Ten Percent Happier with Dan Harris - 608: The Science of Longevity | Dr. Peter Attia

Episode Date: June 12, 2023

Most of us want to stay alive — and healthy — for as long as possible. But how to actually do that, given all the obstacles? What advice should we listen to? How do we find the time and motivation to follow it? And how do we do so without succumbing to what has been called the “subtle aggression of self improvement”?Today, we are launching an ambitious three-week series to tackle these questions. We are bringing on top experts from science and Buddhism who will talk about how to eat better, exercise smarter, and extend your lifespan. Guest number one is Dr. Peter Attia. He has trained at Stanford University, Johns Hopkins, and the National Institutes of Health. He’s the host of a popular health and fitness podcast called The Drive and the author of a new book called Outlive: The Science and Art of Longevity.In this episode we talk about:Why Peter kind of hates the word ‘longevity’The definitions of ‘lifespan’ and ‘healthspan’–and what we can do in five key areas to increase bothThe importance of exercise, including what types of exercise to do, how to measure your fitness, and how even a little bit of weekly exercise can go a very long wayThe roles our genes play in our lifespan and our healthspanThe importance of nutrition, including Peter’s top tips, his personal evolution, and his take on intuitive eatingHow to get better sleep (and when to stop tracking it)How to think about pharmaceutical tools, incl. a discussion of how to make sense of the crowded and unregulated supplement marketThe importance of emotional health, including a raw story from Peter about how he came to understand the importance of mental health, and why he believes tending to your emotional health makes all of the other health levers easier to pull.Full Shownotes: https://www.tenpercent.com/tph/podcast-episode/dr-peter-attia-608See Privacy Policy at https://art19.com/privacy and California Privacy Notice at https://art19.com/privacy#do-not-sell-my-info.

It's the 10% happier podcast. I'm Dan Harris. Hello, everybody. Most of us, I think I'm safe to say this. I think most of us want to stay alive and healthy for as long as possible. But how to actually do that given all of the obstacles? There's so much advice out there and it's changing all the time. How do we know which experts to listen to? And once we've picked our gurus, how do we find time to actually do all the shit they recommend? And even if we have time, how do we motivate ourselves to get off the couch? Oh, and how do we endeavor to work on our health without kicking our own ass all the time,

without being motivated by shame or self-hatred or a desire to get the same abs as our favorite Instagram influencers? In other words, how not to succumb to what has been called, And I love this. The subtle aggression of self improvement. Today we are launching an ambitious three week series to tackle these questions. The timing is perfect. Of course, we're heading into summer when a lot of us start to obsess with even more intensity about how we look. I thought about calling this series can a Buddhist want a beach bud? Ultimately, we landed on Get Fit,

safely. The Buddha stressed that we should get more intimate with our mortality with the non-negotiable fact that we're all gonna die, but nothing about that prevents us from taking care of these bodies while we've got them. The trick is to do it with the right attitude. So we are bringing on top experts from science and Buddhism who will talk about how to eat

better, exercise smarter, and extend your lifespan. This week, we're going to talk to two scientists who are experts in longevity, a little bit more about our kickoff guest in a moment. Next week, we're going to talk about how to exercise, both on a very practical level and on a more psychological level, meaning how to do it without being driven by self-loathing. And in our final week, we're going to talk about food, the impact of specific foods on your mental health, and some thoughts about how to feed yourself without getting coiled up into what researchers call orthorexia, which is an unhealthy obsession with healthy food. This series is a little bit more journalistic than our normal fair.

We're bringing on guests who have all different kinds of viewpoints because we want to expose you to a bunch of different ways of thinking so you can make the smartest decisions for yourself. And because this is such a complex and controversial area you're going to hear me press and probe a little bit more than I often do. My goal is really to help you cut through the blizzard of sometimes conflicting information on these really important topics. So guess number one is Dr. Peter Atia. He trained at Stanford University, Johns Hopkins,

and the National Institutes of Health. He's the founder of Early Medical, a practice that helps patients lengthen their life spans and health spans. He's the host of a podcast called The Drive, and he's the author of a new book called Outlive. Peter's a very interesting guy, very intense, very smart, very meticulous and detailed in his advice. He was actually on this show several years ago, and it's really quite interesting for me to watch how he has changed and in some ways softened without losing his rigor toward the end of the interview you're going to hear him tell a very personal story about why his tone has shifted so much. At times Peter gets a little technical, but stick with it,

he always steers back to the practical. In this conversation, we talk about why he kind of hates the word longevity, the definitions of lifespan and health span, what we can do in five key areas to increase both our lifespan and our health span, the importance of exercise, including what types of exercise, how to measure your fitness, and how even a little bit of weekly exercise can go a long way. The role of nutrition, including Peter's evolution on this issue is how to measure your fitness and how even a little bit of weekly exercise can go a long way. The role of nutrition, including Peter's evolution on this issue and his take on intuitive eating, which has been pretty important for me.

The importance of sleep, pharmaceutical tools, including a discussion about how to make sense of the crowded and unregulated supplement market, and the importance of emotional health, including, as I mentioned before, a very raw story from Peter about how he came to understand the importance of mental health, which he believes will make all the other levers we discuss here easier to pull. So, as I said, stay tuned until the end for that.

Before we jump into today's show, many of us want to live healthier lives, but keep bumping our heads up against the same obstacles over and over again. But what if there was a different way to relate to this gap between what you want to do and what you actually do? What if you could find intrinsic motivation for habit change that will make you happier instead of sending you into a shame spiral?

Learn how to form healthy habits without kicking your own ass unnecessarily by taking our healthy habits course over on the 10% happier app. It's taught by the Stanford psychologist Kelli McGonical and the great meditation teacher Alexis Santos to access the course. Just download the 10% happier app wherever you get your apps or by visiting 10% calm. All one word spelled out. Okay, on with the show. Hey y'all, it's your girl, Kiki Palmer. I'm an actress, singer, and entrepreneur. On my new podcast, Baby This is Kiki Palmer. I'm asking friends, family, and experts,

the questions that are in my head. Like, it's only fans only bad. Where did memes come from? And where's Tom from, MySpace? Listen to Baby This is Kiki Palmer on Amazon Music or wherever you get your podcast. Dr. Peter Atia, welcome back to the show. Dan, it's an honor and a privilege to be back. Let me start here. You say that you kind of hate the word longevity. Why?

I understand that longevity is a shorthand for a lot of things that I do care about, but unfortunately it has also become synonymous with snake oil and I think unrealistic expectations and pipe dreams that actually can found what I think we should be thinking about. So if I'm somewhere where I don't know someone and they come up to me and ask me what I do and I can't whizzle out of it via my normal channels of saying I'm a race car driver or a shepherd and they invariably find out and I can't wheeze a lot of it via my normal channels of saying I'm a race car driver or a shepherd. And they invariably find out, okay, I'm a doctor. The question I dread more than anything else is,

oh, what kind or what is your specialty? Then I'll still go through as many machinations as I can to get out of that by saying, well, I trained in surgery, that the, that the, that the, and I usually end up saying something like, well, I really focus on prevention. I usually end up saying something like, well, I really focus on prevention, and I kind of leave it at that.

But I never allow the L word to creep into the discussion. It may be just people of a certain age, but I think I got that shepherd reference as a Fletch joke. Yep. Am I right about that? Absolutely. And of course, but I'm very serious when I talk about being a shepherd. Yes. Fletch for the uninitiated was a movie that came out in the 1980s, starring Chevy Chase, very, very funny, at least very funny to men and women and everybody in between of our vintage

circa 50 probably. By the way, one huge regret I have, Dan, in the book is that there aren't more Easter eggs in it. And if there was a way I could have had John Koch, toast toast and somehow referenced in the book, that would have been, that would have been so valuable to at least people like you and I. Yes, exactly. And to the eight people listening to this, who got that joke. Anyway, let me just get back to longevity for a second. You talked about that it can get snake oil-esque, meaning that people are saying, yeah, you can live forever,

you can beat aging. Yeah, so I think there's two ways people kind of go about that. There's probably more than that, but broadly speaking, I see they're reading a couple, right? So you have kind of the Silicon Valley, not to throw Silicon Valley into the bus, but there's that sort of the singularity we're going to engineer death away. We're going to biohack death into a thing of the past. And then at the other end of the spectrum, you have kind of the, I'm going to offend people I know. I don't know how to do this without offending them. You have kind of more what would come out of like kind of Bronx or Long Island, it's maybe more of the supplement game. Like, well, we've got this little supplement here.

And if you just take this NAD and this NR, it's the magic elixir of life. And certainly nobody's assuming you're going to live forever by taking their 59, 99 a month supplement. But there's an awful lot of 59, 99 a month supplements that have zero efficacy that are kind of being touted as the quick fix, if you will. And there's everything in between. Those are kind of like two poles of the same problem in my view. One comes across this slightly more credible and serious. There are multi-billion dollar valuation companies that are kind of pursuing those things.

But I think they're doing so at the expense of what really matters Right, which is what can you do today? I want to get into what you can do today I also want to talk about supplements at some point, but staying with longevity granted that you don't love the word But it is kind of people Understand it in English. So having said all that. How would you define it? I Like to think of it as longevity, which is a legitimate word, really is a product, or technically, I guess you would say, the dot product of lifespan and health span. And I think those are things that we can get into a little bit more definition around. And we can start to even attach

our own sense of what matters, especially as it pertains to health span. Because life span is quite binary. Life span, of course, is the period of time in which you are alive. You are born at some point, you die at some point, and the duration in between those is your lifespan. And the medical system clearly fixates on that point. We talk a lot about life expectancy. We talk a lot about the actuarial factors that drive mortality. And we should talk about those things.

There is this other component that if you really, I think push people, Dan, will acknowledge is more important to them. And that is health span, which is harder to understand and define because it's not binary, but it's an indication of quality of life. And even the medical system doesn't define it very well.

So the medical definition of health span is the period of time from which you are free of disability and disease. But I don't find that to be a good enough definition. I think some definition of health span needs to touch on physical robustness, cognitive robustness, and emotional resilience and health.

And I think that goes sort of beyond the medical definition. But that quality of life component is a very important piece because to take an extreme example, there was nobody out here who would want to live 100 years, which is a very long lifespan, if they spent the last 30 of those in some form of decline, be it physical, cognitive, and or emotional. I guess that kind of naturally leads to the question then, which you posed earlier. So what can we do to increase health span? So the good news is all the things that we're going to do to increase health span will naturally

give us more lifespan. So we think of maybe different tools, right, so different behaviors. So I kind of organize them into five, although there's probably a six that would be sort of the waste basket for things that don't easily classify into the other five. But broadly speaking, these would be all the things that pertain to nutrition, sleep, exercise, pharmaceutical tools, which include supplements and include hormones, and of course prescription drugs. And then finally, all of the tools that we would consider

bringing to bear on our emotional health. So for example, meditation would be an example of that. So you've just laid out a great roadmap for this interview. I do want to talk about each of those buckets. Before we do that, just this question, sort of foundational question, I think your argument is that health span and lifespan are more malleable than we might think that, you know, we might look at our parents and the ages in which they went into decline and died and think, well, okay, that's my destiny. But I think you're arguing that it's not. That's correct.

I saw something on Twitter recently, which was sent to me. I take pride in spending virtually no time on Twitter, but someone had sent me this debate between two people who shall remain nameless, two very famous people. And they were debating about how, you know, your genes are your destiny. There's a grain of truth to that in some regard. So if you're thinking about certain diseases, there are certain diseases that are truly hard-coded in your genes. Fortunately, those are very rare.

So fortunately, very few genes are deterministic and very few diseases result from germline mutations, which are genes that you get from your parents. In other words, most genes are not deterministic. They just increase probability or susceptibility. And actually, most diseases result from somatic mutations, which are required. So when it comes to lifespan, which again is the easy thing to measure. That's the thing for which we have lots of robust statistics. Once you reach the age of 85 and up, say 90 and up, genes do influence the length of

your life. So the higher you get an altitude of age, the more genes do in fact play a role. But for most of us who will not live that long, shy of having those genes, genes don't seem to play much of a role in lifespan. So if your parents both died at 55 and 67, there's no reason you can't live to 85.

At that level, it's very uncoupled. It really only becomes an issue once you approach sentinarianhood, where indeed, genes do seem to matter a lot for lifespan. So again, there's a grain of truth in saying genes matter, but people tend to grossly overstate that. So just as a point of personal privilege here, I'll ask a question that the answer will only be of interest to me probably, but my dad has a form of Parkinson's for which he's sometimes apologized to me and my brother and he's a physician.

So maybe he's kind of got that wrong. Yeah, Parkinson's disease is one of the neurodegenerative diseases and there are some genetic relationships there. So when we take care of patients who have parents or relatives with Parkinson's disease or Alzheimer's disease, we do look at certain genes that we know increase susceptibility. But oftentimes we don't find them. Or if we do find them, there's such weak genes that were not convinced that the individual in question is at increased risk with the right behavior changes. Well, that's hardening. All right.

So let's get back to the more universal stuff here. You list these five buckets or baskets that are levers that we can pull in order to increase lifespan and health spend. I'm not sure I'm going to be able to recapitulate the exact order you came up with before. So let me just start with exercise. You have called it the most potent longevity drug in quotes that we have in our arsenal. Say more, please. Longevity, both through lifespan and health span, is impacted more through exercise than any of the other variables we have. And again, we'll always have to keep emotional health

on the side, Dan, because in the extreme cases, you could argue emotional health has a greater impact on all of this, right? So no amount of physical and cognitive health can overcome the lowest low of emotional health. But again, we'll park that at the side because it's not age-dependent. So let's just focus on the more physical biology of agent. Exercise has a greater

impact on delaying the onset of chronic disease, which is the dominant force behind death, right? And you know, we've we've long since eclipsed the era when we die of, you know, what I described in the book as fast death, and we now die of what's called slow death. So exercise is ability to push that back and delay that by a decade or more is unparalleled by nutrition, sleep, other things like that. And then on the quality of life front, exercise is the most potent for lack of a better word no tropic, meaning it's the most potent tool the brain has for brain health, which also, by the way, ties into disease modification. So the most potent tool we have has for brain health, which also, by the way, ties into disease modification. So the most potent tool we have against neurodegenerative disease,

such as Parkinson's disease and Alzheimer's disease, is indeed exercise. And then, of course, it's the most important tool you have to steal your body against the inevitable age decline that comes with advancing years. So everything that has to do with mobility, stability, flexibility, freedom from pain, strength, fitness, cardiovascular, endurance, all those things, exercise is the tool that you use to preserve those things, which allow you to enjoy life to its fullest all the way through.

So the things that you and I at our, you know, young age of 50, whatever, take for granted, those become things that you have taken away from you in your eighth and young age of 50, whatever, take for granted, those become things that you have taken away from you in your eighth and ninth decade of life. And exercise becomes the tool that you use to minimize that decline. So what are we talking about here? Because exercise is a pretty broad term. Yeah. So, the problem in some ways is that the literature is, if you look at some of the epidemiology

where it just talks about exercise in sort of fuzzy vague terms, it's not that helpful, which is why I actually prefer to look at the strongest associations in the literature, which come from what I describe as integral functions of exercise. This is a bit of a confusing idea, but follow me for a moment. And I think it becomes clear why this is a better idea. So it's one thing to say, Dan, really good outcomes come if you exercise five hours a week or more. Okay, but to your point, like doing what, right? Like does gardening for five hours a week constitute exercise, does a brisk walk, you know, constitute exercise. Now far better insights come when you look at things that, again, I apologize for the choice of words because I'm a mathematician at heart, but integral

functions taken to account the area under the curve of a certain event or activity. So hemoglobin A1c, which is a blood test anybody can go and get from their doctor, is an integral function for how much blood glucose they've had in their circulation for the past three months. Similarly, when it comes to exercise, VO2 max is the most potent predictor of length of life. So, VO2, have you ever had a VO2 max test? Done. No. Do you know what it is? No. Okay, so it's a fitness test that athletes do all the time, but anybody could do it. If you wanted to do one tomorrow, you could find a place in New York that would set you up and do it. So you're going to put you on a treadmill or on a bike. They're going

to put a mask over your face that allows them to very accurately measure how much oxygen you're consuming and how much carbon dioxide you're spitting out, basically. And they're going to push you to your absolute limit. So this is about a 15, 20 minute test that gets incredibly uncomfortable at the end, because you are pushed to the point of failure. And what they're measuring is what is the peak amount of oxygen you could consume. This is measured in liters per minute. So right now you and I sitting here are doing next to nothing. We're consuming three to four hundred milliliters of oxygen per minute. Now if I make you stand up and walk around, kind of quickly that might get up to

a liter per minute. If I make you go outside and start jogging, I could get up to two and a half liters per minute. And so and so it goes until I reach a point at which you can't go anymore. The higher that number, and it's typically normalized by your weight, the fitter you are, and by that number, your risk of death goes down. And we measure these using things called hazard ratios. So a hazard ratio is a risk of death, or a risk of something, but in this case, we do it for death. So, the hazard ratio of being a smoker is about 1.4 compared to non-smokers, which means that at any point in time, a smoker has a 40% chance greater of dying from all causes than a non-smoker in the following year. If you look at somebody with type 2 diabetes,

it's going to be about 1.3. So they have about a 30% chance of dying of all causes in the next year relative to the non-diabetic. When you start to look at these measures of VO2 max fitness, the most extreme spread is look at people in the top two and a half percent of fitness for their age and sex Compared to people same age and sex in the bottom 25% take a guess what the hazard ratio is I'm so bad at math. I don't

It's about five very good. Yeah, it's five so it's a four hundred percent difference in mortality Even when you look at something not as extreme, just compare the bottom 25% to the third quartile, those between the 50th and 70th percentile. It's still about a 2.75 hazard ratio. That's 175% difference in all-cause mortality for the coming year. So I'm answering your question in it took a while, but I think hopefully this makes a point, which is rather than sitting here telling you whether you need to be gardening for three hours a week or whether you need to be doing this, you need to be doing the

type of exercise that's necessary to produce a high VO2 max. And although I'm not going to walk you through the same analysis, if we do the same analysis for strength, we get numbers that are almost as convincing. If you take people with the top 10% of grip strength and compare them to people with the bottom 10% of grip strength, there's a 70% reduction in both incidence and mortality from dementia. And is it really the case that having a strong grip protects your brain? Probably not. It's that grip strength is an amazing integral function for the type of strength training and physical robustness that is protective.

I have a ton of questions about this. The first one that's bubbling up to the surface is the cost of this VO2 max exercise. This is a quick technical question. You said it's widely available, but can anybody afford to go get this test and is that important? I don't know what it costs in New York. I can tell you that here in Austin, Texas, it's about $100. The other thing is you mentioned both, so the VO2 max seems like a test of your ability to do aerobic exercise and strength. You also mentioned as being incredibly important. I think there are a lot of people,

including DJ Cashmere is on the line with us, who's been producing this series that we're launching here about getting fit without losing your mind. DJ said to me that something interesting that one of the things he's learned in the process of producing this series is that he's doing a lot of aerobic exercise and basically no strength exercise. I think there are a lot of people who might fall into that category.

And I believe your argument is we really do need to do both. Absolutely. My glib response when somebody says, should I be doing strength or aerobic the answer is yes. Okay. So, we've established that if you're in good aerobic shape and if you have good strength for your age and gender and size, that your odds of having a longer lifespan and health span go up, but there's still the question of, okay, what kind and how much exercise should

I do? So I always start with the question of how much time are you willing to put into this? So I start with what a person can give me and then I reverse engineer it, but the ratio is always about the same. So the ratio is generally going to be optimized around 50% strength, 50% cardio, and within cardio, it's going to be 80% low intensity, 20% high intensity. So to make the math easy, if someone says,

I am willing to do 10 hours per week of exercise. That's a lot, but I do more than that. So I know that certainly 10 hours a week is doable. You're basically going to say, all right, half of that, five hours is going to be strength. And really it's going to be 80% strength, 20% stability. So it's going to be, say, four hours a week of strength training, an hour a week of movement training, preparation, stability

stuff. And on the cardio side, you're going to have five hours, four of which is going to be low intensity, which I'll define in a second. And 20% of that or one hour is going to be relatively high intensity. You can almost think of it as like four, one, four, one is your time. So how do we define those things? So low intensity, I talk about this in great detail on the book and I go into all of the real definitions around it, but it's something called zone two. And there's a very clear biochemical definition

of what zone two training is. And if you're trying to win the Tour de France or if you're a nerd like me, you will follow it to the tea using exquisite little markers of blood lactate and things like that. But for a person who just wants to sort of directionally get it right, that's fine too, you do it off rate of perceived exertion. And that low intensity cardio or zone too is the level of exertion at which you can still speak, you just don't want to. And if you're doing something where, you know, you can't speak anymore,

or you're just out of the range of being able to speak, you're probably into what we call zone three. And if you're at the level where you can actually carry out a conversation with reasonable comfort, you're probably in zone one. And those are not the places you wanna be. You wanna sort of thread the needle to be at that zone too. And that's where you're spending 80% of your cardio time.

And everything would just become an adaptation of that. I mean, we have some patients who might say, look, I'm only willing to do four hours a week of training. Okay, then we're gonna, you know, that's, unfortunately, that's not a lot, but it's still more than zero. And you're gonna get huge benefits doing four hours a week relative to doing nothing. But we just have to adjust accordingly to those approximate proportions.

Finally, if a person has a clear deficit in an area, we also will tweak those numbers and adjust the portfolio accordingly. Are you counting the... does stretching slash flexibility, slash maybe even yoga fit into this at all. No, I would consider yoga to be sort of an adjunct to this. Pilates probably more fits into some of the stability stuff that I spoke about with respect to strength. There's, I think there's two ways to think about flexibility. I tend to think of it more from a neuromuscular control stability standpoint. So, contrary to popular belief, inflexibility is not really about muscles being

inflexible. It's about the brain not letting the person go into that position. So if you were under, let's just pretend you're a person who can't touch his toes. So you're standing up with legs straight and I say, Ben Ford and touch your toes and you can't do it without bending your knees. There's a lot of people I think that would be in that situation. If you put those people under general anesthesia, you can fold them in half. And when they wake up from general anesthesia, they don't feel pain. It's not like you tore their hamstrings. So what that tells us is that the reason that an individual, such as that person, isn't able to touch their toes when they're wide awake, is that their brain is saying, and really

it's not so much their brain, it's probably their entire nervous system, is saying, I don't trust you to be in that position safely, and I'm going to prevent you from getting into that position. So, really, in flexibility, we work on increasing the stability of the risky areas, such as the lower back. That's almost a surely why a person isn't able to get into that position. It's because they don't have the core stability to basically let their body trust them to be in that position.

So we actually work on increasing that. And there's an exercise that I can't describe it as easily, but you can basically take somebody through a core breathing exercise to go from like their hands might be six inches from the floor to being able to touch the floor within, you know, a matter of minutes. And it's not about increasing the stretch and their hamstrings or anything like that. It's about increasing the body's confidence that it can put itself into what appears to be a vulnerable position, which has been forward. I ask about the flexibility part of it. Again, this comes back to kind of a selfish question on my part, but because I'm quickly doing the math in my head, and you know, I work out.

Six, seven days a week, but a lot of the time because I have a bad back is spent stretching doing, you know, PT, but under your math as I'm understanding it, that doesn't actually count toward the hours. Well, again, I think PT is a broad umbrella term. So, you know, I spend two hours a week doing what might be described as PT. I think of it more as stability training. So I work in various systems, one of them is called dynamic neuromuscular stabilization, DNS, another one called PRI, Postural Restoration Institute. So I'm doing a lot of movement preparation that is there for the health of my back, my knees, my hips, ankles, shoulders, neck, etc. And it is a very important part of what I do. So it's fully two hours of, actually a little bit more than that, because it's two dedicated

one hour sessions plus 10 minutes a day, five days a week. of actually a little bit more than that, because it's two dedicated one-hour sessions, plus 10 minutes a day, five days a week, so it's probably three full hours a week that go into movement preparation, stability, or what some people might watch me saying, oh, he's just doing kind of PT movement stuff. And that counts toward your 10 hours, or that's adjunct? Well, in my case, because I'm putting, say, 14 hours a week in, I would say it probably does count towards my 14 hours. In its problem, I'm probably putting a little bit more. Maybe I'm putting 16 hours in, and so that's three of the eight hours that are going into my strength side of the equation.

All right. So at this point, I imagine some people listening to me and they're like, this dude is super intense. Like, he's doing, that's enormous amount of time he's putting into this and he's throwing out acronyms like DNS, PRI, I probably can mangle those. But like I can't do that. I've got two jobs, 85 kids, whatever it is. Am I just out of the running for the increasing

of my lifespan and health span? No, again, it's all a relative question, right? So, you know, if you take a person who is doing zero, exercise, and you just get them to the point where they're doing three hours a week, you will still give them a 50% reduction in all cause mortality, meaning you go from not exercising at all to exercising three hours a week. At any point in time, your risk of dying in the coming year is half what it used to be. I mean, that's a staggering

statistic. There is no other increment that is bigger than those first three hours going from zero to three. So if a person listening to this takes nothing else from it, at least with respect to exercise, take that. You don't have to be exercising 14 to 16 hours per week. There are things that, of course, I'm going to get in terms of health span benefits that I don't think you're as able to get from exercising three hours a week, but it's a curve for which the slope of the curve declines the further it goes out. So you always get the most bang for the bucket, the beginning, and the rate of return goes down as you go out, but there's still always incremental benefit. So maybe another

way to think about it is, if you take a person who isn't saving one penny of their paycheck, and you simply get them to put away $200 every two weeks, that's an enormous change, especially if they're doing it at a reasonably young age. So I don't want perfection to be the enemy of good in this discussion. I explain what I do only so that folks understand how I partition the time across that portfolio, but that should never be viewed as well. If I can't do what that dude is doing, it's not worth doing anything.

That couldn't be further from the truth. That's very helpful. Let me ask one last question and it does relate to mental health. Well, I think a big area of unhappiness for a lot of people, myself included, is getting super judgmental about how our bodies look. How much do you get obsessed with that? Does it matter whether you have an eight pack or a six pack or whatever it is in terms

of your lifespan and health span? Should we care how we look in the mirror or is that not the right way to measure it? So in terms of your lifespan, the presence or absence of a six pack has zero bearing. In fact, subcutaneous fat, which is the main impediment to a six pack, has virtually no bearing on your disease risk. Most of the fat that we store is not unhealthy. Fat accumulation is really only unhealthy when it occurs outside of where we were meant to store it, which is in this subcutaneous area. So it's once we exceed the capacity of our fat stores, and it starts leaking into our

liver, our muscles, our pancreas, kidneys around the heart, around the organs, what we call visceral fat, that's where it starts to become very unhealthy. And you can't see that in the mirror. So let's put that aside for a moment and come back to your question, which I think is a really good question. I would be lying if I said that I don't struggle with the fact that at 50, I don't look like I did when I was 40 or when I was 20. Because the truth of it is I don't. And I often think about David Foster Wallace, who I'm sure you're a big fan of, right?

And you know, so you think like, Fletch probably like David Foster Wallace. Right, so you think back to his commencement speech, at Kenyan College, circuit 2005, he talks about how we all worship something. And what he talks about, and I would really highly recommend that anybody who's not familiar with what we're talking to, go to YouTube and just search David Foster Wallace, this is water, and you'll get an audio recording of this talk. And somewhere near

the back quarter of that talk, I think is the most powerful part of it, where he really gets into this idea that we all worship something. And whatever you worship is effectively the thing that's going to kill you, right? So if you're this person who worships their body, then you're going to die a thousand deaths before they actually plant you in the ground due to the inevitable loss of your aesthetic appeal. All right, if you worship money, you will never have enough. If you if you worship your intellect, you'll always feel like a fraud.

So I'm highly cognizant of this, Dan. And I feel like I've made a lot of progress, which is I just get the fact that I don't look like I used to. And I don't have tissue paper, skin running up and down over my rock hard six pack abs with veins bulging out from beneath it like I used to have like I don't have that and the truth of it is I don't want to do what I need to do to have that anymore. The amount of insanity that I had to adhere to with respect to my nutrition to achieve that I don't want to do that anymore like I don't want to do that anymore.

Like, I don't want to set that example for my kids. And I don't think it's making me live longer. So why would I do it just so that I can feel somehow better about myself when I look in the mirror or, you know, take my shirt off as often as possible on Instagram? Like, again, it just doesn't make sense for me. I'm nodding and smiling. You can see that where listeners can't obviously. Because I think I've arrived in a very similar place. I spent a lot of time bemoaning the fact that for me was, I don't think I was particularly fit at 40, but it was more like 35 where I was single, had no kids and all I did was work,

work out and hang out with my friends. So I could work out for two hours every day, which is probably less than you're doing right now. But I was at that point extremely fit and it showed in the mirror. Now I am quite fit, but it doesn't show in the mirror. And I just have to continuously talk to myself to bring back David Foster Wallace. I need to escape from what he calls the skull-sized kingdom in that talk to get out of my head and recognize what you just said.

I need to give that little talk to myself, dude, what it would take to get that body back. If it's even possible, it would be insane and would take away from the things you really care about, which are like the relationships in your life. Yeah. And here's the thing. Another way to amplify that, because I agree with you 100%. Let's say I said to you, Dan, how old are you right now? 51. Okay. So you and I are basically the same age. So I said, Dan, I got great news for you, man. I have discovered a new training routine, diet routine that will allow you to remain insanely jacked until

you're 60. Now, you've got to do all this other stuff. No meal is going to be an accident. You're going to be training two and a half, three hours a day. It's going to look like that and all this stuff. Okay. Now, at 60, I'm not going to be able to guarantee you these results, but for nine more years, I can guarantee you these results.

Okay. But you're not going to spend much time with your wife and your kids or your friends. And you say, okay, great, I'll do it. So fast forward 10 years from now, you're this jacked 60 year old dude. Are you further off along in life? I mean, at some point you're going to have to face the music, which is, okay, well, I'm still going to lose this body anyway, but now I don't have those relationships and those you can't go back and get. When your kids are gone, I mean, they're gone.

If you try to, you know, say to your kids when they're 30, okay, now Dad's here, I don't think that they're gonna be particularly welcoming. Those relationships, the most important ingredient in them is just time. Hey, man. Coming up, Dr. Peter Atia talks about nutrition, including his understanding of the basic science

and its implications for each of us, his evolution on this issue, and his take on intuitive eating. We talk about sleep and also pharmaceutical tools, including supplements, which can be confusing for a lot of us. Celebrity feuds are high stakes. You never know if you're just gonna end up on page six or do-mo-a or in court.

I'm Matt Bellesai. And I'm Sydney Battle and we're the host of Wundery's new podcast, Dis and Tell, where each episode we unpack a different iconic celebrity feud from the buildup, why it happened, and the repercussions. What does our obsession with these feuds say about us? The first season is packed with some pretty messy pop culture drama, but none is drawn out in personal as Britney and Jamie Lynn Spears. When Britney's fans form the free Britney movement dedicated to fraying her from the infamous conservatorship, Jamie Lynn's lack of public support, it angered some fans, a lot of them.

It's a story of two young women who had their choices taken away from them by their controlling parents, but took their anger out on each other. And it's about a movement to save a superstar, which set its sights upon anyone who failed to fight for Brittany. Follow disenthal wherever you get your podcasts. You can listen ad free on Amazon Music or the Wondery app. Nutrition. Next on my list of the five buckets that you talk about. Maybe just hold forth a little bit on the basics of what we should know about nutrition as it pertains to longevity. You know, in the end, it's kind of funny. This book ends up having two chapters on nutrition,

which is a lot. The only subject matter that gets more is exercise, which has three chapters. It's interesting in that I didn't even want to write about nutrition, because it's the subject matter I just find so polarizing. And frankly, it's the subject of all things I write about in this book that is least conducive to scientific debate. In other words, it just seems to naturally gravitate more towards religion and politics as a type of subject than it does a scientific discipline. We can speculate as to why, but I think I will save that for somebody else,

but I think most observers would understand that what you eat is highly personal, and as such, we're going to really get into our tribes around food and diet. And are you vegan? Are you paleo? Are you keto? Are you this? Are you that? And it's one tribe against the other. And it's actually quite comical, right? Because if anything, nutrition should be a scientific discipline, which is, has no bearing on ideology. So for that reason, I didn't want to write anything about it, because I also realized there's very little we truly know about nutrition. Of all the things that I write about in the book,

it's also the hardest to study. It's the messiest thing to study. It doesn't lend itself to scientific inquiry the way pharmacologic stuff does or even sleep or exercise. These things are much easier to study, but nutrition is very difficult and it's very noisy and as such, there's not a lot that we know. So what do we know? Well, we know that too much nutrition and two little nutrition are both bad states. We also know that we spent 99.99% of our evolutionary past in a world that was scarce of nutrition and therefore our survival, and not just our survival, but basically our ascension to the top of the food chain, depended on some remarkable adaptations, namely the capacity to thrive in a nutrient scarce environment.

That came in the form of energy storage. This is something that we do so well. And it was necessary for our brains. Our brains, which define us as a species, right? We're not the top of the food chain because we're stronger, faster. We literally have no advantage over every other species except our brains. And what enabled our brains was an energetic solution. Our brains are unique because of their energy consumption. It's out of this world. It's 20 to 25% of your total calories, code your brain, Dan,

and it weighs 2% of your body weight. We could not have made that leap without the capacity to store fat, simple and plain. So all of this was working incredibly well until about 150 years ago, or call it even 100 years ago. Once nutrition became so abundant, we switched from being the big problem was under nutrition to now the big problem is over nutrition. So the first rule of nutrition, a requires at least understanding, is a person overnourished or undernourished. And again, most people in the United States are overnourished, some people are adequately nourished, and even fewer are undernourished.

The next question I want to ask when I start to probe into what do we do with nutrition is I want to know if a person is adequately muscled or under muscled. In this ties into exercise, but it also ties into what I'm arguing is the most important of the four macronutrients, which is protein. The four macronutrients being protein, carbohydrates, fat, and alcohol. And protein is the most important of these. And if you're not getting sufficient amounts of protein, which unfortunately most people are not, in large part, because the recommended dietary allowance for protein is incorrect, you're going to have a hard time being adequately muscled. So we want to make sure that you're adequately muscled. The final pieces are you metabolically healthy or not. Now, unfortunately,

when we talk about being overnourished, most people immediately think about obesity. And obesity gets all the attention. Every time the obesity crisis, the obesity crisis, this then no thing. It's a reasonable shorthand for what the problem is, but it's not really specific enough. The issue isn't obesity. The issue is poor metabolic health,

which traffics with obesity, enough, the issue isn't obesity. The issue is poor metabolic health, which traffic with obesity. Two-thirds of the obese people in this country are metabolically unhealthy, but so are a quarter of the lean people. And if you look at the null set, the people who are either obese and metabolically healthy or lean and metabolically healthy, they're very comparable in health outcomes. So over-neurishment is a good proxy for metabolic poor health, but that's the thing we want to be fixated on. And that's really primarily driven by energy balance, and protein intake is what's driving the adequacy of muscle mass. So it's a complicated problem where we're trying to optimize around calorie intake, protein

intake, training. And obviously we go into so much more detail about this with carbohydrates and fats and everything like that. But really it's a biochemistry problem and not an ideological problem around diets. So, what do we do with all that information? What do I as an individual do with this very helpful context you just provided? So I think a person armed with the tools I go through in the book can figure out where they stand on those three questions, right?

Are you over-neurished, under-neurished, adequately muscled, under-muscled, metabolically healthier or not. If you are in the overnourished, metabolically unhealthy camp, you have to reduce intake. So now we get into the tactics. Okay. I need to be eating less than I'm eating now. How do I accomplish that? And broadly speaking, there are three strategies to do that.

I'll explain what they each are, but just the top line is you have calorie restriction, dietary restriction, and time restriction. There's always a form of restriction that is needed here. Now, calorie restriction is, as its name describes, you're just reducing the number of calories you're eating, but of course that's happening in all three of those methods. The difference is in calorie restriction, that's the focus of the strategy. That's the thing you're focusing on is the number of calories you're eating. So this is usually accomplished by people who are tracking what they're eating.

This is the most accurate way to go about doing it. And this is what bodybuilders do. There's a reason bodybuilders can get down to 4% body fat and look like they look. And it's not just the steroids and the training and the jeans. It's really this meticulous attention to nutrition. For most people, it is very difficult to live in a world where you are tracking down to 50 or 100 calories. What you're eating for every meal every day. But it is an accurate way to do things, and it's sometimes illustrative for people to give them a sense of what they're eating. There are, of course, now drugs that are making this much easier.

So I'm sure you've heard of these drugs, stomachlutide and tersepotide. They're all the rage at the moment. Ozzampic? Yes, Ozzampic is the diabetes version of the drug called somic luthide. These are drugs that reduce appetite. So they are pure adjuncts to how you calorically restrict. And that's all they do, right? They basically just globally reduce appetite so that you just want to eat less of anything

and everything in general, you're going to lose quite a bit of weight. A second strategy for reducing intake is dietary restriction. This is, I think, I don't know, maybe the most common now, it's hard to say, but certainly more common than calorie restriction. This is where you pick something in the diet to restrict. So I call it pick a bogeyman or to get rid of it, and the more restrictive the diet, the more likely you are to lose weight. So if you say, I'm not eating any carbohydrates, but you've basically taken out one of the

macronutrient groups, and in particular, you've gotten rid of one that tends to drive a lot of mindless eating around sugars and simple carbs, you're going to lose weight. Most people lose weight on a very significant carbohydrate-restricted diet. If you can do it, a very, very highly fat-restricted diet. If you can do it a very, very highly fat-restricted diet, probably also loses weight for a lot of people. Again, it's much harder to do that. Fat tends to creep into more foods. It's harder to spot in small amounts. But if you said, I'm going to go on the no lettuce diet or the no broccoli diet, you're not going to lose weight. It's just not restrictive enough. The final trick for this or the final strategy, I guess, is time

restriction, where you just say, I'm going to limit the window of time in which I'm eating. And if you make that window narrow enough, you know, you'll ultimately reduce calories, and you'll lose weight. Now, each of these has its limitations. And when it comes to time restriction, which some people refer to as intermittent fasting, one of the major problems there is most people also tend to end up restricting protein too much. And so while they do end up losing weight, they disproportionately lose lean mass or muscle mass along the way, which is exactly what you don't want to be doing. None of these strategies should be accompanied by a significant loss in muscle mass. The objective is always to be losing fat mass,

not muscle mass. And in reality, what that means is no more than 25% of your weight loss should be lean mass. At least 75% of your weight loss should be fat mass. And you can check these with tests like dexatest, like a dexascant is a type of x-ray that very accurately measures body fat and muscle mass. Okay, so that's all very helpful.

And I can imagine some people getting their nape feathers up in reaction to it. I have been very influenced personally by, and I'd be very curious to get your response to this, this thing called Intuitive Eating. I spent many years as a guy would move from strict diets, a strict diet, calorie counting, et cetera, et cetera, working out insanely. And then I had a conversation right here on the show with a woman named Evelyn Tribble, who's one of the early proponents of something called, she actually, and her partner came up with the idea for Intuitive Eating.

The basics of it, and I'm sure you know this, but I'm saying this for the benefit of the listener, is, you know, eat what you want when you want, and listen to your body about when you're full or not. And yes, you should understand the basics of nutrition, but the key move in their view in Evelyn and her partner's view and their followers is that you want to fix your relationship to food in your body start listening to your body for satiety cues mix that in with some gentle nutrition and That is the fundamental fix here and that diets

pervert our relationship to our body pervert our relationship to food and in the long term don't end up working So what say you in response to that. Look, I think this is an area where there simply can't be a solution that works for everybody. I think intuitive eating works pretty well when a person is confronted with good food choices. But there's really still no clear scientific consensus as to what is driving over-eating. So I'll give you an example of various theories that are put forth, all of which have lots of evidence for them, but none of which are complete enough to explain the entire problem, and there are always contradictions. So one theory is we are chasing nutrients. We are wired centrally to chase nutrient density. And because nutrient

density is eroding in food today, which it clearly is. I mean, there's no question that an egg today has less nutrition than an egg did 60 years ago, that ahead of broccoli has less nutrition per gram than it did before, that a piece of steak has less nutrition than I did before. All these things are true. But because we're chasing nutrients, we are requiring more calories to achieve the same amount possible, right? Another one is that we are chasing protein. Right, we're hardwired to get a certain amount of protein in and we have less protein density

in our food today. And therefore, we're just chasing more calories to get the same amount of protein in, and we have less protein density in our food today, and therefore, we're just chasing more calories to get the same amount of protein. Another theory is that we are being hijacked by hyper-palatable foods. So we have never been exposed to foods with such high degree of palatability, largely in due to the combination of sugars, fats, and salts, which the way we eat them today, they never existed in nature. And so we're basically eating beyond a normal physiologic satiety point. I could go on, but there's like a dozen of these theories each of which has lots of evidence to support it, but also some evidence to contradict it. My intuition, no pun intended,

is that an intuitive eating solution can work when the majority of those things are not working against you. Right? So if you put a person in a junk food environment, I don't think intuitive eating is going to be very successful. You say in the book that in the sections where you're writing about nutrition, that you're paying some penance personally. What do you mean by that? Well, I think like a lot of people when you find what works for you

you sort of assume that it's going to be the right thing for everyone and I think if I go back in time God 12 13 years ago when I first became really interested in nutrition, I found something that worked for me so well. It was like scales lifted from my eyes. I couldn't believe the response I was having to this. I just sort of assumed that this was the way everybody would achieve similar results. You know, I sort of character this in the book with a graphic depiction of the Dunning Kruger curve, where experience is very low, but sense of knowledge is very high, or confidence in knowledge is very high. And of course, in reality, the further you actually get out from

shore, the deeper you realize the water is. And so within a short order of time I realized, and I think in large part due to the privilege I have of getting to work with patients, I think you always want to be wary of people who are out there espousing, you know, lots of advice, but they've never worked with anybody. They've never actually watched what people do and what struggles everybody else has. You need a much larger sample size. So I think as I began to see lots of struggles with nutrition across lots of different people, I realized, well, clearly Peter, you're wrong. It can't be that this thing that worked so well for you is going to work so well for everybody.

So let me see if I can repeat that back to you in my own words. You got various associated with low-carb, keto style, and in some ways, like a poster child for the, you know, nerdy, obsessive, biohacker type. And you've been criticized for this. And that's what you're trying to, I think, walk back in the book gently. Am I saying that correctly? Yeah, I wouldn't even say gently. I would say that from about 2010 until probably 2014 or 15,

I mean, I was on a ketogenic diet. I blogged about it a lot, talked a lot about the science behind it, talked a lot about the physiology, a lot about obviously sort of my own experience with it. And today I would simply say my aperture is so much wider. And I realized that a ketogenic diet was a form of dietary restriction. It works really well for many people, but it's certainly not the only way to achieve these results. And also, by the way, there are some people in whom a ketogenic diet makes things worse. So I guess my point is I would just as soon not be associated with

any tribe of nutrition or anything else for that matter and just say, let's just go where the answers are. And let's try to have the greatest toolkit for addressing the problems. The problems are hard enough as they are. Anytime you limit yourself in the number of tools you have, I think you decrease your odds of success. And if you're wed to a particular diet, by definition, you're limiting yourself to tools.

I'm sensitive to time. We've got a couple more buckets to move through here, including sleep and pharmaceuticals. But I really want to time. We've got a couple more buckets to move through here, including sleep and pharmaceuticals, but I really want to carve out enough time to talk about emotional health and your personal story Which is quite moving. So maybe let's move through sleep and pharmaceuticals supplements pretty quickly and then see how much time We can devote to emotional health. Does that make sense as a plan? Of course, sure So what are the basics that we need to know on sleep? We certainly understand things today that we didn't understand 20 years ago. I think

20 years ago, most people sort of thought sleep is not necessary. And by what I say, most people, I mean, outside of sleep scientists, you know, sleep is sort of not useful time. And it's mostly there to rest your body if anything. And it can be short-changed and there really aren't any consequences beyond maybe being a little bit drowsy the next day. I think all of those things today we realize are not really true. First of all, sleep is about as essential to our existence

as anything else. In fact, if you were to say how long could a person live being deprived of food versus sleep paradoxically or maybe unbelievably, you would literally die sooner from sleep deprivation than food deprivation. Furthermore, if you consider that every species out there that we can think of, sleeps, and humans never figured out a way to out-evolve sleep, given how dangerous sleep is from an evolutionary perspective, right? It serves no immediate evolutionary purpose, right? You're not able to reproduce,

you're not able to fend for food or forage for food or defend yourself, and yet you still spend a third of your time in this unconscious state. It must serve some incredibly important purpose that even evolution couldn't weasel out of. Finally, today we know that while your body certainly gets some benefit from sleep,

it's really for your brain. Sleep and unconsciousness are nowhere near the same thing. Baseball back to the head renders you unconscious. It is not asleep. Alcohol makes you drowsy, but it doesn't produce good sleep. With all of that said, I think the question becomes, what does one need to do? The good news is most people with some really careful attention to good sleep hygiene practices can get completely restorative sleep without resorting to pharmaceutical agents

here. Paying attention to consistency of bedtime and wake up time. Paying close attention to darkness, temperature, I.e. colder and darker are better. Being very mindful of what you're doing before bed. So what is your preparation routine look like for sleep? How are you de-stimulating yourself? Little seemingly simple steps like that. Go a long way to restoring people to sleep. And in an ideal world, the average person probably needs to be in bed for somewhere between seven, eight and a half to up to nine hours a night. A good sleep efficiency would be 85% of that.

So if 85% of that time, you are actually sleeping. That puts most people probably in the six and a half to eight hours of sleep range. Again, there are very few people that are going to function optimally outside of that. Just to say, we're not gonna have time to get super granular on sleep here, but Peter has done many episodes on this. We'll put some links in the show notes. We on this show have done a bunch of episodes on sleep,

and so we'll put links to that in the show notes as well. But let me ask one last question on this sleep tip to you, Peter, this is another area where I personally have gotten caught up in a kind of obsessiveness that made me less able to do the thing I was trying to do. I've gotten obsessed with exercise and I think that's been pretty unhealthy for me at times and I've gotten obsessed with nutrition and it's produced a kind of orthorexia where I'm spending all this time.

That's the technical term where I was obsessed with eating correctly and not paying attention to like the actual taste of the food or the people I'm with. And then with sleep, I've spent periods of time where I'm tracking it obsessively and that actually just stops me from being able to sleep. So any recommendations about how to address this without getting too uptight about it?

Yeah, I think you're absolutely right. And one of the things we do with our patients is we really recommend tracker holidays when people are getting that way. And I use it tracker. I use a couple of different trackers actually. And I'll take holidays from them all the time. So if I ever feel like I'm getting to the point where I'm obsessing over it and I'm getting a little annoyed with poor performance. The single most important thing to do is not push harder, but push less, and just take the track or offer a month. That's very helpful. All right, let's kiss medicine or pharmaceuticals and supplements here.

What are the basics from your point of view? Well, it's complicated. I mean, the original title for this, which would be exogenous molecules, which would be the way to really think about these. These are molecules that get put into the body from the outside world. There's different ways to slice and dice this. You can slice it as hormones, which are chemicals in our body that we make already that are signaling molecules, estrogen, testosterone, things like that. So hormone replacement therapy would be an example of that. Thyroid replacement therapy would be an example of that.

You then could think about it through the lens of a somewhat artificial divide, but a regulatory divide that's important, which is FDA approved compounds, so prescription drugs versus unregulated molecules, which are known as supplements over the counter molecules. I'm always amazed when I meet people who say, you know, they'll take 50 different supplements every single day, but they'll never take a single drug prescribed by their doctor because, quote, unquote, it's not natural or something. So if people get bent around the axle of a whole bunch of artificial guidelines here,

basically if you're taking a molecule from outside your body, you want to ask the question, is this regulated? Is it not regulated? Does it occur in nature? Does it not occur in nature? But there are lots of pharmaceutical things that occur in nature. So again, it's, I tend to prefer regulated versus unregulated. This is really the purview of the modern medical system. So we're not going to get into it for the sake of time. But in the book, I really go to great lengths

to explain this transition from medicine 1.0 to medicine 2.0 to medicine 3.0. Medicine 2.0 is the situation that we are in. It's the world in which we live in and it has had remarkable successes in treating this idea of fast death, infections, traumas, acute care issues. And the main stay of therapy for medicine 2.0 has been pharmacologic. I don't think there's any reason to throw the baby out with the bath water as we transition to medicine 3.0, which is far more about risk reduction in a long-term preventive sense and far more around personalizing care.

And pharmacologic agents are important in that regard, but they have to be used differently and we probably need less of them. But there are still things that matter. For example, I go into great length about the importance of lipid lowering therapy for the treatment of, and frankly, just the complete prevention of atherosclerosis, which is the number one cause of death. Not a sexy thing. People kind of want to talk about cancer and Alzheimer's disease, perhaps because they're

more frightening, but cardiovascular disease is still the leading cause of death in the United States, for men and for women, and it's the leading cause of death globally. And it's by a long shot, right? We're talking about 19 million people a year dying from heart disease in the world versus 12 million as number two for cancer. So pharmacology plays a very important role in prevention, along with things like not smoking and controlling your blood pressure. The latter being much easier to do with things like exercise, but for people who can't control their blood pressure with exercise and maintaining an ideal way, I would never want to suggest that we shouldn't be treating their blood pressure with medications because the data are abundantly clear that you will lengthen a person's life,

reduce their risk of a heart attack and stroke by normalizing their blood pressure. You also reduce their risk of dementia. How do we know whether we should be taking supplements and what supplements we should be taking? Well, I mean, I think that depends on, you know, sort of the philosophy of the person taking care of somebody. We tend to put supplements into a couple of categories. One are supplements that are correcting deficiencies.

Do you have a biomarker that you can measure? For example, vitamin D, home assisting, which is an integral function for B vitamins. Can you actually see an observed deficiency? Some people have, for example, a very inefficient manner in which they convert B vitamins. And so you want to supplement them with those vitamins so that they make less of an inflammatory product called homocysteine. Some people just have low vitamin D levels. You know, it's not entirely clear, by the way, that correcting vitamin D is necessarily

conducive to health. That's a much longer discussion, but the downside seems to be so low. So you're always looking for things where the upside is larger in magnitude than the downside is. Then there are other things where you, you know, you sort of look at mechanistic studies or animal studies. For example, you know, we're pretty liberal with the use of a supplement called TheraCumon for people who are at risk of Alzheimer's disease. So it's a really potent anti-inflammatory supplement. It's a sort of more potent version of curcumin, the spice. And I think there's reasonable data.

I wouldn't call it level one. I would kind of call it level two, level three data, that this is going to reduce inflammation and play a positive and productive role in protecting against dementia. Then we look at things like magnesium. Most people are actually somewhat magnesium deficient. And so if you have a person who has symptoms like they're having cramps, which are very common, giving them magnesium in its different forms, slow acting and fast acting, can correct some of those things. So I think it just requires being a little bit more astute about it and kind of deciding where a biomarker is helpful, where a symptom

is helpful, and ultimately where you have to have a bit of a leap of faith and look at indirect evidence. It should people be freelancing on this or working with their doctor. It's like I take magnesium, melatonin, and vitamin D and B, but my doctor told me to. So is that the right way to proceed? It depends. I mean, some doctors know quite a lot about this and others do not at all know about it. So it's really a function of how much your doctor knows. Coming up, Peter talks about emotional health, including a raw story about how he came to

understand its importance and his recommendations for listeners on this front and why quality relationships make all the other levers we've discussed here easier to pull. All right, let's talk about emotional health. I have a bunch of questions about your personal story, but before we get into that, maybe just give us your top line on why emotional health is so important here. Well, I think in the process of writing this book, which began as maybe a manual for how to delay death as much as possible, I sort of realized I wasn't doing a great job of living. And I think that the events of 2017, 18, 19, 20 in my life personally

just changed my thinking about what longevity that funny word means. And it became more about as cliche as the sounds, what does it mean to live my best life as the first order term as opposed to just delay dying? You have a quote here from a stare Perrell who has been on this show many times Famous couples counselor she pointed out to you the irony that you're working so hard on longevity But not on emotional suffering or quote was why would you want to live longer if you're so unhappy? Yeah, what was going on? Well, God, the first time I probably met with us to have been 2017.

And, you know, I was an incredibly unhappy person working very hard, remarkably selfish, failing in every dimension of my life outside of work. Should he husband, should he father, wouldn't say I was getting passing grades as a friend, a brother, son. Just there was just nothing about me that was living a life that I would be proud of. More importantly, I talked about David Brooks who wrote the road to courage. I mean, not doing anything that would be written about favorably in my eulogy. Everything was about my resume.

You missed the birth of a child? Almost missed the birth of my child. And then shortly after his birth, a month later, he had a cardiac arrest, was brought back to life by my wife who managed to do CPR on him and amazingly brought him back to life. And yet, I didn't come home. I was in New York when this happened, where I was at the time basically living or commuting to the plant where I was there more than I was at home. And I just didn't, you know, I didn't come home for more than a week.

Why not? I just didn't feel like it mattered. I felt like it was more important that I stay and do my work. I could talk to the doctors just as easily from New York as if I were sitting in the hospital. I mean, this was, of course, my pathetic, disgusting logic. But it was like, look, I can speak to the doctors all I need to and run through all the tests they're doing on him. He was in the hospital for probably four days after that. So yeah, it's just a complete sense of detachment.

I don't want you to feel alone in this because I've, you know, or like I'm judging you somehow, this events in my life are not as dramatic, but for sure, in the early years of my son's life, I was putting way too much into my professional career, into my resume virtues instead of my eulogy virtues to quote David Brooks. So I have a lot of, I don't know, sympathies the right word because I don't condone either of our behavior, but I, I can't understand it. So I'm not asking you questions from the mount top just to be clear. Not, not taking that way. Okay. Good. So you, you ended up, and I remember talking to you about this, you know, I think somewhat contemporaneously, you ended up spending quite a bit of time in, I'm going to use the term rehab, but that

might be a bit misleading because often we associate rehab with drug addiction. That's true, but you know, actually going back to David Foster Wallace, right? I mean, we are all addicts. And so the real question here is, what is the addiction? I think for many people, the first thought, when you hear that someone is an addict, oh, well, it's to something that is so obviously destructive, right? It's too alcohol, it's the drugs, it's too gambling, it's to something like that. And those things are pretty destructive, and I guess if you could say, if there's anything positive about those addictions, it's that it's very difficult to hide behind them and

Have everybody around you sort of ignore them. I think in my case, it was sort of perfectionism workaholism rage that was my unholy triad and Believe it or not, they kind of worked for me most of my life like I kind of got by right? I mean the workaholism and the perfectionism, no one really saw what was happening internally. They were just seeing the results. And it was like, wow, this guy really accomplishes everything he sets out to accomplish. And the rage was kind of simmering. And, you know, unfortunately, some people saw it, some people saw it more than others. And, you know, for many people, they simply simply could fathom it. And I don't know.

I just, interestingly, I just got a pass on it a lot and got very lucky because there were a few times when it could have got really out of control. And there were a couple times it did get out of control. A couple of fights I got into in college where I'm really, really lucky that I didn't get arrested. What did you learn in this intensive inpatient context about what might have been driving this perfectionism, this unhappiness, this detachment from your family?

Well, you know, there were really two separate doubts. The first is in late 2017. I go off to a place in Kentucky. It's called the Bridge to Recovery. And it's a facility that specializes in trauma-based therapy. So it's, again, most of the people who show up there, in fact, I can't think of one person who did not have a quote unquote traditional addiction. And it's not a detox place.

So a person shows up here, they're at least relatively detoxed from alcohol drugs, whatever it is that is the addiction. But the purpose of this place is to probe the root cause of this. And the thesis here is that trauma is like a tree. It has these roots, which you don't really see. They're beneath the surface, and it has these branches, which are the things that you actually see. And rather than focus on exactly what the branches are, we know that the branches are the things that you see

that land did you here, right? You know, that can be anger, codependency, addictions, other habituated survival strategies. Let's focus on the roots, abuse, neglect, enmeshment, witnessing tragic events. Like what is it that happened that your inner child

has had to adapt to and in the process of adaptation, had some benefits, right? There's been some benefits of the adaptation, but there's been some maladaptive things that have come as well. And it's kind of going back and fixing that problem, which I do believe that until that is done, it's very difficult to make any progress on the branches. You mostly just put band-aids on branches until you really address the roots.

What did you find about your roots? There were different stages. I think in 2017, what I came to acknowledge was, and again, it's not that I didn't know this had happened, but I was finally willing to talk about it as being potentially relevant was abuse that occurred when I was young. And again, I had largely been dismissive of this being a relative feature of what shaped my character, right? In other words, I had always looked back at that with the mind of my adult self and said, well, yeah, I mean, I know that that stuff happened when I was five and when I was seven. But I

mean, like, I'm not, it doesn't, it doesn't factor into anything about me, right? What is, what I failed to appreciate was, you know, yeah, when you're five and when you're seven and those things happen, you're going to adapt in ways that might not seem obvious today. But for example, at a relatively young age, I became very obsessed with never letting anybody be bigger, stronger, tougher than me, right? It was like no, no, no, I'm never going to get bullied or get hurt. And therefore, so much of my adolescence, which was, you know, relentless, this is because it actually comes back to what we talked about with respect to exercise. Like why is exercise relatively easy for me? I think it just became so ingrained in my psyche.

And at the age of 13 and 14 years old, I'm exercising six hours a day. You know, I'm doing things that I couldn't do one day what I did every day back in high school. I just physically wouldn't be able to run that far, lift that much, go to boxing gyms and spend that much time there and all those other things. So there was a real creation of a shield around myself. And I think that there was also more around just when you feel that low about yourself,

you have different ways of compensating. And for me, for whatever reason, I chose one upmanship as the drug that became the drug. And it's important to really understand that that's what it is. So there are some people who in that situation have a certain brain chemistry that will turn to a drug or will turn to alcohol as the dopamine hit that makes them feel better. I'm no better or no worse than that person. For whatever reason, my brain chemistry doesn't get enough of a hit from alcohol or drugs, but it gets a huge hit from getting a hundred percent on a math test or graduating first in my class or winning a tournament.

Like those things were a drug. And there's, you could say, well, Peter, come on, those are good things, right? It's good to graduate first in your class. Sure, but look at where it's coming from. It's not coming from a place of love. It's coming from a place of rage, and it's coming from a place of needing to prove myself to myself and to everybody else. And I can tell you why that's the case, because it's always hollow. There's no joy in this success. It's only met by, it needs to be better next time. What you just said, first just to say I really appreciate, admire, and respect your

openness, and I know it's hard one. So thank you. The second thing is what you just said about these victories ultimately being hollow. Kind of in my mind, links to something you say in the epilogue of your new book, which really to me seems like the bottom line of this whole discussion, which is, and I'm quoting you here, the most important ingredient in the whole longevity equation is the why. Why do we want to live longer for what? For whom? And yeah, it's easy to get obsessed with the technical details. And it's kind of fun and it can be beneficial.

But if you don't have the why, if you're doing it out of what it's sometimes referred to as the subtle aggression of self-improvement, well then it's possible it will blow up in your face and I've certainly experienced that. And so yeah, that seems so important to me. Do you, as I, as I ramble here, am I saying things that resonate with you? Oh, absolutely. Yeah. For sure. So

how do we find our why and what do you recommend in terms of this final fifth and final bucket of emotional health? I think the first 16 chapters of the book are being written where I'm the teacher, I'm the doctor, I'm the whatever. But the final chapter of the book and the epilogue are very different, right? Because they're not the sections where I'm writing with any expertise. Like, I ended the book, I'm really writing as the patient. And as such, I think it's a little harder for me to provide remarkable insight. The way I could, for say, here's how you should exercise, here's how you should eat. I think the quality of your relationships needs to be the most important thing in your life.

And I think if your relationships suck, your life sucks. And I guess what it comes down to is, can you be honest with yourself in the appraisal of that? Now, what I find most, maybe sad is the right word. I think it's very difficult for people to take an appraisal of that without a crisis. I wish I had a better answer, Dan, but I just don't see people. I've seen a lot of people turn their lives around. I've turned my life around, but it took a crisis. It took effectively losing my marriage. It took almost losing my mind. If I went back and talked to my 20 year old self

with all the knowledge I had today, I don't know that I could have convinced him to get help. So maybe the most important thing I can offer here is when you have a crisis, just know that of all the things that we talk about, this is the most malleable. So, you know, we talked about your lifespan being malleable. Yeah, it is,, this is the most malleable. So, you know, we talked about your lifespan being malleable. Yeah, it is, but this is the most malleable.

And I'll give you one example of all the elements of my personality, the one that I thought was most immutable was my inner monologue. So my inner monologue, which I described as Bobby Knight for folks listening to don't know who Bobby Knight is. He was the famed basketball coach at the University of Indiana who I think it's safe to say it was a raging psychopath. Ultimately lost his job because of how much of a psychopath he was. Good basketball coach, but you know, a psychopath. I spoke to myself both in my head and even

audibly as though I were Bobby Knight. So anything that I did, and this happened, so this would happen four or five times a day, it sounds funny now, and I say it, but it was never funny. It can be the silliest thing. Like I'm hanging a shirt out of the laundry and it falls off the hanger because I didn't put it on perfectly and it falls to the ground. I would yell at myself about that. I'm cooking dinner and I slightly over cook it or I'm making scrambled eggs and I slightly overdo them. I'm getting furious at myself. Of course, when it came to things that mattered even more, like I'm shooting my bow and arrow and I miss a shot. I'll snap an arrow across my thigh and scream at myself. I'm driving my race car and I spin or I'm in the simulator and I spin. I'll freak out. I mean, just unbelievable braiding. I mean, this

was there's no memory, no conscious memory I have of not being this way. Okay. My mom tells me stories I don't even remember of how I would lose my absolute mind if I was building a tinker toy and it didn't turn out just as I wanted it. So I assumed this was hardwired. If my mom is telling me stories about things I don't remember, and I've seen it my whole life, it's all I've ever known, clearly it can't change. it's all I've ever known, clearly it can't change. Now the problem with this is twofold. It's not just that you make your own life miserable. But if that weren't bad enough, you're making everybody else's life miserable because a person who hates themselves that much, I mean, how are they going to behave to anybody else? You're going to be an asshole to everybody.

So when I was leaving my second stint at rehab, which was a three week stay at a place called psychological counseling services in Phoenix, Arizona, this was a little over three years ago. One of the parting exercises that was proposed to me by an amazing counselor there, and he was Melissa, was the further foreseeable future. I was going to every single time Bobby Knight reared his ugly head, which again, it's gonna be like five times a day. I were to take out my phone and talk into the recorder

of the phone, but it was a different monologue. Instead, talk as though it's my friend that made whatever mistake I just made, but picture him my dearest closest friend, what would I say? And then I would send that recording to my therapist. Now this was a very hard exercise, Dan. I mean, there were times that this would put me in tears because it was so difficult

to do because I wanted to scream at myself, but instead I'm looking at my friend's face and he's the one that's missed the shot. And now I'm trying to talk to him in a kind way, but to myself. And what was so amazing to me was that after about four months of doing this five times a day, Bobby night vanished. And that's been three years, and I don't even know where that guy is anymore. He could be dead for all I know. It's a brilliant technique that the therapist gave you. And to my knowledge and understanding, it is backed by data. Ethan Cross has done a lot of work at University of Michigan. He wrote a book called Chatter. He's been on the show.

And he has shown that if you can really rewire the way you talk to yourself, Kristen Neff has done a lot of work in the area of self-compassion, which includes a lot of talking to yourself in a different way. And the data there all seemed pretty strong. So yeah, this can maybe some people listening to me and they're like, wow, this guy was super evidence-based until he got to the end, but actually, no, this seemingly soft and gooey stuff is hard-nosed. The final thing I just want to ask you is,

you talked about the quality of our relationships determining the quality of our lives, which is something Esther Peral talks about a lot. It is not the case that listeners are going to walk away with only one thing to do from this conversation, but just say we had only one thing to do. It seems to me like working on our relationships could be the most important variable in terms of the length of our lives and the health span. I mean, it would be supported by that study at Harvard where they followed people for

many, many decades. We had the guy Robert Waldenger be supported by that study at a Harvard where they followed people for many, many decades. We had the guy Robert Waldenger on who ran that study. I believe you might have been on your show as well. That showed that the number one variable for health and happiness for the people he's been following for several decades in the Boston area was the quality of their relationships. So if we had only one thing to do to increase our lifespan, would that be it? It's hard to say. I mean, I do, I'm glad you bring that up because there's another benefit that comes from having great quality relationships, and that includes the relationship with yourself,

is it becomes easier to do all the other things we spoke about. So it is really hard to tell a person that you've got to be able to exercise. You've got to be able to take care of yourself when you sleep. You've got to be able to drink less alcohol. You've got to be able to watch what you eat. It's very hard to do those things when you don't like yourself very much. And I can't tell you how many patients I've taken care of who don't come close to having the self-loathing and self-hatred that I did,

but they still on some level don't particularly like themselves. And so they're suffering on two fronts. They're suffering in every single moment as a result of their self-dustain and how it contaminates every relationship they have, but they're also paying a very long-term price, which is they're not taking care of themselves. So in that sense, there's a very compelling case to be made for this. But of course, I know lots of people out there who I think are doing quite well on this front.

And if I were to look at them in their complete and total form, I might say actually the greatest threat to your life right now is the fact that you have an elevated LP little A, which is going to kill you of a premature heart attack if we don't take dramatic steps to reduce it. Or, hey, you're doing really well on this front, but you're not making time to exercise. And you might be in that situation where we've got to get you doing something three hours a week. So I think it's very difficult to say there's just one thing, but this is probably the

most counterintuitive thing, because I think those other things people kind of have a sense of. And this is definitely one where everyone deserves an audit. Dr. T, I've held you past the allotted time. So in the interest of letting you get back to your day, can I just ask one final question, which is, can you please just plug your new book, your podcast, anything else you've put out into the world that you want people to know about. Yeah, the new book is called Outlive, the Science and Art of Long Jeviti. irony not lost on me. The podcast is called The Drive.

And my site, Peter Atia MD, dot com, is a great place to sign up for a weekly newsletter. We've been putting out for a very long time that people seem to really like and it touches on all of these topics. Congratulations on the new book. I know it took a lot to get there seven years in the making and well worth it. So thank you for your time today and great to see you.

Thank you Dan, great to speak with you again. Thanks again to Dr. Peter Atia, check out his new book Out Live. Thanks again to Dr. Peter Atia, check out his new book, Outlive. Thanks again to you for listening. Would love your feedback on this series we're launching here. It's really an experiment for us. Thanks, of course, most importantly to everybody who works so hard on this show. 10% happier is produced by Gabrielle Zuckerman, Justine Davy, Lauren Smith, and Tara Anderson. DJ Kashmir is our senior producer.

Marissa Schneiderman is our senior editor and Kimmy Regler is our executive producer, scoring and mixing by Peter Bonaventure of Ultraviolet audio. And Nick Thorburn of the band, Islands, wrote our theme. We'll see you all on Wednesday for part two of this series. We're going to talk to Dr. Mark Hyman who also has a book about longevity coming out. He's got some very interesting and sometimes controversial takes and will grail him gently

on those. And don't forget, next week we're talking exercise, including a Buddhist take on exercise in the week after that. We're talking about nutrition, including an intuitive eating take on nutrition. Hey, hey prime members. You can listen to 10% happier early and ad-free on Amazon music. Download the Amazon Music app today. Or you can listen early and add free with Wondery Plus in Apple Podcasts.

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