#866: Sami Inkinen of Virta Health — Reversing Type 2 Diabetes, Rowing 2,750 Miles, and Lessons from Fixing Metabolic Health in 100,000+ People

23:33My workouts every morning, which is about an hour, hour and a half, unless it's a very, very, very high intensity. that's one of the best times where my thinking happens. And sort of problem solving and new ideas and creativity happens there. And then for the Wednesday, I actually just block like an hour and say, it's almost like the time to get the words and the thoughts and whatever that might be off my brain to a paper or obviously in the cloud. Unless I have to do a very kind of left brain, mathematical, deterministic problem solving thing, like literally like, okay, let's look at how do we improve cross margin or something like that.

24:12The creative work does not happen at the desk for me. And I'll give you one thing that I noticed. This was especially during COVID and COVID hit. I was listening a lot of podcasts and music and audio books on 100 % of my workouts. It was maybe like a year. And I realized that problem solving and the creativity almost like stopped. So now I have a rule that maximum of half of my workout, I can listen to Tim Ferriss. I said, sorry. So if your download numbers are going down or listening numbers, it's so sad to skip. Damn it, Sami. I need all the help I can get. So if the brain is in a consumption mode, you're kind of just filling the cup.

24:58And I've noticed the creative thoughts and the problem solving that's happening kind of in a backwards background processing It's not happening. So anyways, that's a tactical thing that I've noticed that too much audiobook podcasts kind of filling the brain and it stops creating stuff. It's very interesting. That's at least my personal experience. So I'm very conscious of on those moments when I'm exercising or walking or driving somewhere that there's kind of like a cutoff point. No more listening. Just let your brain do its thing. And then the Wednesday comes in. It's more like, okay, now I kind of have the framework in my head.

25:33take an hour and a half to, I don't know, write about next year's priorities. So this is the new product we're going to launch. Or even these team letters that I write, I actually write them in my brain when I'm away from the desk. And then when I sit down, it just...

25:49Tim Ferriss:That actually leads into my follow-up question. I can't imagine I'm the only person wondering this, which is when you're doing these workouts, let's just say it's an hour and a half to two hours, the real workouts, right, in the morning. I would imagine quite a lot percolates and comes up. And if you're doing that Monday, Tuesday, maybe also Saturday, Sunday, etc., by the time you get to Wednesday, if I have not taken some step to maybe verbally record some of that or make short notes in a notebook for cues for later, I would be doubtful that I would be able to recall the good ideas that I had earlier in the week.

26:29Tim Ferriss:do you just have a preternatural inclination to be able to remember all that stuff? Or do you take some type of shorthand after the workout so that you can use those then on Wednesday as prompts? How does that work? Essentially, I write emails to myself or store notes. It's the same thing. So there's tidbits along the week and then I have it for Wednesday. And then half may be in the brain and half is written somewhere so I don't forget it all. And you just send yourself an email after the workout with some type of note? Yeah. What is an example of what you might cover in a team slash company email on a Wednesday?

27:11Tim Ferriss:And how long is that? That is, like you mentioned earlier, one of the things you've repeated since day one. What would be an example that you can share? Could be hypothetical, but just like what might you put into that and how long is it? Absolutely. Well, there's sort of half a standard structure. So there's a quote from, again, we can go into details, but, you know, we're in a business of reversing metabolic disease and helping people get healthy with nutrition. So we treat patients like real humans, hundreds of thousands. So half of it is this existing structure. There's a quote from a patient.

27:43So we always kind of lead with, this is why we're here. And here's kind of a positive feedback from a patient. And then there's some business metrics, like how much we've grown and what are the priorities and just a reminder of this year's key objectives. So half is like that. And then the most important other half is topic of the week. So topic of the week is essentially my as a CEO founder essay. And I think that's what you were asking. I would say they're raffling two or three categories. One is what has happened in an external world? What's the context there? And how does that affect us? One example, this is a real world example that I've written quite a bit about.

28:23since we use nutrition as the core tool, but obviously our providers use all the tools in a toolkit, one of the things that has really changed in addressing obesity and metabolic disease over the last couple of years is the GLB-1 drugs. So these are the, you know, the Olympics of the world. And so I've had a number of letters discussing how do these drugs potentially affect how we take care of our patients and what's the impact on our business. So that would be sort of externality and how is that affecting our strategy? So that's one example. The other category is career and personal advice to our team members, like how to make most out of your experience working at Verta.

29:05And around that sort of kind of stuff that we discussed, we've discussed now like personal productivity and how do you make most out of. So that's, I would say, is the second category. and then third is just internal. This is what happened. This is what it means for us. So honestly, I kind of like it. It's my personal outlet. And sometimes I've said, hey, 530 plus essays. There's a book in the making. All we need to do is upload it to chat TPT and we have a book ready to be published.

29:39Tim Ferriss:So I promised I would come back to a thread, which I realized is probably a misworded question. The question I asked was why people have trouble doing what you do, which is saying no to 99 % of the things that normals do or feel compelled to do, to your point about the narrative. And I realize that's perhaps not the right question. The right question might be, what advice would you give to someone who is having trouble saying no or focusing on just a few things? But I can make it much more specific. Because I think the more we can imagine it, perhaps the easier it is to dig into this. So let's say that you had a relatively new hire who is on the younger side, but a 10x engineer or some equivalent of that.

30:31Tim Ferriss:Someone who is clearly a superstar, but who has not established the type of architecture and routine that you have in your life. and let's just say you sense that they are on the path to burnout, which is going to be bad for them. It's going to be bad for the company. It's going to be bad for the patients you serve. And you want to stage an intervention to help them correct course. I imagine you may have even had these conversations. What might that conversation or coaching look like? Well, funny enough, this has been one of the topics of my team letters, one of the 530. I would separate it into two things, my advice.

31:14One would be this sort of planning. I literally, it would be very simple. Sit down for five minutes on a Sunday evening before the week starts and write down what absolutely completely needs to get done next week. Super duper simple, professionally and personally. And schedule it into your calendar. Like literally. And if you have the flexibility, then like block two hours in the mornings to get those two or three things done. And then when life happens or work happens, everything else kind of comes after that. So that to me would be the number one thing. And then I would couple that when Monday comes or Tuesday comes, you know, whether you work in an office or in a remote setting, do not let the universe control your time.

32:04So this means absolutely no notifications. Maybe if you have to get text message for, I don't know, family emergence or something, but like take everything else out and you kind of create that sacred space where you can do that work, whether that's writing or coding or cold calling 15 prospects or whatever that is. It's super duper simple, but it's so easy to then sort of, again, Monday comes, Tuesday comes, and then the world takes over and you're like, oh my God, it's 4 p.m. I haven't done the thing. So I'd say that would be the one category. And then the second category is... Before we get to the second, for some people listening,

32:37Tim Ferriss:if they sit down for 10 minutes on Sunday to write down the things that must get done professionally and personally, they might have a list of 20 things in each category. So are we talking about one thing, three things in each category? I know this seems like very persnickety, but this seems like a possible failure point for people. So what is your suggestion there? It's probably one or two things, But this, again, we could launch into another part, which is obviously you need an architecture, annual thinking, planning. What does the business need, for example? Like I have, in fact, I just have a text file, ASCII file on my computer.

33:18Here's the four things to remember as a CEO now and 20 years from now. Here's the three things for this year. And here's the three things for this week. I literally have a text file and I just update it every Sunday. And a whole another topic, which I'm sure some people think I'm crazy, is I have a 15-year plan for myself, which I kind of accidentally stumbled. It actually could be useful. And I updated every year. And again, we can take that offline or take a bookmark, how that came about. It's been incredibly helpful. And again, I want to highlight structure allows spontaneity and flexibility.

33:56But if you don't have that architecture, then obviously on a Sunday evening, it's like, oh, should I write a book? or get a new job or just do these projects that my boss was asking. So if you don't have that North Star, you could be kind of spinning like a compass.

34:12Tim Ferriss:I did take you off track because you were saying, block these things out in the calendar, like Sunday, five to 10 minutes, block those things out in your calendar if you can, two hours first thing in the morning, do not let the universe dictate how you use your time, block out notifications. And then you said the second thing. Yes, second bucket. this is probably the most important as this relates kind of like a burnout and you just kind of you're falling apart and i'm gonna knock here on on my wood my table not too hard to create any noise but i founded my first software company in april 2000 so now it's with we're here in 2026 so that's 26 years running building fast growth companies and i i haven't cracked yet And again, caveat is it could happen tonight.

35:02But there's a few things I've learned. I think these are applicable to especially any knowledge worker where kind of like everything is just coming to your brain and it's very easy to get stressed and anxious and crack. And I've written about this as well. Here's my formula that has worked for me very well. One, you have to take care of your sort of foundational metabolic health. That's what is it? It's sleep, nutrition, exercises. That's kind of one. If you are metabolically very, very unhealthy, it's very, very likely that you're going to crack under pressure. So that's one. Second one is, it's very helpful to have, especially for kind of founder CEO types, but for anyone, have at least two or three kind of identities or outlets.

35:51For me, it's kind of parent-husband, one, CEO, two, and then wannabe athlete. And so if one's failing, hopefully at least two are the areas, outlets in my life where it's like, oh, it's going okay. And by the way, it's never that I'm rocking and winning and ringing the bell in all three at the same time. And it's very healthful. It's almost like a Jedi mental trick. Like, oh my God, work sucks. But at least my kids love me today. So having that outlet and particular founder types, younger ones, it's often the opposite. They're sort of proud of the fact that I only have one thing and I'm ready and willing to die for my company.

36:31Well, that's all well and good when everything's going well, but you have the first kind of speed bump and then everything falls apart. So that's the second thing I would say. Third one is have peers outside of your company that you can kind of let your hair down. Sorry, sorry that I know. Let your hair down and relax. For me, it's a group of CEOs. other CEOs was, oh my God, can you believe, can you believe these employees are bitching again? But you, obviously you can't say that in front of the company. So having that kind of, personally for me, it's been YPO, the Young President's Organization since, I guess, 2008.

37:09So now it's, for me, it's not anymore the Y, the young, it's just PO. because I'm all in other. So I have that. And then I think the last fourth one I would say is everyone has their own tools, but just understanding how your mind works. It could be meditation, could be some other tools, but that's been a process for myself to just realize that if you are just attached to your thoughts, eventually they are going to get you and you can't really think yourself out of the hole that you've thought yourself into. So unless you can take a step back and kind of like observe like, oh my God, my brain's having a life of its own.

37:44So that's kind of the tool that I would not do crack. So foundational health, you know, have different outlets, identities, have peers you can talk with, could be friends as well. And then some sort of understanding and kind of way of taming your mind, if you will, or being able to see that the mind has the life of its own. That's been helpful for me. And I will say, again, could happen tonight, but I haven't touched any prescription drug for anything sort of mind related. that toolkit has kind of kept me head above the water so far for 25 26 years i have a very

38:21Tim Ferriss:left-turn question for you hopefully it won't be incredibly offensive but i was just thinking when you were like i would knock on wood but i don't want to make any noise and then you're like and let my hair down you know no offense sorry and and you're very polite and i've only been to finland once i was walking around and of course went to the obligatory saunas and so on which I actually can tie into my story. But I was walking around and in the maybe two days that I was in Helsinki, I thought to myself, I lived in Japan, I speak Japanese, I'm still close to my host family who I stayed with when I was 15.

38:57Tim Ferriss:And I thought, Finnish people feel like white Japanese people. That was my feeling there. And the reason it ties into the sauna, different contexts. But if you go to Japan, everything is very restrained, very polite. People don't stare you in the eye when you're walking down the street. In Japan though, if the boss says we need to go out and drink, when you drink, okay. And if the boss says you have to drink, you have to drink, but you go out and you can get really loud and you can get really boisterous. You're allowed to say things when you've had some alcohol that basically everyone agrees they're going to forget the next day like it never happened.

39:37Tim Ferriss:Now, I can't take it that far with Finland, but when I went to the saunas, one thing that I was very surprised by is that they sell huge steinglasses of beer that people bring into the saunas. And I was like, oh, this is where they let their hair down. Okay. Am I totally off base? I don't know if you've spent time in Japan, but culturally, I felt like in my 48 or 72 hours of exposure, I was like, wow, this is actually even Finnish itself has some of like the phonemes, some of the sounds of Japanese. I mean, it sounds like I'm really overreaching now, but am I just an insane person or do you feel like there's something possibly there?

40:19I think there's similarities and you're definitely the connoisseur of a Japanese culture versus me having just been to Tokyo and a few other places a couple of times, But that kind of space and distance and politeness that people, well, actually, there's no distance in Tokyo, obviously, but sort of emotionally, there is a kind of distance in Finland and Japan versus when I came to America 2003, moved to California. It's like everyone's on your face and everything's freaking awesome. And it took a couple of years to, it's like, wait, wait, wait, wait, come on, like, give me space. And everything's not awesome.

40:57So yeah, maybe there are similarities. And then, yeah, alcohol, I'm sure, has been a mental health tool. Not very effective at that in Finland for many, many decades. But sauna, I have to... Well, first of all, there's 5.5 million people in Finland. And there are more than 3 million saunas. More than 3 million saunas. That's crazy. So on average, you have one to two people per sauna in Finland. Babies used to be delivered in sauna in Finland because it's the clean bacteria dies in the heat. It's warm, it's sterilized. There's warm water. I think my mom was delivered in sauna. I was in a hospital just to be clear.

41:40So sauna is beyond being part of the culture. It's part of the DNA. And it's culturally, it's an amazing place actually, not just kind of let loose and your hair down, but you don't have your uniform you don't have your titles you don't have your whatever social economic signals symbols fancy waters and kind of everyone comes together whether that's family or your friends or your community and yes sauna is definitely a place where a lot of things happen in finland and we could talk about saunas and its role in a culture but it's something way, way, way beyond cold bombs and sound. Yeah.

42:20Tim Ferriss:Why is that? Why is it so prevalent in Finland? Because it seems like, and I'm sure you've seen this, but like there are certain studies in the world of psychedelics where it's like they did brain imaging in one study that they have been slicing over and over again and torturing the data again and again to just produce more and more papers on this one study that was done so long ago. It seems like the same group of like 140 Finns has been dissected five million times in various announcements around saunas. But why is it so prevalent there versus other places? I don't know the origin story. Yeah.

43:02And hopefully there's a historian who will check me on this. But it definitely goes back hundreds, let's say many hundreds of years where it was sort of necessary. So, you know, Finland, four seasons, incredibly cold winters. So sauna was a place to kind of basically heat and warm up in a winter. It was also a place where, you know, you could dehydrate food. So that's kind of how it goes way back when. And obviously now, you know, it's not necessary to stay warm and it's not necessary to dry your food. But I think that's kind of where it started. and then initial saunas were kind of duck into the side of a mountain and then you just you burn wood on top of rocks and then you know you extinguish the fire and then you make sure that the smoke goes away and you know the rocks stay hot for a long time ago and that was the original it's called they will still have that kind of saunas today it's called smoke sauna essentially you don't have a way to get the smoke out other than open the door so there's no fireplace where the smoke just goes through a chimney.

44:08So that's called a smoke sauna and it's a special sauna experience. And obviously it takes much more time to heat it and make it safe because you don't want to go there where there's smoke. But I think that's kind of the history. And then somehow I'm missing the link how it became sort of like a culture. But now nobody will build a house without a sauna. Like literally there. First is where it's a sauna and then let's figure out if there's space for a bathroom. Like that's kind of the order in Finland.

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45:55Tim Ferriss:i went to this public sauna it's pretty fancy and there's a word you could probably tell me what it is it's like or something yeah there we go there we go so this is what the act of throwing water on the stones is that what that refers to or the sound that it makes i don't know what the name of the actual location means but the reason i bring it up is they had i have never experienced so many varieties of sauna and they had a smoke sauna room. And in my mind, looking at the menu of options before going in, I'm like, okay, I get it. It's a hot room. How different could it be? But the experiences and the feeling in the body and the way it penetrates your being is very different.

46:44Tim Ferriss:I was shocked because I've spent so much time in dry saunas in the US and And I've also done steam rooms and so on, but I did not expect there to be such a broad palette of experience in saunas. Yeah. So that was just amazing. Yeah. Yeah. So I guess Eskimos have a dozen or so words for snow because they know every nuance and kind of detail. And Finns have dozens of words for different things around sauna that you can't even translate. Lodlu is probably the most important. You judge the sauna and its quality based on lulu. And lulu is essentially, it's after you throw water into the rocks, the fireplace, the rocks, and then the steam comes up.

47:32It's not the steam. It's not the heat. It's the, I guess you could say the spirit of the steam, but how it feels, how it lands. And let me tell you, there's a million different variations how it happens. Is it too hot? Is it too kind of sharp? Is it soft? Does it sort of linger around? And how does it feel on your body? That is low-loo. And you judge the quality of the sound based on a low-loo. And there's a whole science to it. Kind of like how big is the space? Like barrel sound is a very... To get the low-loo right in a barrel sound, which by the way, I have at my house, it's very, very hard because it's too small.

48:08The fireplace, you can't get high enough and you should be sitting kind of above the fireplace. So yeah, low-loo is... If you know one word, low-loo, and you want to impress Vince, you go to a sauna. I say, what a fantastic Lulu.

48:24Tim Ferriss:I feel like I need to reach out to the Finnish tourism board to sponsor this episode. Get people headed over to Finland. I really enjoyed it. It was a very short trip, but hopefully I'll have a chance to get back. Let's talk about metabolic health because certainly Virta, we can talk about Virta. And a part of the impetus for this conversation was tons and tons of text messages back and forth. Some of them I'm sure we can't talk about publicly necessarily because it's internal data or whatever, but I would have, say, a conversation with Dominic D 'Agostino, who some long-term listeners will know, synthesizes novel exogenous, meaning supplemental ketones and so on.

49:06Tim Ferriss:And I was, for instance, I'll give one example, facing a bit of an enigma in my own experience, which was I've gone into ketosis, and I know that's a very kind of sloppy way of putting it, but let's just say getting into ketosis. So eating a predominantly fat-based diet, or even doing it through fasting, getting to a point where I feel like my brain has switched over to ketones. And I was lamenting to Dom, Dominic, that my devices were telling me I was not in ketosis. And I found this implausible because after so many years of experimenting with it, I feel like I have a very good bead on when my cognition clicks over and is actually operating at a much faster kind of CPU capacity.

49:57Tim Ferriss:But my finger pricks with say a Precision Extra device or the Keto Mojo were telling me I was basically not ketosis. And very confusingly, even with a breath-based, I think it's ketone air or something like that, pretty primitive device. But even with that, I was being given a negative. And you sent me a text showing your bar graph over the last 10 years or something of measurable ketone levels going down over time, even though presumably you're increasingly and increasingly fat adapted. And I was like, of course Sami has this data. And then you have some fascinating, fascinating data I have certainly never seen anywhere else looking at different cohorts with various combinations of things with or without, say, dietary ketosis.

50:51Tim Ferriss:That is part of the reason I wanted to have you on. You're just such a meticulous thinker around these things and data cruncher. But let's maybe just define some terms before we get into things. What is metabolic health? And maybe you could tell your personal story because my understanding is at some point yours need a sub 10 % body fat, but your report card in terms of biomarkers and so on came back and you're a pre-diabetic is my recollection. But perhaps you could take that TED talk I just gave and use it as a leaping off point for discussing defining metabolic health and then talking about your own personal journey, maybe as a starting point?

51:29First, the caveat, which is that I do have two muscles decreased, but I'm not a medical doctor and I don't play one on the internet. And I'm sure in this conversation, we'll kind of go into that area. So I just want to be clear. I'm not giving medical advice to anyone and I'm not a medical doctor, but obviously have a lot of experience with the topic that you just asked. I guess the personal story. So just rewind, not quite all the way back to Finland. But again, my background is not in medical field. I'm a physicist by training. And in fact, started my career in a nuclear power plant way back when in Finland, when it was still fashionable.

52:06And I guess nuclear power plants coming back to fashion now, now again, which is just to show that like my background is in sort of science and technology, not in healthcare. However, I've been essentially an athlete all my life, cross country skier, biathlete, came to America, started doing triathlons. Well, you had to ski to school at one point, right? Yeah, sounds very idyllic. Maybe that was a punishment by my parents. So Nordic skiing to school, indeed, first grade through sixth. Sounds terrible, actually. And the biathlon came handy. So carrying a rifle so I could shoot the bears when they were attacking along the way, which may or may not be true.

52:44But yeah, so I was an athlete and have been an athlete all those years. And then after coming to America, started doing triathlons and pretty high level athlete. Again, we're not talking about the Olympic gold medals, but as an amateur and many, many Hawaii Ironmans, I think seven of those world championship races and even won the world championships in my age group as a triathlete 2012, I believe. And I keep that all as a background context because my view on metabolic health and sort chronic disease, type 2 diabetes and obesity was, this is very embarrassing to admit, was the following, which is, it's ridiculous.

53:22It's very simple. People know exactly what to do. Most people, most Americans, they just don't do it. And as a result, we have just obese people everywhere. Everyone has pre-diabetes or type 2 diabetes. By the way, it's more than 50 % of American adults. Now the data is, I think 93%, this is the published peer-reviewed number, 93 % of Americans are metabolically unhealthy in one way or another, American adults. And you know, either you have a high blood pressure or your lipids are off or you're obese or you have type 2 diabetes or prediabetes. And my view, as judgmental as I was, was always, listen, ridiculous.

54:00You know what to do, but you're not doing it. You're eating too much. You're just eating too much and you're not exercising, you're a loser. And that's why I pay too many taxes, because health care is$5 trillion a year, of which almost all of it is metabolic culture related. So that was my view. And I'm very, very embarrassed to say that's how I was thinking, sort of judging people like you're unhealthy for reasons that are 100 % in your control. And then I got the moment where I had to eat a lot of humble pie. And I discovered that despite, you know, being, I don't know, 10 % body fat, dicks or whatever.

54:35And, you know, exercising 15 hours a week and performing well as a triathlete. I was pre-diabetic. All the numbers are off and essentially on my way to type 2 diabetes. And I was like, shit, wait, I'm not one of those people with no willpower. I'm not one of those lazy people. I'm not one of those quote unquote, middle of America, 300 pounds, seat belt extender. That's not me. Seriously? What's going on here? And this was 2012, around the time my previous company, Trulia, went public. And I was like, well, first I have to figure this out for myself. Because if I can't avoid being metabolically unhealthy, nobody can.

55:18Well, guess what? Nobody can. That is the status quo in America today, with so many people metabolically unhealthy. And that got me very interested in this whole topic of what is actually driving poor metabolic health. And fortunately met with amazing scientists who kind of helped me understand that fundamentally obesity, type 2 diabetes and the other conditions that result from poor metabolic health, it's not a personal choice. People don't wake up on a Monday morning and say, I want to gain 200 pounds and develop type 2 diabetes. That sounds awesome. and sticking an insulin needle to my body for the next 10 years every day.

55:54Awesome. Sign me up. No, it's not lack of willpower. However, nutrition and food is the number one driver of poor metabolic health. And if you know how to use nutrition, if you know how to use nutrition to actually improve and reverse your metabolic health, you can take an average, let's just call it 300 pound, middle of America truck driver or average person that we people on the coast often look at like, it's your fault and systematically reverse the condition nutritionally. And essentially, that's what we've done at Virta Health now with more than quarter million patients and scaling fast. But let me just pause there.

56:38That's kind of the how did a Nordic skier physicist from get interesting in metabolic health and then we can take this down to different paths.

56:49Tim Ferriss:Let's hop in. I want to start with, well, as you might expect, a question about diet. I want to know what, looking back, what the problem was with your diet. And also, this is of course a leading question, so feel free to discard it if it's not a good question, but how large a role does high fructose corn syrup play broadly in the US in metabolic dysfunction, right? If that just were removed from the market, what impact would that have? But let's begin with just your personal retrospective. Hindsight 2020, what was wrong with your diet? When you were exercising 15 hours a week, roughly 10 % body fat, performing well in competition, what was wrong with your diet?

57:37Number one question I get like, oh, was it your genetics? Because you were exhausted so much. Obviously, genes play a part in everything. But I just want to remind that given about 60 % of American adults, 6-0, either have type 2 diabetes or prediabetes today, clearly it's not like our gene pool has changed. So it can't really be genes. Or if 93 % of American adults are metabolically unhealthy, it's not like our genes have changed. So no, it's not that SAMe was the N equals one thing with very, very bad genes. This is happening to a lot of people. So that's, I would say one thing. The first one is there.

58:11The second thing is that it is possible to be skinny and lean and metabolically unhealthy. Some kind of people of certain background, especially kind of in Asia, it's more common that you don't gain a hundred pounds, but you're very metabolically unhealthy. Also, you can out-exercise the calories and burn and not gain massive amount of fat, but you can still be elevated blood sugar, elevated insulin, and be insulin resistant. And that's basically what I was doing. It's very, very hard. And I can tell you that I was hungry for 15 years as an athlete. It's like, I'm always more hungry than I could.

58:48And if I eat to my appetite, I'm going to gain fat. I can't do that as an athlete. So now I'm going to answer your question. So my N equals one, I'm absolutely convinced because I was able to fix and improve with this, I was eating six meals a day of essentially incredibly high carbohydrate and incredibly high glycemic index foods and practically no fat for 10 plus years.

59:19Tim Ferriss:So you weren't eating Twinkies. We're talking about rice, things like white rice, or what are we talking about? Rice, bread, apples, granola bars, ketchup, pasta. You know, anything that has a glucose molecule turns into blood sugar. And sure, if it's in an apple or if it's lots of fiber, it comes very, very slowly. But if you're eating 4 ,000 calories a day, of which 3 ,000 is carbs, do the math. 750 grams of carbs a day or more. And so you're basically drip feeding sugar into your veins constantly. Jamba juice in the afternoon, one second diet, tired. I just remember it was my diet all the time.

1:00:00When you're in your 20s, you can overdose. People say dose makes the poison. That's true. You can tolerate for a long time. But once you get to your 30s, you know, it gets very hard. So very convinced that that was it.

1:00:16Tim Ferriss:What are some of the more surprising things that you have seen within Fertile Health now that you have more than an equals one? And what do the interventions look like? Let's start from the front end of your question. What's the most surprising? The most surprising is that we've been able to be successful with literally anyone. And I'll give you one example. And why is that surprising? Even overcoming my own concept of it's all about willpower. I have this, but it's like people are maybe not as educated as I am. Maybe they're kind of busy lives. Maybe they don't have my willpower or kind of the willpower of willpower Olympians.

1:01:05So that's been one of the most surprising. We work with Native American tribes, 800 or so large employers, there's truck drivers. We've analyzed outcomes based on what's called ADI, so Area Deprivation Index. So you take all zip codes in America, and you rank them by average income, and exactly the same outcomes. We looked at race, ethnicities, exactly the same outcomes. And these are like large scale, tens of thousands, hundreds of thousands of patients. So that's one that's been very surprising, which is to say, if you fix the biology, So you fix the outcomes. This isn't, oh, you didn't even go to high school and you have a very busy life.

1:01:48So we need some sort of extra willpower training. No, you fix the biology, you fix the body and the outcome. So that's number one. Number two is the magnitude of improvements. So to give you a couple of examples, someone may have had diabetes, type 2 diabetes for 15 years. they are on 100 units of insulin a day sticking the insulin needle three times a day for 10 years and we can reverse that kind of state of type 2 diabetes in six to nine months and then sustain it for long term 13 percent average body weight loss and this is kind of like on an intent to treat basis not thousand start and then you calculate results based on five successful ones No, you calculate the average results from all the thousand.

1:02:37So 13%. So in our clinical trial, that was about 30 pounds or so. Average weight loss at one year and sustained and mostly fat because we did DEXA scans as well. So I would say the third one is the broad spectrum effects. And some of these are peer reviewed. So we've been able to show not just blood sugar down and reversing type 2 diabetes, not just weight loss, but we've been able to show up to 75 % reduction in liver disease. It used to be called fatty liver disease, but scientists changed it to liver disease. And so it's called MASH and MASHLD. By the way, it's cost$100 billion a year in America today.

1:03:16There's one FDA approved drug today. One FDA approved drug today for MASH. It's one type of liver disease. It costs$45 ,000 a year. No kidding. And it came out to market last year. first time, 2025, billion dollars in sales. We deliver similar results nutritionally.

1:03:32Tim Ferriss:I think this is public. This is in our texts. Paper just accepted through peer review, treating stage four. There is no stage five, if I'm remembering correctly. Metastatic pancreatic cancer, right? This is bad news. This is super, super bad news. I mean, this is kind of, also if my memory serves, this is kind of like a Steve Jobs type situation. But this is treating stage for metastatic pancreatic cancer with three chemo drugs. That's one arm versus same drugs and on Virta trying to get patients into ketosis remotely. And do you want to describe the results of that? This was a very well controlled, a randomized controlled trial for stage for metastatic pancreatic cancer.

1:04:16We ran the trial with a number of academic oncology centers. So but this wasn't just us, a very well-controlled, randomized controlled trial. And before I talk about the results, just a reminder, pancreatic cancer is number two or number three killer, depending on the year of cancers in America. So it's very deadly. It's usually diagnosed kind of too late. So it states for metastatic stage and the life expectancy is usually sort of 12 to 18 months or 12 months. It's very, very deadly cancer. And so we had a trial where we had one arm where we randomized people, it was chemo, three drugs, and then another arm, as you mentioned, same drugs, exactly same therapy, plus the Virta nutrition therapy.

1:05:02And we were able to show just about 35 % life extension on average in that arm. So chemo plus Virta. Again, it's a very deadly disease. So 35 % is stunning. But of course, you know, we're still counting months. It's not that you go from 12 months to 12 years on average. But I guess that going back to your earlier question, that shows the power of metabolic health and poor metabolic health and what might be possible. What is absolutely possible is reversing type 2 diabetes, losing weight, preventing liver disease. We didn't even talk about kidney disease and other things. The fact that we can drive outcomes even with some cancers, and I will say some cancers, I can't say like, oh, nutrition can cure cancer.

1:05:52Not quite, but poor metabolic health. And in our case, we didn't really define the poor metabolic health in the beginning, but essentially it's high glucose levels, high fasting insulin levels, and what you then might call insulin resistance. Your body is primarily burning sugar and you're constantly hungry, you're constantly craving. So even if you're a hundred pounds overweight, you're hungry and you want to eat more of that stuff. That's kind of the typical state of poor metabolic health. And then it manifests itself with type 2 diabetes, cardiovascular disease, fatty liver disease, often eventually chronic kidney disease, and many other things.

1:06:30And seems like, again, not the medical doctor here, but many cancers thrive in that kind of environment, in that kind of poor metabolic health.

1:06:39Tim Ferriss:I don't think that's controversial. It says the non-doctor to the non-doctor. But certain cancers, not all, are very glycolytic, right? I mean, they're really dependent on a steady fuel of sugar to simplify it. Dom, I think for people who want to hear more on that also, Dominic D 'Agostino has spoken about it quite a bit in a couple of my conversations with him. What I want to ask you about, because we've teased it a little bit, the Virta Nutrition Therapy, I'm looking at the Virta Quick Guide right now. And if you don't mind, I'll lay out some of it because this is where, for me, this is where the probably the magic is embedded.

1:07:20Tim Ferriss:And I want to learn more about how you guys get the compliance, the adherence that you do, because that to me has always been this very elusive, I don't want to say missing link, but challenging link with anything approaching what we might consider a ketogenic diet. And I want you to also dispel if I'm making a false equivalence with the ketogenic diet, but you have curb your carbohydrates. Aim to begin around 30 grams per day, just as needed. And you have some very important stuff in here, right? Measure total carbs, not net carbs. This is where people try sometimes outsmart themselves. And then you give examples of what that can look like.

1:08:03Tim Ferriss:And then building your plate, like what does an actual meal plate look like? Non-starchy vegetables, moderate protein, added fat, salt and extras, et cetera. I'd love for you to describe what you have found to work when you're getting people started and just what you've picked up over time in terms of the most helpful components, I was going to say ingredients, but not food ingredients, ingredients for getting people to adhere to these diets. Because my assumption, which may be incorrect, is, okay, I, Tim Ferriss, I can go to Whole Foods and buy salmon and vegetables and this and that. A lot of people in economically depressed circumstances or areas or fill in the blank buy a lot of their, what some people would consider sort of unhealthy food because it's very inexpensive and it's readily available.

1:09:00Tim Ferriss:And like having spent time around a number of Native American reservations, it's like, man, you live in, there are food deserts in the United States. So what have you found, And what have you learned over the course? Because your data set is so incredible. It's just like such a rich and amazing data set. What have you learned about helping with adherence and compliance or modifying the diet itself? I will brag because you said we have big data set. We absolutely have the largest data set of metabolic disease reversal in the world. Millions of patient years of data and data points from each patient every single day.

1:09:36not just qualitative information, but blood biomarkers. Yeah. So let me try to peel the onion to answer your question because it's a lot goes into it. So I guess just to take a step back. Yes, we use nutrition, individualized nutrition as the core therapy to treat our patients. It is our own protocol. I say our own protocol because any kind of generic label that you put into it, people go to Google and they Google and they can go wrong in 1000 different ways. So anyway, so we use our own protocol, but yes, to address and reverse insulin resistance, you do have to reduce your total carbohydrate intake.

1:10:17And we have those response curves to know that the more and the better you do it, the better outcomes you typically see. But that's sort of number one thing I will say that yes, we use nutrition as a therapy to reverse metabolic disease. And I will say that as a physicist, using nutrition as a drug or as a therapy is harder than sort of nuclear physics. Why? For all the reasons you mentioned, because every person makes a medical decision three to four times a day. That's when you eat. It's different today versus tomorrow. And then it's different between individuals. So it is a very, very hard puzzle to solve.

1:10:53Fortunately, computers and software is very helpful about that. So that's kind of one, individual as an interesting. And number two, so what does it take and how do we approach? Key piece, even if you know exactly what somebody should eat, is you kind of need the support system. And I guess that's my tech background with Trulian and other things comes to play that everything we do, we do virtually. So what we can do is we can monitor your biomarkers remotely. We give you tools to do that. We can track blood ketones, blood glucose, your weight, and other things. And then we have actual real medical doctors, not me, who are full-time employees who monitor you and coaches who can then make adjustments.

1:11:36Tim Ferriss:Is that collected through continuous glucose monitors? And is it also blood draws or is it mostly some type of continuous monitoring? It's all of the above. Some patients get a CGM and some it's a finger brick, but not everybody gets a CGM. depends on the situation. We do lab draws one to two times a year. So that's obviously doesn't can't happen daily. Yeah, I got it. With the finger prick, that's some type of Bluetooth enabled thing that automatically syncs the data. So they're not manually having to enter any values. No, no, no. Goes to cloud and gets to us. And I say that because it's kind of like, if you say like, oh, here's how to eat, here's a brochure or a book or something.

1:12:15It's kind of like telling to a car driver that just hold onto the steering wheel straight. It's going to be awesome and here's brake and gas, gas pedal, and you know what's going to happen. The car is going to beautifully stay on the road until the first corner. It's like, oh, forgot to mention that we may need to adjust, turn left, turn right. And so it's the same thing with nutrition, that unless you have this kind of a platform, there's constant adjustments and constant adjustments. It's kind of like a self-driving car, but then if you have the cameras, white lane and yellow lane or line, and you kind of try to keep it in between.

1:12:51So with the remote monitoring, we can kind of try to keep you between the yellow and the white. So that's the second thing. The third piece for adherence, and this, we start talking about nutrition. The most important thing early is to understand the constraints that a person has. I'll give you silly examples. If we tell a vegan to have bacon and eggs for breakfast, you know what happens. They can say F-U-C-K, I'm out. There's no way to convince a vegan to have bacon and eggs for breakfast and vice versa. Like there's other things, obviously, if you are, we work with U.S. Foods, large kind of actually food delivery, food service.

1:13:28It's truck drivers. Their concept of a lump is McDonald's. We can't tell them, oh, here's the list, go shop Whole Foods or everyone and then go home and cook at home. It's like, okay, McDonald's it is. We're going to reverse your diabetes on McDonald's diet. And by the way, we do that.

1:13:48Tim Ferriss:I don't want that to get buried. What are some sample meals that people might get at a McDonald's or something like that? Perfect. Yeah. So that's the next step with food. And maybe I'll give you an example. It's like, okay, now that we know you are a truck driver and you will never become a vegan, you can never become a vegan. Obviously I'm tongue in cheek here, but most of them don't. I'm not a vegan either. And I'm not sure if you're probably not either, right? Yeah. And by the way, we have many, many successful vegan patients. So, and I know, sorry if I started a diet warrior, but so, okay.

1:14:24So example, you structure, okay. So macronocides, it may not be the pinnacle of health, but we can reverse your metabolic disease with that. And let's forget the organics that we'll do that later. If you can, here's what you do. You go there, say, all right, well, you want your burger, maybe even add extra cheese, but please ask them to drop the bun and just have like a lettuce wrap. Get that. Then you go to the condiments. Yeah, mayo might be fine, but don't take the ketchup because we can educate you and tell you that ketchup is colored sugar. You can't have that. Yeah, you want your soda. You really want your soda.

1:14:56Water is not enough. Okay, so go for the Diet Coke. Don't take the soda with the sugar. Again, somebody's listening like, oh, Diet Coke's bad for you. I totally agree. I'd rather drink water. But again, let's not let perfection be the enemy of progress. So that would be a McDonald's kind of a session and off you go. So that's kind of the second step with food. And then the third one is really empowering the patients with, we could talk about AI, like AI-based tools. You go to a restaurant or you're trying to cook something, you can take a picture and we instantaneously say like, hey, what kind of adjustments should you make?

1:15:31and tie that to your actual situation. So how to change that. And this happens every day, two, three, four times a day. And that's the kind of the self-driving car analogy that a car that goes straight is fantastic until you have a corner. And that's 100 % the diets in America today. So you can't do one size fits all. And then before you ask a follow-up question, this is mind-blowing for people and ties to your earlier question as well. the adherence of Virta patients, again, which are like real Americans, not Samis, real Americans, is twice as high at one year as taking a GLB-1 drug. We have 83 % adherence, retention of patients at one year.

1:16:19And look at any of the publicly available data, people stick to GLB-1s like 40%, maybe 50%, 30 to 50%. Why is that? number one reason is the user perceived benefits. It's like, I can't believe I feel this good. I can't believe I've lost 35 pounds. I can't believe I don't need to stick the insulin needle to my body. The stories that we hear from people is like, I'm 65. I thought I don't see my grandkids grow. And I have so much energy that I'm gardening the first time in 20 years or whatever that is. And you know this, like when you're feeling really, really bad, you're sick and everything's hurting and then that suddenly goes away, that's like, life is freaking awesome.

1:17:03And so I think the number one reason is the benefits are so strong versus like a calorie restricted diet where like, this sucks, but I'm going to look good on a beach at least for a week.

1:17:13Tim Ferriss:How did the experience of benefits differ from GLP-1s? Just because we're segwaying directly from that. And certainly a lot of people listening will either directly themselves have experienced or know someone who has lost 35 pounds and feels more energy because the GLP-1s do make you slightly more ketotic. For the people who are wondering why they might feel sharper, that's actually one very plausible piece of the puzzle. But how do the perceived benefits differ in a way, and maybe there's more to explain it, and I'm sure there is, the sort of two times GLP-1 adherence at one year? I guess that's what you said, right?

1:17:52Tim Ferriss:So I'm just trying to identify where those two interventions diverge. First, I will say our averted providers prescribe both oral and injectable GLB-1s when appropriate and or necessary. And when our client, the plan sponsor, like an employer, health plan, have them in a plan design. So I just wanted to mention that so that nobody thinks like, oh, this is some sort of nutrition dogma. No, there's effective pharmaceuticals and especially GLB-1s in obesity and metabolic disease contexts are way better than the 1980s and 90s diet pills. So it's a real, real innovation. You guys don't prescribe FanFan to your patients?

1:18:31We don't. We don't. By the way, there are companies that do that to low cost of GLB-1s, but absolutely we don't do that. I'll start from very basics. The GLB-1s 100 % affect your appetite. So they change how much you eat. So you eat less, but they alone don't change what you eat. So that's the starting point. And if you don't change what you eat, you're not going to be perfectly or even optimally metabolically healthy. And so one example is you lower your appetite, you eat less. But the second you come off these trucks, all the data shows that your weight skyrockets and more likely than not, you gain fat and you've lost muscle muscle.

1:19:14By the way, we've shown the patients who come to us on GLB once, and once they discontinue the drug for whatever reason, a personal choice or side effects, we've been able to sustain that weight loss. This is published in period data, 18 months out. Soon we will have even longer term data, but 18 months, no weight regain. Why? Because we start changing what you eat while you're on the drug. And if you do that, but to kind of sharpen the point to your question. Obviously, we know the side effects of healthy nutrition. None. Every drug has side effects. So that's sort of one thing. And these GLP-1s are tolerated much better than many, many other drugs.

1:19:57But there's a lot of things. Nausea and stomach issues. And it's interesting. We've surveyed the patients who are on GLP-1s in our care. 80 % of them say, I either want to severely reduce the dependence on these drugs or get completely off of. So this idea, which is prevalent, at least in a press, like Americans just want to take a pill and keep taking the pill for the rest of their lives. Most people, if given the choice, if given the choice to be healthy without, they don't want to be taking drugs. Hopefully that answers the question of like, what are the user perceived benefits? Well, there's no user side effects when you're eating healthy food, but with the drugs, you usually have that.

1:20:38I'm not the expert to talk to kind of how energy levels or kind of excitement or mood and things like that change. I think lots of data will come out when millions of people on this shall be once for years, but eager to see what happens. But there's definitely a lot of things to be fully aware of, like lean body mass in elderly populations, 65 and plus people who lose a lot of weight and she'll be once. Yeah. Very kind of alarming reports coming up. So I want to get

1:21:11Tim Ferriss:granular again with just a hypothetical example of a vegan, because this word has come up a couple of times. And in a way, in my mind, I've always envisioned that as a tougher nut to crack than McDonald's, just because so many, how should I put this? This is true across the board. If you just walk through any grocery store, including Whole Foods. There are a lot of junk foods masquerading as health foods, which are full of ingredients that are terrible for you. Incredibly high glycemic, meaning they're going to spike your blood sugar. Maybe we can talk about glycemic index versus glycemic load, but suffice to say, if you eat it and you check your blood sugar within 90 minutes, it's going to be a lot higher.

1:21:52Tim Ferriss:And this seems to be true of a lot of vegetarian or vegan food also. So what would be an example of how a diet plan or let's just say a meal or a day of meals for a vegan, let's just say, on the Virta program? Again, I will say everything has to be individualized, but to use kind of average figures, we rarely have to massively change protein intake for our patients. Maybe surprisingly to some people, the standard of American diet has a keyboard take. Maybe it's a little bit on the low side, but more or less the right amount of protein. By the way, that's the most expensive macronutrient. So sometimes people are like, oh, when you start treating your patients, it must be so much more expensive.

1:22:40Well, actually, protein is the most expensive. We rarely change that a lot. In vegan context, that's probably the hardest thing to get right, to get sufficient amount of protein. And you really have to get at least 1.2 grams per kilo, kilo, one kilo is 2.2 pounds of protein per lean or kind of normal body weight. So if you're 80 kilo, 80 kilo person, which is 176 pounds, that would be kind of lean person. You kind of 100 grams of protein a day is sort of minimum you have to. So that's probably the hardest. And vegans know this very well. It's, you have to look at like nuts and tofu and many to rely on soy.

1:23:24And are you willing to eat eggs? That would be one. So we figure out again with the patient, like, okay, what are you willing to eat? Are you able to have dairy? You know, some people are okay, some not. But that's probably the hardest user to make sure that people get adequate protein. And protein is really, essentially, it's the only a macronutrient that doesn't really store itself. So you kind of have to get it a couple of times, two to three times a day to maintain your body mass. Then after that, it's actually interesting to get the sufficient calories. If there's a lot of crap vegan food, meaning sugar or, you know, cornflakes or whatever, then we start replacing those with healthy fats.

1:24:02And this is also a misconception. Like, oh, it must be so expensive because corn is subsidized. Hence, you can have unlimited amount of corn calories cost nothing. Well, guess what? You can buy 9 ,000 calories. So one liter of high quality olive oil from Costco for like a, what does it cost? Two bucks. So it's a misconception. So the cheap subsidized sugar calories can actually be replaced at the same cost. Now, if you're very, very overweight, you don't want to be replacing those calories because guess what? You want your body to give the fat calories. And then around the kind of healthy vegan food, then we guide the patient towards sort of leafier, less starchy vegetable options.

1:24:49So you can eat very sumptuous vegan food. And I think we even have, because this was a misconception in our very early days. So we've been pretty vocal. We have a bunch of patients who are vegan. If somebody Googles further health on vegan diet or something, there's a couple of our patients have sort of openly shared what they eat, but it's totally manageable. In fact, you just kind of end up throwing out the window the crap vegan food. So I don't know, sugar, frosted cornflakes would be a perfect example of that. Or orange juice or something like that, which I love oranges, but orange juice is essential soda.

1:25:27Tim Ferriss:Tell me if I'm hearing this correctly. So it sounds like if you reduce the high glycemic junk that someone is consuming, you're going to over time improve metabolic health. But is it fair to say that for instance, the truck driver who's eating the lettuce wrapped cheeseburgers and drinking Diet Coke, like man, you do that for depending on the size of the person and blah, blah, blah, blah, blah, obviously. Like if it's a male, I don't know, maybe in three to five days, that person's probably clocking in at, who knows, 0.7 plus millimoles, millimolars, I'm not sure how you say it, ketones, beta-hydroxybutyrate, I would imagine.

1:26:07Tim Ferriss:But in the vegan example, maybe you're simply reducing the glycemic load, but maybe not getting deeply into ketosis just because the question in my mind was related to the protein, right? How do you consume tofu, tempeh, et cetera, et cetera, et cetera, while keeping your total carb count low? It doesn't immediately seem possible to me unless they're willing to eat eggs, right? But if we take eggs off the table, then it seems like you can significantly improve metabolic health, but it may not be through the vehicle of what would technically be considered ketogenic. Is that fair to say? Yeah, that's why we don't really use the K-word.

1:26:51Because again, for two main reasons. One, you Google it and you get your version that you can either love or hate and likely it's wrong. And then two is it's all on a spectrum or kind of a dose response curve. And we never want to let sort of perfection be the enemy of progress. And the less you have hunger and cravings and the better you feel, more sustainable and easier everything is, including just life. And that's what we teach to our patients. And you can kind of be anywhere in the dose response curve and be successful. The further you are, we can pretty much predict not just your health outcomes year out, but even the healthcare cost savings, which is sort of insane.

1:27:33Because drug companies do these trials, you take one pill, this is what happens, take two pills, this and then you kind of want to optimize where you want to be on a curve. Our therapy is no different. We show this to people, we educate, We said, it's your choice and you get here. And the beauty is that we empower people so they can make their choice. And then the beauty also is that you don't have to be perfect and you can still be very, very successful. Average diet is so bad, honestly, that it's relatively easy to make early progress.

1:28:01Tim Ferriss:Yeah, the standard American diet, SAD. I just love it. The acronym is SAD. It's so good. Whoever came up with that, God bless you. What a great acronym. I want to get back to your training. So we're going to get off of Virta in a moment, but I want to say just for people who maybe have heard the last few conversations I've had with Dominic, I am deeply interested in ketosis and the ketogenic diet and exogenous ketones, but I think Virta is approaching this the right way with a greater degree of flexibility. And I would also just point to, for instance, the slow carb diet and the four-hour body, it is not a ketogenic diet.

1:28:42Tim Ferriss:You're consuming legumes, you're consuming a lot of fiber in the form of beans or lentils, et cetera. It is not ketogenic in any way, but it does reduce or eliminate processed food. It eliminates most starchy carbohydrates except for one day a week. And the types of transformations that you can see metabolically are just remarkable. And granted, That is a book, so it by nature of its format is a kind of one size, hopefully fits most, whereas Virta is much more adaptable and customized for the left-right turns that you described. But I wanted to just underscore the fact that I am not a keto purist by any stretch of the imagination.

1:29:27Tim Ferriss:And most of the time I am not in ketosis, although I do spend time in that range. So I want to hop from Virta to a question around training. So just in brief, what is, and I'm not sure this number even exists, but what is it an average non-athlete VO2 max? And what is your VO2 max? I think for, I'm freaking old, by the way. I just turned, do you know how old I am? I don't know how old you are. You've got those impeccable Finnish genetics. I have no idea. Oh my God. I turned 50 in December. Oh, nice. Congratulations. Yeah. So I'm very, very old. This is at least what my... Not that old. Two kids tell me who are like 10 or something.

1:30:11But I think at this age in particular, or even like a 30-year-old fit male, so VO2 max is measured relative to your body weight. So it's how much oxygen you can consume, your body can utilize. So it's milliliters per kilo per minute. I think it's maybe 40. Would be on the average side. 4, 0 maybe, or 35, or 40, or 45. My measure is more than 80, 80 milliliters. This is pretty high, very high. The caveat is it was measured like a couple of years ago, so it's probably a little bit lower today. The max VO2 max tends to go a little bit down as you age. You can still kind of increase the percentage of that that you can produce for 5, or 10, or 15, or 20 minutes.

1:30:54But yeah, it's kind of very, very high. I think the highest ever measured recently, it's more than 100. But if you're 90, you're kind of Olympic, 85 to 90 gets you to Olympic podium in endurance sports. And again, that's not the one and only measure. There's a lot of other things. But if you're above 90, you should not be doing podcasts. You should be in the Olympics.

1:31:19Tim Ferriss:Well, good news, bad news. I'm going to stick with podcasting. I am definitely not above 90. So the reason I'm bringing this up is that in conversations with my doctors and people I really trust, as well as a number of podcast guests like Dr. Tommy Wood, who is a neuroscientist and phenomenal athlete also, the topic of endurance training as it factors in, I hesitate to use some of these labels, but endurance slash aerobic training as it factors in, you'll see very quickly why I'm struggling with terms, factors into health span and longevity. It's become a topic du jour in the last handful of years in particular.

1:31:59And the way it's been presented to me is, and I'm particularly

1:32:03Tim Ferriss:interested in this for its implications for cognitive health and potential volumetric changes in the hippocampus and so on with certain types of training, but given that I have Alzheimer's in my family. But the way I've been taught to think about it is that let's just say zone two is the base of the pyramid, and then VO2 max is the height of the pyramid. And you're trying to maximize the total surface area slash size of that two-dimensional pyramid. And I will confess, I'm very ashamed to confess, I hate sitting on a stationary bike. I absolutely loathe it. I find it It's so boring. And I also just see these long-term changes in the sort of kyphosis, like the hunchback postures of some long-term cyclists.

1:32:52Tim Ferriss:And I want nothing to do with that. I have enough back issues as it is. So my question for you is when you're trying to get a normie to do more endurance-like training, and I am on the path. I have some spinal issues with the lumbar and sacral, so kind of segments of the spine, which I won't bore everybody with right now. But I'm hoping to get to a point where I can actually do sports I enjoy, like jujitsu or other things, which at least for high intensity interval training, mimic something like the Norwegian 4x4 really well. So I could do a round of four minutes, take three minutes off, do another round of four minutes.

1:33:29Tim Ferriss:And like maybe it's four minutes on, four minutes off, or three minutes on, three minutes off, but close enough if I'm doing it consistently. But as it stands right now, I can't really do incline treadmill with say a rucksack or something for zone two because of the hip extension and the issues that causes in the lower back. So despite my best efforts to avoid the stationary bike, I keep on ending up on this damn stationary bike. And road biking just scares me too much with the traffic, say in a place like Austin. Everyone I know here has done road biking for more than a handful of years has had some type of accident.

1:34:04Tim Ferriss:What would be your advice for someone who's trying to get literally back in the saddle to do some training? How do you think about this type of training as it fits into health span and so on? Because I'm not intrinsically someone who enjoys this particular type of training. And I remember for the four-hour body, I was in South Africa at the Sports Science Institute of South Africa, and they did a muscle biopsy of my thigh, my quadricep, my vastus lateralis. And they looked at all the enzymes and I can't imitate a good quality, strong South African accent. It's pretty good. It's a great accent, but years, I can't even say years.

1:34:46Tim Ferriss:That's how you ferret out the South Africans or the North English. But the point is he came back and he showed me these charts of enzymes like citrate synthase, which seem to be correlated to endurance capacity. And basically his message was tertius. I think that was his name. He said, here's this flat line is Homer Simpson. And here is your line, which is like infinitely below Homer Simpson. So I don't think I'm very well built for this stuff. This was a long litany of complaints, but how would you suggest I think about this kind of training? Because it seems important. I'm not sure how to make it more interesting.

1:35:20Tim Ferriss:I do find the interval stuff a little more compelling and it keeps my attention more than the zone two, but it seems like you kind of want to do both. What are your thoughts? I'm just turning this into like a therapy session. Sure. Asking the non-coach a coaching question, my favorite topic, pretending to be an expert. I will take it. I will take it. Yeah. So my, my approach to, I've had a coach and then I essentially 95 % of my life, I have self-coached myself because I take it as an interesting puzzle to try to learn and then surprise, as surprised as an entrepreneur, I don't really want to be told what to do.

1:35:57So ended up self coaching. So based on that experience, and with that caveat, first of all, on a high level, my approach basically in everything in business, metabolic health training is kind of nailed the basics, less marginal gains than crazy. And I know it's boring, it doesn't sell a lot of supplements and stuff. But it's like, nailed the basics, less marginal gains than crazy. And when you do that, that's when you actually get the 99 % of the results. And then for training specifically, also, whatever you want to accomplish, and you've done a lot of sports and lifting, the very basics are very simple.

1:36:34It's progressive overload and specificity. Like progressive overload and specificity. If you don't have progressive overload, even if it's just a walking or hiking or running, you aren't going to get better. Initially, when you've done nothing, come off the couch, it's like very easy progressive overload. It's like do anything and you get better. And then the other one is just a sort of specificity. Like if you want to be a sprinter, you can't train like a marathon runner and vice versa. And, you know, if you want to squat a lot, bench press isn't going to help a lot. So it's literally those principles that I use.

1:37:02But to give specific advice to you, what you just said, to get the cardiovascular stimuli, you obviously have to get your muscles burning oxygen, using oxygen and then burning. either better cars and your heart rate up. So you need to do something for that. The reason cycling or any kind of a bike thing is so widely used, it doesn't take space. And if it's indoors, it's very safe and it's low impact, it's low impact. So one thing I would say for the bike is, and Austin has a lot of good bike stores.

1:37:41Tim Ferriss:I have two indoor bikes upstairs. One was set up by Tech from Melo Johnny's. So I've got the bike. Melo Johnny's, there you go. So one is bike fit. If there's someone who's like a PT and a bike fitter and say, hey, I have these XYZ issues, fit this bike to specifically work for me as much as I hate it. So that's one thing where you could like get the handlebar crazy high or something like that. Maybe even do a lot of standing. By the way, those are fun workouts to kind of, I don't know, do like a three-minute standing, three-minute seated, three-minute standing or whatever. So that would be sort of one thing to consider for the bike that you get a fit that's specifically for your back issues.

1:38:19It may not be the world's most aerodynamic, but if it's stationary bike, who cares? So that's one. The other thing, you don't have a lot of snow around, but I know you occasionally go to places with snow. Nordic skiing and sort of skinning, obviously fantastic. Yeah.

1:38:35Tim Ferriss:Fantastic. Skinning, I love. I love skinning. If I'm outside, I'm not going to get hit by a car. If I could do skinning every day, I would. and my back actually loves it. So yes, I'm 100 % behind skinning. And then of course, often people who kind of totally destroyed their knees and hate swimming, which I hate swimming personally as a triathlete. Well, elements of it are beautiful. You go underwater and it's kind of like meditation, but more than 20 minutes and it's like, please give me a break. See, I will take the swimming over the cycling. I went and did some swimming yesterday. I'm up for the swimming.

1:39:11And then if you live in the mountains, it's very, very easy to get sort of zone one, zone two by just walking, even without extra weight. So you go up, up and sort of speed walk. And then maybe the last one I say, if you have the self-confidence to not feel too embarrassed is Nordic walking. So Nordic skiers do summertime. You either walk or run with them, but you basically have poles and you go uphill. You'll probably get an extra 10 beats, heartbeat and kind of a higher level exercise. So it's kind of like jogging uphill with poles. Poles, poles, yeah. Yeah. Obviously, you could just walk and then use that.

1:39:47I could get into that.

1:39:47Tim Ferriss:I use poles. Yeah, I could get into that. And then to the sort of VO2 max. So building a better aerobic engine in like zone two does help your VO2 max too. And then, of course, if you lower your body fat, body weight, the kind of denominator in the calculation improves. but specifically VO2 max training, you actually get the adaptation pretty quickly. So like, I don't do it all the time, crazy amount, because it can also burn you out. The two most common ways to really hit VO2 max is either you do sort of 30 seconds on-offs for a lot, like you go very hard and then 30 seconds easy, but then essentially you kind of keep hitting the VO2 max oxygen consumption or sort of two to four minutes all out.

1:40:34They're very, very hard or two to three minutes all out. And then you take three minutes off and you do that, whatever, four or five minutes, four or five times. So those are the most effective, I would say, and typical ways to specifically get your VO2 max up, but they can burn you out if you do too many of those. And so like for me personally, what I do typically closer to like a specific event or race, it may be like three weeks where I do two of them a week. So just like six workouts. And then I drop it to, I don't know, one every two weeks or something. It can burn out and the VO2 max isn't just not going to infinitely keep going up, bad news.

1:41:14And so maybe that's how I think about finer sports where you can comfortably and enjoyably do an hour or so of cardio, whatever that is. And then this would be my advice. Think strategically when you do your like a VO2 block, and that could be just three weeks or maybe it's two weeks every quarter or something like that. And then the maintenance dose, again, I'm using dangerous terms here because who knows what the optimal dose is but constantly pushing the vo2 max i think it's just the injury risk it burns you out and it's not going to do anything because once you reach your vo2 max

1:41:53Tim Ferriss:ceiling you kind of are there broader question i want to ask you about is sort of what exercise dogma or sacred cows you have stress tested because i was looking at this is a blog post that you wrote. This is a while ago, and I actually don't have written down here the title, but it's about hacking your running speed in four weeks. And I'm tempted to read this whole thing, but I'll just read some of it. So my total running time averaged one hour, 55 minutes per week. It's a four-step protocol for four weeks. So first, and I won't read all of this, but develop muscular endurance by running 10 to 15 minutes every day.

1:42:37Tim Ferriss:That might surprise people. It's like, hmm, that's more achievable than I would have expected. And you contrast that with the conventional approach of doing like a long run once a week and increasing the distance each week. So I'm not going to steal the thunder. I want you to, we could comment on this as an example, but then broadly speaking, just kind of like unfounded sacred cows. Cause man, there are so many everywhere, not just an exercise, but everywhere. Number two, build your cardiovascular engine with all out, I think this is 10 by one minute set once a week on a treadmill for regulating effort.

1:43:09Tim Ferriss:So the total workout is less than 35 minutes. You give links to scientific evidence. Number three, plyometrics for quick improvements in running efficiency. Even highly trained endurance runners seem to improve their running times in a few weeks of plyometrics, which is not that much. Roughly five minute routine, three times a week, three times 12 explosive box jumps, three times 12 jumps for max height, which sometimes replace with skipping into a hill. I don't know what skipping into a hill is. Maybe you can explain that. And this approach took 40 seconds or roughly 10 % per mile off my best running speed in four weeks leading up to a competition.

1:43:45Tim Ferriss:Typically a 5 % improvement per year is a huge jump. I mean, that's kind of bananas. And then you also added the note simultaneously, she had gained about a pound or two of body weight. So my speed gain wasn't due to change in body weight. So this seems to, and I just confess that I hate endurance stuff. So I'm really wading into the deep end of my ignorance pool here, but this seems to fly in the face of a lot of conventional recommendations. So I was hoping you could, you can speak to anything that I mentioned, but also just broadly speaking dogma in exercise because there's so much crap and there's so many things that never really get stress tested in daily living, health, wellness.

1:44:33Tim Ferriss:You hear all this crap all the time where it's like, you only use 10 % of your brain. That's not true. Evolution wouldn't allow that to be the case, right? Drink eight glasses of water a day. It's like, well, really kind of depends. I mean, there's so many recommendations you hear over and over again. So what have you uncovered? Well, first of all, that particular like, oh my God, I need to get fast in running came. I wanted to do a triathlon. This is already a couple of years of actually just about 10 years ago. Wanted to do a triathlon. And I was training to row across the Pacific ocean with my wife in a robot, which is a whole other kind of this we're going to have.

1:45:06And I had stopped kind of running and I was lifting weights doing a lot of front squats. I was weighing 200 pounds. And like right now I'm kind of in a cycling season. My weight's like 177 pounds. So it was 23 pounds heavier. And I was like, whoa, how do I go from zero to hero? I want to be the Tim Ferriss of running. How do I hack this?

1:45:26Tim Ferriss:You don't want to be the Tim Ferriss of running. I can tell you that is Achilles. So how do I hack this? And in that approach, I basically, I wanted to slice and dice running performance, or at least the minimum fancy Silicon Valley term, first principles, but like into its contributing parts. Like what are the one or two, three things you need to have? One, muscular endurance. Like you can be cardiovascular fit, but go and run a downhill for 30 minutes or even 10 minutes. Like your legs are noodles. You can't continue running. So you need minimum dose for muscular endurance so that your legs don't fall apart.

1:46:01And I think I was running for like a triathlon that had a half a marathon. So 13 miles, 13 by one miles to run. So muscular endurance was one. Then there was the efficiency you mentioned. and so forth. But anyways, to go back to the actual broader question, a couple of things for me. One, especially for endurance sports, one is triathlon and for like a marathon running and other things. One is like you massive load and volume, you kind of get more and more tired over like six weeks, eight weeks, maybe 12 weeks. And then you taper for two or three weeks. And you hope that after your last crazy week, in two or three weeks, you dig yourself out of the hole.

1:46:39And then you're super fast on a race day. It's like literally you're on a knife stage all the time. And I completely changed that in the last four or five years I was really competing in triathlon, which is I want to be ready to race almost at the end of every week, meaning progressive overload, but stay vibrant. And no matter how hard of a workout I do say on a Saturday or Sunday, by Wednesday, I have to be ready to hit hard and feel like I can do almost like my best numbers. Personally, I found that more effective, avoided any kind of overtraining. And I think when you're lifting weights at the gym, this concept is very easier to grasp, much easier to grasp.

1:47:21It's like, let's say do your bench press and for three weeks, your reps or weight just keeps going down. Everybody was like, what the F? Like clearly I'm not either eating enough or I'm lifting too often, but endurance athletes do exactly that. They kind of keep grinding, grinding, grinding. They get more tired Then they help take it out of the hole. So that would be one thing that basically training in a way where you progressive overload, you hit your body, but then in sort of three to four days, you are back better, faster, stronger than ever. And then you keep repeating that. Personally, I found that at least for myself, way safer, way more objective.

1:48:00And I always knew, oh, I'm getting stronger. Oh, I'm getting more tired. All right, I'm going to take two days off or maybe I have a full rest week. So I would say that's one thing. The second thing, again, I'm not a running coach or running expert per se, but especially if you have a multi-sport approach, it's way better to train the cardiovascular engine on a low impact machine. So cycling. So if you're like doing triathlon, I've done more than 10 full distance Ironmans and fastest was eight hours, 24 minutes, which is pretty fast for an amateur, especially before all the aerodynamic games that people now have on bikes.

1:48:36so maybe I could take 10-15 minutes off of that but the 824 is pretty fast I run a 2.56 marathon off the bike I think it was 2.56 2 hours 56 minutes after swimming on a bike it's reasonably fast but my longest run to be able to run a marathon in a triathlon was usually 1 hour 20 minutes which is like I don't know 9 or 10 miles so just as an example that would be the second thing that I don't think you need specificity in that sense if you need to build a cardiovascular engine, do it in a way that doesn't beat your body down. So like cycling versus running. So I think that would be one thing. And then let's leave the nutrition aside, but that's like a war.

1:49:18Like how much should you eat carbs versus this? And should you do carb loading and all that? Needless to say, I'm personally a huge believer that as long as you sort of fuel the work while you do it, you don't have to gain because glycogen stores three grams of water. So if you have 600 grams, let's just say 600 grams of carbs glycogen in your body, so that's 2 ,400 calories. You have another 1 ,800 grams of water. So that's 2.4 kilos. So that's five or six pounds. If you're like fully loaded, I haven't found even for very long distance. You don't need to gain five or six pounds. If you drip feed and fuel the actual work, you get the same results.

1:50:04Controversial statement, but that's my experience.

1:50:07Tim Ferriss:I recommend people read the blog post also. And since you mentioned it, and we're probably not going to go for a six-hour conversation, I can't not mention the rowing 2 ,400 plus miles with your wife. I think that was 43 days plus, 43 days, three hours, something like that, which sounds I mean, it really sounds like a divorce camp to me. And we could spend another three hours just talking about this insane decision to throw for that 2 ,750 miles roughly from California to Hawaii. I mean, the flight itself is pretty long from California to Hawaii. But my question is around domestic peace. Violence.

1:50:55Tim Ferriss:Yeah, minimizing violence. And I was looking at this piece in USA Today, and it says that you had a written and signed formal document that not only described how you would treat each other in the journey, but even how you would respond to specific complaints and crimes. So it's like the only thing more, Sami, than rowing almost 3 ,000 miles is having this document. So I wanted to hear about this document and if it was as helpful as you hoped it would be. And also anything else that you guys figured out in terms of not killing each other over that period of time being stuck on a boat? For listeners, just the context is indeed, it's 2 ,400 nautical miles from Monterey, California to Hawaii, Waikiki Beach, the shortest distance, but weather wasn't really our friend.

1:51:47So we ended up doing 2 ,750 nautical miles. And I think it was 45 days and three hours, but who's counting? So essentially a month and a half, almost seven weeks of rowing with my wife and completely unsupported. I just want to be clear, no helicopters, no follow boats. Like they weren't like submarines around us and helicopters dropping, bonbons. So it was just two of us. First of all, there's so many life lessons. And if you team are fortunate to find a woman of your life, that's definitely a way to test the relationship's longevity. And if you survive it both and come out together, and I will say this, we had been married for four years.

1:52:28We had known each other for six years. Having gone through that experience and hopping off the boat on a platform on Waikiki Beach and hugging my wife, that still is the sweetest moment in my life. And hugging her and knowing there's only one person on this planet who knows exactly what we went through. and it's my freaking wife. And the fact that we got it through, we got it through together. No amount of hardship is going to break this, including having kids. But anyways, so it certainly was life transforming experience in many ways. The document, it served two purposes. One, in a kind of preparation phase, I maybe mistakenly wanted to make sure that my wife is 100 % in.

1:53:14I was like, this is what it's going to take. This isn't show up in two weeks and start rowing. It's going to be a halftime job for six months to even get physically ready and kind of train and know how to jump into survival suit. It's a halftime job. So part of it, the document was like, I'm signing into this. I'm not going to give up, which sounds like the husband is asking wife to do that. But yes, that's me. And then the other half was about behaviors on the boat. and the most important piece of the document that served us very, very well is the following. Any and every decision, once it's made, is water under the bridge.

1:53:58Because we had to make a lot of decisions around safety and navigation and do we go this angle or that. Lots of decisions every day. Like, what do we do today? and you would never know if that was the right decision because the weather changes. And it's one thing to do that at home and then you go to work and you forget it, but you basically stuck in a small stinky box for 45 days. There's unlimited opportunities to get back to it and kind of bigger about it. That was incredibly helpful and served us very well. The one thing I will say, and then you can ask other questions. We had a lot of time, obviously, 45 days, three hours.

1:54:39We sat around six, seven hours a day. So there's 18 hours a day to talk, listen, be together, can't escape, can't go to the bathroom, can't lock the door, go to the bedroom. You cannot. And so some of it was silence. Some of it was, we had to fill the airwaves and we had all kinds of questions to each other. And one of the questions my wife had to me was, I think we were running out of questions. She said, listen, of all our friends, if it wasn't me, who would you marry? And as a diligent engineer, I stepped into that trap and answered it going through friend by friend, landing on the very specific one.

1:55:18But anyways, that is a question no married or unmarried person should ever answer, but I answered.

1:55:29Tim Ferriss:When you were done with your very thoughtful engineer's response to that question, How did she respond? And later was she like, yeah, I just wanted to like, I just for whatever reason wanted to throw a Molotov cocktail into the boat and see what would happen. I mean, like what happened afterwards? Well, the immediate response, I remember it vividly sadly. It was, I can't believe that's the last one I would pick. And yeah, I had to explain myself out of it. But yeah, it was a life transforming trip during which I made several big life decisions, one of which we made together, which was to start a family, which also is a complicated, obviously big decision to have kids.

1:56:14And during the boat, we were both convinced that life's too good to destroy it with children. And we literally changed our minds within the hour at the same time independently, which is quite something.

1:56:28Tim Ferriss:So you decided to start a family, meaning you made the decision to start a family on the boat? or you actually started trying to have a family on the boat? Both, actually. So I think we were about seven or 10 days into the trip. It was very, very stormy early. And I had had enough kind of white space to ruminate about life. And it was like a lightning strike. I still cannot explain this feeling of like, you know, I was in my 30s. And what is there to do? You know, I could start five more companies and I don't know, put my name on the side of a hospital, which I don't want. What's the meaning? Essentially, it's an existential crisis.

1:57:02Like, what can a human do? What's worthy of the life? And obviously, there's a number of things. But the lightning that hit me was, wow, can you imagine raising a child? That's incredible. And I turned to my wife and said, listen, this is kind of weird because we've talked about this and we don't want, but I just feel we should start a family. And her immediate response was, well, I've been thinking about exactly the same for the last 24 hours, exactly the same last 24 hours. And then and there it was, this is it. It's going to happen. And my wife happens to be even more decisive than I am. So we had an iridium satellite phone.

1:57:48This is time way before Starlink, which works, but you can send a text message, barely. And she texted to her girlfriend, who obviously wasn't drawing, and said, Hey, I'm going to give you some data. Can you start tracking my evaluation cycles so you can tell us, text us back, when is the exact timing? And we sure tried on a boat. And I will say that was the least romantic moment for both of us. And the fun part of this story is there's a little bit of a mystery, but we got off the boat just about 10 years and nine months ago now. And my oldest daughter is 10 years old. So there's a little bit of a mystery what happened and where it happened, but it's very close.

1:58:39When you had that lightning strike, you both, very coincidentally or not, had that lightning strike at roughly the same time. If you tried to explain it, do you think it was just the incredible isolation of the two of you?

1:58:59Tim Ferriss:Was it your wife saying, oh my God, I love Sami, but I need at least one other person to talk to? If you had to try to explain it, even if it's grasping for straws, what do you think led to that lightning strike? My guess is it was the clarity of thought when there were no distractions. Like the clarity of thought. And I think there's even a theory of the brain or the mind is kind of Bayesian, like you have priors, you have so many priors and you're always stuck in your rigid thinking. And, you know, obviously there's signs that you can kind of loosen those priors with psychedelics and other things.

1:59:37And then you kind of see things clearly. I honestly think that there was the ability to think cleanly and clearly. And that's kind of what contributed to it. And what I found in life is ultimately the human experience is 100 % subjective. Outside of that, you know, it's just computers, right? And algorithms, but it's 100 % subjective. And when you really tune into the subjective experience, oftentimes the biggest decisions in life are based on that. Like, who do you marry? By the way, I had a spreadsheet for that too. But then I realized, met my wife, I threw the spreadsheet out the window and that was it.

2:00:19Same thing about having children, like the truly meaningful decisions. they are ultimately subjective in nature and when you're truly in kind of touch how does it land how does it feel the answer kind of comes there and i feel in the middle of the road go no email no nothing no job no task no to-dos or just space it was much easier to be in touch with that kind of experience and feeling that's the story i tell but may or may not be true makes sense to me

2:00:51Tim Ferriss:especially after a period of time of being on the boat right once you have the routine aspects more or less on autopilot of course you have the decisions about angle and direction and so on but i want to come back to something you said which was sure i could start five more companies or have your name on the side of a hospital i know as you mentioned that's not of interest it seems like you did not this is from forbes so who knows but did not own a car until you were 36 talks about how minimalist or some might even say austere you have been for certainly a period of time. And you're talking about renting cars from Thrifty.

2:01:35Tim Ferriss:It had the cheapest cars, had not bought a watch in 15 years, exercise clothes are all swag from various endurance competitions, which is funny because I sometimes get shit for wearing all the free swag that I have. Most of what I wear is free stuff that I've gotten. I've never been accused of having a great fashion sense. And the rest of his casual wardrobe is 10 copies of the same t-shirts and jeans. Literally this shirt that I have, I basically have crew and v-neck. It's the same brand. It's the same shirt. It's just different colors. So my question is, is that a Sami thing? Is it a Finnish thing?

2:02:12Tim Ferriss:And what are some examples of where you have found great value in overcoming that type of frugality, where spending money has actually produced a real improvement in your quality of life. Feels like a two-part question. It is, yeah. Maybe the start is, I think I mentioned earlier that I find people say sacrifice, or you have to say no to so many things. I actually find saying no and focusing on the essential incredibly liberating, and it's kind of my happy place. And so for some of these like crap around and too much choice, what color t-shirt or what kind of clothes do I put on? I love the fact that things are as simple as they are.

2:02:56And sure, life is way more complicated now than say 15 years ago. But I actually like not to clutter my life with money or anything else. Let's just put it that way. And keep things very simple. And I'll briefly give the example of the car story. So yes, I've had my driver license ever since it was possible in Finland. It was 18. So 18. But I actually, I didn't buy my first car. My wife bought it. Maybe I was 36 forced because I had been renting thrifty car from San Francisco airport for, you know, eight years. Why that? So this is a funny story, but illustrates my point. Well, first of all, I didn't have any credit in America and I needed a car after I came out of Stanford.

2:03:39So for work reasons, I go to thrifty and rent it. This was like 19 bucks a day. No credit, I could rent it. And then I realized this is amazing because I travel so much for work. I don't need to wash the car. I don't need to change the oils. It got broken into twice in San Francisco. I could just drive the 19 bucks a day car to airport and drive out with a new car. I was like, this is so convenient. No worries. Ford Escape, that was my car of choice. And then one week and I came home years, years later and my wife's like, this is it. you need to own a car. You're an adult, you can't be renting all the time.

2:04:12And she bought me the same Ford Escape that I had been renting for like seven years. So that was it. So that's kind of what I think mainly coming from that the sort of simplicity and convenience, focus on the things that matter. Sure, I have fancy bicycles to ride fast, but no cars.

2:04:27Tim Ferriss:What was the color? I want to know if you threw some flourish in there. Was it white or black or was it like electric blue with a racing stripe? I unfortunately didn't have flames on the side. It was blue, the one that she bought. Oh, look at that. I got it. Yeah, yeah. No spoiler on the back. Yeah. No, no spoiler on the back. So there's that. My approach to money is very, very simple. The less I have to think about, the happier I am. And the fact that earlier success, have enough for house and food and leftovers is wonderful. But if I have to be thinking about the leftovers at all, something's wrong.

2:05:01So it's just simplicity is very, very... Buying time is very helpful. There's some things that just it's good to have kind of service and helpers around. I would say that's a good investment. And then the one and only thing where I would say, yeah, I do like sort of living environment to have a house that you can enjoy, not for the sake of it, but to have the kind of little things and conveniences you have, whether that's to be able to exercise or roll into a lake, roll into a lake from your house. So I would say that, but the less I have to think about money, happier I am. It's just focus on our life and that life's happening.

2:05:38Forget the money. Life's happening. Go and make it happen.

2:05:40Tim Ferriss:Do you have any books that you recommend or gift to people more than others? I am not a big book gifter other than recommend for my like Virta team. And sadly, they are like professionally. And they are all too kind of well-known and common that they would add a lot of value. There's the... Well, what are they? Score will take care of itself. High output management. And I think the score will take care of itself. The 49ers coaches, Walsh's book and high output management. Actually, the high growth handbook by Elad Gilwitz is much, much, much new. And I know you've interviewed Elad. It's in a professional setting.

2:06:21I do read a lot. If you want to plug for a book that I really, really enjoyed over the last year, very inspiring, shows what's possible in life. and a little bit of leaves you wondering like what's really true in a universe and whatnot is Trejo by Danny Trejo. No kidding. Absolutely mind-blowing book. You know who Danny Trejo is?

2:06:43Tim Ferriss:Yeah, Machete. He's appeared in a bunch of Robert Rodriguez films. Robert Trejo. Oh my God. In Austin. That story. How on earth did you end up picking up that book? In our family, I read a lot, but there's one person who reads more. That's my wife. So I'd say half of my book recommendations come from Herbosy screens, 10 books for every one that I read. So it's a good filter. And I tried several times. I laughed several times and I was incredibly inspired and came out reading that book, Belief in Humanity. And just, it was amazing. If you had given me a million guesses for what you were going to say, I never would have guessed.

2:07:25Tim Ferriss:Trejo by Danny Trejo is a T-R-E-J-O, right? I'm getting that. Yes. Yes. Yeah. Okay. Wow. Okay. You're full of surprises, Sami. I like it. Also, if you're ever contemplating having a family, that book also gives humility as you think about how much can you affect your kid's life. And I'm not going to give a spoiler alert, but it's highly recommended. I'll get it on Kindle today. I mean, we have covered a lot. I have a few questions I'd love to ask as we start to wind down. But is there anything else that you would like to cover, make sure that we discuss or anywhere you'd like to point my audience?

2:08:07Tim Ferriss:I mean, I'm going to link to everything in the show notes. Of course, they can find, you know, Virta Health, V-I-R-T-A, VirtaHealth.com on the website and we'll include everything where people can find it easily. But is there anything else that you would like us to cover? I think you cover things very, very well. I would say my professional duty is to be an evangelizer and say this very sad metabolic health mess that we find ourselves in America and globally. And this sadly, the common sense thing that, oh, the diseases that we talked about, type 2 diabetes, obesity, cardiovascular, they're chronic and progressive.

2:08:44And the best we can do is to manage them with an ever increasing load of medications. It's fundamentally not true. And whether that's word or something else, I just want to be very clear that there's hope in the horizon and the hope is largely in the form of nutrition, but not in a traditional way that you need to restrict and suffer. So that's sort of my professional duty to bring hope and say, if you're living with type 2 diabetes, and by the way, people who are living with type 2 diabetes, usually their family members, their relatives, and you've seen people lose eyes and limbs and lives because of type 2 diabetes, to me, mostly completely unnecessary for the last three, four decades, that that disease, among with other metabolic health conditions, is fundamentally reversible.

2:09:29And you don't hear that from your doctor today, sadly. And it's not doctors' fault, they're well-meaning, but you go to medical school, you get literally zero, 0.5 hours of nutrition training. And nobody tells that conditions like type 2 diabetes can be reversed, like systematically, not miraculously. And so hopefully I can be a messenger of hope that these conditions are reversible, especially after I already disclosed that I used to live thinking it's your fault. It's your fault. You're just lazy. You don't have the willpower, but that's not true. Nobody gets these things because they're lazy or they decide.

2:10:09It's because of our food environment and the food environment kind of slowly, but surely poisons us. But if you do tricks and changes, you can actually turn back the clock. So that's my PSA.

2:10:23Tim Ferriss:And I want to say to folks, if you're a large employer, who are the actual customers of Florida Health, right? Like who should actually go check out the website? Yeah. Thank you. That's so nice. Anyone who pays healthcare costs in America could be and should be a customer. If you pay healthcare costs, you are paying for the party of people staying sick and others profiting from the sickness. So this includes self-insured employers, and we work with like 800 of them. So essentially all 14 ,000 employers, self-insurer and thousands of others. So all self-insured employers, obviously health insurance companies when they take risk on their patients.

2:10:58And this includes the private Medicare Advantage, private Medicaid, managed Medicaid organizations, state employee groups. I think we work with 13 out of 50 states today already. So state employee groups and then some government entities, there's VA, there's DOD and others. So anyone who pays, any payer who pays healthcare costs could be our customer. And our pitch to them is, guess what? We'll help you make money. Yes, indeed, we'll help you make money. And a side benefit is we also save lives. And I say that because the love language of American capitalism is dollars. And so when you can help someone else to make money, you're going to be very, very successful.

2:11:38Tim Ferriss:And I love it. Virta has done something that I wasn't sure could be done. You have, as you already mentioned, I mean, the world's largest data set of this type of metabolic health and disease reversal. And the way that you've been able to refine and engineer and iterate and further polish a program for individualized care and sort of mass scale adherence, it's mind-boggling to me. It's really, really incredibly impressive. And I don't want to say I know how much work goes into it, but I think I have an idea of just how challenging that is because I think of myself as someone who kind of specializes in behavioral change.

2:12:23Tim Ferriss:To your point, you can do a lot of really innovative things once you free yourself from the tyranny of the perfect, not letting perfection be the enemy of progress. And that is the mistake of a one-size-fits-all approach, like you need to be on the ketogenic diet and you need to hit this minimal concentration of blood, blah, blah, blah, blah, blah. It's just not going to work on a mass scale. It just doesn't work. But when you have different ways to help people improve 5%, 10%, 20%, 50%, the way that moves the needle over time, this is not the right way to put it, but it defies conventional explanation in the way that, as you already put it, a lot of doctors have been taught in their minimal exposure to, say, nutrition.

2:13:14Tim Ferriss:So the science that you're doing, and I'll say it, it's on me, but really what you're doing with the controls and with the trials, but also with the cohort analysis and everything else you're doing internally, like the science you're doing is incredibly, incredibly valuable. And I don't just mean that in dollar science, it's valuable to humanity. So I really applaud you for building Virta. And I just felt like we needed to have this conversation because, A, you're just such a freak of nature and I wanted to talk to you about all the things we've talked about. But also because what you've built is something that I wasn't sure it could be built.

2:13:53Tim Ferriss:And with the many text messages and seeing a lot of stuff that just blew my mind, I wanted to have you on. So I'm glad and grateful that you took the time. Yeah, thank you so much. And honestly, I appreciate those kind words. It's 11 years in the making and never take it for granted. Bigger company, bigger problems, but trying hard every day. Well, I'm going to pick up Trejo, which is not what I expected to be my immediate next step after having this conversation. But for everybody listening, we will link to everything in the show notes. You can find Sami. certainly you can find Virta first and foremost at VirtaHealth.com V-I-R-T-A you can find Sami Inkanen good luck with the spelling S-A-M-I-N-K-I-N-E-N on all of the places samiinkanen.com on Instagram X etc I'm not sure how active you are on those but check out the blog posts for sure and we'll link to everything as I mentioned in the show notes at tim.blog slash podcast.

2:15:05Tim Ferriss:Just search for Sami, S-A-M-I. I can promise you he's the only one who's going to pop up. And until next time, just be a bit kinder than is necessary to others, but also to yourself. And take those 20 minutes on Sunday, plan it out, get those things in the calendar. Otherwise, it's going to get crowded out by the universe. And then woe is you, woe is us. So take care of that. and Sami again thank you so much for the time thank you very much all right folks till next time thanks for tuning in hey guys this is Tim again just one more thing before you take off and that is five bullet Friday would you enjoy getting a short email from me every Friday that provides a little fun before the weekend between one and a half and two million people subscribe to my free newsletter my super short newsletter called five bullet Friday easy to sign up easy to cancel It is basically a half page that I send out every Friday to share the coolest things I've found or discovered or have started exploring over that week.

2:16:08Tim Ferriss:It's kind of like my diary of cool things. It often includes articles I'm reading, books I'm reading, albums perhaps, gadgets, gizmos, all sorts of tech tricks and so on that get sent to me by my friends, including a lot of podcast guests. and these strange esoteric things end up in my field and then I test them and then I share them with you. So if that sounds fun, again, it's very short, a little tiny bite of goodness before you head off for the weekend, something to think about. If you'd like to try it out, just go to tim.blog slash Friday, type that into your browser, tim.blog slash Friday, drop in your email and you'll get the very next one.

2:16:46Tim Ferriss:Thanks for listening. You guys know I love wearables. I'm sure you do as well. And they're great, but they give you data. Typically, they do not give you solutions. That's why I absolutely love The Pod by this episode's sponsor, 8Sleep. I've been using their stuff for many, many years now. It fits over your existing mattress, tracks your heart rate with 99 % accuracy, plus respiratory rate, HRV, and sleep stages. It is wild how much It correlates accurately to the stuff that you wear on you. Then the Pods Autopilot analyzes your biometrics and automatically adjusts your bed temperature while you sleep with independent temperature control for couples.

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