Modern Wisdom - #772 - Dr Peter Attia - Scientifically Proven Ways To Build Muscle & Boost Longevity

Episode Date: April 15, 2024

Dr Peter Attia is a physician, longevity expert, podcaster and an author. There is essentially an unlimited amount of health advice available on the internet. Working out what is legit science and what is broscience is difficult, but thankfully decades of experience means Peter can help cut through the noise about what is actually most effective to improve your fitness and longevity. Expect to learn why a simple hospital visit can cost $6000 in America, how to improve your cognition, the best supplements everyone should be taking, whether there is any safe dose of melatonin to take, why so many young men are now on TRT, how worried we should be about processed foods, suncream, alcohol and all of your other favourite vices, how we can better deal with mental decline as we age, how to improve your self-talk and much more... Sponsors: See discounts for all the products I use and recommend: https://chriswillx.com/deals Get a Free Sample Pack of all LMNT Flavours with your first box at https://www.drinklmnt.com/modernwisdom (automatically applied at checkout) Get a 20% discount on your first order from Maui Nui Venison by going to https://www.mauinuivenison.com/modernwisdom (use code MODERNWISDOM) Get a 10% discount on Marek Health’s comprehensive blood panels at https://marekhealth.com/modernwisdom (use code MODERNWISDOM) Get up to 32% discount on the best supplements from Momentous at https://livemomentous.com/modernwisdom (automatically applied at checkout) Extra Stuff: Get my free reading list of 100 books to read before you die: https://chriswillx.com/books Try my productivity energy drink Neutonic: https://neutonic.com/modernwisdom Episodes You Might Enjoy: #577 - David Goggins - This Is How To Master Your Life: http://tinyurl.com/43hv6y59 #712 - Dr Jordan Peterson - How To Destroy Your Negative Beliefs: http://tinyurl.com/2rtz7avf #700 - Dr Andrew Huberman - The Secret Tools To Hack Your Brain: http://tinyurl.com/3ccn5vkp - Get In Touch: Instagram: https://www.instagram.com/chriswillx Twitter: https://www.twitter.com/chriswillx YouTube: https://www.youtube.com/modernwisdompodcast Email: https://chriswillx.com/contact - Learn more about your ad choices. Visit megaphone.fm/adchoices

Hello friends, welcome back to the show. My guest today is Dr. Peter Attia. He's a physician, longevity expert, podcaster and an author. There is essentially an unlimited amount of health advice available on the internet. Working out what is legit science and what is bro science is difficult, but thankfully decades of experience means Peter can help cut through the noise about what is actually most effective to improve your fitness and longevity. Expect to learn why a simple hospital visit can cost $6,000 in America, how to improve your cognition, the best supplements everyone should be taking, whether there are any safe doses of melatonin, why so many young men are now dependent on TRT, how worried we should

be about processed foods, sun cream, alcohol and all of your favourite vices, how we can better deal with mental decline as we age, how to improve your self-talk and much more. Another awesome episode from that huge shoot that we did on a virtual LED wall here in Austin Texas and Peter is a legend. The guy is one of the best voices in health and fitness, super evidence-based. He's an MD, he is teaching people and coaching them and helping them on a daily basis and you get to find out all of his best hacks today. It's very good and I hope that you enjoy it.

Don't forget that you might be listening but not subscribed and over the next few weeks we have Mr Ballin, Tim Ferriss and Gary Vee coming on the podcast and you don't want to miss those episodes along with everyone else and the only way that you can ensure you won't is by hitting the subscribe button and it's free and it supports the show and it makes me happy so please go and do it. I thank you. But now ladies and gentlemen please welcome Dr. Peter Attia. What's this story about your son going to hospital and getting some insane medical charge

for a tiny procedure? Yeah, well, it's, it's unfortunately a very common story, right? Where anybody goes to the ER and, you know, they end up needing a bag of IV fluids or something like that. And then they get a bill for thousands of dollars and you actually look through the line item and you realize this is comical, right? You literally charged me $1,400 for a bag of normal saline that costs, I don't know, somewhere between two and three dollars. Um, but it sort of speaks to

a lot of the breaks in the, um, specifically in the American healthcare system. What is it? Why is it so broken? What is it because it's a commercial enterprise? Is it because it needs to be, uh, additional funds need to be brought in from places where they shouldn't what's going on? It has to do with the complexity of a multi-payer system and basically the way contracts are negotiated between payers and hospitals, and you have to decide in those negotiations who is in network

and who is out of network. That's like one sliver of one problem. This exists on so many levels. But in that case, I think the issue came down to some very high deductible that wasn't met coupled with some out of network thing. But the truth of it is there's also ridiculous pricing. So, there's a sort of a false sense of how much things cost in hospitals. It's sort of funny money. Like we're going to really, really mark up the price so that we can give you a big discount if you're in network. So, you see this across the board with all sorts of things in medicine. And to rehydrate your son, it costs like six grand or something. I can't remember the dollar amount.

It was so egregious. Um, and again, I, it's infuriating to me when you keep in, in, in mind the fact that, you know, probably the average American would have a hard time on short notice producing a thousand dollars. And yeah, I'm fortunate enough that I can produce $1,000 without too much difficulty, but for the average person, maybe 50% of the population, that's a really big deal and that's a huge inconvenience. That changes your plans dramatically. It means you're not taking a vacation that summer. It means you're not able to go out with your family for a movie night.

How about me paying off that credit card debt for, et cetera. And it's totally inexcusable. I went to a ghost tour in New Orleans five years ago, and the guy that was taking the tour finished up afterward. And I was asking him about the American healthcare system. And he said this thing, he's really stuck with me. He said, if you get hit by a car, you'd better walk it off.

His point being that there are medical emergencies that can happen that can ruin your life by you having to fix them, not by you not fixing them. Yeah. Um, healthcare is the number one cause of personal bankruptcy in the United States. No way. Wow. It's strange for me as someone who's coming from the UK, right? There are problems with the NHS.

Don't get me wrong. I've had my share of problems with the NHS, but there's a social safety net that picks people up and it feels to me, it feels barbaric to not, you don't get the privilege of healthcare. Like it's just, Oh, you're so sick. Sorry. Like not for you.

It seems, it seems very bizarre coming from the UK. Yeah. And it's a little counterintuitive. The people who are most impacted are not the people at the very bottom of the socioeconomic ladder here, because those are individuals who are going to qualify for something called Medicaid, which is meant to sort of provide for the people who truly have nothing. But if you go one level or two levels up from that to people who do have health insurance, but they're grossly underinsured or they can't afford health insurance because yes,

they're working and yes, they have these other expenses, but they can't afford that. Those are the people that are absolutely devastated by the system here. And again, on the flip side of that, I think on some metrics, the US healthcare system is hands down the best in the world. It's not an accident that when heads of state, you know, Kings and Queens, royalty, you know, whatever need the best procedure, they're going to come to the United States.

Um, and, and so on the one hand, the US has the best to offer in terms of, you know, the tip of the spear in quality, uh, for medicine 2.0, but at the other end of the spectrum, when it comes to cost and when it comes to coverage and accessibility, it's, uh, it's the, you could argue it might be dead last in the developed world. Look at where it all began at the wild west of America though, your cardiac machine being powered by a nice water wheel or whatever it is. Yeah, you talk about this. I really love this conception between medicine 2.0 and 3.0.

You've got to quote, longevity itself and health span in particular doesn't really fit into the business model of our current healthcare system. There are few insurance reimbursement codes for most of the largely preventative interventions that I believe are necessary to extend lifespan and health span. And after our episode last year, I went to fountain life in Dallas, preventative medicine, right?

Full body MRI brain, angiogram, heart angiogram scan with contrast and a Dexer and a microbiome and all this stuff. And it made me realize why it's so medicines backwards. You're trying to fix a problem after it's happened, as opposed to working out what's going to happen and getting out ahead of it. It's wild. Yeah. Lots of people, I think want to improve their mental clarity.

One of the things that is top of mind is my attention, my focus, my ability to pay attention to the stuff that I'm doing. Everyone's a knowledge worker in some form or another now. What do you focus on when it comes to improving cognition for yourself? Um, I think, you know, there, you, you can, I sort of put these into different categories,

right? There's sort of the, the, the things you do to improve the environment of your mind. So I think probably at the top of that list is sleep. So it's very difficult to cognitively perform well when you are sleep deprived. And I realize that many people listening to us will think, come on, I can think of all the

examples in the world. I mean, look at all these people who don't sleep and are still out there clearly doing very well. And the point is you never have the counterfactual for those people, right? What you don't know is imagine that person sleeping eight hours a night instead of three hours a night. I am positive that they would be performing even at a higher level. I put exercise probably at number two. I think it is again, just a remarkable way to provide not just the obvious metabolic and circulatory food, if you will, to the brain, but also kind of think about

the endocrine side of that, right? So BDNF and things of that nature play such an important role in brain health. Nutrition clearly plays a role and managing nutrition is important. I think anybody who's, you know, especially people who are really carbohydrate sensitive will appreciate that the big peak, the big valley that follows, you know, a big carb rich meal is going to, you know, negatively impact cognition. So again, we could build out a few more of those things, but then I think there's kind of the environment within which you work. And I think for me, this is the bigger struggle. So, you know, luckily I think I've sorted out the sleep nutrition exercise side of it.

So my limiter tends to not be those things. It tends to be distraction and busyness and doing too many things at once. That's probably the thing that limits my capacity for high quality work or deep work is Cal Newport would describe it, right? What are the rules or techniques that you set yourself to try and maximize deep work time? Well, I mean, one of the things is I don't actually have any notifications on my phone, except the phone, if it rings.

And, you know, in this day and age, nobody actually calls you. So basically I'm never really interrupted by my phone. I don't get a, I don't get even a vibration. If there's a text message, an email or God forbid, anything stupid, like social media. So I have basically a phone that does nothing

except vibrate if it rings. That's it. Um, and that turns, uh, in talking with people, I realized that's actually seemingly rare. A lot of people look at me like I have three heads when I explain that I don't have any alerts on any aspect of my phone. The other thing I try to do is set aside larger rather than smaller blocks to get work done. So I try to schedule big blocks of time early in the day that are my quality work time. So typically that is seven o'clock to maybe nine o'clock in the morning is always uninterrupted. So there's never anything that's going to be scheduled during that period of time

and I focus on doing whatever. So this morning I did the most important things I had to do during that period of time, knowing that from here to my next meeting, to my next call is only going to kind of dissipate my cognitive capacities. Yeah. I, uh, I went to Dubai, I fled the UK during lockdown and went to Dubai, which I think is four hours ahead of GMT, which meant that I could get up at seven or eight o'clock and I had four hours before anything happened. And it was bliss. It was insane.

It was what it feels like to be Jocko Willink for a while. And I now being in the US, I'm six hours behind the UK, which means that I wake up to just this cacophony of, you know, things that need to be sorted. And there's a video going out and there's emails and there's all this stuff. Uh, but yeah, I think for me. Choosing in advance what you're going to work on and then blocking off a little

bit of time, even if it's just an hour, right? I'm just going to do the one thing that is going to move. And if I actually look at your day and say, what would have had to have happened? What's the one thing that would have had to have been done by the end of the day for me to look back and go success. It's probably not that insane of a thing. It's maybe the thing that you have a bit of hesitation or resistance to doing. It's usually not that insane.

Yeah. It's not a massive list in order to be successful. Okay. So, uh, what about when it comes to working environment, have you, are you sit stand desk, are you take, are you doing pomodor environment? Are you sit stand desk? Are you doing pomodoros? What else from the productivity? Oh, it depends what I'm doing.

But again, I also need quiet to work. That's another thing. So I always kind of look at my daughter who seems to be able to do homework with music on. And I did as well when I was in college. I always had music on when I was doing homework. I wonder if I could have done better if I didn't, but for whatever reason, when it comes to whatever

I do now, which is usually writing, um, I wouldn't be able to do a great job with any distraction sound wise or otherwise. Um, stay, yeah, I like to be standing if I'm not on zoom, uh, my, the way my office is set up, it's just a lot easier to be sitting if I'm on zoom. I also, you know, I think, you know, people ask me all the time, like, do you, you know, do you count your steps or how many minutes you're standing or sitting?

And the truth of it is I don't at all. Right. And the reason is I'm doing so much other stuff that I don't really need to be particularly attentive to those things. All things equal. Of course, I'd rather be standing or walking than sitting. Um, but, but I don't tend to fix it on it. You're ignoring dollars to pick up pennies.

If you're thinking about how much time you're spending standing throughout the day. Yeah. And by the way, I think that is valuable for an individual who can't make two hours a day to exercise, but fortunately I've just made that an unbelievable high priority where yeah, it's, I'm always going to be doing the really important

stuff during dedicated time. What about supplementationally or pharmacologically? What are you using if you need to dial in focus a little bit more? Nothing. Um, I, well, I shouldn't say nothing. So I love caffeine, although I, I'm not

convinced I'm really getting a benefit from her, from it. I am a very, very fast metabolizer of caffeine. So I probably consume 300 to 400 milligrams a day, but if I don't, nothing happens. Like I can't appreciably tell a difference. So for me, it's, I love the taste, I love the ritual, I love making coffee, my wife loves coffee.

It's the one thing I can do first thing in the morning that makes her happy. You know, so it's like, you know, it's, so I don't, I don't, even though people would argue that caffeine of course is a cognitive booster, um, I'm not convinced. I appreciate the, the, the metrics of that. Um, I do occasionally, uh, put a

nicotine patch in my mouth. I probably get more benefit from that. Um, truthfully, and maybe I'm just not aware of other products. The product I use, I think is too high a dose. So you have to, it's a seven milligram pouch. So you have to kind of time it because as you probably know, nicotine is a very unusual molecule where at low doses, it provides a heightened sense of awareness.

So it's actually concentrating you, but then you actually cross over a hump and then nicotine becomes actually quite relaxing and sedating. I didn't know that. Yeah. It's an unusual molecule in that, in that it has the behavior. but then you actually cross over a hump and then nicotine becomes actually quite relaxing and sedating. I didn't know that. Yeah, it's an unusual molecule in that it has behavior. So both of those properties are ideal. It's great to be focused when you need to be focused. It's also great to be relaxed when you need to be relaxed. It's just you don't want those at the same time. So with these seven milligram pouches, and again, there's people watching this that I'm sure are going to be like,

come on, you idiot. Don't you know all this other set of products that are out there? I used to enjoy gum more cause you could chew two milligrams at a time, which was really the right dose to just induce the focus. Um, again, nicotine is an addictive compound. So I say, I don't say this lightly, um, but for whatever reason, I don't appreciate any

of that. So in other words, I might have it three times a week for a month and then forget about it for six months and I don't seem to miss it in any way, shape or form. And obviously the mode of delivery matters. So, you know, I'm not remotely interested in it. Yeah, I'm not, I'm not at all interested in, in, in that it's, it's got to be basically gum or a lozenge or something.

It's so interesting that the dose can take you from where you want to be to where you really don't want to be basically gum or a lozenge or something. It's so interesting that the dose can take you from where you want to be to where you really don't want to be. But it's this. Yeah, or it depends. Like again, sometimes if, you know, and I don't use it in this capacity, but if you really need to relax, a seven milligram slug of nicotine

will relax you. That would just make me want to throw up. That would make me want to throw up everywhere. I'm very nicotine sensitive. Yeah, that's a real issue. So what about, we're talking about. There's one other compound that I add to the list, although I rarely need it,

but if I'm doing a lot of time zone movement, I will also lean on modafinil. Okay, and how would you use that for yourself? Just use it as a quick reset on circadian rhythm in the new time zone, right? So for example- Take it first thing in the morning? Yes.

So take it first thing of the morning of the new time zone, which is not the new, which is not my morning internally, right? So if I had to go to London tomorrow, um, and I had to be there for 48 hours and then come right back, my strategy is let's say I'm leaving Austin at 2 PM. So 2 PM Austin time is what's that?

9pm, 8pm depending on daylight savings. So I would put myself to sleep on the plane within two hours so that I go to bed London time, even though it's 4pm Austin time and I don't want to go to sleep. And then. What would you do to induce sleep? I had kind of a whole long protocol, but basically it comes down to how early did I wake up in Austin the day of when did I exercise? What did I eat?

And then I'm going to try to shut off my adrenal glands with phosphatidyl serine, um, I'm going to take trazodone, a dose of a high dose of melatonin, which is not something I normally use to sleep. And that's going to put me out. What were the first two things that you mentioned? Phosphatidylserine and trazodone. And what do they do? Phosphatidylserine inhibits cortisol output from the adrenal glands.

And trazodone is a funny drug. It's, um, it's actually, it used to be used as an antidepressant in the eighties, but it never really took off because it had this, um, nasty side effect of making you tired. So as SSRIs and the like came on board, it sort of fell by the wayside. We now use it as a remarkable sleep drug. It's incredibly safe.

And more importantly, it doesn't just induce sleep, it induces stage appropriate sleep. It's a very helpful drug for people who don't suffer from any initiation insomnia, but who do tend to wake up intermittently at night, either due to anxiety or just anything that kind of gets people up. Trasadone basically buzzes over that. Smooths that out.

Yeah. Okay. So you've then taken that melatonin, what sort of dose? Again, normally I don't take any, but if I'm looking for the hammer, I'm going to take three milligrams. Wow. Yeah, that is a lot. I mean, here's just before we go on to how to then wake up when you get to London,

the levels of dosage that you can buy in CVS of melatonin. It's crazy. Is wild. Can you just give the overview of how the dose curve works for melatonin with humans? Well, I mean, what's interesting is physiologically, the pineal gland doesn't make that much melatonin, right? It's making, um, micrograms of the drug. So I think the smallest dose I've ever seen that you can buy might be 300 micrograms. Like maybe there's someone out there that makes a 0.3 of a 0.3 milligram.

Yep. Yeah. That's probably the smallest I've seen. Maybe there's a 0.1 out there. I've got a, uh, a spray and each spray, sublingual spray of it is 0.3. Okay. Yeah've got a spray and each spray, sublingual spray of it is 0.3. Okay.

Yeah. So unless I can like, yeah, half trigger it, there's no way I could get that. But most of the time you're looking at one to five milligram, i.e. 1000 to 5,000 micrograms of this stuff and even 10 milligrams. And the problem with that is it seems if you, if you look at the literature, and I haven't looked in a while, but the last time I did doses north of about

six or 700 micrograms, 0.6 to 0.7 milligrams tend to really suppress melatonin receptors in the brain. And so as a long-term strategy, it's probably a bad idea. So would that create basically a physiological dependency? Yep. So my, I try to get patients off melatonin truthfully and reserve it for jet lag and for travel only and not rely on melatonin as a nightly sleep aid. But for a single use, I've got a short amount of time, 48 hours.

I can't mess about here. I need to hit it with a hammer. Yeah. If I, if using this example, if I want to fall asleep at what feels like four o'clock and wake up in seven hours and then two hours later, land in London. And be functional. And be a hundred percent functional and then take that, um, uh, modafinil upon landing.

What sort of dose of the modafinil is that immediately upon waking? Yep. Right. And what sort of dose, any idea? I mean, I usually take 200 milligrams if I'm going to take it, but modafinil can be dosed typically the low end is a hundred and the high end is 600. Okay. Uh, what about our modafinil? I've heard about that. Comparable.

Right. Yep. Same thing. Yep. What is, I'm just speaking to someone that's never taken modafinil. What's the sensation of it like? Uh, it depends on the individual. So I perceive nothing.

I'm just more awake and I'm, I feel fantastic, but I don't get a high from it. that's never taken modafinil. What's the sensation of it like? Uh, it depends on the individual. So I perceive nothing. I'm just more awake and I'm, I feel fantastic, but I don't get a high from it. I don't get any stimulation from it. I know there are some people, I can't tell you what fraction of people, but, but a non-trivial fraction of people actually experience a negative sort of stimulation effect from it. In the case, Oh, like they feel like, uh, it probably feels like what a Fedra used to feel like back in

the day. Oh, it's rushy. Yeah. Wow. Yeah. Now, again, I would argue that in those people, they're simply taking too much and that they're very sensitive to it and they might get the benefit without that negative side effect if they down the dose.

My wife, for example, can't take it, but that's probably because she's only ever tried 200 and I would bet if she ever really needed it, I'd probably give her 50 or 100. In other news, this episode is brought to you by Element. Stop having coffee first thing in the morning. Your adenosine system that caffeine acts on isn't even active for the first 90 minutes of the day, but your adrenal system is and salt acts on your adrenal system. Element contains a science-backed electrolyte ratio of sodium, potassium and magnesium that helps to regulate appetite, curb cravings and improve your brain function. You've probably heard me talk about it a million times and that's because I love it.

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You can get a free sample pack of all eight flavors with your first box by going to the link in the show notes below or heading to drink lmn.com slash modern wisdom. That's drink lmn.com slash modern wisdom. Talk to me about, so that's mental clarity in the now. What about reducing cognitive decline over the long term? I think it's the two big ones by far. I think first and foremost is, is exercise. Um, clearly the most efficacious data, right?

So if you just look at clinical trials, if you just look at mechanistic studies, um, exercise is the best way to get to the bottom of the equation. clearly the most efficacious data, right? So if you just look at clinical trials, if you just look at mechanistic studies, exercise is the best intervention for the brain. I think metabolic health and high quality sleep would probably be next in line. So metabolic health meaning being insulin sensitive, good fuel partitioning, right? Being as far away from the diabetes

end of the spectrum as possible. Again, if you have type two diabetes, your risk of neurodegenerative disease goes up significantly. And then it's all things that pertain to vascular health beyond what's already been stated, right? So if you look at, again, it's important to understand when we talk about dementia, we are talking not just about Alzheimer's disease, but the other forms of dementia. Alzheimer's happens to be the most prevalent, but it's by far not the only one. And so when we think about vascular dementia, frontotemporal dementia, and obviously Alzheimer's disease, all of the risks for cardiovascular disease carry right over there. So what are the things we want to do to maintain low risk for cardiovascular disease? Low burden of lipoproteins, low blood pressure, low inflammation.

Those are the big, big, big three in metabolic health. Lipoproteins, how do we get to low lipoproteins? Usually pharmacologically, truthfully, because for most people to make the lipoprotein level low enough that it, you can factor it out of the equation is not really achievable dietarily, unless you're willing to go on a very extreme diet that I think for most people causes more problems than it solves. So you'd have to be really, really fat restricted to do that. And there are some people who can do okay on that, but most people end up also being too protein restricted. They end up, you know, eventually getting sarcopenia later in life.

There's a whole bunch of other imbalances that come along for the ride. Right. Okay. Blood pressure. What are the big movers when it comes to keeping that in a good range? The big two by far are weight and exercise, weight, meaning weight loss and, uh, and cardiorespiratory fitness. Right. So you're not, this could be the gym bro, as many of my friends are that probably

overweight in terms of what body mass they're carrying, not doing enough cardio training, not doing anywhere near enough cardio, getting out of breath, going upset of stairs, struggling to touch their toes, et cetera, et cetera. And so while really great. Yeah. And so while we have a lot of stairs, struggling to touch their toes, et cetera, et cetera. Looking really great. Yeah. And so while we have a lot of great drugs to treat blood pressure, just as we do for treating lipids, your ability to impact blood pressure

with quote unquote lifestyle is much greater and should always be first line. What does VO2 max or resting heart rate make a bigger impact on when it comes to, I mean, are you looking more towards zone two or toward maximum work to bring that blood pressure under control? Both.

There's total cardio respiratory fitness and you can't really be very high in one without the other. In other words, if you really, really, really have a profound aerobic base, you're going to have a decent VO2 max. And if you have a really high VO2 max, you have to have a pretty significant aerobic base. And I do think that most people would benefit from training those two in a ratio of 80-20 in favor of zone two. Wow. Okay. Yeah. I think, you know, again, for the gym bros out there, of which I am, you know, a card carrying member, um, just throughout your twenties, it's so, if you, if you know what a push pull leg split is, and if you're enjoying going to the gym and getting jacked with your boys, it is so low down the list

of priorities for you to care about doing cardio. Like unless you're going to a B-Thur in two months time and you're a bit fluffy and you think, ah, I'm going to get up and I'm going to do intervals fasted first thing in the morning. That's it. Like cardio is just not on the table. It's true. How many days did you spend in Ibiza? Oh, was that like, if you live in the UK, that's like Cancun, right?

For kind of, yeah. Yeah. So you've got, obviously we've Europe's on our doorstep. Kind of. Yeah. Yeah. So you've got, obviously we, Europe's on our doorstep. So it means that, uh, Mallorca, Magaluf, Malia, Zantii, Ionappa, Ibiza. So Ibiza is the coolest one of the lot because it's sexy house music and it's cool and whatever, whatever.

Um, but there's a, they said that there's a rule of you can ruin any European city by putting direct flights from the UK there. It's so true. You hear these stories about planes that need to be turned around in the sky because they're too rowdy in the way too rowdy. And you think look at any British airport. If you go Easter holidays, look at any British airport, five 30 in the morning, everyone's got a pint. Everyone, parents have got a pint as they're going away.

Cause it's drinking is just such a inbuilt part of British culture. It is in our blood, literally. But I think, you know, we spoke about this last time. I think we're turning a corner with alcohol. I think, I really think we are. I think that the way that people see it is this sort of go to coping mechanism, like the relaxation mode of choice, the thing that alleviates social anxiety.

Perhaps this is because people aren't putting themselves into social situations quite so much they're able to sit in the house a little bit more. But my previous industry was nightlife. And you know, I speak to my ex-business partner and all of the guys I used to work with. And the louty Larry sort of drinking culture has now been wildly supplanted by much more chill sort of brunches and, and it seems to have matured a little bit more. So maybe when I was in London last summer, um, I went to, uh, you know, near around the parliament and stuff, and there was this great statue of Winston Churchill outside of a park.

What do you know the name of the park I'm talking about? It has a statue of Churchill facing out. He's the only one facing out. I think all the other statues of great folks are facing in and it's facing, um, blank on the name of the tavern, like Stevens tavern or something like that. And, you know, so the lore is that that's where Churchill held shop, right? Cause you had to be within a certain distance of parliament.

So if you got called back to parliament, you could go. So basically Churchill lived there. He was always eating and drinking there and holding court. So of course I had to go there and there's no way I wasn't having fish and chips and some pint of whatever.

And I mean, I just did this every day, even though I couldn't stand the beer, but I was like, I'm going to have fish and chips and a pint of whatever your finest. Unspeakable, warm. Horrible piss water is. Yeah, yeah, yeah. But if Churchill did this, I'm doing this. I got from my tour manager, I got a Christmas present of the champagne that Churchill used

to demand was at every lunch meeting. And he made this company create a new sized bottle because a half bottle was insufficient and a full bottle was too much and he couldn't think. So they made a pint bottle of champagne and it's this and it's got the law on the back and it's beautifully designed and apparently it tastes like. Fizzy. I haven't opened it yet. I need to wait for a good occasion.

Um, it tastes like fizzy apple water or something. And, uh, yeah, he made them. Imagine being the guy that goes to a high class champagne establishment and says, it's not quite enough with the half bottle. I don't need a full, make me a new one. And that's the, that's the power that you've got. You say that striving for physical health and longevity, but ignoring emotional health could be the ultimate curse of all. What do you mean by that? Well, um, you know, there's a, there's a, there's this Greek mythology of a fellow I write about in the book, to Thonis, who requests of the gods immortality and he gets

granted eternal life, but not eternal health. And so he has this horrible curse where he's alive, but he's physically decaying all the way into this decrepit never ending state. And so I think an extension of that is, well, if you're, if you're, um, emotional health, which encompasses many things, happiness, the quality of your relationships, any sense of

purpose, any sense of happiness, if that is. In a bad place, why would you want to live longer? I mean, you, you're, you're objectively suffering. So why would extending that suffering be of any value? Um, and again, like And again, you can play thought experiments all day long. So let's play one. So the little bit I know of you, Chris, you enjoy people, right? You're not an antisocial human being. So if I told you, Chris, whatever number you think is the dollar

amount that it's going to take to make you happy, we're going to double it. Okay. That's how much money you've got and whatever metric of your own physical health defined by how big your muscles are, how low your body fat is, how well you can perform. Let's give it to you plus 20%.

Sounds good so far. Yep. And the only catch is you're the only person on the planet now. Now, don't worry. I've created a bunch of bots that will do everything. So your standard of living won't go down. Like you're going to have bots that will do anything

and they'll provide your food and everything. How happy is your life? Like how long until you kill yourself? Not long. No, because think about it, like what are you doing? Right? So that just gives you one example of, wow, if you took away my ability to interact with other people, life is not worth living.

Very few people I could imagine could tolerate that for a long period of time. So sure, that's extreme, but it's a great way to illustrate a point, which is if you have every single thing imaginable, but you have no connection to other people, what do you have? Um, so of course it doesn't have to be that extreme for the point to still remain.

One of the things that I've been thinking about a lot recently is, uh, integrating of emotions because a lot of us that come from a productivity background or a biohacking background or a strength and fitness background, we try to reduce the human experience down to metrics and numbers and reps and sets and stuff like that. But the actual phenomenological experience of being a human is emotions. It's what does, what is the texture of your mind as you move day to day through the things, when you look back at the day, sure, you might be able to say how many words you wrote or how much weight you lifted or how far you ran, but the actual moment to moment experience of that.

Isn't you logging things on a spreadsheet? It's how your mind feels. What, what, what's going on internally? And I really think that that point about emotional health being everything else kind of being subjugate to that is really true. And it's something that I think people gloss over. So when, when you conceptualize emotional health,

what do you, what are you talking, how do you think about the component parts of emotional health or an emotional health regime? You know, some of it depends on definitions and semantics and I don't for a second suggest that the way I do it is the right way or anything like that, the way we talk about it with our patients because we do, um, because it fits into a hierarchy

of all the things we care about managing in terms of longevity risk. So longevity risk is anything that is a threat to the length of your life or the quality of your life. And this has to be one of those buckets. Broadly speaking, there are seven. So within this bucket, I would say it's sense of purpose, satisfaction and joy, achievement, quality of relationships, self-regulation, distress tolerance. Those are probably the biggest buckets that fit into that. And again, you know, Arthur Brooks, who I don't know,

have you had Arthur on the podcast? He's coming on in a couple of months. Oh yeah, so you'll have a great time with Arthur because this is really a big part of what he talks about is the subset of this around happiness. And I think he has a very elegant way of thinking about happiness, right? Which is that happiness is not a feeling any more than the odor of the food

you're consuming is the caloric macronutrient benefit of the food. Uh, and, and therefore people tend to get a little bent out of shape if they don't quote unquote, feel happy in a sort of positive valence emotional sense. Um, and I think that's actually one of the most important things I've learned in the last couple of years is that I shouldn't confuse my feelings with my state of happiness. And that, that when I, when I'm evaluating my emotional state through the lens of happiness, I really want to go through these, these more nuanced metrics around like, am I, am I living

in a manner that is congruent with what I believe my purpose is my purpose, first and foremost, as a father and husband, but then second deep, my, my, my purpose is a doctor. And then maybe my purpose is a public figure. And, and, and these are all different, but, but I feel like I do have a purpose and all the things.

Okay. And then like, what is the state of my relationships? Where are my relationships good? Where are my relations under strain? Where are my relationships lacking in my attention? And then what am I pursuing that is giving me a sense of satisfaction, which really requires doing something hard and achieving a result. Like, and I, you know, some people are more wired to need that than others. Uh, you probably are.

I know I certainly am. And my entire life has been built kind of around hard things to do as little, you know, side projects, you know, physical challenges, sometimes, sometimes business challenges, writing a book, something like that, where you toil and it's hard, but at the end there's something you're, you're proud of. So anyway, it's, it's, it's, it's about

accounting through all of those things. Um, and I look for some people, it's easier than others. There's some people that just naturally tend to find ease within those things and others who don't just as there are some people for whom it's much easier to do cardio and they enjoy it. And there's others who maybe gravitate more towards strength training or maybe others who don't want to exercise at all as their

natural default state. Do you think there's a difference between emotional health and mental health or is this just lexical wishy washy? Um, you know, I used to use the two interchangeably, but I don't know. I mean, I think in the book, I talk about them as slightly different, and I talk about emotional health as this thing that we are talking about now, and mental health as the pathologized state of disease.

So depression, anxiety, bipolar disorder, those would be mental health things. Again, I don't think there's a right or wrong to this as long as one is clear in what they're saying. One of the things that I really appreciated about you was your openness. You've spoken about this a number of times, your openness about your own, uh, sometimes negative castigating in a monologue. It's something that I'm incredibly familiar with as well, myself. What would you say to the people who have poor self-talk, a scolding in a voice

that reminds them of how they fell short way too often. What have you learned about dealing with that? And also about balancing that with your high standards for yourself, about wanting to make a mark in the world, but also needing to be able to give yourself self-love? Yeah, that's an interesting question. I don't know that I could provide generic advice on the topic because it probably depends on where the person is in pain right now. So I know that for me, the message, the reason I was willing to engage in the discussion around changing the behavior was because the output of it was made clear to me. Once I recognized the link between my self-talk

and my rage and I fully accepted the fact that I wanted to rid myself of rage, then I accepted the fact that I had to go and fix the self-talk. So my guess is the only way to really try to convince somebody that you're having an inner Bobby night, which is what my guy was, having an inner Bobby night that screams at you all the time is harmful, is by helping them understand a clear path between how that behavior links to something that is hurting them in another way that is more obvious. And I think if you can't do that, it's probably a little too abstract to just say, you know,

you should be nicer to yourself. I listened on recommendation from a friend to a 20 year old, nearly 20 year old Tony Robbins, awaken the giant within work book on audible. It's about an hour and a half. And I'd never read the original book and in it, he talks about pain, pleasure, principle, and he talks about bringing with decisions that you want to make or with habits that you want to change, bringing as much pain to bear. Look at what this has cost me in the past.

Look at what this is costing me now. Think about what this will cost me in the future and then turn that up to a thousand. So my friend wanted to stop biting his nails. So he thought about all of the times in the past that girls had sort of made an icky sort of move when he put his hands on them, they'd seen them and how ashamed he felt about it at the time and about how this was going to hold him back in the future and how it made him feel like a juvenile and it was immature. And then he went online to turn it up to a thousand and he looked at the worst

photos that he could find of people that had bitten their nails, these awful, you know, like bloody stumps of fingers. And then he thought about the opposite. He thought about how much pleasure could I bring to this, how proud I would be if I'd overcome this thing that I'd done for 20 years about how much more attractive I would feel about how much more confident I would feel when I shake someone's hand. I might put my hand on my girlfriend's leg and these sorts of things. And, uh, I have to say it's incredibly powerful, like to do that, to bring to bear.

And what you're talking about is. There is a inner tormentor that kind of does a thing, but it's all inside of your head and it's upstream from some things that actually manifest that you can kind of hold onto and do a thing. So how do you get, how do you get back up and how do you point the finger at what's actually going on? Well, you bring to bear so much of what's happening in the real world, but yeah, it's, I think this is one of the most common issues, especially people that

listen to this sort of a podcast, you know, the high achievers, they want to do things, they want to leave a mark on the world, want to improve themselves. But so much of that comes from like whipping themselves into submission all the time, I'm going to castigate myself until I, I like bow under the strain of how much torment I've given to myself. But as you know, there's a real myth that you have to do that to perform well, right? And the myth is that there are plenty of great coaches who extract remarkable performance from their athletes without that behavior. It doesn't mean you're not firm and it doesn't mean you don't have high standards and it doesn't

mean that if the team absolutely shits the bed and doesn't show up that the coach isn't going to let them have it. But that's very different from the constant berating. And also I think there's just a real difference in terms of, um, you know, differentiating kind of, um, a negative behavior or a negative outcome from the individual themself is the, is the, is the problem, right? So, so it's one thing to say, I don't like

that I wasn't able to do X, Y, and Z. That's a different statement from, I am a worthless person because I didn't do. A comment on my self-worth on how much respect I am owed by the world. Okay. So take me through how you reprogrammed that self-talk. I understand that you can have this thing, The rage is downstream from the whatever, but what, what did that look like? What did going in and fact checking your, uh,

very stern inner voice look like? Uh, it was, it was actually a very deliberate set of actions because I think you have to do actions and the easiest way to reprogram is through voice. So, uh, I think you have to audibly reprogram a system. I don't think thoughts are enough. And so the exercise that I undertook about four years ago to reverse a pattern of behavior that was in place for more than 40 years was to every single time I had a moment of self,

what was about to amount in a sort of self cursing situation, I would, I was instructed to take out my phone and record audibly a description of what I would say to a friend had they just committed the same quote unquote egregious act. Okay. So example would be if I'm shooting my bow and arrow and I'm really doing a lousy job of it, instead of jumping into self loathing, I would take out my phone and record a memo speaking,

but not to myself, but to my friend. Like if it was you, what if you had just shot as poorly as I did? What would I say to you? And I would be much more gentle. What were the sort of things that you would say? It would be, and again, you have to understand how strange some of these discussions are, cause in the moment you're so angry.

Yep. Right. It would be, uh, Hey Chris, I know you just finished trying to shoot today and it just didn't go well at all. Um, you weren't able to accomplish any of the things you wanted to accomplish. I know it's frustrating. Um, I think you just have to accept a couple of things. One is you're probably a little distracted today if you're being honest with yourself because you have a lot on your mind and truthfully it's a little windy today and it's just hard for those arrows

to fly straight when the wind is blowing at 10 miles an hour. Um, and you know, as you know, from previous experiences, like tomorrow will be a new day. Like you're going to come out here and do this again tomorrow and it'll be better. And we're just going to go back to process and we're going to get it right. And we're going to, we're going to do a couple of drills tomorrow to instill that.

It might be a one minute little voice memo. I'd send that to my therapist and then I don't know, five hours later, something else would come up that would piss me off. I'd burn a steak or something. Cause I turn, you know, I got, I'd got distracted and left the barbecue and inside I'd want to immediately eviscerate myself.

But instead I would pull it out and pretend that it was my brother who had just burned the steak and what would I say to him if we were at his house and he had just burned the steak, how would I make him feel better about it while acknowledging that it sucks? We don't have dinner tonight. You know, and I would do that. And after four to six months of doing this, I don't know, three to five times a day, lo and behold, I couldn't hear Bobby Knight talk anymore. Wow. So it can, it really turned the volume down.

It is in my life, the single greatest example of neuroplasticity that I have ever witnessed. And how old are you? How old were you when you were doing this? I'm 51 now. So 47. Dude, that's wild. Yeah. You wouldn't think it could change.

I think, especially when you're talking about self-talk, it is the internal physics of your system. It literally is the texture through which you interact with your own mind. And it's the fish underwater thing. Like you just, you don't know that it could be different. And to think that it's as malleable as that. And how sticky has that been? Do you need to drop out? You having to go back and do this or is.

No, I've never had to go back and do it. And I've never heard the voice again. Now I want to be clear. This doesn't mean I don't get angry. What it means is a, the frequency with which I get angry is a fraction of what it used to be the, um, and the duration or the blast radius is much narrower. So the last time I got really pissed at myself or pissed at my inability to do

something was I was in the simulator. I'm trying to learn it. I'm trying to learn a new F1 circuit in the simulator and, um, for whatever reason, there are certain tracks that are just very hard. Silverstone is a very hard track to drive. It's very hard to put a perfect lap together and it just really gets under your skin.

And so is Imola. So Imola is a circuit I'm learning right now, like learning in great detail, right? Like I wanna come up with a really cracking time on Imola. And I was down in the simulator and I was going through it and I just couldn't nail the last, the second and third last corners. And I would have these epic flying laps and then

I would absolutely shit the bed in this corner and either off track spin or just lose so much time that I couldn't put a lap together. And you know, after, I don't know, an hour of this, I would just got super frustrated, got out of the simulator and was like absolutely ripping pissed off. But because I didn't indulge in any self talk,

it wasn't like you suck. How can you not do this? Which is exactly what that voice would have said in the past. It was just, Oh, I am so pissed that I am not able to do this right now. Like I'm gonna come and do it tomorrow. And by the time I got from my simulator room upstairs,

I had forgotten about it. And that's the difference. Whereas before that would have stayed with me. And I'm embarrassed to say this, it would have stayed with me for the rest of the day. I would not have been able to shed that anger for the rest of the day and it would have leaked into everything I did. Whereas now, in 60 seconds, it's not that I didn't remember it happened, it just the emotion of it had dissipated already.

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A checkout. So I can imagine there's a number of people whose inner voice perhaps isn't as a pharmaceutical grade as yours was a weapons grade maybe. But presumably that means that if they were to go through a period of this rewiring, that dose could be less intensity would be less difficulty would be less like if you're patient zero for having a really, really bad inner voice, that means that people who just want to make it a little bit better because it's a bit bad should be able to get there.

Have you got any idea what was happening when you're going through it? Like what is it about speaking to the friend? What is it about that increase of distance? What is it about the saying it out loud and? Yeah, you know, I've never really thought about what's happening from a neuro from a neuro biological perspective. It would be, it would be an interesting

discussion to have with someone who's smarter than I am, um, and, or at least understands that more, but it is again, I, I didn't do this because I thought it would work. I really was like, this is kind of a dumb idea. There's no way this is going to work. And I'm going to just be doing this for the rest of my life.

And maybe the fact that I have to do this for the rest of my life is the penance for my sins. But I was like, it can't work. Like again, I just thought like it, it's so ridiculous that I'm going to do this because like you don't, what is the next thing you're going to tell me? I can be a foot taller if I think about it every day. Like if I talk to myself, I'm going to make myself taller.

Like I, I thought that this trait was as immutable as a physical trait. Yep. Yeah. You did a insanely long or intense period of therapy at one point. Can you tell me about that? Yeah, I've done two. So these were like residential therapy programs

that I went to where I spent two weeks in the first one, three weeks in the second one, where you're in a full-time residential place doing therapy 12 to, yeah, probably 12, 13 hours a day. That's like mind rehab. It's like, um, mind rehab. It's like mental. Yeah, it's immersion. Right.

So, so it's different, you know, the way people say to me, people who have felt the need or wondered if it was something they would benefit from have asked me and they said, look, you know, is it the same as just doing X number of hours of therapy? And I say it's not because it's, it's, it's sort of the same of saying like, look, if you really want to learn Spanish, would you be better served doing an hour a week with a tutor, or would you be better served moving to Spain and not letting anybody speak English to you?

Like the difference in speed with which you're going to get there based on total immersion, is very separate. I've never heard of this before. I didn't know this. It's like a meditation retreat, is very separate. I've never heard of this before. I didn't know this. It's like a meditation retreat, but for therapy. I'd never heard of it. Yeah.

And again, these, these programs, and there's probably many of them, you know, they're very well structured, right? So it's not just, it's some group therapy, some individual therapy, you know, EMDR for trauma, family history stuff, you know, it's very uncomfortable. Like there's nothing about it that's enjoyable. So it's, which, you know, I obviously is sort of like a silent meditation retreat where you have moments of profound misery and then moments of bliss.

This is probably more painful than that because you don't really have any bliss. But, you know, the people who lead these kinds of programs are very special and they really understand how to, they can pattern recognize it. The other thing that I think is pretty valuable about these experiences is none of us are really that special. We all kind of think our problems are super unique. No one's as fill in the blank as me. And it's just not true. Like we're all pretty ordinary. And you know, I don't know. Maybe that's maybe people hear that and think

that, no, come on, I am a special flower, but it's like, no, we're not special flowers. We're just kind of trying to optimize for our own, you know, wellbeing and the wellbeing of those around us in our tiny little world. And if I can suffer a little bit less, that's great. But there are lots of people who have seen my problem before. And, um, and if they haven't seen it exactly, they've seen a version of it.

It's an uncomfortable realization, but it's one that I've arrived at as well. There's sort of, it's kind of narcissism to believe, look at how special and unique and, and, uh, difficult to understand. I am, you could never, it would, it would take you an easily a decade for you to be able to get inside the cathedral of my mental pathologies. And it's not, it's not, it's, you know, and I'm, I'm deep in the, I'm in my therapy era at the moment as well. And, you know, the ease with which someone who is trained can see your

patterns and call them out for what they are. And sometimes they have a name and you go, I don't have that. It's like someone accusing you of having a disease and you go, no, no, no, it's not that it's something it's not that what you just described to me is the name of this disease. And as soon as that happens, the kind of veils fall from your eyes a little bit about you being personally cursed. I often think about that term personal curse that you can understand why the ancients used

to believe that the gods use mortals as their playthings because the phenomenon of, of, of rage or of lust or of whatever, it doesn't just feel like some neurochemical imbalance. It's imbued with meaning, right? There is a phenomenological experience of doing this thing. It's not just the thing. It's like more and to sit down with someone and for them to see you, to really see you and to observe what's going on. And this is why, you know, so much of my transition from absolute adult infant to like man child or whatever I'm at now was, it came about from listening to podcasts because for the first time ever I got to hear people that were being completely open and honest about

their experience and me going, Oh wow. Like other people have that thing. This isn't just me. I haven't been, you know, imbued with some unique army of one pathogen that like affects me in this way. Other people have a very like cursive internal self-talk. Other people hold themselves to high standards, but then also feel bad because they're not enjoying life.

Other people, and yeah, to realize that you're not as special as you think you are, and, uh, yeah, to, to realize that you're not as special as you think you are or your problems aren't as special as they think that they are. Yeah. Or as unique. Yes. Yeah. Yeah.

And there is usually a pathway, a pretty well laid out pathway of, okay, well, where does this come from? And then how do we look at it? And then how do we move forward? It's not that hard. I wanted, I don't know whether I'd be able to do two or three weeks of, of full-time therapy, uh, two hours a week is, is a heavy enough for me. So coming out the back of that, what, was there an immediate change or was this

something that required integration, like going on an ayahuasca retreat? Um, the, the, the two were quite different and occurred at sort of, they were separated by a few years. Um, I think the second one was more, was more successful, um, based on the fact that the first one I left, uh, kind of against their advice, right? So they wanted me there for another four weeks, a minimum, another two. You'd done two. I had done two and they want it. They, everybody believed I needed a minimum of two more, but likely four more. It feels like this is the worst case that we've ever seen bringing the doctor.

They're like clear. That's like the mental equivalent of that. Yeah. And I was like, guys, I'm definitely better. And they're like, yeah, you're better than when you walked in, but you're not better, better. Uh, and they were right. I didn't know it at the time. Uh, and I was wrong and I left and I left, this

was in 2017 and I left and I largely held it together until 2019. And then I kind of fell apart again. And by 2020, I was completely apart. And at the beginning of 2020, I had to, I had to go back and pick up the pieces of what I should have done the first time at a different place. And here, this is a place that's a little more intense and they get most people out in a week. And after a week, they said, you, you really need another week. And I sort of saw them. I, I, I was like, one, I had in the back of my

mind, the experience the first time and I thought, okay, I can do it. And at the end of the second week, I really thought I was there and they were like, you're not there. And I was like, I was a little, I mean, I was a lot annoyed actually. It feels like you're working hard.

You're making these sacrifices. You're trying to do better. Yeah. I'm like, I don't know what else you would want from me. Like what would it take for you to say I'm better? And it's really interesting.

I ended up staying for another week and on the the weeks there run Saturday to Friday is a week. So it's seven days, but it starts on the Saturday as the program, right? And on the Wednesday of the third week, which was the 19th of 21 days I was there was the real breakthrough. And so they were right, that's the point, right? But I only realized it then. And so to leave then on the 21st day, and, you know, and this was, you know, it was in Phoenix. So it was a long drive back home, which was a

lot of time to reflect. Um, it was, it was, it was very, very different coming back. I didn't make any of the mistakes I made the first time. And I had a great system in place in terms of therapy, which, which, uh, still exists to this day.

So I'm still doing therapy once or twice a week. And it's the perfect cadence because there are times when things are going, when there's really nothing to talk about and it's just easy to say, hey, I got nothing to talk about today. Okay. You sure? Yeah. What about this? No. All good. No. Great. But having those meetings always on the calendar, um, makes them the priority. How do you think about pulling yourself out of a negative mood? If someone wakes up on a morning and wrong side of the bed syndrome, what would be some of the places that you would say, look, here's a few things that you can do

that can reliably change your mood alongside all of the other stuff that you need to do within a day. You can't just take the day off and fly to Cancun or something. Yeah. So remember a few minutes ago, I said one of the most important things I learned in the last year with respect to this was, was that I don't want to confuse the feelings of happiness with the new, I don't want to include the, I don't want to confuse the scent of happiness with the macronutrients of happiness, borrowing from Arthur Brooks' language. I think the other equally important thing I've learned in

the last year, and I've learned this maybe sooner, but I've really been better at implementing it is, feelings exist for a reason. To be clear,, I'm, I'm not a person who believes that your feelings are right. I think they're wrong most of the time, but the point is they're, they're never accidental. Something calls them. Yep. And I have to explore the something and, and

this is where I've become, I think more savvy in the past year, which is when I get into a funk, which I do, I start to, I don't ignore it. I, and I don't judge it. Those are two very important things. So that used to be my playbook. Ignore it or judge it, ignore it or judge it. Be critical of it or pretend it's not there

and power through. Now it's, and I hate to do this because you sound like an idiot, like Ted Lasso, it's just be curious and non-judgmental about it. Like literally just say, oh, Peter, you seem to really be irritable and you really seem to be lacking interest in things that normally interest you.

You don't even feel like going out and playing with your kids. Like you're very sullen and this, that and the other thing. What is that about? Let's just think about this. Do you feel a loss of intimacy with this person? Are you afraid of this thing? Is there something that's a, you know, that, that is causing fear? Are you afraid of losing something? Are you, are you, do you feel humiliated? Like you start to go through very basic emotions that tend to be negatively valenced and you, you go one layer beneath them. And interestingly, I mean, again, it's one of those things where if you told me this five years ago, I would have said that's impossible that I could ever figure it out, but I tend to stumble into the why.

And then you can start to problem solve. Oh, all of this is due to my fear of this thing happening. And then you can start to say, well, how rational is that fear? And if it is rational, is there something you could be doing about it? And if there's not, how can you brace for this outcome? Like, so again, it's the, um, and so, so going back, the feeling itself might've been totally ridiculous and totally false, but it was a very important clue that took me back to figuring

something out. It's really cool to hear you talk about feelings in that way. This is something I'm trying to learn a lot about at the moment. I'm aware that it sounds like the most sort of performatively autistic thing to say, like, I'm trying to learn how to feel feelings, but like, here we are. And, uh, I really think that it's an area that is ripe for people who like to improve themselves. Guys and girls that are type A go-getters that want to try and achieve things, and they're

completely missing one of the huge elements of this, which is what's the day-to-day experience of your mind like? Not from a mindfulness standpoint, because even mindfulness, you can use that to not feel feelings very well. Like, thought arises and we let it go. It's like, okay, fine, you can use that to not feel feelings very well, like thought arises and we let it go. It's like, okay, fine. But where did that come from? Why did you feel that way?

And are you really applying all of the equanimity that you can to just release, relax and allow these things? That's like, uh, taking a paracetamol to stop pain. It's like the pain is going to continue to be fed up to you. What's causing that? And, um, it sounds so like fluffy and unscientific. And I think another, another part of it is especially coming from like a health and fitness side, people want to be able to control the system.

If I eat this many grams of protein and lift this much, I can expect this amount of muscle gain over a year, given the ba ba ba ba ba. But with emotions, it's just this, it's chaos, right? You don't have the same rigor when it comes to assessing them and when it comes to dealing with them. Uh, but yeah, I, I certainly, for me, it is the area that there is the most room for growth to be able to understand feelings, feel them, integrate them, work out where they're

coming from. It's cool. It's cool to hear that you've got to practice like that. I think it's, I think it's something that we need to be talking about an awful lot more. Well, it's a journey. I mean, it's, I hope to be a lot better at it

in five years, but, and I think the other thing I would really hope is that, um, I hope to be able to teach my kids because I think it would be more valuable than most things I could teach them. Right? Like I do think that had I learned this in my teens, uh, I would have saved myself and by extension, a lot of other people, a lot of pain, um, and,

and a lot of that, you know, the detonation. So, um, yeah, I, it'll be interesting to see like at what point is, is a, is a child sort of mature enough to, to sort of start to, you know, metabolize that. Learn how to emotionally self-regulate and all the rest of it. In other news

This episode is brought to you by Marik health when I wanted to get my blood work done in America I asked around I did a ton of research Marik health came back as the best quality service that you can find and I loved It so much. I reached out to the owner to actually partner with them on the show. They genuinely understand training diet Supplementation and pharmaceuticals. They don't want to make interventions you don't need. They will make suggestions that are minimum dose and appropriate for you and your goals and your age. They're great. It is literally like having a personalised bio health hacker in your pocket that understands

you and your bloods at all time. You might have heard that I took my testosterone from 495 to 1006 and that was with the help of Marik Health without using TRT but by optimising everything else that I was doing in my life. Right now you can get the exact same service that I got by going to the link in the show notes below or heading to marikhelth.com slash modern wisdom. That's M-A-R-E-K health dot com slash modern wisdom. One of the other things that's been happening a lot recently is the rise in TRT usage among young young men, um, maybe in part due to hoping to elevate their mood to improve the way that

they feel. What's your opinion on the, what appeared to be increasing numbers of young men using TRT? Uh, I'm, I'm greatly concerned by it. Truthfully. I think it's, um, I, again, a lot of men, I think don't understand the risks of TRT. And while testosterone is a very safe therapeutic,

I mean, if done correctly, it's safe, a hormone as there is. But, you know, if you're talking about a young If done correctly, it's as safe a hormone as there is. But if you're talking about a young guy who doesn't actually understand the impacts of testosterone on fertility, for example, later in life, doesn't understand what a physiologic dose is versus a super physiologic dose. And especially in the cases where guys have to

get this stuff illegally, then you introduce a whole new layer of contamination and all sorts of things like that. So, net I'm a little concerned, maybe a lot concerned. I also think there are lots of clinics opening up that are kind of trying to circumvent some of these issues.

And again, I think their motivation is to capitalize on an obvious interest, but they do so without necessarily a nuanced approach to how to do this. Take me through the risks of TRT. What are they? High level. So it depends on the, if we're going to talk about TRT done correctly, do you mean literally TRT, testosterone replacement therapy or the- That and it's more malignant offshoots where people start to push dosages and stuff. Take us through the range. Well, I would say let's start with what's sort of known in the medical world, right?

So we'll start with kind of appropriate physician administered testosterone replacement therapy. For an appropriately aged individual. For an appropriately aged individual at an appropriate physiologic dose. Cool. Okay. So the two big risks that people have historically been concerned with are prostate cancer and heart disease.

So an increase in the risk of prostate cancer and an increase in the risk of cardiovascular disease. Both of these have been studied extensively, and I think we can make a very strong and compelling case that testosterone replacement therapy is not increasing the risk of prostate cancer at all. And it may in fact be decreasing the risk slightly.

Um, I've done an entire podcast, I think two podcasts on just that topic. That's how nuanced it is. Um, but again, we, to give you just one example, when we have a guy who has undergone a prostatectomy for prostate cancer, he's had his prostate removed, we will still use testosterone replacement therapy in that guy.

So think about that. You have a guy who had prostate cancer, you will still give him testosterone replacement therapy if it's warranted or indicated post prostatectomy. Now, do you do it and shut your eyes and never look again? Of course not. You're still monitoring his PSA every three months and you're going to look for any sign of recurrence. And if there is, in fact, a recurrence, you would immediately cease it because what we do know is testosterone

would feed prostate cancer. But the point I'm making is around initiation. Is there any evidence that testosterone replacement therapy initiates prostate cancer? The answer is no, there is not. And there is some evidence to the contrary. The cardiovascular disease question is a little bit more difficult and the data are a little bit more muddled, but on balance, they come out in the direction

of TRT does not increase the risk of cardiovascular disease. There's a big trial that was completed last year called the Traverse Trial that gave men androgel, so topical testosterone, and followed them for I want to say three or four years. There was no increase in the incidence of ASCVD, atherosclerotic cardiovascular disease. But there is, so at face value, that study was taken to mean, look, we have one more study, the biggest and best that demonstrated no increase in the risk of cardiovascular disease with TRT.

So the debate should be settled once and for all. Um, I did a podcast on this, wrote a long newsletter on this and the long and short of it is that's a, in my view, that's a slightly premature conclusion because I don't think the traverse study was done perfectly. Uh, most importantly, it, um, did not give men a high enough dose in my view.

So the men started out very hypogonadal with a total testosterone of somewhere between one and 300 nanograms per deciliter, but they were only replaced to about 600 nanograms per deciliter. And while that's a reasonable rate of replacement, I don't think it represents what's happening in the world. Yeah. I mean, we replace patients to higher than that. We replace patients to 800 or 900. We're technically tracking free testosterone and not total testosterone, but usually to get somebody in the range of where we think a good free testosterone is,

we will see a total testosterone that's easily in the 800, 900 nanogram per deciliter range. So it's possible that Traverse Trial only answered the question, does low dose, or as one of my analysts put it, does testosterone light replacement therapy increase the risk of cardiovascular disease? And I think there we can say the answer is probably no. Okay. And what about testosterone replacement therapy when it's done badly?

Yeah. So I think if you even think about it in the medical setting, I think testosterone can be given to very super physiologic levels. And I see patients getting super physiologic levels all the time. They come into our practice, they've been treated at some tea clinic and they walk in with a free testosterone of 35 nanograms per deciliter. Um, you know, which is like twice what you would consider reasonable. And, you know, part of the problem is we don't really know what the long, everything goes out

the window with what I said earlier. Now, can I say that that doesn't increase the risk of prostate cancer initiation? I can't say that because I don't have the data. Can I say that that doesn't increase the risk of prostate cancer initiation? I can't say that because I don't have the data. Can I really say that doesn't increase the risk of cardiovascular disease? No, I can't. It's also by the way, creating a lot more

erythrocytosis. So those people are making red blood cells at an alarming rate and they need to be monitored very closely for increased blood viscosity. Is that, uh, I have a friend of a friend who donates blood every month. Yeah. Is that.

That's why. Because they just making too much and it's too thick. Correct. Wow. I mean, good for the blood donation. Yeah. And again, the question is if you have to give blood every month, if your bone marrow is so revved on that you have to give

blood every month, do we run the risk that you're going to convert into polycthemia vera at some point, which is a disease now where all of a sudden you can't shut that process off. So it becomes self-sustaining even once you've come off the TRT. Yeah. Again, I'm not suggesting that that's happening. What I'm asking is we don't know, right?

And then there's just a big unknown there. The other thing is once you start to get into these super physiologic doses, you start to run into other issues around a lot of estrogen and a lot of DHT. So you'll see these men who are on these super physiologic doses of testosterone also showing up on five alpha reductase inhibitors, which we could talk about why I'm not a huge fan of those, and on aromatase inhibitors, which I'm also not a fan of. Is that to stop gyno and hair loss?

Yes. Right. And obviously I'm not a guy who takes hair loss very seriously, but I think it's a mistake to take a five-valve reductase inhibitor for hair loss. I think there are far better strategies if it matters. And I think even though the risk of finasteride syndrome or post-finasteride syndrome is low, it's not zero and it's potentially irreversible. And this is, this is, I think in a young man taking finasteride, again, if you've been, if

you're listening to this and you're on finasteride and you have no issues, you're fine. It's something that if you hasn't kicked in within, you know, six months, it's not going to kick in, but, um, we do, we do see men who have like a permanent loss of libido. This is reported in the literature. That's what finasteride syndrome is?

Yeah. Okay. So, so basically there's something about blocking DHT that might not be a great idea. Permanent loss of libido would be bad. Um, what, what else haven't we spoken about when it comes to exogenously increasing testosterone levels fertility? Yeah. Well, there's another thing that I think isously increasing testosterone levels, fertility.

Yeah. Well, there's another thing that I think is when you, yeah, fertility for sure. Right. So at, um, once you give exogenous testosterone, um, you're going to cut down on endogenous production, including sperm production. And therefore you're going to see a reduction

in fertility and at some point that's real retrievable, uh, and at some point that's retrievable. Uh, and at some point it becomes more and more difficult to retrieve. So it depends on the person's age when they start and what their testicular reserve is. But, you know, generally speaking, two years of exogenous testosterone can spell the end of endogenous production and therefore a

lifetime dependency, which again, we do that all the time. Like if a guy is old enough and decides it's time to go on TRT, we fully accept that. And there's no risk of being on lifetime T for life within physiologic doses. But for a guy who's young, that might be an enormous risk.

And we, you know, we see this all the time where guys who are doing this in their 20s decide they want to have kids in their 30s and they can't. What else haven't we said about the risks of TRT? I think there's another method of delivery using clomaphene and these are drugs that have the advantage of preserving fertility. They work by inhibiting estrogen receptors in the hypothalamus that trick the brain into thinking you need more testosterone. So now the brain via the pituitary starts producing

more follicle stimulating hormone and luteinizing hormone and you end up increasing endogenous production. And again, I might be a, an unusual skeptic in this regard, but my concern with that approach typically centers around yes, you raise testosterone, but are you getting the full benefits of testosterone? Because I think one of the benefits of testosterone is the benefit in the brain. And if you're now blocking estradiol's impact in the brain, um,

certainly anecdotally, there's questions about whether you're taking away some of the benefits of testosterone, including mood and libido. Would you have any concerns for people being on Clomid for a long amount of time? Is that something that you think shouldn't be used? Um, I would feel very strongly about people

not being on Clomaphin or clomid for a long period of time for another reason, which is it really increases the production of a sterol called desmosterol. And the reason for that, there's a lot of problems with that, including potentially an increase in the risk of atherosclerosis, increase in the risk of cataracts and things of that nature. So I think long-term use of Clomaphene is probably not a good idea. The drug was never intended to be used long-term. It's a fertility drug.

So it's intended to be used short-term. And I think short-term rises in desmostral are not problematic, but lifetime increases or many years of increase, I think would be. And there's a drug that was, there's a drug that increased as most raw levels in the fifties and sixties that was actually pulled from the market because of the increase in cataracts and the increases in

cardiovascular disease. What, what about these, I went to a Prospero in Roatan, which is one of these network states. There's no FDA, uh, jurisdiction there. People are doing experimental follow statin gene therapies. The dudes from tiny circle are doing all of this stuff. It was, it was fun. It was like, I didn't get injected, but I got to see kind of the stuff that was

going on, but I was with, uh, two peptide scientists, one that synthesizes and one that uses them incredibly heavily with clients and stuff, and they were telling me about, is it, it a BT 101 or something? There's a particular peptide that is able to induce testosterone from the brain, which sounded like Clomid, but without this particular feedback mechanism. Are you familiar with any of these? No, not with that one. I'll find some, I'll find some info and put it to you.

Okay. So let's say that we're going to go to the other side of the fence now. There are guys listening who want to naturally improve testosterone production. What are the big movers? What would you suggest? I mean, this is gonna sound like a real crap answer.

I don't think there is a bigger way to naturally increase testosterone than adequate sleep and reduction of cortisol. I think hypercortisolemia stress probably has the greatest negative impact behaviorally on the endogenous production of testosterone, probably through the pituitary gonadal axis and how much can it move the needle? You know, probably to the tune of three or 400 nanograms per deciliter. So if you're not sleeping well and you're under

a lot of stress, it's very easy to end up hypogonadal and therefore fixing that I think is far more beneficial than sort of the litany of supplements out there that may or may not have marginal benefit. So the. Now for women, there's a different answer, but for men, I would say that that's the answer. The hard charging dude that's, you know,

maybe mid twenties crushing it in the office, going to the gym, maybe partying on weekend once or twice, a bit of alcohol, whatever, whatever. Uh, this becomes kind of vicious feedback loop, which is precisely why men are looking to things like TRT because of how hard they're potentially pushing themselves during the week. Yeah. And I think that, you know, so, so to that guy, what I would say is why do you want to replace your testosterone? So let's say he goes and gets checked out and his testosterone is 300 nanograms per deciliter, which, you know, probably puts him at the 10th

percentile, uh, for a man his age. So undoubtedly that would qualify as hypogonadism. So the question is, do you want to fix that because you don't like the number and, or is there a symptom we're trying to fix? And if the symptom is what we're trying to fix, then I would say let's fix that symptom, i.e. poor energy, poor mood, poor libido.

Let's fix that symptom by fixing these other things over here. And by the way, along the way, we might also improve your testosterone. But I, you know, again, like I guess I don't treat that type of patient. So maybe someone who does is listening to me and saying, well, you don't understand.

And, you know, that guy, even though he's only 24, we're never going to get him out of that spiral. If we don't normalize his testosterone and, you know, again, that, that wouldn't be my approach, but I want to be mindful of talking about something I don't do for a living. What about women? Yeah. I think with, with, with women, we have one more trick up our sleeve, which is DHEA.

So again, doing all of the normal behavioral stuff, but it's a little harder to make the connection in women. And this is something I actually learned kind of recently because I used to be very dismissive of DHEA because in men it has no effect whatsoever. But DHEA of course is what allows for adrenal production of testosterone. And the reason it has no impact on men is if you increase a guy's testosterone by 40 milligrams per deciliter, which is about what you're gonna get from adrenal production if you maximize it,

you don't move the needle at all. So taking a guy from 300 to 340 is doing nothing. But if you took a woman from 40 to 80. What's a typical woman's range? Well, it depends by age and it also somewhat depends on where she is in her cycle. But, um, I would say, you know, normal for a young woman might be 60 to a hundred nanograms per deciliter.

Yeah. So if a woman is, you know, symptomatic and she's 30 and you take her from 30 up to 70 with just the addition of oral DHEA, like that's a win. Are there risks? Um, I mean, the biggest risks for women at that 70 with just the addition of oral DHEA, like that's a win. Are there risks? Um, I mean, the biggest risks for women at that level are, you know, the side effects, I would say, right?

So you're looking at increased acne, maybe body hair at that devil, at that level, you're not going to get any of the other real risks that we see with TRT in women. Yeah. Clitoral enlargement, voice deepening and all that stuff. You're not going to get that at those doses. We'll get back to talking to Peter in one minute, but first I need to tell you about Mementos.

You might have heard me say that I took my testosterone from 495 to 1006 last year and two of the supplements I used throughout that were Fidogeoagrestis and Tonkat Ali. I first heard Dr. Andrew Huberman talk about these really impressive effects, which sound great until you realize that most supplements don't actually contain what they're advertising. Momentous make the only NSF certified for Doge Regrestus and Tonkat Ali on the planet. That means they're tested so rigorously that even Olympic athletes can use it and that is why I partnered with them. So if you're not performing in the gym or the bedroom the way that you would like, this

is a fantastic place to begin to naturally improve your testosterone and there is a 30 day money back guarantee so you can buy it, try it for 29 days and if you do not like it, they will give you your money back. Plus they ship internationally. Right now you can get 20% off everything site wide by going to the link in the show notes below or heading to livemomentous.com slash modern wisdom using the code modern wisdom a checkout. That's live M O M E N T O U S dot com slash modern wisdom and code modern wisdom, a checkout that's live M O M E N T O U S.com slash modern wisdom and code modern wisdom. A checkout. Have you got an opinion on the no fap movement?

That's something that's put forward as a potential solution for guys with low T. I'm sorry. I don't even know what it is. Let me teach you about no fap. This is my specialty. It's a men purposefully abstaining from orgasm, either from themselves or with other people. Why? Because it's an internet subculture and the internet likes trends.

And this has been a, what does it have to do with the tea situation? That there are guys out there who have created a link between the frequency of ejaculation and their masculinity, both. Inverse relationship or direct relationship? The more that you do it, the more your energy is sapped. I see. Got it. Has this ever been clinically observed in any form? I can't say it. If it has, I'm not aware of it. What a shame.

I can't say it. I, if it has, I'm not aware of it. What a shame. Jero science researchers report an astounding case study of a 93 year old with the physical fitness of a 40 year old. This was the rower that I wrote about a few weeks ago. Tell me the story of this. Yeah, it's an interesting fellow. He, um, was not a lifelong athlete at all.

Right. So that's the beautiful part of the story in my book. If you're, if you're listening to this and you're a normal person, so was he. And he just kind of took up rowing, like classes, rowing classes. You go, you get on a rowing machine and you just sort of do it.

And he just took such a love to this thing and got so good that at the ripe old age of 93, I mean, honestly, I think his VO2 max, I don't remember if it was reported in the article or if we tried to back calculate it based on his times, but I mean, he at least from that perspective, from a rowing perspective would have the fitness of a great 40 year old. Now I don't want to misrepresent and say that he's a 40 year old because he's not, right? He doesn't have the muscle mass of a 40 year old, although he does

have very low body fat, right? So if I recall, his body fat was probably 16%, which is outstanding. Is his muscle quality the same as yours? No. Would his coordination or fall risk aversion be the same as yours? No. But look, the point is when you compare him to another 93 year old, he's clearly functioning at a level that's in totality, I would say, at someone in their seventies. And to me, that's the game. I'm way more impressed by and interested in that guy than I am in any influencer I see doing any feet of strength, running anything. I don't care. Like I don't care what you can do when you're 40.

I really don't. I really care what you can do when you're 90. How long was he training for? Decades. I mean, this was not. So he'd fallen in love with running, with rowing at 60 or something. In his 60s or something.

Yes, exactly. Okay. And he'd accumulated this capacity over time. Yeah. So think of him like a guy who, you know, didn't really accumulate much wealth until he was 60. And then started investing, but was an amazing investor and a consistent investor and compounded

and compounded and compounded. And in his nineties, he's a billionaire. And it's sort of like, wow, how did this guy justed. And in his nineties, he's a billionaire. And it's sort of like, wow, how did this guy just become a billionaire in his nineties? Well, I mean, he did all this incredible stuff for the past 30 years. Now the good news is you can start that at 30 and be a ridiculously fit 60 year old. And by the way, you'll be a ridiculously fit 90 year old as well. Yeah. It's, it's cool to hear stories like that because I think we've turned such a corner with our understanding of health and fitness within the last, even just

communication about anything, emotions, meditation, history, philosophy, whatever. But there must be a number of people, especially like my parents' generation, who feel a bit. Miffed about the fact that God, if I'd known this when I'd been able to hold on to my health as opposed to doing it now, when I'm in my sixties, that sucks. But you have this example, the other guy who did do that in, you know, what would be considered serious later life, especially for an athletic career to begin or a health and fitness regime and has shown just how powerful that is. Like that's, I think that's very, it's a

very cool story. Yeah. So he's, he's kind of like the poster child for this centenary into Cathalon. I, that I love to talk about, right? It's the, it's the, it's the mental model for what, what I train for, what our patients train for and what we really kind of care about.

Give me your thoughts on Brian Johnson and what he's doing. I don't know him. Have you been observing any of the stuff that he's done with blueprint, with the supplements, with the lifestyle? I try to ignore it. Why? I just have no interest. Okay.

That's interesting. It seems to me, I spent a little bit of time with him. He's been on the show and I spent a bit of time with him in, um, Honduras. And, uh, I think he's kind of like, the way I've come to conceptualize what he's doing for certain areas of the longevity movement is kind of like a scout in an army. It wouldn't do to have an entire army of scouts, but I'm totally fine with someone doing something kind of

experimental and maybe dangerous, maybe not dangerous, whatever, and sort of going up to the, you know, the rocky cliff edge and looking out over the top and then coming back and kind of telling us what they've learned. Um, but I'm both glad that I'm not a scout. Uh, and also I don't think it's necessarily in everyone's interests to also be one too. But it's interesting. I asked him a question saying, uh, is he afraid of death?

Uh, given that almost everything that he's doing is focused on not dying. How much from your perspective, do you see the longevity movement overall and biohacking and health hacking and stuff being a kind of rehabilitated death, denialism, fear of death movement? I don't know. I mean, that's a great question. I, because I don't consider myself part of that movement. I don't, I don't want to speak for it.

I don't, I don't really know. It's probably best to ask those who firmly put themselves as leaders of the movement. I know that I'm probably just as afraid of death as anybody else. I don't want to represent that I'm some monk here who's so at one with the universe that he can't wait to die. I don't want to die. And by the way, I think it's less a fear of death and more a fear of not being here. That's the part that we can't really contemplate. You and I don't have a conception. Nobody listening to us has a conception for what the world exists without that individual in it. That's impossible to fathom. The older you get and the more you have a family or things like that

and you fall in love with things outside of yourself, you then realize, well, actually what would bother me most about death is not being with my family. The stakes are now high. Yeah. So that said, I find the, I find the focus on death avoidance to be futile and silly. So I don't believe there is any scenario ever in which we avoid death. I am a hundred percent in the camp that says we are all going to die. Doesn't matter how much biohacking you do, we are all going to die. So can we delay that? Yeah, I think we can.

Um, can we delay it by a hundred years? Don't think so. Can we delay it by a decade? I believe so, but I like to focus on health span. And I think that that's, I think that's the, the real shortfall of, of, uh, the healthcare system today is that it focuses so much on lifespan and it still does a

lousy job extending it because it does it at such a low quality. But what I think is really good about health span is if you really focus on health span, how strong am I, how much bone density do I have, how good is my VO2 max, how metabolically flexible am I, if you focus on those things, you will get the lifespan benefits along the way, but your, but

your, but the health span piece is actually harder, so focus on that and you get the tail wind of everything else. How long do you think given what we have at the moment, current human physiology, current medical advancements, all the rest of it, if someone threads the needle and manages to avoid any sort of big catastrophes, what do

you reckon is the ceiling for human longevity? Such a great question. I mean, we, we know obviously to date what the ceiling is, right? Which is just based on the longest lived human, which is probably 123. Um, so we know from the study of centenarians that who do live on average, right?

Like two decades longer than the rest of us, they still succumb to the typical diseases and if they don't, you know, they're eventually just going to get pneumonia or something right. So even if you don't succumb to a disease, at some point your immune system and or frailty ultimately end you. Now I am excited about some really cool science that I think can bend the arc of those curves. So if you talk about frailty, sarcopenia, and you talk about immune senescence, I think there's some very interesting therapies that will occur in our lifetime that could push those things back tremendously. So again, I don't give up hope entirely that there's a way to dramatically increase lifespan. But I do find myself troubled by people who think it's going to happen on the back of like this supplement or this goofy,

this goofy, you know, harebrained idea. Like the depth of science that is necessary to do that, I mean you are rewriting the entire epigenetic code to do that. Like that to me is the only way you can revert a cell back to its nascent self. So this is not like sprinkling a few Yamanaka factors, OSKMs on a cell and just, you know, wishing that you're going to end up with a STEM cell back there. Like, no, no, no, no, no, no, this is very deliberate cellular reprogramming. And we clearly don't have the technology to do

this yet, but it's plausible in our lifetime. And then the question is how causal are those changes? Right? That we don't know yet. We know they're correlative, right? So we know what the methylation pattern and the epigenome look like on an old T cell versus a new T cell. But what we don't know is did those changes cause the phenotypic change? And if they did and they did alone and we reverse it, do we get a young T cell back again? Yeah. So some super high dose of NMN or rapamycin or

pick your compound of choice, this isn't going to be able to go in and, and rewrite that code. No, there's no evidence that it will. It's very interesting. Yeah. I, um, I think a lot about what people are trying to achieve with, with the longevity movement, actually that's one question. So you mentioned before that eventually.

So what is it? It's funny. I really, I don't say this to be naive, but like, I don't even, I'm so, I don't pay attention to movements of this nature. Like what, what is the longevity movement? Is this really a thing? I'm pretty sure that r slash longevity is the biggest sub Reddit for people trying to

extend their lifespan. I may have misrepresented them. It may be health span. It may be, you know, there'll be some like very nice synopsis of it. It will be living longer and better or something like that. Right. Uh, but it's a movement of people that are biohackers, health hackers in one

form or another, many of whom will probably be massive fans of your work. But, you know, so, so again, if it's people who are interested in being healthier, but I was thinking more about this idea of like immortality and. Well, I mean, you know, Peter Diamandis has this idea of longevity escape velocity that for every year that you stay alive, there is an amount of time that you, your life is extended because of improved medical stuff and longevity escape velocity is living sufficiently long during this period. That's kind of like the dark ages or the backend of the dark ages of medical

advancements so that you reach this period where you're actually able to extend it infinite. Sure. Um, so that's a question I've got. You mentioned that people in these blue zones or people that are centenarians, super long lives, eventually they succumb to something. Is there such a thing as dying of just old age or is, does everybody die of something? Well, look, there are some people who dying of just old age or is, does everybody die of something? Well, look, there are some people who we would just sort of say they just died in

their sleep and there was nothing really obvious wrong. So we have what is that? Yeah, I don't know. It could be an energetic problem, right? At some point, their mitochondria literally stopped producing enough ATP for them to, to, to, to respire. Um, but you know, I think, yeah, but I think honestly, like, I think many of those people are probably dying of a stroke or a heart

attack and we're not doing autopsies on 104 year olds who die peacefully in their sleep. We're rejoicing them. We're thinking, God, I hope I can be so lucky. Yes. Yes. Yeah. Yeah.

Talk to me about the- Because remember, even if you did an autopsy on someone who had a heart attack, if you didn't catch it, like depending on how long after the heart attack they die, you might not see any evidence of it in the heart muscle. Oh, right. Okay.

So you can show that that person could have died of it and you can show no evidence that that was what caused it. Exactly, right? So if a person is really, really old and you can show no evidence that that was what caused it. Exactly, right? So if a person is really, really old and they have quite calcified coronary arteries with lots of plaques, it's not entirely clear that you would find the exact place where they would have had a heart attack.

And whereas it's more obvious if someone has a heart attack and they live for a while, because then you have a beating heart and a piece of heart muscle that's dying and you get a contrast between the two. Right. I see. That's interesting. I didn't know that.

And again, like I said, most of the time you're just not doing autopsies on these folks. Talk to me about what you consider to be the basic supplements most people should at least be considering. I'm aware that this is incredibly individualized, but most people want to perform better, have some good energy, do well in the gym, so on and so forth. What are the areas in which most people should

be at least looking at supplementation or are there any at all? I mean, I think most people probably would benefit from magnesium. So you have to then decide on which, which ways to take it. Um, I did a whole podcast on this because it is complicated and you want to talk about the speed

with which magnesium gets absorbed. Are you talking about organic, inorganic? Are you taking it more for performance and avoiding cramping? Are you taking it more for GI regularity? Are you taking it more for cognitive, uh, benefits? So all of those would be different forms. I actually take three, maybe four different

forms of magnesium. So I'm keeping track of both the total elemental magnesium I'm getting, but more importantly, the form I'm getting in and how I'm titrating each one to these benefits. And what are you going for there? All of the above, right? So it's GI function, it's- One of the- Muscle function, which ones I'm taking. Yes. So slow mag is my favorite for, uh, as its name suggests, slowly absorbing magnesium. So, you know, minimizing any PVCs and cramping

basically for a person like me, who's very active, sweats a lot, you know, live in Austin. Uh, then I take, uh, magnesium, uh, oxide, which is kind of more the GI version of that. And then I take magnesium L3 and 8, which is the cognitive part of that. So that's the one that gives you better cognitive absorption. I'm trying to think if I take a fourth one, I probably have some magnesium and something else I'm taking, but those are the big three. Okay. Magnesium? Yeah. Creatine, monohydrate. At?

Five grams daily in, I use, again, I don't think it matters when you take it truthfully, but the most predictable and routine time for me to take it is during a workout. So just mixing it in with electrolytes and water and drinking it. Put it in with something else that you're already drinking. Exactly.

Otherwise I'll forget to drink it. Uh, I can't remember. Was it, I think it was Tim Ferris who was talking about, uh, some benefits from much higher doses of creatine 10 to 20 grams a day. Have you looked at any of this? Have you seen any of this stuff? Uh, yeah. I mean, look, when I was a kid, that's how you dosed it.

You would load it. You would do 30 grams a day for a week and 30 grams a day for a week. And then down to grams a day for a week and then you go 30 grams a day for a week and then down to five a day. Now my last look at this literature said that was not necessary at all. And taking five a day, you'll very quickly get to your saturation levels and you're totally fine.

Is there a size of human for whom, if you're 260 pounds, should that be a little bit more? That's possible. I, I, I. And if you're 260 pounds, should that be a little bit more? That's possible. I, I, I. And if you're a 120 pound woman, 110 pound woman, maybe would you keep it at five? I mean, I do. And the only time I sort of tell people to dial it down is if they get GI upset from it, which some people do. Okay. Magnesium, creatine?

I think a lot of people probably could use a little bit of help with methylated B vitamins, maybe some TMG. Again, I- What's TMG? Trimethylglycerate, which is basically we would use these to titrate homocysteine levels. So, if a person's homocysteine levels are elevated, you can basically get their homocysteine levels. So if a person's homocysteine levels are elevated, you can basically get their homocysteine levels normalized with methyl B vitamins. Now, we don't really have, I'm trying to think, we have one study that speaks to the efficacy of that for brain health. But what we're doing is using a proxy, which is we know that homocysteine levels when elevated play a role in at least two diseases, dementia and dementing diseases and cardiovascular disease. And so by asking the question, if you lower homocysteine levels,

do you address that? You're asking the question indirectly, lower homocysteine levels, do you address that? You're asking the question indirectly, is homocysteine causally related to those diseases or not? And looking at the neurodegenerative side, it appears more likely that it is. And there's a very clear mechanism for how homocysteine could be causally related in cardiovascular disease vis-a-vis its impact on endothelial function

and endothelial health. But I would say that that's kind of a soft recommendation. I've got one copy of C677RT or whatever. You know how many people I've met in my life who have the wild type for both MTHFR genes? And you have to keep in mind how many people I've looked at in the past 15 years. I've seen two people that have the wild type.

So everybody has one of the snips on these genes. I actually think they should be the wild type, truthfully. Yeah. I think we've got it backwards. Well, we recently did a reformulation of a mutonics drink and, uh, I was like, guys, can you just check? We're using natural folate for this, right? And we're like, yeah, we are. I was like, we're using methyl cobalamin, right?

We're using methylated B12. And they're like, yeah, we are. But you just don't realize how many, especially if you are thinking about homocysteine levels, if you're thinking about how you're taking B vitamins and you're not thinking about that, totally not, oh, this could be like folic acid or this could be the non-methylated version of the B vitamins. Really interesting.

I take Theracumin. What's that? It's- Activated cumin? Curcumin, yeah, it's basically a more liberated form of curcumin, so more bioavailable. Liquid? No, capsule.

Capsules, okay. What dose? Just more expensive. Good question.? Nope. Capsules. Yeah. What dose? Just more expensive. Good question. I don't remember the dose. It might be 300 milligrams, but I'm not sure. Okay. It's amazing for how often I'm asked this question, you'd think I would know this better. There's other things I just don't recall them.

Magnesium. Yep. Creatine, methylated B vitamins, if appropriate to bring home a cysteine in line. Yep. Cucumin. Or theracumin. Theracumin, special curcumin.

I used an absolute ton of curcumin when I, I ruptured an Achilles four years ago and, uh, I went through playing cricket the British way. And, um, uh, I just threw the kitchen sink and it was COVID. I had nothing else to do. Uh, so I asked every person that I could, how can I keep inflammation down? I can have a, so, uh, TB 500, uh, BPC one five seven, every tarts, cherry juice, like any waving sage over the top of it, making an incantation at the full moon, all of that stuff.

I did all of the things and, uh, the recovery was actually actually really, really good. If anyone ever considers blowing out their Achilles, doing it during a pandemic is actually a really good time to do it because there's nothing else to do. And I grew it back. It's probably the injury I'm most afraid of. It's 12 months of full, very intense. So do you have a sense of why it happened? So I went back to as many people, I mean, this should be a public service announcement.

If you used to play a sport when you were in your teens and you're now 35 or something and you think I'm going to pick that sport back up, very, very slowly reintegrate it. The number of friends that during their teenagers played basketball and then decide to go and play basketball now that they're 34 and they've spent the last two decades gaining muscle in the gym and they're nearly twice as heavy as they were when they played this. And within the first couple of games, they blow out an MCL, the number of friends I've had, it's like a list of friends that have done this just in my friend group. And for me, I was, did one training session to play cricket performed sufficiently well

during that session that I got invited to play on the Saturday. And then with a very limited warmup as normal sort of club cricket is, stepped out to bat. It was having so much fun. It was great. The sun was shining. My dad was over the far side.

We slowed the halt of wickets that we were losing. And I was like, this is the first time I've picked up a bat apart from the net that I did on the Wednesday. This is the first time I picked up a bat in over a decade. I am like 35, not out and playing really good shots. And I just pushed a single through the covers on the right-hand side and set off to run.

And then as I felt something weird, did you hear it? No, but there was shouting at the same time, uh, from the players on the, the fielding team. And then as I went to put my right foot on the floor, it was like if you tried to step on an inflatable water bed on water and it just went like that. And then the bastards ran me out. So while I was laid on the floor like this,

in the middle of the pitch, they went and picked the bales off, which meant I didn't get like a, whatever, is an injured like DNC did not complete or whatever. Uh, they actually ran me out, which was fine. That's okay. Uh, I think the reason that it would have happened was we'd done shuttle runs on the Wednesday, I wasn't doing a massive amount of like high plyo stuff.

And then when I set off, you're wearing spikes on a very hard surface and it's digging into packed dirt, which is what the strip is that you're bowling on. And I pushed the shot through the covers and then set off with my back foot. Heel would have been a little bit off the ground. So calf would have been lengthening as I'm contracting. And then it would have just hit the floor and went. And that was me for, you know, 12 months, uh, 13 days and then got, uh, did you have a complete tear?

Yeah. Full detachment, full detachment. Yep. So got carried back over and I knew within three seconds, I was like, I think that's what that is. And I just, I didn't know enough about it. If I'd known more about it, I would have been more scared. Um, but on the flip side of that, my, uh, calf strength now and mobility.

I've got really insane dorsiflexion, but for anyone that does do it or anyone that's done it recently, yeah, it's going to be a long rehab or if you, if it happens in future, it's going to be a long rehab and it's going to suck in. You're going to feel a little bit unhappy about it, but my function strength, power, everything is back to where it was, including muscularity. So if you looked at my car, I overshot it on my right, on the one that I busted and then had to go and do more work on the left because I built that one back up. And, um, yeah, I think good rehab plan, take your

time getting back to it. And within 12 months, you'll be doing everything that you were able to do. And within two to two and a half years, you won't know that it's there. The only way that you can tell is if you look or if you give it a squidge, cause it's, it's a, like a girthy, it's a girthy boy now.

But, um, one of the things you haven't mentioned is omega threes. Oh, thank you. I do take that as well. I'll keep you right. Um, talk to me about anything else I should be taking cause you're going to remind me. Um, uh, Rhonda Patrick was on the show, big on

omega threes really took me through some interesting stuff to do with, uh, Ethel Estes versus the reactivated version. Yeah. I used to know this and I have, I don't know it anymore. What are you taking? I take Carlson's. I think there are a couple of brands out there,

Nordic Naturals, Carlson's. That's what I'm using. That are pretty good. And I've gone back and forth with them. And then we, you know, you test your levels to kind of see where you're getting the most bang for your, by buck, I don't mean dollar, but how many of the things, how many of the horse pills you have to take. Yep.

Do you know how many you're taking today? I take three of the most potent one that they make, which I think is called elite or supreme or something like that. Whatever the most expensive one is presumably. Yeah. But it's got the most EPA and DHA in it. Are you timing that particularly? Is it with a fatty meal?

Yeah, I mean, because I'm, my compliance is the most important thing. I have an AM and PM slide of, of things that I take. So I think I take one in the AM, two in the PM, or maybe it's the reverse. So, but the point is I just know what I'm, I used to take two and two, but I've titrated it back a little bit. So I'm doing it based off what the EPA and DHA levels are in the red blood cell and the membrane.

Yeah. Yeah. It's a, and I'm sort of trying to keep it between 10 and 12%. It's just for me cooking seafood at home. It's so rare. Like it's the, it's all of the other thing, red meat, ground beef, even liver is more likely to do that than for me to actually think, I should buy salmon.

And it's just one of those things that kind of doesn't really appear to me. Now often try and do it when I go out for food. One thing I've fallen in love with over the last year is oysters. Dude, I love oysters. Now I've become, this is what being an adult is you drink coffee and you have oysters, um, but I've really enjoyed that, but at this is what being an adult is. You drink coffee and you have oysters. But I've really enjoyed that, but at home, it just doesn't factor. So for me, supplementation, when it comes to that, I think is probably really important.

I think so one of the other things that people are quite obsessed about at the moment is water quality. How long of a lever is this? How much should we care about water quality and what it's being transported in and stuff like that? You know, I think it probably depends on where you are and what the risk of contamination is. You know, I mean, I think I take reasonable steps

to ensure it, but I'm also not so obsessive that my life spirals out of control around it. Now that said, I mean, we have, we have a couple of reverse osmosis filters in the, in the house. AquaTruz? I don't know, but I know that they meet the standard for filtering out all PFAS. So there's a, there's a filtration standard that you have to go by and.

They're plumbed in or tabletop. Uh, they're plumbed in. Cool. Yeah, that's cool. Yeah. So it's easy peasy. So all. Change it once every six months or whatever.

Yeah. All water bottles are, you know, we use glass water bottles, they're all filled out of those things and you know, the coffee're all filled out of those things. And, you know, the coffee pot gets filled out of that thing. So the only water I'm drinking out of the tap that's not that is in the bathroom when I'm brushing my teeth, um, and taking my pills

before bed or whatever. Um, so I don't think I obsess over it. I, you know, I, I think that the two most important things you can do to avoid PFAS from a drinking perspective. Or PFAS for the people that don't know. Yeah. So there are these chemicals in plastics, typically, that I think we could make a safe case for having negative health consequences.

Now they're also found in things like Teflon and fire resistant, you know, clothing and things like that. So they show up in other areas, but for most people, the dominant exposure is through drinking, um, water in a plastic bottle, um, or contaminated city water, if you drink it. And, you know, I haven't had our water tested, but I just sort of assumed like why bother testing it?

Why don't I just put the filter in that gets rid, that is known to get rid of it? Hmm. Hmm. Yeah. I had Dr. Shana Swan on the podcast. She wrote the book countdown, which is tracking sperm decline and testosterone levels as well. Yeah.

Interesting. Over decades, a mathematician turned closet epidemiologist, I suppose. And, uh, she was fascinating and her stuff is, is pretty scary. Uh, the impact of this, one of the things that I didn't realize is, you know, you, she was fascinating and her stuff is, is pretty scary. Uh, the impact of this, one of the things that I didn't realize is, you know, you, you talk about declining testosterone levels

and you think men, but it's women. Sure. As well in a big way. Uh, and maybe in, in some ways, given the fact that you've just got the adrenals creating a testosterone for women, you know, less margin for error in some ways too. Um, and she attributes it to plastics, I'm assuming.

Endocrine disruptors, a lot of microplastics. Um, what are your foods being transported in? Um, you know, she gave me this, um, really interesting example of people who get maybe raw milk or something like that. And it's in a glass bottle. It's from a farmer's market. It's like, was it manually pumped or was it pumped through a machine?

Because that machine has got BPA in the pipes and the milk is warm because it's out of the animal. So you're pulling the BPA from the pipes into that, even though it's organic cow grass fed open pasture, but no blah, blah, blah, blah, blah, blah. But okay. What's the transporter? And it's just. A minefield to try and weave your way through.

I mean, one of the big ones for her, and this was, you know, me in my entire twenties, hot food in plastic Tupperware. You know, I'm doing, I'm doing meal prep. I'm eating healthily. It's like you just put baking hot food into, and there's no BPAs in it. Yeah. But it's like BFCs or it's BPFCs or whatever the replacement was that they did for that. So yeah, she's got a big protocol that you kind of follow with regards to that. But I think it's a big deal.

I think the endocondriac disruptor thing is a really big deal. Even if you don't talk about like hormonal birth control being peed out into the water supply and stuff like that, there's, you know, even the way that it is transported to you is something that you should be concerned about as well. Have you looked at the psychological impact of hormonal birth control on women? Is this something you've done much research on? Um, I have not looked at the psychological component of it, but obviously the downstream endocrine component of it we deal with a lot in our female patients, especially as they, those who have been

on it for a long period of time who are then becoming perimenopausal and as you're transitioning them to HRT, obviously one of the results of long-term oral contraceptives is a significant rise in SHBG. So as their sex hormone binding globulin goes up and up and up, their free androgens go down for a given level. So you kind of have this issue where even if you normalize their testosterone or estrogen, they might actually be physiologically experiencing less of them. So that's, you know, again, but definitely not something I consider myself an expert in. The Dr. Sarah Hill wrote a book, uh, this is your brain on birth control.

She's an evolutionary psychologist, but, um, it's really wild. I think a friend has a great question, which is what is currently being ignored by the media, but will be studied by historians. It's a nice frame of what are we kind of overlooking at the moment? And I really think that hormonal birth control will be one of those things that, um, there was a recent Scandinavian study that looked at, you know, we've got this declining female mental health problem, especially among young girls.

So like 40% of American teenage girls have persistent or regular feelings of hopelessness. It's like this real macabre apocalyptic sort of language. And, um, I always ask this question cause I had Jonathan height on the show and he was social media and comparison and blah, blah, blah. But I was like, has anyone factored in the base rate of what increasing levels of hormonal birth control usage has done to like, how much

can this be contributing? And this. And has that changed significantly since 2010? Maybe that's, that's what needs to be locked down. Yeah. But. Cause that's really, I mean, I think the argument in favor of Jonathan's argument is that when you look at the total takeoff or nose dive, if you will, of mental health

for specially girls, it coincides really perfectly with the exact introduction of, you know, Tik Tok and and not TikTok, but Instagram, smartphones and social media. So unless there was a different type of birth control. Yeah. So the question is, was there also a birth control change? Great question. I think, I don't think that there has been a change. I think it's anything, it's going to be kind of like just a steady linear adoption of these, of these drugs. But what you don't know is, is there some sort of predisposition, some sort of psychological,

raw materials that are more susceptible, is this being able to magnify the effect of social media, of social comparison? And Dr. Sarah Hill's works so, I mean, it's fascinating. The change that women have in the kind of partners that they go for, both on and off of birth control, the level of testosterone that they prefer on a man's t-shirt at the same time, the libido and the sexual, not only libido, sorry,

their level of sexual satisfaction with their partner, which also is indicative of partner choice and how effective that is. And I mean, you may or may not have heard these stories, but so many stories of women who get into a relationship with their partner when they're on, get married, decide that they're going to then have children come off and are like, I'm not really that attracted to my partner anymore.

You know, they sort of exit this hormonal fugue state and their kind of eyes are open. And it's not a comment on their partner, particularly it's just that they're in a, a very different hormonal profile now. And what they find attractive has changed an awful lot. It's wild. I mean, the research is, is really, really interesting. Interesting. Yeah.

Totally unaware of that side of things. What about sun cream? What's true about the safety of sun cream? I hear a lot of demonization of it, that it's dangerous, that you can put it on your skin, that it gets absorbed, that it turns into all of these things, but then also skin cancer, not good. What's your position on sun cream? Uh, I'm in the process of learning an insane

amount of this for a podcast I'm doing. So I would, I would say, I have my thoughts now, but they're, they're going to be updated by, you know, a team of PhDs. Check out the drive in three months time. Exactly. When, when we get to do our AMA on this, we're going to visit really two questions that are both

going to elicit a ton of controversy. So the first is how clear is the role of the causality of sun in melanoma? So again, that might seem like a stupid question to ask, um, but the answer is not entirely clear. So what is it about the Sun that increases the risk of melanoma? Is the risk of melanoma increased, for example, in Sun exposure that does not result in a burn? Or does it have to result in a burn? Does it have to result in a severe burn? Does it have to result in a burn during a certain period of your life? All of this is unclear. It's a lot more clear the relationship between sun and

basal cell carcinoma and squamous cell carcinoma. I don't know what that is. They're two other types of skin cancer, but they're non-lethal because they can't metastasize. So, to be afraid of skin cancer really means to be afraid of melanoma. That's the one that can kill you. Um, and so that's going to be the first part of the podcast is really exploring that relationship. And then the second is going to be the deep dive on all of the scunt, all of the, uh, you know, uh, sunscreens out there. And so sort of mineral versus chemical and, um, what, what's, you know, to, to the best of our ability to understand it, what's the, what are

the real risks, uh, if any of, of either of these types. Yeah. There's an awful lot of very vehement, uh, push in both directions, I think for this, I can imagine. Yes. I, I, I'm, I'm, we're, we're certainly not doing this because we never do anything to sort of step in a pile of shit, but I, I, there's no question

that this is going to be inflammatory, but. What do you think, what else would be, I mean, perhaps surprisingly, uh, talking about sun cream, uh, like, you know, real hot topic. It's a, you know, a war zone out there. What are the other really spicy areas that you might not have thought about?

You start talking about pollen or something and it's, it's a real war zone. What is that? I mean, anytime I talk about lipids and heart disease and dietary fats and stuff, anything to do with diet, that always tends to be quite inflammatory because of course, anything that's diet related is sort of very tribal and religious.

I think HRT is a somewhat polarizing topic though, less so now than when I started talking about it. You know, when I really started talking about HRT, most of the medical establishment viewed it as bad and dangerous. And I think more and more the doctors are coming around to realize that, you know, the women's health initiative was such a flawed study, uh, that it's, you know,

responsible HRT is a great thing for women. Um, uh, what else is really controversial? Look, I think, you know, vaccines, I did a, I did a, I interviewed a guy named Brian Deer and we went deep down the MMR causes autism claims and that's obviously a very polarizing and controversial topic. What did you find? I can see absolutely no evidence that the MMR vaccine is linked to autism and instead I see

an incredibly fraudulent guy in Andrew Wakefield who committed literally scientific fraud to confabulate data to make that case and it's an awful shame. I'm not going to sit here and tell you that all vaccines are great or that every vaccine is without risk. That's not the case. But the MMR vaccine is a very important vaccine. That's a vaccine that saves an unbelievable number of lives and an unbelievable amount of misery in children. Um, and it's a vaccine that's targeting a particular, uh, set of viruses whose viremia

is indeed driven by the exact mechanism by which the vaccine works. In other words, there are certain vaccines where vaccination actually impairs transmission, right? That clearly wasn't the case with COVID. Mm-hmm. So you could always make the argument that there was no public reason,

there was no public health reason to vaccinate people against COVID. It was an individual reason. That's not the case with MMR. The nature of how the virus spreads is indeed impaired. Kind of a tragedy of the commons type thing going on. That's right, yeah. So, and again, I mean, just the entire topic of vaccines

is so controversial, but. Was it this controversial five years ago? Or you were- No, I mean, this particular topic was for sure. MMR has always been- MMR is always been. Vaccines overrode, it seems like there's, you know, this particular topic was for sure. MMR has always been. Vaccines overrode, it seems like there's, you know, like vaccine skepticism. Well, now, I think it's been amplified, right?

So I think that the CDC did itself absolutely no favors. Didn't shower itself in glory. No, the way they handled everything around COVID has made it, has actually done a disservice to, I think, vaccine science. And, um. It must be absolutely infuriating if you're a vaccinologist or trying to work on these, you know,

life's work genuinely trying to do things to make people better, to avoid illnesses, to, you know, like eradicate disease and then for the CDC to shit the bed in such a huge, and not just the CDC, obviously, in such a huge way that. Well, that anything in medicine becomes political is a tragedy. And it's, you kind of would want to believe that medicine would be the last thing that could be political, but you know, just two weeks ago, I wrote a piece with our team for the newsletter

about something that I never imagined could happen, which was the American Heart Association deciding in what is clearly just a political kind of woke agenda that race will no longer be considered a risk factor in cardiovascular disease. So they're taking race out of risk calculators. Now, you know, in their defense, I suppose their argument is that, well, race is a proxy for

socioeconomic status. So, you know, but what they argue is that race is a purely social construct with no genetic component. And this is just patently false. I could have written 10,000 words on this with all of the counter examples of where race is indeed a genetic construct and with it come risks. And why we would deprive ourselves of a tool that allows us to better risk stratify people just makes no sense to me, regardless of your political ideology. So unfortunately to see that medicine is also becoming corrupted by ideology is, um, is

very sad, but not surprising, I suppose. I had this idea of toxic compassion. So the prioritization of short-term emotional comfort over everything else. And the ground zero for this would be, uh, body weight has no bearing on health and mortality. Um, well, you know, you don't want to make people who are overweight feel upset. You don't want to sort of activate in them this sense of, Oh, maybe I'm not, maybe I'm going to die sooner or whatever. But by not communicating that to them, they're literally going to die sooner. Like you run the risk of these people getting into all manner of problems because of this

prioritization of short-term emotional comfort over long-term flourishing the truth, accuracy, and the same thing goes for this. The same thing goes for, you know, race has no bearing on your vulnerability to different types of health outcomes. I have zero medical training and I know that that's false. I know that there's disparate outcomes, disparate risk levels for different diseases within different race groups. Like it's wild. It's's wild.

It's really wild. And the fact that you're starting to play about with people's health, you know, I don't think that there's as much truth in the, the accusation as some people might want or that some people might claim, but you know, the doors coming off Boeing planes and stuff like that, bridges, DEI, diverse hires that are doing, you know, this isn't commentating for the New York times and moving culture with culture is not nothing either, you know, people's beliefs and how they see the world

is not nothing, but when you're talking about medicine and airplanes and bridges and going to space, that's, you're really crossing a threshold there. Yeah. Science and engineering really needs to be free of, of anything that, that puts merit anywhere, but at the top and perfection of knowledge.

How warranted is the huge panic about processed foods in your opinion? Well, again, I think the devil's in the details, right? The word processed is a bit of a troubled word because if not for processed foods, you and I would be pretty different right now. Processing is what allows a lot of what we eat to exist. I don't know that processed foods that processed foods by itself inherently implies things are bad. There are lots of processed foods that are excellent foods. What would be an example?

Oh, I mean, like, you know, you take like a really natural form of like wild, I mean, I'm being completely biased because it's a company I'm an investor in, but it's the first thing that popped into my head because I had it for lunch today was like, you know, our venison sticks, right? This company, I'm an investor in called Maui Nui Venison. So sorry for the plug. No, we've got some over there. Yeah. So, you know, that's a processed food, right? Like it had to be, you know, dried and put into plastic and salt had to be added to it. So, but look, that's a very healthy food. Now, is it as healthy as if I had just killed that

deer and just eaten that deer right there? Probably not. You know, I could probably make a case for why it's not, it's probably got more salt in it than it should or et cetera. And those things are there to preserve shelf life. Um, but, but that's clearly a processed food that I wouldn't put in the same camp as a bag of Pringles.

So, you know, we can get into the secondary term of, you know, hyper-processed foods and we can talk about that. But, but I still think it's better to just talk about things from first principles as opposed to labels that are mildly descriptive, but not granular enough, um, to provide real value. So to me, I would rather say, you know, a venison stick is more healthy than Pringles, rather than say, processed food is good or bad.

Understood. What about hyper-processed foods? Is that worthy of the current moral panic? I don't know. I mean, again, it comes down to, there are enough foods in that category that are really totally garbage. There's no doubt about that. And the old adage that as you walk through a

grocery store, most of what's in the aisles is indeed garbage. Most of what's on the perimeter is indeed good. And most of what's on the inside is processed and most of what's on the outside is not. So, look, I feel lucky because I enjoy cooking. I have the means to do it. I don't have to rely on processed foods because

again, you know, one of the things that makes processed foods so appealing is not just the taste, but it's the convenience and the caloric density per unit dollar, right? You can get a staggering amount of calories per unit, monetary unit at a great convenience, right? So the further you can get away from what I call the standard American diet with its four pillars, right? Which is, has to taste really good, has to be really cheap, has to be really cheap.

Um, has to be scalable, right? If you're able to do it at big scale and it has to be really portable and storable. So the solution to that problem is processed food. Um, and the further you can deviate from those vectors, the better. Have you seen this activist letter against Kellogg's? So the guy called Jason Karp, Bill Ackman, um, signal boosted this a couple of days ago, uh, this dude called Jason Karp filed an activist letter against Kellogg's demanding that they stop selling what he calls inferior versions of the product.

In America, there's a red 40 and blue one and yellow five, there's specific colorants that exist and there was this comparison chart and you five, this specific colorants that exist. And there was this comparison chart and you had what's in the Canadian version and what's in the American version. And why is it different? According to him, because it's not being enforced, that there was a request made or that.

So Canada stepped up and made a request for a better product. I, it should have been done based on what I know it should have been done across the board. Kellogg said that they were going to get rid of these things in America, but they didn't and it seems, you know, all manner of conspiracy theories then ensue. They're in bed with the FDA. Someone's being given a backhander. This is indicative of America's total blasé careless nature with the food, someone's being given a backhander. This is indicative of America's total

blasé careless nature with the food that is being consumed by the, you know, pick your explanation of choice, but it seems that there are certainly colorants and some of the ingredients compounds that are in specifically Kellogg's cereal. But let me ask a naive question. Like what Kellogg's product would you consider good for you anyway?

Like what Kellogg's product should we be eating? I don't know. I don't know. I'm not even asking rhetorically. I just don't know enough about their products, but like. It would be cereal. You know, a lot of children having these fruit

loops and stuff like that first thing in the morning. Yeah. I mean, again, I would, I don't mean to sound like a cranky old guy, but why would we want our kids eating first thing in the morning. Yeah. I mean, again, I would, I don't mean to sound like a cranky old guy, but why would we want our kids eating Fruit Loops in the morning? Like, I mean, again, I know I just a moment ago said, well, I, it sounded like, oh, maybe he's waffling on processed food, right? But I'm not waffling on a particular food. Like there, you know, Fruit Loops might be a treat like for dessert, but like

on what planet would you say we're going to start our day with candy? Cause that's all it is. It's just candy that you add milk to. You've got kids. Yeah. What do you, for the parents out there, they, oysters and coffee, sadly for breakfast, probably not going to happen.

What do you feed your kids that satiates their desire for, for their palate to be muy bueno, but also. Yeah. So when they do eat cereal, they eat cereal that's a little less sweet. So they're going to eat Cheerios. Now maybe Kellogg, I don't think

Kellogg's makes Cheerios. No, I think that's Nestle maybe. Yeah. So anyway, so that, you know, Cheerios is kind of their cereal. Uh, you know, they'll put berries in it, yogurt, applesauce, again, processed, but it's, you know, you can get an applesauce that literally has the

only ingredient as apples, right? And that's, that's what they eat. Is that a typical breakfast? What's a typical breakfast? Yeah, oh, bacon, sausage, like they eat venison, eggs, like we make them little, you know, like egg wraps, toast, you know, again, like, it's not like, I don't want to paint the picture

that my kids are these little organic vegan machines. Like, no, no, they're, but again, like what I just described is I think a far healthier breakfast than, you know, eating Pop Tarts or eating Froot Loops. What are you actively trying to avoid, that sugar? Yeah, I mean, I do think we try to be mindful of sugar and crappy junk food and just limit when they're

going to have it and how much they're going to have. So my kids, by the way, I mentioned it a minute ago, but my kids love Pringles. So they can have some, but they're not going to eat like this many of them, right? They're going to have that many of them. Cause we buy like little mini packs of them, which are not cost efficient, but like we're not optimizing for that, right?

We're optimizing for a small serving size where it's like one and done. And dad's not going to eat it. There's this, uh, yeah, that's true because once they've opened it, it's now. Yeah, there's a tube of Pringles like I'll eat it. It's the trickle down effect of, right, okay. I didn't think about that. I didn't think about the fact that if you get your kids something that they like, that's also something

you need to deal with now being in the house. It's so interesting. I am. It's also sometimes you just go out for stuff as opposed to keep it in the house, right? So, you know, we went out for ice cream the other day. And it's better because you just go out, you get it over with, you're done, you come home. But to have ice cream in the freezer every day would be a problem for me.

Yes, I need geographic distances, the best discipline for me when it comes to diet. What about, is there any truth or have you looked at dysregulation that comes from Wi networks and air pods and stuff like that. Have you looked into this? Yeah, I've looked into this a little bit. I gotta tell you, I don't buy it. I mean, if there is a signal, it's a really small signal. I think this is a bit of a majoring in the minor and minoring in the major problem.

I am amazed the number of times, like I'll put up a post on Instagram where I happen to have my AirPods in and I'm giving a post about something meaningful, like here's an interesting thing that you ought to think about for exercise. And there's always 10 people that chime in. I don't even know if I can follow you anymore, the fact that you're wearing those AirPods. And I'm like, first of all, I don't care if you follow me, so please unfollow me. But like, what is it like to go through life so stupid where you actually think that that

matters more than the fact that I'm trying to explain to you something that is in order of magnitude, more important for your health. Like, and I just feel bad that like there are people, again, it's just, it's majoring in the minor and minoring in the major. Yeah. I don't know.

There is an obsession. There seem to be certain areas of health that people love to lock onto, you know, the specific type of artificial sweetener that goes into a beverage, the ionizing or non-ionizing radiation that's coming out of your AirPods, the wifi signal, 5G towers that you live near and bits and pieces like that. Meanwhile, show me your deadlift.

Right. Show me how fast you can row a 2k. Right. Exactly. Yeah. Like why? Do you, do you know your ALMI and your VO2 max? And Elaine Norton and I had this discussion

once on the podcast, which was like, you shouldn't be allowed to even comment on these things on social media until you do a hundred pushups, like literally before you type it into your phone, do a hundred pushups and then get up. And then you can type your stupid comment about my AirPods or about this sweetener or about like, just like, get it right. Get your boulders in place first, please.

Lane, uh, continues to just pick fights with people on the internet. I'm, I don't have the, have the constitution to do what he does, but I love watching him just go to war and he's in the comments and he's fighting back in the comments and like, Hey man, fair play. That's not my bag and I can't do it, but yeah. Yeah. I avoid the comments at all costs, but I, and I rarely even look at them.

Right. So, but, but every once in a while, like someone will, like my team loves to send me the most ridiculous comments. Um. You should put them up. You could pin them on the board and have like a wanker of the month, a wanker of the week. There we go. You can have that one for free.

But yeah, it's so bizarre. The things that people hook themselves into very particular. It's, it's, it's like an obsession. And that's the thing. That's the thing. It's all downstream from sweetness. It's all downstream from whatever. And you're like, dude, I feel like you probably sleep five hours a night.

I think that you probably haven't processed. I mean, you definitely haven't processed many of your emotions because I can see it. It's pouring out of your fingers. I have a friend who is so obsessed with these, what I just basically call conspiracy theories of health. And at some point I was like, how much time are you on social media a day? And he's like, yeah, probably like eight hours a day.

I'm like, I've got a health tip for you. And it doesn't have to do with the AirPods. Sleep, one of the things that we haven't spoken about. What are the most important strategy? There's so much to do on sleep. Sleep actually one of the few places that doesn't seem to be too tribal, you know, like just sleep more.

Maybe some people will argue whether you need to have magnesium L3 and eight or activated charcoal or whatever, whatever, whatever. What are the most important strategies when it comes to sleep quality? Uh, probably regularity of schedule. So, you know, the closer you can be to going to bed and waking up at the same time every day.

That's great. Uh, duration. So leaving room to sleep for a sufficient duration. So in other words, you can do everything right. But if you're only going to give yourself six hours from the minute you get into bed until you have to be brushing your teeth in the morning, you're only going to get so far.

Um, then there's obviously the hygiene that goes into sleep. So temperature, darkness, uh, and stimulation before sleep. So what, what are you doing to get your brain ready to sleep? Again, I always remind people to sort of three factors that are driving this, right?

So you want adenosine to be climbing as high as possible. You want melatonin to be climbing as high as possible and You want melatonin to be climbing as high as possible. And you want cortisol to be plunging as much as possible. So what do you, what do you have to do to make those things true? So to make Adenosine go up, you have to be active, right? Like Adenosine is the by-product of activity. So the more active you are during the day, the more your Adenosine levels go up.

And then you have to say, you have to, you know to put that down, right? That's a sleep signal. Melatonin is driven by light, but again, you have to have the right circadian rhythm. So you have to be getting the right time and doing it at the same time over and over again, which is why when I was talking about my travel schedule, I have to force exogenous melatonin into the equation because I can't rely on the external cues. But that's why I don't want people taking melatonin regularly the equation because I can't rely on the external cues. But that's why I don't want people taking melatonin regularly. I want them relying on the natural way to get it. And then cortisol is probably the hardest one for most of us, even if we, because the typical bio hacker gets number one and two, but you're sort of missing number three, which is how do I actually

get my adrenal glands to come down to let me actually go to sleep? And that's the one where again, you can do it sort of with a pharmacologic or molecular hammer, which is what phosphatidylserine is doing. But again, I don't really want to have to rely on that every single night. Instead, I want to get into a habit of for two hours before bed, not engaging in anything that's going to be stressful to me. So I'm not looking at my phone. I'm not chirping on work emails and looking at things that are, I'm really trying to be doing very little that would produce. And if I am doing some work, I'm not going to suggest, oh, I'll never look at my computer for two hours. What am I going to do? I'm going to do something

that's a little more relaxing. Or I'm going to watch some F1 going to do something that's a little more relaxing or I'm going to watch some F1 highlights or something like that. That's just pure bliss, but is not going to increase my level of stress. Then we've talked about some of the supplements, obviously, that you can take there. I don't think you mentioned about your dose of magnesium. I take two of the L3 and eights, which is, I think that's 166 milligrams is what comes into. Okay. I also use trazodone 50 milligrams.

Every night? Most nights. Um, great sleep aid. Um, and that's, that's, that's it. No, uh, concerns about long-term use with trazodone. No, not a dependency drug. That's good.

When it comes to sleep hygiene, room temperature, core temperature tends to need to drop, or at least it seems to help you fall asleep. If there is someone listening who is having trouble falling asleep, they're struggling to fall asleep. If there is someone listening who is having struggle, trouble falling asleep, they're struggling to fall asleep and they're doing a three, two, one, three hours before they're not eating two hours before they're not drinking one hour before they're turning off screens. They feel like they've got a dark room. They feel like it's relatively quiet. What are the other places that you would look at if someone's struggling to fall

asleep? And then also if someone is having those breaches, if they're finding themselves waking up throughout the night, have you got any idea what that could be caused by? Well, if they're struggling to fall asleep, sometimes I ask the question, are you going to bed too early? So, you know, there are different chronotypes of sleep, there are some people who are truly

night owls and they, you know, they're really not meant to go to bed until 12 or one o'clock. And they really need to be getting up at seven or eight o'clock. And if you force that person to go to bed at 10, because their spouse goes to bed at 10, they might really struggle to get to sleep. And, and, and I, there's a term for that when spouses are on the different chronotype. I forgot the name of the term, but. Unhappiness. Yeah. I would also look to make sure, believe it or not, that a person isn't overslept.

So this is not an entirely improbable scenario where you see somebody who is sleeping too much, they have too much time in bed and therefore they aren't building it up enough or they take a nap during the day or something like that. And they haven't built up enough sleep pressure and so they're having a hard time going to bed. Of course, you also want to rule out things like caffeine. Caffeine inhibits

adenosine by the way, inhibits the adenosine receptor. So that's how for someone who's not like me, caffeine is a wakefulness compound. So those are the other things I'd be looking through on the checklist on is making sure when was the last caffeine or you've, if you, especially if you're caffeine sensitive, the half life is actually quite long. Nine hours. Yeah. I think it's about 10, but yeah, it's, I mean, it's long enough that you can easily get into trouble with it. And what about if you're finding yourself waking up throughout the

night, is that, is that just the same? Well, no, I mean, I think that there, and you know, the question is why are you waking up because you have to pee then with the, if that's the issue, then what do you do, you know, why is that happening? Um, if you're waking up and you're ruminating, honestly, I think the best tool for that is, is CBTI, um, cognitive behavioral therapy for insomnia, very powerful tool. And then there's a whole set of behaviors around that.

Right? So what, what do you do? When should you get up and out and disengage from sleep altogether? When should you try to go back to sleep? And, and so, so we're very liberal in our use of CBTI with patients who are struggling with that. One of the, uh, strange things that happened during COVID. I found myself going to the bathroom more frequently, like having a urinate more

frequently and I was like, ah, it's probably nothing. It doesn't matter. And then it got to what I, uh, ruptured my Achilles and I was going into see my GP. I was like, the classic male, I will accumulate a number of different medical problems before I then decide to bring it up thing. And I was like, yeah, I'm going to the bathroom a bit more than I thought I would.

And immediately it's like, I've got prostate cancer, I'm gonna die. And the doctor turned and he was like, you are the fourth guy I've seen this week that's come and said this to me. I was like, okay. And he said, what I think is happening. And he explained this. I'd be interested to know if you noticed this too, with your patients. During COVID, everybody started working from home. This meant that they were at any time within five yards of the kitchen. They were probably caffeinating a little bit more

because they could get themselves coffee as much, which meant that they were just detraining their bladder and going to the bathroom more frequently. Who is there? There is no boss looking over your shoulder saying you shouldn't go to the bathroom. So this is again, like kind of another public service announcement to guys, maybe it's to girls too,

but certainly to guys, if you're like, oh my God, like I've started having to go to the bathroom more and it feels like I can't, I can't hold it in. Maybe I've got something wrong with me. It's like, this was exactly what I did. So I got put on a, a, a colonergic, um, to like release the, I don't know how, I'm sure you understand how it works. Like make you need to go to the bathroom less frequently and then you retrain. You do a period of retraining, which I've now done and I've full bladder

capacity, congratulations for me. Um, but for it took six months. Wow. It took six months for me to do that, to really get myself back to like, you know, three hour podcast, like bladder capacity, um, my business partner came over, then business partner in the nightlife stuff, and I had my leg up on my thing cause I was in Achilles recovery stuff. And we had a 90 minute meeting. And he went to the bathroom when he arrived. And he went to the bathroom an hour later. I was like, came back in, I was like, dude,

I don't mean to pry here, but you've been you go to the bathroom a little bit more than you would usually say, yeah, I'm really worried about's like, I think I know what's happening. And, uh, sure enough, he did, he did exactly the same thing. So I thought that was just such a, it's so funny how that, you know, detraining, like detraining your bladder, literally, like there's a valve or something that sits above the urethra or whatever. And it's like, that hits a particular amount of pressure when there's pressure in the bladder and it's like, you need to go to the bathroom and you just detrain that.

And it becomes like, so interesting. Yeah. I was totally unaware of that. Yep. And that was the thing that happened, um, on the other side of that though, because I was on, uh, anti cholinergics and they weren't having as much of an effect and they took me from, I think, five milligrams to 10 and I lost 20 IQ points and it was brutal and it was like, you know, I think, five milligrams to 10. And I lost 20 IQ points and it was brutal.

And it was like, you know, I love my thoughts being sharp and quick and being able to play with ideas and stuff. And I forgot the name of a British seaside town called Blackpool. I forgot that for like two minutes during a conversation. I'm like rummaging around in my brain, trying to remember this place that should have come straight up. And that was scary because that was, I basically kind of induced short-term cognitive decline, you know, like a reversible short-term.

It was, that was really scary to me. And that kind of gave me a newfound sympathy for people that are going through, uh, some kind of cognitive decline, because it's, it feels like there's a bit of you that's been pulled away. And the thing that you use to fix the problem is the thing that's being taken from you. So the fact that you're, you know, your cognitive horsepower, I'll search on the internet and I'll come up with a solution and I'll, you know, diagnose, or I'll think about a way to add this new strategy into my routine to make this better.

All of that, the raw materials that you build the solution with are the problem. And yeah, there was just a whole real interesting period, like six months of my life where I was like, I learned an awful lot during that time. One of the other things I think that's a big, at least for me, I'm focusing an awful lot on gut health at the moment,

and this is like a whole other world. There's someone that hasn't been. That reminds me of another supplement I take. Which is? A pendulum probiotic. Okay. Probiotics kind of in the crosshairs a little bit at the moment, what makes a good and bad probiotic?

First, it has to be alive, which turns out to be much harder than, than most companies appreciate. So, um, if you're making anaerobes, which most of the probiotics need to be anaerobes, since those are the bacteria that you're actually trying to replenish in the colon. Um, so an anaerobe has to be manufactured in a, in a completely oxygen free environment, which is really hard to do. I mean, from a manufacturing process, it's very difficult. So most probiotic companies,

when they make their probiotic with the best of intentions, think they're making fill in the blank. But when they kind of count the units and tell you we have this many CFUs or colony formulating units, they're not actually checking if they're alive or not. And by the time these things get to you, they're completely dead. So that's rule number one is you have to actually buy it from somebody who knows what they're making and is able to verify with more sophisticated tools that you're actually getting alive bacteria, um, or at least freeze, I mean, when I say alive, freeze dried and will come back to life when you ingest it.

Um, or we'll come back to a state of, you know, function. Um, so I think that's, that's sort of step one. And then, and then of course, you know, we're still very nascent in this space and still trying to understand what to do. The probiotic I take is really rich in a bacteria called acrimancia, which plays a very important role in butyrate production. So butyrate is very important in metabolism and short-chain fatty acid metabolism, glucose metabolism. And, and, um, this is a, a probiotic that's actually been demonstrated in a small, but, but rigorous and blinded study to lower glucose levels. Hence it's called glucose control. Okay. What else should someone that's never considered good health before be thinking

about? Lots of insoluble fiber. This is, this is the most important thing you feed your gut. So, you know, for all the arguments why, you know, vegetables in particular matter, this is the most important, I think. And I think there are lots of reasons vegetables matter. Um, but this might be the most important and it's the one that you can't get around. Right.

So you can drink a green drink, you know, I, I love AG, you love AG, we can all drink those things and we're getting a lot of the vitamins that come in the vegetables and we're even getting the phytochemicals, but you, the fiber, you can't get in volume in that. You're not getting enough fiber. You have to be able to consume insoluble

fiber to actually feed your gut. So I think that that's probably something most people are deficient in. What are your favorite sources of insoluble fiber? Uh, I love salad stuff, right? So anything that goes into a salad, so lettuce, cucumbers, carrots, celery, all that kind of stuff. Those are, that's probably where I get the lion's share of mine. Is there any truth behind this?

If you blend vegetables and fruits together, it changes the way that it interacts in the gut and it spikes blood glucose and you don't get the benefit of the fiber thing. Um, I don't know about that. The only thing I know on that front is that bananas, believe it or not, might actually impair the absorption of other nutrients from other fruits. And so... Don't put a banana in a fruit salad.

Yeah, or don't put a banana in a fruit smoothie. Might be, yeah, that... It's preliminary and it's a very small study, but, and I don't really drink fruit smoothies, so it doesn't really impact my life, but if someone's really in the business of fruit smoothies, I might differentiate, separate the banana from the rest of the fruit.

What else? Gut health, insoluble fiber, big importance. That means rely on vegetables, continue to have as many cups as you can throughout the day. Yeah. I mean, I, I think that's sort of what I, I get, I'm fortunate. That's the 80%.

Well, well, no, I mean, I just want to be clear and say, like, I feel very fortunate That's the 80%. Well, well, no, I mean, I just want to be clear and say like, I feel very fortunate. I've never had gut issues. Um, my gut tends to be very insensitive to things that I know can cause people a lot of gut issues, such as wheat and dairy and things of that nature. Um, I'm impervious to those things. It doesn't matter.

But that said, if you're not impervious to those things, then you've got to figure out what it is that is causing issues and sensitivities and get rid of it. And the only way that you can really do that is with an elimination diet. You can't do it with some stupid test that someone's going to charge you 600 bucks for that doesn't tell you anything.

You have to actually just take the presumptive offending agent out, run that to ground for a period of time, and then reintroduce it. I'm doing hardcore FODMAP at the moment. Yeah. presumptive offending agent out, run that to ground for a period of time and then reintroduce it. I'm doing hardcore FODMAP at the moment. Yeah. And it's actually not that bad. It's not that there's still loads of foods that you can eat on FODMAP. So I don't really mind all that much.

I mean, it's not exactly the most exciting diet that I've ever done, but I'm holding on. One of the other things that I was interested in talking to you about is motivation. So there's all of these things that we should do and can do to keep ourselves living longer. But there's other competing goals that we have as well. And if compliance, as you said earlier, is one of the most important things, then you're playing this sort of this long

game, how do you think about the component parts of motivation, most important things, then you're playing this sort of this long game. How do you think about the component parts of motivation and compliance and sort of willpower to keep doing things, whether that be from a health standpoint or from a work standpoint as well? How do you- In myself or in others? In both. Um, I think in myself, um, because I tend to be more rational mind than emotional mind. So in, in, in dbt, you learn about this dbt dialectical behavioral therapy.

You learn about the synthesis of rational mind and emotional mind in something called wise mind. And that's, is you learn in something called wise mind. And that's, as you learn in DBT, wise mind is the place you want to be. Like you're at your best because you're using the best of each of these components when you're in wise mind. But different people obviously have a tendency to drift into one of the others more likely. And I tend to drift more into rational mind. And all that means is that data speak to me more than feelings. And as such, when I need to motivate myself, I tend to look at the data more.

But there's nothing wrong with that, there's nothing right with that. There are other people for whom the feelings provide the motivation. And I was actually having dinner last night with somebody and we were kind of talking about just that, which is there are some patients who really, all you need to do to help them understand why they need to do something is bring it back to their goals. So it's a very cognitive motivation, right? Like you want to be able to achieve X, Y, and

Z to do that, you have to do A, B, and C. And anytime you deviate from A, B, and C, I just remind you about X, Y, and Z again. that, you have to do A, B and C. And anytime you deviate from A, B and C, I just remind you about X, Y and Z again. That's me. There are other people for whom the relationship with that practitioner matters the most. Their trainer is the reason that they eventually want to be able to do this. So I think they don't want to disappoint that

trainer and the stronger that bond is, the easier the compliance is. So again, I think it kind of comes down to knowing who you're talking to and understanding what makes them tick. And then that's what you can basically use to, to sort of help people stay motivated and compliant. What about navigating an obsession with perfection? So as soon as you give people tools that they can use, that is an ideal against

which they can begin to measure themselves and they can feel when they fall short from a health perspective. And the pain, self-induced pain that you feel from falling short can then induce stress, which actually isn't particularly good for you in and of itself. How, how do you think about the perils of over optimization and kind of not obsessing over those things and finding that balance? Well, I think it's very important. And obviously the older you get, the wiser you get.

And the more you realize that, um, you know, perfectionism is, uh, youism is potentially an evil master. But I don't know, I think people sort of have to learn that lesson the hard way. I think it's very difficult to teach people lessons until they're in pain. And they have to kind of learn the cost of that is really high. Um, and maybe I need to be, it all, it sort of comes back to what we talked about earlier, right? I mean, perfectionism is just another manifestation of a maladaptive inner monologue. So it comes back to how we talked about that, which is if you want to resolve that, you have to see the

pain points, you have to be able to link that thing to something that is, you know, hurting you. Yeah, it's, it's strange to think about the potential negative externalities of perfectionism because all of the benefits so immediate, you know, you take pride in doing things right, paying attention, being precise and caring about stuff. I think all very good.

And the world will reward you for doing those things because there are people out there who either don't have the capacity or the disposition to be perfectionists in that way. And that means that there is an entire blue ocean out there. But again, like we said before, what are the, like what are the psychological costs? Look, I think they're high. And I think, I think this is a, it's a, it is a dangerous addiction.

It is an addiction like any other. Um, but as you said, it's more societally rewarded and that makes it harder to break. Um, because they're really destructive addictions. You're not fooling anybody like, including yourself, like there's, there's nobody in an alcoholic stupor who thinks this is really. I'm crushing it.

I'm doing so well right now. And everybody is telling me how well I'm doing. Um, that doesn't mean that it's easy to get out of that, but at least step one is, is taken care of. You're a big fan of compounding over time of things slowly accumulating and accruing and stuff like that. What is it when it comes to health and fitness,

what is it that people, how can someone who's in their 20s or 30s made of rubber and magic, never had a health problem, you know, like, yeah, you know, medicines for like other people and stuff like that. Probably they go to the gym, they probably care about diet, but it's not got that real. Like I am investing for my final decade. How can you bring that stimulus, that realization, that investment, like from the far future into the now, how can you motivate an idiot 20 or 30 year old person to care about this stuff? They have to go spend time with people in those, in those later decades.

They have to, they have to spend time around people who are where they're going to be and they have to see for themselves what that looks like. And they have to decide for themselves, am I going to be different than this? And if so, why? Like, you know, the first order response to that might be, oh, well, that'll never be me.

Well, why? Why won't that be you? What was this person like when they were 20? Do you think that they were that different from you? So I think the more time you get to spend in the sea of old age, the more you come to realize, yeah, I'm not that different. And by the way, I experienced this as well. I remember even a decade ago, people talking about what it feels like to wake up and be just kind of sore and just taking a minute to kind of, as you're getting out of bed, you're a little stiffer than you were. I couldn't really relate to it and now I can. So it's given me a little bit more insight into, oh, I can, I could imagine in 10 years,

it's even harder. This is something that I've wanted to ask someone for ages and you're the perfect person. There's a lot of talk and sympathy, rightly, I think given to, uh, women aging, so much value is placed on youth in women. But I do think that the discussion for men about how to age gracefully, about how to kind of accept

your slow physical demise, uh, I don't really hear people speak about that much. How have you got any insights here, either for yourself or for your friends or your clients or anything like that? Well, you know, there's a couple of things there, right? So first of all, there is a sort of, I think there

is an unjust asymmetry there, which is, I do think women seem to pay a higher price for aging in terms of whether it's their view of themselves or even the world's view of them, right? I mean, let's take an example in Hollywood, right? So I think it's probably easier to be a leading man for longer than a leading woman. I would guess that is true.

There's probably data that could support that. So does that mean that female actors are not as good as male actors? Or does it mean that female actors are punished more for aging than male actors? It's probably the latter. That said, I think when men are aging, there might be different things that factor into it.

And this might be one example, but I wonder if more men deal with regret than women because I wonder if more men engage in the kind of emotional stuff that we've discussed already today when they're younger and they take into their older age things that they wish they did different, whether it was with respect to how they were as fathers, how they were as, you know, husbands, whatever the case might be. And I don't know, maybe that's wrong, but I, but I do wonder if that there are differences in aging between the sexes that, that come down to sort of certain areas of socialization as well as biology. How can we, as men learn to deal with that decline?

You know, we take pride in the mile time that we can run and the muscle mass that we hold and the leanness and stuff. And yeah, I don't think it's, youth is much more prized in women than it is in men. But I think the conversation also accounts for that, at least in part, and that's it's written into the cultural sort of rhetoric around women and around aging. I don't think that this exists for men. I don't know that it is, but to your question about

like, how does one cope with the loss of aging? Cause there is loss. I tend to think about it through the lens of how I think about health span, right? So when I talk about health span, it has three components. We've discussed them already, but I'm explicit in saying them now, right?

So there's a physical component, a cognitive component and an emotional component. physical component, a cognitive component, and an emotional component. Two of those three are going to decline as you age, no matter what you do. I don't need to tell you which two they are. Can you alter the course of their decline? Absolutely.

Can you start at such a high, high, high place by working so hard in your 20s, 30s and 40s and slowing the rate of decline that by the time you're 97, you look like someone who is 70? Yes, you can, but make no mistake about it. You are never going to look like someone who is 20. So in addition to doing everything I can to do that, I tend to place more energy in the one that doesn't have to decline with age and maybe kind of rejoice in that one, which is, you know, I was an insufferable, miserable, self-absorbed prick.

And I am so excited to know that when I'm 60, I won't be. Now I have to work really hard not to be. To be clear, it's not the default state that your emotional health will get better over time. You need to work your ass off at it, just as you need to work really hard to maintain your physical and cognitive health as you age. But the beautiful thing is you will actually

increase as you age that emotional piece, if you're willing to do the work. And so my view is do the work in all of them and accept that this one's going down, but this one's going up. And to me, that is true, whether you're a man or you're a woman. And therefore that is the single most important

thing I cling to as I find myself having a little pity party over the fact that I don't like my body as much as I used to and I don't feel as smart as I used to feel and I hurt more than I used to hurt and I'm not as strong as I used to, like nothing about me today, physically or cognitively is what it was 10 years ago. And if I told you otherwise I'd be lying. Yeah. But I'm a way better human being today than I was 10 years ago. And I know that I'm going to be a way better human being in 10 years than I am today. What would constitute an emotional training regime for you if we've got, you

know, VO2 max and zone two and whatever for physical health, what would the emotional training regime be? Well, it really comes down to sort of the, there's the therapy, right? Like those are your sessions in the gym. And then there's kind of everything you're doing in between. It's the, you know, the analogous thing

would be being active when you're even not just in the gym and, and the lifestyle choices you make day by day. So it's, um, how do I put into practice what I'm learning? So, um, I don't know from, I mean, again, I sometimes get embarrassed talking about this stuff because I, I'm a little embarrassed to

talk about what a, what a horrible human being I used to be, but, um. We're all friends here. Yeah. Um, you know, just like I really take joy now in, in being less selfish with the people I care about. And, and to think about how selfish I used to be, like everything revolved around me, my health, my work,

my this, my that. Um, and you know, like yesterday, for example, my, my, my wife who had a long run this morning, a 17 or 18 mile run, she's running for the London marathon. So she was, she had a long run this morning, a 17 or 18 mile run, she's running for the London marathon. So she had a long run this morning and she was like, look, can you go and pick up our daughter whose volleyball practice ended at 930 and then you got to drive her friend home.

And by the time I get home, it's going to be like super late. And again, normally she does that and that's just kind of like, she'll do that pickup that night. Um, and again, this doesn't sound like a big deal, so people watching this are going to be like, what's he even talking about? But in the past, I would have like, been like,

I don't know, babe, like I just, I think you just got to do it cause I got too much stuff to do, but of course it didn't even occur to me. Of course I was like, of course I want you to sleep, like go to bed early, let me go take care of this and I'll do this, this, this thing when I get home and I'll take care of it. And again, it's a very small example, but it's the

practice, it's kind of putting into practice, like how can I be a better spouse because you know, I don't want to be the selfish guy who the earth revolves around. So even though that's one very small, trivial example that happened to occur last night, it's like looking for those opportunities every minute of every day and looking for ways to be a better dad or a better friend or a better

son, because Lord knows I've been so bad at those things for so long. And, and, and, and now I'm really enjoying the opportunity to, to spend more time with my parents in a way that I never did before, because A, they're not gonna be around forever, but also I know that it means so much more to them given that I have kids now too.

Well, also you have this degree of pride in knowing where you came from. Like you are, and maybe I am too, the emotional equivalent of a fat guy that got jacked, you know, like look at how terribly I was the awful condition that I was in previously. And look at all of the work that I've gotten to now. And you're again, the same as the dude that used to be fat that now is like, bro, I did a, I did a 5k park run this weekend. And you're like, the same as the dude that used to be fat that now is like, bro, I did a 5k park run this weekend.

And you're like, well, you know, compared with Elliot Kipchoge, that's nothing. It's like, yeah, but you don't know where I started. It's like going and picking the daughter up and not thinking about it and wanting to be there to support the wife. That's not that big of a deal. It's like, yeah, but look where I started.

Right. And I'm learning that too. I've got, I have a number of patterns. I'm also very cautious, super cautious of like, this is my new toy and I'm now starting to see everything everywhere. I saw a tweet a little while ago that said, um, uh, I just learned about recency bias and of all of them, I have to say it's my favorite. And I'm a great meme, right?

And like, no, it's the Dunning-Kruger effect characterized, right? Yes. Yeah. I don't want to see everything that I do as, oh, there's people pleasing again, or, oh, there's you with your blah, blah, blah, blah, blah. But it's fascinating and it really is an entire new realm of life that I totally hadn't considered. I knew you experienced, everyone's experiences,

emotions, but not everybody actually connects with them. And certainly people don't connect with them on the level where they give them respect. Right. Emotions are kind of this thing to many people, me as well in the past, that were like an annoying, it was like rain.

Like if they're negative. Yes. It's an annoying thing that kind of gets in the way. And every so often it's a sunny day and you're like, fuck it, sweet. Thanks. Thanks guys. But never actually connected with them.

I was like, okay, but why is it raining? What does it mean? And how can I work with this in a bit of a different way and why is it sunny? And do I want this to happen more? And what are the things that I do that engender that? Yeah. And by the way, you also realize if it's sunny every single day and it never

rains, do you really appreciate the sun? Yeah, I, uh, I had dinner with a friend a little while ago who, uh, told me about a girl that he'd started dating and he's the super rational cognitive guy. And she's crazy just in her emotions, both cultivated and natural disposition for both of them. So they've both like become more of what they are in some way. And he said it was like a boxing a Southpaw. He was having sort of, he was coming from his perspective and she was coming from her

perspective. But he asked, he was like, you know, as someone who doesn't feel things the way that you do, said, what's it like? She's like, it's terrible and beautiful. I was like, there it is. It's like you just, the gamut, the spectrum of experiencing things is so much broader. But I've been through a few strong emotions

over the last few weeks. And one of the things that it really made me think about is how little compassion so many people have, especially on the internet. Like you know, you see someone who has a public, they fall flat on their face in one way or another or, you know, they do something silly or the story comes out about them, or they have a public makeup or breakup, or, you know, their ex partner gets with somebody new or whatever it might be. And like, the way that people talk about other humans is so dehumanizing.

It's like it's WWE or a sitcom or something. You're like, you do understand that on the other side of what you see as like a narrative arc, someone else has told you that there's actual humans fucking feeling things, like in the grips of a state. And yeah, like Guy at 36 realizes that people feel feelings, like shock, but yeah, that was, that really, it really sort of woke me up to. Was there something in particular that happened that you saw that, that made you feel this or made you realize this? Not particularly just me, me kind of being in this arc and, and really

sort of sinking into stuff that wasn't, I think the, the Jonah Hill thing that happened about six months ago, uh, was one of these Jonah Hill actor had a girlfriend, they broke up and the, uh, ex-girlfriend kind of released the messages online. And it, the argument largely centered around, should she have released them? Was he in the wrong? Was she in the wrong? And like, it doesn't really matter about that bit.

What matters is the fact that both of these people were wildly hurting. They were showing it in different ways and you know, was he being mature? Was she being immature? Blah, blah, blah. But just the way that people comment on this stuff has no regard for the fact that there is a fucking human on the other side of this. Or like, you know, as another good example, love him or hate him. It doesn't matter. Jordan Peterson, a guy who went through hardcore Benza withdrawal for a year and a half. And I like watched this unfold from basically a front row seat.

I wouldn't wish that on anyone. I wouldn't wish that on anybody. Akathisia flying to first we'll go to Serbia, then we'll go to Russia, then we'll, oh my God, just like in this. Endless, endless torture. And people just at the time making jokes about Michaela's attempt to try and fix her dad or, or, you know, taking it like, who is this man to teach us about responsibility in the modern world when he's addicted to Benzos and he just fucking awful jokes. And I just like, it makes me think like, how bad does your life have to be that

this is the place that you get to that you speak about other people like that. And I'm not, I'm no saint. I'm not like brimming with unbounded empathy for people. I don't say things like that. And it just really, it really sort of resented like a bit, trying to think about a bit more humanity as best I can, I guess. One of the other guys that I've heard about, Ray Pete has a prescription or a piece of advice, which is to take aspirin every day.

Have you come across this? Is this something to do with blood thinning? Yep. And how legit is taking aspirin, 300 milligrams of aspirin every day or whatever it is. Oh, I mean, that's been a well understood therapeutic intervention for folks that are at high risk for cardiovascular disease. I mean, it's an interesting story because it's one of those things where the answer, or the presumed answer has changed so many times. So, there was a day when anybody would take

aspirin for cardiovascular disease prevention, and then it turned into, well, just very high risk and then it was, well, just high risk. Nope, it's just very high risk. Nope, it should be everybody. And it goes back and forth and back and forth and back and forth. And what's abundantly clear is the following. Anybody is going to have a reduction in risk for cardiovascular disease by taking an aspirin,

or typically it's a baby aspirin, which is 81 milligrams, quarter of the dose. But there's also a risk from taking a baby aspirin and the risk is if you fall and bang your head, you have a greater increase in the risk of hemorrhage, subdural or epidural hemorrhage. And so the real question becomes who are the people whose risk of cardiovascular disease is high enough that the benefit they get is greater than the risk of the bad scenario. Not skateboarders. Yeah.

Well, and the good thing is look, skateboarders also are young and they have big heads and their brains don't slosh around too much when they fall and hit their heads. Yeah. Right. But once you start to talk about people in their sixties and seventies and eighties and

the brain atrophies a bit, all of a sudden you're at a far greater risk for a subdural or sheer hematoma. You've actually got room in the head. You have more room for the brain to move. Oh, interesting. So one of my patients who is on a baby aspirin for the appropriate risks was skiing two weeks

ago, fall hits his head, no concussion, up back skiing, everything is totally hunky dory, but he's got persistent headaches for two weeks. CT scan shows small subdural hematomas. Let's stop the baby aspirin immediately and headaches for two weeks, CT scan shows small subdural hematomas. Let's stop the baby aspirin immediately and wait for that to get better. And we're very lucky. We don't need a neurosurgeon to go in there and drain it. So even though you can buy aspirin over the counter,

it's not an entirely benign thing and it comes, it has a lot of benefits. And we put the appropriate patients on it. For example, another case would be patients with LP little A elevations. That's a type of lipid that's hereditary, pretty common. One in 10 people have elevated levels of it, maybe more. And you know, there, the risk of thrombosis from the hypercoagulable state induced by LP little A is greater than the downside of the subdural hematoma risk, which is small, but not zero. That's interesting. And what's the baby? Some people say by the way, that if aspirin were being developed today,

it never would be approved. Why? These risks. Oh, okay. Yeah. So the mechanism of action is aspirin inhibits platelet aggregation. So what's that mean? Platelets are the type of cells in the blood that are partially responsible for clot formation. Okay. Yeah, so aspirin impairs that. By design or as a side effect?

That is its effect. Right. Well, I mean, it's an anti-inflammatory drug that does that. By design or as a side effect? That is its effect. Yeah. Right. Well, I mean, that's, I mean, it's an anti-inflammatory drug that does that. Yeah. Right. Okay. And this is. So actually I think its first indication was actually for pain. Yes. I always think of it as a painkiller rather than as a, something to make my blood flow more easily. Is there a risk of people bleeding out as well? If they were to get some sort of, like, if you were a war fighter, would taking aspirin cause your blood to bleed out more quickly?

Yeah, probably. Although that's probably something that is more driven by other clotting factors, not the platelets. So clotting, blood clotting is a really complex process that doesn't just involve platelets, but also involves a whole bunch of clotting factors, factor two, factor seven, all of these things. And you'll typically see,

so hemophilia, you've probably heard of this disease, is a genetic condition where one of those clotting factors is deficient. And every one of these results in a slightly different type of bleeding disorder. So hemophiliacs, contrary to popular belief, are not at risk of like, you know, spontaneously bleeding all over of like, you know, spontaneously bleeding all over the place, but they will spontaneously bleed into a joint more easily. Uh, I forget all the factors. I can't remember if it's like factor five

deficiencies, they tend to get, you know, you'll tend to notice if they get dental work, it tends to bleed a lot. Um, flossing their teeth, it will even cause a lot of blood loss. So not a lot of blood loss, but relative to what you would expect. So, um, it's, I mean, literally the last

time I knew the ins and outs of all that, I was studying for my med school board. So that's how long it's, that's, there was a day when I knew every one of these things, but, uh, aspirin works on platelets. Speaking of that, I saw a tweet from Elon saying when seeking medical advice, ask your doctor, but also ask an experienced nurse.

Nurses are underrated. You think nurses are underrated with regards to their insight around health and stuff like that? Yeah, for sure. Why? Um, again, it depends on the system, but if you consider a hospital, for example, which is

where you're going to most encounter a nurse, um, you know, like if you think back to when I was in a hospital, for example, which is where you're going to most encounter a nurse. Um, you know, like if you think back to when I was in a hospital, which was in residency, um, how much time was I actually seeing a patient, uh, who was awake? So because I was a surgical resident, we were obviously seeing patients a lot when they're, when we're operating on them.

But when you talk about a patient post-operatively who's going to be in the hospital for a week, I mean, I might spend a grand total of 10 minutes per day with that patient. And the nurse is with that patient for hours a day, literally hours a day. So a really good nurse, and not all nurses are good, just as not all doctors are good, but a really good nurse, which is presumably what he's effectively referring to here, understands things and sees things and recognizes patterns very well. I know that when I was a resident, anyone who was a good resident, and I prided myself in trying to be a good resident,

you would very quickly figure out which were the nurses who you always listen to when they said, there's something wrong with Mr. So and So over there. And they might say, it might be this, or they might say, I don't know what it is, but he is not acting normal. And I tell you more often than not, like something would go wrong. And it's like, yep, you know what? She's seen the pattern enough of his mentation status

or the slight decrease in his urine output. And you know, lo and behold, he's got a GI bleed and it's going to show up at two o'clock tonight. I'm going to be sticking an NG tube down his throat and we're going to output. And you know, lo and behold, he's got a GI bleed and it's going to show up at two o'clock tonight. I'm going to be sticking an NG tube down his throat and we're going to be running, you know, five units of blood in him on the way to the angiocath lab. So, so yeah, I think there's a lot of truth to that. Is that just front lines?

Yeah. And that's, yeah, that's so interesting. I don't even think about that. It's crazy when, you know, there's so much. It's a shame that there's a big nursing shortage in the US. Is there? Yes, absolutely.

Why is- So it's being met by importing nurses from other countries, right? So we bring a lot of nurses in from other countries, but look, I think it's a hard job and I think it's probably underpaid. It's a hard physical job too. Like shift work. And the WHO says any type of shift work is a health risk. Whether you're a firefighter or a nurse or a doctor.

Yeah. So, um, I just, you know, but yeah, I think it's, it's physically demanding. Um, again, you know, it's all, there's so many different types of nursing. It's a very broad profession, right? So, you know, you can do things as an outpatient nurse, an inpatient, surgical nurse, medical nurse, ICU nurse. I mean, there's so much different stuff going on, but it's not easy work,

and it obviously has a lot of emotional consequences as well. How did you deal with that? I mean, it was hard, I think. I think there were moments that struck me out of nowhere, meaning I didn't understand why in the moment I felt so attached. I think there were probably three or four times during my five years of training when, in a way that I couldn't have predicted an hour earlier, I just became completely overcame, overcome with grief as a patient died.

And I, again, I don't, I don't, these aren't things we necessarily spoke about together. So I don't, I don't understand like, was that something that everybody was experiencing or was that just something I experienced? But, but there were, there were a handful of times when I was really just absolutely devastated. And it's not necessarily what you would expect.

It wasn't like, oh, this is a patient I've known for a year. I mean, in one case it was a, and I write about this one case in the book, it was a boy that, I just happened to be the trauma chief that night when he came in in a car accident. So I didn't know him, right? But he died right there be the trauma chief that night when he came in from, in a car accident. So I didn't, didn't know him, right. But, but you know, he died right there in the

trauma bay as I was trying to resuscitate him. And I can't, I've lost track of how many people have died in the trauma bay when I'm taking care of them, like that's, I need scientific notation to remember that number. It's huge. But there was something about that boy on that night that was impossible for me to fathom.

So I'm not sure why. I have a friend, one of my best friends in the UK who became a F1, F2 med student practicing during COVID. Oh, I thought you meant F1, F2 driver. I was like. No, no, no, no. I'm afraid not. We would, both of us would be trackside if that was the case.

And he told me the story during COVID of a lady who came in. And when she came in, she was a little bit short of breath and whatever, whatever she called one one one, or which is kind of like the slightly less intense nine nine nine in the UK. Got taken in and, uh, he saw her and she was a little bit short of breath. Then he saw her 30 minutes later and she was blue. And he saw her 30 minutes later and she was dead from when she'd come in.

And the lady that he was talking to, and that one really hit him as well. And he didn't, I kind of the same as you, he didn't know why he didn't know what it was, but he's told me that story a couple of times. And each time he tells me, it's kind of haunting to just think that, you know, from being someone sat in a Uber or an ambulance or something, and then 60 minutes later you're gone. It's fragile.

It's a lot like the first death I saw, which I think I also write about this in the book when I was a med student, I think it was my second year. And it was a woman that came in short of breath and being the med student, I was sort of, okay, go and talk to her. She's a little short of breath, she's probably having an asthma attack. And what it turned out is she was having a pulmonary embolism and in the midst of sort of just sitting there talking with her, she has a cardiac arrest and that turns into a full code, which ultimately ends with me, you know,

being brought in to do chest compressions. Uh, and, and ultimately she died and it was, again, I, it's, it's, it's, it's one of those things where I mean, I had never seen a person die before and it's compounded by the fact that I had just spent 30 minutes talking to her. Yeah. Yeah.

At this country, this deceleration of aliveness. Yeah. I'm sitting here and speaking with this woman for 30 minutes who then an hour later is dead. Um, and I remember it was a Saturday night and I remember riding my bike back home from the

Stanford hospital, which is on the north side of the campus to where I lived. I lived, you know is on the north side of the campus to where I lived. I lived on the south side of Palo Alto and I remember just driving my bike back. It's like midnight on a Saturday. At the time I had a girlfriend who was an architect. She lived in San Francisco and we never talked about, she had this kind of like, she was skeezed out by medicine. So it's like our relationship was not at all based in talking about my day job or my, you

know, my school. Um, and I remember being very upset when I got home cause I really needed to talk to someone. She, your girlfriend would be the likely person, but I also knew it was like, yeah, she, she's not the one who's going to hear this. Um, but I remember knew it was like, yeah, she, she's not the one who's going to hear this. Um, but I remember that feeling very distinctly of how upset I was and not, and not feeling

like there was someone to talk to about it. What do people gloss over in Outlive that you wish that they didn't? What were the most unpopular, important insights you're about to hit full year on the bestseller list. What do you wish people paid more attention to in the book, whether or not?

I mean, I have to be honest with you. First off, I have been completely and totally blown away by the response to the book. And part of it has been the number of things people have come to me and said that they've changed, either changed their mind about or just changed their behavior about. And through those discussions, there's nothing that stands out to me where people are, you know, I really don't know. I think that the two things that are pleasantly noted are one is, you know, the fact that there's three chapters on exercise, I think was a

deliberate decision just based on the volume of what I needed to say. And I think people have taken that to heart. You know, I think people are saying, wow, I thought I, yeah, I understood that exercise mattered, but I now have a much clearer path for understanding not just how much it matters, but how to think about it comprehensively.

And then I think, look, the final chapter of the book and the epilogue, which were, you know, not, they were not something that was necessarily going to end up in that book. And I think if my publisher had had their way, it wouldn't have ended up in the book. But I, but I actually think that there's a non trivial subset of the population who've read

the book, who say that that's maybe the most important part of the book for them and that it's opened their eyes to the same sort of exploration. So look, if it, if it does nothing else, right, if it doesn't change anything about the way you eat or sleep or exercise or think about heart disease or cancer or Alzheimer's disease, but it ignites in you kind of a curiosity along some

of the stuff we've been discussing. Well, then it's worth it. Then you could just save the time and jump to the last chapter. That's a win. Yeah. Let's say that you could only do 10 exercises for the rest of time.

It could be any machine, any modality. You're talking just weight exercises, strength exercises? Cardio could be anything. It could be swimming, it can be cycling, it can be being on a bullsuit ball, it can be hanging therapy, it can be anything, but you only have 10 modalities. And can one of them accommodate multiple variants of it?

Like would a split squat allow you to do every form of a split squat? No, no, no. So a rear foot elevated is a dedicated. That's the, those are the rules and you've got 10. What are you choosing? Come on now. The bike, bicycle. Road bike?

Yeah. At just that you can do different intensities on the bike. That Road bike. Yeah. Cool. At just, you can do different intensities on the bike, that's allowed. Yeah. Uh, is that because you get the big variations? It's where I get my, it's where I do my zone two and my VO2 max, so I'm going to get my full suite there. Yep.

Um, boy, do I want to use up, I mean, for now, I'm going to throw in rock and swim, but I'm going to reserve the right to come back and say, okay, because that only leaves me seven on, yeah. In the gym. What would be the justification for rock? Um, it's just a, it's, it's just so beautiful

to be out there carrying weight around. It's also the most social thing that I do. So I love when my patients come into Austin and I can go for a rock with them. So, you know, it's, it's, whereas I'm not going to go for a bike ride with somebody or swim with somebody and most people don't want to lift weights together. What about the stimulus itself? Is there something specific to the ruck? Is it to do with the fact that you're loading?

Yeah, yeah, no, I think it's, it's, it's great to be loaded without over pounding the joints, um, and it's also great training for other activities. I do like hunting where you're walking around and it's challenging and you've got to pack on your back with a lot of weight in it. Swimming, why swimming? Even if it does get kicked out. Yeah, I think, you know, look and it's challenging and you've got a pack on your back with a lot of weight in it. Swimming, why swimming?

Even if it does get kicked out. Yeah, I think, you know, look, it's something that's always been near and dear to my heart with my background. And, um, I also think it's a great sport for life. Um, and so it also is something you can really do well at multiple intensities. So you can really kind of do easy, easy, peasy zone too.

And you can do like the most crushing soul burning intervals. Um, it's an amazing way to train your lower body, doing kick sets till the point of like the burn, you know, it's just, it's just, it's a, it's a beautiful whole body workout in a way that virtually nothing is maybe with the exception of rowing. All right. Three. whole body workout in a way that virtually nothing is, maybe with the exception of rowing. All right, three. I'm going to go with a relatively new toy in my life, which is a belt squat.

So I very recently, like in the last four months, got this new belt squat machine and I, I have to say it is the greatest hip hinging device ever. And it's really nice because it's just, you're not actually loading the spine at all. So I'm able to load my body with as much weight as I would have ever been able to tolerate in a back squat or deadlift without any of the axial loading. Um, so that's definitely on the list. Who makes the machine?

Uh, I want to give them a shout out cause I'm so happy with them. Um, and I don't have any affiliation with them. I think it's called squat max or something. It's a guy. Plate loaded. Yeah. Yep. It's a, it's a, it's a guy who's a former NFL player and I'm blanking on his name.

I apologize. I wish I could give them a better job, shouting it out. Hopefully you can link to it somewhere. Yep. But I think it's called squat max MD or something like that. How comfortable is the belt?

I've found a mixed variety. This one is exceptional. And I tried a couple beforehand. Yeah. It's so good. I get bruised hips if I get, you know, you've got some. You should come over and try mine.

Yep. All right, cool. No, it's cool. Cool. Cool. Cool. I have to, I adore the belt squat. I'm someone with lower back injuries. And also I learned this from Dr.

Mike Isretel, the, um, additional, uh, CNS strain that you get from axial loading, which is specifically through the spine. And to be like, Oh, I just get to completely kill my legs. I can bail out whenever I want. I can go to failure as much as possible. I can get someone else to deload the bar or whatever.

The plates get easily to do drop sets. I can do all this stuff and you're telling me that I get to do it. So I'm all in for that. Okay. So that's four. It's going to have to be some variant of a split squat, cause I really love single leg stuff too. So it would either be, um, a traditional barbell

lunge, single leg. Just a walking lunge. Uh, step back. So, uh, or it might be a rear foot elevated split squat with dumbbells or kettlebells. Yeah, I mean that's. And I'm gonna talk to the governing body and see if they're gonna let me count that as one exercise.

I'm gonna really push on the judges here. Okay, all right. I don't think so, I'm sorry. I'm afraid you're gonna have to make a call. You're gonna have to make a call between the two. All right, it's gonna be't think so. I'm sorry. I'm afraid, I'm afraid you're going to have to deny. You're going to have to make a call between the two. All right. It's going to be one of those two. Okay. Um, again, the advantage of those is, is obviously, you know,

legendary across the board. Also, you want some axially loading, right? You do still need to be able to do that. So, so again, here we're doing it with a much lighter weight. If I'm doing, if I have a bar on my back, I'm not really going above 135 pounds when I do that exercise. Yeah. Um.

I love the, uh, walking lunges, all reverse lunges with dumbbells because it just feels, I'm so stable. I don't feel like I'm going to fall over. It's good for grip strength as well, which is quite nice, a little bit of sort of trap work. So yeah. Okay.

So that's five. You've got five more. Yeah. Um, I would do, I would pick, uh, probably a dumbbell press. Like a bench. Yep. Thumbbell bench press. Yep.

Yep. Um, Either a, oh, by the way, if I do pull up, I can do all grips. Right. Sure. You can go chin up and pull up from that. I neutral. Ah, come on. Are you really pushing the limits here?

The governing body is going to have to meet and give me three grips. Okay. All right. So be it. All right. We'll do a three grip pull up. Okay. Um, the squat of the back.

Yeah. Um, how many is that? I think you've got six. So I think you've got four more. Do you ask everybody this question? Am I, and does everybody take this long? Yes. Okay. You're the pain and someone asked me on a Q and a, and I took even longer than anyone.

So I've asked Phil Heath, I've asked some of the greatest bodybuilders of all time. So everybody, I don't think there's a single person that hasn't said dumbbell either bench press or incline bench press. That's like the one that's single threat. Everyone's a bro deep down, but you've got four more. Um, good Lord. I don't even know. I mean, I haven't even included any of the kind of rehab important moves that I do, right? That doesn't count, right? If I'm doing DNS, like dynamic neuromuscular

stabilization stuff where I'm doing like, if you don't know this stuff, the positions won't mean anything, but I'm going to say that doesn't count. Okay. Yeah. Okay. Um, I would probably also do a tricep extension. So an overhead tricep extension, one of my

favorites. So you have to obviously get humeral extension and then a tricep extension on that. Tell you what's a really lovely variation that we've been playing with on our Saturday session is a floor skull crusher with small plates and that is just so nice. Held like this?

No. So on a W bar. Uh, oh, I see what you mean. Yep. Yep. Yep. But just going from the floor, just because I've always felt a bit strange bailing out

when you're on a bench. It's always a bit like, yeah. And if all that you need to do to bail out is just go to here and it hits the ground. Yeah. Um, I've really been enjoying that, but I mean, that's, every guy ignores that it's just pushdowns. Everything is pushdowns or close grip bench.

It's like, dude, get your fucking arms over. It's interesting. I think the literature is pretty clear on this. Isn't there a significant difference in tricep activation when you have humeral extension? Correct. Yeah. So I don't actually do anything that's not extended now. One.

There may be a benefit to it, but I obviously don't spend a lot of time doing arms as evidenced by my arms. Yeah. One thing that I did learn that was interesting, like tricep kickbacks are kind of like, they feel like the shake weight of the upper body or something, but that, uh, Jeff Nippard talked about this, the fact, one of the heads of the tricep only gets activated when the, uh, uh, elbow is behind the torso.

Yep. Um, so you can do this in a number of ways. You could use a, uh, uh, cable and again, put yourself into this position, but that actually is kind of important to get maximum contraction on it. Is that? Interesting. Yeah.

I never thought about that. All right. You're not going to make the top 10 for me. That's fine. That's okay. So you've got three more. Uh, a hanging, uh, leg raise. Again, probably at least 80% of people that

have answered this have put that in as their app movement of choice. Yep. Are you going to hang? I'm going arms in and then I'm going to do, I get all three sides, right? That counts as one movement. Don't even try to tell me that doesn't. I have to say of all of the people I've asked this question to you are the most

litigious, by far the most fucking litigious. Okay. Two more. the most litigious, by far the most fucking litigious. Okay, two more. This is going to be a dumb one for most people, but I'd probably do a farmer's carry. Okay. Yeah. Yeah. I'll give you for this, given that you're probably going to try and litigate

your way through it, I'll give you both unilateral and bilateral for that. Yeah. Um, why? Um, I think for me, it's probably one of the best grip exercises as well. And I like that. Um, and I appreciate getting the unilateral for free. Um, I'll tell you, I would have accepted it, even

if I only could do it with a hex bar. Okay. But that's my, I like doing both, but what I really love doing is I do this set once a week, hex bar loaded up, pick it up 30 seconds of walking, 30 seconds rest, 20 times. So it's a 20 minute set. And you know, I would like to see people of

our age should be able to do that with their body weight. Yes, I've seen you talk about that. And then obviously, you know, once, you know, you keep progressing through that. And, you know, I think I'm up to maybe, I don't know, I'm probably at 115% of my body weight now. So I think A, you're really getting some grip

strength there. Like you're really, you know, when you get into that 15th, 16th set, you're really getting some grip strength there. Like you're really, you know, when you get into that 15th, 16th set, you're really feeling it. Um, but also you're really, you have to have a stable core to be able to do that. You've got to be able to kind of control yourself. You're, you're, you know, you're, you're getting

great, um, uh, dorsiflexion, you know, everything is so much harder when you're carrying that weight. So I think it's a great exercise. It's also one of the exercises I love doing as if it's a, it's a great family exercise. So believe it or not, it's like, it's on the driveway, swearing and sweating. And the kids are doing it with me. You know, they carry their little weights and you know, they're one kids

timing me and all that kind of stuff. Okay. Final one. Two more. No, one more. I feel like I'm just missing something so obvious. It's almost like I need to see other people's choices. Is it bicep curls?

No, I thought about that, but it's like, do you really waste one of your 10 on that? That's true. You've got pull ups. Same as calf raises. You've got, you've got no direct shoulder work, but if you're doing bench and then you've got your holds. No, you know what? I'm going to take a seated calf raise.

Seated calf raise for the number 10. Yeah. For soleus. Why? Um, first of all, contrary to popular belief, a seated calf raise does still hit the gastroc, so you are still strengthening the Achilles as well. And maybe, maybe I would change that to a standing,

but I think the seated, you can load so heavy and I really think that a strong soleus is a healthy lower leg, which I think it's just a way of life. So yeah, I'm going to bring that in at number 10. Hell yeah. Dr. Peter Rittier, ladies and. So yeah, I'm going to bring that in at number 10. Hell yeah. Dr. Peter Attea, ladies and gentlemen, Peter, I really appreciate you. Thank you for joining me on the first ever one of

these that we have done for the people that are just listening. We have been cycling through a Western landscape on a virtual video wall and then a museum atrium complete with moving dinosaurs for the last three and a half hours. I really appreciate you, mate. I love your work.

I love the fact that you're diving so deep and making this stuff accessible to people. What should everyone expect over the next few months coming out from you and your lab and the stuff that you're doing? We've talked about a few of the things. So I think I am excited about this sunscreen thing. Uh, the sun melanoma sunscreen thing is an important one that we're going to do.

Um, we're introducing something new to our podcast, which is going to be quarterly reviews. So we get a lot of feedback. Hey, Peter, love your podcast. Can't keep up man. Three hours a week of super deep diving into stuff. I need the TLDR and yeah, we have great show notes and all other stuff, but. podcast, can't keep up man. Three hours a week of super deep diving into stuff. I need the TLDR. And yeah, we have great show notes and all other

stuff, but what I do, and I think you do the same thing, every time I finish a podcast, I make notes. So I use, I have these cue cards, these eight by five cue cards, and I write down the most important things I learned. And I've been doing this forever and there's like a huge stack of these things sitting in my drawer that nobody's

ever seen. And so I kind of mentioned this to my team three months ago and they're like, tell us what's on it. So we had a call and I read them the last three months, cue cards. And they were like, dude, that's a podcast. Make this into an episode.

That's an episode. Once a quarter you come and read your cue cards because it's what you found the most interesting and how did you change your into an episode. That's an episode. Once a quarter you come and read your cue cards because it's what you found the most interesting and how did you change your behavior as a result of what you learned. So we'll be introducing that in Q2 as well. That's awesome. Uh, where should people go? They want to keep up to date with what you're doing.

I think our site is probably the best place, Peter Atiyah, MD or earlymedical.com. Oh yeah. Peter, I appreciate you. Thanks so much for having me.