The Peter Attia Drive - #103 - Looking back on the first 99 episodes: Strong Convictions, Loosely Held

Episode Date: April 6, 2020

In this episode, originally recorded to be the 100th episode of The Drive, Peter discusses topics that he has changed his mind about since starting the podcast as a result of preparing for interviews as well as from the actual conversations. Peter also reviews some of his favorite moments from the first 99 episodes, shares what books he’s currently reading, and much more. Initially scheduled to be released as episode 100, this was delayed due to recent podcasts covering COVID-19. We discuss: Definition of “strong convictions loosely held,” and the value in trying to shoot down your own hypotheses [2:20]; Metformin—How Peter’s strong convictions have changed since 2018 [8:00]; Getting a dog—Why Peter caved and how it’s going so far [15:45]; Rapamycin—How Peter’s feelings have evolved, and the questions still needing to be answered [20:45]; Archery, the joy of pursuing mastery, and the importance of stillness [26:50]; Zone 2 training—Why Peter has made it a big component of his exercise regimen [37:30]; Deadlifts—Why Peter now believes it’s extremely beneficial to longevity when done properly [41:45]; Read any good books lately? [50:00]; Baby aspirin for preventing blood clotting—Why Peter no longer takes it, and a few alternative options [53:15]; Generic drugs—How and why Peter’s mind has shifted on generic drugs [55:45]; Omega-3 fatty acids, EPA and DHA—How Peter’s long-held views have changed [58:15]; How Peter got better at saying “no” [1:02:30]; Does Peter have any favorite episodes of The Drive? [1:07:15]; and More. Learn more: https://peterattiamd.com/ Show notes page for this episode: https://peterattiamd.com/strong-convictions-loosely-held Subscribe to receive exclusive subscriber-only content: https://peterattiamd.com/subscribe/ Sign up to receive Peter's email newsletter: https://peterattiamd.com/newsletter/ Connect with Peter on Facebook | Twitter | Instagram.

Hey everyone, welcome to the Drive Podcast. I'm your host, Peter Atia. This podcast, my website, and my weekly newsletter, I'll focus on the goal of translating the science of longevity into something accessible for everyone. Our goal is to provide the best content in health and wellness, full stop, and we've assembled a great team of analysts to make this happen. If you enjoy this podcast, we've created a membership program that brings you far more in-depth content if you want to take your knowledge of this space to the next level. At the end of this episode, I'll explain what those benefits are, or if you want to learn

more now, head over to peteratia MD dot com forward slash subscribe. Now without further delay, here's today's episode. Welcome to a special episode of The Drive. To celebrate our 100th anniversary, we have decided to try something a little different. The title of this episode is Strong Convictions Lusely Held. And what that basically comes down to is Bob asking me questions about things that I've kind of changed my mind on over the past year and a half. So we definitely go into a lot of areas where I had a strong point of view, or a reasonable point of view on something, and then after either preparing for a podcast or going through a discussion,

I sort of came away with a different point of view, and it's usually changed my behavior for the better. So we thought this would be kind of interesting and maybe even clever way to go about doing a retrospective on the first 99 episodes. And of course, we also do take a moment to sort of talk about some of the things, highlights, things that I've maybe enjoyed the most or that Bob's enjoyed the most. If you like the style of this episode, by the way, please let us know,

because I'd be open to doing it again. I actually found it quite fun to reminisce. So again, if you find this interesting, please let us know. I'd be happy to repeat this every 50 episodes or so. And I guess without any further delay, I hope you enjoy episode 100 of The Drive. So for episode 100, as I alluded to in the introduction, we're gonna do something a little bit different. And I can't take any credit for this idea. So if you like it, Bob gets all the credit. If you dislike it, well, hopefully you won't dislike it.

But many of you know Bob Kaplan, the guy behind the guy behind the guy. And one of the things that Bob has had the luxury of doing, if you can think of it as a luxury, is sort of helping me get ready for many of the past 99 episodes of podcasts. And there's a lot that goes into making this sausage known as the podcast.

Once in a while, I just get up there and wing it, but I think more often than not, a lot of thought has to go into, who do we want to interview, what do we want to talk about, what do I need to know in order to have this discussion in sort of a thoughtful way. And throughout that process, my opinion on things can change. And sometimes not necessarily through the podcast per se, but just through the evolution of learning and what it means to sort of scour information and test a hypothesis and see data that conflict with your pre-existing way

of thinking about things. I mean, all of these things have led to an enormous evolution over a period of time in the way I think about things and do a lot of things. And I think I know that on some levels that might sound like a real cop out to think that one can change their mind on how things work. But I think that when I've written this before, I think in politics that may be a cop out, but I don't think in science or in medicine that should be viewed as a cop out, I think one should always be malleable and willing to sort of lean into new information.

And in fact, the title of this podcast, Strong Convictions Lusely Held, is a phrase that exists in various different forms. So sometimes it's Strong Opinions Lusely Held, Strong Opinions Weekly Held, Strong Convictions Weekly Held. I've seen many different versions of it. But in particular, this version of it, Strong Con, Lucy Held, is something that I remember one of my patients telling me a couple of years ago in reference to one of his mentors in the investment space. So this patient of mine is himself an investor and he came out of a very successful hedge fund and he spoke very affectionately about

how he was mentored there. And he said that that was sort of one of the things that allowed them to be so successful was they had very strong convictions and they would make bold investments based on those things, but they were very loosely held convictions and they were always looking for ways to change their information. So in that spirit, I am joined today by Bob Kaplan. And I think Bob has, along with maybe two or three other people around me clinically, as good an insight into some of the various things I've changed my mind on. And so, Bob, how do you want to do this? Do you want to just ask me about things I've changed my mind on or point them out to me or call them out?

Yeah, I think that works. Call you out on things I've changed my mind on or point them out to me or call them out. Yeah, I think that works. Call you out on things you've changed your mind. But again, I think it's really important. That's a feature, not a bug. One of the quotes that I heard or somebody talking about this idea of the strong opinions, strong opinions, weekly held is it was on a blog actually and it's Richard Feynman just to confuse everyone.

Richard Feynman, the other, the SUNY biochemist who said that a colleague at NIH said, and by the way, that's SUNY SUNY. Just to confuse people even more. Just to really confuse people now. It's not the Shia Richard Feynman. It's, yeah, forget it. Yes. So he had a colleague, at least he wrote this in his blog and he said, what you do in

science is you make a hypothesis and then you try to shoot yourself down. And I think that that's really succinct and the podcast for over the 100 episodes. Peter has a lot of hypotheses, which is great for me because I think I share a lot of those and I get to dig into them as an analyst. And so, I think from a selfish perspective, what I see in podcasts and the episodes and why Peter's so successful other than his rugged, good looks is that he has a lot of hypotheses. He has a lot of ideas and he's not afraid to just say whatever he thinks and try to find the people who are the absolute experts or even just somebody who disagrees with him and his take on something,

try to dig into it further to see, basically to see if you can shoot it down because I think the more hypotheses you can shoot down, actually things get a little bit simpler, even as much as we're waiting in a lot of this uncertainty. But a lot of that actually occurs behind the scenes. I think, I mean, I hear what you're saying, but I think most of the shooting down

is not actually done in the podcast. It's actually done in the preparation for it and some of the analyses that come after the fact. So I also could imagine somebody listening to this saying, well, your podcast aren't really that contentious. It's not like you're getting into rip-roaring fights. It's not like our podcast is sort of an environment where we're always just trying to come up with a contrarian point of view or an antagonistic point of view. I think a lot of the places where my minds have been changed has been in getting ready to do it. So, and sometimes frankly, it just doesn't have to do with the podcast, but I do think this is a great excuse as any to be a hundred episodes into this thing and say, hey, two years ago, what did I do

or what did I think or how did I behave in a way that was different from today. So yeah, hopefully we've got some interesting ones to talk about. I've seen that you and Nick have been comparing notes. We have. I've got a good mixture here of hard topics and maybe a little softer.

So we'll see if we can sprinkle them in. This might be on the harder side. Metformin. So maybe think about, I guess in the context of the episodes, it was probably, it was summer of 2018 or so, you started the podcast. Since then, how have your strong convictions, if you had them, changed it all since then?

Well, in the summer of 2018, I was taking Metformin, I had been taking it for about seven years. I think I started in 2011, and that was based on a lot of research that I had seen and read and a white paper we had written internally that looked at the benefits of Metformin in people with type 2 diabetes and in people without type 2 diabetes, but with obesity, which was probably just a proxy for hyperinslenemia, but it's not entirely clear. But the benefits were not subtle. In particular, the benefits were around a reduction in cancer mortality and survival with cancer as well. So both a reduction in the incidence of cancer and an increase in the survival of cancer.

And we certainly weren't the only people to figure this out in 2011. There are people who figured this out long before us, but we were sort of, I think, a little bit early on the cusp of viewing metformin as a drug that might have a benefit for people who were not type two diabetic, but looking for sort of a boost and longevity. And truthfully, not a lot of our patients in the practice were taking Metformin one because my convictions, I guess, weren't that strong. And they were strong enough that I was willing to take it because I could also kind of monitor

a bunch of things in the background, but not strong enough that I felt like it should be dispensed like you would dispense chicklets or tic-tacs to people. I don't know why I said chicklets are... Because you'd dispense them like candy anywhere you go. We know. The chicklets and tic-tacs. Yes, that's it. Whenever I don't know the last time I had a chicklet or a tic-tac, do they even make

chicklets anymore? I think they do. I don't even remember seeing these things in a grocery store. And I've seen tick-tax. But I don't think I've seen a chicklet in a long time. I miss chicklets. So that said, a lot of patients over time would say, hey, I've heard about this drug called Metformin,

kind of interested in it, what's your take on it, and sort of share our white paper with them. And in the end, we ended up prescribing it for a number of patients. I would say off label, meaning these aren't patients that were hyperinsulinemic or diabetic. So fast forward, well, actually, we had an interview with near bars alive, who is certainly one of the world's experts on this topic. That was a very interesting podcast. I learned a few things there that I didn't even know before, which, again, I've

given that I'd been spending so much time thinking about Metform, and I think that really speaks to near depth of knowledge on that front. But somewhere along the way, something changed. And the first clue was December of 2018. So in December of 2018, which is when I first became interested in zone two training, it was the first time I'd ever been checking my lactate levels under low levels of exertion, and it was the first time I'd been just checking lactate levels in a while since I hadn't been doing much lactate testing since I stopped competing in lactate testing since I stopped competing in sportswear that mattered. And I was kind of surprised at how high my lactate levels were, especially my fasting lactate, just baseline, like not exercising lactate levels. And that got me poking and poking and poking

and coming to the obvious conclusion that Metformin is a weak mitochondrial toxin. And as such, it probably shouldn't be surprising that you'd have a higher level of lactate. In medical school, every student learns that one of the potential rare complications of Metformin is lactic acidosis. I'm sure somebody in an ER somewhere has even seen it. So again, it's not a huge stretch that you would see elevated levels of lactate, but it did get me thinking, which is, wait a minute. What if the benefits of metformin are only going to be most pronounced in people

who have otherwise quite defective mitochondria to begin with and or people who can tolerate a slight hit in the sort of mitochondrial performance because of all the other benefits they're getting. And what if that doesn't hold true for someone who's otherwise quite healthy and looking to really maximize mitochondrial health and throughput? And basically since that time, I would say that more and more literature have probably emerged suggesting that we might want to think about metformin different in people who are, quote, unquote, sick versus healthy.

I hate using a stupid division like that, sick versus healthy, but I mean, I could sort of explain what I mean in a bit more detail, but I think people get the gist of it. What if this is a drug that still offers a sizeable benefit to people who are metabolically ill, but that benefits sort of evaporates in people who are not. And so I would say that my position today, so I've stopped taking that form. And after making this observation in December of 2018, I then spent the next six months, maybe not that long, maybe the next

four months experimenting a lot with it. So only dosing it in the evening, but not in the morning, reducing the dose, like making a whole bunch of changes to see if I noticed any difference before ultimately stopping it and then stopping it altogether and then realizing a couple of things. One, yeah, my lactate levels went down and my zone two efficiency as measured by lactate went up, but also my glucose levels are a bit higher. There's no question it was suppressing glucose levels and that was probably a good thing. I have no way of knowing if the net benefit of stopping metformin has been positive or

negative, but I now would say I reserve metformin prescriptions for patients who obviously are in need of it from the standpoint of glucose and insulin regulation, but I don't view it really as a pro long-jeviti agent yet. Again, very likely we'll be having a discussion in two years, Bob, and I'll have changed my view again. There will be some new data that will have emerged, that will have told me that, yes, despite the elevated levels of lactate, it's still a net positive, even in someone who's metabolically healthy. And we've obviously looked at a bunch of other papers that look at the impact of metformin on muscle mass and training effects, though a lot of those studies seem suboptimal because they don't

include some of the more functional analyses of the muscle that you'd want to see. So I don't think this is not an open and shut case. We have a lot to continue to learn, but as of today, I have a really different point of view than for the previous decade. And I don't think the jury is necessarily out that in the next 900 episodes that you do going forward, you'll probably have a few that are on metform and then any may change your thinking on it down the road, I imagine. Yeah. I mean, I think one big thing that's going to be interesting is to see if tame, which

is the study that near barzal I spoke about on our podcast, just tame actually get funded. Because again, if tame is done correctly, it's really not going to be weighted towards people with diabetes. It's going to be looking at people without diabetes and asking the question, can this extend life indirectly via mitigating the onset of chronic disease? So in the end, nothing matters more than that is health span and lifespan. All of these other things that we're looking at, such as lactate levels and zone to efficiency or muscle mass, those are proxies for that. So in a large enough study, if we could actually go after the thing that matters, that would

hold great weight. Okay, so I'm going to bring in a little social media into this. On Instagram, I think it's pretty clear that anybody who follows you, that you recently got a dog. You're snuggling up with that pup. And along the same lines, have you changed your mind on having a dog? Because I believe in some of the podcasts, maybe we've talked about in the AMAs and other times about the reluctance to get a dog. And maybe you caving at some point down the road.

Yes, we do have a puppy four weeks ago. We got her little Molly. and you are absolutely correct that remember that scene in planes, trains and automobiles when I think it was John Candy's character says something to the effective if I'd woken up with my head sewn in the carpet I would have been less surprised. Do you remember that line? I think I thought the day that we were gonna get a dog was never. I just thought it'll never happen because I don't have the bandwidth to absorb any additional work. My wife is already functioning at the level of three wives, and it's just like why would we do that to ourselves?

And even though our daughter was the one begging, it's not like she can take care of a dog when she's at school or whatever. So I was just like, no, this is never going to happen. And then I don't know what happened. I mean, I just don't know what happened for lack of a better way of describing it. Somewhere in there, the resistance just weakened. And I was in Australia and I must admit, prior to that Australia trip, we had gone and looked at a couple

of puppies in a dog shelter nearby. And I must admit there were some cute little puppies in there, but I still kind of came away from that experience thinking we just need a couple more years. We just need the two guys to be a little bit older and a little less dependent on us. And then somehow they just went to the dog shelter when I was in Australia. They FaceTime me from there and said, there's this little girl, little puppy, Molly,

she's perfect and they gave me all the reasons why she was perfect. And I actually went out to social media to seek an opinion. This was like one of the few times social media was actually helpful because this puppy was the runt of her litter and she was visually impaired and I really wanted to know if we were biting off more than we could chew.

And so I asked that question broadly and the feedback was overwhelming actually, both on Twitter and Instagram. And people said, she's going to make an awesome puppy. And I will say this, a month in, it's way more work than I expected. And not so much for me, but certainly for my wife and for my daughter and for me too. But I'm taking on 10% of the additional work. But I think people were right that a dog that doesn't see perfectly

perhaps coupled with some other characteristics of just being a rescue dog. She's amazingly gentle and sweet and kind. And I don't know. So I don't regret it, even though it's harder than I thought it would be. And there have been a number of accidents that have required significant cleaning, but I think I'm getting the point that people had been trying to make for years when I had been saying, why would anybody get a dog? Which is, I think there are these intangible benefits that come from a dog that you don't appreciate. If you try to just think about it with your

logical brain, you guys have a dog, right? We do. The dog is past. We're going to get another one. But yeah, I mean, I definitely share your feelings about it. It's funny. It sounds a lot like having a kid where you think you get older. I think if you don't pop one out when you're younger and you're older, you're trying

to think like, when's the right time? We need to line up all these things. It's just like there's never the right time. Although probably anytime is probably the right time if you don't have a kid and then you raise that child and they're probably accidents along the way as well. Whether it's a dog or a person, this is completely inappropriate,

but I thought of it when you were talking about loving a dog. This is a joke, this is not my joke. It says, want to know who loves you more. Put your spouse in your dog in the trunk of a car and drive around for an hour. When you open the trunk, who's happy to see you? I honestly, I think like that joke, I don't know, I've heard it recently, but I would always be amazed that you just think of like dogs and you come home every single day. And it's like you went to Afghanistan toward duty for three years and you came back and you get that kind of reaction every single day.

And it's pretty amazing. I'm a big fan. So I have a. So I'm in the club now. Yeah, I'm in the club. It was interesting too. I caught one thing, which is great is that when people ask you where does Peter T. I get his second opinions, you can say Twitter and Instagram. It's just a nice

When it really counts We're gonna go back to the pharmaceuticals. We've got rapamycin However, your feelings changed on this one Well This is sort of been another area of this one. Well, this has sort of been another area of real interest of mine for many years, not quite as far back as the sort of metform and interest, which started I think around 2010, 2011 for me, but probably by about 2012, and certainly by about 2014, when the first, that sort of really interesting, ever-olomous paper was published by Joan Manek, Lloyd Klickstein, and others in December of 2014.

That was a real peak to my curiosity. That was a paper that showed that the strength of vaccination in healthy subjects who were, I believe, about age 65 could be augmented by basically a rapamycin analog. Which, again, is counterintuitive, right? That's the adaptive immune system getting better with rapamycin. Very counterintuitive because, of course, rapid-mysons on label use is specifically to suppress the adaptive immune system, and that's what makes it such a efficacious tool for mitigating organ rejection. But, of course, what that study would show

was a couple of things, which is there are different ways that you can dose it. Two of the three treatment arms in that study were only being given rapamycin once a week, one at five milligrams, one at 20 milligrams, by the way, I said rapamycin. I almost used Evarolamusin, rapamycin interchangeably, but it was not rapamycin. And that study was sort of the turning point for me. And what it really led to was the next four years, just a deeper and deeper look into all of the literature. We've had, I think, two podcasts that have been dedicated to rapamice in an emtore, one

with David Sabatini, one with Matt Cabraline. I feel like we're overdue for another one, by the way, because I know they're very good. Yeah, and a little inside baseball, but those interviews were, I think, in 2017. That's right. That was at Sabatini, and it was the summer. We went over there, you give a talk.

That's right, yeah. Talked to some photography geeks. Yeah, August of 17. So we're way overdue to go back and revisit that. But basically just more and more data, both in animals and in humans, really got me to a point where I felt really comfortable that one, I was taking enough because you've probably heard me talk about this before that you always think of two risks when you're taking a medication that you don't have an immediate biomarker for. So if you're talking about taking a statin or taking a PCSK9 inhibitor, well, you have

a very clear biomarker that at least tells you if the drug is working. And similarly, you have either clinical signs or biomarkers that tell you if things are going awry. Clinical signs might be muscle aches and you might see outside of complete breakdown of muscle, you might still see significant elevations of CK or significant elevations of liver function tests or things like that. You have some sort of bearing on either symptoms that would cause you to revisit your decision to use the medication or lack of efficacy or other signs that tell you, hey, this isn't a good

idea. But with rapamysin, you don't have any of that. I mean, on the symptom side, obviously, if you take too much, you're going to start to see some of the symptoms like mouth sores and things like that. But you don't really know if you're taking enough and you don't know if you're taking too much beyond some of those symptoms. And so you really have to be able to triangulate

on what the right dose is. And so that's what basically took me about four years. Once I sort of felt like I think this makes sense, there was still, I couldn't quite get to the point where I could understand what to do, how to do it. And I think't quite get to the point where I could understand what to do how to do it. And I think that was sort of the big switch that flipped in, well probably about 18 months ago, kind of in the fall of 2018.

And I would still say that here I am a year and a half later, I'm still really eager to figure out ways that we can have biomarkers that can lend some insight into this. Probably more so on the efficacy side. There's still a lot of questions I have on the use of rapamycin, even though I'm using it. I sort of cycle it a little bit. I think there's lots to be asked there. Is it the right cycling?

Is it the right period? Is the right on versus off? All of those things are, we don't have enough answers yet, but my convictions are now high enough on the side of something that looks like what I'm doing right now is probably beneficial. One thing interesting too, just about the Metform and Enrapa Mison is, I think you might have talked about this with Nier. That was January of last year, so about a year ago, is him and a few other colleagues,

I think Steve Ostead was one of them. They were talking about what is the trial that we want to do. And I think there was a lot of debate and healthy conversation around whether they should use metformin or rapamycin. And I wish that there was enough resources in the world to try both.

But it sounded like they had to do one, and then it was metformin. Yeah, I remember actually having that discussion with Steve Austin over dinner about four years ago, at the time before tame had been fully formulated and saying, if you're only going to get one bite at this apple, rapamycin might be the more interesting agent to study. I think their concern was the monitoring interesting agent to study. I think their concern was the monitoring was going to be more complicated, just the economics of trying to understand how the immune system was potentially changing was going to make that sort of cost

prohibitive study, unfortunately. On the subject of apples, I don't know why this is apples, I think of archery and shooting an apple on someone's head. But are you still practicing archery? I am. I practice a lot. I think archery and driving are the two things that I really sort of just try to carve out time for every single day that I'm not traveling. Luckily, I travel a little less than I used to, so that means more practice.

How do you think that goes? I'm just thinking that in terms of getting better, the more you practice it, is it just do the gains become more and more incremental, or do you always feel like you're learning something each session, so to speak? And I mean, just in terms of archery, I think it's more objective, or maybe you can take your score and say on average, I'm improving over time with those things. Yeah, I mean, I think they're both so different and yet so similar. I think that with archery, it's so hard to explain how addictive it is if you've never

done it, but I think anybody who's fired a compound bow, I think most people are like, oh, wow, I can see why this is this is really something else. First of all, there's no ceiling to how much one can improve. That's the beauty of something like this is you have so much ability to measure how you're doing that you can never say, I've kind of plateaued, I've kind of hit my limit. There's just always a place to go up. And really, it's many different sports in one. There's the indoor target, you're shooting at 20 yards, and at 20

yards, you're expected to be able to hit something the size of a quarter. So if you think about that, something 60 feet away, you have to be able to hit a quarter, 60 feet away. And in a perfect round, you would take 60 shots and do that 60 times. How many times you think I've done that so far, Bob? A hundred. Zero. Zero. Zero. Zero.

Zero. Zero. Zero. Zero. Zero. Zero. Zero. Zero.

Zero. Zero. Zero. Zero. Zero. Zero. Zero. Zero.

Zero. Zero. Zero. Zero. Zero. Zero. Zero. in the tiny little X. And to be clear, there are days when I find that fact in furiating. Like there's times when I get so close and then I blow it at the end. And then as times I just blow it in the first shot and I'm like frustrated and I don't even want to finish. But you also realize that archery is kind of a great metaphor for life. And you can't focus just too much on your target. You really have to focus on the process

or you're not gonna get better. So one of the things we do a lot in archery is called blank bailing, which is taking a shot at a huge target, like there are these big bales without actually looking at a target, like literally not having a target there, so there's nothing for you to fixate onto so that you can just go through the sequence.

And when I'm traveling, I take this thing called a shot trainer with me, which is like a little string attached to something that sits in your hand that sort of mimics the feeling of the riser. And I'll take maybe 20 to 40 shots a day in my room, hotel room, or whatever, that are obviously not aimed at a target or not doing anything, but just going through the muscle memory of where my feet, where is the pressure on my hands, how am I feeling the contraction of my rhomboid, all those sorts of things? Again, if you're listening to this and you're thinking, oh my God, how did that guy

just manage to waste the last three minutes of my life telling me that? Again, I don't think you have to like archery to appreciate the notion of mastery. And I do think that as people we sort of crave getting better at something. And that can be lots of things. It doesn't just have to be sort of a physical domain. It can be an intellectual domain. It can be an emotional domain or a relational domain. But anyway, for me, this habit with archery, this curiosity started three years ago. And now it's something I can't imagine. If a day goes by that I don't do it, I feel like I'm missing something. I think there's something to that process. I mean, I think about

my childhood, the intellectual pursuit. I just always, I had these things uncoupled that I just wasn't very good. I was not a very good student. 1.44 grade point average in high school. What? Don't fire me. Don't. How is that? It's actually really hard to graduate with that kind of. Yeah. It's not as hard to graduate. How do you even get a grade point average of 1.44? The secret is not showing up. That's how you do that. What were you doing? Having fun?

At least what I thought was having fun. At the time, but I was also, I guess to the larger point here, not get into my childhood too much. I mean, you can't throw out the 1.44 without explaining it, but okay. Yeah. I was also playing hockey,

and that's a totally different sport, but I excelled at it. And I went through that like you don't automatically excel to sport like that. I've probably particularly in Massachusetts. Like you got to really work at it and it instilled a lot of stuff in me. And I never made the connection until later in my life that intellectual pursuits and educating yourself and things like that. It's not very much different. It's like in order to be good at blank, you are going to suck at blank.

If you have a few of these victories, Peter, you have so many of these things. I think you're in a way obsessed with mastery and you have so many different things that you've pursued excellence in. That you realize, even if you have no idea what this thing is, if you put the time and the effort in, that you can get better at it. And so I would just, I would put a plug in for anybody to a younger age. Maybe it's like, I never thought about it musical instruments that way, but maybe it is. Like I know Olivia plays the drums and that's something you first start. And you're just like, you can't keep a, can't keep a beat. And then check in a few months later and you can see that progress. And you just know that work and effort and time,

I mean, it sounds like grit, those kinds of things, but they apply to so many different things. And just with this podcast is, I mean, I think there's a parallel there with all the episodes and all the information that goes into the prep with the guests. And I think that you have a predilection to guests who have a healthy obsession,

let's call it healthy obsession with these topics as well. And they just, they know a lot about these things, probably through similar practice with those things. It's funny you bring that up, by the way. I actually had this discussion with Olivia two days ago. And I don't know why, oh, I know how it came up. We were sitting there at dinner, and I was just sort of complimenting her

on how impressed I was with how hard she's been studying this year, which was a real switch that flipped in her and it's like you don't have to ask her to do her homework. She just wants to do it and she makes cute cards and is always like just going out of her way to really try to learn stuff in a way that I just didn't see her doing before. And so I was just saying, hey, that's so great. Bo-bo-bo. And then she sort of asked me, she's like, well, when you were my age, how much did you study? And I was like, Olivia, you have no idea.

You couldn't have done less than I did. I was categorically a moron in school. Again, there's a fine line there. And really what it was was I wasn't interested in what was happening and so my interests were elsewhere But the point I made to her is exactly the point that you made which was The reason that I was ultimately able to do well in the school was fortunately I had spent all of that time still trying to master something and it was that sort of pursuit of that that became transferable and so And it was that sort of pursuit of that that became transferable.

And so I agree. I just think I do pity the person who's never found it interesting to try to get better at something. And to be clear, you can take it too far. I don't consider archery for me to be the greatest form of recreation because I am very internally competitive. And form of recreation, because I am very internally competitive, and I'm sometimes too focused on the result and not the process. So there are days when archery is like meditation to me, just being out there just feels so amazing and the sun is shining and the wind is blowing, and I can sort of disregard the outcome, but that's not often the case. And so when you think about the podcast

with Ryan Holiday, where we talk about stillness, I would say that archery for me does not constitute stillness because stillness can't really have an objective. And I think for me, archery carries with it too much of an objective. So I think for me, archery carries with it too much of an objective. So I still think that one has to have those other things in there. This is sort of funny. I didn't think of it this way, but I think this is one thing I've noticed about having a puppy, frankly. A puppy is as kinetic as she is. It is kind of a form of stillness for

me, like taking her out and walking her and picking up her poop, there's nothing else to be doing, and there's no outcome associated with it. There's no objective. It's literally just a forced reason to be outside and to be observing the completely comical nature of a puppy. So yeah, I think it's funny, even though we didn't pose it this way, if you want to ask me about another really big change in the way I think about things over the past couple of years, it's a huge appreciation for how essential it is to have something that is not object-oriented outcome-based in your life. Like not everything in your life can be outcome based.

I've recently gone back to swimming actually. This might be a good segue to another topic, but it's funny when you were talking about stillness and how some of these little things that you don't even realize are stillness or stillness, I was gonna use the example of washing dishes and then I realized you've got the forks and spoons and knives games, so you turned that into a competition. Even washing dishes. A lot of people just wash the dishes and it's realized you've got the forks and spoons and knives games. So you turned that into a competition even watching people just watch the dishes and it's

like it's therapeutic for them to still. Lost it's stillness for that. But turned it into a competition. But things that were once like, you know, saying, I'm going to even swimming for me now is something that is really a form of stillness. So I just started swimming again a couple months ago and I go like once a week and I don't keep track of how far I'm swimming. I know I'm not swimming too far. I'm in the water maybe 45 minutes to an hour and all I'm doing is swimming. I'm not doing workouts. I'm not looking at the pace clock. I'm not doing

intervals. I literally just get in the water with no agenda other than to get wet and hear the sound of water going by my ears. Probably I'm not even swimming hard enough to get into zone two truthfully. I doubt my heart rates above 120. That's the next topic. That's where I think this is a good segue. If you think about it, you can talk about it, but I think that's one of the things. It's like a governor putting a rate limiter on your performance when you do zone two,

that it's almost like for a lot of people, it's for me doing this reminds me kind of of stillness, although I might read on the bike or things like that, but can you talk about zone two importance and how you're thinking has changed on that? Yeah, when I stopped riding a bike with a purpose, which was for me a time trial, so that would have been late 2014, early 2015, I kind of really just stopped doing any low intensity

aerobic training. So anyone who does ride a bike or swims a lot has plenty of that activity in them. So even if you're training for the 200 meter individual medley, which is a race that's very short, very quick and very painful, you still put in hours and hours a week of aerobic base training. Similarly, if you're training for a one hour all-out time trial, you still put an hours a week of low-end aerobic base training. But when I stopped doing that, I was like, well, I don't need to do this anymore. And I went from cycling to rowing and running.

And I was sort of obsessed with just being as efficient as possible. So everything was all out. I mean, I was, if I was running, it was going to be a six-minute mile. It wasn't going to be a nine-minute mile. I think, especially through the interactions that I had with Inigo, who I met about a year before I had him on the podcast, which was just recently, it was sort of meeting him

and kind of going back through the literature on that type of training and the benefits that it could have, both from the standpoint of metabolic benefits such as glucose, insulin-dependent and insulin-dependent glucose, mediated disposal, looking at just sort of mitochondrial function, mitochondrial health density, and then looking at sort of the sort of neurotropic factors, the BDNF secretion that can come from this type of activity. I mean, all of these things were just pointing towards, this was a glaring hole in my training that I needed to get back.

And so that has been great. And like you said, I mean, one of the things about zone two that I really enjoy is, it's just not that hard. You know, like, frankly, sometimes it's just nice to get on the bike, and I probably spend three or four hours a week doing it, and that is my time to listen to podcasts and audio books. And I really enjoy it.

I can't wait to get on that bike. As sort of boring as it seems to be sitting on a stationary bike for that long, there's never been a day when I've been like, I don't feel like doing this. I just, I always look forward to it. And I think in large parts, it's because I also get to combine it with learning, which you wouldn't be doing if you're out there crushing intervals. And not that there's something

wrong with that. I think each of these things has this time in a place, but I think that we can do zone two our entire lives. We can do it safely. And it just yields enormous dividends. What's nice about that too for I think a lot of your training is you've got the smart erg, so you can tie yourself to the mast that the output, whether you pedal faster, it's gonna give you the output that you pre-desired. So you can't start cheating, which is what I find myself doing

when I don't have it on smart, just the erg that I find myself pedaling faster, just unconsciously, just wanting to push myself harder. But do you use a Wahoo kicker? What's your device? Are you on a Wahoo kicker? So you can set it to either smart or set it at a certain level. Yeah.

I love my Wahoo kicker. Yeah. Me too. Did you ever have a Compute Trainer back in the day? I did. Yeah. I had it on the old Windows computer. I remember that.

I had the little compute trainer and then it's connected to the bike trainer. Yeah. To try simulating the Tour de France one year, just in terms of the time. Yeah. So I talk about time over the summer. I had a bucket.

My wife now, I can't believe she's my wife now. I was living in Las Vegas and it was the middle of our, I would sit in our apartment with a bike trainer and had a bucket with ice of water bottles and things like that. And eggs, I was like, I was gonna eat a gin, I'd die it. So I was eating eggs at the time, but I don't know if that was stillness.

I wasn't going anywhere, it was stationary biking. So on this topic, moving along, the importance of deadlifts as an adult, how is your thinking changed on this? I like your history on this one, so maybe even take it back to in school when you were you were doing powerlifting before it might have been in Vogue. Yeah, yeah, long before it was in Vogue, one of my best friends in high school who was also involved in boxing and martial arts, we would go to the Scarborough campus of the University of Toronto

every day and lift weights. And it was, it's still one of the fondest memories I have of what a gym could be like. It would certainly be the, it was certainly not the sunny, warm golds and Venice, but it had some of those features which was old school, lots of iron, nothing fancy. Of course, unlike a nice gym, this was like two stories below ground, so there were no windows poorly ventilated. So in the summer, it was staggeringly hot. In the winter, it was so cold, you felt like you were getting frostbitten by touching the iron. And aside from me and my friend, there were no kids there. We were 14,

15, 16 years old. And it was this group of men who, to this day, I think back and like, can't believe how strong they were. And most of them competed in powerlifting. And so that sort of got us interested in powerlifting. And that's how we sort of started putsing around with it. And as most people know who are listening, or I guess people who might know who are listening, powerlifting is different from Olympic lifting. Powerlifting is three lifts, the deadlift, the squat, and the bench press. And so yeah, make a long story short, grew up doing a lot of deadlifting, a lot of squatting, a lot of bench pressing. It was always very horrible at bench press, much better at squatting and deadlifting.

Fast forward to, I don't know a few years ago, maybe three years ago, I had an injury where I kind of tore or partially tore one of my obliques. I don't even remember how I did it. I remember it was very stupid, whatever I did. And everything went- Taringa phone book. That would be great.

Possible. But everything went kind of sideways after that. And I really was never able to fully deadlift again without some discomfort. And so again, this is now take it back to maybe 2016. I sort of Decided, you know what maybe the deadlift has reached its point of

futility and maybe I've extracted all I'm going to out of that and There's no denying what a wonderful movement it is in terms of being a total hip hinge compound movement But I was like look I could probably get most of the benefits of a deadlift doing things that place me under less load. And also, again, in this period of thinking about longevity, I thought, why does one need to subject themselves to twice their body weight or more in an axial load? So I sort of got away from it. And then I think all that kind of changed when I started DNS, dynamic neuromuscular stabilization,

which I started about 18 months ago. And we're going to have a podcast on this topic because it's just, there's so much I want to talk about here. And so actually I think today we got an email about how we're trying to make some time for this podcast. So we'll definitely, if you're listening to this and you don't know what DNS is, dynamic neuromuscular stabilization, by all means, you should go read about it, but we're going to have at least one solid podcast on this. But it was through that process that I realized

actually the deadlift for me was going to be beneficial not because of the metabolic benefits. I was not going to be doing tabata deadllift like I used to or even by trying to set records for how much I could lift or anything like that but rather because it becomes a beautiful audit for everything working perfectly. So I deadlifted this morning so today's a Monday, I deadlifted on Saturday, I deadlifted a few days before that, I deadlift at least twice a week, often three times a week, both straight bar and trap bar. And Bob, I don't go that heavy. I don't know the last time. Maybe I've had 400 pounds on one of those on the trap bar in the past year, but I usually sort of stop at about 350 to 375. On the straight bar, I'm even lighter, maybe 185. I do a lot of slow eccentric.

I film every single wrap of every single set. And I study it. And I send it to Beth Lewis, who is my coach. And we do so much around making this deadlift perfect. And I'd rather take a lightweight and deadlifted perfectly several times a week. And I'm not doing like killing crusher sets. Like I mean, it's today was four sets of 10, five sets of 10 maybe. And at no point was I like past my limit.

So again, I can push myself harder doing other things, but what I could get out of doing that deadlift perfectly is, do I have just the right amount of thoracic extension? Do I have just the right curvature in the lumbar spine? Am I activating my glutes? Am I activating my hamstrings? Am I pulling back instead of pulling up and my wedging correctly. Like all of this little stuff translates biomechanically to the activities of daily living that matter to me, like getting up off the floor, picking up one of my kids, lifting a

piece of luggage or something like that. And so if I can do the deadlift and it feels right, then I know I'm ready to do everything correctly. And when I'm deadlifting and I feel like, hey, this isn't correct, this doesn't feel right. Well, first of all, now I've really learned what that feeling is. And secondly, I've now learned the steps that I can go back and reconstruct what needs to be done. And so one of the things I definitely want to do at some point in the next year is actually put together kind of a video on deadlift and deadlift preparation because I think that there are probably 10 exercises that I do as a way to get ready to deadlift. And they don't take long, like this, my deadlift checklist is like 10 to 15 minutes, so it's

not so onerous. It's almost like ketosis, the way we were talking about it in the past, right, which is, it's not even clear if it's the ketones themselves that can sometimes be the benefit versus the metabolic conditions that allow you to make them, right? In other words, I'm not even sure how much of the benefit is the actual deadlift versus all the things you have to do to do the deadlift correctly. And one of the most exciting things just on this last thing I say on this, is it never

occurred to me up until a year and a half ago that you could actually deadlift in a way that puts your spine under traction. That's very counterintuitive. You would think that any time you're lifting under an axial load, your spine is under compression. But it turns out when you learn the right positioning and you understand how to create intra-abdominal pressure and you know how to elongate your spine, you can actually deadlift and create traction in the spine actively. And that's why deadlifting is the most important thing I do before I get on an airplane.

Because when you're on an airplane and you're sitting there for five or six hours, what you really wanna do is not let your spine be compressed. And the deadlift primes me to then go and sort of maintain that activated form of traction. Yeah, it's a significant investment, but I would say it's worth it that you'll bring your hex bar to the gate before your flight, pump yourself up,

and bang out a few sets. I mean, I don't know what it is about the TSA guys. They get so wigged out when you have your hex bar there with the gate overhead. Yeah. If your TSA pre, they don't mind as much. But if you're not TSA pre, they just lose it. Sticklers, they're stickers.

Yeah. Separate topic a little lighter, maybe. Have you read any good books lately? I am about a third of the way through Andrew Solomon's far from the tree. Have you read that? No, I have not. It's super interesting. It's a long book. So yeah, it's going to take a while. But I've actually thought it would be probably really interesting to have Andrew on the podcast. But I've actually thought it would be probably really interesting to have Andrew on the podcast. He's obviously just one of those guys that when you're in the process of writing a book, you probably shouldn't be reading their books because they just make you not want to write

yours anymore because you're so bad. You're like, how does he do it? It's like Sid Mukherjee. You know, it's just one of these people who are just so, so exceptional in their ability to write. Not a word is wasted. Everything is just perfect. So prior to that, I reread Stillness is the key for the third time.

I know we interviewed Ryan a few months ago. That is a book that has just spoken to me probably more than anything else Ryan has written. He's written some really great books in that series. And just overall, the other two books in that series, Ego is the enemy, which I'm also a huge fan of, and the obstacle is the way. But stillness is really the one that kind of captivates me, and that's why I've just finished it for a third time.

I've also gifted that book probably half a dozen times. And so, yeah, I suspect there'll be at least a fourth reading of that book in my future. What about you? Good question. So I was thinking in the context of the podcast and there's so many books, I guess it's not recently, but for the guests, just reading a lot of their books is it's great. It's a pleasure actually think of Gary Tobs and how you read why we get fat. And you had a list of questions and you asked them all those questions.

There's a version of that where I get to read these books, and I have a list of questions, and I'll ask you to ask the questions or ping them off of you. So actually, what I'm reading right now, it's not out yet, but it's really interesting, which is Van Eyper-Saud, who probably be right around the time of this episode, I guess, or now we've recorded around that time. And he has a book called, Ballignant, which is really interesting, and gets into public health policy and cancer. It's funny about the books that you reread. There's like a teleb quote.

It's funny. He's now like the, I would say Einstein or Lincoln, but he attribute all these kind of quotes to him. He has a lot of aphorisms. Is it better to read five books or to read one book five times? I think it depends on the quality of the book. Asra Raza is another guest on the podcast hasn't come up yet.

That's right. Yeah. First cell will be talked to him very soon. That looks like a great book. I'm waiting when you had Sid Mukherjee on to he talked about a PBS that they're going to do another follow up, which is not a book. But for that podcast, I went back and I read the gene and the Emperor of All Malatites and the three laws, which is like a, I guess it's a Ted book.

It's almost like a Ted talk in a book, and that is really, really interesting. And you went into each law in depth there. My thing is I usually go in the sauna about an hour a day, and I either print out a stack of papers that I want to read for research or just read a book in there So I should probably just write all the put these down in a spreadsheet and see what I'm accumulating as far as reading but a bunch of it has been on the podcast prep I also read that stillness is the key which I found that's definitely worth reading again. I've got a bunch of others, but we'll move on That's definitely worth reading again. I've got a bunch of others, but we'll move on. Baby aspirin and the use for prevention of blood clots or thrombosis during a flight.

Yeah, so I used to be of the mindset that anybody who was on a flight, on a long enough flight, should be taking a baby aspirin for prevention of deep vein thrombosis. taking a baby aspirin for prevention of deep vein thrombosis. And I just sort of assumed that that was the case. I mean, it's widely understood that baby aspirin or aspirin in general inhibits platelets and platelets, of course, are one of the cellular matters in blood that's responsible for clotting. So it just struck me as sort of reasonable.

And then, I don't know. Again, maybe about a year, year and a half ago, kind of did a little digging into this and found that there really wasn't much evidence that aspirin or baby aspirin had any efficacy in mitigation of deep vein thrombosis, especially on an airplane. And in digging around, we sort of found that,

well, the gold standard would of course be heparin, which could either be fractionated or ultra-low molecular weight heparin. But these are not very practical. I mean, intravenous heparin is obviously not something you're going to do before a flight. And even the low molecular weight heparins have to be injected. So we found a couple of supplements online. One was called FlightTab, I think. I think it was F-L-I-T-E tab. At the time, you could buy it on Amazon. I haven't looked in a while to see if it's still there. But it was a pretty potent agent that actually had pretty remarkable evidence that it prevented DVT. And then the

other is something that is also pretty easy to get over the counter called nata kinase. And I think that the nato is a plant that's plant derived. I think it actually kind of, it's like sort of a sort of stinky odor is sort of the types of foods that it occurs in naturally. There are certain types of mushrooms or, you know, cheeses or things like that. But these are things that actually turned out to have far more evidence. And they were both things I'd never heard of until we sort of really dug into this question. So that was a bit of a humbling experience because you think, well, look, on first principles,

aspirin's got to be thinning the blood, it's got to be good for this. And then you realize, well, wait a minute, when you, even something as simple as that, when you actually really antagonize the literature, it turned out not to be the case. And the things that did seem to have some efficacy or things I'd never even heard of. It's a little scary because it makes you wonder how many times is that happening throughout the course of my life. Yeah. This sounds apropos. In terms of strong convictions held loosely, you're feeling on generic drugs. Obviously, Catherine Eben was a guest there. What do you think prior to that?

Some of the stuff that you were seeing, I guess the clinic, or at least some of your patients, and taking generic's? Yeah, I mean, Catherine's podcast is, I mean, it would be hard to say that that hasn't been one of the 10 most important podcasts that we've done in this first hundred. If you haven't listened to that, I suggest you just hit pause on this now and go back and listen to it. What number was it? You know? You can search eBEN, eBAN, and your podcast player and it'll show up. But I think prior to that, my view had always been generics are great. They're the exact same as branded, except they're a fraction of the cost and branded drugs are a scam.

That was sort of my default thinking all through medical school. I'd say in the last couple of years, I began to wonder if maybe there were a couple generics that weren't great because in the case of certain drugs where you do have a very clear biomarker for use such as a statin, you put a patient on crest ore, but of course they don't get crest ore, they get rezoovistatin, and you look at their blood level two months later, and there's no change in anything that you would expect to see a change in.

And when you query them, they tell you they've taken it every day, and you believe them, because there's nothing they need to lie. They can easily say, I forgot if they did. You see a couple of those things and you start to wonder if maybe not all generics are created equal. But then of course, in the discussion with Katherine, I came away thinking, oh boy, this is a totally different way of doing things.

And it's frankly, it's completely changed the way we do things in the practice now. So we work primarily with one pharmacy that will either at our insistence or the patient's insistence only issue branded drugs, sometimes even when it is a little bit costly. And when we do generics, we do it through the lens of looking at the companies specifically that make them, and at least taking a first order pass at cross referencing that with sort

of an FDA list of potential bad actors. So, I don't think that has completely mitigated the problem, but I think it's probably taking care of three quarters of it. Another one, this one is a mega-three fatty acids. Your thoughts on that? And obviously Bill Harris is somebody who came on the podcast recently So Catherine Eban was number 71 this for that was in September of last year and Bill Harris Was in December of last year and he came on and talked about

Omega-3 fatty acids So what's your take on Omega-3 and how's it changed? This is funny. I think I'm still sort of in my evolution on this. I mean, I think I've Longly held the for a long time held the view. Longly is that even a word? Did I just make that up? Longly have longly held the view. I have for a long time held the view that EPA and DHA are beneficial. Obviously had some questions as to again, how much of it was the other things that you got when you ate things that were high in EPA and DHA versus just a supplemental thing?

I would say that my thinking has evolved to the point where EPA and DHA by themselves are quite potent drugs. I mean, we really ought to think of them in that way. So that in fact, you look at a drug like Visepa, which is just pharmaceutical grade EPA at the tuna for grams. I mean, that is as potent as any anti cardiovascular disease drug that we have. So clearly EPA has a benefit to it, especially in patients that are at risk for cardiovascular disease. I think with DHA, the clinical trials data are still not clear.

There's a pretty interesting setback on a clinical trial in the fall that was looking at a combination of EPA DHA, and it was a trial that was stopped for futility. So there was no harm from it, but there wasn't the big bang benefit that we frankly expected to see based on the earlier trial with Viseppa, which is just EPA. I think the discussion with Bill Harris certainly increased my level of confidence in the necessity of EPA and DHA and also probably drove me to a point of thinking about it being a higher level that we should strive for. We used to generally look at an RBC or red blood cell membrane level of about

8% to 10%, but I think I came away from the discussion with Bill Harris thinking we could really push that up to 12, 14% without undesirable side effects and also getting more value or more benefit from it. I think one area that Bill had a very strong conviction on that I've also, I've kind of had the opposite conviction to, so I think I'm still in the space of wanting to learn this. So I think my strong conviction had generally been that excessive amounts of omega-6 polyunsaturated fatty acids or poofas were generally not a good thing. And the associative data there is not hard to understand. But again, the problem with the associative data is things that are full of omega-6 poofas

are often crap. So it's easy to see an association with high omega-6 polyinsaturated fat and disease, chronic disease. But Bill's point was that the omega-6 polyunsaturative fats aren't harmful. It's just that diets that are rich in them tend to be void in EPA and DHA. So his real takeaway was don't think about Omega-6 polyunsaturative fats. You just need to add more EPA and DHA and that's the issue. And so I think you and I have been talking about this actually over the past couple of weeks,

but I think I'd really like to go back and do a podcast that looks specifically at the Omega-6 polyunsaturated fatty acid discussion and really kind of dive into the whole Pufa literature from an Omega-6 standpoint. Because again, this is a very polarizing topic. People just on both sides of this, both sides, I think, have people that I think are quite bright. So I'm a bit confused on that. And for me, it's not

really a huge issue personally, because I just don't gravitate towards those oils. Like I find them to be kind of gross, and I don't know why you'd want to consume. Like I wouldn't ever, it wouldn't occur to me to put canola oil on a salad when I could put olive oil on or in something like that. So on a personal level, I think the point is somewhat moot, because N6 poofa don't make up much of my diet. But I do think it has huge implications for public health, and I think it has implications for our patients when we think about people who are potentially eating a lot of poofa. Okay.

One question here, one theme in recent episodes, not overly related to medicine, has been the idea of saying no. I think of Jason Fried, Rick Elias, actually probably Jason Fried twice, I've talked about this thing and how you viewed this sort of in the past and now today, this idea of saying no. How good you are at it when you think it's applicable and if you've improved on this. I've definitely improved on it in the sense that there was a day when I couldn't say no or wouldn't say no to anything or anyone.

The pendulum was pretty far off on one side where I was basically on a treadmill of sort of saying yes to anything and everything that was asked of me, began to realize that I just couldn't do that anymore. And I'm getting a lot better at saying no. And I don't think I'm doing it at a level that's unhealthy either. I mean, you can obviously take these things to far extremes on both sides.

And you could sort of say no to everything and become sort of dysfunctional in that way. It's hard to do. It is hard to do. It is hard to do. And I remember, there was a podcast that, there was someone that Tim Ferris had on his podcast. God, I want to say like a year and a half ago, I forget the name of the person, but hopefully,

we'll find it for the show notes. It was a really good episode on saying no. And I remember that was actually the first time I started really contemplating it. And I remember shortly after listening to it, I had someone who I really liked respected, called me and said, hey, I really like you to be on the board of such and such. And I mean, deep down, I knew it was going to be a pain in the ass. I knew it was just going to be so much work.

And even just the travel of getting to the board meetings was like wasn't in a place where there was easy access and all those other things. And I remember like thinking, I just got to do this. I just got to do this. And I remembered one of the lessons in that podcast was don't answer, just say, can I get back to you? So I pulled the, can I get back to you on this? And then with the benefit of a little bit of distance, I realized Peter, you're crazy. Like you can't possibly do this thing. You already lament the time you don't get to spend at home.

So then the next day I just called him back and said, hey, I can't do this. I'm sorry, but here's why. And just like this person in the podcast with Tim said, the guy understood, it wasn't like I'd committed some grievous, heinous crime and declining this. So I think that's just an important thing to remember.

And yeah, I continue to look forward to refining my no-saying skills. It's interesting. I think it's always hard for ourselves to do it. But then when you think in the context of how you work and operate with other people or decision-making, you'll very easily say no. If it's whether it's like having more patients in the practice, if it's not going to benefit

what you have going on, then you're usually very matter of fact, but I think it's almost like a, it might be like the ego getting in the way or something where you just, you want to tackle everything. I mean, I think it's, this is probably a little cathartic, but it's getting into some of this research where you'll have to tell me know as far as the The deep dives and the rabbit holes that I want to go down where I say like we're just we're on a mission I don't want to give the milk analogy, but for a lot of these episodes and a lot of the guests a little bit of the deep diving can help But I oftentimes it's really about the stuff that you say no to help shape the things that you actually are focusing on

day-to-day that matter. Yeah, that's the insight that you actually are focusing on day to day that matter. Yeah, that's the insight that I think Jason Fried brought to his episode really well, which was when you're saying yes to something, you're actually saying no to something else, you just don't know what that something else is yet. That's a very important insight. And again, I would, anybody who struggles with saying no, I think would benefit greatly from actually both episodes with Jason, because I think we touch on them in both Yeah

Yeah, it's funny. I think at Tim Ferris just himself talking about saying no in his evolution He's probably done his own podcast talking about that and I always think of I do a lot of reading on Charlie Munger and Warren Buffett But if you look at their schedules, they're like practically empty. I think Munger refers to himself as like a book with legs that all he does is he just reads, and that's how he gets smarter. And so he jealously guards his time. You would look at the schedule and you'd say, oh, it's wide open, it looks like,

if you're the secretary and say, yeah, it looks like a schedule's wide open. Nope, it's more about saying no and what that schedule can be open to if you have all those vacancies there. Yeah, I have great envy for that. And I hope to one day get to that point where my calendar doesn't look like it does now. And it's much more last minute things that are being scheduled where you can actually say like, hey, do I want to have this meeting tomorrow as opposed to,

do I want to have this meeting in three months? So I think maybe one more question if you want to take it. I know this one is difficult because it's like, what is the thing? It's like asking you, like which of your children is your favorite. But as far as the episodes go, do any of them stand out in your mind? Maybe even just like the style or the way it's happened or separate question, as far as just doing a podcast, hosting a podcast and interviewing people and having conversations. Are there things like going into this that you thought? I mean, part of it was like you never wanted to do a podcast and interviewing people and having conversations. Are there things like going into this that you thought? I mean, part of it was like you never wanted to do a podcast. And now I think that you might have a different opinion about that.

So how about that strong opinion? Maybe a little more loosely held today as far as doing a podcast. Yeah, you're absolutely right. I mean, I think the first time the idea of a podcast was floated to me, it was about 2014. And I mean, it was the worst idea I ever heard. And it was mostly due to a fear of the amount of work that would go into it, because at the time I knew a few people who were doing podcasts, and it was sort of the only thing they did. It was like, well, that's a non-starter. I just don't have the time to do something where it's the only thing they did. It was like, well, that's a non-starter. I just don't have the time to do something

where it's the only thing I'm doing. So it's just not gonna happen. And I sort of kind of kept that point of view, frankly, until about two years ago, when we, or maybe a little less than two years ago, actually when we decided to give it a try. So yeah, that was a very strongly held, or strong conviction.

Fortunately, loosely enough held that I was able to sort of get out of my own way on that. And, yeah, I really can say that I have enjoyed it a lot. It is hard. It is a little more work than I thought. But also, we have such a big team that works on it that I have it easier than probably a lot of people who do a podcast and that I have a great research team. We have two people that work exclusively on the podcast in Travis and Nick. So all the heavy lifting of making show notes and things like that, None of that falls on my shoulders. So all I really have to think about is having discussions with people

and trying to think of topics that I want to meet people who can speak to those topics. So I've loved it. And it's hard to believe we're at 100 because you sort of realize there's not that many podcasts that sort of get into the territory of multiple hundreds of episodes. And I mean, barring someone for seen thing.

We're gonna one day be that podcast that's on our 300th episode or something crazy. Now, to your first question, honestly, I just thought about this a lot and I do, I get asked this question a lot, Bob, which is what is my favorite episode? And I just, it's so hard because they are so different. There are some that I've really enjoyed from a technical standpoint. I think the Rick Johnson podcast and the Keith Flerity podcast really stand out to me as podcasts that I have gone back

and listened to several times because of the technical content in them. So there are probably half a dozen that are like that for me where they're just just so much interesting information that I can't wait to go back and listen to them again, which I don't listen to most of the podcasts. I think on the other side of the coin there are experiences for me like interviewing Damon Hill was just unbelievable and just to have him be so open and so believable. And just to have him be so open and so just available to talk through his own difficulties and obviously everything that went into his career and beforehand. That was a really special episode for me as just a fan of his and such a fan of F1 and obviously

a fan of Senna who was his teammate when he died. I thought the Rick Elias podcast really, even though I knew Rick really well and there was nothing we talked about that I didn't know, but I just, as it was unfolding and we were having the discussion, I remember thinking, you know what? I think a lot of people are gonna really benefit from this episode.

I know I was. And then we've already touched on some, but you look at the Catherine Eben podcast, which is just an unbelievable opportunity to, I think, help people with information, which is also kind of part of the itch that we're trying to scratch here. So the irony of it is, if I sat here long enough, Bob, I could tell you something special about all 99 that came before this with the exception of the AMAs.

I could probably rattle off something special about 80 of these podcasts through the lens of one or more filter. Yeah, I'm going to bring Tom Brady into the podcast. I mean, it's probably a record as far as how I'm along I've waited. I think he's often asked the question, what's his favorite Super Bowl ring? And he says the next one. So I think maybe you think about that with the episodes, what's your favorite episode? Might be the next one. For me, I mean, that's how it is for me. I like reflecting on these episodes, but the research that goes into these guests and I think we just have

a lot of similarities as far as our interests. So for me, for me, for you, to be creating the podcast that you would want to listen to, having Zee Dog, who's your buddy, Stanford, from Zee Dog to Marty, is it McCarrie? Macarrie. Yeah. Macarrie. I usually say Macarrie. To Mark Messier, to say like, why hasn't somebody sat down

for a multiple hour podcast with Mark Messier? And just talk about the Oilers, one of the greatest teams, if not, I'm sure you would say, maybe the greatest team ever in any sport. I mean, that stuff to me is so cool. Yeah, I think about it that way that it's similar. It's I could talk about each one of them and how great they are, but I'm hopefully looking forward

to the ones that come too. Well, I mean, I am as well. I think we're, I just, I know we're getting better at this. And I remember having, I think I maybe mentioned this once before on a podcast, whether it was ours or someone else's that I had this little tiny fear when we started that we're going to run out of things to talk about and run out of people to interview. And I was sort of reluctant to start this thing and then realize, well, after 50 episodes,

there's nothing left to do. And I think you can attest to the fact that our list of people we want to have on is growing at the same rate as our AMA list of people we want to have on is growing at the same rate as our AMA list of questions. Like, we can't interview people quick enough at the rate that we want to learn stuff. So I have a feeling we're going to be able to do this for a very long time and I do look forward to getting better at it. It is a craft and it's hard.

I do try to listen to some of the podcasts to learn from them and I've certainly picked up a number of things I could be doing better. And as I think I talked about on Tim's podcast, I enjoy listening to other really good podcasts for some insight into how to do this thing better. But anyway, I'm excited about it and it's hard to imagine what the next hundred have to hold actually. Yeah, well, I'm looking forward to it. I think maybe we'd cheer, have some champagne or you can wrestle a centenary and to commemorate the moment. I'm sure you probably have that on your schedule anyway. Yeah, I've got a little bit of centenary in boxing this afternoon.

Yeah. Well, Bob, this was a good idea. I don't know if it was your idea or next idea, but maybe both of you guys deserve credit for this, but I think this was a fun way to commemorate a hundred kind of looking back and looking forward. Absolutely. Thank you for listening to this week's episode of The Drive. If you're interested in diving deeper into any topics we discuss, we've created a membership

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