Please enjoy this transcript of my interview with Sami Inkinen (@samiinkinen), a Finnish-born, Stanford-trained entrepreneur and the founder and CEO/president of Trulia and Virta Health. Virta is on a mission to reverse metabolic disease in one billion people using technology, AI, and nutrition. He is the founder of Fat Chance Row, which he created to […] The post The Tim Ferriss Show Transcripts: Sami Inkinen of Virta Health — Reversing Type 2 Diabetes, Rowing 2,750 Miles, and Lessons from Fixing Metabolic Health in 100,000+ People (#866) appeared first on The Blog of Author Tim Ferriss.
Please enjoy this transcript of my interview with Sami Inkinen (@samiinkinen), a Finnish-born, Stanford-trained entrepreneur and the founder and CEO/president of Trulia and Virta Health. Virta is on a mission to reverse metabolic disease in one billion people using technology, AI, and nutrition. He is the founder of Fat Chance Row, which he created to raise awareness of the dangers of sugar and its connection to diabetes, rowing 2,750 miles from California to Hawaii with his wife—completely unsupported—while breaking a world record in the process.
The content of this episode is for informational purposes only. Neither Sami Inkinen nor Tim Ferriss is a medical professional, and nothing discussed here should be taken as medical advice or a substitute for consultation with a qualified healthcare provider.
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Transcripts may contain a few typos. With many episodes lasting 2+ hours, it can be difficult to catch minor errors. Enjoy!
Tim Ferriss: I will start, I suppose, with something that I can potentially use immediately or some variant thereof. Do you still schedule your week, or at least workouts, each Sunday? And I’m reading here — this is from a blog post. Schedule everything, right? This is “Top Five Tips: Getting and Staying in Shape for People who are Busy.” “I spend 10 to 20 minutes every Sunday scheduling most of my workouts in detail similar to any other appointments in my calendar. Like with most unscheduled tasks and to-dos, they’ll fall between the cracks. On the other hand, with proper scheduling, you’ve managed to get in your workouts with 150+ annual travel days, changing cities, super early wake-ups and delayed flights,” et cetera.
So this is kind of a micro question that edges into the macro just around planning and scheduling, but do you still take time out each Sunday to go through these things?
Sami Inkinen: 100 percent. 100 percent. It’s every Sunday. I just find that structure allows flexibility and spontaneity. If you don’t have structure, nothing gets done, at least in my life. And not that my life is super special, but two pretty young kids, happily married, running a company, growing, that’s thousand employees, and then trying to be a kind of semi-athlete in the process, if I don’t schedule, it’s not going to happen. So I spend about 15 minutes at the end of each week, that Sunday, professionally list the three things that absolutely have to get done, and then I schedule a few things, including workouts, and it works very well.
Tim Ferriss: When do you do that on Sunday?
Sami Inkinen: Well, this could be a long conversation, but it’s either early morning before the kids wake up and Sunday gets going, or if I don’t have it done by Sunday afternoon, then it’s after 7:00 p.m. when everybody else quiets down and I take my own time.
Tim Ferriss: Virta, how many employees do you have right now?
Sami Inkinen: Yeah, Virta Health. So we have about 1,000 employees. And the caveat these days, of course, is don’t brag about employees because the more employees you have, less you’ve leveraged AI. But I guess mentioning 1,000 employees, it’s a real company and obviously growing fast, so it takes fair amount of effort. So about 1,000 people.
Tim Ferriss: Well, the good news is, like so many companies in the news these days, if you did end up over-hiring during COVID or something, you cannot say, “We made a mistake.” You can just say, “We’re using AI to improve efficiency,” when you have layoffs. But we won’t dwell on that. The question I had is, what type of training in your life right now are you currently scheduling each week?
Sami Inkinen: Well, we’re talking about training, so this is sort of physical training.
Tim Ferriss: Physical training. Mm-hmm.
Sami Inkinen: It’s really in two buckets. The primary focus is really endurance sports around cycling. So I do a lot of mountain bike racing as well as road bike racing, so that’s essentially endurance training. So I’d say 90 percent is cycling related, and that’s my core workout that essentially happens in the morning every day. 99 percent of the time, it’s one of the first things. It’s not the very, very first thing in the morning. So that’s one. We can go into morning routines and stuff like that in a second if that’s interesting. But I do a little bit of just core work pretty much first thing after waking up. So I don’t even have to schedule that. That’s sort of a non-negotiable. Before the brain even boots up, I’ve done my core work. But cardiovascular work is the main —
Tim Ferriss: Yeah, let’s not tease. Let’s just hop right into it. So what does the morning look like upon waking up, and what time are you getting up?
Sami Inkinen: Yeah. So, again, let’s separate into traveling and not traveling, traveling for work —
Tim Ferriss: Let’s do non-travel.
Sami Inkinen: Yeah, non-traveling. I wake up 5:00 a.m. latest. This morning, alarm was 4:45, so I wake up pretty early. And I have the amazing privilege and luxury that the second I roll off the bed, I jump into a lake or pond. And it’s not a long time, maybe like a minute, just cold water, a couple of strokes. But essentially it’s a freezing cold shower. And this is a mountain lake, so we are talking like 40-degree weather, pretty much straight off the bed. And after that, maybe just a minute or two of some air squats and jumps and core, literally core work. Nothing too special, so that’s some Supermans and leg raises and stuff like that. And I do it because, again, I race bicycles quite a bit, and I have some lower back issues, and core work, it just never gets done unless it’s the very, very first thing in the morning. And then I’ll throw in a couple of pushups there. So that’s 5 to 10 minutes. Straight off the bed, jump into the lake, dripping wet, little bit core, little bit jumps, a little bit this and that.
And I’m just a huge, not just a believer, but the practical experience I’ve had is mood follows movement and motion. So before I even ruminate or think anything, I’ve already been in a lake and done five or 10 minutes of core work and some jumping and get the heart rate up for a little bit, and that’s pretty much the first five, 10 minutes.
And then the other thing I try to do always right after is do something useful for other people. Do something useful for other people. And what is that in practice when I’m not traveling? It’s preparing coffee for my wife and emptying the dishwasher. And it may sound very simple, but that’s like 15 minutes after I’ve woken up, I haven’t had a second to think about or ruminate, “Oh, my back’s hurting,” or “Oh, my God, so much work,” or whatever that is. It’s like a 15-minute boot-up sequence, and it’s like life’s rocking. And then I’m ready to go and do the other things.
Tim Ferriss: Don’t worry, I won’t have you give the minute by minute for your entire day, but after you have done that, so you’ve made coffee for your wife, you’ve emptied the dishwasher, then what? Are you having your first intake of coffee? What does the next 30 to 60 minutes look like for you?
Sami Inkinen: Man, sounds like you’re mind reader. So I do drink coffee. That’s time for an espresso or a cup of coffee at that point. Everybody else is still sleeping in the house. I sit down, and basically I write down my sleep, how many hours I slept. And I have a little diary. It’s a spreadsheet online, 16 years of data now. And I also write three things I’m grateful for. So this is kind of little gratitude journal, super, super simple things. And I try to focus on the mundane, such as leaves in the aspen trees or warm temperature, just simple things, very, very simple things. So I do that and write down a few things.
And then I usually work for about an hour, so clean email and Slacks, or maybe I have like a 20-minute writing thing, so this is kind of my CEO job. So I try to do about hour of that. And then whenever my wife wakes up, then we have sort of a 15, 20-minute couples moment, drink coffee, and talk about life. It’s a really wonderful moment there. So that’s kind of the very morning.
And then my real workout usually happens between 6:30 and 8:30, the exercise. And then after that, get to office. Exception would be if I have any meetings that are across time zones, then it could be a 6:00 a.m. Zoom or something like that. But before that, I’ve always done my swimming in the lake and a little bit core and maybe a cup of espresso. That’s the routine. And pretty much repeated that for more than a decade. It’s nothing too special. People ask like, “What’s the science behind?” I say, “Listen, if it doesn’t feel good, it’s not right for you. If it feels good, repeat it.”
Tim Ferriss: So I suppose there are different types of fun, right? There’s type one, type 2, maybe type three fun, which is just embracing the suck. God, I can’t remember who sent this to me. It was a friend of mine — maybe you recall who this is because I’m sure I pinged you about it. But they were driving up some windy, incredibly steep road in the mountains, and they were taking a video from their car of some lunatic, who I think they called a lunatic, “Look at this fucking guy. He’s crazy,” on what you could envision, listeners or watchers, as incredibly long rollerblades. They’re basically skis with a single track of wheels on them and poles doing uphill, I suppose, Nordic skating, let’s just call it, going up this unending incline, and they’re like, “God, who is that lunatic?” And of course, who did it end up being? Ended up being Sami. So fun means different things, or feeling good means different things in different contexts.
But the reason, for people who are wondering, why am I digging into all these details? Number one, I like the details, and the details matter, but you have always impressed me with the number of important pillars that you’re able to methodically schedule into your life, and furthermore, within those pillars, how you’re able to operate at a very high level in multiple domains. So that’s why I’m asking about the specifics, because these things, much like workouts, tend not to happen accidentally. If you don’t schedule them, particularly with the number of moving pieces that you have, and frankly the number of moving pieces that any person probably has, things will not manifest magically.
And I’m curious, we talked about the single day, do you have any type of — I know for training you almost certainly do have weekly and monthly architectures, particularly with competitions. But from a work, could be work, could be physical perspective, do you have a consistent weekly architecture of any type where, say, you might batch certain types of tasks or meetings or otherwise on certain days or anything like that? Or is it pretty much Monday to Friday more or less the same daily routine?
Sami Inkinen: I do have a system. Well, a couple of things. First, I think it’s good to remind when myself or anyone’s like, “Oh, here’s the system,” and — the reality is life happens all the time, so let’s just remember that. You’re running a company, you have kids, crap hits the fan all the time, or at least frequently, so obviously you have to be flexible. So what I’m going to share next is the kind of beautiful, clean scenario where you can kind of live with your structure. But the reality is you’re running a company —
Tim Ferriss: The platonic ideal gets smashed a lot.
Sami Inkinen: Exactly. It’s 24/7, and the Sunday afternoon walk with your kids or with your spouse may not happen because you need to address a crisis. But let me start with — you mentioned like, “Oh, I’m kind of impressed how many things you can do.” Honestly, the biggest secret is saying no to 99 percent of the things that many people consider quote, unquote, normal. So what you care gets done. And sometimes people ask me like, “Wow, so many sacrifices. You’re trying to be an athlete and a CEO and a founder and trying to be a parent as well, and you even travel with your kids. You must have so many sacrifices.” I actually find that saying no is incredibly liberating in life. I’m way happier that I’m married to one person versus five. It’s awesome. There’s no way I could be a CEO of many companies. I love the kind of focus.
And so I actually find it personally in life, when you find something that kind of fills your cup and is satisfying and gratifying, just having the one or two things that I focus on and then go all in, rather than a sacrifice, it’s a happy place for me. So anyway, I would say that’s my biggest secret.
Tim Ferriss: I think a lot of people will hear what you’re saying and theoretically agree with it, and yet most people are unable to embrace that in practice, for whatever reason. And it doesn’t mean they’re not capable of doing it, but they don’t do it. Why do you think people have trouble saying no or the default is people are inclined to over-commit or that they do the 99 percent of things that are quote, unquote, normal that you say no to? Why do you think not more people do what you’re describing?
Sami Inkinen: Honestly, if I had a perfect answer, I’d probably write a book about it, but —
Tim Ferriss: With all your spare time. Yeah.
Sami Inkinen: Here’s my guess. I think one might just be a narrative. And I can’t tell you how many times someone has said, “Oh, my, you must be sacrificing so much to be able to do what you do.” And I’m sure you could say the same for an Olympic athlete, like, “Oh, my God, so many sacrifices.” But if you’re an Olympic athlete focused on your sport and your craft, sure, you can’t do 99 percent of things quote, unquote, normal people do, but it’s probably incredibly satisfying to be able to do that one thing for the five or 10 or 15 years of your life. So that’s why I meant maybe it’s a narrative that, oh, if I say no to all these, whatever that is, a movie night every night or some distraction, whatever, staying on social media and watching Netflix four hours a day, then, oh, it’s a sacrifice not to do that. So that’s my guess, one thing, that it’s a narrative in our minds, like, oh, you want to do all these consumption things that maybe take time away from the thing that could move your life or profession forward. So that could be one.
And then the other thing is I think this sort of life structure that if you don’t have a basic — we can go back to your original question, what’s your architecture, what’s your structure? If you’ve never taken the time to take a step back and say, “Hey, how am I allocating my time,” it’s very easy to let the universe or the entropy to take control of your time, whether that’s your inbox or text messages from others or phone calls. It’s actually very, very easy let the world run your life as opposed to you running your life.
Tim Ferriss: Well, let’s talk about the weekly architecture, and then I am going to come back to this particular question that I asked. But let’s take a breather on that, and would love to hear more about the weekly architecture or other architectures outside of the daily.
Sami Inkinen: Yeah. So, again, this is sort of in an optimal world, but I would say professionally I do try to group similar type of tasks into specific days. So just to give you an example, Monday is filled with a lot of group and leadership meetings and stuff like that, so there’s one kind of context switching, that it’s meetings in front of the whole company and in front of leadership team and so forth. So that’s Monday. Tuesday I try to have all my one-on-ones, again, one type of context switching. And as an introvert, that takes a lot of energy, by the way, as important as it is and sometimes very enjoyable, but the kind of one person after another, it’s pretty draining for me personally.
Tim Ferriss: How many direct reports do you have?
Sami Inkinen: Well, I should say this has changed all the time. There’s been 15, there’s been 10, and I had eight for a long time. But for the last couple of months, I’ve had two, only two, which is a very small number. And again, that could be another one-hour conversation. But when you’re building a grow company, you always have to ask yourself, “What’s most important for this year?” And there’s not really kind of a school book-perfect kind of approach. But anyways, it is two right now. So Tuesday is that. Wednesday I actually try to reserve for thinking and writing, thinking and writing. So the default is no meetings. And one example of writing that I do, I write a team letter for the whole company from the CEO. So I’ve now written 553 of them.
Tim Ferriss: Wow. So you do that every week.
Sami Inkinen: Every week, and there’s a one topic, and again, another topic we could dive into. But what I find is that it’s as the company has scaled, there are a few things that are very scalable, like whether my email hits five inboxes or thousand obviously doesn’t take any time away from me, but I can give context, explain what’s happening, what’s important, what’s happening in outside world, what’s happening inside the company, and then every employee feels hopefully some level of connection. So that’s one example.
There’s a couple of things that I’ve kind of repeated ever since day one, and now at thousand-employee scale is still very scalable. But that’s just one example. I could be preparing for board meeting or thinking about strategy, which sounds very high-flying, but I would say one thing that’s very, very easy as a CEO of a grow company is to fool yourself that you’re productive and useful by being busy. But if you miss a decision, something around a corner, no amount of knocking tasks off the to-do list is going to compensate that. It’s almost like managing your own brain and feelings. It’s hard not to have a tightly scheduled calendar, but in fact, having that time open for like, you can go for a walk and think about the problem.
So anyway, so that’s kind of my Wednesday. And then Thursday and Friday is a lot of internal client work and those kinds of things, but I usually — that’s not too structured. But that’s a little bit of a typical week.
Tim Ferriss: On Wednesday, when you’re doing the writing and thinking, what are some of the ways that you structure your thinking? There’s unstructured thinking, right? You go for a walk and kind of ponder and allow the void to invite hopefully some type of insight. But then there’s structured thinking. And I guess to the extent that I know you at all, I would say I’m inclined to think you probably have some prompts or structure or an approach to doing thinking. What does that look like, or how would you speak to that?
Sami Inkinen: Yeah, actually typically the way my brain works is the actual thinking and problem-solving happens 24/7, and I’ll give you a specific example. My workouts every morning, which is about an hour, hour and a half, unless it’s a very, very, very high intensity, that’s one of the best times where my thinking happens, and problem-solving and new ideas and creativity happens there. And then for the Wednesday, I actually just block an hour and say — it’s almost like the time to get the words and the thoughts and whatever that might be off my brain to a paper, or obviously in a cloud. So unless I have to do a very kind of left-brain, mathematical, deterministic problem-solving thing, literally like, “Okay, let’s look at how do we improve cross margin,” or something like that, the creative work does not happen at the desk for me.
And one thing that I noticed, this was especially during COVID, when COVID hit, I was listening a lot of podcasts and music and audiobooks on 100 percent of my workouts. It was maybe like a year. And I realized that the problem-solving and the creativity almost stopped. So now I have a rule that maximum of half of my workout I can listen to Tim Ferriss. Sorry. So if your download numbers are going down or listening numbers —
Tim Ferriss: Damn it, Sami. I need all the help I can get.
Sami Inkinen: So if the brain is in a consumption mode, you’re kind of just filling in the cup, and I’ve noticed the creative thoughts and the problem-solving that’s happening or background processing, it’s not happening. So anyways, this is tactical thing that I’ve noticed that too much audiobook or podcasts filling the brain, and it stops creating stuff. It’s very interesting. That’s at least my personal experience. So I’m very conscious of, on those moments when I’m exercising or walking or driving somewhere, that there’s kind of a cutoff point. No more listening. Just let your brain do its thing.
And then the Wednesday comes in, it’s more like, okay, now I kind of have the framework in my head, take an hour and a half to, I don’t know, write about next year’s priorities or the new product we’re going to launch. Or even these team letters that I write, I actually write them in my brain when I’m away from the desk, and then when I sit down, it just — it comes out.
Tim Ferriss: So that actually leads into my follow-up question — I can’t imagine I’m the only person wondering this — which is, when you’re doing these workouts, let’s just say it’s an hour and a half to two hours, the real workouts, in the morning, I would imagine quite a lot percolates and comes up, and if you’re doing that Monday, Tuesday, maybe also Saturday, Sunday, et cetera, by the time you get to Wednesday, if I have not taken some step to maybe verbally record some of that or make short notes in a notebook for cues for later, I would be doubtful that I would be able to recall the good ideas that I had earlier in the week. Do you just have a preternatural sort of inclination to be able to remember all that stuff, or do you take some type of shorthand after the workouts so that you can use those then on Wednesday as prompts? How does that work?
Sami Inkinen: Essentially I write emails to myself or store notes. It’s the same thing. So there’s tidbits along the week, and then I have it for Wednesday. And then half may be in the brain, and half is written somewhere so I don’t forget it all, but yeah.
Tim Ferriss: And you just send yourself an email after the workout with some type of note?
Sami Inkinen: Yeah. Yeah. Yeah.
Tim Ferriss: Mm-hmm. What is an example of what you might cover in a team/company email on a Wednesday, and how long is that? Because that is, like you mentioned earlier, one of the things you’ve repeated since day one. What would be an example that you can share? I mean, it could be hypothetical, but just what might you put into that, and how long is it?
Sami Inkinen: Half is standard structure. So there’s a quote from — again, we can go into details, but we’re in a business of reversing metabolic disease and helping people get healthy with nutrition. So we treat patients like real humans, hundreds of thousands. So half of it is this existing structure. There’s a quote from a patient, so we always kind of lead with, this is why we’re here, and here’s a positive feedback from a patient. Then there’s some business metrics, like how much we’ve grown, and what are the priorities, and just a reminder of this year’s key objectives. So half is like that.
And then the most important other half is topic of the week. So topic of the week is essentially my, as a CEO/founder, essay, and I think that’s what you were asking. I would say they’re roughly in two or three categories. One is what has happened in our external world, what’s the context there, and how does that affect us? One example, this is a real-world example that I’ve written quite a bit about, since we use nutrition as the core tool, but obviously our providers use all the tools in the toolkit, one of the things that has really changed in addressing obesity and metabolic disease over the last couple of years is the GLP-1 drugs, so these are the Ozempics of the world. And so I’ve had a number of letters discussing, how do these drugs potentially affect how we take care of our patients, and what’s the impact on our business? So that would be ity, and how is that affecting our strategy? So that’s one example.
The other category is career and personal advice to our team members, like how to make most out of your experience working at Virta and around that kind of stuff that we discussed now, like personal productivity and how do we make most out of — so that, I would say, is the second category. And then third is just internal, this is what happened, this is what it means for us. So honestly, I kind of like it. It’s my personal outlet, and sometimes I’ve said, “Hey, 530 plus essays, there’s a book in a making. All we need to do is upload it to ChatGPT and we have a book ready to be published.”
Tim Ferriss: I promised I would come back to a thread, which I realize is probably a misworded question. The question I asked was why people have trouble doing what you do, which is saying no to 99 percent of the things that normals do, or feel compelled to do, to your point about the narrative. And I realize that’s perhaps not the right question. The right question might be, what advice would you give to someone who is having trouble saying no, or focusing on just a few things? But I can make it much more specific, because I think the more we can imagine it, perhaps the easier it is to dig into this.
So, let’s say that you had a relatively new hire, who is on the younger side but a 10X engineer, or some equivalent of that. Someone who is clearly a superstar, but who has not established the type of architecture and routine that you have in your life. Let’s just say you sense that they are on the path to burnout, which is going to be bad for them, it’s going to be bad for the company, it’s going to be bad for the patients you serve, and you want to stage an intervention to help them correct course. I imagine you may have even had these conversations. What might that conversation or coaching look like?
Sami Inkinen: Yeah. Well, funny enough, this has been one of the topics of my team letters, one of the 530. So, I would separate it into two things, my advice. One would be this sort of planning. Literally, it would be very simple. Sit down for five minutes on a Sunday evening before the week starts, and write down what absolutely completely needs to get done next week, super-duper simple, professionally and personally, and schedule it into your calendar, literally. And if you have the flexibility, then block two hours in the mornings to get those two or three things done. And then when life happens, or work happens, everything else kind of comes after that. So, that to me would be the number one thing.
And then I would couple that, when Monday comes or Tuesday comes, it’s whether you work in an office or in a remote setting, do not let the universe control your time. So this means absolutely no notifications. Maybe if you have to get text messages for, I don’t know, family emergency or something, but take everything else out and you kind of create that sacred space where you can do that work, whether that’s writing, or coding, or cold calling 15 prospects or whatever that is. It’s super-duper simple, but it’s so easy to then sort of, again, Monday comes, Tuesday comes, and then the world takes over, and you’re like, “Oh, my God, it’s 4:00 p.m. I haven’t done the thing.” So I’d say that would be the one category.
And then the second part —
Tim Ferriss: Can I pause for one second?
Sami Inkinen: Yeah, sure.
Tim Ferriss: Okay. So before we get to the second, for some people listening, if they sit down for 10 minutes on Sunday to write down the things that must get done professionally and personally, they might have a list of 20 things in each category. So, are we talking about one thing, three things in each category? I know this seems like very persnickety, but this seems like a possible failure point for people, right?
Sami Inkinen: Yeah.
Tim Ferriss: So, what is your suggestion there?
Sami Inkinen: Yeah. So, it’s probably one or two things, but this, again, we could launch into another part, which is obviously you need an architecture of annual thinking, planning, like what does business need, for example. In fact, I just have a text file, ASCII file on my computer. I was like, “Here’s the four things to remember as a CEO now and 20 years from now. Here’s the three things for this year. And here’s the three things for this week.” I literally have a text file and I just update it every Sunday.
And a whole another topic, which I’m sure some people think I’m crazy, is I have a 15-year plan for myself, which I accidentally stumbled that it actually could be useful and I update it every year. And again, we can take that offline or take a bookmark how that came about. It’s been incredibly helpful. And again, I want to highlight, structure allows spontaneity and flexibility, but if you don’t have that architecture, then obviously on a Sunday evening it’s like, “Oh, should I write a book, or get a new job, or just do this project that my boss was asking?” So, if you don’t have that North Star, you could be kind of spinning like a compass.
Tim Ferriss: I did take you off track, because you were saying block these things out in the calendar like Sunday, five to 10 minutes, block those things out in your calendar if you can, two hours first thing in the morning. Do not let the universe dictate how you use your time, block out notifications. And then you said the second thing, and then that’s when I interrupted you.
Sami Inkinen: Yes. Second bucket, this is probably the most important as this relates to a burnout and you’re falling apart. And I’m going to knock here on my wood, my table, not too hard to create any noise, but I founded my first software company in April 2000. So now we’re here in 2026, so that’s 26 years, running, building, fast-growth companies. And I haven’t cracked yet. And again, caveat is it could happen tonight. But there’s a few things I’ve learned, and I think these are applicable to, especially any knowledge worker, where everything’s just coming to your brain, and it’s very easy to get stressed, and anxious, and crack. And I’ve written about this as well. Here’s my formula that has worked for me very well.
One, you have to take care of your sort of foundational metabolic health. What is it? It’s sleep, nutrition, exercises. That’s kind of one. If you are metabolically very, very unhealthy, it’s very, very likely that you’re going to crack under pressure. So that’s one. Second one is, it’s very helpful to have, especially for founder CEO types, but for anyone, have at least two or three identities, or outlets. For me, it’s parent/husband, one, CEO, two, and then want to be athlete. And so if one’s failing, hopefully at least two are the areas, outlets in my life where it’s like, “Oh, it’s going okay.” And by the way, it’s never that I’m rocking and winning and ringing the bell in all three at the same time. And it’s very helpful. It’s almost like a mental trick, like, “Oh, my God, work sucks, but at least my kids love me today.”
So having that outlet, and particularly founder types, younger ones, it’s often the opposite. They’re sort of proud of the fact that I only have one thing and I’m ready and willing to die for my company. Well, that’s all well and good when everything’s going well, but you have the first speed bump and then everything falls apart. So that’s the second thing, I would say.
Third one is have peers outside of your company that you can let your hair down and relax. For me, it’s a group of CEOs. Other CEOs was, “Oh, my God, can you believe? Can you believe these employees are bitching again?” But obviously you can’t say that in front of the company. Personally for me, it’s been YPO, the Young President’s Organization since, I guess, 2008. So now for me it’s not anymore the why the young, it’s just PO, because I’m old enough. So, I have that.
And then I think the fourth one I would say is everyone has their own tools, but just understanding how your mind work. It could be meditation, could be some other tools, but that’s been a process for myself, to just realize that if you are just attached to your thoughts, eventually they’re going to get you, and you can’t really think yourself out of the hole that you’ve thought yourself into. So unless you can take a step back and observe like, “Oh, my God, my brain’s having a life of its own.”
So that’s kind of the tool that I would not to crack. So foundational health, have different outlets, identities, have peers you can talk to, could be friends as well, and then some sort of understanding and way of taming your mind, if you will, or being able to see that the mind has the life of its own. That’s been helpful for me. And I will say, again, could happen tonight, but I haven’t touched any prescription drug for anything sort of mind related, and that toolkit has kept me head above the water so far for 25, 26 years.
Tim Ferriss: I have a very left turn question for you. Hopefully, it won’t be incredibly offensive. But I was just thinking, when you were like, “I would knock on wood, but I don’t want to make any noise,” and then you’re like, “I can let my hair down, no offense, sorry.” And you’re very polite, and I’ve only been to Finland once. And I was walking around. And of course, went to the obligatory saunas and so on, which I actually can tie into my story, but I was walking around and in the maybe two days that I was in Helsinki, I thought to myself, because I lived in Japan, I speak Japanese, I’m still close to my host family who I stayed with when I was 15 and I thought, “Finish people feel like white Japanese people.” That was my feeling there.
And the reason it ties into the sauna, different context, but if you go to Japan, it’s everything is very restrained, very polite. People don’t stare you in the eye when you’re walking down the street. And in Japan though, if the boss says, “We need to go out and drink, when you drink, okay. And if the boss says you have to drink, you have to drink. But you go out and you can get really loud, and you can get really boisterous. And you’re allowed to say things when you’ve had some alcohol that basically everyone agrees they’re going to forget the next day like it never happened.
Now, I can’t take it that far with Finland, but when I went to the saunas, one thing that I was very surprised by is that they sell huge stein glasses of beer that people bring into the saunas. And I was like, “Oh, this is where they let their hair down. Okay.” Am I totally off base? I don’t know if you’ve spent time in Japan, but culturally I felt like in my 48 or 72 hours of exposure, I was like, “Wow, this is actually, even Finish itself has some of the phonemes, some of the sounds of Japanese. I mean, it sounds like I’m really overreaching now, but — am I just an insane person, or do you feel like there’s something possibly there?
Sami Inkinen: I think there’s similarities. And you’re definitely the connoisseur of a Japanese culture versus me, having just been to Tokyo and a few other places a couple of times. But that kind of space and distance, and politeness that people — well, actually, there’s no distance in Tokyo obviously, but sort of emotionally there is a kind of distance in Finland and in Japan versus when I came to America 2003, moved to California, it’s like everyone’s on your face and everything’s freaking awesome. And it took a couple of years to, I was like, “Wait, wait, wait, wait, come on, give me space,” and everything’s not awesome.
And so yeah, maybe there are similarities. And then, yeah, alcohol I’m sure has been a mental health tool, not very effective at that in Finland for many, many decades. But sauna, I have to — well, first of all, there’s five and a half million people in Finland, and there are more than three million saunas. More than three million saunas.
Tim Ferriss: It’s a crazy number.
Sami Inkinen: So on average, you have one to two people per sauna in Finland. Babies used to be delivered in sauna in Finland, because it’s the clean, bacteria die in the heat.
Tim Ferriss: Sterilized.
Sami Inkinen: There’s warm water. I think my mom was delivered in sauna. I was in the hospital, just to be clear. So, sauna is beyond being part of the culture. It’s part of the DNA. And it’s culturally, it’s an amazing place, actually, not just kind of let loosen your head down, but you don’t have your uniform, you don’t have your titles, you don’t have your whatever, socioeconomics, singles, symbols, fancy watches, and kind of everyone comes together, whether that’s family, or your friends, or your community. And yes, sauna is definitely a place where a lot of things happen in Finland. And yeah, we could talk about saunas and it’s its role in a culture, but it’s —
Tim Ferriss: Well, let’s talk about it.
Sami Inkinen: — way beyond cold ponds and sauna.
Tim Ferriss: Yeah. Why is that? Why is it so prevalent in Finland? Because it seems like, and I’m sure you’ve seen this, but there’s certain studies in the world of psychedelics where it’s like they did brain imaging and one study that they’ve been slicing over and over again and torturing the data again and again to just produce more and more papers on this one study that was done so long ago. It seems like the same group of 140 fins has been dissected five million times in various announcements around saunas, but why is it so prevalent there versus other places? I don’t know the origin story.
Sami Inkinen: Yeah. And hopefully, there’s a historian who will check me on this, but it definitely goes back hundreds, let’s say, many hundreds of years, where it was sort of necessary. Finland, four seasons incredibly cold winters. So sauna was a place to basically heat and warm up in the winter. It was also a place where you could dehydrate food. So that’s kind of how it goes way back when. And obviously now, it’s not necessary to stay warm and it’s not necessary to dry your food, but I think that’s where it started.
And then in saunas where you duck into a side of a mountain, and then you burn wood on top of rocks, and then you extinguish the fire, and then you make sure that the smokes goes away, and the rocks stay hot for a long time and you go in. That was the original, it’s called, people still have that kind of saunas today, it’s called smoke sauna. So essentially you don’t have a way to get the smoke out other than open the door. So there’s no fireplace where the smoke just goes through a chimney. So that’s called smoke sauna.
It’s a special sauna experience. And obviously, it takes much more time to heat it and make it safe, because you don’t want to go there, where there’s smoke. But I think that’s kind of the history. And then somehow I’m missing the link how it became sort of like a culture, but now, nobody will build a house without a sauna. Literally, first is where it’s a sauna, and then let’s figure out if there’s space for a bathroom. That’s kind of the order in Finland.
Tim Ferriss: I went to this public sauna, it’s pretty fancy, and there’s a word, you could probably tell me what it is, it’s like löyly or something like that.
Sami Inkinen: Oh, löyly.
Tim Ferriss: There we go. So this is, what? The act of throwing water on the stones? Is that what that refers to? Or the sound that it makes? I don’t know what the name of the actual location means, but you can tell me in a second, but the reason I bring it up is I have never experienced so many varieties of sauna, and they had a smoke sauna room. And in my mind, looking at the menu of options before going in, I’m like, “Okay, I get it. It’s a hot room. How different could it be?” But the experiences, and the feeling in the body, and the way it penetrates your being is very different. I was shocked, because I’ve spent so much time in dry saunas in the US, and I’ve also done steam rooms and so on, but I did not expect there to be such a broad palette of experience in saunas.
Sami Inkinen: Yeah.
Tim Ferriss: So that place was amazing.
Sami Inkinen: Yeah. So, I guess Eskimos have a dozen or so words for snow, because they know every nuance and detail. And Finns have dozens of words for different things around sauna that you can’t even translate. Löyly is probably the most important. You judge the sauna and it’s quality based on löyly. And löyly is essentially it’s after you throw water into the rocks, the fireplace, the rocks, and then the steam comes up. It’s not the steam, it’s not the heat, it’s the, I guess you could say the spirit of the steam, but how it feels, how it lands. And let me tell you, there’s a million different variations how it happened. Is it too hot? Is it too sharp? Is it soft? Does it sort of linger around and how does it feel on your body? That is löyly. And you judge the quality of the sauna based on the löyly.
And there’s a whole science to it, kind of like how big is the space. To get the löyly right in a barrel sauna, which by the way I have at my house, is very, very hard, because it’s too small, the fireplace, you can’t get high enough, and you should be sitting kind of above the fireplace. So yeah, löyly is — if you know one word, löyly, and you want to impress Finns, you go to a salon and I say, “What a fantastic löyly.”
Tim Ferriss: I feel like I need to reach out to the Finnish Tourism Board to sponsor this episode, get people headed over to Finland. I really enjoyed it. It was a very short trip, but hopefully I’ll have a chance to get back.
Let’s talk about metabolic health, because certainly Virta, we can talk about Virta. And part of the impetus for this conversation was tons and tons of text messages back and forth, and some of them I’m sure we can’t talk about publicly necessarily because it’s internal data or whatever, but I would have say a conversation with Dominic D’Agostino, who some long-term listeners will know synthesizes novel exogenous, meaning supplemental ketones and so on.
I was, for instance, I give one example, facing a bit of an enigma in my own experience, which was, I’ve gone into ketosis, and I know that’s a very sloppy way of putting it, but let’s just say getting into ketosis, so eating a predominantly fat-based diet, or even doing it through fasting, getting to a point where I feel like my brain has switched over to ketones. And I was lamenting to Dominic that my devices were telling me I was not in ketosis. And I found this implausible, because after so many years of experimenting with it, I feel like I have a very good bead on when my cognition clicks over, and is actually operating at a much faster CPU capacity.
But my finger pricks with, say, a Precision Xtra device, or the Keto-Mojo, were telling me I was basically not ketosis. And very confusingly, even with a breath-based, I think it’s KetoAir or something like that, pretty primitive device, but even with that I was being given a negative. And you sent me a text showing your bar graph over the last 10 years or something of measurable ketone levels going down over time, even though presumably you’re increasingly and increasingly fat adapted. And I was like, “Of course Sami has this data.”
And then you have some fascinating, fascinating data I have certainly never seen anywhere else looking at different cohorts with various combinations of things, with or without, say, dietary ketosis. So that is part of the reason I wanted to have you on. You’re such a meticulous thinker around these things and data cruncher. But let’s maybe just define some terms before we get into things. What is metabolic health? And maybe you could tell your personal story, because my understanding is at some point you were sub 10 percent body fat, but your report card in terms of biomarkers and so on came back and you were pre-diabetic, is my recollection, but perhaps you could take that TED Talk I just gave and use it as a leaping off point for discussing, defining metabolic health and then talking about your own personal journey maybe as a starting point.
Sami Inkinen: And first the caveat, which is that I do have two master’s degrees, but I’m not a medical doctor and I don’t play one on the internet. And I’m sure in this conversation we’ll go into that area, so I just want to be clear: I’m not giving medical advice to anyone, and I’m not a medical doctor. But obviously, I have a lot of experience with the topic that you just asked.
But in terms of, I guess the personal story, so just rewind, not quite all the way back to Finland, but again, my background is not in medical field. I’m a physicist by training, and in fact, started my career in a nuclear power plant way back when in Finland when it was still fashionable. And I guess nuclear power plants coming back to fashion now, again. Which is just to show that like my background is in science and technology, not in healthcare. However, I’ve been essentially an athlete all my life, cross country skier, bi athlete, came to America, started doing triathlons.
Tim Ferriss: Well, you had to ski to school at one point, right?
Sami Inkinen: Yeah, sounds very idyllic. Maybe that was a punishment by my parents. So Nordic skiing to school in the first grade through sixth, so —
Tim Ferriss: Sounds terrible, actually.
Sami Inkinen: And biathlon came handy, so carrying a rifle so I could shoot the bears when they were attacking along the way, which may or may not be true. But yeah, I was an athlete and have been athlete all those years. And then after coming to America, started doing triathlons, and pretty high level athlete. Again, we’re not talking about the Olympic gold medals, but as an amateur, and did many, many Hawaii IRONMANs, I think seven of those world championship races. And even won the world championships in my age group as a triathlete 2012, I believe.
And I give that all as a background context, because my view on metabolic health and sort of chronic disease, type 2 diabetes and obesity, was, this is very embarrassing to admit, was the following, which is, it’s ridiculous, it’s very simple: people know exactly what to do, most people, most Americans, they just don’t do it.
And as a result, we have just obese people everywhere. Everyone has prediabetes or type 2 diabetes. And by the way, it’s more than 50 percent of American adults. Now the data is, I think, 93 percent, this is the published period of number, 93 percent of Americans are metabolically unhealthy in one way or another American adults. And it’s either you have a high blood pressure, or your lipids off, or you’re obese, or you have type 2 diabetes, or prediabetes. And my view, as judgmental as I was, was always, “Listen, ridiculous. You know what to do, but you’re not doing it. You’re eating too much, you’re just eating too much and you’re not exercising. You loser.” And that’s why I pay too many taxes, because healthcare is five trillion a year, of which almost all of it is metabolic health related. So that was my view.
And I’m very, very embarrassed to say that’s how I was thinking. Sort of judging people like, “You’re unhealthy for reasons that are 100 percent in your control.” And then I got the moment where I had to eat a lot of humble pie, and I discovered that despite being, I don’t know, 10 percent body fat or whatever, and exercising 15 hours a week, and performing well as a triathlete, I was pre-diabetic. All the numbers are often essentially on my way to type 2 diabetes, and I was like, “Shit, wait, I’m not one of those people with no willpower, I’m not one of those lazy people, I’m not one of those ‘middle of America,’ 300 pounds seatbelt extender. That’s not me. Seriously, what’s going on here?” And this was 2012, around the time my previous company Trulia went public, and I was like, well, first I have to figure this out for myself, because if I can’t avoid being metabolically unhealthy, nobody can. Well, guess what? Nobody can. That is the status quo in America today with so many people metabolically unhealthy.
And that got me very interested in this whole topic of, what is actually driving poor metabolic health? fortunately met with amazing scientists who helped me understand that, fundamentally, obesity, type 2 diabetes and the other conditions that result from poor metabolic health, it’s not a personal choice. People don’t wake up on a Monday morning and say, “I want to gain 200 pounds and develop type 2 diabetes. That sounds awesome. And sticking an insulin needle to my body for the next 10 years every day, awesome. Sign me up.” No, it is not lack of willpower. However, nutrition and food is the number one driver of poor metabolic health.
And if you know how to use nutrition, if you know how to use nutrition to actually improve and reverse your metabolic health, you can take an average, let’s just call it 300-pound middle of America truck driver or average person that we, people on the coast often look at like, “Oh, it’s your fault.” And systematically, reverse the condition nutritionally. And essentially, that’s what we’ve done at Virta Health now, with more than quarter million patients and scaling fast. But let me just pause there.
That’s kind of the how did the Nordic skier physicist from Sigma get interesting in metabolic health, and then we can take this down to different paths.
Tim Ferriss: Yeah, let’s hop in. I want to start with, well, as you might expect, question about diet. I want to know what, looking back, what the problem was with your diet, and also, this is of course a leading question, so feel free to discard it if it’s not a good question, but how large a role does high fructose corn syrup play broadly in the US in metabolic dysfunction, right? If that just were removed from the market, what impact would that have? But let’s begin with just your personal retrospective. Hindsight 2020, what was wrong with your diet? When you were actually 15 hours a week, roughly 10 percent body fat, performing well in competition. What was wrong with your diet?
Sami Inkinen: Number one question I get like, “Oh, was it your genetics? Because you were exercising so much.” Obviously genes play a part in everything, but I just want to remind that, given about 60 percent of American adults, six-zero, either have type 2 diabetes or prediabetes today. Clearly it’s not like our gene pool has changed. So it can’t really be genes. Or if 93 percent are American also metabolically unhealthy, it’s not like our genes have changed. So no, it’s not that same was the N equals one thing with very, very bad genes. This is happening to a lot of people. I would say one thing. The first one is there.
The second thing is that it is possible to be skinny and lean and metabolically unhealthy. Some kind of people of certain background, especially in Asia, it’s more common that you don’t gain 100 pounds, but you’re very metabolically unhealthy. Also, you can out exercise the calories and burn and not gain massive amount of fat, but you can still be elevated blood sugar, elevated insulin and be insulin resistant. And that’s basically what I was doing. It’s very, very hard. I can tell you that I was hungry for 15 years as an athlete. It’s like, “I’m always more hungry than I could. And if I eat to my appetite, I’m going to gain fat. I can’t do that as an athlete.”
So now I’m going to answer your question. So my N equals one, I’m absolutel
