This episode is sponsored by Transcend, a veteran
-owned and operated performance optimization
company that I introduced recently as a sponsor
on this show. Well, since then I have actually
been using my products and I have had incredible
success. There was initial blood work that was
extremely detailed and based on that they offered
supplementation. So I began taking DHEA. bpc
157 for inflammation based on the fact that i've
been a stuntman a martial artist and a firefighter
my whole life lots of aches and pains dihexa
to help cognition after multiple punches to the
head and shift work and peptides four months
later they did a detailed blood work again and
i was actually able to taper off two of the peptides
because my body had responded so well to just
one of them that it was optimized at that point
So I cannot speak highly enough of the immense
range of supplementation that they offer, whether
it's male health, female health, peptides to
boost your own testosterone, which I would argue
is needed by a lot of the fire service, or whether
it's exogenous testosterone needed, especially
after TBIs or advanced age. Now, as I mentioned
before, the other side of this company is an
altruistic arm called the Transcend Foundation,
which is putting veterans and first responders
through some of their protocols free of charge.
Now, Transcend are also offering you, the audience,
10 % off their protocols. And you can find that
on jamesgearing .com under the Products tab.
And if you want to hear more about Transcend
and their story, listen to episode 808 with the
founder, Ernie Colling. or go to transcendcompany
.com. This episode is sponsored by TeamBuildr,
yet another company that's doing great things
for the first responder community. As a strength
and conditioning coach myself, who also trains
tactical athletes, dissemination of wellness
information is one of the biggest challenges.
Now, TeamBuildr is the premier strength and
conditioning software for tactical athletes.
And there are several features that really impress
me. Firstly, there is a full exercise library,
so you, the personal trainer, does not have to
create that within your own department. Secondly,
you can send out programming, but also individualize,
which I love. So you blanket program for everyone.
Now you can tweak based on someone's injury,
someone's need to maybe drop some body composition,
rather than having to write a program for every
single person on their own. TeamBuildr also
allows you to build custom questionnaires to
collate health and wellness data. It integrates
with wearables. And I think one of the most important
things is obviously it tracks. To me, it's imperative
that we as a profession start tracking our people
from day one and then over the full span of their
career, therefore catching potential wellness
issues and injuries before they happen. Now,
if you want to try TeamBuildr, they are offering
you, the audience of the Behind the Shield podcast,
a free 14 -day trial to experience all of the
features. And if you want to take a deeper dive
into Team Builder, listen to episode 1032 with
Melissa Mercado or go to teambuildr .com. And
I'll spell that to you because it's not as you
think, T -E -A -M -B -U -I -L -D -R .com. Welcome
to the Behind the Shield podcast. As always,
my name is James Gearing and this week it is
my absolute honor to welcome on the show strength
and conditioning coach and researcher Daniel
Higuera. Now for many of you that listen to the
podcast, I talk about firefighter physical and
mental health and especially the impact of shift
work on both. And one of the pushbacks I get
is, oh yeah, but can you show me the data? And
the sad fact is many areas have not been researched
on firefighters specifically. My guest today,
Daniel, has actually collated numerous studies
from around the world, from fire departments
from other countries and also professions that
mirror what we do. So in this conversation, we
discuss a host of topics from his own journey
into the world of coaching, working with sporting
athletes. the impact of sleep deprivation on
acuity and performance, the chronic impact on
mental health, testosterone depletion, weight
gain, the Swedish firefighter study that showed
that 72 hours was the minimum for recovery, and
so much more. Now, before we get to this incredible
conversation, as I say every week, please just
take a moment, go to whichever app you listen
to this on, subscribe to the show. Leave feedback
and leave a rating. Every single five -star rating
truly does elevate this podcast, therefore making
it easier for others to find. And this is a free
library of over 1 ,000 episodes now. So all I
ask in return is that you help share these incredible
men and women's stories so I can get them to
every single person on planet Earth who needs
to hear them. So with that being said... I introduce
to you Daniel Higuera. Enjoy. Well, Daniel, I
want to start by saying two things. Firstly,
thank you to Justin DeMoss, one of my previous
guests that helped make the connection. And secondly,
to welcome you onto the Behind the Shield podcast
today. Well, thank you for having me on. Justin
DeMoss has been a colleague for a couple of years
now. So it's funny because you guys are at Santa
Ana College. I was an Anaheim firefighter for
a few years. So you literally did, not you personally,
but your organization literally used to do our
annual physical tests years ago when I was working
there. So it's interesting we're having this
conversation 20 years later. Yeah. So when I
got brought on with Santa Ana College, I think
Anaheim was with us for another two, three years
or so. And then Anaheim left our program for
a local competitor. But Anaheim was one, at least
this is the stories that I hear, is Anaheim was
the number one department that we had or the
first department that we as a program at the
college offered health and wellness services
to. Okay, well, very first question. Where on
planet Earth are we finding you this afternoon
or your morning? We're on planet Earth. I'm in
Southern California, more specifically Orange,
city of Orange in Orange County. Brilliant. Well,
I would love to start at the very beginning of
your timeline. So tell me where you were born
and tell me a little bit about your family dynamic,
what your parents did, how many siblings. So
I was born in LA in Lincoln Heights. I was there
until maybe four or five years old, then moved
about 20 miles east of LA, not east LA, but east
of LA, the city, to a city called La Puente.
And then there, me and my sister, mom and dad,
we were there. And then I have two older, or
an older brother and older sister. They're about
maybe 20 years older than me. Yeah, about 20
years older than me. And they are from my dad's
first marriage. So they're my half brother, half
sister, but we still call each other brothers
and sisters, and we've never, ever addressed
each other as halves. But my parents are immigrants.
They came here, my dad came here when he was
14, 15. Made a life here, went back, married
my mom, brought her back. And then I was born
in 91 over here. Immigrants from where? I don't
want to make an assumption. Oh, they're from
Mexico. Okay, I was right. So tell me about that,
because this is especially at the moment. I mean,
there's a lot of tension. There's a lot of nastiness
around the word immigrant. I'm an immigrant,
you know, from UK. What is your parents' immigration
story? What did they talk about as far as the
environment in Mexico? And then how was their
transition into the U .S.? So if I reflect back
on my dad's story, the story that he tells me
growing up is that he was sent here to study.
He was sent here by mom and dad because they
had a little bit of money. I'm not sure how much
money, but they had a little bit. And they said
that the thing was they send their child to come
study in the U .S. So my dad. got here at 14
-ish years old, and he says he struggled. He
says the immigration process itself was difficult.
He doesn't say because of the policies and regulations
of such. He just had bad luck doing it. He lost
his luggage, was living with family who wasn't
too caring, was in and out of that house for
a couple years, living out of his car, living
out of movie theaters. living that immigrant
life until he established himself somehow. And
then now got established, got married, had two
kids, got divorced. And my dad's living the single
life from there. And then he meets my mom back
in Mexico, brings my mom back over once they're
married. And my mom was struggling to learn the
language. She went to school while she would
drop us. me and my sister off at school when
we were in i don't know kindergarten or first
grade whatever the year was and she would go
learn english come back do the whole mom thing
and then she would maintain that that schedule
for however long it took her to get her ged over
here um and then they both hustled to give me
and my sister everything we wanted and everything
almost everything everything we needed and almost
everything we wanted what did they end up doing
profession -wise My dad, he was a professional
truck driver. He would drive the big freight
trains. And then my mom was an elementary school
secretary, front desk. Brilliant. And they gave
me the opportunity to go to school and study
what I wanted to study. I didn't have to worry
about bills. I didn't have to worry about making
rent. They said, work if you want. Well, they
made me work. But they said, use that money for
you. Don't worry about contributing to the household.
And that was a huge opportunity for me. Brilliant.
How much of their journey of your mom working
in education, of your dad being, you know, coming
over here on an educational incentive in the
first place, how much did that impact your journey
into the educational side yourself? Absolutely
zero. Nothing whatsoever. I kind of fell into
this role. So if I go down that story there is
I was interning, volunteering, working. in sports
both or in the professional sector or the collegiate
sector and the private sector and i was trying
to make a career out of that strength conditioning
within the sport realm and i had degrees of success
in it mostly in the private side because then
i started learning the whole marketing thing
in the business side of the training world so
i started building up a good clientele the one
of the companies i was with for a while they
wanted to start a the strength and conditioning
branch for the tactical population, but more
specifically firefighters. So at this time, my
mentor, his name was Bob Mears. He was a former
CEO of Reebok and Lululemon. He left that world
and then started up or partnered up with a company
called Aesthetic Games. And Aesthetic Games,
they wanted to start up a tactical branch to
their program. And somebody tells us, hey, go
check out Santa Ana College. They have big reach
in the fire space. Go, we'll have a conversation
with them. So we go, me and Bob Mears, and he's
doing the sales pitch. He's telling them what
we do and what we can do, what direction we're
going in, the whole thing. Maybe a couple weeks
later, I get an email from the director at the
time of the program, Santa Ana College, Terry
Wan, I'm sure you remember her name. And she
says, hey, how would you like to get a part -time
job over here? I said, sure. Send her my resume,
get an interview, and there I was. I was an adjunct
instructor at Santa Ana College's Department
of Fire Technology. And I was there for about
two years, two and a half years as a part -time
here. They had a full -time position open up,
and I said, sure, I'll apply. I'm not thinking
that I had any real talent in this space. And
as fate has it, fast forward five, six years
later, I'm here in the full -time position as
an associate professor now. What were you playing
as far as sports and exercise when you were in
the high school age? I played soccer all the
way from elementary all the way up to, like,
what, first year of college? Tore my ACL twice,
went to high school, went to college, and that
was the end of my sport career. I ran a little
bit of track, ran track all through high school,
wasn't any good at making it in college. And
I think that's a story for the majority of kinesiology
majors is they played some sport, they got hurt.
They went to physical therapy. The physical therapist
told them, hey, try this career. It's kinesiology.
It's fun. So there's 80 % of us in the kinesiology
field who come from a sport background, tore
their ACL somehow, and now they're trying to
figure out a world in sports, a career in sports.
And that was, sure enough, my story. So I know
you work with EXOs and some other sports -specific
organizations first. This is always an interesting
lens, and I always give the backstory. When I
moved here from England, Literally, I think after
a year or so, I just started realizing that I
heard so many Uncle Rico stories. These guys
are now kind of deconditioned. They're in the
late 20s, early 30s. I could have, would have,
should have had it not been for my ACL, my shoulder,
my labia, whatever it was. And it was over and
over and over again. And this wasn't something
I was accustomed to back in the UK. But then
when I started seeing... the high level of performance
that was eked out of these high school and collegiate
athletes. And then I'm talking to all these high
level coaches and people that were high level
athletes. I started to see that in some cases,
performance became far more important than wellness
and longevity of these youth athletes. With this
lens that you have now, what is your perspective
on that concept? I can answer this question both
ways. The performance on the sports side is,
hey, I know you're tired. I know you want to
do it. Do it. You have to train. You have to
lift. You have to get up early. You have to,
you have to, you have to. But that's what it
takes to move on to that next level. If you want
to play at that, if you're a D2 and you want
to play D1, you have to. If you're D1 and you
want to go to the league, you have to, irrespective
of how you feel. But these are young kids, though.
These are kids who are middle school, high school,
early college. In the college years, these kids
would show up to the weight room having a donut
for breakfast and they would hit some heavy weights.
And I mean, they're young. But now flip it, go
to this side now where I'm on now. And yes, performance
is still important. Yes, you still have to get
stronger. Yes, you still have to do your mobility
training and your cardiovascular training. But
you also had four calls after midnight. And this
is your third day on. You may have a forced overtime
tomorrow. How do you balance that? That is the
tough one. So one side of me is saying, you have
to train because all the risk associated with
the job. The other side of me is saying, you've
got to recover. You have to let the body rest.
So that's a tough one. Yeah, 100%. We'll dive
into that in a bit. I don't want to jump the
gun yet on the whole sleep conversation. When
I see the sports world now, I'll give you a perfect
example, the world that I inhabited, which is
martial arts. you know when i fought with the
shoot box gym it was like fight club you just
got murdered every single class perforated eardrums
broken noses dislocated jaws now if you look
at the martial arts you know the mma gyms a lot
of them they're realizing that less is more if
you look a lot of the the hit training and you
know training philosophies less is more you know
there's less strength conditioning they're not
doing two three four days anymore like they used
to so i'm seeing a lot more intelligent training
and the minimal effective dose versus just beating
these people to death. And I think with these
youth athletes, especially the single sport athlete,
maybe arguably the parents living vicariously
through their child, you're seeing a lot of broken
young people that are really being cheated out
of the love of sports when they actually progress
out of college. And I think this is why we've
got such a huge obesity crisis. Whereas if you
look at some other countries where you're not...
forging so many high -level athletes in the school
age, a lot of these adults continue playing sports
through their 40s, 50s, and beyond. I guess you
can make that assumption there. For me specifically,
I kind of got burnt out with soccer not because
my parents were pushing me on it. It's just something
I did for years. And eventually I want to try
something else. But I can definitely see how...
kids growing up and they're put their parents
are pushing them their coaches are pushing them
eventually it just loses the fun i'm sure they
enjoyed the sport at one point but then they
lose the fun and they no longer want to do that
sport how well how much does that translate over
to the obesity crisis that one i think that's
a bit of a reach i think but now because that's
i'll be saying hey i was pushed so much when
i was little now i don't want to do any physical
activity And on top of that, I'm going to consume
a high amount of calories. And then you go down
the poor body composition route. But yeah, I
think for any of us, when we get pushed too much
in one direction, eventually we're going to push
back. And however that looks, that pushing back
will manifest in, I don't know, less physical
activity, switching to a different sport, whatever
that looks like. Absolutely. All right. Well,
then, as you... Enter the tactical athlete field
and you have this background with training sporting
athletes. What was some of the big kind of shock
moments at the front door? Maybe some of the
misconceptions that you had about the tactical
athletes. Misconceptions I had about the tactical
athlete. I don't think I have a good answer for
this one. I had. Zero expectation coming into
work with five. Actually, no, I'm lying. I thought
I was going to work with what my idea and definition
of an athlete was. I had a high school, early
college kid in my mind, someone who's going to
get up at five and whether they're tired or not,
get the weights in. And then I start working
with fire. And that's not to say that you see
the opposite in fire. But it was now I'm working
with a wide range of adults. These are your 22
-year -old kids who are at the Basic Fire Academy
at Santa Ana College, all the way up to your
52 -year -old firefighter who's ready to retire
next year. And he has two shoulder surgeries,
a bump hip, and a fused back. So then how do
I apply this strength and conditioning principles
that, one, I learned in school and college? that
I've been applying to the athletic population
who are 22 years old. Now, how do I apply it
to this population? This guy, this firefighter,
Johnny, who's 28 years old and we just got on
the job, he's all about it. He has time for the
gym and the job. And it was a little bit easier
to transition into them. But now, how do I talk
to that 52 -year -old who he doesn't care too
much about improving his VO2 max? he doesn't
care too much about improving his his backspot
or his deadlift so what language could i use
then and that's right i struggled a lot is learning
the language and communicating correctly did
you understand how how many hours they work what
the shifts look like prior to actually working
with them no so having zero idea of the fire
service my buddies who were trying to become
firefighters. I remember this specifically. He
said, let's become firefighters. We're 20 years
old at this time. Let's become firefighters because
they fight fires and they go home and sleep the
whole, they go back to the station and sleep
and recover. And they just do that for however
long they're on shift for. And in my mind, I
was like, oh, that's kind of cool. But I never
had any type of gravitation towards the service,
to the fire service. So that's what I thought
fire did when I was 20 years old before I ever
got into the field. It's interesting because
I think, and I've said this, I put this on us,
our profession. We have done a horrible job of
showing the world what we actually do. So for
example, now you go to a city or county council
board and ask for more funds for whatever it
is, whether it's a fourth shift to actually have
a 42 hour work week, whether it's gyms in every
station so you can really put in fitness standards.
And they're like, well, why do you need? more
money like you guys just run a fire or two you
know here and there like you said you go back
and sleep and smoke cigars and pet the dalmatian
and play cards and this is 2025 where that couldn't
be further from the truth so when did you get
to see behind the curtain of what an actual 24
-hour shift truly looks like i didn't begin truly
understanding it until maybe 2020 maybe 21. And
that's when I started getting an idea of what
it is to be a firefighter, like what their life
looks like. And then from there, then my research
academic background kicked in and says, oh, let
me look this up a little bit more from a peer
group standpoint. What is the science saying?
And that's when I started reading about body
composition and obesity and cardiovascular disease
and cancers and the mental health and sleep deprivation.
And the list of topics just began to add up.
So now I was reading it from this. research perspective
but research always always going to have limitations
so i would take whatever was published here and
i would bring it back to the classrooms with
these guys and say hey i read this thing about
sleep deprivation mental health cancer whatever
the topic is what's your guys experience and
for the most part it was it was the same it takes
a while to get the guys to really open up especially
about some of the deeper heavier topics but when
you do it was very similar to what we're seeing
in the research To a caveat, I'm sure we're going
to get into the body composition stuff later,
but that's where I started really opening up
my eyes. It's like, oh, shit. I don't know if
I can cuss, but that's when I started thinking,
oh, man, these guys are on for 48 hours, and
they're on the whole time. Sure, they're not
fighting fires. To the outsider, the public looking
in, they're not doing the hard stuff all the
time. But responding to that 8, 10, 12, 15 calls
a day will take a toll. And they have to be very
sharp for each one of those calls because it
could mean saving the life of somebody's mom
and dad, someone's brother and sister, somebody's
daughter, and they have to be making those decisions.
So that was when I started realizing these people
have a tough life, a professional life. Let's
start with body composition. What's interesting
is if I think of around Anaheim, I would say
compared to pretty much any other department
or geographical area of firefighters that I've
seen around the country, I would put Southern
California as some of the fittest generally.
Like in Anaheim, I can remember and count literally
on one hand, maybe the couple of guys that were
actually overweight. Yeah, maybe one or two have
got a bit of a punch. But I mean, compared to
where I've worked on the East Coast, you know,
there's a numerous one ones that have pulled
the steering wheel out of an engine trying to
haul their ass up to drive. And, you know, ones
that look like they're gonna have a heart attack
when they've climbed a 10 foot ladder. And I'm
not saying that in a mean way. I'm just saying
it like this is how large some of these men and
women are that are wearing the uniform in other
areas in the country. So have you noticed any
correlations geographically, whether it's state
by state, where there are healthier versus less
healthy people uh well you know um less obese
or overweight firefighters and have you noticed
any correlations on why that's the case so a
paper that gets cited a lot is a 2016 2017 paper
i think the author is poston p -o -s -p -o -n
and they what they looked at was it was like
eight different fire departments across the midwest
And this was both professional and volunteer
firefighters. And they did some body composition
tests, BMI and body fat percentage. And they
were looking at the cardiovascular risk profiles
for them. If we're just talking body composition,
and if we're only talking BMI, body mass index,
it was like 79 % for the sake of easy conversation
to say more than 80 % were overweight and or
obese. But BMI has a bunch of limitations. BMI
is just height to weight. And it doesn't discriminate
between the quality of the weight. So it can
easily be dismissed. You throw body fat percentage
in there. Now we're using in -body, bioelectrical
impedance analysis. And when you looked at body
fat percentage, it was more than 80 % of the
firefighters were overweight and or obese. Again,
this is Midwest. So I see this published. Back
then, I'm using this for my dissertation, kind
of talking about body composition in the fire
service. and then i get curious and i start looking
at the numbers that we have so we work with maybe
2 000 firefighters per year it's oh damn cramping
up in my hamstring uh we have we have maybe like
22 to 25 different fire agencies that we work
with across four different counties um and so
i started looking at their numbers and saying
what body fat looks like on our end what does
bmi look like on our end and when i just look
at bmi I would say more than 80, 85 % are overweight,
not obese, overweight. So this is a BMI greater
than 25. But then I look at body fat percentage.
We do two different methods. We do the skinfold
method, and then we do the in -body, bioelectroimpedance
analysis. And then from there, we have an average,
maybe 19 to 20 % body fat, which is on the borderline
of healthy to maybe a little bit on the overweight
side. But nonetheless, the majority of it is
on the, let's say 19 % and under. So if I just
do that stark comparison right there, fire departments
in the Midwest compared to fire departments in
Southern California. And that study that I talked
about, the Boston one, there was maybe 700 participants
on. This is not a study on our end on the one
that we have a body composition, but we have
maybe 2000 participants on this one. And this
was big, big difference in body fat. So then
the question is why, why is there a difference?
the fire service is the same we all have access
to the same information i mean we everybody has
a phone now we can all google whatever we have
to do in order to gain weight and i mean lose
fat and build muscle every what we're all trying
to train for um but is it something stronger
than that something that is pushing us one way
or the other the simplest answer that i can give
you culture here in the in southern california
we we value health to a degree i can probably
say we value vanity as we we live by the beach
we're it's sun out all year round we have 70
degree weather we're in short sleeves or tank
tops the majority of our our life out here um
so we've got to look good and then culture within
your crew itself culture within your fire department
itself all that is going to speak to what level
of fitness you have and this is Maybe I have
a little bit weaker data on this one. More anecdotally
is when we have recruits going through a basic
fire academy, either with the college or now
they get hired on to a department as career firefighters.
And they have, let's say, below average levels
of fitness. They struggle through their academy
and their towers, whether it's a short one or
a longer one. But eventually, if they finish
the academy, like culture is going to take over
and that recruit is going to build up their fitness.
They're going to lift some weights. They're going
to improve their cardio. And now they're up to
par. I've seen that time and time and time again.
So can I chop it down to geography? Sure. But
it's the culture that influences that. That's
really interesting because I've made that observation
many times when I've, I mean, I live, you know,
not by the coast. I'm in the middle of Florida,
but in a very coastal state, very narrow, you
know, coast on both sides. And when you go to
the more beachy towns, you just tend to see less
people that are overweight. And the same in Australia
when I lived and traveled over there, you know,
by the, by the ocean, there's a lot of very fit
people that are surfing and they're mountain
biking. And then even if you look at Colorado,
you know, Boulder and that area, same thing.
So, you know, I talk about this a lot. We'll
get into sleep in a minute, but just, you know,
culturally, if there's a culture of movement.
So if you, for example, are in Europe and your
entire downtown is pedestrianized, even New York
City, like really, if you're going to get around
New York City, you've got to be somewhat fit.
There's escalators, there's streets, there's
all kinds of things. You're not going to be able
to sit and just navigate through New York without
moving. And you'd see, I would argue, less obesity
even in New York City. So coming out of COVID
where we had this. absolute captive audience
and this ability to really move the needle on
some wellness initiatives you know that should
have been a massive one how do we create that
culture of movement as well as obviously nutrition
and it's the same with the fire department in
anaheim we didn't have fitness standards but
the majority of them were extremely fit and you
see people working out all the time you'd see
people playing sports all the time because that
was just ingrained in the culture something interesting
on this one that may wedge itself in here uh
when we pick up a new department and i won't
mention department names but when we pick them
up and we do our first year testing with them
and i compare their first year body composition
and body or just go body fat percentage um to
what it looks like a couple years after it tends
to improve a little bit just within the department
but nonetheless is when i compare their overall
body fat percentage as a department year one
to our whole that we've had the 20 something
departments they're always on the fluffier side
they're always a little bit more chubbier right
and then we work with them for a couple years
and i asked them hey how what changed and they
said education what do you mean education yeah
well you guys came out and you guys talked about
nutrition and what we should be eating and what
we shouldn't be eating and calories in versus
calories out and all those different topics that
we we go and bring to the fire departments and
i asked those like what This information in my
mind, I'm like, this information is available
anywhere. It's on our phone. It's in our fingertips.
But now this is my mind trying to connect dots
is when there is a expert, a subject matter expert
at your fire station, speaking to you as a firefighter,
saying you as a career firefighter, these are
your challenges. This is how to improve your
nutrition. But as a result, you're going to improve
your cardiovascular disease profile, your metabolic
profile, and your body fat percentage. So I think
it's not just education. It's education specific
for the firefighter. And I think that's what
led birth to my social media account is we have
so much information out there for exercise, for
body composition, for sleep, but it's not geared
towards a firefighter. The firefighter themselves,
they're a different breed. Their life is very
different for me as a general population person.
So although our physiology is identical, like
you're going to lose weight by calories in versus
calories out, me too, but how that looks as a
firefighter is very different for me. So I think
that's what motivated me to start this account
and saying, all right, we have to do more firefighter
-specific health and wellness. So the way that
I like to explain it is think of Andrew Huberman,
but for a firefighter. That's the goal with this
account. We'll see where it goes. Absolutely.
Well, I want to get to the fitness diet and standards
there. But before we do, when we're talking about
environment and that either setting you up for
success or failure, as you started diving in,
what were your aha moments as far as the impact
of sleep deprivation on obesity and some of the
associated impacts? So what started triggering
my curiosity on this one is I kept hearing the
guys say, oh, last time or last night we had
two after midnight, three, four after midnight.
And then what never failed was let's get a bowl
of ice cream. You just hang around the table
and shoot the shit, bowl of ice cream. Some guys
would say they would cook a whole lunch, a whole
meal, and they would enjoy whatever meal they
would want at two, three, four in the morning.
And in my mind, I'm just listening. I'm just
listening and I'm thinking, hmm, that's probably
not a very good way to keep your calories down
because you're going to wake up in a couple hours
and want your breakfast and then your lunch and
your dinner and the whole thing. So that's what
got me curious on that route. Then I started
going down the research route and this is studies
not done in the fire population. This is general
population. And they were looking at the sleep
deprived versus non -sleep deprived. And the
sleep deprived group was getting equivalent to
about four, four and a half hours of sleep. And
when they looked at their appetite, like hormone
levels, ghrelin and leptin, the group that was
sleep deprived had higher amounts of ghrelin,
meaning the hormone that makes you hungry compared
to the well -rested group. So that now started
to explain things for me saying, all right, these
guys are waking up three, four times after midnight.
This is adding some stress to them. We all like
food when we're stressed. It's our comfort food.
So maybe that explains it a little bit, but also
is their bodies asking for food. They're hungry.
And if you repeat that for multiple weeks, months,
and years, and throughout your entire career,
you're going to see your body composition, your
body fat start to trend upwards. And this may
get us into a different subtopic here, but I
like to ask the questions to the groups is, hey,
is obesity a choice in the fire service? And
I always get some very good debates on this.
And you have your very fit groups, and they say,
absolutely, obesity is a choice. And I choose
to exercise. I choose not to eat that donut.
I choose, and everything's I choose. And then
there's other kind of groups that get a hold
of this topic, and they say, whoa, hey, man,
I'm super hungry in the morning, and my body
is just calling for it. And then now when they
hear me talk about the ghrelin versus leptin
about sleep deprivation, they say, look, it's
not a choice. And I have to stay very on the
middle on this one because I can't say, yeah,
you're right, it's not a choice. Nor can I say,
hey, you're right, it is a choice. My job is
just to facilitate conversation and bring the
research to them. And then it's up to them to
make their own personal decisions from there.
So that's always an interesting debate between
the fire departments. See, it's interesting that
you say that because this is what I always try
and do. I talk about... you know, the importance
of fitness in the fire service. And I always
highlight how our work week sets us up for failure
on that biologically, as we'll dive into even
deeper. The question needs to be, is obesity
acceptable in the fire service? And I think everyone
would be united in saying no. Ultimately, take
feelings out of it. Should the first responder
be clinically obese or even, you know, really
like vastly overweight? knowing that it's going
to be detrimental to their performance, knowing
that they might not be able to make it to the
top of that building to get that kid or in a
foot pursuit to stop the person with the knife
going into the kindergarten. I mean, these are
very hard black and white conversations. There
is a standard for a reason because you either
can or you can't. So my thing is then from a
place of compassion and empathy, all right, well
then what are the factors that are contributing
to these first responders getting deconditioned?
And how can we reverse those? So I think that's
the better question. Is it acceptable? No. Is
it preventable? Absolutely. That's also a tough
one. You asked a thousand firefighters, should
a firefighter be overweight and or obese? And
there's no one that's going to tell you yes.
But why does it happen? That's a tough one. There
are so many different layers to this. lighter
topic layers to the heavier topic ones the lighter
topic one is i got hurt i tore my acl i have
a knee surgery and i was actually i was physically
active before and then i got surgery and it was
uh six months off eight months off and then we
never pick up our same levels of physical activity
again so that's one the other one is life now
you got married before when you were your first
three years on it was the gym and the job And
then now you have two, three kids under five.
You have a wife, you have a husband, and you
have to do all that. So all your time goes to
that now. All your off -duty time goes to that
now. So then there's those reasons there. And
then the topics get a little heavier from there
is we know that mental health is on the rise
in the fire service. We know levels of anxiety,
depression, PTSD are not starting to rise, but
are high. And how does mental health, poor mental
health, how much does that influence? physical
inactivity and that's a whole rabbit hole from
there is we're just not motivated and i don't
want to exercise i don't feel like exercising
or whatever they may be dealing with at the time
and then that has more long -term consequences
and then this is where i see i have to be careful
how i talk about this one because this one it
could go either way it's uh like the pressure
of your crew It could be, hey, we're going to
exercise today no matter what. We're going to
get something in. That's good pressure. And then
the other one is, hey, Fatty over there is going
to start exercising. And then there's some of
that kind of banter going on. And then it's not
a very good environment to jump on the treadmill,
lift some weights when my other crew member is
giving me a hard time. But that's the fire service.
There's a lot of banter going on. I don't want
to say that's culture, but you see it a lot.
So then there's a wide spectrum as to why it
happens. The follow -up question is, what do
you do from there? And then that's an equally
complicated answer. Yeah. I would argue not complicated,
just layered. But if we look at each layer, we
can really pick apart some actionable items.
Just before we kind of focus and really dive
into sleep. sleep research in our profession
specifically going back to the the sporting athletes
talk to me about the importance of sleep when
it comes to an elite performance in a sporting
athlete there's no question about that one is
you see it so let's go more let's go sports where
there's a high level of consequence if you're
performing correctly Meaning a high -level injury,
it's like combat sports. These athletes who are
in fight camp, they have a big fight coming up
in eight weeks. For those that sleep less than
seven hours per night, their reaction time is
slower. Their output, their power output is slower.
Their strength is lower. So you have these different
items that their athletic performance is beginning
to be compromised. Now you see it in the non
-contact sports or non -combat sports. Now think
more team sports. Think of soccer. You fatigue
much quicker. You don't perform at the same level.
Your level to put out is much lower. And this
is almost a no -brainer in athletics. Now, these
are people who just dedicate themselves to sport.
Their job is a sport. Flip that question over
to now the fire space. How important is sleep
to the firefighter? And it's no longer you're
going to lose a match. It's no longer you're
going to have slower reaction time, although
it's important. Now it's more severe consequences.
And that's a whole topic from there. Well, let's
stay on that for a second. The acute impact,
especially on cognition. Actually, before I even
pose that question. People say to me all the
time, and especially, and we'll get into this
later, but the work week length and the rest
and recovery in between, oh, I need to see studies.
And what I tell them is, well, me too. I'd love
to see a telephone book thickness full of studies
that are out there on sleep deprivation and shift
work in the fire service. But as far as I can
tell, almost none have been done. So really what
we have is to flip it around. OK, well, the way
that we do it now is a great, you know, million
person study where we know how not to do it because
our graveyards are full of the results, you know,
in my opinion. And, you know, all the line of
duties and the medical retirements, there's your
data. But when it comes to actually show me a
gamut of studies and first responders on the
acuity, on the chronic disease, on mental health,
there's almost nothing. From what I can see,
now I'm going to put it to you. You come in,
you've got this long research background. You
come into our profession. I know there's studies
on heart disease. I know there's studies on cancer,
even though, again, none of them seem to mention
sleep. How much research did you actually find
on sleep deprivation and shift work in fire service
specific? So there's a good amount. It's starting
to grow a lot more. What you see so much is sleep
deprivation in shift workers. So this is anybody
who's a shift worker, your police, your nurses,
your medical workers. And then you start extrapolating
that over to the fire service. And then more
and more research is starting to come out of
sleep deprivation within the fire service. I
can probably send you 10 or 20 articles at the
end of this conversation on that. So it's started
to grow a lot more. Let's say over the past decade
and a half, you see a lot more getting published
on this end. The way I explain this is these
studies on sleep deprivation and the shift work,
especially in the firefighter, they're very broad
in nature. It's saying, hey, these who are sleep
deprived, they have a higher risk of anxiety,
depression, PTSD. These who are sleep deprived,
they have poor levels of body composition. These
who are sleep deprived, they have slower reaction
time. So they're very broad in nature. It's just
talking about sleep deprivation. Within the fire
service, we know everybody's sleep deprived.
But to go into more specifics on those, it now
has to be more firefighter specific. Those who
are working at busy stations versus slower stations.
Those who are running 15 calls across a 24 -hour
shift versus those running three calls across
the 24 -hour shift. I think that's the next step
that we're going to be looking at in terms of
research. Because we know the firefighter in
general, they have a higher risk of... poor body
composition, the mental health and everything
else because of the decade and a half of research
we have already. The next step is starting to
look at very firefighter specific worlds, busy
versus non -busy stations. Those doing, those
responding to two to three calls after midnight
versus responding to zero versus one versus or
one and zero, zero and one versus a three and
a fours after midnight. I think that's the direction
we're going in right now. What about 56 versus
42 hour work week? How many studies have been
done on that? Not that I can recall. So coming
from a profession that's hundreds of years old,
where the Northeast has been working that shift
for decades and decades and decades, and the
rest of the country is on 56, our federal brothers
and sisters, 72 -hour work weeks. I find that
crazy that that is just constantly swept under
the rug. We don't want to study that. That is
the most important study is simply setting a
profession standard work week, especially when
you look at, for example, law enforcement who
work 40 hours a week, pilots, doctors, ER nurses,
for example, 36, 40 hours a week, firefighters
who are also paramedics, so they're doing two
jobs simultaneously. 56 hours a week before mandatory
overtime. So to me, and I'd love to just get
your take on this, why haven't we done studies
on arguably one of the most important issues
in this profession? I think it takes somebody
with a firefighter background to get into the
research space to start pioneering that one.
Because those who are from a non -fire space,
this is not even on the radar. Until somebody
who lived the life of a firefighter says, hey,
this is worth looking into. So until that happens,
and I'm sure it's happening now. We talked about
a couple weeks ago that there's some irons in
the fire with that. The closest, closest, closest
thing that comes to mind is a 2016, 2017 paper
in Finland. They looked at HRV cortisol response
on a 24 hours on. And then 72 hours off. So one
on three off. And that is the closest I can think
of, of a 40 hour work week compared to a 50 something
hour work week. I'm going to have to look that
up because that's exactly what I think we should
be doing. The 24 72. So that one, that one, it's
out of Finland. The researchers, I think her
name is like lidocaine, lidocaine. First name
is Natalie. I can send you the paper. And that
one, they had 14, 15 firefighters. And then they
were split into, so it's one 24 -hour shift.
12 hours of that was a firefighter responsibility.
So only responding to fire suppression. The back
half of that 24 -hour shift was EMS, only responding
to ALS, BLS calls. So they were looking at HRV
and cortisol response. On the day on, and then
how those numbers changed the three days they
had off. And then the second layer to that was,
what if you're fit? What if you have a high VO2
max? Because we know that those who have higher
levels of fitness, they can recover much quicker.
So if you have poor HRV response and a high cortisol
response, would the fitter firefighter, would
they be able to recover quicker? And this one,
the result, and I'm going off of memory here.
the results for hrv we also see we obviously
see a depression in hrv so a very general explanation
for hrv for the listeners here is hrv is a term
that measures the time between every individual
heartbeat so if we have a 60 beat per minute
heart rate does that mean our heart is beating
every second on the second like a metronome and
the reality it's not some beats are a little
bit closer together while other beats are a little
further apart and that variability between our
heartbeats that tells us so much about how well
recovered we are how stressed we are and all
that different stuff in there so generally speaking
not always but generally speaking a higher hrv
is desirable it means you're more recovered so
for these firefighters who were on during the
first day on or 24 on their hrv plunges and that's
expected and then from there on is how long does
it take for them to get back to baseline so first
day on No real meaningful recovery. Second day
on, now you're getting some meaningful recovery.
I mean, first day on, your HRV plunges. First
day off, no meaningful recovery. Second day off,
now we're getting some meaningful recovery. Third
day off, that's where HRV is back down to baselines
or back up to baselines. So that's from a HRV
perspective. From a cortisol perspective was
cortisol. It's higher in the mornings. As we
all know, it's what wakes us up in the morning.
It's what gives us that kick to get things going.
And the first day off from their 24 -hour shift,
that cortisol response is blunted. It's suppressed.
So it just tells us how demanding, how stressful
just being on the job is. And in this paper,
they said they responded to one fire during their
24 -hour shift or during their 12 -hour shift.
And then it was like... five or seven different
EMS responses from there. So they don't talk
to the level of intensity of the response of
the calls while they were on. They just give
an absolute number. They said they responded
to one fire call and X amount of EMS calls. And
then from there, they look at the cortisol response
on day one off and it's blunted as it's very
similar to what you see on the first day on,
on their 24 on. Their second day, they start
getting more of a normal cortisol response. It
doesn't get back into a normal cortisol response,
what they call cortisol awakening response, the
AR, until that third day. So if there's some
data you need, that's where that's at. The limitations
to that one, it's a 14 -subject participant and
it's voluntary participation. So everybody who's
going to volunteer for research studies, especially
like this, they're going to be your healthier
population. But that also adds some strength
to your argument saying, if my healthy firefighters
are responding like this how are my unhealthy
firefighters responding so then they put the
layer of vo2 max in there is does vo2 max the
fitter the healthier i am do i recover quicker
and unfortunately the answer was no these individuals
with high levels of vo2 max it was like in the
50s it was low 50s for their vo2 which is high
they didn't influence their level of recovery
at all The limitation to this is they're not
looking at their off -duty life. So they didn't
write down if they're consuming any alcohol,
if they were taking naps during off -duty, if
they were exercising off -duty. So all that is
up for you to guess. So that's the result of
that one there. I can send you that paper. Yeah,
that'd be amazing. I think that was what you
summarized in one of the graphics and that was
hugely well received. But this is the point.
And it's interesting because I had someone reach
out the other day and they said, They're, I think,
in the Northeast as well. I might have that wrong.
But they do 24 on, 24 off. Sorry, 24 on, then
120 off. And it's interesting because we say
about days off. It's not day off because, for
example, 24 on, that second day, you've worked
from midnight to 8. So that second day isn't
even a day off anyway. You've just did eight
hours. And they said it's a 42 -hour work week.
What do you think? And I said, well, the fact
that you're doing a 42 -hour work week. Compared
to a 56, you're winning. However, the 24 .72
to me is still the absolute standard because
just like you've illustrated, we need that 72
-hour period to try and get as close to baseline
before we go back again. I know some people want
that kind of larger number of days on the back
end, but I think it's detrimental and you're
going to slowly get chipped away with that 24
on, 24 off, 24 on. So it's interesting with that.
But then when you put it, like you said, to the
24, 48 or God forbid the 48, 96, and we'll dive
into that in a minute, the lunacy behind that.
But you think about 48 hours without even a rest
day, and then you start trying to climb your
way out of that hole. Or a 24 -48 with a mandatory
overtime. Now it's a 48 with only 24 hours. And
now you're back on again the fourth day. There's
some beautiful data to show. And FSU is going
to, I'm sure, show this with the studies they're
doing with Gainesville. You know, there is science
now. And then, like I said. I don't think it
needs to even be proven. 42 hours healthier than
56. I think there's a lot of common sense to
that. But it's great to see some of these studies
and just line it up side by side. It's kind of
like I told you so, but at least now we've got
data so that when people say to me, oh, I need
the studies, it's like, do you? Well, despite
the fact that you really don't hear some studies
anyway, it just proves up the common sense that,
yes, our first responders need enough rest and
recovery between each shift. so they can operate
at the highest level of acuity and prevent the
long -term chronic diseases that we see. Yeah,
from a logical perspective, I think you have
a really good point on this one. I think what
makes, I think why people are asking, let me
see the data on it, because the data, especially
the peer -reviewed stuff, it tries its best to
remove bias. Research is always going to have
bias to it, but at least it's trying its best.
So it's no longer the members of the department
saying, hey, let's switch from this shift schedule
to that one because they obviously have a dog
in that fight but if they say here's this independently
conducted peer -reviewed research study that
shows this is better than that then that makes
the argument much much stronger now whoever is
the shot callers on this the argument of they're
just saying that because enter excuse here now
it's what's your excuse now that we have this
peer reviewed and we address as many limitations
as we can there's still going to be a bunch but
nonetheless i think that's why asking for data
is so um so common and i think it obviously gives
you a stronger argument yeah yeah it's interesting
like when we talk before we hit record where
i've seen a lot of people ask for data is they
just want to put another hurdle so they don't
have to do the work to move the needle not i'm
not all people but there are certainly a lot
of people because if i just don't have the data
i can say well there's no data but as we just
touched on there's no studies so my men and women
are still dying by the droves i'm not willing
to wait for someone to finally start doing a
study so let's go back to the common sense and
then as you've done pull studies from you know
parallel professions and and areas where we can
apply it and go look this this backs up what
we're saying but it's interesting you say about
leaning into a study on its own are you familiar
with joel billings's study on the 4896 i'm familiar
with some of the studies in the 4896 which are
referring to okay so this one is i mean i had
joel on the show and i'm always you know this
is where as they say a little knowledge is a
dangerous thing I didn't realize the explosion
of leaning into the 4896. And I had Joel on the
show just a few months ago. The one I'm talking
about, I don't know which of his, but he studied
a department. They did, I think, again, it was,
I don't know if it was HRV, but it was certainly
cortisol, if I'm not mistaken. And it was a department
that was going from a 2448 to a 4896. The results
come out. He finds that on the second 24 hours
of the 48, they seem a little bit more rested.
And therefore, it's a better shift. Now, no fault
of Joel's at all. He just did a study. And in
the paper, it shows exactly what was done and
the parameters and all these things. But the
fire service, I believe, ran with that. Now,
Joel, as he described on the show, said, well,
the department we studied ran about one call
a shift and less than one call at night. So zero
calls at night many times. And you've got all
these urban and suburban departments that have
now gone to a 4896 because science says it's
better. Now, what was interesting in the conversation
with Joel is that one takeaway where you found
it was better was because so many of us get up
at like 435 in the morning to drive 70 miles
because we can't afford to live in the city we
work to then start our shift. So there's a lot
of sleep deprivation on day one. If you actually
shift the start time and bearing in mind, we
work 24 hours, you know, you can turn that clock
any way you want to like 11 a .m., 12 noon. You
now create another, you know, well, a good sleep
the night before that shift. So you take that
one positive from that study and you can apply
it to a 2472. But the little knowledge is a dangerous
thing and it breaks my heart. The number of departments
I see bragging about having a 4896. Based on
the science that we've already started kind of
dipping into a bit, what is your perception on
48 hours sleepless or interrupted sleep for a
first responder with, as you said, so many elements
of life -saving skills in their hands? So I guess
I'll take this from a very high scope and then
start narrowing down to answer that question.
A Billings paper. I don't know when this got
published. Let's say late 2010, somewhere in
that time. He was comparing the difference in
sleep quality, comparing the 24 -48, 48 -96,
and then the Kelly schedule. And then the Kelly
was defined as 24 on, 24 off, 24 on, 24 off.
And then I think it was threes and sixes or fours
and sixes. I don't know what the actual Kelly
was. Four and six, usually. As I've learned,
there's a bunch of different derivatives of the
Kelly. But then they use different forms to assess
sleep quality. One of them was called the Pittsburgh
Sleep Quality Index, which is subjective. It's
like 30 different questions, and then you're
answering how well you sleep. And it's asking
you to reflect on the past 30 days. So that was
method number one. Method number two is something
called an emergency service sleep diary. So it's
asking you to reflect, how did you sleep last
night? So now you only have to recall just one
night. And then the third one was what they call
actigraphy. So it's a risk monitor, and it tries
to estimate when you're sleeping based on movement.
And what they found here, when it comes to the
Pittsburgh Sleep Quality, or the PSQI, the worst
one, Kelly. The best one, 2448. And the one right
in the middle, 4896. And then they just start
trying to... figure out why. So this is no longer
the research study anymore. The research just
said the Kelly is the worst, the 2496, 2448 is
the best, and the 4096 somewhere in between.
You start trying to figure out, well, okay, well,
why? Why is the Kelly the worst? Why is the 2448
the best one? For the Kelly one, I think you've
already answered it, is you have to be at the
station at, what is it, 7 a .m.? And if you've
got to drive an hour and a half or two hours,
you're... You're waking up pretty dang early
that night or that morning to get to work. So
you're cutting your sleep in half already. So
that's your last day off. You're already starting
with a shorter sleep window. And then you get
off the next morning. You got to go do that two
-hour drive again and hoping to recover that
day before you're coming back on to shift the
next day. So that's the Kelly one on that one.
And then the other one, the 2448 is the 496.
If you now start merging the findings from two
different papers together, there's billing ones
that we're talking about and the other one that
we just mentioned, the one about the Finland
firefighters. So that one was saying for every
one day off, you need roughly about two days
off. Well, every one day on, you need roughly
about two days off. So then you look at that
24 -48, they were on for one day, two days off,
and you were having somewhat back to baseline
in terms of your cortisone HRV response. So you
can start to understand that a little bit more.
But now 48 hours on or 96 off, it's more that
still that one to two ratio that you start going
on right there. But then how much more is your
recovery or is your stress levels kind of worsened
on that second 24 hour shift? That's a question
worth asking. I don't think I have any data that
I can recall on that one. So having multiple
days on. Is it that much harder to recover? That
one I can shrug my shoulders to and saying, I
can't speak from any one personal experience
nor scientific data that I come across. So you
can speak on that one as to why the 4896 is the
worst one. But when I asked the fire guys that
we work with, they much rather be on the 4896
than the Kelly. Like we have a few departments
that have shifted from Kelly to 48 recently.
And I asked them, how's their experiences? And
across the board, they say it's better. Yeah,
and I lost a train of thought. What was the question
you asked at the very beginning? No, no, it was
really that. I mean, you gave us a great explanation.
What I would say with the danger of the 48 is,
as you touched on, the Swedish model shows that
the 24 hours after you get off shift, so that
first, I'm not going to say a day off, that off
-going day, there's no recovery. The 24 hour
number two, there's some recovery, 24 hour three.
Now you're actually getting to where you're recovered,
ready to actually do another shift. With a 48,
you've got zero. You've now compounded. So, you
know, obviously there's going to be even more
decay on all the things. And then now, you know,
now you're finally clambering your way up. So
for me, what really terrifies me is not only
again, you know, the chronic disease side and
the mental health side and all the other things
that we'll dive into in a minute. But the acuity,
there's a study, there's a number now that's
thrown out a lot. Kirk Parsley was the first
one that made me aware of it. But 24 hours without
sleep is like having a blood alcohol of 0 .1.
Well, I always say, well, that's probably done
with a bunch of college students as the study
recipients who arguably probably spent most of
their life up to that point sleeping every night,
apart from partying here and there. They go in,
they do a sleep study. 24 hours, they do some
cognitive tests. Oh, this is how decayed you
are. Well, now double that and multiply it by
10, 15, 20 years of service. At what level of
acuity have you dropped to by the time you get
to that 36 hour mark of a 48 hour? So now as
a responsibility, as a professional, how dangerous
is it having you behind the wheel of an emergency
vehicle? How dangerous is it having you figuring
out pediatric drug doses or trying to intubate?
You know, this is the thing is no other industry,
no airline, no shipping agency, no nuclear power
plant would let someone be awake, potentially
awake for 48 hours straight. Yet our profession
just turns their head. And to me, the science
says 24 hours is pushing it. And I've got no
problem with 24 hour shifts. I think for a jack
of all trades that we are. With a house that's
got beds in it, we can make that work. But anything
past that, I think it's irresponsible and I think
it's dangerous. A lot of thoughts on this one.
There's a research group out of, I think it's
Harvard Medical. The lead author is Barger. I
don't know her first name, but she published
exactly what you're talking about. It's those
who are sleep deprived, firefighters who are
sleep deprived. what is their risk or their rate
of traffic collisions, car accidents? And it
was much higher. That one's a no -brainer. But
now there's data on that one. And they go down
different rabbit holes from there. Let's do sleep
health programs, sleep education programs for
firefighters, and then there's a bunch of different
follow -up studies to those. There is a company,
I think it's out of Australia, that is more like
virtual reality firefighter training. And now
they have like these VR goggles and they can
light buildings on fire and then they go through
whatever training from there. A research group
got hold of this idea and they said, hey, this
is really cool. Do you mind if we do some studies
on your guys' product with your guys' firefighters?
Sure. I think this is a white paper too. I don't
think it's got published. And they were now looking
at sleep deprived versus non -sleep deprived
and then reaction time. How quickly was the firefighter
making a decision when it came to their fire
suppression duties? And they were tracking that.
Then now more specifically, what was the quality
of that decision? When those who were speaking
prior, they were making less or they were making
more or less quality decisions, lower quality
decisions compared to what somebody else would
do, let's say a captain or an actual firefighter.
The captain calling the shots, the firefighter
doing what they're supposed to do. The quality
of the decisions were much greater when they
were well -rested. I read this maybe four years
ago or so, and I tried to look for the actual
published version. I couldn't find it. I'm assuming
it's a white paper from this VR company. Now
is if you start looking at what are the actual
effects of state deprivation on the firefighter
from an occupational performance, from occupational
standpoint. And then one, we can summarize higher
rates of traffic collisions, just car accidents.
And then two, less quality decision -making,
slower reaction time. That stuff there's data
on. So that one's strong. I think when we apply
it to law enforcement, I think it's incredibly
powerful. If you look at... the mistakes that
were made in those gray areas not the ones that
it was a good shoot you know or the ones that
were completely you know horrendous and it was
the officer that was a thousand percent at risk
or excuse me at fault but those gray area ones
you know the kid suddenly reaches for the glove
box he's actually getting his his driving license
because he's scared and the officer who just
lost you know a fellow officer last week and
has been forced into an extra shift and he hasn't
slept or she hasn't slept for however many hours
or days, whatever it's been, where is that conversation
in law enforcement? And we're talking about all
the wrecks that they have, for example. And you
listen to people talking about, I had a guest
on speaking about a lot of the first responder
accidents that they've processed. And they said
it was interesting. There's one thing that's
absent in a lot of these wrecks with police,
fire, and EMS that you don't see usually with
other people. He said skid marks. because you
know normally a person realizes and they slam
on their brakes but you get these first responders
having these micro sleeps behind the wheel and
they just barrel straight into them and then
even though for me you should have the altruism
and compassion to want to make your people as
healthy as possible sadly that's not the case
in the fire service many times so now you've
got to show them dollars and cents how much money
is spent on lawsuits from when we hit vehicles
when we push the wrong drugs or we're too aggressive
with the patient, you know, whatever it is. So
there is a huge money savings from this point
of view as well, when it comes to giving them
more rest and recovery and getting a fourth shift,
because now you're going to, as you said, as
a linear correlation between sleep deprivation
and poor judgment, imagine the dollar amount
that you could prevent paying and, you know,
obviously more importantly, not hurting the general
public. There was maybe a study, maybe a decade
now when they put a dollar amount to how much
does it cost when a firefighter is off on duty?
I mean, off on disability, off on injury. And
the number is, I don't know, exponential. It
was, I'm going to make up an arbitrary number,
$150 ,000 or $200 ,000, whatever the number was.
I can send you that paper too. And then they
compare it to, let me backtrack on this one.
They had two different groups. We had the healthier
population, fire population, but same department.
Now the unhealthy, let's say less -fetched population,
they both get hurt. What is the dollar amount
attributed to the unhealthy firefighter versus
a healthier firefighter? And there's a big difference
there. The unhealthy one takes longer to recover
to get back on the job. And then they put a dollar
amount to each group. How much does it cost for
each one? So in terms of how much money you're
saving, it's a no -brainer on this one. If we
want to save more money on the long run, let's
invest in whatever modalities, whatever policy
we may have to in order to save more money in
the long end. I think that one's a pretty easy
argument now that there's also data published
behind it as well. Absolutely. We'll stay on
that theme. Throughout my career, I always took
my job very seriously, you know, and I would
say I stayed in shape despite the environment,
not because of the environment. But many, many
times I remember the, as you termed, fluffy firefighters
saying it's always the fit guys that get hurt.
And I actually, you know, got to give kudos to
my last department. They had to pay for all my
injuries from, you know, that were potentially
building up from the career prior. But I had
a back injury, which I rehabbed just with movement
in the end. And then I have meniscus surgeries
on both knees ultimately. But when you look at
the science, and I had Stuart McGill on the show,
for example, and you see the relationship between
someone who's training for their job seriously,
doing the job, doing the strength and conditioning
for the job as well, that's not given the rest
and recovery. you know it's not if it's when
many times so what have you seen as far as the
the relationship between sleep deprivation and
musculoskeletal injuries in firefighters that
are taking their job seriously and doing the
training so the nfpa every single year they publish
a injury report and they start breaking down
what are the most common forms of injuries and
the most common one i think this year the past
year was 23 that got published most recently
And it was like upwards of 40 % of injuries were
strains, sprains and strains and overexertion.
So now this is taking down that rabbit hole of,
well, what's causing so much of these over these
muscular strains and sprains and exertion. And
it could be easily, we can chop it down to maybe
these guys are not strong enough. Maybe they're
not fit enough. Okay. Why are they not fit enough
and strong enough? And then we start. Trying
to answer those questions from there. Then the
question is, what relationship am I noticing
between sleep deprivation and then injury? Is
that the question that I'm trying to answer here?
Yes. All right. So then we start exploring this
a little bit more. Why aren't the guys working
out as consistent as they should? Then we start
exploring this a little bit more and we say,
all right, well, why didn't we do PT today? Last
night I had one, two, three after midnight. Then
motivation goes down. The desire to exercise
is a lot lower. This has been published multiple
times, almost at systematic review levels. So
multiple different types of shift workers. Why
is PT or why is exercise, physical activity so
low in shift workers? And the main, main thing
that always gets brought up is your fatigue.
You're tired. Motivation is low. So then now
PT is decreasing. Lower PT over the weeks, months,
years. And when they're lifting up that one patient
or when they're throwing that ladder, when they're
doing whatever physical exertion they have to
do at whatever intensity they have to do it at,
their body's deconditioned. And unfortunately,
you would see some sort of muscular sprain, strain
and overexertion. I think that's where the pipeline
really leads us to. Well, adding another layer
to that coming from the guy who did keep training
despite it. I went through and did ex -vis at
the bachelor level. And, you know, going through
all the training, you start to learn like from
a skill acquisition point of view and a strength
and conditioning point of view, where you learn,
where you process learning is when you sleep.
When your muscles, ligaments and tendons repair
from the damage you've done, deliberate damage
from strength training is when you sleep. So
in my case, 14 years. of not sleeping every third
day it's no wonder that ultimately something
was going to break because that's literally you
know what is that like four years that i didn't
sleep if you if you add it all up so you know
when i just lean into my exercise physiology
you know that i was taught if you don't have
the opportunity to get in that deep parath excuse
me parasympathetic sleep that restorative sleep
you're not going to have the restorative effects
in your musculoskeletal system. So you are going
to have breakdown and ultimately you are going
to get hurt, which again is a huge dollar amount.
It lends an argument to give these people that
72 hour period. So as you said. the you know
the ones that were kind of in the middle will
get back to being motivated and be able to work
out again and the ones you know everyone else
then who's taking it seriously are doing strength
and conditioning then they're pulling hose and
throwing ladders then they're actually doing
it on calls and they're lifting patients their
body is able to actually recover from that and
therefore be more resilient rather than potentially
just waiting to get broken this reminded me of
uh another side i think it's by poston as well
where they were looking at prevalence of injury
while on duty and prevalence of injury while
on duty and what activities were causing that
injury. The number one category was training,
exercise. Those who were exercising are the ones
who are getting the hurt most often. So if we
stop there, the conclusion is exercise on duty
is bad because injury is high. And there's many
HR departments that have literally done that
and removed gym equipment from stations because
they stopped right there. So we have departments,
and I won't mention names, that say, all right,
you cannot deadlift. You cannot play team sports.
Some team sports are coming back, though. And
there are certain exercises and movements that
you can't do on duty. So if you stop there, that's
the conclusion. Exercise causes more injury.
They're not wrong. But then you look at when
somebody does get injured, how long does it take
them to come back to duty? So the severity of
that injury. So if we have, this goes back to
what we just mentioned a couple of minutes ago,
is now you have two firefighters, they both get
injured. How long does it take them to come back
on duty? The fitter individual, the stronger
individual with higher levels of fitness, higher
levels of strength, lower levels of body composition,
they're back on the floor much quicker compared
to their lower, their unhealthier counterparts.
So from that perspective, you can easily counter
that argument of exercise being bad while on
duty. And now if we're speaking longevity, how
long do they stay healthy throughout their entire
career? That one is a no -brainer as well. Stronger
firefighters, leaner firefighters, higher levels
of fitness. They have healthier levels of mental
health. They have lower risk for cardiovascular
disease, metabolic syndrome. So they can go through
their career in a healthier state. compared to
those who are not exercising is, sure, you're
not going to get hurt from exercise, but you're
going to get hurt from something else. Or it's
going to be unfortunate and you're going to develop
a high risk for cardiovascular disease and metabolic
syndrome. And because the job is so tough on
you guys mentally, your risk of anxiety, depression,
PTSD is much, much higher. So you have one tally
on the column of saying exercise bad because
injury, and then multiple points of argument
as to... why we should continue having a structured
pre -team program for all fire guys. Absolutely.
Well, and then just going back to the sleep,
if you go back to your sporting athletes, if
they didn't sleep or had massively disrupted
sleep three days a week or three nights a week,
what would be the prevalence of injury in a competitive
athlete? And I would argue it would increase
rapidly. So again, why is it any different for
the firefighter? Cannot answer that question
with any level of intelligence. That's just the
fire service. And it takes a pretty strong influencer,
if you will, to really pioneer this. And I'm
assuming that's you, James. I've been beating
the drum. I don't know if I'm influencing anyone,
but I've at least been talking about it. All
right. Well, you touched on mental health. That's
a good segue. The correlation between sleep deprivation
and all things mental health, what are you finding
there on the research side? So this is now getting
to a little bit of what my dissertation looked
at. I was screening individuals for symptomology
of PTSD. It was not saying, it was not diagnosing
them with PTSD, just symptoms that make up PTSD.
So this is avoidance, this is anxiety, this is,
what are the other ones? avoidance anxiety there's
some other ones it's going to come back to me
and now i was looking at call volume as well
so those who had a higher responding to more
calls had higher symptomologies and prevalence
of ptsd now add a layer to that those who had
less sleep and higher call volume had even greater
risk of high and high symptomology of ptsd so
put it together if you're at a busy station and
you're getting very little sleep at a busy station
you have a high risk for developing anxiety,
depression, and symptomology of PTSD. So that
was what my dissertation specifically was looking
at, a subsection of my dissertation. And then
you look at the research at large, and this is
across different populations, not just in the
fire, is sleep is very restorative. And for those
who experience, deal, go through, witness some
sort of trauma, what helps them deal with that
trauma, recover from it is sleep. We start getting
into more of like the neuroscience behind this
and the physiology behind it. And there's some
restorative mechanisms that go on while you're
sleeping that helps you process and recover and
deal and cope with that trauma in a healthy way.
But remove that and you're playing that same
tape over and over and over again while you're
in bed trying to fall asleep. And that over multiple
years at your career. it's going to take a toll
on you. There was a paper that got published
by Janky, Sarah Janky, maybe early 2010s -ish.
I may be wrong on the year. And it was qualitative.
So it was interviewing firefighters from different
ranks, from the fire to the engineer to the captain
and the chiefs as well. But they were getting
them in different groups too so that me as a
firefighter was not speaking in the same group
that my captain or my VC is in. So now it gives
me a little bit more level of comfort to talk
here. And some of the stuff, the quotes that
are in that research, it's heavy. Some of the
stuff is like you go to that one call, you respond
to it, and it's a traffic collision and you see
some stuff. And you know that's the career you're
getting into, but then you have to go respond
to another call right away. And you don't sleep
that night and you're holding on to that memory.
You're collecting these memories. And these experiences
throughout your entire career and you are not
having the resource, one of the main resources,
sleep recovery to help deal with that. So then
that takes us down another deep hole from there
or dark hole from there. This is what I find
exciting. It's maddening that there's resistance
to these conversations, especially the work week.
But being an incurable yet angry optimist. There's
a beautiful opportunity, especially in this recruitment
crisis, because now people are being forced to
pay attention. You're bleeding people. The number
of recruits is dwindling massively. There's something
that's broken. We need to change it. But when
you actually break down all the contributing
elements to especially suicide, you can see them.
No one knows the kind of ratio of everyone's
individual thing, but we know that a lot of us.
have on you know have childhood trauma now some
of them have been able to address it you know
prior to coming on to the profession and that
i 100 believe the post -traumatic growth that
becomes a strength if left unaddressed absolutely
it's a fracture in the foundation then you get
on the job now you talk about sleep deprivation
okay so so with the childhood trauma you have
the ability to understand it as a profession
and start addressing it at the front door make
counseling as normal as pt You know, we know
the reason you put this uniform on is because
there's some things that have probably happened.
And we're going to start working on that as much
as we're going to work on your physical fitness.
Then you get into the sleep deprivation. All
right. Well, this is the way we used to do it
as a profession. But now we understand the impact
and we listen to Daniel's podcast. And now we
get that we need more sleep. Now we're actually
going to fix the work we can give these first
responders the rest and recovery they need between
the shifts. You know, then you obviously that
is going to factor into a better culture. So
maybe some of that toxic culture, organizational
betrayal that we hear is very compounding starts
to improve. You know, then you've got substance
use and alcohol, then you've got the side effects
of psych drugs. And each of these little pieces
we can actually grab and start fixing. But the
biggest one, again, as you just alluded to, in
my opinion, is we know that sleep deprivation
is detrimental to mental health. And that is
an easy one to fix. It's going to take time maybe
to get that person to open up about what happened
when they were young. But we can change the work
week like it's happening in Florida and massively
impact that. And that's going to then fill all
the vacant spots like Gainesville. I think literally
next week we'll be fully staffed. 24, 72, four
platoon, fully staffed with people lining up
to work for them now. So this is where I think
there's an amazing opportunity of rather turning
our heads and just... glamorously burying all
the people that we lose to addiction and suicide
that we can actually pull these out the shadows
into the spotlight and say this is a fucking
huge contributing factor let's fix this you know
we'll work on the other ones too but let's fix
this and the science just as you've said is irrefutable
when it comes to sleep deprivation and everything
from you know the suicide ideation through to
addiction oh a lot to unpack on that one So maybe
two years ago, we have 20 something departments
and we go to each one. I like having these conversations
with them. And I ask them very high scope questions
is, hey, how's overtime in this department? And
almost across the board, two years ago, we're
saying there's a lot of forced overtime. Why
is there a lot of forced overtime? There's just
a lot of staffing issues right now. There's a
lot of openings. We have people retiring and
we're having trouble to fill them in. Why are
you having trouble to fill them in? Applications,
they're much lower. Back then, 10, 20 years ago,
we would have 100 applications for two spots.
And now we have a few applications for 10 spots.
So then it's like, well, why is recruiting so
difficult across departments? And then we start
going down different rabbit holes. But then I
start looking at the departments that don't have
staffing issues. So what are you guys doing while
we're here? why is it so much easier for you
guys to attract talent? And they mentioned, well,
it's opportunity that we have here. We can do
the Helitack stuff here. We can do the USAR.
We can do Hazmat, whatever you want to do. So
it's opportunity. It's like, okay, cool. So the
recruits, they know where to go in order to get
good opportunity. So preface with that, we have
maybe two departments now that they're on the
smaller end, let's say 50 to 60 members for the
department. and they have high call volumes,
high call volume, and they burn a lot too. So
this is where I'm thinking, all right, they're
young recruits. They want to go to a department
where they're burning a lot. But when I speak
to them, they say they have a high turnover rate.
Why do you guys have such a high turnover rate?
They're leaving us for this department and that
department over there. Why are you guys leaving
for those departments? And it says, they're just
so busy here. We have so much first overtime.
We're on a 4896, but... In reality, you're working
96 and having 24 off, maybe 48 off. And the recruits
that are on for a year, they realize this. They're
on for two years, they realize this, and they're
going to lead to where it's a little bit, they
have a little bit more balance. And then now,
so that's that pattern that I've been noticing
over the past three years. So then now departments,
if departments are thinking the way I am, and
I really, really doubt it, Because I'm not a
firefighter. I don't have that mind. But it's
how does the department now mobilize their policies
and their structures in order to attract as much
of this from an opportunity standpoint, but also
from a recovery standpoint. Because now you look
at the generation that's coming into work right
now, and it's not the boomer, the Gen X, or the
millennial population that would prioritize work
over self. Now it's the generation that's prioritizing
self over work. And I'm not saying it's a bad
thing. I think the Gen Z population are figuring
a lot of things out that their predecessors haven't.
But how do you recruit these Gen Zers now? And
how do you tell them, hey, you're going to be
working 96 on. You're going to have a 48 -96
schedule, but in reality, you're going to be
working four on one, maybe two off. And you're
going to see your kids and your family once,
maybe twice a week. And for this Gen Z population,
that's not going to fly. So I see when the Gen
Z becomes the main, like the dominant contributor
to the workforce, especially in the fire service,
something's going to shift. It has to shift because
Gen Z, that's what they're known for. And I think
those are some cultural shifts you're going to
see. I'm so glad that you said that. The reason
being, I've talked about this recently, the Wall
Street Journal put out an article probably a
couple of months ago now. talking about how Gen
Z are leaning heavily into the trades. And it
kind of just underlines what I've been talking
about. But it's a pseudo hypothesis, even though,
again, I would argue it's somewhat common sense.
But my generation, I'm Gen X. You're absolutely
right. I was actually talking to one of the guys
that taught me in my first fire department. And
I've recently been reminiscing. I totally forgot
this. When I got hired, I didn't even know what
the salary was. They didn't post the salary.
It was that competitive. that we just showed
up and then they told us and it was shit. And
we were like, oh, well, you know, we're firefighters
now. Very different now. And it's not like you
said, it's not a negative at all. The Wall Street
Journal, like I said, was saying they're leading
into the trade. So I'm a young person and now
I have all the information available, just like
you talked about earlier, when it comes to nutrition,
strength and conditioning, everything is there.
And so I Google, you know, is it worth going
to college? And it comes up, well, yeah, if you
want to be a doctor. or you know a lawyer then
yes there is there's a track that you have to
go it takes you to college but on the other side
you could spend sixty thousand dollars in student
debt have a piece of paper that doesn't guarantee
you a job and so these young people are going
well that doesn't sound like that makes much
sense i'm not going to do that but if you go
to community college for a year you can be a
welder and make six figures oh yeah i'm going
to do that then that makes perfect sense because
i can be home you know and this is the work week
and and these young people with If we've raised
them right, my generation, they understand about
strength and conditioning and fitness, the importance
of longevity. They understand about nutrition.
They understand about mental health. They value
relationships. Because I would argue a lot of
people in uniform, we've done our best to try
and be present as much as we can. And so I hope
that we've done a good job and this has created
an even better generation. But that great generation
now is looking at the way we work and going,
you guys have lost your mind. like 56 hours a
week, mandatory overtime. Now it's 80. And like
you said, I mean, I worked at Anaheim. It was
the Kelly. So if I got hit on a mandatory, that
was a 72 hour shift for me. Then I have a 24
ride drive again, 70 miles, hope not to die on
the way home. And then I'm back to work again.
So they're looking at it going, this is terrible.
But what's so exciting is in Florida, there's
a revolution happening and they're realizing,
oh, that's broken. So let's get a fourth shift,
create a 42 -hour work week. And lo and behold,
what's happened for those departments? People
are lining up around the building, down the street
to come work for those departments because they're
showing them. Now you can say, well, now we're
giving you an environment of performance. Let's
put in a fitness standard. Let's also be saving
money because as you said. That overtime, that
costs a fortune. That lack of retention where
you train these people and they leave you costs
a fortune. There are millions and millions and
millions of dollars downstream that you're losing.
Workman's comp claims, line of duty death payments,
retirement payments, the lawsuits that we mentioned.
Let's invest in the front. And now these young
people that want to go into the trades, a lot
of them are like, well, now you fixed it. I'd
love to be a firefighter. I wanted to serve.
I value my family and my time. with my loved
ones more than being in a meat grinder at a fire
station. So a bit of a monologue there, but it
just underlines what I've been saying for a long
time is fix the working environment. The profession
is amazing, but the intensity that we work at,
we have to give these men and women the recovery.
And what's interesting is I just did a presentation
in California. I wasn't supposed to be there
to do this specifically, but it was a kind of
leadership. slash, um, mental health, you know,
a couple of days with, with some friends of mine
and this department had just had line of duty
death, a cardiac arrest. And so I talked about
this, this, you know, everything that we've talked
about and the shift and this new work week and
these California firefighters were just, they'd
never heard anyone even talk about it before.
And this is what blows me away. So if we want
to turn this around, like you said, opportunity,
you know, culture, absolutely that a hundred
percent draws people in. But if we really want
to get these young people lining up like they
absolutely did when I was testing, like Anaheim,
I sat against a thousand firefighters for 30
jobs. And this was at the written test. If you
want to get back to that, we have to fix the
things that are broken. So I couldn't agree more
with, you know, like you said, this young generation
are an amazing generation, but they're not stupid.
And they understand the ultimate currency isn't
money. It's time. 100%. Yeah, to add another
layer to that, NFPA, every single year, they
publish call volume trends. And they break down
those call volumes by, are they FHIR, are they
EMS, HAZMAT, et cetera. And every single year
since the 80s, call volume has gone up. There's
only two years in the past 40 years that call
volume has gone down. One was in the 1980s, and
then the other one was recent, 2020. Call volume
went down. So now this is a national level trend.
I tell the departments, let's zoom in now. Let's
just talk about your department. Have you also
noticed the same pattern across the board? Everyone
says, yeah, call volume is much higher now than
when I got hired on 15 years ago. All right.
So call volume is high means workload is higher.
If workload is higher, the same 24 hours means
you're responding to more calls throughout the
24 hour shift. And there's the high chance that
it may start to trickle into your sleep. You
probably were having one call after midnight,
and now you're having two. It was probably taking
you 30 minutes to fall asleep before, and now
it's taking you 60 minutes to fall asleep. So
with this increase in call volume, how is it
going to influence your overall health and wellness?
So that's a topic I use to really start facilitating
discussion and get the group to really open up.
And now I zoom out from that, and I think, all
right, call volume is increasing for all the
departments. And it's becoming known that firefighting
is a carcinogen just in itself is causing cancer.
And the risk for divorce is high and the risk
for mental health is high. This is not a good
recruiting tool for the young generation. And
the young generation is like, nah, I'm going
to go do something else because I value my time
over work. So we're going to have to, when I
say we, I'm talking to the fire service in general.
The fire service is going to have to figure out
how to. become better marketers um some departments
are really leaning into their social medias and
they're doing a good job of showing like how
exciting and sexy it is to be a firefighter and
you see their engagement start to increase so
i see departments trying to move in that direction
but to really double down on how can we prioritize
the wellness of our members is everything you
just mentioned absolutely i think one of the
biggest hooks to me Because I get a lot of pushback
from our own people, like a fighting this change
to a shorter work week, which I honestly, I give
them grace because I think truly they're just
so beat down and so tired and stressed that the
ability to really critically think is kind of
taken away. And I think during COVID was a perfect
example. A lot of arguably normal people got
pulled to an extreme left or right during that
time. And it was because there was a lot of fear
and stress kind of. you know, pushed upon them.
Um, but, uh, well, I think the real hook is firstly
just time with your family. I talk about this,
you know, how many donuts for dads and recitals
and, and graduations and, you know, first steps
have you missed because not, not the, even the
shifts you should have done the shifts that you
were forced to do extra. But then if you want
to really, I'd love to see if you've been exposed
to this research. One of the most harrowing things
that Sarah talked about in this most recent conversation
we had, Sarah Jenke, was the relationships between
our job. And again, you know, there's a correlation
not only with carcinogens, but the sleep deprivation
from shifts, but our job and pediatric diseases,
passing things on to our children. Have you dived
into that side of the research? No. No, I don't
know much about that. Yeah, I forget. But I mean,
the statistics, the percentages are horrendous.
You know, everything from, you know, autism down
some of the pediatric cancers through to the
infertility side. You know, it's a huge, huge
impact. So again, take a step back. I always
ask people, who is the most important thing?
Don't tell me the fire service is in front of
your family. You've got it so skewed if that's
the way you think. So the family is always going
to come first. Well, if it's destroying your
relationships because of all this mandatory overtime
or even the crazy long work week, and now you've
got the potential of passing a childhood disease
to your next child, like, isn't that enough to
fight for? Isn't that enough to say, you know
what? You're right. Why are we working 56 when
the person says that we need to work 56, works
40 hours and goes home on a Friday night at 5
p .m.? Like to me, that that is a real like knife
in the back to get you to pay attention, because
you can beat your chest and talk about I'll sleep
while I'm dead. But what about your daughter
or your son? Are they not worth fighting for?
I can tell that you've given this a lot of thought
and you have very well polished arguments on
this. I'm just I mean, I've sadly I've given
it a lot of thought because I've watched a lot
of coffins covered in American flags. I mean,
that's that's the harsh reality. And I see a
lot of people that struggle to have children.
I know a lot of firefighters whose children do
have health challenges or developmental challenges.
So, you know, it's another layer to this that
I think needs to be addressed. Yeah, the firefighter
has a lot of challenges they have to, one, learn
how to navigate. And hopefully their department
is providing resources. Hopefully they're getting
good information on whatever internet platform.
Because they got to battle PT. They got to figure
out how to PT correctly, how to eat correctly,
how to sleep correctly, how to become good, competent
firefighters, how to go home and still be good
moms, mothers, and fathers. They have a lot of
challenges that they have to get better at, overcome.
100%. All right, one more, well, two more areas.
I want to hit wearables. Before we do. Talk to
me about the relationship again with shift work
and testosterone levels. And then let's kind
of go down the TRT and other more holistic ways
of raising testosterone back up. So at our program,
we have firefighters. They draw blood and they
look at their glucose, their metabolic and their
cardiovascular profile. Now, more and more departments
are looking at their testosterone levels. So
they're drawing blood on duty. And we get those
results because I like numbers. I look at results
or trends as a whole for the entire department.
And what we don't control for is when the blood
is drawn. So is it drawn as soon as they get
to station on their first day on? Or is it being
drawn on that second day on? Or is it being drawn
on the overtime day? So that's something I don't
control. But on average, the firefighter has...
maybe low 400s to mid 400s as an average testosterone
level. This is a total testosterone. So again,
I don't know when it's being drawn. So the normal
level for testosterone, this is just for an average
male, is from 300 to about 1 ,000, somewhere
in that range there. So somebody having 400,
is it normal? Yes. Is on the low end of normal?
Also yes. So what is contributing to the firefighter
almost as a whole having low levels of testosterone?
Actually, before I start answering that question,
then I start splitting them up into age groups.
Does the younger firefighter have more testosterone
than the older firefighter? The answer is obviously
yes. Then I start splitting it up into ranks.
The firefighter versus the engineer versus the
captain. Does one rank have more testosterone
than the other? The answer is also yes, but this
one also correlates with age. It's usually the
older you get, the more likely you are going
to promote. So maybe that's not too much of an
argument there. But nonetheless, what is causing
the firefighter to have low levels of testosterone?
Low normal levels of testosterone. And it's everything
we've discussed already. The poor sleep deprivation
will just plunge your testosterone levels. But
then a good night's worth of sleep will start
to increase your levels overall. So that number
is very volatile. in its sense in itself but
then now it's the testosterone it's the sleep
deprivation and throw in layers of the mental
health in there not even we're just not talking
about like diagnosis of ptsd we're just talking
like i have high anxiety because i always have
to be on when i'm on duty so that alone as cortisol
goes up then your testosterone will go down there's
an inverse relationship there it's not always
the case but for the most part as cortisol is
higher testosterone is going to be a little bit
lower So now we have sleep -deprived and stress
firefighters, and you can start seeing why testosterone
is a little bit on the low end, on the lower
end of normal for the population as a whole.
Then you ask the question, what can I do to boost
my testosterone naturally? The number one answer
to that one is going to be sleep. Get some more
sleep. All right, but I can't because the job.
It's like, all right, what can we do from there?
Then it's going to come down to your exercise
and your nutrition. Lift some heavy weights.
prefer the heavier the weight is the better there's
plenty of studies on this one if you compare
weight lifters those who are lifting reps that
are lower than five meaning the weight is heavy
enough where you can't do more than five reps
compared to lifters who are lifting about eight
12 15 reps then the spike in testosterone post
lift is going to be greater in the heavier weights
so then you get the firefighter that says well
my knee hurts and my back hurts i can't lift
heavy weights all right well then we have to
start addressing those limitations from there
but then the next layer is going to be nutrition
is what is going to help increase my levels of
of testosterone from a nutrition standpoint actually
i got too much ahead of myself right here it's
going to be body composition if my body comp
is too high meaning my body fat is too high then
i am compromising my levels my natural levels
of testosterone production so decrease body fat
get a little bit leaner how do we get leaner
then we start getting into different rabbit holes
from there when it comes to diet and exercise.
From an exercise perspective, just get a little
bit more protein in you. Try to aim for a gram
of protein per pound of lean body mass in the
low end. If you can do it, a gram of protein
per pound of body weight. That's a high -protein
diet. That's really hard to do. I encourage whoever's
listening, a gram of protein per pound of lean
body mass. So to summarize that, try to get more
sleep if you can. If not, do what you can, but
lift some heavier weights. If your joints allow
you, lift some heavy weights. Make sure you're
keeping your body fat levels to rather lean.
So under 19 % is a decent level. And then get
some high -protein diets. If you can do all those,
that's going to be the natural way to improve
your testosterone. Now, non -natural ways, this
is a trend that I'm noticing more and more on,
is more guys are jumping on testosterone replacement
therapy, or TRT for short. So this is a trend
that I've been noticing over maybe the past three
years. When you get more on a one -on -one basis,
the guys tend to open up a little bit more. And
you ask, well, why? And he says, well, I'm battling
the job. The job is tough on me. I'm putting
on fat a lot easier or a lot faster now. It's
harder for me to put on muscle mass. I feel so
tired and fatigued after the shift. And this
is an easier fix. So just off of that experience
or that explanation. That I've heard multiple
times across multiple departments. I'm not saying
good or bad. I'm just saying this is the experience
you're noticing right now. So if I project 10
years into the future, I think TRT, you're going
to see a lot more prevalent. Again, I am not
endorsing TRT, nor am I discouraging it. I'm
just trying to project the trend into the future
here. As more guys jump on it and they start
talking about it on the kitchen table a little
bit more openly than who's ever listening, they
say, oh, shit. My sleep isn't that good. I'm
putting on some body fat. It's harder for me
to put on some muscle mass. This is a $250 per
month solution. Let me try it. So then that's
the trend there. And it doesn't help that we
have major, I want to say influencers or social
media personalities that are openly on these
type of therapies. So then... The guys are listening
to this podcast on the way to work and they're
saying, oh, it works for this guy. Maybe it may
work for me. So that's just the landscape that
I'm noticing. Now, healthy or unhealthy? This
is where we start getting into more of your own
personal decision. It's hopefully you get as
much education as you can and you make the most
educated decision possible. Is being on TRT a
bad thing from the negatives? We just talk about
what are the negatives of too much testosterone?
When we're talking about too much testosterone
is you're now in what they call super physiological
levels. You're no longer in that 300 to 1 ,000
range. You've now taken TRT and your bump numbers
up to 1 ,200, 1 ,500, either because you wanted
to or something else influenced you, whatever
the reason is. Now this is where we start seeing
all the negative side effects of high levels
of testosterone. This is from an aesthetic perspective.
We have hair loss. We have increase in body hair.
We have an increase in gynecomastia. we have
enlargement of the heart increased blood pressure
increased cholesterol we have effect of the liver
affecting your prostate so all these different
items that start to mount up on the negative
column all the positives you know about it already
but all the negatives this is it from here so
if you're going to do it is know that you're
going to be on this for a long period of time
know that you're going to be investing several
hundred dollars per month to doing this Because
if you know that you can invest the money for
the next year, and then finances get tight, and
you have to jump off this therapy because it's
not covered by insurance, or it's more likely
not going to be covered by insurance, then you're
going to have to battle the whole phase of, I'm
no longer taking testosterone exogenously. My
personal systems or my internal systems are not
producing testosterone naturally because I shut
them off with TRT. dark place to be in from there
but if done correctly and you're doing it on
the medical supervision and you're keeping your
cholesterol and your blood pressure and your
ekg is looking healthy and you're feeling good
and your doctor says there's no big red flags
that's up to you so i i think we need to put
a little bit more education out there saying
here's all the pros here's all the cons from
a physiological and a financial standpoint With
that said, now make the best decision possible.
And if you do, then hopefully you have a healthier
career ahead of you. Beautiful. I'm so glad that
you kind of relayed all of those things. When
I had one of the very first guys on the show,
Dr. Kurt Parsley, he was talking about, this
was eight and a half years ago when we did the
interview. He was talking about that scale that
you mentioned. And it's funny now because I've
seen the pendulum go from one side to the other.
If either of us would go to a doctor, let's say
10 years ago, and we sat down and we happened
to even get blood work that looked for testosterone
in the first place, which is a rarity, then they
would be like, you're within normal limits. Because
like you said, 250 to 950. You know, and then
James, you're a firefighter. You're, let's say,
you know, 28 years old and your blood, you know,
your TRT is, you know, 333. You're fine. You're
within normal limits. Well, then Kirk says, well,
that scale was done in one of the Ivy League,
you know, one of the small towns near the Ivy
League schools. And he said, what people don't
realize is the 250 was the 80 year old man that
had one foot in the grave. And the 950 was the
high school wrestler, quarterback, whatever it
was. And then everything in between. So like
you alluded to, the captain's T is a lot lower
than the 21 -year -old's T. And so you have these
tactical athletes that I would argue are probably
more physically and mentally apt than the average
person in their community going in and they're
being told, oh, you're fine. Well, then now the
pendulum swings the other way and you get all
these men's clinics popping up everywhere. And
now they walk in, 28 -year -old firefighter,
like, oh, you're subpar, which is right. But
what you need is TRT, not all the things that
you explained. And let's talk about the side
effects, including reproductive issues. And your
balls will literally start shrinking, atrophying.
Do you understand all these risks first? And
so I think that this is a real, you know, a very
predatory action on a lot of these companies
where they're preying on a lot of these, you
know, young people now, some of them being influenced
by this new surge of bodybuilding again. And
some of them arguably are first responders and
doctors and nurses that are so damn tired, they
just want their brain back. And what's exciting
to me is, I mean, yeah, I've had veterans on
the show, multiple, you know, TBIs and, you know,
the, you know, the natural. production of testosterone
just isn't working in their body, absolutely,
TRT has an application for them. In the middle,
after you've tried all holistic things, including
getting your department to go to a 24 -72 so
you're not breaking down your men and women's
hormones, is the peptides. And this is what I
found. There's a company, Transcend, that are
an excellent company, veteran -owned. They've
got a massive nonprofit arm as well, beautiful
people there. But I was on one called Enclomophene.
And all it does is help your body make a little
bit more. So you're not going down the TRT. I
actually have tapered off to not being on it
anymore. It was almost like a bolus just to get
back. Because it's funny you mentioned the lack
of body composition or muscle growth. I was 168
my whole career, 14 years. And I did CrossFit
for basically all of those years. Didn't put
on a pound of weight. When I went on there, I
took the peptides recently, like a year and a
half ago. put on to went up to about 180 i'm
six foot tall don't look like i'm on any sort
of supplements but i think it just helped kind
of undo the damage of shift work and i've tapered
back off and i feel great apart from the freaking
flu that i got at the moment um so yeah so i
think that's a under discussed middle ground
is you've got all those holistic things but then
the world of peptides can just help your body
boost it up a little bit And then I would argue
then taper back off when you've got your sleep
regulated and your strength training more and
those other ones are in place. But TRT isn't
the only place that you have to go if you can't,
you know, figure out the shift work. The peptides
are a great kind of halfway point where you're
not going to destroy your body, but it will just
give you a little boost to get you back to where
you need. The peptide conversation is something
I know zero about. I get questions on that all
the time at the different departments. And I
have to say, I'm sorry. I don't know enough to
speak on that. And I think that's on me. I got
in that question so many times and I still haven't
done the research on it. I got to put that higher
on my to -do list. I'll send you, I mean, it's
the founder of the company. So obviously he's
talking about his company, but Ernie Colling
is the CEO of Transcend. And I'll send you. that
conversation. Cause it's great. And I just had
their, their MD, who's also a neurosurgeon, Dr.
Venya, another great conversation. So they do
a really good job of just explaining what it
is, all the, you know, and the TRT and everything
else, the downsides, the upsides. So, and with
them, they do like a full, full blood panel,
and then you have a consultation and these are
what are available to you. And like I said, I
got to actually bring them down. I'm like, this
is too much. Like I'm crying and my nipples hurt.
I need to, I need to, and that's just from a
from a peptide, but my natural T is 700 at 51
years old. So it's still up there, but I was
just wanting a little boost because I know 14
years of not sleeping, of course, it's going
to have some damage. So do I need to be, you
know, nudge it up a little bit? But yeah, but
anyway, I digressed. I'll send both of those
to you. There'll be a great, great start for
learning about that. They're from that one company,
but I would argue it's the best company out there
anyway. if i project what a wellness program
would look like in the future for a fire service
um and i'm again i'm projecting here is what
you just mentioned right there is some sort of
online program where let's say that company transcend
goes to department x and says hey we're going
to do a full blood screen on your guys's blood
panel metabolic cardiovascular testosterone minerals
deficiencies the whole thing and then from there
is if you fall into this category if you're I
don't know, your cholesterol is too high. You
got to do X, Y, Z. If your glucose is doing this,
do ABC. If you're deficient on this, here's our
supplements. The one who's doing a very good
job of that, they're not in the fire space. His
name is Dan Gardner. He's a nutritionist for
combat athletes, mostly in the UFC. And you look
at what he's been doing and that's what he does
with his fighters is he does a full panel and
says, you're deficient in this. You're looking
really good on that one. Let's add more of this
into your diet. Let's take these supplements.
Let's change your training like by these parameters.
And that's how we get some prepped up for their
fights. So if I project into the future, some
tech savvy company is going to move into that
space and they're going to kill it in the health
and wellness space for fire. You mentioned supplements.
We talked before we hit record. I'm a huge fan
of Thorne. They actually have the ability to
do blood work even with Thorne and show which
kind of macro micronutrients that you're deficient
on and what profiles work for you. But without
loading the question, that's kind of my personal
perspective. Talk to me about supplementation
through your eyes. So supplementation, as the
word says, it should be supplementing your daily
diet. Now, because the diet of a firefighter,
maybe through because they have a busy shift
or they just don't want to make the decision
themselves, it suffers. Then that's where supplementation
is really coming in. The easiest one, I have
like a list of maybe five supplements that every
firefighter should be taking. And I don't have
any sponsorship, so I'm not promoting any one
specific brand or anything. But whey protein,
whey protein. Get some sort of shake and flavor
and brand that you like and add one or two scoops
of protein to your day. And that will hopefully
get you closer to your one gram of protein per
pound of lean body mass goal that you're trying
to get every day. Because one, that's going to
help you. If you're on a weight loss program
and you're trying to lose some fat, that will
help you maintain as much muscle mass as possible.
If you're trying to build some muscle, then a
high protein diet is almost a non -negotiable.
If you're trying to recover from just the beat
down of the body, high protein is absolutely
necessary. So I think protein is one of those
topics that we discuss a lot more, one of the
supplements that we discuss a lot more. So most
of the guys, they have a decent understanding
of it. So whey protein being number one on there.
Creatine monohydrate, number two on that one.
Creatine is a supplement that's been studied
for two, three, four decades now. And the way
it's been studied over those past decades is
more from an athletic performance standpoint.
There's been two different ways to take it. There's
two options. One is not superior to any other
one. The first option is loading it. You load
it for about five to seven days, 20 to 30 grams
per day for five to seven days. And then you
taper off five grams per day indefinitely. Option
number two is just five grams indefinitely. And
once your muscles become saturated with that
creatine, then you start getting all the benefits
of it. like increased muscular strength, increased
muscular power, and all those different characteristics
that we see, that's a lot more important for
the athletic population. Now, recently, over
the past maybe four to five years, we're noticing
that creatine is taking on a different space
of research. Now, it's more cognitive benefits.
Now, high levels of creatine can help you recover
from concussions at a faster rate. Higher levels
of creatine, this is like 20 to 30 grams, one
dosage of it can help combat the cognitive, all
the the cognitive reductions with sleep deprivation
that's not done in firefighters but nonetheless
it applies to the fire population so now we see
creatine started to take shape and more how does
preaching affect the psychology and the cognitive
performance so number two put creatine on there
number three is some sort of omega -3s or fish
oils is because we do blood work for for the
firefighters we work with And not all of them,
but I would say maybe 25 % of them have low levels
of HDL, high -density lipoprotein, which is that
good cholesterol we want. And if they can get
it above 40, it's even better. If they can get
above 60, even better. The way you can do it
through your natural diet is in consuming more
of those healthy oils, your avocado oils, your
olive oils, more nuts and seeds, your almonds,
cashews, walnuts, your fatty fishes, your salmon,
and your anchovies, sardines, mackerel, tuna,
etc. But if you can't or you won't consume those
items, then pay your 40 bucks for those jars
of omega -3s. Take two of those per day and then
you will see your HCLs begin to improve as well.
The one that's starting to get a little bit more
traction, ashwagandha. Ashwagandha, it's more
of an eastern type ingredient and you're starting
to make it, say it's way down to the western
side. And when we started, when I say we, the
scientific community, when we started researching
it more, is we thought that it was going to help
improve our testosterone and there was one study
that showed an increase in testosterone in in
humans but it was a very poorly controlled study
so there's so much holes in their logic there
so i would say it's a very poor study to base
your decision off of but the better controlled
studies of that for ganda is decreasing symptoms
of anxiety and depression yeah for those who
are having high levels of anxiety because of
the job or whatever reason is supplementing with
levels of ashwagandha and the dosage is it's
a wide range of dosages from like 200 milligrams
a day up to a thousand milligrams a day there's
been studies on those that helps decrease symptoms
anxiety depression and because it's so prevalent
in the fire service i think this is one of the
go -to's so that list would be the whey proteins
the creatine monohydrate the omega -3s ashwagandha
Caffeine, I wouldn't have to say it's a supplement.
Very effective for the athletic population. I
don't have to sell the firefighter on why it's
good. The only thing on that one is if you truly
enjoy your coffees and your carbonated drinks,
especially in the later hours of the day, go
for your decaf ones or go for your non -caffeinated,
stimulant carbonated drinks. I crave carbonation,
and especially later times of the day. I like
something bubbly and I know I have sleep in two
to three. I have to go to bed in a couple hours.
I'll get something bubbly that doesn't have any
caffeine or any other stimulus for that matter.
So I think that's my five list of supplements
that firefighters should consider taking. Beautiful.
Yeah, I consumed a lot of coffee when I was a
firefighter. I know they have an issue with the
energy drinks now and, you know, guys literally
passing out in bunker gear and getting rhabdo
and all kinds of stuff. Definitely worth it.
Ironically, one of my things, I've sworn off
alcohol now and the non -alcoholic beers are
really good. The wines are fucking awful, but
the beers are good. So now I'll have that in
the evening. So it's carbonated. Like you said,
it tastes good. It's got a fraction of the calories
of an actual beer as well. But you feel like
you're having a beer without having a beer. Yeah,
there's always little hacks for everything. Absolutely.
And with the supplements, this isn't a sales
pitch, but just to let people know, Thorne is
the sponsor I use. It's funny you were talking
about combat athletes. If you look at the UFC,
Octagon, Thorne's name is on there. They're the
NSF certified official sponsor for CrossFit,
UFC. So they're legit as far as a supplement
company. And they give everyone pretty much listening,
whether you're a medical field like ER or whether
you're a first responder or military. I think
it's 25 % off now. Another supplement that I
love, be interested to get your take, that I
absolutely see the benefits of is collagen. And
I use Bubz Collagen for that. Have you had much
experience with that? So I've dabbled into the
research on that one. I don't know enough to
speak professionally or any level of intelligence
on it. What I have read is the way that you take
it, whether through ingestion versus a cream.
And the two papers I read on it saying that collagen
has it's more efficacious when you ingest it
so whether it's in a powder pill as opposed to
a cream and i started reading on it because of
i'm starting to get some wrinkles on the side
so i was like oh maybe i should try this that's
as much as i know on collagen it's it's really
good now my my skin you know i've had terrible
skin since i was a kid and my dad looks like
a sharp a so when it comes to wrinkles i'm screwed
but from hair growth, nail growth, I've got dry
skin. So just being less dry, gut health, joint
health, I can see, absolutely see, see the difference.
So yeah, I mean, it's, it's a great, great product.
Bubz is the one I swear by another, um, uh, supplement
company that's, I think they're NSF as well.
Um, but also they, I think 10 % of all their
sales go to a nonprofit as well. So they're a
social business, but, um, yeah, great, great
product. All right. Well, then I want to be mindful
of your time. We'll discuss wearables another
time because I know we've already passed the
two hour mark. So a couple of quick questions
to close out. Firstly, is there a book or are
there books that you love to recommend? It can
be related to our discussion today or completely
unrelated. take on how we adjust to our problems
as life adjusts, as life changes. And they have
different characters on there. One character
is grumpy and complaining about how somebody
moved his cheese, meaning how life changed. And
then the other one is trying to figure out how
to adjust to it. So I've recommended that one
so, so, so, so much. Another one that I've recommended
a lot is called the E -Myth. E -Myth, and I'm
assuming E stands for entrepreneurial. But there
it talks about working in the business versus
working on the business. So if I relate that
over to what I'm doing here is by training, I'm
academic. I read the research and I put it out
there. But now I got to think about the consumer.
How is the consumer looking at my product or
my service? My product is being my post on this,
my social media post. Am I optimizing this for
the colors, for the graphics, for all this stuff?
How do I make this so that my consumer can really
enjoy it? And that's the two different ways of
thinking on whatever your product, service, brand
may be. I recommend that one a good amount. The
pictures that you use, are those AI generated?
They absolutely are. So they are using XAI. Brilliant.
Yeah, they're very good. Thank you. Normally
they've got Euro helmets when you ask AI to make
a fire. Some of them do, and I have to prompt
them, do not use those European helmets. Make
it look like they're the US guys. I've tried
using the TPT ones, and it does a very poor job
of animation, at least when I tried it. But yeah,
definitely AI on that one. All right. Well, then
same question, but films and documentaries. I'm
a huge Christopher Nolan fan. Anything Christopher
Nolan, anything Martin Scorsese. I sound like
a regular guy at this point. Anything Martin
Scorsese and Christopher Nolan, I'm for it. The
one movies that I can watch over and over and
over again, Dark Knight, the one with the Joker.
Fantastic movie. Fun fact on this one is I took
a college course on the philosophy of Batman
and Joker. I invested hundreds of dollars to
take this college course to just learn another
philosophy. It's the other one. I can watch Godfather
1 and 2 over and over again. Again, I sound like
a typical guy. I love Inception. Inception's
awesome. Interstellar was amazing as well. Documentaries.
I don't watch so many documentaries. I don't
watch any documentaries. You know what's interesting
about Godfather? I wrote a book last year and
I'm writing the screenplay now. Just finished
the pilot. But before I did, I was thinking,
well, I'll get someone to write the script. And
my friend who's an author and a screenwriter
himself, who's already created films, said, you
need to write it yourself. So then I'm like,
all right, well, let me buy a book on how to
write screenplays. But he was telling me that
the guy that wrote the actual Godfather story,
that wrote the script, he just wrote the script.
That was it. He just said, I'm just going to
do it the way I'm going to do it. Then the studio
said to him, hey, we want to make a sequel to
this. So he's like, well, shit, I better learn
how to write scripts now then. So he goes and
buys a book. I think it's the same one I bought.
And at the beginning, they give an example of
like a really well -written script. And it's
The Godfather. So basically, he was like, well,
I guess I don't need to read a book on writing
scripts. So the irony was, you know, again, kind
of getting outside the box and believing in your
own creativity. The Godfather script was written.
differently than a lot of scripts and it was
ended up you know hailed as one of the best scripts
in hollywood it's a fantastic movie absolutely
all right well then next question is there a
person that you recommend to come on this podcast
as a guest to speak to the first responders military
and associated professions of the world all my
colleagues my colleagues are phenomenal i've
learned so much from them like some of the stuff
that i've said today i take it from my colleagues
like when i say the gym and a job or three kids
under five like those terms are well verbatim
what my colleagues say. And I think you know
them already. One of them, Jennifer Maloney,
I'm sure you've worked with her many times. She's
more of an OG in our program. Robin Leafblad,
she's amazing. She's very intelligent. And we
have a new faculty who's doubling down on the
mental health side of the first responders. And
it's Tomas Rubalcaba. He's maybe third, fourth
year PhD program now. Yeah, they're... Fantastic,
fantastic. They're extremely intelligent, very
knowledgeable. One individual that I've started
to talk to a little bit more, he is a colleague
of mine in the PhD program. He spent maybe a
decade working with military, more on the mental
health space. And he left military. He's now
working with us. And his name is James Branham.
Very smart dude as well. So I can connect you
to those. Thank you. Yeah, I have to definitely
work through all of them because I don't think
I've even spoken to Jennifer before, if I'm not
mistaken. Yeah, she's been with the program for,
I don't know, I'm assuming 20 years. Sorry, Jen,
if you're listening. I don't know how long it's
been. I'm going to speculate here. Well, maybe
I have. Maybe back when I was wearing the uniform
in Anaheim. All right. Well, then the very last
question before we make sure where people can
find you and your work, what do you do to decompress?
What do I do to decompress? A lot of weightlifting.
I've gotten into jujitsu. Uh, so those are my
go -to decompress and stuff is one way lifting
a lot of Jiu Jitsu. And I like to work on my
house a lot. Like right now, this used to be
my office is to be really well furnished and
it is currently under a lot of renovation. Um,
so I'll be renting this place out, um, and finding
another place to live in. So that's usually how
I spend my time now that I'm out of school. Absolutely.
All right. Well, then for people listening, where
are the best places to follow you, reach out,
et cetera, online or on social media? The only
social media that I'm active on is going to be
Instagram. It's going to be Dr. Daniel Higuera.
So D -R dot Daniel, D -A -N -I -E -L. My last
name, Higuera, H -I -G -U -E -R -A. I recently
logged on to LinkedIn and maybe two months since
I've been on there. And I've had so many requests
and messages. Like, where did this come from?
And I'm going to assume it was you because then
I said, I was mentioned in one of your posts.
And yeah, so I started responding to a lot of
the messages on LinkedIn. Some companies started
reaching out to me and someone said they want
to partner for research studies. And yeah, so
although I have LinkedIn, I'm not too active
on it. If you want to reach me, reach me on Instagram,
Dr. Daniel Aguirre. Beautiful. Well, I want to
thank you so much. When I first saw whichever
slide it was that first came across my radar
by chance, I was like, okay, this is exactly
what we've been talking about. As you said, you
do present it so well. Every slide is eye -catching
and there's information on there. And then in
the text, you're talking about the study and
then the limitations of the study. So it really
is kind of pulling people in. So your lens coming
from the sporting background as an athlete, as
a coach, and then working with this population,
I think is so, so important. So I want to thank
you so much for being so generous with your time
and coming on the Behind the Shield podcast today.
Thank you for having me, James.