. That's the, the beautiful idea that, you know, to

• 18:14Speaker 00

  be what you want to be, you have to kind of enact your own change. And below that, I have a quote from me, commit to getting off your ass. That if you, that if you don't commit to do it every single day, it just doesn't end up happening. You can kind of think about it and theorize about it, but you have to really commit to making it happen. That's actually how I start, start the book is with those two quotes.

• 18:32Speaker 01

  Wow. Well, if it's to compliment you, I like your quote better than Gandhi's.

• 18:36Speaker 00

  They complement each other.

• 18:38Speaker 01

  I'd rather have yours on my walls than Gandhi's. But so, so, you know, this, this concept around motivation, I want to drill into that a little bit because I think what happens to most people is, you know, I have, I have a quote that I derive too, called, that says that aging is the aggressive pursuit of comfort. Because the more aggressively we pursue comfort, I believe the faster we age, which I think very much speaks to what you've been doing.

• 19:03Speaker 00

  A hundred percent.

• 19:04Speaker 01

  And you writing scripts in the nineties for exercise, you must've been like way out there. Like your colleagues are like, oh, there he is. He's, you know, he's a granola tree hugger, whatever, you know, no science behind that. But, but, you know, you, you were cognizant enough to know how it impacted your life and your brother's lives and like your role as an athlete and what it did for you in your capacity to practice medicine, be present for lectures, taking information, regurgitate information. It became what it sounds like to me, like a superpower for you, like this sort of secret superpower, which was just that you were fit, right? It's not, not rocket science, but, and I think there's a lot more wide stream, you know, mainstream acceptance for it. But when you have people that have had habitual patterns for so long, like I listen to my parents,

• 19:48Speaker 01

  I kid you not, my mom has the same argue with my dad every single night. And she's like, John, you don't eat onions and you're not eating enough vegetables. I'm like, Mom, he's 82, you've been married 60 years, he's never put one in his mouth. What makes you think that it's going to change?

• 20:04Speaker 00

  Exactly.

• 20:05Speaker 01

  He's not changing. Just let the man eat, right? I mean, at this point, he's made it eight, you know, decades. He's, he's going to get, or many more decades out of it that he's going to get, but it ain't going to include onions and it ain't going to be bell peppers. And just, just accept it.

• 20:20Speaker 00

  Is what it is.

• 20:21Speaker 01

  But, but when people have gotten accustomed to this sedentary lifestyle and they've gotten comfortable, right? And they really just want you to fix what's wrong, doc. Like, listen, my knee is bothering. Can you just fix the knee and just, I don't want to do all this other stuff. Like, how do you get them off their ass?

• 20:38Speaker 00

  Yeah. It's, that's the, that's the $100,000 question. And I'll give you two answers to that. Number one is that for me, and what I write about is there are really three components to a motivational strategy. Knowledge, emotion, and belief.

• 20:53Speaker 01

  Knowledge, emotion, and belief.

• 20:56Speaker 00

  So knowledge, knowledge, I know I should be doing this. And most people know in this day and age, you know, when I started talking about this, you know, people knew it, but I think they know it more now. And you can't go anywhere without knowing that. And there's really a stigma around people who are inactive, you know, much like people that are, you know, smoking has a stigma, inactivity has a stigma now too. So I think we've done, I don't feel badly about that, actually. I don't, because I feel like activity promotes health for all the reasons we've talked about. So I think, knowledge, I know I should be doing this. Emotion, I feel like I should be doing this. And so there needs to be an emotional response from, I know I should be doing this, to I feel like I should be

• 21:37Speaker 00

  doing this. And that piece is a step around what makes people enjoy what they're doing.

• 21:45Speaker 00

  And I'll get back to that in a second. And then belief, I believe I can do this. And there and going from somebody that knows they should be doing it to somebody that emotionally feels like they should be doing it, somebody believes they can do it is really the step, the steps I've seen. And, and one of the things I've been lucky enough to do in addition to my role as a, as a doctor and athlete is, is about 15 years ago, I recognized that one of my, one of my powers was influencing people. I think I was an influencer in activity before there were influencers per se.

• 22:16Speaker 01

  Right.

• 22:17Speaker 00

  And I started teaching exercise classes and I started 15 years ago. I had one of my patients was a, was a general manager at one of the gyms near my office in New York. And, and she said, Hey, listen, Sunday afternoon, about three o'clock, our place is empty. Cause I asked her about, can I borrow a studio over to start teaching exercise? Interestingly, my, one of my brothers and I were very competitive in triathlon. And I walked into a, a plyometrics class at a gym I was going to, and I took it and the next day I was like, oh my God, I'm sore as hell and my muscles feel great. And I started generating more power.

• 22:49Speaker 01

  Plyometrics is, that's body weight.

• 22:51Speaker 00

  Body weight, yeah, a little small jump training.

• 22:53Speaker 01

  Yeah.

• 22:54Speaker 00

  A lot of the kind of modern day CrossFit, high rocks type stuff.

• 22:56Speaker 01

  Right.

• 22:57Speaker 00

  And burpee, broad jump being one. And so I was, oh my God, I feel great. And so I started learning about this and then I said, I want to start teaching this to my patients. And plus I realized that when I had a community doing this horrific stuff together with me, it was fun, as you've noticed as well.

• 23:15Speaker 01

  Yeah.

• 23:15Speaker 00

  And I wanted to go do it. And so I started running these classes. Like my first class was like 15 people in the basement of gym, had to be one of the worst fitness. I had no idea, no idea how to put together.

• 23:25Speaker 01

  Like if you could go pull that video now, you'd be so embarrassed.

• 23:28Speaker 00

  Terrible, terrible, terrible. But, but I started learning about teaching fitness. Fast forward to today, we have like about 55, 60,000 people on our list serve for these fitness classes and we run these massive classes.

• 23:41Speaker 00

  We get, last year we got about almost 14,000 people up moving.

• 23:44Speaker 01

  Wow.

• 23:45Speaker 00

  And it's so empowering. And when I started, it was just people like me, runners and triathletes in Central Park, doing hill sprints and jump squats. Over time, people brought their kids and their parents and their grandparents and multi-ethnic, multi-size. Now we run everything from yoga to Zumba to strengthening.

• 24:05Speaker 01

  And where are these run? Are these run in your, your facility?

• 24:07Speaker 00

  I do them both know. They're out in Central, all in public places.

• 24:10Speaker 01

  Okay.

• 24:11Speaker 00

  And then we have different kind of grants from different companies to put them on. We, we get the Flight Deck of the Intrepid, which is a huge aircraft carrier in New York City.

• 24:18Speaker 01

  That's cool.

• 24:19Speaker 00

  Thousand people at once.

• 24:20Speaker 01

  I've driven by that.

• 24:20Speaker 00

  Yes, thousand people at once, three times a summer. You'd love to have you come.

• 24:23Speaker 01

  Yeah.

• 24:23Speaker 00

  And it's so empowering because not only has the vibe changed, but the energy from people of all different, multi-generational, multi-ethnic, from all over the place people come in. And it's just so, it's, it's really what motivation is, which is people help, people want to connect and they want to help other people. And, and so yes, you can do a, you know, some workout on your own in your, in your room, but it's so much better to have a community. And that's what I realized early on. And so I think one of my superpowers was, was really to recognize that bringing people together was a way to harness motivation and to encourage motivation. That really made a big difference.

• 25:00Speaker 01

  That's so cool. And you know, you have, I love that you have a philanthropic side to you too. You say like every fourth class should be free.

• 25:08Speaker 00

  Oh, they're all free. They're, everything's free. So everything I do is free and they get subsidized. I mean, I'm lucky that as a physician, I do fine and, and, and I really want this to be a prescription that encourages people to, to, to, to go forth and to inspire others. And that's to me, everything I do is, is in that space is all free. And I, and I, and I want it that way because I want people to be able to come and to bring people from different communities. And it really is people all working together.

• 25:35Speaker 01

  Yeah. So, I mean, as a sports medicine physician, obviously you're seeing the whole gamut, right? You're seeing people that have sports related industries, but injuries, but they're not, they're not a professional athlete. And then you're seeing the really, really high performers, you know, the people that are functioning at, at the highest level of performance in their, their careers or athleticism. And what have you seen in the data coming from using exercise as a prescription, some medical prescription, which I love? What have you seen in the data? Like what, what biomarkers do you see shift? And what are the consequences of those? Because when you look at the broad data on the status of healthcare in America and the number of people with metabolic syndrome, the number of people that have chronic, chronic

• 26:20Speaker 01

  disease, the, the cost of chronic disease to the average American, we don't realize what portion of our tax revenue is just going to support preventable chronic disease.

• 26:30Speaker 00

  A hundred percent.

• 26:31Speaker 01

  Can we get a little granular maybe on some of the biomarkers that you're seeing?

• 26:35Speaker 00

  Sure. So I think there's, it's kind of a, it's a broad question. I think first of all, there's, there's no question that people are healthier when they move and you know, the, the pillars of, of functional medicine, you know, healthy activity, healthy community, healthy movement, healthy diet, healthy sleep. You know, these are some of the things that are, you know, ubiquitous. And then when you look at, you know, some of the work done in blue zones where people are not necessarily wealthy, but they live to 90 years plus routinely, you know, they're communal, they eat, they're not hugely.

• 27:06Speaker 01

  Communal is a big one too.

• 27:07Speaker 00

  Yeah, hugely important. They eat a kind of a diet, not with many pre-processed foods. Everything's relatively healthy. They move every day, doesn't have to, they're not doing HIIT workouts, but they're moving every day. And you know, those things are all really important to kind of think about health and, and, and the, the financial burden of chronic disease, as you say, is, is, is really incredible. And people don't realize how much money we are spending as a country on treating disease. Now, some of that I think is important, but I think the piece that I want to really think about is, you know, how can we incentivize paying for and encouraging prevention rather than paying for disease treatment? And so, you know, we encourage all kinds of things in our country already. So we encourage people to buy houses by making tax deductions for houses.

• 27:52Speaker 00

  We encourage people to get married and have kids by making tax deductions. You know, the, the things we want people to do, we incentivize that behavior.

• 27:59Speaker 01

  Right.

• 27:59Speaker 00

  And so, you know, thinking about incentivizing movement is a great concept to me. You know, when, when Mike Bloomberg talked about taxing sugary sodas in New York City, he almost got, you know, out of town.

• 28:12Speaker 01

  I remember.

• 28:13Speaker 00

  But, but he was right to start thinking about incentivizing the, we tax cigarettes, you know, incentivizing things that we want people to do because left to our own devices, you know, either we're going to pay some for, for prevention, or we're going to pay a lot more for disease on the backside. So I love the idea of thinking about what are the things we can do to incentivize the changes that we want to see. And then on the biomarker question, I think that we are learning more about that as we go. I will say, I feel like there's a little bit of, when people hear the kind of concept of longevity and I want to live as long, long as possible. Yeah, I always get a little bit uncomfortable in that space because the truth of the matter

• 28:54Speaker 00

  is, as we talked about, we've done a great job in longevity in modern science with, you know, the things that got us from our life expectancy of like.

• 29:02Speaker 01

  Sanitation.

• 29:03Speaker 00

  Exactly. Forty-one years old in the 1800s to now, you know, almost 80, 150, 200 years later, you know, sanitation and antibiotics and vaccines and all the things that have made a huge difference in health.

• 29:15Speaker 01

  Sure.

• 29:15Speaker 00

  So I think that is a bit of a misnomer. I know the movement has kind of taken on quote unquote longevity, but I think what we're really talking about is kind of healthy longevity, health span. And unfortunately.

• 29:24Speaker 01

  I agree with you.

• 29:25Speaker 00

  And then unfortunately, the United States, we have the widest gap between what's called the lifespan, health span gap, meaning our average expectancy is about 81 years old, but we have an almost 10 year, almost 11 years now lifespan, health span gap. So the last 10 to 11 years, on average, people live in poor health.

• 29:41Speaker 01

  Yeah.

• 29:42Speaker 00

  And so that is very expensive and that is really burdensome, not only on, on the people, but on their families. And think about how many people are, you know, it's, it's agonizing to see a parent go through all that. And that, that does not mean if you move every day, you will not get, I mean Lance Armstrong was the fittest guy on the planet and he had testicular cancer, right? So it's not a one-to-one correlation, but it's on average, you know, can we affect people's health through some of these preventive measures? And the answer is I definitely think we can. We have to start thinking about how we incentivize people to, to do the things we want them to do.

• 30:13Speaker 01

  So without like governmental incentives and state incentives and tax, you know, incentives, how have you, in, in your practice, running all of these exercise classes, prescribing medicine, prescribing the medicine of exercise? How have you kept people's motivation over a prolonged period of time? Cause I'm very interested in that too. You know, when I look at professional careers, you know, I'm always fascinated, not by the athlete that was great once, but by the athlete that was great over a long period of time. Lance Armstrong is a perfect example. I mean, I think seven Tour de Frances. I mean, look, I'll give you all the performance enhancing drugs you want. Go win seven back to back.

• 30:50Speaker 00

  He was a beast before he was doing, I mean, that guy was a beast.

• 30:52Speaker 01

  In a field where everybody was doing the same stuff.

• 30:55Speaker 00

  Right.

• 30:55Speaker 01

  He was the best. Yeah. And I mean, and, and there was, there was a cohort of people whose lives were dedicated to beating him, right? I mean.

• 31:03Speaker 00

  Doing the same kind of stuff.

• 31:04Speaker 01

  So it's, it's always fascinating to me that they can maintain that level of intensity over a prolonged period of time. Bring that down to the masses, which is what you're working with and prescribing exercise for.

• 31:18Speaker 02

  One of my favorite bio hacks outside of breath work by far is mineral salts, Baja Gold Sea Salt. It's got all of the trace minerals that the body needs. You know, most of us are not just protein deficient, meaning amino acid deficient or fatty acid deficient, we are mineral deficient. So a quarter teaspoon of this in water, first thing in the morning will make sure that you get all of the essential minerals that you need. It tastes amazing. In fact, I made a steak today. I actually made a grass fed steak with grass fed butter and I put just mushrooms and a little bit of rosemary and I sprinkled Baja Gold Sea Salt all over the top. Try it, it'll be your new favorite for cooking too. It's the cheapest and one of my favorite bio hacks. I don't know, a 15 or $20 bag of this will probably last you five years. This is literally the world's best biohacking secret.

• 32:00Speaker 01

  Now let's get back to the Ultimate Human Podcast. Is there anything that you've noticed helps people stay motivated longer?

• 32:07Speaker 00

  It's a great question, and it may be surprising to you. And so there was an interesting study done in Germany where they took two groups of people over, it was only an eight week study, but I use it in a lot of my talks, looking at exercise compliance. And they looked at what can we do over an eight week period of time? They took two groups, they randomized them, and they had one group who did exercise that was fun. And the fun group got to choose their workouts, they had music, they got a lot of positive reinforcement from the instructor. And the not fun group did basically many of the same exercises with basically a Germanic, non-smiling trainer and no music and no input on what was happening.

• 32:49Speaker 00

  And over eight weeks, they looked at their exercise frequency and their self-reported exercise enjoyment. And there was a statistically significant difference in the fun group. And the fun group wanted to go more, they wanted to go longer, and they had self-reported better experience than the non-fun group. And so the answer to me, the holy grail of compliance, if the holy grail of fitness is compliance, the holy grail of compliance is fun. And I think that's one of the biggest lessons we can learn. If you've come to any group event, people are smiling. Like they come to my classes, but the end of a triathlon, the end of a running event. And that's one of the things that I worry about in our, in our fitness influencer world. So many of these people look jacked and they have great muscles and they look awesome,

• 33:34Speaker 00

  and they just don't look happy. They look like they need a good mac and cheese, like they just do not look happy. And I just feel like, I just feel like the importance of fun and smiling is a big piece of compliance, not over maybe a week or a month, but over a lifetime. Smiling, what makes you smile? And I have people that love yoga, people love dance, people love strength training, but what makes you tick is what I found when I interviewed, so for my book, I interviewed my patients from all different generations, even people in their 90s who are still very active. And fun was, and fun, I think, it's a great question, the answer is fun. What makes you smile? If you smile, you're likely to keep doing it.

• 34:15Speaker 00

  And I think it's great, last piece on this, is that a challenging exercise is essentially holding in a crab or a reverse plank, where you have your hands and feet off, your butt off the ground, hands and feet on the ground. And I was trying to get people in one of my outdoor classes to hold the reverse plank for about a minute, and people hated it. And like, yeah, we can do a forward plank, we hate this reverse. And so then I had this idea where I brought a whole bag of balloons, and everybody blew up a balloon, and like 6:30 in the morning in Central Park, everybody had a balloon. And I get these ugly hats from Chinatown in New York that are like bright gold that say king. And you can get a king hat if you are basically the last person to keep your balloon off the ground while keeping your butt in the air.

• 34:59Speaker 00

  And so basically they're doing a reverse plank crab position with one hand on the other.

• 35:03Speaker 01

  So you're in a squat position?

• 35:04Speaker 00

  You know, you're kind of hands and, and you have to keep one arm, just basically balancing, keeping your balloon in the air. And people are just laughing out there and having a great time. It's like two, two and a half minutes, you don't even notice you're doing it because you're just laughing and smiling, having a great kind of isometric plank type exercise. So the idea is fun is a huge, I want people to think about, you know, so many of your listeners are in the fitness world. And I think, yes, we're all teaching fitness and what we're really prescribing is community in the veneer of fitness.

• 35:38Speaker 01

  Amen. Wow, it's so good to hear you say that.

• 35:41Speaker 00

  That's where it is.

• 35:42Speaker 01

  I think it's so good to hear you say that because meta-analyses, big data studies, blue zone studies, all, you know, link back to this sense of community, connection, purpose. Like, life's got to have meaning, things have to have, have, have meaning, you know, in these blue zones, they are, they are some of the most connected and surrounded by love and connection of anywhere else in the world. And I don't think that you could delete that and still have, you know.

• 36:10Speaker 00

  Couldn't agree more. And I think it's one of the challenges in our Western society. Interestingly, I forget which one of the blue zones it's in, it's one of them where there's, there's a term where it's a multi-generational experience, kind of equivalent to like a bar mitzvah in Judaism, where you go, the younger people go and they present life's problems to the elders and they talk through, and there's a, there's a whole built-in multi-generational experience built into one of these blue zones. There's a, there's a specific term for it, but I totally agree with you that this, as in Western society, we have kind of increasingly put our older generations out in different places, we're encouraged to kind of segment ourselves. I feel like the pandemic and remote work was one of the worst things that happened to people's mental health.

• 36:54Speaker 01

  I think so too.

• 36:55Speaker 00

  I wrote a, actually interesting, when, when the pandemic started happening and, you know, medicine, our life didn't change, a lot of people's lives changed around us. They started doing remote work and doing whatever and, and working from home, and we were still going in, doing our jobs. But I wrote an op-ed for the, for the New York Times, probably two years after the pandemic started, Tyler, working from home may not be as healthy as you think. And I talked about the science of, you know, the science of technology. So it's interesting. So I looked at basically with every evolutionary invention, from, from the wheel to the bicycle, to the car, to the airplane, to the computer, to the smartphone, people could basically move less because they could do more at home.

• 37:40Speaker 00

  And so this remote work was the, was the, was the pinnacle of that. You could work from home, eat from home, socialize from home, and people got used to doing that. And yet people's imperative to move is the same from, you know, way back when. And so I talked, the title was, people working from home may not be as healthy as you think. I thought I was going to get 10 to one love letters in the comments, dude, thank you so much for pointing this out. It was like 10 to one, like, screw you, don't touch my work from home. It was like I was slapping their grandma. I was like, I'm just pointing out, you know, the evidence. Totally. They didn't want to hear it. But, but I think this remote work has been a real challenge for people's physical and psychological. I think people need each other, and I feel like that's why the fitness community is

• 38:23Speaker 00

  so important, because I feel like it's a place where people, you know, can really interact. And that's why I think we've seen a real rise of these group fitness activations, and people don't want to be alone, it's not good for them.

• 38:34Speaker 01

  Yeah, you know, in fact, I, for a period of time, I owned a CrossFit gym. I actually exited it because, because the combination of speed and heavy weight, I wasn't a big fan of.

• 38:45Speaker 00

  Yeah, I agree.

• 38:46Speaker 01

  But I didn't think we should be deadlifting for time, 400 meter sprint, deadlift for time, complex, you know, compound Olympic lifts, you know, with soccer moms, you know, really, really difficult thing, but.

• 38:57Speaker 00

  It was good for our business, but yes.

• 38:59Speaker 01

  Yeah, great for your business. But conceptually, one of the things I, I loved about it, and there's data around this too, you know, your, your propensity to stick to a workout routine if you have a workout partner, you know, goes up precipitously, you know, if you have somebody holding you accountable. What I noticed was the 6:00 AM class became like the 6:00 AM class, the 7:00 AM class was the 7:00 AM class, the 8:00 AM class was the 8:00 AM class, and it was all the same people. And they really sort of built this community and they'd almost be like, where's Janice today? What the heck? Thursday, Janice isn't here? Somebody call her? Like, and these were not like tight friends. The only commonality they had was our fitness, you know, was our CrossFit class.

• 39:40Speaker 01

  But, you know, they were so regular and they supported each other so much, one of them didn't show up. They were calling them, texting them, are you okay? Like, what happened? We are worried sick. And, and then going through hard things as a group and emerging out the other side. Sometimes I would look around the gym and like, everybody's plastered on the floor, leaning up against the walls, you know, the wads over, laying on the weights. But there was a smile on everybody's face and everybody was like, you did a great job, you know? And, and there is so much to that, community, connection, because you wake up, you're a little tired, but you're like, oh, I don't want to disappoint my class.

• 40:20Speaker 00

  Yeah, 100%.

• 40:21Speaker 01

  And they get out of bed and then they move their ass.

• 40:24Speaker 00

  Yeah, 100%. And that's in the idea of actually calling push, push, was I want people to learn how to push themselves mentally, physically, and physiologically. And it's, you can push yourself mentally with other people, you can push yourself physically with other people, but I think physiologically, you really need other people to help push your physiology.

• 40:44Speaker 01

  And it feels good when you're showing up for somebody else too.

• 40:47Speaker 00

  Absolutely.

• 40:48Speaker 01

  Right? That sense of need is almost like, you know, caregiver, like, you know, like, I need to be there today because my partner's not going to have a partner, kind of. And I think the more that we can weave that in, you know, it's, you know, when I go back and I think about my life as a young child on the playground recess, we had a long, long recess, I went to Montessori school, so we had to actually do recesses a day. And, and I remember there wasn't a lot of structure to research, but they would throw balls out on the field and stuff. And then pretty soon, like a group of boys and a group of girls, we'd line up, we'd pick teams, and next thing you know, there was a kickball game going on, or a soccer game going on. And like, we problem solved, and we problem solved around exercise. And I look, I didn't realize what was going on back then, nine years old, I wanted to hit my friend with a stick.

• 41:32Speaker 01

  But, but, you know, and when I think about the intelligence of that, you know, it really made for a great learning environment.

• 41:40Speaker 00

  Yeah.

• 41:41Speaker 01

  Right? Because after you blow the carbs out, and you come back in, you can start to take, take in information again. So where do you see this convergence of modern allopathic medicine and exercise as medicine, even food as medicine? Where do you see these converging? Because I think one of the big problems is that a physician cannot make a living prescribing exercise.

• 42:04Speaker 00

  Correct.

• 42:05Speaker 01

  Let's be honest. There's no ICD, ICD 9, 10 codes, or ICD 10 codes, or ICD 11 codes, you know, in there for reimbursement for that. So how do these worlds collide? I think you did it out of passion and personal interest, but a lot of physicians don't have the same orientation.

• 42:25Speaker 00

  Correct. So I think that this is a case where technology can really help us. I think one of the things that happened since the pandemic is that, you know, before the pandemic happened, I never had done telemedicine ever. I never did a virtual visit ever. I didn't know what that was. I remember when, when our offices shut down, and they said, we're going to switch over to Zoom, we're like, what was that? We didn't know what that was, like, we had no clue. There was no such thing as virtual visit. I think one of the things that's come out of that is people's increasing comfort with virtual health in some ways. And I think the ability to track movement on people's devices, upload that information to, to get, I think right now, we have a bit of a TMI situation where people are getting

• 43:08Speaker 00

  all kinds of data, all kinds of blood tests, all kinds of movement stats and sleep stats. Like, I wore one of those rings for a couple of weeks, it's like, you got to sleep with them. I'm like, yeah, dude, tell me something I don't know.

• 43:18Speaker 01

  I already know I feel like shit.

• 43:19Speaker 00

  Exactly. But I think that the idea of of getting information that can be synthesized very easily and quickly, you know, I think that the old vital signs of, you know, temperature and respirations and blood pressure, pulse, they were really important and have been very important as a fundamental of seeing a doctor. But how much you're moving and what kind of activity, how much intensity? And we're increasingly really recognizing the value of intensity throughout your day. So encouraging people to put in intensity into their lives, not only their HIIT training, which you and I both love, but also just intense periods of getting people to take the stairs. There was a really interesting study that came out of the European Heart Journal a couple week, about about a month ago, looking at what's what's called VPA or vigorous physical

• 44:04Speaker 00

  activity and people putting two minutes of VPA into their day every single day versus people that didn't.

• 44:10Speaker 01

  Just two minutes.

• 44:11Speaker 00

  Two minutes of like things like taking the stairs or air squats, things to get their heart rate up. And that made a difference in their health outcomes of heart disease and diabetes, etc. So encouraging people to think about intensity, but then more importantly, how many intense minutes have you been doing, Mr. Jones? How many intensity, how much activity you've been doing? That may be part of the medical visit of the future. And now if I want somebody to see nutritionist, I can just refer them to a virtual nutritionist in some cases, and that's very easy to do. So I think that in the future, there'll be hopefully places where people have a more holistic view of their of their health. And I think over time that will become part of what we do. We're not there yet, but I think we're further along than we used to be.

• 44:51Speaker 01

  And doctors should be able to make a living doing things like this, you know, not not disincentivize or de-incentivize to do things that they're not covered for, you know?

• 45:01Speaker 00

  Yeah, I think our system in general is screwed up that way. I think unfortunately, the system really encourages people's procedures. And so there's been a real shift towards procedural medicine. So if you have somebody with meniscus tear in my office, and that may not be a surgical meniscus tear, and you manage them along, and maybe they need an injection and some strengthening, and they do a lot better from that, and they're feeling a lot better versus if somebody gets an arthroscopic surgery for that, which may not be great, the right treatment for them, but it's a lot easier to do, it's quicker, it reimburses a lot better. And people used to do those a lot. These degenerative meniscus tears were treated surgically. There was just a 10 year study published looking at the outcomes of those, and they did less well than the people treated non surgically with the same problems.

• 45:43Speaker 01

  Wow.

• 45:43Speaker 00

  But there was a real incentive towards the procedure. And so our system has has incentivized procedures instead of outcomes. And I think one of the things to think about over time as we get more data is we'll be able to basically incentivize outcomes. They were trying to do that with some of the earlier generation Obamacare people, but I think they didn't get far enough down the road. And there were a lot of other things baked into that people didn't like. But I think the messaging around this is encouraging outcomes is where we should be thinking about where we're going would be helpful for, because unfortunately, we have a procedure based world.

• 46:18Speaker 01

  Wow, I've never heard it framed that way. We incentivize procedures and not outcomes. And if you look at the outcome data, you might actually change the procedure.

• 46:26Speaker 00

  Correct.

• 46:26Speaker 01

  Yeah, no, that's, this is one of the reasons why I'm excited about AI, because I think what AI is going to do for us is is bubble things to the surface, you know, and have it be the truth. I think we've done so many peer reviewed placebo controlled, randomized clinical trials that, you know, and some of them directly contraindicate each other depending on the outcome, and maybe the study design or, you know, faulty faulty mechanics in the study or what have you. And so, you know, it's really easy to get super myopic and argue these finite points of why you should do something and why not. But what AI can do is take 700 trillion independent variables and create an actual result. Hey guys, here's the outcome. It's not debatable, right? Like, you know, I use

• 47:09Speaker 01

  this example all the time. We've never done a randomized placebo controlled study on parachutes. So we don't have any actual scientific data that they work, right? It's never been proven. Nobody would jump out of an airplane without one. So because we know what the outcome would be, right? Because we look at the outcome. And, and, and that's really an interesting vantage point to say, you know, if we actually started to focus on outcomes, not just these procedures.

• 47:36Speaker 00

  Yeah.

• 47:36Speaker 01

  We might change the whole architecture of how.

• 47:39Speaker 00

  Yeah. So I have a great example of a recent study that was published actually last year in the New England Journal of Medicine. It was, it was one of the 10 best studies in our society last year, looking at, so some of the most difficult patients to take care of are people that have kind of moderate to morbid, moderate obesity, BMI greater than 30, with arthritis in their knees and knee pain, because they come in and they're like, hey, my knee hurts. And we're like, well, we want you to lose some weight, your knee will feel better. And like, yeah, I would, but I can't move because my knee hurts. And so there's not been a great way to to think about those. So there was a really interesting study that was done, done in 61 sites in 11 countries where they took people who had, they had to be basically have a BMI over 30. They had to have arthritis grade two to

• 48:24Speaker 00

  three, so moderate arthritis on an X ray, and those symptoms correlating with that. So arthritic knees, overweight, and

• 48:31Speaker 01

  And reporting pain or mobility or reduction of, yeah.

• 48:34Speaker 00

  And they were broken up into two groups. One group, which was one third of the group, was injected with a placebo and the doctors and the patients didn't know which group they were in. They signed up being in the study. So one group was injected with the placebo and both groups got the same information on diet and exercise once a week. And so the placebo group was injected with saline. Two thirds were given one of the GLP ones. The study was funded by Novo Dornisk, but in any case, you know, it needed to be done. And so, and so they were injected with GLP one, and they tracked them for 14 months. So what happened? So the study, the group, the group that basically was given the placebo

• 49:17Speaker 00

  lost about 3% of weight. The group that basically was given the GLP one lost about 20% of their weight. Their knee pain reduced by about half, and their their self reported activity profile increased by about half compared to the placebo group. So the idea was that the GLP one was almost twice as effective at weight loss and knee score pain and activity profile. So that problem was a lot better. Now, the problem with that is that, you know, we don't know the long term effects of some of these peptides like GLP ones. And so there's some question on that, but we do know the long term effects of chronic obesity, which are really dangerous to people. So that study really is a great way of structuring. It

• 49:58Speaker 00

  was a double blind placebo controlled study. It was scientifically really well done, looking at a specific problem that helped us look at what we do. And so now we're looking at, and actually, I'm, I'm talking with some colleagues about putting together a survey study of sports medicine doctors, because in my view, five years from now, sports medicine doctors are going to be prescribing GLP ones for people in that category of overweight with arthritic knees, because they're so challenging. And our old paradigm of just lose weight and your knee will feel better. Like, dude, I would if I could, but my knee hurts too much. And so there's a lot in there about this shifting world we're in, which I'm really excited about. I think we're going to have a whole different framework and way of thinking about these problems that really blends together the different worlds. It's just we have to get there.

• 50:43Speaker 01

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• 51:28Speaker 01

  Yeah. So, so it was the weight loss coming off the knees, relieving the pain that allowed the mobility.

• 51:33Speaker 00

  Thousand percent. And, and it's a, it's a different way of thinking about it. We didn't have that option before.

• 51:38Speaker 01

  Yeah. Now, I know you're not a psychologist or a psychiatrist, but I have been reading a lot of studies recently on comparing SSRIs and mobility. And one of the first things, signs of early depressive symptoms is people become more and more and more reclusive, right? Less social interaction and less mobility. So their, their level of time they spend sedentary increases dramatically, and it almost correlates with the, with the level of symptoms. At least there's a correlation there between being very, very sedentary or increasing the amount of time that you're sedentary and your grade on these different,

• 52:20Speaker 01

  different psychological scores of depression. And how were they were able to reverse a lot of these, just with mobility as an intervention alone, using placebos, you know, sugar pill versus SSRI, but in both cases using mobility and showing that in some cases, exercise significantly outperformed psychiatric medication.

• 52:43Speaker 00

  Absolutely. And that's, there was that, you know, we'll increasingly great evidence on that exact point. I think the problem is that people would rather take a pill sometimes. They would rather take the easy route. But the problem with a number of these SSRIs is they have, you know, they're easy to go on, they're very difficult to get off, they have a lot of side effects, libido, etc. They're not perfect, and they affect everybody differently. So what we talk about a lot is exercise as a first line drug. And that's why, that's an exact example of the medicine of exercise. Because in that case, yeah, it may feel good to go for a speed walk or a run or go to a, you know, a strength class. But I'm talking about this as your physician, you're depressed, and I want you to take

• 53:27Speaker 00

  this instead of taking those other things. And let's see how that works.

• 53:30Speaker 01

  Yeah.

• 53:30Speaker 00

  And that doesn't mean there aren't people like schizophrenia that need medication or bipolar disorder that need medication. But what I'm talking about is garden variety, anxiety, depressive symptoms, etc. Those kind of things can be, you know, the best treatment for those as a first line treatment is, is exercise. And so how do we teach doctors about that? When I talk to psychiatrists and psychologists, I did a grand rounds lecture recently to a group of psychiatrists at Cornell. And I asked them at the beginning, raise your hand if you prescribe exercise to your patients. And almost everybody raised their hand, but there's no standardized way to do it. They don't, they have no formula. They don't really know who to do it, how to do it.

• 54:05Speaker 01

  Good for them, though.

• 54:06Speaker 00

  Yeah, they do it, but they don't, they all recognize it. But there's no formal mechanic to do it. And so I think that's where. This whole kind of field is, is that we want this to become, to think of exercise as a medicinal intervention.

• 54:22Speaker 01

  Yeah, I mean, I'm of the mindset that some is better than none.

• 54:26Speaker 00

  Absolutely.

• 54:26Speaker 01

  No matter what you're doing. And like you said, attached, getting the fun component in there. I mean, that's a really interesting way to look at motivation is to draw people into doing what they love to do. My wife likes to ballroom dance and dancing can be intense.

• 54:39Speaker 00

  No, it's great. And if she loves doing it, do you do it with her or not?

• 54:41Speaker 01

  No, she, she has a, she has a Russian dance partner that she's convinced me is gay, but I need to go check this guy out and make sure that he's, you know, playing for the, playing for the same team and not, you know, circling my wife.

• 54:55Speaker 00

  But it's, it's interesting though, that I think that the

• 54:57Speaker 01

  That's a true story, by the way.

• 54:59Speaker 00

  The piece on that, that is, is exactly what I was talking about before, is that everybody has a thing that makes them smile. And for her, if it's doing the, because my mom was into that, doing the bra. I mean, I remember we came home and, you know, she had four boys and she was, you know, she was amazing, an amazing mother, a psychoanalyst and tons of energy, but it came home and like mom had a fake tan, like dude, mom, what are you doing? Then mom had fake nails, like mom, what are you doing? Mom became a devoted, she would go in the middle of the day, ballroom dancer. She's like devoted, she would go to these different balls and she had a dance teacher of the same ilk. And, and it made her smile and it really gave her a purpose, you know, purposeful, you know, to me, I suck at ballroom dancing and yeah, fine, I could do it.

• 55:44Speaker 01

  I would do it for my wife, for sure.

• 55:45Speaker 00

  Yeah, it was fun. But anyhow, my mom loved it. And I think your wife loves it. And so I think the idea here is that what is your why? What makes you feel a purpose? And if it's ballroom dancing or whatever it is, that's great.

• 55:58Speaker 01

  So tell me where all this is going for you. What projects are you working on? Which am I audience to be excited about? That you're, that you're, you know, you're endeavoring to do?

• 56:08Speaker 00

  Well, first, I think the idea of kind of studying motivation and talking about motivation, you know, push was, I worked for about five years on my book, Push, about trying to understand the science of motivation. And when I looked at it, my other books have been a lot about taking care of your body or your achy knees or, you know, very hard things. Push is a lot about how do I assess my own motivation? And how do I realize where I am on my own motivational spectrum? And then how do I make it better? What are the things standing in my way? What's limiting me? And so I've been talking and thinking a lot about lecturing about motivational health and basically trying to unchart, unlock your own motivation, which I think people can really do. There's a term I've been, I've

• 56:50Speaker 00

  been really using, which I love, called lowering the cost to act, which is basically taking what you want to do and making it what you do. And, and so that means I know I should be strength training. I know I should be walking. I know I should be moving. I know I should be doing whatever thing. What are the concepts that are going to make me make what I want to do and what I do the same? When I started researching push, I thought there were people that were motivated and then people that were unmotivated. I don't think that anymore. I think everybody's motivated.

• 57:22Speaker 01

  Yeah.

• 57:23Speaker 00

  I think the people that are successful have learned how to lower their cost to act, meaning they pay for a trainer in advance. They join a walking community. They join a running community. They join a high rocks. They join a CrossFit gym. They join ballroom dancing. They join things that will make them want to go. And I've seen so many different instances of this. I had one guy who I write about, who really wanted to go to the gym, but he couldn't get himself to do it. And he would go, he financed guy worked super early in the morning. And then the way home, he's like, I'm tired. So what he would do in the morning, he loved his, his workout clothes and his workout shoes. He would go to one of the local gyms that had day lockers. It's six in the morning, he'd lock his stuff in the locker room. And then if you come back at the end of the day, if you're not

• 58:06Speaker 00

  there, they cut off your lock and put it in the lost and found. So he would have to go back to the gym to pick up his stuff on the way home. He's like, as long as I'm here, I might as well.

• 58:12Speaker 01

  Yeah, that's good.

• 58:13Speaker 00

  And that's it lowered his cost to act. And so this whole idea of, of learning to understand and unlock your own motivation, because I feel like we've, many of us in this kind of health, healthy space, talk about the same kind of things. But how do we get people to actually do it? And not only people like us, we're going to do it no matter what. But how do we get the other people to do it? And I think that whole idea of figuring out how to lower people's cost to act, I find to be very powerful. So working on that. And then I'm also lucky to be involved with our local running organization called the New York Road Runners Club, which is a world's biggest running club, put on the New York Marathon and a whole bunch of events in New York. And we are starting a whole research collaboration around figuring out why runners get hurt and what we can do to

• 58:58Speaker 00

  keep them on the road. So I'm very interested in that as well.

• 59:00Speaker 01

  Wow. So, so what are, one, some things that people can do to lower their cost to act? And for a listener right now, who's like encouraged and motivated and excited about this, what could they get up and do today, you know, to sort of change the trajectory about how they've been viewing mobility in their life? I mean, how do you take something that hasn't been a priority for two decades, three decades in somebody's life and shift it to a priority without some kind of traumatic life event where they've come to see you for their

• 59:31Speaker 00

  Yeah, yeah. No, it's a great, I mean, that's, that's most people. And I think they have to, they have to figure out what motivational trigger they have. For many men, it's financial. Guys respond better. So this, this whole idea of lowering the cost to act comes, there's a center for behavioral economics at Penn and it's a, it's a, University of Pennsylvania has a dual center between Wharton, the business school and the med school, trying to figure out behavioral economics, what makes people change. And interestingly, they came to the conclusion it was like a dollar thirty a day. It's a little, small number. But, but men respond better to financial triggers. So men who are listening should find a trainer and prepay 10 sessions.

• 1:00:09Speaker 01

  Ooh.

• 1:00:10Speaker 00

  And so if you prepay, like dude, I paid the money, they're charging me if my ass is there or not, I'm going to go there and get my, men respond very well to that trigger. Women respond very well in general to communal triggers. And so I'm going to join a community, I'm going to have a friend, I'm going to sign up for a thing with a friend.

• 1:00:27Speaker 01

  Do it with a girlfriend.

• 1:00:28Speaker 00

  Do it with a girlfriend. I'm going to start doing that. And those in generalities tend to be the two most effective triggers for people. And then you start, one thing I write about and think about a lot is what I call the exercise wheel. If you want to get a, from your old CrossFit days, if you want to get a tractor tire from here to across the room, the biggest energy is getting that damn thing up off the ground. Once it's rolling, it gets a momentum of its own.

• 1:00:53Speaker 01

  Right.

• 1:00:54Speaker 00

  Not flipping, but rolling. And so if you can get that thing rolling, it starts to basically get its own speed and momentum. And that's what I want people to think about. How do I get my own tractor tire rolling? And that's by lowering my cost to act.

• 1:01:05Speaker 01

  Wow, that's so great. I mean, you know, there's, there's some really interesting technology coming out, these predictive AIs. I was actually looking at one this morning. A group came over in the AI space and was demonstrating it to me. And I thought it was really fascinating because what it did was it painted a picture of exactly who you are now, based on the exact date of today, right? Your BMI and all of these, all these other data scores, your, your hyperinsulinemic, you're insulin resistant, you have high triglycerides, you have all of this going on. If you took these actions, this is where you'll be in 10 weeks, this is where you'll be in 12 weeks, and this is where you'll be in 21 weeks. And it actually created photorealistic images of their body morphic.

• 1:01:47Speaker 00

  I love that.

• 1:01:48Speaker 01

  And I was like, wow, that's really cool. Now, the downside would be if it wasn't accurate, but they are assuring me that this is with extraordinary accuracy because the amount of data that they were able to pull into this, which is another thing I'm encouraged, you know, with, by AI about.

• 1:02:04Speaker 00

  Yeah.

• 1:02:05Speaker 01

  So if you knew you might look like that by this date, that's sort of something we can conceptualize. It's like, okay, Thanksgiving is three months out and the whole family's going to be here. By Thanksgiving, I can look like this. Or my wedding date, my son's wedding, my, my buddy's bar mitzvah, whatever it is. I think those kinds of triggers for people, exactly what you were talking about, whether they're financial or communal.

• 1:02:27Speaker 00

  That's lowering their cost act. And that's, that's a great way to think about that. I'm lowering the cost act by basically, I want this outcome. And so this is where I'm now. I want to get to that outcome.

• 1:02:36Speaker 01

  Yeah, but it was the first time that I'd seen be able to show it to you.

• 1:02:38Speaker 00

  That's so cool.

• 1:02:39Speaker 01

  It's like, you're sitting here, you look like this. How about, you want to look like this? This is how long it's going to take.

• 1:02:43Speaker 00

  Can I have biceps like you? That's what I'll take.

• 1:02:47Speaker 01

  Thank you. No, you're making, you're making me feel great. Dr. Metzl, this has been amazing, man.

• 1:02:51Speaker 00

  Loved it, loved it.

• 1:02:52Speaker 01

  For my audience that has enjoyed this as much as I am, where do they find you?

• 1:02:56Speaker 00

  So I'm on a social media at DR Jordan Metzl. That's kind of my main Instagram, LinkedIn. Not doing TikTok, I probably should, but I'm not.

• 1:03:06Speaker 01

  You don't want the Chinese spying on you?

• 1:03:08Speaker 00

  Exactly. They can spy, I don't care. And then I've actually been working, you'll see there, I've actually been working with an AI company about doing a an AI of just my own information. So that's been really interesting. This company, it's in my link tree for my Instagram, but basically it's all the talks and lectures and podcasts and research papers, everything I've done over 25 years, all loaded into one AI. So then they can ask me a question from wherever and I can answer them when I'm sleeping. So it's good.

• 1:03:35Speaker 01

  Love that. So I'm going to put all of that in the show notes and I wind down all of my podcasts by asking my guests the same question. What does it mean to you to be an ultimate human?

• 1:03:47Speaker 00

  To me, the ultimate human is to me, would meant to be a doctor, which is I got into medicine because I really loved helping people. There's just people have different jobs, they have different, you know, they're, they're, they're, they're filled by different things. Some people want to be seen, some people want to be financially successful, some people want to be famous.

• 1:04:09Speaker 00

  To me, I, listen, I love being successful. I love all those things, but the most gratifying is when you can help somebody and they look at you and say, hey, Dr. Metzl, you really made a difference in my life. I did this thing. I get a picture from somebody finishing some event or something and said, I really am so thankful to you for helping me get to this piece. And, and it's that one-on-one human connection. To me, an ultimate human is, is basically helping other people achieve their goals. I find that to be so gratifying.

• 1:04:35Speaker 01

  That is so good, man. You know, John Maxwell calls it about living a life of service, not a life of significance. And if you've ever had the benefit and the gratification of living a life of service and seeing that service come back to you in a very rewarding way, which is rarely monetary.

• 1:04:54Speaker 01

  It really is deeply gratifying. Before we close out, and I usually don't do this, but it just sparked my interest in something. Is there a, a patient of yours or story that really stands out to you? Like someone that came in to see you just battered, broken, desperate, desolate, maybe not. But, and you did this prescription of medicine, maybe you had some other traditional medical interventions? And that story sort of still sticks in your mind?

• 1:05:23Speaker 00

  Not only do I have one, but I started, I started Push with it. So I start Push with a narrative story about a woman that came in to see me in her late 60, mid 60s. And she had simultaneously had a breast cancer diagnosis and lost her husband in the same two-year span at 68.

• 1:05:42Speaker 00

  Now those two things together could put people to the point where they're like, listen, I just don't feel like doing this anymore. I'm alone. But she was a fighter and, and she started, she started going out for walks and she started walking. And then she started slow jogging and then she started slow jogging a bit more. And at age 70, she ran her first marathon and I start my book with her. Then she did another marathon. By age 82, by age 82, she'd run 15 marathons. And at age 83, she started teaching a kettlebell class for people 80 and over.

• 1:06:15Speaker 01

  No, really?

• 1:06:17Speaker 00

  She's the first patient in my, she's the first story in my book.

• 1:06:19Speaker 01

  That is amazing.

• 1:06:21Speaker 00

  And, and I find people like that so, I'm so, I'm lucky because, you know, listen, being a doctor is not easy. It's, it's tiring. You're there a long, people see like Instagram doctors, like, hey, it's not like that. Like you're there early, you're there late, you get a lot of people, a lot of questions, a lot of energy, a lot of interaction. It's exhausting.

• 1:06:41Speaker 01

  Yeah, yeah, a lot of withdrawals.

• 1:06:42Speaker 00

  It's, it's, it's a lot of withdrawals, but it's so gratifying to have people like that. In the book, I call her Alice. And, and Alice's story is exactly the story of basically overcoming sadness through activity and, and not only herself, but she inspires so many people around her that, that I consider someone that I have to be so gratifying.

• 1:07:04Speaker 01

  That is an amazing story. And there's so many layers to that story too, because she found her community and her connection. You know, losing, losing a husband, I imagine at mid 60s, probably married for a long time, very isolated and then getting this.

• 1:07:19Speaker 00

  Community movement, all the things together.

• 1:07:21Speaker 01

  Yeah. Did she beat the best cancer conventionally?

• 1:07:24Speaker 00

  No, no, no. She did through chemo and everything. Yeah. Chemo, yeah, chemo. And then started using, then started using exercise just to help her feel better because she was so depressed and it really made a huge difference for her.

• 1:07:34Speaker 01

  Amazing. Dr. Metzl, thank you so much for coming on the Ultimate Human Podcast. This was amazing. I know my audience is really going to enjoy it. Your energy was very catchy. So I'm sure I went right through the camera and motivated my audience. So guys, until next time, that's just science.