This is the first episode of the Don't Die podcast, featuring Bryan Johnson, Kate Tolo, and Dr. Mike Mullin. They deep-dive into a recent study that questioned creatine's muscle-building effects, discuss the problems of the modern healthcare system from an ER doctor's perspective, and cover AI luminary Andrej Karpathy's sleep tracker experiment results. The conversation is packed with practical advice on health optimization and anti-aging.
1. The Start of the Don't Die Podcast
Bryan opens by sharing an experience at a restaurant with his team. Watching food being served at a regular restaurant for the first time in a while was shocking.
"Watching food arrive at every table, thinking about what I've learned about food and toxins and how food is processed in the restaurant system... My team said 'Bryan, welcome to normal society. This is how people actually live.'"
Bryan describes the experience as feeling like time-traveling back to the early 21st century — realizing how far removed their health system is from mainstream society.
This podcast is a space where three people practicing the philosophy "We are the first generation that won't die" share weekly improvements to their health protocols. Bryan and Kate talk about 150 times a day, and Bryan and Dr. Mike talk 5-6 times daily, continuously refining their protocols.
2. An ER Doctor's Perspective: Preventable Diseases
Dr. Mike Mullin shares his experience as an ER doctor, describing it as completely contrasting with his current health optimization work.
"The ER was like banging your head against the wall all day. All the problems that result from a culture that doesn't value health. The side effect is people get extremely sick and come to the ER at the end of their life or disease process saying 'fix me.'"
Dr. Mike estimates that 80-90% of ER patients have preventable conditions. While acute issues like car accidents, appendicitis, gallbladder problems, and infections are harder to prevent, most chronic diseases are preventable.
The Reality of the ER System
Dr. Mike explains the differences between American and New Zealand ERs. In New Zealand, doctors see about 10 patients per day, versus 30 in America — three times as many in the same timeframe.
"It's chaos. You're not putting out fires; you're trying to slow down the spread."
His advice for people going to the ER is surprising:
"Honestly, I'd say input your symptoms into an LLM like ChatGPT and ask it what to do, then make sure that actually happens."
Kate actually used this method when her mother went to the ER. She chatted with ChatGPT, role-playing as the patient, asking about symptoms, and had it generate about 100 questions. The AI recommended specific tests, which ultimately led to an accurate diagnosis (corneal inflammation and scratch).
Dr. Mike emphasizes that while doctors dislike patients who Google before coming in, this is actually active self-advocacy. The system is so broken that without asking your own questions, you'll get pushed down the path of least resistance by doctors and nurses alike.
3. The Creatine Study Controversy: No Muscle-Building Effect?
This week's key topic is a new creatine study. UNSW (University of New South Wales) research found that standard 5g/day creatine supplementation without training does not lead to muscle gain.
Over 12 weeks, both the creatine group and the control group gained the same 2kg of muscle mass, and the initial weight gain from creatine was attributed to water retention rather than actual muscle.
The Study's Unique Feature: The Wash-In Period
Dr. Mike explains the most interesting aspect — the study measured a "wash-in period." Traditional gym-bro creatine loading involves 20g/day for 5-7 days to saturate muscles. Since increased creatine also increases body water, this study measured lean mass at Day 0 and Day 7 to account for water gain.
"They accounted for the extra water weight you gain when starting creatine. And that's the difference from other studies. Other studies found changes, but that may be because they didn't include this wash-in period."
Study Limitations
Dr. Mike highlights several important limitations:
- Insufficient wash-in period: They used a 7-day wash-in, but at 5g (not 20g), muscle saturation actually takes 3-4 weeks.
- Prior creatine studies already showed weak muscle mass data: Previous studies also showed only very small muscle mass changes.
- Creatine's real strengths lie elsewhere:
- Longevity
- Cognitive function
- Skeletal muscle mass
- Metabolic health
- Speed and power (especially in well-trained athletes)
"What we learned from this study is that when untrained individuals do a 12-week exercise program, there's not much difference in muscle mass whether they take creatine or not. But we learned nothing about cognitive function, recovery, or power and strength output."
How Much to Take?
Dr. Mike recommends weight-based dosing for general health:
- 0.1g per kg of body weight: About 7g/day for a 70kg adult
- 5g/day is generally sufficient for average builds
- Diet consideration: Standard American diet already provides 1-2g/day, so only 2.5g extra may be needed
- For vegans: Higher doses may be needed since they don't eat red meat
For cognitive improvement, higher doses have been studied:
- Brain trauma, sleep deprivation, mild cognitive impairment: 10-20g/day
- Maximum safe dose: Up to 30g/day studied over 5 years with no major side effects
"Excess creatine is excreted through urine. There appears to be no such thing as a dose that's too high."
The Team's Conclusion
Dr. Mike firmly states this study won't change his creatine advice at all.
"Creatine has more data backing it than virtually any other supplement we know of, as Bryan mentioned. And the data is overwhelmingly positive. There are certainly studies showing no change or benefit, but there are no studies showing harm."
Bryan takes 5g and is currently experimenting with 10g. When traveling, he increases to 20g to compensate for sleep deprivation and test cognitive enhancement.
4. The Importance of Body Awareness
Bryan describes developing extremely high body awareness over years of health protocols.
"I can feel my heart rate at any moment. At any given moment, I can tell you fairly accurately how fast or slow my heart is beating."
Through countless treatments and careful observation of every body part — colors, tones, functions — he's learned what to look for. This contrasts sharply with his former self, who would just power through headaches and poor days.
Connecting measurement to sensation creates excellent intuitive sensors. You learn to feel what the measurements show, developing refined intuition.
The Paradox of Body Awareness
But Dr. Mike raises an interesting question — can body awareness have a downside?
He describes a recent experience at a Las Vegas casino with his wife:
"How are all these people still standing? They're all drinking, smoking, eating pizza and corn dogs... If I did that, I'd literally fall on the floor. I'd feel terrible. When you get healthy, you create this body awareness where you can't even allow yourself to slip up anymore. But those people are walking around fine, no chronic back pain, and seem to be feeling great while putting garbage in their bodies."
Kate explains this demonstrates the brain's compensatory ability. In a Cornell drinking study, at low-to-moderate intoxication levels, behavior may appear unimpaired, but brain scans show actual damage. The brain is simply compensating.
At high intoxication levels, the brain can no longer compensate, and both behavior and scans show impairment. This is why cognitive decline starts long before symptoms appear.
"You're more drunk than you realize. And in those moments at the casino, you're more 'dying' than you realize."
5. Andrej Karpathy's Sleep Experiment
Kate introduces this week's highlight: Andrej Karpathy's sleep tracker study. Karpathy is an OpenAI founding member and former Tesla Autopilot AI director — a giant in the AI field.
He tested four sleep trackers (Oura, Whoop, Eight Sleep, Apple Watch) over two months and concluded Oura and Whoop were top-tier.
Karpathy's Key Findings
"Overall, I say with absolute conviction: Bryan was basically right, and my sleep score strongly correlates with the quality of work I can do that day."
"When my sleep score is low, I lack initiative. I lack courage. I lack creativity. I'm just tired."
"When my sleep score is high, I can do anything. On the best days, I can sit and work for 14 hours and lose track of time. This is not subtle."
The important point is that it's not a single night's sleep but the accumulated sleep depth over the past several days that matters. One bad night is okay, but several in a row is bad news, and vice versa.
Bryan's Reaction
Bryan felt tremendous accomplishment reading this.
"What I was really trying to do was augment ourselves. And what Andrej is doing is building future intelligence in the form of AI. And through this research, he's actually building his own intelligence."
Bryan realized after selling Braintree to Venmo that we're at an astonishing moment of evolving as a new species. The most important thing was to enhance his own intelligence to see this moment clearly and act wisely.
"That the designer of superintelligence is leaning into sleep as something that makes sense on every dimension... we take on so much every day. So for someone as amazing as Andrej to come out and say 'sleep works, it dramatically improves my life, you can measure it, and you can actually build a life system around it' — that was... really a great joy."
6. The Need for a Health Travel Advisory System
Kate proposes an interesting idea: something like a travel advisory for health. As new studies emerge, they go viral and impact society, but they don't contribute to an updated information platform. Just as there are "things to know before traveling to Japan," creatine should have a website saying "this new study came out but here's why it doesn't change anything. Here's what you need to know."
Bryan agrees it's a big problem. Studies get published and settle into our health consciousness background noise, becoming abbreviated truths like "I remember creatine didn't really help with muscle — why am I taking it?"
"There's also a recency bias. We assume newer means better. When in reality it's a tiny study of 60 people, coming after decades of research."
Closing
Bryan closes by revisiting the restaurant experience. Even at a famous Venice health restaurant, thinking about food, toxins, and how food is processed in restaurant systems, it was shocking.
"My team said 'Bryan, welcome to normal society. This is how people do things.' But the system we've built is so far removed from that... it was really shocking. It felt like time-traveling back to the early 21st century and watching a movie."
All three enjoyed this conversational format and await viewer feedback. There are 6-7 more topics they couldn't cover this week, including embryo selection technology, so future episodes look promising.
Health begins with measurement, measurement leads to awareness, and awareness enables wise choices. Small daily choices will accumulate to make us "the first generation that won't die."