00:00:00
going from zero activity to just 90 minutes a week is about a 15 reduction in all cause mortality Jesus Christ Dr Peter attia world-renowned physician
00:00:11
doctor for anything performance or longevity related he has the secret for living a long healthy and happy life
00:00:18
most people listening to us are going to die in cardiovascular disease cancer diabetes if we want to really figure out
00:00:25
a way to live longer we need a totally different Playbook how early do some of these diseases begin the minute you're
00:00:31
born but we only really think about the risk over a 10-year time Horizon as a 30 year old you don't get excited about
00:00:37
exercise in your sleep but there's a 400 percent higher risk of dying in the coming year when you compare the fittest two and a half percent to someone at the bottom 25 in the coming year and then
00:00:50
once you hit the age of 65 if you fall and you break your hip there's a 15 to 30 percent chance you will be dead
00:00:56
within the next 12 months really you have to realize is you're taking this for granted when you talk about the
00:01:04
deterioration of Health you have these three categories emotional health deterioration why have you included that because despite being very physically
00:01:10
healthy I was not living a good life I was in such an awful cycle of anger workaholism that I don't think my
00:01:17
marriage would have survived I realized I don't want to be this person and lose my kids I don't think I could have
00:01:23
survived it and I'm sure many people listening to us can relate were you able to discover the root cause of that more
00:01:28
than that I was able to get rid of it how so what you really need to do is what are the biggest misconceptions in your mind about weight loss I have thought a lot about this so
00:01:42
Dr Peter attia he is the man that wrote the book on how to live a long happy and
00:01:51
healthy life and he argues that everything we know about health and what that actually means health of the Mind the body and the emotions is wrong and
00:02:02
outdated he says that there's disease growing in you and me right now but the problem is
00:02:12
because we can't see it we're doing nothing about it Dr Peter's work turns the light on it allows you to see that in many cases
00:02:26
in action now will increase your chance of disease and a much shorter Life by 70
00:02:32
percent 170 percent and in some cases if we don't take action Now by 400 percent I've had lots of conversations on this
00:02:43
podcast about health about diet about all of these things but for many of you this one will be the one that changes your life this will be the one that makes you ask some difficult but
00:02:55
important questions about your health and what health means for you I walked away from this conversation realizing that if I don't take action now I'm going to be forced to take action
00:03:10
then and I can unequivocally say that this conversation has changed my life I have a suspicion it's going to change yours [Music]
00:03:23
Peter [Music] Dr Peter you talk about so much in your work I've been through every interview you've done
00:03:35
your book other conversations you've had you talk about a lot so many things that
00:03:41
I'm absolutely fascinated by my first question for you is what is your mission and why are you doing this I think that
00:03:52
um there is no greater um desire for people than to be healthy especially when you consider how we can define health more broadly than just physical health wins you can include
00:04:07
kind of emotional health it's kind of the great equalizer and nothing else really matters if you don't
00:04:13
have it right so it doesn't really matter if you're famous or not famous it doesn't matter if you're rich or poor if if your health is compromised and
00:04:24
anybody who's been through an illness where their health has been compromised I think we'll realize in a moment
00:04:30
what they've taken for granted and I I've just become personally endlessly fascinated by this topic and
00:04:38
in my own quest to understand this better and better the next natural step was to begin to do
00:04:44
it as a doctor right to begin to kind of help patients with this and at some point
00:04:50
you can only treat so many people and so podcasting and ultimately writing a book
00:04:56
just became a way to put as much of that information as possible out there for more and more people to access do you know why U of old people became fascinated by this was there a stuff
00:05:07
dominoes that fell I think so yeah I mean I think um you know I'd always been interested in
00:05:13
performance um because I'd always you know at least as as far back as you know being 12 or
00:05:19
13 years old you know I'd always been obsessed with one form or another of some sort of
00:05:25
physical Obsession whether it be you know boxing when I was really young or Marathon swimming later in life
00:05:32
but when my daughter was born when I was 35 that was the first time that everything kind of pivoted and I had a little bit of a
00:05:43
glimpse into the future I would say and I just sort of realized oh you know the The Joy I'm experiencing In This
00:05:50
Moment is so surprising to me so unanticipated and I really want to be able to experience this again means not just with other children of
00:06:03
mine but potentially with grandchildren and on top of that I had a bit of a wake-up call which was I realized that all the men in my family died prematurely of heart disease obviously I
00:06:14
knew that fact before this time but I think it was the Confluence of those two things it was the realization that yeah
00:06:20
you know if you don't figure something out and do something about this you're probably going to die of heart disease in your 60s which is not that far from
00:06:27
now you know 25 30 years from now and you now really have a motivation to live longer and to live better longer and so that in many ways kind of began
00:06:40
the change in my direction my focus to to being one that was not purely just focused on performance anymore but sort of focused on understanding Health in a different way
00:06:52
this concept of medicine 3.0 is a concept which I only discovered in your work never had the time used before um what is medicine 3.0 and how did you get
00:07:03
to the point when you realized that there needed to be an iteration on the current system of Medicine
00:07:09
yeah the reason I think you hadn't heard of it before is I don't think it's been described before so you can't be faulted
00:07:14
for that um but as I began writing the book and thinking about how I was practicing and how people like me
00:07:25
practice I realized that it is a very distinct change from the current form of Medicine
00:07:32
and in a way to not be just critical of the current form of medicine I had to put it in the context of what existed
00:07:39
even before that and that's how I sort of realized well we're in this version of medicine called medicine 2.0 but it's following something called medicine 1.0 and it's an enormous Improvement above
00:07:51
that so maybe I can spend a moment just kind of explaining what those three are and I think that's probably the easiest
00:07:56
way to explain the current form so um medicine 1.0 is everything that existed before we really understood the science of Medicine so for most of human history we had no
00:08:10
idea why people got sick or why people died or what an infection meant and we sort of thought that these were plagues from the gods or things of that nature but a couple of things happened in the
00:08:24
past you know 100 few hundred years the first was the idea of a scientific method
00:08:31
something that we take for granted today where you can make an observation about something in the world formulate a guess
00:08:37
called a hypothesis about why it's happening and then design an experiment to test it that's called the scientific
00:08:43
method that's an invention that's a creation we had to figure that out also things like a light microscope which you know up until 140 years ago or
00:08:54
so didn't exist allowed scientists and doctors to be able to actually see these microscopic things called bacteria and
00:09:01
then ultimately the development of things like antibiotics and eventually vaccines all of these things made an
00:09:06
enormous difference in reducing the suffering and death due to what I call in the book Fast death so fast death is pretty much how we used to all die fast death would be trauma and infection
00:09:21
and up until about 150 years ago life expectancy would have been high 30s low 40s and most of us succumbed to fast death
00:09:34
but with the Advent of medicine 2.0 through all those transitions I just described in the span of a few Generations we've doubled life expectancy right so now
00:09:45
life expectancy is roughly twice what I just said a minute ago and most people do not die from Fast
00:09:51
death but it's been supplanted by slow death today most people listening to us are
00:09:57
going to die from cardiovascular disease from cancer Dementia or other neurodegenerative diseases complications
00:10:05
of diabetes and on the one hand that's a sign of progress it means like Hey we're living
00:10:11
long enough to die from those things but we've made scant progress against those
00:10:18
things in fact if you go back and strip out the top eight causes of infectious death or communicable death death from communicable diseases or infectious diseases today if you strip
00:10:32
them out our life expectancy is not much better than it was in the 1800s in other words that doubling of life expectancy that we've experienced comes almost exclusively to the reduction of
00:10:46
those fast deaths and has little to do with any success we've had against slow death if we want to really figure out a way to live longer and I would argue more
00:10:56
importantly live better meaning when we're in the last Decades of our life not be in a state of total decline we
00:11:01
need a totally different Playbook and that Playbook is medicine 3.0 and it involves real prevention so that means
00:11:09
taking True step steps at prevention very early in life it also involves being very personalized
00:11:16
in how you do things so it means you can't just do paint by numbers you can't just sort of say the same thing to
00:11:21
everybody clearly there are certain things that make absolute sense across the board
00:11:27
such as sleep and exercise you know but the way you might use medications is going to have to be much more tailored to an individual you say that there are there are four points to Medicine 3.0 which is the
00:11:40
prevention the being unique in your treatment um to each individual an honest assessment and acceptance of risk yeah one of the things that I don't think we
00:11:52
think enough about as doctors sometimes is is risk right now I think doctors are very good at thinking about the risk of
00:11:59
doing something yeah um I think you know usually a doctor is pretty good at understanding you know if
00:12:04
you have this surgical procedure there's a risk of an infection there's a risk of bleeding there's a risk of all these
00:12:10
things if you take this medicine there's a risk of this side effect or that side effect but I don't think we spend enough time
00:12:16
thinking about the risk of not acting or the risk of not acting when we do so this is where I think it gets a bit
00:12:23
more nuanced um prevention doesn't come without risk right I mean you're still going to have to do something in in the state of prevention
00:12:36
um so the question is understanding the time Horizon upon which you're considering risk so I'll give you one very specific example
00:12:47
um at least in the U.S and it might be the same in the UK um we only really think about the risk of heart disease over a 10-year time Horizon so look at someone like you
00:13:00
you're 30 years old right so what is your 10-year risk of having a heart attack I can tell you without knowing anything about you it's really low good it's as
00:13:13
close to zero as we could have in medicine but what if I did a blood test on you
00:13:19
and I found biomarkers in there that were predictive of very high risk later in life now that would be actually quite possible there's there's about a one in
00:13:31
ten chance you might have a biomarker called LP little a for example which is just a certain lipid in your body about
00:13:39
a one in ten chance you have that dramatically increases your risk of cardiovascular disease my uncle died
00:13:45
very early I believe in his 50s of a cardiovascular disease interesting so knowing that by the way could be
00:13:52
helpful because that would prompt me to ask you more questions and want to know more about all the people in your family
00:13:57
so here we have a 1 in 10 chance and by the way we wouldn't leave it to chance we would just check it and we let's say
00:14:03
we checked your level and you had that you had that lipoprotein or you had an elevated level of another lipoprotein APO lipoprotein little B and again these
00:14:11
are kind of technical terms but they're very common things and they're easy to measure the medicine 2.0 view here would be well
00:14:19
there's nothing wrong with you now and there's not going to be anything wrong with you for the next 10 years
00:14:25
we don't need to do anything about it conversely if I take a lifetime view of risk I would say yeah but the risk to something happening in the next 40 years is actually quite
00:14:39
significant so my risk of doing nothing is probably much higher than my risk of doing
00:14:45
something today so my risk of doing something today would be non-zero but small but my risk of doing nothing if I
00:14:52
take the appropriate time Horizon is much bigger this is one of the things in your book that really really got me
00:14:57
thinking was I have to say and I believe a lot of people probably feel the same way I've gone through my life thinking
00:15:04
to some degree I'll worry about avoiding these diseases later I'll I'll when I get to 45 then I'll start taking this thing seriously because then I'm getting into that territory where most people I
00:15:17
know that get cancer or Alzheimer's or all of these cardiovascular things that's when it tends to happen so I'll
00:15:23
think about it then totally understandable um and I'll frame this in the context of
00:15:31
a question I get asked all the time which is hey Peter when is the best time to start thinking about this stuff and I say look I can't answer that because there are two competing issues
00:15:44
that are crossing when I meet somebody who's in the last decade of their life do you know how much they are thinking about this like it's all they're thinking about
00:15:56
it's all they're thinking about every minute of every day is a confrontation with their own mortality
00:16:03
the problem is they don't have much time to change the direction of the ship you may recall in the book I write the sort of I use the metaphor of the Titanic
00:16:16
right it's not that the Titanic didn't see the iceberg it's that it didn't see the
00:16:21
iceberg in time it didn't have enough Runway to really move out of the way and that's why the Titanic gashed the side of the boat now at the other end of the spectrum a
00:16:32
30 year old like you has unbelievable potential to change the Arc of your life you have so much runway to
00:16:45
through manipulating nutrition and exercise and sleep and stress and all of these things to completely alter the to
00:16:52
the disease trajectory of your life the problem is and I'm not just speaking to you personally but more broadly to
00:16:58
someone who's as young as you it's harder to find the motivation because there are no reminders of your own
00:17:05
mortality you're Superman right the worst thing that happens to you is a hangover so I always get asked
00:17:12
like when is the right time to start worrying about this and the short answer is look as soon as possible but then
00:17:18
there's a reality that says for most people it's not until they're in their 40s maybe once they have kids that they start to appreciate their own mortality and that that provides some of the
00:17:30
motivation to say you know maybe I'll be a little less focused on optimizing everything for today
00:17:37
and I'll start thinking a little bit about tomorrow so again another way to think about this is saving for retirement
00:17:42
a lot of people in their 20s and 30s who are making good money aren't necessarily
00:17:48
taking the most prudent Financial steps to ensure Financial Freedom when they're
00:17:53
in their 70s because let's be honest it's more enjoyable to spend money today than to
00:18:00
set some of it aside but there are a lot of people later in life who think I wish I was a little bit
00:18:06
more responsible earlier on how early do some of these disease if you looked at my sort of metabolic health or if you were able to look inside my body which I'm sure you're able to do how early do
00:18:16
some of these diseases begin in my in my life at what age do you see some of these things coming yeah it's
00:18:23
super interesting because there are some elements of you as a person that are going downhill the minute you're born and there are others that are not so
00:18:35
let's let's use two examples let's start with something where your body is getting better and better and
00:18:44
um you know you're probably only peaking now but you haven't really started to age
00:18:51
um your muscle quality okay so when you were five years old your muscle quality was nothing like it is today but as you enter your 20s the quality of
00:19:04
those muscle fibers these type two one these type 1 and type 2 muscle fibers so these are kind of slow to fatigue but
00:19:11
high endurance fibers are the type one fibers the type two fibers are very very powerful but they're kind of quick to
00:19:18
fatigue the quality of both of those fibers is very high and the more you train them the higher quality they will
00:19:25
be but as you enter your 30s you will now start to experience a shrinkage of those
00:19:32
type 2 muscle fibers you will be less powerful in your 30s in your late 30s especially than you were in your mid to late 20s so that's a form of Aging you are declining it's not an accident that
00:19:46
the most powerful athletes in the world are at their peak in their late 20s and early 30s so sprinters for example
00:19:52
that's a prime example of a pure pure Power Sport um we look at other things like more of your muscular endurance that will Peak even a little bit later you can keep that going a little bit later
00:20:06
we look at certain forms of cognition so if we look at something called fluid intelligence right this is raw
00:20:13
horsepower processing speed you have more of it right now than I do meaning you're going to have faster processing speed better memory all of these things
00:20:24
are going to be better when you're 30 than at my age I'm 50. because that's already started to decline in me
00:20:31
there are some things however that began Aging in you the minute you were born and one of them is actually going back
00:20:37
to this idea of atherosclerosis or cardiovascular disease well that's an example of a disease process that begins
00:20:44
right away at Birth and even though it almost never rears its head as far as death before you're 50 make no mistake about it it's starting on day one and we know this by the way because when
00:20:58
we look at studies of people who die for completely unrelated reasons so somebody who you know dies in a car accident or
00:21:06
soldiers dying in war and we look at their the arteries of their heart we already see quite Advanced disease so the truth of it is you already have
00:21:17
pretty significant disease in your coronary arteries it hasn't risen to the level of ever causing a heart attack and
00:21:24
it's unlikely to do so for another 20 years maybe even another 30 years but it's compounding it is compounding exactly and if you want to live to be 90
00:21:35
free of cardiovascular disease it makes a big difference if you can slow it down
00:21:40
when you're in your 20s and 30s interesting that's really what I'm trying to change in myself is I'm trying to find the motivation like you said when we're not confronted with our mortality it's
00:21:52
interesting because my life changed because of the pandemic in part because I got to see
00:21:57
um the relationship between things like obesity poor metabolic health and mortality for the first time and that's really when I started working
00:22:08
out every pretty much every day now it was three years ago in March 2020 2020 when I was watching the
00:22:17
TV and it was that confrontation of like oh my God the reason why I'm having a better outcome with this disease is
00:22:22
because I'm in better metabolic Health metabolic shape and it's funny that it has to take those things in our lives
00:22:28
for us to make the changes quick one before we get back to this episode just give me 30 seconds of your time
00:22:34
two things I wanted to say the first thing is a huge thank you for listening and tuning in to the show week after
00:22:39
week means the world to all of us and this really is a dream that we absolutely never had and couldn't have imagined getting to this place
00:22:46
secondly it's a dream where we feel like we're only just getting started and if you enjoy what we do here please join
00:22:52
the 24 of people who watch this channel regularly and have hit the Subscribe button means more than I can say and if
00:22:59
you hit that subscribe button here's a promise I'm gonna make to you I'm gonna do everything in my power to make this
00:23:05
show as good as I can now and into the future we're going to deliver the guests that you want me to speak to and we're
00:23:11
going to continue to keep doing all of the things you love about the show thank you thank you so much back to the
00:23:16
episode when you talk about the deterioration of Health you have these three categories cognitive decline um decline in loss and function of our
00:23:23
physical body and then emotional health deterioration why emotional health deterioration why why have I included that yeah why
00:23:30
have you included that well I mean maybe I'll just take a step back and say where
00:23:35
I kind of put these all in perspective so you know the the title of the book right is outlive the science and art of
00:23:41
longevity and what is longevity well longevity is really about two things it's about the length of life and the word for that is lifespan but
00:23:53
it's about the quality of life and the word for that is Health span and it's Health span that has those three
00:23:59
components you just described Health span meaning quality of life is determined by your cognitive function so
00:24:07
what's your processing speed what's your executive function what's your memory all of these things it's determined by
00:24:13
your physical health how much strength do you have are you free from Pain how much endurance do you
00:24:19
have what what capacity do you have to do whatever you want to do physically are you Limited in any way by pain
00:24:26
strength movement balance Etc and then the final piece is emotional health what's the state of your relationships are you do you have joy in your life do you have a sense of
00:24:39
purpose are you happy um not all the time right do but do you have the capacity to regulate your emotions and so now to answer your question why would that be included well
00:24:51
the truth of the matter is it wasn't something I always included right it wasn't something I necessarily thought
00:24:57
much about until it was I think very starkly pointed out to me by a very astute therapist who in observing my own struggles in life said something to the effect of isn't it
00:25:12
really ironic that you are putting so much energy into helping people live longer and yet you
00:25:19
are paying no attention to your own misery and I think that was you know and that
00:25:26
was about six years ago and that was kind of when I realized I needed to rethink my approach to this problem and
00:25:33
as I write about in the book I think I would make the case today that if your emotional health is suffering none of the others really matter that much so what you really need to do is think
00:25:46
about a way to have all of these things in order what does she mean by your own misery
00:25:52
well I mean I think at that point in my life I mean I there's there's no two ways about it I
00:25:57
mean I was just incredibly miserable incredibly angry um despite being very physically healthy
00:26:04
right despite doing all of the important things to be physically healthy right exercising uh you know
00:26:12
in all the right ways eating well sleeping well optimizing every aspect of my health but but living living a bad
00:26:20
life what were the symptoms of that what were the kind of for you to start to spot
00:26:25
that because sometimes we don't know in our own behavior and sometimes it's reflected back on from other people
00:26:30
we'll get feedback from our wife or our girlfriend yeah I mean Detachment from others
00:26:38
um prone to anger workaholism selfishness you know it wasn't it wasn't subtle it wasn't like hmm I wonder if you know I'm
00:26:50
not being my best self no if I if I was being honest and confronting it I was not I was not living a good life did you
00:26:56
know that in the moment had I asked you in the moment are you happy what would you have responded
00:27:05
I think I would have probably said to just that question sure right but but I think to a deeper prodding um
00:27:17
no and and there were there were a lot of things that happened in there but but certainly a very powerful one was going
00:27:26
to the funeral of um a woman my age who was the mother of my daughter's best friend so my younger daughter's best friend her mom died of cancer and so all the
00:27:40
parents you know we're at the free we're at the funeral and at the time I was you know
00:27:47
really going through a lot of difficulty um in my own marriage and this woman who died was a very successful lawyer
00:28:00
um really pretty remarkable and I was really sort of struck how at the funeral people had the nicest things to say about her what a beautiful mother she
00:28:14
was she had three kids and nobody talked at all about her career like there was not a single word about her achievements in life it was only a
00:28:26
discussion about the quality of her Life as a mother and that might sound very obvious because when was the last time you were at a funeral where they talked about
00:28:38
someone's career accolades but that in a moment really fused an idea from a book I had just read by a guy named David Brooks called the road
00:28:51
to character I don't have you read it in the book David Brooks talks about this idea of there being um resume virtues and eulogy virtues
00:29:04
and I really understood in that moment that my entire life at that moment had been only predicated on bolsting my resume virtues I had never spent a
00:29:16
moment thinking about my eulogy virtues and at that moment to your question if someone had asked me how is your eulogy I would have been brutally honest and
00:29:28
said it is awful there is not a single nice thing anybody who matters about me in other words of the people who should matter most they
00:29:39
won't be able to say anything nice about me is that painful to admit yes it's painful to admit today and it was painful to acknowledge then
00:29:52
wow I'm so impressed that you're able to because I thinking about cognitive dissonance and how psychologically uncomfortable that must be to face
00:30:04
you hint in the book about I think it was in the last chapter of the book you start hinting about the origins of that behavior the
00:30:12
workholism and all of those things and I can totally relate I think I'm a total workaholic I think I sacrifice too much
00:30:18
in the pursuit of like accolades sometimes in my life everyone knows me including these guys will all say that
00:30:23
about me um and I've often tried to in hindsight figure out where that came from in me
00:30:28
and undo that it's funny because reading this book the last chapter I actually wrote in my notes remember I just wrote Because the chapters called emotional health I wrote brackets trauma and the role that trauma
00:30:42
plays I didn't expect to find that subject matter in this book about longevity um what's your thoughts on the role trauma plays and how we go about understanding it so that we can live a
00:30:56
have a long Health span I think there's probably a lot of people who can relate to the stuff I write about in the Final Chapter and you're right that chapter is
00:31:08
a significant deviation from the first 16 chapters so there's 17 chapters in the book and I I basically make the argument that I
00:31:20
am the doctor for 16 of them the first 16 I'm talking about this as though I'm the doctor you're the patient I'm going to help you and this is how to do all this stuff and then in
00:31:32
the Final Chapter I'm saying actually now I'm the patient and I'm going to kind of walk you through this journey
00:31:37
I've had and hope that it basically motivates each of you to have a similar examination of yourselves and um
00:31:48
I I think that many people I can't tell you what fraction of people but I think many people have maladaptive behaviors
00:31:56
in their life that are indirectly or directly the response to something that we would Define as trauma and and Trauma is a very vast uh concept right I think it's very easy when you
00:32:11
hear the word trauma to think of abuse and you know that can be physical abuse sexual abuse spiritual abuse these things like that and it's true I did experience abuse in my life
00:32:24
um but trauma can be much more than that trauma can be abandonment uh enmeshment
00:32:31
witnessing tragic things so there are lots of things that are traumatic I discussed them in the book and what happens to children who are
00:32:42
traumatized and it can also happen to adults but I think most often the formative years of our lives are when
00:32:49
these things happen is we we adapt and I think that's the kind of remarkable thing about us is how adaptive we are
00:33:01
and those adaptations can often be very positive but a lot of times they have negative collateral or maladaptive
00:33:13
consequences in addition and some of those adaptations that are negative are addictions some of them are other maladaptive behaviors like anger
00:33:24
some of them include you know things like codependencies so you can sort of look at people and realize that hey you
00:33:34
know maybe that person who grew up in the home of Alcoholics even if it was an otherwise reasonably
00:33:40
well-meaning home and it's not like they were getting hit with a belt buckle every night but they weren't getting the
00:33:45
type of attention that they needed and their adaptation was to have an attachment disorder that wouldn't
00:33:52
manifest itself really fully until they were apparent so this this type of analysis really I
00:34:00
think everybody needs to spend some time thinking about it and needs to spend some time asking themselves hey which of
00:34:06
my behaviors are maladaptive and it's something that's done and I think it needs to be done without judgment this
00:34:13
isn't about saying I'm a bad person because of X Y and Z even though I think I can objectively look back at my own
00:34:19
behaviors at that time in my life and say those are awful behaviors I'm not proud of those behaviors but it's
00:34:24
separating the behavior from the self it's not saying I'm a horrible human it's saying I'm a human who did horrible
00:34:31
things and I want to understand why I love that approach because I think about the maladaptive Behavior patterns I had
00:34:37
that stood in the chance stood stood in the way of my chance of emotional health and good relationships and a lot of
00:34:43
those stem back to my childhood and um what I witnessed in my home and then distort the way that made me adapt and
00:34:50
the beliefs it gave me about romantic relationships for example so I became totally avoidant of those until later in
00:34:56
my life when I realized this pattern um the third point in your in your list of things that cause sort of I guess longevity of one's Health span is that emotional health
00:35:07
deterioration so before we get into the other two my question really was on that third point of emotional health
00:35:14
what for you has helped you to um self-analyze and become aware and to then get those things out of your way that stand a chance of costing you your emotional health was it
00:35:27
therapy was it introspection is it journaling is it honesty with oneself well I mean in my case I think the
00:35:33
situation was so far gone that I actually had to go away on two occasions um so I I had to go away in uh in it the
00:35:45
first time for two weeks uh to an inpatient like what's called a residential care facility which was two
00:35:52
weeks of like 14 straight days of 14 hours a day just doing trauma therapy in group and
00:36:00
individually and uh you know two weeks might not sound like a long time but boy that was
00:36:06
about the most brutal exhausting thing I'd ever done in my life and then again I had to do it for three weeks at a
00:36:17
different facility so again 21 days of inpatient treatment but also now really learning what the tools were to manage myself how do I fix that behavior how do
00:36:30
I how do I manage it so sort of like you have an injury you go to rehab you know
00:36:36
there's an acute healing phase but then there's a well now you want to make sure you're strong and that you don't injure
00:36:42
it again because that injury took place because of some weakness and and that's not not a Perfect Analogy but the point is you know there's a reason that you're shoulder separated yeah and we want to
00:36:54
make sure it doesn't happen again even once you're better and you sent yourself there twice yes and no I mean truthfully
00:37:00
I don't think I had a choice I don't think my I don't think my marriage would have survived so I I think it was
00:37:08
um I'm not sure I had a choice truthfully so I went very reluctantly I did not want to go but it was there was a an ultimatum essentially yeah
00:37:22
wow what was the greatest sort of gift that process gave you oh it gave me my life
00:37:37
I mean it literally saved my life really for sure how well I don't think I don't think I would I just don't think I'd be alive today without it right I think had I lost I mean I was on such a
00:37:59
I was on I was in such an awful cycle of Shame and self-loathing and deterioration that I don't think I could have survived it
00:38:12
so was that that was a narrative in your head at the time that you when you talk about shame and self-loathing that's
00:38:17
what the the voice in your head was yeah the the voice is you are an awful human being that's why
00:38:25
you behave this way and there's nothing that can be done about it you you're born this way you you are defective
00:38:36
and this is what defective people do look in many ways it's a lack of accountability right
00:38:41
it's sort of saying you have no agency in this you you can't change this because you
00:38:48
are you're defective when they do an autopsy on you they will see something in the temporal lobe of your brain that
00:38:54
explains your pathology were you able to discover the root cause of that narrative in your head
00:39:02
yes absolutely and and more than that I was able to get rid of it really yeah I'll give you one very tangible example I had a very very vocal inner critic
00:39:20
um and I think I'm sure many people listening to us can relate to that which is you know I was such a perfectionist I
00:39:27
was such a workaholic but any mistake I made I would eviscerate myself verbally so and this was I mean this is mistakes
00:39:40
that don't matter okay so one of my hobbies is archery I love archery so every day almost every day certainly if I'm not traveling I'm going to be out in the backyard shooting my bow and arrow
00:39:52
now does anybody else care nobody right is this my livelihood depend on this no but if I'm not shooting well
00:40:03
I am screaming at myself I will break an arrow over my thigh and these are carbon arrows they'll leave welts the size of your finger
00:40:15
one of the exercises we had to do was and this was once I left the second therapy place that was three weeks so the one of the big realizations there
00:40:28
was that this was happening because that voice like I didn't realize that that was unusual
00:40:33
so the exercise was every single day until this voice goes away which I thought would never happen which meant I thought I was signing up to do this exercise for the rest of my life
00:40:46
you take out your phone and you talk into the phone with a replacement voice for that voice and pretend you're talking to your
00:40:57
closest friend as if it were them who made the mistake and I say hey Chris I know you're having a bad day today I can tell it's hard you're not shooting
00:41:10
well it's okay you know what some days it's just not going to go well plus it is a little windy today let's be honest it makes it a bit harder and
00:41:21
why don't we just pack it up and come back and try again tomorrow you know just talk in a kind way talk in the way
00:41:27
you would literally speak to your friend and then I would send that recording to my therapist
00:41:32
so every day my therapist is getting multiple versions of these voicemails but this is important because I'm
00:41:39
audibly doing this multiple times a day and within about four months The Voice just went away really yeah
00:41:51
let's never come back how has it changed you as a father oh my God it's a it's a it's a it hasn't
00:41:58
changed me as a person right as a father as a husband as as a boss as a friend I mean it's it's just
00:42:04
um again it makes me a little sad to think oh God I wish I knew this when I was I wish I wish I did this at 25 you know instead of
00:42:15
all of this again I just think of all of the collateral damage in my life you know all of the people near me who have suffered unnecessarily as a result of
00:42:29
you know of of of of me being a wrecking ball um how much of that could have been prevented in some ways this kind of comes back to your very first question right which is I'm 30 I'm Invincible how
00:42:42
do I get excited about this look maybe the answer is as a 30 year old you don't need to get excited about
00:42:48
you know your nutrition and exercise in your sleep as much as a 50 year old does but
00:42:55
a there's a lot of benefit to doing so because you'll get more benefit from it but maybe it's just focusing on
00:43:00
emotional health so that you get yourself fixed before you start a family because I think you know and and I think
00:43:08
you know I feel lucky I think my kids are still young enough I hope that my kids don't have too many memories of
00:43:13
their of their dad in that in that state your belief about where that came from although there's no evidence there's no memory of anyone you know saying well this happened and whatever else but
00:43:25
is your belief that you weren't born with that and that something might have happened and you've kind of inferred that in some way
00:43:32
yes I think that was a really really important breakthrough that happened on the 19th day of that second stint I had in therapy in that inpatient therapy
00:43:44
session so that was a 21 Day program that I assumed was only going to be 14 days and at the end of 14 days they they needed me to they wanted me to stay another week everybody wanted me to stay another seven days and I was so
00:43:57
reluctant at this point I was exhausted I just didn't think I could do it again but they were adamant that I stay
00:44:03
another week and I knew the first time I had gone for two weeks and left I left kind of against their recommendations and I realized I never really got fully
00:44:15
better I got somewhat better but not fully better so I decided to just submit to them and say okay fine
00:44:21
I will stay as long as you tell me to and it was on that 19th day that I had perhaps the single most important Revelation for me again this is very personal and
00:44:33
the point of this is not that everybody else is going to relate to this it's only that I hope everybody else is
00:44:39
willing to consider their own version of this but what I the the last thing I could
00:44:44
never let go of was that I was born as a perfect child right like meaning we all are right not just me but
00:44:57
all of these kind of maladaptive behaviors were the result of things that I didn't deserve and again it's not all
00:45:12
what we call Capital T dramas it's not it's not necessarily the abuse I mean I think in my case perhaps the most impactful things of my childhood were
00:45:22
were more like neglect and not not traumatic not like the kind of neglect that's gonna that has you you should be taken out of a house or anything like that I'm just talking about not getting a certain type of
00:45:34
attention that I probably should have had and for whatever reason that manifested itself in really odd behaviors that as a kid I just said those are just bad behaviors but that's
00:45:49
just who I was and I think what I realized is and what I finally came to accept is no
00:45:56
those are adaptations to something that you didn't deserve and that might sound like a very subtle
00:46:01
distinction but it made all the difference in the world and it made me realize in part by it by looking at my
00:46:07
own kids that you know there is a real innocence to children that can very easily get
00:46:15
injured and and and when it does they're going to make sure that they don't get hurt again
00:46:21
and and the way they're going to do that is as I said initially in their best interest but ultimately it tends to result in really negative consequences
00:46:31
for the way they formulate relationships with themselves with for the way they form relationships with others for the
00:46:37
way they're going to parent for the way they're going to be a husband or wife um
00:46:43
and so that was that was a huge breakthrough so important and so powerful and I I
00:46:49
don't I don't think I've ever said this but really thank you for sharing that because um I got a lot from it and I've had lots
00:46:55
of conversations about this but I've got a lot from that specifically that point about um didn't deserve for it to happen and
00:47:02
really it's a response that's trying to make sure you don't experience that pain again so it's really again it's your
00:47:08
body is is doing everything in its power to help you and to protect you and some of these behaviors end up being maladaptive which then stand in the way
00:47:14
of your chance of emotional health that is the third category of deterioration which is the emotional
00:47:19
health deterioration so let's go a little bit earlier in the book and let's talk about the decline and the loss of function of our physical
00:47:27
bodies as well um medicine 3.0 as we talked about earlier you talk about these five core
00:47:33
things that help to increase our chances of longevity as it relates to our health spans what are those five things well
00:47:39
there's the one we just talked about right so all the tools that deal with how do you improve your emotional health
00:47:44
yeah again most of modern medicine only thinks about you know if you think about
00:47:50
where does medicine 2.0 rank on that it doesn't really except in the arena of mental health right when it comes to clinical depression anxiety personality disorders you know bipolar disorder
00:48:03
there we have a branch of medicine called Psychiatry that deals with those things but outside of that medicine
00:48:09
doesn't really deal with people like me you know I none of my problems quote unquote Rose to the level of you know a clinical diagnosis that would require
00:48:20
medical therapy okay tool two exercise again we can talk a lot about it if you want a little about it but the point is it is not remotely given anything beyond
00:48:32
lip service by medicine 2.0 medicine you know if you go to your doctor here at the NHS and say okay tell me what my
00:48:40
workouts should be like good luck right how much time should I be spending in zone two versus
00:48:45
zone five like what type of lifting should I mean there's no way they're going to give you that type of insight
00:48:51
or specificity uh the third one is nutrition again sure every doctor is going to tell you eat less exercise more but they're not really for the most part going to be able to help you manage
00:49:03
nutrition certainly I didn't learn anything about nutrition or exercise when I was going through my medical training and most Physicians don't so
00:49:11
I'm not saying that there aren't doctors out there who don't understand these things what I'm going to say is they had to learn that stuff on their own outside
00:49:17
of their traditional training so crazy the fourth one is sleep and that fits in the same category sleep is an essential pillar of Health but we learn nothing about it in our
00:49:28
medical training in fact most of our medical training is paradoxically sleep deprived so it's sort of it's a great
00:49:34
irony the fifth and final thing that you have as a tool in the longevity toolkit
00:49:40
is is all the molecules so drugs hormone supplements and there that's the one thing you sort of do learn in
00:49:46
traditional medicine is you you at least learn about the the pharmacologic side of it you don't really learn anything
00:49:52
about supplements so most doctors don't really understand much about supplements and interestingly most doctors don't
00:49:57
really understand a lot about hormones as well so medicine 2.0 is is good at what it
00:50:04
does but it's very limited so it's kind of like having a contractor that only has one tool instead of five tools and as we discussed earlier I think they're applying those tools too late in the
00:50:16
game how can you prove let's start with exercise then how can you prove to me that exercise is important
00:50:22
yeah it's a great question so start with the easiest way to do this is to look at
00:50:28
what the absence of exercise does versus looking at the absence or presence of other known bad things now for me to explain this I have to explain a technical term called a hazard
00:50:42
ratio so if you'll bear with me while I explain what a hazard ratio is it will reap lots of fruit later on a hazard ratio is a mathematical
00:50:52
derivation that comes from looking at a group of people following them prospectively following them into the future and looking at the rate at which
00:51:04
they die so a hazard ratio is a number if that number is 1.5 it means that there's a 50 percent increase in the risk of death for one
00:51:18
group versus the other so for example if we want to know is smoking bad for you we might ask the question what is the hazard ratio for smokers to non-smokers
00:51:33
when it comes to getting lung cancer okay and the answer is like 10. really it's 10 times more about 10 times more likely to get lung cancer if you're a
00:51:44
smoker than if you're a non-smoker now if you look at the hazard ratio across the course of life
00:51:52
for all causes of death it's about 1.5 meaning a smoker is about 50 percent more likely to die in any given year than a non-smoker which will all cause
00:52:04
mortality all cause mortality is the gold standard for understanding death and disease because it takes into
00:52:09
account every form of death okay okay what if you have type 2 diabetes everybody understands that having type 2 diabetes is very problematic and people with type 2 diabetes are at about twice
00:52:22
the risk more or less of cancer heart disease maybe one and a half times the risk of Alzheimer's disease but when it comes to all cause mortality every cause of death it's about a 1.4 Hazard ratio
00:52:36
40 out of 40 percent increase in all cause mortality again that's a stark number it means at any moment in time if
00:52:43
you take two people who are ever and otherwise always identical but one has Type 2 diabetes and one doesn't this
00:52:49
person has a 40 higher risk of dying in the coming year in the coming year yeah Jesus Christ yeah wow okay we can keep
00:52:58
doing this what if it's high blood pressure versus normal blood pressure that's a hazard ratio of about 1.2
00:53:04
20 percent same everything I just said but it's twenty percent okay what if it's someone
00:53:10
who has end-stage kidney disease their kidneys don't work anymore they're on dialysis hanging by a thread waiting for a kidney transplant it's about 2.7
00:53:23
that's a 170 percent increase in all cause mortality in the subsequent year okay now let's talk about some other things
00:53:35
what if I ask the question what happens if I take a group of 50 year olds pick any age pick any sex and we're going to take the top
00:53:47
15 to 20 percent in strength and compare them to the bottom 15 to 20 in strength
00:53:54
for that age and sex what's the difference what's the hazard ratio there what would your guess be uh
00:54:02
1.1 to 1.2 yeah yeah it's three two hundred percent difference in all cause mortality can you make a distinction between strength and
00:54:14
muscle mass okay yep we can do it so muscle mass just if we did it just on muscle mass it's about two or a 100 difference so muscle mass turns out to
00:54:26
be an amazing proxy for strength but strength is even better okay yep so high strength and high muscle mass produce a hazard ratio of about 3.5 okay because you can have a lot of muscles but not be
00:54:38
strong yeah kind of and you can be strong and have not as much muscle okay and that matters more by the way but but they're pretty tightly correlated okay yeah now let's look at VO2 max so VO2
00:54:51
max is the best tool we have to measure Peak cardiorespiratory Fitness so this is a test that you actually have to take it's it's done on a treadmill or on a bike they put a mask on your face and
00:55:03
then the mask measures how much oxygen you use so in the book I talk in great detail
00:55:09
about this test it's something anybody can do it costs probably 100 quid it's not like super expensive
00:55:15
um and everybody should know their VO2 max I really think everybody should know it and in the book I even offer some
00:55:20
ways that you can estimate it just by running at a track or something like that so sorry it's the the measure of
00:55:26
how much oxygen you're inhaling and exhaling no yeah it's the difference between how much you inhale and exhale
00:55:32
is how much you're using so the way that the way the test is working is there's a little oxygen sensor so if you're
00:55:37
breathing in we know that the air you're breathing in is 21 oxygen we know the flow rate and we let's just say you're
00:55:44
you're blowing it out at 14 so we know you used up seven percent times the flow rate we figure out how many liters per minute of oxygen you're using at the max and what's good and what's bad
00:55:55
yeah so it depends on your age and sex but at your age so for a 30 year old male we would say
00:56:03
oh I need the table is in the book um really I could estimate it 60 50 56 would put you in the top two and a half percent and that means that I'm oh sorry what's that number mean yeah
00:56:18
that's 56 milliliters of oxygen per kilogram of body weight per minute okay so I think I'm 96 kilograms at the moment okay very heavy so you would need to be
00:56:38
5.3 5.4 5.5 liters yeah no no yeah you need to be about 5.5 liters per minute you would need to consume 5.5 liters of oxygen per minute to come out to about a
00:56:52
VO2 max of 56 or 57 milliliters of oxygen per kilogram per minute that would put you at the top two and a half percent for your age and sex so I'm going to figure out is taking more
00:57:03
oxygen from the air that I breathe a sign of good health yes it means it's it speaks to how hard how fast and hard
00:57:11
your heart can pump yeah and how good your muscles are at utilizing oxygen ah okay it is the most important metric we have for Peak cardiorespiratory Fitness
00:57:22
and sorry for getting a bit too big because I really want to understand this and I'm sure there's a lot of people
00:57:28
trying to understand this as well so what are the things that stand in the way of good VO2 max
00:57:33
in terms of my and also the the lungs yeah it turns out that not much of it is limited by the lungs so the question is
00:57:40
where are you limited okay okay so how does this test work do you prefer to run or bike I prefer to
00:57:46
bike okay so we're going to put you on a bike we're gonna put this mask on your face that allows no other air in or out
00:57:52
it's only going to be metered by what's coming from the machine the bike is going to be
00:57:59
um one that has forced resistance to it it's called an ergometer so we're going to set it to 100 Watts nice and easy I'm
00:58:05
going to tell you to warm up for a while and then after a 10 minute warm-up it's going to start increasing the power
00:58:12
that's that you are forced to Pedal against okay and every two minutes we're going to add some amount 25 or 50 Watts and and you're going to say you have to
00:58:23
stay above about 70 rpm and this test is going to go until you can't do it anymore it's going to go till you basically drop so what's limiting you is clearly not
00:58:36
the amount of oxygen in the air and it's actually not the ability of your lungs to get oxygen into your blood
00:58:42
you're limited by the how hard and fast your heart can pump that blood through your body and how efficient your muscles are at taking the oxygen out and using
00:58:55
it and the difference between so again a 30 year old who's in the top two and a half percent of their age group might be at 56 57 but to put that
00:59:08
in context the guy who wins the Tour de France this year is 85. wow and by the way when that number reaches 20
00:59:22
or certainly 18 19 you have a hard time just getting around like you wouldn't be
00:59:27
able to walk up a flight of stairs that gives you a sense of the of the gradient now let's get to my point that answers your question you asked how can I say exercise is so
00:59:39
powerful well what do you think is the hazard ratio when I compare someone at the top two and a half percent to someone at the bottom 25 in terms of VO2 max yes
00:59:53
two percent versus the top bottom 25 bottom 25 that's quite big two percent is quite narrow um I'd say
01:00:04
1.1.5 which is what so you think it's less important than strength because we've just established for strength it's
01:00:10
about three so I'm just I'm increasing it now because I was so wrong on strength yeah you see what I mean uh
01:00:17
well what would I have said had you not told me the strength one so um by the way I think your guess is a completely reasonable guess because the answer is so absurd I'm gonna say 1.5
01:00:28
Hazard Hazard ratio it's five five which means 400 percent difference in all cause mortality if you compare the fittest two and a
01:00:41
half percent to the least fit 25 percent wow so it makes a huge difference so this is why I can say with absolute
01:00:52
certainty nothing compares to exercise nothing compares to having a high VO2 max High muscle mass and high muscle strength they are more beneficial for you than
01:01:07
any bad thing you can think of is bad for you why why the is the muscle mass piece so important and the strength piece why is
01:01:21
that causing me to stay alive I think there are several reasons as you get so there's there's I put them in two buckets structural and metabolic let's start with the latter
01:01:33
muscles are where you dispose of glucose so glucose regulation is one of the most
01:01:40
important metabolic functions of the body our ability to metabolize glucose and regulate glucose levels is Central to our existence on this planet and when we get it just a little bit wrong we go to
01:01:53
hell in a hand basket that's what type 2 diabetes is type 2 diabetes raging type
01:01:58
2 diabetes only means you have an extra five grams of blood sugar one teaspoon in your circulation that's it the difference between you and someone with type 2 diabetes so bad that they're
01:02:13
going to get their digits amputated is an extra one teaspoon of glucose in the bloodstream that's how critical it is that we regulate our blood sugar
01:02:25
and the most important part of blood sugar regulation is having muscles that are big enough to put the glucose into and that are insulin sensitive enough to respond to the signal of insulin
01:02:38
and glucose is stored in just a couple of places in our body it's only stored in the liver and in the muscles but the
01:02:43
muscles store 80 of it okay so okay so muscles are really really good for glucose regulation because it gives the sugar more place to hide that's right so the other reason muscle mass
01:02:56
and strength is so important is as we age fragility and Frailty become an enormous
01:03:04
liability in death there's a figure in that book that shows the mortality associated with falling and it becomes
01:03:15
catastrophic once you hit the age of 65. once you hit the age of 65 if you fall which is pretty likely and you break your hip or your femur the
01:03:28
long bone in your leg there's a 15 to 30 percent chance you will be dead within the next 12 months
01:03:35
really yes it's insane because you become set a dream yeah there's a lot of reasons for it but certainly a loss of function is a big one you can also just die as a result of
01:03:48
hitting your head you can die from a fat embolism or a blood clot you can die from sepsis you can die from you know
01:03:54
heart attack because you you know there's there's so many things that can kind of kill you in response to it but
01:04:00
even the people you know the 70 to 85 percent of people who don't die 50 of them will experience a significant loss
01:04:06
of function that never recovers after so this this issue of sarcopenia which is loss of muscle mass and Frailty and fragility become the you know the
01:04:22
absolute keeper of death for people once they reach the seventh decade of life again
01:04:28
if you're 30 years old it's impossible to Fathom this stuff because you're indestructible yeah yeah even at my age
01:04:35
I mean I feel indestructible and I'm 50 but this changes and we have to do all we can to Ward it off so that's why muscle mass matters so much
01:04:48
there's this kind of long-standing belief that you as you age there's so many just it's just kind of inevitable
01:04:54
you put on fat you know you slow down and you're saying and I think you communicated very clearly in the book
01:05:00
that it doesn't have to be inevitable all of this stuff to some degree well I mean look I I'm I'm very I'm very
01:05:07
careful to to try to be as realistic as possible I I get a little put off when I
01:05:13
see people in this sort of quote-unquote longevity space saying things that I think are just science fiction right
01:05:19
like oh you're at 90 you can be just as fit as you are at 40 and stuff and I I see Zero evidence that that's happening I don't see any biotechnology on the horizon that is going to completely and
01:05:32
reversibly change aging um yet I don't think In Our Lifetime no and this is something I spend you know an absurd amount of time on both as an
01:05:46
investor uh and and just as a you know a person who thinks about this from my own podcast and the types of guests that I
01:05:52
bring on and the type of science that I'm paying attention to but but no I really do not see anything in our
01:05:58
lifetime that is going to undo aging I think we have some ideas of places we can look right I think that for example if you could
01:06:11
completely restore the epigenome to what it looks like in a young State across the entire genome I think that could have a profound effect on function
01:06:24
but do we have do I see ways that we could do that I it you know it's a longer discussion but I think the complexity there is many
01:06:34
many decades away that said um what I think we do not need to do is accept the complete and total inevitability of Rapid decline so the
01:06:46
decline is non-linear this is the important thing to understand so what was your decline from
01:06:52
20 to 30. wasn't that bad no no and from 30 to 40 it's not going to be that bad from 40 to 50 it's going to be more from 50 to 60 it's going to be even more from 60 to 70
01:07:05
it's going to be way more and 70 to 80 is falling off a cliff so if you if you look at this is actually one of the figures I wanted to include in the book but you know you're always sort of scrapped for space so we
01:07:16
took it out but I have a figure that shows both muscle mass and spontaneous physical activity in people by decade
01:07:23
and it's just based on like a huge data sample of people and it's really interesting to watch the correlation how strong it is right so physical activity and muscle mass go like this and they
01:07:36
just fall off a cliff and the cliff for both is 75 for both men and women like that's where you see an enormous reduction in muscle mass and activity level because of Behavioral well I think it's
01:07:48
a you know it's the age-old question is are they losing muscle mass because they're becoming less active or are they
01:07:54
becoming less active because they're losing muscle muscle mass and I think it's both okay I think these two feed
01:07:59
off each other and um and they get haunted right presumably because what you said about the quality of the muscle as well that's
01:08:05
right so you have to Ward this stuff off right I mean as your type 2 muscle fibers are deteriorating and you're
01:08:12
putting more fat into muscle the quality of that muscle you go from being you know primed to wagyu so you have to Ward that stuff off right and the way to Ward that off is to
01:08:23
lift very heavy things that's the only way to stimulate the type 2 muscle fiber this type 2 muscle fiber won't get
01:08:29
stimulated by light movements so it's not just that resistance training is necessary but it's it's resistance
01:08:35
training that's actually quite heavy people who hear that they go okay they get it they're on board they're going to
01:08:41
exercise how much do I need to do because listen can it be is it I've got to change my
01:08:48
whole life in exercise seven days a week and run marathons now Dr Peter or is this what would you recommend I always
01:08:54
start this question by saying how much can you do but okay I'm gonna I'm gonna play devil's advocate here I'm gonna respond as one of my viewers right I'm gonna say listen I'm so busy you don't understand
01:09:06
Dr Peter I'm I've got kids I've got this I've got a job I'm already I already have no time I'm not sleeping out here
01:09:13
so I don't have any time I mean I I it requires a thorough discussion around that I mean is that really true no of course it's not yeah so then you have to get into the weeds
01:09:23
like how much time are you watching TV how much time are you on social media how much time are you doing things that
01:09:28
might not be um as high a priority as doing this other thing um so so once you kind of get through that I do I do sort of put put it on them and say I would much rather you
01:09:41
tell me the number than I tell you the number I can tell you what I think the number is right like if you're playing the
01:09:46
optimizing game and if you're saying I want to be the absolute best fittest version of me that is humanly possible when I'm
01:09:59
in my 80s how much do I need to be training for that the answer is probably one and a half to two hours a day one and a half to two hours a day seven days a week yeah
01:10:12
I mean of course it's not going to be the same every day and and it looks different but but it's going to average out to 10 to 14 hours a week
01:10:19
but but rather than tell somebody that because I think that's very off-putting yeah I would just say just tell me what
01:10:25
you got if you tell me you've got five hours a week that you can do this I'll give you
01:10:31
a great set of things you can do in five hours and My Hope by the way is six months from now you're gonna feel so
01:10:37
much better that you're gonna say you know what I would like to up this to seven hours a week
01:10:43
what's the difference in all cause mortality if I go from doing zero exercise to doing just a bit yeah that
01:10:48
that's a great question and for some people that question is all they need to get started
01:10:54
going from zero activity to just 90 minutes a week is about a 15 reduction in all cause mortality so I'm 50 less likely to to die in any given Year from
01:11:07
all causes if you go from being completely sedentary to just doing 90 minutes a week
01:11:13
which is only like what I know 15 minutes a day 12 minutes a day yeah or just you know three times 30 minutes a
01:11:19
week that's a huge that's a huge shifting of very important odds yeah and and truthfully like I probably spend more time convincing
01:11:32
people not on the all-cause mortality data but on the health spandex because people
01:11:38
don't we didn't think about it yeah death is so abstract it really I don't think it I don't think it even sets in
01:11:45
until you're in your 50s like I think it's very it's very hard to capture the finitude
01:11:53
of what it means to be a human when you're young I think it's true at all ages but but I really think
01:12:00
it's so much better to just focus on the quality of life you want to live what do you want to physically be able
01:12:06
to do throughout your life and it's easier in people who have been around aging people yeah you know which again a lot of people in their 30s their
01:12:18
parents aren't even necessarily old enough that they can fully appreciate it they might have to think well do I still
01:12:25
remember what my grandparents were like at the end of their life and was I inspired by them and if so that's
01:12:31
what I want to do great and if I don't want what they had which is the answer I think most people will have then what do I need to do to be different what was it for you I remember what it was for me
01:12:43
yeah for me it's again it's I didn't know my grandparents uh I suspect just my training in medicine like I was around so many people at the end of life that
01:12:57
like to see yeah it was it was just imprinted early my arm I told this story once or twice in this podcast before but I was in Bali walking down some a long set of stairs when I say alongside of
01:13:09
stairs I mean down the side of a cliff going down to canoe with my partner and I was walking down those stairs in the
01:13:15
sunshine it dawned on me that my father probably couldn't walk down these steps and my dad is maybe a 60 65 and I
01:13:23
thought he wouldn't be able to come down these stairs which means he wouldn't be able to go canoeing with his family and we share a lot of genetic uh information
01:13:30
me and my father of course so that was one of those real big moments and actually Jack who films the podcast he
01:13:36
he after I shared that with him he and we had some guests on the podcast um he shared with me his own moment where he was climbing a mountain I think
01:13:42
last month weren't you Jack and he he got to the top of the mountain and thought to himself God like it was
01:13:48
such an unbelievable experience for him uh he correct me if I'm wrong it was an epiphany moment you go I wouldn't be
01:13:54
able to climb this bloody mountain with all these people and feel this sense of accomplishment if I and it's those moments for me where I thought this
01:14:00
is that's my health span I want to be able to do this yes you wrote one of the chapters in your book is about stability um
01:14:07
found that really um surprising again I'd never even come across the concept of stability or why
01:14:12
it's important that's why it needed an entire chapter because it is a very foreign concept chapter 13 stability why
01:14:19
why is it important and what does it mean yeah I think this is this is the stability is a difficult thing to
01:14:25
explain I mean you can sort of talk about it technically right stability is the capacity to transmit force from the
01:14:32
body to the outside world and from the outside world back to the body without injury so anytime you're taking a step
01:14:38
you're applying Force to the ground that's what's allowing you to walk forward so
01:14:44
you apply Force to the ground the ground applies an equal opposite Force to you that's Newton's law and you move forward
01:14:50
um when you're running why are you going faster you're going faster primarily because you're applying more Force to the ground
01:14:57
and therefore the ground is applying more Force to you and that's propelling you forward the difference between me and Usain Bolt
01:15:06
among other things is his capacity to apply Force to the ground is two and a half times my ability to apply Force to the ground so in all that Force
01:15:20
how do you make sure that the action of the force mechanism is all for the desired purpose in this case propulsion and not for undesirable purposes like
01:15:33
leaking of energy which is what it feels like when your knee hurts when you're walking down the stairs or your hip or
01:15:39
something like that so the analogy I use in the book to describe this is that of a car because I
01:15:45
love cars and I talk about the difference between a race car and a street car a race car can be even half the power of
01:15:53
A Streetcar in terms of horsepower but because it's smaller lighter and has a stiffer chassis and slick tires
01:16:00
much more of its power is being delivered directly to the road without slippage or energy loss and therefore it's going faster and so this idea is a very important
01:16:13
part of aging so most people who have some sort of chronic injury it can really be traced back to an instability
01:16:20
whether it be an instability of their scapula and that's why they really have tennis elbow or an instability in the
01:16:28
you know in in their abdomen in their lower back and that's why they have back pain instability in the feet that
01:16:35
translates its way up into knee pain all of these things matter greatly and a big
01:16:42
part of how we train is making sure that we do exercises that bolster our stability again this feels very um relevant to me because I'm
01:16:53
currently got a Grade Three tear in my hamstring got a growing problem so I'm on physio for the grade three tear how
01:16:59
did you tear it um playing football but I have a couple of suspicions surrounding it because about a month before I got the
01:17:07
foot pain that they call plantar fasciitis plantar fasciitis so I went to the I think it's called a podiatrist and
01:17:13
I got my foot x-ray things done where they give you the insoles and then following that I got loads of injuries
01:17:20
um I think my hypothesis is that I took these insoles put them straight in and then proceeded to do two hours of
01:17:25
football basically running a day and I think something in me just broke because I suddenly got all these injuries and
01:17:31
then I was meant to be playing Old Trafford Manchester United's football ground in front of 70 000 people and the day before in training I got I pulled my
01:17:38
hamstring um and I and I and I think that everyone's been speaking to me about my
01:17:43
injury and saying well you know maybe it was something in your lower back and maybe this and maybe your feet weren't whatever
01:17:49
um kind of rings true to what you're saying about stability I clearly have something which is not wasn't wasn't prepared for me to suddenly start
01:17:55
training for two hours a day um and everything started breaking well and look I mean it's it's hamstring injuries are very stubborn
01:18:06
injuries um and a lot of people are really imbalanced right much stronger quads than hamstrings um my personal take is and I'm sure I'm going to really upset some podiatrists
01:18:20
here I think that um that insoles foot inserts uh arches arch support probably should be reserved only for some people and most people actually
01:18:32
need to learn to strengthen the intrinsic muscles of the foot and that that's the issue that's underpinning the
01:18:38
plantar fasciitis and once you have a Str Because by the way your foot is not that much different from your hand in terms of the amount of musculature in it and yet if you think about the dexterity
01:18:49
that you have with your hands and the strength that you have in your hands I think you'd be surprised at how weak
01:18:55
your feet are and I don't just mean you I'm not singling you out I think this is true for most of us because shoes really
01:19:01
Shield us so much from what our feet should be doing so um yeah I think I think your hypothesis is actually probably spot on and I think
01:19:12
what you really need to do is strengthen your feet so that your arches can can self-support
01:19:19
um and that you can sort of regain the springiness that is that is within your feet I spoke to Dr Daniel Lieberman
01:19:25
about this yeah yeah he said the same thing yeah he said your feet were too weak and it makes perfect sense to me because I do not think about I always
01:19:31
think in terms of my ancestors and I think my ancestors didn't walk in these cushioned blunts Yaga shoes they were
01:19:38
out Barefoot yeah building up the strength and so when I went from my cushioned balenciagas to suddenly
01:19:43
training two hours a day on feet that just didn't have the muscles of course I I pulled loads of I had all these issues
01:19:49
and so I actually changed my Footwear and I don't have the insoles anymore and I'm now using those Vivo Barefoot yep do
01:19:56
you recommend those do you think I do I really I mean again I think there's lots of companies that make them I wear a brand called zero like x-e-r-o
01:20:04
um and and but the Vivo barefoot's a great brand and I yeah I think that a minimalist shoe is a great way to go I I have the luxury of basically working from home so I'm pretty much Barefoot 24
01:20:16
7. I I work out Barefoot and my own gym like I I'm I'm in my and then when I do my activities like my rucking and stuff like that when I'm Outdoors like I'm you know I'm in a wide toed shoe that is uh
01:20:30
you know at most would have maybe an eight millimeter uh um increase in heel but yes minimalist
01:20:36
shoe now one thing to keep in mind is if you're transitioning from Big shoe to minimalist shoe don't do it all at once
01:20:43
so um you can also injure yourself in the right shoes if it's too much too soon they did say that to me when I bought them yeah they said just like sort of ease yourself in because you need to build up the muscles in your feet super
01:20:56
interesting no one's ever spoken to me about this before but um I just find it saying I'm like why did anybody tell me this I mean we do a
01:21:02
lot of things if you think about it like think of all the things we do to kids at such a young age that set them down the wrong path right like we put them in big
01:21:09
shoes when they're little we put them in desks to sit down in class and we take away a lot of physical activity Comfort
01:21:16
we prescribe Comfort to everything yeah convenience have you read the Comfort crisis by Michael Easter no oh man such
01:21:25
a such a fantastic book and it talks about this oh yeah I mean it's really the whole thesis of the book
01:21:31
right is that we have engineered discomfort completely out of our lives and uh it's a you know it's an enormous
01:21:39
problem both for our physical and mental health the answers are actually quite simple when you reflect upon it you go you know
01:21:45
how are we born to live we're so far away from how we were born to live and if I just followed more of
01:21:50
um the instruction manual of my ancestors maybe I wouldn't have all of these kind of you know modern issues with that comfort
01:21:58
in many many respects has caused me but it's tough because you have to sort of think about what is the
01:22:06
there are a lot of gifts that come from the modern world right and like I don't think you would want to go back in time 100 years and be alive I probably wouldn't live very long would I either yeah I mean and let's let's even make it
01:22:19
less than that like let's say even 70 years like you know once we're through the sort of infectious pandemic stuff right like what you know would we really want to go back and be alive 70 years
01:22:30
ago just before World War II I mean I I wouldn't like I yeah they had electricity and stuff but I I like the modern world but there's a huge set of
01:22:42
responsibilities that comes with the modernity of our world today food is so abundant today I mean these
01:22:48
people did not struggle with obesity because they weren't surrounded by really tasty hyper hyper palatable
01:22:55
calorie dense food in total excess we are that means we have to exercise some moderation most of them had far more physical jobs than you and I do
01:23:06
I mean you and I don't have to lift a finger to make a living whereas 75 years ago we probably did
01:23:15
and it's great that we don't have to I think you could argue look you're having a far bigger impact on the world than you would have ever had 75 years ago but
01:23:22
that comes with a responsibility to yourself is this one I was seeing this sort of resurgence of discomfort as a
01:23:28
hobby and a sport in an industry I think so yeah I I think so and and again Michael writes about this so
01:23:35
um so well you know they write about he writes about things called musogi's which are these very very difficult
01:23:40
challenging things that you might have yourself do once a year um he also writes a lot about something
01:23:47
that is just an enormous hobby of mine called rucking have you are you familiar with rucking so rucking is something
01:23:54
that I I think it was probably started by the military and it's really how the military does the great majority of its
01:24:00
conditioning and it's walking with a weighted backpack um and I mean the military will do this they might go on a 24-hour Ruck where
01:24:11
you're carrying half your body weight so picture you carrying in your case right like close to a hundred pounds on your back for a day and
01:24:23
um so there's actually an awesome company in the U.S called go rock that makes really good rucksacks that are just ergonomically designed to put weight plates into and then they sell
01:24:35
these plates and stuff so I mean this has become a total Obsession of mine so I rock three or four times every week
01:24:42
and luckily where I live in Austin Texas it's incredibly hilly so it's just up and down up and down very steep hills and I'll go anywhere from you know 50 60
01:24:54
pounds on some days I'll really push it and go up to a hundred uh for shorter rucks and you know I'm only doing it for
01:25:01
like an hour at a time but we it's very hot where I live in the summer so it's just it adds an extra layer of discomfort but it's great yeah because I don't know whether it was
01:25:12
just what the circle I'm exposed to in the information I'm exposed to but it just seems like all of these Ultra athletic you know painful long distance
01:25:21
um Sports have become super popular the Spartans of the you know I actually just recently invested in one
01:25:27
um because of this very reason because I'm seeing this Comfort crisis and I always think that when there's one one pole Rises the other one Also Rises so
01:25:34
when digital music record you know old school vinyl records became big and I think in a world of comfort people are
01:25:39
going to seek out extreme discomfort and it sounds like you're doing that with your rucking yeah if you've been
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listening to this podcast over the last few months you'll know that we're sponsored and supported by Airbnb but it
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01:25:55
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01:26:02
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01:26:09
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01:26:22
that's airbnb.co.uk slash host sugar is it an interesting topic because it's really been demonized I think and may maybe rightfully so but um I wanted to talk to you about sugar
01:26:35
because it's actually been really front of mind for me lately and when I say A little I mean literally in the last 48 hours I'm I went away to a a wedding
01:26:44
um and I remember they didn't have a lot of drinks so I was opting for the sugar-free drinks the things that say no
01:26:50
added sugar in them like you know I won't name the brands but the ones that have zero and diet on them
01:26:57
first question is is sugar the devil as people have become to tell me and also if I'm drinking these zero drinks with the diet and the zero on it am I in the clear
01:27:10
this is a very complicated topic and I think it's one that's also very contentious and it's also one in which I've probably
01:27:20
my thinking has probably also evolved as as as the science I think has kind of evolved so
01:27:27
let's start with what I don't think anybody disputes I don't think there's any anybody out there thinking that high
01:27:33
sugar foods are somehow nutritious right that's not the question at hand the question is
01:27:40
calorie for calorie is sugar somehow different from let's just limit it to other sources of carbohydrates so what is sugar so I'm assuming when
01:27:53
you're talking about sugar you're talking about sucrose or high fructose corn syrup those would be the two dominant forms of sugar but just to
01:28:00
demystify it sucrose which is the white powder you would put in your coffee or tea that's just one molecule of glucose
01:28:07
and one molecule of fructose stuck together that's table sugar and if you contrast that with pure
01:28:14
glucose so like eating rice is basically pure glucose it's going to be broken down into pure glucose how different are
01:28:22
they well obviously the thing that differentiates them is the fructose that's the thing that's different now
01:28:27
it's true that fructose has a very different Pathway to be metabolized the body breaks down fructose in a very different way from the way it breaks down glucose and by breaks down I mean
01:28:39
it gets energy from it the whole purpose of eating is to make this thing called ATP ATP is the currency of life it's the
01:28:48
currency by which energy is transmitted throughout the body and the way we make ATP out of glucose
01:28:53
is I think I can probably say this smarter than the way we make it out of fructose the way we make it out of fructose has a
01:29:05
problem a slight problem now it doesn't really matter if you're not consuming a lot of fructose
01:29:11
but if you're consuming fructose in a liquid form it has a real problem I.E if you are drinking sugar there's a real problem and the problem is this when you make
01:29:24
ATP out of fructose you temporarily deplete the cell of energy to the point where more energy is needed this is just a consequence of the speed
01:29:39
at which we metabolize fructose we do it quickly all the time in this way but if you're eating an apple for example it's not really an issue because
01:29:51
yes the Apple has fructose in it but you know it's not that it's not that much and you're eating it so it's it's a piece of solid food with fiber and water that's taking a long time to exit your
01:30:03
stomach but if you drink a big glass of apple juice well I mean first of all that's much
01:30:10
more fructose and it's liquid and it's just going straight out of your stomach and your liver is going to encounter it
01:30:15
much sooner as is your gut and therefore you're much more likely to want to eat more after in other words it creates more of a hunger response
01:30:27
so the real issue with sugar is calorie for calorie is it more damaging than just glucose I actually think the answer to that question is probably not really yeah but
01:30:41
in the real world is that possible in other words if I put you in a metabolic ward in a hospital where you had no control over what you ate other
01:30:53
than me putting it in front of you and I gave you two different diets and one was
01:30:58
higher in fructose than the other I'm not convinced it would make that much of a difference it's possible it would if we went to extremes you know maybe at a high enough
01:31:09
fructose level we might actually induce more fat production in the liver we might actually create some fatty liver
01:31:15
disease maybe even drive insulin resistance um but I might have to go pretty high on
01:31:21
that but the real problem is if I just let you have as much fructose and sugar as you
01:31:27
wanted you'd probably end up overeating in response to this energy depletion thing so I don't sort of describe myself as like a hardcore sugar avoider I mean
01:31:42
like we're here in London and I mean I'm gonna have dessert probably most nights
01:31:48
right I'm on vacation um but I also acknowledge it that it's you know like not something that I want to be eating on a regular basis you know just added sugar all the time
01:32:04
um I don't drink sugar sweetened beverages that's definitely a place where I draw a
01:32:09
line so I think there's something about liquid sugar that is more problematic than solid sugar
01:32:15
um so I'd rather eat my sugar and at least have the benefit of it being more slowly absorbed than drink it um what's always diet drinks though yeah
01:32:27
so I look I don't drink them personally very often um and in part that's I think due to
01:32:38
a little bit of uncertainty I think we still have about their impact on our metabolism through our gut
01:32:45
I think there's I think there were emerging data that suggests that at least certain non-nutritive sweeteners like things like
01:32:58
um well in the U.S it's like NutraSweet I think it's Aspartame is the underlying agent
01:33:06
or saccharine or sucralose I think there's some some suggestion that the effect that they have on the bacteria on your gut
01:33:17
might be detrimental to your health I think it's too soon to really say that but my view is
01:33:24
don't take the risk well I don't need to I suppose like I'm I'm I love soda water
01:33:30
like I love carbonated water so I'm just happy to drink that but I'm sure once a month I'm gonna have a Diet Coke or
01:33:36
something but it's not a regular thing but I but I will say this when I see people who are struggling for example
01:33:41
with weight loss and they're drinking four Diet Cokes a day one of the first things I'll do is have them stop completely and replace that with just water or sparkling water why
01:33:52
uh I'm not sure I I just empirically have seen even though they're not getting any calories that a either it's
01:34:00
impacting their eating behavior when they're not drinking the coke uh or maybe it's having some negative impact
01:34:06
on their gut that is that is impacting the way they're metabolizing their food this is this is rather unscientific at
01:34:13
this point but it's just empirically is something I've observed everyone cares about weight loss it's such a big topic everyone wants to
01:34:19
lose weight I mean as you clearly um specify people want to lose fat they don't want to lose weight people want lose fat which is something I heard you say um what are the the biggest misconceptions in your mind about weight
01:34:32
loss because but I guess the narrative is to lose weight you kind of you just need to eat less that's kind of the
01:34:39
is that true and what are the big misconceptions that you hear that we need to overcome yeah I think that is
01:34:44
largely true I think that um eating less uh is the the more important step towards weight loss um and that the role of exercise is
01:34:56
important but less because of just the straight number of calories you burn in other words the increase in energy that you expend through exercise is usually
01:35:07
offset by increased appetite you use the word calories there yeah contentious words sometimes it shouldn't be people people come and come on this podcast and told me that
01:35:17
calories are like the concept of it's kind of like a lie in the sense that they're not all even some cat you know a
01:35:24
stick of celery has this many calories and then when you boil it has this many calories and it's well yeah I think people tend to
01:35:32
get a little off in the Weeds on stuff that that might not matter that much um yeah it's certainly true that not all calories um are absorbable the same way and an
01:35:43
example of celery is a pretty extreme example because so much of celery is um an insoluble fiber right so most of the mass of celery is water and insoluble fiber there are virtually no
01:35:55
calories in celery um but at the end of the day it's not rocket science to figure out how many calories you're ingesting in a certain amount of food and the truth of it is if
01:36:07
a person wants to lose weight as you said what they really want to do is lose fat Mass there's I've never met anybody out there who says I want to have less muscle so we want to have less fat and
01:36:20
therefore we have to create an energy deficit um now there are other elements to this
01:36:26
that matter so we don't we just want to leave on the side that if you're sleep deprived you're going to be very insulin
01:36:33
resistant it's that's a much easier path to being overweight not sleeping not sleeping right so you
01:36:40
you can't correct a weight problem without correcting a sleep problem what about a stress problem yep that's even
01:36:47
harder to correct because it's harder to measure but yes hypercortisolemia high stress
01:36:52
makes it very difficult to lose weight my partner said this to me this weekend she was trying to figure out how in one
01:36:58
stage of her life when she was in her words eating very very healthy food she says I still wasn't losing weight and
01:37:04
she she hypothesized in the car as we were driving that she thought it might be to do with her stress levels at that time in her life and I remember thinking
01:37:11
oh that's an interesting hypothesis yeah so high stress poor sleep inactivity all of those things will make it very difficult to lose weight even in
01:37:22
the presence of whatever perfect diet you're on so those things have to be addressed right you have to be sleeping well you have to be active because activity increases insulin sensitivity
01:37:34
and we want those muscles to be sensitive to insulin so that they quickly get glucose out of circulation
01:37:40
and also exercise increases the sensitivity of your brain to what are called satiety hormones the hormones that tell you when to stop eating so and and the difference between an
01:37:54
exercising person and a non-exercising person uh is that that non-exercising person has a blunted response to those hormones so sometimes they're eating
01:38:05
when they don't need to be eating they're not getting the message that says we have enough nutrition on board
01:38:11
now anybody can blow through that signal but I would like to know that that signal is there
01:38:16
so when all of that is said the question then becomes how do you create an energy
01:38:22
deficit and basically there are three ways to do it there are three strategies to create an
01:38:29
energy deficit I'd describe them as CR Dr TR so that stands for calorie restriction dietary restriction and time restriction
01:38:42
so let's explain them okay so calorie restriction is what it sounds like just eat less that's the most direct way to go about doing this so you know I gotta eat 500 fewer
01:38:55
calories a day and I'm gonna have to track what I'm eating and count my macros and make that happen Okay that has the advantage of being the most
01:39:05
direct way to do this but it has a disadvantage frankly of being harder to do in some ways you have to pay the most attention to it it also has the advantage by the way of being
01:39:17
pretty flexible and agnostic to what you eat so you know there are certain foods you
01:39:23
like there's no food that's off the table when you're doing calorie restriction it
01:39:29
provided you're eating less overall got a friend that said this to me he said it doesn't matter what you eat just
01:39:34
restrict the calories remember thinking that was strange advice because he was like you can have Domino's Pizza every day you just if you'll lose weight if
01:39:40
you have less calories that's right now the problem is he's absolutely right but the problem is
01:39:46
it can be very difficult to not suffer through calorie restriction if you're just eating crap
01:39:54
because the body still at the end of the day keeps score with respect to nutrition
01:40:00
and the body still wants protein the body still wants nutrients the body still wants vitamins minerals so if you
01:40:08
say look I'm going to eat 2 000 calories a day a Cadbury's you might lose weight but you'll
01:40:14
probably be in purgatory along the way and you certainly won't be healthy so we also want to make sure we're not
01:40:19
confusing health and weight here now we come to dietary restriction dietary restriction is what most people
01:40:24
think of when they think of a diet this means as I described in the book you know pick
01:40:30
your favorite Boogeyman or two and just cut them out of the diet so basically everybody that's arguing
01:40:36
about their perfect diet is arguing about dietary restriction so you want to take out carbs you want to take out
01:40:42
animal products you want to take out everything but meat you know it's a carnivore diet you want to go South
01:40:48
Beach paleo Mediterranean those are all just forms of dietary restriction and generally speaking the more restrictive you are in the diet the less you will
01:40:59
eat so I mean it's I don't think it's an accident that people who go on a carnivore diet typically lose a ton of
01:41:05
weight same is true of a ketogenic diet I did it yeah my scales it was like this
01:41:11
this was the it was a it was a horizontal line my weight maybe a little bit up and then I did keto for eight
01:41:17
weeks and it was a vertical line down every time I hit those scales and the Bluetooth thing sent to my weight to my phone this vertical line down I lost a
01:41:24
stone in the space of those eight weeks roughly my girlfriend was like stone is 16 pounds something like that yeah eight
01:41:30
kilos 14 step what do they go from 14 Stone 5 to 14 Stone 8 to 13 stone eight yeah which I think yeah and were you hungry
01:41:42
um I couldn't sustain it easily I'd say that because if we went to restaurants and stuff I was always trying to get like taking corn out of it like taking the wrap off a burrito and stuff and
01:41:53
um whatever else um was I hungry after I got past the first week I wouldn't say I
01:41:58
was hungry no but I also didn't find it sustainable because of honestly because of the nature of the modern world where
01:42:04
it's so hard to find those things when you're living a very fast-paced life hungry for some kind of nutrient maybe I
01:42:11
think there was some kind of psychological calling to go back to work to my previous diet and then I went to
01:42:16
New York and that's when it fell down and then did you regain the weight or what happened oh yes
01:42:22
oh yes just as fast as I lost it I went from this keto diet to the New York diet and it was so extreme how quickly I put
01:42:28
that weight back on again um just being honest yeah well it's interesting right so I again it's a very
01:42:35
extreme diet and I think you know people are gonna definitely lose lose weight on it and and look for some people it's
01:42:40
easy to sustain for others it's not um but nevertheless that's dietary restriction and again I think the advantage of dietary restriction is you're not being restricted in the
01:42:52
amount you eat you're just being restricted in what you eat and um The Challenge then really comes down to the craving of certain types of foods so obviously on a ketogenic diet you're
01:43:03
going to really crave carbohydrates um yeah so the final strategy is time restriction and people call this intermittent fasting as well but it's basically saying all right how about I
01:43:16
create a smaller window in which I eat so I'm just going to allow myself to eat you know from noon to 8 PM or 2 P.M to 8 PM or 2 P.M to 6 p.m and the narrower
01:43:29
and narrower you make that window the more likely it is that you will induce a significant caloric deficit and
01:43:36
therefore you will lose weight what do you think of fasting G fast not anymore uh at least not deliberately uh I mean I
01:43:43
sometimes end up fasting just by the nature of whatever I'm doing but um again fasting has a lot of advantages
01:43:49
it's conceptually the easiest by far I think it is just the easiest to execute on and because for most people it's just
01:43:56
easy to not eat for a period of time and then have no restriction when they are eating um I think the biggest challenge of
01:44:02
fasting comes down to protein intake and protein is in my view obviously I write
01:44:07
about this in the book The most important macronutrient the one we need to be paying the most attention to and
01:44:13
when you are intermittently fasting it is very difficult to get the right amount of protein in and in the right Doses and therefore it's the most
01:44:24
difficult to maintain muscle mass and we always have to remember that you know if we're losing weight we still
01:44:31
want to be able to maintain muscle mass we want to just lose fat mass and not lose both I'm fasting as we speak
01:44:39
um I haven't eaten today yet and it's I think it's just after six the reason for that is because before this podcast I
01:44:45
realized that if I eat before I have a conversation my brain doesn't work it feels like and I'm having spoken to
01:44:52
some experts the energy rushes to my gut so I can't I can't speak as well and I can't think as well so I ordered the
01:44:58
food just before you got here and then I said to my sister I can't eat it and within an hour of you so I'll eat it
01:45:04
after but yeah and the health benefits are one thing but the cognitive impact as well has been quite quite big for me
01:45:11
um so you don't fast no no I used to fast a lot I mean I used to do days and days at a time alcohol another thing I wanted to talk to you about I'm thinking of quitting
01:45:23
what is the um what is the advice from a doctor like yourself about alcohol and do you drink I do
01:45:30
it's a very interesting topic so I and it's so long that I I don't want to I don't want to spend another hour on this because I'm sure that's not the answer anyone is looking for I will say this
01:45:41
um alcohol ethanol which is the alcohol we drink is toxic um its toxicity is non-linear so its toxicity kind of goes like this meaning at low levels it's just a little bit of
01:45:54
an increase but the more you drink the more it becomes toxic so um you know for most people there's not an appreciable amount of toxicity at one drink a day but you know two three
01:46:07
drinks a day starts to become quite toxic but there is no dose of ethanol that is
01:46:13
helpful so the question becomes why is there so much epidemiology out there suggesting
01:46:20
the benefits of modest alcohol intake so there's this thing in the alcohol research field called the J curve the J curves a picture A J curve for all cause
01:46:31
mortality it means that at total abstinence mortality is here but as you drink a little bit the mortality goes down before it really Rises sharply as
01:46:43
you increase the drinking that's what the epidemiology shows and it goes down well again epidemiology is fraught with many limitations especially epidemiology
01:46:54
of nutrition okay it's much worse than the epidemiology of say exercise or infectious diseases
01:46:59
and proponents of alcohol argue that and they might be right to some extent that there are some pro-social benefits of alcohol alcohol at least in the form of
01:47:11
red wine is also potentially something that comes with some antioxidants and things of that nature
01:47:17
my view is that that literature is highly flawed and that that literature is confounded by a negative survivorship
01:47:25
bias and it's confounded by the fact that net that non-drinkers often have a health reason for being a non-drinker and in other words there are people who are completely not drinking because of a
01:47:40
health reason that's forcing them to be not drinking and people who drink and die as a result of it dilute the pool of data that we have of the toxic effects
01:47:53
of alcohol As Time Marches forward so it's a long-winded way of saying I think anybody who's thinking about not drinking should absolutely engage in that there's no health benefit to be
01:48:05
drinking um you asked me if I drink the answer is I do um but I don't drink if it sucks like in other words there has to be a good reason for me to
01:48:17
drink so my my sort of Mantra is don't drink on airplanes like they always just have crap alcohol what's the point right
01:48:24
like if I'm going to drink if I'm gonna have a glass of wine it has to be really good I don't have a hard time opening a bottle of wine that I
01:48:30
bought and deciding actually I don't like it that much and pouring it down the sink I'm not gonna drink it because it's there
01:48:36
um so that's that's kind of how I think about it now there are a couple of rules I think that make drinking less
01:48:43
toxic so rule number one is really try not to have more than one drink in a day and definitely not more than two
01:48:51
the hard rule there for me second is I do not want to be drinking more than three hours or less than three hours before bed in other words I do not want alcohol to
01:49:02
negatively impact my sleep which it has a devastating consequence of my sleep so if I'm going to drink I want I'd rather
01:49:08
have a cocktail early than drink into the wee hours of the night sleep's really important to you isn't it for sure super important to meso and life-changing this little weep thing
01:49:18
yeah yeah I see that I've actually changed my life and you've probably noticed how your whoop score changes
01:49:23
with and without alcohol and it's all flashing red and it's the first time that happened I had one glass
01:49:30
of wine and I woke up the next day and my my Vital Signs my heart rate variability was flashing red and it
01:49:35
literally says did you have a drink last night it changed my life yeah it changed my life forever and honestly I'm
01:49:41
absolutely obsessed with sleep in a very healthy way some people think oh that's you know you might be waking up and feeling bad no I look at it and if I've
01:49:47
not slept well I'll adjust my day accordingly um you share some stats around sleeping
01:49:52
in the book what are what it what is the stat or the two stats that changed your
01:49:57
perspective on sleeping or that really you would you would tell someone if you're trying to convince them of the importance of sleep
01:50:03
it's so interesting I'll tell you it's not even a stat I think it's more of it almost goes back to the type of
01:50:09
discussion you'd have with somebody like a Daniel Lieberman right thinking about this through the lens of our ancestors so
01:50:15
um I I was always someone who de-prioritized sleep um you know very busy person uh high energy didn't really seem to need that
01:50:28
much of it even in high school uh was sort of always go go and um you know at one point I was sort of having a discussion with a with a colleague about sleep and I was making the argument that like I didn't really
01:50:41
need any of it you know and um I almost you know made a point like it's almost a shame we can't just work our way out of it and he sort of posed to me in a very Socratic way
01:50:52
well you know given how evolutionarily unwise sleep would be right you are unconscious for a third of your life and
01:51:05
me we know that our ancestors slept on an average of about seven to eight hours every 24 hours they didn't do it always straight away but we know that they're sleeping basically a third of their life
01:51:18
um that's a time when you can't forage for food you can't defend yourself against predators you're not mating like
01:51:25
there's nothing from an evolutionary perspective you're doing those are the three highest priorities of evolution and you're not doing them why would
01:51:32
Evolution have kept this thing around like and by the way why has no species figured out a way out of it
01:51:39
and I think through that lens I was sort of like huh yeah interesting maybe this thing does
01:51:45
matter so in some ways I think that's probably one of the most powerful things that you can hear
01:51:51
um and sure there are lots of statistics about how fragmented sleep broken sleep
01:51:56
or short sleep can increase your risk in particular of cardiovascular disease and dementia I think there's a less clear
01:52:03
relationship to cancer but I think the relationship is quite clear to cardiovascular disease and dementia in
01:52:09
addition to insulin resistance and obviously therefore weight gain so for people even if you're just coming at
01:52:14
this through the lens of of of weight or or excess body fat I mean that's probably motivation enough for many people and then of course there's how you feel and how you perform and your
01:52:25
creativity and your ability to articulate yourself which I notice in your mood huge one for me especially
01:52:30
when you're running teams unslept days in my worst days um the last thing I wanted to ask you about was just again a conversation I've
01:52:37
had with my friends recently when I say my friends I mean this group of my five best mates and different voices in in
01:52:43
the group about hormone replacement therapy and one of my friends in particular is very keen on it he says
01:52:49
that when we get older we should all take I think testosterone I think it's trt um because it will help us in all these
01:52:55
different ways and I've sat here and spoken to people about menopause as well and um the hormone therapy you can take when
01:53:01
you when you go through menopause what is your position on on taking these um hormone replacement therapies to improve our Health span and our emotional state Etc
01:53:14
yeah I think um it's a long discussion but I have a lot of podcasts on this topic because I think it's so misunderstood um you know we have a lot of data on the
01:53:25
use of testosterone replacement therapy in men and while I think it is generally over prescribed and I think generally at
01:53:32
least in the U.S men are receiving trt far too early in their lives um I think the the data for responsible use
01:53:42
of trt uh are very positive so uh the risk uh you know again historically the risk would be increased risk of prostate cancer increased risk of heart disease
01:53:53
those have not borne out again at physiologic doses a very low risk proposition that comes with many benefits uh most notably of course being benefits of body composition but also
01:54:06
insulin sensitivity um I think the cognitive benefits are a little more controversial not entirely
01:54:12
clear that testosterone replacement therapy preserves cognition as we age but it hasn't been studied perfectly so it's I think that's a bit of a TBD as far as estrogen and progesterone
01:54:25
replacement therapy or hormone replacement therapy for women I think this is unfortunately a very controversial topic that shouldn't be uh
01:54:31
I think it's anybody who's really scrutinizes the literature here as opposed to just chooses to believe what
01:54:37
they were told um has to come away believing that it's a net positive for women especially women who are symptomatic right so women
01:54:44
who are having hot flashes and night sweats as they're going through menopause they benefit enormously from
01:54:49
hormone replacement therapy and in the case of HRT for women the estrogen is so important as it protects their bone density so women really go through this risk of osteopenia and osteoporosis when
01:55:03
they go through menopause because their bones get weaker in response to estrogen loss so being able to restore that is is
01:55:09
so important and then of course you have all of the sexual side effects of menopause as well that are ameliorated
01:55:15
by estrogen another thing that hasn't been yet completely well studied but I think
01:55:21
is becoming increasingly of interest in the United States is the use of testosterone replacement therapy in women as well so most people don't
01:55:28
associate testosterone with women but it's actually a very interesting statistic that women have 10 times more
01:55:34
testosterone in them than they do estrogen it's just that estrogen is the dominant hormone for their sexual characteristics
01:55:42
so we mostly just think about their estrogen and progesterone but we should never ignore their testosterone because
01:55:48
a it's ten times more abundant than their estrogen even though it's 1 20th as abundant as it is in a male
01:55:56
but it still plays an important role in muscle mass mood and libido and sexual function orgasmic function all sorts of things so we think a ton about all of these hormones in our patients and um
01:56:10
I think um you know you just have to make sure that if you're going down that path you're doing it with a doctor who really
01:56:17
understands it because there are some real big mistakes that can get made especially in young men who end up on a
01:56:23
high dose of testosterone and they haven't been told that hey by the way you know a couple years into this if
01:56:29
you're on a high dose of testosterone you're going to lose the ability to make your own and you're not going to be able to make
01:56:35
sperm either really you can imagine imagine being 30 having you know some Doc in a box puts you on a boatload of testosterone and then when you're 35 you're like yeah I think me and my wife
01:56:47
want to have kids and you're like nope that's not happening wow so there's one has to be one has to know what they're doing because there are ways to give other hormones that
01:56:58
preserve fertility and things like that I'm super scared of all this stuff you know I'm super scared of messing with the chemical balance of my body uh it's
01:57:04
my default is is I don't even take like what you call it like penicillin if I'm if I have excruciating pain somewhere in
01:57:10
my body I won't take any medicine because I'm because I always ask myself the question what's the cost there's always a cost somewhere and I don't
01:57:16
think we think about that enough and one of the things obviously happening at this chapter of my life is my hair is going to recede
01:57:22
and I'm watching as my friends will battle this in their own ways some of them are doing the testosterone shampoo some of them are taking pills for it I
01:57:29
am I've surrendered it's going back I don't care because I'm too scared to mess with my chemicals I don't want my libido to go I don't want to not be opportunity actually I'll just share one last interesting story with you so there
01:57:40
is um the most common drugs that are the most common pills that are used for treating that are called five Alpha
01:57:48
reductase Inhibitors so again I don't know what their names are in the UK but in the in the U.S the two drugs are
01:57:55
finasteride and dutasteride for receding hairlines yeah okay so these are drugs that block the conversion of
01:58:02
testosterone to a more much more potent Androgen called dihydrotestosterone DHT so testosterone gets turned into DHT by an enzyme called five Alpha reductase DHT is the hormone that's driving hair
01:58:16
loss so understandably if you take a drug that blocks that enzyme you will make less DHT you will have less hair loss um and these drugs do work but
01:58:30
a relatively small but not insignificant number of men who take these drugs have awful side effects and the scariest part is it
01:58:43
appears that a subset of those men do not lose the side effect even if they stop
01:58:49
taking the drug and the side effects are very sexual right so these are you know
01:58:54
difficulty achieving orgasm loss of libido um and and you know so it's a very controversial topic um but I think it's something that we definitely want to make sure men are
01:59:07
aware of when they're taking high doses of these hormones that is exactly why I'm not taking them
01:59:13
that is exactly why I'm not taking them I'm just always scared I have that default man messing with the chemicals in my body there's no free lunch in life
01:59:19
is there your book is amazing um your book is really really amazing um very very comprehensive you took many
01:59:26
many many many many many many many many years to write it and it's really an amalgamation of all of your insights
01:59:31
your podcasts your your Genius and your lived experience and your perspective it's a wonderful wonderful book that I highly recommend anybody who's
01:59:38
interested in the subject map we've talked about today going goes and gets there's so much more that we could have talked about in there
01:59:44
if anybody wants the more and more detail and all the stuff we've talked about the book is the place to go we
01:59:49
have a closing tradition on this podcast where the last guest leaves a question for the for the next guest not knowing who they're going to leave it for
01:59:55
um and I don't get to read it until I open the book so the question that was left for you by Our Last guest they don't know who they're leaving it for so
02:00:02
um this is also the longest question I've ever seen in this new age of AI when Humanity has logic machines that will outlogic humans how
02:00:17
are you going to help Humanity lead with love what is your purpose as a human in
02:00:25
a world where AI is contributing to life hmm I think my answer is going to be very uninteresting because I have relatively
02:00:37
low um expectations that my life will matter that much in the new world so I think that the most important impact I will
02:00:52
have is on my kids I think this is probably more about the world my kids will inherit and therefore I think the most important thing I can do is ensure
02:01:03
that my kids are um as well adjusted as possible um and as curious as intellectually curious as possible and so whatever I
02:01:15
can do to sow those seeds is probably going to have a better impact on the humanity of the world than anything I would do
02:01:25
thank you thank you so much thank you for writing this book and taking giving me so much
02:01:31
of your time I really really appreciate that and you've helped me to answer some really important questions in my life that are genuinely really really important and obviously my job then is I
02:01:38
go on and do this podcast forever and I'm going to continue to harvest all of that wisdom and share it with everybody and and take that forward so thank you
02:01:44
so much for your generosity there um it's an amazing book you have a great podcast as well highly recommend everyone can check this book out outlive
02:01:50
by Dr Peter an amazing book thank you so much thank you very much really enjoyed it
02:01:56
[Music] I'm someone that understands probably from doing this podcast the importance
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