Hello friends, welcome back to the show my guest today is Dr. Peter AA he's a physician longevity expert podcaster and an author there is essentially an unlimited amount of Health advice available on the Internet working out what is legit science. And what is Bro Science is difficult, but thankfully Decades of experience means Peter can help cut through the noise about what is actually most effective to improve your Fitness and Longevity expect to learn why a simple hospital visit can cost 6,000 in America how to improve your cognition the best supplements. Everyone should be taking whether there are any safe doses of melatonin why so many young men are now dependent on trt? How worried we should be about processed foods Sun cream alcohol and all of your favorite vices how we can better deal with mental decline as we age how to improve your self-talk and much more.
Another awesome episode from that huge shoot that we did on a virtual LED wall here in Austin, Texas. And Peter is a legend. The guy is 1 of the best voices in health and fitness super evidence-based. He's an MD. He is teaching people and coaching them and helping them on a daily basis and you get to find out all of his best hacks today. It's very good and I hope that you enjoy it. Don't forget that you might be listening but not subscribed and over the next few weeks. We have Mr. Bolan Tim Ferriss and Gary Vee coming on the podcast and you don't want to miss those episodes along with everyone else and the only way that you can ensure you won't is by hitting the Subscribe button and it's free and it supports the show and it makes me happy. So please go and do it.
Thank you.
But now ladies and Gentlemen, please welcome.
Dr. Peter attia
What's this story about your son going to hospital and getting some insane medical charge for a tiny procedure?
yeah, well, it's it's unfortunately a very common story right where anybody goes to the ER and you know, they end up needing a bag of IV fluids or something like that and then I get they get a bill for thousands of dollars and you actually look through the line item and you realize
this is comical right? You literally charge me $14 for a bag of normal saline that costs. I don't know somewhere between 2 and 3 dollars. Um, but it s speaks to a lot of the breaks in the um specifically in the American Healthcare System.
What is it? Why is it so broken? What is it? Because it's a commercial Enterprise is it because it needs to be uh additional funds need to be brought in from places where they shouldn't what's going on.
It has to do with the complexity of a multi-payer system. And basically the way contracts are negotiated between payers and hospitals and you have to decide in those negotiations who is in network and who is out of network. Um, that's like 1 slivers on on so many levels. Um, but in in that case, I think the issue came down to you know, some very high deductible that wasn't met coupled with, you know, some out of networking, but the the truth of it is there's also ridiculous pricing. So so there's a sort of a false sense of how much things cost in hospitals. It's sort of funny money like we're going to really really mark up the price so that we can give you a big discount if you're in network, right, you know, so you you see this across the board with all sorts of things in medicine and to rehydrate your son it costs
like
6 grand or something?
I can't remember the dollar amount. It was so egregious. Um, and again I it's it's infuriating to me when you keep in in in mind the fact that you know, probably the average American would have a hard time on short notice producing a thousand dollars. And yeah, I'm fortunate enough that I can produce a thousand dollars without too much difficulty, but for the average person, maybe 50% of the population that's a really big deal and that's a huge inconvenience, right? That means
That changes your plans dramatically. It means you're not taking a vacation that summer it means you're not, you know not able to go out with your family for paying off that credit card debt for ETC. And it totally it's totally inexcusable.
I went to a ghost tours in New Orleans 5 years ago.
And the guy that was taking the tour finished up afterward and I was asking him about the American Healthcare System. And he said this thing is really stuck with me and he said if you get hit by a car, you'd better walk it up.
His point being that there are medical emergencies that can happen that can ruin your life by you having to fix them not by you not fixing them.
Yeah. Um Health Care is the number 1 cause of personal bankruptcy in the United States.
No way.
Yeah.
Wow.
It's strange for me as someone who's coming from the UK.
Right. There are problems with the NHS. Don't get me wrong. I have had my share of problems with the NHS but there's a social safety net that picks people up and it feels to me it feels barbaric.
To not you you don't get the privilege of healthcare like its just oh, you're so sick. Sorry like not for you. It seems it seems very bizarre coming from the UK.
Yeah, and it's a little counterintuitive. The people who are most impacted are not the people at the very bottom of the socioeconomic ladder here because those are individuals who are going to qualify for something called Medicaid, uh, which is meant to sort of you know provide for the people who truly have nothing. Um, but if you go 1 level or 2 levels up from that to people who do have health insurance, but they're grossly underinsured or they can't afford health insurance because yes, they're working and yes, they have these other expenses, but they can't afford that um it those are the people that are absolutely devastated by uh, the system here and and again on the flip side of that I think on some metrics the US Healthcare System is hands down the best in the world. It's not an accident that when heads of state
You know kings and queens royalty, you know, whatever need the best procedure. They're going to come to the United States. Um, and and so on the 1 hand the US has the best to offer in terms of you know, the tip of the spear in quality, uh for medicine 2.0 but at the other end of the spectrum when it comes to cost and when it comes to coverage and accessibility, it's uh, it's the but you could argue it might be dead last in the developed world. Look at where it all began the
wild west of America their your cardiac machine being powered by a nice water wheel or whatever it is. Yeah, you talked about this. I I really love this conception between uh medicine 2.0 and and 3.0. Uh, you've got a quote longevity itself and health Span in particular doesn't really fit into the business model of our current Healthcare System. There are few insurance reimbursement codes for most of the largely preventive interventions that I believe are necessary to extend lifespan and health span and after,
Our episode last year. I went to Fountain life in Dallas preventive medicine right full body. MRI brain angiogram heart angiogram scan with contrast and a dexa and a microbiome and all this stuff.
And it made me realize why it's so medicine's backwards. You're trying to fix a problem after it's happened as opposed to working out what's going to happen and getting out ahead of it.
It's wild.
Yeah.
lots of people
I think want to improve their mental Clarity 1 of the things that is top of mind is my attention my focus my ability to pay attention to the stuff that I'm doing. Everyone's a knowledge worker and some form or another now, what do you focus on when it comes to improving cognition be yourself.
Um, I think you know there you can I sort of put these into different categories, right? There's sort of the the the things you do to improve the environment of your mind. So I think
probably at the top of that list is is sleep. Uh, so it's very difficult to cognitively perform. Well when you are sleep deprived and I realized that many people listening to us will think come on I can think of all the examples in the world. I mean look at all these people who don't sleep and are still out there clearly doing very well. Um, and the point is you never have the counterfactual for those people. Right? What you don't know is imagine that person sleeping 8 hours a night instead of 3 hours a night. Um, I I am positive that they would be performing even at a higher level.
Um, I put exercise probably at number 2. Uh, I think it is again just a remarkable way to provide not just the obvious metabolic and circulatory, uh food if you will to the brain, but but also kind of think about the the endocrine side of that right so bdnf and things of that nature, uh, play such an important role in brain health, um nutrition clearly plays a role and managing nutrition is important. Um, I think anybody who's, you know, especially people who are really carbohydrate sensitive will will appreciate that the the the the big peak The Big Valley that follows, you know, a big carb Rich meal, uh is going to you know, negatively impact cognition. So again, we could build out a few more of those things, but then I think there's kind of the environment with within which you work and and I think for me this is the bigger struggle so I you know, luckily I think I've sorted out the Sleep nutrition exercise side of it. So my limiter tends to not be the
those things it tends to be distraction and busyness and doing too many things at once. That's probably the thing that limits my capacity for high quality work or deep work is Cal Newport would describe it. Right? What are the rules or
techniques that you set yourself to try and maximize deep work time?
Well, I mean 1 of the things is I don't actually have any notifications on my phone except the phone if it rings and you know in this day and age nobody actually calls you. So basically I'm never really interrupted by my phone it I don't get a I don't get a even a vibration if there's a text message an email or God forbid anything stupid like social media. So I have basically a phone that does nothing except vibrate if it rings that's it.
Um, and that turns in talking with people, I realize that's actually seemingly rare a lot of people look at me. Like I have 3 heads when I explain that. I don't have any alerts on my on any aspect of my phone.
um
The other thing I try to do is set aside larger rather than smaller blocks to get work done. So I try to schedule big blocks of time early in the day that are my quality work time. So typically that is
7:00 to maybe 9:00 in the morning is always uninterrupted. So there's never anything that's going to be scheduled during that period of time and
I focus on doing whatever's so this morning. I did the most important things I had to do during that period of time knowing that from here to my next meeting to my next call is only going to kind of
dissipate my cognitive capacities. Yeah, I uh, I went to Dubai. I fled the UK during lockdown and went to Dubai which I think is
4 hours ahead of GMT which meant that I could get up at 7 or 8:00 and I had 4 hours before anything happened and it was Bliss. It was insane. It was what it feels like to be jokr willing for a while. And uh, I now being in the US I'm 6 hours behind the UK, which means that I wake up to the just this cacophony of you know things that need to be sorted and there's a video going out and there's emails and there's all this stuff. Uh, but yeah, I think for me,
Choosing in advance what you're going to work on and then blocking off a little bit of time. Even if it's just an hour. You're like, alright, I'm just going to do the 1 thing that is going to move and if you're actually look at your day and say what would have had to have happened. What's the 1 thing that would have had to have been done by the end of the day for me to look back and go success. It's probably not that insane of a thing. It's maybe the thing that you have a bit of hesitation or resistance to doing it's usually not that insane.
Yeah.
It's not a massive list in order to be successful. Okay. So, uh, what about when it comes to working environment if you are you sit stand desk. Are you take are you doing pomodoros? What else from the productivity for
depends what I'm doing? Um, but again, I'm I I also need quiet to work. That's another thing. So I was kind of looking at my daughter who seems to be able to do homework with music on and I did as well when I was in college. I always had music on when I was doing homework. I I wonder if I could have done better if I didn't but for whatever reason when it comes to whatever I do now, which is usually writing. Um, I wouldn't be able to do a great job with any distraction soundwise or otherwise, um,
Stan yeah, I like to be standing if I'm not on Zoom. Uh, my the way my office is set up. It's just a lot easier to be sitting if I'm on Zoom. I also you know, I think you know people ask me all the time like do you you know, do you count your steps or how many minutes you're standing or sitting? And the truth is I don't at all right. And the reason is I'm doing so much other stuff that I don't really need to be particularly attentive to those things all things equal. Of course, I'd rather be standing or walking than sitting. Um, but but I don't tend to fix it on it.
You're ignoring dollars to pick up pennies. If you're thinking about how much time you're spending stunning throughout the day.
Yeah. And by the way, I think that is valuable for an individual who can't make 2 hours a day to exercise, but fortunately, I've just made that an unbelievable high priority where yeah, it's I'm always going to be doing the really important stuff
during dedicated time. What about supplementation or pharmacologically? What are you using if you need to dial in focus a little bit more
Nothing. Um, I do well I shouldn't say nothing. So I love caffeine. Although I I'm not convinced. I'm really getting a benefit from her from it. I am a very very fast metabolizer of caffeine. So I probably consume 300 to 400 milligrams a day. But if I don't nothing happens, like I I can't appreciably tell a difference. So for me, it's I love the taste. I love the ritual. I love making coffee my wife loves coffee. It's the 1 thing I can do first thing in the morning that makes her happy, uh, you know, so it's like, you know, you know, it's it's so I don't I don't even though people would argue that caffeine of course is a cognitive, uh booster. Um, I'm not convinced. I appreciate the the the metrics of that. Um, I do occasionally, uh, put a nicotine patch in my mouth. I probably get more benefit from that, um, truthfully and maybe I'm just not aware of other products the product I use I think is too high a dose. So you have to it's a 7 milligram pouch. So you have to kind of time it because as you probably know nicotine is a very unusual.
Molecule where at low doses it provides a heightened sense of awareness. So it's actually concentrating you but then you actually cross over a hump and then nicotine becomes actually quite relaxing and sedating. I
didn't know that.
Yeah, it's it's an unusual molecule in in the and it has Behavior. So, um, both of those properties are ideal. It's great to be focused when you need to be focused. It's also great to be relaxed when you need to be relaxed. So you don't want those at the same time. Yeah. So with these 7 milligram pouches, and again, there's people watching this that I'm sure are going to be like come on you idiot don't you know, all this other setup products that are out there. Um, I used to I used to enjoy gum more because you could chew 2 milligrams at a time which was really the right dose to just induce the focus. Um, again nicotine is an addictive compound. So I said, I don't say this lightly, um, but for whatever reason I don't appreciate any of that. So in other words, I might have it
3 times a week for a month and then forget about it for 6 months and I don't seem to miss it in any way shape or form. Um, and obviously the mode of delivery matters. So, you know, I'm not remotely interested in anything. Yeah. I'm not I'm not at all interested in in in that. Um, it's it's got to be basically gum or a
lozenge or something.
It's so interesting that the dose can take you from where you want to be to where you really don't want to be.
But
it's the yeah, or it depends like again sometimes if if you know, and I don't use it in this capacity, but if you really need to relax
7 milligram slug of nicotine will relax you want to throw up that would make me want to throw up everywhere. I'm very nicotine
sensitive. Yeah. No, that's a real issue.
So what about we're talking about
there's 1 other compound that I add to the list. Although I rarely need it. But if I'm doing a lot of time zone movement, I will also lean on modafinil.
Okay, and how would you use that for yourself? Just use it as a quick reset on circadian rhythm in the new time zone. Right? So for example first thing in the morning, yes, so take it first thing of the morning of the new time zone which is not the new which is not my morning internally, right? So if I had to go to London tomorrow, um, and I had to be there for 48 hours and then come right back. My strategy is let's say I'm leaving Austin at 2 p.m. So 2 p.m. Austin time is what's that 9:00 p.m. 8 p.m. On daylight savings, so I would
Put myself to sleep on the plane within 2 hours so that I go to bed London time. Even though it's 4:00 p.m. Austin time and I don't want to go to sleep. And then what would you do to induce sleep? I had kind of a long protocol but basically it comes down to how early that I wake up in Austin the day of when did I exercise? What did I eat? And then I'm going to try to shut off my adrenal glands with phosphatidyl serine. Um, I'm going to take Trazodone a dose of a high dose of Melatonin, which is not something I normally use to sleep.
And that's going to put me out. What would the first 2 things that you mentioned, uh phosphatidyl serine and trazodone and what do they do
fast with all serine, uh inhibits cortisol output from the adrenal glands and trazodone is a funny drug. It's um, it's actually it used to be used as an anti-depressant in the 80s, but it never really took off because it had this um, nasty side effect of making you tired so as ssris and the like came on board it sort of fell by the wayside. We now use it as a remarkable sleep drug. It's incredibly safe and more important.
Importantly, it doesn't just induce sleep. It induces stage appropriately. It's a very helpful drug for people who um, don't suffer from any initiation insomnia, but who do tend to wake up intermittently at night either due to anxiety or you know, just any anything that kind of gets people up trazadone basically buzzes over smooth that out. Yeah.
Okay, so you then take that melatonin what sort of dose?
Again, normally I don't take any but if I'm looking for the hammer, I'm going to take 3 milligrams. Wow. Yeah, that is a lot. I mean,
he's just before we go on to how to then wake up when you get to London.
The levels of dosage that you can buy in CVS of melatonin. It's crazy is wild can can you just give the overview of how the dose curve works for melatonin with humans? Well,
I mean it what's interesting is physiologically the pineal gland doesn't make that much Melatonin right? It's making um
micrograms of the drug
so
I think the smallest dose I've ever seen that you can buy might be 300 micrograms. Like maybe there's someone out there that makes a 3 of a 3 milligram. Yep. Yeah, that's probably the smallest I've seen maybe there's a a
0.1 out there. I've got a a a spray and each spray sublingual spray of it is 0.3. Okay. Yeah. So unless I can like yeah half trigger it there's no Echo,
but most of the time you're looking at 1 to 5 milligram i.e. and even 10 milligrams. And the problem with that is it seems if if if you look at the literature and I haven't looked in a while, but the last time I did.
Doses north of about 6 or 700 micrograms 6 to 7 milligrams tend to really suppress melatonin receptors in the brain. And so as
a long-term strategy, it's probably a bad idea. So would that create basically a physiological dependence?
Yep. So my I try to get patients off melatonin truthfully and reserve it for jet lag and for travel only and and not rely on melatonin as a as a nightly sleep aid, but for but if you're going to
I I want them to be as low as possible 48 hours. I can't mess about here. I need to hit it with a hammer.
Yeah, if if using this example, if I I want to fall asleep at what feels like 4:00 and wake up in 7 hours and then 2 hours later land in London and be functional and be 100% functional and then take that
uh, uh, mafan upon Landing what sort of dose of the MAF is that immediately upon waking?
Yep.
Alright and what sort of does any idea
I mean, I usually take 200 milligrams if I'm going to take it, but maffin will be dosed. Typically the
Low end is 100 and the high end is 600.
Okay, uh, what about armor doanel? I've heard about that
comparable.
Yeah. Yeah same thing. Yep. What is I'm you're speaking to someone that's never taken. Mafan. What's the sensation a bit like, uh, it depends on the individual.
So I perceive nothing. I'm just more awake and I'm I feel fantastic but I don't get a high from it. I don't get any stimulation from it. I know there are some people I can't tell you what fraction of people but but a non-trivial fraction of people actually experience a negative sort of stimulation effect from it.
Oh, like they feel like uh, it probably feels like what a fedra used to feel like back in the day.
Oh, it's rushy.
Yeah. Wow. Yeah now now again, I would argue that in those people. They're simply taking too much and that they're very sensitive to it and they might get the benefit without that negative side effect. If they down the dose my wife for example can't take it, but that's probably because she's only ever tried 200 and I would bet if she ever really needed it. I'd probably give her 50 or 100.
In other news this episode is brought to you by element. Stop having coffee first thing in the morning, you're a dentist in system that caffeine acts on isn't even active for the first 90 minutes of the day, but your adrenal system is and salt acts on your adrenal system element contains a science-backed electrolyte ratio of sodium potassium and magnesium to helps to regulate appetite curb cravings and improve your brain function. You've probably heard me talk about it a million times and that's because I love it. It tastes fantastic. It's got zero sugar. No junk. No colors, no artificial ingredients or any other BS and it's how I start every single morning. Best of all there's a no BS no questions asked refund policy with an unlimited duration. So you can buy it 100% risk free. If you don't like it for any reason they will give you your money back and you don't even need to return the box. That's how confident they are that you love it right. Now. You can get a free sample pack of all 8 Flavors with your first box by going to the link in the show notes below or heading to drinklmnt.com Modern wisdom. That's drink lmnt Comm slash.
modern wisdom
talk to me about so that's mental Clarity in the now.
what about uh
Reducing cognitive decline over the long term.
I think it's the the
2 big ones by far. I think first and foremost is is exercise. Um, clearly the most efficacious data, right? So if you just look at clinical trials, if you just look at mechanistic studies, um exercise is the best intervention for the brain. Um, I think metabolic health and high quality sleep would probably be
Next in line. So metabolic Health meaning being insulin sensitive good food fuel partitioning right being as far away from the diabetes end of the spectrum as possible. Um, again, if you have type 2 diabetes your risk of um, neuro neuro degenerative disease goes up significantly. Um, and then it's all things that pertain to vascular Health Beyond what's already been stated? Right? So if you look at you know, again, it's important to understand when we talk about dementia. We are talking not just about Alzheimer's disease, but the other forms of dementia Alzheimer's happens to be the most prevalent, um, but it's by far, you know, not the only 1 and so when we think about vascular dementia, uh, frontal temporal dementia, and obviously Alzheimer's disease all of the risks for cardiovascular disease carry right over there. So what are the things we want to do to maintain, um, low risk for cardiovascular disease low burden of lipoproteins low blood pressure. Uh low inflammation. Those are the big big big 3 and metabolic Health lipoproteins. How do we get to low lipoproteins?
Um, usually pharmacologically truthfully because for most people to to make the lipoprotein level low enough that it you can Factor it out of the equation is not really achievable dietary unless you're willing to go on a very extreme diet that I think for most people causes more problems than it than it solves. So you have you have to be really really fat restricted to do that and there are some people who can do okay on that but most people end up also being too protein restricted they end up, you know, eventually getting sarcopenia later in life. There's a whole bunch of other imbalances that come along for the ride,
right? Okay, um blood pressure.
What are the big movers when it comes to keeping
that in a good range the big 2 by far are weight and exercise weight meaning weight loss and
uh and cardiorespiratory Fitness, right? So you're not. This could be the gym bro as many of my friends are that
probably overweight in terms of what body mass. They're carrying not doing enough cardio. I'm not doing anywhere near enough cardio getting out of breath going upset of stairs struggling to touch their toes, etc. Etc.
Looking really great. Yeah, and and so while we have a lot of great drugs to treat blood pressure just as we do for treating lipids your ability to impact blood pressure with uh, quote unquote lifestyle is much greater.
And should always be first line. What?
Does VO2 max or uh resting heart rate make a bigger impact on when it comes to I mean, are you looking more towards Zone 2 or toward maximal work
to bring that blood pressure under control both this total cardio respiratory Fitness and you can't really be very high in 1 without the other in other words. If you really really really have a profound aerobic base. You're going to have a decent VO2 max. And if you have a really high VO2 max, you have to have a pretty significant aerobic base and and I do think that most people would benefit from training those 2 in a ratio of 80/20 in favor of Zone 2.
Wow, okay. Yeah, I think you know again for
the Jim Bros out there of which I am, you know a card carrying member. Um
Just throughout your 20s. It's so if you if you know, what a push pull leg split is and if you're enjoying going to the gym and getting jacked with your boys.
It is so low down the list of priorities for you to care about doing cardio, like unless you're going to a Bea in 2 months time and you're a bit fluffy and you think I'm going to get up and I'm going to do intervals fasted first thing in the morning. That's it. Like cardio is just not on the table.
It's true. How many days did you spend in a Visa? Oh, was that like if you live in the UK, that's like Cancun right for
kind of yeah. Yeah, so you've got obviously we Europe's on our doorstep. So it means that uh, mayora. Magalo Malia zonte onapa IBA. So IBA is the coolest 1 of the lot because it's sexy house music and it's cool and whatever whatever um, but there's a they said there's a rule of you can ruin any European city by putting direct flights from the UK there. It's so true. You hear these stories about uh planes that need to be turned around in the sky
because you know, they're too rowdy in the
yeah.
Yeah
way too rowdy and you think
Look at any British airport if you go.
Easter holidays look at any British airport 5:30 in the morning. Everyone's got a pint everyone parents have got a pint as they're going away because it's
Drinking is just such a inbuilt part of British culture. It is in our blood literally, but I think you know we spoke about this last time. I think we're turning a corner with alcohol. I think I really think we are I think that the way that people see it as this sort of
Go to coping mechanism like the relaxation mode of choice the thing that alleviates social anxiety perhaps this is because people aren't putting themselves into social situations quite so much they're able to sit in the house a little bit more. Um, but my previous industry was nightlife and you know, I speak to my uh, ex-business partner and all of the guys I used to work with and the Lai Larry sort of drinking culture has now been wildly supplanted by much more chill sort of brunches and and it's seems to have matured a little bit more. So maybe we when I was in London last summer, um, I went to
uh, you know near around the Parliament and stuff and there was this great statue of Winston Churchill outside of a park. What do you know the name of the park I'm talking about. It has a a statue of Churchill facing out. He's the only 1 facing out. I think all the other statues of great folks are facing in and it's facing um blanking on the name of the tavern like Stevens Tavern or something like that and you know, so the lore is that that's where Churchill held
Shop, right because you had to be within a certain distance of parliament so that if you got called back to Parliament you could go so basically Churchill lived there. He was always eating and drinking there and holding Court.
So, of course I had to go there and there's no way I wasn't having fish and chips and some pint of whatever and I mean I just did this every day even though I couldn't stand the beer but I was like, I'm going to have fish and chips and a pint of whatever your finest unspeakable warm. Horrible piss water is but if Churchill did this I'm doing this
I got from my tour manager. I got a a Christmas present of the champagne that Churchill used to demand was at every lunch meeting and he made this.
Company create a new sized bottle because a half bottle was insufficient and a full bottle was too much and he couldn't think so. They made a pint bottle of champagne and it's this and it's got the law on the back and it's beautifully designed and apparently it tastes like fizzy. I haven't opened it yet. I need to wait for a good occasion. Um, it tastes like fizzy Apple water or something and uh, yeah, he made them. I imagine being the guy that goes to a high-class champagne establishment and says
they say it's not
quite enough with the with the half
bottle. I don't need a full but you make make me a
newer. I mean, that's the that's the power that you've got.
Yeah.
You say that striving for physical Health and Longevity but ignoring emotional health could be the ultimate curse of all, what do you mean by that?
Well,
um.
You know, there's a there's a there's this Greek mythology of of fellow I write about in the book tonus who who requests of the Gods, uh immortality and he gets granted eternal life, but not Eternal health and so he has this horrible curse where he's alive, but he's physically decaying all the way into this decrepit NeverEnding state.
and so I think in extension of that is well, if you're if you're um, emotional health which encompasses many things happiness the quality of your relationships any sense of purpose any sense of Happiness if that is
in a bad place
Why would you want to live longer? I mean you your your objectively suffering. So why would extending that suffering be of any value? Um, and again like you can you can play sort of thought experiments all day long. So, uh, let's let's play 1 so, um,
You know the little bit I know of you Chris you enjoy people right? Like you're not an antisocial human being so if I told you, um, Chris whatever number you think is the dollar amount that it's going to take to make you happy. We're going to double it. Okay, that's how much money you've got and whatever metric of your own physical health defined by
How big your muscles are how low your body fat is how well you can perform. Let's give it to you plus 20% sounds good so far. Yep. And um, the only catch is you're the only person on the planet now.
Now don't worry. I've created a bunch of bots that will do everything. So your standard of living won't go down like you're going to have Bots that will do anything and they'll provide your food and everything. How how how happy is your life? Like how long until you kill yourself not long know because think about it like what are you doing? Alright, so that just gives you 1
example of wow, if you took away my ability to interact with other people their life is not worth living very very few people. I could imagine could tolerate that for a long period of time. Um, so sure that's extreme, but it's a great way to illustrate a point which is if you have every single thing imaginable, but you have no connection to other people
What do you have?
Um, so of course, it doesn't have to be that extreme for the point to still remain.
1 of the things that I've been thinking about a lot recently is uh integrating of emotions because
a lot of us that come from a productivity background or a biohacking background or a strength and fitness background. We tried to reduce The Human Experience down to metrics and numbers and reps and sets and stuff like that. But the actual phenomenological experience of being a human is emotion. It's what what does what is the texture of your mind as you move day to day through the things when you look back at the day sure you might be able to say how many words you wrote or how much weight you lifted or how far you ran but the actual moment to moment experience of that isn't you logging things on a spreadsheet? It's how your mind feels what what what's going on internally and I really think that
that point about emotional health being
Everything else kind of being subjugate to that is really true and it's something that I think people gloss over. So when when you conceptualize emotional health, what do you what are you talking? How do you think about the component parts of emotional health or emotional health regime?
You know some of it depends on definitions in semantics and I don't for a second suggest that the way I do it is the right way or anything like that the the way we talk about it with our patients because we do um because it fits into a hierarchy of all the things we care about managing in terms of longevity risk. So longevity risk is anything that is a threat to the length of your life or the quality of your life. And this has to be 1 of those buckets broadly speaking. There are 7 So within this bucket, I would say it's um sense of purpose.
Satisfaction and joy achievement quality of relationships self-regulation distressed tolerance. Th those are probably the biggest buckets that fit into that. Um, and again, you know Arthur Brooks who I don't know. Have you had Arthur on the podcast he's coming on in a couple of months. Oh, yeah, so you'll have a great time with Arthur because this is really a big part of what he talks about is the subset of this around happiness. Um, and I think he I think he has a very elegant way of of thinking about happiness, right which is that happiness is not a feeling anymore than the odor of the food you're consuming is the caloric macronutrient benefit of the food, uh, and and therefore people tend to get a little bent out of shape if they don't quote unquote feel happy in a sort of positive veilance emotional sense. Um, and I I think that's actually 1 of the most important things. I've learned in the last couple of years is that I shouldn't confuse my feelings with my state of happiness and
That that when I when I'm evaluating my emotional state through the lens of happiness. I really want to go through these these more nuanced metrics around like am I am I living in a manner that is congruent with what I believe. My purpose is my purpose first and foremost as a father and husband, but then secondly my my my purpose as a doctor and then maybe my purpose as a public figure and and and these are all different but but I feel like I do have a purpose and all those things. Okay, and then like what is the state of my relationships? Where are my relationships good, where are my relationships under strain where my relationships lacking in my attention? Um,
And then what am I pursuing that is giving me, uh, a a a a sense of satisfaction which which really requires um, doing something hard and achieving a result like and I you know, some people are more wired to need that than others. Uh, you probably are I know I certainly am and my entire life has been built kind of around hard things to do as little, you know, side projects, you know, physical challenges sometimes sometimes business challenges writing a book something like that where you Toil and it's hard but at the end there's something you're you're proud of. So anyway, it's it's it's it's it's it's about accounting through all of those things. Um, and I I look for some people it's easier than others. There's some people that just naturally tend to find ease within those things and others who don't just as there are some people for whom it's much easier to do cardio and they enjoy it and there's others who maybe gravitate more towards strength training or maybe others who don't want to exercise at all as their natural default state. Do
you think this?
A difference between emotional health and mental health or is this just lexical wishy-washy. Um,
you know, I
used to use the 2 interactions.
I I don't know. I mean I think in the book I talk about them as as sort of slightly different and I talked about emotional health as this thing that we are talking about now and mental health as the pathologized state of disease. So depression anxiety bipolar disorder. Those would be mental health things. I I again, I I don't think there's a right or wrong to this as long as 1 is clear and what they're saying.
1 of the things that I really appreciated about you was your openness you've spoken about this a number of times your openness about your own, uh, sometimes negative castigating in a monologue. It's something that I'm incredibly familiar with as well myself. What would you say to the people who have poor self talk a a scolding in a voice that reminds them of how they fell short way too often. What have you learned about dealing with that and also about balancing that with your high standards for yourself about wanting to make a mark in the world, but also needing to be able to give yourself self-love.
Yeah, it's an interesting question. Um.
I don't know that I could provide generic advice on the topic because it probably depends on where the person is in pain right now. So I know that for me.
The message the the reason I was willing to engage in.
The discussion around changing the behavior was because the output of it was was was made clear to me, right? So once I recognized the link between my self-talk and my rage
and I fully accepted the fact that I wanted to rid myself of Rage.
Then I accepted the fact that I had to go and fix the self talk.
So my guess is the only way to really try to convince somebody that
um, you're having an inner Bobby Knight, which is what my guy was having an inner Bobby Knight that screams at you. All the time is harmful is by helping them understand a clear path between how that behavior links to something that is hurting them in another way that is more obvious. And I I think if you can't do that, it's probably a little too abstract to just say
You know, you should be nicer to yourself.
I listened on recommendation from a friend to a 20 year old nearly 20 year old Tony Robbins awaken the giant Within
Workbook on Audible. It's about an hour and a half and I never read the original book and in it. He talks about pain Pleasure Principle and he talks about bringing with decisions that you want to make or with habits that you want to change bringing as much pain to bear. Look at what this has cost me in the past. Look at what this is costing me. Now think about what this will cost me in the future and then turn that up to a thousand. So my friend wanted to stop biting his nails. So he thought about all of the times in the past that girls had sort of made an icky sort of move when he put his hands on and then they'd seen them and how ashamed he felt about it at the time and about how this was going to hold him back in the future and how it made him feel like a juvenile and it was immature and then he went online to turn it up to a thousand and he looked at the worst photos that he could find of people that had bitten their nail these awful, you know, like bloody stumps of fingers and then he thought about the opposite he thought about how much pleasure could I bring to this? How proud I would be if I'd overcome this thing that I'd done for 20 years about how much more attractive I would feel about how much more confident I would feel.
When I shake someone's hand I put my hand on my girlfriend's leg and these sorts of things and uh, I have to say it's incredibly powerful like to do that to bring to bear.
And what you're talking about is?
there is a
inner Tormentor that kind of does a thing.
But it's all inside of your head and its Upstream from some things that actually manifest that you can kind of hold on to and do a thing. So, how do you get how do you get back up? And how do you point the finger at what's actually going on? Well, you bring to bear so much of what's happening in the real world. But yeah, it's I think this is 1 of the most common issues especially people that listen to this sort of a podcast, you know, the high Achievers they want to do things. You want to leave a mark on the world want to improve themselves.
But so much of that comes from like whipping themselves into submission all the time. I'm going to castigate myself until I
Like bow under the strain of how much?
Torment I'm giving to myself and but as you know
it there's a real myth that you have to do that to perform. Well, right. Um, and the and the myth is that you know.
There are plenty of great coaches who extract remarkable performance from their athletes without that behavior?
So and it doesn't mean you're not firm and it doesn't mean you don't have high standards and it doesn't mean that if the team absolutely shits the bed and doesn't show up that the coach isn't going to let them have it but that's you know, that's very different from the constant berating. And also I I think there's just a real difference in terms of
um
you know differentiating kind of um, a negative behavior or a negative outcome from
the individual themselves is the is the is the problem right? So so it's 1 thing to say, I don't like that I wasn't able to do X Y and Z that's a different statement from I am a worthless person because I didn't do a comment on my self-worth on how
much respect I am owed by the world. Okay, so take me through
how you
Reprogrammed that self-talk I understand that you can have this thing. The rage is Downstream from the whatever.
But what what did that look like? What did going in? In fact checking your uh, very Stern in a voice look like
Uh, it was a it was actually a very deliberate set of actions because I think you have to do actions and the easiest way to reprogram is through voice. So, uh, I think you have to audibly reprogram a system. I don't think thoughts are enough and so, uh the exercise that I undertook, uh about 4 years ago to reverse a pattern of behavior that was in place for more than 40 years was to every single time. I had a moment of self, uh, what was about to amount in a sort of self cursing, um situation I would I was I was instructed to take up my phone and record audibly a a a a description of what I would say to a friend had they just committed the same quote unquote egregious act. Okay, so example would be if
I'm shooting my bow and arrow and I'm really doing a lousy job of it instead of jumping into self loathing. I would take up my phone and record a memo speaking but not to myself but to my friend.
You know, like if it was you what if you had just shot as poorly as I did, what would I say to you?
and
it I would I would be much more gentle. Well, what would the sort of things that would be it would be?
You know and again you have to understand how strange some of these discussions are because in the moment you're so angry.
Why right
it would be. Uh, hey Chris. I know you just finished trying to shoot today. And it it just didn't go well at all. Um, you weren't able to accomplish any of the things you want to accomplish.
I I know it's frustrating. Um, I think you just have to accept a couple of things 1 is
Um, you're probably a little distracted today. If you're being honest with yourself, um because you have a lot on your mind and you know, truthfully it's a little windy today and I I it's just hard for those arrows to fly straight when the wind is blowing at 10 Mi an hour. Um, and you know, as you know from pre previous experiences, like tomorrow will be a new day like you're going to come out here and do this again tomorrow and it'll be better and we're just going to go back to process and we're going to get it right and we're going to we're going to do a couple of drills tomorrow to to instill that that was it. You know, it might be a 1 minute little voice memo. I'd send that to my therapist and then I don't know 5 hours later. Something else would come up that would piss me off. I'd burn a steak or something because I turn you know, I got I got distracted and left the barbecue and and and inside I'd want to immediately eviscerate myself. But instead I would pull it out and pretend that it was my brother who had just burned the stake. And what would I say to him if we were at his house and he had just burned the steak. How would I make him feel better about it while acknowledging that it sucks. We don't have
dinner tonight, you know, and and I would do that and after 4 to 6 months of doing this. I don't know 3 to 5 times a day low and behold I couldn't hear Bobby Knight talk anymore.
Wow, so it can it really turned the volume down. It is in my
life the single greatest example of neuroplasticity that I have ever witnessed.
And how old are you? How old were you when you were doing this? I'm 51 now. So 47.
Dude, that's wild. Yeah, you wouldn't think it could change.
I think
especially when you're talking about self-talk.
It is the internal physics of your system. It literally is the texture through which you interact with your own mind and it's the fish underwater thing like you just yeah, you don't know that it could be different.
And to think that it's as malleable as that and how sticky has that been do you need to drop back? Are you having to go back
and do this or is no I've never had to go back and do it and I've never heard the voice again. Now, I want to be clear. This doesn't mean I don't get angry. What it means is a the frequency with which I get angry is a fraction of what it used to be the um, and the duration or the blast radius is much narrower, so
The last time I got really pissed at myself or pissed at my inability to do something was I was in the simulator. I'm trying to learn. I'm trying to learn a new F1 circuit in the simulator and um
For whatever reason there are certain tracks that are just very hard. Silverstone is a very hard track to drive. Uh, it's very hard to put a perfect lap together and it just really gets under your skin and so is emela so emila is a circuit. I'm learning right now like learning in great detail, right? Like I want to come up with a really cracking time on emila and
I was down in the simulator and I was going through it and I just couldn't nail the last the second and third last corner is and I would have these epic flying laps and then I would absolutely shit the bed in this corner and either off track spin or just lose so much time that I couldn't put a lap together and you know after I don't know an hour of this I would just got super frustrated. I got out of the simulator and was like absolutely ripping pissed off.
But because I didn't indulge in any self-talk it wasn't like you suck. How can you not do this which is exactly what that voice would have said in the past. It was just oh I am so pissed that I am not able to do this right now. Like I'm going to come and do it tomorrow. And by the time I got from my simulator room upstairs I had forgotten about it and that's the difference whereas before that would have stayed with me and I its I'm embarrassed to say this it would have saved me for the rest of the day. I would not have been able to shed that anger for the rest of the day and it would have leaked into everything I did.
uh, whereas now
in 60 seconds. I it's not that I didn't remember. It happened it just the emotion of it was had dissipated already. In other news. This episode is
brought to you by Maui Nui venison, Maui Nui delivers the healthiest red meat on the planet directly to your door. First off. The venison sticks are seriously delicious not gamey at all and unbelievably convenient to eat.
No, 1 accident hits their protein goals and these little puppies will help you throughout the day if you're traveling if you're on the road or if you're just a rushed human like the rest of us these things will help you to hit your protein goals and ensure the you're getting good quality meat throughout the day not only do they provide the most nutrient-dense and high protein red meat available. They're the only stress-free 100% wild harvested red meat on the market. Also, they're actively combating the environmental destruction caused by Maui's Axis deer overpopulation, which literally looks like a wildfire from above so by eating meat they're actually helping the environment get 20% off your first order by going to the link in the show notes below or heading to Maui new venison.com modern wisdom using the code modern wisdom at checkout. That's Maui Nui venison.com modern wisdom and modern wisdom.
A checkout so I can imagine there's a number of people whose inner voice perhaps isn't as uh pharmaceutical grade as yours was a weapons grade maybe um, but presumably that means that if they were to go through a period of this rewiring that dose could be less intensity would be less difficult. You would be less like if your patient zero for having a really really bad inner voice. That means that people who just want to make it a little bit better because it's a bit bad should be able to get there. Have you got any idea what what was happening when you're going through like what is it about speaking to the friend? What is it about that increase of distance? What is it about the saying it out loud
and
Yeah, you know, I've never really I've never really thought about what's happening from a from a neurobiological perspective. It would be it would be an interesting discussion to to have with someone who's smarter than I am. Um and
Or at least understands that more but it is again. I I I didn't do this because I thought it would work. I really was like
it's kind of a dumb idea. There's no way this is going to work and I'm going to just be doing this for the rest of my life and maybe the fact that I have to do this for the rest of my life is the Penance like for for my sins, but I was like, it can't work like again, I just thought like it. It's so ridiculous that I'm going to do this because
Like you don't what is the next thing you're going to tell me? I can be a foot taller if I think about it every day, like if I talk to myself, I'm going to make myself taller. Like I I thought that this trait was as immutable as a physical trait. Yeah. Yeah.
You did a
insanely long or intense period of therapy at 1 point you tell me about that.
Um, yeah, I've done 2. Uh, so these were like residential therapy programs that I went to where I spent uh 2 weeks in the first 1 3 weeks in the second 1 where you're you're in a full-time residential Place doing therapy.
12 to you know, probably 12 13 hours a day. That's like um
mind rehab.
It's like mental really? Yeah, it's immersion. Right? So so it's different. You know, the way I
people say to me people who have felt the need or wondered if it was something they would benefit from have asked me and they said look, you know.
Is it the same as just doing X number of hours of therapy? And I say it's not because it's it's it's sort of the same of saying like look if you really want to learn Spanish.
Would you be better served doing an hour a week with a tutor or would you be better served moving to Spain and not letting anybody speak English to you like the the the difference in speed with which you're going to get there based on total immersion, uh is is very separate. I've never heard of this before. I didn't know this.
It's like a Meditation Retreat but for therapy, I'd never heard of it.
Yeah, and again these these programs and there's probably many of them, you know, they're very well structured, right? So it's not just it's some group therapy some individuals therapy, you know EMDR for trauma family history stuff, you know, it's very uncomfortable. Like there's nothing about it. That's enjoyable. So it's uh, which you know is sort of like a silent Meditation Retreat where you have moments of profound misery, um, and then moments of of of bliss this is probably more painful in that because you don't really have any Bliss, um, but
You know the the people who who who lead these kind of programs are very special and they really they really understand how to how to they think they can pattern recognize it. You know, the other thing that I think is pretty pretty valuable about these experiences is none of us are really that special like we all kind of think our problems are super unique like no 1's is fill in the blank as me and it's just not true. Like we're all pretty ordinary. And you know, um, I don't know I maybe that's maybe people hear that and think that no come on. I am a special flower but it's like no we're not special flowers. We're just kind of trying to optimize for our own, you know, well-being and the well-being of those around us in our tiny little world and um if I can suffer a little bit less, that's great, but there are lots of people who have seen my problem before and um, and if they haven't seen
it exactly they've seen a version of it. It's an uncomfortable realization, but it's 1 that I've arrived at as well this sort of its kind of narcissism to believe look at how
special and unique and and uh difficult to understand I am you could never I it would it would take you an easily a decade for you to be able to get inside the Cathedral of my mental pathology and it's not it's not it's not you know, and I'm I'm deep in the I'm in my therapy era at the moment as well and you know the
Ease with which someone who is trained can see your patterns and call them out for what they are. And sometimes they have a name and you go I don't have that. It's like someone accusing you of having a disease and you go no no. No, it's not that it's something it's not that what you just described to me is the name of this disease.
and as soon as that happens
the kind of veils fall from your eyes a little bit about you being personally cursed I often think about that term personal curse that you can understand why the Ancients used to believe that the gods use Mortals as their play things because the phenomenon of of of Rage or of lust or of whatever it doesn't just feel like some neurochemical imbalance it it's imbued with meaning right. There is a phenomenological experience of doing this thing. It's not just the thing. It's like more and
to sit down with someone and for them to see you to really see you and to observe what's going on and this is why you know so much of my
Transition from absolute adult infant to like Manchild or whatever. I'm at now was it came about from listening to podcasts because For the First time ever I got to hear people that were being completely open and honest about their experience and me going.
Oh, wow, like other people have that thing. This isn't just me. I haven't been you know imbued with some unique Army of 1 pathogen that like affects me in this way other people have a a very
like cursive internal
self-talk other people hold themselves to high standards, but then also feel bad because they're not enjoying life other people and uh, yeah to
to realize that you're not as special as you think you are.
or
your problems aren't as special as they think that they are.
Yeah, or as unique.
Yes. Yeah. Yeah, and there is usually a pathway a pretty well laid out pathway of okay. Well, where does this come from? And then how do we look at it? And then how do we move forward? It's not that hard.
I want to I I don't know whether I'd be able to do 2 or 3 weeks of of full-time therapy. Uh, 2 hours a week is is a heavy enough for me. So coming out the back of that. What was there an immediate change or was this something that required integration like going on an Ayahuasca retreat?
Um
The the the 2 were quite different and occurred at sort of they were separated by a few years. Um, I think the second 1 was more was more successful. Um, based on the fact that the first 1 I left, uh kind of against their advice, right? So they wanted me there for another 4 weeks at a minimum another 2. You'd done 2, I had done 2 and they wanted they everybody believed I needed a minimum of 2 more
but like 4 more feels like this is the worst case that we've ever seen bring in the doctor. They're like clear that's like the mental equivalent of that.
Yeah, and I was like,
Guys, I'm definitely better and they're like, yeah, you're better than when you walked in but you're not better better. Uh, and they were right. I didn't know it at the time. Uh, and I was wrong.
And I left and I left this was in 2017.
And I left and I largely held it together until 2019.
and then I kind of fell apart again and by 2020 I was completely apart and at the beginning of 2020 I had to I had to go back and pick up the pieces of what I should have done the first time at a different place and here this is a place that's a little more intense
and
They get most people out in a week.
And after a week, they said you you really need another week and I I sort of saw them. I I did I I was like 1 I had in the back of my mind the experience the first time and I thought
Okay, I can do it and at the end of the second week, I really thought I was there and they were like you're not there.
And I was like, I was a little I mean I was a lot annoyed actually, um,
it feels like you're working hard you're making these sacrifices you're trying to do better.
Yeah. I'm like, I don't know what else you would want from me. Like what would it take for you to say? I'm better and
It's really interesting. I on a you know, I ended up staying for another week and on the the weeks there run.
Saturday to Friday is a week is it 7 days but the it starts on the Saturday as the program right and on the Wednesday of
The third week which was the 19th of 21 days. I was there was the was the real breakthrough and and and so they were right, you know, that's the point right? Like they I but I only realized it then and so that to leave them on the 21st day.
Like, you know, and this was you know, it was in Phoenix. So it was a long drive back home, which was a lot of time to reflect. Um,
it was it was it was very very different coming back. I didn't make any of the mistakes. I made the first time and I had a great system in place in terms of therapy which which still exists to this day. So I'm still doing therapy once or twice a week and um,
It's a it's you know, it's the perfect Cadence because there are times when things are going when there's really nothing to talk about and it's just easy to say. Hey, I got nothing to talk about today. Okay, you sure? Yep. What about this? No all good great. But I having those meetings always on the calendar, um makes them the priority.
How do you think about pulling yourself out of a negative mood if someone wakes up on a morning and wrong side of the bed syndrome?
What would be some of the places that you would say? Look here's a few things that you can do that can reliably change your mood alongside all of the other stuff that you need to do within a day. You can't just take the day off and fly to Cancun or something.
Yes, so remember a few minutes ago. I said 1 of the most important things I learned in the last year with respect to this was was that I don't want to confuse the feelings of happiness with the new I don't want to include the I don't want to confuse the scent of happiness with the macronutrients of Happiness borrowing from Arthur Brooks language. Um, I think the other equally important thing I've learned in the last
Year, and I I mean I've learned this maybe sooner but but I've really been better at implementing it is um feelings exist for a reason.
So to be clear, I'm I'm not a person who believes that your feelings are. Right? I think they're wrong most of the time but the point is they're they're never accidental something caused them. Yeah, and I have to explore the something and and this is where I've become I think more Savvy in the past year, which is when I get into a funk which I do.
I start to I don't ignore it. I and I don't judge it. Those are 2 very important things. So that that used to be my playbook ignore it or judge it ignore it or judge it be critical of it or pretend. It's not there and power through now it's and I hate to do this because you sound like an idiot like Ted lasso. It's just be curious and non-judgmental about it. Like literally just say ah,
Peter it you seem to really be irritable and you really seem to be lacking interest in things that normally interests you you you don't even feel like going out and playing with your kids like you're very Sullen and this that and the other thing.
Like what is that about?
Let's let's let's just think about this like
do you feel a loss of intimacy with this person?
Are you afraid of this thing? Is there something that's a you know, that that is causing fear. Are you afraid of losing something? Are you are do you feel humiliated like you start to go through very basic emotions that tend to be negatively valenced and you you go 1 layer beneath them and interestingly.
I mean again, it's 1 of those things where if you told me this 5 years ago, I would have said that's impossible that I could ever figure it out, but I tend to stumble into the why and
And then you can start to problem solve. Oh, I'm actually all of this is due to my fear of this thing happening.
And then you can start to say well how rationale is that fear?
and if it is rational, is there something you could be doing about it and if there's not how can you brace for this outcome like so
again, it's the um, and so so going back the feeling itself might have been totally ridiculous and totally false, but it was a very important clue that took me back
to figuring something out. It's really cool to hear you talk about feelings in that way. This is something I'm trying to learn a lot about at the moment. I'm aware that it sounds like the most sort of performatively autistic thing to to say like, I'm trying to learn how to feel feelings. But like here we are and uh,
I really think that it's an area that is
ripe for
people who like to improve themselves guys and girls that are type a go-getter that want to try and Achieve things and that completely missing 1 of the huge elements of this which is what's the day-to-day experience of your mind like not from a mindfulness standpoint because even mindfulness you can use that to not feel feelings very well like thought arises and we let it go. It's like okay fine. But where did that come from? Why did you feel that way? And do you really applying all of the equan that you can to just release relax and allow?
These thing that's like, uh taking a paracetamol to stop pain. It's like the pain is going to continue to be fed up to you. What's causing that?
Yeah, and
um, it sounds so.
Like fluffy and unscientific and I think another another part of it is especially coming from like a health and fitness side people want to be able to control the system. If I eat this many grams of protein and lift this much. I can expect this amount of muscle gain over a year in the
butt with emotions. It's just this it's chaos, right? You don't have the same rigor?
when it comes to assessing them and when it comes to to dealing with them, uh, but
yeah, I I certainly for me it is.
The area that there is the most room for growth to be able to understand feelings feel them integrate them work out where they're coming from. Uh, it's cool. It's cool to hear that. You've got to practice like that. I think it's I think it's something that we need to be talking about an awful lot more.
Well, it's a journey. I mean, it's um, I hope to be a lot better at it in 5 years. But um, and and I think the other thing I would really hope is that um, I hope to be able to teach my kids because I think it would be more valuable than most things I could teach them right? Like I I do think that had I learned this
in my teens
Uh, I would have saved myself.
and by extension a lot of other people a lot of pain, um, and and a lot of that, you know the the detonation so, um,
Yeah, I I it'll be interesting to see like at what point is is a is a child sort of mature enough to to sort of start to.
You know metabolize that learn how to emotionally self-regulate and all the rest of it. In other news. This episode is brought to you by Maric Health. When I wanted to get my blood work done in America. I asked around I did a ton of research and Maric Health came back as the best quality service that you can find and I loved it so much. I reached out to the owner to actually partner with them on the show. They genuinely understand training diet supplementation and pharmaceuticals. They don't want to make interventions. You don't need they will make suggestions that are minimum dose and appropriate for you and your goals and your age. They're great. It is literally like having a personalized bio health hacker in your pocket that understands you and your Bloods at all times. You might have heard that I took my testosterone from 495 to 10006 and that was with the help of Maric Health without using trt. But by optimizing everything else that I was doing in my life right now, you can get the exact same service that I got by going to the link in the show notes below or heading to Maric health.commerce.state.ny.us.
K health.com modern wisdom 1 of the other things that's been happening a lot recently is the rise in trt usage among young men young men, um, maybe in part due to hoping to elevate their mood to improve the way that they feel what's your opinion on the what appear to be increasing numbers of young men using trt? Uh, I'm I'm greatly concerned by it. Truthfully. I I think
it's um,
I I think
Again, a lot of men I think don't understand their risks of trt. And while testosterone is a very safe therapeutic. I mean, uh, if if done correctly it's safe for hormone as there is uh, but you know, if you're talking about a young guy who doesn't actually understand the impacts of testosterone on fertility, for example later in life, uh doesn't understand what a physiologic dose is versus a super physiologic dose and especially in the cases where guys have to get this stuff. Illegally, um that then you introduce a whole new layer of contamination and uh, all sorts of things like that. So so net net I'm a little concerned, um, maybe a lot concerned. I also think, you know, there are lots of clinics opening up that are kind of trying to circumvent some of these issues. And again, I I I think they're
I think their their motivation is to capitalize on an obvious interest, but they do so without uh, you know necessarily A nuanced approach to how to do this
take me through the risks of trt. What are they high level?
So it depends on the on if
we're going to talk about trt done correctly. Do you mean literally trt testosterone replacement therapy or that and
it's more uh, malignant offshoots where people start to push dosages and stuff like take us through, you know the range. Well,
I would say let's start with what sort of known in the medical world, right? So we'll start with kind of appropriate physician administered testosterone replacement therapy for an appropriately aged individual appropriately aged individual at an appropriate physiologic dose. Cool. Okay. So the 2 big risks that people have historically been concerned with are prostate cancer and heart disease. So an increase in the risk of prostate cancer and an increase in the risk of cardiovascular disease, both of these have been studied extensively and I think we can make a very strong and compelling case that testosterone replacement therapy is not increasing the risk of prostate cancer at all. And it may in fact be decreasing the risk slightly.
Um, I've done an entire podcast. I think 2 podcasts on just that topic. That's how nuanced it is. Um, but again we to give you just 1 example when we have a guy who has undergone a prostatectomy for prostate cancer. He's had his prostate removed.
Um, we will still use testosterone replacement therapy in that guy. So think about that you have a guy who had prostate cancer.
You will still give him testosterone replacement therapy if it's warranted or indicated post prostatectomy now.
Do you do it and shut your eyes and never look again? Of course not you're still monitoring his PSA every 3 months and you're going to look for any sign of recurrence. And if there is in fact a recurrence, you would immediately see it because what we do know is testosterone would feed prostate cancer. But the point I'm making is around initiation. Is there any evidence that testosterone replacement therapy initiates prostate cancer? The answer is no there is not and there is some evidence to the contrary.
The cardiovascular disease question is a little bit more difficult and the data are a little bit more muddled. But on balance they come out in the direction of trt does not increase the risk of cardiovascular disease. Now, there's a big trial that was completed last year called the Traverse trial that gave men, uh, uh AndroGel so topical testosterone and followed them for I want to say 3 or 4 years and there was no increase in the incidence of ascvd atherosclerotic cardiovascular disease.
But there is so so at face value that study was taken to mean look we have 1 more study the biggest and best that demonstrated no increase in the risk of cardiovascular disease with trt. So the debate should be settled once and for all um, I did a podcast on this and wrote a long newsletter on this and the long and short of it is that's a in my view that's a slightly premature conclusion because I don't think the Traverse study was done perfectly.
Uh, most importantly it um did not give men a high enough dose in my view.
So the men started out very hypogonadal with a total testosterone of somewhere between 1 and 300 nanograms per deciliter, but they were only replaced to about 600 nogs per deciliter. And while that's a reasonable rate of replacement. I don't think it represents. What's happening in the world. Yeah. I mean, we replace patients to hire them that we replace patients to 800 or 900 where technically tracking free testosterone and not total testosterone but usually to get somebody in the range of where we think a good free testosterone is we will see a total testosterone. Uh, that's easily in the 800900 nogler range. So it's possible that Traverse trial only answered the question does low dose or as 1 of my analysts put it does testosterone light replacement therapy increase the risk of cardiovascular disease and I think there we can say the answer is probably no. Okay and what about testosterone replacement therapy when it's done badly?
Yeah, so I think
If you even think about it in the medical setting I think testosterone can be given to very super physiologic levels and I see patients getting super physiologic levels all the time and they come into our practice. They've been treated at some T clinic and they walk in with a free testosterone of 35 nanograms per deciliter. Um, you know, which is like twice what you would consider reasonable and you know part of the problem is we don't really know what the long everything goes out the window with what I said earlier now, can I say that that doesn't increase the risk of prostate cancer initiation. I can't say that because I don't have the data. Can I really say that doesn't increase the risk of cardiovascular disease? No, I can't it's also by the way creating a lot more ithis so those people are making red blood cells at an alarming rate and they need to be monitored very closely for increased blood viscosity
is is that uh, I have a friend of a friend who donates blood every month is that that's why because they just making too much and it's too thick
Correct. Wow, I mean good for the blood donation people.
Yeah. And again the question is if you have to give blood every month if your bone marrow is so revved on that. You have to give blood every month. Do we run the risk that you're going to convert into polimera at some point which is a disease now where all of a sudden you can't shut that process off so it becomes self-sustaining even once you've
come off the
trt. Yeah again, I'm not suggesting that that's happening. What I'm asking is we don't know right and and there's just a big unknown there. The other thing is once you start to get into these super physiologic doses you start to run into other issues around a lot of estrogen and a lot of DHT, so you'll see these men who are on these super physiologic doses of testosterone also showing up on 5 Elite reductase Inhibitors, which we could talk about why I'm not a huge fan of those and on aromatase Inhibitors, which I'm also not a fan of is that to stop gyno and hair loss. Yes,
right
and um,
Obviously, I'm not I'm not a guy who takes hair loss very seriously. But um, you know, I I think it's a mistake, uh to take a 5 Alpha reductase inhibitor for hair loss. I think there are far better strategies if it matters and um, I think you know, even though the risk of uh, finasteride syndrome or post finasteride syndrome is low. It's not zero and it's potentially irreversible and this is uh, this is I think in a young man taking finasteride again, if you've been take if you're listening to this and you you're on finasteride and you have no issues, you're fine. It's something that if you hasn't kicked in within, you know 6 months it's not going to kick in but um, we do we do see men who have like a permanent loss of libido. This is
reported in the literature asteroid syndrome is
yeah. Okay, so so basically there's something about blocking DHT that might not be a great idea.
Permanent loss of libido would be bad. Um, what what else haven't we spoken about when it comes to exogenously increasing testosterone levels fertility.
Yeah. Well, there's another thing that I think is when you yeah fertility for sure, right so at um, once you give exogenous testosterone, um, you're going to cut down on endogenous production including sperm production. And therefore you're going to see a reduction in fertility and at some point that's retrievable, uh, and at some point it becomes more and more difficult to retrieve so it depends on the person's age when they start and what their testicular Reserve is, but, you know, generally speaking 2 years of exogenous testosterone can spell the end of endogenous production and therefore a lifetime dependency which again we do that all the time like if a guy is old enough and decides it's time to go on trt. We fully accept that and there's no risk of being on Lifetime t for life within
Physiologic doses but for a guy who's young that might be an enormous risk? And and we you know, we see this all the time where guys who are doing this in their 20s decide they want to have kids in their 30s and they can't
What else haven't we said about the risks of trt?
Um, I think there's another method of delivery using uh, chromaphone and choffin and these are drugs that have the advantage of preserving fertility. Uh, they work by inhibiting estrogen receptors in the hypothalamus that trick the brain into thinking you need more testosterone. So now the brain uh, via the pituitary starts producing more follicle stimulating hormone and luteinizing hormone and you end up increasing endogenous production. Um, and again, I I might be a an unusual skeptic in this regard but my concern with that approach typically centers around. Yes, you raised testosterone, but are you getting the full benefits of testosterone because I think 1 of the benefits of testosterone is the benefit in the brain and if you're now blocking estradiol impact in the brain, um, certainly anecdotally there's questions about whether you're taking away some of the benefits of testosterone including
Mood and libido would you have any
concerns for people being on Clomid for a long amount of time? Is that something that you think shouldn't be used?
Um, I would feel very strongly about people not being on chin or Clomid for a long period of time for another reason, which is it really increases the production of a sterile called Desmos. Um
Interest so and the reason for that there's a lot of problems with that including potentially an increase in the risk of atherosclerosis increasing the risk of cataracts and things of that nature. So I think long-term use of Clomid not a good idea. The drug was never intended to be used long-term. It's a fertility drug. So it's intended to be used short-term and I think short-term, uh rises in Desmos are not problematic but lifetime increases or many years of increase I think would be and there's a drug that was there's a drug that increased as moral levels in the 50s and 60s that was actually pulled from the market because of the increase in cataracts and the increases in cardiovascular disease.
What?
What about these? I I went to uh prospera in Roatan, which is 1 of these Network States. There's no FDA, uh jurisdiction there people are doing experimental fyat in gene therapies. The dudes from Tiny Circle are doing all of this stuff. It was it was fun. It was like I didn't get injected but I I I got to see kind of the stuff that was going on, but I was with uh, 2 pep scientists 1 that synthesizes and 1 that uses some incredibly heavily with clients and stuff and they were telling me about is it uh bt101 or something, but the there's a a particular peptide that is able to induce testosterone, uh from the brain which sounded like Clomid but without this particular feedback mechanism. Are you familiar with any of these know not not not
with that 1
I'll find some I'll find some info and put it to you. Okay. So let's say that we're going to go to the other side of the fence. Now, there are guides listening who want to naturally improve testosterone production.
What are the big movers what would you suggest?
I mean his going to sound like a real, um, crap answer.
I don't think there is a bigger way to naturally increase testosterone than adequate sleep and reduction of cortisol. I I I think hyper cortisol Mia stress probably has the greatest negative impact behaviorally on the endogenous production of testosterone probably through the pituitary, uh, gonadal axis. And um, you know, how much can it move the needle
You know probably to the tune of 3 or 400 nanograms per deciliter. Um, so if you're not sleeping well, um and you're under a lot of stress. It's it's very easy to end up hypogonadal. Um, and therefore fixing that I think is far more beneficial than sort of the the Litany of supplements out there that may or may not have marginal benefit. So the the now for women there's a different answer but for men, I would say that that's the answer
the hard charging dude that's you know, maybe mid-20s crushing in the office going to the gym maybe partying on the weekend once or twice bit of alcohol, whatever whatever whatever, uh,
This becomes kind of vicious feedback loop, which is precisely why men are looking to things like trt because of how hard their
potentially pushing themselves during the week. Yeah, and I think that you know, so so to that guy what I would say is why do you want to replace your testosterone? So let's say he goes and gets checked out in his testosterone is 300 nogs per deciliter which you know, probably puts him at the 10th percentile, uh for a man his age. So undoubtedly that would qualify as hypogonadism. So the question is do you want to fix that because you don't like the number
And or or is there a symptom we're trying to fix and if the symptom is what we're trying to fix then I would say let's fix that symptom.
And by the way along the way we might also improve your testosterone.
but I um
You know again like I guess I don't treat that type of patient. So maybe someone who does is listening to me and saying well, you don't understand and you know that guy even though he's only 24 we're never going to get him out of that spiral if we don't normalize his testosterone and you you know, again that that wouldn't be my Approach but I want to be mindful of talking about something I don't do for a living. What about women? Yeah, I think with with with women we have 1 more trick up Our Sleeve, which is DHEA. Um, so again doing all of the normal behavioral stuff, but it's it's a it's a little harder to make the connection in women. Um, but but and this is something I actually learned kind of recently because I used to be very dismissive of DHEA because in men it has no effect whatsoever. Um, but DHEA, of course is what allows for adrenal production of testosterone and the reason it has no impact on men is if you increase a guy's testosterone by 40 milligrams per deciliter, which is about what you're going to get from adrenal production. If you maximize it you don't move the needle at all. So taking a guy from 300 to 340 is doing nothing but
If you took a woman from 40 to 80, what's a typical woman's range? Well, it depends by age. And it also somewhat depends on where she is in her cycle. But um, I would say, you know normal for a young woman might be 60 to 100 nanograms per deciliter. Yeah. So if a woman is, you know symptomatic and she's 30 and you take her from 30 up to 70 with just the addition of oral DHEA like that's a win the risks.
Um, I mean the biggest risks for women at that level are you know, the side effects I would say, right? So you're looking at increased acne, maybe body hair at that devil at that level. You're not going to get any of the other real risks that we see with t blah blah blah. Yeah clitoral enlargement voice deepening and all that stuff. You're not going to get that at those doses.
We'll get back to talking to Peter in 1 minute. But first I need to tell you about momentous, you might have heard me say that I took my testosterone from 495 to 100006 last year and 2 of the supplements. I use throughout that were for dojo aggressors and tonat Ali I first heard Dr. Andrew hughman talk about these really impressive effects, which sound great Until you realize that most supplements don't actually contain but they're advertising momentous make the only NSF certified for dojo regresses and tonat Ali on the planet. That means they're tested. So rigorously that even Olympic athletes can use it and that is why I partnered with them. So if you're not performing in the gym or the bedroom the way that you would like this is a fantastic place to begin to naturally improve your testosterone and there is a 30-day money back guarantee so you can
Buy it. Try it for 29 days. And if you do not like it, they will give you your money back. Plus they ship internationally right now. You can get 20% off everything sitewide by going to the link in the show notes below or heading to live momentous.com modern wisdom using the code modern wisdom a checkout. That's live m o m e n t o u s cam wisdom and code modern wisdom
a check out. Have you got an opinion on the nofap movement? That's something that's put forward as a potential solution for guys with low T.
I'm sorry. I don't even know what it is. Let me
teach you about nofap. This is my speciality. It's uh men purposefully abstaining from orgasm either from themselves or with other people.
Why?
Because it's an internet subculture and the internet likes Trends and this has been a what does it have to do with the T situation that there are guys out there who?
have created a
link between the frequency of ejaculation and their
masculinity both inverse relationship or direct relationship. The more that you the more that you do it, the more
your energy is sapped. I see got it. Have you ever seen has this ever been clinically observed in any
form?
I can't say it. I I if it has I'm not aware of it. What a shame.
Geroscience researchers report an astounding case study of a 93 year old with the physical fitness of a 40 year old. This was the rower that I wrote about a few weeks ago.
Tell me the story of this. Yeah. It's an interesting fellow he um was not a lifelong athlete at all. Right. So that's the beautiful part of the story in my book. If you're if you're listening to this and you're a normal person, so is he and he just kind of took up rowing like like classes rowing classes, you know you go you get on a rowing machine and you just sort of do it and
He just took such a love to this thing and got so good that at the ripe old age of 93. I mean, I honestly I think his VO2 max.
Um, I don't remember if it was reported in the article or if we tried to back calculate it based on his times. But I mean he at least from that perspective from a rowing perspective would have the fitness of a of a great 40 year old now, I don't want to misrepresent and say that he's a 40 year old because he's not right. He doesn't have the muscle mass of a 40 year old although he does have very low body fat. Right. So if I if I recall his body fat was probably 16% which is outstanding is his muscle quality the same as yours. No, um, you know would his coordination, uh, or fall risk aversion be the same as yours. No, but but look the point is when you compare him to another 93 year old, he's clearly functioning at a level that's you know, in totality I would say at someone in their 70s and to me that's that's the game like I'm way more impressed by and interested in that guy than I am in any influencer. I see doing any feat of strength run.
Any like I don't care like I don't care what you can do when you're 40, I really don't I really care what you can do when you're 90,
how long was he training for?
Decades, I mean this was not
so he'd fall in love with running with rowing at
in his 60s or something. Yes.
Exactly. Yeah, okay and he'd accumulated this capacity over time.
Yeah, so think of him like a guy who
You know.
Didn't really accumulate much wealth until he was 60 and then started investing but was an amazing investor and a consistent investor and compounded and compounded and compounded and it is 90s. He's a billionaire.
And it's sort of like wow, how did this guy just become a billionaire and his 90s. Well, I mean, he did all this incredible stuff for the past 30 years. Now. The good news is you can start that at 30 and be a ridiculously fit 60 year old and by the way, you'll be a ridiculously fit 90 year old as well.
Yeah, it's it's cool to hear stories like that because I think
we've turned such a corner with our understanding of health and fitness within the last even just communication about anything. It's emotions meditation history philosophy. Whatever.
But there must be a number of people especially like my parents' generation who feel a bit.
Miffed about the fact that God if I'd known this when I'd been able to hold on to my health as opposed to doing it now when I'm in my 60s that sucks, but you have this example of a guy who did do that in you know, what would be considered serious later life, especially for an athletic career to begin or a health and fitness regime.
And has shown just how powerful that is. Like that's I think that's very it's a very cool story.
Yeah, so he's he's kind of like the poster child for this centinary into Catholic that I love to talk about. Right? It's the it's the it's the mental model for what what I trained for what our patients trained for and what we really kind of care about
Give me a thoughts on Brian Johnson and what he's doing.
I don't know.
Have you been observing any of the stuff that he's done with blueprint with the supplements with the lifestyle with
I I try to ignore it?
Why?
I I just have no interest. Okay,
that's interesting. It seems to me. I I spent a little bit of time with them. He's been on the show and I spent a bit of time with him in. Um
Honduras and uh
I think he's kind of like the way I've come to conceptualize what he's doing for certain areas of the longevity movement is kind of like a scout in a an army. It wouldn't do to have an entire Army of Scouts. But I'm totally fine with someone doing something kind of experimental and maybe dangerous maybe not dangerous whatever and sort of going up to the you know, the rocky Cliff Edge and looking out over the top and then coming back and kind of telling us what they've learned. Um, but I'm both glad that I'm not a scout. Uh, and also I don't think it's necessarily in everyone's interests to also be 1 too.
But it's interesting. I asked him a question.
saying
uh, is he afraid of death given that almost everything that he's doing is focused on not dying.
How much from your perspective do you see?
the longevity movement overall and biohacking and health hacking and stuff being a kind of
rehabilitated death denialism fear of death movement
I don't know. I mean, it's a great question. I I because I don't consider myself part of that movement. I don't
I don't want to speak for it. I don't.
I don't really know. I it's probably best to ask those who firmly put themselves as leaders of the movement. Um, I know that
I'm probably just as afraid of death as anybody else. I I don't want to like represent that I'm some Monk here who's so at 1 with the universe that he can't wait to die. I don't want to die. It's and by the way, I think it's less a fear of death and more a fear of not being here. Like that's the part that we can't really contemplate. Um, because I don't you and I don't have a conception know nobody listening to us has a conception for what the world exists without that individual in it. That's impossible to fathom.
so um and the the the you know, the older you get and the more you
You know, you have a family or things like that and you fall in love with things outside of yourself you then realize well, actually what would bother me most about death is not being with my family are now hi. Yeah, so
That said I find.
The I find the focus on death.
avoidance to be futile and silly
so I don't believe there is any scenario ever.
In which we avoid death. I am 100% in the camp that says we are all going to die.
Doesn't matter how much biohacking you do. We are all going to die.
So can we delay that yeah, I think we can um, can we delay it by 100 years don't think so. Can we delay it by a decade believe so
But I like to focus on health span and I think that that's I think that's the the real shortfall of of uh, the Health Care system today is that it focuses so much on lifespan and it still does a lousy job extending it because it does it at such a low quality. But what I think is really good about health span is if you really focus on health span, how strong am I how much bone density do I have? How good is my V2 Max how metabolically flexible am I if you focus on those things you will get the lifespan benefits along the way but you're but you're but the health span piece is actually harder. So focus on that and you get the Tailwind of everything else.
How long do you think given what we have at the moment current human physiology current medical advancements all the rest of it. If someone threads the needle and manages to avoid any sort of big catastrophes. What do you reckon is the ceiling for
human longevity such a great question. I mean, we we know obviously to date what the ceiling is.
Right, which is just based on the longest lived human which is probably 123. Um, so we know from the study of centinaro live on average right like 2 decades longer than the rest of us, um, they still succumb to the typical diseases and and if they don't, you know, they're eventually just going to get pneumonia or something, right? So even if you don't succumb to a disease at some point your immune system and or Frailty ultimately end you um now I'm I am excited about some really cool science that I think can bend the Arc of those curves, right? So if you talk about Frailty sarcopenia and you talk about immune sinnis,
I think there's some very interesting therapies that will occur in our lifetime that could push those things back tremendously. So again, I don't give up hope entirely that there's a way to dramatically increase lifespan. Um, but I do find myself troubled by people who think it's going to happen on the back of like this supplement or this goofy, you know hairbrained idea like the the depth of science that is necessary to do that. I mean you are rewriting the entire
Epigenetic code to do that. Um like that that to me is the only way you can revert a cell back to its nascent self. So this is not like sprinkling a few yamanaka factors oskm on a cell and just you know, wishing that you're going to end up with a stem cell back there like no no no, no. No, this is very deliberate cellular reprogramming and we clearly don't have the technology to do this yet. But I it's plausible In Our Lifetime and then the question is how causal are those changes right that we don't know yet. We know they're correlative. Right? So we know what the methylation pattern and the epigenome look like on an old teac cell versus a new t-c cell
But what we don't know is did those changes caused the phenotypic change and if they did and they did a loan and we reverse it. Do we get a young
T-cell back again?
Yeah, so some super high dose of nmn or rapamycin or pick your compound of choice. This isn't going to be able to go in and and rewrite that code
know. There's no evidence that it will.
It's very interesting. Yeah, I am.
Um, I think a lot about
What people are trying to achieve with with the longevity movement? Actually, that's 1 question. So you mentioned before that eventually people.
So what is the it's funny. I I I really I don't say this to be naive but like I don't even I'm so
I don't pay attention to movements of this nature. Like what what is the longevity movement? Is this really a thing?
I'm pretty sure yeah, I'm pretty sure that our slash longevity is the biggest subreddit for people trying to extend their lifespan.
I may have misrepresented them. It may be healthspan. It may be you know, there will be some like very nice synopsis of it. It will be living longer and better or something like that.
Right?
Uh, but it's a movement of people that are biohackers Health hackers in 1 form or another many of whom will probably be massive
fans of your work, but you know, so so again if it's people who are interested in being healthier, but I I was thinking more about
this idea of like immortality and well, I mean, you know, Peter diamandis has this idea of longevity escape velocity that for every year that you stay alive. There is an amount of time that you your life is extended because of improved medical stuff and Longevity escape velocity is living sufficiently long during this period that's kind of like the Dark Ages or the back end of the Dark Ages of medical advancements so that you reach this period where you're actually able to extend it infinite sure. Um,
So that's a question. I've got you mentioned that people.
In these blue zones or you know people that sent an Ariens super long lives eventually, they succumb to something. Yeah, is there such a thing as dying of just old age or is does everybody die of something?
Well,
look there are some people who we would just sort of say they just died in their sleep and there was nothing really obvious wrong. So we yeah, what what is that? Yeah. I don't know. It's could be an energetic problem right at some point there might achy, a literally stopped producing enough ATP for them to to to to to respire. Um, but you know, I think top death. Yeah, but I think honestly like I think many of those people are probably dying of a stroke or a heart attack and we're not doing autopsies on 104 year olds who die peacefully in their sleep. We're rejoicing them. We're thinking God. I hope I can be so lucky.
Yes.
Yes. Yeah. Yeah talk to me about the because remember even if you did an autopsy on someone who had a heart attack if you if you didn't catch it and like if depending on how long after the heart attack they die, you might not see any evidence of it in the heart muscle.
Oh, right. Okay, so you can show that that person could have died of it and you can show know
that was what caused it exactly. Right? So if a person is really really old and they have you know, quite calcified coronary arteries with lots of plaques. It's not entirely clear that you would find the exact place where they would have had a heart attack and um, whereas it's more obvious if someone has a heart attack and they live for a while because then you have a beating heart and a piece of heart muscle that's dying and you get a contrast between the 2 right. I see that's interesting. I didn't know that and again, like I said most of the time you're just not doing autopsies on these folks talk to me about what you
consider to be.
The basic supplements most people should at least be considering I'm aware that this is incredibly individualized but most people want to perform better have some good energy do well in the gym. So on and so forth. What are the areas in which most people should be at least looking at supplementation or the are there any at all?
I mean, I think most people probably would benefit from magnesium. So you have to then decide on which which ways to take it. Um, I did a whole podcast on this because it is complicated and you want to talk about the speed with which magnesium gets absorbed. Are you talking about organic inorganic? Are you taking it more for performance and avoiding cramping? Are you taking it more for GI regularity? Are you taking it more for cognitive, uh benefits. So all of those would be different forms. I actually take 3 maybe 4 different forms of magnesium. So you're I'm keeping track of both the total Elemental magnesium. I'm getting but more importantly the form I'm getting in and how I'm kind of titrating each 1 to these benefits and what are you going for then?
Um all of the above, right? So it's it's it's GI function. It's what muscle function which ones I'm taking. Yeah. So slow mag is my favorite for uh, as its name suggests slowly absorbing magnesium. So, you know minimizing any PVCs and cramping basically for a person like me who's very active sweats a lot, you know live in Austin. Uh, yeah, then I take uh magnesium, uh oxide which is kind of more the GI version of that and then I take magnesium L3 and 8, which is the cognitive part of that. So that's the 1 that gives you better cognitive absorption. I'm trying to think if I take a fourth 1
I probably have some magnesium and something else I'm taking but those are the Big 3. Okay magnesium. Yeah, uh creatine monohydrate at 5 grams daily in I use again. I don't think it matters when you take it truthfully, but the most predictable and routine time for me to take it is during a workout. So just mixing it in with electrolytes and water and drinking
put it in with something else that you're already drinking
exactly. Otherwise, I'll forget to drink it.
Uh, I can't remember.
Was it I think it was Tim Ferriss who was talking about, uh, some benefits from much higher doses of creatine 10 to 20 grams a day. Have you looked at any of this? Have you seen any of this stuff?
Uh, yeah. I mean look when I was a kid, that's how you do dosed it. You would load it. You would do 30 grams a day for a week. And then you go 30 grams a day for a week and then down to 5 a day. Now my last look at this literature said that was not necessary at all and taking 5 a day you'll very quickly get to your saturation levels and you're totally fine. Is
there a size of human for whom if you're 260 pounds? Should that be a little bit more? That's possible. I I and
if you're
120 pound woman 110 pound woman, maybe
would you keep it at 5, I mean I do and and the only time I sort of tell people to dial it down is if they get GI
upset from it, which some people do
Okay magnesium.
creatine, um
I think a lot of
people probably could use a little bit of help with methylated B vitamins,
maybe
some TMG. Um again, I what's TMG trimethyl glycerate, which is um,
Basically, we would use these to titrate homocysteine levels. So if a person's home assisting levels are elevated, um, you can basically get their homocysteine levels normalized with methyl B vitamins now there we don't really have trying to think.
We have 1 study that speaks to the efficacy of that for brain health. Um
But by but but but we're what we're doing is using a proxy which is we know that homocysteine levels when elevated play a role in at least 2 diseases right dementia and dementing diseases and cardiovascular disease. Um,
And so by you know asking the question if you lower homocysteine levels, do you address that you're asking the question indirectly is homocysteine causally related to those diseases or not. Um and looking at the neurodegenerative side, it appears more likely that it is and there's a very clear mechanism for how homocysteine um could be causally related in cardiovascular disease Visa V its impact on endothelial function and endothelial health, but I would say that that's like that's kind of a soft recommendation. Um, I've got 1 copy of
c677t
or whatever. Yeah. I I I I I you know, how many people I've met in my life who have the wild type for both MTHFR genes
And you have to keep in mind how many people I've looked at in the past 15 years. Um, I've seen 2 people that have the wild type so everybody has a has 1 of the Snips on these jeans. They're they're I don't I actually think they should be the wild type truthfully.
I don't even I think we've got it backwards. Well we had to when we for we recently did a reformulation of of newtonic the drink and uh, I was like guys, can you just check we're using natural folate for this right? Like yeah. We are I was like, we're using methyl cobalamin, right? We're using methylated B12. Yeah, we are but you just don't realize how many especially if you are thinking about homocysteine levels. If you're thinking about how you're taking B vitamins and you're not thinking about that. It's totally not. Oh this could be like folic acid or this could be the non-metal at version of of the B vitamins really interesting.
Um, I take Thera human.
What's that? It's activated cumin cumin. Yeah. It's basically a a
more liberated form of curcumin. So more bioavailable liquid. No capsule. Yeah. Okay. What does just more expensive? Uh, good question.
I don't I don't remember the dose. It might be 300 milligrams, but I'm not sure.
Okay. Um.
It's amazing for how often I'm asked this question. You'd think I would know this better. Um.
mg
There there's other things. I just don't recall them
magnesium.
Yep
creatine.
Methylated B vitamins if appropriate to bring homocysteine in line.
Yep.
Procurement
therapy human special curcumin. I used an absolute ton of cumin when I erupted in Achilles 4 years ago and uh, I went through playing Cricket the the British way and um, uh, I just threw the kitchen sink and it was coid. I had nothing else to do. Uh, so I asked every person that I could how can I keep inflammation down? How can I so, uh, TB 500's uh bpc157
Every tart cherry juice like any waving Sage over the top of it making a incantation at the full moon all of that stuff. I did all of the things and uh, the recovery was actually actually actually really really good. If anyone ever considers blowing out their Achilles doing it during a pandemic is actually a really good time to do it because there's nothing else to do and I grew it back
nicely. It's probably the injury, I'm most afraid of its
12 months of
Full very intense. So do you have a sense of why it happened?
So I went back to as many people. I mean this should be a
Public Service Announcement, if you used to play a sport when you were in your teens, and you're now 35 or something and you think I'm going to pick that sport back up.
Very very slowly reintegrate it. The number of friends that during their teenagers played basketball and then decide to go and play basketball now that they're 34 and they've spent the last 2 decades gaining muscle in the gym and
They're nearly twice as heavy as they were when they played this and within the first couple of games they blow out an MCL. The number of friends. I've had it's like a list of friends that have done this just in my friend group. Uh, and for me I was
Did 1 training session to play cricket?
Performed sufficiently well during that session that I got invited to play on Saturday. And then with a very limited warm-up as normal sort of Club Cricket is uh stepped out to bat and was I mean so much fun. It was great. The Sun was shining. My dad was over the far side. We slowed the halt of wickets that we were losing and I was like, this is the first time I've picked up a bat apart from the net that I did on the wedding day. This is the first time I picked up a bat in over a decade and I'm like 35 not out. I'm playing really good shots, and I just
Pushed a single through the covers on the right hand side and set off to run and then as I I felt something weird, did you hear it? No, but there was shouting at the same time, uh from the the players on the the Fielding team and then as I went to put my right foot on the floor it was like if you tried to step on an inflatable water bed on water and it just went like that and then the bastards ran me out. So while I was laid on the floor like this in the middle of the in the middle of the pitch, they went and picked the Bales off which meant I didn't get like a uh, whatever it is an injured like DNC did not complete or whatever. Uh, they actually ran me out which was fine. That's okay. Uh,
I think the reason that it would have happened was we'd done shuttle runs on the wedding day. I wasn't doing a massive amount of like high Pio stuff. And then when I set off you're wearing spikes on a very hard, uh surface and it's digging into packed dirt, which is what the strip is that you're bowling on and I pushed this shot through the covers and then set off with my back foot heel would have been a little bit off the ground. So calf would have been lengthening as I'm Contracting and then it would have just hit the floor and went and that was me for you know, 12 months, uh, 13 days and then got
Uh, did you have a complete tear
ya full Detachment fold Detachment? Yeah, so got carried back over and I knew Within
3 seconds. I was like, I think that's what that is. And I just I didn't know enough about it if I'd known more about it. I would have been more scared. Um, but on the flip side of that my uh, calf strength now and Mobility, I've got really insane dorsal flexion, but for anyone that does do it or anyone that's done it recently. Yeah. It's going to be a long rehab or if you if it happens in future. It's going to be a long rehab and it's going to so I can you you're going to feel a little bit unhappy about it. But my function strength power everything is back to where it was including muscularity. So if you looked at my
you totally symmetric
I overshot it on my right on the 1 that I busted and then had to go and do more work on the left because I built that 1 back up and um, yeah, I think good rehab plan take your time getting back to it and within 12 months you'll be doing everything that you were able to do and within 2 to 2 and a half years. You won't know that it's that the only way that you can tell is if you look or if you give
Switch because it's it's a like a girthy. It's a girthy boy now but um 1 of the things you haven't mentioned is Omega-3s. Oh, thank you. I do take that as well. I'll keep you right um talk to me about
anything else. I should be taking because you're going to remind me.
Um, Rhonda Patrick is on the show big on Omega-3s really took me through some interesting stuff to do with uh, ethyl Esters versus the reactivated version.
Yeah, tell me I used to know this and I have
I don't know it anymore.
What are you taking?
I take Carlson's. Um, I think there are a couple of Brands out there Nordic Naturals Carlson. I'm using that that are pretty good and I've gone back and forth with them and then we you know, you test your levels to kind of see where you're getting the most bang for your um By Buck. I don't mean dollar but how many of the things how many of the horse pills do you have to take?
Do you know? How many are taking today?
I take 3 of
the most potent 1 that they make which I think is called.
Elite or supreme or something like that?
Whatever the most expensive 1 is
presumably yeah, but it's got the most EPA and DHA in it.
Are you timing that particular is it with a fatty meal?
Um, yeah, I I I mean because I'm my compliance is the most important thing. I have an AM and PM slide of of things that I take. So I think I take 1 in the am2 in the PM or maybe it's the reverse. Um, so but the the point is I just know what I'm I used to take 2 and 2, but I've titrated it back a little bit. So I'm doing it based off what the EPA and DHA levels are in the red blood cell in the membrane.
Yeah. Yeah.
Yeah. It's uh, and I'm sort of trying to keep it between 10 and 12% It's just for me.
Cooking seafood
at home. It's so rare. Like it's the it's all of the other thing red meat ground beef even liver is more likely to do that than for me to actually think. Ah, I should buy salmon and I should it's just 1 of those things. That kind of doesn't really appear to me now often try and do it when I go up food 1 thing. I've fallen in love with over the last year is oysters, dude. I love oysters now, I've become this is what being an adult is you drink coffee and you have Oysters. Um, but I've really enjoyed that but at home, it just doesn't Factor. So for me supplementation when it comes to that I think is probably really important. I think so 1 of the other things that people are quite obsessed about at the moment is water quality.
How long a Believer is this? How much should we care about water quality and what is being
transported in and stuff like that?
You know, I think it probably depends on where you are and what the risk of contamination is. Um,
uh, you know, I mean, I think I take reasonable steps to ensure it but I'm also not so obsessive that my life spirals out of control around it. Now that said, I mean we have we have a couple of reverse osmosis filters in the in the house aquatis. So, um, I don't know but I know that they meet the standard for filtering out all P fast. So there's a there's a filtration standard that you have to go by and it plumbed in or tabletop other plumbed in cool. Yeah, that's cool. Yeah, so it's easy peasy. So all change it once every 6 months. So yeah all water bottles are you know, we use glass water bottles. They're all filled out of those things and you know, the coffee pot gets filled out of that thing. So the only water I'm drinking out of the tap, that's not that is in the bathroom when I'm brushing my teeth, um and taking my pills before bed or whatever. Um,
So I don't think I obsess over it. I you know, I I think that the 2 most important things you can do to avoid Pas from a drinking perspective. That's pretty fast for the people that don't know. Yeah. So there are these chemicals in Plastics. Typically that um, I think we could make a safe case for um, having negative Health consequences. Um, now they're found in things like Teflon and fire resistant, you know, clothing and things like that. So they show up in other areas, but for most people the the dominant exposure is through drinking, um water in a plastic bottle.
um or contaminated City water if you drink it and
You know, I haven't had our water tested but I just sort of assumed like why bother testing it why don't I just put the filter in that gets that is known to get rid of it.
Yeah. I had Dr. Shanna Swan on the podcast. She wrote the book countdown, which is tracking sperm Decline and testosterone levels as well. Yeah of the Decades, uh, mathematician turned closet epidemiologist, I suppose and uh, she was fascinating and her stuff is is pretty scary. Uh, the impact of this 1 of the things that I didn't realize is, you know, you you talk about declining testosterone levels and you think men but it's women sure as well in a big way, uh, and maybe in in some ways given the fact that you've just got the adrenals creating a testosterone for women, you know less margin for error in some ways too. Um, and she attributes it to plastic. So I'm assuming endocrine disruptors a lot of microplastics. Um, what are your Foods being transported in? Um, you know, she gave me this. Um,
Really interesting example of people who get maybe raw milk or something like that and it's in a glass bottle. It's from a farmer's market. It's like was it manually pumped or was it pumped through a machine? Because that machine has got BPA in the pipes and the milk is warm because it's out of the animal. So you're pulling the BPA from the pipes into that even though it's organic cow grass-fed open pasture, but no blah blah blah blah blah blah, but okay, what's the transport and it's just
a Minefield to try and weave your way through um
I mean 1 of the big ones for her and this was you know, me and my entire twenties hot food in plastic Tupperware. You know, I'm doing I'm doing meal prep. I'm eating healthily. It's like you just put
baking hot food into and there's no bpas in it. Yeah, but it's like bfc's or its BPF C's or whatever the you know replacement was that they did for that. Uh, so yeah, she's got
A big protocol that you kind of follow with regards to that but I think it's a big deal. I think the endocrine disruptor thing is a a really big deal.
Even if you don't talk about like hormonal birth control being peed out into the water supply and stuff like that. There's you know, even the way that it is transported to you is something that you should be concerned about as well.
Have you looked at the psychological impact of hormonal birth control on women? Is this something you've done much research on?
Um, I have not looked at the psychological component of it, but obviously the downstream endocrine component of it we deal with a lot in in our female patients. Um, especially as they you know, those who have been on it for a long period of time who are then becoming per menopausal and as you're transitioning them to HRT, obviously 1 of the uh, results of long-term, um, oral contraceptives is a significant rise in shbg. So as their sex hormone binding globulin goes up and up and up and up. They're free androgens go down for a given level. So you you kind of have this issue where even if they you normalize their testosterone or estrogen they might actually be physiologically experiencing less of them. So that's you know again, but definitely not something I can consider myself an expert in
the
uh, Doctor Sarah Hill wrote a book. Uh, this is your brain on birth control. She's an evolutionary psychologist. But um,
It's really wild. I I think.
A friend has a a great question, which is what is currently being ignored by the media, but will be studied by historians. It's a nice frame of what are we kind of overlooking at the moment and I really think that
Hormonal birth control will be 1 of those things that um, there was a recent.
Scandinavian study
that looked at you know, we've got this declining female mental health problem, especially among young girls, like 40% of American teenage girls have persistent or regular feelings of hopelessness. It's like this real macab apocalyptic sort of language and um, I always ask this question because I had Jonathan Hight on the show and he was social media and comparison and blah blah blah.
But as like how has anyone factored in the base rate of what increasing levels of hormonal birth control usage has done to like how much can this be contributing and this
and has that changed significantly since 2010?
Maybe that's that's what needs to be looked at.
But because that's really I mean, I think the argument in favor of Jonathan's argument is that when you look at the total takeoff or nose dive if you will of mental health for specially girls, it coincides really perfectly with the exact introduction of you know, Tik Tok not Tik Tok but Instagram smartphones and and and social media. So unless there was a different type of birth control. So the question is was there also
so 1 a birth control change great question. Uh, I think I don't think that there has been a change. I think it's anything it's going to be kind of like just a steady linear adoption of of these of these drugs, but what you don't know is is there some sort of predisposition some sort of psychological. Uh, um,
Raw materials that are more susceptible is this being able to magnify the effect of social media of social comparison, uh and Dr. Sarah Hills works. So I mean it's fascinating the the change that women have in the kind of partners that they go for both on and off of birth control, uh, the um level of testosterone that they prefer in a man's T-shirt at the same time the libido and the sexual, uh, not only libido sorry, uh, their level of sexual satisfaction with that partner, which also is indicative of partner choice and how effective that is and I mean you may or may not have heard these stories but so many stories of women who get into a relationship with their partner when they're on
get married decide that they're going to then have children come off and they're like
I'm not really that attracted to my partner anymore. You know, they sort of exit this.
Hormonal Fugue State and they're kind of eyes are open and it's not a comment on their partner particularly. It's just that they're in a a very different.
Hormonal profile now and what they find attractive is has changed a novel. It's wild. I mean the research is is really really interesting.
Interesting. Yeah, totally unaware of that side of things.
What about Sun cream? What's true about the
safety of sun cream. I hear a lot of demonization of it that it's dangerous that you can put it on your skin that it gets absorbed that it turns into all of these but then also
skin cancer not good. What's your position on
sun cream? Uh, I'm in the process of learning an insane amount of this for a podcast I'm doing so I would I would say
I have my thoughts now, but they're they're going to be updated by.
You know a team of
phds check out the drive in 3 months time
exactly. When when we get to do our AMA on this we're going to visit really 2 questions that are both going to elicit a ton of controversy there. So the first is
How clear is the uh role of the causality of sun in melanoma?
So again, that might seem like a stupid question to ask. Um, but the answer is not entirely clear. Um, so what is it about the Sun that increases the risk of melanoma is is the risk of melanoma increased for example in sun exposure that does not result in a burn.
Or does it have to result in a burn does it have to result in a severe burn does it have to result in a burn during a certain period of your life all of this is unclear. Um, it's a lot more clear the relationship between Sun and basil cell carcinoma and squamous cell carcinoma. I don't know what that is. There are 2 other types of skin cancer, but they're non-lethal because they can't metastasize. So, you know to be afraid of skin cancer really means to be afraid of melanoma. That's the 1 that can kill you. Um
And so that's going to be the first part of the podcast is really exploring that relationship. And then the second is going to be the Deep dive on all of the all of the uh, you know sunscreens out there and so sort of mineral versus chemical and um, what what's you know to to the best of our ability to understand it? What's the what are the real risks? Uh, if any of of either these types? Yeah, there's an awful lot
of very vehement, uh, push in both directions. I think for this I can
yes, I I'm I'm we're certainly not doing this because we never do anything to sort of step in a pile of shit, but I I there's no question that this is going to be inflammatory. But what do you think what else would be? I mean, perhaps surprisingly,
uh talking about Sun cream, uh, like, you know real Hot Topic it's a, you know, a war zone out there. What are the other uh, really spicy areas that you might not have thought about. Are you start talking about pollen or something and it's it's a a real war zone but is there
Um, I mean anytime I talk about lipids and heart disease and uh dietary fats and stuff anything to do with diet. That's always that that always tends to be quite inflammatory. Uh, because of course, you know, anything that's diet related is sort of very tribal and and religious. Um, I think HRT is a somewhat polarizing topic though less. So now than when I started talking about it, you know when I really started talking about HRT, um,
most of the medical establishment viewed it as bad and dangerous and I think more and more the doctors are coming around to realize that you know, the Woman's Health Initiative was such a flawed study, uh that it's
You know responsible HRT is a great thing for women. Um,
uh, what else is really controversial?
Look, I think you know vaccines. I did a I did a I interviewed a guy named Brian deer and we went deep down the MMR causes autism claims and that's obviously a very polarizing and controversial topic. What did you find?
Uh, I can see absolutely no evidence that the MMR vaccine is linked to autism and instead. I see an incredibly fraudulent guy and Andrew Wakefield who committed, you know,
Literally scientific fraud to um confabulate data to to make that case. Uh, and it's an awful shame. Uh, like I'm not going to sit here and tell you that all vaccines are are great or that every vaccine is without risk. That's that's not the case. Um, but the MMR vaccine is a very important vaccine that's a vaccine that saves an unbelievable number of lives and an unbelievable amount of misery in children. Um, and it's a vaccine that's targeting a particular, uh set of viruses whose virya is indeed driven by the exact mechanism by which the vaccine Works. In other words. There are certain vaccines where vaccination actually impairs transmission right that clearly wasn't the case with Co um, so you could always make the argument that there was no public reason there was no Public Health reason to vaccinate people with against Co it was individual it was an individual reason that's not the case with MMR the nature
of how the virus spreads is indeed impaired. It's got kind of a tragedy of the commons type thing
going on. That's right. Yeah.
So, um,
And again, I mean just the entire topic of vaccines is so controversial but was it this controversial 5 years ago?
Do you are you
know, I I mean this particular topic was for sure. MMR model has always been has always been that
seems overall. It seems like there's you know, like vaccine skepticism.
Well now now I think it's been Amplified right? So I think that the CDC
Uh did itself. Absolutely. No
favors didn't shower itself in glory
know the the way they handled everything around coid has made it. Um,
has actually done a disservice to I think vaccine science and um, it must be absolutely
infuriating if you're a vaccinologist or
Trying to work on these, you know life's work. Genuinely. Yeah trying to do things to make people better to avoid illnesses to you know, like eradicate disease and then for the CDC to shit the bed in such a huge and and not just the CDC obviously, uh in such a huge way that well that that
that anything in medicine becomes political is a tragedy and it's you kind of would want to believe that medicine would be the last thing that could be political but you know just 2 weeks ago. I wrote a piece with our team for the newsletter about something that I never imagined Could Happen which was the American Heart Association deciding in what is clearly just a political kind of woke agenda that race will no longer be considered a risk factor in cardiovascular disease. So they're taking race out of risk calculators.
Now, you know in their defense I suppose their argument is that well race is a proxy for socioeconomic status. So, you know, but what they argue is that race is a purely social construct with no genetic component.
And this is just patently false. Um, and the you know, I could have written 10,000 words on this with all of the counter examples of where race is indeed a genetic construct and with it come risks and why we would deprive ourselves of a tool that allows us to better risk stratify people. Uh just makes no sense to me regardless of your political ideology. So unfortunately to see that medicine is also becoming corrupted by ideology is um is very sad, but not surprising I suppose
I had this idea of toxic compassion. So the prioritization of short-term emotional Comfort over everything else and what the
Ground Zero for this would be uh
body weight has no bearing on health and mortality. Um, well, you know, you don't want to make people who are overweight feel upset. You don't want to sort of activate in them this sense of oh, maybe I'm not maybe I'm going to die sooner or whatever but by not communicating that to them
They're literally going to die sooner like you run the risk of these people getting into all manner of problems because of this prioritization of short-term emotional Comfort over long-term flourishing the truth accuracy and the same thing goes for this. Yeah, the same thing goes for you know race has no bearing on your vulnerability to different types of Health outcomes.
I I have zero medical training and I know that that's false. I know that there's disparate outcomes for different disparate risk levels for different diseases within different race groups.
Like it it's wild it's really wild and the fact that you're starting to play about with People's Health. You know, I I don't think that this is much truth in the the accusation as uh, some people might want or that some people might claim but you know the doors coming off Boeing planes and stuff like that Bridges Dei diverse hires that are doing, you know, this isn't
commentating for the New York Times and moving culture with culture is not nothing either, you know people's beliefs and how they see the world is not nothing, but when you're talking about medicine and
airplanes and bridges and going to space
that's you're really crossing a threshold there in
the world. Yeah science and engineering really needs to be free of of anything that that puts.
Merit Anywhere But at the top and and Perfection of knowledge.
How
warranted is the huge Panic about processed foods in your opinion?
Well again, I think the devil's in the details, right the word processed is a bit of a troubled word because if not for processed foods.
You and I would be pretty different right now. Like I mean processing is what allows a lot of what we eat to exist. Um, so we you know, I don't know that
that processed foods
By itself inherently implies things are bad. There are lots of processed foods that are excellent Foods. What would be an example? Oh, I mean like, you know, you take like a a really natural form of like wild. I mean I'm being completely biased because it's a company I'm an investor and it's the first thing that popped into my head because I had it for lunch today was like, you know, our venison sticks right this company. I'm an investor in called Maui venison. So sorry for the we know we've got some other. Yeah, so, you know, that's that's a processed food. Right? Like it had to be, you know, dried and put into plastic and salt had to be added to it. Um,
so
But look that's a very healthy food. Now is it as healthy as if I had just killed that deer and just eaten that deer right there. Probably not and I could probably make a case for why it's not it's probably got more salt in it than it should or Etc and and those things are there to preserve shelf life. Um, but but that's clearly a processed food that I wouldn't put in the same camp as a bag of Pringles.
So, you know we can get into the secondary term of you know, hyper processed foods and and and we can talk about that. But but I still think it's better to just talk about things from first principles as opposed to labels that are mildly descriptive but not granular enough, um to provide real value. So to me, I would rather say, you know, a venison stick is more healthy than Pringles rather than say processed food is good or bad
understood. What about hyper processed foods is is that worthy of the the current moral Panic, you know, I don't
know. I I I mean again, it comes down to there are enough Foods in that category that are really totally garbage right? There's there's no doubt about that and the old adage that as you walk through a grocery store. Most of what's in the aisles is indeed garbage. Most of what's on the perimeter is indeed good. Um, and most of what's on the inside is processed and most of what's on the outside is not so
um
Look, I I feel lucky because I enjoy cooking I have the means to do it. I don't have to rely on processed foods because again, you know 1 of the things that makes processed foods. So appealing is not just
the taste but it's the convenience and the caloric density per unit dollar right? You can get a staggering amount of calories per unit, uh, uh, you know monetary unit, um at a great convenience, right? It's uh, so so
the further you can get away from what I call the the the the sort of standard American diet where it's with its 4 pillars, right which is you know has to taste really good has to be really cheap, um has to be scalable, right? You have to be able to do it at Big scale and it has to be really portable. And so the solution to that problem is processed food. Um, and the further you can deviate from those vectors the better. Have you seen this activist letter
against Kelloggs
So the guy called Jason karp Bill Ackman, um signal boosted this a couple of days ago, uh, this dude called Jason Kopp filed an activist letter against Kellogg's demanding that they stop selling.
What he calls inferior versions of the product in America, there's a red 40 and blue 1 and yellow 5 there's specific colorants that uh exist and there was this comparison chart and you heard what's in the Canadian version and what's in the American version and then why is it different?
According to him, um because it's not being enforced that there was a request made or that. Um,
so Canada stepped up and made a request for a better product. I I it should have been done based on
what I know. It should have been done. The board Kellogg said that they were going to get rid of these things in America, but they didn't and it seems you know all manner of conspiracy theories then ensue they're in bed with the FDA. Someone's being given a backhander. Um, this is indicative of America's total blase careless nature with the food that is being consumed by the you know, we pick your explanation of choice, but it seems that there are certainly colorants and some other um,
Ingredients compounds that are in specifically color, but let me ask you naive question like what
Kellogg's Product would you consider good for you? Anyway, like what Kellogg's products should we be eating?
I don't know. I don't know.
I'm not even asking rhetorically. I just don't know enough about their products but like it would be cereal, you know, a lot of children having these
Froot Loops and stuff like that first thing in the morning.
Yeah. I mean I again I I would I I don't mean to sound like a cranky old guy. But why would we want our kids eating Froot Loops in the morning?
Like I mean again it I know I just a moment ago said well, I can't it sounded like oh, maybe he's waffling on processed food, right? But I'm not waffling on a particular food
like
there, you know Fruit Loops might be a treat like for dessert but like on on on would you say we're going to start our day with candy because it's all it is. It's just candy that you add milk to you've got kids. Yeah.
What do you for the parents out there they
Oysters and coffee sadly for breakfast. Probably not going to happen. What do you feed your kids that satiates their desire for for their pallet
to be Bueno. But also, yeah, so when they do eat cereal they eat cereal that's a little less sweet. So they're going to eat Cheerios now, maybe Kellogg. I don't think Kellogg's makes Cheerios do it. No, I think that's nestled maybe yeah. So anyway, so they you know, Cheerios is kind of their cereal, uh, you know, they'll put berries in it yogurt applesauce again processed, but it's you know, you can get an applesauce that literally has the only ingredient as apples, right? Um, and that's that's what they eat. Um, is that typical breakfast? What's a typical breakfast? Oh bacon sausage like they eat venison. Um,
Eggs, like we make them little you know, like egg wraps toast, you know again like it's not like I'm I don't want to paint the picture that my kids are these little organic vegan machines like no. No, but but again, like what I just described is
I think a far healthier breakfast than you know, eating Pop-Tarts or eating, uh
fruits what are actively trying to avoid that sugar.
um
Yeah, I mean, I I I do think we try to be mindful of.
Sugar and crappy junk food and just limit when they're going to have it and how much they're going to have. Um, so my kids by the way, I mentioned it a minute ago, but my kids love Pringles.
so
They can have some but they're not going to eat like this many of them, right they're going to have that many of them because we buy like little mini packs of them which are not cost-efficient but like we're not optimizing for that right? We're optimizing for a small serving size where it's like 1 and done and dad's not going to eat it
this this. Yeah, that's true because once they've opened it it's now.
Yeah, there's a tube of Pringles. Like I'll eat it. It's the trickle down effect of right? Okay,
I didn't think about that. I didn't think about the fact that if you get your kids something that they like that's also something you need to deal with now being in the house. It's so interesting. I um,
It's also sometimes you just go out for stuff as opposed to keep it in the house. Right? So like you know, we we went yeah, we went out for ice cream the other day and it's better because you just go out you get it over with you're done you come home, but to have ice cream in the freezer every day would be a problem for me. Yes, I need uh,
Geographic distances the best discipline, uh for me when it comes to diet. What about
is there any truth or have you looked at dysregulation that comes from Wi-Fi networks and airpods and stuff like that. Have you have you looked at? Yeah, I've looked into this a little bit. I got to tell you. I don't buy it.
I I mean I
If if there is a signal it's a really small signal. I think this is a bit of a majoring in the minor and minoring in the major problem. I am amazed the number of times like I'll put up a post on Instagram where I happen to have my airpods in and I'm I'm giving a post about something meaningful like, you know, here's an interesting, you know thing that you ought to think about for exercise and there's always 10 people that chimed in I don't even know if I can follow you anymore the fact that you're wearing, you know those airpods and I'm like
First of all, I don't care if you follow me. So please unfollow me but like what is it like to go through life? So stupid where you actually think that that matters more than the fact that I'm trying to explain to you something that is in order of magnitude more important for your health like and I just feel bad that like, there are people again, it's just it's majoring in the minor and minoring in the major.
Yeah, I I don't know. There is an obsession there seemed to be certain.
Areas of Health that people love to lock on to you know, the specific type of artificial sweetener.
That goes into a beverage.
The the ionizing or non-ionizing radiation that's coming out of your airpods. The the Wi-Fi signal 5G towers that you live near and bits and pieces like that.
meanwhile
Show me your deadlift.
Right or show me how fast you can row a 2K
right exactly. Yeah.
It's like why
do you do, you know your almi and your VO2 max?
In Elaine Norton and I had this discussion once on the podcast which was like you shouldn't be allowed to even comment on these things on social media until you do a 100 push-ups.
like literally before you type it into your phone do a 100 push-ups and then get up and then you can type your stupid comment about my airpods or about this sweetener or about like just like
get it right get your Boulders in
place first, please Lane, uh continues to just pick fights with people on the internet. I'm I don't have the um,
Constitution to do what he does, but I love watching him just go to war and he's in the comments and he's fighting back in the comments and like hey man fed fair play. That's not my bag and I can't do
it. But yeah, he uh, yeah, I I avoid the comments at all cost. But I and I rarely even look at them, right so but but every once in a while like someone will like my team loves to send me the most ridiculous comments.
Um,
You should put them up. You could pin them on the board and have like a a wanker of the month a
wanker of the week.
Have that 1 for free be the same. Um
But yeah, the it's so bizarre the things that people hook themselves into very particular.
It's it's it's like an obsession and that's the thing. That's the thing. It's all Downstream from sweetness. It's all Downstream from whatever. You're like dude. I feel like you probably sleep 5 hours a night.
I think that you probably haven't processed. I mean you definitely haven't processed many of your emotions because I can see it. It's pouring out if you your
fingers I I have a friend who is so obsessed with these what I just basically call conspiracy theories of Health. Um, and at some point I was like how much how much time are you on social media a day?
And he's like, yeah, probably like 8 hours a day. I'm like, I've got a health tip for you.
And it doesn't have to do with the airpods.
Sleep 1 of the things that we haven't spoken about.
What are the most important strategy there's so much to do on sleep sleep actually 1 of the few places that doesn't seem to be too tribal. Uh, you know, like just sleep more maybe some people will argue whether you need to have magnesium L 3 and 8 or activate in charcoal or whatever whatever whatever whatever.
What are the most important strategies when it comes to sleep quality?
Um, probably regularity of schedule. So, you know, the closer you can be to going to bed and waking up at the same time every day. That's great, uh duration. So leaving room to sleep for a sufficient duration.
So in other words, you can do everything right? But if you're only going to give yourself 6 hours from the minute you get into bed until you have to be brushing your teeth in the morning.
You're only going to get so far. Um.
Then there's obviously the hygiene that goes into sleep. So temperature Darkness, uh and stimulation before sleep. So what what are you doing to get your brain ready to sleep again? I was remind people that sort of 3 factors that are driving this right. So you want a dentist to be climbing as high as possible you want melatonin to be climbing as high as possible and you want cortisol to be plunging as much as possible. So, what do you what what do you have to do to make those things true? So to make a denos go up you have to be active right? Like a dentist is the byproduct of activity. So the more active you are during the day the more your adenosine levels go up and then you have to say you have to you know, put that down right that's a sleep signal melatonin is driven by light. But again, you have to have the right circadian rhythm. So you have to be getting the right time and doing it at the same time over and over again, which is why when I was talking about my travel schedule, I have to force exogenous melatonin into the equation because I
I can't rely on the external cues, but that's why I don't want people taking melatonin. Regularly. I want them relying on the natural way to get it.
And then cortisol is probably the hardest 1 for most of us, even if we because the typical biohacker gets number 1 and 2 but you're we're sort of missing number 3, which is how do I actually get my adrenal glands to come down to let me actually go to sleep. And that's the 1 where again you can do it sort of with a you know, a pharmacologic or molecular ham Hammer which is what phosphate is doing. But again, I don't really want to have to rely on that every single night. I want to get into a habit of for 2 hours before bed not engaging in anything that's going to be stressful to me. So I'm not looking at my phone. I'm not, you know chirping on work emails and looking at things that are I mean, I'm really kind of trying to be
Doing very little that would produce and if I am doing some work, I'm not going to suggest. Oh, I'll never look at my computer for 2 hours that what am I going to do? You know, I'm going to do something. That's a little more relaxing or I'm going to you know, watch some F1 highlights or something like that. That's just pure Bliss but is not going to to to increase my level of of stress. Um,
And then we've talked about some of the supplements obviously that you can take their do you
I don't think you mentioned about your dose of magnesium.
Um, I take 2
of the L3 anatase, which is I think that's 166 milligrams is what comes into? Okay. I also use Trazodone 50 milligrams every night most nights. Um, great sleep aid. Um,
And that's that's that's no uh concerns about long-term use with trazodone know.
Not a dependency drug.
That's good. Um.
when it comes to sleep hygiene
room temperature cold temperature tends to need to drop or at least it seems to help you fall asleep.
If there is someone listening who is having struggle, uh trouble falling asleep the struggling to fall asleep and they're doing a 321 3 hours before they're not eating 2 hours before they're not drinking 1 hour before they're turning up screens. They feel like they've got a dark room. They feel like it's relatively quiet. What are the other places that you would look at if someone's struggling to fall asleep and then also if someone is having those, uh, breaches if they if they're finding themselves waking up throughout the night if you got any idea what that could be called.
Well if they're struggling to fall asleep, sometimes I ask the question. Are you going to bed too early? So, you know, there are different chronotypes of sleep. There are some people who are truly night owls and they you know, they're really not meant to go to bed until 12:00 or 1:00. And then you really need to be getting up at 7 or 8:00. And if you force that person to go to bed at 10:00 cuz their spouse goes to bed at 10:00. They might really struggle to get to sleep and and and I there's a term for that when spouses are on the different chronotype. Um, I forgot the name of the term but uh,
Unhappiness.
Yeah, um, I would also look to make sure believe it or not that a person isn't overslept. So this is not an entirely improbable scenario where you see somebody who
Is sleeping too much they have too much time in bed. And therefore they aren't building it up enough or or they take a nap during the day or something like that and they haven't built up enough sleep pressure. And so they're having a hard time going to bed. Of course. You also want to rule out things like caffeine caffeine inhibits adenosine by the way inhibits the adenosine receptor. So that's how for someone who's not like me caffeine is a wakefulness, uh compound so that those are the other things I'd be looking through on the checklist on is making sure when was the last caffeine are you if you're caffeine sensitive the half life is actually quite long 9 hours. Yeah. I think it's about 10. But yeah, it's I mean it's long enough that you can easily get into
trouble with it.
I'm what about if you finding yourself waking up throughout the night? Is that is that just the same?
Well, no, I mean I think that there in you know, the question is why are you waking up? Because you have to pee then if the if that's the issue then what do you do? You know, why is that happening? Um, if you're waking up in your ruminating honestly, I think the best tool for that is is cbti, um cognitive behavioral therapy for insomnia very powerful tool and then there's a whole set of behaviors around that right? So what what do you do? When should you get up and out and disengage from sleep altogether? When should you try to go back to sleep? And and so so we're very liberal in our use of cbti with patients who are struggling with that 1 of the
uh,
strange things that happen during Co I found myself going to the bathroom more frequently, like having a urinate more frequently and it's like
That it's probably nothing. It doesn't matter and then it got to what I uh ruptured my achilles and I was going in to see my GP I was like
The the classic male, I will accumulate a number of different like medical problems before I then decide to bring it up like thing and I was like, yeah, I'm um, I'm going to the bathroom a bit more than I thought I would immediately it's like I've got prostate cancer. I'm going to die and uh, the doctor turned to me and he was like you are the
fourth guy. I've seen this week that's come and said this to me.
I was like, okay. He said what I think is happening and he explained this I'd be interested to know if you noticed this too with your patients.
During Co everybody started working from home this meant that they were all at any time within 5 yards of the kitchen. They were probably caffeinating a little bit more because they could get themselves coffee as much which meant that they would just draining their bladder.
And going to the bathroom more frequently, who is there there is no boss looking over your shoulder saying you shouldn't go to the bathroom. So this is again, like kind of another public service announcement to guys. Maybe it's to girls too but certainly to guys if you're like, oh my God, like I've started having to go to the bathroom more and it feels like I can't I can't hold it in. Maybe I've got something wrong with me. It's like
This was exactly what I did. So I got put on a a a colonic, um to like release the I don't know how I'm sure you understand how it works like make you need to go to the bathroom less frequently. And then you retrain you do a period of retraining which I've now done and I full bladder capacity. Congratulations for me. Um, but for it took 6 months, wow, it took 6 months for me to do that to really get myself back to like, you know 3 Hour podcast like bladder capacity. Um, my business partner came over my but then business partner in The Nightlife stuff and I had my leg up on my thing because I was in Achilles recovery stuff and we had a 90-minute meeting and he went to the bathroom when he arrived and he went to the bathroom an hour later and I was like came back in and I was like, dude, I don't mean to
pry here but
you've been uh, you going to the bathroom a little bit more than you would usually like. Yeah. I'm really worried about it. It's like I think I know what's happening and sure enough he did. He did exactly the same thing.
So I thought that was just such a it's so funny how that you know draining like draining your bladder literally like this is a valve or something that sits above the urethra or whatever and it's like that hits particular amount of pressure when there's pressure in the bladder and it's like you need to go to the bathroom and you just drain that and it becomes like
so interesting. Yeah, it's totally unaware of that.
Yep. And that was the thing that happened, um on the other side of that though because I was on uh anticolinergicos
And it was brutal and it was like, you know, I love my thoughts being sharp and quick and being able to play with ideas and stuff. And I forgot the name of a British Seaside town called Blackpool. I forgot that for like 2 minutes during a conversation and like rummaging around in my brain trying to remember this place. That should have come straight up and that was scary because that was I basically kind of induced short-term cognitive decline, you know, like reversible short-term.
It was that was really scary to me and that kind of gave me a newfound. Uh sympathy for people that are going through uh,
Some kind of cognitive decline because it's it feels like there's a bit of you that's been pulled away and the thing that you use to fix the problem is the thing that's being taken from you. So the fact that you're you know, your cognitive horsepower what I'll search on the internet and I'll come up with a solution and I'll you know diagnose or I'll think about a a way to add this new strategy into my routine to make this better all of that the the raw materials that you build the solution with are the problem.
And the yeah, that was just a whole real interesting period like 6 months of my life where I was like, uh, I learned an awful lot during that time.
1 of the other things, I think that's a big.
At least for me, I'm focusing an awful lot on gut health at the moment. And this is like a whole other world for someone that hasn't been that reminds me of another
supplement I take which is uh pendulum probiotic. Okay? Yeah.
Probiotics
kind of in the crosshairs a little bit at the moment what?
What makes a good and bad probiotic?
Uh first it has to be alive.
Which
turns out to be much harder than than most companies appreciate. So, um, if you're making an which most of the probiotics need to be anob since those are the bacteria that you're actually trying to replenish in the colon. Um, so an Ane has to be manufactured in a in a completely oxygen-free environment, which is
Really hard to do. I mean from a manufacturing process. It's very difficult. So most probiotic companies when they make their probiotic with the best of intentions think they're making fill in the blank. Um, but when they, you know, kind of count the units and tell you we have this many cfus or Colony forming units, um, they're not actually checking if they're alive or not by the time these things get to you. They're they're completely dead. So, um, that's that's Rule Number 1 is you you have to actually, you know, buy it from somebody who knows what they're making and is
um as able to to verify with more sophisticated tools that you're actually getting a live bacteria, um, or at least freeze. I mean when I say alive freeze-dried and will come back to life when you ingest it.
Um, or we'll come back to a state of you know function. Um, so I think that's that's sort of Step 1 and then and then of course, you know, we're still very nent in this space and still trying to understand what to do. Um, the probiotic I take is um is really rich in uh, in a bacteria called armania, which plays a very important role a role in butyrate production. So butyrate is very important in metabolism and short-chain fatty acid metabolism glucose metabolism. Um, and um, this is a a probiotic that's actually been demonstrated in a small but but rigorous and blinded study to lower glucose levels,
Pence it's called glucose control.
Okay, what else should someone that's never considered gut health before be thinking about lots
of insoluble fiber.
This is this is the most important thing you feed your gut. So, you know for all the arguments why you know vegetables in particular matter. This is the most important I think and and I think there are lots of reasons vegetables matter. Um, but this might be the most important and it's the 1 that you can't get around.
Right, so you can drink a green drink, you know, I I love AG you love AG we can all drink those things and we're getting a lot of the vitamins that come in the vegetables and we're even getting the phytochemicals but you the fiber you can't get in volume in that you're not getting enough fiber you have to be able to consume. Um insoluble fiber to actually feed your gut. So I I think that that's probably something most people are deficient in what are your favorite sources of insoluble fiber, uh, I love salad stuff, right? So anything that goes into a salad so lettuce cucumbers carrots celery all that kind of stuff. Those are that's probably why I get the Lion's Share of mine.
Is there any truth behind this if you blend
Vegetables and fruits together it changes the way that it interacts in the gut and it spikes blood glucose and it you don't get the benefit of the fiber thing. Um, I don't know about that. The only thing I know
on that front is that bananas believe it or not might actually impair the absorption of other nutrients from other fruits. And so don't put a banana in a fruit salad. Yeah, or don't put a banana in a fruit smoothie might be yeah that that it's preliminary and it's a very small study but and I don't really drink fruit smoothies, so I doesn't really impact my life. But but if if someone's really in the business of fruit smoothies, I might differentiate separate the banana from the rest of the fruit.
What else gut health insoluble fiber big importance? That means rely on vegetables continue to have as many cups as you can throughout the day.
Yeah, I mean I I I think that's sort of what I I again, I'm fortunate right? That's the 80% Well, well no, I mean I I just want to be clear and say like I feel very fortunate. I've never had gut issues. Um my gut T tends to be very insensitive to things that I know can cause people a lot of gut issues such as wheat and dairy and things of that nature. Um, I'm impervious to those things. It doesn't matter but that said if you're not impervious to those things, then you've got to figure out what it is that is causing issues and sensitivities and get rid of it. And the only way that you can really do that is with an Elimination Diet. You can't do it with some stupid test that someone's going to charge you 600 bucks for that doesn't tell you anything. You have to actually just take the presumptive offending agent out run that to ground for a period of time and then
reintroduce it.
Um, I'm doing hardcore FODMAP at the moment. Yeah, and uh, it's actually not that bad. It's not that there's still loads of foods that you can eat on FODMAP. So I don't really mind all that much. I mean it
It's not exactly the most exciting diet that I've ever done, but I'm Holding On.
1 of the other things that
I was interested in talking to you about is motivation. So there's
All of these things that we should do and can do to keep ourselves living longer.
but there's other competing goals that we have as well and if compliance as you said earlier is 1 of the most important things then
you're you're playing this sort of this long game.
How do you think about the component parts of motivation and and compliance and sort of willpower to keep doing things whether that be from a health standpoint or from a work standpoint as well? How do you in my myself for an others and both?
Um
I think in myself, um
because I tend to be more.
Um rational mind that emotional mind. So in in in DBT, you learn about this DBT dialectical behavioral therapy, you learn about the synthesis of rational mind and emotional mind in something called wise mind and that's as you learn in DBT wise mind is the place you want to be like you're at your best because you're using the best of each of these components when you're in Wise mind, um, but different people obviously have a tendency to drift into more 1 of the others more likely and I tend to drift more into rational mind and all that means is that data speak to me more than feelings.
and as such
when I need to motivate myself, I tend to look at the data more but there's nothing wrong with that. There's nothing right with that. There are other people for whom the feelings provide the motivation and you know, I was actually having dinner last night with somebody and we were kind of talking about just that which is there are some patients who
Really?
All you need to do to help them understand why they need to do something is bring it back to their goals. So it's a very cognitive motivation. Right like you want to be able to achieve X Y and Z to do that you have to do a b and c and anytime you deviate from a b and c. I just remind you about X Y and Z again, that's me. Um, there are other people for whom the relationship with that practitioner matters the most they're trainer is the reason that they eventually want to be able to do this. So like they don't want to disappoint that trainer
and the stronger that bond is the easier the compliance is um
So again, I think it kind of comes down to knowing who you're talking to and understanding what makes them tick and then that's what you can basically use to to sort of help people. Stay motivated and compliant. What
about
Navigating an obsession with perfection, so as soon as you give people tools that they can use that is an ideal against which they can begin to measure themselves and they can feel when they fall short from a health perspective and the pain self-induced pain that you feel from falling short can then induce stress, which actually isn't particularly good for you in and of itself.
How how do you think about the Perils of over optimization and kind of not obsessing over those things
and finding that balance?
Well, I think it's very important and and obviously the older you get the wiser you get and the more you realize that um.
you know perfectionism is
uh, you know, potentially an evil master. Um, but I don't know I think people sort of have to learn that lesson the hard way. Like I don't I think it's very difficult to teach people lessons until they're in pain.
and they have to they have to kind of learn like
You know the cost of that is really high. Um and
Maybe I need to be it also it sort of comes back to what we talked about earlier. Right? I mean perfectionism is just another manifestation of uh, a maladaptive inner monologue.
So it comes back to how we talked about that which is if you want to resolve that you have to see the pain points. You have to be able to link that thing to something that is, you know hurting you.
Yeah, it's
it's strange to think about the potential negative externalities of perfectionism because
all of the benefits so immediate, you know, you take pride in doing things right paying attention being precise and caring about stuff.
think
all very good and the world will reward you for doing those things because there are people out there who either don't have the capacity or the disposition to be perfectionists in that way and that means that there is an entire blue ocean out there. But again like we said before what are the
like
what are the psychological costs?
look, I think they're high and I think I think this is a it's a
it is a dangerous addiction. It is an addiction like any other um, but as you said it's more societally rewarded and that makes it harder to Break, um, because they're really destructive addictions. You're not fooling anybody like including yourself. Like there's there's nobody in an alcoholic stuper who thinks this is really good. I'm crushing it. I'm doing so well right now and everybody is telling me how well I'm doing. Um,
That doesn't mean that it's easy to get out of that. But at least Step 1 is is taking care of.
You're
a big fan of compounding.
Over time of things slowly accumulating and accruing and stuff like that.
What is it when it comes to health and fitness, what is it that people?
How how can someone?
Who's in their 20s or 30s?
Made of rubber and Magic never had a health problem, you know like yeah, like, you know medicines for like other people and stuff like that. Probably they go to the gym. They probably care about diet but it's not got that real like I am investing for my final decade.
How can you bring?
that
stimulus that realization that investment like from the far future Into the Now, how can you motivate an idiot 20 or 30 year old person to care about this stuff. They have to go spend time with
people in those in those later decades. They have to they have to spend time around people who are where they're going to be and they have to see for themselves what that looks like and they have to decide for themselves. Am I going to be different than this? What and if so why like you, you know, the first order response to that might be? Oh, well, that'll never be me.
Well, why why won't that be you? What was this person? Like when they were 20, do you think that they were that different from you?
um, so I think the more time you get to spend, uh in the in the sea of old age the more you come to realize
yeah, I'm not that different like
and and by the way, I experienced this as well. Like I
I I remember even a decade ago.
You know people talking about what it feels like to wake up and be just kind of sore and just taking a minute to kind of.
as you're getting out of bed like you're a little stiffer than you were and
I couldn't really relate to it and now I can so it's giving me a little bit more insight into oh I can I could imagine in 10 years. It's even harder.
This is something that I've wanted to ask someone for ages and you're the perfect person.
There's a lot of talk and sympathy rightly. I think given to uh women aging so much value is placed on youth in women, but I do think that the discussion for men about how to age gracefully about how to kind of accept your slow physical demise. Uh, I don't really hear people speak about that much how
Have you got any insights here either for yourself or for your your friends or your clients or anything like that? Well,
you know, there's a couple things there. Alright. So first of all, there is a sort of I think there is an injust asymmetry there, which is I I do think um women seem to pay a higher price for Aging in terms of
Whether it's their view of themselves or even the world's view of them, right? I mean, let's take an an example in Hollywood, right? So
I think it's probably easier to be a to be a leading man for longer than a leading woman. I would guess that is true. There's probably data that could could could support that. So does that mean that female actors are not as good as male actors or does it mean that you know female actors are punished more for aging than male actors? It's probably the latter.
um
that said, uh, I think
You know.
I think when men are aging.
There might be different things that factor into it and and this might be 1 example, but I I wonder if more men deal with regret than women because I wonder if more men.
Engage in the kind of emotional stuff that we've discussed already today when they're younger and they they take into their older age things that they wish they did different whether it was with respect to how they were as fathers how they were as you know, husbands whatever the case might be and I don't know maybe that's wrong but I but I do wonder if that there are differences in aging between the Sexes that that come down to sort of certain areas of socialization as well as biology.
How can we as men?
Learn to deal with that decline, you know.
we
take pride in the mild time that we can run and the muscle mass that we hold and the leanness and stuff. And yeah, I think it's
youth is much more prized in women than it is in men.
But I think the conversation also accounts for that at least in part and that's it's written into the cultural sort of rhetoric around women and around aging. I don't think that this exists for men.
I don't know that it is but to your question about like how does 1 cope with the
The loss of Aging because there is loss. I
I tend to think about it through the lens of how I think about health span, right? So when when I talk about health span, it has 3 components.
Um, we've discussed them already, but I I'm explicit in saying them now, right? So there's a physical component a cognitive component and an emotional component.
2 of those 3
are going to decline as you age no matter what you do.
I don't need to tell you which 2 they are.
Can you alter the course of their decline? Absolutely?
Can you start at such a high high high place by working so hard in your 20s 30s and 40s?
And slowing the rate of decline that by the time you're 97, you look like someone who is 70. Yes, you can.
But make no mistake about it. You are never going to look like someone who is 20.
so
in addition to doing everything I can to do that. I tend to place more energy in the 1 that doesn't have to decline with age and maybe kind of rejoice in that 1 which is you know, when I was 20, I was an insufferable miserable self-absorbed prick.
and I am so excited to know that when I'm 60, I won't be
Now I have to work really hard not to be to be clear. It's not the default state that your emotional health will get better over time. You need to work your ass off at it just as you need to work really hard to maintain your physical and cognitive Health as you age, but the beautiful thing is you will actually increase as you age that emotional piece if you're willing to do the work and so
My view is do the work in all of them and accept that this 1's going down. But this 1's going up and to me that is true. Whether you're a man or you're a woman and therefore that is the single most important thing I cling to as I find myself having a little pity party over the fact that I don't like my body as much as I used to and I don't feel as smart as I used to feel and I hurt more than I used to hurt and I'm not as strong as I used like nothing about me today physically or cognitively is what it was 10 years ago. And if I told if I told you otherwise I'd be lying. Yeah.
But I'm a way better human being today than I was 10 years ago. And I know that I'm going to be a way better
human being in 10 years than I am today. What would constitute an emotional training regime for you? If we've got, you know V2 Max and Zone 2 and whatever for
physical health, what would the
emotional training regime be?
Well, it it really comes down to sort of the there's the therapy right? Like those are your sessions in the gym and then there's kind of everything you're doing in between it's the you know, the analogous thing would be being active when you're even not just in the gym and and the the lifestyle choices you make day by day. So it's um
How do I put into practice what I'm learning? So um
I don't know for I mean again, I I sometimes get embarrassed talking about this stuff because I I'm a little embarrassed to talk about what a what a horrible human being I used to be but um, we're all friends here. Yeah. Um,
You know just like I really take joy now in in being less selfish with the people like care about and and to think about how selfish I used to be like everything revolved around me my health my work my this my that um, and you know, like yesterday, for example, my my my wife who had a long run this morning a 17 or 18 mile run. She's training for the London Marathon. So she was she had a long run this morning and you know, she was like look, you know, can you go and pick up our daughter whose volleyball practice ends at it, you know 9:30 and then you got to drive her friend home. And by the time I get home, it's going to be like super late. And again, normally she does that and you know, and and that's just kind of like she'll do that pickup that night. Um,
And again, this doesn't sound like a big deal. So people are watching this are going to be like, what's he even talking about but in the past I would have like been like, I don't know babe. Like I just I think you just got to do it because I got too much stuff to do.
But of course it didn't even occur to me. Of course, I was like, of course, I want you to sleep like go to bed early. Let me go take care of this and I'll do this this this thing when I get home and I'll take care of it. And again, it's a very small example, but it's the practice. It's kind of putting into practice. Like, how can I be a better spouse because of you know, I I I don't want to be the selfish guy who the Earth revolves around. Um, so even though that's 1 very small trivial example that happened to occur last night it it's like looking for those opportunities every minute of every day and looking for ways to be a better dad or a better friend or a better son. Um, because Lord knows I've been so bad at those things for so long and and and and and now I'm
Really enjoying the opportunity to to spend more time with my parents in a way that I never did before because a they're not going to be around forever. But also
I know that it means so much more to them given that I have kids now too. Well, also you have this.
Degree of pride in knowing where you came from like you are and maybe I am to the emotional equivalent of a fat guy that got jacked.
you know, like look at how
Terribly I was the awful condition that I was in previously and look at all of the work that I've gotten to now and you're again the same as the dude that used to be fat that now is like bro. I did a I did a 5k park run this weekend and you're like well, you know compared with Elliot Koga. That's nothing. It's like yeah, but you don't know where I started its like going and picking the daughter up and not thinking about it and wanting to be there to support the wife. That's not that big of a deal. It's like yeah, but look where I started, right?
And uh, I'm learning that too. I've got I have a number of
patents. I'm also very cautious super cautious of like
this is my new toy and I'm now starting to see everything everywhere. I saw a tweet a little while ago that said, um, uh, I just learned about recency bias and of all of them, I have to say it's my favorite
and that's a great meme right
and like
no it's the Dunning Krueger affect characterized, right? Yes. Yeah.
Yeah. Yeah, and I don't want to see everything that I do as oh, there's people pleasing again or oh there there's there's you with your blah blah blah blah blah. Um,
But
it's fascinating and it really is.
an entire new
realm of life that I totally hadn't considered. Are you exper everyone's experiences emotions, but not everybody actually connects with them and certainly people don't connect with them on the level where they give them respect.
Right emotions are kind of this thing too many people.
Me as well in the past that were like an annoying it was like rain.
Like
if if they're negative,
yes, it's an annoying thing that kind of gets in the way and every so often it's a sunny day and you're like fucking sweet. Thanks. Thanks guys. Um,
But never actually connected with them. I was like, but why is it raining? What does it mean? And how can I work with this in a bit of a different way and why is it sunny and do I want this to happen more and what are the things that I do that and gender that?
Yeah. And by the way, you also realize if it's sunny every single day and it never rains. Do you really appreciate the Sun?
Yeah, I uh
I I had dinner with a friend a little while ago who?
told me about a girl that he'd started dating and he's
the super rational cognitive guy and she's like crazy just in her emotions, uh, both cultivated and natural disposition for both of them. So they've both like become more of what they are in some way and he said it was like a boxing a southpaw. He was having sort of he was coming from his perspective and she was coming from her perspective, but he asked he's like, you know as someone who doesn't feel things the way that you do said, what's it like,
She's like it's terrible and beautiful. I was like, there it is. It's like you just the gamut the the spectrum of experiencing things is so much broader, but I've been through a a a few strong emotions over the last few weeks and uh 1 of the things that it really made me think about is how little compassion so many people have especially on the internet like, you know, you see someone who has a public
Uh, they fall flat on their face in 1 way or another or you know, they do something silly or story comes out about them or they have a public makeup or breakup or you know, their ex partner gets with somebody new or whatever. It might be.
And like the way that people talk about other humans is so dehumanizing. It's like it's WWE or or a sitcom or something. You're like you do understand that on the other side of what you see as like a narrative Arc. Someone else has told you that there's actual humans fucking feeling things like in the grips of
a a a state
and
yeah, like
Guy at 36 realizes that people feel feelings like shocked. But uh, yeah, that was that really
it really sort of woke me up to was there something in particular that happened that you saw that that made you feel this made you realize this
not particularly just me me kind of being in this Arc and and really sort of sinking into stuff there wasn't I think the the Jonah Hill thing that happened about 6 months ago, uh was 1 of these Jonah Hill actor had a girl friend, they broke up and the uh, ex-girlfriend kind of released the messages online and it the argument largely centered around should she have released them was he in the wrong was she in the wrong and like it doesn't really matter about that bit. What matters is the fact that both of these people were wildly hurting they were showing it in different ways. And you know, was he being mature was she being immature blah blah blah.
But like just the way that people comment on this stuff.
Has no regard for the fact that there is a fucking human on the other side of this or like, you know, as a another good example love him or hate him. It doesn't matter Jordan Peterson a guy who went through hardcore benzo withdrawal for a year and a half and I like watched this unfold from basically a front row seat.
I wouldn't wish that on anyone I wouldn't wish that on anybody aceia flying to First. We'll go to Serbia, then we'll go to Russia then. We'll oh my God, just like in this.
Endless endless torture and people just at the time making jokes about Michaela's attempt to try and fix her dad or or you know taking like who is this man to teach us about responsibility in the modern world when he's addicted to benzos and he just fucking awful jokes. I just like it makes me think like how bad does your life have to be that this is the place that you get to that you speak about other people like that and I'm not I'm no saint. I'm not like brimming with unbounded empathy for people. I don't say things like that and it just really it really sort of reentered like a bit trying to think about a bit more Humanity as as best. I can I guess
1 of The Other Guys
That I've heard about Ray peat.
has a
a prescription or a piece of advice which is to take
Aspirin every day. Have you come across this? Is there something to do with blood thinning? Yep, and how legit is taking?
Aspirin 300 milligrams of aspirin every day or whatever it is.
Oh, I mean
that's been a well understood. Uh
A therapeutic intervention for folks that are at high risk, uh for cardiovascular disease. I mean, it's it's an interesting story because it's had um, it's 1 of those things where the answer or the presumed answer has changed so many times so, you know, there was a day when anybody would take aspirin for cardiovascular disease prevention and then it turned into well just very high risk and then it was well just high risk. Nope. It's just very high risk. Nope. It should be everybody and it goes back and forth and back and forth and back and forth. And what's abundantly clear is the following.
um
anybody is going to have a reduction in risk for cardiovascular disease by taking an aspirin or typically it's a baby aspirin, which is 81 milligrams.
a quarter of the dose
But there's also a risk from taking a baby aspirin and the risk is if you fall and bang your head you have a greater increase in the risk of uh hemorrhage.
Subdural or epidural Hemorrhage? And so the real question becomes who are the people whose risk of cardiovascular disease is high enough that the benefit they get.
Is greater than the risk of the bad scenario not skateboarders? Yeah. Well and the good thing is look skateboarders also are young and they have big heads and their brains don't slosh around too much when they fall and hit their heads. Yeah, right, but once you start to talk about people in their 60s and 70s and 80s and the brain atrophies a bit all of a sudden you're at a far greater risk for a subdural or sheer. You've actually got room in the you have more room for the brain to move how interesting so 1 of my patients who is on a baby aspirin for the appropriate risks was skiing 2 weeks ago fall Hits his head no concussion up back skiing. Everything is totally hunky dory.
But he's got persistent headaches for 2 weeks CT scan shows small subdural hematomas.
Let's stop the baby aspirin immediately and wait for that to get better and we're very lucky. We don't need a neurosurgeon to go in there and drain it.
So, um, even though you can buy aspirin over the counter, uh, it's not an entirely benign thing and it comes it has a lot of benefits and we put the appropriate patients on it. Uh, for example, another case would be patients with LP little a elevations. That's a type of lipid. Um, that's hereditary pretty common 1 in 10 people have elevated levels of it, maybe more and
You know their the risk of uh thrombosis from the hypercoagulable state induced by LP little a is greater than the downside of the subdural hematoma risk, which is small but not zero.
That's interesting. And what's the baby some people say, by the way that if aspirin were being developed today, it never would be approved.
Why
these risks?
Oh,
okay.
Yeah, so the mechanism of action is a aspirin inhibits platelet aggregation.
So what's that? What's that mean platelets are the type of cells in the blood that are partially responsible for clot formation. Okay. Yeah, so so aspirin impairs that by Design or as a as a side effect. That is its that is its effect. Yeah,
right.
Well, I I mean that's I mean it's an anti-inflammatory drug that does that yeah,
right, okay.
And this is so actually I think it's first indication was actually for pain.
Yes, I always think of it as a painkiller
rather
than as a something to make my blood flow more easily. Is there a risk of people bleeding out as well if they were to get some sort of like if you were a war fighter?
Uh, would you would taking aspirin cause your blood to bleed out more quickly? Yeah, probably although that's probably something that is more driven by
other clotting factors. Not the platelets. So clotted blood clotting is a really complex process that doesn't just involve platelets, but also involves a whole bunch of clotting factors Factor 2 Factor 7 all of these things and you'll typically see so hemophilia, you've probably heard of this disease is is a genetic condition where 1 of those clotting factors is deficient. Yes. Yes and every 1 of these results in a slightly different type of bleeding Disorder. So hemophiliacs contrary to popular belief are not at risk of like, you know, spontaneously bleeding all over the place, but they will spontaneously bleed into a joint more easily. Uh, I forget all the factors. I I can't remember if it's like Factor 5 deficiencies. They tend to get you know, you'll tend to notice if they get dental work. It tends to bleed a lot, um flossing their teeth it will even cause a lot of blood loss. So not a lot of blood loss but relative to what you would expect so
um
I it's I mean literally the last time I knew the ins and outs of all that I was studying for my med school board. So that's how long it's that's there was a day when I knew every 1 of these things but uh aspirin worked
on platelets speaking of that. I saw a tweet from Elon
Saying when seeking medical advice act ask your doctor, but also ask an experienced nurse nurse is underrated. You think nurses are underrated with regards to their Insight around health and stuff like that.
Yeah for sure
why
um again, it depends on the system. But if you consider a hospital for example, which is where you're going to most encounter a nurse, um, you know, like if you think back to when I was in a hospital, which was in residency, um, how much time was I actually seeing a patient?
Uh who is awake so because I was a surgical resident we were obviously seeing patients a lot when they're when we're operating on them. But when you talk about a patient post-operatively who's going to be in the hospital for a week, I mean, I might spend a grand total of 10 minutes per day with that patient and the nurse is with that patient for hours a day literally hours a day. So a really good nurse and not all nurses are good just as not all doctors are good, but a really good nurse, which is presumably what he's effectively referring to here. Um, you know, understands things and sees things and recognizes patterns, uh, very well and I know that when I was a resident anyone who was a good resident and I prided myself in trying to be a good resident. Um, you would very quickly figure out which were the nurses who you always listen to when they sort of said there's something wrong with Mr. So and so over there and they might say it it might be this or they might say, I don't know what it is, but he is not acting normal and I tell you more often than not like something would go wrong and
It's like, yep, you know what she's seen the pattern enough of his mentation status or the slight decrease in his urine output. And you know, lo and behold he's got a GI bleed and it's going to show up at 2 oclock tonight. I'm going to be sticking an NG tube down his throat and we're going to be running, you know, 5 units of blood in him on the way to the angiocath lab. So um, so yeah, I think there's a lot of truth
to it is that just front lines and that yeah, that's so interesting. I don't even think about that. It's crazy when you know, there's so much, uh,
It's a shame that there's a big nursing shortage in the US
is that
yes, absolutely. Why is so it's being met by, you know importing nurses from other countries, right? So we um, you know, we bring a lot of nurses in from other countries. Um, but look, I think it's a hard job and I think it's probably underpaid.
It's it's a hard physical job too. Like shift. Whoa
says any type of shift work is a health risk, you know, whether you're a firefighter or a nurse or a doctor.
Yeah. So, um, I just you know, but yeah, I think it's it's physically demanding. Um,
Again, you know, it's all there's so many different types of nursing is a very broad profession. Right? So, you know, you can do things as an outpatient nurse and in person inpatient, you know surgical nurse medical nurse ICU nurse. I mean, it's there's so much different stuff going on, but but it's not easy work and um, and it obviously has a lot of emotional consequences as well. How did you deal with that?
Um, I mean, it was hard. I think uh, I think the there were there were moments that CA that struck me out of nowhere.
Meaning I didn't understand why in the moment I felt so attached. I think there were probably 3 or 4 times during my 5 years of training when
You know in a in a way that I couldn't.
I couldn't have predicted an hour earlier. I just became completely overcame overcome with grief. Um as a patient died. Um, and
Um, I I again I don't I don't these aren't things we spoke about together. So I don't I don't understand like was that something that everybody was experiencing or was that just something I experienced but but there were there were a handful of times when I was really just absolutely devastated and it's not necessarily what you would expect it wasn't like. Oh, this is a patient. I've known for a year.
Um, I mean in 1 case, it was a and I write about this 1 case in the book. It was a it was a boy that I just happened to be the trauma chief that night when he came in from in a car accident, so I didn't didn't know him right but but you know, he died right there in the trauma Bay as I was trying to resuscitate him and
I can't I've lost track of how many people have died in the trauma Bay when I'm taking care of them. Like that's I need scientific notation to remember that number. It's huge.
But there was something about that boy on that night that was impossible for me to Fathom.
Um, so I'm not sure why I have a friend 1 of my best friends in the UK who uh,
Became a a F1 F2, uh, med student practicing, uh during coid. I thought you meant F1 F2 driver. I was like no no, no. No, I'm afraid not we would both of us would be Trackside if that was the case. Um, and he told me the story during Co of a lady who came in and when she came in she was a little bit short of breath and whatever whatever she called 1 1 1 or which is kind of like the slightly less intense 999 in the UK.
Got taken in.
And uh, he saw her.
And she was a little bit short of breath. Then he saw a 30 minutes later and she was blue and he saw a 30 minutes later and she was dead from when she'd come in the lady that he was talking to and that 1 really hit him as well. And he didn't I kind of the same as you he didn't know why he didn't know what it was, but he told me that story a couple of times and each time. He tells me it's kind of Haunting to just think that you know from
being someone sat in a
Uber or an ambulance or something and then 60 minutes later you're gone and it's it's fragile and uh,
It's a lot like the first death. I saw which I I think I also write about this in the book when I was a med student. I think it was my second year and uh, it was a woman that came in short of breath and you know being the med student I was sort of okay go and talk to her like this is you know, she's a little short of breath. She's probably having an asthma attack. Um, and what it turned out is she was having a pulmonary embolism and in the midst of sort of just sitting there talking with her she has a cardiac arrest and you know that turns into a full code which ultimately ends with me, you know being brought into to do chest compressions, uh, and and ultimately she died and it was again,
I it's it's it's it's 1 of those things where
I mean I had never seen a person die before.
And it's compounded by the fact that I had just spent 30 minutes talking to her. Yeah. Yeah this Contra this deceleration of
the liveness.
Yeah. I'm sitting here and speaking with this woman for 30 minutes who then
an hour later is dead.
Um, and I remember it was a Saturday night and I remember riding my bike back home from the Stanford Hospital which is on the north side of the campus to where I lived. I lived, you know on the south side of Palo Alto and I remember just driving my bike back. It's like midnight on a Saturday.
and
you know at the time I had a girlfriend who was an architect. She lived in San Francisco.
And we never talked about there was she had this kind of like she was skis out by Madison. So it's like our relationship was not at all based in talking about my day job or my you know my school. Um, and I remember being very upset when I got home because I really needed to talk to someone. She your girlfriend would be the likely person but I also knew it was like, yeah, she she's not the 1 who was going to hear this. Um, but I remember that feeling very distinctly of how upset I was and not and and not feeling like there was
someone to talk to about it.
What?
Do people gloss over in outlive that you wish that they didn't? What would the most unpopular important insights? You're about to hit full year on the bestseller list.
What you wish people paid more attention to in the book, but they're not.
I mean I I have to be honest with you. I first off I have been.
Completely and totally Blown Away by the response to the book.
And part of it has been the the number of things people have come to me and said that they've changed.
either change their mind about or just change their behavior about
And I through those discussions. There's nothing that stands out to me where people are.
You know, I I I I really don't know. I I think that the 2 things that are pleasantly, uh noted are 1 is you know, the the fact that there's 3 chapters on exercise I think was a deliberate decision just based on the volume of what I needed to say and I think people have taken that to heart. You know, I think people are saying wow, I thought I yeah, I understood that exercise mattered, but I now have a a much clearer path for understanding not just how much it matters but how to think about it comprehensively and then I think look the final chapter of the book and the epilogue which were you know, not
They were not something that was necessarily going to end up in that book. And I think if my publisher had had their way it wouldn't have ended up in the book. But I but I actually think that there's a non-trivial subset of the population who've read the book who say that that's maybe the most important part of the book for them and that it's opened their eyes to to the same sort of exploration. So look if it if it does nothing else, right if it doesn't change anything about the way you eat or sleep or exercise or think about heart disease or cancer or Alzheimer's disease, but it ignites in you kind of a curiosity along some of the stuff we've been discussing. Well, then it's worth it.
Then you could just save the time and jump to the last chapter.
That's a win. Yeah, let's say that you could only do 10 exercises.
For the rest of time. It could be any machine Any modality, you're trying to just wait exercises straight exercise cardio could be anything you can pay could be swimming. It can be cycling. It can be being on a bosu ball. It can be hanging therapy. It can be anything but you only have 10 modalities
and can we can can 1 of them accommodate multiple variants of it, like would a split squat allow you to do every form of a split squat. No,
no. No. The
rear foot elevated is a dedicated correct?
That's the those are the rules and you've got 10
What are you choosing?
Come on now.
the bike
Bicycle road bike. Yeah, cool
At just that you you can do different intensities on the bike. That's allowed. Yeah. Uh, but is that because
you get the big variation. It's around 2. I get my it's where I do my zone 2 and my VO2 max, so I'm going to get my full Suite there.
Yep.
Um,
boy, do I want to use up?
I mean for now I'm going to throw in rock and swim but I'm going to reserve the right to come back and say okay because that only leaves me 7 on yeah in the gym.
What would be the justification for Ruck?
Um, it's just a it's it's just so beautiful to be out there.
Carrying weight around it's also the most social thing that I do. So I love when my patients come into Austin and I can go for a rock with them. So, you know, it's it's whereas I I'm not going to go for a bike ride with somebody or swim with somebody and and and most people don't want to lift weights together.
What about the stimulus itself? Is there something specific to the rock is it to do with the fact that you're loading
joints? Yeah. No, I think it's it's it's it's great to be loaded without overpowering the joints. Um, and it's also great.
Training for other activities. I do like hunting where you're walking around and it's challenging and you've got a
pack on your back with a lot of weight in it swimming while swimming
even if it does get kicked out. Yeah, I think
you know, look it's something that's always been.
Near and dear to my heart with my background and um, I also think it's a great sport for life. Um, and so
It also is something you can really do. Well at multiple intensities so you can really kind of do easy easy peasy Zone too and you can do like the most crushing Soul burning intervals. Um, it's an amazing way to train your lower body doing kick sets till the point of like the burn the you know, it's just it's just a it's a beautiful whole body workout in a way that virtually nothing is maybe with the exception of rowing. All right 3
um
I'm going to go with a relatively new toy in my life, which is a belt squat.
So I very recently like in the last 4 months got this new belt squat machine and I
I have to say it is the greatest hip hinging device ever and it's it's really nice because
it's just you're not actually loading the spine at all. So I'm able to load.
My body with as much weight as I would have ever been able to tolerate in a back squat or deadlift without any of the axial loading. Um, so I that's definitely on the list who makes the machine.
Oh, I want to give them a shout out because I'm so happy with them. Um, and I don't have any affiliation with them. I think it's called.
Squat Max or something. It's a
guide plate loaded.
Yeah.
Yep.
It's a it's a it's a guy who's a former NFL player.
And I'm blanking on his name. I apologize. I wish I could give them a better job shouting it out. Hopefully you can link to it somewhere.
Yep.
Um, but I think it's called squatmax MD or something like that.
How comfortable is the belt? I've found a mixed variety this 1 is exceptional and I and I tried a couple beforehand. Yeah, it's I get bruised tips. If I get you know, you've got
some you should come over and try mine.
Yep. All right, cool. No,
it's cool. Cool. Cool. I have fantastic.
I adore the belt Squad. I'm someone with lower back injuries. And also I learned this from Dr. Mike is retell the um additional
At CNS strain that you get from axial loading, which is specifically through the spine and to be like, oh, I just get to completely kill my legs I can bail out.
Whenever I want I can go to failure as much as possible. I can get someone else to deload the bar or whatever the the plates easily so you drop sets. I can do all this stuff and you're telling me that I get to do it. So I'm all for that. Okay, so there's 4
It's it's going to have to be some variant of a split squat because I really love single leg stuff, too.
so it would either be
um a traditional barbell
lunge single leg just a walking lunge, uh step back. So yeah reverse lunge. Yep.
Or it might be a rear foot elevated split squat with dumbbells or kettle bells.
Yeah, I mean that's I'm and I'm gonna I'm gonna talk to the governing body and see if they're going to let me count that as 1 exercise.
I'm going to really push on the judges here. Okay? All right. Uh, I don't think so. I'm sorry. I'm afraid I'm afraid you're gonna have to make you're gonna have to make a call between the 2.
All right. It's gonna be 1 of those 2.
Okay.
Um, again, the advantage of those is is obviously, you know, legendary across the board. Also you want some axially loading right? You do still need to be able to to do that. So so again here we're doing it with a much lighter weight if I'm doing if I have a bar on my back, I'm not really going above 135 pounds. When I do that exercise.
Um, I love the walking lunges or reverse lunges with dumbbells because it just feels I'm so stable. I don't feel like I'm going to fall over it's good for grip strength as well, which is quite nice A little bit of sort of trap work. So yeah. Okay. So that's 5 You've Got 5 more.
Yeah. Um,
I would do I would pick uh
probably a dumbbell press
Like a bench. Yep, thumb Branch, press. Yep. Yep.
um
either a oh, by the way, if I do pull up I can do all grips right sure. You can go chin up and pull up from that
and neutral.
Ah, come on you really pushing the limits here. The governing body is going to have to meet and
give me 3 groups.
Okay. All right. So be it. All right. We'll do a 3 grip pull-up. Okay, um the squat of the back. Yeah.
um
How many is that? I think you've got 6 so I think you've got 4 more. Do you ask everybody this
question? Am I and does everybody take this long?
Yes.
Okay,
you're the the pain and someone asked me on a Q&A and I took even longer than anyone so I've asked Phil Heath. I've asked some of the greatest bodybuilders of all time. So everybody I don't think there's a single person that hasn't said dumbbell either bench press or incline bench press so that's like the 1 she got for it. Everyone's a bro deep down. You've got 4 more. Um,
good Lord.
I don't even know I mean.
I haven't even included any of the kind of rehab important moves that I do right? Like the I'm going to there that doesn't count. Right like if I'm doing DNS like Dynamic neuromuscular stabilization stuff where I'm doing like, you know, uh, like a i if you don't know this stuff the the positions won't mean anything but I'm going to say that doesn't count.
Okay. Yeah.
Okay. Um,
I would probably also do uh, a tricep extension. So an overhead tricep extension 1 of my favorites. So you have to obviously get humeral extension and then a tricep extension on that
tell you what's a really lovely variation that we've been playing with on our Saturday session is a floor skull crusher with small plates and that is just so nice held like this. No sew on a w bar.
Uh, oh, oh, oh I see. Yep. Yep. Yep. Yep, but just going from the floor just because I I've always felt a bit strange bailing out when you're on a bench. It's always a bit like yeah and if all that you need to do to bail out is just go to here and it hits the ground. Yeah. I've really been enjoying that but that I mean that's yep every guy ignores. It's just push Downs. Everything is push Downs or close grip bench. It's like dude get your fucking arms over you it's interesting. I think the literature is pretty clear on this isn't there a significant difference in tricep activation when you have humeral extension, correct? Yeah. Yeah. So I
I don't actually do anything that's not extended Now 1 there may be a benefit to it. But I obviously don't spend a lot of time doing arms as evidenced by my arms. But
1 thing that I did learn that was interesting like tricep kickbacks are kind of like they feel like a shit the shake weight of the upper body or something but that uh, Jeff nippard talked about this the fact 1 of the heads of the tricep only gets activated when the uh, elbow is behind the Torso. Yep. Um, so you can do this in a number of ways you could use a a a cable and again put yourself into this position, but then that actually is kind of important to get maximum contraction on
it. Is that interesting. Yeah. I never thought about that. All right you I'm not going to make the top 10 for me.
That's fine. That's okay. So you got 3 more
uh
a hanging, uh, leg raise
Again, probably at least 80% of people that have answered this have put that in as their app movement of choice. Yeah. Are you going uh to hang
I'm going with arms in and then I'm going to do I get all 3 sides right that that that counts as 1 movement, but don't even try to tell me that doesn't
I have to say of all of the people I've asked this question to you are the most litigious I the most needy but fuck the most fucking litigious. Okay 2 more
This is going to be a dumb 1 for most people, but I probably do a farmers carry.
Okay. Yeah. Yeah, I'll give you for this given that you're probably going to try and litigate your way through it. I'll give you both unilateral and bilateral for that.
Yeah.
Why?
Um, I think for me it's probably 1 of the best grip exercises as well and I like that um, and I appreciate getting the unilateral for free. Um,
I will tell you I would have accepted it. Even if I only could do it with a hex bar.
Okay, but
that's my I I like doing both but what I really love doing is I do this set once a week hexbear loaded up.
Pick it up 30 seconds of walking 30 seconds rest 20 times. So it's a 20 minute set.
and
you know, I I would like to see people of our age should be able to do that with their body weight.
Yes.
I've seen you talk and then obviously, you know, once you know, you you keep progressing through that and you know, I think I'm up to maybe
I don't know. I'm probably at 115% of my body weight now. Um, so I think a you're you're really getting some grip strength there. Like you're really, you know, when you get into that 15 16th set you're really feeling it. Um, but also you're really you have to have a stable core to be able to do that. You've got to be able to kind of control yourself. You're you're you know, you're you're getting great. Um, dorsy flexion, you know, everything is so much harder when you're carrying that weight. So I think that's a great exercise. It's also 1 of the exercises. I love doing as a it's a it's a great family exercise. So believe it or not. It's like it's on the driveway the swearing and sweating. Yeah, the kids are doing it with me, you know, they carry their little weights and you know their 1 kid's timing me and all that kind of stuff.
Okay.
So 2 more
No 1 more
I I feel like I'm just missing something so obvious.
It's almost like I need to see other people's choices.
Is it bicep curls?
No, I thought about that but it's like do you really waste 1 of your 10 on that? That's true. You've got pull-ups
same as calf raises. You've got you've got no direct shoulder work, but if you're doing bench and then you've got your holds. No, you know what? I'm going to take a seated calf raise.
Seated calf raise for the number 10.
Yeah.
Why?
um
First of all contrary to popular belief a seated calf raise does still hit the gas drop so you are still strengthening the Achilles as well. Um, and maybe maybe I would change that to a standing but I think the seated you can load so heavy and I really think that a strong Soleus is a healthy lower leg.
Just think it's I think it's just a way of life. Um, so yeah, I'm going to bring that in at number 10.
Hell. Yeah, Dr. Peter here. Ladies and gentlemen Peter. I really appreciate you. Thank you for joining me on the first ever 1 of these that we have done for the people that are just listening. We have been cycling through a western landscape on a virtual video wall and then a a museum Atrium complete with moving dinosaurs, uh for the last 3 and a half hours. Uh, I really appreciate you mate. I love your work. I love the fact that you're diving so deep and making this stuff accessible to people what should everyone expect over the next few months coming out from you and your lab and the stuff that you're doing.
We've talked about a few of the things. So I think I'm I am excited about this sunscreen thing. Uh, the sun. Melanoma sunscreen thing is an important 1 that we're going to do. Um, we're introducing something new to our podcast which is going to be quarterly reviews. So we get a lot of feedback. Hey Peter love your podcast can't keep up Man 3 hours a week of super deep diving into stuff. I need the tldr. And yeah, we have great show notes and all other stuff. But what I do, and I think you do the same thing.
Every time I finish a podcast I make notes. So I usually I have these cue cards these 8 X5 cue cards and I write down the most important things I learned and I've been doing this forever and there's like a huge stack of these things sitting in my drawer that nobody's ever seen. And so I kind of mentioned this to my team 3 months ago and they're like
tell us what's on it. So we had a call and I read them the last 3 months cue cards and they were like, dude.
That's a podcast into an episode. That's an episode once a quarter you come and read your cue cards because it's what you found the most interesting and how did you change your behavior as a result of what you learned? So we'll be introducing that
in Q2 as well. That's awesome. Uh, why should people go don't want to keep up to date with what you're doing.
I think our site is probably the best place Peter attia MD or early medical.com.
Hell, yeah Peter. I appreciate you. Thanks so much for having me.
