The School of Greatness - 1046 How to Heal Stress, Trauma & Mental Health Issues w/Peter Attia

Episode Date: December 16, 2020

On today's podcast, Lewis interviews Physician Dr. Peter Attia. Peter focuses on the applied science of longevity, the extension of human life and overall well-being. Peter trained for five years at the Johns Hopkins Hospital in general surgery, where he was the recipient of several prestigious awards, including resident of the year. He’s spent the last few years being mentored by the top medical scientists and now hosts The Drive, a weekly, deep-dive podcast focusing on maximizing longevity, and all that goes into that from physical to cognitive to emotional health. Lewis and Peter's conversation covered a range of topics like what the main causes of stress are, how we can develop our emotional resistance, the importance of therapy, how food affects our mental health and so much more!Part 1: www.lewishowes.com/1045For more go to: www.lewishowes.com/1046Check out Peter Attia's website: https://peterattiamd.com/The Science of Sleep for Ultimate Success with Shawn Stevenson: https://link.chtbl.com/896-podA Scientific Guide to Living Longer, Feeling Happier & Eating Healthier with Dr. Rhonda Patrick: https://link.chtbl.com/967-podThe Wim Hof Experience: Mindset Training, Power Breathing, and Brotherhood: https://link.chtbl.com/910-pod

This is episode number 1046 with Dr. Peter Attia. Sounds very cliche for someone who's so interested in science as I am, but I think once you cease to live in a relational way, I think you're on that path to a very slow death. Welcome to the School of Greatness. My name is Lewis Howes, a former pro athlete turned lifestyle entrepreneur, and each week we bring you an inspiring person or message to help you discover how to unlock your inner greatness. Thanks for spending some time with me today. Now let the class begin. Jim Rohn said, take care of your body. It's the

only place you have to live. And Arianaanna Huffington said, when we know ourselves, the sources of our stress, how we respond, and what actions help us recharge, we're far better able to minimize the damage. I'm so glad you're here. If you listened to part one already, then get ready for an incredible part two. And if you haven't listened to part one yet, that's okay. You can listen to this as a standalone episode and then go listen to the previous episode. My guest is Dr. Peter Attia, and this will blow you away. He focuses on the applied science of longevity, the extension of human life and overall well-being of your lifespan. Every time I talk to scientists and doctors and people working

on the body and medicine and health and nutrition, it fascinates me when they come to this realization that there's only so much you can treat the body. There's only so much you can treat the material. There's only so much you can do with the proper sleep, with the proper nutrition. And until we truly heal the mind, the emotional side of things, sometimes all that other stuff will only get you so far. And in this episode, we dive deep on the causes of stress and how to become happier. The main cause of mental health issues and trauma, ways we can develop our emotional resistance and how this is key in life to be happier. We talk about the importance of therapy, the main things to do to live a healthier life, the foods Peter does and doesn't recommend for the quality of your life,

the danger of non-alcoholic fatty liver disease, this is big, how food affects your mental health, yes, it will affect you in a big way. And the biggest lessons Peter has learned from his work as a physician. Do me a favor and click the link wherever you're listening to this right now, this episode, and share it with a friend while you're listening.

You have the power to help inspire and transform lives just by sharing this episode or just copy and paste the link lewishouse.com slash 1046. And you can send this over text or social media and make sure to tag me, Lewis House and Peter Attia as well. And click that subscribe button right now on Apple podcast to stay up to date of all the greatest information from the greatest minds in the world on the school of greatness. Okay, in just a moment, the one and only Peter Atiyah. If we aren't able to have control or learn to navigate our emotion and the way we think,

then we're going to make bad decisions, which will turn into bad results for our health and our life. bad results for our health and our life. Is this off that if we, the root being mental and emotional health is potentially the thing that could cure and help us live longer, but if we take care of everything else but that, then we're always going to go back to these negative patterns that hurt us or is that off? I don't think it's off. I think they all have to be in place. I mean, I think the, you know, I'll share with you one sort of illustration. So I've been working on this book for four years now, and it's evolved a lot because it started out mostly just being a book about the science of longevity. So, you know, to me, a very, very technical book, but one that I was incredibly proud of and one that I think would have been read by the 15 most respected scientists in the field who would have thought it kept getting reworked and reworked until it basically got to a point where it was a pretty good overview of every single thing we've talked

about today, except for this emotional and mental health piece. Um, and, and that's, you know, that's, that's basically the piece that's delaying it, but it is that realization which said there could be no greater torture than to figure out how to live longer and how to preserve cognitive and physical health, but without that emotional piece being in check. In other words, to extend a miserable life is torture. So at the root of what we're trying to figure out here is how do we cultivate inner peace, inner happiness, peace of mind, peace of emotions during our life? That's a big component to healthspan, right? It is. And I won't represent that I fully have this figured out. I mean, in fact, that would be the hubris

to declare that would be embarrassing. But I think for me, I like the word joy because it just, it kind of captivates one of the things that I have found to be central in my journey in this space, which is it captures the piece about being with others that I've so historically ignored. I'm very fortunate to have a few therapists, three actually. So I actually have a therapist in each of those disciplines, right? So I have somebody that I work with on the behavioral side, on the psychotherapy side, and on the pharmacology side. And the person who is my psychotherapist, so she's the one that I speak with weekly about this, you know, the how am I feeling stuff. Her name is Esther Perel.

Oh, I love Esther. I've had her on many times. She's amazing. And, you know, she said to me a couple of years ago, maybe two years ago, and she said, look, you know, you've run a playbook that has only had three plays in it. You've executed them as well as anybody could execute those three plays, but you were really at the end of this. And those three plays were obsession, detachment, and rage. And that's it. Those are the only three tools you have. And they're the only tools you've had since you were five years old and you've gone very far with them, but it's led to incredible isolation, incredible pain, and all of these other things. And it took a while to understand how that could be the case and how to begin to fix that. And it's not something that you change overnight, of course, but what I'm so much more appreciative of now is the fundamental difference that comes from

fighting back the urge to detach. So again, this is just one very, very narrow example, but there are probably some people who can appreciate this, which is in periods of fear, it's sometimes easy to pull back and to retreat. And to me, that's a joyless state, right? That's basically saying, I don't want to be connected to anyone. I don't want to be relational, to borrow a word from another amazing therapist I had, Terry Real, who actually met through Esther. real, who actually met through Esther. So once you sort of stop living a relational way, I just, I mean, it sounds very cliche for someone who's so interested in science as I am, but I think once you cease to live in a relational way, I think you're on that path to a very slow death. When you isolate yourself more and you don't cultivate strong relationships, you die

faster. Is that what I'm hearing you say? Well, whether you die faster in the death certificate or not, some data would suggest you do, but I think those data are difficult. Yeah, you suffer more. So what does it matter? Even if you don't end up in a casket sooner, you might as well because you're suffering and suffering. Yeah. You're lonely. You're isolated. So what were the three players? You're miserable and you're, you know, yeah. Yeah. So what were the three plays that you added to bring more joy in your life? Well, I think it's, I think it's basically looking at how to reverse each of those patterns and working very hard to do so. And that's been a lifelong, or I shouldn't say lifelong journey. It's only something I've been working on for three years, but it's definitely harder than anything I've ever done.

So from rage to, what would be the opposite for that? Oh, to an expanded emotional vocabulary, right? Oh, to an expanded emotional vocabulary, right? So rage for me, think of a funnel where every possible negatively valenced emotion funneled into rage. Anger and rage. Anger becomes rage. Fear becomes rage. Uncertainty becomes rage. Anxiety becomes rage. Defensiveness. Becomes rage. Yeah. Resentment. Yeah. Rage. Right. Okay. So the first step in that is mindfulness. So meditation obviously is a very important exercise that we can do to learn how to stop and identify that. And so if you look at me

today versus if you look at me three years ago, when I literally was on the verge of killing somebody in a parking lot at some point, a big difference is now if something upsets me, I now have the gap between stimulus and response to examine the emotion and say, oh, that email really upset me because the person implied something that is threatening to my credibility or something like that. So it's like having the space to go through that process and then having the vocabulary now to do it. Now, literally, it means I've had to print out worksheets like I'm in grade school again with sheets and I go through exercises. So I have homework every single week where I go through, okay, when this happened, how did you feel? What was that emotion signaling to you?

okay, when this happened, how did you feel? What was that emotion signaling to you? So there's, you know, part of it is going through that type of an exercise. So I think that's been the biggest tool there. I think as far as the obsession goes, part of it has been, that's been more of a displacement. So that's been more of a, you know, I created a contract basically much in the same way that a person who goes into a 12 step program does. So I do consider myself a recovering addict. And I just think that I have more of a socially acceptable addiction. So I think we look at people, yeah, perfectionism and hard work are socially acceptable addictions, but the reality of it is they can be quite damaging to your offspring, which is, I think, for most of us, our biggest fear is that we hurt our kids. And so after going into,

you know, I did effectively go into rehab. And after doing that, I have a contract and I have people that function as my sponsors. And there has been some very, very deliberate changes in practices. start out with creating very structured things that you wouldn't think a parent would need to do, but mandatory 30 minutes of playtime each day. I just think people have lost the art of joy and play. It's one of the reasons I have a... It's funny, I'm in this high-end condo building here in Los Angeles, right in the middle of Century City. I'm not sure if you've been to this area, but there's a lot of corporate buildings. And so everyone's in their suits and ties. And I literally am right next to my studio about two blocks away. And I have a scooter that I get on, not an electric scooter. I have like a manual scooter where I push myself on a scooter. I come down the elevator with a scooter and walk out my front building hallway. And there's literally every luxury car you can think of every one of

kinds, Lamborghini to Ferrari. It's kind of obscene. These types of cars that you see, the Rolls Royces, all of them were in like the heart of Beverly Hills. And I come out on a scooter and I just don't care. I'm scooting around. I don't care what people think about me. I'm going to have fun because I feel like a lot of people lost the art of being a child, of joy, of play. And I'm trying to enjoy it myself and also cultivate in others. Hey, it's okay to just be goofy and playful and have fun, right? So mandatory playtime, I think, is a powerful thing. This is a big part of the playbook. It's just, um, it's, it's, I mean, it's, it's grunt work actually, but it, you, you have to do it to create new habits and it doesn't take as long as you would think. Um, I thought it would

take a lifetime to change. And yet I would say, even, even when I look at how much I've changed in the last six months, I would have never believed this much change was possible in this short period of time. How important is healthspan and lifespan related to healing the past, whether that be yesterday's past event, childhood past, relationship past, all past hurt? How important is healing the past with healthspan i don't think at first again that's a very good question assuming we're not talking about things that are so suppressed that we can never understand them but which we could debate how much that could still be impacting today and the answer is it could still be a lot and it probably is

i'm a huge believer in understanding previous trauma. And in fact, I've interviewed several people on the podcast about that. Lori Gottlieb, who I think you've had on the show, she's excellent. A very close friend and remarkable psychiatrist, Paul Conti, Corey McCarthy. I've talked about this with a lot of people. Corey was a guy who was incarcerated for many years, kind of turned his life around in jail. But again, you could peg so much of his tragic't want to talk about mental and emotional health as much. I think that's changing by the way. And I think people like Lori and Paul are a huge part of that change. I hope with that comes an understanding that we have got to figure out a better way to deal with trauma and trauma is not all big T trauma. It's not all, yeah, it's a lot of little T traumas add up. And most of us, I think, have had some sort of adaptations to things in our past that have come at a cost. And so a lot of those adaptations are positive, right? A lot of those adaptations are what got us through those things. And that's why I think many people are reluctant to face them and say, hey, this thing's bad. I mean, I certainly refuse to ever acknowledge any of my traumas as problematic, even though I never had an issue, they're very productive. In a very convoluted way, they told a story that

I thought was very good. And they resulted in all of these traits like rage, obsessiveness, and isolationism. Where you got results. I got amazing results. You can put your head down and do anything. So it's when you let that armor down, when you put that guard down and you allow yourself to sort of crack open. And Laurie wrote about this in a way that I thought was beyond amazing in her book, which is why I wanted to interview her. There was a particular story about two of the people she wrote about in her book that I thought most amazingly demonstrate how a traumatic past can just create for a devastating life, no matter the success. It feeds into all of the above. So I think that to answer your question, does that impact the

physical? Yes. Does that impact the emotional? Yes. And I'll share with you a story that I think even Paul and I discussed, which was about six years ago, I had a patient who was really on the verge of being diabetic. So she wasn't, but she was close and she was probably 20 pounds overweight and was very frustrated because she was incredibly compliant with everything I asked her to do. So I said, we're going to change your nutrition this way. She did it. We're going to change your exercise this way. I need you to sleep more this way. We did everything right. And her numbers got a bit better. She didn't really lose any weight. She wasn't really feeling much better. And I was really feeling like if it were anybody else, I would say she's probably not doing what I'm asking,

but I really knew she was. And one day we were just sort of sitting there talking and I don't know how it came up. I knew that her father had died when she was young, like in college, but something about the way it came up this time made me think it was creating a much bigger imprint that had been dealt with. Now, she'd been on an antidepressant since college. She's now in her mid-40s, so we're talking 25 years later. But I just wondered, I said, is there an issue here? Is there a psychological pain that is literally impairing her body's ability to get better? I said, look, this is going to sound crazy, but I'd like you to go and see this other doctor. He's a psychiatrist, but he's really, really smart.

And I want to explore this mind-body connection in a way that doesn't sound so hokey. Would you be up for this? And to make a long story, she said, yes. And within a year, you couldn't recognize her. You know, yes, he'd made changes in her medication. So maybe it's possible that some of the medic, you know, changing her from one type of antidepressant to another could have made a difference. But I do believe that a bigger part of the difference was just that she got so much more in touch with what had happened and came to grips with it and had begun to work through that trauma, that kind of letting that go. And you've probably read The Body Keeps Score. And there are lots of people who have really talked about this idea. And I've seen now enough empirical examples of this that I'm inclined to believe this is true and therefore it shouldn't be ignored. What do you think are the main causes of emotional and mental health disease, I guess?

What are the main causes of the lack of a strong mental and emotional well-being? If you come at it through the lens of trauma, so let's take off the table for a second, the sort of genetic causes, because there's a clear genetic relationship with mental health. So I know, for example, in my family, there is a non-trivial amount of genetic mental health problems. So I had an uncle who had schizophrenia. I basically have the following in my family, I think schizophrenia, depression, and probably maybe some bipolar. So there's clearly a genetic component. I'm inclined to think that trauma plays a great role in this. And I think trauma comes in different flavors. So the most obvious form of trauma is abuse. And abuse can be physical, sexual, spiritual. Those would be sort of obvious forms of abuse.

Another one would be neglect. So neglect is a form of trauma. of trauma. And that can be a kid who grows up in a house with two parents who never lay a hand on him or her, but completely ignore him and don't parent him at all. Or he's raised by a nanny, but really never gets the attention that a child needs from a parent. Abandonment is another form of trauma. So this is different from neglect. This is obviously more extreme. And it's when a child is actually abandoned by one or more parents. Another form of trauma that most people don't think of is enmeshment. So this is when a child basically has to grow up too quickly and is forced into the role of sort of being an adult with one of their parents. And that doesn't at all imply a sexual connotation or anything, but it's- The responsibility is very early.

That's right. And also just the emotional burden that comes with it. Right. So, you know, an example might be a single mom who basically relies on her 10 year old son as her confidant. Yeah. Exactly. As a confidant and complains to him about her boyfriend and, you know, and, and basically makes, you know, he has to grow up far too quick and things like that. And then I think another part of trauma is basically witnessing tragic events. And that could be like in the case of my patient, you know, losing her father suddenly or, you know, post 9-11, many people were obviously traumatized by things like that. So there are lots of tragic events that can do it. Now, within each of those, Lewis, any two people can have a totally

different response. Based on your emotional tools that you have. Based on your resilience to begin with. So again, one of my favorite examples of this is, do you know who Rick Elias is? Does that name ring a bell? I'm not sure if I do. So amazing guy. He was on that US Air flight that crashed in the Hudson River 11 years ago, January 2009. He has a beautiful TED Talk. It's very short. It's like seven minutes long that talks about it. And it's titled something to the effect of the three most important lessons I ever learned in life. And it's basically what he learned in the couple of minutes thinking he was dead. Rick is one end of the spectrum, right? He lives through this plane crash that night. He was back on a plane to fly home to Charlotte. Like crazy, you know, right?

Like four hours after he's almost dead, he's back on a plane flying. His life is taken off. They had a 10-year reunion for the survivors where they all got to meet up with, you know, Captain Sullenberger, you know, the guy who did this amazing landing. Yeah, Captain Sully. You know, he mentioned to me there were people from that night whose lives have been destroyed and who've never been able to get on a plane since. Oh, man. So think about that for a second. The exact same experience will produce an entirely different set of responses in people. And that's why I think we have to be very humble when we think about trauma. And that's why I get a little annoyed when I hear people say, well, this person

had this happen to them and look at how great their life turned out. And somehow they say that as though to minimize what has happened to somebody else. And to me, that's just utter nonsense. And judging people's experiences and making them wrong or telling them, you know, step up or whatever is what I'm hearing you say is not the best approach, which is probably something that I would have done in the past as this football mindset of like, just tough it up and quit being a wussy and, you know, quit crying about some scrapes here and there. But that's not the best approach. No, it's not. It's not.

It's not a great long-term approach. We have to be, we have to be pretty nuanced in this and we have to be, we have to be able to really kind of treat everybody's pain like it's their own pain and nobody else's. And now, And not comparing. Yeah. I went through all these tragic events and I'm able to deal with it, but you went through this little trauma and you're stuck on this, not doing that. Yeah. The two fastest ways to not recover from trauma are to compare yourself to others and to minimize your pain. It sounds crazy, but the moment, and I,

you know, believe me, I went through, I could tell just horrible experiences of going through kind of this, this journey and, and having to, to fight the, the fight, the urge to do those things, but just the constant desire to minimize and say, it's not that bad. It's not that bad. It's not that bad. Let's stop making a big deal out of this. Or, yeah, but this person went through so much worse and none of that matters. Whatever, a hundred people on that airplane all experienced the same external truth, which was the plane crashed, but there's a hundred different internal truths that came out of that. So emotional resilience is a massive key. And what I'm hearing you say in some of the ways to develop more emotional resilience is to have psychotherapy,

is it pharmacotherapy and behavioral therapy to gain tools, awareness, acceptance, forgiveness. I would say when indicated. Certainly, most people probably don't need pharmacotherapy, meaning they don't need any medications to aid in these things. But there is such an amazing toolkit of medications out there that do aid in increasing this buffer, what I think of as this bandwidth of distress tolerance, right? So again, it's the difference between, if you think about a person who can only live between the temperature of 97 and 98, boy, they're going to be in for a tough life compared to somebody who can live between 95 and 105. Similarly, a person who anytime they fall below here, they're going to be depressed. And anytime they go above here, they're going to flip into a fit of rage. That's a miserable life compared to somebody who can live here. What would you say are some of the things besides going to therapy as gaining tools?

What would be some of the things that we could develop more emotional resistance or emotional fitness, as someone like Tony Robbins calls it, emotional fitness to be able to stay more calm on the range of emotions? Kind of like when you see Tom Brady, where you throw an interception or you throw a touchdown, it's a similar emotion and not allowing yourself to get too high or too low. What are some key tools we could do to develop more emotional resistance in your mind from your personal experience? You know, for me, I think it's been several things. I do think mindfulness meditation, so a Buddhist style of meditation or a Vipassana style of meditation has been very helpful because it is a tool that teaches you to examine your mind. And that's effectively what we're dealing with here. So when somebody is all over the place with respect to their emotions, what is probably happening is they're being hijacked by thoughts. That's generally what's happening. And that's okay because that's innate. That's as common

as the day is long. Is mental illness, negative emotional fitness, I guess, is that our thoughts are being hijacked over and over in a negative way and therefore we get stuck in states of depression or... Yeah. And again, this is so complicated, right? Because you want to separate out some of the really clear pathologic states that I think fall outside of the purview of this. But I think for many people, it's you have a genetic predisposition to depression or dysthymia that then gets exacerbated with negative thought patterns. And so the question is, how do you break that cycle? I think step one is learning

to recognize it. So just, do you see it? Being aware of your thoughts. Are you even aware that you're thinking? I don't know if you meditate, Lewis, but for most people, when they become early in their meditative practice, it's like the first time they realize how much they're thinking when they're not doing anything else. They're walking down the street and you realize, oh my God, I'm thinking. Dan Harris, who's a good friend. Dan is one of my favorite people to talk about this stuff with because I think he's so down to earth in being able to communicate the humor of this. And his book, 10% Happier, which is actually the reason. It was his book, 10% Happier, which is actually the reason it was his book, 10% Happier, that got me to start meditating. He just does such a funny job of explaining how ridiculous our minds are. The dumb, dumb, dumb stuff we keep saying to ourselves, the loops of just complete stupidity.

So step one is recognize that. Step two, can you not judge it? Can you instead just label it unemotionally? Oh, that's a planning thought. Oh, that's a regretful thought. Oh, that's a judgment thought. Okay. So to me, that's really hard to do. And if I can do that 20% of the time, I'm doing well. But being able to do that 20% or 25% of the time, which is probably where I am, has had like an 80% improvement in the quality of my life, which I actually wouldn't have expected that. I would have thought you needed to get to 80% there to have 80% elsewhere. So it tells me that some of

the other things I'm doing are probably moving the needle as well. And a big part there is journaling. So yeah, another good friend of mine. I love a doctor is telling us to journal. You know, I love a physician is telling us to journal. Yeah. Have you interviewed Ryan Holiday? Yeah. A few times. Yeah. So you know this, Ryan is a big proponent of journaling and I find it to be really productive. And at times I go in a structured way, meaning like there have been periods where I've said, look, I'm going to journal through these three things every single day. So I'm going to journal something that I thought about that upset me, something that I'm really proud that I did, something blah, blah, blah, blah, blah. And so you're sort of forced yourself to come up with these three things,

but that becomes a very good pattern because it now gets you into that thinking process. And then other times, like right now, I'm not doing structured journaling, but I'm doing really sort of deep, deep, insightful journaling on sort of threads that are relevant and that I sort of bring into therapy and they become kind of the substrate for those discussions. How important is it for you to have consistent therapy, whether it's weekly or monthly, but having something consistent to go to, to share thoughts, feelings, and emotions. And where would your life be if you didn't have it in a consistent base? Would you be able to do it on your own or is the accountability so much greater than self-discipline, mental fitness? There are some things that just naturally come to me and I don't need any

accountability on them. So exercise is one of them. I love exercise. I've loved it since I was a kid. There are probably times when it's bordered on unhealthy and addictive. That said, once a week, I still work with this amazing woman named Beth Lewis and there's a great structure that's provided and she sometimes prevents me from doing more than I should and is constantly fine-tuning and honing what I do. In terms of mental health, I've struggled with this a lot in the sense that there have been many periods, even recently, where there's still a tiny bit of shame associated with it.

There's this thing that says, man, why am I not more together as a person? Like why does my wife not need to do this and I still need to do four hours of therapy a week? And am I going to be doing this for the rest of my life? Because I don't think there's ever going to be a day when I'm not going to be doing therapy. Maybe it will be just two hours a week, but I don't, I've been personally, I'm not sure I see a day when I'll ever be, you know, just not, not doing it. I don't think it's

possible. I think it's, um, I don't ever want to go back to where I was. So, so similarly, it's sort of like the alcoholic who says, I'm in a 12-step program. It's really working for me. I go seven days a week. Am I going to be going seven days a week in 10 years? Maybe not, but I'm probably still going to be going. And it might be once or twice a week. Yeah. Well, it's interesting you say that because I wrote a book a few years ago called The Mask of Masculinity, actually three years ago, this next week coming up with the anniversary. And it was all about the mask that men wear to project something, a false image in the world with their friends at work, sports, all that different stuff. And as I was doing this kind of book tour during this time, there was a lot of women that would actually show up because they wanted to understand the men in their lives better.

a lot of women that would actually show up because they wanted to understand the men in their lives better, why the men are acting this way, why they're not emotionally have a range of emotions seemingly. And so the rooms were typically 50% men and 50% women. And I would ask the rooms, I would say, okay, for the women in the room, raise your hand if once a week you get together with a couple of girlfriends or a girlfriend and you talk about your issues, your body image, your stresses, your concerns, your fears, your insecurities about relationships and career. Almost 100% of the women raise their hand. And I go, keep your hands up if you do this daily. You're on the phone with a girlfriend. You have tea.

You're eating for lunch. Almost all of them keep their hands up. And I go, for the men in the room, put your hand up if once a month you get together with a group of guy friends and you talk about your emotions and your feelings and your body image and your insecurities around this at work, maybe two or three people would put their hands up in the whole room. And I would say, are you guys part of a church group that kind of forces you and schedules this so you can show up and do this? And most of them are like, yes. Very rarely would there be men that say, I do this on a regular basis because I enjoy it. And imagine, and I would say to the women, imagine not doing this, only doing this once a month, never doing this once a year, 10 years, never talking about these things, how to make

you feel. And I'm not saying it's right or wrong for what the way men have shown up and the actions that men have done in the history to harm people. But I tell women, they're like, yeah, it would drive me crazy. I would be unswell. I would be sick. I would be emotionally unstable if I didn't have a friend to communicate to. And whether that's therapy in a private setting or a friend you trust or a group of friends, I just think it's important to have these conversations and share and not hold back our shame because I think that's what makes us emotionally and mentally sick. I couldn't agree more with that. And I think it's important for men and women and all human beings to have some consistent conversations. And for you, it's been therapy that's worked really well. And I think I'm a big proponent of it.

So I'm glad you're talking about it. And I'm glad that this is the thing that's part of your book. That's you're adding more and more of this because the more I hear you talk about these things, I just feel like the emotional resilience. It's like you can, even with some of your students,

your clients, it's like you've given them all the practical things on the physical, the nutritional, and they still weren't having the ultimate breakthrough until the mental health, emotional health breaks through. insight into the world because many of them are very successful people. So many of them have, I've been able to learn at, it sounds awful, but at the expense of some other people that all the success in the world isn't necessarily enough. So I've seen that money is virtually not correlated with happiness. So and by the way, money is not correlated with quality of a person. And by the way, money is not correlated with quality of a person. So I've seen some people that are staggeringly wealthy who are the most beautiful souls you'll ever meet. And you know damn well that they were beautiful souls before they had money.

Basically, money just became a multiplier of how good they are. And similarly, I've seen people that have a staggering amount of money and they're just the nastiest creatures on the face of the earth and their money has just given them a megaphone to be more obnoxious. And the same thing is true of happiness and misery and all of these things. So I think the thing that has been sad to watch is the people who have, for example, people who have, for example, in the case of resources, the ability to do so much for so many, but they don't understand how to share because they don't have this joy, right?

Like they just, like, you know, I mean, it sounds ridiculous to say this, but, you know, can you imagine meeting somebody who says, look, you know, I'm only worth half a billion and it drives me nuts, or I'm only worth $2 billion and I can't stand it. And I'm not saying that to be critical of them, by the way, because I would argue that I say things equally nonsensical, though maybe not about money. But you sort of realize that is important to address. That contributes to the quality of their life. And in that case, probably to the quality of countless other people's lives, if their focus could shift. If you could give one main thing for people to focus on in each of these categories, cognitive, physical, and emotional resilience, if all they had time to get started was to think about one thing for each to apply to their life, what thing should they apply after this? To improve the quality of their health span,

which would hopefully improve the quality of their lifespan. Well, maybe we could do it the other way. We could do it through the food, the exercise, the sleep, and stuff like that. I mean, on the food front, we didn't really talk about this, but I would say there's, I think there's sort of three variables that you're constantly able to manipulate with respect to food. how much you eat and just how much, like a little bit or a lot. The second is when you eat, do you go 12 hours not eating and 12 hours eating or 16 hours and not eating? What people refer to as time-restricted feeding. And then the quality of what you're eating. So for example, are you eating anything you want or are you limiting certain things in the nutrition so we call that last one dietary restriction the middle one time restriction the first one caloric restriction the most important piece of advice i would give on nutrition is you should always be incorporating one of those restrictions one of those restrictions. One of those restrictions you should always be doing

throughout the day. Sometimes you should be incorporating two of them, occasionally incorporate all of them. So these days I am pulling very hard on my dietary restriction lever. So I'm being much, much more diligent about what I'm eating. The quality of your food. The quality of my food is extraordinary. I'm not paying any attention to how much I eat. I'm just eating until the point where I'm satiated. And I'm not paying outrageous amounts of attention to when I'm eating. So I'm not fasting forever, though I probably only eat within an eight hour window most days, sometimes 10. But I'm not doing very long fast. I'm certainly not

doing any major fast or anything like that, but I'm really pulling hard on that dietary restriction lever. Now, if I were to let up on that a little bit and relax a bit on what I ate, I would have to start pulling harder on the other two. You would need to do longer times of restrictive or intermittent fasting. Or just restrict the amount that I'm eating when I eat. Of calories. Yes, exactly. Interesting. Right now, you're focused more on the quality of the food, which is what are those main

foods that you're eating that you believe are increasing the quality of your health span and your lifespan? So basically the things that I'm avoiding in spades are any form of refined carbohydrate. So I'm just not eating any junk food. I have zero added sugar in my diet at this point. So the carbohydrates that I'm eating are virtually all vegetables plus berries, quite a bit of macadamia nuts and almonds. I'm eating a lot of venison as one of my main sources of meat, a lot of fish. Yeah, pretty simple, repetitive meals. I eat the same thing pretty much every day, chicken, broccoli, and sweet potato.

And I restrict the sweet potato at night. Yeah. And I'm just eating that pretty much throughout the day. Yeah. I could probably eat the same thing. I'm sort of eating two meals a day and they're sort of being repeated. And what I'm avoiding is just what I, what I'm prone to do, um, during periods where I'm not paying enough attention, which is eating off my kids' plates and nibbling on, you know, crap in the pantry between here and there. Yeah. Yeah. Yeah. So if you could, I asked this question to, uh, Rhonda Patrick and I said, if you could only eat five foods a day, that would help you be a

healthier human being and live longer, what would those five be? I'm curious, what would those five foods a day be for you that- For me or for, so not necessarily for someone, but for, well, it's hard, right? Because you take somebody who has an ApoE4 gene, you might have to deal with this in a different way. So I don't think one could actually answer that question definitively for people. I could tell you for me what it would probably be. Sure. If I had to limit myself to five foods, I would probably rotate. I'd say, oh boy, that's tough. If you're on an island and you got to live off these five foods to have a quality of life. So I'd take avocado for one because I could get a huge amount of monounsaturated fats. So I would want my, I'd need a spreadsheet to figure this out, Louis, because I would want 50% of my, I want 50 to 60% of my calories probably to come from fat.

And I'd want most of that to be monounsaturated, so I'd probably want the avocado to be high. From a protein perspective, I'm a huge fan of eggs. I think the choline is an awesome source. It just does so many amazing things for you. But I'm also a huge fan of salmon because of the dose of EPA and DHA that you can get at such a low mercury content. I'm also really, really fond of wild game, but I guess we don't want to waste all of that. In terms of a vegetable standpoint, now we're getting pretty limited because you want to be able to balance enough insoluble

and soluble fiber. You're certainly not going to waste it on something like lettuce. I'm a huge fan of string beans and broccoli. I don't know if they quite have the nutrient density. I guess I would say, Lewis, I don't know that there's a way to pick just five things and do a great job, but it's probably in the ballpark of what I just described. I like that. What's your thoughts on fruit? You know, it's one of those things that really fits into the category. You didn't say fruit here at all. Well, fruit wouldn't make my top 10, not a chance, right? So, you know, again, I think fruit being described as one homogeneous class of foods is as ridiculous as describing men as one homogeneous class of species, right? It just doesn't make any sense, right? So to put blueberries and raspberries in the same categories as mangoes and bananas and grapes, they have virtually nothing in common, right? The latter is basically all sugar.

The former is very little sugar. So if we're optimizing for antioxidants, then the goal would be to have as much of an antioxidant as we can have, but with the lowest cost possible from a sugar standpoint. And then the manner in which you take it, dried food versus not, you know, smoothies versus not. So, you know, the only thing that you can do to make fruit worse is to, you know, put it into a shaker, you know, to juice it, right? So if you take the fiber away from it, that's the worst. It's all sugar. Yeah. You basically reduce the one thing nature put in there to regulate the speed at which it hits your liver. Your liver, of course, is the primary, though not the only organ that is responsible for metabolizing fructose, which is the

primary sugar in fruit. So you want to think about fruit through that lens. So whatever benefits come in fruit, and there are certainly benefits, it comes at a bit of a cost depending on your metabolism. So do I like fruit? Yeah. I like berries. I like an apple here and there. I mean, I love all fruit, but I never eat dried fruit. And it's outside of when I'm on vacation, we love going to Hawaii and there's an area where you can get your fresh coconuts. Yeah. Yeah. When you can, when you can do that kind of stuff, I'm going to go all in of course, but these aren't parts of my staple diet because the glycemic response is just too high. So I've, I've heard this from other doctors that I've had on that are not a fan of fruit really at all. I mean, very limited fruits

or smaller apples opposed to the bigger modified apples that people talk about. And I've had some backlash from people that are all fruit eaters, who love fruit, who see the benefits of fruit, who are like, fruit is not the enemy, so don't say it is the enemy. What is the balance there from your research and the facts saying like, okay, have some fruit every now and then, but every day, apples, bananas, lots of sugar. The dose makes the poison and it really comes down to the individual. I mean, I think the real challenge is when people try to talk about things as universally true in science and especially in medicine. So we talked earlier about non-alcoholic fatty liver disease. So this is the most rapidly increasing epidemic in the United States, bar none. In about

a decade, it will be the leading indication for liver transplantation in the United States. What is this called? Non-alcoholic fatty liver disease. How do we get that? Yeah, that's the great question. It used to be that the only way you got fatty liver disease was from drinking too much. A lot of alcohol led to fat accumulation in the liver, which ultimately led to scarring of the liver, which led to cirrhosis, which led to liver failure. We're talking Mickey Mantle here, which led to liver transplant, okay, if you were lucky. In the 90s, this other thing started showing up. It had probably been there longer, but we didn't really pick it up until the 90s. We were like, but we're seeing

a lot of people with this alcoholic fatty liver disease who claim to not drink, including little kids. What's going on? Couldn't be distinguished, by the way, from alcoholic fatty liver disease. But because it showed up so often in people who weren't drinking, it had to be renamed. Instead of being alcoholic fatty liver disease, it became non-alcoholic fatty liver disease or NAFLD. And we now know pretty clearly that fructose is probably the biggest driver of that, which shouldn't be that surprising given the similarity between fructose and ethanol. And so you would blame the majority of that probably on sugar intake, not necessarily fruit intake. Candies, cakes, refined sugars. Absolutely.

And by the way, not all sugar is created equal. Liquid sugar seems to be much more damning than solid sugar. So sugar-sweetened beverages and juice would be the biggest culprits by far. So then the question becomes, well, what do you do about this? Well, we have patients with non-alcoholic fatty liver disease. In fact, there's zero chance somebody listening to this podcast doesn't have non-alcoholic fatty liver disease, given that at this point, probably 20% of the country has it to some extent. So if you have non-alcoholic fatty liver disease, you should not be eating fruit. That's as sure as God made little green apples. If you have NAFLD, you should not be eating fruit until that thing is better. You

have to be restricting fructose. You have to be eating more choline. You have to be probably restricting calories in general. You have to be exercising. We're used to be doing a lot of things because you're on a very slippery slope towards diabetes along with the liver damage that comes with it. Now, at the other end of that spectrum, if you're metabolically healthy, fit as a fiddle, can you be eating four or five servings of fruit a day? Sure. So, you know, nobody's right when they say it's all this or it's all that. You got to know how to tailor the therapy to the individual and then identify who's at risk. And, you know, again, like our patients with non-alcoholic fatty liver disease, we are limiting them to less than 10 grams of fructose per day, which, you know, if they wanted to use it all in fruit would be like a handful of berries. Like a bite of an apple would be that. Yeah, I mean, maybe a bit more, but, you know, you have to make the exception because, as you said, there are other forms of carbohydrates that still come with sugar.

Like most bread is still going to have some sugar in it. And you want to make those allowances if they're still consuming things like bread. What about rice? So rice doesn't have any sugar. No, rice is pure glucose. So that still can contribute to diabetes wildly if you're an individual who's susceptible, contribute to diabetes wildly if you're an individual who's susceptible, but it does not seem to contribute to NAFLD as much. And this was demonstrated pretty elegantly by three people on two very well-done studies. By disclosure, I led an organization that funded one of those studies. So I have to disclose that, but I had no part of the studies that looked at kids with NAFLD and asked the question, if you just restricted fructose, but not glucose, could you fix it? And the answer appears to have been yes. In other words, in the kids with NAFLD, you didn't have to restrict

carbohydrates in total. You just had to restrict the fructose. So in those kids, at least the rice and the potatoes were still okay, but you had to cut the fruit, especially the juices and the sugars to fix the problem. And what's the difference between fructose and glucose? So they look very similar, but they're slightly different as a molecule. Fructose is sweeter. Sugar is made up of one molecule of each. So when fructose and glucose are connected, that's what makes sucrose or sugar, table sugar, or high fructose corn syrup to a first order approximation. But the biggest difference, the bar none heavyweight champion difference is every cell in your body can metabolize glucose and we have an infinite

capacity to store it and it's not toxic in any way. You can make you as fat as can be because as you noted, eventually you'll put it into your fat cells, but there's no toxicity associated with it in that sense. Whereas fructose can really only be metabolized by the liver in any meaningful quantity and its metabolic byproducts are quite toxic, uric acid being an awful metabolic product of it. And as you start to accumulate it, it becomes quite inflammatory. So as the liver starts to accumulate fat, it becomes very inflamed. And this fat accumulation leads to another process called steatosis and ultimately cirrhosis. So it's a much bigger problem. So sugar is death, essentially. The more sugar you eat, the worse you are.

There's zero upside to consuming sugar. but there are varying degrees of downside depending on the individual. The upside is it feels good for the moment. It tastes good, and your brain gets a hit of adrenaline or dopamine or whatever. And then the other 99.9% is a downside. That's right. And for some people, there's relatively small downsides. There are some people for whom, look, they get away with it, and it doesn't cause big issues. And that's right. And for some people, there's relatively small downsides. There are some people for whom, look, they get away with it and it doesn't cause big issues. And that's great. Probably 10 to 20% of the population is largely immune to the metabolic downsides. But for most

of us, that's not the case. And there is a toxic dose. And I don't mean acutely toxic. I just mean chronically toxic. And how much of an impact does sugar make on our mental and emotional health? Well, I mean, I think there's certainly emerging data that is, there was a paper that actually just came out two weeks ago, looking specifically at fructose metabolism in the brain as one of the, you know, very important pathways of promoting Alzheimer's disease. In fact, I think there's a subset of Alzheimer's disease that is effectively an energy disorder disease. So in other words, there's a subset of Alzheimer's disease that looks like diabetes in the body. So you could think of it as like this brain diabetes. So in that subset of people who are really becoming susceptible to that

illness, you couldn't do anything worse than continue to consume sugar. And that says nothing, of course, on the short-term side, as you said. For many people, sugar creates highs and lows that probably itself doesn't lead to emotional lack of resilience, but contributes to it indirectly by probably narrowing somewhat that band of tolerance that we have. Most people agree when they eat better, they cope better with stressful things. And also most people acknowledge that when we're under stress, we tend to drive ourselves towards short-term comfort foods and we stress eat to get that short-term hit that you referred to. I feel like we've just scratched the surface

of so many topics I want to go down, but hopefully we can get you back on for another two, three-hour interview because I felt like this went by like that. But just scratching the surface, Peter, I really appreciate this. I've got two final questions for you before I ask those. I want to make sure people check out your content, Peter Attia Drive, the podcast. You're going to get a lot more information on this. Go check out that podcast there. Also, you're on social media a lot. I loved your article about Topo Chico and the potential downsides of sparkling water. I'm a big sparkling water guy myself. You have a fascinating blog where you write about a lot of stuff with a research and a science backing everything make sure to check out your website uh peter atia md everywhere twitter instagram facebook as well

with lots of great content and hopefully the book coming out in the next year so make sure to be maybe two to be on the newsletter subscribe to the podcast so you can stay up to date when that comes out. This is a question I ask everyone at the end, two questions. This one's called the three truths. So I'd like for you to imagine for a moment a hypothetical question scenario that you live as long as you want. You figured out the rules of hacking, of living, healthspan, lifespan. You're 150, 200 years You're as old as you want to be and you're healthy. But for whatever reason, it's your last day and you've accomplished

every dream. You've put out all the content you want to put out there. You've got a great family life, everything. But for whatever reason, all your content has to leave this world and no one has access to your information anymore. The interviews are gone, videos, books, they're gone with you to the next place. But you get to leave behind three lessons that you've learned that you would share with the world. And this is all we would have to remember you by are these kind of three lessons or what I like to call the three truths. What would you say are your three truths? So we didn't talk about this today, but I think an important principle of knowledge acquisition is differentiating the search for truth versus the need to being right. So I would say the first thing is knowing the truth is more important than being right. I guess the second one we did talk about today, which is that the pursuit of joy is a good thing. Although we didn't get into it, there's a belief I think that many people have that says joy would reduce productivity,

would reduce drive, would reduce ambition or all of these things. I'm not convinced those things are true. And even if they are, who cares? And then I think the final thing, which at least to date has been a big part of this journey, has been realizing that eulogy virtues matter more than resume virtues. So if you think about who are those people that are going to be there at the end and what's going to matter to them versus what your CV says, that is a principle that I think is worth preserving. Those are beautiful. I love those three truths. Peter, I want to acknowledge you for a moment, man. This has been highly insightful for me, very powerful, and I'm just

so appreciative of your joyful drive to finding the truth, doing the research, diving in to serve all of humanity and serving us to live healthier lifespans and longer lifespans. So I really acknowledge you for the gifts you are and the curiosity and the effort you put in. Now, gratefully, in the last couple of years, in a joyful state to serve humanity, I really think that more people need to be like you. So I'm grateful for your existence and for being here. And my final question for you is what's your definition of greatness? I think it has two components and I want to make sure I represent that I've never figured out how to achieve this, but I've seen it. I've been able to see it on a couple of occasions and it's really

special. The first is the obvious one, which is domain mastery, right? It's like a true mastery of whatever the domain is, whether it be intellectual, physical, whatever. But the few people that I've seen that I think about as great did something beyond that, which is they do it with a level of humanity that elevates everyone around them to a place where those people have also never been before. So we do see great athletes who do this, but just as much we see great community workers who do this. I mean, there's this missionary doctor who's one of my heroes in this world. And these people are exceptional at what they do, but equally important is they somehow

everybody around them is at their best when they are in their orbit. So to me, it's those two things that are almost impossible to find together. That's cool. Peter, thank you so much for being here, my man. Thank you for having me. Thank you so, so much for listening, my friend. I hope you enjoyed this. And if someone sent you this link, then send them a thank you message in return. Just text them or

call them and say, hey, thank you for sending this and letting me be aware of how I can improve my health. You've got a great friend in that person who sent you this link and make sure to pay it forward. Just copy and paste the link wherever you're listening to this right now on Spotify or Apple podcast or anywhere you're listening to podcasts and send this to someone or use the link lewishouse.com slash 1046 and text someone posted on social media and tag myself Lewis House and Peter Atiyah as well. And make sure if this is your first time here, click that subscribe button right now on Apple podcast to stay up to date from the best information from the greatest minds in the world every single week. And leave us a rating and review over there as well.

That really helps us spread the message of greatness to more people when you do that. So please subscribe and leave a review right now. And if you want inspirational messages to your phone every single week from me, then text the word podcast right now to 614-350-3960. Do it right now. Text the word podcast to 614-350-3960 to stay up to date on the latest and greatest from me to your phone every single week. And I want to leave you with this quote from Aug Mandino, who said, always do your best. What you plant now, you will harvest later. And that is true with your health. Isn't it interesting when we eat horrible, when we sleep bad, it tends to catch up to us later. We start to get affected. We start to

get sick. We start to see issues with our health. And when we take care of our health now, it always pays off later. If no one's told you lately, you are loved, you are worthy, and you matter. I'm so grateful for you. You know what time it is. It's time to go out there and do something great.