#771 - Dr Peter Attia - Scientifically Proven Ways To Build Muscle & Boost Longevity
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Hello, friends, welcome back to the show. My guess today is doctor Peter a tear. He's a physician, longevity expert, podcasting and an author. There is essentially an unlimited amount of health advice available on the internet.

Working out what is legit science and what is bro signs is difficult, but thankfully, decades of experience means Peter can help cut through the noise about what is actually most of of to improve your fitness and longevity. I expect to learn why a simple hospital visit can cost six thousand dollars in america. How to improve your cognition, the best supplements everyone should be taking, whether there are any safe doses of military, an why so many Young men, and now dependent on T R T.

How worried we should be about process foods, sun cream, alcohol and all of your favorite devices, how we can Better deal with mental decline as we age, how to improve yourself, talk and much more. Another awesome episode from that huge shoot that we did on a virtual L. D.

Wall here in awesome texas. And Peter is a legend. The guy is one of the best voices in health and fitness, super evidence based.

He's an md. He is teaching people and coaching them and helping them on a daily basis. And you get to find out all these best tax today, it's very good and I hope that you enjoy IT.

Don't forget that you might be listening but not subscribed. And over the next few weeks, we have mister bowen, tim ferris and gary v coming on the podcast you do to miss those episodes along with everyone else. And the only way that you can ensure you won't is by hitting the subscribe button and it's free.

And IT supports the show and IT makes me happy. So please go and do IT. I thank you. But now, ladies and gentlemen, please welcome, doctor Peter, a tear.

What's this story about your son going to hospital in getting some insane medical charge for a tiny procedure?

Yeah but it's unfortunate. A very common story right where anybody goes to the er and you know they end up meeting a bag of iv fluid or something like that, and then they get a bill for thousands of dollars. And you actually look through the line item and you realize this is always right. You literally charged me fourteen hundred dollars for a bag of Normal sAiling that costs, I don't know, somewhere between two and three dollars. But IT sort of speaks to a lot of the brakes in the specifically in the american health care system.

What is IT? Why is IT so broken? What IT is IT because it's a commercial enterprise is IT because IT needs to be uh, additional funds need to be brought in from places where they shouldn't.

What's go on IT has to do with the complexity of a multiple are system and basically the way contracts are between payers and hospitals. And you have to decide in those negotiations who is in network and who is out of network. That's like one sliver of one problem.

This this exists on on so many levels. But in in that case, I think the issue came down to you know some very high deductable that wasn't met, coupled with some out of network thing. But the truth of IT is there's also ridiculous pricing. So so there's a sort of a false sense of how much things cost in hospitals in sort of funny money like we're onna really, really mark up the Price so that we can give you a big discount if you're in network, right? You know so you see this across the board with all sorts of things in medicine .

and to I write your son that costs like six grand or something.

I can't remember the dollar amount IT was so agreement ous. Um and again, I it's infuriating to me when you keep in in in mind the fact that probably the average american would have a hard time on short notice producing a thousand dollars and yeah fortunately enough that I can produce a thousand dollars without a too much difficulty. But for the average person, maybe fifty percent of the population, that's a really big deal and that's a huge inconvenience, right? That means that changes your plans dramatically IT means you're not taking a vacation that summer IT means you're .

not you not able to go out with your family .

for a total is totally .

inexcusable. I went to a ghost tour in new orleans five years ago, and the guy that was taking the two finished up afterward, and I was asking him about the american health care system. And he said, this thing is really stuck with me.

He said, if you get hit by a car, you'd Better walk IT off. His point being that there are medical emergencies that can happen, that can ruin your life by you having to fix them, not by you not fixing them. yeah.

Um health care is the number one cause of personal bankrupcy in the united states. No way.

wow. It's strange for me as someone who's coming from the U. K.

right? There are problems with the nh. Don't get me. I ve had my share of problems with the nh, but there's a social safety night that picks people up.

And IT feels to me, IT feels Barbara, to not you you don't get the privilege of health care. I could just, oh, you're so si sorry, like not for you IT ms. IT seems very bizarre ing from the U.

K. yeah. And it's a little counterintuitive. The people who are most impacted are not the people at the very bottom of the society omy later here because those are individuals who are gona qualify for something called medicate, which is meant to sort of you know provide for the people who truly have nothing.

Um but if you go one level or two levels up from that to people who do have health insurance but they're grossly underinsured or they can afford health insurance because, yes, they're working and yes, they have these other expenses but they can't afford that. Um those are the people that are absolutely devastate ted by the system here and and again, on the flip side of that, I think on some matrix, the U. S.

Healthcare system is hands down the best in the world, is not an accident that win heads of state, you know king's in queens, royalty, you whatever need the best procedure, they are going to come the states um and and so on the one hand, the U. S. Has the best to offer in terms of, you know, the tip of the spear inequality for medicine two point o but at the other end of the spectrum, when IT comes to cost and when IT comes to coverage and accessibility, it's a it's the you could argue that might be dead last in the developed world.

Look at where IT all began, the wild of america. That your cardiac machine being powered by a nice water wheel IT, is that you talk about this. I really love this conception between medicine two point o and three point o you've got a quote, longevity itself and health spending particular doesn't really fit into the business model of our current health care system.

There are few insurance reinforcement codes for most of the largely preventative interventions that I believe in necessary to extend lifespan and health span. And after our epo de last year, I went to fountain life in dallas, preventative medicine, right? Full body am alright, brain and diagram, heart and geographical can with contrast, and the dexter and a microbiome, all this stuff and IT made me realized why it's so medicines backwards. You're trying to fix the problem after that happened as opposed to working out what's going to happen and getting out ahead of wild.

Yeah, lots of people.

I think, want to improve their mental clarity. One of the things that is top of mind is my attention, my focus, my ability to pay attention to the stuff that i'm doing. Everyone's a knowledge worker in some former another. Now what do you focus on when IT comes to improving cognition? Be yourself.

Um I think you know you I sort of put these into different categories right there, sort of the the the things you do to improve the environment of your mind. So I think probably at the top of that list is is sleep, uh, so it's very difficult to cognitively perform well when you are sleep deprived. And I realized that many people listening to us will think, come on, I can think of all the examples in the world.

I mean, look at all these people who don't sleep and are still out. They're clearly doing very well. Um in the point is you never have the counter factual for those people, right? What you don't know is imagine that person sleeping eight hours a night instead of three hours a night.

Um I am positive that they would be performing even at a higher level. Um I put exercise probably at number two. I think IT is again just a remarkable way to provide not just the obvious meta ball I can circulatory, uh, food, if you will, to the brain but but also kind of think about the the underground side of that, right?

So B, D, N, F and things that nature play such an important role in brain health and nutrition clearly plays a role, and managing nutrition is important. I think anybody who's you know, especially people who are really carbon droid sensitive will appreciate that. The the the big peak, the big valley that follows, you know a big carridge meal is going to negatively impact cognition.

So again, we could build out a few more of those things. But then I think there's kind of the environment within which you work. And and I think for me, this is the bigger struggle.

So you luckily, I think i've sort IT out the sleep nutrition exercise side of IT. So my limiter tends to not be those things IT tends to be distraction and business ness and doing too many things at once. That's probably the thing that limits my capacity for, uh, high quality worker. Deep work is called new port. Would describe IT.

right? What are the rules or techniques that you've set yourself to try and maximized boke time?

Well, I mean, one of the things is I don't actually have any notifications on my phone except the phone. If IT rings, you know, in this DNA, nobody actually calls you. So basically, i'm never really interpreted by my phone.

I don't get, I don't get even a vibration if there's a text message, an email or god, forget anything stupid like social media. So I have basically a phone that does nothing except vibrate if IT rings that's IT um and that turns in talking with people. I realize that actually seemingly rare.

A lot of people look at me like I have three heads when I explain that I don't have any alerts on my on any aspect of my phone. The other thing I tried to do is set aside larger, rather than smaller blocks to get work done. So I try to schedule blocks of time early in the day that are my quality workout.

So typically that is seven o'clock to maybe nine o'clock in the morning is always uninterrupted. So there's never anything that's going to be scheduled during that period time. And i've focused on doing whatever this morning I did the most important things I had to do during my period time, knowing that from here to my next meeting to my next call, is only going to kind of dissipate my cognitive capacity.

Yeah, I I went to dubai. I fled the U. K. During lockdown and went to dubai, which I think is four hours ahead of G.

M, T, which meant that I could get up at seven, eight o'clock. And I had four hours before anything happened and IT was bliss. IT was insane.

IT was what he feels like to be jock a link for a while and um I now being in the U. S. And six hours behind the U. K. Which means that I wake up to just this opi of things that need to be sorted and is a video going out and there's emails and there's all this.

But yeah, I think for me, choosing in advance what you're going to work on and then blocking off a little bit of time even if it's just an hour, i'm just going to do the one thing that is going to move. And if you actually look at your day and say what would have had to have happened, what's the one thing that would have had to have been done by the end of the day for me to look back and go? Success is probably not that insane of a thing.

It's maybe the thing that you have a bit of hesitation or resistance to doing, do you not that insane? It's not a massive list in order to be successful. okay. So ah what about when IT comes to working environment of you are you sit stand desk, you take you doing pales what else from .

the productivity depends what i'm doing. Um again, I I also quiet to work. That's another thing.

I was kind of look at my daughter who seems to be able to do homework with music on, and I did as well when I was in college. I going doing homework. I I wonder if I could have done Better if I didn't.

But for whatever reason, when IT comes to whatever I do now, which is usually writing um I wouldn't be able to do a great job with any distraction sounds wise or otherwise. Ah i'd like to be standing if i'm not on zoom the way my office is set up. It's just a lot easier to be sitting with him on zoo M.

I also, I think, you know, people ask me all the time, like, do you, you know, do you count your steps or how many minutes are standing or sitting in? The truth is I don't at all right. And the reason is i'm doing so much other stuff that I don't really need to be particularly attentive to those things. All things equal, of course, i'd rather be standing or walking than sitting um but but I don't to fix that.

don't you're ignoring dollars to pick up pennies if you're thinking about how much time you spending standing through the day?

Yeah and by the way, I think that is valuable for an individual who can't make two hours day to exercise but fortunately, i've just made that an unbelievable high priority where yeah it's i'm always going to be doing the really important stuff during dedicated time. What about .

implementations, ally or pharma? Logically, what are you using if you need to dial and focus a little bit more?

Nothing I I shouldn't say nothing. So I love caffe ine, although I am not convinced i'm really getting a benefit from from IT. I am a very, very fast metabolic of caffeine, so I probably consume three hundred to four hundred milligrams a day.

But if I don't, nothing happens, like I can't appreciably tell a difference. So for me, I love the taste. I love the ritual.

I love making coffee. My wife loves coffee is the one thing I can do first thing in the morning that makes her happy. You know so it's so you know know it's it's so I know I don't even know.

People would would argue that caffeine, of course, is a cognitive a booster. Um i'm not convinced. I appreciate the the metrics of that.

I do occasionally put a nicot patch in my mouth. I probably get more benefit from that truthfully. And maybe i'm just not aware of other products. The product I use, I think is too high a dose, so you have to its a seven milligram pouch, so you have to kind of time IT because as you probably know, nickel is a very unusual molecule where at low doses IT provides a heightened sense of awareness.

So it's actually concentrating you, but then you actually cross over a hump and the nickey becomes actually quite relaxing instigating I didn't know that yeah it's it's an unusual molecule. IT has behavior. So um both of those properties are ideal.

It's great to be focused when you need to be focus is also great to be relaxed when you need to be relaxed. You don't want those at the same time, yes. So with these seven milligram pouches, and again, people are watching that, i'm sure going to be like, come on, you idiot, don't you know all the other set of products that are out there? Um I used I used to enjoy gun more because you could two milligrams at a time, which was really the right dose to just induce the focus um nickel teen is an addictive compound so I say I don't say this lightly um but for whatever reason I don't appreciate any of that so in other words, I might have IT three times a week for a month and then forget about IT for six months and I don't seem to miss IT in any way, shape or form and obviously the mode of delivery matters so you know i'm not move interested in yeah not at all interested in in it's to be basically come or a laws and you're something is so interesting .

that the dose can take you from where you want to be to why you really don't want to be.

But if this IT depends like again, sometimes if if and I don't use IT in this capacity. But if you really need to relax, seven milligram slog of nike teen will relax you.

That row up that would make me want to throw up everywhere and very .

nics yeah it's a real shop.

So what about were talking there's .

one other compound that I add to the list, although I rarely needed, but if i'm doing a lot of time zone movement, I will also lean on medival.

okay. And how would you use that for yourself?

Just use that as a quick reset on sr cadia rythm in the new time zone, right? So first, first and morning. yes.

So take the first thing of the morning of the new timezone, which is not the new, which is not my morning internally rights. I had to go to london tomorrow and I had to be there for forty eight hours. Then come right back.

My strategy is lets them leaving Austin at two P M. So two P M. Austin time is, what's that? Nine P M A P M, depending on daylight savings. So I would go put myself to sleep on the plane within two hours, so that I go to bed london time, even though it's four P M S. In time, and I don't want to go to sleep.

And then what would you do to induce sleep?

I had kind of a whole long protocol, but basically IT comes down to how early did I wake up in Austin, the day of when did I exercise? What did I eat? And then i'm going to try to shut off my address ino gLance with foswick syrian um i'm going to take trason a do a hyda military is not something I Normally used to sleep and that's onna put me out what was the first two .

things that you mentioned for .

us with little syrian and president and what do they do fast with the syrian? A inhibits a cortisol output from the juno glens and tracked down as a funny drug. It's, it's actually, I used to be used as an antidepressant the eighties, but IT never really took off because I had this nasty side effect of making you tired.

So as essays and the like came on board, IT sort of felt by the wayside. We now use IT as a remarkable sleep drug. It's incredibly safe. And more importantly, IT doesn't just induce sleep. IT induces stage appropriate sleep. It's a very helpful drug for people who don't suffer from any initiation in somalia, but who do tend to wake up intermittently at night either due to anxiety or you know just any anything that kind of gets people up trees on basically.

Buzz you. okay. So you've then taking that military, what sort of does?

Again, Normally I don't take any, but if i'm looking for the hammer.

i'm going to take three milligrams. Wow, yeah, that is a lot. I mean, he's just before we go on to how to them wake up when you get to london.

The levels of dosage that you can buy in civs of militaris zy is wild. Can you just give the overview of how the dose curve works for melatonin with humans? Well, I mean.

what interesting is physiologically, the peniel gland doesn't make that much metta, right? It's making micrograms of the drug. So I think the smallest dose i've ever seen that you can buy might be three hundred mi grams. Like maybe there's someone out there that makes a point three of a point three. Milgram, yeah, that's probably the small lest i've scene.

Maybe there's A A point one out there. I've got a spray and each spray, subsequent spray of IT is point three. okay.

Yeah, so nice. I like you money trigger IT. No, I but most of .

the time you're looking at one to five milligram, I eat one thousand to five thousand micrograms of this and even ten milligrams. And the problem with that is IT seems if if you look at the literature and I haven't looked in a while, but the last time I did, doses north of about six or seven hundred micrograms, point six to point seven milligrams tend to really suppress melanin receptors in the brain. And so as a long term strategy, it's probably a bad idea.

Create basically a psychological.

So I try to get patients off military and truthful ly and reserve IT for jet leg and for traveled only and and not rely on melatonin is as a nightlight sleep bed.

But but if you're going to, I want to as low as forty eight hours. I can't ss about here. I need to hit with a hammer.

yeah. If using this example, if I I want to fall asleep at what feels like four o'clock and wake up in seven hours, and then two hours later, land in london functional and be a one hundred percent functional. And then take that, medifast upon landing。

What sort of those of the medicine is that immediately upon waking? Yep, right. And what sort of those? Any idea?

I mean, I usually take two hundred milligrams. I'm going to take IT. A def can be typically the low end is one hundred and the .

high hundred and six hundred. Okay, uh, what about all model? I thought about that comparable.

Same thing. What is you speaking to someone that's never taken to? What's the sensation of .

IT like a depends on the individual. So I perceive nothing. I'm just more awake and I I feel fantastic, but I don't get a high for IT. I don't get any stimulation for IT.

I know there are some people I can't tell you what for action of people, but but a non trivial for action of people actually experience a negative sort of stimulation effect from IT in the king, like they feel like IT probably feels like what a fever used to feel like back in the day, always. Russie, yeah. yes.

Now again, I would argue that in those people, they're simply taking too much and that they're very sensitive to IT and they might get the benefit without that negative side effectively down the dose. My wife, for example, can't take IT, but that's not because she's only ever tried to. And I would bet if you ever really needed that, probably give her fifty one hundred.

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This no B S, no questions ask refund policy with an unlimited duration. So you can buy one hundred percent rise free. If you don't like IT for any reason, they will give you your money back. You don't even need to return the box. That's how confident they are that you love IT right now. You can get a free sample pack of all eight flavors with your first box by going to the link in the show notes below or heading to drink L M N T dotcom sah modern wisdom that drink L M N outcome flash modern system. Talk to me about so that's mental clarity in the now what about a reducing cognitive decline over the long term?

I think it's the the two big ones by far. I think first and foremost is is exercise um clearly the most affected ious data, right? So if you just look at clinical trials, if you just look at mechanistic studies, um exercise is the best intervention for the brain.

Um I think metai like health and high quality sleep would probably be next in line. So meta oic health, meaning being inland sensitive, good full fuel partitioning, right being as far away from the diabetes end of the spectrum is possible. Um again, if you have tied to diabetes, your risk of um the genre disease goes up significantly and then it's all things that pretend to vascular health beyond what's already been stated, right?

So if you look at again, it's important understand when we talk about dementia, we are talking not just about alzheimer disease but the other forms of dementia. Alzheimer happens to be the most prevalent um but it's by far you know not the only one. And so when we think about vascular dementia, uh, frontal temporal dementia and obvious ly zeiss s disease, all of the risks for cardio accused disease Carry right over there. So what are the things we want to do to maintain a low risk for cardio asked disease, low burden of paper proteins, low blood pressure, low inflation tion? Those are a big, big, big three in meta lic health .

lipper proteins. How do we get to .

low lipper proteins? Um usually pharma logically, truthfully, because for most people to to make the lipper protein level low enough that IT you can factor out of the equation is not really achieve vly dietary unless you're willing to go on a very extreme diet that I think for most people causes more problems than IT than IT solves. So you have to you have to be really, really fat did to do that.

And there are some people who can do okay on that, but most people end up also being to protein restricted. They end up, you know, eventually getting sark opinion later in life. There's a whole much of mother imbaLances .

that come along to the right, right. Okay, blood pressure. What are the big move is when he comes to keeping that in a good range.

The big too by far are weight and exercise weight meaning weight loss and um and cardio respiratory finance.

right? So you're not this could be the jimbo, as many of my friends are that probably overweight in terms of what body must like Carrying.

not doing enough cardio.

do anything, getting out of breath, going up set of staff, struggling to touch the toes and really great. yeah.

And so while we have a lot of great drugs to trip blood pressure, just as we do for treating lipids, your ability to impact blood pressure with, uh, quote, quote, lifestyle is much greater and should always be first line.

What does the two max or a resting heart rate make a bigger impact on when IT comes to a are you looking more toward zone two or toward maximum work to bring that blood pressure under control?

Both this total cardio respiratory ith and you can't really be very high and one without the other. In other words, if you really, really, really have a profound erotic c base, you're going to have a decent vio two max. And if you have a really high vio tub, ask, you have to have a pretty significant error c base. And and I do think that most people would benefit from training those to in a ratio of eighty twenty in favor of zone too.

Wow, okay, yeah I think you know again for the jimbo's out there, of which I am you know a card Carrying member just throughout your twenties, it's so if you if you know what a push per leg split is and if you're enjoying going to the gym and getting jacked with your boys, IT is so low down the list of priorities for you to care about doing cody like unless you are going to a betha in two months time and you're a bit fluff. Y and you think I am going to get up and i'm going to do interview fasted first thing in the morning that's IT like cardio.

just not on the table.

true.

How many days that you spend in a VISA? Oh, was that like if you live in the U. K, that's like cancer, right?

For kind of, yeah yeah. So you've got only you see we europe on our door step. So that means that mayorkas maglev mali a zani iron APP er a beat so beat is the cool is one of the lot because it's sexy house music and it's cool and whatever.

Um but there they said there's a rule of you can ruin any european city by putting direct flights from the U. K. there. So true. You hear these stories about a plants that need to be turned around in the sky .

because are too ready.

And yeah, way too rally. And you think, look at any british airport. If you go easter holidays, look at any british airport, five, thirty in the morning, everyone's got a paint.

Everyone, parents have got a pint. Is that going away? Because drinking is just such a inbuilt part of british culture.

IT is in our blood, literally. But I think that we spoke about this last time. I think we're turning a corner with alcohol. I think I really think we are.

I think that the way that people see IT is this sort of go to coping mechanism, like the relaxation mode of choice, the thing that alleviates social anxiety. Perhaps this is because people are putting themselves into social situations, quite so much of the able to sit in house a little bit more. But my previous industry was nightlife and you I speak to my, uh, x business partner and all of the guys I used to work with. And the louy, Larry sort of drinking culture has now been wildly supplying ted by much more chill sort of brunches and and IT seems to have matured a little bit more.

So maybe when I was in london last summer um I went to a near near around the parliament stuff and there was this great statue of winston n. Churchill outside of a park. Know the name of the park i'm talking about IT has a statue of churchill facing out.

He's the only one facing out. I think all other statues of great folks are facing in and it's facing um like on the name of the tavern, like Stevens tavern or something like that. And so the law is that that's where churchill held shop, right? Because you had to be within a certain distance of parliament.

So if you got called back to parliament, you could go. So basically churchill lived there. He was always eating in, drinking there and holding court. So of course, I had to go there and there is no way I wasn't having fish and chips at some point of whatever. And I mean, I just did this every day though I couldn't stand the beer, but I was like, i'm going to have fish .

and chips and a pint .

of whatever you're is. But if churchill did this.

i'm doing I got from my tour manager, I got A A Christmas present of the champagne. The churchill to demand was at every lunch meeting. And he made this company create a new sized bottle because a half bottle was insufficient and the full bottle was too much, and you couldn't think so.

They made a pint bottle of champagne. And it's this and it's got the law on the back. And it's beautifully designed and parenting tastes like fizz. I haven't opened IT yet. I need to wait for good um IT takes a cisy apple water or something and yeah, he made them I imagine being the guy that goes to a high class champagne establishment and says this is not quite enough without with a half. That's the that's the power that .

you .

ve got yeah you say that striving for physical health and longevity, but ignoring emotional health could be the ultimate curse of all. Would you mean by that?

Well, um you know there's a there's greek mythology of a fellow I write about on the book tithonus who who requests of the god's immortality and he gets granted eternal life but not eternal health and so he has this horrible curse where he's alive but he's physically decaying all the way into this decrepit, never ending state and so I think an extension of that is, well, if you if you're emotional health, which encompasses many things, happiness, the quality of your relationships, any sense of purpose, any sense of happiness, if that is in a bad place, why would you want to live longer? I mean, you you're objective suffering.

So why would extending that suffering be of any value? Um and again, like you can you can play sort of thought experiments all day long, so let's let's play one so um you know the little bit know if you Chris, you enjoy people right like you're not an anti social human being so if I told you, um Chris, whatever number you think is the dollar amount that it's gonna take to make you happy, we're gonna double IT. Okay, that's how much money you've got and whatever metric of your own physical health defined by how big your muscles are, how low your body fat is, how well you can perform, let's give IT to you plus twenty percent sounds good.

So yeah.

And um the only catch is you're the only person on the planet now. Now don't worry, i've created a bunch of bots that will do everything so your standard of living won't go down like you're onna have bots that will do anything and we'll provide your food and thing. How happy is your life? Like how long until you kill yourself? Not long? no.

Because think about that, right? What are you doing? right? So that just gives you one example of wow. If you took away my ability to interact with other people, life is not worth living. Very few people, I could imagine, could tolerate that for a long period of time. Um so sure that's extreme, but it's a great way to illustrate a point which is if you have every single thing imaginable but you have no connection to other people, what do you have um so of course, that doesn't have to be that extreme for the point to still remain.

One of the things that been thinking about a lot recently is integrating of emotions. Because a lot of us that come from a productivity background or a bioactive background or a strength and fitness background, we try to reduce the human experience down to metrics and numbers and raps and sets and stuff like that. But the actual phenomenon, logical experience of being a human, is emotions.

what? What is the texture of your mind as you move day to day through the things? When you look back at the day, sure, you might be able to say how many words you wrote, or how much wait you would lifted or how far you run.

But the actual moment to moment experience of that isn't you logging things on the spread sheet, is how your mind feels, what what's going on internally. And I really think that at that point about emotional health being. Everything else kind of being subject get to that is really true and it's something that I think people gloss over. So when when you concept ze emotional health, what you what you talking, how do you think about the component parts of emotional health or an emotional health regime?

You know some of that depends on definitions in semantics. And I don't for a second suggest that the way I do IT is the right way or anything like that. The way we talk about IT with our patients because we do um because IT fits into a hierarchy of all the things we care about managing in terms of longevity risk.

So longevity risk is anything that is a threat to the length of your life or the quality of your life. And this has to be one of those buckets. Broadly speaking, there are seven. So within this bucket I would say it's sensitive purpose, satisfaction, enjoy achievement, quality of relationships, self regulation, distressed tolerance, those are probably the biggest buckets that fit into that. Um and again, you know Arthur Brooks, so I don't know have you had Arthure on the podcast?

He's coming on in a couple of month.

Oh yeah so you'll have a great time with our third because this is really a big part of what he talks about is the subset of this around happiness. Um and I think he I think he has a very elegant way of of thinking about happiness, right which is that happiness is not a feeling any more than the older of the food you're consuming is the chloric maco neutral benefit of the food and therefore people tend to get a little bent out of shape if they don't quote on quote, feel happy in a sort of positive violence emotional sense.

I think that's actually one of the most important things i've learned in the last couple of years, is that I shouldn't confuse my feelings with my state of happiness and that when I when i'm evaluating the my emotional state through the lens of happiness, I really want to go through these more nuances metrics around, like, am I, am I living in a manner that is concurrent with what I believe my purposes, my purpose, first and foremost, as a father and husband. But then second deep might my purposes a doctor, and there may be my purposes of public figure. And these are all different.

But but I feel like I do have a purpose. All of the things, okay. And then like, what is the state of my relationships? Where are my relationships good? Where are my relations understand in where my relationships lacking in my attention um and then what am I pursuing that is giving me A A A sense of satisfaction which which really requires um doing something hard and achieving a result like and I you know some people are more wired to need that than others you probably are I know I certainly am in my entire life has been built kind of around hard things to do as little you know side projects know physical chAllenges, sometimes sometimes business chAllenges.

Writing a book, something like that where you toil and it's hard, but at the end, there's something you're you're proud of. So anyway, it's about accounting through all of those things. And I look for some people, it's easier than others. They're some people that just naturally tend to find ease within those things and others who don't. Just as there are some people for whom is much easier to do cardio and they enjoy IT and there's others who may be gravitate more towards strength training or maybe others who don't want exercise at all as their natural default state.

do you think there's a difference to emotional health and mental health or is this just mexico wish wash?

Um you know I used to use the two interchangeably um but I don't know I mean what I think in the book I talk about them as as sort slightly different and I talk about emotional health. Is this thing that we are talking about now and mental health as the pathology, zed state of disease. So depression, anxiety, bipolar disorder, those who would be mental health things again, I don't think there's a right wrong. And this as long as one is clear and what they're saying.

one of the things that are really appreciated about you was your openness. You've spoken about this a number of times. Your openness about your own sometimes negative castigating in a monologue, something that i'm incredibly familiar with as well myself. What would you say to the people who have poor self talk a scolding in a voice that reminds of how they fell short way too often? What if you learned about dealing with that, and also about balancing that with your high standards for yourself by wanting to make a mark in the world, but also needing to be able to give yourself self love?

Yeah an interesting question. Um I don't know that I could provide generic advice on the topic because IT probably depends on where the person is in pain right now. So I know that for me the message, the reason I was willing to engage in the discussion around changing the behavior was because the output of IT was was made clear to me, right? So once I recognized the link between my self talk and my rage, and I fully accept at the fact that I wanted to rid myself of rage, then I accepted the fact that I had to go and fix the self talk. So my guess is the only way to really try to convince somebody that um you're having an inner Bobby night, which is what my guy was having an inner Bobby night that screams at you all the time, is harmful is by helping them understand a clear path between how that behavior links to something that is hurting them in another way that is more obvious. And I thought I think if you can't do that, it's probably a little too abstract to just say, you know.

you should be nice for to yourself. I listened on recommendation from a friend to a twenty year old, only twenty year old tony Robins awaken the giant within work book on audible now on a half. And i've never read original book.

And in IT, he talks about pain, pleasure, principle, and he talks about bringing with decisions that you want to make, or with habits that you want to change, bringing as much pain to bear. Look at what this is cost me in the past. Look at what this is costing me now, think about what this will cost me in the future, and then turn that up to a thousand.

So my friend wanted to stop biting his nails. So he thought about all of the times in the past that girl had some of made an iki sort move when he put his hands on the nd scene them, and how IT shamed he felt about IT at the time, and about how this was going to hold him back in the future, and how I made him feel like a juvenile and IT was immature. And then he went online to turn up to a thousand.

He looked at the worst photos that he can find of people that had bitten. Then they are awful, you know, like bloody stumps of fingers. And then he thought about the opposite. He thought about how much pleasure could I bring to this, how proud I would be if I to overcome this thing that i'd done for twenty years.

About how much more attractive I would feel, about how much more confident I would feel when I shake someone's hand and I put my hand on my girl's friends, like, need such a things. And I have to say it's incredibly powerful, like to do that, to bring to bear. And what you're talking about is there is a inner tormentor that kind of does a thing, but it's all inside of your head and it's upstream from some things that actually manifesto you can kind of hold onto and do a thing.

So how do you get how do you get back up and how do you point the finger at what's actually going on, where you bring to Better so much what's happening in the real world? But yeah, it's I think this is one of the most common issues, especially people that listen to this sort of a podcasting in the high achievements. They want to do things I want to leave a mark on the world, want to improve themselves. But so much if that comes from like whiped themselves into submission all the time, i'm going to investigate until I I like bow under the strain of how much tall i've given to myself. And but .

as you know, there's a real myth that you have to do that to perform well, right? And the myth is that, you know, there are plenty of great coaches who extract remarkable performance from their athletes without that behavior. So and IT doesn't mean you're not firm and IT doesn't you don't have hyste ards.

And IT doesn't mean that if the team absolutely hits the bed and doesn't show up, that the coach is going to let them have IT. But that's you that's very different from the constant bearing. And also I I think there's just a real difference in terms of um you know differentiating kind of um a negative behavior or a negative outcome from the individual themself.

Is the is is the problem, right? So so it's one thing to say I don't like that. I wasn't able to do X, Y and z. That's a different statement from I am a worthless person .

because I didn't do some work. How much respect I by the world okay, so take me through how you reprogrammed that self talk. I understand that you can have this thing.

The rage is downstate in from the whatever. But what what did that look like? What did going in in fact checking your a very stn in a voice look like um IT was IT .

was actually a very deliberate set of actions because I think you have to do actions and the easiest way to reprogram is through voice. So I think you have to audit bly reprogram a system. I don't think thoughts are enough. And so the exercise that I undertook about four years ago to reverse a pattern of behavior that was in place for more than forty years was to every single time I had a moment of self um what was about to amount in a sort of self cursing um situation I would I was I was instructed to take up my phone and record auditable ly uh of a description of what I would say to a friend, had they just committed the same quote on, quote, a greg ous act okay. So example would be if i'm shooting my bow and aero and i'm really doing a lousy job of IT, instead of jumping into self losing, I would take up my phone and record a memo speaking, but not to myself, that to my friend, you know, like if I was you, what if you had just shot as poorly as I did, what would I say to you and IT, I I would be much more gentle.

what so of things to be, you know.

And again, you have to understand how strain some of these discussions are because in the moment you're so angry, right? IT would be a hay ris. I know you just finish trying to shoot today, and I just didn't go well at all.

You were able to accomplish any other things you wanted to accomplish. I I know it's frustrating. Um I think you just have to accept a couple of things. One is um you're probably a little distracted today if you're being honest with yourself um because you have a lot on your mind and you know truth. Ly, it's all the windy today and I I is just hard for those errors to fly straight when the wind is blowing at ten miles an hour.

And you know as you know from previous experiences, like tomorrow will be a new day, like you're going to come out here and do this again tomorrow and it'll be Better and we're just going to go back to process and we're going to get IT right, and we're going to be going to do a couple of drills tomorrow to instead that that was a one minute little voice memo i'd sent that to my therapy. And then I don't know, five hours later, something else would come up that would pissed me off. I'd burn a stake or something because I turned, you know, I i'd got distracted and left the barbecue.

And inside i'd want to immediately invitation myself. But instead I would pull IT out and pretend that IT was my brother who had just burnt the stake. And what would I say to him, if we were at his house and he had just burned the stake, how would I make him feel Better about IT while acknowledging that IT sucks? We don't have dinner tonight, you know and and I would do that. And after four to six months of doing this, I don't know, three to five times a day, low and behold, I could not hear Bobby night talk anymore.

wow. So I can IT really turn the volume down.

IT is, in my life, the single greatest example of neuroplasticity that I have ever witnessed.

And how do you but how old are you when you .

doing is i'm fifty one now, so forty seven.

Did that while .

you wouldn't think you could change.

I think especially when you're talking about self talk, IT is the internal physics of your system. IT literally is the texture through which interact with your own mind. And it's the fish underwater thing like you just you don't know that you could be different. And to think that it's as malleable as that and how sticky has happened, do you need to drop out you having to go back and do this or no.

I i've never had to go back and do IT, and i've never heard the voice again. Now I want to be clear. This doesn't mean I don't get angry.

What that means is a the frequency with which I get angry as a fraction of what I used to be. The um and the duration of the blast radius is much narrowed. So the last time I got really pissed myself or pissed at my inability to do something was I was in the simulator.

I'm trying to learn i'm trying to learn a new f one circuit in the simulator. And um for whatever reason, there are certain tracks that are just very hard. Silver stone is a very hard track to drive.

It's very hard to put a perfect lap together and IT just really gets under your skin. And so is emilia. So emilia is a circuit i'm learning right now, like learning in great detail, right? Like I want to come up with a really cracking time on emilia.

And I was down in the simulator and I was going through IT, and I just couldn't nail the last, the second and third last corners, and I would have these epic flying laps, and then I would absolutely shit the bed in this corner and either off track spin or just lose so much time that I couldn't put a lap together. And you know, after I don't know an hour of this, I would just got super frustrated, get out of the simulator and was like, absolutely ripping passed off. But because I didn't indulge in any self talk, IT wasn't like, you suck.

How can you not do this? Which is exactly what that voice would have said in the past. I was just H, I am so pissed that I am not able to do this right now, like i'm going to come to do IT tomorrow. And by the time I got from my simulator room upstairs, I had forgotten about IT. And that's the difference whether before that would have stayed with me. And I am embarrass to say this, I would have said me for the rest of the day, I would not have been able to shed that anger for the rest of the day, and I would have leaked into everything I did now in sixty seconds. It's not that I didn't remember IT happened IT, just the emotion of IT was participated already.

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So I can imagine as a number of people whose inner voice perhaps isn't as pharmaceutical grade as yours was a weapons grade maybe um but presumable that means that if they want to go through a period of this rewiring the those could be less intensity, would be less difficulty. You would be less like if you are patient zero for having a really, really bad invoice. That means that people who just want to make IT a little bit bit of because it's a bit bad should be able to get there.

Have you got any idea what what was happening when you are going through? Like what is IT about speaking to the friend? What is IT about that increase of distance? What is IT about the saying IT out loud? And yeah.

you know, i've never really, i've never really thought about what's happening from a from a neurobiological perspective IT would I would be an interesting discussion to to have with someone who's smarter than I am um and or at least understands that more but IT is again, I I didn't do this because I thought I would work. I really was like this kind of a dumb idea.

There is no way this is going to work, and i'm going to just be doing this for the rest of my life. Maybe the fact that I have to do this for the rest of my life is the pennants like for my sins but I was like, I can't work like again. I just thought, think IT it's so ridiculous that i'm gonna this because, like, you know, what is the next thing you're going to tell me? I can be a foot taller if I think about IT every day. Like if I talk to myself, i'm going to make myself taller like I thought that this trait was as immutable able as a physical trip.

Yeah, you did a insanely long or intense period of therapy at one point. He tell me about that .

um yeah done to uh so these were like residential. There are people programs that I went to where I spent two weeks in the first one, three weeks in the second one where you're you're in a full time residential plays doing there be twelve to probable twelve thirteen hours a day.

That's like mind rehab, like mental.

It's emersion right. So it's different of the way people say to me. People who have felt the need or wondered if there was something they would benefit from have asked me and they said, look, you know, is that the same me is just doing x number of hours of therapy and I say it's not because it's it's it's sort of the same of saying, like, look, if you really want to learn spanish, would you be Better served doing an hour a week with a tutor or would you be Better served moving to spain and not learning anybody speak english to you? Like the difference in speed with which you're going to get there based on total emersion, uh, is very separate.

I've never heard of of this before. I didn't know this. That is like a meditation retreat of therapy i've .

never heard of yeah and again, these programs and there's probably many of them if they're very well structured, right? So it's not just it's some group therapy, some individual therapy, E M D R for trauma, family history stuff. It's very uncomfortable like there's nothing about IT is enjoyable so it's um which you know I obviously is sort like a silent meditation retreat where you have moments of profound misery in the moments of of bliss.

This is probably more painful than that because you don't really have any bliss. Um but you know the people who who who lead these kind of programs are very special and they really they really understand how to how they can patent recognize you know the other thing that I think is pretty, pretty valuable about these experiences is not of us are really that special like we all kind of think our problems are super unique. Like no one's is filling the blank as me and it's just not true like we're all pretty ordinary and you know um I don't know maybe that maybe people hear that and think that no come on, I am a special flower but it's like we're not special flowers.

We're just kind of trying to optimize for our own you know well being in the well being of those around us in our tiny little world. Um if I can suck a little bit less, that's great. But there are a lots of people who have seen my problem before and um and if I haven't seen IT exactly, they've seen a version of IT.

It's an uncomfortable realization but it's one that i've arrived that as well that sort of its kind of notices m to believe look at how special and unique and and a difficult to understand I am you could never IT would IT would take you an easily a decade for you to be able to get inside the cathedral of myanmar logy. And it's not it's not it's know I am deeply i'm in my therapy error at the moment as well.

And you know the ease with which someone who is trained can see your patterns and call them out for what they are. And sometimes they have a name and you go, I don't have that. So like someone accusing you of having a disease, you go, no, no, no.

It's not that. It's something. It's not that what you've just described to me is the name of this disease.

And as soon as that happens.

the kind of veils fall from your eyes a little bit about you being personally cused. I often think about that term personal cuts that you can understand why the ancient used to believe the god's use mortals as their play things. Because the phenomenon of of of rage, or of lust, or of whatever IT doesn't just feel like some neurochemical imbaLance IT.

It's imbued with meaning, right? There is a phenomenon, logical experience, of doing this thing. It's not just the thing. It's like more and to sit down with someone and for them to see you, to really see you and to observe what's going on.

And this is why you know so much of my transition from absolute adult infant, like manchild, or whatever I met now, was IT came about from listening to podcast because for the first time ever, I got to hear people that would be completely open and honest about their experience. Are we going, oh, well, like other people have that thing. This isn't just me.

I haven't been, you know, imbued with some unique army of one pathogen that like affects me in this way. Other people have a very like cursive internal self talk. Other people hold themselves to high standards, but then also feel bad because they're not enjoying life.

All the and yeah to realize the not as much as you think you are or your problems aren't as special as they think that they are always unique. Yes, go. yeah.

And there is usually a pathway, a pretty well laid out pathway of, okay, well, where does this come from? And then how do we look at IT and how do we move forward? It's not that hot.

I wanted I I don't know whether I be able to do two or three weeks of a full time therapy, two hours a week, as is a heavy enough for me. So coming out the back of that, what was there an immediate change? Or was this something that required integration like going on a aliases, a retreat?

Um but the two were quite different and occurred sort they were separated by a few years. Um I think the second one was more was more successful um based on the fact that the first one I left a kind of against their advice, right so they wanted me there for another four weeks at a minimum another two done to I had done to and they want IT they everybody believed I needed a minimum of two more but likely for more feels .

like this is the worst case that we've ever seen bringing the doctor that I not like the mental equivalent .

of them yeah and I was like, guys, i'm definitely Better and they're like, yeah, you're Better than when you walked in, but you're not Better. Better and they were right. I didn't know IT at the time, and I was wrong, and I laugh, and I laugh.

This was in two thousand and seventeen, and I laugh. And I largely held IT together until two thousand and fifty. And then I kind of fell apart again. And by twenty and twenty, I was completely apart.

And at the beginning twenty, I had to I D go back and pick up the pieces of what I should have done the first time at a different place. And here this is a place that's a little more intense, and they get most people out in a week. And after a week, they said, you, you really need another week.

And I sort of saw them. I I was like one I had in the back of my mind experience the first time. And I thought, okay, I can do IT at the end of the second week, I really thought I was there and they were like, you're not there and I I was a little I think I was a lot annoyed actually els.

like what you're making me sacrifices. You're trying to do Better .

yeah like I don't know what else you would want for me. Like what would you take for you to say i'm Better? And it's .

really .

interesting. I ended up staying for another week and on the the week's there run saturday to friday is a week, so at seven days but IT starts on the saturday as the programme, right, and on the wednesday of the third week, which was the nineteenth of twenty one days, I was there was the, was the real breakthrough. And so they were right.

You know, that's the point, right? Like they, but I only realized IT then. And so to leave them on the twenty first day like you know and this was was in phoenix, there was a long drive back home which was a lot of time to reflect um IT was IT was IT was very, very different coming back.

I didn't make any mistakes I made the first time and I had a great system in place in terms of therapy, which which still exists to this day. So i'm still doing therapy once, twice a week. And it's it's the perfect cat ents because there are times when things are going, when there's really nothing to talk about and it's just easy to say, hey, I got nothing to talk about today.

Okay, you sure. yeah. What about this now? I'll good, great. But I having those meetings always on the calendar um makes them the priority.

How do you think about pulling yourself out of a negative mood if someone wakes up on the morning and Brown side of the bed syndrome? What would be some of the places that you would say? Like, here's a few things that you can do that can reliably change your mood alongside all of the other stuff you need to do within the day. You can just take the day off and flight cco or something.

yes. Remember, a few minutes ago, I said one of the most important things I learned in the last year with respect to this was that I don't want to confuse the feelings of happiness with the I don't want to include I don't want to confuse the scent of happiness with the macro nutrient of happiness borrowing from Arthur Brooks language um I think the other equally important thing i've learned in the last year and I I mean i've learned this maybe sooner but but i've really been Better at implementing IT is um feelings exist for a reason so to be clear, i'm i'm not a person who believes that your feelings are right.

I think they're wrong most of the time. But the point is there, they're never accidental. Something calls them yet, and I have to explore the something. And this is where i've become, I think, more savy in the past year, which is when I get into a funk, which I do, I start to, I don't ignore IT. I and I don't judge IT. Those are two very important thing so that that used to be my playbook ignore IT or judged, ignore IT or judged, be critical of IT or pretend it's not there and power through.

Now it's and I hate to do this because you sound like an idiot like ted lasso it's just be curious and non judge mental about IT like literally just say ah Peter IT you seem to really be irritable and he really seems to be lacking interest in things that Normally interest you you you don't even feel like going out and playing with your kids like you're very solon and this that another thing like what is that about let let's just think about this. Like do you feel a loss of intimacy with this person? Are you afraid of this thing is there's something that's a you know that that is causing fear?

Are you afraid of losing something? Are you are do you feel humiliated like you start to go through very basic emotions tend to be negatively valued and you you go one layer beneath them. And interestingly, I mean, again, it's one of those things where if you told me this five years ago, I would have said that's impossible that I could ever figure IT out. But I tend to stumble into the why and and then you can start the problem solve.

Oh, i'm actually all of this is due to my fear of this thing happening and then you can start to say, well, how rational is that fear and if IT is rational, is there something you could be doing about IT? And if there is not, how can you brace for this outcome? Like so again, it's the um and so so going back, the feeling itself might have been totally ridiculous and totally false, but IT was a very important clue that took me back to figure something out.

It's really cool to hear you talk about feelings in that way. This is something i'm trying to learn a lot about at the moment. I'm aware that this sounds like the most performative of autistics thing to say, like i'm trying to learn how to feel feelings like here we are and.

I really think that is an area that is ripe for people who like to improve themselves, guys and goals that are taipei go gets that want to trying achieve things. And they're completely missing one of the huge elements of this, which is what's the data experience of your mind, like not for me fulness standpoint, because even mindfulness, you can use that to not feel feelings very well. Like thought a rises and we let IT go take, okay, fine, but where did that come from?

Why did you feel that way under you really applying all of the equivalent ity that you can to just release, relax and allow these thing that's like a taking a paracosma to stop pain. It's like the pain is going to continue to be fed up to you what's causing that and um that sounds so like floppy and unscientific. And I think another another part of IT is especially coming from like a health and fitness IDE.

People want to be able to control the system. If I eat this many grams of protein and lift this much, I can expect this amount of muscle again over a year, given the but with emotions, it's just this. It's chaos, right? You don't have the same rigor when IT comes to assessing them and when IT comes to to dealing with them.

But yeah I certainly for me, IT is the area that there is the most room for growth to be able to understand feelings, fill them, integrate them, work out whether coming from um it's cool. It's cool to hear you've got to practice like that. I think it's I think it's something that we need to be talking about novel lot more.

Well, it's a journey. I mean, it's I hope to be a lot Better out in five years. But and I think everything I would really hope is that um I hoped to be able to teach my kids because I think that would be more valuable than most things I could teach them right like I do think that had I learned this in my teens I would have saved myself and by extension a lot of other people a lot of pain um and and a lot of that the the detonation so yeah it'll be interesting to see like at what point is is is a child sort of mature enough to to sort of start to meta lizer to learn how to emotionally self .

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That's M A R ek health dotcom sush modern wisdom. One of the other things that been happening a lot recently is the rise in T, R, T usage among Young man. Young, maybe in part due to hoping to elevate the mood to improve the way that they feel. What's your opinion on the what appeared to be increasing numbers of Young men using T, R T?

I'm greatly concerned by IT. Truthfully, I think it's I think again, a lot of men, I think don't understand the risks of T R T. And while testosterone is a very safe therapeutic, I mean, if if done correctly, it's safe for hormone is there is but you know if you're talking about a Young guy who doesn't actually understand the impacts of testosterone on on fortitude, I, for example, later in life, doesn't understand what a physiologic dois versus super physiologic dose.

And especially in the cases where guys have to get this stuff illegally, that then you introduce a whole new layer of contamination and uh all sorts things like that. So so that net am a little concerned um maybe a lot concerned. I also think you know there are lots of clinics opening up that are kind of trying to circumstance some of these issues. And again, I think there I think their motivation is to capitalize on an obvious interest, but they do so without you know necessarily a new once approach to how to do this.

Take me through the risks of T R. T. What are the high level?

So IT depends on the if we're going to talk about T R T done correctly, do you mean literally T R T test from replacement .

therapy or the and its more off shoots where people start to push dosages and stuff. I take a through in range. Well.

I would say let's start with what sort of known in the medical world, right? So we'll start with kind of appropriate physician administered testis replacement therapy for an .

appropriately aged individual.

appropriately age individual at an appropriate physiologic dose. okay. So the two big risks that people have historically been concerned with, our prostate cancer and heart disease. So an increase in the risk of prostate cancer and an increase in the rising of cardiff, asked disease. Both of these have been studied extensively.

And I think we can make a very strong and compelling case that testa throon replacement therapy is not increasing the risk prostate cancer at all and IT may in fact be decreasing the risk slightly. Um i've done an entire podcast, I think two podcast on just that topic. That's how nuances IT is.

Um but again, we to give you just one example, when we have a guy who has undergone a prost attack to me for a prostate cancer, he said his prostate removed um we will still use testosterone replacement therapy in that guy. So think about that you have a guy who had prostate cancer. You will still give testosterone in placement therapy if it's warranted or indicated post process text to me.

Now, do you do IT in such your eyes and never look again? Of course not. You're still monitoring his PSA every three months, and you're going to look for any sign of recurrence.

And if there is, in fact, of recurring, you would immediately see IT. Because what we do know is testosterone one would feed prostate cancer. But the point i'm making is around initiation.

Is there any evidence that test host tran replacement therapy initiates proceed cancer? The answer is no, there is not. And there is some evidence to the contrary. The cardiff asked this question is a little bit more difficult in the data, are a little bit more muddled. But on baLance, they come out in the direction of T, R, T, does not increase the risk of cardiovascular disease.

Now there was a big trial that was completed last year called the traverse trial that gave men uh android jail, so topical test stern and followed them for, I want to say, three or four years. And there was no increase in the incidence of a vd athletica cardio asked disease. But there is so so a face value that study was taken to mean, look, we have one more study, the biggest best that demonstrated no increase in the risk of cardio asar disease with T.

R. T. So with the debate should be settled once and for all. Um I did a podcast on this road, a long newsletter on this and the long insert of IT.

Is that a in my view, that's a slightly premature conclusion because I don't think the traverse study was done perfectly. Most importantly, IT did not give men high enough dose in my view. So the men started out very hyppolito atal with a total testosterone of summer between one and three hundred nanograms per desolator.

But they were only replaced to about six hundred anagrams predecessors. Or and while that's a reasonable rate of replacement, I don't think IT represents what's happening in the world. I mean, we replys patients to higher than that. We replys patients to eight hundred and nine hundred.

Were nick tracking free test astro and not told test aston one, but usually to get somebody in the range of where we think a good free test aston one is, we will see a total testosterone one ah that's easily in the eight hundred nine hundred nine o gram prodest later range. So it's possible that traverse trial only answered the question does loads. Or as one of my analysts put IT, does testosterone light replacement therapy increase the risk of cardio of asia disease? I think there we can say the interests probably no.

okay. And what about test us on replacement therapy when it's done badly?

yeah. So I think if you even think about IT in the medical setting, I think the testosterone can be given to very super physiologic levels and ice patients getting super physiologic levels all the time they come into our practice. Theyve been treated at some t clinic and they walk in with a free testosterone of thirty five anagrams per desolator um know which is like twice which you would consider reasonable.

And you know, part of the problem is we don't really know what the long everything goes out the window with what I said earlier. Now can I say that, that doesn't increase the risk of prostate cancer initiation? I can't say that because I don't have the data.

Can I really say that doesn't increase the risk of creative activities? No, I can. It's also, by the way, creating a lot more a brithers psychosis. So these people are making red blood cells in an alarming rate, and they need to be monitored very closely for increased blood discos.

Is is that I have a friend of a friend who donates blood every month?

Yes, that that worked .

because they just making too much and it's too take correct. Wow, I mean good for the blood donation ah and again.

the question is if you have to give blood every month, if your bone marrow is so read on that you have to give every month, do we run the risk that you're gna convert into political ma era at some point, which is a disease now where all of a sudden you can't shut that process off, so get himself sustaining .

even once if you come off the yeah again.

i'm not suggested if that happening. What i'm asking is we don't know, right? And there's just a big unknown there. The other thing is, once you started to get into the super physiologic doses, you start to run into other issues around a lot of astringent and a lot of dht. So you'll see these men who are on the super physico logic goes of testosterone, also showing up on five alpha reductions inhibits, which we can talk about why i'm not a huge fan of those. And on aromatase inhibitors.

which are also not going to stop now.

And hell is yes, right? And um obviously i'm not not a guy who takes her loss seriously. But you know I think it's a mistake to take a five half a reductive inhibitor for hair loss. I think there are far Better strategies if IT matters.

And um I think you know even though the risk of phanatic roy syndrome or post finasteride syndrome low, it's not zero and it's potentially irreversible and this is this is I think in a Young man taking phanatic ID again, if you've been to if you're listening this and you're on fanatic oed and you have no issues, you're fine. It's something that if you hasn't kicked in within you know six months it's not gonna kick in. But um we do we do see men who have like a permanent loss of libido.

This is report in the sydney.

Yeah and so so basically there's something about blocking D H T. That might not be a great idea.

Permanent loss of the beddu would be bad. What what else haven't we spoken about when IT comes to exogenous sly increasing text on levels fall late yeah well there's .

another thing that I think is when you yeah fertility for sure right. So at um once you give exogamous to astor's, um you're going to cut down on endogenous production, including sperm production and therefore you're going to to see a reduction in fertility. And at some point that's retrievable um and at some point IT becomes more and more difficult to retrieve.

So IT depends on the person's age when they started in what they're a particular reserve is. But you know generally speaking, two years of exogamous testosterone, one can spell the end of endogenous production and therefore a lifetime dependency, which again, we do that all the time. Like if a guy is old enough and decides it's time to go on T, R, T, we fully accept that.

And there's no risk of being on lifetime t for life within physiologic doses. But for a guy who's Young, that might be an enormous risk. And and we we see this all the time where guys who are doing this in their twenty years decide they want to have kids in their thirties and they can.

What else haven't we said about the risk of duty?

I think there's another method of delivery using clumsy, clumsy. And these are drugs that have the advantage of preserving fertility. Uh, they worked by inhibiting estrogen receptors in the hyper Thomas that trick the brain into thinking you need more test aston so now the brain via the pituitary starts producing more follow stimulating harmon and uti zing hormone and you end up increasing endogenous production um and h again, I might be a an unusual skeptic in this regard, but my concern with that approach typically centres around, yes, you raise testosterone. But are you getting the full benefits of testosterone because I think one of the benefits of test's tran is the benefit in the brain and if you're now blocking extraditions impact in the brain um certainly anecdotally, there's questions about whether you taking away some of the benefits of testosterone, including mood in lib .

to would you have any concerns for people being on climate for a long amount time? Is that something did you think shouldn't be used?

Um I would feel very strongly about people not being on close main or closed for a long way of time for another reason, which is IT really increases the production of a sterol called dismasted role um interest. So in the reason for that, there's a lot of problems with that, including potentially an increase in the risk arthritic k rose is increase in the risk of cataracts and things of that nature.

So I think long term use of columbus in is probably not a good idea. The drug was never intended to be used long term. It's a fertility drug, so it's intended to be used short term. And I think short term rises in demonstration are not problematic. But lifetime increases or many years of increase, I think would be there is a drug that was there is a drug that increased as moist role levels in the fifties and sixties that was actually pulled from the market because of the increase in car acts and the increases in cardiovascular disease.

What what about these? I I went to A A prospera in Robertson, which is one of these network states. There's no F D A uh h jurisdiction that people are doing experimental foresta and gene therapies to do from tiny circle doing all of this stuff. IT was IT was fun. IT was like, I didn't get injected, but I I got to see kind of the stuff that was going on.

But I was with two peptide, one that synthesizes someone that uses them incredibly heavily with clients and stuff never telling me about is IT B T one or one or something that a particular peptide that is able to induce test stone um from the brain, which sounded like limit but without this particular feedback mechanism you familiar any of these? I'll find some, i'll find some inform part to you. okay.

So let's say that we're going to go to the other side of defense. Now there are guides listening who want to naturally improve, test us room production. What are the big movies?

What would you suggest? I mean, he's gonna sound like a real crap answer. I don't think there is a bigger way to naturally increase testosterone than adequate sleep and reduction of cortisol.

I I I think hyper cortisol mia stress probably has the greatest negative impact behaviorally on the endogenous production of testosterone probably through the petitti GUI axis. And um you know how much can you move the needle, you know probably to the tune of three or four hundred anagrams per desolator. So if you're not sleeping well and you're under a lot of stress, it's it's very easy to end up. Um and therefore fixing that, I think is far more beneficial than the little ney of supplements out there that mayor may not have marginal benefit.

So for .

women, there's a different answer, but for men, I would say that that's the answer.

The hard charging do that you know maybe mid twenties crashing in the office, going to the gym, maybe parking on weekend once or twice, bit alcohol, whatever, this becomes kind of vicious feedback loop, which is precisely why men are looking to things like T R. T. Because of how hard that potentially pushing themselves during the week.

yeah.

And I think that you so so to that guy, what I would say is why do you want to replace your test? So let's say he goes and gets checked out in his test test one of three hundred and orem predecessor which you know probably puts him at the tenth percent tile um for a man his age so undoubted that could qualify as hypothesi atis m so the question is, do you want to fix that because you don't like the number and or or there a symptom we're trying to fix? And if the symptom is what we're trying to fix, then I would say, let's fix that symptom. I E poor energy.

poor man, poor liba.

Let's fix that symptom by fixing these other things over here. And by the way, along the way, we might also improve your test aol. But I am, you know again, like I guess I don't treat that type of patient so maybe someone who does is listening to me and saying, well, you don't understand and you know that guy even though he's only twenty four, we're never onna get him out of that spirit le if we don't Normalize his destoyer one and you know again that that wouldn't be my approach but I want to be mindful of talking about something I don't do for a living.

What about women? Yeah I think with with women we have one more trick up person leave which is daga um so again, doing all of the Normal behavioral stuff but it's it's it's a little harder to make the connection in women um but but and this is something I actually learned to kind of recently because I used to be very dismissive of daga because in men IT hasn't no affect whatsoever. Um but D A G A of course is what allows for a dream al production of test astro.

And the reason that has no impact on men is if you increase a guys testosterone by forty milligrams per deslys or which is about what you're going to get from a general production, if you maximize IT, you don't move the needle at all. So taking a guy from three hundred to three forty is doing nothing. But if you took a woman .

fro m 4 to ab， what's a typical woman's range?

What happens by age and IT also somewhat depends on where SHE isn't her cycle. But I would say, you know, Normal for a Young woman might be sixty two, one hundred manager. ms. Predecessor, yeah. So if a woman is, you know symptomatic and she's thirty and you take her from thirty up to seventy with just the addition of oral D H G A like that a win the risks um I mean the biggest risks for women at that level are you know the side effects I would say, right? So you're looking at increase acne, maybe body here at that at that level, you're not going to get any of the other real risks that we see with two .

limits and clatter.

al enlargement, voice deepening and all that stuff. You're not going to get that at those.

We'll get back to talking to Peter in one minute. But first I need to tell you about momentous. You might have to say that I took my test test room from four ninety five to one thousand and six last year, and two of the supplements I used throughout that dog, ogresses and tongue at ali.

I first heard doctor Andrew huberman talk about these really impressive effects, which sound great, until he realized that most supplements don't actually contain what the advertising momentum make. The only N S F certified for dojo aggressors and tonka I on the planet that that tested so rigou's ly that even olympic athletes can use IT. And that is why I planted with them. So if you're not performing in the gym or the bedroom the you would like, this is a fantastic place to begin to naturally improve your testosterone. And there is a thirty day money back guarantee, so you can buy IT, try IT for twenty nine days.

And if you do not like IT, they will give you your money back, plus the ship internationally right now, you can get twenty percent of everything, sights wide by going to the link in the shower, ots below, or heading to live momentous stock com at sash modern wisdom using the code modern wisdom a checked that live O M E N T O U S dot com flash modern wisdom and code modern wisdom a check out. We've got an opinion on the no fat movement. That's something that put forward as a potential solution for guys with a i'm .

sure I don't .

even know what that is. Let me teach you about no fact. This is my speciality is men purposefully abstaining from orgasm, either from themselves or with other people.

But why?

Because it's an internet subculture and the internet likes trends.

And this has been what does that have to do with the tea situation?

That there are guys out there who have created a link between the frequency of event lation and the masculinity, both inverse .

relationship or direct relation.

The more that you, the more that you do IT, the more yal energy accept. I see. Got IT have you got to? As there have been clinically observed in any form.

I can't say IT if he has, i'm not aware of IT IT.

What a shame. Gill science researchers report an astounding custody of a ninety three old with the physical fitness of a forty old.

This was the role that I wrote about a few weeks ago.

Tell me the story. This.

yeah, an interesting fellow. He was not a lifelong athlete. De at all, right? So that's the beautiful part of the story in my book. If if you're listening to this and you're Normal person, so was he. And he just kind of hook up, growing like the classes, rowing classes, you know, you go, you get on a rowing machine and you just want to do IT.

And he just took such a love to this thing and got so good that at the ripple didja ninety three I mean I honey, I think his view to max um I don't remember I was reported in the article or if we tried to back calculate IT based on his times but I mean he at least from that perspective, from a rowing perspective, would have the fitness of of a great forty year old. Now I don't want to misrepresent and say that he's a forty year old because he's not right. He doesn't have the muscle mass of a forty old although he does have very low body fat right.

So if if I don't fight recall his body fat was probably sixteen percent which is outstanding. Is his muscle quality the same as yours? No um you would his coordination uh or fall risk aversion be the same as as no but but look the point is when you compare him to another ninety three year old, he's clearly functioning at a level that you know in totality, I would say, at someone in their seventies and to me that's that's the game.

Like i'm way more impressed by an interested in that guy. Then I am in any influence, cyc, doing any feet of strength running and I like I don't care, like I don't care what you can do in you're forty. I really don't I really care what you can do when you're ninety.

How long was he training for decades?

I mean.

this was not. He's fall in love .

at unit with throwing IT OK.

And he accumulated this capacity over time.

Yeah so think of him like a guy who you know didn't really accumulate much wealth until he was sixty and then started investing but was an amazing investor and a consistent investor and compounded and compounded and compounded and in is ninety he's a billion aire and it's sort of like, wow, how did this guy just become a billionaire? His nine as well. I mean, he did all this incredible stuff for the past thirty years. Now the good news is you can start that at thirty and be a ridiculously fit sixty year old. And by the way, you'll be a ridiculously fit ninety year old as well.

Yeah, it's it's cool to his stories like that because I think if we've turned to such a corner with our understanding of health and fitness within the last, even just communication about anything with emotions, meditation, history, but there must be a number of people, especially like my parents generation, who feel a bit myth about the fact that god, if i'd known this when i'd been able to hold onto my health, there's supposed to doing IT now, when i'm in my sixties, that sucks. But you have this example, the other guy who did do that, and you know what would be considered serious later life, especially for an athletic career to begin or a help in fitness regime, and has shown just how powerful that is like that. I think it's very it's a very cool story.

yes. So he's kind of like the poster child for this centenarian decaf on I that I love to talk about, right? It's the, it's the, it's the mental model for what what I train for, what our patients train for and what we really can't care about.

Give me a thoughts on brian Johnson and what he's doing. I don't know have you been observing any other stuff that he's done with blueprint, with the supplements.

with the lifestyle? I'd try to ign IT .

why I I just have no interest.

Okay.

that's interesting. IT seems to me I spent a little bit time with them if been on the show, and I spent a lot of time with them honduras's, and I think he's kind of like the way have come to concept ze. What he's doing for certain arrives at the longevity movement is kind of like a scout in a an army he wouldn't do to have an entire army of scouts. But i'm totally fine with someone doing something kind of experimental and maybe dangerous, maybe not dangerous, whatever, and sort of going up to the in the rocky Cliff dge and looking out over the top and then coming back and kind of telling us what they've learned um but i'm both glad that i'm not a scout uh and also I don't think it's necessarily in everyone's interests to also be one to but it's interesting I asked him a question saying easy, afraid of death are given that almost everything that he's doing is focused on not dying. How much from your perspective do you see the longevity movement overall and buy a hacking and health hacking and stuff being a kind of rehabilitated death denialism, fear of death movement?

I know it's a great question. I because I don't consider myself part of that movement, I don't I don't want to speak for IT. I don't I don't really know.

It's probably best to ask those who firmly put the themselves as leaders of the movement. I know that i'm probably just as afraid of death as anybody else. I I don't want to represent that.

I'm some monk here who's so at won with the universe that he can't wait to die. I don't want to die. It's by the way, I think it's less fear of death and more a fear of not being here. Like that's the part that we can't really contemplate um because I don't you and I don't have a conception no nobody listening to us has a conception for what the world exists without that individual in IT that's impossible to father them. So um in the the the you know the older you get in the more you you know you have a family or things like that and you fall in love with things outside of yourself, you then realized, well, actually what would bother me most about death is not being .

with my family. Hi yeah.

So that said, I find the, I find the focus on death avoidance to be future and silly. So I don't believe there is any scenario ever in which we avoid death. I am one hundred percent in the camp that says we are all going to die.

Doesn't matter how much biohacking you do, we are all going to die. So can we delay that? Yeah, I think we can.

Um can we delayed by one hundred years? Don't think so. Could we delayed by a decade? Believe so. But I like to focus on health span and I think that that's I think that's the the real shortfall of of the health care system today is that IT focuses so much on lifespan and IT still does allows your job extending IT because IT does IT at such a low quality.

But what I think is really good about health span is, if you really focus on health span, how strong am I? How much bone density do I have? How good as my vo 2 max？ How metabolite flexible in I? If you focus on those things, you will get the lifespan benefits along the way. But but the health span piece is actually harder. So focus on that and you get the tail wind of everything else.

How long do you think, given what we have at the moment, current human physiology, current medical advanced and all the rest of IT, if someone thread the needle manages to avoid any any of big catastrophe? What you reckon is the ceiling for human longevity?

Such a great question. I mean we we know obviously to date what the ceiling is right, which is just based on the longest live human, which is probably hundred and twenty three um so we know from the study of centenarians that who who do live on average, right, like two decades longer than the rest of us, they still to come to the typical diseases.

And and if they don't, they are eventually just going na get a nema or something, right? So even if you don't succubus to a disease, at some point your immune system and or frailty ultimately end. Um now i'm I am excited about some really cool science that I think can bend the arc of those curves right?

If you talk about frailty sark opinion and you talk about immune and essence, I think there's some very interesting therapies that will occur in our lifetime that could push those things back tremendously. So the again, I don't give up hope entirely that there's a way to dramatically increase lifespan. Um but I do find myself troubled by people who think it's onna happen on the back of like this supplementary, this goofy you know hairbrained idea like IT the depth of science that is necessary to do that.

I mean you are rewriting the entire epi genetic code to do that um like that to me is the only way you can revert a cell back to its nice and self. So this is not like sprinkling a few years monarch factors O S K S on a cell and just you know wishing that you're going to end up with a stem cell back there. Like no, no, this is very deliberate cellular reprogramming, and we clearly don't have the technology to do this yet, but it's plausible in our lifetime.

And then the question is how causal are those changes, right, that we don't know yet. We know they're correlative, right? So we know what the methylation pattern, the epigenome, look like on an old t cell versus a new t cell. But what we don't know is, did those changes cause the pandemic change? And if they did, and they did alone, and we reverse IT, do we get a Young tea cell back again?

Yeah so some super hydro ve N M N or rap micon or pick your compound of choice. This isn't going to be able to go in and and rewrite that code.

No, there's no evidence that IT will.

It's very interesting. Yeah, I am. I think a lot about what people are trying to achieve with with the longevity movement.

Actually, that's one question. So you mentioned before that eventually. So what is.

It's funny. I I really I don't say this to be nice, but like I don't even i'm so I don't pay attention to movements of this mature like what what is the longevity movement is really thing.

I'm pretty sure that our slash longnose ity is the biggest submit for people trying to extend their lifespan. I may have misrepresented them IT may be held span IT may be it'll be some like a very nice and upset of IT IT will be living longer and Better or something like that right? Um but it's a movement of people that are biohackers held hackers in one former another, many of whom will probably be massive fans of your work.

But you know so so again, if it's people who are interested in being healthier, but i'm thinking more about this idea of like immortality and what I mean.

you know, p to the AManda has this idea of longevity escape velocity that every year that you stay alive, there is an amount of time that you your life is extended because of improved medical stuff. And longevity escape is living sufficiently long during this period that kind of like the dark ages, or the back end of the dark ages of medical advancements, so that you reach this period where you actually able to extend IT infinite. sure.

Such a question i've got. You mentioned that people in these blue zones, or but in the people the centenarians, see a long lives. Eventually they succumbed something. Is there such a thing? Is dying of just old age, or is does everybody die of something?

Well, look, there are some people who we would just sort of say they just died in their sleep. And there was nothing really obvious wrong. So we what .

is yeah I don't know.

This could be an energetic problem, right? At some point there might a ona literally stopped producing enough atp for them to to respire think that yeah but I think on esty, like I think many those people are probably dying of a stroke or a heart attack. And we're not doing autopsies on one hundred and four year holds who die peacefully in their sleep. We're rejoicing them. We're thinking, god, I hope I can be so lucky.

Yes, yes. yeah.

Talk to me about the, remember, even if you did an autopsy on someone who had a heart attack, if you, if you didn't catch you in, like if depending on how long after the heart attack they die, you might not see any evidence of in the heart muscle.

Oh, right. okay. So you can show that that person could have died of IT and you can show, no, that was what caused exactly right?

If a person is really, really old and they have, you know, quite qualified corner arteries with lots of x, it's not entirely clear that you would find the exact place where they would have had a heart attack and um where's it's more obvious if someone has a heart attack and they live for a while because then you have .

a beating heart and a piece .

of heart muscle that's dying and you get a contrast .

between the right I just not talk to me about what you consider to be the basic supplements. Most people should at least be. I'm aware that this is incredibly individualized, but most people want to perform Better, have some good energy, do well in the gym. So and so for what are the areas in which most people should be at least looking at supplementation? Other are other unit all .

when I think most people probably would benefit from magnesium. So you have to then decide on which which ways to take IT. I did a whole pog guests on this because IT is complicated, and you want to talk about the speed with which magnesium gets absorbed.

Do you talking about organic and organic? Are you taking IT more for performance and avoided and cramping? Are you taking IT more for G.

I. regularity? Are you taking IT more for cognitive benefits? So all of those would be different forms. I actually take three, maybe four different forms of magnesium. So you're i'm keeping track of both the total elemental magnesium i'm getting, but more importantly, the form i'm getting in in and how i'm kind of tiring each .

one to these benefits and .

what are you going for the um all of the above right so it's it's G I function. It's muso function, which ones i'm taking yet so slow egg is my favorite for um as its name suggests, slowly absorbing magnesium so you minimizing any PVC and cramping. Basically for a person like me who's very active, sweat a lot.

You live in Austin. Then I take a magnesium um oxide, which is kind of more the G I version of that. And then I take magnesium l three and eight, which is the cognitive part of that. So that's the one that gives you Better cognitive absorption. And trying to think if I take a fourth one, I probably have some magnet sim and something else i'm taking, but those are the .

big okay .

magnesium yeah um creative one hydrate five grams daily and I use again. I don't think that matters when you take IT truthfully, but the most predictable and routine time for me to take IT is during a workout. So just mixing in with electro al lights and water.

I put IT in with something else that you're .

already drink IT. Oi, oh.

I forget to drink IT. Ah I can't remember was IT. I think that was ten ferris, he was talking about a some benefits from much higher doses of creating ten to twenty grams a day. Have you looked at any of this? We're seen any of this stuff.

Um yeah, I mean, look, when I was a kid, that's how you dose IT. You would load IT. You would do thirty glaze a day for a week and how many thirty grams a day for a week and then down to five a day. Now my last look at this literature said that was not necessary at all. And taking five a day, you'll very quickly get to your saturation levels in your totally fun.

Is there a size of human for him if you're at two hundred and sixty pounds? Should that be a little bit more as possible? And if you hundred twenty pounds women, hundred and ten pound woman, maybe we can keep IT at five.

I mean, I do. And the only time I sort of tell people to die IT down as if they get G I upset from IT, which some people do.

Okay, magnesium creating. Um I think .

a lot of people probably could use a little bit of help with method ted by vitamins, maybe some T M G. Um again, I was T M G try method list rate, which is um basically we would use these to the trate homa system levels. So if a person's homo system levels are elevated, you can basically get their homa sistine levels Normalized with method b vitamins. Now there we don't really have trying to think we have one study that speaks to the efficacy of that for brain health. But but but what we're doing is using a proxy, which is we know that homa sistine levels were elevated, play a role in at least two diseases, right, dementia and demanding diseases in cardiology, lar disease.

And so by, you know, asking the question, if you lower home assisting levels, do you address that? You're asking the question directly is how system cauSally related to those diseases or not? And looking at the neurodegeneration side, IT appears more likely that IT is and there's a very clear mechanism for how homa sistine um could be causing related in cardiff asia disease VISA v its impact on antithetical function and antithetical health. But I would say that that kind of a soft recommendation. Um i've .

got one copy of c six. You know how many people i've met in .

my life who have the wild type for both M T H F R genes and you have to keep in mind how many people i've looked at the past fifteen years. Um i've seen two people that have the wild types. So everybody has has one of the snips on these genes there there I I actually think they should be the wild type truthful. And I think we've .

got backwards, but we had to when we form recently did a reformulation of meta ic to drink. And I was like, I can you just check we're using natural folli for this, right? Like here we are. It's like we're using method cobalt in we're using method to between not yes, we are, but you just don't realize how many, especially if you are thinking about our city levels of you thinking about you taking b vitamins, you're not thinking about that totally. Not oh, this could be like folic acid or this could be the non method ted version of of the vivid, really interesting .

um I take their human .

what it's devait man cucumber yeah .

basically a more liberated former curcumin. So more by available liquid, no capture. What does just more expensive? A good question. I don't I don't remember with the dose you might be .

three hundred milligrams.

but i'm not sure. Okay, you would be its amazing for how often I asked this question. You'd think I would know this Better 去。

There are other things I just don't recall magnetise um yeah creating mathlete b vitals, if appropriate, to bring him a system .

in line for special coq.

I used an absolute turn of kickin when eruption the kill four years ago, and I went through plane cricket the british way and um I just threw the kitchen sinks and I was covered. I'd nothing else to do. So I asked every person that I could, how can I keep information down? I can I so tb, five hundred.

Ds, uh, B P C, one five seven, every taught Cherry juice like any, waving sage over the top of IT, making a encounters at the full moon, all of that stuff. I did all of the things, and the recovery was actually, actually, really, really good. If anyone ever considers blowing out there were kill is doing IT during a pandemics is actually really good time to do, is nothing else to do.

I grew back the injury i'm most afraid of.

It's twelve months of full, very intense. So do you have .

a sense of why IT happened?

So I went back to as many people. I mean, this should be a public service announcement. If you use to play sport when you are in your teens and you are now thirty five or something, and you think i'm going to pick that sport back up, very, very slowly reintegrated the number of friends that during the teenagers played basketball and then decide to go and play basketball, now that the thirty four, and they've spent the last two decades gaining muscle in the gym, and they nearly twice as heavy as they were when they played this. And within the first couple of games, they blow out.

And M, C, O, the number of friends i've had is like a list of friends that have done this just in my friend group. And for me, I was did one training session to play cricket performed sufficiently well during that session that I got invited to play on saturday. And then, with a very limited warm up as Normal set of club cricket is a stepped out to bad.

I was, I mean, so much fun. IT was great. The sun was shining.

My dad is over the far side. We slowed the halt of wicket that we were losing. And I was like this the first time picked up a bat.

Apart from the net that I did on the wednesday is the first time I picked up a bat in over a decade. I don't like thirty five not out and playing really good shots. I just pushed a single through the covers on the right hand side and set off to run.

And then as I, I felt something weird. Did you hear? IT, no, but there was shouting at the same time from the the players on the the fielding team. And then as I went to put my right foot on the floor, IT was like, if you try to step on an inflatable water bed on water, and IT just went like that, and then the bus has run me out.

So while I was laid on the floor like this in the middle of in the middle the pitch, they went and picked the balls off which meant I didn't get like a whatever is an injured like dnc did not complete or whatever they actually run me out which I find that's OK. Um I think the reason that I would have happened was we done shuttle runs on the wednesday. I wasn't doing a massive amount of like high pio stuff.

And then when I set off, you're wearing Spikes on a very hard uh surface and it's digging into pack dut, which is what the strip is the new bowling on. And I pushed the shut through the covers and then set off with my back foot. Hill would have been a little little off the ground, so cough would have been lengthening as i'm contracting and then IT would have just hit the floor and went. And that was me for, you know, twelve months, thirteen days, and then got a .

complete her .

full attachment, full attachment. yeah. So got Carried back over. And I knew within three seconds I like, I think that's what that is, just I didn't know enough about IT if i'd known more about that would be more scared. But on the flip side of that, my a cough strength now and mobility, i've got really insane dollar if lection.

But for anyone that does do IT or anyone that's done IT recently, yeah it's gonna a long rehab or if if that happens in future, it's gonna long rehab and it's gonna feel you're onna feel a little bit unhappy about IT. But my function, strength, power, everything is back to where I was, including musculars ity. So if you looked at my metric, I overshot IT on my right on the one that I busted and then had to go and do more work on the left because I built that one back up and um yeah I think good rehab plan.

Take your time getting back to IT and within twelve months you'll be doing everything that you were able to do and within to tuna half y, as you won't know that. Is that the only way that you can tell us if you look or if you give IT a squid because it's it's like a good thy is a girl. Y boy, now, but one of the things you haven't mentioned.

this omega es, oh, thank you. I do that well.

I'll keep you right .

and talk to me about should .

be taken um run the Patrick on the show big on to me, get trees really took me through some interesting stuff to do with athletic verses the reactivated .

version yeah I know I used to know this and I have, I don't know .

IT anymore.

What are you taking? I take carl sons. Um I think there are a couple of brands out there. Orc naturals pretty good. And i've gone back and forth with them and then know you test your levels to kind of see where you're getting the most bang for your um by buck. I don't mean dollar, but how many of the things how many the horse pills you have to take.

you know how many .

are taking to take to take three of the most potent one that they make, which I think is called elite or supreme or something like that.

what the most exam prep.

but it's got the most E P A D H in IT time in that .

particular is IT with .

a fatty meal. Um yeah I I I mean because I my compliance is the most important thing. I have an A M and P M slide of of things that I take.

So I think I take one in the A M, two in the P M, or maybe it's the reverse. So but the point is I just know what am I used to take two and two, but i've titrated IT back a little bit. So i'm doing IT based on what the E, P, D, H, A levels are in the red blood.

So in the membership.

yeah yeah it's i'm sort of trying to keep IT between .

ten and twelve person. It's just for me, cooking seafood at home is so rare like it's the it's all of the other thing red me ground be if even liver is more likely to do that, then for me to actually think I should buy salmon. And I is just one of those things that kind of doesn't really appear to me now, often try and do when I got food, one thing I fAllen in love with over the last year, oysters.

Do I love oysters? Now I break up. This is what being an adult is.

You drink coffee and you have oysters. Um but I really be enjoyed that. But at home IT just doesn't fact. Some of me supplementation when IT comes to that, I think, is probably really important, I think so one of the other things that people are quite obsessed about the moment is water quality. How long of liver is this? How much should we care about water quality and what is being transported in and stuff like that?

You know, I think I probably depends on where you are and what the risk of contamination is. Um you know I mean, I think I take reasonable steps to ensure IT, but i'm also not so obsessive that my life spirals out of control around IT. Now that said, and we have with a couple of reverse osmosis filters in the in the house equators, I don't know, but I know that they meet the standard for filtering out alp fast. So there's a there's a filtration standard that you have to go by.

And the plum in a table .

top other plant den, cool. Ah that's cool you so it's easy. Pz.

so when IT once every six months.

so yeah, all water bottles are, you know we use glass water bottles. They are all filled out of those things. And you know the coffee park gets filled out of that thing.

So the only water i'm drinking out of the tap that's not that is in the bathroom and and brushing my teeth and taking my pills before Better whatever. Um so I don't think I obsess over IT. I you know I I think that the two most important things you can do to avoid pay fast from a drinking perspective.

pay fast that the people .

I don't know yeah so there are these chemicals in plastics typically that um I think we could make a safe case for having negative health consequences. Um now they're also found in things like tough, long and fire resistance, you know clothing and things like that so they show up in other areas but for most people, the the dominant exposure is through drinking water in a plastic bottle or contaminated city water if you drink IT and you know I haven't had our water tested, but I just sort of assumed like why bother testing and why don't I just put the filter in the gets that .

that is known to get rid of IT? Yeah I had doctor chana swan on the podcast. He wrote the book countdown, which is tracking spon decline and test us run levels as well just over the decades. Mathematical turned closet epidemiologist I suppose uh, SHE was fascinating and her stuff is is pretty scary. Ah the impact of this one of the things that I didn't realize, you know you he talk about declining test ron levels and you think men but it's women sure as well in a big way um and maybe in in some ways, given the fact that you've just got the renal creating test test from for women, you know less margin for era, you in some ways too um and .

SHE attributes IT to plastics as .

soon and cry disrupters a lot of microplate tics what are your foods being transported in um you know he gave me this um really interesting example of people who get maybe bilk or something like that and it's in a glass bottle. It's from a farmers s market like was IT manually pumped or was IT pumped through machine because that machine has got B, P, A in the pipes and the milk is warm because is out of the animal.

So you're pulling the B, P, A from the pipes. Into that, even though IT organic cow grasped open pasture. But no, but okay, what's the transport? Just a minefield to try and wave your way through.

What I mean. One of the big ones for her, and this was mean my entire twenties, hot food in plastic type a. You know I am doing meal prep I meaning healthfully.

So you've just put baking hot food into and there's no B P S in IT. Yes, it's like B F C or it's B P F C or whatever replacement was that they did for that. Ah so yeah, she's got a big protocol that you kind of follow with regards that.

I think it's a big deal. I think the disrupt thing is a really big deal even if you don't talk about like how men will both controlled being peed out into the water supply and stuff like that. You even the way that IT is transported to you is something that you should be concerned about as well. Have you looked at the psychological impact of human or both control and women is something you do much research .

on um I have not looked at the psychological component of IT, but obviously the downstream endpoint component of IT. We deal with a lot in in our female patients, especially as they you know those who have been on IT for a long period of time who are then becoming parameter poser and is your transitioning them to hrt. Obviously one of the the results of long term um or a contraceptives is a significant rise in h bg. So as the sex on binding global in goes up and up and up, their free androgen go down for a given level. So you you kind of have this issue where even if they you Normalize their testoon or estrogen, they might actually be physiologically experiencing less of them so that you again, but definitely not something I consider myself an expert.

The doctor, Sarah hill, wrote a book, uh, this is your brain on birth control, you, an even really psychologist, but it's really wild. I I think a friend has A A great question, which is what is currently being ignored by the media, but will be studied by historians. That's a nice frame of what we overlooking at the moment. And I really think that how much control will be one of those things that um there is a reason scandinavian study that looked at, you know we ve got this declining female mental health problem, especially among Young girls, like forty percent of american teenage girls, have persistently or regular feelings of hopelessness. It's like this real mccall apocalyptics sort of language and um I always asked this question because I had JoNathan hide on the show and he was social media and comparison and ba ba but as has anyone faced in the base rate of what increasing levels of harmony both control usage has done to like how much can this be contributing and .

and has that changed significantly since two thousand and ten?

Maybe that's that's what needs to be looked.

but because that's really I mean, I think the argument in favor of john athens argument is that when you look at the total takeoff or nose dive, if you will, of mental health for specially girls, IT coincides really perfectly with the exact introduction. You know tiktok, not tiktok, but instagram, smart phones and social media.

Unless there was a different hype of birth .

controlled question there also. So one of birth control change.

great question. Uh, I think I don't think that there has been a change. I think it's anything it's going to be kind of like just a steady lenie adoption of of of these drugs.

But what you don't know is, is that some sort of previous position, some sort of psychological um um raw materials that are more acceptable? Is this being able to magnify the effect of social media, of social comparison? And doctor sa hills works.

So I mean fascinating to to change that women have in the kind of partners that they go for both on and off of birth control, are the um level of tests room that they prefer in amman's t shirt at the same time the libido and the sexual uh not only libido, sorry, uh the level of sexual science s faction with that partner, which also is indicated of partner choice and how effective that is. And I mean you may or may not heard these stories, but so many stories of women who get into a relationship with their partner when that on get married, decided that they going to then have children come off. And like, i'm not really that attracted to my partner anymore, you know, they should exit this home.

Mono fugue state. And the kind of eyes open and it's not a comment on their partner particularly, is just that there are A A very different homonyms file now and what they find attractive has changed in novel IT wild. I mean, the researchers is really, really interesting.

interesting yeah totally unaware that .

side of things. What about suncream? What's true about the safety of sung cream?

I hear a lot of demonization of IT, that it's dangerous, that you can put IT on your skin, that he gets absorbed, that IT turns into all of these, but then also skin cancer not good. What's your position on sunk? Uh.

i'm in the process of learning an insane amount of this for a podcast i'm doing. So I I would say I have my thoughts now, but they are they're going to be updated by you know a team of P H D.

Check out the drive in three months exactly when .

we get to do our ama on this. We're onna visit. Really two questions that are both going to a listen, a ton of controversy is what the first is, how clear is the role of the causality of sun in mellon oma? So that might seem like a stupid question to ask, but the answer is not entirely clear.

So what is IT about the sun that increases the risk of milano a? Is, is the risk of melanoma increased? For example, in sun exposure that does not result in a burn? Or does IT have to result in a burn? Does that have to result in a severe burn? Does that have to result in a burn during a certain period of your life? All of this is unclear.

Um it's a lot more clear with the relationship between sun and based on cell car sonoma and grama sel car camera, there are two other types of skin cancer but they're nonlethal because they can't meta stice ze. So you know, to be afraid of skin cancer really means to be afraid of melanoma a that's the one that can kill you. Um and so that's going to the first part of the podcast is really expLoring that relationship. And then the second is going to be the deep dive on all of this and all of the you know sunscreen out there and so sort of mineral versus chemical and um what what's you to the best of our ability to understand IT? What's the what are the real risks, if any of the either these types yeah.

there's an awful lot of very violent push in both directions. I think for this.

I can yes, we're certainly not doing this because we never do anything to sort step in a pila shit. But I there's no question that this is going to be inflaming.

but what do you think what else would be, perhaps surprisingly? Uh, talking about sudden cream, a like you know real hot topic was on out the what are the other really spicy areas that you might not have thought about you'd start talking about pollen or something and it's a real was .

what um I mean, any time I talk about lipids and heart disease and dietary fats and stuff, anything to do with diet that's always that always tends to be quite in because of course, you anything that diet related is sort of very tribal and religious. I think hrt is a somewhat polarizing topic that less so now than when I started talking about IT.

You know, when I really started talking about ht, most of the medical establishment viewed IT as bad and dangerous. And I think more and more, though, dockers are coming around to realize that, you know, the women's health initiative was such a flawed study a that it's but you know, responsible ht is a great thing for women. What else is really controversial? I look, I think you know vaccines, I I did I interview to get in brian deer, and we went deep down the m mr. Causes autism claims. And that obviously a very polarizing and controversial topic.

What to define? Uh.

I can see absolutely no evidence that the m. mr. Vaccine is linked to autism. And instead I see an incredibly fraudulent guy in underwaves field who committed you know literally scientific fraud to confabulating data to make that case and it's an awful shame uh i'm not going to sit here and til you that all vaccines are are great or that every vaccine is without risk.

That's that's not the case um but the m mr vaccine is a very important vaccine. That's a vacine that saves an unbelievable number of lives and an unbelievable amount of misery and children. And it's a vaccine that's targeting a particular set of viruses whose veria is indeed driven by the exact mechanism by which the vaccine works.

In other words, there are certain vaccines where vaccination actually impaired transmission, right? That clearly wasn't the case. We go IT. Um so you could always make the argument that there is no public reason. There is no public health reason to vaccinate people against cover IT was an individual was an individual reason that's not the case with mr. The nature of how the virus spreads is indeed in the .

kind of a tragedy of the commons type things going up.

So um and again, I mean that just the entire topic .

of vaccines is so controversial.

but was IT this controversial five years ago? No, I mean this particular .

topic was for sure IT like vaccines skepticism.

Well now now I think it's been amplified, right? So I think that the cdc did itself absolutely no favors.

shower itself in glory.

No, the way they handled everything around covet has made IT has actually done a disservice to, I think, vaccine science.

And you must be absolutely infuriating if you're a vaccine knowledge st to trying to work on these inner life's work, genuinely trying to do things to make people Better, to avoid illnesses to, you know, like a addictive disease. And then for the C, D, C to hit the bed in surge, a huge and and not just the C D C, obviously, uh, in such a huge way that well .

that that that anything in medicine becomes political as a tragedy. And it's you kind of would want to believe that medicine would be the last thing that could be political.

But now, just two weeks ago, I wrote a peace with our team for the news letter about something that I never imagined could happen, which was the american hard association deciding in what is clearly just a political kind of woke agenda, that race will no longer be considered a risk factor in cardiff. Asked lar disease. They're taking race. Out of risk calculators now you know in their defense, I suppose their argument is that will raise a proxy for social economic status so you know but what they argue is that race is a purely social construct with no genetic component and this is just patently false um in the you know I could have written ten thousand words on this with all of the counter examples of where races indeed a genetic construct and with IT come risks and why we would deprive ourselves of a tool that allows us to Better risk stratify people just makes no sense to me regardless of your political ideology so unfortunately to see that medicine is also becoming corrupted by ideology is um is very sad .

but not surprising I suppose I had this idea of toxic compassion so the prioritization of short time emotional comfort over everything else and the ground zero for this would be body weight has no bearing on health and mortality um well, you know you don't want to make people who are overweight feel upset.

You don't want to sort of activating them this sensitive maybe i'm not maybe i'm going to die sooner, whatever, but by not communicating that to them, they're literally going to die sooner. Like you run the risk of these people getting into all manner of problems because of this prioritization of short term emotional comfort over long term flourishing. The truth, accuracy.

And the same thing goes for this know the same thing goes for, you know, race has no barring on your vulnerability to different types of health outcomes. I I have zero medical training and I know that that's false. I know that desperate outcomes, desperate risk levels, different diseases within different race groups like it's wild, it's really wild.

And the fact that you're trying to play about with people's health, I don't think that this is much truth in the the accusation is a some people might want or that some people might claim. But you know the doors coming off, boeing planes and stuff like that, bridges, D, E, I, diverse, higher that are doing, you know, this isn't commentating for the new york times. And moving culture, we culture is not nothing either. You know, people's beliefs and how they see the world is not nothing. But when you're talking about medicine and airplay and bridges and going to space, that's you're really crossing .

a threshold down yeah science and engineering really needs to be free of of anything that that puts merit anywhere but at the top and perfection of knowledge.

How warranted is the huge panic about processed foods in your opinion?

Well, again, I think the devils in the details, right, the word process is a bit of a troubled word because if not for processed foods, you and I would be pretty different right now. Like, I mean, processing is what allows a lot of what we eat to exist. Um so we you know I don't know that that processed foods by itself inherently implies things are bad. There are lots of processed foods that are excEllent food.

What was an example? Oh.

I mean, like you know you take like A A really natural form of like wild. I mean, i'm being completely bias because it's the company. I'm an investment. But the first man popped into my head because I had IT for lunch today was like, you know our vaccine sticks, right? This company, I an investor and called my uy venison.

so sorry for the people.

So you know that's that's a process food, right? Like had to be you know dried and put into plastic and salt had to be added to IT. 嗯， so but look, that's a very healthy food.

Now is IT as healthy as if I had just killed that deer and just eaten that deer right there? Probably not I could probably a case for White and now it's probably get more sault in IT than IT shooter and and those things were there to preserve shelf life um but but that's clearly a profess food that I wouldn't put in the same camp as a bag of pringles. So you know we can get into the secondary term of you know hyper processed foods and we can talk about that. But but I still think it's Better to just talk about things from first principles as opposed to labels that are mildly descriptive but not granular enough um to provide real value. So to me I would rather say you know a venison stick is more healthy than pringles rather than say process food is good or bad.

Understood what about hyper process foods? Is is that worthy of the the current moral panic?

You know I don't know. I I mean, again, IT comes down to there are enough foods in category that are really totally garbage, right? There's there's no doubt about that.

And the old dad tage, that is, you walk through a grocery store, most of what in the eyes is indeed garbage. Most of what's on the parameter is indeed good um and most of what's on the inside is processing. Most of what's on the outside is not.

So look, I feel lucky because I enjoy cooking. I have the means to do IT. I don't have to rely on progress foods because, again, you know, one of the things that makes process food so appealing is not just the taste, but it's the convenience. Emco ric, density per unit dollar, right?

You can get a staggering amount of calories per unit um you monetary unit um at a great convenience right it's um so so the further you can get away from what I call the sort of standard american diet where it's with its four pillars, right which is you know has the taste really good, has to be really cheap um has to be scalable, right? You able to do IT at big scale and IT has to be really portable and storage. So the solution to that problem is processed food, and the further you can deviate from those vectors, the Better.

Have you seen this activist letter against collogue? So the guy called Jason court bill ackman um signal boost to this a couple of days ago, this too called Jason cp filed an activist letter against collogue demanding that they stop selling what he called in theory of versions of the product in amErica there's red forty and blue one and yellow five specific colorants that exist and those this comparison child you had what's in the canadian version and what's in the american .

version and why is that different .

according to him? Um because it's not being enforced that there was A A request made or the um so canada .

stepped up and made a request for a Better product.

IT should have been done based on what I know I should have been done across the board. K og said that they were going to get rid of these things in america, but they didn't. And IT seems all manner of conspiracy theories that issue they're in bed with the fda. Someone's being given a back hander. Um this is indicative of america's total blazy careless nature with the food that is being consumed by the we pick your explanation of choice but IT seems that there are certainly colorants and some other ingredients compounds that are in specifically .

nave question like what color gues product would you consider good for you anyway？ Like what color gues products should we be eating?

I don't know, I don't know.

I'm not even asking rhetorical. I just don't know enough about their products but like IT .

would be cereal you know a lot of children having these fruit loops and stuff like that first thing .

in the morning yeah I mean, again, I I don't mean to sound like a cranky old guy, but why would we want our kids eating fruit loops in the morning? I mean, again, i'd know I just a moment ago said, well, I IT sounded like you maybe he's waffling on process food, right? But i'm not waffling on a particular food like you know fruit loops might be a treat like for dessert but like you on on what would .

you say we're going .

to start our day with Candy because it's all IT is is just Candy that you add milk to .

you've got kids yeah what do you for the parents out there, the oysters and coffee? Sadness for breakfast probably not going to happen. What you feel your kids that say create their desire for for that pilot to be? no. But also, so when they do IT cereal.

they eat cereal that's a little less sweet. So they going to eat cherie s now maybe Carolus I don't think colleagues makes serious, I think so anyway. So you know, cherise is kind of their cereal. They put berries in a yoga apple sauce again process. But you can get an apple size that literally has the only ingredient is apples um and .

that's that's what .

day is a typical breakfast ah h bacon like the venison um eggs like we make a little you know like eg rabs toast you know again, like it's not like I don't want to paint the picture that my kids are these little organic video machines like but but again, like what I just described as I think a far healthier breakfast then you know eating pop arts or eating what you loops.

what are you actively trying to avoid the sugar?

Um yeah I mean, I do think we try to be mindful of sugar and crappy junk food and just limit when they're gonna have IT and how much they're gonna have. So my kids, by the way, I mentioned that a minute go, but my kids love pringle so they can have some, but they are not going to eat like this. Many of them, right? They're going to have that many of them because we buy like little mini packs of them, which are not cost efficient. But like we're not optimizing for that, right? We're optimizing for a small serving size where it's like one and done and that is not gonna at IT does this?

Ah yeah that's true because once theyve opened that it's now yes.

are two be printers like all it's the trickle down effective.

right? okay. I didn't think about that. I didn't think about the fact that if you get your kids something that they like, that's also something you need to deal with now in the house. So interesting it's also sometimes you just .

go out for stuff is supposed to keep IT in the house, right? So we went in out for ice cream other day and it's Better because you just go out, you get IT over where where you're done, you come home. But to have ice cream in the freezer every day would be a problem for me.

Yes, I need geographic distances. The best discipline for me when IT comes to diet. What about is there any truth or have you looked at this regulation that comes from wifi networks and ipods and stuff like that? Have yeah.

looked into this a little bit. I gotta tell you, I don't buy IT. I mean, I if if there is a signal is a really small signal. I think this is a bit of a majoring in the minor and minor in the major problem.

I am amazed the number of times like i'll put up a post on instagram where I happened to have my airports in and i'm giving a post about. Something meaningful like you know here's an interesting you know thing that you want to think about for exercise and there's always ten people that try in I don't even know if I can follow you anymore. The fact that you're wearing you know those airports and i'm like, first all, I don't care if you follow me, so please unfolding me. But like, what is IT like to go through life so stupid where you actually think that that matters more than the fact that i'm trying to explain to you something that is in an order of magnitude more important for your health. Like and I just feel bad that like there are people as economies just it's majoring in the minor and minoring in the major.

Yeah, I don't know. There is an obsession. There seem to be certain areas of health that people love to lock onto, you know, the specific type of artificial sweetener that goes into a beverage, the the ionised or non ionizing radiation that's coming out of your records, the the wifi signal, five g towers that you live near in, bits and pieces like that. Meanwhile, show me your dead lift, right? Show me how fast you can roll a two k right?

exactly. yeah.

Like.

why do you do you know your A M I and your view, two max in a ay north that I had this discussion once on the podcast, which is like, you shouldn't be allowed to even comment on these things on social media until you do one hundred push PS. Like literally before you type IT in to your phone, do one hundred push ups and then get up and then you can type your stupid comment about my ipods or about this sweater's or about like just like get IT get your boarders in place first, please.

Lane continues to just pick fights with people on the internet. I don't have the constitution to do what he does, but i'd love watching him just go to war. And he's in the comments and needs fighting back in the comments and know eight months that that's not my bag and I can't do IT.

But yeah he yeah I avoid the comments at all costs, but I and I really even look at them, right? So but everyone's or else, like someone like my team loves to send me the most ridiculous comments.

You should put them up. You could pin them on the board and have like A A banker of the month, ranker of the week. We go you can have that one for free Peter thing um but yeah that is so bizarre.

The things that people hug themselves into very particular it's it's it's like an obsession and that's the thing. That's the thing. It's all downs.

Am from sweet as it's all downs. Am from what event you like did I feel like you probably sleep five hours night? I think that you probably haven't process. I mean, you definitely have a process, many of your emotions because I can see IT it's pouring .

out if you feel I have a friend who is so as with these, what I just basically call a conspiracy theories of health um in at some point I was like how much how much time were you on social media a day and he's like, yeah probably like eight hours a day. I'm like i've got a health tip for you and IT doesn't have to do with the airports.

Sleep one of the things that we haven't spoken about, what are the most important strategy this so much to on sleep sleep actually one of the few places that doesn't seem to be too tribal um you know like just sleep more. Maybe some people will argue whether you type magnesium three and eight of activate in check, whatever, whatever, whatever. What are the most important strategies when IT comes to sleep quality?

Probably regularity of schedule? So you know, the closer you can be to going to bed and waking up at the same time every day, that's great. Uh, duration. So leaving room to sleep for a sufficient duration. So in other words, you can do everything right.

But if you're only onna, give yourself six hours from the minute you get into bed until you have to be brushing your teeth in the morning, you're only going to get so far um then there's obviously the hydra that goes into sleep so temperature, darkness and stimulation before sleep. So what what are you doing to get your brain ready to sleep again? I always remind people a lot of three factors that are driving this, right?

So you want a denizen to be climbing as high as possible. You want melatonin to be climbing as high as possible, and you want cortical to be plunging as much as possible. So what do what do you have to do to make those things true?

So to make a denote y go up, you have to be active, right? Like a Denny is the by product of activity. So the more active you are during the day, the more your identic levels go up.

And then you have to say, you have to, you know, put that down, right? That's a sleep single. A melatonin is driven by light. But again, you have to have the right circadian in rythm. So you have to be getting the right time and doing at the same time of which is why, when I was talking about my travel schedule, I have to force EXO ogen, ous military on into the equation, because I can't rely on the external cues, but that's why I don't want people taking military and regularly. I want them relying on the natural way to get IT.

And then cortisol is probably the hardest st one for most of us, even if we because the typical biohacker gets number one and two, but your ressort of missing number three, which is how do I actually get my adrenal glands to come down to let me actually go to sleep. And that's the one where, again, you can do IT sort of with A A pharmacologic or molecular and hammer, which is what fox potato syrian is doing. But I cannot really want to have to rely on that every single night.

Instead, I want to get into a habit of for two hours before bed, not engaging in anything that's going to be stressful to me. So i'm not looking at my phone. I'm not you know, cheaper on worker males and looking at things that I I mean, really kind of trying to be doing very little that would produce.

And if I am doing some work, i'm gonna suggest all, I never look at my computer for two hours that what am I going to do? You know, i'm going to do something that's a little more relaxing or watch some f one highlights or something like that that's just pure bliss but is not going to to increase my level of of stress. Um and then we've talked about some of the supplements.

obviously that you can take there. You I don't think you mentioned about .

your dose of magnesium. I take two of the l three and adds, which is I think that's one hundred and sixty six milligrams as what comes into okay I also use transit on fifty milligrams every night. Most notes um great sleep pid um and that that you know are .

concerns about long term youth with resident on not .

a dependancy drug .

that's good. When IT comes to sleep hygiene temperature, cold temperature tends to need to drop. At least this seems to help you fall asleep. If there is someone listening who is having struggle, trouble falling asleep, the struggling to fall asleep, and the doing a, three, two, one, three hours before they're not eating, two hours before they're not drinking, one out before the turning up screens, they feel like they got a dark room, they feel like it's relatively quiet, what are the other places that you would look at if someone struggling to fall asleep? And then also, if someone is having those breaches, if if they're finding themselves waking up throughout the night, you've got any idea what that could be causing.

Well, if they're struggling to fall asleep, sometimes I ask the question, going to bed too early. So you know, there are different chronic types of sleep. There are some people who are truly night hours and they you know they're really not meant to go to bed until twelve one o'clock and they really need to be getting up at seven or eight o clock.

And if you forced that person to go to back at ten because there's spouse goes to about at ten, they might really struggle to get to sleep. I feel there's a term for that when spouses are on the different chron type. I forgot the name of the term.

but on the happiness yeah.

I would also look to make sure, believe in or not that a person isn't overslept. So this is not an entirely improbable scenario where you see somebody who is sleeping too much, they have too much time in bed and therefore, they aren't building up enough or or they take a naps during the, they are something like that, and they haven't built up enough sleep pressure. And so they're having a hard done going to bed.

Of course, you also want to rule out things like caffeine. Caffeine inhibits of denis sing, by the way, inhibit denis y reception. So that's how for someone who's not like me, caffeine is a wakefulness compound. So that those are the other things i'd be looking through on the checklist on is making sure when was the last caffeine or if you just you feel caffeine sensitive, the half life is actually quite long now.

Now yeah.

I think it's about ten. But yes, I mean, it's long enough that you can easily get into trouble with IT.

And what about if you're find yourself waking up throughout the night? Is is that just the same?

Well, no, I think I think that they know that the question is why are you waking up because you have to pay with effects the issue what you do know why is that happening? Um if you're waking up and you're ruminating, honest, I think the best tool for that is C B T I um causing a behavioral therapy for insomnia, very powerful tool. And then there's a whole set of behaviors around that, right? So what what do you do?

When should you get up and out and disengage from sleeping together? When should you try to go back to sleep? And and so so we're very liberal in our use of C, B, T, I with patients .

who are struggling with that. One of the strange things that happened during covered, I found myself going to the bathroom more frequently, like, haven't urinate more frequently like that. Probably nothing doesn't matter.

And then I got to what I update. My kill is and I was going to see my G. P. I. I did the classic meal.

I will accumulate a number of different like medical problems before I then decide to bring IT up like thing and I, yeah, I got the bathroom a bit more than I thought I was immediately like, i've got process cl, i'm going to die and, uh, the doctor turned to music. You are the fourth guy i've seen this week that's come and said this to me, is that okay? He said what I thinks happening and he explained this, would be interested to know if you notice this to the oai ents.

During covet, everybody started working from home. This meant that they were, at any time, within five yards of the kitchen, they were probably caffeine a little bit more because they could get themselves coffee as much, which meant that they would just be training the blade and going to the bathroom more frequently. Who is that? There is no boss looking over your shoulder saying you shouldn't to the bathroom.

So this is, again, like kind of another public service announcement to guys. Maybe it's to go stupid. So you to guys feel like, oh, my god, like I ve started in to the and feels like I I can't hold IT in. Maybe i've got something wrong with me like this was exactly what I did. So I got put on A A collegian um to like release the I don't know, I M sure you know that works like make you need to go to the bathroom less frequently and then you retrain.

You do a period of retraining which i've now done and I full blade capacity congratulations for me um but for IT took six months wow IT took six months for me to do that to really get myself back to like you know three hour podcast like blood capacity. My business partner came over, then business partner in the nightlife stuff, and I had my leg up on my thing because I was in a kills recovery stuff. And we had a ninety minute meeting. And he went to the bathroom when he arrived, and he went to the bathroom an hour later, I was like, came back. And as I dude, I don't mean to try here.

but you mean.

no, you going to buy through a little bit more than you would like you really worried about is like, I think I know what's happening. Uh, sure enough, he did. He did exactly the same thing. So I thought there was just such a it's so funny how that d training like, d training a blood literally like this is about of something that sits above the throw, whatever. And it's like that hits particular amount of pressure on the pressure in the batter is like you need to go to bathroom and you .

just detrained that and IT becomes like, so interesting and .

that was the thing that happened. Um on the other side of that though, because I was on a anti Colin erg x and they weren't having as much of an effect and they took me from, I think, five milligrams to ten and I lost twenty I Q points and I was brutal and IT was like, I love my thoughts being sharp and quick and being able to play with ideas and stuff and I forgot the name of a british seaside town or black hole.

I forgot that for like two minutes during a conversation, like remaining around in my brain trying to remember this place that should have come straight up. And that was scary because that was I basically kind of induce short term cognitive decline, you know, like a reversible short term IT was that was really scary to me. And that kind of gave me a new fd sympathy for people that are going through some kind of cognitive decline because IT IT feels like there's a bit of you that's being pulled away.

And the thing that you use to fix the problem is the thing that's being taken from you. So the fact you you know your cognitive horsepower, I will search on the internet, i'll come up with the solution and all you know diagnose or think about a way to add this new strategy to my routine to make special all of that the the raw materials that you build the solution with are the problem. And yeah, that was just a whole real interesting period, like six months of my life for as like I lead off of a lot during that time. One of the other things, I think that a big at least for me, i'm focusing in all a lot and good health at the moment. And this is like a whole other world does someone .

that hasn't been that reminds me of the support and I take, which is penguin probiotic, okay.

pro biotics kind of in across hair a little bit at the moment. What what makes a good and bad probiotic first?

That has to be alive, which turns out to be much harder than the most companies appreciate. So if you're making anna robes, which most of the probiotics need to be antrobus es, since those are the bacteria that you're actually trying to replenish in the column. Um so an aneroid has to be manufactured in in a completely oxygen free environment, which is really hard to do.

I mean from a manufacturing process is very difficult. So most probiotic companies, when they make their probiotic with the best of intentions, think they're making fill in the blank. Um but when they you know kind of count the units until you we have this many CF uses colony forming units. Um they're not actually checking if they're alive or not, but the time these things get to you there, they're completely dead. So um that's that's rule number one is you have to actually you know buy IT from somebody who knows what they're making and is um as able to to verify with more sophisticated tools that you're actually getting alive bacteria um or at least freeze.

I mean when I say alive, freeze, deride and will come back to life when you injust IT um or will come back to a state of you function um so I think that that sort of step one and then and of course, we're still very niche in this space and still trying to understand what to do. The probiotic I take is um israel rich and in a bacteria called accounts a which plays very important role, a role in beauty rate production. So butera is very important in metabolic short chain fadeea metabolic glucose metabolism um and um this is A A probiotic that's actually been demonstrated in a small but but rigorous and blinded study to lower glue cose levels and that's called glue cose control.

Okay, what else should someone that never considered good health before be thinking about? Lots of .

insoluble fiber? This, this is the most important thing you feed your get. So for all the arguments why you vegetables in particular matter, this is the most important, I think.

And and I think there are lots of reasons vegetables matter, but this might be the most important and it's the one that you can't get around, right? So you can drink a Green drink, know? I love ag.

You love ag. We cannot drink those things. And we're getting a lot of the vitamins that come in the vegetables and we're even getting the fighter chemicals.

But you the fiber you can't get in volume in that you're not getting in a fiber. You have to be able to consume um insoluble fiber to actually feed your gut. So I I think that that's probably something most people are deficient in.

What are your favorite sources of insoluble?

I love salad stuff, right? So anything that goes into a salad, so let us, cucumbers, carrots, salary, all that kind of stuff, play, work at the line. shrewd.

Is there any truth behind this? If you blends vegetables and fruits together, IT changes the way that IT interacts in the gotten Spike split glucose. You don't get the benefit of the fiber thing.

I don't know about that. The only thing I know on that front is that bananas believe IT or not might actually impair the absorption of other nutrients from other fruits and so don't put a banana in a .

fruit side yeah or don't put .

a banana in a fruit smoothly might be yeah that that it's preliminary and its a very small study, but and I don't really drink fruits moodie, so doesn't really impact my life. But but if if someone's really in the business of fruit smoothies, I might differentiate, separate the banana from the rest of the fruit.

What else got health, insoluble fiber, big importance? That means rely on vegetables, continue to have as many cups as you can throughout the day.

Yeah, I mean, I I I think that sort of what I I get unfortunate, but well, well, no, I mean, I I just want to be clear and say like I feel very fortunate i've never had got issues. My god tends to be very insensitive to things that I know can cause people a lot of gut issues such as wheat and dairy and things of that nature.

Um i'm previous to those things that does not matter, but that said, if you're not impervious to those things, then you've got to figure out what IT is that is causing issues and sensitivities and get rid of IT in the only way but you can really do that is with an elimination diet. You can't do IT with some stupid test that someone's going to charge you six hundred box for. That doesn't tell you anything. You've have to actually just take the presumptive offending agent out, run that to ground for a period of time and then reintroduce IT.

Um i'm doing hard core fod map at the moment, op, and it's actually not that bad, not that there's still loads of foods that evening on fod map, so I don't really mind all that much. I mean, IT not exactly the most exciting diet that i've ever done, but i'm holding on one of the other things that I was interested in talking to about his motivation. So there's all of these things that we should do and can do to keep ourselves living longer, but there's other competing goals that we have as well. And if compliance, as he said earlier, as one of the the most important things, then you you're playing this sort of this long game, how do you think about the component parts of motivation and and compliance instead of will power to keep doing things, whether that be from a health standpoint, from a work standpoint as well?

How do you in myself for and others.

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I think in myself, because I tend to be more a rational mind, that emotional mind. So in in D B T, you learn about this D.

B T dialectical .

behavioral therapy. You learn about the synsi of rational mind and emotional mind in something called wise mind. And that is you learn in D B T. Wise mind is the place you want to be like you're at your best because you're using the best of each of these components when you're in wise mind.

Um but different people obviously have a tendency to drift into one of the others more likely and I tend to drift more into rational mind. And all that means is that data speak to me more than feelings. And as such, when I need to motivate myself, I tend to look at the data more.

But there's nothing wrong with that. There's nothing right with that. There are other people for whom the feelings provide the motivation.

And you know, I was actually having dinner last night with somebody we were kind of talking about just that, which is there are some patients who really all you need to do to help them understand why they need to do something is bringing them back to their goals. So a very cognitive motivation, right? Like you want to be able to achieve X, Y and z.

To do that, you have to do b and c. And anytime you deviate for maybe and C, I just remind you about X, Y, N, Z again, that's me. Um there are other people for whom the relationship with that practitioner matters the most.

The trainer is the reason that they eventually wanted be able to do this. They don't want to disappoint that trainer. And the stronger that bond is, the easier the compliances. So again, I think that kind of comes down to knowing who you're talking to and understanding what makes them tick. And then that's what you can basically use to, to sort to help people stay motivated and compliant.

What about navigating an obsession with perfection? So as soon as you give people tools that they can use, that is an ideal against which they can begin to measure themselves and they can feel when they fall short from a health perspective. And the pain, self and juice pane that you feel from falling short can then induce stress, which actually isn't tickly good for you in of itself. How how do you think about the perils of over optimization and kind of not obsessing over those things in finding that baLance?

Well, I think it's very important and and obviously the older you get the wiser you get in, the more you realize that um perfectionism is um you know potentially an evil master. Um but I don't know. I think people sort of have to learn that less than the hard way like I I think it's very difficult to teach people lessons until they're in pain and they have they're kind of learn like, you know the cost of that is really high um and maybe I need to be and also IT sort of comes back to what we talked about earlier, right? I me, perfectionism is just another manifestation of a man adaptive venter monologue.

So IT comes back .

to how we talked about that, which is, if you want to resolve that, you have to see the pain point. You have to build a link of that thing to something that is, you know, hurting you.

Yeah, it's it's strange to think about the potential negative externalities of perfectionism because all of the benefits so immediate, you know, you take pride in doing things right, paying attention, being precise and caring about the stuff, think all very good and the world will reward you for doing those things. Because there are people out there who I did not have the capacity of the disposition to be perfectionist in that way.

And that means that there is an entire blue ocean out there. But again, like we said before, what are the like? What are the psychological costs?

But I think they're high and I think I think this is such a IT is a dangerous addiction. IT is an addiction like any other. Um but as you said, it's more society rewarded and that makes IT harder to break because the really destructive addictions, you're not fooling anybody like including yourself like there's there's nobody in an alcoholic super who thinks this is really crushing IT. I'm doing so well right now and everybody is telling me how well i'm doing. Um that doesn't mean that it's easy to get out of that, but at least step one is is taking care .

of you're a big fan of compounding over time of things slowly accumulating into crowing and stuff like that. What is IT when IT comes to health and fitness? What is IT the people or how?

How can someone whose in their twenties or thirties made of rubbering magic never had a health problem? You know like, yeah you know, medicines for like other people and stuff like that. Probably they go to the gym, they probably care about diet, but it's not got that real.

Like I am investing for my final decade. How can you bring that stimulus, that realization, that investment like from the far future into the now? How can you motivate an idiot, twenty or thirty old person to care about this stuff?

They have to go spend time with people in those, in those later decades. They have they have to spend time around people who are where they're going to be, and they have to see for themselves what that looks like. And they have to decide for themselves, am I going to be different than this? what? And if so, why? Like you you know, the first order response to that might be, oh, it'll never be me.

Well, why? Why won't that be you? What was this person like when they were twenty? Do you think that they were that different from you? Um so I think the more time you get to spend in the in the sea of old age, the more you come to realize yeah i'm not that different like by why I experiences this as well.

Like I I remember even a decade ago, you know people talking about what IT feels like to wake up and be just kind of sore and just taking a minute to can as you're get out of bed, like if you're a little stiffer than you were. And I couldn't really relate to IT. And now I can. So it's given me a little bit more insight into. Oh, I can I could imagine in ten years, it's even harder.

This is something that i've wanted to ask some on bridges in other perfect person. There's a lot of talk and sympathy, rightly, I think, given to a women aging so much value is placed on youth in women. But I do think that the discussion for men about how to age Gracefully, about how to kind of accept your slow physical demise ah I don't really hear people speak about that much. How have you got any insight here? I'd be yourself for your friends like your client or anything like that.

Well, know there's a couple of things they're right. So first, father is sort of I think there isn't in just a symmetry there, which is I do think um women seem to pay a higher Price for aging in terms of whether it's their view of them selves or even the world's view of them, right? I mean, let's take an example in hollywood, right? So I think it's probably easier to be a to be a leading man for longer than a leading woman.

I would guess that is true. There's probably data that could, could, could support that. So does that mean that female actors are not as good as male actors? Or does IT mean that, you know female actors are puni shed more for aging than male actors? Is probably the latter.

Um that said, I think you know I think when men are aging. There might be different things that factor into IT and and this might be one example. But I I wonder if more men deal with regret than women because .

I wonder if more men engage .

in the kind of emotional stuff that we've discussed already today, when they're Younger, and they they take into their older, a age, things that they wish they did different, whether IT was with the respect to how they were as fathers, how they were, you know, husband's and whatever the case might be. And I don't know, maybe that's wrong, but I do wonder if that there are differences in aging between the sexes that that come down to a certain areas of socialization as well as biology.

How can we, as men, learn to deal with that decline? You know, we take pride in the mile time that we can run there of the muscle mass that we hold in the leaders and stuff. And yeah, I don't think it's youth is much more prized in women than IT is in men. But I think the conversation also accounts for that, at least in part and that if it's written into the cultural sort of rehearing around women and around aging, I don't think that this exists for men.

I don't know that IT is, but to your question about like how does one cope with the the loss of agent? Because there is loss. I I tend to think about IT through the lens of how I think about health span, right? So when when I talk about health span, IT has three components.

We've discussed them already, but I am explicit in saying them now, right? So there's a physical component, a cogniac component and an emotional component. Two of those three are going to decline as you age.

No matter what you do. I don't need to tell you which two they are. Can you alter the course of their decline? absolutely.

Can you start at such a high, high, high place by working so hard in your two and thirties and forties and slowing the rate decline, that by the time you're ninety seven, you look like someone who is seventy? Yes, you can. But make no mistake about IT, you are never gonna look like someone who is twenty.

So in addition to doing everything I can to do that, I tend to place more energy in the one that doesn't have to decline with age. And maybe kind of rejoice in that one, which is, you know, when I was twenty, I was an insuperable, miserable, self absorbed prick. And I am so excited to know that when i'm sixty, I won't be now I have to always work really hard not to be.

To be clear, it's not the default state that you're emotional health will get Better over time. You need to work your ass off at IT just as you need to work really hard to maintain your physical and cognitive health as uu age. But the beautiful thing is you will actually increase as you age that emotional peace if you're willing to do the work. And so my view is do the work in all of them and accept that this one's going down, but this one's going up. And to me, that is true whether you're a man or you're a woman.

And therefore, that is the single most important thing I clink to as I find myself having a little pity party over the fact that I don't like my body as much as I used to, and I don't feel as smart as I used to feel, and I hurt more than I used to hurt, and i'm not as strong as I used like nothing about me today physically, or cogniac vely as I was ten years ago. And if I if I telling you whether wise, i'd be like, yes, but on my way Better human being today than I was ten years ago. And I know that i'm going to be a way Better human being in ten years than I am today.

What would constitute an emotional training regime for you if we've got, you know, via two maxi zone two or whatever, for physical health, what would the emotional .

training regime? Well, IT IT really comes down to sort of the there's the therapy, right, like those are your sessions in the gym and then there's kind of everything you're doing in between. It's the the analogous thing would be being active when you're even not just in the gym and and the lifestyle choices you make day by day. So it's um how do I put into practice what i'm learning so I don't know from I mean, again, I I sometimes get embarrass talking about this stuff because I i'm a little embarrass to talk about what a what a horrible human .

being I used to be but .

rare fancy a you know just like I really take joy now in in being less selfish with the people I care about and and to think about how selfish I used to be like everything revolved around me, my health, my work, my this, my that I know yesterday. For example, my, my my wife who had a long run this morning, seventeen and eighteen, my run share training for the london marathon. So he was a long run this morning.

And you know, SHE was like, look, you know, can you go and pick up our daughter who's volya all practice and you know, nine thirty, and then you gotta drive for friend home about time I get home. It's going to be like super late and again, Normally SHE does that and you know and that's just kind of like she'll do that pick up that night um anything this is time like a big deal so people are watching this. You're going to be like what's even talking about but in the past I would have like been like I don't obey like I just I think he just got to do IT because I got too much stuff to do but of course, IT didn't even occur to me.

Of course I was like, of course I want you to sleep like go to bed early. Let me go take care of this and i'll do this this this thing when I get home and i'll care IT. And again, it's a very small example but it's the practice it's kind of putting into practice like how can I be a Better spouse because of you know I I don't want to be the selfish guy who the earth revolves around. Um so even though that one very small trivial example that happened to occur last night, it's like looking for those opportunities every minute of every day and looking for ways to be a Better dad or a Better friend or a Better son um because lord knows i've been so bad at those things for so long and and now i'm really enjoying the opportunity to to spend more time with my parents in a way that I never did before because either not going to be around forever but also I know that IT means so much more to them .

given that I have kids now too well also you have this degree of pride in knowing where you came from, like you are. Maybe I am to the emotional equivalent of a fat guy that got jacked. You know, like, look at how terribly I was, the awful condition I was in previously, and look at all of the work and i've gotta do now.

And you, again, the same as the do that used to be fat. That now is like, bro, I did. I did a five k poker on this weekend.

You compared with ga, that's nothing is like, you know, I started, it's like going to picking the daughter up and not thinking about IT and wanting to be there to support the wife. That's not that big of a deal. It's like, yeah, but look what I started right and i'm learning that too.

I've got I have a number of patterns are also very cautious, super cautious of like this is my new toy and i'm now starting to see everything everywhere. I saw a tweet a little wild go. That said, I just learned about recency bias. And of all of them, I have to say it's my favorite.

And the great meme, right? And like now it's the dump google effect characterize right?

Yeah, yeah, yeah. I don't want to see everything that I do is there's people pleasing again or there's you with your but it's fascinating and IT really is an entire new realm of life that I totally hadn't considered. Are you every experiences, emotions, but not everybody actually connects with them. And certain people don't connect with them on the level where they give them respect, right? Emotions are kind of this thing.

Too many people, me as well in the past that we are like an annoying is like rain I can if if a negative yes it's an annoying thing that kindly gets in the way and every saw up in a Sunny day you sweet thanks thanks guys um but never actually connected with them I go but why is IT raining? What does IT mean and how can I work with this in a bit of a different? Why is IT Sunny? And do I want this to happen more? And what are the things that I do that and enda.

yeah. And by the way, you also realize if it's Sunny every single day and I never rains, do you really appreciate the sun?

Yeah I I I had them with a friend that while I go here, told me about a girl that he study dating and he's the supermarket tional cognitive guy and she's a crazy just in her emotions uh, both cultivated and natural dispensation for both of them. So theyve would like become more of what they are in some way. And he said he was like boxing a south pole he was having sort of he was coming from his perspective and he was coming from her perspective.

But he asked, he is like, you know, as someone who doesn't feel things the way that you do said what's IT like, which is that is terrible, beautiful. And that IT is is like just the gaming. The spectrum of experiencing things is so much broader. But i've been through a few strong emotions over the last few weeks, and one of the things that IT really made me think about is how little compassion so many people have, especially on the internet.

Like, you know, you see someone who has a public, they fall flat on the face in one they are another, or you they do something silly, or that story comes out about them, or they have a public makeup or breakup, or you know, the export and gets with something new. Whatever might be unlike the way that people talk about other humans is so dehumanizing. It's like it's W W, E or or a sit com or something you like.

You do understand that on the other side of what you see is like a narrative arc. Someone else is told you that the actual humans fucking feeling things like in the gripes of at a state. And ah I like a guy at thirty six realizes that people feel feelings like shock but um yeah that was that really that really sort of woke me up to was there something particular .

that happened that you saw that that made you feel this? May you realize .

this not particularly just me me kind of being in this art and really sort of thinking into a that wasn't, I think the the jona hill thing happened about six months ago. I was one of these jha hill act had a girlfriend.

They broke up and the, uh x girl end kind of released ed the messages online and in the argument, largely sended around, should he have released them? Was he in the wrong? Was he in the wrong? And like, he doesn't really matter about that bit.

What matters is the fact that both of these people were wildly hurting. They were showing IT in different ways. And, you know, was he being mature? Was he being immature? Ba, but I just the way that people comment on this stuff has no regard for the fact that there is a fucking human.

On the other side of this, I like, you know, another good example, love in my hate. MIT doesn't matter. Jordan Peterson, a guy who went through hard call benz za, withdraw for a year and a half.

And I like watch this unfold from basically a front row seat. I wouldn't wish that on anyone. I wouldn't ish that on anybody archive.

Sia, I flying to first. We go to serbia, got to russia. deal. Oh my god. Just like this endless, endless torture. And people just at the time making jokes about macao's attempt to try and fix her dad or or, you know, take IT.

Like, who is this man to teach us about responsibility in the modern world when he's addicted to bezos and just cking awful jokes? I just like that makes me think, like, how bad does your life have to be that this is the place that you get to? Did you speak about other people like that? And i'm not i'm no saint.

I'm not like brimmed with unbounded empathy for people. I don't say things like that. And I just really a really sort of resented like a bit trying to think about a bit more humanity as best I can, I guess.

One of the other guys that i've heard about rape peat has A A prescription or a piece of advice, which is to take aspirin every day. Have you come across? This is something to do with blood thinning up and how legit is taking aspirin three injured milligrams of aspirin .

every day or whatever IT is. Oh, I mean, that's been a well understood therapeutic al intervention for folks that are at high risk for cardio asia disease. And it's it's an interesting story because it's had um it's one of those things where the answer or the presumed answer has changed so many times.

So you know there is a day when anybody would take aspirin for cardio, asked disease prevention and then IT turned into well, just very high risk and then IT was well, just high risk. Nope, it's just very high risk. nope.

IT should be everybody. And IT goes back and forth and back and forth, back and forth. And what's abundantly clear is the following. Anybody is going to have a reduction in risk for cutting collar disease by taking an aspin or typically, it's a baby aspirin, which is eighty one milligrams quarter the dose, but there's also a risk from taking a baby aspirin. And the risk is if you fall and banging your head, you have a greater increase in the risk of uh hedge subtle epidermis age and so the real question becomes, who are the people whose risk of cardiovascular disease is high enough that the benefit they get is greater than the risk of the bad scenario.

not skateboards yeah .

well and the good thing is, look, skateboarders also are Young and they have big heads and their brains don't slash around too much when they fall and hit their heads, right? But once he started to talk about people in their sixties and seventies and eighties, and the brain atrophy a bit, all of the sun, you're at a far greater risk for .

a subdual or sheer ly.

You got room and you have more room for the brain to move. So one of my patients who is on a baby aspirin for the appropriate risks was ski two weeks ago. Fall hits his head, no concussion, up back skiing, everything is totally honky dory.

But he's got persistent headaches for two weeks. C T. Scan shows small subdual hematomas. Let's stop the baby asprin immediately and wait for that to get Better.

When we're very lucky, we don't need a neurosurgeon to go in there and draining. So um even though you can buy aspirin over the counter ah it's not an entirely benie thing. And IT comes IT has a lot of benefits.

And we put the appropriate patients on IT, for example, in other case would be patients with lp little a elevations that's a type of lipid that's hereditary. Pretty common one in ten people have elevated levels of IT, maybe more. And you know there, the risk of a throb sis from the hyper coequal state induced bio pilla is greater than the downside of the subtle heaton, a risk which is small but not zero.

That's interesting. And what's the people say.

by the way, that if aspirin were being developed today, IT never would be approved.

Why these risks? yeah. Okay.

yeah. So the mechanism of action is aspirin inhibits platelet aggregation. So platelets are the type of cells in the blood that are partially responsible for the formation. Okay, yeah. So, so aspirin impaired that by design .

or about as a side.

that is that is its effect. Yeah right. Well, like, I mean that I mean an anti flaming drug that does that.

Yeah right. okay. And this is so actually .

I think its first indication was actually for pain.

Yes, I always think of IT is a pain killed yeah, something to make my blood flow yet more easily. Is there a risk of people bleeding out as well if they were to get some sort of like, if you were a war fighter, uh, would you would taking aspin calls your blood to bleed out more quickly? Yeah, probably.

Although that's probably something that is more driven by other clowning factors, not the plate that so blood clotting is a really complex process that doesn't just involve platelets, but also involves a whole bunch of causing factors. Factor two, factor seven, all of these things, and you'll typically see.

So hemophilia, you've probably heard of this disease, is is a genetic condition where one of those clotting factors, fish and every one of these, results in a slightly different type of bleeding disorder. So hemophiliac country, to popular belief, are not at risk of like spontaneously bleeding all the place, but they will spontaneously bleeding into a joint more easily. Uh, I forget all the factors I can't remember.

It's like factor five deficiencies they tend to get you'll tend to notice if they get dental work, IT tends to bleed a lot, floating their teeth that will even cause a lot of blood loss. So not a lot of blood loss, but relative to what you would expect. So I mean, literally the last time I knew the ins, so I lad, I was studying for my met school boards. So that's how long it's that there is a day when I knew every one of these things, aspirin works on playlets.

Speaking of that, I saw tweet from elon saying, when seeking medical advice, ask your doctor, but also asking experienced nurse, nurses are undated. You think nurses are undated with regards to their inside, around, held and stuff like yeah for sure.

Why um again, that depends on the system. But if you consider a hospital for example, which is where you're going to most encounter a nurse, um you know like if you think back to when I was in a hospital, which was in residency, um how much time was I actually seeing a patient, uh, who is awake? So because I was a surgical resident, we were obviously seeing patients like when there when we're Operating on them.

But when you talk about a patient post Operation vely, who's going to be in the hospital for a week, I mean, I might spend a grand total of ten minutes per day with that patient. And the nurse is with that patient for hours a day, little literally hours a day. So a really good nurse, and not all nurses are good, just as not all doctors are good.

But a really good nurse, which is presumably what he's effectively referring to, hear, you know, understands things and sees things and recognizes patterns very well. And I know that when I was a resident, anyone who was a good resident and I prided myself trying to be a good resident, um you would very quickly figure out which were the nurses who you always listen to when they sort of said they're something wrong when mr. So one so over there and they might say that might be this.

So they might say, I don't know what IT is, but he is not acting Normal. And I tell you more often than not like something would go wrong and it's like, you know what SHE seen the pattern enough of his mentation status or the slight decrease in his year and output and you alone behold, he's got A G I bleed and it's going to show up at two o'clock tonight. I'm going to be sticking an ng tube out on his throat and we're going to be running into five minutes of blood in him on the way the o catholic so um so yeah I think there's a lot of truth.

Is that just front lines? Yeah that's yeah that's so interesting. I don't even think about that. It's crazy. One know this so much a it's a shame .

that there's a big nursing shortage in the U S. Yes, absolutely. Why so it's being met by you know importing nurses from other countries, right? So we um you know we bring a lot of nurses in from other countries um but look, I think it's a hard job and I think it's probably underpaid. It's it's a hard physical job too.

like shift work. W H O says any type of shift work is a health risk when you are firefighter or nurse or a doctor.

Yeah so um I just know but yeah I think it's it's physically demanding again, it's all there are so many different types of nursings of very broad profession, right? So you know you can do things as an an outpatient nurse and impression impatient surgical nurse, medical nurse, ICU nurse. I it's there's so much different stuff going on, but but it's not easy work and that obviously has a lot of emotional consequences as well.

How did you deal with that?

I was hard, I think, I think there were, there were moments that can't, that struck me out of nowhere. The meaning, I didn't understand why in the moment I felt so attached. I think there were probably three or four times during my five years of training when, you know, in a way that I couldn't, I couldn't have predicted an hour earlier.

I just became completely overcome. I overcome with grief as a patient died. and. Um I don't I don't these are some things we necessary spoke about together.

So I don't I don't understand like was that something that everybody was experiencing or was that just something I experienced? But but there were there were a handful of times when I was really just abb solution devastated, and it's not necessarily what you would expect. IT wasn't like all this is a patient i've known for a year.

Um I mean, in one case IT was a and I write about this one case in the book IT was I was a boy that I just happened to be the trauma chief that night when he came in from in a car accident so didn't know him right but but you know he died right there in the trauma bay as I was trying to accessory him and I can't. I've lost track of how many people have died in the trauma bay when i'm taking care of them like that. I need scientific notation to remember that number is huge. But there was something about that boy on that night that was impossible for me to have them. So not sure .

why have a friend, one of my best friends in the U. K. Who became A F one, f two um met student practicing during copy.

If you meet everyone of two driver.

I was like, no, no, no. I'm afraid not. We would both of us would be tracked side if was the um and he told me the story during copy of a lady who came in and when SHE came in, SHE was a little bit short of breath and whatever whatever SHE called one one, one or which is kind of like to slightly less intense, nine, nine, nine in the U.

K. Got taken in and he saw her and SHE was a little bit short of breath. Then he saw a thirty minutes later, and he was blue.

And he saw her thirty minutes later when SHE was dead per month. He coming later, he was talking to, and that one really hit him as well. And he didn't kind of the same as you.

He didn't know why, didn't know what I was, but he stop me that story a couple of times. At each time, he tells me it's kind of hunting to just think that know from being someone SAT in a uber or an ambuLance or something. Sixty minutes later gone. It's fragile and it's a .

lot like the first death I saw, which I I think I also write about this in the book. When I was a mad student, I think was my second year and was a woman that came in short of breath and you know being the mad student, I was sort of okay, go and talk to her like this you know she's little short of breath. He is probably having an as attack um and what IT turned out is he was having a plumet ebulis m and in the myths sort of just sitting they are talking with her SHE has a cardiac rest in you know that turns into a full code which ultimately ends with me you know being brought in to do chess compressions and and ultimately he died and IT was again. It's one of those things where I mean, I had never seen a person die before and it's compounded by the fact that I had just spent thirty minutes talking .

to her yeah this country is declared that i'm sitting .

here in speaking with this woman for thirty minutes, who then an hour later, is dead. And I remit was a saturday night, and I remember riding my bike back home from the stanford hospital, which is on the north side of the campus to where I lived. I live, you know, on the south side of palo alto.

And I remember just driving my bike baskets like midnight on a saturday. And, you know, the time I had a girlfriend who was an architect, SHE lived in san Francesco, and we never talked about there. SHE had this kind of like SHE was ski zed out by medicine. So it's like our relationship was not at all based and talking about my daily job or my you know my school um and I remember being very upset when I got home because I really needed to talk to someone your girlfriend would be the likely person but I also knew I was like, yes, she's not the one who's going to hear this but I remember that feeling very distinctly of how upset I was and and not feeling like there was someone to talk to about IT.

What do people gloss over in outlive that you wish that they didn't? What was the most unpopular, important insights you're about to hit full on the best selling st. What do you wish people paid more attention to in the book or or not?

I mean, I have to be honest with you. I first off, I have been completely and totally blown away by the response to the book. And part of IT has been the the number of things.

People have come to me and said that they've changed, either change their mind about or just change their behavior about. And I throw those discussions, there's nothing that stands out to me where people are, you know, I really don't know. I think that the two things that I are pleasantly tly noted.

Our one is, you know, the fact there's three chapters on exercise, I think was a deliberate decision just based on the volume of what I needed to say. And I think people would take him out to heart. You know, I think people are saying, oh, I thought I yeah, I understood that exercise mattered.

But I now have a much clear path for understanding not just how much IT matters, but how to think about IT comprehensively. And then I think, look, the final chapter of the book in the epilogue, which were, you know, not there were not something that was necessarily going to end up in that book. And I think if my publisher had had their way, IT wouldn't have vent IT up in the book.

But I, but I actually think that there is a non trivial subset of the population who ve read a book who says that that maybe the most important part of the book for them, and that it's open their eyes to to the same sort of exploration. So look, if if, if IT doesn't nothing else, right? If IT doesn't change anything about the way you eat or sleep or exercise, or think about heart disease or cancer, alzheimer sees but IT egg nights. And you kind of a curiosity along some of the stuff we ve been discussing more than it's worth IT. Then you could just save the time and jump to the last chapter.

That's a one, let's say, that you could only do ten exercises for the rest of time, could be any machine.

any modality exercises can .

be anything you can pay IT can be swimming IT can be cycling IT can be be on a bus ball I can be hind in therapy can be anything, but only have ten modalities.

And we can, one of them accommodate multiple variants of IT. Like what a split squad allow you .

to do every form of a split, no.

elevated as a dedicated .

grates that those of the rules. And you ve got ten, what are you choosing?

My now .

the bike .

bicycle, road bike yeah go at just you .

can do different intensities on the bike that's a loud ah ah but is that because you get the big vi get .

where I do my own two in my view two max. I'm going to get my full week there yes. What do I want na use up? I mean, for now, i'm going to a throw in rock and swim but i'm going to reserve the right to come back and say because that only leaves me seven on in the gym.

what would be the justification for rock?

Um it's just it's it's so beautiful to be out there Carrying weight around. It's also the most social thing that I do. So I love when my patients come into Austin and I can go for a rock with them. So you know it's whether I am not going to go for a bike ride with somebody, you're swim with somebody, and most people don't want to lift weights together.

What about the stimulus itself? Is that something specific to the rock is IT to do with the fact that your loading yeah.

yeah, no. I think it's it's great to be loaded without over pounding the joints um and it's also great training for other activities. I do like hunting where you're walking around and it's chAllenging and we ve got to pack on your back .

with a lot away in IT swiming swiming even if does get kicked out.

Yeah I think you know look at something that's always been near dear to my heart with my background and I also think it's a great sport for life. Um and so IT also is something you can really do well at multiple intensities, so you can really kind of do easy easy P Z zone too and you can do like the most crushing soul burning intervals. Um it's an amazing way to train your lower body doing kick that till the point of like the burn know it's just it's just it's it's a beautiful whole body workout in a way that virtually nothing is maybe with the exception of growing ing alright.

three.

I'm going to go with a relatively new toy in my life, which is a bet squad. So I very recently, like in the last four months, got this new belt squad machine. And I I have to say IT is the greatest hip hanging device ever and it's it's really nice because it's just you're not actually loading this fine at all. So i'm able to load my body with as much weight as I would have ever been able to tolerate in a backscatter dead lift without any of the axel loading. Um so that's definitely on the list.

Who makes the machine?

I want to give them a shout. Tc, because i'm so happy with them and I don't have any affiliation with them. I think it's called squats or something.

It's a guy loaded.

Yeah yes, it's a guy who's a former nfl player, and i'm blanking on his name. I apologize. I wish I could give them a Better job shouting IT out. Hopefully you can link to IT somewhere. But I think it's called squad max md.

or something like that. How comfortables about? I've found a mixed variety .

as one is exceptional. And I tried a couple beforehand and .

I get a ruiz tips. If I get you know, you've got some.

you come over and try and no.

it's O I I .

adult about squad.

I'm someone with lower back injuries. And also I learned this from a doctor, mike retail, the additional cns straining that you get from actually loading, which is specifically through the spine. And to be like, oh, I just got to completely kill my legs.

I can bail out whenever I want. I can go to failure as much as possible. I can get someone else to delete the bar or what I the plates easily to do, drop sets. I can do all this stuff and you're telling me that I get to do so i'm all in for that OK. There's four.

It's going to have to be some very into a split squad because I really love single leg stuff too. So IT would either be um a traditional barbell lunch.

single leg just walking .

lunch .

ah set back so yeah yeah or IT .

might be a rear foot elevated split squad with dumbbells.

kettle bells yeah. I mean, that's I am going to talk .

to the governing body and see if you can let me count that as one exercise. I'm going to really push on the judges here okay.

all right. Um I don't think so. I'm sorry. I'm afraid i'm afraid you gna have to make you're going to have to make a call between the two.

right? It's going to be one of those two, okay. Um again, the advantage of those is is obvious legendary across the board. Also, you want some actually ally loading, right? You do still need to stable to do that. So so again, here we're doing IT with a much lighter way if i'm doing if I have a bar on my back, i'm not really going about one hundred and .

thirty five pounds when I do that exercise. Yes, um I love the a walking lunches or reverse lunches with dumbbells because he just feels i'm so stable. I don't feel like i'm gna fall over. It's good for grip strength as well, which is quite nice, a little bit of sort of proper work.

So yeah, okay, there's five, five more I would do. I would pick probably a dum .

bell press .

like a bench. yes. Mb, 嗯。

Either a or, by the way, if I do pull up, I can do all grips, right?

Sure, you can go chin up and pull up from that unneutered. Come on. You really pushing the limits at the governing body is gonna to meet.

Give me three grips.

okay, all right, so be IT. All right.

We'll do a three grip. Pull up I can.

Um the square of .

the back yeah. How many? I think .

you've got six. So I think you've four more.

Do you ask everybody this question? And I, everybody take this long? Yes.

you are the pain. And someone asked me on A Q, N. A. I took even longer than anyone. So i've asked fill heath, i've asked some of the greatest body builders of all time. So everybody, I don't think this a single person that hasn't said dumbbell either benches or incline bench press that's like the one you go fat everyone's bro. Deep down .

you've got formal. childwall. I don't even know. I mean, I haven't even been included any other kind of rehab important moves that I do, right? Like I mean, that doesn't count, right?

Like if i'm doing DNS like dynamic in your musical stabilization stuff for i'm doing like you know like a if you don't know this stuff, the positions won't mean anything. But I mean to say that doesn't come OK OK. um.

I would probably also do A A try sep extension. So an overhead try sep extension, one of my favorite. So you have to obviously get humorous extension and then a try .

sep extension on at tell what a really lovely variation that we've been playing with on a saturday session is a floor slim crush with small plates and that is just so nice. Hope like this. no. So on A W bar.

I but just going from the floor .

just because I i've always felt a bit strange bail out when you're on a bench, I was a bit like, yeah and if all that you need to do to bail out is just go to hear and IT hits the ground yeah ah yeah i've really been enjoying that but I mean, that's you every guy ignores it's just pushed down. Everything is pushed down one or close create bench. It's I do to get you back in arms. It's interesting.

I think the literature is pretty clear on this. Isn't there a significant difference and try sep activation when you have humorous extension, correct? yeah. So I don't actually do anything that's not extended. now.

One.

there may be a benefit to you, but I have to spend lot of time doing arms as evidence spend.

My one thing that I did learn was interesting, like try step kickback. Ks are kind of like to feel like a the shake weight of the upper body or something but that um jeff nett talked about this, the fact one of the heads of the choices have only gets activated when the uh a elbow is behind the torso. You um so you can do this in a number ways you could use A A cable and again, put yourself into this position. But that that actually is kind of important to get maximum contraction on IT as O.

A A hanging like again, probably at least eighty percent .

of people that have answer this have put that in the drap movement of choice. Are you going, uh.

to have i'm going games in and then i'm gna. Do I get all three sides right? That counts. One, don't even try to tell me that.

Have to say, of all of the people i've asked this question to you is the most fucking little just okay too more.

This gonna a dumb one for most people but i've probably do a farmers Carry.

okay. Yeah i'll give you for this given that you're probably going to trying to litigate your way through IT, i'll give you both unilateral and bilateral to that. Yeah why um I think for me it's probably .

one of the best grip exercises as well and I like that um and I appreciate getting the unattended for free um I ll tell you I won't accepted IT even if I only could do IT with a hacks bar but that's my I like doing both but what I really love doing is I do this at once a week. Hacks bar loaded up, pick IT up thirty seconds of walking, thirty seconds rest twenty times so the twenty minutes set and you know I I would like to see people of our age should be able to do that with their body weight.

Yes, I and then obviously.

you know once you know you you keep progressing through that and you know I think i'm up to maybe I don't know, i'm probably one hundred and fifteen percent of my body weight now. Um so I think you're really getting some grip strength there like you're real when you get into that fifteen and sixteen said you're really feeling IT um but also you're really you have to have a stable core to be able to do that. You've got to be able to kind of control yourself. You you know you you're getting great um uh doorframe you know everything is so much harder when you're Carrying that weight so holding IT to great exercise one of excise I love doing as if it's a fit of great family exercise.

So believe IT or not, it's like it's on the driver .

swearing and sweats. The kids are doing IT with me. They Carry their little weight there.

One kids timing more.

I am feel like i'm just missing something so obvious, like I need to see other people's .

choices is IT bye calls.

Now I thought about that, but it's like, do you really waste one of your time on that?

That's true. You ve got pull up same as conference. You've got you've got no direct show the work. But if you're doing bench and then you've got your holes.

no, you know what? I'm going to take a seated cafe race.

seated carefu ys for the number .

ten perso ous.

why? First .

of .

all.

contrary to popular belief, a seated career rys does still hit the gas rock. So you are still strengthening the killers as well. And maybe, maybe I would change that to a standing, but I think this seated you can load so heavy.

And I really think that a strong solid is a healthy lower leg. Think it's I think it's just a way of life. Um so yeah i'm going to bring them in one .

number how yeah dog. Peter, ladies and gentlemen, Peter, I really appreciate you. Thank you for joining me on the first ever one of these that we have done for the people that are just listening.

We have been cycling through a western landscape on a virtual video wall and then a museum atrium, complete with moving dinosaurs for the last three and half hours. I really appreciate you. May I love your work? I love the fact your diving so deep in making this stuff accessible to people. What should everyone expect over the next few months coming out from? And your love in the stuff the other day.

you talk about a few of the things. So I think i'm I am excited about the sun screen thing. Sun mEllenda and screen thing is an important one that we're going to do.

Um we're introducing something new to our podcast, which is going to be quarterly reviews, so we get a lot of feedback. Hi, Peter. Love your podcast.

Can't keep up men three hours a week of super deep diving into stuff. I need A, T, L, D, R. And yeah, we have great shown notes in all other stuff.

But what I do, and I think you do the same thing, every time I finish a podcast, I make notes. So I use, I have these q cards, these eight, five, five q cards, and I write down the most important things I learned. And i've been doing this forever.

And there is like a huge stack, this thing sitting in my drawer that nobody's ever seen. And so I kind of mention this to my team three months ago, and they are like, tell us what's on IT. So way to call. And I read them the last three months q cards and they were like, good.

That's a party, an episode once a quarter.

You come and read your q cards because it's what you found the most interesting. And how did you change your behavior as result to what you learn? So we'll be introducing that in q two as well.

That's awesome. Where should people go? They want to keep up today with what you do.

I think our site is for the best place, Peter, t md or early medical dotcom allia.

Peter, I appreciate you so much.

me.