Let's say right now I want more cognitive function. What do I do? And it depends. It depends on the kind of cognitive function I want. A lot of the time I would do 1.5 milligrams of nicotine as a lozenge. Probably the best nootropic cognitive enhancer I've come across. It has all sorts of other benefits. 1.5 is a very low dose. If you're doing it every two or three days, it's not addictive at all. You can read all the studies on nicotine. It's frankly a fascinating compound. There's even some studies that show that it could lower risk of Alzheimer's, and other neurodegenerative disorders. So I find that very effective as a nootropic.
Hello, Max. You are the founder of Superpower, an all-in-one place for people to take care of their health, combining the best lab tests with frontal interventions and AI. So, welcome to Modern Healthspan, and thank you so much for joining us.
Richard. Excited to be here.
Thank you, Max. So, Max, what do you think? You're looking at healthcare and healthspan and how to extend people's health. So what do you think is the biggest thing that people in their 50s and 60s are missing in healthcare at the moment?
I think so many people don't actually know what is going on inside their body. And until you know what is going on, it's very hard to actually take action, right? And if you go to your primary care doctor, they might test 15, 20 blood biomarkers, and that doesn't show you the complete picture of your health. They're not testing hormones, they're not testing your gut, they're not testing toxins, they're not testing inflammation; they're doing only very simple blood biomarkers. So I think the starting point, the thing most people should be doing in their 40s and 50s, is actually getting a more complete picture of their health, and that tends to start with more comprehensive testing.
The thing is that testing can get very expensive. I mean, because I get testing and I get it done separately, right? I don't go to my primary healthcare. But you know, it's expensive if I want to test hundreds of biomarkers. Does that mean that becomes a limiting factor, actually?
Yeah, I think it used to be expensive, and I don't think it's nearly as expensive anymore. It used to be, if you wanted to test 100-plus blood biomarkers, something that would cost you maybe a thousand dollars to $5,000. And what we're seeing is the cost of testing is coming down, right? And this has been a trend over the past 20 years. The genomic test cost a billion dollars in 2000, and today it costs $99. And a big part of what we're doing as well is trying to bring that price down. Part of — I don't want to really plug Superpower too much — but part of what we do is say to people: rather than an annual physical, start your journey with us for $199 a year. We'll start the journey with a blood test of over a hundred-plus blood biomarkers. It would have cost a thousand dollars in a hospital. It would cost a couple thousand if you sought it out yourself. We'll give it to someone for $200. Far, far, far cheaper, and a really special experience.
So I'd certainly like to come back to Superpower and how it works. But just thinking about data that we can collect — so if I'm like a biohacker and I collect my Oura ring data... I have an Oura ring. What do you think about biohackers and collecting — and people who just collect their own data?
I think that many people should do it at least once, right? The advantage of the Oura ring is after you do it for a month or two months, you start to learn what inputs change the outputs, right? What actions actually change how I sleep. And that's really powerful if you've never seen that before. And it starts to change your behavior because you see the effect. Now you get two months in, and all of a sudden you probably realize what inputs drive what outputs, and you don't necessarily need the device anymore. So I think many of these devices are things that people should test. I don't necessarily think that right now, in their current state, they're things people have to wear for an extended period.
So some people I know — some professional people — have kind of poo-pooed biohacking, saying, you know, we know what really moves the needle, right? It's eat less, move more, and some things down there. Well, kind of what's your thought on biohacking in general and collecting your own data? Is that really important?
Well, if I look at the idea of biohacking, it basically says we can do things to improve our biology that improve our life. And that is a fundamentally sound idea, right? It basically says there are tools out there beyond just our body and beyond just living that actually improve our lives. And there's the whole argument of: what about diet, exercise, sleep? And I agree that those are the foundations. The catch is that many people are trying to do them. They've been trying to do them for decades, and either it's not working or you hit a ceiling pretty quickly on the size of the effect, right? We've been trying to get people to lose weight for 60 years. Obesity has gone up every year for 60 years in the US. GLP-1s come along and obesity starts going backwards, right? Obesity is upstream of just about every chronic disease. And we can say diet, exercise, sleep, but the reality is: look at our food system. Our food system is micronutrient-depleted, mineral-depleted. There's all sorts of heavy metals and plastics and pesticides that exist in the system that used to not exist, right? So let's say we're in our ancestral days — we're foraging for food and we're hunting food, and everything is wild and nutrient-dense. Yeah, I don't think we need supplements. We don't need biohacking. In a modern world where everything is not what it used to be, that's when we can actually start supplementing, because we need to fix what some industrial-era food economy has introduced.
So you talked a little bit about you see what the results are, and based on that — do you think that we should always do test, intervention, test, no test, intervention, test, right? Or should you just look at — or is looking at empirical data, observational data, and then saying, 'well, in most people this helps, so I'm going to try it'?
I think there are several things where we can say in most people this helps, therefore I'm going to try it, and we can have a very high hit rate. For example, in most people vitamin D supplementation helps; in most people magnesium helps; in most people glycine helps; in most people omega-3s help; in most people a whole food diet helps. So I think we can say it in some instances. That said, there are some cases where we can't say it, right? I can't say to someone to take a methyl blend to lower homocysteine unless I see they have high homocysteine. I can't say to someone take this liver function stack to improve your liver detoxification unless I see that their liver isn't functioning as well as it should. So there are some things that I think we can make a pretty good guess without data and say most people should do this. And then there are some things where, to know what to do, you typically need data, because you don't want to do those things if you don't actually have a problem.
Do you think so? So there are many people who are doing biohacking and they're trying different things. Is this adding to the total data? How many anecdotes do we need before we consider that something actually has data to it?
I love this question, because there are two schools of thought. One school of thought is: unless there's papers and clinical research and double-blind randomized control trials, we don't know what to do. That's one school of thought. Another school of thought says: humans have been around for 60,000 to 100,000 years on planet Earth. Maybe over that period we learned a thing or two, and that's anecdote, right? And I think before we have any research paper, we have anecdote, we have clinical evidence, we have what we're seeing on the ground, we have people experimenting, and that is the first step in the scientific method, right? Before there's research, there's observation. So I actually do think we should be paying attention to observation. And many things which we observed or reasoned about 20 years ago that were dismissed have now proven to be true. Look, we rewind even further — we dismissed washing your hands, we dismissed germs and viruses, we dismissed the Earth revolving around the sun — a little bit different, but similar kind of thread and idea. And I think we do a version of that today, which is like we dismiss anecdote and we say, 'but where's the evidence? Where's the paper?' And my general contention here is we can't always wait for the evidence. Let's start with what we're seeing on the ground and use that as the jumping-off pad, and then we get to the evidence.
How do you think about how much evidence you need? Because I certainly see — I mean, I agree with what you're saying, but I see this real problem. You know, is a mouse study enough? Is a worm study enough? Is a small human trial enough? I mean, at what point do we say, okay, there's enough evidence that I should try this?
I think that if we have long-term clinical use and long-term human use, number one, that's important. Number two is: do we have an understanding of the safety — partially coming from long-term human use and partially coming from an understanding of mechanism? And then probably number three is, even if the science hasn't been started yet, we should be able to have a sense of the mechanism. All right. I think it's typically not enough to say, 'oh, this for some reason works.' I think we want a hypothesis around why it works, right? Because that kind of reduces risk and makes sure that there's some validity to the claim.
I mean, do you see any way — so, like, taking rapamycin for example. So rapamycin is an approved drug, but it seems to help with longevity, but it's not approved for longevity and never will be, at least under the current way that the approval process works. Is there any way to, I don't know, promote it, or to promote other drugs, other supplements of that nature?
Yeah, I think this is a fascinating question, right? Which is again, where's the line — like, where is the line between what we do and what we don't do? My general view is, if something is close to zero risk and plausible benefit, the kind of Pascal's Wager answer is: I am going to take that thing, right? And I'd put vitamin D in this category. Now look, we know there's benefits of vitamin D. You can feel it subjectively, but there's close to zero risk. I'd go as far as to say there is zero risk. And therefore I think that's something that is very easy to pursue. I'd put magnesium in this category. I'd put omega-3s in this category. I would put gut microbiome testing before it was a thing in this category. I'd put whole food eating in this category. Then there are some that are a little bit risky. And it's like, yeah, we think they have an observed benefit in rabbits and mice and worms, and we understand the mechanism to an extent, but we haven't been using them for a very long time in humans. And I'd put rapamycin in that category, right? Yes, there's plausible benefit. Yes, we understand the mechanism. But I think for many people, we haven't been using rapamycin for long enough for the average person to say, 'therefore I'm going to do it.' So with something like that, I would generally say wait for a little bit more evidence before pursuing it.
Because we don't have decades of evidence around rapamycin, and medical opinion and consensus changes pretty quickly with that stuff. And I also think the benefits — like, I would maybe change my mind if the benefits were more pronounced, right? Like, if there were very clear lifetime benefits and it's like, 'look, I understand the risk argument, but the benefits are massive.' For example, GLP-1 — I would contend that yes, there's risk, probably similar risk with a GLP-1 like Ozempic compared to rapamycin, but the benefits are far larger. The impact on weight, the impact on metabolism, the impact on insulin sensitivity, the impact on inflammation is massive. And we understand how being overweight, insulin resistant, and highly inflamed is upstream of just about every single chronic disease. So even if there's some risk with a GLP-1, for example, I think because it is so broad-acting and so effective, the risk-reward trade-off is probably worth taking. And I'd contend that a GLP-1 is likely a better longevity drug than rapamycin.
If you're overweight? Or would you add that kind of criteria — that if you're overweight, GLP-1 is good? I mean, if you're...
No, no, no. I would say for most people, even a microdose of tirzepatide is better than nothing, just because of what we're seeing with the potential impacts on neurological function and how they're neuroprotective, the impact on inflammation, and basically how it improves metabolic response and insulin sensitivity. So I think we're just seeing broad-acting effects from these compounds. Now look, if I was really slim and wanting to play it conservative, you can wait three years. It's not like doing it today makes an enormous difference. But I think on the balance of probabilities, these compounds are going to be useful for just about everyone.
Right. In micro doses. But...
Micro dosing, totally. Yeah.
Right. And at the moment all of these are under patent, right? So they're all expensive. Is that correct?
Yeah, it's a bit murky. So semaglutide was Ozempic, a Novo Nordisk drug. What we're seeing is that the patent isn't really holding up in court, because GLP-1s have been around since like the 1990s. Eli's was first developed in 2001, I think like 2006 or something, right? So they've been around for some time, and Novo's patent isn't really holding up. So a lot of compounding pharmacies are just making semaglutide, and it's more the embeddedness of Novo with the government and the regulators that confers defensibility versus some court-of-law patent. Tirzepatide — that's Eli's drug. The patent is a little bit more defensible with that. We're still seeing a lot of compounding pharmacies manufacturing it. There are ways to get around the regulation and the patent which these compounding pharmacies are tapping into. For example, a claim that they'll make is that this person needs 2.3 milligrams and the dose I can get is only three or four, and therefore we need a compound. So there are people trying to get around it. And I think with each subsequent class of GLP-1 — Eli's blockbuster one that's going to come out mid to late next year is retatrutide — with that will be, I think, even more defensible. I think it's actually going to be quite hard for someone to infringe that patent or claim that that patent doesn't hold. So some of them are under patent, some of them are equivocal, and increasingly the patents are going to get stronger as the compounds become more novel.
Do you see any issue with people? So people eat less when they have these GLP-1 agonists, which helps lose weight, but they also lose muscle mass, or can lose muscle mass. Do you see that as an issue? Or if you take these really micro doses, do you not get that?
So, GLP-1s themselves mechanistically are not catabolic. They don't mechanistically result in muscle loss. The thing that results in muscle loss is eating less, potentially exercising less, consuming less protein. That's what results in muscle loss. So if you eat a lot less, you're probably going to lose muscle. Now, if you take it for inflammation reasons and longevity reasons and preventative disease reasons, and you're not trying to lose weight, you're not trying to eat less, you're not going to lose muscle, right? Like, they're not actually mechanistically catabolic. There are actually several frontier physicians who argue mechanistically they're slightly more anabolic than they are catabolic. People argue that by improving insulin shuttling into cells, it makes it easier to convert glucose uptake into muscles, which is anabolic. I don't know whether that argument is valid, but the conclusion that I kind of run by is: yes, you'll lose muscle if you're losing a lot of weight and eating less. That's dangerous. You shouldn't want to lose muscle. If you're micro dosing and you're eating the right amount and exercising the right amount and getting protein, you're not going to all of a sudden lose muscle.
Right? Okay, yeah. So it is the maintaining the food. And I mean, one issue is that as we get older, sometimes we eat less. But I mean, it's just something you have to manage.
Could you — thinking about a personal protocol — how do you go about building an optimal protocol for yourself? I mean, what is it you think about? What data is it you look at?
Yeah, I love this. So, I kind of split it into probably like three categories. One is: what are the base case things I should do, and just about everyone should do? And that looks like ensuring micronutrient balance, hormone balance, mineral balance, metabolic function, gut health, low inflammation, high-quality sleep. That's the basics. And everyone should make sure those foundations of health are in check and have parts of their protocol that, independent of your goals and your data, still target those foundations of health. So everyone should make sure they have the foundations of health. I can get into in a moment what that looks like for me. The second thing I think about are: what are your unique goals, right? Like, what do I uniquely care about, and how can my protocol help me get what I care about? For me, I care about focus sometimes when I'm working. I care about injury recovery if I'm playing soccer or if I'm in the gym. I care about general cognition and IQ. I care about not being too stressed and being able to sleep. I care about putting on muscle. So there are some of the things I individually care about. So that's the second input into the protocol, which is what are my personal goals, right? Not everyone cares about focus and cognition. And then the third input is: what does my unique data tell me I should do? And there are a lot of things I see in my data that change my protocol and introduce things into my protocol that would not otherwise be there. So I guess we can kind of go through an example.
I will wake up in the morning and I will start by going to the bathroom, and I'll put ozonated coconut oil in my mouth and I'll swish that around. And the reason why that's good for me is I've got a lot of bad oral pathogens in my oral microbiome, and I've tested that with the oral microbiome test, and my gum health is not that good, and I found this, given my unique data, is useful. I don't think that's necessary for everyone. It's good given my unique data. After that I'll put in an electrolyte. I'll crack this little electrolyte — it's basically salt water — and I'll put that under my tongue for 30 seconds to a minute. That one, on the other hand, I think just about every single person should do. And the reason why is our mineral balance after sleeping is often depleted, and we need to replenish minerals that we lost. A lot of people add shitty electrolytes. This is a more natural form of an electrolyte. Quinton is the name of the brand. So that's going to be in that first category.
I will then go to the kitchen. I'll take maybe 20 supplements, and some of them are in that first category — the things everyone should take. I think everyone should take a high-quality multivitamin, right? That is your A, D, K, E, B, and a bunch of other things as well. I think everyone should, and I do that. I'll take omega-3s. I think just about everyone should take omega-3s. And that's like the basics, and that's what I think most people should do. Now, I have some other goals, so I then go to my goals and I say, what else should I do to achieve my goals? So I'll take acetyl-L-carnitine, which is good for — I guess kind of good for weight loss — then also good for like verbal fluency and cognition. So that's one of my goals. I will take an organ blend. It's basically a freeze-dried blend of liver, kidney, spleen, heart — the organs we used to eat in ancestral days. This is just encapsulated into a supplement. I'll take that. And the reason I take that is it's good for like vitality and testosterone and performance. Again, that's unique to my goals. It's not about my data, it's not about what everyone should do, but that's unique to my goals. So it gives you a little bit of a flavor of the morning stack and how the three inputs are: what should most people do, what are my goals, what is my data. And then throughout the rest of the day this kind of theme continues, but I won't bore you with that.
But can you talk about cognition? Because I am interested, and we generally don't focus on that, right? We focus on what it is we can do for physical performance, but what do you do for your brain performance?
There are two ways I think about this. One is: how do we solve for chronic cognition? Like, how do we actually just lift up the level of our performance over an extended period of time, and making sure the foundations of our health are in check? And the second way to think about this is: how do I drive acute performance? If in this very moment I want greater cognitive faculty, what do I do? So let's step through them one at a time. In terms of general cognitive performance, I think of the starting point here as solving for the foundations of health. Sleep, very, very, very important, right? If I'm not sleeping well, cognition over the course of the day is going to be down, and you have a higher risk of Alzheimer's and other cognitive diseases, right? So that's a foundation I will solve for. Metabolism, right? If my metabolic health is out of whack — I used to be pre-diabetic — you eat carbs and you feel fatigued, you feel brain-dead, you feel brain fog. Eating becomes this cognitive impact event, and you increase decline, you increase chronic disease risk. So metabolism is another foundation. Toxins are another one, right? I used to be in a very moldy environment. I used to have almost mercury toxicity levels. These impact cognitive function, they impact neurological function, they can result in all sorts of nasty things. So I think it's important to eliminate toxins from your environment and diet and food and clothes and self-care products, and if they've accumulated in your body, to remove them from your body, and you'll typically find that you have higher levels of mental performance. Hormones, another foundation, right? If your hormones aren't balanced, your cognition is not going to be where it should be, and you potentially increase risk of different diseases as well. And then gut health. There was a period of my life where I couldn't focus. I couldn't like sit down and do anything, and I actually think a surprising amount of these ADHD-like symptoms started in my gut, and I healed my gut, and lots of other things started to fall into place. So that's kind of the first category: solve for the foundations of health — inflammation, metabolism, toxin exposure, gut health, sleep, etc. There are a few others. And solve for those foundations, and that will boost cognition.
The second way I think about it is: let's say right now I want more cognitive function. What do I do? And it depends. It depends on the kind of cognitive function I want. A lot of the time I would do 1.5 milligrams of nicotine as a lozenge. Probably the best nootropic cognitive enhancer I've come across. It has all sorts of other benefits. 1.5 is a very low dose. If you're doing it every two or three days, it's not addictive at all. You can read all the studies on nicotine. It's frankly a fascinating compound. There's even some studies that show that it could lower risk of Alzheimer's, right? And other neurodegenerative disorders. So I find that very effective as a nootropic. I'll drink a lot of green tea. Caffeine is good for performance, and theanine is also good for mental clarity. And those are some of the basics for me. If I want to go a little bit more intense, I'll add a cholinergic — so something that increases acetylcholine production in your brain, and that improves focus. Alpha-GPC is the cholinergic I will use. And then if you want to go even more extreme, you can start adding on certain peptides for cognitive performance as well. Semax and Selank are the two that are becoming very popular.
You said you fixed your gut health, so you must have measured the gut health. How did you do that? I find there's not many companies that actually have good gut health checking.
Yeah, we have a gut health test, and I did the gut health test and I saw all sorts of things that were wrong. And we'll basically show someone what are the levels of bad bacteria or bad pathogens — do you have too many bad things? We'll show someone the levels of good things — do you have not enough good things? And then we'll show parasites, yeast, candida, fungal populations, and all other nasties that might exist. And depending on what you see, you need a different protocol. Now, for me, there was primarily just not enough good. I didn't have a ton of bad. I didn't have any of these weird things going on, but I didn't have enough good bacteria. So I did a lot of things to support the population of good bacteria. And a lot of people are like, just take a probiotic. Now the catch is that doesn't really work if your gut isn't actually a kind of healthy environment, if it doesn't have the right levels of acid, if the gut lining isn't strong enough. You can't just add a probiotic and assume that will fix things.
So who reviewed the data? Did you review the data, or did you get an expert? I mean, I think reviewing microbiome data is non-trivial.
I was working with a really great functional medicine doctor who builds out Superpower's protocols at the time. And these people are very hard to come across, right? Maybe like one in a thousand, one in 10,000 doctors can do this. And that's not accessible to many people. So a big part of what we've tried to do is turn that into an algorithm, right? And then everyone can start to access the brains of the best doctors around the world. So now when I do a test, I just chat with my AI about it, and I get my report, and it tells me what to do. So I don't have to do the thinking.
The things to do, are they mostly diet, or is there other interventions for your...
Gut?
Yeah, so I think about it as: number one, kill bad stuff, right? Sometimes we need to go through like a killing cycle to get rid of bad stuff. Number two is repair kind of gut wall lining and general gut health. And that looks like things like glutamine, glutamine, different things, BPC57 for the gut wall, different fibers, prebiotics. So that's kind of number two. Number three for me is, okay, now that I've killed the bad things and I've kind of repaired or healed the gut lining, how do I actually start introducing good things? And that looks like taking a prebiotic, taking a probiotic, having all sorts of fibers, normal soluble and insoluble fiber, resistant starch as well is a very helpful kind of fiber. Adding colostrum in I find quite helpful. So basically, how do I build up as much good stuff as possible? And then sometimes, one of the things I'm grappling with at the moment is I don't think I'm metabolizing protein effectively enough. So I'm probably going to add HCL, which is basically a stomach acid that helps with the breakdown and metabolism of protein, because I have quite a lot of protein in my diet. So the set of all of those things allows you to improve your gut health.
Yeah, that sounds very, I don't know, well thought through, very intentional. Do you think that more data is always better? Do you think you can get to a point where people see data that they don't understand and then they just worry?
People definitely worry when they see data, whether they understand it or don't understand it. I don't think that means we shouldn't show some of the data, right? Like if you have cancer and you see you have cancer, you're going to worry, and you better worry, right? Because you've got to get rid of that cancer before it takes your life. So yeah, I think people will worry. I don't think it's a bad thing. I think that's the human body saying, 'I know I have to take action. I know I have to fix things, and thank God I'm taking action today rather than when it's too late.'
Yeah, I kind of think it, you know, it's like it's your data. You should have access to it. Are CGMs still only under prescription in America, or can anyone...
No, you can actually buy them. You can literally buy them from Abbott and Dexcom direct to consumer now.
Ah, perfect. That's definitely better.
Yes. So, as we get older, our health starts to decline, but it actually starts to decline, I think, a lot earlier than we think it does. I mean, because you're in your 30s and 40s and you still feel fine, but things are starting to go wrong. So, do you agree with that? And how would you kind of identify at what point what is going wrong?
Uh, I think that we have certain times in our lives where we actually see quite a big step function in aging, and in our mid-30s is one of those, right? From around 20 to 33, people feel more or less the same. And then you hit 35 to 40, and that is kind of an aging moment for a lot of people. They start to feel, 'Oh, this is what aging is like.' Now that said, there's a lot of accumulated damage and things happening in your younger years that result in that, right? So aging is not all of a sudden something happens; it's a gradual process, even before someone thinks they're aging, that they are aging, and that's part of why it's important to start as soon as possible. That's how I think about it. The protocol that you use should change over time, right? And I guess this should be informed based on your data and your goals. Maybe your goals would change as well. That would be an interesting thought. I mean, you would have to input your goals.
So, I guess, what metrics would you be looking at to identify when you need to start taking action?
Uh, I think most people should take action as soon as possible. Now, many people are only motivated to take action when they see something wrong. And most people have something wrong, right? But if you're testing enough, you see pretty quickly that, oh, okay, I thought I was healthy, but I'm not actually healthy. So I think most people should take action. There's a lot of action to take. Unfortunately, we aren't as healthy as we were decades ago. And when you start seeing what is happening inside your body, it's like a motivating impetus to take. And that's part of why I said get the Oura Ring as well, right? When you see you're not sleeping well, when you see how restless your sleep is, when you see how high your heart rate is and how low your heart rate variability is, that's motivating. So I do think in general, data is motivating.
Data is motivating, but it's not always easy to tie it to a specific protocol. So is that, by the way, is that something that Superpower provides? So you do all these measures and then you provide like a protocol or a suggested solution?
Yeah, yeah. I think like the main reason to get testing done is so you know what to do, and we can't just not tell someone what to do, right? That's the most important part. So part of the reason why we collect a lot of data and preferences and budget and goals and everything else, family history and personal history, is because all of that comes together in a protocol that tells someone what to do. And we sent a survey out to our members a couple of weeks ago and we asked them, 'How does this compare to your primary care doctor in your annual physical?' And 93% said it was either far better or life-changing compared to their primary care doctor, which is crazy, right?
Do you see it as like a replacement for the primary care doctor, or is it like an adjunct?
