Those people are saying I would love it if I could live a little bit longer, and that's called lifespan living longer and extending life, but I'm more interested in extending my health span, which is the quality of my
life Welcome to the school of greatness. My name is Louis house a former pro athlete turned lifestyle entrepreneur and each week. We bring you an inspiring person or message to help you discover how to unlock your inner greatness. Thanks for spending some time.
With me today now let the class begin.
This is episode number 1045 with dr. Peter Atia. Buddha said to keep the body in good health is a duty. Otherwise, we shall not be able to keep the Mind strong and clear and Tony Robbins said the human body is the best picture of the human soul who I am excited about this one. My guest today is dr. Peter Atiya and Peter focuses on the
applied science of longevity the extension of human life and overall well-being Peter trained for five years at the Johns Hopkins Hospital in general surgery where he was the recipient of several prestigious Awards including resident of the year and he spent the last few years being mentored by the top medical scientists and now host the drive a weekly Deep dive podcast focusing on maximizing longevity and all that goes into that from physical to cause
Active to emotional health and our conversation was fascinating that I decided to split it up into two episodes. So this first episode is going to blow you away. We talked about which chronic diseases are killing people the most and this is going to shock you how our approach to medicine is so wrong how type 2 diabetes affects our health and so many people the four huge factors of type 2 diabetes how to reverse type 2 diabetes. Then this is big the four key pillars.
Of being a kick-ass 100 year old. This is a powerful section what the three main pieces of our health span are how important sleep is for longevity. Most of you don't sleep enough and you're not going to live long enough the way you truly want to and what habits we should be creating at night to sleep better. This is going to blow you away. I was fascinated. I did not want this to stop. That's why you've got to check out part 2 coming very soon and share this with someone who needs to hear.
This can truly impact Empower and help someone's Health in such a profound way. If they listen to this send them to Louis house.com, 1045 or just copy and paste the link wherever you're listening to this right now and make sure to click that subscribe button on Apple podcast right now. So you can stay up-to-date to all the greatest inspiration in the world on the school of greatness. Okay in just a moment the one and only Peter Atia now there are more
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Welcome back everyone to school of greatness podcast. Very excited about our guests name is Peter Atia. I'm a super excited to hear Ben wanted to have you on for a while and you are extremely highly respected in the community of nutrition learning about diabetes weight loss about extending life having a higher quality of life. So I'm very grateful that you're here.
Thanks for having me one.
And we were talking offline for a second about what you think is the most interesting for people right now in terms of longevity in terms of extending life and extending the quality of life. But I think it's a Hot Topic right now that everyone wants to people are afraid to die and people don't want to be sick and you mentioned something interesting about the impact of emotional and mental health in terms of longevity. So I'm curious we could start there about how important is mental health for our length.
Of living and the quality of our life and what can we do to increase the quality of our mental health?
You know, I think it's something that has been so ignored typically by Madison and I think part of it has to do with just a stigma that's associated with mental health and that can be depression in a formal sense where we have a diagnosis of depression or Mania or hypomania bipolar schizophrenia all these things that you know, sort of get labeled by a diagnostic criteria, but frankly, I think it goes much broader than that. It basically comes down.
to how well do we all cope with distress because life is stressful and whether it's really big stress like loss of job due to covid or loss of a spouse or divorce or just frankly the day in and day out kind of grind of Life the the tools that we have to cope with that distress and maintain kind of a buffer within which we function really determines so much of the quality of our life and when people
People come to me as patients. Most of them are paradoxically not saying the the silly things you might expect which is I I want to live forever. I'm in pursuit of immortality know I think most people are saying I would love it if I could live a little bit longer and that's called lifespan living longer and extending life, but I'm more interested in extending my health span, which is the quality of my life. And so to that end healthspan has three pieces, right? It's the cognitive.
So how well does your brain work as you age and we could talk about what makes that what makes up cognition. Then there's the physical piece. So, you know, basically what we think of as the exoskeleton, right? So your bone mineral density your muscle mass function ability to move Freedom From Pain all of those things and then of course this third piece which we just talked about which is the emotional resilience and the ability to maintain a tolerance around us.
Stress and and again those three things to my mind sort of form the boundaries of quality of life. When any of those are lacking even in the absence of disease, right? You could have no no imminent death on your doorstep. But if your cognition is sliding if your physical body is breaking down through injury or if you're just emotionally on well, it doesn't seem to matter that much. It's
not a high quality of life. If one of the three is off.
If all three are off you might be in a completely depressed state in physical pain will have some mental challenges and you're just like, what's the point of even being here?
Yeah, I you could even go further and say most people when they think of death think of what we call cardiopulmonary death or what. I'm calling death certificate death. So and so died of a heart attack, so and so died from breast cancer. So and so died from
In a car accident and all of those things basically your heart and your lungs stop working and you're dead and that's the end of it but most people actually and I can't give you a stat because I think this is more sort of more of a heuristic but probably 80% of people have actually died one of the other deaths before they die a cardiopulmonary death. So they've either died a cognitive death which is to say their minds have become so dull that they're really
Not able to be the people they wanted to be their body has broken down so much that the things that once gave them so much joy, whether it even, you know, being the ability to play Sports Ski golf whatever it is that they love play with their grandkids. They're deprived of those things or emotionally, you know, they've become despondent. They've become depressed. They've become secluded in a way that has basically robbed them of Joy. So so you sort of reach
Each one of these other types of death that precludes the cardiopulmonary death certificate death, right? And to me we want to minimize that Gap, right? We would like it such that you know when you die, it's really your first encounter with death of any
form, right? I think when I talked to David Sinclair about this, he said the key is not to extend life and be in pain for 20 30 years of suffering. He's like the ultimate way would be to live till
A hundred a hundred and five whatever may be and then die quickly like have something suddenly fail and then don't try to extend that with a lot of pain and suffering for 20 years, but die within the next couple weeks and actually it be rapid is what he's mentioning is kind of like where you extend the quality of Health span as long as you can and then you have a short window of pain suffering or whatever may happen until the body then shuts down. He says that would be the ultimate way to live and
die as opposed
and I agree with that. Yeah. Yeah, I completely agree. And unfortunately if we Embrace that that is optimal and I've yet to meet a person who doesn't feel that way right? Like I've never met a person who says no, no. No, I want to suffer as long as possible. Yeah. So let me accept these
baby. Keep me right? Yeah.
So if you accept what David me and 4,000 other people would argue then you have to ask the question. Why
is medicine practiced the way it's medicine the way it's practiced because let's think about medicine for a moment medicine says
we don't do anything until there's a problem. Right? So the entire system of the way a diagnosis works the way a diagnosis is attached to a set of symptoms the way it is treated the way it is billed for and the infrastructure of Health Care delivery is all around waiting until there is a problem treating that problem and basically, you know, doing better and better at treating chronic disease and I don't want to suggest that we have not done a good job of that right? So if you go back in time,
60 years your likelihood of dying from your first heart attack was well over 50% in other words, you know, somebody shows up with a heart attack. And by the way for men two-thirds of those we're going to occur before the age of 65. So you show up with your first heart attack, you know at that time. You probably two seventy eighty percent chance of dying on first presentation. Well today thanks to Emergency Medical Care stents blood thinners all sorts of other things we have going
Lots of medications that's no longer the case. I mean we can keep people alive for unbelievable periods of time. We have things like dialysis we can do organ transplantation we can do so many things that do indeed extend life in a chronic sense and I'm not suggesting that we shouldn't do those things. It's just that when most of us finish medical school, we haven't got the foggiest clue on how you would tackle the problem the way say David explained it. There's there's no
Place to say that because if you really believe in that system, you have to figure out how to prevent disease not treat disease. They're not the same thing.
Yeah, what would you say is the main cause of chronic disease for most people? Well,
that's a tough question because so you want to think of there are basically three categories of chronic diseases so we can break the big three down and I actually think of chronic disease in for but I'll explain why I'm talking about I sort of think of them as the Four Horsemen of
Death but it's sort of three pillars on a pedestal. Okay. So the big three are in order atherosclerosis disease. So that's vascular disease meaning a heart disease and stroke. So those two are the heavyweight champions of death or people will die of those than anything else. Yeah, and that's been true for a hundred years and I don't suspect it's going to change that much. Okay, but not too far behind it is cancer.
And then take a little step further and you reach neurodegenerative disease of which Alzheimer s disease is Far and Away the most common and also the most rapidly increasing. So again, you have heart disease and stroke cancer and the neurodegenerative disease and we'll just talk about it through the lens of Alzheimer's disease because that's the most common and those three effectively make up three quarters of deaths of people who don't smoke if you smoke we will check
Change the ratios a little bit and add, you know chronic lung disease and a few other things aside know before you go on there is
vaping considered smoking.
I think it's a bit too soon to tell it hasn't been around long enough for us to know if it behaves just like smoking did so I think the precautionary principle needs to be in order there obviously vaping is not identical to smoking but you might be trading one known.
Nasty thing for an unknown nasty thing right? So I think it's just and you have to remember how long it took before the evidence implicating smoking became dispositive. I mean that really took about 60 years. So, you know, I just personally it's not something I would think of as you know doing in abundance. I gotcha. So we got those big three diseases and then they rest on top of the fourth Horseman, which is kind of the answer to your
Question, right? So there's one disease which is not really thought of as a disease. But I think of it as a Continuum that is the foundation upon which all of those sit. So it is the one thing that makes all three of those worse and in its most extreme State it's type 2 diabetes, but but that's a Continuum that starts at hyperinsulinemia. So high levels of insulin insulin resistance non-alcoholic fatty liver disease type two,
Diabetes so that's a spectrum that probably afflicts.
Oh a half at easily one half of all Americans have a Maris have type 2 diabetes. No are on that Spectrum have just described. Yeah. Yeah
Spectrum including
so art starting with elevated levels of insulin
daily and the Time by like daily. They have spikes of sugar spikes.
They would wake up with an insulin level that I would deem too high. And then anytime they eat something their insulin is too high. That's the first step and then that also turns into now what we call insulin resistance and
That's sort of a harbinger of insulin resistance which means boy insulin resistance means your muscles. Don't do what they're supposed to do in the presence of glucose. So when a person eats glucose which is basically any form of starchy carbohydrate, so anything any carbohydrate that's not a vegetable potatoes rice and this could be good carbohydrates that we all would think are reasonable potatoes, you know rice something like that and includes of course junk carbohydrates, you know candy bars and stuff like that. Your body is supposed to really
be easily be able to take that glucose and park it inside the muscle and it's supposed to simultaneously tell your liver. Hey, stop making so much glucose because the liver is constantly making glucose to keep your brain happy because your brain loves glucose and needs it. And so when a person becomes insulin resistance, both of those things start to break down, they can't put the glucose from the bloodstream into their muscles and they can't tell their liver to stop making it so both of those things result in glucose going up and that is actually the definition of type 2 diabetes.
He's and then somewhere in there. You also have this problem where you start accumulating fat in your liver and that's you know, so like I said about 50% of the population is somewhere within that Spectrum with about 10 to 12 percent being at the far end in that. They have Frank type 2
diabetes. How do you know if you have type 2 diabetes like I don't even know how do you probably do I'm feeling symptoms or is it you go to the doctor and they tell you what their beat symptoms that you would
Could recognize. Oh, this is something that's happening. I
should take a look. No, it's much. It's much more Insidious than type one diabetes and it's unfortunate that type 1 and type 2 diabetes share the word diabetes and their description because they're quite different diseases. So we'll put type one aside for a moment, but type 2 diabetes is a very clear diagnosis, but it's made by one number and I don't think it's actually a particularly great definition. But the definition of type 2 diabetes is having a hemoglobin A1c, which I'll explain in a second above.
Point five percent. So we've reduced the diagnosis of this to one simple laboratory tests that most people would get every year and what that number means is how much of your red blood cells are basically saturated with glucose. And once you get to a point where 6.5 percent of your red blood cells have been saturated with glucose, we would impute from that that you have an average blood glucose level above a hundred and 40 milligrams per deciliter and we would
acknowledge that above that threshold. You have type 2 diabetes Well historically we diagnosed it by making people drink glucose and then timing like looking at frequent, you know, sort of pre defined time intervals how high their glucose got and we would make the diagnosis that way
and what happens when we have type 2 diabetes what actually happens to our bodies is this decrease our lifespan and the quality of our health span. Is it something that's manageable for a long time?
Yeah, it actually impairs everything. So unregulated diabetes can be acutely fatal, of course, so if glucose levels get too high and their unregulated, you know, you could die from hypoglycemic coma you could have, you know, organ failure things like that. Fortunately that is almost unheard of so acute death from Diabetes Type 2 type 1 is a different story from type 2 diabetes.
Almost unheard of it's really The Chronic death and The Chronic damage of type 2 diabetes comes in two flavors, or I should say has two axes. There are two things that are driving it all three of those diseases, by the way that I mentioned have diabetes as either their first or second greatest risk factor,
the heart disease cancer and right
Naruto so for so for so I would say for heart disease actually for
Disease, it would probably be the third biggest risk factor behind smoking and high blood pressure for cancer. It would be the second biggest risk factor after smoking and for Alzheimer's disease. It's a bit tricky because there's such a strong genetic component, but you might be able to make a case that once you normalize for genetics. It would be a toss-up between diabetes and vascular disease which are themselves dependent as to the next biggest.
Risk factor. So again, there's no disputing. The diabetes is an unbelievable risk multiplier for Alzheimer's disease for cancer and for heart disease, and so now the question becomes well, I mean you could also ask what else does it do? So, you know, it also leads to blindness amputations impotence all sorts of things that might not shorten the length of your life, but we're definitely impair the quality of your life.
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Is there a way to reverse type 2
diabetes there is and that's kind of the great news, you know it we can get into the semantics around curing versus reversing but I actually liked the term you used because it doesn't really Force One to get into that.
Antics I would say you can absolutely put type 2 diabetes into remission and I've done this many times myself with patients and there are many Physicians who have done this but it also it starts by acknowledging you know what the disease is and it is a disease of carbohydrate intolerance. There's no way around
that. So what does that mean essentially and tolerance meaning you've abused the use of eating so much carbohydrates that the body can no
longer I
I would even tone it down further, you know Louis. No, I would just I would just say look, let's be unemotional about it. And let's say a person with type 2 diabetes has in some combination created a metabolic environment where the carbohydrate intake is exceeding the capacity for glucose disposal the capacity to put glucose at work. Now, I think there are four huge things that factor into that and the first job of the doctor is to figure out
How to rank order them so, you know what to work on? Okay? Okay. So the most obvious one because you alluded to it and I think it is the most obvious is in take you how much glucose are you eating so back when I was a marathon swimmer.
I see I was swimming I averaged about 28 hours a week in the water. So I'm
like you're burning
calories. I'm your Bernie stop swimming. Yeah, but I was
pre-diabetic. Oh man.
Now how do you make sense of the fact that a guy that's in the water for hours a day on average is pre-diabetic. I mean, it just shouldn't happen and in looking back at my life. I think my I had limitations on two of the four things. We're going to talk about but on the
Side I had this incorrect belief that I needed to be drinking sports drinks all day
sugar sugar sugar
sugar sugar. I'm drinking Powerade and Gatorade like it's my job gulping. Yeah. Yes. Yeah, like I don't get through a spirit swim practice without going through two liters of this crap and then I'm drinking, you know, I'm drinking probably a leader in our in the ocean and stuff like that. So you can have a problem on the input side. You were simply consuming too much of this stuff. You can have a problem on the
Outside which means you do not have enough muscle or you do not have sufficient enough mitochondria within the muscle to take up that glucose. That wasn't my problem. I actually at the time was you know more muscular than I am now was obviously exercising far more than I am now, but for many patients the lack of exercise is a really key issue when it comes to type 2 diabetes are
sedentary. They're not moving and therefore their body is weak.
And it's it takes off.
They don't have a place to put the glucose you have to have a place to park it and there's only two places glucose can be stored liver and muscle and the liver is a very small Supply. So the more muscle you have the more places you have to store
glucose. So the glucose cannot be stored in fat it
can but and you don't want that to happen so you can get up easily. Yes, and you can't do that acutely. So you that's not something that can happen in an hour. So the only way you can acutely get rid of
glucose is to put it into muscle or into the liver. And so that's why someone with type 2 diabetes gets glucose spikes. Yes, you're right. They eventually put that into fat
but in the short on a break down quickly or yeah.
Okay. Yeah. Okay. So what's the third thing the third thing which is getting more attention now and I think this by the way was the second factor in my pre-diabetes is sleep disturbance. Hmm. So, you know most of my swimming
My supposed by swimming career kind of took place during my residency in shortly after and obviously sleep deprivation was a big part of you know surgical training and right even when I finished my residency or I should say what I left my residency and went into you know working in Consulting. I still sort of took the surgical ethos with me, which was I'll sleep when I'm dead. Yeah, and I was like, yeah, this is awesome. Like I love I loved working. I love training. I'll I just
didn't sleep was just such an aggravating thing to me and I remember routinely I'd come home from work. It would be 11 o'clock at night. I'd be up at 4:30 for swim practice like that was life every day and what we now realize and this has been demonstrated. So elegantly with some really clever painful research, which is if you take subjects normal subjects and just sleep deprived them for two weeks by to the tune of four hours a night. So that's pretty extreme but only for two weeks.
So I just took you know 20 guys like you and took them from eight hours a night to four hours a night for two weeks. And then did these glucose tolerance tests? I could reduce your glucose disposal by 50% I could basically within two weeks turn you into an almost diabetic shot. I sleep depriving you. Yeah,
so reduce the ability to assimilate it into take that
glutes. Yeah reduce the ability to clear glucose out of your
circulation and if it's not cleared then it turns into fat.
Or its surrounding your organs and it's making you weak it
get leads to higher levels of insulin. Which come back to in a moment. You asked a minute ago. How does this disease hurt you? Well, it hurts you through two vehicles that hurts you through the high insulin which causes one set of problems and then the high glucose which causes another set of problems. So okay having having having horrible sleep, you know, and there are some people for whom this is unfortunately an occupational hazard, right? So, you know people
Work night shifts. It's going to be much harder to sleep during the day and people who had dumb jobs like me and residency where you just don't get to sleep. So there are lots of people from this is an occupational hazard and then frankly, there are you know, there's the things that we're doing to ourselves too much time on electronics, you know, we know that you know sitting there looking at your phone looking at social media till you go to bed is not good alcohol has a horrible impact on sleep. So, you know not being thoughtful about the timing of alcohol even the timing of meals eating too late in the evening. So lots of things we do,
Do impair both the duration and quality of
sleep before we get to number four, I want to add to this. What's the latest we should be eating before we sleep how many hours before? I
think this is somewhat empirical but it seems that about three hours is a pretty good Gap, you know, so I'm kind of an early too bad guy. So I like to be in bed, but you know by 9 and absolutely no later than 10:00 and I'm kind of trying to be done by about six which again is I can do that most nights and if I you know, maybe one night a week, I'm
Be eating within an hour and a half a bit, but I clearly see a difference in the parameters that I pay attention to like heart rate and heart rate variability in temperature overnight because those things all move in the wrong direction with a meal if you eat
a healthy meal. It's a an hour before bed. I'm talking about grains and lean meat and healthy stuff or if you eat pizza an hour before bed. Are they both going to impact your ability to sleep better or is
The quality of the food before you go to bed matter.
Yeah, that's a really good question. The short answer is yes, it does matter. So the probably the two things that would have the greatest determination would be the Simplicity or glycemic. The Simplicity of the carbohydrates are the glycemic load because that's going to impact the sort of glycemic roller coaster you go on at night and then probably the amount of protein because that has a greater contribution to What's called the thermogenic effect of food.
So the thermogenic effect is how much does your body temperature actually rise to digest the food our bodies want to be very cold at night. So anything you do that opposes that leads to lousy
sleep. So what foods help you sleep better that keep you colder. What are those Foods whether it's an hour for three hours before?
Yeah. I honestly it's like almost anything you're going to eat is going to come with something that's going to slightly raise your temperature. So I just generally say try to not eat.
Too much before bed and I go out of my way to avoid the two things that I think are worse. So I just say I wouldn't have huge protein before bed and I don't want to have anything that's going to raise my blood sugar before bed. So, you know, I'd have an avocado before bed. I'd have you know something that's like, you know, I just generally don't eat before
bed the body reward you in terms of you weight or if you don't eat right before bed. Is it going to sleep better sleep deeper being cooler and therefore help we help you have more energy than x
If you don't eat before bed,
yeah, and this is at least for me been most easy to exhibit and I think many of my patients would agree during periods of fasting. So fasting is kind of a funky State because you're all you're altering so many other things in the physiology but one of the things that happens especially by about the second day of a water-only fast is you really are seeing the impacts of what deep sleep can look like in a state that is totally absent food, and it's
It's very interesting because you're competing with two forces one that's keeping you awake and one that's helping you sleep a lot deeper the one that's keeping you awake is cortisol. You have more of it. You have more stress hormones when you're fasting because that's the thing from a prehistoric standpoint. That would have been going on right fasting would trigger a signal that says go get more food right be alert be focused alert go get food. Like we don't want to die. And so that's kind of keeping you awake. But the flip side of that is the total absence.
Of nutrient is allowing you to get into this amazing sleep and your body temperature is really going down because your body is turning down its metabolism. So I actually find fasting sleep to be some of the most amazing physiology because I'm watching this plummeting temperature rising heart rate variability falling heart rate, all of these really valuable things, but a little bit of rising cortisol that can lead to Shorter sleep times, but I still feel quite you know rejuvenated by
sleep Mom. Okay?
I want to stay asleep for a second. I need to get the fourth one, which I'm going to close that Loop but do we does that hurt us if we naps throughout the day or take a power nap for 20 to 40 minutes is that help our bodies recover more even if we're doing the 7 or 8 hours of sleep, or does that not matter?
You know, it depends I would say naps are not a bad idea provided they don't reduce your drive to sleep later. So I just got back from
Like a hunting trip last month, we're just based. I mean first of all was exhausting right you sort of hiking 10 or 11 miles a day on vertical walls, you know, carrying a 50 pound pack. It's all the stuff that is physiologically as taxing as it gets at altitude, right? So but there was no way you could go to bed like any earlier than 11 and you had to be up by 4:30 really? Well just because you know, you have the most the two times when you're going to have the best opportunity.
To go and stock the animal is in the evening and in the morning so that those are the times so, you know, there was no way I was going to survive a week of that. If I didn't carve out an hour and a half to two hours in the middle of day and the data sleep and I'm normally not a napper but I made it a priority above anything else including practicing, you know with my bow and arrow in the middle of the day, which I would normally want to do. Nothing was a higher priority than getting that nap in during the day because I was deficient at night.
Getting that nap in the day didn't rob me of the ability to sleep at night. Why you still were passing out right when you got in your pillow? Absolutely. Now, let's say we talked about a person who is getting seven and a half or eight hours of quality sleep at night. Is there any downside to a 20 minute power nap? I would say no, but if going any longer than that, I would be I would be mindful of because you know, sleep comes down to balancing basically three things. The first is cortisol. So the stress
encode of cortisol must decline in the evening for you to be able to sleep. The second thing is you have to accumulate something called adenosine. So adenosine is kind of like this metabolic breakdown product that is Court, you know corresponds to how much work we do physical work cognitive work. So more adenosine makes us more tired. That's how caffeine works by the way caffeine blocks the adenosine receptor. So it functionally makes you think you have less adenosine and napping reduces adenosine.
Make sure you don't reduce it to much. The third is melatonin, by the way, which has to go up. So good sleep is when melatonin and adenosine go up and cortisol comes down. So I guess to close that out. I would say if you are sleeping so short during the middle of the day and this is what I was thinking about on my trip. You want to try to replicate a full sleep cycle in your nap, which is about 90 minutes. So that's why I really said look, I'm going to set aside two hours.
To take a nap in the middle of the day to get to give me one full sleep cycle because I'm clearly being deprived of one during the nighttime. And
is there such a thing as too much sleep if you're getting 10 12 14 hours of sleep every day consistently that does that affect the body in a negative way
really an interesting question by the way and quite a controversial question in the Sleep literature. So there is no question that hypersleep has been associated with poor outcomes. So you
There's an inverse you share. Sorry a U-shaped curve of mortality with sleep. Right? So people who don't get much sleep have a higher mortality and it's really more of a J curve, right? So they kind of as you
get more and more sleep than
mortality comes down down down, but then it does sort of uptick. So you get these people who are sleeping a lot and they're actually having worse outcomes than the people that are in the seven and a half to nine range historically that has been explained by the fact that people who are sleeping a lot are usually sick and that's why
why they're sleeping a lot. So we're not we're missing. We got the arrow of causation wrong. We're saying, you know, are they sick because they're sleeping too much or they sleeping too much because they're sick right while I think that the majority of the hyper sleepers are hyper sleepers because there are because they are sick there is actually some emerging evidence to suggest that absent that there might be a downside and too much sleep. But again, I think for most people most of us are on the other end of that Spectrum, which is we're constantly battling.
The need to get enough and that's either through you know, our kids our work our stress our Electronics. Yeah our food our alcohol, you know all the above our
travel and is this a negative if you're a kid and you're eating a lot of junk food, you're not sleep you're staying up late because you're whatever playing video games all night, but you've got all this energy all day and you're active their negative 4 in your early ages teens or early
NTS through lacking sleep eating poorly or is there a way to recover in your 20s from the damage you've done in here before
20? That's a good question. I mean certainly you can break it down into sort of the behavioral habits. I'd and you can talk about it through the physiological ends. The good news is before the age of 20 or 30. We are pretty remarkably resilient. I mean, you're an athlete so you can relate how old are you now Louis your nerdy 737
You might not have fully appreciate I'm 47. So I'm a full decade older than you and when I think about 17 to 27 to 32 11 247. I can really talk about those decades through the lens of resilience like at 17. You could shoot me and I think I'd still get up the next day. Fuck you. Just couldn't write your Superman. Yeah, you're absolutely Superman and I do.
No II feel like the first observation of not being Superman for me kind of kicked in about 42 is about five years ago was the first time I was like, oh, so this is what people talk about. Right? Like you can't just go out and crush it every minute of every day. And I think that's just one lens which is through the lens of exercise, but the same is true of physiology right like or
For example, many of my patients have observed this I've observed this like I was never a big drinker in college, but certainly there were enough occasions in med school or college where I'd go out and drink far more than anyone should and yet somehow the next day I could like get up at six in the morning and go and do whatever I need to do. Like I remember one night actually being out drinking until 3:00 in the morning. I mean having so much to drink it was ridiculous and somehow getting up at 6 in that morning to do a hundred mile bike ride. Oh my gosh, man prabhat probably still.
Partially drunk and but felt fine by about like 2 hours into the ride today if I had three glasses of wine, like the headache I'm going to have the next day is going to last me till the middle of the
day is that because your body was able to assimilate the glucose into the muscles and it used it for its to its Advantage then and now it's like takes over so it's a
very good question. I really I mean I could I could sort of you know speculate on what it is, but I just think there's an over so there's this thing called homeostasis.
Jesus right which is one of the Hallmarks of Youth and it's one of the Hallmarks of aging and you know, it's the ability to or it's our lack of homeostasis. We lose this ability to get the body back into the zone of Optimal Performance. So everything about the human body is very particular for example, take pH which is the amount of acidity in our body. We're so highly regulated like our body really needs to be at a pH of seven point four. So seven would kill you.
And seven points six or seven point seven would kill you and this is a scale that goes from 0 to 14 to put that in perspective. Okay. So tiny perturbations will kill you. How good is our body at staying in that amazing temperature right? You go much below about 94. You're dead you go much above about 104. You're dead. How good are we at staying in that range? Oh, I mean good. I mean we generally stay within a one point five degree band. So this homeostasis thing is amazing.
Gets weaker and weaker as we get older and so your ability to tolerate bad food bad sleep sedentary Behavior more stress all those things. It just gets weaker and weaker and weaker and I think it declines nonlinearly. So again, what you experience as a decline between 30 and 40, it's bad 4250 now that's worse 50 to 60. You can fall off a cliff.
Is there a way to reverse
this? I don't think we know I think you can definitely slow the progression of it.
And I know you know what I would say, you probably can reverse it. Right? So just as you can clearly reverse diabetes diabetes is a glucose homeostasis problem and it's clearly reversible. But you know, so there are probably some variants of this that are harder to reverse than others. But but now I think we can reverse this process but it gets harder, you know, it gets harder as time goes on it gets harder the further the further you are into, you know, sort of the physiologic Trap what?
You doing to reverse it. Now that you've been experiencing this kind of non maybe a cliff but a dip over the last five years for yourself. How are you thinking about it?
Well, I sort of had a change of heart five years ago. So actually six years ago 2014, so I sort of hung up my bike which at that point that point I'd switched from swimming to cycling is sort of my main sport, but I you know at that point a couple of things had happened so one I had become very familiar with a lot of
Emerging research on excessive cardiovascular training which again is a
rich man's problem ultramarathons Ultra
biking Ultra swimming hiking. That's right. That's right. That's right. So I'd be again there and it's the same sort of curve right where as exercise dose of exercise goes up mortality comes down, but it has this little bit of a j where once you start to get into hyper amounts of exercise, especially over the age of 40. You're actually driving an
You send mortality now ideally. Yes,
you know, I mean like running a marathon once a year or is it running a marathon every week?
Yeah, great. Great Point running a marathon once a year probably not increasing your mortality at all. But, you know running 40 50 miles a week probably is if especially at that age now again, this gets to your point about resilience someone in their 20s doing that.
Doesn't seem to have any impact on mortality. It really only seems to be an issue. If you continue. In fact, I did an interview with a cardiologist James O'Keefe on my podcast who is you know, the world's expert on this and an end. It was actually James's work six years ago because I heard him speak at a conference 10 years ago. We became friends. I know it's one of those things. I'm sure you've experienced this where you hear something and you don't want it to be true. So you basically come up with all the reasons you're going to poke holes in it and pull you 5 p.m. When you
find the evidence.
The other way, yeah. Yeah
and eventually became very difficult to ignore that this hyper amount of exercise was counterproductive the so that's one piece of the the change six years ago
the second although it's probably bad that I just committed to doing the marathon next year yesterday.
That's all right, though. You'll be fine. I just think don't do one a month. Yeah, and then I think the second thing was I realized like we sort of funny but I realized like my Prime was so far behind me, but I needed to think about like what what was
What was I doing this in service of right like and not that I needed anyone other than myself to do these things because I'm very self motivated so I don't like but just as a joke one day I asked my wife I said hey, do you know what my PR is for 20K
like Micron or Swim?
Yeah bike on a 20K bike on the time trial and I was like, this is my wife. She hears me talk about this stuff all the time. I have spreadsheets and
models and data and I analyze my power data every single day and I'm trying to break the record for San Diego like I'm really so switched on to this she'll probably get it within a minute she'll guess what my PR is within a minute she was off by 20 minutes meaning she wasn't even in the zip code so I was like huh that's funny like it's like literally the most important person in my life couldn't care less about this and what I realized was you know I need to start thinking about a difference
sport which is the sport of longevity so what is it mean to be a kick-ass hundred-year-old and so that was the beginning of a mental model for me that in the past two years has gained much more traction called the Centenary and Olympics huh so how do you train to kick ass at a hundred should you get there and of course everywhere along the way
So that now dominates my landscape of training, which means I don't, you know care about how fast I can you know ride a 40 kilometer time trial because that doesn't quite fit into what a centenarian needs to be able to do.
What is your mindset going into a 40 mile bike then or some type of experience? Is it more the joy of it
so I don't I don't I don't I don't drink no my training is very specific. But now it is fundamentally organized around four pillars. So the pillars being stability strength.
Mitochondrial aerobic efficiency and anaerobic performance and so each of those then has a super layer detail approach and I still ride my bike for hours a week. So it's a fraction of what I used to do and it's now very much geared to a certain energy system and a type of training.
What was the fourth want stability strength mitochondria
and mitochondrial efficiency or aerobic efficiency and then the fourth and final one is anaerobic performance.
So you focus on those form.
Metrics now on a day-to-day
basis. Yeah. Yeah, those those four pillars sort of make up the training program, which is then in service of something that I invite every patient to Define for themselves, which is because you will have a different, you know set of variables for me potentially, but you know, my centenarian Olympics has you know, 18 events in it, you know, like I want to be able to pull myself out of a pool that you know where there's a one foot gap between the water and the curb like lift myself up.
I want to be able to hop over a three foot fence. I want to be able to walk three miles in an hour. I want to be able to carry to 10-pound bags up four flights of stairs. I want to be able to goblet squat 30 pounds because that's about the weight of a kid. I want to be able to get up off the floor without using my hands. So I could rattle off all of my 18 things and you would say Peter those seem really easy and you'd be right as a 37 year old stud, but the point is
as a serger all
A lot of them aren't easy.
Most 60 year olds couldn't do this if their life depended on it and I have yet to meet but maybe one person in their 80s or 90s who can and so that's the aspiration is to get to that level in your 80s or 90s. How do you work that backgrounds to inform your training in your 60s in your 50s and in your 40s and it's actually very hard and
as I'm getting into you know, I'm three years away from 41 to someone in my age range be thinking about when they're
I'm
healthy. I feel good, you know, maybe have some aches and pains here and there when I'm training hard or something, but the most part I feel amazing. What should I be thinking about moving forward so that I continue to feel amazing and have the ability to do these things.
So we don't I think it's never too late to at least become familiar with what these ideas mean and it doesn't mean that you have to go whole hog and devote yourself to this. Like I've obviously made a very conscious choice that
I don't go to swim meets. I don't go to bike races. Like I don't train for those things anymore and a big part of that is just time, you know, there are only a hundred and sixty eight hours in a week. And you know, I have a very clear set of priorities and I'm willing to set aside 10 to 12 hours a week for exercise which by many people's standards is still quite a lot but probably by the standards that you exercise and certainly by the standards that I used to exercise, you know, I've never exercised so little in my life, so I have to be very efficient with every one of those
Minutes and that means I'm laser focused on the four principles of that in your case. I think it comes down to saying okay, how much time do you want to vote devote to the long game? How much time do you want to devote to the short game another way to think about this would be investing if you're looking at an Investment Portfolio, you might say how much do I want to put both time and money. So the actual capital I set aside but also the amount of time I spend deliberating over it into my retirement account.
This is how much do I want to invest as a day trader for short-term gains for you know money that I'm going to be using in the near term. That's maybe even supplementing my income today. So you could have totally different strategies for that. That's totally fine. So I'm just in the category where I'm only thinking about long-term permanent capital and so so that's the first question is you have to decide how do you want to do that? And it might be that you say, you know Peter at 37. I just want to focus on running a marathon. I've always wanted to do an Ironman. So I'm going to go and do that.
And you know, I want to climb Mount Everest and that's going to require like you might have a whole bunch of these bucket list things and truthfully. I would say do them now because it's only going to get harder as you're
talking about do it later. Yeah. Yeah. Yeah. I mean, I
don't think you're gonna want to do it later. So it so get those things out of the way. Yeah, and then maybe when you turn 40 you say, okay now it's time. I'm going to really focus on my centenarian Olympics when I have a better sense of what those events look like for me
personally, that's interesting. Is there a list somewhere of your 18 on your website that I can link up for people to check this
out?
No, it's it's not we have we have a I think I have a subset of them for for for our patients in our you know, documents that talk through this stuff, but it'll be in my book. I want to
close the loop on these four things. We talked about sleep for a while. The first one was intake of glucose. Second thing was you don't have the efficient muscle to take into glucose the third as sleep disturbance talk about that for a while. What was the fourth thing?
That we were going to cover here stress. Yeah.
So cortisol is a really important hormone without it. You'd be dead but too much of it can really wreak havoc and a big part of what too much cortisol does is really drive that excess production of glucose out of the liver and so of these for I certainly have never seen a case where just stress alone resulted in diabetes in a person who's new to
Nutrition intake, you know, they're there in take their exercise in their sleep were perfect. But it it really is like having just a little bit of extra kindling on a fire. It's a Molly gets there. Yeah, it's it is it's a
multiplier. What are the three causes of stress?
Well, I mean, I think there are many causes of stress, right? So so I think you've got kind of the the there's that you could divide it into sort of internal versus external right? So I think of this in a way that says look,
It's really more about a person's response to externalities
response to the experience the event the that's running that happen.
That's right. You can have three people that are exposed to the exact same externality that have three completely different responses to it. So I think it's less productive to focus on the external piece and more productive to focus on the internal peace. So this is where
I think my favorite by far well, so so now I think there are three ways we can go about coping with this which because this kind of goes this is just the tip of the iceberg is the stress piece. This really becomes now the sort of Gateway into what is mental and emotional health all about. Yes. And and and and and now I think there are basically three you can see on the very pillared structure leave like I write I like it. So now we go into basically three ways that we can
Approach dealing with this one of these is through Psychotherapy, which I'm a huge huge proponent of pharmacotherapy, which I'm also a proponent of the way. I think it's vastly misunderstood and then behavioral therapy, which I'm an overwhelming proponent of and particular type of behavioral therapy called dialectical behavioral therapy or DBT and again it CT there. Yes, dialectical behavioral therapy not to be confused with cognitive.
Native behavioral therapy or CBT which is also popular but I believe that DBT is more efficacious. But that said I think different personalities respond different two different versions for what it's worth my personality response so much better to DBT than CBT. So therefore I found it to be much more
helpful. So these three things will help give us the tools to cope with
stress. Yes. Got
you and what I'm hearing you say is it's
We a lot of people lack tools for these three main things cognitive physical and emotional resilience. We're lacking the tools to then amplify them in our favor as opposed to against us and the more tools we can gain then we could hopefully take the actions to live healthier and longer.
Yeah, and it has to be proactive. I mean, I think that's the piece that's inherent in what you said is
At some point you have to decide you're going to go on offense. So this you can't just sit on defense and say I'm going to take it as it comes and what's going to happen is going to happen. And and and I just I think you you you have to take this view which has I'm going to be incredibly proactive and I might not be able to control everything. You know, I don't represent it. You know, there's some path where everybody's going to be able to make it to live to a hundred. There are just some people whose
Beans don't don't don't command that and that's fine. You know, there are people out there who have so many, you know, genetic things working against them that they'll be lucky to make it to 80. But but the point is with without making these proactive changes, they might have lived only until 70 and to your earlier point. They might have spent the last 20 of those years in an unbelievable state of misery. So when you contrast, you know, living 270 spending 20 years
as in misery versus living 275 with maybe two years in misery. It's it just doesn't even strike me as a trade-off.
Thank you so so much for listening to this episode. I hope you got a ton of value out of this again. I did not want to stop this conversation and that's why it continued and the next episode episode number 1046 will be the second part of this and in that episode. We really dive in on the cause of stress and how to be happy.
The main cause of mental health issues and traumas ways. We can develop our emotional resistance that danger of non-alcoholic fatty liver disease how food affects our mental health and so much more. So make sure to click that subscribe button right now on Apple podcast to listen to the school of greatness and stay up-to-date with the greatest information from the greatest Minds in the world every single week. And also if you want inspirational messages sent to your phone from me every single week,
Eek join my texting list by texting the word podcast 2614 350 3960 again text the word podcast right now just six 14350 3960 to stay up to date on that and please leave us a rating and review over on Apple podcast. If you enjoyed this to help us spread the message to more people and I want to leave you with this quote from Thomas Edison who said the doctor of the future will give no medicine but will instruct his patients.
Care of the human frame and diet and in the cause and prevention of disease Oh Thomas Edison. Thank you for that quote. Stay tuned for part two with dr. Peter a TIA and if Known As Told You Lately you are loved you are worthy and you matter and you know what time it is it's time to go out there and do something great.
