The LIFE-EXTENSION Doctor: "The ONE thing that's increasing your chance of early-death by 170.8%!" Peter Attia (E267)

[0] Going from zero activity to just 90 minutes a week is about a 15 % reduction in all -cause mortality.

[1] Jesus Christ.

[2] Dr. Peter Ritia.

[3] World -renowned physician, the Hutu Doctor, for anything performance or longevity -related.

[4] He has the secret for living a long, healthy, and happy life.

[5] Most people listening to us are going to die from cardiovascular disease, cancer, diabetes.

[6] If we want to really figure out a way to live longer, we need a totally different playbook.

[7] How early do some of these diseases begin the minute you're born?

[8] But we only really think about the risk over a 10 -year time horizon.

[9] As a 30 -year -old, you don't get excited about exercise in your sleep, but there's a 400 % higher risk of dying in the coming year when you compare the fittest 2 .5 % to someone at the bottom 25%.

[10] In the coming year.

[11] And then once you hit the age of 65, if you fall and you break your hip, there's a 15 % to 30 % chance you will be dead within the next 12 months.

[12] Really?

[13] You have to realize you're taking this for granted.

[14] Shit.

[15] When you talk about the deterioration of health, you have these three categories.

[16] Emotional health deterioration.

[17] Why have you included that?

[18] Because despite being very physically healthy, I was not living a good life.

[19] I was in such an awful cycle of anger, workaholism, that I don't think my marriage would have survived.

[20] I realized I don't want to be this person and lose my kids.

[21] I don't think I could have survived it.

[22] And I'm sure many people listening to us can relate.

[23] Were you able to discover the root cause?

[24] of that?

[25] More than that, I was able to get rid of it.

[26] How?

[27] So what you really need to do is...

[28] What are the biggest misconceptions in your mind about weight loss?

[29] I have thought a lot about this, so...

[30] Dr. Peter Aetia, he is the man that wrote the book on how to live a long, happy and healthy life.

[31] And he argues that everything we know about health and what that actually means, health of the mind, the body and the emotions, is wrong and outdated.

[32] He says that there's disease growing in you and me right now.

[33] But the problem is, because we can't see it, we're doing nothing about it.

[34] Dr. Peter's work turns the light on.

[35] It allows you to see that in many cases, in action now, will increase your chance of disease and a much shorter life by 70%, 170%, and in some cases, if we don't take action now by 400%.

[36] I've had lots of conversations on this podcast about health, about diet, about all of these things.

[37] But for many of you, this one will be the one that changes your life.

[38] This will be the one that makes you ask some difficult but important questions about your health and what health means for you.

[39] I walked away from this conversation, realizing that if I don't take action now, I'm going to be forced to take action then.

[40] And I can unequivocally say that this conversation has changed my life.

[41] I have a suspicion it's going to change yours.

[42] Peter.

[43] Dr. Peter, you talk about so much in your work.

[44] I've been through every interview you've done, your book, other conversations you've had.

[45] You talk about a lot.

[46] So many things that I'm absolutely fascinated by.

[47] My first question of you is, what is your mission and why are you doing this?

[48] I think that there is no greater desire for people than to be healthy, especially when you consider how we can define health more broadly than just physical health.

[49] You can include kind of emotional health.

[50] It's kind of the great equalizer and nothing else really matters if you don't have it.

[51] Right.

[52] So it doesn't really matter if you're famous or not famous.

[53] It doesn't matter if you're rich or poor.

[54] If your health is compromised and anybody who's been through an illness where their health has been compromised, I think we'll realize is in a moment what they've taken for granted.

[55] And I've just become personally, endlessly fascinated by this topic.

[56] And in my own quest to understand this better and better, the next natural step was to begin to do it as a doctor, right?

[57] To begin to kind of help patients with this.

[58] And at some point, you can only treat so many people.

[59] And so podcasting and ultimately writing a book just became a way to put as much much of that information as possible out there for more and more people to access.

[60] Do you know why you of all people became fascinated by this?

[61] Was there a self -dominus that fell?

[62] I think so, yeah.

[63] I mean, I think, you know, I had always been interested in performance because I'd always, you know, at least as far back as, you know, being 12 or 13 years old, you know, I'd always been obsessed with one form or another of some sort of physical obsession, whether it be, you know, boxing when I was really young or marathon swimming later in life.

[64] But when my daughter was born when I was 35, that was the first time that everything kind of pivoted.

[65] And I had a little bit of a glimpse into the future, I would say.

[66] And I just sort of realized, oh, you know, the joy I'm experiencing in this moment is so surprising to me, so unanticipated.

[67] and I really want to be able to experience this again, which means not just with other children of mine, but potentially with grandchildren.

[68] And on top of that, I had a bit of a wake -up call, which was I realized that all the men and my family died prematurely of heart disease.

[69] Obviously, I knew that fact before this time, but I think it was the confluence of those two things.

[70] It was the realization that, yeah, you know, if you don't figure something out and do something about this, you're probably going to die of heart disease in your 60s, which is not that far from now, you know, 25, 30 years from now.

[71] And you now really have a motivation to live longer and to live better longer.

[72] And so that in many ways kind of began the change in my direction, my focus, to being one that was not purely just focused on performance anymore, but sort of focused on understanding health in a different way.

[73] this concept of medicine 3 .0 is a concept which I only discovered in your work.

[74] I've never had the term used before.

[75] What is medicine 3 .0 and how did you get to the point when you realized that there needed to be an iteration on the current system of medicine?

[76] Yeah, but the reason I think you hadn't heard of it before is I don't think it's been described before, so you can't be faulted for that.

[77] But as I began writing the book and thinking about how I was practicing and how people like me practice, I realized that it is a very distinct change from the current form of medicine.

[78] And in a way to not be just critical of the current form of medicine, I had to put it in the context of what existed even before that.

[79] And that's how I sort of realized, well, we're in this version of medicine called Medicine 2 .0, but it's following something called Medicine 1 .0, and it's an enormous improvement above that.

[80] that.

[81] So maybe I can spend a moment just kind of explaining what those three are.

[82] And I think that's probably the easiest way to explain the current form.

[83] So medicine 1 .0 is everything that existed before we really understood the science of medicine.

[84] So for most of human history, we had no idea why people got sick or why people died or what an infection meant.

[85] And we sort of thought that these were plagues from the gods or things of that nature.

[86] But a couple of things happened in the past, you know, a few hundred years.

[87] The first was the idea of a scientific method, something that we take for granted today, where you can make an observation about something in the world, formulate a guess called a hypothesis about why it's happening, and then design an experiment to test it.

[88] That's called the scientific method.

[89] That's an invention.

[90] That's a creation.

[91] We had to figure that out.

[92] Also things like a light microscope, which up until 140 years ago or so didn't exist, allowed scientists and doctors to be able to actually see these microscopic things called bacteria.

[93] And then ultimately the development of things like antibiotics and eventually vaccines, all of these things made an enormous difference in reducing the suffering and death due to what I call in the book Fast Death.

[94] So fast death is pretty much how we used to all die.

[95] Fast death would be trauma and infection.

[96] And up until about 150 years ago, life expectancy would have been high 30s, low 40s, and most of us succumbed to fast death.

[97] But with the advent of medicine 2 .0, through all those transitions I just described, in the span of a few generations, we've doubled life expectancy.

[98] Right?

[99] So now life expectancy is roughly twice what I just said a minute ago.

[100] And most people do not die from fast death.

[101] But it's been supplanted by slow death.

[102] Today, most people listening to us are going to die from cardiovascular disease, from cancer, dementia, or other neurodegenerative diseases, complications of diabetes.

[103] And on the one hand, that's a sign of progress.

[104] It means like, hey, we're living long enough to die from those things.

[105] But we've made scant progress against those things.

[106] In fact, if you go back and strip out the top eight causes of infectious death or communicable death, death from communicable diseases or infectious diseases, today if you strip them out, our life expectancy is not much better than it was in the 1800s.

[107] In other words, that doubling of life expectancy that we've experienced comes almost exclusively.

[108] to the reduction of those fast deaths and has little to do with any success we've had against slow death.

[109] If we want to really figure out a way to live longer and I would argue more importantly, live better, meaning when we're in the last decades of our life not be in a state of total decline, we need a totally different playbook.

[110] And that playbook is Medicine 3 .0 and it involves real prevention.

[111] So that means taking true steps at prevention very early in life.

[112] It also involves being very personalized in how you do things.

[113] So it means you can't just do paint by numbers.

[114] You can't just sort of say the same thing to everybody.

[115] Clearly, there are certain things that make absolute sense across the board, such as sleep and exercise, you know.

[116] But the way you might use medications is going to have to be much more tailored to an individual.

[117] You say that there are four points to medicine 3 .0, which is the prevention, being unique in your treatment, to each individual, an honest assessment and acceptance of risk?

[118] Yeah.

[119] One of the things that I don't think we think enough about as doctors sometimes is risk, right?

[120] Now, I think doctors are very good at thinking about the risk of doing something.

[121] Yeah.

[122] I think, you know, usually a doctor is pretty good at understanding, you know, if you have this surgical procedure, there's a risk of an infection, there's a risk of bleeding, there's a risk of all of these things.

[123] If you take this medicine, there's a risk of this side effect.

[124] or that side effect.

[125] But I don't think we spend enough time thinking about the risk of not acting or the risk of not acting when we do.

[126] So this is where I think it gets a bit more nuanced.

[127] Prevention doesn't come without risk, right?

[128] I mean, you're still going to have to do something in the state of prevention.

[129] So the question is understanding the time horizon upon which you're considering risk.

[130] So I'll give you one very specific example, at least in the U .S., and it might be the same in the U .K., we only really think about the risk of heart disease over a 10 -year time horizon.

[131] So look at someone like you.

[132] You're 30 years old, right?

[133] So what is your 10 -year risk of having a heart attack?

[134] I can tell you without knowing anything about you.

[135] It's really low.

[136] Good.

[137] It's as close to zero as we could have in medicine.

[138] But what if I did a blood test on you and I found biomarkers in there that were predictive of very high risk later in life?

[139] Now, that would be actually quite possible.

[140] There's about a one in ten chance you might have a biomarker called L .P. Little A, for example, which is just a certain lipid in your body, about a one in ten chance you have that dramatically increases your risk of cardiovascular disease.

[141] My uncle died very early, I believe in his 50s of a cardiovascular disease.

[142] Interesting.

[143] So knowing that, by the way, could be helpful because that would prompt me to ask you more questions and want to know more about all the people in your family.

[144] So here we have a one in 10 chance, and by the way, we wouldn't leave it to chance.

[145] We would just check it.

[146] And let's say we checked your level and you had that, you had that lipoprotein.

[147] Or you had an elevated level of another lipoprotein, APO, lipoprotein little B. And again, these are kind of technical terms, but they're very common things and they're easy to measure.

[148] The Medicine 2 .0 view here would be, well, there's nothing wrong with you now and there's not going to be anything wrong with you for the next 10 years.

[149] We don't need to do anything about it.

[150] Conversely, if I take a lifetime view of risk, I would say, yeah, but the risk to something happening in the next 40 years is actually quite significant.

[151] So my risk of doing nothing is probably much higher than my risk of doing something today.

[152] So my risk of doing something today would be non -zero but small.

[153] But my risk of doing nothing if I take the appropriate time horizon is much bigger.

[154] This is one of the things in your book that really, really got me thinking was I have to say, and I believe a lot of people probably feel the same way, I've gone through my life thinking, to some degree, I'll worry about avoiding these diseases later.

[155] I'll when I get to 45 then I'll start taking this thing seriously because then I'm getting into that territory where most people I know that get cancer or Alzheimer's or all of these cardiovascular things that's when it tends to happen so I'll think about it then totally understandable and I'll frame this in the context of a question I get asked all the time which is hey Peter when is the best time to start thinking about this stuff And I say, look, I can't answer that because there are two competing issues that are crossing.

[156] When I meet somebody who's in the last decade of their life, do you know how much they are thinking about this?

[157] Like, it's all they're thinking about.

[158] It's all they're thinking about.

[159] Every minute of every day is a confrontation with their own mortality.

[160] The problem is they don't have much time.

[161] to change the direction of the ship.

[162] You may recall in the book, I write the sort of, I use the metaphor of the Titanic, right?

[163] It's not that the Titanic didn't see the iceberg.

[164] It's that it didn't see the iceberg in time.

[165] It didn't have enough runway to really move out of the way.

[166] And that's why the Titanic gashed the side of the boat.

[167] Now, at the other end of the spectrum, a 30 -year -old like you has unbelievable potential to change the arc of your life.

[168] You have so much runway to, through manipulating nutrition and exercise and sleep and stress and all of these things, to completely alter the disease trajectory of your life.

[169] The problem is, and I'm not just speaking to you personally, but more broadly to someone who's as young as you, it's harder to find the motivation because there are no reminders of your own mortality.

[170] you're Superman right the worst thing that happens to you is a hangover so I always get asked like when is the right time to start worrying about this and the short answer is look as soon as possible but then there's a reality that says for most people it's not until they're in their 40s maybe once they have kids that they start to appreciate their own mortality and that that provides some of the motivation to say you know maybe I'll be a little less focused on optimizing everything for today, and I'll start thinking a little bit about tomorrow.

[171] So again, another way to think about this is saving for retirement.

[172] A lot of people in their 20s and 30s who are making good money aren't necessarily taking the most prudent financial steps to ensure financial freedom when they're in their 70s.

[173] Because let's be honest, it's more enjoyable to spend money today than to set some of it aside.

[174] But there are a lot of people later in life who think, I wish I was a little bit more responsible earlier on.

[175] How early does some of these disease, if you looked at my sort of metabolic health or if you were able to look inside my body, which I'm sure you're able to do, how early does some of these diseases begin in my life?

[176] At what age do you see some of these things coming?

[177] Yeah, it's super interesting because there are some elements of you as a person that are going downhill the minute you're born.

[178] and there are others that are not.

[179] So let's use two examples.

[180] Let's start with something where your body is getting better and better.

[181] And, you know, you're probably only peaking now, but you haven't really started to age.

[182] Your muscle quality.

[183] Okay?

[184] So when you were five years old, your muscle quality was nothing like it is today.

[185] But as you enter your 20s, the quality of those muscle fibers, these type 1 and type 2 muscle fibers.

[186] So these are kind of slow to fatigue, but high endurance fibers are the type 1 fibers.

[187] The type 2 fibers are very, very powerful, but they're kind of quick to fatigue.

[188] The quality of both of those fibers is very high.

[189] And the more you train them, the higher quality they will be.

[190] But as you enter your 30s, you will now start to experience a shrinkage of those type 2 muscle fibers.

[191] You will be less powerful in your 30s, in your late 30s especially, than you were in your mid to late 20s.

[192] So that's a form of aging.

[193] You are declining.

[194] It's not an accident that the most powerful athletes in the world are at their peak in their late 20s and early 30s.

[195] So sprinters, for example.

[196] That's a prime example of a pure, pure.

[197] pure power sport.

[198] We look at other things like more of your muscular endurance that will peak even a little bit later.

[199] You can keep that going a little bit later.

[200] We look at certain forms of cognition.

[201] So if we look at something called fluid intelligence, right, this is raw horsepower processing speed.

[202] You have more of it right now than I do, meaning you're going to have faster processing speed, better memory, all of these things are going to be.

[203] better when you're 30 than at my age.

[204] I'm 50 because that's already started to decline in me. There are some things, however, that began aging in you the minute you were born.

[205] And one of them is actually going back to this idea of atherosclerosis or cardiovascular disease.

[206] Well, that's an example of a disease process that begins right away at birth.

[207] And even though it almost never rears its head as far as death before you're 50, make no mistake about it.

[208] It's starting on day one.

[209] And we know this, by the way, because when we look at studies of people who die for completely unrelated reasons, so somebody who, you know, dies in a car accident or soldiers dying in war, and we look at the arteries of their heart, we already see quite advanced disease.

[210] So the truth of it is, you already have pretty significant disease in your coronary arteries.

[211] It hasn't risen to the level of ever causing a heart attack, and it's unlikely to do.

[212] so for another 20 years, maybe even another 30 years.

[213] But it's compounding.

[214] It is compounding.

[215] Exactly.

[216] And if you want to live to be 90 free of cardiovascular disease, it makes a big difference if you can slow it down when you're in your 20s and 30s.

[217] Interesting.

[218] That's really what I'm trying to change in myself is I'm trying to find the motivation.

[219] Like you said, when we're not confronted with our mortality, it's interesting because my life changed because of the pandemic.

[220] in part because I got to see the relationship between things like obesity, poor metabolic health and mortality for the first time.

[221] And that's really when I started working out pretty much every day now.

[222] It was three years ago in March 2020 to 2020 when I was watching the TV.

[223] And it was that confrontation of like, oh my God, the reason why I'm having a better outcome with this disease is because I'm in better metabolic health.

[224] metabolic shape.

[225] And it's funny that it has to take those things in our lives for us to make the changes.

[226] When you talk about the deterioration of health, you have these three categories, cognitive decline, decline in loss and function of our physical body, and then emotional health deterioration.

[227] Why emotional health deterioration?

[228] Why have I included that?

[229] Yeah, why have you included that?

[230] Well, I mean, maybe I'll just take a step back and say where I kind of put these all in perspective.

[231] So, you know, the title of the book, right, is Outlive the Science and Art of Long longevity.

[232] And what is longevity?

[233] Well, longevity is really about two things.

[234] It's about the length of life and the word for that is lifespan.

[235] But it's about the quality of life.

[236] And the word for that is health span.

[237] And it's health span that has those three components you just described.

[238] Health span, meaning quality of life, is determined by your cognitive function.

[239] So what's your processing speed, what's your executive function, what's your memory, all of these things.

[240] It's determined by your physical health.

[241] How much strength do you have?

[242] Are you free from pain?

[243] How much endurance do you have?

[244] What capacity do you have to do whatever you want to do physically?

[245] Are you limited in any way by pain, strength, movement, balance, et cetera?

[246] And then the final piece is emotional health.

[247] What's the state of your relationships?

[248] Do you have joy in your life?

[249] Do you have joy in your life?

[250] Do you you have a sense of purpose?

[251] Are you happy?

[252] Not all the time, right?

[253] But do you have the capacity to regulate your emotions?

[254] And so now to answer your question, why would that be included?

[255] Well, the truth of the matter is it wasn't something I always included, right?

[256] It wasn't something I necessarily thought much about until it was, I think, very starkly pointed out to me by a very astute therapist who in observing my own struggles in life said something to the effect of isn't it really ironic that you are putting so much energy into helping people live longer and yet you are paying no attention to your own misery and I think that was you know and that was about six years ago and that was kind of when I realized I needed to rethink my approach to this problem and as I write about in the book, I think I would make the case today that if your emotional health is suffering, none of the others really matter that much.

[257] So what you really need to do is think about a way to have all of these things in order.

[258] What does you mean by your own misery?

[259] Well, I mean, I think at that point in my life, I mean, there's no two ways about it.

[260] I mean, I was just incredibly miserable, incredibly angry, despite being very physically healthy, right?

[261] Despite doing all of the important things to be physically healthy, right?

[262] Exercising, you know, in all the right ways, eating well, sleeping well, optimizing every aspect of my health, but living a bad life.

[263] What were the symptoms of that?

[264] What were the kind of for you to start to spot that?

[265] Because sometimes we don't know in our own behavior and sometimes it's reflected back or on from other people we will get feedback from our wife or our girlfriend yeah i mean detachment from others um prone to anger workaholism um selfishness you know it wasn't it wasn't subtle it wasn't like hmm i wonder if you know i'm not being my best self no if i if i was being honest and confronting it i was not i was not living a good life did you know that in the moment had i asked you in the moment at you happy, what would you have responded?

[266] I think I would have probably said to just that question, sure, right?

[267] But I think to a deeper prodding, no. And there were a lot of things that happened in there, but certainly a very powerful one was going to the funeral of a woman my age who was the mother of my daughter's best friend.

[268] So my younger daughter's best friend, her mom died of cancer.

[269] And so all the parents, you know, we're at the funeral.

[270] And at the time, I was, you know, really going through a lot of difficulty in my own marriage.

[271] And this woman who died was a very successful lawyer, really pretty remarkable.

[272] And I was really sort of struck how at the funeral people had the nicest things to say about her.

[273] What a beautiful mother she was.

[274] She had three kids.

[275] And nobody talked at all about her Like, there was not a single word about her achievements in life.

[276] It was only a discussion about the quality of her life as a mother.

[277] And that might sound very obvious because when was the last time you were at a funeral where they talked about someone's career accolades?

[278] But that, in a moment, really fused an idea from a book I had just read by a guy named David Brooks called The Road to Character.

[279] I don't have you read it.

[280] In the book, David Brooks talks about this idea of there being resume virtues and eulogy virtues.

[281] And I really understood in that moment that my entire life at that moment had been only predicated on bolsting my resume virtues.

[282] I had never spent a moment thinking about my eulogy virtues.

[283] And at that moment, to your question, if someone had asked me, how is your eulogy, I would have been brutally honest and said, it is awful.

[284] There is not a single nice thing anybody who matters about me. In other words, of the people who should matter most, they won't be able to say anything nice about me. Is that painful to admit?

[285] Yes, it's painful to admit today, and it was painful to acknowledge then.

[286] Wow.

[287] I'm so impressed that you're able to, because thinking about cognitive dissonance and how psychologically uncomfortable that must be to face, you hint in the book about, I think it was in the last chapter of the book, you start hinting about the origins of that behavior, the work -holism and all of those things.

[288] And I can totally relate.

[289] I think I'm a total work -holic.

[290] I think I sacrifice too much in the pursuit of, like, accolades sometimes in my life.

[291] Everyone knows me, including these guys will all say that about me. And I've often tried to, in hindsight, figure out where that came from in me and undo that.

[292] It's funny because reading this book, the last chapter I actually wrote in my notes.

[293] I just wrote, because the chapter is called Emotional Health, I wrote Brackett's Trauma and the role that trauma plays.

[294] I didn't expect to find that subject matter in this book about longevity.

[295] What's your thoughts on the role trauma plays and how we go about understanding it so that we can live a, have a long health span.

[296] I think there's probably a lot of people who can relate to the stuff I write about in the final chapter.

[297] And you're right, that chapter is a significant deviation from the first 16 chapters.

[298] So there's 17 chapters in the book.

[299] And I basically make the argument that I am the doctor for 16 of them.

[300] The first 16, I'm talking about this as though I'm the doctor.

[301] You're the patient.

[302] I'm going to help you.

[303] And this is how to do all the stuff.

[304] And then in the final chapter, I'm saying, actually, now I'm the patient and I'm going to kind of walk you through this journey I've had and hope that it basically motivates each of you to have a similar examination of yourselves.

[305] And I think that many people, I can't tell you what fraction of people, but I think many people have maladaptive behaviors in their life that are indirectly or directly the response to something that we would define as trauma.

[306] And trauma is a very vast concept, right?

[307] I think it's very easy when you hear the word trauma to think of abuse.

[308] And that can be physical abuse, sexual abuse, spiritual abuse, these things like that.

[309] And it's true.

[310] I did experience abuse in my life.

[311] But trauma can be much more than that.

[312] Trauma can be abandonment and meshment, witnessing tragic things.

[313] So there are lots of things that are traumatic.

[314] I discuss them in the book.

[315] And what happens to children who are traumatized, and it can also happen to adults, but I think most often the formative years of our life, lives are when these things happen, is we adapt.

[316] And I think that's the kind of remarkable thing about us is how adaptive we are.

[317] And those adaptations can often be very positive.

[318] But a lot of times they have negative, collateral, or maladaptive consequences in addition.

[319] And some of those adaptations that are negative are addictions.

[320] Some of them are other maladaptive behaviors like anger.

[321] Some of them include, you know, things like codependency.

[322] So you can sort of look at people and realize that, hey, you know, maybe that person who grew up in the home of alcoholics, even if it was an otherwise reasonably well -meaning home and it's not like they were getting hit with a belt buckle every night, but they weren't getting the type of attention that they needed.

[323] And their adaptation was to have an attachment disorder that wouldn't manifest itself really fully until they were apparent.

[324] So this type of analysis really, I think everybody needs to spend some time thinking about it and needs to spend some time asking themselves, hey, which of my behaviors are maladaptive?

[325] And it's something that's done, and I think it needs to be done without judgment.

[326] This isn't about saying I'm a bad person because of X, Y, and Z. even though I think I can objectively look back at my own behaviors at that time of my life and say, those are awful behaviors.

[327] I'm not proud of those behaviors.

[328] But it's separating the behavior from the self.

[329] It's not saying I'm a horrible human.

[330] It's saying I'm a human who did horrible things, and I want to understand why.

[331] I love that approach because I think about the maladaptive behavior patterns I had that stood in the way of my chance of emotional health and good relationships.

[332] And a lot of those stem back to my childhood and what I witnessed.

[333] in my home and then the way that made me adapt and the beliefs it gave me about romantic relationships, for example.

[334] So I became totally avoidant of those until later in my life when I realized this pattern.

[335] The third point in your list of things that cause sort of, I guess, longevity of one's health span is that emotional health deterioration.

[336] So before we get into the other two, my question really was on that third point of emotional health, what for you has helped you to, self -analize and become aware and to then get those things out of your way that stand a chance of costing you your emotional health.

[337] Was it therapy?

[338] Was it introspection?

[339] Is it journaling?

[340] Is it honestly with oneself?

[341] Well, I mean, in my case, I think the situation was so far gone that I actually had to go away on two occasions.

[342] So I had to go away in the first time for two weeks.

[343] to an inpatient, like what's called a residential care facility, which was two weeks of like 14 straight days, of 14 hours a day just doing trauma therapy in group and individually.

[344] And, you know, two weeks might not sound like a long time, but boy, that was about the most brutal, exhausting thing I'd ever done in my life.

[345] And then again, I had to do it for three weeks at a different facility.

[346] So again, 21 days of inpatient treatment, but also now really learning what the tools were to manage myself.

[347] How do I fix that behavior?

[348] How do I manage it?

[349] So it's sort of like you have an injury.

[350] You go to rehab, you know, there's an acute healing phase, but then there's a, well, now you want to make sure you're strong.

[351] you don't injure it again.

[352] Because that injury took place because of some weakness.

[353] And that's not a perfect analogy.

[354] But the point is, you know, there's a reason that your shoulder separated.

[355] And we want to make sure it doesn't happen again, even once you're better.

[356] And you sent yourself there, choice?

[357] Yes and no. I mean, truthfully, I don't think I had a choice.

[358] I don't think my, I don't think my marriage would have survived.

[359] So I think it was, I'm not sure I had a choice, truthfully.

[360] So I went very reluctantly.

[361] I did not want to go.

[362] But it was, there was an ultimatum essentially.

[363] Yeah.

[364] Wow.

[365] What was the greatest sort of gift that process gave you?

[366] Oh, it gave me my life.

[367] I mean, it literally saved my life.

[368] Really?

[369] For sure.

[370] Well, I don't think, I don't think I would, I just don't think I'd be alive today with, without it, right?

[371] I think had I lost, I mean, I was on such a, I was on, I was in such an awful cycle of shame and self -loathing and deterioration that I don't think I could have survived it.

[372] So was that, that was a narrative in your head at the time that you, when you talk about shame and self -loathing, that's what the, the voice in your head was.

[373] Yeah, the voice is, you are an awful human being.

[374] That's why you behave this way.

[375] And there's nothing that can be done about it.

[376] You're born this way.

[377] You are defective.

[378] And this is what defective people do.

[379] Look, in many ways, it's a lack of accountability, right?

[380] It's sort of saying, you have no agency in this.

[381] You can't change this because you're defective.

[382] When they do an autopsy on you, they will see something in the temporal lobe of your brain that explains your pathology.

[383] Were you able to discover the root cause of that narrative in your head?

[384] Yes, absolutely.

[385] And more than that, I was able to get rid of it.

[386] Really?

[387] Yeah.

[388] I'll give you one very tangible example.

[389] I had a very, very vocal inner critic.

[390] And I think, I'm sure many people listening to us can relate to that, which is, you know, such a perfectionist.

[391] I was such a workaholic.

[392] But any mistake I made, I would eviscerate myself verbally.

[393] So, and this was, I mean, this is mistakes that don't matter.

[394] Okay.

[395] So one of my hobbies is archery.

[396] I love archery.

[397] So every day, almost every day, certainly if I'm not traveling, I'm going to be out in the backyard shooting my bow and arrow.

[398] Now, does anybody else care?

[399] Nobody.

[400] Right.

[401] Does my livelihood depend on this?

[402] No. But if I'm not shooting well, I am screaming at myself.

[403] I will break an arrow over my thigh.

[404] And these are carbon arrows.

[405] They'll leave welts the size of your finger.

[406] One of the exercises we had to do was, and this was once I left, the second therapy place that was three weeks.

[407] So one of the big realizations there was that this was happening because that voice, like I didn't realize that that was unusual.

[408] So the exercise was every single day until this voice goes away, which I thought would never happen, which meant I thought I was signing up to do this exercise for the rest of my life.

[409] You take out your phone and you talk into the phone with a replacement voice for that voice and pretend you're talking.

[410] to your closest friend as if it were them who made the mistake.

[411] And I say, Hey, Chris, I know you're having a bad day today.

[412] I can tell.

[413] It's hard.

[414] You're not shooting well.

[415] It's okay.

[416] You know what?

[417] Some days it's just not going to go well.

[418] Plus, it is a little windy today.

[419] Let's be honest.

[420] That makes it a bit harder.

[421] And why don't we just pack it up and come back and try again tomorrow?

[422] You know, just talk in a kind way.

[423] Talk in the way you would literally speak to your friend.

[424] And then I would send that recording to my therapist.

[425] So every day my therapist is getting multiple versions of these voicemails.

[426] But this is important because I'm audibly doing this multiple times a day.

[427] And within about four months, the voice just went away.

[428] Really?

[429] Yeah.

[430] That's never come back.

[431] how has it changed you as a father oh my god it's a it's a it's a it's a it's a how has it changed me as a person right as a father as a husband as as a boss as a friend i mean it's it's just um again it makes me a little sad to think oh god i wish i knew this when i was i wish i wish i did this at 25 you know instead of all of this again i just think of all of the collateral damage in my life you know, all of the people near me who have suffered unnecessarily as a result of, you know, of me being a wrecking ball, how much of that could have been prevented?

[432] In some ways, this kind of comes back to your very first question, right, which is I'm 30, I'm invincible, how do I get excited about this?

[433] Look, maybe the answer is, as a 30 -year -old, you don't need to get excited about, you know, your nutrition and exercise in your sleep.

[434] as much as a 50 -year -old does.

[435] But A, there's a lot of benefit to doing so because you'll get more benefit from it.

[436] But maybe it's just focusing on emotional health so that you get yourself fixed before you start a family.

[437] Because I think, you know, and I think, you know, I feel lucky.

[438] I think my kids are still young enough.

[439] I hope that my kids don't have too many memories of their, of their dad in that state.

[440] Your belief about where that came from, although there's no evidence, There's no memory of anyone, you know, saying, well, this happened and whatever else.

[441] But is your belief that you weren't born with that and that something might have happened and you've kind of inferred that in some way?

[442] Yes, I think that was a really, really important breakthrough that happened on the 19th day of that second stint I had in therapy, in that inpatient therapy session.

[443] So that was a 21 -day program that I assumed was only going to be.

[444] 14 days and at the end of 14 days, they needed me to, they wanted me to stay another week.

[445] Everybody wanted me to stay another seven days.

[446] And I was so reluctant at this point.

[447] I was exhausted.

[448] I just didn't think I could do it again.

[449] But they were adamant that I stay another week.

[450] And I knew the first time I had gone for two weeks and left, I left kind of against their recommendations.

[451] And I realized I never really got fully better.

[452] I got somewhat better, but not fully better.

[453] So I decided to just submit to them and say, okay, fine, I will stay as long as you tell me to.

[454] And it was on that 19th day that I had perhaps the single most important revelation for me. Again, this is very personal.

[455] And the point of this is not that everybody else is going to relate to this.

[456] It's only that I hope everybody else is willing to consider their own version of this.

[457] But the last thing I could never let go of was that I was born as a perfect child, right?

[458] Like, meaning we all are, right?

[459] Not just me, but all of these kind of maladaptive behaviors were the result of things that I didn't deserve.

[460] And again, it's not all what we call capital T traumas.

[461] It's not necessarily the abuse.

[462] I mean, I think in my case, perhaps the most impactful things of my childhood were more like neglect and not traumatic, not like the kind of neglect that's, that has you, you should be taken out of a house or anything like that.

[463] I'm just talking about not getting a certain type of attention that I probably should have had.

[464] And for whatever reason, that manifested itself in really odd behaviors that as a kid, I just said, those are just bad behaviors, but that's just who I was.

[465] And I think what I realized is, and what I finally came to accept is, no, those are adaptations to something that you didn't deserve.

[466] And that might sound like a very subtle distinction, but it made all the difference in the world.

[467] And it made me realize, in part by looking at my own kids, that, you know, there is a real innocence to children that can very very, very easily get injured.

[468] And when it does, they're going to make sure that they don't get hurt again.

[469] And the way they're going to do that is, as I said, initially, in their best interest, but ultimately it tends to result in really negative consequences for the way they formulate relationships with themselves, for the way they form relationships with others, for the way they're going to parent, for the way they're going to be a husband or a wife.

[470] And so that was a That was a huge breakthrough.

[471] So important and so powerful.

[472] And I don't think I've ever said this.

[473] But really thank you for sharing that because I got a lot from it.

[474] And I've had lots of conversations about this.

[475] But I've got a lot from that.

[476] Specifically that point about didn't deserve for it to happen.

[477] And really it's a response that's trying to make sure you don't experience that pain again.

[478] So it's really, again, it's your body is doing everything in its power to help you and to protect you.

[479] And some of these behaviours end up being maladaptive, which then stand in the way of your chance of emotional health.

[480] That is the third category of deterioration, which is the emotional health deterioration.

[481] So let's go a little bit earlier in the book and let's talk about the decline and the loss of function of our physical bodies as well.

[482] Medicine 3 .0, as we talked about earlier, you talk about these five core things that help to increase our chances of longevity as it relates to our health span.

[483] So what are those five things?

[484] Well, there's the one we just talked about, right?

[485] So all the tools that deal with how do you improve your emotional health?

[486] Yeah.

[487] Again, most of modern medicine only thinks about, you know, if you think about where does medicine 2 .0 rank on that, it doesn't really except in the arena of mental health, right?

[488] When it comes to clinical depression, anxiety, personality disorders, you know, bipolar disorder, there we have a branch of medicine called psychiatry that deals with those things.

[489] But outside of that, medicine doesn't really deal with people like me. You know, I, none of my problems, quote unquote, quote, rose to the level of, you know, a clinical diagnosis that would require medical therapy.

[490] Okay.

[491] Tool two, exercise.

[492] Again, we can talk a lot about it if you want, a little about it.

[493] But the point is it is not remotely given anything beyond lip service by Medicine 2 .0.

[494] Medicine, you know, if you go to your doctor here at the NHS and say, okay, tell me what my workouts should be, like, good luck, right?

[495] How much time should I be spending in zone two versus zone five?

[496] Like, what type of lifting should?

[497] I mean, there's no way they're going to give you that type of insight or specificity.

[498] The third one is nutrition.

[499] Again, sure, every doctor's going to tell you, eat less, exercise more, but they're not really, for the most part, going to be able to help you manage nutrition.

[500] Certainly, I didn't learn anything about nutrition or exercise when I was going through my medical training, and most physicians don't.

[501] So I'm not saying that there aren't doctors out there who don't.

[502] understand these things.

[503] What I'm going to say is they had to learn that stuff on their own outside of their traditional training.

[504] So crazy.

[505] The fourth one is sleep, and that fits in the same category.

[506] Sleep is an essential pillar of health, but we learn nothing about it in our medical training.

[507] In fact, most of our medical training is paradoxically sleep deprived.

[508] So it's sort of, it's a great irony.

[509] The fifth and final thing that you have as a tool in the longevity toolkit is is all the molecules.

[510] So drugs, hormone, supplements.

[511] And there, that's the one thing you sort of do learn in traditional medicine is you at least learn about the pharmacologic side.

[512] But you don't really learn anything about supplements.

[513] So most doctors don't really understand much about supplements.

[514] And interestingly, most doctors don't really understand a lot about hormones as well.

[515] So medicine 2 .0 is good at what it does, but it's very limited.

[516] So it's kind of like having a contractor that only has one tool.

[517] instead of five tools.

[518] And as we discussed earlier, I think they're applying those tools too late in the game.

[519] How can you prove to, let's start with exercise then.

[520] How can you prove to me that exercise is important?

[521] Yeah, it's a great question.

[522] So start with, the easiest way to do this is to look at what the absence of exercise does versus looking at the absence or presence of other known bad things.

[523] Now for me to explain this, I have to explain a technical term called a hazard ratio.

[524] So if you'll bear with me while I explain what a hazard ratio is, it will reap lots of fruit later on.

[525] A hazard ratio is a mathematical derivation that comes from looking at a group of people, following them prospectively, following them into the future, and looking at the rate at which they die.

[526] So a hazard ratio is a number.

[527] If that number is 1 .5, it means that there's a 50 % increase in the risk of death for one group versus the other.

[528] So, for example, if we want to know, is smoking bad for you, we might ask the question, what is the hazard ratio for smokers to non -smokers when it comes to getting lung cancer.

[529] And the answer is like 10.

[530] Really?

[531] It's about 10 times more likely to get lung cancer if you're a smoker than if you're a non -smoker.

[532] Now, if you look at the hazard ratio across the course of life for all causes of death, it's about 1 .5, meaning a smoker is about 50 % more likely to die in any given year than a non -smoker.

[533] Which you call all cause mortality.

[534] All cause mortality is the gold standard for understanding death and disease because it takes into account every form of death.

[535] Okay.

[536] Okay.

[537] What if you have type two diabetes?

[538] Everybody understands that having type two diabetes is very problematic and people with type two diabetes are at about twice the risk more or less of cancer, heart disease, maybe one and a half times the risk of Alzheimer's disease.

[539] But when it comes to all cause mortality, every cause of death, it's about a 1 .4 hazard ratio.

[540] 40 % increase in all cause mortality.

[541] Again, that's a stark number.

[542] It means at any moment in time, if you take two people who are in otherwise always identical, but one has type two diabetes and one doesn't, this person has a 40 % higher risk of dying in the coming year.

[543] In the coming year?

[544] Yeah.

[545] Jesus Christ.

[546] Yeah.

[547] Wow.

[548] Okay.

[549] We could keep doing this.

[550] What if it's high blood pressure versus normal blood pressure?

[551] That's a hazard ratio of about 1 .2.

[552] 20%.

[553] Same.

[554] Everything I just said, but it's 20%.

[555] Okay.

[556] What if it's someone who has end -stage kidney disease?

[557] Their kidneys don't work anymore.

[558] They're on dialysis hanging by a thread waiting for a kidney transplant.

[559] It's about 2 .7.

[560] That's a 170 % increase in all -cause mortality in the subsequent year.

[561] Okay.

[562] Now, let's talk about some other things.

[563] What if I ask the question, what happens if I take a group of 50 -year -olds, pick any age, pick any sex, and we're going to take the top 15 to 20 percent in strength and compare them to the bottom 15 to 20 percent in strength for that age and sex?

[564] What's the difference?

[565] What's the hazard ratio there?

[566] What would your guess be?

[567] 20 % 10 % yeah so you're 1 .1 to 1 .2 yeah yeah it's 3 shit 200 % difference in all cause mortality can you make a distinction between strength and muscle mass okay yep we can do it so muscle mass just if we did it just on muscle mass it's about 2 or a 100 % difference so muscle mass turns out to be an amazing proxy for strength but strength is even better.

[568] Okay.

[569] Yep.

[570] So high strength and high muscle mass produce a hazard ratio of about 3 .5.

[571] Okay.

[572] Because you can have a lot of muscles but not be strong.

[573] Yeah.

[574] Kind of.

[575] And you can be strong and have not as much muscle.

[576] Okay.

[577] And that matters more, by the way.

[578] But they're pretty tightly correlated.

[579] Okay.

[580] Yep.

[581] Now let's look at V02 Max.

[582] So VO2 Max is the best tool we have to measure peak cardio respiratory fitness.

[583] So this is a test that you actually have to take.

[584] It's done on a treadmill or on a bike.

[585] They put a mask on your face.

[586] And then the mask measures how much oxygen you use.

[587] So in the book, I talk in great detail about this test.

[588] It's something anybody can do.

[589] It costs probably 100 quid.

[590] It's not like super expensive.

[591] And everybody should know their VO2 max.

[592] I really think everybody should know it.

[593] And in the book, I even offer some ways that you can estimate it just by running at a track or something like that.

[594] So.

[595] Sorry, it's the measure of how much oxygen you're inhaling and exhaling?

[596] No, yeah.

[597] It's the difference between how much you inhale and exhale is how much you're using.

[598] So the way the test is working is there's a little oxygen sensor.

[599] So if you're breathing in, we know that the air you're breathing in is 21 % oxygen.

[600] We know the flow rate.

[601] And we, let's just say you're blowing it out at 14%.

[602] So we know you used up 7 % times the flow rate.

[603] we figure out how many liters per minute of oxygen you're using at the max.

[604] And what's good and what's bad?

[605] Yeah.

[606] So it depends on your age and sex.

[607] But at your age, so for a 30 -year -old male, we would say, oh, I need the table is in the book.

[608] Really, I could estimate it, 60, 50, 56 would put you in the top 2 .5%.

[609] And that means that I'm...

[610] Oh, sorry, what's that number mean?

[611] Yeah.

[612] That's 56 milliliters of oxygen per kilogram of body weight per minute.

[613] Okay.

[614] So a high number...

[615] How much do you weigh?

[616] None of your business.

[617] I'm joking.

[618] How many kilos?

[619] I think I'm 96 kilograms at the moment.

[620] Okay.

[621] Very heavy.

[622] So you would need to be 5 .3, 5 .4, 5 .5 liters.

[623] Yeah.

[624] No, no. Yeah, you'd need to be about 5 .5 liters per minute.

[625] you would need to consume 5 .5 liters of oxygen per minute to come out to about a VO2 max of 56 or 57 milliliters of oxygen per kilogram per minute.

[626] That would put you at the top 2 .5 % for your age and sex.

[627] So I'm trying to figure out, is taking more oxygen from the air that I breathe a sign of good health?

[628] Yes.

[629] It means it speaks to how hard, how fast and hard your heart can pump and how good your muscles are at utilizing oxygen.

[630] Ah, okay.

[631] It is the most important metric we have for peak cardio -resportatory fitness.

[632] And sorry if we're going a bit too, a bit more here, because I really want to understand this, and I'm sure there's a lot of people that's trying to understand this as well.

[633] So what are the things that stand in the way of good VO2 max in terms of my, and also the lungs?

[634] Yeah, it turns out that not much of it is limited by the lungs.

[635] So the question is, where are you limited?

[636] Okay.

[637] So how does this test work?

[638] Do you prefer to run or bike?

[639] I prefer a bike.

[640] Okay, so we're going to put you on a bike.

[641] We're going to put this mask on your face that allows no other air in or out.

[642] It's only going to be metered by what's coming from the machine.

[643] The bike is going to be one that has forced resistance to it.

[644] It's called an ergometer.

[645] So we're going to set it to 100 watts, nice and easy.

[646] I'm going to tell you to warm up for a while.

[647] And then after a 10 -minute warm up, it's going to start increasingly.

[648] increasing the power that you are forced to pedal against.

[649] And every two minutes, we're going to add some amount, 25 or 50 watts.

[650] And you're going to say, you have to stay above about 70 RPM.

[651] And this test is going to go until you can't do it anymore.

[652] It's going to go until you basically drop.

[653] So what's limiting you is clearly not the amount of oxygen in the air.

[654] and it's actually not the ability of your lungs to get oxygen into your blood.

[655] You're limited by how hard and fast your heart can pump that blood through your body and how efficient your muscles are at taking the oxygen out and using it.

[656] And the difference between, so again, a 30 -year -old who's in the top 2 .5 % of their age group might be at 56, 57, but to put that in context, the guy who wins the Tour de France this year is 85.

[657] Wow.

[658] And by the way, when that number reaches 20 or certainly 18, 19, you have a hard time just getting around.

[659] Like, you wouldn't be able to walk up a flight of stairs.

[660] It gives you a sense of the gradient.

[661] Now, let's get to my point that answers your question.

[662] You asked, how can I say exercise is so powerful?

[663] Well, what do you think is the hazard ratio when I compare someone at the top 2 and a half percent to someone at the bottom 25 percent?

[664] In terms of V02 max?

[665] Yes.

[666] The top 2 percent versus the top bottom 25?

[667] Bottom 25 percent, that's quite big.

[668] Top 2 percent is quite narrow.

[669] I'd say 1 .1 .5, which is what?

[670] So you think it's less important than strength?

[671] Because we've just established for strength, it's about three.

[672] So I'm just changing it now because I was so wrong on strength.

[673] Yeah, yeah, yeah.

[674] You see what I mean?

[675] Well, what would I have said had you not told me the strength one?

[676] So, um, by the way, I think your guess is a completely reasonable guess because the answer is so absurd.

[677] I'm going to say 1 .5 hazard ratio.

[678] It's five.

[679] Five.

[680] Which means 400 % difference in all cause mortality.

[681] If you compare the fittest two and a half percent to the least fit 25%.

[682] Wow.

[683] So it makes a huge difference.

[684] So this is why I can say with absolute certainty, nothing compares to exercise.

[685] Nothing compares to having a high VO2 max, high muscle mass, and high muscle strength.

[686] They are more beneficial for you than any bad thing you can think of is bad for you.

[687] Why is the muscle mass piece so important and the strength piece?

[688] Why is that causing me to stay alive?

[689] I think there are several reasons.

[690] As you get, so there's, I put them in two buckets, structural and metabolic.

[691] Let's start with the latter.

[692] Muscles are where you dispose of glucose.

[693] So glucose regulation is one of the most important metabolic functions of the body.

[694] Our ability to metabolize glucose and regulate glucose levels is central to our existence on this planet.

[695] And when we get it just a little bit wrong, we go to hell in a handbasket.

[696] That's what type 2 diabetes is.

[697] Type 2 diabetes, raging type 2 diabetes only means you have an extra 5 grams of blood sugar, one teaspoon, in your circulation.

[698] That's it.

[699] The difference between you and someone with type 2 diabetes so bad that they're going to get their digits amputated is an extra one teaspoon of glucose in the bloodstream.

[700] That's how critical it is that we regulate our blood sugar.

[701] And the most important part of blood sugar regulation is having muscles that are big enough to put the glucose into and that are insulin -sensitive enough to respond to the signal of insulin.

[702] And glucose is stored in just a couple of places in our body, right?

[703] It's only stored in the liver and in the muscles, but the muscles store 80 % of it.

[704] Okay, so muscles are really, really good for glucose regulation because it gives the sugar more place to hide.

[705] That's right.

[706] So the other reason muscle mass and strength is so important is, as we age, fragility and frailty become an enormous liable.

[707] ability and death.

[708] There's a figure in that book that shows the mortality associated with falling, and it becomes catastrophic once you hit the age of 65.

[709] Once you hit the age of 65, if you fall, which is pretty likely, and you break your hip or your femur, the long bone in your leg, there's a 15 to 30 percent chance you will be dead within the next 12.

[710] months.

[711] Really?

[712] Yes.

[713] It's insane.

[714] Because you become sedentering.

[715] Yeah.

[716] There's a lot of reasons for it, but certainly a loss of function is a big one.

[717] You can also just die as a result of hitting your head.

[718] You can die from a fat embolism or a blood clot.

[719] You can die from sepsis.

[720] You can die from, you know, heart attack because you, you know, there's so many things that can kind of kill you in response to it.

[721] But even the people, you know, the 70 to 85 percent of people who don't die, percent of them will experience a significant loss of function that never recovers after.

[722] So this issue of sarcopenia, which is loss of muscle mass, and frailty and fragility and fragility become the absolute keeper of death for people once they reach the seventh decade of life.

[723] Again, if you're 30 years old, it's impossible to fathom this stuff because you're indestructible.

[724] Yeah.

[725] Even at my age.

[726] I mean, I feel indestructible and I'm 50, but this changes.

[727] And we have to do all we can to ward it off.

[728] So that's why muscle mass matters so much.

[729] There's this kind of longstanding belief that as you age, there's so many, it's just kind of inevitable.

[730] You put on fat, you know, you slow down.

[731] And you're saying, and I think you communicated very clearly in the book that it doesn't have to be inevitable all of this stuff to some degree.

[732] Well, I mean, look, I, I'm very, I'm very careful to try to be as realistic as possible.

[733] I get a little put off when I see people in this sort of quote unquote longevity space saying things that I think are just science fiction, right?

[734] Like, oh, at 90 you can be just as fit as you are at 40 and stuff.

[735] And I, I see zero evidence that that's happening.

[736] I don't see any biotechnology on the horizon that is going to completely and reversibly change aging.

[737] yet?

[738] I don't think in our lifetime, no. And this is something I spend, you know, an absurd amount of time on, both as an investor and just as a, you know, a person who thinks about this from my own podcast and the types of guests that I bring on and the type of science that I'm paying attention to.

[739] But, but no, I really do not see anything in our lifetime that is going to undo aging.

[740] I think we have some ideas of places we can.

[741] can look, right?

[742] I think that, for example, if you could completely restore the epigenome to what it looks like in a young state across the entire genome, I think that could have a profound effect on function.

[743] But do we have, do I see ways that we could do that we could do that?

[744] It's a longer a discussion, but I think the complexity there is many, many decades away.

[745] That said, what I think we do not need to do is accept the complete and total inevitability of rapid decline.

[746] So the decline is nonlinear.

[747] This is the important thing to understand.

[748] So what was your decline from 20 to 30?

[749] Wasn't that bad.

[750] No. No. And from 30 to 40, it's not going to be that bad.

[751] From 40 to 50, it's going to be more.

[752] From 50 to 60, it's going to be even more.

[753] From 60 to 70, it's going to be way more.

[754] And 70 to 80 is falling off a cliff.

[755] So if you look at this is actually one of the figures I wanted to include in the book, but you're always sort of scrapped for space so we took it out.

[756] But I have a figure that shows both muscle mass and spontaneous physical activity in people by decade.

[757] And it's just based on like a huge data sample of people.

[758] And it's really interesting to watch the correlation, how strong it is, right?

[759] So physical activity and muscle mass go like this and they just fall off a cliff.

[760] And the cliff for both is 75 for both men and women.

[761] Like that's where you see an enormous reduction in muscle mass and activity level.

[762] Because of behavioral stuff.

[763] Well, I think it's a, you know, it's the age old question is, are they losing muscle mass because they're becoming less active?

[764] Or are they becoming less active because they're losing muscle mass?

[765] And I think it's both.

[766] I think these two feed off each other.

[767] And they get harder, right?

[768] Presumably, because what you said about the quality of the muscle as well.

[769] That's right.

[770] So you have to ward this stuff off, right?

[771] I mean, as your type 2 muscle fibers are deteriorating and you're putting more fat into muscle, the quality of that muscle, you go from being, you know, prime to waggoo.

[772] So you have to ward that stuff off, right?

[773] And the way to ward that off is to lift very heavy things.

[774] That's the only way to stimulate the type 2.

[775] muscle fiber.

[776] This tight two muscle fiber won't get stimulated by light movements.

[777] So it's not just that resistance training is necessary, but it's, it's resistance training that's actually quite heavy.

[778] People will hear that.

[779] They go, okay, they get it.

[780] They're on board.

[781] They're going to exercise.

[782] How much do I need to do?

[783] Because listen, can it be, is it, I've got to change my whole life and exercise seven days a week and run marathons now, Dr. Peter?

[784] Or is there, what would you recommend?

[785] So I always start this question by saying, How much can you do?

[786] Okay, I'm going to play doubles advocate here.

[787] I'm going to respond as one of my views.

[788] I'm going to say, listen, I'm so busy.

[789] You don't understand, Dr. Peter.

[790] I'm, I've got kids.

[791] I've got this.

[792] I've got a job.

[793] I'm already, I already have no time.

[794] I'm not sleeping out here.

[795] So I don't have any time.

[796] I mean, it requires a thorough discussion around that.

[797] Is that really true?

[798] No, of course it's not.

[799] Yeah.

[800] So then you have to get into the weeds.

[801] Like, how much time are you watching TV?

[802] How much time are you on social media?

[803] How much time are you doing things that might not be as high a priority as doing this other thing?

[804] So once you kind of get through that, I do sort of put it on them and say, I would much rather you tell me the number than I tell you the number.

[805] I can tell you what I think the number is, right?

[806] Like if you're playing the optimizing game and if you're saying, I want to be the absolute best fittest version of me that is human.

[807] possible when I'm in my 80s, how much do I need to be training for that?

[808] The answer is probably one and a half to two hours a day.

[809] One and a half to two hours a day, seven days a week.

[810] Yeah.

[811] I mean, of course, it's not going to be the same every day and it looks different.

[812] But it's going to average out to 10 to 14 hours a week.

[813] But rather than tell somebody that, because I think that's very off -putting, I would just say, just tell me what you got.

[814] If you tell me you've got five hours a week that you can do this, I'll give you a great set of things you can do in five hours.

[815] And my hope, by the way, is six months from now, you're going to feel so much better that you're going to say, you know what, I would like to up this to seven hours a week.

[816] What's the difference in all -cause mortality if I go from doing zero exercise to doing just a bit?

[817] Yeah, that's a great question.

[818] And for some people, that question is all they need to get started.

[819] Going from zero activity to just 90 minutes a week is about a 15 % reduction in all cause mortality.

[820] So I'm 15 % less likely to die.

[821] In any given year from all causes, if you go from being completely sedentary to just doing 90 minutes a week.

[822] Which is only like, I know, 15 minutes a day, 12 minutes a day.

[823] Yeah, or just, you know, three times 30 minutes a week.

[824] That's a huge, That's a huge shifting of very important odds.

[825] Yeah.

[826] And truthfully, like, I probably spend more time convincing people, not on the all -cause mortality data, but on the health span data.

[827] I thought so.

[828] Because people don't, we don't think about our death.

[829] Yeah, death is so abstract.

[830] It really, I don't think it, I don't think it even sets in until you're in your 50s.

[831] Like, I think it's very, it's very hard.

[832] to capture the finitude of what it means to be a human when you're young.

[833] I think it's true at all ages, but I really think it's so much better to just focus on the quality of life you want to live.

[834] What do you want to physically be able to do throughout your life?

[835] And it's easier in people who have been around aging people.

[836] Yeah.

[837] Which, again, a lot of people in their 30s, their parents aren't even necessarily older.

[838] enough that they can fully appreciate it.

[839] They might have to think, well, do I still remember what my grandparents were like at the end of their life?

[840] And was I inspired by them?

[841] And if so, that's what I want to do, great.

[842] And if I don't want what they had, which is the answer I think most people will have, then what do I need to do to be different?

[843] What was it for you?

[844] I remember what it was for me. Yeah, for me, it's, again, it's, I didn't know my grandparents.

[845] I suspect just my training in medicine.

[846] Like, I was around so many people at the end of life that like, you got to see.

[847] Yeah, it was, it was just imprinted early.

[848] I told this story once in this podcast before, but I was in Bali walking down some, a long set of stairs.

[849] When I say a long set of stairs, I mean down the side of a cliff, going down to canoe with my partner.

[850] And I was, I was walking down those stairs in the sunshine.

[851] It dawned on me that my father probably couldn't walk down these stairs.

[852] And my dad is maybe 60, 65.

[853] and I thought he wouldn't be able to come down these stairs, which means he wouldn't be able to go canoeing with his family.

[854] And we share a lot of genetic information me and my father, of course.

[855] So that was one of those real big moments.

[856] And actually Jack, who films the podcast, he, after I shared that with him, and we had some guests on the podcast, he shared with me his own moment where he was climbing a mountain, I think last month, weren't you, Jack?

[857] And he got to the top of the mountain and thought to himself, God, like it was such an unbelievable experience for him.

[858] that he correct me if I'm wrong it was an epiphany moment you go I wouldn't be able to climb this bloody mountain with all these people and feel this sense of accomplishment if I and it's those moments for me where I thought fuck this is that's my health span I want to be able to do this yes you wrote one of the chapters in your book is about stability found that really surprising again I'd never even come across the concept of stability or why it's important that's why it needed an entire chapter because it is a very foreign concept chapter 13 stability why why is it important?

[859] What does it mean?

[860] Yeah, I think this is, this is, stability is a difficult thing to explain.

[861] I mean, you can sort of talk about it technically, right?

[862] Stability is the capacity to transmit force from the body to the outside world and from the outside world back to the body without injury.

[863] So anytime you're taking a step, you're applying force to the ground.

[864] That's what's allowing you to walk forward.

[865] So you apply force to the ground.

[866] The ground applies an equal opposite force to you.

[867] That's Newton's law.

[868] And you move forward.

[869] When you're running, why are you going faster?

[870] You're going faster primarily because you're applying more force to the ground.

[871] Therefore, the ground is applying more force to you, and that's propelling you forward.

[872] The difference between me and Usain Bolt, among other things, is his capacity to apply force to the ground is two and a half times my ability to apply force to the ground.

[873] So in all that force, how do you make sure that the action of the force mechanism is all for the desired purpose, in this case, propulsion, and not for undesirable purposes like leaking of energy, which is what it feels like when your knee hurts, when you're walking down the stairs, or your hip or something like that?

[874] So the analogy I use in the book to describe this is that of a car, because I love cars, and I talk about the difference between a race car and a street car.

[875] A race car can be even half the power of a street car in terms of horsepower, but because it's smaller, lighter, and has a stiffer chassis and slick tires, much more of its power is being delivered directly to the road without slippage or energy loss, and therefore it's going faster.

[876] And so this idea is a very important part of aging.

[877] So most people who have some sort of chronic injury, it can really be traced back to an instability, whether it be an instability of their scapula, and that's why they really have tennis elbow or an instability in their abdomen, in their lower back, and that's why they have back pain, instability in the feet that translates its way up into knee pain.

[878] All of these things matter greatly.

[879] And a big part of how we train is making sure that we do exercises that bolster our stability.

[880] Again, this feels very relevant to me because I currently got a grade three tear in my hamstring, got a groin problem.

[881] So I'm on physio for the grade three tear.

[882] How'd you tear it?

[883] Playing football.

[884] But I have a couple of suspicions surrounding it because about a month before, I got the foot pain that they call planterfaciitis.

[885] Plentophagitis.

[886] So I went to the, I think it's called a podiatrist, and I got my foot x -ray things done where they give you the insoles.

[887] And then following that, I got loads of injuries.

[888] I think my hypothesis is that I took these insoles, put them straight in, and then proceeded to do two hours of football, basically running a day.

[889] And I think something in me just broke because I suddenly got all these injuries.

[890] And then I was meant to be playing at Old Trafford, Manchester United.

[891] it's football ground in front of 70 ,000 people.

[892] And the day before in training, I pulled my hamstring.

[893] And I think everyone's been speaking to me about my injury and saying, well, you know, maybe it was something in your lower back and maybe this and maybe your feet weren't, whatever, kind of rings true to what you're saying about stability.

[894] I clearly have something, which is not, wasn't prepared for me to suddenly start training for two hours a day.

[895] And everything started breaking.

[896] Well, and look, I mean, it's, it's, it's, hamstring injuries are very stubborn injuries and a lot of people are really imbalanced right much stronger quads than hamstrings my personal take is and I'm sure I'm going to really upset some podiatrists here I think that that insoles foot inserts arch support probably should be reserved only for some people and most people actually need to learn to strengthen the intrinsic muscles of the foot and that that's the issue that's underpinning the planter fasciitis.

[897] And once you have a, because by the way, your foot is not that much different from your hand in terms of the amount of musculature in it.

[898] And yet if you think about the dexterity that you have with your hands and the strength that you have in your hands, I think you'd be surprised at how weak your feet are.

[899] And I don't just mean you.

[900] I'm not singling you out.

[901] I mean, I think this is true for most of us.

[902] because shoes really shield us so much from what our feet should be doing.

[903] So, yeah, I think your hypothesis is actually probably spot on.

[904] And I think what you really need to do is strengthen your feet so that your arches can self -support and that you can sort of regain the springiness that is within your feet.

[905] I spoke to Dr. Daniel Lieberman about this.

[906] Yeah, yeah.

[907] He said the same thing.

[908] Yeah.

[909] He said your feet were too weak.

[910] makes perfect sense to me because I do not think about, I always think in terms of my ancestors, and I think my ancestors didn't walk in these cushioned Belencia -Yaga shoes.

[911] They were out barefoot, building up the strength.

[912] And so when I went from my cushioned Balenciaga's to suddenly training two hours a day on feet that just didn't have the muscles, of course I pulled loads of, I had all these issues.

[913] And so I actually changed my footwear, and I don't have the insoles anymore, and I'm now using these Viva barefoot shoes.

[914] Do you recommend those?

[915] Do you think they're good?

[916] I do.

[917] I really, I mean, again, There's lots of companies that make them.

[918] I wear a brand called Zero, like X -E -R -O.

[919] But the Vivo Barefoot's a great brand.

[920] And I, yeah, I think that a minimalist shoe is a great way to go.

[921] I have the luxury of basically working from home.

[922] So I'm pretty much barefoot, 24 -7.

[923] I work out barefoot at my own gym.

[924] Like I'm in my, and then when I do my activities, like my rucking and stuff like that when I'm outdoors, like I'm in a wide -toed shoe.

[925] that is, you know, at most would have maybe an 8mm increase in heel.

[926] But yes, minimalist shoe.

[927] Now, one thing to keep in mind is if you're transitioning from big shoe to minimalist shoe, don't do it all at once.

[928] So you can also injure yourself in the right shoes if it's too much too soon.

[929] They did say that to me when I bought them.

[930] Yeah.

[931] They said just like sort of ease yourself in because you need to build up the muscles in your feet.

[932] Super interesting.

[933] No one's ever spoken to me about this before.

[934] I just find it saying, I'm like, why did anybody tell me this?

[935] I mean, we do a lot of things.

[936] If you think about it, like, think of all the things we do to kids at such a young age that set them down the wrong path, right?

[937] Like, we put them in big shoes when they're little.

[938] We put them in desks to sit down in class, and we take away a lot of physical activity.

[939] Comfort.

[940] We prescribe comfort to everything and ease, convenience.

[941] Have you read The Comfort Crisis by Michael Easter?

[942] No. Oh, man, such a fantastic book.

[943] And it talks about this.

[944] Oh, yeah.

[945] I mean, it's really the whole thesis of the book, right, is that we have engineered discomfort completely out of our lives.

[946] And it's a, you know, it's an enormous problem, both for our physical and mental health.

[947] The answers are actually quite simple when you reflect upon it.

[948] And you go, how are we born to live?

[949] We're so far away from how we were born to live.

[950] And if I just followed more of the instruction manual of my ancestors, maybe I wouldn't have all of these kind of, you know, modern issues with that comfort in many, many respects has caused me. But it's tough because you have to sort of think about what is the, there are a lot of gifts that come from the modern world.

[951] Yeah.

[952] And like I don't think you would want to go back in time 100 years and be alive.

[953] I probably wouldn't live very long, would I?

[954] Yeah, I mean, and let's even make it less than that.

[955] Like let's say even 70 years.

[956] Like, you know, once we're through the sort of infectious pandemic stuff, right?

[957] I'm like, would we really want to go back and be alive 70 years ago just before World War II?

[958] I mean, I wouldn't.

[959] Like I, yeah, they had electricity and stuff, but I like the modern world.

[960] But there's a huge set of responsibilities that comes with the modernity of our world today.

[961] Food is so abundant today.

[962] I mean, these people did not struggle with obesity because they weren't surrounded by really tasty, hyper -palatable, calorie -dense food in total excess.

[963] We are.

[964] That means we have to exercise some moderation.

[965] Most of them had far more physical jobs than you and I do.

[966] I mean, you and I don't have to lift a finger to make a living.

[967] Whereas 75 years ago, we probably did.

[968] And it's great that we don't have to.

[969] I think you could argue, look, you're having a far bigger impact on the world than you would have ever had 75 years ago.

[970] But that comes with a responsibility to yourself.

[971] Is this one we're seeing this sort of resurgence of discomfort as a hobby and a sport and an industry.

[972] I think so.

[973] Yeah.

[974] I think so.

[975] And again, Michael writes about this so well.

[976] You know, they write about, he writes about things called Masogis, which are these very, very difficult, challenging things that you might have yourself do once a year.

[977] He also writes a lot about something that is just an enormous hobby of mine called Rucking.

[978] Are you familiar with Rucking?

[979] So rucking is something that I think it was probably started by the military.

[980] And it's really how the military does the great majority of its conditioning.

[981] And it's walking with a weighted backpack.

[982] And I mean, the military will do this.

[983] They might go on a 24 -hour ruck where you're carrying half your body weight.

[984] Wow.

[985] So picture you carrying, in your case, right, like close to 100 pounds on your back for a day.

[986] And so there's actually an awesome company in the U .S. called Go Ruck that makes really good rucks that are just ergonomically designed to put weight plates into and then they sell these plates and stuff.

[987] So, I mean, this has become a total obsession of mine.

[988] So I Ruck three or four times every week.

[989] And luckily where I live in Austin, Texas, it's incredibly hilly.

[990] So it's just up and down, up and down very steep hill.

[991] and I'll go anywhere from, you know, 50, 60 pounds on some days, I'll really push it and go up to 100 for shorter rucks.

[992] And, you know, I'm only doing it for like an hour at a time.

[993] But it's very hot where I live in the summer.

[994] So it's just, it adds an extra layer of discomfort.

[995] But it's great.

[996] Yeah, because I don't know whether it's just what the circle I'm exposed to and the information I'm exposed to, but it just seems like all of these ultra -athletic, you know, painful, long -distance, sports have become super popular, the Spartans of the, you know, I actually just recently invested in one because of this very reason, because I'm seeing this comfort crisis, and I always think that when there's one, when one pole rises, the other one also rises, so when digital music record, you know, old -school vinyl records became big, and I think in a world of comfort, people are going to seek out extreme discomfort, and it sounds like you're doing that with your rucking.

[997] Yeah.

[998] Sugar is an interesting topic, because it's really been demonized.

[999] I think, and maybe rightfully so, but I wanted to talk to you about sugar because it's actually been really front of mind for me lately.

[1000] And when I say literally, I mean, literally in the last 48 hours, I went away to a wedding.

[1001] And I remember they didn't have a lot of drinks.

[1002] So I was opting for the sugar -free drinks, the things that say no added sugar in them.

[1003] Like, you know, I won't name the brands, but the ones that have zero and diet on them.

[1004] First question is, is sugar the devil, as people have become to tell me. And also, if I'm drinking these zero drinks with the diet and the zero on it, am I in the clear?

[1005] This is a very complicated topic.

[1006] And I think it's one that's also very contentious.

[1007] And it's also one in which I've probably, my thinking has probably also evolved as the science, I think, has kind of evolved.

[1008] So let's start with what I don't think anybody disputes.

[1009] I don't think there's anybody out there thinking that high sugar foods are somehow nutritious, right?

[1010] That's not the question at hand.

[1011] The question is calorie for calorie is sugar somehow different from, let's just limit it to other sources of carbohydrates.

[1012] So what is sugar?

[1013] So I'm assuming when you're talking about sugar, you're talking about sucrose or high fructose corn syrup.

[1014] Those would be the two dominant forms of sugar.

[1015] but just to demystify it, sucrose, which is the white powder you would put in your coffee or tea, that's just one molecule of glucose and one molecule of fructose stuck together.

[1016] That's table sugar.

[1017] And if you contrast that with pure glucose, so like eating rice is basically pure glucose, it's going to be broken down into pure glucose.

[1018] How different are they?

[1019] Well, obviously the thing that differentiates them is the fructose.

[1020] That's the thing that's different.

[1021] now it's true that fructose has a very different pathway to be metabolized the body breaks down fructose in a very different way from the way it breaks down glucose and by breaks down i mean it gets energy from it the whole purpose of eating is to make this thing called ATP ATP is the currency of life it's the currency by which energy is transmitted throughout the body and the way we make ATP out of glucose is, I think I can probably say this, smarter than the way we make it out of fructose.

[1022] The way we make it out of fructose has a problem, a slight problem.

[1023] Now, it doesn't really matter if you're not consuming a lot of fructose.

[1024] But if you're consuming fructose in a liquid form, it has a real problem, i .e., if you are drinking sugar, there's a real problem.

[1025] And the problem is this.

[1026] When you make ATP out of fructose, you temporarily deplete the cell of energy to the point where more energy is needed.

[1027] This is just a consequence of the speed at which we metabolize fructose.

[1028] We do it quickly all the time in this way, but if you're eating an apple, for example, it's not really an issue because yes, the apple has fructose in it, but it's not that much and you're eating it.

[1029] So it's a piece of solid food with fiber and water that's taking a long time to exit your stomach.

[1030] But if you drink a big glass of apple juice, well, I mean, first of all, that's much more fructose and it's liquid and it's just going straight out of your stomach and your liver is going to encounter it much sooner, as is your gut.

[1031] And therefore, you're much more likely to want to eat more after.

[1032] In other words, it creates more of a hunger response.

[1033] So the real issue with sugar is calorie for calorie, is it more damaging than just glucose?

[1034] I actually think the answer to that question is probably not.

[1035] Really?

[1036] Yeah.

[1037] But in the real world, is that possible?

[1038] In other words, if I put you in a metabolic ward in a hospital where you had no control over what you ate other than me putting it in front of you, and I gave you two different diets and one was higher in fructose than the other, I'm not convinced it would make that much of a difference.

[1039] It's possible it would if we went to extremes.

[1040] You know, maybe at a high enough fructose level, we might actually induce more fat production in the liver.

[1041] we might actually create some fatty liver disease, maybe even drive insulin resistance.

[1042] But I might have to go pretty high on that.

[1043] But the real problem is if I just let you have as much fructose and sugar as you wanted, you'd probably end up overeating in response to this energy depletion thing.

[1044] So I don't sort of describe myself as like a hardcore sugar avoider.

[1045] I mean, like, we're here in London and, I mean, I'm going to have dessert probably most nights, right?

[1046] I'm on vacation.

[1047] But I also acknowledge it that it's, you know, like not something that I want to be eating on a regular basis, you know, just added sugar all the time.

[1048] I don't drink sugar sweetened beverages.

[1049] That's definitely a place where I draw a line.

[1050] So I think there's something about liquid sugar that is more problematic than solid sugar.

[1051] So I'd rather eat my sugar and at least have the benefit of it being more slowly absorbed than drink it.

[1052] What about these diet drinks, though?

[1053] Yeah, so look, I don't drink them personally very often.

[1054] And in part that's, I think, due to a little bit of uncertainty, I think we still have.

[1055] about their impact on our metabolism through our gut.

[1056] I think there's, I think there were emerging data that suggest that at least certain non -nutrative sweeteners, like things like, well, in the U .S., it's like NutraS.

[1057] I think it's Aspartame is the underlying agent or saccharine or sucralose.

[1058] I think there's some suggestion that the effect that they have on the bacteria on your gut might be detrimental to your health.

[1059] I think it's too soon to really say that.

[1060] But my view is, don't take the risk.

[1061] Well, I don't need to, I suppose.

[1062] Like, I love soda water.

[1063] Like, I love carbonated water.

[1064] So I'm just happy to drink that.

[1065] But I'm sure once a month I'm going to have a Diet Coke or something.

[1066] But it's not a regular thing.

[1067] But I will say this.

[1068] When I see people who are struggling, for example, with weight loss and they're drinking four diet Coke's a day, one of the first things I'll do is have them stop completely and replace that with just water or sparkling water.

[1069] Why?

[1070] I'm not sure.

[1071] I just empirically have seen, even though they're not getting any calories, that A, either it's impacting their eating behavior when they're not drinking the Coke or maybe it's having some negative impact on their gut that is.

[1072] that is impacting the way they're metabolizing their food.

[1073] This is rather unscientific at this point, but it's just empirically as something I've observed.

[1074] Everyone cares about weight loss.

[1075] It's such a big topic.

[1076] Everyone wants to lose weight.

[1077] I mean, as you clearly specify, people want to lose fat.

[1078] They don't want to lose weight.

[1079] People want to lose fat, which is something I heard you say.

[1080] What are the biggest misconceptions in your mind about weight loss?

[1081] I guess the narrative is to lose weight, you just need to eat less.

[1082] That's kind of the, is that true?

[1083] And what are the big misconceptions that you hear that we need to overcome?

[1084] Yeah, I think that is largely true.

[1085] I think that eating less is the more important step towards weight loss.

[1086] And that the role of exercise is important, but less because of just the straight number of calories you burn.

[1087] In other words, the increase in energy that you expend through exercise is usually offset by, increase appetite.

[1088] You use the word calories there.

[1089] Yeah.

[1090] Contentious words sometimes.

[1091] It shouldn't be.

[1092] People have come on this podcast and told me that calories are like the concept of it.

[1093] It's kind of like a lie in the sense that they're not all even.

[1094] Some, you know, a sticker celery has this many calories.

[1095] And then when you boil it has this many calories.

[1096] Well, yeah, I think people tend to get a little off in the weeds on stuff that might not matter that much.

[1097] Yeah, it's certainly true that not all calories are absorbable the same way.

[1098] And an example of celery is a pretty extreme example because so much of celery is an insoluble fiber.

[1099] So most of the mass of celery is water and insoluble fiber.

[1100] There are virtually no calories in celery.

[1101] But at the end of the day, it's not rocket science to figure out how many calories you're ingesting in a certain amount of food.

[1102] And the truth of it is, if a person wants to lose weight, as you said, what they really want to do is lose fat mass. I've never met anybody out there who says, I want to have less muscle.

[1103] So we want to have less fat.

[1104] And therefore, we have to create an energy deficit.

[1105] Now, there are other elements to this that matter.

[1106] So we just want to leave on the side that if you're sleep deprived, you're going to be very insulin resistant, it's, that's a much easier path to being overweight.

[1107] Not sleeping.

[1108] Not sleeping.

[1109] Right.

[1110] So you can't correct a weight problem without correcting a sleep problem.

[1111] What about a stress problem?

[1112] Yep.

[1113] That's even harder to correct because it's harder to measure.

[1114] But yes, hyperchortosillemia, high stress makes it very difficult to lose weight.

[1115] My partner said this to me this weekend.

[1116] She was trying to figure out how in one stage of her life when she was, in her words, eating very, very healthy food, she says, I still wasn't losing weight.

[1117] And she, she hypothesized in the car as we were driving that she thought it might be to do with her stress levels at that time in her life.

[1118] And I remember thinking, oh, that's an interesting hypothesis.

[1119] Yeah.

[1120] So high stress, poor sleep, inactivity, all of those things will make it very difficult to lose weight, even in the presence of whatever perfect diet you're on.

[1121] So those things have to be addressed, right?

[1122] you have to be sleeping well.

[1123] You have to be active because activity increases insulin sensitivity, and we want those muscles to be sensitive to insulin so that they quickly get glucose out of circulation.

[1124] And also exercise increases the sensitivity of your brain to what are called satiety hormones, the hormones that tell you when to stop eating.

[1125] So the difference between an exercising person and a non -exercising person is that that non -exercising person has a blunted response to those hormones.

[1126] So sometimes they're eating when they don't need to be eating.

[1127] They're not getting the message that says, we have enough nutrition on board.

[1128] Now, anybody can blow through that signal, but I would like to know that that signal is there.

[1129] So when all of that is said, the question then becomes, how do you create an energy deficit?

[1130] And basically, There are three ways to do it.

[1131] There are three strategies to create an energy deficit.

[1132] I described them as CR, DR, DR, TR, TR.

[1133] So that stands for calorie restriction, dietary restriction, and time restriction.

[1134] So let's explain them.

[1135] So calorie restriction is what it sounds like.

[1136] Just eat less.

[1137] That's the most direct way to go about doing this.

[1138] So, you know, I got to eat 500 fewer calories a day.

[1139] and I'm going to have to track what I'm eating and count my macros and make that happen.

[1140] Okay, that has the advantage of being the most direct way to do this.

[1141] But it has a disadvantage, frankly, of being harder to do.

[1142] In some ways, you have to pay the most attention to it.

[1143] It also has the advantage, by the way, of being pretty flexible and agnostic to what you eat.

[1144] So, you know, if there are certain foods you like, there's no food that's off the table when you're doing calorie restriction.

[1145] It provided you're eating less overall.

[1146] Got a friend that said this to me, said, it doesn't matter what you eat.

[1147] Just restrict the calories.

[1148] I remember thinking that was strange advice because he was like, you can have Domino's Pizza every day.

[1149] You just, if you'll lose weight, if you have less calories.

[1150] That's right.

[1151] Now, the problem is, he's absolutely right.

[1152] But the problem is it can be very difficult to not suffer through calorie restriction if you're just eating crap.

[1153] Because the body still at the end of the day, keeps score with respect to nutrition.

[1154] And the body still wants protein.

[1155] The body still wants nutrients.

[1156] The body still wants vitamins, minerals.

[1157] So if you say, look, I'm going to eat 2 ,000 calories a day of Cadbury's, you might lose weight, but you'll probably be in purgatory along the way.

[1158] And you certainly won't be healthy.

[1159] So we also want to make sure we're not confusing health and weight here.

[1160] Now, we come to dietary restriction.

[1161] Dietary restriction is what most people think of when they think of a diet.

[1162] This means, as I describe it in the book, you know, pick your favorite boogeyman or two and just cut them out of the diet.

[1163] So basically everybody that's arguing about their perfect diet is arguing about dietary restriction.

[1164] So you want to take out carbs, you want to take out animal products, you want to take out everything but meat.

[1165] You know, it's a carnivore diet.

[1166] You want to go South Beach, Paleo, Mediterranean.

[1167] Those are all just forms of dietary restriction.

[1168] And generally, speaking, the more restrictive you are in the diet, the less you will eat.

[1169] So, I mean, it's, I don't think it's an accident that people who go on a carnivore diet typically lose a ton of weight.

[1170] Same is true of a ketogenic diet.

[1171] I did it.

[1172] Yeah.

[1173] My scales, it was like this.

[1174] This was the, it was a horizontal line my weight, maybe a little bit up, and then I did keto for eight weeks, and it was a vertical line down.

[1175] Every time I hit those scales and the Bluetooth thing sent my weight to my phone, this vertical line down.

[1176] I lost a stone in the space of those eight weeks, roughly.

[1177] A girlfriend was like...

[1178] A stone is 16 pounds?

[1179] Something like that, yeah.

[1180] Eight kilos -ish.

[1181] What did I go from 14 stone 5 to...

[1182] 14 stone 8 to 13 stone 8.

[1183] Yeah, which I think, yeah.

[1184] And were you hungry?

[1185] I couldn't sustain it easily.

[1186] I'd say that, because if we went to restaurants and stuff, I was always trying to get, like, taking corn out of a...

[1187] Like, taking the wrap off a burrito and stuff and whatever else.

[1188] Was I hungry?

[1189] After I got past the first week, I wouldn't say I was hungry, no. But I also didn't find it sustainable because of, honestly, because of the nature of the modern world, where it's so hard to find those things when you're living a very fast -paced life.

[1190] Hungry for some kind of nutrient, maybe.

[1191] I think there was some kind of psychological calling to go back to my previous diet.

[1192] And then I went to New York, and that's when it fell down.

[1193] And then did you regain the weight or what happened?

[1194] Oh, yes.

[1195] Oh, yes.

[1196] Just as fast as I lost it.

[1197] I went from this keto diet to the New York diet, and it was so extreme how quickly I put that weight back on again, just being honest.

[1198] Yeah.

[1199] Well, it's interesting, right?

[1200] So, again, it's a very extreme diet, and I think, you know, people are going to definitely lose weight on it.

[1201] And look, for some people, it's easy to sustain.

[1202] For others, it's not.

[1203] But nevertheless, that's dietary restriction.

[1204] And again, I think the advantage of dietary restriction is you're not being restricted in the amount you eat.

[1205] you're just being restricted in what you eat.

[1206] And the challenge then really comes down to the craving of certain types of foods.

[1207] So obviously in a ketogenic diet, you're going to really crave carbohydrates.

[1208] So the final strategy is time restriction.

[1209] And people call this intermittent fasting as well.

[1210] But it's basically saying, all right, how about I create a smaller window in which I eat?

[1211] So I'm just going to allow myself to eat, you know, from noon to 8 p .m. or 2 p .m. to 8 p .m. or 2 p .m. to 6 p .m. And the narrower and narrower you make that window, the more likely it is that you will induce a significant caloric deficit.

[1212] And therefore, you will lose weight.

[1213] What do you think of fasting?

[1214] Do you fast?

[1215] Not anymore.

[1216] At least not deliberately.

[1217] I mean, I sometimes end up fasting just by the nature of whatever I'm doing.

[1218] But again, fasting has a lot of, a lot of advantages.

[1219] It's conceptually the easiest by far.

[1220] I think it is just the easiest to execute on.

[1221] Because for most people, it's just easy to not eat for a period of time and then have no restriction when they are eating.

[1222] I think the biggest challenge of fasting comes down to protein intake.

[1223] And protein is, in my view, obviously I write about this in the book, the most important macronutrient, the one we need to be paying the most attention to.

[1224] And when you are intermittently fasting, it is very difficult to get the right amount of protein in and in the right doses.

[1225] And therefore, it's the most difficult to maintain muscle mass. And we always have to remember that, you know, if we're losing weight, we still want to be able to maintain muscle mass. We want to just lose fat mass and not lose both.

[1226] I'm fasting as we speak.

[1227] I haven't eaten today yet and it's, I think it's just after six.

[1228] The reason for that is because before this podcast, I realized that if I eat before I have a conversation, my brain doesn't work.

[1229] It feels like, and I having spoken to some experts, the energy rushes to my gut.

[1230] So I can't speak as well and I can't think as well.

[1231] So I ordered the food just before you got here.

[1232] And then I said to my system, I can't eat it.

[1233] And within an hour of you, so I'll eat it after.

[1234] But, yeah, the health benefits are one thing, but the cognitive impact as well has been quite, quite, quite big for me. So you don't fast.

[1235] No, I used to fast a lot.

[1236] I mean, I used to do days and days at a time.

[1237] Alcohol, I think I wanted to talk to you about.

[1238] I'm thinking of quitting.

[1239] What is the, what is the advice from a doctor like yourself about alcohol?

[1240] And do you drink?

[1241] I do.

[1242] It's a very interesting topic.

[1243] So I, and it's so long that I don't want to, I don't want to spend another hour on this because I'm sure that's not the answer.

[1244] Anyone is looking for.

[1245] I will say this.

[1246] Alcohol, ethanol, which is the alcohol we drink, is toxic.

[1247] Its toxicity is nonlinear.

[1248] So it's toxicity kind of goes like this, meaning at low levels, it's just a little bit of an increase.

[1249] But the more you drink, the more it becomes toxic.

[1250] So, you know, for most people, there's not an appreciable amount of toxicity at one drink a day.

[1251] But, you know, two, three drinks a day starts to become quite toxic.

[1252] but there is no dose of ethanol that is helpful.

[1253] So the question becomes, why is there so much epidemiology out there suggesting the benefits of modest alcohol intake?

[1254] So there's this thing in the alcohol research field called the J curve, the J curve.

[1255] So picture a J curve for all -cause mortality.

[1256] It means that at total abstinence, mortality is here.

[1257] But as you drink a little bit, the mortality goes down.

[1258] before it really rises sharply as you increase the drinking.

[1259] That's what the epidemiology shows.

[1260] And it goes down.

[1261] Well, again, epidemiology is fraught with many limitations, especially epidemiology of nutrition.

[1262] It's much worse than the epidemiology of, say, exercise or infectious diseases.

[1263] And proponents of alcohol argue that, and they might be right to some extent, that there are some pro -social benefits of alcohol.

[1264] alcohol, at least in the former red wine, is also potentially something that comes with some antioxidants and things of that nature.

[1265] My view is that that literature is highly flawed and that literature is confounded by a negative survivorship bias and it's confounded by the fact that non -drinkers often have a health reason for being a non -drinker.

[1266] In other words, there are people who are completely not drinking because of a health reason that's forcing them to be not drinking and people who drink and die as a result of it dilute the pool of data that we have of the toxic effects of alcohol as time marches forward.

[1267] So it's a long -winded way of saying I think anybody who's thinking about not drinking should absolutely engage in that.

[1268] There's no health benefit to be drinking.

[1269] You asked me if I drink.

[1270] The answer is I do, but I don't drink if it sucks.

[1271] Like, in other words, there has to be a good reason for me to drink.

[1272] So my my sort of mantra is don't drink on airplanes.

[1273] Like they always just have crap alcohol.

[1274] What's the point?

[1275] Right?

[1276] Like if I'm going to drink, if I'm going to have a glass of wine, it has to be really good.

[1277] I don't have a hard time opening a bottle of wine that I bought and deciding, actually, I don't like it that much and pouring it down the sink.

[1278] I'm not going to drink it because it's there.

[1279] So that's kind of how I think about it.

[1280] Now, there are a couple of rules, I think, that make drinking less toxic.

[1281] So rule number one is really try not to have more than one drink in a day and definitely not more than two.

[1282] Hard rule there for me. Second is I do not want to be drinking more than three hours or less than three hours before bed.

[1283] In other words, I do not want alcohol to negatively impact my sleep, which it has a devastating consequence on my sleep.

[1284] So if I'm going to drink, I'd rather have a cocktail early than drink into the wee hours of the night.

[1285] Sleep's really important to you, isn't it?

[1286] For sure.

[1287] Super important to me as well.

[1288] It's been life -changing.

[1289] This little weep thing.

[1290] Yeah, yeah, I see that.

[1291] Absolutely changed my life.

[1292] And you've probably noticed how your whoop score changes with and without alcohol in your system.

[1293] One glass and it's all flashing red.

[1294] And it's the first time that happened, I had one glass of wine and I woke up the next day and my vital signs, my heart rate variability was flashing red, and it literally says, did you have a drink last night?

[1295] It changed my life.

[1296] Yeah.

[1297] It changed my life forever.

[1298] And honestly, I'm absolutely obsessed with sleep in a very healthy way.

[1299] Some people think, oh, that's, you know, you might be waking up and feeling bad.

[1300] No, I look at it.

[1301] And if I've not slept well, I'll adjust my day accordingly.

[1302] You share some stats around sleeping in the book.

[1303] What is the stat or the two stats that changed your perspective on sleeping or that really you would tell someone if you're trying to convince some of the importance of sleep.

[1304] It's so interesting.

[1305] I'll tell you, it's not even a stat.

[1306] I think it's more of, it almost goes back to the type of discussion you'd have with somebody like a Daniel Lieberman, right?

[1307] Thinking about this through the lens of our ancestors.

[1308] So I was always someone who deprioritized sleep.

[1309] You know, very busy person, high energy didn't really seem to need that much of it.

[1310] Even in high school was sort of always go, go, go.

[1311] And, you know, at one point I was sort of having a discussion with a colleague about sleep.

[1312] And I was making the argument that, like, I didn't really need any of it, you know.

[1313] And I almost, you know, made a point, like, it's almost a shame we can't just work our way out of it.

[1314] And he sort of posed to me in a very Socratic way, well, you know, given how evolutionarily unwise sleep would be, right?

[1315] You are unconscious for a third of your life.

[1316] And we know that our ancestors slept on an average of about seven to eight hours every 24 hours.

[1317] They didn't do it always straight away.

[1318] But we know that they're sleeping basically a third of their life.

[1319] That's a time when you can't forage for food.

[1320] You can't defend yourself against predators.

[1321] You're not mating.

[1322] Like there's nothing from an evolutionary perspective you're doing.

[1323] Those are the three highest priorities of evolution.

[1324] And you're not doing them.

[1325] why would evolution have kept this thing around?

[1326] Like, and by the way, why has no species figured out a way out of it?

[1327] And I think through that lens, I was sort of like, huh, yeah, interesting.

[1328] Maybe this thing does matter.

[1329] So in some ways, I think that's probably one of the most powerful things that you can hear.

[1330] And sure, there are lots of statistics about how fragmented sleep, broken sleep, or short sleep can increase your risk, in particular of cardiovascular disease and dementia.

[1331] I think there's a less clear relationship to cancer, but I think the relationship is quite clear to cardiovascular disease and dementia.

[1332] In addition to insulin resistance and obviously therefore weight gain, so for people, even if you're just coming at this through the lens of weight or excess body fat, I mean, that's probably motivation enough for many people.

[1333] And then, of course, there's how you feel and how you perform.

[1334] And your creativity and your ability to articulate yourself, which I notice, and your mood, huge one for me, especially when you're running teams.

[1335] unslept days in my worst days.

[1336] The last thing I wanted to ask you about was just, again, a conversation I've had with my friends recently.

[1337] When I say my friends, I mean, this group of my five best mates and different voices in the group about hormone replacement therapy.

[1338] And one of my friends, in particular, is very keen on it.

[1339] He says, when we get older, we should all take, I think, testosterone, I think it's TRT, because it will help us in all these different ways.

[1340] And I've sat here and spoken to people about menopause as well.

[1341] And the hormone therapy you can take when you, when you, go through menopause.

[1342] What is your position on on taking these hormone replacement therapies to improve our health span and our emotional state, et cetera?

[1343] Yeah, I think it's a long discussion, but I have a lot of podcasts on this topic because I think it's so misunderstood.

[1344] You know, we have a lot of data on the use of testosterone replacement therapy in men.

[1345] And while I think it is generally overprescribed and I think generally at least in the U .S., men are receiving TRT far too early in their lives.

[1346] I think the data for responsible use of TRT are very positive.

[1347] So the risk, you know, again, historically the risk would be increased risk of prostate cancer, increased risk of heart disease.

[1348] Those have not borne out.

[1349] Again, at physiologic doses, a very low risk proposition that comes with many benefits.

[1350] Most notably, of course, being benefits of body composition, but also insulin sensitivity.

[1351] I think the cognitive benefits are a little more controversial, not entirely clear that testosterone replacement therapy preserves cognition as we age, but it hasn't been studied perfectly.

[1352] So I think that's a bit of a TBD.

[1353] As far as estrogen and progesterone replacement therapy or hormone replacement therapy for women, I think this is unfortunately a very controversial topic that shouldn't be.

[1354] I think it's anybody who's really scrutinizes the literature here, as opposed to just chooses to believe what they were told, has to come away believing that it's a net positive for women, especially women who are symptomatic, right?

[1355] So women who are having hot flashes and night sweats as they're going through menopause.

[1356] They benefit enormously from hormone replacement therapy.

[1357] And in the case of HRT for women, the estrogen is so important as it protects their bone density.

[1358] So women really go through this risk.

[1359] of osteopenia and osteoporosis when they go through menopause because their bones get weaker in response to estrogen loss.

[1360] So being able to restore that is so important.

[1361] And then, of course, you have all of the sexual side effects of menopause as well that are ameliorated by estrogen.

[1362] Another thing that hasn't been yet completely well studied, but I think is becoming increasingly of interest in the United States is the use of testosterone replacement therapy and women as well.

[1363] So most people don't associate testosterone with women, but it's actually a very very important.

[1364] very interesting statistic that women have 10 times more testosterone in them than they do estrogen.

[1365] It's just that estrogen is the dominant hormone for their sexual characteristics.

[1366] So we mostly just think about their estrogen and progesterone, but we should never ignore their testosterone because, A, it's 10 times more abundant than their estrogen, even though it's 120th as abundant as it is in a male.

[1367] But it still plays an important role in muscle mass, mood, and libido and sexual function, orgasmic function, all sorts of things.

[1368] So we think a ton about all of these hormones in our patients.

[1369] And I think, you know, you just have to make sure that if you're going down that path, you're doing it with a doctor who really understands it because there are some real big mistakes that can get made, especially in young men who end up on a high dose of testosterone.

[1370] And they haven't been told that, hey, by the way, you know, a couple years into this if you're on a high dose of testosterone, you're going to lose the ability to make your own.

[1371] And you're not going to be able to make sperm either.

[1372] Really?

[1373] You can imagine, imagine being 30, having some dock in a box put you on a boatload of testosterone.

[1374] And then when you're 35, you're like, yeah, I think me and my wife want to have kids.

[1375] And you're like, nope, that's not happening.

[1376] Wow.

[1377] So there's one has to be, one has to know what they're doing because there are ways to give other hormones that preserve fertility and things like that.

[1378] I'm super scared of all this stuff.

[1379] You know, I'm super scared of messing with the chemical balance of my body.

[1380] It's my default is, I don't even take, like, what do you call it, like penicillin?

[1381] If I'm, if I have excruciating pain somewhere in my body, I won't take any medicine.

[1382] Because I'm, because I always ask myself the question, what's the cost?

[1383] There's always a cost somewhere, and I don't think we think about that enough.

[1384] And one of the things obviously happening at this chapter of my life is my hair is going to recede.

[1385] And I'm watching as my friends all battle this in their own ways.

[1386] Some of them are doing the testosterone and shampoo.

[1387] Some of them are taking pills for it.

[1388] I am, I've surrendered.

[1389] it's going back.

[1390] I don't care because I'm too scared to mess with my chemicals.

[1391] I don't want my libido to go.

[1392] I don't want to not be able to have kids.

[1393] Actually, I'll just share one last interesting story with you.

[1394] So there is the most common drugs that are, the most common pills that are used for treating that are called five alpha reductase inhibitors.

[1395] So again, I don't know what their names are in the UK, but in the, in the US, the two drugs are finasteride and dutastoride.

[1396] For receding hairlines?

[1397] Yeah.

[1398] Okay.

[1399] So these are drugs that block, the conversion of testosterone to a more, much more potent androgen called dihydrotestosterone, dh