The LIFE-EXTENSION Doctor: "The ONE thing that's increasing your chance of early-death by 170.8%!"

Dr Peter Attia 0:00 Going from zero activity to just 90 minutes a week is about a 15% reduction in all cause mortality.

Steven Bartlett 0:08 Jesus Christ.

Dr Peter Attia 0:09 Dr. Peter Attia-

Steven Bartlett 0:10 World-renowned physician.

Dr Peter Attia 0:12 The go-to doctor for anything performance or longevity related.

Steven Bartlett 0:15 He has the secret for living a long, healthy and happy life.

Dr Peter Attia 0:18 Most people listening to us are gonna die from cardiovascular disease, cancer, diabetes. If we want to really figure out a way to live longer, we need a totally different playbook.

Steven Bartlett 0:28 How early do some of these diseases begin?

Dr Peter Attia 0:30 The minute you're born. We only really think about the risk over a 10-year time horizon. As a 30-year-old, you don't get excited about exercise and your sleep, but there's a 400% higher risk of dying in the coming year when you compare the fittest 2.5% to someone at the bottom 25%.

Steven Bartlett 0:48 In the coming year?

Dr Peter Attia 0:49 And then once you hit the age of 65, if you fall and you break your hip, there's a 15 to 30% chance you will be dead within the next 12 months.

Steven Bartlett 0:58 Really?

Dr Peter Attia 0:58 You have to realize you're taking this for granted.

Steven Bartlett 1:02 Shit. When you talk about the deterioration of health, you have these three categories. Emotional health deterioration. Why have you included that?

Dr Peter Attia 1:08 Because despite being very physically healthy, I was not living a good life. I was in such an awful cycle of anger, workaholism that I don't think my marriage would've survived. I realized, I don't want to be this person and lose my kids. I don't think I could've survived it, and I'm sure many people listening to us can relate.

Steven Bartlett 1:26 Were you able to discover the root cause of that?

Dr Peter Attia 1:28 More than that, I was able to get rid of it.

Steven Bartlett 1:30 How?

Dr Peter Attia 1:31 So what you really need to do is-

Steven Bartlett 1:34 What are the biggest misconceptions in your mind about weight loss?

Dr Peter Attia 1:37 I have thought a lot about this, so-

Steven Bartlett 1:42 Dr. Peter Attia. He is the man that wrote the book on how to live a long, happy and healthy life, and he argues that everything we know about health and what that actually means, health of the mind, the body and the emotions, is wrong and outdated. He says that there's disease growing in you and me right now, but the problem is because we can't see it, we're doing nothing about it. Dr. Peter's work turns the light on. It allows you to see that in many cases, inaction now will increase your chance of disease and a much shorter life by 70%, 170%, and in some cases, if we don't take action now, by 400%. I've had lots of conversations on this podcast about health, about diet, about all of these things, but for many of you, this one will be the one that changes your life. This will be the one that makes you ask some difficult but important questions about your health and what health means for you. I walked away from this conversation realizing that if I don't take action now, I'm going to be forced to take action then, and I can unequivocally say that this conversation has changed my life. I have a suspicion it's gonna change yours. (instrumental music)

Steven Bartlett 3:26 Peter, Dr. Peter, you talk about so much in your work. I've been through every interview you've done, your book, other conversations you've had. You talk about a lot, so many things that I'm absolutely fascinated by. My first question for you is, what is your mission and why are you doing this?

Dr Peter Attia 3:50 I think that, um, there's no greater, um, desire for people, uh, than to be healthy, um, especially when you consider how we can define health more broadly than just physical health. Once you can include kind of emotional health, um, it's kind of the great equalizer, and nothing else really matters if you don't have it. Right? So it doesn't really matter if you're famous or not famous. It doesn't matter if you're rich or poor. If, if, if your health is compromised, and anybody who's been through an illness where their health has been compromised, uh, I think will realize in a moment what they've taken for granted, and I, I've just become personally endlessly fascinated by this topic, and in my own quest to understand this better and better, the next natural step was to begin to do it as a doctor, right, to begin to kind of help patients with this. And at some point, you can only treat so many people, and so podcasting and ultimately writing a book just became a way to put as much of that information as possible out there for more and more people to access.

Steven Bartlett 5:03 Do you know why you of all people became fascinated by this?

Dr Peter Attia 5:06 Yeah.

Steven Bartlett 5:06 Was there a set of dominoes that fell?

Dr Peter Attia 5:08 I think so. Yeah. I mean, I think, um, you know, I had always been interested in performance, um, because I'd always, you know, at least as, as far back as, you know, being 12 or 13 years old, you know, I'd always been obsessed with one form or another of, of some sort of physical, uh, obsession, whether it be, you know, boxing when I was really young or marathon swimming later in life. But when my daughter was born, when I was 35, uh, that was the first time that everything kind of pivoted and I had a little bit of a, a glimpse into the future, I would say, and I just sort of realized, oh, you know, the, the joy I'm experiencing in this moment is so surprising to me, so unanticipated, and I really want to be able to experience this again, which means not just with other children of mine but potentially with grandchildren.And on top of that, I had a bit of a wake-up call which was, I realized that all the men in my family died prematurely of heart disease. Uh, obviously I knew that fact before this time, but I think it was the confluence of those two things. It was the realization that, yeah, you know, if you don't figure something out and do something about this, you're probably gonna die of heart disease in your 60s, which is not that far from now, you know, 25, 30 years from now. And, you now really have a motivation to live longer and to live better longer. And so that, in many ways, kind of began the change in my direction, my focus, to, to being one that was not purely just focused on performance anymore, but sort of focused on understanding health in a different way.

Steven Bartlett 6:52 This concept of Medicine 3.0 is a c- concept which I only discovered in your work. I've never heard the term used before. Um, what is Medicine 3.0, and how did you get to the point when you realized that there needed to be an iteration on the current system of medicine?

Dr Peter Attia 7:09 Yeah. Uh, uh, the reason I think you hadn't heard of it before is I don't think it's been described before, (laughs) so you can't be faulted for that. Um, but as I began writing the book and thinking about how I was practicing and how people like me practice, I realized that it is a very distinct change from the current form of medicine. And in a way to not be just critical of the current form of medicine, I had to put it in the context of what existed even before that, and that's how I sort of realized, well, we're in this version of medicine called Medicine 2.0, but it's following something called Medicine 1.0, and it's an enormous improvement above that. So, maybe I can spend a moment just kind of explaining what those three are, and I think that's probably the easiest way to explain the current form. So, um, Medicine 1.0 is everything that existed before we really understood the science of medicine. So, for most of human history, we had no idea why people got sick, or why people died, or what an infection meant, and we sort of thought that these were plagues from the gods or things of that nature. But a couple of things happened in the past, you know, 100, few 100 years. Uh, the first was the idea of a scientific method, something that we take for granted today, where you can make an observation about something in the world, formulate a guess, called a hypothesis, about why it's happening, and then design an experiment to test it. That's called the scientific method. That's an invention. That's a creation. We had to figure that out. Also, things like a light microscope, which, you know, up until 140 years ago or so didn't exist, allowed scientists and doctors to be able to actually see these microscopic things called bacteria. And then ultimately, the development of things like antibiotics and eventually vaccines. All of these things made an enormous difference in reducing the suffering and death due to what I call in the book fast death. So, fast death is pretty much how we used to all die. Fast death would be trauma and infection, and up until about 150 years ago, life expectancy would've been high 30s, low 40s, and most of us succumbed to fast death. But with the advent of Medicine 2.0, through all those transitions I just described, in the span of a few generations, we've doubled life expectancy, right? So now, life expectancy is roughly twice what I just said a minute ago. And most people do not die from fast death, but it's been supplanted by slow death. Today, most people listening to us are gonna die from cardiovascular disease, from cancer, dementia or other neurodegenerative diseases, complications of diabetes, and on the one hand, that's a sign of progress. It means like, hey, we're living long enough to die from those things. But we've made scant progress against those things. In fact, if you go back and strip out the top eight causes of infectious death or communicable death, death from communicable diseases or infectious diseases, today if you strip them out, our life expectancy is not much better than it was in the 1800s. In other words, that doubling of life expectancy that we've experienced comes almost exclusively to the reduction of those fast deaths, and has little to do with any success we've had against slow death. If we want to really figure out a way to live longer, and I would argue more importantly live better, meaning when we're in the last decades of our life, not be in a state of total decline, we need a totally different playbook, and that playbook is Medicine 3.0, and it involves real prevention, so that means taking true step- steps at prevention very early in life. It also involves being very personalized in how you do things. So, it means you can't just do paint by numbers. You can't just sort of say the same thing to everybody. Um, clearly there are certain things that make absolute sense across the board, such as sleep and exercise, you know, but the way you might use medications is gonna have to be much more tailored to an individual.

Steven Bartlett 11:36 You say that there are, there are four points to Medicine 3.0, which is the prevention, um, being unique in your t- treatment, um, to each individual, an honest assessment and acceptance of risk?

Dr Peter Attia 11:48 Yeah. One of the things that I don't think we think enough about as doctors sometimes is, is risk, right? Now, w- I think doctors are very good at thinking about the risk of doing something.

Steven Bartlett 12:00 Yeah.

Dr Peter Attia 12:00 Um, I think, you know, usually a doctor is pretty good at understanding, you know, if you have this surgical procedure, there's a risk of an infection, there's a risk of bleeding, there's a risk of all of these things. If you take this medicine, there's a risk of this side effect or that side effect.... but I don't think we spend enough time thinking about the risk of not acting, or the risk of not acting when we do. So, this is where I think it gets a bit more nuanced. Um, prevention doesn't come without risk, right? I mean, you're still gonna have to do something-

Steven Bartlett 12:33 Mm-hmm.

Dr Peter Attia 12:34 ... in, in the state of prevention. Um, so the question is understanding the time horizon upon which you're considering risk. So, I'll give you one very specific example. Um, at least in the US, and it might be the same in the UK, um, we only really think about the risk of heart disease over a 10-year time horizon. So, look at someone like you.

Steven Bartlett 13:00 Mm-hmm.

Dr Peter Attia 13:00 You're 30 years old, right? So, what is your 10-year risk of having a heart attack? I can tell you without knowing anything about you, it's really low.

Steven Bartlett 13:12 Good.

Dr Peter Attia 13:12 It's as close to zero as we could have-

Steven Bartlett 13:15 Okay.

Dr Peter Attia 13:15 ... in medicine. But what if I did a blood test on you and I found biomarkers in there that were predictive of very high risk later in life? Now, that would be actually quite possible. There's, there's about a 1 in 10 chance you might have a biomarker called Lp (a) , for example, which is just a, a certain lipid in your body. About a 1 in 10 chance you have that dramatically increases your risk of cardiovascular disease.

Steven Bartlett 13:44 My uncle died very early, I believe, in his 50s of, of a cardiovascular disease.

Dr Peter Attia 13:48 Hmm. Interesting. So, knowing that, by the way, could be helpful, 'cause that would prompt me to ask you more questions and wanna know more about all the people in your family. So, here we have a 1 in 10 chance, and by the way, we wouldn't leave it to chance. We would just check it, and we ... let's say we checked your level and you had that, you had that lipoprotein-

Steven Bartlett 14:06 Mm-hmm.

Dr Peter Attia 14:06 ... or you had an elevated level of another lipoprotein, apolipoprotein (1) b. And again, these are kinda technical terms, but they're very common things, and they're easy to measure. The medicine 2.0 view here would be, well, there's nothing wrong with you now, and there's not going to be anything wrong with you for the next 10 years. We don't need to do anything about it. Conversely, if I take a lifetime view of risk, I would say, yeah, but the risk to something happening in the next 40 years is actually quite significant. So, my risk of doing nothing is probably much higher than my risk of doing something today. So, my risk of doing something today would be non-zero but small, but my risk of doing

Dr Peter Attia 14:51 nothing, if I take the appropriate time horizon, is much bigger.

Steven Bartlett 14:55 This is one of the things in your book that really, really got me thinking, was I have to say, and I believe a lot of people probably feel the same way, I've gone through my life thinking, to some degree, I'll worry about avoiding these diseases later.

Dr Peter Attia 15:09 Hmm.

Steven Bartlett 15:09 I'll, I'll, I'll ... when I get to 45, then I'll start taking this thing seriously (laughs) 'cause then I'm getting into that territory where most people I know that get cancer or Alzheimer's or all of these cardiovascular things, that's when it tends to happen, so I'll think about it then.

Dr Peter Attia 15:25 Totally understandable. Um, and I'll frame this in the context of a question I get asked all the time, which is, "Hey, Peter. When is the best time to start thinking about this stuff?" And I say, "Look, I can't answer that because there are two competing issues that are crossing." When I meet somebody who's in the last decade of their life, do you know how much they are thinking about this? Like, it's all they're thinking about. It's all they're thinking about. Every minute of every day is a confrontation with their own mortality. The problem is, they don't have much time to change the direction of the ship.

Steven Bartlett 16:11 Hmm.

Dr Peter Attia 16:11 You may recall in the book, I write the, sort of, I use the metaphor of the Titanic, right? It's not that the Titanic didn't see the iceberg. It's that it didn't see the iceberg in time. It didn't have enough runway to really move out of the way, and that's why the Titanic gashed the side of the boat. Now, at the other end of the spectrum, a 30-year-old like you has unbelievable potential to change the arc of your life. You have so much runway to, through manipulating nutrition and exercise and sleep and stress and all of these things, to completely alter the t- the disease trajectory of your life. The problem is, and I'm not just speaking to you personally, but, uh, more broadly to someone who's as young as you, it's harder to find the motivation because there are no reminders of your own mortality. You're Superman, right? The worst thing that happens to you is a hangover.

Steven Bartlett 17:11 Hmm.

Dr Peter Attia 17:11 So, I always get asked, like, "When is the right time to start worrying about this?" And the sh- the short answer is, look, as soon as possible, but then there's a reality that says, for most people, it's not until they're in their 40s. Maybe once they have kids, that they start to appreciate their own mortality and that that provides some of the motivation to say, you know, maybe I'll be a little less focused on optimizing everything for today, and I'll start thinking a little bit about tomorrow. So again, another way to think about this is saving for retirement. A lot of people in their 20s and 30s, who are making good money, aren't necessarily taking the most prudent financial steps to ensure financial freedom when they're in their 70s. Because, let's be honest, it's more enjoyable to spend money today than to set some of it aside. But there are a lot of people later in life who think, "I wish I was a little bit more responsible earlier on."

Steven Bartlett 18:08 How early do some of these disea- if you, if you looked at my sort of metabolic health, or if you were able to look inside my body, which I'm sure you're able to do, how early do some of these c- diseases begin?... in my, in my life? At what age do you see some of these things coming?

Dr Peter Attia 18:23 Yeah, it's super interesting because there are some elements of you as a person that are going downhill the minute you're born, and there are others that are not. So, let's, let's use two examples. Let's start with something where your body is getting better and better and, um, you know, you're probably only peaking now, but you haven't really started to age. Um, your muscle quality.

Steven Bartlett 18:52 Mm-hmm.

Dr Peter Attia 18:53 Okay? So, when you were five years old, your muscle quality was nothing like it is today. But as you enter your 20s, the quality of those muscle fibers, these type 2, 1, these type 1 and type 2 muscle fibers, so these are kind of slow to fatigue, but high endurance fibers are the type 1 fibers. The type 2 fibers are very, very powerful but they're kinda quick to fatigue. The quality of both of those fibers is very high and the more you train them, the higher quality they will be. But as you enter your 30s, you will now start to experience a shrinkage of those type 2 muscle fibers. You will be less powerful in your 30s, in your late 30s especially, than you were in your mid to late 20s. So, that's a form of aging.

Steven Bartlett 19:42 Mm-hmm.

Dr Peter Attia 19:43 You are declining. It's not an accident that the most powerful athletes in the world are at their peak in their late 20s and early 30s. So, sprinters, for example.

Steven Bartlett 19:52 Mm-hmm.

Dr Peter Attia 19:52 That's a prime example of a pure, pure power sport. Um, we look at other things like more of your muscular endurance, that will peak even a little bit later. You can keep that going a little bit later. We look at certain forms of cognition. So, if we look at something called fluid intelligence, right? This is raw horsepower, processing speed. You have more of it right now than I do, meaning you're gonna have faster processing speed, better memory, all of these things are gonna be better when you're 30 than at my age. I'm 50. Because that's already started to decline in me. There are some things, however, that begin aging in you the minute you were born, and one of them is actually going back to this idea of atherosclerosis or cardiovascular disease. Well, that's an example of a disease process that begins right away at birth, and even though it almost never rears its head as far as death before you're 50, make no mistake about it, it's starting on day one. And we know this, by the way, because when we look at studies of people who die from completely unrelated reasons, so somebody who, you know, dies in a car accident or soldiers dying in war, and we look at their, the arteries of their heart, we already see quite advanced disease.

Steven Bartlett 21:13 Really?

Dr Peter Attia 21:13 So, the truth of it is, you already have pretty significant disease in your coronary arteries. It hasn't risen to the level of ever causing a heart attack and it's unlikely to do so for another 20 years, maybe even another 30 years. But-

Steven Bartlett 21:30 It's compounding.

Dr Peter Attia 21:31 It is compounding, exactly.

Steven Bartlett 21:32 Like money.

Dr Peter Attia 21:32 And if you want to live to be 90, free of cardiovascular disease, it makes a big difference if you can slow it down when you're in your 20s and 30s.

Steven Bartlett 21:45 Interesting. That's really what I'm trying to change in myself is I'm trying to find the motivation. Like you said, when we're, when we're not confronted with our mortality. It's interesting 'cause my life changed because of the pandemic.

Dr Peter Attia 21:55 Mm.

Steven Bartlett 21:55 In part because I got to see, um, the relationship between things like obesity, poor metabolic health and mortality for the first time, and that's really when I started working out, uh, ev- pretty much every day now. It was three years ago in March 2020 to 2020, when I was watching the TV, and it was that confrontation of like, oh my God, the reason why I'm having a better outcome with this disease is because I'm in better, um, metabolic health, metabolic shape. And it's funny that it has to take those things in our lives for us to make the changes. Quick one before we get back to this episode. Just give me 30 seconds of your time. Two things I wanted to say. The first thing is a huge thank you for listening and tuning in to the show week after week. It means the world to all of us and this really is a dream that we absolutely never had and couldn't have imagined getting to this place. But secondly, it's a dream where we feel like we're only just getting started. And if you enjoy what we do here, please join the 24% of people who watch this channel regularly and have hit that subscribe button. It means more than I can say, and if you hit that subscribe button, here's a promise I'm gonna make to you. I'm gonna do everything in my power to make this show as good as I can, now and into the future. We're gonna deliver the guests that you want me to speak to, and we're gonna continue to keep doing all of the things you love about this show.

Steven Bartlett 23:14 Thank you. Thank you so much. Back to the episode. When you talk about the deterioration of health, you have these three categories: cognitive decline, um, decline in loss and function of our physical body, and then emotional health deterioration. Why emotional health deterioration? Why- why do you add that back?

Dr Peter Attia 23:28 You mean why have I included that in-

Steven Bartlett 23:29 Yeah, why have you included that?

Dr Peter Attia 23:31 Well, I mean, maybe I'll just take a step back and say where I kinda put these all in perspective. So, you know, the, the title of the book, right, is Outlive: The Science and Art of Longevity. And what is longevity? Well, longevity is really about two things. It's about the length of life and the word for that is lifespan.

Steven Bartlett 23:52 Mm-hmm.

Dr Peter Attia 23:53 But it's about the quality of life, and the word for that is healthspan. And it's healthspan that has those three components you just described.

Steven Bartlett 24:01 Mm-hmm.

Dr Peter Attia 24:01 Healthspan, meaning quality of life-

Steven Bartlett 24:03 Mm-hmm.

Dr Peter Attia 24:04 ... is determined by your cognitive function.

Steven Bartlett 24:06 Mm-hmm.

Dr Peter Attia 24:06 So, what's your processing speed? What's your executive function? What's your memory? All of these things. It's determined by your physical health. How much strength do you have? Are you free from pain? How much endurance do you have? What, what capacity do you have to do whatever you want to do physically? Are you limited in any way by pain, strength, movement, balance, et cetera? And then the final piece is emotional health. What's the state of your relationships? Are you...... do you have joy in your life? Do you have a sense of purpose? Are you happy? Um, not all the time, right? Do- but do you have the capacity to regulate your emotions?

Steven Bartlett 24:46 Mm-hmm.

Dr Peter Attia 24:47 And so now to answer your question, why would that be included? Well, the truth of the matter is, it wasn't something I always included, right? It wasn't something I necessarily thought much about until it was, I think, very starkly pointed out to me by a very astute therapist who, in observing my own struggles in life, said something to the effect of, "Isn't it really ironic that you are putting so much energy into helping people live longer and yet you are paying no attention to your own misery?" And I think that was, you know, and that was about six years ago, and that was kind of when I realized I needed to rethink my approach to this problem, and as I write about in the book, I think I would make the case today that if your emotional health is suffering, none of the others really matter that much. So what you really need to do is think about a way to have all of these things in order.

Steven Bartlett 25:49 What did you mean by your own misery?

Dr Peter Attia 25:52 Well, I mean, I think at that point in my life, I mean, I, there's- there's no two ways about it. I mean, I was just incredibly miserable, incredibly angry, um, despite being very physically healthy, right? Despite doing all of the important things to be physically healthy, right? Exercising, uh, you know, in all the right ways, eating well, sleeping well, optimizing every aspect of my health, um, but- but living a- living a bad life.

Steven Bartlett 26:21 What were the symptoms of that? What were the kind of, for you to start to spot that? 'Cause sometimes we don't know in our own behavior and sometimes it's reflected back on from other people. We'll get feedback from our- our wife or our girlfriend or-

Dr Peter Attia 26:33 Yeah. I mean, detachment from others, um, prone to anger, workaholism, um, selfishness. You know, it wasn't- it wasn't subtle. It wasn't like, "Hmm, I wonder if, you know, I'm not being my best self." No, if I- if I was being honest and confronting it, I w- I was not- I was not living a good life.

Steven Bartlett 26:56 Did you know that in the moment? Had I asked you in the moment, "Are you happy?" what- what would you have responded?

Dr Peter Attia 27:06 I think I would have probably said to just that question, "Sure," right? But- but I think to a deeper prodding, um, no. And- and there were- there were a lot of things that happened in there, but- but certainly a very powerful one was going to the funeral of, um, a woman my age who was the mother of my daughter's best friend. So my younger daughter's best friend, her mom died of cancer, and so w- all the parents, you know, were at the f- were at the funeral. And at the time, I was, you know, really going through a lot of difficulty, um, in my own marriage, and this woman who died was a very successful lawyer, um, r- really pretty remarkable, and I was really sort of struck how at the funeral people had the nicest things to say about her, what a beautiful mother she was. She had three kids. And nobody talked at all about her career. Like, there was not a single word about her achievements in life. It was only a discussion about the quality of her life as a mother. And that might sound very obvious because when was the last time you were at a funeral where they talked about someone's career accolades? But that, in a moment, really fused an idea from a book I had just read by a guy named David Brooks called The Road to Character. I don't know, have you read it?

Steven Bartlett 28:53 No.

Dr Peter Attia 28:54 In the book, David Brooks talks about this idea of there being, um, resume virtues and eulogy virtues, and I really understood in that moment that my entire life at that moment had been only predicated on boasting my resume virtues. I had never spent a moment thinking about my eulogy virtues. And at that moment, to your question, if someone had asked me, "How is your eulogy?" I would have been brutally honest and said, "It is awful." There is not a single nice thing anybody who matters about me... In- in other words, of the people who should matter most, they won't be able to say anything nice about me.

Steven Bartlett 29:44 Is that painful to admit?

Dr Peter Attia 29:46 Yes, it's painful to admit today, and it was painful to acknowledge then.

Steven Bartlett 29:52 Wow, I'm so impressed that you're able to. Because I- thinking about cognitive dissonance and how psychologically uncomfortable that must be to face, you hint in the book about, I think it was in the last chapter of the book, you- you start hinting about the origins of that behavior, the workaholism and all of those things, and I can totally relate. I think I'm a total workaholic. I think I sacrifice too much in the pursuit of, like, accolades sometimes in my life. Everyone that knows me, including these guys, will all say that about me. (laughs) Um, and I've often tried to, in hindsight, figure out where that came from in me and undo that.

Dr Peter Attia 30:30 Mm.

Steven Bartlett 30:31 Well... It's funny because reading this book, the last chapter, I actually wrote in my notes, I rem- I just wrote, 'cause the chapter is called Emotional Health, I wrote, "Brackets, Trauma," and the role that trauma plays. I didn't expect to find...... that subject matter in this book, about longevity. Um, what's your thoughts on the role trauma plays and how we go about understanding it so that we can live a, have a long health span?

Dr Peter Attia 31:01 I think there's probably a lot of people who can relate to the stuff I write about in the final chapter. And you're right, that chapter is a significant deviation from the first 16 chapters. So there's 17 chapters in the book, and I, I basically make the argument that I am the doctor for 16 of them. The first 16 I'm talking about this as though I'm the doctor, you're the patient, I'm gonna help you, and this is how to do all the stuff. And then in the final chapter, I'm saying, actually now I'm the patient and I'm gonna kind of walk you through this journey I've had, and hope that it basically motivates each of you to have a similar examination of yourselves. And, um, I, I think that many people, I can't tell you what fraction of people, but I think many people have maladaptive behaviors in their life that are indirectly or directly the response to something that we would define as trauma. And, and trauma's a very vast, uh, concept, right? I think it's very easy when you hear the word trauma to think of abuse.

Steven Bartlett 32:13 Mm-hmm.

Dr Peter Attia 32:14 And, you know, that can be physical abuse, sexual abuse, spiritual abuse, these things like that. And it's true, I did experience abuse in my life. Um, but trauma can be much more than that. Trauma can be abandonment, uh, enmeshment, witnessing tragic things. So there are lots of things that are traumatic, I discuss them in the book. And what happens to children who are traumatized, and it can also happen to adults, but I think most often the formative years of our lives are when these things happen, is we, we adapt. And I think that's the kind of remarkable thing about us, is how adaptive we are.

Steven Bartlett 33:00 Mm-hmm.

Dr Peter Attia 33:01 And those adaptations can often be very positive, but a lot of times they have negative collateral or maladaptive consequences in addition. And some of those adaptations that are negative are addictions, some of them are other maladaptive behaviors like anger.

Steven Bartlett 33:24 Mm-hmm.

Dr Peter Attia 33:25 Uh, some of them include, you know, things like codependency.

Steven Bartlett 33:28 Mm-hmm.

Dr Peter Attia 33:29 So you can sort of look at people and realize that, hey, you know, maybe that person who grew up in the home of alcoholics, even if it was an otherwise reasonably well-meaning home and it's not like they were getting hit with a belt buckle every night, but they weren't getting the type of attention that they needed. And their adaptation was to have an attachment disorder that wouldn't manifest itself really fully until they were a parent.

Steven Bartlett 33:55 Mm-hmm.

Dr Peter Attia 33:55 So this, this type of analysis really, I think, everybody needs to spend some time thinking about it, and needs to spend some time asking themselves, "Hey, which of my behaviors are maladaptive?" And it's something that's done, and I think it needs to be done without judgment.

Steven Bartlett 34:12 Mm-hmm.

Dr Peter Attia 34:13 This isn't about saying, "I'm a bad person because of X, Y and Z," even though I think I can objectively look back at my own behaviors at that time in my life and say, "Those are awful behaviors. I'm not proud of those behaviors." But it's separating the behavior from the self. It's not saying, "I'm a horrible human."

Steven Bartlett 34:29 Mm-hmm.

Dr Peter Attia 34:29 It's saying, "I'm a human who did horrible things, and I want to understand why."

Steven Bartlett 34:33 I love that approach, because, uh, I think about the maladaptive behavior patterns I had that stood in the chance, stood in, stood in the way of my chance of emotional health and good relationships, and a lot of those stem back to my childhood and, um, what I witnessed in my home, and then the sto- the way that made me adapt and the beliefs it gave me about romantic relationships, for example. So I became totally avoidant of those until later in my life when I realized this p- pattern. Um, the third point in your, in your list of things that cause sort of, I guess, longevity of one's health span is that emotional health deterioration. So before we get into the other two, my question really was, on that third point of emotional health, what for you has helped you to, um, self-analyze and become aware, and to then get those things out of your way that stand a chance of costing you your emotional health? Was it therapy? Was it introspection? Is it journaling? Is it honesty with oneself?

Dr Peter Attia 35:31 Well, I mean, in my case, I think the situation was so far gone that I actually had to go away on two occasions. Um, so I, I had to go away and, uh, and, and, the first time for two weeks, uh, to an inpatient, like, what's called a residential care facility, which was two weeks of, like, 14 straight days of 14 hours a day just doing trauma therapy in group and individually. And, uh, you know, two weeks might not sound like a long time, but boy, that was about the most brutal, exhausting thing I'd ever done in my life. And then again, I had to do it for three weeks at a different facility, so again, 21 days of inpatient treatment, but also now really learning what the tools were to manage myself. How, how do I fix that behavior? How do I, how do I manage it? So it's sort of like you have an injury, you go to rehab, you know? There's an acute healing phase, but then there's a, well, now you wanna make sure you're strong and that you don't injure it again, 'cause that injury took place because of...... some weakness. And, and that's not a, not a perfect analogy.

Steven Bartlett 36:49 Mm-hmm.

Dr Peter Attia 36:49 But the point is, you know, there's a reason that your shoulder separated.

Steven Bartlett 36:53 Yeah.

Dr Peter Attia 36:54 And we wanna make sure it doesn't happen again, even once you're better.

Steven Bartlett 36:56 And you sent yourself there, twice?

Dr Peter Attia 36:59 Yes and no. I mean, truthfully, I don't think I had a choice. I don't think my, I don't think my marriage would have survived. So, I, I think it was, um... (clears throat) I, I'm not sure I had a choice, truthfully. So I went very reluctantly. I did not wanna go.

Steven Bartlett 37:18 But it was, there was a, an ultimatum, essentially?

Dr Peter Attia 37:22 Yeah.

Steven Bartlett 37:23 Wow. What was the, the greatest, sort of gift that process gave you?

Dr Peter Attia 37:29 Oh, it, it gave me my life. (pause) I mean, it literally saved my life.

Steven Bartlett 37:39 Really?

Dr Peter Attia 37:40 For sure.

Steven Bartlett 37:44 How?

Dr Peter Attia 37:47 Well, I don't think, (pause) I don't think I would be, I just don't think I'd be alive today without it, right? I think had I lost, I mean, I was on such a, I was on, I was in such an awful cycle of shame and self-loathing and deterioration that I don't think I could've survived it.

Steven Bartlett 38:12 So was that wha- that was the narrative in your head at the time? That you, when you talk about shame and self-loathing, that's what the, the voice in your head was...

Dr Peter Attia 38:20 Yeah. The, the voice is, "You are an awful human being. That's why you behave this way. And there's nothing that can be done about it. You, you're born this way. You, you are defective, and this is what defective people do." Look, in many ways, it's a lack of accountability, right? It's sort of saying, "You have no agency in this. You, you can't change this because you are, you're defective. When they do an autopsy on you, they will see something in the temporal lobe of your brain that explains your pathology."

Steven Bartlett 38:57 Were you able to discover the root cause of that narrative in your head?

Dr Peter Attia 39:02 Yes, absolutely. And, and more than that, I was able to get rid of it.

Steven Bartlett 39:08 Really?

Dr Peter Attia 39:08 Yeah. I'll give you one very tangible example. I had a very, very vocal inner critic, um... And I think, I'm, I'm sure many people listening to us can relate to that, which is, you know, I was such a perfectionist. I was such a workaholic, but any mistake I made, I would eviscerate myself verbally. So, and this was, I mean, this is mistakes that don't matter, okay? (laughs)

Steven Bartlett 39:42 Mm-hmm.

Dr Peter Attia 39:42 So, one of my hobbies is archery. I love archery. So every day, almost every day, certainly if I'm not traveling, I'm gonna be out in the backyard shooting my bow and arrow. Now, does anybody else care? Nobody, right? (laughs) Is, does my livelihood depend on this? No. But if I'm not shooting well, I am screaming at myself. I will break an arrow over my thigh, and these are carbon arrows. They'll leave welts the size of your finger. One of the exercises we had to do was, and this was once I left the second therapy place that was three weeks, so the, one of the big realizations there was that this was happening. 'Cause that voice, like I didn't realize that that was unusual.

Steven Bartlett 40:33 Mm-hmm.

Dr Peter Attia 40:34 So the exercise was every single day until this voice goes away, which I thought would never happen, which meant I thought I was signing up to do this exercise for the rest of my life, you take out your phone and you talk into the phone with a replacement voice for that voice, and pretend you're talking to your closest friend as if it were them who made the mistake. And I say, "Hey Chris, I know you're having a bad day today. I can tell. It's hard. You're not shooting well. It's okay. You know what? Some days it's just not gonna go well. Plus, it is a little windy today, let's be honest. That makes it a bit harder, and why don't we just pack it up and come back and try again tomorrow?" You know, just talk in a-

Steven Bartlett 41:26 Mm-hmm.

Dr Peter Attia 41:26 ... kind way. Talk in the way you would literally speak to your friend. And then I would send that recording to my therapist. So every day my therapist is getting multiple versions of these voicemails. But this is important because I'm audibly doing this.

Steven Bartlett 41:40 Mm-hmm.

Dr Peter Attia 41:41 Multiple times a day. And within about four months, the voice just went away.

Steven Bartlett 41:50 Really?

Dr Peter Attia 41:50 Yeah. And it's never come back.

Steven Bartlett 41:54 How has it changed you as a father?

Dr Peter Attia 41:55 Oh my God, it's a, it's a, it's a... How has it changed me as a person, right? As a father, as a husband, as, as a boss, a- a- as a friend. I mean, it's, it's just, um... Again, it, it makes me a little sad to think, "Oh God, I, I wish I knew this when I was, I wish, I wish I did this at 25." You know? Instead of all of this, again, I'll, I just think of all of the collateral damage in my life, you know? All of the people near me who have suffered unnecessarily as a result of, you know, of, of, of, of me being a wrecking ball. Um, how much of that could've been prevented? This, and in some ways this kinda comes back to your very first question, right? Which is, "I'm 30, I'm invincible, how do I get excited about this?" Look, maybe the answer is, as a 30-year-old you don't need to get excited about, you know, your nutrition and exercise and your sleep as much as a 50-year-old does. But-... a, there's a lot of benefit to doing so 'cause you'll get more benefit from it. But maybe it's just focusing on emotional health so that you get yourself fixed before you start a family.

Steven Bartlett 43:04 Mm-hmm.

Dr Peter Attia 43:05 Because I think, you know, and, and I think, you know, I feel lucky, I think my kids are still young enough. I hope that my kids don't have too many memories of their, of their dad in that, in that state.

Steven Bartlett 43:17 Your belief about where that came from, although there's no evidence, there's no memory of, of anyone, you know, saying, "Oh, well this happened." And whatever else. But is your belief that you weren't born with that, and that something might've happened and you've kind of inferred that in some way?

Dr Peter Attia 43:32 Yes. I think that was a really, really important breakthrough that happened on the 19th day of that second stint I had in therapy, in that inpatient therapy session. So that was a 21-day program that I assumed was only gonna be 14 days, and at the end of 14 days they, they needed me to, they wanted me to stay another week. Everybody wanted me to stay another seven days, and I was so reluctant at this point. I was exhausted. I just didn't think I could do it again. Uh, but they were adamant that I stay another week, and I knew the first time I had gone for two weeks and left, I left kind of against their recommendations, and I realized I never really got fully better. I got somewhat better, but not fully better. So I decided to just submit to them and say, "Okay, fine. I will stay as long as you tell me to." And it was on that 19th day that I had perhaps the single most important revelation. For me. Again, this is very personal and, uh, uh, the point of this is not that everybody else is gonna relate to this, it's only that I hope everybody else is willing to consider their own version of this. But what I, the, the last thing I could never let go of was that I was born as a perfect child, right? Like, meaning, we all are, right? Not just me. But all of these kind of maladaptive behaviors were the result of things that I didn't deserve, and again, it's not all what we call capital T, traumas. It's not, it's not necessarily the abuse. I mean, I think in my case, perhaps the most impactful things of my childhood were, were more like neglect. And not, not traumatic neg- not like the kind of neglect that's go- that has you, you should be taken out of a house or anything like that. I'm just talking about not getting a certain type of attention that I probably should've had, and for whatever reason, that manifested itself in really odd behaviors that as a kid I just said, "Those are just bad behaviors, but that's just who I was." And I think what I realized is, and what I finally came to accept is, no, those are adaptations to something that you didn't deserve. And that might sound like a very subtle distinction, but it made all the difference in the world, and it made me realize, in part by, by looking at my own kids, that, you know, there is a real innocence to children that can very easily get injured, and, and, and when it does, they're gonna make sure that they don't get hurt again. And, and the way they're gonna do that is, as I said initially, in their best interest, but ultimately it tends to result in really negative consequences for the way they formulate relationships with themselves, with, for the way they form relationships with others, for the way they're going to parent, for the way they're going to be a husband or a wife. Um, and so that was a, that was a huge breakthrough.

Steven Bartlett 46:47 So important and so powerful, and I, I don't, I don't think I've ever said this but really thank you for sharing that because, um, I got a lot from it, and I've had lots of conversations about this, but I've, I got a lot from that, uh, specifically that point about, um, didn't deserve for it to happen, and really it's a response that's trying to make sure you don't experience that pain again. So it's really, again, it's your body is, is doing everything in its power to help you and to protect you, and some of these behaviors end up being maladaptive which then stand in the way of your chance of emotional health. That is the third category of deterioration, which is the emotional health deterioration. So let's go a little bit earlier in the book and let's talk about

Steven Bartlett 47:24 the decline and the loss of function of our physical bodies as well. Um, med- med- Medicine 3.0 as we talked about earlier, you talk about these five core things that help to increase our chances of longevity as it relates to our health spans. What are those five things?

Dr Peter Attia 47:39 Well, there's the one we just talked about, right? So all the tools that deal with how do you improve your emotional health.

Steven Bartlett 47:44 Yeah.

Dr Peter Attia 47:45 Again, most of modern medicine only thinks abou- oh, m- you know, if you think about where does Medicine 2.0 rank on that-

Steven Bartlett 47:52 Mm-hmm.

Dr Peter Attia 47:53 ... it doesn't really except in the arena of mental health, right?

Steven Bartlett 47:57 Mm-hmm.

Dr Peter Attia 47:57 When it comes to clinical depression, anxiety, personality disorders, you know, bipolar disorder. There, we have a branch of medicine called psychiatry that deals with those things. But outside of that, medicine doesn't really deal with people like me. You know, I, none of my problems, quote-unquote, rose to the level of, you know, a clinical diagnosis that would require medical therapy.

Steven Bartlett 48:21 Mm-hmm.

Dr Peter Attia 48:22 Okay. Tool two, exercise.

Steven Bartlett 48:25 Mm-hmm.

Dr Peter Attia 48:25 Again, we can talk a lot about it if you want, a little about it, but the point is, it is not remotely given anything beyond lip service by Medicine 2.0. Medicine, you know, if you go to your doctor here at the NHS and say, "Okay, tell me what my workouts should be." Like, "Good luck." Right? "How much time should I be spending in zone two versus zone five? Like, "What type of lifting sh-" I mean, there's no way they're, they're going to give you that type of insight or specificity. Uh, the third one is nutrition.

Steven Bartlett 48:55 Mm-hmm.

Dr Peter Attia 48:55 Again-... sure, every doctor's gonna tell you, "Eat less, exercise more." But they're not really, for the most part, going to be able to help you manage nutrition. Certainly, I didn't learn anything about nutrition or exercise when I was going through my medical training, and most physicians don't. So, I'm not saying that there aren't doctors out there who don't understand these things. What I'm gonna say is, they had to learn that stuff on their own outside of their-

Steven Bartlett 49:17 That's crazy.

Dr Peter Attia 49:18 ... traditional training.

Steven Bartlett 49:19 So crazy.

Dr Peter Attia 49:20 The fourth one is sleep, and that fits in the same category. Sleep is an essential pillar of health, but we learn nothing about it in our medical training. In fact, most of our (laughs) medical training is paradoxically sleep-deprived.

Steven Bartlett 49:33 (laughs)

Dr Peter Attia 49:33 So, it's sort of, it's a great irony. The fifth and final thing that you have as a tool in the longevity toolkit is, is all the molecules. So drugs, hormones, supplements. And there, that's the one thing you sort of do learn in traditional medicine, is you, you at least learn about the, the pharmacologic side. But you don't really learn anything about supplements, so most doctors don't really understand much about supplements. And interestingly, most doctors don't really understand a lot about hormones as well. Um, so Medicine 2.0 is, is good at what it does, but it's very limited. So it's kind of like having a contractor that only has one tool instead of five tools, and as we discussed earlier, I think they're applying those tools too late

Dr Peter Attia 50:16 in the game.

Steven Bartlett 50:17 How can you prove... Let's start with exercise then. How can you prove to me that exercise is important?

Dr Peter Attia 50:22 Yeah, it's a great question. So start with, the easiest way to do this is to look at what, um, the absence of exercise does versus looking at the absence or presence of other known bad things. Now, for me to explain this, I have to explain a technical term called a hazard ratio. So if you'll bear with me while I explain what a hazard ratio is, it will reap lots of fruit later on. A hazard ratio is a mathematical derivation that comes from looking at a group of people, following them prospectively, following them into the future, and looking at the rate at which they die. So a hazard ratio is a number. If that number is 1.5, it means that there's a 50% increase in the risk of death for one group versus the other. So for example, if we want to know, is smoking bad for you, we might ask the question, what is the hazard ratio for smokers to non-smokers when it comes to getting lung cancer?

Steven Bartlett 51:36 Okay.

Dr Peter Attia 51:36 And the answer is like 10.

Steven Bartlett 51:39 Really?

Dr Peter Attia 51:39 It's 10 times more. You're 10, about 10 times more likely to get lung cancer if you're a smoker than if you're a non-smoker. Now, if you look at the hazard ratio across the course of life for all causes of death, it's about 1.5, meaning a smoker is about 50% more likely to die in any given year than a non-smoker.

Steven Bartlett 52:02 Which you call all- all-cause mortality.

Dr Peter Attia 52:04 All-cause mortality is the gold standard for understanding death and disease 'cause it takes into account every form of death.

Steven Bartlett 52:11 Okay.

Dr Peter Attia 52:11 Okay. What if you have Type 2 diabetes? Everybody understands that having Type 2 diabetes is very problematic, and people with Type 2 diabetes are at about twice the risk, more or less, of cancer, heart disease, maybe one and a half times the risk of Alzheimer's disease. But when it comes to all-cause mortality, every cause of death, it's about a 1.4 hazard ratio.

Steven Bartlett 52:36 40% more likely-

Dr Peter Attia 52:37 About a 40% increase in all-cause mortality. Again, that's a stark number. It means at any moment in time, if you take two people who are ev- in otherwise always identical, but one has Type 2 diabetes and one doesn't, this person has a 40% higher risk of dying in the coming year.

Steven Bartlett 52:53 In the coming year?

Dr Peter Attia 52:54 Yeah.

Steven Bartlett 52:54 Jesus Christ.

Dr Peter Attia 52:55 Yeah.

Steven Bartlett 52:56 Wow. I can't-

Dr Peter Attia 52:56 Okay. We could keep doing this. What if it's high blood pressure versus normal blood pressure? That's a hazard ratio of about 1.2. 20%, same, everything I just said, but it's 20%. Okay, what if it's someone who has end stage kidney disease? Their kidneys don't work anymore. They're on dialysis, hanging by a thread, waiting for a kidney transplant. It's about 2.7.

Steven Bartlett 53:23 Jesus.

Dr Peter Attia 53:23 That's a 170% increase in all-cause mortality in the subsequent year. Okay. Now, let's talk about some other things. What if I ask the question, what happens if I take a group of 50-year-olds, pick any age, pick any sex, and we're gonna take the top 15 to 20% in strength and compare them to the bottom 15 to 20% in strength for that age and sex. What's the difference? What's the hazard ratio there? What would your guess be?

Steven Bartlett 53:59 Uh, 20%? 10%?

Dr Peter Attia 54:02 Yeah, so you, 1.1 to 1.2?

Steven Bartlett 54:04 Yeah.

Dr Peter Attia 54:05 Yeah, it's three.

Steven Bartlett 54:06 Shit.

Dr Peter Attia 54:07 200% difference in all-cause mortality.

Steven Bartlett 54:11 Can you make a distinction between strength and muscle mass?

Dr Peter Attia 54:15 Okay. Yep-

Steven Bartlett 54:16 Just-

Dr Peter Attia 54:16 ... we can do it. So muscle mass, just, if we did it just on muscle mass, it's about two.

Steven Bartlett 54:22 Okay.

Dr Peter Attia 54:22 Or a 100% difference. So muscle mass turns out to be an amazing proxy for strength, but strength is even better.

Steven Bartlett 54:29 Okay.

Dr Peter Attia 54:30 Yep. So high strength and high muscle mass produce a hazard ratio of about 3.5.

Steven Bartlett 54:35 Okay, 'cause you can have a lot of muscles but not be strong.

Dr Peter Attia 54:39 Yeah.

Steven Bartlett 54:39 Kind of.

Dr Peter Attia 54:39 And you can be strong and have not as much muscle.

Steven Bartlett 54:43 Okay.

Dr Peter Attia 54:43 And that matters more, by the way.

Steven Bartlett 54:45 Okay.

Dr Peter Attia 54:45 But, but they're pretty tightly correlated.

Steven Bartlett 54:47 Okay, cool.

Dr Peter Attia 54:47 Yeah. Now let's look at VO2 max. So VO2 max is the best tool we have to measure peak cardiorespiratory fitness. So this is a test that you actually have to take. It's, it's done on a treadmill or on a bike. They put a mask on your face, and then the mask measures how much oxygen you use.... so in the book, I talk in great detail about this test. It's something anybody can do. It costs probably a hundred quid. It's not, like, super expensive. Um, and everybody should know their VO2 max. I really think everybody should know it. And in the book, I even offer some ways that you can estimate it just by running at a track or something like that. So-

Steven Bartlett 55:25 Sorry, it's the, the measure of how much oxygen you're inhaling and exhaling or-

Dr Peter Attia 55:28 No, yeah. It's the difference between how much you inhale and exhale, is how much you're using.

Steven Bartlett 55:33 Ah, okay.

Dr Peter Attia 55:33 So the way the- the way the test is working is there's a little oxygen sensor. So if you're breathing in, we know that the air you're breathing in is 21% oxygen and we know the flow rate. And we... Let's just say you're- you're blowing it out at 14%, so we know you used up 7% times the flow rate. We figure out how many liters per minute of oxygen you're using at the max.

Steven Bartlett 55:53 And what's good and what's bad?

Dr Peter Attia 55:56 Yeah. So it depends on your age and sex, but at your age, so for a 30-year-old male, we would say, oh, I need the... The table is in the book. Um, really, eh, I could estimate it. 60? F- 50... 56 would put you in the top 2.5%.

Steven Bartlett 56:15 And that means that I'm-

Dr Peter Attia 56:16 Oh, sorry, what's that number mean?

Steven Bartlett 56:18 Yeah.

Dr Peter Attia 56:18 That's 56 milliliters of oxygen per kilogram of body weight per minute.

Steven Bartlett 56:23 Okay. So a- a high number is-

Dr Peter Attia 56:25 How much do you weigh?

Steven Bartlett 56:26 Uh, none of your business. (laughs) I'm joking. (laughs) 90... How many kilos-

Dr Peter Attia 56:30 I think-

Steven Bartlett 56:30 I think I'm 96 kilograms at the moment.

Dr Peter Attia 56:32 Okay.

Steven Bartlett 56:33 I'm very heavy.

Dr Peter Attia 56:33 So you would need to be 5.3, 5.4, or 5.5 liters. Yeah. No, no, yeah, you'd need to be about 5.5 liters per minute. You would need to consume 5.5 liters of oxygen per minute to come out to about a VO2 max of 56 or 57 milliliters of oxygen per kilogram per minute. That would put you at the top 2.5% for your age and sex.

Steven Bartlett 57:01 So what I'm trying to figure out, is taking more oxygen from the air that I breathe a sign of good health?

Dr Peter Attia 57:05 Yes. It means-

Steven Bartlett 57:06 Okay.

Dr Peter Attia 57:06 It's... It speaks to-

Steven Bartlett 57:08 Ah.

Dr Peter Attia 57:08 ... how hard, how fast and hard your heart can pump-

Steven Bartlett 57:12 Yeah.

Dr Peter Attia 57:12 ... and how good your muscles are at utilizing oxygen.

Steven Bartlett 57:16 Ah, okay.

Dr Peter Attia 57:17 It is the most important metric we have for peak cardiorespiratory fitness.

Steven Bartlett 57:22 And sorry if we're going a bit- bit too- because I really want to understand this, and I'm sure there's a lot of people that sat- trying to understand this as well. So what are the things that stand in the way of good VO2 max in terms of my... And also the- the lungs.

Dr Peter Attia 57:36 Uh... Yeah, it turns out that not much of it is limited by the lungs.

Steven Bartlett 57:39 Oh, really?

Dr Peter Attia 57:39 So the question is, where are you limited?

Steven Bartlett 57:41 Okay.

Dr Peter Attia 57:42 Okay, so how does this test work? Do you prefer to run or bike?

Steven Bartlett 57:45 I prefer to bike.

Dr Peter Attia 57:46 Okay, so we're gonna put you on a bike. We're gonna put this mask on your face that allows no other air in or out. It's only gonna be metered by what's coming from the machine. The bike is going to be, um, one that has forced resistance to it. It's called an ergometer. So we're gonna set it to 100 watts, nice and easy. I'm gonna tell you to warm up for a while. And then after a 10-minute warmup, it's going to start increasing the power that's, that you're forced to pedal against.

Steven Bartlett 58:15 Ah, okay.

Dr Peter Attia 58:15 And every two minutes, we're going to add some amount, 25 or 50 watts. And- and you're gonna see, you have to stay above about 70 RPM.

Steven Bartlett 58:25 Mm-hmm.

Dr Peter Attia 58:26 And this test is going to go until you can't do it anymore. It's gonna go till you basically drop. So what's limiting you is clearly not the amount of oxygen in the air, and it's actually not the ability of your lungs to get oxygen into your blood. You're limited by the ab- how hard and fast your heart can pump that blood through your body and how efficient your muscles are at taking the oxygen out and using it. And the difference between... So again, a 30-year-old who's in the top 2.5% of their age group might be at 56, 57, but to put that in context, the guy who wins the Tour de France this year is 85.

Steven Bartlett 59:14 Wow.

Dr Peter Attia 59:17 And by the way, when that number reaches 20, or certainly 18, 19, you have a hard time just getting around. Like, you wouldn't be able to walk up a flight of stairs. So it gives you a sense-

Steven Bartlett 59:31 Interesting.

Dr Peter Attia 59:31 ... of the- of the gradient. Now, let's get to my point that answers your question. You asked, how can I say exercise is so powerful? Well, what do you think is the hazard ratio when I compare someone at the top 2.5% to someone at the bottom 25%?

Steven Bartlett 59:50 In terms of VO2 max?

Dr Peter Attia 59:51 Yes.

Steven Bartlett 59:53 (quietly) 1.5... The top 2% versus the top- bottom 25. Bottom 25%, that's quite big. Top 2% is quite narrow. Um, I'd say 1.5, which is, what, 50%-

Dr Peter Attia 1:00:06 So you think it's less important than strength? 'Cause we've just established for strength, it's about three.

Steven Bartlett 1:00:11 So I- I'm just changing... I'm- I'm increasing it now 'cause I was so wrong on strength. (laughs)

Dr Peter Attia 1:00:15 Yeah, yeah, yeah, yeah.

Steven Bartlett 1:00:15 You see what I mean? Uh, uh, well, what would I have said had you not told me the strength one? So, um-

Dr Peter Attia 1:00:23 By the way, I think your guess is a completely reasonable guess, because the answer is so absurd.

Steven Bartlett 1:00:27 I'm gonna say 1.5 hazard ratio- hazard ratio.

Dr Peter Attia 1:00:30 It's five.

Steven Bartlett 1:00:31 Five? So you're-

Dr Peter Attia 1:00:32 Which means 400% difference in all cause mortality if you- when you compare-

Steven Bartlett 1:00:39 I have a dubious case.

Dr Peter Attia 1:00:40 ... the fittest 2.5% to the least fit 25%.

Steven Bartlett 1:00:45 Wow, so it makes a huge difference.

Dr Peter Attia 1:00:47 So this is why I can say with absolute certainty, nothing compares to exercise. Nothing compares to having a high VO2 max, high muscle mass, and high muscle strength. They are more beneficial for you than any bad thing you can think of is bad for you.

Steven Bartlett 1:01:16 ... why- why the- is the muscle mass piece so important? And the strength piece, why is that cau- causing me to stay alive?

Dr Peter Attia 1:01:23 I think there are several reasons (clears throat) . As you get- so there's, there's- I put them in two buckets, structural and metabolic. Let's start with the latter. Muscles are where you dispose of glucose, so glucose regulation is one of the most important metabolic functions of the body. Our ability to metabolize glucose and regulate glucose levels is central to our existence on this planet, and when we get it just a little bit wrong, we go to hell in a handbasket. That's what type 2 diabetes is.

Steven Bartlett 1:01:56 Hmm.

Dr Peter Attia 1:01:56 Type 2 diabetes, raging type 2 diabetes only means you have an extra five grams of blood sugar, one teaspoon in your circulation. That's it. The difference between you and someone with type 2 diabetes so bad that they're going to get their digits amputated is an extra one teaspoon of glucose in the bloodstream. That's how critical it is that we regulate our blood sugar. And the most important part of blood sugar regulation is having muscles that are big enough to put the glucose into, and that are insulin-sensitive enough to respond to the signal of insulin.

Steven Bartlett 1:02:38 And glucose is stored in just a couple of pla- places in our body, right?

Dr Peter Attia 1:02:41 It's only stored in the liver and in the muscles, but the muscles store 80% of it.

Steven Bartlett 1:02:45 Oh, okay. So if- oh, okay. So muscles are really, really good for glucose regulation because it gives the sugar more place to hide.

Dr Peter Attia 1:02:53 That's right.

Steven Bartlett 1:02:53 (laughs)

Dr Peter Attia 1:02:54 So the other reason muscle mass and strength is so important is as we age, fragility and frailty become an enormous liability in death. There's a figure in that book that shows the mortality associated with falling, and it becomes catastrophic once you hit the age of 65. Once you hit the age of 65, if you fall, which is pretty likely, and you break your hip or your femur, the long bone in your leg, there's a 15% to 30% chance you will be dead within the next 12 months.

Steven Bartlett 1:03:35 Really?

Dr Peter Attia 1:03:36 Yes. It's insane.

Steven Bartlett 1:03:38 Because you become sedentary.

Dr Peter Attia 1:03:40 Y- yeah. You- there's a lot of reasons for it, but certainly a loss of function is a big one. You can also just die as a result of hitting your head.

Steven Bartlett 1:03:48 A fall, yeah.

Dr Peter Attia 1:03:48 You can die from a fat embolism or a blood clot. Uh, you can die from sepsis. You can die from, you know, heart attack because you, you know- there's, there's so many things that can kind of kill you i- in response to it. But even the people, you know, the 70% to 85% of people who don't die, 50% of them will experience a significant loss of function that never recovers after. So this, this issue of sarcopenia, which is loss of muscle mass, and frailty and fragility become the, you know, the absolute keeper of death for people once they reach the seventh decade of life. Again, if you're 30 years old, it's impossible to fathom this stuff 'cause you're indestructible.

Steven Bartlett 1:04:34 Yeah.

Dr Peter Attia 1:04:34 Even at my age, I mean, God, I feel indestructible and I'm 50. But this changes, and we have to do all we can to ward it off. So that's why muscle mass matters so much.

Steven Bartlett 1:04:48 There's this kind of long-standing belief that you- as you age, there's so many just- it's just kind of inevitable.

Dr Peter Attia 1:04:54 Mm.

Steven Bartlett 1:04:54 You put on fat, you know, you slow down, and you're- you're saying, and I think you communicated very clearly in the book that it doesn't have to be inevitable, all of this stuff, to some degree.

Dr Peter Attia 1:05:03 Well, I mean-

Steven Bartlett 1:05:04 Mm-hmm.

Dr Peter Attia 1:05:04 ... look, I- I'm, I'm very, I'm very careful to, to, to try to be as realistic as possible. I, I get a little put off when I see people in this sort of, quote unquote, "longevity space" saying things that I think are just science fiction, right? Like, "Oh, at 90 you can be just as fit as you are at 40," and stuff. And I, I see zero evidence that that's happening. I don't see any biotechnology on the horizon that is going to completely and reversibly change aging. Um...

Steven Bartlett 1:05:35 Yet? Or do you-

Dr Peter Attia 1:05:37 I don't, I don't think in our lifetime.

Steven Bartlett 1:05:38 Okay.

Dr Peter Attia 1:05:38 No. A- and this is something I spend (clears throat) , uh, uh, you know, an absurd amount of time on, both as an investor, uh, and, and just as a, you know, a person who thinks about this for my own podcast and the types of guests that I bring on and the type of science that I'm paying attention to. But, but no, I really do not see anything in our lifetime that is going to undo aging. I think we have some ideas of places we can look, right? I think that, for example, if you could completely restore the epigenome to what it looks like in a young state across the entire genome, I think that could have a profound effect on function. But do we have- do I see ways that we could do that? I, I- it- you know, it's a longer discussion, but I think the complexity there is many, many decades away. That said, um, what I think we do not need to do is accept the complete and total inevitability of rapid decline. So (clears throat) the decline is non-linear. This is the important thing to understand. So what was your decline from 20 to 30? Wasn't that bad.

Steven Bartlett 1:06:55 No.

Dr Peter Attia 1:06:55 No. And from 30 to 40, it's not gonna be that bad. From 40 to 50, it's gonna be more. From 50 to 60, it's gonna be even more. From 60 to 70, it's gonna be way more. And 70 to 80 is falling off a cliff.So if you, if, if you look at- this is actually one of the figures I wanted to include in the book, but you know, you're always sort of scrapped for space, so we took it out. But I have a figure that shows both muscle mass and spontaneous physical activity in people by decade, and it's just based on like a huge data sample of people. And it's really interesting to watch the correlation, how strong it is, right? So physical activity and muscle mass go like this, and they just fall off a cliff. And the cliff for both is 75, for both men and women. Like, that's where you see an enormous reduction in muscle mass and activity level.

Steven Bartlett 1:07:46 Because of behavioral stuff?

Dr Peter Attia 1:07:47 Well, I think it's a, you know, it's, uh, the age-old question is, are they losing muscle mass because they're becoming less active or are they becoming less active because they're losing muscle ma- muscle mass? And I, I think it's both.

Steven Bartlett 1:07:58 Okay.

Dr Peter Attia 1:07:58 I think these two feed off each other.

Steven Bartlett 1:08:00 Mm-hmm.

Dr Peter Attia 1:08:01 And, um-

Steven Bartlett 1:08:01 And they get harder, right, presumably, 'cause what you said about the quality of the muscle as well.

Dr Peter Attia 1:08:05 That's right. So you have to ward this stuff off, right? I mean, as your type II muscle fibers are deteriorating-

Steven Bartlett 1:08:11 Hmm.

Dr Peter Attia 1:08:12 ... and you're putting more fat into muscle, the quality of that muscle, you go from being, you know, prime to Wagyu.

Steven Bartlett 1:08:19 (laughs)

Dr Peter Attia 1:08:19 So you have to ward that stuff off, right? And the way to ward that off is to lift very heavy things. That's the only way to stimulate the type II muscle fiber. This type II muscle fiber won't get stimulated by light movements. So it's not just that resistance training is necessary, but it's, it's resistance training that's actually quite heavy.

Steven Bartlett 1:08:38 People who hear that, they go, "Okay, we get it. They're on board. They're gonna exercise." How much do I need to do? Because listen, you know, uh, can it be, is it, I've gotta change my whole life and exercise seven days a week and run marathons now, Dr. Peter? Or is there s- what would you recommend? What would you prescribe?

Dr Peter Attia 1:08:53 So I always start this question by saying, "How much can you do?"

Steven Bartlett 1:08:59 But okay, I'm gonna, I'm gonna play devil's advocate here. I'm gonna respond as one of my viewers by, I'm gonna say, "Listen, I'm so busy. You don't understand, Dr. Peter. I'm, I've got kids, I've got this, I've got a job. I'm already, I already have no time. I'm not sleeping out here. So I don't have any time."

Dr Peter Attia 1:09:16 I mean, I, I, it requires a thorough discussion around that.

Steven Bartlett 1:09:19 Sure.

Dr Peter Attia 1:09:19 I mean, is that really true?

Steven Bartlett 1:09:21 No, of course it's not.

Dr Peter Attia 1:09:22 Yeah.

Steven Bartlett 1:09:22 It's not.

Dr Peter Attia 1:09:22 So then you have to get into the weeds. Like, how much time are you watching TV? How much time are you on social media? How much time are you doing things that might not be, um, as high a priority as doing this other thing? Um, so, so once you kind of get through that, I do, I do sort of put, put it on them and say, "I would much rather you tell me the number than I tell you the number." I can tell you what I think the number is, right? If you're-

Steven Bartlett 1:09:46 Yes.

Dr Peter Attia 1:09:46 ... playing the optimizing game and if you're saying, "I want to be the absolute best, fittest version of me that is humanly possible when I'm in my 80s, how much do I need to be training for that?" The answer's probably one and a half to two hours a day.

Steven Bartlett 1:10:08 One and a half to two hours a day, seven days a week?

Dr Peter Attia 1:10:11 Yeah. I mean, of course, it's not gonna be the same every day, and, and it looks different. But, but it's gonna average out to 10 to 14 hours a week. But I, but rather than tell somebody that, 'cause I think that's very off-putting-

Steven Bartlett 1:10:23 Yeah.

Dr Peter Attia 1:10:24 ... I would just say, "Just tell me what you got. If you tell me you've got five hours a week that you can do this, I'll give you a great set of things you can do in five hours." And my hope, by the way, is six months from now, you're gonna feel so much better that you're gonna say, "You know what? I would like to up this to seven hours a week."

Steven Bartlett 1:10:43 What's the difference in all-cause mortality if I go from doing zero exercise to doing just a bit?

Dr Peter Attia 1:10:48 Yeah. That, that's a great question. And for some people, that question is all they need to get started. Going from zero activity to just 90 minutes a week is about a 15% reduction in all-cause mortality.

Steven Bartlett 1:11:03 So I'm 15% less likely to, to die.

Dr Peter Attia 1:11:05 So in any given year from all causes, if you go from being completely sedentary to just doing 90 minutes a week.

Steven Bartlett 1:11:14 Which is only like, what, I don't know, 15 minutes a day, 12 minutes a day? Whatever.

Dr Peter Attia 1:11:17 Yeah, or just, you know, three times 30 minutes a week.

Steven Bartlett 1:11:20 That's a huge, that's a huge shifting of very important odds.

Dr Peter Attia 1:11:25 Yeah. And, and truthfully like, I probably spend more time convincing people not on the all-cause mortality data, but on the health span data.

Steven Bartlett 1:11:36 I thought so.

Dr Peter Attia 1:11:37 It's-

Steven Bartlett 1:11:37 'Cause people don't, we don't think about our deaths.

Dr Peter Attia 1:11:39 Yeah, death is so abstract. It really, I don't think it, I don't think it even sets in until you're in your 50s. Like I, I think it's very, it's very hard to capture the finitude of what it means to be a human when you're young. I, I think it's true at all ages, but, but I really think it's so much better to just focus on the quality of life you wanna live. What do you wanna physically be able to do throughout your life? And it's easier in people who have been around aging people.

Steven Bartlett 1:12:14 Yeah.

Dr Peter Attia 1:12:15 You know, which again, a lot of people in their 30s, their parents aren't even necessarily old enough that they can fully appreciate it. They might have to think, "Well, do I still remember what my grandparents were like at the end of their life? And were, was I inspired by them? And if so, that's what I wanna do." Great. And, "If I don't want what they had," which is the answer I think m- most people will have, then what do I need to do to be different?

Steven Bartlett 1:12:41 What was it for you? I remember what it was for me.

Dr Peter Attia 1:12:44 Yeah, for me, it's, again, it's, I didn't know my grandparents. Uh, I suspect just my training in medicine. Like I, I was around so many people at the end of life that like-

Steven Bartlett 1:12:58 You got to see.

Dr Peter Attia 1:12:58 Yeah, it was, it was just imprinted early.

Steven Bartlett 1:13:02 My, I, I told this story once or twice on this podcast before, but I was in Bali walking down some, a long set of stairs. When I say a long set of stairs, I mean down the side of a cliff-

Dr Peter Attia 1:13:11 Mm.

Steven Bartlett 1:13:11 ... going down to canoe with my partner. And as I was walking down those stairs in the sunshine, it dawned on me that my father probably couldn't walk down these stairs.

Dr Peter Attia 1:13:19 Mm-hmm.

Steven Bartlett 1:13:19 ... and my dad is maybe 60, 65, and I thought he wouldn't be able to come down these stairs, which means he wouldn't be able to go canoeing with his family, and we share a lot of genetic, uh, information, me and my father, of course. So that was one of those real big moments, and actually, Jack, who films the podcast, he, he... After I shared that with him, he... And we had some guests on the podcast. Um, he shared with me his own moment where he was climbing a mountain, I think last month, weren't you, Jack? And he, he got to the top of the mountain and thought to himself... God, like it was such an unbelievable experience for him that he... Correct me if I'm wrong. It was a, an epiphany moment, you go, "I wouldn't be able to climb this bloody mountain with all these people and feel this sense of accomplishment if I..." And it's those moments for me where I thought, "Fuck, this is... That's my health span. I wanna be able to do this."

Dr Peter Attia 1:14:02 Yes.

Steven Bartlett 1:14:03 You wrote... One of the chapters in your book is about stability.

Dr Peter Attia 1:14:06 Mm-hmm.

Steven Bartlett 1:14:07 Found that really, um, surprising again. I'd never even come across the concept of stability or why it's important.

Dr Peter Attia 1:14:13 (laughs) That- that's why it needed an entire chapter, because it is a very foreign concept.

Steven Bartlett 1:14:18 Chapter 13, Stability. Why? Why is it important, and what does it mean?

Dr Peter Attia 1:14:23 Yeah, I think this is, this is, uh... Stability is a difficult thing to explain. I mean, you can sort of talk about it technically, right? Stability is the capacity to transmit force from the body to the outside world and from the outside world back to the body without injury. So anytime you're taking a step, you're applying force to the ground. That's what's allowing you to walk forward. So you apply force to the ground. The ground applies an equal opposite force to you, that's Newton's law, and you move forward. Um, when you're running, why are you going faster? You're going faster primarily because you're applying more force to the ground-

Steven Bartlett 1:14:57 Mm-hmm.

Dr Peter Attia 1:14:57 ... and therefore the ground is applying more force to you, and that's propelling you forward. The difference between me and Usain Bolt, among other things, is his capacity to apply force to the ground is two and a half times my ability to apply force to the ground. So in all that force, how do you make sure that the action of the force mechanism is all for the desired purpose, in this case, propulsion, and not for undesirable purposes, like leaking of energy, which is what it feels like when your knee hurts when you're walking down the stairs, or your hip, or something like that? So the analogy I use in the book to describe this is that of a car, 'cause I love cars, and I talk about the difference between a race car and a street car. A race car can be even half the power of a street car in terms of horsepower, but because it's smaller, lighter, and has a stiffer chassis and slick tires, much more of its power is being delivered directly to the road without slippage or energy loss, and therefore it's going faster. And so this idea is a very important part of aging. So most people who have some sort of chronic injury, it can really be traced back to an instability, whether it be an instability of their scapula, and that's why they really have tennis elbow or an instability in the, you know, in, in their abdomen, in their lower back, and that's why they have back pain, instability in the feet that translates its way up into knee pain. All of these things matter greatly, and a big part of how we train is making sure that we do exercises that bolster our stability.

Steven Bartlett 1:16:50 Again, this feels very, um, relevant to me, because I currently got a grade three tear in my hamstring, got a groin problem, so I'm on physio for the grade three tear.

Dr Peter Attia 1:16:59 How'd you tear it?

Steven Bartlett 1:17:00 Um, playing football.

Dr Peter Attia 1:17:01 Mm-hmm.

Steven Bartlett 1:17:01 But I have s- a couple of suspicions surrounding it, because, uh, about a month before, I got the foot pain that they call-

Dr Peter Attia 1:17:09 Plantar fasciitis.

Steven Bartlett 1:17:10 ... plantar fasciitis. So I went to the, I think it's called a podiatrist-

Dr Peter Attia 1:17:13 Yeah.

Steven Bartlett 1:17:13 ... and I got my foot X-ray things done where they give you the insoles, and then following that, I got loads of injuries. Um, I think m- my hypothesis is that I took these insoles, put them straight in, and then proceeded to do two hours of football basically running a day. And I think something in me just broke, 'cause I suddenly got all these inj- injuries, and then I was meant to be playing at Old Trafford, Manchester United's football ground, in front of 70,000 people, and the day before in training, I got a... I pulled my hamstring. Um, and I, and I, and I think th- everyone's been speaking to me about my injury and saying, "Well, you know, maybe it was something in your lower back, and maybe this, and maybe your feet weren't... Whatever." Um, kind of rings true to what you're saying about stability. I clearly have something which is not... wasn't, wasn't prepared for me to suddenly start training for two hours a day, um, and everything started breaking.

Dr Peter Attia 1:18:01 Well, and, and look, I mean, it's, it, it's... (laughs) Hamstring injuries are very stubborn injuries, um, and a lot of people are really imbalanced, right? Much stronger quads than hamstrings. Um, uh, my personal take is, and I'm sure I'm gonna really upset some podiatrists here, I think that, um, that insoles, foot inserts, uh, arch in- arch support probably should be reserved only for some people, and most people actually need to learn to strengthen the intrinsic muscles of the foot, and that that's the issue that's underpinning the plantar fasciitis. And once you have a str-... 'Cause by the way, your foot is not that much different from your hand in terms of the amount of musculature in it, and yet if you think about the dexterity that you have with your hands and the strength that you have in your hands, I think you'd be surprised at how weak your feet are. And I don't just mean you. I'm not singling you out. I mean, I think this is true for most of us, um, because shoes really shield us so much from what our feet should be doing. So, um, yeah, I think, I think your hypothesis is actually probably spot on, and I think what you really need to do is strengthen your feet so that your arches, um, can, can self-support, um, and that you can sort of regain the springiness that is, that is within your feet.

Steven Bartlett 1:19:23 I spoke to Dr. Daniel Lieberman about this as well.

Dr Peter Attia 1:19:25 Yeah, yeah.

Steven Bartlett 1:19:26 He said the same thing.

Dr Peter Attia 1:19:26 Yeah.

Steven Bartlett 1:19:27 He said, "Your feet were too weak." And it makes perfect sense to me because I do not think about... I always think in terms of my ancestors, and I think my ancestors didn't walk in these cushioned Balenciaga shoes. They were out barefoot-

Dr Peter Attia 1:19:39 Yeah.

Steven Bartlett 1:19:39 ... building up the strength. And so when I went from my cushioned Balenciagas to suddenly training two hours a day on feet that just didn't have the muscles, of course I, I, I pulled loads of... I had all these issues. And so I actually changed my footwear and I, I don't have the insoles anymore and I'm now u- using those, those Vivobarefoot-

Dr Peter Attia 1:19:55 Yep, yep.

Steven Bartlett 1:19:55 ... shoes. Do you recommend those? Do you think they're good?

Dr Peter Attia 1:19:57 I do. I really th- I mean, again, I think there's lots of companies that make them.

Steven Bartlett 1:20:00 Yeah.

Dr Peter Attia 1:20:00 I wear a brand called Xero, like X-E-R-O. Um, and, and, but the Vivobarefoot's a great brand. And I, yeah, I think that a minimalist shoe is a great way to go. I, I have the luxury of basically working from home, so I'm pretty much barefoot 24/7. I, I work out barefoot at my own gym.

Steven Bartlett 1:20:19 (laughs)

Dr Peter Attia 1:20:19 Like, I, I'm, I'm in my... And then when I do my activities, like my rucking and stuff like that, when I'm outdoors, like I'm, you know, I'm in a wide-toed shoe that is, uh, you know, at most would have maybe an eight millimeter, uh, um, increase in heel. But yes, minimalist shoe. Now one thing to keep in mind is if you're transitioning from big shoe to minimalist shoe, don't do it all at once. So, um, you can also injure yourself in the right shoes if it's too much too soon.

Steven Bartlett 1:20:49 They did say that to me when I bought them.

Dr Peter Attia 1:20:51 Yeah.

Steven Bartlett 1:20:51 They said, "Just, like sort of ease yourself in because you need to build up the m- the muscles in your feet." Super interesting. No one's ever spoken to me about this before, but

Steven Bartlett 1:20:59 um, I just find it so int- I mean, why didn't anybody tell me this about my feet?

Dr Peter Attia 1:21:02 I mean, we do a lot of th- If you think about it, like think of all the things we do to kids at such a young age that set them down the wrong path, right? Like, we put them in big shoes when they're little, we put them in desks to sit down in class.

Steven Bartlett 1:21:13 Mm-hmm.

Dr Peter Attia 1:21:14 And we take away a lot of physical activity.

Steven Bartlett 1:21:16 Comfort. We prescribe comfort to everything and ease.

Dr Peter Attia 1:21:18 Yeah.

Steven Bartlett 1:21:19 Convenience.

Dr Peter Attia 1:21:20 Have you read The Comfort Crisis by Michael Easter?

Steven Bartlett 1:21:23 No.

Dr Peter Attia 1:21:23 Oh man, such a, such a fantastic book.

Steven Bartlett 1:21:28 And it talks about this?

Dr Peter Attia 1:21:29 Oh yeah, I mean it's really the whole thesis of the book, right, is that we have engineered discomfort completely out of our lives. And uh, it's a, you know, it's an enormous problem, uh, both for our physical and mental health.

Steven Bartlett 1:21:42 The answers are actually quite simple when you reflect upon it and you go, y- how were we born to live? We're so far away from how we were born to live, and if I just followed more of, um, the instruction manual of my ancestors, maybe I wouldn't have all of these kind of, you know, modern issues with that comfort in many, many respects has caused me.

Dr Peter Attia 1:22:01 But it's tough because you have to sort of think about what is the... There are a lot of gifts that come from the modern world, right?

Steven Bartlett 1:22:10 Yeah.

Dr Peter Attia 1:22:10 And like, I don't think you would want to go back in time 100 years and be alive.

Steven Bartlett 1:22:14 I probably wouldn't live very long, would I, either?

Dr Peter Attia 1:22:16 Yeah, I mean... And let's, let's even make it less than that. Like let's say even 70 years. Like w- you know, once we're through this sort of infectious pandemic stuff, right?

Steven Bartlett 1:22:26 Right.

Dr Peter Attia 1:22:26 Like, would, you know, would we really want to go back and be alive 70 years ago, just before World War II? I mean, I, I wouldn't.

Steven Bartlett 1:22:34 Mm-hmm.

Dr Peter Attia 1:22:35 Like I... Yeah, they had electricity and stuff, but I, I like the modern world.

Steven Bartlett 1:22:38 Mm-hmm.

Dr Peter Attia 1:22:39 Uh, but there's a huge set of responsibilities that comes with the modernity of our world today. Food is so abundant today. I mean, these people did not struggle with obesity because they weren't surrounded by really tasty hyperbali- hyper-palatable calorie-dense food in total excess.

Steven Bartlett 1:22:58 Mm-hmm.

Dr Peter Attia 1:22:58 We are. That means we have to exercise some moderation. Most of them had far more physical jobs than you and I do. I mean, you and I don't have to lift a finger to make a living, whereas 75 years ago, we probably did. And it's great that we don't have to. I think you could argue, look, you're, you're having a far bigger impact on the world than you would've ever had 75 years ago, but that comes with a responsibility to yourself.

Steven Bartlett 1:23:25 Is this why we're seeing this sort of resurgence of discomfort as a hobby and a sport and an industry?

Dr Peter Attia 1:23:29 I think so. Yeah, I, I, I think so. And, and, and again, Michael writes about this so, um, so well. You know, they write about, he writes about things called misogis which are these very, very difficult challenging things that you might have yourself do once a year. Um, he also writes a lot about something that is just an enormous hobby of mine called rucking. Have you... Are you familiar with rucking? So rucking is something that I, I think it was st- probably started by the military, and it's really how the military does the great majority of its conditioning, and it's walking with a weighted backpack. Um, and the, I mean the military will do this. Th- they might go on a 24-hour ruck where you're carrying half your body weight.

Steven Bartlett 1:24:13 Wow.

Dr Peter Attia 1:24:13 So picture you carrying, in your case, right, like close to 100 pounds on your back for a day. And, um, so there's actually an awesome company in the US called GORUCK that makes really good rucksacks that are just ergonomically designed to put weight plates into, and then they sell these plates and stuff. So, I mean, this has become a total obsession of mine. So I ruck three or four times every week, and luckily where I live in Austin, Texas, it's incredibly hilly, so it's just up and down, up and down very steep hills. And I'll go anywhere from, you know, 50, 60 pounds. On some days I'll really push it and go up to 100, uh, for shorter rucks. And um, you know, I'm only doing it for like an hour at a time, but we, it's very hot where I live in the summer, so it's just, it adds an extra layer of discomfort. But it's great.

Steven Bartlett 1:25:10 Yeah, 'cause I don't know whether it's just, eh, what the cycle I'm exposed to and the information I'm exposed to, but it just seems like all of these ultra-athletic, you know, painful long distance, um, sports have become super popular. The Spartans of the... You know, I actually just recently invested in one, um, because of this very reason, 'cause I'm seeing this comfort crisis and I always think that when there's one-... when one pole rises, the other one also rises, so when digital music record, you know, old school vinyl records became big-

Dr Peter Attia 1:25:37 Mm-hmm.

Steven Bartlett 1:25:37 ... and I think in a world of comfort, people are gonna seek out extreme discomfort, and it sounds like you're doing that with your rucking. (laughs)

Dr Peter Attia 1:25:43 Yeah. (paper crinkles)

Steven Bartlett 1:25:43 If you've been listening to this podcast over the last few months, you'll know that we're sponsored and supported by Airbnb,