#40: Peter Attia, MD, Founder of Early Medical — improving your lifespan and healthspan, the centenarian decathlon, and the process of making major life changes

Welcome to From Startup to Grown up, the podcast. My name is Alyssa Cohn. I'm an executive coach, an angel investor, and the author of From Startup to Grownup. Each week I talk to founders, creators, advisors, investors, and builders of all kinds about their insights and experiences in going from startup to grownup.

Okay, today I have a super exciting guest on the podcast, and this one is a little different from my usual discussions today. Dr. Peter Attia is joining me. Peter Attia is the founder of Early Medical, a medical practice that applies the Principles of Medicine 3.0 to patients with the goal of lengthening their lifespan and simultaneously improving their health span. He is the host of the Drive, one of the most popular podcasts covering the topics of health and medicine. And he's the author of a new book, Outlive the Science and Art of Longevity, which covers a treasure trove of topics specifically related to increasing lifespan and health span. So now, why would I have Peter on the show? Because my show is about helping founders and all leaders grow. And as I say all the time, the first person you lead every day is yourself. And your health is the foundation on which everything else you do rests. So you need to be conscious of how you're maintaining your health so you can flourish in the rest of your life. Our discussion was filled with wonderful nuggets. Peter talks about his framework for lifespan and healthspan that will help you put this into context and manageable categories for yourself. He also covers my favorite concept of his the centenarian decathlon. We talk about what that is, why it should matter to you, and what you should do yourself to train for your own centenarian decathlon. Peter and I also do a case study. We talk about a founder or a leader, sort of a typical founder or leader, and how he would guide them if he met them on a plane and they started talking. I would just say personally that Dr. Peter Attia's work has been transformational for me, and it's changed a lot of.

How I think and more importantly, what.

I do as it relates to my own fitness and my own nutrition. So I'd absolutely encourage you to check out his work.

And I certainly know you're gonna get.

A ton out of this conversation that we have on my podcast. So please enjoy this wonderful conversation with Dr. Peter Attia.

Peter, welcome to the show. I am so excited to have you.

Well, thank you so much for having me, Alyssa.

I'm thrilled.

And I guess first, Peter, I wanna ask you a question. If people ask you the question, what do you do for A living. How do you answer? That.

Depends where I am and how much or how little I want to talk about it. So in all honesty, as much as it sounds like a bit of a jerk move, if I'm in the company of strangers, I figure out a way to not talk about what I do.

What if you were trying to talk about what you do, what if you were trying to describe kind of the totality of what you do, how would you answer?

I would say that I'm a physician who's really interested in prevention in a meaningful way and I would try not to use the L word very much. Although eventually it would all roads would sort of lead to that word.

I, I'm gonna now use the L word. I'm assuming you mean longevity.

Yes.

How come you stay away from longevity? Are people like allergic to that?

Yeah, no, I am allergic to that word actually, because I think it, it comes with such connotations of snake oil and charlatans and nonsense and probably rightfully so. I do think, and I try to write about in the book that look, look, you know, there's a really thoughtful way to engage with that word and it does have meaning, but it's not bumper sticker meaning. So it's one of those things where if you want to have a serious discussion about it, you can. But if you're, if people are just trying to be polite and ask you what you do, then there's, there's no need to really talk about it.

Right. Okay, that makes sense. But that all said, you do a lot of different things and one thing is that you're, you know, I've experienced you as a real thought leader on, I think a lot of like the forefront of, of medicine and of science and really science based tools. And so I'm curious if you could start by just talking about, you know, your thoughts about medicine 2.0 and moving into medicine 3.0 as you describe in your wonderful new book, outlive.

So medicine 2.0 is where we are right now. I, I do believe we are kind of coming to the end of medicine 2.0 though. And I won't get into the transition from 1.0 to 2.0. But as you know, is, as I write about in the book, that took a long time. I mean that was about a 300 year transition. 2.0 to 3.0 will not take that long. And I would argue we've only been in 2.0 for about 130, 150 years. Is that, that's about when we've been so what. What medicine 2.0 has done very well is introduce us to the scientific method, introduce us to a way to glean insight and discern causality from correlation. And in particular, this tool, namely the randomized control trial and the statistical methods that have enabled it have solved a lot of the acute problems that once eradicated our species. Right. So all the mainly infectious diseases, but also trauma, anything that sort of results in acute care. Medicine 2.0 has been a remarkable tool. And that's again, everything from frankly, infectious diseases that we don't even think of anymore, like smallpox and polio, right up into things like Covid and HIV, Hepatitis C. Another enormous victory for Medicine 2.0 in the last decade. What Medicine 2.0 has been largely unsuccessful in doing is treating the chronic diseases that still basically kill us all now. So, you know, if you're living in the developed world and you're not smoking, the probability you're going to die from heart disease, cancer, neurodegenerative disease, frankly, if you are smoking, all that is true as well. It's just the odds shift a little bit in which one, you know, there's about an 85% chance you're going to die from, from one of these horsemen of chronic diseases. And truthfully, medicine 2.0 hasn't done a great job of that. We've, we've extended life a little bit. In other words, we live longer with those diseases, but we, we certainly don't live longer without them and demonstrably don't live much better either.

That. I think that's so true. And I love, you know, this, this show is a lot about founders and entrepreneurs. And in some ways, I really see you as like your own entrepreneur and kind of the forefront of thinking through what new advances need to happen to really help people get beyond medicine. Medicine 2.0, it's kind of how I see it. And I'm not going to talk about longevity, but I think what distinguishes you from the charlatans is your framework. So I'd love it if you'd maybe talk about your framework and for overall health and longevity.

Well, you know, it's funny, I have so many frameworks. That's one thing that is. It's part of, it's sort of in my DNA, I think, is I love having a framework for everything. But it starts with just understanding what longevity is. Right. Longevity is. You could think of it as kind of the dot product between lifespan and health span. You can think of it as the, you know, graphically I represent it as a curve that shows lifespan on the x axis and health span, quality of life on the y axis. And so there's a longevity curve. And as we move to the right, I. E. As time increases, our health span declines, and we also move closer to our point of no lifespan. So understanding what makes these two things is pretty important, right? So. So the lifespan thing is generally harder, pardon me, is easier to understand because it's so binary. It's. It's absolute. You're either alive or you're dead. And therefore, the lifespan arm of longevity involves delaying the onset of the things that kill us or avoiding those things that kill us acutely, such as motor vehicle accidents, something that I don't think we think a lot about, but it is actually a surprisingly high cause of death, as is falling. If you're over the age of about 60 or 65, that starts to become a staggering cause for mortality, both acutely and chronically, meaning, acutely, when you fall, you can. You can die, but even within the first year after a fall. The big ones, of course, however, are atherosclerotic cardiovascular disease, cancer, neurodegenerative disease. These. These really account for the vast majority of lives lost. On the healthspan side, we see much less of a relationship to age when it comes to one of the three things that make it up, which is emotional health, but a very strong tie to age with the two others. So cognitive health, physical or skeletal health, and emotional health are the three things that define healthspan, and they are obviously not binary. These are quite analog, and they, you know, generally stay pretty robust until you're in your fourth or fifth decade. And then those two age dependent ones, cognitive and physical capacity, begin to decline. And then emotional health is actually a bit of a wild card. There are some people for whom it's always an issue. It's never an issue. It gets better with age, gets worse with age. That. That one's less coupled to age, but no less important in the grand scheme of things. In other words, you know, there's no point living longer if you're miserable. So even if just one thing is out of whack, the whole system kind of falters.

Yeah. You know, your point about, you know, cognitive health and muscular health, like I was. I think that was my big insight when I first started being familiar with your work. The idea that everything's going along and you take a lot of things for granted and then something happens, and I guess it's just simply aging, and it's age 65 or age 70 or 75. And I think people aren't thinking about that, but could you maybe share, like, why they should be thinking about that? I mean, what does happen in sort of those latter years?

This is a problem I spend a lot of time thinking about, maybe even too much, actually. I think there are times when it might be at my detriment because I spend so much time thinking about the last decade of life. But when you spend a lot of time observing people in the last decade of your life, you realize that what's most debilitating is not that they are at the end of their life. In other words, it's not the knowledge that in eight years they won't be respiring. It's their actual quality of life in that moment. So that last decade of life we call. We have a term for that. We call it the marginal decade. So that last decade of life, which everyone is going to have a marginal decade. And while you rarely know the date you enter it, you invariably know it when you're in it. What people suffer from most there is usually not the disease, but the symptom. It's the frailty, it's the lower back pain, it's the immobility, it's the lack of stamina, it's the inability to get up off the floor, it's the inability to pick a grandkid up out of a crib, it's the inability to remember what you used to remember or converse. If we're talking about something that's, you know, marching you along the path towards dementia. But it's really quality of life that is the biggest issue, not length of life. And I don't think, again, going Back to medicine 2.0, you know, the current definition of health span is the freedom of time in which you are free from disability and disease. And I find that to be a very unhelpful definition. It's simply too crude. Right? I mean, I'm as free from disability and disease today as I was when I was 20. Now I'm 50. But there's no question my health span is compromised relative to where I was 20 years ago or 30 years ago. And it's possible that in 20 years I will still be as free from disease and disability as I am today. But there's no question I will have less strength, less stamina, probably more aches and pains. And so I just think we need a tighter definition of health span, and that really enables us to have objectives that we pursue in that final decade. And of course, if the final decade is remarkable. Everything before it is as well.

Yeah. Oh, that's a great point, actually. That's right. If you keep going for that remarkable last decade, by definition, you're going to have remarkable decades and sort of healthy decades leading up to that. And I would just say, you know, Peter, the reason I really, I think, got lit up by your work was when you shared this, this concept of the centenarian decathlon. And I was like, oh, I get that. As especially specifically as I regularly put my own suitcase in the overhead compartment of the, you know, of the airplane, like all the time. And the men will always say, oh, can I help you? And I say, no, no, no. I train every day for this. Thank you. I got it. So could you maybe share with the listeners what the centenarian decathlon is, maybe at how you came up with that insight? And then I'm going to also ask you how you walk people through clarifying their own sport, their own decathlon.

You know, how I came up with it is actually kind of a confluence of events. One not so sad and one kind of sad, frankly. So it was in, basically, in 2015, I stopped competing in some sport for the first time in my life. So basically I had always been doing something competitive and it was swimming or cycling or whatever. But basically in 2015, I, you know, just sort of decided I had way too much going on in my life. You know, I, at that point had my second child and I was working two jobs and, you know, just insanely busy and, you know, training 20 hours a week to be a competitive cyclist was no longer in the cards. So I, for the first time, found myself not really having a goal with respect to exercise. So I exercised, but I didn't train. And there's a distinction. Anybody who's trained knows the difference. So just park that on the side for a moment and fast forward to 2018 or so. I'm at the funeral of a close friend for, for this, for. For her, for her mom. And I hadn't seen her mom in a while, but the last time I saw her, everything seemed remarkable, which was more than a decade earlier. And here I was now getting kind of a catch up on everything that had been happening in the interim. And what became abundantly clear to me was the last decade of her life was really unpleasant. All the things that she used to love to do, tending to the garden, playing golf, playing with grandkids, were basically no longer things she could do, mostly due to physical frailty, less due to cognitive. Now, at the very End of life cognition also became an issue in the last year. And I think I, I mean, I literally was just sort of sitting there in the pew thinking this is what we need to be training for. Like I've been training, I've been exercising aimlessly for the past three years. And yeah, I'm still fit, but I don't have a purpose. And I need a purpose. And I think I want this to be my purpose. I want my purpose to be what does 80 or 85 year old Peter look like? And the more I thought about it, I realized I need to train kind of like a decathlete does. Because as people might know who watch the Olympics and things like that, or track and field, you know, the decathlete, while generally regarded as the greatest athlete in the world, that's the title that's bestowed upon them, are not the best at any one thing, but they're very good at many things. And I thought that's actually what life is, right? Life is being a generalist in terms of physical capacity. But that requires training with specificity. So we don't want to confuse the fact that the decathlete has this huge breadth of physical skill with the fact that they don't train with specificity. Oh no, they train with tremendous specificity, but they have to spread it out over a lot. And so over the course of a couple of years that, that really evolved into a model that then worked its way into my practice, which is I don't want to be the only one training for the centenarian decathlon. I think this has become a mental model now that we will use with all of our patients, by the way, most of whom are like I was, which is if they're exercising, they're not really training for something. They're just exercising because exercise is good for you. But how do we create specificity around that? Which by the way, sometimes means getting rid of certain exercises that might actually be long term harmful.

Oh, I didn't really think of that. That's so interesting. I mean I, and I've heard you talk about this notion of, I think what, what you've borrowed from Annie do called back casting could and maybe I'll just share a little anecdote. Also I have a friend, I saw her out in California a few, just a few months ago and she said, yeah, I was talking to my doctor and we take these five or six mile hikes every now and again, da, da, da. And he said, you know, there's going to be a time if you don't like train, if you don't work out that you're suddenly not going to be able to do those five or six mile hikes, it's just going to sort of happen. And so what I love about your model is you've actually really primed people to think about what do you want to do when you're 80 or you're 90 or even kind of on the way. So could you really talk about your process for walking people through thinking about that last decade?

So it starts by being very clear and very specific about what you want to do in that last decade. And we have found that it's very difficult to ask people that as an open ended question because, you know, in reality, I think most people only have a vague sense of what they want. They have a better sense of what they don't want. But we think it's actually easier to give people a menu. And we, so we do. We have a menu that has a little over 50 items on it and they're, they go through it and they check it off.

What are some examples?

Well, I've mentioned a couple. Do you want to be able to sit on the floor for 30 minutes? Do you want to be able to get up off the floor on your own? Do you want to be able to pick up a child who weighs 30 pounds from the ground? What about a child out of a crib? Do you want to be able to walk 1 mile in an hour, 2 miles in an hour, 3 miles in an hour? Do you want to be able to walk up an incline? Do you want to be able to hike on uneven terrain? Do you want to be able to get out of a swimming pool without steps, I. E. Lift yourself up out of the pool? I mean, it goes on and on and on and on. Do you want to be able to open a jar? Do you want to be able to have sex? I mean, it just keeps, it's an endless list. It's probably got 80 items on it now that I think about it. And then we say, do you layer anything on top of that that is really unique and specific to you? So for example, there were things on my centenarian decathlon list. And oh, by the way, I should say, even though we call it the centenarian decathlon, you're allowed to have many more than 10 items on it. So that's, there's, you know, again, it's just another model here. Yeah, thank you. But there are several things on my list that I don't think I know a single patient of mine. Who has on their list, you know, archery is something I love, so to be able to pull back a 50 pound compound bow is on my list. Even though that's probably not something most people would care to do. Being able to drive a race car at about within 5 to 8% of how fast I can drive one now is something I would like to do. Again, Paul Newman was able to do that into his 80s, so that's something I want to be able to do. So, so. And again, like, let's say you're, you know, a ballroom dancer. You might say, look, I still want to be able to dance 30 minutes doing this type of dance twice a week. You again, not something I'm going to pick, but it might be very special and specific to you. So you have to come up with this list and you have to really scrutinize it. And then you have to sort of like, are you willing to fight for this? Because I've never met a person who's done this exercise who is nearly fit enough today to do what is going to be necessary to do that tomorrow. So before you go any further, you really push them. Are you sure you want to do that? Are you sure you want to do that? Do you want to dial that back? Do you want to. Nope. Once they've settled in on it, you then say, okay, let's go through what is required to do your list and let's break it down into its constitutive elements. So, for example, how high a VO2 max do you need to do that hike? And the answer might come back as it needs to be about 28 mils per minute per kilogram.

Okay, I want to interrupt you for one quick second because people are not going to really know what VO2 max is or that measurement. So it's really a measurement of cardiovascular fitness, is that right?

That's right. It's, it's. It's probably the most important measurement we have of peak aerobic capacity. So this is a test anybody can get done. It probably costs a couple hundred bucks. You can go to any, you know, the places all over the place will do this test for you. They'll put you on a bike or a treadmill and they're exercise you to failure. And they'll determine this number. And this number, by the way, is more highly correlated with longevity than any other number we have. In fact, it's more highly correlated with longevity than any other factor I can think of. Perhaps with the exception of having centenarian relatives, if you yourself reach the age of about 60 or 65. But when you think about things like smoking, high blood pressure, you know, diabetes, all those things, this is still more predictive of a good outcome than those are predictive of a bad outcome. So nevertheless, if a person has, you know, if a person tells you what you want to do, you can tell them it requires this much strength, this much stamina, this much peak aerobic, you know, et cetera, et cetera. And we also know how much those parameters decline by year or by decade. So if a person is saying, I want to be able to do X, Y and Z when I'm presumably 85, you have to draw a line in the sand somewhere and assume how old you'll be in that last decade. But let's just say, okay, 85 to 90. This is the backcasting part. You now wind it back and say, well, you're 50 today. Given the rates of decline, you need to be here today if you want to be here tomorrow. Are you almost without exception, the answer is not even close. So even though you're higher today than what is needed to do those things today, you're nowhere near high enough when you factor in the decline that you're going to experience. And so now we have to begin training you for that. We have to train you to get your glider high enough to fight the inevitable gravitational pull of aging. And this is really relentlessly focused on healthspan, right? These are. These are real health span targets. But you get a lot of lifespan benefits along the way because exercise, as you can probably relate to, is the single most potent thing we have at our disposal to reduce our risk of death.

And that's where you. I mean, what you just said is so beautifully. It beautifully illustrates the specificity that you're talking about. You know, there is a specificity you have to target to either go play with your grandchild when you're 85, or walk and carry groceries, you know, at 85. And the specificity has to do with the amount of strength and also aerobic capacity that you need to get there and starting now so that you, as you decline, you still are able to take on that. That kind of. That burden, if you will. That physical burden. Exactly. Yeah. I love that. I think that's so inspiring, and I think it's especially important for people at all ages. And I'm talking to you, my listeners, you younger people who aren't realizing that this is important and you're giving away your health and trading health for wealth. So that kind of brings us to the book this beautiful big book called Outlive. I guess I am certainly wanting to know, with all the things that you do, you have your podcast, you have your practice. Why did you decide to write the book?

Well, I started to write the book actually two years before I launched the podcast. So the podcast launched in the summer of 18. This book started in earnest. You know, I guess I had my first contract to write it in probably the summer of 16 or maybe even earlier than that. So in that sense, it's sort of weird. But the book long predated the podcast. I think, if I'm being brutally honest, if I had, if I were where the podcast is now, I don't know that I ever would have done this, but I'm glad I did it. In other words, there is something that you can do in a book that you can't do in a podcast. And I think that while writing this book was much harder than I expected, and it basically got written and rewritten three times. It is an opportunity to put all in one place. A very comprehensive look at how I think about this problem and in a way that I think can function a little bit more as a both guide to thought and guide to action. And I think you. You sort of need a bit of both. Right. I. I think as you probably recall in the book, I kind of rail against the notion of just tactics. Tactics. Tactics, Right. The tell me what to do, tell me what to do, tell me what to do. And instead kind of focus a little bit on, well, I will tell you what to do, broadly speaking, but once you understand why you need to do those things, because the what to do is going to change. I mean, we have to understand by necessity, science makes progress, this stuff advances over time, and therefore the exact details of these tactics will likely change over time. But the underlying principles, the strategic part of this is much more likely to stay true, and therefore, understanding that will enable you to adjust tactics in the presence of new information.

That's very well said. Can you give an example, like one example of strategic principle that you need to understand as a foundation that would be, you know, would remain constant despite what tactics might change?

Yes. I think, you know, one of the most important strategic pillars of. I've already alluded to it, actually, of living longer, is the importance of living longer without disease, not living longer with disease. So there's. There's really two ways to think about this problem. And medicine 2.0 has made it abundantly clear that we intervene once disease is present. And all of our treatments are geared towards Prolonging the period of time you have with disease. Now, obviously on the margin, there are exceptions to that, right? Like yes, I think we do take great steps to try to prevent cardiovascular disease by controlling blood pressure and cholesterol. But I argue not nearly enough. Right. I would argue, for example, that in the case of cardiovascular disease, the current treatment guidelines are to treat when 10 year risk of major adverse cardiac event exceeds about 5%. And by the very manner in which these risks are calculated, that basically means you would never treat anybody below 40 outside of the most extreme situation. But given that atherosclerosis begins effectively when we're kids, it means you have to take a much longer view. In fact, there's a completely different view I would add, which is you don't treat time based risk horizons, you treat causative risk factors. So again, that's a strategic difference, right? So you don't tell a smoker to wait until their risk of lung cancer is 5% to stop smoking. You tell them to stop smoking the minute they put a cigarette in their mouth. Because we know smoking is causally related to cancer. This is a totally different approach. So in the case of atherosclerosis, you lower apob, regardless of the long term risk because APOB is causal in the development of atherosclerosis. Not that we want to get down that deep rabbit hole, but that, but it sounds like a very subtle distinction, but it's actually not. It's philosophically quite distinct.

Oh yeah, I don't think it sounds subtle at all. I think that's exactly right. Your, your, your analogy with smoking, I think is so powerful and exactly right on. And you know, it is a big book. You know, I read a cover to cover. I'm not sure if everyone's going to read a cover to cover immediately. Where do people start?

Well, I hope they start with chapter one, truthfully, because it's laid out in three parts. Right. And the first part is the shortest, but it sets the stage for the frameworks. The frameworks are laid out in part one. Part two is giving you the background on the adversaries. Right. This is where you really get a deep understanding of the, the horsemen of death. And then the, and then the longest part is part three, which is really about the tactics. That's the deep dive on nutrition and exercise, sleep, et cetera.

Yep, I love it. That's great. And then one thing you touch on and in a very personal way is something we talked about earlier, emotional health. And you talk in the book very movingly about your own, you know, mental health challenges and kind of what that was. Like many founders, I should just say founders and entrepreneurs are 30% more likely to experience mental health challenges, anxiety, depression, panic disorders, those kinds of things than their counterparts. So this is a very relevant topic for a lot of people, certainly for entrepreneurs. And I would. I would love it if you wouldn't mind sharing, you know, sort of what it was like to recognize that you had your own emotional health to take care of that to take care of and what that was like and what you did about that.

Well, it wasn't pleasant. I mean, I think, you know, probably, maybe. Maybe anybody else who's been through these things can relate to. I think it's a lot of the times we don't act until we don't have much of a choice. I would say that when I think back to all of the negative things that shaped my life, I don't know that I would change any of them because they've made me who I am, and I'm fully happy to have the good with the bad in who I am today. My only real regret is how long it took to address the challenges and what the collateral damage was in that time period. What would have happened if I could have addressed this 20 years sooner than I did? How many fewer people, how many fewer injuries would have been suffered by others, let alone myself? So I can't beat myself up about that because I think you sort of have to say you're only ready to change when you're ready to change. And that point for some people never comes. I think for some people, that point comes relatively easily. And then there's probably someone like me for whom it takes a lot to finally hit whatever your rock bottom is going to be. Anyway, I'm just glad it happened in the first half of my life.

Yeah, yeah, I hear you. Some of us have to get hit over the head, I think, for sure. What advice do you have for other people? Just as they kind of hear the knocking and then maybe the more insistent knocking, you know, before they get hit over the head. Do you have advice for people about how to think about their own emotional health challenges and how to focus on them?

Such an important question. Yeah, it's such. Such important question. And it's really something that I spend a lot of time talking about this with patients because, you know, we. We do care about our patients completely. Right. It's not just how long you're living and what your VO2 max is and how low your lipids are, but. But for our patients in whom we sense or who are willing to share with us that they're, you know, their relationships are, are, are in tatters or that they're, you know, struggling with addictions or things like that. The only, the only thing I can sort of say is if, if, if, if, if you're not in some form, if you're not kind of in peace right now, why would you want to stretch this out? Right? And, and I think ultimately for me, that argument, and I don't know that that argument makes sense for everyone, but I think for a number of people, if you're in the space of saying I'm trying to improve my health, but yet you can't take care of this one issue or at least look into it, you're basically just extending misery. And that on first principles just doesn't seem like a great idea. But again, I want to be thoughtful about it and realize that that doesn't necessarily mean the same to everybody. And for many people it's very hard to get to the point where you say you need help and, or help is possible, change is possible. I also think that's a big obstacle. I think there's a misconception out there that I certainly felt that was some of my resistance to change, which was, hey, the, I wasn't so delusional to think I was perfect, but I thought that the downside of my problems was well worth the upside. And the upside was the drive, the discipline, the motivation, the perfectionism and those things I had achieved a lot on the back of those things. So it seemed that the collateral damage they were yielding was totally worth it. I don't think that's right. I actually don't think that's true. I don't think you have to give up in its entirety the good to address the bad.

That's very well said. I think that a lot of entrepreneurs and leaders I work with are very self critical and they would see that there's this so called upside of my self criticism, which is I really push myself hard and there is a cost to that. And then one could make the case, well, maybe actually if you had more perspective and could be kinder to yourself, you could get even further, in a sense. And so testing out, by the way, it's scary to test out that theory. If you sort of assume that your self criticism is what's being, you know, making you successful, or your, you know, your, your, your perfectionism, as you said, is making you successful, then it's hard to give that up.

Yeah. And it's funny, I had a therapist who went so far as to say, I think there's a good chance that you will, from this point on, maybe not be as outwardly successful as the trajectory you might have been on, but I would argue it's still worth it. And here are the reasons why. And so, in other words, and I don't know if that's true or not, but I actually went into this at the end, finally accepting that, yeah, that's probably right, I'd rather be 7, 10, the person I could be but not be in misery 24, 7, and basically a wrecking ball in everybody's life.

Yeah, I think it's a good bargain. It's a good bargain. You know, my last sort of, you know, category, I think, of questions is we talked about the idea of doing a little case study. So I work with a lot of founders. I'm going to give you a typical founder scenario, and I'd love to know maybe what your advice to this founder is. So we have an entrepreneur. Let's say it's a he. It's a male. He's 35 years old. Let's just say he's in fine health, but he really hasn't been to the doctor since he left his pediatrician at age 18. So who knows? He works all the time because that's what founders do. He's on a plane all the time seeing customers, seeing investors. Let's say, like, he doesn't really get much exercise, but plays soccer on the weekends sometimes when he's home with friends, has a few close friends, and is definitely on the emotional roller coaster of a founder. So he's, you know, used to be real thin, let's say now he's starting to gain some weight. What would you say to this person and what kind of advice is a starting point? Knowing this person is not by nature obsessed with health and also doesn't have much time.

So, you know, I never try to impose on other people anything. In fact, we make it so hard for people to get into our practice for this reason. Right. Like we. The hoops that someone has to jump through to get into our practice is the goal is to make 90% of people walk away in the process, and it's pretty successful. So I guess for this hypothetical situation, I would say if I found myself sitting with this person, an airplane, and the conversation came up, I guess I would just start by asking him, you know, what is? What is? You know, I'd start with, what do you want the last decade of your Life to be like. And I, I would really work from that angle. Right. And, and so if that person. And, and by the way, there's a really good chance that that person says, I don't know, I don't care, I'm not thinking about that. But like, I gotta close the series A in two months and our competitor is doing this and da, da, da, da. And I think, to be honest with you, I would say, good, go and do that. Like, that's, I mean, I think you have to be realistic in a situation like this. So again, to make the question more interesting, to make my answer more interesting, let's assume that this was a long enough flight and he was in an introspective enough mood and he came back and said, you know, I would hope that by that point, you know, I've, I've got kids and maybe grandkids and that I've done really well in business and I'm enjoying the fruits of that. Okay, so if you land there, then I would say, great, then what do you need to do now to minimize the damage or offset the damage that you're enduring in, in pursuit of this goal? Because let's be honest, what you're doing is not what we were physiologically meant to be doing. There's nothing about working 80 hours a week living on airplanes, shuttling across time zones, eating crap, drinking alcohol. None of that stuff is in our best interest. And rather than sort of bust your chops and say, stop all that now, go be a monk. I'm going to say, how much time are you willing to put into damage control now such that let's say when you have your exit in five years, you can get a little bit more serious about your health. And I would take whatever he gave me in terms of time, and I would say, how are we going to allocate that into the amount of additional sleep you need and the amount of exercise you need to do and maybe the amount of, you know, thinking you need to do around food. Although food doesn't tend to be more of a time issue. That tends to be more of a, you know, kind of a behavior issue. Right. But the two big time sucks are really exercise and sleep. And so again, based on what he's doing now and based on what he's willing to do, I would work with him and, you know, sort of think through that.

So let's say five hours. He's willing to give you five hours. How would you roughly do something?

Well, let's assume, just for argument's sake, that Two more hours of sleep a week would get him good. Right? So, so would get him good enough because I'd really want to try to get him to at least seven hours a night of sleep. There's an enormous drop off in performance that happens below that. Despite what people. There's a lot of people who think, oh, no, no, no, I need six hours a night, I'm totally fine. No, you might be tolerating six hours per night, but you are absolutely not thriving. So let's just make the math easy and say we'd use two of our five hours to bolster his sleep and then that gives him three hours to exercise outside of what he's doing on the weekends. So on the weekends he's playing soccer and that's great. But I would say, look, if during those, during the three hours of the week, you could do 90 minutes, you could do three one hour workouts and we could structure, oh, I don't know, I might have him do two of them as strength training and one of them as a dedicated modest intensity cardio. And then we're basically using his soccer as high intensity cardio. I would take that and say that that would be a great starting place, a great start.

And then hopefully sow the seeds with the conversation that you had. Sow the seeds for the future.

Right. And just remind him that health is a lot like wealth. Right. It really compounds. So it's hard to make exceptional gains quickly in that sense. It's not like having a startup. And by the way, when you have an enormous uptick in value of a startup, it's still compounded. You just didn't see it. Right. I mean, you know, the IPO happens on one day and that's the generational wealth you might generate. But the reality of it is you still had to build that thing day after day after day over whatever period of time. So health requires the same thing. Now, just like you can lose all of your wealth in a day, you can lose all of your health in a day. So it is asymmetric in that regard. But we're going to focus on the upside of this and say you've got to compound little bit by little bit every day. So it's also just kind of about developing the habits. It's going to be a lot easier when you're 40 to turn up the dial of what you do if you're not starting from zero and if you've already built a set of routines and habits around exercise.

And so I love it. Yeah, habits, routines and mindsets. Kind of probably. I love that. Peter, one last question. What do you wish you had known earlier on your journey?

Well, I mean, look, I think for me personally it's very hard to think of anything outside of kind of some of the emotional health stuff when it comes to that. I think that that's, again, that's. If I could go back and change anything, that's probably what I would do, is sort of figure out a way to have dealt with these issues much sooner in life and spare myself and the people closest to me some of that agony. That's probably the thing I would have done the most.

Yep. I appreciate that, Peter. Thank you for being with me today. I want to tell everybody to pick up this book, outlive. It's fantastic. Check out Peter's podcast. It's called the Drive. It's fantastic. Peter, you've really affected my life very personally and I just want you to know I really appreciate it and I appreciate you being here today.

Alyssa, thank you very much. I really appreciate it. And thank you for the kind words.

Thanks for listening to From Startup to Grown Up.

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