The Tim Ferriss Show - #398: Peter Attia, M.D. — Fasting, Metformin, Athletic Performance, and More

Starting point is 00:00:00 At this altitude, I can run flat out for a half mile before my hands start shaking. Can I ask you a personal question? Now would have seemed the perfect time. What if I did the opposite? I'm a cybernetic organism, living tissue over a metal endoskeleton. The Tim Ferriss Show. This episode is brought to you by Humans Beet Elite. The product is Beet Elite, not Meat Elite, not Beet, B-E-A-T, but Beet, B-E-E-T Elite, which you might consider an endurance superfood,

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Starting point is 00:05:21 So, discover this cutting- edge indoor cycling bike that brings a studio experience to your home. Peloton is offering listeners of this podcast a limited time offer. Go to onepeloton.com that's spelled O-N-E-P-E-L-O-T-O-N.com. Enter the code Tim podcast, all one word at checkout and get $100 off accessories with your Peloton bike purchase. Get a great workout at home anytime you want. Go to onepeloton.com and use the code TIMPODCAST to get started. Well, hello, boys and girls. This is Tim Ferriss, and welcome to another episode of The Tim Ferriss Show. I am here with some, might mistake him as Borat, sample.

Starting point is 00:06:06 A man is like a horse. We say in Kazakhstan, if a man is happy, happy, you know, happy, is like if a horse is happy. But on the internet and in his clinical duties, he's known as Peter Attia. Dr. Peter Attia, welcome back to the show. Thank you. Thank you for having me. And Peter, for those who do not know anything about your background, we'll cover just the basics, but what would be a kind of speaker bio short version of Peter or Tia just to get people up to speed who have not heard previous episodes?

Starting point is 00:06:50 Part-time shepherd, part-time race car driver, part-time archer, part-time doctor. And that pie chart has most of the pie on doctor. What else do we have here? Doctor interested in longevity. I guess I have to do all the serious stuff now. Podcast host, courtesy of you. Podcast is called The Drive, and it focuses on things beyond driving, mostly, I guess, things related to longevity.

Starting point is 00:07:25 And dad. I guess that's another thing on the bio. Another responsibility. And for those who have not heard our prior conversations, Peter is my go-to resource for anything related to extension of lifespan or more accurately health span. So threading the needle of combining both longevity and performance. And that's across many different dimensions. We're probably not going to spend all of our time on that today, but Peter is one of the most methodical and oftentimes obsessive people I've ever met, and that's coming from me, keep in mind. So I think it was in episode one that we talked about, so we're not going to spend time on it now. But Peter's very, very, very particular etiquette

Starting point is 00:08:19 for stapling, which has measurements in the metric system and so on so we're not going to get into that but peter is my de facto expert when it uh when it comes to many different things including longevity and one of our episodes which was a group episode with two other very very accomplished scientists was actually recorded on easter island as a teaser for people who might want to explore, which is known as Rapa Nui and is the namesake from which rapamycin is named, which we may talk about. And there you have it for preface to our conversation. But we're going to try something today, which is a first. And I think we're going to call it temporarily five things with Peter Thier. It might end up being more than five, but I know Peter pretty well, and Peter knows certainly me quite well. I said, what do you think of doing

Starting point is 00:09:17 an episode where we talk about, say, five things that you're excited about currently, five things you've changed your mind on in the last whatever it is, a year, two years, three years, whatever. And then five absurd or stupid things that you do or still do. And we're going to give that a shot. And I think we'll maybe cycle through. Do you think we should do the five excited, five change, five stupid in that grouping, or should we do one, one, one and kind of cycle through? Ooh, that's a good question. I don't know. I was all mentally prepared to go from one category to the next. So I would suggest do the opposite of what I was prepared for. Perfect. Let's cycle through. So what is the first thing you'd like to confess or describe that you're excited about?

Starting point is 00:10:08 So the first thing, and I guess for the listener, you were very kind enough to give me a heads up that this is what you wanted to talk about. So I actually did have some time to think about this, which fortunately allows me to not sound like an idiot, which is what I would have sounded like if you had just asked me this cold. So the first thing I have on my list about excited stuff is the centenarian Olympics, which is my favorite sport. It's the sport that I am exclusively training for. And, um, it has become one of the highest priorities within my medical practice in the past, probably two years. So the idea is the following. I had this, um, I think I can call it an epiphany actually, uh, maybe 18 months ago to two years. So the idea is the following. I had this, I think I can call it an epiphany actually, maybe 18 months ago to two years ago. I was at the funeral of a close friend,

Starting point is 00:10:51 the parent of a close friend. And like all funerals, there's a somber nature to them, but on some level, people are also generally rejoicing in the fact that a person hasn't suffered too much. And in the case of my friend's parent, who'd been diagnosed with Alzheimer's disease, the time from diagnosis to death was like six months. And everyone was like, oh, that's great. There wasn't much suffering there. But I knew that parent for many years. And what I realized in spending more time talking with everybody was that the last 10 years of their life, even though their brain was still intact, shy of was golf and gardening, like landscaping, really some killer landscaping. We're basically off the table, you know, courtesy of nipping, you know, like, um, hip injuries, shoulder injuries, back injuries, all these other things. And so I sort of reflected on this for a while and realized

Starting point is 00:11:58 that pretty much the standard path that people go on, which is before they actually die their physical death, you know, the sort of what I call death certificate death, they tend to die some combination of a cognitive and physical as an exoskeleton death. And so we're sitting there at the funeral and I'm, I don't know, I'm just thinking there's got to be a way to stop this because nobody's really thinking about this. We do all this amazing training for athletes who are, you know, trying to go to the Olympics or even being weekend warriors or doing whatever they're going to do. But why aren't we training to be kick-ass 90 year olds? So my hypothesis was, well, it's just a lack of specificity. I mean, what separates, you know, a professional athlete from a weekend warrior is generally the specificity and the intensity with which they pursue this thing.

Starting point is 00:12:46 So I said, well, what if we came up with an event that actually defined what one would want to be able to do when they're 100, using that just as a benchmark. Again, you may never live to 100, but to train to achieve this thing when you're 100, you'll obviously be in great shape when you're 80. And so I sort of came up with this idea of the Centenarian Olympics. And the first thing you got to know about the Centenarian Olympics is it's very personal. It's individual. Everyone will have a different set of events. So you and I might have a different looking Centenarian Olympics, though I think there are some common things to all.

Starting point is 00:13:19 So the first thing I did to figure this out was I, for myself, which is, you know, the person I'm solving for in the first iteration is sort of mapped out how old everyone in my life would be when I'm a hundred. So how old would my kids be? How old would their kids' kids be? And all the way down. And that gave me kind of a mental model of what the world looks like when I'm in my 10th decade. And what I realized is the things that are probably going to give me the greatest joy at that stage will involve interacting with those littler people. And my kids won't be that little, they'll be in their 60s or whatever, but their kids will be in their 20s and 30s and their kids' kids will be basically the age of my

Starting point is 00:14:02 youngest kids now. And so I just started paying more attention to what I do with them. And it's stuff that, you know, Tim, you and I would take for granted. In fact, I'm guessing anybody listening to this is going to take it for granted. But kids, you've seen my kids a million times, they play on the floor. So step one, can you get up off the floor? Can you lay on the floor? Can you do something on the floor? And can you get up under your own support? Again, you could do that blindfolded today, but watch how

Starting point is 00:14:30 many people, even in their 60s, let alone 70s and 80s, can't do that. And then you start to deconstruct why. What are the structural misgivings that prevent someone from doing that? Another thing I noticed is how often toddlers come running at you head first, and they don't actually stop when they get to you. So there's an implicit assumption that as they're running to you, you're going to be able to pick them up and stop that momentum. And if you can't, you're going to get a headbutt to the groin. So that's a very essential part of the equation here. So I started saying, well, how many times has my son, my youngest son come running at me? And how often, how often do I have to drop down into a goblet squat, grab him and pick him up?

Starting point is 00:15:10 And so basically I listed out 18 things that I can do today that I want to be able to do when I'm 90, for example, and those events constitute my centenarian Olympics. And so I'll rattle off a couple of them, but you know, a 30 pound goblet squat. Again, could you do that today, Tim? Yeah, you could do a hundred of those today, but how many 90 year olds can do that? Very few. Walking up three flights of stairs with 10 pounds of groceries in each hand and walking down under the same load. Again, biomechanically, that's not a trivial task. The walking down has its own challenges. The walking up has its own challenges. Being able to pull myself out of a pool where the gap between the water and the surface, the lip of the ground is six inches away. So being able to actually pull myself up.

Starting point is 00:16:05 As I said, getting up off the floor with a single point of support, being able to put a 30-pound suitcase over my head, all these sorts of things. Which would simulate putting your luggage into the overhead. Exactly. I don't want to get to the day when I can't put my luggage above myself in the airplane. And once I sort of mapped out all these things, I kind of broke down what the movement patterns that were necessary to do this. So this requires the ability to hip hinge. This requires a certain amount of aerobic efficiency. This requires a

Starting point is 00:16:36 certain amount of anaerobic efficiency. This requires a certain amount of scapular stability, et cetera, et cetera. And they basically condense into four elements of health, which is stability. So the ability to control, you know, using the muscles of the body, control the exoskeleton such that load is transferred safely through muscles as opposed to unsafely out joints, strength, aerobic efficiency, and anaerobic performance. And then you back out of that and say, well, if you want to be able to do all of those things by the time you're a hundred or say in your 10th decade, so between 90 and a hundred, what do you need to be doing when you're 70? Because there is going to be an inevitable

Starting point is 00:17:18 decline from 70 to a hundred. And if you can do this metric at 70, what do you need to be able to do at 60? And what do you be able to do at 60? And what do you be able to do at 50? And since that's the decade I'm closest to, I'll be 50 soon. That becomes my benchmark is, okay, so that's what I'm training for. And so this idea we've sort of translated to our patients, which is, unless you really have a strong desire to do an Ironman or run a marathon, most people are exercising without a real sense of purpose. And so the question is, could you create a true sense of purpose around this and then work backwards to build towards it?

Starting point is 00:17:57 And obviously we're not going to know the answer to that question until people start getting there. But my strong belief is you can and you should. And if you don't do this, if you just assume by chance you're going to get there, I think the likelihood of that is low. And if we look at one of those exercises and you can pick any one, let's just take the goblet squat. Yeah, goblet squat to simulate picking up a toddler. How do you back out from doing that at 90 or 100 with 30 pounds? Do you assume a certain amount of sarcopenia, is that the right word? Muscle loss per year from 70 to 100 and then somehow calibrate a much higher weight for a certain number of repetitions as a result? How

Starting point is 00:18:42 do you think through that calculus? It's exactly that. So it's not rocket science to figure out a 30-pound goblet squat at 90 equals how many pounds at 50. The bigger question is to understand how you have to do it biomechanically at 50 to ensure you can still even do it safely at 90. So let's just say the number is 90 pounds at 50. It's not that hard to goblet squat 90 pounds for a fit guy like you,

Starting point is 00:19:13 but it's actually kind of hard at our age or anybody's age, frankly, to do it perfectly, especially with complete scapular protraction, which is another thing you want to be able to do because remember, you're holding a toddler here so you need to be completely stabilized through the upper and lower body and the thing that's nice about a goblet squat just as one example you want to just describe a goblet squat to people for those who don't know i mean there's we could use a kettlebell as an example or something else yeah yeah so if you're picturing holding a dumbbell or a kettlebell and you have both hands on it and it's in front of you and you're going into a squat

Starting point is 00:19:49 position that way. So as opposed to like a barbell squat where the bar is on your back and you're holding it back. The nice thing about this goblet squat is it's a little bit more representative of real world movement because you now have your scapula that have to move forward. That's called protraction. And you have to be able to stabilize that position, which is going to be holding the kettlebell or the dumbbell or the child. Or if you're our friend, Kevin Rose, you want to be able to throw a raccoon at 90. Also helpful for those who haven't seen, you don't have to get into it. There's a great video of Kevin Rose throwing a raccoon. You can look it up. Back to the children and the goblet squat. Yeah. And then of course you get into the real minutiae of what does it really mean to be able

Starting point is 00:20:35 to squat safely? And again, for most people, myself included, before I was really putting a lot of thought into this, to do a heavy hip hinge activity like a squat or a deadlift, you will naturally tend to fall into a place of lumbar compression. You will compress the spine when you do these things. That's not that sustainable. What you really want to be able to do is get to a point where you can do those things under spinal traction, which sounds very counterintuitive. Most people think of traction as something you can only achieve when you hang, which is elongating the spine. But it turns out if you generate concentric intra-abdominal pressure from diaphragm to pelvis, you can actually stretch out the spine while you're under load. And once you start doing it biomechanically correctly at the age of 40 or

Starting point is 00:21:23 50 or whatever, and you start to carry that forward, then you're sort of winning on two fronts, with the more important of those being by the time you get to 90, you actually have the ability to even move in that direction and stabilize your trunk, which is the rate-limiting step for a squat. It seems like with many of these movements, and I suppose in many things in life, if you want to play the long game, you kind of have to check your ego at the door, right? Because you would probably be making some trade-offs in terms of the amount of weight you can lift, etc., if you're going to be training technically to be able to perform these movements at 90 right you might have if you're not going to be doing a wide power lifter squat with a limited range of motion compared to say an olympic ass to heels squat very different in terms of biomechanics and what you can do

Starting point is 00:22:19 i mean i work with three people um a woman named beth, a guy named Michael Stromsness, and another guy named Michael Rintala. And all of them have a training in something called dynamic neuromuscular stabilization or DNS. And then they all, of course, bring in their own expertise outside of that from powerlifting and other athletic disciplines. And Beth, who's sort of the one that kind of defaults into my deadlift program. So I deadlift twice a week and we started from scratch. So we have basically, you know, imagined I've never deadlift, even though I started deadlifting at the age of 15 and power lifted all the way through high school. Her view is no, we're starting from scratch. It's as though you've never done this before.

Starting point is 00:22:59 And one day a week I'm doing straight bar, you know, very traditional closed leg straight bar deadlift. And I mean, she had me starting at 105 pounds and I was not allowed to progress from that for a couple of months. And I was like, Beth, at least let me just get to 135 so I can use the goddamn 45s on the side of this thing. I mean, it's getting ridiculous here. And she's like, no, you're not ready yet. I'm just imagining a row of like five or ten pound plates with the bar, your knuckles scraping the floor. Well, luckily we had ten pound bumpers. I'm just kidding. I'm kidding.

Starting point is 00:23:43 So we were juxtaposing the straight bar deadlift with very lightweight. And she was letting me use more weight on the hex bar. But we had to fix a whole bunch of movement defects. Yeah. Hex bar, for those who don't know, also known as a trap bar, so-called, in the former case, because it is a hexagon that you step inside of so that effectively the bar path is traveling through the center line of your body. And so the hex bar is much easier to deadlift because you are in a more advantaged position, but it's also easier to do incorrectly. And the reason for that is you don't have a bar in front

Starting point is 00:24:15 of your shins. And so if you're like me, you tend to default into a very quad dominant deadlift. And what Beth realized was we had to break that cycle. And the only way we were going to get you to use your hamstrings, Peter, is if we changed your position. And I, you know, the, the, the idea was the best way to change your position was put a bar in front of your shins that you can't go through. So anyway, that's one example, but yeah, to your point about checking ego, um, so much of what I do these days in the weight room looks really silly and it's not using nearly that much weight. I mean, today you should have seen me like what I was doing in the gym today. It was sort of comical

Starting point is 00:24:55 to watch. Um, you know, a lot of single arm pressing in, you know, positions that are really forcing me to generate the right amount of concentric force inside my trunk and when you say concentric force in the trunk what do you mean because i'm familiar with concentric eccentric as thought of say in a bicep crawl with lifting the weight in this case contracting uh concentric movement versus eccentric lowering so picture like someone putting yeah yeah like someone putting a balloon inside your belly. Let's pretend for a moment they could strip all your guts and liver and everything out, and you could put a cylindrical shaped, but round top and round bottom balloon inside your abdomen. So at the top, it's mimicking sort of the shape of your diaphragm.

Starting point is 00:25:44 And at the bottom, it's sort of like the shape of your pelvis. And then the idea is you sort of start to blow that up and you generate this pressure that comes out. So all of the muscles are sort of getting longer and under more tension. And the force is sort of uniform all the way throughout. And that's called intra-abdominal pressure or IAP. And what I've realized over the past little over a year now is most of us have lost the ability to put air into our pelvis. Or put pressure really is the right way to think about it.

Starting point is 00:26:21 You're not literally putting air in your pelvis. The air doesn't go below the diaphragm. but we don't know how to generate that pressure in the abdomen. And by being able to do that, that's what enables you to actually stabilize your spine. Um, so, so people who say, you know, people say to me all the time, I can't believe you a deadlift like that seems so crazy. Aren't there better ways to get the same activation of the muscles in your glutes or hamstrings or quads? And the answer is yes and no. I mean, you can certainly do those things without having to go under that load, but a deadlift is an amazing audit as is a squat for that matter. And I do, I think of those things as audits because if you're doing them correctly,

Starting point is 00:27:04 and once you learn the proprioceptive cues that you're supposed to feel, you know when you're having a good day and a bad day. And if you're having a good day, that's the feeling you want to replicate. Yeah, audits. There are quite a few movements that act as good audits. Turkish Get Up, also a nice little audit for another day, perhaps. So let's, I'm kind of doing the math here. I'm like, like all right if we

Starting point is 00:27:25 have 15 or 17 this is going to be a long podcast uh but let's put a bookmark in the centenarian olympics which we might come back to you never know something you've changed your mind on so the in no particular order other than the order that i listed these things out um the use of metformin in very healthy individuals is something I've changed my mind on. So I don't think we talked about this on any of our other podcasts. I don't think so. So what was the previous position or conclusion? 2010 view, which sharpened and became more and more bullish from, say, 2010 through 2015-16, was that metformin was a very, very low-risk cancer-mitigating drug in anybody.

Starting point is 00:28:22 Now, I believed that it was more so in patients who had diabetes or conditions that approximated diabetes, like hyperinsulinemia. But the data were, I think, quite convincing to me. And my extrapolation was, well, even in people who don't have diabetes, this is still a great longevity agent. And for those who don't know, what does metformin do? Well, you know, that's a... That is a big question. Yeah. And that's part of the rub is metformin does a lot of things. It's a mild mitochondrial toxin, and this becomes relevant to the story. So it sort of inhibits the first complex of the mitochondria, what's called complex one. And by doing so, and it seems to do so almost, I mean, preferentially in the liver,

Starting point is 00:29:13 it leads to a cascade of events that activates an enzyme called AMP kinase. And when you do that, the body basically starts acting like it's in a fasted state. So it's sort of like a junior fast and a pill. And for people with diabetes, what's beneficial about it is it lowers the amount of glucose that the liver puts into circulation. So there's plenty of benefit to that. And there's no disputing its efficacy there. And in the last five years, frankly, it's become a very popular topic. I've interviewed a guy named Nir Barzilai on my podcast, and we've talked exclusively about this. Nir is one of the world's experts on metformin, and he's leading the charge to do a very large clinical trial to test

Starting point is 00:30:00 the question of whether metformin is a longevity drug in non-diabetics. Anyway, the point is my baseline view was that this is the case and I had been taking metformin since 2010. What changed a year ago was I began doing a very focused type of exercise that was geared towards mitochondrial performance and efficiency, something called zone two training, where you basically push the boundaries of how much work you can do while keeping lactate below two millimolar. So lactate is a byproduct of metabolism under conditions in which you're asking the body to make ATP, which is the energy currency at a rate faster than can be sustained aerobically using oxygen only. So by pushing the boundaries of how much work you can do, and I mean work in the very technical sense, so how fast you could run, how many watts you could push on a bike, and ratcheting up that

Starting point is 00:30:59 level while still keeping lactate below two, you're training your mitochondria to become more and more efficient. And what I started noticing when I was mucking around with different drugs was whenever you have metformin in your system, that output goes down. And again, when you thought about it for a minute, that shouldn't be surprising. It's a mitochondrial toxin. Could you, just don't lose your train of thought, but what are mitochondria? So fucking fascinating, but mitochondria, I think really, really interesting. I don't want to take us off the rails. Yeah, they do a lot of things, but for the purpose of this discussion, what they do is they do the most efficient form of energy transfer, which is transferring energy that comes

Starting point is 00:31:43 in the chemical form of energy, like food energy, right? So when you eat something like glucose or fat, or your body breaks down and gives you glucose and fat, how do you turn the energy that is stored within those chemical bonds, the carbon-carbon bond, the carbon-hydrogen bond, et cetera, how do you turn that into ATP? And you do that by first breaking those things down and getting electrons into these electron donors. And people who might remember from a high school class something called the electron transport chain that runs through the mitochondria.

Starting point is 00:32:16 And those electron donors eventually donate back, make an energy gradient that makes ATP. And in the end, all they spit out is carbon dioxide and water. So that's why we breathe out carbon dioxide and water vapor in exchange for taking food and making energy. So they play an essential role, obviously, in energy production. And if you lose the ability to make energy with the mitochondria, that's effectively what happens to a cancer cell. So this idea of zone two efficiency is so important for metabolic health that I started questioning, well, why the hell would metformin be a good thing if it's impairing that? And basically after doing a lot of experimenting with and without metformin, metformin under different clearance pathways, et cetera, et cetera, it became unambiguous to me that metformin was

Starting point is 00:33:11 impairing this, and there was no two ways about it, and then I began to question, well, you know, how would you reconcile that with the fact that metformin is helpful, and then you realize, well, metformin's only really ever been shown to be helpful in people who have diabetes. And when you look at the sort of mitochondrial performance of people with diabetes, it's abysmal. In fact, even though that's not a hallmark that the medical system would typically pay much attention to, but if you do that type of zone two testing in people with diabetes, it's such a contrast between them and someone without diabetes. So I realized, well, maybe when you are all, when your mitochondria are that sick, a little bit more toxicity doesn't matter that much. But if you're playing a different game, it might. Now, since that time, a number of other studies have come out. I've written about one of them, maybe actually two of them that look at the effect of mitochondria, pardon me, um, metformin and mitochondrial inhibition on the difficulty of growing muscle mass, which again,

Starting point is 00:34:10 it's not as interesting to me, but that appears to be a totally different issue, which is the blocking of, um, sort of the stress response. Um, I think the jury's still out on all this. Meaning that it appears that metformin appears to inhibit versus not administration of metformin. Correct. Hyper-free muscle growth. That's right. Metformin seems to impair the inflammatory response that would be pro-growth to muscle,

Starting point is 00:34:40 pro-adaptation, for lack of a better word. I think it's still too soon to say how this story shakes out, but I was basically in the past year, I've seen enough data to suggest that for me personally, the benefits of just focusing and doubling down on my exercise are probably going to yield better results than the use of metformin. And of course, then the question is, how do you translate that into patients? And where do you draw that line? Which patients are sufficiently on the healthy enough side? And I don't know the answer. I think my thinking on that is the more you exercise and the healthier you are, the less benefit and potentially the more detriment you could experience from metformin. I mean, I suppose this is not Tim playing a doctor on the internet, but just thinking about that, that even if someone were, say, pre-diabetic

Starting point is 00:35:35 or presenting the symptoms or biomarkers of someone who's pre-diabetic, it might make sense to try other interventions before metformin, right? Because you might slap on 10 pounds of muscle mass, and lo and behold, they're much better at disposing of glucose or any number of things could change. I think no matter what, like if you take somebody who's got diabetes, I don't think people appreciate how potent a tool fasting exercise and sleep are. You know, when you rob someone of sleep, when their sleep sucks, when they're not exercising,

Starting point is 00:36:12 and when they have full stores of glycogen in liver and muscles, which is basically the state you're in when you're constantly fed, the ability to reverse those three things is, is more powerful than all drugs combined. I mean, so, so I agree if, if, if there's a way that you can treat patients without using medication, one should always do it. Um, sometimes metformin does offer a great step forward. And again, it, you know, it comes down to every patient's ability to sort of, you know, adhere to exercise and all these other things. Would you ever consider using metformin, uh, uh, maybe this is more a job for acrobose. Is that, yeah, you remember that, but, uh, using say metformin selectively when you're going through

Starting point is 00:37:01 a period of overfeeding for some period for, for some purpose. I mean, I think those are exactly the kind of questions I'm still struggling with, which is, does it make sense to cycle metformin? Does it make sense to only use metformin in the evening, but not use it in the morning? So you, let's say in the morning, you know, you exercise, but in the evening when most people are fed, like for one of the things I did notice when I stopped taking metformin is definitely my nighttime glucose levels are just a little bit higher because nighttime glucose is controlled by the liver. It's not really a function of what you just ate. It's, um, you know, you're so far outside of that last meal that it's, it's generally the response of the liver putting glucose in circulation and titrating that. So

Starting point is 00:37:39 yeah, I think they're probably different, like, you know, five different ways that you could sort of slice this thing up and decide on how to do it. And I don't know the answer. And I guess I reserve the right to change my mind again. But for now, that's been a pretty big change for me. Absurdity, stupidity. I know we have a wealth of options because you and I are sort of connoisseurs of the absurd. So one of them, which is the one that you already know about, and I know you're a big fan of, is egg boxing. I just cannot get enough of egg boxing. Okay. So, oh God, where do we even go with this? Because this could be a podcast in and of itself. So, but I don't think we have time to tell the story. If people look it

Starting point is 00:38:27 up or we can link to a video of the, the Ramanujan of egg boxing. That's right. But that is maybe a story for another time, which really does put into concrete terms just how ridiculously obsessive Peter can be. But what is egg boxing? So it's a sport slash game where whenever you're making something with eggs, you hold an egg, you hold another egg, you bang them off each other. The one that cracks, you obviously break. And the one that didn't crack, that's considered one win. So let's say these are two eggs you've never touched before. You smash them. That guy is now 1-0. And then you pick up another egg. Let's say you want to make five eggs. And you smash. And let's say that guy wins again. So he's now 2-0. And then you smash again. And let's say he loses. Well, then he retires with a record of 2-1. And the other guy

Starting point is 00:39:22 is now 1-0. And you keep going. And at the end, like when you break your last egg that day, you write down how many wins the last guy has, because by definition, the last one standing is always the winner. And then the next time you come to make eggs, you just play again. And so I don't know when I started playing this game,

Starting point is 00:39:40 but it was somewhere in high school, and I've never stopped. And I take it very seriously, and I guard the champion very closely. and as you're alluding to we did we did there was there was one very very special egg in my life in 2007 and 2008 who i nicknamed ramanujan after the great mathematician not a great boxer but he was such a prodigy amongst eggs. Probably a terrible boxer. Yeah, yeah. But he's the only egg I've ever had where his winning record was so great that I lost track of his actual record. Was it in the hundreds, thousands?

Starting point is 00:40:16 Oh, I mean, put it this way. He was the champion for more than a year. Now, all right, we're going to continue on to future bullets, but I will say, if my memory serves me correctly, that at one point you were like, I want to know what type of strange abscess or structural abnormality exists in this egg, but you couldn't get someone to agree to X-ray the egg for you, so you snuck it into your pocket? Well, no, the plan was I was going to go to the ER

Starting point is 00:40:47 and pretend I had a groin injury and have them do a CT scan of my pelvis with rhamnosian in my pocket because I wanted to see what was really going on inside of him. And alas, we shall never know. He died a tragic death. He died an awful tragic death that i might explain in the video okay we'll link in the show notes to the video uh which includes a demonstration of the proper technique for egg boxing and i don't know if you know this but nick stenson who works for me uh in the podcast actually built championship belts for the eggs.

Starting point is 00:41:26 Oh, I saw them because I remember voting on what the championship belts should look like. That's right. So now we have championship belts for my eggs. And it's one of those things people always say, Peter, when are you going to start making swag for your podcast? The first piece of swag I would ever make would be championship eggs, like the championship belts for the eggs. Well, you know, I should give you credit where credit is due. You have introduced me to a number of people who've been on this podcast, including Jocko Willink, who is a master of merch. No big surprise, great at execution. And I'm thinking that you might even be able to sort of create the equivalent of the celebrity bobblehead dashboard for your dashboard craze by having particular personalities represented in the world of egg boxing you

Starting point is 00:42:15 could have a jocko egg boxing iteration of some type you'd have to clear it with the big man himself obviously but i'm literally going to call Jocko tonight and actually, I love the idea. All right, we're back. I like this cycling through. I think we should go back to excited about. Okay, the next thing I have on my excited list is just overall the space of fasting and the potency of fasting. But it's sort of taking a page out of your playbook, right? So the work that you've done recently with Johns Hopkins is basically, and I was talking about this with a bunch of people today at the race, and they were like, what is Tim really excited about these days? And I said, well, you know, and I kind of walked them through your

Starting point is 00:42:59 thesis. In context, by race, we mean F1 here in Austinin and if you don't know anything about f1 just consider this top cars have what is it 500 million behind them put into them teams of hundreds i mean it's oh yeah yeah yeah 500 million dollar a year budget easily just team of team of a thousand so uh all right so continue didn't mean to interrupt but so. So what I've realized is, and I've vented about this many a time. In fact, I have an entire Sunday email devoted just to my vent on this, which is it really bothers me that we don't, like if fasting is such a potent tool, and I don't think anybody who's studied nutrition or biochemistry would disagree with that. It's sort of odd we don't know how to dose the tool. And so, as you know, Tim, I fast for about seven days a quarter.

Starting point is 00:43:55 And this is how it ties into the Hopkins. Is the question of dosing? Is the question of studying something. It's basically taking, yeah, so it's basically saying, okay, I fast seven days a quarter, and and people ask me rightfully so, but Peter, how do you know to do that? Like, you know, I, you know, someone will say, well, I fast three days a month and that's a comparable number of days, total days fasted, but what's producing the ideal physiologic response that would lead to life extension or the minimum reduction of, you know, disease risk. And again, it bothers me greatly that I don't know that. So it sort of occurred to me that what we need to do is form a little coalition. And a number of my patients have already said, oh, sign me up. I'm in. And we'll basically put a pot of money together and find the best people who understand and can help us pick the right animal model.

Starting point is 00:44:45 Because we're not going to be able to study this in humans like you have to accept that you that we're in the option b territory there is no option a there's no let's do this experiment in humans and study them for 20 years wouldn't get cleared by the irb or it would take too long just takes too long yeah if you want a hard outcome which is actual mortality you have to do this in an animal model yeah yeah agreed okay missed that last part. Yeah. So, so should it be mice? Well, you know, mice have the advantage of being really easy to study and you could probably know the answer in a year. Um, and that might be the answer, but it will require people really smart to understand what the equivalents are for mice in fasting. And it's

Starting point is 00:45:22 not going to be a linear extrapolation from our humans. Like for example, you know, a mouse that fasts for two days dies and loses 25% of its body weight directionally. So that's not going to be that helpful. I'm thinking ostriches. I mean,

Starting point is 00:45:35 I'm kidding. I'm kidding. Sorry. Just being an idiot. Yeah. Yeah. I know. I mean,

Starting point is 00:45:38 I have no idea what it is like ferrets. I mean, I just, I don't know. But what I really want to do is in the next couple of years, come up with the next best answer. And until that time, unfortunately, I'm going to continue to flail, which means I'm going to continue to fast, but do so without much real insight about what the quote-unquote best way to do it is, or if regimen A is better than regimen B.

Starting point is 00:46:05 But I think this idea of just saying, you know what, look, NIH is probably not going to fund this because I don't think this is a question they're that interested in. Industry is not going to fund this because you can't sell a fast. You know, VCs aren't going to fund it. Like when you look at all of the traditional funding vehicles that would go into exploration of question, this one really has to come down to philanthropy. And I have no interest in like creating an organization to do this. So why not just, you know, bring a coalition of people together, find the right people and just directly fund them. What would the study design look like? So let's just say, and again, I don't know if you would do this, but let's just say it was agreed upon that mice would be an appropriate model. And let's just say that, you know, you

Starting point is 00:46:51 agree that there would be three arms, right? One arm would be mice that were on regular mouse chow, and it would be important that it would be proper chow, not nonsense chow. Like a lot of these studies are done with pure sugar, high fat, nonsense chow. The goal isn't to do that. The goal is to take like healthy mice and then picking the right strain is in itself a huge decision that would have to go into this. So you have the ad lib feed.

Starting point is 00:47:16 So these are the mice that are allowed to eat normally. Yeah. Ad libidum. Yes. Then you'd have probably. Which means they can eat as much as they want. That's right.

Starting point is 00:47:23 And you have to be very careful about what that looks like by the way in animals in captivity so you you you still you might have to actually put them on a confined number of calories and maybe it's not ad lib and then you'd have different fasting regimens so you'd have the equivalent of three days a month what does that look like maybe that's i don't know that probably works out to be something like eight to maybe eight hours of fasting 16 16 hours of food exposure i have no idea and then there's the well what is seven days a quarter look like or nine days per quarter and those are contiguous days yes yeah and then maybe you've got the whopper which is like once a year they just do a mega fast which for a mouse would probably be 24 hours and then the idea would be you know follow them over the course of their

Starting point is 00:48:09 lives and if you pick a mouse you know pick you pick a mouse that's like 12 months old at the outset you'd probably know your answer in about a year and a half what would you be uh what are the outcome measures or what what would you tracking? The most important one would actually be death. I see. Would be lifespan. But, you know, if we could gather other indirect measures, disease-specific measures, if, you know, depending on the budget for such a study,

Starting point is 00:48:37 if we could also kind of shotgun and look at some metabolomic, proteomic signals as well, that would be especially interesting because the only way we would ever triangulate on this in humans would be to look at biomarkers in humans that are surrogates of good things happening. So things like autophagy, the inhibition of senescent cells, reduction of inflammation in areas that we don't really want it to be in. So those would be kind of the two prongs of this thing, which is get the hard outcome of mortality in the animal model, try to get some biomarker data. And again, it just, like I said, it really,

Starting point is 00:49:21 when you think about how potent fasting is as a tool, that we don't know what the dose is. It's like, I've got this thing, it's called Tylenol, and I know it reduces fevers and prevents muscle soreness. How much do I take? I have no idea. Like, think of how frustrating a problem that is. Well, especially with that example, a very dangerous problem to have. Yeah. What does your current fasting look like in the sense of timing? Is there a particular day

Starting point is 00:49:50 of the week that you tend to start on? And how do you lead from whatever your current normal is into the fast? So for the past couple of years, I've done the same thing once a quarter called the, I think Bob calls it the KFK nothing burger. So it's a week of keto that leads into a week of water-only fasting that is sandwiched on the other end or bookended by another week of keto. Is the keto hypocaloric? Is it isocaloric? It's a eucaloric ad libitum keto diet. So the purpose of it on the way in is generating ketones so that when you enter the fast, you suffer a little bit less.

Starting point is 00:50:32 The rationale on the way out is to prevent me from eating like an idiot. Sorry. Can you relate to that? I can relate to that. And we've done a lot of damage together. Just hearkening back to our fantastic trip to Easter Island with... I don't think we said no to a dessert the whole week. Yeah, David and Nav, two incredible, incredible scientists.

Starting point is 00:50:56 And they were just appalled and disgusted because we were so well behaved until we had two or three glasses of wine and decided, you know what, tonight's going to be cheat night. And the entire table was just piled with plates of dessert. And I'm not ashamed. I'm not ashamed. But I am thinking next year of changing it to three days a month

Starting point is 00:51:19 just as a way to mix things up. It'll be a little less socially intrusive. The, the week of fasting becomes a little bit of a grind. I only do it when I'm away from my family and I always go Saturday to Saturday, uh,

Starting point is 00:51:32 or sorry, I always go Sunday to Saturday. So I, I do like Saturday and last meal is always a Saturday and first meal is a Saturday. Um, whereas I was thinking, yeah,

Starting point is 00:51:43 what if I just did like a Monday, Tuesday, Wednesday, the first Monday, Tuesday, Wednesday, the first Monday, Tuesday, Wednesday of every month or something like that? That would be an alternative way to do it. Yeah, I've done more of that. I've done seven day and 10 day, but I've done more of the three day. I've always started on Thursday early dinner. That was the last meal because I could kind of gut through. I wasn't doing the... So you prefer to be... See, I like to be fasted during the week more than the weekend. I can get grumpy depending on the transition because I'm not doing... Generally, I'm not doing the ketosis first. I'm not coming into it producing much in terms of ketones.

Starting point is 00:52:15 So I'm going cold turkey, water only, let's call it 7 p.m. on a Thursday. And then I can kind of gut through Friday, especially if I schedule things such that I'm having mostly admin-like phone calls and so on. Nothing that requires any degree of delicacy or diplomacy. So I don't leave scorched earth in my inbox that I need to unfuck for days afterwards uh so usually it's early and then i go water only and i'll walk a lot on friday basically just do a walk and talk with lots of water and a handful of electrolytes and so on are you supplementing when you go water only are you going directly from ketosis ketogenic diet into water only and not supplementing? No, I'm supplementing with sodium, magnesium being the two main things.

Starting point is 00:53:11 Are you supplementing with different types of magnesium or just a single type? Yeah, two different types. During the fast, I use slow mag and I use L3 and 8 in the evening. So slow mag, I take two slow mag in the morning, two slow mag before bed, along with two magnesium L3 and 8 in the evening. So slow mag, I take two slow mag in the morning, two slow mag before bed along with two magnesium L3 and 8 before bed. That's the mag teen? Yes. That's good stuff. It's really a fantastic product.

Starting point is 00:53:38 I'm glad I passed 10 different times on investing in the company. Those are the best investments. Well, I mean, my feeling, it sounds stupid. When you're like, this record-setting trout just kept throwing itself into the boat and I just tossed it out. And then I was like, oh yeah, I'm on a fishing trip.

Starting point is 00:54:00 Oh, that was dumb. Shouldn't have done that. What's something else that you've changed your mind on? Okay, this one's a little heavier. I think that the fate of one's personality may not actually be set. I think I have historically believed that we are born with hardwired motherboards and our personalities are set in stone and there's no changing them. And in particular, I think for me, you know, you and I have talked about this a lot. I've never known a time of not being angry. I've just, I don't, I mean, I think I was probably just a pissed off fetus is sort of my, I don't think that's actually true, but that's been my

Starting point is 00:54:42 belief template. And I don't know, I think just a few years ago, I just, maybe more than that, maybe 10 years ago, even 15 years ago, I remember kind of having this discussion with my dad once. It was really sort of a sad day because my wife and I, who had been barely married, we might've been married for like a couple of years and my parents were over and it was just, I mean, I'm too, even, I'm even too embarrassed to tell the story, but my wife and I had a fight, which was basically just me being a total Piece of shit. In other words. It's not even like there was any symmetry in this It was just I was 100 wrong and I dug my heels in

Starting point is 00:55:14 And I was such a jerk and you could sort of tell my parents were just so sad for us Um, and I think sad for me at my sort of miserable existence And I sort of remember my dad not saying anything, but sort of his body language being like, dude, what? I mean, what are you doing? Like, why are you such an asshole? Um, and so I preemptively struck at him, which was, look, I don't even want to hear about it, man. Just like, I'm not meant to

Starting point is 00:55:45 be around other people. You know, I just, I just remember going like launching into this tirade about how I am not really designed to be around other people. Like there was just no two ways about it. Like I'm way too volatile. I'm way too angry. I'm way too, you know, all of these other things. Um, and I think I've carried that belief system with me up until about a year ago, up until probably, yeah, up until about a year ago, maybe a year and a half ago. And I now realize that that entire narrative is simply incorrect. It's no more correct than saying, you know, I have two copies of an APOE4 gene, which is, you know, which would be a genetic template that would make you much more likely to get Alzheimer's disease. But arguing that it's

Starting point is 00:56:24 a given that you're going to get Alzheimer's disease. That's not the case. These are not deterministic genes. And similarly, I don't think that these flaws in our personality are deterministic. And while there may be people who are more or less predisposed to be one way or the other, and then of course, events in life can reinforce that and push you more into that. And then the response to that can reinforce that. So all of those three factors can drive you in a given way. I know this sounds like a very glib example, but I really think that with enough work, you can start to overcome these deficits. And I think that for me, I think I'm only 50%, you know, as angry as I was during my, you know, sort of anger heyday.

Starting point is 00:57:14 And so I don't know, to me, that's amazing. Like that, that, because I now, I, I now have this confidence that I've never had before, which is two years from now, I might only be 50% of what I am today. And that would be 25% of what I was at the outset. So the tracking of the fury half-life. Yes, exactly. So, so I just, I just think that that's, that's my personal example. But for someone who says, you know, I'm just not fill in the blank enough or I'm too fill in the blank. I do think a lot of us start to buy our narrative and we just start to believe the story. And for me, that is by far the most hardwired story I've ever believed about myself. And there are lots of stories I believe about myself, right?

Starting point is 00:58:04 I mean, we all have our insecurities, and I'm too this, or I'm too that, or I'm not this enough, or I'm not good enough, or blah, blah, blah. But this one was like, no, no, no. That one you don't get to change. Like, that's eye color. And there's not even a contact lens you can put on it.

Starting point is 00:58:18 Like, it just is what it is. I've seen, certainly, and I mean, we talk about a lot of this in the first episode of your podcast where you and i had a long long conversation about many of these things the drive will link to it but i don't i don't know if i'm if i if we talked about this particular perspective on what we might view as deficits or weaknesses and that is finding a way to inspect them as coping mechanisms and protective mechanisms

Starting point is 00:58:52 that served an incredibly important function at some point. That's exactly right. So instead of refusing and rejecting those pieces of you, maybe feeling anger towards them, certainly, which I've done plenty of. Instead, looking at how you might thank them for mitigating or preventing, even if it ended up being now counterproductive when overused, but some point these were responses that protected you right like if that if that were the assumption how would how might you look at them differently could that possibly be true and that's been incredibly important for me in reconciling all all different

Starting point is 00:59:40 types of facets of myself that i've long held kind of resentment and anger towards. Yeah. I mean, and we could, if we were to really double click on this topic, that that's exactly the direction we'd, we'd go, which is, it starts with a little bit of self-empathy and introspection and realization of, well, let's examine the why this, this must've served some purpose at some point that this was an adaptation to something. Let's acknowledge that. And, um, you know, in the words of, of Terrence real, who, um, I just recently interviewed for my podcast. Um, you know, it's, it's, it's taking that adaptive child in you and thanking them, but just moving them to the back seat,

Starting point is 01:00:27 like making sure their hands aren't actually on the steering wheel. And saying, hey, thank you. Thank you for the help you gave me during this period, but I need you to just sit back there now and just chill out, man. Just look out the window. We're just going to go on a drive, but the adult has to drive now. This is a hard segue into stupid and absurd things but let's fucking force it what's funny is looking at the stupid

Starting point is 01:00:51 thing you would you would i'll just tell you what it is and you'll see why it's really fun so the the next stupid thing on my list is tearing phone books but i will say it's not out of rage this is like a wine pairing it works perfectly yeah so when i was in college a good friend of mine named todd remington uh one i never forget this i was at so so it was his wife and my then girlfriend were like best friends so we were all the all four of us were at their place and he came home with a phone book like a standard two two and a half inch phone book. And he goes, do you think you can tear this?

Starting point is 01:01:30 And I, in college, I was like really strong, right? I was like, probably not, but let me try. And I like, you know, just wailed on this thing. And of course could not tear this phone book. And then he shredded it, like just ripped it in half. And I was like, oh my God, how did you do that? And he's like, you know, he immediately just told me, he's like, look, it's a and i was like oh my god how did you do that and he's like you know he immediately just told me he's like look it's a technique and he explained the technique and i was like all right well do you have another phone book he's like no that was our only one and

Starting point is 01:01:53 i was like all right we gotta go get more and this was back in the day when like you had phone books so we i remember this we got into his uh land rover or whatever no he had like a i was like i don't know some some Toyota like- 4Runner. 4Runner, that was it, yeah. And I still remember in a silver 4Runner, we drove to the mall, which was like 20 minutes away, and we went into the phone store

Starting point is 01:02:13 because they had phone stores inside of malls. This is like pre-cell phone. And they had a wall of phone books, like hundreds of them. And I just, I don't know why, like it was just such an obnoxious thing of me to do. I just started grabbing all the phone books and the woman comes up and she goes,

Starting point is 01:02:29 not a word, nothing like just totally. And the woman comes up and goes, what are you doing? And I was like, Oh, um, I work at a camp for kids and we do a lot of paper mache and the phone

Starting point is 01:02:43 books are the best for paper mache. And she was like almost apologetic. She's like, oh, oh, oh, okay. I think I mumbled like it was a camp for kids that had like less than a week to live or some stupid thing. Yeah, it's awful. So we leave the store with as many phone books

Starting point is 01:03:01 as two guys can carry, go back to his house and I practiced that night until my hands bled and I could tear phone books. And by the end of that night, I was very good at it. And then it became fully pathologic as an addiction. So I could not see a phone book and not tear it. You're like the cookie monster of phone books. That is

Starting point is 01:03:26 exactly right. It was like cookie monster. So I remember in college, I rode my bike everywhere. And this was back in the era of phone booths and phone books. And so anytime I rode past, even if I was late for class, if I saw a phone booth, I stopped, laid my bike down, went into the phone booth, grabbed the phone book, tore it, got back on my bike, rode to class. So I just left in my wake, torn phone books everywhere. So fast forward a couple of years, I'm applying to medical school. I put together a spreadsheet of all the factors that go into the decision of where do you want to go? What kind of research opportunities? What's their ranking in the US News and World Report? What's their success in getting you into the residency of your choice? What type of this? Blah, blah, blah, blah, blah, blah. What is the size of the phone book in that

Starting point is 01:04:10 city? It was one of the columns in the spreadsheet. It was absolutely a criteria. So what was the sweet spot? Was it the bigger, the better? Was it, it's not the size, it's how you use it? I mean, what are you talking about? At some point, once you're, if your technique is impeccable and you're strong enough, and it really just comes down to grip strength, it's not like the strength of your biceps or something like that. It's basically how strong are your hands and how well do you know the technique. You become limited by hand size. So for example, I could never tear the Toronto phone book. It was simply too big. I couldn't get my hands around it. At some point, enough strength will overcome it.

Starting point is 01:04:46 I'm sure if I were stronger, I could have done it. So the sweet spot for me was about three inches. And so I wanted to go someplace where the phone book was sort of two and a half to three inches, all things equal. Or you could get in some good working sets. Yes, exactly. And so now I go through medical school, tearing every phone book in sight. I just can't stop. And I'll conclude this stupid story by saying how it has a funny ending, or not ending, but a funny point in the middle. So I don't actually remember this. I only remember this because she reminded me of it. But

Starting point is 01:05:22 on the very, very, very first date with my wife which was in baltimore which we met at hopkins we're downtown baltimore and not in like the part where you get killed but in like kind of a nicer part of baltimore and it was that time of the month or year or whatever when the phone books were being distributed and so we went to this dinner called the Sobo Cafe. I still remember. And as we walked out, there was a stack of like five phone books on the doorstep of an apartment building. And I said to her, like a little child, I was like, do you want to see me tear a phone book? And she was like, no. And I was like, let me show you. And then of course- Undeterred. So I was like, here, try to tear it like my hundred pound

Starting point is 01:06:05 wife is going to tear a phone book and she's like i can't tear it and i was like watch i tore it she's like why did you tear that phone book i was like do you want to see me do another one she's like definitely not i was like i'll show you let me show you the technique so then i pick up the second one i tear it she's okay, definitely don't do that again. Of course, I tore all five of them. And it's such a dick move. That's five people that didn't get their phone book. And I always left the halves there for people to-

Starting point is 01:06:38 Just in case they want to reassemble. It's not like you can't find the number in it, but now it's just a bigger mess. And yeah, she just reminded me of that. I don't know, five years ago, she's like, do you remember that night you tore all those phone books? So I don't know. I don't know what it was about it.

Starting point is 01:06:52 I will say this. I'm nowhere near as good at it as I used to be. I remember trying to do a couple of phone books a few months ago. And it's definitely a technique you have to stay up to speed on like it the first one i fumbled on a little bit and the second one i got after it but well you know i would imagine you might want to do a preemptive funeral for phone books at some point like you will have no more phone books i mean there's a possibility you'll have to go to like a museum of phone books to even get a hold of something that you might desecrate with

Starting point is 01:07:26 ripping yeah it's it's um i mean i think that's i think that's probably why i'm not as good at it anymore i just don't get the reps all right it sounds like you're still pretty excited about phone books but we'll have to we'll keep that in the absurd bucket yes i i i took this section to be stupid things i do not stupid things i did oh nice that's even absurd bucket yes i i i took this section to be stupid things i do not stupid things i did oh nice that's even better oh yeah yeah no i like present tense uh excited about what's next up on excited about so this is something that you deserve quite a bit of credit for but just sort of archery hunting and the consumption of wild game. Um, and again, this, it started out totally benign as, oh, maybe I'll just get a bow. You know, Tim has told me about why he enjoys this. And I've got a

Starting point is 01:08:16 bit of a sense of, you know, and just for the listeners, I guess the story is, uh, it would have been the summer of 2016. You were getting ready to go out on a hunting trip. The irony of it, of course, was it was with a guy named Jonathan Hart, who I would get to know years later. Yeah, founder of a great brand called Sitka. Yeah. Excellent, excellent gear. Yep, unbelievable gear. And after watching you go through that journey of training for and going on the hunt, I was like, you know, I'm going to get a bow.

Starting point is 01:08:47 It just might be one of those things I want to do every, you know, couple times a month. And just to pause for a second. the perfect or more perfect than i used to understand cocktail of characteristics that make something more likely to be your crack cocaine of activities tell me what you think well in theinker with right it takes it brings in some degree of mathematics and physics which you have background in uh so there's more to it but continue yeah so so in early 2017 i call up the local bow shop, Performance Archery in San Diego, just get real lucky. And the guy that happens to answer the phone, JR, turns out to be a complete obsessive. I mean, it turns out everyone that works there is totally obsessive.

Starting point is 01:09:56 But JR might even take it to another level just in terms of his technique obsession. And the rest is history, as they say. And it's now at the point where in some ways my life revolves around this thing um if you come to our house i mean you have you haven't been in a while you need to see what it looks like now yeah i haven't seen the new ranch it is out of control i mean we we it's like you know those lives those huge block targets now yes you know like the five feet by five feet block targets i mean i've I've got like eight of those, every animal you either shoot at the three spot or the five spot So I get you know

Starting point is 01:10:48 I i'd like to get 90 shots out of the way first part of the day At the target and then do the longer range shooting the 3d target shooting um And and I will say this it a big part of this is this has been an amazing tool tying it back to part of the training, a new set of emotional skills. So there was a day when if I didn't shoot well, that was the end of the day. Everything went off the rails. And I've talked about this, I think, once even on a post, an Instagram post. I was kind of opening up about this, which was like, even as

Starting point is 01:11:25 recently as a year ago, I remember there was a day when there was something wrong with my bow that I didn't realize at the time, but I ended up lodging three straight arrows into the fence. So I'm taking long range shots, but I missed something in my bow and one, two, three arrows into the fence. And you can't recover an arrow once it's in the fence. So that's like three arrows I just flushed down the toilet. And I was so pissed that when I took each of them out of the fence, because you'd have to snap them to pull them out of the fence, I then proceeded to snap each one over my thigh. Now these are 450 to 500 grain carbon fiber arrows. was welted for a week which you know if you like you basically give yourself like a tie kickboxing leg kick with each one of those yeah and you know so when you

Starting point is 01:12:13 think about the complete and utter stupidity of that type of behavior um i've now realized archery is always going to be an amazing teacher because either you go up there and you just have this amazing day where you're in this flow state and everything goes well and it feels amazing or it's some variation of not going that way but you get to practice this skill of distancing yourself from the narrative that is dude you suck you suck how can you be so bad at this you know and all of these awful stupid thoughts that sort of spiral you out of control. So, so that's the part of it. And then of course, the other thing is, you know, then once I finally took these skills into the field and began to hunt and began to experience this cycle of, you know, what is it like to go into an area where you have an animal that is a pest that needs some

Starting point is 01:13:05 population control in the area that we hunt? It's so much the case that the government is basically killing these animals and just leaving them for dead or burying them. And you instead get to go and try to use your skill to do this and then harvest the animal and then feed your family and feed yourself. I mean, the whole thing is just such an incredible experience that has changed many things about the way I look at food. It certainly reduced my appetite for consuming food that I haven't had some relationship with. And I think my aspiration is by next year, meaning by 2021,

Starting point is 01:13:51 to only eat food that I've killed, which I think I'll be able to get there by next year. Yeah, there's a lot to discuss there. It's, A, making me want to get back into archery. I do have my gear. And I only recently reconnected, or I should say connected, with two guys who train here in Austin, which I'm excited about, not for hunts here, but at higher elevation and don't hunt very often in part because it's been mostly larger game. So you've got a lot of meat afterwards to keep you busy. Oh, and I remember you were on, on Joe rogan's show and the name of the bird that i shot just for clarity uh was a grouse yes mountain chicken it's like the chewiest fastest running mountain

Starting point is 01:14:35 chicken you can imagine so that's what that was it was an amazing shot i was happy with that i was very happy with that yeah there's a grouse at like 30 yards with a bow. I was very happy with that. But the bow, or I should say archery practice, also is a really good audit in my experience. If you're nervous system, if you feel recovered, but your nervous system is not where it should be, your body really tells you with archery, at least in my case, like it's,

Starting point is 01:15:05 it's a, it's a very effective and very fast assessment tool. I agree. I think it's an emotional audit as well. Um, I think the, you know, John Dudley, who, um, is, is, you know, probably one of the greatest influences on archery for me. Uh, if people, if people are interested in archery and don't know who John Dudley is, you just need to hit pause on this one podcast now and go over to John Dudley's podcast called Knock On. And this is a guy who's a world-class archer who also has the skill of being an amazing teacher.

Starting point is 01:15:41 So a lot of people can be world-class, but they don't know how to explain to schmucks like us, like how they actually are doing what they're doing. But John is that really rare intersection of someone who is exceptional, but really knows how to break archery down. And, you know, his, his teaching is, I mean, one of the greatest lessons I learned from him, which is obvious, but it's really good to hear it from someone so good, is you have no influence over the arrows that are not in your quiver. So every time you take that shot, it doesn't matter how bad it is, you can't do anything about it. And simply worrying about it increases the probability that that error that's still in your quiver is going to be a bad shot that's a good metaphor yeah what type of gear do you use currently so currently i'm using and why yeah

Starting point is 01:16:36 so currently i'm using the hoyt rx3 bow um which i absolutely love you know it's it sounds so stupid and my wife laughs at me when I say this, and I'm sort of joking, but not really. Like, I love it so much. It's the only inanimate object I've ever wanted to sleep with in my bed. Like, I just, like, I love everything about it. I just love the way it looks and the way it feels.

Starting point is 01:16:59 Like, I mean, compound bows, as you know, are just ridiculous pieces of engineering. Yeah, they are. It's just hard to believe that they've figured out a way to make something so efficient. I only shoot with a back tension release. What type is that? I use John Dudley's release called the Noctuit and the Silverback. He has a pure back tension release called the silverback.

Starting point is 01:17:25 And then the knock to it, it has a thumb trigger on it, but you still do it with back tension. So when your thumb is on it and the rhomboid contracts, that's what actually pulls the thing back. But technically you could cheat with the knock to it. You can't with the silverback. The silverback is a pure back tension release. Could you explain the significance of back tension and then what that is if you just kind of paint a picture for people who are imagining archery? So if you picture your, let's say your right eye dominant, that would mean your left arm is holding the bow out and your right arm is pulling the string back. Now these compound bows are very hard to pull back. In the olden days, you used to actually pull compound bows with your fingers and you

Starting point is 01:18:11 would release off your finger. Today we have a release that clips onto a little loop on the string called a D-loop and you're pulling on that release. But whether you're doing that or just pulling on a string, you still need the release to be a surprise. So a surprise release or a surprise shot is an essential part of archery because it combats the sort of need of the motor system, of your CNS and motor system, to sort of have this trigger anxiety or trigger panic while looking at the target so if you're looking at the target and you pull the trigger uh you're going to have a less accurate shot than if you're following the perfect biomechanics and the shot releases without your knowledge and so the way to do that is don't you need to get to a certain equilibrium with your focus before said surprise absolutely yes you have to yeah so so when you think about looking out well so what are you doing in arch in it with a compound bow you have

Starting point is 01:19:08 two holes you have the um sight which is one hole and you have the peep which is another hole so those have to be aligned and just if for those who haven't used compound bows so the sight is going to be if you imagine your left arm straightened out in front of you the sight is going to be not that dissimilar from say the top, the iron sights on a handgun or something like that. You have a sight down by your hand, and then you have another hole that is actually on the string itself, and you're lining those two up. That's right. So you have to get those two things lined up. In the sight, there's a level, like the thing you'd hang a picture with or something with a little bubble.

Starting point is 01:19:44 So the first thing you're doing is you're getting rear sight front sight acquisition then you have to get the bubble level and then you have to get the pin where you want it to be now i use a pin that comes in the side because i have multiple pins in the bow but if you have a pin at the bottom of the single pin it's the same idea so you've now got rear sight front sight acquisition bubble level pin on target, and then the target is still going to be moving. That's okay. You have to trust the process. If all those other things are fine and that sight, that pin is sort of moving gently around your target, that's okay. What you don't want to do is try to time that and punch the trigger while it's there. So instead, that's

Starting point is 01:20:25 where you're contracting the rhomboid and being surprised by when the tension is actually achieved in the trigger. Yeah, true with a lot of, as far as I can tell, firearm instruction also. Yeah, I've never fired a gun in my life, which sounds odd, I suppose. But anyone I've talked to who's like a marksman, they'll say the same thing. Like there's still a surprise release on the trigger. That's so much to talk about. All right, archery. I have seen your playground once, but it sounds like it's expanded.

Starting point is 01:20:59 The hamster cage has more toys in it now, it sounds like. Yeah, and I'm about to order like the monster elk. Peter's menagerie. Animals of death. The animated pet cemetery in the back of your house. Changed your mind on. What else have you changed your mind on? Well, this, you know, in some ways sorts of sort of builds

Starting point is 01:21:25 off the last one a little bit but it's it's basically this idea that that that childhood experiences um can matter in ways that after the fact seem sort of irrelevant so um so that's not the belief that you have reversed that's the the current. Yes, that's correct. The current belief is, yeah, so I'll rephrase it. I used to believe that, you know, traumatic events in your childhood probably weren't that relevant or could be net positives if they, you know, and it's, this is effectively like a parallel to the first thing. Um, to the previous one we talked about, about personality stuff. I think what I've come to realize through, you know, extensive interaction with experts in this space, my own experience, the experience now of many people that I know is if a child perceives helplessness,

Starting point is 01:22:27 even as an adult, if you look back and think that wasn't so helpless, you have to be thoughtful about what the implications and ramifications of that are going forward, right? So, you know, for example, let's take an extreme example. If a child loses a parent when they're young, um, you might say, well, look, they have another parent. That other parent is a loving parent. Everything is going to be fine, but there's an enormous amount of chaos that's inserted into that person's life. And, um, if a child perceives that as, asness, that can really shape the subsequent years of their life. That can shape aspects of their personality that I don't think I ever, I just don't think I really understood and appreciated before. And I've seen this now with a number of

Starting point is 01:23:19 my patients, for example, using that example, patients who lost parents when they were very young, seven years old, eight years old, 12 years old, suddenly and or tragically, or not suddenly or tragically. I mean, you could have someone who's suffering for three years with cancer and it's not sudden, but it's still to a child, they perceive things differently. An extension of that, which comes back to this whole thing around anger, and this was part of my motivation to sort of begin to make sure I wasn't so angry, was I almost never got angry at my kids, right? But my kids saw me angry. So, you know, the last time I got really, really pissed in front of my kids was a year ago. And I remember this very well. We were actually driving to a funeral of the mother of one of my daughter's best

Starting point is 01:24:05 friends. So this is a young woman, a woman who's in her forties who dies of cancer. And we're going to the funeral. It was exactly a year ago. So it's not a happy day. And so it's me and my wife and my daughter going to the funeral and I'm driving. And, you know, traffic is sort of moving along at a sort of slow pace. And there's a merging lane that's coming on. And there's this woman who's not paying even a modicum of attention to what's going on. She's on her phone or something. And then at the last minute, she just goes like accelerates, jumps in front of us.

Starting point is 01:24:43 I almost hit her. And I mean, normally that would be annoying, but on that day I went ballistic. Now she didn't even hear me, right? She's in another car, but the torrent of just, you know, profanities and like what I wanted to do to her and say to her and blah, blah, blah, blah, blah was unbelievable. Heightened presumably by the fact that I was just in this awful mood about all this other stuff, whatever. I never for a moment would have realized like that could have an effect on my daughter. It's like, I'm not yelling at her. I'm not yelling at my wife. I'm not like, you know, I'm yelling at some random stranger in front of us. But I realized that kids internalize that stuff different.

Starting point is 01:25:28 Kids and, you know, my daughter is not a baby, but she's still a child. They internalize that type of stuff as it's still like it's still hitting them. Right. So I don't know. I don't have to think like there's still shrapnel that is hitting them in a way it wouldn't hit an adult. And so you take an extreme that's very minor, you take an example that's very minor, like that one,

Starting point is 01:25:53 versus something that's very major, like the funeral we were going to, which is for her friend's mom. I don't think we are paying enough attention to how these things that kids experience can shape their personality. And to be clear, these are two-edged swords. There are some good things that can come from hard experiences. I'm not suggesting everything is negative, but you don't have to throw the baby out with the bathwater, right?

Starting point is 01:26:19 You can accept some of the positives that come from these things without ignoring the things that need to be mended or repaired. So I think that broad topic is something that I have really been much more attentive to both in myself and in my patients and in understanding their lives and their emotional health as it pertains to the events of their childhood. Speaking from my firsthand interactions with you, you are, and we talk quite a bit, or just text stupid jokes to each other, at least that with fair frequency and you you are much less anger ridden than you have been

Starting point is 01:27:10 historically which is really nice to see and i mean it's something that i've battled with a lot myself also quite possibly for similar reasons or some similar reasons but what resources or tools if any i don't know if there are any books uh or anything else that you would recommend or simply mention as having been valuable for defusing the default anger response or helping you to revisit the story of that being an inalterable aspect of your personality? I think there have been a lot of things. There's no one thing, which isn't to say that for others, one thing couldn't do the trick.

Starting point is 01:27:54 I think the good news is if somebody's listening to this and they're also thinking to themselves, man, I just wish I was a little less angry too. I think the good news is the probability that you are walking around with as much anger as me is hopefully low. You're probably starting from a better place and therefore maybe your anger is less recalcitrant to change. There were many things. So I'll start with one. Meditation has made a big difference, not by itself. Meditation simply gives a gap. That's, that's the only thing meditation does

Starting point is 01:28:27 is it creates a pause between the stimulus and the response. And that gap used to never exist. That gap, I didn't even know it was a gap. So it was a, it was a, it was a potential space that I didn't realize had the potential to be a space, which meant stimulus. You know, woman cuts you off while you're on the way to worst funeral you could be imagining going to, blowing up. That's happening in microseconds, not milliseconds. Well, the difference is today,

Starting point is 01:28:59 because that still happens every day, like some stupid thing will happen that would have normally fired me off. The difference is now I have seconds to inspect that and look at the template of beliefs that are feeding into that and examine the why which is what like what is anger right i mean so so that's that so that's the if the first thing is using a practice of vipassana meditation to create a tool in the mind to slow time down then the second one is and is that sorry to uh to jump in but just for specifics i know that you and i both used sam's waking up app uh do you now meditate uh without that what does the practice look like no i i i

Starting point is 01:29:43 use either sam's or Dan Harris's. I go back and forth between them. And yeah, so sometimes I'll do like a month on one and not see the other one and vice versa. I sort of go back and forth with no rhyme or reason. The Harris twins, unrelated. Yes, exactly. The brothers Harris, no relation.

Starting point is 01:30:02 So yes, just having just, again, I can think of a million analogies. It's like, imagine, you know, being a race car driver and you get to see time travel half as fast as the other drivers. Well, you're going to be a much better driver. Like, you see the road coming at you at half the speed. The second thing is just work through really helpful therapy has been actually examining what is, what, what anger stems from. So I think, you know, the first time I was ever, you know, I want to say forced to, or suggested to play the game of emotional check-in, I didn't have a vocabulary.

Starting point is 01:30:41 So the question was, how do you feel right now? Pissed off. Okay. Say more. How do you feel? Fucking pissed was, how do you feel right now? Pissed off. Okay. Say more. How do you feel? Fucking pissed off. How do you feel? So fucking pissed off that if you fucking ask me again, I'm going to fucking kill you. Like that was the only response I had, right? What I didn't have at the time was I didn't even have a vocabulary to understand I'm hurt. I'm sad. I feel helpless. I don't feel in control. So, so I had to learn a new vocabulary and start to learn what those other things looked like so that I could, in that gap of time, start to say, oh, you're feeling X, but you have such a beautiful default wide lane highway that turns X into anger. And oh, by the way, yours turns Y into anger and yours turns Z into anger too. Like that's

Starting point is 01:31:35 Peter's thing. Other people might have depression or sadness or anxiety as these other well-worn paths that come out of these various converging stimuli. So learning how to recognize what was understanding that has made a big difference. Another thing has just been traditional insight-related therapy. So Esther Perel, who I actually met through you many years ago, who is an incredibly important part of my life today. I'm trying to think. Oh, I know. For every Jocko, you get one Esther Perel. I'll take it. So I'll give you another. I'll tell you the last time I actually lost my shit. It wasn't a year ago. It was a year ago was with that, that funeral. It was more recently than that. It was when, um, one of our chickens got killed. And so I'm up actually shooting, doing my archery. And, um, I hear my daughter like kind of scream, like

Starting point is 01:32:37 something's wrong. And I kind of run down and she's crying. And I see one of our chickens is mangled into like a million pieces. And of course, I immediately figure out what's going on. And, you know, we had just lost one, like, I don't know, a month earlier. I thought I had reinforced the coop as much as possible, but clearly I hadn't done a good enough job. And I just went off on a tirade. I mean, and again, I'm embarrassed to even say all the things I said because it's so stupid. I'm basically yelling at whatever animal that is no longer there

Starting point is 01:33:10 that killed our chicken about what I'm going to do to it. I mean, again, we can laugh at it. It's so ridiculous, though, right? What Esther was able to point out was, let's deconstruct that whole situation. So first of all, why are you angry? Well, if I'm going to be brutally honest about it, I'm angry because I feel inadequate.

Starting point is 01:33:31 I failed. My job is to protect my family and my chickens are now a part of my family. I failed at protecting these chickens. It can't be that I'm actually angry at the bobcat for being a bobcat. Marcus Aurelius once said something along the lines of, it's like being angry at a fig for making fig juice or something like that,

Starting point is 01:33:54 or like a fig tree for growing figs or something. So no, there's no way I'm pissed at the actual bobcat who killed the chicken. That's like the carbon cycle. That's the way it works. I'm pissed at myself. I have failed to protect my family. I feel helpless, blah, blah, all those other things. But the point is in that moment,

Starting point is 01:34:16 I missed an opportunity to console my daughter. I was so consumed with my own rage and my own, like, and rage, as you can probably relate to to and many people who get angry can relate to is a very it's a very numbing transiently numbing thing lots of dopamine gets secreted in that outburst that actually makes you feel a bit better now that doesn't last long it's a very hollow i think there's a saying about the it's like a honey with a poison tip or something like that you know it's a very hollow, I think there's a saying about the, it's like a honey with a poison tip or something like that, you know, it's a very short-lived transient benefit that comes with a long tail of misery. But I lost an opportunity, which was my daughter's actually very upset about this. I mean, like, you know, not only do our chickens give us eggs, but like the kids love

Starting point is 01:35:03 them. They play with them every day. They all have names. They all have like, we know everything about every one of those chickens and their personality. So it's no, it's no different than her losing her cat or her dog. Um, and instead of consoling her, like I'm wrapped up in my own nonsense. So sometimes you just actually have to be confronted with that type of brutal truth. And again, if you go back to the first thing, which is you now have a gap, the next time, a couple months later, something came up, it wasn't related to the chicken, but it was something where I think the Peter of old would have gone right down the default pathway of just raging. I had a little bit, I had that breathing room to notice the feelings of another

Starting point is 01:35:44 person and realize, wait a minute, the much more important thing to do here is make sure that person is okay and not, you know, go down your own stupid rabbit hole. Um, another tool that I think has been very important here, you know, Ryan holiday, um, recently put out, and I'm sure it's still available a whole work, like a whole sort of 10 day or 11 day course on anger. Um, Ryan writes about anger a lot. Um, and I've talked with him about this actually on, uh, in my interview of him very recently, which probably by the time this is out, will not even be out yet. But, um, those types of exercises are helpful. Again,

Starting point is 01:36:21 it comes down to this idea that once you accept that this is not something you are hardwired to, like your height or your shoe size, and you can start to change it, you just have to start working at it. So there are a number of other tools as well. I think a lot of this sort of David Foster Wallace relational reframing stuff also has been just incredibly helpful. So there is an audio recording of his commencement speech, This Is Water, that you listen to on a regular basis. Yeah, to this day I still listen to it at least once a month, usually more than that.

Starting point is 01:36:55 So people can find that in the show notes. I'll put that in the show notes as well. For you, at this point in time, what do you think, what are the characteristics of a therapist who is good for Peter? I'm curious because I have historically, and I've largely gotten over this, but had a skeptical view of most therapists. And you come from a math background, you come from a hard science background, and also the experience of a surgeon where a pass fail or an A plus versus a C minus is, I would imagine, pretty tangible and easy to assess, right? It's like if you're doing reconstructive surgery and the person's nose nose on the side of their head, well, you don't fucking pass, go. You do not collect

Starting point is 01:37:50 the money. And with therapy, it is a softer, in some respects, or I wouldn't even say softer, it's a harder field to assess. At least I've, I have viewed it that way. Uh, how do you, how do you, how do you wrap your head around that? How do you think about, I mean, that's a,

Starting point is 01:38:14 that's a great question. And I, I don't have an answer. I mean, I have my answer, but I don't know that that's the answer. It almost assuredly is not in the end. Two things have to be firing, right?

Starting point is 01:38:26 There has to be the connection and chemistry between you and the therapist or between, like, I'll just talk about me. I have to be able to connect with that person, which is, and for me, that means that their insights have to be such that I exit almost every session thinking, wow, like I see something I didn't see before. Um, I love that. Um, so, and then, so that's the sort of short term tangible, like that insight is that's, that's, that's surprising. That's the point where, first of all, I journal in the sessions a lot and I sometimes even record the sessions. That's how powerful I

Starting point is 01:39:05 find some of these insights to be where I can't even capture them all if I'm there, um, without those tools. The, but the, but the second thing that matters to me is the results, you know, in the end, none of this stuff matters if it's not reducing your suffering. And that's sort of, I mean, I use that term very deliberately instead of if you're not happier, because I don't exactly know what happiness means, but I do know what suffering means. And I do know what it's like to suffer less and anything that helps me suffer less, which is quite easy for me to assess is a good thing. Um, and so if I feel that there's this connection chemistry and constellation of insights that are constantly evolving from the discussions and it's translating to a phenotypic benefit that's resulting in…

Starting point is 01:39:53 That is the most fucking Peter Attia way to describe this ever. Phenotypic benefit. Don't worry, folks. I don't get it either. Jesus. All right. don't worry folks i don't get it either jesus all right i'm gonna have to let you edit my book before i catch any of those things in there um uh then those are those only two things that matter so so in other words like you know there's other little things like i think for me the the therapists that are really valuable are also the ones that um you know frankly just don't have a hard time telling you when you're wrong.

Starting point is 01:40:27 You know, they just don't have a hard time telling you you're totally full of shit and deluded or that you're being a dick. I mean, you know, I mean I've had, you know, so I have three main therapists,

Starting point is 01:40:37 which sounds I know ridiculous, but I think when you're trying to solve some of my issues, but you know, Esther, it's like a pit crew. Yeah, exactly. Esther and Terry and Lori. And I mean, I have had some really brutal sessions with Lori.

Starting point is 01:40:54 And I don't know why it's worked out that way. Like each, they all know each other, by the way, very well. So it's another thing. It's not a counterproductive experience because the three of them know each other and they all know they're chipping away at different pieces of things but i mean i've had some very difficult you know interactions with with her where you know she has just said to me like you are being a spoiled little baby you know like do you do you see what you're do you see what you're

Starting point is 01:41:23 how you're behaving right now? And I think the fact that she can do that matters a lot. I think there are a lot of people that would give me a pass on stuff. Because it's easier to. It's hard to stand up to someone. Yeah, I think you need, or it needs a strong word. But I certainly, when interacting with specialists of almost any type i prefer people who can fire me very easily do you know what i mean because then it makes it a lot easier for them if they're in demand or are completely utterly concerned with how many billable hours they're

Starting point is 01:42:04 racking up that they can be like, you know, Peter, you're making this really fucking difficult for both of us. And I just want to like pause for a second to allow you to like wallow in how fucking unnecessarily difficult you're making this. And it's like, Oh,

Starting point is 01:42:17 okay. Oh yeah. Which, uh, yeah, I think, I think I'm probably also the problem child, uh, oftentimes.

Starting point is 01:42:26 So we were on. So I think we're now into stupid things again. All right. Let's do it. Stupid things. So to this day, I still play a game called Forks and Knives. Forks and Knives. Forks and Knives is the name of the game.

Starting point is 01:42:42 So I have an awesome system with my wife which is she likes to put stuff in the dishwasher and hates to take it out i hate putting stuff in the dishwasher and i love taking it out i just i don't like touching dirty stuff i really like clean stuff and i don't know why she doesn't like taking it out because that seems more enjoyable but anyway um and as kid, this game started when I was a kid. My mom says, like, I was the best at chores. Like, my brother and sister apparently didn't like doing chores as much as I did, but I loved chores. I was like her little helper.

Starting point is 01:43:17 So whatever she said to do, I couldn't wait to do. And one of my chores was doing the dishwasher, and I loved it. So this started when I was probably like about eight. And I remember she used to always say, Peter, can you put away the forks and the knives? And it really kind of got to me. Because I was like, why don't you also include the spoons in that discussion? It's not just forks and knives.

Starting point is 01:43:38 It's forks and knives and spoons. And she would be like, acknowledge that I said that. But the next day she'd forget. And she'd be like, can you please put away the forks and the knives? So I was like, I'm going to just start keeping track. And so I played this game where I would count the forks and the knives and the spoons. And the game is the spoons would win anytime there were more spoons than forks and knives. Now, if anyone who's played this game, and I'm guessing the answer is nobody. Wait a second. The number in the dishwasher?

Starting point is 01:44:07 Yes. That you're removing? Yes. Okay, I see. So basically, every time I got to do this, it turned into a game of who's going to win, the forks and the knives or the spoons. Which was a counting.

Starting point is 01:44:15 That's just a counting game. But I was always rooting for the spoons because they're the underdog. Because the probability of the spoons winning is very low. You generally have way more forks and knives combined than spoons. So over the years, the game evolved, and I started to allow other things to be proxies for spoons. So if there was like a spatula or a carrot peeler,

Starting point is 01:44:35 that would get to go in the spoon category, just to sort of level the playing field a little bit. The handicap. Yeah, you had to handicap this thing somewhat. But the game started, you game started almost 40 years ago. And to this day, I mean, just two days ago, I played Forks and Knives versus Spoons. And I love it.

Starting point is 01:44:50 I love the game. And it's at the point now where I don't want anybody else to put that stuff away. So let's say Jill is putting stuff away. I'm like, no, no, no. I want to get the Forks and Knives. I got to get those guys. And let me tell you, Spoons don't win much.

Starting point is 01:45:04 It's a sad state of affairs if you're a spoons fan. But if they win once every three months, it is freaking awesome. It just feels so good when the spoons win. What is the furthest you've stretched the label of spoon? Can you think of anything? There was a big inquiry came into the rule committee about 20 years ago where I thought if I could start including

Starting point is 01:45:30 cups as spoons, because they, you could, you could see how you could create sort of a post hoc analysis that would suggest that, well, a cup sort of holds things like a spoon holds things. You could drink soup out of a cup just as you could use a spoon. But I decided that was a very slippery slope. And I didn't want to take the game down that road. I thought that was going to really tarnish the sport that I loved so much. So I decided I would rather lose 90 times out of 91 times, but know that that one time I won, it was the sweetest victory. This is going to seem like a complete non sequitur, but that, as you were saying this on the rules committee, I'm thinking about doping in sports. And then I started thinking about this

Starting point is 01:46:14 conversation we had long ago about Xenon gas. I don't know if you remember this. Did you end up ever looking more closely at Xenon gas? Yeah. I, I i it's so funny you remember that i actually called um what's the name of the company air gas and i think it's called praxair like the two yeah and basically the deal died when i just couldn't get a reasonable supply of xenon gas reasonable meaning like enough for me to use i basically had to to buy enough to, you know, provide xenon gas for the entire universe. And the speculation was that, or maybe it wasn't speculation, maybe it'd been confirmed. I can't remember because I don't know how you track such a thing, but, or maybe you just have to catch them inhaling, but it was being used by endurance athletes at the Sochi Olympics.

Starting point is 01:47:01 Yes. It was basically a legal PED. And this was probably six years ago. And at the Sochi Olympics? Yes. It was basically a legal PED. And this was probably six years ago. And at the time, I was still competing in cycling. And I was like, well, I was comfortable with the safety profile. It was legal. And it was enhancing performance. So I was like, I want xenon gas. I want to take a big bong of xenon gas every day before I go and work out. Are there any other currently legal performance enhancing drugs that you think the cat and mouse game of dopers and anti-doping

Starting point is 01:47:37 committees have not yet, or I should say, I'm not sure which is the cat and which is the mouse. I guess the cat is the IOC and so on has not caught up to. Or things that are simply difficult to test for. Well, the latter definitely growth hormone fits into that category. So growth hormone is clearly banned by WADA, USADA and every entity out there, but it's very difficult to check for because it's a human recombinant equivalent. And unlike something like testosterone, where you can give somebody testosterone, but you can, even though it's bioequivalent, you can, if you're getting it from the outside of your body, other things change inside your body that become a signature of it. Whereas that's not quite as

Starting point is 01:48:23 easy to do with growth hormone. Now, would a signature in this case be, would it be looking at a ratio of, what is it? Testosterone? It's epitestosterone. Yeah, yeah. And if you take enough of it, obviously you'd see inhibition of luteinizing hormone, follicle-stimulating hormone, things like that.

Starting point is 01:48:39 So no, I'm not close enough to it at all. I don't, I just don't, you know, it's been a long time. I mean, one thing that I did notice just through some sort of personal interactions I've had with professional athletes who are also interested in sort of mind-altering drugs is psilocybin is not banned by WADA and MDMA is. And I sort of find that hilarious because I don't think either of those things have a performance enhancing,

Starting point is 01:49:11 like, I mean, MDMA would be a performance. Great for Greco-Roman wrestling. Yeah, it's like, I can't think of one sport that gets better with MDMA. So I was sort of amazed to see that on the WADA list. Maybe if you went very high dose, what is it? Methylene dioxide? I mean, yeah, I mean, technically it's a methamphetamine, but I, I, I don't know. What is the term for the eye movements that are so often characteristic of

Starting point is 01:49:39 higher dose MDMA use? It's like astigmia. I can't't remember the term but it would definitely not be good for something like archery where the eyes effectively do this back and forth kind of ratcheting movement i can't remember the term somebody i'm sure pointed out when they hear this uh yeah psilocybin that that's that we could certainly delve into just from a it's like many things better get the dose right if you're thinking of using it as a performance enhancing or and in truth you know i've i have talked to people who have said at very low doses psilocybin um has actually enhanced their physical performance um so so who knows maybe there was something to that for i've heard the same from endurance athletes using uh relatively or i know not relatively low doses of lsd like 10 or 15 micrograms or maybe even tend to take 25 wow uh but it's hard to believe like it seems so

Starting point is 01:50:37 imperceptible like that seems like such a small dose does indeed yeah i mean this this upcoming weekend by the time this comes out it will have passed but there's the psychedelic science event here in austin with maps and one of the sessions is specifically focused on microdosing which this would fall under the umbrella of at 10 to 15 micrograms uh all right where aren't we excited we're back to excited, yeah. All right, yeah. We'll do one or two more. Let's go with excited. Next thing I'm pretty excited about is just driving,

Starting point is 01:51:10 just sort of getting deeper and deeper into the craft of learning how to drive a race car and sort of just training both in the simulator and actually on a racetrack with a race car. And again, I think part of it is I just, I love, you know, I love mechanical things. I love cars. I love driving them fast. And there's no better place to do that than on a racetrack. But also part of it is it's another one of these audits, you know, like archery, it is not a sport that gets better the more pissed you are. It is not a sport that gets better the harder you squeeze. And it's also a sport where, let's say you miss an apex on a turn.

Starting point is 01:52:05 If you think about that or dwell on it anymore, it only increases the likelihood you're going to miss the apex on the next turn or miss your break point or miss your turn in point or do something wrong. So it's one of these things that teaches you a skill that I just think is good for life, which is you don't want to not know that you made a mistake because then you run the risk of making that mistake again, but you can't beat yourself up for making the mistake. So you have to have a relatively short half-life for torturing yourself. Otherwise you will spiral out of control. And it's really amazing. I just happen to be very lucky to have a great coach, a guy by the name of Thomas Merrill, in driving. And I don't know. He's just so good at spotting when my mistakes start. And it's never really the case that when I screw something up at, you know, turn seven where I went off track. That was the first screw up.

Starting point is 01:52:43 Yeah. Not even close. He's like, actually, look at what you did at turn seven where I went off track. That was the first screw up. Yeah, not even close. He's like, actually, look at what you did at turn five. And then look at how that fed into turn six. By the time you got to seven, it was... He said, look, the only way you were not gonna crash at seven is if you had slowed down enough to a speed much slower than you would normally go there

Starting point is 01:53:01 because of the mistake you made in five and six. So I think for a lot of people, again, it's easy to look at what people are doing in a race car and not think there's much to it. But of course, like many things, the further you are from the shore, the deeper the ocean is Bob Kaplan says. And so the more I do it, the more I appreciate the gap between me and Sebastian Vettel. And you're wearing an Ayrton Senna shirt as we speak. And for those people who don't know who that is, you should absolutely watch a documentary called Senna, which is just incredible, which I think helped me at least as someone who's completely naive to race car driving to develop a high level of appreciation for just how hard it is to perform at a high level in those circumstances.

Starting point is 01:53:58 I mean, it's, and how incredibly dangerous it was at that point in time. Things have changed quite a bit, but when he was racing, certainly far more dangerous. Yeah, in the 60s, I would say sort of mid, early to mid 60s into mid 90s, it was a staggeringly dangerous sport, unacceptably so. Something occurred to me that I don't think I've ever asked you before.

Starting point is 01:54:31 And that is, have you considered, maybe you already have something that fits this bill, but picking a hobby or something to obsess about that is a group activity or a partner activity? Because it seems like most of the things I find you gravitate towards and become very obsessed about are, even though there might be other humans around, they're mostly solitary experiences.

Starting point is 01:55:03 Yeah. You're not the first person to ask me this and i i think it's a great point um i suspect the problem is i love these things i do so much i barely feel like i have as much time as i want to do them but it might be the case that as my kids get older and i can do more of these things with them or, or different things with them that that would sort of scratch that itch. But there's definitely something to be said for it. I mean, I think ever since I was 13, I've been so, that was sort of a turning point, I think, in my personality or something where I just remember really gravitating towards individual things, um, for a whole bunch of reasons i could probably unpack that's i think that could be an entirely separate podcast uh so racing changing your mind

Starting point is 01:55:55 um i would say the next one here on this list would be and this is going to sound almost silly but on the i've changed my mind on the benefits of exercise being much greater than I ever envisioned. So I would probably classify as a borderline exercise addict. So for me to say I now actually think exercise is incredible and has all these benefits is sort of a funny statement. Which is not to say that I didn't think it had benefits before, but I don't think I understood or appreciated metabolically. So if you just take one example, probably like four years ago, three years ago, I had one of our analysts do this exercise that took him about a year, which was with some direction around where to start,

Starting point is 01:56:46 comb through all the literature on Alzheimer's disease and get a sense of what tools in the toolkit would be most beneficial to prevent it or reduce the risk of it and or delay it. And, you know, I mean, it was, anything was in, anything was on the table, what drug, what supplement, what this, what that. And he came back and said, and we had a framework that was a very mechanistic framework. He came back and said, um, it's definitely exercise. And I was like, dude, that, I mean, that sounds like such a politically correct thing to say, come back with like a real answer, please. Like, that's just sounds dumb. It's exercise. Like how can it be exercise? And of course it, you know, he came back and made the case. And in the end, I believe that case, which is when you look at what exercise does from a

Starting point is 01:57:33 vascular standpoint, from a growth factor standpoint, you know, the creation of BDNF, brain derived neurotropic factor. Um, I really believe that, and again, you shouldn't take the view that you should only do one thing, but if you're, if you're really view running as cardio, but then you, in the case of resistance training, are obviously utilizing the vascular system in your heart. But how do you think about type and dose? So the literature is not crystal clear on that, but if you loosely take three types of exercise, which is modest or low intensity, quote unquote, cardio, high intensity cardio and strength training. If you took those as the three legs of the exercise stool, the good news is they all appear to increase BDNF. They all appear to have benefits though to different degrees on vascular tone,

Starting point is 01:58:39 circulation, et cetera. What I basically decided a couple of years ago, or maybe a year ago, was in the absence of better information, just having a portfolio approach to those in the context of the training for the Centenarian Olympics was the best of both worlds. So in other words, my training is programmed through the Centenarian Olympics, which requires that you have training, a very specific type of training in all three of those legs coupled with the tabletop, which is stability. So you have these four pieces of training, stability, strength, aerobic, and anaerobic. And by doing these every day or some combination of them every day, you also know that to at least to a first order approximation, you are getting

Starting point is 01:59:24 the benefits of brain health. And then of course, I mean, while we're just on that topic, I think sleep and periods of nutrient cycling and obviously the appropriate steps on nutrition. Nutrient cycling, meaning fast and famine? Yeah, I think some period. I guess it's probably the same. Feast and famine, yeah, yeah, yeah.

Starting point is 01:59:42 That'd be a great name for a podcast about fasting. Faster famine. Right, feast or famine. But it's funny, like, you know, if you think about Silicon Valley right now, right? Like everybody's so obsessed with this nootropic and that nootropic, but what I don't think people understand is

Starting point is 01:59:59 correct nutrition, exercise, and sleep are far better nootropics than modafinil. I mean, modafinil might be one of the most potent nootropics out there, but it's actually not that strong a nootropic. It's actually kind of a weak nootropic, actually, by the literature. It is pretty amazing how many narcoleptics are Olympic-level sprinters, though. They can prescribe modafinil. Anyway, ProVigil, anti-narcolepsy drug, true story.

Starting point is 02:00:25 Wow, eight of the top ten are narcoleptics. Who would have thought? That's how they get so much time to train. Back in the good old days. What are things, and I know you're a fan, correct me if I'm wrong, but of Matt Walker and a lot of his thinking on sleep. And I shouldn't say thinking.

Starting point is 02:00:44 I mean, his research related to sleep. How have you changed or better yet improved sleep protocol, things that you prescribe, not necessarily chemicals, to patients to improve sleep quality? I mean, sleep is a hard thing because it's sort of like exercise in the sense that you can't just give somebody a pill that makes sleep better. Um, it really comes down

Starting point is 02:01:14 to changing. It's, you have to sort of accept you're going to make behavior change. You have to prioritize this thing. And it's not just the eight hours you want to spend in bed. It's the buildup to it. So my sort of simplest toolkit, which is what I basically employ. I mean, most nights I don't require a supplement to sleep. It's not like I'm taking, you know, melatonin or even using Kirk parsley supplement. I mean, those things are, I'm basically reserving for jet lag situations and things like that. But if I'm, if I'm doing everything correctly or fasting, you know, that's another time when you need a little bit of a boost, but if I'm doing everything correctly, you know, using the right amount of blue light blocking glasses. And I've recently switched to a new brand that, that I am fricking super jazzed about. It's, I mean, I find, first

Starting point is 02:01:59 of all, they actually have published research that, you know, actually i shouldn't um i don't know if it's been published yet but anyway they they have data that i've actually seen that demonstrate you know how much they're able to block blue light and at least according to my my um sort of sleep tracking metrics they're they're definitely contributing to much more deep sleep than I've seen historically. Can you name? Yes, yes. It's called Felix Gray. F-E-L-I-X? Yes. Felix and then Gray.

Starting point is 02:02:31 Actually, you can see the box right sitting over there. So those glasses sitting right over there are my Felix Grays. And they're just redonkulous. G-R, well, people can find it. A-Y or E-Y. Yeah, yeah, yeah. I think it's A-Y or E-Y. Yeah, yeah, yeah. I think it's A-Y. And so, you know, I'm very religious about using those things.

Starting point is 02:02:51 He looks great. Is that a real person or is it like Ashley Madison? I have no idea. Yeah, yeah, yeah. It might be in the latter, yeah. So, I use those things religiously. I'm very attentive to how much light is around me as the sun is going down i'm also very attentive of not doing stupid things in the evening and we've talked a lot about this not looking at email not looking at social media not looking at things that are going to potentially

Starting point is 02:03:18 activate or phosphorylate me in any way it's another peter peterism don't fucking phosphorylate me um also just being very consistent in bedtime and wake-up time you know and and when when i'm really in the zone it's it's early to bed early to rise so understanding your own chronotype are you an early or late chronotype you and i've talked about this a lot. Um, incredible darkness in the actual room at night or using, I use this thing called the Alaska bear eye shade. It's like, you can buy it on Amazon. It's eight bucks. It's like this little silky Alaska bear. It's the stupidest name ever. I don't know why I love it though. I have, I have 20 Alaska bears because I have them everywhere so i'm never without one um and um i use i just upgraded in the last six months from the chili pad to the uler that's o-o-l-e-r kevin yeah our buddy kevin uses

Starting point is 02:04:15 that as well yeah i have no affiliations with any of these companies by the way so i feel totally happy to just plug them shamelessly um for no personal gain um and the uler is a big step in the right it's it's really taking the chili pad to another level first one's on me i do take sponsorship money yeah but this has come up with kevin uh that's a joke people in case you can't take it for fuck's sake uh yeah this has come up a couple times recently. The other thing is almost elimination of alcohol. So I'll probably have a drink tonight, right? We're going out to dinner,

Starting point is 02:04:52 like a bunch of friends getting together in Austin tonight. I mean, I'll have a drink tonight, probably. Yeah, you were the one who really put it on my... I certainly academically or intellectually understood that alcohol, even though it, in some some cases seems to make it easier my sleep was in terms of quality after say two and a half three drinks yeah i mean i'm i'm down to probably three or four drinks a month uh that's that's basically it and and and there i've i've gone two months without a single drink it's like it has to be worth it. Cause even at one drink,

Starting point is 02:05:45 I'm going to experience some degradation of sleep. And could you, what, what type of degradation? It's generally a reduction in REM, uh, for sure. Uh, a slight reduction in deep and an increase in fragmentation. So you're in a, you're just, you're moved into that stage one, stage two, uh, space a bit more. Do you see a, uh, spike in, uh, for lack of a specificity, the middle of the night in resting heart rate after you drink two or three drinks? Well, I see a higher resting heart rate period and a lower heart rate variability for sure. And a higher body temperature. Um,

Starting point is 02:06:25 and I don't know the last time I had two drinks in a night, but, but definitely it's one to two is also a really big step up. So, you know, look, it's, everyone's got to decide what they're going to do and what their priorities

Starting point is 02:06:39 are. And I'm not here to say don't drink at all, but I just have to, I just, I just, I would just say like, don't be mindless in your drinking is sort of my point like if you're gonna drink like make it really freaking worthwhile like do it for a reason don't just do it because the alcohol is there is it uh i don't know if you've

Starting point is 02:06:56 seen anything anecdotally or experienced this personally but is is it is it just the ethanol or is there variability across vehicles for the alcohol itself? Is a sipping tequila going to do less damage than the equivalent blood alcohol content achieved through red wine or something like that? I don't know if you've looked at any of this yourself. I mean, anecdotally, it's hard to know because your mind is also sort of feeding into a narrative around this stuff. But certainly drinking my Class A Azul Reposado seems to be less toxic than having... Well, I'll tell you, I mean, I've given up certain things. I don't drink a Moscow Mule anymore. I make a mean-ass Moscow Mule. I love that drink so much. I love the ginger beer, the lime, the whole ritual. But what I really decided was it's just

Starting point is 02:07:51 not worth combining sugar and alcohol together. Once in a while, you can have sugar. Once in a while, you can have alcohol. Putting the two together is like, I mean, you might as well just kick yourself in the nuts at that point. So I just don't want to do that. Um, so, so certainly mixed drinks are things that I think just don't have a place in civil society. Um, if, if you care about your liver, if you don't care about your liver, by all means, drink all the mixed drinks in the world. Um, certain, I don't experience this personally. I don't seem to have any issue with red wine. I don't get hangovers. I don't get headaches, even if I have a couple glasses of red wine, but I've certainly seen patients who see a real difference in red wine. I don't get hangovers. I don't get headaches, even if I have a couple glasses of red wine. But I've certainly seen patients who see a real difference in red wine consumption, and it

Starting point is 02:08:30 really seems to sit poorly with them. Similarly, if I drink like my sort of dark favorite super duper Belgian beer, I don't seem to get any bloating or anything from it, but I've seen people who can't really handle that stuff either. Now that would, although it's not a mixed drink. I mean, you're getting plenty of maltose in that, right? So I mean, you're getting a nice little... It's the fructose that I'm most worried about. It's the fructose and the ethanol combined I never want. I see. Because they both go through this similar metabolic pathway and when they're delivered in liquid form, that when the fructose is in a liquid form and the ethanol, which of course is in a liquid form um now you've combined the velocity problem the kinetic problem is working against you what do you mean by that so sugar as a liquid versus sugar as a solid behave differently

Starting point is 02:09:18 and also the dose matters but if you take a bolus of liquid sugar, it's going to make it further down the GI tract than the solid. And certainly in animals, the evidence, Lou Cantley actually published this study in Science about four months ago. You could basically take a mouse model that is primed to get colon cancer. And if you had three groups, so one group is getting just a bolus of glucose, the other group is just getting a bolus of fructose liquid, and the other is getting a bolus of sugar, glucose and fructose together, you could make that animal explode in colon cancer with the sugar, the glucose fructose. And too much of a tangent to get into the why, but it turned out that that effect is probably not present with solid sugar, which does not mean solid sugar doesn't come with its own problems. But it's the ability of the transit time to get there quickly and not get absorbed because it's not being held up in the upper part of the GI tract with fiber and other solid things that you'd have, say, if you were eating it in the form of fruit or even just in, you know, like a piece of cake,

Starting point is 02:10:28 for example. So again, I'm not suggesting, oh, it's good to eat cake, but the single worst thing you can do is drink your sugar. So many questions that I'm going to table for now. On this list, on these three lists, I should should say is there anything that you think i would find particularly thought-provoking or hilarious that you'd like to share my next thing on this stupid list is the what if game um have we talked about the what if game i don't think so so i don't know when this started um it was definitely before i got married but i i just i thought it was really funny to play this game of would you still like me if and then i would make up something really stupid and

Starting point is 02:11:21 even the game itself bugs my wife but i make her do it i make her go through the explanation of why it's yes or no so i still remember the very first one i did would you still like me if if yes and so the very first one i ever did this is probably we've been dating for like a few months and she came over to my place and i made my one of my favorite meals is like a curry stir fry which is a very labor intensive meal. You're carving up a million different vegetables and all this other thing. And so we're sitting there, we're eating this thing. She's like, oh, this is great. And I was like, would you still like me if I was the exact same guy? It always gets prefaced by that. Would

Starting point is 02:11:59 you still like me if I was the exact same guy? But instead of using a knife to cut these i was like this really flexible guy with long toenails and i used my toenails to cut them so i sat cross-legged on the floor and i sliced and diced all the vegetables using my toenails but i was everything else about me is the same and she's like oh, oh. She's like, what? And I was like, I want you to like literally picture this. I'm the same guy. Everything about me is the same, except for this one little thing,

Starting point is 02:12:35 which is I just like to use my toenails to cut the vegetables instead of a knife and a chopping block. And she's sort of humored me with that. And I just went over and over and over again. And to this day, I still play this game constantly. And I actually asked her before I came over, I was like, do you remember some of the ones that really annoyed you when I would ask these?

Starting point is 02:12:52 And so she reminded me of a few. So one of them, we were in Italy this summer and we walk into a department store and they have this big, bright red Speedo with a gold belt. And I was like, would you like me if i was the exact same guy but i only wore this as my shorts so like i would still wear shoes and a shirt but instead of wearing like the shorts that i'm wearing now like i would only wear this bright red speedo with the

Starting point is 02:13:17 big gold belt the european this this american hero yes yeah and she's like yeah probably not i'm like and then of course whenever she says I'm always like, how can you be so superficial? How can that one thing be such a deal breaker? Another one that she remembered was car dancing. I was like, what if I was the exact same guy, but I would dance like crazy while I was driving? And then I would mock. Do you remember in 16 Candles when Anthony Michael Hall is dancing around Molly Ringwald at the dance? Yes.

Starting point is 02:13:46 I would do that dance, but I always did that while driving. And I was like, what if I was the exact same guy, but I did that? What if I wanted to watch the Smurfs for two hours every single day? I loved the Smurfs. The Smurfs. The TV show. The TV show, not movie adaptation. That's right. Right, right, right. So I loved Hefty Smurf, and I was totally Smurfs. The Smurfs. The TV show. The TV show, not movie adaptation. That's right.

Starting point is 02:14:05 Right, right, right. So I loved Hefty Smurf, and I was totally obsessed with him. Hefty. Remember Hefty Smurf? Oh, I don't. It was like the really muscular dude. Oh, I don't remember Hefty. Yeah.

Starting point is 02:14:15 And so anyway, I just had like a long list. I just always do it. I always play the, I love playing the what if game. And I'm actually kind of amazed at the amount of times she would just veto me based on the stupid thing I say. Well, I would imagine at some point she's like, how can I, he's not going to let me out of this. So like, how do I cut this short or make it interesting for myself? But if anybody else is listening to this and you're trying to just insert a little spice in your life, I can't suggest the what if game highly enough.

Starting point is 02:14:50 It's really where you'll find out like where the rubber hits the road. Oh yeah. How much would it take? How much would I have to pay you to? That's another good one. Yeah. Yeah. Yeah.

Starting point is 02:15:04 That one, How much would I have to pay you to? That's another good one. Yeah, yeah, yeah. That one devolves quickly in my experience if more than two guys are involved, generally speaking. Especially if one of them is Kevin Rose. It's awful very quickly. Hashtag Kev Kev. Sorry, brother. I remember one time, I just have to give Kevin some shit since we know him so well

Starting point is 02:15:26 uh i don't know if i've ever talked about this publicly but kevin was sort of famous i don't think he does this as much anymore uh but he was famous among the friend group i had in the bay area for betting people to do things right i'll, right? I'll give you whatever amount if you do this, right? And he would do this all the time to try to get people in trouble or not in a malevolent way, mind you, just to like create mischief and be like, I'll give you X if you do this. And we were out at a steakhouse in San Francisco and there was this bottle of tabasco or something like that and we're like 80 done with the meal and i had ordered surf and turf and people had ordered various things and kevin goes if you drink that whole bottle of hot sauce i'll give you 20 and i was like okay time out kevin you're not fucking poor and you're offering me 20 dollars

Starting point is 02:16:29 to basically destroy my gi track destroy my gi track maybe have to like tap out for two days or like go to the hospital how fucking cheap are you like that's embarrassing you should be ashamed of yourself and i had just finished the lobster tails or no, there's more to it. It was like a full lobster or half shell or whatever. And I was working on my steak and I said, you know what? $20, that's bullshit. I'll give you $10,000 if you can eat this lobster shell. This is in front of an entire table and to his credit he actually took a crack at it and he he ate like an inch and a half of one of the antenna and was like i can't do this but he did give it a shot so so here's another question how many times in the history of

Starting point is 02:17:20 let's just limit it to homo sapiens do you think that game has been played by females you know if we're talking just because this is getting waiting into dangerous territory but if we're talking uh just knee-jerk response uh when it gets to like dangerous levels of stupidity i'd i'd i'd definitely put that on the low side Very few Yeah, I just I don't know what it is about guys That make us so dumb When it comes to this stuff Yeah, I mean there's a

Starting point is 02:17:51 Just to Maybe give people a showcase By the way, for context In high school For two dollars I drank an entire bottle One liter Or 750 ml

Starting point is 02:18:04 Of lemon juice. You know that real lemon, lemon juice stuff? 750 ml for $2, I drank it in high school. Terrible. Oh, I pretty much perforated my stomach. Terrible. But it was like, oh, well, you're egging me on to do this? Oh, yeah, i'll do that yeah there's a there are many instagram accounts that i sort of

Starting point is 02:18:26 rubberneck at watching and i this probably came via one of my friends who shall remain nameless but it's pretty sure it's just called doing things wrong and it's basically people fucking up like everything you can imagine possible like bmX bike riding, parkour, whatever. And the ratio, like the male-female ratio is astonishing. It's astonishing and also completely unsurprising at the same time. It's just like all guys, you see it coming from a mile away, you're like, terrible, terrible, terrible idea, and then boom, payoff. Turns out that was a bad idea.

Starting point is 02:19:05 It's just sort of funny to think, it's possible our species couldn't have got here. Like, it's possible, like, there's at least another parallel universe that didn't quite make it because the male reproductive end of the bargain could not be lived up to due to just constant stupidity. Yeah, I think it's a fine line, right? I mean, I don't think we're that far away from that already, right? It's just... Well, now it's different because evolution isn't the thing that's like, it's not going to be natural selection that kills us now. We'll just kill ourselves directly. But like natural selection could have basically weeded us out just based on male stupidity.

Starting point is 02:19:44 Oh, yeah. I mean, I don't have kids yet, and I'm astonished that I haven't won the Darwin Award yet, right, at this point. All right, let's do one more excited or changed mind that you think might be a good closer. Well, the other one I had on excited, which I really owe a lot of credit to you, is this whole sort of podcasting thing and learning and learning, learning might even be too strong a word,

Starting point is 02:20:09 practicing this art of interviewing. It is. So, you know, this whole thing started as sort of an experiment a year and a half ago. And I just didn't, I couldn't have imagined how enjoyable it is. I mean, I think what you're doing today is way more fun than what I'm doing. I don't actually like being asked questions that much anymore, but I love asking questions. And I find myself listening to podcasts much more than I ever did before. Um, and listening to now two things. One is what's the content, you know, but also, and perhaps as importantly, if not more importantly, is how is this interview extracting that? How was this interviewer, what are they thinking? What would I have thought at that moment? Did they think of, oh, they went down a path I wouldn't have thought of. Okay. How can, what can I take away from that?

Starting point is 02:20:59 So, um, the good side of that is I think it, it allows me to try to, you know, become better at this craft. The downside, honestly, is I feel much more pressure now. I feel, and not to the point where it's taking away or detracting from the experience, but I, I, I've had to now go back and listen to some of my own podcasts. Cause that's one way you learn is you, you sort of have to go back and listen to it. And that's just, as you probably know, that's a very painful thing to do. Like, do you ever listen to your own podcast oh yeah yeah yeah

Starting point is 02:21:27 yeah absolutely i think you have to if you want to get better at it yeah you have to i mean it's like reviewing footage of a of a training session or something it's it's a requirement i think if you want to do post-game analysis and improve what you're doing, but it can be really painful. It's super tough. So it is again, yet another thing like archery, like race car driving, where, you know, there's this opportunity to be somewhat critical in the spirit of trying to get better. Um, but it's also opened me up to a new world. I never really paid attention to before, which is journalism, like, you know, sort of TV journalism or radio journalism, where, you know, you got to be able to think on your feet, you've got to be able to multitask. And for me, I don't know if

Starting point is 02:22:09 you feel this way, but I think the hardest thing is to somehow parallel process being engaged in the discussion that you're having, but allowing a part of your brain to be thinking about where you are on a path and where you want to go and those are that is that's like next level ninja moves it is uh what's what surprised me maybe the most about the podcast interviewing game or the format of of one-on-one, one-hour-plus interviews is how coachable and improvable many of the component skills are. I've really been astonished by that. And one example of that would be the ability to bookmark, even when not taking notes. Right now, I took notes throughout this conversation in case I wanted to come back to something. But even in the even when not taking notes right now, I took notes throughout this conversation in case

Starting point is 02:23:05 I wanted to come back to something, but even in the case of not taking notes, the ability to bookmark departure points where your interviewee goes off in a different direction and the capacity to then return to those bookmarks as if you had flagged them. That is an ability that, let's throw an arbitrary number on it, like 10x to my ability to do that in any conversation vis-a-vis the podcast. And it makes you wonder, what are the cognitive, what's the mechanism behind that? And does that transfer to anything else? Am I, unbeknownst to me, developing other cognitive functions that correlate to that, right? And certainly listening to your own audio really showcases any tics that you have or any pet phrases or any words that you tend to start too many sentences with.

Starting point is 02:24:01 I used to go, Sue, Sue, Sue, so so and i listened to this audio and it's agonizing and then there was one interview in particular i'd love to hear i know that intros drove you completely insane for a period of time they still do okay so we can come back to that i don't think people fully appreciate how torturous that process can be but i interviewed interviewed Ed Catmull, who I think he's still the president of Pixar, but at the time was president of Pixar. And he was coming out with a book that, great book actually, I think it's Creativity Inc. And he was the first guest ever on the podcast who I'd never had a prior conversation with, or I'd never had a prior conversation with or i never had a prior i'd never had a conversation with him prior to the recording and uh there was a mix-up in communication and he thought the podcast was a lot shorter than my intended time right he's a busy guy and he wasn't angry he wasn't uh

Starting point is 02:24:59 hypercritical but it's it got off to a tense start because I was like, how do I reconcile this? Can we go longer? And it was just an unexpected variable to deal with. And I was very nervous going into it to begin with. And did the interview. I was quite happy with it, all things considered. And then I'm looking at feedback on Twitter. And I see three tweets in a row that are, that are MMM dot, dot, dot, MMM dot, dot, dot. And I see a few of these and I'm like, what the fuck is going on? And I go back and I listened to the audio and every time he said anything, I went, hmm, hmm, hmm, for a fucking hour, an hour and a half whatever it was and i just could not believe how

Starting point is 02:25:51 fucking oblivious i was to the fact that i was doing that every 15 seconds and i i can think of 15 of those right yeah and uh or at one point i don't know what it was it was another nervous tick and one of my interviews and i was going sounded like i had a fucking chipmunk on my shoulder chewing acorns for the whole interview oh torture i mean those things stress me out but not nearly as much as the bigger picture of missing the exit or like if if if an interview is a discussion where you're driving down a road it's like missing a side road yeah you know missing a missing a side road and getting lost or you know and i don't know i mean i i i think i am

Starting point is 02:26:38 better than i was at the outset but i think this is definitely like the steepest learning curve and there's so i mean i have an aspiration for what it can be and i do love listening to great interviewers now in the podcast space it's a bit misleading so if you listen to somebody like steve dubner who i think is fantastic that type of a podcast is produced for economics yes yeah and and so that's a little bit different um but you know i i mean i i that's a little bit different. But I love listening to Katie Couric. I love listening to people do long-form interviews. And I've actually asked Katie for some advice, which has been great. And any chance I get to ask somebody who does this for a living.

Starting point is 02:27:21 Do you recall what you asked her and what she responded with? Or anything that you've picked up from good, which is not always the best piece of advice I've been given so far. Or any good advice. Well, I'll definitely tell you at the outset, the hardest part I had was I, and it's embarrassing because you feel like such an idiot when you're doing

Starting point is 02:27:42 it and you realize it as it happens is you're talking over the person, you know? And I just think like in your excitement, you sometimes just like, oh, okay. But I have another question now. And it's like, I don't want to forget these. I don't want to forget all these questions. So that's something where it's a lot easier in person because body language makes that easier to avoid. I do most of my interviews in person. So that's a bit easier.

Starting point is 02:28:05 Um, I think in the end I've, I've learned it comes down to prep, you know, you, you really, the better interviews are ones where I feel like I'm more prepared and the interviews that I come out of where I think, man, like, I can't believe I didn't know all of these other things that would have allowed me to take this discussion in another direction. There are also many different styles of interviewing, right? I remember early on, I was very lucky, I don't know how this happened, to be introduced to one of the head researchers, if not the head researcher for Inside the Actor's Studio. And I asked him if he'd be willing to look at transcripts of some of my interviews to offer pointers or observations.

Starting point is 02:28:55 And it was very, very valuable. And the point that he made as a preface to feedback was exactly what I said, and that is there are many different ways to skin the cat. And James Lipton, who is fantastic in his role as the interviewer slash host of Inside the Actor's Studio, almost never changes the order of questions. Once he has a stack of questions on blue cards, he will not deviate. He almost, without exception, knows the answers to every question he's going to ask. And that's, say, one end of the spectrum. Then you have a Larry King. And there are others of sort of Larry King's school of interviewing who go in i'm not going to say blind but intentionally

Starting point is 02:29:46 with beginner mind not knowing much about the the interviewee unless they've met them before so that they can ask questions kind of from first principles right mimicking the listeners experience and then you have a lot in between. You have a ton in between. And as you noted, the produced shows like This American Life or Freakonomics are spectacularly good, but they're very different from a minimally edited long form interview of, say, two hours or where we are to almost two and a half hours. And the ability to compartmentalize, like you said, to parallel process is also something that I could not do in the beginning. And I'm not saying I'm the epitome of skill or ability with it now, but it does seem to be a faculty that you can

Starting point is 02:30:38 cultivate. Who are other interviewers you've paid a lot of attention to? I mean, I certainly, when I was getting started, I listened to, and still do listen to quite a bit of of rogan you know joe rogan mark maron very different styles right both very skilled but very different styles uh i think steve ranella actually is a fantastic interviewer uh he's he's he's such a subject matter expert with a lot of what he does. And there are many, many other people who are just outstanding. But is there anyone who's... I think part of the problem is I'm still trying to figure out where I am on that spectrum. So I think one of the goals I have for next year is to hone this craft even more and actually sort of figure out what my voice is and then sort of

Starting point is 02:31:27 start to double down on the learning around that. Now, of course, again, you could argue that being malleable would be the best outcome, being able to do one extreme or the other. I don't go into interviews with questions, but I go in with a lot of prep. I have a team that helps with that. So I go in with four or five, sometimes I did a podcast a week ago with 28 pages of notes going in, but none of them were questions. It was just content. Do you refer to those pages in the midst of the interview? Yeah. So what I usually do is I'll say to the person I'm interviewing, and sometimes I don't. And actually, if you don't mind me interrupting and talking on top of you for a second, what do the prep instructions look like?

Starting point is 02:32:10 When your team helps you prep, what are their marching orders? What do they do? It varies totally by the podcast and subject matter. Give me an example. For this one, for the 28-page one, this was a podcast, which was very difficult because I was interviewing two people.

Starting point is 02:32:24 So I've only done that three times, or maybe even twice, and very difficult because I was interviewing two people. So that's, I've only done that three times, uh, or maybe even twice. And it's much harder to interview two people. And like you, these are people like the example you gave, I'd never spoken with them before. So I identified them as subject matter experts. The subject was THC, CBD, all things related to cannabis. Um, so I identified them as exactly the two smartest people I wanted to talk to in the room, but had never, it was all through email, no communication otherwise. And I said to my team, look, these are things I want to understand that I don't know. I believe these are things the public wants to know. I need a dossier that is the best available knowledge you

Starting point is 02:33:02 have on all of these topics. And then I'm going to basically look where the gaps are and I'm going to sort of run the sled between the gaps in the snow. Did you send five to ten bullets per silo in terms of what Peter wants to know, what the public might want to know? I mean, how much are you sending to your team as a starting point? So in that case, I'm trying to think. I think Jess took the lead on that analysis. No, I think actually Jess took the first cut. So she came back with

Starting point is 02:33:29 kind of like 10 pages of stuff. And then I was like, okay, let me digest this for a couple. What did you provide her first? Like literally nothing, blank space. Oh, it was blank space. Yeah, total blank space. And then she came back

Starting point is 02:33:43 and then I reshaped it and said, okay, well, I also need to know more about this, more about this, more about this. This is good here. Thank you. This one is good, but can you give me a little bit more insight? So that's like one extreme end of the spectrum. And then other podcasts that, I mean, I have podcasts where I literally go in with nothing except blank paper to take notes on while we're speaking. Kind of like what you and I are doing right now for you, where you're, you know, there's nothing you need to prep for this type of an interview.

Starting point is 02:34:10 But, and then there's very technical ones. Actually, I do have 28 pages to my right on egg boxing, but we didn't manage to fully unpack that next time. I mean, it's just, it's such a nascent space. You know, the bottom line is, it's, I'm a little embarrassed sometimes when I listen such a nascent space. You know, the bottom line is it's, uh, I, I'm a little embarrassed sometimes when I listened to myself interview, you know, I, I, I, when you hear it the second time you think, how did you, how did you miss that thing that they said? Like they said something so important. Um, they were opening a door here and you didn't even go in

Starting point is 02:34:41 that door. And that's another, I think part of part of what the people who are good at this can do is they can release their own agenda and sometimes go where the story is more interesting. And I've definitely seen many examples of how I've missed that opportunity. and fixation on remembering questions, which is actually part of the reason why I still often recommend to novice podcasters that they pre-record a number of episodes via phone first, meaning via Skype and Ecamm Call Recorder or Zencaster, because it allows the ability to look at notes so that you're not as preoccupied. What I've found very helpful for myself is more of a structural prep than a content prep in the sense that I will decide as a placeholder, and it's not something that I fixate on, but to have, say, a Post-it note to my side

Starting point is 02:35:38 which says, first 30, this type of stuff, next 30, this type of stuff, next 30, this type of stuff, but no specific questions. And then I will look at the recording time and segue roughly at those two pivot points. The other thing that I found really, really helpful, and this mirrors how I've done a lot of my best writing, which I haven't done in quite a while, and I'm going to be getting back into writing, and that is knowing which handful of questions I'm going to start with, and I'm going to be getting back into writing. And that is knowing which handful of questions I'm going to start with. And I might only get through two.

Starting point is 02:36:07 And then where I want to bookend it. Questions I think could lead to a grand finale or a nice way to wrap up. And then in between, it's just looking for the side streets like the entire time. It's a fun craft. I mean, again, this is sort of like archery sort of like driving a race

Starting point is 02:36:26 car anybody can do it it's hard to do really really well yeah it's like uh i think it's bushnell's law well this was in the gaming world it was in the context of atari at the time but i want to say that the quote is roughly uh a great game is easy to learn, hard to master. Yeah, that'll keep you moving for a long time. Yep, absolutely. So Peter, tell people where they can find you. If they want to listen to the most meticulous dissection of subjects like THC, CBD, MRI, longevity. You've got all manner of subjects.

Starting point is 02:37:12 I mean, you also introduced me to Ryan Flaherty, the savant of speed when it comes to physical training. You cover a lot. The podcast is? The Drive. The Drive. And I exist on any sort of whatever my web you know websites twitter instagram is all peter attia md peter attia md.com and that's only because peter was taken i hate having md it ever i can't say it without thinking about um meet the parents

Starting point is 02:37:41 dr bob bob md if my wife still makes fun of me for that peter attia md if if you had a blog post or series of blog posts that you would suggest people start with if they want to explore your thinking in the written medium where would you suggest people start is there anywhere you would suggest they start we have a five-part series on science understanding science called studying studies yeah that's so good yeah i think that that's that's a helpful one if you consume news about health you know which you do right it's hard not to yeah if you read uh if you consume news about health, you know. Which you do, right?

Starting point is 02:38:25 It's hard not to, yeah. Yeah, if you read, if you are exposed to media that contain any health claims whatsoever, then chances are you're coming across. Yeah, so that's- Studies show bananas increase risk of colorectal cancer 47%. Right, right, right. Wait a second now.

Starting point is 02:38:42 Yeah, yeah, yeah. So if you want to get through the fine print, so studying studies, which, which Bob Kaplan and I wrote in, um, 2017, I believe. Um, I think that's, I think that's a great place to start for folks. Great. And I'll link to that at, uh, timferrissmd.com. No, and I'll, and I'll shamelessly plug for our Sunday newsletter, which I know you like. Yeah. So we, if you, you can sign up for, uh, what I describe as a non lame weekly email. I get your emails and there aren't that many emails that I subscribe to, uh, because I have enough in my inbox, but yours is one I get one of the few and I will link to the newsletter, your newsletter and everything else that we've talked about at Tim.blog forward slash podcast.

Starting point is 02:39:26 Just search Atia, A-T-T-I-A, and it'll pop right up. Anything else you'd like to say? Closing comments? Limericks? Anything else? I don't think so. I think I could certainly offer about 20 more dumb things I do, but we could save that

Starting point is 02:39:42 for another day. We could save that for a follow-up. If you guys enjoyed the format, please let me know in the blog comments that accompany this podcast or on Twitter at tferris, two R's, two S's. Just let me know if you liked or hated this format or anything in between.

Starting point is 02:39:59 The kind of five things with person X. Might do three things with, five things with, whatever. We get the idea. Kind of excited about, changed mind about, and then stupid, absurd things with whatever we get the idea kind of excited about changed mind about and then stupid absurd things thinking about doing more of these because it's a damn easy plug-and-play format for one thing and Peter we we have a we've dinner date and we will we'll get to that at some time in the very, very near future. So I guess autophagy be damned.

Starting point is 02:40:28 Here comes the calories. And thanks for making the time, man. Thank you. Hey, guys. This is Tim again. Just a few more things before you take off. Number one, this is Five Bullet Friday. Do you want to get a short email from me?

Starting point is 02:40:42 Would you enjoy getting a short email from me every Friday that provides a little morsel of fun for the weekend? And Five Bullet Friday is a very short email where I share the coolest things I've found or that I've been pondering over the week. That could include favorite new albums that I've discovered. It could include gizmos and gadgets and all sorts of weird shit that I've somehow dug up

Starting point is 02:41:03 in the world of the esoteric as I do. It could include favorite articles that I've read and that I've shared with my close friends, for instance. And it's very short. It's just a little tiny bite of goodness before you head off for the weekend. So if you want to receive that, check it out. Just go to fourhourworkweek.com. That's 4hourworkweek.com all spelled out and just drop in your email and you will get the very next one. And if you sign up, I hope you enjoy it. This episode is brought to you by Peloton. I love Peloton. Peloton is a cutting edge indoor cycling bike that brings live studio classes right

Starting point is 02:41:41 to your home. You don't have to worry about fitting classes into your schedule, making it to the studio, or dealing with some commute to the gym. I have a Peloton bike in my master bedroom at home and it is one of the first things that I do in the morning. I wake up, meditate for 20 minutes, and then I knock out a short 20-minute ride, usually high-intensity interval training or HIIT. Then I take a shower and I'm in higher gear for the rest of the day. It's beautifully convenient and has become something that I actually look forward to and I was skeptical in the beginning. I didn't think I would dig it and I really do. So you have a lot of options. For one, if you like, you can ride live with thousands of other Peloton riders from across the country on the interactive

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Starting point is 02:43:39 at home anytime you want. Go to onepeloton.com and use the code TIMPODCAST to get started. This episode is brought to you by Humans Beet Elite. The product is Beet Elite, not Meat Elite, not Beet, B-E-A-T, but Beet, B-E-E-T Elite, which you might consider an endurance superfood, or what they would call a nitric oxide activator. Really, all I care about is this product. Beetle Eat was introduced to me several years ago by a multiple time world champion and has since been recommended to me by multiple world-class athletes. And I use it pre-workout for endurance training. That could be cycling, that could be swimming. It is very rarely running, but my subjective experience supports what some of the research would seem to

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The Tim Ferriss Show - #398: Peter Attia, M.D. — Fasting, Metformin, Athletic Performance, and More

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