Continuous glucose monitoring to optimize health span

Dr. Maloof: [00:00:01] We are spending way too much money later in life giving marginal benefits to people and, really, the unfortunate truth is that if we want to get another 20 years of life into the American population we have to start investing in health when we’re young.

Peter Bowes: [00:00:18] Dr. Molly Maloof is a San Francisco-based medical doctor biohacker and health entrepreneur. Hello, and welcome to LLAMA, the Live Long and Master Aging podcast. I’m Peter Bowes. This is where we explore the science and stories behind human longevity. My guest today is Head of Medical Science at Sano Intelligence, she is a data-driven, I think it’s fair to say, biomarker obsessed medical practitioner. She’s smiling, it must be true. All about enhancing health and health span, rather than treating disease when it inevitably happens.

Peter Bowes: [00:00:54] Dr. Molly Maloof, it’s great to see you.

Dr. Maloof: [00:00:56] So great to be here, Peter. Thank you.

Peter Bowes: [00:00:58] Is that accurate? It’s about hitting that problem before it occurs, it’s prevention rather than cure?

Dr. Maloof: [00:01:02] I really love that introduction. I might have to save that and use that in my bio.

Peter Bowes: [00:01:06] Well it’s good. It’s good to be accurate. So Sano Intelligence, what is it?

Dr. Maloof: [00:01:10] Sano Intelligence is a continuous glucose monitoring patch. It’s a micro-needle patch, so instead of it being a needle in your arm like the current CGMs on the market, which are clinical grade, we have a micro-needle approach. So, for a lot of people, putting a needle in their arm and wearing that for two weeks is concerning, it’s scary. So we’re going to be sort of an introductory tool people can use to put on their arm, find out through the course of a day, how their food is affecting their blood sugar in real time.

Peter Bowes: [00:01:40] Is this something we could all get access to? Because obviously one of the issues, and this is something I’d like to do for myself. I haven’t actually ventured into that area yet, because when you’re biohacking, I think you can be deluged with so many things you can monitor. I’m kind of quite strong on just doing one thing at a time, or at least progressing slowly. However, if I did want to monitor my glucose, getting hold of a glucose monitor isn’t that easy, is it in this country?

Dr. Maloof: [00:02:02] It’s not. In fact, it’s clinical prescription right now, and even if you have diabetes type 1 or type 2, it’s actually pretty hard to get one from your doctor and get it covered by insurance. Because a lot of times, you have a fairly brittle diabetic to actually get the treatment you need. And so I personally feel like this is the best tool for monitoring glucose, and glucose is the ultimate lifestyle biomarker, and I think it’s actually one of the better longevity biomarkers as well.

Peter Bowes: [00:02:31] So let’s dig deep into them actually what I want to do is talk about you and your background and how you got to this point. But since we’re there, let’s dive into glucose. Simple question, why would I want to monitor my glucose on a daily basis?

Dr. Maloof: [00:02:46] There are so many different reasons, but the first one is that we have an epidemic of diabetes, and diabetes is happening far more commonly than we realize. In fact, around 80 million people have pre-diabetes and only 11 percent of them know it. And part of the reason why not everybody knows they have pre-diabetes, which by the way is the state of blood glucose being in a fasting state between 100 and 120, and then there’s also a post-prandial glucose you can get tested, which is after meals. If that’s too high you can also get a diagnosis of diabetes.

Peter Bowes: [00:03:18] So, generally, this is the test when you go to the doctor and they say, fast overnight. And you get a little blood test the next day. That is your fasting glucose state.

Dr. Maloof: [00:03:26] Right. You can also get a hemoglobin A1C to get a diagnosis. Although it’s not a very good test. It misses a lot of people, it’s much more sensitive for diabetes and than diabetes. So the last remaining test for testing if you have pre-diabetes is a glucose tolerance test, which is when they give you a bunch of sugar and then they test your glucose after the course of an hour or two. Now the problem with this test is that A. it’s time consuming. Nobody does it. Nobody wants to sit in the lab for two hours. B. drinking a bunch of sugar is in my opinion not the healthiest thing you should have to do for your body and their problem with it is it’s a real world experience. To me, the best test for your glucose metabolism is continuous monitoring because you can actually see how your blood is changing over the course of a day over the course of a bunch of different meals over the course of different exercise programs you might be doing. But back to what I was saying before about pre-diabetes and diabetes, a lot of people don’t know they have a problem before it’s really, they’re really sick. And the pre-diabetic state is a pathological state, in my opinion. Because all the research that I’ve done is showing that we’re losing organ reserve when we increase our blood sugar over the course of our lives, over the course of many, many years our blood sugar can slowly climb silently affecting us. It can affect our vision, it can affect our kidney function, it can affect our blood vessel function and a large percentage of heart disease is related to poor blood glucose control. So we’re waiting until it’s too late, and by the time you have diabetes your body’s already lost half of your beta-cell function and it’s actually lost a lot of beta-cell function when you have pre-diabetes. So I think we’re we really need to be thinking you out blood sugar far sooner than that doctors are telling us.

Peter Bowes: [00:05:04] Are you suggesting that this is something we should therefore all be doing? Because.

Dr. Maloof: [00:05:07] I do

Peter Bowes: [00:05:08] Because we could be preventing a condition that might simply not otherwise occurred to us as being susceptible to?

Dr. Maloof: [00:05:15] Well it’s not even just heart disease, diabetes, but cancer lives on glucose. If your blood glucose is high over the course of many, many years. And you have a little bit of cancer, you’re just feeding it fuel. So I think it’s really important to manage blood sugar. It’s like it’s like a core part of my practice at this point, because if you have poor blood sugar control, you also have impaired hormonal function. It affects cortisol, cortisol can lead to insulin resistance, it can raise your blood sugar, but then it can also make you crave sugar. So there’s this whole intertwined relationship between blood sugar and cortisol blood sugar and your thyroid blood sugar and your sex hormones. And if you don’t have a good control it can affect everything downstream.

Peter Bowes: [00:05:52] So tell me more about the patch that you’re developing. What stage are you with it?

Dr. Maloof: [00:05:58] We are getting better and better accuracy every day. We are hoping to launch in 2019. It is not an easy task to create new technology. I, for some reason, love working with really hard problems, and hardware companies are in my in my opinion, some of the hardest problems to solve. Because they involve know software, firmware, hardware design, you know data interpretation and planning and product development and user testing. And so we’re doing all of these things right now, and we’re doing some small private clinical studies to test it with different interventions, so it’s we’re coming along. I would like to say that we are going to be you know hopefully launching in 2019, that’s what we’re really aiming to do.

Peter Bowes: [00:06:40] And in terms of the physicality of the patch, how easy is it to work. Do you realize you’re wearing it? What is actually involved on a daily basis?

Dr. Maloof: [00:06:48] So you have to, know the difference between our patch and the competitors is these other ones are disposables. And we have a pod that is in a disposable pod that you will use and you will keep, and you’ll put it into the patch and you’ll wear it on your arm and you’ll take it out and recharge it and you’ll reapply with different patches. So we’ve got the micro needles that are disposable and then we have the the little pod that’s rechargeable. The reason why is because we have a Bluetooth, right. So that that syncs to your phone. Most Bluetooth-enabled devices are not disposables. Most companies that are using you know the most current continuous monitors are designed like Abbott Libre is designed to be a disposable patch. So what we have is you put in on your arm, and you know the form factor currently we’re working with designers to make it a little bit cooler looking. But you know the biggest complaint we get is that people ask if you have like a medical device, like are you wearing a nicotine patch or something. So we’re trying to work on it getting to be less medical-looking, because we really want it to be a consumer product. But you know you don’t really notice it much, honestly. You don’t really, oyu feel it when you put it on but you only just feel the, there’s like a mechanism where it kind of it attaches to your arm with this spring-loaded device.

Peter Bowes: [00:08:01] A little bit in the way that activity trackers are now being developed as rings or almost accessories. That you wouldn’t otherwise blink at.

Dr. Maloof: [00:08:09] Right. Exactly. I mean it’s going to take time for us to get to the point where we have wearables that are invisible wearables that are very, very like imperceptible. I think we’re going to have to wait until implantables for that to happen, which I personally would get if I could get a continuous glucose implantable. It would be amazing and I would totally put that in my body.

Peter Bowes: [00:08:29] Now you mentioned the, everything you’ve got to concern yourself with. The hardware, the firmware, presumably, eventually, the marketing and that side if it. You’re a doctor, and presumably a lot of this doesn’t come naturally.

Dr. Maloof: [00:08:41] Oh you know that’s the thing about working in tech for the last six years. I’ve worked with over 20 tech companies now. And so the most wonderful part of my life is that unlike most doctors, I have so much novelty. I get to experience so many different new technologies. I get to work with people who are geniuses at product. I get to work with people who are genius engineers and I get to talk to people who are like signal processing experts and just absorb what they’re teaching me, what I can learn from everyone, really enhances my own worldview and makes me more humbled about, you know I think a lot of doctors kind of walk around with a perspective that they know it all. And I have learned that through working with a bunch of technology companies that there is so much that I don’t know. And in fact the more I learn about the body the less I realize that I do know. And the more that I want to research. And that’s a big part of my life as well is just poring through data, and poring through white papers.

Peter Bowes: [00:09:31] Have you always been like this? Let’s go back to my original thought. What were you like as a child growing up?

Dr. Maloof: [00:09:35] I was definitely the kid in my family who while I was in her dad’s workshop playing with things and tools and taking things apart. And I remember, I once took apart a television, and right before I was about pull out this spark plug, apparently, my dad was like, No don’t do that. You’re going to blow up your face.

Peter Bowes: [00:09:50] Television have spark plugs in them?

Dr. Maloof: [00:09:51] They have some sort of plug that would have generated a spark. And my dad said that if I would have pulled that out it would have probably blown up face. So these are old televisions. But I was also a child who was doing you know science projects on you know, I was fascinated with the body, so they were always related to different organ systems and I decided to become a doctor in fifth grade. I mean it was like a clear calling in my life, that I wanted to I wanted to do this. I was reading Michael Crichton. I loved reading books written by doctors and I loved Russian novels written by doctors so I was kind of a strangely precocious kid.

Peter Bowes: [00:10:27] And looking back now, so making that progression you knew you want to be a doctor. And the kind of training that you had as a doctor. Did it live up to your aspirations?

Dr. Maloof: [00:10:36] I mean medicine was by far, medical school was by far the most challenging intellectual experience I’ve ever gone through. And so, it certainly lived up to the expectation of it being very hard. It wasn’t like I was one of those medical students who was like oh yeah med school was a breeze, because there are people who say that. No not for me it was hard. I had to study a lot. And in the process of studying a lot I let my health fall to the wayside when I was in med school and through that experience I realized that I needed to take better care of myself. And so I started doing yoga and I started exercising more and started eating normal meal times. I stopped skipping meals I started sleeping better. Making my sure I cut myself off from studying at night and meditating. And I did all these things for my lifestyle, because I’d gone to a psychologist because I was so, so upset that I was like not thriving in med school. And he said well, look you’re just not managing your stress well. And I’m like oh so I’m not anxious or depressed and he’s like, no. He’s like it’s your responsibility to fix this I’m like oh. And I took it seriously and I did that, and I dramatically improved my performance in school. I dramatically improved my brain function. I dramatically improved my relationships and I realized that lifestyle medicine was something that I could pursue.

Peter Bowes: [00:11:53] There’s an interesting parallel here isn’t there, between your own life and what you were learning in medical school? The classes that you were going to, that clearly perhaps weren’t teaching you know what real life was showing you.

Dr. Maloof: [00:12:04] No not at all. And, in fact, because of that I decided to design a course for students called Physician Heal Thyself: Evidence-Based Lifestyle. And it’s funnily enough I did this course the first year that the American College of Lifestyle Medicine by David Katz was founded. So I feel like there was a lot of people in the world thinking about lifestyle medicine at the time and I just happened to be a precocious medical student thinking, okay we are not being taught about nutrition. We were taught basically calories in calories out. And I argued with my teacher, because I was reading that book Good Calories Bad Calories. And I was thinking, this is new science and we’re being taught out of date science and this is kind of ridiculous. So I brought in experts who I thought knew more than my current professors did about things like functional medicine and integrative medicine and osteopathic medicine and acupuncture and all these things that we just like weren’t being taught and allopathic medical school. And it was a huge hit of a course, like students loved it. I learned a lot. Everybody learned a lot, and it really helped shape my worldview around how important it is that we care about our lifestyles because 80 percent of our diseases that we treat in hospitals are preventable.

Peter Bowes: [00:13:10] I would venture to say that most people I would say the majority of people just a gut feeling still believe that the calorie in is equal to a calorie out.

Dr. Maloof: [00:13:19] The problem with that theory is that we are not a closed system. And we are also not a single organism. We have a micro biome filled with trillions of other organisms and that affects our blood sugar, that affects our hormone metabolism, that affects a lot of things that we don’t think about every day. Our hormones are intimately tied to our weight set point. And when people develop obesity and overweight over the course of many years, that also changes the structure of their brain, the parts of their brain that establish the set points right. So, you alter your body’s physiology by the nature of how you grow over time. And the problem with calories in calories out is that there have been plenty of studies showing that like people have literally done studies where they add more calories to their diet. What it does is it ramps up their metabolism like a thermostat. So you put more fuel on the fire, the fire will burn harder. Anybody who’s ever fasted will understand it. If you fast you will burn much colder, you will literally turn down the temperature on your body. There’s this great episode on being by Krista Tippett about a physicist who was studying heat transfer and aging. And he basically thought he basically felt that essentially that he feels that like aging is essentially this process of our body is changing over time. But one of the things that he said was that the difference in heat is what is how our bodies detect time, he was theorizing. And so essentially one of the theories that I have around fasting is that when you fast, you’re literally turning down your body’s metabolism and you’re slowing down your your body’s ability to age as fast as it normally would be. I have a better explanation to that written out. I mean we get into fasting next.

Peter Bowes: [00:15:04] Since you brought it up, and I’ve experimented with fasting I know you have too, what kind of fasting do you do, and this is one of the, I suppose irritations for me, is that people say fasting, and it can mean so many different things.

Dr. Maloof: [00:15:18] Well first and foremost, the initial concept of fasting is just not is like the period of time when you’re not eating right. To me like the moment you stop eating is the moment you start fasting.

Peter Bowes: [00:15:27] So you and I are fasting right now.

Dr. Maloof: [00:15:30] We’re fasting right now. But the problem is that it also depends on like when was your last meal. Right. So you know to me like when you stop eating is when you start fasting. And most people are eating six to seven meals a day. And so most people are not really fasting very much at all. Most people are also eating a late night snack or a snack later in the evening, the moment they wake up is the moment they start eating. So they’re probably fasting for maybe eight hours if they’re sleeping. And the problem with that is that you’re pushing a lot of insulin into your body throughout the day and insulin is a growth hormone. It’s a hormone that puts weight on your body, it keeps weight on your body. And so if you’re always have insulin in your body you’re going to be maintaining whatever weight that you have right now. So that’s another reason why calories in calories out is problematic because if you’re eating a lot of refined carbohydrates and sugars you’re putting a lot more insulin into your body because your body has to compensate for that huge stimulus and that over and usually is to overcompensate by pushing up more insulin than it needs. And by doing so you’re putting your body in a growth state and a state that’s wanting to put weight on over time. So fasting is magical because fasting puts your body into a state of catabolism versus a anabolism right. When you think of the word anabolism it’s like anabolic, think of like growth. catabolism is breaking down. Now there are some benefits to anabolism, like putting on muscle. There’s also some benefits to catabolism like losing weight and autophagy – is the way that we take out the garbage of ourselves. And fasting is one of the best ways you can activate those processes in your body.

Peter Bowes: [00:17:03] Autophagy some people describe it as cells eating themselves, just so throwing them out of the body.

Dr. Maloof: [00:17:08] I just think about it is like a dirty kitchen that someone cleaned up put the garbage on the garbage disposal took the garbage out and now it’s spotless.

Peter Bowes: [00:17:15] And fasting accelerates that prcoess.

Dr. Maloof: [00:17:16] It absolutely accelerates it. And you know when I started getting into fasting earlier this year as one of my new year’s resolutions I was like I’m going to learn how to fast. And so I always recommend, because bodies don’t like being shocked, to take your body and slowly ramp it up to the point of getting to 16:8 which means 16 hours fasting eight hours eating. That means if you’re only if you’re actually eating for 16 hours during the day, you basically want to either eat breakfast an hour later or stop eating an hour earlier. Whatever it takes to slowly compress that that time period that you’re eating to an 8-hour period and stick with that for a little while your body adjusts. So slowly hour by hour week by week get your body to adjust to this new regimen. If you can do it easily, you can accelerate the process. But then one of the benefits to getting to like a 24-hour fast is you’re depleting your glycogen stores, and glycogen is your storage carbohydrate. It’s your storage fuel. You’ve got about 24 hours in your body, but when you hit that point where you’ve depleted your glycogen in your liver, it’s called the metabolic switch, and there’s a lot of research that’s happening in health span extension around how beneficial this metabolic switch really is to improving our health, improving our metabolism and improving our metabolic flexibility. And metabolic flexibility is this a fascinating new term that I only learned about a year ago. That is basically our ability to switch from carbohydrate burning metabolism to fat burning metabolism and our ability to do that effectively and easily declines with age because a lot of people develop insulin resistance and lower insulin output as they get older.

Peter Bowes: [00:18:57] So this is the point at which you begin to move into what’s known as ketosis, burning fat-burning ketone bodies.

Dr. Maloof: [00:19:03] Yes. Exactly. And you can burn, you can be burning fat and carbohydrates at the same time. What people kind of get confused about, is they think that you either have to be in full ketosis burning only fat or only burning carbs. Most people are actually burning a little bit of each. And there’s a really cool tool called the Lumen by Metaflow, it’s this Israeli company that I met about a year and a half ago. And they gave me this device and you blow into it and actually shows you in real time what fuel stores you’re burning based on this respiratory quotient, which is a complicated way of describing the difference in carbohydrate, the difference in carbon metabolism by whether you’re burning fat or carbohydrates is fuel. So it comes out as like a number, and the lower the number the more fat you’re burning the higher.

Peter Bowes: [00:19:53] It sounds like actually quite a simple way to assess where you are on that scale.

Dr. Maloof: [00:19:55] I mean it’s a lot faster than pricking your, I mean I have a tendency to just like prick my finger and test my ketones and my blood sugar. But it’s nice to just blow into something and have to do that without having to think OK. Like where am I at? It does, I think you know the company is really early and it needs a lot of work. Still like any new hardware company. But I think it’s very promising.

Peter Bowes: [00:20:17] So explain for us. What is the benefit of moving into that keto-adapted state?

Dr. Maloof: [00:20:26] I’m going to preface this with I’m not a big believer that everyone needs to be Ketonic. In fact, I believe that there are times and places in both our individual lives as well as the individual seasons where we will want to be more adaptive versus more fat-adaptive versus more carb-adapted. To me, carbohydrates are fast fuel that are great for burning when you are active. If you are out and you’re running around and you’re really busy and it’s summertime and you’re getting a lot of activity, you’re going to eat more carbohydrates, because you’re going to need more effective fast fuel. In the wintertime, when you’re not movies as much. You know burning fat and being a little bit more ketonic is better I think, because it’s going to keep me from putting on all that winter weight. I think it might reflect the way that humans evolved. You generally would see more plants in the summertime that are able to be harvested right. And in the wintertime you’d be eating whatever’s in storage. And that is your storage. So yeah that’s one of my belief system. There’s also this whole concept of different body types. There’s different people who have, you know there’s like sort of the ecto, endo, mesomorph body types. Certain people are just sort of big boned, tend to need to be a little bit lower carb, certain people are going to be just higher, fast metabolisms. They tend to be naturally skinny, they tend to eat carbs really easily. And there’s people like me who just are kind of in the middle, whereas, you know for me I have to be kind of careful with my carbs. I use them as fuel. They kind of reflect how much I exercise. But the concept of metabolic flexibility is that you’re not stuck in just carb-burning metabolism, which a lot of people are stuck in. Because a lot of people just eat so many, so much sugar, and so much refined carbohydrates, they eat too many crackers, pies pastries, breads, pastas, pizzas all of these things that have been added to our diets dramatically over the last – I mean if you really look at what’s problematic for our society – over the last like 50 years you know, since the 1970s we’ve dramatically increased the amount of vegetable oils and refined carbohydrates in the diet. If you look at what those are found in, it’s packaged processed foods it’s corporate-made food. So the easiest thing anybody could ever do to optimize our metabolic flexibility and optimize our blood sugar control is reduce these products in the diet and just switch over to three meals a day and then eventually get to two meals a day. And to me that’s like a superpower if you can actually even fast for more than 24 hours without getting crazy, without getting hangry, which by the way I used to get hangry. Now I can fast for a few days, easily.

Peter Bowes: [00:22:52] What’s your definition of hangry and can you give me a scientific basis for us?

Dr. Maloof: [00:22:56] Sure. I mean I actually wrote a bunch of papers on this. So hangry is when people get emotionally upset at a physiologic response that they’re having that they are not adapted to. That’s my definition. So when people are not adapted to food deprivation and they’re eating only carbs all the time and they’re on this glycaemic response roller coaster where they’re always they’re literally pulsing sugar, pulsing insulin, that causes a spike in a drop of their blood sugar which makes them hungrier which makes them riding this little rollercoaster all day long. They cannot easily go a few hours without food and they get quote unquote hangry because what’s happening is they’re getting hungry and they’re interpreting that is a negative signal that there’s something wrong in their body. Because their body is actually in an abnormal state that they’ve pushed it into through food that’s been highjacking their metabolism in a bad way. Right. It’s hijacking their brain and it’s affecting their metabolism poorly. These foods that hit the pleasure, the bliss point the fat, the salt sugar, fat-laden foods, they are toxic for metabolism and they cause all sorts of derangements, including making our brains believe that regular healthy food doesn’t taste good. So there are a lot of stuff going on here but really fundamentally hangry is just people not being adapted to healthy food supply.

Peter Bowes: [00:24:14] And of course being hangry, or angry while you’re fasting is the state I think that most people recognize as a result of not eating and probably most often given as the reason why people don’t want to fast because they think they can’t do it.

Dr. Maloof: [00:24:28] Right. The problem with being hungry is that to me it’s a signal that you are not metabolically flexible. Because the thing is is that as you start depleting your glycogen stores, if you’re not able to easily tap into your fat metabolism, because you haven’t built that metabolic machinery through the process of doing that metabolic switch occasionally, doing these occasional fasts, going you know going lower carb occasionally, doing exercise regularly. If you’re not doing these things you’re not actually able to build that machinery to burn fat effectively. And so when you start depleting your glycogen stores it sends a signal to your body that you are in emergency state because your fuel stores are low. You’re like a video-game player, and your fuel supply is on the last bar and that it can be interpreted as oh my god I am losing my security and life and I need to find food. It’s to me what’s really fascinating is that I used to not be able to focus when I wouldn’t eat, but now that I’m fat-adapted, now that I’m able to fast regularly, I can actually I mean what’s really funny is I’m actually more focused when I’m not eating.

Peter Bowes: [00:25:32] I was just going to say that. Exactly the same observation that once you become experienced in fasting whatever and this does seem to apply to the different kinds of durations of fasting, but once you become to a point experienced, that hanger turns into almost sort of mental euphoric high. Phil Libon think you know as well who’s been on this podcast talks about this a lot, about that euphoria that mental agility that you get through fasting which is quite the opposite to being hungry totally.

Dr. Maloof: [00:26:03] Totally. It’s kind of surprising and astonishing. Phil and I were actually hanging out and he was teaching me all about his whole fasting regiments, and then I went and dug into the literature and what’s really funny is that we had like a slight, this is kind of a non sequitur, we had a slight disagreement recently because I said Phil, I looked at my period tracker on my on my phone and I’ve been fasting a lot over these last three months and I think fasting affected my hormones because my periods went from perfectly regular to irregular. And, arguably, I was pushing myself pretty challenging ways, because I went from 16:8 fasting to 24 hours to 36 hours and this was like every week I would just add another challenge to 48 hours to 72 hours to another week of 72 hours, back to 48 hours, then 56 and I was just like doing all these extended fasts. And as a woman, I believe that our metabolisms are just fundamentally different in certain ways because we have different metabolic needs our bodies are really designed to reproduce and to feed babies. And so when we are without food for a period of time it sends a signal to our bodies – this is what I believe – that we need to focus on self-preservation rather than reproduction, because our body cannot do one. It’s like if you are if you have a major life stress, for example, a lot of women’s will get irregular, because the stress is a signal to their body that they’re not safe. Your body doesn’t want to reproduce when it’s not safe. And so, fasting too much can disrupt female hormones. So it’s really, really important for women to recognize that you can go overboard. It’s really, really you have to be extra vigilant as a woman because women are prone to body dysmorphia, women are prone to eating disorders and so I think that like even though the last three months I’ve gotten so many physical benefits from fasting a lot. I’ve also recognize that like I need to bring this like, just like I actually give a disclaimer like a cautionary disclaimer for meditation, because meditation can cause psychotic breaks, fasting can activate all sorts of problems in people including, and especially women need to be careful about it.

Peter Bowes: [00:28:14] Yeah, and it’s the disclaimer that I always give as well. That fasting, putting it simply, isn’t for everyone. And I think we’re all very individual.

Dr. Maloof: [00:28:22] I’m going to disagree with you there. I totally disagree there.

Peter Bowes: [00:28:25] For everyone?

Dr. Maloof: [00:28:25] I think fasting is for everyone. I think fasting is, in fact, maybe there’s a small percentage of people who have metabolic genetic diseases, who absolutely probably cannot fast effectively because of some sort of you know abnormality in their body’s make up. But I actually think that most of modern diseases and massive fasting deficiency and the fact that we have a metabolism that’s still adapted to fasting and we haven’t been giving it that signal enough, means that like part of the reason why we are so sick, is that we are never switching that we’re never flipping the metabolic switch. We’re not exercising enough. We’re not doing the things that our bodies have been evolutionarily adapted to do. And so because of that I think chronic diseases is a byproduct.

Peter Bowes: [00:29:10] Interesting. Although I think I would, maybe you will disagree on this as well. But I think if you are considering fasting, you need to take or at least if you are a doctor or a registered dietitian take a good look at your life, state of your body and your diet, and just assess wether in the very short term it’s something that’s sensible for you to do.

Dr. Maloof: [00:29:28] Well right. Like if you’re a pregnant or breastfeeding. Great example. You don’t want to be taking the fuel and metabolizing it. It needs to go to building your baby and your baby’s brain.

Dr. Maloof: [00:29:39] Right. Yes exactly. We mentioned Phil Libon, if you want to listen to Phil’s story, it is an extreme story.

Dr. Maloof: [00:29:45] It is a great story.

Peter Bowes: [00:29:46] It’s a great story. It’s Episode 22 of the podcast if you want to look in the index and find what Phil has to say. And it brings me back really to my one of my first thoughts and that is there are so many different types of fasting, Phil talk about his seven or even 10 day complete water fast and he loves it, he thrives.

Dr. Maloof: [00:30:04] He has coffee, though, too.

Peter Bowes: [00:30:06] Coffee, yes. A little caffeine getting him through. That’s very different to your 16:8 or 23:1 Or the prolong, which I’ve done, which is described as a fasting mimicking diet is not a complete fast, so you eat maybe days 2 to 5. About 700 calories just over a thousand on day one. So it’s enough of a reduction. You certainly go into a Ketonic state after a couple of days, and I’ve proven that myself, but you’re not completely fasting but you are fast mimicking your body I suppose is tricked, in a sense, to think that you are actually.

Dr. Maloof: [00:30:38] It’s really, really intelligent.

Peter Bowes: [00:30:40] It’s fascinating isn’t it. Have you tried that?

Dr. Maloof: [00:30:42] I have tried it. I actually personally feel that it’s easier to fast with nothing that it is with something. And actually that’s something that I discovered through a series of experiments I was doing with Phil on three-day fasts and basically I discovered that the fat fast that Jason Fung was talking about where you have a little bit of fat if you need it, that was actually the hardest fast for me. The easiest fast for me was the one was just straight coffee and tea, because all the extra caffeine was really great for metabolism and I got I actually dropped into Ketosis faster than I did when I had extra fat. Because it makes sense I was actually burning the exogenous fuel versus my own fuel. But I also found that I did a fast with a three-day fast with human ketone asters and I felt that I felt that that was somewhat helpful, but not, I personally think the easiest fast for me was the one that was just coffee and tea.

Peter Bowes: [00:31:38] A lot of people say that. So did you find yourself consuming more coffee than you would normally during that?

Dr. Maloof: [00:31:45] Definitely.

Peter Bowes: [00:31:45] Is that okay?

Dr. Maloof: [00:31:46] I don’t know. I don’t really condone excessive amounts of caffeine, but as somebody who, because like it can actually disrupt female hormones and other people’s hormones. But like I do drink a couple cups of coffee every day and I love caffeine. It’s like my favorite for sure. Favorite drug. But, definitely, you know the amount of green tea I was consuming that one day was like the second day of my. I was just like whoa. It was like quite a lot.

Peter Bowes: [00:32:11] So you’re now in the biotech world, you still see patients?

Dr. Maloof: [00:32:15] I still do, yeah.

Peter Bowes: [00:32:16] And in sort of boutique practice way?

Dr. Maloof: [00:32:18] Yes, exactly.

Peter Bowes: [00:32:19] Please tell me about that.

Dr. Maloof: [00:32:20] Well, you know the best way to describe is it’s bespoke medicine. So I really do made to measure medicine, so it’s based on your body’s chemistry, and by that I mean your genetics your metabalonics, your clinical chemistry markers, your hormones, your microbiome, your immune markers, your micronutrient tests, your continuous heart-rate variability monitoring. I like to look at the body from a perspective of, it’s like a data science, right. So I want to get as many interesting signals as possible and then figure out what’s noise, and figure out what’s actually something that reflects what’s going on in that person’s body and their life. And so I take a two-hour medical history. So I ask so many questions to an individual. And I have about 20 different questionnaires I go through to figure out what’s going on with their health and what’s going on with their lifestyle. And through that I’m able to figure out, okay. Where are the biggest deltas that we need to close to optimize this person’s health so that they do not decline further? Or that they become even higher performing.

Peter Bowes: [00:33:18] And so ,for now let’s just take an example of a 50-year-old woman for example. Coming out of, let’s say it’s an otherwise, there’s nothing significant wrong. She’s not really complaining of any problems. What are the main biomarkers? I know you look at a lot. But can you give me maybe a top five?

Dr. Maloof: [00:33:38] Yeah. Vitamin D on everyone. It’s just so important for immune system health, and immune system how the important as we age, because our immune systems eventually fail us. And because of that we develop things like infections and cancer. Immune systems are intimately tied to our ability to protect ourselves from viral diseases. And so, Vitamin D is just fundamental to immune system health. And most people are spending 90 percent of the time indoors.

Peter Bowes: [00:34:07] I was going to say here in California you would think it isn’t a problem.

Dr. Maloof: [00:34:09] You would think it’s not a problem but then have patients in LA who go surfing regularly and they have vitamin D of 30. It’s not high enough. And then you know for a woman who is probably hitting menopause or perimenopausal I would definitely look at her hormones. So I would look at a you know a dried urine hormone testing. It’s basically like the full hormone metabolism picture. So sex hormone metabolism, cortisol metabolism and there’s a few other markers that they measure around, like melatonin and things like testosterone, and all that good stuff. So I want to look at hormones especially and then iron metabolism for women is just always an issue. And for a lot of women who are older, they develop things like fibroids and they end up with anemia, there’s also quite a lot of hemachromatosis that’s undiagnosed. And I always like to look at ferritin, as a marker of iron metabolism, because if it’s extra high it’s also a marker of inflammation. So ferritin’s really important to me. And then, what else would I look at? I mean I like to look at this test called a new nuTravel, because I like to look at micronutrients, to see are they getting a healthy diet? I can basically take this test and know if they’re getting the appropriate amounts of Omega 3s, of micronutrients through to plant-based the vito-nutrients, I can look at if they’re getting enough amino acids, if they have any amino acid imbalance. And it also gives me a decent look at the krebbs cycle. So I can actually see if there’s any issues with their metabolism and different things.

Peter Bowes: [00:35:39] The Krebbs Cycle being?

Dr. Maloof: [00:35:39]  Our bodies have mitochondria and the mitochondria have different metabolic machinery for using carbohydrates or fat as fuel. So using this test you can actually see if there’s any issues in these pathways that are causing them to be have basically any problems with metabolism for example. There’s a lot of things that can impair metabolism that we don’t look at like heavy metals. So certain things like mercury can cause defects in these pathways.

Peter Bowes: [00:36:11] Do you think mitochondrial health is under appreciated by the medical profession?

Dr. Maloof: [00:36:15] Absolutely. 100 percent. I mean it’s one of my biggest interest right now. Because, but it’s also something that it’s not the first thing that I look at, because a lot of what you do upstream will affect it downstream. But mitochondrial health, I mean fasting and reducing sugar is like the best thing you can do for optimizing your mitochondrial health because autophagy is partially related to optimizing mitochondria, and mitophasia is a thing that they that they talk about in all the literature around health span that fasting can help basically enhance mitochondrial health.

Peter Bowes: [00:36:48] We did an episode about nR, the vitamin B3 supplement, there’s a lot of press about it, to boost essentially to boost NAD.

Peter Bowes: [00:36:58] What do you think about that?

Dr. Maloof: [00:36:59] Like niagen and elysium.

Peter Bowes: [00:37:01] That’s exactly what we did.

Dr. Maloof: [00:37:02] I think they’re great. I think there’s a lot of promise to them. I used to kind of write them off a little bit but the more research that I do, the more I’m like no there’s actually some real serious science to this. It’s still a little bit too expensive, unfortunately. But I have taken them in the past. I think they tend to be they tend to work better for people who are older, interestingly. I think they’re probably best used as you get older, kind of like melatonin is probably best to use as you get older. As your body starts being more depleted in these things you tend to get a bigger effect change. So someone who’s young may not need it as much as someone who’s older.

Peter Bowes: [00:37:38] So your patients clearly will pay a significant amount of money for your expertise. I was curious for those people who can’t afford that what best can they do when they go to their doctor and they’re in there for 10 or 15 minutes, that crucial consultation, maybe once a year if they are lucky. What should they be asking?

Dr. Maloof: [00:38:01] I think a lot of people are not getting like full blood panels from their doctors and they’re getting like a few metabolic biomarkers. But I do like at a baseline like you know like for the blood I do, you know you can get like 70 biomarkers for around $400 dollars. And that, and I’ve gotten the cost down dramatically, but like $400 dollars is still a lot of money for a lot of people spend. But there’s a lot of data in just blood tests. And so I think that like even though I’m doing urine, I’m doing stool, I’m doing wearables, I’m doing all these other fancy tests. The basic blood you can get from your doctor that are overlooked are things like CRP homocysteine. Lipoprotein particle analysis of your cholesterol. a lot of you are just getting regular cholesterol panels and they don’t know they have problems with LPA they don’t know if they have problems with LDL particle bead patterns. They don’t know if they, you know likes high-resolution CRP is a great marker for inflammation, even just a white blood cell count is really helpful because if it trends up too high that’s actually not great for longevity. And then if you get a bunch of these, there’s actually a company that that my friend started and it’s like it’s a website and it’s called, there’s a few companies, there’s like there’s InnerAge by this Harvard researcher that works with basically a bunch of biomarkers for detecting what he thinks your real age would be. And then there’s also Alexander has a website that like you plug in these biomarkers that can give you what your biological versus your chronological age would be. So like, we’re starting to get some really fun ways to biohacking your own labs, but you need to get those labs in the first place. My friend Joe Coen at Selfhacked has a platform as well. I really like his platform. You know getting the numbers and starting to interpret them and figuring out what they mean, is like part of your job as a human. And expecting your doctor to do it all for you for what he’s being paid to do, it’s just not realistic.  Doctors aren’t paid for health, they’re paid for sickness the health care system is a sickness billing industrial complex.

Peter Bowes: [00:40:04] This is going back to the old paradigm, isn’t it?

Dr. Maloof: [00:40:06] Yeah. And so if you want extra you have to pay a little extra. And the thing is that someday we’re going to be able to prove to insurance companies that this is going to expand people’s health and reduce morbidity and probably mortality. But until we get to that point where insurance companies really are bought into this we have to spend a little bit extra money out-of-pocket. So I get an HSA and I use that funding that’s tax free to pay for my labs.

Peter Bowes: [00:40:30] Yeah, actually I’ve just gone as well. That’s great. I think again under appreciated by a lot of people. But purely talking here in the United States, maybe this isn’t applicable around the world, but purely from a tax management perspective it seems to make sense.

Dr. Maloof: [00:40:44] I think so.

Peter Bowes: [00:40:44] Yeah. Is the route to change is that we over test. The question stems partially from going back quite a few years when a lot of interest in whole body scans.  I remember doing a story about it and getting a lot of criticism from people saying well, is there’s a danger of false positives here. Are we overstepping that mark?

Dr. Maloof: [00:41:04] I think it depends on the type of test and what you’re testing for. Like yes we are definitely over testing with CTs, I mean cat scans are a lot of radiation. It’s like 100 x-rays every cat scan. So if you can avoid getting a CT-scan. Yeah don’t do that. Now, are we over testing? I mean like everyone’s going to argue with me that yes, I’m an over-tester. But I also am not so obsessed with like necessarily the individual biomarker as much as the patterns that I see over time. So when I look at like you know the blood labs of a person change over time, over the course of working with him for a year, like someone might say well you know, doc it’s like been six months and I don’t feel that much different and then we look at their labs and they’ve gone from the Red Range in multiple biomarkers to the yellow range to the green range. And now it’s like I’m like I’m showing them that like they’re basically aging in reverse in terms of their biomarkers. And to me it’s like that’s helpful because you don’t always notice the affects of your changes as fast as you notice the blood labs change. So I’m a big fan of testing more often. I like to test every 3 months.

[00:42:07] Interesting, you just reminded me about something. Actually, you just reminded me about something. Going back to the conversation about fasting, there’s lots of elements and lots of benefits to fasting. We focus in our conversation mostly on the things that you can feel and see now. I think for most people it is fact loss, weight loss. There’s a longer-term perspective to fasting and has things going on inside our bodies that we can’t see, that may in 20 or 30 years time, and I’m thinking of cancer prevention. Yeah it could be a huge benefit. It could potentially be the biggest benefit of fasting.

Dr. Maloof: [00:42:36] Well like I had a friend who emailed me, he’s a young guy. He’s really healthy. And he says Molly I my wellness fax labs back, and everything’s fine except for my LPA is really high. And everything I seem to read online says that you can’t do anything about it. And I go, well that’s funny, because I just read in Jason Fung’s book The Complete Guide to Fasting, that somebody reported dropping their LPA dramatically through fasting regularly. And he, I mean that’s just one thing you can do.

Peter Bowes: [00:43:05] Just tell us what LPA is.

Dr. Maloof: [00:43:06] Lipoprotein(a) it’s largely a genetic marker of cardiovascular risk, essentially. So he’s very concerned about it, and I’m like, you know I used to think that it was just fully genetic and that you couldn’t do anything about it, but now there’s all these case reports of people dropping their LPA through fasting. So you know, maybe there are things we can do. I mean part of the reason why I am such a big believer that fasting should be part of our lives is, you know, I did research on all these different diseases that could help. And cancer reduction in animals dramatically cardiovascular disease risk reduction, hypertension reduction, improving heart rate variability, and reducing cholesterol, reducing blood sugar and reducing risks of autoimmune diseases. I mean like there’s a lot of benefits to it, and these are a lot of things that by the way right at my family. So like I was like, wow I could take all these supplements which I do. But or I can maybe just are fasting more and you know I think fasting is actually a lot a lot easier than people realize. It’s just, we’re so adapted to just eating all the time. And we’re so stuck on this sort of like treadmill, the hedonic treadmill of food. And the problem with that is that it’s like, it’s always about that next hit. End every meal is in a lot of cases for a lot of people, their next hit of the food addiction that they have. So you know, it’s funny. There’s actually this group called Overeaters Anonymous. And I don’t necessarily recommend people go there, because there’s like a religious component to it. But pretty much all they espouse is don’t eat refined sugar, don’t eat artificial sweeteners, don’t eat, basically they say don’t eat any sugar, don’t eat any refined flour products. And that’s like all they tell people to do, because that actually can reprogram your brain and your dopaminergic signaling pathways to be less obsessed with food. And when you become less obsessed with food, then your body can actually start adapting naturally to like what it wants to be eating which is whole natural foods.

Peter Bowes: [00:45:04] Yeah there are some simple big changes we can all make.

Dr. Maloof: [00:45:09] It’s taken me years to do this stuff. Getting rid of refined carbs is like really hard. But it’s taken me. I mean I’ve done it over the last few years. Increasing my vegetable intake to six cups a day has also taken me years, reducing my sugar intake to almost zero. I mean I eat dates and fruit.

Peter Bowes: [00:45:28] Do you take those vegetables as vegetables and raw vegetables?

Dr. Maloof: [00:45:33] I eat them as vegetables, cooked and raw.

Peter Bowes: [00:45:34] So a smoothie maybe?

Dr. Maloof: [00:45:36] I don’t really do as many smoothies anymore, mostly because, I mean like I like smoothies. But to me you’re actually, people don’t understand this, but when you put something in a smoothie, even if you’re putting a lot of fiber in it, you’re still turning that fiber into powder, and so you are getting rid of some of the fiber benefits.

Peter Bowes: [00:45:55]  There’s almost an element of processing.

Dr. Maloof: [00:45:57] You’re basically chewing the food with a bunch of rotating teeth. So like you are breaking down the food. And it’s I don’t think it’s a problem, necessarily, but there are certain you know there’s some fiber that you are going to break down more in the smoothie. But like if it means that you’re going to get that that’s what is in your body then then do it.

Peter Bowes: [00:46:19] So I asked the question about vegetables. So I think that, just observing people, that is the barrier, of just the practicality of eating vegetables.

Dr. Maloof: [00:46:27] It’s the preparation. I mean I meal prep vegetables like once or twice a week. So I always have fresh vegetables in my fridge.

Peter Bowes: [00:46:36] That’s the secret, isn’t it?

Dr. Maloof: [00:46:37] It’s really the secret is just preparation. It’s like people look at these like bodybuilders, and I’m not condoning bodybuilding. But they look at these people and they’re like oh my god they are like so amazing and like all they’re really doing is like regimenting what they do in the gym and in the kitchen. They have like very specific amounts of foods that they’re consuming on a day to day basis, and they’re like playing with their metabolism with amount with the amount of carbs and fats that they consume and that they consume. It’s like fascinating to me. But it’s also like, the key is that we  we all need to start looking at our food as our medicine. Some people are looking at food as performance-enhancing food, right. They’re like their regimenting their foods to the point where they might get some sort of outcome they want. We all need to look at our food as this opportunity to like dose ourselves everyday with things that are going to make us as healthy and fit and happy as possible. It took me years to do this. But like every year I would choose a different vegetable color that I would just add more of. And I was like this is really simple. I’ll just eat more green things this year. The next year was red things, the next year it was yellow things, and the next year was purple things. Before I knew it I was just eating all the rainbow and now I like crave, crave, crave, crave vegetables. And, in fact, when I did a month on Keto earlier this year I really found it really problematic because I just couldn’t eat enough vegetables. And I was just like my body was like I can’t wait to just shove my face with salad. And it was just like I don’t eat a bunch of crap on it. Like you can really screw up a salad with just adding too much nonsense to it. Like well you have to kind of fall in love with things that are good for you, and to me that’s just the secret. It’s just like learn to love things that you think are not good.

Peter Bowes: [00:48:14] You mentioned supplements a little while ago. Yeah how many do you take a day?

Dr. Maloof: [00:48:18] Oh, man. I should show you my bottle. So I have a custom compound that I make myself. And ,normally it’s around 10 to 12 pills. But this one is about 18, because I experimented with adding a prenatal into it. So I took a prenatal formula that I designed and I added it to my custom. So now it’s 18. But it’s got milk thistle, it’s got you know all my B’s. It’s got you know a few other detox supplements. It’s got a bunch of things in it, that to me, make me feel awesome every day. And most of the things that are in the supplement are based off of my labs. So I put things in there based on what I’m seeing in the data.

Peter Bowes: [00:48:55] And if you had the perfect utopian diet, would it be possible to get all those supplements without taking them as extra.

Dr. Maloof: [00:49:05] You would still want, I mean like not everybody wants to eat turmeric every day, necessarily. Like I like turmeric and I have a bunch of it in my fridge. I like literally  Lechter-fermented turmeric paste I made myself, like, yeah – I do that. But I find that like green tea, for example. I really like green tea. But if I drink 10 cups, which I did when I was fasting, I’m getting a lot of caffeine. So EECG is a nice thing you can take out of the tea, put it into a supplement, and you don’t have all the caffeine in it. So there are certain reasons why you might want to add things to a supplement versus. And like Vitamin D. Yes if I lived outside, it would be a different story. But even though I try to spend a lot of time outdoors I’m still getting as much sun as I would like. So you know, I think yes you could probably get it from a perfect diet, but most of our food supply is, unfortunately the soil that we’re growing on is being more and more depleted every day. So you know that’s the saddest thing about our environment is that we do not realize how much the way that we live our lives and the way that we are just you know we’re really harming the environment, how that is harming our bodies. How that’s harming our access to nutrients and food. And so, you know like we’re not living in the same kind of food environment that we were 50 years ago.

Peter Bowes: [00:50:25] And of course the ultimate goal here, and we talked about it in the beginning, is healthspan. A phrase that I use a lot, I’m sure you do as well. What is your definition?

Dr. Maloof: [00:50:36] I think it’s as simple as the number of years that we have living healthy free of disease and disability. It’s the concept of compression of morbidity and the definition of morbidity is disability and frailty and so you know, having seen grandparents of mine decline over the course of many years and just to be debilitated by disease, I said to myself, this is not going to be my destiny. This doesn’t have to be our lives, there are enough cultures in the world where people thrive into old age with energy and vitality. We just are accepting of this experience because it’s so commonplace and it’s so sad to me that we have made diabetes seem like a inevitable disease and a culture that essentially just wants to treat it with pills and is totally okay with the government paying $70,000 to give people artificial limbs because they had to have a limb amputated. What if we spend that money on keeping them healthy earlier in their lives? What are some of that money and keeping children healthier and establishing good habits younger in life? Like what if we spent it on teaching pregnant mothers how important it is for them to have good blood sugar control because if they don’t have good blood sugar control, they are programming the metabolism of their children to have detrimental effects later in life. So I think that we have it all wrong. We are spending way too much money later in life giving marginal benefits to people and we are not investing in health when we’re young and really the unfortunate truth is that if we want to get another 20 years of life into the American population we have to start investing in health when we’re young. It cannot be when we’re 50 and 60 that is too late. I have to to be like a vocal person about this because I don’t feel like enough people realize that like you can’t just say you don’t care. Like I cared about my health when I was young. In fact, one of the things that was really interesting is that I thought I was caring about my health when I was young when I was actually pushing myself, burning myself into the ground with way too much work. So like we need to re-conceptualize the way we even understand health.

Peter Bowes: [00:52:44] And it’s not so much. Well it’s partly not caring, but it’s also that young person’s image of them getting older thinking I’ll deal with it then, or oh they’ll have found a cure by then. I can smoke now, it’s okay because by the time I’m 50 it won’t be a problem anymore, which is hugely misguided, of course.

Dr. Maloof: [00:53:01] It’s totally misguided. And you know the bigger problem I have is that it’s also this mantra in our culture that like oh the healthcare system will take care of me or social security will take care of me or Medicare will take care of me. That is not going to be the case when we are grownups. Like when we are older, I am just not convinced that we are going to have healthcare available for everybody if we continue with the level of disease that we have today. It’s just too expensive. And so it’s bankrupt bankrupting our country. It’s far too much of the GDP it’s not does not make economic sense. And so I think that the thing that we need to think about is reconceptualizing health as instead of being this complete absence of disease or infirmary, it’s the ability to adapt and self-manage in the face of adversity. And that means that it’s not about managed care. Okay. The healthcare system managing your care is not enabling you to adapt and self-manage. It’s managing you. That is not what we need to be teaching people we need to be teaching people that you need to take control of your health. You need to have ownership over your destiny. This is your body and you have responsibility for it. And we’re not teaching children that. And that’s the problem. We’re teaching children by the way that we train them, by the way that parents basically use food to pacify them, the way that my even one of my family members uses packaged process cake, not really cake but crackers, to make her daughter calm down. What, she doesn’t realize is that she’s putting her kid on this glycemic rollercoaster, and the kid’s brain is responding to that insulin surge and that blood sugar surge and that drop. And that giving her these foods, she’s actually programming her to associate food with I’m OK. And the problem is that you need to be able to be OK without food, because that’s actually what our bodies are designed to do. We’re designed to be able to survive long periods of time without food. And you know like that’s what we’ve lost.

Peter Bowes: [00:55:02] It’s a fundamental reeducation of medical practitioners but everyone from what you say.

Dr. Maloof: [00:55:07] It is, it’s a fundamental worldview shift. I mean look I would love for the invention of calorie restriction memetic and exercise emetics to come. I would love for me to be able to take a tool and just take a supplement and get all the benefits from not having to fast and workout, because frankly it’s hard work. But I don’t think that’s going to happen.

Peter Bowes: [00:55:32] I’ve looked at this a lot over the years. I don’t know that I want it to happen necessarily. I actually quite like my exercise.

Dr. Maloof: [00:55:40] Yeah, I love exercise. But you know exercise is taking me back into too. Yeah I was actually fairly sedentary during my 20s. I was very fit during my teens. I was a competitive runner, got into my 20s started studying, studying, studying, studying, studying. It was very sedentary, and then late 20s started coming upon me, and I said oh god, I can’t believe that I think I’m espousing optimal health optimization and I’m not exercising enough. So I started walking 10,000 steps a day. I stopped driving to work, and then I started you know taking longer routes to work and then I started doing kettlebell workouts with apps on my phone. And then I started doing like the 7-minute workout and then I started weightlifting and then I started doing yoga again. And then I started running again. And then I started you know doing these things that were more challenging, but it was a slow gradual progression to a place of better fitness and that’s how people need to think about health. They need to stop looking for quick fixes and they need to start recognizing it takes years to make your body shift. If you have someone like me helping you, I can accelerate the process dramatically. But you still need to put in the work. And that means like I have to look at exercise as 4 percent of my day. I’m starting to I’m starting a meditation program. It’s an hour of my day. Four percent of my day is going to go to meditation.

Peter Bowes: [00:56:54] And you prioritize it?

Dr. Maloof: [00:56:55]  I have to now, I’ve signed up for this program like I’m doing it. You know I’m committed to it.

Peter Bowes: [00:57:00] But you want to do it?

Dr. Maloof: [00:57:02] I do want to do it, because I want, so one of my goals at the beginning of the year was I want to be able to maintain the best brain function and the best relationship function, despite anything that life hits me with, which means I want to be able to be calm under pressure. I want to be able to be the best version of myself under stress. And to get to that point you actually have to give your body a little bit of stress overtime to get your body acclimated to doing things like this. So, for example I was fasting while I was traveling from Israel to Lebanon. And you’re not supposed to do that. And I did it anyway, and I did get stuck in Lebanon for three and a half hours. And I did get through. But it was a tenuous process of, you know taking my statement and going to the military court and figuring out what was I doing in Israel. I told them two years ago, but I was just there. And I was fasting the whole time. And I was like so calm, so collected, not sweating, having a good time, joking around in the back of this windowless room filled with cigarette smoke. And I’m like, I did it. Like I actually brought myself to a place where I can be under serious stress, I can be perfectly calm. And I just used my iPhone app on my Apple Watch app, the breathe, I did the breathe, and I just started breathing deeply. And I was like we are such resilient creatures if we want to be. But you have to choose. And the way you become resilient is you have to have control of your life and you have to have a connection to others. and you have to have a sense of purpose if you have those three things and you can adapt to anything that life hits you. But if you don’t have those things, then that’s where you actually really need to start. Because why do you even need your help if you don’t have a purpose for it?

Peter Bowes: [00:58:39] Yeah, that I agree. That by the way the Israel, Lebanon story fasting, I know there’s a lot more to this story than you just said which we won’t go into now, but I know you told this story to Geoff Woo on his human podacst. A great podcast, I’d thoroughly recommended it. In fact, it’s thanks to Geoff and his team that we’re together.

Dr. Maloof: [00:58:59] Oh yeah that’s true.

Peter Bowes: [00:59:00] I heard you on the show was such a great interview, that I wanted to meet you.

Dr. Maloof: [00:59:03] Thank you.

Peter Bowes: [00:59:03] So thanks to everyone at HVMAN because I think they’re a great bunch as well.

Dr. Maloof: [00:59:10] Oh they’re awesome.

Peter Bowes: [00:59:10] So, final question. And I ask this of everyone and you’ve gone into this in some detail already. What are your own personal aspirations as they apply to your longevity? Do you have a vision of yourself at 90 or 100 years old?

Dr. Maloof: [00:59:23] Oh yeah.

Peter Bowes: [00:59:24] Do you focus on that? What is it?

Dr. Maloof: [00:59:25] I mean here’s the thing. The first thing I want to say is I am ok if I don’t get to 100, but I really want to get to my 90s. I really, really do. I want to be fit and that includes mentally fit. You know I want to have a sense of inner calm and inner peace. And I actually do have a lot of most of the time I have it. But I think that there’s going to be a point where, when I’m older and I’ve got grandchildren, I think I’m actually going to probably be more peaceful than I am now. But I think I want to look back on my life and I want to say that I squeezed everything I could possibly have gotten out of this existence. I don’t really think I’m going to have regrets because I’m not the kind of person who lives that way. But I do think that I want to have had a few companies behind me. I would have sold the companies behind me. I want to have a few kids. I want to have grandchildren, hopefully one husband. You know like I still want to be traveling you know like I love travel. It’s like one of my favorite things to do. I would have liked to have gone to most of the countries in the world. I don’t I mean like in terms of health span. Like I’m okay with the idea of having to have joints replaced if I need to. I hope I don’t need that. But if I do it’s fine. I hope that I have a continuous glucose monitoring patch or glucose monitor implanted so that I have that in the moment knowledge. And I hope to have made a big impact on the world in reconceptualizing what health is about. and actually challenging people to actually just try harder you know and to push themselves further. And to accept less mediocrity from their lives. Because we are so capable of so much more than we’re doing today. And I think that like life is, our society is actually getting better and a lot of ways. But for a lot of people it’s the simplest lifestyle factors that are holding them back from reaching their full potential. They’re stuck at the base of the hierarchy of needs, of Maslow’s hierarchy. And they’re not surviving well. Part of that’s really just comes down to food. And so I hope to have made an impact on the food system in some way.

Peter Bowes: [01:01:38] Well I think you’re making an impact already.

Dr. Maloof: [01:01:41] Thank you.

Peter Bowes: [01:01:41] This has been a really good conversation. How can people get in touch with you and get involved with what you do?

Dr. Maloof: [01:01:46] Sure, you can find me on LinkedIn. Molly Maloof M.D., on Twitter, Molly Maloof M.D. You can find me on Instagram DrMolly.Co. I also have a website with that same name and you can email me at [email protected].

Peter Bowes: [01:02:04] Great. I’ll put all of those details in the show notes for this episode at our website, that’s LLAMApodcast.com. You can follow us in social media at LLAMA podcast. And if you’re listening on the Apple podcast platform you can rate us and review us there. A positive review will be great. It’s certainly very helpful as we move the podcast forward. Molly Maloof, thank you very much, indeed.

Dr. Maloof: [01:02:31] Thanks Peter.

Peter Bowes: [01:02:32] And thank you for listening.