Before You Get Comprehensive Work Done, Decide What Your Threshold of Action Is
“The likelihood of doing comprehensive testing and finding everything ‘normal’ is low, so don’t have testing done unless you’re willing to accept the uncertainty that comes from needing to make decisions (or not) with incomplete—and at times conflicting—information. Before you check your APOE gene, for example, you should know what you’ll do if you have one or two copies of the ‘4’ allele.”
TF: Decide beforehand—and not reactively when emotions run high—what types of findings are worth acting upon or ignoring, and what your “if/then” actions will be.
The Dangers of Blood Test “Snapshots”
It’s important to get blood tests often enough to trend, and to repeat/confirm scary results before taking dramatic action. This has been echoed by other guests who have appeared on my podcast like Justin Mager, MD (page 72), and Charles Poliquin (page 74):
“In 2005, I swam from Catalina Island to L.A., and I had my friend Mark Lewis, who’s an anesthesiologist, draw my blood around 10 minutes before I got in the water on Catalina Island and then 10 minutes after I got out of the water in L.A., 10.5 hours later. It was a real epiphany for me, because I had developed something called systemic inflammatory response syndrome, SIRS, which is something that we typically see in hospitalized patients who have horrible infections or who have been in really bad trauma: gunshot, car accident, that sort of thing.
“My platelets went from a normal level to 6 times normal. My white blood cell count went from normal to—I don’t know—5 times normal. All of these huge changes occurred in my blood, so that you couldn’t distinguish me from someone who had just been shot. . . .
“I’ve always been hesitant to treat a patient for any snapshot, no matter how bad it looks. For example, I saw a guy recently whose morning cortisol level was something like 5 times the normal level. So, you might think, wow, this guy’s got an adrenal tumor, right? But a little follow-up question and I realized that at 3 a.m. that morning, a few hours before this blood draw, the water heater blew up in his house. The normal level of morning cortisol assumes a guy sleeps through the night. He had to de-flood his house.”
4 Bullets to Dodge
“If you’re over 40 and don’t smoke, there’s about a 70 to 80% chance you’ll die from one of four diseases: heart disease, cerebrovascular disease, cancer, or neurodegenerative disease.”
“There are really two pieces to longevity. The first is delaying death as long as possible by delaying the onset of chronic disease (the ‘big four’ above). We call that the defensive play. The second is enhancing life, the offensive play. On that defensive play, there are basically four diseases that are going to kill you. In other words, if you’re 40 years old and you care about this, you’re probably not going to die in a car accident or homicide, because you’re out of that demographic. You’re less likely to die of X, Y, and Z. It turns out that when you look at the mortality tables, there’s an 80% chance you’re going to die from cardiovascular disease, cerebrovascular disease, cancer, or neurodegenerative disease, period.
“If you remember nothing else, remember this: If you’re in your 40s or beyond and you care about living longer, which immediately puts you in a selection bias category, there’s an 80% chance you’re going to die of [one of] those four diseases. So any strategy toward increasing longevity has to be geared toward reducing the risk of those diseases as much as is humanly possible.
“[For those who don’t know,] cerebrovascular disease would be stroke, and there’s two ways you can have a stroke. One is through an occlusion; the other one is through bleeding, usually due to elevated blood pressure and things like that. Neurodegenerative disease, as its name suggests, is degeneration in the brain. The most common cause of that is Alzheimer’s dementia, and Alzheimer’s is one of the top ten causes of death in the United States.
“[Studies] suggest to me that there’s something about highly refined carbohydrates and sugars—and potentially protein, though it might be for a different reason—that seems to raise insulin, which we know, by extension, raises insulin-like growth factor (IGF). And we know that IGF is driving not just aging but also certainly driving a lot of cancers, though not all of them.”
Supplements That Peter Does *Not* Take
Peter consumes a fair selection of supplements based on his own blood work, so it’s highly personalized. He does not take, however, a number of the common ones:
Multivitamin: “They’re the worst of both worlds. They contain a bunch of what you don’t really need and don’t contain enough of what you do need. It poses an unnecessary risk with no up side.”
Vitamins A and E: He’s not convinced he needs more than what he absorbs through whole foods.
Vitamin K: “If you eat leafy green vegetables, you’re getting enough. K2 might be a different story for some people, depending on their diet.”
Vitamin C: “Most of us get sufficient amounts in our diet, and while megadoses might be interesting, especially for combatting viral illnesses, it’s not bioavailable enough in oral form.”
He is a proponent of magnesium supplementation. Our ability to buffer magnesium with healthy kidneys is very high. He takes 600 to 800 mg per day, alternating between mag sulfate and mag oxide. He also takes calcium carbonate 2 times per week. Two of his favored brands are Jarrow Formulas and NOW Foods.
The Logic of Low-Dose Lithium
Based on conversations with Peter, I now take low-dose lithium in the form of 5 mg of lithium orotate. The more I read epidemiological studies, the more I’ve come to think of lithium as an essential, or conditionally essential, element. 1 to 5 mg is enough to effectively ensure you are getting the high range of what is naturally occurring in groundwater in the U.S. As a primer, I suggest reading the New York Times piece, “Should We All Take a Bit of Lithium?”* From that article:
Although it seems strange that the microscopic amounts of lithium found in groundwater could have any substantial medical impact, the more scientists look for such effects, the more they seem to discover. Evidence is slowly accumulating that relatively tiny doses of lithium can have beneficial effects. They appear to decrease suicide rates significantly and may even promote brain health and improve mood.
And from Peter: “Lithium is actually really, really safe at low doses—basically anything below about 150 mg—if you have normal kidney function. It’s one of those drugs that got such a bad rap with the large doses that were sometimes needed to treat recalcitrant monotherapy bipolar disorder, but those doses—easily approaching 1200 mg—have nothing in common with the logic above.”
More Comedy—Long Ago, When Peter Went from 170 to 210 Pounds, Gaining Mostly Fat
“Frankly, I just got aggravated beyond words. We joke about it now, but at the time I literally said to my wife, ‘I’m going to go get a gastric bypass.’ And she said, ‘You are the most ridiculous human being who’s ever lived. We’re going to have to talk about our marriage, if that’s what you’re considering at the weight of 210 pounds.’ I actually did go and see the top bariatrician in the city of San Diego, and it’s kind of weird story because, even though I was obviously overweight, I was the thinnest person in the waiting room by a long shot. It put it in perspective. [I thought to myself,] ‘Peter, you think you’ve got problems. I mean, these people each weigh 400 pounds.’ And when it was my turn to see the doctor, the nurse took me up to the scale and weighed me. We got on the scale, and I’m like 210. She says, ‘Ah, this is fantastic. Are you here for a follow-up?’”
On Dropping Running and Picking up Weights
“Nothing breaks my heart more than seeing that person who’s struggling to lose weight who thinks that they need to run 20 miles a week. They have no desire to do it, their knees hurt, they hate it, and they’re not losing weight. And I’d like to say, ‘Well, I’ve got great news for you. You don’t ever need t
o run another step a day in your life, because there’s no value in that.’
“There is value in exercise, though, and I think that the most important type of exercise, especially in terms of bang for your buck, is going to be really high-intensity, heavy strength training. Strength training aids everything from glucose disposal and metabolic health to mitochondrial density and orthopedic stability. That last one might not mean much when you’re a 30-something young buck, but when you’re in your 70s, that’s the difference between a broken hip and a walk in the park.”
Peter’s Path to Meditation
10% Happier by Dan Harris is the book that got Peter meditating regularly. After limited success with open monitoring or mindfulness meditation, he was introduced to Transcendental Meditation by a friend, Dan Loeb, billionaire and founder of Third Point LLC, a $17 billion asset management firm.
✸ Most-gifted or recommended books
Surely You’re Joking, Mr. Feynman! by Richard Feynman
Mistakes Were Made (But Not by Me) by Carol Tavris and Elliot Aronson. The latter is a book about cognitive dissonance that looks at common weaknesses and biases in human thinking. Peter wants to ensure he goes through life without being too sure of himself, and this book helps him to recalibrate.
✸ Peter’s best $100 or less purchase?
Peter has a monthly daddy/daughter date with his 8-year-old daughter. The below came up at the tail-end of one outing:
“We were walking back to the hotel, and one of those rickshaw guys came up with a fully lit-up bike. I would normally never even think about hopping a ride on one of those things, but I could just see this look in her eye: ‘Wow, this bike has lights all over it.’ [So we hopped on.] This guy gave us a ride back, which probably cost $20, so not even $100. And, believe me, it’s $20 more than we should have spent to just walk back, but the look on her face was worth every dollar I have. I just got a little cheesy and cliché because old dads are like that, but that’s the best $20 I’ve spent in a long time.”
✸ Who do you think of when you hear the word “successful”?
Peter mentioned several people, including his friend John Griffin, a hedge fund manager in New York, but I’d like to highlight his last answer: his brother. Peter’s brother Paul (TW: @PapaAlphaBlog) is a federal prosecutor, a great athlete, and father of 4 kids under the age of 5. He thinks an enormous amount about being a better federal prosecutor, and thinks just as much about how to be a better father. Peter elaborates:
“Success is: Do your kids remember you for being the best dad? Not the dad who gave them everything, but will they be able to tell you anything one day? Will they able to call you out of the blue, any day, no matter what? Are you the first person they want to ask for advice? And at the same time, can you hit it out of the park in whatever it is you decide to do, as a lawyer, as a doctor, as a stockbroker, as a whatever?”
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* Anna Fels. “Should We All Take a Bit of Lithium?” The New York Times (Sept. 13, 2014).
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Justin Mager
Dr. Justin Mager has helped me with dozens of my “human guinea pig” experiments, complete with blood testing and next-generation tracking. He’s brilliant and hilarious. Justin appeared on the podcast with Kelly Starrett (page 122), a mutual friend and collaborator. When we ended the episode, I asked my usual “Where should people check you out?” Justin’s answer was, “My honest parting comment is not to check me out, just fucking look in the mirror and check yourself out. My aspiration is to go underground and be a ghost.” Love this guy.
“We’re Not an Object, We’re a Process”
“We want to judge things as good or bad. . . . So, there’s this idea that inflammation is bad, [thus the opposite] is good. High cholesterol bad, low cholesterol good. [But] you have to understand what blood testing actually represents. First of all, it’s a snapshot. It’s a moment in time, and we’re not an object, we’re a process.”
“Optimal” Depends on What You’re Optimizing For
“[For instance], there’s some literature that suggests that if you have high LDL cholesterol, you can actually build more lean body mass at a faster rate. So, if you’re in a strength-building phase, it actually might be to your advantage to actually have that present . . . you need to know context. You [also] have to understand what the marker actually represents, not just [have] a judgment of whether it’s good or bad.”
Hey, Doc, What Does Cholesterol Do?
“I like to ask that to physicians, especially if they’re antagonizing me about my practice methods. I say, ‘Hey, what does cholesterol do?’ and it’s interesting, because a lot of them will take a step back and they’ll fumble, because they’re so indoctrinated into the algorithm of ‘All I really need to do is identify high cholesterol and treat it’ versus understanding what purpose it serves in the human body.”
TF: There is a big difference between understanding something (what you want in a physician) and simply knowing its name or labeling it. This is also one of the lessons that Nobel Prize winner Richard Feynman’s father taught him. The story is contained in Surely You’re Joking, Mr. Feynman!, the most-gifted book of several people in this book, as well as in a wonderful short documentary called The Pleasure of Finding Things Out.
“The rule is: The basics are the basics, and you can’t beat the basics.”
“What you put in your mouth is a stressor, and what you say—what comes out of your mouth—is also a stressor.”
Spirit animal: Siberian tiger
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Charles Poliquin
Charles Poliquin (TW/FB: @strengthsensei, strengthsensei.com) is one of the best-known strength coaches in the world. He has trained elite athletes from nearly 20 different sports, including Olympic gold medalists, NFL All-Pros, NHL All-Stars and Stanley Cup champions, and IFBB bodybuilding champions. His clients include America’s first-ever Olympic gold medalist in women’s wrestling, Helen Maroulis, long-jump gold medalist Dwight Phillips, NHL MVP Chris Pronger, and MLB batting champion Edgar Martínez, among many others. Poliquin has authored more than 600 articles on strength training, and his work has been translated into 24 different languages. He has written 8 books, including a short gem entitled Arm Size and Strength: The Ultimate Guide.
Just Because You Exercise Doesn’t Mean You Deserve Sugar Water
“The most important thing I’ve learned about nutrition is you need to deserve your carbs . . . to deserve [hundreds of kcal of carbs] post-exercise, you need to be sub-10% body fat. And the quickest way to know if you have sub-10 body fat as a male is: Can I see the lineal alba [vertical separation] on your abs? In other words, can I see all ab rows? One ab row doesn’t count; you’ve got to see them all. In other words, you have to have penis skin on your abs.”
TF: One female reader responded on social media with “What if it’s someone else’s penis skin?” Might be a workaround.
“I’ve got some athletes who do best on 70% carbs, 20% protein, 10% fat. But they deserve their carbohydrates. They’ve got a great pancreas, they’re insulin-sensitive, blah, blah, blah, they’ve got a lot of muscle mass. But some athletes, they’re allowed 10 licks of a dried prune every 6 months. That’s all they deserve and that’s all they’ll get. And after 6 months, they’re actually allowed to look at calendar pictures of cakes once a week.”
TF: For a low-carb post-workout option, see goat whey on page 84 (Portable Fuel).
How Do You Identify a Good Strength Coach?
“A good strength coach should get a female, no matter what her body fat is, to be able to do 12 chin-ups in 12 weeks.”
Charles’s Typical Breakfast
Charles takes breakfast seriously. His typical combo includes some type of wild meat (typically pan fried in Meyenberg goat butter), nuts, and sometimes berries or avocados:
“I really like macadamia nuts, but I vary that so I don’t develop intolerances. . . . On the road, one o
f the reasons I stay at the Marriott worldwide is it’s the only place that will serve steak and eggs.” When traveling, of course, things can be harder: “In Manchester [UK], for example, there was no way I could get steak and eggs for breakfast, so my assistant and I bought sardines. So we had sardines and Brazil nuts for breakfast the next day. I don’t negotiate on that. For me, I either have meat, fish, or seafood and some nuts.”
TF: I bolded the above, as I have many friends who’ve been tested for food intolerances and called me with: “I’m intolerant to navy beans! Egg whites, too!” Such results don’t necessarily mean you have genetics that disallow these foods. There’s a decent likelihood that A) you’ve simply been consuming too much of the same food and provoked a correctable autoimmune response, or B) the lab has made an error. I’ve seen labs return every patient (dozens) in a given week as intolerant to egg whites. Lab errors happen, equipment malfunctions, and people make mistakes. The moral of the story: Vary your food sources and confirm any scary test results with a second test.
Tools of Titans Page 9
