Simple Habits That Could Add Decades To Your Life - Dr Peter Attia

The reality of it is having a very high VO2 max being incredibly strong that's going to do more for your lifespan and health span than any piece of technology or biohacking or manipulation of gut biome or any other thing that people are talking about I mean it's just not even within the same zip code and you don't need a lot of technology to do those things you just need to put in the work Patriots Yeah welcome to the show thank You very much Chris would you say that you have a unique or different perspective when

it comes to longevity uh I don't know that's an interesting question uh yeah maybe in some ways I do I suppose it seems to me that you're focusing on not just lifespan but also Health span as well not just physical health emotional health mental health that more holistic view seems to be different to me Yeah and also I think kind of a somewhat low-tech approach as well um and I'm completely interested in you know fascinated by obsessed with all the high-tech stuff and the you know the science that hopefully will come through in the in

the coming decades but I you know maybe going back to my background in in Risk Management I really think everyone should always be hedging everything they're doing so you know to just assume that we're going to Come up with some amazing technological breakthrough that's going to you know start to defy aging while not doing all of the things that we can do with the technology that exists today strikes me as unwise what's that background in Risk Management um I after I left my first stint in medicine in 2006 I went to work for the consulting

firm McKinsey and Company and though I was recruited there to do health care I ultimately uh wound up in The risk practice because my background in math so uh I yeah I was doing you know credit risk and uh cool stuff like that all right and how does that inform the way that you show up for your work now um I think it's essential right I think I think everybody should be trained in some understanding of risk everyone should be trained in probability statistics uh you know that's to me the much more important stuff in

mathematics Um and I I think that understanding how to think about uh symmetric and asymmetric risk understanding expected value thinking about how to hedge risk all those things are you know important not just in you know thinking through financial instruments where banks are constantly making mistakes anyway but as you think about your own life so I'll give you a very silly example so uh two weeks ago a friend said hey you want to come you know skiing you know he's going To go to this amazing place and Ski and I said no he's like how

do you not want to do this and I was like well I don't personally get enough pleasure from skiing to justify the downside right so the upside for me to go skiing with you is this much the downside is this much but that's my decision that doesn't mean you shouldn't go skiing right because for him the upside is probably much larger and maybe he's a much better skier than I am so his downside is much Less but it's thinking through simple things like that every decision I make I sort of put through that Matrix that

makes a lot of sense I'm interested by this low-tech approach that you've mentioned and I I keep on bringing this up a mutual friend Andrew huberman uh yourself it has really been at sort of the Forefront I think and Kelly starrette's new uh new book um he's almost sort of stripping things Back a little bit uh there was a movement you know 10 years ago this sort of Advent the absolute like Frontier of the biohacking Quantified Self and it really seems like that's not being reversed but being taken back to um a much more simple

set of rules for people to follow yeah look I think they're not mutually exclusive and I'm certainly no stranger to all of those things and I probably still do things that most people would Consider excessive when it comes to you know tracking things and monitoring things and incorporating technology into what I do but the reality of it is you know having a very high VO2 max being incredibly strong that's going to do more for your lifespan and health span than any piece of technology or biohacking or manipulation of gut biome or any other thing that

people are talking about I mean it's just not even within the same Zip code and you don't need a lot of technology to do those things you you just need to put in the work well it seems to me that one of the longest levers is compliance on whatever the program is that you're going to do and one of the problems that I found certainly I struggled tracking macros right I've always struggled tracking macros so for me learning what intuitive eating felt like actually meant that I adhered to my diet more effectively than Setting the

bar for compliance so high that I just constantly failed and then I didn't get any motivation from doing it and I feel like that is a little microcosm for tons and tons and tons of ways where the bar has been set too high for people to actually access these protocols yeah everybody's got to figure out the system that works for them I think using nutrition as an example so um you know as I talk about in the book There's basically three ways to go about reducing intake so if you're over nourished which is the kind

of way I describe people that have too much body fat especially in places where you don't want it right so it's not really the subcutaneous fat we're worried about it's the visceral fat it's the intramuscular fat it's the peripancreatic fat perinephric fat all of those things that are metabolically destructive so not the Cosmetic fat that Actually has no metabolic um consequence so let's assume you established that a person needs to you know me I need to lose I need to reduce energy intake I can do it by calorie counting or tracking my macros I can

do it by dietary restriction by sort of identifying things within the diet that I don't want to eat and limiting them or I can do it via time restriction just narrowing the window down in which I eat each of those has its pros and cons but What matters is that you figure out what kind of works for you so for me personally dietary restriction has always produced the best outcomes if I simply pick certain boogeymans in the diet and say I'm not going to eat those things everything falls into line whereas when I track macros

which by the way sometimes produces better results in the short term it can be harder to maintain conversely I have friends who can track macros all day long every day And they can do it automatically like they don't have to be in it like that one I'm not built like that in the slightest and that's okay I mean again I think the point is I I you know sort of would want my patients for example to try all three and figure out which one works for them and as I always say like you're better off

being 7 out of 10 in performance but doing it every single day then being 10 out of 10 some days 0 out of 10 other days and you Know that kind of cyclic performance generally leads to worse outcomes over the long run one of my friends Alex mentioned to me the other day that most people have a bucket of perhaps between 5 and 10 meals that they typically eat and he said that one of the longest levers when it comes to altering your diet is to just look at those five to ten meals even forget

about everything else it's like what do you eat the most you probably have For me it's like full recipes that I go back to very consistently okay what's that constituted of and how can you just Tinker with that a little bit for it to be closer to what your goals are I thought holy [ __ ] like that's such a low-tech solution and yet in terms of what it does does it grow any corn does it actually work probably super effective yeah that's one of the things I enjoyed most about macro tracking when I do

it is you know the app I use which Is called carbon has you know and I'm sure this is true of any of the apps now they're all so much better than they used to be 15 years ago when I started trying to pay attention to this but you basically put in your recipes so you're not necessarily going to pre you know populated things you're saying look when I make an omelette I always do it the same way it's eight egg whites it's four yolks it's half a tablespoon of butter doing it for 25 years

the exact same way Every time so just click click click click click and now I can know and you're and you're absolutely right there's probably no more than about six things that are constituting eighty percent of what I eat talk to me about the difference between slow death and long death ah okay so um I mean as the name suggests it really comes down to the rate of time between when the onset of the illness takes place and when you demise so if you Think about the greatest successes in medicine our current medical system what

I call medicine 2.0 medicine 2.0 is remarkably successful in treating fast death so um when you think about trauma when you think about a person who's you know driving down the street uh car hits another car and you know they suffer a significant injury that 100 years ago would have killed them we now have you Know remarkable capacity to save lives in that situation infectious diseases of course would be the poster child for this up again up until 150 years ago we stood no chance against uh most infections and today you know some of the

most devastating bacteria barely you know touch the surface and and by the way viruses that once you know wiped out civilizations we can now vaccinate against and all these things so we've effectively doubled human lifespan uh Going from about 40 to 80 years by treating fast death so big win for medicine 2.0 um the problem is we haven't really made much progress against slow death so slow death is what most people think of when they actually think of death now when you think of cardiovascular disease cerebral vascular disease cancer neurodegenerative disease metabolic disease those are

slow deaths even when a person drops dead suddenly of a heart Attack right a person who's been asymptomatic their whole life and drop dead suddenly of a heart attack that disease was killing them for 30 years so unfortunately we just haven't made much progress there and as I argue that's where we have to make progress that that has to be the transition if we want to be serious about longevity why is that not a priority currently I don't think it's not a priority I think we just have the wrong strategy so Um if you have

the wrong strategy you will fail and I would argue that we don't have the right strategy for addressing those problems so it's not due to a lack of trying I think we've been trying very hard to eradicate slow death and I would argue that the fact that we've had such little success given the enormous resources that have been put in both financially and simply sheer effort I think is proof positive that we need a Different approach we're going to go through a lot of insights today that people can apply to their lives before we even

get into that how should someone think about building a framework of how they can take the tactics that we talk about today and actually use them as we mentioned at the very start compliance adherence you can have the best strategy in the world if you don't end up applying it it means nothing what is your best advice on how people can Form a framework of tools that they can actually use well I think you have to start with the objective uh so so everything I talk about it I've always talked about this way or at

least you know for more than a decade and I certainly have written the book through this lens which is you go from objective to strategy to tactics so we always want to start with the objective and I do think it's worth being clear for any individual what Their objective is and I take a lot of time with patients going through this so um you know when you go to your doctor that's not a common question what is your objective and again it's not the fault of the doctor I think it's the fault of this system

the system isn't really set up to ask that question the setup the system is more set up to kind of play a bit of whack-a-mole is there a problem right now is there a symptom right now that I need to address but if You're trying to play this sort of long game you have to work backwards and say okay what do you want to be true at the end of your life and the the framework that I use for that is called the marginal decade so the marginal decade is the last decade of your life

everyone will have a marginal decade and that's not a pleasant thought for many of us to think about right I don't love thinking about the fact that I'm going to have a Marginal decade but I will now you never know the day you enter your marginal decade um but many people know when they are in it and the question then becomes what do You Want To Be True in that decade so let's play the game with you how old are you Chris 35 okay so let's assume that you know fate will smile on you and

you know God forbid you're not going to have some premature death you Know you're not going to die in a car accident next week or be stricken with cancer in you know 10 years or something like that so let's just assume your marginal decade is kind of the ninth to Tenth decade of your life what do You Want To Be True in that decade I would like to still be able to move without assistance what kind of moving uh I would love to be able to still walk Okay uh I would love to be I'm

adored dogs so being able to take the dog for a walk being able to throw the ball a bigger dog golden retriever okay is that a big dog yeah big for a 90 year old yeah okay that's okay okay you can be ambitious here I am ambitious yeah big golden retriever okay um I was gonna be able to walk a golden retriever yep how far 30 minutes a day okay yep uh maybe twice a day if I could at best Hills or no Hills uh not so fussed about hills okay Hills can Hills can go

but do you want to live in a house that's got uh a balcony okay so would need to be able to go up and down stairs okay um would love to still be able to pick up grandchildren I have no idea whether that's realistic at 90 years old but that would be something I'd love to do pick them up from the floor from a crib Okay um would love to have still a good quality of sleep um and would love to be able to have sex at 90 yep not something I've considered good question let's

say yes let's say yes I'm still going at 90. okay um and probably most importantly above all Of this is still have proper cognitive function like still I I value the quality of my thoughts more than anything on the planet um I still want to be able to learn I still want to be able to satisfy my curiosity you know if I was still able to have conversations like this at 90 that would be just fantastic to me uh I assume you don't want to be in pain that would be good okay so again we

could drill into this a lot Further but I think what would emerge and by the way this isn't this is a valuable exercise because I don't think a lot of people do this um but I I think everybody needs to do this and needs to go really far down the rabbit hole and what you'll realize is um by the way everything you've said is totally reasonable like I have some people when you play this game with them you know the first thing they say is I want to be heli skiing when I'm 90 and It's

like I'm not going to tell you that's not possible but like that that's the first thing you would say is a little odd right but everything you're saying is is achievable but is challenging so for example walking a golden retriever um at the age of 35 you don't even have to think about it but if you actually look at the force that's in that leash and the amount of Balance and strength and lower leg variability you need to not fall over when that's happening by the time you're in your 70s that's going to be very

difficult so you have to build up an enormous Reserve in those capacities today to cope with and anticipate the inevitable decline that's going to come in all of those so so that's that's how you start you start with the objective you reverse engineer what the implication of each objective Is and you you know you you we understand pretty well what the decline of those properties looks like I need to stop you that how realistic is it for some male in his 90s to still be able to have sex without any assistance well it depends how

you define assistance I think the use of like phosphodus Trace Inhibitors is probably going to be required what's that like a drug like Viagra or Seattle understood um but otherwise I think it is realistic Um but again like think about what that comes down to so a big part of that is going to come down to your microvascular system so there's a reason that you know having type 2 diabetes having atherosclerosis is an enormous cause of impotence it's not affecting your brain what it's affecting is microvasculature the blood flow of the penis so there's a

there's an argument for being very metabolically healthy I mean I see this even in Patients who are in their 50s and 60s who at one point are completely dependent on drugs like Cialis and then you get them metabolically healthy and all of a sudden they're like oh I don't need this anymore I wonder how many men who aren't that concerned about getting overweight who aren't that concerned about losing a foot but if you tell them that penis would stop working that would be the final motivation for them to look after that diet whatever it takes

Okay So we've got uh objective yep then we have to think about what the strategy is right and this is where I think um it's very complicated in this problem is this where people get lost I think so I think this is the step that most people just skip all together and go right to the tactics so they say okay I hear you on objectives now tell me how to eat how to exercise how to sleep Etc um and I think you can't skip this Bucket and there's a reason that those like chapters in the

book that are devoted to this um if you're playing um if you're if you're trying if you're asking questions that are straightforward you don't really need a strategy so if you said to me Peter my objective right now is not to get a sunburn we don't need a major strategy like it's Relatively straight we can go straight to tactics you're going to avoid the sun altogether if you need to be in the sun you're going to wear long sleeves and a hat and you're going to wear sunscreen and blah blah blah and it's it's pretty

straightforward but when you say my objective is to live 10 years longer than I otherwise would and do so at a much higher function as evidenced by that list of things you just said well I can't just jump to tactics They're not obvious so instead I have to go through a whole bunch of indirect measures because I don't have what I really want right what I really want is I'd love to be able to rely on the gold standard which is randomized controlled experiments that would give me the answer for reasons that are self-evident and

obvious and not worth explaining we don't have randomized controlled experiments that answer all the Questions that pertain to taking a 35 year old and setting him up to be the best 95 year old so we have to have an option b and option b really rests on a whole bunch of other pillars of strategic Insight so one of those things is what are the inferences we can make from observational data of long-lived well-functioned humans so looking at the centenarians for example who we very quickly figure out are genetically Gifted so they're they're they're their superpower

was picking the right parents but we can still learn a lot from them uh we'll put that aside for a moment the other thing we can look at is short-term human studies that don't cover the hard outcome such as the full duration of your life but cover certain things so for example there might be hard outcome studies that look at heart disease or stroke or heart outcomes that look at performance and functional metrics such As strength resilience and things like that we then look at animal literature or non-human literature I think to be more accurate

that looks at the full duration outcome so I think we can look at some of those animal studies and get a pretty good sense of what's affecting lifespan and health span but we have to be careful with it like we do with everything and that we we want to be very thoughtful that we're not just sort of zeroing in on one model so this is Again where where we look at things that favor lots of models so you know something that's consistent across mice and worms and flies and dogs is much more interesting than something

that is only going to work in one Mouse model in one person's lab then we want to look at mechanistic studies so how can we understand for example the benefits of exercise when we look at the cellular level when we understand them you know when we look at Proteomic metabolomic changes of exercise and how do you know what do those things tell us as an example about say exercise or sleep restriction or dietary restriction and then the final tool that I think we look at in our strategy bucket is mendelian randomization so sometimes you actually

let nature do the randomized controlled experiment for you so mendelian randomizations are very elegant types of studies where when you Can find genes that are responsible for phenotypes of interest you can ask the question as nature shuffles those genes do we establish causality by the outcome so when you put all five of those together that's how you start to Cobble together what your tactics are and that's the final piece of it so what are your tactics you basically have five domains you have all things that pertain to what you eat all things that pertain to

how you exercise and move how you Sleep all the drugs molecules supplements hormones that you could possibly take and then all the you know call it the bucket of things that you would do to manage emotional and mental health when you break it down like that longevity seems very simple that you have these five key areas that you're focused on where are people focusing their attention in your opinion when it comes To both Health span and lifespan longevity that have the shortest levers but people are giving undue attention to yeah that's such a great question

I I think what's what I find funny is that everybody and I'm sure I'm not sure I know I've been guilty of this myself it's it's very tempting to just focus on your favorite thing like there was a point in time where virtually all of my attention Was focused on nutrition like I really felt that nutrition was the the Alpha and the Omega of this entire equation and all you had to do was sort of eat a certain way and everything was going to work itself out um obviously the medical establishment is hyper focused on

the the medicine side of this as evidenced by the fact that's the only thing we learned in medical school and residency right it's not like Anybody taught you how to administer exercise or nutrition even if you knew that those things mattered you had no education in how to actually do anything about it it would sort of be like an oncologist who knows chemotherapy is good but doesn't know anything else like doesn't know which chemotherapy or what dose or what schedule or what biomarkers to use to track the progress of the chemotherapy in the um you

know in the Tumor as it regresses so um so each each entity I think just kind of has their own expertise um you know where I stand today I would say a lot of people are kind of majoring in the minor and minoring with the major when it comes to nutrition is sort of a belief that I have I think once you get beyond the real fundamentals of energy balance and protein intake I honestly Think a lot of people are spending too much time um thinking about the finer details of it um and and and

the evidence at least at this point in time is not really there in an overwhelming way to say that it matters a whole heck of a lot once you achieve that in other words there are multiple different ways to achieve energy balance to achieve you know adequate distribution of fats Macronutrients and things like that but the belief system that I once had and that I think many others have that you know this exact ratio of omega-6 to omega-3 is what's essential if that's true it's not based on any evidence as of this time you've mentioned

the protein intake very important what are your thoughts on this current movement at the moment which is people Avoiding and sometimes demonizing meat consumption because of activating the mtor pathway yeah I think there's a bit of a confusion between chronic activation of the mtor pathway and acute Activation so we do need mtor to be active sometimes right I mean mtor is the most important amino acid sensor we have in our body and if we want to be in a uh in an anabolic State at some times which we do it's going to have to be

activated right In fact I would argue that the three most important amino acids leucine lysine methionine will mtor is the leucine sensor right I mean leucine and mtor were sort of made for each other this is very different from the metabolically ill person whose mtor level is probably chronically elevated there's also an issue with tissue specificity and again part of the challenge here is in humans we have no way of measuring this so we can measure This stuff in mice you can sort of look at mtor activation and muscle versus liver versus some other tissue

in humans we can't do any of this we don't have what David sabatini refers to as an mtor integrator a signal integrator so the sort of the way that hemoglobin A1c is an integrating function of average glucose right it integrates glucose level over the previous three months roughly we don't have a tool like that to measure mtor activity so Um again I think that the the belief that we need to limit amino acids to limit mtor activity is is kind of a backwards way to think about it what that's really going to do is create

a situation of sarcopenia which uh muscle like loss of muscle as we age okay yeah surely though if people are consuming three to four servings of 25 to 50 grams of protein per day is that not just going to continue to just Spike M toward does that not end up Netting out at mtol just being elevated throughout the day not necessarily I mean you have to remember the the um the duration that you know free amino acids stay in your circulation is pretty low um you're also probably still spending 12 to at least 14 hours

a day when you're not eating right so even so so so I'm someone who probably takes a lot of effort to consume you know 1.8 to 2 grams of protein per kilogram of body weight and that's going to be spread out over three to four meals but there's probably still 14 hours a day when I'm not eating anything and during that period of time those amino acid levels are going to be really low I heard about you doing some very extreme fasts over the last few years talk to me about those yeah I don't do

that anymore but I used to do a lot of fasting for many years I would you know Do a seven to ten day fast quarterly and a three-day fast monthly that's intense that seems intense yeah me you know I'm someone that's done intermittent fasting I sat down with David Sinclair four and a half years ago I think in his office at Harvard uh and you know when David first came onto the scene which was the first time I'd really really heard intermittent fasting as being pushed as a longevity lever uh I thought This is great

like you know it's something that I can do it's for the lazy Among Us it actually makes eating food easier because we've managed to reword skipping breakfast as doing intermittent fasting but I found it incredibly difficult to blend staying fit staying muscular and doing intermittent fasting I really really struggled to make that work um what have you got first off why have You changed your approach to intermittent fasting I know that you've gained a ton of muscle recently um and how have you worked in blending your understanding of intermittent fasting and its positive benefits with

the fact that you want to look good feel good perform well yeah so again I still think going back to kind of what are the three ways that you can reduce caloric intake you can you can calorie restrict directly so Just track and reduce globally you can dietary restrict which is pick certain elements within the diet carbs fat whatever restrict or you can time restrict create a smaller and smaller window in which to eat um the biggest drawback of that final strategy which again is a viable strategy but the biggest drawback of it in my

opinion is the the reduction in protein intake so this has been borne out in the Literature so we've seen we've seen clinical trials that have documented this that first and foremost the time restricted feeding within that 24-hour period doesn't seem to produce any benefits above the caloric restriction that it brings that's a very important caveat okay it's just meaning there is nothing magical about the time restriction beyond the calories that are being restricted wow okay so the hunger signal that people get which is those of Us that have taken like the Sinclair red pill this

is a signal that I'm hungry this is homies it's happening this is discomfort this is good for me has no different impact than small amounts of satiation throughout the day with there is nothing that has been measured or documented in any clinical trial that suggests that that is beneficial over the clerk restriction in other words if you're going to eat 2 000 calories spread out over 12 hours or You're going to eat 2 000 calories spread out over six hours where you're you know calorie you know your time restricted feeding for 18 hours we're not

seeing any difference wow now and now that's not here's what's interesting that's often not what happens so what more likely happens is the person who calorie restricts um has an easier time Believe It or Not maintaining muscle mass than the person Who time restricts why probably for two reasons uh although this hasn't been fully teased out in the in the data because they're not tracking it this closely but my my impression is that when you time restrict you're just less likely to eat as much protein and secondly as you kind of alluded to earlier it's

a delicate balance to get the right Amount of amino acids into the muscles you can't have too much and you can't have too little so what you don't want to do is waste for lack of a better word your amino acids down a gluconeogenic pathway where they're basically being used as glucose substrate what would cause that to happen either too much or too little so it wants too much and what's too little yeah sort of 10 to 20 grams of protein the liver is going to preferentially Take that and use it as glucose and anything

over about 50 grams the liver is going to say I'm going to take that excess and also make it glucose so let's just say your number is 180 grams of protein per day eating 18 servings of 10 grams a day not going to achieve optimal results having one serving of 180 also not going I've tried both yeah yeah um so that person really probably ought to be doing four servings of 45. right so you're saying for most people it Seems like roughly a sweet spot is 25 to 50 grams per serving exactly right so in

this regard and that that time restricted feeding guy has a really hard time doing that if he's going to be deliberate about that how big is the gap when does a feeding window stop great question probably about three or four hours so it's basically impossible for the time restricted feeding person unless they're willing to eat protein outside of their window Right okay which if you are a dogmatic around if you're dogmatic it becomes very difficult correct but if you're if you understand that there and what we do with our patients who who want to do

time restricted feeding because I think it's the easiest one to do yep like I would agree it's the easiest one conceptually to do it's the easiest one to be compliant with so what we would say is look it's just about the calories so I still want you to have a low Calorie protein shake in the morning where you're going to have 200 calories of a protein shake that's basically just protein some you know cashew milk and a few frozen berries um but at least you got that protein dose in yep the other thing that I

would say leads to what we experience clinically as a lot of people losing muscle mass when they do this is a lot of people exercise in the morning but their feeding window is in the evening So now they're creating a little bit of a gap especially if they're untrained it's less less of an issue in a trained individual but in an untrained individual we do see some benefits to having the amino acids uh restored in Greater proximity to the training how worried should we be about artificial sweeteners I don't know uh would be the short

answer I I think that this is another one of those things where uh Boy people really love to demonize these things um but if you if you really just want to look at the facts let's talk about facts right so aspartame which is the original kind of the OG sweetener uh everybody loves to demonize aspartame or NutraSweet but the reality of it is if there is toxicity to it it's probably impossible to measure at regular doses this is a substance that at least the last time I checked had more data on it From a safety

perspective than any other molecule tested by the FDA you're kidding no it's it's just because again it's been around since the 1960s right so does that mean that if you consume the equivalent of 12 cans of diet soda a day it's safe probably not but we don't know right so um where do I think these sweeteners potentially reek the most Havoc you know one is I I think that they probably increase your appetite for Sugar anyway so if you're if you're consuming them in an effort to avoid sugar um you have to be just mindful

of the fact that am I robbing Peter to pay Paul um if you really want to eliminate sugar as one of your dietary strategies uh you might just be better off reducing sweet things altogether and what you'll discover because I've gone I've done this myself I've had periods in my life where I've been you know very dogmatic About restricting sugar I'm not that dogmatic about it these days right but when I have been you know one of the things I noticed was how unbelievably sweet things are that I used to not think were that sweet

like berries you know like you know raspberries aren't generally thought of as the sweetest thing in the world but when you completely eliminate artificial sweeteners and regular sweeteners you know after a few months berries become Insanely sweet you know 85 chocolate becomes mind-bogglingly sweet as opposed to what most people would think but it's kind of bitter um you know there was a recent study published that looked at uh one particular sweetener erythritol and um it was a pretty poorly done study um but look it asked some interesting questions right which is you know is a

metabolite of this potentially atherogenic I was androgenic uh would it Lead to or cause atherosclerosis what's that cardiovascular disease sort of the the the inflammatory disease of the coronary arteries and other arteries um um again I I think the data are are pretty underwhelming that artificial sweeteners are harmful but I also think there's probably a class of differences between them so my personal favorite of all of them is something called allulose Um allulose is it's basically natural it is an enantiomer of fructose meaning it's a molecule that's almost identical to fructose with one very minor

structural change what's unique about it is it has in my opinion the best taste because the thing I don't like about artificial sweeteners is I just don't like the taste I actually like the taste of sugar I don't like the taste of you know saccharin I don't really like the taste of aspartame I certainly don't like the taste of stevia I mean that to me makes me want to vomit but alulose has the same taste the same mouth feel as sugar and the only drawback is it's only 70 is sweet which is not a real

drawback because you could always dose it up if you want it also has the added benefit of it appears to actually reduce blood glucose a little bit it appears to have an effect where it pulls glucose um into the kidney and like basically Increases the filtration glomerular filtration of glucose so it slightly lowers glucose not as potently as something called a an sglt2 inhibitor which is a class of drug that does that but it's it's very interesting nonetheless so um you know I guess if I were thinking about how I would consume it I would

probably consume more allulose than other things but unfortunately it's still not that prevalent in Foods you Have to you have to just buy the allulose itself so if I'm making something I'll use allulose in it what I like about this framing is it gets to one of the reasons why doing a randomized control trial for diet stuff is so hard because how are you going to be able to control for the psychological training that having a sweet thing even if it is a zero calorie sweetening even if it's a zero calorie sweet thing with no

Downstream risks to your body unless You take it at insane dosages how are you going to be able to control for what that does psychologically to people's expectations of the sweetness of their foods of the frequency of having sweet things throughout their diet um yeah I think that's a really nice little microcosm there one of the I'm wearing a wood band at the moment um some people are drowning in data now right we've gone from a world where we Knew nothing to where some people know a lot but I would guess on average that even

people who care about the health and fitness are still mostly not wearing a Tracker they're still mostly not getting blood panels done they're still mostly not going and getting a full body MRI scan etc etc what are the most important metrics for someone who is completely uh unindoctrinated into the world of looking at Vital Signs within their body What are the most important metrics for people to be looking at well I mean again I I have a pretty long list on that because we're we're holding ourselves to a pretty high bar um so the way

I think about this is what are the inputs to what what I call the longevity risk assessment so um there were basically about seven or eight things that are a threat to your length of life and quality of life we've Talked about them already right so cardiovascular disease cerebrovascular disease cancer neurodegenerative disease Orthopedic injury emotional distress misery like all those things right so how do we know how you're stacking up on all of those things what are the inputs to do them so yeah blood tests family history selective genetic testing colonoscopy MRI liquid biopsy VO2

max Test Zone 2 test dexa scan I mean the list is long and I I think in our Matrix We have over 40 things that go into that or over 40 inputs that go into our risk assessment and then that risk assessment leads to outputs so what do you do in response to the the ranking of risk based on those things okay run the Matrix go and do those things and then let's come back and measure and do again so it's hard for me to say what the most important is because it really comes down

to an individual so if an individual shows up and they have a Significant family history of cardiovascular disease well look a CT angiogram is going to be very important and a blood test that's measuring LP little a lipids and APO B is essential because you have to know which you know which of these things is responsible for that you know certainly you know a continuous blood pressure monitor or at the at a minimum you know we would have patients checking their blood pressure at home two to three times a day for a Month again super

low Tech right you might think how is that interesting well it's enormously interesting because blood pressure is one of the biggest risk factors for Alzheimer's disease and cardiovascular disease so again people are obsessed with things like you know their sleep data but don't forget the really you know you know less sexy stuff that we could have measured forever such as blood pressure but knowing how to Measure blood pressure accurately is important and I I think you know undiagnosed hypertension is an epidemic in this country what do people get wrong when measuring blood pressure the first

thing they get wrong is they don't measure it but assuming they do measure it um they're not stationary for five minutes before they measure it they don't have the cuff on correctly they don't have their arm in the right Position you know if your arm is too low or too high you're going to get an inaccurate reading your arm really needs to be the cuff needs to be right at the level of your heart um you you have to pay very close attention to where the cuff tells you to put it you know you want

to be about an inch above the break in your arm and there's a a good cuff will tell you where the how to line it up with the brachial artery in your arm You don't want to have just had coffee right before you do it you don't want to be sitting like I am with your legs crossed your legs need to be uncrossed so there's a whole protocol for how to do this and there's a very good study called the Sprint study that that really established the the measurement standard for how to establish um a

proper measurement for blood reading which was you know five minutes sitting stationary without doing Anything stimulating measurement five minutes of you know doing nothing again repeat measurement five minutes repeat measurement so 15 minutes to get three measurements taking the average that's a blood pressure now we don't ask our patients to do that we ask them to do it once but two to three times a day so you should even out any inconsistencies yeah and you'll also notice trends like are you normal in the mornings but elevated in the afternoons and uh you know the Data

are really clear that anything above 120 over 80 has long-term risk associated with it and so when we see people that have an elevated blood pressure we want to make sure we're addressing that and there's lots of ways to address it before you have to go down the pharmacologic pack but if you have to go down that path you're much better off going down to protect your kidneys your brain and your heart what is good and what is bad about different Types of cuffs or automatic cuffs okay yeah so the gold standard is of course

a manual cuff so having an actual person yeah who's who's got a stethoscope on the brachial artery and measuring your blood pressure the problem is unless you're you know you have like for me that's what I do typically because my wife can measure my blood pressure even I can measure my own blood pressure so marry someone who is trained for taking blood pressure that's what you're saying But the automated cuffs are pretty good um in me they run high so across the board automatic automated cuffs tend to run 10 to 15 millimeters per Mercury high

systolically and they're accurate diastolically that's just a glitch I have never been able to come up with a compelling explanation for why but I'm not unique in this um I we do see this uh in a number of people where the the gold standard runs lower than the than the cuff Um so the challenge of doing an a manual cuff when you're at your doctor's office is the challenge of having your blood pressure checked at the doctor's office for some people it produces this syndrome called white coat hypertension where my mom's got that yeah they

just you you sort of get you know and by the way the other thing is most the time you walk into the doctor's office they don't even adhere to this principle right five Minutes yeah yeah you sort of run in from the parking lot run up the flight of stairs sit down in the waiting room last time you had a coffee yeah yeah so so again I'm I think that blood pressure is a very difficult thing to to accurately glean in the doctor's office for all those reasons and that's why I just think everybody should

you know buy one I I don't have any affiliation with any company that makes these things but there's a brand that I like called Omron Omron that's the one we tell our patients to get you can get these things on Amazon and um what are the most common uh lifestyle interventions let's say that someone does get toward that 120 over 80. where should they go first what do you think exercise is is a big one aerobic exercise is an enormous way to lower blood pressure as is weight loss so weight loss is going to be

mostly Driven by nutrition and then aerobic exercise and and sleep so because I track my blood pressure pretty regularly um two of the most obvious things that show up when I'm not well slept is you know higher blood glucose and higher blood pressure I went to uh Medellin I went to bioaccelerator down there and got a ton of stem cells for a week medellin's at altitude and they were coming in and testing my blood pressure three four Times a day using that and I had a nurse doing it which was nice you know to have

uh the sense that A team's there for your health that was I really enjoyed that part and felt like I was being cared for uh but at altitude and I'm a heavy guy uh at altitude my blood pressure was not happy um so I came back and I thought I really need to I really need to make a change here I really need to because even if it is at altitude et cetera Etc I was in There with uh Al Jermaine Sterling who is um the current UFC 135 champ uh and yes Elite athlete yes

best in the world literally what he does but he wasn't struggling and I figured I I probably could do with making a change here so what's the what's the altitude there I don't know I don't know High higher than higher than I'm used to I presume um and you're getting stem cells for what so they reached out and suggested that I go And get a procedure I've got two bulging discs L3 L4 and L5 S1 that's been an issue for a while although it is I've managed to get it to a very manageable place now

which I'm very happy with um a little bit of rotator cuff it just bro injuries you know like sometimes my knees are a little bit achy I had a full Achilles Detachment playing Cricket a couple of years ago most British way that you can do it um so I went in and I had a 110 million Uh through IV two separate ones uh oxygen chamber twice two sessions of that a bunch of vitamin IVs Two intra-articular Shots into the shoulder uh quadriceps tendon above and below the patella and then straight into the Achilles and then

a intradiscal injection into L3 L4 and uh every faster joint as well done my lumbar spine under general for the spine stuff which was great under nothing for the local injections which Were spicy but um that was seven eight seven eight weeks ago now uh and three months is around about the the time when this stuff's supposed to kick in so I'm very much looking forward to seeing uh how that works I enjoyed psychologically it was neutral physically slightly difficult um the sort of uh is it cytokine information response is something to behold um for

the next 24 hours it felt like Anyone that's had Doms after a three-month break from the gym imagine that kind of stiffness but exclusively in the tendons of the places that have been touched oh God it was so localized and so I was laughing in for the next day as I sort of totted around like a robot um it was very interesting experience what about Health metrics that people are overlooking so we've mentioned you know Even the stuff that you've given there in terms of Top Line probably VO2 max is your HIV your resting heart

rate your blood blah blah blah is there something that most people well think about how many what how many people listening to us today do you think know their VO2 max very few yeah very few yet there is no metric that I am aware of that is more highly correlated with the length of a person's life than their VO2 max wow why not even close why why that Particular metric well there's probably two things going on right one it actually does matter a lot it's an amazing proxy for health if you think about have you

had a VO2 max test done recently not recently I had one done last one was probably four years ago okay so think about how miserable it is right like what is it testing right it is testing your maximal consumption of oxygen well to get to that level we are stressing you to the Highest degree possible it's it it is as its name suggests it is a maximal VO2 max test so the higher that number is the more oxygen your muscles can utilize the more fit you are the healthier you are the more capacity you have

uh to avoid illness and um so I think there's the biological reason for it I think the other reason for it as opposed to say your Zone 2 threshold which I think would probably be equally predictive Um is that it's a metric that is so ubiquitous it's very standardized it's easy to test for conceptually not necessarily physically and so you have a metric that we can easily capture so it's for example it's better than like a deadlift right in deadlift there's variability of form there's too much risk of people getting hurt it would be a

harder metric to track So you have this metric that you can track and then the having a high number tells you something about the person right to have that number you must be to have a high number you must be exercising a lot and we know the benefits of exercising a lot right the person who has a VO2 max at the top two percent of their age I mean by definition they're doing a lot of exercise and exercise has more benefit than probably any other single Intervention we can do so again it's I throw that

out there because I say like yeah we know those things we know exercise matters but when it comes right down to it most people don't know if they're fit enough most people don't know their VO2 max most people don't know their almi appendicular lean mass index they don't actually know how much muscle mass they have they don't know where they stack up for other people their age and sex and Yet that's also a highly highly predictive metric of how long you're going to live they don't actually know how strong they are they don't know if

they're in the top 25 percent of their age or sex for strength so I think it just comes kind of back down to the basics but like we have to know these things if we you know what gets measured gets managed and if you if you're not measuring these things There's I don't know what you're managing what is the best protocol that you have found for improving VO2 max in terms of training uh it's two things right so so you want to think of the the the way I think of cardio respiratory Fitness is it's

a pyramid so you have a base to a pyramid and you have a peak to the pyramid and you want the biggest possible pyramid so the area of the pyramid is your total cardiorespiratory But also wide exactly so the width of the pyramid is your zone two that's your sort of aerobic efficiency metric so if you and your VO2 max is the height of the pyramid so if you want a high pyramid you also need a high base so you have to do training that widens the base and raises the peak so the base widening

training is what we call zone two training so again there's lots of ways to do that but the simplest way to do it is to train at an rpe that barely allows You to maintain a conversation so um the way I describe it to people is I do my zone two on a bike uh on a trainer indoors right I'm listening to podcasts and audio books it's a it's a pace of training where I'm mostly able to breathe through my nose um but that just speaks to the fact that I have pretty good Airways a

better metric is if my wife comes in and talks to me or If the phone rings and it's important and I pick it up I can carry on a conversation but it's strained the person absolutely knows I'm exercising they're doing something fusion um but I can speak if it if I'm at the point where I can't speak I'm outside of zone two I'm into zone three what uh heart rate is that have you got any idea for you yeah for me it's uh typically a heart rate in the high 130s okay that's a little higher

than I would have Guessed but yeah you might speak but cardiovascular well but it also varies day by day so yesterday I was having such a lousy day uh probably because I didn't sleep really well that that ended up being a heart rate of about 131 to 132. so it varies I've had it days where it's as low as 130 and days where it's as high as 145. how old are you 50. wow so that is that's still very fit I'm gonna guess that'll speak to the fitness that you've got Um well I think it

just speaks to the bigger point I think is that it just speaks to kind of the variability you have in heart rate between individuals um but then to train the peak of the pyramid I think the most efficient way to do that is kind of so so VO2 max training is maximized between three and eight minute intervals so if an interval you will train VO2 max if you're doing something harder than that if you're only doing something you can hold for 30 Seconds or one minute that will still give VO2 max benefit but not nearly

as much as if you can push it closer to three four five minutes Etc so for me personally I'm I mostly do that at four minutes so I'll do four minutes very hard four minutes of recovery four minutes very hard four minutes of recovery so I do those also on a bike usually and I'll do those outside on a hill cycling this yeah so there's a hill near My house that is up it's a it's a just a straight Hill that's not so steep like meaning I'm in the saddle I don't have to be out

of this I'm just in the saddle looking at my power meter and my heart rate and just going very very hard for four minutes getting to the top feeling like I want to puke going back down doing it again just repeat repeat two sets no I'll typically do four to six Okay how often per week I just do that once a week okay and that seems to be well again it's remember what I'm training for now when I was training as a cyclist I was doing those types of workouts three times a week and they

were much longer and much more grueling but again I was optimizing for a much broader array of Fitness but for today for all I'm doing is no I'm just you know I'm just trying to be a good I'm just trying to be fit as a person Not as an athlete so yeah once a week of doing a very hard VO2 max set four times a week doing those lesser zone two sets how long on zone two uh 45 to 60 Minutes a session okay so you're looking at what 180 to 240 minutes cumulatively correct so

I'm basically doing four to five weeks of cardio training a week which is you know depends who you ask like first by my historical standards that's very very low obviously for some people that would still be considered a lot Um I I think you know I think it would be crazy not to want to capture the benefits of something like exercise um so we do you know sort of sit down with everybody and say okay how much time are you willing to put into exercise and then that's how we sort of think about how to

allocate time across all Endeavors strength um you know stability aerobic efficiency Peak aerobic power we we do take kind of A portfolio approach to that but starting through the lens of how much time are you willing to put into it so someone like me who's willing to put in 10 to 12 hours a week that's you know the role of the bases as much as you want absolutely yeah okay so you've got four pillars strength stability VO2 max zone two yep strength and stability talk to us about that um so strength is probably the easier

One for people to understand um you know that's basically your ability to generate Force um and of course within strength you have different you know different areas of strength so I don't do a lot of maximal stuff anymore so in other words I'm rarely If Ever I don't think I really ever go below three reps so the the heaviest I will go is five reps stuff so I'll do you know I'll do dead lifts 35 ish UMR because you're not doing it but I can sort of predict it because I do use a velocity tracker

so if you've seen these yeah yeah the BuzzFeed things yeah yeah so I do measure bar speed um so I can have a prediction of it I can have a prediction of one RM um but yeah usually I'm sort of in the 5 to 15 rep range when I'm training so I'm basically but but what I'm always trying to do is make sure I'm somewhere between Zero and two reps in reserve so that's I'm really training off reps in reserve okay that's my overarching principle of training is so so even if I'm at five I'm

probably training to one to two rep in reserve if I'm at 15 I'm still one to two reps in reserve there's the body builders out there that want to do supersets and drop sets to failure that are tearing their hair out at the moment yeah I'm sure and again I there are Absolutely sets where I do go to failure but the truth of it is it's very hard to go to failure all the time I I think I think if people are being brutally honest with themselves like they still had another one or two reps

left every time yeah I don't I I mean I I I know what it's like to go to failure um and you don't you you only have so many of those matches every day um so I don't even try to play that game I just sort of say like I know I've learned that I've got if I stop now there's only two more I would get before I would violate my form so badly that I would either injure myself or you know just effective transcending ego lifting is uh one of the most difficult things that

you can do forget about the consistency and all of that it's transcending ego lifting um strength formulating a strength protocol across the week what are you Prioritizing you're prioritizing large lifts are you prioritizing session length etc etc yeah it first of all there's quite a bit of um variability in my in my training um but generally I'm doing four days a week and not generally I'm always doing four days a week and it's two days lower body two days upper body now I I used to I've for Years also done three days of mixed longer

sessions but I prefer what I'm doing now I prefer doing two lower Body days two upper body days and uh yeah I prioritize big lifts and I'm sort of working on like so today I had 24 working sets uh of of upper body uh you know on Monday I had 18 sets of lower body 18 working sets of lower body and probably on Friday it'll be a little bit more volume it'll probably be 22 to 24 sets of lower body uh working in that five to Fifteen yes uh which is Ish Opie eight e eight

eight eight and a half Yeah yeah sometimes maybe as little as seven on some things especially if you've had the [ __ ] night sleep yeah the night before yeah um what when you're looking at movements for instance what was your session this morning can you remember in terms of exercises yeah so uh uh I did floor presses uh dumbbells yep yep I did um pull Downs I did incline press I did row I did um um like incline curl uh overhead tricep extension and um and then a preacher curl you know it's not a

true preacher bench but hanging over a bench doing a preacher to create the same angle yep and then uh laying tricep extension and then always in between them I'm doing stability work so we didn't come to stability but I'm Doing I do two dedicated days of stability a week so Tuesday Thursday I do a full dedicated hour of stability training and then on the off days it's not Tuesday Thursday I'm getting in at least 20 minutes of stability per day on on either side of the exercise like throughout the workout so the stuff that we've

gone through so far the Jim Bros will still understand what cardio is the cardio Bros will still understand what lifting is Nobody understands what balance training is yeah no one understands what what are the principles behind this no one's ever thought about stability training before uh how do you integrate it into your workouts and then also what does a dedicated session look like yeah it's very difficult to explain um it's actually I think it was the hardest chapter in the book to write truthfully um because It's it's not it's it's hard enough to show people

in videos or to have friends over who want to work out with me and put them through the exercises that's actually very difficult um so you know I lead with an analogy in the book where I talk about the difference between streetcars and track cars because I'm a car nut and I being on the racetrack is probably one of my favorite Things to do and um so so the analogy I give is is this which is um if you took if you take a street car with very high horsepower and you put it on track

and you let it race against the track car which is lighter less horsepower typically for a given engine size or for a given class size slick tires on it which one's going to be faster I mean it's no comparison right The track car rips the streetcar into Oblivion even though by the way the streetcar will go faster in a straight line um so the example that I use in the book is a real example I compare at the time this is you know seven or eight years ago my streetcar at the time was like a

uh an actually a modified e92 M3 so nice I've modified it changed all the airflow that thing was putting out 475 horsepower big German based yep and At the time my track car was a spec E30 M3 I'm sorry not even an M3 just a spec E30 okay right but everything's stripped out roll cage is in stiff as hell 165 horsepower engines in it oh this is the stock engine yeah it's a six in line right okay yeah yeah so so you've got the this the stock 165 horsepower engine it's very light the car weighs

like probably 2 400 Pounds versus the M3s 3 400 pounds m3's got street tires on it this one's I'm running you know probably Hankook slicks on it but to your point the chassis stiff as a button suspension super stiff and yeah I was going faster in the straightaways in the M3 but my lap time was two seconds faster which on a track is might as well be a day yep um in the spec E30 and of course what does it come down to it's cornering speed what does cornering Speed come down to it comes down

to of the 165 paltry horsepower in that engine every little bit of it is making it where it belongs remember what is the name of the game in driving a race car it's all about friction it's all about power loss it's all about transmitting what's happening in the crankshaft to the tire tire to the street that's it you only have four points of contact with the outside world nothing else matters and so again we're not talking About aerodynamics because these aren't Aero cars right so in the in the streetcar first of all I have much

more slippage at the tires because I've got I'm not running slicks secondly the chassis is so loose right swallowing all over the place I've got all this all this energy loss with energy leaking out of that car not making it to the surface of the track it's like having laxity in a joint that's right so every time you're Hurting your knee you're hurting your elbow something's hurting that's an energy leak so again even if one doesn't care about performance just from an injury perspective this is something we want to avoid we want to avoid it

and again my introduction to stability only came the hard way it's not like I was born out of the womb realizing this was an important thing I mean I had to go through horrible injuries to finally arrive at This place where I said you know I'm tired of being in pain I'm tired of the fact that my elbow hurts when I do pull-ups and you know oh like half the time I deadlift or squat my back hurts you know my SI joint hurts the next day like I was just kind of tired of that and

then I got very fortunate and that I landed um in the in the company of a guy named who I write about in the book briefly his name is Michael stromsness and he's A practitioner of something called DNS Dynamic neuromuscular stabilization and the very first time I met him you know at the time I was like my main complaint was uh basically my right SI joint and my right elbow I had tennis elbow having never played tennis and he said all right you know take your shirt off and hop up on the bar and do

some Pull-Ups so I I did and rattled off you know 15 pull-ups or something which I could do easily at the time Um and he's like oh that's horrible like those are those are and by the way these are good form pull-ups I'm not doing like bro pull-ups where I'm like jerking up and down I'm doing like full extension up like everything perfect and he's like yeah you have no capacity to control your scapula so your scapula is winged and in doing so you are transmitting all of that Force into your elbows you cannot retract

your scapula you Don't have the control you don't have the stability in the scapula so you're leaking energy through your scapula in your arm so to make a very long story short that that which started in 2017 um just took me so far down the rabbit hole of not just DNS but other other schools of thought I would later go on to meet someone named Beth Lewis through Michael who um you know has has her own expertise around Um other other disciplines and we basically just started piece by piece rebuilding my movements and by the

way that meant spending a year not doing pull-ups and not dead lifting as I re-learned how to how to align my body again and so today I'll still spend two days a week working with a guy here in Austin named Kyler Brown who's amazing um working on just dedicated DNS things and again if you watched the exercises I was doing you would be thinking what is He doing you know like why is he doing you know why is he in these baby positions like moving in these odd ways but a lot of what DNS is

based on is the idea that up until we were about two years old we all moved almost perfectly um most of our movement patterns that are corrupt which we all have as adults only started to kick in once we were about two uh maybe one but but generally about two So so there's a very predictable you know neuromuscular set of or sequence of movements that are genetically programmed into us the ability you know the way a child reaches for something the way a child rolls the way a child stands the way a child you know

gets into a bare position all of these things are basically hardwired into us and the goal of this type of training is to basically provide a software update on the crappy software we've ins you know We've we've overridden that system with let's say someone doesn't live in Austin doesn't have access to your very smart friend there are lots of DNS practitioners across the country but you would advise doing this with instruction I think so yes efficiently complex and nuanced and I think DNS is um is very difficult to learn um I shouldn't say that I

haven't tried to learn it off you know videos and online and there might be ways to do it But but I think you know trying to find a practitioner is a good way to start um and then once you have it going it's it's always great to to to you know continue on your own and there's a lot of stuff I do with my friend Kyler that's not DNS I mean you know one of the issues I've been having injury-wise I have very flexible ankles I think a lot of former swimmers do and so one

of the drawbacks of that is when I do freaks I love doing box Step-ups we're both Cut From the Same Cloth I knew that you were a massive fan of these they're my favorite movement for the lower body I absolutely love I love doing them in all regards I love doing them very very heavy I love doing them very very slowly all these things well because my ankles are so flexible and I can really really dorsiflex I have a tendency sometimes when I'm because like as you know when you're when you want to do a

step up the real key to it Is pre-loading the glute and the ham correct not bouncing off the floor that's right so so to pre-load you want to be able to shift forward and glide the femur back that creates an enormous stretch eccentric stretch so that that front leg is loaded boom you pop up okay well in doing so I often will drive my knees so far over my toes because I have the flexibility of my ankles but sometimes I'll develop a little bit of discomfort there in the front so one of The things I'm

working on with Kyler is Soleus strengthening to actually counteract that move movement bring it back yeah and so the amazing exercises that he has come up with for me to do these you know to do solely a strengthening which again you have to you have to be very deliberate about doing that it's easy to strengthen your gastrox the Soleus requires more effort I learned this intimately during my Rehabilitation absolutely I overshot it Actually it was hilarious so um this is not a good time to snap an Achilles but during Cove it wasn't bad um and

I overshot it on my right leg which is the one that snapped and I ended up having to then work on my left more aggressively to catch it up because I'd ended up building up a calf that was bigger I mean I learned so much man from that the first thing was I had a 13-day wait period because I was doing it on the NHS although I managed to find uh One of the top three surgeons in the entirety of the UK through a friend who was on the NHS to come and do my reattachment

which was really really great it felt like being um fitted in at the end of the day with a barber that needs to do the haircut and I was waiting around all day all day all day and then it got to the very end and we he had to run it back and I had to go back tomorrow I've been fasted all day because I was going to go into General And think blah blah blah anyway um a bunch of the things that I learned from that coming out the other side were how important it

is to be able to deal with not just strength but plyo especially for that ankle position but what I'm thinking here when when you're talking about your challenges with box step ups there's a guy called Dr Eddie Joe PhD on Instagram now he took a massive Hiatus for like three years but He did these really great breakdowns of academic literature in infographics which lend themselves to Instagram very nicely and I'll never forget this one from nearly four years ago I think and there'd been a study done looking at muscle fiber recruitment for glute exercises and

you know you look at the glute Factory bum lab things for girls that want big glutes or me that's increasingly realized that my back gets better the bigger that my bum gets Um and glute Bridge donkey Kickback side raises all manner of Fantastical exercises that that girls do and he'd ranked them by uh the amount of muscle fiber recruitment the top five exercises were step UPS or step up variations it's like Step Up cross body step up like lateral step up something something something and then maybe hex bar deadlift was in the sort of upper

middle uh deadlift another one and then you get down toward Like glute Bridge Kickback and it's at 25 and I think it's 95 on this particular scale of this number would Step Up So for anybody that wants to improve like lower body power I just I absolutely adore that movement and it's so easy to do we um you know in the first iteration of writing the book I had intended to put so much detail in about instruction on like kind of the most important movements in the end it was getting too Long so what I

did is I ended up creating videos for a handful of them and one of them is the step up so there's a pretty good video um on this like the book will Point people to where to go on our site to see it and it's I just watched it yesterday it's a pretty good instructional video is it you doing it it's me doing it with Beth and I talking through how to do a step up cool uh weighted unweighted low box High box the whole thing eccentric Concentric what are the pitfalls how do you you

know how do you unload the ribs to you know you know do them me correctly and all that stuff so beautiful yeah um going back to some of the other uh we've spoken about sweeteners what about vaping if you had a look at any of the signs from vaping I I it's kind of a little bit of a moral panic at the moment if you look at certain areas of the ancestral paleo worlds on the Internet uh what's your thoughts on vaping and its potential let's come back to kind of the risk reward Matrix right

so again I view everything through this two by two so what's the risk is it closer to getting hit by a tricycle or getting hit by a train and what's the reward is it picking up a dollar or is it picking up a gold coin so I think that the I don't think we have Sufficient data to say that it's picking up that it's getting hit by a tricycle um I don't think the industry is standardized enough to be sure that what is being inhaled is sufficiently clean maybe it is maybe some companies are better

than others I mean we could talk about that all day long but I'm not personally willing to put my trust in that in that market in that infrastructure in those companies whatsoever so so for me personally this Would be a no-brainer there's no upside in it to me what would you be concerned about going into your body it's not just the nicotine it's the stuff oh no first of all nicotine I love like I'm all about nicotine how do you use nicotine in a safe way um I would chew gum or I would use I

use like a lozenge or I ch um there's like these little patches that you you know kind of suck on Zen pouch what have you Found is your favorite brand for those um I'm blanking on the name of the brand um they come in a little round colorful thing I don't remember the name of the brand got you and you're using three makes five makes um unfortunately that's the maybe I haven't bought in a while from these guys I bought so many the first time by accident that I'm still living off the Last two years

worth I literally just like an idiot accidentally bought 10 times more than like a prep up yeah so um Unfortunately they only come in sevens which is no way dude I would you can't do it all at once that would be in my mouth for 30 seconds and then I would have to take it yeah yeah so I go in out in out and out and out um I think they have a four as well so it's a little bit more manageable yeah but truthfully like I think two Milligrams is sort of the right dose

one to two milligrams is probably the sweet spot and then you don't need to think about taking it in and out yeah yeah yeah yeah um so so no to be clear like the the the nicotine is not the problem right uh it's the it's just like with cigarettes nicotine is not the problem with cigarettes yes there's an addictive component to it the problem is the toxicity of the vehicle that's Delivering the nicotine in the form of tobacco well with vaping I don't have any sense of what's happening when you have a heated metal filament

that is burning combustible products some of which I may or may not be inhaling through a filter like what I'm saying is not that I know there's something wrong with this but I'm saying I have no confidence in that industry to regulate itself or our regulatory agency to regulate them and therefore Because I don't know where it is on the risk parameter but I definitely don't feel comfortable saying it's getting hit by a tricycle it could be getting hit by you know a small car it could be getting hit by a train for all I

know we you know it's just an unknown and then you know how would I justify it well unless I felt that the reward Matrix was picking up gold coins it just doesn't justify it to me so is that a moral panic I don't think so I Think it's just saying like what's the risk reward trade-off for it Justified skepticism perhaps uh another Revolution that's going on at the moment which I've been at the sort of front row seat of has been alcohol and the reduction in the consumption of alcohol I think people realizing it's no

surprise that it's a a really dangerous risk but people who considered that one drink was okay that two glasses of wine because this in Resveratrol Coming from the red grapes etc etc um I was a club promoter for a very long time so I was in the trenches partying hard for all of my 20s which is why your uh 90th to 100th year estimation I think is unfortunately going to be a little bit too generous but I went sober for six months really loved it um most to do with the lifestyle changes cognitive cognitive improvements

uh what it meant in terms of habit in terms of Consistency energy uh money time all that stuff came back to drinking didn't like it went back to sober for another six months came back to drinking for a couple of months didn't like it did a thousand days sober uh I never had a an issue with substances but just really loved what it had done for me and you know five years hens six years hence now the low and no movement seems to be really really gaining speed Is that so why is it so surprising

like why is it that something that ostensibly obviously wasn't that good for us is now only just beginning to kind of get some momentum of people thinking oh maybe this thing that makes me feel like a total pile of dog [ __ ] the next day is something that I shouldn't take all the time I don't know I can't speak to it the only thing I could speculate is that with the uh with the rise of sleep trackers I think you really have some Objective data on the downside and I don't I don't think anybody

who's worn a whoop who doesn't look at their heart rate variability pre and post alcohol consumption or the fragmentation of their sleep is not saying what the hell it's insane why is it such an impact for the unindoctrinated amongst us let's say that you've got a heart rate variability of 70. if you were to have two glasses of beer or two small glasses of wine on an evening finishing at nine or ten pm And then go to sleep on the night it wouldn't surprise me if from 70 your heart rate variability is down in the

30s yeah or the 40s what is happening inside of the body that's causing that to happen so alcohol is metabolized um into different elements but but one of the metabolic byproducts of alcohol is quite toxic and um I suspect I don't know but I suspect what's happening is the toxicity of that is changing the autonomic nervous system So in what you want what you want to be doing when you're sleeping is in a maximally parasympathetic State um that the so-called rest and digest State and that's really what heart rate variability is measuring right heart rate

variability along with other things such as heart rate itself and temperature respiratory rate are proxies for your autonomic nervous system and anytime those things move in the wrong direction so heart rate goes up heart Rate variability goes down respiratory rate goes up temperature goes up all of those things happen when you drink that to me is a very strong signal that something about the toxicity of the metabolic byproduct of ethanol is putting the body into more of a fight-or-flight response as opposed to arrest and digest response it it's so hilarious that the thing that a

lot of people use and has been used for a long time I can't get to sleep I'll have a Glass of whiskey uh isn't really aiding with sleep it's just sedating people yeah that's the Insidious thing about it right is people confuse sedation Consciousness and sleep and I I you know I'd love to tell the glib anecdote right which is like if I hit you over the head with a baseball bat you would lie motionless for 12 hours but of course there's no confusion over the fact that you are not sleeping and nothing about that

experience is good for your brain Or your body in terms of rest and recovery so yes alcohol is very sedating but it doesn't promote sleep in the way that we know sleep Works in terms of its stages and its functionality in terms of healing let's say that no one has looked at Alzheimer's or neurodegenerative disease what do we need to know the first thing I think everybody needs to know uh you're talking about from a personal risk standpoint or just understanding the disease personal risk Okay yeah so the first thing I I you know we

want to know from all of our patients is tell us your family history right that you know there is a genetic component to this disease so let's understand what your susceptibility is um would you ask them that ahead of just saying go and get a genetic tester oh absolutely yeah because the the I think the family history is more telling than the genetic test wow okay because remember the genetic test we look at is We look at the most common Gene which is the gene that's easiest to test for which is apoe there are a

dozen other genes that we look at but they're much harder to sift for there aren't really great commercial tests for them and God knows if there's something lurking that isn't part of this current Paradigm of what we understand yeah exactly did it show up yeah if it showed up yeah so so right out of the gate we want to know is is Um is dementia in your family if so what type do we think it is so do we think it's Alzheimer's dementia do we think it's vascular dementia do we think it's front to temporal

lobe dementia do we think it's Lewy Body dementia is there Parkinson's disease when you think about just comparing Parkinson's disease Lewy Body dementia Alzheimer's disease those are three types of neurodegenerative diseases that are on a spectrum where Alzheimer's is the is the most Cognitively destructive Parkinson's is the most movement movement destructive Lewy Body is taking bits of both of their playbook right so Lewy Body is destructive to both movement and cognition well we want to understand exactly what pattern you may or may not be a part of we also want to understand age of onset

so um tragically there there's a fortunately very very rare but um you know still unfortunately Prevalent form of early onset Alzheimer's disease these are people who are afflicted in their 40s and 50s is that what Chris Scott no no he got he realized something during that day yeah Chris Chris learned that he has two copies of the APO E4 Gene and the APO E4 Gene is the most common genetic uh you know the most common Gene responsible for Alzheimer's disease but not but it's not early it's not early onset right it's a late onset predisposition

okay The early onset ones are um called app psen1 psen2 um so again those can be tested for we don't normally test for those because it's normally so Apparent from family history uh of course now if we document that we would of course test for it tragically I think that's a variant of Alzheimer's disease that is um I think it's less clear how much you can prevent lifestyle Independence right whereas the one that Chris has and that 25 of the population has if they have one copy of that Gene that's highly amenable to prevention which

really gets to why we want to know this stuff you want to know this stuff because one sometimes that's the motivation people need to take this seriously when they're 35 years old and young and indestructible because that's the time you want to actually act and secondly there are certain things that we know are even more important to people with That genotype so it would factor into what medications we might use to lower cholesterol it might factor into how much omega-3 EPA and DHA we would want them to take it might factor into other choices we

might make around nutrition and even in people who are exercise time limited it might factor into how we prescribe exercise what are the biggest prophylactics against mental degradation over time So I did recently did a podcast on this um it's an AMA on my podcast that is 100 devoted to all interventions that improve cognition And Delay the onset of dementia and I sort of broke it down into here are the things for which there is no ambiguity about the benefit so enormous signal I'm not going to talk much about them because it's I'll give you

you know the basics on it and then I spent the entire Podcast talking about the gray stuff where there's probably a benefit but it's harder to quantify so you're asking what are those things that I didn't really talk about it's basically exercise um uh lipid management not having type 2 diabetes and probably sleep having adequate sleep those are those are the No Regret moves that that have Enormous impact and it's probably in that order so it seems like looking at what we've spoken about so far today and you mentioned it earlier on you thought diet

was this unbelievably huge lever it seems now that exercise is one of the longest if not maybe the longest I think it is that you're talking about I think it is yeah I think the day certainly the data would suggest that right so in other words you go back to So a hazard ratio is a very it's an important tool in statistics to understand the relative risk or benefit of any intervention so a hazard ratio of one means that this intervention has no benefit and no harm a hazard ratio of 1.5 means this intervention is

50 percent riskier than the Baseline a hazard ratio of 0.75 means this intervention is 25 percent less risky right okay so um when you just go off those numbers What's the what's the hazard ratio of smoking well it depends on the study but it's about 1.4 so what that means is and that's for all cause mortality so that means that if you're if you compare a smoker to a non-smoker all things equal at any point in time that smoker is 40 more likely to die in a given year than the non-smoker it's devastating right if

you look at hypertension it's about 1.2 1.21 so having high blood Pressure means you're about 20 to 21 more likely to die in a given year than someone who's identical to you in every way except they don't have high blood pressure if you look at somebody with you know atherosclerosis so Advanced cardiovascular disease it's about 1.25 um if you look at somebody with end-stage kidney disease so someone who's on dialysis it's like 2.75 that means there are 175 percent more likely to die in a given year than Someone who's not in end-stage renal disease so

now start comparing all of these other interventions I'm talking about well let's go back to the VO2 max if you take somebody who's in the bottom 25 of fitness which by definition 25 of the population are and you compare them to somebody who's in the top two percent for their age It's a five that has a ratio is five so it means it's 400 percent difference in mortality if I take somebody who is in the bottom quartile of strength and compare them to the top quartile of strength it's about three as a hazard ratio so

when you go through these metrics of exercising or muscle mass or strength or cardiorespiratory Fitness it just dwarfs everything else including diabetes Including smoking so and again this isn't a zero-sum game like the goal is get as many things on your side as possible be of normal weight don't have diabetes be sleeping well don't smoke but be strong as hell have a high VO2 max I mean you want you want to Stack the odds as much in your favor as possible there's no guarantee in life and this there's still an enormous stochastic random bad luck

component to life I could walk out of here and get Hit by a car but I'd like to control what I can control heart disease is the biggest killer on the planet at the moment born on why are our hearts so fragile I mean actually I would argue they're not right if you consider what your heart is doing right you know it's like this amazing organ that is beating non-stop without any instruction from you consciously and has this remarkable capacity to respond to your Autonomic nervous system On Demand right someone runs through this door and

startles us our heart rates are going to Skyrocket instantly we don't even need to tell it something bad is happening right I you know you you go to you know get stem cells at elevation your heart rate knows to get jacked uh so so so so so this this thing is in a remarkable muscle um but it has Um it has a narrow blood supply you know so um and it doesn't have a remarkable capacity to revascularize itself that's probably its biggest drawback you know other muscles in our body uh have in much easier time

undergoing angiogenesis so if you know if you suffered kind of uh you know an occlusion of of a blood vessel a small blood vessel in your leg It wouldn't cause as much trouble because you'd have kind of an easier time creating collateral flow around it but in the heart that's that's that's less the case and of course the stakes are much higher you probably wouldn't notice it if a you know a silver dollar size patch of your quad stopped working it wouldn't reek as much Havoc as if an equal sized patch of your left ventricle

stopped working um so the problem is that Evolution didn't really care about atherosclerosis that's that's really the problem right so atherosclerosis is driven by factors that Evolution wasn't at all caring about because they didn't interfere with reproductive Fitness so smoking high blood pressure and high APO B are the main drivers of atherosclerosis and none of those things were on Evolution's radar in fact you could argue Um High APO B for a period of our human history would have been beneficial APO B being the lipoprotein that wraps around LDL and vldl would have played an important

role in a scarce nutrient environment which we were in up until a few hundred years ago and today of course it creates a problem right today those apob particles those LDL particles are carrying cholesterol into our artery walls and our immune system which by the way is doing the Best job it can like the little train that could is treating that as though it's a foreign Invader and mounting an enormous immune response and it's that immune response it's actually leading to the creation of plaque that ultimately results in a heart attack so when it comes

to heart disease it seems like there's two broad elements here one would be restricting the things which cause risk and the other would be improving yourself from Baseline what Are the big buckets in either of those you mentioned smoking smoking blood pressure and APO B so if you just took those three things off the table it's very hard to imagine how you can get atherosclerosis so if you don't smoke if you maintain a blood pressure at or below 120 over 80 and if your APO B is maintained at the physiologic level that kids have you

can't get atherosclerosis how does someone know about their ipob simple blood test cost about 12 bucks Okay and how often do you need to get that done uh I mean I probably check mine three or four times a year I probably check mine three times a year um yeah and if it came back and said this is high then you would try to ask the question why is it high how much of this is going to be fixable by diet how much of this is going to be fixable pharmacologically truthfully to get to the levels

that are necessary to eradicate atherosclerosis for most People does require pharmacologic intervention this is probably in in my opinion if antibiotics represent the biggest win of medicine 2.0 uh anti-lipid therapy would be the second biggest win okay that's stopping the bad yep improving the good for the hot yeah so again exercise not surprising um and probably more so the benefit on cardio here you're probably going to see more of a the data would certainly suggest that cardio is the more Important exercise of the two but again I always caution people you're not just feeding your

heart you got to worry about your brain you got to worry about your body so we're never going to get into the to a cardio or strength Paradigm it's and it's always going to be and but just to be clear the cardio training probably has a better impact on the heart um um sleep So uh lo you know poor sleep has devastating impact on the heart probably through sympathetic overtone uh hypercortisolemia things like that so stress becomes another thing that really matters it's kind of again it's one of these sort of fuzzy terms that kind

of seems like oh yeah yeah stress I'm sure but but I think the data are very clear that high levels of cortisol um are are really damaging to coronary arteries Um and then again nutrition kind of factors in probably to the pharmacologic strategy so there's no question that um for you know if you're if you were saying what would be the most Draconian nutrition step I could take to minimize my lipids um you could take that step but you're probably creating three other problems in its wake right so if you went on like a 10

fat diet You would probably drop your lipid levels to you know very healthy levels the problem is what other problems would you how do hormones look yeah how do your hormones look how does your muscle mass all these other things and so what you call it lifelike only having temps on fat in your diet right so the way I think about it is when I can use so so if I can use pharmacology to solve a problem without creating another problem that's a far Better use case than using nutrition to solve a problem that creates

a whole bunch of other problems because you can be more targeted yep yep understood that's interesting what about motivation like what do you think about motivation because we're talking here about all of these things that we could do and should do and potentially need to do but those are the competing goals that people have got as well in here What have you found given that you know overwhelming number of things that you get exposed to but anyway it'd be good if I added this into my routine you could get to the stage where there is

no life left in your life yeah how do you map your intervention threshold and then try to stay adhering and compliant given all of the stuff that there is to do well I mean I think everything has a season right so there's been periods of My life when I've been far more disciplined and far more regimented than others and um again I just I kind of always want to remind myself that I never want to be in the situation where everything is off the rails so if I'm really feeling stretched thin if I'm really feeling

like I can't do it all then I have to start prioritizing then I have to start you know if you're on a Lifeboat and you can only take so many Things this is where it really matters that you think about what you need and so if um you know if if for example when I was you know finishing the book and under you know unusual amounts of stress based on the demands of the book the demands of my practice the demands of the podcast all these other things I just made a very clear unilateral Decision

like there's certain things I'm not going to care about and one of them is going to be eating like I'm going to indulge and kind of eat whatever the hell I want to eat but I'm not going to compromise sleep or exercise because I know that those two things Factor far more into my productivity my cognitive capacity and my mood truthfully and yeah in an Ideal World I would be firing on those cylinders plus eating perfectly but I was like look sometimes I will Sometimes I won't and if my assistant manages to be able to

get me a great salad for lunch today that's awesome but if she can't and I feel and I'm starving and I just want to go and have a bowl of cereal soapy I'm just gonna have a bowl of cereal like I'm not going to beat myself up over this or Let It Bleed into some other areas and of course you know I hope that that's not something that endures forever Um and of course you know it doesn't you know you just have to remember that um you got to remember why you're doing this right so

I think I don't know that motivation is the right word I think it's sort of purpose that that matters um I don't really know what motivation means I I at least for me personally I'm sure for some people that word has meaning for for me kind of purpose is the thing that matters a more accurate Word for me to have used would have probably been something like consistency over a long period of time yeah for this because we're looking at longevity by definition up until the end of life yeah you asked you began this conversation

asking what I want to look like when I'm still having sex when I'm 90. um which means that you're making decisions in the now which are very different to If you only have a five year or a 10 year or even a 20 year timeline to what you do you know you're training protocol which the risk to reward it may be fun to do this particular training style it may be but what's the injury risk and what would the downstream costs of that be in 30 40 50 years time um I don't have great advice

for how to get somebody there I mean I just know that I've crossed that threshold Um probably in the last five years and I'm I'm really happy about it I I really it's it's it's actually created a much greater sense of calm in my life um less hurried in a way yeah and also just um less less harsh you know it used to be that every day I used to say this every day you have to burn at least one match and a match for me being burned was a physical exertion to the point of

wanting to puke I had to do that at least once every single day there was no workout seven days a week that didn't at least produce that once um so even like if I was out on a recovery ride I would still have to close the ride there was a I used to live at the top of a hill and it was a one kilometer Hill and it would always be a one kilometer Sprint to the death where I was always trying to hit a PR um or every if I went into the weight Room

and the goal today was to deadlift it was like always going to try to PR and I mean I am so far from that mentality today that it's it gives it sometimes you know like I'll go in and I just don't feel right during the warm-up like it just doesn't feel good and I'll say you know what I'm not I'm going to abort the deadlift today I'm gonna go and do some safer exercises where the stakes are a lot lower and if I make a mistake I'm not going to get Punished for it the way

I'm going to punished if I'm doing deadlifts and I you know don't have my form just right um and so yeah you've got to be able to play the long game I think and I I don't know what to tell somebody to get them there other than anchoring them to the marginal decade because if you know what you're training for then of course you wouldn't take that risk right like and and honestly I think what we have an Epidemic of is people who don't know what they're training for like you know if you really stop

them and ask them like are you doing this because you want to look good on the beach are you doing this because you want bragging rights are you doing this are the other guys at the gym look at you like it's okay to say that the answer to those questions is yes but at least be deliberate about what you're doing and why because if you are doing This to look good on the beach or to have bragging rights then you might have to compromise some of your long-term goals but at some point you got to

decide like what matters the most what sacrifices did you need to make whilst writing this book it's been a very long labor as far as I'm aware there was a draft at some point that essentially just got totally burned two two drafts and it's not a small book I Mean it's like a it's a it's a a big boy um what did you have to sacrifice as someone that likes to get things right likes to optimize what did you have to sacrifice in order to well I mean I think I I had to learn to

compromise a little bit truthfully um you know I had a co-author I have an editor and I think I had to learn that sometimes They would have a point of view that was different from my point of view and I had to make concessions and I actually think that in the end those concessions were valuable so one of the biggest conflicts early in the writing process um so I wrote the first version by myself and nobody liked it right so everybody was like this is way too Technical and there's no story there's no story it's

just a technical Treatise on longevity Um and I was I really rejected their suggestion that this book needed to have part of me in it I was like that's going to be that it's gonna have no credibility it's just gonna read like you know pop fiction garbage like well when I look at where that book is now I realize no it had to have part of me in it this is partly my story and it's a story of my patients and it's this it's it's basically a very technical book That is weaved together between the

stories of people and you know there's a saying right like never make a point without telling a story never tell a story without making a point I you know this is something I really really rejected in 2016 2017 in the first iteration of that book um there are countless other examples of things where I was adamant that it needed to be done a certain way and luckily people around me who are smarter Than me said no I don't think that's the way to do it I think I think we need to cut this down a

lot and that's a hard thing to do when you're writing when you're writing you know there's this sort of thing that's called you need to learn to kill your babies and that's a really hard thing to do like I had there were chapters of that book that were literally twice as long and I thought they were really good and that left on The Cutting Room floor They're gone um and they're better now shorter it's okay that I didn't say everything that needed to be said a bunch of things that we haven't spoken about so far

today are hate cold sunlight grounding meditation rejuvenative practices social connection how do you map these onto the discussion about longevity I recently read a book by Robin Dunbar uh friends uh sorry uh the social brain his new one and then it He says one of the biggest discoveries that we've seen over the last decade has been the unbelievable power on Health and Longevity outcomes to having a social group has with us where do you fit all of this stuff in the heat that cold the sunlight the grounding the friends how does all of them I

mean I put them in sort of different buckets but but I would agree with that right I mean I think that I mean we are evolutionarily so wired to Be social creatures and that doesn't like I'm an introvert but which means like I don't like really being around that many people and I certainly don't like being around strangers um but I would die if I was alone so you know people who are introverts don't necessarily aren't immune from this either um and by the way I love playing thought Experiments right so so you know one

of the thought experiments I would play with myself when I was sort of wrestling with this was if you could have everything you wanted you could achieve everything right you could be the most physically fit you could have the most knowledge you could have the most cars and race cars and race tracks and blah blah blah but you live alone in this planet all of your needs are met by robots that Do everything else right so the the robots are you know pulling the oil out of the ground to make the gasoline for your race

cars and they're building it and they're farming your food or whatever whatever it is like but you're alone like think about that existence right like you can't fathom in existence alone regardless of how good everything else is in your life in fact that would be the closest thing to hell that I think I could ever imagine So we certainly know at the extreme end of the spectrum that loneliness is an enormous predisposing factor for suicide right so suicide is just the most extreme form of emotional death um but I I think there are a lot

of people who never get close to Suicide but who then enter kind of the second orbit around suicide which we would call parasuicide so engaging in behaviors that are Ultimately Reckless enough that they cost you your their life I mean you would argue that smoking is parasuicide excessive drinking is parasuicide using dangerous illicit drugs that unfortunately nowadays are so often laced with fentanyl is parasuicide is driving a strip back three series with a V6 engine and roll cage Parry suicide I don't think so I think it's I think driving to the racetrack to do those

things is basically parasuicide now I It's so funny I actually brought my daughter to the racetrack for the first time two weeks ago Kota uh no I went to Harris Hill so um I would love to bring her to CODA I wanted to start her at Harris Hill it's a smaller track you don't get nearly as fast and she was so reluctant for like a year to come how old is she she's 14. okay and I was like she's like well how what happens if we Hit something and I was like well Olivia the way

they design race tracks it's like it's anticipated that you're going to lose control of the car sometimes so everything is designed to minimize that plus the cars are safe so anyway she finally came I have a GoPro on the dash filming us driving it is hilarious to watch her head like moving around and stuff because the uh you know she's right you know what a Hans is yep yeah so the the belts came off her Hans I Don't think my coach strapped her in tight enough and so pretty soon she's like you know she's still

strapped in there but she's not like I am like when I'm in there like my Hans is like um and I showed the video to one of my buddies he goes she looks like one of those monkeys they used to put on rocket ships like just like you just see a big helmet head like bobbling around it's hilarious but anyway uh no I I would I would not describe that as parasuicide I Would describe that as nor would I describe skiing or other sort of risky Sports I just think you have to decide where they

are within your risk behavior um but then you go even beyond that and I think there's you know behaviors that that aren't going to kill you but they're just going to make your life so miserable right like having horrible relationships with people um That degrades the quality of your life and while I do think that that does shorten your life ultimately right I do think that there are biochemical ways that that impact probably through stress hormones probably through you know greater activation of sympathetic you know an imbalance between sympathetic and parasympathetic flow I think those

things absolutely do impact our immune Function our cardiovascular function all these things um even if they didn't what's the point I'm going to think about the enjoyment of Life yeah that we can break things down into an objective list of metrics and how does it impact the things that we can measure that are going on but what's your felt sense of life like yeah so go back to what you said in your marginal decade And I think most people when you ask them about their marginal decade none of it's in isolation it's you said picking

up grandkids being able to walk your dog which is a companion being able to have conversations with other people that's the cognitive piece so I think when most people really think about this they can't escape the fact that their quality of life is inextricably linked to interaction with other people we haven't spoken about emotional health As an individual at the moment um it might surprise people to think about when you have the discussion about longevity you're talking time on the planet bone density muscle mass cardiovascular risk etc etc what about emotional health how should people

even frame that in the discussion that we're having I think it has to be top I think it's right that's right there with those Other things I don't think it's I don't think it's something that should be thought of as an afterthought it's uh it matters just as much um again you know long life with you know poor emotional health is is probably a curse what rejuvenative practices do you find best you know we 10 12 14 hours a week of sometimes punishing sometimes sub-punishing workouts and yeah usually sub punishing right so call it 12

to 14 Hours a week of exercise is very important for me um I do sauna four days a week I try to do four days a week um session length uh minimum 30 so so 30 to 60. at uh 196 to 200. are you taking a break but those you must be go straight through on that I I can I usually will go 30 and then a quick break though 60 at 200 would be uh I've never done 60 or 200 I've done 60 at like 194. that's hard okay right so four times a week

yeah Four to five times a week and by the way that's doubly regenerative for me or rejuvenative depending on because like I'm again I never do that alone right so I'm gonna do that with a friend I'm gonna do that with my wife yep and it's always just an awesome time to be like last night talking about you know my whole my wife and I spent the whole time talking about you know a session she had with her therapist and how you know how much she learned and it was just so Wonderful to have kind

of backing yeah multiple things on top it's just it's just being able to do multiple things at once that are both um really beneficial um I like rucking that's something we didn't really talk about I don't really lump that into my exercise bucket of time though it is um it is obviously a great type of exercise but because of the way that I'm doing it which is I'm not taking any Electronics with me and I'm not multitasking when I do it it really is just as much about my brain as it is my body so

rucking of course just for folks who don't know it's basically walking around with a very heavy backpack so you know sweet spot is about a third of your body weight um and uh you know so I'll go and do about three three and a half miles with as many Hills as I can find and not I'm not taking anything like I don't I'm not Listening to podcasts or books or anything I don't have my phone with me so it's really just uh something that's unusual for me because usually I mean they're working or if I'm

exercising in the gym I'm listening to music if I'm on my bike there's always multiple stimulus going on yeah I'm listening to a podcast or something like that but here it's truly just observing thoughts what's your divisive choice for rook and Goruck yes absolutely love those guys is that do they do anything that isn't because they do the thing that's like a big penis coming out of your back where you can literally plate load it right I'm gonna guess you use a more I have a pack so there's a there's a there's an actual pack

that has pockets in it so you drop the plates in it cool and you've got what's like 60 pounds seven pounds in there 60 and I have several packs so I Have one my wife has one we have one for Anytime friends come over and I've just got like we've got tons of weight so away we go oh here we go yeah so it's like I like to do wrecking Wrecking meetings with friends okay yeah cool so you have a cold plunge love that as well what are you aiming to hit per week then um

again it depends uh probably also about four times a week um and again that's something I like doing with my wife even though she's Tiny she can she can actually take the cold almost as much as I can I have a lot more insulation than she does worse for conversation than a sauna perhaps yeah not as much the usually the conversation there is how much longer yeah yeah yeah yeah yeah yeah okay um and and then truthfully I think the most sort of rejuvenating practice is playing like I I'm really lucky because I have my

daughter doesn't like to play as much but we still play like we you know we Play volleyball she loves volleyball so anytime I can be out on the court with her playing volleyball I'm teaching her how to drive stick so that's something that she loves doing she'll be like that can we go and drive and it's like yep get in the pickup truck go to the parking lot and you know making her start on steep hills and stuff like that is awesome and my boys are eight and five and so all they do is play

and so I get to play every single day get down on The ground you're probably on the ground grass playing Lego jumping on a trampoline goofing off I like doing Lego myself that's another Super that's a super enjoyable thing for me to do what is you I saw did you post something saying that shares of Lego had increased by 25 at some point and your wife had accused you of being single-handedly responsible contributing to it you moved the Lego Market yeah yeah yeah wow um I got sent by a very good friend Tim Bishop from

Australia uh a Coliseum Lego set yeah this is one of the three biggest Lego sets yeah so he sent me this uh which is one of the four so the yeah look tell me what's the first biggest the first biggest I think sucks it's the world map lame it's so lame right second third uh second is the Eiffel Tower that's the new Eiffel Tower there was an old one right the new one is really cool have you done that one uh We have not my boys want it okay my boys are just finishing the Titanic

which is the third largest and the Coliseum is the fourth right and it's funny my boys I was putting them to bed last night and we were playing the rank order game which one would you want and I I said that I think that I think the coolest is the Titanic followed by the Coliseum okay well I've got that have you done it yet no I haven't even opened it up um Tim sent it to me with the a letter About uh the man on the stadium floor is it yeah the Teddy Roosevelt question yeah

uh which was very meaningful yeah and he shipped the thing from Australia or maybe he hasn't yeah he must have done because it had the note in it God yes I shipped it across the planet you can do it I mean I find that I I love doing Lego I do the my favorite of the Technic cars so I have all of them okay um do you do this I'm gonna get because one of the other things that I had Kelly Star on the show yesterday you know Monday this week and there's this big movement

at the moment for being on the ground yeah spending as much time hips below knees as possible do you consider that as well are you legoing no I I do Lego on a table I was like it's so complicated like I have I have multiple plates laid out with all the different pieces and so your workstation needs to be optimized yeah I can tell that you're surgical With your Lego creation um but my you play on the floor with kids because kids play on the floor understood yeah and that's also something that factors into how

you think about this last decade of your life which is if you want to play with grandkids and that's why by the way I think the Step Up is an amazing exercise the Step Up is the movement that tells you you can get up off the floor Um tell you one thing I haven't brought it up yet today I've been playing around with a Vitruvian at home which is kind of like a tonal it's like magnetic Drive training thing and they they sent me one two or three months ago this thing's so much [ __

] fun it's so cool um so you can imagine a like a stepper like one of those Reebok things that ladies in Aerobic class would use a little bit bigger than that flat on the Ground magnetic drive two cables that come out of it two nylon cables tons of attachments that go in you can belt squat by slotting something between the two they can be a long bar that goes between the two you can use it all these different bits there's a bench as well and the bench has got one uh leg is shorter than

the other so it can go flat or you can flip it and then it's an incline um It's so much but is it working is it it's magnetic yeah okay yeah yeah so you can have time and attention uh if you start to fail on a rep it'll it'll dial the weight back and then as you get to the top it'll turn it back on yeah so it can do eccentric only training yeah and it goes up to 440 pounds of of weight and doing step ups with that or doing my favorite movement with that

is a front foot elevated split squat so putting up onto that handles in either hand So much [ __ ] fun and it feels so how much room does it take up not just literally just this the size of a like the Reebok step yeah that's it and there's no more room to eat how much are they three grand and uh three three and a half and if you get like the uh looks sweet of additional things the nicer handles the belt squat Etc you're probably looking at all in including shipping probably like under three

and a Half something like that they're not a sponsor on the show but they sent me this thing and if you had a thousand square foot 500 square foot apartment in New York you could slide it but it's got little wheels on it put it up against a wall it would take up no room and do this thing [ __ ] crushes you it absolutely destroys you um and there's the app as well that they've done something else I thought was really Cool you can do not only individual workouts where there's a video and the

person does it and it tells the machine what you're doing and it gives you time in between for rest or to change the things over and you change it over with the guy or the girl um but it can do entire programs where it pings you and says you need to do lower body today and then you press it and then away you go I trained in the gym for nearly 20 years Now and this thing's really fun and I really really enjoyed the variation that it's added into my training so you know thinking about

Lego thinking about getting down on the ground thinking about stuff like 10 years ago if you'd said oh you're going to love box step-ups so [ __ ] off I'm not going to enjoy box step-ups uh all of these different training modalities are great pickleball's great I'm really enjoying and I think that you Mentioned it as well like transitioning the um goals that you've got yeah what are my aims what are my priorities here uh the first time I spoke to David Sinclair like I said four years ago just after the first time he did

Rogan and I thought this is really interesting I learned about anime and all this [ __ ] and I went to go and see him and it still sounded to me a lot the longevity movement generally Um halfway between like something for other people because I was made of rubber and magic and 30 years old uh and uh just it was it was sitting over there whereas now it very much feels like I need to I really need to take heed of this it's not just about learning it and teaching it to other people it's

like okay [ __ ] like how do I start to integrate this into my life and I think that a lot of more people are feeling that as well now Yeah well I mean I the the interesting thing is the relationship between the age of an individual and when they start to pay attention to these things and the younger you are the greater your advantage in terms of the compounding benefit of the changes so this is all about you know daily practice right this is all about day in and day out adhering to these things

but the drawback of being young is that marginal decade is a very Abstract concept less motivating yeah so it's harder for you to stay focused on a goal that's so far away conversely when you look at people in their 60s they've they're already on the downside they've they've watched their parents go through this they've they've watched people live and die through horrible marginal decades they have all the motivation in the world if we want to use that word They just have less room to alter the course if they're really far off so I I've I've

I'll never know what this perfect time is to to begin other than right now you know the perfect time was yesterday the next best time is today um but it's it's always interesting to observe that difference between the extremes of age did you become chronically aware of your own mortality As you went to the beginning of your 30s I think it's just it's the first time where warm-ups take a little bit longer where hangovers failed they never felt that good but they feel start to feel really really rough um and it does it it's a

very strange situation especially as a guy especially as a guy who's taken a lot of pride in the way he moves or looks or his physique and stuff to start to kind of at the top of a roller coaster you go oh This isn't going up anymore I'm kind of weightless at the top and maybe this is the biggest or the fittest or the strongest that I'm ever going to be uh and realizing that it's like oh [ __ ] I need to I need to think more carefully about this um but another side you

know when we're talking about motivating young people to consider in your 20s or whatever to think about longevity one of the prescriptions that you've got Is you have like a 15 to 30 minute window for sleeping for wake and like try and lock that in if you do that throughout your 20s you're not going to have a massive number of Life Experiences now that being said it's not a prescription you're still fine for you to go and travel and change time zones and all the rest of it but there is a degree of like look

just go and live life and perhaps part of the reason that you're able to Deal with that when you're younger is that it is more indicative of the kind of lifestyle that you're going to live and then as you do get a little bit older things are going to be routinized kids will be need to be taken to school work will require you to be at a place at a particular time you can't just piss off and do a season in Ibiza or you know like move to Hawaii for a couple of months or whatever

right um and I think I like that I like the Journey I really enjoy the The Arc that I can feel happening with my training with my fitness um with the way that I look at stuff and thankfully your friends grow with you and you tend to be friends with people that are your age so you're all thinking about the same things you're all thinking about like dude you like if you drink the wrong amount of water on the night time do you have to get up and go to the bathroom in the middle of

the Night like [ __ ] yeah like right dude I feel like we need to do a bit of research on this you know what I mean yeah Peter I really appreciate you I really appreciate your work I think the book's fantastic it's been a labor of love for [ __ ] over half a decade for you uh if people want to check out all of the stuff that you do where should they go um I think the everything is under my peter attia MD so the website we have a Newsletter that comes out every

Sunday that's um I think pretty good um and then the podcast the drive thanks Peter thanks Chris what's happening people thank you very much for tuning in if you enjoyed that episode then press here for a selection of the best clips from the podcast over the last few weeks and don't forget to subscribe peace foreign