1045 Key Health Habits to Live Over 100 & Prevent Chronic Diseases w/Peter Attia

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Most people are saying, I would love it if I could live a little bit longer. And that's called lifespan, living longer and extending life. But I'm more interested in extending my health span, which is the quality of my life.

Welcome to the School of Greatness. My name is Lewis Howes, a former pro athlete turned lifestyle entrepreneur. And each week we bring you an inspiring person or message to help you discover how to unlock your inner greatness. Thanks for spending some time with me today. Now let the class begin. This is episode number 1045 with Dr. Peter Attia. Buddha said, To keep the body in good health is a duty, otherwise we shall not be able to keep the mind strong and clear. And Tony Robbins said, the human body is the best picture of the human soul. Ooh, I am excited about this one. My guest today is Dr. Peter Attia and Peter focuses on the applied science of longevity, the extension of human life and overall well-being. Peter trained for five years at the Johns Hopkins Hospital in general surgery where he was the recipient of several presigious awards, including Resident of the Year. And he spent the last few years being mentored by the top medical scientists and now hosts the Drive, a weekly deep dive podcast focusing on maximizing longevity and all that goes into that from physical to cognitive to emotional health. And our conversation was fascinating that I decided to split it up in two episodes. So this first episode is gonna blow you away. We talk about which chronic diseases are killing people the most, and this is gonna shock you. How How our approach to medicine is so wrong. How type 2 diabetes affects our health and so many people. The four huge factors of type 2 diabetes. How to reverse type 2 diabetes. Then this is big. The four key pillars of being a kick-ass 100-year-old. This is a powerful section. What the three main pieces of our health span are. How important sleep is for longevity. Most of you don't sleep enough. and you're not going to live long enough the way you truly want to, and what habits we should be creating at night to sleep better. This is going to blow you away. I was fascinated. I did not want this to stop. That's why you've got to check out part two coming very soon. And share this with someone who needs to hear it. This can truly impact, empower and help someone's health in such a profound way if they listen to this. Send them to lewishouse.com/1045. we'll just copy and paste the link wherever you're listening to this right now. And make sure to click that subscribe button on Apple podcast right now so you can stay up to date to all the greatest inspiration in the world on the School of Greatness. Okay, in just a moment, the one and only Peter Attia. Welcome back, everyone, to School of Greatness podcast. Very excited about our guest. his name is Peter Attia. I'm super excited you're here. Been wanting to have you on for a while. And you are extremely highly respected in the community of nutrition, learning about diabetes, weight loss, about extending life, having higher quality of life. So I'm very grateful that you're here.

Thanks for having me, Louis.

And we were talking offline for a second about what you think is the most interesting for people right now in terms of longevity, in terms of extending life and extending the quality of life, which I think is a hot topic right now that everyone wants to, people are afraid to die and people don't want to be sick. And you mentioned something interesting about the impact of emotional and mental health in terms of longevity. So I'm curious if we could start there about how important is mental health for our length of living and the quality of our life. And what can we do to increase the quality of our mental health?

I think it's something that has been so ignored typically by medicine. And I think part of it has to do with just the stigma that's associated with mental health. And that can be depression in a formal sense where we have a diagnosis of depression or mania, hypomania, bipolar, schizophrenia, all these things that sort of get labeled by a diagnostic criteria. But frankly, I think it goes much broader than that. It basically comes down to how well do we all cope with distress? Because life is stressful. and whether it's really big stress like loss of job due to COVID or loss of a spouse or divorce, or just frankly the day in and day out kind of grind of life, the tools that we have to cope with that distress and maintain kind of a buffer within which we function really determines so much of the quality of our life. And when people come to me as patients, Most of them are paradoxically not saying the silly things you might expect, which is, I want to live forever. I'm in pursuit of immortality. No, I think most people are saying, I would love it if I could live a little bit longer, and that's called lifespan, living longer and extending life. But I'm more interested in extending my health span, which is the quality of my life. And so to that end, health span has three pieces, right? cognitive piece. So how well does your brain work as you age? And we could talk about what makes up cognition. Then there's the physical piece. So, you know, basically what we think of as the exoskeleton, right? So your bone, mineral density, your muscle mass, function, ability to move, freedom from pain, all of those things. And then of course, this third piece, which we just talked about, which is the emotional resilience and the ability to maintain a tolerance around distress. And again, those three things to my mind sort of form the boundaries of quality of life. When any of those are lacking, even in the absence of disease, right? You could have no imminent death on your doorstep, but if your cognition is sliding, if your physical body is breaking down through injury, or if you're just emotionally unwell, It doesn't seem to matter that much.

It's not a high quality of life if one of the three is off. And if all three are off, you might be in a completely depressed state in physical pain. It will have some mental challenges and you're just like, what's the point of even being here?

Yeah, you could even go further and say most people, when they think of death, think of what we call cardiopulmonary death. or what I'm calling death certificate death. So and so died of a heart attack. So and so died from breast cancer. So and so died from in a car accident. And all of those things, basically your heart and your lungs stop working and you're dead and that's the end of it. But most people actually, and I can't give you a stat because I think this is more sort of more of a heuristic, but probably 80% of people have actually died one of the other deaths before they die a cardiopulmonary death. So they've either died a cognitive death, which is to say their minds have become so dull that they're really not able to be the people they wanted to be. Their body has broken down so much that the things that once gave them so much joy, whether it even be the ability to play sports, ski, golf, whatever it is that they love, play with their grandkids, they're deprived of those things. or emotionally, you know, they've become despondent, they've become depressed, they've become secluded in a way that has basically robbed them of joy. So, so, so you sort of reach one of these other types of death that precludes the cardiopulmonary death certificate death. Right. And to me, we want to minimize that gap. Right. We would like it such that, you know, when you die, it's really your first encounter with death of any form. Right.

I think when I talked to David Sinclair about this, he said, the key is not to extend life and be in pain for 20, 30 years of suffering. He's like, the ultimate way would be to live till 100, 105, whatever it may be, and then die quickly. Like, have something suddenly fail and then don't try to extend that with a lot of pain and suffering for 20 years, but die within the next couple weeks and actually it'd be rapid is what he's mentioning is kind of like where you extend the quality of health span as long as you can, and then you have a short window of pain, suffering or whatever may happen until the body then shuts down. He says that would be the ultimate way to live and die as opposed to.

And I agree with that.

Yeah.

Yeah, I completely agree. And, and unfortunately, if we Embrace that, that is optimal. And I've yet to meet a person who doesn't feel that way, right? Like I've never met a person who says, no, no, no, no. I want to suffer as long as possible. Yeah.

Hook me up to the machines, baby. Keep me up.

So if you accept what David, me and 4,000 other people would argue, then you have to ask the question, why is medicine practiced the way it's medicine, the way it's practiced? Because let's think about medicine for a moment. Medicine says, We don't do anything until there's a problem, right? So the entire system of the way a diagnosis works, the way a diagnosis is attached to a set of symptoms, the way it is treated, the way it is billed for, and the infrastructure of healthcare delivery is all around waiting until there is a problem, treating that problem, and basically doing better and better at treating chronic disease. And I don't want to suggest that we have not done a good job of that. So if you go back in time 60 years, your likelihood of dying from your first heart attack was well over 50%. In other words, somebody shows up with a heart attack. And by the way, for men, two-thirds of those were going to occur before the age of 65. So you show up with your first heart attack, at that time you probably had a 70-80% chance of dying on first presentation. Well, today thanks to emergency medical care, stents, blood thinners, all sorts of other things we have going, lots of medications. That's no longer the case. I mean, we can keep people alive for unbelievable periods of time. We have things like dialysis, we can do organ transplantation. We can do so many things that do indeed extend life in a chronic sense. And I'm not suggesting that we shouldn't do those things. It's just that when most of us finish medical school, we haven't got the foggiest clue on how you would tackle the problem the way, say, David explained it. There's no system in place to say that because if you really believe in that system, you have to figure out how to prevent disease, not treat disease. They're not the same thing. Yeah.

What would you say is the main cause of chronic disease for most people?

Well, that's a tough question because, so you want to think of, there are basically three categories of chronic diseases. so we can break the big three down. And I actually think of chronic disease in four, but I'll explain why I'm talking about. I sort of think of them as the four horsemen of death, but it's sort of three pillars on a pedestal. Okay, so the big three are in order atherosclerotic disease. So that's vascular disease, meaning heart disease and stroke. So those two are the heavyweight champions of death. More people will die of those than anything else.

Yeah.

And that's been true for a hundred years and I don't suspect it's going to change that much. Wow.

Okay.

But not too far behind it is cancer. And then take a little step further and you reach neurodegenerative disease, of which Alzheimer's disease is far and away the most common and also also the most rapidly increasing. So again, you have heart disease and stroke, cancer, and then neurodegenerative disease. And we'll just talk about it through the lens of Alzheimer's disease, cuz that's the most common. Okay. And those three effectively make up three quarters of deaths of people who don't smoke. If you smoke, we will change the ratios a little bit and add chronic lung disease and a few other things.

Side note before you go on there, is vaping considered smoking?

I think it's a bit too soon to tell. It hasn't been around long enough for us to know if it behaves just like smoking did. Okay. So I think the precautionary principle needs to be in order there. Obviously, vaping is not identical to smoking, but you might be trading one known nasty thing for an unknown nasty thing. Right. So I think it's just, and you have to remember how long it took before the evidence implicating smoking became dispositive. I mean, that really took about 60 years. So, you know, I just, personally, it's not something I would think of as, you know, doing in abundance.

I gotcha.

So we got those big three diseases and then they rest on top of the fourth horseman, which is kind of the answer to your question, right? So there's one disease, which is not really thought of as a disease, but I think of it as a continuum. that is the foundation upon which all of those sit. So it is the one thing that makes all three of those worse. And in its most extreme state, it's type 2 diabetes. But that's a continuum that starts at hyperinsulinemia, so high levels of insulin, insulin resistance, non-alcoholic fatty liver disease, type 2 diabetes. So that's a spectrum that probably afflicts oh, a half, you know, easily one half of all Americans have type two diabetes. No, are on that spectrum I've just described. Yeah. Yeah.

The spectrum, including.

So are starting with elevated levels of insulin daily.

And they're talking about, like, daily, they have spikes of sugar spikes.

They would wake up with an insulin level that I would deem too high. And then anytime they eat something, their insulin is too high. That's the first step. And then that also turns into now what we call insulin resistance. And that's sort of, that's sort of a harbinger of insulin resistance, which means, boy, insulin resistance means your muscles don't do what they're supposed to do in the presence of glucose. So when a person eats glucose, which is basically any form of starchy carbohydrate, so anything, any carbohydrate that's not a vegetable, potatoes, rice, and this could be good carbohydrates that we all would think are reasonable, potatoes, you know, rice, something like that, and includes, of course, junk carbohydrates, you know, candy bars and stuff like that. your body is supposed to really easily be able to take that glucose and park it inside the muscle. And it's supposed to simultaneously tell your liver, hey, stop making so much glucose, because the liver is constantly making glucose to keep your brain happy, because your brain loves glucose and needs it. And so when a person becomes insulin resistance, both of those things start to break down. They can't put the glucose from their bloodstream into their muscles. and they can't tell their liver to stop making it. So both of those things result in glucose going up, and that is actually the definition of type two diabetes. And then somewhere in there, you also have this problem where you start accumulating fat in your liver. And that's, you know, so, so like I said, about 50% of the population is somewhere within that spectrum with about 10 to 12% being at the far end in, in that they have frank type two diabetes.

How do you know if you have type two diabetes? Like, I don't even know. How do you know? You probably don't know. Oh, I'm feeling symptoms. Or is it, you go to the doctor and they tell you, would there be symptoms that you would recognize, oh, this is something that's happening.

I should take a look at it. No, it's much more insidious than type one diabetes. And it's unfortunate that type one and type two diabetes share the word diabetes in their description because they're quite different diseases. So we'll put type one aside for a moment. But type two diabetes is a very clear diagnosis. but it's made by one number. And I don't think it's actually a particularly great definition, but the definition of type 2 diabetes is having a hemoglobin A1c, which I'll explain in a second, above 6.5%. So we've reduced the diagnosis of this to one simple laboratory test that most people would get every year. And what that number means is how much of your red blood cells are basically saturated with glucose. And once you get to a point where 6.5% of your red blood cells have been saturated with glucose, we would impute from that that you have an average blood glucose level above 140 milligrams per deciliter. And we would acknowledge that above that threshold you have type 2 diabetes. Historically, we diagnosed it by making people drink glucose and then timing, like looking at frequent, you know, sort of pre-defined time intervals, how high their glucose got, and we would make the diagnosis that way.

And what happens when we have type 2 diabetes? What actually happens to our bodies? Does this decrease our lifespan and the quality of our health span? Is it something that's manageable for a long time?

Yeah, it actually impairs everything. So unregulated diabetes, can be acutely fatal, of course. So if glucose levels get too high and they're unregulated, you could die from a hyperglycemic coma. You could have organ failure, things like that. Fortunately, that is almost unheard of. So acute death from diabetes, type 2, type 1 is a different story. From type 2 diabetes, almost unheard of. It's really the chronic death and the chronic damage Right. Of type 2 diabetes comes in two flavors, or I should say has two axes. There are two things that are driving it. All three of those diseases, by the way, that I mentioned have diabetes as either their first or second greatest risk factor.

The heart disease, cancer, and neurodegenerative disease.

So, I would say for heart disease, actually for heart disease, it would probably be the third biggest risk factor behind smoking and high blood pressure. For cancer, it would be the second biggest risk factor after smoking. And for Alzheimer's disease, it's a bit tricky because there's such a strong genetic component. But you might be able to make a case that once you normalize for genetics, it would be a toss-up between diabetes and vascular disease, which are themselves dependent as to the next biggest risk factor. So again, there's no disputing that diabetes is an unbelievable risk multiplier for Alzheimer's disease, for cancer, and for heart disease. And so now the question becomes, well, I mean, you could also ask, what else does it do? So, you know, it also leads to blindness, amputations, impotence, all sorts of things that might not shorten the length of your life, but would definitely impair the quality of your life.

Is there a way to reverse type 2 diabetes?

There is, and that's kind of the great news. you know, we can get into the semantics around curing versus reversing, but I actually like the term you used because it doesn't really force one to get into that semantics. I would say you can absolutely put type 2 diabetes into remission. And I've done this many times myself with patients, and there are many physicians who have done this. But it starts by acknowledging, you know, what the disease is. And it is a disease of carbohydrate intolerance.

You know that old saying. It's not what you say, it's how you say it.

I think that goes for how we live, too.

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There's no way around that.

So what does that mean? Essentially intolerance, meaning you've abused the use of eating so much carbohydrates that the body can no longer.

I would even tone it down from there. You know, Louis? No, I would just, I would just say, look, let's be unemotional about it. And let's say a person with type 2 diabetes has in some combination created a metabolic environment where the carbohydrate intake is exceeding the capacity for glucose disposal, the capacity to put glucose at work. Now, I think there are four huge things that factor into that. And the first job of the doctor is to figure out how to rank order them so you know what to work on.

Okay.

Okay. So the most obvious one, because you alluded to it, and I think it is the most obvious, is intake. How much glucose are you eating? So back when I was a marathon swimmer, I was swimming, I averaged about 28 hours a week in the water. So I'm like- you-'re burning calories.

You're burning.

Stop swimming.

Yeah.

But I was pre-diabetic.

Oh man.

Now how do you make sense of the fact that a guy that's in the water four hours a day on average, is pre-diabetic. I mean, it just shouldn't happen. And in looking back at my life, I think I had limitations on two of the four things we're going to talk about. But on the input side, I had this incorrect belief that I needed to be drinking sports drinks all day.

Sugar, sugar, sugar.

Sugar, sugar. I'm drinking Powerade and Gatorade like it's my job.

Gulping it, yes.

I don't get through a sprint swim practice without going through two liters of this crap. And then I'm drinking, you know, I'm drinking probably a liter an hour in the ocean and stuff like that. So you can have a problem on the input side. You are simply consuming too much of this stuff. You can have a problem on the output side, which means you do not have enough muscle or you do not have efficient enough mitochondria within the muscle to take up that glucose. That wasn't my problem. I actually at the time was you know, more muscular than I am now was obviously exercising far more than I am now. But for many patients, the lack of exercise is a really key issue when it comes to type two diabetes.

They're sedentary, they're not moving, and therefore their body is weak and it's, it takes.

They don't have a place to put the glucose. You have to have a place to park it. And there's only two places glucose can be stored, liver and muscle. And the liver is a very small supply, so. the more muscle you have, the more places you have to store glucose.

So the glucose cannot be stored in fat.

It can, but, and you don't want that to happen. So you can't get up acutely. Yes, and you can't do that acutely. So you, that's not something that can happen in, in an hour. So the only way you can acutely get rid of glucose is to put it into muscle or into the liver. And so that's why someone with type two diabetes gets glucose spikes. Yes, you're right. They eventually put that into fat. But in the third trimester, the liver.

Starts to break down quickly or yeah, okay.

Yeah.

Okay.

So what's the third thing? The third thing, which is getting more attention now, and I think this by the way was the second factor in my pre-diabetes is sleep disturbance. So, you know, most of my swimming, most of my swimming career kind of took place during my residency and shortly after, and obviously sleep deprivation Big part of, you know, surgical training. And even when I finished my residency, or I should say when I left my residency and went into, you know, working in consulting, I still sort of took the surgical ethos with me, which was, I'll sleep when I'm dead. And I was like, yeah, this is awesome. Like, I loved, I loved working, I love training. I just didn't, sleep was just such an aggravating thing to me. And I remember routinely I'd, come home from work, it would be 11 o'clock at night, I'd be up at 4:30 for a swim practice. That was life every day. And what we now realize, and this has been demonstrated so elegantly with some really clever, painful research, which is if you take subjects, normal subjects, and just sleep deprive them for two weeks to the tune of four hours a night. So that's pretty extreme, but only for two weeks. So if I just took 20 guys like you, and took them from eight hours a night to four hours a night for two weeks and then did these glucose tolerance tests. I could reduce your glucose disposal by 50%. I could basically within two weeks turn you into an almost diabetic by sleep depriving you. Yeah.

So reduce the ability to assimilate it into take that.

Yeah. Reduce the ability to clear glucose out of your circulation.

And if it's not cleared, then it turns into fat or it's surrounding your organs and it's making you weak.

It leads to higher levels of insulin, which I'll come back to in a moment. You asked a minute ago, how does this disease hurt you? Well, it hurts you through two vehicles. It hurts you through the high insulin, which causes one set of problems, and then the high glucose, which causes another set of problems. So, having horrible sleep, you know, and there are some people for whom this is, you know, unfortunately an occupational hazard. Right? So, you know, people who work night shifts, it's gonna be much harder to sleep during the day. You know, people who had dumb jobs like me in residency where, you know, you just don't get to sleep. So there are lots of people for whom this is an occupational hazard. And then frankly, there are, you know, there's the things that we're doing to ourselves. Too much time on electronics. You know, we know that, you know, sitting there looking at your phone, looking at social media until you go to bed is not good. Alcohol has a horrible impact on sleep. So, you know, not being thoughtful about the timing of alcohol, even the timing of meals. eating too late in the evening. So lots of things we do impair both the duration and quality of our sleep.

Before we get to number four, I want to add to this. What's the latest we should be eating before we sleep? How many hours before?

I think this is somewhat empirical, but it seems that about three hours is a pretty good gap. So I'm kind of an early to bed guy. So I like to be in bed by nine and absolutely no later than 10. And I'm kind of trying to be done by about six. which again, I can do that most nights. And if I, you know, maybe one night a week, I'm gonna be eating within an hour and a half of bed. But, but I clearly see a difference in the parameters that I pay attention to, like heart rate and heart rate variability and temperature overnight, because those things all move in the wrong direction with a meal.

If you eat a healthy meal, let's say an hour before bed, I'm talking about grains and lean meat and healthy stuff? Or if you eat pizza an hour before bed, are they both going to impact your ability to sleep better? Or is the quality of the food before you go to bed matter?

Yeah, that's a really good question. The short answer is, yeah, it does matter. So, probably the two things that would have the greatest determination would be the simplicity or glycemic, the simplicity of the carbohydrates or the glycemic load, because that's going to impact the sort of glycemic roller coaster you go on at night, and then probably the amount of protein because that has a greater contribution to what's called the thermogenic effect of food. So the thermogenic effect is how much does your body temperature actually rise to digest the food. Our bodies want to be very cold at night. So anything you do that opposes that leads to lousy sleep.

So what foods help you sleep better? that keep you colder. What are those foods? Whether it's an hour before or three hours before?

Yeah, I honestly, it's like almost anything you're gonna eat is gonna come with something that's gonna slightly raise your temperature. So I just generally say try to not eat too much before bed. And I go out of my way to avoid the two things that I think are worse. So I just say I wouldn't have huge protein before bed and I don't wanna have anything that's gonna raise my blood sugar before bed. so, you know, I'd have an avocado before bed. I'd have, you know, something that's like, you know, I just generally don't eat before bed.

The body really rewards you in terms of if you wait or if you don't eat right before bed, is it going to sleep better, sleep deeper, be cooler, and therefore help we help you have more energy the next day if you don't eat before bed?

Yeah. And this is at least for me been most easy to exhibit. And I think many of my patients would agree. during periods of fasting. So fasting is kind of a funky state because you're altering so many other things in the physiology. But one of the things that happens, especially by about the second day of a water only fast, is you really are seeing the impacts of what deep sleep can look like in a state that is totally absent food. And it's very interesting because you're competing with two forces. one that's keeping you awake and one that's helping you sleep a lot deeper. The one that's keeping you awake is cortisol. You have more of it, you have more stress hormones when you're fasting, because that's the thing from a prehistoric standpoint that would have been going on, right? Fasting would trigger a signal that says.

Go get more food, right?

Be alert, be focused, go get food, like we don't want to die. And so that's kind of keeping you awake. But the flip side of that is the total absence of nutrient is allowing you to get into this amazing sleep and your body temperature is really going down because your body's turning down its metabolism. So I actually find fasting sleep to be some of the most amazing physiology because I'm watching this plummeting temperature, rising heart rate variability, falling heart rate, all of these really valuable things, but a little bit of rising cortisol that can lead to shorter sleep times. But I still feel quite, you know, rejuvenated by sleep. Wow.

Okay. I want to stay asleep for a second. I knew you got the fourth one, which I want to close that loop.

But.

Does that hurt us if we nap throughout the day or take a power nap for 20 to 40 minutes? Does that help our bodies recover more even if we're doing the seven or eight hours of sleep? Or does that not matter?

You know, it depends. I would say naps are not a bad idea provided they don't reduce your drive to sleep so I just got back from like a, a hunting trip last month where just based, I mean, first of all, it was exhausting, right? You're sort of hiking 10 or 11 miles a day on vertical walls, you know, carrying a 50 pound pack. It's, it's all the stuff that is physiologically as taxing as it gets at altitude. Right. So, but there was no way you could go to bed like any earlier than 11 and you had to be up by 4 30.

Really?

Well, just because, you know, you have the most, the two times when you're going to have the best opportunity to go and stalk the animal is in the evening and in the morning. So those are the times. So, you know, there was no way I was going to survive a week of that if I didn't carve out an hour and a half to two hours in the middle of day and the day to sleep. And I'm normally not a napper, but I made it a priority above anything else, including practicing, you know, with my bow and arrow. in the middle of the day, which I would normally want to do, nothing was a higher priority than getting that nap in during the day because I was deficient at night and getting that nap in the day didn't rob me of the ability to sleep at night.

You still were passing out right when you got in your pillow.

Absolutely. Now let's say we talk about a person who is getting seven and a half or eight hours of quality sleep at night. Is there any downside to a 20-minute power nap? I would say no. But if going any longer than that, I would be mindful of it. Because sleep comes down to balancing basically three things. The first is cortisol. The stress hormone cortisol must decline in the evening for you to be able to sleep. The second thing is you have to accumulate something called adenosine. Adenosine is like this metabolic breakdown product that corresponds to how much work we do physical work, cognitive work. So more adenosine makes us more tired. That's how caffeine works, by the way. Caffeine blocks the adenosine receptor, so it functionally makes you think you have less adenosine and napping reduces adenosine. So you just want to make sure you don't reduce it too much. The third is melatonin, by the way, which has to go up. So good sleep is when melatonin and adenosine go up and cortisol comes down. So, I guess to close that out, I would say if you are sleeping so short during the middle of the day, and this is what I was thinking about on my trip, you want to try to replicate a full sleep cycle in your nap, which is about 90 minutes. So that's why I really said, look, I'm going to set aside two hours to take a nap in the middle of the day to get to give me one full sleep cycle because I'm clearly being deprived of one during the nighttime.

And is there such a thing as too much sleep? If you're getting 10, 12, 14 hours of sleep every day consistently, does that affect the body in a negative way?

Really an interesting question, by the way, and quite a controversial question in the sleep literature. So there is no question that hyper sleep has been associated with poor outcomes. So, you know, there's a inverse U, or sorry, a U-shaped curve of mortality with sleep, right? So people who don't get much sleep have a higher mortality. And it's really more of a J curve, right? So they kind of, you know, as you get more and more sleep, the mortality comes down, down, down. But then it does sort of uptick. So you get these people who are sleeping a lot and they're actually having worse outcomes than the people that are in the seven and a half to nine range. Historically, that has been explained by the fact that people who are sleeping a lot are usually sick. And that's why they're sleeping a lot. So we're not, we're missing, we got the arrow of causation wrong. We're saying, you know, are they sick because they're sleeping too much or are they sleeping too much because they're sick? Right. While I think that the majority of the hypersleepers are hypersleepers because they're, because they are sick, there is actually some emerging evidence to suggest that absent that, there might be a downside and too much sleep. But again, I think for most people, most of us are on the other end of that spectrum, which is we're constantly battling the need to get enough. And that's either through, you know, our kids, our work, our stress, our Electronics, our food, our alcohol, you know, all the above, our travel.

And is it a negative? If you're a kid and you're eating a lot of junk food, you're not sleep, you're staying up late because you're whatever, playing video games all night, but you've got all this energy all day and you're active. Is there a negative for in your early ages, teens, early 20s through lacking sleep, eating poorly, or is there a way to recover in your 20s from the damage you've done in your before 20?

Yeah, it's a good question. I mean, certainly you can break it down into sort of the behavioral habit side and you can talk about it through the physiologic lens. The good news is before the age of 20 or 30, we are pretty remarkably resilient. I mean, you're an athlete, so you can relate. How old are you now, Louis?

You're near 37. 37.

So you might not have fully appreciated, I'm 47, so I'm a full decade older than you. And when I think about 17 to 27 to 31 to 47, I can really talk about those decades through the lens of resilience. Like at 17, You could shoot me and I think I'd still get up the next day. Like you just couldn't, right? You're Superman. Yeah. You're absolutely Superman. And I don't know, I feel like the first observation of not being Superman for me kind of kicked in about 42-ish, about five years ago was the first time I was like, oh, so this is what people talk about, right? Like, you can't just go out and crush it every minute of every day. And I think that's just one lens, which is through the lens of exercise. But the same is true of physiology, right? Like, or I'll give you another example. Many of my patients have observed this. I've observed this. Like, I was never a big drinker in college, but certainly there were enough occasions in med school or college where I'd go out and drink. far more than anyone should. And yet somehow the next day I could like get up at six in the morning and go and do whatever I need to do. Like I remember one night actually being out drinking until three in the morning. I mean having so much to drink it was ridiculous and somehow getting up at six in that morning to do a hundred mile bike ride.

Oh my gosh, man.

Probably still partially drunk. But felt fine by about like two hours into the ride. Today, if I had three glasses of wine, like the headache I'm going to have the next day is going to last me till the middle of the day.

Is that because your body was able to assimilate the glucose into the muscles and it used it to its advantage then and now it's like it takes over?

It's a very good question. I really, I mean, I could sort of speculate on what it is, but I just think there's an over, so there's this thing called homeostasis, right? Which is one of the hallmarks of youth. And it's one of the hallmarks of aging. And, you know, it's the ability to, or it's our lack of homeostasis. We lose this ability to get the body back into the zone of optimal performance. So everything about the human body is very particular. For example, take pH, which is the amount of acidity in our body. We're so highly regulated, like our body really needs to be at a pH of 7.4. So seven would kill you and 7.6 or 7.7 would kill you. And this is a scale that goes from 0 to 14, to put that in perspective. Wow. Okay. So tiny perturbations will kill you. How good is our body at staying in that? Amazing. Temperature, right? You go much below about 94, you're dead. You go much above about 104, you're dead. How good are we at staying in that range? Oh, I mean good. I mean, we generally stay within a 1.5 degree band. so this homeostasis thing is amazing. It gets weaker and weaker as we get older. And so your ability to tolerate bad food, bad sleep, sedentary behavior, more stress, all those things, it just gets weaker and weaker and weaker. And I think it declines non-linearly so, again, what you experience is a decline between 30 and 40. It's bad. 40 to 50. Yeah, that's worse. 50 to 60, you can fall off a cliff.

Is there a way to reverse this?

I don't think we know. I think you can definitely slow the progression of it. And, you know what? I would say you probably can reverse it, right? So just as you can clearly reverse diabetes, diabetes is a glucose homeostasis problem and it's clearly reversible. But, you know, so there are probably some variants of this that are harder to reverse than others, but no, I think we can reverse this process. But it gets harder, you know, it gets harder as time goes on. It gets harder the further you are into, you know, sort of the physiologic trap.

What are you doing to reverse it now that you've been experiencing this kind of not maybe a cliff, but a dip over the last five years for yourself? How are you thinking about it?

Well, I sort of had a change of heart five years ago. So actually six years ago, 2014. So, I sort of hung up my bike, which at that point I'd switched from swimming to cycling as sort of my main sport.

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But at that point, a couple of things had happened. So, one, I had become very familiar with a lot of emerging research on excessive cardiovascular training, which again, is a rich man's problem.

Ultramarathons, ultrabiking, ultra swimming, hiking.

That's right. That's right. So, again, and it's the same sort of curve, right? Where as exercise dose of exercise goes up, mortality comes down, but it has this little bit of a J where once you start to get into hyper amounts of exercise, especially over the age of 40, you're actually driving an increase in mortality. Now, really? Yes.

Does that mean like running a marathon once a year or is it running a marathon every week?

Yeah, great, great point. Running a marathon once a year, probably not increasing your mortality at all. But running 40-50 miles a week probably is, especially at that age. Now, again, this gets to your point about resilience. Someone in their 20s doing that doesn't seem to have any impact on mortality. It really only seems to be an issue if you continue. In fact, I did an interview with a cardiologist, James O'Keefe, on my podcast who is the world's expert on this. It was actually James's work six years ago, because I heard him speak at a conference 10 years ago. We became friends. I, you know, it's one of those things I'm sure you've experienced this where you hear something and you don't want it to be true. So you basically come up with all the reasons you're gonna poke holes in.

It until you find the evidence.

You find the evidence the other way.

Yeah.

Yeah, yeah. And eventually it became very difficult to ignore that this hyper amount of exercise was counterproductive.

So that's one piece of the change six years ago. It's probably bad that I just committed.

To doing the marathon next year yesterday. That's all right though. You'll be fine. I just think don't do one a month.

Yeah, exactly.

And then I think the second thing was I realized, it was sort of funny, but I realized my prime was so far behind me that I needed to think about what was I doing this in service of, right? And not that I needed anyone other than myself to do these things, because I'm very self-motivated. So I don't, But just as a joke one day, I asked my wife, I said, Hey, do you know what my PR is for 20K?

Like, bike, run or swim?

Yeah, bike on a 20K bike on the time trial. And I was like, this is my wife. She hears me talk about this stuff all the time. I have spreadsheets and models and data, and I analyze my power data every single day, and I'm trying to break the record for San Diego. I'm really so switched on to this. She'll probably get it within a minute. She'll guess what my PR is within a minute. She was off by 20 minutes, meaning she wasn't even in the zip code. So I was like, Huh, that's funny. It's literally the most important person in my life couldn't care less about this. And what I realized was, I need to start thinking about a different sport, which is the sport of longevity. So what does it mean to be a kick-ass 100 year old? And so that was the beginning of a mental model for me that in the past two years has gained much more traction called the Centenarian Olympics. So how do you train to kick ass at 100 should you get there? And of course, everywhere along the way. So that now dominates my landscape of training, which means I don't, you know, care about how fast I can, you know, ride a 40 kilometer time trial because that doesn't quite fit into what a centenarian needs to be able to do.

What is your mindset going into a 40 mile bike then or some type of experience? Is it more the joy of it?

So, I don't, I don't, I don't, I don't train. No, my training is very specific, but now it is fundamentally organized around , so the pillars being stability strength, mitochondrial or aerobic efficiency and anaerobic performance. And so each of those then has a super layer detail approach. And I still ride my bike four hours a week. So it's a fraction of what I used to do, and it's now very much geared to a certain energy system and a type of training. Um, what was the fourth one? Stability strength, mitochondria and mitochondrial efficiency or aerobic efficiency. And then the fourth and final one is anaerobic. performance.

So you focus on those four metrics now on a day-to-day basis?

Yeah, yeah. Those, those four pillars sort of make up the training program, which is then in service of something that I invite every patient to define for themselves, which is, because you will have a different, you know, set of variables for me potentially. But, you know, my Centenarian Olympics has, you know, 18 events in it. You know, like, I want to be able to pull myself out of a pool that, you know, where there's a one foot gap between the water and the curb, like lift myself up. I want to be able to hop over a three foot fence. I want to be able to walk three miles in an hour. I want to be able to carry two 10 pound bags of four flights of stairs. I want to be able to goblet squat 30 pounds because that's about the weight of a kid. I want to be able to get up off the floor without using my hands. So I could rattle off all of my 18 things and you would say, Peter, those seem really easy. and you'd be right as a 37 year old stud. But the point is, as a 30.

Year old, a lot of them aren't easy.

Most 60 year olds couldn't do this if their life depended on it. And I have yet to meet, but maybe one person in their 80s or 90s who can. And so that's the aspiration, is to get to that level in your 80s or 90s. How do you work that backwards to inform your training in your 60s, in your 50s, and in your 40s? and it's actually very hard.

And as I'm getting into, you know, I'm three years away from 40. What should someone in my age range be thinking about when they're, you know, I'm healthy, I feel good, you know, maybe have some aches and pains here and there when I'm training hard or something, but for the most part, I feel amazing. What should I be thinking about moving forward so that I continue to feel amazing and have the ability to do these things?

So I don't, I think it's never too late to at least become familiar with what these ideas mean. And it doesn't mean that you have to go whole hog and devote yourself to this. Like I've obviously made a very conscious choice that I don't go to swim meets, I don't go to bike races, like I don't train for those things anymore. And a big part of that is just time. You know, there are only 168 hours in a week and, you know, I have a very clear set of priorities and I'm willing to set aside 10 to 12 hours a week for exercise, which by many people's standards is still quite a lot, but probably by the standards that you exercise and certainly by the standards that I used to exercise, you know, I've never exercised so little in my life. So I have to be very efficient with every one of those minutes. And that means I'm laser focused on the four principles of that. In your case, I think it comes down to saying, okay, how much time do you want to vote to the long game? How much time do you want to devote to the short game? Another way to think about this would be investing. If you're looking at an investment portfolio, you might say, how much? Do I want to put both time and money, so the actual capital I set aside, but also the amount of time I spend deliberating over it into my retirement account, versus how much do I want to invest as a day trader for short-term gains for, you know, money that I'm gonna be using in the near term that's maybe even supplementing my income today. You could have totally different strategies for that and that's totally fine. So I'm just in the category where I'm only thinking about long-term permanent capital. And so, so that's the first question is you have to decide how do you want to do that? and it might be that you say, you know, Peter at 37, I just want to focus on running a marathon. I've always wanted to do an Ironman, so I'm gonna go and do that. And, you know, I want to climb Mount Everest and that's gonna require, like, you might have a whole bunch of these bucket list things.

And truthfully, I would say do 'em.

Now, 'cause it's only gonna get harder. 'Cause you're not gonna be able to do it later. Yeah. Yeah, yeah, yeah. I mean, I don't think you're gonna want to do it later. So get those things out of the way. And then maybe when you turn 40.

You say, okay, now it's time I'm gonna really focus on my centenarian Olympics when I have a better sense of.

What those events look like. for me personally. That's interesting.

Is there a list somewhere of your 18 on your website that I can link up for people to check this out?

No, it's, it's, it's, it's, it's not. We have, we, we have a, I think I have a subset of them for, for, for our patients in our, you know, documents that talk through this stuff. But it'll be in my book.

I want to close the loop on these four things. We talked about sleep for a while. The first one was intake of glucose. Second thing was you don't have the efficient muscle to take in the glucose. The third is sleep disturbance. We talked about that for a while. What was the fourth thing that we were going to cover here?

Stress. Yeah. So cortisol is a really important hormone. Without it, you'd be dead. But too much of it can really wreak havoc. And a big part of what too much cortisol does is really drive that excess production. of glucose out of the liver. And so, of these four, I certainly have never seen a case where just stress alone resulted in diabetes in a person whose nutrition intake, you know, or, you know, their, their, their intake, their exercise and their sleep were perfect. But it, it really is like having just a little bit of extra kindling on a fire.

It's a multiplier.

Yeah, it's a multiplier.

What are the three causes of stress?

Well, I mean, I think there are many causes of stress. Right. So, so I think you've got kind of the, you could divide it into sort of internal versus external, right? So I think of this in a way that says, look, it's really more about a person's response to externalities.

Response to the experience, the event, the thing that happened.

That's right. You can have three people that are exposed to the exact same externality, that have three completely different responses to it. So I think it's less productive to focus on the external piece and more productive to focus on the internal piece. So this is where I think my favorite by far. Well, so now I think there are three ways we can go about coping with this, which, because this kind of goes, this is just the tip of the iceberg is the stress piece. This really becomes now the sort of gateway into what is mental and emotional health all about. Yes. And now I think there are basically three, you can see I'm a very pillared, structured, left-brained guy, right?

I like that.

So now we go into basically three ways that we can approach dealing with this. One of these is through psychotherapy, which I'm a huge, huge proponent of. Pharmacotherapy, which I'm also a proponent of, though I think it's vastly misunderstood. And then behavioral therapy, which I'm an overwhelming proponent of, in particular a type of behavioral therapy called dialectical behavioral therapy, or DBT. And again, it's- DBT, yes, dialectical behavioral therapy. Not to be confused with cognitive behavioral therapy, or CBT, which is also popular, but I believe that DBT is more efficacious. But that said, I think different personalities respond different to different versions. For what it's worth, my personality responds so much better to DBT than CBT. So therefore, I found it to be much more helpful.

So these three things will help give us the tools to cope with stress.

Yes.

Gotcha. And what I'm hearing you say is it's we, a lot of people lack tools. for these three main things, cognitive, physical, and emotional resilience. We're lacking the tools to then amplify them in our favor as opposed to against us. And the more tools we can gain, then we could hopefully take the actions to live healthier and longer.

Yeah, and it has to be proactive. I mean, I think that's the piece that's inherent in what you said is at some point, you have to decide you're gonna go on offense. So you can't just sit on defense and say, I'm gonna take it as it comes, and what's gonna happen is gonna happen. And I just, I think you have to take this view, which says, I'm going to be incredibly proactive, and I might not be able to control everything. I don't represent that there's some path where everybody's gonna be able to make it to live to 100. There are just some people whose genes Don't command that. And that's fine. There are people out there who have so many genetic things working against them that they'll be lucky to make it to 80. But the point is, without making these proactive changes, they might have lived only until 70. And to your earlier point, they might have spent the last 20 of those years in an unbelievable state of misery. So when you contrast living to 70, spending 20 years in misery versus living to 75 with maybe two years in misery. It just doesn't even strike me as a trade off.

Thank you so, so much for listening to this episode. I hope you got a ton of value out of this. Again, I did not want to stop this conversation. And that's why it continued. And the next episode, episode number 1046 will be the second part of this. And in that episode, we really dive in on the cause of stress and how to be happier, the main cause of mental health issues and traumas, ways we can develop our emotional resistance, the danger of non-alcoholic fatty liver disease, how food affects our mental health, and so much more. So make sure to click that subscribe button right now on Apple Podcasts to listen to the School of Greatness and stay up to date with the greatest information from the greatest minds in the world every single week. And also, if you want inspirational messages sent to your phone from me every single week, join my texting list by texting the word podcast to 614-350-3960. Again, text the word podcast right now to 614-350-3960 to stay up to date on that. And please leave us a rating and review over on Apple podcast if you enjoyed this to help us spread the message to more people. And I want to leave you with this quote from Thomas Edison who said, the doctor of the future will give no medicine, but will instruct his patients in care of the human frame, in diet, and in the cause and prevention of disease. Ooh, Thomas Edison, thank you for that quote. Stay tuned for part two with Dr. Peter Attia. And if no one has told you lately, you are loved, you are worthy, and you matter. And you know what time it is? It's time to go out there and do something great.

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