You might think we’re heading into a low time of year for suicides because they peak during the cold, dark months of winter. But, in fact, suicide peaks during the spring and early summer.

This is just one example of the popular beliefs around suicide that turn out to be myths. Here to unpack more of these myths, as well as the truths around this poorly understood subject, is Rory O’Connor, the leader of the Suicidal Behaviour Research Laboratory and the author of When It Is Darkest: Why People Die by Suicide and What We Can Do to Prevent It. Today on the show, Rory discusses possible reasons for why suicides go up in the warmer months and why men die by suicide more often than women. He explains that suicide doesn’t happen without some warning signs and why someone’s improved mood might be one of them. In the second half of the show, Rory walks us through the real reasons people move from having suicidal thoughts to acting on them, and what works to prevent suicide.

Resources Related to the Podcast

• The Suicide and Crisis Lifeline
• The Suicidal Behaviour Research Laboratory
• Atlantic article: “The Troubling Link Between Springtime Allergies and Suicide”
• AoM Podcast #585: Inflammation, Saunas, and the New Science of Depression
• AoM Podcast #886: What the World of Psychology Gets Wrong About Men
• AoM Podcast #756: How the Desire for Status Explains (Pretty Much) Everything
• “Why Men Kill Themselves” by Will Storr

Connect With Rory O’Connor

• Rory’s faculty page

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Read the Transcript

Brett McKay: Brett McKay here, and welcome to another edition of the Art of Manliness podcast. You might think we are heading into a low time of year for suicides because they peak during the cold, dark months of winter but in fact, suicide peaks during the spring and early summer, this is just one example of the popular beliefs around suicide that turn out to be myths. Here to unpack more of these myths, as well as the truths around this poorly understood subject is Rory O’Connor, the leader of the Suicidal Behavior Research Laboratory and the author of When It Is Darkest: Why People Die by Suicide and What We Can Do to Prevent It. Today in the show, Rory discusses possible reasons for why suicides go up in the warmer months and why men die by suicide more often than women. He explains that suicide doesn’t happen without some warning signs and why someone’s improved mood might be one of them. In the second half of the show, Rory walks us through the real reasons people move from having suicidal thoughts to acting on them and what works to prevent suicide. After the show’s over, check out the show notes at aom.is/suicide.

Alright, Rory O’Connor, welcome to the show.

Rory O’Connor: Thank you, I’m delighted to be here, Brett.

Brett McKay: You are a professor of psychology who researches suicide and suicide prevention. I’m curious, what led you down this career path?

Rory O’Connor: Well, that’s an interesting question. Like many things in life, this path was serendipitous. As an undergraduate student in Belfast in Northern Ireland, I’d been studying depression, and I thought I was going to continue my undergraduate work into looking at depression rather than suicide itself. But then as things happen, I got a call in the summer of… I think it must have been the summer of 1994, so quite a while ago, and the person who turned out to be my PhD supervisor told me that there was an opportunity for a funded scholarship PhD program on suicide, and so that’s where it all began, just that phone call and I decided that that’s the direction I would go. And I suppose what’s quite interesting to my point of view is that, well, clearly suicide is the most devastating of outcomes from depression and other mental health problems. But I suppose I didn’t quite envisage where that journey would take me, and in particular, that man, that phone call, my PhD supervisor, the person without whom I wouldn’t have done the research on suicide, sadly, some years later, he took his own life. And I often think back to that phone call and really, I often wonder what was in his mind at that time, why did he ask me? He wasn’t a suicide researcher. So it’s just funny how these things happen. But I’m incredibly grateful to him because it genuinely was like a sliding doors moment which changed my life.

Brett McKay: What did your family think when you told them, “I’m gonna do my PhD in suicide?”

Rory O’Connor: Well, my mother in particular, she was quite concerned because she knows me as a person and she just knew that everything I would do, I would put me heart and soul into, and so her big concern was the impact on me, on my own mental health. And yeah, one of the first questions she asked me was, “My God, you’re not gonna kill yourself. Are you?” That was her genuine fear that if I was so immersed in this… And I suppose that question was really an important question to ask and something I remind myself of daily, of reminding myself to look after my own mental health, as well as now the mental health of the people I work with here in my team in Glasgow.

Brett McKay: You’ve written a book called When It Is Darkest: Why People Die by Suicide, and What We can do to Prevent It, which is a book where you’ve taken the research you’ve done on suicide and suicide prevention and presented it for a lay audience. We’re gonna talk about this book but before we do, I think it’s important to talk about how to talk about suicide. I’m sure a lot of people have noticed maybe in the past decade or so, when we talk about suicide or someone who has taken their own life, you hear people say, “He died by suicide,” instead of, “He committed suicide,” why that shift?

Rory O’Connor: Yeah, it really has been a marked shift I would say in the last 20 years, and the reason for the shift is because the term “committing suicide,” it harks back to a time in many countries where suicide was illegal. And so it harks back to that criminal undertone, that it was seen as a criminal offense. And indeed in the United States and in the UK, thankfully, suicide is no longer a criminal offense but there are still many countries in the world in which it is a criminal offense. And I just know from speaking to countless people who are bereaved by suicide or people who’ve been suicidal themselves, they often are quite upset about that criminal over undertone. So for that reason, I think we shifted and been much more careful in our language because to my mind, we can talk about people dying by suicide, it conveys the same message and it’s not going to cause distress to those who are bereaved. So in all the work that I do, I avoid the term “committing suicide” for that reason.

Brett McKay: What’s the state of suicide in the West today? Are rates increasing or decreasing?

Rory O’Connor: In some sense, there’s no simple answer to that question, so maybe I’ll try and answer it in a couple of ways. If I look at the suicide rates, say, over the last 40 years… Now, if I take a global perspective first. So on a global perspective, the suicide rates have decreased by about 30% or thereabouts over the last 40 years or so. However, if you try and disentangle then where the decreases have happened, you see that much of the decline in suicides happened in Asian countries, in India and in China and other Asian countries, largely in China. And so that tells you a pattern, yes, on a global context, in those lower, middle income countries historically, the suicide rates have been decreasing. Now, if I take then the last 20 years and focus in on, say, the United States or the United Kingdom, you see a different pattern. Indeed in the United States, you’ve seen this upward trend in suicides. And then if I look in the UK, say over three or four years before the pandemic hit, similar to the United States, the suicide rates were increasing. And in Australia, New Zealand, other western countries, in those recent years, suicide rates have been on the increase.

Now, when the pandemic hit, many of us working in the field of suicide research and suicide prevention were really, really concerned about the potential impact of Covid 19 on the suicide rates. Now, thankfully, our concerns were not realized because the suicide rates broadly speaking did not increase basically in a global context. And indeed with a colleague, Jane Pirkis from Melbourne University, she led this big international initiative of 33 countries across the globe, and it covered the first, I think it was 15 months of the pandemic, and within those first 15 months, broadly speaking, the suicide rates did not increase. Now, there were some exceptions. For example, Japan, there are some signals now that the suicide rates might be increasing in Japan but the broad picture is that the pandemic did not see the increase that we feared. But now my concern is, and we’re starting to see this in the United States, in the UK, and in other countries, is now with the cost of living crisis and the potential economic turmoil and the Ukraine crisis and other things going on in the world, our concern is that suicide rates are starting to go up again. So we had this period when they didn’t increase during the pandemic, we need to be really, really vigilant moving forward.

Brett McKay: Are there demographics, groups that are more susceptible to suicide, say, by age or sex?

Rory O’Connor: Yes, well, if we just focus on Western countries or high-income countries, suicide rates are significantly higher in men than a women. In the United States and in the UK, about three quarters of all suicides are by men, but then if you look to other countries to lower middle income countries, you see less of a disparity between males and females. But I think in every single country in the world, men outnumber women in suicide. Now, if you look down at age profiles, again, you have the nuances, there’s slightly different patterns in different countries but broadly speaking, suicide is rare before puberty, and then when puberty hits and those periods through from puberty right up to your mid-20s, you see this increase in suicidal thoughts, behaviors, and deaths by suicide. And again, there are slight differences in countries, but in the UK, for example, the leading middle-aged men are the group most at risk of suicide.

And in other countries, older-age men are at increased risk or the highest risk group but the concern many of us have is that we are starting to see this increase in young or youth suicides again. And that really reminds me of when I first started researching this field in the 1990s, the biggest risk group were young men. And if we think back to the 1990s, we had just all emerged from a recession or real economic turmoil. And my concern now here is we’ve a similar pattern, we’ve gone through a recession a few years ago, we now have this cost of living crisis and the broader uncertainty in the world, and my concern is that young people are being maybe even more at risk and that their suicide rates may start to increase faster. So we need to be so, so careful and protect our young people.

Brett McKay: Speaking to the sex breakdown, something that I’ve read, and I want to see if this is true. Is it true that women attempt suicide more often than men but men are more likely to actually take their lives because they use more lethal means?

Rory O’Connor: Yes, broadly speaking, that’s a correct statement, I agree with that, is that yes, women are more likely to engage in nonfatal suicidal behavior. However, the explanation for that differential isn’t as straightforward as saying it’s all down to the method that has been used. That’s certainly part of it, we know that men are more likely to use more lethal methods and obviously therefore more likely to die, say, on a first attempt but it is more complicated than that. And I think we need to look at issues around masculinity, what it means to be a man in today’s society, issues around the way we structure and tailor treatment. So the question I often ask is, “We know there are effective treatments, psychological treatments, which reduce risk of suicidal behavior but the question is, do they work for men, and are they tailored for men?” And that is linked to the fact that the way men help-seek is perhaps different from women.

And we know that men are less likely to seek help for mental health problems. And so what we should be asking is… Instead of blaming men for not seeking help, which sometimes is part of the narrative, we should be saying, “Actually, perhaps the treatments and support coupled with the stigma around help-seeking, mental health, masculinity, these are all contributing to a situation, and like a perfect storm of factors, together with the increased use of more lethal methods of suicide. And that’s really, the complexity, is the answer to the question of why there are more male suicides than female suicides.

Brett McKay: What are some of the biggest myths around suicide, and how can those myths get in the way of helping people who are susceptible to suicide?

Rory O’Connor: To my mind, probably the single most common myth that I have come across is that if you ask somebody whether they’re suicidal, it will plant the idea in their head, and it’s really important that we squash that myth because there is no evidence at all that by asking somebody whether they’re suicidal that it actually will make them suicidal, there’s just no evidence. However, there’s now quite a bit of evidence showing the opposite, showing that actually if you ask somebody that question, and I agree it’s a difficult question to ask, but if you ask that question, ask somebody directly whether they’re suicidal, there’s evidence showing that actually it can get them the help that they need. And I often describe that question as being potentially the start of a life-saving conversation. So that would be myth number one.

Then another myth I often think is important to highlight, Brett, and that is this idea that… And it comes from a place of real sadness and heartbreak, is that the number of people that I have encountered over the years, both loved ones as well as health professionals, who have come up and told me the story that the person who they’ve lost to suicide had seemed okay, had seemed well in the days and weeks before they died. And so the myth is that if there’s this improvement in mood that’s associated with reduced risk, that’s a myth because it’s the opposite in too many cases. And I suppose to clarify it, I’ll make it clear what I mean in a second. What the work or the research and evidence suggest is that if there is an unexplained improvement in mood, it could mean that the person has resolved to end their life, and because they’ve resolved to end their life as a way of dealing with their pain, their mood lifts because they found a solution to their pain, a solution to their problems.

And the reason it’s concerning is, as a person’s mood lifts, their cognitive capacity, their motivation, their ability to plan and carry out the suicidal act increases. So the message on that myth is, if there is any unexplained improvement in mood, if somebody has been in a depressive episode, please check in with them to try and understand why their mood is lifted. Now, of course it could be their mood has lifted because their treatment has kicked in, either their medication or their psychosocial treatment has kicked in or their crisis has abated but the concern is if somebody seemingly improves in mood, in emotional wellbeing and you don’t know why, always, always check in to ensure they’re doing okay.

Brett McKay: Okay. So if someone’s mood improves, it can actually be a danger sign because they may just be feeling relieved that they’ve made the decision to stop struggling and take their own life. And another related myth is that someone will always be depressed before they die by suicide. Mental illness is correlated with suicide but sometimes someone hasn’t been depressed, and we’re gonna talk more about this later, but they haven’t been depressed but then they experienced some sort of a big setback or humiliation that leads them into this spiral of suicidal thoughts. And these things relate to another myth, which is that there aren’t any warning signs before a suicide. A lot of times, when someone takes their own life, their friends and family, they’re shocked and they say they didn’t see any signs it was coming, but your research shows that there are typically signs, they can just be hard to recognize.

Rory O’Connor: The sad reality is that warning signs for suicide are difficult to spot, but there are warning signs. And so the things I would often highlight are changes in behavior, that could be changes in eating, sleeping, drinking. Like sleeping in particular, because we know that disrupted sleep, sleep problems are associated with suicide risk because obviously if your sleep is interrupted, that’s a basic… In biological terms, we would describe it as a basic homeostatic function. You don’t sleep well, your problem-solving is affected, your mood is affected, your self-regulation is affected. So changes in these basic processes are important to look out for. But other things like… And this certainly only probably applies to some cases, people who are starting to get their life in order, their life affairs in order, that would be another warning sign that the person may have resolved to die by suicide.

And then obviously if somebody has been bereaved by suicide themselves or they’ve experienced a marked loss either in status or in relationships, things like that, those marked changes can have an impact. So again, I would be checking in with somebody as well. Also, people who are talking about feeling trapped and hopeless and feeling a burden on those around them because we know that sense of burdensomeness is at the heart of the suicidal thinking. The person feels, “Actually, if I end my life, the people around me would be better off if I was dead.” And so those are the sorts of things I would highlight as warning signs, but the reality sadly is our ability to predict suicide is no better than chance, it’s no better than the toss of a coin, it’s really difficult to predict who will die by suicide, but we should be still checking in with people if we are concerned, of course.

Brett McKay: Is there a seasonality to suicide? Because I think maybe there’s a common belief out there that a lot of suicides happen in the winter because it’s dark and cold, maybe the holidays make people feel sad. Is that true?

Rory O’Connor: Well, the holidays bit is probably true but not necessarily the winter bit. Again, the best evidence… If you try and bring together all the evidence from across the world, the best evidence suggests that suicides actually peak in spring, summertime, so the increase in that period… And actually in December, they’re actually lowest on Christmas day, but then they peak on new year’s day. And so the question is, Well, why do you see this seasonal effect? And the short answer is, we don’t know for certain. Part of it could be due with, as we move seasons, there’s a change in our sleeping patterns and our physical activity, it could be maybe linked to… If we look at occupations at risk of suicide, as you move into spring, perhaps there’s increased work-related stress, say, if you’re working in the agricultural sector, if you’re a farmer or whatever it may be, so you can see increased stress and risk there. But it could also be the fact that as we move into spring and summer and the brightness and vitality of spring and summer, if you’re struggling with your mood, there’s that mismatch or that dissonance between your internal world and your external world, and perhaps that’s part of the explanation as well. So yes, there are seasonality effects but we need to do more research to understand why they persist.

Brett McKay: I saw this article in the Atlantic, this is speculative, but a factor that might contribute that seasonality is… In the spring, there’s allergies, and inflammation can potentially contribute to depression and mental illness. Again, this is speculative but I thought that was interesting, I saw that a couple months ago.

Rory O’Connor: No, absolutely. And I may have read that same article in the Atlantic actually. No, I think we need to look at the allergens and the role of allergens because, as you say, there’s growing evidence that the impact on how they can activate some of the obviously biological systems which are associated with mental health problems like depression. So I think that’s an area we need to look at in much more detail because remember, one of the things certainly I’ve recognized more and more as I’ve studied suicide and suicide prevention is… And I often describe it as, historically, we’ve either been too focused on the individual or too focused on the context in which an individual lives without bringing those together. Those people who do work on brain imaging and biology, that’s all great. And those people who do work on social contexts and cultural factors, that’s brilliant as well. But ultimately, as John Donne said… That idea of “no man is an island,” we need to recognize it each… If we’re to understand suicide risk, we have to understand the individual in their context, and that context includes these wider environmental factors that you’ve mentioned, as well as of course things closer to home, like obviously relationship crises, mental health problems, bullying, unemployment and on. We need to look at the environmental context as well.

Brett McKay: And we’ll talk about some of these factors ’cause you’ve developed this model, the integrated motivational volitional model of suicide behavior. Maybe we can talk about some of those factors in that model but just broadly speaking, big picture, why do most people decide to take their own life?

Rory O’Connor: Well, the answer to that question I often give is, people end their life as a way of managing unbearable pain. And so for whatever it is, 703,000 people who die by suicide each year, there’s a whole complex set of reasons which will lead to each one of those individuals dying by suicide. But I think the common thread is that those people feel trapped by unbearable pain, which can be caused by a whole range of factors, it could be caused by the fact that your relationship ended or the fact that you had experienced trauma as a child or the fact that your mental health problems are really, really unbearable, but the key driver is seeing suicide as the ultimate solution to your pain. And for Edwin Shneidman, who’s a founding father of suicide prevention from the United States, often talked about this idea of seeing suicide as a permanent solution to our often temporary problems. And so for me to answer the question of why people die by suicide, the answer to that question is, we need to understand, What are the drivers to the mental pain by which an individual feels trapped by? And they see no alternative, no way to end their pain, no solution to that pain, and the only solution is the ultimate solution, that is, to take their own life. So it’s like the person in essence doesn’t want to die, they just want the pain to stop, they just can’t bear the pain.

And maybe we’re gonna go on to talk about my model of suicide, that’s at the heart of my model, that sense of entrapment. And then just say the key premise of the model is that suicidal thoughts emerge, they come out of this sense of entrapment but that sense of entrapment is triggered by feelings of defeat and humiliation. And those feelings of defeat and humiliation are often triggered by loss, by shame, or by rejection. And although that’s the common spine to understand the emergence of suicidal thoughts, then the question goes, For every one of us who become suicidal, the pathways to defeat, the pathways to entrapment are unique.

Brett McKay: We’re gonna take a quick break for a word from our sponsors.

And now back to the show. Let’s dig into the integrated motivational volitional model of suicide behavior that you developed that can help practitioners but also other people, loved ones or even individuals who might be experiencing suicidal ideation, help them figure out where they are in that path towards suicidal behavior. And the first part of the model is the premotivational phase. What are the factors there that can influence whether someone decides to take their own life?

Rory O’Connor: Yeah, the premotivational phase is part one. There are three parts to the model: The premotivational phase, the motivational phase, and the volitional phase. The premotivational phase is like the background context in which suicidal thoughts or behaviors may emerge, the motivational phase is a central… The middle bit of the model, and that’s really trying to understand the emergence of suicidal thoughts, and then the third bit of the model is called the volitional phase, and that’s trying to understand who is more likely to cross a precipice, from thinking about suicide to acting on their thoughts. Going back then to the premotivational phase, the premotivational phase is really trying to understand, What vulnerabilities do we all carry? For example, we all have different vulnerabilities, they could be biological vulnerabilities, for example, there’s evidence that people with low levels of serotonin and other metabolites. And [0:26:14.8] ____ metabolites and other neurotransmitters are associated with suicide risk, that’s a potential vulnerability factor but it’s never an inevitability, it is just a vulnerability factor.

Another vulnerability factor we’ve done quite a lot of work on is on different types of perfectionism, and there’s one type of perfectionism which is described as socially prescribed or just simply social perfectionism. And what that is is if you’re high on social perfectionism, and I speak as somebody who is also high on social perfectionism, is that we’re overly concerned about the expectations of others such that we continually live our life thinking that we’re letting others, important people in our lives down. And I describe it in the book When It’s Darkest, I describe people who have this high social perfectionism as basically having thin psychological skin such that when the bows and arrows of life come at us, when negative events occur, our skin is much more likely to be pierced metaphorically. And so let’s say it’s our premotivational phase because the concern is that people who are high in social perfectionism are much more likely to feel defeated or humiliated when stuff happens to them.

Brett McKay: The social perfectionism is interesting. Will Store, we had him on the podcast talk about his book about social status. He wrote an article about male suicide and he talked a lot about this social perfectionism and the role that plays, as well as status defeat in men can play in a man susceptibility to suicide.

Rory O’Connor: Yeah, no, absolutely, I know Will, Will’s a good guy, and actually Will Store interviewed me as part of that article, and then obviously initially, it was an article in the book or one of his books. And he’s exactly right, which is, that social perfectionism is a really useful framework for us to try and understand as Will has done, understand male suicide. But the way I’ve tried to conceptualize it is, try to understand, Well, how does it increase risk, in my case from a psychological perspective? And I think that idea of the thin skin-ness is a useful way to think about that. So we’ve got that vulnerability aspect, and then the other two bits are environmental influences and negative life events, they’re the last two parts of that premotivational phase. And the environmental influences are really recognizing that this idea that we know that there’s a socioeconomic gradient to suicide and that basically people from more socially disadvantaged backgrounds are much more likely to die by suicide. Some estimates are you’re three times more likely to die by suicide if you’re from a socially disadvantaged background compared to a more affluent background. And now, that’s not to say that people from more affluent backgrounds don’t take their own lives, because they do, but the risk is higher when there’s more social disadvantage.

And then the last bit on the premotivational phase is we know that people who die by suicide or attempt suicide have experienced a disproportionate number of negative life events, and that’s both in childhood as well as across their lifespan. And actually, when you look at the psychophysiology of suicide risk, we also know that people who attempt suicide or die by suicide, their stress system, their cortisol system… Remember cortisol is like the fight or flight hormone we need to help us either defend ourselves or flee a threatening situation. The people who are suicidal, their cortisol system is dysregulated, it’s not working as well, so it adds to the vulnerability.

Brett McKay: Okay. So the premotivational face, these are just the background factors that are already in place in someone’s life that could make them more vulnerable to suicidal thoughts, they won’t necessarily lead to suicide but they’re potential vulnerabilities. You move into the motivational phase of this, this is when ideation and intention formulation occurs. And I think you said what usually kickstarts the ideation is some sort of defeat, whether you lose a relationship, you lose a job, etcetera.

Rory O’Connor: Yeah, absolutely. I’ve touched on the motivational phase when I was answering one of the previous questions, that central idea that suicidal thinking is driven by or it grows out of feelings of defeat and humiliation from which you cannot escape. And it’s that sense of mental pain and entrapment which drives the emergence of suicidal thoughts. And again, when we think about what then drives or causes defeat or humiliation, that’ll be unique for all of us, it’ll be different for every one of us. And defeat and humiliation, again, are often also driven by loss, rejection, or shame. So I think when we’re trying to understand risk at an individual level, that’s a really helpful way to think about it, is asking ourselves, Well, what are the potential drivers to somebody feeling defeated or humiliated? And ultimately, what are the drivers to them feeling trapped? And then if we can identify those drivers, the causes of defeat, the causes of humiliation, we can hopefully intervene either to change the thing that’s leading to the defeat or humiliation. Or if we can’t change that, thinking of ways to support the individual through that crisis time.

Brett McKay: Well, in this part of the model, you have this idea of, I think it’s a threat to self-moderators and motivational moderators. What are those?

Rory O’Connor: Yeah, they are psychological factors. We’re trying to understand… If we think about the model as a horizontal line going from… On the left-hand side, you’ve got defeat and humiliation, and then if you move from left to right, you move from feeling defeated to feeling trapped. And then you move from feeling trapped to suicidal. The threat to self moderators and motivational moderators are psychological factors which we hypothesize facilitate or impede the movement from left to right. That includes things like if you’re a really good problem solver, social problem solver, and you’re feeling defeated… Well, actually if I’m feeling defeated and I can solve the problem, I’m less likely to feel trapped. So let’s take an example of where good problem solving will arrest or stop the movement from left, from defeat to entrapment. Or for example, if you’re feeling trapped, what increases the likelihood that you might become suicidal? Well, if I’m feeling trapped and I’m really socially isolated or I feel that I’m a burden on those around me or if I feel disconnected, I’m much more likely to feel suicidal.

And so that sense of being a burden, that sense of support or isolation, they are these motivational moderators which help us understand who is more likely to move from feeling trapped to suicidal. And although often in the model, we frame it as risk, the presence of all these factors lead to risk, the motivational moderators and the threat to self-moderators help us identify what we describe in psychological terms as targets that we could focus on which will hopefully protect somebody from moving from defeat to entrapment to suicidal thinking.

Brett McKay: There’s the motivational phase, you have the defeat or humiliation which leads to entrapment, which then could lead to suicidal ideation and intent. What causes someone to start shifting over from just ideation to, “I’m actually gonna do something?” We’re moving to the volitional part of this.

Rory O’Connor: Yeah, the volitional phase is the third part of the model, and it’s our attempt to try to identify what we think is about 30% of people who have thoughts about suicide, we think about 30% move from thoughts to suicidal acts, and that includes fatal as well as nonfatal suicidal behaviour. According to the model, there are eight key factors, which I call “volitional moderators” or “volitional factors” which increase the likelihood that you make that transition, you act on your thoughts. And they include things like having access to the means of suicide.

It stands to reason, if I’m suicidal and I’ve ready access to the means of suicide, well, I’m more likely then to act on my thoughts because if it’s ready access, it means that the environmental constraints on you accessing that method are reduced or low, then anything which leads to reduced constraints on access to means increases the likelihood that you’ll engage in that behaviour. And indeed, if you look at the evidence for what works at a public health level to prevent suicide, it is interventions which are focused on restricting access to the means of suicide. That’s like for example having barriers in places of concern, not having ready access to medication and so on. That’s one of the volitional factors.

Others include exposure to suicide. What we mean by “exposure” is that if you know somebody else who’s died by suicide. And again, it stands to reason that if I have having thoughts of suicide and I know somebody who’s died by suicide, I’m more likely to act on my thoughts. And that’s because the mechanism could be that if somebody close to you has died by suicide, that method of death is potentially more cognitively accessible. Or it could be that if that person is like you, you’re modeling their behavior or it could be that it legitimizes the behavior for you because if a loved one uses that method of coping with a distressing situation, well, maybe that’s something you would consider. That’s one of the volitional moderators.

I’ll just say there’s eight of them but I won’t go through all eight, I’ll do a couple more. Impulsivity is one of the volitional moderators. Again, the idea that if you’re having thoughts of suicide and you’re impulsive, it stands to reason you’re more likely to act on your thoughts. And then just maybe two last ones. Second last one in the list, if you read the model, is basically this idea that having mental imagery around dying or death. What we think happens is, if somebody is having thoughts of suicide and they’re picturing themselves either dying or dead, that’s perhaps like a rehearsal mechanism or it could act as a habituation of making death less scary. So then the presence of both thinking about suicide and imagery around death increase the likelihood that you’ll act on your thoughts.

And then one very last one is past behavior. The single best predictor of any future behaviour is whether you’ve engaged in that behaviour in the past, it’s exactly the same for suicidal behaviour. The evidence shows that if you’ve engaged in suicidal behaviour in the past, you’re statistically more likely to engage in suicidal behaviour in the future or sadly die by suicide. It’s important to put that in context because although past behaviour is one of the strongest predictors of future suicidal behaviour, the majority of people who say are suicidal or have attempted suicide in the past won’t do again in the future and will never die by suicide.

Brett McKay: Okay. So that’s the integrated motivational volitional model of suicide behaviour. And what this allows you to do as a practitioner or anybody, there’s points where you can see where you can start doing some preventative things. I’m going to start working here in the motivational part… Or I’m going to start working here in the volitional part. So based on your research, not only do you research suicide, but you research suicide prevention. What’s the best thing that works in suicide prevention?

Rory O’Connor: I’ll answer that in two ways. Large-scale public health interventions have been shown to be effective, that’s things, as I mentioned earlier on the restricting access to the means of suicide, anything which restricts access to the means of suicide has been shown to be effective in reducing suicide. So that’s good news, that’s really good news. Now, that’s challenging, for example, in the United States, that’s challenging when we think about firearms, that’s a really complicated topic to address, given the constitutional implications and so on. That’s a big public health-type example. But if I focus in on the individual level, over the last 20 years, there’s been growing evidence that psychosocial interventions, these are like talking therapies, things like cognitive behavior therapy have been shown to be effective in reducing suicidal behavior over time. So that’s good news. There’s a growth in the evidence base for those sorts of talking therapies.

There also has been a lot of interest and focus on brief interventions, things like safety planning. And safety planning is an intervention that we’ve done some work with ourselves over here in the UK, but safety planning was developed by Barbara Stanley and Greg Brown in the United States. It’s an effective intervention, but it’s a simple intervention, and it really focuses in on the volitional phase. If you think about cognitive behavioral therapy or CBT, it’s more focused on the motivational phase, it’s trying to understand the complex factors that lead to defeat and entrapment and suicidal thinking and so on. But a volitional phase intervention like safety planning is trying to interrupt suicidal thoughts so that somebody doesn’t cross the precipice from suicidal thoughts to suicidal acts.

And it’s very, very simple, the intervention basically has six steps. Step one is you work collaboratively with somebody who’s suicidal to try to identify the warning signs that a suicidal crisis might be escalating. So hopefully, if you can identify in advance, you can intervene and do something to keep yourself safe. And then in steps two, three, four, and five, it helps the individual identify people or places or organizations that they can go to either to distract themselves as the suicidal thoughts might be escalating, or if they feel they cannot keep themselves safe, somewhere to go in crisis or somebody to contact in crisis.

And then step six is the last step of this intervention, and it’s working again collaboratively with the person to help them keep their environment safe, and by keeping their environment safe, what we mean is basically to increase the distance between them and a method of suicide. If they thought about how they might end their life, what can we do to ensure that when that crisis escalates again, they do not have ready access to the means of suicide. So something like that I would really focus in on, that safety planning, it’s only one example as a brief intervention, but a really important one because it’s something which intuitively makes sense, Brett, but something we can all be thinking about.

Brett McKay: And then also on an individual level, if you know someone who you’re worried about, we talked about this earlier, don’t be afraid to ask them if they thought about taking their own life because it’s not going to implant that idea in their head to do it, it’s just that could actually be the thing that could kickstart them getting the help they need.

Rory O’Connor: Yeah, absolutely. And really, we cannot emphasise that enough, if you are concerned, please ask somebody directly whether they’re suicidal. But I appreciate that that’s a difficult thing to do, and again, I describe some tips in the book. But in essence, if the person answers “yes,” that I am suicidal, in many respects, that’s your biggest fear… If you ask that question, and somebody says, “Well, yes, I am suicidal.” Your biggest fear is, “Well, what do I do next?” What you do next is you just validate how they’re feeling and say, “That must be really difficult for you.” That’s all we mean by “validation.” “That must be really difficult for you.”

It’s not about trying to solve their problems, it’s trying to acknowledge, be alongside them in their distress and then encourage them to think about how they might be able to get support if they think they cannot keep themselves safe. And that sense of common humanity, that sense of connection and treating an individual as worthwhile, as somebody who’s valued in this world, because many people who are suicidal don’t think that they have a role in society anymore and feel that they are a burden. So anything which promotes connectedness and then encourages them to maybe reach out, speak to their physician, their general practitioner, somebody else in their life who can help keep themselves safe. I would really encourage people to do that. Please, please reach out.

Brett McKay: Let’s talk a little bit… You talk about this in the book, about those who are bereaved by suicide, so family members who had a loved one that took their own life. How does their grief differ from someone who might have just experienced someone who died by other causes? And any advice for them on how they can navigate that? And I guess the other question there too would be, What can people do to help those who are bereaved by suicide?

Rory O’Connor: Yeah, again, really important questions. The grief associated with a suicide is complicated because, of course, any sudden death is devastating, but on top of the sudden death, there’s often shame and guilt and, “What could I have done differently?” And again, I speak as somebody who’s twice bereaved by suicide, and in particular, with a close friend of mine who took her own life. I still ask myself today what I could have done differently and I felt in part responsible for not being able to save her life. And many people bereaved by suicide feel the same. So part of it is trying to be more self-compassionate. No one of us should ever be held or can ever be held responsible for the actions of another person. Recognizing that the prediction of suicide is so, so difficult, and as I said earlier, it’s no better than chance, our ability to predict suicide. And so recognize that every day is different, every day is different and it’s the pain, anger, the steps of bereavement, that people go through them differently. And probably the only certainty about bereavement by suicide is its uncertainty, is its unpredictability, some days you might feel okay and other days not, and it can come on such unpredictably obviously.

And I suppose it’s also recognizing that although as days become weeks and weeks become months, it’s all about moving forward, it’s not forgetting, it’s just you’re moving, step forward, step forward, step forward. You’re changed as an individual, of course, you are, and it’s just trying to recognize that, and things do become a bit easier.

In terms of advice for those who are around those who have been bereaved, again, it’s just recognizing that the person is going through unbearable pain. Don’t be frightened because one of the big fears, again, is, “I’ll say the wrong thing.” And again, the advice that I would certainly give, and I know from speaking to countless others who have been bereaved, is as long as somebody treats you with humanity and compassion, you’re unlikely to say the wrong thing. And don’t judge. It’s nonjudgmental. Don’t try and tell the person how they’re feeling, just be alongside the person and let them know that you’ll be with them, you’re there if they need them at any stage. And please don’t cross the road because that still happens, that idea of people who are bereaved by suicide and people cross the road instead of speaking to them, and that’s often out of fear of saying the wrong thing. Please, please support each other.

Brett McKay: Well, Rory, this has been a great conversation. Where can people go to learn more about your work in the book?

Rory O’Connor: To find out more about our work, we have a website, the website is www.suicideresearch.info that’s suicideresearch.info, and the book is available I think everywhere, so wherever you tend to get your books, in Amazon or wherever, or other obviously booksellers, the book’s widely available.

Brett McKay: Well, Rory O’Connor, thanks for your time, it’s been a pleasure.

Rory O’Connor: Thanks so much, Brett, I really enjoyed our conversation.

Brett McKay: My guest today was Rory O’Connor. He’s the author of the book, When It Is Darkest: Why People Die by Suicide, and What We Can Do to Prevent It, it’s available on amazon.com and bookstores everywhere. Check out our show notes at aom.is/suicide, where you can find links to resources, we delve deeper into this topic.

Well, that wraps up another edition of the AOM podcast. Make sure to check out our website at artofmanliness.com, where you’ll find our podcast archives, as well as thousands of articles that we’ve written over the years about pretty much anything you think of. And you’d like to enjoy ad-free episodes of the AOM podcast, you do so on Stitcher premium. Head over to stitcherpremium.com, sign up, use code “manliness” to check out for a free month trial. Once you’re signed up, download the Stitcher app on Android or iOS and you can start enjoying ad-free episodes of the AOM podcast. And if you haven’t done so already, I’d appreciate it if you take one minute to give us a review on Apple Podcasts or Spotify, it helps out a lot. If you’ve done that already, thank you. Please consider sharing the show with a friend or family member who you think would get something out of it. As always, thank you for the continued support. Until next time, this is Brett McKay reminding you to not only listen to the AOM podcast, but put what you’ve heard into action.

The post Podcast #900: The Myths and Truths Around Suicide appeared first on The Art of Manliness.

Dumbbell-like devices have been used since ancient Greece to build athleticism and muscle. Today, they remain an effective tool in a man’s strength-training arsenal. 

Dumbbells are handy for isolation movements like bicep curls and are easier on the joints than barbells. They can be swapped in for certain barbell lifts if an injury prevents using a barbell for that exercise (e.g., swapping the barbell shoulder press for a dumbbell shoulder press), or they can be one’s preferred equipment for getting a full-body workout.

There’s just one problem with dumbbells: To build strength, you have to train using the principle of progressive overload — adding reps or weight each week — and to add weight to dumbbell workouts, you have to use progressively heavier pairs of dumbbells. But that requires access to a huge set of them, where the first pair starts at around 10 pounds and each subsequent pair is 5 pounds heavier, on up to around 100 pounds. That’s almost 20 potential pairs of dumbbells.

That’s fine if you belong to a gym, and they provide that big ol’ range of dumbbells on a big ol’ rack for patrons. But if you’re working out at home, a full set of dumbbells can cost you somewhere in the ballpark of $3500 to purchase and will take up a heck of a lot of space. It’s a non-starter for the average guy.

To solve this dilemma, manufacturers of fitness equipment have created adjustable dumbbells. All you need is a single pair of them, as each dumbbell can be toggled from lighter to heavier weights. Adjustable dumbbells are a lot more affordable than getting a full set of the traditional variety and take up far less room.

But do adjustable dumbbells really work as advertised, and if so, which of the various kinds available are the best?

I recently field-tested four models, and below I offer my unbiased, non-sponsored take on each of their pros and cons and which I’d recommend most.

PowerBlock Elite EXP Adjustable Dumbbells

With the ability to adjust the weight of each dumbbell from 5 to 50 pounds (up to 90 pounds if you buy extension kits), these dumbbells pack the utility of up to 20 traditional dumbbells within a small footprint. 

Pros

Compact design. One of the standout features of the PowerBlock Elite EXP is its compact design. The dumbbells have a block shape and don’t sit in a special cradle as other adjustable dumbbells do. Out of all the adjustable dumbbells I tried, the PowerBlock Elite EXP takes up the least amount of space.

Durable. As we’ll see, many adjustable dumbbells are pretty finicky and require you to treat them with kid gloves. When I used the PowerBlock, I felt I could be rougher with them and not worry that they’d break. 

Price. Right now, you can buy a pair for $430 on Amazon, making it one of the cheaper adjustable dumbbell sets out there. However, the extension kits to increase their weight capacity to 70 and 90 pounds cost $125 and $170, respectively. So it’s a good entry-level adjustable dumbbell, but if you think you’ll quickly max out the weight capacity and have to buy the extensions, then it won’t ultimately be a real bargain.

Cons

Weight adjustment. The weight adjustment mechanism on the PowerBlock is kind of annoying. The process involves removing a plastic pin and sliding it into the desired weight slot. Using the pin to adjust the weight will allow you to go up or down by 10 pounds. If you want to adjust the weight by 2.5 to 5 pounds, you remove some metal cylinders from the handle. Compared to other adjustable dumbbells I tried, the weight adjustment process is pretty clunky. 

Bottom line: if you’re looking to get a lot of weight variations in a cheaper, compact piece of equipment, the PowerBlock Elite EXP is a great option. But be aware that they’ll feel different compared to traditional dumbbells.

MX85 Rapid Change Adjustable Dumbbells

If you’re looking for an adjustable dumbbell that feels more like a regular dumbbell, check out the MX85 Rapid Change. It allows you to adjust the weight from 12.5 pounds to 85 pounds and do so quickly.

Pros

Feels more like a traditional dumbbell. The MX85 Rapid Change looks and feels more like a traditional dumbbell than the PowerBlock. (However, large, oddly-shaped “plates” lend these dumbbells their own kind of awkwardness — see below.) 

Adjusting weight is a breeze. The MX85 Rapid Change uses a dial system to adjust the weight. You turn a dial on each side of the handle to increase or decrease the weight. So if you want a dumbbell that weighs 12.5 pounds, you’d set both dials to one; if you want the dumbbell to weigh 85 pounds, you’d set the dials to 10. Much easier to adjust than the PowerBlock.

Adjustment mechanism is made of metal. The adjustment system in the handle uses metal gears and a metal rod to adjust the weight, making it much more durable than its competitors that use plastic and nylon. 

Cons

Weight adjustment increments are weird. While it’s easy to adjust the weight on the MX85 Rapid Change, the weight increments you can adjust to are really dang weird. You can increase from 12.5 pounds to 85 pounds in 8-pound increments. So weight increments look like this: 

12.5, 21, 29, 37, 45, 53, 61, 69, 77, 85

Never in my training career have I thought: “Hey, I need to do a set of 10 at 53 pounds.”

Five-pound jumps, 10-pound jumps, yes.

Eight-pound jumps? Huh?

This is probably the biggest flaw with the MX85 Rapid Change.

Can’t drop. Like most adjustable dumbbells, you can’t drop the MX85 Rapid Change. If you do, you risk breaking the adjustment mechanism in the handle. While you can’t drop them, I’ve found the MX85 Rapid Change durable. I haven’t felt like they’re falling apart after a few months of use.

Price. At $600, the MX85 Rapid Change is pricey.

Bottom line: The MX85 Rapid Change is an easy-to-use adjustable dumbbell set that allows you to get heavy. However, I wouldn’t recommend them due to their odd shape and size and their weird weight adjustment increments.

SMRTFT NÜOBELL 80lb Classic

A customer review said, “If Apple made an adjustable dumbbell, it would be the NÜOBELL.” And after using all these adjustable dumbbells, I’d have to agree. With the ability to easily adjust from 5 pounds to 80 pounds, the superior design of the NÜOBELL puts it at the top of my list.

Pros

Easy to adjust the weight. Changing the weight on NÜOBELL is a breeze. Simply rotate the handle and adjust the weight up or down by 5 pounds. 

Speaking of that 5-pound adjustment, this is a big advantage the NÜOBELL has over the MX85 Rapid Change. You can go from 5 to 80 pounds in nice, standard 5-pound increments (5-10-15-20-25-30-35-40-45-50-55-60-65-70-75-80).

The ease of adjusting the NÜOBELL has made my workouts super fast. I can quickly change weight from lift to lift in seconds. 

Cons

Less durable. Like other adjustable dumbbells, you can’t drop the NÜOBELL since it could break the adjustment mechanism. And because the adjustment mechanism on the NÜOBELL is made of plastic, it’s a bit more prone to breaking than the MX85 Rapid Change. 

I experienced the lack of durability firsthand when I got my NÜOBELL delivered. One of the boxes I received looked like it had been taken out back and beaten with a crowbar. When I opened the box, the handle on that dumbbell was broken. It wouldn’t adjust. 

I ordered my NÜOBELL from Rogue Fitness, so I emailed customer support, and they quickly sent me a replacement handle. (Thanks, Rogue! Excellent customer service!)

Since then, the NÜOBELL has worked like a champ. I’m careful when I set them down, though. I don’t want them to break.

Price. The NÜOBELL is $600 at Rogue Fitness, so pricey. They cost the same as the MX85 Rapid Change, but I think the NÜOBELL provides a better experience. 

Bottom line: The NÜOBELL is my favorite adjustable dumbbell. The range of weights and the ease of adjusting weight is phenomenal. The only downside is that I feel like I have to treat them with kid gloves. I’d love for them to come out with a more durable version that you could drop. Where’s the Steve Jobs of dumbbell design when you need him?

Rogue Loadable 15LB Dumbbells

While technically not an adjustable dumbbell, a loadable dumbbell is an old-school way to get various dumbbell weights with minimal equipment. Loadable dumbbells are basically mini barbells that allow you to increase their weight using the smaller-sized barbell plates you may already have. The loadable dumbbells that I have are from Rogue. Dubbed the “DB-15,” this dumbbell is a beefy 15 pounds without plates (they also offer a 10-pound version, but you can’t load as many plates on it). They look just like a miniature version of their famous Rogue Ohio Barbell. 

Pros

Compact design. When the dumbbells are unloaded, they occupy hardly any space in my garage gym. I store them right next to my plate holder.

Can go as heavy as you want. The DB-15 has a long 6.75″ sleeve that allows you to put a lot of weight on it. I made a 115-pound dumbbell for some rows using two sets of 25-pound plates, and I still had room for more weight.

Super durable. Rogue’s Loadable Dumbbell is incredibly durable. You can drop these with abandon, and they’ll keep on ticking. If you’re looking for dumbbells that you don’t have to baby, these are it. 

Price. A pair of DB-15s will set you back $300. If you already have weight plates, buying a set of loadable dumbbells will be much more cost-effective than purchasing an adjustable set of dumbbells. If you don’t have plates, things can get expensive as you start buying them.

Cons

Hard to adjust the weight. The biggest drawback of the loadable dumbbell is that it’s tedious and time consuming to adjust the weight. You have to load them just like a barbell: put weight and a collar on each side of the sleeve. Changing the weight out on the loadable dumbbell slowed down my workout time. 

I can see myself using the loadable dumbbells combined with an adjustable dumbbell in the future. I’m pretty close to maxing out the weight on the NÜOBELL on my dumbbell bench. I’ll probably continue to use the NÜOBELL for my warm-ups on the dumbbell bench since it’s so fast to increase weight, and then use the loadable dumbbells for my heavy working set.

The other issue with the long sleeves is that you can’t rest the dumbbells on your knees without pain. Resting a heavy load on top of your knee doesn’t feel good as you get ready to hoist the weights onto your shoulders.

Bottom line: If you already own barbell plates and are looking for a more affordable way to get started with dumbbell training, a pair of Rogue Loadable Dumbbells is the way to go. The biggest downside is the hassle of adjusting the weight on them.

The post Adjustable Dumbbell Review: Which Set Deserves a Spot in Your Gym? appeared first on The Art of Manliness.

An important part of manhood has always been about having the competence to be effective in the world — having the breadth of skills, the savoir-faire, to handle any situation you find yourself in. With that in mind, each Sunday we’ll be republishing one of the illustrated guides from our archives, so you can hone your manly know-how week by week.

Tourniquets exist in a class of medical techniques associated with wilderness survival and military medicine primarily because they are only used in drastic, uncontrollable circumstances. Whether on the battlefield or some distant peak, a tourniquet is often the only way to stop excessive bleeding to severely injured limbs. Using a strip of fabric, belt, or other material, tourniquets constrict blood flow until the wound can be attended to by medical professionals.

During World War II, tourniquets were used heavily in the field, but because soldiers often had to wait hours on end to be seen by surgeons and medics, their constricted limbs suffered nerve and tissue damage that forced amputations. The perceived relationship between tourniquets and amputation caused them to fall out of use for decades, but research that emerged from the battlefields of Iraq and Afghanistan showed that, when used correctly, the benefits of tourniquets far outweigh the risks, especially in circumstances where patients can receive proper medical care within a few hours of their application.

The bottom line is that when blood loss from a limb injury risks death, a tourniquet is a lifesaving technique that cannot be ignored.

Like this illustrated guide? Then you’re going to love our book The Illustrated Art of Manliness! Pick up a copy on Amazon.

The post Skill of the Week: Apply a Tourniquet appeared first on The Art of Manliness.

When men think about optimizing their hormones, they tend only to think about raising their testosterone. But while increasing T can be important, an ideal health profile also means having testosterone that’s in balance with your other hormones as well.

Today on the show, Dr. Kyle Gillett joins me to discuss both of those prongs of all-around hormone optimization. We start with a quick overview of the different hormones that affect male health. We then get into what qualifies as low testosterone and how to accurately test yours. We also discuss what causes low testosterone in individual men, and how its decline in the general male population may be linked to both birth control and the world wars. In the second half of our conversation, we discuss how to both raise testosterone and get rid of excess estrogen, including the use of some effective supplements you may never have heard of. We then get into the risks and benefits of taking TRT, before ending our discussion with what young men can do to prepare for a lifetime of optimal T and hormonal health.

Resources Related to the Podcast

• AoM series on testosterone, including How I Doubled My Testosterone Levels Naturally
• AoM Podcast #761: How Testosterone Makes Men, Men
• AoM Podcast #878: The Fitness Supplements That Actually Work 

Connect With Dr. Kyle Gillett

• Kyle on IG
• Gillett Health Podcast on Spotify and Apple
• Gillett Health on YouTube
• Gillett Health website

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Read the Transcript

Brett McKay: Brett McKay here and welcome to another edition of The Art of Manliness Podcast. When men think about optimizing their hormones, they tend only to think about raising their testosterone, but while increasing T can be important, an ideal health profile also means having testosterone that’s in balance with your other hormones as well. Today in the show, Dr. Kyle Gillette joins me to discuss both of those prongs of all around hormone optimization. We start with a quick overview of the different hormones that affect male health. We then get into what qualifies as low testosterone and how to accurately test yours. We also discuss what causes low testosterone in individual men and how it’s decline in the general male population may be linked to both birth control and the world wars. In the second half of our conversation, we discuss how to both raise testosterone and get rid of excess estrogen, including the use of some effective supplements you may never heard of. We then get into the risk and benefits of taking TRT before ending our discussion with what young men can do to prepare for a lifetime of optimal T in hormonal health. After the show is over checkout our show notes at aom.is/optimalt.

All right, Dr. Kyle Gillette, welcome to the show.

Dr. Kyle Gillette: Thank you. My pleasure.

Brett McKay: So you are a medical doctor. You do family practice, you specialize in obesity but also hormone optimization, helping people have healthy hormones so they live a flourishing life. And today I’d like to talk about hormones, particularly male hormones. I think when most people think about male hormone optimization, they think about testosterone and which is obvious why you do that. And we’re gonna dig deep into testosterone today. But are there other hormones that affect male health that people often overlook?

Dr. Kyle Gillette: There certainly are. So even testosterone in and of itself, there’s nothing unique about it compared to other androgens. There’s just one androgen receptor. Testosterone just happens to be the most well-known androgen. So there’s DHEA, which is a very weak androgen. It’s produced by the adrenal glands, which are small glands above the kidney. There’s DHT, which is dihydrotestosterone. This is a very strong androgen. You don’t have as much of it as testosterone, but it’s vitally important for what’s called secondary sexual characteristic development, like the deepening of the voice, growing facial hair, those secondary sexual characteristics which are vital.

Brett McKay: And also I think people often overlook estrogen plays a role in male health.

Dr. Kyle Gillette: Certainly, testosterone aromatizes and directly converts to estrogen. So the way to think about estrogen is the more estrogen the better for your health because it prevents things like heart attacks at a correct ratio to where you feel good.

Brett McKay: Okay, so we gotta have some estrogen in there at the right balance. And then there’s another hormone called SHBG. What does that do?

Dr. Kyle Gillette: So SHBG is also known as androgen binding globulin. It’s a protein, it’s made in many places, the liver makes most of it, but the testes also make some of it. And SHBG stands for sex hormone binding globulin, it most strongly binds DHT and then it binds testosterone, relatively strongly, DHEA weaker than that. And then estradiol, which is your main estrogen, even weaker than that. So think of this as regulating all of the hormones and keeping them more stable. The higher the SHBG, the more stable the level will be. Men produce a lot of testosterone during sleep. So the level is generally much higher in the morning. But if you have a very low SHBG you’ll crash and you can actually have deficient levels of testosterone in the evening routinely. But normal levels in the morning if you don’t have enough SHBG, the most common cause of an SHBG deficiency is insulin resistance, which is often due to too many calories or too many carbohydrates and sugar.

Brett McKay: So what’s interesting about all those hormones is they interact with each other. It’s a complex system so if you raise the level on one, one might go down or up. So I think a lot of guys they get too focused on, well I gotta increase this one thing or reduce this one thing. Well, if you do that you’re gonna have these cascading effects that might not be optimal.

Dr. Kyle Gillette: Correct. I actually heard an advertisement from a TRT clinic this morning and it said new studies shows that men with low testosterone are more prone to cardiovascular disease and early death and diseases of aging. And I thought to myself, this is odd because they are implying that you need testosterone replacement to prevent this. But of course that is a logical fallacy because just replacing the testosterone without figuring out what’s actually causing it in the first place, not that TRT is wrong, but you need to figure out what the cause of it is and then address it.

Brett McKay: Okay. And I hope we can talk about TRT ’cause I know a lot of guys are thinking about doing it or maybe they are doing it and they might have questions about that. Let’s talk about testosterone. So there’s two ways to measure testosterone or two measurements of testosterone that I read about. One is total testosterone and free testosterone. So first, what’s the difference between the two and as a clinician is there a particular number you focus on?

Dr. Kyle Gillette: Yeah, so total testosterone is a total amount of testosterone, whether it’s bound or unbound, when testosterones bound it in general does not bind the androgen receptor, which is on the X chromosome. And total testosterone includes a testosterone bound to albumin, which is the main protein in the blood and also SHBG which we talked about earlier. But free testosterone or any free androgen is what is going to be what is actually binding to the receptor. And then it takes it into the nucleus of the cell and then it binds to DNA to cause what’s called gene transcription. So the androgen receptor gene that’s on the X chromosome is then mostly activated by free testosterone. Oddly enough, sometimes I make the analogy of plumbing. So you have a pipe that’s your bloodstream that takes testosterone everywhere and then you have different types of cells. For example, a muscle cell or a brain cell or a germ cell in the testicle or a somatic cell in the testicle, which we don’t have to get into. But anyway, the free testosterone level can be very different in the bloodstream, which is where we measure it on a blood test versus inside the cell. So it is possible to have symptoms of low testosterone because you don’t have enough androgen in the cell but have a normal level in the blood. It’s rare but it’s possible.

And the opposite is possible, to have a low level in the blood but still have enough inside the cell that’s free to be causing normal gene transcription.

Brett McKay: Okay. So just to recap there, total testosterone is made up of bound and unbound testosterone. Bound testosterone could be bound to albumin or SHBG. And then when it’s bound to those things it can’t attach to the antigen receptor in the cell and so it can’t be… Can’t effect have those changes on the cell. Free testosterone, unbound testosterone is free testosterone. So as a clinician, when you do a blood test on a patient, what number is more important to you? Which one are you gonna be focusing on more? Is it the free or the total?

Dr. Kyle Gillette: I think both are equally important. For athletic purposes, for muscle building purposes. Usually that’s more correlated with free testosterone level. However, symptoms and how you feel is usually correlated more with total. Insurance companies and academic societies usually put more weight into total testosterone, partly because free testosterones are often measured inaccurately so often it’s more accurate to calculate your free testosterone using your total testosterone and your SHBG and then you estimate what your free testosterone is. Some societies say low testosterone is often best treated if you one, have symptoms. And then two, also have a testosterone below about 400. That’s what the urologists say. Most other societies go by 300 and I tend to agree with the level of 400 with a caveat if you have significant symptoms and with a second caveat, if you cannot improve that naturally in any way after identifying the root cause.

Brett McKay: Okay. I wanna dig more into diagnosing low testosterone because there’s lots of commercials out there. You just mentioned one or these businesses popping up where you can just go in, get a blood test and like, hey, you got low T, here’s testosterone and maybe they don’t. So you mentioned two things you look at to diagnose low testosterone, you’re gonna do blood work and if it’s below 400, coupled with if the patient is reporting symptoms of low testosterone, we’ll talk about the symptoms of low testosterone here in a bit, but let’s talk about blood work. ‘Cause I think a lot of guys out there, they think it’s a panacea, if you just take a test, you take the test and it says, oh well, your T is at 400. They’re like, well I got low T. Why isn’t one blood test alone sufficient to diagnose low testosterone?

Dr. Kyle Gillette: Yeah, in general testosterone levels can have what’s called outliers. It’s the statistical phenomenon. But it’s especially true of testosterone where you could check it one time and your testosterone that morning could be low because the last two nights you’ve had poor sleep and poor diet and other lifestyle factors. Males that are generally seeking a TRT prescription know those very well because there’s various things that you can do to artificially make your testosterone level look low that morning. So in general, the recommendation is to recheck it two to three times after a good night of sleep and normal diet and whatever you’re doing normally not after you’ve dieted down to 7% body fat to do an ultramarathon or body building show, then your testosterone is certainly going to be low. But when you’re at a healthy body fat and there’s not an artificial something else that is going to make your testosterone look low. There’s a runner, his name is Nick Bare and he also is doing a body building show and I saw that he got his total testosterone checked and he’s a healthy guy. I’m not sure what his baseline testosterone is and his total testosterone was right at 100 before his body building show.

So that was obviously secondary to the caloric deficit. That wouldn’t necessarily count as a testosterone reading that you could put stock in assessing TRT or not. But for most people they probably won’t be in a scenario like that. But it is important to get at least two readings. If you’ve been sick before, then maybe just postpone the blood test by a week. That way you get an accurate reading.

Brett McKay: Let’s move on to the symptoms. So you do the blood test, what symptoms are you looking for to diagnose low testosterone?

Dr. Kyle Gillette: Yeah, could be through any system. So it could be anything from depression, anxiety to low libido is certainly classic. Low muscle mass is not really one that we look for. Testosterone levels that are naturally produced are not as correlated as people would think with body composition and muscle mass and athletic performance. So it’s not uncommon to see a pretty high level athlete have a total testosterone of let’s say 450 and let’s say someone that has very low muscle mass and maybe even 20%, 22% body fats have a total testosterone of 1000 and there’s not as much correlation. But other things that you would look for seriously is, for example, erectile dysfunction, sexual health in general, sperm production. So if there’s a patient that is having even sub-fertility, just a little bit of trouble getting pregnant, that individual should certainly have a test of his testosterone as well.

Brett McKay: So with low libido, how does a guy know if he has low libido? Because that seems like it’d be pretty subjective.

Dr. Kyle Gillette: Yeah, libido obviously has a lot of psychosocial factors as well. It’s usually taken at a patient’s word and a lot of times when you’re testing these patients, you’ve known the patients for a while, sometimes you haven’t. But if they’re telling you that it’s low relative to what it usually is and no other factors have changed, for example, you know they’ve been married to the same person for five years, they’re not actively going through problems in the marriage, there’s not something else that would be affecting the libido. So that would usually come up in the social history. When you do a history and physical on a patient, it is important to dig into the social history to make sure there’s not something else that is affecting the libido.

Brett McKay: So besides the low libido, maybe the lack of drive, what are the consequences of suboptimal male hormone levels like chronically? Is it gonna affect your cardiovascular system? Is it gonna affect cancer? Does it affect things like that?

Dr. Kyle Gillette: It will. If someone is significantly hypogonadal for a long time, they’re at much higher risk of osteoporosis, which leads to bone fractures and even mortality as well. They’re at higher risk of neurodegenerative disease, likely largely due to low estrogen. If you don’t have a lot of testosterone, you’re probably not converting a lot of it to estrogen and if you’re not doing that then you’re also at risk of cardiovascular disease. Estrogen is very cardioprotective and helps with the production of good cholesterol to help take cholesterol out of the plaque. So they’ve done studies and you look at one group of people that have true hypogonadism, which is generally two levels under 264 or so, and then one group you give TRT and then one group you don’t give TRT, you would think that the group that you give TRT would’ve a shorter lifespan ’cause androgens do cause excess production of “bad cholesterol.” They do increase a particle called ApoB, which is the most important one to watch for cardiovascular risk. But the group that you give TRT actually has less heart attacks and strokes.

Brett McKay: Right, because what you were saying before, the testosterone creates estrogen and then the estrogen protects the heart. So let’s talk about the causes of low testosterone. What can be behind low T?

Dr. Kyle Gillette: Most commonly, metabolic syndrome. So excess calories, excess carbs, insulin resistance, high fasting insulin leads to the liver not producing SHBG. So you might be producing a decent amount of testosterone but it’s being metabolized so fast that it’s difficult to use. That’s most common. The second most common I think is sleep apnea or obstructive sleep apnea. Obviously that kind of goes hand in hand with metabolic syndrome but often it goes hand in hand with PTSD. I saw a study on young men that had just gotten out of the military and they had been diagnosed with PTSD and they tested them all for sleep apnea and something like 80% of them had sleep apnea and they were all under under a BMI of 25. So there’s certainly a lot of stress component as well. The limbic system includes places like the hypothalamus and the amygdala and downstream to that is the hippocampus and the amygdala, downstream of those is the hypothalamus and that’s some of the places of the brain that are involved in sleep regulation and breathing.

So the theory is that apneic episodes don’t just come from having a huge neck and excess body fat, but there are other factors like trauma at play. And when you have a patient with severe sleep apnea, they have a score called a AHI score and if that score is very high, like 100 or 200, you almost always see deficient testosterone levels.

Brett McKay: Okay, so having metabolic syndrome, being overweight, sleep apnea, any other causes of low testosterone?

Dr. Kyle Gillette: Yeah, so theoretically xenoestrogens could be a cause of low testosterone. These are things like phthalates. These are also things like bisphenol A, also known as BPA, you might see BPA free on water bottles from time to time. These do bind various estrogen receptors and are likely suppressive. By suppressive, I just mean they shut down the production of the hormones that lead to testosterone production to some degree. Heat damage is also kind of an honorable mention. Some people might be familiar with what varicose veins are. Varicocele is where there’s varicose veins in the scrotum and some people with varicocele can have venous cooling very well. The testes wanna be about 91 to 92 degrees where the body is 98.6 degrees. So if you can’t keep your testes at 91 or 92, then you’re going to have less testosterone production and less sperm production. And in the more severe cases you’ll have atrophy, which is shrinking because, think about them as factories. If you’re not using the factory, they start to shut down.

Brett McKay: And besides these lifestyle factors and environmental factors, you could also have just an issue with your pituitary system, right? You might have a tumor or something in pituitary gland that’s dysregulating the release of hormones.

Dr. Kyle Gillette: Correct. I suppose that would be likely one of the more common less modifiable risk factors. There’s not a lot that you can do about that. You can take supplements like vitamin B6 or like vitamin E, but a lot of times pituitary microadenomas or even macroadenomas, basically it’s a small tumor in the brainstem. The pituitary gland is where you make a lot of different hormones like growth hormone and like LH and FSH. But LH is the main hormone that’s produced there that leads to testosterone release. So there’s two different types of hypogonadism. There’s primary and secondary. So primary is where the testes are not functioning. And then secondary, think about it, it’s two steps instead of one step. So the LH can be low in secondary hypogonadism and if your LH is very low and a hormone like prolactin or IGF-1 is very high, then that might be a sign of a pituitary micro adenoma. In which case you need MRI.

Brett McKay: And LH, that’s Luteinizing Hormone, correct?

Dr. Kyle Gillette: Correct. LH is Luteinizing Hormone. FSH is follicle stimulating hormone. They do crosstalk to some degree, but LH mostly helps with testosterone production and mostly binds to the Leydig cell in the testicle. And FSH mostly binds in the seminiferous tubules and helps with spermatogenesis.

Brett McKay: So I mean listeners have probably heard reports that T levels in men have been declining in the past few decades. Do we know what’s causing this sort of general decline? Is it just all these lifestyle, like people are getting fatter, there’s not sleeping, they’re stressed, and the stuff in the environment is that kind of what we’ve decided is the cause of the lower T levels?

Dr. Kyle Gillette: The various causes that we’ve already discussed are likely the primary causes of what is causing declining testosterone levels. But I think there is another factor, and a lot of that has to do with what I’d call epigenetic drift. Some people might call it natural selection, I might call it unnatural selection, where individuals with higher testosterone levels are no longer being selected for as early. And also a lot of individuals are having kids later on in life, for example, in their 30s or even 40s, when you might have very different maternal and paternal hormone profiles. That’s one of the reasons why I recommend if men are taking medications like Finasteride or Dutasteride, that they stop their Finasteride 90 days before attempting conception and they stop Dutasteride, depending on what dose they are, usually six months before conception. By the way, spermatogenesis takes about 60 days or two months. That way they have enough time to wash out before they start producing the sperm in the germ cells so that they wouldn’t pass down any epigenetic changes to potential offspring.

Brett McKay: Okay, so maybe this is… The idea is that… Again, this is theoretical, right? The testosterone increases aggression and risk taking behaviors and that’s not as adaptive in our safe high tech modern landscape. So men with lower testosterone might be more successful these days and women choose those men for their partners and then when they have children, the men pass down his genes and then his children have lower testosterone too. And that just perpetuates, just lower testosterone in the male population overall. Also, this idea of selection, I’ve heard that, I read this somewhere, correct me if I’m wrong on this, that women on birth control, they’re not attracted to higher testosterone men. Is that true?

Dr. Kyle Gillette: Yeah, that is one of the major players of what I would call unnatural selection. Another interesting unnatural selection, I suppose, if you look at, not very recently, but the World Wars, certainly in World War I and World War II or in the Korean War or Vietnam War, but especially wars that… Even if a war has a draft, the individual that has higher testosterone and also more sensitive androgen receptors, so this is probably true throughout all of human history, you would… And this obviously cannot be proven scientifically, but theoretically that individual would be more likely to volunteer to go to the front line or to very risky positions. And if that male passes away at age 18 or age 19, then that is likely a fecundity rate of zero. So no offspring from that individual and then you start to have genetic drift.

Brett McKay: Okay, so again, this is theoretical, what you’re saying is that men with very high testosterone, they’re gonna take more risk and in doing so, that may take them out of the gene pool by taking those risks. And there’s more opportunity for that sort of risk taking during big global conflicts like the world wars, right? More high T men die, they lose the chance to reproduce and pass on their genes. And then that just contributes to the declining testosterone in men in general. And that’s gonna have echoes through the generations. And on top of that, we have selection factors going on in the mating market as well.

Dr. Kyle Gillette: Yes. And it’s not like it’s an be all end all. All or nothing. You select for high testosterone or you select for low testosterone. There’s a lot more psychosocial factors at play, but we are certainly seeing that there’s likely a decline in testosterone even a bit more than could be accounted for by just metabolic syndrome and sleep apnea. Maybe things like heat damage to the testicle, maybe things like xenoestrogens are playing some part in this, but we’ll probably never know. But it’s very fun to speculate about it.

Brett McKay: Well, the heat damage to the testicle, what would… Causes like keeping your laptop on your lap, sitting down a lot, would that cause heat damage?

Dr. Kyle Gillette: Probably not significantly enough, but if you already had a Varicocele and you already spent an hour in the jacuzzi, keeping your really hot laptop and phone directly over your scrotum is certainly not gonna help. I suppose someone could prove this at some point. They’ve actually done a lot of studies where they look at the scrotal temperature and they’ve randomized two groups of usually, college students and one group they have wear basically like a sock around their scrotum that has something really warm in it. So they warm up the scrotum artificially to 98 degrees instead of 91 or 92 degrees. And in the individuals that don’t have varicocele, they can still overcome that heat damage because their venous pooling mechanism is so good at buffering that heat damage. So that did not affect their testosterone production and it did not affect their spermatogenesis. However, in individuals that already have impaired venous cooling, for example, with varicocele or varicose veins then it did.

Brett McKay: We’re gonna take a quick break for a word from our sponsors. And now back to the show. Let’s talk about optimal levels of testosterone. So below 400, and if you’re experiencing low testosterone symptoms, that’s not good. Is there an optimal level, as like a level that guys should reach for or is it gonna differ from man to man?

Dr. Kyle Gillette: It certainly differs, but that’s kind of an easy answer. So I’ll get into it more than that. A lot of times people have told me that I say individualized, I say that word a lot because health is individualized. We are all unique, we have different genetics, we have different epigenetics and we have different growth and development past that as well. But for most men, an optimal testosterone level is between about 500 and as high as you can go naturally. So there is some individuals with a total testosterone of 1500, they almost always have really high SHBG. So a lot of times their free testosterones only 20 or 25, between about 550 and whatever you can produce top in endogenously naturally without medication.

Brett McKay: But you also said it could be lower. I mean you mentioned there are athletes who are at 450 and they’re healthy. So if you get a blood test and it’s below 500 a little bit, you probably… I mean, I guess you shouldn’t worry too much about it if you’re not experiencing any symptoms.

Dr. Kyle Gillette: Correct.

Brett McKay: Okay, that’s good to know. So let’s say a patient comes to you reporting symptoms of low T, you do a series of blood tests that show yeah, that your T levels are low, they’re below 400. What’s your first line of attack in helping this patient get his T levels up?

Dr. Kyle Gillette: First thing to look at would be LH and FSH. If those are really low, then I’m worried about the pituitary or the brain. If those are really high, then I’m worried about the health of the testicles. If they’re in between, then I look for another pathology like diabetes, metabolic syndrome, insulin resistance, sleep apnea, etcetera. I also look at prolactin and IGF-1, make sure you assess their tumor risk. And then I also look at estradiol. If it’s a very high estradiol, then estradiol is likely what is suppressing the production of LH from the pituitary. So you have estradiol, which is your main estrogen, which is causing less testosterone production. And in that case, I look at things like alcohol consumption that can up-regulate aromatase or consumption of excess calories or fat that can up-regulate aromatase, which converts testosterone to estrogen by the way. So those are the first things.

Brett McKay: Beyond that, what are you looking at?

Dr. Kyle Gillette: Beyond that, I’d like to, if pertinent, do an exam, make sure, especially if this individual is developing, if they’re an adolescent or whatnot, you need to make sure that they’re through all the tanner stages. Basically tanner stages one to five, five is done, when you’re essentially adult growth and development to make sure that they don’t have some unusual or unlikely syndrome. And then after that I’d like to look at their fasting insulin, their A1C, see if there’s something that I can correct. I look at their cortisol. If their cortisol is high, then there’s a lot of lifestyle factors and also supplements that can help control cortisol like Ashwagandha or Emodin. I look at their prolactin. So if their prolactin is just a little bit high, then maybe I do start them on some Vitamin B6 or some Vitamin E. If their estrogen is high, maybe I start them on some Calcium D-glucarate that helps with estrogen glucuronidation and metabolism. It basically helps you excrete it through your stool and then repeat labs in one, two, maybe even three months and see if we can improve those things along with, as always, diet and exercise.

Brett McKay: Okay. So it sounds like the first line of attack, if it’s not a pituitary problem, you’re gonna be primarily doing lifestyle changes, right? Quitting drinking, getting better sleep, diet, exercise to help get that insulin sensitivity back online. So yeah, lifestyle stuff would be the first line of attack and then will it take maybe one to two months before you start seeing results from that?

Dr. Kyle Gillette: Yeah, often it does. A lot of times you feel better the first week and a lot of times your testosterone production recovers very quickly. But occasionally, I use medications as well. So some people utilize a short course of HCG, which essentially binds the LH receptor, takes the place of LH and occasionally, I’ll utilize very short courses. By very short, I mean, a week or maybe two weeks of selective estrogen receptor modifiers or sometimes longer in the right patient, especially very young patients that you’re trying to stimulate endogenous production, these are often patients that desire fertility within the near to mid near future.

Brett McKay: Besides diet, exercise, sleep, managing stress, you mentioned a few supplements that you recommend men taking to optimize male hormones. Are there ones that you recommend for just any guy who… Maybe they don’t have any problems with testosterone but they just want to feel good? Are there ones that you like and that are safe?

Dr. Kyle Gillette: Creatine 5g-10g a day would be a great start. L-carnitine would be a consideration, especially if they’re interested in athletic performance optimization or body composition optimization, L-carnitine would be reasonable. Consider checking a TMAO to make sure that it doesn’t convert to that in too high of a rate. Another reasonable addition if someone has high estradiol would be Calcium D-glucarate to make sure that they’re binding up extra estrogen and excreting it.

Brett McKay: I’ve heard that Boron can impact testosterone. How does boron increase T levels?

Dr. Kyle Gillette: Boron works okay for people with really high SHBGs. It increases free testosterone by decreasing SHBG. The effect wears off to some degree if you take Boron for a very long period of time. If you have very low levels or you’re insufficient or deficient in Boron, it works extremely well and a lot of people consume Dates or Raisins because they tend to be relatively high in Boron.

Brett McKay: There’s another something I’ve been hearing about lately, Tongkat ali, I think that’s how you pronounce it. What’s going on with that one?

Dr. Kyle Gillette: Tongkat ali is also known as Longjack. So Tongkat’s active ingredients are Eurypeptides, one of which is Eurycomanone. And Tongkat is helpful because it upregulates a couple different enzymes in the steroidogenesis pathway. There’s been plenty of human study on it, with mixed results and it looks like the cause of the mixed results is, sometimes people have great activity of those enzymes. So that’s not the rate limiting step in testosterone production. So think of it as a signal, think of your testicles as a factory. Tongkat is a signal to that factory to ramp up production, but if your factory is already operating at maximum capacity or it’s limited by something else, then that’s not going to improve your testosterone level. Tongkat works on very similar enzymes that are also upregulated by insulin and IGF-1. So in general, if you’re in a caloric deficit or if you’re trying to lose weight or body fat, Tongkat will work better. If you have a low fasting insulin or a lower end IGF-1, Tongkat will also likely work better. And I’ve seen this anecdotally as well.

Brett McKay: A couple years ago, I remember ZMA was a big supplement that was pushed for increasing testosterone levels. Anything to that?

Dr. Kyle Gillette: ZMA is very reasonable to add if you have a low alk phos. So if you look at your CMP, which is your metabolic panel, there’ll be an enzyme called alkaline phosphatase. Alkaline phosphatase along with GGT are two intracellular enzymes. And the lower these two are the more likely you are to have insufficient levels of Zinc and magnesium. That’s why when I have input to various companies designing a supplement to optimize testosterone, I almost always put in Zinc, Magnesium and Vitamin D. You just wanna make sure these aren’t the right limiting step. Think about trying to optimize your testosterone is like trying to get into a fraternity. You’re not just making best friends with one of the people and then just hoping that nobody else will blackball you. You wanna make sure that you address each individual because if you… Let’s say you forget your Vitamin D and forget your Zinc, you’re deficient in Zinc, you’re deficient in Vitamin D, those two things will hold you back.

Brett McKay: Once you start down this path of increasing your testosterone or getting them optimized, is there any benefit to getting them higher? So let’s say you started off at 400, you had low T symptoms and then through lifestyle changes and maybe taking some supplements, you bump it up to like a 700. Are you gonna get any more benefit from testosterone by getting it up to 800 or 900?

Dr. Kyle Gillette: Past about 600, there’s little to no benefit, other than bragging rights.

Brett McKay: At what point would you have a patient go on testosterone replacement therapy?

Dr. Kyle Gillette: At any point when the risks outweigh the benefits and they understand both the risks and the benefits in their own terms.

Brett McKay: So what are the risk of TRT?

Dr. Kyle Gillette: Yeah, one of the risks is it causes more fluid retention and swelling. One of the risks is if you hyper convert to estrogen, estrogen will then bind to the liver and cause more SHBG and platelet production. And if your platelets go very high past a certain point, we know that people on oral estrogen, the blood clot risk is associated with how high their platelets and SHBG go. It’s likely the same for TRT. So if you go on TRT and you go into a huge bulk and you start consuming a bunch of alcohol and your platelets skyrocket, then it is gonna increase your blood clot risk. So TRT is not in and of itself going to improve health, it’s just going to be a tool to help you achieve a lot of your goals. Another risk of testosterone is if people have heard of medications called statins. Those work by decreasing the activity of an enzyme called HMG-CoA reductase. Any androgen including testosterone increases the activity of this enzyme. So often people’s cholesterol and it’s not actually cholesterol, they are lipoproteins, but people’s “bad cholesterol” gets worse. That’s why we watch that ApoB number very closely because we know that ApoB is the particle that is going to lead to plaque formation in areas like the coronary artery.

Brett McKay: And I guess the benefits of TRT is that you’ll mitigate those symptoms of low testosterone?

Dr. Kyle Gillette: Correct. And there’s of course other benefits as well like the benefits of estrogen, that we discussed earlier, being it’s cardioprotective benefit. And one of the main benefits of testosterone in a lot of individuals that I see start is they might have a… Let’s say they have an A1C of 5.7 or 5.8, which is technically pre-diabetes. You’re very unlikely to get diabetes on testosterone compared to if you are not on TRT. So a lot of individuals, perhaps they’re, I wouldn’t say doomed, but very likely to get diabetes and TRT can make a huge difference, especially when combined with other insulin sensitizing medications to prevent that.

Brett McKay: Do you keep people on TRT indefinitely? Is it like once you start to keep doing it or are there periods where you’re like, “Well, we’re gonna take you off and see what happens” or well how does that work?

Dr. Kyle Gillette: Most individuals are on indefinitely, but not everyone. Occasionally there’ll be a patient that is profoundly hypogonadal and the benefit of testosterone at that time is just huge. Let’s say it’s a patient who has a BMI of 40 and they weigh 400 pounds and they also don’t have a huge amount of lean body mass to lose in proportion. Everybody who weighs 400 pounds is gonna have a lot of lean body mass, but just less relative to your average person and they wanna maintain as much of that as possible. They need that tool in order to exercise, even if it’s somewhat of a placebo tool, that still helps. So if it gets them having a very healthy lifestyle, they go on that medication, perhaps they go on another medication like a GLP-1 for a short period of time and then they don’t really know what their baseline testosterone is. So maybe after two years they’ve learned those lifestyle interventions. They very slowly are ready to come off of every medication and then you can use a medication like HCG to help restore natural production. Perhaps one week of a medication like Enclomiphene or Novedex or even Raloxifene. And then you see what their natural production capability is. You give them a few weeks and perhaps they restore to a total testosterone of 600s, which is likely quite good in that situation or perhaps they go down to 100s again.

But a lot of people would want that chance to go back to producing their testosterone naturally. And in some cases it does work. I would say 90% of people that start on testosterone are going to remain on it indefinitely. But I would also say that 90% of people that go on testosterone can very likely regain at least their previous level of testosterone if they were to want to come off.

Brett McKay: Well, here’s a question. With female hormone therapy, you might start taking it during menopause to help with symptoms, but at a certain point, once menopause is over, I think you’re supposed to get off those hormones. Does something like that happen for men? I mean, you might do TRT throughout your 50s and 60s and then at a certain point you’re in your 70s and you’re like, Well I don’t need to do this anymore. Or are there 80-year-old or 90-year-old guys taking TRT?

Dr. Kyle Gillette: There are 80 or 90-year-old guys taking TRT. Occasionally, you’ll do a dose adjustment. It just kind of depends on the situation, but a lot of times when males reach that age, they are less likely to have as much benefit and they are more likely to have slightly more harm. So it’s a moving target over time where you get out the scale and you’re weighing the risks and the benefits and at that point when a patient’s already on TRT, you also weigh the risks of how difficult it would be to come off, which is not extremely difficult. But it is difficult because there’s medication regimens that you have to go with and even with those medications often there is a short period of time when you don’t feel great.

Brett McKay: So we’ve been talking about optimizing male hormones in grown men, but let’s say we got some dads and moms out there listening and they’ve got boys who are about to start or are in the middle of puberty. What can they do for their sons? What can young guys do to make sure they set themselves up for a lifetime of male hormone optimization?

Dr. Kyle Gillette: First and foremost, no huge dirty bulk in early adolescence. What I mean by that is, I mean, let’s say there’s somebody that’s trying to put on weight for football or whatever other reason, can’t think of any reasons where it would be worth it, but they’re putting on weight and also putting on fat. Adipose tissue in fat, adipose tissue is fat, that is going to increase the conversion to estrogen and estrogen is gonna close the growth plates of the bone. So that’s gonna prevent you from reaching full stature, both in height and other areas of your skeletal developments as well. So that’s a great initial recommendation. Thinking about gut health and fiber consumption is also very important. That’s gonna prevent, again from over, it’s called intrahepatic circulation of estrogen. Estrogen is not necessarily the enemy. In fact, a little bit of estrogen is neat to what’s called priming the pituitary in order to fully kickstart adolescence.

And that’s one of the reasons why boys with very high body masses have higher estrogens. The pituitary gets primed too early and something called precocious puberty is happening, which is too early of puberty. So that’s another thing to consider. In addition to that, you wanna have a reasonable balance between cardiovascular exercise and resistance training. You certainly want to do both because adolescents can be thought of as your free endogenous steroids of, I’ll say cycle, just because people understand it. But your free endogenous steroid boost where you know you are going to be one, super sensitive to all the androgens that are released, probably most people remember puberty and you’ll also be having a lot of androgen around, regardless of what you do, even if your health hasn’t been great. So when that endogenous steroid burst happens, that is the perfect time to take advantage of those lifestyle tools to build up very high bone mineral density and very high lean body mass without putting on excess body fat.

Brett McKay: I imagine young people getting plenty of sleep is important too.

Dr. Kyle Gillette: Yes, extremely important. And that might be one of the most common causes of suboptimal hormone profiles in adolescents.

Brett McKay: What about supplementation? Is supplementation something you encourage in young people to optimize their hormones or is you just focus on the diet and exercise?

Dr. Kyle Gillette: With the oversight of a doctor, I do encourage supplementation, if it makes sense. For example, let’s say there’s a young person and they get a stool test and the beta-glucuronidase enzyme is very high. We know that that individual is just recycling their estrogen over and over again, that makes something like a Calcium D-glucarate or with the oversight of the doctor maybe even a very low dose of an aromatase inhibitor, a very reasonable addition. And then if you get blood tests, you can actually check the hormones to make sure that they’re increasing at the correct rates, that your DHT is optimal, your testosterone’s optimal, your estradiol is optimal, your IGF-1 is optimal, and then you can tweak a supplement. Supplements are just like medications, they have pharmacologic effects so they have an effect on the body and the body metabolizes them.

So things like Creatine can be very reasonable. Creatine does not affect the development of the kidneys. I did a podcast with my good friend James O’Hara recently. We get a lot of questions from pediatricians because the AAP, which is a society of pediatricians, still recommends no Creatine supplementation whatsoever up to the age of 18. So not even, not even a 17-year-old. So I just kind of thought that was… And it’s been 15 years. So they’re gonna update their recommendation within the next couple years whenever they have a joint meeting. But that’s definitely a vestige of times past when we thought that Creatine was harmful to healthy kidneys. You just check a Cystatin C because Creatine makes your creatinine blood marker look abnormally high. Falsely high. So Creatine can make sense in a lot of kids as well. And then if there is a kid that has really low insulin IGF-1, sometimes Tongkat makes sense in that individual.

And then in some kids that do have optimal hormone profiles, let’s say there’s an athlete and he’s developing or she’s developing and they have very high testosterone, very high IGF-1, that’s great, you know that Myostatin levels are gonna be really high after you have that burst of androgen during adolescence. Myostatin is gonna stop the muscle from developing and cause you to start putting more fat into the tissue. I think that Myostatin inhibitors, week ones like Fortetropin, which comes from fertilized egg yolks or Epicatechin. CocoaVia is a good source of Epicatechin. Different cocoa powders have a lot of Epicatechin. Green tea has EGCG, which is another Epicatechin. Basically, those take down the levels of Myostatin. Those are also very reasonable to take for the right patient.

Brett McKay: What about, should parents be sweating about xenoestrogens in their kids? Like, make sure they get certain types of deodorants or cosmetic products and avoiding plastics?

Dr. Kyle Gillette: Bisphenol A and phthalates. Yes. That’s kind of where I personally draw the line, where if you are worried about every single thing, we live in an unnatural environment, more so than ever. So those are usually the ones that I say to avoid. If you live in an area that more likely has contaminants and microplastics, a lot of times I do recommend testing your water. There are a lot of services that do this. I personally used MyTapScore to test both the water, from the tap and the water through my Berkey filter. If you have young children. And that seems like a very reasonable time to use a water filter if you don’t know what the contents of your water is. And then as far as foods, of course, avoiding ultra processed foods, I think, it was ultra processed mac and cheese that got a bad name for having high phthalates. I assume they fixed that by now, but I actually don’t know. So a lot of times it’s the same recommendations as any other whole food diet. And then know your sources, try to avoid contaminants at very high levels and use the Pareto principle, try to do right most of the time and you’ll get most the benefit even if you’re just doing it some of the time.

Brett McKay: Well Kyle, this has been a great conversation. Where can people go to learn more about your work?

Dr. Kyle Gillette: My hub is on Instagram, kylegillettmd, and it’s Gillett Health on all other platforms. I do have a podcast that we fairly recently have, I guess, gotten pretty good audio and video of, but that’s on YouTube, Spotify and Apple Podcasts. We have a clinically, I guess, a clinical grade podcast. And then we have a layman’s podcast that we’re gonna call After Hours, which should provide good entertainment.

Brett McKay: Fantastic. Well, Dr. Kyle Gillett, thanks for your time. It’s been a pleasure.

Dr. Kyle Gillette: Thank you.

Brett McKay: My guest today was Dr. Kyle Gillett. You can find more information about his work at his website, gilletthealth.com. Also, check out his podcast, Gillett Health podcast and check out our show notes at aom.is/optimalt where you’ll find links to resources where we delve deeper into this topic.

Well, that wraps up another edition of The AOM podcast. Make sure to check out our website at artofmanliness.com, where you can find our podcast archives as well as thousands of articles that we’ve written over the years about pretty much anything you think of. And if you’d like to enjoy ad-free episodes of the AOM podcast, you can do so on Stitcher Premium. Head over to stitcherpremium.com, sign up, use code MANLINESS at checkout for a free month trial. Once you’re signed up, download the Stitcher app on Android or iOS and you can start enjoying ad-free episodes of the AOM podcast. And if you haven’t done so already, I’d appreciate if you take one minute to give us a review on Apple podcast or Spotify, it helps out a lot, and if you’ve done already, thank you. Please consider sharing the show with a friend or family member who you think could get something out of it. As always, thank you for the continued support. And until next time, it’s Brett McKay, reminding you to not only listen to the AOM podcast, but put what you’ve heard into action.

The post Podcast #893: Optimize Your Testosterone appeared first on The Art of Manliness.

Every gym has that person.

The person who loudly grunts and yells when he’s exercising. This guy is an extreme example of the phenomenon.

While it seems like it’s dudes who are more likely to grunt while working out, women sometimes do it too.

When I was in college at the University of Oklahoma, there was a girl who would grunt with abandon while she sprinted on the treadmill in the student gym. So as you did the elliptical machine while watching VH1’s Tool Academy (the pinnacle of the classical era of reality television), you could hear her carry on, making loud noises that sounded like she was giving birth. 

When I’m lifting really heavy, I’ll do some subtle grunting. I don’t do it on purpose. It just sort of happens. Instead of a loud yell, it sounds like I’m straining to release a built-up bowel movement. When I’m doing Bulgarian squats, I’ll let out a fairly loud “AHHHHH!” as the lactic acid accumulates in my quads. It seems to help me finish those last few reps. The operative word here is seems.

After I finished a recent set of yelly Bulgarian squats, I pondered, “Does yelling, moaning, and grunting actually do anything for my lifts? Does it help me hoist heavier weights, or is it just cathartic and/or theatrical?

AoM investigates.

The Science of Grunting, Yelling, and Moaning While Exercising

Believe it or not, scientists have researched this very question. 

In 2014, sports scientists Chris Rodolico and Sinclair Smith conducted an experiment involving 30 participants squeezing a handgrip in three ways: just squeezing, squeezing and exhaling, and squeezing while making a vocalization. The researchers found that more force was generated when exhaling compared to just squeezing, but the most significant increase in force (10%) was observed when the subjects vocalized while squeezing.

So yelling and grunting does make people stronger, at least on grip tests.

A similar 2014 study examined whether yelling and grunting helped tennis players hit the ball harder. Thirty-two athletes participated, and stroke velocities and isometric forces were measured while they grunted and while they didn’t. The results indicated that dynamic velocity and isometric force increased nearly 5% when the athletes grunted during both serves and forehand strokes. 

This adds more affirmation to the idea that vocalizing while exercising does make you stronger. 

But why does it have this effect?

Sinclair Smith hypothesized that yelling could activate the autonomic nervous system, which controls the fight-or-flight response, resulting in an adrenaline rush that helps muscle contractions become more complete and forceful. It’s the same idea behind the research that’s shown that swearing can increase your tolerance to pain.

When availing yourself of the force-generating power of yelling and grunting, you’ll of course need to exercise some discretion, especially when you decide to unleash your barbaric yawp while deadlifting in a public gym. It can be annoying and distracting to some people, so practice good gym etiquette. If you’re in a black iron powerlifting gym where such behavior is expected, then yell with abandon. If you’re in a more sedate, upscale gym where most of the clientele are retirees working the Nautilus machines, rein in your exercise noises. And if you’re in a Planet Fitness, you’ll have to decide if goosing your chances of hitting a bench press PR is worth activating the Lunk Alarm.

The post Does Yelling While Exercising Make You Stronger? appeared first on The Art of Manliness.

One of my favorite things about my recent interview with Kelly Starrett about essential health practices was that he reintroduced me to the concept of “sleep pressure.” I know I had heard the phrase before, but I hadn’t thought about it in years. Since our conversation, it’s been regularly on my mind and given me a great rubric for making decisions around my daily routine.

Sleep pressure, as the name implies, is the drive towards sleep that accumulates during the day. Interestingly, scientists aren’t entirely sure what creates sleep pressure, but it’s believed to be related to the creation of adenosine. This makes sense: adenosine is a chemical that helps regulate the sleep-wake cycle, and just like sleep pressure, it rises during the day and falls while you slumber. Adenosine is produced when cells consume energy. The more physical and mental activity you engage in during the day, the more adenosine is created, and the more tired you become.

You certainly don’t need a biology degree to understand the dynamics of sleep pressure; it’s a phenomenon you’ve experienced firsthand. Think back to times you hiked all day or spent hours swimming in the ocean; how did you sleep that night? Probably amazingly well because of the huge sleep pressure you’d built up. As I mentioned in my conversation with Kelly, I still remember the sleep I got while visiting Italy as the very best sleep of my life. Kate and I walked miles and miles and miles around Rome during the day, under the bright hot sun. When we’d get back to the hotel at night, we’d both fall asleep the instant our heads touched the pillow and stay in an utterly dead-to-the-world state of profound unconsciousness until morning. That’s the power of sleep pressure.

People often complain of trouble falling and staying asleep and seem uncertain as to why they experience these issues. But it’s usually not a great mystery: they spend most of their day indoors, sitting and sedentary. Little activity = little sleep pressure = poor sleep.

While few of us have schedules that will allow for doing hours of activity every day, all of us can incorporate a little more effort, sweat, and sunlight (fresh air and sun both seem to increase sleep pressure for some reason) into our daily routines. Move more. Spend more time walking. With the clients he’s worked with, Kelly has noticed that improvement in sleep begins to kick in once you start hitting just 6,000-8,000 steps a day. When he had special operators in the Army’s Delta Force add 12,000-15,000 steps on top of their usual day-to-day training, it effectively squashed their insomnia problems altogether. 

What’s great about sleep pressure is that building it requires doing the kinds of practices that contribute to overall health but can be tempting to skip because the benefits are longer-term and less tangible. Better sleep is a visceral, short-term reward that’s easier to get motivated to work towards. 

Sleep pressure is a simple concept, and once you absorb it, you’ll start looking for ways to increase it as you go about your day. We created the visual guide above to help get it ingrained in your head so that throughout your daily routine, you’ll be thinking about where your sleep pressure dial is sitting, make choices that move the needle in the right direction, and enjoy deep, restful sleep every night as a result. 

For more tips on the health practices that will enhance your everyday vitality, listen to our podcast with Kelly Starrett:

The post The Importance of Building Your Daily Sleep Pressure appeared first on The Art of Manliness.

There’s plenty of advice out there about how to have a better daily routine. But what’s just bunk and what actually works to improve the quality of your day and your overall life?

My guest, medical-doctor-turned-science-educator Stuart Farrimond, took a deep dive into the research to find the authoritative answers to that question, and he shares them in his book Live Your Best Life: 219 Science-Based Reasons to Rethink Your Daily Routine. Today on the show, we walk through a daily routine, from morning to night, and Dr. Farrimond shares some best practices to make the most of it. We discuss why waking up to an alarm clock feels so terrible, why you shouldn’t drink coffee first thing in the morning, the ideal length for an afternoon nap, how to improve your commute, the best time of day to exercise, and more.

Resources Related to the Podcast

• AoM Article: What Every Man Should Know About Sleep
• AoM Article: The Digestive Power of an After-Dinner Walk
• “It’s Not Just What You Eat, but the Time of Day You Eat It”
• AoM Article: How to Stop Your Snoring
• AoM Article: Unleash the Power of the Nap
• Sunday Firesides: Your Routine Needs Rites of Passage

Connect With Stuart Farrimond

• Stuart on IG
• Stuart on Twitter

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Read the Transcript

Brett McKay: Brett McKay here and welcome to another edition of the Art of Manliness podcast. There’s plenty of advice out there about how to have a better daily routine, but what’s just bunk and what actually works improve the quality of your day and your overall life? My guest, medical doctor turned science educator, Stuart Farrimond, took a deep dive into the research to find the authoritative answers to that question, and he shares them in his book, Live Your Best Life: 219 Science-Based Reasons to Rethink Your Daily Routine. Today on the show, we walk through a daily routine from morning to night, and Dr. Farrimond shares some best practices to make the most of it. We discuss why waking up to an alarm clock feels so terrible, why you shouldn’t drink coffee first thing in the morning, the ideal length of an afternoon nap, how to improve your commute, the best time of day to exercise and more. After the show’s over, check out our show notes at aom.is/dailyroutine.

Alright, Dr. Stuart Farrimond, welcome to the show.

Stuart Farrimond: Thanks for having me.

Brett McKay: So you started off your career in medicine, but then you made the jump to science writing, particularly you writing about health and science for a lay audience. Why did you make that jump?

Stuart Farrimond: Yeah, so originally I was a medical doctor. I was working in a UK hospital, so I’m based in the UK and we’re talking about 15 or so years ago, I was diagnosed with a brain tumor, so it was just kind of completely out the blue, unexpected. I was having some tests for some other stuff. It was discovered and I actually had the scan and the result whilst I was at work one day and essentially it was a cancerous and malignant brain tumor that I had to have surgery on pretty much straight away. So I guess what was I was 25 or so, yeah, about 25 when I was diagnosed with it. So I had the surgery, it went well, but it left me with epilepsy afterwards. And because of the epilepsy, it basically meant that I couldn’t carry on with medicine because part of the, as I’m sure you appreciate part of the job of being a hospital doctor is that you gotta do hours of hours on calls, night shifts, things like that.

And basically I couldn’t really do that and not risk having a seizure in my profession. So that led to me having to step down from medicine, sort of take basically long-term sick or they always sort of say, well, keep the job that you can always come back at any point. But basically I don’t really… How can… My epilepsy is never gonna go away. My brain tumor’s never gonna go away. So I’ve never been able to go back. To be fair though, I don’t miss it because after I left medicine, I got a job in teaching and I taught for three years in a further education college in the UK and further education colleges, they’re like a halfway house between school and university. And I ended up teaching science themed topics to young people who were interested in going to some kind of health profession.

And I just really fell in love with teaching and then busting people’s ideas of what science is, because I don’t know about you, but at school for many of us, science was this really dull and dry subject. And actually for me now, I find that science is a thing that helps us understand the world and actually makes me more amazed about the world around me, how my body works and I wanna share that with other people. And I discovered the joy of doing that when I was doing this teaching job. And then it kind of evolved into doing things more broadly. And I realized that actually these 16, 17, 18 year olds, they don’t really appreciate the science of the every day and they reflect pretty much what the average Joe on the street appreciates. And so I realized actually if I can reach more people, then I can touch their lives in ways that help them actually appreciate the world more and appreciate how science can inform pretty much every area of your life. And that’s where I am now. So I write books about lots of different themes. I do quite a bit on the science of food and cooking, as well as this book that we’re gonna talk about today, which is about health and wellbeing, about pretty much every area of your life.

Brett McKay: And what’s the state of your brain cancer today?

Stuart Farrimond: So my brain tumor is that it was a low-grade glioma. A glioma is basically the name for these tumors. Probably the most common types of these malignant brain cancers, although that said all brain cancers are quite rare. It regrew a few years ago, it came back and it’s now more aggressive than it was. It’s gone from what’s called a grade 2 to a grade 3. So it’s more aggressive than it was before. And I’ve had to have more surgery and chemotherapy and radiotherapy, which happened, I guess about three or so years ago. And I finished off my chemotherapy during the COVID lockdown. So the first lockdown, so we’re talking 2020 February time, that’s when I sort of, I finished the treatment of most recently and I just have three monthly scans for the tumor. And thus far since then, it’s not been growing, which is pretty good.

I think that’s sort of, it’s unexpected. So I’m doing pretty well things considered. So that’s where I’m at. So every three months I go through the mill of, is it growing back? Is my life gonna just turn upside down with one day, one results? So just sort of always living under that cloud. But it does make you really appreciate every day. And so when I write my books, when I do talking, when I’m on this podcast with you, it matters because I may or not be here for, well, nobody’s gonna be here forever, but I appreciate that life is very, very temporary and very fleeting. So you wanna make everything count.

Brett McKay: Yeah. And you mentioned in the forward of this book we’re gonna talk about, Live Your Best Life, you were finishing this while it was during COVID and you were doing your treatments and you said that… You know, the questions you ask, you answer or seek the answer in this book. Things like how to get the best sleep, what’s the best breakfast, what’s the best way to not be stressed out at work? A lot of people will think, “Well, that’s kind of mundane and straight” but for you, you mentioned like, “Well, no, actually this stuff’s really important.” ever since your diagnosis, like you said, you have an appreciation for these really small things. These little small things add up to make a life well lived. So your book, Live Your Best Life, it’s organized around questions, but then you organize these questions about our daily routines. So you start off in the morning, work your way to the afternoon and then to the night. So let’s start off with the morning and take a look at some of these questions you answered, one question I think some people might have had is why is it that sometimes when we wake up we feel refreshed, ready to take on the day, you just feel awesome, but other mornings you just feel super groggy and it takes like an hour to fully awaken? What’s going on there?

Stuart Farrimond: Yeah, so that groggy sensation that you get in the morning when you sort of feel half drunk, almost kind of zombie-like we have a name for that and that’s called sleep inertia. And basically what’s going on in your brain is it’s not fully switched on yet because waking up in the morning, you’re going from this comatose unconscious state into the land of the living and it takes a while for your brain to switch on for all those cogs to get going, like getting a car start on a cold morning, that sort of thing. And that’s called sleep inertia. Whether you get sleep inertia varies on how well rested you are and also interestingly how you woke up. So when we sleep, we go through different stages of sleep, we cycle between going through deep sleep and light sleep. During deep sleep is when we’re snoring and that’s when all the restorative work goes on, in light sleep that is when we’re dreaming.

That’s when if you were to lift some of these eyelids up, you’d see their eyes darting left and right. And sometimes that’s when we speak, when words sort of escape from our dreams. And if you wake up from the deepest sleep, from the deep sleep, then you will wake up quite groggy. Whereas if you wake up from the light sleep, from the dreaming sleep, which is the natural way for you to do, in the early hours, you dream more and then you naturally come out of that into waking. But if you wake up from the deep sleep, you will generally wake up with that grogginess. So several factors, one of which is if you are poorly rested, you’re more likely to have it. If you are stressed, you’re more likely to have disturbed sleep and you are more likely to have this sleep inertia.

A lot of us though, do just get sleep inertia in the morning. And so I would always say, and part of what I put in the book is that don’t check your smartphone first in the morning because regardless of how well you slept that first 30 minutes, you will be experiencing some sleep inertia. When you look at people’s brain scans during that time, your brain actually looks like you are slipping back into sleep again. So you are only actually half awake, which is why you shouldn’t really make any decisions first in the morning. You should just get yourself up, get yourself going, get yourself in the shower, whatever your morning routine is, and then hold off checking emails, all the other stuff, all the Jesus of the day, up to later on and interesting I think that is why, because we can’t make decisions very well first thing in the morning.

Why I think we tend to have the same thing for breakfast everyday because we can’t cope with making difficult decisions first thing in the morning. So sleep inertia lasts about half an hour can last up to 2 or 3 hours depending on all those different factors that I’ve mentioned. There’s no solution for it. You’ve just gotta ride it out. But just be aware of it. So let yourself ride out. You guys be very wary about jumping in the car straight after waking up because you will be suffering from this and so you will be at higher risk of making mistakes when you’re in the car during that time.

Brett McKay: Well, another thing you point out too is the sleep inertia that’s caused by waking up during a deep sleep is one of the reasons why you don’t wannna hit the snooze button on your alarm because you’ll fall back to sleep and you might fall back into that deep sleep and then you wake up and you’re all groggy.

Stuart Farrimond: Yeah, absolutely. So alarms, ideally, in an ideal world you would wake up naturally and that is when your body is naturally used to waking up. You’ll find this out is that if when you’re on vacation and there’s no pressure, you’ll find out what your natural waking time is and that will give you a good gauge. And if you have a job that lets you, and if you can have any capacity to change your job so that you can have it so that you wake up at your natural waking time, that is the ideal. Unfortunately, many of us have to have alarms ’cause alarms aren’t very good ways of waking up because they basically stimulate our primitive vital flight response. We wake up as if a panther has just, or a tiger just walked into our room. It’s that there’s this part of our brain called the amygdala, which is alert to threats all the time, even when we’re asleep.

And so when you have a loud noise, it fires off the amygdala, gets adrenaline going, gets you fired up, you wake up with a jolt basically because your primal brain thinks there’s a threat. So you’re not in a great place when you wake up. You’re not waking up relaxed, calm, ready for the day. You hit the snooze button and you’re quite right, 10 minutes or so on the snooze button is just about the right time to start slipping into the deep sleep. You then can wake up back into a jolt again. And so actually you feel increasingly groggy And actually all those sort of rude awakenings, they kind of add up. And so they all increase your stress levels in the morning. And furthermore, if you wake up naturally or you just wake up, you just get up. When you wake up naturally you’ve got a natural chemical boost from a hormone called cortisol, which is a stress hormone that is released when you wake up. It’s been building up slowly in the early hours, getting you ready for waking up. When you wake up you get this surge like a jab in the arm of this hormone called cortisol. It’s the stress hormone. That’s what gets you going. If you stay in bed, if you keep hitting the snooze button and that will fade away and so you’ll lose your natural get up and go hormone.

Brett McKay: Okay, so we wake up, we might be having that sleep inertia, feeling groggy, I think the first thing that a lot of people do to counteract that is like, “Well, I’ll just have my morning caffeine.” Whether that’s coffee or tea or some other type of caffeinated beverage. But you’ve found research that suggests drinking coffee or caffeine first thing in the morning, you’re actually not doing anything. Why shouldn’t you drink your caffeine right when you get out of bed?

Stuart Farrimond: Yeah. Answering this question, if I’m gonna give an answer to the best time to drink coffee, if it’s different to what you do, most people don’t like to hear it ’cause everybody thinks their way of drinking coffee is the right way of doing it because they find that helps them. In reality, when you look at the science, if you find out how caffeine works, then you can understand when the best time should be to have coffee. Caffeine works by blocking a naturally sedative relaxing chemical in the brain called adenosine. And this is a substance that is produced naturally throughout the day. When you wake up in the morning, it’s very low.

Throughout the day, it builds up and it builds up. It’s sort of like a waste product of your brain throughout the day. When you sleep at night, your brain gets rid of it all and it’s adenosine that makes you sleepy. Not the sleep hormone called melatonin that people so often know about when people… People take melatonin supplements because they think it’s gonna help them sleep, most of the time it doesn’t do anything at all. The thing that makes you sleepy is this brain hormone called adenosine and caffeine works by blocking that substance, that adenosine. And that’s great because in an evening or if you are driving in an evening and you need to sort of a pick me up to keep yourself going, then having some coffee, that will keep you going, that will keep you on the road because it knocks the edge of this adenosine that is making you feel sleepy and wanting to make you to go to sleep.

But first thing in the morning, that is the time when you have your lowest levels of adenosine. So you have your coffee first thing in the morning and actually it’s not gonna be doing much. It’s like you’ve already got this get up and go hormone called cortisol, getting you going first in the morning. Having coffee on top of that is basically like throwing a couple of matches onto an already raging bonfire. It’s not gonna do very much. And actually first in the morning, strong coffee is more likely to make you jittery and give you the side effects of caffeine, make you more uptight, make you a bit more anxious rather than when actually if you’re gonna have coffee, you’re gonna have caffeine and you want to have it so that it picks you up and it gets you going. So a sort of a nice way of doing it is to wait an hour, hour and a half, maybe a couple of hours into the morning. So the cortisol shot in the arm has started to fade and Adenosine has started to come up, so that mid-morning when you’re starting to feel a bit sluggish, and that will be a time when to have your coffee that it will actually… You get much more bang for your buck if you have your coffee then.

Brett McKay: Okay, so shift to two hours, or wait an hour to two hours.

Stuart Farrimond: Yeah.

Brett McKay: Let’s talk about breakfast. Is there an ideal breakfast that will help us get going in the morning?

Stuart Farrimond: Now breakfast is interesting one ’cause that’s, it’s a meal for which we have breakfast foods for, and we don’t really have lunch foods or evening meal foods, but we have breakfast foods, which is kind of a curious thing, across the world there will be breakfast foods. And you tend to find that if you take a step back and you look across cultures that breakfast tend to be based on starches, on carbohydrates or what you call carbs. They’re the things that provide the… And I know that they’re sort of, they’re seen as a bad thing these days, carbs are, but actually they’re the main fuel for your brain. They’re the main fuel for your muscles. So if, especially if you’ve got an active job, if you’re a kid, then breakfast is really important and ideally it should be based on carbohydrates ’cause they’re the main fuel that your body and your brain likes to use.

You can get by without it. And interestingly, if your body, if you’re not a morning lark, if you wake up in the morning and actually you don’t want breakfast, it doesn’t feel right for you, your body isn’t asking for it, then there is no benefit in forcing yourself to have a breakfast. Skipping breakfast does not make you put on weight. There is no evidence for that. And actually when they’ve done the studies and they’ve got people to skip breakfast, they actually lost weight compared to putting it on. So it’s a myth that the breakfast is the most important meal of the day. Many people will need a breakfast because of their lifestyle, because of their body clock, but it’s not the thing that it’s made out to be.

Brett McKay: It’s interesting your observation about there being special breakfast foods across cultures and that they’re usually carby foods. There’s been some research coming out that our bodies metabolize carbohydrates and just food in general better in the morning and we get less efficient at it as the day wears on. And so maybe there’s like some wisdom into how people used to schedule their meals, right? Like today, our biggest meal for most people in the west, it’s dinner and we eat that late. But a couple centuries back, the biggest meal of the day was, well they called it dinner but it was like at midday, right? So they had a really big, what we would call lunch and then they just have a very light supper in the evening. So it might be better for you to eat more of your carbs and calories earlier in the day.

Stuart Farrimond: And there is some evidence for that. And I think eating big and late at night that that is linked with poor sleep. There is definitely evidence for that because at nighttime everything shuts down. The whole intestinal system goes into sleep much like the rest of you. So if you have a big meal at night, it’ll just be sitting there largely overnight and actually that’s not very good for you really because it’s gonna more likely to give you indigestion, it’s gonna disturb your sleep, as you process the food your intestines generate quite a lot of heat in that process of digesting the food. So especially protein, that’s something that generates a lot of heat. Your body has to work quite hard to process that, to digest it, which is why you’ll get meat sweats at nighttime if you had a big meal in an evening.

So whether it’s bad for putting on weights, that’s a controversial thing, but generally speaking you’re probably best avoiding a large meal on the evening. That said in the Mediterranean they eat really late and people only sit down for the evening meal about 8 o’clock in the evening oftentimes. And I don’t know how they do it, typically you’d have it like a pastry and a coffee first in the morning as your breakfast, then you’d have have a lunch and then you’d have a big thing in the evening meal. And that’s the way they’ve always done it. And I don’t know how they do it because generally, the evidence would say that’s not the ideal way of doing things. So yeah, you’re quite right is that a big meal in the evening is probably not ideal for most people.

Brett McKay: Okay, so you’re eating breakfast in the morning, maybe. You don’t have to eat breakfast necessarily, but you’re probably, hopefully definitely brushing your teeth. So what’s the best time to brush your teeth? Is it before you eat breakfast or after?

Stuart Farrimond: It depends what you have for your breakfast. If you have anything citrus for breakfast. There’s pros and cons of each of them. If you have anything with citrus for breakfast, then avoid brushing afterwards because citrus and indeed carbonated drinks are quite acidic and if you have something acidic, then you brush your teeth, there is a risk that you start to brush off the enamel, which is the super hard, very white protective coating that’s on the covering of your teeth. So I would say typically it’s better before because it means that you can get rid of the detritus from overnight. We often wake up with very bad breath in the morning and that’s because there’s been an overgrowth of bacteria in the night because we produced less saliva over the night and saliva has antibacterial properties in it. And so overnight we’ve had this overgrowth of bacteria. So it’s good to… You could brush before and afterwards that would even be better providing that you haven’t had anything citrus for breakfast.

Brett McKay: We’re gonna take a quick break for a word from our sponsors.

And now back to the show. So let’s move on to our commute. A lot of people commute’s like the worst part of their day. Why does our commute make us so miserable? And then anything we can do to improve it.

Stuart Farrimond: Yeah, yeah. And research shows that an extra 20 minutes onto your morning commute can impact job satisfaction as much as a 20% pay cut. And what happens is that we associate our commute with our job. Psychologically we see it as one and the same thing. So if we don’t enjoy our commutes, it means that our job satisfaction overall will be lessened. So likewise, if you can improve your commute, then you can improve the quality of your job experience. 90 minutes of total commuting time a day seems to be the turning point for when it starts to impact our health. So if you are commuting 45 minutes each way, then that’s a point at which you gotta be very careful that it may be impacting your health. Because if people have a total commute of more than 90 minutes every day they tend to be… They weigh more, they’re more likely to have diabetes, more likely to have higher blood pressure. All the things that we associate with the ills of the day, they are linked with longer commutes.

And that’s largely if you… Because most people commute, they do it sedentary, they’re doing it in a car or they do it on some kind of public transport. To improve your commute, in any way you can, make it as active as possible. So walking, cycling, anything that moves your legs and that will improve your commute or make you healthier and also put you in a better place when you get to work. So that’s one thing that you can do. If you’ve got a journey that has multiple stops, try and simplify your morning commute because a lot of the thing that makes the commute bad and stressful is stress on the journey. It’s holdups in the traffic, it’s delays, it’s somebody cutting you off in the traffic. It’s something getting in your way. It’s roadworks. These are things that… And if you add to that, if you’ve gotta drop the kids off at school and you’ve got to do another errand on the way to work, that makes it all the more stressful. And so that will negatively impact your commute. So make your journeys as simple as possible, try and make them active. And yeah, I guess the thing is to try and see if there are ways in which you can make it less stressful and possibly shorter, especially if you have a sedentary form of commute.

Brett McKay: And what’s counterintuitive though is you found the research that suggests that some people, like they need a commute for their job to make that transition. Right? The commute itself can act as a transition from home life to work life and work life to home life.

Stuart Farrimond: Oh, absolutely. Yeah. And we discovered this now. We’re working from home and some people’s mental health has worsened as a result of this. And because we have commuted since Neanderthal times, since stone age, there’s good evidence to show that we’ve always moved away from where we live and where we sleep to go and do our daily work. And there’s something really important in that, and it seems to be the ideal commute is about 15 minutes. And that gives you just enough time to mentally move yourself away from home life and into work life. And conversely, when you’re coming back, it’s really important that we switch off from work and that we reengage to what’s going on at home. We start thinking about our family, our spouse, so that when we get home we’re interested in them and we’re not preoccupied by our work. And so having that physical distance helps mentally with having that mental distance. And so it is good for our mental health to have a commute, and 15 minutes, research points to being the optimal length of time.

Brett McKay: Let’s take a look at our work life. We’re at the office. Is there anything to the idea that there’s certain types of work we should do in the morning or the afternoon?

Stuart Farrimond: Yeah. And this comes back to your body clock and what you find is that there are differences because obviously night owls is flipped a little bit and they work better in the evening. But for most of us, something like 75% of us, the first 2 or 3 hours of our working day, and when I say our working day, that’s from 9 o’clock in the morning, I’m assuming that that’s the sort of the standard time of the working day. Those first, that morning is our brains primetime. That is when we need to prioritize the most important tasks. So I don’t know about you, Brett, but sometimes I sit down at my workstation first thing and I start work and I go, “All right, I’m gonna clear out my emails or I’m gonna do something on social media.” But in reality, that’s probably not the… You really shouldn’t be doing that because those first 2 or 3 hours, until you get to about 11:00 midday, that is when your brain is, the computing and the thinking powers of your brain are at their maximum.

So you should first thing prioritize that thing that you’ve been putting off, that project, that assignment, whatever it is that work, sort of bite the bullet and get on with it. Because after that time, after those first 2 or 3 hours after lunchtime, whatever you do, no matter how much coffee you have, you are not getting that back again. It’s a one hit deal. You’ve gotta make the best of it the first thing in the morning. Some people say they work especially in stateside. I know people like to boast about how many hours they work and how they got up so early in the morning and they stayed at work till gone dark. But actually people who do that, they’re not productive as they think they are. And it’s about understanding how your body works and you can actually work smarter and not harder. So that is one way of doing it is realizing my most productive time, my mentally my most productive time is gonna be in the morning before 11 or 12 o’clock when things will naturally start to slow down. So yeah, that would be what the science would point towards.

Brett McKay: Well, let’s talk about just being at the office this day. Most people have jobs where they’re sitting down, it’s sedentary. Anything we can do to alleviate some of the, I don’t know, it hurts like, it doesn’t feel good to sit down all day. And then also I think it’s a mental stressor. Anything we can do throughout the day to maintain our health and mental sharpness?

Stuart Farrimond: Yeah, it was once fashionable to have Standing work stations, which some people get on with and they’ve not really taken off in the way that it was once imagined. It’s often said that sitting is the new smoking. It’s nothing as bad as smoking. But yeah, there are high correlation between sitting a long time and poor health, weight gain and all the things associated with Western lifestyle. So a good way to do it is to try to make yourself stand up and do something. If you work from home, then make yourself a cup of tea every, or whatever it is, or a cup of coffee, maybe not coffee, but get yourself a glass of water or something regularly. You may even set yourself a timer just to get up, walk around and…

Yeah, and that will help. The thing is that you can’t concentrate for very long periods of time anyway. Between 60 and 90 minutes is the maximum capacity in which you can focus on a task with complete concentration, and actually be performing well. So, when your concentration starts to fade on any given task, swapping to something else is good. Taking a break is even better, and using that as an opportunity to stand up and walk around. Another thing that I heard, which I thought was quite a smart thing, is get yourself some dumbbells or a dumbbell, and put it somewhere maybe by your kettle or by your fridge somewhere that you’ll often go to in the daytime. It’s maybe a little bit more difficult to do in office space at work, but you could do it. You could put a little dumbbell somewhere, and whenever you go there, you can do a few sort of arm curls with it.

And you’re not gonna become really masculine or become Arnold Schwarzenegger from it, but it will just help. Any kind of physical exercise will help combat the overall fatigue, because fatigue will worsen as we’re lots of times sedentary. So, any of these things, take the stairs if you can, anything that you can. And it’ll be specific for you, be it for your working environment. You’ll know things that you can do, if it involves setting a timer on your phone every 45 minutes from now saying, “Stand up now.” That will help.

Brett McKay: Oh, let’s shift to the afternoon and evening. Some people get sleepy, naturally sleepy, like 1 o’clock, 2 o’clock. Is it okay to take a nap in the afternoon? And if so, how can you do in a way so it doesn’t disrupt your sleep in the evening?

Stuart Farrimond: Yeah. Again, something that’s become quite trendy is having an afternoon nap, having this… And the siesta is, as you probably appreciate, is very much ingrained in Mediterranean culture and in Chinese culture. There used to be a law in China that meant that workers were entitled to an afternoon nap. It was a right that they could have their, I think 90 minutes or something like that in the early afternoon where they could have a sleep. And actually having an early afternoon nap is something that seems to be a part of our biology, because we evolved in the Savannah. And if you’ve ever been to equatorial regions, you will know that the middle of the day after about 1 or 2 o’clock in the afternoon, it’s absolute… I did my medical elective in West Africa, and those hours of the day, you had to retreat inside, you couldn’t do anything. It’s utterly, utterly stifling.

People in the states who live in the southern regions, as you all know this very well, that you can’t do very much. And so our body is geared to actually taking… Is just lying down and resting during that time. S, even now it’s in our genes that during that time we naturally get sluggish. We have the post lunch slump that isn’t actually entirely to do with the lunch itself. It just happens to be our body clock is geared towards slowing down, actually having a nap at that time. So, yeah it’s a difficult thing to get your head around because we have this whole thing, “I’ve got to work 9:00 to 5:00, having a sleep is lazy.” But I know a lot of the tech companies are now getting onto this ideal, they have been in recent years of having your sleep pods where you can go and have a nap.

And if you can work that into your day, you may well find that energy, mood, learning and productivity are boosted by a 10 to 20 minute nap in the early afternoon. If you go longer than that, if you go to about 60 minutes, then that’s the time where you will… Over more than about 20 minutes to 60 minutes, you may well find that when you wake up, you have that groggy thing again, that sleep inertia. So, you wake when you feel worse than before and you think, “I’m never gonna… Why do people do this nap thing? I just feel wasted for the rest of the day.” And that’s because you’ve gone into deep sleep. If you gonna do longer than half an hour, then you should do 90 minutes, ’cause 90 minutes is enough time to go into deep sleep and out again, and you’ll come out feeling refreshed.

Problem is that if it goes much longer than an hour and a half, it obviously eats into your day and it can affect your nighttime sleep. So, ideally 10 to 20 minutes. And another way that I’ve heard people do is to have a coffee before you have your nap, and it takes about 15, 20 minutes for the full effect of the caffeine to kick in. So, that will… When you wake up again, you’ll have the combination of the feeling refreshed from the nap, and the sort of the extra boost from the caffeine. Personally, I don’t do that one because I find that the caffeine will affect me before I get to sleep, but that’s a tried and tested thing that many people do.

Brett McKay: Alright, let’s talk about exercise. When’s the best time to exercise or it doesn’t matter?

Stuart Farrimond: Any exercise is good, but when you look at people’s physical performance, you find that it is best eight to nine hours after waking. So, that we’re talking early, mid-afternoon for most people. It’s geared towards your body clock as well, so you tend to find that people who are in their early 20s and teens, ’cause their body clock is shifted forward by a couple of hours. They will tend to be in their prime in the early evening time, which I’ve… My theory behind this is that most world records are broken in the early evening time. Some of that is gonna be because things are televised in the evening time that’s when they put on events, but I think that large part of that is that world records are broken in that time. Olympic world records are broken that time, is because people who are athletes, they’re generally in their early 20s, so they have a body clock that peaks later in the day. And so their prime physical time for exercise is in that early evening time when they’re performing at their best.

But it’s the same for you and me, Brett is the best exercise time will be in the mid-early to mid-afternoon. You can try this, I don’t know if you do much exercise, Brett, but if you go for a run first in the morning and then you do another run at 5:00 or 6:00 in the evening, you will find that the one in the afternoon, evening time will be easier. And you’ll probably find that you can do better times than you did first in the morning. And that’s just a nature of the fact that our body takes awhile to warm up, it’s like a locomotive. It just sort of takes away everything, all our muscles, all the chemical processes and the enzymes that power our muscles, which are just the chemicals that work within our muscles to get them going. They take a while to get going throughout the day. I think they warm up throughout the day. But that said, any kinda exercise is good and morning exercise is still good for you, but generally speaking, it’s better to do the most vigorous exercise later in the day because going at it too hard in the morning, you’re much more likely to have a risk injury.

Brett McKay: Yeah, I’ve noticed that. So I do power lifting and when I first started, I trained first thing in the morning, so I had like the sleep inertia thing going on, I was really groggy so I didn’t perform as well. I think the other issue too was I didn’t have time to eat before I trained. So I was training in a fasted state and that’s not good if you’re doing explosive strength stuff. And then when I shifted to training later in the afternoon, things got better and my performance started improving. And I still notice the difference today, right? Like sometimes I can’t train in the afternoon for whatever reason. So I have to train in the morning, and there’s a big difference between afternoon training and morning training. And it’s interesting that given people perform better or do better later in the day that competitions, things like 5K races, I’ve done weightlifting competitions, amateur ones, they’re usually in the morning, and my wife, she’s a runner and I think she’d do more running races if they were later in the day because she likes to run but she doesn’t like to run at 7:00 or 8:00 o’clock in the morning. She’d much prefer to run late in the afternoon or early evening.

I think it’s interesting. We need more competitions later in the day, I think. Okay, so we’ve covered waking up, commuting, working, exercise, and then comes nighttime, right? It’s time to sleep, and in the book you suggest, the kind of sleep hygiene tips that I think most people are familiar with if you want to get better sleep, but what about snoring? Snoring can disrupt your sleep and possibly other people’s sleep. So what can we do to stop snoring?

Stuart Farrimond: Yeah, four in 10 blokes snore. It’s one of those things like you never know you do it until somebody tells you, but yeah, it is a problem. I know a couple that they can’t sleep in the same bedroom anymore because he snores so loudly and he doesn’t like being woken up to be told. I mean I snore sometimes when I roll onto my back, but yeah it can be really problematic. How can we stop it? The reason why we snore, you can either have nasal snoring which is because of the configuration of your nasal cavity or you can have mouth snoring or throat snoring, which is probably the most common type of snoring. And that is because at nighttime when we go into this deepest sleep, the deep restorative stage of sleep, we become very floppy. Every… The tone of the muscles drops a lot so everything becomes relaxed.

And of course that means that the muscles at the back of the throat that keep our windpipe open, they can relax so much that it starts to close our airways and it becomes like a flapping door in a breeze as it vibrates and you have this snoring sound, it’s more likely to happen in people who are bigger, people who are overweight. So people often find if you lose some weight then the snoring will stop. Lying on your back is also more likely to cause snoring. Something that people have done with great success is in their night wearing their pajama top. They’ll sew in a tennis ball into the middle of the back so that it’s impossible for them to lie on their back. And they find that is quite a drastic thing to do. But they find that that is enough to stop them snoring ’cause it stops them rolling into the back. There’s lots of different things, lots of different aids that you can buy.

There’s like nasal strips, things that you can put into your nose. There’s chin straps, there’s pillows, there’s some evidence that pillows, antis-snoring pillows can help because they align your neck in a certain way so that you keep the airways open more and you’re much less likely to snore. The thing is that if you snore and you are very, very sleepy in the daytime, then you could be experiencing, could be suffering from what we call obstructive sleep apnea or OSA. That’s very, very common, more common than I think we appreciate, and that is actually very harmful for your health, not least because your sleep is so unrestorative that you will drift off in the daytime and your risk of having a car accident while driving are very, very… Are magnified hugely because you’re not getting restorative sleep. What happens with people with OSA is they’re snoring and as the muscles relax even more and more, eventually it blocks off their airways.

So you start to suffocate, you then wake up with a jolt but it’s so brief that you don’t realize that you’re awake. ‘Cause interestingly in those very lightest layers of sleep between awake and being asleep, you have no memory of it. You may have noticed this Brett, you’re sat on the sofa, you’re watching a movie or something, your partner drifts off, falls asleep and you wake them up and say, you fell asleep, they will swear blind, “I was not asleep.” And that is because in those periods of very light stages of sleep, you have no memory of it. So when people wake up with a start very briefly, they’ll have no memory that they’ve had a very disturbed sleep. Every time they go into that deep restorative sleep, they’re being woken up at the very deepest part of it.

So they’re not getting the benefits of sleep. So throughout the daytime they’re constantly fatigued and that has long-term impacts, much like doing night shifts, actually unfortunately no matter what we do seems to… When you’re working against your body clock, it has negative effects, causes your arteries more likely defer process called atherosclerosis, increases likelihood of having diabetes and other such conditions by having long-term disturbances to sleep. And this is also the case with OSA, obstructive sleep apnea. So if you feel exhausted, if you find yourself falling asleep when you’re waiting for the lights to go from red to green, or you’re woken up because somebody’s sounding the horn behind you and especially if your partner says that you snore, then it’s worthwhile getting an assessment for that because it’s something that’s very treatable.

Brett McKay: Well Stuart, this has been a great conversation. Where can people go to learn more about the book and your work?

Stuart Farrimond: Yeah, sure. The book is called Live Your Best Life. If you are outside of North America, it’s called the Science of Living. So the Science of Living or Live Your Best Life. You can find out more about me on all the socials. My name is Dr. Stuart Farrimond or Dr. Stu Farrimond. My handle is realdoctorstu, all one word. R-E-A-L-D-O-C-T-O-R-S-T-U. And that’s what I’m on, on Twitter and Instagram and all those things. I’m not a big social media user, but I will do updates of books and things. I’ve got a book out recently, which is all about gardening believe it or not. So it’s a completely left field thing for me. But that’s selling very well as well. It’s just another one of my missions of using science in the everyday in ways in which you wouldn’t have thought.

Brett McKay: All right, well, Dr. Stuart Farrimond, thanks for your time. It’s been a pleasure.

Stuart Farrimond: Awesome. Thanks Brett.

Brett McKay: My guest today was Dr. Stuart Farrimond. He’s the author of the book Live Your Best Life. It’s available on amazon.com. You can find more information about his work at his website, stuartfarrimond.com. Also, check out our show notes at aom.is/dailyroutine. Where you can find links to resources where we delve deeper into this topic.

Well, that wraps up another edition of the AOM podcast. Make sure to check out our website at artofmanliness.com. Where you can find our podcast archives as well as thousands of articles that we’ve written over the years about pretty much anything you’d think of. And if you’d like to enjoy ad free episodes of the AOM podcast, you can do so on Stitcher premium, head over to stitcherpremium.com. Sign up, use code manliness at checkout for a free month trial. Once you’re signed up, download the Stitcher app on Android or iOS and you can start enjoying ad free episodes of the AOM podcast. And if you haven’t done so, I’d appreciate if you take one minute to give us a review on Apple podcast or Spotify. It helps out a lot. And if you’ve done that already, thank you. Please consider sharing this show with a friend or family member who you think will get something out of it. As always, thank you for the continued support. Till next time, this is Brett McKay reminding you to not only listen to AOM Podcast but put what you’ve heard into action.

The post Podcast #888: The Science of a Better Daily Routine appeared first on The Art of Manliness.

Kelly Starrett, a doctor of physical therapy, has trained professional athletes, Olympians, and military special operators, helping them unlock peak performance. But as he approached his fifties, he started to see cracks appearing in the health of the folks around him. What had worked for his peers in their 20s and 30s, wasn’t working anymore; they were gaining weight, having surgeries, and just didn’t feel good.

So he and his wife and fellow trainer, Juliet, decided to write a book — Built to Move: The Ten Essential Habits to Help You Move Freely and Live Fully — that took all that they’ve learned from training elite performers and distilled it into the foundational practices that everyone, at every age, can use to develop lasting mobility, durability, and all-around health. Today on the show, Kelly unpacks some of those essential physical habits, sharing the “vital signs” — tests that will help you assess how you’re doing in that area — as well as daily practices that will help you strengthen and improve that capacity.

Resources Related to the Podcast

• Kelly’s previous appearance on the AoM podcast — Episode #213: Undoing the Damage of Chronic Sitting
• AoM article on the Sitting-Rising Test
• AoM Article: 7 Simple Exercises That Undo the Damage of Sitting (including the Couch Stretch)
• AoM article on foam rolling
• AoM Article: The Benefits of Hanging for Strength and Mobility
• AoM Article: 12 Balance Exercises You Can Do on a 2×4
• AoM Podcast #638: How Changing Your Breathing Can Change Your Life
• AoM Podcast #678: Physical Benchmarks Every Man Should Meet, At Every Age
• Muscles and Meridians: The Manipulation of Shape by Phillip Beach
• Video of Kelly demonstrating the Couch Stretch
• Video of Kelly demonstrating the squat test
• Video of 90/90 sit/stretch
• Video of Chris Hinshaw demonstrating the Old Man Balance Test
• Get yourself a pull-up bar
• The SlackBlock
• Kelly’s article on fixing shoulder pain, including a video on the Shoulder Spin-Up

Connect With Kelly Starrett

• The Ready State website, including the Built to Move book page
• The Ready State on IG
• Kelly on Twitter

Listen to the Podcast! (And don’t forget to leave us a review!)

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Download this episode.

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Read the Transcript

Brett McKay: Brett McKay here and welcome to another edition of The Art of Manliness podcast. Kelly Starrett, a Doctor of Physical Therapy, has trained professional athletes, Olympians and military special operators, helping them unlock peak performance. But as he approached his 50s, he started to see cracks appearing in the health of the folks around him. What had worked for his peers in their 20s and 30s wasn’t working anymore. They were gaining weight, having surgeries, and just didn’t feel good. So he and his wife and fellow trainer, Juliet, decided to write a book Built to Move: The Ten Essential Habits to Help You Move Freely and Live Fully. They took all they’ve learned from training elite performers and distilled it into the foundational practices that everyone at every age can use to develop lasting mobility, durability, and all around health. Today on the show, Kelly unpacks some of those essential physical habits, sharing the vital signs, test that will help you assess how you’re doing in that area, as well as daily practices that will help you strengthen and improve that capacity. After the show’s over, check out our show notes at aom.is/builttomove.

Alright, Kelly Starrett, welcome back to the show.

Kelly Starrett: It is great to be here, my friend.

Brett McKay: So you’ve spent your career helping professional athletes, members of the military achieve elite performance, and I think a lot of people, they probably know you for the book you wrote, and it’s been almost a decade ago, Supple Leopard, which is just this bible of different movements and things you can do to help you move better so you can perform better. Your new book is Built to Move: The Ten Essential Habits to Help You Move Freely and Live Fully. This book is focused less on things like setting PRs and more on just what are the building blocks of feeling good and being vital overall over your whole lifetime. And in the book you talk about 10 physical practices and then each practice has a test or some metrics that you call vital signs to see how you’re doing with that habit.

And this book really resonated with me. We were talking before the podcast, I turned 40 recently. And in my 30s, I was really… I’m power lifting. That was my thing, and I still do it, but what’s interesting is when I was 35, 36, I could just go hard all the time and recover really fast. About two years ago, injuries started popping up and it was like tendon stuff, just overuse my… Your knee hurts and then your hips are achy. And then in 40, it’s the same thing. And now my shift has been moving away from performance, right? Trying to deadlift more and more and more weight to, I just wanna be durable. I just don’t wanna hurt when I get up off of… Out of a chair. And it’s funny, I was rereading Aristotle, his book on Rhetoric, and he goes on this tangent about fitness and health and beauty and it’s really poignant.

He said this, he says, “For a man in his prime,” and he thought a man in his prime was like thirties to maybe 40. He says, “For a man in his prime, beauty is fitness for the exertion of warfare together with a pleasant, but at the same time formidable appearance.” And I can relate to that when you’re in your 20s and 30s, you just wanna look Jack, you wanna be strong, whatever. Then he says, “For an old man, beauty and fitness is to be strong enough for such exertion as necessary and to be free from pain through escaping the ravages of old age.” And that one, I resonate with Aristotle on that one. I wanna be free from pain, but just strong enough to do what I gotta do throughout the day.

Kelly Starrett: Yeah. Here… Here’s what’s really crazy about that, is that we’re starting to see a generation of young athletes who follow these principles in the book because they found that it really does enhance the short game. And what you’re seeing is, and what we’re appreciating now is that when we are working with young athletes who are making millions of dollars, they realize that if they can control their sleep and their minimum ranges of motion, some of these pieces in here, they actually can extend their career. So it means… Means a lot of money to them. And then what ends up happening is that universally, the athletes we work with actually realize they can go harder and they’re actually capable of more. And remember, this is a laboratory. So what I’m transferring that to myself now is, you mean I can get to Friday night and feel like I’m not just smoked, that in the afternoons I can get home from my job and actually be more present for my partner and my kids.

Okay, I’m in. And when my friends say, “Hey, we’re going for a pickup bike ride, or basketball game,” I feel like I’m not gonna injure myself to do that. So these 10 behaviors, we chose these 10 because they’re the hinges that open the biggest doors. And simultaneously, if you are not interested in exercise, you don’t identify with power lifting, you don’t identify with diet culture. We realize that there’s a lot you can do to begin to have a conversation with your body, so you don’t end up just sort of devastated by accident. You took a fall, your bone densities… I mean, just realizing that the long game is the short game and to what your point is, you don’t have to feel wretched. And we really haven’t empowered people so if we use an example, pain is a great example of oftentimes the sort of the fulcrum or the catalyst that initiates a lot of conversations with people about their bodies. “This pain won’t go away. It used to just go away. I just ignore it or take some ibuprofen for few days and it went away.”

And suddenly people are realizing, Hey, I’m living with this thing all the time. Is this who I am now? Like, should your hips hurt? So couple of things. One is that I want everyone to hear pain is a request for change. Unless you have a clear mechanism of injury, or you’ve got something occult going on, like a fever or an infection, something obvious. Or your pain is interrupting your ability to occupy your role in your family or do your job, those things are medical problems. They’re medical emergencies. I want you to go get help. Everything else is typical, which means what we’ve said to a generation of people is that pain is a medical problem. So until you’re ready to go talk to a doctor or a physical therapist about it, it’s not serious, or you should just live with it.

And what we set up people to do is just to go ahead and self-soothe it any way they want with bourbon, with THC, with whatever thing could make themselves feel better. And what we’re trying to do here is say, Hey look, if we’re gonna untangle complexity around pain, we need to make sure that you’re eating enough protein and micronutrients, that you’re sleeping and that you’re moving. And then we can also say, Well, hey, these tools that we’ve discovered over the last 15 years to help restore your position and make you bench more, well they can be redeployed for you and your family when someone’s achilles hurts or their knee hurts. And we realize that we have this real rich tapestry of options that I can drop into my household without having to engage with a physician, without being an expert, and I can start to make myself feel better and ultimately use that as a catalyst to transform how I’m interacting in my world.

Brett McKay: Okay, so these 10 essential habits, they’re great for, if you’re a young athlete who’s keyed in on performance, it’ll help you with that. But even if you’re not interested in that, you just wanna feel good and vital throughout the day, it’s gonna work for you too. Alright, let’s talk about some of these. You lay out 10 tests and then with each test or marker habits you can do on a daily basis to help you improve that. The first one you talk about is the sit and rise test. What is this test and why do you think it’s important?

Kelly Starrett: Oh, isn’t that great? So this is a test that has been well validated to show all cause mortality and all cause morbidity. If you struggle to sit crisscross applesauce on the floor and then stand up from that position without putting a knee down or putting a hand down, like you can’t just pop up and down like every 5-year-old, right? Ask your kids to do this, they’ll crush it because it’s not about strength. But what you’ll see is, holy moly, I’m stiff, and that stiffness, I can’t access my power, I can’t access my shapes, and that means that I have fewer movement choices. So I’m like, here, get up and down off the ground holding this baby. And you’re like, I can’t, I have to hold the baby with two hands and now I gotta put the baby down. What you start to see is that it has these follow along implications.

The number one reason people end up in nursing homes, they can’t get up and down off the ground independently. And what’s notable, I think is one of the things that we know is if we were trying to launch a business, save for retirement, train for the world championships, we set a goal and we work backwards from that goal, but we do not engage in that thinking towards our own health and behaviors. So if we know that we have this simple idea that really is a nice predictor of how you’re gonna fare as you get older and stiffer and weaker, theoretically, none of those things have to be true by the way. Then why don’t we one, put it on your radar and show you that, hey, if you got it, no problem. Good, keep doing what you’re doing. But if this was trickier than you thought or you couldn’t do it, let’s pay attention to that, because the first order of business for all of our interventions is exposure.

So the first thing that we’re saying is if you are struggling to get up and then off the ground, well what we want you to do is start spending some time on the ground while you’re watching TV every night. Isn’t that simple and reasonable? Sit cross-legged, sit 90/90, kneel. It doesn’t matter, but if we know that getting up and off the ground ends up being a nice predictor of how well and affluently you can move through the world because you have more hip range of motion, you can play better pickleball, you can deadlift better, what you’ll see is if your lifestyle is working for you, you’ll ace this test. If your lifestyle is introducing what we call a session cost, which is a concept we use when we’re looking at how gnarly the session was the day before. So you and I go and do some crazy deadlift workout, and the next day I’m crippled and you’re not. I paid a higher session cost for that, right? My force was down, things hurt, I couldn’t do it again. Well, we can start applying that session cost idea towards what’s going on with my day-to-day living, my movement fluency, the workouts I’m doing, and is that costing me in terms of this sort of third party validation test, which is show me you have some hip range of motion.

Brett McKay: Yeah. Okay. So you lay out the test, it’s really simple. So everyone can do this right now, they’re listening to us. You just sit on the floor and then get up off the floor and what you do…

Kelly Starrett: Cross-legged. Cross-legged.

Brett McKay: Yeah, cross-legged, cross-legged, right. And you start off, you give yourself a score of 10 and then you subtract a point. If you do one of the following, brace yourself with your hand to the wall, place a hand on the ground touching your knee of the floor, supporting yourself on the side of your legs, losing your balance. And if you do that, you subtract. If you have a low score, it means like, well you got room for improvement.

Kelly Starrett: That’s right. And that’s the right word.

Brett McKay: Yeah.

Kelly Starrett: You got room for more improvement. It’s not bad.

Brett McKay: No.

Kelly Starrett: You got room for improvement.

Brett McKay: I think that’s a good point you made about most people go to nursing homes because they can’t get up off the ground, right? Because like as soon as you can’t move independently, you’re gonna need 24/7 support care there. And it just usually starts going downhill from there. And you hear about… When you hear about like an older elderly person, they fall down, they break a hip, you think, oh man, this is bad. They’re probably not gonna be around much longer.

Kelly Starrett: Not to be Mac Cobb here, but one of the greatest predictors of the gnarliest things that can happen to you is to break a hip after 70. The research is a… Like you die within five… I mean, it’s so bad. And you have to understand exactly what you’re saying. I suddenly lost my mobility. I can’t feed myself, I can’t move, I’m bedridden, I lose my muscle mass, I lose my conditioning, I lose my bone density, I lose my… And then my brain starts to go and my social connections start to go. One of the things that we’re, I think obsessed with in this culture is like all the hard science, like deadlift more or wattage, poundage but all of the ancillary things that happen by being in a community start to go away if your world gets smaller.

One of the things that’s nice about a lot of these behaviors in the book, like eating as a family, is that we are trying to strengthen our social bonds. What we found in COVID was that holy moly, the brain is a social organ. It needs other brains to actually work and be a brain. And what we know is that we need stronger families, stronger households that are more connected to each other and more connected to their neighbors and their community at writ large. And some of those easy ways are to eat together and to go walk around and nod your head at your jerk neighbor. I mean it really, it’s transformative. So what you’re seeing is when we start making inadvertent choices from lack of choice because we don’t realize we’re doing certain things, it starts to take away a lot of our movement choice, which ultimately has implications in the kinds of society we find ourselves in our 50s, 60s and 70s, 80s, a 100, you’re gonna be a 100-years-old. 54% of kids who are in the fifth grade right now are gonna be 105.

Brett McKay: And so there’s… As you said, to improve on this test, the thing you gotta do is just sit on the floor more and there’s no…

Kelly Starrett: That would be a great start. Right. That’s a…

Brett McKay: Yeah, and there’s no specific way you have to sit, you can do crisscross applesauce. I like… My favorite one is the 90/90 sitting, where you kind of put your hips to the side, that feels really good.

Kelly Starrett: Yeah. You are working on an internal rotation there. And there’s a great writer osteopath, I think, and his name is Phillip Beach and he wrote a book called Muscles and Meridians and it really is like functional embryology… I just wanted to throw it out there because I’m a physio and I had to have a bunch of embryology and if I’d had this book, I’d been stoked on it, I would’ve understood it more effectively. But he believes that one of the ways the body tunes itself is that we spend time on the floor. It actually opens up our pelvic floors. It restores motion in your low back, it loads tissues, it loads your hamstrings, it keeps your hip range of motion good so you have more movement choice. It’s one of the ways that our bodies have engaged with the environment for two and a half million years.

Look, I’m not pint… Like I live in a cool mid-century modern house, I love it. But we have to appreciate that just a few hundred years ago, we did a lot more sitting on the ground, toileting on the ground, eating on the ground, building fires, and hanging on the ground. So it’s almost like we know intuitively that, okay, if… This is one of the things that actually helps the body work better. Well it’s pretty easy for you to watch TV at night and sit on the ground for 30 minutes. Just sit on the ground for a little bit and you’ll see that… You’re like, oh, there’s my roller or maybe I’ll roll my calves out. But exposing yourself to these bigger ranges of motion and fidgeting around, you’ll see aggregates. And we start to stack these behaviors, these behaviors start to compound. And if you get 30 minutes of sitting on the ground seven days a week, you’re starting to spend a lot of time in these fundamental positions that do things like improve your squat, improve your ability to run up the hill, right? Make your back feel better, make your knees feel better, etcetera, etcetera.

Brett McKay: Alright, let’s talk about the next vital sign, which is breathing. When you have an assessment, the breathe pull test, what’s going on there?

Kelly Starrett: The body oxygen level test. So I think breathing’s had its moment, right? Wim Hof gets everyone going. Laird Hamilton, we have Patrick McKeown of Oxygen Advantage. There’s so many great systems and it’s not like the yogis have been talking about this forever, but what we discovered was, there was a lot of low hanging fruit in terms of improving people’s VO2 max and mechanical ventilation. So this is why this matters. If you come to me as a physical therapist, you’re like, “Kelly, I have back pain.” There’s three things we’re gonna talk about day one, no matter what. We’re gonna talk about your sleep, because if you’re not sleeping that eight hours, it’s really difficult for me to figure out is it your brain or is it your body? What’s happening here? Number two, I’m gonna make you walk a lot, because I need you to de-congest your system, your lymphatic system, which is the sewage of your body, is built into your musculature. And if you move your musculature, you move your sewers. If you don’t move your musculature, the drains block up. And if you’ve ever seen a gross sink, that’s your body. If you don’t move, that backed up sink, you have to flush that stuff and that’s all done through movement.

So moving and then we’re gonna talk about breathing. And what we’re gonna see is if the first motion of the trunk, everyone is obsessed with it’s okay to round your back when you deadlift. Of course your spine’s supposed to flex and rotate and twist, but the first movement of the spine is breathing. And what we find is that, it’s a nice indicator of sort of vitality in terms of you can find positions that allow you to ventilate more so it improves your VO2 max, but breathing more effectively does things like opens up your upper back so and you put your arms over your head, makes your low back feel better, allows you to create more intraabdominal pressure when you lift.

And as we found out in the last 10 years of really monkeying with breathing, that when we got people more CO2 tolerant, which is what the body oxygen level test does, it allows people to access more hemoglobin. So one of the things we found, believe it or not, is that people who had COVID and smoked, that was a bad deal to have those things, but they were more comfortable with lower body oxygen levels in their body. And the reason was is that they were smoking so much that their CO2 levels were really high and had set their brains at being very comfortable with these lower oxygen levels. Obviously that’s a problem if you can’t breathe. But from a performance standpoint, what we found is people whose brains were more comfortable running higher CO2 levels, those people are actually able to strip off more oxygen off the hemoglobin. So the body oxygen level test is just a simple way of you being aware of how good you are at utilizing what’s available to you.

Brett McKay: And so you just hold your breath for as long as you can. You want… I guess you aim for 30 to 40 seconds.

Kelly Starrett: You exhale.

Brett McKay: Okay, yeah, you exhale then hold your…

Kelly Starrett: Just take a breath, exhale and then see how long you can go, because it turns out you got plenty oxygen on board to hold your breath for two minutes, three minutes, four minutes, five minutes. What you don’t have is a brain that is gonna tolerate the skyrocketing CO2 levels. So your drive to breathe is actually the rising CO2 level. And what we find is now… Because we’ve been doing this long enough with our athletes, is that now we’re seeing athletes be able to breathe nose only, push 90% of their max heart rate, they’re much more efficient, they don’t have to burn the sugar. But also what we find is, man, if we’re gonna talk about your neck pain and your jaw pain, we need to talk about your breathing. And getting you to breathe through your nose, getting you to not breathe only up in your neck like you’re being chased by cocaine bear, those things really end up making a difference in terms of how your brain perceives you in your environment and the effectiveness of not yanking on your neck every single time you take a breath. Imagine this, you’re on the Peloton bike and you’re rounded and you wanna go faster. If I say get into a position where you can take a bigger breath, you’ll automatically organize your body in a way where you have better access to your ventilation and better access to your diaphragm. And those shapes can be applied to work, to holding my kid, to rocking, to whatever I wanna do.

Brett McKay: And yeah, the practice that you recommend, you just said it there, just start breathing through your nose only throughout the day.

Kelly Starrett: That’s one of the practices. Super simple. Tape your mouth shut at night. That’s become very common. But we also have some breathing drills you can do. And here’s one of the things that I want people to understand, is that I think we’ve become habituated to thinking about all of our health behaviors have to occur in these one-hour blocks. That’s weird. No one has time to go to a one-hour balance class or one-hour breathing class, or one-hour mobility class. If you do anything, I want you to go to the gym. I want you to go to your garage and lift heavy weights. That’s what I want you to do. But I want you to bury and hide the reps, everything else. So we do a lot of this breathing stuff on our warm-ups, on our daily walks, during… While we’re spinning up on the bike. It’s so easy to integrate these things into your life.

Brett McKay: So the next vital sign is about your hips, and this one really spoke to me because my hips have been really achy lately. And so the assessment you have for this is the couch stretch. So tell us about this test and what is the couch stretch.

Kelly Starrett: If you had to pin me down and say, “Kelly, what is the one thing I should do from a one-on-one mobilization?” I am obsessed with you being able to take your hip into extension. So if you imagine a lunge position, lunge shape, that’s hip extension. So standing up from a squat is extending your hip, but actually taking your hip into extension is the magic. And what we find is that the way we train the session cost of our day-to-day lives, we see that people are pretty ineffective at having good full hip extension and having control in that hip extension. So what we’re seeing here’s though, there’s a lot of knee pain and a lot of back pain that’s a symptom of not being able to extend your spine or extend your hip. So your knee behind butt is really the magic. It’s not knees over toes, it’s can you get this knee behind your butt. And the couch stretch, if you’ve never done it before, you should Google couch stretch, we invented it so that we could get people doing it while they’re watching TV. And basically you start on the ground, this is the full couch, you put your knees up against the wall, your back is away from the wall, and you put your shin in the corner where the wall meets the floor. So your foot is pointing towards the ceiling and you’re kneeling away from the wall, and then you bring your other foot up into a lunge, so it looks like sort of exaggerated run shape, except your leg is bent up.

Then all I want you to do is squeeze your butt, take five breaths, can you raise yourself higher, yourself more torso upright, take five breaths and squeeze your butt, and then ultimately can you go straight up and down? And what we find is people really struggle because their quads are so stiff, hip is stuff, their butts turn off. That’s one of the reasons now why you’re running and wobbling your back and your hamstrings are stiff all the time because they’re doing all the work that your glutes should be doing. So if we can get people to improve this, it’s amazing how many things start to feel better.

Brett McKay: And then the daily practice for that test, you just do the test, like you just do the couch stretch every day?

Kelly Starrett: You could. We also throw in some isometrics, show you where you can spend some time the end of your day or during the day. Just put your hip into extension a little bit while you’re washing dishes, while you’re hanging out, squeeze your butt, just do some isometrics, hold that for 30 seconds. We also realize that this is a great place to do some soft tissue mobilization, so you can get on the ground while you’re watching TV, roll out your quads, roll out your hips, and you’ll see that those systems start to improve.

Brett McKay: We’re gonna take quick break for a word from our sponsors.

And now back to the show. Let’s talk about shoulders, another problem that a lot of guys experience as they get older. Shoulder is a weird thing. It’s incredible. It’s got this amazing range of motion, but it can get jacked up really bad. What are the most common shoulder problems you see in the regular Joe athletes you come across?

Kelly Starrett: Well, what’s interesting is, think about it this way, you have the brain, which is the most complex structure in the known universe, seriously, it is, attached to a structure that is equally as sophisticated. So this brain body thing we’ll walk around in is the most extraordinary structure in the known universe. And your shoulder, let’s just start by saying, is designed to last 100 years easily. So when you suddenly throw an error signal and your shoulder hurts, we want you to understand that, A, that’s not typical. It’s a request for change. Well, what change are we talking about? Well, no one on the planet connects range of motion to pain. And there could be a lot of things. Nothing could change. You could have incomplete range of motion, shoulders don’t hurt. All of a sudden you have a baby, you’re sleep-deprived, you have a deadline at work, you smash a bunch of pizza, you drink some beer, [chuckle] it doesn’t matter, whatever the stressors are, and your shoulder starts hurting, and you’re like, “What happened?” Nothing happened except your brain became much more sensitive to your lack of tissue quality or your inability to express normal range of motion.

So what we have here is a really important system. I think most people can recognize or wrap their heads around that. If we were gonna talk about your lower back health, we really should be talking about what’s going on with your pelvis and your leg too. It’s weird how you have big muscles that attach from your spine to your leg and no one looks at how well your leg moves. So if your leg doesn’t move well on your body, it can be yanking, it could be tensioning, it could just be putting mechanical input into your lower spine. So that’s why we look at the spine, the pelvis in the leg as a system. Well, there’s the same system upstream, it’s your neck, it’s your thoracic spine, your chest and your shoulder. They make a trifecta of positions. So if I wanna improve your neck pain, I gotta look at your shoulder range of motion. If I wanna look at your shoulder range motion, I also need to look at how well your thoracic spine works. Remember I told you already, we’re moving in that direction ’cause we’re getting you to take big breaths and you breathe in your upper back? Well, what we’re doing here is we’ve got some simple tests for you around some key range of motion positions and some isometrics that are easy to get you started on untangling what feels like a complicated system. It’s not that complicated.

Brett McKay: Yeah, you got two tests. My favorite was the one where you lay on the floor on your back and then you see how far you can get your arm back, basically.

Kelly Starrett: Yeah, basically it’s an I, Y and T, but really in that situation, or if you’re just… Elbows are out to your side at 90 degrees and you flex the back of your hand to the ground, we’re looking at how much force you can create there. And what you see is if you’re struggling to get to that position, you’re weak in that position. Well, welcome to your rotator cuff. And a lot of times, your rotator cuff, or rotator cup, depending on which patient is telling you about their shoulder pain, the rotator cuff is this sort of non-specific idea that I have muscles that help rotate my shoulders. Well, we look at a lot of rotation capacity with our athletes, and what we see is that when you lack fundamental range of motion in your body, specifically in your shoulders, can’t put my arms over my head, can’t achieve some of these fundamental shapes, your force production starts to go down, which means that when you approach some of these positions at high speed, like playing golf, that can be a problem because you see a lot of inhibited musculature, a lot of force production, like it’s taken away and now you’re just hanging on your tissues.

Brett McKay: Any daily practices that people can do to help their shoulder health?

Kelly Starrett: Oh yeah.

Brett McKay: There’s a lot, but I mean, what’s one or two that you’d recommend, like, “Do these and you’ll be good?”

Kelly Starrett: Yeah, it’s interesting, if we look at our movement traditions, everyone listening has probably gone to a yoga class once. And when you’re in there, you’re like, “Holy crap, these people love Downward Dog. Why is Downward Dog so important?” And you do so much Downward Dog. Downward Dog, Downward Dog. Well, Downward Dog is an overhead position. So if there’s one thing you could do is at least once a day, put your arms over your head. Hanging from a door jamb, put your arms over your head, take some breaths. If you have a pull-up bar, which you should have in your house, hang from your pull-up bar. I cannot tell you how hanging will fundamentally change your life. Hang with different grips. You don’t even have to hang with your feet all the way off the ground, put a pull-up bar in your kids’ doorway, but it’s secretly for you. We have a pegboard in our garage, we’ve got pull-up bars outside, inside the house, in our garage, and just hanging will transform your shoulder function, and transform your upper back. If you’re getting that hump in your upper back and neck, hanging is the solution.

What I would direct you to is some kind of shoulder motion every day. And if you did something like Sun Salutation, cool. That would cover it. But also, if you’re really interested in taking the next step, on our site, we have something… And even if you Google “Kelly Starrett shoulder spin-up,” you will come up, and it’s a quick five-minute routine that touches a whole lot of spine shoulder positions. You don’t need any equipment. I use it for all my elite athletes, I teach it to all our teams, and it’s just like daily vitamins for your shoulder, even if you’re not gonna load your shoulder, even if it’s a lower leg day.

Brett McKay: Right. So you’re big of the squat, and that’s one of your tests. Why is being able to get down into a full squat important for human durability?

Kelly Starrett: Isn’t that interesting? We look at squatting as exercise, not squatting as movement choice. Lower yourself down off a cliff or a ledge, you’re gonna have to squat all the way down. One of the things that happens is obviously getting up and down off the ground is useful there, but it’s one of the ways where we can start to expose the tissues of the body to their full range. So taking the knee and flexing it all the way, taking the ankle and flexing it all the way. Letting your back round in that bottom position is really important to normalize the motion of the back. In yoga, for example, they call it Malasana, and they’re like, “It’s a pelvic floor mobilization.” Well, it turns out your pelvis and your femurs are connected directly to the connective tissue of your pelvis. This is why when you get kicked in the nuts, you feel a stomach ache. So what we’re seeing here is that when we restore how people’s hips move, it changes the connective tissue muscular systems and restores it to, again, native range. But also what we start to see is, man, you’re gonna have better choice, you’re gonna be able to move more effectively, and you’ll see things like your wattage improve on the bike.

Brett McKay: And the test is simple as get down to a full squat, you want ass-to-grass.

Kelly Starrett: That’s right.

Brett McKay: That’s it.

Kelly Starrett: I want ass-to-grass. Ideally, you can do that with your feet straight, but you can even turn your feet out to do that ’cause you may not have the ankle range. But if you fall over and can’t get into a full squat, man, that says a lot about you not having full access to the miracles of your body. Again, we’re not arguing about squat technique, I’m talking about getting up and down off the ground or taking a poo or having waiting for a bus. So this is very much one of those use it or lose it shapes. But the research is clear that people that toilet on ground, sleep on the ground, they engage in a lot more squatting-like behaviors, and lo and behold, we see less osteoarthritis, we see less hip disease, we see less lumbar disease. It’s almost like if we just use our bodies and just touch the ranges once a while, tell our brains it’s safe to be here, we see things like skiing or snowboarding improve.

Brett McKay: In the practice of that, just squat more. Like that’s something you can do throughout the day. I do that. After I read that chapter, I was like, “I’m gonna start squatting more.” I’ve been squatting…

Kelly Starrett: It’s easy.

Brett McKay: During this interview. Like when you were talking, I was squatting.

Kelly Starrett: Oh I love it.

Brett McKay: Yeah.

Kelly Starrett: That’s what I think is remarkable. There’s a lot of opportunities for you to move in a more complete way, and this is what every physical therapist, surgeon, orthopedist on the planet says your hip should be able to do. And if you take all of the range of motion books and you’re like, “What should the ankle be able to do? It should flex this much. How much should the knee flex? How much should the hip flex? What should happen to the lumbar spine?” And then you put them in a blender and shake it up, all those things together end up being a squat.

Brett McKay: Yeah, my goal is to be like one of those 80-year-old ladies in Southeast Asia that are just still squatting, I wanna be doing that.

Kelly Starrett: What’s so cool about that is, actually, it’s a really reasonable goal. So anyone who’s starting this… For some people, it’s gonna be a brutal awakening. You’re like, “Oh, I thought I was super fit. I’m doing Peloton and I do my quarter squats and I look good naked, but I can’t move very well.” And we’ve certainly seen a hinge move towards movement culture. And one of the things that I want everyone to hear is that muscles and tissues are like obedient dogs, and there’s no reason… Yes, it’s gonna be harder to maintain your muscle mass as you get older, but there’s no reason you have to lose your range of motion ever at any age. So one of the things you can absolutely do your whole life is actually have access to your range of motion, ’cause you can imagine if your elbows got stiff, all of a sudden you’re like, “Well, that’s not a big deal. I just can’t feed myself anymore.” You know what I mean? That’s crazy. If your life depended on getting up and down, then you would be really good at getting up and down. I was just in Japan with some friends and we were staying at this cool mountain hotel as we were doing some backcountry skiing, and one of our friends got sick and I was like, “Hey, I really should not spend a few days in this room with this sick guy. Do you guys have any other rooms?” And they were like, “We don’t.”

And then we were like, “This hotel is huge. What do you mean you don’t have any rooms?” They didn’t have any White person rooms, Western rooms. What they had was traditional Japanese rooms. But the Americans who’ve been there before haven’t been able to use those rooms because you sleep on the ground on a futon because the table is set for you to kneel and sit cross-legged, because the shower is built for you to squat and sit in. The whole thing was organized around a person being able to move through the environment. Even the controls for the room were set up at sitting height. So I was like, “Oh, no problem, I got it,” and they were like, “Really? You can do it? Look at you, you’re a huge guy,” and I was like, “It’s no problem. Trust me, I can squat.”

Brett McKay: Okay, so squatting is one. The next test to talk about is the old man balance test. What is this one?

Kelly Starrett: We have this friend named Chris Hinshaw, who is an incredible coach, and he tried to come up with a test where he could beat his kids at, and this challenge is all about balance. And one of the things that we know is that fall risk in the elderly is gnarly, but when we started working on foot strength and foot capacity and balance in our athletes, worked it into games, made ’em spend more time on one leg pressing, single-leg deadlifts, things like that, man, their athleticism went through the roof. And so what we realized is that we needed some better ways to challenge people’s range of motion and their balancing control just day-to-day, little micro-balances, because think about it, someone falls in your family like, Go to this balance class because your balance got so bad and I have to go get formal training? That’s crazy. Look, here’s a simple test for everyone, it’s called the SOLEC. Ready for it? Standing one leg, eyes closed. Stand on one leg, don’t put your foot down for 20 seconds. I bet you’re gonna be shocked at what happens when I take away your eyes. And what turns out is that if your feet are stiff, if your feet are always in foot coffins, shoes, if your feet aren’t strong, you’re really gonna struggle. If you don’t have good anchor range of motion, it’s gonna be difficult for you.

And what we’re trying to do is just bring this awareness of balance and play should be happening in sports. So if you’re riding mountain bikes and playing soccer and pickleball and you’re moving your body, chances are this will not be a problem for you. But for a lot of people who are not doing those things, you’re gonna be shocked at how bad your balance is, and it’s only gonna get worse unless we play with it. So the old man balance test is really simple. Every time you put your shoes and socks on, do it one leg at a time. So stand on your left leg, put your right sock on, don’t put your foot down, put your shoe on, tie it, don’t put your foot down. You’re gonna have to reach down and grab it, you’re gonna have to balance. And so every single time you put your shoes and socks on, you can practice a little bit of one or two minutes of balance, and I guarantee you it’s gonna kick your butt.

Brett McKay: Yeah, and then you talk about it, your house, you have different just balance things you can do. Maybe you put like… You just could put like a 2 x 4 in your house and just walk accross.

Kelly Starrett: Oh, nailed it. How about this? You can put a broomstick down and just balance on the broomstick. But I’m a huge fan of having a dynamic work environment. Well, I want choice. I wanna be able to perch against a bar stool, I wanna stand, I wanna… But on the ground, I have a bunch of balance stuff, so I just do this while I’m at work. If I’m on calls, I’m standing on a thing called a SlackBlock, which is like a portable slack line in your house. It’s tiny. It doesn’t take you many space. And I’m standing on one leg, balancing on the SlackBlock while I’m talking on the phone. And so I get so many hours every week of working on my balance. Does it improve my biking? Yes. Does it improve my skiing? Yes. Does it improve my lifting? Yes.

Brett McKay: Another practice you talk about is just standing more, walking more, moving more throughout the day. If you have a desk job, it doesn’t have to be that you’re in a chair eight hours. There’s different ways you can work, right?

Kelly Starrett: Yes. And if you… Look, I don’t talk about this much, but I had the great pleasure of working with a former US President. I’ve worked with and supported a couple of presidents, and this one president was a pretty prolific book writer, but could not write at a standing desk. So what we had to do was create an environment for this former president to get more movement at the desk because he felt like his best writing happened when he was still. And so that meant we needed to make sure that we were introducing a place to put his foot and a chair that wiggled more, and what I want you to realize is that we didn’t come up with this arbitrarily. Harvard defines sedentary lifestyle as sitting more than six hours a day. That’s an aggregate, that’s all your sitting. That means driving in the car, picking up your kid, it’s all of that. So what we’re trying to do is not battle our physiology, but it turns out…

So right now, I’m talking to you at a standing desk, but I’m actually perching on a bar stool. So I’ve got my foot on the ground, I’ve got one foot up, and in this position, because I’m perching and I’m not sitting, I’m actually above this thing called one-and-a-half metabolic equivalence, which is how much energy my body is using to just function in the background, but the sedentariness is that falling below that one-and-a-half. So sitting in most chairs, you fall below one-and-a-half, and that’s what we’re trying to not do. I need you to accumulate enough non-exercise activity that you actually fall asleep.

One of the things that we found was that a lot of people who are working out weren’t actually moving, still didn’t actually get enough sleep or find that they had enough sleep pressure. What we found was that working with Delta Force, of all the technology that they had access to, they had their guys walk 12,000 to 15,000 steps a day in addition to their training, and it knocked down all their insomnia problems. It really started to make everything better. So if you wanna adapt better to your training, you wanna fall asleep faster, you wanna feel better, you need to look at how much your total movement is, and conversely, how to limit your total sedentary time.

Brett McKay: And this does a lot of things, it’s gonna clear out your system, you talked about that earlier, motions lotion, so you’re gonna move and not feel achy. And then, yeah, I think the sleep component is really important, I’ve noticed that as well, when I move more, I have the best sleep. The best sleep of my life was when Kate and I went to Italy for, I don’t know, she was doing some of school thing. Went to Italy, you walk around Rome all day.

Kelly Starrett: You walk 20,000, 30,000 steps a day.

Brett McKay: Yeah, probably. Yeah, it was insane the amount we walked. And I remember, we got to the hotel, just laid down, we were like, “Oh, we’re just taking a nap,” and we were… It was like 15 hours later…

Kelly Starrett: Kids come back from summer camp and they’re just exhausted and sunburned, that’s the game, but for adults. And you just really nailed it. And what I want people to understand is we can come at this any way you want, but one of the ways that’s important to me is that it’s a hidden calorie burner in my day. So I love dessert, I love ice cream, I love cookies. I’m never gonna turn those things down, ever. If they’re combined, it’s even better, but when we wrote ‘Deskbound,’ my wife found a little conversion, a little calculator, and if she just stood and didn’t sit at her desk during her work day, in the course of a year it was 100,000 calories. I outweigh her by almost 100 pounds, that’s 170,000 extra calories I’d burn every year, that’s like 35 marathons, and all I have to do is just not sit while I’m working. I’m talking about perching, fidget, messing around, walk a little bit. And notice that we didn’t say, “You have to get 10,000 steps,” we saw that all of the benefits really start to kick in at 6,000 to 8,000 steps, which is really reasonable if you just start throwing in short walks after your meals, you take a call, you go for a little stroll in your neighborhood. It’s easy to get 6,000 to 8,000 steps. But the average adult gets less than 3,000, so it’s difficult for me to be sensitive to your foot pain and your Achilles and your junky tissues, if you’re not moving more during the day, which means you just have to be more conscious of it.

Brett McKay: And this is important, this daily movement is important, particularly for those who are… I just said exercising regularly, ’cause they’re thinking, I’m good, I got my hour of cardio in and I got my hour of weight training in, but you’re…

Kelly Starrett: Yeah, smashed it.

Brett McKay: You’re probably still sedentary.

Kelly Starrett: That’s right.

Brett McKay: Yeah.

Kelly Starrett: And if you’ve ever flown on an airplane and look down and you’re like, “Why do my ankles… I have cankles, what’s up my ankles are swollen.” That’s what we’re talking about. Your lymphatic system is backing up because you didn’t move your muscles, you ended up collecting fluid in your ankles, that is edema. But really what’s happening there is that it’s a failure of… It’s why… If you ever go in the hospital, they’re like, pump your legs, do calf pumps. Here are these things, we don’t want you to get a DVT. That deep vein thrombosis happens because people are sedentary in the hospital and they’re so freaked out about it, they hire a physical therapist to come in to tell you to wiggle your feet.

Brett McKay: Okay. So we talked about movement, can you get your steps in, don’t sit down all day, you don’t have to stand up all day, but just move around. You mentioned sleep, if you’re having problems sleeping, moving a lot will help you sleep. Nutrition, what role does nutrition… You’re a physical therapist, and one of the first things you ask is, what are you eating? What role does nutrition play in recovery and just our ability to move well?

Kelly Starrett: Nutrition for better or for worse, become identity politics for so many people, and it’s an identity, and it’s a hobby, and it’s a sport. And it’s a full contact sport. If you get on the Internet and talk about your diet. Universally, what we can start to say is everyone on the planet has protein minimums, you should get this amount of protein, and a really reasonable amount for everyone is 0.7 grams per pound of body weight, which turns out, if you’re sedentary, that’s probably enough. But if you’re over 50 or you’re exercising or trying to change your body composition, it probably is a little bit closer to 1 gram per pound body weight. So you’re keto. Cool. You’re carnivore, cool. You’re paleo, cool. You’re Whole30 cool. You’re vegan or vegetarian, cool, just show me you get this much protein.

And what we find is if you’re trying to change your body composition or you’re trying to recover, but you don’t have the building blocks on hand to do that, you’re not gonna see the gains you want, either way for body composition or otherwise. But the other part of that is that based on some really good data, we find that people don’t get enough micro-nutrients. There is not a single study in the world that says improving your fiber intake doesn’t improve your health. The easiest way to do that is actually eat fruits and vegetables, and so what we found is based on one of our friends, EC Synkowski, her company is OptimizeMe nutrition. She has something called the 800-gram challenge, and every single day, she challenges people to eat 800 grams of fruits and vegetables, and you’re like, “I don’t like vegetables,” cool, you eat fruits.

I don’t eat apples. Cool, you do eat berries and rutabaga. I don’t really care. But it turns out when we get more micronutrients in, all the polyphenols, all the vitamins, all the minerals, you can do that with four big apples a day. But when we get into people’s diets, and we’re trying to talk about soft tissue health and connective tissue health, and brain, health whatever it is, glow, gut health turns out fiber and micronutrients and protein make the basis. For people who are trying to lose weight, when we ask them to eat more and expand their choices, it’s the first time in their life, they’re like, “Holy shit, I had to eat so much to meet these minimums?” We’re like, “Yeah, welcome to it.” A pound of cherries is 230 calories. Go ahead and OD. Let me know what happens. What you’re gonna see is there’s so much food available to… We don’t wanna be restrictive anymore, we want people to hit this baseline.

Brett McKay: If you ate a pound of cherries I think you’d be on the toilet.

Kelly Starrett: It’s an illustrative point. Eat a pound of melon. Eat four apples, you know, what I mean. It really is… And you’re suddenly, I’m like, yeah, you know, the other day, I went to Trader Joe’s got myself up a flat of blackberries, they were just gorgeous, and I ate the entire thing, it was like 400 grams, 350-400 grams, almost half of my micronutrients for the day, and it was 230 calories.

Brett McKay: Yeah. It’s not like…

Kelly Starrett: I love cookies. One cookie from Starbucks is like 350 calories. So what we get is all of this benefit where I’m full, I’m getting all these nutrients. Somehow we demonize fruit. That was ridiculous, where like fruit is sugar. What a bunch of horse crap that is. It’s not the bananas and apples that are the problem. If you eat more micronutrients and fruits and vegetables, you’re gonna protein, your body will start to turn the lights back on.

Brett McKay: So this is great, and then at the end of the book, you have a schedule for people to follow if they’re trying to figure out how can I incorporate all this stuff in my day-to-day. And as you said, you don’t have to make time. Like, I’m gonna do an hour of my built to move routine, no it’s like…

Kelly Starrett: Yeah, no.

Brett McKay: Just you wake up, I’m gonna do this thing, I’m gonna get my steps in, whenever I’m taking a break or on the phone, I’m gonna walk around. I’m gonna get down in the squat, you can just do this stuff as… Like health shouldn’t be a block on your schedule, it should just be a part of your day.

Kelly Starrett: Yeah, what we’ve found is when we handed this thing to our world champion athletes, they were always viewing it through the lens of I wanna go faster, I don’t wanna do it more often, and they found blind spots that enable them to work harder. And when we applied it and gave this to non-exercisers, like we have some publishers who work with us in the UK who are not exercisers and who love pork pies. They were like, “Just reading this, changed my framework and how I perceived the world around me, and it changed me in making different subtle choices,” that all compound over time to really make radical changes where you can feel better and again, work harder and show up and feel fresher. That’s really the game.

Brett McKay: Well, Kelly, this has been a great conversation. Where can people go to learn more about the book and your work?

Kelly Starrett: Go to builttomove.com. We’ve got… Actually, when the book comes out, we’ve got a 21-day Built To Move challenge, it’s free. And it’s basically a video a day just kind of supporting some of these ideas, just to bring you through, you could aim your friends at it. We are @thereadystate on all our socials, and if you are interested in more about how to assess your body more completely, we’ve got the app and everything else.

Brett McKay: Fantastic. Well, Kelly Starrett, thanks for your time. It’s been a pleasure.

Kelly Starrett: Always a pleasure. Keep putting out the good word, my friend.

Brett McKay: Thank you, sir. My guest today was Kelly Starrett. He’s the co-author of the book, Built To Move. It’s available on amazon.com and book stores everywhere. You can find more information about his work at his website at thereadystate.com. Also check at our show notes at aom.is/builttomove, where you can find links to resources, where we delve deeper into this topic.

Well, that wraps up another edition of The AOM Podcast, make sure to check on our website at artofmanliness.com, where you can find our podcast archives, as well as thousands of articles written over the years about pretty much anything you can think of. And if you’d like to enjoy ad-free episodes of The AOM Podcast, you can do so on Stitcher Premium. Head over to stitcherpremium.com, sign up, use code manliness at check out for a free month trial. Once you’re signed up, download the Stitcher app on Android or iOS and you can start enjoying ad-free episodes of the AOM podcast. And if you haven’t done so already, I’d appreciate if you take one minute to give us a review on Apple Podcast on Spotify, helps out a lot. And if you’ve done that already, thank you. Please consider sharing the show with a friend or family member you think would get something out of it. As always, thank you for the continued support. Until next time, it’s Brett McKay reminding you to not only listen to the AOM podcast, but put what you’ve heard into action.

The post Podcast #885: The Essential Habits for Becoming an Agile, Vital, and Durable Human Being appeared first on The Art of Manliness.

For centuries, when someone referred to “dinner,” they meant a meal, the largest of the day, which was eaten around noon. A lighter “supper” was then consumed in the evening. 

Starting in the 18th century and accelerating in the 19th and 20th, the hour at which dinner was eaten moved later and later in the day. This shift occurred for various reasons: later dinners became fashionable; electric lights facilitated dining after dark; and with more men working away from home and not returning until after 5 p.m., an evening dinner allowed the entire family to reconvene for a meal together. 

Today, dinner remains the largest meal of the day but is typically eaten around 6:00-7:00 p.m. in America, and often even later in Europe.

While these large evening meals may be convenient in our modern, industrialized societies, emerging research has shown that this schedule doesn’t align very well with our innate human biology. 

As AoM podcast guest Steve Hendricks shared in our episode about fasting:

our circadian rhythms have hardwired us to process food most efficiently in the morning and early afternoon, and we get worse and worse at it as the day goes on. By nighttime, we’re frankly pretty terrible at processing nutrients. So when we eat later in the day or at night, nutrients linger in places where they shouldn’t, and our overnight repairs become interrupted. And there seems to be just nothing we can do to change this circadian rhythm that governs all of these processes.

Because the efficiency of our metabolism peaks in the morning and then declines throughout the day, people who eat the bulk of their calories early on improve their blood sugar and insulin sensitivity. They’re also less hungry and burn more fat than people who eat their biggest meals later in the day, and this is true even when people are eating the same amount of calories overall and doing the same amount of physical activity; meal timing alone can make a significant difference in overall metabolic health. 

It turns out there’s much wisdom in the old saying: “Eat breakfast like a king, lunch like a prince, and dinner like a pauper.”

While it may be beneficial to eat a bigger breakfast/lunch and keep one’s dinner small (or non-existent — according to Hendricks’ research, the ideal daily eating window is something like 8:00 a.m. to 2:00 p.m.), most people won’t find this idea very appetizing for reasons both practical and psychological. There is something very satisfying about sitting down with loved ones for a big meal after the stress of the day is through.

If you’re understandably not willing to mix up the timing and “weight” of your meals, there is something you can do to blunt the negative effect of eating the bulk of your calories late in the day: an after-dinner walk.

The Digestive Power of an After-Dinner Walk

Whenever we eat, glucose hits our blood, and insulin rises to shuttle it into our cells. In the morning hours, our cells are more insulin sensitive, so that when insulin metaphorically knocks on their doors, the cells are more receptive to opening up and letting glucose in. 

As the morning wears into evening, our cells become less insulin sensitive, meaning they start ignoring insulin’s “knocks,” leaving glucose in our blood. 

What’s more, as the day progresses, our pancreas starts getting sluggish and produces less insulin, meaning our cells will become less responsive to sugar spikes because the knocks from insulin are less loud.

This combo — less insulin sensitivity + less insulin — means that our blood sugar tends to be higher after meals eaten later in the day. This effect is, of course, only compounded when we eat a large meal later in the day. Thus, big dinners are not optimal for our metabolic health. 

Fortunately, our body has another powerful way to clear glucose from our blood that doesn’t rely on insulin: movement. 

Muscle is the primary tissue in our body, and it also happens to be one of the main consumers of glucose. In fact, as Dr. Benjamin Bikman noted in our podcast about metabolic health, “Roughly 80% of the glucose that gets cleared from our blood goes into the muscle.” 

He goes on to explain: “the moment the muscle starts moving — contracting and relaxing — it opens [its] glucose doors even though insulin isn’t there knocking on them. . . . And so if we just get up and start moving . . . [our muscles] begin greedily consuming all of that glucose.”

Bikman imagines your muscles as having tons of hungry little mouths that open up and gobble your glucose as you get going, and I find this metaphor really motivating!

By getting your muscles to soak up glucose in the absence of insulin, an after-dinner walk blunts blood sugar’s rise and allows it to come down quicker.

In a study done on people with diabetes, participants who were asked to walk for 10 minutes after each main meal improved their blood sugar curve more than those who were told to walk for 30 consecutive minutes at a random time, and this “improvement was particularly striking after the evening meal.”

That an after-dinner walk also effectively blunts glucose for people without diabetes is something to which I can personally attest. I used a continuous glucose monitor a few months ago (while I don’t have diabetes, I was interested in tracking my blood sugar), and it was interesting to see the effect post-dinner movement had on my glucose. My blood sugar would usually start rising around 45 minutes after eating. If I did nothing, it would continue to rise and take two hours to return to normal. But if I took a walk after dinner, my glucose levels wouldn’t rise as high, and they’d get back to normal in just 45 minutes — less than half the typical time.

Walking is also an aid to digestion in other ways. Because the intestinal system slows down when you sleep, a big evening meal can sit heavy in your stomach, disrupting your sleep. Research shows that a post-dinner walk stimulates the stomach and intestines, causing food to pass through them more quickly and giving your digestion a head start before you hit the hay. Walking after a meal can also diminish gas, heartburn, and bloating.

How to Take an Effective Post-Meal Stroll

Length/intensity. The faster and longer you walk, the more of movement’s post-meal glucose-sucking benefit you’ll get. (Though walking too fast might upset your full stomach a bit, so don’t ramp the intensity up too high.) But while a 10-minute walk is a good minimum to aim for, a recent meta-analysis showed that taking even a two to five minute walk after eating significantly moderated blood sugar. Any movement helps!

Timing. When I wore a continuous glucose monitor, I noticed that when I took my walk immediately after dinner, the walk didn’t blunt the spike in my blood sugar; instead, it just postponed the spike. When the delayed spike occurred, it had the same magnitude as if I hadn’t taken a walk.

A research study backs my personal results. It seems like if you want to reduce blood glucose, you should wait 30-45 minutes after eating to begin your activity. Happily, this gives you ample time to engage in post-dinner conversation before you get up from the table and take your stroll. 

An after-dinner walk won’t reverse the effect of eating a big meal at a time that runs contrary to your metabolism’s optimal clock. But it will help a little. Hey, it beats eating dinner like a pauper!

The post The Digestive Power of an After-Dinner Walk appeared first on The Art of Manliness.

Dumbbells are a popular and effective tool for strength training and exercise. They’re versatile, easy to use, and come in various weights and sizes, making them suitable for people of all ages and fitness levels.

You can get a full-body workout with a set of dumbbells or use them as I do: as an accessory to the main barbell lifts. I love doing Arnold shoulder presses and bicep curls with dumbbells.

But while doing some of those curls the other day, I got to wondering: “Why are dumbbells called dumbbells?”

I mean, it’s kind of a weird name when you think about it.

I decided to investigate. 

The Ur-Dumbbell: The Ancient Greek Haltere

Not only did the ancient Greeks give us democracy and virtue ethics, but they also bequeathed us the forerunner of what would become the modern dumbbell. Soldiers and athletes would train with various weighted implements to get stronger. One of these strength-training tools was the haltere. 

The haltere

The haltere varied in shape throughout antiquity but most commonly took the form of a semicircle with a hole in it; users would place their fingers through the hole to grip this piece of handheld exercise equipment. Halteres were typically constructed from stone and metal but were also made with wood and wax; athletes would add lead to these wooden and waxen halteres to increase their weight.

Halteres were used similarly to how we use modern dumbbells. Athletes would hold the weights while performing curls, lunges, and deadlifts. They’d also swing them around the way you would an Indian club.

An ancient Greek athlete holding halteres while doing the long jump.

Halteres were used for training in the long jump as well. Athletes would hold the weights in their hands and jump with them to build up power and strength in their legs. They’d also use halteres to jump further. As they jumped, they’d swing the halteres forward to help propel their momentum and then swing the weights backward, letting them go just before landing.

The Romans copied the Greeks and used halteres to train their athletes and warriors. The Greek physician Galen recommended soldiers utilize halteres to get stronger. 

Image from De Arte Gymnastica Aput Ancientes showing modern dumbbell-looking halteres.

During the Renaissance, ancient Greek and Roman training methods saw a revitalization. Health books of the period forwarded Galen’s recommendations for using weighted implements for exercise, and the haltere found its way back into Western culture. The most important Renaissance book that promoted strength training with halteres was Mercurialis’ De Arte Gymnastica Aput Ancientes. Along with training regimens inspired by Hellenistic culture, the book contains elaborate illustrations of jacked Greeks and Romans hoisting things, including halteres, to get stronger. But the halteres that Mercurialis depicted looked different from the oblong semicircles that actual Greeks and Romans used. Instead, they looked like two cones stuck together at their heads, forming a rod in the middle you could grasp. 

They looked like modern-day dumbbells.

Dumbbells Become Dumbbells

Thanks to Mercurialis’ De Arte Gymnastica, by the 18th century, training with handheld weights became a common and accepted form of physical exercise. But when did the haltere start being called a dumbbell, and why was it called that?

Jan Todd, a professor of exercise history, has scoured the historical record on these questions and couldn’t come to a definitive answer.

But what she uncovered offers clues about how the haltere became the dumbbell. 

In 1711, the British poet and essayist Joseph Addison wrote this in his popular magazine, The Spectator:

When I was some years younger than I am at present, I used to employ myself in a more laborious diversion…it is there called…the fighting with a man’s own shadow; and consists in the brandishing of two short sticks, grasped in each hand, and loaded with plugs of lead at either end. This opens the chest, exercises the limbs and gives a man all the pleasure of boxing, without the blows.

It sounds like Addison was shadowboxing using handheld weights that resemble what we know as dumbbells. But in that essay, he never used “dumbbell” to refer to his hand weights.

However, when describing another of his exercise routines in a different essay in the same issue of the magazine, he does use the phrase “dumb bell”:

For my own part, when I am in town, I exercise myself an hour every morning upon a dumb bell that is placed in a corner of my room, and [it] pleases me the more because it does everything I require of it in most profound silence. My landlady and her daughters are so well acquainted with my hours of exercise, that they never come into my room to disturb me whilst I am ringing.

The dumb-bell exercise apparatus, which was used even by a Founding Father. When Benjamin Franklin was 80, a friend asked him in a letter what accounted for his longevity. Old Ben responded: “I live temperately, drink no wine, and use daily the exercise of the dumb-bell.”

When Addison says he was exercising himself upon a “dumb bell,” he was likely referring to a piece of equipment that included four arms with lead balls on their ends. The apparatus was installed a level above the one on which it would be used. A rope attached to the device ran through the floor to where the user stood below. He would pull the rope up and down, turning the apparatus’ weighted arms like a flywheel. This rope-pulling movement resembled that used to ring a big bell (like a church bell), though this “ringing” did not, of course, result in any sound. Hence, the device was called a “dumb bell” — “dumb” as in “doesn’t make a noise.”

So why did the name “dumb bell” get transferred from this piece of 18th-century exercise equipment to haltere-esque handheld weights?

Perhaps it was because the arms on the dumb-bell apparatus kind of resemble the dumbbells we know today. 

Or maybe readers of Addison’s magazine conflated the two articles he wrote together and started thinking of the handheld weights he referenced as “dumb bells” too.

The world may never know.

While there isn’t a definitive answer as to when and why handheld weights became known as dumbbells, it’s clear that by the end of the 18th century, they were regularly being called such (the term “barbell” wouldn’t arrive on the scene for another century). 

It’s also clear that dumbbells have a health-enhancing, strength-improving track record that stretches from antiquity through the present day.  

Long may they continue to be hoisted. 

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