Going from zero activity to just 90 minutes a week, is about a 15% reduction in all. Cause mortality. Jesus Christ,
dr. Peter attea world, renowned physician the doctor for anything performance or longevity related. He has the secret for living a long healthy and happy
life. Most people listening to us are going to die in cardiovascular disease, cancer diabetes. If we want to really figure out a way to live longer, we need a totally different
Playbook how led to some of these diseases.
Us,
begin the minute, you're born. But we only really think about the risk over a ten year time Horizon as a 30 year old. You don't get excited about exercise in your sleep, but there's a 400 percent higher risk of dying in the coming year when you compare the fittest, two and a half percent to someone at the bottom,
25% in the coming year. And then, once you hit the age of
65, if you fall and you break your hip, there's a 15 to 30 percent chance, you will be dead within the
next 12 months
really. You have to realize
Is you're taking this for granted shit?
When you talk about the deterioration of Health, you have these three categories, emotional health deterioration, why have you included that?
Because, despite being very physically healthy, I was not living a good life. I was in such an awful cycle of anger workaholism that, I don't think my marriage would have survived. I realized I don't want to be this person and lose my kids. I don't think I could have survived and I'm sure many people listening to us, can relate, we able to discover the root cause of that, more than that, I was able to get rid.
I love it
how so what you really need to do is
one of the biggest misconceptions in your mind about weight loss. I
have thought a lot about this. So
Doctor Pizza. It's here he is the man that wrote the book on how to live a long happy and healthy life and he argues that everything we know about health and what that actually means health of the Mind, the body, and the emotions is wrong and outdated.
He says that there's disease growing in you and me right now. But the problem is because we can't see it. We're doing nothing about it, dr. Peters work, turns the light on it allows you to see.
That, in many cases.
In action, now will increase your chance of disease and a much shorter Life by 70% 170 percent. And in some cases, if we don't take action Now, by 400%, I've had lots of conversations on this podcast about health about diet, about all of these things, but for many of you
This one will be the one that changes your life. This will be the one that makes you ask some difficult but important questions about your health and what health means for you. I walked away from this conversation. Realizing that if I don't take action, now I'm going to be forced to take action then. And I can unequivocally say that this conversation has changed my life. I have a suspicion. It's going to change yours.
Pizza.
Dr. Peter
You talked about so much in your work, I've been through every interview, you've done your book other conversations. You've had, you talked about a lot so many things that I'm absolutely fascinated by my first question for you is
What is your mission and why are you doing this? You know, I
think that there is no greater desire for people than to be healthy, especially when you consider how we can define health, more broadly than just physical health. Once you can include kind of emotional health, it's kind of the great equalizer and nothing else. Really matters. If you don't have
Have it, right? So it doesn't really matter if you're famous or not famous, it doesn't matter if you're rich or poor. If, if your health is compromised, and anybody who's been through an illness, where their health has been compromised, I think will realize in a moment what they've taken for granted. And I've just become personally endlessly fascinated by this topic and in my own quest to understand this better and better the next natural step.
That was to begin to do it as a doctor, right to begin to kind of help patients with this. And at some point you can only treat so many people and so podcasting and ultimately writing a book just became a way to put as much of that information as possible out there for more and more people to access.
Do, you know why you of all people became fascinated by this? Was that racist dominoes that foul, I think so. Yeah, I mean I think you know, I'd always been interested
in
Formance because I'd always, you know, at least as, as far back, as, you know, being 12 or 13 years old, you know, I'd always been obsessed with one form or another of some sort of physical Obsession. Whether it be, you know, boxing when I was really young or Marathon swimming later in life. But when my daughter was born, when I was 35, that
was the first time that everything kind of pivoted and I had a little bit of a glimpse into the future, I would say and I just sort of realized oh, you know,
The Joy I'm experiencing In This Moment is so surprising to me so unanticipated and I really want to be able to experience this again which means not just with other children of mine but potentially with grandchildren,
And on top of that, I had a bit of a wake-up call which was I realized that all the men in my family died. Prematurely of heart disease. Obviously, I knew that fact before this time. But I think it was the Confluence of those two things. It was the realization that. Yeah. You know, if you don't figure something out and do something about this, you're probably going to die of heart disease in your 60s, which is not that far from now, you know, 25, 30 years from now. And you now really have a motivation to live longer and to live better.
Longer and so that in many ways, kind of began the change in my direction, my focus to being one. That was not purely just focused on performance anymore but sort of focused on understanding Health in a different way. This concept of medicine 3.0 is a concept which I only discovered in your work never had the time used before. What is medicine 3.0? And how did you get to the point when you realize that there needed to be an it?
Raishin on the current system of medicine.
Yeah the reason I think you hadn't heard of it before as I don't think it's been described before so he can't be faulted for that. But as I began writing the book and thinking about how
I was practicing and how people like me practice. I realized that it is a very distinct change from the current form of medicine, and in a way to not be just critical of the current form of medicine. I had to put it in the context of what existed even before that, and that's how I sort of realized. Well, we're in this version of medicine called medicine 2.0, but it's following something called medicine 1.0 and it's an enormous Improvement above that. So maybe I can
and a moment, just kind of explaining what those three are. And I think that's probably the easiest way to explain the current form. So medicine 1.0 is everything that existed before we really understood the science of medicine. So for most of human history, we had no idea why people got sick or why people died or what an infection meant. And we sort of thought that these were plagues from the gods or things of that nature.
But a couple of
things happened in the past, you know, hundred few hundred years. The
first was the idea of
a scientific method. Something that we take for granted today where you can make an observation about something in the world. Formulate, a guess called a hypothesis about why it's happening and then design an experiment to test it. That's called the scientific method.
That's an invention that's a
creation. We had to figure that out. Also things like a light microscope, which
Each, you know, up until 140 years ago or so didn't exist, allowed scientists and doctors to be able to actually see these microscopic things called bacteria, and then ultimately the development of things like antibiotics. And eventually vaccines, all of these things made an enormous difference, in reducing the suffering and death due to what I call in the book, Fast death so fast, death is pretty much how we used to all die fast, death would be trauma and infection.
And up until
about 150 years ago, life expectancy would have been high 30s, low 40s and most of us succumbed to fast
death, but with the Advent of medicine,
2.0 through all those transitions, I just described in the span of a few Generations. We've doubled life expectancy, right? So now life expectancy is roughly twice what I just said a minute ago and most people do not die from Fast death.
Death.
But it's been supplanted by slow death today. Most people listening to us are going to die from cardiovascular disease from cancer Dementia or other neurodegenerative diseases, complications of diabetes. And on the one hand, that's a sign of progress. It means like Hey we're living long enough to die from those things but we've made scant progress against those things. In fact, if you go back and
Strip out the top eight causes of infectious death or communicable death, death from communicable, diseases are infectious diseases today. If you strip them out, our life expectancy is not much better than it was in the 1800's.
In other words, that doubling of
life expectancy that we've experienced comes almost exclusively to the reduction of those fast deaths and has little to do with any success we've had against slow death.
If we want to really figure out a way to live longer and I would argue more importantly, live better. Meaning when we're in the last Decades of our life, not be in a state of total decline, we need a totally different Playbook and that Playbook is medicine 3.0 and it involves real prevention. So that means taking True step steps at prevention, very early in life. It also involves being very personalized and how you do things. So it means you can't just do paint-by-numbers. You can't just sort of say the same thing to everybody.
Clearly, there are certain things that make absolute sense across the board such as sleep and exercise, you know, but the way you might use medications is going to have to be much more tailored to an individual. You say that there are full points to Medicine 3.0 which is the prevention the being unique in your treatment to each individual and honest assessment and acceptance of risk. Yeah.
One of the things that I don't think we think enough about is doctors, sometimes is risk right now. I think doctors are very good at thinking about the risk of doing something. Yeah, I think, you know, usually a doctor is pretty good at understanding. You know, if you have this surgical procedure, there's a risk of an infection. There's a risk of bleeding, there's a risk of all these things. If you take this medicine, there's a risk of this side effect or that side effect, but I don't think we spend enough time thinking about the risk of not acting or the risk of not.
Acting when we do. So, this is where I think it gets a bit more
nuanced.
Prevention, doesn't. Come without risk, right? I mean, you're still going to have to do something in the state of prevention. So the question is understanding the time Horizon upon which you're considering risk. So I'll give you one very specific example at least in the US and it might
be the same in the
UK. We only really think
about the risk of heart disease over a 10 year time Horizon. So look at someone like you. You're 30 years old right. So
what is your 10 year risk of having a heart attack?
I can tell you without knowing anything about
you. It's really low good. It's as close to zero as we
could have in
medicine.
But what if I did a blood
test on you and I found biomarkers in there that were predictive of very high risk later in life. Now, that would be actually quite possible. There's about a one in ten chance you might have a biomarker called LP little a, for example, which is just a certain lipid in your body about a 1. In 10 chance you have that dramatically increases your risk of cardiovascular
disease. My uncle died. Very I am leaving is
FTS if of a cardiovascular disease. Hmm. Interesting.
So knowing that, by the way, could be helpful because that would prompt me to ask you more questions and want to know more about all the people in your family. So here we have a 1 in 10 chance and by the way, we wouldn't leave it to chance. We would just check it. And we let's say we check your level and you had that you had that lipoprotein or you had an elevated level of another lipoprotein, a PO lipoprotein, little B. And again, these are kind of technical terms but they're very common things and they're easy to
measure.
The medicine
2.0 view here would be. Well, there's nothing wrong with you now, and there's not going to be anything wrong with you for the next 10 years. We don't need to do anything about
it.
Conversely. If I take a lifetime view of risk, I would say.
Yeah, but the risk to something happening in the next 40 years is actually quite significant. So my risk of doing nothing is probably much higher than my risk of doing something today. So my risk of doing something today,
would be nonzero but small but my
risk of doing nothing, if I take the appropriate time Horizon is much bigger,
this is one of the things in the book that really, really got me thinking was I have to say and I believe a lot of people probably feel the same way. I've gone through my life thinking
Going to some degree. I'll worry about avoiding these diseases later. Mmm, I'll when I get to 45, then I start taking this thing seriously because that I'm getting into that territory where most people, I know they get cancer or Alzheimer's, or all of these cardiovascular things that's when it tends to happen. So I'll think about it, then totally understandable, and I'll
frame this in the context of a question. I get asked all the time, which is
Is hey Peter. When is the best time to start thinking about this stuff? And I say, look, I can't answer that because there are two competing issues that are crossing. When I meet somebody who's in the last decade of their life, do you know how much they are thinking about this? Like, it's all they're thinking about it's all they're thinking about every minute of every day is a confrontation with their own mortality.
The problem is,
they don't have much time to change the direction of the ship. You may recall. In the book, I write the sort of I use the metaphor of the Titanic, right?
It's not that the Titanic didn't see the iceberg. It's that it didn't see the
iceberg in time. It
didn't have enough Runway
to really move out of the way. And that's what I Titanic gash, the side of the boat.
Now at the other end of the spectrum, a thirty-year-old, like you
has unbelievable
potential to change the Arc of your life.
You have so much runway to
through manipulating nutrition and exercise and sleep and stress. And all of these things
to completely
alter the disease trajectory of your life. The problem is and I'm not just speaking to you personally, but more broadly to someone
Who's as young as you, it's harder to find the motivation because there are no reminders of your own mortality. You're Superman, right? The worst thing. That happens to you is a hangover. So I always get asked like when is the right time to start worrying about this and the short answer is look as soon as possible. But then there's a reality that says for most people, it's not until they're in their 40s. Maybe once they have kids that they start to appreciate their own mortality and that that
I'd some of the motivation to say, you know, maybe I'll be a little less focused on optimizing everything for today and I'll start thinking a little bit about tomorrow. So again, another way to think about this is saving for retirement. A lot of people in their 20s and 30s who are making good money aren't necessarily taking the most prudent Financial steps to ensure Financial Freedom when they're in their 70s.
Because let's be honest, it's more enjoyable to spend money today than to set some of it aside.
But there are a lot of people later in life who think I wish I was a little bit more responsible earlier on
how I lead to some of these dizzy. If you looked at my sort of metabolic health, or if you were able to look inside my body, which I'm sure you're able to do how early do some of these diseases begin in my in my life. At what age do you see some of these things
coming? Yeah it's super interesting because there are some elements of you as a person that are going downhill. The
You're born and there are others that are
not. So let's let's use two examples.
Let's start with something, where your body is getting better and better. And you know, you're probably only peaking now but you haven't really started to gauge your muscle quality. Okay. So when you were 5 years old, your muscle quality was nothing like it is today. But as you enter your
TS the quality of those muscle fibers. These type to want these type 1 and type 2 muscle fibers. So, these are kind of slow to fatigue, but high endurance. Fibers of the type. One fibers, the type two fibers are very, very powerful, but they're kind of quick to fatigue. The quality of both of those fibers is very high and the more you train them, the higher quality, they will be.
But as you enter your 30s, you will
now start to experience a shrinkage of the
Those type 2 muscle fibers.
You will be
less powerful in your 30s in your late 30s. Especially then you were in your mid-to-late 20s. So, that's a form of Aging. You are declining. It's not an accident that the most powerful athletes in the world are at their peak in their late 20s, and early 30s. So sprinters, for example, that's a prime example of a pure pure Power Sport. We look at other things, like more of your muscular endurance that
At will Peak even a little bit later, you can keep that going a little bit later. We look at certain forms of cognition. So if we look at something called fluid intelligence, right? This is raw horsepower processing speed. You have more of it right now than I do meaning, you're going to have faster processing speed better memory. All of these things are going to be better when you're 30 then at my age. I'm 50 because that's already started to decline in me. There are some things
However, that began Aging in. You, the minute you were born and one of them is actually going back to this idea of atherosclerosis or cardiovascular disease. Well, that's an example of a disease process that begins right away at Birth and even
though it almost
never rears its head as far as death, before you're 50. Make no mistake about it. It's starting on day one and we know this by the way, because when we look at studies of people who died for completely unrelated,
Reasons, so somebody who, you know, dies in a car accident or soldiers dying in war and we look at their, the arteries of their heart. We already see quite Advanced disease. So, the truth of it is you already have pretty significant disease, in your coronary arteries, it hasn't risen to the level of ever causing a heart attack and it's unlikely to do so for another 20 years, maybe even another 30 years but if compounding, it is compounding, exactly.
And if you want to live to be 90 free of cardiovascular disease, it makes a big difference. If you can slow it down when you're in your 20s and 30s.
Interesting. That's really what I'm trying to change in myself as I'm trying to find the motivation. Like you said, when we're not confronted with our mortality, it's interesting because my life changed because of the pandemic in part because I got to see the relationship between things like obesity. Paul metabolic health and mortality for the first time. And that's really when I started working out pretty much every day now, it was three years ago.
March 20, 20, 20, 20 20, when I was watching the TV and it was that confrontation of like oh my God, the reason why I'm having a better outcome with this diseases because I'm in better metabolic Health, metabolic shape, and it's funny that it has to take those things in our lives. For us to make the changes quick one. Before we get back to this episode, just give me 30 seconds of your time. Two things I wanted to say. The first thing is a huge. Thank you for listening and tuning into the show week after week means the world to all of us. And this really is a dream that we absolutely never had.
Add and couldn't have imagined to getting to this place but secondly, it's a dream where we feel like we're only just getting started. And if you enjoy what we do here, please join the 24% of people that listen to this podcast regularly and follow us on this app. Here's a promise. I'm going to make to you. I'm going to do everything in my power to make this show as good as I can now. And into the future. We're going to deliver the guests that you want me to speak to and we're going to continue to keep doing all of the things you love about the show. Thank you, thank you so much.
The
episode. When you talk about the deterioration of Health, you have these three categories cognitive decline decline in loss and function of our physical body and then emotional health deterioration. Why a motional Health deterioration? Why do I have I included that. Why have you included that? Well, I mean maybe I'll
just take a step back and say where I kind of put these all in perspective. So you know the the title of the book, right. Is outlive the science and art of longevity and what is longevity? Well longevity
is really about
Two things, it's about the length of life and the word for that is lifespan. But it's about the quality of life and the word for that is Health span and it's Health span that has those three components you just described healthspan. Meaning, quality of life is determined by your cognitive function. So what's your processing speed, what's your executive function? What's your memory? All of these things, it's determined by your physical health. How much strength do
Have are you free from Pain? How much endurance do you
have? What, what capacity do you have to do? Whatever you
want to do physically? Are you Limited in any way, by paying strength movement balance, Etc? And then the final piece is emotional health. What's the state of your relationships? Are you, do you have joy in your life? Do you have a sense of purpose? Are you happy? Not all the time, right? Do but do you have the capacity to regulate your emotions?
Yes. And so, now to answer your question, why would that be included? Well, the truth of the matter is it wasn't something I always included, right? It wasn't something. I necessarily thought much about until it was, I think very starkly pointed out to me by a very astute therapist. Who in observing my own struggles in life said, something to the effect of. Isn't it really ironic that you were putting so much energy into
Helping people live longer. And yet, you are paying no attention to your own
misery. And I think that was, you
know, that was about six years ago and that was kind of when I realized I needed to rethink my approach to this problem. And as I write about in the
book, I think I would
make the case today that if your emotional health is suffering, none of the others, really matter that much.
So what you really need to do is, think about
About a way to have all of these things in order. What does she mean by your own misery? Well, I mean, I think at that point in my life, I mean
there's, there's no two ways about it. I mean, I was just incredibly miserable incredibly angry despite being very physically healthy, right? Despite doing all of the important, things to be physically healthy, right? Exercising, you know, in all the right ways eating well sleeping. Well optimizing, every aspect of
My health, but but living living a bad
life. What were the symptoms of that? What were the kind of for you to start to spot that? Because sometimes we don't know in our own behavior and sometimes it's reflected back on from other people, we will get feedback from our wife or a girlfriend. Yeah, I mean
Detachment from others prone to anger workaholism selfishness. You know, it wasn't, it wasn't subtle
It wasn't like hmm. I wonder if you know I'm not being my best self know if I was being honest and confronting it, I was not. I was not living a good
life. Did you know that in the moment? Had I lost you in the moment. You happy weed, what would you've responded?
I think I would have probably said
to just that question. Sure, right. But I think to a deeper prodding
no. And there were there
were a lot of things that happened in there but but certainly a very powerful one was going to the funeral of a woman. My age who was the mother of my daughter's best friend.
so, my younger daughter's best friend, her mom died of cancer and so all the parents you know, worth of worth of funeral and at the time I was
You know.
Really going through a lot of difficulty in my own marriage.
And
this woman who died was a very successful lawyer, really pretty
remarkable. And I was really sort of struck how
at the funeral people had the nicest things to say about her. What a beautiful mother she was she had three
kids
and nobody talked at all about her career, like there was not a single word
about her achievements in life, it
was only a discussion about the quality of her life as a mother, and that might sound very obvious because when was the last time you were at a funeral where they talked about someone's career accolades, but that in a moment, really fused
An idea from a book. I had just read by a guy named David Brooks called the road to character. I don't have you read
it in the book.
David Brooks talks about this idea of there being resume virtues, and eulogy
virtues.
And I really
understood in that moment that my entire life, at that moment had been only predicated on bolstering my resume virtues. I had never spent a moment thinking about my eulogy virtues, and at that moment to your question, if someone had asked me, how is your eulogy? I would have been brutally honest and said, it is awful. There is not a single nice thing.
One who matters about me in other words of the people who should matter, most they won't be able to say anything nice about me.
Is that painful to admit? Yes, it's painful to admit today and it was painful to acknowledge them.
Wow, I'm so impressed that you're able to.
Because I thinking about cognitive dissonance and how psychologically uncomfortable that must be to face.
You hidden in the book about I think it was in the last chapter of the book. You start hinting about the origins of that behavior of the workaholism and all of those things and I can totally relate. I think I'm a total workaholic. I think I sacrifice too much in the pursuit of like accolades sometimes in my life. Everyone knows me. Including these guys will all say that about me and I've often tried to in hindsight figure out where that came from, in me and undo that. Hmm. Well, it's funny because reading this
Book. The last chapter, I actually wrote in my notes from I just wrote Because the chapters called emotional health, I wrote brackets trauma and the role that trauma plays. I didn't expect to find that subject matter in this book about longevity. What's your thoughts on the role trauma plays and how we go about understanding it so that we can live a
Have a lung Health span.
I think there's probably a lot of people who can relate to this stuff. I write about in the Final Chapter and you're right. That chapter is significant deviation from the first 16 chapters. So there's 17 chapters in the book and I basically make the argument that I am the doctor for 16 of them. The first 16 I'm talking about this is though, I'm the doctor you're the patient. I'm going to help you and this
how to do all this stuff and then in the Final Chapter, I'm saying, actually now I'm the patient and I'm going to kind of walk you through this journey I've had and hope that it basically motivates each of you to have a similar examination of yourselves and
I think that many people, I can't tell you what fraction of people, but I think many people have maladaptive behaviors in their life that are indirectly or directly their response to something that we would Define as trauma. And Trauma is a very vast concept, right? I think it's very easy when you hear the word trauma to think of abuse and you know, that can be physical abuse, sexual abuse.
We'll use these things like that, and it's true. I did experience abuse in my life,
but trauma can be much more
than that trauma. Can be abandonment. Enmeshment witnessing tragic things. So, there are lots of things that are traumatic. I discussed them in the
book and
what happens to children, who are traumatized, and it can also happen to adults. But I think most often the formative years
As of our lives, our when these things
happen is we adapt and I think that's the kind
of remarkable thing about us is how adaptive we are
and those adaptations
can often be very
positive.
But a lot of times they have -
collateral or maladaptive consequences in addition.
And some of those adaptations that are negative or addictions, some of them are other maladaptive behaviors, like anger, some of them include, you know, things like codependency, so you can sort of look at people and realize that, hey, you know, maybe that person who grew up in the home of Alcoholics. Even if it was an otherwise reasonably well meaning home and it's not like they were getting hit with a belt buckle every night, but they weren't getting the type of attention.
In that they needed.
And their adaptation was to have an attachment disorder. That wouldn't manifest itself really fully until they were a parent.
So this this type of
analysis really. I think everybody needs to spend some time thinking about it and needs to spend some time asking themselves. Hey, which of my behaviors are maladaptive
and it's something that's done and I think it needs to
be done without judgment. This isn't about saying I'm a bad person because of XY and
Z, even though I think I can objectively look back at my own behaviors at that time of my life and say those are awful behaviors. I'm not proud of those behaviors but it's separating the behavior from the self. It's not saying I'm a horrible human. It's saying I'm a human who did horrible things. And I want to understand why I left that approach because I think about the maladaptive Behavior patterns. I had that stood in the chance student stood in the way of my chance of emotional health in good relationships and a lot of those stem back to my childhood and
What I witnessed in my home and then distort the way that made me adapt and the beliefs that gave me about romantic relationships, for example. So, I became totally avoidant of those into later in my life. When I realized this pattern, the third point in your, in your list of things that cause sort of, I guess, longevity of one's Health span, is that emotional health deterioration? So, before we get into the other, to my question, really was on that third point of emotional health.
What for you has helped you to self-analyze and become aware and to then get those things out of your way. That stand a chance of costing. You your emotional health? Was it therapy? Was it introspection? Is it journaling? Is it honestly with oneself? Well, I mean, in my case, I think the
situation was so far gone that I actually had to go away on two occasions. So I had to go away in
It the first time for two weeks to an inpatient, like, what's called a residential care facility, which was two weeks of like 14 straight days of 14 hours a day, just doing trauma therapy in group and individually. And you know, two weeks might not sound like a long time. But boy, that was about the most brutal exhausting thing I'd ever done in my life and then again,
N.
I had to do it for three weeks at a different facility. So, again, 21 days of inpatient treatment. But also now really learning what the tools were to manage myself. How do I fix that behavior? How do I, how do I manage it? So it's sort of like you have an injury, you go to rehab, you know, there's an acute healing phase, but then there's a well. Now, you want to make sure you're strong and that you don't injure it again because that injury took place.
Because of some weakness. And, and that's not a, not a Perfect Analogy, but the point is, you know, there's a reason that your shoulder separated. Yeah. And we want to make sure it doesn't happen again. Even once you're better
and you sent yourself that twice. Yes. And no. I mean,
truthfully. I don't think I had a choice. I don't think my, I don't think my marriage would have survived, so I think it was
I'm not sure I had a choice truthfully. So I went very
reluctantly,
I did not want to go.
But it was there was a an ultimatum essentially. Yeah. Wow, what was the greatest sort of gift that process gave you? Oh
give me my life.
I mean, literally saved my life,
we for sure.
How well, I don't
think.
I don't think I would, I just don't think I'd be alive today without it, right? I think head, I lost. I mean, I was on such a, I was on I was in such an awful cycle of Shame and self-loathing and deterioration that
I don't think I could have survived
it.
So was that that was a narrative in your head at the time that you when you talk about shame and self-loathing, that's what the voice in your head was yeah the voice is you are an awful
human being that's why you behave this way and
There's nothing that can be done about it. You you're born this way, you are defective and this is what defective people do. Look in many ways, it's a lack of accountability, right? It's sort of saying you have no agency in this you you can't change this because you are your defective when they do an autopsy on you. They will see something in the temporal lobe of your brain. That explains your pathology.
Were you able to discover the root cause of that narrative in your head?
Yes. Absolutely.
And. And more than that, I was able to get rid
of it. Really? Yeah. I'll give you one very tangible
example. I had
a very very
vocal inner critic.
and I think I'm sure many people listening to us can relate to that, which is, you know, I was such a perfectionist, I was such a workaholic
but any mistake I made I would
Eviscerate myself verbally. So and this was I mean, this is mistakes that don't matter. Okay. So one of my hobbies is archery, I love archery. So every day almost every day. Certainly if I'm not traveling, I'm going to be out in the backyard shooting, my bow and arrow.
Now, does anybody else care nobody? Right. Is this my livelihood depend on this? No.
But if I'm not shooting, well, I am screaming at myself. I will break an arrow over my thigh and these are carbon arrows, the leave welts the size of your finger.
One of the exercises we had to do was
and this was once I left the second therapy place that was three weeks. So, the one of the big realizations, there was that, this was happening because that voice, like, I didn't realize that that was unusual. So the exercise was every single day, until this voice goes away, which I thought would never happen which meant, I thought I was signing up to do this exercise for the rest of my
My life, you take out your phone and you talk into the phone with a replacement voice for that voice
and pretend, you're talking
to your closest friend, as if it were them who made the mistake. And I say,
Hey Chris. I know you're having a bad day today. I can tell it's hard. You're not shooting.
Well, it's okay.
You know what some days. It's just not going to go. Well, plus it is a little windy today. Let's be honest, it makes it a bit harder and
why don't we just pack it up and
come back and try again tomorrow?
You know, just talk in a kind way talk in the way you would
literally speak to your friend and then I would send that recording to my therapist. So every day, my therapist is getting multiple versions of these voicemails. But this is important because I'm audibly doing this. Hmm, multiple times a day.
and,
Within about four months.
The Voice just went away, really? Yeah, that's never come back.
How has it changed you as a father? Oh my
God. It's a, it's a it has it changed me as a person, right? As a father, as a husband is as a boss as a friend. I mean, it's just again, it makes me a little sad to think. Oh God. I wish I knew this when I was I wish I wish I did this at 25. You know, instead of
all of this
Again, I just think of all of the
collateral damage in my life, you know, all of the people near me who have suffered unnecessarily as a result
of, you know,
of me being a wrecking ball, how much of that could have been prevented this in some ways. It's kind of comes back to your very first question, right? Which is I'm
30. I'm Invincible. How do I
get excited about this? Look. Maybe the answer is as a 30 year old, you don't need to get
Excited about, you know, your nutrition and exercise in your sleep as much as a fifty-year-old does. But hey there's a lot of benefit to doing so because you'll get more benefit from it but maybe it's just focusing on emotional health. So that you get yourself fixed before you start a family because I think, you know and I think, you know, I feel lucky. I think my kids are still young enough. I hope that my kids don't have too many memories of their of their dad in that in that state.
You'll belief about where that came from, although there's no evidence, there's no memory of anyone, you know, seeing all this happened and whatever else. But
is your belief that you weren't born with that and that something might have happened and you've kind of inferred that in some way.
Yes, I think that was a really, really important breakthrough that happened on the 19th day of that second stint. I had in therapy in that, inpatient, therapy session. So that was a 21-day program that I assumed was only going to be 14 days. And at the end of 14 days, they needed me to they wanted me to stay another week. Everybody wanted me to.
Another seven days and I was so reluctant at this point, I was exhausted. I just didn't think I could do it again, but they were adamant that I stay another week. And I knew the first time I had gone for two weeks and left, I left kind of against their recommendations and I realized I never really got fully better. I got somewhat better but not fully better. So I decided to just submit to them and say, okay, fine? I will stay as long as you tell me to and it was on that night.
19th day that I had, perhaps the single most important Revelation for me. Again, this is very personal and the point of this is not that everybody else is going to relate to this. It's only that I hope everybody else is willing to consider their own version of this. But what I, the last thing I could never let go of was that
I was born as a perfect child, right? Like meaning, we all are right? Not just me, but all of these kind of maladaptive behaviors were the result of things that I didn't deserve and
Again, it's not all
what we call Capital T, traumas. It's not, it's not necessarily the abuse. I mean, I think, in my case, perhaps the most impactful things of my childhood were were more like
neglect and not not traumatic. Not like the kind of neglect, it's going to that has you. You should be
taken out of a house or anything like that. I'm just talking about not getting a certain type of attention that I probably should have had.
and
for whatever reason,
that
Manifested itself in really odd behaviors that as a kid I just said, those are just bad behaviors but that's just who I was. And I think what I realized is and what I finally came to accept is no, those are adaptations to something that you didn't deserve. And that might sound like a very subtle distinction but it made all the difference in the world and it made me realize in part by looking at my own kids, that
You know, there is a real innocence to children that can very easily get injured and and when it does they're going to make sure that they don't get hurt again. And and the way they're going to do that is as I said initially in their best interest but ultimately it tends to result in really negative consequences for the way, they formulate relationships with themselves with, for the way, they form relationships with others. For the way, they're going to parent, for the way they're going to be.
Husband or wife. And so, that was it, that was a huge
breakthrough.
So important and so powerful. And I, I don't, I don't think I've ever said this but really thank you for sharing that because I got a lot from it. And I've had lots of conversations about this, but I got a lot from that it specifically that point about didn't deserve for it to happen and really it's a response that's trying to make sure you don't experience that pain again. So it's really again, it's your body is is doing everything in its power, to help you and to protect you. And some of these behaviors end up being maladaptive, which then stand in the way of your chance of emotional health that is the
I'd category of deterioration which is the emotional health deterioration. So let's go a little bit earlier in the book and let's talk about the decline and the loss of function of our physical bodies, as well as medicine 3.0 is we talked about earlier, you talked about these five core things that helped increase our chances of longevity as it relates to our health span. So what are those five things?
Well, there's the one we just talked about, right? So all the tools that deal with how do you improve your emotional health? Yeah again most of
Of modern medicine. Only thinks about, you know, if you think about, where does medicine 2.0 rank on that, it doesn't really accept in the arena of mental health, right? When it comes to clinical depression, anxiety, personality disorders, you know, bipolar disorder there, we have a branch of medicine called Psychiatry that deals with those things but outside of that medicine doesn't really deal with people like me. You know, I none of my problems quote-unquote Rose to the level of
You know, a clinical diagnosis, that would require medical therapy, okay tool to exercise. Again, we can talk a lot about it if you want a little about it. But the point is, it is not remotely given anything beyond lip service by medicine 2.0, Edison, you know, if you go to your doctor here at the NHS and say, okay, tell me what my workouts should be like, good luck, right. How much time should I be spending in zone? 2 vs. Zone? 5.
Like what type of lifting should? I mean, there's no way they're going to give you that type of insight or specificity. The third one is nutrition again. Sure. Every doctor is going to tell you eat, less exercise, more, but they're not really. For the most part going to be able to help you manage nutrition. Certainly I didn't learn anything about nutrition or exercise when I was going through my medical training and most Physicians don't. So I'm not saying that there aren't doctors out there who don't understand these things. What I'm going to say is they had to learn that stuff on their own.
Side of their traditional training. So crazy. The fourth one is sleep and that fits in the same category. Sleep is an essential pillar of Health, but we learn nothing about it in our medical training. In fact, most of our medical training is paradoxically sleep deprived, so it's sort of, it's a great irony, the fifth and final thing that you have as a tool in the longevity toolkit is, is all the molecules. So, drugs hormone supplements and there, that's the one thing you sort of do learn in
digital medicine is you at least learn about the the pharmacologic side of it. You don't really learn anything about supplements. So most doctors don't really understand much about supplements. And interestingly, most doctors don't really understand a lot about hormones as well. So medicine 2.0 is good at what it does but it's very limited. So it's kind of like having a contractor that only has one tool instead of five tools and as we discussed earlier, I think they're applying those tools too late in the game.
Can you prove to start with exercise? Then how can you prove to me that exercise is important?
Yeah, it's a great question. So, start with, the easiest way to do this is to look at what the absence of exercise does versus looking at the absence or presence of other known bad things. Now, for me to explain this, I have to explain a technical term called a hazard ratio. So if you'll bear with me, while I explain what a hazard ratio is
It will reap lots of fruit later on a hazard ratio is a mathematical derivation that comes from
looking at a group of
people following them prospectively following them into the future, and looking at the rate at which they
died. So, a hazard ratio is a number
if that number is 1.5, it means that there is a 50% increase.
In the risk of death for one group versus the other. So for example, if we want to know is smoking bad for you,
we might ask the
question. What is the hazard ratio for smokers to non-smokers when it comes to getting lung cancer, okay? And the answer is like 10, really? It's 10 times more loot about 10 times more likely to get lung cancer, if you're a smoker than if you're a nonsmoker.
Now, if you look at the hazard ratio across the course of life
for all causes of death, it's about 1.5 meaning a smoker is about 50
percent more likely to die in any given year than a nonsmoker which you
can all cause
mortality all-cause. Mortality is the gold standard for understanding death, and disease because it takes into account every form of death, okay, okay. What if you have type 2 diabetes, everybody understands that having type 2.
He's is very problematic and people with type 2. Diabetes. Are at about twice the risk. More or less of cancer
heart disease.
Maybe one and a half times the risk of Alzheimer's disease, but when it comes to all-cause, mortality every cause of death. It's about a 1.4 Hazard ratio
40%. Not a
40% increase in all-cause mortality. Again, that's a stark number. It means at any moment in time, if you take two people who are ever in, otherwise always,
Nickel, but one has Type 2 diabetes. In one dozen. This person has a 40 percent higher risk of dying in the coming year,
in the coming year. Yeah, Jesus Christ. Yeah, wow. Like, okay, we could keep doing this. What if it's high blood pressure versus normal blood pressure? That's a hazard ratio of about 1.2 20%. Same everything I just said, but it's 20%, okay? What if it's someone who has end-stage kidney disease? Their kidneys don't work anymore. They're on dialysis.
He's hanging by a thread waiting for a kidney transplant. It's about 2.7. That's a one hundred and seventy percent increase in all-cause. Mortality in the subsequent year
Okay.
Now, let's talk about some other things.
What if I ask the question, what happens if I take
A group of 50 year olds, pick any age, pick any sex and we're going to take the top 15 to 20% in strength and compare them to the bottom. 15 to 20% in strength for that age and sex. What's the difference? What's the hazard ratio there? What would your guess
be 20% template? Yes 01 .12
1.2 yeah yeah it's
three shit. Two hundred percent difference
in all-cause mortality.
Can you make a distinction between strength and muscle mass?
Okay, yep, we can do it. So, muscle mass just if we did it just on muscle mass. It's about to like or a 100 percent difference. So muscle mass turns out to be an amazing proxy for strength. But strength is even better. Okay, yep. So, high strength and high muscle mass produce a hazard ratio of about
3.5. Okay? Because you can have a lot of muscles, but I'll be strong. Yeah, kind of and you can be
Long and have not as much muscle, okay and that matters more by the way but they're pretty tightly correlated. Okay? Yeah. Now let's look at vo2max so VO2 max is the best tool we have to measure Peak cardiorespiratory Fitness. So this is a test that you actually have to take. It's it's done on a treadmill or on a bike they put a mask on your face and then the mask measures how much oxygen you use. So in the book, I talk in great detail about this test it's something anybody can do it cost.
It's probably a hundred quid. It's not like super expensive and everybody should know their VO2 max. I really think everybody should know it. And in the book, I even offer some ways that you can estimate it just by running at a track or something like that.
So, sorry it's the measure of how much oxygen you inhaling and exhaling. No, yeah, it's the difference
between how much you inhale, and exhale is how much you're using. So, the way the, the way the test is working is there's a little oxygen sensor. So, if you're breathing in, we know that the air you're breathing in, is 21%, oxygen.
Jen, we know the flow rate and we, let's just say you're blowing it out at 14%. So we know you used up 7 percent times. The flow rate we figure out how many liters per minute of oxygen you're using at the
max and what's good? And what's bad?
Yeah, so depends on your age and sex but at your age, so for a thirty-year-old male, we would say I need the table is in the book.
Really, I could estimate it. 6050
T56 would put you in the top two and a half percent and that means that
I'm sorry. What's that number mean? Yeah that's 56 mL of oxygen per kilogram of body weight per
minute. Okay? So a high much do you weigh any business objective? Nice. I'm gonna get those, I think I'm 96 kg of the moment. Okay, very heavy. So you would need to be
five point three, five point four, five point five.
Five liters. Yeah, no, no. Yeah, you need to be about 5.5 liters per
minute. You would need to
consume 5.5 liters of oxygen per minute to come out to about a vo2max of 56 or 57 mL of oxygen per kilogram per minute. That would put you in the top two and a half percent for your age and sex.
So I'm trying to figure out is taking more oxygen from the air that I breathe a sign of good
health. Yes. Okay things it's it speaks to how hard how fast and hard.
Your heart can pump. Yeah. And how good your muscles are at utilizing
oxygen. Okay. It is the most important metric we have
for Peak cardiorespiratory, Fitness
and sorry for going a bit too because everyone understand this and I'm sure there's a lot of people do such kind of understand this as well. So what are the things that stand in the way of good vo2max in terms of my and also the lungs? Yeah, it turns out that not much of it is limited
by the lungs. So the question is, where are you Limited?
Okay. Okay, so how does this test work?
Do you prefer to run or bike? I prevent
bike? Okay, so we're going to put you on a bike, we're going to put this mask on your face. That allows no other air in or out. It's only going to be metered by what's coming from the machine.
The bike is going to be
one that has forced resistance to it. It's called an ergometer so we're going to set it to 100 Watts. Nice and easy. I'm going to tell you to warm up for a while and then after a 10 minute, warm up, its going to start increasing.
Increasing the power. That's that you are forced to Pedal against. Okay? And every two minutes we're going to add some amount 25, or 50 watts. And you're going to say, you have to stay above about 70 rpm, and this test is going to go until you can't do it anymore.
It's going to go till you basically drop. So what's limiting, you is clearly not the amount of oxygen in the air and it's actually not the ability of your lungs to get oxygen into your blood, you're limited by the, how hard and fast your heart can pump that blood through your body and how efficient your muscles are at taking the oxygen out and using it. And the difference between
So again a 30 year old who's in the top two and a half percent of their age, group might be at 56 57, but to put that in context, the guy who wins the Tour de France, this year is 85, wow.
and by the way, when that number reaches
20,
Or certainly 1819.
You have a hard time just getting around. Like you wouldn't be able to walk up a flight of stairs.
So it gives you a sense in tells the of the gradient. Now let's get to my point. That answers your
question. You asked how can I say exercise is so powerful? Well what do you think
is the hazard ratio? When I compare someone at the top two and a half percent to someone at the bottom 25% in
terms of VO2 max yes percent versus the top 125 bottom, 25% that's quite big 2% quite narrow.
I'd say.
One point one point five, which is what for you think it's less
important than strength because we've just established for strength. It's about three
so I'm just I'm increasing it now because I was so wrong on
strike. But yeah, I mean,
well, what would I have said? Had you not told me the strength once? Oh,
by the way, I think, your guess is a completely reasonable guess because the answer is so absurd.
I'm going to say. 1.5 hasn't raised Hazard ratio,
it's 55. So you're means
Hundred percent difference in all-cause mortality.
If you compare the fittest two and a half percent to the least fit 25%
house, it makes a huge difference. So this is
why I can
say with absolute
certainty. Nothing compares to exercise.
Nothing
compares to having a high VO2 max. Hi muscle mass and high muscle
strength. They are more
beneficial for you
than any bad.
Odd thing you can think of is bad for you.
While why the is the muscle mass P? So important and the strength. Peace. Why is that causing me to stay alive? I think there are several reasons as you get so there's there's I put them into buckets structural and metabolic.
Let's start with the ladder
muscles are where you dispose of
glucose.
So glucose regulation is one of the most important metabolic functions of the body. Our ability to metabolize glucose and regulate glucose levels is Central to our existence on this planet
and when we get it just a little bit wrong
we go to hell in a handbasket. That's what type 2 diabetes
is type 2 diabetes,
raging type 2
diabetes. Only means you have an extra
5 grams of blood sugar, 1 teaspoon in your circulation. That's it.
The difference between you and someone
with type 2 diabetes so
bad that they're going to get their digits amputated is an extra 1 teaspoon of glucose in the bloodstream.
That's how
critical it is that we regulate our
blood sugar.
And the most
important part of blood sugar regulation is having muscles that are big enough to put the glucose into and that are insulin sensitive enough to respond to the signal of
insulin and glucose is stored in just a couple of places in our body. But
only stored in the liver and in the muscles, but the muscle store 80% of
it, okay? So okay, so muscles are really, really good for glucose regulation because it gives the sugar more place to hide. That's
right. So the other
He's in muscle mass, and strength is so important is as we age fragility, and Frailty become an enormous liability in death.
There's a figure in that book that shows the mortality associated with falling and it becomes catastrophic. Once you hit the age of 65,
Once you hit the age of 65, if you fall, which is pretty likely and you break your hip or your femur, the long bone in your leg. There's a 15 to 30 percent chance, you will be dead within the next 12
months, really? Yes, it's insane because you become set a drink. Yeah, you know, there's a lot of reasons for it but certainly a loss of function is a big one. You can also just died as a result of hitting your head. You can die.
Died from a fat embolism or a blood clot. You can die from sepsis, you can die from, you know, heart attack because, you know, there's there's so many things that can kind of kill you in response to it, but even the people, you know, the 70 to 85 percent of people who don't die, 50% of them will experience a significant loss of function that never recovers after
So this this
issue of sarcopenia which is loss of muscle mass and Frailty and fragility become the, you know, the absolute keeper of death for people, once they reach the seventh decade of life.
Again, if you're 30 years old, it's impossible to Fathom this stuff because you're indestructible. Yeah, even at my age, I
mean, I feel indestructible and I'm 50 but this changes
Has and we have to do, all we can to Ward it off. So that's why muscle mass matters
so much.
This is kind of a long-standing belief that you as you age. There's so many just it's just kind of inevitable you put on fat, you know, you slow down and you'll saying and I think you communicated very clearly in the book that it doesn't have to be inevitable all of the stuff to some degree. Well, I mean look, I
I'm very, I'm very careful to try to be as realistic as possible. I get a little put off when I see people in this sort of quote, unquote, longevity space saying things that I think are
Just science fiction, right? Like oh yeah 90 you can be just as fit as you are at 40 and stuff and I I see Zero evidence that that's happening. I don't see any biotechnology on the horizon that is going to completely and reversibly change aging yet?
I don't think In Our Lifetime. No, I mean, this is something I spend, you know, an absurd amount of time on both as an investor and and just as a you know, a person who thinks about this for my own podcast in the types of guests that I bring on in the type of science that I'm paying attention to but but no I really do not see anything in our lifetime that is going to undo aging. I think we have some ideas of
Places we can look right. I think that, for example, if you could completely restore the epigenome to what it looks like in a young State across the entire genome, I think that could have a profound effect on function. But do we have, do I see ways that we could do that? You know, it's a longer discussion. But I think the complexity there is
many many decades away. That said, what I think we do not need to do is accept the complete and total inevitability of Rapid decline. So the decline is nonlinear. This is the important thing to understand. So what was your decline from 20 to 30?
Wasn't that bad? No no and from 30 to 40 it's not going to be that bad 4250. It's going to be more from 50 to 60. It's going to be even more from 60 to 70. It's going to be way more
and 70 to 80 is falling off a
cliff. So if you if you if you look at
this actually one of the figures I wanted to include in the book but you know you're always sort of scrapped for space. So we took it out but I have a figure that shows both muscle mass and spontaneous physical activity and people by decade.
And it's just based on like a huge data sample of people and it's really interesting to watch the correlation, how strong it is, right? So, physical activity, and muscle mass go like this and they just fall off a cliff. And
the cliff for
both is 75 for both men and women. Like, that's where you see an enormous reduction in muscle mass and activity level,
because of Behavioral.
So I think it's a, you know, it's the age-old question is, are they losing muscle mass? Because they're becoming less.
Or, they becoming less active because they're losing muscle mass muscle mass and I think it's both okay,
I think these to feed off each
other and they get
hotter, right? Presumably because what you said about the quality of the muscle as well. That's right.
So, you have to Ward this stuff off, right? I mean, as your type 2 muscle, fibers are deteriorating and you're putting more fat into muscle. The quality of that muscle, you go from being, you know, Prime to wagyu, no, you have to Ward that stuff off, right? And the way toward that off is to lift
very heavy things. That's the only way to stimulate the type 2 muscle fiber, this type 2 muscle, fiber won't get stimulated by light movements so it's not just that resistance training is necessary but it's resistance training. That's actually quite heavy.
People will hear that Meg. Okay, they get it, they're on board, they're going to exercise. How much do I need to do? Because listen, you, can it be, is it? I've got to change my whole life and exercise. 7 days a week, and run marathons now, dr. Peter or is this? What would you recommend, what? So I
I always
start this question by saying, how much can you do?
Okay. I'm going to, I'm going to play devil's advocate here. I'm going to respond as one of my viewers by honestly, listen, I'm so busy. You don't understand dr. Peter, I'm, I've got kids. I've got this, I've got a job. I'm already already have no time. I'm not sleeping out here. So I don't have any time. I mean, it
requires a thorough discussion around that. It is that really true? Now, of course it's not. Yeah. So then you have to get into the weeds like, how much time are you watching TV? How much time are you on social media? How much time are you doing? Things that might not be.
Be as high a priority as doing this other thing. So, so once you kind of get through that, I do I do sort of put, put it on them, and say, I would much rather, you tell me the number. Then I tell you the number, I can tell you what, I think the number is right. Like if you're playing the optimizing game, and if you're saying
I want to be the absolute best fittest version
of me that is humanly possible when I'm in my
80s. How much do I need to be training for that? The answer is probably one and a half to two
hours a day.
When I have two times a day 7 days a week. Yeah,
I mean of course it's not going to be the same every day and it looks different but it's going to average out to 10 to 14 hours a week.
But rather than tell somebody that because I think that's very off-putting. Yeah, I would just say, just tell me what you got.
If you tell me, you've got five hours a week that you can do this. I'll give you a great set of things you can do in
five hours and My Hope, by the way, is six months from now. You're going to feel so much better that you're going to say, you know
what, I would like to up this 27 hours a week.
What's the difference in old clothes mortality? If I go from doing zero exercise to doing just a
bit. Yeah, that's a great question. And for some people that question is all they need to get started
going from
zero activity to just
90 minutes a week is about a
15% reduction in all cause mortality.
So I'm 50 percent less likely to die in any given Year
from all causes. If you go from being completely sedentary to just doing 90 minutes a
week,
Which is only like I knew 15 minutes a day 12 minutes ago.
Yeah, or just, you know, three times 30
minutes a week.
That's a huge. That's a huge shifting of very important odds. Yeah. And and truthfully like I probably spend more time
convincing people not on the all-cause mortality data, but on the healthspan date it
was a because people don't we didn't think about it. Yeah, death is so
abstract it really, I don't think it. I don't think it even sets in until you're in your 50s. Like, I think it's very
It's very hard to capture the finitude of what it means to be a human when you're young. I think it's true at all ages, but but I really think it's so much better to just focus on the quality of life. You want to live,
what do you want to physically be
able to do throughout your life?
And it's easier in people who have been around aging
people. Yeah. You know, which again a lot of
people in their 30s, their parents aren't even necessarily old enough that they can fully appreciate it. They might have to think. Well, do I still remember what my grandparents were like at the end of their life? And we're at was I inspired by them and if so that's what I want to do great and if I don't want what they had which is the answer, I think most people will have
And what do I need to do to be different? What was it for
you? I remember what it was for me. Yeah, for me.
It's again. It's, I didn't know my grandparents.
I suspect just my training in medicine like I was around so many people at the end of life that like to see. Yeah it was it was just imprinted early
my I'm I told this story once or twice in this podcast before but I was in Bali walking down some a long set of stairs when I say long set of stairs. I mean down the side of a cliff going down to canoe with my partner and I was walking down those stairs. In the sunshine. It dawned on me that my father probably can walk down these, my dad is maybe it is.
60 65 and I thought he wouldn't be able to come down these stairs which means he wouldn't be able to go canoeing with his family and we share a lot of genetic information mean my father, of course. So that was one of those real big moments, actually Jack, who films the podcast, he after, I shared that with him, he and we had some guest on the podcast. He shared with me his own moment where he was climbing a mountain. I think last month when you Jack, and he got to the top of the mountain and thought to himself, God, like it was such an unbelievable experience for him that he created.
I'm wrong. It was an epiphany moment you go. I won't be able to climb this bloody mountain, with all these people and feel this sense of accomplishment. If I and it's those moments for me where I thought, fuck this is, that's my health plan. I want to be able to do this. Yes, you wrote one of the chapters in your book is about stability. Hmm, found that really surprising. Again, I'd never even come across the concept of stability, a, why it's important and that's why it needed
an entire chapter. Because it is a very foreign
concept chapter XIII stability. Why, why is it important
So what does it mean? Yeah, I think this is, this is the stability is a difficult thing to explain. I mean, you can sort of talk about a technically, right stability is the capacity to transmit force from the body to the outside world and from the outside world back to the body without injury. So, any time you're taking a step, you're applying Force to the ground. That's what's allowing you to walk forward. So you apply Force to the ground, the ground applies, an equal opposite Force to you, that's Newton's law and you move forward.
When you're running, why are you going faster? You're going faster primarily because you're applying more Force to the ground and therefore the ground is applying more Force to you and that's propelling you forward. The difference between me and Usain Bolt among other things is his capacity to apply Force to the ground is
Two and a half times my ability to apply Force to the ground.
So, in all that Force, how do you make sure that the
action of the force mechanism is all for the desired purpose. In this case, propulsion and not for undesirable purposes, like, leaking of energy, which is what it feels like when your knee hurts, when you're walking down the stairs or your hip or something like that. So, the analogy,
Oh gee, I use in the book to describe this as that of a car because I love cars and I talked about the difference between a race car, and a street car, a race car can be even half the power of the streetcar in terms of horsepower.
But because it's
smaller lighter and has a stiffer chassis and Slick. Tyres
much more of its power is being delivered directly to the road without slippage or energy loss and therefore it's going faster. And so this idea is
A very important part of aging. So most people who have some sort of chronic injury, it can really be traced back to an instability. Whether it be an instability of their scapula and that's why they really have tennis elbow or an instability in the, you know, in their abdomen, in their lower back. And that's why they have back pain instability in the feet, that translates its way up into knee
pain, all of these
things matter greatly and a
Big part of how we train is. Making sure that we do exercises that bolster our stability.
Again, this feels very mm relevant to me because I'm currently go to a grade 3, tearing my hamstring, got a growing problem. So among physio for the grade 3 tear, how did you tear it playing football? But I have a couple of Suspicion surrounding it because about a month before I got the foot pain that they call
plantar, fasciitis, plantar fasciitis. So I went to the I think it's called podiatrist and I got my foot x-ray. Things done. Where they give you the insoles and then following that I got loads of injuries.
Think my hypothesis is that? I took these insults put them straight in and then proceeded to do two hours of football, basically running a day. And I think something in me just broke because I suddenly got all these injuries. And then I was meant to be playing at Old Trafford in Manchester United, football ground in front of 70,000 people. And the day before in training, I got it, I pulled my hamstring and I think that everyone's been speaking to me about my injury and saying well you know maybe it was something in your lower back and maybe this and maybe your feet weren't whatever.
Of rings. True to what you're saying about stability are clearly have something which is not wasn't wasn't prepared for me to suddenly start training for two hours a day and everything started breaking
well and look I mean it's hamstring injuries are very stubborn injuries and a lot of people are really imbalanced right much stronger quads and hamstrings. My personal take is and I'm sure I'm going to really upset some podiatrist
I think that that insoles foot inserts at our chins arch support. Probably should be reserved only for some people and most people actually need to learn to strengthen the intrinsic muscles of the foot and that that's the issue. That's underpinning. The plantar fasciitis. And once you have asked because by the way, your foot is not that much different from your hand, in terms of the amount of musculature in it. And yet, if you think about the dexterity that you have with,
Your hands and the strength that you have in your hands. I think you'd be surprised at how weak your feet are and I don't just mean you. I'm not singling you out of it and this is true for most of us because shoes really Shield us so much from what our feet should be doing. So yeah, I think I think your hypothesis is actually probably spot on. And I think what you really need to do is strengthen your feet so that your arches can can self-support. And then
Can sort of regain the springiness that are, that is within your feet.
I spoke to dr. Daniel Lieberman about this. Yeah, he said the same thing. Yeah, he said, you'll feel it, too weak and it makes perfect sense to me. Because I do not think about, I always think in terms of my ancestors. And I think my ancestors, didn't walk in these cushioned, Balenciaga shoes. They were out Beth Hoyt. Yeah, building up the strength and so when I went from my cushioned Balenciaga Stu suddenly training two hours a day on feet that it didn't have the muscles. Of course. I I pulled loads of I had all these issues
And so I actually changed my Footwear and I don't have the insoles anymore and I'm now, we're using those Vivo Barefoot. Yep. Shoes. Do you recommend those? You think they're you.
Do I really think? I mean, again, I think there's lots of companies that make them, I wear a brand called zero like xer0 and, and, but, the Vivo barefoot's are great brand and I, yeah, I think that a minimalist shoe is a great way to go. I have the luxury of basically working from home so I'm pretty much Barefoot 24/7. I work out barefooted my own gym like
I'm I'm in my and then when I do my activities, like my rucking and stuff, like that. When I'm Outdoors, like I'm, you know, I'm in a wide toad shoe. That is, you know, at most would have maybe an eight millimeter increase in heel. But yes, minimalist shoe. Now, one thing to keep in mind is if you're transitioning from Big shoe, too, minimalist shoe, don't do it all at once. So, you can also injure yourself in the right shoes. If it's too much too
soon.
They did say that to me, when I told them, they said, just like sort of ease yourself in because you need to build up the muscles in your feet. Super interesting. No one's ever spoken to me about this before, but I just find it. So, now, why did nobody tell me this about, we do? What if you think about it? Like, think of all
the things we do to kids at such a young age, that set them down the wrong path, right? Like we put them in big shoes when they're little, we put them in desks to sit down in class and we take away a lot of physical activity
Comfort. We prescribe Comfort to everything, and yeah.
Vini, insane.
Have you read the Comfort crisis by Michael Easter? No man, such a such a fantastic book.
And it talks about this,
oh yeah, I mean, it's really the whole thesis of the book, right? Is that we have engineered discomfort completely out of our lives. And it's a, you know, it's an enormous problem, both for our physical and mental health,
the ancestors are actually quite simple when you reflect upon it. You go, you know, how are we born to live? We're so far away from how we were born to live and if I just followed more of the instruction manual of my ancestors, maybe I wouldn't have all of these kind of
you know, modern issues with that comfort in many, many respects has caused me,
but it's tough because you have to sort of think about what is the
There are a lot of gifts that come from the modern world. Yeah. Right. And like I don't think you would want to go back in time 100 years and be alive. I
probably wouldn't have very long. Would I eat? Yeah I mean and let's let's even make it
less than that. Like let's say
even
70 years like you know once we're through the sort of infectious pandemic stuff, right? Like what you know what we really want to go back and be alive 70 years ago just before World War Two. I mean I wouldn't like I yeah they had
TriCity and stuff,
but I like the modern world. But
there is a huge set of responsibilities that comes with the modernity of our world
today. Food is so abundant today, I mean, these people did not struggle with obesity
because they weren't surrounded
by really
tasty hyper ballot. Piper palatable calorie dense food in total excess. We are that means we have to exercise some moderation. Most of them had far more physical jobs than you and I
do.
I mean
you and I don't have to lift a finger to make a
living
whereas 75 years ago, we probably did and it's great that we don't have to I think you could argue. Look, you're having a far bigger impact on the world than you would have ever had 75 years ago. But that comes with a responsibility to yourself.
Is this one? I was seeing this sort of resurgence of discomfort as a hobby and a sport in an industry think
so. Yeah, I think so. And again, Michael writes about this so so well,
You know, they write about, he writes about things called muskogee's, which are these very, very difficult challenging things that you might have yourself do once a year. He also writes a lot about something that is just an enormous hobby of mine called rucking. Have you are you familiar with rocking? So wrecking is something that I think it was probably started by the military and its really how the military does the great majority of its conditioning. And its walking with a weighted backpack
And
I mean the military will do this but they might go on a 24-hour Ruck where you're carrying half your body weight. Wow. So picture you carrying in your case, right? Like close to 100 pounds on your back for a day and so there's actually an awesome company in the u.s. called goruck that makes really good rucksacks that are just ergonomically. Designed to put weight plates into
And then they sell these plates and stuff. So I mean this has become a total Obsession of mine so Iraq three or four times every week and luckily, where I live in Austin, Texas. It's incredibly hilly. So it's just up and down up and down very steep hills. And I'll go anywhere from, you know, 50, 60 pounds on some days. I'll really push it and go up to 100 for shorter rucks and you know I'm only doing it for like an hour at a time but we it's very hot where I live.
Summer. So it's just it adds an extra layer of discomfort but it's great.
Yeah. Because I don't know whether it's just what the cycle I'm exposed to in the information exposed to you, but it just seems like all of these Ultra athletic, you know, painful long-distance Sports have become super popular. The Spartans of thought, you know, I actually just recently invested in one because of this very reason because I'm seeing this Comfort crisis and always think that when there's one one, one poll Rises. The other one Also Rises. So when did
It'll music record, you know, old school vinyl records became big and I think in a world of comfort, people are going to seek how extreme discomfort and it sounds like you're doing that with your rocking. Yeah, if you've been listening to this podcast over the last few months, you'll know that we're sponsored and supported by Airbnb but it amazes me how many people don't realize they could actually be sitting on their very own Airbnb for me as someone who works away a lot. It just makes sense to Airbnb. My place at home whilst I'm away. If your job requires you to be away from home for extended periods of time, why leave?
Home empty. You can so easily turn your home into an Airbnb and let it generate income for you. Whilst you're on the road, whether you could use a little extra money to cover some bills or for something a little bit more fun, your home might just be worth more than you think and you can find out how much it's worth or Airbnb. .Co.uk / host:that's Air B&B .co.uk /host sugar is an interesting topic because it's really been demonized. I think and maybe rightfully so but I
To talk to you about sugar because it's actually been really front of mind for me lately. And when I say little, I mean, literally in the last 48 hours, I'm I went away to a wedding and I remember they didn't have a lot of drinks. So I was opting for the sugar free drinks. The things that say no added sugar in them. Like, you know, I won't name the brands but the ones that have zero and diet on them. First question is, is sugar, the devil as people have become to tell me. And also, if I'm drinking
These 0 drinks with the diet zero on it. Am I in the clear? Hmm. This is a very complicated topic and I think it's one. That's also very contentious and it's also one in which I've probably
My thinking is probably also evolved as the science I think has kind of evolved. So
Let's start with what? I don't think anybody disputes. I don't think there's anybody out there, thinking that high sugar foods are somehow nutritious, right? That's not the question at hand. The question
is calorie for
calorie.
Is sugar, somehow different from. Let's just limit it to other sources of carbohydrates. So what is sugar? So I'm assuming, when you're talking about sugar, you're talking about sucrose or high fructose, corn syrup. Those would be the two dominant forms of sugar, but just to demystify it sucrose, which is the white powder. You would put in your coffee or tea. That's just one molecule of glucose and one molecule of fructose stuck together. That's table sugar.
And if you contrast that with pure glucose, so like eating rice is basically pure glucose, it's going to be broken down into pure glucose. How different are they? Well, obviously, the thing that differentiates them is the fructose. That's the thing that's different. Now, it's true that fructose has a very different Pathway to be metabolized the body breaks down fructose in a very different way, from the way it breaks down glucose. And by breaks down, I mean, it gets energy from it. The whole purpose of,
Eating is to make this thing called ATP. ATP is the currency of life. It's the currency by which energy is transmitted throughout the body and the way we make a teepee out of glucose is
I think I can probably say this smarter than the way we make it out of fructose.
The way we make it out of
fructose has a problem, slight problem. Now, it doesn't really matter if you're not consuming a lot of fructose but if you're consuming fructose in a liquid form, it has a real problem.
IE, if you are
drinking sugar, there's a real problem and the problem is this
when you make ATP out of fructose,
Those you temporarily deplete the cell of energy to the point where more energy is needed.
This is just a consequence of the speed at which we metabolize fructose. We do it quickly all the time in this way, but if you're eating an apple, for example, it's not really an issue because yes, the Apple has fructose in it. But, you know, it's not that it's not that much and you're eating it. So it's it's a piece of solid food with fiber and water. That's taking a long time to exit your stomach. But if you drink a big glass of apple juice,
Juice.
Well, I mean, first of all, it's much more fructose and it's liquid and it's just going straight out of your stomach. And your liver is going to encounter it much sooner. As is your gut and, therefore, you're much more likely to want to eat more after. In other words, it creates more of a hunger response. So the real issue with sugar is calorie for calorie. Is it more damaging than just glucose?
I actually think the answer that question is probably not
really? Yeah, but in the real world is that possible
In other words, if I put you
in a metabolic ward, in a hospital where you had no control over what you ate other than me, putting it in front of you and I gave you two different diets and one was higher in fructose than the other. I'm not convinced it would make that much of a difference.
It's possible. It would if we went to extremes you know maybe at a high enough fructose level, we might actually induce more fat production in the liver. We might actually create some fatty liver disease, maybe even drive insulin resistance but I might have to go pretty high on that but the real problem is if I just let you have as much fructose and sugar as you wanted you'd probably end up overeating in response to this energy depletion thing.
So I don't sort of describe myself as like a hardcore sugar, avoider. I mean, like we're here in London and I mean I'm going to have dessert, probably most nights, right? I'm on vacation.
But
I also acknowledge it that it's you know, like not something that I want to be eating on a regular basis. You know, just added sugar all the time. I don't drink sugar, sweetened beverages, that's definitely a place where I draw a line. So I think there's something about liquid sugar that is more problematic than solid sugar. So, I'd rather eat my sugar and at least have the benefit of it being more.
Slowly absorbed then drink it once or twice tonight drinks though. Yeah so I look I don't drink them personally very often and in part that's I think do too.
A little bit of uncertainty. I think we still have about their impact on our metabolism, through our gut I think there's
I think there were emerging
data that suggests that at least certain non-nutritive sweeteners like things like well in the u.s. it's like NutraSweet. I think it's Aspartame is the underlying agent or saccharine or sucralose. I think there's
some
some suggestion that the effect that they have on the bacteria
on your gut might be detrimental to your health. I think it's too soon to really say
that but my view is don't take the risk. Well
I don't need to I suppose I feel like I'm I love soda water like I love carbonated water so I'm just happy to drink that but I'm sure once a month I'm going to have a Diet Coke or something, but it's not a regular thing. But I will say this, when I see people who are struggling for example, with weight loss,
And they're drinking for Diet Cokes a day.
One of the first things I'll do is have them stop completely and replace that with just water or sparkling water. Why I'm not sure. I just empirically have seen, even though they're not getting any calories that a either, it's impacting, their eating behavior when they're not drinking the Coke or maybe it's having some negative impact on their gut that is that is impacting the way, they're metabolized in their food. This is this is rather unscientific it was point, but it's just empirically is something I've observed. Everyone can
Weight loss. It's such a big topic. Everyone wants to lose weight. I mean as you clearly specify people will lose fat. Uh-huh. They don't lose weight people lose fat, which is something I heard you say. What are the biggest misconceptions in your mind about weight loss? Because but I guess the narrative is to lose weight, you eat, kind of you need, just need to eat less. That's kind of the is that true? And one of the big misconceptions that you hear that we need to overcome. Yeah, I think
that is largely true. I think that
eating less is the more important step towards weight loss and that the role of exercise is important. But less because of just the straight number of calories you burn. In other words, the increase in energy that you expend through exercise is usually offset by increased appetite.
Use the one calories that. Yeah. Contentious words sometimes.
It shouldn't be people. People come come on this book Cause and told me that calories are like the concept of its kind of like a lie in the sense that the not will, even some cat, you know, stick of celery, has this many calories. And then when you boil, it has this many calories and it's well, yeah, I think people tend to get a little off in the Weeds on stuff. That might not matter that much. Yeah, it's certainly true that not all calories are absorbable the same way, and an example,
Celery is a pretty extreme example. Because so much of celery is an insoluble fiber, right? So most of the mass of celery is water and insoluble fiber, there are virtually no calories in celery but
at the end of the day it's
not rocket science to figure out how many calories you're ingesting in a certain amount of food. And the truth of it is if a person wants to lose weight, as you said, what they really want to do is lose.
Fat Mass. There's I've never met anybody out there who says, I want to have less muscle. So we want to have less fat
and therefore, we have to
create an energy deficit. Now there are other elements to this that matter so we don't we just want to leave on the side that if you're sleep-deprived, you're going to be very insulin resistant. Its that's a much easier path to being overweight.
Not sleeping not
sleeping, right? So you, you can't correct a weight problem without correcting us.
Sleep problem. What about stress problem? Yep, that's even harder to correct because it's harder to measure, but yes, hypercortisolism Mia high stress, makes it very difficult to lose weight. My pain is said this to me, this weekend, she was trying to figure out how in one stage of her life when she was in her words. Eating very, very healthy food. She says, I still wasn't losing weight and she she hypothesized in the car as we were driving that she thought it might be to do with her stress levels at that time in her life. And I remember thinking, oh, that's an interesting hypothesis.
Yep. So high stress, poor, sleep inactivity. All of those things will make it very difficult to lose weight, even in the presence of whatever perfect diet, you're on. So, those things have to be addressed, right? You have to be sleeping. Well, you
have to be active because
activity increases insulin, sensitivity, and we want those muscles to be sensitive to insulin so that they quickly get glucose out of circulation and also exercise,
As increases the sensitivity of your brain, to what are called satiety hormones, the hormones that tell you, when to stop eating. So, and, and the difference between an exercising person, in a non exercising person, is that that non exercising person has a blunted response to those hormones. So sometimes they're eating when they don't need to be eating. They're not getting the message that says we have enough nutrition on board. Now anybody can blow
Blow through that signal, but I would like to know that that signal is there. So when all of that is said, the question then becomes, how do you create an energy deficit? And basically, there are three ways to do it. There are three strategies to create an energy deficit
I describe them as CR D RT. R, so that stands for calorie restriction, dietary restriction and time restriction.
So let's explain them. Okay? So calorie restriction is what it sounds like just eat less. That's the most direct way to go about doing this so you know I gotta eat 500 fewer calories a day and I'm gonna have to track what I'm eating and count my macros and make that happen, Okay? That has the advantage of being the most direct way to do this, but it has a disadvantage frankly of being harder to do in.
Always, you have to pay the most attention to it.
It also has the advantage by the way of being
pretty flexible and agnostic to what you eat. So, you know, there are certain foods. You
like
there's no food that's off the table. When you're doing calorie restriction provided you're eating less
overall. Got a friend that said this to me said, doesn't matter what you eat. Just restrict the calories. I remember thinking that was your advice because he was like, you can have Domino's Pizza every day. You just if you'll lose weight, if you have less calories, that's right now.
Problem is he's absolutely right. But the problem
is, it can be very difficult
to not suffer through calorie restriction, if you're just eating crap,
Because the body still at the end of the day keeps
score with respect to nutrition.
And the body still wants protein, the body still wants nutrients. Body still wants vitamins minerals. So, if you say, look, I'm going to eat 2,000 calories a day of Cadbury's.
You might lose weight but you'll probably be in purgatory along the way and you certainly won't be healthy. So we also want to make sure we're not confusing health and wait here. Now we come to dietary restriction, dietary restriction is what most people think of, when they think of a diet. This means
As I described in the book, you know, pick your favorite Boogeyman or two and just cut them out of the diet. So basically everybody that's arguing about their perfect diet is arguing about dietary restriction so you want to take out carbs, you want to take out animal products, you want to take out everything but meet you know it's a carnivore diet you want to go, South Beach, paleo Mediterranean those are all just forms of dietary restriction and generally speaking. The more restrictive you are in the diet
The less you will eat.
So, I mean, it's, I don't think it's an accident that people who go on a carnivore diet, typically lose a ton of weight. Same is true of a
ketogenic diet. I did it. Yeah, my scales. It was like this. This was the, it was a, it was a horizontal line, my weight, maybe a little bit up and then I did keto for eight weeks and it was a vertical line down every time I hit those scales and the Bluetooth thing Center, my weight to my phone, this vertical line down. I lost a stone in the space of those eight weeks. Roughly, my girlfriend was like you stone is
In pounds something like that. Yeah, eight kilos are 14 Stone. What did I go from 14? Stone 5. To 14. Stone 8 to 13. Stone 8. Yeah. Which I think, yeah. And were you hungry? I couldn't sustain it easily. I'd say that. Because if we went to restaurants and stuff, I was always trying to get like taking corn out of it, like taking the rap off a burrito and stuff. And whatever else was I hungry after I got past the first week, I wouldn't say I was
Is hungry now. But I also didn't find it sustainable because of honestly, because of the nature of the modern world, where it's so hard to find those things when you're living a very fast-paced life, the hungry for some kind of nutrient, maybe I think there was some kind of psychological calling to go back to work to my previous diet and then I went to New York and that's when it fell down.
And then, did you regain the weight or what
happened? Oh yes. Oh yes. Just
as fast as I lost it. I
went from this keto diet to the New York diet and it was so extreme how quickly I put that weight back on again, just being honest. Yeah.
Well, it's interesting, right. So I again, it's a very extreme diet and I think, you know, people are going to definitely lose lose lose weight on it and look for some people, it's easy to sustain for others, it's not but nevertheless that's dietary restriction and again, I think the advantage of dietary
Restriction is you're not being restricted in the amount. You eat, you're just being restricted in what you eat and the challenge then really comes down to the craving of certain types of foods. So obviously in a ketogenic diet you're going to really crave carbohydrates,
so the
final strategy is time, restriction, and people call this intermittent fasting as well, but it's basically saying all right. How about I create a smaller window in which
I eat.
So, I'm just going to allow myself to eat, you know, from noon to 8:00 p.m. or 2, p.m. to 8, p.m. or 2 p.m. to 6 p.m. and the narrower and narrower, where you make that window. The more likely it is that you will induce a significant caloric deficit
and therefore, you will lose weight. What do you think of Austin's you fast and not anymore? At least not
deliberately I mean sometimes end up fasting just by the nature of whatever I'm doing but again
Fasting has a lot of advantages. It's conceptually the easiest by far. I think it is just the easiest to execute on and because for most people, it's just easy to not eat for a period of time, and then have no restriction when they are eating. I think the biggest challenge of fasting comes down to protein intake. And protein is, in my view, obviously I write about this in the book, The most important, macronutrient the one, we need to be paying the most attention to, and
when you are
intermittently fasting,
It is very difficult to get the right amount of protein in and in the right Doses. And therefore, it's the most difficult to maintain muscle mass. And we always have to remember that, you know, if we're
losing weight, we still
want to be able to maintain muscle mass. We want to just lose fat mass and
not lose both. I'm fasting as we speak, I haven't eaten today yet and it's I think it's just off 26, the reason for that is because before this podcast I realized that if I eat
Before I have a conversation, my brain doesn't work. It feels like, and I having spoken to some experts, the energy rushes to my gut. So I can't I can't speak as well and I can't think as well. So I ordered the food just before you got here and then I said to my sister, I can't eat it and within an hour of you so I'll eat after. But yeah, that the health benefits are one thing but the cognitive impact as well as been quite quite big for me, so you don't fast.
Not, does not know. I tell used to
fast a lot. I mean I used to do days and days at a
time, alcohol thing. I wanted to talk to you about, I'm thinking of quitting.
What is the, what is the advice from a doctor like yourself about alcohol and you drink? I do.
It's a very interesting topic. So I and it's so long that I don't want to. I don't want to spend another hour on this because I'm sure that's not the answer. Anyone is looking for, I will say this alcohol ethanol which is the alcohol. We drink is toxic, its toxicity is nonlinear. So its toxicity kind of goes like this, meaning at low levels.
Just a little bit of an increase, but the more you drink, the more it becomes toxic. So you know, for most people there's not an appreciable amount of toxicity at one drink a day. But, you know, 23 drinks. A day starts to become quite toxic but there is no dose of ethanol. That is helpful. So the question becomes, why is there so much epidemiology out there suggesting
The benefits of modest alcohol intake. So there's this thing in the alcohol research field called the J curve. The J. Curve is a picture of J. Curve for all-cause mortality. It means that at total abstinence mortality is here, but as you drink a little bit the mortality goes down before, it really Rises sharply, as you increase the drinking, that's what the epidemiology shows, and it can hone down well, again.
Ecology is fraught with many limitations, especially epidemiology of nutrition. Okay. It's much worse than the epidemiology of say exercise or infectious diseases, and proponents of alcohol argue that, and they might be right to some extent. That there are some pro-social benefits of alcohol alcohol. At least in the former red wine is also potentially something that comes with some antioxidants and things of that nature. My view is that that literature is highly flawed.
That literature is confounded by a negative survivorship bias and it's confounded by the fact that net that non-drinkers often have a health reason for being a non-drinker. And in other words, there are people who are completely not drinking because of a health reason, that's forcing them to be not drinking and people who drink and die as a result of it, dilute, the pool of data.
De that we have of the toxic effects of alcohol As Time, Marches forward. So it's a long-winded way of saying, I think anybody who's thinking about not drinking, should absolutely engage. In that, there's no health benefit to be drinking you ask me if I drink. The answer is, I do, but I don't drink if it sucks like. In other words, there has to be a good reason for me to drink. So my my sort of Mantra is don't drink on airplanes.
Like they always just have crap. Alcohol, what's the point, right? Like if I'm going to drink, if I'm gonna have a glass of wine, it has to be really good. I don't have a hard time opening a bottle of wine that I bought and deciding actually, I don't like it that much and pouring it down the sink. I'm not gonna drink it because it's there. So that's that's kind of how I think about it. Now, there are a couple of rules. I think that make drinking less toxic. So rule number one is really try not to have more than one drink in a day, and definitely not more.
Than too hard rule there for me second is I do not want to be drinking more than 3 hours or less than three hours before bed.
In other words, I do not want alcohol to negatively impact my sleep which it has a devastating consequence of my sleep. So if I'm going to drink I wanted, I'd rather if a cocktail early then drink into the wee hours of the night.
Sleeps reading, Putin to use in it for sure, super important Amazo and life-changing this little whip thing. Whose yeah, it's, I see that obviously changed my life and you've probably noticed
how your whoop score changes with and without
alcohol in one class and it's all flashing red. And it's the first time that happened. I had one glass of wine and I woke up the next day and my Vital Signs, my heart rate variability was flashing red and it literally says, did you have a drink last night? It changed my life. Yeah, it changed my life forever and honestly, I'm absolutely obsessed.
Sleep in a very healthy way. Some people think oh, that's, you know, you might be waking up and feeling bad. Now, I look at it and if I have not slept, well, I'll adjust my day accordingly, you see, you share some stats around. Sleeping in the book, what it? What is the stat or the two stats? That changed your perspective on sleeping or that really? You would you would tell someone if you're trying to convince them of the importance of sleep? It's so interesting. I'll tell you it's not even a stat. I think
it's more of a guy almost goes back to the type of discussion you'd have with somebody like a Daniel Lieberman right thinking
At this, through the lens of our ancestors. So I was always someone who
Deprioritized sleep, you know, very busy person high-energy didn't really seem to need that much of it. Even in high school was sort of always go. Go go. And, you know, at one point I was sort of having a discussion with a colleague about sleep and I was making the argument that like, I didn't really need any of it, you know. And I almost, you know, made a point like it's almost a shame. We can't just work our way out of it, and he sort of posed.
Me in a very Socratic way. Well, you know, given how evolutionarily
Unwise sleep would be, right. You are unconscious for a third of your life. And we, we know that our ancestors slept on an average of about seven to eight hours every 24 hours. They didn't do it. Always straight away, but we know that they're sleeping basically a third of their life, that's a time. When you can't forage for food, you can't defend yourself against predators. You're not mating, like there's nothing from an evolutionary perspective. You're doing, those are the three
Highest priorities of evolution and you're not doing them. Why would Evolution have kept this thing around like and by the way, why has no species figured out a way out of it? And I think through that lens I was sort of like huh.
Yeah, interesting maybe this thing does matter. So in some ways I think that's probably one of the most powerful things that you can hear. And sure there are lots of statistics about how fragmented sleep broken sleep or short sleep can increase your risk in particular of cardiovascular disease and dementia. I think there's a less clear relationship to cancer, but I think the relationship is quite clear to cardiovascular disease and dementia. In addition to insulin resistance, and obviously, there for weight gain. So for
But even if you're just coming at this, through the lens of of weight or excess body fat, I mean that's probably motivation enough for many people. And
then, of course there's how you feel and how you perform machine and your creativity and your ability to articulate yourself, which I noticed in your mood, huge one for me, especially when you're running teams and slept days of my last days, and the last thing I wanted to ask you about, was it just again, a conversation I've had with my friends recently when I say my friends, I mean this group had my five best mates and different voice.
Has in in the group about hormone replacement therapy and one of my friends particular is very keen on it. He says that when we get older we should all take, I think testosterone and I think it's trt because it'll help us in all these different ways. And I've sat here and spoken to people about menopause as well, and the hormone therapy you can take when you when you go through. Menopause, what is your position on? On taking these hormone replacement therapies to improve our
Health span and our emotional state, Etc.
Yeah, I think it's a long discussion but I've done, I have a lot of podcasts on this topic because I think it's so misunderstood,
you know, we have a lot of data on the use of testosterone replacement therapy in men. And while I think it is generally overprescribed and I think generally at least in the u.s. men are receiving trt far too early in their lives.
I think the the data for responsible use of trt are very positive. So, the risk, you know, again historically the risk would be increased risk of prostate cancer increased risk of heart disease. Those have not borne out again at physiologic doses, a very low-risk proposition that comes with many benefits. Most notably, of course, being benefits of body composition but also insulin sensitivity.
I think the cognitive benefits are a little more controversial, not entirely clear that testosterone replacement therapy, preserves cognition as we age, but it hasn't been studied perfectly. So it's I think that's a bit of a TBD as far as estrogen and progesterone replacement therapy or hormone replacement therapy for women. I think this is, unfortunately a very controversial topic that shouldn't be. I think it's anybody who's really scrutinizes the literature here, as opposed to just chooses to believe what they were told.
Has to come away believing that it's a, net positive for women, especially women, who are symptomatic, right? So women who are having hot flashes and night sweats, as they're going through menopause, they benefit enormously from hormone replacement therapy. And in the case of HRT for women, the estrogen is so important as it protects their bone density. So, women really go through this risk of osteopenia and osteoporosis when they go through menopause, because their bones, get weaker in response to estrogen loss. So, being able to restore
Or that is so important. And then of course, you have all of the sexual side effects in menopause as well. That are ameliorated by estrogen. Another thing that's hasn't
been yet
completely well study, but I think is becoming increasingly of interest in the United States is the use of testosterone replacement therapy and women as well. So most people don't associate testosterone with women. But it's actually a very interesting statistic that women have 10 times more testosterone in them and they do estrogen. It's just that estrogen is the dominant.
Hormone for their sexual characteristics. So we mostly just think about their estrogen and progesterone, but we should never ignore their testosterone because a, it's 10 times more abundant than their estrogen even though it's 1/20 as abundant as it is in a male. But it still plays an important role in muscle mass mood and libido and sexual function orgasmic function, all sorts of things. So we think a ton about all of these hormones in our patients.
And I think, you know, you just have to make sure that if you're going down that path, you're doing it with a doctor who really understands it because there are some real big mistakes that can get made, especially in young men who end up on a high dose of testosterone and they haven't been told that, hey, by the way, you know, a couple years into this. If you're on a high dose of testosterone, you're going to lose the ability to make your own and you're not going to be able to make sperm either any. You can imagine imagine being
230 a having, you know, some Doc in a box, put you on a boat load of testosterone. And then when you're 35, you're like, yeah I think me and my wife want to have kids and you're like no that's not happening.
Wow, so there's that one has to be one. Has to know what they're doing
because there are ways to give other hormones, that preserve fertility and things
like that. I'm super scared of all this stuff. You know, I'm super scared of messing with the chemical balance of my body. It's my default is is I didn't even take like what you're going to like penicillin. If I'm if I have excruciating pain somewhere my body, I won't take any medicine because I'm because I always ask myself the question, what's the cost? There's always a cost somewhere and I don't think we think about that enough. And one of the things obviously happening at this chapter of my life.
Is my hair is going to recede and I'm watching as my friends will battle this in their own ways. Some of them are doing the testosterone shampoo, some of them are taking pills for it. I am, I've surrounded it's going back, I don't care because I'm too scared to mess with my chemicals. I don't want my libido to go. I don't want to not be able to
actually I'll just share one last interesting story with you. So there is the most common drugs that are the most common pills that are used for treating that are called 5-alpha reductase Inhibitors. So again I don't know what their
Are in the UK. But in the in the US, the two drugs are finasteride and do tasks deride.
The receding hairlines. Yeah. Okay,
so these are drugs that block the conversion of testosterone to a more much more potent. Androgen called dihydrotestosterone DHT. So testosterone gets turned into DHT by an enzyme called 5-alpha reductase. DHT is the hormone that's driving hair loss. So understandably, if you take a drug
Drug that blocks that enzyme you will make less DHD. You will have less hair loss,
and these drugs do work, but a relatively small, but not insignificant number of men who take these drugs, have awful side effects and the scariest part, is it appears that a subset of those men do not lose the side effect, even if they stop taking the drug,
And the side effects are very sexual, right? So these are you know difficulty achieving orgasm loss of libido and you know so it's a very controversial topic but I think it's something that we definitely want to make sure men are aware of when they're taking high doses of these
hormones.
That is exactly why I'm not taking them. And is exactly what I'm not taking them. I'm just always gotta have that default and messing with the chemicals in my body. There's no free lunch in life. Is that your book is amazing. Your book is really, really amazing. Very, very comprehensive. You took many, many, many, many, many, many, many, many years to write it. And it's really an amalgamation of all of your insights, your podcast, your Genius, and your lived experience, your perspective. It's a wonderful wonderful book that I highly recommend anybody who's interested in the subject that we've talked about today going.
It goes and gets there's so much more that we could have talked about in there if anybody wants the more and more detail and all the stuff we've talked about the book is the place to go. We have a closing traditional this podcast with the last guest leaves, a question for the next guest, not knowing who they going to leave it for and I didn't get to read it until I open the book. So the question that was left for you by Our Last guest. They don't know who they're leaving it for. So, yeah. This is also the longest question I've ever seen in this new age of AI when Humanity has Lodge,
Kick.
Machines that will out logic humans. How are you going to help Humanity lead with love? What is your purpose as a human in a world where AI is contributing to life? Mmm.
I think my answer is going to be very uninteresting because I have relatively low.
Expectations, that my life will matter that much in the new world. So, I think that the most important impact I will have is on my kids, I think this is probably more about the world, my kids will inherit. And therefore, I think the most important thing I can do is ensure that my kids are as well-adjusted as possible, and as curious as intellectually
Be curious as possible. And so, whatever I can do to sow those seeds is probably going to have a better impact on the humanity of the world than anything I would do.
Thank you.
Thank you so much. Thank you for writing this book and taking giving me so much of your time. I really, really appreciate that. And you've helped me to answer some really important questions in my life that are genuinely, really, really important. And I'll see my job, then is I go in and do this podcast forever. And I'm going to continue to harvest all of that wisdom and share it with everybody in and take that forward. So, thank you so much for your generosity there. It's an amazing book. You have a great podcast as well. Highly recommend, everyone can check this book out out live by dr. Peter, an amazing book. Thank you so much. Thank you very much, really enjoyed it.
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