This is Jackal podcast number 392 with Gary Hilton and me Jocko willing good evening carry, good evening.
The truth is we died together once
before.
We died together once before. So says, the character Thomas, she'll be in the series peaky. Blinders, he's speaking of himself and his brothers who had served as British soldiers in World War one. He and his brothers Arthur and John as well as three of their friends. Danny whiz-bang Jeremiah and Freddie Thorne
We're in the field and they were cut off from the British retreat.
As the British left, the battle they couldn't get away.
They had no bullets left.
They were simply waiting for the Prussian Cavalry to finish them off.
and while they waited,
they decided they should sing the old hymn In The Bleak Midwinter
And they waited to
die.
But in the end, they were spared.
For whatever reason.
Fate, or Providence, or chance, or destiny. The enemy never came, and so they lived.
And Thomas Shelby says, at the end of the story that we all agreed.
Everything after that was extra.
Bonus and that attitude.
That perspective permeates in the way that the Shelby Brothers lived.
and the way many veterans live after War, this is something that war can do to a person if you've
Accepted death, then the rest is all extra.
It's all a bonus.
And so, how do you live? What do you do? Are you taking risks?
Reckless risks. Are you taking advantage of every second that you have or you living to honor the ones who didn't make it home?
Or are you guilt-ridden that you did make it home?
Are you trying to remember or you trying to forget
Are you trying to leave a mark?
Or just trying to leave.
I've seen some of my friends. Do some of those things.
Or all of those things, I've done some of those things.
That's War.
My friend, Peter attia told me a story once I have probably more fitted in my mind over the years.
but it was something like this, he was an, ER, doctor at the time of this story and there was a teenage girl who was brought in by her mother,
And this teenage girl, head broken up with her boyfriend or experienced some other kind of adolescent trauma.
And she tried to kill herself by taking an overdose of Tylenol.
And some time had passed and the young girl realized that this wasn't that smart and she didn't want to die. And so she apparently told her mother and her mother had brought the girl to the hospital where the girl's mother politely told Peter the ER doctor.
What happened?
I can hear the conversation in my head, you know, the kind of casual, ho my daughter. She broke up with her boyfriend and, you know, she took a bunch of pills and, and I think she probably just expected Peter to pump her stomach or give her the antidote or give her an IV or give her an injection of something, or perform whatever, simple routine, medical procedure that would resolve the issue.
And then the girl and the mother could carry on Happily with their lives. Having learned from this little innocent naive Mistake by this young girl.
When Peter asked some questions, he did some math in his head.
And realized based on how long it had been since she had entrusted ingested, the drug and how much she had actually taken as he ran that math in his head. He feared it would be too late because with Tylenol there's a certain point of absorption in the blood.
We're too much has been absorbed.
And the liver is poisoned and the liver fails in the body breaks down.
And you die.
And there is no procedure.
And so Peter quickly ran the necessary tests.
And his fears were confirmed.
But was too late.
There was nothing he or anybody else could do.
She was going to die.
I've thought about that story a lot.
From the girl's perspective from the mother's perspective from Peters perspective.
And I think about that story and how it relates to my own experiences with death, which because of the war, those experiences have been too often and too close.
And I wonder sometimes, do we realize the value of life when we have it?
Doesn't encounter with death, bring fear, or does it bring comfort?
And what do we do? And how do we act when we realize it's all going to end?
because,
It is all going to end.
For everybody.
There Is No Escape. No one gets out of here. Alive days, months minutes or years.
We don't know how much time is left, but the clock is ticking.
Like Thomas, Shelby and his brothers. We are all caught off from the retreat.
We will run out of ammunition.
And we will be waiting for time to come and finish us off.
In The Bleak, Midwinter.
Now strangely or I don't know, maybe not so Strangely I fought about all of this as I was reading Peter's new book. The book is called out live.
Much more positive title, then the subject matter. I just addressed, but it's a book that should be required reading for everyone in and really it is it at least touches upon or borders upon being a textbook, a textbook where Peter does his best to teach us. What he's learned about health and about happiness and about disease and diets and
Eggs and about life, and about death.
And Peter's been on this podcast before I think it was 2016, episode number 56. And there's a privilege to have my friend Peter back here again to discuss well, the discuss, all these things. So, Peter thanks for coming. Thanks for coming by.
Thank you for having me back.
In The Bleak Midwinter, how close am I on that
story? One small detail off one large detail off and the large details, a good one to be off on. So I wasn't the ER, resident. I was the surgical resident. So I wouldn't have been the first person they encountered but the good news is she was one of the lucky ones in that. While her liver did fail, we managed to get a liver transplant for her in time. Oh, she lived, she lived all that wrecks. My holster. It actually makes my story.
The ending it does. But it's, but it's the same point because I was the first person that she saw when she woke up. So, most people in that situation died because the liver, unlike other organs in the body, you don't have a way outside the body to support it. We call that extracorporeal support. So if you take a drug that destroys your kidneys, you could be put on dialysis for a period of time years. In fact, until you got transplanted kidney
Even the heart is true in that way, if you took something that was so toxic to the heart, you could be put on a ventricular assist device or something like that, until a heart transplant, came along the liver, we have no option for that. So you've got got in the case of this girl, if I recall you probably have about a 20 to 36 hour window to get her a liver and that's not big odds. So there's a decent chance that you just died. She was one of the really lucky ones. So she got a liver.
And I, you know, I just remember taking care of her when she's, you know, in the ICU and, you know, I think it's a very mean again. She was very young, right? So, she was probably late teens early 20s.
Probably an unbelievable feeling of Shame and you know I'm sure you read these accounts of the few people who have survived jumping off the Golden Gate Bridge you know. And they all say the same thing, right? I mean there's only a handful of them that have survived and the two things they all say are
They can't believe how long it takes to hit the water. It's technically about a three second fall, but they described it as taking like minutes and to they again it's a no it's a small n, but they all say, the second they jump, they can't believe how much it puts in perspective, whatever it was that made them jump.
Sketchy. That's A lot's of crazy houses. Looking at statistics on the Coronado Bay Bridge. Mmm. And I think,
I want to say like 10 people have survived, is that too? Big of a number. How many people did you say survived? San
Francisco.
It's on the order of 10 or so. And and I'm trying to think like the Golden Gate Bridge. Probably averages to a month. Yeah, it's an I don't know about Cornell that got
unicorn on. Is this similar? Number is, it's a similar number. It gets shut down all the time because people are jumpers are up there. Alright, so you wrote this book, we're going to get into it a little bit and you've also done a bunch of podcast about the book. The book, you did the audiobook of the book. I'm going to try not to
Too much of the book, but you know me, I'd probably will read more than I should. It starts off with this.
Going to the book, the intro of the book. Once again, the book is called outlive the science and art of longevity, and it's a lot more than just that in the dream, I'm trying to catch falling eggs. I'm standing on a sidewalk in a big dirty City that looks like a lot like Baltimore holding a padded basket and looking up every few seconds. I spawned an egg whizzing down from me from above.
And I run to try and catch it in the basket. They're coming at me fast and I'm doing my best to catch them running all over the place with my basket outstretched like an outfielders glove, but I can't catch them. All some of them, many of them, smack the ground splattering, yellow yolk all over my shoes and medical scrubs. I'm desperate for this to stop where the X coming from. There must be a guy up there on the top of the building or on the balcony. Just casually, tossing them over the rail, but I can't see him and I'm busy. So busy, I barely even have time to think about it.
Him. I'm just running around trying to catch as many eggs as possible, and I'm failing miserably emotion. Wells up in my body as I realize that no matter how hard I try, I'll never be able to catch all the eggs.
I feel overwhelmed and helpless.
That's the opening of the book. This is a very similar, like, military, dudes. Like me, we have a dream where the enemy's coming and we're running out of ammo. It's kind of like the Tommy, Shelby thing, like we're running out of ammo and then you run out you're looking for other magazines and their enemies closing on you and you know what's going to happen. And you that's when you wake up drunk drenched in sweat and you're all happy. Look like called me just embed your own good but this
This was the, this is how you viewed, what medicine was doing, what you call the book medicine 2.0, which is here's a problem, right here. Let's fix it right now and not trying to figure out where it's coming from. That's the impact that this dream had on. You is to to to make you think of medicine in a different
way. Yeah. Although not at the time, right? It's only in retrospect that I put two and two together the time. Yeah. It just seemed like that. It's amazing.
To me, that it wasn't obvious, what that dream was about, at the time. Because it's so obvious in
retrospect. Also, you what you thought it was about at the time, was you needed to get better with the basket and be able to move quicker and he'll
just a touch more some stress just stress. Like it was just some dream about internalizing
stress.
How often do you remember your
dreams now?
Oh, you know, it's funny if I'm really deliberate about thinking about it first thing in the morning, I would say probably more than half the
time.
Are your dreams good or your jeans
bad?
Very rarely. Do I wake up and think that there's significant about oh I don't know.
Maybe a little less than half the time that I do, remember a dream. I can, at least say, I bet that to me, ruminating on this fear or this concern. But there, I would say that. The valence of my dreams tends to be negative, it's rare that I wake up and think, oh, I wish I was still sleeping having that dream. It's usually I'm glad that's over.
That could be some kind of a bias though because if you're having a bad bad dream, seem to wake you up more than good dreams, I've been
But we just like, happy good dreams, you keep sleeping. I can always tell when I've had like a bad dream because I wake up. Just drenched in sweat and it's nasty. And my wife is like, URS disgusting. And I'm like, yeah, I'm sorry, but it's always like you're running for him. Oh, you're doing something, you're trying to catch someone like something's going on like that. It's weird that you physically sweat even when you're not moving.
Yeah, for sure. I mean, it's still there still huge.
You know nervous system is activated. I mean it's wouldn't know the difference,
right? Yeah I guess well mine doesn't that's for damn sure. All right, I'm going to fast forward a little bit and could be another chunk of the book. I'll never forget the first patient whom I Ever Saw died. It was early in my second year of medical school and I was spending a Saturday evening volunteering at the hospital which is something the local school and the school encouraged us to do. But we were only supposed to observe because by that point, we knew just enough to be dangerous. That's
A point a woman in her mid 30s came into the ER complaining of shortness of breath. She was from East Palo Alto. A pocket of poverty in that very wealthy Town. While the nurses snapped a set of EKG leads on her and fitted an oxygen mask over her mouth and nose. I sat by her side, trying to distract her with small talk. What's your name? Do you have kids, how long have you been feeling this way?
All of a sudden our fight her face tightened with fear and she began gasping for breath than her eyes, rolled back and she lost Consciousness within seconds. The nurses and doctors flooded into the ER Bay and began running a code on her sneaking. A breathing tube down her Airway and injecting her full of potent, drugs. And a last-ditch effort at resuscitation meanwhile one of the residents began doing chest compressions on her prone body, every couple of minutes. Everyone would step back as the attending physician slap. The defibrillation paddles honor.
Asked and her body would twitch with immense jolt of electricity. Everything was precisely choreographed, they knew the drill I shrank into a corner trying to stay out of the way, but the resident doing CPR caught my eye and said, hey man, can you come over here and relieve me just pump with the same force and Rhythm I, as I am now. Okay. So I began doing compressions for the first time in my life on someone who is not a mannequin.
But nothing worked.
She died right there on the table as I was still pounding on her chest, just a few minutes earlier. I've been asking about her family.
A nurse, pulled the sheet up over her face and everyone scattered as quickly as they arrived.
This was not a rare occurrence for anyone else in the room, but I was freaked out, horrified.
What the hell? It just happened.
Do they give you any heads up at all? Are they talking to you about this, any of this? From a psychological perspective when you are going through dr. School, certainly not. When I was there, I don't know what it's like today, but, you know, it would only go from bad to worse, right? I mean, I went to medical school at Stanford, where that's often how you saw somebody die. But you know, in residency, I was at Hopkins, which was more of a war zone. So there.
What I saw is death was penetrating trauma for the most part in car accidents as well, but I would say the majority of the people that died. Well you know, right in my hands would have been trauma victims and you certainly saw people die. Post surgical procedures, you know, somebody dies after cancer surgery or heart surgery, but they usually didn't die right while you were watching them. The ones who died when you're standing there pumping on their chests and trying to do something heroic. We're usually trauma.
Items and that was just very it was a very common occurrence and no, I don't think that was ever. Yeah, there was just there was no there was no sense of how do you process this and I don't know that I did a great job of it. I mean I probably internalized it more than was healthy and I feel like, yeah, there were many times when I
After right, after that person would die, I would do something like I pick their up. I take their wallet and look through it and like find a picture of them or something like that and it's it, you know? I mean, I'm sure your audience can handle it. But like, I remember the first time, I saw somebody literally whose brains had been blown out, we use those terms very Loosely, right? But, but you know what? That's like, I mean, when you see a person with an entry wound, yay. Big and an exit wound on the other side of their head, you a big and their brains are on the gurney.
That's not what they looked like, 10 minutes earlier an hour earlier. There's not what they look like in their driver's license photo. And yeah, I just think, I think that is something that we would be better prepared to, or we would have been better off if we had some sense of, how do you compartmentalize that?
Yeah, I can tell you that, I don't think the military does a good job of that kind of stuff. At least, it didn't. When I was in we didn't talk about it. It's in fact, it's interesting we even talked about like, hey,
If someone dies, what do we do? What's our replacement plan for that individual, where we get, are we going to get? Another guy was like, oh no, we're not won't happen. Will it was so far from our heads of thinking. It could happen that we didn't even have some kind of a replacement plan. You know, you talk about World War Two, they had replacement plans. If you're not on the head replacement plan to, oh, here's what you're gonna get for Replacements. We have another platoon full of stragglers that they're going to come in on the, you know, the fourth wave and they'll fill in whoever's whatever spots are empty. Wouldn't have that so that means you're not even thinking about it. So now you're not thinking
Got it. It's like okay, what what what goes on, what goes on, what how do people are people supposed to handle it? So it's interesting that even in medical school where you are 100% going to see people die. You're not giving any sort of prep for that. Now, listen. It's also like, oh, you're going to be inundated with that and we've been doing it for however many years. 100 200 300 years. There's been people going to medical school and people figured out so we're
good. Yeah I mean I think that I think the
Image of that approach in medical school. Is that it produces a level of callousness that I think, all of us experience to some extent, which is you tend to retreat from from Death. Now, when it's a cute death, you don't have a choice, you don't have time to retreat. Meaning, when that patient comes in, who has been in a horrible car accident, or he's been shot or stabbed, you're going to be there and do your job and they're going to die and that's that. But you do tend to retreat from their family and and you know, you have an enormous obligation. I think to the
Family of someone who dies under your watch and in trauma. It is, especially difficult to wrap your head around this, because by definition, the last time that family members saw them, they were 100% normal, like their kid left the house today. Totally fine. And got T-boned in a car accident, and now they're dead.
Who should be the one to talk to them.
I think that the physician has to be there. Now, it's true that hospitals have social workers, and have people that can come in, to help with that. But I think that the doctor needs to be there and we don't get, we didn't certainly get any training in that, and I think a lot of doctors don't want to be there for that because they don't feel equipped.
I was on my first deployment to Iraq and
I'm not going to go into the details of what happened but essentially we had ended up recovering a body of an American Soldier and we put this this individual you know, he's in a body bag in the back of our vehicle in the back of a Humvee. And one of my friends was in the backseat, I'm in the front seat and
It was, yeah, it was, we're driving and the body, the bag started to leak. And my friend who is in the backseat, like he's all of a sudden, there's the blood is kind of going on to his boot. It's running down a seat or whatever and he's yelling at me, you know, he's yelling at me and yelling, you know,
Fucking pull over. We've broken that, you know, he's out, he's mad, he's a trained. We can't like pull over, he came to us like stopping on a the middle of a convoy, or we could but like, well now what additional risk or incurring and he's yelling and this guy's a dear friend of mine, but it was one of those things where I'm thinking
This is going to leave a deep mark on and this is wheat. This was a soldier that we didn't know. This was a soldier that we went out and helped recover and so we didn't know this this soldier at all. And yet, my friend is in the backseat, he's gotten his boutonniere. This guy's blood is leaking into the way a Humvee setup is sort of like you're in a, you know, I guess the way to describe it would be the lunch. School school. Lunch trays that you have that have like a little little for yeah. So you have like the
vision for your seats and there's a place where your feet go and it's all one big molded thing. And so that is what kind of track blood into my friends feet. And I could hear in his voice. He was just, you know, yelling at me like walking stop. Hey we got this book, there's any, I'm like, hey bro, we're going to be okay. We had we can't stop right here. Come on man. We can't stop. And yeah again that was he probably hadn't thought about that at this juncture in his career in the military.
And me and you know what? I did when we got back nothing I didn't pull him aside. I didn't say hey bro, are you Ki didn't do any of that we just like hey what's our next mission? You know, so it's another case where sure and you know what, he did got ready for the next mission, you know, I mean that's what he did
but
it functions but as you mentioned, it's it's definitely not the optimum way to go about dealing with this kind of thing.
In life.
Listen, this book is big and 410 pages of actual book, and then I think it's got a little more after that. Obviously, I'm not gonna read the whole thing and you read the I listened to the sample, the audio book, you read it. You did an outstanding job and I think you realized how hard it is to read books. I was the hardest thing I've ever done, it's a challenge for sure but get the book. Get the audio book. Listen, you've done a bunch of podcasts. You do you been on Rogan's? You've been on
Hubermanns, you've been on Peterson's like you've been a, you've done a bunch of podcast around the book and there and there's a lot of there's you guys, deep-diving a bunch of different stuff.
So I'm feeling like I'm getting a little bit, going to be getting a little bit tangental in this with what I'm going to be talking about or what I want and what made what the book makes me think about. That's outside of the normal stuff you say in the second book, I think about how spanning and it's deterioration in terms of three categories or vectors. The first Vector is of deterioration is cognitive decline. Our processing speed slows down, we can't solve complex problems with the quickest and he's that. We once did our memory begins to fade, our executive function is less reliable our personality changes. And if it goes on for long enough,
if even are sentient, self is lost. Fortunately, most people don't progress all the way to Frank dementia. But many people experience, some decline in their cognitive capacity, as they age. Our objective is to minimize this. The second Vector of deterioration is the decline and eventual loss of the function of our physical body. This may precede or follow cognitive decline. There is no predetermined order. But as we grow older freaked for Frailty stalks us, we lose muscle mass and strength along.
Bone density, stamina, stability, and balance, until it becomes almost impossible to carry a bag of groceries into the house. Chronic pain, prevents us from doing things that we once did with ease. At the same time, inexorable progression of disease, might leave us gasping for breath at. When we walk to the end of the driveway to fetch the newspaper, or we could be living a relatively active and healthy life until we fall or suffer. Some unexpected injury. That tips us into a downward spiral from which we may never recover.
My patients rarely expect this decline to affect them. And when I read that we had a guy on the podcast. A guy named Dean lad who's in the United States Marine Corps in World War Two. And he had done, I forget, which island can't. He did multiple Island assaults with the Marine Corps in the Pacific and he was on, I think it might have been his second but he'd already done one or two.
Island assaults in the Pacific and is so he's going into Tarawa and as he's going into Tarawa, I was asking him. I said, hey were, you know, were you scared? And he was like, no, because in his mind he's, this is what he said in the podcast, he's like in my Isa died, none of this stuff could happen to me. Like he was going to happen to the other guys. I'm sure the other guys must've been scared because because maybe they thought they were going to get shot, maybe they thought they thought they were going to get blown up, but I wasn't scared because that wasn't going to happen.
And he ended up actually getting gutshot 800 meters off the beach and only by the disobeying orders of two other marines, that dragged him back to about and threw him on. Did he live. But what do you think that is? What do you think it is in human beings? Myself included, 100%, I by the way believe that if I'm on a commercial aircraft and it blows up in the sky, I'm going to survive. So what is that? And and how does that? How do you have?
To try and convince people that they are actually part of
this. Well, the first question, is the hard one and also the one for which I just don't think I have an answer. I mean, there's probably some evolutionary reasons for it. I think there are I think it stems from a broader problem so I don't know if you've read Oliver berkman's book four thousand weeks no it's a fantastic book and I've had him on the podcast as well. Although by the time this one comes out it might not yet be out because I just interviewed him recently.
But he talks about sort of one of the most important issues with respect to the human condition is our inability to cope with finitude. Like, we simply can't accept the finite nature of our lives. And that's why he really uses this 4000 weeks thing. It's a very jarring thing. I keep a calendar in my office on the wall with one block for each week. So it's got 52 blocks per row.
Row and it's got 88 Rose, you know, assuming I'm going to live to 88 which of course there's zero guarantee I will and every Sunday I color in a block. So you know, I'm into like the 50 first row of coloring in those blocks.
Those rows are looking lead,
boy. Well, there's no denying. I'm more than halfway done and my kids every day they come in. They look at this thing and even they're starting to figure out like Daddy's more than halfway through life. And so I think there's something important about
Putting that in front of our face. Now, I have an advantage that I think the average person doesn't, which is I've spent a lot more time observing the end of life. This thing I call the marginal decade. So the marginal decade is just defined as the last decade of your life which by definition. Nobody Knows the day. They enter it. Like nobody knows that any including people who died of natural causes, they don't know the actual day they are standing 10.
Ears away from the end of their life but most people know when they're in it. You know, most people have a sense of I've got less than 10 years to go as someone I once spoke with about described it to me he goes I'm on my last roll of toilet paper.
And I'm going to be very careful about how I use each Square.
No more, gratuitous toilet paper using around here, every minute counts. And of course if we could apply that principle at the beginning, that's a different situation. So I suspect that that this is such a painful concept for us that we just simply irrationally, block it out and say that's not going to be me like, you know and also it's so it you know, it occurs over a relatively long period of time that you think. Well. All right, look, I'm in my
These today and I mean, I'm, I can do anything, there's nothing I can do,
it's not like I'm
gonna wake up one day and not be able to do all of these things. So when we ask our patients, to go through this exercise, which is a part of the marginal decade exercise, which is Define, we Define your centenarian decathlon. So we give them a list of, like, 50 activities. Some of these are activities of daily living. Like, do you want to be able to carry a piece of luggage?
Koj up an escalator that's broken. So 30-pound, luggage carried up, two, flights of stairs. Functionally, some of these are you know very recreational specific. Like do you want to be able to go and Hike, you know this many miles at this speed over this type of terrain and we show people this list of 50 and we're like pick the 10 that matter most to you the ambition that people come up with is remarkable.
Oh, I'm going to be heli-skiing
in my marginal decade and they're very
serious about this. They're very serious about this because they can heli-ski in their 40s which is what I'm asking them to do this. And in their mind, there's no reason they shouldn't be heli-skiing 50 years from now.
I don't want to tell them they're not I just want to show them that the amount of strength eccentric, strength, concentric strength cardiorespiratory Fitness like I do we March through the measurable metrics, the amount of things you need to do that are here
If you want to do this when you're 85 and we know the rates at which these things decline, this is where you need to be at 45 in terms of those metrics and you're only here your well below that. So you're still above the threshold to do them but nowhere near above the threshold given the inevitability decline. In other words, you're telling me that you want your glider to be able to fly another two miles, but you're only 500 yards in the air if you want to go to there, too.
Miles. You need to be a mile up.
The deterioration is inevitable.
The decline is inevitable.
Decline is inevitable. We have some control over the pace of it. We do so. So in other words,
the first derivative is absolutely - once you reach a certain age, but you have a lot of say, in the magnitude of that derivative
So you got this, this chapter in here is called the centurions and you look at a bunch of people that are over a century old, which is pretty awesome, which is pretty awesome to be, I'll hold you almost century-old. That's pretty awesome. And you got a bunch of different examples in there and of course, you cite, a bunch of examples where the people are drinking whiskey and smoking cigars. And you go through all of that. When I was reading this,
You know, I've written some books and the the fiction books I've written which are one adult fiction book when in a bunch of kids fiction. Books, story needs an arc, right? You kind of have a story arc.
and,
Sometimes I look at a lifespan of 80 years or whatever you said 88 years, 70 years. Like, that's pretty good story arc. You can fit a good solid story arc in there.
How long is long
enough?
In terms of lifespan. Yeah.
Well, I mean, look, there's a lot of cliches and ways to look at this, right? It's not about the, the length of life, it's about the quality of life. It's it's, it's not the number of years. It's the Life In Those Years look, I think there are extreme examples that we would all agree are not ideal. Okay, so I think we would all agree that.
If you take someone who has the greatest quality life, they're the greatest person, they're living life to the fullest and yet they died. Prematurely at 50, they're struck down by an accident or by a cancer diagnosis that they didn't live long enough, right? They should have lived longer and then we would all agree on that. I think similarly, we would agree that a person who lives a long life from an Actuarial perspective. You know, someone that lives into their 90's. Remember, the median life expectancy today in the United States for a male is probably
Hovering around 80 or just slightly below. So, you take somebody who out lives that by 15 years, but, you know, since they were in their 70s, they've been in a stage of the stage of such fragility that they haven't really been able to enjoy anything or they've been physically totally fine. But cognitively there in such a state of decline, or both mind and body are fine, but they're miserable Sons a bitches and I have no meaningful relationships and contribute nothing to the world. Well, maybe that's too long, you know? So,
So, I just I don't I just don't think we know the answer that question. I think, I think it's a complex integration of Life Span and health span. And that's why I think this healthspan concept is so important. And it's something that for understandable reasons because it's not as objective, especially on the emotional side, is largely ignored by the medical community, right? The medical definition of Health span is freedom from disability and disease.
that's a, that's a, that's a broad definitions and in my view, not a helpful definition because
Are you as free from disability and disease? As you were when you were 20 min you are, but if push comes to shove, the Jocko of today, couldn't physically do what the Jocko of you know, 30 plus years ago. Could do? Yeah, you don't have the recovery. We're a city right now, you have other things, you have more wisdom, right? I would bet that you're emotionally more competent. So Health span has to include these more nuanced ideas. It can't be just about disability.
And
disease. I have two comments on this. Number one, - my mom, I think was last year, my mom was talking to me or talking on the phone and she said something along the lines of like, you know, it's been a hard getting on my mom's, my mom. And dad are indeed getting in their 80s, late 70s 80s. And so, their friends were all late, 70s 80s. And my mom was saying, you know, it's been really hard for three months, four months, whatever. Because
This person died, this person by this person died and I said, hey Mom.
I have gone to like, so many funerals of guys that were 2732 4129.
And all your friends. Lived a full happy life. I mean I get it, it's sad but be thankful. That's part one. The other thing I wanted to say which is on a lighter note, I have a friend who had sleep apnea and so we had the big machine and he was in an unhappy marriage and he would rip the machine off at night because
Very aggressive hostile, you know, form seal friend of mine, he would rip the machine off at night and his wife. One time, we was trying to put it back on him in the 90s batting her hands away and they woke up in the morning and she said, you know, you need to let me put my machine on, you know, put your machine on, you need to keep that on and he says, if I take it off, just leave it off. And she said, we want me, you'd want me just to leave it off with. That's what you want me to do. You want me to do anything? And he goes, no, just let me die.
Die, just let me die. So, that's the other end of the spectrum. I guess, if you're in an unhappy marriage, that can be that can be a real bummer. You know, the other thing.
Have You Ever Seen The Show? By the way, I want to go back. I want to go back to the first point you made was I really, I've been thinking a lot about that lately and I just to take it back to to all of her bergman's book. That's one of the framings that he talks a lot about and it's this idea that okay, we're really struggling with this idea that we're only here for four thousand weeks like we as a species because we have because of the sentient nature of our Consciousness like we can really process that in a way.
Animal can't write. So they're not tormented by their or by their finitude, we are
And he said, look, you know, if you think about it through the lens of cosmic insignificance one, none of us matter, right? So let's just let's accept that none of us matter. But another framing is the probability of any of us. Being here is infinitesimal, it can't even be calculated. It is so small. Like on the day, you were created like the probability that that that that was the day that your parents had sex. And that one sperm and that one egg.
Aged to meet to create you because if it was a different sperm and or different egg, it would be your brother. It wouldn't be you, right? So the probability of your existence is so remote, we can't put a number on it. It's functionally zero.
And he said, you know, look
you think about this another way to imagine. This is how grateful are you to have any number of weeks?
And again, I still would argue that just the way we're wired. I think sometimes it's too short, right? I don't think that the 29, year-old at the funeral, no matter how much they accomplished in their 29 years, you're still mourning on some level but you know, if you make it to 80 and you die, it is sad. And I just saw somebody I sort of know, reasonably well died at 83. And he was one of those guys you never thought could die. So it was a little
Just it sort of it was it was just upsetting in a way that it would be more so than just anybody dying. But you know how amazing is it that any of us might get four thousand weeks,
be stoked? Yeah. Have you ever seen the show? True Detective? Hmm. Okay. I watched the first one to watch the first one.
Is it like a Netflix series or
something? They don't know what's on HBO.
HBO series The it's done two three. I think they've got three out, four three out. The first ones
words like three seasons. Yeah three
seasons. The first one is really, really good, especially the first, the early episodes. Anyways, cops Mayhem going on. But there's a character in there called rust cohle whose it's just an unbelievable. Unbelievable character. Amazing character, just a really smart cynical guy who's going through life and
At this one point, he's being investigated for crimes. There's a whole plot but he's being investigated. He's sitting down. Interviewing there's, there's cops that are interviewing him and he goes on this speech, which you can go watch on YouTube. But basically, what he's saying is he's talking about looking at DBS dead bodies. He's talking about looking at DB's for 14 hours and he's going through pictures. And he's saying, look, it doesn't matter if you're looking at pictures or if you're looking at real.
Real or if you see them just before they die or just after they die, you'll see that in that last moment.
They realized they they're okay because they realize that everything that they've loved and everything they've hated and everything that they've lived and everything that they've worried about and everything, they've been sad about everything. They've been happy about. I think he says it's just a dream that they had in their own head and they can just let it all go.
Just let it all go.
What do you think about that?
Hmm.
I don't know. I don't know if everyone goes through that. I don't know if everybody experiences that right. And again it might depend on the time scale, right? It might, if if that's a statement about the MS prior to expiration, maybe there is something to that and right we also just really don't understand death. I mean it really is a vexing problem. Like we don't understand the neurochemical process of death. We don't you know, when you know I'm sure you've heard like all of these people and have near-death experiences come back and basically say the exact same
Same thing, it's kind of hard to believe they're just making this up or something, right? Like there's clearly something really profound. That's occurring, neurochemical e. And that in those final moments, you know, presumably for the people who aren't like decapitated or something like that where it's instantaneous surprise death.
But what I find interesting is that, you know, like there are some people who I hear talk about it there. So look, we're all dying, we're all terminally dying. So we're all we all have a terminal disease, but there are some people for whom that terminal disease is so apparent. So you, I'm sure you've heard Sam Harris. Talked about The Hourglass, have you heard about this? This is, I find this to be a very powerful way to think, about life and death. So all of our lives are represented by an hourglass. So when you're born, there's you know, all the
And is in the top, none is in the bottom, and then immediately, the sand just starts flowing, but The Hourglass is opaque at the top. So you never actually know how much sand remains in The Hourglass. So we watch the accumulation of sand in the bottom with Clarity. That's the years we're living but we have no idea how much time remains now. Some people, you know, let's say someone gets a cancer diagnosis and it's a very bad cancer diagnosis. So it's, you know, you have pancreatic cancer and it's it's spread to your
Your liver. This is as close to a certain diagnosis as possible, you know, you've got six to nine months to live. What that means is, now there's all that opacity starts to become transparent in the upper bulb. And you see that there's actually very little sand there, and it was those days, get closer and closer to the end, it becomes more and more clear.
And I would say that there are very different reactions that people have to that and maybe I spend a disproportionate amount of time thinking about that. And wondering, you know, what's my reaction going to be? Because I've seen many people in that in that final stage of sand and I've seen very different reactions
But I would imagine that yes, virtually everybody, if they're being honest with themselves, realizes that many of us, certainly, I would be the heavyweight champion of this probably spend time worrying about things that don't justify worry.
I have a really had, a really weird kind of horrible comparison to this. I was thinking of people that quit.
People that quit, whether they're quitting, you know, in Seal training, whether they're quitting like, you're training with them, and you see them just quit and you can see you, sure. There's, there's a, there's a moment of
They end up with the the the shame and the, how do you know, she would should have stuck through it. But there's also like a split second where they rationalize with themselves and they say I don't have to do this anymore. That's what I think of. When I when I think of that like someone getting they just life is upon them and it's the
weight and you can't
keep it together anymore.
Good. I hope I don't feel on my deathbed like a quitter. I really hope I don't that would send me and I would just want to appreciate that. I don't think at all. All right, I'm going to fast forward again. The book is four hundred and ten pages long get it, get it there's so much good so much incredible information in here. It's too.
To me, it's like a textbook as well, right? It's a textbook because it has so filled with with knowledge and and information that look, there's a bunch of great stories in it but it's a textbook to teach you this stuff and a reference back to unless you're a medical doctor or you're not going to read this thing one time and be like or like you know it's cool for me because I've been listening to you and known you for a long time. So I've I've heard you talk about these things a lot so I get to read them and I'll get oh that's that's that definition. I've been missed. So
Get the book going a little bit here. I'll top the G represents the catabolic side of metal and again, I'm fast forward. This is a totally different section. I'll talk to G represents the catabolic side of metabolism, when the cell stops producing new proteins and instead begins to break down old proteins and other cellular structures into their amino acid components, using the scavenged materials to build new ones. It's a form of cellular recycling, cleaning out the accumulated junk in the cell and repurposing it for or
opposing of it. Instead of going to Home Depot to buy more, lumber and drywall, screws the cellular contractor scavenges through the debris from the house. You just tore down for spare material that he can reuse either to build and repair the cell or burn to produce energy. Otology is essential life. If it shuts down completely the organism dies, imagine if you stop taking out the garbage or recycling, your house would soon become uninhabitable except instead of trash badge, trash bags. This cellular cleanup is carried out by specialized organelles
Called lysosome. So I said it right lysosomes lysosomes which package up the old proteins with other debt treas, including pathogens and grind them down via enzymes for reuse in addition, the lives lysosomes also break up and Destroy things called Aggregates, which are clumps of damaged proteins that accumulate over time. Protein aggregates have been implicated in such diseases as Parkinson's and Alzheimer's. So to getting rid of them is a good thing impaired autopsy.
Gigi has also been linked to alzheimer's disease related, pathology Parkinson's disease and other neurodegenerative disorders. Mice, who lack one specific otology Gene. Succumb to neurodegeneration within two or three months. By cleansing ourselves of damaged proteins and other cellular junk autophagy allows cells to run more cleanly and efficiently and helps them.
And helps make them more resistant to stress as we. But as we get older on top of G, declines impaired, otology is thought to be an important driver of numerous aging-related phenotypes and ailments such as neurodegeneration and Osteo osteoarthritis.
So this is how long have people known about otology? This is something look. I went to high school in the freaking 80s, right? But I remember some stuff from biology, I don't remember a damn thing about otology. Well I mean I
think we'll put it this way. The Nobel Prize for the genetic elucidation of how a toffee G works. Was awarded relatively recently. So long after you and I were in high school. Okay. So in that sense, it's a
It'll more recent of an understanding.
It's, you know, the million dollar question because you can't read what you just read and not ask, okay, how do I make sure this is happening? What do I need to do to make sure I'm in the right balance. And, of course, there is a balance, very few things in biology are just a straight line or a monotonic increasing or decreasing function. They're usually use or inverted. Use, not always. And we'll talk about some exceptions, potentially Fitness is an example of one where there's no you or inverted, you it's just a straight-up, the more fit you are the longer you live on average.
. Higher, your VO2 max longer your lifespan, but with the top pudgy, there's a Goldilocks principle. You want to have the right amount and the, the, the most important things that are required to signal to a tapa. G are generally reduction of nutrient in one form or another. Now, the two obvious ways to do that. One is obvious, I guess one is less obvious. The most obvious way to do that is fasting, right? So when you are fasting after some point in time, and
Most people are surprised to learn. We don't know how long that is in humans. So we we know in mice, very well. How long a mouse needs to fast before it. You know, has a sufficient amount of a toffee going on but the metabolism of mouse is so much faster than ours that we can't extrapolate. So you know in humans we could probably say that a day is not long enough. Five days is probably long enough no idea where the balance is but what's interesting
Sting is at the cellular level. Exercise is a really important tool for a tapa G because at the cellular level when you are exercising, the cell is actually experiencing enough of an energy deficit that it triggers this process. So this is why exercise and fasting would probably be the two most important tools we have outside of pharmacology. There's one drug that may also, you know, be used for this purpose but again, it's a little too soon to say at least in humans.
And so that's where we want to point people.
What up? That's another thing. And I think I going to get to this later. But, you know, you talked about the chances of us being here is so small. This freaking system that we're rolling around in is a damn Miracle of you. Think about this stuff going on inside your body? Something you've never thought about before that, we'd even know what's going on until pretty recently. It's insane. What our body is doing all the time to be here to be sitting here, surviving living.
Yeah, my kids right now, you know, my boys, they're young of course and you know them. Well, they're going through that very predictable stage that five, six, seven, eight year olds go through, which is total obsession with dinosaurs and sharks. So pretty much all we're doing is watching everything. There is to watch on YouTube about dinosaurs and sharks and my the oldest of them, the who's eight. Like he knows every fact about these things. Do you know that if a Spinosaurus lost its spine, he would still be able to survive because as I kind of you know,
At its finest. Like I knew what a T-Rex was and a Triceratops, like I just didn't, I don't have any recollection of this. He knows all of them. And, you know, it if you think about it, like how many millions is? So let's just say, like 30 million years ago, you had these things roaming the Earth with their little tiny pea brains and to think that like we're here today, like this is unbelievable and we I love talking about Evolution and natural selection with them, like I really
Joy talking about it yesterday. My, my son was debating with me and he might be
right. I think he's wrong, but
he was trying to convince me that the great white shark is, has evolved from the Megalodon. And the Megalodon did not really go extinct and I'm like, I don't think that's true, buddy. I think the Megalodon is extinct and maybe the great white, you know, everything, who just but, but these things are kind of unbelievable. And even at the simplest level, I still can't believe. It works like just at the level of a great white shark or, you know,
Never mind something that's as sophisticated as we are.
Yeah. When you got also act in here think about your kids, right? And I was thinking about Jiu-Jitsu the other day, Jiu-Jitsu is evolving, it's so much faster right now than it did 30 years ago. And it's because more people are participating, but it's more. Because the information is just readily accessible. So, you can go on YouTube and you can learn all this stuff and I heard an interview I think it was
I think Lex Friedman was interviewing the chess player, the greatest chess player, Garry Kasparov, yes, he was interviewing Kasparov and he he asked Kasparov if he could meet, if he could be Magnus Carlsen and Kasparov said, no, but what was interesting. There's two things that he said, number one, he said, because I thought you could beat him of course, because you've been playing longer and you're like the guy, he said, I can't think as fast as I used to. So,
Oh, there's the greatest chess player in the world and he's saying, no, I can't do what I used to do which is crazy because there's no physical thing. We this was such that it was like one of the first times I ever accepted the fact that the cognitive decline is a real thing that was number one, number two. He said he he said Magnus, he has all my moves and he's had all my moves. And so he didn't have to create a new of my moves, he just got them. And so now he's
creating he's building on what's already there. So when we advance in medicine, let's say, are we advancing at a faster rate now than we did 50 years ago? Because everyone's just the information is all there. I mean, now we've got a i that can pull up all this old information you could do studies. Is it, are we getting better? We're getting
faster.
Yeah, in some ways I mean the concept of course that you're describing is the most important concept of our Evolution, right? And I think one fun way to think about this actually life was over a couple of weeks ago and we were having dinner and and sitting around you know our job was making sure that none of the food got burnt on the grill. So while we were sitting there this I posed this thought experiment to him which was which I'll pose to you now so you know what? You know it's 2023. This is everything you need.
No, I'm going to put you in a time machine and send you back.
Two thousand years. Now make it. Let's make it 5,000 years, you're gonna send you back 5,000 years. How much can you bend the Arc of civilization with the knowledge you have now, five thousand years ago?
Yeah. Well, that depends if I don't just get it, you know, die.
Let's assume I put you back in the appropriate part of, you know, the five thousand years ago, I'd have to put you in Egypt to be in the center of civilization, right? So I'm going to put you back in Egypt, I'm going to color your skin. The right color I'm going to make you look like you're a gypsy.
In, right? So you're not going to have the knowledge that I have. You have the knowledge, you have now, but let's be clear. You don't have any more than the knowledge you have now, right? So you know what 2023 looks
like
and you're in 3000,
BC, can you bend the Arc of the universe in some areas
where, let's talk about?
Why can't I tell you straight up? Like because I'm sitting here thinking if they want, I would probably provide little to no value in medicine. Now
look there's one area you
could.
Could take collect cleanliness, right?
Exactly sanitation is the only thing I can think of where if you put me back in time, I could make a difference. Now that assumes people listen, because remember and I write it whole chapter or not, I bribed a whole section about semmelweis. He came up with this idea first and they put him in an insane asylum where he died. So you also have to assume people would listen but
outside of that man yeah I
got nothing to offer. Yeah you can imagine you standing there. You'd sound like a profit. We're going to have these things are
Called iPhones and you're going to learn in this thing called the init.
Like what I mean that's like A Connecticut Yankee in King, Arthur's Court, remember that book? No yeah it's like this guy goes back from Connecticut Yankee goes King Arthur's Court of the one of the things he does he knows when the eclipse is going to happen and so he's actually I'm going to blot out the Sun and now my gosh but okay. Sorry continue yeah. So so my point is
like all of the the modern nature of the world we have today is all predicated on knowledge transfer it
It's codification and transfer of knowledge. And until that happened like we were in the dark ages for hundreds of thousands of years and then the reason I think were, you know, technology is increasing exponentially is due to two that it's and these have fed off each other, right? So, the more we can codify knowledge, presumably starting with the printing press, the more we could get to the point where we could generate knowledge that could do all these other things. So, to answer your question, I think it's nonlinear. I think there are some spikes, so I'll give you an example.
You know, most things that people think about most people understand Moore's, Law, which is kind of like the paint and it's about an 18-month doubling, or halving, depending on how you look at it, you know, semiconductors and, you know, so sort of Chip size and capacity. Well, there's actually been one thing in medicine that has taken a step function faster than Moore's Law and is genetic sequencing. So, when the first human genome was sequenced in about the year, 2000 the cost of sequencing.
Went down at a Moore's law rate until about 2006. And then it just went boom. Boom, just drop to nothing and now it's continuing at Moore's law rate, but from a way, lower Baseline and that big drop was high throughput sequencing next gen high-throughput sequencing. So like that's one example where there's been a step function change in recent years in the past, you know, 15 years that has made at least genetic sequencing
You know, completely transformational but you know what? It hasn't translated to a huge impact in health. So it's been a big scientific breakthrough that hasn't really translated to a huge impact in health. I think there are other areas where I think we are starting to see areas where I'm optimistic. So in cancer Therapeutics I think,
It's been largely pretty unsuccessful for you know, 75 years and then in the last 10 years there's been a pretty big Improvement in harnessing the immune system. Now we're still in totally nascent days but I would say this is probably a conservative estimate eight percent of people who would have died even 25 years ago are living today with metastatic cancer.
And we made zero progress from 1950 to 2000 on metastatic solid, organ cancer. And, and so now we've, you know, throwing moving, we're moving.
Yeah, that's good. Your initial question about what I would do if I've thousand years ago and I was like, well, there's one area like I know Jiu-Jitsu and you don't need anything for that because, like, look, I know about weapons but I couldn't, I don't know how to make the metal to
make a weapon, right? I know there's, I know you can take like
Bat guano and make freakin
gunpowder somehow right, but I wouldn't be able to pull it off but I know did it. So I'd be I could I could Jackson people up. I put together an army, we take over the world, I can say that. Well,
what kind of weapons were they using 5,000 years ago? What did the Egyptian armies, use?
My guess is a yeah, she'll have a trebuchet. Yeah, I don't know if I yeah I could show the show the Trevor each other so they could we could we could start if they didn't have but I guess if they have bow and arrow yet we could get the bow and arrow Out start using that crossbow. Yeah.
A crossbow. But again like figured I'd have to go into the procedure
concept. Here is that military advancement would be the most important thing that we could bring to us as civilization.
Well, that's the most important thing I could bring. I think the you would be a much better person to send back in time I would make things much worse. It would be much smarter to send Peter and tia back, not Jocko. We just end up in some weird war like freaking dystopian time right now but but, you know got them. So let's
say you sent me back, right?
And let's say by some miracle. I could convince people to wash their hands that would have an enormous impact. But you know what I couldn't do. I couldn't build a
microscope. Yeah. It's going to say you can build with you. I mean, could you build a scalpel
It wouldn't be as much value. They would probably have it. It's the anesthetic. I wouldn't be able to build ether. I wouldn't be able to make ether and that was the big breakthrough in. By the way, it didn't happen until the late 19th century. Can you believe they used to cut people surgically until just 140 years ago? Without find it? Call 150 years ago you would undergo surgery, like, white-knuckling it. Yeah, they
him. They were hard back then, huh? Do people just pass out or you think they just got through it?
Depends. So, it's totally, it's really interesting. When you go back and read about surgical, what was prized in a surgeon pre, anesthesia versus post pre anesthesia. The only thing that mattered was how fast you were. Damn, like, literally didn't matter how accurate you. It was like, can you operate
fast? They used to operate in front of crowds. Yeah,
that was actually not. That was me. You would even see operating Theatres that exists probably in up until the 1940s or 50s who's going usually students and other chemicals.
To observe but it's not just like it's
not right? It's not the riffraff. Yeah, no. It's like the medical students.
Okay well that makes sense. Really still do that
right? I mean not in a formal theater where you know not much
but you but you're probably watching
videos.
Yeah, look when I was in, when I was in medical school, I I I'd have VHS is of procedures that I would watch. So that I, you know, I didn't want, I didn't want to go in and try to like assist on my first one without having watched it, a bunch of times, it's
crazy. There was a guy in ramadi Army Captain, Awesome guy. And he would sit back like, go out on Ops and he would run a camera the whole time I video camera from his Humvee. And he go back and just sit there and watch and he'd be like, oh yeah, he would know that little, what that door looked like, what that courtyard look like that's squared away.
You know, that's the. Why would you not do that for you? An awesome. All right, I'm gonna fast forward a little bit in the 1950s, a surgeon in Topeka, Kansas named Samuel. Zellman was operating on a patient whom he knew personally, because the man was an aide in the hospital where he worked, he known. For fact, the man did not drink any alcohol. So he was surprised to find out that his liver was packed with fat. Just like one of my patients decades later. This man did, in fact drink a lot, a lot of Coca-Cola
Zellman knew that he consumed a staggering quantity of soda as many as 20 bottles or more in a single day. These were the older smaller cobol's. Not the super-sized we have now, but still zelman estimated that, his patient was taking an extra 1600 calories per day. On top of his already ample meals among his colleagues. Almond noted, he was distinguished for his appetite, his curiosity piqued zelman, recruited 19, other obese, but non-alcoholic subjects are for a clinical study. He tested their blood in your
Urine and conducted liver, biopsies on them. A serious procedure performed with a serious needle, all the subjects bort, some sign or signs of impaired, liver function, in a way that eerily anyway, eerily similar to the well-known stages of liver damage. Seen in Alcoholics, this syndrome was often noted but little understood. It was typically attributed to alcoholism or hepatitis when it began to be seen in teenagers in the 1970s and 80s worried doctors.
Of a hidden epidemic of teenage binge drinking, but alcohol was not to blame in 1980, a team at the Mayo Clinic. Dubbed this hitter, oh, unnamed has heed on the unnamed disease, non-alcoholic stadio, hepatitis, my center-right steatohepatitis. The I don't have to Titus or Nash since then it is blossom into a global plague more than one in four people on this planet, have some degree of Nash or its precursor known
is non-alcoholic fatty liver disease.
How disturbing is
that?
Yeah, the hidden
epidemic. They thought initially that kids were just binge drinking and that's why they had this fatty liver but it was just because our freakin diet was heinous.
Yeah. In fact, I think I open this chapter talking about a patient that I, you know, this is when I was an intern and I was assisting on a procedure. This was a patient who had colon cancer, he was there to get the right part of his Hemi colon removed and you know,
We are in a, my job was to pre-op him, so that meant I had to go and ask him all the mundane questions. Among them is, how much do you drink and that's relevant form, an anesthesia perspective, right? So you got to know if somebody's a big drinker, he claimed to not drink at all. So fine. So we get into the OR and again my job is to pretty much just retract and suction. That's it. I'm a lowly intern at this point and we open them up and like the biggest fat liver just pops out of this guy.
And the attending surgeon is upset at me thinking, clearly I didn't even do. The one thing I was supposed to do, which was figure out if this guy was a drinker and of course, it turned out he wasn't and you know, none of us really thought much about it at the time and but you know this was more than 20 years ago and we now realize today that nafld e and Nash are the leading indication for liver transplant in the United States.
And this chapter is called the crisis of abundance. Because this
Is just too much Coca-Cola, too much freaking crap. Which is crazy. Right? Like that's where we're at, that's what's going on?
Yeah, I mean, let's let's start with the Positive spin. Going back to our evolutionary discussion.
Well right, okay. All right. To positive polarity, icaza not. I like
it. All right. So.
You talked a minute ago about how amazing it is that we're here. And I assumed you were mostly referring to humans. It's obviously true of all species, but it is true like we are. We're in a league of our own. But what puts us in the league of our own? Is it our strength? No, even your strength right now. Is it our speed now? I mean, it's one thing that catapulted us out of the swamp and passed every other species.
Pre or current. And that is our brains. Our brain is the defining feature of our species and we pay a price if you will to have a brain like ours, and it's a metabolic price. So your brain takes up two percent of your body weight and yet it consumes 25% of your metabolic rate, 25% of the calories you eat,
Go to feed that two percent of your body weight.
So,
how could we possibly get
where we are without evolving a very elaborate system? To make sure you never run out of energy and that's what we had to do, right? And so, and if you, by the way, if you look at primates today, right? These would be our nearest evolutionary relatives. They don't have this capacity, right? When you overfeed primates, they get more muscular
When you overfeed humans, we get fatter and again in light of all, we're going to talk about. That's not a good thing, but from an evolutionary perspective, it's important because muscle is a lousy source of energy.
Fat is not fat is a wonderful source of energy. So basically we were the, we were like the only electric car to show up with a huge battery. Everybody else basically had an electric car with a mini battery, and that meant they couldn't drive very far. We were the only ones that could drive all over the place. So if you think about it up until a couple hundred years ago,
Those, you know, tens of thousands of years of evolution served us really, really well. We were incredibly active food was incredibly scarce, we didn't have natural, we didn't have unnatural light, and we didn't really have chronic stress. We only had acute stress. So, you've got a cute but no, chronic stress. No, you know, unnatural light, scarce food. And your active is hell.
And by active as hell. I don't mean. We were like running marathons a day but like,
but your we're more asking Gathering you're moving
around. Yeah. And we conserved energy like it's a bit of a myth to say that humans were like constantly huffing it we look for every reason to not move an inch because of the scarcity problem. Rightly you never wanted to wait, but you put all those things together and we were in perfect energy balance.
And then, you know, 100 years ago or so, all that started to change when we, we tried to solve a problem. The problem was, hey, we don't want to be in farms anymore, like we want to do other things. We want to set up a society where people can do things other than be in charge of growing their own food. So we're going to centralize that we have to be able to scale that problem. So we have to be able to grow food at huge scale. We have
Able to preserve food to be able to ship it and distribute it. We should really make it taste good as well. You know, they start to get into the hedonic side of this, and you basically arrived at this thing called the standard American diet. And it, you know, none of those things I mentioned that were part of the optimization State involved, make it not harmful like that, that was neither a goal. Nor, I think to be
It was just, it wasn't considered it was, how do you make it cheap? How do you make it abundant? How do you make it non perishable and how do you make it taste good? Those were basically the criteria. And so what we have today is the standard American diet and so when you take our genes and superimpose them on the standard American diet, it's the crisis of overabundance and for most of us that requires being deliberate because if we just let our brains run rampant, I mean for most of us we end up in an unhealthy.
Day.
Yeah. Because part of our part of the evolution that we made was to want to eat all this stuff that tastes good. And that's just what we have to fight against that.
Absolutely, I mean if you think about it like, you know it's not an accident that we like sweet things. I mean, that was a very important characteristic to have, right? I mean we depending on which which ancestral tribe you look at. I mean some of them got up to 20, 25 percent of their calories from berries and honey, I mean we were we really wanted to know.
What sweet was? That was a very important trait. In fact, I think I write about it very briefly, you know, one of these things, I'm sure you can relate to this Jocko as you're writing a book. You sometimes forget the first version versus the published version because it's been hacked down. So like the first version of this book was 200,000 words. What people are reading here is 120 Thousand Words which is still to your point, a very long book book but the 200,000 word book that was A Treatise and I think some of this got caught I think there's a much longer section I
About the evolution of an enzyme called Yura case. And how basically, there was a period of time in which we also couldn't get very fat, but I, we, I mean Apes that became us, right? So, these Apes basically left, Africa, went to Europe. Ice Age comes and they're only the subset of the Apes that developed a mutation to.
To preferentially store fat, out of fructose survived, because they could eat enough fructose in this fall to fatten up for the lean times during the winter and the ones who couldn't develop that mutation died off the surviving ones, came back to Africa. They basically became the precursor to us as humans. So again, very valuable set of mutations up until you know, the last 0.001% of our time on this.
Planet,
that's an amazing system. This freaking flash Bots were running around it, isn't it really? It's nuts. Speaking of that, I'm going to fast forward here. Scientists have been exploring. The medical Mysteries of the human heart for almost as long as poets have been probing. It's metaphorical. Depths it is a wondrous organ of tireless. Muscle that pumps blood around the body. Every moment of Our Lives. It pounds Hardware exercising slows down. We sleep. Even micro. Adjust it
It's rate between beats a hugely, important phenomenon called heart rate variability. And when it stops, we stopped, our vascular network is equally miraculous a web of veins arteries and capillaries that if stretched out and laid end-to-end would wrap around the earth more than twice,
About 60 thousand miles, if you're keeping score, so that's each individual human. So I have that
Are these like microscopic, that's why?
Yeah, so if you think about it, like coming out of your heart is one huge artery called the aorta and then it immediately splits. So it comes it has three things that hop off it, okay? So their major arteries, but if you trace the like the the major arteries they become smaller and smaller arterioles that become capillaries, that become venules, that become veins. Tiny veins, that become bigger veins and bigger veins, that become the two major veins. That flow back into the heart. So what it's saying is, yeah, you too,
All of those things. Because once your the capillary level, you have a whole bunch of these things in parallel. It's not just a Serial process, so it's take all of that out. And yeah, it's insane.
Each blood vessel is either way. Yeah,
not not to just harp on this idea. This is one of those things that I don't think gets enough attention in terms of like how that even works, like we like the best and brightest Engineers Material Science Engineers on. This planet can't come close.
To making materials that can do this. Because if you think about it, how does something that small stay paitent, it shouldn't like, we can't even figure out a way to make an artificial coronary artery. Like if someone needs a coronary artery bypass we can only use their native blood vessel from somewhere else and that's a an artery. That's like a millimeter and a half wide in diameter. It's evens visible to the eye. We still can't come close to making something.
That small, let alone the microscopic stuff.
It going on same path or each individual. Blood vessel is a Marvel of Material Science and Engineering capable expanding and expanding Contracting dozens of times per minute, allowing vital substances to pass through its membranes and accommodating huge swings, and fluid pressure with minimal fatigue. No material created by man can even come close to matching this. If one vessel is injured, others regrow to take its place, ensuring continuous blood flow throughout the body, then it's interesting.
My wrote here was F1, engineering is F1 car, engineering is like a miracle and but compared to the human hand, to the human heart to the human brain. Like it's just not even, it's nothing, it's a joke.
Yeah, it's pretty amazing and how our bodies managed to work.
So my other note here,
Was.
What is what is it that we do? We know what? We don't know, what is the spark that makes life?
Because we can't create an amoeba right now, can we?
Do we know what we're missing? Do. We can we can we identify what it is that? We don't
know.
Well, I mean I should clarify this, there are some ways to create synthetic life at a very like, an algae or something like that. There is some type of synthetic biology that can be done,
so we can take no algae. We can take the material that is in
algae. No, I shouldn't. I shouldn't say that. Here's what we can't do. Let's so going with algae which is really simple, right?
So what makes algae special or makes plant special for that? Matter is photosynthesis we can't in a black box make photosynthesis
In other words, we can't in a black box, make something that takes carbon dioxide and Light.
And fixes carbon atoms, and spits out, oxygen, and water. Like we can't do that.
You know, it depends. Okay, so your questions have been difficult to answer because we can, you could argue
We can take an egg and a sperm and merge those together using in vitro fertilization. And we can grow that out there. I get that. But we're starting with the perfect genetic material at the outset. Like, we're starting with a perfect egg in a perfect sperm, and we inject
them and both those things are alive, right? When you say they're alive, I
don't know. I mean, I guess this, that's a bit of a semantic question. Right? What I mean, how do we Define
alive?
It's not bad. Meaning if you take an egg and you put it out in the on the shelf and hit it with a hammer and put it in the sonnet, it's not going to work anymore,
right? That's right. Yep.
Same thing with a sperm. Yep. So there's something there's some attribute that they have that. I believe we would call life. It's
alive for. Yeah, there's there's yeah. I mean, I guess you could say it's cellular respiration would probably be
the definition or the
lines. I think, I think cellular respiration would be this cellular definition of life.
So, which means, which is metabolic, right? So, it's a metabolic definition of life and we can't create
that. No. Do we know what it is that? We're what we're missing, do? We understand that as a chemical thing?
Well, I mean, what we understand, why it's happening. We don't like, we can't make a mitochondria. Yeah, that's what's so freaking crazy, right? Yeah, we can't make the engine that drives cellular
respiration.
So when working on
that, I mean, we're not even working on that, what we're working on is, how do we minimize the damage to our mitochondria, right? Because if you think about aging, there are Hallmarks to aging I list all nine of them in the book, right. And I think one of the most important or significant Hallmarks of Aging is mitochondrial dysfunction so as we age our mitochondria become less and less functional. So
What is interesting? It would as it would be to see if we could make mitochondria, I would settle for, can we figure out how to stop or decline? Stop the decline of and or reverse the decline of mitochondrial dysfunction.
We get along and then the good news, is we have some interventions that do exercise does right like exercise, clearly blunts, that effect. And if you take a person with type 2 diabetes, which would be kind of the Hallmark state of mitochondrial dysfunction and you get that person exercising like crazy and their diabetes goes away. Like you've improved the state of their mitochondria. Absolutely. So we have functional tests that are usually exercise based to determine mitochondrial Health but shy of
of that. Like it's not like we've got a drug that we can give somebody to Tinker with that system or to take an 80 year old and give them 20 year old mitochondria just not happening.
Not yet, we got a long ways to go, don't we?
I think very long and in a way that's kind of what like, you know, there's there's an entire topic. I don't touch on in this book and it's a very deliberate decision, right? And and, and it's basically the entire topic of the Sci-Fi of anti-aging, right? Like, so, in some ways, I'm sure there are some people who will read my book and come across and come to the end of the book. And do you like
Where's all the cool shit? Oh you might like cry. Oh
yeah, are just like weird freeze ourselves are like where's all the you know cellular engineering stuff and where's all the you know, the highfalutin really cool ideas that are you know, we're going to become immortal. And and the reason I don't write about that stuff is one. I think enough other people are but but more than that I think that I'm trying to write the operating manual for what you can do today.
And if nothing else, even if any of those other things, come to be viable In Our Lifetime. And I don't think they will. This would still be your hedge, right? This is the what you can do today, like, why does exercise matter? Why, would exercise at a decade to your life and more importantly? Even if it didn't even if, you know, I've often said this I think I even make the point in the book. Even if you told me exercise was going to shorten My Life by a year, it would still be worth it based on the dramatic expansion.
Action and quality of life. And if you're, I think most people, if they really think about it, they don't care as much about length of life outside of those extreme states. Nobody wants to die at 50 now go, no matter how good their life is, but if you say to somebody, do you care? If you live to 78 versus 88, if you told them that the 88 was going to be 15 years of poor quality. And the 78 was going to be six months of poor quality. I'm not sure. I know anybody who wouldn't take the 78.
So as bring it back to the mitochondria like we might not know for a very long time, how to rebuild those things but we sure as hell, know how much exercise will give you better mitochondria more of them and better ones.
I've speaking of high school science, I was taking my high school science class and I remember it was in, can't I think it was in chemistry and like, we, finally got this something where my teacher was like. We don't know why this happens.
It was the first time in my Scholastic career and I was like, well you know I was I was sitting there doodling or doing something. He said we don't actually know why this happens and I was like, wait a second. What? He's a we don't know. It should have been the thing that sparked me to enter physics and become a scientist. What is that? I was like man. That's messed up. You know stupid to knuckleheaded to try and think I could go try and figure that out. Interesting
fast forward a little bit gets her great for that, right? I mean the amount of stuff that like, you know, because kids
Sir, they just don't care. They'll just ask questions and they'll keep asking and they'll keep asking they'll keep asking. And
that's the answer. You question where you were? You've gotten to? I don't know yet.
Oh yeah, tons tons ask me. That's all your time. Yeah, my especially the boys, right? Because they're at that age, where they're my daughter now, just doesn't ask me too many questions. You'll notice that you don't know anything. But the boys love asking like, you know, all those kinds of
questions. Yeah, that's good. All right. Fast forward a little bit. Richard Nixon declared a national War. Again, I'm skipping through like
Massive chunks of this book. Go get the book. I don't think I'm doing a good job of skipping Parts. I think I'm skipping too much. But anyways, that's what we're doing. Richard Nixon declared a national war on cancer in 1971. Initially, the Hope was that cancer would be cured within the next five years in time for the bicentennial, you want to talk about some presidential promises gone wrong, good job yet. It remains ee undefeated in 1976 and still by the time I finished medical school in 2001 and
Day for all intents and purposes despite well over 100 billion. Spent on Research via the National Cancer Institute. Plus many billions more from Private Industry and public Charities, despite all the pink ribbons and yellow bracelets and literally millions of published papers on the PubMed database, cancer is the second leading cause of death in the United States right behind heart disease.
Together. These two conditions account for almost one in every two American deaths. The difference is that we understand the Genesis and progression of heart disease fairly well. And we have some effective tools tools with which, to prevent and treat it as a result mortality rates from cardiovascular disease, have dropped by two-thirds since the middle of the 20th century but cancer, still kills Americans, at almost exactly the same rate. It did 50 years ago.
So, cancer horrible.
That being said, I read one time that nurse they surveyed nurses.
You know how would you want to die?
And the nurses chose cancer. Hmm. The n and I guess it was what they said, was you have time. You can say goodbye, you can set things up correctly.
That's what they thought.
I had a friend died of cancer.
Pancreatic cancer, how
old
48 something like that. Very fit, very fit, triathlete type guy and
and
I remember I didn't I Googled it was it was early internet so this was probably
Those not earlier, it was like 2,000 and let's say, 2010, 2011, 2012 something around there. And one of my other friends called and said, hey, we just got, you know, he has cancer, he's got this kind of cancer, pancreatic cancer, I Google it. Pancreatic cancer Soul cancer, survival rate after two years, 0% something that will maybe was survival rate after
fighting if it's spread. Yeah, 0%. Well, will overall it's like less than 5% for
everybody? Yeah,
it's the most.
Lethal cancer, along with the a certain type of brain
cancer. He died. Four months later, I mean, it was, he must have not known about it until late which I know you get into in the book. But
yeah, it was
awful. What it did to this incredibly healthy guy in a very short period of time, which is what surprised me when these nurses said, I think cancer would be the best way, but I guess you have that time to make things, right?
I'm really I don't know why you telling that story really reminds me of another one of these memories I have from residency. So I was doing a rotation in the ER. So as a surgical resident you will do typically one month a year as the surgical lead of the ER, so you're in the ER taking care of everything that walks in. But they're, they're driving to you the surgical cases and so that means, you know, anything that needs to be
Be stitched up, sewn up, drained puss, this that and the other thing put a chest tube in your kind of doing all those things. So I'm in the I'm in the surgical wing of the of the ER at Hopkins and this young girl comes in and God she was she was she was probably 21. She's her mom brought her in and she was just complaining of back pain and it had been like pretty significant been something we've been going on for weeks.
And she finally, you know, they just came to the ER which again is kind of an unusual place to go for back pain. You normally would go and see your doctor or go and get a referral to PT or something like that. And you know, I examine her and she's really in a lot of pain and I remember there's a handful things you just sort of remember and I remember like, just beautiful beautiful completely healthy looking 21 year old, but there was no question that as I pressed on her spine, like it was really quite
Tender. And so I suspect that maybe she had a fracture, like, it's possible. She didn't report any trauma and who knows? Like, I just assumed look either, she's got some fracture there because there's some tenderness or, you know, more likely, maybe she's, you know, really had some serious disc disease. And so, you know, for a fracture, the test you want to do is a CT scan, not an MRI at the time it was to it would take too long to get the MRI. So I figured look let's do the CT, scan, if nothing.
Else, we don't see a fracture, we would probably just admit her for pain and then, you know, she would get it, you know she'd go to the you know Orthopedic floor something they would do an MRI and figure out. Okay. So anyway to make a long story short do the CT scan she's got metastatic pancreatic cancer and it's spread to her bone and that's why she's in so much pain. And I mean it's again it's just one of those moments where like I can't believe this is happening.
And how do I go and tell this girl and her mom? And her mom looks like she's, you know, 45 like her mom's a young woman and and at that point she's going to be admitted to not a surgical floor because this is not a surgical case when the cancer has spread, she's going to be admitted to a medical service to a medical oncology service. And you know, they're going to they're going to palliate her at this point. They're probably in. They might give her some ineffective chemo but it's mostly palliation.
And I just, you know, I just remember not wanting to let her go. Like I just had this sense of like God, I wish I wish I could admit her to a surgical service, which of course was made no sense at all, right.
But you know, pancreatic cancer is awful. I mean, it is awful. It's, you know, it's one of those cancers that gives cancer a bad name and it's interesting that there's a subset of pancreatic cancer, that is curable. So most of them are what are called exocrine pancreatic cancer. So the adenocarcinoma of the pancreas. So the pancreas is made up just broadly speaking 5% of the pancreas is
Endocrine, that's the part that secretes, insulin and glucagon and these peptides, and then 95% of it is exocrine, it secretes the digestive juices, that's where the majority of cancers arise. And those are the cancers that are essentially uniformly fatal, but every once in a while, someone will get a pancreatic cancer of the endocrine system, like a glucagon Oma or an insulinoma, believe it or not. Those cancers are almost always survivable provided you don't let
Them Fester forever. Do you know who died of a pancreatic endocrine tumor unnecessarily.
No, Steve Jobs.
How that
happened. So he was diagnosed with a tumor and for reasons I don't, I was never involved in his care. Of course, I didn't never knew the guy, but based on everything I've read, he just decided he was going to beat this treatment. He was going to beat his cancer with juice and stuff like that. So he went way too long without getting treatment and by the time he did get treatment, the cancer had spread to his liver.
It was a bit too late, they treated him, but ultimately he needed a liver transplantation which is a very unusual procedure you would do. You normally would never do a liver transplant for cancer? That has spread to the liver, but you could do it for this type of cancer, but even then it was too little too late and he ultimately died as a result. So it's sort of one of the great ironies, right? Which is you have this person who, you know, had such a remarkable impact on the world.
Gets diagnosed with the cancer, but gets really lucky in that he gets diagnosed with a cancer. That is survivable. But, you know, for reasons of his own just felt that he could sort of beat this without traditional treatment, but you know, the people I've spoken to and I do know people who were involved in his care and they've all said that head, he undergone the standard treatment for that immediately probably still be alive.
Is this is this just crazy
ego.
I don't know. I mean, I again having never met the guy knowing nothing about him, you know, literally only having read a bunch of his biographies, you know, his biographers would certainly speculate and they have
but I don't understand. Yeah. And at a certain point, your doctors are telling you and then you're, you know, I'm sure he went and got a second opinion and a third opinion, and they're all like, hey, bro, you need to get this taken care of and he's like, no, I'm good past.
Me the carrot juice. Yeah, damn, that's insane. I did not know that.
Fast forward a little bit important to bring this up the final and perhaps most important tool. In our anti-cancer, Arsenal is early aggressive screening this remains a controversial topic, but the evidence is overwhelming that catching cancer. Early is almost always net beneficial. Unfortunately. The same problem I encountered in residency applies today, too many cancers are detected too late and after they've after they've grown and spread,
Very few treatments work against these Advanced cancers, in most cases outside of the few cancers that respond to immunotherapies the best. We can hope for is delay is to delay death slightly. The 10-year survival rate for patients with metastatic cancers virtually the same. Now as it was 50 years ago, 0,
We do we need to do more than hope for novel therapies when cancers are detected early in stage 1, survival rates Skyrocket. This is partly because of simple math. The early stage cancers compromise, fewer total cancer cells or sorry. Comprise fewer total cancerous cells with fewer mutations and thus are more vulnerable to treatment with drugs that we do have, including some immunotherapies, I would go so far as to argue that early detection is our best hope.
For radically reducing cancer. Mortality where does the resistance come from?
I think it
comes from an overly simplistic view. So let's take a step back, right? You alluded to kind of medicine 2.0 earlier and we, you know, I one of the first chapters in the book is kind of devoted to explaining the difference between medicine 2.0 and 3.0. And by the way, it's the
underlying that's the underlying theme of the book. Is that medicine 2.0 is hey, we treat what hits us medicine 3.0 is or sorry medicine. 2.0 is we catch the eggs that are dropping from the from the building?
Medicine 3.0 is we go and find out who's dropping these eggs and we get them to stop. So it's prevention, interdiction, early, introduction, early detection. That's what medicine 3.0
is. Yeah. So as you go deeper and deeper into that, you realize that one of the Hallmarks of medicine 2.0 is an appropriate Reliance on randomized, control, trials. So, again, if you take a step back and go into the medicine 1.0 days, which was basically all of human history up,
Up until the late 19th century. We were just making stuff up. Like everything was just sort of made up. Everything was a story, right? I mean I mean if you go back and really think about it, like that's how we made sense of the world around us. We are storytelling creatures. And we had to make sense of the Sun, the moon, the stars, Darkness, bad things happening. Every, you know, how why is Johnny sick? It must be the bad. Humors must be the bad air.
Clear. It's getting dark. And then light clearly these things are revolving around us, right? So you can't fault us for doing this. But once the scientific method was really developed, this happens in the sort of middle of the 17th century, you fast-forward a couple hundred years and we now start coming up with this idea of doing experiments and this becomes very, very important. In fact, it becomes the Cornerstone of medicine to
2.0 and these experiments, which everyone has heard of called, randomized controlled experiments have an area where they work really well. But they have blind spots, so, they work really well when the interventions are simple, and when the outcomes are going to occur relatively quickly, so a good example, of a randomized control trial is, you know, does giving kids, you know?
Vaccine for measles prevent measles. And, you know, even that's too complicated. Let's take something simple like does using this antibiotic when you have an ear infection, reduce the risk of perforated eardrums and long-term complications. You would take a bunch of kids and you would randomize some of them to the antibiotic and some of them to a placebo and you would follow them. And you would very quickly, see that there's a difference, and because they've been randomized, you've eliminated the bias. This is the magic of randomization. It takes out bias. We otherwise can't eliminate
Nate bias. Fully randomized control trials. Don't work very well in nutrition because the intervention is way too complicated. It's very difficult to tell a group of people to go and do something nutrition wise and have them be perfectly compliant for five years and come back and compare it to another group of people we can talk about some examples of where that's work. But nevertheless, it's challenging. There's that time course so
Even with the best of intentions, the randomized controlled experiment has a problem which is it's only giving you average information. So you put n people into the system, they're all different.
You run an intervention and you get an average outcome.
That's valuable information at the population level. It's not very valuable information at the individual level. Any individual that went into the computation of that average could be quite distinct. There's quite a variance to that.
So bringing this back to cancer screening, the real issue with cancer, screening is the the technologies that are typically debated all have strengths and weaknesses. All have limitations all have blind spots and if you look at this in a very simple way and you factor in dollars,
You might make the case that you know the only way it's Justified to catch a cancer is if it saves money in the long run and that's kind of true in a way. But it's based on a couple of problems that I'm not really here to write about. So I'm only here to write about the individual. I'm not here to write about the policy and the reason being is I think the policy side is broken. So we have artificial costs associated with
Health Care in the United States. So none of the dollars that we talked about in the US are real dollars. It's just funny money. They're made up numbers and it's gotten a lot worse in the past.
Twelve years. So 12 years the US government made a deal with the devil and the deal was you promote the Affordable Care Act? We will never negotiate with you on price again.
To the drug companies. So we just pay much more for that. Furthermore, we have this two tiered system of for-profit, not-for-profit in healthcare. So all of a sudden unlike everybody else, we have a for-profit Health Care system which just drives up cost remarkably. So, you know, that's a whole separate discussion which I'm not interested in at the moment, I'm actually asking the question, what should you do, what should your wife do to maximize?
Their odds of not getting cancer or if you get cancer beating it. So in that situation, we have to stack screening modalities. So let's take breast cancer as one example. And then we'll take prostate is another example and use those to because they're, those are the second and third leading causes of cancer death. So it's lung breast and prostate colon pancreatic. Those are the top five, those five, cancers are responsible for more than 50% of cancer deaths in the United States.
So, the standard, you know, thinking on breast cancer, historically has been mammography, and a mammogram is a decent test, but it's not a great test because no, single test is a great test. A mammogram has like a roughly 90 percent sensitivity, and 85 percent specificity. So sensitivity means How likely is it to see cancer? If cancer is present. So the answer is about 90%, the 85 percent specificity
Issa. T means How likely is it to say no? Cancer is there. If indeed know cancer. Is there 85% that might sound?
Okay, it doesn't sound okay to me at all, bro. Honestly. Yeah, it doesn't
because when you start to factor in the relatively low prevalence of cancer, which might be one in ten, your positive, predictive value in your negative predictive value were horrible. So this is how mammography got a bad rap and this is why some people say well, you know, mammography is like yeah, you should do it but you know, we don't need to do it that often or
Or you know, you've got all these reasons for not doing it or. And what I would say is, yeah, mammography is really good at some types of cancer. It's good in women, typically post menopause, because post-menopause, their breast tissue is much less grip glandular. So it's easier for the X-ray to see. It's also better when cancers have some degree of calcification in them.
But it's not good for glandular, glandular breast tissue, it's not creepy. If great, if the cancer doesn't have any calcification in it. So instead of just thinking about mammography we should be thinking about. How do you combine mammography with either ultrasound or MRI which are far more sensitive? Now again A lot of people are just going to say who's going to pay for that. Well, I'd argue. That's where we should be spending money. We shouldn't be spending money on drugs that we're going to put people on when they have metastatic cancer.
Cycle after cycle after cycle, after cycle, it's much better to spend the money right now. When you treat something, that's very small. Similarly, for prostate cancer. I mean, the PSA test has basically become persona non grata. So basically, the thinking today is there is no official recommendation on prostate cancer screening. Despite the fact that it's the second leading cause of cancer death in men, there is no actual recommendation on screening and the reason is people say the PSA test is neither sensitive nor
Specific enough and that's true. It's an in particular on the specificity. It has very low specificity.
But that's if you take it in isolation, in other words, if you say, look, we're only going to care. We're only going to trigger, you know, an awareness, if a guy's PSA is over 4, and if you do that, you're going to be doing a lot of unnecessary biopsies. You're also going to miss quite a few prostate Cancers. And I just think of that as like I don't know paint by numbers, right? Like yeah, paint-by-numbers sucks like if you want to be a real artist, you can't have lines that you coloring with numbers. Like you have to go beyond that.
And to do that, for example, you should be looking at the velocity of PSA. So not just looking at. So if you check a guy's PSA every year, you should be not just looking at the number. But what's the rate of change? If that is over .45 per year? That's even if the absolute numbers are low. That's a reason to be concerned. Secondly, you should be looking at PSA density, so not just looking at the PSA but dividing the PSA, by the size of the prostate. So, you're looking at how much PSA is coming out per unit size of prostate, and the bigger that number, the highwomen,
The
concern. And if you have any man, that's high risk and there are lots of different things that easily would tell you, somebody's high risk, you should be doing other tests such as a 4K test. And if any of those other things trigger you would do a prostate MRI. And if you do all of these things, you could say, oh gosh, the cost is a little bit higher. Yeah, but it's a fraction of the cost and the morbidity that comes with missing that and waiting until that cancer has spread to the Bone because against once prostate cancer has spread to the bones it there's no going back.
Back, there is no effective treatment, it's a terminal condition. So, all of these things come down to just understanding the basics of the following observation, which is every Cancer that gets treated at an early stage. When compared to the same cancer being traded at a late stage even when they use the exact same drugs as a dramatically different survival profile, and we don't need very very fancy drugs to treat these early stage cancers.
So, do does the hospital
Poodles, just run the numbers and think, well, we got a hundred patients. If we give them all all this screening, that's going to cost more than what it's going to cost to
give. It's not the hospital's, it's the payer. So you know, it's a really complicated system our system is and you know it's funny we were talking about this before the podcast started that I'll never write another book again and that's largely true because there's only two conditions on which I would ever write a book again. One is I'd have to have enough time to do it and that's not going to happen.
Or like a decade and two there would have to be a topic. I'd be willing to go deep enough into to spend five years doing it. One of the few topics that would at least trigger that is this topic and write, which is
And I don't know if I could ever do it, right? Like, I just, I don't know if I could in just five years. Wrap my head around this. If I totally, immersed myself. But how would you structurally fix our system? And one element of that problem is the you have the wrong people owning the risk, right? Like we should actually own the risk for our lives, we would make better decisions. You want someone with skin in the game owning the risk hospitals should not be profiting off.
He's care. Like there's all these things that are totally broken but it's the payer that's making the calculation that's saying look I mean we, you know, we don't want to do these things because it
payers, primarily the insurance
companies. Hmm. Or the employer. So it depends on the size. So with a usually, for a company more than 50 people. The employer is the insurance company. So, you know, if you're if you're, you know, if you're General Motors, you are insuring your employees. You do it through.
Someone that's like looks like an insurance company, you do it through at our Blue Cross or whatever, but you're the one that's footing the bill and you're the one that's your the actuary basically.
So, but they're doing what I said which is they got a hundred people or whatever that number is and they run the numbers and say, look, it'll cost this much money for all this different screening, or we just roll the dice. And usually dice come up, that will lose a couple
people where they just look at lousy studies, right? Like there was a study that got so much attention last year by all of the anti screening
It was a study done in the New England Journal of Medicine. So again, very prestigious Journal might have been jamming, but I think it was an internal medicine and it was a study done in Europe and it was testing the hypothesis, which is hey, what's the efficacy of colonoscopy for colon cancer? Screening now, I mean, I don't know how many pages in this book. I devote to the reasons why colonoscopy is one of the most important tool we have because of those five top cancers that kill colon cancer is the only one that we could completely prevent meaning. It's the only one that we can do.
Definitively look at and stopped in its
tracks. You say that. So every, every colon cancer starts as a polyp. That's right. And you can see the polyps, and you can get rid of them. That's right. This is like just the facts. Yep. So, here's this opportunity you. This is a, this is a can't think basically
eliminate. That's right. You could eliminate that, I can't say that for breast, completely, or prostate or lung, or pancreatic. Those are more complicated cancers. Obviously not smoking would get rid of 85 percent of lung cancer. So that's a given.
But 15% of lung, cancers are coming in non-smokers. And if you took all the smokers out a lung cancer, and just looked at the non-smokers and never smokers lung, cancer would still be the seventh leading cause of cancer death, that's how devastating it is. So back to this question. So so this study and I believe it was done in the Scandinavian country but I'm blanking on exactly. Which one if in fact it was in Scandinavia was a 10-year study. That if you read the headline, you would come away thinking. Yeah, it's not worth doing
Rasca P, because the headline was in the group that was randomized to get a colonoscopy versus the group that was randomized. Not to the reduction. In colon cancer, was only I'm going to sort of its I've written about this briefly but I'm going to butcher it. It was small, it was like a couple of percent and so the argument put forth by the anti screening Advocate would be all those colonoscopies. The cost of doing those wasn't worth saving a couple of percent of people from getting colon cancer. But again, here's
You have to be a good consumer of science. You cannot just rely on the headline. You have to look finer okay so the first thing is the study was very poorly done. The study tested taking a group of people and telling them to do nothing and telling a group of people and recommending they get a colonoscopy in the next 10 years. Now, I don't remember the number, but it was less than 40% of the people who were told to get a colonoscopy, actually did get one colonoscopy in that 10-year window of time.
So to me I'm more interesting study if you're really trying so in other words all that study told us that if you tell people to get a colonoscopy in 10 years and and it might have been less, it might have been like, it might have been 25% of the people actually did it one in ten years that you're not going to make that much of a
difference because because in the book, you say it should be. It's not once every 10 years. So this is this thing can progress. What do you recommend? The book every 23 years. Something is no definitive answer to this? Because no one can do the full.
On how long it truly takes for a polyp to develop. But in our practice, we're typically looking about every three years for modest risk, normal risk individuals, higher risk individuals. So someone who gets a colonoscopy and you find a Cecil polyp, which is a higher risk, polyp or someone who gets colonoscopy and they didn't have a complete bowel prep. So you the endoscopist couldn't visualize the complete:. We're going to repeat that in a year but let's just say all things go. Well all systems are go, you go and have a:.
Tosca P. They pull off a couple of pedunculated polyps that turn out to be nothing. We recommend two to three-year repeat as aggressive as that sounds.
But again in this experiment, they did 10 years. We can recommend, you get it and then they actually use this as a reason to not get colonoscopies. That's right. Must be. That's insane. How does it? How does somebody publish something like that?
Well, again, you know, it's people would look at that and say, I mean it was a big randomized, control trial. But again, there's a big confusion. I mean, I think even in the medical establishment, there's a very big confusion between what is efficacy? Which tests how well something works if done perfectly versus Effectiveness? How well, something works based on how you're told to do it. Both of those things are important, they're not the same, you have to know which one you're testing.
Okay, so there's cancer. Damn, and I'm thinking as I am going through this and as we're doing this podcast, I realized like I would, I would have been much better off to have laid out, kind of the way you lay the book out and my didn't do that. So I apologize because you hit these topics, you know? And the next one that you get to is Alzheimer's.
You say this Alzheimer's disease, perhaps the most difficult most attract intractable of the horsemen diseases and you talk. That's what the book. That's another main theme of the book tells the, the horsemen diseases, The Four Horsemen.
Yeah these are the main four diseases that are the result of chronic death. The chronic disease is so cardiovascular disease, cancer, neurodegenerative disease and dementia. And then the fourth one is kind of the foundational one, which is all of those metabolic diseases, like non-alcoholic fatty liver disease and type 2 diabetes.
Yep. So you hit these
He's in this point in the book you're talking about the the most intractable of the horsemen diseases, we have a much more limited understanding of how and why it begins and how to slow or prevent it than we do a theater or solar. Scrolls is how do I say that frickin word atherosclerosis? Yeah that unlike with cancer we currently have no way to treat it once symptoms begin and unlike type 2 diabetes and metabolic dysfunction. It does not appear to be readily reversible. Although the jury's still out on that. This is why almost without
Caption my patients fear dementia, more than any other consequence of Aging including death, they would rather die from cancer or heart disease than lose their minds, their very selves. I had, I watched a close friend of mine, actually, a couple close friend of mine, their father got Alzheimer's, and it was way more rapid.
Than I envisioned. And he was a very active, very physically healthy individual. And this came on very quickly and it was horrible. He was angry. He was confused, he was violent, this is horrifying.
And and another important lesson that was passed on to our past this on everyone as they didn't try and get him into a home until he was too far gone mentally, where it could not be explained to him, what was happening, he didn't accept it. You know, you can go and if you can make that transition, while you're more mentally aware of what's going on and you make the decision and now you are in a home but like good family.
It's trying to do, you know, we don't want to take you on over shoe in there. You know, you stay out here and he didn't want to go in, right? And by the time they got him in, he got kicked out.
Got kicked out of the home like he was too too violent. It was all it was absolutely awful. The only blessing and all this is that he did die. He died relatively quickly after it got really bad.
the weird thing about this is,
Like you say, we lose our minds and their very selves.
Who are we?
The guy who are you? Who am I? What makes me me and if I behave a certain way, when am I not me
anymore?
Yeah, it's an interesting question and again it's a human question, right? It's I don't think we can. I don't think we can think about this through the lens of any other animal.
You know.
A meditator would say we are not our thoughts, right? I mean, I think that that would be, that would be one of the tenets of mindfulness-based meditation is learning to create distance between our thoughts but, you know, on some level, we are right. I mean, I think on some level we are, we are
We are our Consciousness, we are our thoughts. I think those two. I don't think those two are mutually exclusive. I guess. Is what I'm saying. I think we, I think we can. I think it's very valuable to be detached from our thoughts and it's very important to understand that they are things that pass through our minds and that. But at the same time, you know,
there are certain things about me that would cease to make me me if they didn't exist.
I had a woman on this podcast friend of mine, her name is Sarah Wilkinson. Her husband was a seal Elite. Seal great reputation and sheep. They got married when, you know, when he died, I think they got married actually before he was in Seal training and then she spent has spent her his career with him. And he he killed himself while he was on active duty.
and,
What she said was the guy, she married was not the guy that killed himself like he was a different person. And look, what was it? Was PTSD. It was explosive breaching. Like all those things that the brain gets exposed to, and that's why I've been. I've been thinking a lot about that ideal lately is you know, what makes you you and what point are you not you anymore? And I guess there's a lot of
Second and third order effects that go into that, you know, do you say hey if I no longer remember these things and I'm not me anymore. Then put me in a home let me you know put Beyond put me out to pasture.
The.
The Alzheimer's disease, the way it's described in the book when it's like, it sounds like spider webs kind of in the brain. Is that what it is? That's what it appears to be. Yeah, I mean it's basically Dental, you like, dip out of, that's the word you use. There's a word Dental to describe what the brain looks like. Well, there's something in floss. That's the only thing.
You know, there are these proteins that get folded and amyloid is this is the Protein that's most associated.
With, with Alzheimer's disease. And if this amyloid protein, gets misfolded inside the inside the neurons, it's, it's an inflammatory process and then you get these other types of neuro fibularis, detangles called Tau, and they're kind of these structural Tangles around the neurons. So, so there's very much a physical process that's actually happening in the cells that are
Growing the cells. And one of the challenges is that we don't have a direct way to measure those in an early stage. Now, as of right now, we do have some pretty interesting advances. Where there are certain blood tests that can look for things that correlate very well with those findings. Both the amyloid, and the Tao.
So we are just now starting to do this type of stuff where we can use a blood test or if you're willing to be a little bit more aggressive, you could use a lumbar puncture. So do a spinal tap on somebody. And look at the cerebrospinal fluid, we don't do that in clinical practice, but they do that in research studies. And you can identify beta amyloid and Tau in people who are still normal and we can use that. And you might say, well, what's the value in that? I think they're vacant.
You do anything? Well, yeah, I think the value in that is we can we can start to reverse that and we are seeing that. Now again, this is still too early to tell because it hasn't been you know, studied in a large rigorous fashion. So anecdotally, all I can tell you is we do see that making positive changes and there's we can list what those changes are. Can take people who are preclinical. So either they don't have any signs of cognitive impairment or they only have mild signs.
Called MCI of cognitive impairment and we can pull those people back. What? I don't think we can do is take people in Frank, dementia, and make a difference.
Well, speaking of what we can do about these things and and I'll give myself a little reprieve here in saying that this next part of the book that you write part 3 of the book is the basically what we can do about it, part of the book and you go through a section talking about thinking tactically versus thinking strategically, which is a great thing to put in the book, especially from my military perspective, strategically obviously the big picture of what we're trying to accomplish overall and tactically. How do we actually
Make things things happen, and you say this in medicine 3.0, which I think we've described now, and I apologize for not describing that more clearly out of the gate. This is this is us trying to prevent things from happening medicine. 3.0, we have five tactical domains that we can address in order to alter someone's Health. The first is exercise, which I consider to be the far most potent dominant in sorry, potent domain in terms of its impact on both lifespan and
Band of course exercise is not just one thing so I break it down into components of aerobic efficiency maximum aerobic output, VO2 max strength and stability, all of, which we'll discuss in more detail. Next is diet or nutrition or as I prefer to call it nutritional biochemistry. The third domain is sleep, which is gone unappreciated by meant medicine 2.0 until relatively recently. The fourth domain encompasses, a set of tools and techniques to manage and improve emotional health, our fifth and Final
I'll domain consists of various drugs, supplements and hormones. That doctors learn about in medical school and Beyond. I lump these into one bucket called exoticness molecules meaning molecules we ingest from outside the body and the beautiful thing about those as we can control all those different things, we have some level of control over which is Awesome. Chapter 11.
Exercise, the most powerful longevity drug. I never want to fight in the ring. I always won in preparation Muhammad Ali.
This gives good background here several years ago. My friend John Griffin. Pinged me with a question about how he should be exercising. Should he be doing more cardio or more weights? What did I think? I'm really confused by all the contradictory stuff I'm seeing out there. He wrote behind his seemingly. Simple question, I heard a plea for help. John is a smart guy with an incisive mind and yet he used even. He was frustrated by all the conflicting advice from experts, touting, this or that workout as the sure path to perfect health. He couldn't figure out what he needed to be doing in the gym or why.
This was before I had gotten back into full-time, practice of medicine. At the time, I was immersed in the world of nutrition research, which if anything is more confounding than exercise science, Rife with contradictory findings and passionately held dogmas back by flimsy data are eggs, bad, bad or good. What about coffee was driving me nuts, too. I remember those days. I started typing out a reply and kept on writing, by the time I hit send, I had written close to 2,000 words way more than he asked for the poor guy. Just wanted a quick answer. Not a memo. I didn't.
Very VI, either. I later expanded that email to a 10,000 word, manifesto on longevity, which eventually grew into the book you're holding in your hands. Clearly something about John's question, triggered me. It's not that I was a passionate devotee of strength or training over endurance or vice versa, I'd done plenty of both. I was reacting to the binary nature of his question. In case you haven't figured it out by. Now, I'm not fond of the way we reduce these complex nuanced. Vitally important questions down to simple either.
Oars cardio or weights, low carb or plant-based olive oil or beef Tallow. I don't know, must we really make such take sides the problem and we shall see this again in the nutrition chapters is that we have this need to turn everything into a kind of religious War over, which is the one true church. Some experts experts insist that strength training is superior to cardio while an equal number assert, the opposite the debate,
As endless as it is pointless. Sacrificing science on the altar of advocacy. The problem is that we are looking at these hugely important, domains of life exercise, but also nutrition through far too narrow lens. It's not about which side of the gym, you prefer. It seemed so much more essential than that, more than any other tactical domain we discussed in this book. Exercise has the greatest power to determine how you will live out the rest of your life. There are reams of data supporting the notion that even a fairly minimal.
Amount of exercise can lengthen your life by several years, it delays. The onset of chronic diseases pretty much across the board, but it also, amazingly of is amazingly effective at extending and improving Health span. Not only, does it reverse a physical decline, which I suppose is somewhat obvious but it can slow or reserves or reverse cognitive decline as well. So if you adopt only one new set of habits, based on reading this book, it must be in the realm of exercise. If you currently exercise, you will likely want to rethink or and modify your
Graham. And if exercise is not part of your life, at the moment you are not alone. Seventy percent of the u.s. population is like, you now is the time to change that right now. Even a little bit of daily activity is much better than nothing. Going from zero weekly exercise to just 90 minutes per week can reduce your risk from dying. From all causes by 14%, it's very hard to find a drug that can do that. Thus, my answer to questions like the one, my friend,
On Griffin asked me is yes. And yes. Yes, you should be doing more cardio and yes you should be lifting more weights. Yes, I was so stoked when I was reading this part of the book because I finally felt like I was doing something good because I work out very religiously and that was awesome. So I should have
had you read that chapter? Oh you think yeah like don't you think a guest reading? How did we not think of that? That
would have been cool. Yeah, I would
Cool guest reading by Jack.
Yeah, I could have thrown in this little chapter here. I would had to get somebody to help me, you know put the phonetic pronunciation for some of the words what I was thinking so that was weird. 77% of people that don't exercise, I am. So if you were to ask me that question, I was I was probably got to be at least 15 or 20 percent of people in America who don't exercise. Like that's how that's how much I mean. Obviously, I own a gym I do jujitsu.
I do CrossFit like everything that I'm doing, I'm around people that work out and people that come up and talk to me.
All over the world. They all work out. So 70%, that's crazy. What, with your patients?
Is there anything that stops your patients from exercising? When you get that patient? That's like you give them the program and three months later he's like well, but you know next month I'm really going to start for real because he hasn't done anything yet. What's the most wholesome
back? Yeah, I think there are, there are probably a number of things so it's really a subset of people who
Genuinely don't enjoy it. And I try to be sympathetic to that because I acknowledge that I genuinely do enjoy it. Now, it's not clear to me is, do I enjoy it? Because I just started it at such a young age, and it's always been a part of my life and I've done it enough to appreciate the short-term and long-term benefits of it.
you know, one of the things I try to explain to people is that
All of these things that were talking about. But let's use exercise because I think it's the most important.
Have an advantage over of them that saving for retirement is not. So it's not like rocket science that you would tell somebody when they get out of college and start their first job like you got to you got to put some money away, right? You got to save money for for when you're, you know, going to retire and
That, you know, there's value in that and we understand that, but we should also acknowledge that when you ask somebody to do that, there is no short-term gain that comes from that. So, if you're making a thousand bucks a week and you want to set aside 150 bucks a week, there's lots of long term gain to that, but let's be clear. You get nothing in the short term for doing that, you're just $150 lighter every week, it's 150 bucks, you could be spending on anything and you are
Not, but almost everybody would agree that there's value in doing this.
With exercise.
I can point them to all the long-term data and I can make a more compelling case for this than I can for anything else. Again, I can't restate this enough, right? Like, is it better to be fit than to not smoke? Yes. Is it better to be fit than to not be obese? Not have diabetes, not have high blood pressure, nothing compares to Extreme Fitness, in terms of lifespan, with, with respect to all cause mortality in health span.
I can give them all of that. That's like saying you can save $150 a week and I'm going to give you the greatest rate of return. I have an investment vehicle, it's going to give you the greatest rate of return such that, that $150 a week is going to be 10 million dollars in 40 years, that would require a great rate of return.
But but I can say that. Yes, what you also get something in the short term, you do like you get something every single day that you do it
and that's why I mean by exercise is this really potent drug and we can't replicate it because it's not just one molecule. It's doing so much every single time you pound it right? You're getting an endorphin raise, you're getting an immediate response to your vascular system. It's changing your energy levels. It's allowing you to do things here and now
That make you better. There's a psychological component when you do something that is difficult in the gym, or on the track, or in the pool, or wherever you choose to get your exercise. And you develop a sense of fortitude. Again, I'm saying any of these things to your audience is done, right? It's sort of like, what's the expression? It's like telling singing to the choir. Yeah. Singing to the choir singing. Something about the pope. Right? So so I don't need to go through all of that but but
If someone's never done it, and they've never experienced the short-term benefits. The inertia can be really hard. So again, I think this is an argument for, I think why we want kids to be active? I think it's very important that kids are active because I think this is a very important lifelong skill and so again I you know you I'm sure you've been asked these questions. Like if you could, you know, change one thing in the in the in the world today, what would it be with respect to
No,
you're particular issue and I think for me, the one thing I would probably change is Institute a much more rigorous process of physical, education, and exercise from from, from basically, the time kids are born, so it's just take all those movements that kids do perfectly which they do, they're all perfect. When they're born and just never let that go away, and everything should be built around movement, everything education should be built around
movement. Isn't that crazy? Gone and complete opposite direction. Like they don't they have schools with no.
Ee now. And, and when they do have P, it's like nothing. No, it's funny. You were saying this, if why don't you tell your audience this? But you, actually, when I wrote discipline equals freedom field manual, I sent you. Speaking of chapters, I sent you the chapter on physical fitness and I was like, hey, I got and on diet. I was like, hey man, here's what I'm here's what I'm putting out, how am I doing? And you were like, freaking good to go because, which meant, I basically had already been listening to you for a while. So, so that's cool. But
I was going to say, oh I was going to say this this reminded me, you talked about like putting money in the bank physically I remember when I was gonna join the Navy and I was like damn you know, this is like 20 years is a long time but I remember thinking to me as a 17 year old hey when I when I join I'm going to be in such good. Physical shape that when I get out I'll still be like good to go and I was right like it teaches you a lot about physical fitness and it keeps you be.
Was a physical culture of life, is there anything? So, if you get one of these clients of yours, one of your patients, by the way, you have a practice where you help people longevity again. I'm skipping all kinds of stuff today. When you have someone that doesn't want to exercise, have you found anything that helps them? And I have to preemptively say this, people ask me all the time, like, well, how does someone get through SEAL training and some people say, like, you know, you've
Got to have something like really meaningful. The fact of the matter is, there's guys that like having a girlfriend, that dump them in high school, I'm going to show her, I'm going to be a seal and they make it. There's someone else that you know told his dad that I'm going to do this and that's enough. There's like it and there's someone else's ago. They told me I couldn't do it at the recruiting station so I'm going to do it just to prove them wrong. There's and there's some people like odds want to serve my country. I want these people have an infinite number of reasons that they just make it through this.
Program and it doesn't really matter. It doesn't really matter which one you have some people. You I see people on like online will comment like you'll never make it through. If you don't have the y or if you I'm like bro you don't know this dude just like wants to prove his older brother wrong and he makes it like that stuff happens. Have you figured out a way to coerce that out of people. So they understand the value that they'll get, if they freaking exercise 90 minutes a week.
Yeah, it's a combination of things.
It's different for everybody, but I definitely do a little bit of carrot and a little bit of stick. So the stick is usually showing them what the end looks like, without it
days, it's going straight, Scared Straight.
Well, it's marginal decade reality, right? It's like, okay. So let's, let's talk about the inevitability of
decline. I don't know what you told life Babin, but I called today and he's like, he's like breathing hard. And I'm like, oh, what's going on? He's a cop scale. Finished a workout. I was like, oh, I'm getting ready to record with Peter T right now and he goes, yeah.
Why I'm here right now? We're talking about that marginal decade, man. I'm I got my job model in the bath right now, which is funny, you know, I've been, he's been hanging out with me for freaking 17 years, but it wasn't until he looked at his marginal decade from you or he's like, I better get my ass hitting the gym. So there you go. Good job. Yeah.
And look part of it is we're all victims of what works for us and for me that's a very motivating thing, like it's really motivating for me to think about that last decade. I'm now old enough that some of the things
Things that used to motivate me, don't vanity. Matt motivates me less. Okay. I'm going to be honest. Like the first time I stepped foot in a gym it was for a totally different set of reasons. Then the reason I lift weights today
you wanted them
guns. Just he said you didn't, you didn't want it. You don't want to be. You didn't want me to scrawny kid anymore, right? You wanted to show everybody how strong you were, how tough you were. And that and, and sort of none of that stuff means to me today. What it did then. So now I have a different point of view, but I will say this, look, that's the stick.
The carrot part is and this is this is come with with you. No more years doing this is realizing that I just want someone to get a win because once they get a win, they're going to get addicted to the win. So when I start with that patient, who's doing nothing, I don't I hate when they say Peter. What do you do? Because I'm like, wrong question. Like, for me to tell you what I do is just going to make you feel worse and make you feel like this is not
You know, achievable, it's not cheap. But so, so let's forget that. Who cares what I do? I've been doing this since I was a fetus basically, what, what do we want you to do? And I will say something like hey if we can get you working out three hours a week, well actually I take a step back and go. How many hours are you willing to give me of your time?
And they might say 90 minutes. And they might say three hours, and they might say, five hours, whatever it is. But let's just say they say three hours I say great and I point them to the data. It's a look with a three hour. If you gave me three hours of your time, and I could do whatever I wanted with you during that period of time. And I promise, we're not going to hurt you, right? We're going to, we're going to take this incrementally, you know. This is how much we're going to extend your life potentially, and we're talking about years and this is the difference in quality of life, so I get them to buy into that, okay?
Then I say. All right, here's the formula. Half of that time, we're going to do cardio half of that time, we're going to do strength training. And what is the cardio look like? I showed them what it's going to look like and it's not crushing, we're just not there to crush anybody. They don't have any aerobic base at this point. So, all I want them doing is really easy peasy stuff, and it's just about habit building as much as it is about the stuff and it's like, hey, like this is a great time for you to listen to podcast, listen to audio books, listen to
Music, whatever it is in the weight room. We're not, I don't care what you do. If you're someone who wants to go to a gym and work out on a bunch of machines because they don't look intimidating that's great. But if you want to do something a little more complicated, let's just get you carrying things. Can you know? And again we it's a bit more nuanced because I want to make sure they can do it safely and all these other things but it's like what a step UPS on a box look like what does carrying look like? So they might have this idea that they're walking into a CrossFit gym and they're going to be doing cleans and they're going to be squatting.
Laughing. It's like, no, no. You're not gonna be doing any of that stuff anytime soon. And and and I think if people give you three to six months of that, I'm still waiting for someone who at the end of that period of time says I don't feel better and if they feel as long as as long as you get there, your home, run your good. Yeah
the chapter goes I mean the chapters. All kinds of good detail in their Zone to VO2 max strength training, grip, strength, concentric and eccentric loading.
Can you cover all kinds of stuff in there with in a in clear language? That helps people understand what they need to do. So go get the book. The next section here is the gospel of stability, chapter 13.
Relearning how to move to prevent injury? This is like a journey that you had to go on and what does it mean to you? When you when you want to explain to people? What is what do you mean by the gospel of
stability? Yeah, I mean this is a I think it's one of the most complicated chapters in the book and it was definitely the hardest one to write from a technical standpoint because I think stability is something people kind of understand but it doesn't really have a great definition. I mean, I Define it in there in the, you know, the best ways. I
And, but I think the easiest way to think about it, is, you know, a stable body is a body that transmits Force to the outside world, without dissipation of force and energy leak, and it's 12 which force can be applied without internal collapse, and dissipation of energy or injury. So, you know, just an example thinking about that, right? Like, you know, if you're walking up a flight of stairs and our, you're carrying something heavy up a hill and your knees hurt or you're walking.
Down a hill and your knees hurt. That's that's an energy dissipation, right? And you can, you can really go through what's the path of force from the point of contact, which virtually every time we're making contact with the outside world. It's our hands in our feet that are doing the contact. And how is that force moving from your hand, or from your feet into the center of your body? Because that's where it's always going, right? So your feet are transmitting Force through your ankles, your knees your hips, into your pelvis.
Etcetera. And, you know, stability really comes down to creating an exoskeleton that allows that force to be transmitted safely. So the injuries that we have, many of which are chronic. But even the acute ones are usually acute on chronic weaknesses. So you know, when somebody tears their ACL that wouldn't necessarily have happen, you know, if you took 10 people and expose them to that same Force at that.
Same moment, maybe seven of them would have torn their ACL, three of them wouldn't have. And a lot of that can be attributed to different types of strength. So, stability, in the knee, for example, lateral strength, in the knee stability, within the back explains. A lot of why people have, you know, as I did lower back injuries and why, you know, failure to generate sufficient intra-abdominal pressure can lead to energy leak. So,
To me, this concept of stability goes so hand-in-hand with strength because a big part of Health span is not just being strong and having good cardiorespiratory Fitness. It's also being free of injury. It's being relatively pain-free and I think that a very important part of this journey for me personally has been learning how to manage the sins of my youth from an injury
perspective.
I am, I, I often get asked about like, you know, this kind of stuff, especially with jiu-jitsu people, they're like okay, you know what, dangers, if you had, and I'm like, hmm, I'm pretty good to go. You know, I'm pretty good to go and I think the reason that I'm pretty good to go again knock on wood thousand times is because I work out and I work out religiously so I think that
When you, you know, you put your foot down, you put your arm down and you get injured, because that's what happens, or we have a friend, that just tore, his ACL, like, taking a step, literally, like you doing Jujitsu, but he wasn't getting. He looked, he wasn't no, nothing Dynamic. He was taking a step. He's actually taking a step backwards felt at week. Falls down on the mat, like holding his knee, torn ACL, from nothing scary. But I feel like working
Nowt, lifting squatting doing pull-ups, doing dips. I feel like those things, I feel like, I feel like I have, pretty good stability. I knew at this juncture, I need to work on my flexibility. Again, I you I worked on my flexibility several years ago and I got flexible and I felt good about it and then I I'm the worst the
worst. What would like give me an example of something that is is suboptimal for you. My shoulders are
really, really inflexible right now. The
In fact about
night and I have lost a lot of mobility in them and I've just started getting it back started proactively doing the stretches that I did for. I just I just showed shoulder that hurt me one time. This was probably 15 years ago maybe even longer than that. Yes, probably 15 or 20 years ago, had a shoulder that was constantly hurting constantly hurting constantly hurting and finally, I did like religious stretching and either pain went away and Mobility.
And it felt great. So I'm going to go through that protocol again and get it back. But those are the kind of things where I know and another thing your had to, you know, burst her sword from sore necks. No. Anyways, I
have a so builds Jim. Yep. Special chips,
built built my gym, but we were having a conversation and it's really easy to have an exercise that you for whatever reason can't do for whatever period of time. For instance, a polyp, right? You could say, oh, I
My shoulder can't do a pull-up. It's very easy to never do a pull up again in your life. Hmm, and that's not good. So, what I told him is like I don't even whatever I try and keep the exercises that I've been able to do before and continually try and maintain them. And if for some reason like I got a I got an arm injury by Dean Lester, my friend, my coach, he's
Owing a Jujitsu move. He's never hurt me. While we were training in 20-something years, he was showing a move and like really hurt my arm and so for six or seven months, I couldn't do an overhead squat because I just could not exceed. You know, you got all kind of lock out your arms, overhead squat. I could not do it. And when I finally could extend my arms again,
I could I just didn't have the strength anymore and I could see. I was like, oh, that's what happens to people. What happens to people is they go, oh, I guess that's gone. And I said to myself, I will not submit to this. I will give me the PVC pipe where let's start again. Let's go and slowly started building that strength back so I think that's what happens. And I know we've got a section in here about or maybe we already covered the section. But you talked about the fact that you
You see people get derailed. Matter of fact, we want one of the stories you tell and here is one of your friend's moms. She was healthy doing well. She fell broke his femur something and then all sudden you can't work in the garden. You can't walk around anymore and everything falls apart. That's why. Here's the, what grit. Here's some great piece of advice. I don't know if you have this in here. This is from me because I get asked this question all the time.
I hurt my arm, I hurt my back, I hurt my whatever I'm sick. What should I do? And this is such a good answer, I'm going to give it to you. Do what you can you do, what you can? You look you used to be able to do 20 pull-ups and now you can only do a - and only on one arm right now because your shoulders hurting your other cool. Do what you can? Oh you can't run anymore because you got your knees tweaked cool but you can go on the hand bike. Cool do what you can and then try and
Get back trying, trying to aggressively go back now, I'm not too aggressively but go back and retake those exercises reach it. I was I was building a house and while I was building a house is living another house, my house that I was living in had a garage where I put my garage gym with whatever 7-foot ceilings. I couldn't do muscle ups in those, and I didn't think much about it. It wasn't like I was injured, I think I just oh, you know and it took
Months build the house sold for 18 months. I would wasn't really doing muscles, didn't really think about it again, you know, he's Kiddin. Couldn't go up that high so that just wasn't doing, didn't think about it? I was really excited. Got back to my new house. Had my I have, I have 20-foot ceilings in my garage now, so like I can do muscles. Rope comes after but I did that first muscle up work out and I was like oh, the whole you got week in.
This Pratap look, I did dip the whole time. I did post all time, but I got weak and then I just have to rebuild that. That's a good thing is if you've had to rebuild before from an injury you realize that you can rebuild you had the shoulder surgery.
Yeah. So I had I tore my labrum probably for the first time in boxing. Anytime you once you dislocate or subjects your shoulder, you're going to damage that labrum. And so, I had multiple subluxation 's in my, in my teenage years.
and then swimming, you know, as an extreme distance swimmer, that that sort of made things were so by about
2012, it was, it was sufficiently bad that I knew surgery, you know? I knew I was going to need surgery, but I met, you know, some really good folks who rehab me to the point where I was doing awesome. So, in 2020, when we came to Austin, I, you know, met this awesome. Oh, actually, I'd met him many years before, but he happened to be an Aussie was an orthopedic surgeon to split his time between New York and Boston named Alton Baron. And I went to see Alton having a little shoulder pain,
No. And he said, well, let's do another MRI. It's been, you know, eight years since your last one and it's like, yeah, it's horrible. Like dude, you're you don't have a labrum, it's just, it's all hanging off there and more importantly that explains your symptoms, right? The MRI by itself, doesn't actually tell you the whole story. It's let me examine you and see where your pain is and he's like, yeah. I mean, luckily you do so much other stuff like your rotator cuff is an amazing shape. It's so strong, but your rotator cuff is stabilizing your shoulder.
And not your labor. Your labrum is what should be holding that in place. So I said, so do I do you think I need surgery? Now he goes no, I wouldn't. I wouldn't do it until you can't take it anymore. Like, let's see how far you can milk this. And I was like great. And then, finally, in one day in 20, 22 January, 20, 22. I was I was driving my car at the racetrack and there was just something about the way I was getting in and out of the car that day that just finally tipped it over the edge and to make a long story short, we were like
Yep. Okay, now it's time to do the surgery. So we did the surgery in March at 22 and actually put a video up on Instagram of him and examining me under anesthesia on the table. Because that's the only time he could ever fully demonstrate how loose the shoulder was because I had to be under general anesthesia for the rotator cuff to relax and it's one of the most gruesome videos you'll ever see. It's like, I'm sitting up,
intubating. I remember that. Yeah. And he's just
going one and I mean, it's like,
He demonstrates like if there was any doubt that you needed this surgery, we just erase that doubt. So I have the surgery and it's so funny to hear you talk about you know what you just said because these are all my fears, right? It's like, you know, grip strength is such an important part of my existence like so much of what I do is predicated on, being able to carry things, being able to hang being able to do pull-ups, you know, the dead hang is one of my favorite tests. It's a it's not a regular part of my training but it's a
Test set twice a month, I will do a dead hang for time and there's something we do with our patients. And, you know, my goal was to get to five minutes, you know. Five minutes is generally considered the gold standard. Like if you can dead, hang 45 minutes, you're really special, I'd never got there. But I was at like, 44 minutes and 36 seconds or
something, how big of a
bar? Probably like a oh, you know, I do it on a 45, like a regular like, okay. Olympic. Parcel skinny, right? Okay, yeah.
So I put that up on the pull-up
bar. Can it rotate while it's there?
It doesn't. Okay. Yeah it's let's sort of locked in cool my wife by the way, first time she ever did a dead, hang went 308. They
like that's
ridiculous for anybody but for a woman that's really strong. So I knew that post-surgery, like, it was going to be. And again, not, this is not true for every shoulder surgery, but because of the name,
Because of the nature of mine. I knew it was going to be six months before I could deadlift and is going to be six months before I could carry anything very heavy. So I knew how much my grip strength is going to decline. So I did as much as I could around it, right? So it's funny the day after surgery, I was in the gym in a sling doing leg extensions and leg curls. And within three days, I was even able to do this other machine where you strap a belt to your waist and you do like, you know, sort of like deadlifts but without holding the bar, so it's right.
But I'll tell you what. Here we are today. 15 months post surgery. I still can't get the four and a half minutes like and I'm working at it but that's like I tell this story to say when you lose it it can take a while to get it back. And why this matters is the most important rule of working out is, don't injure yourself doing it? Because once you get to a certain age any time on the side,
Mine's is going to just make it harder and harder to get back. So you know you alluded to the broken hip story, right? I mean these statistics are so important to understand for two reasons. One is so let's just State the stats. Once you're 65 and up if you fall and break your hip or femur.
Depending on the study, there's a 15 to 30 percent chance. You're dead in a year.
The one-year mortality of a broken hip or Femur for those aged 65 and up is 15 to 30 percent.
What's equally tragic in my mind is of the 70 to 85 percent of people who don't actually die, half of them will have a full level reduction in Mobility meaning if they were able to walk easily before they will require a cane for the rest of their lives, if they were walking with a cane before, they will go to a walker. If they were in a walker before they will go to a wheelchair. That's called a full reduction in
functionality.
Some of the freaking stud and they're 72 years old and they break their femur doing Jiu-Jitsu. They're
more likely to survive than someone who's not right. Because I mean, again, there's a lot of acute things that can go wrong, you know, you can have a fat embolism, you can have a, you know, a pulmonary embolism. There's a lot of stuff that can go wrong in the perioperative phase but a big part of why those people die if they don't die immediately, it's the inactivity. It's, you know, once you
Reach a certain age, it can take 6 months to 12 months, to put on the amount of muscle, you'd lose from 10 days of inactivity.
Think about that for a second, right? Like 10 days of inactivity is not a lot for someone who gets injured,
if that's like.you know you went on vacation and decided. Oh, you know what, I'm just going to relax and you didn't work out.
Well, it's funny. You say that the MIT is one of things. We talked about a lot with our patients is we've got a lot of patience. And at the end of the year, they're not making gains. And what we're realizing is, you know, you're in Abby's it for a month like you undid all the work you did. Now again, you're not killing it for those 11 months, but you're doing good enough for 11 months.
But you just undid it in a month.
What is that? What is that? When you're
23?
I don't know, but it wouldn't be as
dramatic. Seemed like when I was 23
definition, nothing matter. Yeah. It was just, it was just like, nothing better
job do whatever you're still, it's gonna
Crush. Yeah, yeah. But you know, the experiments that are done are done in, you know, 60 65 year, olds and as you get older, you become more anabolic Lee resistant. That meaning, literally, it is harder to experience, anabolic function, you require more protein to make the same amount of muscle.
You had more steak.
Let's go
Go.
So you can continue here much denial. There is over here on my side of the table, like I'm like, hey, the guy I was talking about earlier, that won't happen to me. That's me all day long. That's my attitude. It's frickin jacked-up or it's really cool. I don't know. We think Kerry, I think it's good to go. More steak more, milk more. Did you do keep it rolling. Now so you again the chapter and go ahead,
oh no, I was going to ask you, tell me, tell me a little bit about I mean,
Jiu-Jitsu fascinates me. I don't do it. I've never done it. My boys. Both do it. They love it. I'm so happy to see them doing it. It seems. Especially the younger ones. Still, you know, you just have a hard time getting his attention sometimes, but but the older one who's eight, like it really is the thing. He loves, I can really see him doing this as his thing. He loves it in a way that he didn't love any other thing, he tried. Yes. And so, you know, like do kids get injured doing
This. I mean, like what are the, what are the, what are the things that a parent needs to understand? Is their kid is doing,
Jiu-Jitsu kid's gonna get injured in Jiu-Jitsu, same likelihood, soccer basketball, whatever else.
What are the main injuries? Are they head injuries, are they shoulder injuries, knee
injuries, knees, shoulders, elbows just sort of like, they're playing basketball,
so kids more resilient because he just freaked out back so much quicker
kids. Honestly, my kids didn't get hurt doing Jiu-Jitsu like
They were doing Jiu-Jitsu seven days a week from the ages of zero now from the ages of 5 to, like, for the girls 11:55, and for my son five, until current
time. And
they never had any kind of serious injury. My daughter that did gymnastics got injuries from gymnastics. My daughter, that did ballet got way. Worse injuries, ballet is crazy.
So I don't think there's like huge for kids. I think it's
great. And what about the opposite end of the spectrum? Like what are the oldest people? You have come into the gym,
60.
Yep, but no one in their 70s and 80s, but
there's people that there's people that compete at 70, they have a masters division at 70 and up, it's definitely, you know, depends on the person you can do it. I mean, Ellie. Oh, Gracie the, the founder of Gracie, Jiu-Jitsu he was doing jiu-jitsu.
And rolling until he was in his 80s, 90s, still doing it. So you can do it. I think it can be a lifelong sport. I think he'd be a lifelong sport as much as as much as tennis or golf or, you know, people play Pick-up basketball. I mean, it just depends on what you do with yourself and if you let those little movement slip away and you don't say to yourself, hey I'm going to get that movement back. You know, if you don't do that, it's going to go. See if you don't, if you don't use it, you're going to lose it. That's
That's an accurate statement. So the other thing that's great about Jiu-Jitsu is, you know, they're going to get cardiovascular work. They're going to get strength training, the great flexibility. All from one big thing, so that's kind of nice too. Not to mention, they'll never get, they'll never get beat up at least, not in school by someone their own age, right? Can there be a sixteen-year-old when they're 12? Yeah, but generally speaking 16 year-olds, don't beat up 12 year olds like generally speaking. They might bully.
They might push them around but you usually have peer or near peer bullying situations and so they're not going to get bullied, which is amazing. They're gonna be able to protect other people and what's interesting, they generally speaking will not become bullies because they understand what physical confrontation does to people. And they don't like it and they recognize that it's not a way to get power over people. So it's
Beneficial across the board across the board. Freaking awesome.
Do you have an occasional like catastrophic injury in Jiu-Jitsu? Yep. Competition. Yep. With kids competition. They generally hopefully have coat referees that will stop the match. If you know a kid gets in an arm lock and he's not tapping because little kids, they won't tap. They want to win so bad. They won't Tableau and so a good ref will stop the match. You win, you know, the other kid win. Sorry you. You shouldn't have gotten.
Not in a position. I always coached and wrapped like that. Hey, I don't care if you weren't going to tap you recall that position you lose, but but they also are pretty safe. The way they do it in terms of they don't allow certain submission holds at certain ages because you don't have the maturity to tap out. There's moves in Jiu-Jitsu is a move called the heel hook, which is putting torsion on the ankle, but what it ends up doing is it's very strange.
It's very different than other submission holds because it doesn't hurt until it until it injures you. So you can see a lot of people, they don't want to tap that. I want to tap a little attack
boom. And you don't want to tap, do they know they're in the heel hook? They know they're in the heel hook generally. So they're just thinking I can get out of this and get out. I can get out, I can you get out of
it? You can. Yes, you can, you can't get out of some Hooks and that's what they're trying to do. And I always, we know we as instructors
Structures in general always saying Hey listen this doesn't hurt an arm, lock it hurts before you're injured. A choke, you just go to sleep, a straight knee, lock it hurts before you're injured. But the heel hook, I mean, you tell me as a doctor, like, you don't have nerves inside your knee by your ACL. That's telling you there's pressure there, right? That's just there. And what would the purpose of being there being nervous around? Guess? It wouldn't be any. So, in the heel hookman,
Manipulates the knee but it's the pressures coming from the heel and the foot, right? So with like any straight arm lock or anything like that, the pressure is directly on the
joint that you're manipulating them. This one's like you know that the next one in the chain that's actually getting the pressure and the
Damage. Yeah, there was just my kids just sent me a video of someone getting he looked. And luckily, for the person that didn't app, you could see that it broke their tib-fib, it just broke the bones, which is great because then you find
You
get four weeks later, it's stronger than it was, you know, that ACL is lifelong. You're dealing with yes. Oh yes, Jiu-Jitsu safe and beautiful for your children. The most important thing you can give children even more important than love. You got a whole chapter about that stuff stability. You go into nutrition here and you kick it off with you say potato, I say nutritional biochemistry which is classic that you got a quote from 5 Min in here.
Religion is a culture of Faith. Science is a culture of doubt.
Very important to understand. And you tell a story in here, I'm not going to read it, but the same story that I freaking had with my wife who used to be like you're not allowed to talk about nutrition with my friends. Like, and this was in the, I guess it was in the 2000s where I was pretty fired up about nutrition. And, of course, my wife's friends would would go crazy at the table with me, you know what he owed. Oh, you're giving your kids poison. That's cool. You know, that? That was how I'd open up the conversation and then you
Say this.
Actually you say, I am no longer a dogmatic advocate of any particular way of eating such as a ketogenic diet or any form of fasting. It took me a long time to figure this out, but the fundamental assumption, underlying the diet Wars and most nutrition research. That there is one perfect diet that works best for every single person is absolutely incorrect. More than anything. I owe this lesson to my patients who struggles have taught me a humility about nutrition that I never could have
and from Reading scientific papers alone. So that's what you figured out. People are
different. Hmm. And again, Perfection can often be the enemy of good. And and so we
We want to be careful that we don't lose sight of what is known and what is speculated and what's a first-order term versus a fifth order term. And I think what's abundantly, clear, are the first order
terms? Give me an example.
Don't be over nourished and don't be undernourished.
Consume sufficient enough protein to support the anabolic activity of muscle.
Derive sufficient micro nutrients from your food, vitamins, minerals, things like that, avoid toxins in food,
that's about it. So we're going to advise, I had a friend at here at this gym and he was got pretty chunky. We might go so far. As to say, you got fat, he was over nourished, he was over nourished. And then, you know, six months later, he's back to his kind of fighting weight. And I said, well if you don't even cut some serious weight, huh?
And I said, yeah, I did. I said, would you like what you do? He said, I stopped eating like an asshole. And I was like, everybody. That's, that's probably a great diet, stop eating, like, an asshole because we all know what that means and you don't have to read a freakin book or be a scientist to know what eating like an asshole donut asshole. We could go down the list, like, how much spaghetti can you, possibly? I can eat it all. If I'm an asshole to myself.
Yeah. It's I found it very helpful that you are explaining to people and then you go you go into
You know, you talk about everything in this chapter and and you hit the
dietary. I mean, I have a nice dress kind of the irony of this. I wrote two chapters on nutrition. It's a 17 chapter book, exercise gets three chapters, that's insane nutrition, gets to everything else gets one and, you know, there was a part of me that wanted to do a very glib chapter on nutrition, which would have been a paragraph basically, just stating the kind of stuff we're talking
about. Don't even like an asshole. Yeah, it's like look, be an energy
balance. Get enough protein.
Oh teen avoid the toxins get the right but but of course I go into the detail right? Which is you have to be able to answer three questions about yourself or anybody else if you're in the business of trying to treat this. And again it's really easy to get the answers to these three questions. Are you over? Nourished are undernourished. Are you adequately muscled or under muscled? Are you metabolically healthy or not?
When you know, the answer to that question, then it's just a matter of understanding. Do you need to increase intake, decrease in trach, maintain intake? Go up or down on protein and what do you need to do with exercise sleep? And all the other things that factor into that, vis-à-vis metabolic health for most people. The answer is, you need to eat less, you need more protein. So you need less total calories, you need more protein calories and that's what brings it full circle to strategy.
Versus tactics, right? So there are basically three strategies to reduce energy intake, dietary restriction, calorie restriction time, restriction. So once you identify your strategy, then you can get into all the tactics and the tactics is where the religion happens.
Okay crazy. It's unbelievable.
You were kind of crazy. Yeah, bro. You were doing. I went out to dinner with you in New York. It was like, you me, Tim like just a bunch of dudes and we were out having a good time,
so I still remember the
restaurant. Yeah, I was freaking delicious, but you would know. I would not. Because you sat there with an empty plate in front of you, as you were in the middle of a four, a five, a five
days into a 7 day pass for something.
Yeah.
Oh, that was awesome. I that you really missed out that night though. That's take. I got was
amazing. I've been back since took her place, I
do he tripled down. So look again, I just have a note here that says get the book because this is a textbook, this is going to help you do an assessment, it's going to help you answer those questions and then guide you in in a direction of which of these strategies and tactics, you can utilize to sort your nutrition out
The next section is the Awakening
your favorite
section. Yeah. And you know what? I figured this was gonna happen so I broke out my book just one equals freedom field manual. And here's what it says, sleep is a necessity. Humans need to sleep. Failure, to get enough sleep has serious side effects, lack of sleep can cause negative hormonal changes, interfere, with the metabolizing of glucose, increased blood pressure, and suppress, the immune system less
Sleep. Also means less human growth hormone in your body, which means less muscle mass and weaker bones. Mentally, the brain is impacted as the ability to pay attention. And concentrate begins to diminish, and problem solving, and basic, reasoning become less acute. Furthermore, over an extended period, there are psychological effects like paranoia and even hallucinations, so that's me. You're on it. You got it? That's me, I wrote that. Now we can that you know like I don't know. People think
Wake up early. I've always waked up early, I've always woken up early and people think I don't believe in Singapore that you need sleep. And I'm not like that. I actually understand that people need sleep and the and quite frankly, other people need more sleep than I do. That's just the way it is. I'm not bragging. It's been like that. My whole life, I have a don't need a lot of sleep and that's the way it is. But I've never told anyone like, hey, you need to sleep less. I've never told anybody that we confirm. I don't think
think I've ever told anybody that I've never told anybody hey, you need to sleep less and you go into some pretty great detail in this book about sleep and it actually, you know, I'll just read the section old man blood scary as it can be in some situations. This short term harm done by a night or three of poor sleep pales in comparison to the damage that we do to ourselves. If this situation continues Kirk parsley, who's been on this podcast,
Observe this, when he was a physician to the seals, he was also a seal outwardly. These men appeared to be prime physical specimens, finely honed in the rigorous training. But when parsley analyze their blood test, he was shocked. Many of these young guys, had the hormone levels and inflammatory markers of men's several decades, older than them old man, blood parsley called it because their training exercises and missions often began at odd hours of the night and required them to stay awake for 24 hours or more at a stretch.
Which they were chronically sleep-deprived their natural sleep-wake cycles. Utterly disrupted. When Kirk told me the story I experienced a jolt of recognition to I, I too had had old man blood during my, not thin, Peter phase in this is earlier part of the book where you are not and you and good shape swimming freaking to Catalina Island but you're also metabolic disaster and not looking as lean as you should. According to your wife who said you should try be a little
You said, let's not a little less not fit with elevated insulin, high triglycerides in a testosterone level in the bottom. Five percent of men in the United States. I'd always attributed my poor health and hormone imbalance to the point of my, at that point, to my lousy diet and died alone. But I'd also spent at least a decade in a state of severe sleep deprivation in residency and afterward belatedly. I realized that not sleeping. It actually caught up to me as well. It was probably even evident my face.
Studies have found that people who sleep less chronically tend to have older-looking flabby or skin than people their same age, who sleep more. Now, I recognize that sleep, diet, and risk of long-term diseases are all intimately connected to each other knowing what I do. Now, I would bet that a few months of perfect sleep. Could have fixed 80% of my problems back, then, even on a crappy diet,
Sleep
and I remember, you know, just make sure people understand why I make such a bold statement there because I was exercising. 28 hours a week. Yeah. In other words I look back at that and say how is it that would so much exercise. I was still, you know, in the state I was in and I think that there are extreme cases with extreme sleep deprivation where, you know, because the old saying the old adage is can you out exercise a bad diet? And the traditional thinking is know, the truth of it is you could
If you can exercise enough, like when I was growing up, I could clearly out exercise a bad diet because I have the world's worst diet and I was probably six percent body fat and fit is a fit. Like, I mean I looked like a
specimen and you also had freaking like high testosterone and cortisol.
Absolutely. So there's clearly a scenario you can, but the difference is like I couldn't exercise that much today. If my life depended on it, you know, I mean I ask this question of
A couple of our mutual friends, right? Who were former seals, who live in Austin now. And one night we were having dinner, this is probably like a year or two ago and I was like, okay, I get from having talked to enough for you guys that like, getting through buds is mostly here. Like, you know, I get that. Well, you guys are no more mentally. You guys are probably, at least as mentally strong today, as you were, then could you get through buds today? And every one of them said, no.
And the reason is they said we don't physically recover the way we used to, like, we couldn't do that volume of suffering today in our late 40s and early 50s. And so, that's why I just think the strategy of I'm going to out exercise. My bad diet like that strategy will not work Beyond a certain age. In that age is pretty young sleep. Introduces. Another wrinkle to that which is really bad sleep and really bad diet. There's no there's no out exercising that at any point either? Yeah.
I
think when when it comes to females going through SEAL training, I think one of the things that's going to be very problematic is the ability to recover quickly enough because they don't have like the testosterone. The don't think they have the hormones to to recover because you are getting a beat-down you are getting
annihilated and it's hard for us is six months, right?
Six months. Yeah. And what I think would happen is I think
that what would happen was if you took an extremely fit person, which I had a actually was lafe lafe and I were having a discussion. This discussion is matter of fact and tia Claire to me who's a CrossFit Champion. I mean, just an incredible specimen of a woman just badass. And I was saying, I said, you know, I mean, you take someone like to your car. I'm sure I said, she got she can deadlift more than me and he's like, no, she can't. I was like, bro. She's like a professional athlete, of course.
Can bubble blah. And I'm and he's like, no, there's no way and I'm like, I bet she can he's like, I bet you can't, we looked it up and her dead lift? I think it was, you know, 405, you know, which is freaking outstanding for a girl. But for a man that's pretty normal rights. Pretty normal. But so, so, but it's still like so she's in the she's in the ballpark, right? She's in the ballpark.
But if you are, I think will happen with a female in Seal training is like, they give you the weekends to recover, but you're barely recovered on Monday morning barely. And then you go another week and you have to recover again and again, and again. And I think what happened is a song
isn't is buds. The worst of it
as far as far
as the physical demand and the the recovery or
lack thereof. It's not, it's not well,
Not because you go overseas and you'll be in some situation where you'll be getting crappy nutrition and even worse sleep or just as bad sleep and you'll be nervous. And like it's going to be worse. It's going to be worse. So that's what I think would happen is I think I think they would need recovery time and they just wouldn't have, they wouldn't be able to keep up over. They probably, they probably be in the top 20% on the runs and swims in the first week. They be in the top 40 percent and the runs and swims in the second week, they
be in the bottom 50% and the third and fourth week, and then and then they just would continue go
down and what was the at the worst of your training. I assume he'll week was the biggest sleep deprivation you've ever experienced in a, in a training. Not, if not in real life, it is and is hell. Week 30 years ago, the same as hell week today, in terms of sleep deprivation, a damn close. Okay. Yeah,
yeah, yep, it's it for, yes, it's the same. It's the same, they'll sleep. They sleep a couple hours and usually why they put you to sleep is to get people to quit.
Because Auntie, you know, you've been awake for Sunday and then Monday, and then Tuesday and then they'll come and say, like, Hey listen, we just got in trouble with the commanding officer and he says we've been too hard on you guys. And he's now told us that you guys need to guys are going to get six hours of sleep and you have to get dry. So go put on dry clothes and you guys will see you in six hours and then you like, welcome to put on dry clothes and you crawl into bed, and then 20 minutes later an hour later or 40 minutes later they're in there with Bowling Center, you right back.
Surfs on a bunch of people. Like I'll do not getting back into this game so and they do that a couple times they do that or something like that. So that's why they let you sleep they let you sleep so that you have to wake up and go back into hell. So that's a transitional period that sometimes and wonder how
much use is there of stimulants,
what kind of stimulants
modafinil you know riddle in things like that.
None.
Did they check guys for that? Or like I mean in your day and age, those things weren't popular but today those are very popular drugs that any high school kid could get ahold of. Do you have any idea if they're a drug
test? The shit out of these kids?
They do so you're getting drug tested during
hell week. I don't think drug test them during hell week, but certainly after how weak and prior to hell week, you're, you're getting drug tested a lot. How much do you eat during hell week? As much as you want? You just to? Well, yeah, you know, time you eat a time, that's, that's
Not limited on nutrition. No, you're you're basically. And then coffee, you can have coffee.
I don't know, I didn't drink coffee. I still don't drink coffee, and I don't know if you could drink off your. I don't think you can. I don't think you can drink coffee during hell week. I don't
know. By the way, there must be a real difference between if you get your if you're doing your hell week in January versus August, there's a big difference is the dropout rate significantly higher in
January. It's higher. It's higher for sure.
It's you know the deal San Diego to can be 37 degrees. No, can be 37 degrees. The interesting thing is what is it in the winter? Hell weeks, the the cold. So you'll get more quitters in Summerhill weeks, they'll get more chafing and more swelling.
And more disease, but more people will make it because cold, is
it what month? Did you do it
spring? I think met late May and here's the other thing like when you're when it's winter time, they check the water temperature. They put you in that water until someone's getting hypothermia.
Oh so you'll spend less time in the water in January on a I
got so that means in the wintertime you're running more, you're doing more and some forces depending on who you are.
Because some people, you know, that did cross country, they don't care. If they run, they run all day. Some people that did water polo, they'd rather swim. There's some people when you go to a pool Evolution, it's it's a rest for them. I was very comfortable in the water. Any of the pool? Not the swims, but not tying pool comp. Well, I failed pool comp, but life-saving, those kind of things. Drown proofing. I was, they were like a break for me. Some people were absolutely horrified of those things. Some people, you know, you take a kid that grand
The country in college, he's doing a 4-mile timed run. There's no doubt that he's going to pass, and he's going to be fine. Guy that swam in college or played water polo. He's going to pass those swims really easily. So people, depending on what your strengths are, you'll have some time where it's, you'll get a little reprieve, but they'll find your weakness to because no one is good. Well, just about no one is good at everything. And even they you and you will get some studs, you'll get some frickin guys that are complete and utter studs and occasionally making sometimes they quit.
Sometimes they quit because they lost something for the first time, you know, they never lost a race before and that's too much for me. They never failed pool complex guy. Did you know I'd failed all kinds of stuff in my life so I feel book on Bullseye cool. What I need you to fix it, but the sleep deprivation thing, you know, some people have bad hallucinations and stuff. And I didn't really have. I had like one whose Nation. You know, I was, we were
paddling our boat and I
looked across the ocean. I found I saw traffic light and I was like and I knew it I was like, well, there's
We're in the ocean. So there's no traffic light. I'm just hallucinating and it wasn't that big of a deal. I recovered from Hell Week pretty quickly. And like I said I've always been I'm very functional without sleep as well. Very functional. Like when I hear Matt Walker and he'll say, you know, if you've had less than five hours of sleep, you cannot use your basically it's the equivalent of four beers or it's a comment of whatever.
That is just not true with me. It's cheesy. And it's not true with many of my friends too. It's not true with many of my friends or at least a decent amount of my friends. I thought I just went out to I I was I did an event in Las Vegas got on a plane red. I slept two hours on the red. I arrived at my next gig and was speaking and interacting and answering questions for eight hours.
Like literally no Factor, literally no factor and and so I don't know if I think there's some a little bit of exaggeration or something with that or I don't know what am I
wrong. I mean, I don't know exactly what the stats are. I kind of forget but it's
I don't think it's four beers. I think it's
Is it four hours is equal to a blood-alcohol of?
.08. Maybe that sounds about right. Yeah, baby. Yeah, there's no doubt. There has to be, there has to be
personal things like you get. Some alcohol. Be, I'm a different man. You want to see some changes, bro. It'll give you know, slate lack of sleep. It's gonna be gets to get me on the sauce. Get me on the fire water and Albert out. You'll meet a different Jocko all day.
When did you stop drinking?
Basically, when I retired it was. So that was in 2010. And I didn't like, it wasn't like, yeah, just all of a sudden. I wasn't hanging around with a bunch of my friends.
Anymore. And I told you, I just stopped and I looked up and I was like, well, no point in doing that anymore. I mean, and I won the World Cup. I had a Guinness. You know, I don't like the taste of alcohol anymore at all. Don't have any desire for it and man, I've seen it just destroy. So many people that I just can't. I can't get on board. I can't give money to that industry. That's can't do it. I'm I'm, I'm becoming more and more anti-alcohol every, you know, every moment of my life now,
And and look, I've been kind of giving the caveat that you know, about had a lot of fun and bonded with the guys and I've started to just like kind of kind of think about that too. And think well, how much fun would I've been having? If I wasn't drinking? What if I wasn't doing that? What would I be doing? What did I miss out on? So I'm even starting to revoke that caveat a little bit as I get older and and and you know, the culture was very strong for alcohol in the whole military, it was even stronger in the Seal team.
And you're a frogman, that's what we're doing. And I was like oh that's what we're doing a little bit later. I'm here, I'm here to be a frogman. Let's go. That's what we're doing. I'm in and I'm going to do it hard, so watch this. But thankfully I, you know, I always also, you know, some people have the, they say, I have an addictive personality and it's almost like a humble brag, like have an addictive personality. I think you actually do have an addictive personality. So some things. Yeah, I don't think I have it. Like, I'm like, okay, cool.
Yeah, I I can stop doing something. Maybe Jiu-Jitsu is a little but but you know, I go to I go times where I can't train and I don't freak out about it, so I don't think I have an addictive personality and it scares me when I think about people that do have that, it scares me to think about what it must be like to want to drink alcohol, or do whatever things so badly that you can't control it. That's, that's very scary to me. I think I have a little bit of
I think I have a little bit of I like to be in control of what's happening and which is weird because when it comes to leadership, I don't have that at all. I don't need to be in control and everyone that works for me will tell you like oh yeah, chocolate is like he's crazy. You let me do whatever I want because I had somebody say something to me about that. About me wanting to you. You want to control stuff. I'm like, actually, I don't care talk to anyone that's ever worked for me, unless they were an idiot, and I had to micromanage them, which is a very small category of people, but most people, they work for me, they were like, doing whatever they want.
And I'm giving him free rein and backing them up and supporting them. But for my personal life, I don't like to feel like I'm going to lose control or feel, like I can't control something that's happening. So that's what scares me about. The doesn't scare me. But the Psychedelic, you know, Villages that people are going on because and will the way I explain it to some of my friends that have been on these voyages and it's been very helpful for them and I've said, like well I feel like I'm
Driving down the road at 80 miles an hour in my vehicle. I don't think I need to stop. Pull over to the side, take apart, my engine, put it back together again, and like, hope I got it right. Doesn't seem like a worthwhile risk to me and I don't feel like I have, you know, that I don't feel bad or feel good. I'm happy. So there's my my thoughts but sleep back to sleep.
The other thing is you can only the short sleepers, the genetic short sleepers, which I don't know from one. I don't think I don't really think I am because it sounds like it's so rare that it could be impossible that I could be one. I used to think it was genetic because one of my kids is like the same way doesn't need to sleep. One of my kids. My oldest daughter doesn't need to sleep. My middle daughter. Go pull her out of bed. You know, my wife, pull her out of bed, my son somewhere in the middle.
Youngest daughter, pull her out of bed. So I thought. Okay, well, that makes sense would be different genes, but they don't hear how rare it is that you're actually really a short sleeper. I'm like, well then I can't be me, but I can survive. First, you're on a pretty small amount of sleep without really much inhibition, and I don't think that's cool. In fact, I want, I want to sleep more. I want to, like, let's go but to your point, which,
You explained in great detail. In the book, there are all kinds of negative impacts to not sleeping enough.
And you've got a section in here about looking at the book, go get the book but you know, don't drink alcohol. Don't eat anything less than three hours before bedtime. I'll stay in from like electronics. For at least one hour before bed of we're doing anything anxiety producing or stimulating such as greeting work, email or God help you checking social media for the folks that have access to a saint or a hot tub.
Go getting that before, bed room. Should be cool. Ideally in the mid-60s I hate to sound like one of those people that I guess I am now but I have a sauna and I have a bed cooler thing and that bed. Cooler thing is
legit yeah it's nice. It's freaking legit it
and when I had it's cold and so like I don't really have like the crazy sweat nightmares anymore.
I guess they're more in Arctic environments, but it works out. Good. Give yourself enough time to sleep. You call it, sleep or scientists. Call it sleep opportunity. Fix your wake-up time, don't deviate it from it. Even on the weekends,
this is where I feel really lucky because my boys, especially the middle one. He's like, this kid is on a clock. He cannot sleep past 6 a.m. Yep. So we don't sleep past 6:00 a.m. you. Don't doesn't matter if it's a holiday, doesn't matter if it's a weekday
Day, doesn't matter if it's a weekend, it's, we're always up at 6:00 and there's something good about that, right? You, you don't get into what's called social jetlag, which is when people try to, you know, Short change their sleep during the week, and then make up for it on the weekends, it doesn't work that way.
Yeah. We're you do the opposite. This is what I've always advise people. Oh, it's Friday night. Some to go out a little later, I'll sleep in. Okay, so now you wake up it ate and now it comes 10:00 at night. You're not tired.
It's because you had more sleep, so you stay up until midnight. And now you can actually until 10:00. And I can't go to sleep until 1:00 in the morning and now you're free. You're getting up early on Monday and it sucks. Oh, so there you go. Get your sleep. Everybody from me.
Get your sleep, definitely, from the doctor here. Get you sleep chapter 17 work-in-progress the high price of ignoring emotional health in. This was the surprise chapter.
On Tuesday, July 11th, 2017. At 5:45 p.m. to be exact, I had received a call from Jill, my wife, she was in an ambulance with our infant. Some sun are written on the way to the hospital. For some reason. He had suddenly stopped breathing and Fallen unconscious. His eyes were completely rolled back in their sockets and he was lifeless and blue with no heartbeat on the quick reaction of our Nanny had saved him. She rushed him to Jill. Who is a nurse? Her Instinct took over.
Recover. She immediately put them on the floor and began performing CPR rhythmically. But carefully pressing your fingers on his tiny sternum as the nanny frantically dialed 911. He was barely a month old. By the time, the firefighters Stone to the house. About five minutes later Ayrton was breathing again and his skin was turning from Blue back to Pink as oxygen return to his body the firemen were stunned. We never see these kids come back. They told Jill to this day we still don't know how or why it happened but this is likely what occurs when baby dies
In babies died suddenly in their sleep, they choke for a moment on their own saliva or some other insult occurs, and they vary. And they're very immature. Nervous systems fail to restart their breathing. When Joe called me from the ambulance, I was in New York in a taxi on 45th Street, on 54th Street on my way to dinner. After she finished telling me what the story, I just said, without a shred of emotion, okay, call me when you get to the hospital so I can talk to the doctors in the eye.
I see you.
She got off the phone pretty quickly, and of course it's obvious. Why she was upset? Our son had nearly died in the right thing for me to say the only thing to say was that I was getting the next flight home
Jill stayed in the hospital with a written alone for four days. She pleaded with me to come home. I called and daily to talk to the doctors and discuss each day's test results. But I stayed in New York with my important work. Aaron's Cardiac Arrest happened on a Tuesday, but I did not come back home to San Diego until Friday of the following week. 10 days later.
Even today. Just thinking about what happened. I feel nauseous about my behavior. I can't believe I did that to my family. I can't believe what a blind, selfish checked out, husband, and father, I was and I know, I may may may never fully forgive myself for as long as I live. I must have been giving off very troubled Vibe during this period because around then my close friend Paul Conte, a medical school classmate, who is now? A brilliant and very intuitive psychiatrist began urging me to go to this place in Kentucky.
Key.
I looked it up and it seemed to be a place for addicts. This doesn't make sense. I told him I'm not an addict, he explained to me over several months of gentle discussion, that addiction can take many forms. Not merely to drugs or alcohol. Often, he continued. It's an outgrowth of some trauma that has happened in a person's past. Paul is an expert in trauma, and he saw that, I displayed all the behavioral signs anger, Detachment obsessiveness, a need to achieve that.
Fueled by insecurity.
I don't know what it was that happened, but you just have to trust me on this. He said he was relentless.
I agreed to go to Kentucky but I was still looking for any excuse to get out of it in early, November, a woman from the bridge, which is the rehab place in Kentucky, called to do my intake interview. It was a long, tedious conversation and my patience finally expired when she asked. Have you ever been subject to any kind of abuse?
I got so angry. I yelled fuck you and hung up the phone.
After this call, I decided to cancel my plans today. What was wrong with these people asking such an idiotic questions that Thanksgiving weekend was still a blur. It's the only Thanksgiving in our life together when we didn't go to dinner with friends or family or host one ourselves. We just stayed home alone on Sunday night. Jill begged me to go to again to go to Kentucky. I just can't go off the grid for that long. I said my patients need me and you need me to help with the kids.
This was total bullshit and we both knew it. She replied point-blank year of no help to me. In fact, you're hurting me and your kids very badly.
Confronted with the brutal truth. I knew I had to go.
So you go out to this place in Kentucky.
You get out there, you are you know trying to keep a low profile.
I thought it was funny that you get called out that you wanted a private room, you know, because you're so important and know you're going to get a roommate, I'm going to fast forward a little bit after 45 days, I could no longer remain silent, which is what you have done for your first several days. They're not telling anybody anything, they'd set aside almost an entire day. When we were all supposed to tell our life stories from the beginning, we had an hour each and we were supposed to prepare.
So it's finally telling my life story for the first time to this group of perfect strangers. Not even jeolla heard the whole thing. But I was telling it in a way that was very matter-of-fact this happened. When I was five this happened when I was 7 and so on some of it was sexual some of it was physical, but it was not all bad. I explained these events terrible. As they were had, led me to take a boxing and martial arts at, at the age of 13, I got to punch bags, people and that channeled, my anger, I learned how to protect myself, but I also gained
Put in Focus qualities that proved invaluable. When around the age of 19, I pivoted from pugilism to mathematics terrible. As it was, my past was also with what set me on the path to becoming a doctor. I continued growing somewhat defensive throughout College. I did volunteer to the shelter for sexually abused teenagers and I became close to many of them over four years, including one young woman who had been abused by her father. When she attempted suicide, one of my one of many attempts, I went to the to visit her in the hospital.
I was a senior by then and I had already applied to the top PHD programs in aerospace engineering but I wasn't really sure it was my calling spending so much time in the hospital with her helped lead to the Epiphany that I was meant to care for people, not solve equations so you see like included parts of my past may have been bad but in a way they also ended up setting me on a course towards a better life. Some of the kids I grew up with and boxed with. Meanwhile we're getting arrested for armed robbery and getting girls pregnant high school and all kinds of other stuff that could have easily been me.
Me. So in a way I said my abuse may have actually saved my life. I don't really even need to be here.
Right. Then one of our therapists Julie Vincent cut me off, there are many rules at the bridge and one of the most important ones was no minimizing. You're not allowed to minimize anything that someone else is saying in your especially not allowed to minimize your own experiences, but she didn't flag me for that. Instead, she asked a simple question. You were five years old when this happened first to you, right? That's right. I replied. And your son Reese is almost 5 years old right now, right? I know,
Nodded. So, you're saying it's okay, that this happened to you and you were his age, but would you be okay with people doing that to Reese now?
Another rule of the bridges. You're not supposed to hand. Anyone? Kleenex, when they're crying, they're supposed to get up and fetch it themselves.
Now it was my turn to stand up and walk over to the kleenex box. It all came pouring out of me. And finally I was able to embrace why I was there and begin the hard work of unpacking the last 40 years of my
life.
when you're going to this place and you show up there,
You know, they say like someone that's going to Seal training.
When you when you go there you know if you're going to quit or not like deep inside, you actually know, do you think you knew what was going to happen when you went to this place?
No.
No. I mean I was just, I was just I was just so angry, you know? I don't think, you know, I wasn't really there on my choice, you know? I mean
If I didn't go, I was leaving the house, right? And never coming back. So
I think I just you know I just had so much anger that I I wasn't thinking about anything other than just trying to get through the day and this place is
Wonderfully awful, right? I mean they deprive you of everything, they don't, you don't, you don't have a phone, they take your books away. There's
I mean, I think I mentioned are the only thing they let me indulge in was exercise, you know, I could get up at 4:30 and they have this janky little Universal machine somewhere in the basement that like, you know, I could go down and use and run in the woods. Like that was it, right? So so aside from that, you're stripped of every defense mechanism, you have
But no, I had no idea what I was in store form.
Now I've felt like talking about combat which I've done I mean, basically cuz I have a podcast and I, you know, I've said that when my friends have died,
I've often been the guy that's giving the eulogy and matter fact, I have a sop. Now, if someone I know dies, I'm immediately writing because I don't know if I want to get the call or not, but Imma Be ready. And I found that to be very, I think that's very helpful.
And so is this the first time? Were you able to, like, Express these things that you'd gone through growing up? Yeah, it's it's it's more than that though, right? I think stating them as facts, is not really the issue it's understanding.
It's stop, it's not justifying them anymore, right? So I think again, there, it wasn't, like, I didn't know this, it happened. It wasn't like, I blocked this out. It was that
You know, bad things happen to everybody and we come up with adaptations, this is a normal healthy important thing. If we don't adapt to bad things, we're hosed, right? Like, that's the end of our species. So,
The only issue is, how many of those adaptations are positive? How many of those adaptations are negative and what I don't think I ever appreciated was that all of the attributes of my personality that were positive and negative. We're actually quite linked. And they all kind of stemmed from A coping strategy around these issues of my childhood. And
I think the first sort of,
thing that I had to kind of realize in that moment was
That the, you know, this place in the bridge, they use a model, right, where you have kind of, you know, you're born as a young healthy child and then you suffer some sort of insult and they, they talk about this thing as the trauma tree, right? So, the trauma tree has branches and Roots. So the branches are the things you see there above the ground, right? So the branches are addiction codependency, you know, all the things that we think of, as, you know,
Habituated survival strategies, the roots are the things beneath the surface, that's the trauma, so that can be abuse, neglect, and measurement, witnessing tragic events, would be traumatic. And the thing to figure out is, how do we go from sort of the young healthy child into an Adaptive child?
into a maladaptive adult and like what is that transition look like, and what adaptations are serving you well, and which ones aren't
And I think that was really, you know, a big part of the takeaway, right? Which was many of those adaptations, have served me incredibly well,
But some of them haven't, some of them have been very destructive and you know, we were talking earlier about alcohol. Well, I feel very fortunate but like you, I mean, I can't, I can't actually relate to somebody who drinks alcohol through addiction. So there's very different chemistry in people's brains. There are some people for whom ethanol triggers, a pleasure Center in them the way I can't relate to. So, you know, drugs.
Halt gambling. These things have never resonated with me. Those aren't my addictions. It just so happens that my addictions are very socially acceptable. I mean, work is a very socially acceptable. Addiction perfectionism is a very socially acceptable. Addiction anger can be tolerated provided you can sort of keep it in check, which I mostly could.
But again, you know, as the story you read at the outset displays, I mean it can get to a point where you're so detached and you're so addicted to, you know, work and you know, your own sort of narcissistic beliefs that, you know, the destruction is just enormous around, you know, to those who are closest to you again. It's not it's not visible to the outside world, but it's it's absolutely visible to the people closest to you.
So you go here, you get you get, I would say from from what you write in the book. It's sort of get its moves in the right direction. It does. Yeah, I leave early, I only stay for 14 days and
most people believed I needed to be there for 6 weeks.
But I begged to go and they were lit.
Fast forward a little bit here.
Weren't covid, X.
2020 as March bled into April, it became clear. There was no end in sight. One day, in late, April 2020, I was on a Routine Morning Call with my practice manager when I couldn't take it anymore and started venting
I've lost control. I told her I can't keep my patients stories straight anymore. Was it patient X or patient? Why, who just last week told me the about his daughters struggle at school. Was a patient a or patient be whom, I needed to reach out to that evening about an issue. She was having. She tried to soothe me saying I was doing the best I could under the circumstances and that our patients were grateful. But the more she talked the angrier I got
And just like that, I spun into a radical self-destructive episode 1, like, I've never experienced before, or since even remembering it now is terrifying. I threw a table across our living room. I tore my t-shirt to pieces. I screamed in Rage and pain. My wife begged me to leave the house for fear, I would harm her or the kids. I thought about driving myself into a bridge abutment or some other structure fast enough that I'd be killed.
I was convinced that I was broken defective.
When they autopsied my brain, they would discover just how screwed up. I was I was beyond fixing nothing could make it right.
I ended up holed up in a motel on the phone with Paul Esther and Terry. They and they insisted that I needed to go back to a place like the bridge now true to form. I stubbornly disagreed, claiming that I could fix this with just a little more time and support. If only I could get home and get some rest after pleading with them for 48 hours. I finally relented and the middle of the night. I drove myself to Phoenix Arizona to be admitted into a place called psychological counseling, services or PCS.
Terry had been telling me about PCS for nearly a year. He said it was a place. That worked miracles. Healing wounds. That seemed Beyond permanent permanent. I asked how he could be. So sure he said I just needed to trust him.
So, you had out there fast forward a little bit on my second day, I was assigned to write a list of 47 affirmations. Representing one positive statement about myself for each year of my life, I made it to about five or six before I got completely stuck for days and days I couldn't come up with anything good to say about myself. My perfectionism and my shame did not permit me to believe anything. Nice about myself, I just couldn't do it finally on the 19th day a blistering. Hot Wednesday morning, it happened, one of my therapist.
Marcus was pushing deeper and deeper into a story. I told him earlier about how it's stopped wanting to celebrate my birthday's. When I was about seven, in fact I revealed I would keep my birthday, a secret until well into my 20s. His question made it clear? That this was not something a healthy child would do and it likely Mass something more deeply wrong. He just kept digging and would not let it go.
That recognition pushed me into an emotional free fall. It had been two and a half years in the making, but I finally was able to let go and accept the truth about my past and how it shaped me without any excuses or rationalizations all that. I had become good and bad was in response to what I experienced. It wasn't simply the Big T traumas either, we uncovered many, many more little T traumas hidden in the cracks that it affected me even more profoundly.
I hadn't been protected, I hadn't felt safe. My trusted been broken by people who are close to me, I felt abandoned, all of that, had manifested itself. As my own self-loathing as an adult, I had become My Own Worst Enemy, and I hadn't deserved any of it. This was the key Insight, that little sweet boy. Did not deserve any of it, and he was still with me.
Once I had accepted all of this, it was easy to write out the 47 affirmations.
so, when you're going through this, with these people, with these therapists,
Was it? What was it? What will happen? So what's going on? Like I literally don't know what this looks like. Like explain it to me if I never seen a boxing match before, what is going on with these therapists? I know we get it. You get into the dialectical behavior therapy. DBT, what does this look
like? Well, PCS is set up as about
80% individual therapy, about 20% group therapy, you're doing therapy from 7:00 in the morning, till 7:00 at night every day. 30 minutes for lunch basically seven days a week. Most people go there for one week, I was there for three. So I was there for 21, straight days, which meant I went through. I went with three different groups, so, I basically did the same thing effectively,
but with three different groups of people, but I had the same individual therapist so we were kind of going deeper and deeper and deeper and again you know I didn't want to stay for three weeks but I also knew from the last time like I'm going to surrender a little bit on this one and I'm going to I'm going to stay as long as they tell me I need to stay this time and so at the end of that second week, I really thought I was there and then my friend Paul called me the night before I was supposed to leave and said
We think you need another week and I was like, I can't do another week of this, like I just can't do any more of this and, you know he just said like, you got to trust me? And I did, and it made sense because of what happened in that last week like that, you know, there's the, there's a quote in there about
You know, the stonecutter hitting the stone right? And it's like on that hundred and first, you know, hit the stone breaks and it looks like well, he did nothing for the first hundred know, the first hundred were just as essential to that one. So even though I think kind of everything really came together for me on that 19th day, it goes back to two and a half years earlier in Kentucky and all the work that had happened in that two and a half year period of time. But it really it just it really
Together on that one, one that moment and and through you know Marcus is real probing and then it was more into the little T stuff truthfully, right? It wasn't into the big obvious stuff at this
point. It's a little t look like yeah I mean it's you
know, it's in my case. I think it was more around
Not not not having a dad around probably was, was the most formative thing that I had just never assumed mattered. I just didn't think that that meant anything. And I think I finally came to accept the fact that you can't use a totally rational brain of a forty-year-old to try to explain what a two-year-old three-year-old or four-year-old five-year-old experience. They don't process things that way.
And I think, once I came to understand that I just stopped making any excuses, you know, I think there was always still some lingering excuses, and they were really standing in the way of doing this, this
kind of work that needed to be done. So we're going to excuse, be, well, I get mad but this is the way I was treated well, as a kid. So that's just the way I am, is that the type of excuse we're talking
about? Um, no, I mean, no. So,
Excuse. I mean, yes. That could be. But that what? So it would more be
Hey, you know, I might not have had this kind of attention as a kid, but it doesn't matter because, you know, I wasn't getting beat to a pulp every single day. Like there was always sort of a way, like, it wasn't that bad. It what, you know, or another excuse could be. So that that's an excuse towards. What's happening to you? Another excuse could be like
You know, I have a horrible temper but like I don't hit my wife or my kids so therefore it has no effect on them right? Like yeah. They see me like screaming at a driver or pulling a guy out of his car and almost killing them. But I mean like I'm not hurting them and not realizing of course how you know illogical that is,
this is I guess it's because covid-19 on but like I remember exactly when this was happening because you and I were talking all the time like
like, yeah, and it's weird for me because
Like seem normal and you told me, like, I can't remember, he told me before, or after you, you went, I don't remember if you told me, hey, I'm going somewhere or if you told me after I just got back from somewhere, but I remember you indicating that you had gone and you said something along the lines of like a, I'm not addicted to anything, but I need to get some shit, sort it out, type thing, that's the thing. And I was like, okay cool. But the reason I'm saying that is because
cuz from just to just to your point that from the outside,
I didn't have any like, look, that I think like you're gets pretty pissed. When you read, you know, misses a shot real, whatever sure. But you know, whatever, I didn't think that was a any kind of like deep issue, you know. So from my perspective again, to be aware of your friends and pay more attention so that you can help out is a good thing to do and obviously in the veteran world, we need to do that, but clearly,
Only it's not just veterans that go through. Trauma, Big T, trauma a little T trauma, whatever. And might need some freaking support sometimes and who knows like
You don't like to talk a little bit about, you know, if you see someone that's doing this kind of stuff, like losing their temper, or their, they're doing things that you think that's a little weird.
That seems a little strange like just to be like, dude, what's going on? Are you good?
I don't know. I feel like a bad friend, you know, to not. Maybe just be a little bit more
proactive. Yeah, I mean, I don't know. I mean, look, I think you know, Paul Conti was able to see that because he's literally one of the smartest psychiatrist on the face of the Earth. Like, I just don't know that a normal smart, a normal, otherwise, smart person could could sort of put those patterns together. So I, you know, I just feel lucky that, you know,
And again, Paul, I remember him saying this, he's like you just live your life like a trauma victim. And I was like, what the hell you talking about? I'm not a trauma, victim, and he goes, okay. But I'm just, I'm just telling you. You, like, you walk, like a duck. You quack, like a duck. It's possible. You're a duck.
And that's a functional alcoholic. But your functional trauma because you're freaking highly functional. I mean, damn, you know, like
Just kicking ass across the in so many different aspects of life for extended period of time. You know like hard to say, how often but you around. What's the Conte quite a
lot, right? Because Paul and I shared an office in New York. Okay, so call I probably saw Paul more than any friend, you know, during like a five-year period. Okay, you know, 2015 to 2020 and
But again, he knew me in med school like he's known me forever. He understands. Yeah he just understood the perfectionism, the rage, the the constant need to prove myself. And again, I think it's I'm I'm not here to suggest that like striving isn't good or any other things like that. That's not that's not the point here, right? The point is at what point do these things become maladaptive, right? And there you could take someone else who's working, just as hard as me.
You know, just as committed to excellent work but it's not coming from this place of insecurity. It's coming from a place of love and it could be a totally different experience and it's not destroying their life. In the point here is it was destroying my life. That's the point. That's only thing that matters is and that's why again this chapter is not written as like you need to do this, it's not a, you need to do this. It's this is a story that I hope. Lets you examine yourself because there is no question in my life that I
I was like there was just a trail of body bags
around me. If you wouldn't have gone gotten this help or you're getting divorced, your wife wasn't going to see you anymore. She was going to get custody of the kids. You were going to get pissed off. You were going to stop working. So much, everything is going to fall apart, that's the trajectory were on. I mean, I don't think I would be
alive today.
Because shame is really the problem here, right? Shame is the shame is the thing, that that kind of, underpins all of this stuff, right? And that's so every time you make a mistake, at least in my case, every time I would make a mistake, I would hammer myself harder for it. Right like. So for example, let's go back to when I come home from that trip 11 days or 10 days. After my son is almost dead.
Do you think I'm acting better or worse? As a result of that?
Like the logical person would say. Oh my God, you must have been bending over backwards to be a better. Husband after you were such a dick, but that's the logical person. No, no, the reality is, you feel the shame for how you've behaved? So you come home and you act worse again. Shame is an awful thing. How do you act
worse? Like what do you do? You're just more aloof more distant more of a dick, more Gruff.
Less helpful.
Probably went back on the road 3 4 5 days later.
Are you and your mind
thinking? Well I'm just like such a beast of a human that I just this stuff doesn't faze me and I'm just carrying on
you know it's funny. I wish I knew I wish I could go back and find out what lies that guy was telling himself. Probably your job is to provide, like your job is to be the financial provider, not to do not provide any emotional support.
So this view you explain this story, you know, obviously like I said get the book but what is a beautiful thing is? It says this one section. It says if you take nothing else from my story, take this if I can change.
You can change.
then, you know, this is you're talking about this specific, kind of emotional side of it, but it's really all aspects of health and of life and
that idea right there.
If I can change, you can change. And by the way, you have health issues earlier in the book, you have metabolic issues earlier in the book, you have opiate addicts. You talk about opium this book. I don't know if you do know but you talked about a lost time you're online podcast. Like you have been through really bad spots in just about every aspect or potential way a person can be in bad spots and yet you figured out
That you can
change.
This one's the hardest.
This was the only one I really thought couldn't be changed. I always had confidence the others could change. I always felt like I could Bend The Arc in anything else. This was the only one where I was like this is truly unchangeable
I've never had a stronger belief in my life stronger than the belief in gravity that I could not change this. This set of traits in myself.
That these were hard wired into my motherboard at Birth. When's the last time you lost your temper?
Well, never in a destructive way in since 2020.
Now I won't like let me be completely clear. Three days ago is the first time in three years, I got mad at another driver and honked at them and yelled at them.
Was this in traffic or is this on the race course?
No, no. It was just, we just it was a I was at the airport in San Diego and I went to get the car and I'm driving back to get pick up my family and a bus, cut me off, and I was like, all right, so I pull out of the way.
And then I go to go around them the other way and then the bus like almost smashed me into a wall. So I pull out and I'm like, I mean, I just got super pissed in that moment. And, you know, I'm hot, I like literally laid on my horn for 30 seconds, right. Like how do you not see a vehicle? You literally almost put me into the wall and that's the first time I've had like, road rage in three
years. And what was your debrief to yourself after
that?
I went through kind of like, okay, what what mate, what else was, what? Wells was really bothering you that day because you've been cut off a thousand times in the last three years and you've never cared. So, what is it about that day? And secondly,
did you figure that out?
Yes, I think this is the this time really Rizal most really resulted in an accent like it's a if there's an asymmetry, when a bus is almost cutting you off. Also, this sounds dumb and I don't know if this justifies any of it.
But in my mind it's like this was an airport bus at the airport, like you should know your way around the airport, you shouldn't be weaving in and out of lanes with concrete on either side. Like there was sort of an expectation but regardless it was on my mind, like, for a couple days. I was really like examining this. And here's another thing I've learned like, you have to forgive yourself, like, I'm not, I'm not here to say I'm perfect, but I'm here to say that. I'm not going to let one mistake spiral into 20. So,
Oh there you know I say this to my patients all the time. Don't beat yourself up if you miss your work out for a day but just don't miss it, two days in a row, just get back in the gym. The next day. Don't worry about it.
If you eat if you if you go on vacation and eat like crap, come back and start eating well, don't let a mistake spiral into Infinite mistakes. And so, in many ways, it comes back to this idea of Shame, right? It's really tempting for me to just berate myself in shame because of my misbehavior, but instead it was like, you know what? That's like not a proud moment for me. Like, I'm not proud of the fact that I laid on the horn and yelled at someone who, by the way, doesn't hear me, but it doesn't matter like this. The point is,
Like I'm not proud of how I acted and I'm going to do better next time. But just by doing that I can do better next time, right? That didn't, it didn't root and I'll tell you what, I was most proud of is about 30 seconds. After that, I picked up my family and I was totally fine. Whereas like three years ago, that would have ruined the day. I would have my wife. When I got in the car, I have been like
you wouldn't fucking believe what? Just happened? This fucking idiot, I'm gonna go
find them.
But instead like to this date, my wife might hear this podcast but she would otherwise have no idea what just took place. So it's just like we're done with that. So, you know, it's a little bit of a setback, but there's a victory.
I know that you post feel the other day after you dry fired my boat and you're like, hey our click on it, you start off with out. Like, this is progress, I was like, oh no. And then and I was thinking the same thing. I was like, well and then you clean it. You like, hey, you know what? I
You know, it's really dumb and I just feel shouldn't do it and you know what's okay?
Yeah I mean like I had to I drive fired a bow in April of 2021 was last time I drive fired a bow.
And, I mean, and I, that was after going through all of this and I did, okay, but I had to go jump into an ice bath.
Like that was the own and I still screamed, I was so pissed when I broke it. But prior to that when I drive fired a bow like 2019,
I smashed the bow after.
Like, so, you know, people listening might not understand what happens. When you drive fire a bow, you've already broken the string, the cans and the limbs well then I just broke the boat. I was like I just I'm going to destroy this though. Everything is gone.
So, yeah, like I, I think that's like, literally the, if you did say like, what are the three things you're most proud of in the last 12 months, I literally would put that on those, the top three drive from their boat riding about and within three minutes, first of all, not yelling, not screaming, not throwing anything and within three minutes being,
okay? It's so crazy that you're a freaking grown-ass, man. That's a dock.
Dr. Liz look at your life incredible and you do that kind of shit. It's like oh you did that kind of shit? It's like it's kind of crazy, right? Isn't that kind of crazy? Yes, it's so hard to have like picture that I have a friend named JP to know, do you know? JP's I know you do my friend JP do he's in the SEAL Teams with me. He was very young when he worked for me and
Like I said he's, you know, had a bad temper.
And at one point, I was like, hey man, losing your temper is a weakness.
And we broke it down, you know, like later because we look at our dads, right? And you're like, oh and when my dad loses his temper, it's like a force, it's like a thing. It's like no one know, all of a sudden he cannot be turned into like a weird Superman character. Because now everyone cows to cows down to his behavior and ever gets out of the way and it's just like, so you see that and you go along, I wanted to come to get that super power and I was what JP grew up with like oh, you know, that's a
A power and I was like, hey man, when you lose your temper, it's a weakness and that impacted him because he never saw it that way. And I don't even remember when I figured that out. I don't really remember when I figured that out, but it was, I was in the SEAL Teams and, you know, probably saw some idiot officer freaking lose their tempers are yelling and screaming and everyone the platoon going, what an idiot. And I remember thinking I will never do that. You will never see me. Lose control my emotions. That's
That's, that's a bad thing and then just never let that happen again. That's that's like,
I think Echo Charles has a similar story where Echo Charles realized at some point that losing your temper, he read it in a book, actually, he read in a book that losing your temper was a sign of, you know, insecure. That's what it was for him. It was he read in a book that losing your temper was a sign of insecurity. He's like, I'll never lose my temper again. And, you know, I've haven't seen Michael loses temper. No, it's a long time but
That's just, yeah, it's just so weird to think about that. And think about how negatively that can impact you
When you, when you see your kids lose their temper, how do you, how do you help them? See the
The problems that it causes. And I guess how old are they?
Just turned six and will be nine at the end of the summer
and Olivia is already what 1414? So she's good to go. So, yeah, six years old, they're kind of not quite there yet, but 9, it's like if you're losing your temper at 9. We can start discussing how that's going to impact you.
So leads you do you have any conversations like that we do and they lose their temper?
Yeah, I mean, look, it's, you know, one of the great questions you can ask a kid when they're misbehaving in general. After the fact is
How did that impact the outcome? Right? As opposed to just saying, don't do that, right? It's like, okay, you made a choice to act. A certain way. There were repercussions from how you acted. How did it work out for you?
And that's one lesson I've taken away another lesson that I think every parent knows is the most important thing to do when a kid is losing it. And this is not easy to do. But it is important thing to do is to not lose it yourself.
I get asked like what you're a, how do you discipline your kids? What's your favorite way of discipline? Do you, you know, do you beat them? Do you make them do burpees, do you want out? You know, think got a bunch of and and I got asked that.
A while ago and I was like I can tell you my favorite form of discipline with children. My kids, my favorite form of discipline was asking them questions because when you say the exactly what you didn't like, hey that make you feel better. How's that? How's that outcome? How that how that helped you? How does it make? You look? What do you think? Everyone's thinking of you right now that you lay it on the floor, crying, when you're seven or you're storming off the field, when you're ten, or whatever. The case may be asking questions is powerful, discipline disciplinary tool for children.
Um like I said there's so much of this that you cover which we didn't even touch on, we didn't cover the actual tools that you use that you got taught to to handle this to you. Have tools that you learned to utilize just like I could teach you how to shoot a bow. You got taught at what to do when your temper starts to flare up. When you start feeling certain emotions, and it's all in the book, and it's so worthwhile to
Read that for yourself and for your family and for everybody around you, that you can either tools that you can utilize to come to overcome those things.
But you know what, I'm going to fast forward a bit and kind of close this thing out. I mean, we've been in here for I think approaching four hours, you write this.
As my recovery progressed, I noticed my preoccupation with dying began to fade away, and my quest for longevity. No longer felt like a grim desperate task. Now the things I did every day felt welcomed necessary, I was enhancing my life and looking forward to the future. My journey to outlive finally had Clarity purpose and meaning it brought me back to something. My dear friend, Rick Alias had told me Rick had been
The 155 passengers on US Airways flight that emergency landed in the Hudson River in January of 2009, as the plane was coming down, Rick and most of the other passengers were certain that they were going to die.
Only the pilots skill and more than a little luck prevented disaster. If the plane had been going down and if the plane even going a little faster, it would have broken apart on impact. A few miles per hour slower and the nose would have tipped forward and it would have sunk into the river. A handful of tiny factors like that made the difference between everyone on that plane living and many or most or all of them dying that day changed Rick's outlook on longevity in a way that really
Resonates with me all that time. I had been obsessed about longevity for the wrong reason. I was not thinking about a long healthy life ahead instead. I was mourning the past. I was trapped by the pain that my past had caused and was continuing to cause I wanted to live longer. I think only because deep down, I knew I needed more Runway to try and make things, right.
But I was only Looking Backward not forward. I think people get old when they stop thinking about the future. Rick told me.
If you want to find someone's true age, listen to them.
If they talk about the past and they talk about all the things that happened and that they did, they've gotten old.
If they think about their dreams their aspirations, what they're still looking forward to their young.
Here's to staying young, even as we grow older. So, that's the book. That's some good advice from the doctor and you give away advice all the time. You're still doing that now. That's what you're doing now.
What currently? What are you doing? Tell us what you're doing where we can find you.
Well, my podcast, the drive still comes out every week. So that's, you know, continue to be a huge Joy. We're about five years into that and we've come no closer to running out of topics to explore than we were five years ago. So, I see no end in sight to that. And we have recently launched, what we soft-launched, it'll be kind of rolled out a little bit more this year, a product called early, which is sort of a digital
How to describe it other than kind of a master class of everything we do in the practice. So, this is something that took us two years to build and it's it's it's truly the this is all you need to know to do all this and it, you know, it's got its probably 30 hours of Highly produced video, plus tons of downloadable material and stuff like that. So we had a very limited release of it in April where we put it out for four days just to our subscribers. We're going to have another
Release later that year, and then probably open up to the public in the beginning, in 2024,
because your practice, we've mentioned your practice, but your practice is helping people have better health span of Life Span. Yeah, but it's super
small and as its effectively closed. Right. I mean at this point it's sort of a friends and family
but this is a way for a normal person to say. All right, I read this book because look what we covered today I did but I barely dust it on anything that's in the book today. Like it's freaking 410 pages of dense.
Mm information, we barely touched on any of it. And once you get done with that book, you're you're going to send yourself. I need more. So, the podcast, you have a subscription version of the podcast as well,
that's right. So, it's one episode of month is dedicated to subscribers called an AMA and then and then the show notes are for subscribers only. So, yeah, we don't, we don't have any ads on our podcast, it's all subscriber.
You're on Twitter? Yeah, Instagram
or on Instagram? The most you're on. You have a YouTube channel? Yep, you have a Facebook. They're all,
they're all Peter Atia.
MD, Peter, it TMD. He got it, done. He got it. Done. I
let only because somebody had Peter, T of before I started with pleasure, otherwise I wouldn't have thought to put the MD on there. It seems a bit douchey.
But well, luckily, there was no other Jocko will inks back when I got ahold of my stuff, but um, jogo will and Kim D. Definitely
Definitely not, that's for sure. Carrie sir, you got Echoes job right now. You got any questions I gotta Echo question, actually. Oh damn. So, so you talked a lot in the book about sleep and,
you know, the effect that has on our ability to perform and things like that. I'm curious
about your kind of opinion on mouth taping. Do you have an opinion
or do yoga? But it's really, it's really important for people who are mouth breathers to not be mad.
With breathers. So when you're breathing through your mouth,
Be at a wake or sleep. I mean you basically want to reserve mouth-breathing only for when there is no other option which should really only be when you're exercising strenuously. And so, if you're sleeping in your mouth breathing, it is sending a message to your brain that your energy requirements are significant and you're in a more sympathetic state. So your sympathetic nervous system ramps up. Your parasympathetic nervous system goes down, your heart, rate goes up, your heart rate, variability goes down. So this is a physiological State. You don't want to be in when you're trying.
Going to rest and recover. So, again, once you address any structural issues that a person might have in their nose, being able to put on mouth tape for people, is an awesome tool to teach them how to nasally, breathe,
right on and what are some of the benefits of nasal breathing? I know there are some, I'm just not 100% sure what
they are. I mean, everything actually start there that we I write a lot about sort of how so much starts with the breath, right? So you're breathing strategy and there were basically two major, breathe
Strategies your breathing strategy, determines your center of mass or Center Mass determines, how you how you kind of exist with gravity in the world, right? So are you hunched over? Are you sitting up too much being in that high sympathetic low parasympathetic state by itself is counterproductive to your health. So that's that's really why you want to be nasally breathing. Got it cool. Yeah. JP Danelle and I both
have been geeking out about the mouth tape. We both do it now when we sleep and
And it's, it's been crazy beneficial for me. I used to wake up with
headaches, a lot of times and because my mouth was, like, gaping open when I'm sleeping, I guess, but it's been super
helpful. Awesome. Yeah, I'm glad you and I'm glad you asked that question because that's the type of information that you can get from from your podcast, from the drive podcast, from the book from the newsletter that you sent out from everything. So I'm glad you. I like legit. Like that's, I'm glad you asked that because I spent all my time, talking about death and hell and all this other stuff. So
That's what I did but that's not what you do for a living. That's just the stuff I wanted to talk to you about, you know, as as mess my bro. Peter, you got any closing thoughts?
No, guys. This is, It's a privilege to sit down and be able to go deep into this stuff.
Well, thanks for joining us. Once again, I can't believe it's been seven years or yeah. Something like seven years since you came on this last time. Thanks for all you're doing to our
last time, I was on, I was just starting to write this book but it that way. Wow,
crazy. Thanks for what you're doing for so many people. You give away so much information and everybody is should be a so appreciative of that. Thanks for your friendship. Over the years, man.
It's been very meaningful to me, but like your friend Rick said after his exposure, to death on that seemingly doomed, plane. I like to think more about the things we will do in the future, the hunting, the shooting, the driving, and the Mystery Mission, the mystery Mission, which I got for you, which is going to be so freaking awesome. I got Peters wife asked his friends to send a video with
Thing some request some event that they were going to that we would do with Peter individually in the future sometime in the future in the next five years and I couldn't think of anything. Because what do you get? What do you do with Peter Taylor? Like I was like, oh we go hunting all we go shooting oh wait there's a bunch of stuff. I was like yeah blah blah, blah, no offense of people that said that because it'll be awesome but I got struck with a bolt of lightning of something that I know he could never guess it's something that he's been preparing for his whole life.
Yeah but that he doesn't need to prepare for but that's something that he's never done before. If you can imagine all
that and it's we do you remember how you worded it in the
video when I say.
So you gotta remember my wife. This is she asked me. What do you want for your birthday? And I said, this is what I want. I want any presents, I don't want to party, I want. I want an experience with each of my friends and and, and so it's this to our video, right? Because, you know, every person's going to talk for a few minutes and it's amazing and jacko's is
I will call you with a pack list and coordinates and a time to meet freaking warning order on the stand. And by the way, he preface this with a beautiful beautiful kind of a lot of really, you know? And it the ask wasn't what do you have to say to Peter but a lot of people did that. Anyway, it was very kind and meant a lot to me but after Jocko had one of the sweetest things to say it was
This is the gift pack list, coordinates time, be there.
It's going to be like, it's going to probably be 33 days total with maybe a day of travel on either side or half day of travel. So it's going to be awesome. But that's what I like to think about. Like, your friend, Rick advised, I like to think about what we're going to do in the future. We're going to do that. We're going to do rock, marches, we're going to, we're going to do a lot of cool stuff in the future, and I think,
Think as much as we can we will do our best to stay young and outlive. Thanks bro. Thank you.
and with that Peter, Atia has left the building and well,
Freaking. I legit. I'm glad you asked that question at the end because that's kind of knowledge that he is freaking packed with. And we end goal is in the first blank. Ask me the guy's life has been. He's been overachievers all whole life. Me, just he is brilliant and he's been focusing on this stuff.
For decades and and he's willing just to give it away. So and I didn't do the best job of like bringing forth that information. That's what the whole book is filled with get the audio book. Like do you really want to hear me sit here and read the scientific parts of this book? I was like, well, I could do that or you can go get the audio book and listen to the doctor himself, read it. That's what we did. I'm glad you asked that question. So people recognize how much information they can get from him from his podcast from this book outlived.
The science and art of longevity.
Yeah, you got an opportunity, you got Peter T in the room and you're gonna just what's up? Something cooking on the brain. Yeah, I've been typing that mouth, you Taping that mouth breather up. Yeah. Wrote meet me and JP Danelle. We've been geeking out about that, man. We both use the same, like, brand of tape or whatever. And it's been, it's been great in your hostage tape on them, but it is, right? Yeah, that's that's the one we both been using and it works man. Not waking up. All, you know, headaches and wrong. I'm glad because for so many years. I've been running.
I'm telling people, hey quit being a mouth breather, right? Like, what's your problem this time all this time Ruth? And I know there were some scientific Truth for it. Right? But guess what? But the dog was right again, man, the mouth reasons, I it's, there's there's Lads got that tape. I was wanting to tell you to get that tape for you. Close that mouth boy, was a guy that was a mouth breather in the SEAL Teams. But somehow is his nickname wasn't mouth-breather, was fart sniffer. Because
it kind of looked like he was cut out his mouth open like he was kind of like gate trying to sniff that fart. Yeah. Very rough nickname all my homeboy but yeah that's the way it goes. Sometimes it's crazy to. I catch myself closing like literally I'll be breathing through my nose more throughout the day to and I'll just notice it like my mouth closed. I'm breathing through my nose. I don't know if
that's you know, a
subconscious thing that's going on because it seemed a Improvement, bro. I feel like that bagged friend
Now that didn't tell his buddy had a booger hanging out, you know, I should have been like a brother your mouth breathing on me man. Step back, shut shut shut your mouth man. Shut your mouth right off. Well your boys on it. We're getting taken care of right right. There you go. Well that's one of the many ways we can try and become healthier and live healthier, live longer have a better health span of Better Lives, all that stuff.
So, that's what we're doing. Need to get the right fuel in your system. By the way, you might as well go get that Jocko fuel. 100% get that Jocko fuel hitter. What am I thinking about? I'm thinking about molk cuz cuz that's one thing Peter was saying, you got to up that protein, gotta up the protein you might as well as get that up, that protein when it tastes good. And it's what does that word satiating right fills? You up crack that milk and get it done are
TD style. So RTD, if you're not in the industry, that means ready to drink, you can get get some more. Could just have in your house. You can drink 30 grams of protein like a boss, two minutes. I'm like yes, it's mighty tasty and, you know, it's crazy. It's so it's filling you feel, you feel good. So get some of that and and look, I'm still old school with the pal, pal, get the milk powder because if you feel like you want a little bit more, you know, like if you want to
Full-on meal that's dessert and they'll Shake action. You want milkshake action? Yeah. Yeah. Go get yourself. Get some of the powder joint Warfare. Super. Krill, krill oil, vitamin D3 is. We got it all for you time. War time War. You want longevity bro. You want eyesight? Yeah, he want that he get that socket at Time. Warner. Get the time or time Wars the subscriptions for time Wars. Crazy right now because you when you so when you go to jakka fuel.com you can
You can get it and then if you like it, you can subscribe to it. So right now like once people go on time War, there's hitting that subscribe button, just send that shit. Tell me boy, send it to me. I was I was digging into the Jocko system the other day because I was told around y'all feel you don't get some stuff and yeah I was looking at there's like the Jocko system and the echo system and I was like digging around yours. I was like okay got the full stack there's go like in that system to so all the cool things we just mentioned. They're all like,
It in order in that in that stack so easy act? Yeah, time Wars. One of them I told you this before, like I will take time or until I die. Just the way that what you get out of it from a from a feeling good perspective to like the joints to the and the eyesight thing was crazy to me, the ice I think was crazy, my eyesight got legitimately better like a little bit about say I have to look at what what the Monster was because I that's when I noticed it. But miss
It's crazy. So anyways go to tacklehead.com, get yourself some of that. If you don't go to Jocko fuel.com, you can go to Wawa, you can hook it up at Wawa bottom right corner that shelf. They kind of, we got. So, we gotta put the squeeze got put on us by the big imperialistic beverage companies, you know, who they aren't, you name them? There's you know who they are, trust me, but they went paid millions of dollars to try and subdue the rebels.
Try and take out the rebels we're out there on. What planet are we on Hall? For some tattoo, we can use Tatooine, right? We're out there trying to be free trying to offer people. Something that is actually good for them. They're trying to they're trying to take us out with the Death Star. You can't deny performance, Jamie Cochran said that when she was on the podcast of the other day, man. And that's what I think about our people, clear shelves, like you can't compete with that, you know, you can't buy that away from us. That's the way it goes down, it. Look if not vitamins
GNC a were coming into a fees. So all those military commissaries or across the world, be able to get your supply build, the get it Hannaford Dash stores in Maryland, wait for ShopRite H-E-B a Chibis represent. All you've all my people down in Tejas, just rolling in there and just getting after it. Thank you, appreciate it. The, you got a full Supply at HEB, we're sending it as fast as we can, Meyer up in the midwest. Harris Teeter in there. Now, Lifetime Fitness in their Shields rolled into she
Eels 300,000 square feet of just awesomeness, go and check that out. And they also have Jocko fuel. They got everything you want including Jocko Fuel and and by the way, I want to punch a little Jim's small, Jim's Jiu-Jitsu, Jim's CrossFit Gyms, where in there, where the where the where the energy drink across fit. So when you get done knocking out that Annie knocking out that workout of the day before you hit it, you can get that energy drink after you hit it, you get that molcajete.
Forget that protein in you, if you're a, if you own one of those gems, you want to sell rocket fuel?
Go to jair, email JF sales. I do at geography l.com, we can hook it up if that wholesale account. That also click account rolling origin, usa.com we just we just launched workout gear, hey it took a while, I know, trust me, I know trust me, I know but to re-establish a supply chain of American-made materials so that we could cut and sew it here in America, took a little bit of extra time then to design it properly. Get the
Right materials. It took some time, but we got it now. R-tx Roll, Train, execute execute, execute, you can get that, you can get hunkier, you can get you two together, you can get, you know, what hoodies, bro, our hoodies American, yes. 100%, right. We're if you're in America, you wear a hoodie. Yes, right. You're just you have a hoodie. You probably got to get yourself one more. Get yourself an American-made kilo. Hoodie get the kilo.
You still kilo hoodie, the if you're if you're in the northern part of the state's, get the heavy but the kilo everywhere else. I don't see you. You never lived in the northern part of the states, right? Because in the summertime in the fall, you don't need you don't need that. You the Heavies for the cold weather, you need that kilo like Helix all year round Helo hitter and look you live. This is what we were taught as just threw a dart at a, at a meeting with origin and Jocko Fuel and they're like well you know it's it's it we're not going to be selling many.
Kilos right now cuz it's the summertime. It was like, Broadway, talking about, what are you talking about in California? You need a, you need a kilo year around hundred percent baggy around back, back of the back of the Jeep. I've got two key, like two kilos, you know, after 7 p.m., you throw that little guy on you good. But California, but, east coast, same thing. You, yeah, I was in Maine when I was growing up in Maine, the sun goes down, guess what? You need to put that kilo on that kilos, of go to piece of.
Equipment, that should be with you at all times. Now, listen, I'm not gonna lie to you. I have a blue kilo. I have a black Kela bluegills. What? I work out in the morning, black kilos, kind of the where around. I have a cami I haven't wrapped her kilo assigned. Look. Do I wear it when I'm out in the woods yet? Do I wear? When I'm also rolling down? Down the street. Hell, yeah. Do you wears it. Roll it into the podcast video every day? Yes, yes. Yes, I do, sir. And then I have a. Do we have a zip up on now?
To and I got one of those what I found out about cool about the folds up for travel. If you're traveling you may want to have some variable warmth, right? So you have it may not sound like much. We use unzip that bad boy and Olson. Let that coolness in or little chill chill. Chill coming through little wind, no problem. Zip it up. We're good. Get that versatility with the kilo, zip hoodie, dude, I just invented that, right? If you get hot unzip it,
I'm over here. Smart, very good Technologies. From giving Peter a tee, a run for his money on Intel on his intelligence because I said, if you get hot you can unzip your hoodie. Check it out. Origin, usa.com go get yourself an American-made hoodie and wear it with pride. Help your help. The National Security in this country and help your children live in a stable free nation in the future. That's what we're doing. Origin, usa.com
You'll also got Jocko store Jocko store.com. Do you had one job a job? I want. You blew it junko story. Where that girl here is that right there. Oh, he's game over, man. What do you say Jack, let's get what jocular go. Let's give it a go. Here we go. Jocko store.com boom, we got rash. Guards, t-shirts trucker, hats beanies hoodies. We got the shirt Locker subscription. It goes putting out a short every month, new design every month. This is one of the earlier.
Short Locker ones. This is still one of my favorites, though. Got the element D and we got layers in every shirt. This one's got the 004. 34 at the bottom,
no big deal,
but great subscription. New shirt, layers layers in the layers layers. It's like the first time. Echo said that, and I was like, are you kidding me? And now we say it's, everyone says, it's so true people talking about them layers, actually, we can't go back. I don't know who said that first,
I might have said that first gotta watch the tape. Got to go back to the tape, man. We'll check it out. Yeah, if you want to get some of those later chocolate store.com, subscribe to the podcast. So also subscribe to Jocko underground.com, we got that going on and just in case all other forms of communication, go down, will be there on the Underground Jocko underground.com, we got a YouTube channel, subscribe to that origin USA. YouTube channel, Jocko fuel, YouTube channel, Ashlyn front, you do. We got some YouTube channels. You want some? You want to get some, you watch some videos, watch some good.
Once psychological warfare and iTunes Flipside, campus.com Dakota Meyer, just making cool stuff for you to. Hang on your wall, got some books. Outlive the science and art of longevity by dr. Peter Atia, just get that book. It's a textbook for you on how to be a better human. So, there you go. I've also written a bunch of books. You know what they are? Final spin. Leadership, strategy and tactics cold warrior or the code evaluation is the protocols discipline was freedom field.
Ma'am. I mentioned it to they had to quote it today because I knew Peter T was going to come at me. You gonna come at me? Yeah, you gotta sleep.
You got to sleep, it's good for you.
Take that mouths on tape. That mouth boy way the warrior. One, two, three, four, and five.
Everywhere I go, those parents are thinking, because what their kids are doing.
So they're doing Jiu-Jitsu. They're doing pull-ups. Do enough stuff that Peter T was talking about today. He talked about how you would change. The way children are raised, his kids are Warrior Kids, by the way, forgot to mention that today, but his kids are absolute Warrior Kids. He posted the other day there, when the warrior kid, work out there in the game, bro, get the kids, you know that, but making the dragons about face extreme ownership that economy leadership. It's all there. Are Salon front. We have leadership from sold C. We solve problems through leadership. That's what we do. Go to echelon.
Arkham for details next big event. What say we get the council which is sold out. We got we got a battlefield August 8th, through the 10th at Little Bighorn. I think there might be a couple tickets left.
So if you want to come and check that out, come and check it out. We got a woman's assembly, run by Jamie Cochran, our chief operating officer. What'd she say you just quoted her. Can't deny performance. Yeah, there you go. Well, there you go. You want to learn about that activity. Go to the women's assembly, which I think it's called Women's Summit. So, it's the assembly now. Okay? Yeah. So they they had a, you know,
a little name change, but
the woman's assembly, it's a free live event that we host.
First through the extreme ownership Academy, got it and the Summit is an actual live event via simple reason. Yeah, the assembly will be the in-person event in Phoenix. Okay, it's September 14th and 16th Phoenix Arizona. So go check that out if you want, we also have online training extreme ownership Academy.
This is where you learn the Jujitsu of life on a, that's where you learn the Jujitsu of life. And listen, if you don't understand your Jutsu, let me explain it to you. A person that weighs 150 pounds can beat a person that weighs 250 pounds. That's what can happen when you Jutsu, if you want to learn Jujitsu of life so you can outmaneuver out think
Overcome problems lead. Go check out extreme ownership Academy extreme ownership.com, how much of how much of your career? Would you say was relationships? Based on the team's like percentage was 99% 99% right on 99% was relationship-based. I I will have to think about this. I never and I feel like I just got done saying this to a company I never.
Had to say hey look dude, I told you to do which is not relationship bike that's authoritarian bait, that's ranked based never had to do that. Never had to do that very seldom and I can't think of any examples where my boss told me like, hey, shut up and do what I told you to know because I had a good relationship with him. They want to know my opinion they wanted to take lead from me. We were influencing each other, we were listening to each other up down and across the chain of command. So you want to talk about how to get through life?
A Better Way. Build good relationships. So we actually teach because there's this is, you can't, what if I asked you like right now. Hey, hey Carrie, build me a 40-foot Gaff, trig Schooner boat. Would you be able to do that - no, you don't know how know their skills, you would need. Yes. Or the same thing with building relationships. There's skills that you need. There's things you can do to build strong relationships, and when you build a strong relationship, you build a strong team when you build a
I'm team you get the results.
So that's what we're doing. Go to extreme ownership.com and learn how to build relationships, learn how to make decisions, learn how to get better and learn how to lead. That's what we're doing. Also if you want to help service members active and retired, you want to help their families when help gold star families. Check out Mark. Lee's mom, mom. Ali. She's got a charity organization. If you want to donate or you want to get involved to go to America's Mighty Warriors dot-org. She is doing all kinds of things to help.
Our veterans and also don't forget about heroes and horses dot-org. That right there is Micah Fink's organization. We just got a report in from the field. Did you get that report from the field? I did not. Okay, I probably should have related to you currently Michael Fink. He just actually had a wrestling match with a bear and he was about to submit it when out of nowhere.
Ooh, a bald eagle and the bear got scared and ran away. So we're still giving it to Micah undefeated 100% 100% undefeated in the field. He's out there getting after it. No. But seriously my caffeine doing awesome stuff, helping veterans, First Responders find themselves out of the Wilderness. It's an awesome program. If you want to connect with us on the interwebs, Peter, a TIA is on Twitter on the G on YouTube and Facebook all of them at Peter, Atia MD. And
Carrie Hilton is at carry underscore Helton. Didn't get that getting get it. Ha still still haven't gotten that one. Resolved didn't get that carry help. Is there another Carrie? How not there? Somebody has that there is yeah and yeah I hit him up try and try and say a man. Okay he's not active - yeah.
Did he get it before? Like yeah, yeah he's had it for a long time. I'd first hit him up a couple years back. He was just like hey man, like if you know maybe we can work something out, throw you a hundo bra, no interest zero interest in responding to Cadillac ATS, some computer out there. I that scary carries at underscore Helton and I'm at Chaco willing, just watch out for the algorithm and just just please and thanks to all the service men and
and women out there who are on the front lines of Defense around the world, keeping us safe. Also thanks to our police law enforcement, firefighters paramedics, EMTs dispatchers, correctional officers, border patrol, Secret Service. All First Responders, thank you for keeping us safe here at home and a special. Thank you right now in honor of dr. Peter Atia, thanks to all of you doctors nurses, that's an honor of Peters wife, Jill and all the healthcare professionals out there. Who
Support us in our darkest hours and to anybody else out there and everybody else out there.
just remember what Peter do you said if he can change, so can you
So can you and that is so powerful. It's so true. Look, if you've been on the wrong path, if you taken some hits, if you've been doing some things you shouldn't have been doing if you're not as healthy or productive as you should have been and maybe you haven't been the best mother nor the best father or the best husband or best wife. Maybe you've been hyper-emotional or not emotional enough and maybe you've been lazy and gluttonous and just generally freakin miserable.
You don't have to be.
You can't change overnight but you can change. You can do it.
But in order to change who you are, you have to change what you do, how you live and that is something you do have full control over and there is no better time to start than now.
To put down that donut pick up that kettlebell.
And get after it. And until next time, this is Carrie and Jocko out.
