The Daily Hacks To Live Longer & Reverse Your Age | Dr. Peter Attia

If someone was only going to watch or listen to the first few minutes of this, and you could give three to five main keys to living longer, what would you start by saying with that?

Well, the, the, the, the slightly nuanced answer would be it's going to be highly dependent on where you're most deficient today across the different, call it, levers that you can pull.

Okay.

But if you were going to try to take a view that on average, where are most people failing to capture benefit, I would say first and foremost, it's around exercise. I think everybody knows exercise is good for them. The question is how much? And it turns out that there's really no upper limit to the benefits you accrue from exercise. So I would say the first piece of advice I would give is however much you're exercising, you can probably do more and you will extract more value. And yes, there are going to be people who I'm speaking to that are already probably exercising at the point where there's diminishing returns.

Too much and they're hurting themselves.

Yeah. So, so, but acknowledging that we're talking to kind of 90% of people watching this, you can be exercising more. To which the next question is great cardio or weights? The answer is yes, you gotta do both. And they, you know, the, the benefit of having incredibly high cardiorespiratory fitness and being incredibly strong is strong so significant that it dwarfs even the harm of type 2 diabetes, smoking and kidney failure. In other words, the magnitude of benefit that being strong and having high cardiorespiratory fitness brings is greater than the harm and magnitude of those other things. Wow, okay, so that's gotta be number one on the list.

So it can't just be, oh, I'm a runner, I like cycling and I like swimming and that's all I'm gonna do. You've got to incorporate some type of resistance strength training.

That's right.

Bodyweight training, even just something where you're.

And to be honest with you, if we're going to be really technical, even bodyweight training is probably not enough. Really. If you think about kind of the aging muscle, it has a few characteristics that define it. And the most important characteristic of the aging muscle that we can see is the loss of what are called type 2 fibers. So if you think back to your life growing up playing sports, what was the thing that most defined your athletic ability was probably your explosiveness. Yes. And explosiveness is really. Those are, those are what type 2 fibers are. Those are fast twitch muscle fibers that Give you explosiveness and power even more than strength. Those muscle fibers shrink as you age.

Really.

And it's the shrinking of those muscle fibers that is what defines the aging muscle. So we have to be able to resist against that as much as possible. Our goal should be to slow and delay that as much as possible, because as we lose those type 2 or fast twitch muscle fibers, that's when we start to get into trouble as we age. And unfortunately, you can't exercise those muscles without heavy weight.

Really?

Yep.

Or at least super heavy weight or just more weight than you're comfortable with.

More weight than you're comfortable with. And you know, you're not going to do that with body weight alone. Body weight alone, it's gonna be very difficult, too. I mean, you could, there are tricks around it, but you can, you know, you, you can, you can certainly make body weight very complicated. Look, if you're doing upside down, you know, presses, that's, that's sufficient body weight.

Yeah, yeah.

Certainly for some people, push ups would be sufficient, but probably for someone like you, it's not. Right. Right. So, and similarly, like, if you're only in the gym and you're, you're getting all of that strength training, but you're not paying attention to your aerobic efficiency and your peak aerobic output, you're also just leaving, you know, money on the table.

Really?

Yeah. So. Man.

Okay, so we need to be thinking about both cardio and also strength training. I think Dr. Gabrielle Lyon talks about, like the, the, the need for building muscle and, and having more protein.

Yeah.

So that we can have bigger, stronger muscles. It doesn't mean you have to look bulky or something, but you want your muscles to be stronger so you can live longer.

Yeah. Muscles serve two really important purposes. The first is a metabolic purpose. The second is a structural purpose. So the metabolic purpose is your muscles are the most important repository for glucose. Glucose regulation is such an important part of controlling disease risk. So when glucose is unregulated, it ultimately leads to a condition called type 2 diabetes. But even long before you get to having type 2 diabetes, if you have glucose dysregulation in the form of insulin resistance, you're still at increased risk of cancer, heart disease, and Alzheimer's disease. And it's significant. It's not like a minor increase in risk. It's a near doubling of risk. So the most important organ in the body to regulate glucose is probably muscle. Right. I mean, the pancreas and the liver obviously play an important role, but the muscle is the storage unit. For glucose.

And when we build more muscle or have more muscle, essentially we can process the sugars through that, we have more.

Place to store it, and we can do it with less insulin. So insulin is an important hormone that drives glucose into the muscle. But if the muscle is resistant to that insulin, that's called insulin resistance. You need more and more insulin to push and force the glucose in. And while that initially works and it gets the glucose in, it eventually leads to a problem with very elevated levels of insulin, which if chronically elevated, are synonymous with disease.

Right, and just creates more body fat too, right?

Well, yes, because then insulin, of course, when it's chronically elevated is driving more fat accumulation and less fat breakdown. So chronic elevated insulin is not something we want. And the best way to avoid that is to have muscles that are both big enough and sensitive enough to bring glucose in. Wow. And so that's the metabolic side on the structural side. Yeah, that's. I mean it comes back to strength, which is, you know, I always say this, Ben, everybody, nobody's ever come up with a contra view to this, but there has never been a 90 year old person in the history of our civilization going back a hundred thousand years, who said, I wish I had less muscle, I wish I was less strong. When you're at the end of your life, sarcopenia, the loss of muscle becomes an enormous limiting factor on your quality.

Of life because you can't pick yourself up, you can't put yourself off the couch or the bed. If you fall, you, you know, those are those commercials when we were growing up, it was like, I've fallen and I can't get up.

Right.

You watch that all the time, it's like, cause they didn't have the muscle to be able to push themselves up.

And even if you think about something less extreme than that, although that's still very realistic, it's hey, I can't get on the floor and play with my grandkids and I have a hard time getting out of the chair, let alone picking up my grandkid out of the crib or pushing them on the swing because I don't have the balance and the strength to do that. So I just think that for most of us, we take for granted what we're blessed with today in terms of strength and flexibility and freedom from pain. And as that starts to be taken away from us, so too I think there's a lot of our quality of life. Yeah.

Is it hard? How much harder is it to build muscle past 50, 60, 70, 80?

You can always sort of. Well, it's a complicated answer because it depends on where you're starting from. Right. So a person who is completely untrained will have a much easier time building muscle, even if they start in their 60s. Right. So if you took a completely untrained person in their 60s, they're going to respond remarkably well to even the smallest amount of stimulus. If you take a person who is well trained and has been well trained their entire life and they're in their 60s, they're going to have a very hard time making gains. But. But that's okay because they're starting at a much higher place. So that that person who never did anything is here, they're going to very easily get to here. The person who's always been here, they're just trying to hold on. So this person's still in a better place. So the question really ought to be how high can you get relative to your genetic potential as opposed to what's the rate of change? So the good news is, you know, even though this person can't get any higher, they're just holding on and maintaining. They're still functionally going to be in a great shock.

With everything that you've known, you've been study, you've been writing this book for seven years, but you've been studying this most of your life. Really, what is the thing that you try to, that you're afraid of if you don't do in terms of moving your body, exercise and lifting weights? Like, what are your big fears personally at your age that you're like, I know I need to do this weekly, daily to give myself the best chance for longevity.

So there's two separate things going on. The first is, you know, When I was 27, 7, I had a really devastating back injury. So it was a bad back injury, but it was made much worse because the surgeon who operated on me operated on the wrong side and really, really ruined my back.

Oh my gosh.

So I.

How do they do that? Don't they exit and say, this is.

Before the days of like mar x, before the days of that. Oh my gosh. And. And so not only did they screw up the operation, when they went back to clean it up, they kind of did an unnecessary operation. So they ended up really doing a lot of damage to my back.

How old were you?

27.

Oh, man.

So I sort of lost a year of my life in terms of pain and movement. I was bedridden or floor ridden. I didn't even lay on a bed. I laid on A floor for three months, couldn't walk, and it took about nine months for me to get to the point where I could have a day of not being in excruciating pain. So even though today I'm 100% pain free and 100% functional, if you look at my back on an MRI, you can't believe I can walk. Holy. It looks so bad.

Really?

Yeah.

Do you have screws and bars?

No, luckily I don't have hardware. It's just what was removed. It's so much bone was removed that it looks like my spine is the most unstable thing. It's basically just asking to be fused at two levels.

Oh, my God.

And the discs are dead from L4, L5 to S1.

But you look great, look great, I.

Feel great, and I have no pain. But, you know, that's been a lot of hard work and that requires daily work to maintain that. So if I don't stick to a very strict regimen of spine care, that can vanish overnight. Right. If I'm, you know, if I decide I'm going to travel for three days and not do anything, I will start to have a sore back. So that's just one example of something where I'm incredibly, in a way, fortunate to have suffered so much for so long because it left such an impression. You know, I think if people only have a bad experience with their health for a week, it's easy to forget. But if, you know, when you think about people who have cancer and who survive cancer and they're, you know, they're laying there on their deathbed and they miraculously make it back, I think those people are forever changed for the better. They're scarred, but they're also for the better. And they really have a lease on life that we can't relate to.

A sense of gratitude, appreciation, and really a presence of like, I've got to make sure I take care of myself today for my future self.

Yes. And while I don't think I can relate to that from the standpoint of life, I can relate to it, at least in this domain with respect to my physical body pain and the freedom to be able to do anything physically. Yeah. So, yeah, my kids tease me, but I always park as far away as possible in the grocery store to celebrate that. I can walk easily because I used to not be able to do that.

Wow. So you're taking to every stairs you can take. You're walking far away.

I was in New York. I was in New York this week and we were in a building and we had to go up to the sixth floor, and I was with some people, and they're like, there's the elevator. And I was like, why would I take a look. They're taking the stairs, and they're like, you have two suitcases. I was like, I know, it's awesome, right? Like, let's do it.

A little mini workout.

Yeah.

That's amazing. Okay, so what is the routine that you will never miss to support you, to outlive and live a healthy life?

Well, from an exercise standpoint, you know, I lift weights four days a week. I do cardio four days a week, and I do this thing called rucking two to four days a week. Rucking is carrying a heavy backpack. Have you ever.

For how long, how heavy, how heavy and how long?

So in rucking, an ideal place to get to is a third of your body weight. So I carry 60 pounds, and I have a little route around my house that's three miles. Very, very hilly. And, you know, I go. I'm. I'm walking as quickly as I can up and down hills. So getting, you know, a good cardio workout going up the hills and getting a really good kind of leg workout down the hills as you have to basically prevent yourself from going too quickly.

What are the benefits of rucking?

I think there are so many. Right. So you do get this short burst aerobic or anaerobic workout as you're bursting up the hills, and you really work on what's called eccentric strength when you're going down the hill. So eccentric strength, of course, is the strength of a muscle as it is lengthening, which is not something we mostly train. So if you're doing a leg extension or a leg curl, you're strengthening the muscle in its shortening phase, which is concentric. That's important. But it's equally, if not slightly more important, at least in an aging individual, to be training the muscle to get stronger as it's getting longer. That's how most people end up hurting themselves. Most people don't fall walking upstairs or walking up a curb. They fall walking down the curb because they don't have the deceleration and the.

Balance and the stability and the strength to go down. Interesting.

So you're getting that benefit. And then frankly, I would say at least 50% of the benefit is just. Is the psychological benefit because I don't ruck with music or my phone, not listening to podcast or anything like that. It's a very specific activity that I do to be out in the middle of nowhere. So you've read Michael Easter's book, I'm sure the Comfort Crisis.

I haven't read this one yet, but, you know Michael.

Yeah, yeah, yeah, yeah. And so Michael writes a lot about this in the Comfort Crisis and sort of the benefits of. Of being in nature without any interruption. And I think that that's probably something that we don't fully appreciate the importance of, for. For humans. Right. Is like, we didn't evolve out of nature. And yet if you think about how many people don't spend any time in nature, that's very jarring, I think, to our psyche, to our nervous system. This environment we're sitting in is incredibly foreign. We didn't evolve in this environment. We've only had an environment like this for a hundred years or less.

Right.

So. So that's. That's not even a fraction of time from an evolutionary perspective. So I. I feel strongly that being outdoors every day is really important, and this is a great way to be outdoors.

What are the other. So, okay, so is it more for strength then because you're carrying a third of your body weight, or is it more for cardio? Because. Because you're walking, you're getting heart rate.

You get the cardio when you're kind of walking uphill, you get the strength when you're walking downhill, and you get the psychological benefit all the way through.

How long should you be going for?

It takes me on my route a little under an hour to do that. Three miles.

Three miles, yeah. Is there any side effects to that for people, you know, should people who have.

I think you should start on a.

Bunch of weight and just walk around?

No, I mean, I. I sort of recommend people. Typically, assuming you can walk with no difficulty, I recommend people would start with a sixth of their body weight. Six. Yeah. So that would be me starting with 30 pounds.

Gotcha.

And working your way.

Are you wearing a specific vest you like?

Yeah, yeah. There's a company that I love. It's called Goruck Goruk.

Okay. I've heard of this.

Yeah, yeah, yeah. So Goruck makes specific rucksacks and even the plates that you slide into them so it's really balanced and everything else. Yeah, yeah.

Now, what do you think you're. How long have you been doing this rucking?

A little over a maybe a year and a half. Well, I used to do it with a weighted vest long before that, but the. This is much better. Using the rucksack is a much better setup than the weighted vest.

What is. What are the things that you're noticing the main benefits to adding this to your routine versus before not doing this.

Type of activity, my eccentric strength in my quad, in my lower quads, and my ability to just be comfortable. Like I. So, you know, going down. Yeah. Hunting is something I love doing. So archery, bow hunting is a big part of my life, is a big passion. And that's almost by definition in really difficult terrain. And so it used to always be the case when, when you're out there and you're having to scale, you know, very, very steep grades. That, that's, that's always like the hardest part, frankly, is the. Is the hills. And I certainly feel better doing that now. I think I also just, I can't overstate the psychological benefits of doing this. Like, it's a real. I always feel just so much better. And, you know, I live in Austin, Texas, so you can imagine it's not cool in the summer. And I always do this at the hottest time of the day, so I try to do this at 4 or 5pm and so there's also another sort of hormetic stress of doing this when it's 105 degrees. Last year we had an especially hot summer. It was above 100 degrees probably for 90 out of 100 days.

Crazy.

And being out there in that heat, going at it, I mean, it just. You come back, it's almost like you've also had a sauna as well.

It's like a spiritual experience.

Yeah. Yeah.

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Specifically with rucking in general, in life?

Yeah. What are the, of the, of the joints, the bones or the muscles? What causes people the most pain later in life then?

Well, the root cause, I think, is a lack of stability. And stability is a neuromuscular problem. So stability is hard to define, but there's actually a reason that it warrants a whole chapter in this book. So there's 17 chapters in this book, and one of them is just on stability because I think it's such an important topic and yet really difficult to explain. But it's, I think it's easiest to explain using an analogy. And the analogy that I use is one of a race car versus a streetcar. Right? So a race car can have less horsepower and still go much faster than a streetcar. And part of that is due to being lighter. Part of that is due to having slick tires. But a big part of that is having a stiffer chassis that wastes less energy. So when a race car's engine is humming, all of that power is going straight to the drivetrain, straight to the wheels, and those tires have more grip and it's going straight to the road. So more power from the engine is making it to the street and less energy is being lost and dissipated. A streetcar doesn't have that stiffness. It's optimizing for something else. It's optimizing for a comfortable ride, and in the process, it's willing to lose energy all the way through the chain. Well, the problem is in us, when we lose energy, energy dissipation is coming out in joints. So that's, you know, everything from the scapula. You know, if you're doing a pull up, that's your scapula winging up. You're losing energy there because you can't stabilize the scapula. So now you're putting more stress into your elbow and your arm is doing more of the work than your lats. It's when, for example, when you're landing, if you're walking, your leg is collapsing inward because you don't have the strength in the foot or in the medial part of the quad to resist that force and transmit force down. So basically, you want all the force you transmit from your body to the outside world and from the outside world to your body to have the least amount of Energy dissipation.

Do the shoes we wear matter in terms of like, what the energy from striking the ground and how it's transferring through the shoe throughout the whole body?

Yeah, absolutely. I mean, if you think about it, we didn't have shoes for most of our existence. Right. So if anything, we would have had something to cover our feet to protect it from abrasions. But this idea of wearing, you know, big sneakers that are meant to kind of buffer, you know, or spring us is a relatively modern phenomenon. That's like a less than 50 year ago phenomenon. Even 1970 running shoes were largely just, you know, thin, thin things that were meant to protect your, the surface of your feet. And so, yes, I do believe that the shoes that we're wearing are playing a huge role in kind of the problem with our feet.

What type of recommendations do you have with shoes in terms of size of sole or style or brands? Is there anything that you recommend?

I mean, I like minimalist shoes for almost everything that I do. So I, there are lots of different brands out there. I, I'm partial to a brand called Zero, which is spelled X E R O. I have no affiliation with, with any of these companies. But, but they make a great minimalist shoe. I, I also like another brand called Altra. I think it's a L, T R A. They make a, a zero, a zero drop shoe, but also with a wide toe box. That's another problem we have is we get these little narrow shoes. Yeah. You know, your, your, your fingers and your toes are similar. So imagine if you spent your whole life with your hands in things like this, like how useless would your hands be? And similarly, when your toes are constantly kind of mashed into a tight shoe, you lose the dexterity of the foot. The foot shouldn't be nearly as dexterous as the hand, by the way. It's not quite, doesn't, it's not quite the same, but it's. Most people, myself included, don't have nearly the dexterity of their feet that they should have. If you look at a child, right. Like, I'm lucky. I have little kids, right? So at least one of my kids, like, I, you know, I still look at his feet and just marvel. My wife actually just sent me a video of my son's feet the other day. He was laying on her kind of watching something on the couch and his feet were just sitting here and she just sent me like a 15 second video of his toes. He was just watching whatever he was watching on tv and his control, oh, what he was doing with his toes. And I was just like, I could eat those little things. They're so freaking cute. But it's amazing, like, what he still has the capacity to do because he's.

You haven't conditioned him and put him in a box.

And in his case, like with my kids, we're never going to. Right. Like, they're all. They're either barefoot or in Crocs. You know, if they really feel like being that or mostly they're in a wide box. Minimalist shoe Crocs.

Are those good for us as a dog?

Probably not. I think they're a bit too much. Yeah, yeah.

Too much sole.

Yeah, yeah, yeah.

Wider shoe. Wider.

You got. It's better for the. It's fine for the toes, but I still think it's. I still think it's a bit wobbly.

Got it. Okay.

You're a bit disconnected from the ground.

I know Mark Sisson. I don't know if you know him.

I know Mark well.

He has launched a new shoe company, kind of.

Yeah.

The finger. The finger shoes as well. Does that help with dexterity? I guess.

I think so, yeah.

You have like some individual flexibility with it.

Yeah, yeah. Those shoes, I mean, they're. They're literally putting a spacer between your toes. So they're really kind of spreading it out.

Okay. What is the benefit to having more space with the toes as opposed to.

It basically allows the foot to act as it should. Right. So again, if you just think of like the stability of a surface like this versus this, this is a much.

More stability and control. Interesting. Okay, so we've covered a decent amount on exercise and that was number one of the top three to five things. I'm curious and I could go even farther in this, but I think that's a good place to start. Lifting, resistance training, some type of cardio. And you're saying it sounds like it could be any type of cardio as long as we're doing it for what, 30 minutes or something? A minimum. A few times a week.

Yeah. I mean, I think, you know, again, it depends where you're starting from. So if you're doing nothing, look to get a mile walk. Yeah. You know, getting to three 30 minute sessions a week would be amazing, I think if you're kind of not just trying to hit minimum effective dose, but if you're actually trying to see like, okay, where do I really start to hit that curve at? You know, where I'm getting like 80% of the value here. You're probably talking three hours a week. Of cardio would be kind of the sweet spot.

Three hours, not one.

Not at once. But say, you know, 45 minutes, four times a week.

Got it.

For example. Or, you know, 60 minutes, three times a week.

Do you need to be pushing yourself in the cardio more? Just consistent.

I mean, we talk about something called zone two, which is where I think 80% of your cardio should be at the intensity of what's called zone two, which is.

What's the heart rate of that?

I guess it's not really a function of heart rate. I think there's a very technical definition for it that I get into in the book, but I think the easiest way to describe it to people is it's the level of intensity at which you can still talk but you're uncomfortable doing. So if you can't talk, you're past it too much. Too much. If you can talk relatively easily, you're below it. So you've got to find that zone where if you're out there and you're doing something and your phone rings or you're on the stationary bike and your phone rings and you answer it, the person knows you're exercising.

Gotcha. Makes sense. So for that.

So that's 80. That should be 80% of your cardio volume by time.

Gotcha.

And then 20 should be at a higher intensity.

Higher intensity. Gotcha. Okay. And then you like also just adding rucking for the extra benefits psychologically being in nature, the stability.

Yep.

On the knees, all these different things. And you probably feel like, amazing when you take that weight off, too.

Yeah, I feel like, oh, on a hot summer, Austin day to jump in the pool right after that is the greatest feeling.

That's incredible. Okay, so this is number one on longevity, and the science and art of longevity is the exercise. And these are the kind of the categories you're talking about. What would you say is number two for maximizing our longevity?

I think, you know, you. This is almost an extension of that, and you already alluded to it, but I think most people are probably underdoing it on protein to support what we just discussed. So it, you know, and I see this more with female patients than with male patients, but I see it across the board with people that most people are limiting their ability to put on muscle mass by being deficient in protein intake.

Is there ways to increase muscle without that much protein intake?

I mean, it's challenging. You're. You're going to be limited at some point by amino acids, obviously, you know, anabolic steroids and things can Sort of help.

I mean, naturally.

Yeah, but. But at the end of the day, you're, you're, you know, you do require exogenous meaning from the outside world. You have to put amino acids in your body as the building blocks to undergo this process known as muscle protein synthesis.

Really?

So the RDA, the recommended dietary allowances. 0.8 grams of protein per kilogram of body weight. That's off by a factor of two. It should be at least twice that.

Is what we should be doing daily.

Yeah. In other words, we are, we're being told to eat half the protein that we really require.

How much is that? I guess in pounds?

Yeah. So how much do you weigh right now?

245.

Okay, so that would for you be. You should be eating at least 200 grams of protein a day.

Is there a maximum that is inefficient?

It's not. Yeah. So. So there's two issues. So. So 3, 3 grams per kilogram would be considered too much. Too much.

So what does that.

So in your case, 350 grams of.

Protein a day or something?

Yeah, yeah. So minimum for you.

And what if I did less? What if I did 100 grams of protein a day, say for a year, would I not be able to put on muscles?

You'd have a very hard time putting on muscle.

Would the muscle size. It'd be hard. Or the muscle strength, like the quality of the muscle strength?

Yeah, probably. Clearly size at 100 grams a day. And it also. But, but of course, not all hundred gram a day. You could have four people eating 100 grams of protein a day and they could get different results if. Depending on the protein source. Right. So, you know, plant protein is going to be less efficient than animal protein. It's less bioavailable. If you ate all of that protein in one meal versus someone who spread it out across multiple meals, the person who's spreading it out is going to get more efficiency, really. But if you spread it out too much. So 100 given as 10 grams every two hours is an awful way to give protein because the liver is going to utilize a lot of it for a process known as gluconeogenesis, which means turning protein into glucose. You don't want that. So if you were going to only eat 100 grams of protein a day, you'd probably be best off going 100. Sorry, 30, 30, 40 or something effect.

And at 200 gram. So what is the.

So at 200 grams per day, you're probably looking at 54 times a day is the optimal Dosing.

Wow. And that will support me in maintaining my muscle strength. Maintaining my muscle mass as well.

Yep.

And the ability probably to just recover faster, you know, sleep better, train better.

Well, and it's also, I mean, it's a very important nutrient. It's also, you know, associating nutrient and so makes you less hungry. Yeah, yeah. So it's going to provide more, more satiation because, you know, the challenge with nutrition is for many people, they're kind of what I call overnourished. They have more fat on them than they need. But under muscled, that's probably the most common body type we would see right now in America is not enough muscle, too much fat. So that's a, that's a complicated problem to solve nutritionally, but an important one to solve because you have to reduce total energy intake while typically increasing protein.

Yeah, it's interesting.

So you've got to eat more protein, less carbs and fat to make that worse.

What is the obesity number at right now in America and versus the world?

I don't think I could tell you the world number at the moment. Obesity in the US is probably a little over one third of the population now.

One third of the population?

Yeah.

And what is the determining factor of obesity?

Yeah, it's a crap definition. It's defined by BMI, body mass index, over 30 kilograms per meter squared.

Got it.

I think that's a weak definition. I understand why it's used. It's basically easy to measure. All you need to know is a person's height and weight. But it's pretty useless because it doesn't take into account body fat and muscle is quite heavy. So you can have a person who's quite lean, muscular and they're obese or at least overweight. Like I'm significantly overweight by bmi, but you know, by body fat I'm not. So I think actually a more helpful definition. And if someone's just thinking about this, like, hey, do I need to be worried? It's take your height and your waist size, your circumference of your waist actual measure not your pant size and divide them. And if that number is. If, if your waist size divided by your. It's easier to do this. If your height divided by your waist size is more than 2, that's a problem. So if you're 6ft tall and your waist measures more than 36 inches, that's probably a better indication of you being obese.

Okay, well, I'm glad it's not that. That's good. I'm 64 and I have 34 waist, so hopefully that's. Oh, yeah, I got to get down a little bit more, but. Okay, this is interesting. So more protein. What I'm hearing you say is animal protein is better protein or more efficient protein. Efficient protein.

So I think people get so hung up on this whole plant, animal nonsense again.

I just, you know, you work with the science.

Yeah. Just let's just deal with the science. Right? Yeah. So if you don't want to eat animal protein, that's fine, but you just have to acknowledge if you're going to eat vegetable protein, you're going to need more of it. You're going to probably need to cook it, and you're going to need to be more fastidious and deliberate in paying attention to the types of amino acids. There's 20amino acids and you're going to have to pay a little bit more attention looking at, you know, how much methionine, how much leucine, how much lysine am I getting? So again, you don't have to eat animal protein. It just makes your life easier. If people eat animal protein, we give them guidance on total protein intake. When people only want to eat animal plant protein, we give them guidance on both quantity of protein and quantity of specific amino acids.

Wow.

And both can work, but the latter just requires more effort.

What are the three most efficient types of meat to get the protein that you need, do you think the most quality types of.

Well, I'm privileged and biased at the same time. Right? Privileged because I get to eat wild game most of the time. So most of my meat is venison and elk, both of which are wild game. So this has the advantage of having a much better nutrient profile than, you know, pastured or grown meat. Unfortunately, not everybody is going to have access to that, you know, either because they don't hunt themselves or they don't know people who do, or, you know, in truth, it's more expensive. I mean, unfortunately, our food system is pretty broken, and based on the way that we subsidize food, we've created a really perverse economic incentive for people to eat very low quality food. So, you know, the only thing I would offer on that statement is that, you know, we all have disposable income. That's going to go somewhere. I think we should really emphasize the quality of our food as a worthwhile thing to splurge on.

Right. What types of, I guess animals would be the best quality of meat, though, if you're not doing game.

Yeah. If you don't have access to elk and venison and these sorts of things. You know, I, I think all of them have their limitations. It's more, it's less about, you know, whether you're eating chicken or beef or fish. I think all of them have limitations if they're, if they're grown the wrong way, really. So what I'd really be looking for is the closest thing that you can buy that is wild. And by the way, I still think a great thing to do is when whatever town you're in, you find local farmers that are doing things free range, right. That are doing things organically, that are doing things where, you know, the animal is eating as close to possible what it would have eaten in nature. And for most people, like in a, especially in towns like where I live in Texas, like, it's not that difficult to find farmers that, that you can go and work with directly and make that happen. And again, I'm sure someone listening to this is going to be like, dude, are you freaking kidding me, man?

That's too much. Too much work, expensive this.

And I'm like, that's true, but what's more important than your health? So it's like you kind of have to decide, like, is it, is it worth a few less dinners out in exchange for spending a little bit more money on what you eat at home? Right. I don't think there are easy answers, but, but I do think it matters, right?

So, so chicken, beef, fish, they all.

Have, they can all be crap if they're grown the wrong way. Right? The bottom line. And they can all be valuable if they're not. And that's true of eggs, that's true of dairy. I mean, all of these things are unfortunately very different from the way they were 50 years ago.

So more protein. And if we were, if you're going to be plant based, what would be the main sources of protein you would gain or which plants would you want to eat most of the time to give you the most benefit?

Yeah, I mean, pea protein is pretty good. Soy protein unfortunately has to become kind of part of the mainstay of your, of your, of your protein intake, I can say, unfortunately. Well, I mean, you have to be kind of mindful of how much of it you ingest. You know, certainly you can get some aromatizing. You know, you can get, you can sort of get a little bit more estrogen than you might want out of some of those things. Pea protein is actually a pretty decent quality protein, but you just have fewer options, right? Like, if you're truly plant based. I think it's a lot easier for persons a vegetarian because at least they're willing to eat eggs and dairy. And you can get a lot of benefit out of, you know, yogurt, cheese and eggs. Eggs are an amazing source of protein and they're very rich in some of the most important amino acids.

Okay, more protein.

Number three.

What would you say is the third thing we should be thinking about to extend our life in a healthy way?

Well, although I didn't write about it in the book due to the folks at the publisher thinking, ah, come on, come on, come on, this book's long enough already. Take this out. I actually think that people could be very deliberate about paying attention to when they're in cars. It's not a, it's not a particularly often talked about cause of mortality or injury, but car accidents are a real problem still. There are over 3,000 people a year that die in car accidents and many, many more who are injured in car accidents. And those things are in some ways equally troubling. Right? I mean, if you get hit very badly in a, in a car accident and your T bone and maybe you don't die, but if you suffer, you know, a horrible neck injury that debilitates you for the rest of your life, that's. You might not show up on that statistic, but it's still an enormous detriment to your quality of life. So about three years ago, my research team did a really good deep dive into understanding how people die on the road because that's effectively in some ways what a part of this book is about. It's like, well, if you, if you want to maximize how long and well you live, if you start with the length part, you got to know how you die. You have to go to the death and work backwards. And so in that particular domain, how do people die on the road? And there are really predictable ways that people unfortunately die on the road, mostly.

On their phone or texting or.

Well, yes, yes, yes, but location wise. Right, location wise. So location wise, your big three are intersections. So four way intersection, T intersection or T junction. So this can be either an intersection that's a T or like a parking. Like, you know, you're coming out of, you know, one. Like you're coming out of a parking lot onto a. Under road. Yeah, yeah. And then head on traffic without a median. So there's a lot of, you know, we have a lot of those roads in Texas. Right?

So high speed, two lane, four lane.

Exactly. Two lane, four Lane no, four feet away. That's right. Just you and cars are going 60 miles an hour trusting.

I'm just going to this little line, this little yellow line is going to.

Keep us and it just takes one person to get distracted for one second and boom, it's a head on collision that is now functionally you hitting a wall at 120 miles an hour. Because if it's 60 and 60, the relative impact of that is deadly. And so, so those are such high fatality accidents, it's difficult to put in words. And every, I feel like every month I see a bad accident and about every three months I see a fatal accident on the street nearest to my house that is like that. It's, it's brutal.

Wow. So being mindful of.

So, so what can you do about that? So knowing that, how would you change your behavior? Well, so a couple things, right. So one, let's just talk through the two way street thing. So the street that I'm talking about in, in Austin is two and two. So two and two, it's a six mile stretch of two by two at 60 miles, 50 to 60 miles per hour speed limit. So rule number one, unless I'm passing someone, I'm never in the left lane. Why? Because that's the lane that's going to get dinged. I'm going to be in the right lane. And you know what, if I have to be a little slower, I don't care. I do not want to be in the left lane because that I want my margin of safety with an extra lane. Secondly, unfortunately for this particular street, it is a direct east west run. What that means is in the morning, half of those people are blind as a bat when the sun is low. And in the afternoon the other half are blind as a bat when the sun is low for those 30, 60.

Minutes or whatever it is where it's right there.

Yeah, Brutal blindness. You couldn't have built the worst road.

Oh my gosh.

So what I'm thinking about when I'm out at those hours, which I hate, is if I can see really well, by definition, the sun is behind me, the other people can't see worth a damn. So I'm even more careful knowing that guy can't see coming to intersections. Most fatalities at intersections are caused by an individual who runs a red and hits a person who had the right of way. So it's a, it's an especially tragic event because the person who's getting hit the most fatal injury is, was a green.

He had a green light is a.

Person has a green light, goes straight, and they get hit from the left T bone on the driver's side by a person. Ran a red light. Today when I was driving here, I was on. I think I was on Santa Monica blower. I don't remember. I was the first one stopped at a red. It was a red. As red as could be. Twenty seconds later, a Prius went straight through and didn't even stop.

20 seconds, 20 seconds after.

In other words, this. We're not paying attention one bit. They didn't see.

It wasn't like a yellow, then red. And then two seconds later, it was 20.

It was so long after that, I assumed the light had turned green.

Right.

And I almost went, wow. And then I looked and it was like still red. And it was red for another minute. I mean, this person absolutely did not notice a red light. Anything it hit, luckily didn't hit anyone. Didn't. I mean, I couldn't believe this guy. He clearly didn't even know because he didn't even slow down. You would have thought, like, he would have recognized it and been like, freaked out or something. No, just gone right through. So this is happening all the time. So what do you do? So what it means is every time you're going through an intersection, you assume there is someone getting ready to run it, and you scan three times. So I always scan left, right, left before I go through an intersection with the right of way. So again, does that guarantee I'm not going to die in a car accident? Not at all.

Someone could still hit you from behind.

Yeah. I'm hoping that this attention to these things maybe reduces my risk by 50%. Wow. There's nothing, you know, there's nothing you can do to fully protect yourself. But I think being mindful of those things, having that sort of situational awareness gives you, I think, a little bit better odds in an otherwise, you know, unsexy problem.

I think it's smart. Yeah. And what would be the last two things of the top kind of five.

That you would say, Well, I think, you know, if we could sort of pick one disease that is the number one cause of death, it's clearly cardiovascular disease. Right. So globally and in the United States, heart disease kills more people than any other disease.

Really? How much is it? How many people die a year?

So globally, about 19 million people die per year of a heart attack.

Heart attack?

Yeah.

Around the world, yeah. 19 million people a year. Heart attack?

Yeah. Cancer, number two, about 12 million. So, I mean, it's almost twice the Mortality of the next closest disease.

Heart of heart failure. Heart attack.

Heart disease. Yeah. Atherosclerotic cardiovascular disease.

And that's. Is that more on the emotional side of things and stress or is that more that you just don't have good cardio?

No, no, no. I mean, I think there, there's, you know. Well, so going. The other thing I would point out before we even talk about that is this is true of men and women as well. So, so I think there's a belief that an erroneous belief that it's. Heart disease is a male disease. No. It's the leading cause of death in men. It's the leading cause of death in women. It's the leading cause of death in men in the US and the world. It's just by every metric, it's the number one bestseller.

What is the main cause of a heart attack or the main causes?

Yeah, so, so a heart attack is shorthand for a process where there is an occlusion of blood flow to a significant enough part of the muscle of the heart that, that, that a process known as ischemia takes place and that heart muscle dies.

That's the attack. Yeah, the heart muscle dies and there's.

An attack that is the heart attack. And that can be, you know, that can occur in a very small blood vessel and it can result in a non fatal heart attack. People can have small heart attacks where not, not a big enough part of the heart muscle dies. People can also get medical attention quickly enough and the blockage in the artery that's causing that death can be opened up. Right. They can put a stent in there in the emergency room or you know, you get to the emergency room, they take you to the cath lab and they stent it and give you clot busting medicine and it opens it up and if you do that quick enough, you can get blood back to the area and minimize the damage that takes place. But about 50% of people who have a heart attack die first time and that's their first sign of heart disease. So they didn't have chest pain before that. It's not like they were having chest pain for years.

Really.

Their first rush with heart disease is sudden death.

Because you hear about these, I mean, I don't know how common this is, but you hear about someone that had a heart attack and died on the treadmill, who is 45 years old, healthy, you know, good looking, not overweight, and just had a heart attack and died.

Right.

And you hear these stories. So what is the cause of it happening.

So it's a complex disease, but fortunately, of all the diseases, it's the one we understand hands down the most. Now, that's the good news. The bad news is it's going to take me a minute to explain it, and I'll do my best to not get terribly technical.

You're good.

So it starts with cholesterol, which everybody's heard of. And cholesterol certainly gets a bad rap. You know, everybody kind of understands cholesterol is bad stuff, but it's important to sort of get the context right. So cholesterol is a substance that every cell in our body makes. It's a very important chemical. It's a lipid. It's a type of fat. But it's important for several reasons. It's the most important building block of the cell membrane. So every one of our cells has. Is like a sphere, and it has this membrane, and it allows the cell to be fluid. It allows the cell to change its shape and have little channels across its surface that allow things like glucose and sodium to come in and out and all sorts of things like that. So naturally, something that important, the body would figure out a way to make it. And the body does. It makes a lot of cholesterol. Now, cholesterol, because it's a fat, doesn't dissolve in water. So if you've ever made salad dressing and you dump oil and mix it with vinegar, you know that they separate completely. So there's a bit of a challenge the body has to solve for, which is how do you transport this fat throughout the body? You have to put it in the highway. Well, the highway is our circulatory system. And even though it might not look like it when you get cut, if you look at your blood, it's just water. Your blood is just water. The reason it's so red is there's a bunch of red things in it, like red blood cells and platelets. But if you've ever seen what happens to your blood when you put it in a tube and spin it in a centrifuge, it separates immediately. So all the red stuff goes to the bottom. And then you can see it's basically just clear stuff. It's just basically water called plasma. So we can't move this cholesterol through the body because it's water insoluble. We need a trick. And the trick is the body made these little spherical submarines that are water soluble to put the cholesterol inside. And those little spherical submarines are called lipoproteins.

Okay.

Okay. Those lipoproteins have different densities. So there's high density lipoprotein, a low density lipoprotein, a very low density lipoprotein, and the low density lipoproteins and the very low density lipoproteins, LDL and vldl. People call those good and bad cholesterol, but that's a bad name. It's the lipoproteins that are the problem. Those things get stuck in artery walls. And in particular in the coronary artery system, which are very small arteries, this becomes especially problematic. So these lipoproteins, they get up into the artery wall, a lot of the times they come back out and nothing goes wrong. But often enough, they get stuck in there. And when they get stuck in there, the body reacts, I guess appropriately in that it thinks there's a foreign invader and it kicks off an immune response. And it sends immune cells to the artery to go and eat or ingest or what's called phagocytose, those cholesterol particles. And when it does that, it kicks off an enormous inflammatory cascade that ultimately results in the body trying to repair the damage it's causing. All the while, what it's doing is setting itself up for a disaster. It builds this thing called a plaque. And eventually when that plaque ruptures and all the platelets that are clotting cells come to repair it, that's what stops the blood flow. So the heart attack is caused by one of these plaques rupturing and the blood flow getting stopped.

Got it.

Okay, so knowing that, what would you do? So what are the biggest drivers of that? The first is the number of those lipoproteins. So the more of those low density lipoproteins you have, the greater your risk of this happening.

The more of those you have, the greater the risk.

That's right. The more of you can think of it as kind of like a random process. So, you know, the more cars going down the road, the more chance that one of the cars is going to bump into a curb. Sure. Okay, so fewer cars on the road is better for everybody.

So how do we minimize the cars?

So there are some dietary ways to do it and there are some pharmacologic ways to do it. And, you know, the, the how much of each you need depends on the situation you're in. But the reality of it is, if. If you really wanted to prevent heart disease, you know, it's funny, I think almost everybody would benefit from lipid lowering drugs to take that lipoprotein down as far as possible. And I'll explain why in a moment. I'll come back to it. The second thing that drives cardiovascular disease is blood pressure. So elevated blood pressure causes a mechanical stress on those artery walls, and it makes them more susceptible to. To those little lipoproteins going in. So you can think of it like the integrity of the wall is what keeps those lipoproteins out. If you damage the integrity of that wall, more and more of them get in. And the third thing is smoking.

And that's blood pressure.

Yes, high blood pressure. The higher your blood pressure, the more stress you're putting on that wall, the more shear stress.

And how do you decrease blood pressure? What's the efficient ways to do that?

I mean, weight loss is an enormously efficient way to do it. Exercise is an important way to do it. In some people, sodium reduction matters if their kidney function isn perfect.

Okay.

And if all else fails, I mean, sleeping adequately does it. So correcting things like obstructive sleep apnea can help. And ultimately pharmacology helps if none of those other things work. And then the third one is smoking. Yeah. Yeah. So smoking is an enormous driver of cardiovascular disease, and it has a chemical irritant on that same thing. So smoking sort of chemically irritates the artery wall. So basically, all roads to cardiovascular disease have to do with the integrity of the artery wall and the ability of the lipoproteins to get in and do their damage.

We know about how bad smoking is, but how bad is vaping compared to smoking?

Yeah, it's a great question, and it's one that I don't think we know the answer to yet. My view is the precautionary principle is in order. So if a person said, I'm going to choose between smoking and vaping, like, I'm a lifelong smoker, and the only way I'm going to ever stop smoking, you know, two packs of Camels a day, is if I go to vape. I think it's the lesser of two evils. So that's a different situation than if you said to me, I'm not a smoker, but I'm really. I'm kind of thinking about taking up vaping.

Right.

I'm going to try to talk you out of it.

Right.

And what are the.

What are the negative side effects to vaping?

So I. Again, I think there's a big unknown. We don't know yet about the following. I don't think we understand what's happening when Those filaments are burning inside that device. Like, I don't think we understand what particulates are there. So, so the pro vaping person will say, well, there's no tobacco in it.

Yeah, there's no tobacco.

Okay, that's, that's great. So that problem is resolved. I don't know what there is in there. And until I do, I'm very uncomfortable with the idea of taking anything down into my lungs over and over and over again without a lot more data. Yeah. So again, if someone is saying, look, this is an alternative to smoking, I would say there are far better alternatives. There are smokeless ways to get nicotine because nicotine is the addictive component of tobacco. Nicotine, by the way, is actually not harmful. Nicotine is actually quite beneficial. Nicotine has a lot of benefits in the brain.

So the other chemicals that are.

That's right, yeah, connected. So nicotine is addictive. That's problematic. But otherwise it's a very positive molecule for brain health. So if a person is saying, I'm stuck on nicotine, I would say use a gum, use a patch, use like a lozenge. There are lots of ways to get nicotine that don't put you at risk the way vaping does.

And you would say over vaping, do those other things, the gum, the passion.

I just, I, I, if any person who I meet who's vaping, I'm going to try to talk them out of it.

Yeah, that makes sense.

And, and if in 20 years I'm wrong and we discover vaping is like, good for you, which is. I'm willing to, I'm willing to take that. I'm willing to take the asymmetry of that.

Yeah, of course. Now, what about smoking marijuana? What are the pros or cons to ingesting any type of smoke into your lungs?

Again, I think for long reason. Yeah, yeah. I think the reason we probably don't see a strong association between marijuana use and lung cancer the way we do with smoking is the dose. Like, you know, I, I mean, again, I don't, I don't, I'm not particularly fond of marijuana. Personally. I've never enjoyed it, but I can't imagine that someone is smoking more than a couple joints a day, even if they're a heavy user. Sure.

How does it affect your brain or other?

Well, those are separate issues which we can sort of talk about in a sec, but I think just on the basis of like lung health, heart health.

It'S not going to affect your heart.

I suspect it's not nearly as bad as tobacco because you simply don't do as much. Now it's unfiltered, and there's probably a ton of crap that you're ingesting, but it's sort of like smoking one cigarette a day doesn't materially increase your risk. But nobody smokes one cigarette a day. Right. People are going to smoke 10 cigarettes a day or 15 cigarettes a day. If you were probably smoking 10 or 15 joints a day, I would bet that you're very likely in the same risk category, if not greater than tobacco, because least tobacco is filtered. Right. With the heart. That's right, with the heart and with the lungs.

Okay, cool.

Because remember, lung cancer is hands down the leading cause of cancer.

Lung cancer.

Oh, my God. Like, not even close.

Wow.

Leading cause of cancer death is.

That's through smoking? Mostly.

Yeah. Tragically, 15% of lung cancer patients have never smoked a cigarette in their life.

15%.

15%. In fact, if you just looked at. So lung cancer is the leading cause of cancer death, followed by breast in women, prostate in men, followed by colon, followed by pancreatic. Those are the big killers. But if you just looked at the people who smoke, who've never smoked, who get lung cancer, that would be the seventh leading cause of cancer death.

How do they get lung cancer?

Nobody knows. It's also a big mystery why women are disproportionately affected. Two to one.

Interesting.

Yeah, we. We wrote a piece on this once, speculating it could be estrogen, it could be lack of testosterone, but we. Nobody knows. Nobody understands why women seem much more susceptible to. Much more susceptible as non smokers to lung cancer than male non smokers. Huh.

Between men and women, who attracts disease more?

Well, women live longer on average than men, at least in the United States. That's probably true globally. And women tend to get certain diseases later, like heart disease, the incidence of heart disease and the. Even though women are just as likely to die of heart disease, they die later of heart disease. Certain diseases favor men and certain diseases favor women. So, for example, lung cancer in a non smoker, disproportionately women. Alzheimer's disease, disproportionately women. Two to one.

Really?

Parkinson's disease, disproportionately men, about two to one.

What's the difference between Alzheimer's and Parkinson's?

Alzheimer's is a disease that almost consistently or almost exclusively deals with cognition. So it affects the brain, and it is a dementing disease. So it robs people of memory, cognitive executive function, processing speed, et cetera. Parkinson's disease is more of a movement disorder. Doesn't really affect cognition, muscular like. But it affects motor control and movement. And so people with Parkinson's disease have a tremor and have a very difficult time moving. Wow. So they're both neurodegenerative diseases, but they're at different ends of the spectrum.

But one, the Parkinson's. It'll affect your body, but you should be sharp still.

Most patients with Parkinson's disease still have their cognitive faculties. Right. Whereas Alzheimer's patients do not.

What are the causes of both of those, and how can we minimize that for ourselves?

Yeah, I mean, it's hard to say definitively what's causing them. We know more about Alzheimer's disease than Parkinson's disease. So we know, for example, that of all the people with Alzheimer's disease, 1% of them have it because of genes that are programming them to get it. So this is very tragic, but there, you know, there are a handful of genes, three in particular, that make up the majority of these patients who are almost destined to get Alzheimer's disease and tragically, to get it at a very young age. These are people that are getting it in their 50s. So fortunately, that's rare. Again, it's only 1% of cases, but it's 1% too much, and we really don't have any options for these patients. So that's.

Once you start getting it, it's hard to reverse.

That's right. That's right. So this isn't 1% of people that have this. This is 1% of Alzheimer's cases come with this. Of the other 99% of people who get Alzheimer's disease, a couple things we know. One is there is another gene that predisposes you, but not in a fashion that's called deterministic. Deterministic means if you have the gene, you get the condition. Fortunately, most genes are not deterministic. Most genes just increase risk, decrease risk, modify risk. But there's a gene called APOE4 that increases risk of Alzheimer's disease. So this is a gene that about 25% of the population has. So at least 25% of the population has one copy of that gene. About 2% of the population has two copies of that gene. Those people are at a much higher risk. The people with one copy are at about two to three times the risk. And then there are people with no copies that still make up part of the cases. So of all the people with alzheimer's disease, about 2/3 of them have that gene. The APOE4 gene. 1/3 do not, even though the two thirds of people who have Alzheimer's with that gene are only representing 25% of the population. So you get a sense of the risk.

Okay, and how do we prevent this?

The gene we can't do anything about. So then we get to the modifiable factors. So what are the modifiable factors? There are basically a handful of really big ones. The first is exercise. We know that exercise dramatically reduces the risk of not just Alzheimer's disease, but all causes of dementia. The second is not having type 2 diabetes. Type 2 diabetes is a massive risk multiplier for Alzheimer's disease and dementia. And dementia. Okay, the next one is blood pressure. High blood pressure dramatically increases the risk of especially vascular dementia, but also Alzheimer's disease. Smoking does as well. Poor sleep almost assuredly does. The data are less clear there, but I think they're sufficiently strong that I would be very comfortable saying now that short sleep also increases the risk of dementia. And the final thing that I think, there's two other things that I think we can say with a very high degree of certainty. One is elevated levels of that low density lipoprotein. So same thing that's driving heart disease is driving Alzheimer's disease. And then there's another protein in the blood called homocysteine, and elevated levels of that seem also causally related to Alzheimer's disease. Meaning lowering that homocysteine lowers the risk of Alzheimer's disease. That was actually demonstrated in a clinical trial called the Vitacog study. And so that's an important part of what we give every patient is high amounts of B vitamins to keep their homocysteine level low. So you basically want low homocysteine, low levels of low density lipoprotein, lots of exercise, normal blood pressure, adequate sleep, not having type 2 diabetes. You're really. Even if you have an APOE4 gene, if you do all of those things, you're dramatically improving your odds against neurodegeneration.

What do people in their 20s and early 30s, what are they doing that they should stop doing to start living a longer life? You know, because you think, when you're 20s, I'm invincible. I'm gonna be up all night. I'm gonna be, you know, whatever, drinking or. I never drank. I've never been drunk. But I would be like Red Bulls all till like, three in the morning, like dancing techno clubs or whatever, and just, you know, eating whatever, working out, but doing double burritos and pizza all night. Like, what are the Things that you wish people's in their 20s and early 30s knew that if they stopped or restricted those things, it would just benefit them so much in their 40s, 50s and beyond.

You know, I'd hesitate to sit here and suggest that someone in their 20s or 30s maybe live like a monk, because at some point, you know, I really do understand the value of saying like, everything has a season in your life.

Yes.

And there are things that I did in my 20s and 30s that I don't think were remotely good for me, but they were incredibly fun and they, you know, I mean, when I was in medical school, the once a month there was like a 25 cent beer night at the bowling alley and it was all 80s music. Amazing. I have some remarkable memories of that that are so disgusting. And I can't believe that we would drink so. Right. So I think rather than saying never do this, never do this, never do this, what I would say is develop good habits. So here's a better way to think about it. If you're 20 or 30 years old and I come to you and I say, what's the most important thing you can do to set yourself up financially? You wouldn't tell me never to spend money, you wouldn't tell me to save every penny, but I bet you would tell me to get into the regular habit of saving and investing. Because if you get into a regular habit of doing something, one, you have the compounding benefit of it, but it also becomes built in to your behavior. Yes. So what I would say to that 20 or 30 year old is still make it a habit to exercise six days a week. Make it a habit to eat responsibly most of the time. Make it a habit to not drink to excess most of the time. And yeah, I get it. Like when you're 20, you can recover from an awful night of boozing in the way you or I could never recover today. But if you make the habit the bad thing, it's much harder to break those habits later in life. I mean, I feel very fortunate that at least exercise has always been in my life.

That's great.

So it really doesn't require any willpower now to exercise. Like, it's just, it's an embedded part of my existence, it's a part of my psyche, it's a part of my mental health strategy. So I think that's really what I would say is it's less about what you do on any one given day and more about getting into the habit of putting, putting money every week off that paycheck into your 401k. And yeah, you're going to spend money on stupider things when you're 20 than when you're 50, but still be in the discipline of saving and compounding.

Yeah, exactly. And if you do that, you know those daily habits, then you can still go to Coachella for three nights.

And that's right. Crazy.

And recover and get back.

Make sure when you get back. I'm going to get back on program. I'm going to. I'm going to. I'm going to get a workout in and I'm going to eat well, I'm going to sleep well.

Do you think it's possible to live in our 90s or beyond 100 with no diseases? Active, mobile and mentally clear and sharp?

You know, there are people who have already done this. I have a whole chapter in the book dedicated to them. They're called centenarians. I think it's chapter four because I think it's interesting to understand what it is about them. Now I'll spoil it for people and say that this chapter doesn't tell you to do what they do because here's the interesting thing. The centenarians, it turns out, on average. Read the opening quote. It's my favorite.

Whiskey is a good medicine. It keeps your muscles tender.

That was Richard Overton, who I think is. Was110 when he said that. Wow. And this guy who lived in Austin, Texas, by the way, used to drink whiskey all day and light stogies on his stove and sit on the porch. And he was just this incredibly healthy guy right up until the day he died, I think.

Didn't Ryan Holiday do a piece on him or something? Yeah, yeah, he's on this porch, sitting on the porch. Just.

Just hilarious. And it's true. Most centenarians are like this. They literally do everything wrong. They don't exercise, they drink, they eat like crap. Well, they just hit the genetic lottery. Okay, so they have amazing genes and they. They have, you know, lived long despite their behaviors, not because of their behavior.

And it sounds like they almost. They have this lightness to their emotional and mental way of viewing the world, some of them.

But there's just as many that are crotchety old. Really? Yeah, absolutely.

There's genes keep them alive.

There is no rhyme or reason. So there are two enormous cohorts that have been studied. One by a guy named Nir Barzilai at Albert Einstein in the Bronx and one by a guy named Pearls in at Boston University. And yeah, I mean, there's simply no Pattern to their behavior, their attitude, the.

Way they perceive the world.

Not a single thing can predict their behavior except their genes. Wow. So with that said, I. I'm going to assume that your question is, for those of us who weren't gifted with the genetic lottery, is it possible? I believe the answer is yes. Whether it's 90, 95, 100, I'm not sure. What I do believe is possible is that with enough work, with enough compounding benefit of all these things we're talking about, that last decade of your life can be a very high functioning decade. I call it the marginal decade. So marginal decade for most people is a period of significant decline, cognitively and physically.

It's suffering.

That's right. Pain. That's right.

Agony, frustration, resentment. All these things.

Yeah. So there's an emotional component that can be there. But even if the emotional stuff is good, like I look at people who I know who are in their late 80s, and they're surrounded by friends and family and love and all those things, but physically they just can't do what they want to do. You know, they can't walk, they can't drive anymore. You know, they don't have the reflexes, they don't have the, they're not as sharp. So, you know, if you start early enough and are deliberate enough, there is no guarantee you will ward that off. But it's a probability game. You are, you give yourself way better chances. Again, is there a guarantee that if you put money away into a 401k and invest it in the most, you know, wise, savvy way that you can growing up, that you're going to retire with a lot of money? There's no guarantee. Right. You could be trying to retire the day before Lehman Brothers blew up in September of 2007 and your 401k goes to zero. I mean, those things can happen and you might have to work an extra five years to dig out of that hole. But on average, it's much more likely that that person is going to do well than had they never saved and they expect to just buy lottery tickets. Right.

How old are you now?

50.

50. So what's your vision for your lifespan? How, how long? If you could predict the year and live as long as you wanted to be, how long would that be?

I, I can't even fashion it. I think the most important thing to me is to live long enough that my kids are fine without me. I mean, that's so that, believe it or not, is not very long. Right. I mean, my kids are almost 6, almost 9, almost 15. So if my youngest kid is, I don't know, 30, and that. What does that put me? That puts me in my 70s, you know, I will have done the most important thing I was put on this earth to do. Wow.

Yeah.

And really, I'm. I'm less concerned with how long I live, which I'd be lying if I said I want to live. I don't want to live a long time. Of course I do. But I'm much more concerned with that quality of life. I'm much more concerned with what am I able to do. And I would happily compromise length of life in favor of quality of life. And I define quality of life maybe different from how you would or maybe different from how someone watching us would. So I do think it's important that everybody have a very honest discussion with themselves about what constitutes quality of life. What do you want to be able to do in your last decade? We all have a last decade, and none of us know the day we enter it, but most of us know when we're in it. So what do you want to be able to do in that decade? And I have very clear metrics of what I want to be able to do, and that's what I focus on.

What are those main things you want to do in the last decade?

Well, I mean, I'm assuming. So for planning purposes, I'm assuming that's my late 80s, maybe even early 90s. And I want to be as functional in that period of time as an otherwise very healthy, fit 70 year old would be, which means I want to be able to exercise every day. I want to be able to play with small children. I want to be able to do archery. I would like to even be able to drive a race car still, by the way, Paul Newman was still driving his race car up until about six months before he died and still driving some pretty quick laps.

How old was he?

Oh, God. We'd have to look it up, I think. Late 80s.

Wow.

Yeah. I want to be able to hike on uneven surfaces. I want to be able to swim every day. I want to be able to have sex. I want to be able to travel and do so in a manner that's like, real. Like, you know, not just get wheeled around and go from place to place.

But like, walk around, do everything yourself.

Yeah. Actually get onto the train. Actually carry my suitcase onto a train. Take my suitcase off the train. You know, I want to be able to play with great grandkids, or probably not great grandkids, but probably Grandkids on the floor like play Lego.

That's beautiful vision. Now I'm curious. I just turned 40amonth ago. A month and a half ago.

And When's your birthday?

March 16th. Oh, on March 19th, 1983.

I'm 73.

Yeah. So 10 years almost exactly. And it hasn't really like, I've never put emphasis on my age for the number.

Yep.

Because I've never wanted to limit myself. And that was something my dad taught me early on. So we never really celebrated birthdays, which is a whole nother story. But it's benefited me in believing in myself, you know, being younger, starting the game when everyone else was older, being the age I am now, just not just always believing myself. No matter the age. It hasn't really hit me that soon, you know, if I'm able to live as, you know, in my 90s or whenever soon, essentially in the next decade, I will have been on this earth longer than I will be still on this earth. Right. Like my first half will be longer than where I'm ending up. Have you thought about that, being 50 now? They're like, okay, maybe you have 50 years if, you know.

Probably not. Yeah, no, no. I've almost assuredly spent more time on this earth than I have left.

Right. How does that hit you? How does that, how does that feel mentally, emotionally?

So I don't think of it that way. And maybe this is just a coping mechanism. So it's possible I'm just delusional. But the way I think about it is more in terms of the quality of that life. So I would say that we all have different seasons. And I don't think, for example, the first 45 years of my life were a great season. Really? Sure. I mean, I think that physically everything was great, but I don't think emotionally everything was great. And therefore, in some ways I'm still an infant in terms of kind of a level of emotional maturity and level of connection and better relationship with myself and better relationship with others. So in some ways I think, well, I'm a 5 year old who still has 35 years to live maybe. So, you know, the good news is when you think of all of these things that determine quality of life or health span, you're thinking of cognitive, physical and emotional. Well, there's no denying the gravitational pull on the first two. They're going to go down. Your cognitive and physical performance have already peaked. Mine long ago peaked. I'm on the downslide. I mean, that's just reality. You can't deny it. Especially people like us who weren't doing horribly when we were younger. Right. Like, in other words, you're never going to be physically the guy you were when you were 20. Not a chance. And nor will I, because I was already at such a high level. I'm not cognitively ever going to be what I was when I was 20. But the good news is you're wiser.

Than when you're 20. Exactly.

I'll be. I. And, and this is what. I don't know if you. Have you interviewed Arthur Brooks?

No.

Okay, so. So Arthur Brooks talks about these different types of intelligence, crystallized versus fluid intelligence. And yes, the people who age gracefully are able to transition and accept that different type of intelligence. And you, you, you go from that more computational, you know, what's called fluid intelligence, into a more crystallized intelligence that is more about wisdom. But the good news is that last bucket of emotional health is not tethered to age at all. Not tethered to biological age. So in many ways, I accept the decline of these first two, knowing that this last one is going to get better.

Interesting. Let's speak about emotional health. And how does that play into longevity and the quality of your life living longer?

I mean, I think it has two clear ways that it factors into it. Right. The first is, I would call it indirectly. Right. So when a person's emotional health is not well, it's very difficult for them to do what is in their own best interest with respect to their own health. So a person whose emotional health is not well is not going to be sleeping, eating, exercising, motivated to do the things to take care of themselves. And I see this all the time. I mean, this is absolutely something I see front and center with my patients.

Is they know what they need to do.

They know what they need to do.

But they're not emotionally stressed.

There's too many things getting in the way. There's too much emotional baggage that's getting in the way of their relationship with food, their relationship with exercise, stress, relationships, all of those things. So that's the indirect price of emotional health not being optimized. And then, frankly, I think there is the more destructive piece, which is suffering. And I think that, as Esther Perel mentioned to me, and I write about this, that there. What is the point in living longer if you're not happy? What is the point of living longer if your relationships suck? What is the point of living longer if your wife hates you or your kids don't know you? It's, it's. I don't Think anybody would think that that's, that that's paradise. No matter how long you live on.

The calendar, if you can go back to 22, what did you wish you would have mastered? Better emotional health, mental, you know, mental cognition or the physical health, what do you wish you would have put more attention to then, to give you the benefits now and the rest of your Life to age 22, when you were 22? Yeah, you could go back and say, you know what the physical side of health, the, the emotional side of health or the, the brain health. Where would you put more attention to back then for yourself?

Personally, I, I mean, it's, it's a, it's a hard question. The, the, the obvious answer would be emotional health because of course I, you know, but, but, but of course, emotional health is an impossible thing to fix without awareness. So in this thought experiment, we would also have to assume that I'm given the awareness that I have a crystal ball that is going to show me the future and say to me, if this is not addressed, this is what is coming for you.

Well, I mean, you could have said that for your physical health too, if you would have not stayed healthy physically and been obese and had, yeah, you would have had suffering physically.

Well, but, but again, I, I sort of naturally did that anyway.

Got it.

So, so for me personally, I think that was the most, that was the biggest opportunity. But the catch is I would have had to convince myself to do it.

Right. And what would have those things been that you would have done differently with your emotional health that you feel like would have given you more, whether it be peace or emotional abundance or, I don't know, just a lightness or an energy that was different. What would you have done differently or coach yourself of doing?

Well, again, I, I, it would, it would only be me today who's able to go back and do this, but I think I would sort of say, look, I'm going to loan you money because you didn't have two nickels to rub together to go to therapy. And I want you to explore the roots of your anger. I want you to explore the roots of your perfectionism. I want you to explore the roots of your need to achieve. And I think if you can, if you can really explore what's at the root of that, you're, you're, you're still going to be able to do things. You're still, you're not going to lose the ability, you're not going to lose your drive to be a productive human being, but you'll do it less from a point of view. Rage and inferiority.

Where did those two things come from? The rage and inferiority?

I mean, I think, you know, there were just various elements of my childhood that just for reasons I'll never understand. Like what. You know, as you've discussed, I'm sure many times, like, you can put five people in the exact same situation, expose them to the exact same ingredients in the exact same soil, and they're going to sprout different plants. You just don't know why. For whatever reason, the set of circumstances I was in produced several phenotypes. You know, one of them was a sense of nobody will hurt me. So this is the, this is the armor that will protect me. One of them.

I'm not going to let anyone hurt me.

I will never let anybody do this. So there is. There is an enormous armor that will protect me. I think another one was, I will show them how good I can be.

Wow.

And so whatever it is I'm going to do, I am going to be the best person who's ever done that thing.

I feel like I have both those for myself, too. Yeah.

Yeah. I think a lot of people who go through that type of experience do. And of course, the, The. The kind of insidious nature of that type of narrative is that it's highly rewarded.

So there's a benefit to, to have.

There is an upside to that.

There's also massive consequences at prices we pay.

Yeah, there's collateral damage is the way I try to describe it. Right. It's like. It's like a tank driving through a city. It absolutely gets where it's going to go.

It gets your results.

Gets it. You're. The traffic doesn't stop you, but the body count in your wake, the damaged street, the damaged cars, all that stuff, no one's going to hit you when they run through the intersection. But, but all the, all the, the turmoil that you cause around you is. Is so problematic. But again, if the results are good enough, you kind of get to sneak your way through life. And most people kind of tolerate it, and only those people closest to you really see how bad it is. And, you know, and then you start believing a narrative that says, this is who you are. You just like, okay, yes, I'm not going to pretend I'm not, you know, I'm not going to pretend I'm perfect. But at the same time, you know, if to. To change this would be like, to change my height or my eye color. Like, I can't do those things.

This is identity about it.

This is, this is hardwired. Wow.

So you would have gone back and done some therapy back then and said.

A, you're not hardwired to be this way. B, let's understand what's driving this. C, I'm going to try to convince you that you can have a lot of the upside without most of this downside. But you're going to pay a price now. You're going to pay the fiddler one way or the other.

Right.

But if you pay them now, there's going to be fewer bodies.

Yeah. How long have you been doing therapy now?

Oh, at the level that I've been doing it, six years.

Six years?

Five, five and a half years.

What are the main benefits that you've seen physically, cognitively and emotionally through doing that practice?

Well, interestingly, I mean, I would say certainly I sleep better.

Really?

Yeah, absolutely.

Which helps your lifespan.

Sure, sure. I mean, I think that's, that's, that's, that's better. Secondly, and by the way, that's like the least of the benefits. Right. I'm starting with the low hanging. Right. But I think another thing is my, my, my body is less beat up. Like, I don't push myself the way I used to. If something doesn't feel right, I'll just stop doing it. I'm not.

You don't push your ego to the limit. Yeah.

I'm not proving anything to anyone. I just don't care. Like if I'm, if I set out to do deadlifts on Friday and my back doesn't feel great, I'm not doing deadlifts today. It's okay. I'll do split squats instead. It's fine. I can come back and try again next Friday. There is no ego involved in what I'm trying to do physically. All I'm trying to do is play the game, you know? You know, Simon Sinek wrote this book, Infinite Games.

Right.

My life has now become an infinite game. It's not a finite game anymore. I'm not trying to win, I'm just trying to keep playing. Obviously, the most important thing comes down to just the harmony in my life. Yes. So my life was a life that had no harmony. And now my life is a life that is mostly harmony. And when I do something to remove the harmony, I recognize it very quickly. And I'm very much in the mode of repairing it as opposed to digging my heels in and proving that I'm right.

Yeah. This is beautiful, man. So much good wisdom in this interview. We'll have to have you come back on for another episode. But I want people to get the book. Outlive the Science and art of longevity. Dr. Peter Attia. Make sure you guys get a few copies. This is the bible of longevity and living a better, healthier, happier life. So make sure you guys get this. Get a few copies for your friends and family. So much good research, science, seven years poured into this, but really a lifetime of, of wisdom and experience, but seven years in writing. So make sure you guys get this. Get it on audible if you want to listen to it as well. You've got an amazing podcast, you're on social media. How else can we support and serve you?

I think that's it. I mean, if people are interested in kind of the technical stuff around this stuff. Yeah, the Drive is a great place to. It's a great resource. We have a newsletter that comes out every Sunday. It's free, so it's just something you have to sign up for on our site. And yeah, we love creating this type of content. We really.

You're amazing.

We think that, you know, people absolutely have much more agency than I think they believe with respect to their health. I mean, most of what's in this book does not require a doctor. Right? You don't need a doctor to put in place what we're talking about.

Exactly. I want to acknowledge you, Peter, for your continual transformation. I think talking about the emotional health for me is really inspiring because that's what I've been up to the last few years as well. And what you said, harmony. I've never felt this much harmony in my life because I'm doing the emotional practices and it doesn't mean every moment I'm imperfect, but doing it consistently, just like doing the exercise and eating protein more consistently and all these other things give us longer benefits. So I acknowledge you for doing that, for talking about it as part of longevity and really quality of life, because who wants to live a long life if we're suffering? So I acknowledge you for everything that you've created in this book and also doing the emotional work for yourself, letting go of the need to prove and protect like I did for most of my life as well. And I asked you about your three truths before, so I'm going to link that up for people to go back and listen to the previous episode. Yeah, but I'm curious, the final question, what's your definition of greatness now?

I guess it's just being. And this might sound glib, but I, but I think there's, I think there's something to it. I think it's just being comfortable with who you are. And what I mean by that is not feeling the need to have the approval of others all the time. And so that can manifest as needing to have others who you don't know, like on social media, which might be the lowest form of that approval, but also even a harder level of that step is having people who you do know. And that might mean like going your own way when people think you need to do something else. So I think that's probably the highest form of greatness. I mean, isn't it Joseph Campbell who wrote, you know, the hero is the. Is the person who has the courage to pursue their own bliss? And what I realized was, you know, 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.