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Jay Shetty PodcastJay Shetty Podcast

The LONGEVITY Doctor: Are You Actually HEALTHY? 70% Of The Population Is NOT | Dr. Peter Attia

Today, I am excited to share my conversation with Dr. Peter Attia, dubbed the longevity expert.

Dr. Peter AttiaguestJay Shettyhost
Aug 7, 20231h 31mWatch on YouTube

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Transcript

  1. 0:00 – 0:14

    Intro

    1. PA

      You talk to a person the day before they're going to die, they would give anything and everything for more chance at life

    2. SP

      The bestselling author and host

    3. JS

      The number one health and wellness podcast On Purpose with Jay Shetty

  2. 0:14 – 3:42

    Identifying Underlying Health Issues

    1. JS

      Could you walk us through what it feels like to think you're healthy, to maybe even feel you're doing okay, but in reality there's something going on behind the scenes?

    2. PA

      Yeah. I mean, I think there were two sort of things that were a wake-up call for me, and neither of these things happened immediately. I think it's just sometimes the realization that happens immediately. So the first one is I'd always been an athlete my whole life, in-insanely active, uh, potentially even un-un, you know, active to an unhealthy level. And, you know, the focus of that obsession had always shifted, but at the point in the, the story that we're talking about, at this point I was sort of a ultra distance swimmer, so I was, you know, probably in the water swimming twenty-four to twenty-eight hours a week plus y-you know, other types of training. Yet, you know, I found out, this is probably around fifteen years ago, that... well, actually on top of that I was sort of insulin resistant, I was overweight. And again, not that I didn't know I was overweight, you sort of can realize that. But, but that I was sort of insulin resistant and, you know, that's sort of the first step on the way towards, um, type 2 diabetes. It was really at that time that I also, I think, confronted my own family history. So just within my genes, the acknowledgement that, you know, basically every man in my family died prematurely of heart disease. Uh, and in some cases very prematurely, in their 40s. Those two realizations in my mid-30s, which also happened to coincide with the birth of my daughter, which was my first child, was a real wake-up call, and the realization that, you know, I needed to figure something out so that I didn't just, you know, march down the footsteps of what seemed to be my destiny.

    3. JS

      And even then you were in the medical profession, right? Or not?

    4. PA

      Yeah, although I had actually left medicine at this point. So after 10 years of medical training, including medical school, I became sort of disillusioned with medicine and left. So at the time that I'm having this realization, I'm actually in the world of finance-

    5. JS

      Right

    6. PA

      ... uh, and quite far from medicine.

    7. JS

      What was your biggest fear at the time? Like, if you could take yourself back to that moment, like, what was the fear that you had?

    8. PA

      Yeah, that I wouldn't be around to, you know, be with my grandkids and things of that nature. Because I think, you know, prior to my daughter being born, I didn't really think I would be the kind of person who would find any joy in having kids, and that changed in an instant the second she was born. I'm sure there are lots of people who can relate to that. Probably more so men than women, I think, because the switch is a little more binary when we have kids. And then the thought of, you know, I'm not gonna relive this in thirty years with grandkids, um, I think that was probably the thing that was the most motivating factor.

    9. JS

      Wow. Yeah. It, it needs that kind of incentive to get activated, and the reason I ask that question is everyone who's listening or watching, I want you to think about what that fear, what that challenge is for you, because often fear isn't a great motivator to keep going, but it's a great place to start. And, and our health almost starts there sometimes. Like, I remember that. I remember feeling like Superman when I was in my early 20s, and then all of a sudden having certain health challenges. I got into chronic fatigue. I had polyps in my throat that had to be lasered out. I lost my voice for a few months, and-

    10. PA

      Mm

    11. JS

      ... that wasn't life-threatening, but it was life-altering in the sense that I couldn't communicate in the same way. It was different getting my voice back and not feeling like it was as strong or powerful, and then having gut issues and inflammation issues and acid issues and all of these things, again, like, they weren't... it's not that my life was gonna end that year, but it's like you start thinking long term and you start thinking about living a unhealthier, harder

  3. 3:42 – 8:50

    When To Start Investing In Your Health

    1. JS

      life. When is the right time for people to consciously start actually investing in their health? And I'm gonna caveat that with, what is generally happening, happening in the different decades of our life? So what's happening between zero to ten, ten to twenty, twenty to thirty, thirty to forty, forty to fifty? And when is the time when you have a bit more control and ability to shift the trajectory of your health, bar any, of course, major complications or, or surprises?

    2. PA

      I've never actually been asked it that way, but the way you asked it kind of makes me think about different things. The aging process in some ways, uh, there are some aspects of it that are moving in the wrong direction the moment you are born. In other words, the, the moment a fetus comes into this world, there are certain aspects of aging that are only getting worse. There are others that are not. So you have to imagine now they're... we're talking about different things, so I'll give you an example of each. Something that's getting worse the second you're born is the damage to your arteries. So we call this process atherosclerosis. This is what leads to heart attacks and strokes. Heart attack and stroke is the leading cause of death in the United States for both men and women, and globally for both men and women. But it takes an awfully long time. That's why you've never heard of a baby having a heart attack. That's why teenagers don't have heart attacks and people in their 20s, it's almost unheard of they would have a heart attack. But the disease is starting right away, and we know this because when we've looked at people who have died prematurely from other causes, car accidents, homicide, suicide, and you look at their coronary arteries, you already see evidence of disease. So we know that this is happening right away, and it's simply a matter of time until it reaches a critical level that results in disease. And of course, everybody's accelerating at a different rate based on many factors: genetics, um, smoking, high blood pressure, metabolic health, all these other things. But point being, that's something for which you could technically argue it's never too soon to start prevention. Then there are other things in which we're actually getting better and better and better until we reach a certain point, and then we start to demise. And an example there might be sort of cognitive capacity. So we might have our greatest neuroplasticity in the first few years of life, but we're also building on that, and if we're in the right environment, we're exposed to the right things, we're actually getting, you know, better and better and better at our fluid intelligence, and that probably reaches our peak sometime in our third decade. So that's something where, you know, you're actually getting better and better and better, and then it slowly starts to decline.

    3. JS

      Mm.

    4. PA

      And then there are all sorts of things that are mixtures of these things. So for example, your physical capacity, your muscle mass, strength, power, type two muscle fibers, cardiorespiratory fitness, all of those things are also increasing in capacity. Again, depending on which of those things we're talking about, if it's, you know, power and explosiveness, that probably peaks early in the third decade. If it's strength, that peaks a little bit later. Peak cardiorespiratory fitness, again, in your twenties, and then those things will start to decline. What's undoubtedly clear is for you and I, we're pretty much in decline. So most people listening to this are in a state of decline, and part of the objective, I think, ought to be to slow the rate of decline as much as possible. But there's another aspect to your question I think is very important, right? Which is, like, at what point should you start putting effort into this? And that's a very difficult question because it encompasses a couple of th- things. When you talk to a person... uh, let's do this as a thought experiment. You talk to a person the day before they're going to die. I mean, they would give anything and everything they have for more chance at life. Despite how high their motivation is, there's no runway left. Conversely, if you went into a high school and talked to a bunch of freshmen and said, "I've got the program for you that is gonna add fifteen years to your life," I mean, they couldn't be less interested, right? So there's a sweet spot somewhere where I almost think people need to go through a little bit of decline, kind of like what you described. It wasn't life-threatening, but you just need to realize that you're fallible-

    5. JS

      Mm-hmm

    6. PA

      ... to sort of say, "Hmm, I can project this movie forward a couple of decades. I've now mature enough to maybe see my parents, see my grandparents, aunts, uncles, friends, people's health deteriorate and realize that's a bit of a reality check that it's coming for me, but yet I still have long enough to bend the arc of my life."

    7. JS

      Mm.

    8. PA

      And so I think those are the two curves that we're trying to intersect.

    9. JS

      Yeah. That's a great answer, and I, and I appreciate that. Uh, I feel the same way. Unfortunately, it always comes through some sort of pain or some sort of reality check or wake-up call that gets us going. And it's interesting what you were saying about cognitive function and ability as well. There were studies that I read that said that the average age of most successful entrepreneurs is thirty-seven, and it's fascinating because we live in a world right now where everyone wants to be a successful entrepreneur by the time they're twenty-one or twenty-five, and we put these artificial pressures on ourself when actually there's so much more to

  4. 8:50 – 11:26

    Why You Should Know Your Family’s Health History

    1. JS

      it. In the genetics versus environment debate, what have you-- what's the latest in that space of like-- because I think we're not-- you said you dove into your family's history. I think most of us are not fully aware of our family's history, even though every time I saw a doctor growing up, they'd always ask, "Is there this in your family's history? Is there that?" First of all, how aware do we need to be of our family's history? How important is that for people to figure out? And second of all, what is that breakdown between genetics and personal environment and career and work?

    2. PA

      You know, I think actually family history is such an important thing. It's one of these things that we stress to the nth degree with our patients, so much so that, you know, it takes them weeks sometimes to gather the information that we want to know. Because we want to know... and we give them ten questions for each member of the family, so your parents, your grandparents, your aunts and uncles, your siblings. Like, we wanna know everything. Do they have high blood pressure? Do they have high cholesterol? Do they take this medication? Do they take that medication? What was their cognitive function like in the last decade of their life? You know, what type of cancers did they have? Did they have, uh, low bone density? You know, do they have osteoporosis? I mean, we really want to understand every detail about it. And I think a big part of the reason why is contrary to what maybe people believe, a genetic test does not give you that information. So if, if you and I went out and got a genetic test, and I don't just mean an o- you know, over-the-counter genetic test like twenty-three and me, but I'm saying if we went out and got the best whole genome sequence money could buy, we spent thousands and thousands of dollars and literally looked at every one of our, you know, twenty to thirty thousand genes, we still wouldn't be able to impute from a risk standpoint what you can gather from a very well-collected family history, and the reason for that is most genes by themselves are not deterministic, which really gets to your second question. So if most genes are not deterministic, they need something in the environment to sort of trigger them. Furthermore, most conditions that we care about are polygenic. It's easy to think of the sort of Mendelian monogene-type conditions. They get a lot of attention, and they're important to be sure, but the vast majority of things that people care about, cancer, heart disease, dementia, they are not really just related to a single gene, and in many cases, we don't even know what the collection of genes look like. So genes matter, but I think we're gonna get the majority of our information by understanding our family history in terms of susceptibility, and the environment matters greatly, and the extension of that is, of course, you have great agency over that.

  5. 11:26 – 14:16

    The Best Methodology To Get A Complete Family History?

    1. JS

      Yeah. And what is the best methodology for getting the family history in a complete, comprehensive way that's actually gonna be beneficial?

    2. PA

      It can be hard if members of the family are deceased. So for people your age and my age, you know, our grandparents, I mean, at least for me, my grandparents are long gone.

    3. JS

      Yeah, same.

    4. PA

      So it's, you know, do your parents really remember? And part of it, it just comes down to are they being prompted by the right questions? Now, again, to be honest, in my family history, I have very limited understanding of grandparents because You know, they just died long enough ago, and frankly, I don't think my parents were necessarily great historians of this. In my case, where the bulk of my understanding came from was that my dad came from a very large family. You know, there were 10 kids, two that died young, so eight that survived to adulthood. And there, I was able to elucidate really good information and really understand that there's something very bad going on with respect to heart disease. On my mom's side, I could also see some issues with her two siblings as well that also gave me a sense of, you know, what some predispositions might be.

    5. JS

      Mm. Where can people find those questions, or how can they connect with that approach to-

    6. PA

      You know, that's a good question.

    7. JS

      Yeah.

    8. PA

      I, I don't... We, we have a, a, a program that we've developed called Early-

    9. JS

      Mm-hmm

    10. PA

      ... um, which is like a digital product that is our practice. I know that it is within there.

    11. JS

      Got it.

    12. PA

      Yeah, yeah.

    13. JS

      Perfect.

    14. PA

      So if people, like, look for Early, I, I don't know if you... I, I should know how to do this.

    15. JS

      [laughs]

    16. PA

      If you go to, like, earlymedical.com, there's a way to find it.

    17. JS

      Got it. Got it. Okay, perfect. Yeah, no, I think that, that kind of practical step is so needed-

    18. PA

      Yeah

    19. JS

      ... because one of the biggest things, when I was talking to my team and talking to the community about health, one of the biggest things that came out is, "Jay, we're just stuck on where to start."

    20. PA

      Yeah.

    21. JS

      Like, "I don't know where to start. I don't... There's just too much information out there. It's oversaturated."

    22. PA

      Yep.

    23. JS

      "Everyone's telling me to do this and that." And it's almost like, well, let's figure out your genetic history. Like, that's a great place to start because that's where we came from.

    24. PA

      Yeah, this program, Early, is divided into 12 modules. We think each module would take you about a month to get through, and that's the first or second module.

    25. JS

      Mm-hmm.

    26. PA

      I think the first module is setting your goals and going through kind of this type of exercise, and then the second module is, okay, how do you get your family history? How do you take that information and extract what the implications are for you and then go from there?

    27. JS

      What's your take on, like, full body scans and that kind of testing, and how often should it be done? Because I think, again, what's happening, I was talking to some younger people in our audiences, Gen Z, and it was just like going to see a doctor has become, like, not even a thought.

    28. PA

      [laughs]

    29. JS

      And I could see that in my generation, but I remember my parents' generation, like my mom will still call me up and be like, "Have you seen the dentist every six months?" Like, "Have you been to the doctor every 12 months?" Like, you know, my mom will still do that with me, but I find that that kind of culture is diminishing day by day because of a lack of trust, because of a lack of transparency, so many different things.

    30. PA

      Mm-hmm.

  6. 14:16 – 19:02

    Are You Actually Healthy? How To Predict Early Health Risk

    1. JS

      What is your take on getting checks, which checks, how often? And I guess the question is, how do people know how healthy they are? And Early's a great plan, but from the other point of view.

    2. PA

      It depends on the type of scan. So for example, there are certain scans that are gonna be very helpful at predicting risk from heart disease. So for example, a coronary calcium scan for the heart or a CT angiogram for the heart. Those are tests that I don't think are absolutely essential, but they can be very helpful if you're trying to further stratify risk.

    3. JS

      Mm-hmm.

    4. PA

      You referred to a whole body scan, so for the best example of a whole body scan that I think provides value is an MRI.

    5. JS

      Mm-hmm.

    6. PA

      The reason being is an MRI doesn't have radiation, whereas a whole body CT scan or a PET scan, uh, would have, uh, staggering amounts of radiation. We would never wanna do that, um, just from a screening perspective. But of course, not all MRIs are created equal, and any time you're doing a screening test, you have to be aware of something called sensitivity and specificity, and these are really important parameters. We've put out a lot of content on this because I think it's very confusing for people. So sensitivity is the capacity of a test to detect something if the something is present. So if you're looking at a sensitivity of an MRI scanner for cancer, the, the sensitivity is how likely is this to detect cancer if cancer is present? So on the topic of whole body scanners, MRIs are very sensitive. And again, not all MRIs are created equal, but I'm assuming we're talking about the best of the best.

    7. JS

      Yeah, yeah.

    8. PA

      That's good news. Means if you go into an MRI scanner and you have a cancer, the MRI is quite likely to pick it up. Now, it does have some blind spots, and every screening test has a blind spot. So a, a blind spot that's worth acknowledging for an MRI is a small calcified breast cancer. That's easily gonna get missed by an MRI, and that's why it's not a substitute for mammography. A woman would need to do both. The next parameter of s- of a screening test is the specificity. This says how likely is this test to give you a negative result if indeed the condition is not present? So it's the mirror opposite of sensitivity. Here is where those whole body scanners are abysmal. They have very low specificity.

    9. JS

      Mm.

    10. PA

      What that translates to in English is they have a lot of false positives. I always tell patients, "Look, if you're gonna go and get these scans," and we advocate that our patients do, but they, we, we do it in a much more kind of robust way where it's part of a multiple system of screening tests so that we're covering the bases of everything and trying to attach to the strength and weakness of each study. But when it comes to that MRI, we say, "Look, there's a really good chance you're gonna come out of this test and there's gonna be some false positives we're gonna need to chase down." So I always feel bad when people sign up to do these scans and they aren't aware of that because it generates sometimes more stress on the back end.

    11. JS

      Yeah, yeah. I, I went through that. We had an MRI done, and they found, like, almost like a group or a cluster of things in an area, and they were like, "Ugh, that could be cancer." Then I had to go and do a, um, uh, endoscopy as well, and luckily they found it was nothing. But I remember for that [laughs] week before-

    12. PA

      Yep

    13. JS

      ... I was like, "That's it. It's all over. Here it is." Like, you know, I need to-

    14. PA

      Whereas I think sometimes if you're told up front-

    15. JS

      Yeah. Yeah

    16. PA

      ... "Hey, Jay, there's like a fifteen percent chance-"

    17. JS

      Yeah, I didn't-

    18. PA

      "... we're gonna find"

    19. JS

      I was not told up front. Yeah.

    20. PA

      Yeah. We're gonna... And we, we wanna make sure our patients understand that. And by the way, a subset of our patients, probably ten percent, decide, "I don't wanna have the scan-

    21. JS

      Yeah

    22. PA

      ... because I don't wanna cope with that."

    23. JS

      The stress. Yeah, yeah.

    24. PA

      Yeah.

    25. JS

      Yeah. And it was real. I was like, "All right. I'm gonna have to get focused on figuring this out 'cause it sounds bad," and I didn't have that layup, as you said. And it's, it's really interesting and, and that's what I find so fascinating today, right? Like- There's managing your health, and then there's the stress and the pain that comes with figuring your health out, whether it's the overexposure to too much information, whether it's bad information in the past. And then we're like, "Oh, well, just forget it. I don't want to do any of it." I mean, that's what I feel your book does, and that's what your work does, is trying to help people figure out, "Well, let me give you all the information. Here's how you can know what's good for you and tested for you and right for you." One of the things that I love that you talk about is you talk about the need to get rid of, you know, just focusing on, on a random diet or following a random diet and actually looking at, like, eating habits and patterns that work for you. And so just putting a little, uh, footnote for everyone who's listening, the book will walk you through how to make sense of how to know what is right for you, what is wrong for you, whether you should do something, which I think is, like, the biggest anxiety driver for so many people when it comes to their health. When it comes to food, I think fasting has become trendy. It's become a big thing that everyone's talking about. Uh, you know, we hear so much about every single diet in the world. There's always a new one that's coming on the surface.

  7. 19:02 – 25:31

    Addressing Damaging Health Trends

    1. JS

      How have you helped people one-on-one actually discover what's right for them? Because I've found that my eating patterns are very different to the trending habits of how to eat food and even fasting.

    2. PA

      Yeah, I mean, I think the first thing is, as you said, it's just letting people understand that the less you can pay attention to social media fads and your news feed on Google or whatever, the better. Acknowledge that there is surprisingly little known about the relationship between nutrition and health, and people are gonna be shocked to hear that 'cause I think most people think the exact opposite. Most people think that nutrition is the most important pillar of health, and the reality of it is, outside of very extreme states, that's, that's really not true. And the very little bit we know about nutrition just frankly speaks to the challenge of scientific inquiry into something as difficult as nutrition to study. And the reason for that is you can't study us as humans very well. We're very messy subjects. So we're not like mice, where, you know, you can put us in a cage and control what we're eating and follow us through the duration of our lives. It doesn't work that way. So when you're trying to make inferences about nutrition in humans, you have to rely on poorly controlled studies called epidemiologic studies, which are fraught with all sorts of limitations that I talk about in the book. Or if you're gonna control the study, you can only do it for a very short period of time. There's only a short period of time in which I can control exactly what you're eating. So as a result of that, we don't know a lot. So I, I always want to start with, what do we know? Well, we know that protein is a very important macronutrient. There are four macronutrients: carbohydrates, fats, proteins, and alcohol. People kind of forget alcohol, but it's important to understand it's very caloric, and so it constitutes a source of energy. It's the worst [chuckles] macronutrient. Um, but nevertheless, it's... You know, you'd be amazed. Sometimes people are getting, like, fifteen to twenty percent of their calories from alcohol if they drink enough. So protein is really important, and it's not a source of energy the way carbohydrates and fat is, but it's a structural macronutrient. And so I always start with that and say, "Look, rule number one is you have to make sure you're getting enough protein." Uh, and this is especially true if you're over 50. 'Cause if you're over 50, you start to become resistant to the effects of protein. That's called anabolic resistance. And loss of muscle mass in people over 50 is a significant driver of mortality, uh, and a s- and a significant driver of, uh, poor quality of life.

    3. JS

      Mm-hmm.

    4. PA

      You know, if you really start to think about it, even if a person is of sound mind and they're not, you know, suffering from some intractable disease later in life, a great source of misery is simply being physically unable to do things.

    5. JS

      Mm-hmm.

    6. PA

      After that, it really comes down to, what do we understand about energy balance? Well, we understand that too much nutrition, I call this overnutrition, is bad, and that the body historically, uh, developed lots of tools to store energy 'cause that's what allowed us to evolve the way we did. And up until, I don't know, a hundred years ago or so, that was a great skill to have. It's now, uh, thwarting us in an, in an environment of too much food.

    7. JS

      Mm-hmm.

    8. PA

      So now this ability that we had, this superpower, basically, to store excess energy, has become a liability. In the United States, certainly, the vast majority of people, probably over seventy percent of people, are overnourished, and that's the thing that's driving a lot of their poor health. If you're overnourished, you have to correct that problem. The way to correct that problem is to eat less, and there are three strategies to do that. One of them is to deliberately go about cutting calories. That's called calorie restriction, or CR. The other one is called dietary restriction. That means limit certain things within the diet. And if you are restrictive enough, that will indirectly also reduce total intake. And then the third is fasting or time-restricted eating, where you create a narrower and narrower window each day in which to eat. All of these things can work, and all of those things have significant limitations that you, as an individual practicing this, need to know.

    9. JS

      Yeah, it was incredible. I was looking at the just history of the design of plates and cups randomly. I don't even know how I got there.

    10. PA

      How much bigger they're getting.

    11. JS

      Just how much bigger-

    12. PA

      Yeah

    13. JS

      ... they're getting. And it was insane for me to think that the way plates are designed, the way cups are designed, the way anything's designed transforms how we consume. And it's fascinating to think that just because of a larger plate size, we're now eating larger amounts, and we think it's normal in our time, whereas someone else would have think we were feasting.

    14. PA

      I'm sure you still get back to Europe all the time, but, like, look at the difference in portion sizes-

    15. JS

      Yes

    16. PA

      ... when you're in, you know, Italy versus the United States.

    17. JS

      Yeah.

    18. PA

      It's, it's comical what a difference it is.

    19. JS

      [chuckles] Yeah. I remember as a kid coming to the States, and obviously, when you're a kid, everything that's big is better.

    20. PA

      Yeah, yeah.

    21. JS

      And I remember, like, pulling over at the gas station, and I'd see, like, this massive, like, you know, jumbo thing to fill your drink cup in and, like, you know, forever refills or whatever it is.

    22. PA

      Yeah. [chuckles]

    23. JS

      And just that co- as a kid, I was like, "This is the coolest thing in the world." And now you look and you're like, "Wow, that's..." You know, there's no need for that. So it's, it's fascinating also how these cultural shifts and cultural changes Have made some of these things harder for us today. So you said CR, DR, and TR. Those, those are the three that people need to experiment with each of those because-

    24. PA

      Yeah, ba- basically-

    25. JS

      Yeah

    26. PA

      ... if you are in that over-nourished camp, you need to-

    27. JS

      Yeah

    28. PA

      ... employ some combination of CR, DR, and/or TR.

    29. JS

      Mm.

    30. PA

      And if you're adequately muscled, that's... You just, you can just focus on that. If you're inadequately muscled, you have the added challenge of needing to boost protein intake-

  8. 25:31 – 28:39

    What Supplements Do You Recommend?

    1. JS

      think I would love to hear your takes on supplements that are working, types of supplements, types of ingredients, types of, uh, chemicals that are making a difference, natural supplements too. I'd love to hear your thoughts on nootropics because I'm just hearing about nootropics everywhere right now. Adaptogens, as you just tried as well. We've been, we've been focusing on adaptogens. I'd love to... Let's talk about your take on great supplements that everyone needs to take, not, not a brand, but I mean, like specifically-

    2. PA

      Yeah, yeah

    3. JS

      ... and then your take on nootropics and adaptogens. That would be fantastic.

    4. PA

      I mean, I definitely do take some supplements. I'm always careful to kind of make disclosures. So one thing I do supplement, I take something called AG, and I'm an investor in AG, uh, but I've been taking it long before I invested in it, and I know the founder very well. I'm very under the hood of exactly how their products are made and sourced. And, uh, for folks who aren't aware, AG is like a green that you, you know, just mix in with water. I drink it every morning.

    5. JS

      They sponsor the podcast. [laughs]

    6. PA

      Oh, do they?

    7. JS

      Yeah, yeah, yeah.

    8. PA

      Oh, okay. Okay, cool.

    9. JS

      Yeah, yeah.

    10. PA

      And my approach to that is if you buy the thesis that we need to be having X amount of vegetables a day, and let's be clear and be transparent, I can't guarantee that that is true because we don't know. That's another example of something that the epidemiology tells us is true, but there are many confounders there. But my view is that it's better to err on the side of that's probably true than the, than the counter. So if you buy the thesis that you need X amount of vegetable a day, I actually find it very difficult to do that without exception. There are lots of days I can, but there are enough days that I can't. So my view of a supplement like AG is it's my belt and suspenders approach. It's a, it's, it's basically my way of guaranteeing that by 7:00 in the morning I've met my needs.

    11. JS

      Mm.

    12. PA

      And then if I have a salad for lunch and dinner as well, perfect. I went a little overboard. But that's better than the reverse to me. So that's one.

    13. JS

      And, and AG specifically, talking about that kind of a supplement, that's a vegetable-focused supplement.

    14. PA

      That's right.

    15. JS

      Not all supplements are-

    16. PA

      That's right

    17. JS

      ... specifically focused on that.

    18. PA

      No, no, no. That's-

    19. JS

      So that's, yeah

    20. PA

      ... that's specific to AG.

    21. JS

      Yeah, yeah.

    22. PA

      There's another supplement I take which is a probiotic. Now, no one has been a more [laughs] vocal critic of the probiotic space than me. I have generally viewed it as a space that has demonstrated no efficacy despite all the intentions in the world. In the past year, I have sort of changed my take. So there was this study that came out that looked at a certain type of probiotic and noted that a certain type of bacteria in it would help with the production of something called butyrate, and this was actually helping with, uh, glucose disposal. The results of the study actually were pretty impressive. It was a relatively short study, a three-month study, but it demonstrated in the group that was actually taking this probiotic, and this was in a blinded, randomized trial, that these patients with Type 2 diabetes had a significant reduction in, in blood glucose. Even though I don't have Type 2 diabetes, I sort of subscribe to the idea that everybody benefits from lower blood glucose, including those without diabetes. So that's a probiotic that I take. I don't have any involvement with the company. The company's called Pendulum. Um, but I take their, I take their glucose control probiotic.

  9. 28:39 – 35:50

    What Is Glucose Control?

    1. JS

      Can you walk us through a bit on glucose control?

    2. PA

      Yeah.

    3. JS

      Because I think that's still an area that, for people who are not as well informed, that, that's an area that I, I learned about probably in the last year and a half that has changed what I eat first thing in the morning.

    4. PA

      Yeah, yeah.

    5. JS

      It's changed what I'm eating at different times. Like, to me, I was just like, oh, if I need a boost of something, as long as it's a healthy sugar, it's fine, not only to realize that, you know, causing spikes in my blood, uh, blood glucose levels. So could you walk us through that a little bit?

    6. PA

      You know, glucose is this essential, very simple carbohydrate. It's kind of the final common pathway of most carbohydrates. There are other simple carbohydrates as well, fructose being one of them. So sugar, for example, table sugar, is a, is a molecule of fructose and a molecule of glucose. But glucose is the, is the most abundant carbohydrate final breakdown product, and it's very highly regulated. At any point in time, you're walking around with y- you know, if you haven't eaten that day, somewhere between four and five grams of glucose in your blood. Maybe say four to six grams of glucose in your blood, which is just over a tablespoon, or a teaspoon rather. So tiny, tiny amount. But you're using it constantly, and therefore, your liver is constantly putting more out into your circulation ever so delicately. And the balance of that is so fine that if that level were to be just twice as much, if you were to go from one teaspoon, two sp- teaspoon to two teaspoons, that would be consistent with having Type 2 diabetes. So Type 2 diabetes is a condition where an individual can't control the amount of glucose in their blood. This is very problematic because glucose, when it becomes too high, starts sticking to proteins, and it starts causing damage, uh, all over the place, but primarily to small blood vessels. So blood vessels in the heart, blood vessels in the kidney, in the brain. If you're in, if you're, you know, in the extremities of the toes. That's why people with type 2 diabetes are more susceptible to amputations, kidney disease, heart disease, strokes, Alzheimer's disease, all of these things. Anything that compromises blood flow and oxygen. So it turns out that even if you don't have type 2 diabetes, and that today is just defined by a threshold of average blood glucose above one hundred and forty milligrams per deciliter. Even if you are not in that category, it still appears that your mortality goes down the lower your average blood glucose. So meaning within the normal range of glucose, lower is still better. People sometimes say, "Well, does that just mean, you know, you should never eat a food that raises blood glucose?" No, that doesn't necessarily mean that at all. What it means is you need to be mindful of matching your glucose consumption to your capacity to dispose of glucose. And those are factors that are, of course, um, highly impacted by how much you sleep. So sleep... interruptions in sleep dramatically reduce your capacity to put glucose into your muscles, which means glucose levels get higher. It also has to do significantly with how much you exercise and how much muscle mass you have. So people can have completely different, uh, tolerances for glucose, and I think I write quite a bit about this-

    7. JS

      Mm-hmm, mm-hmm

    8. PA

      ... which is, you know, basically trying to understand your, your glucose tolerance level comes down to matching it with your insulin sensitivity, muscle mass, activity levels, sleep, stress, et cetera.

    9. JS

      Mm-hmm. Absolutely. Thank you so much.

    10. PA

      Yeah, yeah.

    11. JS

      Sorry, and I cut you off from moving forward.

    12. PA

      No, that's okay.

    13. JS

      Yeah, yeah.

    14. PA

      So, so just to go back to this other point quickly. So there are lots of other supplements that I think can be really valuable. I think B vitamins are very important-

    15. JS

      Yeah

    16. PA

      ... especially methylated B vitamins. Vitamin D is very important. Many people, I think, don't have sufficient levels of vitamin D. I think the data on vitamin D, we could do an entire podcast on that. The clinical trials looking at vitamin D levels are really poorly done clinical trials, and so I think if a person looks out at the literature and the literature says there's no evidence that vitamin D really helps, I would argue pretty strongly that those trials haven't asked the right question and weren't designed correctly. So my view is it's better to probably err on the side of caution and make sure your vitamin D is probably somewhere between about forty and sixty, and if you're not achieving that through natural, uh, exposure to sunlight, which many people are not, then you're probably better off supplementing. There are a couple of other supplements I really believe in, and I think magnesium is a very important one, and I think you have to be thoughtful about the form in which you take magnesium. So you can take magnesium in a slow-absorbing form or a fast-absorbing form that's poorly absorbed technically, and I think we need both, right? So I think that, um, like a, a poorly absorbed magnesium would be like a citrate, glycinate, or oxide, and those actually really help with bowel regularity. So for anybody who's a little bit constipated or just, you know, kind of needs to be a little bit more regular, we always wanna have in anywhere from two to five hundred milligrams of one of those forms. Conversely, I think virtually everybody also benefits from a slow-absorbing form of magnesium. The brand that I like is called Slow Mag. Again, I don't have any affiliation with any of these companies unless I'm disclosing it as I did with AG. That actually... You know, so, uh, most people, if they notice, "Oh, I have a little bit of cramping sometimes," or, you know, "I'm getting little palpitations called PVCs sometimes," those get a lot better with magnesium supplementation. So, so I think most people benefit from that. There's another type of magnesium that I'm a fan of called magnesium L-threonate, which is magnesium paired to a transporter that gets the magnesium into the brain. I think there's reasonable evidence. I wouldn't say it's incredible, but I think it's quite good that magnesium L-threonate is beneficial to the brain and, and might even have some capacity to reduce the risk of dementia. Before bed, I tend to rely on ashwagandha, which I believe you said is in there. So I take a big dose of ashwagandha and, uh, glycine and, um, again, I take that magnesium L-threonate, and those are kind of things that I think, uh, hel- help with reducing cortisol and making it a little easier to sleep. Then the final supplement that I do think most people benefit from, and there are probably many others, but I'm just sort of going through-

    17. JS

      Yeah

    18. PA

      ... a few that I can think of, would be fish oil. So most people probably don't consume enough marine fat-

    19. JS

      Mm-hmm

    20. PA

      ... to get what I think are ideal amounts of EPA and DHA, which are two very special types of fats called omega-3-

    21. JS

      Mm-hmm

    22. PA

      ... um, fatty acids. [lips smack] And, um, EPA and DHA, I think the balance of evidence is r- is quite strong that they're both beneficial to the heart and the brain. EPA probably a little bit more for the heart. DHA probably a little bit more for the brain. I take a brand that I've h- had tested because you always wanna be careful about contaminants here, and it's... So it's, it's made by a company called Carlson's. Again, I have no affiliation with them, but I take their EPA and DHA, um, daily as well.

    23. JS

      That's a fantastic summary for anyone who's, who's looking. I, I take all those things.

    24. PA

      Yeah.

    25. JS

      You know, I think that's a brilliant summary, and I, I really hope everyone who's listening and watching, you know, get those checks and tests done and, and grab those supplements because again, I like what you're saying, that it's all about erring on the side of caution, right? It's, it's almost like protecting yourself, being safe, rather than assuming that, A, you get this or, B, it doesn't really matter.

  10. 35:50 – 39:11

    How Has Nutrition Changed Over The Last 50 Years?

    1. JS

      You know, is it that we used to find these supplements in other forms before? Or as humans, have we always ignored this and now we've suddenly figured it out? Or has our lifestyle just got so stressful and intense that we're needing more of all of this to support the pace at which we're moving?

    2. PA

      That's a great question. I do think that the supplement world is such a slippery, dirty world that I always wanna throw out a disclaimer, which is when I talk about these things, I'm also very diligent about the brands that I buy.

    3. JS

      Mm-hmm.

    4. PA

      So again, I have no affiliation [chuckles] with any of these entities, but having looked at third-party testing, I find the brand Jarrow, J-A-R-R-O-W, the, the brand Pure Encapsulations, to be two of the most reputable companies out there. So I'm basically always gonna try to buy from them if I can, even if I'm paying a little bit of a premium. Your question is a very good one, and I don't know how much you've paid attention to kind of the field of regenerative agriculture, but it's a topic that interests me quite a bit. And the more I've read about it, um, the more I've come to realize that I, I actually think part of the problem is our food today is far less nutrient-dense than it once was.

    5. JS

      Mm-hmm.

    6. PA

      And so I do think that many of us don't get the same quantity and density of nutrients today that we did for the same caloric intake, say, fifty years ago.

    7. JS

      Mm-hmm.

    8. PA

      And the proponents of regenerative agriculture would argue that a big part of that has to do with soil health.

    9. JS

      Mm-hmm.

    10. PA

      So as the health of the soil has deteriorated with more tillage, more fertilizers, uh, less crop rotation, all of these things, the net result of that is the plants themselves are less healthy. So when you're eating a plant, you're getting less nutrient density. And of course, when you're eating meat, if you're an omnivore, the meat is also less healthy and less nutrient dense because it's eating a less nutrient dense-

    11. JS

      Plant

    12. PA

      ... plant, which is growing in a less nutrient dense soil. And so the old adage that, you know, it's hard to be healthier than the animal you eat, which can't be much healthier than the plant it eats, which can't be much healthier than the soil it grows in, brings this whole thing full circle. And so I, I suspect that that plays a pretty significant role in it, coupled with the changes in our lifestyle, right? So many of us would have got sufficient vitamin D, for example, in the past because we would have been outside more and we would have been active more, and, you know, today we aren't, as one example.

    13. JS

      Are you seeing the rise of more regenerative farming and places to buy regenerative vegetables, or is that-

    14. PA

      Yeah, I mean you have-

    15. JS

      Is that even a thing yet?

    16. PA

      No, it, it absolutely is. And, and there, there, there are, there are some great places. Uh, you know, certainly one of my sincere hopes is that, you know, we see, we see a greater and greater movement to scale this because I, I, I do think regenerative agriculture is not only what I think of as one of the most important ways in which we can improve human health through nutrition, um, but, but for folks who are also concerned with, with climate change and the effects of anthropogenic CO2, regenerative agriculture probably has more potential to attenuate that than anything else, inclusive of electrifying the entire transportation grid.

    17. JS

      Mm.

    18. PA

      And that's a pretty bold statement.

    19. JS

      [laughs] It is. It's very bold, and that's why I want to dive into it too. Like

  11. 39:11 – 45:09

    What Is Regenerative Agriculture?

    1. JS

      what gives you confidence to make that bold statement? Like what have you seen that has given you that conviction?

    2. PA

      It really comes down to understanding the capacity for plants to fixate carbon. I'm sure everybody understands, you know, the basics of how, how CO2 works, right? So why, w-why is there a concern with the combustion of fossil fuels? Because when you're combusting a fossil fuel, whether it be coal or natural gas, you're taking carbon that was sequestered billions of years ago in the form of fossilized, you know, uh, organic matter, and you're now liberating that carbon dioxide out. So how do we get carbon dioxide back in the system? Well, plants do that. So plants have a capacity to do something that no animal does, which is they fixate carbon. So they... Fix, fixing carbon literally is just the chemical process of taking a carbon out of the-- out of CO2 and attaching it to another hydrocarbon. The way that regenerative agriculture, uh, works is by storing more and more CO2 and carbon specifically in the soil. So right now, the way conventional agriculture works, when you're constantly tilling the soil, you're leaching carbon out of the soil. And so, you know, when you look at the mathematical models that look at how much carbon could be brought back into the ground and sequestered, i.e. brought out of the atmosphere, it's more significant than the carbon that's being put out through the combustion of fossil fuels. The reason I'm particularly excited about that is you're basically getting two wins for the price of one, right? So you're reducing atmospheric CO2, but doing so in a manner that's also very positive for our health, because in doing that, you're increasing the soil health and by extension, then the nutrient density of plants and ultimately animals and ourselves.

    3. JS

      What's your take on regenerative agriculture versus lab-produced vegetables and meats?

    4. PA

      I have yet to see any evidence that laboratory-produced, uh-

    5. JS

      Meats and vegetables. Yeah

    6. PA

      ... meats and vegetables can be done really well at scale, or that they are particularly, um, certainly any more viable in terms of, uh, of, of the nutrient density. I think in part it comes down to the complexity of soil. There's a great book I would recommend for people who [chuckles] want to go really deep on this. I believe the book is called What Your Food Ate, and it's, it's a wonderful book. It's a, it's a bit of a deep dive. It's a nerdy book. It's not light reading. And they go into incredible detail about-

    7. JS

      David R. Montgomery, is that right?

    8. PA

      Yes, and there's another author as well, a female.

    9. JS

      Ann-

    10. PA

      Yep

    11. JS

      ... Ann Bickley?

    12. PA

      Yep. Once you get under the hood of how complex soil is... So for example, many people talk about the human gut biome.

    13. JS

      Mm-hmm.

    14. PA

      And uh, you know, we talked a minute ago about probiotics, right? Well, the human gut biome is really complicated, and we haven't figured out a way to perfectly model it. I mean, maybe we're just getting to the point where we can figure out if we add a little bit more of one bacteria, can it make a difference in, in the direction that this thing goes? Well, it turns out that soil is probably even more biodiverse and complicated than the bacteria in our gut. And so again, I just think it's very difficult for us to sort of play super farmer and think that we can kinda replicate what nature has figured out for, you know, literally a billion years.

    15. JS

      Wow. So, so yeah. So your understanding is actually that we don't know enough about the complexity of the soil, which is actually what is impacting the quality-

    16. PA

      Right

    17. JS

      ... of the vegetable, or hence the meat.

    18. PA

      And all the way up the chain.

    19. JS

      And all the way up the chain.

    20. PA

      Yeah.

    21. JS

      Hence, even if we can produce a vegetable or meat in a lab- It won't have that same-

    22. PA

      Uh, that, that's my take on it

    23. JS

      Yeah, yeah. That's, so that's-

    24. PA

      Which says nothing about... Which says nothing, by the way, about the scale factor.

    25. JS

      Mm-hmm.

    26. PA

      I think at the end of the day, scale matters. Like, I mean, f- food... I, I think it's safe to say agriculture is the second-largest industry in the world.

    27. JS

      Mm-hmm.

    28. PA

      Just in terms of, like, the magnitude of what it takes, you have to have solutions that work broadly. And, and by the way, I think that's still... There are certainly proponents of regenerative ag who say it can be scaled, but I think that's an open question still.

    29. JS

      Regenerative agriculture being scaled, is it-

    30. PA

      Right. Can it be scaled-

  12. 45:09 – 49:04

    Take Control Of Where Your Food Comes From

    1. JS

      What's your take on people trying to create little farms in their home? Like, their, their, like, mini growing, you know, vegetable and-

    2. PA

      Yeah, I mean, look, I think it's wonderful. I think if you can grow your own vegetables... I mean, we have a vegetable garden, and there's no question that the, the, the, the vegetables we grow taste infinitely better than anything we're gonna buy at the grocery store.

    3. JS

      And how do you take care of the soil in, in your area? Or you're saying because it's untouched, it naturally has-

    4. PA

      Yeah. I mean, we use, we compost our own stuff, so... But it's, you know, look, it, it's not even big enough to completely feed us.

    5. JS

      Right. [laughs]

    6. PA

      So, you know, it's, it's... There's work that goes into this, and I, and I have friends that, that do have the time and effort to at least, you know, support themselves fully.

    7. JS

      That's beautiful.

    8. PA

      Yeah, yeah.

    9. JS

      Yeah, I love that. Yeah, no, my wife's really, my wife's really big on that. She wants to build a little vegetable garden at the back right now in, in the same way, because that's one of her core beliefs as well, so like you-

    10. PA

      Just, just this past weekend I was, I, I had to put all this chicken wire around the fence where our garden is because these squirrels are figuring out a way to get under the fence, and they're, like, eating all the tomatoes and the peppers and stuff, and it's dri- Like, my son, who's eight, this is his project.

    11. JS

      [laughs]

    12. PA

      And it just drives him nuts when the squirrels are getting them, so...

    13. JS

      What a great age to, like, get connected to the-

    14. PA

      So, so great

    15. JS

      ... yeah, to the land and to the soil and to growing. That's so beautiful. I love that. Yeah, we've had a gopher problem for, for years here, and it's like, it's always ruining the lawn, and I'm like, "Well, if I plant vegetables here, those vegetables are gonna be gone." So-

    16. PA

      Yeah, you, you have to be, you have to be smart about it.

    17. JS

      Yeah, yeah. Incredible. Uh, I, I wanna make sure that everyone knows the book dives into cancer, Alzheimer's. Uh, we talked ab- we, we're gonna dive into exercise in a second. We talked about diet, uh, you know, eating less, eating patterns. I wanna make sure, because I don't wanna either repeat things that are already in the book or repeat things you've talked about in other interviews, and so I just want everyone who's listening to know that, that, you know, it dives into multiple key diseases that we're all struggling with today and the biggest challenges. One thing I wanted to talk to you about, which I think you really wonderfully highlighted, was this challenge between physical health and emotional health, and you talk about the need for prioritizing emotional health as well, and I've found that so much of my subtle emotional health was so based on physical health. So what I mean by that is I found at one point in doing all of my checks and tests that... And by the way, I was doing, I was functioning at, like, a really optimal level. I was just feeling tired, and when we did my test, we found that my vitamin D was at a 10.

    18. PA

      Mm.

    19. JS

      This was around two, three years ago, and I realized the majority of the challenges I was having was because I was sleeping... We rented a home during COVID. We moved from our apartment, and when we rented this space, I never slept well in that space because it was just the most, like, noisy, loud area because there were... It was, it was in the middle of, uh, too many animals, too many things at night, like, going through the floorboards. Like, it was an old, old space, and so there was like... I was waking up multiple times, which I don't usually go through. And so I started to find that a lot of my emotional challenges, whether it was fatigue, irritability, um, you know, stress because of that environment, was causing emotional challenges, but it was actually all coming from a physical space-

    20. PA

      Mm-hmm

    21. JS

      ... if that makes sense.

    22. PA

      For sure.

    23. JS

      And, and I think so often these days I find a lot of us are just trying to solve everything in our mind rather than recognizing that often it's a chemical, it's biological, it's, it's physical. Uh, so I wanna just point that out to people, because I think a lot of us are like, "I could have done anything to change. I was working out. I was trying to sleep right. I was doing everything I possibly could," but- Because my vitamin D was at a level 10, there's not much you can do un- instead of ta- uh, apart from taking vitamin D supplements.

  13. 49:04 – 53:10

    The Link Between Physical & Mental Health

    1. JS

      How, where are you saying this relationship, where are you seeing this relationship between emotional health and physical health?

    2. PA

      Well, th- they're absolutely linked. And, you know, I think that one of the things that I've observed, you know, my therapists will always ask me at the beginning of a session is, "How are you doing physically?"

    3. JS

      Mm-hmm.

    4. PA

      Um, "So are you in pain?"

    5. JS

      Mm-hmm.

    6. PA

      Right? "Is, you know, d- is, is your shoulder bugging you? Is your back bugging you? Do you have, like, an ulcer in your mouth or something like..." [chuckles] Like literally, something like that. "How are you rested? Uh, and how much stress are you under?" And the reason I think is those things exacerbate vul- vulnerabilities that we have-

    7. JS

      Mm

    8. PA

      ... on the emotional side-

    9. JS

      Mm

    10. PA

      ... on the mental side.

    11. JS

      Mm-hmm.

    12. PA

      So if you take an individual in two parallel, the same individual in two parallel universes, but in one situation they have lots of issues going on physically, right? So they're not well-rested, their vitamin D is low, they're in pain, and you have another individual for which everything is physically, uh, firing on all cylinders, and you present them with the same emotional distress, you're gonna see a completely different response. That's a big part of why I think it does matter to keep your physical health in order to optimize your emotional health. But I would also argue that you could still have your physical health in perfect order and, y- you know, not be coming close to addressing your emotional health.

    13. JS

      When you use the term emotional health, what does that constitute for you?

    14. PA

      I try to distinguish it from mental health, right? I think mental health is a subset of emotional health, but it's the perhaps the more medicalized piece of it. So in, in medicine, we use something called the DSM, the Diagnostic and Statistical Manual. I think we're on version five, and that's the one that codifies psychiatric illnesses, right? Everything from depression, anxiety, different personality disorders, and all sorts of things like that, and those things clearly matter. But I'm talking about something that is applicable to everyone, whereas those things might only be applicable to people who would meet diagnostic criteria. So emotional health, in the sense the way I think about it, kind of encompasses your relationships with other people, your sense of purpose, fulfillment, happiness, joy, spontaneity. All of these things that every human should be thinking about because every human is a part of those things. In my case, you know, so the, so the book is written, basically it's 17 chapters. Sixteen of the chapters are me, you know, writing about it as the doctor-

    15. JS

      Yeah

    16. PA

      ... the, the scientist, and then the last chapter, which is about emotional health, is me actually just writing about my personal experience and my own... Well, transformation, I think, would be an understatement. You know, I think that the most important lesson for me in the past decade has been that all the health stuff that's-

    17. JS

      Mm-hmm

    18. PA

      ... that makes up most of that book, how do you reduce your odds of getting cancer? How do you reduce your odds of getting heart disease, Alzheimer's disease? How do you make sure your muscles work better in the last decade of, you know, their life? All those things, they're very important.

    19. JS

      Mm-hmm.

    20. PA

      But if you're miserable-

    21. JS

      Mm-hmm

    22. PA

      ... none of it matters.

    23. JS

      Mm-hmm.

    24. PA

      Right? If your relationships suck, none of it matters. And I can't state that enough, but I, I couldn't have understood that a decade ago. You know, I had to personally experience things going really wrong. I had to nearly lose everything to realize I've really missed the plot here, and if I don't get this stuff addressed, then, uh, the rest of this outliving doesn't mean anything.

    25. JS

      What was the wake-up call for you? Or what was the-

    26. PA

      Uh, I mean, I think it f-- you know, it was essentially almost losing my family, right? It was just being so, so selfish and so-- such an awful person that, you know, I, I, I finally woke up and realized how much I was hurting everybody around me. And I was confronted with that and confronted with the reality that I had no choice but to go away and get help to, to sort of address my own, uh, reasons for why my coping mechanisms were so negative.

  14. 53:10 – 55:23

    How Childhood Traumas Impact Our Behaviors

    1. JS

      What, what made you so selfish and awful? Like, where did that come from?

    2. PA

      Well, I mean, again, at the time, I had no clue, but, but I also, at the time, I don't think I was even privy to understanding what, um, what I was doing. But, but obviously, as I, as I talk about in the chapter, and I... What I basically learned is I think a lot of my adaptations had to do with, you know, certain things in my childhood, some of which were, you know, I describe as kind of big T trauma and some of which are, frankly, just little T trauma. But, but collectively, they just produced a response, an adaptation. I talk about this sort of model of trauma where wounded children become adaptive children, and adaptive children are there to protect the wounded children, and I think that's a remarkable trait of us as humans, right? We are very resilient. The problem is that a lot of those adaptations become maladaptive in adult life, and I think that's really what I was dealing with, was so many of my adaptations, you know, for example, control, drive, perfection, anger, all of those things served me quite well as a child. But as a husband and as a father, they were not serving me well anymore, and all of the good that came from those adaptations, for example, a strong work ethic, a desire to, to, to do good, was, was more being done for the wrong reasons. It was, "I'll show them. I will, you know, I will matter. My, my self-esteem will be based on performance," et cetera. And I think all of that had to be turned on its head. For me, that was sort of my journey, was learning how to undo all of the maladaptive behaviors to try to keep the good parts of the adaptation- And then shed the, the, the harmful ones

    3. JS

      Why do you think it takes us-- Thank you for sharing, by the way, and I, I know you go into it more depth in the book, and I, I find this fascinating, and I think people... I'm so happy that you address it because I think people find it especially fascinating from coming from you because often they're just seen as such separate things and separate pursuits. But for you to unify in them is, is really, really interesting.

  15. 55:23 – 1:04:54

    Addressing The Root Causes Of Our Problems

    1. JS

      Why do you think it takes so many of us so long to address the very root cause of so much of our problems? And you partly covered it there, that some of these things become superpowers in the material world. Like they're phenomenal at, you know, manipulating the outside world through control and, uh, perfectionism, et cetera. But then in the inner world and the, the family tends to suffer from that. Why does it take us so long to look backwards, almost to look forwards in both our genetic-

    2. PA

      Yeah, yeah

    3. JS

      ... background and our also genetic trauma in that sense?

    4. PA

      I don't think we want to uncover painful things unless the pain that we're confronting is greater than the pain we're going to encounter by doing so. That's probably my simplest thought as to why. I just think that, like, how many people, without ever having experienced dental pain, would go to the dentist, right? Like you do as a kid 'cause you're sort of told, but, but when I think about now, like why do I put so much effort into taking care of my teeth? It's because I've learned how miserable it is when, um, when I don't. I think until you experience enough discomfort in the present, and in my case that came through the circumstances I write about, the pain of turning around and going back and exploring what happened and why and, and then embarking on the corrective steps and learning a whole new language and a whole new set of skills. I mean, there's-- we-- in chemistry we call that the activation energy of a chemical reaction, right? So, you know, every chemical reaction has to overcome sort of, some sort of activation energy, and the higher that activation energy, the less likely that reaction is to take place. So enzymes, which people have heard, what's an enzyme do? An enzyme or a catalyst will make that reaction more likely. It lowers that barrier to activation. So I think what we need in our life are catalysts. We need something, and unfortunately, I think sometimes it often has to be painful, a loss to, to force us to do that. I make a point when I showed up in the first rehab place I went to, there was this... there was a woman that I met there who could sort of see from the look on my face that I wasn't happy to be there. She just said to me in, in a manner that was just so perfect, she said, "Hey, nobody shows up here on a winning streak."

    5. JS

      [laughs] Yeah.

    6. PA

      It's just a hundred percent true.

    7. JS

      Mm. How, how did you help the people around you that you cared about be patient as you went through your own journey? Because I feel like it's really interesting when we're trying to solve our own wounds and pain, it's already so hard. But because we've taken on responsibilities or commitments, whether that be in a marriage or as a parent or even as a CEO or a boss or whatever it may be, it's like all of a sudden you have so many other commitments that you had taken on even before you realized you had to work on yourself. Did you find yourself helping them while you helped yourself to be around and be supportive as opposed to like tap out and say, "You know what? We don't wanna be around"? Because I think we often look at like, how are people helping us in our time of struggle, but sometimes it's like we already committed to them and then we realize that. Does that make any sense?

    8. PA

      It makes a ton of sense, and I, I, I will tell you, I think it just speaks to how fortunate I am and perhaps why I feel I have an obligation to talk about it, which is I just think I was really lucky and that the people around me stood by me and let me go through this and, and gave me the chance to do it and stood by me because I don't, I don't think many people would have. I, I really, you know, I've said this to my wife many times. I describe her as like, you know, sort of hall of fame wife who didn't really need to stick by me. I think she had enough reasons to leave and take my kids away and just say, "To hell with that guy." And that she didn't, I will forever pay that forward. And I think the same is true of people that I worked with who knew I was struggling. I think deep down believed that I was not a bad person. I was a good person who did very bad things, and that I deserved another chance. I wish I could say I was supporting them on that journey, but I don't think I was. I think I was just reeling in pain and lucky that they stood by me.

    9. JS

      Well, thank you for sharing that. That's, that really hit me. There's... You know, don't expect people to catch you when you're falling, but if they stand by you, never let them leave your side, because I think most of us could probably, the fortunate ones, attest to that. I would say that about my wife too. I'd say that about my parents. I'd say that about the people that I'm surrounded by, that sometimes I haven't had the capacity to help them as I help myself, even though I w- I intend to. But the problem sometimes is we do the other extreme where we demand them to help us. That's the balance. It's like the gratitude that you're displaying right now is, is actually like the right, I think, a wonderful balance because we do either/or. We either go, "I'm gonna solve this myself, and I don't need anyone," or, "I want my family to solve my problems for me."

    10. PA

      Mm. Interesting. Yeah.

    11. JS

      And like we live in one of those extremes, and you're actually saying, "Well, I had to help myself. I had to admit I didn't have the capacity to help them at the time, but now I'm just grateful, and I'm humbled by the fact that they stayed here." Like there's some, there's some beauty to that, and, uh, that, that really resonates.

    12. PA

      It's probably four years after one of the events that I write about in this book, which was when my son almost died. I was talking to Esther Perel, and I was just saying, "I don't think I could ever forgive myself for what I did." And she said, "That's okay. I think it's okay that you remember this for the rest of your life. I think there's a degree of humility you need to carry with you forever." And I, I think that was a really wise thing to say, right? Like, I think it would've been easy to have said, "No, no, no, no, no, you should just forget about this and move on." But she's like, "No, you should remember this forever. This is the humility you need to remember." And, and she described it in a very eloquent way, which was, "You need to understand that there's a monster in you, and he's never gonna go away."

    13. JS

      Mm. Mm.

    14. PA

      "I'm confident you will keep him in the corner for the rest of his life, but don't ever take an eye off him."

    15. JS

      Yeah.

    16. PA

      "And don't ever think that just because you're better now, you're better for life. This is a constant process."

    17. JS

      Yeah. And, and remembering that there's a monster in you, but you are not that monster.

    18. PA

      That's right, yeah. He's over in the corner, and you have the r- you are the one in charge of whether he stays in that corner.

    19. JS

      Yeah, it reminds me, I remember in my early experience of living as a monk, I said to one of my monk teachers, I was, I said, "I just feel like I'll never overcome my ego. Like, it just is too big. Like, it- there's, there's too much to deal with." And it's not that it's coming out in an externally gross way that it's manifesting, but I, I can s- I know it's there. You know, we've trained in self-awareness and, and I can see it. And he said to me, "Yeah, it's always gonna be there." [laughs] He goes, "It's, it's not going anywhere." And he said, "It will always act as your anchor-

    20. PA

      Mm

    21. JS

      ... and ground you and humble you, even when you soar to new heights or whatever else your life brings to you, that you knowing that it's there is actually what will help you-

    22. PA

      Right

    23. JS

      ... you know, stay grounded," which is such a beautiful reminder as opposed to like, "Ego death, and we're gonna crush it," and it's interesting with health too, right? With emotional health and physical health, that from what you said, the first thing you said today was, you know, there are certain things from the moment you're born that that's it. It's already going in the wrong direction. And we often think of like, "How do I end this?" Or, "How do I start this? How do I finish this?" And it's like, well, most things are just in motion. They're not beginning or ending. They're just-

    24. PA

      Yeah

    25. JS

      ... already happening. And as you said earlier, we're trying to slow it down, or we're trying to be aware of it, or we're, we're trying to monitor it. When you were speaking about your family there, and you were talking about that emotional well-being, there was something that came to mind. There were these two beautiful words you used which one of them is used a lot, but one of them not so much. But you talked about joy and spontaneity, and I love the word spontaneity. I think it's not used enough when we talk about emotional health. Joy is used, but the challenge I find today when I'm talking to people is that we're so overexposed to whether we- it's, whether chemically we're talking about dopamine or whether we're just talking about, like, joy, like, fun, pleasure, instant gratification, which we've talked about for such a long time, that everything feels boring almost. It's, it's hard for people to get to a state of joy or spontaneity. I find that a lot of people have a sense of like, "Well, what's there to look forward to?" Or like, "Ugh, well, nothing's that great. It's okay." Like, you know, whereas before... And now it's like, it feels like you've gotta up the results so hard, and the problem is even when you up it, like you're thinking that happiness is in Europe on that yacht.

    26. PA

      [laughs]

    27. JS

      Right? And it's like, even if you got there, it won't actually even live up to that experience that you put in your mind.

    28. PA

      Right.

    29. JS

      Because it was never about the physical manifestation of it. It was, it was the idea that you've overexposed yourself to so much pleasure that now even the highest pleasures don't satisfy

  16. 1:04:54 – 1:06:01

    Prioritizing Family

    1. JS

      or suffice. H- how do we work on that? Like, what is the health and emotional version of approaching that problem?

    2. PA

      I wish I knew.

    3. JS

      [laughs]

    4. PA

      I mean, a- and I think you're addressing one of the most important questions, and this is something I, I really struggle with because, you know, for me, I... And I was just talking about this with someone earlier today. I think about the next decade of my life, this amazing time where I get to be with my kids the most because, you know, as you're probably aware, the, the data are pretty clear that once your kids leave for college, the amount of time you'll get to spend with them is, is quite small. I think it works out to basically you have a total of 19 years with your kids, 18 of which occur until they leave for college, and then one year is the sum total of time you will spend with your kids the rest of your life on average. So I look at that, and I think I regret the time I've wasted so far, right? But so, so that's the stuff I talk about, and now I'm here in the future. I think, wow, the greatest source of joy I really experience is with

  17. 1:06:01 – 1:10:33

    Make Room For Joy & Spontaneity

    1. PA

      my family. That to me is what spontaneity is, right? Spontaneity for me is an important... The reason I brought it up is I'm a very rigid person by nature. Like, part of control for me is rigidity. Deviating from my plan is a very hard thing to do, but I also realize it's a very important thing to do.

    2. JS

      Mm-hmm.

    3. PA

      So, like, I'm the kind of guy who makes lists on weekends.

    4. JS

      Me too. [laughs]

    5. PA

      Right? Like, there's just ev- Like, there's a list of 12 things that have to be done on Saturday and eight things that have to be done on Sunday, and you can imagine that that, that rigidity takes any spontaneity out of life. And one of the great things I've learned is how to screw the list sometimes.

    6. JS

      Mm.

    7. PA

      The other day when I went to get, you know, had to go to Home Depot to get all the chicken wire to do the thing like that, wasn't on the list that day, but I could see that my son was upset that the squirrels were eating his tomatoes, and I was like, "You know what? I'm sp- I'm supposed to be doing X, Y, and Z. Let's go to Home Depot."

    8. JS

      Yeah.

    9. PA

      I think interestingly, a- anyone who, who does that, which I'm sure is everybody listening to this at some point can experience that- Those are probably the things that bring more joy-

    10. JS

      Mm-hmm

    11. PA

      ... than the yacht in Ibiza. It doesn't mean that you should never go on the yacht in Ibiza.

    12. JS

      Yeah, definitely.

    13. PA

      I think it just means-

    14. JS

      I'm not saying that either.

    15. PA

      Yeah. I think it just means that don't dismiss the stuff that's right in front of you. And again, for most people, I really do believe connection is that thing. Like, just having intimate connection with friends and family probably provides more of that than any of these other kind of material things.

    16. JS

      Yeah. And, and I think what you're saying is actually true, and I, and I wanna clarify that point too, that I actually think that when you are not missing the simple things that are right in front of you, then when the big material thing is right in front of you, you won't miss that either. That's, that's the point, I believe. Like, I think that if someone is grateful for where they're at and what they see and what they experience and are able to immerse themselves in it, then the same happens on vacation. The same happens on the yacht as, as our thought experiment. Like, the idea is, is that the ability to experience a flower as a thought experiment in the most immersive way allows you to experience a garden, which allows you to experience a forest, which allow... You know, it's, it's a you can't really fully experience the forest if you didn't know how to experience a leaf. That idea of that much immerse. And I've, and I've personally experienced both the presence and absence of those experiences, where sometimes I'm walking up and down here or, or doing my morning hike, and you completely miss the view because you're on your phone, or even if your phone's not there, you're thinking about something. And then w- and then the second you look up and you go, "Oh, wait a minute," like, "This was right there." And so I think we all experience presence and absence, and I've found that beautiful th- we think beautiful things will make us more present, but actually we'll be absent even in beautiful things if we're not present for the small things, and I've seen that again and again and again. Uh, and in your example, I want... And I'm just, I'm only picking at this because I think there's so much lived experience in what you're saying, and, and the scientific backbone helps too. It's like how have you also not ended up... Because it sounds like your kids and your family is just so important to you, which is beautiful, and I think that's true for so many people. But again, I find that a lot of the people that I'm talking to are living at the other extreme, where they're like, "Jay, I am so giving in to everything my kids wanna do and my family wants to do that I don't even have any of my own habits and disciplines," right? Like, for you, going to get chicken wire was a spontaneous moment of love for your son who's worried about this project that he loves, whereas for some people, all they're living in is not spontaneity, but in urgency, and, and then they're not getting... I was speaking to a friend the other day and they were telling me, "Jay, I wake up at 6:00 AM, but, but what hap-" And then I, I was kind of walking through their schedule with them for the day and helping them map habits, and they were like, "I don't know what..." And I was like, "Well, when do you start cooking lunch," for example, that they as part of their day they have to do, and they were like, "12:00." And I was like, "So what happens between 6:00 AM and 12:00 noon?" They're like, "I don't know." And I was like, "What do you mean, like, you don't know? [laughs] Like, that's six hours of time. Like, where does it go?" And then they were like, "Emails, phone calls, random people call, random things happen." It's all like... I'm like, "Wow, you're waking up pretty early, which is amazing, but now all of that six hours is just lost in kind of moving." How have you found that balance between,

  18. 1:10:33 – 1:17:36

    Life Non-negotiables

    1. JS

      like, I love my children, I wanna be there, but I also need to do everything I say in this book, which takes time and energy?

    2. PA

      I don't wanna necessarily use myself as an example-

    3. JS

      Totally

    4. PA

      ... because I also realize, like, I have some really good things going for me, which is I have, like, an amazing spouse and I have an amazing team and all of these things. But what everyone around me has figured out is if you wanna get the best out of me as a husband, as a father, as a friend, as a boss, as a colleague, whatever it is. If you want the best version of Peter, he also has to be well rested. He has to be eating well. He has to be exercising. He has to be doing the, the things that he has to do every day for his mental health. I am actually quite structured when it comes to that stuff.

    5. JS

      Mm-hmm.

    6. PA

      So I'm very routined-

    7. JS

      Mm-hmm

    8. PA

      ... with how I do things. So I do not take a single call or meeting, with very rare exceptions, once a month there's an exception to this rule, before 11:00 AM.

    9. JS

      Mm-hmm.

    10. PA

      I am scheduled without a break from 11 to 5 every single day.

    11. JS

      Mm-hmm.

    12. PA

      So I have six hours of pure schedule-

    13. JS

      Mm-hmm

    14. PA

      ... that I consider that not my time. That's my patients' time. That's my team's time. That's me giving 30 hours a week to everybody. I get up at about 6:00. From 6:00 to 11:00 is really sacred time. So 6:00 to 7:00 is just coffee with my wife and playing with the kids. So my daughter, of course, no, she's still sleeping, but the boys, we're playing board games, doing puzzles, having coffee, doing whatever. From 7:00 to 8:00 is work. Just get the emails done, uh, read whatever I need to read, et cetera, et cetera. From 8:00 to 11:00 is hobby plus exercise.

    15. JS

      Wow.

    16. PA

      So every day I'm either in the simulator driving or shooting my bow and arrow, and then I'm exercising. From 5:00 till about 7:00 is family time, so I'm usually cooking dinner, playing with the kids, going to, you know, jujitsu, whatever it is. And then 7:00 till 10:00 is some combination of family time plus work, and that's where there's has to be some flexibility.

    17. JS

      Yeah. Yeah.

    18. PA

      Like, how much more work do I need to do? And the price I pay for that is I have to work on weekends too.

    19. JS

      Mm-hmm.

    20. PA

      Right? Why? Because, like, I'm forcing the time to be spread out.

    21. JS

      Mm-hmm.

    22. PA

      And so that means, like, yeah, there's just, you know-

    23. JS

      Yeah

    24. PA

      ... there's other things I'm gonna have to make sacrifices around. But I guess my point of that is you have to kind of try to take hold of the schedule a little bit and sort of say, like, there are certain things that are non-negotiable. So not exercising is a non-negotiable. Not having some time with my family is a non-negotiable. Uh, I rarely travel anymore. I used to travel 20 days a month. I travel two to three days a month now. Just very deliberate and conscious decisions about how I wanna spend my time and the importance of, you know, taking care of my body in an effort to take care of everything else.

    25. JS

      Absolutely. No, it's-- and, and I definitely, I agree. I don't think we wanna use ourselves as examples or, you know, as, as the way to do it because everyone's so personal. I think it's just useful understanding that that structure is needed for that spontaneity.

    26. PA

      What might be more helpful for people to understand how I communicate this with my wife. So my wife is that person who will put everybody ahead of herself. So what I have to help my wife do is realize, "Hey, like, you need to go for a run too because that matters a lot to you."

    27. JS

      Mm-hmm.

    28. PA

      "And you need to go out with your friends and have drinks-

    29. JS

      Mm-hmm

    30. PA

      ... once every two weeks because that matters," or, "You need to go and get a mani-pedi with your daughter and actually relax. I'll pitch in and do this other thing because I really feel strongly about you doing that." And that's not something I would've done before. Before, I would've just sort of said, "Hey, it's awesome. You're doing everything. Great."

  19. 1:17:36 – 1:23:53

    Ways To Prevent Cancer

    1. JS

      ways of preventing and confronting cancer, um, both holistic and, you know, traditional medicine?

    2. PA

      You know, the way I sort of think about it is there are three things to be thinking about, three, three categories. So the first, as you said, is what steps can you take to prevent cancer? The second question is, if you get cancer, how can you catch it as early as possible? One thing we really do know is that if you treat a cancer earlier, your chances of beating it go up.

    3. JS

      Mm-hmm.

    4. PA

      And the longer you wait to treat it, meaning the later you catch it, the worse your odds. And then the third question is, if you do find cancer, what are the ideal treatment strategies? Let's start with the first question, and this is the least satisfying because we don't know a whole lot about what's causing cancer. So we know two things for sure. We know that smoking is a big driver of cancer, and we know that obesity is a big driver of cancer. Now, obesity is a bit of a misleading term because it's just kind of a overly simplistic way to think about what's actually happening. The data say obesity, but really what it means is insulin resistance and inflammation. Those are two hallmarks of obesity that are present in seventy, eighty percent of cases of obesity. And if you look at the data more closely, that's what's actually driving cancer. So it's not actually how much fat you have on your body. It's more how much fat is in certain parts of your body that are metabolically problematic. But after those two things- Smoking and instead of obesity, I just prefer to say poor metabolic health. We have some one-off examples. We know that there are certain types of exposures, pesticide, you know, certain types of pesticides, for example, certain type of toxins, but those don't account for the significant majority of them. So for many people, cancer is still a mystery. In other words, whatever it caused, whatever caused the initiation of the genetic mutations that ultimately led to a cancer that the body was not able to, on its own remedy, is still a bit of a black box. And some very prominent, uh, cancer biologists actually just argue that it's bad luck. In other words, it's a stochastic process. So our genes are constantly replicating, but when mistakes are made, mutations occur, and some of these mutations drive cancer. And there's, broadly speaking, two types of mutations. There are mutations in tumor suppressor genes, so these are mutations in genes that are there to stop t- cancers when cancers appear. And then there are mutations in what are called oncogenes. These are genes that propagate cancer. So mutations in any of these things can actually lead to cancer. So once you sort of accept that you're gonna do everything in your power to not get cancer, which is to say you're not gonna smoke, you're gonna be as metabolically healthy as possible, you're gonna exercise, sleep, do all those things right, the next most important thing is thinking about your strategy for cancer screening. You know, this is where I probably differ significantly from the mainstream, you know, establishment view, which is, is actually kind of, you know, not that aggressive on cancer screening. I would argue that we have to be very aggressive on cancer screening, provided we can get our minds around the problem we discussed a little while ago, which is we understand that there's gonna be... The, the harder you look for something, the more [chuckles] likely you are to find something that isn't relevant. But if you understand that going in and you're willing to accept that risk and evaluate each finding in a thoughtful way, I think that for most people, psychologically and physically, the benefit is, is a net positive one.

    5. JS

      Got it.

    6. PA

      And so that means looking at things that are-- For example, with a colonoscopy, doing it earlier and more frequently than is the standard recommendation. The standard recommendation is not to begin till you're forty-five. We would recommend that everybody, even without a family history, begin at least five years before that. It also means repeating colonoscopies more frequently, especially in the finding of certain types of polyps. Whole body screening, you talked about with certain types of MRIs. We also use something called the liquid biopsy, so it's a blood test that looks for really, really small fragments of DNA in the blood and can identify the presence of cancer and the tissue of origin. Now again, none of these tests are perfect, so each of these tests have things that they're going to miss, but the idea is that the more you're layering these tests, the better your odds are of finding something earlier. And then the final point is, okay, well, what are the strategies? W- you know, if should you have cancer... And this is where I think we just have a little bit more promise now than we did a decade ago. So a decade ago, 'cause this is the first time I did this analysis, in the previous fifty years, so from, you know, sixty years ago until ten years ago, the overall survival improvement in cancer was about three percent.

    7. JS

      Wow.

    8. PA

      It was abysmal. But in the past ten years, it's been about another eight percent.

    9. JS

      Mm.

    10. PA

      And while that doesn't sound remarkable, and the implication of that is half the people who are diagnosed with cancer today will still die from cancer, it's the biologic insights and the trajectory that we're on right now that gives me much more hope, and that is primarily based on a couple of things. The first is the field of immunology has really taken off. The tools that we have to harness the immune system to attack cancer have become so dramatic-

    11. JS

      Mm. Immunotherapy, right?

    12. PA

      That's right.

    13. JS

      Yeah, yeah.

    14. PA

      That it really is, I think within the next decade, which I know seems like an infinite amount of time for someone who's got cancer right now, we're really seeing changes that I think are going to allow immunotherapies to go from the niche place that they occupy in only working for certain types of cancers like melanoma and kidney cancer, to being able to go after the holy grail of cancers, which are what we call the solid organ epithelial tumors: breast, pancreatic, colon, lung. These are the big cancers that do the majority of the killing. Fifty percent of cancer deaths are just five cancers: lung, colon, breast, prostate, pancreatic. That's more than fifty percent of all cancer deaths.

    15. JS

      Mm.

    16. PA

      Until you have a solution for those, we're not-- we don't have a solution for cancer.

    17. JS

      Got it. Got it.

    18. PA

      And I do believe

  20. 1:23:53 – 1:28:09

    Identifying Self-destructive Behaviors

    1. PA

      that we are really moving in that direction.

    2. JS

      We've touched on this point a few times of almost the stress about stress for health, and that's a really interesting way of thinking about it. It's like the stress of, "Oh, I need to work out today." The stress of, "I need to have my supplements today." The stress of, "I can't sleep. Why am I not sleeping?" Right? Like, we stress about the things that are good for us. How have you helped your patients? How have you coached them through that? How do you guide people through that? Because I think a lot of people go, "Well, then I'm just not gonna do anything, because at least then I'm not stressed." I don't think that's the wisdom [chuckles] in what you're saying. I don't think you're saying, "Well, yeah, d- it's better not to have any stress at all." How do you help people to engage and, you know, use that stress in a healthy way? Or how do you guide patients through that stress?

    3. PA

      I mean, I think every patient's different, and I think you have to sort of get to know the person a little bit and figure out what, what's the underlying issue. So I, I do think that there are a lot of people who frankly self-sabotage. Going back to kind of like where I was, I mean, my self-destructive behaviors weren't coming directly at the expense of my physical health.

    4. JS

      Mm.

    5. PA

      They were coming at the expense of my emotional health. But I actually think there are a lot of people who have very similar stories to mine, but their manifestation is it's coming at the expense of their physical health.

    6. JS

      Mm.

    7. PA

      They are sabotaging their ability. They, they are coming up with a million excuses why they can't eat well, they can't exercise, they can't do this, they can't do that. And so you have to be able to get to the root of the problem and- So there are many patients where we just think, "Look, you're not going to get better without trauma-based therapy." Like, until you come up with a way to care enough about yourself to stop punishing yourself in this way... Because I do-- I think people punish themselves in different ways. You could almost argue I used to punish myself by overdoing all of those healthy things. Like, some of the exercise I was doing was actually a form of punishment. So on the surface, you'd say, "Boy, that guy's really healthy." But no, he wasn't. Another thing I always think about is when we're in the spirit of trying to build new habits, sometimes perfect is the enemy of good. Typically, what I want is a win, and I think that what people just need is a win.

    8. JS

      Mm-hmm.

    9. PA

      And it doesn't have to be the biggest win. It just has to be a win. So if you're looking at a person for whom nothing is optimal, don't try to fix all things at once. Pick the one thing that you think they have the greatest odds of being able to make a difference on, and just work on that and accept the fact that the other things will continue to be suboptimal. But you develop their confidence in that one thing. How about for twenty minutes a day you do something active? You go and walk for twenty minutes a day. If you're talking about a person who's never lifted a finger, that would be a huge win. And you might do that before you get into the details of this type of training or that type of training, or we're gonna tweak your nutrition and optimize your protein intake. I mean, that's just overwhelming, and you're probably just more likely to fail at everything and create kind of a compensatory negative reaction. But again, I, I, I don't think there's a paint-by-numbers approach. I think you... In the way we do it with patients, I think you just have to treat everybody [chuckles] individually. And by the way, when something's not working, you have to accept it and pivot and try something that is.

    10. JS

      I think that's the key word, pivot.

    11. PA

      Yeah.

    12. JS

      That's the key word. Everyone, uh, Peter Attia, the book is called Outlive: The Science and Art of Longevity. If you don't already have it, please go and grab a copy. Uh, I, I highly recommend it. Of course, today's conversation's been fantastic. I've tried to touch on topics that Peter may not have been asked about in a million different interviews. He's got fantastic interviews out there on so many awesome podcasts as well. So if you're more interested in the parts we didn't cover, please do go and watch those and get informed. Uh, Peter, it's been such a joy sitting down with you today, honestly. There's been, uh, moments where I've been mind-blown and moments where I've been taken aback and felt really, you know, in my body and really present where my feet are. And, uh, I'm just really grateful that we got to have this conversation. We got to share so much incredible insights with our community today, and I want you to make sure that you tag me and Peter on Instagram, on TikTok, on Threads, uh, with what you're learning, what you've taken away. What are the things you're gonna apply and practice with? What's something you're gonna experiment with this week? That would make me really happy, is that you just take one thing away from this and you're like, "I'm gonna try that out. I'm gonna figure this out for myself." That would be an awesome

  21. 1:28:09 – 1:31:15

    Peter on Final Five

    1. JS

      place to start. Peter, we end every episode with a Final Five, a Fast Five. So these questions have to be answered in one word to one sentence max. Uh, so Peter Attia, these are your Final Five or your Fast Five. The first question is, what is the best health advice you've ever heard or received?

    2. PA

      Exercise every day.

    3. JS

      Second question, what is the worst health advice you've ever heard or received?

    4. PA

      Do a cleanse.

    5. JS

      Ah, interesting. Why? That's inter- yeah. Okay.

    6. PA

      Oh, I just think that, y-you know, I've seen, I've seen some of those things go really bad where people, you know, get really mucked up and dehydrated. And I've, I've seen people actually take in some chemicals and compounds that dramatically alter liver function tests and things like that.

    7. JS

      Wow. Okay. All right. Uh, question number three, what's something you're currently trying to unlearn?

    8. PA

      Continuing to work on perfectionism. You know, unlearning-

    9. JS

      Mm.

    10. PA

      Or, or detuning it.

    11. JS

      Uh, question number four, what's something that you're a very big proponent of, but a lot of people may disagree with you, and you're-- they're like, "Mm, I'm not sure about it"?

    12. PA

      Maybe the importance of very heavy strength training in post-menopausal women.

    13. JS

      Interesting. Let, let's dive into that, 'cause that's, that's fascinating. I'm really-

    14. PA

      Yeah

    15. JS

      ... glad how specific you went. That's great.

    16. PA

      W-women post-menopause are so unbelievably susceptible to osteoporosis and osteopenia with the loss of estrogen. Unfortunately, many women in that situation are not getting hormone replacement therapy, and so they're doubly, uh, susceptible to it. I think there's just a, a cultural belief that, you know, women don't need to lift weights, and if they do, it's very light. Uh, but the truth of it is you really need to lift heavy things to make your bones stronger.

    17. JS

      Mm.

    18. PA

      And that doesn't mean it has to be complicated stuff like squats or deadlifts or things like that. But, you know, one of the most important things is carrying, doing a farmer's carry. So holding very heavy dumbbells in your hands and walking. So important, and it doesn't matter how old you are.

    19. JS

      Got it. Great. Fifth and final question. If you could create one law that everyone in the world had to follow, what would it be?

    20. PA

      You must go into nature for at least an hour a day with no electronics.

    21. JS

      And just be.

    22. PA

      Just be outside, be in nature, but be untethered to electronics or obvious distractions.

    23. JS

      Beautiful. Peter, that's fantastic. Thank you so much again for your time, your energy, your presence today. I hope this is the first of many times that you'll come back on, on purpose. And again, if you don't already follow Peter... Peter, where's the best place you'd like people to find you? I know you're on Instagram and YouTube and everywhere, but-

    24. PA

      Yeah, I think everything is Peter Attia MD is, is all the handles everywhere. And, uh-

    25. JS

      Amazing.

    26. PA

      Yeah. So thank you very much. I really appreciate this.

    27. JS

      Thank you. If you loved this episode, you'll enjoy my interview with Dr. Daniel Amen on how to change your life by changing your brain.

    28. SP

      If we want a healthy mind, it actually starts with a healthy brain. You know, I've had the blessing or the curse to scan over a thousand convicted felons and over a hundred murderers, and their brains are very damaged

Episode duration: 1:31:15

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