Episode 55: Paving the Way For Personalized Medicine ft. Dr. Molly Maloof

Authored by Zhill Olonan • 
February 13, 2018

Dr. Molly Maloof is on a mission to radically extend healthspan and maximize human potential using scientific wellness, technology, educational media, & lifestyle medicine. Her iterative programs take the quantified self to the extreme through comprehensive testing of clinical chemistry, metabolomics, microbiome, genetics, & biometrics (e.g. heart rate variability & continuous glucose monitoring). We discuss the future of personalized, holistic health and performance. 

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Transcription

Geoff: Hello, this is Geoffrey Woo, from the HVMN Enhancement podcast. I'm real excited to have Dr. Molly Maloof with me on this program today. We've crossed paths multiple times in different media reports, and more recently, in different conference and panel events talking about human performance and biohacking. I think, Molly has a really interesting story, because she's not only an MD with a practice, a concierge practice, working with some of the top executives and entrepreneurs in Silicon Valley.

She's also an active advisor to a number of interesting human performance startups in the Bay Area, and I think, also globally. Recently, came onboard running medical and science for Sano Intelligence, which is a cool continuous glucose monitoring startup that I've been tracking for the last year, couple of years. Excited to have you on the program.

Molly: Well, thank you.

Geoff: This is our first, I think, in person podcast for 2018.

Molly: No way.

Geoff: A great one to kick this year off.

Molly: Cool.

Geoff: How did you get in this space? I think it's always great to zoom back, and get your personal story.

Molly: Sure.

Geoff: I think, what is intriguing about your background is, I think I've talked to a lot of doctors on this program, and also a lot of interesting tech entrepreneurs. Both, I think having both of those skillsets in one person is quite unique.

Molly: Thank you. I guess it goes pretty far back into my childhood, where my dad was always obsessed with technology. Where I grew up, we always had to have the newest, latest, greatest stuff, in the middle of the Midwest. By the time I hit eighth grade, I was pretty acutely aware that my body was changing by then. I remember starting to read magazines, and I started reading Popular Science. I started wondering all about my biology. I read about fighter pilots taking Modafinil in the Army. This was before it was a prescription drug. This was a substance that the government was giving people to avoid having to sleep.

Geoff: Right.

Molly: I thought, that was the coolest thing. That you could take something, and not have to sleep, and you could just work. Because, I was pretty rambunctious young person. I started taking supplements in high school, just trying to figure out what was going on with my body. Trying to see if I could do-

Geoff: You were going to store, and-

Molly: I was going to the store, the health food store and buying supplements.

Geoff: Cool.

Molly: Taking things I probably shouldn't have taken, like Ephedra. At one point I was taking that, and I remember-

Geoff: Which is, now, band.

Molly: It's band.

Geoff: Yes.

Molly: I remember sitting in class being like, I feel like my arms are floating. Maybe not the smartest thing in the world to do at the time. But, I've always been interested in performance, and doing ... I was one of those students who was in every varsity, in two varsity sports, and student government, on the dean's list, and all these clubs. I just wanted to always be doing things. It's hard to do that. For a lot of my life, I went through these phases of just working really, really hard, and then burning out. Fortunately, I've gotten to my 30s, and I finally have, I think, balance, sort of.

Geoff: Figuring it out, an adult finally.

Molly: I think I figured a lot of it out by now. Not, everything, by any means. That's the thing about biohacking, and health optimization, is there's no destination. It's like, your body's gonna change throughout your life, and so you're gonna have to try to mitigate some of the problems that come along with being human.

Geoff: Right.

Molly: My practice evolved out of a desire for there to be this concept of perfect world medicine. What if you could be the kind of doctor that you used to have, where you could spend as much time as you wanted with patients, and you could really get to know them, and really understand their bodies. Then, taking it to a step further, thinking about, what if a doctor could really make you healthier? That was how my practice evolved. Then, building a practice up from scratch is expensive, so I started consulting with startups at the same time as I was building this practice.

Geoff: Right.

Molly: I worked for a company that did personalized medical research, and then from there I started working with a company called 3Scan. Then, word of mouth comes, San Francisco's not that big.

Geoff: Right.

Molly: But, I jumped into the tech scene, because I saw that medicine was going to be transformed by technology. I was sitting in my residency at the time, hating my job, hating my life, and feeling like I wanted to innovate medicine. My attendings were like, great, you want to do that, you've got 20 years of waiting in line before you have enough autonomy and authority to do so.

Geoff: Right.

Molly: I was just like, that's not enough at all.

Geoff: No, right.

Molly: I was fortunate to meet some amazing doctors in Silicon Valley, who I could model my practice after, who were optimizing health. I also worked with other doctors who were developing expert systems for wellness, and these experiences were like my extended residency, essentially. Now, I have, what I consider to be a pretty great life, because, I kind of get to what I want.

Geoff: Right.

Molly: I have some, I think I have respect in our community, of people how know what I do. But, I'm by no means in the mainstream.

Geoff: Right. Well, it interesting. I think most doctors would agree with, 100% what you just said. But, I think it seems like the institutional framework of how medicine is reimbursed by insurers, and payers, and all this stuff. People can't practice in a way that, I think, what you're saying. Which is, you want to get to know the patient, or know your client, or your ... Really just, like you're coaching someone through their life transitions.

Molly: Right.

Geoff: Now, and I think you talk to people inside hospital systems, it's like, 15 max churning your patients in and out, and then writing a script.

Molly: It's a billing and coding system that is designed to treat and prevent, well, sometimes prevent.

Geoff: Right.

Molly: But, mostly treat disease.

Geoff: Right.

Molly: Right? The systems not just, it's just not designed to do what I do. But, that's why I believe the technology space is so important. Because, we're creating a second system of, a consumerization of medicine.

Geoff: Right.

Molly: And, a market of health.

Geoff: Right.

Molly: There's this concept of, people have always thought about alternative and complementary medicine.

Geoff: Right.

Molly: But, a lot of this is becoming truly more mainstream, and acceptable.

Geoff: What would you say to the skeptics? If it's not inside the hospital system, it's BS, it's fuzzy.

Molly: It takes 17 years to get from the bench to the bedside. If it's in the hospital system, it's old medicine. If it's in the hospital system it's like ... Frankly, a lot of what really works in medicine, is military medicine. It's the stuff that we have learned from the battle field-

Geoff: Right.

Molly: ... That turns out saves lives. But, if you're traumatized, and you're broken, they will fix you. But, chronic disease, we're still teaching medical students calories in, calories out. Turns out the body is not closed system.

Geoff: Right.

Molly: We're still teaching students that, if you look at the American Diabetes Association recommendations for food, it's eat as many whole grains as you want.

Geoff: Right.

Molly: You go to the grocery store, and you see whole grains on Trix.

Geoff: Right.

Molly: There's a problem with what we're telling people about health in the mainstream medicine world.

Geoff: Right.

Molly: Because, it's old.

Geoff: Right.

Molly: It's old science. The problem is-

Geoff: How many hours of nutrition lectures did you get? I think I was talking to some other doctors, and said you got two lectures in nutrition.

Molly: They were not accurate, and they were very minimal.

Geoff: Right.

Molly: I actually complained, and said, look, this calories in, calories out stuff is not true. There's this great book that just came out called, Good Calories Get Bad Calories. It was all about how certain carbohydrates, like refined sugars, and refined carbs spike insulin, and that can contribute to obesity.

Geoff: Right.

Molly: That's important to know, right? They were just like, they just shook their head at me. I was like, okay, I'm gonna do something about this. I actually-

Geoff: There's no actual response. They were just like, no.

Molly: I actually designed a course for medical students called, Physician Heal Thyself, Evidence Based Lifestyle. It was all about all these things that we weren't being taught. Food as medicine, exercise as medicine, sleep as medicine, healthy relationships as medicine. Just toxic relationships is poisonous.

Geoff: Poison, yeah. Interesting. Is that being implemented in different universities, or how is that rolling out right now?

Molly: The only thing I know about medical education right now, comes from medical students that I'm watching on Instagram. I actually am not super connected to the medical education sphere anymore, because I just am so busy. But, I do see a younger generation of doctors that are starting to emerge, and starting to recognize that they want to be a part of this movement. There are organizations, like the Institute of Functional Medicine, and the Institute of Integrated Medicine, and there's a few others, that are making some movements in this space.

That doctors are, there's actually, I have a few colleagues that, they knew going into medicine that they were not, they were only going to do a year of their residency to get their license, and they were going to practice functional medicine. One of them has a chain of clinics called Parsley Health. Her name is Dr. Robin Berzin. Another one is, Dr. Stephanie Daniels, who works in South Bay, and she's amazing. There is now a new path to practicing the way that you want to practice, but it's not, it's a small number compared to the masses.

Geoff: Right. It seems like, to me, as an observer that's interested in the space, that there's definitely a decentralization of almost every single industry, right? You see cryptocurrencies with finance, and think you start seeing that with biology, with biohacking. More and more, consumers, our listeners are probably empowering themselves with information listening to this podcast, reading about the latest science, and the latest research coming out of the clinic, what supplements, what inventions, what device they could be tinkering with, and arming themselves. When they come and see a doctor like yourself, it's more of an educated conversation, rather than, tell me doctor, what I should do for the next year, for the next 15 minutes.

Molly: Right. A lot of my patients come to me with spreadsheets of all the supplements they're taking. It's a lot, but they're like, I don't want to manage this all the time.

Geoff: Right.

Molly: But, then also, I like what you said about people really educating themselves.

Geoff: What do you see in your practice?

Molly: I think the biohacking movement that, frankly, Tim Ferris was as big part of starting, and Dave Asprey, and frankly, there's doctors that came before, there's people who came before them who are part of this.

Geoff: Right.

Molly: But, this isn't, I think this is a reaction to the system not serving people's desires for better health, right, and so people are having to do it themselves.

Geoff: Right.

Molly: There's that website Selfhacked, Joe Cohen has.

Geoff: Right.

Molly: I've got friends at this company called, Neurohacker. There's, it's not just a few figure heads, there's a lot of people that are doing this now. Because, you can't go to doctor, there's not enough doctors who do what I do, and one's that do what I do, frankly, we are all mostly very expensive.

Geoff: Right.

Molly: People want to, especially young, smart, bright people, they want to save money. They want to spend their money on the supplements and experiment. I'm a big believer in self experimentation. Frankly, a lot of what you see in modern medicine, is doctors experimenting on you.

Geoff: Right.

Molly: Right, they're like, well, that statin didn't work, let's try this one.

Geoff: Right, those are clinical trials, right? Just placebo versus some intervention. Let's see if it works.

Molly: Well, gosh, some of these clinical trials ... I actually have friends in biotech, and I do want to believe that there are ... I do know that there are good scientist out there that are doing good science. But, there are also a lot of people that are very carefully designing these studies, to get the outcomes that they want.

Geoff: Right.

Molly: They've told me how they do this. What they do is, they start with the endpoint that they want to show the FDA. Because, the FDA only really cares about endpoints.

Geoff: Right.

Molly: Then, they design the study so that they get a certain number of people with this type of presentation into the study, so that they know they're gonna get this effect size.

Geoff: Right.

Molly: Basically what you do is, you have a doctor, or a bunch of doctors who are recruiting for the same disease, and then you pick the patients from the people that they've recruited.

Geoff: Right.

Molly: That happens, so a lot of these drugs, when they come out, they've only been tested on these small populations of people that they know they're gonna work.

Geoff: On the perfect, perfect patients.

Molly: Exactly. Then, they give them to everyone, and we wonder why there are so many side effects.

Geoff: Right.

Molly: I'm not saying biotech is all bad. Because, frankly, there are, I've had patients who have had really, really important benefits from certain drugs that are change, that have saved their lives.

Geoff: Right.

Molly: But, I do think that it's important to realize that, you're gonna be unique, and no matter what you put in your body, it's your own experiment.

Geoff: Right. I think people, it's funny to me. Because, I think it's a drug is a chemical that you put into your mouth, food is a chemical you put into your mouth.

Molly: Mm-hmm (affirmative).

Geoff: These are, there's no magic distinction between, this is an FDA drug, this is a magic, gonna work for everyone, versus a food. I think biology is complicated enough to realize that, yes, you're a ... There's a cascading network effect. Your biology is different from mine. We're gonna respond differently to different interventions. How do you actually personalize? I'm curious, how do you apply that personalization to your practice, then?

Molly: Well, the first thing, I've developed a system, I guess you could say, around this cycle. Because, you go through these cycles of experimentation, right?

Geoff: Yeah.

Molly: It starts with really analyzing a person's goals for their health. Because, everyone's gonna have their unique outcome that they want to achieve.

Geoff: Right.

Molly: Then-

Geoff: What are the most popular?

Molly: It depends on if you're a man or a woman.

Geoff: Living longer?

Molly: Living longer, better skin.

Geoff: What are the difference between men and women?

Molly: A lot of men want performance. They want to be able to adapt to stress. They know they're gonna put their bodies under stress, so they just want to be-

Geoff: Like athletic performance.

Molly: Yeah, they want athletic, but they also want, a lot of people want work performance and brain performance. Especially, a lot of engineers who don't workout. They want their brains to work, that's all they care about. Then, there are some athletic goals people want to achieve. Then, depending on an individual's health problems, because everyone's gonna have a certain number of health issues. It's unavoidable in this country, to not have something slightly wrong. But, hormonal imbalances are common in men as well.

Then, for women, a lot of it is, if you just look at Instagram. It's beauty, it's energy, fertility, and skin. It's a lot more about aesthetics and appearance. But, then there are also the body builder men that want the aesthetics, right?

Geoff: Right.

Molly: Then, gut health is something that everybody's trying to fix.

Geoff: That's interesting.

Molly: There's the goals, and then what I do is, I figured with ... Part of a job of a good consultant is, asking the right questions. Part of a job of good doctor is asking, to me, everything you can ask a person. I ask both the traditional medical history questions, that analyze what could be wrong, in a sense of modern disease. Then, I also ask a series, I have a bunch of questionnaires around lifestyle and environment.

I've got sleep questionnaires, I've got psychosocial questionnaires, I've got executive function questionnaires, I've got nutrition, digestion, stress, metabolism. I'm really looking at all these different layers of a human, and all of their qualitative descriptions of what's going on. Then, you're going to look at the quantitative.

You're looking at the labs, you're looking at the genetics, you're looking at the nutrition analysis, like the NutrEval from Genova. You're looking at the microbiome. Now, we have companies like Biome, that give us the microbiome. You're looking at the, what is it? You're looking at essentially all the organisms that growing in a person's body. Then, the hormones are important, and clinical chemistry markers, markers of methylation, and some immune markers as well. There's probably more that I'm leaving out. But, there's a lot of tests.

Geoff: Basic lipids, right?

Molly: Lipids, cortisol testing.

Geoff: Right.

Molly: If someone has a family history of heart disease-

Geoff: Right.

Molly: ... We'll do more heart disease testing.

Geoff: Right.

Molly: I basically will tailor their lab panels to whatever they're predisposed for.

Geoff: Right.

Molly: And, whatever I see in their medical history. The, from that, we start layering the data, right? You see the genetics, you see the predispositions to certain things. Then, you see the actual expression of that in the laboratory tests. Then, you see what are they complaining of? Then, you start trying to see some pattern recognition.

Geoff: Right.

Molly: Then, from there we go into the basics of optimizing health. The simple things, I always tell people, it's like, how do you grow a human? Well, you have to have light, you have to have water, you have to have air, you have to have food. But, you have to have the right amounts for everyone, right?

Geoff: Yeah.

Molly: I'm looking at a person's home, I'm making sure they've got home water purifiers, air purifiers. I'm making sure that they're getting enough fluid throughout the day. I'm making sure that they're not drinking too much alcohol. Just the basics initially.

Geoff: Right.

Molly: Because, you just have to, if those aren't being covered, it's like everything else is detailing.

Geoff: Right.

Molly: Then, really looking at the nutrition from the lens of, what do we need to add, what do we need to takeaway? What's going on with their meal timing? There's so much to discuss around circadian rhythms, and it really ... A lot of, when I think about food, I think about a person's current life, and current settings, and current stress levels.

Geoff: Right.

Molly: Right, so I may not recommend a ton of fasting to somebody whose like totally screwed up their adrenal or they -

Geoff: Right, and they're underweight already, right.

Molly: They're underweight, they're undernourished. They may not be the best person for the job, right?

Geoff: Don't fast if you're underweight, yeah.

Molly: Right, or if you're exceptionally stressed out, why would I send you to crossfit, which is gonna spike your cortisol even more.

Geoff: Right.

Molly: It's always about figuring out what can we do to get this person into a bit more balance. Then, sometimes it's hiring trainers to work with them. It's also looking at sleep is really key. It's a lot of the basic stuff that you have to deal with first. Then, you get into things like the hormones, you get into the gut. Gut health is really next.

Geoff: Right.

Molly: Gut health is like, if your gut is not functioning, then you're gonna have disease. You have to optimize the gut, and then you have to look at a person's hormones, and you have to basically see, what is their blood sugar like, what is their thyroid like, what are their sex hormones looking like. All of these are intertwined with blood sugar. If your blood sugar is abnormal, then all your hormones are gonna be off.

Geoff: Right.

Molly: I use continuous blood glucose monitoring for people.

Geoff: Cool

Molly: So that, people can see-

Geoff: Which, ties into Sano as well.

Molly: Which, ties to Sano.

Geoff: I'm actually wearing one right now.

Molly: Me too.I can go into more, but then there's detoxification, and there's mitochondrial health, and then there's immune system health. It's really just, there's a lot of these things you can't address until you address the first things, first and foremost.

Geoff: Right. It's interesting, blood sugar, that you've seen as a key indicator for so many downstream diseases.

Molly: That was the one thing that I got out of all this. Doing all the studies on all these people for the last five years, it just came down to one thing. I was like, what can I do to scale what I do the masses?

Geoff: Right.

Molly: I was like, blood sugar is the ultimate lifestyle biomarker.

Geoff: Right.

Molly: It reflects your stress levels, it reflects if you don't sleep well, because you tend to eat more carbs.

Geoff: Right.

Molly: It reflects your exercise, if you-

Geoff: Cortisol release elevates glucose.

Molly: Cortisol is huge. Because, I've been wearing this pretty much off and on for about a year now. I can see in my patterns when I was most stressed out. I can literally see the months where I was moving, and I was super stressed out. I felt like garbage those months, but to see it, it's like the stock market of your blood stream. It's like, you know when things are going well, and you know when they're not.

Geoff: It's interesting that, I think, if you look at just the disease charts, diabetes, pre-diabetes effects a third of Americans.

Molly: Half the people with pre-diabetes don't even know that they have it.

Geoff: Right.

Molly: That's the big thing around Sano Intelligence is like, we're not gonna diagnose and treat disease.

Geoff: Right.

Molly: But, we are going to show people what's going on inside their bodies.

Geoff: Right.

Molly: So, that they might be able to be doing ... They might be more inclined to do something about it. Maybe, that one thing that they do is, they go the doctor. Sometimes when patients go to doctors, and they say they have pre-diabetes, the doctors are like, great, what are you gonna do about it? The patient's like, you're supposed to tell me.

Geoff: Right.

Molly: I have patients who come to me, because they're like, I'm pre-diabetic. I don't know what to do.

Geoff: Right.

Molly: It turns out that you look at their diets, and some people have really healthy diets, and are pre-diabetic. It comes down to the stress piece.

Geoff: Right.

Molly: Then you're like, well, where's your stress coming from, and then you can start triangulating by this actually can help detect what's stressing you out. It's fascinating.

Geoff: It's interesting that you're applying it in your practice for non Type I's. Originally, glucose monitors are designed for Type I's.

Molly: Right.

Geoff: Now, it seems like it's almost ubiquitous tool that you almost referring to all your patients.

Molly: Yeah, I put it on everyone.

Geoff: I think that's the future. Because, I think, when I look at it, it's like okay, we have our dashboards for our computer, for our cars. You have stock tickers that track our money portfolio.

Molly: Right.

Geoff: Why don't we have any sensors that tell us real time data on ourselves. I'm curious what you respond to critics who say, that's too much information for that users? Is that a question that ever comes up? Because, I've had a couple conversations with reports, or skeptics who are like, or some doctors who are more old school, like that's-

Molly: There's a lot of information, but there's definitely a lot of information. But, part of what we're doing at Sano is, we're making meaning of that signal, so that you don't have to do it yourself. Our vision is that, we're gonna have so much data from so many people, that eventually, we'll be able to find out things, and be able to give you insights without even knowing you. That's the dream, right, is that we can actually predict what's going on, and give you really actionable information, without actually seeing you. To me, that's the ultimate goal of scaling my brain.

Geoff: Right.

Molly: I'm like, what if I can put this into an app, and then help millions of people. How great would that be? Whether or not we do, it's gonna be hard. It is hard. I just went through all these different accuracy numbers of all these different devices.

Geoff: Right.

Molly: It turns out that Abbot is 12 to 15% inaccurate.

Geoff: Right.

Molly: I started checking with a-

Geoff: With finger pricks?

Molly: ... Finger prick, and I started feeling really, really confused. Because, I was just like, whoa. It's amazing I've gotten so much value out of this, given that it's not perfect.

Geoff: Right.

Molly: That's a thing that people are gonna have to realize.

Geoff: I think it's directionally correct. But, it's like, are you 100, or 95, or 90.

Molly: It definitely will detect patterns.

Geoff: Yes.

Molly: That's, I think, the big key with this.

Geoff: Right.

Molly: Is, what is the overall pattern telling you.

Geoff: Right.

Molly: Overall, if I see a person's fasting glucose is like pretty high every day, even if it's not a perfect number, I know that they need to do something. If I see their postprandial glucose is consistently pretty high.

Geoff: Right.

Molly: It may not be exactly as high as they say it is, but that is an alert that we need to think about what you're eating.

Geoff: Right.

Molly: I've just seen it change with people's lifestyle changing, so it can be done.

Geoff: I think that's why I, I think I initially got connected with Ashwin, the CEO of Sano, I think, because we were experimenting with continuous glucose monitor for different fasting protocols. Yes, you can materially see your fasting blood glucose drop over time.

Molly: That's awesome.

Geoff: I think, you guys got awesome news recently, right? Fitbit came in as an investor.

Molly: Yeah, totally.

Geoff: I think it's, what are, beyond that news, what are the big things we can expect from the company?

Molly: I should really have a chat with Ashwin, about what I can talk about.

Geoff: Some things are secret in the pipeline then.

Molly: There's, well, first of all, it's gonna take a little while for this to come out. 

Geoff: For the listeners out there, what is a high level value prop of Sano? Just to make sure that we're all on the same page.

Molly: We have continuous glucose monitors right now.

Geoff: Yes.

Molly: But, it turns out, that if you're not a diabetic, it's actually pretty hard to get one.

Geoff: Yes.

Molly: In fact, you have to go around the system, which is basically the definition of biohacking-

Geoff: Right.

Molly: ... In order to get what you want.

Geoff: Right.

Molly: I can order these in bulk, because I'm a doctor.

Geoff: Because, you're a doctor, yes.

Molly: But, if you want to do this for optimizing your health, you don't have that option.

Geoff: I either go to a doctor, like yourself-

Molly: You have to go to a doctor.

Geoff: ... And, be like, I'm curious, or I have pre-diabetes.

Molly: Right.

Geoff: I want to monitor this.

Molly: That's the thing, your insurance isn't gonna cover it.

Geoff: Right.

Molly: Even if you have diabetes, your insurance might not cover it. That's the crazy thing about this world of medicine is like, you have to be pretty brittle diabetic, or complain a lot to your insurance company, to get what you want, and to get what you need. And, they are pretty expensive. The core value proposition is that, we will have something, ideally, direct to consumer, off the shelf, that you can just pick up, put on, download the app, start tracking. It's gonna be different than the clinical grade tools, because we are developing a lifestyle, it's really a lifestyle tool.

Geoff: Right.

Molly: Because, of the FDA, and we can't diagnose and treat disease, and we can't use this, technically, in the clinical setting. But, I wouldn't, frankly, if I had diabetes, I would still be finger pricking to verify the numbers.

Geoff: Right.

Molly: Just, because if you're dosing Insulin for carbohydrates, you want to be as accurate as possible.

Geoff: Right.

Molly: It's more, for me, there's a few value propositions. First, to the individual. Just being able to get access to something that typically is hard to get from your doctor, is great.

Geoff: Right.

Molly: Second of all, there's a lot of experimentation you can do with your body, and this can be a tool for helping you validate those experiments.

Geoff: Right, right.

Molly: And, see the results of those experiments, right?

Geoff: Right.

Molly: Then, there's also this, I'm sure you've heard of this recent paper that came out, maybe a year or two ago. All about how-

Geoff: Different insulin responses to different foods.

Molly: Yeah, different glucose responses to different foods. If we all ate the same thing, we might all have different reactions, right? Because, of that knowledge that we have now, we need a tool that can enable people to see that what's right for you, isn't right for me.

Geoff: Right.

Molly: I eat a bunch of, so beans are a great example. I really like beans, and they're a longevity food. Every blue zone diet has them. But, beans have lectins, and lectins can actually activate your immune system. For me, who has celiac, if I eat lectins, I actually feel really not great for a little while. Partially, because I'm just predisposed to autoimmunity. Anyone who has celiac is more likely to develop more autoimmunity. I have to be, I eat a pretty strick autoimmune, paleo diet. Which, is very similar to the Wahls Protocol. Essentially, it's lots of, it's basically lots of vegetables, healthy meats, some starchy vegetables, fruits, but very careful, like berries mostly.

Geoff: Right.

Molly: Some nuts and seeds, and some eggs occasionally. I'm debating on those right now. But, it's a pretty rigid diet, right?

Geoff: Right.

Molly: If I eat grains, if I eat beans, even though these are what are cornerstone foods for most of the country, my body totally changes. I gain water weight like crazy overnight. It's inflammation, and it's my body's reacting to it. There's also this big question around, what do we not know about how food affects us individually, and at scale, and what can we use to test this. Right? There's not that many tools right now that exist, that enable you to get this data. And, once we get data on millions of people, we should be able to apply some machine learning, and artificial intelligence, and start really figuring out what's going on-

Geoff: Optimizing.

Molly: ... With the individual. Figuring out, how do we reverse pre-diabetes, and diabetes.

Geoff: Right.

Molly: Right? How do we get a person, because the doctors will tell you it's not reversible. But, there's plenty of doctors out there who can reverse this.

Geoff: Right.

Molly: Another thing I want to mention-

Geoff: Why do you think that is? I think you see early success with Virta Health, which is an app that's coaching people through their diet.

Molly: They have some success, but they have a bunch of failure that no one talks about.

Geoff: Sure. I'm curious, yeah, what is your take on it?

Molly: This is the thing, so I spent the whole last year trying to figure out, do we tell people to cut carbs, do we tell people not to cut carbs.

Geoff: Right.

Molly: There's plenty of people who believe ... There's a doctor that actually recommends starch for diabetes. A high starch diet, low fat diet.

Geoff: I think I've seen that.

Molly: There's literally doctors who recommend all sorts of things. My, after spending ... At the end of last year, not 2017, 2016. I spent a lot of 2016 going to nutrition conferences. I went to all these conferences with all these expert doctors. You've got people like Jason Fung, who is all about-

Geoff: Fasting.

Molly: ... Fasting and low carb eating.

Geoff: Right.

Molly: Ketogenic. Then you've got Dr. Greger, and Dr. Katz, who are all about low fat, high carb eating. You're like, these guys are deeply respected in their fields.

Geoff: Right.

Molly: But, they're both giving you a very different recommendation.

Geoff: Completely opposite recommendation too.

Molly: Then, you got the Zone diet people, who are in the middle. Then there's the Mediterranean, which is a little bit higher carb. Then, you've got the Atkins. I just realized, there's a whole spectrum of what works for people.

Geoff: Right.

Molly: How do you figure that out, right? You're not gonna be able to go to a doctor like me, and spend $5000 to do an initial workup, right? That's too expensive.

Geoff: Right.

Molly: Maybe we can figure this out through this tool. I experimented with low carb eating last year, and found that I felt like garbage. I felt really bad when I ate really, really high fat. Turns out that I'm a APOE ε4 gene, I've got one of them. I have to be careful with saturated fat intake.

Geoff: Right.

Molly: A lot of my fat was coming from animals, and butter, and things like coconut oil.

Geoff: Triglycerides and LDLs were elevating?

Molly: It was my LDL particle number, and my overall total cholesterol. My triglycerides were find, and my hemoglobin A1C was super low, right?

Geoff: Okay.

Molly: It was at that lowest, so it was pretty low then, but now it's even lower. I started eating carbs again, adding more vegetable carbs back in.

Geoff: Right.

Molly: Eating a lot more vegetable cards in August. Then, slowly but surely, my cholesterol normalized. I still eat fat, but I don't eat as much saturated fat at all. 

Cholesterol normalized, and then I started feeling really, really good. Like, really good. Then my, and then what else? Then, my hemoglobin A1C was even lower. Now, it's 4.7.

Geoff: Yeah, that's quite good. What, 6.5 is the danger zone?

Molly: Mm-hmm (affirmative), yeah exactly.

Geoff: Right.

Molly: I look at anything above 5.7 as risky.

Geoff: Right, right, right.

Molly: But, there was a point this time, you're not gonna believe this, but this time last year, I was like 5.5, 5.6. Now, I'm 4.7, so in a year I've dropped a point. I did all this experimentation with glucose monitoring, and found that for me, I'm just not designed to be more Atkins, more Keto.

Geoff: Right.

Molly: I'm designed to be a bit more balances. But, I have people who do remarkably well on high fat diets.

Geoff: Right.

Molly: I have people who do remarkably well on low fat diets. It's like, we don't have answers.

Geoff: I think the answer's, well, the hypothesis is definitely personalization, right?

Molly: We have answers. The answer is that you have to test yourself.

Geoff: You got to test yourself. Right.

Molly: But, why should it take you your whole life to figure this out. We should have technology that can do it for us.

Geoff: Yes.

Molly: I like Biome for that too. I think Biome, if they were to just give you the reasoning behind why they give these food recommendations, it would be an even more powerful product. But, they do a pretty good darn job at letting you know the kind of micronutrient ratios you should have, and the foods that you should be eating. It's like trying to scale functional medicine.

Geoff: No, absolutely. I think the way I've been thinking about this space is that, there are cool companies, like Sano, that are building out the sensors on the human platform, right? We need more and more ubiquitous, cheaper, more available sensors. These are expensive, there's a little bit of a needle, a little bit painful, not too bad. My Sano sensor is-

Molly: It's a microneedle.

Geoff: ... It's a microneedle. It's on the skin, doesn't really penetrate beneath the dermis, so that's cool. Companies like ours, we're building the consumables, or inputs into the system that can manipulate those numbers.

Molly: Exactly.

Geoff: For our ketone ester, our human ketone product, we often times see, and we were talking a little bit about this before. Before our going live here is, that we'd see 20, 30% drops in glucose within 30 minutes.

Molly: Wow.

Geoff: Then, we'd see elevations of ketones between three to five mMol in that same timeframe.

Molly: See, that's so cool. To me, having a tool to help people fast more comfortably, why not? We all should be fasting.

Geoff: Right.

Molly: I personally, don't really like the way it feels the first two days of fasting. I don't want to be around people.

Geoff: What does your fasting protocol look like?

Molly: I can only do it if I'm not around anybody, and I have to basically not talk to people, and stay by myself or a weekend. I'll do it on weekends, but I don't do ... I don't know how you guys go to work and function. If I fast at work, I'm just running late to meetings. I think, I don't have a good answer for this. I have done some reading about fasting and women's bodies being different than men's. But, it just seems like our brains are wired to be in alert mode when we get super low blood sugar. It does seem, anecdotally, women tend to get hangrier. I know I do.

Geoff: Right.

Molly: But, the thing is, every time I'm fasting, and I've really worked hard to do it, I remember just feeling amazing. I haven't done it in a while, and that's one of my big goals this is year is, to really ramp up the fasting. Starting with, there was actually a great talk I saw on the internet recently, by this doctor, I think it's Berg. He's a chiropractor, but he's got tons of videos, like 33 million views of all his videos. He's crazy popular. But, he gave a talk on how to gradually transform your meal schedule into more of a fasting schedule.

Geoff: Right.

Molly: Going from five meals a day, which a lot of people are eating with snacks, to three meals a day, to intermittent fasting, to two meals a day.

Geoff: Right.

Molly: To, eventually getting into the actual fast.

Geoff: Right.

Molly: Then, what can you do to make that slightly easier.

Geoff: Right.

Molly: I really like that pattern concept. Because, it's really hard to change physiology over night. You can do it, it just won't feel good.

Geoff: Right. I think our mutual friend, Phil Lubin, has been pretty public about doing seven day, multiple day longs fasts.

Molly: He's a beast, man. He can do it for a week at a time, and he does it every other week. I'm just like, he has figured out how to do the social thing, which is interesting. A lot of the problem with fasting is, the social acumen. Because, if you're me, and like you, you get invited to a lot of stuff. The problem with being invited to a lot of stuff is, there's always opportunity to eat. Then, you start realizing that, as a culture, we just don't stop eat.

Geoff: We constantly eat.

Molly: That's another thing about, so I've been doing all this research on glucose monitoring, and how to make meaning out of this information. I found some studies on hunger biofeedback using glucose monitoring. What you do is, you basically train your body to only consume food when you're at 80 to 85 blood sugar. Which, basically means, that you have to be pretty hungry.

Geoff: That's quite low, right.

Molly: But, I've noticed that when I wait for that, I'm authentically hungry, and the food tastes better, and it's just better for metabolism.

Geoff: Right.

Molly: I think that's another big powerful thing is, people need to learn to be hungry again. Maybe not crazy, super-duper hungry all the time. I just personally don't function as well at work, if I'm not fueled.

Geoff: Sure.

Molly: But, you guys have nailed it, you guys have figured it out. You guys, I just know that you do it every week, and I want to figure out how to do it without, not wanting to hurt people.

Geoff: I think, for myself, I think it's, there's definitely a struggle with transition. Because, I think, the way I think about it, is we've just trained ourselves, as you said, to eat and expect food every couple hours. I think our bodies expect that insulin spike, the sugar rush, and the crash. The first few times you start fasting, you're pulling yourself out of that lurch.

Molly: Right.

Geoff: Or, you're lurching yourself, right? Because, you have a very consistent rhythm of adding glucose.

Molly: Yeah.

Geoff: I think it's just as much as you've trained over the last 20, 30 years of our lives. We need to retrain ourselves out of it.

Molly: It's like, you're constantly putting food in, but you're not taking the garbage out regularly, right?

Geoff: Right.

Molly: Fasting, essentially, we're eating ourselves. We're taking out the garbage.

Geoff: Right.

Molly: That is powerfully, powerfully therapeutic.

Geoff: Right.

Molly: We all probably should be doing this, as a measure for branding disease like cancer.

Geoff: Right.

Molly: In fact, Dr. Jason Fung, part of his treatment of diabetes is just intensive fasting regimens for his clients. The questions is, how do we get the cost of ketones down? Because, it's just not affordable right now.

Geoff: Right now it's pretty expensive. They run $3 a dose, but we're working with some synth bio companies to bring it down further, right? Ostensibly it can get down the cost of sugars. It's the core feedstock for the GMO E.Coli is sugar.

Molly: Interesting.

Geoff: Right, so we can hopefully, at mass volume, get it to a little bit more expensive than sugar, which would be really interesting.

Molly: Whoa, that would be amazing. I think it would be really powerful, because I think that, if you think about evolutionary biology, the reason why fasting is so difficult is, because it does activate stress hormones on purpose. Your body, when you drop your blood sugar to a certain level, you start releasing adrenaline, you start-

Geoff: Right.

Molly: You start preparing your body for finding food, right?

Geoff: Right.

Molly: For basically making sure that you can take care of yourself, and that's a natural innate alert mode.

Geoff: Right.

Molly: Now, you guys have harnessed that in a positive way, because for some people, it's like you're getting free Adderall, right?

Geoff: Right.

Molly: You're getting that free dose of catecholamines, that's like, now I can focus.

Geoff: Right.

Molly: But, some people don't seem to have that same response. Some people seem to respond in a way that's like, I just feel super low energy, and I can't focus.

Geoff: Right.

Molly: I think that making it more comfortable for people to fast, is huge.

Geoff: One of my working hypotheses there is, that perhaps your ketones haven't elevated enough to overcome that low blood sugar, right?

Molly: Yeah.

Geoff: Because, when you're fasting, you're lowering your blood sugar, as you drain your glycogen reserves.

Molly: Right.

Geoff: Your endogenous ketosis just hasn't kicked in yet.

Molly: No.

Geoff: You have low glucose, and low ketones, so you naturally feel crappy. Can you bridge it by having high ketones while you're fasting?

Molly: It seems like a great idea.

Geoff: You skip that medium step.

Molly: It seems like a really smart, and an authentic hack that doesn't seem to have a lot of downsides.

Geoff: We got to do an experiment when we have more supply. We actually finger prick you, and track your glucose on your CGM.

Molly: Oh my God, yes, totally.

Geoff: We'll coordinate that. One thing that you've mentioned, that I thought was interesting, was circadian rhythms. That's something that, talking about things I want to focus on this year. I wanted to focus my eating windows better around circadian rhythms. That often means, eating your larger meals earlier in the day.

Molly: Totally.

Geoff: Where a lot of my fasts have been focused on eating later lunches, earlier dinners. I'm curious to hear your thoughts there, and how have you incorporated in your practice or personally?

Molly: Well, a lot of my thinking on this has been informed by, again, Dr. Jason Fung, because I read everything he writes. But, he basically believes that, and there's actually studies that have shown that, basically when you load most of your meals at the beginning of the day, your metabolism, it just functions more optimally. It basically is more effective. Because, you're using that fuel.

Geoff: Right.

Molly: Your body is using the fuel, because you're active.

Geoff: Right.

Molly: Right? Unless, you're sedentary. A lot of people are sedentary, so you're basically destroying your metabolism by being sedentary. Frankly, I was doing that through a lot my 20s. I worked in front of a computer, that's basically your job as a doctor, or as a techie, is be in front of a computer.

Geoff: Right.

Molly: We're all, one of the biggest things you can do to damage your metabolism is, to sit around all day. But also, by eating late at night, and not using that fuel, your body is going to logically store it.

Geoff: Start loading it up, yep.

Molly: It's like, we should probably be using most of our fuel during the daylight hours. It seems like we're designed to do that. It seems like, if you look at most of the animal kingdom, unless you're a nocturnal animal, you're not active at night.

Geoff: Right.

Molly: Now, there are plenty of people who are night owls, but there's a lot of research that shows that, if you eat at night, metabolism is impaired.

Geoff: Right. Your natural growth hormone release is mitigated.

Molly: The risk of cancer in night shift workers is dramatically higher. Part of that is, because metabolic derangement. There is this argument that cancer is a metabolic disease. There's a lot of great new books on this, and like Tripping Over the Truth.

Geoff: Right. Can you summarize that argument? I think it's an interesting debate.

Molly: Sure. The argument is that basically, I guess I'll just give you a little anecdote. I was in residency and working on a pediatric cancer ward. We were feeding all these kids whatever they wanted, because they were sick, and that's what you do, right? But, I was like, wait, wait, wait. Let's think of some first principles here. What does cancer eat? Cancer eats sugar.

Geoff: Eats glucose, yeah.

Molly: Why are we feeding them sugar? Why are we pouring fuel on a fire? They looked at me like, you're trying to hurt the children's feelings aren't you. I was like, I'm trying to save their lives. I just lost it. I really, I had a few patients die, and it was just really hard. Because, I was just like, we're doing everything we can. Pediatric Oncology has an incredible rate of success, but imagine even how much higher it would be, if we weren't giving the fuel that feeds that cancer.

Geoff: Right.

Molly: Now, there's a lot of doctors working with ... There's actually a doctor, and there's a great podcast called P5 Protocols, and there's a doctor on the podcast, and I can't think of his name. But, he wrote a book on cancer as a metabolic disease.

Geoff: Thomas Seyfried, Boston.

Molly: Yes, and he basically has a program. I believe it's him, and they're giving people with cancer Metformin, and even statins, in order to modulate the metabolism of a person's body, as an adjunct treatment to chemo and radiation. They're finding really good benefits from this. Because, cancer is like this organism that grows out of control.

Geoff: Right.

Molly: Really, it's like there is this belief that the western way of life does contribute to cancer formation, because we're basically flooded with glucose at all times.

Geoff: Right.

Molly: We don't have a lot, and I think it was, there was this guy who worked with the Grateful Dead. He did all their sound, I believe. I really wish I had a better memory, but the guy ends up getting throat cancer. There's an article about him in the Rolling Stone actually, all about this. It's an old article. But, he lived for 15 or something years with esophageal cancer, which is one of the most mortal cancers.

Geoff: Right.

Molly: Literally eating pureed meat. The guy just went keto, hardcore keto. Because, he's like I'm gonna starve this thing, and he did. He survived for a while. Not that I think that every cancer can be treated with ketogenic diets.

Geoff: Right.

Molly: But, I do think that a ketogenic diet is a therapeutic diet for somebody who has cancer.

Geoff: Right, I think it's worth concern as a nutritional adjunct to the standard care.

Molly: Absolutely.

Geoff: I think the way I think about the genetic theory of cancer, versus the metabolic theory of cancer is, that the classic hypothesis of why cancer happens is, some mutation in the DNA. Then, that cascades toward, there's uncontrollable growth. But, the metabolic theory is like, okay, the metabolism has issues that's generating a lot of free radicals. That, in of itself is mutating the DNA for uncontrolled growth.

Molly: Right.

Geoff: You can fix the metabolism, perhaps you can stem off a lot of the end cancer effects.

Molly: It could also be both. It can also be you have, this hypothesis.

Geoff: Right.

Molly: Then, you end up with the conditions that enable that cancer to grow.

Geoff: Right.

Molly: Right? It turns out that a lot of us have predispositions to cancer. If you just start digging into genetics, you're gonna find that you're predisposed for a lot of things.

Geoff: Sure.

Molly: I have a family history, I didn't need to look at my genetics to know that I would probably be at risk for cancer. My mother had colon cancer. I actually convinced her to get a colonoscopy, and she had stage one, early stage, cut it out, cured.

Geoff: Wow.

Molly: But, it turns out that her grandfather, and her great-uncle had colon cancer too. There's probably a genetic component, even though the doctor said that she didn't have a genetic component. I'm like, come on, let's look at our family history. Let's, these are logical brains here. I'm gonna get colonoscopy sooner, but I'm also, one of my big goals for this year is, to really start limiting red meat, and processed meat. Now, bacon is the most delicious thing in the world, but I'm probably one of those people who shouldn't be eating a lot of it at all.

Geoff: Right.

Molly: I don't eat a lot of it, but I think that the key is looking at what you're predisposed for, and then trying to design your optimization protocols, to mitigate those risks.

Geoff: Right.

Molly: Assuming, not assuming, but knowing that you have these predispositions, but it's the epigenetic programming that actually expressing them.

Geoff: Right, right. You mentioned processed meats. I remember when we were on the panel, we had, one of the Soylent co-founders there, and you were tearing ... That was amusing to me.

Molly: I hate Soylent.

Geoff: Sitting next to, in between you two.

Molly: I was being a little bit rough, I know.

Geoff: Yeah, but I thought it was valid points. I think, we're in the heart of Silicon Valley, where Soylent is doing quite well feeding people-

Molly: GMO soy.

Geoff: ... GMO soy.

Molly: And, all sorts of weird, other additives.

Geoff: I think it's worth having that counter point, and that discussion. Why are you so viscerally reactive against, or critiquing Soylent's approach?

Molly: Well, first of all, I find it really weird that people are voluntarily consuming something that traditionally has only been recommended for people who are seriously ill, right?

Geoff: Right.

Molly: I have patients with inflammatory bowl diseases.

Geoff: Right.

Molly: Let me tell you, that they do not really enjoy having to be on elemental diets. It's not good. It's interesting that somebody who's a healthy person would choose to eat oily cereal milk as their main source of calories. I just think it's a symptom of this mis-prioritization of people's energy throughout the day. Feeding yourself is a very important thing you should know how to do as a human adult. But, a lot of people have been raised by their parents, they go to college, they eat whatever's in the food court, and they never really learn how to take care of themselves. They never really learn how to cook. We have this gigantic epidemic of chronic disease, that is not gonna be fixed if we are feeding people oily cereal milk-

Geoff: Right.

Molly: ... As calories.

Geoff: Right.

Molly: It's not, and so I called it dead food in the thing. Soylent's not dead people, it's dead food. I said that, because it's like, if you eat plants, if you look at plants, it looks like a living thing, right? You want to, most of your diet should be plant based, right? Then, there should be some protein, and I'm an omnivore, I eat meat. But, I'm moving more and more towards game meat and wild fish as my main sources of protein. Plus, I do some Bone Broth Protein powder, because it's the only one that doesn't taste like garbage. Also, just I don't react to it. I react to everything, it seems.

But, I just don't really like the idea that people are just drinking this bottled substance straight, and only that. You need to actually think about the general recommendations to eat a well balanced diet. That's not a well balanced diet. That's an imbalanced diet. When these guys are sitting in front of computers typing away, and not thinking about their bodies, it's a bigger symptom of this problem with our culture. People are just dissociating from their reality, and getting sucked into the digital realm, and that's not healthy either.

Geoff: Right.

Molly: We all need to disconnect a bit more, get out, actually go to a farmers market, look at food, decide what feels good-

Geoff: Right.

Molly: ... And, start learning about what your body needs. You can't just, I don't know, I guess you could grow a garden by just pouring Miracle-Gro on it all the time, but it would probably eventually die if you just poured Miracle-Gro on it all the time.

Geoff: Sure, yeah.

Molly: You might want to put some compost in there.

Geoff: Right. That's the critique of the modern factory farming system, where just a ton of fertilizer, the meats are higher in nitrogen, because of all the fertilized grain, versus grass fed beef.

Molly: Right.

Geoff: And, all that discussion.

Molly: Right.

Geoff: I'm curious, I think, if some of the Soylent people, that fans out there that I know are probably listening, there would be the counterpoint, that they're not ... I think, the idea has involved into being, you don't eat Soylent every single day, all the time. You replace a crappy hamburger instead.

Molly: There's definitely a lesser evil argument. But, I think I would redesign the formula. First of all, it's funny that they use soy in Soylent, it makes sense, right? Because, obviously, what are you gonna make it out of if it's not people?

Geoff: Right.

Molly: But, I don't think that people are educated enough around GMOs, and there's so much argument, are GMOs good, are GMOs bad?

Geoff: Right.

Molly: They are not good or bad. There are good ones, and there are bad ones. Right, just like anything else in the world. Just like, there's meat that's not good. There's meat that's not bad. There's arguments that people would say all meat is bad, but I'm not gonna say that. Fish is actually pretty darn healthy. Where does it come from? That changes it right?

Geoff: Yep.

Molly: Factory farmed salmon from an unhealthy farm that pours antibiotics all over it, it's not the same salmon as Alaskan.

Geoff: Alaskan wild.

Molly: Alaskan wild, not the same things.

Geoff: Right.

Molly: Just like that, GMOs, some of them just happen to be not as good as others. Like, glyphosate is often used in GMO soy production. That has been shown through many MIT research studies, there's a doctor who has an entire page of just publications, on why this is bad for the microbiome. I just wouldn't ... I'm like, if there's something that's gonna disrupt my microbiome, I am not gonna consume that. Maybe, I-

Geoff: An additive to the soy, rather than an innate part of the GMO.

Molly: It's the way that they grow the soy, in order for it to be roundup ready, right?

Geoff: Okay.

Molly: I just think that people, I'm not a big fan of soy either.

Geoff: I think that's a sub question. We've got a lot of questions around-

Molly: There's a lot of people who do.

Geoff: ... The estrogenic like effects of soy.

Molly: There's estrogenic effects. There's also, like fermented soy seems to be better, and Japanese cultures that consume a lot of soy tend to do more fermented soy.

Geoff: Right.

Molly: But, I'm just not a big fan of the monoculture crops. A lot of the corn, and a lot of the soy that's in our food supply is what's making us sick. There's a great documentary called, King Corn, if you haven't seen it.

Geoff: It's interesting, about the history, right? Corn subsidies are a backbone of middle Americ farmers.

Molly: I'm from there, by the way. I lobbied for healthcare reform in D.C., and I also lobbied for medical students in Springfield, Illinois. I remember standing there waiting for my representatives, and having them talk about how new technology is gonna enable even greater yields for corn, greater numbers of bushels per acre. I was just like, just thinking to myself at the time, even I knew this 10 years ago. We're not gonna end up being able to feed the world on grains, if the world is getting sick and dying.

Geoff: Sicker on grains.

Molly: Maybe that's our ultimate existential strategy for destroying the human race, is just like-

Geoff: We kill ourselves with grain.

Molly: ... We kill ourselves with food.

Geoff: Then, just less population growth, and it's sustainable now.

Molly: I guess, that's what we're doing, right? It's just slow.

Geoff: Yeah, and painful, where healthcare is a six USGD cost.

Molly: It's insanity.

Geoff: It's a slow expensive bleed of human civilization.

Molly: That's the funny thing about cryptocurrency, and the healthcare systems. I started having this understanding recently. Where like, everyone's freaking out like, cryptocurrency isn't valuable, it's not worth anything, it's all made up. I'm like, so much of the healthcare system costs are made up. A cost of a syring to draw blood is dramatically marked up once you get to the hospital, and then you're billed for that. That's money being created. A lot of these evaluations, where these cryptocurrency companies, yes, they're being totally overblown-

Geoff: Right.

Molly: And, they're being made up as we go, but isn't that all of the money system?

Geoff: All of culture, all of society, all of currency, yeah. That's a whole different debate.

Molly: Whole other debate.

Geoff: I'm curious, so you have Sano, and then you have your concierge practice going. What other exciting things are you working on with your advisory positions, and all of that? What else is on the radar for you for '18?

Molly: There's a company called Biomarker.io, and I'm a really big fan of them. You guys should know about them. Because, what they're doing is, they're creating a platform for taking all of this personalized data from all these different streams from our body, and enabling supplement companies to actually prove their claims. They're using streams from even healthcare records now. They're able to, have taken records from Epic, and Cerner, and also wearable technologies, and all the API platforms and aggregators. They're taking all that data and they're saying, you have this product that you want to sell.

Geoff: Right.

Molly: But, turns out clinical studies are really hard and expensive to do. We're gonna help you prove it. We're gonna use this platform, and teach companies to 

help them find real value in their products.

Geoff: Interesting, is there a consumer offering, or is it focused-

Molly: I want there to be a consumer offering.

Geoff: Right.

Molly: I don't know, you really, when it comes to startups, you always have to follow the money.

Geoff: Right.

Molly: Unfortunately, the money is in the companies, and not the consumers. However, I think that the supplement space is gonna be revolutionized by a personal haul of technologies. The more that we can actually aggregate all this information, and figure out what's working for us, what might work for us. Selfhacked has this genome reader that does a pretty decent job of giving you your predispositions to different deficiencies and other things.

Geoff: Right.

Molly: But, it's just a start, right? We actually need to see the supplement space become more personalized. I actually spoke about this two years ago at the MBJ summit. All about why the next big thing in supplements is gonna be personalization. I live this company, because I think they're gonna enable a lot more of that.

Geoff: 100% agree. There's a huge market. The global market for supplements is 50 billion plus. It's a huge industry.

Molly: Totally.

Geoff: It's still basically based on the same legislation and technologies in the 70s, essentially.

Molly: Totally.

Geoff: It's like, okay, our understanding of what supplements have signal, what is noise, and how do we actually does it for the right person at the right time?

Molly: Right, exactly. To me, they're medicine, and they just happen to be over the counter. Which, I'm all about consumerization of everything. I'm just like, make everything available.

Geoff: Cool. Biomarker.io.

Molly: What else am I interested in? There's a company that I'm not advising, but I am a big giant fan of, called Leaf Therapeutics. I was speaking as someone who, as someone such as yourself, who likes continuous monitoring of everything. It's a heart rate variability patch that has an app associated with it, that will-

Geoff: It's a patch?

Molly: It's a patch-

Geoff: Huh, okay.

Molly: ... That you put on your chest, and I've used heart rate variability.

Geoff: Like the Polar.

Molly: I've used the First Beat, Polar, Wahoo, there's all types. I use them to exercise. But, this one's specifically for heart rate variability, and it's such an important marker. I think glucose and heart rate variability, if we have these streams at all times, we'd all be better off.

Geoff: They're pretty simple.

Molly: Pretty simple.

Geoff: It's not like you're gonna do crazy blood draws, or anything crazy.

Molly: No.

Geoff: These are pretty basic.

Molly: Yeah, but they're really useful, because it's a real time stress sensor. What they're doing is, they're designing this platform around reducing anxiety. It can also be done for reducing hypertension, it can also be done for reducing stress, it can be done for improving meditation. HRV has got endless possibilities.

Geoff: Right.

Molly: But, I think Apple does collect it from the watch, but I don't think that they've done a great job at-

Geoff: Do they surface it? My understanding is that their sensor's not accurate enough to do HRV.

Molly: Well, they are reminding you to breathe. I don't know, is that just automatic, I don't know. I think that they do have rudimentary HRV, but I don't think that they're showing it to you. Now, it is way more accurate when it's on the chest.

Geoff: Right.

Molly: I did this for a few weeks last summer, with the Leaf Therapeutic, and it was really big, clunky. But, the coolest thing is that, it's got haptic feedback. When you are getting stressed out, it will alert you, and it'll teach you through the pattern, just to use your breath to slow down-

Geoff: Right, right.

Molly: ... Your emotions, and actually reduce your heart rate, and to actually improve your variability.

Geoff: Interesting.

Molly: It's giving you this real time. There was this moment where I left their office, I had it on, I was walking down the street. I had to get this medication to a patient who lived in San Rafael. I had to call a Lyft to get her the medicine on time, and it was like there was traffic, and there was so much going, it was Soma.

Geoff: Right.

Molly: There's crack heads, and I was feeling the stress, and I could actually feel it start vibrating. After I had dropped of the Lyft, I started consciously breathing, and before I knew it, I was back to baseline. I just thought that was really cool, a really cool experience to have, where I literally just got this thing off the shelf. They just gave it to me.

Geoff: And, it worked.

Molly: And, it worked. There's another company that's the Oura, I think it's-

Geoff: Oura Ring?

Molly: It was Oura Ring, but then there's another one that is like a thing you hold in your hands, you meditate with, that used heart rate variability. I think heart rate variability is gonna experience a big movement in this next year.

Geoff: I agree. I think a lot of our athlete partners that we work with-

Molly: Recovery.

Geoff: ... They use that for recovery, as a marker for recovery. How hard should they train today, versus tomorrow.

Molly: That's huge in fitness.

Geoff: The data is robust there.

Molly: I think that's something that we all need to recognize too, as we're athletes at the office, right?

Geoff: Right.

Molly: We're using, we're stressing ourselves out every day.

Geoff: Right.

Molly: But, how hard should you push your exercise after you've had a crazy, crazy day at work.

Geoff: Right.

Molly: Maybe you should be doing yoga this evening instead of crossfit, I don't know.

Geoff: Interesting.

Molly: There's this idea of being able to really use these tools to tailor our lifestyle, to optimize our health in real time.

Geoff: 100%. Anything that's, it sounds like you're in a huge gamut here. What other things, or other sensors?

Molly: This is a fairly taboo topic, but I'm a big believer in psychedelic medicine. I think that MAPS is actually getting closer and closer to their financial goals.

Geoff: Interesting. That's the MDMA?

Molly: MDMA assisted psychotherapy. These studies are just getting better and better. The idea that ... There's this idea of wellness being body, mind, and spirit, right?

Geoff: Right.

Molly: HRV in a lot ways is, your body and your mind. You're learning really about how to manage your emotions, how to manage your physical experience.

Geoff: Right.

Molly: But, there's this spiritual aspect of medicine, that just hasn't really been ... It's just been so taboo for so long. Meditation is great. I'm a big believer in meditation. Meditation has enabled me to trip on my own neurochemistry. I've been to meditation retreats where I've just been totally high on my own brain. It's awesome.

Geoff: This is like a silent retreat?

Molly: It's a specific type of meditation. It's very obscure, esoteric stuff that you would not ... It's actually discovered, the one I went to is ran by a doctor, of all things. He's a French doctor.

Geoff: I'm curious about all of this. It's interesting. People have very strong subjective experiences. There's clearly a signal there. Meditation has real quantifiable metrics as well.

Molly: Meditation and psychedelics are ... Meditations like, if you're gonna take a week, or two weeks to go climb a mountain, right? Whereas psychedelic is like, I'm just gonna take you in helicopter right up to the top of that mountain.

Geoff: Right.

Molly: It's a shortcut, and if you do in the context of a therapeutic environment, people have experienced debilitating PTSD being revered. I've seen patients with, this is something that happened last year, but ketamine assisted therapy for depression. It's like, now in clinical offices.

Geoff: The data is really good on that.

Molly: It's just like, it's available to people. It's possible that within two years, we will be able to administer, legally, psychedelics as medicine, in a context of compassionate use.

Geoff: That'd be really cool.

Molly: I just think that there's a lot of people with trauma in our country. Both from years of racial discrimination.

Geoff: Right.

Molly: Lots of war, refugees.

Geoff: Right.

Molly: Lots of rape. We also know the, Me Too movement's come out of this awareness of a lot of trauma. People are traumatized by human life. If there's ways that we can help with that spiritual realm, and healing that trauma, and enabling people to actually move on, I just think that it's truly transformative, and it enables to people to ... For a lot of people, it's how they deal with those underlying issues. It's really hard for them to make the behavioral changes that they need to optimize their body.

Geoff: Right.

Molly: I'm just a big ... I just have a huge hope that they government isn't gonna continue to crack down on all this.

Geoff: I think it shouldn't be a taboo. I think we should talk about it. I think, when people are being prescribed antidepressants, SSRIs, these are potent drugs too. Everything is a compound that we're eating. Why are some just, ooh, those ones are scary? These are just as bad, if not worse for you.

Molly: Totally.

Geoff: Straight up, in terms of mortality usage, or LD50s. Some of the drugs that we're prescribing people, are worse than psychedelics.

Molly: Exactly. That's the thing about SSRIs. In teenagers, there's a black box warning that it'll make you more likely to kill yourself. Because, it'll take you just out of depression, just enough, because it doesn't work very well. But, it takes you just out of depression, just enough, that you enough energy to shoot yourself. That's terrible.

Geoff: Yeah, geez.

Molly: We need things that actually fix the problem.

Geoff: Right.

Molly: The underlying issue.

Geoff: Right.

Molly: What they do is, they enable you to go to that space of pain and fear, and actually do it in an environment where you feel pretty good.

Geoff: Right.

Molly: Right, you feel pretty great when you're on these drugs.

Geoff: Right.

Molly: They're also a lot safer. The stuff that's on the street, the stuff that people are taking, I tell people don't take MDMA if you're buying it off from a drug dealer. It's gonna, you don't even know what it is.

Geoff: Right.

Molly: It's probably something totally different than you think.

Geoff: Right, right.

Molly: I'm like, don't do that to yourself.

Geoff: Right, right.

Molly: But, if you had, imagine if you could go to a mental fitness center.

Geoff: Right.

Molly: And, see a doctor who could literally help you train your brain for better mental fitness.

Geoff: Right.

Molly: Another big thing that I'm interested in, I don't know if you're interested in this at all. But, neurofeedback is something I'm gonna start doing this year. Because, I think that one of the problems with our culture, especially in tech is, there's literally shiny objects everywhere. We become so trained to seek dopamine, that we actually forget to be able to focus on demand when we need to. I've just heard that neurofeedback is really great for ADD.

Geoff: Interesting.

Molly: I don't take any stimulants, but I take supplements, but I don't take any hardcore stimulants. But, I have been told that it's really helpful for that. Then, I know companies, there's a few companies that are actually trying to make more commercially available ... I can't think of the name of this company, because I just heard about them at an event.

Geoff: EG headsets that help you do neurofeedback?

Molly: Yeah, neurofeedback for specific use cases.

Geoff: I've seen a couple of those, yeah.

Molly: That's interesting.

Geoff: It seems to be a popular thread, actually, I'm glad you brought it up. Just the sense that tech companies have addicted us to their service with dopamine.

Molly: Yeah, it's dopamine, dopamine. Now, we have cryptocurrency, and then it's like everyone is day trading now, right?

Geoff: Yeah.

Molly: We're all checking GDEX and Binance, and everyone's playing, everyone's gambling every day on that. That's part of why cryptocurrency, I think, is so popular, because of that. I'm reading a great book actually, right now, two books. One of them is called, The Hour Between the Dog and Wolf. It's all about the biology of traders.

Geoff: Right.

Molly: All about the hormonal impacts, and the impacts of different neurochemistry cocktails on large scale trends in the economic system, based on people's biology.

Geoff: Right.

Molly: Then, there's also a great book that I'm reading, there's another one called, The Psychology of Risk. It's all about psychology of trading. Because, I think that we probably are in a bubble right now, and there's this mass hysteria that everything is awesome. I hope it's not a bubble, because I would like to believe that the future is all about decentralized money systems.

Geoff: Right.

Molly: But, I'm really interested in, just how biology effects every day, and how biology affects cultures, and how biology affects populations.

Geoff: Right.

Molly: Especially, populations of people acting in sync around certain topics.

Geoff: Right. It's interesting, I remember reading some early data around testosterone in male traders being very, very correlated to the decisions they're making.

Molly: Totally.

Geoff: Higher risk tolerances, bigger bets. This is interesting.

Molly: I have a great story for you. I had a client who, fascinating client, who developed this really weird adrenal disorder out of the blue, in this 50s. He was a high functioning, normal guy. His doctors all said, you just have anxiety. He's like, I've been on expeditions to multiple continents in subzero temperatures, and I was the chillest person at those events. I'm not an anxious person.

Geoff: Right.

Molly: He ends up having these issues, and turns out that he has this, we discovered together, that he had this genetic disorder, that actually forced him to develop hyper testosterone levels. Instead of hypogonadism, it's hypergonadism. He legitimately had higher testosterone than a normal person.

Geoff: Right.

Molly: But, he also had extremely low cortisol. He was literally the perfect combination of an investor. He literally took gigantic risks with no fear, and luckily he was very intelligent.

Geoff: Right.

Molly: He ended up shorting a European government at one point, and making a ridiculous sum of money.

Geoff: Right.

Molly: But, the funny thing was, is it was his biology that predisposed him to this. Unfortunately, later on in life, it started going haywire.

Geoff: Backfiring.

Molly: His adrenals started producing certain chemicals, and he ended up with malignant hypertension. I don't want to get to into details, because of HIPA. But, fundamentally, it was, by learning all about this himself, he understood his entire life. I think that there's so much about biohacking that it's like, it's about self discover.

Geoff: Right.

Molly: It's actually about understanding why you're unique. Now, that he's on a certain cocktail of medicines, his hypertension's gone. But, he went to the best specialist in the whole world, and nobody could figure it out. I just happened to find this weird genetic defect that is now being published.

Geoff: That's cool.

Molly: There's actually an expert doctor who's publishing it with him, because I didn't want to write the paper.

Geoff: That's cool. I think it's a cool ... It's just cool to realize, maybe if you're really good at trading, maybe it is, okay, how can we, if we don't have that lucky factor of genetic, I guess, characteristics, how do you manipulate your body-

Molly: Exactly.

Geoff: ... In a way that can mimic some of those benefits?

Molly: I think pretty much everyone in San Francisco has some sort of big coin interest right now. It just seems like it. It's funny, when you-

Geoff: Maybe when this goes out, everyone's already like, they're super excited.

Molly: Everyone's going up and going down, and we're all experiencing these emotions.

Geoff: Right.

Molly: Even if you're not in it, I even know people who don't invest in it, and they're experiencing the emotions, because they're just angry that everyone's interested in this, right?

Geoff: Yeah.

Molly: But, the people who are in it, there's ... It would be really great if we could figure out how to not let the wild volatility of this market affect us physiologically.

Geoff: Right.

Molly: I think, that the key is meditation. The key is, really training your body to just take that space, between perception and reaction, and learn to decide how you're gonna react.

Geoff: Right.

Molly: Instead of just reacting. But, unfortunately, it's just so commonplace to be a reactive person, and if you look at Trump, the man is so ADD.

Geoff: He's pure reactive.

Molly: He's pure reaction, he's pure ego, and he doesn't have any space between perception and reaction. I've heard that he can only read one page at a time, and it has to have his name on it multiple times.

Geoff: Yeah, to get his attention.

Molly: That's a great symptom of the country's problems. The man who's leading the country has no attention span. Neither do all the kids in the country. If we all just took a step back, and really slowed down our lives, and really just spent more time in contemplation, we'd probably be much better at all the things that we do.

Geoff: I agree. I think, talking about 2018 interests, I think, I've shutdown all my notifications on my phone.

Molly: Wow.

Geoff: I've turned my screen from color to black and white, so it's less.

Molly: Oh my God, that's so hard. I've done it, and I can't handle it.

Geoff: Why, because it's too boring, too-

Molly: It just makes me sad. I'm just like (sigh), like why?

Geoff: I want my colorful, expensive phone.

Molly: I want the colors. I bought this phone to receive the colors.

Geoff: I think it is just, how do you setup yourself in a way to distract yourself less. I think you're absolutely right. How do you think more deeply on fewer things?

Molly: Well, there's this great book called, The Disciplined Pursuit of Less. There was a big article in the Wall Street Journal a few days ago, all about by doing fewer things, we are actually going to be more successful. It's taken me years to figure this out. But, one of my big goals over this year, like you're asking me all the things I'm involved with, is like frankly, I'm doing too many things as it is. I'm like, I've been approached by TV studios to do shows, and I'm just like, I can't do it all, or I'm not gonna do it all well.

Geoff: Right.

Molly: I'm trying to figure out, of all the things that I get to do ... Which, I'm now in a really great position to be able to decide what I do with my time, pretty much all the time ... It's like, what do I really, really want to do, and what does the world really need right now? The world really needs to calm down, nourish themselves, and connect with each other way more. One of my big priorities is just, seeing my family more often. That's, to me, really cultivating my friendships, and my relationships, that's the big, that was, of all the things that were stressful last year. I moved a couple times, and just moving is just one of the most stressful things you can do.

Geoff: Right.

Molly: But, having support from family, and friends, and community is so important. It's the most valuable thing you can create. They say your network is your net worth. What I'm really working on right now is, how do I cultivate deeper relationships with fewer people, and really make those matter? Because, at the end of your life, you're gonna look back on all your success, and it's not gonna matter. It's the people that you lived with.

Geoff: 100%. I think, I want to almost leave it at that. Because, I think that's a perfect point to end the conversation. I think, there sounds like there's a lot of things that we should check back in on.

Molly: Yeah, sure.

Geoff: In the next few months-

Molly: Love to.

Geoff: ... When some of these things get sorted out, and they're underway, and as you [inaudible 01:11:36] threads. I'll be like, just keep track, and follow along the ride here.

Molly: I'm so in on doing some biohacking around the ketones. Let's do it.

Geoff: All right. Thank you so much.

Molly: Thank you.

Geoff: Cheers. As always, enjoyed all the questions, and requests for different guests. We always appreciate that feedback. As always, if you like the episode, please give us high ratings on your different platform. You can subscribe on YouTube, SoundCloud, Apple, and Google Play. Thank so much.

You can find and subscribe to the HVMN Enhancement Podcast on iTunes, Spotify, and Youtube.

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HVMN Co-founders Michael Brandt and Geoffrey Woo