Going Under: Anesthesia Answered with Dr. Brian Schmutzler
Going Under: Anesthesia Answered is a podcast with renowned physician and anesthesiologist Dr. Brian Schmutzler. Together with Award-Winning Co-Host and television journalist, Vahid Sadrzadeh, the podcast aims to answer not only your most pressing anesthesia questions but to provide the most up-to-date medical data available.
This weekly medical podcast will release a new episode every Thursday at 5 am. Thanks in advance for being a listener.
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Going Under: Anesthesia Answered with Dr. Brian Schmutzler
Measuring What Matters: Why Dr. Peter Attia is Right
In this episode of Going Under: Anesthesia Answered, Dr. Brian Schmutzler and Vahid Sadrzadeh unpack how wearables, testing, and everyday habits translate into real gains in healthspan.
Then we dive into Peter Attia’s case for training today to stay functional at 80 and beyond. VO2 max, HRV, strength standards, and food quality emerge as practical levers you can pull now.
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This is going under Anesthesia Answered with Dr. Brian Schmutzer. I'm Vahid Sadarzade. We're brought to you by the Butterfly Network. We are.
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SPEAKER_01:We're back to medicine this week. I mean, we were talking about medicine last week. Yeah. Just with monsters. Um talking about tech this week, actually. Tech and then Dr. Peter Atia, who is one of your favorites that you've kind of uh followed for a while. Followed and listened for uh for a long time, and he kind of made his national, national debut, I guess, coming out party on uh 60 Minutes.
SPEAKER_02:60 Minutes is pretty pretty uh high class. So um yeah, he's been he's been a national figure for a long time, but I think being on 60 Minutes is you know, he's got a couple of books, and but I think being on 60 Minutes is kind of the pinnacle for him. He actually got to talk about all the stuff that he's written about and preaches about on his podcast and stuff. So and he does long form podcasts, like two and a half hour podcasts.
SPEAKER_01:I mean, we could talk for two and a half hours. I don't know if anybody wants to listen to us.
SPEAKER_02:I'm not that interesting for two and a half hours.
SPEAKER_01:Your wife and my wife would not want to listen to us for two and a half hours. I can tell you that.
SPEAKER_02:Yeah, I don't think so.
SPEAKER_01:Um, but we are talking about tech to start uh the show, and he likes to wear the wearables, as we like to say. The Apple Watch, the Aura ring, the what it's the quite low current ring, and then this is the whoop uh whoop. There we go. All of these things over the last five years have kind of taken a hold. I mean, so and not only with with what you're wearing, but headphones and glasses and all to quote unquote make your health better. Yeah, make you more aware of your sleep habits, of your walking habits, closing the rings on your uh iPhone. That's a big deal. Serious. Um so let's talk about tech in general and why it's such a big deal, other than the money for companies to sell these products.
SPEAKER_02:Yeah, so I mean, I think there's been a health craze, and I can't remember, I looked up the data, but it's like billions and billions of dollars a year on on health. Um, you know, up until the 70s, really nobody even went to like the gym, right? Gyms didn't even really exist till the 1970s. So Alnold. Yeah. Yes, true. He started going to the gym. Yeah, that's right. Good looking guy. Yeah. Uh so no, so um, I mean, I think ever since then it's been building, and as technology has caught up with, you know, the the things that I'm wearing right now used to be big machines that you had to hook up to at a hospital to get the data. Um, and so as that's caught up, I think more and more people are are wanting to get the the information. So for me, the reason I wear so many, I've got three of them on right now. I think I've got a couple other things at home that I've used in the past. But so the reason for me that I wear so many is they all kind of do different things for me. And I like to compare the data too. I'm kind of a kind of a nerd that way. So like I want to see, you know, does my current ring match my whoop match my my um Apple Watch? So um I would say overall, I think the data I get from the whoop is probably the most impactful. Um it most accurate to or just most impactful? How do you how do you measure accuracy, right? I mean, I can only really measure precision, which is how close each of them are to each other. And it by that by that um measure, they're not none of them are that precise because they're pretty off from each other. I mean, I'm probably within 10% when you're talking about calorie burn between the Apple Watch and Whoop. Um I'll be honest, I haven't gotten into the current quite quite enough yet to give it a rating yet. Um the but so the reason I really like the whoop is because I never have to take it off. I can take a the battery that comes with it, you put the battery on as you're wearing it. So you never take it off. Um and it does most of its information off of um heart rate variation. So that's a whole big topic we could talk about. We probably do a whole podcast on heart rate variation, but um the higher your, and I'll probably explain this poorly, but the higher your heart rate variation when your heart rate is slower, the better. And the lower the heart rate variation when your heart rate is faster, the better. So you're supposed to have more heart rate variation at rest than you are when you're active. Gotcha.
SPEAKER_01:So we'll talk about VO2 Max because that's a big one, too. I've had, I mean, the Dr. Pieter Ortia mentions VO2 Max, and I've actually trained with VO2 Max when I was first training for marathons. I know it doesn't look like it right now, but back in the day it sucks. No, it does suck. I mean, you wear this monitor thing, and you're like this and the whole thing, and yeah, it it's a whole thing. Yeah. Um, but again, for those who train with VO2 Max, it works. Um but but there's also training that goes along with it because you can't just get to that. I mean, we're talking about zones, right? Yeah, zone two. You know, again, if you're if you're competing, let's say you're a marathon runner and you know, those world-class marathon runners, they can train and run in zone four for 26 miles. Oh, yeah, yeah, yeah.
SPEAKER_02:I can't do that.
SPEAKER_01:Their zone two is like my zone five. Yeah. Meaning they have to burn less energy to get to that speed or whatever it's called, right? I'm not explaining it correctly, but yeah, it's almost like the zone of your heart rate. And if you zone two is basically comfortable, right? Ish. Yeah, you're burning. You should be able to hold it for long periods of time. Yep. So why? And now I'm going down the rabbit hole, right? But like let's say you run a 10K, you're gonna be running in zone four and zone five for most of the time because it's only feel it bigger. You're gonna feel it. You're gonna feel burn, you're gonna feel lactic acid. Yeah, you can't keep that up for 26 miles. Nope. Nope. Zone two, why do we run our you know, marathons at a nine-minute pace instead of a seven-minute pace? Because in zone two, you could probably keep that for longer. Oh, yeah. Yeah, you don't feel like you're gonna die after 10 minutes. Right. But these athletes that are high class, why do they go to Colorado and train? Why do they train in high altitudes? Because they can get the most out of their VO2 max. Yep. So it's hey, if I'm at zone three, I can hold that for longer. If I'm at zone four, I can yeah, yeah. Zone five, I don't think anybody can along. But yeah. But but if you look at that, yeah, that's why these athletes are training at higher elevations to get the most of their VO2 max.
SPEAKER_02:There's also, so you actually it's basically um, it's basically legal doping. So you go to altitude, there's less oxygen, your body creates more red blood cells, more oxygen gets carried around your body. It's it's it's um legal cheating, basically. Um, it's funny. So I actually have a DEXA scan, resting metabolic rate, and uh VO2 max schedule for a week from Friday, the 14th. Do you really? Yeah, you should come, you should come film it. I'll do it. Yeah, that's awesome. Week from Friday, yeah. A DEXA scan is the bone density, right? Yeah, yeah. And it also tells you like fat percentage and stuff.
SPEAKER_01:So which we'll talk about with Dr. uh Atia because he believes in that DEXA scan kind of testing. He thinks you should do it once a year, I think is what he said. So I don't know. I mean, I literally before two years ago, I never even heard of the thing. But you know, in in terms of the wearables, do you find that it's more of a hindrance or it's more of a meaning I've got to charge these things, I've got to wear these things, I've got to remember these things. Because the old school boomer X here, we're not boomers. Not you in particular, but the old school person would say, I used to walk 10 miles in the snow back in my day. They would say, Listen, we did all this without this stuff.
SPEAKER_02:Right. But they also had active jobs, they weren't sitting behind a desk all day long. They also had a diet that wasn't poison. We've talked about this before. You know, our food is basically poison. So um, yeah, I think it's totally worth it. Um, I really like, like I said, I really like the whoop because all I have to do, I have batteries, I have several batteries all over the place. The batteries aren't expensive. I keep a battery charge, I click it on, I'm good. This lasts like two weeks without having to charge. I charge my watch every night. If if the whoop had a watch on it, I would probably switch completely from the Apple Watch to the Whoop and like it connected to the cell phone because it's it's more geared towards the metrics. Correct, yes, that's all it is, right? So it tells you sleep, it tells you stress that you had during the day, tells you calorie burn. Like I know the Apple Watch does that, but the the integration with the Whoop app is much better than the integration with the Apple. So Apple is more Yeah, it's it's like a It's more tech than substance, right? I mean, not in a bad way, but it's like that's what it's focusing on. It's not for somebody who's serious about it for sure. Um, but this doesn't have a watch. I need a watch, right? So this doesn't have a watch on it. So I need something that has a how do you feel about Garmin's? Uh I haven't used one in years, ever since I got an iPhone. I've had an Apple watch since I got an iPhone 2012 or whatever it was.
SPEAKER_01:Yeah, the Garmin's for me, um, you know, let's say iPhone in 2007, I had an iPhone. Um Garmin's for me, I used up until like 2014. Okay, yeah.
SPEAKER_02:Um they were really good with the GPS. They were you went out with a r for a run, they were, and you compared it to some because I used to wear like a polar all kinds of different stuff. The Garmin's were very, very accurate when it came to GPS, but that's all they've done. I mean, the Garmin did GPS for you know 20 years or whatever.
SPEAKER_01:I have to say that um the ring. Which one do you do? I have the aura ring. Not not on me right now. I have the current ring, which is from Cuelo. So do it. I'm assuming they do the same things, sleep, heart rate, yep, those type of things. Yeah. Um I I really like the idea of the ring. Yeah. Yeah. If it was able to track more of the athletic side of it, you know. I the Apple Watch to me is very we talked about this, but I think it's very inaccurate.
SPEAKER_02:Probably. And well, they actually say, so there's a lot of data on this, that anything on your wrist is inaccurate because of the way you move, right? Right. So they most most people, and Atia has one that he um I think it's called Morpheus, one that he kind of I don't think that he is supporting it necessarily, but he he says that's the one he uses for his clients. That's a chest strap. Your chest strap is going to be by far your most accurate. Well, for every time I do this, it's thinking I'm running, right? Or it's strap, man.
SPEAKER_01:I used to so bad. Yeah. It's really uncomfortable. You know, I mean, like I haven't worn one since those polars back in the day, but it is interesting to know where tech has come. It's come a long way. Oh, yeah. Um, I'm really interested. Do you have the new metas? The one where the screen's in there?
SPEAKER_02:No. You have so do you know this? You have to set up an appointment and go see them. It in the meta. Yeah, in a meta store somewhere. No, it's a meta store. Yeah, yeah. So I tried to set it up when I was in somewhere I was traveling. You have to go in and do a uh like a product demo, and then you have the option to buy them. But they have like limited amounts of demo, they're about 800 bucks, I think.
SPEAKER_01:Yeah, see, I I'm I'm really excited for them. Obviously, I wear glasses, and I have the the metas that are the picture. Yeah, the standard. But it's really interesting to see where they've come with these glasses. And I and I encourage people because he's been kind of one of my go-to YouTube people over the years. Um, Casey Neistat. I mean, he's known worldwide. Yeah. But the the latest video he did was the correlation between phones, smartphones, and smart glasses. Interesting. And they're going like this. Okay. So as the tech gets better in the glasses, you need this less.
SPEAKER_02:That's true. That's true. I mean, the watch did the same thing.
SPEAKER_01:In our lifetime, we thought the iPhone was a game changer, right? Like it was literally did everything.
SPEAKER_02:Yeah.
SPEAKER_01:What is the glasses? What are they not good?
SPEAKER_02:Google tried this. They remember the Google Glass with the Yep.
SPEAKER_01:Yep. But I think technology is good. Saturday Night Live episode. They're so bad too, right? I mean, like, it was bad. And it again, it didn't last long. And then Apple, let's say it's that's a failure. Yeah. Okay.
SPEAKER_02:Well, they they have the the big um it's the computer on the big glasses, right? But the the battery's too heavy and the glasses are too heavy.
SPEAKER_01:They're too bulky. Yeah. They need to get to a place where they're making but but how interesting that Meta is the one to take the torch and maybe run with the Meta's Google now, aren't they?
SPEAKER_02:Or was it Meta Meta? Meta's face Facebook. Facebook. I know. I thought they caught they uh got together with Google. On the glasses? Yeah.
SPEAKER_01:I don't I didn't know that. Maybe not. But maybe somebody can set the record straight in the comments. But uh the the impetus is okay, those glasses are gonna get to a point where you can do everything. Maybe in our lifetime, are these going to be useless? No. You don't think so? No. It's interesting to think about though, because again, the technology you're wearing on your wrist, right there on your left hand, yeah, that can do everything. Almost.
SPEAKER_02:But they also said the phone's gonna get rid of the computer. I still have a laptop. No, I'm not editing on my my glasses. That's what I'm saying. There are things you're going to do on your phone. But I don't edit on my phone either. Right, but there's a lot of things you do on your phone that you're at some point you're gonna try to do on your glasses and be like, yeah, it's just it's I can't I can't do it the way I need to do it on my glasses. I need my phone.
SPEAKER_01:I will I will say this. We are getting to a point in AI. Maybe in Chat GBT where voice commands could do everything you want it to do. I've got a great story about voice commands.
SPEAKER_02:Tell us. So not to not to push on boomers, but a boomer, a close family member. Uh, we were walking around Arizona. Okay. And um, he or she was trying to get directions and was asking Siri, and Siri kept messing up. Yeah, and finally he or she said, Siri, now you listen to me. And Siri said, Don't speak to me that way. Well, yeah, I mean, I I've cussed at Siri before. For sure. Siri doesn't like it. Siri does not like it. She will not, she will not take that. Um, yeah, so so I mean, I I think the tech is gonna improve with glasses for sure, but I still just like the phone didn't replace the laptop, the glasses aren't gonna replace the phone. There's still gonna be people carrying the phone around.
SPEAKER_01:But I feel like we're in this weird place now.
SPEAKER_02:Yeah.
SPEAKER_01:You know, like we discovered the internet, and then you know, we had Al Gore created the internet. It's too soon. You have to be up a certain age to remember that. Too soon. You know, like, and so we had the internet, big, huge discovery. We had a phone that did everything. Yep, big huge discovery. Now we're in this place where I feel like it's kind of the wild, wild west of technology. And you're you're almost at a place where what is next and what is going to not replace, but what is gonna be that all-encompassing thing that gets us there?
SPEAKER_02:My argument would be you're not gonna have one, right? They used to say, like, oh, the phone, you get rid of all your other devices if you have the phone. I mean, look at me. I got the I I got, you know, so everything just serves a purpose. Correct. It's the iPad. Right. Serves a purpose. It's like cutting the cord. Remember, they talked about cutting the cord for cable. Oh, it's gonna be so much better. You're gonna get Netflix and you're gonna do this and this, and you know, it's gonna be way less expensive. You know what happened? Everybody has everything now, and you're spending way more money, right? There was a thing that I saw that to get all the NFL games, yeah, you would have to spend like$2,800 in the during the season on all the different platforms to be able to watch every NFL game. So I I I don't think I don't think the glasses will get rid of the phone. I think it will help. Um, but so in terms of the wearables, so what do we what do we get to measure? We get to measure resting heart rate, heart rate variation, O2 saturation, VO2, there's even some VO2 max. I don't know how it's probably not very accurate, but VO2 max, um temperature, O2 saturation. So it has all kinds of measurements. And for me, the important part is the trend, less so than the actual number, right? Because I'll probably go in and do a VO2 max and it'll be totally different, you know, be 30% different than what I have from all these wearables. All I care about is that when I'm looking at the wearables, am I getting better or worse or staying the same? And how do certain things affect? Like if I have a cardio workout, how does that affect all of the the um different parameters versus if I have uh an anaerobic workout? If I eat something, like there's one the um you can put input in that you had alcohol, and that's one of the things, like even a single drink for me. I don't sleep well, and the next day my like readiness score is always lower, even just one drink of alcohol. So it's interesting to see.
SPEAKER_01:It is a full-time job. No, no, no. I mean I'm I'm being to do wearables? No, to I guess this is a good transition to Dr. Atia. Yeah. Because Dr. Atiya went on 60 minutes and basically outlined what his whole mission is, right? Yeah. It's lengt uh health span. Longevity in life via health span, right?
SPEAKER_02:Yeah. So just we gotta define that. So health health span in the way he defines it is living not only to older age, but living to older age, being able to do all the things that you need to do. And not falling off the cliff, right? Right. And so 75 is the cliff, right? Yeah. And you're going off the cliff at 75. But to do all your activities of daily living. So he doesn't expect you at 85 or 90 to be running a marathon, but you ought to be able to walk up the stairs. You ought to be able to carry your own groceries into the house, you ought to be able to not worry about falling down and breaking a hip, right? So his whole argument in the his probably most his his most popular book is Outlive, which is a great book. Um, his his whole premise is do things now in your 20s, 30s, 40s, even 50s to ensure that you are strong enough that when you do decompensate in your 80s and 90s, you only decompensate to the level of being able to do what you need to do, your standard walking up the stairs, mowing the lawn, escaping trash out.
SPEAKER_01:Velocity. There we go, is what he calls it. Yeah. Um, so this these are key themes. Let me just mention the key themes and we can just walk through them and talk about them. Yeah. So the number one theme that he was talking about was the marginal decade. So this is falling off the cliff at 75, and what you just described was was uh escape velocity. Yep. The number two theme was medicine versus traditional care, and what he's calling medicine Medicare, Medicare. I'm sorry.
SPEAKER_02:Is it say medicine? Medicine. Medicine, medicine, medicine 2.0, which is what we're currently in, which is disease treatment instead of prevention. He wants to get to medicine 3.0. This is all an outlive. Yeah. This is a gr an awesome book to listen to to read. I I've probably read it three or four times by this point. Um, but medicine 3.0 is truly preventative medicine, right? How do you how do you use, and this is one of the other points he makes, how do you use exercise? How do you use diet? How do you use disease? Right. Yeah, and then we'll get to that, but how do you use all these things to create an atmosphere in your body that that prevents disease and not not just doesn't prevent, not just you know, not getting obese and and you know, working out or whatever, but how do you use all these things together to create an atmosphere in your body that allows you to live and live well, well into your 80s and 90s?
SPEAKER_01:Ten hours a week is what he's proposing or what he does, right?
SPEAKER_02:Which is way above what USP STF, UF, USP STF, which is like the national organization that makes these recommendations.
SPEAKER_01:What what do you like as a physician, right? Like what is your kind of So you can over-exercise, but you can't over-move, is what I would say.
SPEAKER_02:So if you're out running, if you run a hundred miles a week or you're lifting weights for four hours a day, that's over-exercising. If you're not training for every anything.
SPEAKER_01:I mean, if you're long term, long term.
SPEAKER_02:Correct. Yeah. So so it what I would recommend to people is, you know, like he says, maybe an hour and a half, two hours a day if you can get it in, but movement all day long. Walking your dog. Walking, yeah, right. And even fun stuff like go run around the house with the kids or just go for a walk. Go after dinner, and that's a huge thing. I don't remember if it's Peter or T that talks about this or not, but um, they they did a big study that compared people who ate dinner and then whatever, watched TV and went to bed, or ate dinner, took a walk and then went to bed.
SPEAKER_01:These are also, and I want to mention, these are perfect scenarios not to take into uh consideration genetics. Right, right. Not to take into consideration, I mean, I feel like, and I'm not saying this from a personal perspective, but I feel like 40 is also like a ledge.
SPEAKER_02:It is. I think it's a ledge in terms of how you feel. I don't think a lot of people go off the ledge like, oh I I can't walk up a flight of stairs anymore. Right. I I understand that. Yeah, but I it's way you feel for sure. You turn 40, and what you used to be able to do and be like, yeah, I'm a little sore, but I'm great, you know, if it's like two, three days you're sore. Right. You know, so I think that's a cliff too. Um, you know, I I don't know, and that's partly genetics, but I think what his whole point is, is that you you want to hedge your bets, right? So if you've got, you know, terrible genetics, but you do all the things he says, you know, you might live to 75 and fall off the cliff. Whereas if you didn't do the things he says, you might live to 65, fall off the cliff, and then die three years later, or die five years later. So I mean, I think it's just it's getting your health the best you can get it for you.
SPEAKER_01:I think the biggest thing, and and this is you know, I I like to travel. I know you like to travel. You and the family like to travel. Yeah. You know, we we've seen it with people who go to Italy, go to Europe, and see how those Japan, yeah, see how those people live, and they're like, wow, why is the population so much healthier than the United States?
SPEAKER_02:So a lot of walking and then the food. The food is not processed the same way. We have so much poison in our food.
SPEAKER_01:People are for the most part become sedentary here in the United States. Yeah, you know, that that's the word you hear. Sedentary. I've literally never heard that terminology used in Europe ever in my life. Or Japan. Or Japan. Yeah, Japan for sure. I mean, like Asia in general, yeah. People are taking trains, they're walking, they're gardening, they're you know, I mean I mean, you name it. In in Europe, it is the diet. Now, you do have some overweight people in Europe. Sure, but essentially it's diet and movement. You know, people walk a lot of places.
SPEAKER_02:Even the carbohydrates are different. And I hear this, I I've never been to Europe or Japan, so I can't speak by experience, but what I hear they are different. Yeah. The carbs. You eat a piece of bread in the United States, you feel bloated, you feel, you know, just bleh. People say you eat bread and pasta in Italy or Europe, or you're like, you're fine. Rice in Japan, you don't you don't feel the same way.
SPEAKER_01:Because there there are no really, I mean, there are processed foods, but even the processed foods are processed differently, yeah.
SPEAKER_02:Are processed differently. Again, and he talks about it in his book. Food is food is either medicine or poison. That's the next point. But food, food as medicine, exercise as medicine, as a drug almost, as opposed to poison, right? So sedent being sedentary, that's poisoning yourself. Eating processed foods, especially in the United States, and even carbohydrates that aren't grown in a certain way, right? They spray folic acid all over our food supply. And a lot of people in the United States. Even a healthy soup food supply, though. Right. And a lot of people in the United States have the MT M T MTHFR gene uh mutation, which means that you don't process folic acid. You have to take a methylated folic acid. So what happens when you take that foled folic acid without it being methylated? You don't process it, you get bloated, you get weight gain, you get stomach pain, you get all this kind of stuff. So um that's that's a huge thing, too, that that really nobody wants to talk about. And I was hoping that our current HHF, HHS secretary would speak about it a little bit, but he hasn't done a whole lot of it yet.
SPEAKER_01:So the the fourth point, and and I want to get to this here, and I I did have a point here because uh what I do want to do is talk a little bit about diabetes. Yeah. And I'm not sure if Peter talked about that. He does, yeah. But the fourth, the so we have two left. The fourth uh thing, theme that he talks about is testing and metrics, uh, and that they matter. Yep. I know you're big on this. Uh there's a large part of our population, and I just admitted ten minutes ago I didn't really know what a DEXA scan was. Till five years ago. Yeah. I mean, what are those things? Yeah. And is there uh such a thing as too much testing?
SPEAKER_02:Probably. I mean, you there's probably overkill. Um, so DEXA scan is basically uh an x-ray that then evaluates the the machine, calculates out bone density and fat percentage. And not only fat percentage, but where on your body that fat is and whether it's um subcutaneous fat, which that's the fat like that you see when you have a belly or something like that, right? So subcutaneous fat, while not pretty, is is not really dangerous. That's not the fat that's gonna kill you. It's it's visceral fat that's gonna kill you. So that's the fat that's around your liver, around your heart, all that sort of stuff. Um so that's what your DEXA measures for the most part. Resting metabolic rate takes uh into account basically how much, how many calories your body burns. If I were to sit and not move for 24 hours, how many calories would my body burn? That gives you a good sense of sure, you know, if if that number is 2,500 and you eat 2,000 calories a day, you're gonna lose weight. If that number is 1,800 and you eat 4,000 calories a day, you can't move enough to fight all those extra calories. And then the VO2 max, which is probably what he says is the is the best measure. That's your overall fitness, that's how well your body utilizes oxygen and and takes that oxygen and does what it's supposed to do with it. So that's probably the best indicator of longevity.
SPEAKER_01:Number five is his personal story and motivation. And I think this is gonna hit home with a lot of people becoming a father, yeah, was big for him to realize this. And then baby weight. We all gain a little baby weight. I'm not sure what you're talking about. Um, and then it it was also the and and I want if you could talk a little bit about this. The medical training and being around a hospital, oh yeah, he says is not conducive to living a healthy lifestyle. Explain that a little bit. Yeah. So I mean because you're around sick people a lot, right?
SPEAKER_02:I mean go ahead and I'll kind of explain the story after. So the hospital is not conducive to health. Um, so you there's a lot of demand, so it's high stress. There's a lot of sitting, charting, doing a lot of things, not active. The food in hospitals is terrible. Um, I still remember like you would when at Riley Hospital, when I was in training, you would walk. Walk into that hospital and there's a McDonald's that is just packed, and just everyone's the evening McDonald's in the middle of yeah. And I get Ronald McDonald did a really nice job with the Ronald McDonald house and lots of donations and blah blah blah. But you got this gigantic McDonald's, you walk in, that's all you smell is McDonald's in the hospital. Um so the food is not good for you. Um, and then uh the hours, right? So lack of sleep. Like almost all clinicians, particularly physicians, are are sleep deprived, don't sleep enough, right? So I mean, I you know, probably on average four to five hours a night is what a physician would would sleep. And then they're working 60, 70, 80 hours a week. So I mean, sleep is huge, right? Lack of sleep drives cortisol up, cortisol makes you retain weight, makes you have heart attacks. There's a whole lot of things that cortisol does, you know, being stressed, which is what most yeah, which which is what most clinicians are, right? Live chronically stressed. I know stress. Yeah, they know.
SPEAKER_01:I mean, stress stress is it's it's a silent killer, yeah. I would say and it's ubiquitous too. So you I mean, I I could say like, oh, I'm I'm okay. Yeah. But like beneath it all, it's like, why am I gaining weight? Yeah. Why is my hair turning gray? Why, you know, all these things of like, man, I'm stressed. Yeah. Oh, yeah. But it's not really fully understanding because some of us, some people live on this line of wow, it's the stress factor. It's the, you know, you're always kind of living on the edge of your seat.
SPEAKER_02:Well, and and what he talks about is acute stress is actually good, right? So if you have an acute, stressful situation, you know, a lion, and even historically, a lion jumps out in front of you, you have to run, big cortisol, you know, um, uh norepinephrine, you know, adrenaline release, and then it goes away. The problem is this low-level or even mid-level chronic stress. Your body is not designed to have those hormones circulating around all the time. So, yeah, you've got to figure out a way. And I think he talks about this too. So meditation, um, you know, taking time off. Um, something that I've been doing lately is taking a Sabbath, right? So where I don't, I don't really answer my phone or deal with any work stuff from Friday night until Sunday morning. Um, and so I mean, some of that is, you know, that it takes a few weeks to get over the stress of what am I not doing that I should be doing. Uh, but once you get over that, it's actually it's actually been pretty good. Happy to take a Sabbath starting December 2nd. Oh, yeah. After the football season. Yep. Yeah. Yeah. That would be great. Until January 2nd or 3rd when we start the playoffs.
SPEAKER_01:Uh December 20th. Oh, 19th and 20th. Three weeks, two and a half weeks. Three and a half, two and a half weeks without stress. Uh, so the key takeaways here are focus on fitness metrics, which we talked about. Um train like you're preparing for your later decades. Yep.
SPEAKER_02:Yeah. And I love that. So he has this whole I wish I remember they were, but he has this whole thing like farmers carry, dead hang. Like there's five or six things that he says, train to get to whatever those numbers are. I think it's like two minutes on the dead hang for men. It's um your body weight spread across two dumbbells for the farmers carry. Uh, I can't remember what all five of them. It's five or six things. I have to go back and reread the book again, but there's five or six things that he's like, train to do these. If you can do these in your 40s and 50s, you'll be fine in your 70s, 80s, and 90s.
SPEAKER_01:Um he's talking a lot about too. One of one of the things you can do is life is not a magic pill, it's a combination of a lot of things working together. Interestingly enough, you and I have been to a uh surgeon conference. Yes, yeah, the ASMPS, yeah. Where they're talking a lot about metabolic surgery. And one of the questions you asked when you were going around was the pillp one, yeah, or surgery. Yeah. And a lot of the surgeons are like, well, you got to do both. Right. Because it's a lifestyle. It's a lifestyle change, correct, yeah. And having been somebody who has dedicated their mainly their later twenties and early thirties for the better part of a decade into triathlons and marathons and training people, it is very hard, and I will say this it's very hard to turn something like that into a lifestyle.
SPEAKER_02:Yeah.
SPEAKER_01:It's too much. It's too much, right? Like you can't train all year long for a marathon. You can't train all year long for an item.
SPEAKER_02:And that's probably overtraining. It is. You know, and it burns you out. You could probably do it for five years or even 10 years, like you did, but you can't do that for a lifetime. So, what I like about what Peter Atia says is these are the general things that you can do. And I I don't think 10 hours a week of exercise is overkill. I I mean, it's more than is recommended, but 10 hours. What five, five days, 30 minutes? 30 minutes, five days, yeah. So it's yeah, 150 minutes versus 10 hours would be what 600 minutes, right? So it's four times as much. I still don't think that's overtraining. If you look at the studies that came out, you can you can overtrain, but the overtraining is either super high intensity aerobic or super high intensity intensity anaerobic, and it's at the like 15 or 20 hour a week mark. It's these guys who, you know, sit in the gym for four or five hours a day, six days a week, or you know, run, like I said, 100 miles or 150 miles a week.
SPEAKER_01:So but it is, and this is what I was getting at in the beginning. Yeah, it tends to be a full-time job to look after your health. Uh-huh.
SPEAKER_02:Yeah.
SPEAKER_01:It is. I mean, like, you know, look how much effort you put in. Yep. And I'm not saying it's a bad thing. I'm just saying if others are looking in and saying, wow, like, you know, look how much how much more it is to eat healthy. Oh, yeah. Cost-wise.
SPEAKER_02:Cost wise. Look how much it is to meal prep. You're talking about time there, right? If you if you work out 10 hours a week, you meal prep five hours a week, you meditate. That's a part-time job. Right. You meditate, you meditate an hour a day, so seven hours a week. I mean, you add all that up, you're probably at 25 or 30 hours a week that you're doing health.
SPEAKER_01:But and then the other 15 hours you're thinking about, right? You're thinking about how to meal prep and do all those things. Yeah. Um, so it is it is a full-time job, but there is something to be said for how do I take that, how do I prep for that and make it into a realistic thing. Because I think far too many times, and me included, you say, okay, like I need to get to this weight, fine, but how do I sustain that over a long period of time? It's like when you do a carb diet and you take away carbs, guess what? At some point, you're going to add carbs again. You have to, yeah. You can't live your whole life without it. So, how is it a long-term? And I think that's what Dr. Peter T is getting at here is these are all measures for long-term success and not just a short-term fix. Yep. Uh, and the last thing he talks about uh really is health care. Yep. And how are we taking care of our health? What are we doing to take care of our health? Not well. Yeah.
SPEAKER_02:We're we're treating disease instead of creating health. You know, like he said, medicine 2.0 versus medicine 3.0.
SPEAKER_01:Incredible. Yeah. Well, man, we we you know, we could go for another 30 minutes on this topic.
SPEAKER_02:Yeah, I could go for a long time on this topic. I the other thing I will say, yeah. Um, in general, if you read the data, fat does not make you fat. Carbs make you fat. Correct. Right. So if you look at why do people lose weight on the keto diet, part of it is you're you're calorie restricted, but part of it also is that your body doesn't hold on to water or um it doesn't hold on to water the same way and doesn't hold on to fat the way it holds on to carbohydrates. Carbohydrates get turned into triglycerides. Triglycerides are what are what often are the cause of cardiac disease.
SPEAKER_01:I'm gonna give a shout out to Rodney. Okay.
SPEAKER_02:Yeah, yeah, yeah.
SPEAKER_01:Because Rodney said a while ago, he said, because I was watching my metrics, you know, like what I'm eating and my um, you know, fat versus protein versus carbs. And he said, if you're eating carbs, fine. If you're eating protein, fine. If you're eating fat, fine. But if you're eating fat and carbs, yeah, that's the problem. Yeah, it's a big problem.
SPEAKER_02:That's yeah, that's a problem. Well, and and you know, I don't I don't really buy into the glycemic index thing, but I definitely do buy into the processed, right? So eating something that is just pure sugar is different than eating an apple or eating a sweet potato or something like that, or or even you know, non-processed rice, you know.
SPEAKER_01:I I don't want to see what Peter Tia has to say between the hours of three and five o'clock PM when I'm hanging on for dear life. Exactly. Yeah, and that's how I can tell. Like it's the sugar is a drug because every day it'll like kick in. Oh, yeah. Ooh. Craving. Yeah. You need sugar. You know? Yeah. And it's always in the form of an airhead or a starburst or a skittle.
SPEAKER_02:You know, it's never like you're not grabbing a sweet potato. Exactly. Apple, though, apples are actually pretty good. Apples are good. And they're sweet. Yep. And they're there's a lot of fiber in there, so that helps you to like slowly digest and stuff. I mean, you can it just takes a lot of effort. Yep, it takes effort to figure it out. It's all right. Well, we'll we'll link his uh book. Yeah, I would link out live his book and then link the 60 minutes interview if we can link that somehow. Absolutely. So yeah.
SPEAKER_01:All right, we'll uh link it on YouTube and uh of course we'll link it in the um show wherever you get your podcast. Yeah. Uh this was a good one.
SPEAKER_02:Yeah, I love it. I love it. I uh Peter Ati is great, so I would love to. I mean, if you're listening, which I'm sure you're not, he may be. And you would like if you'd like to come on and talk on the show, we would love to have you.
SPEAKER_01:Yeah. You guys can work out 10 hours uh a week and I'll take video.
SPEAKER_02:Yeah.
SPEAKER_01:I will not be he's in way better shape than I am, so that's for sure. Well, thanks for listening. This has been going under anesthesia answered with Dr. Brian Schmutzler, brought to you by the Butterfly Network. The Butterfly Network. We'll see you next time. See you in the next one. You beat me to it. I know.
