Dr. Rhonda Patrick: Maximizing Healthspan with Exercise, Sauna, & Cold Exposure

If you could pill up what vigorous intensity exercise does, it would be the biggest anti-aging blockbuster out there. After these 2 years of exercise, they measured their hearts, you know, of course they measured at baseline, and their hearts grew and become and became more flexible. So much that was reversed about 20 years of aging. So, their hearts actually looked like a 30-year-old heart rather than a 50-year-old heart. This was after 2 years of this intense exercise training protocol. There's no reason to go in a 212° F sauna. I think, you know, 190 max. Like, that's that's that's hard. 190 is hot. I go I do 180 personally. Um but, I think that's important because I know if you go on Instagram, there's a lot of influencers that are going really really hot, and I just don't think that's a great idea. So excited to be here. Um boy, it was great. I woke up this morning, bright light exposure first thing in the morning. We set my circadian rhythm, elicit the cortisol response, right? Get that serotonin, inhibit melatonin. Um what a great place to have a conference. So, thank you to the organizers for inviting me. Excited to be here. Uh today, we're going to talk about some behavioral strategies that I think are very important for improving the way we age and the way we feel. I mean, these things go hand in hand, right? So, we're going to talk about the power of vigorous intensity exercise. We're going to talk about using thermal [snorts] stress in the form of deliberate heat exposure and deliberate cold exposure to really improve the way we age. And so, just to give you a heads-up of what we're going to discuss, we're going to get into exercise and particularly a vigorous type of exercise, and we're going to talk about cardiorespiratory fitness. We're going to talk about brain aging, reversing heart aging. And then, we're going to talk about exercise snacks. Then, we're going to get into deliberate heat exposure with a big focus on regular hot saunas. We're going to talk about being, you know, it being an exercise mimetic. We're going to talk about heat shock proteins, Alzheimer's disease. We're going to talk about infrared saunas versus hot baths versus regular hot sauna saunas as well. And then, we're going to get into some of the cold exposure data, and we're going to talk a lot about some of the hormonal responses, some of the effects on the brain, on metabolism and muscle. And then, we'll get into some protocols as well. So, let's get started, and I like to start with this slide because if you could pill up what vigorous intensity exercise does, it would be the biggest anti-aging blockbuster out there. So, when I say vigorous intensity exercise, what I'm talking about here is the kind of exercise that you do and you can't really have a conversation while you're doing it. You're really putting in some hard effort. So, you just you're really not able to talk while you're doing that kind of exercise. If you wear a heart rate monitor, it's the kind of exercise where you're about 80% your max heart rate or greater. That's the kind of exercise that when I say vigorous intensity, that's what I'm talking about today. And I want to start by talking about cardiorespiratory fitness. So, cardiorespiratory fitness is often measured by something called a VO2 max. You've probably heard of this. VO2 max is really just the maximal amount of oxygen that you can take up during maximal exercise. Cardiorespiratory fitness has really become a very very important biomarker of our healthspan and lifespan. So, there've been countless studies now, and this study I'm showing you here is showing it's stratifying people based on their cardiorespiratory fitness and their life expectancy. And what they did it shows is that people that have a low cardiorespiratory fitness, if they can move anywhere above that low, even to a low normal, they're still low, but they're on a nor low normal range, that's associated with a 2-year increase in life expectancy. And if you compare people from the low to the high, that's about a 5-year increase in life expectancy. And there've been other studies that have actually analyzed if you can improve your VO2 max, your cardiorespiratory fitness, from what each for each unit that you improve it, so a unit is actually 1 ml per kilogram per minute, that is associated with a 45-day extension in life expectancy. So, for each unit you go up and you increase it, that's 45 days added to your lifespan. Why is VO2 max important? I mean, if you think about VO2 max, your cardiorespiratory fitness, it's you know, we're talking about measuring it when we're doing maximal exercise, but really, you know, everything we do relies on our cardiorespiratory fitness, even just sitting still. Just to sit still and breathe, it takes about 3 ml per kilogram per minute of oxygen. When I'm just having a conversation, like me up here on stage talking to you guys, that takes about 11 ml of um per kilogram body weight per minute of oxygen, right? So, as we're aging, we we we start with our with our cardiorespiratory fitness, and there's things we can do to get high, right? And that's where we want to be. But, as we're aging, we kind of head towards this cliff. We're going down. Our cardiorespiratory fitness declines with age. And so, you want to really bank in all you can and improve your cardiorespiratory fitness early on because you want to be higher up because you will reach that cliff. You just want to reach it at a later time point, right? There was a study that was published a few years back in JAMA, and I really like this study because it showed that there really didn't seem to be an upper limit in the benefits for improving cardiorespiratory fitness. So, people that were at like the elite, the top 2% the elite level for their cardiorespiratory fitness, they had a 80% lower all-cause mortality than people that were low cardiorespiratory fitness. Not a big surprise. But, even people that had a high cardiorespiratory fitness, we're talking like the top quarter percent of the of the participants, the [snorts] elite people still had a 20% lower all-cause mortality compared to those people with a high. I mean, these are healthy people, a high cardiorespiratory fitness. But, what was so fascinating about this study was that researchers looked at biomarkers that could predict mortality. And so, they looked at things like type 2 diabetes, smoking, cardiovascular disease. These things, of course, pre- predicted a lower life expectancy, right? A higher all-cause mortality. However, a low cardiorespiratory fitness actually predicted better. So, in fact, people with a low cardiorespiratory fitness had a lower life expectancy than even people with type 2 diabetes or even people smoking. So, in other words, having a low cardiorespiratory fitness was like smoking in terms of life expectancy. And people don't think about that. We think about all these diseases. We talk a lot about type 2 diabetes. We talk a lot about, you know, cardiovascular disease, how terrible it is for your health, how bad smoking is, but nobody's talking about how terrible being sedentary is, not being physically active. It is a disease, and it should be treated as a disease. We really need to think about our cardiorespiratory fitness. We need to think about how important it is. We're supposed to be moving and improving that cardiorespiratory fitness. So, how do we improve it? Endurance aerobic exercise is one of the best ways to improve cardiorespiratory fitness. However, vigorous intensity exercise is actually better. And we know this because there have been multiple studies, and there've been meta-analyses of these studies looking at people that actually do the physical activity requirements, the guidelines that are out there. So, this is about 2 and 1/2 hours per week of moderate intensity physical activity. So, this is the type of exercise that you do that's aerobic, and [snorts] you can kind of have a you can talk while you're doing it, but you're very breathy. So, you're really not at that intense level where you're pushing really hard, but you're you're getting physical activity. About 40% of people doing that 2 and 1/2 hours per week cannot improve their cardiorespiratory fitness. They're so-called non-responders, unless they engage in vigorous intensity exercise, particularly high-intensity interval training. So, that's the kind of exercise where you're doing short bouts, intervals of high intensity. So, it could be anywhere from 20 seconds long to 30, maybe a minute long interval where you're going hard, and then you have a period of recovery. When those individuals that did not respond to just normal moderate intensity exercise engage in high-intensity interval training, they're able to improve their cardiorespiratory fitness. And it's thought the reason for that is because, you know, cardiorespiratory fitness, you're you're you're transport- porting um oxygen. You're breathing it in, your lungs are taking it in, and then your vascular system is transporting it to other tissues like the muscle, um the brain, right? It's [snorts] It's thought that the harder the stress that you're putting, the greater the ad- adaptation. So, your body is responding to a greater amount of stress when you're going harder, when you're working out harder. There's a variety of protocols out there that have been shown to actually improve cardiorespiratory fitness. I like to talk about probably one of the hardest ones. Uh it's called the Norwegian 4 by 4. This The reason it's called that is because the Norwegian ski team uses it as part of their training protocol. And what it is is you for 4 minutes, this is a 4-minute interval where you're going as hard as you can, not all out, as hard as you can and maintain for that entire 4 minutes. And it takes a little bit of try and trial and error to figure out what that intensity is. It's going to be you're going to be it's going to be hard, but you're not going all out. That would be impossible. And then you and then you do light exercise, very very light exercise. You let your heart rate go down and recover for 3 minutes. And you do that four times. So it's 4 by 4. And um this protocol has been shown in countless studies to improve the VO2 max. Now there's other ways to improve your cardiorespiratory fitness. You can do a 1-minute on, 1-minute off, even 20 seconds on, 10 seconds off. I mean, whatever works for you. I think the most important thing here is what are you going to do? What are you going to do on a weekly basis? What are you going to be able to do? What do you like to do? That's the most important. You don't necessarily have to do the 4 by 4. I do this once a week. Um I think it's great if you can, but you don't necessarily have to. Um >> [snorts] >> if you haven't gotten a VO2 max test, like that's where you go into a lab and you wear one of those masks, you get on treadmill or on a stationary bike and you're doing like, you know, 15 minutes of running as fast as you can for the entire 15 minutes. Pretty brutal if anyone's done it. Um you can you can estimate your own VO2 max actually by by using any type of a wearable device that tracks your distance and your heart rate. And so it's called the 12-minute uh run test. And basically what you're doing is you're running for 12 minutes on a flat surface. It has to be flat. And you're you're you're calculating your distance. And there's an equation you can look up called the Cooper test, the Cooper equation, and it'll help you convert your it'll estimate your VO2 max essentially. And that's a pretty good way to do that. I like I want to take a minute here. We're going to talk about that Norwegian 4 by 4 again as part of this this protocol that was done by a Dr. Ben Levine at UT Southwestern in Dallas. Um he's probably one of the world's leading experts in cardio cardiovascular exercise, cardiologist, exercise physiology. He studies how the heart ages and how we can reverse that aging through different lifestyle strategies and also what accelerates that aging as well. So he's looking at both ends of the spectrum. And um just generally speaking, what what happens to our heart with as we age? Well, a lot of things. I'm not going to spend hours discussing that. You probably have other people here talking about that. But generally speaking, as we age, our heart shrinks and it gets stiffer. It's stiffer with age. Um and that's not a very good thing for cardiovascular health. You want your heart to be flexible. You want to be able to respond to stressful situation situations. You don't want your heart to be stiffer. And so what Ben um set out to do was try to see if he could reverse some of this shrinking and stiffening of the heart in people that are middle-aged. They're 50-year-olds that didn't have any identifiable diseases other than the fact that they were sedentary. So they had one disease, as I just mentioned. Sedentary being sedentary is a disease. Um but they didn't have any other diseases. They just weren't physically active. And [snorts] he separated these 50-year-olds into two groups, one with the treatment group, one with the sham control group. The treatment group underwent a 2-year pretty intense exercise training protocol. Where at the end of the 2 years, they were exercising for about 5 hours a week. A large portion of that was vigorous intensity exercise. They were doing the Norwegian 4 by 4 once a week. But they didn't start out there. It was a progressive workup, right? You can't just take someone that's not ever worked out in the gym and then start them on the 4 by 4 and doing 5 hours a week, right? So they progressively worked up to that point. The sham control was kind of like yoga-ish stretching, you know, enough where they thought they were getting a treatment, but it wasn't actually the treatment. After these 2 years of exercise, they measured their hearts, you know, of course they measured at baseline, and their hearts grew and become and became more flexible. So much that it was reversed about 20 years of aging. So their hearts actually looked like a 30-year-old heart rather than a 50-year-old heart. This was after 2 years of this intense exercise training protocol. And I love this study uh because it really shows one that it's never too late, and these were 50-year-olds, they're in middle middle age, and two, that you really have control of the way your heart ages, right? I mean, this is pretty I would say unbelievable that you can actually after just 2 years of really putting in effort, reverse the aging of your heart by about 20 years. The control group, I mean, they they didn't have any of this, by the way. And yoga's great, but it just isn't going to reverse the structural aging changes in your heart. We also know that exercise has massive effects on the brain. So it's an immediate cognitive enhancer. So you can just do a 10-minute bout of vigorous intensity exercise. Again, you're getting that you're putting in that effort, and you can improve reaction time, executive function. I mean, there was actually a 14% increase in cognitive performance in this cohort that just did 10 minutes. I do 10 minutes of exercise like before almost any talk I give, anything anything I'm doing that requires my brain to be working. 10 minutes, everybody has 10 minutes, right? And it's amazing how you feel after that. We know that vigorous intensity exercise rewires the brain almost immediately. So it actually, like I said, it speeds up reaction time, especially on executive function tasks. It improves working memory. It improves impulse control. So, you know, if you have a lot of tabs open, you're not going to be going to the social media or you're not going to be getting on X or Instagram or whatever. You know, so it helps you with that impulse control. I mean, these are all I would say little hacks that most of most of us in here that are also high performers, you know, you're taking care of yourself and your patients, but we're also high performers. So it's it's kind of really important to kind of use some of these tools that we can to just improve our impulse control and our cognitive function as well. Why is vigorous intensity exercise so good for the brain? And I keep saying vigorous because when you are working really hard, you're forcing your energy system to produce energy quicker than your mitochondria, which are the little organelles inside of your cells that are essentially mostly responsible for producing energy, can can can keep up with. And so essentially you can't get oxygen to your cells quick enough to make energy because mitochondria need oxygen to make energy in the form of ATP. And so you're forced to do that outside of your mitochondria using um glucose as a source of energy. And that glucose gets converted into energy, but also lactate. And for a long time, lactate was thought to be this just metabolic byproduct of glucose metabolism, glycolysis. Turns out, Dr. George Brooks at uh UC Berkeley decades ago came up with this lactate shuttle theory. It's no longer a theory. It's been proven many many many times. Um lactate is not only an energetic molecule, so it gets shuttled back into cells, including the muscle, and is used to make energy like glucose, like fatty acids. In fact, it's more energetically favorable than glucose. You can actually make more It takes less energy to make energy from lactate than it does from glucose. But even more importantly, lactate is actually a signaling molecule. So when you're forcing your muscles to work really hard, you're generating that lactate. A lot of people associate that burn you feel in your muscles with the lactate generation. I mean, that's kind of a okay association, I guess. Lactate itself is not responsible for the burn. Um it's the hydrogen ions, but that's a whole other story. The lactate then goes into your circulation and it gets transported to other organs, especially the brain. And it acts as a messenger. It's a way for your muscles to communicate with other organs and say, "Hey, I'm working really hard. We got to respond to this, like otherwise we're not going to be able to like survive." And so what happens is it is communicating with the brain and the heart and the liver and all these other organs where the lactate's going into, and it's activating a variety of stress response pathways so that you can deal with stress. And in the brain, lactate increases brain-derived neurotrophic factor. In fact, it is the molecule that is signaling to the brain to increase brain-derived neurotrophic factor. So this is a growth factor in the brain that is responsible for the growth of new neurons, um particularly in the hippocampus. We'll get to that in a minute. It's also important for learning, for memory, and neuroplasticity, right? That's important for your brain's ability to adapt to the changing environment. It plays a very important role in not only brain aging, but also mental health. So people with depression, for example, major depressive disorder, they have problems with neuroplasticity. Their brain is not adapting to a changing envi- environment. And so they're unable to adapt, and that is uh plays a role in depression. We also know that lactate itself signals to the brain to make neurotransmitters. We have human data on this, both serotonin, most people think about serotonin as that neurotransmitter involved in mood, makes you feel good. It's also involved in executive function, and more importantly, impulse control. Um and I talked about all those studies showing that vigorous intensity exercise has a pretty profound effect on impulse control. Well, there have been human studies that have done dose-dependent um exercise protocols where people do light exercise, moderate intensity, or they do vigorous intensity exercise, and it's the vigorous intensity exercise that increases lactate the most, and that's also associate associated with the most impulse control. We want impulse control. We want to be able to be focused. And norepinephrine as well. So our brain also is working very hard when we're doing vigorous intensity exercise. It's not just our muscles that are working hard. It's not just our and that are working hard. It's not just our cardiovascular system that working hard. Everything is working hard including our brain. And and and like I said, lactate is the way is the communication is the communicating factor there, right? And so, norepinephrine is increased also human studies showing this as well. That's involved with focus and attention and improved um memory as well. So, lactate's responsible for doing all these things. There are many different protocols out there, human protocols, human data showing uh different type of exercise intensities can increase brain-derived neurotrophic factor in the plasma where it's measured, which correlates with brain levels as well. Um the more intense the exercise, the more BDNF that you're going to make. It's definitely a dose and duration-dependent process. So, if someone that's doing like a pretty hard 30-minute run really gets a lot of BDNF, but you can also do these these hit protocols, right? The 1-minute on, 1-minute off, even doing that for you know, six times um has been shown to really massively increase brain-derived neurotrophic factor. So, the key here is just get those hard intervals in whatever your favorite protocol is and you'll be getting that BDNF boost. I like to talk about this study even though it's about gosh, it's a 2011 it was published I think PNAS. Um I love this study because it showed that exercise can reverse the brain the the the aging brain. Um and this was this study was in an older adult. They were doing more like 70 75% max heart rate, so not quite as vigorous, but pretty vigorous for this cohort cuz they're older adults. Uh they did this for about 1 year and it was incredible what happened to their brains. So, typically when you hit about 65 brain atrophy really starts to accelerate and people start to lose about on average 1 to 2% of their hippocampal brain volume per year. Well, these older adults that engaged in this type of exercise, they were doing like three times a week about 30 minutes of this type of exercise. Not only did they not experience that brain atrophy over that year, they gained brain atrophy. So, they gained about 1 to 2% in their hippocampal region. So, again, brain-derived neurotrophic factor is responsible for the growth of new neurons. They were able to actually grow new neurons in their hippocampal brain region. The control group, again, the stretching group didn't experience that either. So, I think this is a nice way to kind of wrap up the brain section here showing that vigorous intensity exercise, putting in that effort, really is good for the brain and improving brain aging. But, what if you don't have a lot of time and you know, you still want to get some improvements to the brain, to the heart, um cancer risk. There's something called exercise snacks. Uh these are really short bursts of vigorous intensity exercise. Again, you're going to that 80% or more max heart rate range and it could be 1 to 3 minutes long. These are any any type of exercise you like to do. You could do, you know, body weight squats, burpees, high knees, jumping jacks, you know, there's lots of different ways to do exercise snacks. >> [snorts] >> Um but there's now a lot of evidence out there that they're highly highly beneficial. In fact, there have been about three very large studies. They're called vigorous intermittent lifestyle activity studies, Vilpa, VILPA. Um these [snorts] studies have been done in people that have been wearing accelerometers, so researchers can measure their heart rate and they can measure, you know, distance >> [snorts] >> that people are moving. And what has been found is that people that are wearing these accelerometers, if they get their heart rate up 1 to 2 minutes three times a day they have a 40% lower cancer-related mortality, a 40% lower all-cause mortality, and a 50% lower cardiovascular-related mortality than people that are not doing these types of short bursts of exercise throughout the day. And this is even in people that identify themselves as non-exercisers. In other words, people that are like, "No, I don't go to the gym. I don't take time to like out of my day to like actually try to exercise." Yet, they were doing these types of like exercise snacks. In many cases, it was it's not the structured type of snack I told you about where you kind of like get up and do some, you know, air squats. It's more like taking advantage of everyday situations. Like, "I'm not going to use the elevator ever. I'm going to sprint up the stairs, not just walk. I'm going to go fast, right? Or I'm going to vigorously or briskly walk to the office or whatever." So, they're taking advantage of everyday situations to get their heart rate up and it really does pay off. So, there's a lot of ways that you can actually implement exercise snacks throughout your day. Um there was this recent study that came out showing that doing about 30 body weight squats every 45 minutes for like a 7 and 1/2-hour work week was better at improving glucose metabolism than a 30-minute walk. I love doing exercise snacks. We're actually all going to get up right now and we're going to do just 1 minute of body weight squats. What do you think? 1 minute of body weight squats. Everyone turn to the side. Kind of like I'm going to set my timer. Okay, is everyone up? Up? You ready? Okay. You ready? So, we're going to do body weight squats. Put in the effort. Don't just like go through the motions, but like try to like go fast. Try to squat as low as you can. All right, here we go. 1 2 3. So, we're going to do 1 minute of this. Really like try to get your heart rate up. Feel the burn. Feel uncomfortable. Feel uncomfortable. Okay, we got 45 seconds left. >> [snorts] >> Now, I'm not going as fast because I want to like be able to talk. But, usually I'd be going a lot faster. We got 30 seconds left, guys. I know, you guys are like, "What? This is the longest minute of my life." >> [laughter] >> Okay, we only got about 15 seconds left. COME ON, DON'T STOP NOW. Keep going. 10 9 8 7 6 5 4 3 2 1. All right, everyone. Amazing. If you don't feel great right now, there's something wrong with you. >> [laughter] >> So, >> [sighs] >> set your timer for 45 minutes. >> [gasps] >> Do it again. No, but like seriously, when you're sitting you can you can take you can take 1 minute. I don't care if you're in your office with a patient. Do do it with your patient. You can take 1 minute if you're at your desk. I I'm serious. I challenge you. Try to find a way to implement exercise snacks. It'll change your life. All right. We're going to switch gears and we're going to talk about another type of stress. Exercise is one type of stress. We're going to talk about thermal stress from deliberate heat exposure. >> [gasps] >> And if you think if you anyone in here that's done a hot tub or a sauna um a steam shower, hot yoga you know that a lot of the physiological responses are very similar to moderate-intensity exercise. So, as you're sitting in a hot tub, as you're sitting in a hot sauna your heart rate starts to go up. You start to feel hot. You start to feel uncomfortable. You start to sweat. A lot of the same physiological processes that happen when you're doing moderate-intensity exercise, not vigorous, but moderate happen when you expose yourself deliberately to heat. Increase heart rate. Uh your your stroke volume goes up. You have increased cardiac cardiac output. In fact, there's been a head-to-head comparison looking at sauna versus a stationary bike. So, individuals did about 100 watts on a stationary bike for about 15 minutes or they were in a hot sauna for about 15 minutes. And the physiological responses that were measured were identical. So, during the activity, heart rate went up, blood pressure went up. After the activity, whether it was sauna or stationary cycling blood pressure was improved compared to baseline. The uh resting heart rate was improved, was lower. So, head-to-head comparison, sauna is mimicking moderate-intensity physical activity. There have also been studies looking at exercise alone plus or exercise plus sauna. And observational data shows that people in Finland that exercise they have a longer life expectancy than not. But, people that exercise and sauna have a longer a life expectancy than people that only just exercise. So, in other words, there seem to be an additive effect on improving life expectancy. And there's been intervention trials that have again, Finland, uh Dr. Dr. Jari Laukkanen, friend of mine. Um he's probably the the one of the world's leading experts on sauna research. He took a cohort of participants split them into two groups. One group is doing stationary bike. The other group is doing stationary bike bike and then getting into a hot sauna. In this case, it was only about 15 minutes. 175 179° F sauna. And then he measured their cardiorespiratory fitness, you know, at baseline and after the intervention and a variety of other biomarkers as well. And what he found is that exercise plus sauna improved cardiorespiratory fitness better higher than just exercise alone. Which isn't that hard to believe considering I just told you that sauna is like an exercise mimetic. So you're essentially extending the time of your workout. There was also better improvements in blood pressure, in lipid biomarkers as well compared to just exercise alone. Also data from Yari's Dr. Jari Laukkanen's lab has shown that men that use the sauna two to three times a week have about a 22% lower sudden cardiac death than men that only use the sauna one time a week. Men that use the sauna four to seven times a week have about a 63% lower sudden cardiac death than men that use it one time a week. Now, sudden cardiac death, you know, if you think about heart attacks, if you have a heart attack, you want to survive it. First of all, you don't want to have the heart attack, but if you have it, you want to survive it. And in the US, a heart attack, someone's having a heart attack like every 30 seconds. So if you can survive that heart attack, it's pretty big. 63% less likely to die from sudden cardiac death if they were doing the sauna four to seven times a week. And by the way, saunas in Finland are very ubiquitous. There's also a lot of public saunas as they call it that are free as well. So a lot of people have access to saunas. His data also showed that in a dose-dependent manner, sauna use was also associated with lower all-cause mortality. So people So this in this case it was men that use the sauna two to three times a per week had about a 24% lower all-cause mortality. If they boosted that up to four to seven times a week, they had a 40% lower all-cause mortality than men that only use the sauna one time a week. They also had a lower cardiovascular related mortality. Again, in a dose-dependent manner. If they went up to four to seven times a week, that was a 50% lower cardiovascular related mortality than men that only used it one time per week. So we're seeing this clear dose response here. This data was adjusted for many many different types of confounding factors. So you know, physical activity, lipid, you know, type two diabetes, diet, all these things were looked at. In addition to that, Yari took a cohort of individuals that actually were unhealthy. So they did have type two diabetes. And even in those cohorts, sauna use was associated with lower all-cause mortality, lower cardiovascular related mortality as well. So it really seems to be a true phenomenon that's being observed. And we'll get to some of the intervention data that kind of corroborates it. But we also know that sauna lowers stroke risk in a dose-dependent manner. Again, two to three times per week, 14% lower stroke risk. This was in both men and women compared to just one time a week. Four to seven times a week, 61% lower stroke risk. I mean, these are pretty phenomenal numbers we're talking about here. And I know I spent like the first 30 minutes of my talk talking about vigorous intensity exercise. But I mean, we all are in the real world here and there's a lot of people that just won't put that effort in. And it's a lot easier to get some people to sit in what they think is a spa, hot tub, hot sauna, than it is to get them to go and do a Peloton 10-minute interval, right? Maybe you can get the exercise snack in. I think that that that definitely is something that's doable. But it's it is it is really kind of relevant to a lot a big percentage of population that is really not going to engage in physical activity or perhaps they're even injured and they can't, right? So I think it it opens a lot of doors. Sauna use is also linked to lower hypertension in a dose-dependent manner. And this goes across not just sauna use. There was actually a lot of really early, I mean, this data dates back decades, data showing that hot baths, like hot tubs, lower blood pressure as well. So again, dose-dependent manner, two to three times per week, you get about 24% lower risk of hypertension. Go that you go up to 47 times per week, you get a 46% lower risk of hypertension. You really want to see this dose dependence when you are looking at any types of observational data because you can never really establish causation. And so it really helps strengthen the data if it's actually showing you that it's dose-dependent. There have been intervention trials as well showing that if you expose people to even just a single sauna session, but multiple sauna sessions, they improve their blood pressure after using the sauna, even after a single sauna session. So I you know, the sauna is causing vasodilation. It's doing a lot of the same, like I said, it's increasing cardiac output while you're doing it. A lot of the same things that's happening when you're engaging in moderate intensity physical activity. >> [snorts] >> Most of the parameters used in those studies were out of Finland. In Finland, they do typically their sauna temperatures around 174 to 179° Fahrenheit. They also often will put water on hot rocks to create humidity, about 20 to 30% humidity. And that does make it feel hotter as well. The duration spent in the sauna is very important. So with those studies, for example, like the sudden cardiac death study I was talking about, if those men only stayed in the sauna for 10 minutes, the effect was very much dampened. So it was like they only had an 8% lower risk of sudden cardiac death two to three times per week versus like the, you know, 25% lower risk of sudden cardiac death. So it was really the sweet spot was they had to stay in the sauna greater than 19 minutes. So I like to say 20 minutes is the sweet spot because once they hit that 20-minute mark, then they were getting the most robust effect. So really duration is important. Frequency as well. We already talked a lot about that. It was dose-dependent. The minimum effective dose, two times a week, you're going to at least get some benefits. The maximum, you know, dose, 47, right? Four if you're really kind of trying to be time efficient. >> [snorts] >> But a big question that everyone always wants to know is, what about infrared saunas? What about hot baths? Do they have the same effects? Well, let's start with hot baths because they they seem to really mimic a lot of the same effects as hot saunas. And and we'll talk about some data there with blood pressure, but they also increase brain-derived neurotrophic factor. There have been studies showing that sitting in a hot bath, 104° Fahrenheit is the is the temperature most of the studies. People have their shoulders submerged down and they're in there for 20 minutes. It's hard to do. I I mean, if you sit down and try it, it's hard. You want to always put your arms out. You get hot. But that's the the protocol there and brain-derived neurotrophic factor goes up. Blood pressure improves and we're going to talk about heat shock proteins. When it comes to infrared saunas, there was a head-to-head of moderate intensity exercise, hot sauna, and infrared sauna. Unlike the data I started out with telling you about how hot saunas do mimic moderate intensity cardiovascular exercise, for the same amount of time, infrared saunas do not do that. And it's not that big of a surprise because infrared saunas are going up to maybe 145° Fahrenheit max. They're not getting quite as hot. They're working through a very different mechanism, right? So they're using infrared radiation to kind of move molecules around to make you hotter, to make you sweat. So it's not the same at the same duration amount of time spent in the sauna. That doesn't mean that you can't double the amount of time you spend in infrared sauna and actually start to get those effects because you can. If you stay in an infrared sauna for 20 minutes, it's not going to be much of anything with respect to increasing cardiac output and all these things I talked about. If you stay in there for 40 minutes, you're going to get you're going to get those effects. So it all depends on how much time you're willing to spend in the infrared sauna. That also doesn't mean that there aren't benefits to infrared sauna. There's a lot of thermoregulatory mechanisms that are going on as well and you're sweating a lot. You are excreting some heavy metals and things that you're exposed to. But if you're looking for these effects that I'm talking about here in today, you're going to probably have to double your time or maybe two and a half it. And it's still we don't have a lot of data to show that it has the same effects, but I think it likely does if you if you get to that right duration spot, which I think is about 45 minutes to 60 minutes. I already mentioned that hot baths do improve blood pressure. Countless studies on that. But I want to shift gears and talk about this adaptive response that happens. So you know, we are stressing our bodies when we are exposing it to heat, whether that's hot air or hot water. Part of the adaptive response is an increase in something called heat shock proteins. As their name implies, they respond to heat, but they also actually are increased um when we're exposed to other types of stressors like exercise, um like eating a phytochemical like sulforaphane, for example. These heat shock proteins, um what they do primarily is they prevent proteins inside of our cells, inside of our vascular system, inside of the you know, extra inside of the extracellular space in our brains from aggregating and forming these protein aggregates. So heat shock proteins help keep proteins folded in their right three-dimensional structure. That way they can do their function properly and that way they get degraded. They, you know, when the when their time when the protein's time is up, then a new protein is made. It's properly folded. So heat shock proteins play a very important role in that full process. And so there've been studies that have shown, for example, in animal models, if you expose them to amyloid beta 42, the toxic protein that aggregates and is associated with the pathology of Alzheimer's disease and you give these mice, you know, heat shock you make them express a lot of heat shock proteins, it actually protects against the aggregation of this amyloid beta 42. So, it protects against Alzheimer's disease. The same goes for some of the cardiovascular aggregates that happen in the vascular system as well. >> [snorts] >> Um, heat shock proteins also slow muscle atrophy. There have been studies that have exposed individuals locally to heat on one leg and they're they're disuse they're disusing that leg so they have like a cast or something they're not they're not exercising or using that leg. Um, and the heat shock proteins as well as the heat local heat prevent about 40% less uh muscle atrophy. So, they play a role in preventing muscle atrophy. But, they're also associated with longevity. Human longevity. So, individuals have variations in the heat shock 70 gene that make them have a more active heat shock 70 gene so they're making more heat shock protein 70 which is one of the major heat shock proteins. If those individuals have one copy from either mom or dad, that's associated with a one-year increase in life expectancy compared to people that don't have any of those copies. They're just making normal amounts of heat shock proteins. People that have two copies so they're homozygous, those individuals have a two-year increased life expectancy compared to people that don't have any copies. So, again we're seeing a dose-dependent effect here with um with those alleles. And this extends to lower organisms as well. I I've done these experiments with my own hands um in worms and in flies. If you expose them to a really short burst burst of heat, it'll extend their life expectancy by like 20%. So, it seems to be an evolutionary conserved mechanism as well. And we know that people that sit in a relatively hot sauna, actually not even that hot, 163°F sauna for about 30 minutes, they can increase their heat shock proteins by 50% over baseline. Heat shock proteins again this is another sort of dose dose and duration-dependent response. I mentioned 20 minutes in a 104° bath for you know, shoulders down also increases heat shock proteins. Sauna also lowers inflammation so there have been a variety of studies um initially it has the same response as exercise where you're increasing IL-6. This is kind of this kind of funny cytokine because oftentimes it's associated with inflammation, but IL-6 is also kind of like a signaling mechanism because when you put the right the good type of stress on your body like exercise or heat stress, the IL-6 that's produced is actually signaling and you make something called IL-10 the anti-inflammatory cytokine and so you end up having this net anti-inflammatory response which is the same thing that happens with exercise. Yes, you're generating inflammation while you're doing that exercise, but the response the adaptation that your body is um you know, undergoing to respond to that inflammation is to make a lot of anti-inflammatory cytokines to deal not only with that acute inflammation, but that response is long-lasting. So, essentially like days later you're still having an anti-inflammatory response which means all the other stresses of aging you're kind of combating combating that better, right? So, this is that so-called hormetic effect where you're giving the little dose of a a good type of stress and the response that stress is so robust that it really is just improving the way you age. It's resilience. It's building resilience and that's really what we're talking about today. >> [snorts] >> Sauna use is also associated with a decrease in dementia and Alzheimer's disease. In this study here this was out of again Dr. Laukkanen's lab. He showed that people that use the sauna four to six times per four to seven times per week had a 65% lower Alzheimer's disease risk as well as dementia risk. Um I want to take a moment here to talk about another study out of Finland that showed the same thing. It was about a 60% lower dementia risk if people used the sauna um frequently. However, that study looked at temperature so they they they basically [clears throat] looked at different types of temperatures that people were using and they found something very interesting. And that is is that when people started to go to the really extreme hot level so they were going above 200°F they were getting like 200 to 210 212°F that sort of like that go hard go home mentality, they actually had a higher two times higher risk of Alzheimer's disease. I think that's important because you know, often times there is this go hard go home, but when we're talking about stress, you know, we're giving we're we're the whole point is we want to give ourselves the right dose the right amount of stress to have that really important anti-inflammatory antioxidant you know, adaptive response. But, like heat is it's a hard stress and you don't necessarily want to be going in 212°F sauna that's very hot and your head is exposed to that heat, too. It's not really understood what the mechanisms are there, but there's no reason to go in a 212°F sauna. I think you know, 190 max like that's that's that's hard. 190 is hot. I go I do 180 personally, um but I think that's important because I know if you go on Instagram there's a lot of influencers that are going really really hot and I just don't think that's a great idea. Um, we don't have any evidence that going that hot is beneficial and if anything we have evidence that it potentially might be harmful, right? >> [clears throat] >> So, overall this is a from a paper I published in 2018. Um or sorry 2021. I think you know, it's pretty clear sauna improves health span deliberate heat exposure through sauna through hot baths. We are you're mimicking car modern physical exercise. Doing in conjunction with exercise is better than exercise alone. You're improving your cardiovascular health. It improves endothelial function and it it improves arterial compliance and you're getting that heat shock protein response. By the way, the heat shock proteins stay activated for about 48 hours. So, the more frequently that you're exposing yourself to heat or exercise which also raises your core body temperature, you're getting that heat shock protein response, right? So, that's good especially if you don't have those alleles where you're having an overactive heat shock protein 70. Okay, the last fourth of the talk I'm going to talk about cold stress. I'm in my cold plunge smiling. I usually don't smile and I often say prof pain words, but um we're going to totally talk about a different type of thermal stress here. Um, we're going to talk about deliberate cold exposure. There's a lot of things that we could talk about, but because of time we're going to just talk about a few. Um, I'm going to focus on increased brown adipose tissue. Um, this is the thermogenic type of adipose tissue. We're going to talk about the effects on mood and cognition that's like my favorite. We're going to talk about the effects on mitochondrial biogenesis the growth of new mitochondria both in adipose tissue and what that means and also in muscle tissue and what that means. And then [snorts] we're going to talk about some precautions because depending on the protocol, the timing of the protocol um and other things that you're doing it may blunt some muscle hypertrophy from your resistance training and that's something to keep in mind as well. So, cold stress much like heat stress causes adaptations and these adaptations are also dose and duration-dependent. So, for example people that spent one hour in 57°F water had a fivefold increase in norepinephrine, right? That's uh it's norepinephrine is both a hormone and a neurotransmitter. As a hormone it causes vasoconstriction and that's what's happening when you get into the cold it's causing vasoconstriction, but also when you get into the cold it's increasing norepinephrine in the brain in the locus coeruleus region of the brain. Those studies have also been done. But, who wants [snorts] to go into 57 by the way is not warm. I mean if you've anyone's done 57 it feels pretty darn cold. Um, who wants to do that for one hour? Um, luckily two minutes at raises norepinephrine by twofold. This is my favorite thing. This is my spot. I I do about 49°F for two minutes. I like to get that little norepinephrine pump cuz I'm it really helps with the focus and the attention improving mood. Sort of it has a little bit of an anxiolytic effect where anxiety is a little bit lowered as well. And two minutes is way easier than one hour, right? >> [snorts] >> And then 35°F that's really cold. Um, not a huge fan of that, but if you just go in there for 20 seconds if you really want to be efficient, that also is associated with a twofold increase in norepinephrine. Now, if you stayed in there for two minutes versus 20 seconds you're probably going to go up a little bit more in terms of your norepinephrine response, but the bottom line here is dose and duration-dependent. You kind of get the point. And I this is just to show you guys there's evidence that yes, cold does increase norepinephrine in the brain. It's not just the hormonal response that's occurring. It's the brain as well and anyone that's done deliberate cold exposure knows this is true. You feel it immediately. There have been some studies. Um, this was a very small cohort study that was done in people with major depressive disorder and they were exposed to cryotherapy. So, not cold water immersion, but they were going into those cryo chambers with a very very cold air. And um researchers wanted to look at how it affected their mood. And so, there was a treatment group and then there was the sham control. The treatment group they were getting about minus 256°F. I've done cryotherapy several times. I much prefer cold water immersion. Um, there's something about the water contacting your skin where it just makes it much more robust of a effect at least for me. Um, however, it's a lot easier to have this this sham control here. They had a minus 58° F sham control, which does people going in that feel like they're totally getting a a response. A placebo group is very obviously very important when you're studying any kind of depressed depression because the placebo effect is very real and you'll get an antidepressant effect. And so the people that did the 2 minutes at that minus 236° F five times a week for 2 weeks did have a pretty major anti sorry, antidepressant effect. In fact, in fact, the Hamilton scale they improved by about 17 points, which is kind of phenomenal. Just to give you reference basis, I think if you have like a 2.5 change in that scale, it's considered to be clinically relevant and they had 17. So. Um let's shift gears and talk about the effect of deliberate cold exposure on thermogenesis on brown brown adipose tissue. So, one of the regulating responses here is the norepinephrine response. When you are making norepinephrine, when you're making it in your vascular system, the hormonal effects, it is a signaling mechanism much like we talked about with the lactate. Well, the norepinephrine is increasing a protein called UCP1, which then signals to your adipose tissue to make more mitochondria. So, it's an adaptation because the more mitochondria you have in your adipose tissue, the more energy that you can burn and the more heat as a byproduct is made and so your body is finding a way to stay alive when you're sitting in the cold. And the way that it's adapted to do that is to make more mitochondria. Therefore, you can burn more energy in your adipose tissue. So, your your stored fatty acids undergo lipolysis. You start to metabolize those, right? And therefore, you're making energy and then heat is dissipating, right? And so you're warming yourself up. And this is an adaptation that happens the more you expose yourself to the cold, the more you start to make brown fat. And so that that is something that is a therapeutic target for many many different researchers out there. They're trying to find a way to make a pill to increase brown adipose tissue, to increase mitochondrial biogenesis in brown adipose tissue because that would be a you know, weight loss mechanism, right? Because you're burning more fat. It's also it's it's also associated with improving metabolic health as well. We know from studies that young healthy people, this in this case they were men, if they walked around with a cooling suit that was cooling their body to about 50° F for 2 hours daily, after 1 month, they had about a almost 50% crease in brown adipose tissue. That's really a lot. That's a lot. I've seen other studies where 15 minutes, do I have that slide? No. I've seen other studies where 15 minutes in 50° F cold water can also increase the bio the mitochondrial biogenesis in your adipose tissue. So, if you if anyone's in here has done deliberate cold exposure, you know that 15 minutes is hard. In fact, the sauna, it gets harder the longer you stay in cuz you're getting hot and you're uncomfortable. The cold gets easier the longer you stay in. So, if you can get past about 4 minutes, you can you can actually do 15 minutes at 50° F. But, adipose tissue is not the only tissue where mitochondrial biogenesis occurs in response to deliberate cold exposure. Muscle also is increased. So, um this there there's been a few studies that have shown again, what's happening is when you're getting yourself exposed to the cold, norepinephrine goes up. That increases a protein called PGC1 alpha, which then increases mitochondrial content in muscle tissue. That is associated with decreased muscle atrophy. It's associated with improved endurance performance. In fact, there's actually been several studies that have shown elite tennis players, rowers, let's see, what else? There've been a variety of different endurance runners that in between their their their sort of sets that they're doing, if they engage in deliberate cold exposure, they actually improve their running time or their reaction time, whatever you know, metrics being measured, but it's essentially increase or improving their athletic performance. This is very specific to endurance type of activities only. And I'll talk about that probably in the next slide, but it it's really important that I also just want to point out the best way to increase mitochondrial biogenesis in muscle tissue is actually high intensity interval training, way more robust than deliberate cold exposure. With that said, deliberate cold exposure does also increase mitochondrial biogenesis. It's an adaptive response again. In fact, individuals that spend about 15 minutes again at 50 So, if you're I think that the sweet spot here is 50° F, 15 minutes. That's the number for increased mitochondrial biogenesis in muscle and increased myo mitochondrial biogenesis in adipose tissue, which then is translating to brown adipose adipose tissue, right? The reason it's brown adipose tissue is if you look at a little fat droplet under a microscope, the more mitochondria it has in it, the browner it looks under the microscope and that's where it got its name from. Very important to point this out and that is deliberate cold exposure after any kind of resistance strength training type of exercise where you're trying to put mechanical force in your muscle to increase muscle protein synthesis to cause muscle hypertrophy can blunt some of those anabolic effects. For a variety of reasons, there have been multiple studies now, the most recent one by Luke van Loon. Um He showed that essentially because the the cold exposure is causing vasoconstriction, you're basically for a period of time, you're not getting as much amino acids to muscle, you're not getting as much of the inflammatory and growth factors to the anabolic signaling to the muscle tissue. You end up having a blunted hypertrophy hypertrophy effect. That's not to say you don't experience some muscle hypertrophy, you do. It's just if you compare it to a sham control group, it's blunted. And so if you're really trying to maximize your muscle gains, it's a good idea to not engage in deliberate cold exposure, cold water immersion, cryotherapy, whatever fill in the blank your favorite cold exposure method is anytime around resistance training. And you may go, "Well, when do I do it?" Um I think it's the safest if you're doing it on recovery days or days where you're doing more endurance training like a run, more of a like a zone two moderate intensity training kind of day. Those are the best days to do it or perhaps like many many many hours after or before you're going to do your training because you do run the risk of blunting your muscle protein synthesis. So, to sum that up, we talked about some protocols. If you're really just wanting a little brain pop, if you're wanting to get that norepinephrine response, if you're wanting to perk up before you sit down at your desk or before you're giving a talk or before you're doing something cognitively demanding, you can you can do your hit protocol, which is my fav, or you can do your your 2 minutes at 50° F and get that norepinephrine boost. You can also do 35° F for 20 seconds if you really can't stand the 2 minutes. That's another option. For mitochondrial biogenesis, whether it's in adipose tissue or in muscle, the key here is 50° F for 15 minutes. And actually like once you work your way up to that point, it becomes easier because you have more brown adipose tissue, it doesn't feel as cold. And so after like a couple of weeks, you'll actually notice that it doesn't feel as cold, but it goes away very quick. If you stop doing it, it's gone. You'll you'll have to readapt. So, with that said, I'm going to conclude the three habits that we talked about today. Vigorous intensity exercise, really, you know, there's a variety of protocols out there. Whether you're doing the Norwegian 4 by 4 or you're doing the 1 minute on, 1 minute off 10 times or you're doing Tabata's, 20 seconds on, 10 seconds off, find a way to make it frequent. Or you're doing your exercise snacks. Find a way to just start doing them throughout the day. If it's three times throughout the day, great. If it's six times, even better. Find a way to just get up and do 1 minute. 1 minute. You feel great after that minute, right? If you do that about six times a day, it's amazing. Um you want to try to incorporate some deliberate heat exposure. If you don't have access to a sauna, hot baths are great. If you don't have a hot tub or a jacuzzi, get a pool thermometer, stick it in your bathtub and make sure you keep refilling the hot water so that it stays about 104° F or close to that. Very easy, very accessible for many people that don't have saunas as well. If you have an infrared sauna, you probably going to have to double your time to about 45 minutes or more. And then deliberate cold exposure, hard to do if you don't have your own cold plunge, although depending on where you live in the US in the in the winter, cold showers can do wonders as well. If you're in Florida, not so much all all times of the year. I've gone to Florida in the in in the winter where I'm like, "This isn't cold at all." So, you know, the the benefits are also dose and duration dependent. 50° F, 15 minutes if you want that mitochondrial biogenesis boost. And with that, thank you so much. I think we're going to take some questions. I'm looking forward to those. Thank you so much, Rhonda. So, who loved that? >> [laughter] >> I mean, Yeah. I literally have chills right now. So, she is a if not the powerhouse on all of those subjects in the entire world. So, the fact she's on our stage and I'm actually up here is literally a bucket list item. So, I'm going to dive in. I mean, we've been doing this, you know, now for a day plus and the amount of questions, I mean, you obviously have very, very hot, pun intended, topics. Um the amount of questions coming in around all the subject matter is is is literally mind-boggling. So, I'm going to dive in. First off, a personal thank you. I learned everything I do I do sauna every single day. You guys know I talk about resilient behaviors and sauna and all sorts of things, but it's for you that I learned all of that. So, thank you cuz your contributions are literally I don't think you understand what you're what you're contributing to this space. It's it's truly incredible. Thank you. >> So, So, I'm going to do my best to categorize these because there's a lot and there's a lot of overlap and you may have actually just answered some things that I didn't hear. So, um repetition is the mother of learning. So, we'll just sort of dive into some of this. So, I'm going to hit at some point micronutrients. I know that's a big passion of yours. I'll hit the top three that I know you always educate on cuz I think our audience is going to want to hear that. I'll get into some more stuff about exercise, hot, cold, I mean, all the things. Let me just sort of lead off with Okay. There was a whole category that came in around cycling women. So, women who have menstrual cycles and exercising and hot and cold and I know this is going to be kind of a all-encompassing discussion, but even just pre-menopause, perimenopause, menopause, and exercise recommendations, do they change? Does your heat schedule change? Does your cold Does anything change relative to the menstrual cycle? If we can start there. Okay. Um I have some pretty strong thoughts on this and it it's probably not what you're going to expect. I do think there's a lot of hype out there on inducing fear around this topic. I think if a woman listens to her body, I mean, that's all you really have to do, honestly. If you're on your cycle, I mean, you're not going to go as hard, right? I mean, there's times that you're just it's pretty clear. Um when it comes to like the hormonal responses that are happening from some of these, you know, types of exercise that people are so worried about high-intensity exercise being bad for women. Like the problem with that statement is it doesn't encompass the nuance there, which is essentially that all stems from data showing that women in a calorically deficit state that are doing extreme types of exercise, whether it's very long duration endurance or very high volume, high intensity training. That, you know, is kind of like if you're in this calorie deficit, then you can you can have a pretty strong effect on hormones and that's the problem, I think. So, if you're not in a calorie deficit and you're not really I don't know that there's anything to worry about other than the fact that you probably should making be making sure you're getting enough iron, to be honest, if you're menstruating. Um if you're postmenopausal, I mean, again, I think that you should just be probably working out harder. Um so, yeah, I I my my thoughts are don't sweat that topic so much. Please, listen to your body and it's really not a huge issue for most people. Thank you for that. How do you see intermittent fasting and time-restricted feeding or eating intersecting with exercise timing for optimizing metabolic health? For metabolic health? Okay. Yeah, that's important. So, I think that if you're doing any kind of intermittent fasting protocol, whether that's time-restricted eating and you're eating all your food within like an 8-hour window, what you really, really need to keep in mind is making sure you're getting enough protein, right? Because that's that's the key for preventing Anytime you're in a caloric deficit, if you're skipping meals, you have to make sure you're going higher on the protein, even higher than you would if you weren't in a you know, caloric deficit. So, you want to make sure you're getting enough protein. I would say at least 1.6 um grams per kilogram body weight per day, probably closer to two, to be honest, if you're actually skipping meals. Um [snorts] If you're engaging in exercise, you probably, depending on the type of exercise, so if you're doing high-intensity exercise or resistance training, you don't really want to do that in a fasted state. So, you want to time those types of exercises closer to like a meal. If you're doing more of an endurance type of training, as long as it's less than an hour, you can actually enhance some of the metabolic adaptations and maybe that's the question you're asking. If you're wanting to increase more things like autophagy, so this is what a lot of people are doing They're aiming to increase autophagy and that's why they're intermittent fasting, among other reasons, but autophagy is when you're in in that fasted state and essentially you're clearing out a lot of the the damage that's accumulated within cells, whether it's protein aggregates or pieces of DNA, just all the gunk. Um Caloric restriction and being in an energy deficit does that, but so does exercise. And when you pair the two together, you can kind of enhance that process even more. So, also some of the mitochondrial adaptations that you're going to experience from your endurance training will also be enhanced somewhat if you do them in a fasted state. I don't know that it makes that big of a difference, but if you really, really like trying to dial in every single thing, um I think that that's also key. When it comes to metabolic health, also high-intensity vigorous exercise is the most important because it's that it's causing an intense stress on your muscles, which are increasing glucose transporters to come up to the cell surface, bring glucose in better. That's even It lactate is the molecule that's actually signaling to do that. So, you really have to go harder to get that response. Timing that with um time-restricted eating is great if you can try to eat your your meal earlier in the day, you're going to get like a double hit, right? Because as we're getting as we throughout the day, our metabolic I would say health, our glucose metabolism, fatty acid metabolism, all these things aren't as efficient as they are earlier in the day. And so, if you're timing if you're doing both of those things, then you're really optimizing for metabolic health in both both directions. Great, thank you. This next series of questions is sort of around the same topic. The high-level one is, how do you if someone doesn't exercise and they're sedentary, what are you How do you discuss just initiating exercise? One, two, these are all prescribers in the room and we treat a lot of pathology. So, we see autoimmune disease, we see cancer, we see people fibromyalgia, things that are just like lots of metabolically a lot of inflamed sort of metabolic derangement going on. How do you plan and I know it's also individual It's based on the person, but generally speaking, how do you plan or or educate or at least recommend exercise regimens, hit or otherwise, for someone, let's say, with autoimmune disease, which is so prevalent, or or fibromyalgia, any of these chronic conditions? What would you say to both the sedentary person who never exercises? How would you introduce them to it? Secondly, the person who's highly inflamed, but also needs to do it? Yeah. Um I'm going to try to answer that question the best I can in a short period of time without all the nuance. Um So, first and foremost, I like to turn to the exercise snacks because we all did them together for 1 minute and you can introduce that. You can like in your office or wherever you're seeing your patient, you can actually just we're going to do this together for 1 minute and it they don't have you know, just as hard as they can and whatever they can do. What what they need to get is that dopamine response, right? They need to feel that dopamine themselves because you can tell them all the things you all the benefits, you can give them all the science. I mean, you can lecture them, just throw it all at them, but at the end of the day, like they need to have they need to have something that makes them want to do it, right? And so, if you do that short exercise snack with them, they're going to get that dopamine response and they're going to feel it and they're going to be like, "Wow, this is how I feel after just this one little short minute of, you know, whatever it is you do with them, jumping jacks, high knees, whatever. You chair squats, right? For like older adults. Um I think that's a great place to start. I've done it with my mom. Um the other place is group exercises. Huge. Like there's a social component. Um there's a component of like you have to show up, right? Accountability is there. And so, like if you kind of can find any type of group exercise, you know, whether So, for example, just I got my mom in a seniors CrossFit. You know, she's 70 years old and she's now going to a seniors CrossFit class three times a week. She's been sedentary her whole life and she's been doing this CrossFit now for the past 9 months and she goes three times a week and she loves it. It blew my mind that I never thought I'd be able to get her to do that, but it it happened and how and how did it happen? Well, one, uh the friends that she's made there. So, I did there there's a real power in these group exercises. So, if you you can find something where people can go and like have a community, it really it's not just like going to the gym by yourself and yeah, you can do that and make friends, but like a class, you know, where they actually have to show up and they make friends and it really helps. Um with respect to like fibromyalgia and all those things, um people will start to notice as they start to work out, it's like the opposite of what they think. They think they have to rest and not move, but it turns out that's like the worst thing they can do. And if they start moving, all these anti-inflammatory mechanisms kick in. They actually start feeling better. And so, even just getting them again to the short burst of exercise snacks or starting out with the class that it's not necessarily vigorous intensity, but it's like it's something that's that they can do. And again, they get the dopamine, they start to notice they have to feel these effects and that's when it get what's going to get them going back to it. And then with the sauna, um that's also a really good place to start and to bring it in, you know, combination as well because it is easier to go sit in a sauna and they do kind of feel like they're getting a spa treatment and there are beneficial effects from that as well, but I really think it should be paired with exercise because exercise is the king. There's nothing that compares to getting getting physically active. Awesome. Um maybe easy one. What is your favorite wearable? Um well, right now my favorite wearable only is it's my Apple Watch because of all the other not just fitness reasons. Um I do like the Whoop as well. And then I'm I'm actually uh diving into Google's Pixel. I'm actually on their uh scientific advisory board uh for Pixel and there's like a new AI assistant coming with that that is really cool. Very cool. Very cool. Personal question I've wanted to ask you. I am into the Carol bike. Are you familiar? I have one. You have one. Okay, I didn't know that. So, um a lot of people don't know what that is. Can you just explain what it is and then I love to just hear your thoughts on that. I'm about 6 weeks in to mine and there's a Norwegian 4x4 on there that I'll do. And so when I when I knew you were going to be talking about that, I mean again, chills. So, can you just tell people what that is and kind of what it's claiming that you'll get cuz I mean it kind of blew me away when I started like doing it, but also reading what they're claiming and the research around it. So, I'm just curious. Yeah, I mean uh full disclaimer, I have a Carol bike, but I've only used it a handful of times because um I've got my routine down on my Peloton and I'm mostly not doing I'm doing other stuff types of training, but to essentially the Carol bike, you know, it's is it's kind of forcing you to do it's like a protocol where it's forcing you to do it in a in a way where it's not like you you kind of have to go with it in a way. So, it's like it it changes the intensity, you have to keep up with that change in intensity. Um they added the 4x4 because of me. Um I had Really? since with them on that. That's hilarious. And I was like, I hate how the Peloton has no 4x4. Oh my Um and so they they added the 4x4 and that for that reason alone, I like the Carol bike. Okay. >> Um but I you probably can describe it better than I have because I have used it so infrequently and only for the Norwegian 4x4. Well, the way that I discussed it Carol bike's an AI sort of generated stationary bike that you you bring home, you order it, 5 weeks later you build it. It's easy to build and you start doing it. Their whole claim is literally 3 days a week, a 5-minute exercise, 15 minutes, 15 minutes. After 8 weeks, your VO2 max goes up 12 to 15%. 15 minutes a week and that's doing their classic what they call rehit, reduced high-intensity interval. And that's it. So, what I have in my practice and you may as well, I have cyclists that do triathlons, Iron Mans, what have you. These are very very fit people. They love the Carol bike as an augment to what they already do in their normal training regimen. They just swear that it helps sort of what they feel is this margin, this very slim margin to improve their cardiorespiratory fitness. So, anyways, I was just intrigued about your thoughts on that because there's a bunch of other things like different exercises in it, but who can't do 5 minutes 3 days a week? That was the other thing that really appealed to me and they have a 100-day uh money-back guarantee. So, if you get it and you do, oh I don't know, four times a week and you feel like it's not doing it, um you can send it back. So, anyways, have you I was just curious about what your thoughts were. >> to the whole like hit protocols improve cardiorespiratory fitness and like, you know, 15 minutes a week absolutely is going to do that. Yeah. >> And improve it. >> And I mean again, stationary bike, right? It's so great on the joints. You're in the AC. It's not like you have to drive or go or or put stress on. So, it just made a lot of sense to me. So, I appreciate that. I'm going to switch now into um the micronutrient category and and I'm going to leave this off with one that that may not be familiar with the audience and I'd love for you to explain this, but this this idea of omega-3s and fatty 15. Are you familiar? Yeah. So, so pentadecanoic acid, I believe, but but what we we teach on EPA DHA and the importance of those and why systemically they're important, but as compared to Can you Can we at least describe what fatty 15 is and is there I have a conceptual idea of the two differences, but I'm curious about your thoughts on this since you love that space. I Well, let me just say looking at the data on, you know, fatty 15, it's very weak. It's very observational. It's very I it's it's just I don't I don't know that there's enough there. It's kind of like, are we looking at the foods that it's in and that's what's happening um versus, you know, if you're if you're comparing it to like EPA DHA, I mean there's just decades and decades. It's probably the most well-studied fatty acid like molecule one most most well-studied molecules. Tons of evidence on actually supplementing with it, right? Where we know it's actually due to this molecule versus like the fatty 15 where there's a lot of observational evidence in like, okay, this is found in these types of meats, these types of foods. There's a little bit of supplements that it's like the supplement studies are so far and few where it's like by a company that's making that molecule. So, there's a little bit of a conflict of interest and they're very very small studies with all sorts of problems. So, um from an evidence-based approach, I find it interesting. I don't quite know what to make of it yet, but I will say that with the omega-3s, I am confident Yeah. that those are highly beneficial and that most people are in fact 80 to 90% of the population is deficient in omega-3. They're not getting enough. Yeah. And that you can essentially increase someone's life expectancy by 5 years by bringing them from a, you know, low omega-3 index, which is 4%, to a high index, which is 8%. Um so, to me um probably not the answer you want to hear. [snorts] I do I do think it's an interesting area to keep keep my finger on the pulse, but um because I'm so critical and evidence-based, I still I I have to be like very balanced >> Absolutely. >> talk about it. And there's definitely no answer I want to hear. So, you basically just verbatim said what I thought you would because you're a researcher and I already knew sort of the answer, but I was asked to ask. So, so that that's got to do Hey, I'm waiting. I'm waiting for the cool study. I'm like, I'll be the first to talk about it. So, on the ratio of EPA to DHA, I assume it depends on what you're going for and what you're treating, but generally speaking, can you just talk to that to the audience? Yeah, the ratio to EPA to DHA. So, first of all, let's talk about like, you know, these these fatty acids. Um DHA is predominantly found in our cell membranes. It plays a role in the fluidity of our membrane. So, it does kind of the opposite of what trans fats do. Trans fats will stiffen, they get incorporated into the cell membrane in endothelial cells lining the lining our vascular system, our arteries. They'll stiffen it and cause cardiovascular disease. Well, DHA does the opposite. It makes it more flexible. It makes it more fluid. And so, um it's very important component of our cell membranes including in our neurons. In fact, if you're not getting enough DHA, what happens is transporters and receptors like neurotransmitter receptors like serotonin, like dopamine, they're structurally not uh optimal because the membrane stiffen and so neurotransmitters can't bind them as well. And so, you'll find that transport of nutrients, even glucose has been studied showing that glucose transport into the brain across the blood-brain barrier because the glucose transporters are they're they're they're structurally not optimal when you don't have enough DHA, which accumulates at the blood-brain barrier. Then you're not getting enough glucose into the brain. You're not You're not You You get the idea. You're not binding, you know, the serotonin receptors are not binding serotonin, so you don't get the effect. Same with dopamine. So, the So, DHA plays a very important role in a lot of functions. Also, muscle tissue. So, there's studies now by Chris McGlory um showing that DHA actually having high levels super high levels of DHA in the muscle can make it can sensitize it to amino acids. So, that plays a role in obviously muscle protein synthesis and um preventing muscle atrophy as a um function of disuse. Um EPA on the other hand is also incorporated into cell membranes, but doesn't have as big of a role as DHA. It has a very important anti-inflammatory role as well. And so, um it's playing a big role in cardiovascular health. I think if you're wanting if you're someone that's really got like cardiovascular disease, then like you're focusing more on a higher EPA. You want higher EPA. If you're someone that's really you've you've got a familial history of Alzheimer's disease or dementia or Parkinson's disease, brain neurodegenerative disorders, really focus is DHA. So, I think it depends on what outcome we're looking at. I like to get both, but really uh depression is interestingly um EPA because of the anti-inflammatory effect as well. But um so, my thoughts are here. It's not just a one-size-fits-all. It's like, what endpoint are we looking at here, right? Cardiovascular disease or brain brain dysfunction. So, we would hear checks omega checks omega quant omega indexes. Yeah, okay. Not enough. >> Few hands. So, um yeah, something I've been doing for years and yeah, just glad you're on stage cuz I want to ask you that. Nice. There's something supplements They're rancid. Okay, let me talk Can I talk to that question? So, the question is, oh you shouldn't be taking fish oil supplements because um you know, fish oil is a polyunsaturated fatty acid. Polyunsaturated fatty acids are very prone to oxidation. Um I will say this, I there's not a single study. In fact, there were studies that were deliberately fed people oxidized fatty acids and they had no negative effects. And that was already like I still think you should get a quality fish oil supplement for sure. Like don't get me wrong. But there's more than one study and and the only reason I know about this is because when I submitted an article for peer review, reviewers were jumping on my case about. I was like the opposite. I was like, oh, it's oxidized. You have to and they were like, three studies right here. They gave them they fed people oxidized fish oil. And guess what? Markers were still improving and things were not going bad. So I was like after that I was like, okay, I can't I'm I'm sold, you know. Show me the data. I will change my mind on something, right? It's all about following the data. So the bottom line here is that you know, even even a sub-optimal fish oil supplement is beneficial. And I think there's there's a lot of perverse incentive in some of these influencers saying these things because if you create that fear response, people will listen to you. They get more followers. They get, you know, so you have to really be careful with that effect because it's a real effect. And at the end of the day, you know, I'm an associate scientist at the Fatty Acid Research Institute. I've published I've two publications with omega-3 fatty acids. I'm involved in clinical trials right now. I mean, I I I can't tell you enough like omega-3 fatty acids, it's like one of the easiest things that we can do, you know, it's supplementing with the fish oil. About 2 g a day will get most people from a low index of 4% to a high omega-3 index. By the way, we're talking about omega-3 fatty acids in red blood cells. That's the omega-3 index. And and it has a huge impact on 90% lower sudden cardiac death, 5-year increased life expectancy, a just a whole host of benefits, neurodegenerative disease as well, dementia risk is lowered. Um we have all these randomized controlled trials now. We have the reduce it trial with Vascepa high EPA showing 25% lower adverse cardiac events including stroke and heart attack compared to placebo. We have the vital study where people were actually given a low dose. They were given like 800 mg of Lovaza. So that's the prescription form of omega-3 that's EPA and DHA. If we look at secondary outcomes, these individuals had about a 30% lower heart attack risk compared to placebo. This was a 5-year study. These are large randomized controlled trials. This is causation, not just observational data, which all points in that direction as well. So I don't think there's an argument that people can make when it comes to supplementing with fish oil is bad when we're seeing, you know, 30% reduced heart attack and death from heart attacks. Yeah. Compared to placebo. 100%. For the timekeepers, I apologize, but I'm next to a power house. I've got three more and then I'll be done. Magnesium, you know, huge, right? It's a big micronutrient you talk about a lot. Can you just break down how you think through the different forms of it and when you choose to use what you choose to use based on what? Yeah, so magnesium's an essential micronutrient. We can't make it in our body. We have to get it from our diet, right? Half the population's not doing that because it's essentially found in dark leafy greens. So supplementation is another way to get it. The RDA for magnesium for women is about 300 to 350 mg a day. For men, it's about 350 to 400 mg a day. If you're sweating a lot, you're using the sauna, you're physically active, those requirements can go up between 10 to 20%. If you're a high-level athlete, again, those levels can go up. And most people [clears throat] aren't even meeting that. So imagine, you know, how deficient people are in magnesium. >> [snorts] >> It is a cofactor for over 300 enzymes. Important to make energy. You can't make ATP without magnesium. You also need it to repair damage to your DNA. So it plays a very important role in preventing age-related cancer. That's not something that's going to show up in your 30s or 40s, maybe 50s. As you get to your sixth, seventh, eighth decade of life, you know, cancer start to show up. And if you've been a lifetime of magnesium deficiency, you're not repairing that damage to your DNA as well. That can lead to oncogenic mutations. Also, magnesium stored in bones. And so anytime you're in a magnesium deficient state, you pull it out of your bones because you have to maintain plasma levels of magnesium. And so a plasma magnesium test isn't necessarily going to show someone's getting insufficient magnesium because you're going to pull it out of your bones. So it also plays a role in osteoporosis. What what forms of magnesium can people take? That's like the big question. So there's a lot of forms out there. The classic one that people used to take, magnesium dioxide, terrible. It's just not bioavailable at all. Um so forget that form. When it comes to supplementation, some of the best and most bioavailable forms are the the organic salts. So you're getting magnesium citrate, magnesium malate, magnesium taurate. And then magnesium glycinate is a really good one. So those are some of the most bioavailable forms. Magnesium glycinate I like to take because at night especially because glycine, so it's it's attached to a glycine molecule. And so if you're taking glycinate or bisglycinate, that's two glycines, you end up you end up getting glycine as well, which is also seems to help with sleep a little bit. So magnesium glycinate is a very bioavailable form. I think that's a great form to take. There's also magnesium threonate. Magnesium threonate is a form of magnesium that was developed by a group of researchers to look at the effects of getting magnesium into the brain more readily. And so animal studies show that it can actually more readily cross the blood-brain get into the brain. There's two small human cohort studies looking at magnesium threonate and its effect on cognition. It seems to improve cognition. I'll say this, take it with a grain of salt. We do need more evidence, but it is looking promising. Um that data had to be pulled together just because I think there wasn't enough sample size to power the study. Often times you'll have to do that if you don't have a large enough sample size. So the thing with magnesium threonate is if if you're looking for the brain effects, so improved cognition, just consider that magnesium is potentially going to the brain more. And so you want to get the other form as well to like be in this in your circulation to help repair damage, to help with energy as well. So I think that people that are only taking magnesium threonate are missing out and should be taking also maybe magnesium glycinate or magnesium malate or citrate, whatever whatever form you like. Like I said, I like the glycinate. Perfect. Thank you. Um maybe an easy one. What's one area of your research you feel providers underutilize in everyday patient care and how could we integrate it more effectively? Well, I would say the omega-3 index. I only saw a couple of hands and I think that's like it's one of the it's one of the easiest things and you get a very robust effect in terms of the way you age, cardiovascular, brain, mood, muscle, endless, right? And life life expectancy. Super easy. You can get someone to take 1.5 to 2 g a day. It's well below the 4 g that is prescribed to patients with, you know, high triglycerides or cardiovascular disease. Um so I would say that was that would be the the the biggest thing. Also a multivitamin, honestly. Um simple simple multivitamin. Yeah, omega's a huge passion of mine as well. So last one, always like to conclude with these types of questions cuz I think the audience is very curious. What is September 2025? What is Rhonda Patrick's weekly resiliency behavior schedule? What do you do? Uh weekly? Weekly. Okay. So I probably work out about usually [snorts] 5 hours a week when I'm at home and not traveling. That's one of the most important things I focus on. I have to get my high-intensity exercise and my resistance training. I do it like it's like I it's like you can't miss brushing your teeth and that's how I view this. I have to do it. Someone asked me at the last event like, well, you talked all about this cardiorespiratory fitness and vigorous-intensity exercise. What about the muscle? And I'm like, yeah, you got to do resistance training. I just didn't talk about it today. Like you have to do it. So I like to do a lot I do CrossFit training. I do that 3 hours a week. Um that I like it because it incorporates both the high-intensity and it incorporates resistance training and strength training. So I starts out with strength training and resistance training and then it like incorporates the the hit stuff and cardiovascular and the rowing and the biking, sprinting and stuff. So I really like doing that because I'm getting all of the resistance training that I need. I'm getting the hit. And then my additional hours of working out are running. And sometimes I'll do as my exercise snacks. But the the running I also like for other reasons. It's kind of my you know, it's recovery days where I run. And it's also really just when my brain kind of like cleans out and I like go through all the stuff that is like in my head and it like is a very it's like this mental cleaning out for me that I love. And I also get ideas. So it's like a daydreaming kind of effect as well. >> [laughter] >> Um on top of that, I like to do my nightly sauna. So I used to be I was I would do a couple of them after my exercise to kind of lengthen the workout, but like I got to get work done before school pick up and all that, right? So now I do saunas at night. My husband and I have this ritual we like to do it before bed. I put a video on how heat stress also can improve sleep. So that is something that I do a couple of hours before bed. These days I've been doing I switch between the sauna. We also have a hot tub. I like I like being outside at night and looking at the stars. And so I I probably do that like five times times a week where I'm getting the heat stress before before bed. Um so that's my exercise. I don't really the cold exposure I'm I'm really just a seasonal cold exposure person. I do it in the summer. Um I I don't really keep it up in the winter. I'll totally admit it. I'll talk all about the science behind it, but like at the end of the day if I get my my hit and my my training is I know I'm that's the most important for me. Um when it comes to my my diet, you know, I've really increased my protein intake to meet my my exercise needs. So I used to really not work out like lifting, you know and now I'm I'm doing a lot of lifting and so I'm trying to aim for it. I do about 1.6 g per kilogram body weight per day. Most of my meals like I'll have you know for breakfast it'll be just just some eggs. Maybe maybe I'll have like an avocado and then I do a green kale blueberry smoothie as well and then I take my vitamin let's see for lunch sometimes I'll just have like a salmon it's like salmon not salmon a turkey burger that's homemade so I do like more protein and then for dinner I'll have like a big salad or a lot of vegetables along with my protein chicken or salmon or turkey or red meat and then I take a lot of vitamins. Oh, I also take a lot of creatine in the morning so I do 10 g a day in the morning. And um and then in the morning my other vitamin is a multivitamin I do in the morning. I do my creatine and then I do some omega-3s in the morning as well and then at night I'm doing a lot of stuff. I mean I'm doing the magnesium. I'm doing more omega-3. I do the vitamin D vitamin K2. I'm doing niagen true niagen for the NAD. I'm doing gosh like what else am I doing? Oh, I do cocoa via in the morning which is like you know cacao one and I'm there's these are these are the core ones that magnesium I do I mentioned that at night but yeah I think there's like more that I'm missing. I do um Oh gosh PQQ um Yeah. Yeah. Like what else? Anyone seen my supplement list? There's like there's ones that I'm missing but melatonin right now cuz I'm jet lagged. Got back from China a couple days ago. But that's that's that's pretty much my nutrition supplement exercise. One interesting thing I learned about Ronda is her idea of a stack is much different than mine. So I'm going to use exercise next I think that's that's >> I do I do those. I like sit up and I'll I'll get up and I'll do my my my one minute like usually I do squats or I'll do burpees. Burpees like gets my heart rate up more than than just squats. I would if you were up to me we do burpees but there's no space. >> [laughter] >> Burpees everyone would hate me. Well, so Ronda just like all the speakers I didn't say this earlier but they're going to be here today. They're going to be around so if I sincerely apologize there were so many questions that came out I could not get to all of them. If you have questions she's available and again all the speakers will be so just one more round of applause please for Ronda Patrick. Thank you.