Why You’re Still Tired — And How to Fix It (with Dr. Andy Galpin)

Mark Hyman, MD

Full Transcript

Automatically generated. Please forgive any typos or errors in the following transcript. It was generated by a third party and has not been subsequently reviewed by our team.

Dr. Mark Hyman
People who are doing it right, like why am I so tired? Like I try to sleep well, I exercise, I eat good, like they're still feeling exhausted.

Dr. Andy Galpin
You should feel a little bit tired in the afternoon. You should feel pretty tired at night. These are normal things. This is not dysfunction. Doctor Andy Galpin Who has helped elite athletes to peak performance from the Olympics to pro sports to the military Breaks down how to decode fatigue.

Sleep and energy using science, not guesswork. If you have high quality muscle, it's really hard to have metabolic problems.

Dr. Mark Hyman
Sleep regularity is more important than people think, meaning going to bed and waking up at the same time every day.

Dr. Andy Galpin
When it comes to perceived feeling, your energy levels, that regularity will play a bigger impact than the total hours.

Dr. Mark Hyman
Before we jump into today's episode, I wanna share a few ways you can go deeper on your health journey. While I wish I could work with everyone one on one, there just isn't enough time in the day. So I built several tools to help you take control of your health. If you're looking for guidance, education, and community, check out my private membership, the HymanHive, for live q and a's exclusive content and direct connection. For real time lab testing and personalized insights into your biology, visit Function Health.

You can also explore my curated doctor trusted supplements and health products at doctorhyman.com. And if you prefer to listen without any breaks, don't forget you can enjoy every episode of this podcast ad free with Hyman Plus. Just open Apple Podcasts and tap try free to start your seven day free trial. Well, Andy, so good to have you on the doctor Hyman Show. It's been a long time coming.

I followed your work for a long time, and I also think you're doing stuff which is really great, which is taking what you learned from elite athletes and extreme performance needs to the everyday person who's struggling with just how do I feel better and do better and function better. Right?

Dr. Andy Galpin
Yeah.

Dr. Mark Hyman
So I think I think there's a lot of insights that you've learned. I wanna unpack those today and get into it. I wanna start with something that is really a big issue in America, which is energy. Or should I say the lack of energy and this issue of fatigue and everybody struggles, you know. I'm just wondering from your perspective in in terms of the work you see, what's the most common cause of the fatigue that's out there, this sort of endemic fatigue in America?

Dr. Andy Galpin
Yeah. I'm glad you started this because you're right. I'd say of all the people that we've worked with or coached or seen, this is probably the number one thing, most common thing that comes up. I think the best place to start is realizing number one, fatigue itself is not pathology. It is normal to be tired.

This is actually a good thing because we're now getting signals from the body on on some sense. Right? We don't want the, I'm exhausted all day. I can't function without six hundred milligrams of caffeine. Right?

So there's limits here, of course. But I'm saying that because we have actually dealt with a lot of people who are struggling with this concept. The first sign of fatigue they get, they then pathologize it. They think that there's a disorder or they have a deficiency, and then they run down the spectrum of problems. Right?

So we don't wanna cause problems and overanalyze when they don't really exist. You should feel a little bit tired in the afternoon. You should feel pretty tired at night. Like these these are normal things. This is not dysfunction.

So fatigue is not automatically dysfunction. If it is the point where it's disrupting your life, we're having a second conversation. And we'll spend most of our time there.

Dr. Mark Hyman
Yeah.

Dr. Andy Galpin
But it was important for me to point that first part out

Dr. Mark Hyman
because I don't know, Andy. I I I used to have lots of energy when I was younger and and it changed over time. I remember when I started medical school, I used to have even energy all day. And then somehow, I thought that I was supposed to drink coffee in medical school. Yeah.

And I never drank coffee before medical school. And then I would like have this crash in the afternoon. What what is going on, you know, with that? I mean, I think I think it's not normal really to feel sluggish in the afternoon. Is it?

Dr. Andy Galpin
Well, some some amount of let's define, again, sluggish versus I feel a little bit more tired. I'm not feeling at 10 out of 10 energy and focus and concentration. If it is, I can't move. I can't get throughout the day. Now and we wanna make a change with that.

Now now we have a conversation. Right? So number one, you may not have to overthink this. Simple things like maybe ten minutes of backing off is enough. You'll you'll be stunned.

You again, you might not have the these pathologies other than going on. It could be the fact that you have podcasts coming in all day. You have nonstop stimuli coming in. You have everything firing at you at all cylinders, and that didn't happen when you're 20. You weren't on your phone all day when you were 20.

Dr. Mark Hyman
It wasn't a phone. There wasn't a phone. Landlines when I was 20. Right.

Dr. Andy Galpin
But there wasn't the internet. There wasn't these things. So when we hear these stories a lot of times I'm thinking, know but the world you live in now is not the world you lived in twenty years ago.

Dr. Mark Hyman
Definitely not. No.

Dr. Andy Galpin
And so now you might not you might need strategies now that you didn't have to have in that time, which could be as simple as for you, you might get super restored by just literally setting a timer for twelve minutes and going and standing out in the sun. Someone else that might do not do anything at all. They might need to close their eyes and lay down. Fall asleep, don't fall asleep. I don't really care.

It might be physical activity. There's lots of different things that give people energy back, and it can be as short as this eight to twelve minute window. So my first stopping place in this journey is to say, like, okay, what what do we really mean by fatigue? Is are you noticing it happening on days when you're writing, Or are you noticing it happening on days when you trained really hard in the morning? Like what is the thing that's kicking so there may be something there that is going, hey, you had your hardest training session this week.

Let's not be surprised when you're little bit tired this afternoon. That's not a dysfunction. Right? I could go on and on examples, but this this first landing stop is again making sure that we're really understanding

Dr. Mark Hyman
There's normal variations in our Normal variations. That's what I'm talking about people who just feel Okay.

Dr. Andy Galpin
Exhausted all day. Yeah. We don't have to overthink this one either. The first place we're gonna look now is sleep. Yeah.

Somewhere, depending on the data source you look at, seventy to eighty percent of sleep disorders will go undiagnosed. I can't tell you how many how many people we've had come through, I sleep fine. I sleep great. I sleep pretty good. And then we actually run proper analyses on them, and they have anywhere between moderate to severe sleep disorders.

We actually had one guy, very interesting, in Colorado. He lived, in multiple houses. So he lived at sea level normally. Older guy, drank a lot, didn't take care of his health, but he was fine. A little bit of snoring, energy was pretty much okay.

And then when he went to his house in Vail, he went from moderate to extreme sleep apnea. He had no idea. He was just giving this energy things, I don't understand. Well, house was at like 9,500 feet.

Dr. Mark Hyman
Mhmm.

Dr. Andy Galpin
Right? Pretty high, yeah. That will exacerbate sleep disorders massively. So his tiny sleep disorder here became hugely problematic there. And it was so bad, we had to basically intervene and say like, you have a strong risk of a real cardiovascular event happening here at elevation.

Because his snoring, his everything like went off the charts. So things like that can happen where again, he didn't have a a traditional if you went to a sleep hospital, you'd be diagnosed with a sleep disorder, but that didn't mean he had great sleep. He just didn't recognize it. And we've seen things like this happen a number of times. That's a pretty, like, esoteric example I gave you, like a really deep one.

But we see this stuff happen often. My energy's super, super low. Like the common one is I think I need testosterone. Okay, fine. That's between you and your doctor, up to you.

But have you actually diagnosed your sleep? Have you done anything there? Well, no, I sleep fine. Or I use a consumer wearable. Okay, great.

These are awesome for many things, but you've now spent all this money on a high level dietitian. You spent all this money on a trainer and then you've done nothing for your sleep. You haven't really analyzed it at the highest level possible. Just because you don't have a clinical disorder doesn't mean you don't have something there that is causing a ton of fatigue.

Dr. Mark Hyman
As I remember when a patient had they said, doctor, I don't know why. I'm just tired all the time. I said, how many hours a night do you sleep? It's like five hours. I'm like, I think you need to sleep eight.

That'll be $500, please. Yeah. Exactly. You know?

Dr. Andy Galpin
Yeah. Get more sleep.

Dr. Mark Hyman
Right.

Dr. Andy Galpin
I tend to skip past that one actually because so many people just like, I already sleep seven and a half or whatever. But you're right, many people don't even get close to the number. But once you've had that number, if you're the person who says like, I do sleep my seven, or we'll get this one a lot. Man, even if I sleep eight and a half or nine hours, I still feel tired. Yeah.

Okay. Sure. But if you slept for five hours for the two weeks before, that one night is not gonna fully restore you. No. This will take plenty of time.

And high quality effective sleep looks different for different people. And so precision is available there. We can start to figure out what is ideal recovery for you, what actually solves that problem or what doesn't. So there's just a lot more granularity we can get with sleep, but that is always the first place we're gonna look.

Dr. Mark Hyman
What are the problems that most people have with sleep? What's causing them?

Dr. Andy Galpin
The biggest one that people don't pay attention to outside of total sleep is sleep regularity. So they'll say, hey. I got my eight and a half hours or seven and half or whatever it is, but we had social jet lag. Social jet lag is this idea of you basically give yourself jet lag on the weekends, not because you sleep less, but because you sleep in a two or three hour different time domain.

Dr. Mark Hyman
Yeah.

Dr. Andy Galpin
So let's say you go to bed at ten on the weekdays, wake up at six. There's your eight hours. But then the weekend, you stay up till 2AM. Yeah. And sleep till ten.

Dr. Mark Hyman
Yeah.

Dr. Andy Galpin
You still got your eight, but you've given yourself jet lag because you're now four hours off. For 20 year olds, you can get away with that. Yeah. For early 30 year olds, you can get away with that. But past that, it becomes really debilitating.

This is a really common, I sleep eight hours, I use my tracker, it says I'm at eight and a half, but I'm exhausted all the time.

Dr. Mark Hyman
Sleep regularity is more important than people think. Meaning going to bed and waking up at the same time every day.

Dr. Andy Galpin
When it comes to perceived feeling

Dr. Mark Hyman
Yeah.

Dr. Andy Galpin
Your energy levels, that regularity will play a bigger impact than the total hours will. That that is the thing that's gonna make you feel awful. You can survive on seven, six and a half, like if you have to, if it's really consistent. Very hard for people to survive on inconsistent sleep schedules. By survive, I mean feeling good.

Feeling great, right, not death. That's a sort of separate issue.

Dr. Mark Hyman
But there's No partying anymore. That's it.

Dr. Andy Galpin
Yeah. Of course, you wanna live your life, right, and be resilient. But you also wanna be reasonably consistent, right? Now somebody like a lot of the clients we work with and I'm you're the same way I'm sure I am. Actually do physically travel a lot.

Dr. Mark Hyman
Yeah.

Dr. Andy Galpin
So we have to manage this inconsistent schedules that are outside of our routine. So if you're in a situation, let's say you're also a shift worker or somebody that has inconsistent work schedules and you don't have the ability to control and go to bed at the same time, other options you can have is trying to become more resilient to sleep changes. And that's something that few people really talk about. When we when we have conversations like this, a lot of people will hear things like, well, that's great. I love to go to bed at 09:00 every day and sleep till, you know, 7AM or whatever the case, but not possible with my schedule.

Okay. I get it. That's most of the world, actually. Right? Everyone we work with, all of our athletes, all of our military, all of our government leaders, they're all on wild schedules.

They don't have they're not at home every day. Understand. What can you do? Become hyper resilient to change. So there's this whole facet within sleep where we can optimize resilience.

And resilience is actually one of our biggest keys. What we focus on at Absolute Rest is not optimizing sleep in terms of sleeping ten hours a night. Right? This whole idea of sleep optimization is actually takes a lot of people in the bad direction. You don't necessarily wanna be an optimal sleeper.

You wanna be a resilient sleeper, which means you can still sleep for six hours and show up the next day dialed in performing and executing. You can have an inconsistent schedule and we can still be great. That is where I think most people will get more bang for their buck is focusing in on that sleep resiliency.

Dr. Mark Hyman
That's such an important concept, Andy, because whether it's your blood sugar or your metabolism or your brain health, the goal here is how do we build more physiological resilience, more ability to have elasticity in our activities, behaviors so that we're not, like, stuck in a rigid physiological pattern. And disease really is less and less and less resilience. When you look at what disease is, it's the the loss of physiological resilience and metabolic and physiologic flexibility. And so what you're talking about is how do we build more flexibility? So can you unpack how do we do that?

It sounds good, but, like, I'm very curious.

Dr. Andy Galpin
Yeah. So your brain will do a lot of that for you if you get out of its way, specifically for sleep. Here's what I mean. If you're looking at a a wearable and you're getting hyper focused on the amount of minutes you spend in deep sleep, we're probably already in the wrong conversation.

Dr. Mark Hyman
Yeah. I do that. Right. I'm like, shoot. I only got thirty minutes.

I'm like, oh, I got an hour. Oh, I got know, like

Dr. Andy Galpin
Not good. For a bunch of reasons. Number one, accuracy is an issue. But even the the concern. Deep the idea of deep sleep is not a manufactured term, but it actually changes what categorizes, what counts as deep sleep.

But there's a whole litany of problems.

Dr. Mark Hyman
And different trackers will tell you different amounts.

Dr. Andy Galpin
Different amounts, right? So out the gates, you should know that, again, we're dealing with problematic data.

Dr. Mark Hyman
Yeah.

Dr. Andy Galpin
And now you're making real life decisions, changing therapies and drugs and supplements and lifestyle routines based on

Dr. Mark Hyman
Problematic data.

Dr. Andy Galpin
This is not a good strategy. Right? We wanna be concerned with things like, alright. If you had a day where you sat here and you did five hours of podcasting, you had five different guests in that came in for an hour, you did five podcasts, and you had four meetings, I would expect a different sleep architecture tonight than if you had a day off today and you went and played in the lake

Dr. Mark Hyman
for two hours. Which I did yesterday.

Dr. Andy Galpin
Okay. Right?

Dr. Mark Hyman
Yeah.

Dr. Andy Galpin
You should not have the same amount of deeper n three or slow wave and REM as you had the night before because there's a different cognitive load. There's a different physical load. So what we wanna do, in fact, if we made this word mark and I said, hey, we're gonna put you through sleep restriction training. So we used to call it like back in the day. And we're gonna load you down to five hours of sleep per night.

And then we're gonna stay at five hours of sleep no matter what. You're gonna go to bed at midnight, wake up at five every single day.

Dr. Mark Hyman
That's like a nightmare.

Dr. Andy Galpin
You know what would happen to your deep sleep? It would rock it up. Why? Because your body would learn pattern recognition really quickly. I don't have eight hours to mess around.

I will get into deep, I will get into REM, I will get into these cycles hyper fast because there's no wiggle room there. Yeah. If I do the opposite and I let you have a you lay in bed for two hours and you sleep for nine, then we would see the exact opposite effect here, right?

Dr. Mark Hyman
So you get less deep sleep?

Dr. Andy Galpin
You wouldn't get less per se, but your body wouldn't have as much rush to get into it, to stay into it. The rhythms would be the architecture would be different is the most accurate way I can say. The pattern would look different, right? So now when you're comparing your data and you're not paying attention to the fact that what happened to your sleep last couple of nights and all of a sudden, oh my god. Last night, I got this I got my ninety minutes deep sleep.

Well, are you coming off a sleep restriction? Did you sleep for you know, were you traveling? How well, yeah. Of course it is. It wasn't the supplement you did.

It wasn't the meditation or thing. It's the fact that you were sleep deprived. Or the opposite. Oh my gosh, my deep sleep went down. Okay.

By a few minutes, don't care. Maybe you're fine. Maybe you're actually now sort of restoring back to baseline and getting into a gray spot. So you can develop more resiliency by understanding what's happening in these scenarios and doing different strategies that help you. We use something at absolute rest called the wind down index.

And so this is not only

Dr. Mark Hyman
sleep So you mentioned absolute rest a couple of times. Can you just share with us what that is?

Dr. Andy Galpin
Yeah. That's our that's our sleep company. So this is this was born out of many years ago, I was at one of these like behind closed doors human performance meetings where people are trying to unpack how do we get people on Mars, and how do we get high performers and athletes. And sleep came up, and we pretty quickly realized that even the high most high profile athletes, the richest government leaders and executives, the only thing we have for sleep is a sleep hospital or a consumer grade wearable. And everyone like looked at me, they're like, surely these million dollar or billion dollar athletes have I'm like, we got nothing else here.

And so we actually came together like on the spot and created this company, Absolute Rounds, where we said if you had to maximize sleep performance and not sleep duration, sleep resilience, what would it look like? Well, I would wanna know exactly how somebody's sleeping. And again, nothing about against consumer wearables. They're awesome. We use them at absolute rest.

But we wanna know exactly the highest precision gold standard. I want the same exact technology in a sleep lab in your house. We created that. We have full FDA approval. We can run full medical grade clinical sleep studies on people in their house.

And not only do we not only look at things like their sleep staging, you know, REM and things like that, but we look at fragmentation and stability within that. We can look at when you're on your right side versus your left side or your back, and we can start to see exactly how you're sleeping. And that's critical because below that, we now can then figure out why. So maybe you're having these mild apneas that wouldn't qualify again as this medical disorder, but they're only happening on your right shoulder. This is actually something that's happened many times.

And now you get somebody off the right shoulder and their sleep apnea goes down by ninety percent on day one and never comes back. It's a slight pillow change. We've had one recently where actually somebody was having a little bit of blocking of their nose at night, couldn't breathe through their nose, didn't realize it, went to mouth breathing. Happening because there was a little bit of dander stuff happening in his sheets. So all we had him do is start washing his sheets once a week instead of like once every couple of months like most men do.

Dr. Mark Hyman
Right? Woah. He's a housekeeper. Boom.

Dr. Andy Galpin
Problems are gone now. Right? So there's sometimes really easy solutions, but we got those because we understood how he was sleeping at a gold standard level, and then we understood why. And so we look at blood markers, we look at genetic markers, we look at behaviors.

Dr. Mark Hyman
Are there blood biomarkers for

Dr. Andy Galpin
sleep? Totally.

Dr. Mark Hyman
Like what?

Dr. Andy Galpin
Absolutely. Well, you you would start with basic stuff you would think of. Hematocrit, hemoglobin, ferritin, iron levels. Really good example. If you see somebody who doesn't exercise, they're unfit, but you see hematocrit and hemoglobin are really high, really good chance you've got some sort of apnea.

Spleen will get go nuts. Right? If you're choking at night, your spleen will start kicking out red blood cells. You'll start to see hematocrits 51, 50 twos. Mhmm.

Right? You start seeing hemoglobin sixteens for men, a little bit lower. Women, you might see like 48 hematocrit. You start seeing hemoglobin's thirteens, fourteens.

Dr. Mark Hyman
Yeah.

Dr. Andy Galpin
Now I looked at one of my athletes and I'm like, great, we're fit. But you go, oh, you don't exercise at all. Great. Now you might just genetically have good markers there, but probably not. And then you start looking at things like MCV and other markers, and you just got on this whole line and you get into ferritin, like all these other markers, twenty, thirty markers you can look at.

You start to realize all these are high in the presence, and now you start looking at inflammatory markers, starting to get up there high. And you start to build this story. It's not one marker that you could just look at. It's this combination of things that you have to cross out for false positives, false negatives, and you start to see. But that first one, really high.

And we know that's the case. There's a lot of data on this. If you have take somebody that has apnea and put them on CPAP, hematocrit and hemoglobin will come down. You're like, oh, that's if they're elevated, right?

Dr. Mark Hyman
They're starting from oxygen, they make more red blood cells.

Dr. Andy Galpin
Yeah, right. And you start to look at like like ninety day distributions of red blood cell size and you're trying to see, oh, they're coming down. Why? Because those red blood cells don't have to hang on for a hundred and fifty days anymore because they know they're out of limitation. So I know that was like a little bit technical,

Dr. Mark Hyman
but Yeah, that's interesting.

Dr. Andy Galpin
It's things like that where you can start to paint a picture and say, hey, now we're guiding towards different therapies. We don't need you to go on iron. Or we want whatever like you get false sense

Dr. Mark Hyman
And low iron does lead to sleep disruption.

Dr. Andy Galpin
Totally, right?

Dr. Mark Hyman
Even if even if your blood count's normal, you have low ferritin.

Dr. Andy Galpin
Of course, right? And that's gonna happen in over probably thirty percent of physical active people.

Dr. Mark Hyman
Super don't realize and the doctors usually don't check.

Dr. Andy Galpin
No, not at all, right? So you wanna look at a bunch of markers there.

Dr. Mark Hyman
As part of function health, do all that, which is really pretty amazing. We've seen, you know, a lot of people deficient.

Dr. Andy Galpin
Yeah. You can actually start to see indications of those from the blood first. So you start to see those things pop up. Your algorithms that function are probably gonna flag and say, hey, how's your energy? Oh, subject to questionnaire is low.

Interesting. Here, you should go get a sleep study done. Like, don't get it in a hospital. Get it done at home so we can do three or four or five nights, not like one weird night at a sleep hospital

Dr. Mark Hyman
where You're all wired up and it's strange.

Dr. Andy Galpin
All those wires are you don't need them anymore. Like the technology can be done all wirelessly.

Dr. Mark Hyman
Yeah.

Dr. Andy Galpin
Right? So this can be done and then have that analyzed and looked at and say, okay, great. Actually, we don't need medication yet. We need actually to improve sleep and then get out of the way. Yeah.

The body will actually recover back how it wants to, and we don't have to over medicate, over supplement.

Dr. Mark Hyman
So what are the most common things you're seeing with sleep and the lack of sleep resilience, and how do you get people towards a better sleep resilience?

Dr. Andy Galpin
Yep. So the step number one we already covered, more consistent. Consistent is always our starting place, as close as we can within that. Past that, we I started talking about the wind down index. Why I brought that up?

If you look at something like sleep onset latency, how long it takes you to fall asleep at night, right, the general numbers there are gonna be five to twenty minutes. Right? So if you're falling asleep within, like, two minutes, that's probably a good sign that you're sleep deprived. Takes you twenty, twenty five when you're gonna have other issues falling asleep. Especially thirty plus minutes to fall asleep on average per night.

Alright. We don't have a good fall asleep strategy. Here's why this stuff matters. If you are exhausted, you might fall asleep really really quickly. But if you're not physiologically wound down, you'll oftentimes wake up at two in the morning, three in the morning.

Dr. Mark Hyman
Boom. Kinda tired but wired. Yeah.

Dr. Andy Galpin
Tired and wired. Right? You'll fall asleep from exhaustion, but you'll only get those three or four hours, can't go back to sleep. Then you'll look at blood glucose, and you know that's gonna be that's gonna be a problem. Right?

And so it's not necessarily a carbohydrate issue in this particular case. It's the fact that you're, look at your resting heart rate. Look at your pulse wave. Look at, sort of these cardiopulmonary measures, and you'll start to see other signs that corroborate. You're asleep, but you're not downregulated.

You're really pretty wired. So the common person of a lot of people wake up at the middle of the night at some point, but the it happens all the time. I may be sweaty. I may be out of breath. I can't get back to sleep.

That's gonna tell us, okay. We're not winding down. So in that particular case, you build resiliency by saying, I know I'm gonna have a limited window today, or I'm off schedule, fine. I can get better at that by having a consistent wind down routine. Because that will actually down regulate me and give me more quality sleep in those same hours.

Because I'm not spending the first forty minutes actually trying to just bring my heart rate down or

Dr. Mark Hyman
So wind down and get like hot bath, meditation.

Dr. Andy Galpin
It's incredibly individual. Rest work, yoga. Some of them are great. What's really key to wind down routines, it is not the act, it's the pattern. The number one key to wind down routine is to have some consistent thing you're doing.

Whether that consistent thing is even whatever, right? It can be journaling.

Dr. Mark Hyman
Mhmm.

Dr. Andy Galpin
It can be write down the things you have to do tomorrow. Fine. Those things might not work for you. Mhmm. What you want is the 60 to 90 minutes prior to sleep to be doing the same ish things that you do.

If that is all those things you mentioned, fine. Great. Love them all. I don't do any of those really. Like, they don't work for me.

But you wanna kinda do the same things

Dr. Mark Hyman
What do you do?

Dr. Andy Galpin
So for me, we have little kids. We're always gonna go through the little kid routine, right? We're doing all the things in order at the pretty much the same times with the kids. That's my pattern too. Because I'm going through that.

Like, that's tremendous joy. That's you know, I'm being present. I've checked out of work. I'm not on my phone. I'm not doing emails.

I'm reading stories. We're doing all the things and wrestling with the kids and making mom mad because I'm wrestling with kids five minutes before bed. But that forty minute routine with my kids is my first forty minute. That is my internal signal that I'm done for today. I don't care what else happens.

I'm not checking my email when I'm playing with my kid. Mhmm. Not gonna happen. Right? From there, then I'm going in.

We're gonna shower. That's great. Then I'm getting in. I'm a thousand percent gonna watch TV. You're gonna watch TV?

100% of the time. Like, TV will be on. I might watch a Seattle Mariners game. I might watch whatever. I'm not watching, like, a murder mystery, but we'll watch oftentimes, like, twenty to maybe forty minutes of TV.

The blue light doesn't bother us at all. We use environmental sensors, so we're testing everything. We're looking at melanopic light, not just total lux. Like, we have everything measured and monitored, all this technology I use myself. So I can objectively say that stuff does not negatively impact my sleep, but it positively impacts my psychological downregulation.

It is a click in my What

Dr. Mark Hyman
if your team loses? Is that

Dr. Andy Galpin
Ask my wife, she'll say different.

Dr. Mark Hyman
That's a stress.

Dr. Andy Galpin
Yeah. But for me personally, like I really enjoy that stuff. But I don't do it very often. So when the TV like goes on for me, it is a huge click that, okay, you're done. That's it.

All that other stuff on your phone, it does not matter. All you're worrying about is like what the three two pitch is on the sixth inning

Dr. Mark Hyman
Yeah.

Dr. Andy Galpin
For the fourth batter. What's he gonna throw a curveball? He's gonna go off speed? Is he tunneling that pitch? Like Yeah.

And then my wife will generally read or she's watching the same thing too. Right? But that's her thing too. Right? She's like, I can get lost in this book now.

Nope. I don't have to worry about anything

Dr. Mark Hyman
else. Mhmm.

Dr. Andy Galpin
So it's really consistent. So when I travel, when I'm doing things, if I'm off schedule, it's pretty easy. Like I was just in The Middle East for a couple weeks. Wife was in New York last this weekend. When I'm way time zones off, I keep the same system.

Right? I keep the same exact system even if I'm two or three or six hours off schedule. Yeah. And it just signals my body of going, you ate, you did this, and you did this in this row. In order, far easier.

And so when I looked at that stuff objectively on our whole bunch of metrics, my wind down index is very, very similar regardless of time zone I'm in when I can keep that pattern up. When it gets dissimilar is when that thing gets thrown off.

Dr. Mark Hyman
You're kinda cueing your body, you know, like Zavlov's dog to have a certain response at a certain time.

Dr. Andy Galpin
That's exactly right.

Dr. Mark Hyman
By a certain stimulus, right?

Dr. Andy Galpin
Yeah, exactly right. And if you're

Dr. Mark Hyman
Like called behavioral conditioning.

Dr. Andy Galpin
Pattern recognition is the single biggest physiological feat we have as humans. Humans. That is the thing we are most talented at. If you wanna call this resilience and sensitivity, this is a great thing too. Right?

If you become too sensitive, your pattern recognition is now I have this window. This if you're listening, I'm my fingers are right next to each other. Right? And so now when I bump up against those walls, things feel out of whack, out of place. This is discomfort.

But if my window was huge, now I'm super resilient, I can still land that plane regardless of the turbulence. And that's ultimately what we're after. So your question was how do we develop more resilience? That's one of my big keys, is getting a consistent timing mechanism in your brain that says this is what's gonna happen. Therefore, we fall asleep quickly.

We do it effectively even if I'm in a different time zone, even if my total duration is short. I started off on the right foot and that will be more restorative sleep.

Dr. Mark Hyman
It's so tragic that historically in this country, sleep has been seen as a weakness. It's It certainly was when I was in residency in medical school. Of course. And, you know, I believe that sleep was optional. Yeah.

For years, I was working as a, you know, resident and then a family doctor in a small town where I delivered babies. Not too far from you, actually, in, in Idaho.

Dr. Andy Galpin
Oh, nice. Okay.

Dr. Mark Hyman
Yeah. A little town, and I, you know, I take an ER call 247. Sure. I did the next day, I'd have to go to work and see patients, or I'd have to deliver babies.

Dr. Andy Galpin
And Mhmm.

Dr. Mark Hyman
It was my schedule was nuts. And and I worked eighty hours a week and it was, you know I think I really destroyed my sleep rhythms.

Dr. Andy Galpin
Well, know what's crazy? People don't appreciate this about medical doctors because they tend to get kind of a lot of grief more recently. They just in a couple years ago reduced the residency hours from a hundred and twenty week to eighty or something like that. Yeah. Let that sink

Dr. Mark Hyman
It's still nuts but it's like two work weeks in one is a big improvement over three work weeks in one.

Dr. Andy Galpin
But that was like

Dr. Mark Hyman
Yeah.

Dr. Andy Galpin
If you're a medical doctor in America, you probably did many months of a 100 plus legitimate hundred plus hours per week. Yeah. And now they made it soft on these new doctors

Dr. Mark Hyman
and got a So soft. You gotta yeah. We we we had a we had a we had a big concession in my residency where we had a labor organizer and and negotiator as one of the residents, and he negotiated our contract so that we basically got off at noon the day after call. So instead of working

Dr. Andy Galpin
Oh, sure.

Dr. Mark Hyman
Twenty four hours and then going again till the following night at 06:00, we got off at noon after a whole night with not sleeping, which is still not

Dr. Andy Galpin
years of negotiations.

Dr. Mark Hyman
Which is still not Yeah.

Dr. Andy Galpin
It's it's a tough

Dr. Mark Hyman
So sleep is is a real reason for this lack of energy is what you're saying. It is the most one.

Dr. Andy Galpin
After that, would say categorically, you now start thinking about energy in versus energy out.

Dr. Mark Hyman
Mhmm.

Dr. Andy Galpin
Right? So energy in could be a number of different things. It could be total caloric intake is too high or too low. It could be carbohydrates are too high or too low. It could be a distribution.

It could be a timing. You eat too frequently. You eat infrequent for your physiology. But you're you're gonna start thinking, okay. If I'm sleeping great effectively, objectively sleeping well, do I don't have enough energy in?

Or am I doing something that's there? And is it a lack of energy, or is energy instability? Meaning, I feel pretty good from 9AM to noon, but then I get really tired. Okay. You don't have a lack of energy.

You just have these wild waves energy. Now that's where the nutrition side could come in. Okay. Let's maybe tinker with less frequent eating or more frequent eating or more fiber or more protein. Like, there's lots of different ways that you could play with that, and that and that has come up a lot.

Where that has actually been the solution is you just need to actually your eating strategy is ineffective. The other big category would be the opposite, energy output. You're training too hard. Your volume is way too high, or you had a big jump in exercise volume, miles or, lifting weights or whatever the case is, too much high intensity for you right now. Right?

Or it could be the opposite. Your body doesn't produce energy because you have poor mitochondrial function. You have low muscle mass. Right? So it's it's something on that end of the energy output.

Or your body is unduly stressed, So it's burning a lot of energy internally that you don't realize. We call these hidden stressors. This could be psychological stress. Let's use example if you have a cold, an infection, but you don't realize it. You don't have a runny nose or whatever.

Anyone that's had, like, a kind of cold, you're just exhausted. You have no idea why. Well, your body is burning legitimate amounts of ATP to try to fight off this infection. You didn't realize it. And this is where things like micronutrient deficiencies or pathologies or stuff like that, like these things can cause fatigue and exhaustion Yeah.

Outside of it. Right? So those are real things. They are very far down the list. Again, let's not overthink this.

If you're tired, make sure you're sleeping well. Make sure you're eating and you're not over there. This is we've seen people that have resting fit people. VO two max is 60 plus for men,

Dr. Mark Hyman
right? Wow.

Dr. Andy Galpin
That's 50 is plus. And your resting heart rate's 70.

Dr. Mark Hyman
Seventy?

Dr. Andy Galpin
Sixty five.

Dr. Mark Hyman
That's high.

Dr. Andy Galpin
Your respiratory rate overnight respiratory rate of 17 breaths per minute.

Dr. Mark Hyman
Which is high.

Dr. Andy Galpin
This is not somebody who's cardiovascularly unfit. Why are you exhausted all day? Well, see. Sympathetic drive is full throttle all day. You're breathe you're basically, like, kinda jogging all day, and then you're training hard.

So your v two max is up there, but we can see this is why you're exhausted. It's the fact that we actually have to bring that down a little bit. You're over you're over over breathing. You're chronically hyperventilating, not pathologically, but just below that. So it's things like that where we're starting to look on those second layer, second tiers and saying, okay.

Sleep is fine. Check that off. Nutrition is great and solid. You're burning too many calories, not because you're training, in this case, sympathetic drive. So now we can do lots of different strategies, which could include any of the things we talked about from meditation to maybe you need to see light more frequently, to you need to actually take a little bit more time off of work, to do you realize which work tasks give you energy and which ones take energy away.

A lot of people have not made that connection. The introvert extrovert kind of stuff. Right?

Dr. Mark Hyman
Yeah. Very individual. Yeah.

Dr. Andy Galpin
Yeah. This is pulling energy from you. Right? So if you're an introvert like me and you're in shaking hands and an appearance all day, I don't care if I take 50 steps. I'm gonna be exhausted at the end of that day.

Like, I could eat 12,000 calories and I'll be physically exhausted at the end of the day because, like, I just don't like being around people that much. So maybe it has nothing to do with anything else there. It's the fact that you haven't recognized and realized you need more social interaction if you're an extrovert to give more energy back. You you we could give you a bunch of examples, but you're getting the point. It's really figuring out what gives you energy, what takes your energy, and then maybe making some structural changes to your lifestyle or daily routine that balance that a little bit more.

Dr. Mark Hyman
Figuring out what is it that makes you resilient Yep. And less fragile in terms of your Totally. Sleep architecture and

Dr. Andy Galpin
Yeah.

Dr. Mark Hyman
Your ability to rest and turn off at night because you got, you know, like you said, you overexercise which isn't most people's problem. No. But a lot of people probably use you work with

Dr. Andy Galpin
Yeah, for sure. A lot of our non athletes Yeah. That come to our coaching programs, that's that. It's just like I

Dr. Mark Hyman
remember watching something to do with Kobe Bryant. He was like, yeah, you know, the reason I sell is because I get up early and I work out and then I work out three times a day, whereas my other competitors don't work out as much and so I train and I'm better. I'm like, I don't know, is that good or bad?

Dr. Andy Galpin
People get Work

Dr. Mark Hyman
for him to be a better performer for sure.

Dr. Andy Galpin
Yeah. You know, like next week I'll be up in Canada with a guy named Cam Haynes. Cam's almost 60 And 60. 60 years old. A couple days ago, he ran 250 miles.

Damn. Two fifty. Right? He did this for his book launch. I think it's called Enduro or something like that.

He's 60. He has a broken foot, and he ran 250 miles.

Dr. Mark Hyman
On a broken

Dr. Andy Galpin
foot. On a broken foot. Prior to the race, he knew it was broken. It's been broken for months. Right?

The way that Cam gets to the world is maximal grit. Right? He doesn't optimize, he doesn't perfect, he does the opposite. I'm gonna put myself through insane things like that, like Kobe's example, right?

Dr. Mark Hyman
Insane amount of

Dr. Andy Galpin
pain. Because it gives him the mental edge of saying, okay, you deserve the win now. Right? Where other people don't need that to get to that same place.

Dr. Mark Hyman
Yeah. Probably not happening in my lifetime.

Dr. Andy Galpin
For sure, right?

Dr. Mark Hyman
Normally. I might bike a 100 miles but running 250 miles, no.

Dr. Andy Galpin
Well either way, right? So for you, you wanna be in this place where you have the ability to express true grit. Sometimes the answer is you need to be tougher. And sometimes the answer is you're over optimizing. Right?

So this is one thing kind of with people that are taking more onus and autonomy of their own personal life and control. Optimize leads to problems. Right? Because it leads to sensitivity. So if you have to have like a ninety minute routine, like I was saying earlier, if you have to have that to even fall asleep, and if one thing in your ninety minute routine goes wrong and you can't fall asleep for an hour

Dr. Mark Hyman
Yeah.

Dr. Andy Galpin
You've you've done wrong. That's not resilient at all. Now you become hypersensitive if you have to have your morning routine. If you have to do your breath work, you have to exercise. Right?

You can't go a day without exercising. We've had many people like that. Okay. We this is actually not this is fragile.

Dr. Mark Hyman
Yeah.

Dr. Andy Galpin
You're very fragile. Alright? Laird Hamilton's a good good friend of mine. He would always be like, don't let me leave you in the woods. Which is like his way of saying, if like you're over there worried because you're like didn't do your warm up today and like we're on the wave or something, I don't care.

I'm leaving you behind. Like I'm not don't be so precious.

Dr. Mark Hyman
Laird Hamilton's. Yeah.

Dr. Andy Galpin
It's like be more resilient. Be able to execute and have a great day even if you have a broken foot. Yeah. Even if you didn't get your nootropics in today. Even if you didn't do your breath work and you follow.

Dr. Mark Hyman
Sleep is a big thing and your absolute rest is a pretty intensive program. That's not for everybody, right? Yeah It's pretty it's pretty expensive, it's pretty intensive.

Dr. Andy Galpin
A 100%. Yeah. Yeah. This is you know, if you have to get sleep right and you wanted everything to know about sleep and you want a guided coaching throughout the whole thing, like that that is that program at the at the core.

Dr. Mark Hyman
And you have a new device that goes along with it that's

Dr. Andy Galpin
a Yes. So we can run Sleep tracker. And full FDA clinical sleep studies on your fingertip. It's not a tracker. It's not like a check your sleep score with a proprietary algorithm, it's all that stuff.

So that tracker itself is a part of the big program. Yeah. It's

Dr. Mark Hyman
not And the wearables are not that great or they I mean, because I I I'll walk from where three at night and and get three different reports in the morning. Like, one said you slept like ten hours, one said I said eight, one says I got thirty minutes of deep sleep, one says I got an hour, one says I got a 100% score, and then one said I got a 70% score. I'm like, woah.

Dr. Andy Galpin
We are pro everything. Wearables and trackers can be really effective for rough calibration. Right? So some people have as you're aware, some people have no idea what they're eating. Yeah.

They have no sense of what their sleep is. A tracker? Great. An aura, a a whoop, they're gonna get people roughly calibrated. That's awesome.

They're good for accountability. A lot of people will make better choices with their behaviors. The the bad behaviors, the dumb behaviors, the I ate a pizza right before bed, the alcohol, the inconsistent because they know they're getting tracked. They know they wanna do better. So it can be good for awareness.

It can be good for calibration. It could be good for internal accountability.

Dr. Mark Hyman
Yeah.

Dr. Andy Galpin
For us, when my athletes know I'm watching, like they make better choices. Yeah. So those are all tremendous. And if you look at the the hundreds of thousands of people that now use that, it's in that good thing. So if your entry point is that, I'm I'm all for it.

That's great. But you what you don't wanna do is what we talked about earlier. Use the minute detail of the sleep stage to freak out.

Dr. Mark Hyman
Right.

Dr. Andy Galpin
Are you familiar with orthosomnia?

Dr. Mark Hyman
It's like orthorexia which is obsessing about your food. I imagine obsessing about your sleep.

Dr. Andy Galpin
These are clinical sleep disorders that are induced from sleep Wow.

Dr. Mark Hyman
It's a new diagnosis.

Dr. Andy Galpin
You just have to be like, sure you're not if you care that much, no offense, but if you care that much, you probably shouldn't be spending $400 on a wearable and making all those decisions. Yeah. Like, there are are better solutions.

Dr. Mark Hyman
So bottom line, like, sleep is a big cause of fatigue. Yeah. Huge. Learn simple practices that can help you become more sleep resilient and less fragile around your sleep.

Dr. Andy Galpin
Yep.

Dr. Mark Hyman
Get a wind down routine.

Dr. Andy Galpin
And if you've done all 50 of those things, go to the next level. Like, go get some objective testing done because of the fact that you can you could legitimately have a sleep disorder. And all the meditation in the world is not gonna fix that.

Dr. Mark Hyman
Right. If you have sleep apnea or if you have some thyroid issue or something else is going on

Dr. Andy Galpin
A 100%.

Dr. Mark Hyman
Heavy metal poisoning or yeah. There's a million reasons why sleep goes wrong, so you you don't wanna ignore the medical reasons. But if you've kinda crossed it over the list, then you

Dr. Andy Galpin
Yep.

Dr. Mark Hyman
You can go deeper. So I wanna sort of transition and talk about what you've learned in your decades of working with elite athletes, Olympic athletes, top professional sports athletes, MVPs, you know, just the the best of the best. And you you you learn a lot from people like that that can apply to the rest of us because most of us aren't that. Right? Sure.

Most of us are just trying to figure out how to do a little bit better. And and I guess to let's sort of start out by talking about what are the insights that you've gotten from high performers about what they do that applies to us?

Dr. Andy Galpin
When I say high performers, I will talk about athletes as much as you want. But we also have worked with the most elite military groups, people that run huge corporations

Dr. Mark Hyman
Executive athletes.

Dr. Andy Galpin
That don't like that don't even exercise, I guess is my point. So when I say high performer, I mean the smartest people, the best decision makers, the people that this is high performance for us. Right? Physical sports is one avenue. But performance could be, again, you're a better writer.

You're more creative. And we work with some of the most famous musicians in the world. Right? These are high performers to us. So answering that question, what do people that perform at these high levels, physically, mentally, cognitively, creatively, whatever, there's not one thing that they all do.

Some of them eat really well. Some have no concept of what they're eating. Some of them are metabolically healthy. Some are not. Everything you can imagine here, I would say I could show you an example of somebody who's the best in the world, and they don't do any of those things right.

I think the one lesson from all of them, though, would be in general, being tough helps. And tough is great because tough can be built. So if you are running companies and you do not wanna get up on Saturday and you don't wanna work and you're tough, you can get it done. Right? If you're an athlete and you have to go talk to the media about why you suck today, that's really hard.

They don't feel hard in the weight room when they're lifting weights and when they're exercising, when they're tired. But maybe being in front of a camera is really hard for them. Sitting in front of the GM and them telling you, like, you're not gonna play this year. We're cutting yours. Those are hard conversations that most people don't realize happen at professional levels.

Not just sports, but running companies, having a hard conversation with a kid Mhmm. With an adult. Like those are really tough. So my biggest lesson from those people is the ones that tend to be tough tend to do the best more often.

Dr. Mark Hyman
And how do you get to be tough?

Dr. Andy Galpin
It's a learnable thing. It is a practice. In the sense of physical tough is fine, right? You can do that. But it is the ones that I just talked about are saying, okay.

Dr. Mark Hyman
Mental toughness.

Dr. Andy Galpin
Start when you can. Right? So have that first conversation, and it's gonna be awful and go poorly, and then keep doing it. Expect failure. Expect it to not go great.

And then you just you just have to trust the fact that you knew you know you need to get to here, and you know the first time you lifted weights you didn't, you know, squat a thousand pounds. And so the first time you learned this skill or this practice or whatever, it's never going it's not going to be pretty, but you keep going. And if you can believe that, then you can get past that. That is developing toughness. It is developing skill.

If you're Cam Haines, you're tough no matter what. Cam Haynes' kid just ran like a two thirty marathon in jeans and then did 10,000 pull ups in twenty four hours.

Dr. Mark Hyman
What?

Dr. Andy Galpin
The Haynes gene is incredible. They genetically are just super tough.

Dr. Mark Hyman
That seems harder than running two fifty miles. That's 10,000 pull ups.

Dr. Andy Galpin
10,000 pull ups in twenty four hours.

Dr. Mark Hyman
I don't think I can do 20.

Dr. Andy Galpin
I think his other kid ran the marathon with like 45 pounds on his back and in like combat boots.

Dr. Mark Hyman
Yeah. I I I went to med school with a family like that. Those guys were just like he would put on 50 pounds and go skiing for two hours, you know, cross country skiing up in the mountains.

Dr. Andy Galpin
We we had another guy actually, Lance McCullers Jr, Texas guy Mhmm. Plays for the Astros. He just pitched last week for the first time in like three and a half years. And the toughness he had to have for those three and half years because he kept getting hurt.

Dr. Mark Hyman
Mhmm.

Dr. Andy Galpin
Everybody got mad at him, all the fans, you're taking all of our team's money, like all these things.

Dr. Mark Hyman
Mhmm.

Dr. Andy Galpin
His tough was like, we have a three or four year horizon.

Dr. Mark Hyman
Mhmm.

Dr. Andy Galpin
We have to get through this and I don't get to do the thing I like at all.

Dr. Mark Hyman
Because he was injured and he to

Dr. Andy Galpin
get And then he kept getting hurt and just So there are different forms of toughness and the only way to build those things is just continuing to go after those, to continuing to try. Show back up. You fell off your diet. Fine. It's okay.

Be tough. Get it going again. You lapsed

Dr. Mark Hyman
What is that saying when the going gets tough, the tough get going?

Dr. Andy Galpin
Yeah. Like grit. However you wanna

Dr. Mark Hyman
like Grit. Yeah. There's actually an incredible book written about this. Yeah. I think, a UPenn professor about

Dr. Andy Galpin
Yeah. Angela Duckworth's Yeah.

Dr. Mark Hyman
Grit book. As a as a key strategy for success in life. It's like

Dr. Andy Galpin
It's hugely important. The grit of dealing with your five year old who just, like, won't

Dr. Mark Hyman
But why do some people have grit and some people don't? Some people, like, you know, like stub their toe and they're off work for six months, you know? Other people

Dr. Andy Galpin
Yeah.

Dr. Mark Hyman
You know, they're they're like in a car accident and they're working as soon as they can open their eyes, you know?

Dr. Andy Galpin
Yeah. You're I don't know. It's a little bit out of my area. I could tell you one thing. Know Andrew a friend of mine.

Dr. Mark Hyman
Yeah. Of course. Yeah.

Dr. Andy Galpin
He talks a lot about some of the new data in last couple of years about there's specific areas of the brain that are developed when you push through discomfort. Mhmm. And so there's actual physical structure that gets smaller when you don't do that very often. It gets larger when you do it more And so that was actually a pretty new finding.

Dr. Mark Hyman
No. No. Wait. So so you can exercise your way

Dr. Andy Galpin
You can exercise?

Dr. Mark Hyman
I mean I mean I mean metaphorically exercise your tough part of your brain

Dr. Andy Galpin
A 100%.

Dr. Mark Hyman
By doing the hard things.

Dr. Andy Galpin
I think that if you would pull up the neuroscientists in the room here, think they would all agree with largely agree

Dr. Mark Hyman
with that. Yeah. You know, I I experienced this recently. I was I had an unfortunate situation in my back and ended up, you know, having pretty severe back surgery, and I lost, like, you know, pounds. Yikes.

And I was in bed for a bit, and, it was tough. And when I got out and I I literally couldn't walk, I had a walker. And so, you know, four months ago, I was on a walker and couldn't walk. And I literally had to from within a week or maybe the day actually, day after my surgery, I had to start with physical therapy, which means I had to stand up for the first time. I had to learn how to sit down in a chair as opposed to laying on my back.

I had to learn how to stand up. Yep. I had to just learn how to walk without a walker and a cane, and then I had to learn how to walk without a cane. And I mean, it was and I remember just feeling like crap. Like, you just after you go through that, I just I had no energy.

I slept for four hours a night for six weeks. I was exhausted. And every day I got in the gym and I worked with my physical therapist, I worked with my trainer, and even when I was like, I am just wanna, like, lay in bed and binge on Netflix and disappear from the world, I got up there and did it. Because I knew that if I just put one foot in front of the other and if I just built those building blocks

Dr. Andy Galpin
Yep.

Dr. Mark Hyman
That I could get back. And I've gained 20 pounds back. I have my energy back. I have my strength back. I'm fitter than I was before Mhmm.

The surgery. I'm in less pain. And I you know, it was like but that I think like, my doctor said to me, like, Mark, most most people who went through what you went through would still be on a walker this Yeah. And you're, like, in the gym every day lifting weights and you know.

Dr. Andy Galpin
Yeah. Well you had

Dr. Mark Hyman
two business, three businesses and

Dr. Andy Galpin
You had that skill because of residency. Because of probably a thousand of the things you've done within your life where you know what resistance looks like, you know what then getting over it, you don't wanna do it, but you know what the back end looks like. Yeah. Right? And there was probably many days where you failed.

You didn't do it or you but you know what that

Dr. Mark Hyman
I did the best I could which was, you know, not as intense or as much as I could do.

Dr. Andy Galpin
Yeah. You know, as a scientist, you learn this pretty early one way or the other. When you try to publish papers, you go through peer review. Peer review is just a nice way of saying everybody gets to tell you how terrible your paper is.

Dr. Mark Hyman
Yeah.

Dr. Andy Galpin
Right? So if you can't handle things like criticism Yeah. You learn to develop it. Right? You have to get tough in that sense of saying, okay, great.

They're probably right there. If you're out in the public sphere, if the first time you get a a mean comment on social media and like you just wanna get back on there and fire back away, okay, you can develop that toughness over time. And so wherever tough means to you in different areas, it can be worked on, it can be improved if you expose yourself. You have to keep exposing. You had to show up to the gym.

Dr. Mark Hyman
It reminds me of that quote where I loud so it said, you know, the journey of a thousand miles begins with one step.

Dr. Andy Galpin
There you go.

Dr. Mark Hyman
And it's just like one step. Yep. And for so many people, it's hard to take that one step to make that one incremental change in your life or your behaviors or your diet or your exercise or your sleep routine or whatever it is Yeah. To actually start to compound the benefit that you see over time.

Dr. Andy Galpin
We always say the hard part about making changes in life is acceleration, not velocity. So here's what I mean. If you are used to waking up and running five miles every morning, running five miles is not hard because that is the constant velocity you're at. Yeah. But if you are used to walking running zero miles and you go to run one mile, that is a huge difference that is far harder than the person who runs five every day.

Dr. Mark Hyman
It's true.

Dr. Andy Galpin
It's true. Because it's acceleration. It's change of direction. It's massive start. It's massive stop.

Dr. Mark Hyman
Right? That's true.

Dr. Andy Galpin
That is the hard part. But you have to always remind yourself acceleration is going to be harder. But once you get past that and that becomes the norm, then this will be easy. Yeah. And so it's just getting through that mentality or getting reminding yourself constantly of it's going to be hard.

It's gonna Yeah.

Dr. Mark Hyman
Because if you're like, you know, 300 trying to get down to one fifty is a very daunting idea.

Dr. Andy Galpin
Impossible feeling.

Dr. Mark Hyman
Right? But but it's possible one Yeah. Little step at a time. And I've seen this dozens and dozens of times with my patients. If if if once they sort of get catch the threshold where they realize they can do it Yeah.

They have their own information, they have some early wins, it's it's powerful to see what can happen to people.

Dr. Andy Galpin
Yeah. You you wanna in the cases like that when people are trying to make dramatic changes, where we have found the most consistent success is you have to get some consistent practice. Mhmm. Don't let perfect be the enemy of good. So don't worry about getting a really expensive sleep study done and blood work done and all this stuff.

I don't care if your plan is perfect at all. Give me consistency. The weight will start coming off. Now we'll get the plan better. We'll we'll we'll we'll

Dr. Mark Hyman
kinda had it right. Just do it. Just do it. So, Andy, you know, there's a lot of myths out there in the fitness and longevity space. Yeah.

What what are the big ones that are coming across your horizon and that you're trying to dispel on a regular basis?

Dr. Andy Galpin
Yeah. I think this is actually kind of bring this last part of the conversation would bring up several, and that would be that there is one eating strategy that we all should have, that there is one workout routine that's better, that this type of training is better than that type of training, or, you should have this many hours or minute. None of that is objectively true for all of us. None of that. If you want an example routine or protocol to get started because you're in that place of I don't even know what to do.

I've never used supplements. I don't work out. Like, I'm so lost. Great. Pick one thing.

Go buy an app. Go buy a PDF. Go buy a work and just so you have a plan. But let's not fall ourselves into the sense of thinking that there is every woman going through menopause has to work out this way. What?

Every 30 year old has to do this with their training. None of those things are true. They're just simply not. And they can Well,

Dr. Mark Hyman
it's about what you want, what your goals are, where you're starting, where you need

Dr. Andy Galpin
to be Your physiology is different, right? Like your ancestry is completely different. Your baseline is different. All this is there. And so that stuff can be suffocating for people.

I realize, again, you want people want examples, they know where to get started. That's great. That's fine. But the biggest global myth would be that, that there is, you know, fill in the blank nutrient or otherwise that is either awful and evil for us or we have to do it.

Dr. Mark Hyman
Well, there's certain things I think are probably no.

Dr. Andy Galpin
There's plenty that

Dr. Mark Hyman
I think Like trans fats and high fructose corn syrup, I'm like a hard no on those.

Dr. Andy Galpin
Sure. For you, like great, right?

Dr. Mark Hyman
I don't know. I think from anybody shouldn't be eating those things.

Dr. Andy Galpin
I don't think anyone's gonna do well eating a bunch of them.

Dr. Mark Hyman
No, right. But once in a while for sure.

Dr. Andy Galpin
You can probably objectively say no one will do well eating a lot of

Dr. Mark Hyman
those. That's right.

Dr. Andy Galpin
I like probably There's probably some

Dr. Mark Hyman
of them. There's something.

Dr. Andy Galpin
But yeah. So there's

Dr. Mark Hyman
And I think everybody should exercise. The question is what, how much, how frequently, what kind of There's

Dr. Andy Galpin
thousand things we could bucket into like basically everybody should drink water. Yeah. Okay, fine. Like I'm not gonna but many of the final level of detail. How many grams of this?

How many ounces like, okay. Yeah. There there's not as many hard and fast rules there. Physiology is really good at finding a way if you give it the space. Right?

If you live it, have the opportunity, it will find ways.

Dr. Mark Hyman
You talk about these concepts of aging and you say you're so you're not anti aging, you're anti being fragile. Anti fragile. What does that mean? Like

Dr. Andy Galpin
So I'm I'm younger. Alright? I'm just

Dr. Mark Hyman
And by the way, I'm not anti aging either. We all age. We all get older. Like, I'm not anti that because I I'm I am that.

Dr. Andy Galpin
Yeah.

Dr. Mark Hyman
Yeah. But I'm pro healthy aging. Of course. And I'm pro being more resilient and I'm pro being more flexible. Yep.

Right? It's like I wanna be able to do whatever I wanna do. Like, I wanna go heli skiing tomorrow, I wanna do that. I wanna ride my bike 50 miles, I wanna go do that.

Dr. Andy Galpin
Here's what I mean by the antiaging thing. If you wanted to maximize the amount of lifespan and wellness span, health span, however you wanna define that, you could. You could take away all your risk. You could go to zero. You could never leave your house.

You could eat the same thing every day. You probably will live longer if all of your risk was taken to zero.

Dr. Mark Hyman
I know somebody like that.

Dr. Andy Galpin
So do I. Right? And say this with love because I wrote his exercise program. K? So you can do that.

And you write it from the perspective of minimizing risk.

Dr. Mark Hyman
Yeah.

Dr. Andy Galpin
My personal philosophy, and again I've said this like in public, it's not a I'm not talking behind our friends back here. My philosophy is the opposite. I'm more sounds like aligned with yours, which is I wanna be able to go out and be whatever I wanna be in any given moment. And I want my Achilles to be resilient against going playing a pickup game of basketball and not tear tomorrow. I want my energy to be resilient to where if I don't have food for a day, I can still be fine and not get cranky and grumpy.

I wanna also be able to drink some wine and not feel like my head is gonna explode for two months. Right? I wanna be able to be all of these things, and I'm not going to do those things very often. I'm not going to do these things very often. But I want the ability to touch into areas where I can feel all of the joys and experiences of life that are the way that I wanna live them Mhmm.

While also then not compromising my long term health at all. I want very so that's what antifragile means to me is I wanna be able to have a week of really poor sleep because we're doing this huge thing in one of our companies, and I'm super excited about it, and we're building like, I remember Doctor. Dre had a line that said, like, if you've never worked forty eight straight hours on something, you've never done something interesting. Like that was his thing of like, if you get so into what you're doing and you should have the ability to cruise and not have to be like, well, no, it's it's 3PM. I gotta start my wind down routine.

Like

Dr. Mark Hyman
Right.

Dr. Andy Galpin
No chance. Right? Like, I wanna be able to do wild stuff that doesn't put me in a, well, I'm just gonna live however I wanna live and if I die at 60, I die at 60. I'm not interested in that at all. I wanna live as long as I possibly can but be as resilient and antifragile as possible so that a bad exchange, somebody's mad at me, something happened.

Okay. Fine. A positive thing. Great. I wanna be able to handle those insults like jumping on a basketball court and not having something blow.

Or against somebody being mad at me and yelling at me or getting an argument at

Dr. Mark Hyman
work Yeah.

Dr. Andy Galpin
And not ruining my day for a week. Right? Like, that's where that's that stuff is fragile.

Dr. Mark Hyman
It's basically being physically, emotionally, psychologically, even spiritually resilient.

Dr. Andy Galpin
Yeah. Right? Yeah. We wanna be resilient, but we wanna also be present because one thing you could do is desensitize to all of it, which is not good either. Right?

So somebody who is constantly working for delayed gratification has a hard time being present. Right? So you're never gonna have the piece of cake. You're never gonna take the day off and go play in the lake the whole day because you got work to do, right? Then you're gonna have a hard time being in the moment and experiencing what I personally think is part of our joys of life.

Dr. Mark Hyman
Absolutely.

Dr. Andy Galpin
But if all you ever do is choose immediate gratification, have the cheeseburger every day, sleep in today, don't work, have the wine, well then your delayed gratification needs needs some work, right? Make better choices. So it's finding that balance for you and your threshold of saying, how do I still choose some presence Yeah. And immediate gratification while doing mostly delayed gratification?

Dr. Mark Hyman
Yeah. Mean, the way I think about it is is in order for you to be resilient and be flexible and be able to do what you want because that that's my definition of health. Know, I wanna wake up in the morning and do whatever it is that brings me joy that I wanna do. I wanna hike up a mountain, I wanna do that. You know, last last January, I hiked in Patagonia and I was able to do a 15 mile hike in a day with a mile vertical elevation

Dr. Andy Galpin
That's

Dr. Mark Hyman
and a mile vertical down. And and it was like the mile vertical was compressed in like three and a half miles

Dr. Andy Galpin
up the How sore were your quads the next day?

Dr. Mark Hyman
You know, it wasn't so bad. Really? No. I I See, that's my I had I had poles.

Dr. Andy Galpin
I don't care.

Dr. Mark Hyman
So I did poles on the way down. I don't care

Dr. Andy Galpin
at all.

Dr. Mark Hyman
I did poles. I just traded the weight. And, you know, we had crampons and we like, you know, did the whole thing. And then the glacier in in Patagonia and now was 64 years old. And and I don't wanna have to think twice about whether I can do that or not.

Now, there may be a point in life when I'm a 100, maybe I won't be able to do that. I don't know. But why not? Like, I see these guys sprinting and running at a 100 years old. My my, inspiration in in, junior high was this guy named mister Gibson who was my gym teacher.

And he showed us movie that, you know, like things would happen when you're a little kid have these imprinting effects on you. Yeah. Right? I was like 14 and I saw this movie and I was like, holy shit. And it was a movie about people who were doing extreme athletic feats with all sorts of problems.

Like Yeah. One guy had no feet and ran the Boston Marathon and this guy Larry Lewis was a 105 years old. He lived in Marin in Northern California and he would run across the Golden Gate Bridge every day, five miles to go to work as a waiter all day Wow. And he would run home at the end of the day. I mean, I was in my twenties, I ran to medical school four miles and ran back four miles every day, but that was that was in my twenties.

Dr. Andy Galpin
Yeah.

Dr. Mark Hyman
And I'm like, wow, if that's possible, then it's possible. Yeah. You know? And so that's my definition of health and I I think in order to do that, you have to make regular deposits in your health bank account. You can make withdrawals.

Totally. Right? If all you do is make money and save it, you're never gonna enjoy life. Right? But in my mother always used to say that, you know, money is energy, you know, and it's meant to be used but you also have to save energy to spend energy.

Right? You have to save your money to spend your money.

Dr. Andy Galpin
Yep.

Dr. Mark Hyman
And and the same thing with with your health. I think you have to make more deposits and withdrawals throughout your lifetime. And the cumulative benefit is that when you're older, you can do whatever it is you wanna do. Like I went heli skiing last year for the first time in my life.

Dr. Andy Galpin
Crazy.

Dr. Mark Hyman
You know, I mean I mean I wish I didn't have to wait till was 65 but because it was so much fun. Yeah. You know, I can afford it now. Can do it. I had little kids and a family and it wasn't as accessible but it you know, that that's how I define health.

And it's it's not just the absence of disease, it's it's something beyond that that allows us to be resilient and not fragile.

Dr. Andy Galpin
Well, you and I are very aligned on that. Right? I don't do disease at all, like the the traditional medical disease.

Dr. Mark Hyman
I'm not

Dr. Andy Galpin
an MD. Yeah. We eat the opposite end of the spectrum. If you wanna think about that as sports, great. If you wanna think about that as the ability to do twelve hours of work on your computer

Dr. Mark Hyman
Yeah.

Dr. Andy Galpin
Great. I want you to be able to sit there and not be like, oh, just have to go move. Like, no. Like, get through it. Be able to be focused.

Can you perform cognitively? Really hard work for long periods of time. Like you're able to hike all day through exhaustion. Right? So I want the physical capacity.

Dr. Mark Hyman
I wasn't even that tired.

Dr. Andy Galpin
There you go. Right?

Dr. Mark Hyman
Now now my wife, she she it was in South America so there was all these great wines but I don't really drink that much and she was drinking wine at night and I wasn't. And when we got back, our biological age scores

Dr. Andy Galpin
Oh, sure.

Dr. Mark Hyman
Hers were worse, mine were better.

Dr. Andy Galpin
What elevation were you guys at? Probably pretty high.

Dr. Mark Hyman
You know, not that high there. I think it was like 10,000 feet. Okay. That's enough

Dr. Andy Galpin
to get a physiological effect though.

Dr. Mark Hyman
But it wasn't like, you know, like stupid high. It was just because it starts low. You know, and it sort of brings us to this fact of like, okay, well how how do we need to think about, our physical activity as we age? Because you know, in your twenties, thirties it's different than your forties, fifties, sixties. And for me, I I I don't have many regrets in life.

But when I was younger, I thought, you know, cardio aerobic was important. And, you know, I I was a yoga teacher, so I did a lot of yoga. And I thought that was my, quote, strength training. And I was kind of this skinny kind of guy who was kind of not that muscular. And I was like, I I don't really like gyms.

I'm intimidated to go in like, went to a Gold's Gym in Yeah. In Venezuela. So I'm like, woah. Know, like, all these guys literally could pick me up with one finger. And I'm like, I just feel a little intimidated and insecure and and plus gyms are smelly and I don't loud and I don't really like it.

And I hurt. And if I did 10 push ups, it would hurt for three days and I'm like, this is no fun. Yeah. And I kind of put it off, put it off, off. And and I started when I was 59 to start to it really seriously No kidding.

The strength training. Yeah.

Dr. Andy Galpin
Okay.

Dr. Mark Hyman
And my my dad, I didn't I got him when he was 89 started on it. Sure. But but, it it really has changed my life. And I was sort of shocked at how much I ended up enjoying it, liking it, and how much of a difference it's made, and how much more I focus on it than I did when I was younger and particularly even more than cardio. So can you talk about how our training should evolve as we get older?

Dr. Andy Galpin
If you think about this idea we've been talking about a lot, antifragile. Here's what this means. You want ability to do wild stuff, climb a mountain. Work all day. Great.

Even lower level than that. If you wanna survive, your body has to have certain physiological capabilities. It needs to be able to produce and utilize energy. It needs to be able to recover. It needs to able to move through space.

So then back engineering, what training do I have to do to fill in that gap? That's how I always think about this question. Number one, this is basic physical activity. I don't even mean structured exercise. This is step count.

This is are you moving throughout the day? Because you can train and do all the lifting of weights and all the cardio. And if your step count is just a rough guide here, there's nothing magical about step count, but as a rough guide of physical movement, is 500 steps per day, there's a lot of data to suggest you're not gonna be optimizing health. So humans were meant and have spent many, many, many, many millennia moving a lot throughout the day. And so if that movement needs to be exercise, great.

If that movement needs to be a standing treadmill or walking treadmill at work, if that just means you walk three times a day or you stand up paddleboard, whatever it is, you garden, you my wife was a preschool special ed teacher for many years. And she would do 30,000 steps a day. Because she's just running two feet back and forth all day just handling four year old autistic kids, right? So she didn't need any more physical activity. Where we're, say, 30 years old, I would come home being in a laboratory pipetting chemicals and taking muscle biopsies all day.

Like, I hadn't moved all day. I hadn't moved, and she's like so I needed to, at that point in my life, had to reengineer movement.

Dr. Mark Hyman
Yeah.

Dr. Andy Galpin
I had to walk throughout the day. She did not need to go on a walk ever for her life. Right? So step number one is that. Is there some movement, and you may need to structure that in, that may need to feel like exercise to you?

It could be three, ten minute walks a day or whatever. Or it could be like, hey. My lifestyle is already physically active. That box is checked. K?

The next step up then is do we have a a ability to handle a high heart rate? Cardiovascular capacity, maximal aerobic capacity, v o two max. You could define this and organize this a lot of ways. But your heart and your whole cardiopulmonary system will do better if it can handle really high bouts of high intensity. So, again, engineer this.

Do you get something like that in your day already based on your vocation? Yes? Then I don't need to do as much high intensity intervals in my training. Or I get none of that, then I might need to do some interval training. This could be on a bike, on a rower, this could be sprint work, this could be your pickleball game.

This could be a lifting about of weights but is more of a high intensity interval type of circuit training.

Dr. Mark Hyman
Yeah.

Dr. Andy Galpin
Thousand ways you can get there, but something at least once in your week where your heart rate gets as high as you can get it. I don't even care if you measure it, but just you know what I'm talking about.

Dr. Mark Hyman
But you know, it's it's interesting, you know, we we we look at I learned in medical school that the maximal heart rate of someone is two twenty minus their age. So I'm 65, so for me that would be a 155. Two twenty minus 65 is a 155. Sure. But I routinely get in the high one seventies Yeah.

If I'm, you know, playing tennis or if I'm, you know, doing heavy duty exercise. So the body can do more, right?

Dr. Andy Galpin
Well, so you know how the two twenty Doesn't

Dr. Mark Hyman
mean I'm sick, right?

Dr. Andy Galpin
Yeah.

Dr. Mark Hyman
Yeah. I'm not sick.

Dr. Andy Galpin
You know how two twenty minus your age was developed, that equation?

Dr. Mark Hyman
I don't actually.

Dr. Andy Galpin
So it's it's like a lot of science, it's not as rigorous as one would think. It's a rough guide. I'm still routinely over 200 beats per minute. I'm not 20 years old. Yep.

Right? We've had elite endurance athletes, elite athletes who their v o two max is well below or their max heart rate's well below predicted. So they are a 25 year old, but their max heart rate's one seventy. And their elite v o two max is 75, 80. Right?

World record holders, things like that. So your maximum heart rate, that number two twenty minus your age, the story, the lore is that was actually written out on like the back of a sheet on a plane ride. So a couple of guys were headed to a conference and they had to have some way to kinda present something and they're just like, two twenty minus your age and like ran some numbers like, yeah, that works out pretty well.

Dr. Mark Hyman
I was like Oh wow. That busts that man.

Dr. Andy Galpin
Yeah. It's not. We can do that with actually a lot lot of physical

Dr. Mark Hyman
But it does matter like when you get older to do more strength training, doesn't it?

Dr. Andy Galpin
Well we haven't got there yet. But yes. So baseline physical activity.

Dr. Mark Hyman
To get your heart rate up to a good amount.

Dr. Andy Galpin
Not even heart rate up. Like the low physical activity. This is zone one, zone two, zone zero, I don't care what zone you have.

Dr. Mark Hyman
This is moving.

Dr. Andy Galpin
You have to move because you have to actually engineer the ability to create low levels of energy very consistently. Right? People that can do this stuff all day don't have lulls of energy. They're not tired or exhausted all day. People that don't, that sit all day, they have they're way more likely to be that person that's exhausted all the time.

Dr. Mark Hyman
Because their mitochondria don't work

Dr. Andy Galpin
as It's everything. Mitochondria is one way to explain it, but it's a whole cascade of physiological things that just don't work very

Dr. Mark Hyman
well. Mhmm.

Dr. Andy Galpin
So baseline physical activity, low level physical activity

Dr. Mark Hyman
basically human what you're saying is human beings, just like food, require exercise to function properly.

Dr. Andy Galpin
Yeah. Now you move up to that higher intensity stuff. Then you have to say, okay, great. Cellular stuff is okay. Endocrine system's probably okay.

Lymphatic system's probably okay. Immune system's probably okay because I'm doing my physical activity. Things are moving, things are pumping, things are functioning. I'm just keeping my brain alive or flowing. I got high heart rate up, so that kept my left ventricular left ventricle functioning well.

Kept my aorta like the physical structures of your heart and lungs grow great. But you haven't really taken care of muscle health yet. So skeletal muscle very specifically is not gonna respond optimally to those first two things I said. You don't have to, but if you look at there's lots of research on lifelong strength trainers. Lifelong endurance athletes.

Yeah. Neither one of them are up at their best.

Dr. Mark Hyman
Meaning if if all they do is strength training all

Dr. Andy Galpin
they do is We've done this research in our lab with twins. Right? So monozygos twins, exact same DNA with different things. And when you look at the folks who don't lift weights, they don't tend to have as high muscle quality. They don't they start to lose power and speed more frequently.

This is a problem as you age successfully because now your reaction time slows down. Your ability to catch yourself from a fall slows down because you don't have speed and foot power And the eccentric strength to catch yourself and brace and stop the fall and a whole host of things happen. Mhmm. And so adding in strength training, however that looks for you, if that means to be means to be you need to walk into the gym for thirty minutes, get on a couple of machines, not know what you're doing. That's fine.

Like that is enough

Dr. Mark Hyman
for you Not that you're doing, you're gonna cause yourself injury sometimes, right?

Dr. Andy Galpin
Generally when you're starting you're gonna be okay. Unless you're doing things really heavy and really aggressively, you're fine. If you just pop on a machine, kinda do eight to 10 reps, don't really know what you're doing, you're actually gonna be fine. But having some component in those three domains, now by doing that, you've also probably built some proprioception, some balance. Hopefully, you're going through full range of motion.

So now you're working on flexibility and mobility. Because every time I talk about things like this, people are like, don't talk about flexibility. Like, well, you don't need to necessarily go anywhere to train it if you're moving properly. And if you're lifting weights in a full range of motion, then flexibility is in large part taken care of. If you wanna add some more on top of that, great.

Dr. Mark Hyman
Yeah.

Dr. Andy Galpin
All for it. Like go ahead. If you wanna if that means yoga, awesome. That means stretching, great. Pilates, like fine, all those.

But from a physiological need to survive

Dr. Mark Hyman
Mhmm.

Dr. Andy Galpin
Those are the things. They keep all those systems intact, and there's ample research now on the brain. So you're talking about dementia and Alzheimer's prevention heavily positively benefited by these things. And so if you're doing those three categories, you're metabolically going to be healthy, your bones will be healthy, your joints will be healthy, and your brain will stay healthy. That is going to be our massive quadfecta for staying alive for a long time.

So at least once a week for all of those, if you like lifting weights more and you wanna do two or three times a week with it, great. If you're more into endurance, you wanna do that, you wanna keep strength training once or twice a week, fine. You can shift along the spectrum here, but I would say most people need to have at least one of those three components every week.

Dr. Mark Hyman
And, you know, as a doctor, when you begin to understand the the physiology of exercise Yep. What actually happens to your body and the profound like like, the profound changes that happen in your body when you exercise that literally can mitigate, slow or reverse most chronic diseases.

Dr. Andy Galpin
Yeah.

Dr. Mark Hyman
And that that can actually activate all these longevity pathways in your system. Yeah. And you mentioned a lot of them. There is nothing else on the market that can do that.

Dr. Andy Galpin
Yeah. I mean, if you start stacking up sleep and exercise, everything else, of course nutrition would be up there, right? But if you want bang for your buck, everything else gets way down the list of magnitude now.

Dr. Mark Hyman
Yeah.

Dr. Andy Galpin
Yeah. Like way, way down the list.

Dr. Mark Hyman
I always say you can't exercise your weight on a bad diet, so that is true. You can Certainly. I see a lot of people are exercising a lot and still very overweight or men are looking healthy because they haven't changed their diet.

Dr. Andy Galpin
So Certainly related to body body size and body composition. Yeah. You're gonna have a really hard time catching up to the plate.

Dr. Mark Hyman
Yeah. What you're what you're

Dr. Andy Galpin
saying before

Dr. Mark Hyman
reminded me what Peter Ortiz says, don't major in the minors and minor in the majors. Which essentially is like the majors are sleep, exercise, what you eat Yeah. And then everything falls below that, right?

Dr. Andy Galpin
Yeah. Mean as long as you're not like in this this energy toxicity, then like and the fact that what I mean by that is your total caloric intake is egregiously and excessively higher than your expenditure. Right? There's a lot of stuff within that. But if you do that and your body composition is okay, the next biggest thing is you can swing are sleep and exercise.

And really does have a huge impact on you. Again, we've done some of this work in our lab. You pick the thing that you're most interested in. You know, I wanna have more energy. I'm worried about dementia.

Okay fine. And we can show you data on data on data that are just gonna like overwhelm you. And what's great about this, like I'm so tickled for the last decade because as an exercise scientist this is stuff we've been screaming for 30 And now the other communities are catching on and we're like communication. We've been saying this. I actually took when I was a PhD student we did our anatomy class in med school.

So I was the only PhD and then the rest were future MDs. But the guy teaching it was a PhD, not an MD, right? So it was like alright. And we would go you remember med school, you would go through these just onslaught. You do a whole medical chapter a day, right, in the curriculum.

The next day is the next chapter, right? Yeah,

Dr. Mark Hyman
it's a lot. It was a lot.

Dr. Andy Galpin
And we spent like two and a half or three days on diabetes medications, right? And you're just going through, okay, this is what this does, here's contraindications, here's side effects, here's mechanism, blah blah blah blah blah, right? You just go through them all and I'm just like pulling my face off or my skin off my face because I'm like, this is awful, I hate all this, right? But you have to know it. Okay, great.

And then he gets to the very end and he's like oh yeah and then we forgot and you'll know where the story's going. But he said we forgot the last drug on the market. It does everything we've talked about already. It has a higher attitude of effect, it has no side effects and like I know where he's going. Like immediately I was like finally, he's finally gonna say it after two days of torture and all the kids are like, they got their notebooks out, their pens are ready to write this drug down.

And I won't say the word on here but he said it's bleeping exercise. And slammed on the table and walked out.

Dr. Mark Hyman
That's right.

Dr. Andy Galpin
And I was like, there you go.

Dr. Mark Hyman
That's it. That's right.

Dr. Andy Galpin
And now even this week there's other data that got published on type two diabetes and muscle mass. Yeah. Effectively showing if you have high quality muscle mass, it's extraordinarily rare to have type two diabetes.

Dr. Mark Hyman
Yeah. Yeah. Mean, it's interesting when you look You just

Dr. Andy Galpin
don't get it.

Dr. Mark Hyman
When you look at type two diabetics, their mitochondria have as function have as effectively as as people who don't have type two diabetes. And that is related to exercise.

Dr. Andy Galpin
If you have high quality muscle, it's really hard to have metabolic problems. It's not impossible, but it's really hard. And so when you look at like a what can I do about it? Maybe have something going on with you have something happening psychologically and food is a problem or trauma or like at least something you can do is have good muscle. Good muscle will help you metabolically more than just about anything.

Then you can work on the diet if that's a sticking point or we want you to start there, but you get what my point is saying. It's Boy, muscle.

Dr. Mark Hyman
Important for brain health, heart health, hormone health, digestive health, lymphatic function, muscle health. I mean, this

Dr. Andy Galpin
And the system runs through muscle.

Dr. Mark Hyman
You know, I cofounded a company recently called Function Health that Yeah. I've heard. Deep comprehensive biomarker testing.

Dr. Andy Galpin
Yeah.

Dr. Mark Hyman
And, you know, we're looking for all sorts of things. And we're recognizing that there are biomarkers of mental health, metabolic health, cardiovascular health, so many different things, brain health. But you kind of look at it from a little different angle. Yeah. And you you co founded a company called Vitality Blueprint, looks at blood work for performance, which is the other end of the spectrum.

Not disease, but like what can your blood test tell you about where you are in the spectrum of human performance and optimizing that? And how do we look at biomarkers and, customized approach to health that, like, can expose hidden gaps in our energy performance resilience that we can learn from blood testing. So what what are the most important blood biomarkers for performance that are overlooked and that you can act on? Things that you can make a difference with.

Dr. Andy Galpin
Yeah. So it's not necessarily about the blood markers. There are some esoteric ones at the very end. Right? So for example, for a high performance athlete, we might spend more time on a panel of magnesium related markers.

So not just serum magnesium. That's a really bad way to understand magnesium in the system, right, because it's almost all in bone. But something like magnesium RBC. Right? There's other ways.

Okay. Copper, zinc, like there's some other things we would do on a micronutrient end of the spectrum that you're probably not getting as just a general health. But to be honest, Mark, like that's we we don't spend a ton of time on those ones. We look at almost all the same markers you probably have on your what's your best panel at function? Probably a 100 markers?

Dr. Mark Hyman
Yeah. A 110 markers and then 60 at half a year. Yeah.

Dr. Andy Galpin
Right. Our biggest panel at Vitality is a 100 and some. Right? And it's probably, if I had to guess

Dr. Mark Hyman
Probably the same

Dr. Andy Galpin
ones. 90 of the same? Probably. Yeah. What we do differently is entirely based upon how we're analyzing and interpreting it.

Mhmm. That's the big thing. If you're here because you are concerned about whether you need hormone therapy or you think you have a clinical issue, go to function. Vitality cannot help you. If you wanna know your LP, ApoB, I'm sure you guys measure those.

Yep. Don't we don't even measure them. Yeah. We believe they're important, but I that's not something I can modify to make you perform better tomorrow. Right?

Those are go to function

Dr. Mark Hyman
Yeah.

Dr. Andy Galpin
For all that, to work with your team. What we are gonna do is look at those markers and say, do you have a bunch of things that are suboptimal? Maybe you don't hit a clinical threshold, but you're on the low end and you're not on what we call our high performance range. So you wouldn't be here to have the most energy.

Dr. Mark Hyman
Right.

Dr. Andy Galpin
You wouldn't be here to have the most muscle recovery. Mhmm. You're not as anabolic as we could possibly be. Now do we have a string of these? What patterns are we recognizing and what can we do with that, and how do we program solutions that are not that are something that an athlete can do?

In other words, lifestyle, nutrition, and or third party certified supplements. We don't give medications, drugs, any of those things come out of it because our athletes can't use it. Whatever reason. That's your doctor's perspective. I can give you a thousand examples.

We talked about a couple earlier. But let's take a look at something like hematocrit hemoglobin just because we brought that up earlier. Yeah. So when you look at endurance exercise, the single most important adaptation you will get is total blood volume. That's the name of the game.

You wanna go after more blood volume. If you see more blood volume, your fitness will be up. If it goes down, it is the opposite. Most people have no idea. This is a total blood volume game.

Now I doubt you've ever ordered a total blood measure.

Dr. Mark Hyman
No. I was like, what is that test?

Dr. Andy Galpin
Can't, right? It's not something you're gonna order.

Dr. Mark Hyman
Okay, good. Was like, wait, did I miss that in medical school?

Dr. Andy Galpin
You did actually. Okay, let me ask you this. You may or may not remember these numbers, but if you had somebody come into your clinic and their total blood volume was eight liters, most MDs are going go, Get them on a diuretic right now, you're going to have a cardiovascular event, right?

Dr. Mark Hyman
Sure.

Dr. Andy Galpin
I'm gonna look at that and go, that dude's super fit. Because they'll both be true. Right? You have to know if One's

Dr. Mark Hyman
a heart failure patient, one's an athlete. They're different,

Dr. Andy Galpin
right? Exactly, right? Same blood marker and a different range, right? So total blood volume is our key. Now on a blood test where you would go from that is hematocrit and hemoglobin.

Right? You can't get total blood, it's a difficult thing. And so the numbers I said earlier, if you're a female and your hematocrit is 44, 45, 46. Your male, it's a little bit higher, 47, 48, 49. Okay, great.

Now I'm gonna stack that up against something like hemoglobin. And your hemoglobin for a female is thirteen, fourteen, 15, male fifteen, sixteen, 17. I'm looking at that going, great. Pretty good markers there. Function might flag those and go, hey, these are higher than they should be.

There may be some cardiovascular stuff. Go get checked out. Totally different thing. Right? The same exact numbers is the interpretation.

Where we would look at then that next is something like the sleep apnea stuff. Are you seeing no? How's your energy? No. It's great throughout the day.

No sleep apnea? Great. These are training induced. We know you've been exercising. Here's our questionnaire.

Do you train a lot? Yeah. Okay. Interpret there. Then we could go on to other ones and say, let's look at cholesterol markers.

Cholesterol markers not from your heart disease perspective, but as an inflammatory marker. Like, specifically, like things like LDL. If you see elevated blood glucose in LDL and somebody's eating really well and training really hard, and then you start looking at second and third, tertiary markers of inflammation like CRP, creatine kinase, like ESR, and you start to say, wait a minute. Those are all fine. Creatinine creatinine creatinine kinase, all these are good here, but LDL is elevated.

Okay. Now actually go talk to your doctor. You might have something happening here, familial or some other reasons. Right? But if we look at that and go, okay.

Blood glucose is a little bit high and hemoglobin number's a little bit off, we can actually cross reference. Is this acute dehydration? Is this chronic dehydration? Is this inflammation from exercise? We stack on something like AST and ALT

Dr. Mark Hyman
That's a liver test.

Dr. Andy Galpin
Liver test. Well, ALT very specifically, right? But AST is the most amount of AST in your body is in muscle. So you will always see, almost always see elevated AST in people that have a lot of muscle mass. We see the same thing in liver too because it's a relationship there.

Dr. Mark Hyman
You have a patient like that who's like two hundred and like seventy pounds of solid muscle. Oh yeah. Like, well your liver tests are off me. He's like, yeah.

Dr. Andy Galpin
Yeah. He's not going through liver failure. No. So you could actually look at something like Cystatin C and start going down to GT and other markers and saying like okay, can cross from it. Your liver's fine.

What you're seeing is you're jacked. You have a lot of muscle, right? And so to be able to look just at the markers themselves and understand, oh this is an exerciser, this is an endurance athlete, this is somebody that has just a lot of muscle mass.

Dr. Mark Hyman
Now

Dr. Andy Galpin
what do we do about it? So when you look at the same markers, albumin, sodium, potassium, I almost guarantee everybody has had albumin on every blood test they've ever done.

Dr. Mark Hyman
For sure.

Dr. Andy Galpin
And almost

Dr. Mark Hyman
never Which is the protein in your blood. Yeah.

Dr. Andy Galpin
Yeah. It's the protein in your blood that carries tons of markers, cortisol Yeah. Andabolic hormones, tons. It's never out of range. So most people skip right by it, right?

Dr. Mark Hyman
Well, it is if you're malnourished, yeah.

Dr. Andy Galpin
It's super high in only one case basically, in the case of your dehydration, right? So because it's a concentration issue, right? Now we're gonna go back to hematocrit hemoglobin. They're also concentration issues, right? So they're matter so if you see albumin, hematocrit hemoglobin all going after the same thing, then we can look.

If hemoglobin or sorry, if albumin is normal, you'll see acute dehydration. If hematocrit and hemoglobin are up because they're concentration issues. But if all three are elevated, now we can see chronic dehydration. Those all three will be within the reference range, but they'll all be on the upper end.

Dr. Mark Hyman
So you're kinda reading the tea leaves. You're you're seeing the same thing that everybody else sees as a doctor Yeah. But you're you're picking up clues within those biomarkers that everybody else is missing.

Dr. Andy Galpin
The 100%. It's that And

Dr. Mark Hyman
they give you insights into the the level of fitness, health, performance, dehydration. All sorts of subtle things that that affect the quality of your ability to perform and function whether you're a corporate athlete or a, you know, professional athlete.

Dr. Andy Galpin
Yeah. Right? So because these things are not, again, clinical cutoffs, but someone's not asking to say, what's my disease risk? They're saying, I wanna look, feel, perform better right now. And so our granularity is different.

Our expectations, the reference ranges that we use are entirely based upon maximum health. We published a study a couple years ago where we looked you're familiar with NHANES database.

Dr. Mark Hyman
That's the National Health Nutrition Examination Survey.

Dr. Andy Galpin
You're very familiar

Dr. Mark Hyman
with Every year and basically the government surveys the population, does blood work and various diagnostic tests, history questionnaires. It's a great way of tracking a population. We learn a lot from it. Like Yeah. Ninety percent of us are nutrition deficient, for example.

Dr. Andy Galpin
This is Yeah. What has it been going on for thirty plus years? Yep. So you have good data on people over thirty years. Right?

Now there's an enormous amount of problems with NHANES. Right? But if you were to go to order a blood test right now from anybody and something is high or low, what they mean by high or low is on a bell curve.

Dr. Mark Hyman
Yeah, you're out of the normal reference range.

Dr. Andy Galpin
The normal but that normal reference range is 95 percentile.

Dr. Mark Hyman
Yeah.

Dr. Andy Galpin
So if you are high, that means you're in the high two and a half percentile.

Dr. Mark Hyman
Yeah.

Dr. Andy Galpin
But let's say Mark, you're in the ninety fifth percentile. Yeah. I don't wanna be in the like I wanna you're just a little bit not diabetic. Yeah. It's like woah woah woah, hold on time out.

Right? As a medical doctor for general population, that is that's what we should be screening. Right? Like huge disease

Dr. Mark Hyman
But I'm like you though. As a doctor, I don't I don't look for what's quote normal. I look for

Dr. Andy Galpin
Yeah.

Dr. Mark Hyman
Reading the tea leaves about where the where the edge cases, the people moving in the wrong direction

Dr. Andy Galpin
Yeah.

Dr. Mark Hyman
That it can be subtle. Exactly. That aren't like, you know, the labyrinth ranges, vitamin d is 30. Well, think it should probably be 45 to be optimal.

Dr. Andy Galpin
Our performance range is 55.

Dr. Mark Hyman
Yeah. Or yeah. Exactly.

Dr. Andy Galpin
55 to 75.

Dr. Mark Hyman
Or Ferritin, you know, the reference range for your iron stores is 16. Well, it should be probably 45 or 50 to be good. Right?

Dr. Andy Galpin
So you so that's another good example. Right? Like, you there's actually recent papers on Ferritin very specifically. You'll see reference ranges. Like do you happen to know offhand what your guys' ferritin reference range?

Dr. Mark Hyman
16.

Dr. Andy Galpin
Okay.

Dr. Mark Hyman
It was the low end.

Dr. Andy Galpin
What's the high end? Probably would flag a

Dr. Mark Hyman
couple 100.

Dr. Andy Galpin
Yeah. You you'll see 300 Yeah. To 400. Right? Yeah.

So you'll get your labs back, and your ferritin won't say that it's high or low unless it's lower than 15 or higher than 400. It's What am I doing here, right? Despite ample data that says like yo, if you're over one hundred eighty, you're gonna have inflammatory problems, you're gonna have oxygen stress, like you're gonna have all these things there, right? So with the NIH or the NHANES thing is what I was saying. We looked in that database and what's interesting is there was no relationship between the amount of muscle mass people had and their strength training history.

Dr. Mark Hyman
Really?

Dr. Andy Galpin
In that database. You know what that tells us?

Dr. Mark Hyman
They were

Dr. Andy Galpin
How did they get their muscle? If they had a lot of muscle, that hadn't we had no bearing or understanding if they lifted weights or not. Which means people in those national databases have generally accrued their muscle by just being bigger. Larger people, ate more, bigger body mass, comes along with more muscle. Yeah.

That's the type of population that we're using to build these reference ranges on. Yeah. Do you wanna be compared to that? No. Okay.

So

Dr. Mark Hyman
My sister always used to tell a funny joke. She says when the Vermont farmer was asked how's his wife? He says, compared to what? Always. Compared to what is the answer.

Dr. Andy Galpin
Always. Right?

Dr. Mark Hyman
Right.

Dr. Andy Galpin
So we are comparing to what we believe based upon the available data, our twenty years of of database internally, and how you should be performing at your best. And then from there, we're gonna work to craft and what's really careful and specific about this is we're gonna work to craft solutions that are solving as much we can what's causing biomarkers to be up. So there's a handful of biomarkers. You mentioned vitamin D. That's a really easy one.

If vitamin D is low, the solution is very simple. Get vitamin D up. Right? You wanna use sunlight. We'd all advocate for that most.

Right? You wanna go to food. You wanna go to supplements. That's your choice. But low biomarker, get that biomarker up.

That's not the case for other biomarkers, though. Just because you like for example, if your sodium is low, you don't need to ingest more sodium in your diet. You don't need more electrolytes. That's a because that is not that is a systematic marker. That is telling us something about acute fatigue and chronic fatigue.

That is a overtraining. That is a sympathetic overdrive marker. So if you start to look at things like sodium and potassium ranges, and sodium is trailing low, Still within the reference range. Potassium is trailing high. Sodium potassium ratio specifically starts getting below 30 or above 35.

I now know this has nothing to do with your diet per se. It's nothing to do with you needing a banana or a packet of Element, right, which all in love of. This is a case of you saying, okay, your allostatic load is too high. What is going on here? We need to reduce fatigue.

That is the entire thing there. That is a key function of like it's not necessarily looking at the market and saying it's higher load then therefore take this thing, take less of this thing. It is trying to backpedal and say well what is the cause of that? And so when we can come back in that particular case and say hey, you actually need to tone down your training a little bit. And then those markers go back you're doing your

Dr. Mark Hyman
stress response goes up when you're training too much.

Dr. Andy Galpin
And every single time in that exact example, what do you think happened to DHEA pools? What do you think happens to total testosterone? What happens to free testosterone? They're plummeted, right?

Dr. Mark Hyman
Yeah.

Dr. Andy Galpin
And so we get to like, oh my low testosterone's my testosterone's low, that's why I'm tired. No. No. No. No.

You're tired because of up here. Fix that and then watch that testosterone go way up. Right? There's plenty of cases when you need to take exogenous testosterone, but you you get the the point here.

Dr. Mark Hyman
So so we really have to rethink the whole way we interpret lab tests, which is not what's, quote, normal, which is just a statistical number based on averages in a population. And the population, if it's sick, it's gonna be skewed sick. Right? It's it's where we can read the tea leaves to sort of interpret variations from that normal range that give you clues about what's happening either for disease or for Yeah. Things that affecting your energy, performance, fitness Yep.

Quality of your health even if you don't have a disease.

Dr. Andy Galpin
100%. Right? So we were trying to say you wanna perform at your best. You tell me what perform means. I don't care.

I wanna be able to do a b c. Fine. Now we're gonna look at that and say if you wanted to perform at your absolute best, what would that look like? Right? It's not necessarily about having fancy new markers.

It's taking the information we already have in front of you and getting more extraction of more objective data, asking very scientifically validated questions. What's your objective? How do you feel? Right? So a, and c is here, but I feel great.

That might be a normal thing. So what we create is what we call molecular signatures of people. And we establish a signature of people and now we understand what is your normal variation. So I have a handful of things and you'll see this really commonly

Dr. Mark Hyman
in How do you vary from

Dr. Andy Galpin
your optimal? Bingo.

Dr. Mark Hyman
As opposed to somebody else's optimal?

Dr. Andy Galpin
Like MCVs tends to be very high in people. Not very high, like a little bit elevated. I can guarantee your MCV is probably at the upper end all the time. Probably up there all the time. Normal for you.

Probably you might even be out of the reference range. Pretty normal thing. Right? If you were out of the reference range for, another marker though, like albumin, if your albumin was constantly seven, I'd be like, that's a problem. I don't care what your argument you're gonna make, that is a problem.

So there is clear distinction of like this is dysfunctional, and then there is, these markers are really sensitive. These markers are really insensitive. What is your normal milieu? What is that molecular signature that comes with your lifestyle, where you live, the water you drink, what kind of food you eat? And now let's create deviations from that.

That allows us to then not beat our head in the wall with supplements or whatever to try to fix something that is not actually a problem.

Dr. Mark Hyman
And I think what's really exciting, Andy, is that, you know, like things like sodium potassium ratio. Like, that's something doctors never learn anything about.

Dr. Andy Galpin
It's it's really clear and super present.

Dr. Mark Hyman
Right. And so so I think what's really exciting is we're entering an era where you're not gonna have to rely on an individual doctor or an individual exercise physiologist, but we're gonna enter an era where we're gonna be able to use AI to help us look at all the world's literature on how to optimize for performance or health using biomarkers and get insights that we never had before.

Dr. Andy Galpin
Well, combined with your individual data.

Dr. Mark Hyman
That's right.

Dr. Andy Galpin
Your n one Search the literature and give me my n of one. Right? Because this is a combination. As a medical doctor from your perspective, you have your evidence based practice. Yep.

And then you have the, well, I've been working with this girl for fifteen years. I know her physiology. How do you meet that in the middle? That that is the new age of meeting the middle. Yeah.

Now let's have AI scan all the literature. I can't catch it all. But let's also integrate your unique signature and let's figure out what is the path forward for you based on your goals and wants and desires and whatever else that you certainly care about, right? Incredible. This is our new avenue forward.

Our stuff is software.

Dr. Mark Hyman
Yeah.

Dr. Andy Galpin
You can take any of your old blood work and upload it through our stuff and have it all analyzed and interpreted for you in this exact frame of mind.

Dr. Mark Hyman
Amazing.

Dr. Andy Galpin
So someone can take function and go great. Here's my blood report, go to my medical doctor, then take their function thing, upload in vitality and go great. I want now the performance swing.

Dr. Mark Hyman
Yeah. I wanna do that. Wanna do that.

Dr. Andy Galpin
Let's yeah. Let's take a look

Dr. Mark Hyman
at it. I wanna do that. You think we're testing too much or not enough?

Dr. Andy Galpin
That's a really good question. Here's how I'll frame my answer. In the next two to five years, that question will be entirely different because of technological advances that are gonna allow you to do some of the things we have to do in venous draw full normal blood draws at home in a continuous fashion. Like continuous glucose monitor. Great.

Well now that technology is advancing where we can get a lot of biomarkers continuously. Where we can get kits at home and we can do tests at home. There's a lot on the market now. A lot of them are really clunky and don't work and their numbers are way off. I've tested a ton of them.

But it doesn't take a stretch of the mind to think it's gonna be there. Maybe it's three years, five years. It's gonna be Theranos probably won't ever happen. But okay. So how how does this look when we can repeat these tests?

And we've done lots of experiments where we do full 100 markers every day for, like, six days. Right? It's like, how much of these? So we're getting a sense now of stability and instability of individual markers and variants within people. Yeah.

That is where this thing is gonna go. So when you ask about, like, we testing too frequently or infrequently, it kinda depends on what your aptitude for this stuff is. If you're the

Dr. Mark Hyman
I don't mean frequency. I mean enough biomarker. Because, you know, a lot of a lot of the medical profession goes, there's too much unnecessary testing, it leads people down the wrong road and

Dr. Andy Galpin
I'll answer this. And anxiety

Dr. Mark Hyman
and it's unnecessary, it's too costly, blah blah blah blah.

Dr. Andy Galpin
I don't think that's for a public official to decide. Right? I like a ton of this stuff. This is what I do. I have also seen that case.

I have seen that case where people have given themselves extreme legitimate clinical anxiety, depression from things like that. Our our clients

Dr. Mark Hyman
If they don't have the right guidance with it.

Dr. Andy Galpin
Our people have come into our coaching program, paid a lot of money, and we've had to go, you're done. We're taking your some of our athletes, John Rom, professional golfer. He's said this a bunch publicly so I can say it. The the whoop or the oar had to get taken off. The sleep tracking was causing issues with him.

The same thing with blood. We've had plenty of our clients who were like, dude, you're done. Like, this is a net negative big time. And that was the opposite. So I don't think this is something we could generally say of like there.

If we're thinking about what should the government pay for, that's a different question. Right? What should be covered free for me? Those are different questions. I understand if you're a official that's making those decisions and you wanna make an argument that we shouldn't be making it free to have Mark's 400 panels measured for everybody at age 20.

Oh, okay. But that's really different than me paying cash out of my own pocket to do what I want with my medical Yeah. Situation. That's a that's a fundamentally different I

Dr. Mark Hyman
agree. And I think we're entering an era where the costs are coming way down.

Dr. Andy Galpin
Way down.

Dr. Mark Hyman
The capacity to do not just more just general blood tests but metabolomics, proteomics, omics for literally pennies. Yeah. I mean, we're seeing just amazing scale like, you know, Moore's law is applying to medicine too. Of course. And and so what was a billion dollar test to get your genome sequence is now $300.

Dr. Andy Galpin
$300. Yeah.

Dr. Mark Hyman
So it's like, okay. If if And and then the question is what do you do with all that data? How do you make sense of it? And that's where AI machine learning comes in. I think in my view, it's always good to know.

Like I've never been sorry by knowing more data about an individual Yep. To help me guide them about what's working with their So

Dr. Andy Galpin
it all comes down to a couple of things. And again, knowing your patient in your case, knowing your your person who you're working with, how do they respond, how they react, that stuff. But I would make a really strong argument, and I I would fight anybody on this. If possible, at age 30, maybe 35

Dr. Mark Hyman
Get a baseline.

Dr. Andy Galpin
Of everything. Here's what I mean everything. A v o two max test, a full DEXA scan of bone density.

Dr. Mark Hyman
Now those numbers And body count?

Dr. Andy Galpin
Yeah. Body composition, of course. Right? Metabolic health testing, a way over a 100 biomarkers, blood based biomarkers, a cognitive test. Right?

All this stuff should be done at around 30, 35. The vast majority of people will walk out of that test with no medical problems, and that would be the point. Mhmm. That would be the exact point. And now we don't repeat that every year, maybe even every five years, but let's get it at 30.

And now when you're 40 we repeat. Because when you show up to our program at 40 and your VO2 max is 25

Dr. Mark Hyman
That's not good.

Dr. Andy Galpin
Fill in the blank, right? Let's take a more egregious one. Your total testosterone is 400. And your fatigue, low energy. I think it I have no maybe you were at 300 when you were 25.

Maybe it's up. I don't have any idea. 400 is like this gray zone, right? I'm like I don't know. Maybe it was a thousand.

And now it's 700 and that's why you feel because you're down 300. Mhmm. There's way more complication than that. But you see the point. I don't have any idea what baseline Baseline, yeah.

Right? Do this which was actually like there's so much crossover between our groups, it's funny. So I know you guys just got Ezra.

Dr. Mark Hyman
Imaging, yeah.

Dr. Andy Galpin
Cool. So you're doing blood and MRIs for cancer, right? Yeah. So you're doing blood for disease and much more.

Dr. Mark Hyman
Yeah.

Dr. Andy Galpin
We do the same thing. But you know what we do with our MRI scans? We use Springbok. Springbok does the same thing, twenty to thirty minute full MRI, full body MRI scan. And it gives us a three-dimensional image of every muscle in your body.

There's no cancer screen there, have no idea. I don't care. But what I can look at is what's the exact size of your vastus lateralis on your right leg versus your left leg? What's your hamstrings groups look like? Like each individual muscle.

Dr. Mark Hyman
Interesting.

Dr. Andy Galpin
And so now I have baseline. So for Lance McCullers, for Walker Buehler, another one of our Major League Baseball pitchers, I'm gonna look at every single rotator cuff muscle. I'm gonna watch it develop every single year, ideally twice a year, and start to say okay, you have to have your elbow and shoulder be able to throw a 100 pitches a game for 30 games a year. So the development of your infraspinatus by 10% versus your teres minor, this is a big deal for us. I wouldn't do that for you, you don't care, right?

No. But I might look at

Dr. Mark Hyman
it go I'm throwing any pictures.

Dr. Andy Galpin
I might look at it and go, oh do you realize your trap on your right side is 25% larger than your left side? And you've been having a lot of neck pain? Weird. Oh, your gastroc on your right side is 40% larger than on your left side, and that hip's been bothering we can start to see huge

Dr. Mark Hyman
Information.

Dr. Andy Galpin
Asymmetries. But if you do it at 30 or 35, whatever, now we have that baseline. Do you know what sarcopenia is? I know you know the term. Yeah.

But scientifically, we don't even agree what sarcopenia is.

Dr. Mark Hyman
Muscle loss, but what does it mean?

Dr. Andy Galpin
But how much is normal? How much is not? Well, you know why we don't know? We have no database. I have no idea what a normal amount of muscle is.

I have no idea. All we have is like BMI studies. Right. But imagine if everybody was scanned through Springbok, and I can say the average sixty to sixty five year old male, his vastus medialis was this big. And I could do the distribution, the 95% distribution that we do on blood work for every muscle in your body.

And so now you get that ECL you get that knee replacement, and they clear you after four weeks because you're not in pain, know, your flexibility is back. But I can look and go, woah woah woah woah woah. That vastus lateralis is 80% of where it was before the surgery. We need to now write five more physical training Right. Or physical therapy.

This is why we're justifying it. We're not back to return.

Dr. Mark Hyman
Yeah.

Dr. Andy Galpin
Or we're aging improperly. This is where you were every five years we run this scan, and now we are seeing this advanced drop in muscle mass.

Dr. Mark Hyman
Yeah.

Dr. Andy Galpin
Feel it. The thousand things, right? Incredible. So what we're doing is like very similar, but I'm doing it from this end of the And you're doing it from Yeah.

Dr. Mark Hyman
It's true. I mean, you know, you're talking about, you know, muscle mass and and muscle function and and the variations. But, you know, I think our ability to get large data sets on individuals is gonna change our our whole health care system. And and as the costs come down and as it becomes more democratized

Dr. Andy Galpin
Yep.

Dr. Mark Hyman
You know, where people wanna use their HSAs or FSAs to pay for it Really? There's there's just so much we can learn. I I mean, it didn't occur to me till after Function acquired Ezra, which is a full body MRI and Yeah. Imaging company that both also does other imaging. That combined with liquid biopsies

Dr. Andy Galpin
Oh, sure.

Dr. Mark Hyman
And full body sort of biomarker testing and annual serial full body MRIs which we've gotten down to four ninety nine which all 37 a day.

Dr. Andy Galpin
I saw that announcement. I was like, what?

Dr. Mark Hyman
Yeah. It's crazy. Right? We cut the price.

Dr. Andy Galpin
Because it was like yeah. Was like 1,500 or something?

Dr. Mark Hyman
Yeah. Five times less the price. Yeah.

Dr. Andy Galpin
And

Dr. Mark Hyman
it it it just sort of the light bulb went on and I'm like, wow, you start when you're say 35 and do that, you never have to die from cancer. No one ever has we we can't prevent getting cancer Yeah. But we can make dying cancer historical footnote by getting this data every year. My dad died of cancer at 91, my sister died at 57. My dad was otherwise very healthy.

He walked his dog two or three miles a day. He was, you know, playing tennis at 90 years old. But Mhmm. You know, he's a smoker when he's younger. And if he'd had this low dose CT and if my sister had the full body MRIs, they never would have died.

And and I realized, wow, I have a choice. Like, I can I can make dying of cancer optional? If I ignore it, I might die of cancer. But if I do screening every year, I'm never gonna die of cancer because when you pick it up in stage one or two, it's over ninety five percent survival at five years, which is, you know, basically a cure. So yeah, it's it's it's a different era.

Okay.

Dr. Andy Galpin
So You can do it. So my my point here would be something like Springbok can be it doesn't require a special machine. It can be done in an MRI machine. So now let's add that on top of the cancer screen. Yeah.

And now you never have to die of low muscle. Sarcopenia could be gone.

Dr. Mark Hyman
Yeah.

Dr. Andy Galpin
It's right there, right?

Dr. Mark Hyman
Well, we do we do actually offer MRI body composition testing. It might be different than what you're

Dr. Andy Galpin
Oh, totally different, right? Yeah. Because you're getting how much muscle versus body fat, which is great. But now let's image and three d model every single muscle

Dr. Mark Hyman
That's crazy. It's amazing what we can do. So you've done a lot. You've built labs. You've coached champion athletes.

You've done plenty of analysis of people. Time works and blood and sleep. What do you do? What are your, like, non negotiables? Because you're talking about resilience and flexibility.

Like, you gotta have stuff that you just like that's Andy's non negotiable. What's it? What's your daily non negotiable?

Dr. Andy Galpin
Okay. I don't like non negotiables in the traditional sense. I as I said earlier, I wanna be able to not work out and be fine with it. I wanna be able to not eat and be fine with it. Right?

Now there are certain things I'd like to do. I like to lift weights. I like to exercise. I live up in the mountains. I I love like I'm so obsessed with wild animals, particularly deer Mhmm.

And things like that. Like that is my jam. It's my new Instagram. Like if I'm spaced out at work, I'm not on my phone, I'm for sure looking out my window for deer.

Dr. Mark Hyman
You don't have to ever do that in Austin here. We got deer on the lawn everywhere.

Dr. Andy Galpin
Why run somebody's lawn?

Dr. Mark Hyman
I'm coming out my property all entire time.

Dr. Andy Galpin
I texted my

Dr. Mark Hyman
wife and

Dr. Andy Galpin
I was like, yo.

Dr. Mark Hyman
Yeah. Is what The apocalypse will be fine. There'll be plenty of food to eat. Yeah. Austin.

We have

Dr. Andy Galpin
deer all over property but

Dr. Mark Hyman
that was No predators here, so funny.

Dr. Andy Galpin
The the only real Honestly, like my true non negotiables as in things I force myself to do every day is some sort of involuntary gratitude.

Dr. Mark Hyman
Wow.

Dr. Andy Galpin
Thankfulness, right? So no matter where I'm at, no matter what I'm doing, I always try to remind myself because it's still wild to me. It's wild I'm sitting in this room. Like you've been around for so long

Dr. Mark Hyman
before finally heard you. And

Dr. Andy Galpin
I'm like twenty years ago I'd be like, hey what are the chances are you'd be in room with Mark Hyman? I'm gonna say zero. Zero, right? Where I come from, my background, the kids that I grew up with, I'm like, the things I've done, I was just in The Middle East.

Dr. Mark Hyman
Yeah.

Dr. Andy Galpin
I've been with the world's most successful athletes. I'm like, my business partners and I, my wife and I, my brother and I, I'm still just like, how? How did this all happen? Yeah. So the one non negotiator for me is always no matter what.

Dr. Mark Hyman
Being grateful.

Dr. Andy Galpin
Being grateful because all of us have been through trauma at some point and you know that all this could go away. All this could go away by the time we finish this podcast.

Dr. Mark Hyman
Right? Mhmm.

Dr. Andy Galpin
So that's the only thing. There are things I like to do more than this stuff but the one thing that I will say like no matter what the day is or situation, if I'm on the side of a mountain somewhere, like I'll be next week in Canada trying to chase down a bear and I'm freezing or whatever the case is going on, it's like, yo, this is pretty rad. This is a pretty cool thing you get to do Yeah. Every day. So that is on my

Dr. Mark Hyman
Gratitude. I love that. That's a good one. That's a good non negotiable. I think that's that's someone everybody should take home.

And if if you had to kinda sort of just distill your work into a principle or two that people could understand, what would you say it is?

Dr. Andy Galpin
Think I've hit a lot of my major philosophical points this far. One maybe I'll add to this is a saying that I stole from Bill Bowerman. It's the way I finish every episode of our podcast of my podcast. If you have a body, you're an athlete. If you look at something like the NBA combine, the NFL combine, like these testing events that they do prior to drafting a player, and you looked at all the testing they go through, and then you look at a longevity clinic, you're notice this is really, really similar.

Alright. So I do this a lot of times when I present, so I'm kinda giving it away. But if we take Brian Johnson, right, who's clear with wanting to live for forever, the most longevity person we could follow, right, on the end of the spectrum. Yeah. Whatever, okay.

And we went the opposite end of the spectrum, and we went to Fred Warner, one of the best football players in the world. I might talk to those two dudes in the same day. And if we started look putting a list down of what do they care about, and we said v o two max and metabolic flexibility and healthy joints and reaction time, hand eye coordinate, I could fill this whole list out and they would be the

Dr. Mark Hyman
same. Mhmm.

Dr. Andy Galpin
And then at the very end, it'd be like, I wanna never die. Okay. And then the very end over here would be, I need to make sure I'm over two hundred and twenty five pounds, I need to sack a quarterback, and my shoulder needs to have this ability. Okay. Fine.

So there are some ends there. But the reason that we've built our lab the way we have and these companies the way we have is because I fundamentally believe that. I want to give everyone the opportunity to look however they wanna look. You might wanna look skinny. You might wanna have way more muscle.

You might wanna look like fine. We have the ability, the technology, and the knowledge to help people look how they wanna look physically. That sounds vain. I always hated that, but as I got older, I'm like, man, that's actually really important. People like don't like how they look.

That sucks. That has a big impact on their life. So I want you to look however you wanna look, and if I don't like how that looks, that's fine. That's up to you. You wanna feel a certain way.

Right? You wanna feel more energetic. You wanna feel more focused. You wanna feel less back pain. Okay.

Whatever that feel is to you. And then the third one, wanna perform. You define perform. You wanna be able to paddleboard for six hours or hike up a mile elevation. Wanna be able to perform, be more focused with your kid.

Be more present, not distract I don't care. But if I were to say, hey, give me the ability to have these three areas and you tell me the rules of the game, and then you tell me the restrictions. Oh, and by the way, I only have a thousand dollars I can spend. Oh, and by the way, I'm an alcoholic and I refuse to stop drinking.

Dr. Mark Hyman
Okay. I'm like with that.

Dr. Andy Galpin
These are the things we get, right?

Dr. Mark Hyman
Yeah.

Dr. Andy Galpin
Oh, and by the way, I'm on a plane twice a week. Fine. You tell me the rules of the game, tell me what's not negotiable, and then I'm gonna do everything. And you can see I get really passionate about this. I'm like, let's go.

Now let's find solutions because you're an athlete. That's what I'm treating you as. You have a performance you have to hit. Mhmm. Mhmm.

I don't care if that's sports. I don't care if that's physical. You like this is a game. I'm competing now. I'm gonna fucking win.

Like we're gonna go after this thing. You told me some ridiculous thing you're not willing cool. Great. You have a medical thing we can't well fine. You give me those hard give me that hard case.

Give me that thing that is impossible and and we're gonna go deploy all means and solutions. And we will find this damn anchor. We will get that anchor out of the way, and you're gonna crush. Like that is what I get hyper passionate about. It's probably why I don't get like as personally passionate about population wide health stuff.

Yeah. Great. Great. But like I want that other person who's just like yo, a b and c are going on. I'm not gonna let you change those at all.

But now find a way to make fuck. Great. Let's go. Like, let's go and now we're gonna do this, this, this, and we just get after it.

Dr. Mark Hyman
That's great.

Dr. Andy Galpin
So we attack everyone like that's why we say if you have a body, you're an athlete. If you wanna use those abilities

Dr. Mark Hyman
That's good take home.

Dr. Andy Galpin
To kick a ball better, cool. If you just wanna be a healthier ager, if you wanna live to forever, I don't really care.

Dr. Mark Hyman
It's so great. I mean, it's it's such a great thing you do because, you know, most of medicine is focused on sort of the end stage diseases and not on performance or optimization or feeling better or things that matter to people. Mhmm. Like, yeah, it matters not to die from some terrible thing. Fine.

But like, every day, people living their lives, they just wanna feel better. They just wanna be able to do the things they love to do and not be restricted. And and your work has really helped people to understand what that is. So how can people find you? Where where can they learn more about your work and what you're doing and all the things you're working on?

Dr. Andy Galpin
No, I really appreciate all that. The thing that I hate about longevity is it's unfalsifiable. But feeling better now is an AB test. You did or you didn't better. My podcast is Perform with Doctor.

Andy Galpin. It's only in seasons. So season two just came out, season three will come out next year or something like that. So it's pretty easy to follow along with. We have a new lab that we're building in Parker University.

So we're building a 64,000 square foot human performance lab. And you actually outlined exactly what that lab does two seconds ago. It is that. It is my belief in understanding where the limits of human capacity. How do we push adaptability and resilience?

And we have some that will be open to the public. It's not open yet. But we're conducting

Dr. Mark Hyman
research. I'm gonna go. It's not that far from here.

Dr. Andy Galpin
Yeah, man. We'll have you down. Well, we have some technology in there that doesn't exist in the world anywhere else.

Dr. Mark Hyman
Can't wait.

Dr. Andy Galpin
So we have that and then

Dr. Mark Hyman
Pay me when it's open.

Dr. Andy Galpin
Yeah. We'll we'll actually get you there for pre opening.

Dr. Mark Hyman
Okay, great. Great.

Dr. Andy Galpin
Which would be easy. Then website and social media

Dr. Mark Hyman
are Great. And your website's andygalpin.com? Yep. Great. Well, Andy, thanks for what you do.

Thanks for being so passionate about it. Thanks for caring how to make each of us feel a little bit better, do a little better, live a little bit more fully and be grateful for everything in our lives. So thank you for being on the podcast and doing everything you do.

Dr. Andy Galpin
It's an honor, pleasure. Thank you so much.

Dr. Mark Hyman
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We'll see you next time on the doctor Hyman show. This podcast is separate from my clinical practice at the Ultra Wellness Center, my work at Cleveland Clinic, and Function Health where I am chief medical officer. This podcast represents my opinions and my guests' opinions. Neither myself nor the podcast endorses the views or statements of my guests. This podcast is for educational purposes only and is not a substitute for professional care by a doctor or other qualified medical professional.

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