April 11, 2024

From podcast: https://bengreenfieldlife.com/podcast/solosode-470/

[00:00:00] Introduction

[00:00:37] Things Ben changed his mind on

[00:02:03] Ketosis and ketogenic diet

[00:12:29] The carnivore diet

[00:20:26] Exercise and plaque build-up

[00:41:32] Plasma velocity measurement

[00:45:52] The use of aspirin

[00:50:05] The benefits of ginger

[00:53:39] The impact of Viagra on heart health

[01:00:13] Over-prescriptions of statins

[01:04:24] Ad for Ben’s house

[01:06:04] Analyzing the Heart Health Snippet

[01:11:01] Cold exposure

[01:20:08] Is THC harmful?

[01:27:46] The sleep hygiene

[01:33:50] The importance of being moderate

[01:38:15] End of Podcast

[01:39:16] Legal Disclaimer

Ben:  In this episode of the Ben Greenfield Life show.

Big things have changed my mind about keto, carnivore, cryotherapy, statins, THC, sleep hygiene, minimal effective dose of exercise, and a whole lot more.

Fitness, nutrition, biohacking, longevity, life optimization, spirituality, and a whole lot more. Welcome to the Ben Greenfield Life show. Are you ready to hack your life? Let's do this.

I get a lot of questions about things that I've talked about in the past. It's kind of the blessing and the curse of being a content producer, having a blog. It's like everything you put out there is evergreen. A lot of it you don't necessarily go back and edit every time that you have some new update. One of my clients yesterday, he sent me a message about my timing of a certain supplement. And, I thought, “Gosh, I don't even use that supplement.” He referenced an article and it was 10 years old, my supplementation protocol, the gold standard supplementation protocol. It's like, “Well, it's kind of an old article.”

And, as a result, I'm currently in the throes of writing “Boundless 2.0.” I mean, my giant bible of biohacking is three and a half years old is already feeling at least to me knowing how quickly research and health science and needs and technologies change in dire need of an overhaul. So, I'm literally rewriting that book. And, this podcast I figured would be a good opportunity for me to share with you some of the things that I think would be relevant to you in the health and fitness categories that I have changed my mind on. And gosh, I don't really think I need much more of an introduction than that besides letting you know that the shownotes are going to be at BenGreenfieldLife.com/470. That's BenGreenfieldLife.com/470.

And, let's start with ketosis, ketogenic diet, keto, whatever you want to call it. I first became interested in the concept of ketosis when I met this young freckle-faced researcher named Dominic D'Agostino at an event. I believe it was the Ancestral Health Symposium. I was attending that along with Peter Attia, who also seems to have developed a distinct interest in ketones. And, at the time, he was doing very long fasting for 24 hours and then going out on long difficult bike rides and the like, and using different strategies to enhance ketosis to do so. And, as a matter of fact, I believe when I ran into Dominic D'Agostino in this event, he was presenting a paper. He wasn't very well-known at that time but I think Peter Attia was the guy riding the bike on the photo in Dominic's lab in which they were testing out these drinkable ketones as a way to enhance ketosis.

Well, long story short is I started to experiment with the idea of eating a high-fat low-carb diet. The availability and affordability of drinkable ketones like HVMN or Delta G or Ketone IQ, those are three big companies that make this kind of stuff. It just wasn't really available around then. Ketone Aid would be another example of a company that now makes these drinkable ketones. And so, you'd primarily get into ketosis with pretty extensive carbohydrate restriction and a high intake of fats.

Now, because at the time I was racing all over the world as an Ironman triathlete, this really clicked for me because ketones can be a preferred fuel for the liver, for the heart, for the diaphragm, for a lot of these organs that would support long-distance endurance.

In addition, when you're trying to eat as much as you need to eat to support say Ironman-level training, if all of that is coming from say the old-school Gatorade Sports Science Institute recommendations for total carb intake, then you also tend to get things like gut fermentation and blood sugar dysregulation and other problematic issues that occur when you're living off of scones and biscottis and sugary energy drinks and gels.

So, I started to experiment with and even begin to use ketosis in my racing. I was then recruited by Dr. Jeff Volek for a big study he did at University of Connecticut where he had me and a group of other endurance athletes follow a strict ketogenic diet. I mean, we're talking 90% fat, 10% whatever, carbs and protein, and whatever was left over. But, it was a massive amount of fat intake for this ketogenic protocol, which I followed for 12 months. I mean, to give you an idea of this, when I showed up at the lab to do the VO2 Max test, the muscle biopsies, the three-hour treadmill run, and the like, I recall getting on the treadmill to start the three-hour run and they gave me one strawberry mixed into a heavy cup of cream. That's the type of diet that we're talking about.

So anyways, the results of that study I'll link to them in the shownotes. It's called the FASTER Study. It kind of rewrote the textbook showing that people who followed a high-fat diet could burn more than 1.5 grams of fat per, I believe this would be per minute during exercise. And, that was larger than the 1 gram or so per minute that was the prevailing thought at the time. So, you could turn yourself into kind of a fat-burning machine by restricting carbohydrates and being in ketosis. The problem was that long-term, it seems to result in me and many of the other athletes that I talked to and a lot of the people I was working with long-term dysregulation of thyroid function or in guys, endocrine function, in women, some markers of fertility like kisspeptin and FSH and LH.

And so, ultimately, I got a little bit disillusioned with this idea of strict ketosis. And, it's interesting because if you look at the ketogenic diet, a lot of people talk about it for weight loss but therapeutic ketosis has been around since the 1920s for the treatment of epilepsy. So, the ketogenic diet is a carbohydrate-restricted diet that has been used for a very long time to treat a number of different chronic diseases and conditions. Now, you'll a lot of times hear people talk poorly about ketosis in the medical community because they're referring to what's called keto acidosis. That typically results in diabetic patients who have insulin insufficiency. And, in that case, the body gets starved of glucose because it doesn't have sufficient amounts of insulin to transport the glucose into the cells for fuel. And, because of that, the body keeps it in circulation and the blood glucose levels get dangerously high. So then, the body goes into a mode where it produces a ton of ketone bodies in response to the liver sensing the really low levels of insulin. And, when blood glucose levels are high, and at the same time you have a lot of ketone bodies, that's a dangerous state of ketosis. It's almost like a hypoglycemia combined with hyperketosis. But, that form of keto acidosis is different than the harmful effects of keto that I was referring to when I mentioned that. It seems to have an impact on endocrine function. Even energy levels, sleep, thyroid function, et cetera.

So anyways, the therapeutic ketogenic diet if you look at it is indeed very similar to what I was following when I did that Jeff Volek study. It was like 85 to 90% carbohydrate. Protein will typically make up anywhere from 10 to 15% of the diet. Very minimal percentage comes from carbohydrates like 5, maximum of 10%. And usually, that's even from green leafy vegetables and other less starchy vegetables. Complete elimination of grains and legumes and roots and tubers and fruits and processed foods and just about any added sugars.

So, if you look at that version of a therapeutic ketogenic diet, it has been shown to have therapeutic effects for a lot of things. Cancer, it appears that cancer if you look at the metabolic theory of cancer seems to thrive in a glucose-rich environment and thus shifting the cancer away from being able to feed on a high amount of sugar seems to be beneficial for cancer patients. Especially for neurodegenerative disorders, Parkinson's, Alzheimer's, therapeutic ketogenic diet seems to have some really good disease-modifying properties. It also, because of the impact that the ketogenic diet can have on lymphocyte function can help out with autoimmune issues: Multiple sclerosis, Crohn's disease, rheumatoid arthritis. I sometimes wonder if part of that is just because a therapeutic ketogenic diet is also restricting some of those autoimmune triggers like legumes and grains. But nonetheless, seems to have a good impact on that as well. Even cardiovascular disease. Nutritional levels of ketosis have been shown to improve blood lipids and triglyceride levels. I don't think that's necessarily happening from the people who are just eating the fatty cuts of the pork chop and ribeye steak and putting a stick of butter in their coffee, but restriction of carbohydrates particularly seems to have an impact on the presence of cardiovascular disease.

So, yes, there are some use cases for a therapeutic ketogenic diet, but what I've changed my mind on is that you should restrict carbohydrates intensively to turn yourself into a fat-burning machine. I have since adopted more of a carb-cycling approach. So, my current diet, I actually don't eat a lot of carbohydrates until the evening. Then in the evening, I'll have 200 to 300 grams of carbs, which is fantastic because those are precursors for serotonin, which are precursors for melatonin so you sleep better. I typically will use some kind of a blood glucose disposal agent prior to dinner like berberine or apple cider vinegar or bitter melon extract to allow my body to take up that glucose more efficiently. And, by doing that, I can actually be in this state of hyperfocused ketosis the entire day, and then in the evening, have carbs make sure I'm sending the message to my thyroid and my endocrine system that is not starved of sugars, and then wake up the next morning and rinse, wash and repeat. That type of cyclic ketogenic approach seems to work very well.

In addition to that, what I've changed my mind on is I've shifted pretty far away from a largely saturated fat-based version of ketosis. And, this is primarily related to the concept of nutrigenomics. Meaning, you can test your genes and you can see, for example, if you tend to have the genes that would predispose you to having an inflammatory response to saturated fats. And, if that's the case, then if you were going to restrict carbohydrates, you would want to have a more Mediterranean approach like avocados, avocado oil, olives, extra virgin olive oil, fish, sardines, herring, mackerel, anchovies, et cetera, rather than big, marbly rib eyes and pork chops and oodles of butter and coconut oil and a lot of these other saturated fats. So, even the style of the type of ketosis that you choose or the type of fats you choose for a ketogenic diet play a role here.

So, yes, I am careful with sugar, very careful with added sugars, particularly. Added sugars and seed oils are two things that I look for on ingredient labels if I happen to be eating out of a package. But, I'm no longer the strict ketogenic diet endurance guy. Instead, I'm at about 200 to 300 grams of carbohydrates, which is a lot more than the poultry 30 to 60 grams of carbohydrates I used to have when I was, of all things, racing Ironman Triathlon. Feel a lot better, sleep a lot better, testosterone is better, thyroid is better. So ultimately, even though I think there are use cases for a strict therapeutic ketogenic diet, I don't think that it's everything that I had chalked it up to be at one time.

So, that's the skinny on the keto diet. Shownotes are at BenGreenfieldLife.com/270. As always, I welcome your comments, your questions, and your feedback on this or any of the other topics that I cover on today's show.

The next one is also a diet-related topic, namely the carnivore diet. I recently sent out a tweet about a study that kind of turned my head. I said hardcore carnivore enthusiasts may not dig this, but in this meta-analysis of prospective cohort studies, higher fiber intakes were associated with reduced risk of mortality from all causes, including cardiovascular disease and cancer. And, this was a dose-response analysis, meaning every 10-gram increase in total daily fiber intake up to 40 grams was associated with a lower risk of all-cause mortality, cardiovascular disease mortality and cancer mortality.

Now, the reason that I think this is important to think about especially when we're looking at something like a carnivore diet is because one of the downfalls of that diet is the lack of fiber. And, I followed, so I background on this. I had Paul Saladino, Carnivore MD, fly out to my house. We had a great time. I made a mistake and only put salt on it per his exact specifications and barely cooked it at all and sat there and watched him eat it, carpaccio style with a little bit of salt. And, I think he had his bowl testicles that he had in his little Pyrex glass container and a whole host of other carnivore fruit-free, vegetable-free foods.

I, after interviewing him, was so interested in this idea of eating only meat and getting almost everything that you need from meat that I followed a strict carnivore diet for 12 weeks after I interviewed him and I felt pretty good on it. I think that especially because it can control a lot of issues people would get from plants like autoimmune triggers or gut distress, et cetera. That is a short-term kind of like ketosis, a short-term therapeutic diet. There's something to be said for it. It's also very simple to follow. Like, when you open up the menu at a restaurant, you just tell them, “Hey, order me the chicken without any sides and steak without any sides and maybe some of that beef tartar without any crackers or bread,” and I'll be good.

It's also very societally restrictive though. When my wife would come out with a big salad she'd made or we go over to a friend's house for dinner and I'm taking an extra portion of meat that somebody else isn't getting. And, there are some societally restrictive issues in the same way that it was very hard to walk past an Italian restaurant, went on a strict ketogenic diet. But, the fiber part of it was something that I'd always wonder a little bit about, and this recent study got me thinking even more about that. And then, a secondary study came out on longevity. And, this study was using methylation and age-tracking data and they looked at polyphenol intake. Things like green shakes, black walnuts, green tea, mitigation of a high amount of red meat intake, the use of dietary polyphenols like resveratrol and EGCG and curcumin, a lot of things that are considered to be poisons or toxins on a traditional carnivorous diet. Well, they found a significant age-slowing effect from a polyphenol-rich diet. And, part of that could have been due to the gut-brain axis or the gut metabolism axis.

So, it's difficult to get a high amount of polyphenols on a carnivore diet unless you're sprinkling it with blueberries and pomegranate seeds and the like. It's also difficult to get enough of this fiber that seems to reduce all-cause risk of mortality. And then, if you look at some other issues that have made me kind of change my stance on champing a carnivore diet beyond just a therapeutic way to clean up the gut or to reduce any issues that might be autoimmune related like let's say rheumatoid arthritis or something like that, there are some other deficiencies that can be present.

For example, if you're not including organ meat and eating this so-called nose-to-tail approach, then you would risk vitamin A deficiency because most of the muscle meat is a pretty poor source of bioavailable vitamin A.

You could say the same thing for vitamin B, folate and biotin deficiencies are something that are low in meat but that you find in a lot of the awful, the liver, the heart, the kidney, even the thymus glands. These are the type of things that should be added into ideally a carnivore diet.

Vitamin C is an essential antioxidant that's very difficult to get from a strict carnivore diet. You can get it though if you eat a variety of organ meats like beef spleen, for example, has 50 milligrams of vitamin C in it. That's not a ton but it's a decent amount.

So, the next one to think about would be vitamin E. You can get that if you're including a lot of fish, fish eggs, particularly, grass-fed, grass-finished beef, tends to be a little bit higher in vitamin E. But, that's another one that you risk building up a deficiency of on a carnivore diet.

Boron is a mineral, and you might not be able to get that on a strict carnivore diet because you don't find that in a lot of meats or organ meats. So, low boron intake has been linked issues with bone health and brain health and hormone production. So, that's another one that you could be missing. You could say the same for calcium, which you could get from dairy foods and plant foods but there's not an appreciable amount in meat. People on a carnivore diet, for example, should eat fish with the bones or even take a calcium supplement or a bone mineral matrix to avoid calcium deficiency. I know a lot of people who are on a carnivore diet who are doing that, just literally using ground-up bone or bone capsules or eggshells or fish with bones to be able to address the calcium piece.

Potassium. On a carnivore diet, you could eat a lot of octopus and a lot of salmon to get potassium. But, if you're not getting a lot of those foods, you're going to risk a potassium deficiency as well. You could say the same thing for copper unless again you're adding in more organ meats to a carnivore diet. And then, the bigger ones that I would be concerned about are polyphenols. These plant polyphenols, antioxidants that have been shown in many research studies to combat cancer and infections and heart disease and in this latest study literally slow aging based on methylation clocks. The carnivore diet doesn't really contain any plant polyphenols. So, you could supplement with things like curcumin or lycopene or green tea or pterostilbene. But, I actually think that if you're following a carnivore diet, that the polyphenol piece is something to think about and then, of course, the fiber piece. Strict carnivore diet, you're not going to get a lot of dietary fiber. I know a lot of carnivore enthusiasts who are now doing things like mangoes and avocados and blueberries. And, I don't know how those are carnivore, but they're throwing them in. And, that's important because fiber is what your gut bacteria use to produce short-chain fatty acids like butyrate, which is an anti-inflammatory compound to nourish the lining of your small intestine. It's important for flora, but we now know that it reduces all-cause risk of mortality. And, it's tough to get that 40 grams of fiber from a carnivore-based diet.

So, I would say if you were going to supplement or if you were going to add things like blueberries, avocados, high intake of organ meats, some of these other polyphenol-rich foods, you could probably get by on a carnivore diet. But, I had a good, I would say, 12 to 20 weeks after I interviewed Paul Saladino where I was kind of mentioning to a lot of people that it would be a good idea to try. And now, I think if you're going to do a carnivore diet, you should at least pay attention to fiber and polyphenol intake. And, from a supplementation standpoint, a lot more than that if you're not eating fish with the bones, fish eggs, and organ meats.

So anyways, not that I want to throw that diet under the bus, I think it's better than a lot of diets out there, but I still think that similar to a plant-based diet, you still risk certain amounts of deficiencies.

So, the next big thing that I've changed my mind on, this is a big one, is exercise. I, of course, am a self-proclaimed masochist when it comes to exercise. I had 20 years of Ironman Triathlon. I competed in the Kona Hawaii World Championship six times. I raced for Reebok and Spartan obstacle course racing for four years. I've done marathons. I've done tons of open-water swim races. I've been an endurance athlete since I was maybe 18 years old or earlier. I would say 17 years old up until around 37 years old. So, 20 solid years at least of pretty hardcore endurance training. And then, you start to see some of these new studies that have come out. Some of the more popular ones have been spearheaded by a researcher named James O'Keefe.

We know that overtraining can lead to chronically elevated cortisol levels. It's a quick path to what's called HPA axis dysfunction, hypothalamic pituitary adrenal axis dysfunction, brain fog, mood, sleep, irritability issues. And, even though I think that can be addressed with smart training, smart recovery, and a certain amount of fatty acid and other nutrient-dense food intake, in many people, including myself, there is a paradoxical increase in the risk of cardiovascular disease from excess training, particularly endurance training, because of the potential for plaque formation in coronary arteries and arterial stiffness and inflammation.

There's a researcher named James O'Keefe, and I'll link to some of his studies in the shownotes, who has identified the so-called Goldilocks zone for exercise to be no more than 150 minutes per week of moderate-intensity aerobic exercise or 75 minutes per week of vigorous-intensity aerobic exercise, which is quite often exceeded by people who think they're doing a fitness of favor when they're in fact creating long-term cardiovascular inflammation and damage.

So, in addition to that when it comes to strength training, I mean there was a recent 2022 systematic review and meta-analysis that suggested that if you're doing hard and heavy super like difficult strength training, above 60 minutes a week, that your life expectancy begins to become the same as if you were sedentary, like a law of diminishing returns, and definite increase potential for risk of mortality when you exceed 130 minutes per week of that. More than two hours and 10 minutes per week of hard and heavy strength training appears to be not that great. And, I'm not talking about, I don't know, Knees Over Toes Guy, sled pushes and elastic band poles of the gym, I'm talking about a heavy strength training routine; powerlifting, deep squats, heavy dead lifts, and the like. But, there's something to be said about this idea of gradual inflammation, particularly in the absence of well-programmed recovery days really not doing your long-term health and longevity a favor.

Now, unfortunately, when it comes to the plaque piece of this, most standard lipid or cholesterol panels or blood tests don't give you a lot of clues about that. I didn't realize that I had significant plaque accumulation. And, until I went over to Fountain Life and I used their AI-based diagnostic imaging tool called Cleerly Scan, which is a CT angiography scan of the heart, to see that I had a significant level of plaque buildup in my LVA, my left, what's it called, the left something ascending, the left ventricular ascending I believe artery. That's the one where the widowmaker would occur if that plaque broke loose. This is how healthy people often die of heart attacks suddenly.

There are other test you could do besides a CT angiography. There's one called a heart blood test by a company called Prevencio, which is a blood test that gives you some markers for proteins that are associated with plaque. You could also get what's called an arterial stiffness index test. And, companies like Fountain Life, another good one is NextHealth. They offer comprehensive screenings. You can go in there and get a full body MRI, DEXA bone density scan, GI Health mapping, DNA testing, and some of these more advanced heart workup and protocols.

I actually recently talked about this when I recorded a Q&A episode 458 in which I talked about heart health and statins and my new view on the fact that I think there is a use case for statins, particularly in people who have plaque accumulation. I'm on a statin now. I'm on a PCSK9 inhibitor, an injection once every two weeks, and a small daily dose of rosuvastatin and acetamide because that's really the only thing that I've seen good clinical data behind. Not anecdotal alternative medicine, take your red yeast rice extract type of data, which I did all of the natural things for a while. They didn't work because my follow-up scan showed the plaque was still accumulating. And, this was even after stopping the hard and heavy exercise.

But, here's what I had to say in episode 458 where I addressed this issue.

Alright, so as you probably gathered from the introduction and the title to this podcast, I'm kind of a little bit infatuated with heart health and metabolites in general because, well, frankly, I'm going to open the kimono for you. So, I've recently gotten this Cleerly test done, C-L-E-E-R-L-Y. Now, this is important because I think that lipid testing is going to be a thing of the past in probably five years compared to more advanced diagnostic imaging. One of the reasons for that is because when you get a cholesterol panel, it's really not showing you what's in your tissue. That's a blood measurement of your cholesterol. It could correlate to how much cholesterol is say in your brain increasing risk for Alzheimer's or how much plaque is potentially building up in your heart, but when you measure your cholesterol and you get those values back, it's not actually indicative of what's building up from a tissue standpoint. And, that's very important and I'll be doing a more comprehensive heart health episode in the coming months to dig into some of the subtle details surrounding what I've just described.

But, long story short is I personally went and did a Cleerly test, C-L-E-E-R-L-Y. Now, this is an AI-driven test that is based on non-invasive coronary CT scanning to measure the amount of plaque buildup in the coronary artery. So, its aim is to detect heart disease before symptoms arise because this is important to know. The first symptom for more than half of coronary artery disease patients is actually a heart attack. And, that's a pretty unpleasant way especially if it's one of the widowmaker varieties of heart attacks for you or a loved one after you've deceased to find out that there was something going on with your heart that all the lipid panels, all the LDL and HDL and triglyceride measurements on the planet didn't actually indicate to you was going to occur because there are a lot of people walking around with pretty healthy lipid panels who actually have some type of blockage, some type of plaque buildup. In many cases, unstable plaque, which can be the more concerning variety.

So, this Cleerly scan is, in my opinion, one of the best ways to actually truly see what's going on in terms of plaque buildup in your heart. So, the way that it works is you go into a doctor's office and they use what's called coronary computed tomography angiography. So, yeah, there is a little bit of radiation involved with this test because they actually do have to use radiative imaging to see what's going on. So, when you do this test, what they're using is a diagnostic scan or imaging of the heart that then goes on to use AI to basically predict the amount of no plaque, mild plaque, moderate plaque, or severe plaque in the arteries. And, this is very significant because it is really the only way to directly measure the levels of atherosclerosis that might be occurring.

So, this has been studied and I'll link to a really impressive study in the shownotes. It's called “AI evaluation of stenosis on coronary CTA.” So, what they're looking at is comparing whether this coronary angiography is actually able to, based on some of the artificial intelligence-based solutions built into it, allow you to truly know what's going on in terms of plaque buildup in the heart. And, it has been identified as a very accurate and robust non-invasive tool for the identification and exclusion of cardiovascular disease; namely the type of cardiovascular disease that's related to plaque buildup in your arteries.

So, I went in and got this test done. First of all, I know that some of you might be concerned about the amount of radiation that might be occurring in response to a test like this. And yes, you do get exposed to radiation and know its faults when you hear people say, “Oh, you're getting exposed to far more radiation when you travel on an airplane or go through an airport scan.” The fact is, you'd have to take about 500 transcontinental flights to get exposed to the same amount of radiation that you would get exposed to during one of these Cleerly scans. Yet, I think that doing one of these every three to five years is actually pretty prudent in my opinion because at this point I truly believe it's the best diagnostic stand that you can do to actually know what's going on in your heart. Can you actually take care of that radiation exposure, mitigate it somehow? Well, it's also false that all these different herbs out there can protect you from the effects of radiation. People talk about alpha lipoic acid and mistletoe and ginkgo and apple pectin, all these things that you should take in response to radiation. It's possible that those might have a mild effect, but the only supplement so to speak that I think really truly works and has effective evidence behind it for radiation is simply iodine.

For example, I have two bottles in my pantry of Life Extension's Potassium Iodide, it's a pretty hefty dose of iodine. I still take it once per week just because I travel a lot, I go through a lot of airport scanners, et cetera. There's a lot of non-ionizing and ionizing radiation that we're just naturally exposed to during the course of our lifetimes. So, I use it as almost a preventive agent. If you're interested more about iodine and the other effects that it can have in terms of improving metabolism, improving thyroid health, et cetera, go back and listen to my podcast episode with Dr. Leland Stillman. Dr. Leland Stillman and I talked quite a bit about iodine. So, if anything, you can take potassium iodide for a few days leading into a Cleerly scan and after a Cleerly scan if you want to address some of the radiation that you're going to get exposed to during this thing. But nonetheless, I still do think that it is a prudent test to do.

And, just so you know, the radiation is measured in what's called millisieverts. So, 1 millisievert would be equivalent to the average amount of radiation that a person receives in a year. And, I believe one of these scans exposes you to something in the range of anywhere from 5 to 15 millisieverts. So, it's pretty significant, the amount of radius you naturally get exposed to over the course of a year or over many, many transcontinental flights on an airplane, for example.

So, that all being said, I went in and got this Cleerly scan done and I did this a few months ago. My results showed a high amount of plaque in my arteries. Now, some of this is based on genetics, some of it is due to a robust history of masochistic amounts of endurance exercise, which as Dr. James O'Keefe has demonstrated definitely has a law of diminishing returns when it comes to heart health. Once you exceed a certain number of minutes of endurance exercise per day, you see arterial stiffening and inflammation and plaque formation that occurs that dictates that more endurance exercise is not better. It's something right around the range of more than 90 minutes of the type of marathon type training, Ironman Triathlon type training per day that would result in unnecessary stress on the heart.

Now, the interesting thing is that a lot of the type of plaque or if you've gotten, let's say, a calcium scan score, the type of elevated calcium that you might see in the arteries of an endurance athlete is more stable. It's more tightly packed and it's less likely to result in some of that plaque breaking off and causing something like a stroke or a heart attack, but nonetheless, it is concerning, especially if let's say, you've done a whole bunch of endurance exercise, seen the light and realized that it might not be all that great for you stopped but then are living with all of that leftover plaque in the arteries and perhaps even aggravating that with a high intake of oxidized fat, saturated fats, a dirty keto diet, which we'll talk about later, et cetera. It's something that you definitely need to worry about or at least be aware of especially if you're an endurance athlete. 

And, sure enough, my levels were around in the mid-400 range, which is pretty high for plaque. I'd love to see that below 100. And so, as a result of that, I've actually been researching a lot of different arterial scrubbing compounds. Pomegranate would be one. There are other fantastic supplements and I'm currently going through and testing many of them short-term though; however, I am using red yeast rice extract, which is basically nature's statin. I'm using niacin and I'm using CoQ10 because any type of statin whether a prescription-based statin or a natural statin like red yeast rice extract can strip the body of its coenzyme Q10 levels and cause issues in the tissues so to speak and mitochondrial health.

So, I have already started on addressing the buildup of plaque in my arteries, but that's what kind of got me down this road of being very interested in plaque formation and what one can do about that if you do a Cleerly scan and find out that it is indeed an issue.

The last thing that you should know regarding this whole idea of cardiac blood tests, diagnostic imaging, and even the use of artificial intelligence to develop algorithms for predicting risk of heart disease is that there is one other company I kind of have my eye on and will likely do a test with at some point during my year of the heart so to speak. And, this company actually is indeed called a HART, H-A-R-T, or at least their test is called the HART test. The company is Prevencio Med. Now, they're very interesting. You can go to PrevencioMed.com to check them out. But essentially, they have a test called the CVE, which measures in a pretty significantly accurate way, your risk of heart attack, stroke and cardiac death. And, all they're measuring are four different proteins. One called NT-proBNP, which is associated with myocardial heart stress. 

One called kidney injury molecule-1 or KIM-1, which is associated with cardiorenal dysfunction and injury. One called osteopontin, which is associated probably most notably for me or anyone else concerned about plaque with calcification and plaque formation. And then, one called the tissue inhibitor of metalloproteinases, which is associated with plaque rupture potential and also left ventricular enlargement and dysfunction or so-called athlete's heart.

So, the way that their tests work is they take these proteins and based on previous research and their internal algorithms associate these pretty simple protein measurements with your risk for anything that they are measuring for. They also have one in addition to the CVE, I just described to you, the CADhs, which assesses three different proteins to look into your risk of obstructive coronary artery disease. And, they have a few other tests that look at more obstructive peripheral artery disease. One that looks for aortic valve stenosis. One that even looks at your blood test for risk of amputation. One that looks at kidneys. But, I think the most compelling is this CVE test and the CADhs test, which again will test for obstructive coronary artery disease and heart attack, stroke, or cardiac death. So anyways, I'll link to Prevencio Med also in the shownotes because that's another one that I will likely be exploring in greater detail this year.

Another important thing to note is that in a lot of the research that I've done, these newer PCSK9 inhibitors appear to be a pretty safe and effective way to treat plaque when it comes to melting plaque so to speak. And, I'm going to do a big podcast about this with a cardiac physician in the coming months. But, it turns out that some of the PCSK9 inhibitors and perhaps to a lesser extent some of the statin dosages that can be used in small to moderate amounts have quite a few benefits that I think overcome any of the potential deleterious effects of statins such as the stripping of coenzyme Q10 in the body or soreness or things of that nature.

So, what I'm actually doing right now is a test. I'm doing this protocol of red yeast rice extract, niacin, CoQ10, pomegranate, and a few other arterial scrubbing agents. And then, I'm going to go in and do a repeat Cleerly scan and lipid panel. And then, I'm going to start on a statin, namely I'll be taking a small dose of what's called ezetimibe and a small dose of what's called rosuvastatin. I'll be taking about 10 milligrams of the rosuvastatin, about 5 milligrams of the ezetimibe per day. And, that's based on a pretty robust paper that showed that depending on the stage of plaque accumulation in one's heart, there are certain levels of statins that you'd want to take. For example, stage two, which is technically where I'm at would be well-treated by rosuvastatin, ezetimibe, a small amount of aspirin, which I'll get into soon, and then what's called rivaroxaban. If it were a much, much more significant amount of plaque, you would also throw in cardiac rehabilitation, PCSK9 inhibitors, what's called bempedoic acid, ASA, and a few other long alphabet letter soup names that I'll link to a paper if you want to clarify this.

So, the paper is called “Integrating Coronary Atherosclerosis Burden And Progression With Coronary Artery Disease Risk Factors To Guide Therapeutic Decision-Making.” I know that's a mouthful but basically what they did was analyze all of the different statin-based and medical-based methods to get rid of atherosclerotic burden because frankly, this is not something plaque accumulation. What I'm referring to is not something that you're necessarily stuck with for life. You can literally melt it away. And, I had one physician friend who was showing me his plaque score which was up in the 500s and he's since gotten it down below 100 using some of the statin-based approaches that I've talked about combined with a little bit more of a Mediterranean diet physical activity, et cetera. However, my take as I'm trying the natural root first, and then I'll try the statin root. And, I'm just basically using myself as a guinea pig to see which one has the greatest impact on plaque score and on lipid panels. So, ultimately that is the TLDR of how I've gotten to be so interested in heart health in the first place and why several of the things I'm going to mention on today's show are indeed related to heart health.

So, that all being said let's address a couple of other things related to the heart while we are on this topic. So, the first is let's say that you did not want the radiation and you weren't able to go in and get something like a Cleerly scan. There are companies such as Fountain Life, which has several locations in the U.S. There are companies like NextHealth as well that can offer this type of Cleerly scans. There are also one-off locations, for example, a friend of mine recently in Austin, Texas was asking me about where they could get this scan in Austin, Texas. There's a place called Austin Heart that does it. You would just google the name of your city plus Cleerly scan to see if it would come up.

But, a recent article actually indicated that an even less invasive measurement could also tell you some things about your heart that go above and beyond what a simple lipid panel or even more advanced lipid panel could tell you. The most notable that was recently published was a research paper on what's called plasma viscosity. Now, plasma viscosity measures the viscosity or the thickness of your plasma. That's the liquid part of your blood and it's affected by the amount of proteins in the blood. So, protein levels in the blood can increase as a normal response to infection or inflammation and plasma viscosity will increase when these proteins are produced abnormally. So, when you measure the viscosity of the blood, it's a direct indication and even more sensitive I would say when it comes to heart health of your actual atherosclerotic risk compared to something like, let's say, C-reactive protein or even things like Applebee or your HDL to triglyceride ratio. This appears to be even more accurate than that.

So, you can actually ask your physician to order this test for you. It's a blood test that they do. They measure it by taking your plasma and they calculate the force that's needed to send your plasma down this thin tube over a period of time. So, normal plasma viscosity, the plasma would go down the thin tube more quickly but the thicker or the more viscous your blood is, the slower the blood would travel down that tube. So, this is probably one of the reasons that aspirin seems to be so effective for a variety of reasons including heart health because it can decrease plasma viscosity. And, I'll talk about aspirin here shortly because there's some interesting things you should know about it.

But basically, this plasma viscosity test in a recent paper basically showed significant correlation to indicating your risk of a cardiovascular disease event and also just all-cause mortality in general. So, the takeaway from this is that from here on out, if I do get a lipid panel, I'll be asking my doctor if they can also order a plasma viscosity test. And then, in an ideal scenario, if you're throwing in something like diagnostic imaging with a Cleerly scan every three to five years or perhaps a little bit more frequently until you're sure that you've reduced your plaque burden, that's in my opinion kind of a gold standard for many of the type of things that you should look at for the heart.

Now, if you go to BenGreenfieldLife.com/HeartHealth, you'll find a podcast where I actually took a video camera and an audio recorder to a doctor's office about four years ago and talked about a lot of other things that can be used to find out everything that could be going on with your ticker so to speak. And, this included an electrocardiogram, both resting and with exercise, a blood flow score, nitric oxide measurements, an echo ultra or ultrasound echocardiogram which shows kind of the thickness of the muscles in the heart. And so, if I could go back and do that entire podcast all over again, I would have also done the Cleerly scan. However, everything that I talk about in that podcast episode is pretty decent as far as if you want to know everything that was going on in your heart, what to actually go and ask your doctor about ordering or doing for you. So, that's kind of the idea behind plasma viscosity and kind of a newer measurement that's come up as far as something that could be good for the heart.

Now, I also mentioned just a little bit ago aspirin. Now, aspirin is interesting because not only can it be used for treating something like plaque accumulation, but there was also a recent paper that shows that aspirin actually mimics everything that calorie restriction does for you. So, we get this age-associated deterioration in cell function and overall organ function that is associated with what's called disabled autophagy, meaning your normal autophagic flux in the body, the extent to which your cells cleanup is something that tends to decrease in its efficacy over time. 

Now, this is why intermittent fasting can be a good life extension strategy because if done properly without excess of restriction of certain macronutrients like never eating carbs or being a pre-menopausal woman and doing excess intermittent fasting or being a very lean active weightlifting male and not eating enough food for too long a period of time. There are some issues with intermittent fasting, but overall, it is a fantastic way to increase cellular autophagy, especially if the fast is longer than 16 hours. I'm not necessarily endorsing fasting longer than 16 hours every day. I think that something like a well-timed one to four time a month 24-hour such as a dinner time to dinner time fast is a good way to spark cellular autophagy. And then, you can do a shorter 10- to 12-hour intermittent fast on a daily basis to get some of the other gut-relieving benefits of fasting and some of the other longevity benefits of fasting.

But nonetheless, aspirin appears to induce the same type of autophagy benefits that fasting does and that many of these calorie restriction memetics like metformin or berberine or bitter melon extract can do. Now, the dosage of aspirin needs to be taken into account because even though low-dose aspirin can be very effective for this, if you're already on other blood thinning agents, particularly fish oil would be the one that leaps out as the most commonly taken supplement that would thin the blood, you do need to be aware that there is increased risk of bleeding. And, while a baby aspirin can definitely decrease your risk of a heart attack or a stroke, you want to be careful if you're combining with other blood thinning agents and that's just something that you can talk to your doctor about or you can analyze any other blood thinning agents that you're taking and make sure that you're taking a very low, low dose of aspirin if that is the case.

And so, just to contextualize this for you, a low, low dose of low-dose aspirin would be somewhere around 70 to 80 milligrams per day. A slightly higher dose of low-dose aspirin would be above that like 80 milligrams all the way up to around 300 milligrams per day. A typical aspirin dosage taken for pain or inflammation or fever is 600 plus milligrams. So, when we're talking about low dose, it's close to 1/10 of what a normal dose for inflammation or pain would be and you'd want to be on the low end of low dose if you're already taking fish oil or any other blood thinning agents. But, what's interesting is, and this has influenced me to think a little bit more about in addition to getting on red yeast rice extract, niacin, and CoQ10, getting on low-dose aspirin is because it appears to bleed into other areas of your life, pun intended, see what I did there, in terms of the longevity enhancing effects. So, aspirin at low doses seems to be relatively risk-free, especially if you're not getting a brand that's high in aluminum, which some of them are. You can do a Google search for aluminum-free or low-aluminum aspirin to see some brands. But basically, it acts almost like a calorie restriction memetic, which can induce cellular autophagy. So, good to know about aspirin. And so, that's one thing that you can add to your list of something to look into as far as heart health and also cellular autophagy goes.

Now, another thing to look into and this was also a recent paper that was just published is ginger. So, this was this was a paper that came out a couple of months ago on the effects of ginger on human serum lipid profiles. What it found, long story short, is that ginger had a significant impact on triglyceride levels in human subjects. So, the reason this is important is because there's something called your atherogenic index, which is your triglyceride to HDL ratio. Ideally, that should be, in my opinion, below 1. Meaning, my HDL for example is up at about 130 my triglycerides are around 70, so I have a very low triglyceride to HDL ratio. A ratio above 4 is considered to be pretty significant as far as increase for cardiovascular disease risk. And so, the idea of lowering triglycerides through mitigating sugar intake, vegetable oil intake, overall calorie intake, excess fructose intake, et cetera, is a good idea. But, it appears that throwing some ginger into the mix and using that frequently as an herb or a spice if you want to call that because it actually is pretty spicy in your cooking is a good idea.

And, this isn't the first paper or investigation into ginger in correlation to heart health that has come out. Ginger has been studied since the '90s as far as I'm aware for reducing plasma cholesterol, for inhibiting LDL oxidation, for attenuating the development of atherosclerosis, and now, it's shown for decreasing triglycerides. So, I actually use ginger quite a bit already so I'm not really needing to change much up there. I use ginger powder. I just have a big herbal glass container of ginger powder. I use dry ginger quite a bit when I travel as a cheap digestive hack. Not only do I travel with peppermint oil in my fanny pack, but I grab ginger root when I go to the grocery store. I chop up ginger root, I put that in a pot or a pan in water, which is especially good if I'm staying in a suite or an Airbnb or a place where I have access to water that I can boil. And, every morning, I just wake up and I boil the water with the ginger tea and then I have that to sip on throughout the day. And then, I also have the little ginger pieces that get all nice and soft in that water. And, I'll chew on those and it's fantastic for gut health as well as many of you know. 

But ginger also has a really great impact on the heart and it's pretty dirt cheap to just go grab some ginger root if you happen to be traveling somewhere, organic please because this is a root and can bioremediate certain things from the soil. But, organic ginger root that you just boil in water each morning whether you're at home or on the road can be a really great way to easily get access to ginger pretty cheap, and then ginger powder that you use in cooking, for example, or some of these dried gingers, that can also be a good way to do it.

My wife likes the ginger chews, but in my opinion, those are just a giant sugar bomb that you're chewing on throughout the day. So, I think they're called the Gin Gins. I'll occasionally have one of those Gin Gins, but what I like better is some of these herbal supplement companies that'll sell ginger lozenges or ginger chews with lower amounts of sugar or again, save money, cut out the sugar entirely and just go straight to the ginger root. And yes, you can put a little bit of organic stevia or monk fruit extract into ginger tea and it's actually pretty tasty. A little bit of a raw organic honey in there can be pretty good too if you're not concerned about the fructose. And, I will get to the fructose here shortly because that's something else I want to tell you about.

We've talked about ginger, we've talked about aspirin, and then also it turns out that there's a hidden benefit too so-called dick pills as well. That's right. Viagra, which I think — this is based on memory recall not something that I'm looking at as far as a paper but I believe that Viagra was first investigated for its blood pressure lowering effects before it became rebranded as a men's sexual health agent. Although it works fantastically for women also in the blood flow sexual performance orgasmic departments, but tadalafil, the active ingredient in Viagra, and sildenafil is also acting similarly. It's what's called a PDE5 inhibitor, a phosphodiesterase 5 inhibitor. And, essentially what that means is it's going to increase nitric oxide pretty dramatically, particularly in the nether regions although it does have a full body flushing vasodilatory effect. And, because of that, it opens up the arteries.

So, no surprises here that it turns out that both of these compounds, sildenafil and tadalafil, have been shown now to significantly reduce the likelihood of progression to heart failure, myocardial infarction, and death compared with people who were not taking either those drugs. So, they studied men for five years and found that they had a much lower risk of most heart disease risk factors if they were taking an erectile dysfunction pill.

Now, could you skip the pharmaceutical prescription or the sketchy online dick pill pharmacy and get a similar effect from something like a nitric oxide lozenge or nitric oxide supplement? Most likely. I've used the nitric oxide supplements before. I have used the JOYMODE, which is a sexual performance booster with arginine and citrulline and things like that in it. And, that's got vitamin C in it as well to lower the rate of breakdown of the nitric oxide. And, I've also used Viagra. I think that Viagra is definitely the most powerful and the only way I'm gauging this metric is literally by the hardness of said dick. But, at the same time, the nitric oxide pills seem to work pretty well and that JOYMODE stuff also despite it being a central nervous system stimulant that if you take too close to bedtime is going to keep you awake works pretty well also.

There are also certain formulas. Dr. Mike Major, a doctor out of Phoenix, introduced me to a little lozenge I've talked about on podcasts before. It is a mix of tadalafil, amorphine, and a certain peptide called PT141 that is fantastic for both libido and erectile quality all at once. And, it's also great for women also. There are also companies, one being Nootopia, for example. Nootopia is mostly known as a nootropic or a smart drug company run by BiOptimizers, the same company that makes some supplements that I like, Gluten Guardian, for example. Great supplement that turns gluten into soup basically if you have it prior to eating bread or pasta or something like that. So, a great friend for your trip to Italy or your next trip to the steakhouse. But anyways, Nootopia has a blend now of a nitric oxide precursor, a dick pill-esque type of compound that I recently received in the mail. That one I've used a little bit of too and it also seems to work pretty well.

So, ultimately, it doesn't have to be Viagra or sildenafil or tadalafil, but what you should know is that many of these supplements that can increase sexual performance have a direct positive impact on the heart. Now, the only thing that I'm concerned about here is that there are, to my understanding, many adolescents and teen boys and young men who don't need an erection pill actually taking it for sex. There's a big, big difference between the type of erection that you get when you take particularly something like Viagra versus a normal natural erection. What happens, I think psychologically, is that guys get addicted to this stuff and can't really engage in confident sex unless they have this pill in their body because they're a little bit fearful about maybe the person that they've been having sex with suddenly seeing that or feeling that their dick isn't quite as hard as it used to be and so that gives them performance and anxiety issues or they feel like they just can't get it up unless they take their supplement beforehand.

So, I want to issue a word of caution if you're a young man listening into this that I do not recommend that you begin to rely upon these things as a crutch in the same way that I don't think anyone in a healthy state should have to rely on coffee or some type of nootropic or smart drug as a crutch to get throughout the day. Good sleep is better. The same thing with something like your erection quality, fellas. If you're eating a diet rich in nitrates with arugula and you're working in beetroot and a lot of natural compounds, getting high amounts of vitamin C and making sure that your underwear isn't too tight and lifting weights with your legs, which triggers a lot of these androgen receptors in the legs. If you're doing all of these things, then the Viagra or the nitric oxide or the PDE5 inhibitor or the PT141 or whatever, that should be the icing on the cake. But please, do not use my podcast as an excuse to think that you got to take some kind of a fancy supplement every time that you want to have sex. I don't. But, yeah, there's certain nights where I just know it's going to be a big date night with my wife. I'll take something like that. And then, now that I know the benefits for heart health, I'm making sure that I make a point especially when it comes to my plaque score and what I've seen as far as my own risk for atherosclerosis using some type of nitric oxide precursor or blood flow or vasodilatory agent on a daily basis.

The other cool thing is if you have some type of a sauna practice, infrared sauna practice, et cetera, there's a very popular protocol called the Niacin Flush that is a protocol where you take a high dose of niacin before you go and get into the sauna because you increase your sweat rate, your removal of toxins, you increase your body temperature a little bit. And, this type of compounds have a similar effect as that high-dose niacin. So, it's great for kind of going along with sauna like a turkey and cranberries so to speak. I suppose in this case, beetroots and goat cheese. So, there you have it.

Okay. The next thing that I wanted to talk about while I am still, yes still, on the topic of heart health, now I did mention earlier probably much of the chagrin of my don't ever go near a prescription statins are the devil listeners that I am considering low dose statins. I'm going to do low-dose statins. I already have them. I'm just doing a washout period where I compare them to red yeast rice extract, again just using myself as a guinea pig so I know which one is better for me to be taking for life. But, I do still think that statins are overprescribed.

Now, there was a recent article that came out that looked at a risk tool that was released by the American Heart Association. And, what that risk tool is is it's what physicians use to identify people who should be prescribed cholesterol-lowering statins. So, this is a risk tool that combines age, sex, smoking status, cholesterol level, blood pressure, and other factors to calculate your risk of having a heart disease or a stroke or a fatal coronary disease in the next 10 years. 

So, the problem is that it turns out that when they looked at the calculated risk that would indicate that someone should be put on a statin to the actual incidence of heart attack stroke or death from blocked arteries, the correlation was not that great, and actually indicated a pretty significant risk for over-prescription of statins. And, not just over-prescription of statins at a low dose which is the exact protocol that I'm considering, again, 5 milligrams of one, 10 milligrams of another, but a pretty high dose of statins that considering some of the side effects and expenses of statins would dictate that this risk calculator is not all that great. It strikes at the heart of the risk calculator and the severe overestimate of risks in this article. And, it turns out that there are a lot of people who are at high risk based on this calculator who actually are not. And remember, they're not doing actual diagnostic imaging, they're not doing a calcium scan score, they're not doing Cleerly score. This isn't even based on your lipid panel, it's just looking at some of these factors that you would literally almost type into a web browser or answer on a piece of paper. And, those calculator risks would put you on a medication that you don't actually need to be on. 

The other thing that's just shocks me about these calculators is they don't take into account diet and exercise. Obviously, if you have a healthier lifestyle and a healthier diet, those same inputs would add up to less risk. So, being this age with this cholesterol level and this blood pressure would add up to a lower risk if you're exercising or avoiding trans fats or say eating a bunch of blueberries or something like that.

So, long story short, the reason I bring this up is because it returns back to the value, in my opinion, of getting actual data, getting actual diagnostic imaging, and not just using some type of a American Heart Association risk estimator to look at whether or not you actually do have cardiovascular risk or whether or not you should be say placed on a statin. And, of course, the other very important thing to remember is that many people have normal lipid values, a low-risk score on a test like this risk estimator by the American College of Cardiology, and still have high levels of plaque. In some cases, that can be unstable plaque or a high calcium scan score in which case your lipid panel isn't telling you much. This risk factor screening isn't telling you much, but the diagnostic imaging is where the real magic lies in terms of telling you what's truly going on with your heart.

Now, I did speak incorrectly, I think, as I was describing that risk estimator tool to you because it does actually take into account your total cholesterol, your HDL cholesterol and your LDL cholesterol. That's it. But, it doesn't take into account triglycerides, APOE, the cholesterol particle size, inflammation, blood sugar status, et cetera. So, that's just something to think about again when it comes to the weakness of something like a risk estimator.

That really wraps up most of what I wanted to tell you about heart health. 

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Now, this is interesting and I hope that snippet was helpful for you for a couple of reasons. First, not only does it mean I've changed my mind on hard and heavy exercise and now I walk a lot, I play pickleball, I do strength training a couple times a week, I swing the kettlebells a couple of times a week, and I occasionally throw in a cardio session or a hike. But, I'm no longer doing hard and heavy MetCon-style training every day. Now, you may have perked up a little bit there in that section where I talked a little bit about statins. And, just to give you the background on this, I've had episodes like what pharmaceutical companies don't want you to know about statin, and the most mind-blowing information on heart disease you'll ever learn, and other interviews that I'll link to in the shownotes. And, I've cited statistics like out of 100 high-risk people taking a statin for five years, around 98 of them don't see a benefit to their heart health at all but they get exposed to the significant side effects and complications from taking a statin. And those, whatever it comes out to, 1.8 people that do benefit will live an average of six months and a maximum of one year longer than those who didn't take the statin, which kind of makes you wonder if it was worth taking the statin with all the side effects and expense in the first place. And, the beneficial effects of a statin only apply to people at the highest risk for a future heart attack, which are primarily middle-aged men who've already had a heart attack.

I've also cited stories the recent one that was published on a news website that the actual calculator that doctors use to identify your risk of having a heart attack or stroke overestimates the likelihood of those events by 500% or more. And, because physicians use that routinely in their offices to identify people who should be prescribed, cholesterol-lowering statins, there's actually a pretty big risk here that many statins are being needlessly prescribed. But, where I've changed my stance is that when you look at these studies, they don't differentiate between people with high plaque accumulation, people without high plaque accumulation. And, when I looked at the data that, for example, one of the doctors showed me at Fountain Life of the literal artery scrubbing effects and reversal of plaque accumulation from people who followed a PCSK9 inhibitor and a low dose double statin combo like the rosuvastatin and ezetimibe, I was pretty blown away. And, that's why I'm using those two statins in my own protocol.

Now, some people will say, “Well, Ben, what about the CoQ10 stripping from statin? Should I take CoQ10?” Well, I've also changed my mind on that. I've told a lot of people if you're on a statin you should take a CoQ10. But, it turns out that CoQ10 has never been shown to reverse statin-associated muscle symptoms like muscle soreness or poor muscle function that often tends to be a result of taking statins. You instead need the building blocks for CoQ10. And, those two building blocks are vitamin E and vitamin K, namely vitamin E as a form of mixed what are called tocopherols and tocotrienols, and vitamin K as MK4. If you are taking a good vitamin E complex and a good vitamin K complex, that's even better than taking a CoQ10 supplement if you're on statins. So, what I do is I use a supplement from Designs for Health called Tri-K, which has the MK4 in it which acts very similarly to CoQ10 but does a much better job at maintaining CoQ10 levels than CoQ10 does. 

And then, I take a supplement also from Designs for Health called geranylgeraniol. I interviewed Dr. Barrie Tan about this way back in the day. He recently sent me more data about its effects on keeping CoQ10 levels up and reducing the statin-associated muscle symptoms. And, that's got all eight forms of vitamin E in it. So, if you're taking something like the Designs for Health, GG and the MK4, if you're on a statin, you would be doing the exact protocol that I do. I take three little soft gel capsules of the Tri-K each day. I take four of the GG each day. And, I think that's a wise move for anybody taking a statin. But basically, the effects of exercise on heart health and the potential for statins to help undo some of that damage assuming you've stopped the mindless hardcore exercise makes a pretty compelling case for me to let you know about having changed my mind on high-intensity exercise and the dose of it and then also the kind of the take on statins. I don't think they're all bad. I think there's a time and a place, especially if you have plaque accumulation. So, shocker and I'm sure there's a lot of natural diet and supplement enthusiasts who are going to not like that, but it is the case. Yes, I'm lining the pockets of the pharmaceutical companies, so assuming.

Alright, it's a decision though that you should make with your physician. I am not a doctor. I don't even play one on TV so don't misconstrue this as medical advice

Alright. So, let's move on to cold exposure. Cold exposure, there's been a few videos circulating around the internet. I'll play you the audio of one right here.

Thomas: There's a video going around the internet that says cold plunging is probably the dumbest thing you could ever do. That video it seems really concerned with people who suffer from thyroid problems, and I share that concern. It's about 3% of the population would have some sort of hypothyroidism and they should know that cold plunging will recruit brown fat into their body that helps modulate their thyroid. Now, if you're thinking about maybe doing a little cold plunging experimenting with that on your own to see if it will help your thyroid function, there's some things you should know. A cold plunge is nothing like a plane crash. It's nothing like being on the Titanic. A cold plunge is something you do of your own volition. And, there was nobody on the Alaskan Airlines flight that blew out its door, they landed said, “Yeah, let's do that again.” When you get into the cold plunge, you're choosing to do something hard.

And, there's a lot of good science on this. Huberman just did a post with David Goggins talking about how choosing to do those hard things builds up your anterior mid-cingulate cortex, your resolve, your tenacity. And, Kelly McGonigal, she wrote a whole book called “The Upside of Stress” in which she talked about the cold pressure test and the story that people tell themselves about stress in the way that stress can benefit your health and extend your lifespan.

Now, the video wants you to think that it's based in science. It shows a journal article and it puts up a nice graph of body temperature going down over time. But, what the video doesn't say is that the authors of that article, they think body temperature is going down because people are getting healthier and living longer. So, when they cite that study, they want you to believe exactly the opposite of what the study authors are claiming. Our bodies are evolved to expect cold. Our ancestors had it. If we don't get enough cold, it's no wonder we slip into a state of disease.

Cold plunging is one of the best things you can do to stimulate the production of new mitochondria, and it's mitochondria that are the key to aging. So, when you get into the cold plunge and you stimulate mitobiogenesis, you reverse the rate at which you age.

Now, there's one point about the video on which I agree. Cold plunging is sexy. Ben Greenfield calls cold plunging Viagra for the whole body and he's got a really good point. Men who cold plunge experience a boost in their sexual performance. Cold plunging is one of the antidotes for erectile dysfunction. Women who cold plunge experience a boost in their fertility and better birth outcomes. It turns out that more cold is exactly what people in Western industrialized countries need.

Ben:  So, what you heard there was my friend, Thomas Seager who's involved with the Morozko cold tubs talking about these sensational science-flavored anti-cold plunge videos with beautiful models and CGI footage from popular disaster movies that would have you believe that cold plunging is the dumbest thing that you can do. And, a lot of that is based on the potential for cold plunging regularly to excessively stimulate the sympathetic nervous system, cause a big dump of things like epinephrine and adrenaline or norepinephrine, and actually cause you to be a little bit too hyped up. I would say that for, let's say men who have a higher risk of having a heart attack between the hours of about 5:00 a.m. and 7:00 a.m. in the morning. Getting up and jumping into a cold plunge, yeah, might not be the best idea to greet your day with that strategy.

But, why is this something I've changed my mind on? Well, I was a cold plunge freak for a while. I was 10 to 15-minute ice bath, 30-minute-long open water cold swims, a lot of times for Triathlon training, but nonetheless, getting out and shivering for hours on end. And, the fact is that if you actually look at the research on the benefits of cold plunging, first of all, you don't even have to get in water.

There was one study that got published last month. And, this study was on, was it the Journal of Biochemistry? And, what it showed was that very short daily cold exposures of less than 30 minutes, we're talking about being outside in cold weather at around 55 degrees Fahrenheit, was sufficient to induce structural changes in brown adipose tissue that caused this metabolic process that allows you to break down white fat and create more metabolically active brown fat, which helps to regulate blood sugar, which helps you to burn more calories, and which helps to even alleviate things like high cholesterol, impaired insulin secretion, even insulin resistance in type 2 diabetes.

So, other studies have shown that a lot of the benefits that you get as far as the feelgood appetite stabilizing blood sugar lowering effect of cold plunges come from just a brief foray like 30 to 60 seconds into cold water that's colder than 55 degrees. My strategy for cold plunging is now not only a time-hacking strategy, but I think it's a healthier strategy. I keep a cold tub near my office that's generally somewhere in the range of 33 to 40 degrees, which I realize is cold, but I will get in that thing for 10 to 60 seconds, that minimum effective dose of cold plunging. And then, once per week, I do a longer hot-cold contrast therapy session. My go-to session is five minutes of hot tub, five-minute cold plunge, four minutes hot tub, four cold plunge. Three-three, two-two, one-one. And, if you're concerned about the potential for excess nervous system activation, excess shivering, some of the things that people seem to be talking about on the internet when it comes to the deleterious effects of ice bathing, then that's a pretty good strategy.

There was a post by a guy named Carnivore Aurelius. He's got a great Twitter account. He post some good stuff but he says cold plunging daily is one of the dumbest things you can do. Sure, do it every now and again but it's not the panacea it's made out to be. Cold plunging is the most stressful thing you could do to yourself. Your body doesn't know you're in a nice LA studio cold plunging. It thinks you're on the Titanic sinking. In nature, falling in cold water meant we're going to die. As a result, it massively spikes adrenaline in all of your stress hormones. And, when you get out of a cold plunge, it feels amazing just like how surviving a plane crash would. You thought you'd die and then you did it.

This comes at a massive cost. Injecting animals with acute doses of stress hormones mimics aging. You're basically aging yourself faster for a mood boost. Regarding it as being anti-inflammatory, inflammation isn't a bad thing. Inflammation is how your body heals. Chronic inflammation is an issue and if you're chronically inflamed, it means you need to remove something instead of adding a cold plunge to cover up the symptoms. We're warm-blooded creatures for a reason. Our body needs to maintain its temperature of 98.6 degrees for everything to run optimally. And, most people today are already cold. The last thing they need is more.

Well, he makes a couple of good points there, but frankly, yeah, excess activation of stress hormones from doing excess cold plunging is an issue. But, your body also thinks it's going to die when you have a heavy squat barbell on your back or when you're running up a steep hill and your body thinks you're getting chased by a lion, or when you're eating plants and herbs and spices that have mild amounts of plant defense mechanisms in them. Having a little bit of a hormetic stress response to a hard thing is not a bad thing, it's just excess use of any of those things. And, I might get to that a little bit later on in this podcast. I want to talk about this whole concept of, coined recently called, biopharming.

But basically, his idea behind inflammation, yeah, cold can also shut down inflammation. You shouldn't do a long cold plunge after workout for that reason. Your body needs to be able to mount its own anti-inflammatory response. But, does that mean you shouldn't take some cold showers? Do like I do and just jump real quick in a cold soak for 10 to 60 seconds a couple of times a day, maybe have a longer hot-cold contrast session once a week. Absolutely not. Those things are fine. So, basically with cold, it all comes down to the dose, and that's what's most important.

So anyways, so I've changed my stance a little bit on cold.

Next, I know everybody was excited about this one, THC. I had a period of time during my life where I swore by a little gummy before bed to help relax, maybe a little hit on a vape pen here and there to induce creativity. The more and more studies I see, the less or I should say the more I become disillusioned with the use of particularly THC-rich sources of cannabis. I mean, even if you look at the most recent randomized crossover trial that got me thinking about pointing this out to you during today's episode, they used cannabis before running on a treadmill. There's a great book about this called the “Runner's High” and it made exercise more enjoyable, but the ratings of enjoyment and positive effect were higher in the participants who used the CBD-dominant products compared to those who use the THC-dominant products. And, when I tweeted that, I said they probably killed fewer brain cells too.

Dr. Daniel Amen has done some fantastic writeups on THC, and I'm very cautious with it now. I might eat a gummy once a month before let's say my wife and I are going to get it on because I think THC is a great sex drug. There's been occasional times when I've had a lot of pain. Well, I've got this shoulder thing going on right now. I had about 6 milligrams of THC last night to help to kill a little bit of the shoulder pain before I went to bed, but it's pretty rare that I'll do that because there is no biological free pass.

So, for example, let's treat a few myths that Dr. Amen has talked about. Marijuana makes you happy. The fact is marijuana actually increases the risk of depression and suicidality. Now, the 2019 Journal the American Medical Association Psychiatry published a review of 11 studies with over 23,000 people and found that cannabis use, particularly during adolescence, increases the likelihood of becoming depressed, having suicide thoughts, or attempting suicide in young adulthood. There's also the idea that cannabis helps you sleep better, it doesn't. As a matter of fact, THC-rich strains unlike CBD strains suppress your REM sleep cycles, suppress dreaming, which means you're getting less memory consolidation and emotional processing. This is also why I think people who use cannabis frequently tend to have long-term, short-term memory deficits. I think part of it is the improvement in the brain that's supposed to be occurring during certain sleep stages that don't occur when you're using THC for sleep. This is why I think a full spectrum CBD that might have trace amounts of THC in it, technically it would have to be less than 0.3%, is a much better choice if you want to target the endocannabinoid system for sleep.

As a matter of fact, according to a 2022 study that was in the Regional Anesthesia and Pain Medicine Journal, people who used cannabis in the previous month were more likely to sleep less than six hours or more than nine hours. And, those who use the drug frequently tended to be at the extremes of sleep duration getting too little or too much sleep. So, no cannabis, and when I say cannabis, I'm talking about THC-rich strains don't help with sleep.

People say it's a natural way to calm anxiety, but weed can actually make some people feel more anxious. So, there's research in the Journal Neurology showing that higher concentrations of THC are associated with increases in anxiety, racing thoughts, a fast heart rate, common symptoms of anxiety are experienced by a lot of people who use THC. I don't think it's better than CBD at quelling anxiety, I think is potentially worse. Not only that, but you get that paranoid everybody knows I'm high type of effect.

Cannabis makes you more creative. Maybe, but it can also induce psychosis. So, you're at increased risk of psychosis. There was a 2019 study in the Lancet Journal Psychiatry that suggested 10% of new cases of psychosis might be linked to these newer high-potency strains of cannabis and that daily usage of high-potency weed were five times more likely to develop a psychotic disorder. I think you could say the same thing. And, I've written articles about this before about high and frequent use of a lot of these plant medicines, ayahuasca, ibogaine, DMT, magic mushrooms, et cetera. I think that it's opening some portals, so to speak, to a spiritual dimension that does threaten to induce some form of psychosis or schizophrenia or bipolar. And, I've seen that happen to a lot of my friends and it's kind of sad when they're off on their 38th ayahuasca retreat and they're getting worse, not better.

Memory. I briefly mentioned this, but marijuana definitely impairs short-term and long-term memory because THC attaches to receptors in the hippocampus, and that can impair memory. There's a 2016 study that found that past use of cannabis is associated with a decline in verbal memory. Other research shows a link to memory problems later in life if you use it during adolescence. They did brain imaging works for over 30 years at Dr. Daniel Amen's clinic, and they showed that marijuana use negatively impacts brain structures involving with memory.

There's a 2017 study by Amen clinics publishing the Journal of Alzheimer's disease, a more than a thousand marijuana users and they found a decrease in blood flow is most pronounced in the hippocampus, one of the brain's major memory centers. So, when people tell you it doesn't affect their memory, they're wrong, it impairs long-term and short-term memory. It also negatively impacts the brain, which is probably also why it has an impact on memory.

In the world's largest brain imaging study, over 62,000 different spec scans, which is a blood flow to the brain, marijuana use was associated with lower blood flow and accelerated aging in brain tissue. Meaning that you can literally age your brain more quickly when using marijuana. And, part of this is also due to the fact that THC, when interacts with neurons in the brain, causes a huge increase in free radical production and basically its inflammatory leakage from cells in the brain when you use it, particularly in high amounts with high THC strains.

And then, smoking pot doesn't affect your kids. Well, if women use pot when they are pregnant, it's been shown in multiple research studies that prenatal exposure to marijuana impacts fetal brain development, leads to cognitive deficits, and increase the risks of neuropsychological problems. They did three different large-scale longitudinal studies from the U.S., Canada, and the Netherlands and found that the children of marijuana users exhibited greater impulsivity and hyperactivity were more likely have memory issues, and had lower IQ scores compared to the offspring of nonusers. And, other research shows that as adolescence, the children of pot smokers are at a greater risk of having attention problems, depressive symptoms, and delinquent behavior. So, if you're pregnant, yeah, you may want to set aside the Snoop Dog tracks and the Cheetos for a few months at least. And again, I don't think that THC as a major part of your supplementation protocol or whatever you want to call that is a good idea.

Even with alcohol. I've said this before on the show, I've micro-dosed with alcohol. I have a small amount of alcohol, 3 to 4 ounces of organic red wine on a nightly basis, but I haven't been drunk in 15 years. And, I rarely have more than one drink. And, the reason for that is that I think alcohol is okay in very small amounts, it may even induce this hormetic effect. But, in large amounts, it's poison. And, I would say that you could say the same thing for THC but it's even more serious in terms of the amount that takes for it to deleteriously impact you. And, I don't think it's a good idea to frequently be using marijuana despite me going through a phase in my life where I would tell people, “Hey, yeah, don't worry about having a gummy. Hit in a vape pen. It's not that big of a deal just don't turn into a pothead.” I think it's more serious than I've ever really realized based on the most recent research that I've seen.

Alright. So, let's move on, speaking of weed, to sleep. So, I recently sent on a tweet about three different handy hacks to keep your phone from damaging your sleep patterns. One is this system called the 1 Tap Zap, which basically just sucks all the blue light and the EMF and everything out of your phone screen.

Another option is the red light iPhone hack. I'll link to this as well. It's a little section that you can access in the accessibility function of your iPhone with a triple tap on the side button. You can suck all the blue light out of the phone.

And then, there's also a blog called the bluelightdiet.com, and I have this installed on my phone. It's called a Circadian Control Panel, meaning when it's at night, I can push the Sleep button, it'll automatically turn my phone into airplane mode and suck all the blue light out of the screen. Or, I can put it in off mode, it'll totally disable Wi-Fi, Bluetooth, put it in airplane mode and just decrease any electricity coming off the phone from a radio frequency standpoint.

So anyways, I'll include links to all those different helpful resources when it comes to sleep hygiene related to your phone. But, the way I think about this is that there's four different gold standard sleep hygiene components: Light, temperature, sound, and stress management.

So, for example, to manage light, you would get exposed to as much natural sunlight during the day as possible. You could even use light-producing devices like the Beacon 40, which is super bright flickering light. I have it next to the trampoline and my Zen den. I jump up and down that thing while I'm looking at the bright lights in the morning, particularly when I've come back from a trip and I need to realign my circadian rhythms. I have a similar one on my desk called the EVY made by OptoCeutics, blast me with blue light during the day. You could use different glasses that will blast you with bluish-green light spectrums like the Io or the Re-Timer glasses. And then, in the evening, you can dim the screens. You can use software like Iris on your computers. You can dawn blue light-blocking glasses. You can implement red light bulbs or even cheapo red light headlamps or as they call them overseas torches at night.

So, red light, it's basically lots of blue light during the day, absence of it at night.

For temperature, keep the room as cool as possible. 60 to 64 degrees is the sweet spot. Avoid hard exercise sessions and heavier spicy meals in the three hours leading up to bedtime to keep the temperature down. To manage sound, you can use earplugs and background noise-producing apps. I like one called Sleepstream with some soft wraparound headphones like SleepPhones. Other good apps NuCalm, Brain.fm. I've really been digging Yoga Nidra lately. There's even 8-hour Yoga Nidra session that I use when I travel. There's one gal named Ally Boothroyd. I don't know her. I'm not affiliated with her at all, but her tracks on YouTube, which if you have YouTube premium obviously just free to download and add to your phone are fantastic. Ally Boothroyd's Yoga Nidra tracks or non-sleep deep rest protocols on YouTube. I'll link to those in the shownotes by the way at BenGreenfieldLife.com/470.

That's great. So, we got light, we got temperature, we got sound, but the fourth component of sleep hygiene, stress management, can be the trickiest to tackle. See, I used to be the guy who would wander in my hotel room and open my laptop on the bed, flop down my belly, and work on my laptop or keep a business book handy by the bedside. And, that's a bad move because that mentally associated my bedroom with stress and stimulation and work. And, this can be all the more problematic for hard-charging high achieving people who are often genetically hardwired as I learned when I read Doug Brackmann‘s book called “Driven,” which is excellent, by the way, with patterns that would have allowed us to be good, awake and alert, sentries or soldiers 4,000 years ago but doesn't serve us too well in this modern era where an email incoming to your laptop propped up on your belly and bed really isn't that big of a sleep-disrupting threat as your brain perceives it to be.

And, there are genes that actually can affect this. The two most common that affect the stress response are the COMT gene and the ADR A2B gene. You can get these tested with a simple salivary DNA test. For example, your COMT gene determines how fast your body can clear neurotransmitters like dopamine and noradrenaline. If you have a slow COMT gene, you're more likely to stay stressed for a longer period of time. And, stress can, of course, interfere with your sleep.

So, even though I've really been in to light and temperature and sound for a long time, I'm more and more interested in sending messages to my brain that associate the bed with just sleep and occasionally sex. So, if you're one of those folks who's genetically hardwired like I am to lay awake at 3:00 a.m. plotting out 27 crazy business ideas and reprocessing a recent argument with your co-worker, your spouse, my best advice is to eliminate as many forms of work as possible from the bedroom, including business books and replace those with fiction or easy magazines, banish the laptop and TV from the bedroom room,  and I'll link to them in the shownotes, use software like 1 Tap Zap or the red light iPhone trick or the greatest help hack ever, the smartphone shortcut. And, I'll link to all those on the resources page, but you want your device to be completely useless boring, and dim at night. You want your bedroom to be boring and you want, when you walk into your bedroom or your hotel bedroom, for your body to know that that's not a place where you work. Particularly in the bed, it's a place where you do boring things or mildly entertaining things like an easy book of fiction and you don't actually do work or associate that area with stress. And, I've just been more and more into that as a very big form of sleep hygiene, something I'm going to be addressing in much more detail in my upcoming “Boundless 2.0” book. But, in the meantime, just something to think about regarding sleep.

Now, the last thing I want to mention comes back full circle to what I was talking about with cold plunges. I think that you can easily harm yourself and definitely harm yourself with certain forms of biohacking. Let's take red light or ozone or hyperbaric oxygen therapy. All of those create oxidative stress. A hot sauna session creates oxidative stress. Sunlight and red light therapy create oxidative stress. Micro doses of alcohol that in some studies seem to promote longevity probably act that way because, you guess it, oxidative stress, but it's the dose that's the poison. Bitters and herbs and spices and alcohol and plants, when they're used in appropriate amounts are not going to kill you. Just like exercise or heat or light or alcohol can all induce cellular resilience by forcing your body to create its own endogenous antioxidants and upregulate its own cellular resilience. 

And yes, you could go run back-to-back marathons or get dehydrated and mineral-depleted from spending three hours in the sauna or hang out 10 hours at the beach without sunscreen and down a bottle of vodka or mow through an entire loaf of bread drenched in lentil soup served over a giant grocery shopping cart full of kale. And yeah, you're going to get excess oxidative stress. You can get vitamin D toxicity and other toxicities from excess supplementation and not actually looking through the labels. It's so often that someone will hire me to go through their nutrition plan with them. And, I get their big plastic bag full of supplements or their spreadsheet. That's always a warning sign when somebody has a spreadsheet for their supplementation protocol. And, there's 10 things that overlap with each other and they're overdosing on at least five different compounds. You can have a poor social life from an orthorexic approach. Like strict adherence to a keto diet or a carnivore diet that's basically just keeping you from enjoying food with friends and family. I understand if you have a disease that you're managing, but a lot of people don't have a disease, they just like to brag about their diet.

Excess dietary restrictions, OCD with exercise or with nutrition. There's a lot to think about here, but basically what I'm getting at is that a lot of these biohacks can become, back to this coin I recently termed, bioharms. When biohacking becomes bioharming is when you're using excess amounts of so-called hormetic stressors: plant defense compound, supplements, red light, ozone, hyperbaric oxygen, sauna, even cold, you name it, instead of doing the small minimum effective dose of those type of compounds. So, sauna, sure, four to five times a week, 20 to 45 minutes. You don't need to be some Japanese sauna marathoner. I guess they have sauna offs over there where people die.

For training, hit rewind and go listen to my section on the Goldilocks zone again. Sleep. I already talked about that too. Poor social life. You got to live a little. Sometimes go outside your diet. I follow the 80-20 rule, 80% of the time I have a pretty strict diet, and 20% of the time I just let myself go knowing that human connectivity and relationships trump all. I mean, research has shown, the psychological and physical health benefits of social contact are so great that they can outweigh the harmful effects of other risk factors like staying out past your bedtime or, God forbid, having a non-fermented slice of non-sourdough bread at the restaurant or maybe having one and a half cocktails instead of 0.5, whatever. We know that if you're with people, if you have good relationships, if you have good social contact, it trumps a lot of those factors.

So, just something to think about when it comes to your own protocols and asking yourself, “Hey, am I going overboard? Am I doing too much of this?” Because that's certainly something I've changed my mind on. For me, it's about getting the minimum effective dose in, then go spend time with family, achieve the purpose in life God has called me to, play a little pickleball, go on a walk. So now, it's your turn. It's time for you to quit listening and go party with your family, your loved ones. And, in the meantime, I'm going to put links to everything I talked about at BenGreenfieldLife.com/470. If you dig this kind of what I've changed my mind about podcast episodes, certainly leave me a note over there. I read all your questions, your comments, your feedback. I'd love to hear what you think. And, until next time. I'm Ben Greenfield. Thanks for listening in.

Do you want free access to comprehensive shownotes, my weekly roundup newsletter, cutting-edge research and articles, top recommendations from me for everything that you need to hack your life and a whole lot more? Check out BenGreenfieldLife.com. It's all there. BenGreenfieldLife.com. See you over there. 

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