Thrive with Us by Dr. Sarah Rasmi brings a useful lens to deliberate heat exposure: less noise, more attention to what the body is actually adapting to. The value is not in chasing discomfort. It is in applying the right signal, at the right dose, with enough recovery to become more resilient.
Full transcript with clickable timestamps linking back to the source video.
Everyone's talking about NAD + peptides, cold plunges, and saunas, but are these buzzwords or actual game changers? I'm joined today by Dr. Rammy Khalil, US double board certified internal medicine physician to talk about what we actually need to do to live a longer and healthier life. Welcome Ramy. Thank you for joining me today. Thanks Sarah. Nice to be here. So longevity buzz word big big time everywhere. Yeah. What are your thoughts? Why are we so obsessed with it? Oh, longevity. Um, you know, I think people the idea of the the reason that longevity is so sexy now, it seems to kind of have like appeared out of thin air in the past 5 years, right? Yes. Um, and I think the we got the causality wrong. It's not that we've we're suddenly advanced and we've come through some medical breakthrough and that's why longevity science is now a mainstream thing. I don't think that's it at all. Um, I think it's more that there are a constellation of things have happened in a post-pandemic world that have made space for an industry to grow, a wellness industry and a longevity industry coupled with the failures of a traditional healthcare industry as well. So, it's that recipe for it's that recipe that's made longevity medicine now something that suddenly everyone's talking about. But again, it is not that you know this medicine or this science is is new or groundbreaking or we we just got that much better better at it. Um I I think that's an important way to frame this this movement. Yes. No, I'm hearing you and it makes sense that, you know, there are a few different external kind of factors that have really brought it to the forefront. And I think one of the things that's really important for us to also dive into, and we will later today, is we're talking about longevity. There's a lot of trends, but the evidence and the data to support a lot of these things
data to support a lot of these things that people are hearing about and people are recommended to do lifestyle-wise, it's just really not there. It's not um and it's uh I I think the the main theme of what the longevity and wellness industry sells is um is a narrative. [laughter] This is what I this is what you know when patients come to me and they ask me for XYZ you know things that they've heard on social media peptides and NAD plus and and full body MRIs and you know all these things that they they want to ask me to prescribe for them. um you know I try to share with them this idea that the this the evidence behind them is exceptionally weak if non-existent. So most of the the science upon which this these interventions are based or at least sold is mouse medicine. It's lab lab science, you know, not clinical trials, not studied in humans. Um I I like to kind of cite BPC 157. I'm sure you've heard that one, right? That's a peptide that everyone's talking about. Um, that's been studied in fewer than 30 humans. Wow. That's not to say fewer than 30 humans have taken it. Obviously not. But it's been has not been studied in a proper controlled way in more than that number of people. Mhm. And that usually, you know, that usually gets like a bell go off in people's heads. So, whoa, you know, that doesn't sound right. How is that possible that it's not been studied in more people than that? How is it not FDA approved? It's not, you know, these meds are not these things are not FDA approved. But the story, the narrative that's being sold is a very sexy one. It's a narrative of control that you can uh manage your health through action by doing these things. And for some people that that doing is therapeutic. Uh but it doesn't require the evidence to sell it. And therein lies I think the harms because these things can at best be um useless. they they don't work at
be um useless. they they don't work at worst they can harm and that's the you know the thing that I tend to um uh really harp on is that it's not harmless a lot of these interventions so it's important to understand what is the mechanism of what's being sold yes what does the person who's selling it stand to gain if you buy it and um and you know what is the risk is there safety data data behind it and I always ask I approach every s every intervention asking those three things first I think it's really important And one of the things that comes up for me as you're sharing that is this idea that on a global scale, there is a huge difference in what is required in order for something to be passed and approved as medication versus as a supplement. And I think a lot of lay people are not aware of that distinction. And so when they see that something is being sold in a bottle, it's being sort of taken at face value, that this is going to be therapeutic, that this is going to be helpful to achieve XY Z. And then as you were referencing as well, wondering about who is promoting and what it is that they have to gain. And a lot of people who are maybe not trained medically or scientifically are much more comfortable upselling and minimizing some of the nuances like what you were sharing earlier about the difference between a controlled clinical trial and a mouse study. It's a huge difference. Yeah. The supplement bit's a real one. I mean we your liver and your kidneys don't distinguish between a supplement and a prescription med. Mh. It's still a thing you're consuming and your body will have to metabolize it. But we tend to see the prescription from the pharmaceutical company as um as different potentially something more sinister where the supplement is is something that we default to thinking of as natural. Yes, it's coming from the earth. Right. But that's not necessarily the case. In fact, the rigor applied to the
case. In fact, the rigor applied to the manufacturing process of that supplement is very likely less than the rigor that's applied to the manufacturer of the drug. So, you don't know the purity of the compound. You don't know what's in it. You don't know where it came from. And there's nobody holding that pharmaceutical company or the company that manufactured it to any sort of standard. So, in a way, supplements, while we perceive them as less dangerous, they can be more dangerous. Yes. I mean, I'll ask patients, "What medicines are you taking?" And uh they'll say, "I'm not taking any medicines." And I now learned that you can't just stop there. You have to say, "What supplements do you take?" And that's when the floodgates open. And now, yeah, I'm taking these 15 supplements. Um so, so there there's yeah, there there is this kind of and that kind of taps into this idea of distrust of the traditional healthcare institution. I don't want a prescription medicine from a doctor. I'm healthy. I'm going to do this my on my own and I'm going to take a supp supplements instead. I'm going to manage this with supplements. But it's just it's ironic that I think in some cases in many cases not at best the supplements have little data to support their use and at worst they can actually put you in a worse they can harm you. They can um so uh yeah I it's a it's an interesting uh paradox. It is it really is an interesting paradox and I mean I think it's important to say that it's not necessarily something that people should stay away from but really what it is that you should be doing is uh reviewing your history and your symptomatology and your physical health goals with you know your your doctor and then evaluating based on all of those things what are the things that are indicated and I would imagine that in some cases supplements can be prescribed and do have a role and can have benefits. But this idea that, you know, I can fix everything. I can prevent everything. I can live to be 120 just by buying all of these bottles of who knows what with the greenwashing labeling and the fitness in and
labeling and the fitness in and longevity influencers. That's not very accurate. Yeah. Right. Yeah. No, it's not. Um and it's I think it's a nice segue into why why do we want this? you know, why do we want to take these things and why why are we now obsessed with longevity? I think um I think that, you know, for the the majority of human history, we cared about not dying young. Mhm. So, we didn't want to die in our 40s from pneumonia. Mhm. Thanks to antibiotics, sanitization, vaccines, post 1950, we're now in a situation where people are living into their 80s, which is, you know, previously extremely rare. Mhm. And when you get to that decade of life, other diseases start to pop up. Diseases that you would have never, you know, reached if you died in your 40s or 50s. So things like metabolic syndrome, diabetes, heart disease, stroke, fractures from uh low bone density, these things now are popping up and they're painting a picture of old age that isn't too pretty. Mhm. And it's again, it's pretty new. You know, it's it's in the past 70 years we're starting to see a lot of this uh a lot of these diseases creep up. Um, and I I uh I think that our interest in longevity is really a a fear of mortality and also a fear of dependence and morbidity, being um 80 and unable to walk or recognize your grandkids or live independently. So I like to give everybody the benefit of the doubt. never shame anybody for an interest in longevity trends because at the core of it is a desire to avoid morbidity in your old age and that is an a very human and
and that is an a very human and admirable want. Yes. Absolutely. And I think what you are pointing out makes a lot of sense in terms of that fear of morbidity and now with um you know people living longer we have seen most of us in our personal lives um people that have been affected by some of the things that you've mentioned and it is very difficult to watch and imagining yourself having those experiences can be quite challenging. I think for me from the perspective of a female and I would imagine as well for males it can be the same. There is also this obsession with chasing the fountain of youth. And so even when I'm casually on my phone, I mean, I guess it's my algorithm, so maybe I'm interacting with some of these things, but there's a bombardment of not only living longer, but looking younger for longer. And that pressure to be 50 and look 30 uh I think kind of adds and plays a role in this longevity obsession that we have. Yeah. Um there's a it's interesting social media component there. Um I also think part of the reason that we're we're having a main longevity is having a mainstream mo moment is because of social media. we now have access to the rest of the world. And um and with that access comes um with that access you you start to surface common themes that may not have otherwise presented themselves. Yes. In within like your own community if you didn't have access to the internet, right? Um, this is a bit abstract, but you know, I I feel like when you now have the world at your fingertips, you also have the world of human sentiment at your fingertips. And so everybody everybody you now can find a lot more people who are interested and anxious about living into old age and that anxiety kind of acts as fuel,
and that anxiety kind of acts as fuel, which isn't a bad thing. It's not it's I don't think you you know more than I do. I I think anxiety can be positively motivating to an extent and it can be pathologic. It can be harmful. So using and harnessing some amount of anxiety about old age and living uh becoming frail can be good. It can motivate you to take action in your 20s and 30s and 40s which are arguably the most important time to build uh health. Mhm. And you know, I I think if you can take that amount of anxiety and use it to help you uh um change some behavior early in life, great. But um it's it tends to be more uh negative whenever you're suddenly, you know, 50 60 and you're you're looking at um these interventions as a way to kind of rescue you. Yes. And that's where I think some level of um maybe this is a a wrong word to use, but kind of like desperation comes into play. It's like what can I do now? I need a quick fix now. I I don't have time. I don't have patience. I need to do something and I need to do it now. And that that disinterest in patience is super dangerous. From my point of view, most good things when it comes to longevity, the stuff that works, it requires time and patience. There is no quick fix. There are very few of them. rather I should say very few quick fixes. Uh so if your interest is only in quick fixes or if in the narrative of quick fixes like peptides then I I think you're going to be you're setting yourself up for disappointment unfortunately. No, I think that makes a lot of sense and you're absolutely correct in that we can have worries or anxiety or fear that can be helpful because it mobilizes our resources and facilitates some change. And what I'm hearing from you is that when it comes to longevity as well as I guess most if not all other physical and mental health issues or challenges is
mental health issues or challenges is that um prevention and promotion are best and then after that it's early intervention and then the worst kind of place to start is from as you said that place of almost desperation of I've gotten here and it's terrible and I need to find a way to magically undo do the last few decades of of choices which is a very difficult thing to do even behaviorally let alone biologically. So starting early is important and having good solid foundation and habits and lifestyle patterns I think are worth their weight in gold. Um but let's talk about some of these trends. Uh, one of the things that I mentioned at the beginning of this episode is the cold plunge and the sauna. We're seeing those everywhere. So, what are your [snorts] thoughts on those? Do they help? Are they worth it? Um, it depends on your frame of reference. So, from a longevity perspective, if you want to answer the question, do these things help us live longer lives? The answer is no. Okay? And I think that's going to be the theme for the rest of our conversation, right? So, the answer is no, but there's nuance, so we can go through them. So um what we do know we can start with cold plunges. So when you get into a cold plunge the idea here is that um exposure to extreme cold like that will reduce inflammation. It activates brown fat and theoretically theoretically important word. It should you know that that chronic uh decrease in expo exposure to inflam inflam inflammation and activation of brown fat should help you live longer. That's the theory. In studies it has not panned out. Okay. Um so this is the and what yeah in studies it hasn't panned out. Okay. Uh now why do people feel good after it? And it's because when you get into uh a cold bath like that your dopamine levels will surge your norepinephrine levels will surge.
your norepinephrine levels will surge. So that will make make you feel alert almost euphoric. Mhm. And yes, there are some transient reductions in inflammatory markers that don't last more than a few days. Okay. So, the benefit washes out. There's an immediate feeling of that is a desirable feeling which is fine, but there's no longevity benefit. There's also an important risk which I don't think people really think about which is that it has been shown in patients who have either undiagnosed or diagnosed heart disease to cause cardiac arhythmias and potentially sudden cardiac death. You know, if you think about you suddenly just plunge somebody into into cold water, your body is like, "Whoa, what just happened?" And your heart rate can just surge into, you know, above 120 and in doing so, you can trick trip uh trip yourself into an arhythmia. Mhm. And patients have died, people have died. Wow. So, it's not likely, but you know, there is risk. This is the nuance that I'm talking about. There's always nuance with these things. It's not just about does it work. what harm could you potentially be bringing upon yourself? So, my my recommendation to people who want to do cold cold plunges is um if you like it and if you have the money for it because it's not cheap. These cold baths are if you want to buy one, it's like I think like $ 7 $ 10, 000. Yes. Uh so if you like it and it's and you don't have any, you know, other conditions that would uh potentially put you at risk, yeah, sure, go ahead and do it. Will it extend your life? There's no data for that right now. Okay. So in terms of is it going to help you [clears throat] live longer? There's no data to support that it's going to. Are there any benefits? People might feel better and there might be some shortterm for a couple of days. But also, as you were saying, there are potential risks. And you mentioned something very important, which is diagnosed and also undiagnosed. And this is the part that I think people need to be really mindful of is that we are not always fully aware of our health status. And that's why when we're doing things that are going to shock our system,
that are going to shock our system, quote unquote, it is really important to get sign off from our doctors. I would imagine this is a good segue into into um some peptides like okay like I think GLP1s for instance um so you know here we people can get GLP1s without a prescription. Um so I I get a lot of people into my office asking them you know what medicines are you taking? I just started Mangaro. Uh, okay. Who's prescribing that? Oh, I just bought it myself. Okay. You know, this is there's risk there because this is these meds are heavyduty medications that affect multiple organ systems and have potential risks associated with them that I hope somebody had counseledled you on before you start taking them. [snorts] Um, let we haven't, you know, let alone the the risk of self dose titration going up in dose on your own. So, there's so much risk in taking these meds by yourself, but because the they're available and they're trendy and everyone's talking about them and you know your your friend who took them is has lost 15 pounds and they feel great, there's this drive and this want to go and do it yourself. But the again, you know, there's risk in doing that if you don't have the full picture of your own health. Mh. So, one thing I also tend to find often is that I'll get a new patient maybe in their 40s or 50s come to see me and it will become immediately apparent that they haven't really had a checkup or a doctor's visit for just routine a routine check-in for decades. Yes. You know, maybe not as maybe not since they were young like since they had a pediatrician because of this idea that they're they're fine. you know, they they were healthy as a teen. They maybe were an athlete when they were younger. And so they um kind of ride this wave of I'm invincible. Nothing's nothing's nothing could happen to me. It's easy to ride that wave in your 20s. Yes. Even in your 30s. And then I think when
Even in your 30s. And then I think when you start hitting 40s, you start to feel different. Yes. But you uh but you you're still kind of like riding on the w on that that shrinking wave of I used to be a healthy person. That identity of I'm a healthy person. and you go to the doctor for the first time and suddenly you know you have pre-hypertension and pre-diabetes and fatty liver and uh you know a high cholesterol all these things have been building up unnoticed by you because they happen yeah behind the scenes. So, um, so I feel like one of the things that we can do, and I we're kind of taking a little bit of a detour here, but one of the things that I think people can do to, um, to prevent this panic or this idea of, oh crap, I'm 50 now, and what I need to start thinking about longevity is not lose sight of the importance of regular check-ins with a physician or a doctor or a care team. Doesn't have to be one person. It could be multiple people. But having somebody who can check in with you at a regular basis, and I mean regular like at least once a year. Yes. From the moment that you graduate from your pediatrician all the way until end of life, that believe it or not has a strong evidence base for decreasing all cause mortality. people who have longitudinal continuous relationships with their doctor, they live longer, they spend less on their healthcare, they go to the ED less. It's not like a metaphorical thing. The actual relationship is the intervention. It's been well studied, of course. So, I can't stress enough like, you know, if we're talking about interventions, the relationship with having a good relationship with a doctor who really takes time and gets to know you is probably better than any peptide you can take. Yes. Yeah, absolutely. So, I think maybe one of the first things that we want to suggest to people is find at least one good doctor that you can connect with. Go proactively. You know, look into all of the things that could be happening invisibly
that could be happening invisibly because you might be presenting and feeling relatively good and hopefully you are, but there can be things that either have happened or are brewing. And then over time the doctor gets to know you, gets to know the pattern, gets to understand how things might be working together and then can suggest some of those um preventative care as well as you know um early interventions and hopefully avoid things becoming really problematic. And then the part that you were talking about the relationship I think dovetales really nicely into one of the things that we know is really important for longevity longevity and that is being part of a community and having social connections. Yes, definitely. Yeah. Um, I mean that is I mean we when we talk about the the big four things that are rich in evidence for promoting health span and and a long life. One of them is and I think one of the biggest ones is social connection. Um avoiding lo loneliness. Loneliness is itself itself is a risk factor for Yes. uh all for cardiovascular disease all-c causeed mortality rate goes way up in people who are lonely or who are actually isolated. Uh the the statistic I I share that tends to turn heads is that loneliness is being lonely is about as equivalent as smoking 15 cigarettes a day. I don't know if you've seen that study. Yes, I have. So, um when you think about cardiovascular risk from smoking, it's just as important to be connected with with people. Mhm. And I'm not talking, maybe this goes without saying, but I'm not talking, you know, how many friends you have on Instagram or uh or how many followers you have. It's about having deep meaningful connections
about having deep meaningful connections with even one person. Yes. Having even one meaningful connection, being seen by somebody, heard by somebody, understood by somebody, that can go a long way. Far more than a dozen artificial connections that you may have with people. Mhm. And I feel like that's that's something that probably a lot of people here in Dubai might it might resonate with them. You know, people might there's there's um I feel like there are probably a lot of people walking around here with trying to emanate this the illusion of, you know, being connected when in reality they're probably lonely. They may not have as many rich, deep, and meaningful connections as as we think they do based on their outer shell. Yes. And I think that that is something that is happening on a global scale. And I think this idea of a disconnect between how we're presenting and what actually is happening for us internally, whether that's physiologically or psychologically, is is really huge. I do think it is important to emphasize again the benefit of those social relationships. And I'm glad that you pointed out the difference between volume and the quality of the connection. Also, something else to take into consideration is that different people have different sociometers. And even within our life, our lifespan and different phases of our life, we will have different preferences. Like I might need or want more social connection from the people that are close to me or from more people than you might. I might wake up today and really want to connect with someone. And I might wake up tomorrow and be like, I just want to lock myself in my room and watch Netflix. And all of that is okay. It's just about being seen, being heard, and having someone you can turn to and someone that you can share with. And I think one of the things that's helpful here in the UAE is because the vast majority of us are are um expatriots, we came here or someone in our family
we came here or someone in our family came here. And so that experience of coming somewhere new and having to start from the ground up in terms of building that community rather than just having it kind of there and taken for granted as you might in your place of origin if you were born and raised in the same place. Um so it it's easier to form adult relationships but there's a difference between those surface level adult relationships and the meaningful connections that actually help. So I feel like there's a lot of different factors. there's the potential to be able to do it, but then also with the fast-paced lifestyle and all of these other things that are going on, um sometimes we don't actually get there. Yeah, that's an interesting layer. I I um I hadn't thought of it, but it's it's a seemingly obvious one, which is that most people, you know, they like you said, they come here and they probably leave a lot of deep relationships they had formed in their life back in their home country. Um and so, you know, where does that leave you here? Mhm. So it's not not impossible, but I think more it's more more challenging to forge those those meaningful connections uh in a place where the majority of the people here are from somewhere else. And I think still while it's getting better, I still think it's it's a fairly transient population. Again, we're I think we're moving more towards people really laying roots here. Yes. So that may change but but yeah I mean social connection more again more more potent as a longevity intervention than anything you can buy and it's free. It doesn't cost a thing. You know you can pick up the phone and call I I mean my recommendation to anybody who actually is serious about living longer is call your mom, you know, call your dad. You probably haven't talked to them in a while. That friend that you haven't connected with in a couple months, just pick them up and call them. Don't text them. Pick them up and call them. Yes. Instead of paying the few hundred dirhams to go for the cold plunge, spend it on lunch with someone that you care about with devices away and just like really focused um
and just like really focused um interaction. Devices away. That's an important one. Yeah. Not really relevant to longevity, but that's an important one. Yeah, definitely helps with fostering that connection in the moment and longer term. Okay. So, we were talking about the cold plunge and then what about sauna? Okay. So, sauna, the data is a little bit more interesting. It's not there's no real risk to to sauna, okay? As as there was with with uh cold plunges, but you know, the idea is you will lower your blood pressure and then in doing so that that can also reduce your your cardiovascular risk. Um there was a really large um observational study out of Finland, okay, that studied a lot of men who did sauna and there was some promising data that there were these these men lived lived longer and they had lower incidence of cardiovascular death. Um the problem is it's an observational study. So that may not mean like something to the average lay person, but it means that we didn't really we're not really able to extract out some confounding variables. Things like could this population be the same population that has access to a gym or that has more social connection or that exercises more often. So there are some other variables at play that could explain that benefit and um and we don't know. We just don't know. But but there is more more data there than there is with I think cold plunging. So again, if you have access to a sauna and you would like to do it on a regular basis like four to seven times a week. Okay. Sure. You know, it can make you feel good. Um there's also a social element to it in many cases, but do you have to do this or or will this extend your life? It's not very clear that there's that that's the case. Yeah. And I think it's really important to [snorts] emphasize the difference between like controlled clinical trials and observational or correlational studies where we cannot conclusively say
studies where we cannot conclusively say that A caused B. We can say that you know as A went up B went up but as you were just saying a few moments ago there's also CDE E and F that maybe were playing a role maybe a bigger role that haven't been parsed out. So although it's promising and although it shows that there is a connection, we don't want to overstate that. And I'm not familiar with the Finnish study. But what I'm aware of when it comes to Finnish sauna culture is it's it's a cultural thing, right? They spend a lot of time there. It's very regular. And so even if we were able to say that, you know, that using the sauna increases your lifespan, how much are they using that? And are we going to be doing the same thing? And if we're not going to be doing the same thing, are we going to net the same benefit? Right. Yeah. Like, you know, one one sauna session a week, that's not what the subjects in that study were uh using sauna four to seven times a week. So a lot. So that's a lot of sauna to commit yourself to and especially if the the benefit really is unearned from a longevity perspective. Um but again if if it makes you feel good and you have the the means to do it certainly you can the the risk there is low. Uh but yeah I mean this is why I keep harping on what's what is this what does the data show behind it. I I like to call myself evidence-based, which I never thought was I never thought calling myself evidence-based would be a um controversial thing, but today it seems to be, you know, it seems to be controversial to say you're evidence-based. It kind of has like a a negative layer to it. You know, um my reaction to that is look, the evidence is not perfect. Science is not perfect. No. But the method is sound. So the scientific method is one that we cannot
scientific method is one that we cannot abandon. No matter how uh uh appetizing or sexy it might be to just abandon the scientific method and just base our recommendations on anecdote, we cannot abandon that because if we do, I think you know we as a people will be in a lot of danger and our kids will be in a lot of danger. Um we need to recognize that while the framework is sound, sometimes the execution of that framework can fail. And you know we see it with we saw it during the pandemic. Mhm. Could we have done things differently during the pandemic? Absolutely. But in the moment you know it was an evolving evolving time. Recommendations changed. That doesn't mean that healthc care was bad or scientists were bad or the the government was bad. It's just that we we did the best we could with the information we had at hand. Um, nutritional science is another great example. The whole food pyramid, it's totally, you know, we don't think about food the way we used to think about and nutrition. Um, but again, we we worked with the best that we had. So again, the execution can fail and science will change as that's the whole point of the the scientific method. As new data emerges, we have to be ready to change our mind. Actually, it's a sign of strength. Exactly. So it's not a sign of, you know, being fickle. It's not like oh well you said this this was true uh last year and now it's not true. Well if the data if a new data emerged then that's that's what you do when it comes to the science you know and it's our responsibility. The thing is is that as scientists and so for us as psychologists we're social scientists right and one of the things that's really important is that for everything that we do has to be falsifiable and we need to put effort into falsifying that. And what that means is we don't just arrive at a conclusion that this is a good thing and then we just leave it be. Like people will will challenge and try to prove or suggest or compile data to the contrary so that we can understand really what's happening in that moment
really what's happening in that moment and we can communicate that information in a nuanced and accurate way. But you said sexy and unsexy. This is very unsexy. Even like, you know, growing up in North America and watching the pharmaceutical ads, like you see all of these like people doing various things and then you have like 15 minutes of, you know, whatever it is, um, all of the the terms and conditions and all of the asterisks and all of that kind of stuff. People don't like that. And I think that's why longevity is also having a moment because a lot of the people that are proponents of that are not necessarily married to the scientific method and so they feel comfortable speaking very authoritatively without that nuance and it's easier to digest and it just sounds better. Yeah. It's it's easier to kind of sell the lie because because you don't require evidence to sell it. Yeah. Um, yeah, I I think that uh from my perspective, and I've talked about this before, I I think that the one of the reasons again that Longevity is having a moment, we is that we we had a institution that is meant that was meant to look after you and um and help you prevent disease. It's called primary care. Mhm. That may not resonate with some listeners because of where their home country is, but primary care is the idea of like, you know, a GP where some some people from different parts of the world might might that might resonate with them. But the idea of like um a jack of all trades doctor who you see over time and I think that primary care, which is what I'll call it from now on, is failing. And it's failing because of the model in which it lives cannot sustain relationships with patients. This is why you and probably many others
This is why you and probably many others listening are used to quick visits with doctors who don't know them or maybe even doctors who they've seen before but barely remember them. You know, so you probably if you've seen a doctor, you saw them a year ago and they didn't remember they saw you or because it was so quick or you've been to a hospital and you went in with one issue and suddenly you have, you know, a list of prescriptions and supplements and testing that you want to do in referrals. Um, this is what happens when you destroy systematically primary care through a payment model that cannot support it. And the payment model I'm talking about is insurance. Mhm. When you again when you destroy that, you leave a vacuum and longevity and wellness filled that vacuum with open arms and they'll spend 90 minutes with you for a cash price and they'll tell you whatever you want. And there's really, you know, they they will even reduce I shouldn't say this about all practitioners, but generally speaking, the evidentiary standard is reduced in offering what what is offered during those appointments in order to make you feel like you are being attended to. There's a lot of power in that feeling being being attended to, being felt like someone's listening to you. Um because we lost that in traditional insurance-based practice. Insurance just doesn't it's a volume game with with insurance. You lose that. You you will go, you know, that hunger doesn't go away. Patients still want that. People still want that. So, they'll go where they can find it. And that's unfortunately that tends to be in a direction that is away from evidence-based practice towards things like longevity and functional medicine uh which just they don't have the same scientific rigor. And you mentioned the word falsifiable. A lot of the stuff that is in the like the cabinet of offerings from longevity and functional medicine practitioners is is unfalsifiable. like they'll order a test
test test and make a claim that this is what's wrong with you and here's the narrative arc of what um what's what's wrong like here's the this is there's a villain there's a hero there's an an intervention um that narrative arc is really easy for us to accept and and latch on to and the testing that is used to confirm or validate that narrative is unfalsifiable I cannot say there's no way for me to be able to say that the result of your micotoxin test for instance is not what's causing your symptoms. Yes. And so it puts you in a an impossible situation. Yes. Where now you have a result and it's an abnormal one that doesn't connect cleanly with meaningful um and measured outcomes. But yet we have this result and the narrative we can now spin a narrative around it that says this is why you don't feel good. Mh. And I now have the supplement that will help you feel better. Yeah. So, it's there's so much psychology at play here. There really is. I mean, as you were saying that, I was thinking about the roots to persuasion. And we have two different ways to persuade people of things broadly speaking. There's the central route that's like, you know, with thoughtful detailed arguments and then there's the peripheral route which is like the so-called sexy stuff and statistics and lab results can fall into that because what will happen a lot of times is people don't even want to know what the number how the number was derived. It's like but there's a number. If there's a number it must be true. And also if like we just said a few moments ago, there's that social connection piece. And if one of our fundamental human needs is to be connected and to be validated and to be seen and to be heard, then having that in any space, let alone in a medical space where you're not used to, that's going to be very, very validating and that's going to be very enticing. And then add the
to be very enticing. And then add the number into that. and then add the promises of the supplements or whatever it is that's there without any of the nuance, you've got your quick fix towards the fountain of youth. So there you go. [laughter] And I'll add one more layer onto that which is the idea of cash pay. Yeah. Because when there's what is that saying when you pay whenever you pay attention so when when you're in an insurance model by and large you're not really paying for your healthcare. Someone else is paying and that's [clears throat] part of the problem. That is part of the the skewed incentive triangle of insurance which I can go on for about hour I can go on for hours about this but [laughter] but but generally speaking because you're not paying for your health that creates a warped incentive for you to consume health care and in a way that may not benefit you or your doctor or your insurance company. But when you pay now when you've exited that you're go you're hungry you're looking for somebody who will spend time with you. these clinics, these, you know, longevity wellness clinics will will charge cash, which I'm not opposed to, by the way. I operate in a cash pay clinic, so I don't think that that is what's wrong, you know. But when you suddenly pay cash, you now are more invested in the interaction that you've just paid for. Mhm. Uh and so what usually happens, I think, is that you meet with um a a practitioner who's selling you a narrative. Mh. Um and they've spent 90 minutes with you. And so the the cognitive dissonance, if that's the right thing, that follows is well, you've spent so much time with me and I've spent so much money that I now I I assume that you are genuinely interested in me. And for me to say otherwise would would be an admission that I've been duped like that I spent money and it wasn't money well spent and I don't want to make that admission. So I'm even more inclined to buy into the
I'm even more inclined to buy into the narrative. So it's almost like a self-feeding um it's a self-feeding process. Yes. And I think it's important as well um you know when you were saying at the beginning there's not a lot of evidence for most of this stuff and that was going to be the narrative throughout the episode and there are a few things including social connections which we've talked about and a few other important things that we will also um discuss. that there is a difference between doing something because you think it's going to add years to your life, doing something because you think it's going to improve your health, either short, medium, or long term, and doing something because it feels good. And I'll give you even an example from my own personal life. So, um, I try to be as healthy as I can, and it's important, especially at at my age, to kind of keep things up physically. So, whenever I go to the gym, if I finish my strength and cardio training, my gym has a lot of the bells and whistles. And now what I've started to do is not the cold plunge. I'm not into that at all, okay? But I'll do the sauna every once in a while. And I'll do the normch that, you know, put my legs inside that compression thing for the muscle recovery. I don't even know if it's going to extend my life. I don't even know necessarily if they make me feel better physically, but what I'm signaling to myself in that moment is you just did something that was good for you and this is what you feel like doing. Go for it. You deserve to have that time and to make that time and to like look after yourself without the phone away from work and just it feels like self-care. Yes. And I think it's okay. Right. Yeah. I think an a good analogy it'd be like taking a multivitamin. Okay. So, the benefits of multivitamins are I think minimal. Yes. They don't hurt. Um the amounts of of u you know the
Um the amounts of of u you know the individual ingredients in each of these it's modest. You you'd have to be somebody who lives at the fringes of like your nutrition has to be at the fringe for you to really benefit from a multivitamin. But, you know, they help, right? So, but I think what's most important, what's more important is the act of waking up in the morning and you take that pill out and you take it and in a small subconscious way. Yeah. You've started your day, right? I'm going to do something for my health, right? So, I don't think it's wrong. There's nothing wrong with it. If anything, it can help you. Even bio bio biologically, it can help you. But mentally, arguably, it helps you even more. So, the act of doing these things can give you put you in a mindset. You know, the same thing kind of with intermittent fasting, which is something else we can talk about. um intermittent fasting itself very debatable whether the actual act of fasting is better than just caloric restriction. So if you compare people who intermittent fast to people who just count calories and they eat the same amount. The amount of weight loss from both is the same. The metabolic benefits is also pretty similar. There may be a [clears throat] little bit of an edge to fasting, but at the end of the day, if intermittent fasting is something that puts you in a mindset of I'm doing something for [clears throat] me to to be healthy and I want to be in a healthy mindset today and skipping breakfast is going to help me do that and make good decisions, then the there's more power to intermittent fasting than the, you know, the caloric restriction itself. You see what I mean? So, it's I feel like it's exactly what you were tapping into. Yeah. Exactly. And I just don't want anyone who's listening to this to think [clears throat] that we're just like poo pooing on the the longevity uh movement. There's nothing wrong with pursuing some of these supplements and treatments if it's done from a place of information and awareness and under the guidance and recommendations of a physician. Ideally, someone who knows
physician. Ideally, someone who knows you and has known you for some time to be able to really zoom in and zoom out. When you were talking about the primary care model, I think the thing that really appeals to me as a consumer about that is that you have one person who can toggle between zooming out. Here is the big picture and whoops, we have this. We need to look into this. Let's drill down here. Okay, we have this result. How does this fit into the big picture? and that kind of back and forth in and out in pursuit of of um health prevent uh promotion and um and and illness prevention. I I love that actually. I never thought I never use that zoom in zoom out, but it's it's perfect. It's exactly what I I'd like to think I'm doing for my patients. I have the ability to zoom out, which you can't you you h you can't have anybody zoom out if your care is broken across multiple different specialists. Every one of those specialists is doing what they believe is in their best interest for you. Yes. But if their um if their lens is restricted to their discipline, then invariably you will have a fragmented health picture. So the ability to have one person who's highly trained who can zoom out and see it all. And then again, like you said, zoom in when needed. Exactly. That is that I think that is the the power of of primary care amplified by time. And I would imagine that as a primary care physician, there have been times where, you know, you have recommended supplements and maybe you have told someone, sure, by all means, if you want to do the sauna, And you've talked people through the the risks or the things that they need to consider in terms of starting on a course of GLP1s. So, it's not that all of the things that we've talked about and the other things that we haven't gotten to are completely off the table. It just has to be done from a place of of knowledge and information. Yes. And and discipline and you know I the most important thing is the relationship. At the end of the
is the relationship. At the end of the day, the relationship is the most important thing. So if somebody comes to me, which is often, and they come to me asking about peptide X, Y, and Z and um you know, all these very trendy things, I never will say, "No, see you later. That's not I'm not that that's not me." Um you've already you've you've made you've you've taken time out of your day to talk to me. Let's talk about what it is actually that you're interested in. Why are you interested in these things? First of all, tell me about your life. Tell me about who you are. You know, who are you married? Are you have kids? What do you do? What's your sleep like? Let me learn more about you. Let me learn about what what more you're what let me learn more about what you're anxious about, what goals you have, why you're interested in these things, and how maybe we can address your goals using more hardened pathways that are more rooted in evidence. Um, and of course, we can always discuss the things like the longevity interventions. And at the end of the day, if you want to take them, I I'm I'm here. I'm here for you. I'm never going to say like, you know, see you later. That's not me. If you want to take them, let's let me be your partner. Even though I've explained that maybe this is not something that's rooted in the science, if you're going to take them, at least let's take them together so that I can monitor you [clears throat] for any negative effects should they come. Exactly. Uh I So again, the relationship most important thing if if you don't have the relationship, then then I your primary care practice dissolves. Mhm. So, primary care physician relationship with him or her as well as relationships more broadly, those are two very important things. You mentioned that in your interview or consultation with a patient, you will ask about a whole lot of things and one of them is sleep. Is sleep important? Hugely so. the the four things that kind of the big four that I talk about, social connection, sleep, that's that's one, food, and uh exercise. It's the same thing that we tell people. Yeah. So [laughter]
Yeah. So [laughter] those it's it's like it's boring, right? It's boring. It's it's not exactly sexy, but no, you know, is that saying if you could package exercise in a pill or sleep in a pill, it would you'd be the richest person. So I'd be very rich if I could package exercise into a peptide. But sleep. So yes, sleep is incredibly important. Um not just the number of hours of sleep. So we know that the people who sleep less than seven hours of sleep increase in risk for all all cause mortality. We also know that people who sleep routinely more than 9 hours Mhm. also have negative outcomes. It's not because sleep is bad. It's just that the people who are sleeping more than 9 hours usually something's wrong like there's some other illness that we're not diagnosing. So the sweet spot is seven to nine eight hours. That's a sweet spot for people. And more important than the duration of sleep is the consistency. So sleeping every day at the same time, waking up every day at the same time. That's hugely important. Yes, arguably more important than again any peptide that you could take. Uh but we don't focus uh too much on it. You know, we tend to think about sleep as something that you can kind of pack in. So I can get like two hours. I can go to take a nap. I'll I'll get two hours now and then I can get four hours later. Um I'm too busy to sleep. I don't have time for that. Uh that is taking years off your life. It is. And you know from a mental health perspective in conversations I've had with my colleagues particularly psychiatrists a lot of times the first thing that they do is help people get their sleep under control before managing any of the other symptomatology or presenting problems. Sleep takes care of a lot of things, but like you said, it can be an afterthought. And one of the things I've also observed, and it's difficult to kind of avoid this, like we have the week and we have the weekend, and people have more of a routine during the week and they have a different routine in the weekend. But if you're someone who is drastically changing your sleeping and
drastically changing your sleeping and waking hours, it's almost the equivalent of jetlagging yourself. Yeah. once a week and it's you're just in this constant cycle of of recovery and trying to catch up and it never really feeling like enough. And the naps um I think people also need to take into consideration how long they are and at what point of the REM cycle you're coming out of them because sometimes you can come out of it feeling relatively refreshed and other times it can be even worse. M what's your take on uh sleep trackers? Oh my goodness. So I [laughter] have I have a lovehate relationship with sleep trackers. I think that part of my take as a social scientist is I just love data and I love numbers and I love monitoring trends over time. So the first thing I do every morning when I wake up is I check my sleep score on my my Apple Watch. And I realized at some point in time it's like I'm waiting for this device to tell me how I slept instead of just being like do I [laughter] feel good or not good. Um but you know I think it can be helpful sometimes. It helps you identify certain things that maybe you are doing um that can impact on the sleep score. So, going to bed later. Um, and then kind of trying to go backwards and figure out why, like maybe I had a fourth coffee at 3: 00 p. m. And I should probably try not to do that. When I first started using the sleep trackers a few years ago, they were causing me so much anxiety. Like, I would wake up, it wasn't this one, it was a different setup. I would like wake up and make sure that it was actually working. I'm like, "So, I'm ruining my sleep to see how well I'm sleeping."and then not believing the data that I'm getting. What am I doing here? It's pretty common though the the sleep the tracker anxiety around sleep. Um it there's there's it's like a counter a counterproductive thing with these sleep trackers. So I I also I tried one
tried one for the same reasons interested in in data collection and then u about four to six months later I ditched it which is actually around the time that most people ditch these wearables a lot. four to six months is kind of that time when pe people's anxiety about the data that's being collected tends to outweigh the the kind of novelty of the device and so they end up stopping it. But yeah, [snorts] I mean it's it it taps into this bigger theme of data collection and equating that equating data collection with doing something healthy. So, Mhm. I have um a good number of patients who probably subconsciously feel that collecting data about their health, whether it be through a tracker or expansive blood tests or full body MRIs or, you know, collecting all this data is in some way doing something for their health. Yes. Kind of like what we talked about that it's this idea of managing health anxiety through action. Exactly. And collecting data is one act action that you can uh that you can maybe do to make yourself feel better. But ultimately it's not really doing anything. And if if anything, it may only be precipitating anxiety [clears throat] about results that are not actionable. Yes. And I think it's really just important on a psychological level for all of us to be aware of how the information that we're collecting is impacting us or how it's making us feel. So, if you have a wearable and you're using it to track your sleep or you're using it to monitor your heart rate and you're finding that you are having a lot of anxiety about what the data is, what the trends are, it's compromising your ability to actually self-reflect and look inwards on how you're actually feeling without the wearable, then that might be a sign that we need to kind of shift our relationship with it. Um, I find again with the Apple because that's the only one that I'm familiar with on the homepage dash there's like this uh section called trends. And for me if I [clears throat] see a
And for me if I [clears throat] see a trend like your exercise minutes are up compared to like how they were last month I find it motivating and it kind of makes me try to continue with that tempo. And the opposite also if it's like you know you've not been standing very much lately compared to last year then that might prompt some behavior change. So I'm aware of it and I know that it can incentivize behavior that I want it to and I'm not obsessing over it but I'm spending a lot of time and attention monitoring that. And so I think it's really important for people to kind of really think about that and if something is no longer serving you just stop. Yeah. Change it or stop. I was uh It's a funny story. I used to wear an Apple Watch mostly because I like getting the notifications. So, like, you know, if I'm at work and if I get a text, I can just quickly glance and know if it's something serious. But of of course, it tracks me, too. And then for Christmas two years ago, I got two gifts. One was a Whoop and one was an aura. Oh. And so, I couldn't say no to both of them. So, I was the weirdo who was wearing an Apple Watch, a Whoop, and an Aura. Wow. Trifecta. [laughter] So I I did that for a couple months and then basically ditched all three. But Oh wow. But yeah, I mean, you know, data collection um data collection can come with some risk. We talked like we talked a little bit about uh full body MRI. Mhm. That's one thing that is hot now. It's it's it is collecting data without a meaningful way to act on that data. For the most part, most of the stuff you catch with a full body MRI, for instance, you we don't know what to do with it. You don't know what to do. Sometimes I don't even know what to do with it. It's just the MRIs are really good at picking up weird things and so you'll you'll find something and once you find it, you can't unknow it. It's it's in your brain and that's going to be something that you always will know. Um and if you're the kind of person that can handle that, that's fine. So if you can handle that information and process it and pack it away and understand that this is not meaningful, then that's fine. But but you might not be that kind
fine. But but you might not be that kind of person. So that kind of person, I would not recommend getting a full body MRI or a biological age test or something like that. like these biological age tests that give you a number, but what does that number mean? And and can you do anything about that number? Actually, the answer is no. There's really not much you can do to change that number because the test doesn't measure doesn't change with individual interventions. These were tests that were initially validated on large populations, epigenetic, you know, level of uh interest in these tests. Yeah. So um and there's also a lot of test to test variability on these things. So you might check your biological age one month and then the next month do nothing and it can be different and all of that during that month you might have had a lot of anxiety about trying to reduce your biological age. You know that that's not the point that you're missing the point here. You're missing the force for the and I think that and um there is probably some level of self - selection bias. people that are opting into these biological a tests. People that are opting into like the inbody analysis kind of tests, um people that are opting into the full body MRI are probably people that might be more likely to be um anxious or go that way than people who aren't. So then now they're getting more uncertainty and more variability and that becomes very very difficult to deal with. Yeah. So, I don't know if there's there's any um psychological studies to support that, but that's one of the things that came up for me. And then this is the other important part. It's that the test variability. So, it's just like stepping on a scale. I can step on a scale at your office half an hour after I leave home in the same clothes and with everything being exactly the same and there will be a different read. And there are many different things that can contribute to that. So if we become overfixated on those data points that can create a lot of issues for us in terms of actually doing the things that better our health but also very
better our health but also very importantly they can create and take a very big toll on our mental health and our motivation which then also impacts what we do on a physical level. Right. Yeah. It's um it's it's noise at the end of the day. I think most of it is noise and it's distracting noise from the four pillars, the things that I think most people should be focusing on. If you're not focusing before you spend money on any peptide stack or longevity protocol or um any advanced diagnostic, ask yourself, have I done everything I can to master the big four? Mhm. Sleep, exercise, food, and social connection. All free. Mhm. So, if you haven't spent as much effort as you can on these things, or if you're not at least in tandem exploring these things, then I think you need to reorient your priority. Yes. And that's like I was saying before, that's one area where we are fully aligned. And when we have clients coming to see us that are exhibiting all sorts of challenges in their lives, one of the very first things that we'll do is assess all of those. And the thing that often happens is the people that need to fix their nutrition, their sleep, their exercise, and their level of social connection find it very difficult. And so we need to be able to break down some of those barriers. And one of the things that often helps our clients is help having them understand it's not an all or nothing thing. You don't need to sleep seven to eight hours every single night. You don't need to, you know, be interacting with someone in a deep meaningful conversation every single day. You don't have to have perfect nutrition, all of that stuff. You don't need to exercise for three hours at the gym. Take one step. Commit to doing it for a few days. Build a little bit of
it for a few days. Build a little bit of momentum. you'll start to yield those benefits and then that will help to start build that um that that habit and that habit is very transformative. And if you want to, you know, slap some magnesium gel on your knees before bed because psychologically that's going to make you feel like you're going to fall into the sleep much more easily, by all means go for it. But those really are the pillars of our physical and our mental health. And those are the things that people really do need to focus on as unsexy and also um scary, intimidating as they can be sometimes. Yeah. I like this all or you know the all or nothing um approach is is um an intoxicating one and and it is dangerous. Mhm. Uh so it's great to point out to to people that it doesn't have to be that. Uh and and probably it's you know from an exercise bene perspective for instance it's the biggest benefit the biggest leap you get is going to be from going from zero to 30 minutes a day as compared to from 30 to 60. The that leap is much smaller. So it's it's the it's this demographic or this cohort of people who probably feel overwhelmed by the idea of all or nothing that would stand to benefit the most by just doing a little bit just a little bit, you know. Um and these habits, you know, they compound. Yeah. And and try try and see how it works and collect your own data, be your own scientist over time and hopefully you'll be able to yield those benefits. Rammy, thank you so much for your time and for your insights today. And again, reiterating the big four, the big four physically and the big four psychologically. Very important, accessible, free, and don't need to be as intimidating as they might feel. Absolutely. And make sure you see your primary care doctor. Yes, of course. Build that relationship. It m it makes a world of a difference.
world of a difference. Definitely. Yeah. Thanks, Sarah. Thank you.
Transcript auto-generated by YouTube. Verbatim — duplicates intentionally preserved.
64 minutes of source material 70 Reacher quality score
The strongest thread in this conversation is discernment. Deliberate heat exposure is most useful when it is treated as a precise stimulus, not a personality trait. The body responds to dose, context, recovery, and consistency.
Cold, heat, breath, nutrition, and movement all work through biological mechanisms. They shift the nervous system, alter circulation, change inflammatory tone, and create an adaptive response. The felt benefit comes when that challenge is brief enough to recover from and repeated enough to become familiar.
A sustainable protocol should make daily life steadier. It should support sleep, training, focus, emotional regulation, and long-term health. If a practice creates anxiety, exhaustion, or a need to constantly escalate, the protocol needs refinement.
Wellness trends move quickly. Evidence moves more slowly, and that is its value. Good practice leaves room for uncertainty, medical context, and the simple foundations that repeatedly outperform novelty: sleep, movement, nutrition, connection, and recovery.
The protocol is only as strong as the recovery it creates.
Start with control. Build consistency. Let intensity arrive only when the foundation is steady.
Choose a protocol you can repeat without strain. Consistency creates the adaptation.
Track how you sleep, focus, train, and recover after the practice. The after-effect matters more than the performance.
Keep medical context in view, especially with fasting, hormone changes, cardiovascular risk, pregnancy, or a history of fainting.
