No Hype, Just Standards · Conversation
The doctor who wrote "Lies I Taught in Medical School" on reversing four chronic diseases without drugs
What this episode says
- Lufkin was a full-time professor practicing, teaching, and running a lab funded by the NIH, pharmaceutical companies, and device makers when a few joints became painful and his labs came back with four chronic diseases he had only ever seen in patients. His doctors prescribed a drug for each, for life, and told him lifestyle does not really work. With daughters in elementary school, he went back to the literature and found a body of evidence he and most of his colleagues had never been taught.
- He applied it to himself. Over months his numbers reversed, his doctors assumed the lab equipment was broken, and he came off every medication. He has stayed off them by lifestyle alone, and made it his mission to keep other people from making the same mistake he made.
- His framing of modern medicine is generous and specific: the surgeries, pharmaceuticals, and public health of the twentieth century transformed humanity, and if he is hit by a car he wants all of it. The failure is applying the same pills and surgeries to the chronic diseases that now consume roughly 80 percent of health care resources: obesity, diabetes, hypertension, cardiovascular disease, stroke, cancer, Alzheimer's, and mental illness. The drugs control symptoms while the disease progresses. The common root, in his view, is metabolic health, and there is no pill for it.
- Doctors treat disease; being healthy is on the patient. He says it as a patient: when he goes to a doctor it is to get less sick. He is also blunt about patients, himself included: offered a once-a-day pill that means nothing has to change, most people take it. The fifteen-minute appointment and the lazy patient are the same problem from two sides.
- Type 2 diabetes is his worked example. Metformin, sulfonylureas, and insulin control blood sugar and save lives acutely, but treated that way it becomes a lifelong, progressive disease: the leading cause of kidney failure and dialysis, of many kinds of blindness, and of surgical amputation, and a driver of heart attack, stroke, and Alzheimer's. Nearly half of American adults and one third of adolescents now have diabetes or prediabetes. Remove sugar and starches and, for most people, it goes into remission and stops progressing.
- The one test he would send a symptom-free 50-year-old to get tomorrow: fasting insulin. Diabetes is diagnosed by glucose and A1c, but the pancreas holds glucose normal for years to decades by producing more and more insulin. A man can have a normal glucose and a normal A1c and be well down the road to diabetes. It costs about ten dollars, any lab will run it, and he wants it near five, well below what the lab calls normal.
- On 90 days of full compliance: fasting glucose changes daily, which is why a CGM shows the effect of a meal within hours. Elevated fasting insulin takes longer to come down but moves. Seed oils, canola, sunflower, soybean, are the other change he would make: highly processed, pro-inflammatory, and everywhere since McDonald's and Burger King replaced beef tallow in the early 1990s. They are in salad dressings, bread, baked goods, and even Trader Joe's hummus; a long ingredient list is the alarm.
- As a radiologist he can see metabolic disease that the blood panel cannot: coronary artery calcification before symptoms, visceral fat around the organs that drives inflammation, and liver fat. Non-alcoholic fatty liver disease did not exist as a category before the 1980s and is now the leading cause of liver failure and transplant; radiologists rarely measure or report it unless severe. He estimates 30 to 50 percent of American adults have some degree of it. He tells the nursing-home story from Heather Sandison's memory-care homes: a patient who knows his grandchildren's names in ketosis and does not recognize them on junk food.
Doctors don't make me healthy. When I go to a doctor, it's to get less sick. Being healthy is on me.
Who Robert Lufkin is
Dr. Robert Lufkin is a practicing physician and radiologist, a professor at the UCLA and USC medical schools, the author of more than 200 peer-reviewed papers and more than a dozen books, and the inventor of a biopsy needle still used around the world. He studied computer science at Brown before medicine. His lab took money from the NIH, from pharmaceutical companies, and from device makers; he was, in his own phrase, inside the building. Then he wrote a book called Lies I Taught in Medical School, whose subtitle says where he landed: how conventional medicine is making you sicker, and what you can do to save your own life. He also built the Longevity Health Scan, a single CT study that reports coronary calcium, arterial biological age, liver fat, bone density, and the fat around the heart, the things a blood panel cannot see.
The day the labs came back
Everything was going fine. He was seeing patients, teaching, and running research when, in a short span, a couple of joints became very painful. The labs and his doctors produced four chronic-disease diagnoses he had only ever seen in patients. He asked what he could do, and the answer was a prescription for each one, for life, and a dismissal of lifestyle as something that does not really work. His daughters were in elementary school, and these were serious, progressive diseases. So he did what he says any patient can do: he went back to the literature and found a whole body of evidence he had not been taught and most of his colleagues still do not know. He applied it to himself. Over months the numbers reversed. His doctors assumed the lab equipment was broken. He came off every medication and has stayed off them by lifestyle alone. He says he felt terrible, for the damage to himself and for the patients and trainees he had taught the other way. His mother was a dietitian, so he grew up knowing food mattered; the dietary profession of the time, he says, overlooked what certain diets do for exactly these diseases.
First principles
The computer-science habit he kept is to read the paper behind the claim: controlled trial, or an association that shows correlation and not cause? Every claim in his book carries a reference so the reader can check it, and he urges people to do the same with everything thrown at them by television and the internet. On the information overload that makes that hard, he is an optimist about AI: more scientific discoveries are being made in a year than were made in the previous ten, a model can find and cite the studies behind a claim in seconds, and health care is the field where a single physician can least hope to internalize a patient’s genetics, every lab in a lifetime, family history, and childhood stress. AI can reduce that to actionable items.
What Western medicine gets right, and where it fails
He wants it on record that he is part of the problem and part of the solution. The surgeries, pharmaceuticals, and public health of the twentieth century transformed humanity, and if he is hit by a car outside, he wants a blood transfusion, his spleen out, and his fracture set. The failure is in taking the same tools to the chronic diseases that exploded in the twenty-first century in numbers never seen before: obesity, diabetes, hypertension, cardiovascular disease, stroke, cancer, Alzheimer’s, and mental illness, which together consume roughly 80 percent of health care resources. Applied there, the pills and surgeries control symptoms while the disease keeps progressing. The common root, he argues, is metabolic health, and there is no pill for it. The most powerful medicine anyone will take is the set of lifestyle choices made every day. He says the next part as a patient: doctors do not make him healthy; when he goes to a doctor it is to get less sick. Being healthy is on him, and it is decided every morning, in whether he walks, lifts, eats, and sleeps.
Zac raises the fifteen-minute appointment and the supply of doctors that cannot match the demand. Lufkin agrees and turns it around on patients, himself included: offered a once-a-day pill with no side effects that means nothing about him has to change, he will take it. A surgery that costs a week off and returns him to his life as it was is the same bargain. Zac adds that it also feels safe, because we trust the system as we should. Both agree that for the chronic diseases, the bargain is a bad one.
Type 2 diabetes, worked through
More than 90 percent of diabetes is type 2, nearly half of American adults have diabetes or prediabetes, and prediabetes is diabetes. The Journal of the American Medical Association has reported that one third of adolescents now have one or the other. Metformin, sulfonylureas, and insulin control the sugar and save lives acutely. What is not communicated, in his view, is that treated that way it becomes a lifelong, progressive disease: the leading cause of kidney failure and dialysis, of many kinds of blindness, of surgical amputation in the United States, and a driver of heart attack, stroke, and Alzheimer’s. For most people it is a sugar toxicity. Remove sugar and starches and the symptoms go, the disease goes into remission, and it stops progressing. He does not think patients are told that clearly enough, and Zac adds that the pill is also the easier sell to a patient who does not want to change.
The test almost nobody orders
Zac asks for three tests a symptom-free 50-year-old should get tomorrow. Lufkin leads with one: fasting insulin. Diabetes was first diagnosed by tasting sugar in urine; today it is diagnosed by glucose and A1c, both of which are useful and both of which miss the mechanism. Eat sugar, glucose rises, the pancreas makes insulin, glucose falls. Do it for years and the pancreas makes more and more insulin to hold glucose normal. So glucose and A1c read normal for years to decades while fasting insulin climbs, and the man is already insulin resistant. Ask your doctor for it, or order it yourself online for about ten dollars. And do not aim for the lab’s normal; he wants it around five, well below the reference range. On Zac’s 90-day question: fasting glucose changes daily, which is why a continuous glucose monitor shows a single meal, and elevated fasting insulin comes down more slowly but does come down.
Seed oils and the 1990s
His second change: seed oils. Canola, sunflower, soybean, anything pressed from a seed, highly processed and pro-inflammatory. The evidence is less strong than for sugar, but compelling enough to avoid them. Until the early 1990s deep frying was done in beef tallow; a campaign against saturated fat, which he says was wrongly demonized for half a century, pushed McDonald’s and Burger King to switch, and the world followed. Seed oils are cheap, reusable many times, and taste like nothing, which is why nobody eats them on purpose and everyone eats them: most salad dressings, bread, baked goods, and even Trader Joe’s hummus made with canola or soybean oil instead of olive. Olive and avocado oil are the alternatives, and studies have found both adulterated with cheaper seed oils that no one can taste. His alarm is a long ingredient list.
What imaging sees
As chief of metabolic imaging, he can see what the blood panel cannot. Coronary artery calcification before any symptom. Body composition with the split between subcutaneous fat, which is healthy in small amounts, and visceral fat around the organs, which produces inflammatory cytokines and drives the chronic inflammation behind metabolic disease. And liver fat. Until the 1980s fatty liver meant alcohol; then a new kind appeared in people who had never had a drink, and doctors did not believe them. Non-alcoholic fatty liver disease is now the leading cause of liver failure and liver transplant, has nothing to do with alcohol, and is driven by glucose and diet. Radiologists rarely measure it and rarely report it unless severe, so only the worst cases are seen; some estimates put it at 30 to 50 percent of American adults. His broader number is that 80 percent of adult Americans have metabolic disease, and every one of the chronic diseases, including mental illness, has a metabolic driver.
On dementia, which Zac says is close to home for him, Lufkin describes the ketogenic diet, which removes sugar and starches and shifts the body from glucose to ketone metabolism, and tells the story from Heather Sandison’s memory-care homes, where residents eat ketogenic food instead of the ice cream and cake most nursing homes serve, and some improve and leave. One patient, in ketosis, knows his grandchildren’s names and picks them up; off it, he does not recognize them. He cites Chris Palmer at Harvard reporting similar responses in schizophrenia and depression, and is careful to say it does not cure everyone. In some patients the regression is dramatic.
Transcript
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0:00 When I go to a doctor, it’s to get less sick. They thought the labs were broken, the blood tests were broken. And basically, I went off all medications and now I have stayed off them by changing my lifestyle. Everything came back normal. Cholesterol, fine. Blood sugar, fine. Blood pressure, a little warm, nothing worth medicating yet. And you walked out of that doctor’s office, 47 years old, and you could not tell anybody what’s actually wrong with you. Because on paper, nothing is. I’m Zac Armstrong, retired Naval Commander, F-18 guy, 27 years in uniform, now a performance coach for high-performing men over 40. And this is no hype, just standards. My guest today teaches the thing I just described to you. Dr. Robert Lufkin is a practicing physician and a medical school professor. Over 200 peer-reviewed papers, more than a dozen books. His lab took NIH money and pharmaceutical money and device money.
1:01 He was inside the building. Then he wrote a book called Lies I Taught in Medical School. And the subtitle tells you exactly where he landed, how conventional medicine is making you sicker and what you can do to save your own life. Think about what it takes to do that. For him to stand up in front of his profession and say the thing that he teaches is the thing that he got wrong. He also built something called the Longevity Health Scan. One CT study that reports your overall calcium, your artery biological age, and liver fat, and your bone density, and the fat sitting around your heart, which is to say all these things your blood panel will not see. So I went and got him. He’s not here to lecture you. He is here as proof that a man can look at his own results in his own body and change course. If he can do it with his name on the syllabus, what the hell is your excuse? If you get something out of this one, hit subscribe. It costs you nothing and it puts this in front of the next guy who thinks he’s just getting older. All right, let’s get into this. Hey, Dr. Lufkin again. Thank you for joining us. I’m going to start off right off the top. You spent decades as a full professor at UCLA and USC
2:04 And radiology societies invented a needle that’s still used worldwide. Then your own labs came back and something changed. Can you walk me through that day on exactly what changed? What did they find? And what was your first reaction as the guy who was actually teaching this stuff? Yeah, yeah, great question, Zac. Yeah, I was a full-time professor at a large medical school here in Southern California and everything was going fine. I was teaching patients. I was practicing medicine. I was doing research. When kind of in a short period of time, I began to have some symptoms. Like a couple of my joints became very painful. And then when I checked the labs and went to saw my doctor, they made the diagnosis of four chronic diseases that I’d never had before. And I’d seen in my patients, but I’d never experienced them in myself.
3:05 And so I went to the doctor and said, what can I do? And they said, well, we have a prescription, a drug for each one of these conditions. Of course. And they prescribed the drug. Shocking. Each one. And talking with them, I asked, well, what about lifestyle? Is there anything else I can do? And they said, nah, that really doesn’t work. You’re going to be on these medicines for the rest of your life. So get used to it. And at that point, it wasn’t that long ago. My daughters were in elementary school and I realized this wasn’t going to end well because these were very serious diseases that were progressive and all. So it kind of forced me to examine what I’d been taught, what my beliefs were. And I went back to the literature. And I realized that there was a whole range of studies
4:05 And knowledge that was available that I wasn’t aware of. And many of my colleagues are still not aware of. And in fact, the ability to change these diagnoses around. And so I basically applied those to myself. And I’ve worked in a world where I work with mainly executives and lawyers, stuff like that. And we work on their overall health optimization through blood work and through continuous monitoring systems. And they’ll tell me, hey, yeah, my doctor prescribed this and that. And I always tell them, you understand that when he did that, that was for life. When your numbers improve, you don’t remove it. Hey, your A1C went down or your cholesterol went down. We’re still going to keep you on the stat because the statins reason went down. And I don’t think people have that understanding. And I think that’s kind of what you felt like. What do you mean for life? Yeah. Yeah. And drugs have side effects. And I was looking for something that, one,
5:06 That possibly would control these without drugs. And I didn’t realize it was possible to literally reverse them, which is what happened to me. I implemented some relatively simple lifestyle changes. And over a period of months, I went back to my doctors and they couldn’t believe it. They thought the labs were broken. The blood tests were broken. And basically, I went off all medications. And now I have stayed off them by changing my lifestyle. And at that point, I sort of rededicated my life to make it my mission to help other people not make the same mistake that I made and take back their health. Sure. And as somebody who had been teaching and working with his own patients, how did it hit you knowing that, oh, man, I haven’t been telling these people lifestyle changes as I’ve been pointing more towards medication. How did that impact you when it actually hit your own well-being?
6:09 Well, I felt terrible. I mean, personally, the damage I’d done to myself, but all the other patients and doctors in training that I taught, I mean, as it turns out, my mom was a dietician. So I was growing up, I was seeped in the idea that food was important for our health. But unfortunately, the standard teaching of the dietary profession back when I was young, and even to some extent this day, overlooks some of the benefits of particular diets in managing these diseases. Yeah, I think people don’t understand how much food, sleep, not drinking can impact you in so many ways. We always want that quick fix. If you remember, Stables commercial is the easy button, right? We always want that as human beings, because that’s our nature. That’s who we are. That’s how we’re built. Yeah. But again, the simplistic things that can make a change in lifestyle. Here’s one that I thought was super interesting,
7:10 And probably people don’t know about you, is you actually can study computer science at Brown before you ever went into the medical world, before AI ever came out. How does that engineering brain kind of look at the human body differently than just a doctor coming to med school? Well, I try to be analytical, and I try to go to first principles. And there’s so much information now in the world in which we live that’s constantly being thrown at us. So I look at papers and try and scientific papers when a claim is made, and then I try and analyze the paper. Was it a controlled trial, or was it a epidemiological association where associations can be seen but not causation? And try and dive in in that. And I think it’s something that we can all do. We don’t have to be a computer scientist or even a physician. We as patients, as we take back our health, can begin to look at these studies
8:11 And look critically at the claims that are constantly thrown at us from television and internet and media all the times about what we should be doing. And even the claims that I make in the book, it’s nothing really that I invented or even discovered. It was out there already. And every time I say something in the book, I always add a reference. So that anyone can look at it, can check the scientific study that it’s based on. And I urge everyone to do that, to check the science and really be curious about claims when they’re made about certain things. Yeah. And so I think it just hit something, knell in the head, and it affects all of everyone of us on a day-to-day basis. It’s almost an information overload. We live in a time where information flows more freely than it ever has. And it’s more accessible.
9:12 How do you delineate what’s right, what’s wrong? So somebody’s listening, they go, that’s great, doctor. But how am I supposed to do that as a regular person, know which one’s right, which one’s wrong? Yeah. It’s challenging. Fortunately, back to computer science, we’re in the midst of the most significant artificial intelligence revolution in history. 2026 actually is there are more scientific discoveries being made in one year now than were being made in the last 10 years. And this knowledge revolution that’s powered by AI is changing forever the world we live in. I mean, it’s an incredibly exciting time. I mean, 2026 is the most amazing year that I’ve ever lived in until, of course, 2027 will be even better. So we have our AI overlords until that comes up. Yeah. And to speak to that, I think the great thing about AI,
10:15 You know, obviously it’s not perfect and we hear a lot about the negative things, but it’s also a great source of knowledge and wisdom that we can ask them about claims and we can ask them to cite the scientific papers and the reason that these claims are valid or invalid. And they can be very helpful at searching, you know, all the information in the world that would take us, you know, hours to days to weeks to go through that. And that’s affecting all of our lives in every single business there. And we even have humanoid robots over there. I was going to ask that later. I was going to ask that later. It’s like iRobot, the movie iRobot, we’ll submit those like. They’re going to be playing a role in our lives, especially, you know, in 2027 when many of these are going to be hitting the market and really good. But the point is, healthcare is one field where there’s so much information, even, you know, my own information, my genetics, every lab I’ve taken over my lifetime,
11:18 My family history, my childhood history, you know, what sort of stresses I had growing up. And all these things are very difficult for a single physician to internalize. And the great thing about AI, it’s able to take tremendous amounts of information and reduce it to actionable items. So I think we’re going to see more and more about that. And I’m extremely bullish about AI and the way it’s going to transform healthcare. No, I’m the same boat. I think my wife, like when I ask her a question, she won’t even pay attention to me now because she’ll think I’m talking to AI at some point. I’m so into it. All right, so most of my guys are high achieving people, former military officers, executives, AMLAW, 100 type guys. And they get the reading from their doctor and everything’s in normal range. I think you will know as well, normal range though is of the whole population, not necessarily optimization.
12:18 On that standard panel, what is the one number that is lying to them? And what should they be asking about it instead? Yeah, and let me, it’s a great question. But before I answer it, let me back up a little bit and frame this conversation about western medicine or modern medicine. It’s not east and west, but when we say western medicine, we mean orthodox medicine that’s like it’s taught at medical schools. And we hear us in this conversation, we’re saying, oh, the doctor just gives you pills and they don’t work or they have side effects. Well, I want to go on record after spending my whole career in medicine and being part of the problem, but also part of the solution. Western medicine in the 20th century, those of us that were around then, realized that western medicine truly transformed the lives of everyone and elevated humanity, largely through public health measures and other things,
13:19 But the surgeries and the pills and pharmaceuticals that were developed transformed the lives of so many people and made the world truly a better place. And even today, a quarter of the way into the 21st century, if I get hit by a car outside, I’m going to want western medicine. You know, I’m going to want- Acute injury. A blood transfusion, exactly, acute things. I’m going to want my spleen removed, my fracture set and all that. But the challenge in what this book talks about and what we’re talking about today, is the chronic diseases that have just exploded on the scene in the 21st century. They were present in the 20th century, but now they’ve grown in biblical numbers, unprecedented before in history. And we’re talking about obesity, diabetes, hypertension, cardiovascular disease, stroke, cancer, Alzheimer’s disease, and even mental illness.
14:19 And these now take up, by some estimates, 80% of our healthcare resources to deal with these diseases. And the problem is, when modern medicine takes the same pills and surgeries that were so effective in the 20th century for the things that were important then, when they apply them to these chronic diseases, they don’t really work. Or they may work and control the symptoms, but for many of the diseases, the underlying disease still progresses. And that’s what this book is about. And there’s a common root for all of the diseases I mentioned. I believe it’s metabolic health. And there’s certain things we can do with our lifestyle that will effectively reduce our risk for all these diseases, and in some cases, even reverse the disease themselves. And the problem is, there’s no real pill for metabolic health.
15:19 It’s something, the most powerful medicine that we’ll ever take is the lifestyle choices that we make every day. And that’s the thing. And it’s sort of a new era of medicine that we’re speaking as a patient now. I mean, I realize that doctors don’t make me healthy. When I go to a doctor, it’s to get less sick. And I’m a doctor, right? But I admit that. Doctors are very specialized in treating diseases, specific diseases. But being healthy is on me. And that’s something that I have agency in. And I get to decide every day when I wake up, when I go for a walk, when I lift weights, when I eat, when I sleep, all these things. And that’s really the empowering thing for patients today, I think. You and I are so locked and step right there. I couldn’t agree more with almost everything you said.
16:19 And I think, I say it all the time, and I don’t know what your opinion is. I think one of the traps, because we’re all human beings. We all have our certain things and we get used to our habitual nature or fall, lock, and step and things. And I think doctors are no different and we have a system, right? And a lot of our systems too is the amount of healthcare that is needed right now isn’t being matched by the supply of doctors or nurses and what. So it’s almost like, hey, I got to get a patient in. I got 15 minutes. I got to look at this here real quick. And then I know to prescribe this and then I got to move on to the next patient. Do you feel like that’s part of the problem too with it? Absolutely, Zac. I think you’re really hitting on it. And we’re critical of doctors and healthcare system in the last few minutes. But let’s look at patients too. Because you hinted at it before, but it’s not all on doctors. I mean, as a patient, I know I’m basically lazy. When I go to my doctor, like everyone, we have a finite amount of time.
17:20 And true, the doctor visits are very short. But the patients too, I know that if a doctor offers me a pill and it will make everything better without side effects and without any long-term consequences, especially stop the disease, then I will take that pill. I’ll gladly do that because it’s something that I do once a day maybe and I don’t have to change who I am. I don’t have to change my behavior or anything like that. The thing I’ll add to that too is it makes somebody feel safe. Yeah. The doctor tells them, hey, this will help you and I will help you out. You don’t have to do this. This is all you have to do. And they’re going to believe it because we put our trust in our medical system as we should. And we feel safe. And when you feel safe, you’ll then you’ll tend to do that thing. And I feel that’s a human condition. Yeah, absolutely. I mean, even to the point of surgery, you know,
18:20 I may say you have a condition but we can operate and we’ll take care of it. And it’s one and done. And I may have to take a week off from work and that sort of thing. But then at the end of it, I basically go back to my life the way it was. And I don’t have to change who I am. So the patients are always always willing to participate in that interaction. And I think the problem is, as you know, as we’re talking about that these chronic diseases that take up 80% of our healthcare system now, they do have medicines for them. They do have surgeries for them. But in the vast majority of cases, the surgery or the medicines may treat the symptoms and make people feel better. But the disease will continue to progress onward. And, you know, and if I can give an example, is type 2 diabetes now. It’s the major form of diabetes.
19:23 Over 90% is type 2 diabetes. By some estimates, you know, we’re approaching 50% of the adult population with either pre-diabetes or diabetes. And pre-diabetes is diabetes. But an even scarier thing is the Journal of the American Medical Association just came out with the fact that adolescents now, one third of them have diabetes or pre-diabetes. And, you know, with two teenage daughters, I could see how, but it’s, you know, it’s scary. And the problem with diabetes is it’s a sugar problem, right? Sure. Blood sugar levels. Yeah. Blood sugar levels. And glucose. And if you go to a doctor, they will say, you know, we have medicines for that. We have Metformin and sulfenolureas. And if it gets really bad, we’ll give you insulin. And these are truly life-saving medicines. You know, insulin will save your life from an acute hyperglycemia event. And the medicines
20:23 Will reduce the symptoms. But what is not communicated often enough or well enough is that when we treat type 2 diabetes with these medicines, we take this and it becomes a chronic disease. In other words, it goes on throughout your life and it continues to progress and get worse. What does it progress to? The number one cause of kidney failure and dialysis is type 2 diabetes. The number one cause of renal, I’m sorry, of many kinds of blindness is type 2 diabetes. Heart attack, stroke risk is all type 2 diabetes. Alzheimer’s. All the chronic diseases we mentioned are increased with type 2 diabetes. The number one cause of amputation, of surgical amputation in the United States is type 2 diabetes. And so this is a very serious disease, although we can control the symptoms acutely. It’s really lifestyle.
21:23 It does mean. All right. It boils down to lifestyle. Yeah, it does mean a good ending. But yeah, then the other point, yeah, to your point is there is usually now increasingly a conversation about lifestyle. And the interesting thing about lifestyle is for most people, diabetes is a sugar toxicity. And if you eliminate sugar and starches from your diet, the diabetes essentially goes away. The symptoms go away, but the disease also goes into remission to this point. It doesn’t progress. In other words, you don’t get amputation. You don’t get blindness. You don’t get renal. You don’t get all these things down the line because your diabetes is under control now and your insulin resistance is under control. And I just believe that that isn’t being communicated to the patient enough. It’s either have a pill once a day, don’t worry about it, or you’re going to have a lecture on changing your life, changing how you eat,
22:23 Changing how you exercise and everything like that. But it’s lifesaving. But it goes back to your point too, though. It’s the patient. It’s on the patient too, because when you go back to, hey, humans unconditionally can be lazy, especially with stuff like that. That’s on them, because a lot of that’s lifestyle. But when we talk about these diseases, heart disease, diabetes, dementia, you’ve been saying for decades earlier, you can predict these. So is there a 50-year-old sitting out there right now, he said, with no symptoms, what are three tests you would say, hey, go take tomorrow that maybe can predict some of these things in your future if you don’t change lifestyles? Yeah, there are a few tests that are rarely or in some cases never gotten by the physician. One is something called a fasting insulin. That’s the best one. Yeah, insulin is a hormone. Your audience probably knows this, but it basically does a lot of things, but it also handles blood sugar
23:23 In your body. The disease of insulin, type 2 diabetes, is overproduction of insulin and due to sugar in the diet. What happens is people measure type 2 diabetes and literally diagnose it, not by insulin levels, but by glucose levels. Glucose levels are a great indicator. Diabetes was first diagnosed by people would taste the urine and taste the sweet, the sugar in the urine. And that’s the sign of diabetes. We now take sugar in the blood and test fasting glucose or hemoglobin A1C, which is an average of over 90 days. These are literally the diagnostic criteria for pre-diabetes and type 2 diabetes. Depending on what your A1C is, you’ll have one or the other. And that’s great. I mean, it’s great to look at that. The problem is, if I’m eating a high sugar diet,
24:24 My sugar is going to shoot up and what’s going to happen? My pancreas is going to make insulin and it’s going to drive the sugar back down. I eat more sugar, the insulin is going to go up and drive it down. And over time, the amount of insulin produced by the pancreas goes up and up and up. And it’s doing that to maintain the glucose normal. So my glucose is still normal for years to decades before I get type 2 diabetes, even though my fasting insulin is way up there. So the value of fasting insulin is you can have a normal glucose, normal hemoglobin A1C and still be on the road to diabetes and still have insulin resistance. So fasting insulin, you can ask your doctor for it or if you don’t want, you can go online and order it yourself from a number of labs. It costs about $10. Yeah, all of them.
25:25 And check it yourself. And like you said before, don’t follow the normal levels because you don’t want to be normal. You want it down around five or so, which is way below what most labs call normal. Okay, so my clients don’t have time for like a two-year reversal protocol. If a guy gives you 90 days in total compliance, what can actually move that matters and what cannot move in 90 days? Yeah, I mean, it depends on the disease. But the underlying metabolic markers that we’re talking about, Yes, if that’s what I’m trying to talk about. Literally fasting glucose changes daily. That’s why we have the CGM’s and we can see that. So almost immediately when we change our diet, we can change our glucose levels. The insulin, fasting insulin levels, if they’re elevated, will take longer to come down.
26:26 But that’s a great place to start. And those are the two metabolic markers that you can do. Other things in your diet, seed oils, there are pro-inflammatory types of oils that have basically taken over our food system. The evidence is not as strong on those, but it’s still pretty compelling to avoid them because they’re pro-inflammatory in nature. And I don’t think people understand a lot of the oils, they’re not even like, they’re blended. And so people don’t understand that olive oil you’ll see on the shelf doesn’t mean it’s not blended. You need to check and make sure of these things. Absolutely. Yeah, by seed oils, we mean like canola oil, other types of sunflower oil, anything with a seed in it. And these oils are highly processed. They’re pro-inflammatory.
27:26 And they really hit the scene in the 1980s and 90s, which is when all these chronic diseases took off and just exploded. A lot of other things happened in the 1980s and 90s with our food system. But seed oils is one in particular. All frying was done, deep frying was done in beef tallow for the most part. And then in the early 1990s, there was a campaign to get rid of beef tallow. And famously, McDonald’s and Burger King switched out to seed oils and didn’t use beef tallow. And then everyone around the world basically followed, thinking that seed oils were healthier because beef tallow has a lot of saturated fat, which was wrongly demonized for half a century. And still, many clinicians urge people and dietitians
28:27 To avoid saturated fat, which I don’t agree with. But by going to these seed oils, they create a whole other problem of… And basically, the majority of food today is cooked in seed oils because they’re less expensive. Yep, that’s the big thing. They don’t… You can reuse them many, many times. But it’s not just fried foods. You can avoid all fried foods, but you’re still gonna get seed oils because they’re in most salad dressings have seed oils because they’re inexpensive. And they don’t taste that different from other types of oils. It’s not like, oh, that… Like with sugar, you could tell the sweetness and we eat sugar because it’s sweet and certain things associated. People don’t eat canola oil because it tastes good. They canola oil, they consume just because it’s in our food supply. And it’s in our food supply because it’s inexpensive. And it’s cheaper than beef tallow
29:29 And these other things. And as you said, it’s not just the salad dressings, but even if you buy… What are healthy oils? Obviously, olive oil, avocado oil. Avocado oil is healthy. It’s not made from the seed of the avocado. It’s made from the meat of the avocado. But as you pointed it out, there’ve been some studies recently where people analyze olive oil or avocado oil and they find they’re adulterated with seed oils. 100% Because people can’t tell the difference. They taste the same, but they’re much cheaper. So you can basically save money by adulterating these things. But it’s not just salad dressings. It’s in the bread. It’s in the baked goods. If I go to Trader Joe’s and I want to eat health, I’ll grab their hummus. But you look at their hummus and it’s made with canola oil or soybean oil instead of olive oil. So even the hummus,
30:29 You have to be careful with. It’s so prevalent in the ingredients. If you see a long ingredient list on something, you should… Little alert systems should be going off in your head. So your chief metabolic imaging at a large network, what does imaging show you about metabolic disease that a blood work can’t? Yeah, I mean, my background is in radiology, which is medical imaging. And there’s a lot of information on medical images related to metabolic disease. Because metabolic disease, these changes in insulin and blood sugar and insulin resistance and all these things have effects throughout our body. So, I mean, in the extreme, we can see them as, coronary artery disease, calcifications in the coronary arteries. Even before people are symptomatic, you can see that. You can measure body composition, which is where fat and muscle is distributed in the body.
31:30 And you can tell two different types of fat. One is subcutaneous fat, which is a healthy kind of fat to have a little bit of. It serves a great purpose, but the dangerous kind is what’s called visceral fat. It’s fat around organs. Because it’s pro-inflammatory, it makes a lot of inflammatory cytokines, drives inflammation. And inflammation, chronic inflammation, is one of the drivers of metabolic disease, along with what we talked about with insulin resistance. So, this visceral fat shows up on the scans. And you can see that. You can look at other types of things on imaging. And the problem is, the radiologists don’t usually report it, like liver fat. Fatty liver is, it has a fascinating story too. Up until the 1980s, the leading cause of fatty liver disease was alcohol.
32:30 And it was called alcoholic fatty liver disease. But in the 1980s and 90s, like we talked about, something else happened in that a new type of fatty liver disease appeared that had never been seen before. And patients would go in and they’d be diagnosed with fatty liver. And the doctor would say, well, you need to cut back on the alcohol. And the patient would say, doctor, I’m a teetotaler. I’ve never had a drop of alcohol. And the doctor would say, well, sure, but you need to eat to have less of it. You know, they wouldn’t take them seriously. Of course. Evidence is a point. Because it’s the cause of that. But what happened in the 1980s, a new type of liver disease, a new type of fatty liver disease, it looks just like alcoholic fatty liver disease took over and it exploded in the population in the last 45 years to the point that today, it’s the number one cause of liver failure,
33:31 The number one cause of liver transplants, and it has nothing to do with alcohol. It’s called non-alcoholic fatty liver disease. And it’s related to glucose and dietary factors that drive it. So, and that can be seen on the scans, also on the imaging. But unfortunately, doctors, radiologists usually don’t report it out, the fatty liver disease, unless it’s very severe. And they usually don’t actually measure it. So, we only see the severe cases. But some studies are estimating that up to 30% to 50% of adult Americans have fatty liver disease at some stage. And of course, the famous here yeah, is 80% of adult Americans have metabolic disease. I mean, we know that already. Most Americans are either overweight or obese. Most Americans are either hypertensive, most adults are either hypertensive or being treated
34:31 For hypertension, and you go on and on and on. And all these diseases have a metabolic driver. I mean, who would have thought that mental illness is related to the diet that you have and metabolic dysfunction, which is a lifestyle thing. Yeah, and one that is near and dear to my heart is dementia. And I think there’s a lot of correlation there as well now too. Yeah, yeah. Alzheimer’s disease famously by putting people on a ketogenic diet, which is a metabolically favorable diet that removes sugar and starches basically. And it changes the body from glucose metabolism to ketone metabolism. And as it turns out, that’s very metabolically healthy for all the metabolic diseases we talked about. But some really interesting things when we talk about dementia, some patients respond dramatically to a ketogenic diet. Some patients with Alzheimer’s disease
35:33 Even. There’s Heather Sandison, is a protege of Dale Bredesen. And she has a series of nursing homes for Alzheimer’s patients. But the interesting thing about these nursing homes is patients go there and some of them get better and leave. Usually Alzheimer’s is sadly a one-way street. In other words, people don’t generally recover from it. But Heather and others have reported dramatic response to this favorable diet. I had her on my podcast recently and I was talking to Heather and I said, Heather, you put everyone in your Alzheimer’s homes on a ketogenic diet when they get in there. That’s, instead of feeding them ice cream and cake, which most nursing homes do, they feed them healthy ketogenic type foods, which can be delicious. It is delicious. And I said to her, how do you know there’s any benefit from that?
36:34 Is there any evidence? That it’s the ketogenic diet that does it. Maybe it’s something else. She goes, well, you know, we never know, but in some cases it can be dramatic, like Mr. Smith. When he’s in ketosis, in other words, when he’s eating the ketogenic diet, his grandchildren will come in the room. He’ll remember all their names. He’ll hug them and pick them up and smile. When he goes back to eating junk food or when he gets out of ketosis, when the grandchildren arrive to see him, he doesn’t remember them at all and doesn’t recognize them. And it’s really, really dramatic. And Chris Palmer, in the mental illness area, has said a similar thing about his patients with schizophrenia and depression as well. And again, for both Alzheimer’s and mental illness, I’m not saying that ketogenic diet cures everybody. Yeah, but in some patients, it can have dramatic
37:34 Regressions. And in the case of the schizophrenia, Chris Palmer, he’s written a book called Brain Energy. He’s at Harvard Hospital. And he puts patients on ketogenic diet also. I had him on my podcast again and I asked him, I said, Chris, how do you know that it’s the ketogenic diet that does anything with your patients? I mean, they’re on all different kinds of things. And he said the anecdote also, well, Mr. Johnson, he was hospitalized chronically in the hospital on heavy medications for his schizophrenia. And schizophrenia, your audience may know, is an unusual medical condition that has a symptom that some like anything else, you hear voices talking to you. That’s the sign of schizophrenia that’s really unique to that disease. But anyway, he put Mr. Johnson on a ketogenic diet and he gradually got off all his medications in the hospital.
38:35 And then he was actually able to return to his home and be with his family and actually get a job and go back into society and live. And so I said, yeah, but how do you know ketones had anything to do with it? And Chris says, well, with Mr. Johnson at least, it’s very interesting because he tells me when he’s out and around when he goes off his diet and eats some junk food, he can tell very quickly because the voices will come back and start talking to him again so he knows to get off the junk food and he doesn’t eat good. I tell people all the time, ribeye doesn’t come with ingredient label, eggs don’t come with it. These things with those long ingredient levels, there’s stuff in there that’s gonna hurt you for multiple things. What about this one? How about, where do you land with fasting versus protein first for a man who’s over 50 who’s trying to maintain muscle because I’m a firm believer in lean muscle mass and VO2 max, there’s two of the bigger longer indicators for a longer life, inequality life. Obviously, those camps kind of contradict each other.
39:35 So where would you land there? Yeah, I mean, that’s a great question, Zac, because it deals with a fundamental conflict as we get older and it’s related to mTOR activity, which is a primordial switch, biological switch we have that switches between growth and basically protein muscle building, turning mTOR on, which is very important as we get older because sarcopenia or loss of muscle and frailty is a big cause of death in elderly people, literally fall and break their hip and falls of other kinds. So turning mTOR on and lifting weights and eating protein is really important. But the downside of turning mTOR on and eating protein and other things is that mTOR also accelerates cell growth.
40:35 So things like cancer, heart disease, Alzheimer’s disease have all been linked to increase mTOR activity. So we want to turn mTOR down for some reasons too, because when we turn mTOR down with fasting, as you said, when we cut out protein and cut out food altogether, we turn mTOR down and it goes into sort of survival mode or scarce mode for the cells and they begin something called autophagy where they repair themselves and it’s very beneficial. So the short answer is you want to have both. But what do you do? Well fortunately nature has come up with a system. mTOR is not designed to be turned on all the time or turned off all the time. I mean we evolved. There are times when we want to grow in times of abundance when we just had a kill in the hunter-gatherer things and we’re eating and then we may go a week
41:35 Without eating while we’re hunting again and that fasting period turns mTOR down where we have autophagy and repair and all these benefits. And that’s kind of the natural cycle of we believe that human beings evolved with. And the problem with since about 10,000 years ago with agriculture and then literally the last 200 years ago with refrigeration and then the last since the 90s the junk food era. There’s food around us all the time and we’re eating all the time. So we’re turning mTOR on all the time. So what do we do? Well the good strategy that I like to follow and many people recommend is to you have to lift weights if you’re getting older. You have to. Bondicity, testosterone, the muscle mass, have to. Yeah, if they had weight rooms in nursing homes there’d be a lot fewer people in nursing homes. But the problem is lifting weights and eating protein
42:35 Turns on mTOR. So we don’t want to do it all the time. So strategies people have come up with is basically do intermittent fasting where we narrow our eating window. So we’re not like grazing every hour that we’re awake. We may narrow the eating window to six hours or so. And then when we do go to the gym and we should do it two or three times a week to especially when we’re lifting weights we want to have protein and we want to take the protein right near that. Because mTOR responds rapidly. I mean it’s similar to glucose. I mean it’s harder to measure the exact mTOR levels like we do glucose. But the belief is that it responds to things. So we want to eat our protein on the days we’re lifting. And then we can fast and not completely fast. But I mean completely fasting is good.
43:35 But you shouldn’t do it all the time. Maybe once a quarter or something for a 72-hour water fast or something. But narrowed eating windows or intermittent fasting we can do the other days and turn mTOR down. So it’s kind of a combination of both if you can. Yeah so what I heard is you need to come up with a device that can measure it just like a CGM. And if you pass that you got a worthwhile needle again going. All right. What’s the standard that you’ve been given that you refuse to lower and that when you drop because evidence has changed? Oh okay. Well before we do that let me just mention one thing. You talked about CGM’s. You know continuous glucose monitors. How powerful they are and how valuable they are. And they tell us when we’re basically mTOR responds to glucose and oxygen and other things. So when glucose is high mTOR is high. When ketones are high then mTOR is off. Well they’ve just released
44:36 The FDA has just approved a continuous glucose monitor that actually also does continuous ketone monitors. Oh really? I didn’t hear that. Yeah and I’m not sure if it’s available with prescription yet. It literally just came out but you can get your doctor to prescribe it and hopefully soon you’ll be able to request it yourself like you can with CGM’s like that. Yeah so question is. I’ll repeat it for you. Yeah so you had a standard you were given that you what’s the standard you have that you refuse to lower and what’s one that you’ve probably dropped or maybe dropped because evidence now says otherwise. Yeah well the I guess the the one the one that I the one that that I refuse to lower is that that that I wasn’t aware of before but now I’m aware of that that food and lifestyle
45:37 Really matter exercise sleep stress and nutrition really matter and they’re the most powerful medicine that most of us will ever take in our lives and we get to choose every single day like I said when we get up what we can do about that. The the the belief that that I’ve that I’ve changed is kind of the converse of that was that that lifestyle really didn’t matter that the way to treat the way to treat disease is with a medication or with surgery and that there was very little you could do to move the needle with lifestyle and now I’ve completely completely inverted that as far as chronic disease you know which is 80% of our system obviously the acute disease situation
46:37 We still want to go to the we still want to depend on those life-saving Western medical things but for the vast majority of the diseases that I mentioned we want to have lifestyle be a foundation even if we’re going to go to pharmaceuticals and surgery we want to have the lifestyle in place as as as kind of the the root of everything that we build on. I agree and I think when people hear you say it they say oh man lifestyle I got to change my whole life that’s not what you’re saying because I know what you’re saying it can be as simple as all right you have a high A1c you’re a pre-diabetic or you’re diabetes all right instead of after you eat just go walk for 10 or 15 minutes and your blood sugar levels are going to lower instead of going you know ramping up and staying at a level they’re going to calmly come down and that’s an easy lifestyle fix a 10-minute walk after you eat and you can help yourself these are small things that people it’s not uprooting your whole life that’s not what you’re saying correct absolutely yeah it’s the little the little things like that and also
47:37 How we frame it and how we look at it it’s we should look at it not as a diet that oh I have to go on this until my hemoglobin A1c improves then I can go back to eating you know ice cream like a crazy person stuff exactly but rather it’s a lifestyle that I choose for myself because I want to be healthy for my family for my friends for myself and it’s a choice that I celebrate and I embrace it’s not like I’m giving up something and you know with all these with all these different nutrition patterns you can find stuff that that that is joyful that you like I used to I and growing up with my mom the dietician we we subs we got rid of butter because butter has high saturated fats and we replaced it with margarine which is basically full of seed oils and it’s pro-inflammatory and very very unhealthy but now by going back
48:39 To this healthier lifestyle I can now eat butter as much butter as I want and maybe maybe not as much cake or maybe not as much ice cream but there are there are alternatives there and and you know you find out when you when you cut down your sugar consumption actually your taste buds kind of tune up so that now after not eating sugar for a while when I bite into an apple which in the past would have taste kind of like cardboard because I what my taste buds were muted now the the sweetness and the sugar is yep the natural that’s beautiful yeah right all right here’s a question for you the wellness space full of doctors trying to sell supplements and courses your website sells training how should a skeptical executive tell the difference between you and hype or misinformation wow it’s it’s it’s a mine field out there it’s so bad it’s so bad it’s so bad beware of geeks bearing griffs right
49:43 But yeah it’s it’s it’s challenging and it’s I mean it’s not a single person can be trusted I mean I don’t think you should you should believe any one person necessary and necessarily unless they support it with documentation so the the ultimate test is not you know Dr. Jones says so but these studies showed this finding that that sounds you know sounds positive it’s and it’s going to work and it’s it’s challenging though I mean finding people that you can trust and and that that have worthwhile you know worthwhile information because there’s so much information out there now and I would say genuineness too like it’s not just like you know I think people always are searching for a human connection too and they want somebody that cares on the other side and to be able to find not only that person that has like evidence to back them up but has a genuine care
50:43 And genuine warning somebody to get better not because they just want to prove it but because they want it because it’s you’re trying to help another human being yeah I think that’s missing a lot now yeah yeah no that that goes a long way just for that yeah that human contact is is very very important absolutely and then if a 55 year old to listening right now does one thing before he close what’s right now one thing he should do before he closes this episode what is it should he change lifestyle what is like one thing that you would say hey just start here start there I mean one thing you could do is just stop eating junk food or processed food for 24 hours and and see how they feel yeah that’s what this state when you go to the grocery store stay on the outside of it just hit the outside house and if you miss all those inside aisles you’re gonna do a pretty good job well hey I appreciate it the way I like ending these is we do are going to do 10 questions it’s rapid fire I don’t want any thought process this first thing comes to your mind just pop it out all right
51:43 All right here we go first question eggs or oatmeal oh eggs no question yeah for sure is easy which lie from your book do you still catch yourself half believing um sometime about about statins it’s not a you know it’s not a clear question but statins you know in some cases they do add value and it’s you know it’s really a case by case thing okay metformin or the treadmill you only get one well I would treadmill no question I would start with the treadmill and if you still need metformin then you can add it on what is one thing your doctor does that you would fire him for well all the things we’ve talked about basically not over in fasting insulin just calming normal as healthy those sort of things okay uh fasting or lifting which one would you give up first
52:44 Give up fasting yeah because building muscle is uh yeah all right here’s a good one when’s the last time you ate something you tell a patient not to I was uh at a at a wedding and I had a bite of the cake with my daughters yeah so not their wedding you’re still in high school but yeah all right longevity drugs are absolutely exploding on the market right now what is one that you would say is something that you say you put a good weight of hey I like this I believe in this and what’s one you would say is bad well the good one’s a revolutionary I mean rapamatas has been around for a while but I think the the one that is even more powerful is the GLP1 agonist you know trisempetide ozempic you know different labels and then retitutrites coming out but all those GLP1 agonists are really revolutionary as far as longevity and then second question is which one
53:46 Has been discredited I think risveratrol used to be popular in the 2000s you know grape leaves and all but I think there are problems with getting biological levels that are significant here’s a tough one because I would have a tough one answer in this too I feel like I know which one sleep or exercise if you have to have one on the you know the worst side I would say you only get you know you had to give up a little less sleep to get more exercise or you have to give more you know more sleep and less exercise which way would you go? I would give up exercise because sleep is I mean I never realized this but you know the study with high school with college students healthy college students they deprived them of sleep and they immediately became metabolic dysfunction pre-diabetic you know they so sleep hits you really fast whereas you can go without a week without exercise and relatively speaking you can be okay but you can’t go for a week without sleep
54:46 You’ll be dead you know or in bad shape You know I’m gonna go stop with the talk questions real quick because that’s one of those studies that I actually use a lot you see testosterone go down you see so many things that happen within that study and I don’t think people understand because we live in a society where we go all right I only got five hours of sleep but I’m still operating today you hear that kind of stuff and then for me I pay attention to sleep but the deep and REM sleep where that cognitive and muscular repair happen people just don’t understand how powerful that is to the body Absolutely yeah Zac that’s great All right this is if a UCLA colleague of yours called you a quack tomorrow what’s the first word out of your mouth? You know intelligent people can agree to disagree and you know I’m still learning you know there’s stuff I thought was true 20 years ago that I don’t think is true there’s stuff I thought was true five years ago that I don’t think is true and we all you know we’re all just doing our best trying to understand the science
55:47 And you know the the amazing you know wonders of the human body so we’re all we’re all struggling If we’re not trying to progress you know you’re just staying at status quo you’re doing yourself a you know you’re doing yourself a disservice and you’re not trying to actually live or at least live a better life right Absolutely All right here’s one and this will be the one I close out what age do you plan to die at and what’s your confidence level? That’s a great question my my great great grandmother lived to my great grandmother lived to be 105 she was born during the Lincoln administration and she died during the Kennedy she lived to see people walking on the moon and it was amazing so you know that’s something to shoot for it’s really good but I think you know people talking about longevity escape velocity we’re entering unprecedented times
56:47 With our knowledge of science and medicine so I wouldn’t look at the future through the lens necessarily of the last 50 years that things are accelerating and you know who knows what’s going to happen Yeah well hey I appreciate having you on the show this is great I look so much forward to this because our belief systems are so intertwined and not much that comes out of that I’ve read about you or listened to that I disagree with so I was really grateful to have you on and I appreciate it Thank you so much Zac it’s been a it’s been a pleasure I really enjoyed the conversation Dr. Lufkin thank you generally it’s one thing to be right about something and it’s a whole other thing to stand up and say you taught the other version for years and here’s what I want you to take out from this one I’m talking to the guy who’s been told he is fine he just told you the fat you cannot see is the fat that’s going to kill you that is the tissue sitting around your heart
57:47 Right now that your scale cannot find your mirror cannot find and your annual physical is not looking for and that number on your blood panel that would have warned you about it is not on that panel because nobody ordered it that is not a conspiracy that is a system doing exactly what it was built to do it was built to catch you when you fall over it was never built to make you better at 48 than you were at 42 those are two different sports they’re playing sick care and you’re trying to perform so take him at his word and get to one number not 12 one and he named fasting insulin and that is his call to make not mine take it to your own doctor and you get told if it’s not necessary then ask him why that is a whole assignment because the gap between what your lab say and how you actually feel is not imaginary and it’s not permanent either and it’s trainable that is the entire premise of the show standard markers standard advice standard results you want a different result get a different standard this episode was for the man over 40
58:48 Who is doing everything he used to do and getting less back who has been told he is normal and he knows he’s better than that that is you you’re not broken you’re not old you’ve just never actually been measured hey if this was useful rate it review it subscribe and send it to the one guy you keep thinking about while listening to this right now he will not get the test because his doctor told him to he might because you did this is no hype just standards