286. Dr. Jordan Metzl: Why Movement Is a First-Line Drug for Depression

20:05Gary Brecka:Exactly. He's not changing. Just let the man eat. Right. I mean, at this point he's made it eight, you know, decades. He's, he's going to get however many more decades out of it that he's going to get, but it ain't going to include onions and it ain't going to be bell peppers. And just, just, just accept it. It is what it is. But, but when people have gotten accustomed to the sedentary lifestyle and they've gotten comfortable, right. And they really just want you to fix what's wrong, doc. Like, listen, my knee just bothering me. Can you just fix the knee and just, I don't want to do all this other stuff.

20:35Gary Brecka:Like, how do you get them off their ass? Yeah. That's the, that's the$100 ,000 question. And I'll give you two answers to that. Number one is that for me, and what I write about is there are really three components to a motivational strategy, knowledge, emotion, and belief. Knowledge, emotion, and belief. So knowledge, I know I should be doing this. And most people know in this day and age, when I started talking about this, people knew it, but I think they know it more now. And you can't go anywhere without knowing that. And there's really a stigma around people who are inactive, much like people that are, smoking has a stigma.

21:16Inactivity has a stigma now too. So I think we've done, I don't feel badly about that actually. I don't, because I feel like activity promotes health for all the reasons we've talked about. So I think knowledge, I know I should be doing this. Emotion, I feel like I should be doing this. And so there needs to be an emotional response from I know I should be doing this to I feel like I should be doing this. And that piece is a step around what makes people enjoy what they're doing. And I'll get back to that in a second. And then belief, I believe I can do this. And going from somebody that knows they should be doing it to somebody that emotionally feels like they should be doing it, somebody believes they can do it, is really the steps I've seen.

22:01And one of the things I've been lucky enough to do, in addition to my role as a doctor and athlete, is about 15 years ago, I recognized that one of my powers was influencing people. I think I was an influencer in activity before there were influencers per se. And I started teaching exercise classes. And I started 15 years ago. One of my patients was a general manager at one of the gyms near my office in New York. And she said, hey, listen, Sunday afternoon, about three o 'clock, our place is empty. Because I asked her about, can I borrow a studio of her to start teaching exercise? Interestingly, one of my brothers and I were very competitive in triathlon.

22:39And I walked into a plyometrics class at a gym I was going to, and I took it. And the next day I was like, oh my God, I'm sore as hell. And my muscles feel great. And I started generating more power. Plyometrics, that's body weight. Body weight, jump, yeah, a little small jump training. A lot of the kind of modern day CrossFit high rocks type stuff. And burpee broad jump being one. And so I was like, oh my God, I feel great. And so I started learning about this. And then I said, I want to start teaching this to my patients. And plus I realized that when I had a community doing this horrific stuff together with me, it was fun as you've noticed as well.

23:15And I wanted to go do it. And so I started running these classes. My first class was like 15 people in the basement of Jim had to be one of the worst fitness. I had no idea how to put together a playlist. Like if you could go pull that video now, you'd be so embarrassed. Terrible, terrible, terrible. But I started learning about teaching fitness. Fast forward to today, we have like about 55, 60 ,000 people on our list serve for these fitness classes. And we run these massive classes. Last year, we got about almost 14 ,000 people up moving. Wow. And it's so empowering. And when I started, it was just people like me, runners and triathletes in Central Park doing hill sprints and jump squats.

23:53Over time, people brought their kids and their parents and their grandparents and multi-ethnic, multi-size. Now we run everything from yoga to Zumba to strengthening. And where are these run?

24:06Gary Brecka:Are these run in your facility? Yeah, I do them both. No, they're out in Central, all in public places. Okay. And then we have different kind of grants from different companies to put them on. We get the flight deck of the Intrepid, which is a huge aircraft carrier in New York City. That's cool. A thousand people at once. I've driven by that. Yes. A thousand people at once, three times a summer. You'd love to have you come. Yeah. And it's so empowering because not only has the vibe changed, but the energy from people of all different multi-generational, multi-ethnic from all over the place people come in.

24:35And it's just so, it's really what motivation is, which is people help. People want to connect and they want to help other people. And so, yes, you can do some workout on your own in your room, but it's so much better to have a community. And that's what I realized early on. And so I think one of my superpowers was really to recognize that bringing people together was a way to harness motivation and to encourage motivation. That really made a big difference. That's so cool.

25:01Gary Brecka:And you have, I love that you have a philanthropic side to you too. You say like every fourth class should be free. They're all free. Everything's free. So everything I do is free and they get subsidized. I mean, I'm lucky that as a physician, I do fine. And, and, uh, and I really want this to be a prescription that encourages people to, to, to, to go forth and to inspire others. And that's, to me, everything I do is, is in that space is all free. And I, and I, and I want it that way because I want people to be able to come and to bring people from different communities. And it really is people all working together.

25:35Gary Brecka:Yeah. So, I mean, as a sports medicine physician, obviously you're seeing the whole gamut, right? You're seeing people that have sports-related injuries, but they're not a professional athlete. And then you're seeing the really, really high performers, you know, the people that are functioning at the highest level of performance in their careers or athleticism. And what have you seen in the data coming from using exercise as a prescription, some medical prescription, which I love? What have you seen in the data? What biomarkers do you see shift and what are the consequences of those? Because when you look at the broad data on the status of healthcare in America and the number of people with metabolic syndrome, the number of people that have chronic disease, the cost of chronic disease to the average American, we don't realize what portion of our tax revenue is just going to support preventable chronic disease.

26:30Gary Brecka:100%. Can we get a little granular maybe on some of the biomarkers that you're seeing? Sure. So I think it's kind of a broad question. I think first of all, there's no question that people are healthier when they move. And, you know, the pillars of functional medicine, you know, healthy activity, healthy community, healthy movement, healthy diet, healthy sleep, you know, these are some of the things that are ubiquitous. And then when you look at, you know, some of the work done in Blue Zones where people are not necessarily wealthy, but they live to 90 years plus routinely, you know, they're communal.

27:04They eat, you know, not hugely correct. Communal is a big one too. Yeah, hugely important. They eat kind of a diet, not with many pre-processed foods. Everything's relatively healthy. They move every day. It doesn't have to, they're not doing HIIT workouts, but they're moving every day. and those things are all really important to kind of think about health and the financial burden of chronic disease, as you say, is really incredible and people don't realize how much money we are spending as a country on treating disease. Now, some of that I think is important, but I think the piece that I wanna really think about is how can we incentivize paying for and encouraging prevention rather than paying for disease treatment?

27:45And so we encourage all kinds of things in our country already. So we encourage people to buy houses by making tax deductions for houses. We encourage people to get married and have kids by making tax deductions. You know, the things we want people to do, we incentivize that behavior. And so, you know, thinking about incentivizing movement is a great concept to me. You know, when Mike Bloomberg talked about taxing sugary sodas in New York City, he almost got, you know, out of town. Oh, I remember. But he was right to start thinking about incentivizing the, we tax cigarettes, you know, incentivizing things that we want people to do because left to our own devices, you know, either we're going to pay some for prevention or we're going to pay a lot more for disease on the backside.

28:29So I love the idea of thinking about what are the things we can do to incentivize the changes that we want to see. And then on the biomarker question, I think that we are learning more about that as we go. I will say, I feel like there's a little bit of, When people hear the kind of concept of longevity and I want to live as long as possible, I always get a little bit uncomfortable in that space because the truth of the matter is, as we talked about, we've done a great job in longevity in modern science with, you know, the things that got us from our life expectancy. Sanitation. Yeah, exactly.

29:0341 years old in the 1800s to now, you know, almost 80, 150, 200 years later, you know, but sanitation and antibiotics and vaccines and all the things that have made a huge difference in health. So I think that is a bit of a misnomer. I know the movement has kind of taken on quote unquote longevity, but I think what we're really talking about is kind of healthy longevity, health span. And unfortunately - Health span, I agree with you. And unfortunately in the United States, we have the widest gap between what's called the lifespan health span gap, meaning our average expectancy is about 81 years old, but we have an almost 10 year, almost 11 years now, lifespan health span gap.

29:38So the last 10 to 11 years, on average people live in poor health. And so that is very expensive and that is really burdensome not only on the people, but on their families. And think about how many people are, it's agonizing to see a parent go through all that. And that does not mean if you move every day, you will not get, I mean, Lance Armstrong was the fittest guy on the planet and he had testicular cancer, right? So it's not a one-to-one correlation, but it's on average, can we affect people's health through some of these preventive measures? And the answer is I definitely think we can. we have to start thinking about how we incentivize people to to do the things we want them to do

30:13Gary Brecka:so without like governmental incentives and state incentives and tax you know um uh incentives how have you in in your practice running all of these exercise classes prescribing medicine uh prescribing the medicine of exercise how have you kept people's motivation over a prolonged period of time because i'm very interested in that too you know when i look at professional careers you know i'm always fascinated not by the athlete that was great once but by the athlete that was great over a long period of time lance armstrong's a perfect example i mean yeah i think seven tour de francis i mean look i'll give you all the performance enhancing drugs you want go win seven back-to-back he was a beast before he was doing i mean that guy was in a field where everybody was doing the same stuff right he was the best yeah i mean and and and there was yeah there was a a cohort of people whose lives were dedicated to beating him right i mean uh doing the same kind of stuff i mean so But it's always fascinating to me that they can maintain that level of intensity over a prolonged period of time and bring that down to the masses, which is what you're working with and prescribing exercise for.

31:18Gary Brecka:One of my favorite biohacks outside of breathwork by far is mineral salts, Baja Gold Sea Salt. It's got all of the trace minerals that the body needs. You know, most of us are not just protein deficient, meaning amino acid deficient or fatty acid deficient. We are mineral deficient. So a quarter teaspoon of this in water first thing in the morning will make sure that you get all of the essential minerals that you need. It tastes amazing. In fact, I made a steak today. I actually made a grass-fed steak with grass-fed butter, and I put just mushrooms and a little bit of rosemary, and I sprinkled Baja Gold sea salt all over the top.

31:49Gary Brecka:Try it. It'll be your new favorite for cooking, too. It's the cheapest and one of my favorite biohacks. I don't know, a$15 or$20 bag of this will probably last you five years. It's literally the world's best biohacking secret. Now let's get back to the Ultimate Human podcast. Is there anything that you've noticed helps people stay motivated longer? It's a great question. And it may be surprising to you. And so there was an interesting study done in Germany where they took two groups of people over, it was only an eight-week study, but I use it in a lot of my talks, looking at exercise compliance.

32:21And they looked at what can we do over an eight-week period of time. They took two groups, they randomized them, and they had one group who did exercise that was fun. and the fun group got to choose their workouts. They had music. They got a lot of positive reinforcement from the instructor and the not fun group did basically many of the same exercises with basically a Germanic non-smiling trainer and no music and no input on what was happening. And over eight weeks, they looked at their exercise frequency and their self-reported exercise enjoyment. And there was a statistically significant difference between the fun group and not the fun group wanted to go more.

32:59They wanted to go longer and they have self-reported better experience than the non-fun group.

33:04Gary Brecka:Wow. And so the answer to me, the holy grail of compliance, if the holy grail of fitness is compliance, the holy grail of compliance is fun. And I think that's one of the biggest lessons we can learn. If you come to any group event, people are smiling. Like I come to my classes, but the end of a triathlon, the end of a running event. And that's one of the things that I worry about in our fitness influencer world. so many of these people look jacked and they have great muscles and they look awesome and they just don't look happy. They look like they need a good mac and cheese. Like they just do not look happy.

33:38And I just feel like the importance of fun and smiling is a big piece of compliance, not over maybe a week or a month, but over a lifetime, smiling. What makes you smile? And I have people that love yoga, people love dance, people love strength training, but what makes you tick is what I found. when I interviewed, so for my book, I interviewed my patients from all different generations, even people in their nineties who were still very active. Wow. And fun was the, and fun, I think, so it's a great question. The answer is fun. What makes you smile? If you smile, you're likely to keep doing it.

34:15And I think it's great. Last piece on this is that a challenging exercise is essentially holding in a crab or a reverse plank where you have your hands and feet off the ground, your butt off the ground, hands and feet on the ground. and I was trying to get people in one of my outdoor classes to hold a reverse plank for about a minute and people hated it. And like, yeah, we can do a forward plank. We hate this reverse. And so then I had this idea where I brought a whole bag of balloons and everybody blew up a balloon and it was like 6.30 in the morning in Central Park. Everybody had a balloon. And I get these ugly hats from Chinatown in New York that like bright gold that say King.

34:51And you can get a King hat if you are basically the last person to keep your balloon off the ground while keeping your butt in the air. And so basically they're doing a reverse plank crab position with one hand or the other.

35:03Gary Brecka:Oh, so you're in a squat position. Yeah, you're kind of hands in, hands in. Ah. And you have to keep one arm, just basically balancing, keeping your balloon in the air. And people are just laughing out there and having a great time. It's like two, two and a half minutes. You don't even notice. You're doing it because you're just laughing and smiling, having a great kind of isometric plank type exercise. So the idea is fun, is a huge. So I want people to think about, you know, so many of your listeners are in the fitness world. And I think, yes, we're all teaching fitness and what we're really prescribing is community in the veneer of fitness.

35:38Wow, it's so good to hear you say that.

35:41Gary Brecka:I think it's where it is. I think it's so good to hear you say that because meta-analyses, big data studies, blue zone studies, all, you know, link back to this sense of community, connection, purpose. like life's got to have meaning things have to have have have meaning you know the in these blue zones these are they are some of the most connected and surrounded by love and connection of anywhere else in the world and and i don't think that you could delete that and still have you know couldn't agree more and i think it's one of the challenges in our western society interestingly i forget which one of the blue zones it's in is one of them where there's there's a term where it's a multi-generational experience, kind of equivalent to like a bar mitzvah in Judaism, where you go, the younger people go and they present life's problems to the elders and they talk through and there's a whole built-in multi-generational experience built into one of these blue zones.

36:36There's a specific term for it, but I totally agree with you that this, as in Western society, we've kind of increasingly put our older generations out in different places. we're encouraged to kind of segment ourselves. I feel like the pandemic and remote work was one of the worst things that happened to people's mental health. I think so too. I wrote a, actually interesting, when the pandemic started happening and in medicine, our life didn't change. A lot of people's lives changed around us. They started doing remote work and doing whatever and working from home. And we were still going in and doing our jobs.

37:10But I wrote an op-ed for the New York Times probably two years after the pandemic started. Tyler, working from home may not be as healthy as you think. And I talked about the science of - Isolation. You know, the science of technology. So it's interesting. So I looked at basically with every evolutionary invention from the wheel to the bicycle, to the car, to the airplane, to the computer, to the smartphone, people could basically move less because they could do more at home. And so this remote work was the pinnacle of that. You could work from home, eat from home, socialize from home, and people got used to doing that.

37:49And yet people's imperative to move is the same from way back when. And so the title was People Working From Home May Not Be As Healthy As You Think. I thought I was going to get 10 to 1 love letters in the comments. Dude, thank you so much for pointing this out. It was like 10 to 1, like, screw you. Don't touch my work from home. It was like I was slapping their grandma. I was like, I'm just pointing out the evidence. Totally. They didn't want to hear it. But I think this remote work has been a real challenge for people's physical and psychological. I think people need each other. And I feel like that's why the fitness community is so important because I feel like it's a place where people can really interact.

38:28And that's why I think we've seen a real rise of these group fitness activations and people don't want to be alone. It's not good for them.

38:34Gary Brecka:Yeah, in fact, for a period of time, I owned a CrossFit gym. I actually exited it because the combination of speed and heavy weight, I wasn't a big fan of. Yeah, I agree. But I didn't think we should be deadlifting for time, 400 meter sprint, deadlift for time, complex, you know, compound Olympic lifts, you know, with soccer moms, you know, really kind of a difficult thing. But - It was good for our business. Yeah, great for your business. But conceptually, one of the things I loved about it, and there's data around this too, you know, your propensity to stick to a workout routine if you have a workout partner, you know, goes up precipitously.

39:12Gary Brecka:You know, if you have somebody holding you accountable, what I noticed was the 6 a.m. class became like the 6 a.m. class. The 7 a.m. class was the 7 a.m. class. The 8 a.m. class was the 8 a.m. class. It was all the same people. And they really sort of built this community and they would always be like, well, where's Janice today? Janice, what the heck? It's Thursday. Janice isn't here. Somebody call her. Like, and these were not like tight friends. The only commonality they had was our fitness, you know, was our CrossFit class. but you know they were so regular and they supported each other so much one of them didn't show up they were calling them texting me okay like what happened um we are worried sick yeah um and and then going through hard things as a group and emerging out the other side sometimes i would look around the gym and like everybody's plastered on the floor leaning up against the walls you know the wads over the laying on the weights um but there was a smile on everybody's face and everybody was like you did a great job you know and um and there is so much to that community connection because you wake up you're a little tired but you're like oh i don't want to disappoint my class yeah 100 and and they get out of bed and then they move their ass yeah 100 and that's in the idea of actually calling push push was i want people to learn how to push themselves mentally physically and physiologically and it's you can push yourself mentally with other people you can push yourself physically with other people but i think physiologically you really need other people to help push your your physiology it's very difficult it feels good when you're showing up for somebody else too absolutely right that sense of need is almost like you know caregiver like you know like i need to be there today because my partner's not going to have a partner yes um and i think the more that we can weave that in you know it's you know when i go back and i think about my life as a young child on the playground recess we had a long long recess i went to monastory school.

41:06Gary Brecka:So we had to actually do recesses a day. And, um, and I remember there wasn't a lot of structure to research, but they would throw balls out on the field and stuff. And then pretty soon, like a group of boys and a group of girls, we'd line up, we'd pick teams. And next thing you know, there's a kickball game going on or a soccer game going on. And like, we problem solved and we problem solved around exercise. And I look, I didn't realize what was going on back then. Nine years old. I want to hit my friend with a stick. But, um, but you know, and when I think about the intelligence of that you know it really made for great learning environment yeah right because after you blow the carbs out um and they come back in you can start to take take an information again so where do you see this convergence of modern allopathic medicine and exercise as medicine um even food as medicine where do you see these converging because i think one of the big problems is that a physician cannot make a living prescribing exercise correct Let's be honest.

42:05Gary Brecka:There's no ICD-9-10 codes or ICD-10 codes or ICD-11 codes, you know, in there for reimbursement for that. So how do these worlds collide? I think you did it out of passion and personal interest. But a lot of physicians don't have the same orientation. Correct. So I think that this is a case where technology can really help us. I think one of the things that happened since the pandemic is that, you know, before the pandemic happened, I never had done telemedicine ever. I never did a virtual visit ever. I didn't know what that was. I remember when our offices shut down and they said, we're going to switch over to Zoom.

42:45We're like, what was that? We didn't know what that was. Like we had no clue. There was no such thing as virtual visit. I think one of the things that's come out of that is people's increasing comfort with virtual health in some ways. and I think the ability to track movement on people's devices, upload that information to get, I think right now we have a bit of a TMI situation where people are getting all kinds of data, all kinds of blood tests, all kinds of movement stats and sleep stats. Like I wore one of those rings for a couple of weeks. It's like, you got to sleep where I'm like, yeah, dude, tell me something I don't know.

43:17I already know I feel like shit. Exactly. But I think that the idea of getting information that can be synthesized very easily and quickly. You know, I think that the old vital signs of, you know, temperature and respirations and blood pressure, pulse, they were really important and have been very important as a fundamental of seeing a doctor, but how much you're moving and what kind of activity, how much intensity. And we're increasingly really recognizing the value of intensity throughout your day. So encouraging people to put in intensity into their lives, not only their HIIT training, which you and I both love, but also just intense periods of getting people to take the stairs.

43:56It was a really interesting study that came out of the European Heart Journal about a month ago looking at what's called VPA or vigorous physical activity and people putting two minutes of VPA into their day every single day versus people that didn't. Just two minutes. Two minutes of things like taking the stairs or air squats, things to get their heart rate up, and that made a difference in their health outcomes of heart disease and diabetes, et cetera. So encouraging people to think about intensity, but then more importantly, how many intense minutes have you been doing, Mr. Jones? How many intense, how much activity have you been doing?

44:29That may be part of the medical visit of the future. And now if I want somebody to see a nutritionist, I can just refer them to a virtual nutritionist in some cases, and that's very easy to do. So I think that in the future, there'll be hopefully places where people have a more holistic view of their health. And I think over time that will become part of what we do. We're not there yet, but I think we're further along than we used to be.

44:51Gary Brecka:And doctors should be able to make a living doing things like this, not disincentivized or de-incentivized to do things that they're not covered for. Yeah, I think our system in general is screwed up that way. Unfortunately, the system really encourages people's procedures. And so there's been a real shift towards procedural medicine. So if you have somebody with a meniscus tear in my office, and that may not be a surgical meniscus tear, and you manage them along and maybe they need an injection and some strengthening and they do a lot better from that and they're feeling a lot better versus if somebody gets an arthroscopic surgery for that, which may not be the right treatment for them, but it's a lot easier to do, it's quicker, it reimburses a lot better and people used to do those a lot.

45:33These degenerative meniscus tears were treated surgically. There was just a 10-year study published looking at the outcomes of those and they did less well than the people treated non-surgically with the same problems. Wow. But there was a real incentive towards the procedure. And so our system has incentivized procedures instead of outcomes. And I think one of the things to think about over time as we get more data is we'll be able to basically incentivize outcomes. They were trying to do that with some of the earlier generation Obamacare people, but I think they didn't get far enough down the road.

46:03And there were a lot of other things baked in that people didn't like. But I think the messaging around this is encouraging outcomes is where we should be thinking about where we're going would be helpful because unfortunately we have a procedure-based world.

46:18Gary Brecka:Wow. I've never heard it framed that way. We incentivize procedures and not outcomes. And if you look at the outcome data, you might actually change the procedure. Correct. Yeah. Yeah, no, that's, this is one of the reasons why I'm excited about AI, because I think what AI is going to do for us is bubble things to the surface, you know, and have it be the truth. I think we've done so many peer-reviewed, placebo-controlled, randomized clinical trials that, you know, and some of them directly contraindicate each other depending on the outcome, maybe the study design or, you know, faulty mechanics in the study or what have you.

46:51Gary Brecka:and so you know it's really easy to get super myopic and and argue these finite points of why you should do something and why not but what ai can do is take 700 trillion independent variables and create an actual result hey guys here's the outcome it's not debatable right like you know i i use this example all the time we've never done a uh randomized placebo-controlled study on parachutes so we don't have any actual scientific data that they work right it's never been proven. Nobody would jump out of an airplane without one. So, because we know what the outcome would be, right? Because we look at the outcome and, and, and that's really an interesting vantage point to say, you know, if we actually started to focus on outcomes, not just these procedures, we might change the whole architecture of how.

47:39Yeah. So I have a great example of a recent study that was published actually last year in the New the only journal of medicine, it was one of the 10 best studies in our society last year, looking at, so some of the most difficult patients to take care of are people that have kind of moderate to morbid, moderate obesity, BMI greater than 30, with arthritis in their knees and knee pain. Because they come in and they're like, hey, my knee hurts. And we're like, well, we want you to lose some weight. Your knee will feel better. And like, yeah, I would, but I can't move because my knee hurts. And so there's not been a great way to think about those.

48:11So there was a really interesting study that was done, done in 61 sites in 11 countries where they took people who had, they had to be basically have a BMI over 30. They had to have arthritis grade two to three. So moderate arthritis on an X-ray and those symptoms correlating with that. So arthritic knees, overweight.

48:31Gary Brecka:And reporting pain or mobility or reduction of, yeah. And they were broken up into two groups. One group, which was one third of the group was injected with a placebo and the doctors and the patients didn't know which group they were in. They signed up being a study. So one group was injected with the placebo and both groups got the same information on diet and exercise once a week. And so the placebo group was injected with saline. Two thirds were given one of the GLP-1s. The study was funded by Novodornis, but in any case, you know, it needed to be done. And so they were injected with GLP-1 and they tracked them for 14 months.

49:11So what happened? So the group that basically was given the placebo lost about 3 % of weight. The group that basically was given the GLP-1 lost about 20 % of their weight. Their knee pain reduced by about half and their self-reported activity profile increased by about half compared to the placebo group. So the idea was that the GLP-1 was almost twice as effective at weight loss and knee score pain and activity profile. So that problem was a lot better. Now, the problem with that is that, you know, we don't know the long-term effects of some of these peptides like GLP-1s. And so there's some question on that, but we do know the long-term effects of chronic obesity, which are really dangerous to people.

49:54So that study really is a great way of structuring. It was a double-blind placebo-controlled study. It was scientifically really well done looking at a specific problem that helps us look at what we do. And so now we're looking at, and actually I'm talking with some colleagues about putting together a survey study of sports medicine doctors, because in my view, five years from now, sports medicine doctors are gonna be prescribing GLP-1s for people in that category of overweight with arthritic knees, because they're so challenging. And our old paradigm of just lose weight and your knee will feel better, like, dude, I would if I could, but my knee hurts too much.

50:31And so there's a lot in there about this shifting world we're in, which I'm really excited about. I think we have a whole different framework and way of thinking about these problems that really blends together the different worlds. It's just we have to get there.

50:43Gary Brecka:If you know me, you know I don't recommend anything I haven't personally tested. That's not a marketing line. That's just how I operate. I've been on the road my entire career, different time zones, brutal schedules, no margin for days off. And so I'm constantly testing what actually works in my own body. NED was something I keep coming back to. It's the molecule your cells use to produce energy and repair, and it declines faster than most people realize. When I found Symbiotica's liposomal NAD, the absorption technology is what got my attention. I tested it. I felt it. And it's been in my bag ever since.

51:14Gary Brecka:I'm always evolving what I put in my body, and this one has stayed on the list. I'm genuinely excited for you to experience it. This is the standard we hold every product to before it even reaches you. Now let's get back to the Ultimate Human podcast. Yeah, so it was the weight loss coming off the knees relieving the pain that allowed the mobility. A thousand percent. And it's a different way of thinking about it. We didn't have that option before. Yeah. Now, I know you're not a psychologist or a psychiatrist, but I have been reading a lot of studies recently on comparing SSRIs and mobility. And one of the first things, signs of early depressive symptoms is people become more and more and more reclusive, right?

51:58Gary Brecka:Less social interaction and less mobility. So their level of time they spend sedentary increases dramatically and it almost correlates with the level of symptoms. At least there's a correlation there between being very, very sedentary or increasing the amount of time that you're sedentary and your grade on these different psychological scores of depression. and how they were able to reverse a lot of these just with mobility as an intervention alone using placebos, sugar pill versus S or S or I, but in both cases using mobility and showing that in some cases exercise significantly outperformed psychiatric medication.

52:43Absolutely. And that's, there was that, you know, increasingly great evidence on that exact point. I think the problem is that people would rather take a pill sometimes. They would rather take the easy route. But the problem with a number of these SSRIs is they have, you know, they're easy to go on. They're very difficult to get off. They have a lot of side effects, libido, et cetera. They're not perfect and they affect everybody differently. So what we talk about a lot is exercise as a first line drug. And that's why that's an exact example of the medicine of exercise. Because in that case, yeah, it may feel good to go for a speed walk or a run or go to a, you know, a strength class, but I'm talking about this as your physician, you're depressed and I want you to take this instead of taking those other things and let's see how that works.

53:30And that doesn't mean there aren't people like schizophrenia that need medication or bipolar disorder that need medication. But what I'm talking about is garden variety, anxiety, depressive symptoms, et cetera. Those kinds of things can be, the best treatment for those as a first line treatment is exercise. And so how do we teach doctors about that? When I talk to psychiatrists and psychologists, I did a grand rounds lecture recently to a group of psychiatrists at Cornell. And I asked them at the beginning, raise your hand if you prescribe exercise to your patients. And almost everybody raised their hand, but there's no standardized way to do it.

54:02They have no formula. They don't really know who to do it, how to do it. Good for them though. Yeah, they do it, but they all recognize it. But there's no formal mechanic to do it. And so I think that's where this whole kind of field is, is that we want this to become, To think of exercise as a medicinal intervention.

54:22Gary Brecka:Yeah. I mean, I'm of the mindset that some is better than none. Absolutely. No matter what you're doing. And like you said, getting the fun component in there, I mean, that's a really interesting way to look at motivation is to draw people into doing what they love to do. My wife likes to ballroom dance. And dancing can be intense. No, it's great. And if she loves doing it, do you do it with her or not? No, she has a Russian dance partner that she's convinced me is gay, but I need to go check this guy out and make sure that he's, you know, playing for the same team and not, you know, circling my wife.

54:55Gary Brecka:But it's interesting though that I think that the piece on that, the piece on that that is exactly what I was talking about before is that everybody has a thing that makes them smile. And for her, if it's doing the, because my mom was into that, doing the bronze, I mean, I remember we came home and, you know, she had four boys and she was, you know, you know she was amazing an amazing mother a psychoanalyst and tons of energy but you came home and like mom had a fake tan like dude mom what are you doing then mom had fake nails like mom what are you mom became a devoted she would go in the middle of a ballroom dancer she's like devoted she would go to these different balls and she had a dance teacher of the same ilk um and uh and it made her smile and it really gave her a purpose you know purposeful you know to me I suck at ballroom dancing and fine I would do it for my wife for sure but anywho my mom loved it and I think your wife loves it and so I think the idea here is that what is your why what makes you feel a purpose and if it's ballroom dancing or whatever it is that's great so tell me where all this is going for you what projects are you working on what should my audience be excited about that you're endeavoring to do Well, first, I think the idea of kind of studying motivation and talking about motivation, you know, Push was, I worked for about five years on my book, Push, about trying to understand the science of motivation.

56:20And when I looked at it, my other books have been a lot about taking care of your body or your achy knees or, you know, very hard things. Push is a lot about how do I assess my own motivation and how do I realize where I am on my own motivational spectrum? and then how do I make it better? What are the things standing in my way? What's limiting me? And so I've been talking and thinking a lot about lecturing about motivational health and basically trying to unchart, unlock your own motivation, which I think people can really do. There's a term I've been really using, which I love called lowering the cost to act, which is basically taking what you wanna do and making it what you do.

57:01And so that means I know I should be, strength training. I know I should be walking. I know I should be moving. I know I should be doing whatever thing. What are the concepts that are going to make me make what I want to do and what I do the same? When I started researching push, I thought there were people that were motivated and then people that were unmotivated. I don't think that anymore. I think everybody's motivated. I think the people that are successful have learned how to lower their cost to act, meaning they pay for a trainer in advance. They join a walking community. They join a running community.

57:32They join a high rocks. They join a CrossFit gym. They join ballroom dancing. They join things that will make them want to go. And I've seen so many different instances of this. I had one guy who I write about who really wanted to go to the gym, but he couldn't get himself to do it. And he would go, he, he financed guy, worked super early in the morning. And then the way home, he's like, I'm tired. So what he would do in the morning, he loved his, his workout clothes and his workout shoes. He would go to one of the local gyms that had day lockers. it's six in the morning he'd lock his stuff in the locker room and then if you come back the end of the day if you're not there they cut off your lock and put it in the lost and found so he would have to go back to the gym to pick up his stuff in the way home he's like as long as i'm here i might as well yeah that's good it lowered his cost to act and so this whole idea of of learning to understand and unlock your own motivation because i feel like we've many of us in this kind of health healthy space talk about the same kind of things um but how do we get people to actually do it.

58:29And not only people like us, we're going to do it no matter what, but how do we get the other people to do it? And I think that whole idea of figuring out how to lower people's cost to act, I find to be very powerful. So working on that. And then I'm also lucky to be involved with our local running organization called the New York Road Runners Club, which is a world's biggest running club put on the New York marathon and a whole bunch of events in New York. And we are starting a whole research collaboration around figuring out why runners get hurt and what we can do to keep them on the road so i'm very interested in that as well

58:59Gary Brecka:wow so um so what are uh one some things that people can do to lower their cost to act and for a listener right now who's like encouraged and motivated and excited about this um what could they get up and do today um you know to sort of change the trajectory about how they've been viewing mobility in their life i mean how do you take something that hasn't been a priority for two decades, three decades in somebody's life and shift it to a priority without some kind of traumatic life event where they've come to see you for their years or their back. No, it's a great, I mean, that's most people. And I think they have to figure out what motivational trigger they have.

59:37For many men, it's financial. Guys respond better. So this whole idea of lowering the cost to outcomes, there's a center for behavioral economics at Penn and it's a, it's a University of Pennsylvania has a dual center between in Wharton, the business school and the med school, trying to figure out behavioral economics, what makes people change. And interestingly, they came to the conclusion it was like$1.30 a day. It's a little small number. But men respond better to financial triggers. So men who are listening should find a trainer and prepay 10 sessions. And so if you prepay, like, dude, I paid the money.

1:00:12They're charging me if my ass is there or not. I'm gonna go there and get my, men respond very well to that trigger. Women respond very well in general to communal triggers. And so I'm going to join a community. I'm going to have a friend. I'm going to sign up for a thing with a friend. Do it with a girlfriend. Do it with a girlfriend. I'm going to start doing that. And those in generalities tend to be the two most effective triggers for people. And then you start – one thing I write about and think about a lot is what I call the exercise wheel. If you want to get a – from your old CrossFit days, if you want to get a tractor tire from here to across the room, the biggest energy is getting that damn thing up off the ground.

1:00:50Once it's rolling, it gets a momentum of its own.

1:00:53Gary Brecka:Right. Not flipping, but rolling. And so if you can get that thing rolling, it starts to basically get its own speed and momentum. And that's what I want people to think about. How do I get my own tractor tire rolling? And that's by lowering my cost to act. Wow. That's so great. I mean, you know, there's some really interesting technology coming out, these predictive AIs. I was actually looking at one this morning. a group came over in the AI space and was demonstrating it to me. And I thought it was really fascinating because what it did was it painted a picture of exactly who you are now based on the exact data of today, right?

1:01:25Gary Brecka:Your BMI and all these other data scores, your hyperinsulinemic, your insulin resistant, you have hydroglycerides, you have all of this going on. If you took these actions, this is where you'll be in 10 weeks, this is where you'll be in 12 weeks, and this is where you'll be in 21 weeks. and it actually created photorealistic images of their body morphic image. I love that. And I was like, wow, that's really cool. Now, the downside would be if it wasn't accurate, but they are assuring me that this is with extraordinary accuracy because the amount of data that they were able to pull into this, which is another thing I'm encouraged by AI about.

1:02:05Gary Brecka:Yeah. So if you knew you might look like that by this date, that's sort of something we can conceptualize. it's like, okay, Thanksgiving is three months out. The whole family's going to be here. By Thanksgiving, I can look like this. Or my wedding date, my son's wedding, my buddy's bar mitzvah, whatever it is. I think those kinds of triggers for people, exactly what you were talking about, whether they're financial or communal. That's lowering their cost act. And that's a great way to think about that. I'm lowering the cost act by basically, I want this outcome. And so this is where I'm now, I want to get to that outcome.

1:02:36Yeah, but it was the first time

1:02:37Gary Brecka:that I'd seem to be able to show it to you. That's so cool. It's like, you're sitting here, you look like this, How about you want to look like this? This is how long it's going to take. Can I have biceps like you? That's what I'll take. Thank you. No, you're making me feel great. Dr. Metzl, this has been amazing, man. Loved it. Loved it. For my audience that has enjoyed this as much as I am, where do they find you? So I'm on social media at drjordanmetzel. That's kind of my main Instagram, LinkedIn. Not doing TikTok. I probably should have, but I'm not. You don't want the Chinese spying on you?

1:03:08Exactly. They can spy. I don't care. And then I've actually been working, you'll see that I've actually been working with an AI company about doing an AI of just my own information. So that's been really interesting. This company, it's in my link tree for my Instagram. But basically, it's all the talks and lectures and podcasts and research papers, everything I've done over 25 years, all loaded into one AI. So then they can ask me a question from wherever and I can answer them when I'm sleeping. So it's good.

1:03:35Gary Brecka:Love that. So I'm going to put all of that in the show notes. and I wind down all of my podcasts by asking my guests the same question. What does it mean to you to be an ultimate human? To me, the ultimate human is to me, would mean to be a doctor, which is I got into medicine because I really loved helping people. There's just, people have different jobs. They have different, you know, they're filled by different things. Some people want to be seen. Some people want to be financially successful. Some people want to be famous. to me i listen i love being successful i love all those things but the most gratifying is when you can help somebody and they look at you say hey dr metzel you really made a difference in my life i did this thing i get a picture from somebody finishing some event or something and said i really i'm so thankful to you for helping me get to this piece and and it's that one-on-one human connection to me an ultimate human is is basically helping other people achieve their goals i find that to be so gratifying that is so good man uh you know john maxwell calls it about uh living a life of service not a life of significance and if you've ever had the benefit and the gratification of living a life of service and seeing that service come back to you in a very rewarding way which is rarely monetary um it really is deeply gratifying before we close out and i usually don't do this but you just spark my interest in something is there a a patient of yours or story that really stands out to you like someone that came in to see you just battered broken desperate desolate maybe not um but uh and you did this prescription of medicine maybe you had some other traditional medical interventions and that story sort of still sticks in your mind uh not only do i have one but i started i started push with it so i start push with a narrative story about a woman that came in to see me in her late 60s, mid 60s.

1:05:33And she had simultaneously had a breast cancer diagnosis and lost her husband in the same two-year span at 68. Now those two things together could put people to the point where they're like, listen, I just don't feel like doing this anymore. I'm alone. But she was a fighter and she started going out for walks. and she started walking and then she started slow jogging and then she started slow jogging a bit more. At an age 70, she ran her first marathon and I start my book with her. Um, then she did another marathon by age 82, by age 82, she'd run 15 marathons. And at age 83, she started teaching a kettlebell class for people 80 and over.

1:06:15No, really? She's the first patient in my, she's the first story in my book. That is amazing. And, uh, and I find people like Like that's so, I'm so, I'm lucky because, you know, listen, being a doctor is not easy. It's, it's tiring. You're there a long, people see like Instagram doctors like, Hey, it's not like that. Like you're there early, you're there late. You got a lot of people, a lot of questions, a lot of energy, a lot of interaction. It's exhausting. Yeah. A lot of withdrawals. It's, it's, it's a lot of withdrawals, but it's so gratifying to have people like that. Um, In the book, I call her Alice.

1:06:49And Alice's story is exactly the story of basically overcoming sadness through activity. And not only herself, but she inspires so many people around her that I consider someone that got to be so gratifying.

1:07:04Gary Brecka:That is an amazing story. And there's so many layers to that story too, because she found her community and her connection. You know, losing a husband, I imagine in the mid 60s, probably married for a long time. very isolated and then getting this community movement, all the things together. Yeah. Did she beat the best cancer conventionally? No, no, no. She did through chemo and everything. Chemo, yeah. Chemo, yeah. Then started using, then started using exercise just to help her feel better because she was so depressed and it really made a huge difference for her. Amazing. Dr. Metzl, thank you so much for coming on the Ultimate Human Podcast.

1:07:37Gary Brecka:This was amazing. I know my audience is really going to enjoy it. Your energy was very catchy. So I'm sure I'll bring through the camera and motivate my audience. So guys, until next time, that's just science.