Peter Attia (on longevity)

[0] Welcome, welcome, welcome to Armchair Expert, Experts on Expert.

[1] I'm Dan Rather, I'm joined by the Duchess of Duluth.

[2] Good afternoon, sir.

[3] How are you?

[4] I'm good.

[5] Listen, I have a very exciting announcement for the 12 people who have reached out to me on social media.

[6] As maybe people have seen Ted Seeger's, we drink in the attic.

[7] We do.

[8] We have a full keg.

[9] We got a keg -rater.

[10] It's glorious.

[11] And a lot of people have been asking, where can I get?

[12] get Ted Seegers.

[13] And I can finally tell all 12 people that if you go to Tedseegers .com, it'll tell you a list of the retailers in Michigan.

[14] You could go and buy it in person.

[15] You could go shop in the store and pick up a six or a Ted Seekers.

[16] Or you could order if you're in one of the states that allows us to ship non -alcoholic beer.

[17] You can order direct -to -consumer.

[18] Okay.

[19] So you can get it in other states.

[20] That's right.

[21] There are a handful that don't allow that.

[22] Okay.

[23] And you should move out of those.

[24] states if you live in one of those states.

[25] Yeah, sucks for you guys.

[26] Well, state will know Ted Seeger's?

[27] Yes, Ralph?

[28] Yes, it's Ted, T -E -D, and then Seeger's S -E -G -E -R -S.

[29] Ted Seegers .com.

[30] Go there, find out where you can go get this limited run of six -packs or order some if you live in a state that knows how to party.

[31] It's also, in case people don't know, it's your non -alcoholic beer brand.

[32] It is my non -alcoholic beer brand that I have created with two of my best friends from Michigan Aaron Weekly and Aaron Tyrell.

[33] Best friend Aaron Weekly and Aaron Tyrell.

[34] And it's really good.

[35] As someone who likes alcohol, I can say it's really good even without having alcohol.

[36] And he didn't agree to be an ambassador, but I do want to mention that Michael Shannon, when he had a pint of it in the attic, he said, they should serve this in the schools.

[37] Yes, he did say that.

[38] So I can't think of a bigger vote of confidence.

[39] Okay, so go to Tedseekers .com if you want to get some Ted Seegers.

[40] There's also a little bit of merch available too.

[41] So anyways, limited run.

[42] You could pre -order for our next batch.

[43] Go there.

[44] It's a fun time and just go and read it.

[45] You'll laugh even if you don't order anything.

[46] You'll cry.

[47] You'll be reunited with loved ones.

[48] Okay, but today's guest is incredible.

[49] We're obsessed with him.

[50] Everyone in our world is also obsessed with him.

[51] Peter Atia.

[52] Peter Atia knows the human body.

[53] He's one of the guys in the crew of like a Huberman.

[54] Lane Norton.

[55] The guys who are obsessed with optimization but have a lot of science behind them.

[56] Yes, Peter was a surgeon, a doctor.

[57] He also did statistical on risk analysis for a big insurance provider.

[58] He's a genius.

[59] And he also hosts a podcast and he's a best -selling author.

[60] Everyone I know is reading Outlive, myself included.

[61] It's fantastic.

[62] Outlived the science and art of longevity.

[63] And he has a great podcast called The Drive where you can hear him talk to people like Lane Norton for several hours and get into the weeds.

[64] Please enjoy my new friend and my hero, Dr. Peter Attia.

[65] Wondry Plus subscribers can listen to Armchair Expert early and ad free right now.

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[67] Or you can listen for free wherever you get your podcasts.

[68] They record another show in here Monica sits here And she likes a different headset volume But it's actually, it's good We haven't been in here forever But I bet you were in here since I left Yeah, probably God damn it Wobby Wob Do you have a Wobby Wob in your life Who's just fucking bulletproof and so dependable?

[69] Perhaps not as great But you can't do a podcast without this phenotype Yeah and you were at the forefront of biology perhaps cloning Wobby Wob.

[70] Are we ethically?

[71] I would want to do that.

[72] I think it's ethical.

[73] I think the question is, the way it worked out with Dolly wasn't so great that she...

[74] What happened to Dolly?

[75] I just don't think the life expectancy was there.

[76] Oh, it wasn't.

[77] Did you hear that incredible?

[78] It was a This American Life, and then for a minute they had a video version of this American life, and there was this story of a man who had a bull, and he had the bull cloned.

[79] Have you heard this one?

[80] No. Oh, my God.

[81] They had this family bowl, and it was very docile.

[82] It hung out in the front yard in the same.

[83] spot under this tree.

[84] It could come into the house.

[85] It died.

[86] They were heartbroken.

[87] Some state college with the great agricultural programs.

[88] They cloned it.

[89] Came back to life.

[90] And the man at the point of this story in this American life had been gored three times by the clone.

[91] And they're doing a lot of the interview from the hospital.

[92] And what's confusing to the owners of the clone is that it sits in the same spot.

[93] All the behavior is like eerily similar.

[94] It is the same.

[95] Yet it has gored the owner three times and the guy's not giving up because in his mind it's the same thing that's so interesting and genetically it may be but then we get into nurture or whatever else happens but just the unwillingness to admit oh wow i guess maybe this isn't the same if you had another rob it might just have a totally different skill set he might steal from me who knows this one might you're right how long are we going to evaluate him peter welcome i'm very very excited to have you i've enjoyed you on so many of the podcasts I also listen to, you're this fun intersection for a few people that I really like.

[96] Of course, Huberman, I like.

[97] I really like Lane Norton.

[98] And it seems you do too.

[99] Yes, Lane's a great friend.

[100] Yes.

[101] Isn't he a wonderful addition to this whole space?

[102] Yeah.

[103] It's like a niche.

[104] It's like a club you guys have.

[105] There's a type in a group.

[106] There is.

[107] What do you think about that?

[108] Do you recognize that you're in a group or that you're a type?

[109] There's a bit of a geography thing.

[110] There's a group of us in Austin, although Lane is not and Andrew is not yet.

[111] yet but yeah I guess I suppose there kind of is yeah I guess a weird parallel I would draw would be like the rising of the intellectual dark web now that thing is all splintered and gone scatty wampas when did that term first come about is that like a 2018 I can't remember the origin of it I know it and I have forgotten it but I do know that Sam recently officially disavowed himself from this because all these Sam Harris oh he did because all these people that were quite appealing for me especially they were provocative they were not afraid to test the boundaries of all these things but then you started seeing slowly oh they were all crazy in their own way and ultimately with more and more fans they started exposing some of their craziness i don't predict that for you guys as a subculture we need a name for them yeah maybe over the course of this interview we'll come up with something you're really good you wouldn't put yourself in that group i would not You're going to have to define the characteristics of the group clearly to exclude yourself.

[112] Okay.

[113] I would say that I've never put it on as an identity.

[114] So I think I am provocative or I think I have a high degree of disagreeability.

[115] Some of these components that maybe are consistent among that group.

[116] But that's not my identity.

[117] I'm never trying to perpetuate that or defended.

[118] It just kind of arises.

[119] Now, I have other identities I've created that are way more destructive and I admit are bad.

[120] but that's just not one of them, I don't think.

[121] Although Monica would be better at deciding if that's...

[122] Yeah, I don't think you're in that group, but I think that's mainly because you haven't committed your life to...

[123] Stirring the pot.

[124] Yeah, I guess.

[125] Maybe we're talking about two different things.

[126] I don't know.

[127] See, I only think of it as an identity through friendship.

[128] Like, I would also include Jocko in that group.

[129] Who's Jock?

[130] So Jock Willink is a former Navy SEAL.

[131] He has a great podcast called Jocko Podcast.

[132] and we're all just friends that have things in common, even though the topics we explore are totally different.

[133] Ostensibly, you all are in pursuit of kind of peak or optimal health.

[134] Right.

[135] I agree.

[136] There's probably a defining characteristic.

[137] And Dax will be dipping in the middle of this, so that immediately takes him out of the category.

[138] That's right, and I've thought about the fact that I will be dipping at some point in front of you, chewing tobacco, aka dipping.

[139] And I've already had some defenses plan and some admissions of failure, yeah.

[140] So of the whole gamut.

[141] Okay, let's start at the beginning.

[142] You're Canadian from Toronto and you're Egyptian.

[143] Well, my parents are both from Egypt, yeah.

[144] They moved from Egypt to Toronto.

[145] Yep.

[146] At what ages?

[147] Well, my mom and her 20s, my dad, and his 30s.

[148] Pretty late.

[149] Yeah.

[150] And then they had you promptly thereafter.

[151] My mom came at 20 and had me at 22.

[152] Met your dad in Toronto?

[153] No, it was kind of weird.

[154] It wasn't an arranged marriage, but she went to...

[155] But it wasn't not arranged?

[156] Yeah, yeah.

[157] That's how my parents are to.

[158] school with my dad's younger sister.

[159] You know, my mom to this day has some resentment, right?

[160] Because she never wanted to leave Egypt.

[161] My father couldn't wait to get out.

[162] And he came seven years earlier.

[163] He went back to marry my mom.

[164] Sort of tricked her into coming to Canada.

[165] Like this is just going to be a temporary thing because she had no desire to leave.

[166] Like you're playing with Huberman in Austin.

[167] Exactly.

[168] And my mom was profoundly distraught, being isolated in Canada, hated it.

[169] She didn't know certain things.

[170] Like, she didn't know what snow was.

[171] So the very first time it snowed, she literally called my dad to say, there's this white stuff.

[172] They lived in this tiny piece of dump apartment building.

[173] There's this white stuff coming down.

[174] What is it?

[175] You know, you couldn't Google it.

[176] And he said, oh, the neighbors are just probably throwing paper from the upper apartment.

[177] Oh, my gosh.

[178] That's normal.

[179] Yeah.

[180] There's an accountant up there who's rapidly shredding documents.

[181] Yeah.

[182] So she was just like, Moribund depressed And then had me So I was supposed to cheer her up From all of this Yeah, that always works That's a recipe for six bucks And what does Coptic mean Coptic Egyptian?

[183] Yeah, so Coptics are The descendants of the pharaohs There would be the first sect of Christianity No shit So was religion prominent in the house?

[184] My parents did sometimes go to a Coptic church in Toronto But I think that was just as much To be associated with other Egyptians But I didn't really feel a strong sense of attachment.

[185] And I regret that.

[186] Up until I was five, I could speak Arabic.

[187] And if you send me to the Middle East now for a couple of weeks, especially to a part of the Middle East where the accent is similar, I will understand them within two weeks.

[188] But I do regret that my parents didn't force upon me the language.

[189] It would be a great language to know.

[190] It's a challenging language.

[191] Yeah.

[192] Let me also be up front with what I hope my focus today will be.

[193] as I've heard you on all these other podcasts lay out a lot of the very dense and esoteric bits and pieces of hormone therapy and all these different things that Tim Ferriss did brilliantly that Huberman does that you do on your own podcast brilliantly I think chapter 17 for me will be of the most interest so I want to lay out everything and outlive but I also will have a particular interest in that and that's obviously something I think that we do a little differently than other things so if you'll bear with all this childhood stuff I think it'll come to bear when we get into chapter 17 of your book.

[194] What was the vibe in the house?

[195] By definition, the family's outsiders.

[196] Mom doesn't want to be there.

[197] That's not ideal.

[198] What is dad up to professionally?

[199] My father did everything, but his main gig was he owned a restaurant.

[200] So it was the first Middle Eastern restaurant in Toronto, if not in Canada.

[201] Was it on Young Street?

[202] No, it wasn't on Young Street.

[203] It was in a crappier part of Toronto called Scarborough.

[204] Okay.

[205] So it was on Kingston Road.

[206] He worked there during the evenings, so from 5 o 'clock till midnight, and then during the day, he was a stockbroker.

[207] Get out.

[208] So my father worked incredibly hard.

[209] In two of the most stressful jobs you could probably take on.

[210] Yeah, I suppose so.

[211] Stock trading and all restaurants fail, right?

[212] This is what we know about him.

[213] I mean, the pressure he must have been under.

[214] Yeah, probably the most consistent thing I remember from my childhood as far as my parents is the tension between them with respect to how much he worked and his, absence.

[215] He was gone before I woke up in the morning, and he did not come back until I was in bed, so I didn't see him.

[216] But I didn't think that was abnormal.

[217] And I remember when my parents would fight, which was all the time, I kind of sided with my dad.

[218] I thought my mom was being, I didn't know the word at the time, but a little histrionic.

[219] Right, right, right.

[220] I thought, like, why are you busting his balls?

[221] He's working.

[222] And my dad's defense was, I'm doing this for you kind of thing, which is the great lie we told him.

[223] Right, right, right.

[224] Yeah, yeah.

[225] Exactly.

[226] Well, I mean, you need him to make money to live.

[227] I think it's ultimately horseshit.

[228] I think everyone pursues their own glory for themselves.

[229] Yes, and by the way, the moment I recognize this was during the final episodes of Breaking Bad.

[230] Do you remember when he says to Skyler, I've always been saying, I've been doing this for you guys, I've been doing this for you, and she rolls her eyes and is about to get really pissed.

[231] And then he apologizes and he goes, that was a lie.

[232] This has all been for me. I thought that was one of the most honest moments in television history.

[233] I'm like, that's the truth.

[234] We're all selfish little beings.

[235] for our own glory and esteem.

[236] Some people benefit from it collaterally, which is great.

[237] And then we focus on that collateral benefit and build the whole story on that.

[238] So those are sort of my main recollections of childhood.

[239] And how did you fit in in school?

[240] I'm imagining you're not dying to bring kids home like Monica was.

[241] But was a diverse there?

[242] Because Toronto now is.

[243] It's fucking insanely diverse.

[244] We lived in two different areas.

[245] The first place I lived was not very diverse.

[246] And I definitely felt like a really big.

[247] outsider.

[248] Nobody had skin my color and my skin's not that dark.

[249] It's not.

[250] But I still got called N -word every day, which I didn't even know what that meant.

[251] When I was maybe 12, we moved to another part of Scarborough, this east part of Toronto.

[252] And that was much more diverse.

[253] So when I was in high school, by that point, if I think back to like my circle of five friends, it was one guy is black, Jamaican, one guy is Korean, one guy is Indian, one guy's Italian.

[254] It's the UN.

[255] Yeah, exactly.

[256] So that looks more like probably how people think of Toronto now.

[257] Oh, got it.

[258] Yeah.

[259] And how did you fare in high school?

[260] I didn't like school growing up.

[261] Some of this is just based on what my mom told me. I think I was a bright kid.

[262] And I was put into a special program that got canceled when I was in third grade.

[263] It ran out of funding.

[264] So then I got put back into the sort of regular public school.

[265] And my mom said, yes, I got bored.

[266] And then had a succession of a couple teachers that didn't like me, probably because they were frustrated.

[267] with me, I couldn't wait to sort of rebel against these teachers and I couldn't stand them.

[268] So when I got to high school, I was a very lousy student.

[269] I had one thing that maybe made a difference for me, which was as I was descending in my slide towards the bottom, well, I guess I had two things going from me. The first is I took a huge love of boxing.

[270] Yeah, what age?

[271] 13.

[272] Instigated by a movie?

[273] I think there were two things simultaneously.

[274] The first is probably some of the stuff we'll talk about in chapter 17 that's simmering.

[275] But I think superficially, it was a fight.

[276] It was Marvin Hagler versus Tommy Hurons in April of 1985.

[277] Yes.

[278] If you're from Detroit.

[279] Are those boxers?

[280] Are those people in your school?

[281] Those are boxes?

[282] Two of the most famous, what, middleways?

[283] Yeah.

[284] Well, we have a very strong female.

[285] No, but I'm glad you make that point.

[286] I shouldn't assume that.

[287] But the 80s were defined by Hearns Hagler, Herns.

[288] Herns Leonard.

[289] Yeah, yeah.

[290] To this day, this is probably regarded as one of the greatest fights in boxing history.

[291] It's a short fight.

[292] It's only three rounds, but it's three rounds of two guys that come as close to killing each other as you can do with leather on your hands.

[293] I just watched that fight in awe, and the guy who won Marvin Hagler became my hero, and I was like, tell me what I need to do to be that guy.

[294] And he looked vaguely like Mr. T, who was also popping up in pops.

[295] That's right.

[296] He had kind of a very scary.

[297] Rocky three had already come out.

[298] So now I'm doing this thing where I'm completely obsessed with boxing and martial arts, so I get into martial arts as well.

[299] And I'm doing these two things to the exclusion of everything else in life.

[300] When I say this, people think you're exaggerating, but I'm not exaggerating.

[301] Six hours a day, this is what I did.

[302] You have the power of myopathy?

[303] Yes, yes, exactly.

[304] The only thing I do in moderation is moderation.

[305] So it was, wake up every morning at 5 .30, run 5 to 10 miles, come back, go to the gym, do your rope work, do bag work, do weights.

[306] In the middle of the day, go and lift weights again, an after school, bag work and anaerobic work in the evening, gym, sparring before bed, pushups, bed.

[307] What?

[308] Every day.

[309] Were you small?

[310] That's, I know a weird question, but were you like, I want to be strong?

[311] I definitely wanted to be strong.

[312] I was a middleweight, so it was 160 pounds.

[313] That's big for high school.

[314] No, no, not when I was 13, though.

[315] So, yeah, I probably started out at a welterweight.

[316] I probably went from, like, low 140s to 160.

[317] Okay, so that's a really abnormal amount of motivation for a kid that age.

[318] So my question now is, was the voice that was motivated?

[319] Was it a fuck you to one person I'll show you or was it you're a lazy piece of shit?

[320] You're worthless.

[321] I think it was more I will show you and you is everybody.

[322] It wasn't to any one person.

[323] I mean, do you have a good sense of less than?

[324] Absolutely.

[325] Even after all the therapy I've been through, I don't look back at that and think I was trying to win the approval of my father.

[326] What I have come to accept is that five -year -olds internalize things differently than 55 -year -olds.

[327] So I can't use my brain today and look back and go, oh, you must have thought this, not this.

[328] No, no, I don't think any of that's true.

[329] So I'm sure on some level there was a sense of abandonment that performance -based esteem became the sort of dominant theme of my life.

[330] But the reason I think I got fortunate is that I think different people tap different things for dopamine.

[331] You have to be careful not to get into value judgments, right?

[332] I think there are some people who tap substances for dopamine, and there are some people who tap achievement for dopamine.

[333] I don't think they're any different.

[334] Society happens to reward.

[335] award one more than the other.

[336] So I just got lucky that my dopamine switch got triggered by achievement.

[337] Although maybe, you know, like I chose another route.

[338] I had a few going, but they all leave you in the same spot ironically.

[339] Societally, it looks like one's productive, inconstructive, but if you are left as a void with the whole ever -growing that you're trying to fill, misery and suicidal ideation, that's got to be the only thing we measure as a sign of success.

[340] Well, and the other thing is sometimes the chemicals, for example, or gambling or other things that are more visibly destructive, actually lead to a quicker treatment.

[341] They're on the wrong side of the math for the dopamine equation, right?

[342] That's right.

[343] Yes.

[344] Okay, which we'll inevitably get into an hour five of this.

[345] So I'm making my way through high school and high school today.

[346] Parents are so involved.

[347] That wasn't the case when we went to high school.

[348] No, you and I are the same age.

[349] Yeah, like my parents didn't know a thing.

[350] If the school didn't call, they weren't going to know.

[351] If you weren't getting suspended, your parents had no idea what was going on.

[352] I knew that there was some sort of tacit expectation I would go to university because that's what immigrants would expect.

[353] That's why they came here.

[354] Yeah, that's why we came so you wouldn't have to work in the restaurant.

[355] But that was about it.

[356] And then so you fast forward to 12th grade.

[357] I'm nowhere near ready to go to college.

[358] In Canada, at the time, you had to take certain prerequisites.

[359] Maybe they're like what we would call APs now.

[360] And you have to have six of them to go to a Canadian university.

[361] I had exactly zero in 12th grade.

[362] So I'm not going anywhere.

[363] One morning, my math teacher says, hey, I heard you're not going to university.

[364] And I said, yeah, that's right.

[365] Have you seen Hearns Hagler?

[366] I expected him to give me the old, that's a dumb idea speech.

[367] And he didn't.

[368] He just said, what are you thinking about doing?

[369] And I told him, he goes, I really respect you for following your dreams.

[370] and I totally get it.

[371] Which at that time was boxing.

[372] Did you tell him?

[373] Oh, yeah, yeah, yeah.

[374] And he told me about how when he was young, he was really torn and really wanted to play in the NHL, which of course every Canadian kid does.

[375] But then he just ended the discussion with something that was just such a master move.

[376] He just said, you know, I just think that if you don't go to university, the world will miss out on a gift you have for mathematics.

[377] Oh, what a champ.

[378] I know you're not 100 % applying yourself, Peter, but I really think you have something special that I don't see often, you should at least just consider that.

[379] I really credit this guy, Woody Sparrow, to totally changing the direction of my life.

[380] Yes, and by the way, it goes to show, and it's all individual.

[381] Some people respond really, really well to criticism and fear -based everything, but the notion that all you were probably looking for was, I see you, you're good, I'm proud of you, you have a skill, give it to everybody.

[382] Positive, loving, kind, generous.

[383] They could have set you down for a thousand hours of interrogation telling you how you've erred and you'll just hunker down for that fight right for sure and so at that point everything came about frankly emulating woody and so woody who is our math teacher had previously worked as an engineer but then went back and got a master's in mathematics so i just decided well i'm going to be an engineer who specializes in math and mechanical engineering so that's what i went on to do i'm going to go major in woody i'm going to be woody I want a graduate program.

[384] But how'd you do that with zero?

[385] I had to come back for an extra year.

[386] Okay.

[387] But then I came back that next year.

[388] And this goes back to the boxing thing.

[389] The six hours of training gave me, for lack of a better word, I think just the discipline.

[390] Yeah.

[391] All of a sudden I said, well, you used to train six hours a day.

[392] How about you cut that down to two and you study six hours a day and make up the difference?

[393] And so that summer, I basically had a lot of work to do to get up to speed on all the stuff I didn't know.

[394] Then I just attacked that last year with a vengeance.

[395] When I look at your story, story, there's a lot of like, yeah, I'm going to be a mechanical engineer, or I'm going to be a mathematician, whatever it's going to be, and then we flip when we leave Queens.

[396] How do we go from that to then I'm going to medical school at Stanford?

[397] I pick this university because it's the one place that allows you to do a double major in math and engineering.

[398] So I get there, and I decide I want to, on the side, do some volunteer work.

[399] This is very curious to me. I know this story.

[400] What's missing from the story to me is what motivated you to do that.

[401] I don't know.

[402] I mean, that's a really bizarre choice for a 19 -year -old to make who's just got to college.

[403] I don't even know how I did this.

[404] It's pre -internet.

[405] This means I went to the yellow pages.

[406] It's so weird and random.

[407] Yeah.

[408] But I somehow find this organization called Citizens Against Sexual Child Abuse.

[409] Wow.

[410] And there's this guy named Paul Peterson who runs this.

[411] And it's literally like a halfway house for teenagers who can't live at home anymore because they've been sexually abused.

[412] And you're 19?

[413] Yeah.

[414] Oh, my God.

[415] I mean, that totally needs an explanation, but do you know it?

[416] I don't think I fully accepted what had happened to me as a kid.

[417] So I've been molested.

[418] I don't know if you know that about me. I'm super open about that.

[419] So part of me, when I heard that, I was like, huh, is that a response to your own sexual trauma or is that?

[420] I think it probably is, although I certainly at the time didn't make the connection.

[421] Yeah, of course.

[422] I end up spending the next four years volunteering there.

[423] So one or two nights a week, I ride my bike over to the halfway house and hang out and make dinner and play board games with kids that are not that much younger than me. All of this is happening and it's very compartmentalized and it's a bit of a secret.

[424] So virtually nobody knows.

[425] I think I had one girlfriend in all of college who knew that this was like this thing I did on Wednesdays.

[426] There's no virtue signaling going on and there's nothing outward facing or extrinsic about it.

[427] No, if anything, I'm a tiny bit embarrassed.

[428] Yeah, yeah, yeah.

[429] I like that.

[430] It makes it more pure for me. So in my last year of engineering, the plan had always been then to go often do a Ph .D. in aerospace engineering.

[431] That's the perfect merger of the control theory and mathematics and the mechanical engineering, and I'd always love planes and rockets.

[432] The Challenger blew up when we were kids.

[433] That's right.

[434] Yeah, yeah.

[435] But now I'm having a really weird existential crisis, and I'm not excited about it.

[436] So I win this very prestigious scholarship that says, you can now go anywhere you want.

[437] And it's a rare scholarship because most of the government scholarships don't allow you to leave the country.

[438] But I did want to go to the U .S. So I wanted to go to Stanford, Princeton, or MIT, or Caltech would be the big four aerospace programs.

[439] And this scholarship, I got two of them, said, you can go anywhere.

[440] And I'm like, yeah, I don't want to go.

[441] I don't know why, but I'm just sort of having this sense of, I don't think I want to be an engineer.

[442] This is one of those times when I look back at life and say, I wish I journaled.

[443] Like, I wish I had a better insight into what was going on circa 19.

[444] This would have been 95.

[445] But all I know is I'm struggling.

[446] And I even go and see a school counselor.

[447] I remember talking to this woman and trying to explain to her.

[448] this and just not getting any clear insight as to why I don't want to do this now.

[449] And there's something else I want to do and I don't know what it is.

[450] I want to have some sort of purpose.

[451] Now, I'm about to tell you a very embarrassing story.

[452] I can't believe I'm about to tell this.

[453] This is a very same place for embarrassing stories.

[454] There was one young woman in this, quote, unquote, halfway house.

[455] She had been abused by her father and uncle.

[456] So the father and the father's brother had been abusing her.

[457] And not just her, but her sisters as well.

[458] And I was just so pissed about this, right?

[459] I was just in such a low point.

[460] I was becoming so depressed that I had this ridiculous idea, which was, I was going to go and kill the dad and uncle.

[461] Absolutely.

[462] And I wasn't so naive to think that I was going to get away with it.

[463] I didn't think I'm going to be Rambo.

[464] No one's going to figure this out.

[465] Yeah.

[466] I'm going to end up living in Seattle in the mountains and it's all going to be fine.

[467] I kind of knew if you do this, you're going to go to jail the rest of your life.

[468] but I thought it's still worth it to help these girls and maybe even send a signal to all the other pieces of shit out there.

[469] Yeah.

[470] Okay, so great.

[471] Just time out.

[472] I think maybe you and I both subscribe to this very flawed notion that we can teach people lessons.

[473] Yeah.

[474] Like the amount of times I've been out at stoplights in L .A. thinking, well, this person will learn once and for all.

[475] That doesn't happen.

[476] You cannot teach anyone anything.

[477] That's very noble.

[478] I mean, I know you think that's embarrassing, but it's like, very fine.

[479] I'll tell you where it gets even more embarrassing.

[480] I'm really going down the path of kind of thinking about this and really planning it out.

[481] And in the process of doing that, this girl, the one that I want to help, ends up in the hospital.

[482] She had tried to take her life and luckily had failed.

[483] So now she's in the hospital.

[484] There's certain moments that are very crystallized.

[485] This is one of them.

[486] So I'm in the waiting room visiting her, and I have my lunch, you know, because I was still a health.

[487] fanatic.

[488] So everything I ate was perfectly titrated.

[489] So my chicken breast was here, my rice cake was here, my this was here.

[490] Already.

[491] Already.

[492] Just fanatic.

[493] Well, boxing, I guess.

[494] Yeah, yeah, exactly.

[495] So I'm in this beautiful open sun room, which you wouldn't expect for a hospital to have such a nice waiting room.

[496] And it's several floors up.

[497] And there's two tables.

[498] There's one that has a ton of people.

[499] And then there's a completely empty one.

[500] I sit at the empty one and I'm eating.

[501] And this older woman walks in and goes to sit at the full.

[502] one, and they don't make room for her.

[503] And it's really clear to me that they don't want her to sit there.

[504] She says, can I sit here?

[505] And I said, of course.

[506] So we're sitting there and we just get chit -chatting.

[507] She was wondering what the rice cake was.

[508] I said, oh, try a piece of this rice cake.

[509] And maybe 15 minutes later, someone comes and gets me to go and see this girl.

[510] And as I'm getting up, the woman says, oh, you're not a doctor here.

[511] I should have realized that.

[512] If you were a doctor, you wouldn't have been so nice to me. And I thought it was interesting that she even thought I was a doctor in the first place because I'm clearly just a schmucky college student, but her comment struck me, because she was a patient, by the way.

[513] And I know this sounds very cheesy, but that was the moment when I had a total epiphany, which was, wait a minute.

[514] What if going into medicine is an alternative here because clearly it made a difference in this woman's life to sit here and be nice to her for 15 minutes.

[515] And medicine is kind of a science, and I do love math and science.

[516] And so that moment literally catalyzed what was clearly months of agony without a clear sense of what should I do.

[517] So that was the transition.

[518] Again, just like in high school, I still needed a year because I graduated from college, but I hadn't ever taken a single prerequisite to go to medical school.

[519] So then that summer, I had to take the MCAT, which is like the standardized test for med school, but without having taken the classes.

[520] So that was really hard.

[521] The night before the test, I learned meiosis and mitosis were different.

[522] Oh my God.

[523] And all that time, I thought they had been misspelled.

[524] in the study guide.

[525] Because I bought one of the cheap study guides.

[526] I didn't buy the official one.

[527] I bought one of the discount ones.

[528] And I was like, these discount things, man. No one spell checks them.

[529] And then the day before I realized, oh my God, they're two different things.

[530] So I scrape through the MCAT and then that calendar year following, I teach calculus to pay the bills, and then I take my prerex.

[531] And that's how I end up going.

[532] But let me tell you what the really embarrassing story is.

[533] When I'm applying to medical school, I'm interviewing at one very prestigious medical school.

[534] and I'm being interviewed by this psychiatrist.

[535] And typically when you're interviewing at a med school, there's two or three interviews, right?

[536] This guy asks me basically questions that lead me down the path of talking about why did I decide to apply to medical school and it gets me to the story of this girl and I actually, in the interview, admit that I was thinking about killing these guys.

[537] Okay.

[538] This is literally 15 minutes into a 45 -minute interview.

[539] Maybe not the best foot forward.

[540] Yeah, yeah.

[541] The guy goes, all right, this interview's over.

[542] Just done.

[543] So I remember I had like a full day of interviews and I literally just went to the airport and I was like, I don't think I'm going to get in here.

[544] We can probably head back home.

[545] And I'm going to make a little edit on my next interview.

[546] Oh my God.

[547] Note to self, never tell that story again.

[548] In 2023, though, if you had said it, people would have applauded your honesty, I think.

[549] I don't know what anything is like in the med school circuit these days.

[550] So you end up at Stanford.

[551] I imagine there's a bit of a culture shock there.

[552] It's pretty different from Toronto.

[553] Yeah, I had never really been west of Toronto.

[554] The first time I went there was to interview.

[555] And it was the only school I applied to on the West Coast.

[556] And I remember applying there and thinking, oh, God, if I have to apply here 10 straight years to get in, this is the one I want to go to.

[557] Yeah.

[558] Because I think I finally realized how much I hated being cold.

[559] I remember it was a February and it was like 70 degrees.

[560] There's a lot of immediately appealing things.

[561] I coming from a very similar area.

[562] And I'd say culture, despite the Canadian -American thing.

[563] We suffer a lot from tall poppy.

[564] We suffer a lot from, I don't know.

[565] The darkness.

[566] The darkness of the winter is unbearable.

[567] And the stock and trade where I'm from was a story where someone ultimately was trying to belittle your status.

[568] In the end of every story is, and then I told him to fuck off or I punched him or I quit the job.

[569] And then you come out here and you're like, huh, I feel very light.

[570] Everything is kind of positive.

[571] It's kind of shocking, I think.

[572] I couldn't have been happier.

[573] I think back to those four years of medical school.

[574] I felt very fortunate because you're at a little bit of the mercy of the other people that show up in your class.

[575] I mean, Stanford is a small class.

[576] There's only 85 students.

[577] That's about half the size of a normal med school.

[578] But immediately there was a group of guys that just clicked.

[579] Have you had Paul Conti on?

[580] No, but you talk about Conti.

[581] Okay.

[582] Okay.

[583] Okay.

[584] Yeah.

[585] So Paul is one of my classmates.

[586] And there's a group of half a dozen of us that were inseparable, all from non -traditional backgrounds, meaning none of us were pre -med.

[587] We were all a little older than the average student coming in.

[588] I think there's something invaluable about forming friendships in that period before you have all the professional identities that kind of safeguard you from a lot of things.

[589] Oh, for sure.

[590] When you touch back into that group, they remember, no, no, you're not a doctor.

[591] Like, I met the kid who was confused.

[592] I know who you are.

[593] Yeah.

[594] There's some magic to that.

[595] The same way your childhood friends are very important to keep in the mix.

[596] Stay tuned for more armchair expert if you dare.

[597] We've all been there.

[598] Turning to the internet to self -diagnose our inexplicable pains, debilitating body aches, sudden fevers, and strange rashes.

[599] Though our minds tend to spiral to worst -case scenarios, it's usually nothing, but for an unlucky few, these unsuspecting symptoms can start the clock ticking on a terrifying medical mystery.

[600] Like the unexplainable death of a retired firefighter, whose body was found at home by his son, except it looked like he had been cremated, or the time when, and an entire town started jumping from buildings and seeing tigers on their ceilings.

[601] Hey listeners, it's Mr. Ballin here, and I'm here to tell you about my podcast.

[602] It's called Mr. Ballin's Medical Mysteries.

[603] Each terrifying true story will be sure to keep you up at night.

[604] Follow Mr. Ballin's Medical Mysteries wherever you get your podcasts.

[605] Prime members can listen early and add free on Amazon Music.

[606] What's up, guys?

[607] It's your girl Kiki, and my podcast is back with a new season, and let me tell you, it's too good.

[608] into the brains of entertainment's best and brightest.

[609] Okay, every episode I bring on a friend and have a real conversation.

[610] And I don't mean just friends.

[611] I mean the likes of Amy Poehler, Kell Mitchell, Vivica Fox.

[612] The list goes on.

[613] So follow, watch, and listen to Baby.

[614] This is Kiki Palmer on the Wondery app or wherever you get your podcast.

[615] Okay, I want to make this observation.

[616] I've met a lot of surgeons.

[617] I've been operated on a lot of surgeons.

[618] We have interviewed several surgeons.

[619] There's a personality type.

[620] So it's like apex controlling, pretty errant.

[621] again.

[622] Mind you, these are qualities I kind of want in my surgeon.

[623] But there seems to be a type.

[624] Would you agree with that assessment?

[625] And how did you find yourself being pulled to being a surgeon specifically?

[626] When I went to medical school, I actually thought I would do pediatric oncology.

[627] Right away, as soon as I show up in medical school, I'm spending time in the pediatric oncology ward doing that kind of stuff.

[628] But also, you know, sampling around broadly because you have two years of classroom only where you can do whatever the heck you want in the hospital with your free time.

[629] And then you have these two years of clinical rotations, which are highly structured.

[630] And by the end of that third year, you better know what you want because that's where you're applying.

[631] Out of the gate, when we started our first clinical rotations, I did pediatrics and surgery first.

[632] And I really wanted to like pediatrics, and I didn't.

[633] And I really didn't want to like surgery because the lifestyle is pretty miserable at the time.

[634] And I did.

[635] And I think it just came down to personality fit.

[636] So the pediatrics one, this was a little bit after the Austin Powers movies.

[637] And I was obsessed with fat bastard.

[638] Do you remember?

[639] Yes, of course.

[640] He had a Dutchess?

[641] Oh, Scottish.

[642] So I would basically run around the pediatrics ward talking about eating the babies.

[643] Because remember he wanted to eat mini -me?

[644] Get in my belly.

[645] Yeah, yeah, yeah, yeah.

[646] And so I would do that to all the babies.

[647] I would talk about eating babies.

[648] Oh, my God.

[649] All about a white meat.

[650] Killing the predator, eating babies.

[651] Not one of the pediatric residents laughed.

[652] They just didn't like me. They didn't think I was funny.

[653] They didn't want anything to do with me. So I realized, like, you have to be around people that you laugh with and you goof around with.

[654] Well, can I also make an armchair psychoanalysis observation?

[655] I think you're perfectly positioned to do that.

[656] I mean, you love control.

[657] Yeah.

[658] The training is controlled.

[659] The diet is control.

[660] The repetition of left, left, right.

[661] You know, everything is fucking control.

[662] Now, patients who are babies who you have a communication barrier with, who you're not going to be able to observe how they take on your treatment recommendation versus I open you up I cut here I suture here I cauterize this one is so vastly more control oriented yeah was that the same mob yeah I guess that didn't take a lot did it?

[663] Well we're both smart no no it's right there on the table no it was yeah I mean that's a through line it seems in your whole life yeah yeah I end up doing surgery deciding that despite the challenges of that type of training this is what I want to do then you end up at Johns Hopkins, where you're doing your residency.

[664] The decision to go to Hopkins was a hard one because I loved being in California so much.

[665] But Hopkins was the epicenter of surgical training, in part because of where it sits.

[666] Sure.

[667] This is the wire circuit.

[668] That's exactly right.

[669] Yeah, you're getting a lot of gunshot wounds.

[670] You're getting all kinds of emergency.

[671] And the wire, I think, came out of a book called The Corner.

[672] After I matched at Hopkins, I had a friend who was one year ahead of me who was also doing his surgical residency at Hopkins.

[673] He was an E .N .T. And I said, hey, Brian, any advice for me before I come out?

[674] And I'm expecting him to, like, tell me to read a textbook or don't live in this part of town, do live in this part of town.

[675] He doesn't give me any of that.

[676] Never eat at a...

[677] Right, right.

[678] Instead, he goes, read the corner.

[679] No shit.

[680] And I said, why?

[681] And he goes, because this is exactly the patient you will see in the ER 50 times a day.

[682] So you need to understand this very well.

[683] Yeah, what great advice.

[684] So you get here, and now you are your residency, you perform a lot of operations.

[685] You even then go on to work as a surgical oncologist at another place in Baltimore for two years.

[686] At the NIH.

[687] And then you do it again.

[688] You up and decide I'm not going to be a surgeon.

[689] So this is crazy from the outside.

[690] Yes.

[691] And especially for my dad.

[692] So the one detail I didn't mention is when I decided to go to medical school, my father was very upset at me. No. Which was very interesting because it was the first time he'd really ever weighed in on a decision.

[693] He was so upset at me that we didn't speak for almost a year.

[694] Now, isn't APEC's first generation goal?

[695] Doctor.

[696] I thought it went doctor and then back up lawyer.

[697] I mean, this was like written in stone.

[698] I think part of it was he thought you already have this great degree that you got for free.

[699] You've got scholarships to go and pay for the PhD.

[700] And why would you go and take on $250 ,000 of debt to go and do this other thing?

[701] You almost got.

[702] out of this scot for you can be in positive earning immediately and instead you're going to get yourself into a hole you're going to be working at a restaurant and just trading fucking penny stocks during the day and not present with your family so then yes now i decide to do something even more ridiculous okay so why do we leave that by the way all this stuff is very brief in your book so i want people to know like this is the step when you read his book which is phenomenal everyone that reads it loves it christian's obsessed with it she had to come meet you before this interview but this is the stuff that's kind of not in there that I had a great curiosity about.

[703] I am really loving surgical training, but the camaraderie in that group is also second to none.

[704] It's like being in war, right?

[705] Everyone's up.

[706] They're sleep deprived.

[707] The stakes are high.

[708] Victory's unparalleled.

[709] If you save someone's life.

[710] Yeah.

[711] People who come to Hopkins typically have an appreciation for tradition.

[712] It's where the American residency system came from.

[713] So you walk by the statues.

[714] You see the photos of the gods of this field.

[715] Well, it's the curriculum that Rockefeller decided to fund all other kinds.

[716] to adopt.

[717] I mean, it's the one.

[718] So everything's going sort of well, but there are moments when I'm frustrated.

[719] Now, I write about one of these in the book, so I won't go into it in much detail, but basically there are just these moments when I realize I'm not being encouraged to think creatively.

[720] In fact, I'm being very discouraged from that.

[721] I sort of understand on the surface, there's a lot you have to learn in medicine, and you're not going to figure out a new place to put the appendix.

[722] This is where the thing sits.

[723] This is where the aortic valve sits relative to the pulmonic valve.

[724] There shouldn't be much creativity there.

[725] there were certain things that I just thought were kind of being done a little bit backwards, and I would propose other ideas for things, and the nature in which that kind of was being turned down really irked me. Well, it was vitriolic.

[726] You had been screened at for suggesting something that ultimately would have been beneficial.

[727] Now, do you think this was driven primarily by tradition and locked into a paradigm or, and maybe in concert with the enormous liability issue that drives so much shit?

[728] Like, if you do everything per the schedule, there's nothing in question.

[729] court when that case comes around that they can point to any divergence that might imply liability.

[730] Do you think some of it was driven by that?

[731] I think so.

[732] Have either of you read the book, Alchemy?

[733] No. It's written by Rory Sutherland.

[734] It's one of the most interesting books I've read in the past year.

[735] So as soon as you finish reading Outlive, pick up Alchemy.

[736] Yeah, yeah.

[737] And he talks a lot about different strategies for marketing and how there's kind of the obvious way to do things.

[738] And it's safe because if it doesn't work, you can always say, yes, but this is the way we do it.

[739] And then there's this other way that's much riskier, has way more upside when it works, but if it fails, you will get fired.

[740] Right.

[741] And I think that's probably true across many professions.

[742] There were also some personal things that really irked me. I don't know how true this is today, but back in the day, there was no wiggle room in life.

[743] And in a span of two months, there were two things that mattered to me that I missed.

[744] So one of them was my best friend from high school, got married, and wanted me to be his best man. Now, he gave me an eight -month heads -up.

[745] Oh, boy, yeah.

[746] If you can't do that.

[747] So I had an eight -month heads -up to be at a wedding, to be a guy's best man, and had the okay to do it.

[748] And then a week before, got told, sorry, we're going to change the schedule.

[749] You're not going.

[750] And that ground my gears.

[751] Someone's controlling you.

[752] Yeah.

[753] A month later, my wife ran the Baltimore Marathon.

[754] And again, I had this one day off per month to go and somehow it got taken away for me and now I'm not there watching her run the marathon.

[755] This was just making me so angry.

[756] And on that night that I was supposed to be at my friend's wedding, I was instead on trauma call and I was in sort of a salty mood and I'm down in the ER and I'm looking at a film of a trauma patient and the radiologist who I'd never met before.

[757] This is this woman I'd never seen before, which is odd.

[758] All the faces are familiar, but somehow I hadn't seen her before.

[759] You know, we're getting chatting and she's very nice.

[760] And she says, oh, you seem kind of in a bum mood.

[761] What's up?

[762] And I just said, I'm not supposed to be here tonight.

[763] I tell her the story.

[764] And she's like, oh, you should go work at McKinsey and Company.

[765] And I'm like, what's that?

[766] Wait.

[767] She just said that randomly?

[768] Yes.

[769] Well, here's the thing.

[770] I later found out she had done the same.

[771] So she had started her residency in surgery at another hospital, had left to go to McKinsey and company, had done that for a couple of years, decided she wanted to come back to medicine, but didn't want to go to surgery, so came back and did radiology.

[772] So now she was a radiologist.

[773] Oh, my God.

[774] Wow.

[775] Wow, wow, wow.

[776] I don't think she said that to me after 30 seconds.

[777] It was probably like a 20 -minute discussion, but that planted the seed.

[778] Well, it's all about timing in life, right?

[779] Yeah.

[780] She says that two weeks before when you still think you're going.

[781] You probably don't even hear it.

[782] That's right.

[783] You probably don't even remember it.

[784] Sounds like she was a secret recruiter or something.

[785] It's hilarious.

[786] Just like going into spaces and like, hey, have you ever thought about this?

[787] Yeah, like an inside head hunter?

[788] Yeah.

[789] Oh, I like that.

[790] We're going to have to teach you a lot of radiology.

[791] This is the kick.

[792] We have nine years to go acquire all this.

[793] No one will ever find out.

[794] So six months later, I decide, after a lot of soul searching, I'm going to leave.

[795] Wild.

[796] In some ways, at the finish line of your residency?

[797] Yeah, between med school post -back residency, I'm now 10 years in.

[798] Aye.

[799] Okay.

[800] Which, again, seems insane, and everybody thought you are so crazy to do this.

[801] Yeah.

[802] Okay, now here's where it looks a little suspicious from the outside that you have some bizarre fear of success.

[803] I don't even really know what that means, to be fully honest with you, I remember learning in a calm class, like the difference between fear of failure.

[804] But it's curious to me that right at the moment where you were going to get your kind of engineering math credentials, you bail out, and then right at the moment you're about to be, you know, you bail out, there is some interesting pattern right there as well.

[805] There really is.

[806] And I'm also trying to project forward a decade and ask the question in a different way as best I can, which is don't make the decision to leave now because you're upset about what happened over the past six months, because that is transient.

[807] If you're going to make the decision to leave, it needs to be based on other things.

[808] And in the end, it really was.

[809] What upset me more than anything, and I actually wrote a manifesto about this, although I wish I could find it, was I didn't feel like anything I was doing mattered.

[810] And there were really awful examples.

[811] These are extreme and rare, but they were heartbreaking where a trauma patient comes in having been shot like six times.

[812] You operate on this person for six hours.

[813] You go through every bag of blood, Johns Hopkins has.

[814] This person walks out of the hospital a month later only to get shot in the head and killed a month later.

[815] And you're sort of like, what are we doing here?

[816] You're also cutting off limbs of diabetics.

[817] You're cutting out tumors that's going to come back.

[818] Especially certain types of cancers like pancreatic cancer.

[819] They're all going to come back.

[820] Yeah.

[821] I opened the book writing about this kind of dream that I had that at the time I didn't really understand.

[822] I think now I look back and I really get what the dream was.

[823] I at this point was very frustrated with medicine, felt like I had really wasted a decade of my life and was a little bit ashamed of it because I felt like an idiot.

[824] And I thought if you had just finished your engineering degree, gone to business school, done any other thing, like look how much further you'd be ahead.

[825] I felt like a schmuck and I just wanted to get away.

[826] Well, one pattern is this kind of fear of success for whatever the thing is.

[827] But then on another way, there's this really admirable thing, which is hard to do, which is to not throw good money after bad.

[828] It's like, yeah, you just potentially wasted 10 years of your life.

[829] So the solutions to waste another two?

[830] What was Joseph Campbell's book that I read around the time?

[831] The Hero's Journey?

[832] Yeah, yeah.

[833] There's a line in that book that says sort of the hero is the one who has the courage to pursue his own bliss.

[834] That line stuck with me, and I remember thinking exactly what you said.

[835] At the time I was, whatever, 34, maybe.

[836] And I was like, look, in 10 years, I'm going to be 44.

[837] Think about what you want to be doing when you're 44, not thinking about the sunk cost.

[838] So I agreed completely.

[839] And I thought that the sunk cost fallacy was a bad idea.

[840] Again, there was an interesting point because when I ended up getting recruited to go to McKinsey, the assumption was, of course, I would do health care.

[841] And I did a little bit of health care, but I did virtually all finance.

[842] In risk assessment.

[843] Right.

[844] But were you also like, oh, my dad's right?

[845] That would keep me there.

[846] It never crossed my mind, actually.

[847] Wow.

[848] My hunt is you've always made yourself so busy on the thing you're focusing on that you leave little room to wallow.

[849] There was zero introspection in my life at that time.

[850] And in fact, you're at peak skill set for distracting yourself every second you're awake so that you don't have to consider the more underlying foundational things that might need examining.

[851] Yeah, I've always got kind of another addiction.

[852] and at the time it's now open water swimming.

[853] Yes, this is hilarious.

[854] Monica, the man in front of you has swam from Long Beach to Catalina and also swam round trip, Lanai Maui.

[855] I read that, and I could not even wrap my brain around it.

[856] How far is that?

[857] Let's do Catalina, what's that 40?

[858] 21 miles as the crow flies.

[859] The first time I swam it, I got to basically swim it in a straight line, so it was 21 miles.

[860] The second time it wasn't.

[861] Your zigzag.

[862] Yeah, so it was about 28 miles.

[863] How long does it take to swim?

[864] The first time it took me only 10 and a half hours, the second time, like 14 and a half hours.

[865] Oh my God.

[866] How many rounds of talking yourself out of panic do you go through?

[867] You start these swims in the middle of the night.

[868] Oh.

[869] Because you want to avoid the wind and chop as much as possible.

[870] And the water is at its roughest, typically from about noon to 8 p .m. You do not want to be on the water then.

[871] So you'll start that swim.

[872] at midnight and try to finish by before noon the next day.

[873] Do you have any concern of like boats hitting you?

[874] I think on one of the swims I had to pause in treadwater for 20 minutes while one passed, but you've got a huge boat there that's navigating for you.

[875] Okay, great, yeah, right, great, right, right.

[876] You're not just on your own.

[877] No, no, no, no, no. Somebody's got to be able to feed you off a kayak and stuff like that.

[878] This is so insignificant, but I want to tell you.

[879] My wife is shooting on a barge and Bora Bora.

[880] I'm there visiting.

[881] I find out that there are no boats going back to the hotel until six hours later, and that's too long for me. and I'm looking at this little island, you know, it's in a toll.

[882] So there's all these tiny little islands around the center.

[883] So I'm looking at that.

[884] I'm like, oh, I can swim that.

[885] How far is it?

[886] Do you have any idea?

[887] I can tell you what I thought it was.

[888] Looking at it, I thought it was probably a mile swim.

[889] Tell her I'm going to do it.

[890] She says no. Then she starts filming.

[891] I do it anyways.

[892] Mind you, I got flippers.

[893] I found flippers.

[894] So I'm like, I'm golden.

[895] And I was swimming for about 45 minutes.

[896] And I look at the island.

[897] And it's not closer.

[898] And then I turn around and I look at the barge I left.

[899] It's very far away.

[900] I have that moment.

[901] I'm like, what have I done?

[902] Which direction do I swim in?

[903] I have a little panic attack.

[904] I make myself lay on my back for a minute, float and try to get my head straight again, and then commit to go into the island, which I did.

[905] Wait, wait, you finished the swim.

[906] I think I was swimming for about three hours.

[907] And the probability that you swim in a straight line is pretty low.

[908] Think of how much extra swimming you did.

[909] For sure.

[910] And I'm going on my back because I'm tired.

[911] You know, now I'm just backstroking and floating for a while, trying him in the same direction.

[912] But the punchline is.

[913] The story is, in my mind, I was going to walk across the little island, then swim across the little channel to the next island and make my way through the 14 islands that would land me at the hotel.

[914] I get on the island.

[915] I'm so excited to start walking.

[916] And all these fucking dogs come barking.

[917] And every single island had dogs.

[918] The people have huts there.

[919] Everyone has dogs that protect the island.

[920] So I ended up just walking in shoulder high water.

[921] That's where the dogs would kind of swim out to.

[922] Kristen finished filming, got back to the hotel.

[923] I saw that I wasn't in there.

[924] assumed I was working out at the gym I finally knock on the door I don't have the key I don't have anything I knock on the door probably 9 o 'clock at night it's dark I've been in the dark and she goes where you at the gym I'm like no I wasn't at the time my feeder bleeding I was so fucked oh you're chafed I mean the whole thing it was a sunburned that was my swim and again it was probably I don't even know a hundredth of what you've done so I just really feel like I have a respect for what that's like to be out there in the ocean staring at something that's not getting any bigger for hours well one of the the things you do when you're swimming marathons is you never look up.

[925] How do you know that you're going straight then?

[926] You're following the kayak who's beside you.

[927] So you have a large boat that is doing the true navigation.

[928] Okay.

[929] You have a kayak 20 feet off the boat and you're about 610 feet off the kayak.

[930] When you breathe, you breathe to the kayak.

[931] That sets your direction.

[932] So swimmer sets pace, kayak and boat set direction.

[933] And you never, ever lift your head up.

[934] And the one time I did, I was doing a training swim to swim across Lake Tahoe.

[935] I don't do my due diligence on the boat captain, so we get this guy who I later realize is drunk the entire time.

[936] Sure.

[937] And we're swimming the widest part of the lake, so it should take no more than six hours.

[938] It's a 12 -mile stretch.

[939] So I bring, like, an idiot, only six hours worth of food on the kayak.

[940] I'm making great time.

[941] You can feel it in the water if you're doing well.

[942] And I'm having a good day.

[943] At about the four -hour mark, I make the mistake of looking up.

[944] But you can't tell how far you were.

[945] And I say to the guy in the boat, how far are we?

[946] And he goes, about four months.

[947] miles and I'm like, perfect.

[948] That's just what I thought.

[949] Put my head down, swim for another two hours, and then I look up again, it hasn't changed.

[950] Can I guess, too, that you've kind of set your pace knowing it's ending in four miles?

[951] There's some aspect there.

[952] We're just on cruise control.

[953] I've been swimming for six hours and it's weird that I'm not seeing the bottom because the visibility in Tahoe is 300 feet.

[954] I should see the bottom and I don't.

[955] And I look up and it's the same as it was two hours earlier and I'm like, how far are we?

[956] And he goes, yeah, about four miles.

[957] Wait, what?

[958] He had no clue.

[959] And as we later saw from the GPS tracing, we just did a big series of S's across the lake.

[960] Oh, my wife tells the story.

[961] She goes, I've never seen you throw a bigger temper tantrum.

[962] Yeah.

[963] I started just slapping the water going, fuck, fuck, fuck.

[964] I mean, I was so mad, but mostly just at myself.

[965] So anyway, I have to swim another few hours.

[966] So does your wife ride in the, what is she doing?

[967] She was in the kayak.

[968] She just rides in the kayak.

[969] This is crazy.

[970] It's pretty wild.

[971] She doesn't care.

[972] She's like, this is a cool thing you do.

[973] No, no, no, no. She's a total trooper.

[974] Well, she runs marathons as we learned.

[975] So she's got it too, right?

[976] She's a freak.

[977] But she has horrible motion sickness, and it's less in the kayak than on the boats.

[978] Okay.

[979] Wow, that's supportive.

[980] Okay.

[981] Now we got to fast forward.

[982] Do you think anybody is still listening to this podcast?

[983] Of course.

[984] We literally have not provided any value to the listener.

[985] No, that's so.

[986] like to hear the story.

[987] That's what's funny is from the outside you have an idea of how you can add and be beneficial to people.

[988] And sure, a lot of it is the science in this book and the four horsemen and the strategies.

[989] But as 17 points out, none of that means fucking shit if your head's not straight.

[990] Yeah.

[991] We see it all time.

[992] I know so many people that are peak fitness that are going to be dead shortly because their minds are a mess.

[993] Anyways, your wife after one of these big swims to Catalina points out that you are about 50 pounds heavier than you had been earlier in your life and that perhaps you might want to look into this a bit and then you get some lab results and you learn that you're pretty much in route to being diabetic.

[994] This really becomes what sets the course that leads to outlive, right?

[995] You have all this other training.

[996] You have all this kind of ancillary stuff, but that stuff will end up getting woven together.

[997] But based primarily on you yourself at 36 recognizing you're on a path that's probably going to end poorly.

[998] Yeah, so two things have happened almost simultaneously.

[999] One is my daughter, who's our first, is born, and the second is the stark realization.

[1000] Although, you don't gain 50 pounds overnight or whatever it was, maybe it was 40, but that was kind of an aha moment, which is, yeah, she's kind of right.

[1001] So that, coupled with my daughter's birth, had the following effect.

[1002] One, it was the first time I wasn't just focused on performance.

[1003] I remember when my daughter was born and I suspect anybody listening who's had a kid, especially the first one, there's like a new gene that starts transcribing, especially I think for the men because I think for the women, it starts as they're pregnant.

[1004] But I think for the guy, there's sort of this detachment until the baby's actually born and then you look at this thing and you're like, oh my God.

[1005] Well, Kristen was in labor for 22 hours and all of a sudden the whole team rushed in and then they were wheeling her down to the emergency room for a C -section because the baby's heart rate had fallen, all that stuff.

[1006] And on that run down to the operating room, I remember thinking, like, oh, please God, just let Kristen live.

[1007] Forget this baby.

[1008] I don't care.

[1009] And then hours later, I'm holding the baby.

[1010] It switched within the course for me of like three hours.

[1011] Even when my wife was in labor, I was at McKinsey at the time, I was sitting there on my laptop building models in Excel, not even remotely interested.

[1012] I was like, let's just get this thing over with.

[1013] I got to get back to work.

[1014] Right, right, right, right.

[1015] And I had apparently, I don't really remember saying this, but my wife repeats it so often that it's probably true.

[1016] We had a a cat at the time that we had rescued in Baltimore like an alley cat her name was midnight i was obsessed with this cat i would say i hope i can love this baby as much as i love midnight sure sure yeah yeah yeah and then the same thing happens again when you have a second child i could never love it as much as the first they're going to be fair to this second kid how on earth will they compete no it's it's so interesting so that whole thing is going on where i'm now thinking about living longer because this thing is amazing and then on top of that i'm thinking about my family history which had always been kind of an abstraction to me, but now I'm realizing, wait a minute, these dudes all drop dead in their 40s and 50s.

[1017] Why will you be different?

[1018] Yeah, exactly.

[1019] Unless you intervene dramatically.

[1020] Right.

[1021] Now we get into Outlive, your book, which is about ultimately longevity.

[1022] And I think maybe the first concept that is most helpful to talk about is the difference between lifespan and health span.

[1023] Let me update you on everything I've been taking as you're now my doctor for this conversation.

[1024] So I've been on testosterone for, I guess, about six years.

[1025] I have, in the back of my mind, thought, I don't know, maybe it'll shave off three years somehow.

[1026] No matter what I know about the science behind it, part of my brain goes, anything that's too good to be true is too good to be true.

[1027] Perhaps it's going to shave off four years, five years.

[1028] I don't know.

[1029] But I am very at peace with the notion of, well, I'd much rather have 25 really fun, productive years where I pursue my hobbies and I'm on fire to work and you can take the ending for it.

[1030] So I myself had made that kind of mental deal with myself.

[1031] I'd rather have a really high quality of life that's a little shorter.

[1032] This feels a little bit similar to that, although your thought is that those two things aren't diametrically opposed.

[1033] Yeah, they're not mutually exclusive.

[1034] I mean, you could think of examples where they are.

[1035] Okay, you and I both love motorsport.

[1036] So I could come up with a scenario where if I said, look, for me, the only thing that matters in health span is going under seven minutes on the Nuremberg ring.

[1037] Right, yeah, yeah.

[1038] And I put all of my focus into doing that.

[1039] Oh, and by the way, I have to do it in Nikki Lauda's 1976 Ferrari because Nikki was the first person to go under seven minutes in the ring and anything.

[1040] Of course, I'm never going to get there, but the only thing that gives me joy in life and health span is that I may shorten my lifespan so much dying, trying, that it might not be worth it.

[1041] Right.

[1042] There are examples where these can be diametrically opposed.

[1043] Someone might be able to convince themselves that their heroin habit is really increasing the quality of their life.

[1044] Yeah.

[1045] There's also these unique, the documentary about this climber.

[1046] He was like the least famous of all these climbers.

[1047] He was a master of all the different domains of mountain climbing, got very into ice climbing.

[1048] Ultimately died.

[1049] He died really young.

[1050] It's a very sad documentary.

[1051] But I was also looking at it going, well, they were saying before he was this obsessed with climbing, when everyone would do a hit of acid, he would do nine hits.

[1052] And then he'd do 13 hits of ecstasy.

[1053] And I'm like, you know, this guy was going to die, period.

[1054] That's his makeup.

[1055] Like, whatever's happening in that mind.

[1056] So this other thing probably prolonged his life and was less destructive.

[1057] And I don't know that it's a loss.

[1058] I think for him, perhaps, that was the best option of a lot of terrible options.

[1059] We all know stories of people who die doing exactly what they love.

[1060] And there's also something kind of weird and romantic about it when they die.

[1061] Like my hero, as you can probably tell, is Ayrton Sena.

[1062] Yeah.

[1063] And my youngest is named after.

[1064] You could argue who's the best racer of all time.

[1065] He is easily the most artistic and elegant.

[1066] F1 racer of all time.

[1067] Died prematurely and died unnecessarily.

[1068] So basically the front piece of the suspension rod through the helmet.

[1069] Yeah.

[1070] But the real point is unnecessarily in that he didn't need to be pushing that hard at that moment.

[1071] I mean, we could do a whole podcast on his death.

[1072] But going back to your macro point, absolutely.

[1073] Health span matters, and I think most people will arrive at the conclusion you did, which is, I do not want extreme lifespan if the latter years are in low quality.

[1074] And interestingly, the medical system we live in is fixated on lifespan and not health span.

[1075] Because it's quantifiable, right?

[1076] You can see the appeal of it.

[1077] It's like, well, if you go to 112, that's better than 110.

[1078] The medical definition of health span is not a very robust one.

[1079] It's the period of time in which you are free from disability and disease.

[1080] That's a very low bar.

[1081] And it doesn't mean anything.

[1082] Like, what does that mean?

[1083] What does disability mean?

[1084] I'm technically nowhere near as able as I was at 20, at what point will I become quote unquote disabled?

[1085] And if you're an agony getting out of your recliner, you're not disabled, but is that how you want to live?

[1086] Is that quality of life?

[1087] And even where do we draw the line for disease?

[1088] You and I have prostate cancer right now.

[1089] Well, we have multiple cancers, I'm sure, right now, yeah.

[1090] But like, the question is, are we going to die from that?

[1091] So I would say if we could define health span better, we would have a better chance of managing the metrics that matter.

[1092] And in some ways, I think what the book tries to do is come up with a far better sense of what health span is and points out if you really optimize on health span cognitive physical and emotional you will get the lifespan benefits along the way okay so let me just really tie up your career which is you did this risk assessment for a long time ultimately you started your own private practice where you help people become optimal and in doing this you ask your patients i'm going to start with what do you want the last 10 years, your marginal decade to look like.

[1093] Do you want to be kayaking?

[1094] Do you want to dance?

[1095] What do you want to do?

[1096] And I think all of us have a fantasy.

[1097] I probably won't be on a motorcycle at the track, sadly.

[1098] In the last 10 years, I don't know, but that would be one of mine, right, if I was shooting for the stars.

[1099] But once, and I love this calculus, once you establish what you want to do, we actually know what it takes to do those things.

[1100] We know what kind of muscle mass you have to have.

[1101] We know what kind of lung capacity and oxygen volume you have to have to do these activities.

[1102] And if we know what those numbers are and we know how precipitously you decline, that's pretty exact as well.

[1103] We can back, Phil, and figure out where you need to be today.

[1104] So as you decline year over year, you'll end up where you want to be.

[1105] This is kind of a cool novel.

[1106] I don't know if it's proprietary to you, but it's a very cool way to look at your life and assess it and set goals.

[1107] Yeah, I'll give you an example just because I did one yesterday with a patient.

[1108] He's 62.

[1109] We were going through the marginal decade exercise.

[1110] And we start with the high level stuff.

[1111] So he is obsessed with soccer.

[1112] And one of the things he wants people to do in the last deck of his life is take his grandkids to every MLS stadium in the country.

[1113] I want to get sort of granular.

[1114] And he says, okay, so we have a cabin and it sits above a lake.

[1115] And there are 80 steps that go down to the lake.

[1116] And I love to paddleboard.

[1117] And he's like, if I could be in my mid -80s, and I could walk down there, paddleboard, and walk up, I would be living the dream.

[1118] And I was like, perfect.

[1119] Let's now quantify that.

[1120] Okay, the steps are six -inch steps.

[1121] We can calculate, to your point, the exact V -O -2 max that is required to get from the bottom to the top without stopping.

[1122] Cardio -respatory capacity.

[1123] We also know the amount of eccentric strength you require to walk down 80 stairs.

[1124] Because, by the way, it's going to hurt more to walk up.

[1125] You have a greater chance of injuring yourself walking down.

[1126] Right.

[1127] When you get older, you lose your brakes.

[1128] So breaks are the things that save you when you're walking off curbs, downstairs, et cetera.

[1129] Totally different training system.

[1130] So we have metriced everything that he wants to do.

[1131] And so now we know, okay, your VO2 max needs to be X. You need to have this much eccentric strength, this much concentric strength, this much lower leg variability at 60 to be able to do this at 85.

[1132] Because, as you said, we know the rate of decline.

[1133] Right.

[1134] And you're not there.

[1135] So you're way higher now than you need to be at 85, but you're nowhere near high enough to account for that.

[1136] Isn't that a great way to value?

[1137] So you have to now train up to the level, which will take you about five years to train up to that level so that as you continue to train and the inevitability of decline kicks in, you will hit your goal.

[1138] So think of it as a glider.

[1139] If you know where you want the glider to get, you can predict how high you need to be here to make sure you land over there.

[1140] Yeah, another great way to look at it.

[1141] Now, you're asking the very hardest ask, really.

[1142] This is an ounce of prevention's worth of a pound of cure.

[1143] This is the marshmallow test.

[1144] This is delayed gratification.

[1145] This five years of building.

[1146] But it's a little better than that.

[1147] But on the surface, it's like, wait, you're going to ask me to basically triple my fitness or whatever it is so that I can enjoy this thing 10 years from now.

[1148] The caveat is, no, no, actually, you'll be enjoying tomorrow much more.

[1149] That's the thing.

[1150] And I always point out to patients the difference between what I'm asking them to do and what maybe their investment advisors asking them to do.

[1151] If you think about it, when you're 25 years old, let's say you were wise enough to seek counsel from someone and they told you like, hey, if you could put 15 % of your paycheck away every single week right now, this is going to pay enormous dividends when you're in your mid -60s.

[1152] You can show them all the spreadsheets and they can intellectually get it.

[1153] But the truth of it is, they literally get.

[1154] nothing for the next 40 years when they do that.

[1155] The payout is truly 40 years away.

[1156] In that sense, it's still worth it, I think, to do that.

[1157] And we talk about some caveats around those things, right?

[1158] I don't know if you've read Bill Perkins' book, Die with Zero.

[1159] No. Die with Zero, by the way, takes a different take, which is most people aren't spending enough when they're healthy enough to enjoy it.

[1160] Yes, travel.

[1161] Yeah, yeah.

[1162] With all this stuff I'm asking you to do, there is a huge compounding benefit of it, but it's also paying you a dividend every day in real time.

[1163] It's a benefit you will realize today.

[1164] I've been proselytizing after reading dopamine nation on here for a while.

[1165] So I think a lot of people are pretty familiar with the notion of suffering for six minutes in cold water, getting a two and a half hour dopamine elevated state.

[1166] Working out produces suffering equals prolonged and asymmetric dopamine, which is ideal.

[1167] So even if you're just a dopamine junkie like me, it'll be immediately satisfying en route to getting to this ultimate platform.

[1168] that you will then glide into your 80s with.

[1169] But it is a big ask, I think, or it's the thing people are least receptive to.

[1170] Because let's talk about right now medicine 2 .0, how we think about disease, chronic disease, the ones we fix, the ones that are still lingering, what the mass percentage of all of us will die of, and how those things are completely impervious to intervention once they've begun virtually.

[1171] Let's get into that.

[1172] So how do people die?

[1173] And what's medicine 1 .0, 2 .03 .0.

[1174] Medicine 1 .0 was medicine before there was a scientific method and an understanding of disease and treatment and how to test ideas even.

[1175] We pretty much died fast deaths, as I talk about it in the book, and fast death is essentially infection and trauma.

[1176] That's more or less how we died for 99 % of our existence on this planet as humans.

[1177] And during the era of medicine 1 .0, which ran right up until, basically the end of the 19th century, we didn't really know anything.

[1178] The first novel thing was this isn't induced by the gods.

[1179] Yes, exactly.

[1180] That was the breakthrough in Greece.

[1181] I mean, even Hippocrates moved away from that.

[1182] Right.

[1183] But prior to that, it was bad humors and the gods are doing this to us, et cetera.

[1184] Now, Hippocrates didn't have the tools scientifically to understand much more, but he knew there was something in the natural universe that was doing this.

[1185] But Francis Bacon, in the mid -1600s, sort of codifies the scientific method as a way in which you test ideas.

[1186] We take this for granted today, but if you think about it, it's kind of a remarkable idea that allows you to disentangle cause and effect.

[1187] There are a couple other things that took place over the next couple hundred years, the development of the light microscope being an enormous piece of the puzzle, because now you could for the first time look at things that you didn't realize existed before, namely bacteria, then obviously the development of antibiotics.

[1188] And so in a relatively short period of time, medicine 1 .0 progresses to medicine 2 .0.

[1189] These things in the span of two to three generations literally double human life expectancy.

[1190] Yeah, it's the biggest paradigm shift in medical history and remains so.

[1191] 70 % of deaths are kind of neutralized by these technologies.

[1192] Yeah, in fact, I think I have a chart in the book where I point out that if you go from the life expectancy over a hundred year period where it goes from just under 40 to about 80.

[1193] If you strip out the top eight infectious and communicable diseases, it hasn't changed.

[1194] Oh, wow.

[1195] And there's more to it, right?

[1196] There's critical care.

[1197] There's trauma care.

[1198] Like, if you have a heart attack today, by the way, your risk of dying is much lower because we've got stents.

[1199] We've got clot -busting drugs.

[1200] We've got AADs.

[1201] Exactly.

[1202] We've got the whole thing.

[1203] I always want to be careful because it feels like, oh, I'm offending people if I say medicine 2 .0 has kind of failed this.

[1204] No, no, no. It's done an amazing thing.

[1205] thing to date, but it is ill -equipped to cope with slow death.

[1206] And slow death is what we die of now.

[1207] Which is the four horsemen.

[1208] So cardiovascular disease and cerebrovascular disease, cancer, neurodegenerative disease, and all of the metabolic diseases that simmer underneath them.

[1209] So type 2 diabetes, fatty liver disease, insulin resistance, all of the things that double your risk effectively of the other horsemen.

[1210] That last category, am I right?

[1211] And they lower the entire system, those metabolic disorders.

[1212] That's right.

[1213] When you are anywhere on that spectrum from insulin resistance to type 2 diabetes, your risk of Alzheimer's disease, heart disease, cancer.

[1214] Your brain's functioning worse.

[1215] It just becomes systemic.

[1216] Okay, so 19 million a year, you say globally die of heart disease, which is much higher than cancer, which I guess is.

[1217] Cancer is about 12 or 13.

[1218] Little shock to hear that.

[1219] As was I. Because in the U .S., it's not as big a gap between cancer and heart disease.

[1220] In large part, I think, because we're doing better against heart disease than the rest of the world is we have a lot more tools yeah exactly we have the quadruple bypass we've got some shit that we can't do with cancer you're saying death by yes okay so we just got to be very clear and i think anyone who's had a family member they themselves have been going through it not to be dismissive of medicine 2 .0 but these four horsemen all of our current and modern technologies to treat them are really bad you'll be like the fifth expert we've had to talk about how terrible we are at treating chronic disease.

[1221] We're worse in some than others, right?

[1222] So we probably have had more success in heart disease than we have in others in cancer.

[1223] There have been some pretty exciting breakthroughs in the past decade with respect to immunotherapy and checkpoint inhibitors.

[1224] But I think it's about an 8 % improvement in survivals over the last 50 years in cancer.

[1225] Obviously, some things are coming online.

[1226] A .I will actually, in theory, be able to deal with the primary and foundational issue of treating chronic illness, which is we are so individualistic and the things that are going to work for us are going to be individualistic treatments and there's no real capacity in the current system to analyze all this data to map your genome to actually figure all this out the amount of manpower that would take is not realistic although we may be approaching some help on that side of it i think there's a more fundamental problem which is if we could draw the analogy back to medicine the transition from 1 .0 to 2 .0 the fundamental issue was the new way of thinking around the embracing of the scientific method.

[1227] Without that, there could have never been the transition, and all the microscopes and antibiotics in the world wouldn't have mattered.

[1228] Similarly, I think that the analogous transition from 2 .0 to 3 .0 comes down not to the technology, although more technology will undoubtedly be better, but it comes down to an understanding of how you must treat causal risk factors immediately, as opposed to waiting.

[1229] I think this is the thing that Medicine 2 .0 is getting very wrong.

[1230] Medicine 2 .0 is using a playbook, which says, treat once disease is there, meaning make the patient live longer with disease.

[1231] Medicine 3 .0 kind of acknowledges we're going to abut the limits of technology, and we're only going to eke out marginal benefits there.

[1232] The game is one when you live longer without disease.

[1233] That's a conceptual breakthrough, but if you fully, in terms, personalize it, you treat prevention in a very different way.

[1234] Well, this might be a great time to talk about the centenarians.

[1235] People who've lived to 100, and you've studied them a bunch for this book.

[1236] And what you found was that they, in general, drank more and smoked more and ate shittier.

[1237] They did?

[1238] Oh, my God, that's great news.

[1239] I know.

[1240] You're going to live to be a thousand.

[1241] I love it.

[1242] I'm going to die of 52, sober.

[1243] but what you discovered immediately is that you're not looking at a group of people who were great at fighting off illness what you're looking at is a group that delayed the onset of any of these chronic illnesses and that they themselves died at the same rate everyone else dies of them once they're there that's exactly right centenarians have a superpower because we know it's genetic it's not behavioral so their superpower is not because they eat kale every day or pick your favorite biohacking trick no it's a purely genetic gift that they got.

[1244] Well, let's call it a sacrament, because all this diet shit's religion now.

[1245] Yeah, exactly.

[1246] So pick your sacrament.

[1247] Take your sacrament.

[1248] As a broccoli, is it meat.

[1249] And so their gift, which is bestowed genetically, is that they live longer without disease.

[1250] And so I go through a number of examples.

[1251] But if you decided to kill somebody at 85 who's going to become a centenarian and you look at their coronary arteries, you wouldn't be able to distinguish them from a 65 -year -old.

[1252] So if you look at the age at which they have their first heart attacks, get their first diagnosis with cancer, it's always about 20 to 30.

[1253] 30 years after a non -centenarian.

[1254] Right.

[1255] It's not like there's super healers that can combat illness in their bodies.

[1256] They just happen to be genetically.

[1257] That's right.

[1258] There happened to be a whole lot of genes, none of which by themselves are remarkable, but in some weird polygenic combination, just bestow this beautiful talent of delaying them.

[1259] And I talk about a number of them.

[1260] So I remember when I first realized this, which was 2012.

[1261] And I was happy.

[1262] Because I was worried that there would be nothing we could learn from centenarians.

[1263] But instead, what I took away from it was, well, while we can't mimic their genotype, we can mimic their phenotype.

[1264] If we can do the things that they don't have to do to delay the onset of disease, we might not live to a hundred, but we're likely to live longer, better.

[1265] And now there are tools by which people can live better, increase their health span, ultimately get to the height they need to be at for the glider to live.

[1266] land where they want to be at 85.

[1267] And those tools are nutrition, exercise, sleep, emotional health, and medications, which would include hormones and supplements.

[1268] We should hit the most powerful one right out of the gates.

[1269] And then I'm going to resist the urge to get all the answers I want with my own hormone therapy.

[1270] And I think we should really focus in on women because I think women have been excluded from this treatment for really important reasons that need to be debunked here.

[1271] And I think maybe we should focus on women for this.

[1272] I'm policing myself.

[1273] I'm stating out loud my objective to not self -serve on this.

[1274] No, it's interesting.

[1275] I get asked all the time to speak about both TRT and HRT, which we kind of use as terms to distinguish between male and female.

[1276] And the HRT story is much more interesting to me. And it's much more important because there's a lot of bad myths about TRT, but the mythology in HRD is so much worse.

[1277] Testosterone replacement therapy versus hormone replacement therapy.

[1278] It might include estrogen, but also testosterone progesterone okay so let's just say exercise of all these things you've had varying obsessions with nutrition i know you're keto for three years you've run the gamut and your conclusion at the end of it is if there was a single thing you were going to advise people to do it would be exercise of all the interventions and i always put emotional health at the side for the reason you alluded to a little while ago yeah which is if that house is not in order none of this other stuff matters esther prell said it best to you yes how long do you want to live if you're miserable right yeah exactly what's the fucking point so that's really the most important one yes yes yes if that's not in order after 17 everything else is a joke so let's maybe think of it as one plus four we're just putting a pin in that yeah yeah but of the other four i could always find an example of an extreme where if it's not corrected it's catastrophic if you took a person and you didn't let them sleep at all they'd probably die in two or three weeks literally if you let them only sleep three hours a night no amount of exercise is going to fix that problem.

[1279] Like, that's such a catastrophic deprivation.

[1280] Similarly, if you calorie restricted a person to the point of malnutrition, well, at some point, that's going to become the dominant feature.

[1281] So when I say exercise is the most powerful tool we have, what I really mean is, one, it's the only tool for which there doesn't appear to be any upper bound to the benefit.

[1282] There's no upper bound to the lifespan benefits that come from high strength, muscle mass, and fitness, especially strength and cardiorespiratory fitness.

[1283] Muscle mass, you can debate that at some point it becomes counterproductive, obviously, if you look at huge bodybuilders.

[1284] Yeah, they starve their organs.

[1285] Yeah, yeah, yeah.

[1286] So maybe take out the extremes.

[1287] But in terms of what, like, a normal person could achieve.

[1288] And even more important for females, I think this would be counterintuitive for a lot of people that females in general are going to deal with osteoporosis at a rate, I don't know how many standard deviations above males.

[1289] It's definitely higher and it comes back to the hormone question because estrus, for both men and women is the most important hormone in the regulation of bone density.

[1290] And women lose it very suddenly, men don't.

[1291] And then additionally, the best way to create bone density is through heavy strength training.

[1292] Right.

[1293] Also counterintuitive.

[1294] A lot of people assume impact is the best tool.

[1295] And I was surprised to learn this when I did all the research on this for a podcast I did a couple of years ago.

[1296] Turns out heavy lifting actually has a greater impact on bone density than running or something that is, you know, impact -related.

[1297] Well, which makes tons of sense.

[1298] Your body of all of the miracles that exist in it, its ability to create homeostasis or change itself to deal with whatever new is in the system is just extraordinary.

[1299] So if you're lifting more, the body's like, we're not going to let these legs break.

[1300] We've got to make these legs stronger because this person's now lifting more.

[1301] Adaptation is an awesome feature of our existence.

[1302] It's really staggering how quickly it happens and how we adjust and the body knows what to do.

[1303] How many lifting for women is what?

[1304] What would the recommendation?

[1305] be?

[1306] I mean, it's really no different from men.

[1307] The same things I want men doing, I want women doing.

[1308] Deadlifts?

[1309] Yes, deadlifts and some factor of your body weight, right?

[1310] Yeah, and by the way, if a person says, look, my anatomy doesn't lend itself to a deadlift.

[1311] I don't have the years of conditioning to learn the movement.

[1312] You can still do a hip thruster, which is you don't have the axial loading, but it's still giving you a very similar movement.

[1313] Now, the problem with the hip thruster is it's not giving you as much loading on the bone either.

[1314] So when you give up one thing, you give up another.

[1315] But one of the things that I'm most adamant about women doing is farmers carries.

[1316] You hold two heavy dumbbells or kettlebells and walk.

[1317] So you're strengthening grip.

[1318] Everything from your hands to your scapula have to be completely engaged.

[1319] And then you're also, of course, creating that axial load on the spine.

[1320] And your core is really engaged because your balancing mechanisms are all fucked up now.

[1321] You've got weights throwing everything off.

[1322] We have metrics for our patients for everything we do.

[1323] And so for carries, we think a male should be able to carry their body weight for a minute pretty easily.

[1324] And a female, 75 % of their body weight for a minute.

[1325] Okay, we're going to start training.

[1326] Yeah.

[1327] I can't wait to see you in the driveway doing laughs with some, let's see 70.

[1328] That's easy.

[1329] And all you got to do is carry two 40 pound dumbbells.

[1330] You're reset.

[1331] What you might realize when you start is you're going to be limited by your grip.

[1332] And that's okay.

[1333] That's what has to be trained.

[1334] Should I work my way up?

[1335] Absolutely.

[1336] Okay.

[1337] Yeah, don't start at the test set.

[1338] Okay.

[1339] Yeah.

[1340] I say work your way down.

[1341] Start with 300 pounds.

[1342] And then once you recover from the tears, then try 250.

[1343] That will be so easy.

[1344] You say it's the most powerful longevity drug exercise.

[1345] Yeah, when you look at the data, the easiest way I think to make this case is to look at the deficiencies of each thing.

[1346] So what does a deficiency of sleep result in with respect to all -cause mortality?

[1347] What is a deficiency in nutrition?

[1348] And by deficiency, I mean deficiency in optimal nutrition.

[1349] So type 2 diabetes and obesity.

[1350] How does that impact your health?

[1351] How does the impact of horrible sleep impact your health?

[1352] How does the impact of horrible fitness impact your health?

[1353] So that's the easiest way to address this question.

[1354] And when you do it that way, nothing compares.

[1355] I talked about the risk of having type 2 diabetes.

[1356] So that's the most extreme example you can have of being overnourished and metabolically unhealthy.

[1357] That will shorten your life by approximately six years, and it will increase your all -cause mortality by about 40%.

[1358] What that means is if you compare a person with type 2 diabetes to a person who does not at any point in time where they're standing, the person with type 2 diabetes has a 40 % chance greater risk of dying in that coming year.

[1359] So it's significant.

[1360] That's not that different from smoking.

[1361] That's the binary evaluation of it, but there's so many other...

[1362] The quality...

[1363] We're not even talking about the change in your vision, the erectile dysfunction, the amputations.

[1364] It's nuts what the body will start doing.

[1365] Right.

[1366] Does nutrition matter?

[1367] Absolutely.

[1368] That's the most extreme example of why nutrition matters.

[1369] Now we talk about sleep.

[1370] Well, what?

[1371] is sleep deprivation do similar analysis not quite as big a number but in the same ballpark these are epidemiologic so i would just argue that sleep deficiency type 2 diabetes they're all about the same and they work in concert quite often hormonal issues when you're sleep deprived there's a lot of things that don't get processed is daunting though because you can't control it necessarily but you can control the environment so much like i used to not be a great sleeper and i would say of all the domains now like I probably would give myself highest marks on sleep.

[1372] Really?

[1373] No kidding.

[1374] What's your routine?

[1375] I mean, I always hesitate to say this stuff because people are like, oh, that guy's such a dogmatic piece of shit.

[1376] Well, you're a certain type of person.

[1377] Yeah, I do what I do and it works for me. So I use this thing called an eight sleep, which I have no affiliation with, but it's like a company that makes this mattress cover, and it cools the mattress.

[1378] I have the same, not that brand, but I have an uller, yeah.

[1379] Yeah, and I love this thing, and your spouse can be at a different temperature.

[1380] My wife does not like it to be as frigid as I do.

[1381] So super cold.

[1382] The room is kept also very cold.

[1383] As cold as my wife will let me make it.

[1384] It's dark.

[1385] And then I also have a real routine around what I'm doing before bed.

[1386] So I have two phones.

[1387] I have like my regular phone.

[1388] And then I have my bat phone.

[1389] The bat phone has no email on it.

[1390] Nobody knows the phone number.

[1391] It has no social media on it.

[1392] The only purpose of it is to use the savant system and to take pictures.

[1393] So it's the phone that I use if I'm out with my kids and I just want to be present.

[1394] It's the only phone I'm looking at after dinner.

[1395] It's the only phone I have with me. This was probably top five ideas I've ever had in my life because I realized I was internalizing crap I was seeing in email or getting text messages or even allowing myself to look at social media in the evening.

[1396] Well, the problem is you want some of the features.

[1397] Yeah, I want the camera.

[1398] Yeah, exactly.

[1399] Yeah, you want to be able to navigate to the restaurant you've never been to, perhaps.

[1400] That's right.

[1401] So just a little bit of hygiene around preparing the body to sleep.

[1402] And then I have just kind of a whole list of supplements that I use, like glycine, aschwaganda, magnesium L3 and 8, sometimes phosphatidilcerine, and sometimes tracidone, which is actually a low dose of what was formerly used as an antidepressant never took off as an antidepressant because people were too tired.

[1403] People were too tired if they were taking 300 milligrams of the stuff, which was the dose you needed as an antidepressant, but if you take like 50 milligrams, you still actually get tired.

[1404] Yeah, I take a half of tracadone.

[1405] I'm allergic to it, though.

[1406] When I take it, my nasal immediately I get clogged.

[1407] I cannot tip.

[1408] over a half, I have to break the pill on half, or I start getting that.

[1409] What do you think that is?

[1410] I don't know, but I would see if you could find a really good compounding pharmacy and see if they could try and make it with a different filler.

[1411] Ah, maybe the filler I'm allergic to.

[1412] You have to be careful with compounding pharmacy.

[1413] Some of them are so dicey.

[1414] That's a separate discussion.

[1415] Right, right, right.

[1416] Okay, so exercise we've made a case for.

[1417] Let's talk about why.

[1418] I think most men of my age, whether or not they're on hormone replacement therapy, they certainly have friends.

[1419] who are.

[1420] Women don't have that luxury whatsoever.

[1421] And a lot of it's based on one single study.

[1422] Yeah.

[1423] So in 2002, a study was published called the Women's Health Initiative.

[1424] And the purpose of the study was to test this idea in a prospective, randomized fashion, which was do women who take hormone replacement therapy have a lower risk of various outcomes?

[1425] So bone fractures, heart disease, cancer, et cetera.

[1426] And prior to this, it had just been largely accepted that hormone replacement therapy was a good thing.

[1427] There's one very obvious, undeniable fact about hormone replacement therapy, which is it reduces what are called vasamotor symptoms.

[1428] So when a woman goes through menopause, I'm sure you've known women who have, one of the things they'll often talk about is, I've got these hot flashes and night sweats.

[1429] And that's due to estrogen withdrawal.

[1430] And so when a woman is experiencing estrogen withdrawal, she's going through those vasimotor.

[1431] symptoms.

[1432] Now, they tend to be somewhat transient.

[1433] The odd woman never experiences them.

[1434] Most do.

[1435] And they won't go on for her entire life, but they could persist for five to seven years.

[1436] And for some women, it's beyond disruptive.

[1437] There are also sexual side effects that don't get talked about very much, but vaginal atrophy, vaginal dryness, pain with intercourse, reduced libido.

[1438] And again, nobody wants to talk about those things, so it sort of gets ignored.

[1439] Dry vagina is one of my favorite topics but anyways continue i guess i'm an anomaly outlier so again historically starting in the 1950s or 60s basically physicians were treating women with estrogen and progesterone initially they forgot the progesterone they didn't realize that was important until they figured out if a woman still has her uterus and she just gets estrogen the lining of the endometrium thickens and it increases her risk for uterine cancer so once that was figured out it was realized nope you got to get progesterone as well because it opposes the estrogen and makes sure the lining doesn't get too And everything was going great.

[1440] And all of the observational epidemiology said, HRT is God's gift to women.

[1441] Then this study comes along and says, well, we should really test this.

[1442] And so the test was done.

[1443] And in 2002, the trial was halted early because the authors concluded that HRT was increasing the risk of breast cancer.

[1444] There aren't many topics I've gone deeper on than this one.

[1445] So I'm going to have to figure out a way to explain this in three minutes as opposed to four hours.

[1446] Yeah, yeah, yeah.

[1447] interviewed Joanne Manson, who was one of the PIs on that.

[1448] So if people really want to get into the weeds on this, they can go and hear that podcast.

[1449] And I've written about it extensively.

[1450] But the Reader's Digest version is the study was done in a pretty suboptimal way.

[1451] First, they excluded young women.

[1452] They excluded women going through menopause.

[1453] What was the average age?

[1454] Late 50s.

[1455] The women were on average about 10 years out of menopause.

[1456] The rationale for that, there were kind of several given.

[1457] And people give you different stories when you talk to people.

[1458] I've kind of gone down the rabbit hole on this a bit.

[1459] Some argue, well, we just want to mimic what's being done in the community.

[1460] Some argued we couldn't have symptomatic women in the trial because they would never accept a placebo.

[1461] And they would know they were on the placebo because their hot flashes and night sweats wouldn't be going away.

[1462] So there may be some merit to that, but keep that in the back of your mind.

[1463] The other thing that I would argue is the biggest criticism of the trial, and I'm amazed it doesn't get talked about today, is the formulation of HRT that they received.

[1464] While I understand why they did it, it was a dominant source at the time, is not something that's used today.

[1465] There's two trials run in parallel.

[1466] One for women with a uterus, one for women without.

[1467] So if you don't have your uterus, you just get estrogen.

[1468] The type of estrogen they got was called conjugated equine estrogen, which is the estrogen extracted from the urine of mares.

[1469] So it has 12 different estrogens in it, of which estradial is the dominant one.

[1470] The women who did have a uterus would get that conjugated equine estrogen plus a synthetic progesterone called MPA.

[1471] And these were both paired up against a placebo.

[1472] After about five years in the group that got the estrogen and the MPA, the synthetic progesterone, their risk of getting breast cancer was five cases per thousand.

[1473] In the placebo group, it was four cases per thousand.

[1474] In the other group, it was reversed.

[1475] So the implication was in the MPA plus estrogen group, you had a 0 .1 % in absolute risk increase of getting breast cancer, but it was a 25 % relative increase, right?

[1476] Five versus four cases per thousand.

[1477] So the headline turned into HRT increases risk of breast cancer by 25%, which turned into estrogen, except everybody conveniently forgot that the estrogen only group had the opposite.

[1478] The estrogen only group had a 25 % reduction in breast cancer.

[1479] Both, I would argue, completely irrelevant.

[1480] Here's what's interesting.

[1481] No difference in survival.

[1482] This was only a difference in incidents.

[1483] of breast cancer.

[1484] There was zero difference in mortality from breast cancer.

[1485] Yes, but I have an overarching frustration with the way science is reported in the media and my anecdotal examples.

[1486] I got curious like, wow, all the data's in.

[1487] Was Sweden right or wrong about not distancing?

[1488] I wanted to find out.

[1489] So I start typing that in the internet and I start finding out almost identical thing.

[1490] 25 % higher death rate.

[1491] Well, that's pretty fucking significant.

[1492] I guess they paid the price.

[1493] Dig a little deeper, dig a little deeper.

[1494] By the way, it's the exact same numbers.

[1495] It is.

[1496] four out of 10 ,000 deaths versus five in Sweden.

[1497] Sure, that's 25%, but that is nothing.

[1498] That's 0 .005 versus 0 .004.

[1499] Yeah, what's the collateral cost?

[1500] And if your rate of something is one in a billion or 1 .5 in a billion, sure, it's 50 % higher, but of what?

[1501] Many years ago, a guy named Bob Kaplan and I wrote a six -part series called Studying Studies to help people understand how to read science.

[1502] And one of the things that we spent an entire article on was make sure you always know the difference between relative risk and absolute risk.

[1503] And it's sort of one of my pet peeves when the absolute risk data are known and they're buried because they don't sound as sexy as the absolute risk, right?

[1504] The two cases per billion versus one case per billion, the relative risk is 100 % difference or 50 % if you're reducing.

[1505] That sounds amazing.

[1506] So the study was not only halted, but it overnight, and I mean literally, overnight changed the practice of hormone delivery to women.

[1507] And what is most infuriating to me, I actually had one of my analysts build a model to look at this, which was, can you estimate for me over the past 20 years how many women have been deprived of hormone replacement therapy as a result of this study and how many additional hip fractures that's resulted in versus how many lives have been saved due to breast cancer?

[1508] The latter is an easy question to answer.

[1509] The number of lives that have been saved due to breast cancer reduction is zero.

[1510] There was no difference.

[1511] Even when they did the 17 -year follow -up, there was still no difference in breast cancer mortality, only a 0 .1 % difference in breast cancer incidents.

[1512] And that was only in the CEE plus MPA group.

[1513] The CEE alone group had an actual reduction in breast cancer incidents, no difference in mortality.

[1514] Your point, none of this matters.

[1515] It's all irrelevant, basically.

[1516] Versus what hip fractures.

[1517] What do we model that on it?

[1518] We estimated very conservatively.

[1519] I think we said about 20 ,000 women have died of hip fractures in that period of time.

[1520] That could have been prevented.

[1521] And that says nothing about symptoms.

[1522] So then how many women have...

[1523] Quality of life has been detracted.

[1524] I think it's unavoidable that there's some underlying misogyny here.

[1525] When men have a problem, well, let's pull out all the stops and let's fix this.

[1526] When women have a problem, either they should suffer.

[1527] I don't know what it is.

[1528] They're not prioritized.

[1529] Their symptoms are actually worse than ours.

[1530] Yes.

[1531] And yet they're under -treated.

[1532] I was losing interest in my hobbies.

[1533] I wasn't breaking out in a full sweat at the movie theater and needing to go into the bathroom and towel myself down.

[1534] I just didn't want to go to the track as much, and I didn't like that.

[1535] I think there is some undercurrent of misogyny behind this.

[1536] I think that's probably fair.

[1537] I don't know how conscious or unconscious it is, but it really frustrates me how much time I have to spend arguing with other doctors about this.

[1538] I know, you know, I have a hormone doctor, and my wife was like, give me his number.

[1539] I want to get tested and I want to see if I should be on stuff.

[1540] And he said, I don't do women.

[1541] What?

[1542] Which is very, very common.

[1543] Just because they don't feel like they know enough about it?

[1544] No, I think they just don't want the liability.

[1545] Public consensus is so moral panicky about it.

[1546] But doesn't testosterone can cause stuff?

[1547] There's some liability there too.

[1548] Yeah, I also think HRT in women is much more complicated.

[1549] Like when I really wanted to learn this, I had to go and find people who were doing this every minute of every day, go to their clinics, work with them, see the cases.

[1550] is it's much more nuanced.

[1551] Of course, the interesting thing is, to me at least, it is very clear that the negative effects of the HRT in the Women's Health Initiative were due to the MPA.

[1552] I think there were some other factors going on, but the point is nobody uses MPA anymore.

[1553] Women today use bioidentical progesterone.

[1554] They use something called micronized progesterone.

[1555] Alternatively, if they don't like progesterone, because a great number of women can't stand progesterone.

[1556] It drives them crazy.

[1557] So what you do in a case like that is they just use progesteruncoded IUDs because that gives the local protection to the endometrium.

[1558] And then they're just on their bioidentical estrogen, which the easiest way to do that is typically a patch or a cream.

[1559] And I'm pretty sure that we can very confidently say that we're not increasing their risk of breast cancer, cardiovascular disease.

[1560] And I think there's pretty good evidence we're reducing their risk of heart disease.

[1561] And at least for women with an APOE4, probably their risk of dementia as well.

[1562] And we're unquestionably reducing their risk of bone fracture as long as improving symptoms.

[1563] Birth control is...

[1564] Birth control is, but it's a lower dose.

[1565] Okay.

[1566] So, yeah, birth control works by giving you a high enough level of estrogen and progesterone, but it's synthetic to prevent you from ovulating.

[1567] Oh, okay.

[1568] I'm really glad you laid that out.

[1569] I think that women should feel just as encouraged to go explore that as an option for increasing your health span as a man would feel.

[1570] Women don't know anything about women's bodies.

[1571] did a show about me and Liz Plank, we froze our eggs at the same time we did this show.

[1572] Every time I went to the doctor, we were like, we don't know what anyone's talking about.

[1573] We don't know what that is.

[1574] We don't know what FSA.

[1575] We don't know anything because you're not taught it.

[1576] They didn't do clinical drug trials on women.

[1577] We find out an accident ambience twice as potent in them.

[1578] You know, they don't like to study women because they have a period.

[1579] And for three days of the month, they're afraid that their results won't be.

[1580] You know, there's all these crazy explanations for why they've just not been studied, not been.

[1581] in trials.

[1582] Stay tuned for more armchair expert, if you dare.

[1583] Okay, I guess the thing that I am most curious about that I would like you to explain to us, and this is really for Monica's sake as well, is I think there's so much confusion around cholesterol.

[1584] I know, if I can just tell you anecdotally what happened to me, which is I've always had really high cholesterol.

[1585] And then, of course, I've had low HDL as I've been on testosterone, is that's, tends to be a side effect, I'm told, of testosterone.

[1586] It lowers HDL.

[1587] How much are you taking?

[1588] I'm on a pretty average, moderate dosage.

[1589] What's your total testosterone and free testosterone levels?

[1590] Total is usually between 900 and 1100.

[1591] Okay.

[1592] That's actually what qualified me for is my total T was lower, but fine.

[1593] My free T was a mess.

[1594] I had a ton of the binding clobulin, but that is all straightened out over the course of it.

[1595] But regardless, I had bad cholesterol results.

[1596] and then had the plaque scan of the heart, had 0 % plaque.

[1597] So then my general practitioner told me, well, let's do your arteries in your throat and see if there's plaque in there.

[1598] If there's not, I don't really care about these numbers.

[1599] Now, there was a tiny bit in my carotid.

[1600] So I then ultimately went to red yeast.

[1601] It's lowered it in the range.

[1602] Everything's groovy.

[1603] Monica just got some really bad.

[1604] Well, well, well, well.

[1605] Yeah, there was a mistake in the results.

[1606] Tri glycerides.

[1607] Yes, it said I had the range.

[1608] like 600 triglycerized and I was like I should be dead I don't understand but had you accidentally eaten before was it not fasting I had fasted and so that's what my doctor was like you need to do this again with fasting and in my head I was like oh my god I went back a week later the test was fucked up so I did retake triglycerides were fine normal HDL high and LDL is also high my ratio's good you're above the range they want you to be in total yes exactly above the range and it's genetic also definitely runs in my family, but I decided not to care too much about it.

[1609] Well, he's going to tell us, so I think you should break down cholesterol for us and explain to us what APOB is in LPA and APOE, and there's ways for us to discover whether we need to be obsessed with this or not.

[1610] Is that fair to say?

[1611] Yeah, I mean, I think you probably have to start with a bit of an explanation of what cholesterol is.

[1612] It's just a fat, and it's made by our body.

[1613] We make a ton of this stuff because it's essential for life.

[1614] It's necessary for every single cell in your body to have cholesterol in its cell membrane.

[1615] And then some of the most important hormones in your body are made from cholesterol.

[1616] So testosterone, estrogen, progesterone, cortisol, to name a few.

[1617] Every cell in your body, except for red blood cells, make cholesterol.

[1618] But the problem is you have to be able to move this stuff through the body.

[1619] How do you move something in the body?

[1620] Well, you typically move through blood.

[1621] Our blood moves a lot of things.

[1622] Everything from oxygen and hemoglobin and carbon dioxide to electrolytes and glucose.

[1623] So blood is water with protein in it.

[1624] So everything that moves in blood, either needs to be water soluble or needs to be trafficked in something that is water soluble.

[1625] Those are the only two conditions.

[1626] So glucose, sodium, potassium, they're water soluble.

[1627] So how about it?

[1628] They just get to travel freely.

[1629] Cholesterol, not water soluble.

[1630] Therefore, it needs to be packaged in something.

[1631] That something is called a lipoprotein.

[1632] Those lipoproteins, if you separate them on a gel, which is just a technique you do in the lab, you would come to realize they have different densities.

[1633] So there are high density ones, low density.

[1634] density ones, very low density ones, and hence the name, low density lipoprote, L -D -L -H -D -L -L -D -L -L -D -L.

[1635] The observations between the relationship between cholesterol and cardiovascular disease, without telling you the entire story, which is fascinating, I'll just give you the punchline, is that the ones that have something called an APOB wrapped around them, which are the LDLs and the VLDLs, they are the ones that go into artery walls.

[1636] They penetrate the little cells of the artery wall, they get stuck back there, and they undergo a chemical process called oxidation.

[1637] Once they get oxidized, that is inflammatory, and the body says, I got to go fix that, because the body thinks there's a problem, which there is.

[1638] What the body doesn't realize is it's not an infectious problem.

[1639] And so unfortunately, the body tends to overreact to that, sends immune cells, which create a cascade of inflammation that ultimately results in the body trying to rebuild it, put smooth muscle there, put calcium there, sort of like you would would pour concrete over a nuclear reactor.

[1640] And not just making the circumference smaller.

[1641] It's taking up space and restricting.

[1642] Yes.

[1643] And flow through there.

[1644] But typically, that's not what's going to kill you is not the slow, gradual reduction of diameter of the artery.

[1645] What's going to kill you is when these plaques, as they're now called rupture, and that creates an acute clot that immediately results in the cessation of blood flow and oxygen to the heart.

[1646] So that's what a heart attack is, or a stroke if it occurs in the brain.

[1647] I don't want one to pop.

[1648] I don't want a popper.

[1649] Oh, I don't want to pop out.

[1650] So early 80s, the observation was, hey, the amount of cholesterol in those LDL particles, we call that LDL cholesterol, that's the number you see on the lab, that number seems to correlate pretty well with your risk of heart disease.

[1651] The higher that number, the higher your risk, lower that number than lower your risk.

[1652] We know today that there's an even better way to approximate your risk.

[1653] of heart disease, and it's not by looking at the cholesterol in the LDL particle, but it's by counting all of the particles that can go in the wall, which are mostly LDL, 85 % of them are LDL, but it's also VLDL and even another one called LP -L -A.

[1654] And the way to count them is to measure the concentration of that thing that wraps around them called APOB, or APA -Laprotein B. So we don't really look at the LDL cholesterol.

[1655] We don't care about that number.

[1656] We care about the APOB concentration.

[1657] Why isn't this the standard test they're giving us?

[1658] Oh, God.

[1659] People who poop who it will tell you that it's more expensive.

[1660] I mean, the most expensive lab I can find in the U .S. that measures an APOB might charge you $18 for it.

[1661] Oh, my God.

[1662] Oh, my God.

[1663] That's way too much.

[1664] If they could get that to nine, I'll get a test.

[1665] Yeah, yeah.

[1666] No, it's largely an ignorance thing.

[1667] Oh, wow.

[1668] This should be, I mean, you have a lot of campaigns right now, but this one should be, I feel like moved to the front.

[1669] I might have more podcast content on this than anything else.

[1670] Okay, okay.

[1671] So this is your cost.

[1672] Is this the thing that sometimes they test once a year?

[1673] My doctor just tested something.

[1674] He's like, I'd like to do this once a year.

[1675] But I don't know what it is.

[1676] Breast exam?

[1677] No. I mean, he did touch my breast.

[1678] No, no, no, no, no, no. I don't remember what it is.

[1679] Okay, go on.

[1680] So APOB, along with another number called L .P. Little A is something that I think everybody should know.

[1681] Now, L .P. L .A. is another type of LDL particle, but it's just a really bad one.

[1682] It has another lipoprotein on it called APOB.

[1683] Lipopoprotein little A. Part of the reason here the nomenclature really sucks.

[1684] Yeah, these are bad.

[1685] These are just bad names.

[1686] If you were writing a movie about this, you'd come up with way better names.

[1687] No, I feel like I have a lot of your story imprinted in my brain.

[1688] But once we get to this cholesterol thing, I haven't even attempted to cement them.

[1689] I'm like, as too many acronyms.

[1690] Now, really quick, I think a lot of people have a spurious idea that your cholesterol is directly what you're eating.

[1691] The cholesterol that's in your food is what becomes a cholesterol in your body, but that's not true, is it?

[1692] Correct.

[1693] The biggest determinant of your color as it's measured in your blood as genetics.

[1694] Again, all but the red blood cell are making the ample amount of cholesterol.

[1695] The cholesterol you measure in your blood only represents about 10 % of your total body pool of cholesterol.

[1696] And you could eat a cholesterol -free diet in theory and still make tons of cholesterol.

[1697] Absolutely.

[1698] We don't absorb very much of the cholesterol we eat.

[1699] There are certain people who have a genetic mutation.

[1700] I can't believe I'm about to say this.

[1701] And they're ATP -binding cassettes.

[1702] Oh, that's what Monica has, ATP -binding cassette mutation?

[1703] Yes.

[1704] In G5 or G8?

[1705] No, I don't have that.

[1706] G8.

[1707] I was combing over our labs pretty soon.

[1708] Yeah, so there are some people that have these mutations in these, in these transporters where they will actually absorb some cholesterol from their diet.

[1709] But for most people, the cholesterol in your diet is too bulky to be absorbed.

[1710] And instead, what we're absorbing is just reabsorbing the cholesterol that we're making.

[1711] So there's a pool of cholesterol that we make, mostly in the liver, that gets recirculated throughout the body, and cholesterol homeostasis is the balance between those.

[1712] Well, I'll tell you when I had my own anecdotal experience with it was I did go vegan for a full year.

[1713] And at the end of that year, when I got my test, cholesterol was exactly the same.

[1714] Clearly, my intake of cholesterol had diminished greatly and zero impact.

[1715] And that's when I was like, oh, this is so clearly genetic.

[1716] What are triglycerides?

[1717] So triglycerides are the storage form of fat.

[1718] A free fatty acid is just the most efficient way we can store energy in the body.

[1719] So it's just a string of carbons with hydrogens on them.

[1720] and breaking those bonds liberate a ton of energy.

[1721] So how would you store those?

[1722] So you take a three carbon backbone and you put a fatty acid on each one, hence it's tri.

[1723] So triacilaclycerol or triglyceride.

[1724] Those lipoprotein things are carrying triglycerides as well as cholesterol because triglycerides also don't dissolve in water.

[1725] So I need to get tested.

[1726] And what test do I request?

[1727] An APOB.

[1728] A standard lipid panel, but make sure it includes an APOB, and an LP.

[1729] Little A. Okay.

[1730] And if those are normal, we're fine.

[1731] Well, again, it depends what normal is.

[1732] I have a much more aggressive standard for what normal is.

[1733] And this is one of the things I talk about in the chapter on heart disease.

[1734] I say this is where I think we're really failing on heart disease prevention.

[1735] You know, heart disease is still the leading cause of death globally and in the U .S. And it's also the leading cause of death for women and men.

[1736] It's kind of like Numero uno just across the board.

[1737] And it doesn't need to be.

[1738] And the reason is we're really missing the boat on the causality of ApoB.

[1739] There are certain things where we're, I think, pretty smart about understanding causal risk.

[1740] So smoking is causally linked to lung cancer.

[1741] That doesn't mean that everyone who smokes will get lung cancer, and it doesn't mean that every person with lung cancer smoked.

[1742] Neither of those conditions are true.

[1743] But there's no disputing the causal relationship between smoking and lung cancer.

[1744] And so our approach to preventing lung cancer must involve not smoking.

[1745] not doing the following.

[1746] It doesn't say smoke when you're young, but once you look like you're going to get lung cancer, we're going to tell you to stop.

[1747] Once we see small cancers, we need you to stop.

[1748] No, when you have a causal risk factor, you have to eliminate it on day one.

[1749] ApoB is causally related to atherosclerosis.

[1750] How do you lower your ApoB?

[1751] So there are clearly dietary ways to do it.

[1752] My view, and this is very unpopular, is do not use your diet as a primary tool to lower your cholesterol.

[1753] Use your diet as a primary tool to control your metabolic health.

[1754] And for some people, that diet will also produce a favorable lipid profile.

[1755] For some people, it will not.

[1756] So I then will bolt on pharmacology.

[1757] We have more pharmacologic tools to control APOB than any other thing that matters in chronic disease risk management.

[1758] Oh, that's great.

[1759] Yeah.

[1760] Whereas some people say, but if I subside on all, only, and they have some obscure plant diet, my cholesterol numbers go down.

[1761] I say that that's great.

[1762] But the problem is you're also protein deficient and you're carbohydrate intolerant and there's all these other things going on.

[1763] So you have done something cool in that you've used this dietary strategy to manage your lipids.

[1764] But I want to use nutrition to manage amino acids to manage muscle mass to manage insulin sensitivity and all those other things.

[1765] So the short answer is there are lots of dietary ways that you can impact lipids, but I treat those like the tail, not the dog.

[1766] Uh -huh.

[1767] And this is where we get into that.

[1768] Statins are one class.

[1769] There's like five classes of drugs.

[1770] Stantins are the most ubiquitous, but they also have the most side effects.

[1771] I know.

[1772] We're against.

[1773] No one likes it.

[1774] And then when I point out that I eat red yeast, which is lowered it, they go, yeah, there's a statin.

[1775] And I'm like, yeah, but I'd rather pay the red yeast farmer than big pharma for their solution.

[1776] I don't know why they're mad when I say I do red yeast.

[1777] I get the same effect.

[1778] Yeah.

[1779] I mean, Red yeast rice is the original statin.

[1780] It's basically what Prevastatin is, the sort of least potent of the statins.

[1781] Okay, we got it just quickly.

[1782] There's so many things in Chapter 17 I liked a lot.

[1783] And it's fun, and you acknowledge it.

[1784] You're like, this chapter almost doesn't feel like it should be in this book.

[1785] It came close to not being in the book.

[1786] Yes, because between Chapter 16 and 17, you transition from physician, chapters 1 through 16, to patient, chapter 17 which of course is impressive as all your academic achievements and the many different career paths you've had i will never be more impressed by a man than when he admits his many many shortcomings and failures that's the bravest that's the most heroic that's what i respect the most and you're pretty brutal on yourself which i enjoyed it's almost like listening to someone in a a a which i'm a member of it's the only place i get to hear that kind of rigorous honesty and taking account and doing an inventory of one's behavior and And yours is pretty fucking abysmal.

[1787] And I applaud you for admitting that.

[1788] It's funny you say that after I got out of the first place I went, which was the bridge to recovery in Kentucky, two weeks stay there.

[1789] Yeah.

[1790] When I got home from that, I do think that one of the reasons I continued to struggle a little bit is I didn't have an AA -like place to go.

[1791] Because when we were at the bridge, we did a 12 -step meeting every single night.

[1792] Right.

[1793] So one night you'd be at N -A, S -A, A -A, and because, because, Because I didn't fit any of those addictions, I was not a participant.

[1794] Like, I wasn't telling my story, but I was still listening.

[1795] And you have to remember where I'm doing this.

[1796] I'm in Bowling Green, Kentucky.

[1797] And there are a bunch of times, Corvette plants.

[1798] Yeah, yeah.

[1799] And so, I mean, there are these big, burly guys with no teeth, meth addicts, destroyed their lives.

[1800] And they're standing up, and they are telling you these stories.

[1801] And I was so moved by this that I, remember thinking you're so vulnerable you're so raw when i got back i was like i need that community like i need to be with other people who are experiencing rock bottom and i just never found it in retrospect maybe i should have just gone to a a and said hey i'm not an alcoholic but i might as well i'm trying to regulate my internal feelings with external things yeah and i'm doing it habitually and destructively and obsessively it's all the same exact thing i was with a friend of mine who's been an a for a time when we were sitting around talking and this comes up endlessly we're all so fucking grateful we were addicts because i don't know how else i find a group of men who are being vulnerable and honest in front of me and demonstrating how i go through life where do i find that i join the fucking elks club i've been doing blend those me that's not what that's about there's no infrastructure unless you're an addict to get that and i just feel like everyone would benefit so greatly from it But your particular ism, if we could say, it's kind of you're a poly addicted, right?

[1802] You're a total workaholic and you have a bit of rage addiction, yeah?

[1803] I can relate so much.

[1804] And perfectionism.

[1805] I love this, you wrote, and you're quoting your therapist, Terry.

[1806] 90 % of mal rage is helplessness masquerading as frustration.

[1807] Yeah.

[1808] I think that's so fucking beautiful.

[1809] We talked about how I think it's very unfair for women that they can't be exploring.

[1810] ways to feel better and be encouraged to do so and have pharmacological answers for that.

[1811] That's so unfair.

[1812] And it's so fucking unfair that men can't possibly share their emotions or acknowledge a weakness or be frail for fear of not getting a mate selected, all these numerous factors on our shoulders that there's just no space for it and that we feel helpless as fuck a lot.

[1813] I'm so scared.

[1814] And the times you see me acting seemingly least scared, I'm the most scared.

[1815] I'm like, it's time to kill or be killed.

[1816] I feel that way because I'm scared I'm going to be killed.

[1817] And it's over nothing because of these childhood traumas.

[1818] It's like, do you ever read, body keeps the score?

[1819] Yeah.

[1820] The most beautiful way to get into that is he's working at a VA hospital and he's watching these vets have these interactions with people working behind a computer and they're having a life -threatening panic overhearing something.

[1821] And he's realizing that information.

[1822] so much different to them than it is to me, something much different is happening.

[1823] And we can't write it off as they're crazy.

[1824] We have to acknowledge and be compassionate.

[1825] I don't know.

[1826] So the notion that you went through all this, I absolutely love.

[1827] And I'm so glad you wrote about it in 17 because it is so important because who gives a shit about lifespan or health span without this?

[1828] How long would you say the process?

[1829] You flipped over a table that pretty much sent you up to Bowling Green.

[1830] No, that was, That was the second one.

[1831] That sent me off to Arizona.

[1832] So I would say the first shoe dropped in, I mean, 2017 is sort of a blur for me. My life was unraveling.

[1833] That's when my friend Paul Conte, probably in about the summer of 2017, really began telling me I needed to go to this place in Kentucky, the bridge to recovery.

[1834] But I'd write about it.

[1835] I kind of had some fits and starts where I committed to go and then bailed and then bailed.

[1836] You treated it like your residency.

[1837] Yeah, yeah.

[1838] You almost got there.

[1839] Yeah.

[1840] And then finally, in Thanksgiving of 2017, my wife sort of gave me an ultimatum and so I went and that was very powerful and very difficult and it was definitely the first time I acknowledged a number of things but I don't think I fully acknowledged or internalized the impact of those things now the good news is when I got back from there and I left a little prematurely you know they really wanted me there for six weeks it was at the time a six week program and during the first two weeks all you're really doing is unearthing the trauma and going through kind of what's called the inner child work but then the last four weeks are the skills you know i just didn't have time it's not that i didn't think i needed the skills but it was like i didn't have time it was like it's christmas i got to go home i can't be away from my patients you know when you're there you're in lockdown mode like you don't have a phone you've a roommate you're in the middle of no privacy yeah and i said i can get these skills as an outpatient and so that's what i basically worked on for two and a half years with some success but not enough yeah you started doing a lot of therapy you have three different therapists at one point that's right and then i have a breakdown in april of 2020 so i had been sober for a long long time in covid relapsed had a full thing covid was very silent if you're someone who grew up in a very unpredictable environment and your goal is to control everything and shore up everything you can sway and then you have this looming thing that is so unknown we have no clue where this is going the Timeline is anyone's best guess.

[1841] The smartest people in the world are flummoxed.

[1842] Even though I didn't acutely or in the moment feel that.

[1843] In fact, I think my role in my group was to try to quiet that fear.

[1844] I think I failed to acknowledge how my own sense of out of control everything had become was.

[1845] It's weird.

[1846] It's only in reflection, do I realize?

[1847] Oh, that thing kind of fucked me out pretty good.

[1848] And I just never felt it in the moment.

[1849] I don't know why.

[1850] It was very curious experience.

[1851] But do you think COVID was part of that for you?

[1852] Yeah, I mean, I know that the day I really lost my mind.

[1853] One of the biggest challenges I've always had is the imposter syndrome.

[1854] So one of the biggest differences between me today and me five years ago is today, if somebody gives me a compliment, I can acknowledge it.

[1855] I can say thank you.

[1856] Yeah.

[1857] And I don't feel like what I used to feel, which is, oh, if you only knew, like I would get so angry when someone complimented me before.

[1858] I wouldn't show them that.

[1859] I would smile.

[1860] but inside there was such a seething rage you're so full of shape you're a fraud you don't deserve this you don't know anything about me you don't know what a horrible piece of shit I am and now I have to fake it even more from you and I was just so pissed but this sense of being a fraud and I don't want anybody to find out and nobody in my life can know this and what happened during COVID in our medical practice the first six months are the busiest we bring on patients in the first six months and then we kind of back off the last six months and that's sort of our cycle.

[1861] So we're bringing these patients on nonstop.

[1862] For me, that's a more stressful time because I'm trying to get to know new people and know every detail about it.

[1863] And now I'm doing it for the first time without seeing them in person.

[1864] So we're doing this over Zoom.

[1865] Basically, I hadn't been back to New York since February.

[1866] There's a pandemic raging.

[1867] They're fearful.

[1868] That's right.

[1869] And on top of that, you have no answers.

[1870] Exactly.

[1871] And I'm spending most of my quote unquote free time with our analysts trying to become as smart as we can on this COVID thing.

[1872] And so, on that particular day, I remember being overcome with a sense of confusion about the patients.

[1873] And I couldn't, for the life of me, remember what was the issue with this guy and what was the issue with that guy?

[1874] And I was sort of venting this to our practice manager.

[1875] And she was trying to make me feel better.

[1876] She was saying, look, you're doing the best you can.

[1877] Like, I think everybody's pretty understanding.

[1878] But the more she tried to comfort me, the more angry I got.

[1879] And that's when I just went ballistic.

[1880] Yeah, yeah.

[1881] Well, the only thing worse than being complimented is to be pitied.

[1882] Yeah, yeah.

[1883] So we were on the phone, and after I got the phone with her, I was at home, I threw a table across the living room and just started destroying the house.

[1884] Wow.

[1885] Yeah, like a child.

[1886] Yeah, because that's how you felt.

[1887] Yeah, helpless.

[1888] I mean, that's exactly the word.

[1889] So you go through the different tools you've picked up, DBT therapy being one that you're a big proponent of, this concept, which I love is evaluating your life as opposed to virtues that you would list on a resume versus virtues that would be read at your eulogy and how there's almost no overlap there.

[1890] The things we pursue for our resume versus what someone's going to say when they remember us, they're not going to mention where you went to college.

[1891] Who would do that?

[1892] That'd be psychotic, right?

[1893] When you started thinking of that being your North Star, the eulogy is very powerful.

[1894] Another thing that was in the chapter 17th that I love is a patient of yours that was highly successful saying, I need to be great so that I don't feel worthless.

[1895] God, I can relate to that.

[1896] This is an epidemic amongst some of the most successful people, and it's very interesting.

[1897] interesting how outward success might even be inwardly, negatively correlated with some of these things.

[1898] I was going to say there's almost no correlation between external and internal, and it might be negative.

[1899] Yeah, yeah.

[1900] I think anyone driven that compulsively is compensating for something, trying to heal something with the wrong medicine.

[1901] And then I was thinking about, well, a few things.

[1902] Of course, when you talk about your kids, I think you and I have told ourselves the same lie, which is I actually have never raised my voice at my girls, or maybe a color.

[1903] couple times when it was like time to stop hitting someone.

[1904] But in general, they've never seen my temper ever.

[1905] Directed towards them.

[1906] Directed towards them.

[1907] Never directed towards their mom.

[1908] And for the most part, they've really only seen about 8 % of it out in the real world.

[1909] I got to do a dust up in Austria last year with a parking attendant that wouldn't let my kids go to the bathroom.

[1910] You know, there's been some moments.

[1911] But what I have lied to myself is that it's not towards them, so why would that scare them, right?

[1912] They know I would never shine that on them.

[1913] But then I go back and I think of the alcoholic stepdad and how the environment changes, how the air in the room changes when someone is in that rageful state.

[1914] And even if you know it's not coming at you, it's just dangerous and it's just scary.

[1915] And knowing that your parent has that side of them is not comforting in any way.

[1916] And so I've really had to confront that recently like, oh, just because it's not aimed at them doesn't mean I am allowed to do it at all.

[1917] in front of them.

[1918] And then getting honest with myself, so I have a technique.

[1919] So in traffic, you say like, oh, someone cuts you off.

[1920] I'd love if that was the only reason I get upset.

[1921] I don't get upset just because someone cuts me out.

[1922] I'm looking in my roof room.

[1923] I'm policing everyone around me. If I see a guy working his way out, I'm already mad about this person way before they cut me off, right?

[1924] I'm on it.

[1925] And I have this trick where I forced myself to start reading license plate numbers of surrounding cars to stop focusing on the person I'm about to have the interaction with.

[1926] And there's this little moment.

[1927] if I'm being dead honest, where it's like, I'm choosing to read the license plate numbers, but there is a euphoria that is attached to my righteous indignation.

[1928] When I am superior to somebody, when I do things better and I'm observing them fucking up, like there is an elevated state.

[1929] So it's not just that I need to avoid the interaction, which is always going to be bad.

[1930] I have to admit I get off on it.

[1931] It is a drug.

[1932] I like being righteous.

[1933] Terry Reel, who's one of the therapists I work with, and you quoted Terry a moment ago, makes this point about rage, which is it's a bit of a sneaky drug because in the short term, the grandiosity that comes from it actually is a form of one -upmanship that makes you feel good.

[1934] The real challenge with it, and this is where I really began to understand my limitations, it was the shame that follows it, and how much it just sets you back.

[1935] It's the ultimate Purick victory.

[1936] It always is.

[1937] And so I think today that might be one of the single most important insights.

[1938] To this day, the most important lesson I've learned is not that I will stop making mistakes.

[1939] It's how much can I shrink the period of time between when I make a mistake and when I rectify.

[1940] So I rarely get angry in a car these days.

[1941] I want to say for the record, me too, but it's been a 15 -year journey.

[1942] Yeah.

[1943] By the way, at one point, I pulled a guy out of his car and almost killed him, like in San Diego.

[1944] Literally in an intersection, got out of my car, went to a guy, pulled him out of his car and was about to slam his head in the door.

[1945] For giving me the finger, by the way.

[1946] That was the offense.

[1947] So a couple months ago, I'm in the car with my middle child.

[1948] We were at the airport and I was kind of going back to pick up the family.

[1949] So I had gone, got the rental card that I'm pulling back.

[1950] And we're pulling into the terminal and a bus, one of the airport buses, comes up beside me, cuts me off, almost puts me into the wall.

[1951] I back out of it and I remember thinking to myself like how did she not see me and then I go to the other lane to just stay away and she literally just puts me into the other wall and I lose my mind of course she can't hear me because I'm screaming at a windshield and I realize my son Reese is watching his dad scream and it's not like I'm using profanity I mean like whatever I can justify it as many ways as I want but the reality of it is he's watching me lose my mind he's never seen me lose my mind in a car before we get back to to pick up my wife and the other two kids.

[1952] And I'm feeling intense shame.

[1953] Your kid at a cortisol dump because you did.

[1954] Right.

[1955] So I think to myself, okay, how am I going to rectify this?

[1956] First, I'm not going to ruin it for the rest of them.

[1957] So my wife's like, hey, everything go okay.

[1958] I'm like, yep, no problem.

[1959] Everything is great.

[1960] So I drive us back to our place and everything is fine.

[1961] But then I pull him aside and I say, Reese, do you remember back there at the airport when that bus cut us off?

[1962] He's like, yeah.

[1963] And I said, do you remember how I yelled at that woman?

[1964] Who was driving the bus?

[1965] Yeah.

[1966] I go, it wasn't right, buddy.

[1967] And I just sort of had the discussion with him.

[1968] him.

[1969] Now, I got to be honest with you, I don't know how much of that he remembers internalized whatever, but I felt like the shame just went away, and that shame would have stayed with me. It would have created more bad behavior.

[1970] That's how you interrupt the cycle.

[1971] That's right.

[1972] I'm sure you guys have both listened to a hundred times David Foster Wallace's commencement speech.

[1973] This is water.

[1974] And what you just said reminds me a lot of that.

[1975] That's what he's talking about.

[1976] It's the choice.

[1977] You can sit there and indulge the fantasy of getting the guy out of the car back there or just screaming at him and telling him what a horrible driver is because by the way he is a horrible driver objectively but guess what i am too i fucking cut people off i'm in a hurry i see it because i'm guilty of it my wife doesn't even see it because she doesn't behave that way but here's the point you choose to think about something else and that to me is the most important part of all of this i can choose how i repair this i can choose to apologize to my wife immediately when I realize I've been a complete piece of shit, as opposed to digging my heels in and out arguing her.

[1978] Or justifying, or you're a victim that had no other choice but to do this.

[1979] Yeah, it's all repugnant.

[1980] You know, the most profound moment, the one that actually set me on the path of getting rid of, I had to go at one at a time.

[1981] First, it was I couldn't get out my car.

[1982] That was all.

[1983] That was the New Year's resolution.

[1984] No more getting out of the car, period.

[1985] You can go ape shit in the car, but you cannot leave the car.

[1986] Next year, we'll go, was no more horn then it was no swearing in the go right you're like I had to inch my way into this it's terrible I'm with my dad he's dying of cancer I'm there nonstop for three months and I'm looking at a man that was never bested he got into it with everybody I can't tell you how many dustups we've had at gas stations and grocery stores and everywhere he went he's like alpha in the dictionary and I'm looking at him and I'm like you won all the little battles and it's caused you to lose the war.

[1987] This killed you.

[1988] It was quite obvious to me and I don't want to get too wooey or whatever, but I believe that's what killed him.

[1989] His insane aggression and that rage, what it did to his body chemically and then how he then dealt with the shame of it by eating too much.

[1990] You know, this whole system really, I think, I was like, oh, that's going to be you.

[1991] You're going to win every battle and die at 60 unless you knock this off.

[1992] And I had to frame it that where I don't think I would have ever been able to really confront it.

[1993] This has been so awesome.

[1994] You're an intimidating person to interview because you've been so brilliant on so many other podcasts.

[1995] You come in with a bit of a track record.

[1996] It's kind of like people who directed Jim Carrey movies in the 90s.

[1997] If it didn't make 100 million, what a failure they would be because they all made 100 million.

[1998] I would want everyone to read, Outlive.

[1999] It's so, so well written.

[2000] It's a lot of complicated concepts and medical stuff that's made incredibly simple.

[2001] You have a real, real art for speaking to the layman.

[2002] It's just very beautifully and simply written.

[2003] And you read it.

[2004] I'm going to tie you with Sam Harris as the most pleasing voice to listen to.

[2005] Wow.

[2006] Very calming.

[2007] There's something very, very calming about your voice.

[2008] Yeah.

[2009] They're not dissimilar voices.

[2010] They're not at all.

[2011] Yeah.

[2012] You're speaking faster than Sam, though?

[2013] I love listening to Sam.

[2014] I'm a bit self -conscious about my reading and was not planning to read it.

[2015] I am slightly dyslexic.

[2016] Okay, great.

[2017] I do have a difficult time reading.

[2018] out loud especially.

[2019] It's so bad that once my middle son and my daughter got to the point where they could read, reading them bedtime stories, they were catching my missed words.

[2020] Same.

[2021] And my flipped words, which I thought was wonderful, by the way, because I was like, well, they're okay.

[2022] Yeah.

[2023] So then, last summer, Rick Rubin, Rick and his wife and kid were staying with us for a couple weeks.

[2024] And Rick said, hey, do you mind if I start recording my audiobook?

[2025] Because you know, Rick's got this book, the creative way.

[2026] He was on to promote it.

[2027] Rick said, hey, do you mind if I start recording here?

[2028] I'll bring my whole team, like, we'll just take the basement and do it.

[2029] I was like, yeah, great, no problem.

[2030] So Rick's down there doing a little bit every day recording.

[2031] And I was like, hey, Rick, the publisher really wants me to read the book.

[2032] I don't think I'm going to be able to, but let's just do a test.

[2033] Can I spend two hours in the booth?

[2034] And he's like, yeah, of course.

[2035] So I go down there one day and I read two chapters.

[2036] And his engineers clean it up and we send it off to Penguin.

[2037] And I don't think it's very good.

[2038] But I also realize, if I'm going to be brutally honest, I'm sort of my harshest critic.

[2039] They're probably going to come back and say, it's fine.

[2040] They come back and they're like, you're right, it's horrible.

[2041] No. Yeah, they're like, it's awful.

[2042] Oh, my God.

[2043] I love that you've done all this growth and you're finally willing to accept you're probably harsh on yourself and no, in fact, oh, my God, this is categorically awful.

[2044] So everyone's like, you're going to need another strategy here.

[2045] What were they so?

[2046] Was it the pacing?

[2047] Yeah, you're so monotone.

[2048] You're so bored reading this.

[2049] Like, this is so unbearable.

[2050] And I was like, God, I thought I was like really giving it my best thing.

[2051] A lot of flourish.

[2052] So then we were saying, well, we're going to have to find an actor to read it.

[2053] And I was sort of, on the one hand, relieved.

[2054] It's such a long book.

[2055] I knew it was going to take a long time to read.

[2056] But then there was a part of me that was like, if I don't have to read it, that'll be two weeks in my life, I get back.

[2057] But when I'm dead, I will want my great grandkids to be able to listen to this.

[2058] For sure.

[2059] Especially some of the parts that are intimate.

[2060] So they introduced me to this woman who they said would coach me. And so she came over, listened to me, read.

[2061] I would have been so insecure.

[2062] Oh, it was awful.

[2063] It was so awful.

[2064] Like, she's literally, I'm sitting there on a mic.

[2065] She's got the headset on, like, where as far as we are.

[2066] And she was wonderful.

[2067] She just gave me such amazing advice.

[2068] And she was like, first of all, I want you to read it like you've never read it before.

[2069] Yes.

[2070] Which is hard because.

[2071] Wait, what was that even mean?

[2072] I'm so bored of the book.

[2073] Of course.

[2074] Like, you've rewritten it.

[2075] So bored of this, right?

[2076] I mean, I've been on set sometimes and watched actors do this.

[2077] And I'm like, how are they bringing so much energy to this on the 20th take?

[2078] Yes.

[2079] So Stacey was like, look, you've got to bring more energy to this.

[2080] And she also slowed me down.

[2081] She said, it's easier to do this when you read slowly.

[2082] I ended up working with her for four hours on a Sunday.

[2083] I absolutely loved her.

[2084] And I said, I will read it if she directs it.

[2085] Wonderful.

[2086] And I was like, great.

[2087] Great.

[2088] And then so it took you about two weeks to do it?

[2089] It took me like 10 days.

[2090] How many hours a day were you doing it?

[2091] Five, six hours a day.

[2092] That's a long time.

[2093] The voice will give out.

[2094] I ended up getting a pharyngeal abscess a few weeks later.

[2095] Wonderful.

[2096] Congratulations.

[2097] They're fun for the whole family.

[2098] Dr. Peter Attia, the book is Outlived the Science and Art of Longevity.

[2099] Everyone's going to get it and read it and they're going to love it.

[2100] And also, please listen to Peter's podcast, Peter Atia Drive.

[2101] How frequently do you do that?

[2102] Once a week.

[2103] Once a week.

[2104] We just turned five.

[2105] Oh, we're on a similar timeline there.

[2106] What a pleasure.

[2107] I'm so glad you came in person.

[2108] This was really great and I hope we get to talk to you again.

[2109] We'll have to do some kind of formula on something.

[2110] All this time we were talking about, I don't care.

[2111] about that at all compared to Formula One.

[2112] My health, my family, nothing.

[2113] I can relate.

[2114] Thank you guys.

[2115] Yes, be well.

[2116] Next off is the fact check.

[2117] I don't even care about facts.

[2118] I just want to get in their pants.

[2119] It's warm out.

[2120] Yeah, it's hot.

[2121] Very sunny.

[2122] It's hot.

[2123] We're in a heat wave.

[2124] And you're in a full jumpsuit.

[2125] Yeah, because I'm in my outfit for the concert.

[2126] Oh, for 10.

[2127] Yeah, because she likes purple.

[2128] Oh, she does?

[2129] Oh, she would have loved shows and shoots my mom's company.

[2130] We all wore matching purple -collared polo shirts.

[2131] Oh, she would have loved that.

[2132] That's why another reason I'm against polo shirts is I had to wear them as my uniform for 14 years.

[2133] Okay.

[2134] Yeah, from 14 to 28, I had purple collared shirts all the time.

[2135] Oh, yeah, that could be part of it.

[2136] High polyester blend, so very sweaty when we'd wash those cars out in the sunshine.

[2137] Oh, is it hot?

[2138] Yeah.

[2139] Of course, then, on my walk, I realized I don't want to wear this to the concert.

[2140] Oh, no. What did you say you wanted to wear once you were walking?

[2141] I don't know.

[2142] I came up with two different outfit ideas.

[2143] One is shorts with a sweatshirt.

[2144] Uh -huh.

[2145] A Taylor Swift sweatshirt.

[2146] Uh -huh.

[2147] And short shorts.

[2148] And shorty shorts.

[2149] But, and then the other is, well, I wore this bathing suit yesterday.

[2150] What's the difference between short shorts and booty shorts?

[2151] Nothing.

[2152] There's nothing.

[2153] There's nothing.

[2154] Okay.

[2155] All right.

[2156] It's synonymous.

[2157] Okay.

[2158] Or I wore a bathing suit yesterday when we were all hanging out at your pool.

[2159] I wore this bathing suit.

[2160] It's kind of sparkly and it's multicolored.

[2161] And multiple people said I should wear it to the Taylor Swift concert.

[2162] Because people are supposed to dress up.

[2163] I mean, you can do whatever you want.

[2164] That's what Taylor says.

[2165] But you can.

[2166] That's what the queen says?

[2167] You can also dress up as one of the albums or a lyric or something.

[2168] And Lover is kind of colorful like that.

[2169] Oh, the album Lover.

[2170] Okay.

[2171] What I have now learned about this Taylor Swift thing, mind you, you couldn't go anywhere in L .A. I met up with the whole Parenthood crew.

[2172] Yeah.

[2173] To pick it on Friday.

[2174] Yes.

[2175] And then we went to this fun restaurant.

[2176] And then next to us, we were like, of course, talking about the strike.

[2177] And then a gal overheard and said, I just want you to know we are very supportive of your strike.

[2178] And then it turned out, she was from Oregon.

[2179] Oh.

[2180] And maybe she was 35.

[2181] She was with her mother.

[2182] Oh.

[2183] And they were in town to see Taylor Swift.

[2184] Yeah.

[2185] Hayes of Huey and Hayes.

[2186] Hayes was here to see.

[2187] No way.

[2188] Yeah, with her girlfriend.

[2189] Yeah, everyone, the Kara, summer of Kara, the Kara hotel's full of people.

[2190] Yeah.

[2191] Someone told me that it's generated $23 million in local business.

[2192] Wow.

[2193] It's like the Olympics.

[2194] Exactly.

[2195] Although I think the Olympics is on the order of like a billion.

[2196] But regardless, yes.

[2197] It's like the Olympics.

[2198] So everyone's, everyone in L .A. over the last five days is virtually going.

[2199] They have some plans to go to Taylor Swift.

[2200] So I think that's adorable.

[2201] The pilgrimage, how excited everyone is.

[2202] I know.

[2203] But then, of course, the bracelets thing.

[2204] I love it.

[2205] I think is so sweet.

[2206] Penae was telling me that Avery, his girlfriend's daughter, had been making bracelets for the last three months in preparation of this show.

[2207] One arm was completely full of bracelets to give away.

[2208] Oh, I know.

[2209] And I thought, this isn't incredibly, I don't even know if she knew or whoever invented this thing, this bracelet swap thing.

[2210] Oh, yeah.

[2211] Not like who invented Taylor Swift.

[2212] I think that's her mom.

[2213] And dad.

[2214] And her, yeah, yeah.

[2215] I was giving them the mom a lot of credit.

[2216] Anyways.

[2217] And her.

[2218] Yeah, her for sure.

[2219] The bracelet thing is the most adorable thing.

[2220] The fact that it reminds me my very favorite childhood book, it's the most important book, which is the warm, fuzzy book.

[2221] Yeah.

[2222] You know all about it.

[2223] And you're born with a bag of warm fuzzies.

[2224] And you give them out to everybody when you see them and warm fuzzies feel exactly like you would think, warm fuzzies.

[2225] But then a witch comes to town.

[2226] And she convinces everybody in this small little hamlet that you have a limited amount of warm fuzzies in the bag you were born with.

[2227] And you should instead give out these cold pricklies.

[2228] And she sells them.

[2229] That way, when you see people, you have something to give them.

[2230] But that way you won't be using up your warm fuzzies.

[2231] You get the metaphor.

[2232] I do.

[2233] Somehow she created warm fuzzies.

[2234] I know.

[2235] And everyone's not afraid to give something away.

[2236] They're going to get something.

[2237] I know.

[2238] Uh -oh.

[2239] This is triggering.

[2240] No, it's not triggering.

[2241] But it is, so if people don't know, which I'm sure they do, but just in case, yes, people make these bracelets with letters and you put the song lyrics or the titles or her name or whatever.

[2242] Taylor themed.

[2243] Yeah, Taylor themed.

[2244] And then, yeah, you give them out to people at the concert.

[2245] people give you it's like it's the community that this human has made it's so unbelievable I think it's a beautiful thing yes and um one bad thing though I didn't plan well with the bracelets and then I ran out of a car so I couldn't go buy beads okay like I didn't plan I didn't make any bracelets there you go it sounded like you made I didn't it I didn't had a plan.

[2246] No, I mean, the plan would have been to make bracelets, and then I didn't.

[2247] You didn't make any bracelets, yeah, yeah.

[2248] And then on Saturday, I was like, oh, my God, the bracelets.

[2249] Like, I have to make so many in the next 48 hours, but I have to buy these beads.

[2250] How will I get to buy these beads?

[2251] Luckily, Molly had, she had a whole bunch of beads, so she made me a couple bracelets.

[2252] Okay, great.

[2253] So you're not coming completely empty -handed.

[2254] Yeah, but I only have four.

[2255] Hey.

[2256] I know.

[2257] And I'm the opposite of, I'm like not a good Swifty because I feel anxious about getting them away.

[2258] Yeah, yeah.

[2259] Yeah.

[2260] Well, because they were made for me. If I made them myself, I wouldn't care.

[2261] Okay.

[2262] But yeah, you're going to, though, get hopefully infected by the spirit of it.

[2263] Yeah.

[2264] And you'll realize that the interaction between you and a stranger is much bigger and more important than any bracelet that it symbolizes.

[2265] I know, but what about if I'll feel guilty because I'm going to get infected so quick and I'm going to give those four out so fast?

[2266] Molly does, well, I think it's a one for one.

[2267] I think you're going to, I think you'll stay net zero.

[2268] You're going to come home with four bracelets, I think.

[2269] Although you might even see some arm cherries there who give you braces without even receiving any.

[2270] Oh, no. That's probably going to happen.

[2271] But Molly didn't make those for you so that you could own a item.

[2272] Well, kind of.

[2273] She made those for you so you could experience the joy of trading bracelets with people.

[2274] She was like, you can give them away.

[2275] Oh, I think we could call her now.

[2276] I might get a different version of the story.

[2277] Anyway, yeah, well, I'm really excited.

[2278] Yeah.

[2279] I'm very excited.

[2280] It's the summer of the women.

[2281] Between Barbie and Taylor Swift tour, I feel like it's very peak feminine power right now.

[2282] Feminine energy.

[2283] Yeah, I like it.

[2284] but it's for men too like men should embrace both right sure uh max greenfield was at taylor i saw a picture he had a ton of bracelets on he's got daughters yeah i think he went by himself oh okay so i'm really pumped but um yeah so i had a bad night right okay so let's hear about your bad night because it started as a good day you came over we all were swimming and playing spades.

[2285] Yeah.

[2286] And there's a new baby on the scene.

[2287] It's very exciting.

[2288] So sweet little baby.

[2289] And then around Forish, you were like, I want a martini.

[2290] Mm -hmm.

[2291] And I need to do some computer work.

[2292] Yeah.

[2293] I'm going to go to Kara.

[2294] Yeah.

[2295] I walked to Kara and I was doing an edit.

[2296] And it was for this episode.

[2297] Okay.

[2298] Which is long.

[2299] Oh, yes.

[2300] Wopper.

[2301] Wopper, great episode.

[2302] In the middle of it, I was like, I should probably go home now.

[2303] Because, yes, don't have a car.

[2304] I'm walking everywhere.

[2305] Right.

[2306] Cara is about 35 -ish -minute walk to my house or to my apartment.

[2307] And I, in the middle, was like, I should probably walk home now while it's still light out.

[2308] Oh, I'll just give it a few more minutes.

[2309] I really wanted to finish.

[2310] Yeah.

[2311] So I finish.

[2312] Right.

[2313] And by that time, it was dark.

[2314] Okay, but I want some details of that, because that was like a five -hour window.

[2315] No, I actually, when I looked at the time of when I actually got to Cara, it was like 5 .30.

[2316] It was?

[2317] Yeah.

[2318] Okay.

[2319] So 530 till 9?

[2320] Till 8 .15.

[2321] Oh, okay.

[2322] So 2 hours and 45 minutes.

[2323] Yeah.

[2324] Maybe 8 .30.

[2325] Did you chat with anyone during that?

[2326] No. No, just head down editing, how many martinis?

[2327] Two.

[2328] Two nice martinis.

[2329] Yeah, it was probably 8 .30 based on the then timeline.

[2330] So, yeah.

[2331] So at 8 .30, it was like, it's 830.

[2332] It's still early -ish.

[2333] Yeah.

[2334] It's fine.

[2335] But when I walked outside, it was very dark.

[2336] Mm -hmm.

[2337] I got a weird feeling about walking for so long back in the dark, but I thought it's fine, whatever.

[2338] And then I'm walking, and then I, you know, I come across some kind of scary characters.

[2339] Sure.

[2340] And that made it more scary.

[2341] Uh -huh.

[2342] And so I'm walking up.

[2343] I walk up Western to go on Los Angeles.

[2344] I figured Los Felos Boulevard would be better than Franklin.

[2345] Yeah.

[2346] Yep.

[2347] I agree.

[2348] And I think I thought.

[2349] More exposed.

[2350] Yes.

[2351] And I think that was sort of, I was like, oh, it'll be fine.

[2352] because I'll just go on Los Fields Boulevard.

[2353] It's light there.

[2354] I don't know why I thought that because then when I turned on Los Fields Boulevard, I was like, oh, it's still really, really dark and feeling desolate and scary.

[2355] So I keep walking and at some point I think I have a lot more way to go and I don't like this feeling.

[2356] Yeah, you're spooked at this point.

[2357] Yes, but I remember I have my other car.

[2358] my Prius, which is parked at my house.

[2359] And on Friday, I had a friend come take it to get it.

[2360] So it has to get a smog check in order for me to be able to get it registered again, updated.

[2361] And so because this car just sits and doesn't get driven, it's always dead.

[2362] Yep, of course.

[2363] So she had to jump it.

[2364] Good for her, resourceful.

[2365] I know.

[2366] She did it by herself.

[2367] Good job, which was amazing.

[2368] She jumped it, drove it to the smog place.

[2369] They said, it won't pass.

[2370] She has to drive it for a week.

[2371] Oh, wow.

[2372] If you just jumped it.

[2373] Did they even try it?

[2374] Yeah, they tried it.

[2375] And it failed?

[2376] Yes.

[2377] Oh, wow.

[2378] And they said that makes sense if you just had to jump it.

[2379] She'll have to drive it for a week.

[2380] And they were like, well, she can't because it's not registered.

[2381] Right.

[2382] And they were like, well, whatever.

[2383] So she drove it around for a bit.

[2384] Uh -huh.

[2385] And then dropped it back on.

[2386] off at my house.

[2387] And I thought, oh, I'll get it tomorrow or whatever.

[2388] And I'll drive it just like close proximity.

[2389] Yeah.

[2390] So I remember I had the Prius and I was like, okay, I'll go get the Prius and I'll drive that.

[2391] Which I had walked past that point, but I decided to turn around, go get it.

[2392] I couldn't get into the gate.

[2393] That was a whole thing.

[2394] Then I finally get to the Prius and then it doesn't start.

[2395] Uh -huh.

[2396] The Prius is also, is it packed to the absolute gills with shit?

[2397] Yeah, I put a bunch of crap on it.

[2398] Buy it on my jog.

[2399] Well, first on my walk with Delta and then my jog, both times I peaked in the windows of that Prius and it looked like it was piled high in the back.

[2400] Yeah, because I had to get stuff out of my garage.

[2401] So I just stuck it in my Prius.

[2402] Yeah.

[2403] Anyway, so it was dead and then I was panicked.

[2404] Uh -huh.

[2405] And I could have, I obviously could have just called an Uber.

[2406] And for some reason, I was like, I can't, I don't, I don't know why I had such a weird block up against calling an Uber.

[2407] And I was right by your house.

[2408] Right.

[2409] So I texted you and said, hey, I'm sorry to do this, but could you or Kristen drive me home?

[2410] Right.

[2411] We were watching Parenthood, all four of us.

[2412] Yeah.

[2413] And I didn't see that you had text for.

[2414] About 10 minutes, I think, was the duration.

[2415] So I saw that, and I was like, oh, shit, sorry for the delay, of course, yeah.

[2416] Yes.

[2417] But I had started walking at this point.

[2418] Uh -huh.

[2419] And at this point, I was crying and panicked.

[2420] And, like, oh, my God.

[2421] And now it's, like, late.

[2422] Now all this time has passed while all this is going on.

[2423] And then you texted and said, yes, come over.

[2424] And I was like, okay, well, I already started walking, so I'll walk back.

[2425] Uh -huh.

[2426] And then Kristen came and got me. Yeah.

[2427] She drove you home.

[2428] Yeah, thank God for her.

[2429] And when you got into your home, did you have a sigh of relief you had made it?

[2430] Or more kind of spiral.

[2431] I was both.

[2432] A little mix?

[2433] Yeah.

[2434] I was happy to be home, safe and sound.

[2435] Mm -hmm.

[2436] But I was also just sad.

[2437] Okay.

[2438] I just felt like very alone, stuck, vulnerable to elements.

[2439] Yeah, powerless, hopeless, dark.

[2440] Did you have any specific fear?

[2441] Was it just an ominous general that I don't want to be doing this?

[2442] Or did you have actual fears of being physically attacked by a stranger?

[2443] What were the fears?

[2444] All of it, but a lot of, like, being attacked.

[2445] Like, I was very aware of how small I was.

[2446] Mm -hmm.

[2447] I was just like, oh, my God.

[2448] You were feeling very small.

[2449] Yeah.

[2450] Yeah.

[2451] I felt like I would not be able to protect myself.

[2452] Right.

[2453] And it was...

[2454] Maybe it's time for you to start carrying a lady Remington.

[2455] No. I'm not doing this.

[2456] Or bear spray.

[2457] Yeah.

[2458] So...

[2459] Well, I'm very sorry you had that evening.

[2460] It's okay.

[2461] After such a fun day.

[2462] Took a turn.

[2463] Yeah, it did take a turn.

[2464] I have to be better about timing.

[2465] I have to know my limits.

[2466] Uh -huh.

[2467] I shouldn't walk in the dark.

[2468] That's not for you.

[2469] We talked about this even just earlier in the day where the walk to my house feels at this point because I do it all the time during the day.

[2470] Yeah, five times a week.

[2471] Yeah.

[2472] Or sometimes more.

[2473] It feels short.

[2474] But it's actually not short.

[2475] No, it's almost two miles.

[2476] Yeah, and so in the day it doesn't matter, but at night, I was realizing, like, there's a lot longer of me doing this.

[2477] Yep, yeah.

[2478] And feeling like this.

[2479] And you're going to cross Vermont.

[2480] There'll be some activity at Vermont.

[2481] There's some bus stops.

[2482] You're going to see some more characters.

[2483] Yeah.

[2484] Anywho, so, yeah, so it was a bit of, but then I took some electrolytes today.

[2485] And you're rebounding a little bit?

[2486] Yeah.

[2487] Bouncing back?

[2488] Mm -hmm.

[2489] Okay, good.

[2490] Big plans tonight?

[2491] And I have big plans tonight.

[2492] I have to definitely be back.

[2493] Raleigh, you got to be back to, yeah, yeah.

[2494] I will.

[2495] She'll get me there.

[2496] Yeah.

[2497] Three and a half hour show, right?

[2498] It's like, yeah.

[2499] Yeah.

[2500] You might have to take a nap between?

[2501] No, I don't have time.

[2502] Okay.

[2503] It's okay.

[2504] I can do it.

[2505] It'll be great.

[2506] It'll be great.

[2507] Seems silly that she's here in town and isn't coming over to the attic to talk.

[2508] Tell me about it.

[2509] I know.

[2510] It's never going to get more convenient for her.

[2511] I know.

[2512] Except I don't know how she could possibly talk.

[2513] You're right.

[2514] She must be on vocal rest.

[2515] I don't know how.

[2516] She's doing so many shows for so long.

[2517] Dancing.

[2518] Unreal.

[2519] I bet she is expending in that three and a half hours in the 15 to 2 ,000 calorie range.

[2520] Probably just for the show, which is an average.

[2521] Probably more than that.

[2522] But in your real life, to go from not having this 2 ,000 calorie output in the evening to doing it, I bet your eating has to change to keep up with that.

[2523] I bet you have to eat a lot more food.

[2524] Like Michael Phelps, those pancakes when he was swimming in those Olympics.

[2525] Dozens of pancakes.

[2526] I hope she is because he was having like 5 ,000 calorie breakfasts.

[2527] Mm -hmm.

[2528] Well, anywho.

[2529] Okay, Peter Attia.

[2530] Okay.

[2531] So you mentioned an episode of This American Life about a client.

[2532] The clone bowl.

[2533] That came up again because I was talking to someone that cloned their dog this weekend.

[2534] Oh.

[2535] And I was asking, is it identical?

[2536] Oh, my God.

[2537] And they were like, yeah.

[2538] But in talking to this friend about it, Kristen was saying she wished she had cloned Lola.

[2539] Like, we would very much like to have Lola again.

[2540] That's funny, though, because Kristen has said once, to me, like, she understands that appeal.

[2541] Mm -hmm.

[2542] But ethically, she would never do that because there's so many other dogs.

[2543] that need raising.

[2544] Yeah.

[2545] And I think her love for Lola is budding right up against her values as far as having to only rescue dogs that need rescuing.

[2546] I think those two things are very understandably in opposition.

[2547] She had Lola for six, 17 years and would like Lola again.

[2548] Interesting.

[2549] Yeah.

[2550] Okay.

[2551] The name of the episode.

[2552] Too late, though.

[2553] You got, apparently you got to do it in the first hour.

[2554] The dog dies.

[2555] Oh, really?

[2556] Yeah.

[2557] Okay, so the name of the episode is called if by chance we meet again.

[2558] If anyone wants to listen to it.

[2559] The synopsis is Ralph and Sandra Fisher, who run a show animal business in Texas, had a beloved Brahmin bull named Chance.

[2560] Chance was a gentlest bull they'd ever seen.

[2561] More like a pet dog than a bull.

[2562] They loved him.

[2563] Kids loved him.

[2564] He had a long career in movies on TV, performing at parties.

[2565] When he finally died, Ralph and Cindy were dead.

[2566] devastated.

[2567] Around that same time, scientists at Texas A &M University were looking for animal subjects for a cloning project.

[2568] They already had some tissue from chance because they had treated him for an illness.

[2569] So Ralph and Cindy offered up Chance's DNA for the experiment.

[2570] Second Chance was born and he was eerily just like Chance, except he wasn't.

[2571] Second Chance was born.

[2572] Come on.

[2573] That was clever.

[2574] Which they found out the hard way.

[2575] You think on the surface it's about that, cloning a bowl.

[2576] But obviously it's much more about trying to recreate things that gave us so much joy or happiness or love or whatever.

[2577] Exactly.

[2578] Larry and I on a walk during our vacation this summer, we're talking about doing parenthood as a reboot or whatever, whether not everyone would want to do that or not want to do it.

[2579] And we're both like, yeah, I mean, that was the greatest experience ever.

[2580] Of course, we'd want to do that again.

[2581] But also, is it like trying to go back to high school and having the same experience.

[2582] Yeah.

[2583] You know, it's very tempting to try to have the same experience over again, but it doesn't necessarily mean you can.

[2584] I know.

[2585] You can't.

[2586] Now, maybe it could be something completely new and also special, but it is interesting to just pump the brakes and go, like, am I trying to basically have a feeling that only existed between, or how old was it, probably 33 to 40?

[2587] Yeah.

[2588] Yeah, it's not going to be the same.

[2589] Yeah.

[2590] Well, he talks about an interview for me. med school, I think, or a residence, for something, where he told the interviewer that he had thought about killing someone.

[2591] Yes, yes, yes.

[2592] And then that ended that interview.

[2593] But that's a ding, ding, ding for this Friday's Armchair Anonymous.

[2594] It is?

[2595] Thinking about killing somebody?

[2596] No, bad job interviews.

[2597] Okay, but I was like, man, I don't remember.

[2598] Yes.

[2599] So that's a ding, ding, ding.

[2600] And an Easter egg.

[2601] And a preview.

[2602] And a duck, dog, dog, goose.

[2603] Okay, did the wire come from the book called The Corner?

[2604] The Corner, a year in the life of an inner city neighborhood by David Simon and Edward Burns, both also created The Wire and released two years before the Wire.

[2605] The Corner is commonly referred to as the prequel to the HBO Powerhouse series, despite having no reference to its characters.

[2606] I'm reading like four books at once right now, which is getting a little hectic for me to keep two different guest books.

[2607] Yeah.

[2608] And then two other ones I started.

[2609] And one's just for fun.

[2610] I almost never read for just straight fun.

[2611] Yeah.

[2612] But I'm reading this Mike Nichols biography for just straight fun.

[2613] Oh, cool.

[2614] It's so interesting.

[2615] It's crazy.

[2616] Wow.

[2617] Yeah, I didn't know shit about Mike Nichols.

[2618] Other than he was a brilliant director when I was growing up.

[2619] He directed all these amazing things.

[2620] I know that everyone loves him.

[2621] I didn't know he was one of two of the biggest comedy duo of the, the 70s and 80s with this woman.

[2622] Really?

[2623] Yeah, he had a stage show that then became a Broadway show.

[2624] They did like every TV show and they did sketches and improv and they're like the first really famous.

[2625] So he was like a huge comedian before he was a director.

[2626] Oh my God.

[2627] Yeah, very interesting.

[2628] And alopecia got a vaccine when he was a kid and all that got alopecia from it and grew up bald with no eyebrows in school.

[2629] Terrible childhood.

[2630] but then started, wanted a wig really bad.

[2631] You know, much of his life governed by this whole thing of having no hair and then finally getting a nice wig for himself when he was making money.

[2632] So he was wearing a wig?

[2633] Yeah.

[2634] And I think, you know, eyebrows you would attach and everything.

[2635] Wow.

[2636] Oh, never knew that.

[2637] Okay.

[2638] He said that cancer has had an 8 % improvement in survival over the last 50 years.

[2639] the overall cancer survival rate was 49 % in the mid -70s.

[2640] It currently sits at 68%.

[2641] It used to be a 49 % survival rate, and now it's a 68.

[2642] So you would go 19 divided by 42 would give you...

[2643] 0 .45.

[2644] The life expectancy has increased 45%.

[2645] Oh, wow.

[2646] Yeah.

[2647] So a lot more than 8.

[2648] Mm -hmm.

[2649] I still haven't done my heavy lifting.

[2650] Okay, yeah.

[2651] Just updates.

[2652] I haven't done that yet.

[2653] You haven't done any dead lifts.

[2654] I haven't done any farmers carries.

[2655] That's what he wanted me to do.

[2656] He wants to see you do a lot of farmers carries.

[2657] I think you should be aiming to have me slung over one shoulder and Rob slung over the other.

[2658] And you do a fireman carry across the driveway with both of us.

[2659] Up and down the staircase.

[2660] Oh, my God.

[2661] One lap of the staircase.

[2662] Yeah.

[2663] Going up would be less scary than going me. down for us.

[2664] Yes, for us.

[2665] Seems reasonable.

[2666] Seems like something I could definitely do.

[2667] Let's see.

[2668] Okay, the Joseph Campbell quote, he has a lot of quotes on bliss, but the main one is if you do follow your bliss, you put yourself on a kind of track that has been there all the while waiting for you.

[2669] And the life that you ought to be living is the one you are living.

[2670] Follow your bliss and don't be afraid and doors will open where you don't know they were going to be.

[2671] So he likes that book, Hero's Journey.

[2672] A lot of people like Hero's Journey.

[2673] I think it was the first very popular expose of the stories that we tell, how we're governed by stories.

[2674] I think that's the first one that got really kind of pop acceptance.

[2675] That were these, we run on stories.

[2676] I think people think that sounds lofty and arty in show businessy.

[2677] I don't think it's show business.

[2678] Well, so many people you hear interviewed that are in Shubman's like I'm a storyteller the people love to say that oh yeah and I can imagine it gets a little nauseating so I don't I think it might be confusing like story as in turning on the television versus we're all we're all in a story where we're the lead and we've constructed it and 100 % of us are and there's having nothing new with art yeah or show business no no yeah I think I think people get that that it's like the narrative in our own head about our life.

[2679] Yeah, yeah.

[2680] We are making that up.

[2681] Right.

[2682] Yeah, I mean, you hope you're the center of your narrative.

[2683] When we saw Barbie, Liz accidentally insulted me. She didn't mean to, but she said, oh, I should rephrase, she didn't insult me. She said something that I took as an insult.

[2684] There we go.

[2685] That's better.

[2686] She said, she said I was Skipper.

[2687] Okay.

[2688] And you know what that means.

[2689] What does that mean?

[2690] Skipper is Barbie's little sister or friend or something.

[2691] Okay.

[2692] And I was like, no, I don't want to be Skipper.

[2693] Like, I don't.

[2694] Who had she made herself?

[2695] Has she given herself any?

[2696] Barbie?

[2697] She wasn't doing that.

[2698] She wasn't like, I'm Barbie and you're a Skipper and you're, she wasn't doing that.

[2699] She was just saying like, you're Skipper.

[2700] And she said, no, I love Skipper.

[2701] And I was like, yeah, everyone loves Skipper.

[2702] Everyone loves the best friend.

[2703] Everyone loves the secondary character.

[2704] Uh -huh.

[2705] I get that.

[2706] But, like, I always feel like that.

[2707] Mm -hmm.

[2708] Like the second, the, um...

[2709] Second banana?

[2710] Yeah.

[2711] The best friend in a movie?

[2712] Yeah.

[2713] So, it's good to make yourself Barbie in your own story.

[2714] Sure.

[2715] And not be Skipper.

[2716] Right.

[2717] You know.

[2718] Unless you think Skipper's cooler, then you should be Skipper.

[2719] No, but you can, you can be the cool version of Barbie, but you should still be at the center of your life.

[2720] Yeah, but then and that would just be, Barbie's the best friend in Skipper's story.

[2721] Right.

[2722] She's the best friend character.

[2723] Yeah, but it's like, you shouldn't try, because I will say me, you shouldn't try to be Barbie.

[2724] You should be what you are.

[2725] You should be like, and then everyone else, all the other characters are that lead character's best friends.

[2726] Yeah, yeah.

[2727] No, that's true.

[2728] It's just the way, it's like in this story that's been, that's about Barbie, this world is based on Barbie.

[2729] Status.

[2730] I don't think it's good to walk around feeling like you're always going to be number two or second best or the other friend or something.

[2731] In the world, which if we're marrying Barbie land, Barbie's the center of that world.

[2732] Right.

[2733] Yeah, you should be the center of your world.

[2734] Yeah, I think so.

[2735] And everyone is, I think.

[2736] Everyone's the lead of their own story.

[2737] I think a lot of people move through life not feeling like that.

[2738] Oh, really?

[2739] I think a lot of people move through life feeling like I'm second.

[2740] I'm not enough.

[2741] I'm on this side when everyone else likes this type of person.

[2742] I'm not that type of person.

[2743] So I think it just leads to insecurity and also.

[2744] But I think Barbie has that too.

[2745] Like everyone has that insecurity.

[2746] fear but it's do you think that your existence is only meaningful because you're friends with this person i think most people have an implicit they have their own value and they're only concerned about their trajectory through planet earth not how they can service their friend that's not their story like i'm going to be the best uh companion to this person i think they're everyone's just motivated by their own selfish desires and plans for their life and they can feel like it's going poorly or good but i can't imagine someone can put themselves in the secondary character role in their mind because you're you are the center of the universe as you know it all the information is coming into this central point your brain and eyes and ears yeah i don't know how someone would think they weren't the center Well, yeah, but I think you can think in the world that I am living in, this society, I provide value when I'm in conjunction with this person, or I'm giving to this person, or yeah, I'm only good enough if I'm with this person.

[2747] I think a lot of people feel like that, actually, still being the center of their world, but understanding that the way society is written or feeling like the way society is written, their side case.

[2748] character.

[2749] And I think it's not good to think that way.

[2750] Right.

[2751] I wonder, though, if the solution is for everyone to think they're the captain of the cheerleading team or be realistic.

[2752] There's only one captain of the cheerleading team.

[2753] But my life is just as important and relevant, not being the captain, not being Barbie, not being that version of a human.

[2754] Yeah.

[2755] I think it's understanding and contributing to a world where we don't make Barbie the most valuable person, where everyone is equally valuable and that you do recognize that this person has as much to offer as Barbie.

[2756] Skipper has as much to offer as Barbie.

[2757] So it's not Skipper's Barbie's best friend.

[2758] It's Skipper's a person.

[2759] Right.

[2760] She hangs with Barbie.

[2761] They hang out together.

[2762] Then there's a, you know.

[2763] Then Ken's around.

[2764] Ken's there.

[2765] Yeah, he's present.

[2766] Anyhow.

[2767] Okay, let's see.

[2768] I think that's it.

[2769] Oh, this is so overdue.

[2770] This is like four episodes, five episodes overdue.

[2771] I was saying birds were cold -blooded.

[2772] A lot of people pointed out that they're warm -blooded.

[2773] Oh, I was just totally wrong on that.

[2774] I thought they were cold -blooded like reptiles, and I was wrong.

[2775] I should have fact -checked it, but I think I just believed you.

[2776] Well, she didn't correct me. I think she was being polite or something.

[2777] Maybe she didn't hear it.

[2778] Maybe she didn't hear it.

[2779] Who knows what happened, but I definitely said it, and people pointed out that that was wrong, and I concede that that was wrong.

[2780] Okay, great.

[2781] But it does help me explain because what is new in dinosaur land is a lot of people saying they were warm -blooded.

[2782] Forever they thought they were cold -blooded, like reptiles, because they look like big lizards.

[2783] Yeah.

[2784] And then, you know, there was a movement to say, well, really, they were birds.

[2785] And then they started putting feathers on Tronosaurus Rex when they would make models of it.

[2786] So sometimes Tronosaurus Rex now have feathers.

[2787] Yeah.

[2788] But this explains.

[2789] how they were like, no, we think it seems to have had the eating pattern of a warm -blooded animal, yet we thought it was a reptile, but now that it's a bird, now see it all kind of makes sense, now that I know birds are warm -blooded.

[2790] Yeah.

[2791] But I thought that was a uniquely mammalian quality.

[2792] Well, that's good.

[2793] I'm glad that got cleared up.

[2794] Yeah.

[2795] I'm so sorry.

[2796] I'm shit the bet on that one.

[2797] Mistake.

[2798] I'm pretty embarrassed, too.

[2799] That's a big one to not know.

[2800] I feel like that's For someone who's supposed to be into animals and crows, who has got so many tattooed all over my body, you think I would have taken the time to learn.

[2801] You can only learn so much.

[2802] It's okay.

[2803] All right, well, that's it.

[2804] Okay, lovely.

[2805] Peter Atia, we've been texting a bunch.

[2806] Cool.

[2807] There's a lot of racing gossip for he and I to engage in, which has been pretty fun.

[2808] Very fun.

[2809] Yes.

[2810] All right.

[2811] Bye.

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