OPP #16: Dr Rhonda Patrick on Inflammation, Modafinil & Sensory Deprivation

 

We're privileged to bring you an interview with Dr. Rhonda Patrick for the 16th episode of the Optimal Performance Podcast. Dr. Patrick is renowned for her work on aging & longevity, metabolism, neurodegenerative disease and the role of micronutrients in the diet. In this special episode we discuss inflammation, anti-nutrients, genetic testing, her views on Modafinil and other powerful drugs, meditation, sensory deprivation and more. Listen to it here!

 

 

 

What You'll Hear In This Episode from Dr. Rhonda Patrick:

• All about inflammation: what it is, how it occurs, and how you can mitigate it
• What you might not know about the trillions of bacteria that live in your gut
• Why food variety is critical to your performance
• The impact of anti-nutrients & lectins on your diet
• Optimal Vitamin D levels (it's involved in over 1000 cellular processes)
• How DNA damage happens and what it does to your telomeres
• Dr. Patrick's views on Modafinil, SSRIs & the other powerful prescription drugs being used to enhance cognitive performance
• Some newly discovered (and unexpected) side effects of Tylenol and anti-psychotics
• How Dr. Patrick is using 23andMe (genetic testing)
• Heat therapy vs cold therapy for recovery and anti-inflammatory markers
• Her upcoming work on stem cells and anti-aging
• Why she's getting into sensory deprivation with float tanks, and the insights she gets from meditation
• Dr. Patrick's top 3 tips to live optimal (and 1 extra bonus tip!)

(This is an audio-only recording)

LINKS & RESOURCES:

• Found My Fitness - Dr. Patrick's website
• Judy Campisi at UC Berkeley's Life Sciences Division
• Are Saunas the Next Big 'Performance-Enhancing Drug'? - Dr. Patrick's guest post on Tim Ferriss' site
• Vitamin D: involved in over 1000 cellular processes and critical to healthy performance
• Vitamin C: a powerful anti-oxidant that can have significant effects on recovery
• 23andMe DNA Testing

Dr. Rhonda Patrick on Inflammation, Modafinil and Sensory Depravation

Ryan: You are listening to the Optimal Performance Podcast sponsored by Natural Stacks. If you're into biohacking performance and getting more out of life, this is the show for you. If you want more on building optimal performance check out optimalperformance.com

Alright, happy Thursday optimal performers and welcome to another episode of the Optimal Performance Podcast. I'm your host Ryan Munsey, and I've got a very, very special guest with us today, Dr. Rhonda Patrick. Rhonda, say hello!

Rhonda: Hello everyone!

Ryan: Thanks for hanging out with us.

Rhonda: My pleasure.

Ryan: So, for our listeners who may not know who you are, which is probably pretty hard these days, Dr. Patrick has a PhD in Biomedical Science from the University of Tennessee, the Health Science Center and St. Jude Children's Research Hospital. She's done extensive research in ageing, cancer and nutrition so we have a lot to discuss today related to optimal performance and living optimal. So, we're really excited for this one. Before we really, really dive in, Dr. Patrick, we always have to take a few minutes, thank our listeners, remind them to head on over to iTunes, give us a 5* review, let us know how much you like the show. And for all the show notes you can always go to optimalperformance.com to see the video version with links, show notes and any resources that we may talk about, which I'm sure there will be plenty of today.

So with that said, Dr. Patrick, let's talk about inflammation.

Rhonda: Sure, inflammation. What do you want to know? You want me to just start riffin' on it? Because I can talk.

Ryan: I am well aware that you can. So, I guess, let's just kinda start at the top. What is it? How do we mitigate it? And then we'll start to get in to some of the roles of the lymphatic system and things like that.

Rhonda: Yeah. Inflammation is an important topic because it is the driver of the ageing process, it is the major driver of the ageing process. And what that means is it's accelerating what's already naturally occurring and with that comes along age-related diseases. So it's an important topic to understand and to understand the important role of the diet and lifestyle and the interaction with the process that causes inflammation. So inflammation is essentially just your immune system overreacting to something that it is programmed to try and defend you against. So it's kind of like your immune system trying to kill what it thinks is a foreign invader in your body and is kind of going on hyper-drive where it's like, trying to - I like to use this metaphor - trying to kill a cockroach in your apartment with a nuclear bomb, you know, as opposed to just stepping on it. So it wreaks havoc on all sorts of tissues and cells in your body and that's really kind of a very simplistic explanation of what inflammation is.

Now, what causes inflammation is much more complicated and I think that the majority of inflammation origins come from the gut. And most people don't realize this, but the gut is actually the organ that hosts the largest concentration of immune cells in your entire body. I think if you ask most people: 'where do you think the largest concentration of immune cells are?' Immune cells are the type of cells that are, you know, killing off foreign invaders and as a side-effect they release all these toxic chemicals that kill, quite nicely kill bacteria, kill viruses, kill other things that may enter our body. But they also kill other cells and damage our tissues. So there's lots of these side effects. These immune cells are largely concentrated in our gut and specifically in the colon. So most people would think maybe it's in the blood or in the spleen or the thymus, but no it's actually in your gut. And the reason for that is because the gut is actually exposed to the external environment. So food we eat, you know, comes in and the gut sees it. And that could potentially be very dangerous.

So, gut health is very important for maintaining, making sure your immune system stays in check. There's a lot of mechanisms by which that occurs. So for one, there's a lot of bacteria in your gut as well. So there's on the order of like 100 trillion bacterial cells in your gut. We're made of more bacterial cells than we are of human cells, which is quite interesting. I actually just had a podcast about this on my iTunes with two researchers from Stanford, Justin and Erica Sonnenburg. They research the gut microbiome and how the gut microbiome is very important for overall health. And so we were talking a lot about this topic, and the gut bacteria are very important because not only do they metabolize the food you eat and produce, you know, some vitamins and minerals, but they also regulate the immune cells in your body. 

And they do this by a variety of different ways. For one, they produce compounds that keep the immune system in check. So they produce compounds that will increase the number of a specific type of immune cell called T regulatory cells, which are very important for preventing autoimmune responses, meaning it's important for preventing your immune system from becoming so active that it starts to attack its own tissue. And that's, you know, autoimmune diseases are associated with things like type I diabetes, with rheumatoid arthritis, multiple sclerosis, asthma. There's a lot of different diseases that are related to autoimmunity. So your gut health is regulating the autoimmune process and these compounds that your immune cells in your gut produce are also very important for making sure that gut barrier stays strong. So, what are these compounds and how do we make them? Well, we have to feed our gut the right foods. 

Ryan: And that's exactly what I was gonna ask you. So, if we take it back to a performance standpoint or how can we manipulate this, what should we be avoiding? What should we be eating?

Rhonda: Right, so the compounds that are produced that, you know, keep the immune system in check, they make sure that you make a specific type of immune cell that prevents autoimmune reactions from occurring and also make sure that the gut barrier stays intact. And that's very important because the gut barrier separates these immune cells from the bacteria in your gut, and when that breaks down your immune cells start to see all this bacteria and that's like a sign of: 'oh my god, I'm being invaded!" So they start firing away all these toxic cytokines, pro-inflammatory blah blah blah, you name it, there's like millions of them. But these pro-inflammatory cytokines get released into the blood stream, they get into the brain, they damage all sorts of tissues. So it's not just damage in your gut, it's damage everywhere in your body. 

So the question is: what do you eat to prevent that damage from occurring and to make sure that you're feeding your gut the right foods? And the rights foods are actually fiber. It's one of the most important foods. Fiber is what a specific type of bacteria, lots of different types of bacteria in your gut, which are often referred to as commensal bacteria because they produce these compounds which are called short-chain fatty acids. Short-chain fatty acids are produced specifically when this bacteria eats fiber. So the fiber that we can't digest gets fermented in our gut, in our colon, specifically by these types of bacteria, and there's lots of different strains that I could rattle off, but really it's lots of them. And they produce these compounds which then regulate the immune system and also feed your gut cells in the colon. 

Between like 60-90% of the energy they require doesn't come from glucose, doesn't come from proteins, doesn't come from any of that. It comes from short-chain fatty acids. They like butyric acid, propionic acid, acidic acid, lactic acid. These are what fuel the gut cells to have enough energy to make the gut barrier. Your gut cells are squirting out this mucus type of gel that kind of looks like snot, which is called mucin. And mucin is the gut barrier. So when you don't feed your gut the right fiber they don't get, you know, the food they need to produce these short-chain fatty acids. So it's a big problem.

Ryan: So what are your favorite foods to provide those fibers and those fatty acids?

Rhonda: Yeah, so really all plant sources. So anything vegetable and many different types of fruits, like apples, pears. These have a type of both soluble and insoluble fiber. And there's a whole different variety of these types of fibers that get broken down into specific compounds. And we haven't identified [unclear 00:10:38] those compounds yet, we just know there's a broad spectrum. So it seems as though getting - what I mean by broad spectrum is - getting a broad spectrum of different vegetables and fruits is important. So not just eating kale, but eating chard, kale, broccoli, spinach, carrots, tomatoes. Like these all have different types of fibers. So really making sure that you're getting your dose of vegetables every day. I think that's my favorite type of fiber not only because it's fiber, but also it has all the micro-nutrients which I so often talk about. Micro-nutrients are also very important. So you're getting a lot of, you know, vitamins and minerals, trace elements and fiber all within this, you know, food source. So that's my number one favorite. 

Legumes are also a very good source of fiber. Lentils, chickpeas, beans. Your favorite beans. I also like nuts and seeds. Nuts and seeds are also a type of fiber, as well as mushrooms! Mushrooms are a great source of beta-glucans which are one of the compounds that are also broken down by your gut bacteria to produce important things that regulate the immune system in a positive way. So those are my favorite sources of fiber. I try to eat those often. 

Ryan: Okay.

Rhonda: In fact, I put them all on my salad so nuts, mushrooms, and greens.

Ryan: Quite a power salad. Now, you mentioned beans. We hear a lot about lectins, anti-nutrients and how they can negatively impact the gut. Talk about that. I mean, if you're eating them obviously you don't think that that's an issue.

Rhonda: I don't. I think that lectins can be an issue. Okay, so first of all a lot of the research on lectins has been done in-vitro meaning you dump the component. So lectins contain an immune type of molecule that is similar to something that our immune cells recognize as like a bacteria. So it's a very similar type of, like a marker, basically.

Ryan: Right. And that's a similar situation with certain dairy proteins, like casein. It's a similar scenario. 

Rhonda: Something like that, yeah. A little bit, yeah. Lectins are much more, they're everywhere in nature. I mean lectins are in plants, they're in beans. They're more concentrated in beans but they're everywhere. They're just in all plants. They're very, very ubiquitous. And they contain this type of marker that looks like an immune signal, like a signal to your immune cells to say: 'wait, this is a foreign invader!' But a lot of those studies that are done, are done on cells that are in culture where you dump a large quantity of lectins on them to create an immune response. And yes, that's definitely gonna create an immune response. In terms of eating beans, okay, not to mention lectins are often heat inactivated and I'm aware people claim that heat doesn't always inactivate them and I'm sure that maybe that is the case. I don't know. I haven't seen, you know, a lot of evidence showing that, you know, it's not inactive with heat. But I haven't really looked for all the evidence either. But, for the sake of argument even if it is not inactivated, the problem with lectins I think mostly comes from people that have gut issues. They already have a gut barrier that is not robust and their immune cells are now able to see the lectin. That's the major problem in my opinion. 

I think that people that have - because beans are such a great source of fiber and it's been shown in numerous studies. They are fermented to the type of nutrients that fuel your gut cells to produce mucin. They regulate the immune system in a positive way. However, I think there are cases of people that have already as a consequence of a bad diet, they may have dysbiosis due to antibiotic overuse, due to eating a high amount of refined carbohydrates. I mean these things not only starve your gut bacteria of the fiber they need but they also do negative things. So, you know, someone that already has a very unhealthy gut may be much more sensitive to eating beans because the immune cells in their gut are already sort of overactive and their gut barrier is already broken down to some degree. So it may have a negative effect on those people. 

Personally, I think that the lectin issue is just overblown and I think that beans are pretty healthy. They're a healthy source of fiber. And I eat lentils and chickpeas and black beans all the time and I don't have, you know, I've got very low markers of inflammation and a variety of different bio-markers of overall health are positive for me.

Ryan: So, tell us a little bit about your favorite markers for inflammation. You mentioned that if you're keeping an eye on that. For some of our listeners if they wanted to look into that for themselves, what should they have checked or try to track?

Rhonda: Well, I think that right now the, unfortunately, consumer available bio-markers for inflammation aren't that great and the standard one is C-reactive protein, which is okay. It's not as sensitive as some other potential bio-markers which some of my researcher friends are trying to possibly get, you know, established as a marker for inflammation. But for now I think C-reactive protein is pretty good. You know, it does obviously, if you're sick or whatnot, that would be elevated no matter what. But other things I think that are really indicative of inflammation is actually if you have a really high LDL particle, or not particle count but total cholesterol. 

Your LDL cholesterol - and I'm not saying that LDL cholesterol is bad. I think, you know, it's good to have LDL cholesterol and I talk about this in another podcast I did recently with Dr. Ron Krauss. But, when you're inflamed, inflammation creates your body to make a lot of LDL cholesterol. And the reason for that is because LDL cholesterol creates binding sites for something called endotoxin, which is released when your immune cells become in contact with the bacteria in your gut, meaning that your gut barrier is broken down. That happens, and so your LDL cholesterol will be really, really high when you're inflamed, you know, if you have high inflammation. So that's another marker and I think that goes well with the C-reactive protein, looking at those two together.  Looking at vitamin D levels also is important.  

Ryan: I know that's something you've talked a lot about. Give us, like, a quick CliffsNotes version of that. You know, where should those levels be?

Rhonda: Yeah vitamin D, because it's actually converted into a steroid hormone, it's important much like estrogen or testosterone. I mean imagine being deficient in those; lots of bad consequences, right? So, having adequate levels of vitamin D is very important and, you know, around 70% of the population has levels of vitamin D that are considered inadequate. And what that means, so what's considered inadequate? So having blood levels of the precursor of vitamin D which is 25-hydroxy vitamin D. Less than 20 nanograms per milliliter is deficient. Having blood levels of the precursor of vitamin D between, lower than 30 nanograms per mil is considered inadequate and having levels between 40 and 60 is considered adequate. And the reason I like between 40 and 60 nanograms per milliliter is because, um there's about 31 studies that have shown that that level of vitamin D is associated with the lowest all-cause mortality. So, you know basically it's associated with the lowest all-cause mortality, dying from diseases such as cancer, neurodegenerative disease, cardiovascular disease, anything but accidents. So I like that. 

And also it's associated with the longest telomere length. And telomeres are very important for protecting your DNA, and are also a bio-marker of ageing. So, by the way, back to the bio-markers of inflammation, another thing that I really like is something that's not readily consumer available but it is- you can find some companies doing this. It's DNA damage. DNA damage and telomere length are two bio-markers of inflammation because when you are highly inflamed, you have high levels of DNA damage, you have high, sorry, shorter telomeres.

Ryan: Who's doing the DNA damage stuff? If we wanted to look into that.

Rhonda: Um, I don't remember the name of the company. I can look it up right now but it's Judy Campisi at UC Berkeley. She's got a company that is looking into that. 

Ryan: That would be really cool to find out. 

Rhonda: Yeah, it's a company that's barely new, and I'm sorry I don't remember the name.

Ryan: It's okay. We can find it and we'll put that in the show notes.

Rhonda: Alright, great! Put it in the show notes, that'll work.

Ryan: So, if you're listening make sure you head over to optimalperformance.com, check out the show notes. We'll have a link right to that for you guys so you can check out whether or not you have DNA damage or how much. We probably all have some, right?

Rhonda: Well getting back to your, you know, I kind of, I went off in a lot of different tangents here but back to your inflammation and performance link. I didn't get into this too much, but really, there's a major effect on cognitive performance. And that's something that I don't think many people realize, the link between inflammation and cognitive performance. 

Ryan: So I don't know if you read Dr. Perlmutter's book 'Grain Brain' but I'm wondering if you're gonna talk about some of the same stuff that's in there.

Rhonda: I have not read his book.

Ryan: Okay. It's very fascinating. We're hoping to have him on the show as a guest, too. But, go ahead and give us your perspective in how inflammation can effect cognitive performance. 

Rhonda: Well there's - I'll try to keep it very brief - there's a lot of ways in which it does. You know, so one of the ways if your gut health - like we talked about earlier - you know, if you're not eating the right foods, if you're not getting enough fiber, you're starving this bacteria of essential precursors to make compounds that regulate not only the immune system but also that keep the gut barrier strong. If that doesn't happen, you start to have a breakdown of the gut barrier, you start to have your immune cells come in contact with bacteria, they start to create cytokines, pro-inflammatory molecules. 

These molecules have been shown to cross over the blood-brain barrier. And it's been shown actually when you - that the thing that happens is, when your immune cells become in contact with your gut bacteria, they start to eat it and kill it, and what happens is bacteria release the endotoxin which I talked about, which is also called lipopolysaccharide. It's a component of the bacterial cell membrane. And that gets released into your blood stream and creates all sorts of inflammatory processes, it continues the cycle of inflammation. 

Well it's been shown if you inject endotoxin into people, they basically start to create these pro-inflammatory cytokines which get across the blood-brain barrier and cause depression. And that can be mitigated by also administering an anti-inflammatory like EPA from fish oil. So if they inject endotoxin and give people fish oil, they don't get depressed. But if they get the injection of endotoxin and do not get the fish oil, they get depressed. And one of the ways that the depression occurs is that these pro-inflammatory cytokines, they set off a cascade of inflammatory processes in the brain and release something called E2 series prostaglandins which, basically those shut off the release of serotonin in the presynaptic neuron.

So serotonin gets released in your presynaptic neuron, gets released into the synaptic cleft and then it binds to a postsynaptic neuron to have, you know, the function occur. And when you have the E2 series prostaglandins, which are these inflammatory mediators, going off in your brain, it stops serotonin from being released. Serotonin is not only a neurotransmitter, but it acts as a hormone in the brain. It regulates not only mood but also regulates behavior, particularly impulsive behavior, aggressive, impulsive aggressive behavior. It regulates appetite, mood, executive function, learning, memory, you know these things are all being regulated by serotonin so shutting off serotonin release in the brain, not a good thing for many reasons. Not only are you not, your learning and memory is disrupted but your mood and your behavior, you become much more impulsive. And this has been shown, um experimentally in people, when you deplete them of their serotonin. 

So, um that's one way inflammation is effecting cognitive function. The other way is that these inflammatory molecules are getting into the brain and that causes all sorts of like, signaling processes to go off where your immune cells in your brain then start to become active, the microglial cells. And they start to try and they're like: 'what's going-?' they get sort of, you know, activated, 'what's going on here?' And this sets off this chain of events of protein aggregation and an accumulation of protein plaques in your brain which then sets off this whole vicious cycle of inflammation and more, you know, protein plaques in the brain and, you know, that leads to neurogenerative diseases, Alzheimer's, Parkinson's, all sorts of problems. So it's not only disrupting cognitive function now, but there's long-term effects in inflammation and regulating brain ageing. So, and that's a very, very, very simple overview.

Ryan: Yeah, and that's actually very similar to what was - what I thought you may say, but that's definitely what Dr. Perlmutter was talking about in the book. And I'm looking up here, right up here somewhere I have notes that I'm actually working on a post talking about those things, the cytokines and crossing the blood-brain barrier and leading to the diseases of inflammation and ageing. But I can't get to them without taking my attention away from you and, you know, getting off track here so we won't do that. But, you know, since we're talking about neurotransmitters and chemicals in the brain and cognitive function, Modafinil is a hot topic in the media right now. Do you have any experience with it? Thoughts on that? Thoughts on the long-term, you know, damage or down side to using it?

Rhonda: So, I'm only very, very slightly, like vaguely familiar with Modafinil. I have no personal experience with it and I haven't done any research, you know, looking into it. But I will say that, I mean I do have some thoughts on it and my thoughts are um, it probably works. It probably does enhance, you know, cognitive performance in the short term. But, it is a drug and the thing to consider and to realize about drugs is that the reason they work is because they're perturbing a metabolic process. Metabolic process being your neurotransmitter release or neurotransmitter reuptake. Whatever the metabolic process are those are all metabolic processes. That's how drugs work. And you have to realize, when you're perturbing something that's naturally occurring in the brain, your body and your brain is very, very smart and there are feedback mechanisms which occur and these feedback mechanisms often have long-term effects.

So, the perfect example is an SSRI. You know, when you take an SSRI and you prevent your neurons from metabolizing serotonin so that serotonin sits around longer and the action of it, the function of it is happening for a longer time period. So you feel better. Well that's all well and good but the problem is that your brain goes: 'oh! I've got a lot of serotonin sitting around here, I'm going to stop making as many serotonin receptors on my neurons to bind to the serotonin because I don't need as many of those since there's so much serotonin around!' And that's not a good thing. When you start to not make as many receptors - and this has been shown, by the way, it is a response to serotonin, reuptake inhibitors - now, when you don't take the serotonin, you become very, your brain isn't responding to the little serotonin that you do make because it doesn't have all these receptors. So, there's all these, like, long-term effects.

And I think that with Modafinil, I don't think there is, I think there's a trade-off. And I don't know if those trade-offs have been identified. I don't think the long-term effects have been identified. But I'm pretty hesitant to take any sort of drug that perturbs any sort of, you know, process in the brain because that reason. Because, you know, and there's many examples where, you know, for example Tylenol. Tylenol's been around for like over 100 years. It's one of the oldest drugs around, and we just started to find out, like a year ago, that it effects social pain. So, we've been using this drug for 100 years and a year ago studies come out going: 'oh, by the way, there's this other effect that we didn't realize that's been occurring for the last 100 years but it actually effects social pain'. And, which isn't too surprising because there are some similar mechanisms between pain, the pain pathways and social pain that they're shared in common. But still it's an example of look, this drugs been around for 100 years and we still are figuring out other effects that are, you know, happening. Another example would be the anti-psychotics which are now, just now we're starting to find out that they're, they have some long-term bad effects where they actually cause brain atrophy. So, they may prevent people from getting violent and all these other sorts of things, but they're literally causing their brains to shrink at a very rapid rate. 

Ryan: Yeah, I was actually gonna ask you somewhere in that answer with the SSRIs, do I detect that maybe you would be opposed to using them? Personally?

Rhonda: Personally, yeah. I - so, you know, I just published a paper not too long ago in the journal, FASEB journal, where I talk about how I think there's a major nutritional role and environmental role in precipitating neuropsychiatric diseases including depression, bipolar disorder. A lot of these diseases that SSRIs are sort of the go-to treatment for, were, you know - we know that people do have certain gene polymorphisms that predispose them to not making as much serotonin or not responding to serotonin very well and that is clear. And I think that people with those gene polymorphisms that are already pre-disposed to low serotonin are particularly vulnerable to other nutritional and environmental factors that also regulate serotonin, vitamin D, omega-3. So, you know, these things regulate serotonin and also trauma.

So when you have any trauma and inflammation, trauma and inflammation both cause tryptophan, which is the precursor that gets into the brain to make serotonin. Tryptophan, when you're inflamed, when you're sick, when you're stressed, so like a traumatic situation, tryptophan does not get metabolized into serotonin. Tryptophan gets metabolized into this other molecule that regulates the immune response. Because your body thinks it's in stress mode, so it's shunting the tryptophan to the immune system.

Ryan: Right.

Rhonda: The problem is you're depriving your brain of serotonin.

Ryan: Right. It's going for survival before optimal function.

Rhonda: Exactly! And so, what, you know, so some of the consequences are, well people like me, so I've looked at a lot of my gene polymorphisms. I think we do not have any gene polymorphisms that predispose me to low serotonin. So, let's say I'm inflamed, I don't have a good diet, I'm low in vitamin D, I'm not as predisposed to becoming very depressed or getting bipolar as someone who does have that gene polymorphism. For example, my mom! I've identified that my mother has a certain gene polymorphism that makes her serotonin get metabolized really, really fast. So, and this is a common polymorphism in people that have major depression and bipolar disorder. And it's, so it's very common for people that have those disorders to have this certain gene polymorphism because the serotonin that they make gets metabolized really quickly. 

But so I think people with those polymorphisms are very, it's very important to optimize what you can in your lifestyle, in your diet to make sure that you're getting the optimal nutrients to give yourself the precursors to make serotonin, to make sure that you're not always in, you know, in a stress mode, you know, inflamed mode. Because back to the gut! If you're feeding your gut the wrong foods, if you're eating a bunch of refined carbohydrates and you're not getting, you know, the right veggies and fiber to, you know, feed your gut the right substrates it needs to keep the gut barrier strong then you are going to have inflammation and that is gonna effect your serotonin. It's gonna cause tryptophan to be metabolized into something called kynurenine. 

Not only does kynurenine strip away the tryptophan, so cause the tryptophan to be metabolized into another pathway and prevent it from being made into serotonin, but kynurenine itself gets metabolized into another compound called quinolinic acid, which crosses over the blood-brain barrier and causes no inflammation! And causes depression! And, by the way, exercise causes kynurenine to be taken up into muscle cells so it doesn't make that toxic thing that gets into your brain. Another reason why exercise is so important for depression and for, you know, overall health and performance in general. But, do you see how everything's connected? 

Ryan: Yes! We were designed to move, we were designed to eat right, just do what we're supposed to do.

Rhonda: Yeah!

Ryan: You've mentioned a few times, looking into, you know, your own DNA and your family's DNA, you know, you've talked about before 23andMe. So I don't think we need DNA examinations to know that we shouldn't eat refined carbohydrates or, you know, Krispy Kreme. But, tell us a little bit about how you're using 23andMe to help people nutritionally and how our listeners could do something similar. 

Rhonda: So I think that there are certain gene polymorphisms that affect the way we metabolize certain micronutrients, they affect the way we metabolize some macronutrients, they affect the way all, we, our, the way we produce cholesterol or the way we recycle cholesterol, things like that. And it is very useful to understand and know which gene polymorphisms we have in those situations because, for example, there's a very common gene polymorphism in one of the enzymes that converts the vitamin D3. Either you make, that you make from the sun, in your skin, or that you take orally from a supplement, or that you get from the fish you eat. So vitamin D3 gets metabolized and converted into a steroid hormone as I mentioned. Well there's an enzyme that does that, and there's a very common polymorphism in that enzyme, in the gene that makes that enzyme, which makes that enzyme not work very well. And so, what can end up happening is someone doesn't know they have this polymorphism, and I've actually met two people, two friends of mine that have this polymorphism. And what's funny is that actually I knew, I knew both of them had it before they identified it. But anyways, that's a whole other story.

Ryan: How did you know? What was the sign? Or what was the giveaway?

Rhonda: I knew because they were so vitamin D deficient and they were talking about this certain type of vitamin D and I was like: 'you have to have this polymorphism, it doesn't make any sense'. And so they both - 

Ryan: So you knew their, you knew their lab values and what they were supplementing with?

Rhonda: Yes!

Ryan: Okay.

Rhonda: Yes, yeah! And so, you could be taking 2000 IUs of vitamin D a day and think: 'I'm getting enough vitamin D because I'm taking 2000 IUs of vitamin D a day'. Well, turns out if you have this polymorphism which makes the enzyme not very active so you're not converting that D3 into the active steroid hormone, which does everything that vitamin D does in the body; so vitamin is turning on, turning off over 1000 genes, which means over 1000 physiological processes including, you know, decreasing genes that, you know, involved in inflammation, increasing genes that are involved in repairing damage, in, you know, genes that are involved in muscle repair, brain function, I mean, on and on. A hundred- a thousand different of these genes. Anyways! You're not gonna know that because if you get your, if you don't get your vitamin D levels measured, you wouldn't know that because you're like: 'oh, I'm taking 2000 IUs of vitamin D and that should be fine'. So, you wouldn't know that in fact, those people actually had to take a much higher level of vitamin D than normal people without that polymorphism would have to take. Um, so that's one example.

Ryan: Let me just ask you a quick question, because you've mentioned a couple of times different lab values. How frequently do you have your blood work tested and how frequently do you recommend other people have theirs checked?

Rhonda: Well, ideally when I'm not running around doing 20 different things, I try to do it every quarter. So I think, I think that is ideal. I would say the bare minimum, twice a year. I would say twice a year is probably, you know, is probably, I mean if you think about how many times you change your oil in your car. You know? I mean, it's the same thing. If you're taking care of your car, if you're getting a tune-up, if you're getting the oil changed, you know, if you're doing all those things to your car why wouldn't you do those to your body? Isn't your body more important than your car?

Ryan: I agree with you! And I think our listeners are in that realm, but I think that the general population is: 'oh, I'm not sick, so I don't need to'.

Rhonda: Right, right, yeah. No, I think that, you know, getting your standard lipid profile, getting some of your micronutrient levels measured, looking at some inflammatory markers, those things are all very good to do, hormone levels. Those are all very important to do and once or twice a year, you know, bare minimum. So, yeah. And yeah, that was, so the vitamin D nutrition just one, I mean gene polymorphisms one example, another very common one is the MTHFR which regulates the way your body metabolizes folate. And that's another very, very common gene polymorphism, where your body folate, when you eat folate in the form of vegetables, folate is in green leafy plants, it does two very important things in your body. One is it serves as precursors to make new DNA and every time you have to repair a damaged cell, whether that's damaged muscle or damaged endothelial cell in your arteries, your vascular system, or any time you're making a new cell, you need new DNA. Folate does that. And also, it serves as a source of methyl groups which is a precursor for epigenetics, which changes the way we turn on genes or turn off genes, it's very important.

And so people have a certain polymorphism that makes them not be able to make those methyl precursors very well and the only way you're gonna know that is by getting a genetic test. And if you do have that then you can supplement with a certain type of B vitamin called L-methylfolate and also you can supplement with the methyl B12 and that's been shown to be very important. So I don't want to go too much into detail but those are just two examples of why I think, you know, getting a 23andMe test is important. 

Ryan: Okay. So, you know, I'm a big believer in nutrient timing and I'm certain, you probably are, too. Can you give us some of your thoughts on, you know, how we can manipulate our intake to maximize both mental and physical performance?

Rhonda: What do you mean, um, nutrient timing to -?

Ryan: Like micro or macro nutrients at certain times. 

Rhonda: Like certain times of the day, or like -?

Ryan: Mhm, or before or after certain activities. Like when would be the best time to ingest protein or carbohydrates, um, does it matter?

Rhonda: Yeah, I mean, I haven't done too much research on when the best time to ingest protein and carbohydrates are. I mean obviously if you're going to eat, carbohydrates that are higher on the glycemic index, um, I think that, you know, after exercise is great because exercise increases the expression of something called glucose for transporters on your muscle cells, GLUT4 transporters. And those - when you have a higher amount of those it causes the glucose to go into your muscle cells which is used to build protein. So for protein synthesis. And obviously you want - any type of sugar you're taking in- you want it to be used for something like building muscle 'cause that's important. So, you know, and I think that protein - lots of studies have shown protein intake in the morning helps with, you know, satiation. But obviously protein intake right before bed also helps with satiation and I think also helps you with growing muscle, so. But I'm really not an expert on that so I just haven't done too much research into that.

Ryan: Okay. What about antioxidants? I know that is something that you've spoken a lot about recently. When's the best time to, you know, take a high dose of a greens powder, or should we still be doing that?

Rhonda: I personally prefer making a vegetable smoothie to a greens powder. I think that the ratios of micronutrients are right. The fiber's in there, you're not getting, you know, too much of one mineral and too little of another because that's also important to not have, you know, you want these ratios to be important. You don't want too much of one mineral, 'cause that can be very damaging. So I think that, you know, micronutrients [unclear 00:43:40] from actual vegetables is my preference, and that's what I like to do myself and also to talk about. But in terms of supplemental antioxidants like, you know, vitamin C, vitamin E, I'm a little more hesitant about taking supplemental antioxidants. 

In general, I do - I kind of oscillate back and forth between vitamin C, vitamin C is very important. It's not just an antioxidant, it's also a co-factor for enzymes. It plays a very important role in mitigating inflammation in the blood vessels. And, which is important for preventing a lot of cardiovascular diseases. However, taking supplemental antioxidants right after you exercise may not be such a good idea and the reason - and a couple of studies have recently shown this - and the reason for that is because part of the positive benefits of exercise has to do with the hormetic effects of it, meaning when you exercise you actually are causing damage. You're increasing inflammation briefly, a short burst of it. And it's also increasing something called reactive oxygen species because your mitochondria are working, you know, harder. And so what's happening is that the mitochondria are working harder when you make more of these reactive oxygen species, it causes more mitochondria to grow, so you're actually increasing something called mitochondrial biogenesis. And the key for that is the reactive oxygen species that are being made in that short burst that's occurring when you exercise. Also the inflammation that's occurring within the first hour, the response, your body's response is to increase the genes that are involved in making all these anti-inflammatory cytokines and anti-inflammatory compounds. So that happens because of the short bursts of inflammation that occurs.

Now if you take a supplemental antioxidant right when you're - like right before you exercise or right after you exercise, then you're going to mitigate that inflammation, you're gonna mitigate that burst of reactive oxygen species. And so, you're not gonna have the increase in genes. So, let me start by saying this, I should've said this at the beginning: supplemental antioxidants, they pale in comparison to the natural antioxidant genes that your body makes. So these genes that make all these different enzymes that are involved, you know, antioxidant responses and anti-inflammatory responses, those are much more potent than taking a supplemental antioxidant. [unclear 00:46:32] supplemental antioxidant aren't important, it just means our body's superior. 

Ryan: We have a superior built-in system that is designed to say: 'hey, we just got stressed, we need to build ourselves up bigger and better to handle that stress better the next time we see it', and if we interject with supplemental antioxidants then we are interrupting that process. 

Rhonda: Yes. I think that is, it's so complicated because, you know, on the one hand that's the case, especially when you're interrupting the process of when you're actually doing this hormetic response, like exercise. Also intermittent fasting, that's another type of hormetic response that it can interfere with. But with that said - 

Ryan: Antioxidants can interfere with intermittent fasting?

Rhonda: Supplemental and- yes. With some of the positive benefits of intermittent fasting, yes. Yes.

Ryan: For the same reasons?

Rhonda: Yes, the same. Well, it hasn't been shown, but I'm speculating just based on my knowledge of biochemistry and what's happening with intermittent fasting and how that is - intermittent fasting is also a hormetic stress.

Ryan: The only reason that one grabs me is I know - I like intermittent fasting, I know a lot of other people in the health and fitness realm do. And I know quite a few who, while they're fasting will ingest, like a greens powder. So they may be mitigating some of the potential benefits that they think they're gaining from fasting?

Rhonda: I don't know exactly what's in a greens powder, so there's a certain level that's important. I mean, your body, you know, vitamin C is needed not only as an antioxidant but as a co-founder for enzymes to work. So, I mean, there's a certain amount of it. Like if you're getting it from foods, you know, I mean that's okay, you're not getting a huge dose of it, but - 

Ryan: It's a natural dose.

Rhonda: Yeah, it's not- it's more in the physiological range where it's being used as the co-factor, it's not like you're getting this huge burst of it to be, you know, to sequester all the reactive oxygen species and things like that. So I don't really know about the green powder you're referring to, it's, you know, like - 

Ryan: I mean, it could be any- I mean I'm just, I'm saying greens powder as a generic 'cause I don't want to say any particular brand, it could be several brands.

Rhonda: Okay, yeah.

Ryan: So, well, you know, if we're talking about not wanting to mitigate that hormesis response. Talk about something that you're also kind of, starting to talk a lot about: saunas and hypothermic benefits. Because in this same discussion of, you know, not having antioxidants directly after a workout, I mean a lot of research is coming out and saying well maybe we shouldn't ice sore muscles for that same reason because we would be blunting that response. Does, you know - tell us a little bit, I guess, about, you know, your sauna and hypothermic thoughts. This is something that Tim Ferriss has recently picked up and I think you were on his show or on his blog talking about this, but, you know give us some of your thoughts on that and does that mean it's better than cold therapy or cryotherapy. 

Rhonda: So, um I did, I recently wrote an article - a long article - on some of the research I had done not experimentally, but from gathering research in the literature on the effects of heat stress by using the sauna and those effects on endurance, on, you know, maintaining muscle mass, also on the brain and that was a guest post on Tim Ferriss' blog so he was very interested in that concept. And it's basically - the principle behind it is that you are stressing your body with heat, and this heat stress will induce a whole host of genes involved in dealing with stress to be expressed at a higher level. And that has been shown in multiple animal models, it's been shown in muscle tissue from humans. Heat stress will activate genes that are involved in dealing with stress. So they activate genes that are involved in repairing damage, they activate genes that are antioxidant genes, they activate anti-inflammatory genes, they activate genes that are involved in preventing proteins from aggregating. 

So one of the specific ones are heat shock proteins, they are robustly activated upon heat. And heat shock proteins are very, very potent antioxidants, they're also very potent at preventing proteins from aggregating and this leads to - protein aggregation leads to problems like, you know, when aggregates occur in your arteries, that can lead to cardiovascular problems and also in your brain, Alzheimer's disease. So, the activation of heat shock proteins are part of that hormetic response which are really, really good, and in fact have been shown in lower organisms like flies and worms to increase longevity, so increase lifespan. Just even one exposure to heat stress can increase the lifespan by like 15-20%, and so that's really quite nice. And also people that have gene polymorphisms that make them have more active heat shock proteins, so their heat shock proteins are active all the time, they are more likely to be a centenarian. So they have a, you know, a higher chance of living to be 100. 

So the sauna has also been associated with longevity recently, you know, it's been associated with a lower all-cause mortality in a dose-dependent manner. So men in Finland that used the sauna 2-3 times a week had a 24% lower all-cause mortality and men that used the sauna 4-7 times a week had a 40% lower all-cause mortality. So they died less of cardiovascular disease, they died less of cancer, they died less of. So and I'm speculating here but because I know the literature, the animal, the mouse literature and the worm literature where the same thing has been shown, where heat stress also increases longevity, I think this may be mediated through heat shock proteins.

And also from another gene that gets activated when you're upon a heat stress called FOXO3, which is another gene that activates all these other genes, it's like this, just, net effect where you just keep activating all these really, really good genes in the brain, in the body that deal with all sorts of stress. They deal with many different types of stress. And that persists for quite some time, it can persist for - even when you become conditioned to it, um, it can persist for weeks. 

So that's really a positive thing in terms of the endurance and the muscle mass, I don't wanna get too much into this, but the heat shock proteins also prevent protein degradation and muscle, the heat stress activates a growth hormone which activates IGF-1, it prevents proteins from being degraded, so it stops muscle atrophy, that's been shown in mice. So if you, you know if you expose mice to a 30 minute, sort of, mouse sauna where you put their whole body in a little chamber and you heat them up and then you, you know, immobilize their leg for a week, they lose, you know, much less muscle mass and they grow their muscle faster, like by 30%. So it prevents muscle atrophy and also it helps with muscle regrowth, that's been shown in mice. And I think that's also because of the heat shock proteins and the IGF-1, et cetera, et cetera. 

Ryan: So saunas are awesome!

Rhonda: Saunas are awesome, yeah! And to get to your question on the cold shock, I think that it's just much more complicated. There are benefits that can be had from doing cryotherapy after a workout. However, it really depends on the workout. So, like I mentioned, when you exercise, the first thing that happens when you exercise is you have a massive inflammatory response. That's the first effect. One hour later - and you can measure this, you know, by doing blood work so, you know, if anyone's working out, immediately after your workout like, you know, 5-10 minutes after your workout you get a blood test, you can look for markers of the inflammation, cytokines, you can look for things that are released from muscle. And, you'll see an increase in those things. One hour after the workout the opposite effect happens: you have a major burst of anti-inflammatory response happening, and that can also be measured. People that are over-training, competitive athletes, professional athletes, people that just take it to the next level, NFL football players, you know, some of these MMA fighters, you know professional fighters - sorry, fighters and athletes in general. These guys are not just going to do their 45 or hour minute workout at the gym where they're doing some leg presses. I'm not saying that that's not a good workout, it is! I'm just saying they're taking it to the next level, they're pushing it to the next level. 

Ryan: Right.

Rhonda: And this has also been shown, that people that are over-training will - during that first period of inflammation that occurs - they spiral out of control and that doesn't stop, they keep having this inflammatory response. Now that is potentially dangerous because then you start to damage muscle tissue, and that has been shown, experimentally, with over-training. Cold shock can prevent and attenuate that inflammation that occurs from over-training. And this is why professional, elite athletes, this is why I think they use cold therapy and cold shock, cryotherapy, whatever you want to call it, after their training. Because they're trained very hard, and you know, of course all of us look up to these - they're our gurus, and we like to do what our favorite athlete does. And so we go: 'oh, well so and so is doing this, it must be good so I'm gonna do this after I go to the gym!' Well, the problem is that you're not training like your favorite - so, when you're not over-training and you go and you do the cold shock then you may be attenuating that positive inflammation that you need to activate all the anti-inflammatory pathways. 

And I think that's what this recent paper that came out, I think it was in the Journal of American - it was in a pretty decent journal, I forget the journal. I read the paper and, you know, these were done in athletes that were doing things like leg presses and some other leg workouts and it did attenuate the, some of the positive effects that occur from the workout. It attenuated some of the mitochondrial biogenesis, it also, I think, prevented some of the protein synthesis, the hypertrophy from occurring, or hypertrophy, whatever you wanna say. Um, so, you know, I think that the take-home here is context and that was a really long-winded sort of answer but - and I probably could have gone on for much longer than that but I think that the take-home here is context, that, you know, if you're over-training, you know, and you ice after over-training and it helps you out and it helps you bounce back and work out, you know, sooner, then it's probably a good thing. But if you're not out there over-training, if you're not pushing it to the next level, if you're not one of those people that are really, you know, takes it to the next level, professional, elite trainer, whatever, competitive athlete, then probably not the best thing for you.

Ryan: Basically, anyone who does or does not get paid, you know, the line of delineation is do you get paid, you know, for the way your body performs. 

Rhonda: Yeah, I think people know, I mean I think that people that are really - that take it to the next level, they have done some sort of cryotherapy after their training and it probably has helped them bounce back. I mean, I've heard people tell me that, but that doesn't mean that everyone should do that, you know? I personally like to do the sauna. I don't, I mean I work out hard but I don't think I over-train, and so I never ice after, I never go ice after I work out. I like to get in the sauna after I work out. That's what I do.

Ryan: Well that was gonna be my next question so, you answered that one. We have very little time left and so, so many questions that I wanna ask you. Um, so, let's kind of go rapid fire. Before we leave the lab so to speak, I wanna know what research have you maybe read or what has you the most excited right now that you haven't had the opportunity to either explore or publish yourself or, what's new and next for you?

Rhonda: Well for me specifically, I am getting ready to publish some exciting data which I can't get too specific about yet, but it has to do with nutrition and DNA damage. So I've been measuring DNA damage in blood, white bloods cells from people. Me and my army of students, my army of students from UC Berkeley. And we have some really exciting data there on specific nutrients that are affecting DNA damage in a positive way in people that are obese and unhealthy. So I'm very excited about that!

Ryan: That's fantastic!

Rhonda: Yeah!

Ryan: Is there any way we can find out some of those details?

Rhonda: Not until the clinical trial is over, which is in, right before Thanksgiving. 

Ryan: Fair enough. 

Rhonda: [unclear 01:00:27] Yeah, I can't, I'm not allowed to talk about it.

Ryan: I understand, I understand.

Rhonda: But I'm also excited about some of the, some research coming out with, you know, stem cells and re-programming stems cells into - re-programming skin cells into stem cells that can form any cell type in the body. I think this has a huge potential for ageing, for tuning up our ageing organs, for brain ageing in general. I think that's all very exciting. And also the new genetic engineering technology, the CRISPR technology I'm very, very excited about because it has the potential to help people that have certain gene polymorphisms like APOE4, that are associated with much higher risk of Alzheimer's, much higher risk of cardiovascular disease and taking out that gene and putting in the right one. So, it also has the potential to boost people - as we age we start to shut off certain genes that are important and we turn on certain genes that are not good, so it has the potential to sort of switch that around. So that's all pretty exciting stuff in the ageing field. 

Ryan: That's cool, very cool. So, a little birdie has informed me that you had your first float tank experience recently. Did you enjoy that? With everything that you have going on, were you able to turn off your mind?

Rhonda: Yes. That's the one thing, the one aspect of my life that I really need to work on is not the stress and, you know, not having such a high stress, you know, all the time, go, go, go, go, go, go, go! And I think meditation is the main focus of how I'm going to help mitigate that. I do exercise which also helps but the flotation experience was very, it was very unique and cool and I really did enjoy it, would like to do it again. Too bad it's just, it's too expensive to do, like, on a routine basis. You know, $50 a session is a little bit too much for my, you know, pockets, but I will say that the thing that I really liked about it the most was that I found it easier to meditate, actually.

And one of the things that I do when I'm meditating is I like to think about and analyze my actions, social interactions, my work interactions, whatever it is and sort of understand my motivations behind them, what - why do I do the things I do? Why do I say the things I say? Why do I interact with people a certain way? Try to understand why I behave the way I do. And I think that having that sort of insight into my own behavior helps me to understand people better. It helps me to have empathy, and to be more compassionate to others and not be so quick to, you know, jump to a conclusion, or you know, sort of dismiss someone. I think it helps me to be much more aware of where someone else is coming from. And I think that's an important part of being a human being that we should all try to work on. I think if we all did work on that our social interactions would be much better!

Ryan: Yeah, we would have a - a much different world that we would live in.

Rhonda: Yeah, not to mention all the positive effects that have been shown on, meditation has been shown to have on brain ageing, ageing in general, cognitive function, you could just go on and on. But I do like the flotation experience. I think that it's easier to shut down, you know, because in a room, I'm sitting here and it's like I'm thinking about this or that and it's easy for me to just kind of get lost on something else and, you know, my mind doesn't just shut off all the other things.

Ryan: The float tank forces that. I mean your senses are deprived, literally.

Rhonda: Yeah, they were, they were. It was very cool, I liked it. I could see myself using it. I do a lot of meditation in the sauna too, by the way, that's one thing I do. I meditate in the sauna. But I also could see myself using it to kind of rehearse presentations, like one thing I do in the sauna is I'll sit down and, so I give a lot of presentations, I'll rehearse them and the flotation tank was another - I was in that Zen thing where I could just go over, you know. So I think it's also useful for other things.

Ryan: Very cool, very cool. So, one last question. Before we get to that, where can our listeners get more of you?

Rhonda: They can get more of me, um well, I also am on iTunes. I have a podcast. You can search 'foundmyfitness'. You can find me on my website foundmyfitness.com where I have YouTube videos I put out on a variety of different health-related topics. I'm on Facebook, I have a fan page and on Twitter. So, you can find all those things on my website foundmyfitness.com

Ryan: We'll put those links on the show notes at optimalperformance.com along with the video and the rest of the stuff. So people can just check it out, watch the video and then click and find their preferred method to follow and interact with you. Um, alright, your three tips to live off. Cannot wait to hear what Dr. Rhonda Patrick has to say.

Rhonda: My three tips! If I only had three, okay. I would say: eat as broad of a spectrum of colored, different colored plants as you possibly can. One. That's because of the micro-nutrients, the fiber, it's gonna mitigate inflammation, it's gonna give you all the, you know, vitamins and minerals you need to run your enzymes and this and that. Okay, so that's one. Two: I would say exercise. That would be two. 

Ryan: Is there a specific or just move?

Rhonda: I mean, I'm just being general here. I think that, you know, I personally like to do a lot of resistance training. 

Ryan: Yeah, I was gonna say, I got a - you have a podcast called 'foundmyfitness', I mean I gotta press you a little bit. There's gotta be - you have to have some kind of knowledge on if you're gonna exercise this might be the best way.

Rhonda: I think there's a, you know, I don't know if there's a best way. I think there's certain benefits from different ways and I, you know, I think combining a lot of those benefits are important, you know. Obviously cardiovascular sort of like, cardio-respiratory fitness, I guess, that's been associated with lower all-cause mortality in multiple, multiple, multiple studies. And that's associated with cardiovascular types of fitness, more you know, sort of getting out and moving. Um but, you know, resistance training is also very important for maintaining muscle mass and the major, major problems when we age is that we start to lose muscle mass. And muscle mass is very important in preventing you from, you know, falling and breaking a bone, which can take you out when you're old! And it's also associated with longevity. And so I think that both of those things are very important. They also have effects on the brain in different ways, so I actually like to do both.

So moving, getting your broad spectrum of plants, and the third would be sleep. Very, very, very important to sleep. I think those are my top three lifestyle - now these are probably a lot more general than you were thinking and it's because I think that those are really the most important for not only optimizing performance - I mean sleep, very important for optimizing performance, for learning and memory. Very, very important for brain ageing. When you sleep is when you repair all the damage in your brain when you sleep is when you get rid of the, you know, you squirt out all these toxic things that build up in your brain. That happens when you sleep, and when you're deprived of sleep you don't get it. 

When you're deprived of sleep, the gut microbes in your gut don't metabolize things, they don't make those compounds we were talking about because they also were on a circadian rhythm. Every cell in your body is on a circadian rhythm meaning it increases the expression of certain genes at a certain time of day, so during the day we increase the expression of genes that make us more sensitive to glucose, insulin. Everything involved in metabolism, those get turned on in the day. At night, we increase all the genes that are involved in repairing damage, repairing DNA damage, repairing, you know, damage that's done to proteins, all these, you know, it's like damage control, that's at night. When we don't sleep, when we're not getting this sleep or we're not on the right circadian rhythm that stuff all gets out of whack and so now you start to have all sorts of problems. So, sleep is very important and I think those are my three top, those are my three top tips and I know they are very general but, you know, you'd be surprised. A lot of people think they're getting enough greens, they think they're getting enough exercise and they think they're getting enough sleep but they're probably not.

Ryan: Right. Okay, fair enough! Those are great tips and if people follow those three things they will be very, very healthy.

Rhonda: Yeah. The fourth would be the meditation! 

Ryan: Okay.

Rhonda: Believe it or not, yeah. 'Cause the mitigating - chronic stress is like, it's like the - it's easy to know when you're not eating healthy. If you're eating chips or you're eating cookies it's physically there, it's tangible, you know you're eating it, you know you're not eating it. When you're eating the greens, you know you're eating something good. Stress, you can't see it; it's silent. It's a silent form, a very unhealthy thing for you that ages you in many different ways; brain ageing, cellular ageing, just I mean, so I think that, you know, both exercise and stress mitigate the - I'm sorry exercise and meditation mitigate the stress. So those are my, those are my top choices. 

Ryan: We got a bonus one!

Rhonda: You got a bonus!

Ryan: Dr. Patrick, thank you so much for hanging out with us. For all of our listeners, remember you can get the show notes at optimalperformance.com like we mentioned and make sure that you head on over to iTunes, leave us a 5* review and if you have not already done so, subscribe to Optimal Performance Podcast.