 Okay, so City Zero, how markets and evolution can save lives and money, gave you a little bit of a background on this. One other thought on the bacon piece, I had lived for almost 48 hours knowing that bacon was the most nutritious pork product on the planet, sworn under a penalty of being dissolved in a hydrochloric acid bath if I gave it up, so that stuff's pretty cool. So here I'll just use this. So Moore's Law, any tech-oriented folks in here. So Moore's Law is a concept that was developed in the late 60s, early 70s, it was this observation that transistor speed tended to double at about a rate of every 18 months. So there was this kind of observation that computing power basically doubled about every 18 months, and a guy named Moore kind of figured this out, and so it's called Moore's Law. And this is held pretty consistent throughout the recent history. There's some thoughts that maybe at some point this is going to plateau out, who knows quantum computing and stuff like that may keep driving this forward. But in addition to this notion that computers get faster, and our ability to do processing of information gets faster, things also tend to get cheaper, and shockingly so. And so we see that as cost per unit of computing drops, the computing power goes up, there are a ton of different observations or market-based analyses that we can apply the same investigation to. Even getting things out of the ground like natural resources, mining and stuff like that tends to follow Moore's Law. We have a market-based intervention where we have innovation being applied to a problem than typically we do things better, faster, and at less cost. And this is just ubiquitous in various markets. This is a hard drive cost, a gigabyte of hard drive, or 1980, it was about a million dollars to get your average gigabyte of processing power. Today it's less than 10 cents. A gigabyte of processing is now so cheap that it's more valuable as a means of advertising than it is as the original artifact intention, which is just amazing. I remember 1980, I remember wearing parachute pants and stuff, and so at a time when something was a value of a million dollars, one million dollars. We have something that is now a key chain trinket, and so it's just an amazing change. It doesn't just apply to, let's say like hard drives and stuff like that. Like I said, these things apply to mining and a variety of other activities. But the cost to sequence a megabase of DNA back around 2001 was again enormously costly relative to what we can apply this problem today. This graph, two important things. The first is that this is a logarithmic graph. And so this drop is artificially stretched out. It should look like a sheer face of a cliff for one thing. The other part that's interesting to point out with this is that the first phase of this decreasing cost of sequencing DNA was largely an outgrowth of the government undertaking the human genome project and starting to sequence large amounts of human DNA, trying to get a handle on what the human genome is. Where the precipitous drop occurs, who knows what caused that? Yeah, private enterprise intervened in the process. And the whole thing became, it diverged away from Moore's law at a shocking rate. It wasn't just a doubling of the information. Again, it became a logarithmic change in the way that this innovation occurred. So today, let's ask the question to the audience. Do we know more today about genetics than we did 30 years ago? Yeah, how about pathology? Biochemistry, epigenetics, I don't even know if epigenetics was a term 30 years ago. So we know more about damn near everything that there is to know, but yet costs of medicine, this is from the Congressional Budgetary Office. It says orthodox government as you could get. There's nothing controversial, no tinfoil hats, nothing weird about this at all. And the projection is that by 2050, we will be spending, we will be in debt 300% of GDP. A massive allocation of that is going to go to healthcare costs. Why is that? How can that be? We know more about all of these problems. Every other thing that we experience in our life gets cheaper and better with regards to technology. We understand pathophysiology of any disease that you want to talk about better than we've ever known at any time, and tomorrow we're going to know it even better. But yet every projection that we have is that costs are going to go up and they're going to go up in a way that is nonlinear, it's exponential. And another graph from the Congressional Budgetary Office, we cannot hang this on demographics. We cannot simply hang this on an aging population. It is clear that the bulk of these costs are related to healthcare. And the bulk of the problems related to healthcare is tied into diabetes, diabetesity, you know, anything that you want to talk about that. I wanted to bring in some information. Well, quickly, this graph ranges from Manage Care Magazine. In the middle bound, we're talking about one in three Americans being officially Type 2 diabetic. The upper bound were basically between 1.5 and 1.2. I don't know how you get a half a person being diabetic. Maybe a leg falls off and it becomes like a zombie entity and goes on or something. But again, this is following like a reverse Moore's Law pattern. We are doing exactly the opposite of what every other industry or technological endeavor does. You pick a thing, I can Google it and find that some sort of innovation, some sort of discovery is driving the prices down on something, except medicine. And why the hell is that? And can we sustain paying that? And the answer to that is absolutely not. People talk about national defense and all kinds of other stuff. If you want to bankrupt this economy and there are several other economies around the world that are relatively wealthy that have been beneficiaries of a demographic bump when you have a small aged population, a large youthful population that is very productive and they have very giving social welfare programs and whatnot. Those things are changing because our costs for dealing with illness are increasing at exponential rates. So I just generally ask this question, what the heck is it that we are doing that's so wrong? And I would make the argument that we are not practicing Darwinian medicine that as Matt alluded in the beginning of his talk, if we have a fleet of healthcare providers that don't really buy into or use Darwinian medicine is kind of the beginning of their hypothesis generation, we're really behind the eight ball with that. This is like trying to do physics without an understanding of quantum mechanics, but that's a whole other topic for a different day. It would be nice if we had an example of something that actually does follow Moore's law type patterns in medicine. And in fact, Lasix is a beautiful illustration of this. Even in non-inflation adjusted dollars, Lasix has plummeted in price. And this graph is out of date. It's in 2004. Current average Lasix prices are about $400 to $600 per eye. And so what you have here is a situation in which you have a problem, people with bad eyesight. You have technological innovation that can deal with that problem because we have markets and a lack of third party payers, which is the definition of the situation that we typically face. Then we see a Moore's law type handling of this problem. So as long as we maintain a third party payer system, as long as people think that medicine is going to be free, that they can have zero co-pay for everything, which in basic economics means that everything becomes... You try to take a limited resource and make it infinite, then what you do is you make the price become infinite. So we've got some serious problems there, but we have obvious solutions in my mind to where we go with this. So this is kind of part one. Part two, or I guess I've got a little recap on it, technology advances, goods and services improve, cost decrease. We know more about pretty much everything under the sun. How can all this stuff be happening? So I'm hoping that this next piece of the story is a little bit of the solution. Hopefully it's the beginning of something that we as an organization, as a movement can embrace if what is happening here is legit, what I think is occurring, that it may again be the skinny end of the wedge towards an opportunity to change things in a really profound way. So back around 2001, three University of Nevada, Las Vegas police officers succain to cardiac events within a year's time, less than a year's time. The cost to retire an officer in the state of Nevada and a lot of states view police, military and fire, anybody in that profession, if they have a stroke, a heart attack, an autoimmune disease, a host of different conditions, if they develop that condition, whether they are on the job or off the job, it's assumed to be an on-the-job workman's comp, L&I issue. So not all states are like that, but many states are like that. Nevada happens to be one of them. So the cost to retire an officer when they suffer a heart attack or a stroke is about $1.2 million. That's the initial on-the-books number that people write down when they're trying to do their budgeting and when they do risk assessment and whatnot. The real costs are actually about 10 times this amount. And this is part of the reason why municipalities all over the country are going bankrupt because they are reporting that they are going to spend $1 amount on things and then they're spending 10 times more on a variety of issues. And this is a perfect illustration of this. So this situation with these doctors or with the officers getting sick, having cardiovascular disease, costing the state and the university huge sums of money to say nothing about the... I hope it's implicit that there's also the human life cost here. When you have people dying on the job, there's the loss of human beings, the loss of fathers, the loss of mothers, you know, all the rest of that stuff. I'm gonna focus on kind of the hard real costs, but the human costs are obviously enormous here, brain drain and all the rest of that. So, specially health is a health maintenance risk assessment program that was founded in 1993. They're in Reno, Nevada. I just moved to Reno back in November. Kind of interesting backstory, which I'll try to weave into this here in a bit. Initially these folks were an orthopedic risk assessment program. So they worked with labor and industry claims, workman comp claims, trying to figure out effective preventative measures for orthopedic issues, you know, like a carpal tunnel, a sea spine, low back issues and stuff like that, and then trying to recommend successful physical therapy medical procedures to offset costs. So these guys have been around since 1993. One of the folks at the University of Nevada, Reno, who was in the police department heard about the folks at UNLV and then they knew the people at specialty health and they said, hey, do you think you guys could develop some sort of a risk assessment program? We had three officers almost died due to cardiovascular events down in Las Vegas. We have a similar problem here in Reno for both the police and the fire. Could you guys possibly develop a risk assessment program? And they said, well, we can certainly look into this. And so they started putting the pieces together on a risk assessment program. They did standard blood work, HDL, LDL, total cholesterol triglycerides, kind of the standard boilerplate blood work. They did framing ham scores, which if you want to blow your brains out, just try to figure out what the hell a framing ham score is. It's both worthless and induces about a 50% suicide rate and those who study it. They implemented it when they put people through the blood work and they were found to have a high risk of, say, metabolic issues based off the blood work that they were looking at, which at that time they were missing a ton of stuff, they would recommend a high carb, low fat, American Heart Association diet. And the results were absolutely dismal. They were frequently worse than the groups that did not receive intervention. Let that one sink in. These guys are getting paid by the city of Reno to do a risk assessment program trying to mitigate cardiovascular disease and the people going through their high carb, low fat, framing ham score oriented program were typically developing type two diabetes at a higher rate, triglycerides going up, cholesterol going south, and they were kind of like, what the hell is going on? I mean, they were following the American Heart Association guidelines. They were doing the due diligence that physicians are supposed to do and follow the rules of the consensus and the results that they were seeing were obviously subpar. It was not addressing the issues that these people suffered from at all. So luckily they kept looking and eventually the whole low carb concept got on their radar. They found some work from Gary Tobs, from Mike Eads and some other folks and they started doing a little bit of work around low carb intervention. They got in contact with the National Lipid Association which these guys are pretty cool. They are far more sophisticated than the American Heart Association and they will even openly endorse a ketogenic diet for high cholesterol issues, elevated LDLP and stuff like that. So they're pretty solid. There's still some things that I would like to mold and change in the way that they look at things but they're pretty solid. They do NMR testing via Lipo Science Labs which I'll talk a little bit about what that is. It's advanced testing, looking at different lipoprotein fractions that seem to have a better correlate with actual cardiovascular events and I'm gonna have some commentary on all that stuff too. But the current program, they do a yearly risk screening. So they pump all the police and fire through a yearly risk screening. Now they do all of them. I'll tell you about the pilot program here in a second. Folks that are flagged as high risk either because of specific lipoproteins or because of overt insulin resistance, those folks receive a low carb slash paleo diet. The paleo thing is kind of a newer addition, the orientation towards gut health and whatnot which I'll get to here in just a bit. They do some targeted pharmaceuticals, some statins and some metformin which I'm gonna comment on that. They do sleep counseling. They used to do it a bit. Since I've come on the scene, they do it aggressively because clearly like the paper that Pedro Bastos was a part of talking about the ancestral biomedical environment and the changes in metabolic health associated with sleep. I think if people are sleeping well, it's very difficult to kill them. If they're not sleeping well, it's hard to keep them alive. So this is a huge problem in police, military, fire and medical situations in which these people are forced to be in sub-optimum sleep conditions almost constantly. And so we need to figure out strategies for mitigating those effects. And so we do sleep counseling and a variety of kind of support material with that. We recommend metabolic type conditioning, circuit type conditioning to help reverse insulin resistance and whatnot, but that we are trying to emphasize an appropriate dose and not kill folks with it. So here's a standard good blood work. They call it the big five. We've got a body mass index which is kind of like eh, whatever, blood pressure. Breathing is actually cardiac output and whether or not the person's a smoker, lipid profile and then blood sugar. This person is pretty solid. I'm only gonna show you the front page of this NMR, this advanced testing, but this person has a, this is nice also for police, military, fire because it's like red light, green light, yellow light, kind of, yeah, it's real easy to get. It's kind of like a bunch of red lights, your foobard and a bunch of green lights are pretty good, but this first one, when you look at the advanced testing, the further analysis of the lipoproteins also look good, but I'm gonna show you one that really qualitatively is not that much different and this is what we call the discordance model. This is the person that typically their doctor doesn't really notice. If you can't see the numbers, I have a chart at the end which we will be able to look at all of the numbers, but the concerning things here, we see an LDL cholesterol of only 117 and so for most physicians, that wouldn't be particularly concerning. That triglyceride that I think is in the 300s would cause me to probably wet my pants if I were the person's doctor. A lot of docs, this is not a flag for them though. They look at HDL, LDL, his HDL is okay, it's a little on the low side and again, I've got a chart here in just a little bit to show you what those are exactly. The upper right, I guess your left-hand corner, LDLP, it's above 2,000. We want that number ideally to be below 1,000, typically. There's some contention with that like Dr. Atiya and myself and Chris Kresser. We've been talking about this a little bit. If you have somebody who has LDLP that's quite elevated like this, but they're eating a low-carb, non-inflammatory diet, doesn't matter, we don't know. The folks at the National Ellipid Association think that it does matter, but it's an opinion because we don't have data to really support it at this point. I'm kind of of the opinion that the elevated LDLP, unless it's familial, hypercholesterolemia is actually a symptom of something else going on. It's not the problem, it's actually a symptom of systemic inflammation. I'll try to build my case on that a little bit, but this is what they're looking at with this guy, and so his triglycerides were 362, total cholesterol was not super high, but normally this guy would fly under the radar, they'd send him back out at work, and this guy looked like off of a Wheaties box. He's a triathlete and ended up having a heart attack while giving a, what's the neighborhood watch? He's given a neighborhood watch talk to a bunch of 80-year-old women, and he collapses on their coffee table and they barely save his life, but the importance here, the idea that's going on, we could have equal amounts of total cholesterol. When we're talking about these different cholesterol fractions and folks like Christopher Masterjohn and a lot of other people are much more knowledgeable on it than I am, but you have lipoproteins, and those lipoproteins are trying to carry lipid-type fragments around our body, either carrying it from the body back to our liver in the case of HDL, carrying it from the liver out to the body in the case of LDL, and depending on the composition of these particles, if they are small and dense, then they could be carrying the same total amount of cholesterol, but we have more particles, and the more particles we have, the higher likelihood we have of these things associating poorly with the vascular endothelium and causing some sort of damage in promoting atherosclerosis or a plaque or something like that. So the takeaway is that we could have the equal amount of LDL cholesterol, but yet different LDL particles, LDLP, and the higher the particle, the supposition is that we have a higher statistical probability of something going wrong. It's kind of the basic idea on that. So this is an after, and I believe that these guys, let me back up, this was a four month intervention, I believe, and so afterwards we've shifted things around pretty nicely. The LDLP is now almost below a thousand, and then this chart kind of summarizes things pretty nicely. The dude's like a mesomorph, like he's just kind of brick poop house kind of build on him, and so he dropped some weight, but he's really thick, meaty dude. LDLP went from 2,200 down to 1,000. The other notables, the triglycerides, are still for me way too high. Like in this scene, I would really like to see those more long, like 50 to 70 or something like that. Like I still think that that's too high and it's showing some, like that insulin resistant score I would like to see lower, but obviously a good improvement. So another person here, this is what they call dead man walking, and this dude when he came in, it was a nightmare right from the beginning. This is his after, and you know what? This was a 10 year intervention. So it shows that with a modification in his nutrition, which was primarily just low carb, not even the paleo orientation, and a little bit of a metformin and whatnot, then he had a pretty remarkable change. And yeah, like the, do we have the, yeah, the triglycerides are better in this one than what the other one was. So we have one more, and this I believe is a six year change and similar kind of dead man walking and the summary chart is I think really valuable. So over 2200 in the LDLP, about a thousand at the end, really, really remarkable triglyceride change. So I like seeing numbers like that. What it tells me as a person is very, very insulin sensitive. So we're getting no collateral damage with regulation of pro-inflammatory pathways with this person. So that still is kind of a question, can you get LDL or insulin sensitivity in this range, but then potentially have a higher LDLP? Would that still be as problematic as somebody who has high oxidative stress and an insulin resistant profile? I don't think the two are equal, but that stuff we'll have to figure out. So this stuff does some pretty remarkable work, especially health. I think they have 1.5 million people in their database and so they have an enormous pool of data that they've been accumulating since 1993. So they're able to do some really nice statistical kind of forecasting on, if we have a white male 45 years old, five foot nine, blah, blah, blah, you know, and extrapolate all of the data, they can do some pretty nice forecasting about disease rates. And so the pilot study that was performed, there were 33 participants at a cost of about $1,000 per person, based on the metabolic changes that we see in these 33 people, and the 33 were the, there were 200 cops and firefighters that were screened, 33 of them were found to be at high risk. So these are the people that were the likely, very high likelihood of a stroke or heart attack within the next five years. So they did these in- No choice, they had to go into the group. Yeah, and this is part of the cool thing, which is really important to point out, the chief of police had his life saved with this program. Chief of fire had his life saved with this program. Six of the city council members had their lives saved with this program. The CFO of the three largest casinos in town had his life saved with this program. So this is an example of the old boys club actually doing something right. They got together and these people who have significant power and significant sway saw a problem, they saw that the police and firefighters were dying, they saw a huge cost in regards to life and the cost of retirement, and they actually got in and did the right thing. And so the reason why this is working in part is because the chief of police, chief of fire, this is mandated stuff. When they tell you to do this, this is your job to eat this way. This is your job to exercise. So it's not a compulsory, you know, like you do it. And that's part of the reason why this stuff has worked. Are they seeing a reduction in cardiac incidents? Well, we're seeing all of the markers that should indicate that. And given that it's been running, this part of the program has been running five years, then we are starting to accumulate enough time on a large enough data set that it's favorable, but we need some more time to run to be able to fully address that. The estimated return on investment is a 20 to one ROI and about a $22 million return on investment. With that pilot study alone. So I'll talk about the overall program at the end, but I'm still, as cool as all this stuff is, I'm still really unimpressed with pieces of it. I still think we're treating symptoms. I still think that elevated LDLP is symptomatic of other things or based on the metabolic profile, it may not be that big of a problem at all. I think that it may be a sign of intestinal permeability, systemic inflammation, et cetera. I'm really curious. I got thinking about the mechanism of action like the National Lipid Association folks use Metformin and use statins significantly. They use very low doses, but they use them consistently. But one day I started thinking about Metformin and what Metformin does, it's actually a pretty cool little drug. It improves insulin sensitivity, both at the liver and at the muscle level. And it just seems to do amazing things when folks are going in for reproductive medicine. Typically they'll look at the male, look at the female and everything, but typically the first line of intervention for females is they put them on Metformin, which is an insulin sensitizer because insulin and estrogen and progesterone and everything are very tightly lined up. But I was thinking about all the benefits that we seem to get empirically observationally from Metformin. I was thinking, I wonder if Metformin actually has effect on LPS, lipopolysaccharide. Lipopolysaccharide is part of the outside coat of bacteria and mammals, basically any vertebrate that gets bacteria into its system has a huge inflammatory response. An interesting thing I think I mentioned last year in my talk, it's physiologically indistinguishable type two diabetes from acute sepsis. Acute sepsis is when you have a very high blood titer of bacteria or lipopolysaccharide endotoxins and it dysregulates the normal glucose homeostasis coming out of the liver, you have elevated blood glucose, you have elevated gluconeogenesis. Everything that you see in type two diabetes you see in sepsis. And so I've been wondering is a bunch of what we're seeing with systemic inflammation and the beginnings of insulin resistance, leptin resistance, is this all related to low grade sepsis? And so part of this thing that I started kind of putting together is that LDL particles are critical, they're part of the innate immune system. So we have the adaptive immune system, it makes antibodies, we have the innate immune system, macrophages and other white blood cells that act in an immediate first responder kind of fashion, but they seem to be tied in really, really tightly with a lot of systemic inflammatory diseases. So LPS binding protein circulates in association with Applebee containing lipoproteins enhances LDL and VLDL interaction. What all that stuff means is that when we have an infection or some sort of septic event, I would make an analogy here of gut permeability, ciliac, non-ciliac gut permeability, a variety of issues that go into that. Lipopolysaccharide makes its way into our system. It is very, very toxic to us and causes profound metabolic changes. So our body really is highly motivated to deal with it. You have lipopolysaccharide binding protein, which can then associate the LPS with our endogenous lipoproteins, HDL, LDL, et cetera. And if it goes through that route, then we can neutralize the LPS in a fairly non-toxic fashion. If it goes the other way though, if this LPS associated with the CD14 protein on macrophages and other white blood cells, we then pump that through into the liver and we have a highly toxic response, basically akin to type two diabetes. This is that beginning of systemic inflammation, possibly this leads into leptin resistance, a whole host of stuff. And this is also just a backup, like a normal response that the body would have to chronic infection is to upregulate cholesterol production because the cholesterol is attempting to remove these LPS particles. So that's some of my thought about LPS and systemic inflammation. But I started thinking about metformin as it relates to all this stuff. And one day I was thinking, I wonder if metformin has some effects on mitigating LPS lipopolysaccharide induced hepatotoxicity. And so I opted into PubMed and sure enough, we found several papers that seemed to indicate that metformin had potent anti-hippatic toxicity effects with regards to LPS, which I thought was pretty cool. And then I had another thought. I wonder if metformin has effect on gut permeability and sure enough it does. And there's a pretty cool, I pulled a couple of things out of the paper. The protective effects of metformin treatment on the onset of fructose induced non-alcoholic fatty liver disease were associated with protection against the loss of tight junction proteins. The tight junction proteins, occludin and zonula occludin's one. And the duodenum of fructose fed mice and the increased translocation of bacterial endotoxin found in mice only fed with fructose. Taken together, these data suggest that metformin not only protects the liver from the onset of fructose induced non-alcoholic fatty liver disease through mechanisms involving its direct effects on hepatic insulin sensitivity, but rather through the altering of intestinal permeability and subsequently the endotoxin dependent activation of hepatic coup fur cells. So metformin is a really cool little drug. It improves insulin sensitivity in a variety of ways and it seems to prevent lipopolysaccharide induced systemic inflammation and it seems to improve intestinal permeability or at least prevent the normal signs and symptoms of intestinal permeability. This is almost like a mirror image. It's a drug that treats all of the problems that we're basically addressing in this kind of ancestral health framework. It's pretty cool stuff. So I'll just really briefly talk about statins for a long, long time. The main mode of action in statins has been suspected or largely known to be the anti-inflammatory effects. So again, when we're talking about modifying cholesterol levels and risk factors, I don't really think that it has that much to do with the cholesterol modification numbers it has to do with the systemic anti-inflammatory effects that statins carry. And this is an old paper. I think it's 2002? Yeah, so it's a pretty old paper. We have way more data on this now. So when I came on the scene with the specialty health folks, I moved to Reno and about three weeks after being there, Dr. Greenwald shot me an email and he said, hey, we really like your work. We'd like to do some lunch with you. And I sat down and these folks showed me all this stuff. And I was like, holy cats, man, this is super cool. And I started looking at what they were tracking. They were doing a low-carb intervention. I said, hey, have you guys started tracking auto-immunity or intestinal permeability or any of that stuff? And they're like, no. And it turned out that both Dr. Greenwald and Dr. Cox, Jackie Cox, who is kind of the statistical super brain behind this whole thing, both of them have autoimmune conditions. Neither one of them really knew it, but we kind of dug that up via blood work. And where they were eating a low-carb diet previously and their carb would inevitably be like a piece of toast and stuff like that, we ended up doing an autoimmune protocol, which we've talked about quite a bit for, I don't know, maybe five years now. We've had some inkling of an autoimmune protocol, variety of paleo, both of them have responded remarkably well. And we've started going back and looking at the data that they've had on their police and fire that they've tracked. And we've dug up some kind of below-the-surface autoimmunity in these folks. So this is what we're looking at now, screening for intestinal permeability also for overt autoimmunity. The stuff that we have cooking next, we have a program that's been running now for three months, four months, that encompasses all of Reno police and fire. The estimated savings on these folks, based off the numbers that we have had currently, over a 30-year period is about $1.2 billion. Yeah, amazing, amazing. And at a time when, if you look at almost any corporation, any municipality, typically the greatest increasing cost that they are facing is healthcare costs. It's going up at between 10 and 15% a year. So this is absolutely gutting the costs in the spending that they were putting into healthcare, potentially. We'll see how it goes. This is the low-carb intervention with the addition of this kind of paleo, gut permeability, systemic inflammation mindset, lots of sleep counseling. We're gonna spread this program to a global audience. We've been contacted by 45 municipalities globally thus far. We have Scandinavia, Australia, New Zealand, the UK, all over the United States, especially health already had a very robust database and networked health maintenance program. So we're able to collect data on all these folks. So basically these folks are gonna be given the tools to implement these programs locally. We will do the data collection and then we're gonna kind of roll from there. We're gonna consolidate that data with those folks. The next step also, we're working on a healthcare provider education, covering trainers, coaches, allied health professionals, MDs, so that we can get folks up to speed in this ancestral health model. And then the big goal is that we're going to develop a health insurance company pushing HSAs and referrals back to these gyms. I've said for a long time, some of you folks may know that I've had on and off stuff with the CrossFit entity and whatnot, but I think gyms like that literally should be our primary care medicine. We shouldn't go to the dock in the box for primary care. We should go to a local decentralized gym where we do functional training and we get sunlight and we have community and we have CSAs in there. So the development of stable well run gyms is actually a huge part of what I'm gonna be up to and educating those people and then creating networks with allied health providers, physicians, et cetera, and then providing direct to consumer blood testing so that we can help those folks, whether they're at high risk or low risk. But the whole thing also is if we can develop a healthcare model that is based on Darwinian medicine and the ancestral health model, it is going to be so much more cost effective than anything else out there, I think it will crush things. And there was a couple of people mentioned that we need to get more science coming out of the back end of this stuff. I agree, but the academics take a goddamn long time to get anything done. And I say that with respect, being at Harvard and all the rest of that, we cannot wait for that to happen. We need to bootstrap this and we need to take responsibility and we need to help each other do this or it won't happen. If we wait for the academic process to occur, it'll be 20 years before we validate the things that we're suspecting today. So we need to do this on our own and it's still outcome based. We're not just making stuff up. We still are hanging our hat on the results that we get, but the economics need to drive this thing. And that's, in my opinion, the direction that we need to drive that boat. As a closer, really interesting how the world works in small circles. So the gentleman on the far right is Ed Greenwald. He is Dr. Greenwald's father. He became a high ranking person at the FBI. The gentleman next to him with the mustache. Does anybody know who he is? Anybody particularly in the anthropology realm? His name is Robert Braywood. Does anybody know that name? We should all. I didn't know, so I'm not gonna hang you guys out. But Robert Braywood was one of the first people to study the transition from the hunter-gatherer life way to the settled agriculturist life way. He wrote some of the very first papers detailing the changes in stature, the changes in dentition, the changes in health status of hunter-gatherers as they transitioned into agriculturists. So he literally is one of the first people to ever study this topic that we are now a meshed in, right in the middle ground. Part of the significance is that he was a super tight friend of the Greenwald family and Dr. Greenwald, the co-founder especially, health. The reason why he went into medicine is because of this man. And he's had a lifelong fascination of genetics, evolution, and everything obviously health related. And so this guy is the guy that contacted me after I was in Reno for three weeks and he's the one that's been running this risk assessment program. And it all largely is an outgrowth of this man that it's somewhere in the history of all the anthropology side of this. We can largely attribute his work as being foundational to it. So it's really, really amazing. And so we'll dedicate this to the next generation. That's Zoe and that's Sophie the giraffe. So I'm not sure, I think I was at 38 minutes. We were a little late if I need to pull up. I can definitely split if folks have questions. I can answer that later. I really thank you guys though, but are we good for a couple of questions? I just can't emphasize enough though that I feel like we are at both a precarious but also an amazing moment in history. I think we can change this all. I really do. 15 years ago, none of this existed. There's a couple of crazy, me talking to Lauren Cordain via email and I mean none of this existed. So this is an amazing time that we are in and I think we have an amazing opportunity. So we'll see how this goes for a year. We'll see if we can get these other programs off the ground. We'll see what type of savings we can get out of it. Maybe the program doesn't work. Maybe it does. I think it will. Time will kind of bear that out, but I think that something like this and us taking responsibility for the way our food is produced for our own health, somebody needs to start this and it's gotta be us. And then we will drag the rest of the people along kicking and streaming. So thank you. Thank you. So we have about five minutes for questions. Hi, very good talk. I was just wondering with the Metformin data that you were showing us, does that permanently affect how the body functions or is it only while people are taking Metformin? It's only while they are taking Metformin, but you do, it's both to some degree because you are changing certain parameters of inflammation that if the person goes off Metformin, they tend to get a long lag period with it. And I think that if you use it as an intervention, like I think for like police, military fire and medical workers who are facing constant sleep deprivation and have a sleep induced metabolic arrangement, I think that those folks should be on low dose Metformin across the board. Like it is so safe, but yet so efficacious in mitigating the effects of insulin resistance that for that population, I would argue, they should be on a low dose, like half what they would normally do, but just a baseline dose. And it's going to help undo the sleep induced metabolic arrangement that is unavoidable from their life. Yeah. Great talk, thanks for giving it. How is this changing your, the training curriculum that you mentioned that we're all dying to know about and say the EVOS program that you had with SU-1-Y and U-Pulse? Is this changing some of the content that's going on there? Not really. I mean, it is in that way, it's very clear that my background is obviously more gym related, but we obviously need to get sophisticated in how we educate allied healthcare providers and also physicians so that we can refer people to this program and like what blood work we're going to track and stuff like that. An interesting backstory with this is Dr. Tara Dahl, who is one of the folks at the National Lipid Association, she and her husband were given a huge grant by the World Health Organization to provide a website where barefoot doctors in developing countries can do their whole medical school curriculum online. And then the people will show up in the UK or Australia, do some clinical work, but otherwise they're anointed and often running. So it's a huge, fully accredited medical school curriculum online. These people have offered to host our education material. So we basically right out of the ACCME accreditation, which is gold-stattered AMA accreditation and peripherally we're basically getting a nod from the WHO on this. So we're basically just like need to bum rush to this thing and make it happen. So yeah. Thank you. Awesome talk, thank you so much. On a personal note, I'm one of those people. My LDLP of 2240, triglycerides of 40, insulin resistance score of four. So I've got this weird sort of schizophrenic numbers. Maybe it's time to get folks like us together and watch us and maybe we need like a forum or some kind of way that those of us that are in that situation, because it seems like it is a gray area. We don't know everything we need to know about this yet. Absolutely, I totally agree. And how many of y'all know Chris Cressor? Chris, can you rate? So the one person in the room raises his hand. Everybody knows Chris. Okay, Chris has some really amazing material coming out in looking at high cholesterol in the paleo scene. And so I think that we need to organize ourselves, do some advanced testing and then consolidate this. Especially health is trying to work with me so that we can do some direct to consumer blood work. And they will be able to provide analysis on this. So then that way you guys will get, if you wanna do advanced testing, they'll be able to send it right to you and you can do it. And you wouldn't, very few doctors are even aware of this stuff. So it's hard to get them to order this whereas you'd be able to order it through specialty health. Yeah. Rick Henrichs, I'm a family physician. And before everybody goes and runs and buys metformin or recommends it for everybody, I just wanted to hold the horses a bit. So there are some bad side effects, nausea, diarrhea. So it's not the wonder drug, but it is a fantastic medication and it does work really well. And I would just like to say, I mean, this is great stuff. And there are physicians that are doing similar things like that that are here and look for good physicians to help you out with that. Awesome. Are you signed up on the Physicians Network? Sure are. The other day I had like five of my seven a.m. morning patients that were from the network. So it's actually working. It actually worked. Cool. Thank you. Thanks. Thank you everybody. I'm just going to cut off questions right now. If you have questions later, maybe Rob will answer them. We'll be in the bar. I'll be in the bar with you. Dr. Lieber. His answers will be much more colorful then.