Health Longevity Secrets
The health advice you're getting isn't working. Want to know what the experts actually do for themselves?
Health Longevity Secrets reveals the real science behind longevity, metabolic health, fasting, and disease reversal—the protocols that researchers and physicians use in their own lives, not just what they tell patients.
Robert Lufkin MD is a UCLA and USC medical school professor, practicing physician, and New York Times bestselling author. After reversing his own chronic disease through lifestyle medicine, he's on a mission to share what actually works.
Each episode features in-depth interviews with world-class scientists, doctors, and biohackers who share their personal health strategies—no sponsored talking points, just real answers.
Your health transformation starts here.
Health Longevity Secrets
When ‘Normal Labs’ Are Unhealthy with Sandeep Palakodeti MD
Feeling “fine” is not a plan. We sit down with Dr Sandeep Palakodeti —an Ivy League–trained internist who left elite institutions—to unpack why so much of healthcare reacts to disease instead of building durable health, and how treating your body like your ultimate asset can change the arc of your life. We dig into the core four foundations (sleep, diet, exercise, relationships), the hidden risks behind “normal for your age” labs, and the personalized strategies that help you extend your prime years, not just your lifespan.
Sandeep explains the gaps in standard panels and why markers like lipoprotein(a), ApoB, and early insulin resistance can quietly raise cardiovascular risk for decades. He shares a practical framework for advanced therapies—rapamycin, peptides, red light, hyperbaric oxygen—rooted in evidence, safety, access, and intent, with explicit stop criteria to avoid blind experimentation. We talk through what it takes to turn vague advice into precise action: strength training as a glucose sink, protein targets, VO2 max, and sleep protocols tailored to your biology and lifestyle.
We also explore the evolutionary case for a longer, more productive middle life. Wisdom tends to peak in the 50s and 60s, exactly when chronic disease often accelerates. With the right diagnostics, coaching, and accountability, it’s possible to keep the energy of a 30-year-old while preserving the judgment of a seasoned leader. From there, we shift to AI’s growing role in medicine: clinical copilots that surface patterns, agentic systems that handle routine care, and how empathy at scale could emerge alongside human guidance for high-stakes decisions.
If you’re ready to manage health with the same rigor as your wealth, this conversation offers a roadmap: better measurement, longer conversations, smarter tools, and a clear strategy that compounds over time. Subscribe, share with a friend, and tell us—what metric will you start tracking this week?
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Blu...
Hey Sandeep, welcome to the program. Rob, thank you so much for having me.
SPEAKER_01:Happy New Year.
SPEAKER_00:Likewise. This is great. I'm so excited to talk to you today to learn more about your book, which is literally coming out this week. We're going to talk about uh the ultimate asset. Extend your prime, not just your lifespan. And there's a lot to unpack there. I want to get into that. But um, maybe before we do that, a little perhaps this is the first time you've been on the podcast, perhaps a little bit about your background. Obviously, you're uh you're an Ivy League trained uh physician, you've worked at topped institutions, you've even you've even helped build uh value-based care models, yet you walked away from the traditional system. Maybe you can expand that and kind of set the stage on how you got there.
SPEAKER_01:Thank you so much, and I appreciate being here. Uh, this is an exciting week for us. Uh, I'm an internal medicine physician. I grew up around medicine. My father's a physician, my brother's a surgeon. And yeah, I always had a sense that the system was not working for most of us that were in it, both those providing care and those of us receiving care as well. Trained as an internist uh out at Kaiser Permanente, wanted to really understand an integrated system from the inside out. Uh, felt followed that uh as at a fellowship at Harvard and then joined the Mayo Clinic as a staff physician there. Uh and, you know, very quickly, while I have an amazing amount of respect for all my colleagues there in the institution, you get a sense as a new attending of the very broken nature of our healthcare system and how much of our jobs are quite reactive to disease and sickness once it sets in, rather than preventing illness from starting. And so I was drawn to this value-based uh kind of care uh where at least I felt that we were shifting the payment mechanism away from fee-for-service transactional medicine to, hey, doc, we will pay you more if you have your diabetics under better control, or your overall population are going to the hospital less and receiving care. Oh, I think that's a worthwhile tenant. But 20 years in, unfortunately, we still have not seen the promise of what we really thought value-based care was going to deliver, which is lower costs and better quality for our overall population across the country. I think there are little pockets of that that are often not scalable and unreproducible. And so when you really step back and think about the most complex industry in the world, most likely, in however, the most successful country the world has ever seen, there's a major mismatch in our outcomes and what we're sort of delivering. And so I bump all of that professional experience up against my own personal life and personal story, which is three of my grandparents died in their 60s from heart attacks, and both of my parents have diabetes. My dad's had multiple heart attacks, and I have two young kids, and I look at them and realize that 30 and 40 years from now is not enough time for me left with them. I owe them many more decades than that, hopefully. And when you step back and think about what is going to help me achieve that goal, it is both the system of care that we deliver and the kind of care that we deliver. And so I came to Velocity Health through those two vectors, which is pair the right kind of system, which to me has been a cash pay, uh, direct uh concierge model outside of the traditional healthcare system with the interdisciplinary, personalized kind of care that I would want for myself and my family. That is a team that knows me deeply, that understands my biology from the genetic level up to understand what therapies are going to work for me and what is not, and can be highly proactive and prevent disease from actually getting there, wrapping around me, bringing in the right people at the right time. So we sought to build that. Uh, that's what we created at Velocity Health, and and we are a 50-state national digital concierge practice. So that's that's my journey in a nutshell.
SPEAKER_00:Yeah, I'm I'm really excited about diving into uh Velocity Health and and your kind of teasing apart your views on things and how you look at how you look at health today. And and uh we we share a background. My first love is internal medicine. That's what I started out in. And it was interesting. And you you talk about medical residency as biologically destructive, you know, self-deprivation, stress, metabolic collapse. Uh, can you go into that a little bit? Yeah.
SPEAKER_01:Yeah, it's ironic, right, Rob, as we think about trainees in healthcare. I think in medical school, you have a little bit of uh flexibility still as you know, on your schedule, you're still a student, but then you get into residency and fellowship. And even the first few years of being a practicing physician, you your time is not your own. And you think about the environment we're in, blasted with LED lights. I know you train in radiology as well. I mean, that kind of circadian disruption that we're under, the trash that we're fed at noon conferences, the sleep deprivation, the lack of exercise, lack of relationships and social connection, all of the things that we talk to our patients about, the underpinnings of a healthy, happy life. I write about in the book, the core four that we must sort of achieve before we get into anything else are sleep, diet, exercise, and our relationships and mental health. If we can't achieve those fundamental things, no amount of biohacking or peptides or supplements or anything are going to help us. I, though, do believe it is quite ironic that as we train in these institutions that are supposed to promote health, that often many of us uh end up in the least healthy state that we've ever been.
SPEAKER_00:Yeah, I mean, I I I love that you you come from really truly a gold standard of medical education, of conventional allopathic medical education. You you trained at the top institutions, you practice at the highest level, and now you're basically taking a view of questioning these things and seeing if there's not a better way. You know, for example, you say that decline is optional. And this is a radical statement for a board-certified uh physician. So what what did you have to unlearn as a doctor before you could say that honestly?
SPEAKER_01:Well, you know, I love your first book about the the lies you taught in medical school, the ones I learned in training across the across time. You know, I think there's a if you take it back to history, there's something called the Flexner Report back in the early 1900s that fundamentally sort of broke apart medical education into pathogenesis and salutogenesis, that of wellness and and promotion of health. And you know, most of our education is really focused on once someone has a disease, we know what to do. And and I sometimes talk about this in various, you know, athlete circles. American healthcare is the best in the world at defense. Meaning, if I were having a heart attack or a stroke, I would want to be in the United States and get my acute care here. We have the best standards in the world to get into a cath lab and you know, save ourselves the best technology in the world. We have the best institutions in the world, the best research in the world. But look at our outcomes, right? Why, why do the does that not all pair with the healthiest population uh that we've ever seen? Well, there's all sorts of reasons, but a big part of that is from a physician standpoint, is we don't learn often the true drivers of real health and wellness. And I know I'm reducing a lot of that, and all the doctors out there are rolling their eyes and saying, of course, we learn a little bit about educ about nutrition and about sleep and about exercise. And we talk to our patients about that. But if we really break down the number of minutes and hours throughout our day and lives that we spend talking about those things, there's plenty of data to prove this. I'm not just making this up. We rarely get the opportunity to talk about upstream drivers of health and how we get in front of those in a structured way that makes sense to you. And you know, some people will say, look, aren't you just telling everyone to exercise and sleep and eat right? Like, yeah, ultimately, a lot of the advice we give is sound advice. But what is going to push someone to all of a sudden uh take on a totally drastic lifestyle intervention like intermittent fasting or ketogenic diet or high-intensity interval training, maybe it's their yearly panel of you know, their lipids that their doctor gets, or maybe it's their hemoglobin A1C that's slowly creeping up, but maybe it's not. So, what I've found is for many high performers, for many CEOs, founders, people who have built amazing businesses and built all sorts of uh legacy-lasting programs and infrastructure, they've done that through a very intentional approach by looking at data, by understanding where their risks lie, by having a strong one-year and five-year and 10-year plan and strategy for how they're going to achieve their goals. Yet, how many of them apply that same kind of framework to their own health and their own wellness? And so that's what we've tried to articulate and create in a very programmatic way. And we can talk about what that actually looks like and feels like, but that is not done in the traditional 15-minute primary care visit, right? You cannot have those kinds of conversations. Even if I see someone once a month for 15 minutes, you know, in our appointments, I meet with people like this for 90 minutes or two hours, and we really get to know one another. And I know their spouse's name and their preferences and their kids and what they're worried about. And all of these things matter when we're saying, hey, you need to sleep better. It's like, okay, well, doc, how do I do that? Like, where do I start? What is the prescription for me versus for Rob? And those are going to be different things. So to me, all of that is stuff I had to relearn, maybe not unlearn from medicine, but we start medical school and we start training from a very population standpoint. Like we look at studies, we try to generalize that. But our job as clinicians, I think, especially as we mature, is take all of that data and apply it to the patient in front of you. Show us what it means to actually be individualized and precise in the kind of care that we're doing. And that means not just following guidelines for every single person, right? Because people are not going to just follow that. So those are many of the tenets I'd think I'd have to unlearn and learn, uh relearn, I'd say, after after medical school.
SPEAKER_00:Yeah, you made a point that that um you argue that that normal labs, uh, normal lab tests are often a warning sign, not a reassurance. So can you can you explain why uh these normal labs may be one of the most normal for your age, for example, may be one of the most dangerous phrases in medicine?
SPEAKER_01:Absolutely. Yeah, we uh I use this line that fine is a four-letter word, and your fine is the biggest misdiagnosis in America, which is most, I won't say most, many patients who come to me tell me a story like this. Doc, something feels off. I'm not how I used to be, I'm not sleeping well, I've gained 20 pounds. I go to my doctor, they check a yearly panel, and they tell me I'm fine, and I don't think I'm fine. So you think about, you know, a typical lipid panel and an A1C and a CBC, which is probably what most typical primary care docs are getting for call a 40, 45-year-old person with one or two risk factors with nothing glaring, right? But there's so much more to that story. Even if your LDL is normal, for example, right now there are guidelines. The European Association, American Heart Association says we should be checking for something called a lipoprotein A. Uh, we know LPA is highly atherogenic, highly thrombotic. Uh, I had a couple people on our own podcast, Dr. Steve Nissan, um, who's one of the leading cardiologists from the Cleveland Clinic, did some of the early trials on lipoprotein A. We're now creating all sorts of therapies for that, but this is a silent killer. My cousin had a heart attack at age 45 and required a quadruple bypass. He had a quote unquote normal LDL, but his lipoprotein A was very elevated. And so no one ever checked for that. No one looked for that. Same thing with a hemoglobin A1C. Just because you're pre-diabetic or your hemoglobin C is 5.5, even or 5.4, that doesn't mean that disease is not occurring, that advanced glycated end products are not accumulating and causing damage to blood vessels and nerves. And so you go to your doctor and they tell you your hemoglobin C is 5.4, you're fine. Like they're not going to do anything until you actually have diabetes. And then they say, Oh, great, you've got diabetes. Now I've got this drug I can give you and I can treat you for it. Okay, well, how about the 30 years of time when I've been coming to you and getting these labs over and over and you've watched the A1C finally climb up? Why didn't we approach it then? Right. I think, again, not to reduce any of my physician colleagues, like they don't have these conversations, but the system is not set up for us to even just have this kind of long format discussion with a patient like we just had, right? That to explain to them all the things that are happening. So when you're told you're fine and you feel that something is off, and we go even just one level deeper, we often find all sorts of things, hormonal issues, inflammation, you know, insulin sense uh resistance off the charts. And we start to craft plans for each of those things because there are structured ways that you can build plans if you actually know what you're looking for, why you're looking for, we don't just hunt and shoot and pray to find some random diagnostic that's off the charts. I think we take a very structured approach to it, and but you have to look in order to know. And so that's where I feel a lot of folks are frustrated with the status quo of their current of the current American healthcare system.
SPEAKER_00:I mean, if if lifestyle is so effective or so important in in health, health span and lifespan, um why why are the colleagues not more why aren't they demanding that lifestyle be be taught and it and used as a treatment tool? Why, I mean, nobody, these are intelligent people. What what do you think the what's the pushback from your colleagues that you talked to? The people that you trained with, the people that you used to work with? What's what's the pushback?
SPEAKER_01:I don't think there's a single physician colleague that we would talk to that would say, yeah, of course I believe diet and exercise and sleep are important, but what am I gonna do? How how am I going to convince all of my patients to do those important things? Well, that's kind of our job, is is my argument. I think honestly, the training environment doesn't allow for that. It's so hierarchical. And you're penalized in healthcare for being an orthogonal thinker. If you are asking questions, if you're saying, hey, why are we spending all this time on disease treatment rather than prevention? You know, it's not the place for you. You're you're quickly ostracized. And so I think, you know, you look at 70% of clinicians are employed physicians now, employed by a health system. 10, you know, 10% of the entire American workforce is um employed by Optum, which is a health insurer, the largest health insurer in our country, United Health Group. And so what does that do to our decision making? Like now every one of those docs has all sorts of overlords telling them you must treat patients in this way or that way. You only have 15 minutes or you're not going to get paid. And it creates all sorts of incentives that they don't want to practice medicine like this. You know, people ask me sometimes, like, you know, how would you describe the kind of medicine you do? Like most primary care docs that would get 90 minutes with their patients, I think would do much of the kind of care that I do, which is actually go really deep with patients and talk about all sorts of things and have the diagnostic suite to be able to do that. But most of us don't, and we're stuck in a system and you know, to to go down that for a moment. Like most of our physician colleagues, you get out 10 years in and you've got a house and a mortgage and kids and this employed job, and it's very hard to break free from that. So, you know, I do hope this next I do feel a sort of zeitgeist uh a turning cultural shift where I get outreach from physicians every single week, multiple physicians asking about how to start their own practice or hey, I'm gonna step out, or I can't be part of corporate um uh you know healthcare anymore because I can't practice in the way I want to practice. So, you know, to bring it back to the question, Rob, I think most of us are stuck in a system that doesn't allow us to do the kind of care that I wish that we all wish we could do. And if given the opportunity, and if you could actually see the light, I think most of us would choose this kind of care every time.
SPEAKER_00:Let's let's um talk about you talk about health span and lifespan and longevity a little bit. Um there there's kind of a uh prevailing concept that oh, uh human beings aren't designed to live evolutionarily. There's no selective advantage after a reproductive age. In other words, we're just designed to have kids and then and then die off. But you make a you make a compelling evolutionary argument in the book that humans are meant to have a long productive middle life. Can you talk about that?
SPEAKER_01:Yeah, I think this is honestly probably one of the most fascinating, you know, philosophical things to go down, which is why do we live after we have passed along our genetic traits, right? Many other animals, they after they reproduce, they have a short kind of unary life after that, and they have a what they die, how are they gonna die, but they passed along their genetic code. And you know, human beings are unique, but we're not completely unique. There are other species that have long later life uh maturity that we've hypothesized for all sorts of reasons. Elephants, for example, have selective um uh uh sort of improvement in outcomes across the herd when they have matriarchs who are uh have been around for many decades and have institutional knowledge, essentially, on especially in times of drought, where do where are the water holes that are really far away that I can lead my family to? Wolves, same thing. I mean, you look across all sorts of different species, and there's not just the collective sort of aspect of teamwork, because that can be extrapolated into just the younger generations and the reproductive age folks. But once you get past that, there is a certain duty. And, you know, in human beings, I'd say potentially an honor there in what is our purpose? It is meant to not only provide wisdom and guidance, but also to be the steady voice. You know, you think about it's very interesting to examine our population because the 50s and 60s are sort of the last window that many people have. And so many of us kind of lock into chronic disease. Unfortunately, during that time, our our behaviors and everything kind of define the rest of our lives. But at the same time, when you look at president, the average age of presidents, senators, house of representatives, CEOs, leaders of NGOs, you know, the all the consequential people in the world, it tends to congregate in that 50 to 65 sort of uh era as well. And so, you know, what is it about that time? Well, it's we finally have the wisdom and the knowledge to pass along, but so many of us are now starting to see the physical aspects of our life break down, and we can't fulfill that duty of ours in middle life. We spend all of that time gathering all this knowledge and wisdom and experience until we're 50 or 60, and then we spend 20 years battling chronic disease when actually our species-driven genetic responsibility is to pass along wisdom and good habits and good uh behaviors, and that starts with our health. And so part of my claim is that we actually have all the tools and all of the diagnostics and all the therapeutics for someone in their 50s and 60s to physically feel and uh you know display objectively health of a 30-year-old while still having that experience and wisdom of a 50 and 60-year-old. And that to me is the most powerful force we can unleash. If many of us who are mature have that energy and that zest, think about how different decisions would be made at government levels and corporate levels and across societies and cultures. And so I think there's a lot to that uh middle age that we don't give credit to.
SPEAKER_00:Yeah, I I yeah, that I think you're you the your your point about the the wisdom and older age, it it um in in I've heard in societies or animals that are social animals that there actually is a survival advantage for, like you say, keeping these old people around. I mean, I think this the story I I hear it is you imagine two two human tribes, right? One tribe basically kills off their elders as soon as they have kids, you know, and they just let them die. There's no the other tribe keeps the old ones alive, the knowledge, the wisdom, and these two tribes go to battle over something, and you have the one tribe with all this wisdom of you know, years and years of battles, collective wisdom versus the other, who do you think will win? You know, and in that case, I hate to reduce everything to that, but uh um you you um you you name the you name the book the ultimate asset. Um what does that phrase mean differently at at 30 versus 50 versus 80 versus 100?
SPEAKER_01:Yeah, it's a great question. I we went through several iterations of of book names, things like the executive edge, which are you know too, I think, dialed into a particular archetype. 50 is the new 30, which is like, you know, just kind of a tired old phrase, I'd say, but does capture a little bit of what we're sort of uh uh going for. But as I just mentioned, it's not about being 30 again, right? Because we actually want that wisdom and we want that that uh knowledge of later age. So, you know, the the real reason of naming it the ultimate asset is as I mentioned, most of our members and and patients we serve, it's it's a uh continuing archetype I've seen over my career, which is people who are so dialed in on so many different aspects of their life, whether it's business or investments or growing their family or doing important things in this world. And every one of those things, they're pouring their heart and soul into, but they're doing that with whether implicitly or explicitly with some ROI in mind, that the ROI for me working on this project and spending my time on this is either personal wealth or it's doing good in the world, or I feel some sort of connection to bigger purpose. And and we all need to sort of find that. Um, but we rarely, I think, approach our own health with the same kind of vigor as we do all of our other assets. And just as we plan things, as I mentioned, in one and two, and five and 10 year sprints, many of us have our, you know, our retirement plans, our 529s for our kids. We're able to plan assets like that out for 20 and 30 years. But when it comes to our health, we we don't see those compounding impacts that we're having with the daily sort of activities. And so the argument we try to make is that there is no bigger ROI in your life. There is no more important asset. And, you know, if you've been watching all this stuff with AI and robotics, it's it is not crazy, Rob, for us to sit here and say in five and ten years that, you know, society will be vastly different when you have armies of robots doing all sorts of different things. And there are all sorts of folks, Elon and others, talking about universal income, high income, and people having what you know they need. In in those sorts of circumstances, you know, health is really the one differentiator we we all have: authenticity to who we are and our own body and health. And I think, you know, medicine and science are going to catch up. My my real belief is that we really just need to kind of keep ourselves alive and well enough for the next 20 and 30 years to allow the rest of science to catch up. Um, you know, the the name velocity health, even the name of our health clinic, is is termed off of this idea of longevity escape velocity, that each, you know, call it five years, we find, discover things that pushes out life expectancy by five years, and we just never sort of really catch up. And so when you think about a compounding asset um over the course of 10 and 20 and 50 years, like what if now we're talking about a hundred years, right? What if we're living to 120, 130, 150? What does that do to your planning of your, your, not only your body and your health and your wealth, but you know, things like assets and retirements and entitlements and society will vastly change in all sorts of different ways. So these are all things we're gonna have to wrestle with at the you know high level sooner than later, I think. But um that's the philosophy under the title, at least.
SPEAKER_00:Yeah, I mean, uh things are accelerating so fast in in science and knowledge and AI, like you say. I mean, uh Ray Kirschwil, I think, who it advanced the longevity escape velocity, one of the people, and Peter Diamondis. Peter just dropped uh an interview this week that he had with Elon Musk, where they talked about surgeons and uh humanoid robots uh uh surpassing surgical human surgical expertise in three years.
SPEAKER_01:He said five, yeah, he said three years. What do you what do you think about that, Roger? Do you buy that?
SPEAKER_00:Um I you know I don't agree with everything Elon Musk says, but I certainly respect his wisdom and his knowledge, and I wouldn't I wouldn't argue with him.
SPEAKER_01:Um I'd say even if he's off by you know uh uh even an order of magnitude, right? Like even if it's 30 years, that's pretty crazy to think that within our lifetimes we might see surgeons that outpass human or robots, robotic surgeons that that outpass you know, human surgeons.
SPEAKER_00:Yeah, I mean this the CES is going on as we consumer electronic shows going on as we record this, and we're seeing now, you know, humanoid robots that are um very, very sophisticated and even entering production. Uh so um I think I think 2026 is going to be an amazing year, unlike any other year in our history for for all sorts of reasons. But how how do you what how do you think uh putting putting uh surgical robots aside and humanoid robots, what do you think that just AI, these these large language models, these frontier models, now they're um, you know, in my space in radiology, they're now surpassing radiology trainees expertise. How do you think that's going to affect your practice and our experience as patients in this? Uh, what and what's what's the time frame for that for you?
SPEAKER_01:I think in profound ways for all of us is the short answer within the next five and ten years is is is my prediction. Um I'll I'll double-click on that. You know, I just this week as we're recording doctronic AI. Um, a good friend of mine is their chief medical officer. They in the state of Utah can now, an AI robot can now prescribe medications and they will take the liability, the medical malpractice as well. I think that was always the question, like, oh, okay, but you know, we can use AI and robots all we want, but ultimately it's still the doctor who's liable for it. Well, what if they're not? You know, and I think these are the things that advanced that advanced pretty quickly. I mean, they're doing tens of thousands of visits a week and a month, to my understanding. And so it's picking up pace. So consumers are starting to become more um comfortable with it, obviously. And you just look at, I saw another report this week on the number of queries in Chat GPT that are health and wellness related, and it's a pretty significant amount. People are going there first, and it's the new Google, right? Like doctors used to make jokes about patients coming in with their stack of Google papers. I regularly get patients now saying, hey, I GPT'd this thing. What do you think about this? And I actually love it. I mean, personally, in our practice, we've created the time and space to allow for that kind of open format discussion and dialogue. I think most of you know, I think AI is gonna be much more consumer accepted as people get more comfortable with that and go to it. I think as the agentic stuff then comes on board and can do things like put in a script for you, it it's going to foundationally change, I think, access discussions, cost discussions. And you know, on the clinical side, we see it in several different ways. We use AI operationally to improve our efficiencies. Um, we we use it to help summarize vast amounts of data. And all of it, though, gets double-checked by clinicians. Uh, we use clinical copilots. So, you know, it might scour all of the data and say, hey, doc, did you consider that, you know, based on these five different data points that this person could have lupus underneath as a unifying diagnosis here? It's like, well, actually, I didn't consider that, but now uh now I will. And that's actually a good point. So I think there, to me, the most powerful combination is going to be human beings plus AI. I think that for low-level, sort of easy stuff, you know, a URI that you need symptomatic stuff or an antibiotic for, or whatever, fine, that's probably not a big deal, or a quick refill on a med that you've been on for a decade, it's it's probably doesn't require a human intervention. And frankly, I bet we will show that safety data, just like self-driving cars show much better data than human operators, will will show that there are less errors on medications and things like that with those kinds of things. But you have to let it play out there's going to be, unfortunately, some bad outcome at some point, right? Where some AI agent made the wrong call and someone dies from it. I fully 100% believe that's going to happen. It's going to cause a moratorium, but ultimately it's going to keep pushing forward because science and technology always does. So that's how I sort of see it. I think we're just bracing for, you know, whatever happens. My last comment I'll make is no matter how good AI gets at diagnosis and potentially even telling you the options, my gut sense is that most people for more serious conditions at least want to chat with a physician and get their success, right? That like the art of medicine, I think, will come back to be a much more important thing where we're guiding people through here's your 10 options. You could do nothing with this and die peacefully, or you could go super aggressive and there's 15 things in between. But the AI can maybe coach you through that. Here's what I've seen over my 30-year career in in how that looks like. So we'll see if I'm right or not.
SPEAKER_00:Yeah, such such a such a challenging, such a challenging time. I mean, the one thing I wonder about is as we get more and more data from wearables, from tracking locations, from sentiment analysis of the emails we send, of the texts we send, how often we interact with friends, that even 90 minutes to spend with the patient isn't enough to assimilate everything. And it's like even you know, day-to-day stuff. Oh, he's not going to the gym anymore. He's going to the liquor store in the strip club. Well, that's a red flag, you know, and but you know, and all those things and just becoming overwhelmed with the data. And I mean, I know from practice when I, you know, when I see a patient in the hospital when back when we had charts, and you know, there was a chart, you set the charts, we all read the top, you know, we read the summaries from all before. Nobody has time to go through it. Well, that's going to be even more so now. And the great thing about AI is it can assimilate huge amounts of information. And then the other, the other part, I mean, as much as you know, I'm a human being and I I love being human and I see the value and the warmth and the, you know, the what physicians can can really bring. I still have to face the fact that the evidence is showing that people are much more revealing, they're much more open, at least on psychological matters, and everything ultimately is psychological. They're much more open when talking to an AI or uh a computer, uh, revealing their history, their, you know, what's going on, yeah, than they are to a person because revealing, you know, when we interact with a person, we're obviously projecting stuff on the people. That's what you would do. It's like, oh, it reminds me of my ex-girlfriend or my ex-friend.
SPEAKER_01:And we're reading their things from yeah, we're reading things from the other person as well, and we're we're making all sorts of judgments on. I fully believe in five or ten years, you know, people will rate AI clinicians as more empathetic and caring to their needs, right? Because they they have infinite empathy, potentially. We're human beings, we have bad days, we have stuff on our mind, we have other things, and like it's it's obviously going to be different. But I think you're right. I mean, the data would definitely show that people are more revealing and probably will rate those kinds of AI bots as more compassionate than us over time as well.
SPEAKER_00:Well, if someone, if someone was able to absorb or read only like 10% of your book, which sections would most radically change their trajectory and their health?
SPEAKER_01:I think that's a good question. We, you know, the core four are where we spend four chapters, and I think everyone would benefit from really creating systems there. It's not just generic kind of sleep and diet advice, but it is it is really, you know, the system to understand your particular circumstance and how you can optimize. But I'd say one really interesting chapter to focus on, and perhaps you know relevant to your readers is the one on advanced therapies. We get so many questions. I get texts once a week, uh at least, uh, on peptides and red light therapy and um, you know, uh hyperbaric oxygen, whatever it is. And I think one of my criticisms of this whole space is that the hardcore science has gotten intermingled with sort of the wellness stuff. And it's hard to sort of figure out what has real data and what has real evidence, and there's a new cold plunge trend or whatever trend every every day and every week. And so, how do you sort of wade through that and figure that out? We have a chapter in the book that gives you a framework for example, how we would think about putting someone on rapamycin or on peptides, and it's this easy framework where we go through the the evidence and the accessibility and the safety and the intent and EASI, and then we rate those things. And so, is there an RCT on rapamyosin for longevity? Yes or no? What is the safety and what are the alternatives there? What is your intent with this? Is it that you just want to experiment? What's ultimately what we pair that with are, you know, stop, like very strict stop criteria. So if you're having reactions or you know, aptis ulcers or whatever it is that we know are side effects, these are hard contraindications. And so I'd say as people are out there getting bombarded with millions of different things about what they should try this week or next week, just step back and try to use a framework like that that helps you make sense of this. Don't put yourself at harm, realize that there's all sorts of cool emerging therapies, but you also have to do it in the right kind of smart way. Um, and I'd say that that chapter probably helps distill that down to the most practical framework around that.
SPEAKER_00:Yeah, if if your future self could could audit your current biomarkers and habits and decisions, what would you be most worried about right now?
SPEAKER_01:My strong family history of early cardiac disease. Um, I don't have an elevated lipoprotein A, but I it's sort Of borderline, my APOB and everything are well controlled. For me, it's probably insulin resistance more than anything. That's what uh plagues my family. I have more visceral fat than I would like. Uh my future self would say you need to do everything you can to get your lipoprotein insulin resistance score less than 25, to improve your muscle mass, to give yourself a glucose sink, to focus on protein and VO2 max and uh prevent any kind of early heart disease. So that's, you know, like any young father, entrepreneur, physician, lots of competing interests, but I do my best to live the values I try to preach as well.
SPEAKER_00:Well, Sandeep, I want to be respectful of your time. Is there anything we didn't cover that you you want to touch on in the last uh few moments here?
SPEAKER_01:The last thing I'll say is, you know, we kind of close out the book with this, which is we need to fundamentally rethink the American healthcare system as well. None of this happens in the traditional fee-for-service, 15-minute primary care visit. And so there are those of us who are attempting to be the change we want to see in the world. And so for any clinician out there, any patient out there who is looking for another way, just know there's a big community of us who are building uh what we think is the parallel system to real health. And uh it's just about finding those like-minded individuals. And we all need to lean on each other to bring about this change at a systemic level. Because it's going to, you know, while you know, books like ours and conversations like this, I hope move the needle in a small way. It will take systemic reform if we're going to do this for hundreds of millions of people.
SPEAKER_00:It's a it's a great uh closing, closing thought for all of us. Uh, the book is called The Ultimate Asset. Extend your prime, not just your lifespan. Sandeep, thank you so much. The book's coming out this week. Uh check Amazon, Barnes Noble, your local bookseller, independent bookseller, everything. Sandeep, thanks so much for spending time with us. It's it's been a real, real pleasure today.
SPEAKER_01:Rob, it's been an honor. Thank you for having me, and I appreciate all that you're doing to move the space forward as well. And uh tell the listeners thank you for spending some time. And uh please reach out anytime. We'd love to chat.