The Rich Roll Podcast - Peter Attia, MD On Becoming a Centenarian Decathlete, Metabolic Health & All Things Zone 2

Episode Date: August 1, 2022

Healthspan extension may pique your interest. But it’s the obsession of today’s guest, a physician and engineer focused on the applied science of longevity to reframe and improve how we live while challenging all we’ve been previously taught about the interaction of health, human performance, and medicine. Meet Peter Attia, MD. Peter’s current practice deals extensively with nutritional interventions, exercise physiology, sleep physiology, emotional and mental health, and pharmacology to increase lifespan (how long you live), while simultaneously improving healthspan (the quality of your life). Today’s conversation, the first in what I hope to be many, focuses on the following specific topics: Longevity. From a holistic perspective, discussing the physical, mental and emotional pillars required to erect the foundation for a long life well-lived, including how and why he is training (as all us of should be) for what he calls “The Centenarian Decathlon”. Metabolic health. What this actually means, how to optimize it, and the role a Continuous Glucose Monitor (or CGM) can play in engaging you with your own metabolic health. Strength, mobility and brain health. Zone 2 training. What it is, how to do it, and why it’s important. Peter is an utterly fascinating human with a clear grasp of science and how to effectively communicate it. I hope you enjoy this exchange as much as I was honored to host it. Watch: YouTube. Read: Show notes Peace + Plants, Rich

So in about 2018, mid-2018 was when I really decided I was 100% all in on my centenarian decathlon. Not just sort of in name, but the sort of the ethos of this thing, which is I am no longer making any concessions. I'm really looking forward to kind of spending the rest of my life trying to figure out how to be a healthy, productive, kick-ass 90-year-old. My insight is how you combine all of these things, right? It's how do you think about aerobic base, anaerobic peak, stability, strength, and how do those things matter when you're 90? And what's the standard we should hold ourselves to? Like, what's a realistic aspiration for someone in their marginal decade, which is the way we talk about the last decade of your life?

For me, that is the sort of defining principle of healthspan, is sort of understanding cognitively, physically and emotionally what you want in the last decade of your life and making sure that you work backwards from there. The Rich Roll Podcast. Longtime listeners know well that longevity is a recurring theme on this podcast. And by longevity, I mean healthspan. How can we, what practices can we adopt to live longer, live stronger, be more agile, more cognitively fit, and simply better than previously thought possible. If like me, this piques your interest, then you are in for a treat because this terrain is the absolute obsession of today's guest,

Dr. Peter Attia, who is a physician focusing on the applied science of longevity to reframe and improve how we live while challenging all that we've been taught about the interaction of health, human performance, and medicine. Peter is a graduate of the Stanford School of Medicine. He trained for five years at the John Hopkins Hospital in general surgery, where he was the recipient of several prestigious awards. He also spent two years at NIH as a surgical oncology fellow at the National Cancer Institute, where his research focused on immune-based therapies for melanoma. And currently, in addition to his medical practice, Peter hosts the DRIVE podcast, to his medical practice, Peter hosts the Drive podcast, which dives deep into all facets of longevity, health, and wellbeing. It's really fantastic. I rarely miss an episode.

Peter is incredibly smart. He's truly innovative in his practice. He is a relentless self-experimenter. And on top of all this, he's also an accomplished endurance athlete. He's among the very few who have swum the Catalina Channel in both directions and is also the first person to double cross the Maui Channel, which is 28.3 kilometers, a 28.3 kilometer swim from Maui to Lanai and then back. In other words, this is a guy after my own heart. And today's conversation, the first in what I hope will be many, focuses on a few very specific topics. First, zone two training, what it is, how to do it and why it's important. We also discuss longevity, no surprise, parsing knowns from unknowns,

hyperbole from evidence-supported facts and practices. We talk about the importance of mobility, strength, and stability, and why we should all be training for what Peter calls the centenarian decathlon. Finally, in addition to a few fun miscellaneous tangents, we cover quite a bit of ground on metabolic health, what this actually means, how to optimize it, and the role that a continuous glucose monitor or CGM can play in engaging you with your own metabolic health. Peter is a fascinating human. This conversation could have literally lasted all day. I loved it. And I think in addition to finding this one just super highly educational,

you're gonna discover a treasure trove of practical, actionable takeaways. I'm pretty certain are gonna improve your current and future wellbeing. And it's all coming up after a brief word from the sponsors who make this show possible. We're brought to you today by recovery.com. I've been in recovery for a long time.

It's not hyperbolic to say that I owe everything good in my life to sobriety. And it all began with treatment and experience that I had that quite literally saved my life. And in the many years since, I've in turn helped many suffering addicts and their loved ones find treatment. And with that, I know all too well just how confusing and how overwhelming and how challenging it can be to find the right place and the right level of care, especially because, unfortunately, not all treatment resources adhere to ethical practices. It's a real problem. A problem I'm now happy and proud to share has been solved by the people at recovery.com, who created an online support portal designed to guide, to support, and empower you to find the ideal level of care tailored to your personal needs.

They've partnered with the best global behavioral health providers to cover the full spectrum of behavioral health disorders, including substance use disorders, depression, anxiety, eating disorders, gambling addictions, and more. Navigating their site is simple. Search by insurance coverage, location, treatment type, you name it. Thank you. I really do. And they have treatment options for you. Life in recovery is wonderful. And recovery.com is your partner in starting that journey. When you or a loved one need help, go to recovery.com and take the first step towards recovery. To find the best treatment option for you or a loved one, again, go to recovery.com. To find the best treatment option for you or a loved one, again, go to recovery.com.

We're brought to you today by recovery.com. I've been in recovery for a long time. It's not hyperbolic to say that I owe everything good in my life to sobriety. And it all began with treatment and experience that I had that quite literally saved my life. And in the many years since, I've in turn helped many suffering addicts and their loved ones find treatment. And with that, I know all too well just how confusing and how overwhelming and how challenging it can be to find the right place and the right level of care, especially because unfortunately, not all treatment resources adhere to ethical practices. It's a real problem.

A problem I'm now happy and proud to share has been solved by the people at recovery.com who created an online support portal designed to guide, to support, and empower you to find the ideal level of care tailored to your personal needs. They've partnered with the best global behavioral health providers to cover the full spectrum of behavioral health disorders, including substance use disorders, depression, anxiety, eating disorders, gambling addictions, and more. Navigating their site is simple. Search by insurance coverage, location, treatment type, you name it. Plus, you can read reviews from former patients to help you decide.

Whether you're a busy exec, a parent of a struggling teen, or battling addiction yourself, I feel you. I empathize with you. I really do. And they have treatment options for you. Life in recovery is wonderful, and recovery.com is your partner in starting that journey. When you or a loved one need help, go to recovery.com and take the first step towards recovery. To find the best treatment option for you or a loved one, again, go to recovery.com.

All right, let's do the show. What years were you at Stanford? 85 to 89. You were a flyer? I was 200 butterflyer. And it was a dream come true to be on that team. Pablo Morales, Jeff Kostoff, Anthony Moss, like Pablo and Anthony being number one and number two

in the world at the time, Jay Mortensen. I mean, it was an incredible unbeatable lineup. And just to be training in like Pablo's lane, like chasing his feet was like, I can't even believe I'm here, but not the ideal regimen, you know, for me to reach my potential, I think. And, you know, Skip is a complicated character. So I've spoke about it at length on the show.

My favorite coach is John Urbanchak from Michigan. I don't know if you've ever met him. I did, I got to, you know, so Ed Moses was a friend of mine. I know, I grew up, we were on the same club team in DC. Oh, no way. Yeah, I mean, he's so much younger. Yeah, yeah, yeah. So in 2012, when Ed was trying to come back to make the Olympic team,

we'd become friends because we met at Masters. Right. And at that, like once I started transitioning from like ultra distance to pool, I realized the only thing I could swim was butterfly. So basically it was like, I'm gonna swim butterfly in IM. That's unusual.

Usually that's the thing people can't do. Yeah, and it's totally random. It was like, you know, cause I used to swim masters and all I would do is swim freestyle freestyle. When they were doing IM, I was just swimming freestyle. And then one day I was like, you know, for reasons we can talk about,

I just decided I'm not gonna swim ultra distance anymore. I was like, well, I might as well start doing all the stuff that they do. And all of a sudden, like we're swimming breaststroke and it's like swimming as fast as all the lane one kids. Wow. And then the coach was like, dude, do that again. And he was like, oh yeah, this is your stroke.

This is what you should have been doing all along. It's just kind of, it's like, it's all about the length of your femur, the flexibility of your hips. Like it's just, it's a weird stroke. That was the one stroke that I couldn't and still can't do. It's, I don't think you make breaststrokers.

I think you're born a breaststroker or you're not. So I also grew up with Mike Barrowman who went on to Olympic Glory in the breaststroke and was part of revolutionizing stroke mechanics at the time. I used to watch the videos. Yeah, incredible. And his coach, Joseph Szabo.

Oh, I didn't know. Yeah, who is a Hungarian guy who really pioneered like the new way of swimming breaststroke. And we were just watching the world championships the other day here at the studio that's going on in Budapest right now. And watching the breaststroke, it's just, it's like a completely different.

Totally different stroke. Yeah, yeah, yeah. And the training the breaststroke, it's just, it's like a completely different. Totally different stroke. Yeah, yeah, yeah. And the training, I mean, it's unbelievable how different the training is now compared to my era. I mean, I grew up in a period where it was just all about volume, you know, two hours in the morning, two hours at night. I mean, my high, I wanna talk about

your insane high school regimen because I had my version of that, just I'm gonna outwork everybody. Yeah, all in the water. And I learned kind of early and often that I wasn't the most talented kid, but I could bridge that gap by just outworking everybody. So I was the most reliable person

to show up for morning workout. The coach gave me the key because I was more likely to show up than him even. And I was successful in that regard, but it required just an unbelievable amount of volume and work. And now when I look at the times, especially world records that are being broken

by like 17 year olds, I'm like, how is this possible? The times are so much faster than anything I could have possibly even conceived of in that time. And my only sense of how that's possible is huge strides in training methodology. For sure. And I got a taste of that. I've dropped in from time to time at USC and trained with post-grad kind of Olympic crew there,

like Ryan Lochte and guys like that. And I didn't even know what was going on. Well, Urbanchak was coaching on the days that I went because I wanted to go see him. I think Dave Marsh was there as well. And I didn't even know what was happening. It was all about power off the wall, speed, explosive speed. Like we were just doing wall work the entire time

and putting like mesh bags around our feet. And I was like, I can't do any of it. Like what happened to like 20 times 200 was like, I can't do any of it. Like what happened to like 20 times 200, you know, stuff that I used to do. Well, to your question about how I met Urbana Check, it's so I just like kind of lopped onto Ed's feet. And I was like, hey dude,

can I come to whatever practices you're doing? And he's like, yeah, sure. It's like me and four other professional swimmers. And I was like, great. And John was like, yeah, cool. So they would do two a days and I would watch morning practice, film, study, and then I would join the afternoon practice in my own lane. And yeah, I mean, look, it was lots of 75s,

lots of 50s from the middle of the pool too. Right. Right. So 50 breast from the center of the pool, dead stop, go boom back. So I just, and then sort of, I became just so obsessed with that, that I kind of brought that back to our master's program. And I was like, look guys,

would you guys be willing to do kind of the workouts, like the best in the world are doing it. Let's do it one day a week. Let's pick Sundays and we'll kind of do our own workout. Right. And it's, I mean, they're very hard workouts. Was that when you were living in Southern California? Yeah, in San Diego.

So I swam at Mission Valley Y. Right, interesting. Was not there a spark to like compete in masters then once you realized like you were a breaststroker? Yeah, for about a year and a half I did and loved it. Totally loved it. And then, you know, basically just the cross training I was doing on the bike got me a little more excited

about being on the bike. And also kind of, I think part of what was so fun about the master's program is what a tight knit group we were and we loved competing. Like we went to every single meet and it was a bit of a hike for me. We moved further north in San Francisco. So I moved to a different master's club and it was just not like nobody hike for me. We moved further north in San Francisco. So I moved to a different masters club

and it was just not, like nobody wanted to go to meets. It was just, people were there to exercise, which is fine, but there wasn't any of that kind of like, we're gonna compete. And so then swimming for me just became kind of a back burner thing. And then that's when I really picked up the bike, which was about 2012.

Yeah. When I was living in San Francisco, I would picked up the bike, which was about 2012. Yeah. When I was living in San Francisco, I would swim with the USF masters. I mean, that was a pretty hardcore group at that time. I don't know if it still survives to this day. You know, when I was in the Bay area, I swam at Stanford until I kind of got, are we recording? Yeah, we're on.

Okay. Yeah. I got a little bit of trouble at Stanford. And then I switched. Why is that? Because Dick Jokums would come to the practice Okay, yeah, yeah, yeah. I got a little bit of trouble at Stanford and then I switched. Why's that? Because Dick Jocums would come to the practice to coach me. And because he knew, like I wanted to do ultra distance swimming.

So I'd be at the Stanford master's practice and Dick would be standing there giving me instruction. And afterwards, the Stanford master's coach, understandably, was like, dude, you can't have Dick standing here. Right. And I was like, all right, well, I'm gonna go swim at Menlo.

It's sort of classic at TIA though. Like you're gonna do an end run around whatever the protocol is. Yeah, yeah, yeah. So in deference and respect to the program, I went and joined Menlo and they were totally cool. It was a much more mellow program. Yeah, yeah, I know some of the people there, that's cool.

But they were like, yeah, we don't care what you do. Well, what's interesting is you picked up swimming later in life. It's a very difficult thing to do for most people. And then distinguish yourself in some pretty impressive open water performances. I know that you're like, you downplay it and all of that, but are you not like the only person,

you were the first, right? I'm sure other people have done it, the double Maui channel crossing. Yeah, although I have to be honest with you, I found out a few years later that there might've been somebody who did it earlier, but I don't know the details of it. But at the time it appeared I was the first to do it.

Yeah, I mean, that's no small feat. I mean, look, I think you have to put feats in different categories, right? I think many more people could have a potential to do something where the challenge is just, can you grind it out? Then the number of people that have the potential to say, be the fastest to do something.

I think those are just two different things. Right. If you're willing to put in the unbelievable amount of time to prepare for something like that, it's doable essentially is what you're saying. Absolutely, it's just about putting your head down. And actually the challenge with the Maui swim is I want it to start at midnight.

So originally my plan was to do something even more audacious was to go Maui, Lanai, Molokai, Maui to swim the triangle, which is a 30 mile circuit. But there's no way you could do that if you didn't start at 10 o'clock at night because you can't be out there during the trade winds. It's just unswimmable. And the boat captain, who's a great captain,

said, there's just too many tiger sharks out here. And when we put a glow stick on your suit, which we have to be able to do to be able to see you, you're just gonna be chum. So he's like, I can't let you, you're just gonna be chum. Yeah. So he's like, I can't let you start before 5.30 in the morning. And that kind of limited how long I could be out there.

So then I said, okay, well, let's do this double, which is still a great swim. Yeah. I mean, there's pretty regular shark encounters during the Maui Channel swim that they do every year. That's primarily like a relay race that they do in conjunction with the Waikiki open water swim.

Like I'm constantly hearing, I've done, I have tons of friends who've done it. It's all fine, but like it's not without its shark problems. Yeah, now there's more sharks in the Molokai Channel. So that channel is really sharky. And I've got a friend who's done that in both directions, got him Forrest Nelson. I mean, that's a tough channel.

That's about 26 miles. And I mean, there's nothing between you and the ocean. So it's, I mean, the water's- It's way out there. Yeah, it's incredibly rough. It's all about the currents with that kind of thing. I just know from doing the Alcatraz swim, it's all about timing the start.

And you can be, you wanna be doing your cross right at the slack in between the ebb and the flow. And the longer that you're out there, the more susceptible you are to the current kind of going out towards the bridge. Yeah, yeah, I mean, I've done Alcatraz a few times and it's actually, I think it's a harder swim to swim into, what's that thing called again, the cove?

Aquatic park. Aquatic park. Yeah, I think it's harder to swim into aquatic park, even though it's a harder swim to swim into, what's that thing called again, the cove? Aquatic park. Aquatic park. Yeah, I think it's harder to swim into aquatic park, even though it's a shorter swim, because you're really threading the needle to get in between those two points. Right, exactly. Whereas when you go to, what's it called, Crissy Field? Yes.

Yeah, that's a longer swim, but it's easy. Because the current starts pushing you in that direction. The current's actually starting to push you in that direction, yeah, yeah, yeah. So you tack straight and you just naturally gravitate towards that finish point. Interesting. In addition, a couple Catalina crossings,

but now you don't swim at all. I mean, I don't swim at all cause I'm three months out of shoulder surgery. So yes, I definitely don't swim at all. Is that the reason though? No, no, I had stopped swimming. But I'm gonna get back to it. I think I'll never do the, I don't think,

I mean, the only condition under which I would do a marathon again is if one of my kids wanted to. When I was in the ocean, last time we were in Hawaii, I think my son was four and we were at the sort of Eastern tip, no, the Western tip of Maui. And you can see Molokai. Right. And he was like, what's that?

And I told him and he's like, he was really interested in that. And I was like, buddy, if you ever decide you wanna swim there, I will come out of retirement and we will do it together. That could be an incredible bonding experience. Yeah, yeah.

Well, this is a good kind of way to segue into one of the main topics that I wanna get into with you, which is this notion of the centenarian decathlon. And I have a very piqued interest in this moment around all of these ideas that have become kind of at the forefront of what you talk about and write about through my own experience

of dealing with lower back pain. Suddenly I'm in a position where I can't run without pain. And even if I'm on the bike for more than a couple hours, my back becomes intolerable. I've got an L4 that's kind of out of whack and sciatic pain. So I was like, all right, well, I'll swim. I'll get in the pool. This should be supportive.

And I signed up for the Key West 20 kilometer swim, which was just this past weekend with the intention of competing in that. But when the yardage started to stack up around six or 7,000 yards per workout, like my back just couldn't deal with it. And I don't know if it's the- Was that in open water or with flip turns?

Well, it was, no, it was flip turns. So yeah, so I think it's all the turns. Like I just couldn't do a flip turn anymore without pain. And so now I'm sidelined in a way that I haven't been in the history of my experiences of being an athlete. And I'm now compelled out of pain to confront and deal with this situation in a meaningful way. And it's been really humbling.

And so, as I think I messaged to you, like the videos that you're putting up about mobility and like glute activation and all of these things have been like the most important thing in my life as I slowly kind of acclimate to a new way of thinking about fitness through movements, et cetera. So I think it would be instructive to explain how this became of interest to you.

And it's obviously it's part and parcel with your interest in longevity, but maybe kind of walk us through that. I mean, there's a story that you probably know, but I think it might be helpful to just explain an unfortunate reality of our species, which is we tend to respond best to pain. A hundred percent.

I mean, any change I've ever made is only because I've been forced to out of extreme pain. Yeah, so my first brush with that came in my last year of medical school. So it's June of 2000 at our alma mater, right? So I'm just on my bike riding to the gym back when it was the Arriaga Center there. I get off my bike, getting ready to lock it up.

And I'm like, God, something does not feel right in my back. Like a really weird pain. And so bad in fact that I decided, you know what? I'm gonna get back on my bike and ride back to wherever I lived. I think I lived in Escondido Village or something. So I do that. And I'm thinking, you know what? I'm gonna get back on my bike and ride back to wherever I live. I think I lived in Escondido Village or something. So I do that. And I'm thinking, you know what?

I'm gonna be fine. I just need to kind of rest today, which is very unusual for me. Like I'm not that guy who takes a day off. Well, the next day I can't actually get out of bed. So I actually call my roommate with two separate lines. I'm like, dude, you gotta get me up. And to make a long story short,

that transitioned into kind of two weeks of debilitating back pain that ultimately led to what I didn't realize at the time was a free fragment. So a fragment of my L5 S1 disc broke off. It was about four centimeters long and it just parked itself on my S1 nerve root. So now I just had the sensation of skin being peeled

off the bottom of my left foot. So I kind of sucked this up for a week. And then finally the Dean of the medical school saw me limping and he's like, what's going on? And I told him and he said, we gotta get you an MRI now. Took me, got an MRI. The next morning I was in surgery and it was just, everything went wrong.

So it was a botched operation. The guy operated on the wrong side. I came out with a foot drop on the right leg. So my right leg was totally- At Stanford Hospital? Yeah. Wow. So my right foot had a drop. So now I couldn't walk

cause I'm dragging the right foot. This turned into an unbelievably complicated story that I won't bore everybody with. But the punchline is I needed multiple trips back to the operating room to fix this problem. And I was probably three months of only able to lay on a floor or bed. Like those were my only two positions. Mom had to fly down to take care of me, to feed me.

Didn't, you know, went from, I'm not sure I'll be able to be a surgeon to I'm not sure I'll graduate on time to I'm not sure I'll ever walk again. Wow. And then an amazing doctor there, actually a guy who I'd like to have on my podcast at some point, his name is Sean Mackey.

He's a pain specialist. He was kind of the guy that broke the cycle and began the treatments that were, that got me out of pain enough to then do the rehab. And amazingly within a year of that incident, I was at Hopkins standing on my feet operating, you know, as a surgical resident. But that was a, that was like kind of an aha moment. And that's also what led to me getting into swimming. So three years later, when I'm, so that was, I was 28 when that happened. So by the age of 31, I decided, you know, I'm going to mix things up a little bit and try this other thing, swimming.

So that, that experience stuck with me. And I do think of that as kind of the best, worst experience of my life, because it gave me a really close up view of what it means to lose your body. And I think most people, unfortunately don't figure that out until it's too late to do anything about it. And I, I got a second chance. So, um, it, which is not to say that at that moment I conceived of what I'm doing today. I certainly didn't. I would spend the next, you know, 18 years pursuing other performance metrics, but it's never left my mind. And it's now completely shaped how I think about taking care of patients and myself.

What's unique and interesting about you and the work that you do is that you're perhaps the only person in the world, or at least the only person that I can think of that has such an in-depth level of expertise in both performance, athleticism, and kind of the mechanisms behind how to optimize that, and longevity, like how to promote that effectively

through evidence-based medicine and science. And it seems like these two worlds are orthogonal to each other. And you've seemed to find a way to kind of synthesize the best of those. So how do these two worlds intersect? And maybe that's a way to kind of, you know, segue into your kind of real interest

and fascination and longevity. I mean, I think you're astute to pick up on that Rich, not the part of my expertise, because I don't think I actually have much expertise on the performance side, but I think you're astute to pick up on the notion that these are often at odds. And it's for that reason that I get contacted a lot

by professional athletes and by professional sports teams, probably at least once a month, coach of an NBA team or something, or performance, some high you know, performance, some high end performance entity reaches out. And outside of the physiologic sports, like swimming, running, cycling, where I think I do actually have a pretty good sense

of the physiology, especially cycling. That's probably the one that has the least technique and the most pure physiology. That's probably where I would have the most insight, but what it takes to be exceptional there and what it takes to live a really long life, I wouldn't say they're completely orthogonal, but they're certainly nowhere near co-linear.

So for that reason, I just say, look, I'm not the guy to help you achieve those goals. I'm probably the guy to help you when you retire and you wanna work towards a different goal. I would assume though that in the Venn diagram between those two worlds, that the intersection has to do with promoting kind of the longevity of one's career, right?

There are certain things that you can do as a professional athlete chasing greatness. Absolutely. That can extend the link. I'm sure like a lot of the people that reach out to you are in the kind of twilight of their career. And it's like, how can I eke out a couple more years doing this? Well, now we have to open ourselves up to these other protocols. That's absolutely correct. And I think, you know, I have a friend who works most exclusively with kind of NFL guys. And his take is from the day you sign your first contract after the NFL combine, after you've shown everybody

how fast you can run a 40 and how much you can bench press and all that stuff, like you stop caring about those metrics forever. The only metric now that matters is not getting injured. You know, that's effectively going to determine your lifetime earnings. And so it's not really about how much faster can you get, it's how much safer can you continue to run fast,

even if it means running a little bit less. So yeah, you're absolutely correct. And in that sense, look, again, I don't think I'm particularly insightful or brilliant on those. I think my insight is how you combine all of these things, right? It's how do you think about aerobic base,

anaerobic peak, stability, strength, and how do those things matter when you're 90? And what's the standard we should hold ourselves to? Like what's a realistic aspiration for someone in their marginal decade, which is the way we talk about the last decade of your life. And the way that you kind of construct an architecture around how to think and approach this

is by working backwards from a perspective of what your values and your goals are or what you anticipate you're gonna wanna be able to do when you're 90 or 80 or 70, and then working back from there to start doing the things that will put you in a position to kind of have that capacity. Exactly.

We would call it forecasting if you say where you are today. So if you say, okay, I'm 50 today. And when I'm 55, I wanna be able to do this. That works reasonably well for short-term goals. But for really complicated problems, it seems easier to reverse engineer them. And I've borrowed the term backcasting from Annie Duke, because I think it's just a better way to contrast forecasting and backcasting. And I just don't see how you can forecast 40 years. It just becomes too vague. You have to anchor to what you're talking about 40

years out. And for me, that is the sort of defining principle of health span is sort of understanding cognitively, physically and emotionally what you want in the last decade of your life and making sure that you work backwards from there. And again, it literally feeds into everything. Like we'll use an emotional example because that's, people don't think about that.

If your vision of the last decade of your life is to be surrounded by family who love you and wanna be around you, but 40 years earlier, you have no relationships, your kids hate you because you're a jerk and you're working all the time, there's a disconnect. Like, do you really think your kids are gonna be around you in 40 years

if they don't wanna be around you right now? So every one of those things has to have a congruency that comes back. Now with the emotional stuff, it's not as metric driven, but when it comes to the physical stuff, it's very metric driven because we know exactly what these things mean. You know, if someone lays out an aspiration,

you can say, well, that will require a VO2 of this many mils per minute per kilogram. You have to be able, your muscles have to be able to consume this much oxygen per minute. If you actually tell me that you wanna be able to hike up that canyon in that many minutes. If you tell me that you wanna be able to stand up

and do X, Y, and Z, it will require this much strength. And we know the rate at which those things decline and therefore we project back. Right, so typically somebody is gonna say, I wanna be able to play with my grandkids. I wanna be able to go on a hike. I wanna be able to get up off the ground or get up off a chair and get up out of bed

and typical type of stuff. So how do you think about, or basically what are the pillars of this? I know you have buckets and how do you think about, or basically what are the pillars of this? I know you have buckets and how do you think about this? Like, what are those? And then from there, like, what are the things that, somebody of my age or just kind of in the middle age sector of life, what should we be thinking about?

And what are some of the practices that we should be starting to adopt? I mean, we would start by being more specific in the marginal decade. So the one thing we don't know is when your marginal decade is going to be. So I don't, you know, I don't, I can't tell looking at somebody,

is it gonna be 80 to 90? Is it gonna be 74 to 84? Is it gonna be 89 to 99? We don't know when that is, and that does play a role, but I think it's worth budgeting for it being later, because that will force you to hold yourself to a higher standard. But we begin with much more specificity. So we, I think we have a little over 50 questions we ask our patients. And this is absurdly specific stuff. I mean,

and some of it is like things you wouldn't think about, like, do you want to be able to have sex? Right. I mean, because if the answer is yes, like there is a certain level of fitness, mobility and strength that's required to do that. Do you want to be able to walk up this many flights of stairs? Do you want to be able to carry this many pounds of groceries?

Do you want to be able to place something of this weight above your head? Do you want to be able to pick up a child of this weight from the ground? And we just sort of force people to go through that exercise and you check off the things that don't matter to you and check off the things that do. And what that does is it turns into basically a consolidated set of metrics for strength and fitness. And other things that are a bit foreign to people like scapular control, lower leg variability,

a big part of what troubles people when they get older, and it gets mistaken a bit for balance, but a lot of it has to do with not just balance, but with lower leg variability and not being able to kind of feel with your feet very well. And so falls as an example, become an enormous cause of morbidity. I've quoted the stat many times,

but if you're over 65 and you fall and break your hip, your 12 month mortality, meaning the probability you'll be dead within the next 12 months, depending on the study is 30 to 40%. Right, so just starting from that as a baseline, like let's try to not fall or in the event that we do fall, how can we be resilient enough so that we don't like suffer

that type of consequence? Yeah, so there's a whole bunch of things that you work backwards from there. And you'd be amazed at how many people, even in their forties and fifties don't possess, even though they're strong enough to meet the metrics of their 90-year-old self, they already show signs of weakness

in terms of instability in their hips, instability in their knees, horrible patterns of walking, pelvic tilts that are too far forward, all of these things that they can sort of muscle their way through when they're younger, but it becomes problematic later. Yeah, I mean, I check every single one of those boxes

and I was listening to the podcast that you did with Lance Armstrong and you were talking about this subject and he was basically saying, look, look, I just wanna put on my shoes and go run. Like, I'm not gonna do any of that stuff. Like that's 100% me, right? And I did that until I just ran myself into the ground

and couldn't do it anymore. And a couple of things, I mean, first of all, for many years, it was all about power to weight, right? Like I'm doing these very specific movements. I'm swimming, I'm cycling and I'm running. So I had incredible efficiency with certain muscle groups, but I wasn't doing any of the kind of gym work required to be balanced in that regard.

And as a result, I have certain atrophies and I have like misalignment in my posture and all sorts of things that, you know, now I'm realizing are super problematic. Not the least of which is my balance is terrible. Like if I stand on one foot or I try to put my socks on, things like that, like it's hard.

And that was like a huge revelatory moment for me to realize like, there's something terribly awry here. And now I'm on a certain type of protocol. Like you tell somebody you have back pain, like people come out of the woodwork and everybody's got like the person you should talk to, but you gotta pick a lane, right?

So I'm working with a certain PT at the moment. And one of the things that this person is having me do is a lot of glute activation work. And I've only been doing this for like a month, but initially, like I had zero glute. I couldn't even, my brain would signal to that muscle group and it wouldn't do anything. Like that's how bad that situation was.

And now I can kind of do these little exercises that are annoying. And as somebody who's like yourself, like I wanna go out and crush it. Like it's very humbling to kind of have to let go of all of that and focus on these little movements. And again, not to rehash this, but me seeing you do this stuff like on video is like,

okay, well, if Peter's prioritizing this, like I realize this is important and it's given me like permission to really kind of embrace this, but it's been, you know, interesting. And I realized like how kind of much work remains in order for me to really be stable. Look, it took me probably three years of backing off

to then go forward again. So in about late 2018, mid 2018 was when I really decided I was 100% all in on my centenary in decathlon. Not just sort of in name, but the sort of the ethos of this thing, which is I am no longer making any concessions. Cause one of the dirty little secrets is, and I love, a friend of mine, Kyler Brown said this to me,

he goes, athletes are the best cheaters, right? The more you're a grinder, the better you are at cheating your way around bad movement patterns. And, you know, I learned this amazingly with my labrum. So I tore this labrum growing up boxing, multiple subluxations, further exacerbated during my open water swimming days.

I was in a swim race once when I was in full extension and the guy in front of me kicked down, took the whole shoulder out of socket. So this thing's been shredded for at least 15 years. And I have managed to fight my way through it and muscle my way through it by cheating, basically using my rotator cuff to stabilize the humeral head, using my traps to stabilize it.

Now I've developed a whole bunch of horrible patterns around it, but he's like, yeah, that's what athletes do. Right. And so. The downstream implications of that become cataclysmic. Yeah, you have to start to unlearn that stuff. So that's what began for me in 2018.

I mean, and you know how it presented actually was I was getting tennis elbow. And I'm like, it's really odd because I don't play tennis. So that doesn't seem like a likely injury. And that's when I first met a guy who kind of got me on this path using something called dynamic neuromuscular stabilization.

And he watched me do pull-ups. He's like, let me see you do a pull-up. And I was like, dude, I own this baby, watch. Did a million pull-ups for him. And he's like, yeah, it's horrible. Like your technique is so bad. You have no scapular control whatsoever. You are transmitting so much force into your elbows

doing that because you can't keep your scapula in place. Another big aha moment, which actually ties into what you said about the glutes. There is a fundamental difference between having a strong muscle and knowing how to recruit it. And for me, the aha moment came with my hamstrings. I have always prided myself in having just the strongest legs, right?

I mean, you know, cyclists have strong legs. I deadlift tons of weight. I do insane amounts of stupid leg curls, every, you name it, I'll do it. But when I was placed on the floor in a very simple position, laying on your back, knees bent, feet flat on the floor in a very simple position, laying on your back, knees bent, feet flat on the floor, could I, without screwing around in my pelvis,

just pull back with my feet? A pure hamstring recruitment. No, could not. Yeah, I can't do that either. Yeah, couldn't do it. And so what that says is, it doesn't actually matter how strong your hamstrings are, you can't recruit them.

And if you can't recruit them, your pelvis is tilted forward. You have to be able to keep your hamstrings are, you can't recruit them. And if you can't recruit them, your pelvis is tilted forward. You have to be able to keep those hamstrings recruited to keep that pelvis in the right position. I mean, it took me a year of daily, I mean, just grinding away at these movements and this practice. And now it's hard for me to remember what it was like

to not be able to recruit my hamstring. So you can unlearn these patterns, but the irony of it is the more of an athletic background you have, the longer it will actually take you to unlearn because you have more bad stuff. Those neural pathways are so embedded. They're so wired. The good news is you have the reps on how to do stuff.

So I think it's a wash taking an untrained person and teaching them versus taking a highly trained person and teaching them takes about the same amount of time, but for different reasons. Yeah, I mean, the athlete knows how to commit to something and follow through, but the trick is the light bulb moment, right? Which is usually triggered by an injury

that forces them to the mat, right? Yep, exactly. That's the situation that I'm in. So for your centenarian Olympics, like what are the events that you're working towards? Like what are the categories? You know, for me, I think my kids are the greatest source of joy in my life.

So, you know, my hope is that my kids have kids and that we're in proximity to them. And I just get to do the kind of stuff with them that I get to do with my kids right now. So again, it's silly, simple stuff, but again, I'm fortunate that I still have two boys that are young, five and eight. And so I realize to play with them is hard. Like they play on the floor. We're building Lego, we're building tracks, we're pushing trucks, we're doing that stuff. And when I look at, for example, my dad, who's 85, like he can't engage with kids like that.

And a big part of it is my dad's mentally as sharp as a tack. He can't get on the floor. So something as simple as can you get on the floor, spend 30 minutes without your back breaking and get up? Now that takes a lot of intra-abdominal stability. You really have to be able to initiate intra-abdominal pressure to maintain that position. And of course, getting up requires

a whole bunch of coordinated activities. I mean, I have a very lofty aspiration, which if I get there is great, which is I'm gonna be able to get up without using my hands still, which I can do now, obviously. But even if I get there is great, which is I'm gonna be able to get up without using my hands still, which I can do now obviously. But even if I can just do it on one point of support, that would be fantastic.

I love archery. It is such a big part of my life. And even though now I'm pulling a 75 pound bow, I think to be able to pull a 50 pound bow in my marginal decade would be fantastic. I love driving race cars. Now, Paul Newman drove a race car until probably a year or two before the end of his life.

And so for me, that's something that, you know, I would love to be able to continue to do. And that requires not just the strength and the coordination and the mental acuity to do it, you have to be able to tolerate insanely hot temperatures. It gets so hot inside of a race car that you have to kind of have the kind of cardiovascular fitness to tolerate insanely hot temperatures. It gets so hot inside of a race car that you have to kind of have the kind of cardiovascular fitness to tolerate that.

Right, but having clarity about what those things are allows you to then back cast to now and start to build the foundation for that capability. Yeah, like we were talking about earlier. I mean, that's a big part of why I do what you do, which is I do some of my activity, like I rock four or five days a week, carrying a weighted backpack,

but I always do it at like five or 6 PM. So in Austin, that's about the hottest time of day. So it's a hundred degrees, sometimes it's 105, 106, and you got a 60 pound pack on your back and you go walk three miles in the hills, your ability to tolerate heat, you know, you go to somebody's barbecue at 11 o'clock when it's 90 and everybody's dying,

you're like, there's nothing. Right, yeah, you can acclimate to that. You just have to engage with it and confront it. One of the things that you've talked about quite a bit is noticing how natural it is for your children to do all of these movements that then become so difficult for us as adults, because we've unlearned them and our sedentary lifestyles kind of detach us

from our kind of natural blueprint and ability to do those things. So, how can we, as most people listening or watching this probably have to sit in a chair for their work and we're sitting in chairs right now. What are some of the practices that could be adopted to help keep us connected to that natural ability that is kind of innate in our unconscious?

I mean, for me, I've taken a very deliberate approach to that. So four or five years ago, when I got introduced to this pattern of movement called dynamic neuromuscular stabilization. Talk about that, it's super interesting. Yeah, so it kind of grew out of the Czech school. So basically, God, I wish I knew the history better. I've forgotten a lot of it.

About a hundred years ago, a Czech neurologist was trying to understand how kids with cerebral palsy had such difficult times with movements. And he basically formulated a hypothesis, which was during the first couple of years of their life, they were missing out on some developmental milestones of movement.

And when they didn't get those patterns, those neuromuscular patterns weren't developed, they could never, they just, they became hosed movement wise. So he said, well, if we can identify what those are by looking at kids that don't have CP, can we teach them to the older kids with CP? And the answer turned out to be, yes, you could.

So that became the Prague school and that's what they were primarily doing. And then another guy came along, I'm blanking on his name. It might've been Vojta or Vojta might've been the original guy. I can't recall who basically said, wait a minute, this is actually a tool that would be really valuable for prehab and rehab for adults. And so that kind of morphed the Prague School into this field of dynamic neuromuscular stabilization, which we abbreviate DNS. And it's still based in the Czech Republic or in Czechoslovakia, I guess, whatever we call it now. And having now been connected

to a number of these practitioners, I have found this to be one of the most important systems that I've incorporated. So initially my exposure to it was basically to fix problems, right? I was fixed. I had two nagging issues four or five years ago. One was this elbow issue, which again, I couldn't understand what it was causing it until I realized it was inability to localize my and control my scapula. And the other was just my right SI joint nagged. You know, I just had this little nagging pain

in my right SI joint. Not, certainly didn't ever raise to the level of lower back pain, no sciatica, nothing like that. But whenever I deadlifted really, really heavy, 50% of that, 50% of those days, I would be punished with some right SI joint pain. And again, these two things seemed completely unrelated until I got under the hood

of what was going on with my movement patterns. And I realized, you know, like every, whatever I was, 45 year old, I didn't know how to move. So what started out as kind of rehab has then just morphed into life movements. So I do an hour a week in person with a DNS teacher. So a guy named Kyler Brown comes to my house once a week,

we just hammer DNS movements together. And then I'll spend 10 minutes every day doing them on my own. And that has been kind of life-changing. Now, of course, with my shoulder injury, Kyler is overseeing the rehab there. And so we're now incorporating really good shoulder rehab coupled with the DNS principles of getting my scapula

to relearn how to move. Because when you have this type of an injury and you have surgery, the brain really wants to shut off how this thing works. So now we're just kind of basically reprogramming it. So what is an example of a DNS movement or exercise? The first one, I'm trying to understand, visualize it. The very first one is something called

learning how to access intra-abdominal pressure. So, I think most people who think about breathing have a pretty good sense that you aren't just breathing into your thoracic cavity, right? A good breath has to have the diaphragm going down. You have to get into the abdomen. What DNS does is it really explains to you how a child is breathing, which is,

if you imagine the waistband of your pants or your shorts, when a child is breathing, that thing is fully expanding. So they have purely concentric force in their abdomen with every breath. And again, if you look at a really good power lifter or something, you'll see the same thing. I mean, the amount of intra abdominal pressure that they have to generate to be able to move such heavy loads is essential. to be able to move such heavy loads is essential. And so that was literally the very first thing we worked on is just, can you access pelvic floor pressure? Can you create enough pressure into your pelvic floor?

Can you maintain it while you breathe? So that, first of all, it's just hard to do that out of the gate. And the second thing is you can do it, but you're not relaxed. So you have to be able to do that, hold it while you can breathe around it. The next things for me that were very important,

I have a very congenitally narrow C-spine. And if you look at an MRI of my neck, you just, you wouldn't believe what a disaster it looks like even though I've never really had an issue. But I'm being very preventative about it. And so one of the other things I'm working on is learning how to use the deep neck stabilizers. So these are muscles that ride on the back. They're inside, you don't see them. So they're not these scalene muscles that are in front. They're the muscles that sit on the vertebral body, sort of deep in my neck. And it's learning

how to use those muscles to keep my head forward. So I'm not relying on these muscles here. And so that's a lot of movements where I'm on my back. Chin is forward using the cue of the eyes looking forward, which kind of lights up that circuit and using various pelvic positions, arm positions and leg positions in there. So it's very subtle and gentle, but it's more about like, how do I connect the, you know,

my intention and my mind to these muscle groups to get them to just activate. The starting positions are now it starts to get very elaborate. Basically, if you, if you, you know, someone Googles sort of a DNS progression, you'll see how complicated it will get. Cause you're basically walking through the first two years of development.

So the stuff I just described is, is like, you know, is the fetus basically. And you start moving into a three month position, a four month, five months, six month position, where now a child is learning how to roll. Well, they roll in a very connected way. So when they're reaching for something with this arm, they're completely connected across their oblique sling.

And they're gonna initiate that movement and down to their foot. This is the other stuff that was just like, when I look at videos of me four years ago and videos of me now, I just don't know what the hell I was doing before. Like how I was getting away with the nonsense of being completely disconnected,

scapulas all over the place and all that sort of stuff. And here's the other thing, the best athletes in the world kind of naturally do this. That's another thing I've learned is that there are some really exceptional athletes out there who have never once spent a minute learning DNS, but when you look at them, they have somehow managed to preserve

those neuromuscular pathways. And that is essentially a big part of what their athletic gift is. And I would imagine it's pretty good for injury prevention, right? If you have the ability to recruit all of these muscle groups, you're inherently more stable and resistant

to a lot of the injuries that are occurring from those imbalances. Yeah, and that's why for me, it's a once a week, do the lesson once a week, push how much further can I get in those things? And then it's part of what we call our dailies. So we have, for our patients, we program things called dailies. Like this is gonna, you know,

whether today's a zone two day, a strength day, a rest day, you still have your dailies. You got your 10 minutes of daily. So I assume there's practitioners, trained practitioners who can teach this, but are there YouTube videos? Like if somebody is listening to this, I mean, how should they go about researching this or finding?

So I did a podcast with one of the probably six or seven most prominent teachers in the United States, a guy named Michael Rantala. And we have the video of my interview with him and then also a few introductory movements, probably another hour worth of videos we made. And I suspect there's gotta be a ton on YouTube. It's the kind of thing where I hate to say it,

but I do think at least initially you do need an instructor because at least for me, and I think I have decent proprioception and kinesthetic awareness, not amazing, but good. I don't think I could have done it without somebody there to poke and prod and correct. And even today, like I just, I get more out of it when Kyler's there. And even when he's there, he's filming me to this day, filming and commenting so that when I'm doing it on my own, I'm watching a video and I'm listening to his cue. And would you say that that is foundational

and a kind of requisite prior to the work that you do with Beth, what's her name? Beth Lewis. Yeah, Beth Lewis, who's kind of taking you through some more type of kind of movement activation type of exercise. I mean, look, I don't think there's anybody who's not gonna benefit from DNS,

but I also acknowledge that I don't think it fixes every problem. So there's a whole other system called PRI, Postural Restoration Institute, which is amazing at fixing another huge problem, which is when that pelvic tilts forward, the ribs flare up. Like that's a very common athlete problem. Beth has names for kind of Beth has broken people down

into three phenotypes. And I can't remember what they all are. There's kind of the loosey goosey one. And then, but then there's the like locked and loaded one. Right, so that's me, that's Lance. That's, you know, our natural state is chest is up, pelvis is forward. Back is arched.

Back is arched. So excess lordosis and learning how to relax my ribs has been insane. Like the guy who does my tissue work, who's been working on me for, I don't know, probably 10 years, eight years. He's shown me pictures of what my lower back looked like five years ago and I don't recognize it.

Like I didn't, so you have these two, you know, erector spinae muscles that run down your spine. If you look at my erector spinae five years ago and you look at them now, you can't believe it. Like right now my back is just flat. Like there is no bulging musculature adjacent to my spine. And before it was just, that was always on fire. I had these huge muscles running up my back

that were just holding me in that locked position. And that's all from being able to just do this. This is exactly where I'm at right now. It's just, it's so locked up back here. And when I lie flat and I try to do pelvic mobility exercises, it's so incredibly limited. Like that pivot is just, I have no range whatsoever. I mean, you'll get it.

Once you learn to use the hamstrings, once you learn how to activate those hamstrings and we started doing it single leg at a time. I mean, this is where Beth's real brilliance shines is just being able to come up with these exercises. Like, you know, if you just put your foot on a one inch block and elevate the right foot more than the left and take turns with the activation.

I mean, all of those things start to make it easier for you to initially get that signal from your brain to those muscles. But I'm just, you know, look, I wish I learned this when I was 18, but I also realized I was too dumb when I was 18 and there's probably no way I would have done it. Yeah, I mean, it's that kind of age old question,

what would you tell your younger self? But that presupposes that your younger self would be at all open to like any of this type of advice. There's simply no way the younger version of me would have. Well, beyond this kind of realm, when you think about longevity and when we talk about longevity, we're really talking about health span,

like what are the other buckets? And I guess a question that I have is, how does this kind of line up with the ideas of the blue zones and these other kinds of principles that guide how to think about setting ourselves up for longevity success? Well, as you said, lifespan and healthspan are the two vectors of longevity. But I do think most people think more about the healthspan one. And the good news is they're not independent vectors, right?

These are actually not orthogonal vectors. They're, even though we represent them orthogonally on a graph, if you take all of the steps to live a better life, they're just invariably going to also lead to a longer life. Now, there are exceptions to this rule. There are certain trade-offs one might make if you were really purely optimizing on one or the other,

but the overlap is so powerful. So I usually tell people not to worry about it. You know, in other words, if they say, I don't care how long I live, I just wanna live the best life possible. It's like, great, you're gonna live longer, by the way. So I think of them, as I said, in those three buckets, sort of a cognitive bucket,

a physical structural bucket and an emotional bucket. And within that physical bucket, just to kind of round it out, you have everything we've just spoken about, which is the stability component. And that's the foundation. Everything has to be built upon that. And then there were sort of think of like three pillars that stand on the foundation, strength and aerobic base, which is effectively a proxy for mitochondrial efficiency and, you know, exceptional fuel partitioning, and then a peak aerobic, you know, slash anaerobic piece. So kind of think of your VO2 max, your zone two and your strength. And again, I think people have a sort of intuitive sense of what those look like, but you know, the devil is in the details and you know, how much time should you be spending on one versus the other? And it's really kind of a function of how much time does, is one willing

to devote to this craft? Right. I think, you know, I think we, for understandable reasons, probably tell people that they don't need to do that much exercise because we're talking to the average person who's doing none. And it's true that if you're doing no exercise, just getting you to do three hours a week has an unbelievable impact on your life, probably more than anything else

you could tell that person to do. But I would hate for the message to end there because I think if you could do 10 hours a week and it's really well-structured, you could, you know, the sky's the limit for what you could achieve. I wanna put a pin in the zone two discussion. I wanna get to that later and go deep on that.

So maybe set that aside for now and we can kind of parse the fitness aspect of this, the exercise aspect of this. But when it comes to these other areas, the emotional area and the cognitive area, like how are you thinking about practices in that regard? I mean, the emotional area, that gets kind of ephemeral, I suppose,

but maybe we'll start with the cognitive stuff. So the cognitive one really comes down to a very strong overlap with how we think about the prevention of neurodegenerative disease, specifically dementia. And so we think of kind of these three areas of cognition, executive function, processing speed, and memory, both short-term and long-term.

Different forms of dementia will take on a different assault on each of those things. And that's become a very interesting study in the field of neurology. You know, there was a day when we just thought of Alzheimer's disease as a disease. You know, the joke, it's not really a joke, but you know, the joke in neurology is

if you've seen one patient with Alzheimer's disease, you've seen one patient with Alzheimer's disease. you've seen one patient with Alzheimer's disease. So I think we're now starting to realize there's a lot of different subtypes within there, but we also realize that there are some commonalities with respect to prevention. And unfortunately or fortunately, depending on how you think about it,

prevention is kind of our best hope when it comes to that. This is even more so than cancer and certainly cardiovascular disease. We really don't have options for patients once they have dementia. This has been an area of extensive study that has yielded effectively nothing. If we're going to be brutally honest,

it has yielded effectively nothing. There are some treatments that can probably slow down progression, but the reality is you just wanna be in a position where you're addressing this even before we have what's called mild cognitive impairment. So what do we know about this? Well, I mean, what we know is exercise

is the single biggest elixir for brain health. And it's amazing how much more powerful it appears to be than nutrition, even sleep. And those things are very important, but exercise is in a league of its own. And we studied this question extensively about eight years ago. And I didn't, I initially just refused to believe

this was the answer because it seemed too simplistic. I thought there had to be something more powerful. I thought DHA or something else could have had a bigger role. But as important as sleep, nutrition are, too simplistic. I thought there had to be something more powerful. You know, I thought DHA or something else could have had a bigger role. But as important as sleep, nutrition are, exercise kind of takes the cake. And I suspect it's because it impacts so many systems, right?

So exercise is going to impact glucose disposal, insulin sensitivity, inflammation. It produces growth factors for neurons, BDNF. So, you know, you tell a person that the most important thing they can do for their brain health is to exercise. That's where you get into the haste. If you could do three hours a week, that's great.

If you can do seven hours a week, it's even better. Sleep does matter. With sleep, I think we have, you know, the problem of sort of one, do you have pathology? Yes or no, right? Do you have sleep apnea? I think there's a lot of undiagnosed sleep apnea out there.

So we kind of have to make sure we're catching those patients because they don't all look the same, right? The stereotype is somebody with sleep apnea is overweight and they're snoring all the time, but it turns out that there's a lot of sleep apnea that doesn't fit into that bucket. So we definitely wanna catch those people.

And then you get into basically duration and quality. So are you sleeping long enough and are you getting appropriate staging? Nutrition matters of course, but I think mostly as it fits into metabolic health. So metabolic health becomes a very important part of this. And then there's the vascular health piece. So all the things that are kind of good for the heart

are good for the brain. Sure. And that means kind of having the lowest level of ApoB or we can sort of loosely talk about that as LDL cholesterol. The lower that is the better and the more regulated your blood pressure is the better. The brain is a highly vascular organ and it has a lot of the same microvascular structures that we see in cardiovascular disease. the more regulated your blood pressure is, the better. The brain is a highly vascular organ

and it has a lot of the same microvascular structures that we see in cardiovascular disease. So the overlap between cardiovascular disease and dementia is enormous. Sure, and whether it's cardiovascular disease or some form of dementia, these are diseases that are being built, you know, bit by bit for decades.

So we can't start thinking about this soon enough. The earlier in our life that we're adopting the lifestyle measures required to sidestep these things, you know, it cannot be overstated. Yeah. And that's in my view, probably the biggest single failing of our medical system today. What I call medicine 2.0 is medicine 2.0 is largely predicated on addressing a risk once it reaches a threshold. So in cardiovascular disease, we typically use the threshold of 5% at a 10 year forward looking window.

So once your risk of heart attack, stroke, or cardiac death reaches 5% for the next 10 years, you are a treatment priority. And I'll give you an example of why I think that makes no sense. So we know that smoking causes lung cancer. There's no ambiguity that there's a causal relationship between cigarettes and lung cancer. So imagine if we said to all smokers out there, the moment we believe your risk of lung cancer exceeds 5% over the next decade, we're gonna make you quit smoking. Conversely, imagine you just said,

the moment you pick up a cigarette, we're gonna tell you to quit smoking because smoking is causally related, totally different framework. And it's the latter framework that I think we have to be thinking about for cardiovascular disease and cerebrovascular disease. And certainly when you talk about health span or longevity,

the low hanging fruit here is dementia, various forms of dementia, cardiovascular disease, diabetes, obesity, high blood pressure. You're not gonna have a long fulfilling life if you don't figure out how to, you know, wend your way around these diseases that are really, you know, the biggest, they're the gorillas in the house that are killing most people.

Yeah, we call them the four horsemen. So ASCVD, so atherosclerotic cardiovascular disease, cancer, neurodegenerative disease, and then the whole cluster of metabolic diseases, which is kind of described as a spectrum from insulin resistance all the way to type two diabetes and everything in between, including non-alcoholic fatty liver disease,

which is poised to become the number one indication for liver transplant in the United States within the decade. Wow, wow. Healthspan medicine, if that is a term, how does that square with some of the stuff that we're seeing now in terms of technological and scientific breakthroughs in this area?

Everything from like, you know, if you're, how does your sense of it's all about like scanning technology and like, I was just at a conference in San Diego the other month and there were people who are like 3D printing human lungs and all kinds of crazy stuff. That's very different from where your focus is. So how are you thinking about this

in a way that perhaps matches or does not match what we're seeing from people like David Sinclair and his kind of opponent in that realm, Charles Brenner. Yeah, look, I mean, I think David and Charles basically go back and forth about two different molecules, right, NR and NMN as precursors for NAD. And again, I would say no disrespect to them, but that's like rearranging the deck chairs

on the Titanic compared to exercise. So look, I would say that the data for the efficacy of NR and NMN as a tool to boost longevity is non-existent at this point in time. And that's not from a lack of testing. I mean, the interventions testing program at the NIH, which is hands down the most rigorous tool we have

for testing different interventions, namely pharmaceutical molecules, unequivocally showed that NR did not work. So if there are benefits to NR and NMN, we haven't seen them yet. And I would argue that if they do exist, they're not going to be that big. They're certainly not going to be on the order

of what we see with exercise. I don't think people, and I don't mean not to come back to exercise. I'm not talking about it because it's like fun and it's because it's easy. I'm talking about it because the magnitude is insane. The difference in risk between a person who's VO2 max is in the top 2.5% for their age and sex to someone who's in the bottom 25%.

So think about that, right? You're in the bottom 25% for your age, which is like, you're an inactive person versus you're in the top 2.5%, which isn't other worldly, by the way, like you and I are probably in the top 2.5% for our age group. It's a five fold difference in accruing risk of all cause mortality.

Wow. So let's pretend you don't have to be that extreme. What's the difference in risk between somebody who's in the bottom 25% and someone who's in the third quartile? It's still a three X difference. Right, and if you're going from completely sedentary. You can get there.

Yeah, very quickly. Yes. Like the improvement. Yeah, very quickly, like the improvement. Yeah, it's interesting how the human, animal is wired though. It's like, ooh, here's a compound that's gonna solve this problem when really, the biggest lever is sitting right in front of us the whole time.

Yeah, I was kind of joking about this with Andrew Huberman the other day, which was, I wish they would just create a rule that says, you're not even allowed to argue on Twitter about a molecule until you're exercising 10 hours a week. Like once you've shown that you can work out 10 hours a week then you've earned the right to bicker about, you know, whether, you know, vitamin D or this or that,

or the other thing is beneficial. So your Twitter account is sort of Bluetooth linked to your garment or something like that. And it won't activate until you've put that time in. And look, this is sort of Bluetooth linked to your garment or something like that and it won't activate until you've put that time in. And look, this is not for a moment to suggest that I am not incredibly excited about the molecule side of this. I think rapamycin is hands down though,

the most important and exciting and promising Giro protected molecule. Yeah, I've heard you speak about that. Yeah. Maybe you can spend a couple of minutes on that. Sure, yeah, so rapamycin is a compound that was actually discovered remarkably serendipitously on Easter Island in the 1960s.

They didn't know what they had at the time and it was sort of purified from the bacteria that were found in the soil there in the 1970s and ultimately produced a drug that was a potent immunosuppressant. So it suppressed the proliferation of T cells and in the late nineties was approved by the FDA for use in patients with organ transplants. But a decade later, another

discovery was made, which was actually, if you dosed it a bit, a little differently, it was a very potent longevity agent. So potent in fact, that it did something no drug or molecule had ever done before or has ever done since, which is it extends life in every organism across the entire spectrum of eukaryotic models. So yeast, worms, fruit flies, mice, we now see it in even other organisms. And again, it does so without contradiction. So we just see this over and over and over again. And that's a very rare feature in science.

Where- And it's been around for many years, decades at this point. 20 plus years. So there is some data sets on the impact of human life over time in the context of organ transplants, but it's not FDA approved for any kind of longevity purpose. Correct, yeah, no, so any, so I take it, you know, and a number of my patients do,

and obviously that's off label, right? So, you know, you can, you can, anything that's FDA approved, you can use, but the use, the way we use it is very different from the way a patient uses it for organ transplants. So a patient for organ transplants is taking kind of a medium dose every day, based on all of the literature,

and including human literature that has studied ways to boost immune function with it. It appears that a higher dose once a week produces the opposite effect, which is better immune function and obviously the longevity phenotype. And so how long have you been using it and are there noticeable effects?

So I've been probably using it for four years. And for me, there are not any noticeable effects. I have some patients who, I would say half the people who take it, maybe a third really claim to feel different, but I don't think that's the norm. And you can never know how to discount placebo effect. It might, I talked to another doctor

who's prescribed it quite a bit. He has a much sicker patient population than me. And he claims that many of his patients feel significantly better. So it might be a function of your kind of baseline health coming in, but I don't truthfully feel anything. So in that sense, it is purely a leap of faith

based on a legion of data. Yeah, yeah. You've mentioned a couple of times, we like we've looked into this, we're studying this. I mean, one of the other kind of differentiators around you and your practice is that you have this head of research and you have a whole team of people

and you're going through all the papers that are getting published all the time and coming up with your own studies to look at the things that interest you in this field. So what are some of the studies that you're currently looking at right now in doing yourself? Or what do you think are the big studies

that we could do or should be doing right now to really get greater clarity in this field? You know, I think one of the interesting questions that we've got funding for, I mean, I think we've got the funding to launch it. We're just kind of waiting for the backlog on some of the COVID related IRB stuff. With Inigo San Milan is to do a study

looking at the use of metformin in really metabolically healthy people. So as you know, there's lots of data suggesting that metformin in non-diabetic patients could extend life. So there's a big study that Nir Barzilai is leading the charge on called the TAME study that is basically asking the question, if you give metformin to people, will they live longer? Non-diabetics. Okay. So that's a very important question. It looks like he just got funding to complete that finally

about three weeks ago that was announced. But my experience with metformin has been a little different. So I took metformin for probably eight years on the basis of all of the epidemiologic data that looked really promising that, hey, metformin is especially going to prevent cancer. But once I got really nerdy on my zone two training

and was really tracking lactate levels and doing all sorts of stuff, I just couldn't help but wonder was metformin potentially poisoning my mitochondria just a little bit, which is again, perhaps part of how it works in the diabetic, but is that counter balancing what I'm doing that's positive? In other words, if you take somebody who's sedentary and diabetic, that might be a worthwhile trade-off because the net benefit is so positive. But in someone like me, I don't need the glycemic

control. Is this a negative? So for that reason, I just sort of stopped metformin. And basically, in our practice over the last few years, we have sort of phased out the use of metformin in patients who are healthy and who are exercising. And frankly, even in patients who are metabolically unhealthy, but whom we're able to push down the exercise pathway, I've been on the, let's not even bother with metformin. But the reality of it is,

I want to know the answer to this question. And I want to know it very specifically in a subset of people like you and I. So if you take people who are, you know, gonna be willing to ride their bike four hours a week, can we do a complete proteomic, metabolomic, muscle biopsy based study where we truly look at the impact of metformin functionally at the mitochondria.

And indigo being the sort of Lord of all things, Z2 and, you know. Yeah, yeah. So indigo is super keen to do this. And it was just this sort of Lord of all things Z2. And you know. Yeah, yeah. So Indigo is super keen to do this. And it was just a question of, could we procure the funding, which we were able to do pretty quickly. Interesting. Because we basically, you know,

my patients love to figure out ways to fund this type of research. Cause you know, you were not gonna get the NIH to fund that. Right, your studies are all being privately funded. That's right. You're not part of the whole grant system. We're basically saying, look, I mean, we can raise this money privately in days.

Why would we subject the investigators to beating their heads against the wall to justify something? And what does that pitch to the investor? Like what are they getting out of it? The knowledge of this, I mean, it's actually- It's purely like a, it's purely a knowledge-based thing. Absolutely, yeah.

Interesting. Let's talk about metabolic health in the kind of context of technological advances and developments. Now we have all these wearables, we have the Oura ring and then I've got the Whoop on and I've been playing around with inside tracker and I've got my levels patch on.

You got it. And it's got me, there's pluses and minuses to all of these things. I mean, one thing that all of these devices have been really good at is getting me very engaged with how my health is doing on a day-to-day basis, which is great. But I do feel like I'm suffering

from kind of this lay person's condition of not knowing what all of this data means or what to do with it. And I think there's a lot of confusion out there about what's meaningful versus what is something we don't need to be concerned with. But I wanna kind of structure this around the subject matter of metabolic health.

So perhaps like define what it is in kind of the context of healthy metabolic function versus metabolic dysfunction. You know, I think the easiest way to start is a very broad definition that would encompass something called metabolic syndrome. So in the, gosh, 1980s, maybe even early 90s, a very, very famous and amazing endocrinologist

at Stanford, a guy named Jerry Riven. He would have been there when you were there. Jerry died probably about four years ago. I was very lucky to meet him several times before he did. And the guy was insanely generous with his time. Like I literally just go to his office and hang out with him and ask him questions. He kind of identified something that at the time

he referred to as syndrome X, which he said, this thing tends to cluster around all diseases that are kind of metabolic in origin, cardiovascular disease, cancer, neurodegenerative disease, diabetes, fatty liver, although we didn't know about fatty liver at the time. All of these things tend to cluster around this thing, he called syndrome X.

And without going through the details of how that migrated, what we now know is he was referring to insulin resistance and what we now call metabolic syndrome. So metabolic syndrome is defined in a very crude way, but everything that's done at the population level is incredibly crude. So it's basically defined by how big your waist is, how high your blood pressure is,

how high your glucose is, how high your triglycerides are and how low your HD is, how high your blood pressure is, how high your glucose is, how high your triglycerides are, and how low your HDL cholesterol is. And there's sort of a line drawn in the sand that says, if three, four, or five of those metrics are beyond a threshold, you have met sin, you have metabolic syndrome. And of course it's a continuum. So I used to know the stats very well,

what fraction of the population had five out of five, which would be, you know, very bad four out of five and what fraction of the population had like zero out of five. And so if you lined up everybody in the country across that spectrum, you're going from the most metabolically healthy to the least metabolically healthy. But I haven't really answered the question for you. I've just kind of labeled it. So what does it actually mean? And I think the best way that I can explain it is through fuel partitioning. So fuel partitioning is basically a fancy way of saying, how does your body know what to do

with the energy you put in it? Where does it put it? And how does it access it later? And someone like you, someone like me, like our bodies are pretty good at doing this. You know, we know when you eat glucose, fat, protein, this part we should use, this part we should store. And when we go to exercise,

we know how to access the right one. So this is where kind of zone two comes back into it. Zone two is basically a test of your mitochondrial efficiency. And this is one of the hallmarks of aging, right? So there are nine hallmarks of aging. And one of them is mitochondrial dysfunction. We just know that as we get older,

our mitochondria get less and less effective. And what you really want are mitochondria that can access fat stores at basically higher and higher levels of work output. So an example of a metabolically healthy person to a metabolically unhealthy person is have them go for a walk. The metabolically healthy person is accessing exclusively fat stores to do that. The metabolically unhealthy person is burning through glucose and glycogen to make that happen.

That's a fundamental distinction between them. Sure. And the trade-off of that is what's the natural history of that? This person is getting fatter and this person is having a harder and harder time regulating their glucose levels. Right. So the more dysregulated you are, the more likely you are to gain weight. It just becomes like a vicious cycle that gets worse and worse. Yeah. And then it really gets worse and worse because the weight gaining part on the surface is what people kind of get worked up about. Oh my God, like I'm getting fatter. But the reality of it is it's not the subcutaneous fat that's the problem. It's not the fat that we see on our waist.

It's the fat that we don't see that's the problem called the sort of the extra, so this is called subcutaneous fat. So if you take the extra subcutaneous fat depots, like visceral fat, the fat that surrounds your organs, the fat that accumulates around the pancreas, the kidneys, the heart, within the muscle itself, and I'm talking right within the muscle cells.

That's the fat that's incredibly destructive. And that can represent a tiny fraction of your total fat. You know, if a person has 20, you know, 20 pounds of fat, let's say 20 kilos of fat on a 200 pound person would from a body fat perspective, probably put them at the 25th percentile. They're pretty run of the mill. But if only 10% of that fat were out

of their subcutaneous stores, that would place them at the 90th percentile for visceral fat. And that's the dangerous fat. That's the inflammatory fat. That's the fat that's truly wreaking havoc with respect to metabolic illness. Right, so typically if somebody is suffering

from metabolic syndrome and they go to their general practitioner, that person is likely to say your blood pressure's high, you're pre-diabetic, we need to put you on this battery of medications. You have patients in which they're displaying similar characteristics, you put them on a lifestyle protocol to try to,

you know, basically reduce these factors and get their metabolic health in check. So explain a little bit about what that process is and just how malleable metabolic health is. I mean, fortunately it is quite malleable and there were, you know, different ways that we go about doing it, depending on what we think are the contributing factors.

So sleep, nutrition, exercise, and pharmacology would be the main contributing factors. Now, there's the fifth thing that we always think about is emotional health. And for some people that can be an enormously contributing factor, both directly and also, and more commonly, indirectly. And is stress a component of that emotional health? both directly and also, and more commonly indirectly.

Is stress a component of that emotional health? And so stress directly just through its endocrine function, right? So hypercortisolemia is completely destructive to your metabolic health in excess. So transient stress, not so much an issue, but this chronic elevation of cortisol is incredibly destructive for insulin resistance

and all sorts of other things. But more importantly and more subtly is it's the emotional health bucket that gets in the way of making some of the behavioral changes in these other buckets. I mean, nobody has a hard time taking medicine. And the reality is you can fix a lot of numbers with the medicine, but you're not getting as much of a benefit

as if you fix them sort of with food, sleep and exercise. So when we're trying to evaluate, so let's say the hypothetical patient comes in and everything is wrong. So then the next question is why? What are the contributing factors? So sleep is the first thing we always wanna look at because it's the easiest one to assess pretty quickly.

And so again, to your point, most of our patients are wearing an Oura Ring. thing we always want to look at because it's the easiest one to assess pretty quickly. And, you know, so again, to your point, most of our patients are wearing an aura ring. So that's provides some information. We use some sleep surveys that are pretty well vetted. So there's probably four or five of them. And depending on what we see on the aura data and what we see in the sleep surveys, we then might move to another test to look for, like an at-home test that can give us a very quick view on apnea. And depending on what we see there,

we might move to a more formal sleep study. And so we're kind of going through, is there pathology, yes or no? Are you overslept or underslept, yes or no? If you're underslept, are you also dysregulated with staging? And we kind of have just an entire rabbit hole we go down with sleep that involves sleep hygiene,

that involves supplements, and sometimes frankly includes medications. I mean, there's a prescription drug called Trazodone that really helps people who are dysregulated in their sleep because of rumination. So it's a non-habit forming amazing drug that more importantly preserves sleep architecture. Most sleep drugs don't really preserve

sleep architecture that well. On the nutrition front, we're asking, the first order question is, are you overnourished or undernourished? And are you, obviously you're metabolically unhealthy, we wouldn't be having this discussion. So overnourished, undernourished, usually if you're metabolically unhealthy,

you're also overnourished. And then the next question is, are you under muscled or adequately muscled? And that plays a hugely important role for our protein strategy and our training strategy. And then once we sort of go through the, well, presumably you're overnourished, let's say you're also under muscled,

let's make it really hard because that's a really difficult reconciliation. Someone's overnourished and under-muscled, they have to lose weight and gain muscle. So now you need a lot of protein and a lot of training. The question then becomes, what is the strategy for intake reduction? You have three strategies,

caloric restriction, dietary restriction, time restriction, and go into all the details of the pros and cons of each one. On the exercise front, it really depends on what they're doing to begin with. Each type of exercise has its benefit, but if you're talking about a person who's starting from zero, we're mostly working on movement, stability, and zone two. I'm not going to push them into VO2 max. I'm not gonna let them get hurt trying to do any significant strength training. It's how do we fix the chassis

so that we can make the car drive faster and faster. And in those patients, you know, literally just putting them on a treadmill and walking them, you know, up an incline can be very beneficial. So assuming high patient adherence to these protocols, what is the timeframe in which you can take somebody who is fairly dysregulated into a zone of relative safety?

Yeah, again, it's all comes down to adherence. I mean, I think back to a patient that joined our practice about a year ago, liver function tests, you know, on arrival were, you know, three, four X normal, demonstrating lots of fatty liver disease, very high degree of insulin resistance. Or we do something called an oral glucose tolerance test

with every one that comes in the door. So they drink a big glucose drink, and then we measure glucose and insulin spikes for the next couple of hours. I mean, I think this patient probably within six months had those things reversed. And this patient was incredibly diligent. This patient was doing everything that was asked.

But I'm less wed to how long it takes and more wed to can we create sustainable things that, if it takes a year, but you found a groove that is sustainable, that's more important to me than trying to fix it in three months. Yeah, interesting. I've had just some interesting revelations

in my own experimentation wearing a CGM, noticing when and how I go out of my sort of zone. I noticed that when I was experimenting with one meal a day, that was a disaster, especially when that one meal a day comes very late, dysregulates my sleep and the spikes were crazy and they don't come down quickly. And I was like, and I'd been doing that for a while.

And I was like, I have to stop doing this. So there's been really helpful kind of feedback that I've gotten from this. But I also admit to not really knowing how to interpret this data. Like when I spike, if it comes down relatively quickly, should I be concerned about that? Or what should I, and I think this is like a danger

with a lot of these trackable types of things is it gives us all this data, but there's less focus on like what to do with the data and really to kind of figure out what is meaningful in all of this. So what should I be thinking about and what are some of the common misconceptions or myths around misinterpretation of wearable data?

So the short answer is we don't know because we haven't had these wearables for long. So it's a really new phenomenon to be able to send people into the wild and measure their glucose continuously. So one has to acknowledge that and then say, well, based on that, how can we extrapolate from what is known?

And so our team did some amazing work on this about a year and a half ago. It was about six months worth of effort to look at all of the literature around three issues of glucose outside of the setting of type 2 diabetes. So we absolutely know in the setting of type 2 diabetes that a higher average glucose is worse. I mean, that is the definition of the metric that we use to make the diagnosis of the disease. The diagnosis is made based on something called the hemoglobin A1C, which is a crude but not horrible way

to estimate the backwards looking average blood glucose of an individual. So if a person's hemoglobin A1C is 5.0%, that tells you, that's giving you an estimate of how much glucose is stuck to their red blood cells. That tells you that over the past three months, their average glucose was about 98 milligrams per deciliter, which is excellent.

That's your average blood glucose over all your ins and outs. Once that hemoglobin A1C reaches 6.5%, that tells us that the estimated looking back over the past three month average glucose is 140 milligrams per deciliter. Now you have type two diabetes, congratulations. Now, of course, to me, this is a continuum. This is another example of where I think it makes no sense

to wait till someone has type two diabetes to sound the alarm. So in our practice, so I'll back up for a second. So then the question became, what do we know about the difference between having a blood sugar that averages 100 versus one that averages 130? Neither of those people have type two diabetes. Is there a difference? And I think if you look at the data, the answer is unambiguously clear. Lower is better. The next question became,

what can be said about variability? So I don't know if the levels one does this, but on the Dexcom meter, which is the one we prefer just because you can calibrate it and it's more accurate. Is that the one that's with Libre? No, Libre I think is the Abbott one, which I'm not particularly fond of because you can't calibrate it. So I just think it's a less accurate meter. But the next thing you can look at is not just your average glucose, but you can look at the standard deviation.

So you can look back and say over the past day, the past week, the past month, the past 90 days, how much variability existed? And so then again, we looked at that question, which is, can the literature tell us anything about variability of glucose? And the answer appears to be yes, less variability is better.

And then the final question, which is probably the hardest to ask, and I don't think we know an answer to this is, are there downsides of transient spikes? Now a spike is inevitable, meaning anytime you eat glucose or any form of carbohydrate, you're going to have, your glucose has to go up. So the question is, does it matter how high it goes?

I don't think we know the answer to that question truthfully. So, you know, we've basically said, look, what if we could just arbitrarily say, keeping your spikes below 140 to 150 is better than keeping them below 200? Because the reality of it is, I'm not really aware of a scenario

whereby you eat good food and your glucose goes to 200. But I'm aware of how to make, I can make my glucose go to 200 like that if you gave me enough Raisinets. But I can't really make it happen by eating beans. And is that more important or less important than how quickly it comes back down to baseline? I think of the three metrics that we care about,

average glucose, variability of glucose, and just the number or frequency of spikes, I would say that the frequency of spikes is probably the least important. In other words, I don't think there's any physiologic harm that comes from a transient spike to 200 by itself. So if I could just sort of robotically say your glucose went to 200

and then it came back to a hundred in an hour, fine. The reality is it doesn't do that though. What happens is if it goes to 200, it's gonna come, it's gonna, you're gonna overshoot cause you're gonna have secreted a pound of insulin into your circulation. When it comes down, it doesn't stop at a hundred. Yeah, it's gonna goes to 200, you're gonna overshoot because you're gonna have secreted a pound of insulin into your circulation. When it comes down, it doesn't stop at 100. Yeah, it's gonna go to probably not 40,

probably go to 60. And what's the effect of that on your appetite? What's the effect of that on the bounce back? And that's why in my experience, and this is just clinical experience, just banging away with patients over the last six years, when we suggest to patients that our metric is avoid spikes over 140 to 150, try to keep your average at a hundred, try to keep your standard deviation below 15, eat around that, let that determine your

carbohydrate tolerance. People just do really, really well. Right, right, right. So this is very empirical and everyone will have a different carbohydrate tolerance. Right, it's a function of your sleep, your stress, your metabolic health, your exercise. It is interesting how much sleep comes into play. Like if I don't sleep well, Oh, your numbers are horrible.

It's terrible all over the map. And I thought, well, is that because of the poor sleep or is the, or is the, you know the lack of stability contributing to the poor sleep? I mean, if you look at the experimental data, so I'm trying to blank on her name. I think it's Eve Van Cotter, she's a researcher at the University of Chicago, did a pretty elegant experiment,

took a group of people, and I'm probably gonna get a few of these details wrong because it's been a few years since I looked at it. So did what's called a euglycemic clamp. So this is the gold standard for measuring glucose disposal and insulin sensitivity. So people are run with a line that runs insulin and glucose into them,

and they're given glucose and insulin such that they have to maintain a euglycemic or normal glycemic response. There's just no blips on a flat line. Right, and then the question is how much insulin do you require to do that? So that now tells you exactly how insulin sensitive a person is.

And this is pinpoint accuracy because that's basically telling you in real time how effective are this person's muscles at sensing insulin and taking glucose out of circulation? Because your muscles are what take your glucose out of circulation in the short run. So you do this test on people and then they were sleep, there was a crossover group.

So a control and then a crossover. And the intervention was, I wanna say two weeks of sleep deprivation to four hours a night, which by the way, like that was my residency for five years. So that's not an unreasonable intervention. And then repeat the glycemic clamp and glucose disposal fell by 50%.

Wow. So in two weeks of, you know, admittedly really bad sleep, you're taking somebody halfway to diabetes. So now imagine a person whose sleep is compromised for years. So that's why going back to what we said at the outset, I mean, if you're not looking at a person's sleep with real seriousness before you try to address

their metabolic health, you could be missing a wolf standing at your door. But the good news, of course, being this malleability piece that it can be corrected. And in the context of a culture where it appears that by 2030, something like 50% of Americans are gonna be either pre-diabetic or diabetic, like, is this not the most important thing

to be thinking about tracking and talking about? Yeah, look, I've gotten into some real battles with people over this, because I've been a very vocal advocate for the use of continuous glucose monitors and everything from trolls on Twitter to- There's a weird Twitter war going on over this, which is confusing to me.

Yeah, and there was an article written in JAMA a year ago that came down on the side of there's no role for using continuous glucose monitors in non-diabetics. And again, I think people are not understanding how to use these things clinically. Right, I mean, that's part of why I'm asking. I do think that there is a lot of room that remains in the education space to help people like myself understand

how to interpret the data and what to do with it. I'm actually empathetic and I understand why saying, like let's slow down a little bit and let's make sure. Cause again, I think our patients have a very different experience. Like I've been using one of these things since 2015 on myself almost continuously. You can imagine how many reps I have

and by extension our patients. And so we know how to use this data to do two things. One, to gain insights into how to change people's eating and two, to use it as a behavior tool to then create compliance over time. Those are two different things, but they're equally valuable. But that said, I don't think that that experience is shared by somebody who just goes

and order one of these things online. So again, I can understand why it can create a lot of confusion for people if they don't have that insight. Yeah, I mean, it does, there's a weird psychological thing that happens because you're essentially gamifying your nutrition, right? And so you look at this interface

and you see where you're supposed to be and you ate this thing and you're outifying your nutrition, right? And so you look at this interface and you see where you're supposed to be and you ate this thing and you're out of it. And you're like, you make a mental note. Okay, I won't eat that thing. And then it's become like, how flat can I make my curve? And like, how, but there is an engagement there that I can't imagine is a negative thing.

Like you are connected to what's happening in your body in real time and with the appropriate amount of education, this has to be. But the flip side is, and this is a fair criticism. So I think when I wrote a piece on this a little over a year ago, and one of the people who criticized me, who I've since engaged with quite a bit, and I think he made a fair point, which I could have been more explicit and should have been, which is if a person looks at their CGM data in isolation, they can still make a mistake. So I'll use an analogy that I don't know if I've since gone back and rewritten about

this, but I've certainly talked about it. If I said to you, Rich, the only metric that matters in life is the number on the scale and lower is better. If I program that into your mind, look, there's no reason you wouldn't take up smoking. You're probably going to lose weight, right? So in isolation, maniacally focusing on one metric can easily lead you to do bad things along the way. And this is no exception. So, you know, I think the glib example is, well, if I literally ate nothing but bacon every single day. Just nothing but fat. Right.

You'll keep your- You'll keep your glucose low. I'm not convinced that that's an ideal diet. Sure, sure. So that's why I think I would say this has to be viewed in the context of everything that you're doing. And there has to be kind of a whole set

of common sense principles that go into this along with just this is the only number that matters. Right, got it. Let's segue into zone two, my favorite topic of all time. It's so hilarious that like zone two training is now like a thing that people love to talk about. Like I've been talking about this forever. I know you have.

Yeah, Phil Maffetone has been talking about it under different names. Yeah, so I cottoned on to the Maffetone method, you know, at the beginning of my ultra endurance training. And I really credit adherence, strict, strict adherence to that philosophy as a vehicle for me making drastic improvements over the course of three year period.

It's, you know, this stuff doesn't happen overnight and I'm constantly preaching the benefits of it. And it's so cool and interesting to see people experiment with it. But I think there's also a lot of confusion about what it actually is and why it's effective. So nobody is better except for maybe Indigo. Is that how you say his name?

Indigo. Indigo at talking about this. So, you know, please allow me to, you know, indulge you in a conversation about zone two training. So I agree. I wish there was a better name for it because as you know, cause you've trained with a power meter on a bike. If you're a student of, you know, cycling power meters,

we use seven zones when we're training in cycling. And so the first thing I say to anybody who's coming to this is please forget everything you know about your numbers and your zones. And this has nothing to do with FTP and the sort of Andrew Coggan sort of stuff. So it's just an energy system. And the way San Milan describes it

is really through five energy systems. And zone two is the one that is basically defined as the maximal level of aerobic output that you can generate while keeping lactate below two millimole. So you could argue that's an arbitrary definition, although physiologically it turns out not to be. So what is lactate?

We have to kind of explain this, I think, in some detail for people to understand why this matters. Because even though most people will do zone two without ever measuring their lactate, and that's fine. If you want to be really on the money, you do need to measure your lactate at least periodically. And I do every day. I mean, I do zone two four days a week.

Every one of those four days a week, I'm measuring my lactate. There's plenty of DIY protocols out there that vary in terms of efficacy, but I'm always encouraging people to get a proper test on a bike trainer or on a treadmill with a technician who's drawing lactate at those intervals so you can really dial in on it.

And I wrote about this in my book and I explained that the top of my zone two was a heart rate of like 145, I think when I was running and 130 on a bike. And then people will tweet me and like, I'm keeping my heart rate at 145. I'm like, no, this is not what I'm saying. I expressly said like, this is me, this is not you. You have to get a proper test to really, you know,

understand your own physiology. Yeah, so how, this gets back to your question about metabolic health. Well, zone two in many ways is the most important functional test we have for determining a person's metabolic health. So I talk to patients about how we have dynamic and static tests for determining their health.

So a static test is just a blood test where tell me what your uric acid is, your glucose, your insulin, all of these things, your triglycerides. A dynamic test is let me give you a bunch of glucose right now and draw your blood over time and watch what it does. Another dynamic test is let me ask you to do work,

ride a bike, run on a treadmill, and let me measure a metabolic byproduct called lactate. And that will tell me an unbelievable amount, perhaps more than anything else about how you function. And this functional test is so important. So when our bodies create ATP, they have choices for what fuel they're going to use. So for all intents and purposes,

there are two fuels to make ATP, glucose and fat. Now with fat, you can only do one thing with it. You can only turn fat into two carbon subunits that get put into the mitochondria where you very efficiently make ATP, carbon dioxide, and water vapor. So that's why when we're, you know, so the input is fat and oxygen and the output is ATP, carbon dioxide, water. So we're breathing out CO2 and water vapor. We're using the ATP. We can do the same thing with glucose. Glucose can be turned from glucose into pyruvate

and pyruvate goes into that same pathway. So glucose and fat can both be churned through that super efficient pathway to make ATP. As the body's demand for ATP grows, it's going to start outstripping the capacity of the mitochondria depending on the fitness of the individual, depending on the fitness of the individual, depending on the efficiency of the furnace. And so it does have an escape valve.

It does have a manner in which it can produce more ATP absent sufficient oxygen, which is the basically the thing, the utilization of oxygen becomes the bottleneck. So, but here it can't do it with fat. So once you tap out on your fat stores, you don't have a way to overspill fat oxidation into this other energy source. Instead, you turn that glucose into pyruvate, but now you turn the pyruvate into lactate. And that does yield a little bit of ATP.

Literally about 1 16th the ATP you would have received if you had run that glucose through the mitochondria. So that's a knock on it. That's the trade-off is you've got a fraction of the energy but the bigger trade-off is that you're generating lactate which now pairs with hydrogen and creates an acid. That acid effectively makes it very difficult for actin and myosin filaments to uncouple.

And if that lactic acid level gets high enough, you start to really feel the inability, the burn in the muscle that creates the inability for you to continue effectively contracting your muscles. So anybody who's done an all out effort knows exactly what that feels like. The other variability being the exhaustibility of the energy source, right?

You have like something like 45 minutes worth of glucose output at that higher zone training rate. Whereas your fat stores are essentially inexhaustible. That's right. Right, so if you can develop a vast zone two capacity, which essentially means being able to be incredibly metabolically efficient at a certain activity in a certain rate of,

at a certain level of exertion that in turn creates mitochondrial efficiency, mitochondrial density, and basically an inexhaustible source of energy to propel you through an ultra endurance event or an endurance event. Yep, and so I thought about this a lot, obviously, when I was swimming, because even more so than cycling,

fueling in really long swims, as you now know, is just, it's a grind, especially in the ocean where the salt water gets in your mouth. If you, you know, on one of my Catalina swims, I remember it was so choppy that on one breath, I turned to breathe, you know, it was the middle of the night, so you can't see anything and just ingested like a gallon of salt water. Nausea is a given. Yeah, you're just puking your brains out. So anything you can do to minimize the requirement for having to feed the glucose engine, especially when you can't really take in a solution in excess of about 6% glucose, 60 grams per liter, you're very limited at how much glucose you can take in.

So absolutely correct. Okay. So now the question becomes what separates men from the boys? Basically, when you look at endurance sports, one of the most differentiating factors is how high is a person's zone two threshold? Let's just use cycling as an example, because it's just so easy to metric. How many watts can a person generate per kilo of body weight if we want to normalize it while keeping lactate below two? And what is it about that lactate below two? If lactate stays below two, you are at that equilibrium where we know that you are in balance. You are not net accumulating lactate yet. Once lactate gets above two, you will begin to net accumulate lactate, meaning you will accumulate lactate yet. Once lactate gets above two, you will begin to net accumulate lactate,

meaning you will accumulate lactate quicker than you can clear it. And that now puts you in a finite strategy of activity. Now, you know, when you and I did races and stuff like that, like when I was in a time trial, my lactate was definitely above two. It was, you know, I would finish a race at a lactate of 16 and probably 10 minutes before the end,

my lactate was eight and 10 minutes before that, my lactate was probably four. So I sort of budgeted to blow up at the end of that race. But if you said to me, Peter, I want you to go out and do a three hour nonstop ride at your maximum, like what's the fastest, what's the greatest distance you could cover in three hours? I have to keep lactate below two.

In fact, when you look at Kipchoge breaking a two hour marathon record, same thing, even though he's running at a speed, most of us can't run for a hundred yards, for him, his lactate was below two to be able to do that, or else he couldn't have done that. Yeah, it's interesting that terminology like VO2 max gets all the attention. And in reality, it's so much less important

than what your Z2 maximum is. And a question that I don't know that I've ever heard a good answer for that I'm curious about is the difference between, like let's say the top end of your zone two is like, I don't know, 250 Watts on a bike. What is the difference between an athlete that can maintain that 250 Watts at below two

for three hours, but then taps out versus the athlete that can maintain that for eight hours? At some point it starts to become a question of like how much fuel can they, cause you're still at the three, eight hour difference, you're gonna have to start ingesting some fuel. So assume equality across fueling. Yeah, then it probably starts to come down

to muscle fibers and things like that. Like at eight hours. Is it mitochondrial density? I don't know that. I mean, I don't think I know the answer to that. I think what I would say is you're going to, you know, because these are fit athletes, like their muscles are actually putting out a lot of power.

I mean, 250 Watts is a lot of power. And so I think you're now starting to get into the limitations of actual fiber damage. You know, for example, like when people feel sore the day after a super intense workout where they had that lactate burn, I think they erroneously assume that it's the lactate that they're feeling,

but they're actually not. They're feeling the microscopic damage to the muscle fibers. So I suspect that that's probably going to be the differentiating factor there. So it's some amount of muscle protein synthesis and some amount of, you know, kind of strength that probably factors into it as well, like actual muscular strength.

I remember when I was training for my first Ultraman, prior to that, I'd messed around in triathlon without a coach, was pretty fit in my own mind, hired a coach. He's like, I can't even tell you anything until you get a lactate test. Like, there's no point in us even talking. Like, I need you to go do this.

I didn't know anything about it. And I was like, ah, it's all be good. Like I go in, that graph was like pathetic. I couldn't believe like how quickly I would go out of zone two. And then my whole program was built upon, you know, this church of zone two, where literally for the first year, I don't think I did a single workout

that was above zone two. There was no polarity in training. And how much did your zone two increase during that course of the year? Unbelievable. Like the improvement was insane. And that's why I became like, I'm such an adherent and a believer in this

without doing any threshold or tempo work whatsoever, I was able to go from somebody who couldn't run faster than 10 minutes per mile without going into zone three to two years later, being able to run like seven 15s in my zone two, without any track work, without any threshold work, any interval work whatsoever, just by building that foundation bit by bit. And it's all about the ability to come back the next day

and the next day and the next day. And I think there's something about that consistency such that when you develop that robustness and you do have an effort, let's say you're attacking a hill or whatever, and you're way out of your zone two to do so, you come back down to that baseline zone two very quickly, as opposed to like, you know, being winded for an extended period of time

and kind of losing pace as a result. Yeah, so when we put our patients through CPET testing, we have about a four page dashboard that we run them through, which is much more extensive than just, it's, yeah, we show you your VO2 max and we will tell you why that's important. But it's also, what is your fat oxidation?

How many grams per minute of fat can you oxidize and over what power range? And what is the shape of your curve? And we benchmarked this against like athletes. So Inigo has given us data, right? So here's the guy who won the Tour de France. Here's a master's athlete. Here's somebody with metabolic syndrome.

And where do you stack up? So you can really start to see how you oxidize fat and how many watts per kilo you can put out at zone two compared to these varying degrees of spectrum. So now all of a sudden, I'm not just saying, yeah, here's your glucose and here's your insulin and here's your triglyceride levels. But I think this is a much more important test

because of its functionality. Right, it does require a lot of humility though. And you have to play the long game with it. And most people like, you know, it's just, what's your two year plan? They're like, well, I wanna do this race in a month or three months or something like that. Like you really have to be patient with it.

Yeah, and again, it fits so well into the centenary in decathlon because if you could be in your 80s and by the way, it is theoretically possible to be in your 80s and still put out two watts per kilo. I mean, there are examples of people who do this. I think Inigo has coached one guy, he's an 81 year old. So he's a world champion at masters 81.

He's about 2.9 or three watts per kilo. Wow. Can you imagine that? We had a guy in here recently, Mike Fremont, he's a hundred and he owns all these world records at half marathon and marathon distance running when he was like 90 and 91. It's amazing that he's able to do that. Talk a little bit about the importance of polarity training. Like you talked about the different energy systems

in the context of polarity training. Like you talked about the different energy systems in the context of longevity. So this idea of Z2 and Z5, because what I see, and I'm sure you see this all the time, is people who spend the vast majority of their training time in that gray zone, where they're not going slow enough to develop their aerobic capacity, their mitochondrial efficiency and density, and they're not going slow enough to develop their aerobic capacity, their mitochondrial efficiency and density, and they're not going hard enough

to really reap the benefits of strength, power, et cetera. Yeah, the no man's land, the garbage training. It's an important zone, by the way, depending on your sport. Like when I was time trialing, we did spend a lot of time at three, four crossover, because that's basically where you were racing for a 20K time trial. So you had to spend a lot of time at three, four crossover. Cause that's basically where you were racing for a 20K time trial.

So you had to spend some time there, but not too much time there, right? So, you know, I would say 80%, I was probably only spending 70. I think in retrospect, I should have been spending a little bit more time there. And at your peak, what was your zone two threshold watts? Two 75. That's pretty good. At 75 kilos. And at your peak, what was your zone two threshold Watts? 275.

That's pretty good. At 75 kilos. Yeah. So it was okay. And for context, for people that are listening or watching like a Tour de France rider is probably a little above 300, somewhere in that range. Yeah, but much lighter than me, right?

So he would be 320 Watts zone two. So the best of the best would be, yeah. Yeah. And, but they'd be 65 kilos. Weighing at 140 pounds. Yeah, exactly. So yeah, I was 275 Watts for zone two at 75 kilos at my best and a better,

like, but not a very high FTP, right? So that was, my FTP was only 310. As a time trialer though, that becomes important. Yeah, I mean, for me, because I was a Merck's time trialist, like, which is such a silly little niche thing, it really, the arbitrage on Merck's time trialing became to your CDA. It's like coefficient of drag times frontal surface area.

Like that was my obsession. That's why I was so obsessed with it. It was like just figuring out like, because it wasn't so much that my FTP wasn't that high. It's that I could hold that at an uncomfortable position. Because in a time trial, you're in such a compromised position from a vascular return standpoint

that if I could hold 300 Watts in a tuck and really minimize my frontal surface area and coefficient of drag, I could go fast enough. You're such a geek. I can't imagine that amount of data. Every single day I would come home from Fiesta Island and model, calculate based on barometric pressure, based on density. Like what was my CDA today?

Like, did I get down to 0.21? How do you have time for anything else? I mean, that's like a job. I mean, there's a reason I don't do it anymore. Yeah, right. Like it was, it was a huge commitment to be able to do that. And, you know, I made a joke about this once.

I was like, it kind of occurred to me, like how little anybody in the world cared. Like one day I was having dinner with my wife and I was like, do you know what my PR is for 20K? Just out of curiosity, like just, I mean, Rich, she was off by a factor of two, like literally couldn't care less. And I was like, that's cool.

I get like, it's amazing how much I care about this dumb thing that no human on the planet cares about, which is fine. There are a lot of things to this day I care about. Like I love precision shooting. So it's like, I, you know, to be able to shoot a dinner plate a mile away is such an important thing to me. It serves no functional purpose on this planet.

Yeah, and all the F1 stuff, right? Which is like, we can talk about that later. And that's a whole sidetrack. But I think, because I'm an engineer, I just think engineers like data. And I really viewed time trialing as purely an engineering problem. Because it's not,

if you think about other types of bike racing, there's strategy involved, there's nuance, there's complexity, but time tri about other types of bike racing, there's strategy involved, there's nuance, there's complexity, but time trialing is purely an engineering problem. Right, the bike is the perfect instrument to extract data from. A watt is a watt is a watt. And basically it becomes this like,

perfect situation for self-experimentation. Yeah, so cool. It's crazy, which is interesting. I know that you, I saw that you posted you were gonna get like a GPS watch and you kind of put it out on Twitter, like which watch should I get? Oh yeah, yeah, yeah.

And you made it very clear that you didn't want a heart rate strap. And I was like, that's very- I know, I know. Anathetical to your whole thing because wrist heart rate is terrible. Exactly. Why would you not-

So you'll love this story, right? So the reason I didn't want a chest strap is because I only want it for rucking. And when you're rucking, you got a 60 pound thing on your back and it's uncomfortable to have a chest strap when you've got so much weight, cause you're stacking.

But there's nothing comfortable about it. How much more uncomfortable are you gonna be to get that pristine data? But it was also like, I didn't want one more dumb thing. So what did I do? I ended up buying four of these watches and keep cycling through them only to realize that wrist based heart rate sucks.

It's terrible. It doesn't matter which brand you're wearing. It's just the technology is not there. So then I returned them all and got the cheapest one money could buy, the Coros Pace II for 200 bucks. It's a good watch though. It's fine.

And then I got, I use on the bike, I use a Wahoo armband and that's what I use now. Right. So now I exercise with the Wahoo armband in this watch. So I defaulted into what everybody told me from the beginning. Got it. All right, well, we're starting to fray at the edges here,

but let's kind of put a pin on the zone two, zone five thing in terms of like- Well, I didn't answer your question actually. Yeah, like we're still in the midst of that. So I would say if you're training for a specific sport, you're gonna have to understand what zone you need to be in and spend the appropriate time there. But if you're talking about health,

I think you're talking 90% is zone two, 90 to 95, five to 10% is zone five, that's about it. So I do one VO2 max workout a week, that's it. Yeah, and you're constantly pricking yourself and figuring out where your zones are. But for the person who's listening, who might not have access to a lab where they can go and actually do this properly,

like how do you- A point of care lactate device is all you really need, right? So you can, I use something called, I think it's called the Lactate Plus. So you can buy these things online. They're not cheap. The device is probably two, 300 bucks

and the strips are probably two bucks a piece. So it's- But how do you administer the protocol when you're actually doing the thing? Well, remember zone two, you're not dying, right? Right, but you still have to go through all the zones to establish. Yeah, so it's empirical.

I mean, the first, you know, the first few times I did it, it took me a while to be like, oh, I'm well below, I'm well below. Whoops, I overshot. Okay, back off. So I would just have a table next to me set up. And the biggest challenge actually is that you have to have soapy rags there

because lactate doesn't wash off with alcohol. So you'll contaminate the whole thing if your hands aren't clean. Nobody's gonna do this. I know you do, but like, I mean, the protocol that I've typically done in a lab and maybe it's different from yours is you get on a bike, you warm up for a while at maybe a hundred Watts,

and then you basically launch into this interval workout. Every four minutes you increase the wattage, like 10 watts or 20 watts. So we do longer intervals because of the lag between lactate and the plasma and in the interstitial. So we'll do six to eight minute intervals and yeah, we'll just have somebody, when our patients go and do the testing,

it's a prick to the ear to get the lactate. Right. But here's the other thing that you can do. So it's heart rate, power, lactate and perceived effort. Right, so we try to triangulate on those. So if I'm telling a patient to do this at home, what I'm basically saying is, here's where I think you're going to be.

So the first thing I'm asking is, what's your resting lactate? Tell me that. So when you wake up and you haven't eaten anything, what's your lactate? If that's two, then you're metabolically so unhealthy. You're screwed. Then we're not doing lactate testing in you.

We're gonna do it all off RPE, purely, that's it. But let's assume you tell me, oh, my morning lactate is one. Great, okay, so then I'm gonna say, do you know your actual max heart rate? Not predicted, but truly achieved. So you tell me that. Then I figure out how fit you are just by a few questions.

The fitter you are, typically the higher a percentage is. So your zone two can be as high as 84, 85% of your max heart rate if you're really fit. If you're not, it's probably closer to 75%. So then I tell them, okay, your heart rate's probably going to be here. And I don't even try to predict watts. So then I say, okay, I want you to get on the bike

and I want you to ride in slow increments until heart rate is about here and your RPE is such that you can talk, but you don't want to. on the bike and I want you to ride in slow increments until heart rate is about here. And your RPE is such that you can talk, but you don't want to. RPE, rate of perceived exertion. So then I would just say, just do that for 45 minutes and then do a quick lactate check.

And if they do that and it's 1.6, I say, great. The next in two days or the next day, I want you to go out and do it. And I want you to add five to 10 Watts. And if you come out and you're 2.5, back off by 10 Watts. So we don't try to answer it all in one day, but you can answer this question over a period of a week. Right.

And how is the adherence with your patients when you tell them, okay, your heart rate is not allowed to go over X and they go out for a walk and the minute there's the slightest incline or they wanna put a little bit of kick into anything they're doing, they're out of zone two.

And they're like, well, this is- I try to keep them separate. So I've actually found outdoor walking and outdoor running to be very difficult for zone two. So just like when I go rucking, I mean, my heart rate is, sometimes I'll hit max heart rate if I'm on a steep enough hill.

So I just consider that a separate form of exercise. But like a stationary bike. Yeah, as uninteresting as it is, I mean, I'm on a stationary bike when I do it because I can control it. And I just, we try to have patients do it on a treadmill, stationary bike, rowing machine, super controlled. Swimming is good too,

because you can really control your pace, but outdoor cycling and outdoor walking, running are hard. Too many variables. So I, which is, we don't wanna discourage people from doing those things, but we just wanna acknowledge, use those for maybe where you get your zone five. Interesting. All right, our time's running short here

and I gotta let you go and get to the airport, but I can't let you go without hearing a little bit about this crazy TV show that's coming out this fall, Limitless, that you did with Chris Hemsworth under the direction of the great Darren Aronofsky. I've seen the trailer. I know it's coming out in this fall and I don't know how much you can talk about it, but it looks absolutely epic and like quite the adventure.

It was a ton of fun. Darren is a really close friend and, you know, Darren kind of pitched this idea to me probably in 2018. He was like, I've got this idea. I'm gonna pitch it to Nat Geo at the time. Of course now it's Disney. And he said, you know, what do you think? And I was like, I think it's a fantastic idea. And he said like, who do you think should be the lead

actor? And we are, we have a very close mutual friend in Hugh Jackman. And I was like, what do you think about Hugh? And he's like, that's perfect. So he went and pitched Hugh to Nat Geo and they loved the idea. Talked to Hugh, Hugh loved the idea. And then it just wasn't gonna work out. Hugh had a bunch of other projects that he really wanted to work on, including Music Man and things like that. Of course, COVID messed everything up.

Yeah. And then I don't know who suggested Chris, whether it was Darren or the networks, but then, you know, Chris became involved and that in some ways changed, I think the focus of the program, because I think the idea- He's quite a bit younger.

Right. Obviously. And you know, Chris is like a superhero. And Hugh of course is, I mean, just, you wanna talk about a guy with legendary fitness. I mean, I don't know if you've seen Music Man. Of course. Yeah. He's unbelievable. Yeah. Yeah.

Not only like in his, you know, in his, you know, superhero fitness levels, but also his ballet. And like, I mean, his ability to move his body in space and time is unreal. Yeah, we were just in New York to watch Music Man spend the weekend with him. And we had dinner after and I was like,

I'm tired watching you. And I don't know how you do that eight times a week. Eight times a week, he does this two and a half hour show for a year. What is he 57 now or something like that? Probably a bit younger than that, probably like maybe 53, 54. But with Hugh, the idea we had was kind of the way

we opened our discussion, which is, you're no longer Wolverine, what is it gonna take to be the best version of you in your 90s? I think with Chris, the focus became a little more, you're Thor, right? Like what are the limits of that and how do they jive with kind of longevity? So yeah, look, it was, it was an amazing experience that took probably twice as long as anyone expected because of COVID. We started filming, we did January and February, a ton of work in 2020, just before COVID hit

in Australia and in Norway. And just by coincidence and by luck, I suppose, those were the months I was heavily involved in. Much of what came after I became less involved in. But there are six episodes and I don't know what I can say about any of them other than I think there's some really good stuff in there. I think my involvement is the least interesting part of it

is my personal take. Like some of the other content that I've seen, I find much more interesting than the parts I was involved in. And I think people will enjoy it a lot. I first found out about it when Ross Edgley was sharing some clips from, where are you guys in Norway? Yeah.

Yeah, and swimming in the freezing water and all of that. And Ross is like, I'm here with Darren and Chris and I'm messaging, I'm friends with Ross. And I was like, what are you guys doing? Like, how come I was not involved in this? Or how come I wasn't invited? I can't believe you guys are. And he's like, I are you guys doing? Like, how come I was not involved in this? Or how come I wasn't invited? I can't believe you guys are. And he's like, I can't really talk about it, but it's cool.

So I've been joking with him about it. And I love Ross to death. And I know that he worked really hard in helping to train Chris for Thor and got him in just insane shape. But I'm curious on your perspective on Ross and his kind of training protocol and philosophy, given that he's attempting to do these ultra marathon swim adventures, I'm always like confused by his approach. I'm like, dude, you should lose like 40 pounds of muscle

and trim down and you would have a better energy, you'll lose some power, but what you will gain in flexibility and efficiency will completely outweigh that. So what did Ross look like when he swam in college? I think he was a water polo player in college. I don't think he even swam competitively and he's always been like compact and strong, but there are videos of him like from years and years

and years ago, like he has definitely progressed as a kind of bodybuilding-esque type specimen. And he has his whole philosophy around it, this mesophasing of the way that he trains, but primarily he's in the gym doing tons of strength training and the swimming doesn't come until much later. But I just know when I put on upper body bulk,

I find it very difficult to swim any distances without a lot of lactate buildup. And when I was at my peak ultra conditioning, where when I was training for Ultraman, which is really a cycling race with a long run at the end of it, I made the choice to sacrifice. Ultra is two 224 mile bikes.

Yeah, it's a three day double Ironman. The first leg though is a 10 climber swim. But I was like, I'll just be like, I will sacrifice my swim power to be able to have better power to weight on the bike and be efficient on the run. And I found, I got, I kind of pushed that too far and got too skinny where I had very little power per stroke,

but I was inexhaustible. Like I just felt like I could swim forever without getting tired. And if he's swimming all the way around, you know, Great Britain and these other challenges that he's planning on right now, like, doesn't that seem like a smarter way to go? I mean, Ross is an amazing specimen.

It's incredible. Yeah. You know, so far be it for me to judge what he's doing because it's working for him. But I just thought like you as somebody who's interested in this kind of stuff, whether you had a perspective. No, not really.

I mean, one of the most interesting things that Ross and I got really fixated on and what was, and I don't know if I could talk about it because I don't know if he's announced publicly this kind of swim he has an aspiration to do. I know about it. I don't think that he's announced it publicly. So, but what we talked about that interested him

was the sleep cycling of it. So a friend of mine, a cyclist named Mike, well, ultra runner, ultra cyclist named Mike Trevino lives in San Diego. First year he did RAM, he was second. He almost won RAM on his first attempt. He got really into sort of timing sleep. So how, you know, cause obviously with RAM,

for people listening, it's this race across America. It's a cycling race where basically it's just who can ride their bike across America the quickest. I think it's this race across America. It's a cycling race where basically it's just who can ride their bike across America the quickest. It's going on right now. Yeah, I mean, these guys are doing this in like eight days. So you can imagine they're not sleeping a whole heck of a lot. And he was talking about how they're now able

to sort of try to wake people up at the right phase of sleep based on rapid eye movement. And so Ross was pretty interested in that, which was if he was about to embark on a really long swim, I mean, we're talking things that would take weeks and probably months, could he really optimize his sleep? Cause what he didn't wanna do is sort of sleep eight hours in a swim.

It's gotta be micro sleeps in there, which again, I can't speak to how healthy or unhealthy that is. It just doesn't strike me as a great longevity play, but in the spirit of sort of pushing the extreme limits of what a human can do, that would be very interesting. Other than just sort of random, like when we used to do swim relays, which we did a lot of these,

I mean, you'd sort of sleep three and a half hours between your legs and it was just, within three days you're dead. Right, I feel like we're at the very beginning of understanding what's going on with that. And it does seem to be very personalized. I know in the ultra running world, like some people, they can do these 15 minute little naps

and they seem to function at a pretty high output and other people just can't manage it. You know, I have such respect for that. There's a part of me that certainly always will miss, um, that, that type of pushing, but I, I, you're done. Yeah, I'm done. And I don't, I don't, I don't, I'm really looking forward to kind of spending the rest of my life trying to figure out how to be a healthy, productive, kick-ass 90 year old. Yeah. Excellent. Well, I think that's a good place to end it for today. I could literally talk to you for six hours about a zillion different subjects. So I really appreciate you indulging me and I hope you'll come back and talk to me again. I really enjoyed talking to you. Yeah. Thank you

for having me. Yeah. Thanks man. So everybody check out Peter's stuff, the drive podcast. I never miss an episode. I think it's fantastic. It's a great public service that you're giving and I commend you for it. And I just appreciate your openness to look at conventional wisdom from a different point of view, but a very objective, grounded science-based perspective. And I've just gotten a lot of value out of what you're doing. So thank you for that. I know you're working on a book that will be coming out at some indeterminate time. You keep teasing it a little bit. So that's exciting.

Anything else you wanna mention or direct people towards? When the book finally does make its way out here, I can't wait to come back and chat about it. Yeah, thanks man. Well, seats open for you. Thank you so much. All right, cheers. That's it for today.

Thank you for listening. I truly hope you enjoyed the conversation. To learn more about today's guest, including links and resources related to everything discussed today, visit the episode page at richroll.com where you can find the entire podcast archive, as well as podcast merch,

my books, Finding Ultra, Voicing Change in the Plant Power Way, as well as the Plant Power Meal Planner at meals.richroll.com. If you'd like to support the podcast, the easiest and most impactful thing you can do is to subscribe to the show on Apple Podcasts, on Spotify and on YouTube and leave a review and or comment. Supporting the sponsors who support the show is also important and appreciated. And sharing the show or your favorite episode with friends or on social media

is of course awesome and very helpful. And finally, for podcast updates, special offers on books, the meal planner, and other subjects, please subscribe to our newsletter, which you can find on the footer of any page at richroll.com.

Today's show was produced and engineered by Jason Camiolo with additional audio engineering by Cale Curtis. The video edition of the podcast was created by Blake Curtis with assistance by our creative director, Dan Drake.

Portraits by Davy Greenberg and Grayson Wilder. Graphic and social media assets courtesy of Jessica Miranda, Daniel Solis, Dan Drake, and AJ Akpodiette. Thank you, Georgia Whaley,

for copywriting and website management. And of course, our theme music was created by Tyler Pyatt, Trapper Pyatt, and Harry Mathis. Appreciate the love, love the support. See you back here soon. Peace. Plants. Namaste. Thank you.