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Frequency · Episode 1
Lessons on Healing from 35 Years of Orthopedic Surgery
Dr. Warren G. Kramer III, MD, has spent 35 years repairing pro surfers and skaters, and what he learned will change how you think about healing, recovery, and aging.
Dr. Warren G. Kramer III, MD • 49 mins • June 9, 2026
About This Episode
How does the body actually heal? Dr. Warren G. Kramer III has spent 35 years answering that question, repairing pro surfers, skaters, and motocross athletes, and what he has learned will change how you think about recovery, aging, and nutrition.
In the first episode of Frequency, the podcast by Phi, founder Kirk Ouimet sits down with one of the most respected names in action sports medicine. The conversation moves from the operating room to the dinner table: why complete rest and icing can slow you down, how platelet-rich plasma restarts healing the body forgot to begin, why your muscles protect your bones as much as calcium does, and the nutrients your skeleton cannot do without.
It is a masterclass in how the human body repairs itself, and what we can do to help it.
Fascia is one of the most important things in our body. It's like having yoga pants inside your body, holding everything snug.
What You’ll Learn
- Why complete rest and icing an injury can actually slow your recovery down.
- How platelet-rich plasma (PRP) restarts healing the body forgot to begin.
- Why your muscles protect your bones as much as calcium does.
- Why D3 alone is not enough, and the role of K2 and absorption.
Chapters
Transcript
Chris:Dr. Kramer is a friend, advisor, and shareholder in Phi. Nothing in this conversation is medical advice.
Kirk:All right, welcome everyone. Thank you for joining us today. Right now I'm sitting here in a beautiful home in Dana Point overlooking the ocean. The waves are rolling in, the breeze is coming through, and it feels like the perfect place to slow down, breathe, and dive into today's conversation. Today we get to learn from someone who has helped athletes get back to what they love. Our guest today is Dr. Warren Kramer,
Kramer:an orthopedic surgeon in Newport Beach and a cornerstone of action sports medicine. He serves on the USA Surfing's High Performance Committee and has led medical care for the World Surf League for decades. He is the surgeon to athletes like Kelly Slater and Ryan Sheckler after the worst slams, and he literally wrote the paper on injuries in professional athletes. Welcome, Dr. Kramer. It's an honor to be with you. Thank you. To start out, we kind of have a tradition on the podcast where we love to
Kirk:give our guests a gift. So I did just do your research on you and it felt appropriate to give you this book by Jim Heimann. It's called Surfing. Very cool. And it's a history of surfing from 1778 to the present day. Nice. And I thought it'd be nice for you to have it in your office, but it's this beautiful like...
Kramer:visual guidebook to the entire sport beautiful so I thought you'd like that I love
Kirk:it so thank you thank you thanks for coming on the podcast awesome I love it you can set that down yes wherever you like um so kind of just to start out a lot of people are gonna who are listening are not even gonna know what orthopedics is at a very high level could you tell us what is orthopedics
Kramer:So let's just start from the beginning. So orthopedics, ortho means straight and pedics comes from child. It was originally spelled P-A-E-D-I-C-K for children. And what it was is so many children back in the 1700s, 1800s, 1900s would have things like polio. and rickets, and they would have deformed limbs. And the original orthopedists would use wood and straps to basically straighten their body, straighten their limbs,
Kramer:so it was a straight child. And then once surgery started getting invented, you know, the invention of ether, and they began having hospitals back in the late 1800s, the earliest orthopedics were basically draining things such as tuberculosis in joints. And then from that, it spread out. And now obviously it's all about trying to fine tune the body the best it can. So when a lot of people think of orthopedics, they think bones. For example, yes, in my job, I
Kramer:take care of bones, like drill through bones and things like that. But I don't really do fractures as much as I used to. It's more joints, shoulder joints, hip joints, knee joints, ankle joints, things like that, where, yes, bones are connected to that. But it's really the joints that give us life and give us speed and give us what it takes to do just walk or do our normal athletics. And so it's really... it's taking care of joints more than just taking care of bones. And you would say that joints are going to be a thing that's more likely to be
Kirk:injured versus bones. For when you think of sports injuries, yes.
Kramer:You think of high velocity, you're going to think more likely bones. But what's interesting is when we talk about energy that goes into the body. There's an old saying, which is a fracture is a soft tissue injury that was so bad, it also broke the bone. So many times you'll start tearing a ligament and the energy isn't high enough. You stop there. But if it's high enough, you'll go all the way and then end up breaking the bone too. And then you end up having to fix everything.
Kramer:Tell me what initially, if you could go back in time and remember,
Kirk:did you know that you wanted to go into orthopedics or can take me to the time where you like made that decision in your mind where I'm like, I'm gonna pursue this and become an expert in it.
Kramer:- So my dad was an orthopedic surgeon. And when I was about five or six years old, he brought home a spinal tray for doing spinal taps. You know, like the great movie, "This is Spinal Tap." But the spinal tap kit had the needles and syringes and all these tubes you had to do it. And I was going around doing spinal taps on every one of my brothers and sisters and my parents, not with a needle, but I was kind of faking the needle part, but pretending like I was doing that. And that was kind of the start of all of it.
Kramer:It was pretty wild, but we were, I mean, it was almost a little bit embarrassing, but I remember being eight, nine years old and I would have like a birthday party or something. And so we'd have a birthday party and then my dad would start showing like home videos, home movies of surgeries that he would do, like big open surgeries inside, like,'cause he was a world famous guy with regard to hip surgery and children and adults. And so here we are watching hip surgeries at my birthday party.
Kirk:- And how old were you?
Kramer:- Oh, eight or nine years old.
Kirk:Okay.
Kramer:Yeah, and I know some of my friends were pretty squeamish about it, but I was going, this is fascinating. This is great stuff. So it was like in my blood very early. - That's incredible.
Kirk:So basically you've learned from your dad. And then did he was a was he a coach and mentor to you then growing up as you got into the practice?
Kramer:So he yes. So he started the practice and I joined it and then my brother joined it. And so when he first started, it was there weren't a lot of orthopedics. And like he was the second orthopedist in all of Orange County. There weren't a lot all over. His best friend was a guy that he did his residency with at Orthopedic Hospital in Los Angeles. who became like the premier sports guy in Salt Lake City. And so they were great buddies forever.
Kramer:But the point was is that there is like, there's a thing called a Kramer osteotomy. It's a special surgery you do for children's hips. You know, there's a Kramer crank
Kirk:Named after your dad. - Yeah, named after my dad.
Kramer:So things like that. So we were definitely ensconced in the whole world of orthopedics from a very early age.
Kirk:Tell me about just thinking about your entire career. I think it's been 17 years. Is there one specific injury that stands out where when you think back to it, you're like, "Wow, that was a really intense thing for me to deal with"?
Kramer:Well, to scare you, my career is 35 years.
Kirk:Okay, okay, here we go. Dumbin' around for a while.
Kramer:And so I started, I was lucky enough I went to high school and when I went, I started college early. I did three years undergrad. So I finished my MD at 24. And so I started really, really young. And from then on, so... I can, let's don't talk about car accidents'cause those are just a bummer. Well, I'll talk about sort of an interesting one and it happened within like four months of starting private practice. So here I was in my, I was 30 years old and this guy,
Kramer:this guy comes in blood all over his elbow. Well, it turned out he and a couple of his buddies were running a stolen car ring. And some other people who were running stolen car rings, they thought they were encroaching on their area. We're talking about Newport Beach. And they basically were going to teach him a lesson. So point blank shotgun wound to his elbow. So the first thing I see is like,
Kramer:obviously pretty mangled. So I go in, put pins, like these pins that stick out of the skin down in his forearm and ones up in his humerus, clean everything out, took them back, you know, start antibiotics, all that fun stuff, clean all the junk, come back, A couple days later, clean it out again. And then I came back four days after that. And what I did is I took bone from your top of your pelvis, like your iliac wing here, took that, reconstructed it into where he had lost bone from his elbow,
Kramer:put it together with plates and screws, and then took his latissimus muscle put it, undermined it through a tunnel under the skin all the way down. So I put it here on his elbow, then took skin graft from his thigh, put it on that. And at one day after surgery, he was going like this basically. Oh yeah. Totally reconstructed his elbow. And you can take tissue and bone from anywhere in the body?
Kirk:Yeah. Yeah. And how old were you when you did this? Like 31. Okay. It was pretty crazy.
Kramer:Did that and then the cops show up like two days later, "Uh, we're taking this guy to jail." Hey, but at least his arms are moving and his heart's ripping.
Kirk:That's wild. It was pretty crazy. I want to hear about, with I guess 35 years practicing, We talked at the very beginning about there being, you know, we were using wood to straighten things out way back in the day. What innovations have you seen in your 35 years then? Has medicine in orthopedics changed over the last 35 or how would you feel? So a lot of changes have been that many times fractures early on were treated in
Kramer:casts. And we, I was far enough along that we had like fiberglass casts, so they weren't that heavy. But even early on in my career at like UCLA and places like that, it was expensive fiberglass casts. So they were still getting good old plaster casts for stuff. They were still hanging people in traction for femur fractures. They were still, you know, doing everything inpatient. For example, if we did a hip replacement 35 years ago, they would stay in the hospital in these thing called slings and springs where
Kramer:basically their leg would be up getting hung and they could move their leg a little bit. They would stay in the hospital for 14 days till we took the staples out. Now we do our hip and knee replacements outpatient. They go straight home.
Kirk:Oh my gosh, that's a massive difference. Oh, exactly. I mean, think about...
Kramer:all of this just loss of normal life revenue by sticking the hospital for 14 days. We were reluctant to let people really walk on stuff early on. Now I do an ACL reconstruction. I'm like, "Start walking immediately." and put them in a CPM machine, get them moving. When we first started, you get an ACL reconstruction, you'd be put in a cast and you'd stay in that cast for six weeks. And it could take you a year before you would get your range of motion back.
Kirk:- So is there kind of like a principle here that after you've injured yourself, you actually need to get back to using your body as soon as possible? - Yes. So, you know, when they talk about RICE,
Kramer:Rest, Ice, Compression, Elevation, the guy who came up with that, this is maybe three or four years ago, he was at one of these conferences and he apologized for coming up with that. He goes, "First of all, rest is not good. Relative rest is okay. Like if you're spraying your ankle, you don't wanna just like stop. You don't wanna put it in cast and just rest it and keep it elevated and do nothing. Because what happens is your bones dissolve and all the, think about all the layers, like from, let's say from your skin down to the bone,
Kramer:like behind your ankle or whatever. You're going through skin, subcutaneous, fascia, muscle, another set of muscles, then you finally get down to periosteum and bones. So you get like six, seven different layers. You put someone either in a cast or you tell them not to move it, they all glom together. They're all supposed to be moving separately. You're not doing yourself any favors by letting them all heal together. So now it's relative rest. Next is ice. Well, we find there is a great study on ankle sprains. that if you like basically ice after the first 24,
Kramer:48 hours and you ice like crazy for the first two weeks, you will delay the healing of your ankle almost double the amount of time. - Oh my gosh, by icing, that's counterintuitive. - Yes.
Kirk:- What do you think is going on there? - I think it's just one of those things where blood flows your friend.
Kramer:Blood brings everything, blood breaks nutrients. So if you don't have the blood flow, 'cause you're icing it down, whoops.
Kirk:Yeah. So basic information like this
Kramer:is gonna have a massive impact on any recovery then? Yes.
Kirk:Tell me, thinking about the future, like if we were to imagine the next 35 years of orthopedics, What kind of innovations do you see?
Kramer:35 is probably too far out, but if you were to look like five years out, is there any validity to like the stem cell treatments or? Yes.
Kirk:Oh, there is?
Kramer:Yeah.
Kirk:Okay, tell us about that.
Kramer:100%. So there's a lot of times where I have people who are in that situation where let's, I'll just make it simple. Let's say someone's starting to get arthritis in their hip. and they've lost 30, 40 % of their cartilage. Well, they haven't lost all of it. So they're at a point where just taking some medication isn't going to do it anymore. Still hurts, but they're not far enough along. They need a hip replacement. And I do hip arthroscopies. I've done almost 3,000, 3,500 hip arthroscopies.
Kramer:So I know I can look in the x-ray and go, "Ooh, you're too far gone." The chance of making you better with hip arthroscopy is 25 % at the most. But what we do is we have this PRP, you know, platelet-rich plasma. You know, some people use umbilical cord, quote, "stem cells," or you can do bone
Kirk:Is that legit, the umbilical cords? - It is legit. You know, the issue is,
Kramer:is that right now, the FDA is not approving it in the United States'cause they had, a bunch of basically E. coli infections where people got, some died, some got really sick. It was basically contaminated material. And it sort of like ruined it for everybody. But you can get stem cells from fat. You can get stem cells from bone. Now, for us, a lot of times we just use high volume PRP. We'll take 60 cc's of blood and spin it down to just 5 or 6 cc's,
Kramer:just 5 or 6 milliliters. Super concentrated, where the amount of pluripotential cells, growth factors, etc. is almost as good as me stabbing into someone's bone. So for that reason, it's a lot easier for the patient. So for that reason, that's kind of our go-to, but there's a lot of times I have people, I will do one PRP shot into their hip, and they'll come back three years later going, "Oh, still feels good."
Kirk:Oh my gosh. - Oh, it's amazing. - Is PRP fairly inexpensive and accessible then?
Kramer:- It's pretty inexpensive, yeah. - Okay, that's incredible.
Kirk:So both PRP and stem cells are gonna continue to, Change, healing. Yes, yes. And I think in a lot of things that we're going to be finding that right
Kramer:now they do, quote, manipulate it down in places like Mexico, Panama, stuff like that. And I've had friends go down there and I read about it and... It's a little hocus pocus. I mean, I kind of get a little bit nervous about when they're manipulating'cause it just increases the chance of there being an infection or chance of something just not working out. And PRP works so well. Trying to get that extra five or 10%, seems like a little bit of an overkill. But I know in the future, I think it will be better.
Kramer:I think in some ways manipulating will become more of a science and it'll probably help the PRP. - So if someone's suffering from like a chronic pain,
Kirk:what's the difference between a PRP shot and a cortisone shot? That may be a dumb question.
Kramer:- No, it's not at all. So PRP is you're giving, so let's pretend you, cut yourself. You get all this blood coming in the area and all that blood is bringing in white cells, is bringing in platelets. And the platelets are basically, they have all these growth factors with them. And they basically are like an army of just rebuilding what was wrong. Now, let's say that you have this chronic, slow injury to your tendon, where it just kind of gets,
Kramer:you're playing basketball, and you kind of tweak a little bit, and you tweak this, or you tweak your knee a little bit, and you never really bleed. You don't really do anything. It just slowly, chronically gets a little bit sicker and sicker and sicker. And same thing with the cartilage in your knee. Okay. Well, you're not mounting that incredible response. You're not getting like you would if you cut yourself. You're not having armies of platelets and armies of white cells coming in and fixing it. So what we're doing is we're basically by drawing the blood and injecting it right in that area, we're giving it six months of healing in one fell swoop.
Kramer:And it works. And it works. It kind of re-kick starts the healing process in the sense. You're kind of re-kickstarting the injury, but making it a real injury so the body really starts to respond.
Kirk:- And the body has natural ability to heal. We just need to draw attention to the area that needs to be healed. What are your thoughts on yoga and Pilates as far as being able to give blood flow to these different joints and tendons? So one thing, you know, when we were learning anatomy
Kramer:and we would go in and we would have cadavers. First thing we did with our cadavers is open the skin, get down, there's a fascial layer over all the muscles. And the first thing we do is just start stripping all the fascia off so we can get down, get down to the quote, the good stuff, get down the muscles and get down to the organs and all that kind of stuff. Now we realize, oops, that fascia is one of the most important things in our body. It basically, think of it this way, it's like having yoga pants inside your body where it basically holds everything
Kramer:snug as well as it holds. It basically is a source, you know,
Kirk:we talk about potential energy and kinetic energy and stuff like that. It's a great source for storing potential energy. You go into yoga, you go into Pilates, and you're twisting. You're not just working the muscle. You're twisting that fascia that then allows it to untwist and release a kinetic energy type of power. There's that book that was like "Born to Run" and talk about how you could get these people who don't even look like they're in great shape, just bounding up balance because they've learned how to sort of use their fascia to
Kirk:use this potential energy of it to allow the muscles not to be overused'cause they're using that. I mean, when, you know what a beefeater is? - Beefeater, tell me. - So you've seen Beefeater gin,
Kramer:right? With a funny hat. Basically, beefeaters were the guys that stand in front of Buckingham Palace totally still.
Kirk:Oh, okay, yeah. - Yes. So the only way you can do that is you gotta have your little muscle and
Kramer:fascia basically pumping and keeping everything going. You're just gonna pass out. As well as you're kind of leaning, you're kind of just kind of lean on your fascia, lean on your ligaments, so you don't, you're not using any muscle per se to stand there all day. You're just leaning on your fascia and ligaments. So would you say, I guess, yoga and Pilates,
Kirk:as far as like a longevity and health span, are probably great activities to be doing? I think all that stuff...
Kramer:I mean, Pilates was originally discovered, like Pilates, back in the 1940s as a means of rehabilitation after World War II. Yeah, it wasn't an exercise program. It was a rehab thing for people who were injured. But the thing with yoga is that... It comes to a place like America. It's always gonna be overused. Now you have to go to power yoga or Bikram yoga or stuff like that.
Kirk:Hot yoga.
Kramer:And a hot yoga and you name it. And so I get a lot of injuries from yoga. I mean, I just, not me personally, but I see patients who get injured from yoga'cause they kind of forget the whole premise of it, which is breathing and allowing all these different structures to just basically relax. as well as just work on tone, work on balance, and things like that. Yoga shouldn't be dropping down and doing 40 hard pushups.
Kramer:So there's a way that you could do the art of yoga in a way that would lead to
Kirk:greater longevity. Crazy.
Kramer:Yeah, you look at Tai Chi and you look at these people in China who they move like gazelles and they're in their 80s. And they're just in these slow motion things. They're not pumping iron and being really, really strong and supple into their 70s and 80s. That's not really the best thing for you.
Kirk:- I wanna take a little bit of a hard right and ask you just off the wall question, which was about music.
Kramer:Yeah. can you listen to music in the operating room while you're working on someone? Always. What are you listening to?
Kirk:So normally, I don't know about you,
Kramer:but I have like Apple playlist. Yeah. We're just kind of, so most of the stuff I listen to is stuff I grow up on. You know, it's sort of like, Like today, what we have playing, like, it's more 70s stuff, Jackson Browne, the Eagles, you know, that kind of stuff. And most of the stuff we do, it's very low background music.
Kirk:Mm-hmm.
Kramer:'Cause I don't want it to be where anybody, it's just enough to keep the area calm.
Kirk:- And maybe help you get into a flow state. - You kind of get in a little bit of a flow state,
Kramer:just kind of relaxing. And sometimes parts of surgery are for the patient, I mean, not for the patient, but for my nurses and stuff, can be a little boring. So they kind of enjoy sort of this, having a little music background. And aside is I knew this one doctor and his anesthesiologist was the guy who was in the music and he's playing this heavy, just, headbanger music. Okay. Really, really loud. And we always have what's called a timeout where you stop,
Kirk:the nurses talk about name of the patient, date of birth, what side you're doing, what's the surgery going to be done, do they have any allergies, do they have any risks, blah, blah, blah. And that's like a normal timeout. Everybody has to stop, listen to the timeout. Okay, boom. We always mark what side we're doing surgery on. And this anesthesiologist had this headbanger music. He didn't really hear the timeout that well, ended up doing surgery on the wrong side. Oh no.
Kramer:Yeah. It was just a simple knee scope. So he poked a couple holes in the knee and then realized, oh my gosh, it's off the right side. - Maybe because he was distracted for what he was listening to. - Exactly. So that's why for us, it's really bellow and we turn it off during all the timeouts and during all the important parts of the surgery. - But other than that, it could actually help kind of calm the environment. - It's totally helpful. 100%. And also we play "Name That Tune." How? I'm always, I always quiz the nurses. So who's playing this?
Kramer:They never know because they're always two generations younger than me. But the music from the 70s is what you're using to heal your patients.
Kirk:Okay, I want to go, I'm imagining you in the operating room. And when you look like, let's just take an example of a bone that is broken or cracked or whatever's happened to it.
Kramer:If we were to zoom in like really close at a microscopic level, what is happening with the bone as it heals? And there's been this story, my 12-year-old broke. the bones in his calf.
Kirk:Yeah.
Kramer:I think that's the tibia.
Kirk:Tibia. Tibia, yeah. And you know, the doctor told him when it heals, it's gonna be stronger than before. Is that accurate? - It's partially true. Okay.
Kramer:Okay.
Kirk:Tell us. Where it's partially true. So let's start. So you break a bone itself,
Kramer:interesting enough, has no nerve endings. So you say, why does a broken bone hurt so badly? It's because there's a thing that goes around it called the periosteum. So think of it like the skin of a hot dog. That's around every single bone. It's called a periosteum. And that, when it gets torn, is what hurts. Okay, that's where the nerves are. And many times you get little sharp shards and kind of sharp edges of the bone that kind of stick into that periosteum. That's where it hurts or poking right into muscle. So you finally could get it set. Now, if you're just letting it heal naturally,
Kramer:especially like in a kid where you're gonna just treat them in a cast, When the bone heals, it heals with what's called basically callus and a little bump. So in other words, the bone is, let's say, the size of my finger like this. You're going to have a little extra bone on each side right where it broke. So it is at that site a little bit stronger than it was when it was that big. So that's the one thing where, yes, it is stronger. - But there's a caveat. - But there's a caveat,'cause we do a lot of times we do surgery on people,
Kramer:we put plate screws, things like that, and they won't form that extra bone. Not always, but sometimes they don't. Sometimes they do. Sometimes you'll get in there and you'll put a plate on, let's say you have to go back and take the plate off, you'll find bone growing up around the plate. Like it really likes to put extra bone. The crazy thing is like with kids is that if they break like one of their long bones, there's so much more blood flow going to that area that it also stimulates
Kramer:the growth plates above and below where the fracture is. So you can get overgrowth of that bone.
Kirk:Which could have like cascading effects with like the overall structure of your body. You have one leg longer than the other. Okay. So for that reason... It's not unusual that if we have someone, a kid like breaks their femur and they're three, five years old, and it breaks and it goes like this, and it'll be overlapped like a centimeter, centimeter and a half, we leave it. We have ones, it breaks and it looks perfect, We'd go like this.
Kirk:Why?
Kramer:Because that way, when they're done growing,
Kirk:the two legs are exactly the same length. Oh, okay.
Kramer:Otherwise, if you leave it like this,
Kirk:the leg that got fractured will end up being centimeters, centimeter and a half longer than the other one. - 'Cause it's laying down new bone to reconnect. - Well, that, and it's so much blood flow are going in the area.
Kramer:It's making the growth plates get more blood flow than normal, so they grow more.
Kirk:One of the things that we looked at when we were designing Stack and thinking about all the vitamins and minerals that we would put in it is we were looking at what happens as we age and don't get all the nutrients that we need. Have you seen cases of people who have osteoporosis and what does it look like in the body? Just tell me a little bit about that.
Kramer:So there's two types of thing. There's kind of like osteomalacia, where you see people who don't get enough vitamin D early on, enough calcium. A lot of that's kind of nutritional early on. And, you know, you kind of hear about that. And then you get, and that's like rickets. You hear about rickets, you know. Fortunately, we don't see it that much anymore. - What was rickets or what is it? - Vitamin D deficiency. And then they have weak bones. Okay. But osteomalacia, you can kind of get weak bones in grownups.
Kramer:And rickets more kind of kids type of thing. Osteoporosis, you're right. The bone is porous normally, but it shouldn't be that porous. So when we see osteo means bone, porous is just that, it's like holes in it. So you look at x-rays and they just, they look, they don't look as dense. They just look a lot less dense. And trying to push calcium in the bones is tricky. because really what it comes down to is you need the vitamin D3,
Kramer:you need vitamin K2, you need biotin, you need all these other things, you know, manganese, you need magnesium, you need all these other things to push it through.
Kirk:I'm just so happy because you're naming everything that we put into Stack. Perfect. Well, what was interesting about the vitamin K2 was... in the research that we were reading on it, it's required to actually move calcium into the bone. Otherwise, it would find itself in the soft tissues. Correct. You need the K2 to make sure it goes in the bone. The whole goal of what we want to do with Stack is try to identify what we need on a daily basis and learn from... There's literally just been... decades and decades of research on all of these core vitamins and minerals.
Kirk:Yeah. And I feel like if we can get them delivered at the right amount at the right time and just something where it's just an easy thing, then I hope that they could have an effect of just longer health by nutrition. So it's interesting that you've seen people suffer as a result of a lack of nutrition. And then ultimately that's going to affect their lifestyle as they age. At what age do we typically notice people starting to have an issue with their skeleton? So
Kramer:Let's back up for one second. So when you think about it, let's say I was to take your femur and strip it from the muscles and stuff like that. Would it be very easy for me to break your femur? And the answer is yeah. Even if it's a loss of your product, it's really easy to break it. I mean, even yours. The point is, is that the thing that protects you just as much from getting fractures, these are surrounding muscles. And starting at about the age of 30,
Kramer:well, really about 40,
Kirk:you'll lose 10 % of your muscle strength every decade. And the things such as manganese, magnesium, all these kinds of things, there is almost more important of keeping your muscle mass during those important years.'Cause you can have a fairly medium osteoporotic bone. If you have good muscle around it, you're safe. For example, someone has a stroke. Guess which side that they break their femur on? The side where the muscles weakened from the stroke.
Kirk:Oh, interesting. Yeah. And believe me, the amount of osteoporosis they have is almost equal on both
Kramer:sides because it's sort of a general, I guess they get more osteoporosis than a weaker bone because it's kind of a, It's a closed loop. You're weaker. That means you're not stressing the joints as much. You're not stressing the bones as much. So the calcium is lost. But the muscles are so important to basically protect the bones. So it's a twofer. Really? The nutrition is going to protect the muscles and protect the bones.
Kirk:And so strength training, resistance training, things like that can help keep the muscle as we age. And then is a bone that is losing strength, is it possible to regain that as we age? - Bone? Yes, yes.
Kramer:But a lot of it comes down to exactly right. It has to be weight-bearing exercises and stuff like, and it's a slow, Slow resolution of that. Years?-Can be.-Okay. So there's a lot of different medications out there that are supposed to help bone come back. But the bottom line, it really has to be done through nutrition. It really has to be done through exercise. So my mom, I got an x-ray on her 30 years ago and she was already getting a little bit of osteoporosis, but she is exercise queen.
Kramer:I mean, she works out every day. I have great pictures of her working out with my daughter, doing planks and doing her biceps and all that kind of stuff. And she has this Tuesday walking group. They call it the Tuesday walkers and she's their leader. and they will start at, there's a place called Heisler Park in Laguna. And it's pretty much round trip is five miles. That's their standard. And she'll do that definitely on Tuesday, but usually walks almost that far on at least four days a
Kirk:week. She's 96. Okay, so she's figured it out. Oh, yeah. She lives on an island in Norway by herself that you can only get to by boat. Okay, well, let's learn from her then. Yeah, exactly. Okay, so if you were to say, and maybe we should just learn from your mom. Yeah. If you were to say, what are the tips for people as we age to be able to stay moving around, not worrying about falls? I think that we've covered everything. resistance training, and like strength training and exercise.
Kirk:What else would you say we've learned?
Kramer:So we'll start from the very, very beginning. It's kind of funny. So she's originally from Norway. And she was on the Olympic team in Norway for running. And her, like, one of her best friends was Stein Eriksen, who was like the Olympic skier who won, you know, the...
Kirk:giant slalom. I think it was 1952 Olympics kind of thing. And the point is, is that she laughs. She goes, I never started smoking because I didn't like my hands. I saw all these women with these elegant hands smoking, and I knew I didn't have elegant hands, so I never went and smoked. But she was half kidding.
Kramer:Lucky her. Lucky her, exactly. But she was all about growing up eating salmon. Where she grew up was on this... Her brothers would go out and fish, and it was probably some of the best salmon fishing in the world. It was this fjord right outside where they lived. So it was all about eating fish. It was all about eating natural stuff. From a time we were little kids, we never had processed food in the house. There was no such thing as cookies. There was no such thing as any of that stuff.
Kramer:we would get "dessert" once a week. And even with my children, we had what's called sugar night, which means they're only allowed to have desserts on Wednesdays and Saturdays.
Kirk:-What was your dessert growing up?
Kramer:-And it would be like a little bit of ice cream or something. -Okay.-And the same thing with our kids. And what's kind of funny is because they had this sugar night thing, they would ask me-- I'll be 6 years old, 7 years old-- "Is tonight sugar night?" I'm like, "No, it's Tuesday, so it's tomorrow." They're like, "Okay." And no problem. No problem. And then when it was sugar night, rather than gorging themselves, they would just eat like a small amount because they're not used to it. And that was enough. It was the same thing with us growing up. I would go to a friend's house like, what are those? Like, we, first time I ever went to McDonald's, I was in Little League and our coach took us there after a game.
Kramer:That was the first time I even in in one of those and what happened when you went for the first? Oh, I just went from really guys. I had a hamburger and think it but yeah this is how long ago was you get a Big Mac with french fries and a drink For 95 cents and the tax in California at the time was 5%. So it's exactly $1.00. - Who knows? I don't even know what it is.
Kirk:Yeah.
Kramer:But the point was, we never had cookies. We never had any stuff. And as one of my friends who's a GI specialist,
Kirk:Oh- It's like 20 bucks now or something.
Kramer:he's from India, he goes, "If you eat natural foods,
Kirk:"you can pretty much eat as much as you want." It's kind of true. a cup of strawberries is 80 calories. Yeah. You know, two cups of grapes is 70 calories.
Kramer:It's like, you can gorge yourself. It's hard to overeat on that.
Kirk:Exactly. You can gorge yourself on that and you're going to be fine.
Kramer:And especially you want to eat the whole food if you can. But as you and I know, the problem is, is that You know, remember who Jethro Tull was? Jethro Tull was a gentleman farmer back in the 1700s in England. And so the group took their name, took his name, but he was the one who invented rotating crops. And so it was super important because basically you would plow one, 'cause like here in the United States, when we first, one of the first things we started growing was tobacco.
Kramer:Tobacco like leeches everything out of the soil so fast So you need to... We've got to put it back in.
Kirk:Exactly. And you need to plow that stuff back under.
Kramer:And you need to use horse manure. You just use nitrates like they do now for fertilizer. And nitrates is what the OKC bombing were. You know, that's what it is. It's not... good for you. And so they just use nitrates and they have ways of spraying food so it looks better. They have ways of spraying food so it, quote, ripens faster. You look at what they do to bananas. Like, oh my God, I don't want to eat all the different ethylene glycols that they use to basically make it. It's true. That's, it's kind of frightening.
Kramer:But the point is, is that for that reason. Even when you, quote, eat natural, you're not getting the nutrients like you used to. And that's where stuff like Stack comes into play because you think you're getting enough manganese. You think you're getting... But where the food was grown, if it's not in the soil, if the selenium is not in the soil,
Kirk:it will not come through the plant. - And this is one of the things we learned when we were researching about all the different vitamins and minerals. And our chief science officer, John Paul, he's, I was like, why do we need selenium? And he was like, there is, on the surface of the earth, there are a variety of like meteorites that have hit the earth and some of them enrich the soil in certain areas with selenium. And then other spots did not get hit by as much of that. And then those entire populations that live there are deficient in selenium.
Kirk:And so there's like an entire region based deficiencies based on where the asteroids sit. I thought that was so fascinating.
Kramer:Oh, so cool. Well, I like your time. I don't mean to interrupt, but you know, you're talking about like vitamin D and K2 and stuff like that. You always think, okay, we live here in Southern California. We're getting enough sun, we're getting enough vitamin D. Well, they did a study of San Diego lifeguards and found 40 % were vitamin D deficient. - What's that from? putting on too much sunscreen or just like they're always under umbrellas or things like that. Or the fact is not everybody's skin can manufacture vitamin D at the same
Kramer:rate as other people. Raised on the genetics. Redheads basically are the best with regard to making vitamin D because they have paler skin and blue eyes and things like that. And they can get all that, but not everybody. So a lot of people run around vitamin D deficient. So sometimes you have to take it orally.
Kirk:There's something when you brought up a... your mom and her diet as she was growing up, one of the things that I really struggle with, and I think a lot of people that live more inland struggle with is getting fish. And when we made the initial formulation for Stack, we were just like, let's just cover base vitamins and minerals. Let's not do anything that doesn't have a daily amount that's been established. And so one of the things that we missed were omega-3s. There's two types of omega-3s,
Kramer:there's, DHA and EPA. And as I've been researching it more and more, having that every day, and actually, as we go and iterate on the product further and Stack is just gonna evolve so much more from where it's at now, but where it's gonna go is, we wanna put DHA and EPA in the Night Stack so that You take it, it'll be released in the first phase right after you have dinner, 'cause you require fat in order to properly bring it in to the body.
Kramer:Exactly.
Kirk:And the impact, at least from the research that we saw, its impact on heart health and brain health seems massive. The biggest problem that we're facing and something that I hope that we can overcome is the tastes of the fish oil pills that are currently providing it. They're extracted from like fish and it's like it's an impure and unclean process. I do think that we have found a supplier that can get us pharmaceutical grade omega threes that are grown from algae.
Kirk:And I think we're looking at right now, microencapsulating that for a sustained release at night.
Kramer:And I think that will have a massive impact on our sleep. So I'm pretty excited about evolving the product in that way. - I think that's superb'cause as much as we all like, okay, we should be eating fish, blah, blah, blah. You realize that, no, I mean, I love fish, but the mercury is an issue. And for example, There is a little island that is 1200 miles from anywhere up in the North Atlantic. They have the highest mercury content in their body of anyone on the planet.
Kirk:And the reason is, is because one of the little things they do is for snacks, they chew on whale blubber. That's how much mercury is in these larger fish. And so if you eat tuna all the time, that's a bad thing. That's too much mercury. So you getting it through this, where you're getting it through algae,
Kramer:where it's protected from the mercury is great. - This is like one of the things that we have been looking at so closely with our third party testing and safety. - Yes. There's just such a range of quality. For me, like I just establish it for myself. I'm like, I'm gonna take the product every day. I want it to be psychotically clean. Yes.
Kirk:And so everything that we're doing, like my requirement was it needs to be medical grade as if it's gonna be used in a study so that it's that pure so that we don't have any problems. So
Kramer:And you absorb it. And what I like about, it's sort of, it's like, again, a little vignette of when my dad one time took an x-ray of this guy's, this woman's abdomen. Says, "Oh, I see you took your vitamin today." She goes, "No, I missed it this morning, "but I took it yesterday." You could see this pill in her GI tract. Hadn't even broken down at all.
Kirk:It's just a
Kramer:It's worthless, completely worthless. Or if you don't have, if your magnesium isn't at least, whether chelated or something like that, the absorption rate for chelate is like 30 plus to 70%, where not, well, what's not? Milk and magnesia, what does it do to you? You use it when you need to get moving.
Kirk:- Yeah, so the bottom line is it's just a laxative. - So you need to have a chelate so it properly gets into your cells. This was a huge problem that we, 'cause when we were trying to figure out which magnesium to put in, there's 12 forms, probably more now, and we iterated through six different forms, and where we landed is magnesium L-threonate for the afternoon, so it's released in the second phase of the Day Stack,
Kramer:And Magnesium L-threonate has a lot of research on it that is like really good for focus and memory and brain health and supports those things. And then at night in our early prototype, we put in magnesium citrate, which was the wrong call. So magnesium citrate is actually not what you want in the middle of the night.
Kirk:And so obviously we have to learn through prototypes, but we ended up putting in the Night Stack, we do magnesium glycinate. which is really good at supporting the deep sleep and the restorative sleep. It helps REM sleep and it helps muscle relaxation. So I'm really liking using glycinate at night. And I think that I'd like to explore a few other options for us, but right now that combination of L-threonate in the day and then glycinate at night, it seems to be a really good winning combination.
Kirk:What's been your experience, just as we get close to wrapping up, what's been your experience with Stack? I feel like I'm turning in my homework to a doctor. - Yeah, yeah, yeah, yeah. - So what do you think about the product? How do you--
Kramer:- Vitamins aren't supposed to be like caffeine, where you're not supposed to take it and notice a major effect. It's kind of, it's supposed to be building your system and solely working good over time, et cetera, et cetera. But I had a period where I didn't have it for a week. I was like dragging. And I finally got my stuff and I started taking it. I felt better that day. I'm like, it's not supposed to work that fast. But I think it does. I think in a lot of ways it really does. - I know why. And I've heard this over and over again.
Kirk:I think it's because we're sustained releasing the B vitamins in the Day Stack. And like, we got into all of this research of what's called pharmacodynamics, and it's how medicine and how material moves through the body. And a B vitamin complex pill will move through your system in 90 minutes. So if you take one of those pressed pill B vitamins, you're gonna pee it out 90 minutes later. With microencapsulation, we use this pharmaceutical technique that can draw it out
Kirk:over eight hours. So we do a little bit of the B vitamins in the morning and then right around one o 'clock to five o'clock, we do a sustained release of the rest of the B vitamins. And I think that a lot of people report back and feel that a lot of people write in the reviews and say, I don't need a second energy drink. I have clear thinking in the afternoon. I'm not reliant as much on like my medical stimulants that I'm taking if they're on those. And to me, that's a huge win. Huge. If we can solve something through nutrition versus medication,
Kirk:that's a win. Yeah. Like I'm a caffeine guy.
Kramer:I don't drink coffee in the morning. I don't drink energy drinks or anything like that. I'd rather get it naturally. I'd rather get it like this,'cause then you don't have that. And more importantly, you're not really addicted to it.
Kirk:Yeah.
Kramer:This is like perfect where, no, I really like it. - Yeah, it feels good.
Kirk:It feels stable. It doesn't feel artificial or anything like that. It feels just like you're more younger. Like you're kind of like a kid again with just good focus and you can go throughout the day. To wrap up, I think, first of all, it's just been, This has just been so good. I felt like we've just got an amazing education from you today. I wanted to just ask a final question to you, which was, as you reflect on your life and your career, is there a person that comes to mind that you're grateful for that has helped you
Kirk:along your life path?
Kramer:You know, I think hopefully my kids say the same thing about me, and I think they do, is like our parents, because our parents definitely put us on the right path. And, you know, you talk about nutrition. They were like early adapters of basically vitamins. You know, they had worked with some companies with stuff early on. And I think it was really important for us. And people probably know that nutrition,
Kramer:My younger brother, he never took vitamins, and he started basically taking some good vitamins at some point. And he goes, "You know, I used to ride in the middle of the pack of my mountain bike group. I did not change my training one bit, but before that, I was in the front of the pack, and that was the only thing differently I did. In other words, I just helped my nutrition." And my dad used to make an old saying by the time we were eight years old, he goes, "You can't make a strong house out of soft bricks." And you just kind of just, if anything parents and kids remember is just that.
Kramer:And this is the glue that puts the bricks together.
Kirk:So your mom and dad. Yeah, yeah, they're incredible. I feel the same. My dad, he's just been such like a support to me. And we just, you know, we're at the point where we just barely launched the company. And he texted me just yesterday and was like, "I hope a million people see what you're doing." And I'm like, I do too. And it's just good to have parents that believe in us. It's incredible that your dad, you essentially learned from a very young age how to heal people through him.
Kramer:And then also just learning from your mom and her diet and her resilience. Incredible. We're so lucky to have parents like that. Really are.
Kirk:One of the things that we're going to do for the podcast is we're going to give away a gift to whoever leaves the most thoughtful comment when we post this online. So... Let's wrap up. And so what we're going to do is we're going to give away... three months of Stack to whoever leaves the most thoughtful comment. So if you're listening now and you've learned something interesting, hop on and on any of the social media platforms, just let us know what you learned. And we'll go and we'll pick someone and we'll hook them up with a few months of
Kirk:Stack, a few hundred dollars worth. And lastly, I just want to say thank you, Dr. Kramer.
Kramer:My pleasure.
Kirk:We, I think we learned a lot and especially focused on nutrition and different lifestyle habits that we can continue to form. So just appreciate you and the time that you spent with us today. And for those who are listening, keep moving. Let's start diving into yoga and Pilates in the right and safe way. And we'll see you next time. Awesome. Thank you, Dr. Kramer.
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