The Joe Rogan Experience - #1108 - Peter Attia

Episode Date: April 24, 2018

Peter Attia is the founder of Attia Medical, PC, a medical practice with offices in San Diego and New York City, focusing on the applied science of longevity.

4, 3, 2, 1. Hello, Peter. Hello, Joe. What's going on, man? A whole lot. You were just telling me something that is one of the most ridiculous things I've ever heard. That you swam from Maui to Lanai. Right.

And you're the only human to ever do that. I'm told I was the first person to swim from Maui to Lanai and back. The one way is a pretty famous swim race that's done every year. You're the first person to do it and go back. Fuck, dude. Why'd you do that?

How long you got? It started when I was a boy. They told me I couldn't do it. What made you want to do that? That's a ridiculous proposition. So I got into, I decided in, this is going to sound silly. I read a book in January of 2004 about this woman named Penny Dean, who still to this day holds the record for the fastest crossing of the Catalina Channel. So swimming from Catalina Island to San Pedro or to, uh,

not, you typically swim to point point Vicente and she had done it in like seven hours and 20 minutes. And I was like, that's amazing. How far is that? As a crow flies, it's 21 miles with the currents. It's a little longer. And I was like, you know, I really want to do this. Um, but I, I got to learn how to swim first. That's three miles an hour swimming. She is a phenom. Penny Dean had a stroke rate of 90 strokes per minute, which I mean, that might not mean anything to someone who doesn't swim. But like to turn to have a hand hit the water every, you know, third-thirds of a second is a remarkable cadence.

Yeah, I can't hold a cadence of that for 100 yards. Wow. And she did it for 20 miles? Yeah. What a beast. She's out of control. Yeah. There's certain people like that, man, that freak me out.

I think marathon swimming might be one sport where, if you just look at the numbers, I think women are better than men. Well, there's that woman who swam from Cuba to the United States, right? She was the first person to do that. Yeah, Diana Nyhan. And didn't she do it like at a fairly advanced age? Yeah. I mean, she's, of course, got an amazing pedigree of swimming and this wasn't her first rodeo.

Right, right, right. Why do you think women are better than men at that? I mean, those of us that – I'm not a member of this community anymore, but when I was, it was one of our favorite topics of discussion. I think opportunities or ideas that were put forth were higher pain tolerance, something about being – evolving to be able to give birth just means they can tolerate pain a lot higher. I think another thing I've heard is buoyancy. You know, women are naturally going to have more body fat, which provides insulation. When you do these swims,

you're not allowed any wetsuits or aids of any sort. Just shorts. You're in a Speedo and a single latex cap, and that's it. And so if you can have a little... And so I think women's hips, because they're going to have more fat on their hips, it corrects one of the big buoyancy issues that we have in swimming. We didn't evolve to swim. We're horrible at it naturally because we swim like this.

We drag our hips through the water. importance of aerodynamics in most of the things that we think about, whether it be archery or race car driving or cycling. In water, it's that much more important because the density of water is thousands of times greater than air. So swimming is just 100% about avoiding drag. Wow. Well, that totally makes sense. I just have been fascinated forever with people that are capable of pushing their brain to do things that other people just don't think are possible, like a Bigfoot 200 race or any of those things. But the swim one is particularly crazy because you can't stop. Right? Like if you're running an ultramarathon and you just want to sit down for a couple minutes and just take a break, can do that but if you're swimming there's not a damn thing you can do you could tread water

is about as good as it gets but you can't touch the boat or the kayak or it's an immediate disqualification oh god that's so crazy man that is such a. So you heard about this woman doing it and that's what. I read this book and I was like, I really want to do this. At the time I was, uh, I was actually in my residency in Baltimore and I was like, you know, I really want to do this and I'm going to have to learn how to swim to do it. So I started taking swimming lessons and then, um, I mean, to make a very long story short, basically by about the summer of 2005, I entered my first swim race, which was a two-mile swim race in Lake Reston, Virginia. And I did it. I was like, oh, my God, I just swam two miles in the open water.

You know, it was hard, but I was like, okay, that's the proof of concept. Now you just got to figure out how to make it 20, 25 miles. You just got to figure out how to make it 20, 25 miles. And so I just, you know, went completely psycho and ratcheted up the training. And then in October of 2005, I did my first Catalina swim. Wow. That's got to be a pretty good feeling, though, when you're done, that you are capable of pushing yourself to what most people think is an impossible distance. Yeah. I mean, people, you asked a moment ago, why do you do this? I would say that in life, velocity means very little, acceleration means everything. So what do I mean by that? Right?

Like if you're going 650 miles an hour in an airplane, you don't actually feel it. You only feel when speed changes. So I've always had this theory that emotionally that's also true. Like happiness is only interesting when it's juxtaposed with sadness. And so the feeling of crawling on the shore after you've been swimming for 12 to 14 hours is amazing. But what makes it especially amazing is that six hours earlier, you thought you were going to die. So you start these swims in the middle of the night to avoid the shipping traffic. So that first swim, boat drops you off at Catalina Island. It's midnight.

That's a darkness you can't imagine. Like you can't even see LA from Catalina. You have to swim for six hours before you even see the lights of Los Angeles. Really? Yeah. What do you see? The stars and the phospho, like bioluminescent organisms in the water. Whoa.

Which is incredible. I mean, that's worth the price of admission. So every time your hand comes through the water, you're pulling and ripping these little things and you're seeing the sparks. And you can't tell where the water ends and the sky starts. In other words, the stars and the bioluminescence looks like one cylinder. Wow. So for the first few hours, that's cool. But then, you know, on my first swim, the water was incredibly rough. I had only swum in the ocean for two weeks before the swim.

I did all my training in a swimming pool and a lake on the East Coast. So now I wasn't used to how to keep the salt water out of my mouth. Right. So then I was like puking my guts out and then my— While you were swimming, you're puking your guts out? Yeah, yeah, yeah. How does that work? You just stop and puke and then keep swimming. Wow. And then, uh, but then my tongue started to get really swollen from the saltwater because again, as I would learn later on, I would

go on to do many more of these swims. But what I learned is the importance of spitting the water out of your mouth very quickly. So in a, in a freshwater pool or lake, you get away with more. But in the ocean, you swallow that salt water, you're going to get sick as hell. So all this stuff's going on. So by five in the morning, you've been swimming for five hours, you're getting cold. You're, I mean, you know, frankly, just physiologically, like your cortisol levels are at an eight or you're just – you feel horrible. It's like it's a really bad feeling.

And you're not even halfway there and it's like you don't know if you can do it and blah, blah, blah, blah. Well, if six hours later you're now crawling out of the water feeling like you've done this amazing thing, that's emotional acceleration. That's like the greatest contrast. I know what you're saying. I mean, I've never experienced that, but I was explaining the other day to a friend of mine about this camping trip that we went on in Montana when it was like nine degrees outside, it was freezing cold. We stayed out there for five, six days. And then when we finally got to a hotel room, I took a shower and it was the most amazing shower I've ever experienced in my life.

And that's a small thing. Right. No, but you take a shower every day and it's like a big deal when you do it in that setting or, or think about the meal you've had, if you've been in a similar situation or starving or lost at sea. Yeah. Yeah. Yeah. I can't imagine. That's a, so now that you've done, how many of these have you done? These crazy swim races or swim? I mean, several. Yeah. Usually these major, major ones are not races. You're on your own. You have to, you go to the federation that oversees that body of water and you say, hey, I want to do this.

And then you, you know, you go through all the channels to do it. Like they have to have an observer there and they, you follow these official rules. So that you can be registered as someone who's actually completed it right and someone's there to make sure you didn't you know you did it correctly um i don't know i've probably done all in probably like a dozen of these but probably like six of them really long ones what's the longest well i that's a good question what is the maui one was 20 miles there and back so 40 miles total no no it's a good question. What is the Maui one was 20 miles there and back. So 40 miles total. No, no, no. It's a, the Maui channel is a 10 mile channel.

So round trip is 20. The bigger question is time in the water because you rarely get to swim these in a straight line. So the Maui Lanai one, I wanted to go Maui, Lanai, Molokai, Maui to do the triangle. And that would have been 30 miles as a crow flies. But we just, you know, boat captain wasn't willing to do it triangle. And that would have been 30 miles as a crow flies, but we just, you know, boat captain wasn't willing to do it at night because of the tiger sharks. And during the daytime, we couldn't physiologically figure out how one could suffer against those, the wind, because the wind gets so brutal in the middle of the day. So even the one that I did, which was

just the there and back, I ended up swimming for 12 hours because on the first way crossing where there was no wind, it took me four hours. And then it took eight hours to get back because I was swimming like the hypotenuse of a triangle, right? Like the current's going this way. So I had to swim this way just to go in a straight line. And I still couldn't. I almost missed Maui. Jesus Christ. So I almost got swept out to Molokai just because the current was about 1.7 knots, which is about as fast as I can swim.

Maybe two knots. Fuck. That is a ridiculous thing, man. Why are you doing this? This is maniacal. Well, I don't do it anymore. I mean, it was certainly, it was an amazing season of my life. But I think once my daughter was born, which was 10 years ago this summer, that's when I, I only probably did two of these after she was born.

Because then the training just got so, I just, you got to live in the water if you want to do this sport. Like you got to – including the winter. You know, like even in San Diego where I live, it's still 55 degrees in the water and you're going to spend three, four hours a day in the water freezing. You know, it's just – so I was like, you know, I just don't have the, the, the drive to spend 25 hours a week swimming. Yeah. What was the, what was going on in San Diego when that guy got bit in half by a shark a couple of years back, they were training for something. Yeah. That's funny. You remember that that was May of 2008. I remember that like it was yesterday. So at the time I lived in San Francisco and this is actually

just before I swam the Maui thing. Now that I think about it, that was 10 years ago. I swam the Maui thing in June of 06, June of 08. So I'm doing all my training in a swimming pool up in San Francisco because I don't want to acclimate to very cold water. I actually want to be in warm water, but I needed one long ocean swim of like 14 or 15 miles as my like last training swim. So I came down to San Diego to do it. And just by bad luck, I came down a few days after that guy was killed. Now, this was a guy, I didn't know him, but he was a triathlete training with a triathlon group that they would go out and swim every morning. And I know the beach exactly where it happened in Solana beach. And, um, unfortunately, like most people who get

attacked by great whites, they have a very, they always attack the same way, which is below and behind stealth bite up and then they, they retreat. So they're trying to basically injure the prey. So their prey exsanguinates and then they take off and then they wait till you bleed out. So they never saw the shark, but you could tell from the bite marks it was. I actually had a friend who was on the beach and saw him when he came out and he was basically dead when he got to shore. He had bled to death. The problem is, so in this case, the shark had bit him and cut through his femoral arteries and veins. And the salt water prevents you from having any hemostasis. So it exacerbates the blood loss. So that's generally how folks perish when they're bit by great whites.

How did they get him out of the water? You know, a bunch of other swimmers came to his rescue. And luckily that commotion prevents the sharks from wanting to come back. So three days later, I go out and I'm swimming at that beach because I swam from – my training swim was La Jolla up to Solana Beach and back. And I got to tell you, like three days after a guy dies where you're swimming, it was about one of the most mentally challenging training swims to be like, because you can't see. Like the water at that part of the beach is so murky, you know, and you're only a couple hundred yards offshore that, like, you can barely see your hands when you're swimming.

And so you're just thinking, is this the day? Dude. Yeah, I'm not interested in that. Gee, I can't see why. Yeah, there's just something about sharks, too. I mean, they're, to me, one of the most terrifying things. First of all, we're so inept in the water. I mean, even a person like you, who's a great swimmer.

Yeah, yeah, we're a joke. Yeah, what we are in comparison to what they are, it're, you're throwing yourself into the world of a super predator and to know that one just jacked a person just a few days before and you're out there swimming around. Yeah. Although I will say this, you know, when it's all said and done, all of the close encounters I've had, probably the scariest moment I've ever had in the water was doing a swim from Santa Rosa to Santa Barbara. So Santa Rosa Island, which is the second furthest North channel Island, you've got San Miguel, Santa Rosa, Santa Barbara. So Santa Rosa Island, which is the second furthest North channel Island, you've got San Miguel, Santa Rosa, Santa Cruz, and Anacapa represent

the top four channel Islands. So we did this November swim. It was a nighttime thing again, swimming from Santa Rosa Island to Santa Barbara. And, uh, at about five in the morning, maybe six in the morning, you're just starting to get enough light where you can see and you're out there. So you really have amazing visibility. And I look down probably 40 feet and I see this enormous thing swimming like this, which is how sharks swim. And I see the dorsal fin in the position that freaks me out and the tails this way. All of that is shark. And I like, you know, like lift up out of the water, kind of hyperventilate for a second. And

I'm thinking to myself, all right, you got to make a judgment call here. If that's really a great white, you probably ought to get out of the water. But if you, the moment you're out of the water, that's it. The swim is over. Like you just spent like months doing this. Like it's done. So then I convinced myself and I think I'm'm right i think it was a dolphin on its side because a dolphin on its side would its fin would its tail fin would be the same way and it could swim that way so in the end i just kept swimming but i mean that scared the shit out of me well they have seen quite a few of them off the coast of malibu there's uh oh there tons. There's no question. They are way more plentiful than we realize.

And all you can do is talk to the fishermen. The fishermen will tell you. Off Coronado, there's non-stop great whites. Really? Oh, yeah. Why are you freaking me out, Peter? The good news is, they see us all the time, and most of the time they realize we're not what they want.

Yeah, they want seals, right? Yeah. Whenever they attack us, they're making a mistake. Now, is there like a suit you can wear, like a Kevlar suit that protects you from getting bitten in half? No, but this is so funny you bring this up. I became obsessed with this thing called the, uh, Oh, what was it called? Christ. You, you, you put the thing on your ankle. Like you had like a little Velcro thing. You'd wrap it on your ankle and had a tail like this long, you know, like four foot long thing. And it was charged and it sends out an electrical impulse that, um,

disturbs the shit out of the sharks. The shark's nose is an organ that senses electricity. So when a shark, like it could be pitch black, it could be soot water, and they can still scope you, you know, from hundreds of yards away based on the electrical activity of your heart. And that organ is their nose. So this little thing, I forget what it was called, like the shark taser or some shit, it puts out a signal that like tases them and they don't want to get within like. Oh, there it is. What's it called? The world's first shark deterrent band.

It's called the shark bands. One on the wrist or ankle. Is this it? I don't know. I thought it had a different name. But because the one that I was going to get and did a ton of research into had a really long tail hanging off it. And that became the problem. Uses patented magnetic technology to repel sharks.

So the tail was a problem because of the drag? No, because it would sound silly, but it would come up and zap you in the nuts. Oh, Christ. So it became unbearable to practice swimming in this thing because you're like, every 37 seconds, you'd get zapped by the tail. And I was just like, yeah. I like how it says reduce the risk. Oh, yeah.

Can I get some numbers, please? I don't want to just hear reduce. By how much? By 1% statistically. And then it also is a leash for your surfboard, too. You can use one of those to strap it to your ankle. Yeah, no.

It's going to come to me like in an hour. I'll remember what this silly thing was called. Jamie will probably find it. Off of Catalina, I know it's one of the best shark fishing places in the world. I have a friend of mine who told me that if you think about like wild places on earth that are just overrun with predators and terrifying like predator prey activity, Catalina Island is one of the top spots in the world. I was like, what are you talking about?

He's like, I'm telling you, man, the shark fishing off Catalina Island is fucking insane. telling you, man, the shark fishing off Catalina Island is fucking insane. And then I watched a television show, just, you know, synchronicity, a couple days later. And it was these guys shark fishing off of Catalina. I was like, what in the fuck? I could have never guessed. They're catching makos mostly. Yeah. And it's actually my recollection, because we swam around Catalina once as well.

The backside is way more aggressive than the front side. The side that faces the Pacific rather than faces Los Angeles? That's right. Yeah. There's way more crazy stuff out there. Yeah, I think that's exactly where they were. Yeah, it looked pretty nuts. I mean, they were bringing in these 15-foot sharks.

I mean, I was like, what in the fuck? These are just floating around out there. You know? I mean, I guess, of course they are, right? I mean, there's a lot of fish out there as well. So I'm sure they're- Catalina is amazing. Pretty crazy place.

I'd swum to it. I'd swum from it. I'd swum around it. I'd done a milling thing, and I'd never stepped foot on it except at the beginning or end of a swim until five years ago I went there for a vacation. Like, I actually just went to Avalon for, you know, three days. I'm like, it's not a place I could live. It's a little, you know, too quiet, but for three or four days, it was amazing. I think people hunt on Catalina. They've got huge Buffalo there. Is that what it is?

Yeah. So apparently there was a movie that was made there back in the twenties or something like that. And they just let a bunch of Buffalo lose? Well, they had a bunch of buffalo, yeah, for the movie. And I guess they never corralled or some sort of shit. So it was totally overrun with buffalo. Well, there was one of the Channel Islands that they had actually turned into a bow hunting destination. Like they had brought in a bunch of deer. I think they brought in stags and a bunch of weird exotic shit.

And they put them on this island. I think they brought in stags and a bunch of weird exotic shit and they put them on this island. I think they even had elk. And then biologists just weren't having it. They're like, this is just so out of whack. And so they had them eradicated. And the way they do that is, it's pretty gruesome. They just gun them down from the air and just

leave the bodies. They just decided that they were an invasive species regardless of how valuable they might have been to people that wanted to go there and eat them. They just decided just for the ecosystem alone. And there's no predators there. And they weren't going to turn the fucking island into a wild kingdom and bring wolves or something in there, which would be pretty goddamn crazy. Imagine if there was an island you could go and they just had wolves and elk running around on an island. Well, I'm surprised they would gun them all down.

At least say make it open season for hunting or something like that. They could have been productive about it. Well, that's an interesting perspective. So biologists look at it in terms of the entire ecosystem, right? They look at it in terms of the plants, the amount of waste, fecal waste that these animals are leaving behind. The fact that they're literally eating everything that they can on this island. They're not supposed to be there. And then they're competing with whatever things are native to that island.

And probably, I mean, if you've got a thousand pound elk, it's not supposed to be on a fucking island. This thing is just eating everything it can. And they don't have a winter either. So it's just like the whole – like they're just not supposed to be there. The Channel Islands themselves are kind of amazing. I mean most people know of Catalina. But there's eight of them. And now two of them you can't step foot on.

You're not allowed to? No. San Clemente and San Nicolas. They're military bases. Oh, OK. So we tried to do a swim from San Nicolas back to Los Angeles. This was a relay swim because it's like an 85-mile swim. And I spent like six months researching it, speaking to a bunch of naval officers.

I was like, hey, is there any way we can – because you officially have to start a swim. You have to be able to touch dry land and be out of the water. And they're like, yeah, you can't come on the island. So in the end, what we decided was we were just going to do a stealth landing. By the time they came down and screamed at us and shot at us, we'd have been off the island. But then we got to the island. Now, the other big thing about San Nick

is that's real shark territory because that's where the elephant seals live. And so when we got out there, we literally could not get to shore because of the elephant seals. Like we're 200 yards off Sand Neck. And, you know, this is after taking a full two days to get out there. I mean, this place is really hard to get to because the water is brutal and you're not in a huge boat.

And, yeah, you're looking at like thousand pound elephant seals that are just like licking their chops, looking at you trying to get in the water. What would they do with you? I didn't want to find out. But they're not predatory, right? I mean, I don't think, no, I mean, I think they're aggressive as hell. Did you see that video of the little girl that's sitting on a dock and a seal jumps up and grabs her in the ass and pulls her into the water? Did you ever see that, Jamie?

Yeah, and I didn't think that seals ever did something like that before. I don't know. I did see a special once about how dolphins could be kind of aggressive with each other. Like, they could harm, you know. Here it is. Look at this. So, the seal is sitting there. And this girl, the sea lion, actually.

Look at this. It comes up and they think the sea lion is being cute. Yeah. But I think it was probably looking for a handout, and these people weren't giving it to her. Oh, and then she turns her butt up. Oh, my God. Oh, my God.

Oh, my God. Jesus. Yeah, fuck that thing. Oh, man. I'd be like, I'd be right back. Fill that fucking puddle with lead. Oh, my God. Imagine if that bit your kid.

Oh, yeah, yeah. Yeah, they jumped up fast. Yeah, they're predators. I mean, they eat things. Yeah. They're not eating plants in the water. They're eating fish and shit, you know, whatever they can get a hold of. They probably eat birds and stuff, too.

They're probably used to scooping things up. But I bet what that's from is them getting too acclimated to people, people feeding them. Oh, for sure. Yeah, there's a – they have an issue in Boulder where Boulder is – have you ever been, Colorado? Yeah. Yeah. Beautiful, right?

Yeah. Gorgeous. Super liberal. Like as progressive as it gets, right? You haven't been to San Francisco. Oh, I have, yeah. I think Boulder is right up there, but there's less people. And everyone's real healthy and active and hiking and stuff like that.

They don't allow hunting for mountain goats on the weekends because there's so many people hiking and going. They don't want people killing these mountain goats in front of them because people freak out. Even though they have decided that they have to control the population and kill a certain number of them to keep the – but so many people go out there that these things aren't scared of people. So it's created this really weird situation where if you are hunting them, you're almost hunting something that's domesticated. People feed them Cheetos. So much so that a friend of mine was talking about it that he was up there with his daughter. His daughter opened up a bag of Cheetos and the goat walked right to – a wild goat.

Lives out in the fucking woods. Walked right up to his daughter and they were laughing she opened up the bag of cheetos and put it and he stuffed his head in the bag of cheetos he knew what to do and he's he's and this guy who was talking about this is a hunter and he's like this fucking goat has like cheeto dust all over its face like it's the craziest thing its face is all red with cheeto dust and it's sitting there chewing these Cheetos. Like, it's done it before. Yeah, yeah.

And it's just – That goat had diabetes, I think. Probably eventually, right? Yeah. Yeah, I was in Costa Rica. There's another similar situation, and we were staying at this Four Seasons out there, and the monkeys have gotten very accustomed to people being there. And so they come by, and they hang out, and out and they're like trying to get things from you.

And my daughter opened up a package of Oreos and the monkey just jumped onto this little ledge like a couple feet away from her. And my wife was like, I really don't think it's a good idea that we feed this thing Oreos. And I said, well, you know, it's probably going to get eaten by a fucking crocodile anyway. I mean, are we poisoning it? Is that what you're thinking? I mean, it's not going to eat this every day. It's not going to be a normal part of its diet. But we hand the monkey an Oreo.

It pops open the Oreo and starts chewing on the frosting like a little kid. And then we're like, oh, this little fucker probably gets these things every week. Right. So it begs the question, does he know how to do that because he's watched some human do it or are we innately wired to do that with Oreos? Ooh. I think he knows how to do it because someone's given him Oreos so many times that he knows that's the good stuff.

The good stuff's the middle. They should just sell that in a paste. Oh, I don't know. I think the middle is only good because you can contrast it. It comes back to the contrast thing. Exactly. I think you're right. I think you're really right.

I think if it was just pure middle, it would be pretty gross. Yeah. If they probably sold pure middle, nobody would buy it. But if they sold those black cookies by themselves, no one would buy those fucking gross things either. No. Shitty ass tea biscuits. They're the worst cookies. Once you eat the white stuff, you're like, all right, I'll eat this stupid ass black cookie.

It's the sunk cost. It's like a coal cookie. Here it is. Here's a little monkey doing it. Look, they grab it from you and they just fucking love. Oh, look at them opening it up immediately. Open it up and start chewing that white stuff. I love it.

Yeah. Crazy. We had, there's a thing that is called the coata mundi. Have you ever heard of those? It's related to the raccoon. It's this weird animal that lives mostly in Central and South America. And it has a northern range that extends into Arizona, all the way up into Mesa, I think.

Like, it gets into the areas where it gets cold. But Arizona, I think, is the only state in the U.S. that has it. But it's this weird-looking monkey raccoon thing that is so domesticated that we gave it some grapes. Here it is. We gave it some grapes, and this is. We gave it some grapes. And this little fucker, there it is. I mean, look at that weird little thing.

It came and sat. We had like a little patio area in the hotel room. And it came and sat down with us. And so calm that it sat and went underneath one of the chairs and took a nap after we gave it some grapes. Like, well, we're hanging around. My daughters are running around, making noise, and this thing's just chilling. It's like a pet. It was a total pet.

It was a total pet. Yeah, there they are. They're cool, man. Weird looking things. People eat them, apparently. Apparently they hunt them in Arizona. You see nachos? Yeah.

I mean, after seeing this, I was just like, I don't think I can hunt that. I'd have to be pretty hungry to eat one of those. They're so cute. Little face. Weird little animal men. Really interesting. Yeah. Our relationship with animals is very odd when they get into close proximity.

Yeah. Yeah. We've got a wicked coyote problem in San Diego, at least in the part I live in. And, you know, it's just one of those things. Once we got rid of mountain lions, because no one wants mountain lions around, the coyotes run amok.

Is that what it is? I think, I mean, I was talking to a friend of mine about this the other day, actually, and he was saying that there's probably only, like in our neighborhood, there's probably only like two mountain lions left and the the coyotes just they've exploded there there's so many of them around like and it doesn't really bother me that much i mean i actually kind of like listening to them howl but you know if you if they get into your chicken coop

yeah i had one kill chickens just a few weeks ago. Yeah, yeah. I have a video of a dead chicken. It was such a bummer, man. We chased it away. It was on the roof of the chicken coop. The way they jump is so stunning. Like, they're so graceful. Like, I've never seen anything that moves like that in the wild the way a coyote does.

There's a six-foot fence. It's on the ground. It jumps to the top of the six-foot fence, almost like it's under different gravity rules than us, and touches the top of the fence, and then boom, it's on the top of the chicken coop. I mean, in like a second. Wow, I haven't seen that.

It's crazy. I have video of one of them jumping my fence. I caught one of them with a chicken in his mouth jumping the fence. Jumped a six-foot fence with a chicken in his mouth. Just jumped, boing, touched the top of the fence with his front paws. Back paws went over right behind it and it was gone. It's crazy. But, you know, look, we need them.

We need them to kill the rabbits and the rats. If we didn't, we'd have a giant. Well, that's what I tell my daughter because she gets all stressed out that there's coyotes walking around our house. And I was like, well, first of all, they're pretty skittish of us. And boy, they keep those rodents under control. They really do. You need them for that. But there's a coyote problem across the country.

They're the only animal that's in every single state and every single city now. Every single city. There's coyotes in Manhattan.attan come on i'm not bullshitting in the park they found them in the park they found them in the bronx they found them in abandoned buildings yeah there's a great book i read called coyote america by a past guest of the podcast named Dan Flores. He's a wildlife historian. It's fascinating. They're a really unusual animal in that when you shoot one, they yell out. Here's this.

What's this? Coyotes in New York City. Look at this. In fucking New York City, dude. In New York City. New York City Police Department, coyote running down the street. Unbelievable. They're everywhere, man.

They have a real problem with them in Chicago. I thought I could escape them when I'm in New York. No, you can't escape them anywhere. They're in all 50 states now. They've completely extended their range and the reason why they extended their range is because we went after them. We hunted them down.

You know, they were able to eradicate wolves and the way they were able to eradicate wolves is they would kill the alpha, and then they would take an animal like a horse, they would shoot it, and then they would fill it up with strychnine. And so then they would rub the alpha, the body of the alpha, all over this carcass of the horse, and then the other wolves would come and smell that the alpha had been there,

and then they would eat the wolf, or eat the horse, rather, and die. And so they were able to do this and essentially use this method, plus shooting them and things like that, to eradicate them from the West because of ranchers and cattle farmers. They've never been able to do that with coyotes. When you shoot a coyote, if they do roll call, like when you hear them howling, if one of them is missing, it sends them is missing it sends the females it sends some sort of a signal where their bodies produce more pups so if one's missing instead of having like three pups you'll have six so you make more coyotes when you kill them

and they extend their range when you persecute them they just extend their range it's they're fucking crazy animal they are wicked smart man they've been chewing at the roof of my chicken coop trying to get in i came outside the other night my dog i have uh i have three dogs but one of them is a golden retriever and that dog has fucking zero instincts i mean it's it is just a it's a little human it's like it's like it's a little marshmallow it's just a yeah so he's fun though go running with his stuff he's a little human it's like it's like it's a little marshmallow it's just a yeah so he's fun though go running with his stuff he's a great dog sweetheart of a dog great pet but like he's like what's going on over there you know what's happening there's a fucking coyote on the

roof dude what do you mean what's going on over there they're literally chewing the shingles off the roof do your job outside one job to do yeah bark he's uh not interested he's just well he's only a year old too, but he's just curious. It's very weird living in proximity with all these things because where I live, we have a lot of hawks, a lot of owls,

a lot of coyotes, and occasionally a mountain lion. I saw a bobcat once, which is pretty interesting. I've never seen one of those. They're weird looking. It's a weird looking thing to see. A friend of mine, I put it up on Instagram. See if you can find it.

It's fucking old. It's an old one on Instagram. A friend of mine had a coyote or a bobcat break into her chicken coop and kill every one of her chickens. And the coyote, there it is. Look at that fucking freaky bitch. How'd you find it so quick? You're an animal.

He's a bobcat. He's got the best searching skills of all time. But look at that. That's in my friend's chicken coop. With a bunch of murdered chickens scattered around it. Look at the look on that thing's face. Yeah. Fuck that.

That look is fuck you. Yeah, that look is fuck you, lady. Yeah, I killed your chickens. Why do you have them outside? Ooh. Crazy, man. So how do you know Jocko? This is how we got connected.

Yeah, yeah. Tell the folks at home. Jocko's like, prepare to get your brain blown out. I'm going to send my friend over. I said, all right, let's do it. So I met Jocko through one of my really close friends, a guy named Kirk Parsley, who's a, also a Navy SEAL, a former SEAL. And, um, Kirk said, Hey, you got to meet my friend Jocko. Basically it was just like, you guys, you just got to meet Jocko. You just have to

experience Jocko. That was basically what it was like a ride. Yeah, yeah, yeah. So I met Jocko. We obviously connected pretty quickly. And then I think, oh, this was before Jocko's book had come out. His first, first book had come out. And I said, I got to introduce you to one of my best friends, this guy, Tim Ferriss, who obviously you know Tim. Because Tim's always looking for a great guest on a podcast. And so I called Tim and I said, look, you gotta just trust me on this one sight unseen. Just have Jocko come to San Francisco next week. Just, I don't need to say anything

else. It will be worth it. And I, luckily I had enough credit in the bank with Tim. I've done, I've been successful on enough site unseen recommendations, but I think the Jocko one was the best one ever. Because he called me while Jocko was still there, and he's like, yeah, that was pretty intense. Yeah, I sent him an email after that podcast. I'm like, that's one of the best podcasts I've ever heard in my life. And I made a post about it. Jocko responded to the post. And then I got Jocko on.

And then I and Tim convinced Jocko to do his own podcast. And now it's huge I mean his podcast I get text messages all the time from people thanking me for telling them to listen to it and then I get tweets from people thanking me for talking Jocko into doing it because it's just there's that just just there's outliers in this world you know in in everything there's outliers in athletics there's out but when it comes to like discipline and motivation and just just when you look at someone who's just undeniable like Jocko's one of those guys he's just undeniable he's he's a specimen he's definitely

off the graph yeah I met him a long time ago when he was training with Dean Lister. And Dean was fighting in the UFC. I remember meeting him. And I'm like, what's that guy's deal? There's certain dudes that have got a whole lot of shit going on behind their eyes. You're like, okay, that guy's seen some stuff. You know? Yeah, I'll tell you a funny Jocko story.

I guess I can tell this story in public. It's pretty funny. So Jocko was in New York just after his book came out. And I was like, look, I want to introduce you to some of my buddies who run hedge funds here because a lot of what Jocko does is he and his partner, they consult with guys like this doing leadership stuff. They consult with guys like this doing leadership stuff. And so we went up to the offices of one of my friends who has this very famous hedge fund. And his office is like on the 50th floor on Park. And it's looking – it's like a beautiful view down Park. And we're just sitting there in his office just shooting this shit. And I forget how it came up.

But somehow we were just talking about like how good is a sniper? Like what does it actually take? And, um, and then of course we're, we're talking very specifically about, um, I can't believe I'm blanking on his name. Um, Chris, um, Bradley Cooper played him in, yeah, Chris Kyle. We're talking cause, cause Chris Kyle had been, um, part of Jocko's team. I forget which SEAL team. Maybe it was when he was SEAL team two. But in fact, I think Jocko said, he goes, you know, yeah, Chris was a part of my team for more of his kills than any of his other kills. And so then we were like, what sets him apart? I mean, obviously any Navy SEAL sniper has got to be amazing.

But Chris took it to another level. What was it? And he said, okay, let me show you what it was. So he said, so he walked us over to the window and he goes, okay, you see that guy in that hat over there, like about a mile down the, you know, you could basically see it because it was like a pink hat or something. I said, yeah. He goes, okay, if you're a sniper, you got to be able to lay down,

not move and put your eye up against this thing and look out at him. And if you ever take your eye off that, you're going to lose the sight. So you got to be able to stay in that position and not move and do it. And I forget what the number was, but Jaco said, the average Navy SEAL sniper can stay in that position without moving, eye glued to the site for X number of minutes. And I forget what the number was. Maybe it was like 15 minutes. He's like, Chris could do that for two hours. He could lay in that position, not moving and not taking his eye off that thing with one eye shut for hours. And he, you know, he's just like, he just had a different, he just

had a different gear. And, um, it was just an was just an amazing i mean i mean those are some of my favorite moments with jaco is when he like can tell you something that is like like there are like maybe three people in the world that would understand why that matters you know sniping is fat is really fascinating right because just sharpshooting just being able to shoot something at a distance, and long-distance shooting is a big sport in terms of target shooting. I mean, there's guys that are out there that are shooting 1,500 yards and doing it competitively. That's a crazy distance. It's amazing.

It's a crazy distance. But when you think about it, you've got a rifle. It's on a rest. You're sitting. You're either on a bench or you're prone or whatever it is, you're lying down most of the time. This is all it is. It's this with your finger. Pull, pull, pull, pull, pull, boom.

Some people are way better at that. Just think of that. Coordinating your vision, getting the reticle set on the target, pulling that, and without movement. The outliers are the people who can do that. And you've got to think, like, when you break down physical movements, right? Like, you watch a gymnastics routine in the Olympics, like, holy shit, and it flips and they land and they stick. It's incredible. But now break it down to just the movement of your trigger finger.

Pull, pull, pull, pull, pull, bang. No movement. You know, I mean, it's, I'm sure you've shot guns, but it's hard to like, if you shoot pistols and you have dummy rounds, you know, like a lot of people, they mix in dummy rounds so that they find out they're jerking the trigger. And when you see, like I was watching a video with um tim kennedy and tim kennedy was uh shooting at the range and he's he's pulling bang bang bang and it goes click and

he goes whoa look at that trigger control like because it was he put the way he pulled it right it didn't go off target it didn't move it was it there was no punch to it you know but you you gotta fucking practice forever just to be able to do that, just to not anticipate the recoil of the gun and yank and move and twitch and just controlling the mind. I mean it's a fascinating thing to me that just pulling this one finger, you would think fucking anybody could do that. I could show you how to do that. Like I've had friends that say they want to go hunting. You know, I want to go hunting. You know, what do I do?

Where do I get a bow? I'm like, slow down. Let's get you a rifle because I could teach you how to shoot a rifle. We could get someone. We could sight in your rifle. We'll go to the range. We'll sight it in 100 yards, get you a good, accurate rifle. And then all you have to do is kind of keep it together.

A rifle, we get into a hundred yards of a wild pig you're going to be able to kill this thing 100 you got years before you're going to be able to shoot that thing with a bow i mean fucking years first but it is and the bow is like my wife said this to me a while ago she said of all the things you do she's like archery seems to be the only one where even if you don't have a good day, you're still happy. Like if I'm on the racetrack and I'm driving a race car or if I'm swimming or whatever and I just have a bad day, like I don't – I'm just not firing on all cylinders. Like it just kind of pisses me off. Right.

There's something about archery where even if I'm not having a good day, like maybe it's an extension of what you're talking about with the trigger finger. So for me, I got into archery because of Tim. And the story that the thing that he told me, which obviously for anyone who. Yeah. The thing that he told me that immediately made me be like, I want to do this was just anything that requires that much perfection just seems great. And he was like, yeah, you don't take a shot unless you can kill the animal. Like, you know, and so like you might take one shot in two days. Like it's got to be a kill shot and the kill shots got to look like X, Y, and Z. And I was like, oh, that's like you got to be dialed in. wow, if you're taking a perfect shot, like it's all in the rhomboids, you know, it's all back here and you've got to be able to do, as you said, you've got to completely be able to eliminate any anticipation, any of this business. And, and so I think that I think of archery for me as

almost like a meditation. Like if you re like, I'm talking in the way that Sam Harris would talk about sort of consciousness and the way you are so hyper aware of what you're doing that, yes, you can daydream and your mind can wander. But if you actually start to imagine the sensations of every part of archery, in many ways it feels like meditating. So I think that's why I'm just like, you know, and I never really thought about it with shooting a rifle because I don't have much experience with guns. But I'm guessing it's very similar. But as you said, like the difference between the good and the great in that is less obvious, you know, at a distance. Yeah, I think offhand shooting a rifle and shooting a bow, I bet I'm just as accurate at 60 yards as the average person is. Not a sniper, but the average person with a rifle.

You can be pretty fucking accurate. You can't off a bench. So there's some similarities. There's a similarity to having the, you have to have perfect technique. You have to have the right stance. You have to make sure that everything's locked in and your your structure is correct but i i agree with you that i think it's some sort of a meditation i also think there's something to hitting a target that is in our dna that's connected to hunting that's connected to survival that's connected to

i mean the thousands of years that people threw arrows and fucking – what is that thing called? What's that thing called that they – The addle addle thing. Yeah. Is that how you say it? Addle addle, right? Yeah. You know what I'm talking about?

Yeah, yeah. Yeah, that's like an advanced spear throwing thing and then archery and just – I think when a person would hit a deer, they knew their tribe was going to eat. And so there's this like charge. And you get a small amount of that juice when you hit a target. Yeah, no, I'm sure there's got to be dopamine that's being secreted when you do that. It's the greatest feeling in the world. Yeah, it shouldn't make sense. Like when you're looking at someone doing it, you're like, what do you give a fuck if that arrow goes in there?

It doesn't make any sense. Like, why does it make sense? But it, there's a fucking sat, like Jamie laughs at me. Cause I'll hit the bullseye from 45 yards. And I'm like,

yes. It's like, you get this little, woo. You get a little, little burst, man. I just liked the whole experience,

even the sound. So sometimes like when my veins get holes in them, like sometimes you put a broadhead through, or you put like a field tip through another one and now obviously sometimes if you trash the vein the arrow doesn't work but like usually just a single hole in a vein will produce a sound that is the greatest sound you've ever heard when that arrow leaves the whistle yeah oh yeah i love it so that's a problem with certain broadheads certain vented broadheads, they whistle. They whistle too much.

They give the animal the heads up. Yeah. So that whole experience of like the perfect release, you know, even when you surprise yourself. Like I've been, I switched over to this Carter Evolution release. Sure. About the. Back tension release. It's the most pure back tension.

It's better than the honey. Because the honey, you could still cheat a little bit. You know, if you were getting lazy, you could twist. You could twist, yeah. Exactly. But the evolution, there is no cheating. Right, you can't. It's like, so you can surprise yourself with a shot.

Yeah, so there's no anticipation. Yeah. Yeah, that's. You can't explain this to people who don't do it. Have you noticed that? No, you can't. They're like, what? Are you rambling about boring the shit out of me?

I have tried to explain this to people who don't know what I'm talking about. I was trying to explain it to Alexander Gustafson, who's in here the other day, and he's a hunter too. But he only hunts in Sweden. You can't bow hunt. It's not legal. And he wanted to learn how to shoot a bow. And so I was explaining that I put my finger on this trigger. My finger sits on the trigger.

I use a Carter too. I use a first choice. That's the name of the race. I go, I, my finger, my thumb is on the trigger, but I never squeeze it.

Yep. The squeezing is all done with my back as I pull. Then it just goes off. And like, you can see his head was like, why, why would you, but you could just do that,

right? Why don't you just do that? You know, it's so counterintuitive but um once i got into it tim actually sent me this book on back tension and then i just devoured it i mean it was sort of like the reading the penny dean book you know is tim doing this a lot now not as much as he should be um but uh trying to hunt with it yeah Yeah. Tim will hunt. Has he done it so far? I know he's hunting, but only with rifles.

No, no, no. He's been on bow hunting trips. That's, in fact, what got me into it because about two years ago, he was getting ready to go to a trip, do a five-day trip in Colorado. And he called me and said, hey, I want to talk with you about some training and some nutrition to get ready for this because it's going to be kind of an extreme whole deal. You know, you're at altitude, you're running around like crazy. You've got to be able to like, like sprint and then be totally relaxed. And so he's like, you know, can you help me think about how to train and what the nutrition would be? And I said, okay, tell me more about what the demands are. And the more he told me, the more I was like, why am I not doing this? This sounds really freaking awesome. So that's, so, uh, and he's got an awesome video of, of, uh, of this.

Uh, he took, I mean, probably he only took one shot in like the whole five day trip and it was a perfect kill. What did he kill? It was a huge bird and I can't even remember what it was. Yeah. Yeah. It was like a bird on the ground, like some huge ass bird, but it wasn't a turkey. It was like, I don't remember what it was, but the shot he was like, you know, it was. Yeah. Yeah. It was like a bird on the ground, like some huge ass bird, but it wasn't a turkey. It was like,

I don't remember what it was, but the shot, he was like, you know, it was one of those things where it was like, because it, you know,

like all my practice is on stationary targets, right? So it's a totally new dimension when it's like the thing's doing this. so it was flying? It was, it was like kind of like

either running on the ground or about to fly or something. But he hit it in motion. I mean, it was a great shot. That's crazy. Yeah, yeah, yeah. I wonder what the fuck that would be. I don't know what it was.

I'll have to ask him. A big bird in North America. Did he shoot a fucking eagle? Was he shooting pelicans? It definitely wasn't an eagle. What the hell is he doing, man? Yeah, I was reading something about the goose problem, Yeah, I was reading something about the goose problem, about how the goose population has exploded because of farmlands and that they literally don't know what to do with the certain population of different kinds of geese that are flying into this country from Canada. It's funny you say this.

I was in Toronto three weeks ago, which is where I'm from, and though I don't go often, and we were, I was with my brother, and we were up taking the kids to some place, and sure enough, like, we're walking from, like, one area to the other, and these geese come up, and they kind of start posturing, and I'm thinking, what the fuck?

And my brother's like, get moving. Like, clearly one of us is near one of their eggs. And I was like, what the fuck? And my brother's like, get moving. Clearly one of us is near one of their eggs. And I was like, what? He's like, oh, yeah, yeah, yeah. He goes, these are the most aggressive creatures. And they're big. Yeah, they're pretty big. So I was like, fair enough.

Let's just keep walking. Don't make eye contact. They're big, but you can cook them. So fuck them. Get out of here, goddamn geese. Yeah, there's a. Goddamn geese. Yeah, there's a certain type of geese that they call ribeye in the sky. Because they have a delicious red meat to them.

What is that called? Which fucking... Goddamn it. But they're very plentiful in Texas. Yeah, they hunt them in Texas. And they literally... What's the meat like? Is it marbled? It looks like a ribeye. Yeah, they hunt them in Texas. What's the meat like? Is it marbled? It looks like a ribeye.

It's crazy. Sandhill crane. Thank you. Sandhill crane. That's what it is. Is there anything you don't know? He's a fucking wizard with the Google, man. With Google, everyone is a wizard, but Jamie's an extra wizard.

He's really good at it. He's a ninja. Yeah, but that is what they call them so it's um it's actually a common phrase because it i've had friends that say it might be the most delicious meat in the world i mean it tastes like a like a like a wagyu ribeye and it's flying around and you could shoot like fucking 10 a day it's crazy like i have friends that hunt these things and you know they're fun they're mostly in texas i don't know where they are but my friends who've hunted them hunted them in texas i mean i'm sure they fly all across the country but yeah it's a crane it's not a goose yeah i've

never been i've only been bird hunting twice i went once uh with anthony bourdain uh for his tv show we hunted pheasantsants and he shot one and then we cooked it and ate it. That was fun. I shot at one and missed. And then I shot a turkey once. Which is pretty interesting. Wild turkeys. Very good. Very delicious. But, you know, it's

when I, I like mammals. I like eating mammals. I prefer red meat. I think it's just better for mammals. I prefer red meat. I think it's just better for you. I think it's more nutritious. It's more exhilarating. There's something about the meat itself.

It just tastes better. I haven't met too many foods I don't like. Really? Well, with the kind of exercise that you do, I'm sure you almost have a voracious appetite. I mean, I do, but nothing like what I used to. I mean, I'm sure you're, you almost have a voracious appetite. Uh, I mean, I do, but nothing like what I used to. I mean, I, I fast pretty much every day. Are you doing 16 hours? What are you doing? Um, it depends. So when I'm in, I split my time between New York and California. When I'm in New York, it's absolutely one meal a day. No ifs, ands, or putts,

because it's just the schedule is such that, you know, I'm seeing patients in the morning and afternoon and I don't want to do, I don't want to waste time to eat. What are you doctoring? That's a good question. I mean, I trained as a surgeon and did cancer surgery, but my practice is based on longevity. So it's sort of how do you apply nutrition, exercise, sleep, stress management, endocrinology lipidology supplements hormones all that stuff like how do you engineer how to make somebody live longer is my clinical interest um so yeah so in new york i eat one meal a day so it's basically like a 22 hour fasting window

and then i'm feeding within a two hour window wow when i'm here um it's about this well i mean yesterday and today it's the same like you know today has just been kind of a busy day. I won't eat till dinner tonight. But my short fast would be 16 hours where I would eat. That's a short fast? That would be a short fast. That's a long one for me. Really?

Dude, you got to get in touch with your evolutionary self. I had this discussion with a friend this morning because he was saying to me he can't do 16 hours. Well, he's a pussy. No, and I't do 16 hours. Well, he's a pussy. No, and I was like – I said he's a pussy. You just told him. No, but I said you got to understand if our ancestors couldn't function when they were hungry, we wouldn't be here. So it's not just that starvation – a short-term adaptation to starvation is necessary.

It's probably beneficial. is necessary. It's probably beneficial. In other words, during these short periods of deprivation of food, we get just a little bit more epinephrine and norepinephrine. We just get a little bit sharper,

a little bit better. I can't even remember what it's like to eat three meals a day. It's been so long. Really? How long have you been doing this? I mean, I've been doing

crazy shit for 10 years, nutritional-wise. Like, I spent three years in ketosis where it was actually one day I was in ketosis for three years. Lots of fasting. But I think intermittent fasting or time-restricted feeding, probably at least five years. And for people listening, what are the benefits of that? Well, I mean, if we're going to be really technical, we have to be clear that I think a lot of the benefits are overstated. And a lot of the benefits are things that we've only studied in animals. So there's a guy named Sachin Panda at the Salk Institute in San Diego who's, I think, one of the world's experts on time-restricted feeding.

But, you know, for example, a 16- hour fast in a mouse produces unbelievable results. If you take a group of, you know, certain types of mice or strains of rats or other rodents and you in a 24 hour period, period, deprive them of any nutrient for 16 hours, but then for eight hours, let them eat whatever the hell they want. They can't gain weight. So, um, and, and the, and the reason we think is that it, once you give a long enough period of time when the, um, animal can ramp up, it's, uh, the, like the enzymes in the liver that are responsible for fat oxidation. I mean, they just basically become fat burn. I hate that term fat burning machine. It's so overused, but that's, they basically just become unbelievably efficient at metabolizing fat.

So, um, we have to be careful though when we extrapolate that because you and I have a very different metabolism than a mouse. Like a 16-hour fast to a mouse is much longer than it is to us. So I don't know if those benefits would extend. Also, it's not entirely clear that time restricted feeding will produce the longevity benefit that we see in other sort of fasting or fasting mimicking types of diets. So for me, what it comes down to is, I mean, honestly, it's just an easier way. It gives me a much more liberty with what I eat during my feeding window. I don't have to be nearly as restrictive when I'm feeding. If I have that period off, it just, just in terms of like my physiologic response. Secondly, there's a convenience thing. Like I kind of hate being tethered to eat. Um, I like knowing that, Hey, if I get into a pinch, like I don't have to

eat right now. If I'm sitting on the airplane and they're serving dog shit, I don't have to eat. I can wait another five hours until I eat. Um, I also just feel much more steady in my energy levels. I, I kind of vaguely remember like 10 years ago when I was kind of like eating a normal diet, how I always had this lull in energy after lunch. Like there was the post lunch, pre dinner. I just don't feel good. Like not that I feel bad, but like I'm not sharp. I'm not in my A game. And I don't even remember what that feels like anymore, which is not to say I feel great all the time, but I definitely don't have that vacillating energy level. Yeah. I've said that to people when I eliminated most carbs from my diet, you know, and I have a friend of mine who talked to his trainer about that. And his trainer was like, you're crazy.

Eat bread, eat pasta. Don't listen to him. I'm like, no, don't listen to him. Like, just, just Google it. That stuff's fucking terrible for you. If you want to eat bread, eat pasta, don't listen to him. I'm like, no, don't listen to him. Like, just Google it. That stuff's fucking terrible for you. If you want to eat carbohydrates, get it from fruits. You know, get it from some natural sources. But if you have a trainer that's telling you to eat bread, get a new fucking trainer.

Because it's just not what you need. I mean, there's nothing wrong with eating it if you want to occasionally and in small doses. But when I eliminated most of that stuff from my diet i felt the exact same thing i felt that midday nap desire go away and then just the fogginess about like at the end of the day like oh god i'm fucking tired and then i'd have to drink a cup of coffee to get ramped back up again and it's just like never- ending cycle of having this insulin spike and then this crash. And that is that's from carbohydrates. It's from refined carbohydrates and, you know, having too much fucking sugar in your body.

And everybody does it. It's like. All right. So this will be funny for you. So Google my name and just put like Peter Atiyah fat. And you're going to see a picture of me when I was a swimmer because all this time we were talking about me swimming, you're assuming like I'm a fit dude. I was a fit but fat dude. Fit but fat. Fit but totally fat.

And this is- What were you eating? Oh, nonstop carbs. Look, there I am. See on the left there. Well, I wouldn't say you were fat. I would say you got a little paunch on you. I don't know.

Wait, wait. There's another picture uh after i swam oh across lake tahoe go to that uh that one right there yeah got a little gut there fella yeah i don't know it's like you're boozing it up yeah but it's also the way you're sitting down like if you stood up and sucked it in for a picture on instagram you might look okay i don't know i i was definitely you know probably what what, maybe 30 pounds heavier. Wow. But, you know, body fat was much greater.

And what were you eating? Oh, I mean, I probably went through three or four bottles of Powerade a day because, you know, you're training all day. And, you know, every post-workout was a carb refeed. And so you're in sort of this vicious glycogen-dependent state. vicious glycogen dependent state. Yeah. And people that, I mean, it's, it's crazy that there's so many folks out there that are living their life that don't even understand that this is a process they're going through. They just think this is eating and exercise. This is what happens, but it's not your body. If you shut up, cut that off, push it away. Enter into a completely different food source. Just change the way you eat. Your body will change.

And just that concept, people, that sounds like horseshit. It sounds like, what are you saying? Are you offering some miracle cure? No, I'm saying you will change the dimension of life that you operate in. It will change because you won't be the same person. You won't, like, who you are is dependent upon a lot of things. But one of them is how much energy you have, how you feel, whether you're crashing. If you change the way you eat, you change the energy you have.

You change the way you feel. It'll change your behavior. It'll change your choices. It'll change your ambitions. It'll change your potential. I mean, your choices. It'll change your ambitions. It'll change your potential. I mean, there's so many things that will change. But there's an interesting question, which I spend some time thinking about, and I've sort of accepted the fact that we might not know the answer, which is when I was growing up, I was exercising like crazy. Not as much as I was when I was swimming, but I mean, sorry, more than I was when I was swimming. But I ate, like I had the world's worst diet growing up. So I would eat, breakfast was a

bowl of, like a box of cereal. So I'd take like one of these Tupperware bowls that was this big and fill it with a full box. So each day I would have just a box of Cocoa Puffs or whatever I would start the day with. And then lunch was a full loaf of bread, which would seven sandwiches plus a plate of fries, plus a big tub of like, like a two liter jug of orange juice. But I was training six hours a day, right? So I would, you know, run 10 miles in the morning in the gym, you know, boxing, like it was, you know, you know what that shit's like. I mean, it's ridiculously energy expending, but the point is I had a hard time holding my weight and I was a middleweight 160 walked around at 158 who walks around below their fight weight. So, you know, my waist was 28 inches. I was

probably four and a half percent body fat and I was eating anything and everything you could put in front of me. And then something happened in medical school where that shit just stopped. And I wasn't even eating as badly at the time. But all of a sudden, the metabolic adaptation just vanished. And, you know, I mean, I wish someone could study this, meaning you would have to take a group of individuals and do muscle and fat biopsies over the course of their life, or at least during this window when we think this is happening. And I think for many of my patients or just even friends, it seems that this happens kind of in your 30s if you're a guy. For women, it's harder for me to tell because I think pregnancy can interfere with this. So sometimes we get a bit of a skewed answer. But if I had to hypothesize, I think that we go from having a lot of lipoprotein

lipase on muscle cells and not much on fat cells to the reverse. So when I was 16 and invincible, my muscles had a lot of this enzyme LPL on it that could just absolutely take whatever I was throwing at them and churn it into energy for the muscle. Whereas when that LPL exists on a fat cell, you're basically just going to store more fat. And now why that would happen over time, I mean, we could guess reasons. But I'd love to know if that's the case because I still can't really figure out, like, why is it today I am so carbohydrate sensitive when there was a day when I could eat? You know, I was probably eating 7,000 or 8,000 calories a day, of which 80% were probably carbohydrates when I was growing up and was lean and mean. Did you experience a crash at all, like post-afternoon crash, post-lunch crash? That's a good question.

Back then, I don't think I did that much back in the day, which would also speak to the idea of better fuel partitioning. Fuel partitioning meaning this sort of technical term for where your body knows to go to excess energy. Are you going to glycogen? Are you going to the fat? And then where are you storing energy? So I suspect I was just better at fuel partitioning as a kid, which I'm sure most of us were. Anyway, it's kind of, of course, the real question, the reason we care about this is like, what could you do about it? Right? Like what, you know, for example, like, that's probably one of the reasons why testosterone, as testosterone goes down, you're going to get fatter, all things equal. And part of the reason is testosterone upregulates LPL and hormone sensitive lipase and all of these other enzymes in the direction of making you leaner versus fatter. So, um, but that, I, I, I just don't think that that's enough of it. You know, I think there's something else that's going on that's triggering that decline. So for you with this 22-hour window of not eating,

what do you think the benefits are other than your energy and slight spikes in norepinephrine and some other hormones? Well, I don't think there's sufficient evidence at this point in time that time-restricted feeding is going to impact my longevity. So I think that's the big claim. And it's the big claim that's being- What is the claim? What are they saying? Oh, I mean, I think the claim would be that fasting mimicry, which could be like what, say, Walter Longo talks about where you do a five-day hypocaloric diet of 750 to 1,000 calories a day for five days, followed by 25 days of ad libitum feeding, meaning eat whatever the hell you want, in terms of total caloric content, the claim is, well, that's going to enhance longevity. Or doing a 16-8 or 18-6 is going to enhance lifespan.

So just to take a step back, I am only aware of three things that have universally extended lifespan across all model organisms. So if you think of like all eukaryotes, right, if you go from yeast to worms to flies to mammals, the only things that uniformly extend life or almost uniformly is caloric restriction and or dietary restriction. or almost uniformly is caloric restriction and or dietary restriction. So total reduction in calories during the lifetime and or reduction of certain subsets of those calories. So there's a super famous experiment that was done. Actually, if anyone's interested, I wrote about it. It's on my blog somewhere, but it's basically this, the best experiment ever done in caloric restriction was between monkeys. And there was a group at the NIH and a group at the University of Wisconsin. And it was like a 19 year experiment or something like that. So you could really study the impact of caloric restriction over these things. And that experiment showed us that caloric restriction extended lifespan if you had a

really shitty diet and it did not extend lifespan if you had a really good diet. Counterintuitive, but it also spoke to the idea that dietary restriction probably mattered. So in other words, if you're eating a regular diet of McDonald's every day, and then we put your counterpart eating 70% of McDonald's every day, that's going to move the needle. But in the Wisconsin, in the NIH experiment, when you took the monkeys that were eating kind of, it wasn't their natural food, but it was less horrible food, the caloric restriction did not extend lifespan. So that threw a wrench in everyone's understanding of caloric restriction. And there are certain

strains of mice that also don't seem to be enhanced in terms of lifespan, meaning just time on earth. But for the most part, nutrient deprivation pretty ubiquitously extends life. The second thing that uniformly extends life across this is a drug called rapamycin, which is kind of like my favorite drug in the whole world. I mean, meaning it's like, I think it's the most important drug in terms of this space. Not necessarily because it's a drug that we'll all be taking, though I do believe that is the case, but more importantly because of what it's taught us about the nutrient sensing pathway and its target, which is this protein called TOR, the target of rapamycin, or mTOR, as you've probably heard of it, is mechanistic target of rapamycin.

And rapamycin inhibits that. Now, it's a bit complicated because there's two variants of it. There's something called mTOR complex 1 and mTOR complex 2. And if you take rapamycin inhibits that. Now, it's a bit complicated because there's two variants of it. There's something called mTOR complex 1 and mTOR complex 2. And if you take rapamycin day in and day out every day, which, for example, transplant patients do, it's an immune suppressant, that doesn't seem to really extend lifespan. But if you take it in a pulsatile way, you selectively get this mTORC1 inhibition without the mTORC2 inhibition. That seems to produce longevity big time. And how does that work? How would you take it selectively? Well, this is sort of one of my main clinical interests because I obviously am waiting for

the day when I can start taking it and ultimately feel that it's safe enough that I could give it to patients. If I'm extrapolating from all of the best data out there, so that's looking at the work that's come out of a guy named David Sabatini's lab. David's a guy at MIT. He's a professor. He's actually the guy that when he was a medical student doing his PhD in 1994, actually discovered how rapamycin works in mammals. He's actually the guy that coined mechanistic target of rapamycin, mTORC, as a name. And so now, whatever we are, almost 25 years later, he's still running the powerhouse lab that understands it. So if you look at all of the literature that's coming out

of their lab, coupled with a guy named Matt Kaberlin at the University of Washington, who's doing rapamycin studies in dogs, along with the work done by someone named Joan Manick, who was at the time at Novartis, is now at a company called Restore Bio, and a few other people. My intuition is that somewhere between two to six milligrams every five to seven days is probably the sweet spot. But, you know, am I confident enough in that to say that we should all be taking it? Not yet. There's a couple of things that like, I want to be able to measure before we do that. But, um, you know, in the animal data, this stuff's remarkable. If you look at Matt Caberlin's dog data, it's remarkable. Like what are they doing with it? Well, so for,

so you own a dog, you know this, right? If you look at outside of euthanasia or accidents, how do dogs die? They basically die of cancer and heart, and they get dilated cardiomyopathy. It's a different type of heart disease than humans get. They don't get atherosclerotic disease. They get heart failure. Their hearts just get too, too, too big, and their rejection fraction, which is the amount of blood, the percentage of blood that leaves the ventricular chamber with every contraction. As that number goes down, bad things happen. Now, to put that in perspective, you and I sitting here, a couple of normal fit dudes, we probably have a resting ejection fraction of 60%. And if we went out there and killed it and

worked out as hard as we could at peak, we might get that up to 80, 85% ejection fraction. killed it and worked out as hard as we could at peak, we might get that up to 80, 85% ejection fraction. So once the ejection fraction gets below 30%, you know, a person starts to become very symptomatic. Well, Matt took these dogs that had low ejection fractions to begin with, and I forget what the exact number was, but it might've been like below 40% or below 30%, put them on rapamycin for 12 weeks. And in just 12 weeks, saw an absolute 10% improvement. So that means that's not going from 30 to 33, that's going from 30 to 40% EF improvement. In other words, it's hard to measure an effect in 12 weeks of a drug. And certainly you're not going to be able to measure a longevity impact over that. So much of the study that's being done with this is looking at surrogate markers that we

assume would portend longevity. So Matt's work focusing on the ejection fraction, Manick's work was focused on immune response, which again was, so this was the turning point for me. This was like December of 2014 was like when everything in my professional world shifted in terms of my interest towards like rapamycin is the thing I want to know everything about because when I was a surgical resident, you know, we used to give rapamycin out like it was cotton candy to all the transplant patients. It was an amazing drug that revolutionized transplant physiology because it had far fewer side effects than massive doses of prednisone and things that we used to have to give

patients. Now you could give them much less prednisone and you could give them rapamycin or cousins of rapamycin like FK506. And what you're doing with that stuff is you're suppressing the immune system so the body doesn't reject the organ? Exactly. Now when you do that, does that leave them susceptible to illness or disease? It does. It does. Would that be the case with rapamycin in person taking it for longevity? And that's the million dollar question. And so I think in two, so in a moment, I'll tell you the story of how rapamycin came to be, because I think it's the most interesting story in biology, certainly in the last 25, 30 years. But when it was approved in 1999 by the FDA, it was for this indication. It was an immune suppressant. It was 10 years before anybody figured out that, oh, wait,

this could also extend life. And therein you had this paradox, which was, wait a minute, how can an immune suppressant extend life? I mean, everybody acknowledges that immunity is a core element of health. And so in December of 2014, I feel like it was like almost Christmas day. I remember thinking this is like the best present I've ever got. Mannix Group published this paper, which they did in a group of about 320 65-year-olds-ish. So they put them into four groups. There's a placebo group. There was a group that got, and it wasn't actually rapamycin. It was everolimus, which is an analog of rapamycin. It's basically the same drug. So there's a group that got one milligram every single day, five milligrams once a week, 20 milligrams once a week.

They did this for something like eight to 12 weeks, and then they washed out, meaning they got nothing for eight to 12 weeks, and then they were hit with a flu vaccine, and then the scientists measured the immune response, doing these really complicated assays where you look at T cell function. So relative to the placebo, paradoxically, all groups, and I say paradoxically because even the group that got one milligram once a day, all saw an increase in immunity, which is a good thing. But the five and 20 group saw an even bigger response. The people who just got five once a week or 20 once a week saw an even bigger response. But the group that took 20 once a week had more side effects. And the biggest side effect of rapamycin acutely is these awful, awful mouth sores called aphthous ulcers. They're nasty.

They're brutal. I used to get them all the time just from, I think, sleep deprivation or any, you know, something that was weakening my immune system. So it's an internal sore, not, not like a cold sore. No, no, no. It's like usually it's a really nasty type of canker sore. Yeah. So once I had one so bad that I was like, this is when I was in residency, and I was like, it was just driving me nuts. So I went to the OR, and I got a bunch of lidocaine, which is a local anesthetic. And I went into the call room, and I just grabbed my tongue and just injected like lidocaine in it. And just when I did that, somebody walked in, and I've got like blood dripping down from my mouth, and I've got a needle in my mouth. And they're like, and I'm like, no, no, no, it's not what you think. It's not what you think. I

swear it's lidocaine. They're like, dude, we're going to tune to help, you know, support groups for people like you. Lidocaine is disgusting. I had my deviated septum fixed and they shoved the lidocaine up there. You know, it's harsh stuff. And the rest of the day, I just felt like shaky and just weird. And then I realized, oh, this is like almost like a cocaine type thing. Like it's a cousin. Do you know why we have lidocaine? Because of cocaine, right? Yeah.

It's a guy named William Stuart Halstead who was so near and dear to my heart because he was the original. He was the founding surgeon at Johns Hopkins and one of the original four horsemen. So the four main physicians that basically have shaped medicine in this country all started out at Hopkins. Osler in medicine, Hopkins in surgery, and two other guys, Walsh, and I'm blanking on Kelly was the third one. And he basically figured out, because you got to remember, like, there was a day when surgery was staggeringly barbaric. Like, prior to ether, surgery was like, all right, can you hold him down?

Like, gag him, get him drunk, gag him, and like, we're going to do our thing. Yeah, it's just crazy. So, God, I used to know all of this shit. I don't remember any of the exact dates anymore, but it was like kind of like mid 1800s to late 1800s when up at, um, Massachusetts general hospital, I forget the name of who it was, but someone basically came up with ether. So ether became the first form of anesthetic, but you know, you were sort of knocking people out. Well, it was, you know, fast forward probably 20, 30 years when Halstead figured out that this thing called cocaine could provide local anesthetic. So he began experimenting with like crazy and, of course, in the process became like patently addicted to it.

So you have this entire generation of surgeons at Hopkins from that early era that were completely coke addicted. So Halstead and all of his first generation of residents. And then of course, from that, we got lidocaine, bupivacaine, all of these things that don't have the same properties. But to this day, cocaine is still used and most people don't realize it, but cocaine is a schedule two drug, meaning it actually has a medical application, unlike heroin, which is Schedule I in the DEA. And marijuana. That's right. But cocaine is Schedule II, and it is still used in some ENT surgery because it has some favorable properties over even lidocaine and bupivacaine for nasal surgery.

Did you know that they still use coca leaves for flavor in Coca-Cola? They actually extract the cocaine from it, use the coca leaves, cocaine goes to medical for i didn't know that i had cocoa tea for my first time uh this summer like real cocoa de latte but like brought up from the mate mate de coco that's what it is oh yeah it's great i could not get enough of that stuff you can't shut the fuck up on it though that's it's a weird sort of high it's a very strange strange thing. It's a very talkative sort of high. I thought it was just everything about it was like just such a great. You ever chewed the leaves? You ever done that like in Peru?

No, no. I've never done it either, but apparently it's really interesting. It's like a coffee sort of a thing, and it's got flavonoids. It's actually probably healthy for you. I just love plants in general. Yeah. Well, we think of the coca leaves as producing cocaine. Cocaine we think of as inherently negative.

But the leaf itself, like, if you just don't extract it, it's actually really good for you. Well, that's the thing. I mean, and that, you know, even, like, thinking about the difference between eating fruit versus eating Oreos. Yeah. Scoop of sugar. Yeah, yeah, yeah. Like, nature's pretty good at regulating how fast this stuff.

So in the case of fruit, like how quickly does fructose hit your liver? There's a sort of governor built into it if you're eating raspberries. Like could you get non-alcoholic fatty liver disease from eating enough raspberries? Yeah, probably. But it's like- You'd have to go crazy. Yeah. You need to become a full-time job.

Or you could just drink a giant gallon of orange juice every day. Right. That would do it. That would do it. Crazy. Because most people think of fresh squeezed orange juice as being, oh, you're eating healthy. Yeah. Look at you over there with your fresh squeezed orange juice.

Yeah, you're juicing. It's totally healthy. Super healthy. Meanwhile, you're just drinking a big old glass of sugar. Literally, your body doesn't know the difference between that and a Coca-Cola. Very little difference between the two, unfortunately. Well, Coca-Cola's got some other stuff in there, caffeine, but other than that, just the sugar itself.

Yeah, your liver would have a hard time telling the difference. So crazy. Most people would think a glass of orange juice at breakfast is a healthy choice. Oh. Well, it's a glass of sugar. Have a Mountain Dew.

Yeah. It might be better. It might get more healthy choice. Oh. Well, it's a glass of sugar. Have a Mountain Dew. Yeah. It might be better. It might get more shit done. Yeah. So the dosage of 1, 5, and then 20. So that study, I remember reading that and thinking, okay. So if you looked at that study, you realized if you're going to be in the placebo, the one a day, the five once a week, or the 20 once a week, the five once a week was the way to go because you got sweet spot.

That's right. You got all the benefit of 20 more benefit than one and the fewest side effects. And how long is this study? That was an eight week intervention with an eight week washout was enough to see the enhanced immunity. Do you think that a longer term study is necessary to see like whether or not the body adapts? Yeah, absolutely. I mean, all this stuff is in its infancy. Now, my shtick is, so right now rapamycin's off patent, right?

So the drug was approved in 99 by the FDA, but this is after an unbelievable, amazing story of like how, you know, this drug almost got lost forever. Like, you know, so there's no economic incentive for a company to, you know, figure out how to do this thing with rapamycin. And even Everolimus, I think ultimately Novartis, and I'm saying this with no actual knowledge other than just my own speculation, but I suspect Novartis was like, well, you know, we're not going to play this game just with Everolimus. And that's, I think,

why it probably spun into this other company, RestoreBio, to sort of combine it with other agents. But at an N of one level, what I'm kind of interested in doing is, you know, using myself as a guinea pig to start to measure the benefits of it, because my hypothesis is three things have to be true. If rapamycin is working, I could be wrong, but, but this is my hypothesis. And this is what I test with, with, with, with other scientists is if you were taking rapamycin at the right dose. Um, so assume you're not getting all the nasty side effects. You're not getting the mouth sores and stuff like that. Three things have to get better. One, your glucose metabolism should at least get no worse, but potentially better. I suspect it's a

function of where you start. So there is one doctor in New York who has like a rapamycin practice. I think he's in, I think he's in the Bronx actually. And I've talked to him a bunch. And when he started it himself, he said, like, the improvements were remarkable just in terms of glucose metabolism. But I think he was starting at a pretty bad spot. But if you or I took it, we might not notice much getting better, but we definitely should not get worse. So that's easy to measure clinically. You do an oral glucose tolerance test, we definitely should not get worse. So that's easy to measure clinically. You do as an oral glucose tolerance test would give you that answer. But two things should get significantly better. The first is immune function should get better, not worse. There is no clinical

way to measure that, but we do know how to measure it. I mean, when I was doing my postdoc, it was in an immunology lab. Like I know how to do that assay. I just don't have like a million dollars worth of equipment to measure it. What is the difference in the dosage even in the high end at 20 versus what you would give someone if they got a liver transplant? Yeah. Yeah. Typical transplant dose would have been like two, three milligrams every day. Okay. So it's quite a bit different.

It is. And it's different on two levels because, you know because when you're giving it every day at a lower dose, you still end up producing tissue levels that might even be comparable to where that person was getting with the spike of 20. And in general, this isn't always true, but in general in pharmacology, certain side effects are the result of the nadir dose and certain side effects are the result of the peak dose. So with every drug, you kind of have to understand this a little bit. But going back to this rapamycin thing, the third thing that has to be true, in my opinion, I could be full of shit, but I think the third thing that has to be true if you're taking the right dose is you need to

see an uptick in autophagy. And so just as if you- What does that mean? Autophagy is this process where the body cells start eating themselves. So it's kind of like a programmed cell death, although technically we reserve that term for something called apoptosis. But when you're fasting, why would fasting produce a benefit? And I think the most logical explanation is enhanced autophagy. So the body basically has to prioritize in the absence of nutrients. The underperforming cells are basically told, eat yourself. And we can recycle some of your components. Maybe this mitochondria is worth saving. This Golgi apparatus is worth saving.

And then we selectively, when we refeed, repopulate the better cells. And in many ways, I think rapamycin can do that in a pill. So the problem is we don't have a blood test to measure autophagy. So in the lab, when you measure autophagy, you need muscle biopsies or they typically even just sacrifice the animals. This has become a very hot area. So the Nobel Prize in Medicine and Physiology was awarded for the genetic, basically the elucidation of the genetic regulation of autophagy in, actually it was 2016. So it's very recent, about a year and a half ago, this is what the Nobel

Prize was awarded for. But what I'm hoping is that we can develop a signature for autophagy with a blood test. So I believe that you should be able to look at someone's blood and look at all of the metabolomics, all of the small molecules, all of the proteome, and there should be a signature. It should look different from the way we look when we're fully fed. Otherwise, would you just take a sample of the muscle tissue, like punch something out? Yeah. And I mean, I'm willing to do it all, and I probably will. We're just trying to get what's called an IRB, an institutional review board. So to do these kinds of studies in humans, even if I'm the only subject and it's just like, I don't care what you do to me kind of thing, we still have to get an

IRB. So we're working on getting an N of one IRB so that we can take muscle biopsies, fat biopsies from me, blood tests, and then start to actually look for that signature. Would it vary in where you got it from? Like, would you want to get it from more than one muscle group? That's a very good question. I don't know the answer. I probably have to talk to people who have a lot of experience doing this with animals, but it actually wouldn't surprise me. Like if I were going to do it, I would just start in the legs because the muscles in the legs tend to be the harbinger of what's going on in the body. So for example, one of the first signs of diabetes, like a decade before you get diabetes, one thing that if you're actually doing this kind of testing in people,

you'll notice glucose, like insulin resistance in the muscles of the legs. So once the legs start to get insulin resistant, you're on a glide path to bad things happening. Once the legs start to get insulin resistant, you're on a glide path to bad things happening. I'm fascinated by legs. First of all, from years of martial arts, but also because over the last year or so, I've been doing a lot of running and it's one of the only muscle groups that I can work out every day. I can run hills every day and I'm not sore. Like that's not even possible for any other group i mean i can kind of do that with boxing you can hit the bag and but as far as like running hills is essentially

like plyometrics like you're pushing your entire weight up and then you're catching with the other leg and pushing it up yeah yeah you can't do that with you can't bench press every day your fucking arms will fall off i mean there's probably someone out there doing it that's proving me wrong but there's nothing like the amount of endurance that you have in your legs but it could just be an adaptation that you've had as well i mean when i was a competitive cyclist i mean there were definitely days when i would especially when we did like multi-day events like there were days when it's just like. You're beaten down.

Yeah, yeah, yeah. Oh, for sure. You're going to learn in the first 10 minutes. Like everybody else is riding together. You're riding alone today. The fatigue level though is significantly different than it would be if you were doing something with your arms every day. It seems like your ability to recover. You can definitely recruit more.

That's probably part of it, right? Okay, so there's more tissue. I think you have more options. Like you can, you know, especially if you really have good proprioception. But for example, like if you're dead lifting, you know, I actually think if you, so you know how you have like the positive and negative motion, concentric, eccentric motion of a weight. If you're willing to do away with the negative, you can lift heavy every single day. So there's this guy named Ryan. Oh, unfreaking believable data.

So you do. I've seen people doing that. You know who I saw? Andre Galvao on his Instagram the other day was doing deadlifts and just dropping the weight. And I was like, that seems weird to me. So when I was a cyclist, this was my training. And it was all put together by this guy named Ryan Flaherty, who I actually introduced. That was another one of my sight unseen introductions to Tim for a podcast. It's a

great podcast with Ryan Flaherty on. And he's, I call him the guru of speed. This is a guy who like single-handedly, I shouldn't say single-handedly. I mean, he's on the shoulders of many other people who have done great work, but has really done an amazing job of figuring out how to make people run fast. And it's a very long story. And I mean, he does such a great job on the podcast. I won't go into it. But for the purpose of this discussion, one of our interests was, hey, could we translate everything you've learned about sprinting into cycling? And his biggest observation was the following.

His biggest observation was the following. If he took 100 runners and lined them up and knew, like before they ran, knew how hard they could hit a force plate treadmill, he could predict the order in which they'd finish the race. So a force plate treadmill, as its name suggests, a treadmill, but it's a special treadmill where it measures the force that number divided by your body weight, that became what he described as mass-specific force, that number, if you rank order it, is the order in which people would finish the run. So it kind of makes sense if you think about it, right? The harder you can hit the ground relative to your own weight, the higher you go, and the higher you go,

the longer you travel with each stride. So Usain Bolt has the highest ever force plate measurement calculation. And it's – I forget what his ratio is. I want to say he's like 6.9 or 7 times more force than his body weight every time he hits. Freaking staggering. Wow. So then Ryan – once he figured all this stuff out, his next question, this is when he was working at USA Track. His next question was, could you train this?

In other words, like, okay, if Joe runs a 4.940 and we want to get that down to a 4.5, can that be done? And it turned out the answer was categorically yes. You have to do two things. You have to get stronger and you have to get lighter. So how do you do that? And that's when he came up with this idea of we do hex bar deadlifts. We lift really heavy. So you're only doing fives, fours, threes, or twos, never more than five reps. And so you'll do five sets every single day and you'll pick it. So some days it'll be five sets of three. Some days it's five sets of five, whatever it is. And they're very well prescribed, like at what percentage of your one rep max

you're doing these at. And it's up, drop, up, drop, up, drop. So you're never getting the actin myosin filament to tear past, because that's what's happening in the negative, is the actin is coming off the myosin and that is creating a micro tear in the muscle. And that's what the muscle rebuilt. That's why we get larger when we lift weights. But when you drop it, you, you unload the muscle when you're relaxing it. So the muscle's not going to get bigger. So you're getting all the benefits, all the strength, which is primarily around the type two B muscle fiber and without the size. So anyway, when I asked Ryan, hey, could we do this in cycling, we did this experiment,

which was he kind of came up, this was for me and two other guys who were very good cyclists. Like I was like, I'm a popper, but these guys were like cat one, cat two collegiate cyclists, but they were like my training partners. So we did this thing where we did the same routine that he had the sprinters doing. And it's a bit more complicated than I've described because you're also juxtaposing the positive only with something called a post-activation potentiation, which you may have already experienced this, but I don't know if you've ever tried to do plyometrics after deadlifting, but it seems counterintuitive that you'd be able to do more,

but you can. Yeah. It has to be a heavy deadlift. More in terms of numbers or more in terms of- No, more in terms of distance, like more in terms of vertical. Really? So your highest plyometric jump is going to come after you've done three sets of three at 95% of your one rep max. And three sets of three dropping or using eccentric? No, definitely dropping. No eccentric?

Absolutely, yeah. Huh. Wow. And so we would superset the plyometrics with the deadlifts. And you would do this every day. And so Ryan, he runs a training camp where he has typically the top 10 college prospects every year just before the NFL Combine come down. And I mean, the changes he makes in their time, like Johnny Menzel was one of them. So obviously, Johnny Menzel has obviously, you know, not panned out in the pros, but most people kind of forget how good an athlete he was. And when he showed up to camp, I forget what his time was, but I want to say it was about, I don't know, you could probably look this up for me. You know, it was three-tenths slower than what he ultimately ran at the Combine. And I think he had the fastest or second-fastest quarterback time at the Combine

after just 12 weeks of doing this. Wow. I mean, it was unbelievable how fast he can get these guys to run. I saw something the other day that I'd never seen before. It's an eccentric bike. It changes back and forth. I've heard of this thing. You're the second person to tell me about this. I think I saw it yesterday. In fact, now that I think about it, it was eccentric and concentric, but it alternates. Yeah, yeah, yeah. And it looked really weird. It forces movement and

you're resisting the movement. See if you can find that, Jamie. It's like an eccentric, is movement and you're resisting the movement see if you can find that jamie it's like an eccentric i forget what it's called but uh like someone sent me this like hey this thing's amazing i was like it's a bike the fuck you talking about it looked different than that the one i saw was also different it was a i think it was like a recumbent yeah yeah that's what i saw too yeah eccentric yeah you're spelling it wrong oh it, it was coming up, though. Oh, it says just centric. Oh, okay. Huh.

Eccentric exercise bike? Try that. But the thing is, it alternated between eccentric and concentric. It wasn't just, hmm. The one with the red on the top row looks like it. What is that? Pediatric ergometer. No, it's not that.

It's for little kids. Well, whatever. I wish I had saved it because I was like, I'm never buying this. But, you know, it just looked interesting. It's just like there's always these new methods of stimulating the body and tricking it into doing things. And I guess that's essentially what a lot of people, the way a lot of people think of intermittent fasting, you're kind of stimulating the body, you're hacking it, tricking it, you know? And I wonder, you know, one of the things that Ryan and I talked about was, could we ever adopt his training system to swimming? And in running and cycling, it's primarily going to be quads, hams, glutes have to be the muscles

that do it. Would you throw things? Well, we were talking about like, you primarily going to be quads, hams, glutes have to be the muscles that do it. Would you throw things? Well, we were talking about like you really got to be able to get the lats fired. But how do you get the lats to fire at such a weight and then without having to do the negative as well? So we just couldn't really kind of figure out how to do it. So we adapted part of his technique to swimming, which was the actual training routine, meaning – so one of the big misconceptions if you're trying to go fast is that you need to still train slow. But the reality of it is like if you're trying to run a marathon at – call it a pace of 215, world-class marathon runner, there's not a lot of benefit to spending much time running at a pace slower than that. If anything, you want to be running slightly faster than that. So you know

who Meb is, the American marathoner who won the Boston Marathon three years ago? No. So amazing marathoner. I think he's the only person to have won the New York Marathon, the Boston Marathon, and to have won an Olympic medal in marathon. He won a silver medal in the 2004 Athens Games. But when he won the Boston Marathon, he was like 38 years old, which in marathon parlance is like, he might as well be a hundred. And he had not really had a great race in the previous few years. So he had been effectively written off in the sport and Ryan actually helped train him. And all they did was apply this principle of sprinting into marathon running, which was,

all right, Meb, if you want to win the Boston marathon, you need to be able to travel like four inches further with every step you take, taking the same number of steps at the same cadence that you currently run. And they, you know, Ryan did the math and said, that means your force number has to go from where it is now, which I think was 1.7, meaning he could only deadlift 1.7 times his body weight. You have to get that up to like 2.6 or something. And so when Meb trained for the Boston Marathon, he was focusing heavily on these deadlifts and doing much shorter, faster runs. And, you know, I mean, if you watch the video of his Boston Marathon win, it's incredible.

Like, you know, he just takes off and, like, leaves everybody behind him, and they're like, yeah, there's no way he'll be able to keep that up. We'll let him go. And they couldn't rein him in. Wow. Do you think that someone's going to be able to break two? Like, that's the big – we were just talking about it the other day. Some guy got really close.

Would you say he hit, Jamie, like 206 or something? I think someone's gone closer. 202? Didn't that guy in Germany last year go even closer? I think it was 202

or something along those lines. And you think that this sort of method is what they're using? So I don't know if I'm allowed to talk about this stuff publicly. Uh-oh.

Don't worry, no one's listening. So short answer is yes, I think this can be done. Everything has to be perfect, right? Meaning you have to have the perfect athlete trained to

peak at the right time, you need the right humidity, like everything has to fire on all cylinders. But just as there was nothing physiologically special about a four minute mile when Roger Bannister broke it, it was more of a psychological barrier. You know, I'm not suggesting for a moment that this will be easy, but you know, we're going to get there. I mean, like this can happen. That is incredible. If you think about how fast you're running to run 26 miles in two

hours and two minutes. It's staggering. I don't think people understand like what, uh, I mean, I was never a great runner. I was about a 250 marathon, 255 marathon when I was a boxer, but never trained as a runner. Like it was just, I just ran so much and I was pretty fast. I just ran so much and I was pretty fast. But when I think about how hard I would have to run to bust out a 250, a 255, and to think, was there any chance I could have ever got that down to a 230? That is such an enormous change in pace. I don't know that I ever could have done that regardless of all the training tricks in the world. And what kind of diet are those guys following?

Well, I know Meb personally. I can't speak to what the other guys do. But I think a lot of those guys are frankly in the state of where I was when they were younger. Meaning like they can probably get away with a lot more. If you look at the physiques of most of these guys, they're, they're perfectly built. Like I'm talking elite level. I'm not talking about like anyone who go runs a marathon, but if you're talking about like the people who are going to win the marathons, they are basically all engine and then chassis in the right place.

That's basically all they come down to. Right. I mean, they are enormous cardiovascular system, very strong quads, hams, glutes, and then everything else is very tiny. When you say enormous, like is literally the size of their lungs? Yeah, you actually look at, well, I mean, it's all relative, but when you look at their frame, their thorax is going to be larger. And is it expanded because of the training? I think so. I mean, you never know cause and effect. Sometimes you could argue like maybe these guys were maybe the people who are drawn to those sports are the ones that are, you know, are drawn to be elite in those sports already had a genetic predisposition. world's best, which is what he competed with, of course, I think his lactate threshold was a lot higher than most people. Genetically.

Yeah. And then, of course, and again, I know it's such a controversial topic, although my view is I think that every single cyclist, at least from 1991 till 2011, was on highly, highly, you know, augmented programs. So, you know, that Lance won seven of those years in that context just tells me that he was, you know, training harder and being more specific to the race. I mean, what people don't understand is like, I mean, Lance only peaked for one race a year. Like everything that that team, US Postal did was geared for that one race. And also when you really look at how much doping they did, it actually wasn't that much. Like, you know, when they were blood transfusing, it might've been two units over the course of a race. And I'm not saying that that wouldn't help. It would help a lot, but that's nothing compared to what people were doing just a few years before Lance came

along. So Lance won, I think his first one in 99. The guy who won before that in 98 was Marco Pantani. Before that was a guy named Jan Ulrich in 97. And before that was a guy named Bjorn Ries. Bjorn Ries' nickname was Mr. 60 because his hematocrit was always over 60. That's freaking – like how that guy didn't die of a stroke, I don't know. Is that from EPO? Yeah. Lance never had a crit over 50 to my knowledge. They would basically always titrate with EPO and or hemoglobin up to 50, which was the trigger.

So, you know, but I think, and again, I, I've never, I don't know Lance at all. So I've, and I've certainly don't know anything about him beyond like the little bits that I have read over time, but I do think his lactate tolerance was remarkable, meaning, um, you know, we measure lactate in athletes, swimmers, and cyclists when they're, you know, trying to figure out what their performance is. And as far as I can tell, there are seem to be these two phenotypes. There's the one phenotype where people can tolerate staggeringly high amounts of lactate. And again, it's not lactate per se that is causing the pain that you're experiencing.

It's the hydrogen ion that accompanies the lactate. So lactic acid, the acid part of that is the hydrogen ion. And that's actually what's poisoning the muscle and preventing the muscle from having this effortless actin myosin act, you know, contract, release, et cetera. But we use lactate as a proxy because where lactate is high, the hydrogen ion is high. And there are some people who can just tolerate like incredible doses. I used to work with Olympic swimmers and, uh, I mean, there were just a couple of these guys, like they could actually be standing with a lactate of 24. I mean, when I was competing, if I had a lactate above 16 or 17, I couldn't be standing like that was just too much pain. Like I was on the floor. If I was over 17, I was puking and I saw dudes that could stand there at 24. and I saw dudes that could stand there at 24. In fact, one of my good friends,

he won a gold and a silver medal in the Sydney Olympics and retired from swimming in 2004, then came back to swim masters. So, and was like, he actually was trying to make a comeback to make the 2012 Olympic team. And when he was training for that, like I would poke him between races and I saw him get out of a 400 individual medley race, which is the hardest swim race of them all. The 400 IM is, I mean, you might as well just shoot yourself. It's so painful. He got out of that, had a lactate of 18,

two minutes later, not two minutes later, maybe seven minutes later, jumped on the blocks and won a hundred breast race, you know, came out with a lactate of 21, that kind of thing. So there are those guys. And then I think at the other end of the spectrum, the word on the street is guys like Michael Phelps are at the opposite end of that, where they are so efficient at shuttling lactic acid out of the cell back to the liver, where this thing called the Cori cycle actually turns lactate back into glucose, that they never have high levels of lactate. Now, again, all of this is sort of, you know, speculation because I don't, I think they were very hush hush about Phelps's numbers, but I heard from reliable and reasonable sources that

he would rarely have a lactate above 8.0, including when he's breaking world records. Whoa. Which for me at 8.0, like I'm smoking and joking, like that's fine. But for, you know, he was so efficient at getting rid of it that yeah. But for, you know, he was so efficient at getting rid of it that yeah, he could, you know, set the world record in the 400 IM and have a lactate of eight. Again, I don't know if this is true, but, but I've, there's certainly a plausible mechanism by which it could be. Well, it's fascinating that this could potentially all be engineered, right? That like through use of CRISPR or something else, you could take all these various facets of performance enhancing modalities, extend a person's ability in so many different ways and create a super person. Yeah, of course. It's interesting,

right? Once you start genetically doing it, if you could, does it become cheating in the same way? Like would we, would we have... Well, does it if you have someone like phelps who has this genetic predisposition to getting rid of lactose lactate and you take someone like me who probably has none of that and you know you juice me up to his level is that cheating i mean it is i don't know i mean those are the questions i mean this is why people like daniel coyle who are so critical of lance armstrong say because because on the hand, you'll have camps that say, look, it's the great equalizer. Like, why don't we just let everybody dope? That's a steroid argument with MMA as well.

Well, and frankly, it's more my argument. But I have a different reason for arguing that way, which is I think having done these sports and nowhere near at the high level that those guys do it, I just know how destructive they are. Like the Tour de France is the most unhealthy thing on the face of the earth. I've heard that it's healthier. Like the Tour de France is the most unhealthy thing on the face of the earth.

I've heard that it's healthier to do the Tour de France on steroids than it is to do it off steroids. Absolutely. When those guys finish the Tour de France, they are osteopenic. I mean their bone density has eroded. Their muscle, they have lost so much muscle mass. I mean it is a devastating, grueling event. Now nothing is going to completely ameliorate that. But like, if we think that like watching these guys kill themselves riding six hours a day, hitting peak thresholds of, you know, six watts per kilogram,

if we think there's anything physiologically reasonable about that, we're out to fucking lunch. But is that the point? I mean, isn't that the point is that you can push your mind to do something your body absolutely doesn't want to do. So you should be rewarded for, for that. And these guys are in a league of their own. I mean, professional cyclists are some of the toughest athletes out there. I mean, obviously every athlete at the peak of their game is remarkable and no disrespect to like the best running back in the NFL, but like you can't even compare that to what a guy does for workload for sure. Yeah. For just the pain, like the best running back in the NFL, but like you can't even compare that to what a guy does for workload for sure. Yeah. For just the pain, like the absolute sheer discomfort, um, and the physiologic torture and the duration of it and all of these other things.

Well, you see it in their faces too. Those guys, like when they retire, they look like they're 10 years older than they are. Yeah. Yeah. Yeah. I mean, they've lost all of the fat. A lot of them, you know, they just, if you, if you don't have fat in your face, I mean, you age really dramatically. They just look exhausted too. I mean, it looks like it's just drained them. Like they've forced to live 30 years inside of 10. Yeah. So it's like, what if we just say, guess what? Everybody's allowed to use whatever amounts of EPO, blood, testosterone to be at the 80th percentile of what we consider normal. So everybody's allowed to walk around with a hemoglobin of 14.7 or up to 14.7 or 15. People would cheat that, right?

Wouldn't they? I mean, if you allow people to use a certain amount. But I also think the testing on this stuff is so JV. Now, there's this idea called the biological passport that was introduced many years ago, which basically said, look, we're going to develop a signature for every person. And now if you deviate much from your signature, we'll, that'll be the trigger. Um, and the argument again by certain people, and I think Daniel Coyle argued this a lot in, um, one of his books that he wrote ripping apart Lance was the Apart Lance, was the reason doping is unfair because the everybody does it argument doesn't hold water is because if you're a person who naturally lives at a hematocrit of 47, you're only getting a slight improvement going from 47 to 50.

If you're a person who naturally lives at 43, you going from 43 to 50, you get a much bigger advantage. To which I say, yeah, but that's true on a relative basis, but an absolute level, if everybody's walking around with a hematocrit of 48 to 50, they still have the same oxygen carrying capacity. It does level the playing field. The concern though, isn't, I would believe the concern is you don't want people to think that the only way to do this sport is to take drugs. Well, absolutely. And it's also worth putting in mind that, and this is sort of my pet peeve with this whole drug and sport thing, is like, I mean, personally, I don't really give a shit. I mean, I just have bigger things I care about than like how many steroids Barry Bonds took to hit all those home runs. But what really does chap my ass is when people don't actually understand how steroids work, right? Like it bugs the shit out of me when people assume that if you

take steroids, you will have, you know, you will hit that many, you know, home runs or you will run this fast or lift this much. The only thing that steroid is doing is enabling you to recover faster from the brutal work that it takes to actually do those things. So, you know, all the, if I, if I shot myself full of EPO, I mean, you've probably seen Icarus, right? I mean, I thought that was, I thought he did it. I thought, uh, Brian Fogle. Yeah. I thought Brian Fogle did a really good job of showing like, I mean, and he was a pretty good responder to the EPO. I think he did a growth hormone, testosterone and EPO. I mean, you saw in the end of the day, he, he finished worse the second year round because his bike ran out of juice. That's my point. You see like people don't realize like one little thing makes

all the difference from a performance standpoint. Yeah. He probably would have done a little bit better, but it's not because the drugs were in him per se. It's because the drugs that were in him allowed to train more. So the reason he was a fitter rider the second year was because his watts per kilo were higher because of how much more he trained. The drugs enabled him to train that much harder. Yeah, that's what it does. It allows you to train harder so you recover better so you have more output. Correct. But we don't want young kids to think that much harder. Yeah, that's what it does. It allows you to train harder so you recover better so you have more output. Correct. But we don't want young kids to think that the only way

to do this is start taking steroids and fuck up your endocrine system. And that's... No, of course not. But we also want to keep in mind, like, see, it almost requires

like a broader discussion, which is like, why do we care? Well, we care in combat sports because it allows you to inflict more damage on your body. No, no, no.

I'm saying like, why would, why do, let's just say I'm not a professional athlete. Okay. Why do I actually care how fast I run or how fast I ride or any of these other things? Well, because you want to brag about it. Okay. Say if you're a weightlifter. Right. So maybe therein lies the problem. I mean, I mean, I, you know, when I stopped cycling competitively, I think a

big part of it was I just realized that performance and longevity stopped being co-linear. They started to become somewhat orthogonal. They started to deviate. In other words, the things that I was doing that were enhancing my performance, and I'm not even talking about drugs, I'm just talking training wise. It seemed to come at the expense of what I believed was going to make me live longer. So specifically the thing I cared most about was cardiovascular health. Now the incidence of atrial fibrillation in highly trained athletes is 10 times higher than that of non-athletes. So like that's a little counterintuitive, right? Like why would people who have such amazingly fit cardiovascular systems have 10 times the risk of this horrible

condition called atrial fibrillation, which yeah, many people have it, but not young. You're not supposed to have that when you're 40. And it's usually associated with cardiovascular disease. And yet people are, you know, showing up with these. I mean, I have four patients who have had to get ablations for atrial fibrillation. What is an ablation? An ablation is a procedure where they stick a catheter up through the femoral artery or in the vein, and then they burn pieces of the heart specifically around the pulmonary veins. And they basically are trying to burn away and create or remove the ability of the electrical system to move in this way. So what's basically happening with this type of athlete's heart is when your heart is constantly being exposed to that high stretch, high ejection

fraction load, you're basically stretching out the electrical system because the electrical system of the heart runs within its muscles. So as you stretch it out, a certain group of people, and we don't know why certain people are susceptible and certain or not, but they just develop this, um, this dysrhythmia. So you're soldering the motherboard as it were. Yeah. Yeah. You can effectively think of that, right? You're like creating new lines to block the connection.

Whoa. That's fucking crazy. Yeah, so think about it. Someone said once, and I don't know if this is true. Maybe you would be able to have some insight. That there's a concept that your entire life you have a certain amount of heartbeats. Does that make sense? Oh, no, of course.

I've heard it many times. I don't know if that's correct. That's fucking scary. Yeah, I don't tend to agree with that because you can't compare one beat to the other. I mean, you can't, you know, it's hard for me to say that, you know, an 80 to 90% ejection fraction beat under incredible load is the same as the beat that I'm, you know, like it is beat per beat the same as the beat I experienced when I'm sleeping and my heart's beating at 40 beats per minute. I think maybe there's a directional truth to that, but I feel like when you're talking about human longevity, it's a game of inches. And that is like something

that's probably directionally true within a mile. Now, when you're talking about human longevity and you, you know, and you're thinking about all these different things that you could do to extend, how much of that is supplementation and do you supplement? Like, are you, are you a person who takes colloidal minerals or are you a person that is interested in antioxidants? Like what, what do you do in terms of that? So I, my view on longevity is it's just, it's the hardest problem there is. And so you got to have every, like I I'm agnostic about what the approach is. So I want to understand everything that you can do with respect to, you know, food, drugs, supplements, hormones.

And to be clear, the only difference between a drug and a supplement is one's regulated and one is not. But I have patients that will say things like, oh, doctor, I don't want to take that drug. I'd rather do it naturally. Can I do it? And it's sort of like, well, okay, you don't want to take a statin, but you do want to take red yeast rice. Well, they both inhibit HMG-CoA reductase, the enzyme that catalyzes the first step of cholesterol synthesis. You're willing to take one that you buy in a drugstore that's totally unregulated, and you're not willing to buy the one that comes from a drug company where the FDA

has their foot up the ass of the company making it to make sure it's perfect. That just strikes me as a false equivalent. So I only say that to just say, like, I think everything should be on the table. And then the question should be, how do you decide what to do? So there are absolutely a bunch of supplements that I take, but I don't have kind of a one size fits all approach to it because I think you've got to be able to kind of measure what's going on in a person, get a baseline and figure it out. So, you know, I mean, my guess is you've had a million people on the show that can talk your ears off about, you know, which people, which people should take methylated vitamins versus which shouldn't. And if you have this MTHFR mutation versus this one, should you be taking this versus that? I think all those things are

valid. Um, some of the stuff that I find even more interesting is actually a lot less sexy and I don't have a good answer for it, but, um, you know, looking at, for example, vitamin D levels. So, you know, you see a huge disparity in the vitamin D levels people have, and it begs the question, do all people run effectively at the same vitamin D level? Um, and is that a function of not just their own individual, like how much sun they're getting, but more importantly, like potentially genetically where they're from. So I'm starting to feel like people who have Northern European, uh, blood might actually run better at a lower vitamin D level than people like me who, you know, come from places near the equator where maybe I just evolved to see more sunlight and have more vitamin D. What's your ancestry?

My parents are both from Egypt. Oh, interesting. So, and the range, like when you look at a laboratory test, when you check somebody's vitamin D, like the range that's offered is 30 to 100 is optimal. That's a big range. Yeah, I'm like, that's probably not the range. So I personally think the range is probably 40 to 60,

but I also measure something called parathyroid hormone that allows me to further titrate that range and stuff like that. Well, when you're talking about this, it's really obvious, really clear that there's so much data to go through that it's, we're, we're learning this and that this is, it's, I don't want to say it's at its infancy, but if we look back a thousand years from now, we will most certainly say that our understanding of this science is at its infancy. Yeah, for sure. I mean, the issue is how do you make sense of a problem or how do you try to solve a problem which is unsolvable? And the reason I say that is the following.

You know, you have what I call kind of the medicine 1.0 world, which was, I define that as everything that took place before Francis Bacon. You can probably tell me when that was. I'm going to guess Francis Bacon is like 1650 to 1670 or something like that. But that was basically the first person to come along and codify the scientific method. So anything that came along before the scientific method may have been correct, meaning there were things that were certainly done back then that proved helpful, but they weren't grounded in a principle of science. In other words, you know, even a blind

squirrel is going to find nuts sometimes. And then we basically threw, you know, following the elucidation of a scientific method, the development of statistics to actually make sense of data, we then got into the sweet spot where I think we are now, which is medicine 2.0. And to me, medicine 2.0 is really good at solving problems that are amenable to relatively short, simple clinical trials. And there has been no better example in this space than infectious diseases. So if you think about the unbelievable improvement in human longevity that has come from antibiotics, antiviral therapy for HIV. I mean, remember 30 years ago, HIV was a lethal, no questions asked lethal condition. Today, it's a chronic disease. For virtually every patient with HIV, it's a chronic disease today, meaning you will die with HIV, not from

HIV. That's almost hard to fathom when you consider how shitty we are at addressing other chronic diseases like heart disease, cancer, Alzheimer's disease. So the problem is if you want to know the answer, should I eat this way or that way? Should I exercise this way or that way? Should I take this drug or that drug or this supplement or that supplement to live longer? We can never know the answer in humans because there is no clinical trial that can answer that question. And we can do that experiment in everything that's not human, but we've already learned the hard way that what happens in not humans doesn't necessarily extrapolate to humans. And we can do things to be slicker about it.

You know, when you study rhesus monkeys for 20 years, it's certainly more interesting than studying mice for one year. But in the end, you know, there's still animals in captivity. They're still not in the same environment and all these things. There's still animals in captivity. They're still not in the same environment and all these things. So my view on this topic is the only way to go to this kind of medicine 3.0 is you've got to have kind of a strategy around how you think about it. And so in many ways, that's what I spend most of my time dealing with is what is a strategy for longevity that becomes a scaffolding upon which you anchor every new piece of data. Because I mean, I know things today from a data standpoint, I didn't know 10 years ago. And to your point, even in five years, we'll look back at stuff we're doing today and think, God, we have

more data. Is that still the right thing to do? And so that strategy to me is sort of fundamentally based on three bodies of literature. And the first is like what did we learn from centenarians? So the people who naturally live to 100, they have the advantage or that body of literature has the advantage of being based on humans. It has the disadvantage of it not being experimental. So we don't know like what cause and effect was. So we don't know what cause and effect was. And then secondly, if you look at all of the animal literature or non-human literature where you can actually do the experiments, what's common there?

And then if you look at one thing at a time and say, hey, vitamin D, yay or nay, antioxidant, yay or nay. So when you're, it's got to be very time consuming for you. I have a research team. I mean, that's when I started this practice about three years ago, I realized like I was losing the battle. I, my ability to sit down and read scientific papers was like shrinking. Yeah. So I hired an analyst, you know, I, he had worked with me in the past. He was amazing. I brought him over full time to do this. Then another one, then another, I mean, now I have four full-time analysts and I mean,

as this practice grows and, or, you know, whatever, I have the revenue to justify it. Like I'll have 10 analysts one day in this practice. And even that's not enough. I mean, as this practice grows and or, you know, whatever, I have the revenue to justify it. Like I'll have 10 analysts one day in this practice. And even that's not enough. I mean, approximately 100,000 papers are published every month on PubMed. Jesus Christ. So I forget. I did the math on that once. I think it's like three papers a minute.

It's pretty stunning when you think about the amount of human achievement that we've experienced just in our lifetime in that regard. Like how many people are working on understanding just the mechanisms of the human body and this data is just piling up as we speak. Yeah, but the problem is the signal to noise ratio is almost zero. So I would say conservatively 90%, if not 99% of that is completely useless. Really? Absolutely. I actually wrote about this once. So when a paper comes out, if it is never cited again,

meaning for the remainder of time, no one ever even goes back to reference that paper, you could probably make the case that that paper is not relevant. And if you then further strip out auto citations, meaning the only time it's ever cited is when the author then goes back and cites his or her own paper. Something like 70 or 80 percent of papers never get cited outside of an auto citation again. Is this because they're not relevant or is it possible to get lost in the shuffle? Like some of them might be worth something?

I mean that's probably possible but I would bet it is much, much more the former than the latter. And then on top of it, a lot of stuff comes out and then years later you realize it was wrong. You know, or it was, and that's more often the case that it was wrong through an honest mistake than wrong through a dishonest mistake. But there's still a lot of wrong through dishonest mistake stuff's coming out there as well. So how much of this data is forcing you or causing you to alter your own patterns? Well, we, we believe internally that probably 100 papers a month enter the literature that are relevant to what we do. Meaning, I mean, some of the literature that comes out, like, you know, the rheumatology literature might be relevant to them, but that's not what I do.

Even that's crazy. Yeah, yeah, yeah. That's more than three a day. Yeah, yeah, yeah. So that's why when I say I want 10 analysts, you see why. Yeah. Like, it's like, it's, you got to, because first of all, it's finding those papers too. So how do you do that?

Like, well, we subscribe to a whole bunch of services that basically pre-filter a bunch of shit for us. And then we have a system where we go about kind of pulling that basically pre-filter a bunch of shit for us. And then we have a system where we go about kind of pulling that stuff. So you get those three a day and then they bring them to you. How do you have the time? No. So that's the thing. And it's funny you say that. I was like, literally, as I was driving here today, I was talking to a buddy of mine and I was like, dude, I'm the fucking bottleneck and I hate it. Like I'm now the bottleneck because the analysts are now churning out stuff faster than I can even provide ancillary feedback. Cause my job is like, you know, you know, you hire great people who are smarter than you and like you just guide them. You just point them in

the right direction. So what we mostly do is create programs where we're going out and looking for new knowledge. So for example, one of the questions that is tormenting me right now, because I still don't know the answer is, is there any benefit to taking human growth hormone from a longevity perspective? There's clearly a performance benefit. Growth hormone is probably the single most abused drug in all of sports. There's no question about that. But is there a way to take it where it makes you live longer? I've never prescribed growth hormone to a patient because, frankly, I'm not yet confident that I know the answer to that question. But I feel like it's worth knowing, right?

Because I can certainly make a teleologic argument for why growth hormone could be helpful. But I can also make a teleologic argument for why it could be harmful. And so, like many things, your knee-jerk reaction to something can often be wrong. And my knee-jerk reaction to growth hormone has historically been causes cancer. Because why? Well, growth hormone tells your liver to make IGF, insulin-like growth factor, and two-thirds of tumors seem to thrive on IGF. So ostensibly, you would think, well, growth hormone can't be right.

But then one of my analysts, Bob Kaplan, pointed out to me a year ago. He's like, you know, Peter, I've been thinking about this. And he's like, given how ubiquitous growth hormone is in sports and how long it's been ubiquitous in sports, like, I mean, this was the drug that turned around U.S. Olympic athletes in the late 70s, early 80s. He's like, where's the body count? Like, where are all of these people dying of cancer from all these years of staggering growth hormone use? We don't really see it. When we went back and looked at literature, I mean, we found that the data on growth hormone and IGF are not nearly as straightforward as people have made it out to be. In fact, there's,

I mean, I could draw it actually for you. Not that anyone will necessarily see this, but at least you'll see what I'm talking about. If this is percentile, so higher, and this is IGF level, right? So IGF level. Most people are listening to this. Well, actually it's getting close to 50-50. We were actually talking about that before, yeah. So the overall mortality curve for IGF and growth hormone is like a J curve, meaning low IGFs, really high mortality. Yes, as you go from about the 70th or 80th percentile up to the 90th percentile, there's a slight increase in mortality. But this is not what you would think of. If you were just reading the headlines, you would think it looks like this. Right. So there's a sweet spot. Not only that, this is overall mortality. What if you parse this out by disease?

Well, that's when it gets really interesting. So cancer's curve looks like this. Very similar. looks like this. Very similar. Yes. But Alzheimer's curve looks like this. Heart disease curve looks like this. So describe that to people that are listening. Well, so what that means is, so for example, Alzheimer's disease and heart disease have an almost monotonic reduction in risk as IGF gets higher and higher and higher. It's only cancer that seems to have that uptick where risk starts to actually rise once you cross past the, call it 70th percentile. And so when you integrate all of these curves together, that's why you see this slight uptick. Now, again, this is epidemiology. So one has to take this with a grain of salt, but this is,

to me, when I saw this graph, which Bob put together, I don't know, a while ago, I was like, wait a minute, this doesn't jive with my preconceived notion of like growth hormone is bad. This warrants way further exploration. And so what that basically turned into is now an enormous internal project that will take us probably a year to complete and will constantly be updated. Like we did this already with testosterone two years ago. We put together like a 40-page white paper on the topic, and then at least once every two weeks it gets updated every time a new paper comes out, basically asking the question like is testosterone replacement beneficial or harmful

and under what situations should it be considered versus not. And again, the goal is to do this unemotionally. And that's hard to do because for reasons I'm not entirely clear on, basically everyone's kind of just emotional about this stuff. Well, they're emotional about steroids because of all the press about Barry Bonds and, you know, all the different baseball players. But why do you think that is? Is it cheating? Is it the cheating aspect of it? Yes, 100%. Yeah. Yeah, I think that's exactly what it is. I think people consider taking any kind of hormone, whether it's growth hormone or testosterone, as cheating. Even if you're

talking about older people that take it. Like I was looking at one of those ads, you know, they have those ads for hormone replacement. This is really old looking guy. Oh yeah, Jeffrey Life, I think those ads for hormone replacement. This is really old looking. Oh, yeah. Jeffrey Life, I think is his name. Dr. Life. Jacked. I mean, he's fucking, he's got a full six pack. He's out of control. He's built like a gorilla.

And my friend was like, God, that can't be healthy. I'm like, what the fuck are you talking about? Look at him. I go, what do you think a 70 year old dude is supposed to look like? They're supposed to be knocking on death's door. That guy looks like he could fuck his way through a building full of teenage girls. You know, he's like, I shouldn't say

teenage, 20 year old, 21. Or 19. He looks like a man who's really fit and healthy with an old guy's head. Yeah. It's weird. And I was like, you know, if it's not healthy, then what is it? If that's not healthy, then what is it?

If that's not healthy, like, oh, he's going to die of cancer. He's going to die of a heart attack. He's going to die, period. If you look at his head, how much time would you give him? If I gave you a bet, okay, we have a million-dollar bet. Give you an over-under of 10 years. How many years are you going to give this guy? Are you going to give him 20? Are you going to give him 30? Wait, wait, wait. You're moving the over-under. You said

I had a 10-year window on that. Right. You get a 10-year buffer. I'll take over on the 10-year. Okay. How many years do you give him? Impossible to know. Am I allowed to talk to him first? No. No. No fucking clue. You're looking at a magazine,

right? No, no, no no i can't because i gotta know his family history i mean honestly of course your parents will tell me more about how long you'll live than what you look like but 70 in america is basically death's door no i think today well so this is a complicated question actually which is actually prompts another analysis we just kicked it's in the 10-year range yeah no so it depends how you ask the question so the question is what is the average life expectancy of a man and a woman today in the 10-year range. Yeah, no. So it depends how you ask the question. So the question is, what is the average life expectancy of a man and a woman today in the United States? And I mean, someone's going to correct me, so I feel like it doesn't matter what I say. I think it's 79 and 81, respectively, for a man and a woman today.

But the more interesting question is this one, which is, so what year were you born? 67. Okay. So in 1967, what was the annual life expectancy or the average life expectancy of a man and a woman? And we could look that up, but I'm guessing it would have been, let's see, life expectancy has been going up at 0.3 to 0.6% per year. We could back out that CAGR.

And let's just say for shits and giggles, like the number was 69 or 73 or something like that. I promise you, you were going to live longer than that. What was it? 67. 67. All right. So would I take the bet that you're going to live longer than 67, even though that was the median life expectancy the year you were born? Hell yeah. I'll take that all day long. And so what we're actually putting, this is just a dumb analysis. I don't even so what we're actually putting, this is just a dumb analysis. I don't even know why we're doing this. Sometimes we just do dumb shit that has no bearing. But what I want to do is create a graph of actual life expectancy as realized versus projected life

expectancy in the year of birth. My hypothesis is that is always a positive number. What I want to know is what's the derivative on it? Is it increasing or decreasing? So I think that science is accelerating our longevity. And that's one of my proof points is that we are constantly underestimating how long we can live. Now, on the other end of that spectrum, I am not one of these futurists who thinks like there's immortality out there. You know, I would be if right now I could sign a piece of paper that would say, Peter, are you willing to commit to a lifespan right now? So you're willing to acknowledge that if there's some major breakthrough, you'll miss out on it. But I guarantee you this duration.

Like, what would you take right now? If I said, Joe, you can be 100 and be fully functional functional at a hundred. So when you're a hundred, you're going to run at a hundred. Yeah. You're going to be like, you're going to be like a fit 60 year old at a hundred. So you're still working out. You're still shooting. Pretty good. Yeah. Would you take it? Nope. In other words, you're willing to bet that by the time we get there. Yeah. Because when it's over, it's over anyway. Yeah. Yeah. So, I mean, to me, I think most people have a greater sense of confidence about where technology goes. Now, I think there really only been a handful of step function changes in longevity.

So, you know, the reduction of infant mortality was huge. Like once we actually figured out how the fuck to deliver babies and not kill moms, like that was a big deal. That had a step function improvement in human longevity. The next one was really sanitation. Like once we figured out that like don't shit where you drink, huge improvement in human mortality. Isn't that hilarious? It's amazing, right? We take that shit for granted now, right?

And then the third one was basically germ theory. You know, starting with Lister and going all the way to Fleming when we figured out like, you know, if you cut open a cadaver and then go and deliver a baby, that's bad. Because there are these microscopic things that none of us anticipate, right? We haven't had a step function improvement in mortality in nearly 100 years. So what's next? Now, I think there are a couple of potentials for that. But what I don't know is if, like, they're going to happen in my lifetime or in your lifetime. But I want to buy the optionality to stick around for it.

By doing all this incremental little shit. Yeah, well, these three-plus papers a day, the options are increasing. It just seems to me that there's a trend, right? The trend is, as you're saying, there is an increase of longevity, but it's not a huge increase. Right. But our understanding of the human body, that seems to be pretty radically improving, especially in terms of nutrition, nutritional absorption, the mechanisms behind nutrition.

On some level, yeah. On some level, I still feel like we're in the dark ages. Right, because you recognize the potential. Well, no, because I think I'm just humbled by how hard it is to actually take care of people. Like I think – so I was about, I'm about as good a responder as you're going to have to carbohydrate reduction. So doing something as simple as just not eating carbs and not eating sugar, like completely changed my health. I mean, at 40, if you compare the 40 year old me to the 30 year old me, like the 40 year old is like literally twice as healthy

as the 30 yearyear-old me. And that was through something as simple, conceptually simple, as making this radical dietary shift. And by what standards are you saying that you're twice as healthy at 40 than 30? How old are you now? 45. And but what is the... I mean, again, I'm speaking a bit glibly.

How you feel, your blood levels. Well, even let's just talk objective. Yeah, yeah, yeah. So like what would be my lipid levels? What would be my triglyceride levels? How much body fat do I have? What's my VO2 max? Like by all of those metrics, like everything was just so much better at 40.

I mean, and so I've – but yet I've seen a lot of patients where you take the carbs out of their diet, doesn't matter. You make them fast. You do this, you do the other thing. You just can't fix some of the underlying metabolic problems. Like what kind of problems? No, I think some people are just so insulin resistant that it becomes really hard to fix them without doing draconian stuff. I mean, I have one patient who is really now, I think, going to in many ways become the poster child for, he's definitely the toughest case I've ever had. And why he's such an amazing guy is he was actually able to do something that's really hard to do, which is stick to something with complete blind faith in me, even when it didn't

feel good, even when I knew it would take a long time to see the results. So he's probably 5'8", weighs 235 at the start. So 5'8", 235, metabolic syndrome, huge amount of fatty liver disease. Not the typical patient in my practice. Most of my patients are kind of young, healthy people who want to like, you know, want this immortality thing. But, um, this is someone who, uh, doesn't fit that description, probably 70 years old, uh, on like, you know, four drugs for blood pressure. That's very heavy for a seven year old. Yeah, it is. Yeah. Oh. And his, and he just had a hip replacement. He basically couldn't walk, Everything was... And we had tried carbohydrate restricting him before. It just didn't work. And part of it was, I don't know how... It was hard for him to stick to it and blah, blah, blah. So I just said to him, look, man, I want to try

something completely fucking extreme. And I want to try it for six months. Every five days... Pardon me. Every month, you're going to spend the first five days eating 500 calories a day of a ketogenic diet. And it's basically just going to be like vegetables, oil. You're basically eating a bunch of salad. And then for the next 25 days, you're going to do a time-restricted ketogenic diet where you're only going to eat in that eight-hour window. And then you're going to repeat that every month for six months. And he was like, I won't be able to do it. And I was like, I know, I know. It seems crazy. I think you will be able to do it. Because remember, all that time that you're not eating, your body's going to have to start eating

itself. And so you'll be all right. And I'm giving you a grossly oversimplified version of what we did, but it was much more complicated than that. There's a bunch of other stuff that we had to do to manage it as well. Well, I mean, he just sent me, I mean, we were in touch all the way along, so it was clear that this was working, but it was just kind of amazing to get a picture from him two weeks ago as we just passed that six month mark. He weighs a buck 75. Whoa. That's 60 pounds in six months. Holy shit. His liver. This is, I mean, and that's interesting, but not nearly as interesting to me as the fact that his transaminases, which are the enzymes that the liver

makes in response to how much fat is accumulating, you know, normal is like less than 40. He was like in the hundreds and you know, the ultrasound showed it was just a bunch of fat and he doesn't drink alcohol. So we knew it was fatty, non-alcoholic fatty liver disease. Now he's in the 20s and 30s. What was his previous diet? What was he eating? Just a normal dude. Yeah. He wasn't a particularly junk food.

He wasn't a junkie guy. The problem is he was metabolically broken. So I'll come back to why I felt like this was a necessary intervention despite how draconian it was. He's on a treadmill 30 minutes a day now. He couldn't walk before. I mean, you take 60 pounds off a person. When you say treadmill, you mean walking on a treadmill? Yeah, he walks on a treadmill now. Yeah. Yeah. He can't really run once you get the hip replacement, right? Yeah, he's got the hip replacement, yeah. So it's basically reprogrammed him. And so the reason I have occasionally pulled that trick out, although it hasn't always worked, is based on this case study I read that's very famous.

I'm sure there's got to be someone on this show who's talked about it. But the paper was published in either the early 70s or late 60s, but it was the longest ever medically supervised fast. So it was this guy who weighed somewhere between 375 and 400 pounds. He did a 382-day inpatient medical fast where he had only water and minerals. At the end of that, something like 382 days, he was down from call it 400 to $1.65. This paper was published seven years later. He weighed like $1.70, $1.75. The crazy thing about that guy is his skin shrank too.

Yeah. So he didn't have that problem that a lot of people have when they lose a lot of weight, where they have all this extra skin. His skin went along with his body. Yeah. And I wonder if that's just due to genetic elasticity. Yeah, exactly. I would like to know.

I would like to know if he had stretch marks when it shrank, you know? You know, it's funny. I've never tried to figure out like whatever came of that patient. I can't imagine he'd be alive now, though I know he was young at the time. But the part that interested me was that he didn't regain all the weight the camp that thinks like that guy got to be 400 pounds just because he was a glutton and a sloth. Like something fundamentally broke in that dude. And what broke was he basically lost the ability to partition fuel correctly. Now, could food play a role in that? Absolutely.

Certainly if you eat enough shit, that can happen. But I think it's more complicated than that. I think it could be epigenetic, if not outright genetic, but probably more epigenetic. And so I'm interested in this idea of how do you reset people? one of the advantages of practicing medicine is you get to, you, you say humble because every, every time you think you're smart and you're like, I got this shit figured out, like you don't, there's like some patient who's got a problem that you can't figure out and it just, you know, drives you nuts. But you realize like, I mean, even just today I was talking to a friend of mine, he's not a patient, but I mean, my God, he's just going through like this devastating health situation. He's been, he has seen every doctor. He's this devastating health situation. He's been he has seen every doctor. He's been to Mass General.

He's been to Stanford. He's been to Hopkins. He's been to the best hospitals in this country. They can't fucking come close to figure out what's wrong with this guy. And so as bad as that is for him, I think that level of humility is actually good for the profession. It's good to what is going on with him that they can't figure out. He's having these horrible neurologic symptoms where he gets these fasciculations and muscle weakness. And obviously the big concern about six months ago when this started was he was

presenting like he had Lou Gehrig's disease, which obviously is about as bad a fate as you can have. Luckily that has been ruled out and they've done a million muscle biopsies and all these other things, but they don't know what's going on. Has he altered his diet? Is he taking? No, no, we don't know what's going on. This is certainly far outside of my area of expertise. I mean, what we talked about today was, look, man, all we really need to be doing is fixing your symptoms at this point.

In other words, there's understanding what's causing this and then managing the symptoms around it. I think the smartest people in the country have figured out they have no goddamn clue what's going on. Let's now figure out how to manage your symptoms, your energy levels, your mood, all of these other things. What has he done for that? Well, I told him today, I was like, look, I'm going to send you a kit. We're going to do a certain blood test on you and a certain urine test on you.

And I want to just figure out what's going on with your four hormone systems. There's basically four hormone systems that play a pretty big role in how we feel. And adjusting those doesn't, I'm not convinced it necessarily makes you live longer, but it can certainly make you live better. So I want to kind of understand, I suspect he's not firing on all cylinders on that dimension, whether it's a result of whatever is going on that nobody can figure out or not. But I'd rather focus on something that I think we can fix. Yeah. The change in diet thing with that guy where he went and fasted for 360 plus days, what did he eat when he got back on food? Great question. I do not know the answer. Now, it might be that that just, I don't recall that being in the paper. But if it wasn't, I don't know if anybody did the follow-up.

But that's – to me, that's the interesting question too, right? That guy's got to feel amazing. Like he got his life back, right? And my recollection is he was a young man. He was in his late 20s, I think. Yeah, I believe I remember that as well. I think I would like to find out what he's eating now to keep his weight at the same level. I mean he must just be so thankful.

First of all, he might be like, I mean, I have friends that are pretty overweight and one that died pretty recently who was really big. And he just had this feeling when he would meet people. I mean, he talked about it a little bit. He was just obese. It was just this thing where you're just, oh, look at this enormous fat guy. And then to go from that to, oh, there's a guy. There's a normal guy. That's just a guy. It's 168 pound guy. Normal. No difference between him and anybody else.

I got to tell you, I know we love to beat up on fat people. We love to turn it into a character defect. But I got to tell you, virtually every fat person that I know or that I've taken care of, they are not disproportionately eating more than their peers. In some cases, yes, but not on balance. The problem is that they simply do everything incorrectly metabolically, you know? So their body is functioning incorrectly. Yeah. And it's, you know, I think there's a genetic component. I think there are dietary exacerbations. I think certainly not exercising makes things worse. So there are lots of predisposing factors. But at the end of the day, what's happening is when you and I eat, like, let's take a meal that,

like if you had pancakes, bacon, and scrambled eggs, that would be like a really good mix of, that'd be a third carbs, a third protein, a third fat. So that's like a shit ton of nutrient, right? If you or I ate that, yeah, it probably wouldn't be that good for us. But like we, you know, let's say we just finished a workout or something. Like we're going to partition such that that glycogen will first and foremost go to replace the muscle and liver stores of glycogen because we have bigger muscles and our muscles are more insulin sensitive. we can actually disproportionately put more glycogen into our muscles, into the leg muscles, because you'll have done that run up the hills, right? And then furthermore, when we want to recruit energy again, we'll have the ability to actually

go back and get fat. In other words, break down fat at lower ATP demands than necessarily always going to glycogen. So in other words, we partition fuel in a smarter way. And these patients, I mean, you can measure this clinically using something called RER and of course doing other blood tests. They can't break down their own fat. So their body is essentially broken in that regard and that can be fixed with diet. It's a hard problem because the way I explain it to people is – so clinically I'm not interested in weight loss, right? I mean that's just not – I'm much more interested in longevity. And yes, sometimes weight loss comes with that.

But like if I ever get stuck doing weight loss, like I'm doing the wrong thing for my interest. But the way I say to people when they want to lose weight is, look, you don't want to lose weight. You want to lose fat. Let's be very clear on our semantics. Weight is irrelevant, right? Unless you're a cyclist or some athlete for whom the actual scale means something. But for people like us, you want to lose fat, not weight. And then when you say you want to lose fat, what does that mean in English? Well, do you want fewer fat cells or do you want each fat cell to be smaller? Those are totally different questions. If you want fewer fat cells, have liposuction. But we know

that that doesn't fix you metabolically. So if you want fewer, if you want to be less fat, you have to have smaller fat cells. Now a fat cell conceptually has two inputs and one output. So now I say, let's reframe the question. You got a room with 100 people in it. You want fewer people in the room. What has to happen? More people have to leave the room than enter the room. So similarly, if you have a fat cell and you want it to be less fat, you got to get more

fat out of it than enters it. And the fat that exits the cell exits via a process called lipolysis. And the inputs to a fat cell are something called de novo lipogenesis, which is turning carbohydrates into fat and re-esterification, which is turning fat like in a free fatty acid into a triglyceride back into a fat cell. Each of those three doors is controlled by hormones. And so the purpose of nutrition or fasting or exercise or drugs or hormones or all these things is to manipulate those hormones in the direction of what I call negative fat flux or what would be referred to in the literature as fat balance, negative fat balance. And the hormones that drive that are many, insulin, hormone-sensitive lipase, testosterone, estrogen, cortisol being the five most important in my opinion. Maybe someone will disagree with that, but I think those are the five that rule the roost.

And so how do you manipulate those? Well, insulin seems to be the most important of the five and there's no better way to lower insulin than to not eat. So the first thing that happened to that dude who went 382 days without anything but water and minerals is he basically had very low insulin levels. In fact, once he got into raging ketosis, which he got into by about day seven, his insulin came up only to prevent him from going into ketoacidosis, which was what would happen if he had no insulin response. In other words, if he was a type one diabetic, he would have died of ketoacidosis, which was what would happen if he had no insulin response. In other words, if he was a type 1 diabetic, he would have died of ketoacidosis because he wouldn't have had the

insulin to regulate the uptick of ketones. But if you or I did this because we have a normal pancreas, we would actually make just enough insulin to suppress ketogenesis and keep that beta-hydroxybutyrate level in the, you know,rate level in the neighborhood of probably 7 or 8 millimolar, as opposed to getting north of 12 to 15, which is when you get into trouble. So how do you manipulate insulin? Nutrition is the first way. If you can't fast, the next best thing is to reduce carbohydrates. Carbohydrates, obviously, are the most insulogenic of food, although protein can be quite insulogenic as well. It has a different response. And then that's when you start to think about these other things. I've seen patients where they just can't lose weight. And I watch what

they're doing and they're doing everything right, but they just can't lose weight. But then you notice their cortisol levels through the roof. It's hard to get rid of fat when you have lots of cortisol. Cortisol is a very anabolic hormone to fat and a very catabolic hormone to muscle, which is the exact opposite of what we want. Testosterone, of course, is the exact opposite. Testosterone is catabolic to fat, but anabolic to muscle. And then, of course, women have a harder time because once women go through menopause, they lose all the estrogen and all the testosterone. And so now they lose two hormones that play a very important role in regulating this. So for these people that are having the issue with cortisol levels, that's exacerbated by stress,

right? Yes. So stress actually exacerbates your weight gain. Absolutely. Wow. That's interesting. In addition to a whole bunch of other stuff. You could literally eat the same diet and gain more weight because of stress. Absolutely. Wow.

Again, hormones are what's driving fuel partitioning. You know, you're responsible for what you put in your mouth, but in many ways at that point, like the hormones take over and decide where it's going. Wow. That's fascinating now you yourself what what's your diet like i mean you told me you only eat once a day but yeah i'm one one meal a day or sometimes two meals a day how many calories are you taking in you know nowhere near what i used to i just don't train that much anymore i mean i kind of lift three days a week and then I, I ride like a stationary bike, like a Peloton or I prefer this thing called a Wahoo kicker where you actually put your bike on it. So I'll do that three or four times a week. Um, I would guess when I sit

down to throw down, it's probably 3000 calories. That's a lot in one meal, huh? Yeah. Although the problem is I'm a fucking pig. Like I'm kind ofusted like i can eat a lot it's it's gross like i gross people out how much i can eat actually it's pretty like for me to only eat 3 000 calories in a sitting is like tame really yeah yeah no i have an eating disorder really i i mean i sort of i i think i have disordered eating yeah i i i'm seems like you just enjoy it because you do it once a day. No, under any circumstance. Like I stress eat. I do get a dope. Like I don't get a dopamine high from gambling or, you know, alcohol.

Like I don't – like those things are not things that I can abuse. Like when I'm really in a shitty place in life, like I soothe and punish myself with food. A lot of people do. So you can relate. And as a thin man, you know, when you're talking to people that are large and have the same issue, it's got to be- Yeah, no, no, it's totally, I mean,

I completely understand what these people are going through, at least in as much as what they, as the physiologic desire for it. I mean, obviously they will experience something even worse because there's the... Like, look, I don't have veins in my abs anymore. I used to. When I was on a ketogenic diet, you know, 7% body fat, I was completely ripped. I'm not ripped anymore, you know, relative to that. That kind of bugs me, like, nobody really knows that. I mean, nobody really gives a shit.

So I can still, like, look like a super healthy dude, a super lean dude, even if I'm not. But, oh, my God, like, when shit's going wrong, like, I want to eat some of the worst foods that have ever been created. You know what I mean? Why is that instinct there? Why is the instinct that when you're not feeling – like for me, it's tired. Like if I'm tired, like if I'm coming home from a gig and it's 2 o'clock in the morning, it's very difficult for me to drive past Wendy's. I want to go to Wendy's and get one of those triple – That could be an adrenal issue.

So a lot of times we'll see when people either turn to sugar or salt in times of fatigue, a lot of times it can be, you know, they don't have the right level of free cortisol at that moment in time. I've always feel it's a willpower issue because if I could just get home, I'll cook something healthy. And then I have victory, you know, because if I get home, I know I've got healthy food at home. I'll eat something really good and it's just as good. But there's something about also there's like you're doing something you know you shouldn't do. There's a little weird little charge there. Yeah, that's interesting. I mean I guess it's different for different people.

I think for me, if I'm really going to be brutally honest about it, I think it's that I like – I sometimes just want to punish myself. And I'm like – like eating bad food is like when you're bad, you eat bad food. Do you give yourself a cheat day? You know, I don't – not really. I mean, I think these days – and, you know, you've got kids, so you know it. I mean, cheat days just present themselves often enough for other reasons. And unfortunately, I think for me, the cheat meals are a lot of times cleaning up a kid's plate or something like that. You know, like – like like like i mean the funny

thing is i just i really i don't know why i just like shitty food like i like macaroni and cheese of course i just forget if they don't eat their macaroni and cheese i gotta eat it my kids asked me to make them peanut butter and jelly the other day and they don't which is really good it's fucking fantastic especially with a glass of milk and they don't eat the crusts and i'm like well these crusts shouldn't go to waste oh god there's kids in Africa that should eat that crust so I ate the crust and then I thought about all the bread with peanut butter and jelly I ate in those crusts I basically ate a

fucking sandwich it's like I'm pretending that I'm just eating a little crust I ate a lot I'm worse than you dude you know what I would have done in that situation I would have been like peanut butter jelly sandwich well I would have started by saying there's not enough peanut butter and jam on these crusts. I don't have the right ratio. So I would have got out the peanut butter and the jam and dipped the crust in there

and then I would have probably made a sandwich. I'm just happy that I didn't eat a sandwich of my own as well as their crusts because I probably could. Once the fucking gates are open, once I'm out there making spaghetti and meatballs, like, all right, let's get some fucking ice cream in this mix too. Once I'm already fucking off. Um, so what do you, what do you eat when you sit down for these 3000 calorie meals? Uh, so if I'm in control of the meal, which I usually am, and I'm, I'm super boring dude. So it's, um, I like to have a salad in a bowl that's larger

than my head. Um, so I always refer to that as a manly bowl. That's the definition of a manly bowl. So it's gotta be like a staggering amount of salad. And my salad is the same every freaking day. It's romaine lettuce. It's tomatoes, mushrooms, cucumbers, carrots. And then the dressing is just extra virgin olive oil, freshly squeezed lemon, salt, and pepper. It's a pretty bland salad in that sense. But, I mean, I can eat that all day every day.

bland salad in that sense, but I mean, I can eat that all day, every day. And then it's a serving of protein. And I usually cycle through salmon, pork, steak, you know, some gamey meat, like whatever. I just sort of cycle through that. And then I usually have some sort of starchy vegetable to go with it. So, um, potato rice, you know, lately the the last couple of weeks, I've been skipping the starch and just mainlining extra salad and extra protein. But, you know, or but that's insane. That's when I'm in San Diego, where I have control over what I eat more in New York, I never eat in my apartment, like I just never cook. So I always go out. And it's a little less regulated. So, I mean, I just love Indian food. I love Persian food. I love food that unfortunately is, you know, got more carbs in it than I'm probably suited for, but I try to modify. So like, um, last week I had, um, um,

this Bob, who's actually one of my, my head analyst, he lives in Boston. He came down to New York for a couple of days. We were doing some work. And we went out for, he loves Indian and I love Indian. So we went out for Indian one night and we hadn't eaten all day. So we ordered, I think, seven or eight entrees. And the waiter's like, you know, you guys know you ordered seven or eight entrees, right? We're like, yeah, yeah, yeah, we got it. We got it.

We're good. And so, you know, we sort of skipped the non or maybe had one non to split instead of normal. I would have had like four nons and only had one bowl of rice, but it's still a lot of carbs. It is. Yeah. Yeah. Non bread is insane. Yeah. Luckily Bob ate more of it than I did. And he's way more Jack than me. So he can get away with eating way more non than me. Um, but yeah, that night, I mean, also those sauces are like so fatty. Like I'm sure that was a 4,000 calorie throw down. The other thing I'm pretty good about is when I'm done, I'm done. So that's the other thing about time-restricted feeding that I think I get away with more

because like when I go back to my apartment, I will rarely have another bite. And when I wake up in the morning, it's like black coffee. You know, I'm not sneaking little shit in throughout the day. Like, whereas if I'm not fasting, it's just too easy for me to just like sneak stuff in. Oh yeah, yeah, yeah.

Like in my office, like I share my office in New York, I share with another doctor who, it's his office actually, I was kind of sublet an office there. But like, I've never seen more office in New York. I share with another doctor who – it's his office actually. I kind of sublet an office there. But like I've never seen more shit in my life like than the stuff patients bring for him to eat. Patients bring him shitty food? Oh, nonstop. To a doctor?

Of course. What are they trying to torture him for torturing them? I don't know. Maybe. But it's like – or drug reps will bring stuff by or something like that. There's an endless barrage of bad food to eat but it's like good bad food delicious like if they were bringing like oreos that actually wouldn't tempt me despite the monkey home-cooked brownie yeah exactly like like or i forget the name of um god i can't even remember the name of some of these

bakeries up there but but yeah there's like some ridiculous shit that shows up and every once in a while like i'm like okay the fast is breaking at four o'clock today. Give me one of those scones. But as long as you do it with moderation, you think you're okay. Yeah, except that my motto in life is moderation is the only thing worth doing in moderation. So the problem is once I start, like, it's usually the wheels come off the bus pretty quick. Do you try to mitigate that with exercise? Like do you say that I went off the rails today, so let's hit the gym and go hard?

It's less that. It's usually I anticipate it. So last week a buddy of mine went to see the David Bowie exhibit. Did you see it, by the way, the Brooklyn Museum? No. Are you a Bowie fan at all? Yeah. Oh, dude, it's there until mid-June or July.

It's in Brooklyn? Yeah,ie fan at all? Yeah. Oh, dude. It's there until mid-June or July. It's in Brooklyn? Yeah. It's at the Brooklyn Museum. I was in Brooklyn a couple weeks ago, but I was only there for two days for the UFC and I had a show out there. So probably one of the best shows I've ever seen in my life. Really? Yeah.

Unbelievable. Actually, I didn't realize it, but it closed at 11 p.m. And they just didn't have the heart to tell me. So I was there until midnight before they finally came and escorted me out of the building. They're like, sir, we closed an hour ago. I was like, damn, sorry, man. So what is it? It's like an exhibit of all of his art, all of his music, all of, and it's like, it's done. You know, when you go to museums and they put the headphones on you and you have to like push the button to hear the thing, it doesn't work that way. Like

whatever you stand near, you get the music associated with that plus or minus a narrative as necessary. Huh. But it was like I've never – like I think they had every one of his costumes. Wow. I mean it was epic. So anyway, that night I knew we were going to go out for a killer dinner before in Brooklyn before we went to the show. we were going to go out for a killer dinner before in Brooklyn, before we went to the show. And so normally I exercise in the morning, but that day I was like, look, I will, your muscles will be a little bit more insulin sensitive. If you can exercise about 30 minutes before you eat,

that's probably about the sweet spot. So if I were to ride at like eight in the morning and then not eat until seven at night, I kind of, I mean, I would still eventually get the glycogen there, but it wouldn't be quite as easy. It would require a little bit more insulin. So in that case, I just modified my day and was like, you know, made my schedule such that I could ride at 5 PM in anticipation of that. And I also wrote a little longer and a little harder, just, you know, like let's really crush this session so that, you know, I can go and enjoy dinner a little bit more. Well, it sounds like you enjoy a lot of things. You have a lot going on.

You've got your medical practice. You have all these different things you participated in as far as athletics, boxing and swimming and cycling. What jazzes you up now? You obviously have a mind that requires a lot of stimulation. Like what keeps you going? I mean I think this longevity thing is the perfect culmination of all of my previous lives in terms of professional lives. So I mean I used to be an engineer and then I went into surgery and then I left that and went into management consulting and like was a hundred, like had nothing to do with medicine for several years. I just worked in credit risk modeling.

And so in many ways, like when you combine medicine with engineering, with risk management, that is what longevity is all about. Like if you want to take the practitioners, you know, the roll up your sleeves approach that that's what it is. So I think that scratches that itch. But, but I think that scratches that itch, but, but I think for me, like I have to be sort of mastering something. So that's where archery and race car driving today become just total obsessions. And like when we were talking earlier, it's like, yeah, I mean, I don't know that I'll ever go hunt. Cause I don't know that I want to spend three days, you know, taking 10 shots when I could be spending, you know, three days taking 300 shots

in my backyard. Like in the end, I think what I really just obsess over is trying to get better at something. And the nice thing when you start things late in life, like I didn't get my racing license till three years ago. And I only picked up archery two years ago or maybe a year ago. Like when you suck so much, like the opportunity to get better is awesome. So I think the bigger itch for me is not intellectual. I think it's like tinkering. It's like figuring out how to do shit better. Yeah. I, I, I share a similar interest in things I suck at. And that's what, one of the things that was so compelling to me about archery when did you start 2013 i think i bought well i bought a bow before that but i didn't really use it

uh 2013 i think is right when i got pretty serious about it you had john dudley on your show once didn't you yeah a couple times dude i wasn't he took i mean that shot through the handle of the kettlebell yeah was that a hundred yards i think it was a little more but yeah yeah that is that's one of my favorite things in the world he's helped me a lot he's a remarkable archery coach and just a great person too just a great i once saw on instagram him and jaco in the uh like they bumped into each other in an airport and so like i saw jaco like two they bumped into each other in an airport. And so, like, I saw Jocko, like, two days later. We had coffee one day. To be clear, Jocko had tea.

I had coffee. Jocko's a tea guy. But I was like, dude, I can't believe you know John Dudley. He goes, I don't know him. He just grabbed me in the airport. And I was like, dude, I would have been. There's the shot. Dude, I want to see this.

He did it with a lighted knock. Yeah, he had a lit knock. Good God damn. People don't have any idea how crazy that shot is. They cannot fathom what he just did. Yeah. I've seen him do some pretty ridiculous shit. He's a bad motherfucker when it comes to archery, that's for sure.

And he's helped me tremendously. Where does he live? He lives in Iowa. He moved to Iowaowa just so he can kill big giant deer because uh he literally bought a farm in iowa a giant chunk of land and raises it for he has he does do some farming but essentially what he does is raises deer he doesn't raise them like there's no there's no fence right he makes it very make it favorable for them to be there like he has food plots that he grows and i mean i hunted on this place a couple years ago it's amazing it's it's an incredible place he loves it i just i remember when i bought

my bow like i just sort of you know went into the arch like performance archery in san diego's like the place to go right yeah went in there and was like okay here's what i want to do they're like why i'm like just want to do it. They're like, okay, great. And then I remember when I got all my kit and my setup and they're like, all right, you got to go to knock on. You got to just watch this dude's videos. Yeah. No, he's literally the best in terms of the average person who's interested in it. He's got a great podcast about it, knock on podcast.

But he gets so geeky and technical in his descriptions and his understanding of it. I mean, he constantly obsesses about form and structure and, you know, archery. To me, my history as a martial artist, it really, it jives with me. It makes sense because you could do, you could muscle things and do them wrong and develop bad habits and you'll never reach your full potential or you could do things correctly and be very very disciplined and focused and understand the what why you're doing something and then really actually reach your full potential there's

really no other way and with archery specifically it's so satisfying like as we were saying before when you do pull it off and you know you do execute that perfect shot with your rhomboids and the hand goes over the back shoulder and you watch that arrow go right into that bullseye. You're like, yes! I have my daughter come out and do the slow-mo shot of me from behind. I've got like a hundred of these dumb things on my phone. And it's just like I can watch them all day. And it's like, did I do it? Did I do it? Nope. Not there. Oh yeah. Look at that. Oh sweet. A lot of it is elbow position to the height of the elbow. The elbow has to be in line with the arrow, you know, and sometimes people are pulling, but they're pulling and

their elbows up here instead of way back here. Yeah. You know? Um, I, I think that's an interesting point about certain things, right? So, so to me, the other thing I like about archery and race car driving is you have to learn some emotional discipline. So you can't get pissed off and work your way through either of those things. You can sort of get pissed off on the bike and it can actually charge you, which is not to say that cycling doesn't have technique in it, but it plays a much smaller role. And in the end, the grr factor can out-trump it. But you can't grr your way out of a shitty shot.

And you cannot, in a car, if you start getting pissed, you're done. You're absolutely done. The same thing can be said for a lot of things, I think. Pool is one of them. Yeah. That's a big one. Golf, which I don't do, but yeah. Yeah.

Listen, Peter, we just did three hours, believe it or not. I don't believe that. It's them. Yeah. That's a big one. Golf. Yeah. Which I don't do, but yeah. Yeah. Listen, Peter, we just did three hours, believe it or not. I don't believe that. It's 2.30. Huh. Isn't that crazy? Look at that. This place is a time warp.

It really is. But I really appreciate this conversation, man. It was really fun. Thanks, man. So thank you. If people want to get a hold of you on Twitter, give them your Twitter address, your website, all that stuff. Yeah, yeah, yeah. Peter, Tia, MD.

A-T-T-I-A. All right. Thanks, man. Thanks, man. It was awesome.