"USE THESE 4 Secrets To STAY HEALTHY Until 100+ YEARS OLD!" | Peter Attia & Lewis Howes

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, healthspan has three pieces, right? It's the.

I think you gotta have a dream.

The School of Greatness. Really?

Yeah.

Please welcome Lewis Howes.

Welcome back, everyone, to School of Greatness podcast. Very excited about our guest. His name is Peter Attia, and he is a physician focusing on the applied science of longevity and many other topics that he covers in his podcast called the Drive. 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?

You know, 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, you know, 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? It's the 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, 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, 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, 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 they're 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, you know, 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 you sort of reach one of these other types of death that precludes the cardiopulmonary death certificate death. 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 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.

Baby, keep me.

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 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, you know, 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. Right. 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, you know, somebody shows up with a heart attack. And by the way, for men, 2/3 of those were going to occur before the age of 65. So you show up with your first heart attack. You know, 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. You know, 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. 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. 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 the most rapidly increasing. 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, because that's the most common. 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, you know, 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. 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. 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. Yeah. So, you know, I just personally, it's not something I would think of as, you know, doing in abundance.

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.

Half Americans have type 2 diabetes.

No, are on that spectrum I've just described. Yeah, yeah.

The spectrum including.

So starting with elevated levels of insulin.

Daily, and then 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 carbohydrates, 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 2 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 that they have Frank. Type 2 diabetes.

How do you know if you have type 2 diabetes? Like, I don't even know.

How do you probably know?

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.

No, it's much, it's much more insidious than type 1 diabetes. And it's unfortunate that type 1 and type 2 diabetes share the word diabetes in their description because they're quite different diseases. So we'll put type 1 aside for a moment. But type 2 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 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 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 neurotransmitters.

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 also, it starts by acknowledging, you know, what the disease is. And it is a disease of carbohydrate intolerance. 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. Stop swimming. 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. Like, I don't get through a sprit swim practice without going through two liters of this crap. 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 2 diabetes.

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

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 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 it. Yes. And you can't do that acutely. So that's not something that can happen 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 2 diabetes gets glucose spikes. Yes, you're right. They eventually put that into fat.

Um, but in the short term, Break down quickly or. Yeah, okay.

Yeah, okay, okay. So what, 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, my, most of my swimming career kind of took place during my residency and shortly after. And obviously sleep deprivation was a big part of surgical training. And even when I finished my residency, or I should say when I left my residency and went into 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. I loved working, I love training. I just didn't. Sleep was just such an aggravating thing to me. I remember routinely I'd, you know, come home from work, it would be 11 o' clock at night, I'd be up at 4:30 for swim practice. Like 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 by to the tune of four hours a night. So that's pretty extreme, but only for two weeks. So if I just took, you know, 20 guys like you and took them from eight hours a night to four hours a night for two, 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 shock just by sleep depriving you. Yeah.

So reduce the ability to assimilate it.

Into, take that glute. 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. And there are some people for whom this is unfortunately an occupational hazard. People who work night shifts. It's going to be much harder to sleep during the day. People who had dumb jobs like me in residency, where you just don't get to sleep. So there are lots of people for whom this is an occupational hazard. And then frankly, there's the things that we're doing to ourselves. Too much time on Electronics. We know that 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 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, you know, so, so I'm kind of an early to bed guy. So I like to be in bed, but you know, by nine and absolutely no later than 10. And I'm kind of trying to be done by about six, which again is, I can do that most nights. And if I, you know, maybe one night a week, I'm going to be eating within an hour and a half of bed. 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 well better, or is the quality of the food before you go to bed matter?

Yeah, that's a, that's a really good question. The short answer is yeah, it does matter. So the 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. 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, honestly, it's like almost anything you're going to eat is going to come with something that's going to 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 want to have anything that's going to raise my blood sugar before bed. So, you know, I'd have an avocado before bed. I'd have 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 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, be alert, 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 rejuvenated by sleep.

Wow. Okay. I want to stay asleep for a second. I know you got the fourth one, which I want to close that loop, but do we, 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 later. So I just got back from like 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 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 the day to sleep. And I'm normally not a napper, but I made it a priority above anything else, including practicing 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.

Right. 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. So 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 kind of 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 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 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 hypersleep has been associated with poor outcomes. So, you know, there's an inverse U shape, 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 about 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 before 20.

Yeah, that'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 37 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 42ish, 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 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 3 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 for its to its advantage then and now, it's like it takes over.

It's a very good question. I really, I mean I could, I could sort of, you know, speculate on what it is, but I, 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 7 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. 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. Eh, 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, 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 and it gets harder the further, the further you are into the physiologic trap.

What are you doing to reverse it now that you've been experiencing this? 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 cycle sport. But I, you know, 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, ultra biking, ultra swimming, hiking.

That's. That's right, that's right. So I'd be 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 you know, 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. And it was actually James's work six years ago because I heard him speak at a conference 10 years ago, we became friends. 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, 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, the second, 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. 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. And not that I needed anyone other than myself to do these things because I'm very self motivated. So I don't like. But just as a joke, one day I asked my wife, I said, hey, do you know what my PR is for 20k?

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. Like, 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. Like, it's like literally the most important person in my life couldn't care less about this. 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, 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 four pillars. So the pillars being stability strength, mitochondrial or aerobic efficiency and anaerobic performance. And so each of those then has a super layered 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.

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 from 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 up 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 6.

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 standards is still quite a lot. But probably by the standards that you exercise, and certainly by the standards that I used to exercise, 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 devote 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 money that I'm going to 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 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 going to go and do that. And, you know, I want to climb Mount Everest. And that's going to require like, you might have a whole bunch of these bucket list things. And truthfully, I would say do them now because it's only going to get.

Harder because you're not going to be able to do it later. Yeah, yeah.

I mean, I don't think you're going to 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 going to 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 not. I think I have a subset of them for our patients in our 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 gonna 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 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 is. 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. The. There's. You could divide it into sort of internal versus external. Right. So I. I think of this in a. In a way that says, look, it's really more about a person's response to externalities. Right.

To the experience, the events, the.

That's right.

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. And now I think there are basically three. You can see I'm a very pillared, structured guy. Right. I like it. 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 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 going to go on offense. So you can't just sit on defense and say, I'm going to take it as it comes and what's going to happen is going to 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 going to be able to make it to live to 100. There are just some people whose genesis don't command that. And that's fine. You know, there are people out there who have so many, you know, 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, you know, 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.

The more I'm hearing you speak and the more I've done my own research, I'm not a medical professional, but I've interviewed a lot of incredibly smart people who studied this. It's. For some reason it's all coming back to emotional and mental health. Because if we aren't able to have control or learn to navigate our emotion and the way we think, then we're going to make bad decisions which will turn into bad results for our health and our life. Is this off that if we. The root being mental and emotional health is potentially the thing that could cure and help us live longer, but if we take care of everything else but that, then we're always going to go back to these negative patterns that hurt us. Or is that all?

I don't think it's off. I think they all have to be in place. I mean, I think the, you know, I'll share with you one sort of illustration. So I've been working on this book for four years now, and it's evolved a lot because it started out mostly just being a book about the science of longevity. So, you know, to me, a very, very technical book, but one that I was incredibly proud of and one that I think would have been read by the 15 most respected scientists in the field who would have thought it was amazing, and nobody else would have read it. So then it basically got reworked, and it became more accessible and more personal, and it kept getting reworked and reworked until it basically got to a point where it was a pretty good overview of every single thing we've talked about today, except for this emotional and mental health piece. And that's, you know, that's basically the piece that's delaying it. But it is that realization which said there could be no greater torture than to figure out how to live longer and how to preserve cognitive and physical health, but without that emotional peace being in check. In other words, to extend a miserable life is. Is. Is torture.

So at the. At the root of what we're trying to figure out here is how do we cultivate inner peace, inner happiness, peace of mind, peace of emotions during our life? That's a big component to healthspan, right?

It is. And I won't represent that. I fully have this figured out. I mean, in fact, that would be the hubris to declare. That would be embarrassing. But. But I think for me, I like the word joy because it just. It kind of captivates one of the things that I have found to be central in my journey in this space, which is it captures the piece about being with others that I've so historically ignored. You know, I had a. I'm very fortunate to have a few therapists. Three actually. So I actually have a therapist in each of those disciplines. Right. So I have somebody that I work with on the behavioral side, on the psychotherapy side, and on the pharmacology side. And the person who is my psychotherapist, so she's the one that I speak with weekly about this, you know, the how am I feeling?

Stuff. Yeah.

Her name is. Her name is Esther Perel.

Oh, I love Esther. I've had her on many times.

She's. She's. She's amazing. And, you know, she said to me a couple of years ago, maybe. Maybe two years ago, and she said, look, you know, you've run a playbook that has only had three plays in it. You've executed them as well as anybody could execute those three plays. But you were really at the end of this, and it's. And those three plays were Obsession, Detachment, and Rage. And that's it. Very expensive. Yeah. Those are the only three tools you have, and they're the only tools you've had since you were 5 years old. And you've gone very Far with them. But, you know, it's led to incredible isolation, incredible pain, and, you know, and all these other things. And it took a while to understand how that could be the case and how to begin to fix that. But as I. And it's not something that you change overnight, of course, but. But what I'm so much more appreciative of now is the fundamental difference that comes from fighting back, the urge to detach. So, again, this is just one very, very narrow example, but there are probably some people who can appreciate this, which is in periods of fear, it's sometimes easy to pull back and to retreat and. And to me, that's a joyless state. Right. That's basically saying, I don't want to be connected to anyone. I don't want to be relational. To borrow a word from another amazing therapist I had, Terry Real, who actually met through Esther. So once you sort of stop living a relational way, I just. I mean, it sounds very cliche for someone who's so interested in science as I am, but I think once you cease to live in a relational way, I think you're on that path to a very slow death.

When you isolate yourself more and you don't cultivate strong relationships. You die faster. Is that what I'm hearing you say? Or you.

Well, whether you fit. Whether you die faster in the dirts, in the death certificate or not, some data would suggest you do, but I think those data are difficult. Yeah. You suffer more, so what does it matter? Like, even if you don't. Even if you don't end up in a casket sooner, you might as well, because you're suffering.

You're suffering. Yeah. You're lonely, you're isolated. So what were the three.

And you're miserable and you're, you know. Yeah. Yeah.

So what were the three plays that you added to bring more joy in your life?

Well, I think it's. I think it's basically looking at how to reverse each of those patterns and working very hard to do so. And that's been a. That's been a lifelong, or I shouldn't say lifelong journey. It's only something I've been working on for three years, but it's. It's definitely harder than anything I've ever done.

So. So from rage to. What would be the opposite for that?

Oh, to. To an expanded emotional vocabulary. Right. So. So you could so, so rage. For me, think of a funnel where every possible, Every. Possibly every possible negatively valenced emotion funneled into rage.

Anger at rage.

Yeah. Anger becomes rage. Fear Becomes rage. Uncertainty becomes rage. Anxiety becomes rage.

Defensiveness becomes rage. Resentment. Yeah, rage.

Right. Okay. So, so the first step in that is, is mindfulness. So, so meditation, obviously is a very important exercise that we can do to learn how to stop and identify that. And so if you look at me today versus if you look at me three years ago when, you know, I literally was on the verge of, you know, killing somebody in a parking lot at some point. A big difference is now if something upsets me, I now have the gap between stimulus and response to examine the emotion and say, oh, you know, that email really upset me because the person implied something that is threatening to my credibility or something like that. Right. So it's like having the space to go through that process and then having the vocabulary now to do it. Now literally it means I've had to print out worksheets like I'm in grade school again with sheets. And I go through exercises. So I have homework every single week where I go through, okay, when this happened, how did you feel? What was that emotion signaling to you? So there's, you know, part of it is going through, going through that type of an exercise. So I think that's, that's been the biggest tool there. I think as far as the obsession goes, part of it has been, that's been more of a displacement. So that's been more of a, you know, I created a contract basically, much in the same way that a person who goes into a 12 step program does. So I do consider myself a recovering addict. And I just think that I've. I have more of a socially acceptable addiction. So I think.

Right.

We look at people, yeah, perfectionism and hard work are socially acceptable addictions, but the reality of it is they can be quite damaging to your offspring, which is, I think for most of us, our biggest fear is that we hurt our kids. And so after going into, you know, I did effectively go into rehab. And after doing that, I have a contract and I have people that function as my sponsors. And there has been some very, very deliberate changes in practices. And it sounds silly, but it had to start out with creating very structured things that, that you wouldn't think a parent would need to do, but, you know, mandatory 30 minutes of playtime each day.

I just think people have lost the art of joy and play. It's one of the reasons I have a. It's funny, I'm in this like, you know, high end condo building here in Los Angeles, right in the middle of Century City. I'm not sure if you've Been this area, but there's a lot of corporate buildings, and so everyone's in their suits and ties. And I literally am right next to my studio about two blocks away, and I have a scooter that I get on, not a electric scooter. I have like a manual scooter where I push myself on a scooter. I come down the elevator with a scooter and walk out my front building hallway, and there's literally every luxury car you can think of, every one of a kind. Lamborghini to Ferrari. It's kind of obscene. These types of cars that you see, the Rolls Royces, all of them. We're in, like the heart of Beverly Hills. And I come out on a scooter and I just don't care. I'm scooting around. I don't care what people think about me. I'm going to have fun because I've. I feel like a lot of people lost the art of being a child of joy of play. And I'm trying to enjoy it myself and also cultivate in others. Hey, it's okay to just be goofy and playful and have fun, right? So mandatory playtime, I think, is a powerful thing.

This is a big part of the playbook. It's just, it's, it's. I mean, it's, it's grunt work, actually, but it, you, you have to do it to create new habits, and it doesn't take as long as you would think. I thought it would take a lifetime to change. And yet I would say even. Even when I look at how much I've changed in the last six months, I would have never believed this much change was possible in this short period of time.

How important is health span and lifespan related to healing the past? Whether that be yesterday's past event, childhood, past relationship, past, all past hurt. How important is healing the past with healthspan?

I don't think first. Again, that's a very good question. Assuming we're not talking about things that are so suppressed that we can never understand them, but. But which we could debate how much that could still be impacting today. And the answer is, it could still be a lot, and it probably is. I'm a huge believer in understanding previous trauma. And in fact, I've interviewed several people on the podcast about that. Laurie Gottlieb, who I think you've had on the show, she's excellent. A very close friend and remarkable psychiatrist. Paul Conti, Corey McCarthy. I've talked about this with a lot of people. Corey was a guy who Was incarcerated for many years, kind of turned his life around in jail. But again, you could peg so much of his tragic life story to getting molested at a ballpark when he was a seven year old boy. I don't think you can disentangle these things. And just as I said at the outset, we're in a world where people don't want to talk about mental and emotional health as much. I think that's changing, by the way, and I think people like Laurie and Paul are a huge part of that change. I hope with that comes an understanding that we have got to figure out a better way to deal with trauma. And trauma is not all. Big T trauma. It's not all. Yeah, it's all. A lot of little T traumas add up. And most of us, I think, have had some sort of adaptations to things in our past that have come at a cost. And so a lot of those adaptations are positive, right? A lot of those adaptations are what got us through those things. And that's why I think many people are reluctant to face them and say, hey, this thing's bad. I mean, I certainly refuse to ever acknowledge any of my traumas as problematic, even though I always, I never had an issue not understanding what they were. But I just thought, well, they're very productive, like in a very convoluted way. They told a story that I thought was very good and they resulted in all of these traits like rage, obsessiveness and isolationism, where you got results. I got amazing results if, you know, you can put your head down and do anything. So it's when you sort of let that armor down, when you put that guard down and you allow yourself to sort of crack open. And Laurie wrote about this in a way that I thought was beyond amazing in her book, which is why I wanted to interview her. There's a particular story about two of the people she wrote about in her book that I thought most amazingly demonstrate how a traumatic past can just, you know, create for a devastating life. No matter the success, it feeds into all of the above. So I think that, to answer your question, does that impact the physical? Yes. Does that impact the emotional? Yes. And I'll share with you a story that I think even Paul and I discussed, which was about six years ago. I had a patient who had looked, you know, was really on the verge of being diabetic. So she wasn't, but she was close and she was probably 20 pounds overweight and was very frustrated because she was incredibly compliant with everything I asked her to do. Right. So, you know, I said, we're going to change your nutrition this way. She did it. We're going to change your exercise this way. I need you to sleep more this way. We did everything right and her numbers got a bit better. She didn't really lose any weight. She wasn't really feeling much better. And I was really feeling like if it were anybody else, I would say she's probably not doing what I'm asking. But I really knew she was. And one day we were just sort of sitting there talking and I don't know how it came up. I knew that her father had died when she was young, like in college, but something about the way it came up this time made me think it was creating a much bigger imprint that had been dealt with. Now she'd been on an antidepressant since college and this she's. Now she's in her mid-40s, so we're talking 25 years later. But I just wondered, I said, is there an issue here? Is there sort of a psychological pain that is literally impairing her body's ability to get better? So I said, look, this is going to sound crazy, but I'd like you to go and see this other doctor. He's a psychiatrist, but he's really, really smart. And I want to explore this mind body connection in a way that doesn't sound so hokey. Would you be up for this? And to make a long story, she said yes. And within a year you couldn't recognize her. Yes, he'd made changes in her medication. So maybe it's possible that some of the medic changing her from one type of antidepressant to another another could have made a difference. But I do believe that a bigger part of the difference was just that she got so much more in touch with what had happened and came to grips with it and had begun to work through that trauma, that kind of letting that go. And you've probably read the Body Keeps Score and there are lots of people who have really talked about this idea and I've seen now enough empirical examples of this that I'm inclined to believe this is true and therefore it shouldn't be ignored.

Huh. What do you think are the main causes of emotional and mental health disease? I guess what are the main causes of the lack of a strong mental and emotional well being, if you come.

At it through the lens of trauma. So let's take off the table for a second the sort of genetic causes, because there's a clear genetic relationship with mental health. So I know, for example, in my family there is a non trivial amount of genetic mental health problems. So I had an uncle who had schizophrenia. I basically have the following in my family. I think schizophrenia, depression, and probably maybe some bipolar. So there's clearly a genetic component. I'm inclined to think that trauma plays a great role in this. And I think trauma comes in different flavors. So the most obvious form of trauma is abuse. And abuse can be physical, sexual, spiritual. Those would be sort of, you know, obvious forms of abuse. Another one would be neglect. So neglect is a form of trauma. And that can be a kid who grows up in a house with two parents who never lay a hand on him or her, but completely ignore him and you know, don't parent him at all, or, you know, he's raised by a nanny, but you know, really never gets the attention that a child needs from a parent. Abandonment is another form of trauma. So this is different from neglect. This is, you know, obviously more extreme. And it's when a child is actually abandoned by one or more parents. Another form of trauma that most people don't think of is enmeshment. So this is when a child basically has to grow up too quickly and is forced into the role of sort of being an adult with one of their parents. And you know, that doesn't at all imply a sexual connotation or anything, but.

It'S, you know, the responsibility is very early.

Yeah, that's right. And also just the emotional burden that comes with it. Right. So, you know, an example might be a single mom who basically relies on her 10 year old son as her.

A confidant. Yeah, or whatever.

Exactly, as a confidant and complains to him about her boyfriend and you know, and basically makes, you know, he has to grow up far too quick and things like that. And then I think another part of trauma is basically witnessing tragic events. And that could be like in the case of my patient, you know, losing her father suddenly or, you know, post 9 11, many people were obviously traumatized by, you know, things like that. So there are lots of, you know, tragic events that can do it. Now within each of those, Louis, any two people can have a totally different response.

So based on your emotional tools that.

You have, based on your resilience to begin with. So again, one of my favorite examples of this is, do you know who Rick Elias is? That name ring a bell?

I'm not sure if I do.

So, amazing guy. He was on that USAir flight that crashed in the Hudson River 11 years ago, January 2009. He has a beautiful TED Talk. It's very short, it's like seven minutes long, that talks about it and it's titled something to the effect of the three most important lessons I ever learned in life. And it's basically what he learned in the couple of minutes thinking he was dead. Rick is one end of the spectrum. Right. He lives through this plane crash. That night he was back on a plane to fly home to Charlotte like crazy, you know. Right. Like four hours after he's almost dead, he's back on a plane flying. His life is taken off. They had a 10 year reunion for the survivors where they all got to meet up with, you know, Captain Sullenberger, you know, the guy who did this landing. Yeah, Captain Sully. You know, he mentioned to me there were people from that night whose lives have been destroyed and who've never been able to get on a plane since.

Oh, man.

So think about that for a second. The exact same experience will produce an entirely different set of responses in people. And that's why I think we have to be very humble when we think about trauma. And that's why I get a little annoyed when I hear people say, well, you know, this person had this happen to them and look at how great their life turned out. And somehow they say that as though to minimize what has happened to somebody else. And to me, that's just utter nonsense.

And judging people's experiences and making them wrong or telling them, you know, step up or whatever is what I'm hearing you say is not the best approach, which is probably something that I would have done in the past as this football mindset of like, just tough it up and quit being a wussy and, you know, quit crying about some scrapes here and there. But that's not the best approach.

No, it's not. It's not. It's not a great long term approach. We have to be. We have to be pretty nuanced in this and we have to be able to really kind of treat everybody's pain like it's their own pain and nobody else is. And now compare.

Yeah, I went through all these tragic events and I'm able to deal with it. But you went through this little trauma and you're stuck on this not doing that.

Yeah. The two fastest ways to not recover from trauma are to compare yourself to others and to minimize your pain. It sounds crazy, but the MO and I, you know, believe me, I went through, I could tell just horrible experiences of going through kind of this, this journey and, and having to, to fight the the fight, the urge to do those things, but just the constant desire to minimize and say it's not that bad, it's not that bad, it's not that bad, let's stop making a big deal out of this. Or yeah, but this person went through so much worse and, you know, none of that matters, you know, like this, this, you know, whatever. A hundred people on that airplane all experienced the same external truth, which was the plane crashed, but there's a hundred different internal truths that came out of that.

So emotional resilience is a massive key. And what I'm hearing you say in some of the ways to develop more emotional resilience is to have psychotherapy.

Pharma.

Therapy and behavioral therapy to gain tools, awareness, acceptance, forgiveness.

I would say when indicated. You know, certainly most people probably don't need pharmacotherapy, meaning they don't need any medications to aid in these things. But there are, you know, I mean, there is such an amazing toolkit of medications out there that do aid in the increasing this buffer, this, you know, what I think of as this bandwidth of distress tolerance. Right. So again, if you, it's the difference between, if you think about a person who can only live between the temperature of 97 and 98, boy, they're going to be in for a tough life compared to somebody who can live between 95 and 105. So similarly, a person who anytime they fall below here, they're going to be depressed and anytime they go above here, they're going to flip into a fit of rage. That's a miserable life compared to somebody who can live here.

What would you say are some of the things besides going to therapies as gaining tools? What would be some of the things that we could develop more emotional resistance or emotional fitness, as someone like Tony Robbins calls it, emotional fitness to be able to stay more calm on the range of emotions. Kind of like when you see Tom Brady where you throw an interception or you throw a touchdown, it's a similar emotion and not allowing yourself to get too high or too low. How do we. What are some key tools we could do to develop more emotional resistance in your mind from your personal experience?

You know, for me, I think it's been several things. I do think mindfulness meditation, so a Buddhist style of meditation or a Vipassana style of meditation has been very helpful because it is a tool that teaches you to examine your mind and that's, that's effectively what we're dealing with here. So when, when somebody is all over the place with respect to their emotions. What is probably happening is they're being hijacked by thoughts. That's generally what's happening. And that's okay because that's innate. Like, that's. That's as common as the day is long.

Is mental illness negative emotional fitness, I guess, is that our thoughts are being hijacked over and over in a negative way, and therefore we get stuck in states of depression or.

Yeah, this. And again, this is so complicated, right, because you want to separate out some of the really clear pathologic states that I think fall outside of the purview of this. But I'm, you know. But I think for many people, it's. You have a genetic predisposition to depression or dysthymia that then gets exacerbated with negative thoughts patterns. And so the question is, how do you break that cycle? I think step one is learning to recognize it. So just do you see it?

Being aware of your thoughts?

Are you even aware that you're thinking like, you know, I don't know if you meditate, Louis, but for most people, when they go, when they become early in their meditative practice, it's like the first time they realize how much they're thinking. Like, when they're not doing anything else, like, they're walking down the street and you realize, oh, my God, I'm thinking, you know, Dan Harris, who's a good friend. Dan, is one of my favorite people to talk about this stuff with because I think he's so down to earth in being able to communicate sort of the humor of this. Right? And his book 10% happier, which is actually the reason it was his book 10% happier that got me to start meditating. He just does such a funny job of explaining how ridiculous our minds are. Like the dumb, dumb, dumb stuff we keep saying to ourselves. Like the loops of just complete stupidity. Right? So step one is recognize that. Step two, can you not judge it? Can you instead just label it unemotionally? Oh, that's a. That's a planning thought. Oh, that's a regretful thought. Oh, that's a judgment thought. Okay? So that, to me, that's really hard to do. And if I can do that 20% of the time, I'm doing well. But being able to do that 20 or 25% of the time, which is probably where I am, has had, like, an 80% improvement in the quality of my life, which I actually wouldn't have expected that I would have thought you needed to get to 80% there to have 80% elsewhere. So it tells me that some of the other things I'm doing are probably moving the needle as well. And a big part there is journaling. Yeah. Another good friend I love a doctor.

Is telling us to journal. You know, I love a physician is telling us to journal.

Yeah. Have you interviewed Ryan Holiday?

Yeah, a few times.

Yeah.

So.

So, so, you know, this. Ryan is a big proponent of journaling and I find it to be really productive. And at times I go in a structured way, meaning, like there have been periods where I've said, look, I'm only. I'm. I'm gonna journal through these three things every single day. So I'm going to journal something that I thought about that upset me, something that I'm really proud that I did, you know, something blah, blah, blah, blah. And so you sort of force yourself to come up with these three things. But that becomes a very, that becomes a very good pattern because it now gets you into that thinking process. And then other times, like right now, I'm not doing structured journaling, but I'm doing, you know, really sort of deep, deep insightful journaling on sort of threads that are relevant and that I sort of bring into therapy and they become kind of the substrate for those discussions.

How important is it for you to have consistent therapy, whether it's weekly or monthly, but having something consistent to go to, to share thoughts, feelings and emotions and where would your life be if you didn't have it in a consistent base? Would you be able to do it on your own? Or is the accountability so much greater than self discipline, mental fitness? Before we continue this video, make sure to subscribe below and turn on the notification bell right now so you don't miss out on these great videos every single day.

There are some things that just naturally come to me and I don't need any accountability on them. So exercise is one of them. I love exercise. I've loved it since I was a kid. It's, you know, it's. There are probably times when it's bordered on unhealthy and addictive. That said, once a week, I still work with this amazing woman named Beth Lewis. And there's a great structure that's provided and she sometimes prevents me from doing more than I should and is constantly fine tuning and honing what I do in terms of mental health. I've struggled with this a lot in the sense that there have been many periods even recently where there's still a tiny bit of shame associated with it. Like there's this thing that says, man, why am I Not more together as a person. Like, why, why does my wife not need to do this and I still need to do four hours of therapy a week and am I going to be doing this for the rest of my life? You know, because I don't think there's ever going to be a day when I'm not going to be doing this therapy. Maybe it will be just two hours a week, but I don't, I've been. Personally, I'm not sure I see a day when I'll ever be, you know, just not, not doing it. I don't think it's possible. I, I think it's, I don't ever want to go back to where I was. So. So similarly, it's sort of like the alcoholic who says, I'm in a 12 step program. It's really working for me. I go seven days a week. Am I going to be going seven days a week in 10 years? Maybe not, but I'm probably still going to be going. And it might be once or twice a week.

Yeah. Well, it's interesting you say that because I wrote a book a few years ago called the Mask of Masculinity. Actually, three years ago this next week coming up is the anniversary. And it was all about the, the mask that men wear to project something, a false image in the world with their friends at work, sports, all that different stuff. And as I was doing this kind of book tour during this time, there was a lot of women that would actually show up because they wanted to understand the men and their lives better, why the men are acting this way, why they're not emotionally have a range of emotions, seemingly. And so the rooms were typically 50% men and 50% women. And I would ask the rooms, I would say, okay, for the women in the room, raise your hand. If once a week you get together with a couple of girlfriends or a girlfriend and you talk about your issues, your body image, your stresses, your concerns, your fears, your insecurities about relationships and career, almost 100% of the women raise their hand and I go, keep your hands up. If you do this daily, you're on the phone with a girlfriend, you have tea, you're eating for lunch, almost all of them keep their hands up. And I go, for the men in the room, put your hand up. If once a month you get together with a group of guy friends and you talk about your emotions and your feelings and your body image and your insecurities around this at work, maybe two or three people would put their hands up in the whole room. And I would say, are you guys part of a church group that kind of forces you and schedules this so you can show up and do this? And most of them, like, yes. Very rarely would there be men that say, I do this on a regular basis because I enjoy it. And imagine. And I would say to the women, imagine not doing this, only doing this once a month, never doing this once a year, 10 years, never talking about these things, how to make you feel. And I'm not saying it's right or wrong for what, the way men have shown up and the actions that men have done in history to harm people. But I tell women, they're like, yeah, drive me crazy. I would be unwell, I would be sick, I would be emotionally unstable if I didn't have a friend to communicate to. And whether that's therapy in a private setting or a friend you trust or a group of friends, I just think it's important to have these conversations and share and not hold back our shame because I think that's what makes us emotionally and mentally sick.

I couldn't agree more with that.

And I think it's important for men and women and all human beings to have some consistent conversations. And for you, it's been therapy that's works really well, and I think I'm a big proponent of it. So I'm glad you're talking about it. And I'm glad that this is the thing that's part of your book that you're adding more and more of this, because the more I hear you talk about these things, I just feel like the emotional resilience, it's like you can, even with some of your students, your clients, it's like you've given them all the practical things on the physical, the nutritional, and they still weren't having the ultimate breakthrough until the mental health, emotional health breaks through.

Yeah, I'm pretty privileged in that my patients give me an interesting insight into the world because many of them are very successful people. So many of them have. I've been able to learn at sounds awful, but at the expense of some other people, that all the success in the world isn't necessarily enough. So I've seen that money is virtually not correlated with happiness. And by the way, money is not correlated with quality of a person. So I've seen some people that are staggeringly wealthy who are the most beautiful souls you'll ever meet. And. And you know damn well that they were beautiful souls before they had money. Basically, money just became a multiplier of how good they are. And similarly, I've seen people that have a staggering amount of money and they're just the nastiest creatures on the face of the earth, and their money has just given them a megaphone to be more obnoxious. And the same thing is true of happiness and misery and all of these things. So I think the thing that has been sad to watch is the people who have, for example, in the case of resources, the ability to do so much for so many, but they don't understand how to share because they don't have this joy, right? Like, they just, like, you know, I mean, it sounds ridiculous to say this, but, you know, can you imagine meeting somebody who's. Who says, look, you know, I'm only worth half a billion and it drives me nuts, or I'm only worth $2 billion and I can't stand it. And I'm not saying that to be critical of them, by the way, because I would argue that I say things equally nonsensical, though maybe not about money, but it's. You sort of realize like that is important to address, that contributes to the quality of their life and in that case, probably to the quality of countless other people's lives. If their focus could shift.

If you could give one main thing for people to focus on in each of these categories, cognitive, physical and emotional resilience. If all they had time to get started was to think about one thing for each to apply to their life, what thing should they apply after this to improve the quality of their health span, which would hopefully improve the quality of their lifespan?

Well, maybe we could do it the other way. We could do it through the sort of through the food, the exercise, the sleep and stuff like that. I mean, on the food front, we didn't really talk about this, but I would say there's. I think there's sort of three variables that you're constantly able to manipulate with respect to food. One is how much you eat. Intake. Yeah, well, and just how much, Like a little bit or a lot. The second is when you eat, you know, do you go 12 hours not eating and 12 hours eating or 16 hours and not eating? You know, what people refer to as time restricted, feeding, and then the quality of what you're eating. So, for example, you know, are you like eating anything you want or are you limiting certain things in the nutrition? So we call that last one dietary restriction, the middle one time restriction, the first one caloric restriction. The most important piece of advice I would give on nutrition is you should always be incorporating one of those.

Restrictions.

One of those restrictions you should always be doing at some throughout the day, sometimes you should be incorporating two of them, occasionally incorporate all of them. So these days I am pulling very hard on my dietary restriction leverage. So I'm being much, much more diligent about what I'm eating.

The quality of your food.

The quality of my food is extraordinary. I'm not paying any attention to how much I eat. I'm just eating till the point where I'm satiated and I'm not paying outrageous amounts of attention to when I'm eating. So I'm not like fasting forever though. I probably only eat within an eight hour window most days, sometimes 10. But I'm not doing very long. I'm not certainly not doing any major fast or anything like that. But I'm really pulling hard on that dietary restriction lever. Now if I were to let up on that a little bit and relax a bit on what I ate, I would have to start pulling harder on the other two.

You would need to do longer times of restrictive or intermittent fasting.

Or just restrict the amount that I'm eating when I eat.

Of calories.

Yes, yes, exactly.

Interesting. So right now you're focused more on the quality of the food, which is one of those main foods that you're eating that you believe are increasing the quality of your health span and your lifespan.

So basically the things that I'm avoiding in spades are any form of refined carbohydrate. So I'm just not eating any junk food. I have zero added sugar in my diet at this point. So the carbohydrates that I'm eating are virtually all vegetables, plus berries, quite a bit of like macadamia nuts and almonds. I'm eating a lot of venison is, you know, is one of my main sources of meat, a lot of fish and Yeah, I mean like pretty, pretty simple, repetitive meals.

I eat the same thing pretty much every day. Chicken, broccoli and sweet potato. And I restrict the sweet potato at night.

Yeah.

And I'm just eating that pretty much throughout the day.

Yeah, I could probably eat the same thing. I'm sort of eating two meals a day and they're sort of being repeated. And what I'm avoiding is just what I'm prone to do during periods where I'm not paying enough attention, which is eating off my kids plates and nibbling on crap in the pantry between snacks here and there. Yeah, yeah, yeah.

So if you could. I asked this question to Rhonda Patrick and I said if you could only Eat five foods a day. That would help, you know, you be a healthier human being and live longer. What would those five be? I'm curious. What would those five foods a day be for you? That.

For me or for. Not so. Not necessarily, but for human beings? Well, it's hard, right? Because, you know, you know, you take somebody who has. As an APOE4 gene, you might have to deal with this in a different way. So I don't think one could actually answer that question definitively for people. I could tell you for me, what it would probably be if I had to limit myself to five foods. I would probably rotate. I'd say, oh, boy, that's tough if.

You'Re on an island and you gotta live off these five foods to have a quality of life.

So I'd take avocado for one because I could get a huge amount of monounsaturated fats. So I would want my. I need a spreadsheet to figure this out, Louis, because I would want 50% of my. I want 50 to 60% of my calories, probably to come from fat. And I'd want most of that to be monounsaturated. So I'd probably want the avocado to be high from a protein perspective. I'm a huge fan of eggs. I think the choline is an awesome source. You know, it just does so many amazing things for you. But I'm also a huge fan of salmon because of the dose of EPA and DHA that you can get at such a low mercury content. I'm also really, really fond of wild game, but I guess we don't want to waste all of that. In terms of a vegetable standpoint, now we're getting pretty limited because you want to be able to balance enough insoluble, insoluble fiber. You're certainly not going to waste it on something like lettuce. I'm a huge fan of, like, string brains, string beans, and broccoli. I don't know if they quite have the nutrient density. I guess I would say, Louis, I don't know that there's a way to pick just five things. Do a great job, but it's probably in the ballpark of what I just described.

I like that. What's your thoughts on fruit?

You know, it's one of those things that really fits into the category.

You didn't say fruit here at all.

Well, fruit wouldn't make my top ten. Not a chance. Right. So, you know, again, I think fruit being described as one homogeneous class of foods is as ridiculous as describing men as one homogeneous class of species. Right. Like, it just doesn't make any sense. Right. So, you know, to put, you know, blueberries and raspberries in the same categories as mangoes and bananas and grapes, they have virtually nothing in common. The latter is basically all sugar. The former is very little sugar. So if we're optimizing for antioxidants, then the goal would be to have as much of an antioxidant as we can have, but with the lowest cost possible from a sugar standpoint. And then the manner in which you take it dried food versus not, smoothies versus not. So, you know, the only thing that you can do to make fruit worse is to, you know, put it into a shake or, you know, to juice it. Right. So if you take the fiber away from it, that's the worst thing.

It's all sugar.

Yeah. You basically reduce the one thing nature put in there to regulate the speed at which it hits your liver. Your liver, of course, is the primary, though not the only organ that is responsible for metabolizing fructose, which is the primary sugar in fruit. So you want to think about fruit through that lens. So whatever benefits come in fruit, and there are certainly benefits, it comes at a bit of a cost, depending on your metabolism. So do I like fruit? Yeah, I like berries. I like an apple here and there. I mean, I love all fruit, but I'm not. I never eat dried fruit. And it's outside of, you know, when I'm on vacation, like, we, we, you know, we love going to Hawaii. And there's an area where you can get, like, your fresh coconuts. Yeah, yeah, yeah. When you can, when you can do that kind of stuff, I'm going to go all in, of course. But these aren't parts of my staple diet because the glycemic response is just too high.

So I've. I've heard this from other doctors that I've had on that are not a fan of fruit really at all. I mean, very limited fruits or smaller apples opposed to the bigger modified apples that people talk about. And, you know, I've had some backlash from people that are all fruit eaters who love fruit, who see the benefits of fruit, who are like, fruit is not the enemy. So don't say it is the enemy. What is the balance there? From your research on and the facts saying, like, okay, have some fruit every now and then, but every day, apples, bananas, lots of the dose makes the poison.

And it really comes down to the individual. I mean, I think the real Challenge is when people try to talk about things as universally true in science and especially in medicine. So we talked earlier about non alcoholic fatty liver disease. So this is the most rapidly increasing epidemic in the United States, bar none. In about a decade, it will be the leading indication for liver transplantation in the United States.

What is this called?

Non alcoholic fatty liver disease. So it used to be.

How do we get that?

Yeah, that's the great question. So it used to be that the only way you got fatty liver disease was from drinking too much. So a lot of alcohol led to fat accumulation in the liver, which ultimately led to scarring of the liver, which led to cirrhosis, which led to liver failure. You know, we're talking Mickey Mantle here. Which led to liver transplant. Okay. If you were lucky. So in the 90s, this other thing started showing up. It had probably been there longer, but we didn't really pick it up until the 90s. And we were like, but we're seeing a lot of people with this alcoholic fatty liver disease who claim to not drink, including little kids. What's going on? Couldn't be distinguished by the way from alcoholic fatty liver disease, but because it showed up so often in people who weren't drinking, it had to be renamed. Instead of being alcoholic fatty liver disease, it became non alcoholic fatty liver disease, or nafld. And we now know pretty clearly that fructose is probably the biggest driver of that, which shouldn't be that surprising given the similarity between fructose and ethanol. And so you would blame the majority of that probably on sugar intake, not necessarily fruit intake, candies, cakes, refined sugar. Absolutely. And by the way, not all sugar is created equal. Liquid sugar seems to be much more damning than solid sugar. So, you know, sugar, sweetened beverages, and juice would be the biggest culprits by far. So then the question becomes, well, what do you do about this? Well, we have patients with non alcoholic fatty liver disease. In fact, there's zero chance somebody listening to this podcast doesn't have non alcoholic fatty liver disease, given that, you know, at this point, probably 20% of the country has it to some extent. So if you have non alcoholic fatty liver disease, you should not be eating fruit. Like, that's as sure as God made little green apples. If you have nafld, you should not be eating fruit until that thing is better. You have to be restricting fructose. You have to be eating more choline, you have to be probably restricting calories in general. You have to be exercising where you'd be doing a lot of things because you're on a very slippery slope towards diabetes along with the liver damage that comes with it. It. Now, at the other end of that spectrum, if you're metabolically healthy, fit as a fiddle, can you be eating four or five servings of fruit a day? Sure. So, you know, nobody's right when they say it's all this or it's all that. You got, you got to know how to, you got to know how to tailor the therapy to the individual and then identify who's at risk. And, you know, again, like our patients with non alcoholic fatty liver disease, we are limiting them to less than 10 grams of fructose per day, which, you know, if they wanted to use it all in fruit would be like a handful of berries.

Like a bite of an apple would be that.

Yeah, I mean, maybe a bit more. But you know, you have to make the exception because as you said, there are other forms of carbohydrates that still come with sugar. Like most bread is still going to have some sugar in it and you want to make those allowances if they're still consuming things like, like bread.

What about rice?

So rice doesn't have any sugar? No, rice is pure glucose. So that, you know, that still can contribute to diabetes wildly if you're an individual who's susceptible. But it does not seem to contribute to NAFLD as much. And this was demonstrated pretty elegantly by three people on two very well done studies. By disclosure, I led an organization that funded one of those studies, so I have to disclose that, but I had no part of the studies that looked at kids with NAFLD and asked the question, if you just restricted fructose but not glucose, could you fix it? And the answer appears to have been yes. In other words, in the kids with nafld, you didn't have to restrict carbohydrates in total, you just had to restricted fruit. You just had to restrict the fructose. So in those kids, at least the rice and the potatoes were still okay, but you had to cut the fruit, especially the juices and the sugars to fix the problem.

And what's the difference between fructose and glucose?

So they look very similar, but they're slightly different as a molecule. Fructose is sweeter. Sugar is made up of one molecule of each. So fructose, sorry, when fructose and glucose are connected, that's what makes sucrose or sugar, table sugar or high fructose corn syrup to a first order approximation. But the biggest difference, the bar none, heavyweight champion Difference is every cell in your body can metabolize glucose and we have an infinite capacity to store it. And it's not toxic in any way you can. You can make, you, as you know, fat as can be, because as you noted, eventually you'll put it into your fat cells, but there's no toxicity associated with it in that sense. Whereas fructose can really only be metabolized by the liver in any meaningful quantity. And its metabolic byproducts are quite toxic, uric acid being an awful metabolic product of it. And as you start to accumulate it, it becomes quite inflammatory. So as the liver starts to accumulate fat, fat, it becomes very inflamed. And this, this fat accumulation leads to another process called steatosis and ultimately cirrhosis. So it's a much bigger problem.

So sugar is death, essentially. The more sugar you eat, the worse you are.

There's zero upside to consuming sugar. And there were varying. But there are varying degrees of downside depending on the individual individual. Right.

So the upside is it feels good for the moment, it tastes good, and your brain gets a hit of adrenaline or dopamine or whatever, and that's. And then the other 99.9% is a downside.

That's right. And for some people, there's, you know, relatively small downsides there. There are some people for whom, look, they get away with it and it, you know, doesn't cause big issues. And that's great. You know, probably 10 to 20% of the population is largely immune to the metabolic downsides, but for most of us, that's not the case. And there is a toxic dose. And I don't mean acutely toxic, I just mean chronically toxic.

Yeah. And how much of an impact does sugar make on our mental and emotional health?

Well, I mean, I think there's certainly emerging data that is, there was a paper that actually just came out two weeks ago looking specifically at fructose metabolism in the brain as one of the very important pathways of promoting Alzheimer's disease. In fact, I think there's a subset of Alzheimer's disease that is effectively an energy disorder disease. So in other words, there's a subset of Alzheimer's disease that looks like diabetes in the body. So you could think of it as this brain diabetes. So in that subset of people who are really becoming susceptible to that illness, you couldn't do anything worse than continue to consume sugar. And that says nothing, of course, on the short term side, as you said, you know, for many people, sugar creates highs and lows. That probably itself doesn't lead to emotional lack of resilience, but contributes to it indirectly by probably narrowing somewhat that band of tolerance that we have. Most people agree when they eat better they cope better with stressful things and also most people acknowledge that when we're under stress we tend to drive ourselves towards short term comfort foods and we stress eat to get that short term hit that you referred to.

I feel like we've just scratched the surface of so many topics I want to go down but hopefully we can get you back on for another two, three hour interview because I felt like this went by like that but just scratching the surface. Peter, I really appreciate this. I've got two final questions for you. Before I ask those, I want to make sure people check out your content. Peter Attia Drive the podcast. You're going to get a lot more information on this. Go check out that podcast there. Also, you're on social media a lot. I love your article about Topo Chico and the downside potential downsides of sparkling water. I'm a big sparkling water guy myself. You have a fascinating blog where you write about a lot of this stuff with research and the science backing everything. Make sure to check out your website Peter atiamd everywhere, Twitter, Instagram, Facebook as well with lots of great content and hopefully the book coming out in the next year.

So make sure to be maybe 2.

Be on the newsletter, subscribe to the podcast so you can stay up to date when that comes out. This is a question I ask everyone at the end. Two questions. This one's called the three Truths. So I'd like for you to imagine for a moment a hypothetical question scenario that you live as long as you want. You figured out the rules of hacking of living, health, span, lifespan. You're 150, 200. You're as old as you want to be and you're healthy. But for whatever reason, it's your last day and you've accomplished every dream. You've put out all the content you want to put out there. You've got a great family, life, everything. But for whatever reason all your content has to leave this world and no one has access to your information anymore. The interviews are gone. Videos, books, they're gone with you to the next place. But you get to leave behind three lessons that you've learned that you would share with the world and this is all we would have to remember you by. Are these kind of three lessons or what I like to call the three truths? What would you say are your three truths?

So we didn't talk about this Today. But I think an important principle of knowledge acquisition is differentiating the search for truth versus the need to being right. So I would say the first thing is knowing the truth is more important than being right. I guess the second one we did talk about today, which is that the pursuit of joy is a good thing, although we didn't get into it. You know, there's a belief, I think, that many people have that says because joy would reduce productivity, would reduce drive, would reduce ambition, or all of these things, I'm not convinced those things are true. And even if they are, who cares? And then I think the final thing, which at least to date has been a big part of this journey, has been realizing that eulogy virtues matter more than resume virtues. So if you think about who are those people that are going to be there at the end and what's going to matter to them versus what your CV says, that is a principle that I think is worth preserving.

Those are beautiful. I love those three truths. Peter, I want to acknowledge you for a moment, man. This has been highly insightful for me, very powerful, and I'm just so appreciative of your joyful drive to finding the truth, doing the research, diving in to serve all of humanity, and serving us to live healthier lifespans and longer lifespans. So I really acknowledge you for the gift you are and the curiosity and the effort you put in now, gratefully, in the last couple years in a joyful state to serve humanity. I really think that more people need to be like you. So I'm grateful for you, your existence, and for being here. And my final question for you is, what's your definition of greatness?

I think it has two components and I want to make sure I represent that. I've never figured out how to achieve this, but I've seen it. I've been able to see it on a couple of occasions and it's really special. The first is the obvious one, which is domain mastery, right? It's like a true mastery of whatever the domain is, whether it be intellectual, physical, whatever. But the few people that I've seen that I think about as great did something beyond that, which is they do it with a level of humanity that elevates everyone around them to a place where those people have also never been before. So we do see great athletes who do this, but just as much we see great community workers who do this. I mean, there's this, this missionary doctor who's one of my heroes in this world, and these people are exceptional at what they do. But equally important is they somehow everybody around them is at their best when they are in their orbit. So to me, it's those two things that are almost impossible to find together.

That's cool. Peter Attia, thank you so much for being here, my man.

Thank you for having me.

If you're looking for more greatness in your life, make sure to check out this video right here. And also check out our free PDF. The three secrets to unlock the power of your mind. To help you change your life. Download it right here.