Something You Should Know - How to Get Unstuck & A New Approach to Longevity - SYSK Choice

Episode Date: May 17, 2025

Drinking water is what keeps you from becoming dehydrated. What you may not know is that there are other factors that can speed up your dehydration that may require you drink even more water than you think. This episode begins by explaining what causes this to happen even when you think you are taking in plenty of water. https://www.eatingwell.com/article/8034255/sneaky-reasons-youre-dehydrated-nothing-to-do-with-water/ Have you ever felt stuck? May you've felt stuck in a job or a relationship or maybe you are stuck trying to come up with a new idea. Sooner or later, we all feel stuck. Luckily, for over 20 years, Adam Alter has studied “stuckness” to help people understand how and why it happens and most importantly how to get unstuck. Adam is a professor of marketing at New York University’s Stern School of Business. He also holds an affiliated professorship in social psychology at NYU’s psychology department and he is author of the book Anatomy of a Breakthrough: How to Get Unstuck When It Matters Most (https://amzn.to/3O2uH7d). We've all heard the advice that to live a long and healthy life you should eat right, exercise, get enough sleep, reduce stress, etc. The problem is that as advice goes – it is pretty vague. Good thing my guest is here. Peter Atia, MD. Peter serves on the editorial board for the journal Aging. He is the host of the podcast, “The Drive”, (https://peterattiamd.com/podcast/ ) which covers topics such as health, medicine, and longevity. He is also the author of a monster best-selling book called Outlive: The Science and Art of Longevity (https://amzn.to/3VTaWBa). Don’t you hate it when someone on a car trip says, “I feel carsick”? There are a lot of ideas on the best way to deal with car sickness but not all of them are effective. Listen as I explain what really works to help prevent motion sickness and alleviate the symptoms once someone starts to get that horrible nauseous feeling. https://www.ahchealthenews.com/2016/05/13/tips-preventing-treating-motion-sickness/ PLEASE SUPPORT OUR SPONSORS!!! CARAWAY: Get 10% off your next purchase, at ⁠⁠https://Carawayhome.com/SYSK⁠⁠ or use code SYSK at checkout. Caraway. Non-Toxic cookware made modern. MINT MOBILE: Ditch overpriced wireless and get 3 months of premium wireless service from Mint Mobile for 15 bucks a month at ⁠⁠https://MintMobile.com/something⁠⁠ ! FACTOR: Eat smart with Factor! Get 50% off at ⁠⁠⁠⁠https://FactorMeals.com/something50off⁠⁠⁠⁠ TIMELINE: Get 10% off your order of Mitopure!  Go to ⁠⁠⁠⁠https://Timeline.com/SOMETHING⁠⁠⁠⁠ INDEED: Get a $75 sponsored job credit to get your jobs more visibility at ⁠⁠⁠⁠https://Indeed.com/SOMETHING⁠⁠⁠⁠ right now! QUINCE: Elevate your shopping with Quince! Go to ⁠⁠⁠https://Quince.com/sysk⁠⁠⁠ for free shipping on your order and 365 day returns! Learn more about your ad choices. Visit megaphone.fm/adchoices

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Public Mobile, different is calling. Today on Something You Should Know, some things that can dehydrate you without you even knowing it. Then, getting stuck. I'm sure you have felt stuck in a job, a relationship, on a project, something. I ran this survey on hundreds and hundreds of people around the world and within about 10 seconds almost all of them could come up with an area of their lives in which they felt stuck.

And what's really interesting about being stuck is that it also feels lonely despite the fact that it's this universal human experience. Also some simple preventions and treatments for motion sickness you should remember. And longevity. What are the things that will help you live longer? I think if most people had to choose between quality and quantity of life, they would choose quality. That's a false choice.

Virtually everything you're doing to increase quality of life is also increasing quantity of life. There are very few exceptions to that rule. All this today on Something You Should Know. We talk a lot about health on Something You Should Know and I guess it motivates me. I mean, I'm not a nut about it, but I try to take care of my health. I want to preserve my mobility and strength as I get older. And I recently started taking this supplement, maybe you've heard about it, it's called Mitopure. Mitopure is a

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and Timeline is offering 10% off your order of Mitopure. Go to timeline.com slash something. That's T-I-M-E-L-I-N-E dot com slash something. Something you should know. I bet you have been told more than once in your life that you really should drink more water. You hear that advice a lot. Seems like it doesn't matter how much water you drink. Someone's gonna tell you you really need to drink more water. And maybe it's a good idea because there are some things that dehydrate you that you may not be aware of. For example, there is some pretty solid evidence that oversleeping and

under sleeping cause dehydration. So, more than 9 hours of sleep or less than 6 hours of sleep and you may need to have some water. Flying in a plane causes dehydration because the air in the plane is typically low in humidity. Sugar intake can cause dehydration, particularly drinking soda, which may sound counterintuitive since soda is a liquid, but excessive sugar intake can cause the cells in your body to flush their water to help the body restore balance. That in turn sends you to the bathroom and leaves your body dehydrated. And of course there's alcohol. Alcohol can suppress a hormone called vasopressin,

which acts to hold on to water in the body. And so you go to the bathroom and there goes your hydration right down the drain. And that is something you should know. I'm sure there have been times in your life when you have felt stuck in a job, in a relationship, or anything else, and it stirs up a lot of feelings of frustration and anxiety, uncertainty, maybe a little fear that you'll be stuck there forever. Being stuck just doesn't feel good. Still, it happens to everyone. Fortunately, for the past two decades, Adam Alter has been studying how people become stuck and how they get unstuck, and he is about to explain what he's discovered.

Adam Alter is a professor of marketing at New York University's Stern School of Business and has an affiliated professorship in social psychology at NYU's psychology department. He's the author of a book called Anatomy of a Breakthrough, How to Get Unstuck When It Matters Most. Hi, Adam, thanks for coming on. Thanks for having me, Mike. So what is that feeling of being stuck? I mean, everybody's felt it, but what actually is it?

Yeah, it's a good question. And there's the kind of stuck that we all felt early in the pandemic where you may have wanted to travel, but government regulations meant that you couldn't, there was nothing much you could do about that. I don't think that's particularly psychologically interesting or worth exploring. It's just the way the world works. Some things you want you can't have. But then there's a kind of stuckness that I actually found in my research is much more common, which is the kind of stuckness that is to some extent within your control, where if you behave the right way, act the right way, learn the right things, do the right things, think the right way, you are likely to move in the direction of getting unstuck. And that's true about all sorts of different things. It's true about what you do at work, what you do at home, your relationships, creative tasks. You know, it's true across what you do at work, what you do at home, your relationships, creative tasks. You know, it's, it's true across a whole lot of different domains.

And so that's the kind of stuckness that I'm really interested in the kind that you can act on. When I think about somebody being stuck or when I'm stuck, it's, it's like stuck in a job or stuck on a project. Like, like you're writing something or something or you get like a writer's block or you can't think of what to say next. I guess there's a lot of ways to get stuck. Doing research, one of the things I did early on

was I wanted to understand the various species of stuckness. And so I sent out a survey to hundreds and hundreds of people, some of them were very, very talented, experienced, some were struggling in all sorts of different ways, but all of them were stuck in at least one respect. And the stuckness varies. For some, it's financial, for some, it's creative, creativity based, for some, it's relationships into personal things. You know, it's, it's, it's a pretty diverse concept, but there are a lot of commonalities

that unite these different instances of being stuck. And then how do you get unstuck? What is the process of becoming unstuck from whatever you're stuck in? We are extremely good at being physically stuck and getting unstuck. We're sort of well engineered for that in a biological and evolutionary sense. So if you stick a human in a position

where he or she is physically entrapped, we marshal all sorts of resources. And you know, every now and again, you'll read these stories of what is known as hysterical strength, which is where people lift cars to, you know, remove themselves from difficult situations, physical entrapment. But unfortunately, the same instincts that make us so effective at dealing with those circumstances actually paralyze us when we're emotionally or psychologically stuck. So the first thing you've got to do when you feel stuck is to really deal with those emotional responses. And there are a number of things you can do. One of the sort of paradoxical things is to often slow down at the beginning.

So your body will tell you and your brain will tell you to speed up, to act, to do anything to get unstuck. But without planning a proper strategy, you're gonna fail. And so very often the first thing you need to do is to slow down, to exhale, to sort of remove some of the pressure that will immediately feel as though it's upon you. Once you've done that, you can start to form some strategies for getting unstuck. You can simplify the problem.

There are a whole lot of different ways of doing that. You can also, one, I think very useful thing when you're trying to come up with new ideas for something, if you're trying to come up with creative solutions, for example, is to dial down how creative or novel the idea needs to be. So a lot of us seek something that's truly, wholly, radically original. And that's really paralyzing. And actually, there's very little true originality in the world.

And the best place to begin is to just tweak existing things that exist in the world. This is often a matter of taking two existing ideas and recombining them in novel ways, which is known as recombination. And so how would you give me an example of doing that? One of the really good examples of this is Bob Dylan. When you ask a lot of really great talented musicians who was the most original voice or the most original songwriter of the 20th century, it's surprising that a lot of them say, Bob Dylan is that person.

Maybe it's not surprising, but what's surprising is how much they agree on that. But when you actually look at the origin of Dylan's songwriting and the basis for his early music, a lot of it ended up being small tweaks on existing ideas. You know, he'd met certain musicians, particularly folk musicians in the early part of his career in the 60s. And those folk musicians influenced him in ways that were profound. And when he was later asked about the influence of those musicians on his work, he said, Oh,

absolutely. I tweaked what they had done. I recombined what they had done with some of what I'd heard in rock and roll. And I had created this kind of newish version that was really a recombination of existing ideas. And you find this in all sorts of different areas. From the outside, these people might look like true originals.

But in fact, when you look more closely, you find that there's a sort of recombination of these existing ideas to form a sort of novel version of whatever those existing ideas were. And do you think that's, do you think it's deliberate? They're actually thinking what you're saying? No, I actually don't. I think most of the time what happens is it's not purposeful. And I think creativity for a lot of people is kind of mystical. We're not very purposeful about it. It's a difficult thing to be creative.

And by definition, that's true. Because if it were easy, you'd be following the herd. And what you were doing wouldn't be particularly novel or interesting. But it turns out with creativity, as with many things, once you understand it, you realize there are some very deliberate algorithmic strategies that help you be more creative. And one of them is exactly this process of recombining.

One of my favorite examples of this is a woman named Arlene Harris, who has made a business of combining existing ideas in new ways. She basically took the cell phone industry in about 2007, 2008, which was essentially designed for young adults. You know, if you think about the original iPhone, it was really, really hard for older adults to use. It was very different from what they'd been used to.

They couldn't type very easily. A lot of them complained about what it was like to use the iPhone. And Harris came in and said, well, look, we've got this product that's tremendously successful for young adults. We have older adults who want some versions of that, but they also want some versions of old phones, of traditional phones, of flip phones, phones with buttons. And she created a sort of hybrid in a phone known as the Jitterbug and ended up selling

that business for a billion dollars. So what she basically did there was she said, yeah, this is not novel. It's not new. It's not sexy. It's not original. But what it is, it's taking an existing market and an existing product, finding a new market that wants something slightly different and bolting these concepts together to form something that is tremendously successful, but isn't really in any sense,

completely radically original. If it's not deliberate, but it's not accidental, what is it? Well, I think some people stumble on this, right? And it's interesting when you're when you're in the business of creativity of whether it's art, music, writing, doesn't really matter the genre you're in, you naturally hoover up information, you hoover up the different strategies that other people in your field use. And without even realizing it, you become a sort of accidental plagiarist. And when you ask people where did these ideas come from, naturally those ideas, whatever their latest idea is, is going to be the product of everything they've ever consumed before.

But humans are really bad at pinpointing the origin of new ideas and really the origin of pretty much anything that they think of. And so when you try to backward engineer what we do when we do new things, a lot of what we're doing is just taking whatever we've been exposed to, creating a sort of Frankenstein's monster

out of it. And that's what our original product ends up being. But once you understand that insight, it's incredibly valuable when you're stuck because it turns the mystical process of creativity into something quite deliberate and algorithmic. And I think a lot of people who understand this have become much more successful and generative as a result of that We're talking about stuckness getting stuck and getting unstuck and i'm speaking with adam alter He's a professor of marketing at nyu's stern school of business and author of the book anatomy of a breakthrough How to get unstuck when it matters most? Breaking news a brand new game is now live at bet 365 introducing prize matcher a daily game unstuck when it matters most. a habit. How can you match that? Check out PrizeMatcher and see why it's never ordinary at Bet365. Must be 19-year-old or Ontario only. Please play responsibly. If you or someone you know has concerns about gambling, visit connexontario.ca, T's and Z's apply.

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I also believe, and that when you're stuck, this would be number one, when you're stuck, one of the best things to do is talk to other people because when you're stuck inside your own head and can't think of any new ideas, go get some from somebody else. I think that's, on its face, that's excellent advice. The thing that most of us do instinctively, though,

is we ask the wrong people. Our friends, colleagues who are trusted, they tend to be people who are a lot like us, demographically, in background, in attitude, in values. And there are really three kinds of people you can get advice from. You can get advice from people who you really like, who you trust, who are often a mirror image of yourself in certain important ways.

And the simpatico that you feel with them, the connection you feel with them is a good thing in every respect, except if you're trying to find something new and creative and different and to get unstuck. So you can start with them, but you also have to think of the other two kinds of people. One of those is known as a non-redundant person. This is just someone whose ideas are different from your own. They don't have to be wildly different or in opposition,

but they're just different in some respect. There's a lot of evidence, for example, that in the creation of TV shows, there's some work that was done on the TV show Doctor Who, which is the longest running TV show of all time. It began in the, I think, the 50s or 60s, that when the team that was working on each episode of Doctor Who involved people who didn't know each other or who'd never worked together or who were otherwise non-redundant, in other words, I had different backgrounds. Those episodes were rated by fans of the show as by far the most innovative, interesting, and memorable. You're looking for people who are non-redundant. But then the third thing you're looking for is to go even one step

further, and that's to find deliberate black sheep. These are people who go against the grain. And Pixar has a number of executives who use this approach. So they'll assemble a team of writers, of artists, of cartoonists and so on. And then they'll go out and find someone who disagrees with the way that team is functioning. And they'll bring them in and they'll say, all right, cat amongst the pigeons, be our agent of chaos and tell us

what we should be doing completely differently. And it's been really, really effective. In fact, a lot of their Academy Awards have come on the back of these films that have been created with the help of this black sheep, someone who's talented, but basically disagrees with the rest of the team. So the next thing I wanted to ask you about

is in my conversations with people about creativity, I think you said earlier on in our conversation that one thing you need to do is maybe slow down a little bit. And yet I find that if you're stuck you need to move you need to build some momentum and and often creative experts will say that the way to be creative is not to try to think of a big idea but come up with start coming up with lots of ideas creative people come up with, start coming up with lots of ideas. Creative people come up with lots of ideas. They're always firing on new ideas. But it sounded like

what you said in the beginning was, no, no, wait, slow down. That's a really important clarification point that essentially before you begin you want to slow down, you want to take a pause. And that could be for all sorts of different reasons and there are some great examples of, for example, athletes who are stuck in the process of some sort of competitive sport, and they pause, they take a beat before they do anything, and then they find that they perform much more effectively. One classic example of this is the soccer player, Lionel Messi, I think the greatest player of all time. He spends the first five, roughly three to five minutes

of every match he plays, ambling around the center of the field, watching all the other players and not really committing to the game. And what he's effectively doing there is he's taking those few minutes to calm down emotionally because he gets quite anxious. But also he's taking that time to develop a strategy that will be useful for the remaining 85 minutes

And so what you're suggesting about you know if you're in a creative Pursuit and arguably the game of soccer there are a million different things you could do you have to be creative You you do want to have lots of different ideas you want to try lots of different things and by pausing for those few minutes He's setting himself up to be able to do that. So I think you're right that after that pause, you want to basically do something, anything. And by definition, you're not stuck if you're moving. And so to move, even if it's not exactly in the right direction you want to be going in, is quite valuable because it unsticks you. It gets you oriented in the right direction.

One of my favorite examples of this is Jeff Tweedy, the frontman for Wilco, and he's also a writer. He talks about the process of writing books and also the process of writing songs. And he says it's difficult. Most people who are very good at this say that it's difficult. And what he does is he'll wake up in the morning and he'll sort of pour out. This is how he describes it. He says, I'm going to pour out all my bad ideas. And so what he's doing is he's not, he's not writing stuff. That's great. Necessarily. A lot of it won't be used, but he, he kind of, I don't know, oils the gears and moves in the right direction by just pouring out the bad stuff.

That's sitting at the top. That's how he thinks of it. And then all the good stuff that's underneath, that's a couple of layers below, is then free to emerge. But you have to go through that process first of pouring out all the bad stuff, all the stuff that's not particularly interesting. I also wonder, my observation anyway, is that it's kind of human nature to get stuck, that we're kind of wired that way, because if we always feel like we're not stuck, then you're probably not going to get ahead. I may say I'm stuck in my job.

There are a lot of people who would love to be stuck like I'm stuck. It's just the things haven't maybe changed a lot, but things are fine. It's human nature to want to do something else. I think that's right. I think one of the most profound insights about stuckness is that every single person is in at least one respect stuck.

It doesn't take many people, it doesn't take most people very long to think of an instance or an area of their lives in which they feel a little bit stuck, at least a little bit stuck. I ran a survey that I had mentioned on hundreds and hundreds of people around the world. And within about 10 seconds, almost all of them could come up with an area of their lives in which they felt to some extent stuck.

And what's really interesting about being stuck is that it also feels lonely, despite the fact that it's this universal human experience. And that loneliness, that sense that you're alone in that process is very isolating. And so you have this weird paradox where people say, I'm stuck. Everyone else says they're stuck, but we all feel isolated in that process. But I think you're right. I think stuckness is absolutely inevitable.

And I wonder if because it's inevitable that you feel stuck that a lot of people might Sabotage or ruin a good thing because just because they feel stuck even though things are fine objectively speaking You have this internal stuckness that makes you do things. Maybe you shouldn't that screw everything up Yeah, I think that's a really profound and important insight that, um, when you're when you're sure. So when you're subjectively stuck, that doesn't mean you're stuck in a sense that requires activation or action or anything in particular, it might just require just resting with that stuckness. That's part of what I

meant by this, the psychological response of feeling like you have to do something, it's really important to pause. And part of that process of pausing and taking a beat is to say, do I need to act? And if I do, in which direction should that action be pointed? And very often the answer is no, you don't need to act. You can sit with that for a little while as uncomfortable as it may be. And it might resolve itself. And if it doesn't, then you've given it a bit more time and you've probably learned something more about that experience of stuckness from that time,

which will make you more effective in dealing with it later on. So I think that pause, that beat at the beginning before you do anything is really, really critical in marshaling your resources in a productive direction. It seems as if a lot of this has to do with how you look at being stuck, that life is not just this free flowing river that everything goes your way every day. You will come upon times when you're stuck and then you'll get unstuck and move on and

get unstuck and then get stuck again. I mean, it's just kind of the way life goes. It's very much a cultural thing, how we think of stuckness and of change in general. So in the West, in the United States, in Australia, where I'm originally from, in Canada, in the UK, we tend to think of things as being fairly consistent across time.

And when they change, we find that a little bit surprising, even though we say change is inevitable. In the East, in East Asia in particular, in Japan, Korea, China, that's the opposite. They anticipate things changing. So one of the studies I did was I gave people a pattern of days where there had been either sun or rain for three days in a row. And then I said, tell me what's going to happen on day four.

Now in the U.S., we say things like, oh, it's a sort of warm streak and it's a warm period. And so the fourth day is probably going to be sunny as well. Or if it's rainy, we're in the middle of a rainy patch. It's probably going to be rainy. In East Asia, people say, oh, no, change is around the corner. If it's been three days of rain, tomorrow is going to be sunny. So East Asians tend to be better prepared for change and therefore for getting unstuck.

And for seeing that stuckness is just sort of a part of life, you will always be experiencing change. Whereas you're right, in the West, we see it as a journey and stuckness is the sort of frustrating thing that intervenes and makes that journey more complicated than we'd like it to be. And so I think when you can change your mindset and adopt the sort of Eastern way of seeing change

as inevitable and as just a necessary part of life that you should always be anticipating, you're much better at coping with that. Well, this is some great insight to file away for the next time I or anybody is feeling stuck. And what I really like is the fact that that feeling, that sense of stuckness that is so isolating is actually universal and everybody feels it.

I, you know, comfort in numbers. I've been talking to Adam Alter. He's a professor of marketing at NYU Stern School of Business. And he is author of a book called Anatomy of a Breakthrough, How to Get Unstuck When It Matters Most, and there's a link to that book in the show notes.

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Get almost, almost anything delivered with Uber Eats. Order now. Alcohol in select markets. See app for details. Generally, I think people hope to live a long and healthy life. And the advice to do that has typically been to eat right, get enough sleep, stay active, and exercise and see your doctor. All of which is probably great advice, but it's a little vague and it's pretty old advice. It's been around for a long time and it turns out there are other things we can do and other technologies we can use to see how we're doing beyond just eating right and exercising. Here to discuss this next

level of health and longevity is Peter Attia He is a medical doctor who serves on the editorial board for the journal aging He is host of a podcast called the drive one of the most popular Podcasts covering the topics of health medicine and longevity and he is the author of a monster Best-selling book called outlive the science and art of longevity Hey, dr. Attia. Welcome. Thanks for coming on something you should know. Thank you so much for having me. You bet. So I think most people know that if you're going to live a long and happy life, your best bet is to eat right, exercise, get some sleep, cut out your stress. So how is what you're

talking about different than that pretty generic e-advice? Well, I mean, I think it comes down to probably specificity, right? Just like, I think everybody knows if you have cancer, you need chemotherapy. But the details are probably what matters a lot more, right? And what separates me, who's not a medical oncologist, from someone who is, is knowing when to use that chemotherapy, which chemotherapy to use, how to cycle it, what doses to use, what biomarkers to be looking at to make sure you're not giving too much or too little, how to monitor somebody when they're in remission. It's the nuance that matters. And so you're absolutely right. I mean, I think

certainly throughout our medical education, it wasn't lost on anybody that exercise was good for you, but when was the last time a doctor asked you what your VO2 max was or what your zone two was or what your ALMI was? Even if they knew to ask those things, did they know what the metrics were, what they were going to hold you up to as a standard? More importantly, how do you get to the place where you want to be? What are those things? If my doctor asked me, I would,

I wouldn't know what he was talking about. I mean, what, can you explain those? Yeah. So those are just kind of a few examples of things that I think are really good signal integrators of things that we understand are beneficial. So we know that exercise is a good for us, but the question is how good is it for us? And one of the ways I think that's easiest to explain this is to look at what an outcome is that reflects a lot of exercise

and compare that to say an outcome that we know is bad. So we know that smoking is bad, right? I don't think there's any ambiguity about that. So how would we explain how bad smoking is? Well, one way to do it is to use a mathematical and statistical tool called a Cox proportional hazard, which spits out something called a hazard ratio. And it basically integrates the effect of smoking over a person's lifetime and says, this is the risk. And when you do that, you come up with an answer that says, and I'm just making this up. I mean, these are actual numbers, but I'm just saying directionally,

let's assume you take somebody who's smoked, got a 20-pack your smoke history, so they smoked a pack a day for 20 years. They're 50 years old. You compare that to a 50-year-old who's never smoked, but otherwise it's the same. What's the difference in risk? The difference in risk is about a 40% increase in all-cause mortality, meaning there's a 40% chance greater that that person is going to die, the smoker, in that year than the non-smoker. That's what that integral function is doing. We can do the same thing on the positive side. We can look at muscle mass.

ALMI stands for Appendicular Lean Mass Index. And it, as its name suggests, is a way to tabulate the total muscle mass you have in your arms and legs. And that's a reflection of how much you do. It's a reflection of how much exercise you do. Similarly, we can look at something called a VO2 max, which is a measure of the peak amount of oxygen your muscles can utilize when you're either on a treadmill or on a bike. It's an exercise test you do. That's obviously important because it's a reflection of how much you exercise. It's a way to capture the volume of exercise a person does. When you compare the hazard ratios of people who have high versus low VO2 max muscle mass or muscle strength, you see that the risk multiplier is so much

greater than 1.4. That's what it means to have a 40% increase in risk. We're talking about 2, 3, 4, even 5 X risk multipliers. Right, but most people aren't going to get down to that level of specificity because how would it change anything? I mean, you exercise, you exercise. If you don't, you don't. I mean, how much?

Well, it's not hard to do any of these things, right? So a VO2 max test, you don't need a doctor to do it. Anybody can just Google VO2 max test near me and you could go and get one of these tests. It probably costs a hundred bucks, maybe 120 bucks. You go and get the test, which means they put you on a treadmill or a bike and they basically just push you until you can't go anymore and it spits out that number. And then that number tells you where you rank. So for your sex and for your age, you will get a percentile. You then decide, do you want to be at the 50th percentile? Do you want to be at the 20th percentile if that's what it spits out? Or do you

want to be in the top 25 percentile or even the top two and a half percentile? There's no limit to the predictive power of this metric in terms of your lifespan. In fact, there is no metric that is more highly associated with longer life than a high VO2 max. Knowing it is the first step and then understanding how you can train it to get better is the second step. How does that work? If you have the test and then you take that number and say it's too low and you want it to be higher, how do you get it higher? So it depends on which number we're talking about. But if we're talking about VO2 max, then the name of the game is obviously more training geared

towards that. So to train VO2 max, I describe it to people, your cardiorespiratory fitness is kind of represented by the area of a triangle. And so picture a triangle standing up on a table. The base of the triangle is your aerobic efficiency. We measure that in something called zone two. The height of the triangle is your VO2 max. The greatest area of a triangle would have the widest base and the highest point. have the widest base and the highest point. As a general rule, what we want people doing is spending 80% of their total cardio training

time at low intensity, which we call zone two. We can talk about what that means in a minute. Then 20% of that time at higher intensity towards that VO2 max. The easiest way to do that and the way we have our patients do it is doing four-minute intervals with one-to-one rest and recovery. That would mean after a brief warmup, you might do four minutes of pushing yourself to about as hard as you can push yourself in that four minutes. Now, you're not going all out because obviously all out effort is only going to last 10 to

20 seconds. This is a really significant effort such that at the end of four minutes, you're absolutely gassed and you need four minutes of passive recovery. If you were doing this on a track, for example, and you were running, you would just walk very slowly for four minutes to recover. If you were on a stationary bike or on a regular bike, you'd pedal really, really slowly. Just doing, gosh, five of those intervals a week in one session would probably be sufficient for most people to significantly raise their VO2 max. But isn't this sounds very like this is for real high-end athletes. I mean, we're in a culture where it's difficult to get people to walk around the block after dinner. I mean, what you're talking

about is way beyond what most people would even think of doing. Perhaps, but I guess I'd say two things about that, right? First is it's all relative to where you're starting. To your point, if we're talking to someone who does zero exercise, for whom, if you could get them to go out and walk after dinner, that's a big win. The good news is they don't have to do that much to still get a big benefit. You'll still get about a 50% reduction in all-cause mortality, meaning at any point in time, if you look out the following year, you can reduce your rate of dying by 50% if you go from zero exercise a week to three hours of exercise a week.

But again, it's got to be strenuous exercise. But the other point I'd say is it depends what problem we're optimizing for, I suppose. So, I'm trying to optimize for a problem which says how do I maximize health span and lifespan? And I guess the question is why wouldn't that be challenging? I mean, if the answer were all you have to do is, you know, drink kombucha and meditate for 10 minutes a day, don't you think people would have done that already? Probably, but there also seems to be this kind of fatalistic when your numbers up, your numbers up and, you know, I do the best I can and, you know, all this, you know, I'd rather be happy and not, you know, be in the gym 20 hours a week. I'd rather live my life.

So I guess it really depends on what's important to you. Yeah, I think it's also important to understand that while that might be true when you're 30, that same attitude is going to reduce the quality of your life when you're older. And I agree that I don't think most people, I think if most people felt that they had to choose between quality and quantity of life, they would choose quality.

What I think people maybe don't realize is that that's a false choice. Virtually everything you're doing to increase quality of life is also increasing quantity of life. There are very few exceptions to that rule. So all this exercise that we're talking about, it's true that the metric by which we measure the outcome is length of life. What's much more complicated to measure because it's subjective is quality of life. And this is actually the single most important thing.

I write about this as something called the marginal decade of life. The marginal decade of life is your last decade of life. By definition, everyone will have a marginal decade. No one knows the day they enter their marginal decade, of course, but most people sort of realize it when they're getting close to the end of it. For most people, the marginal decade is not necessarily a pleasant time. Their body is sort of broken down, they're in pain, they can't really enjoy the things that they enjoyed when they were younger. They tend to become quite passive in life. They're not really participating, they're mostly spectating. Obviously, there are many

exceptions to that and those are probably the people that stand out to us when we think about what we want to be when we're older. Unfortunately, most people who end up having a great marginal decade usually get there on the basis of great genetics and a bit of luck. What I'm arguing is actually we have to train for that. That has to become the purpose because if you train to have a wonderful marginal decade, in other words, to be 80 years old but actually function like a healthy and fit 60-year-old. Well, first of all, that for most people is the single most desirable thing, but also it implies that everything that comes before it is also great. So just like someone who shoots a bow and arrow, which happens to be sort of one of

my favorite pastimes, if that person can be very accurate at 80, 90 or 100 yards and that's where they're practicing, well, by definition, they're very good at 30 and 40 yards. So if you do what you're talking about and really get very specific about what's optimum for you, how much longer and how much better are you going to live? I mean, it sounds like a lot of effort. So what's the payoff for all that effort, generally speaking? I think the payoff is at every point in time, you're able to enjoy the things that you enjoy,

whether they be cognitive or physical. It's important to remember exercise is not only sort of the most potent tool we have at extending lifespan, i.e. living longer. It's also the most potent tool we have at improving cognitive performance. In fact, it's probably the single highest ROI tool a person would have at minimizing the risk of dementia and neurodegenerative disease. So to me, that is the payoff. The payoff is that I'm reducing my risk of the diseases that would most frighten me and I'm

increasing my ability to participate in all of the activities that matter to me. And, you know, will one day matter to me as I get older and my kids get older and I have grandkids and I want to be able to do the things with my grandkids that I so enjoy doing with my kids today. When you look at the landscape, in fact, I was just reading this article about how Alzheimer's disease and dementia is just exploding in many states, and they attribute it to lifestyle and diet and in large part. And I've always thought that people, if you tell them

you need to exercise more and eat better and sleep better and all this, no one goes, oh, really? I didn't know that. Everybody knows that. They choose not to do it. And I wonder why. Why, knowing how important it is, is this apathy to do what's necessary to lead a long and healthy life.

It's probably two different reasons I could think of off the top of my head, right? So the first has to do with a lack of clarity around what that risk is. So I think when people say, yeah, you need to exercise to protect your brain, that seems a little vague. I think if people understood the magnitude of the benefit, that might be 10% of it. But I think the real issue here is the discounting problem, right? This is a hyperbolic discounting problem. It's the same reason that it's really hard to get someone who's 25 years old to save for retirement. If you're making $50,000 a year, you're getting roughly $1,000 a week in your paycheck. Let's

just say it's even $50,000 after taxes. You've got $1,000 in your paycheck after your taxes are deducted. And a financial advisor might say, hey, look, if you could set aside 25 of that, then our 20% of that, $200 a week, it's really going to move the needle when you're 60 or 65. And he's looking and he's thinking, well, OK, I sort of understand that, but it feels really abstract because I'm 25 right now. And that extra two hundred dollars a week would give me an extra two nights of going out for dinner. And I really enjoy that because I get to be with my friends. I'm like, you know, there's no value to be. There's no value judgment in that statement.

It's simply a question of prioritizing. Yeah, I think you're right on it. I think that's exactly it. That that it's just like saving for the future. It's like, I can do that later. I don't need to do it now because I don't feel anything that needs fixing. So why should I bother? Yes.

And I actually think it's even harder than the analogy I gave because the analogy I gave, when you put the $200 away for the future, it doesn't take you any additional time and it's not physically hard. When I'm asking a patient to spend an hour a day or sometimes more exercising, it's an opportunity cost of time. That's coming at the expense of something else.

So talk about diet because there's been so much contradictory information, what you should, shouldn't eat and so when the dust all settles, what say you? We don't actually know as much about nutrition as we'd like to. We know much more about exercise than we know about nutrition. It's much easier to study exercise than it is nutrition. Nutrition is the messiest field of all of health. But what do we know? Well, we know that energy balance matters. We know that when an individual consumes significantly more energy than they're able to put to work, they store it. They store the excess. That's an amazing feature of our evolution. Our capacity to do that, by the way, sets us aside from many of the other species

that we parted ways from millions of years ago and even hundreds of thousands of years ago from an evolutionary perspective. That's what allowed our brains to become so big was this capacity to store energy in the form of fat. This worked really well for us up until like 100, 150 years ago. But of course, now in an environment of excess food where you're not going to starve, this is working against us. Really, that's rule number one, right? Is you don't want to be overnourished, which is, I guess, a kind way of saying you don't want to be carrying around too much excess fat, especially when it gets out of the subcutaneous places where it was designed to be stored and leaking into places like around the organs, in the liver, around the heart, around the kidneys. These are the really dangerous places to store fat. And that's really where overnutrition causes harm.

I don't know how you get younger people to appreciate what the benefits will be in doing what you're talking about or what the problems will be if you don't exercise, if you don't eat right. Those things show up later in life, but boy, they do show up. Let's look at the most extreme example of that. Once you reach the age of 65, if you fall and break your hip, your one year mortality, meaning the probability that you're going to be dead within 12 months of that injury

is 15 to 30%. And a big part of that is yes, a certain subset of people die in the short term as a result of that injury, but many more people die as a result of never getting active again and they'll, they can, they can die very quickly. That's a pretty high number. It is. And that's why, again, we really talk a lot about why do you want to be lifting weights? Why do you want to be doing cardio?

I mean, why do you know accidental falls are the greatest source of accidental death for people above the age of 70. It's an enormous cause of mortality. It's not very sexy. Nobody really wants to talk about it, but the fatality is so high from a broken hip or femur that it is effectively. And again, I gave you data for all comers over 65. When you start looking at that at 75, 85, at some point a broken hip just becomes fatal. There's no greater way to strengthen your bones than to lift heavy weights. That is the signal to tell a bone to increase density.

I really like your perspective on all of this. It's a different way of looking at the whole issue of diet and exercise. It's probably why your book has sold a zillion copies and your podcast doing so well because of your insight into this. I've been speaking with Peter Attia. He is a medical doctor.

He's host of the podcast called The Drive. And the name of his big monster bestselling book is Outlive, The Science and Art of Longevity and there's a link to that book at Amazon in the show notes. Appreciate it, thanks for coming by Peter. Thank you very much, appreciate sitting down with you. If someone in your car has motion sickness,

there are a few important things to remember. First of all, it's a good idea to have some ginger handy. Ginger tea or ginger chews can be as effective as over-the-counter remedies for motion sickness. And peppermint helps too. And there are some things you can do to lessen the severity of motion sickness. For example, look off into the distance and focus on a steady point. That can really help.

Keep your head as still as possible. Sudden head movements can make things worse. And if the front seats are taken, the middle seat in the back of the car is best, because the more you can see in front of you, the better. Those motion sickness wristbands can really help people too and if you don't have one handy, applying pressure with your thumb on the inner arm just above the wrist crease seems to help. And that is something you should know. More than anything we rely on word

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