248 ‒ OUTLIVE book: A behind-the-scenes look into the writing of this book, motivation & main themes

1. 0:00 – 0:08

   Intro

   1. PAPeter Attia0:00

      [upbeat music] Hey, everyone. Welcome to "The Drive" podcast. I'm your host, Peter Attia. [upbeat music]

2. 0:08 – 7:08

   The meaning of the book's title and subtitle

   1. SPSpeaker0:10

      Peter, Bill, how you guys doing?

   2. BGBill Gifford0:13

      Doing all right.

   3. PAPeter Attia0:14

      All right.

   4. BGBill Gifford0:14

      Doing good.

   5. SPSpeaker0:15

      This is the first time we've ever done three people in person, so we'll see how it goes. But, uh, it should be fun, and I think what we're here to talk about is the book. So by the time this comes out, the book will be out, which is still kind of crazy to think about, more so for probably both of you, who have been much more involved in the process than me. But I think what we did is we collected a ton of questions from the audience on wanting to understand the process of the book, who Bill is, what the cover means, what's talked about, all of that stuff. And so we collected those questions. We're gonna cover them today, and it should be kind of a fun way to learn more about the book, what's involved, kind of that inside baseball story about it. So with all that said, I think the first thing we should start with is Peter, how's the voice doing?

   6. PAPeter Attia1:07

      Uh, I would say it is, like, 80% of the way back to normal.

   7. SPSpeaker1:12

      Do you wanna tell people who are maybe unfamiliar how the book tried to kill you through your voice?

   8. PAPeter Attia1:16

      I think the book has tried to kill us in many ways.

   9. SPSpeaker1:18

      [laughs]

   10. PAPeter Attia1:18

       But [laughs] I think most recently, um, between reading the book for the audiobook and then getting some virus and then having a hectic travel schedule to try to do some podcasts, I basically just developed the worst case of laryngitis and a, had a pharyngeal abscess that, uh, caused my vocal cords to stop working.

   11. SPSpeaker1:42

       [laughs] Oh, yeah, which in your profession you kind of need. So it's good that they're, made their way back.

   12. PAPeter Attia1:49

       Yes. But I will say this. I really enjoyed not speaking for two weeks.

   13. BGBill Gifford1:53

       Sort of a vow of silence kind of thing.

   14. PAPeter Attia1:55

       I mean, it was just amazing. I was like... It was amazing how many things I got to tune out. Like, people would, I'd hear people call my name, and I'd be like, "Hmm, I can't do anything about it, so I'm just gonna sit here."

   15. SPSpeaker2:07

       H- how did the family take that? Did they-

   16. PAPeter Attia2:09

       Oh, they loved it

   17. SPSpeaker2:09

       ... use that to their advantage?

   18. PAPeter Attia2:10

       Oh, they l- absolutely loved it. The boys were... What was really funny was the first couple of days, everybody else got very quiet in response to me being quiet. So I, uh, actually, it's a very interesting, um, one of the few times social media turned out to be insightful and helpful. Um, after I posted, I think, the second video of the direct laryngoscopy, someone, uh, a very astute... Actually, uh, several, several commenters said, "Hey, Peter, by the way, don't whisper," 'cause that was basically all I could do. I could go like... I could sort of do this. And they said, "Don't whisper. Whisper is a bad form of phonation. It's actually teaching you the incorrect movements. [swallows] Either don't speak or speak normally but at the lowest volume possible." And I was like, that sort of a... I was like, "Well, that really makes a ton of sense," because my, my throat was actually starting to hurt from all the whispering. It was, you know-

   19. SPSpeaker3:00

       Yeah

   20. PAPeter Attia3:00

       ... utilizing muscles incorrectly and stuff like that. So anyway, so I'm talking very quietly, and my boys, who as you know are not... You can use a lot of words to describe them. Quiet is not, would not be on those lists.

   21. SPSpeaker3:09

       Definitely not one of them.

   22. PAPeter Attia3:11

       They got so quiet in response to me being quiet that I was like-

   23. SPSpeaker3:15

       [laughs]

   24. PAPeter Attia3:16

       ... "We got, I gotta figure out a way to win, to just do this enduringly."

   25. SPSpeaker3:20

       Yeah. [laughs] When, next time you have, like, people over, you need them to just be under control.

   26. PAPeter Attia3:24

       Yeah. I, I think-

   27. SPSpeaker3:24

       You're just gonna, "Oh, Dad can't talk again."

   28. PAPeter Attia3:26

       Yeah.

   29. BGBill Gifford3:26

       So you learned a, a parenting hack.

   30. PAPeter Attia3:28

       Yes, totally. The quieter you are with your kids-
3. 7:08 – 15:47

   Finding the right art for the book cover

   1. SPSpeaker7:08

      the most common question we got as it related to the cover is, can you explain the cover art? And I know for those listening or watching, it went through a lengthy process of a lot of different iterations. So do you maybe kind of wanna talk about that, why you ultimately settled on this, and kind of to you, what it means?

   2. PAPeter Attia7:31

      Yeah, I think, um, the cover is interesting because there were, there were two things that in the back of my mind were enormous stressors as we got closer and closer to the finish line. Um, and by that I mean basically by about the spring of 2022, so about a year, exactly a year ago, you know, we had a manuscript that was... We knew it was too long. It was probably about 190,000 words at that point. So we knew it was gonna get a big haircut, but we knew we basically had the book at that point. But these two things that kind of nagged at me and kept me up at night were, how could this be represented in a cover? And who is gonna read this book for the audiobook? Those two things just created such a low-level anxiety for me, I can't even, you know, talk about it. And so as the spring turned into the summer and our publisher is like, "Okay," like, "we need to get on this cover thing," and they've got kind of a checklist of, okay, for the book to come out in March, we have to have this thing designed by here, and da, da, da, da, da. Um, I just didn't even have a sense of what one does because I couldn't, you know, as Bill can say, I have very strong opinions about everything. I couldn't even offer an opinion on the cover, right? All I could say was, "I want it to be elegant. I want it to be kind of timeless. I don't want it to be too busy." Like, I had vague ideas of what I wanted, and as you know, I'm a font fanatic, so I kind of understood the fonts I wanted, but no sense artistically of what was wanted. So then Bill, uh, sent... This is probably August, right?

   3. SPSpeaker9:17

      Yeah, yeah.

   4. PAPeter Attia9:17

      You sent over an email of a guy named Rodrigo Corral, who I'd never heard of before, but you sent over-

   5. SPSpeaker9:24

      Yeah, yeah

   6. PAPeter Attia9:24

      ... I think his website.

   7. SPSpeaker9:25

      Yeah, my sister is a book designer, and he's like a big, he's revered in, in those circles, and we looked at some of his designs.

   8. PAPeter Attia9:33

      Yeah, and I recognized the books-

   9. SPSpeaker9:34

      And it really kind of pops, right?

   10. PAPeter Attia9:34

       ... and I was like, "Yes."

   11. SPSpeaker9:37

       Yeah.

   12. PAPeter Attia9:37

       This is elegant.

   13. SPSpeaker9:38

       That's the guy, right?

   14. PAPeter Attia9:38

       This is elegant. And while that's happening in parallel, the publisher is churning out, um, designs as well. And I'm kind of like, "Okay, there's a couple of these that are, I could see iterating on." Um, and basically we were, we just, we, we weren't really making a ton of progress until we, I think, just collectively decided... And, and really I, I think, uh, Bill has contributed a lot of things to the project, but if I was gonna say the single most important thing Bill contributed was being adamant that we engage with Rodrigo, and this was late in the game. This was October, if I'm not mistaken. And I remember where I was. I was on a flight, and I got an email from Bill, and, um, it, it said something to the effect of, 'cause we were looking at something that I was almost going to capitulate on. It was a design. I remember what the design was. And I basically was saying, "It's a solid 7 out of 10, and I'm too tired to do anything about it." And Bill was like, "This is bullshit, man. We've worked way too hard on this book to have a 7 out of 10 cover. I think we just, we just, we just, we go and get Rodrigo, and it doesn't matter how much it costs, and it doesn't matter how much it slows the process down, we do it." And I was like, "Yeah, [lip smacks] Bill's right. I don't wanna regret this. I don't wanna, I don't wanna be sitting here in 10 years going, 'Ah, why did we do that?'" So then we reached out to Rodrigo, had a long call with him, and I guess this is what makes great artists great artists, is be- even having this call just talking with him about the book. He didn't have a chance to read the whole book 'cause it's long. And I mean, within three days he threw up 30 covers.

   15. SPSpeaker11:41

       And they're all different.

   16. PAPeter Attia11:43

       Totally different.

   17. SPSpeaker11:44

       They're all sort of evocative. I mean, there were some, there were some images that I liked and that you liked and other people liked and, but different ways to kind of evoke this concept of longevity and outliving and, um, living better and all that stuff, which, I mean, it's really easy to also get that wrong visually.

   18. PAPeter Attia12:06

       Yeah.

   19. SPSpeaker12:06

       Like the, I was telling Nick about the Korean cover of, uh, of my book, Spring Chicken, that portrays a fat guy on a beach chair like frying an egg-

   20. BGBill Gifford12:17

       And that's supposed to mean longevity. So there's many ways it can go off the rails.

   21. PAPeter Attia12:22

       [chuckles]

   22. BGBill Gifford12:22

       So I think he... There was something about this, and, and I think, I don't think this was your favorite at first either.

   23. PAPeter Attia12:28

       It wasn't at first. It was, but it was in my top six.

   24. BGBill Gifford12:30

       Yeah.

   25. PAPeter Attia12:30

       So I remember he sent over 30, and I think we each decided to pick our top five or top six. This was on for all of us. It had a very different font. There were a number of things about it that were different at the time, and I think the font threw me off the first time round.

   26. BGBill Gifford12:47

       Font guy. Yeah.

   27. PAPeter Attia12:48

       Yeah, font guy. I'm very particular about my fonts. And to make a very long story short-

   28. BGBill Gifford12:54

       Yeah

   29. PAPeter Attia12:54

       ... we ultimately decided this was the one we were going to make the winner. And, you know, I wish I could sit here and tell you that the blue, green, yellow, pink all signify something. I, I can't tell you that. What I can tell you is it signifies a bunch of things to me, right? It signifies kind of a keyhole that you're walking through. It's a passage. Um, but it also looks like a target, and that's a big part of this. There's a very subtle theme in this book about lots of metaphors that revolve around archery. Um, anyway, I could talk about it, it length. I'm not sure, Bill, what, what you think.

   30. BGBill Gifford13:34

       Well, it's, it's different. I showed it to different people, like my partner Martha and various other people, and everybody kind of liked it, but they had a different reason.
4. 15:47 – 26:47

   Who is Bill Gifford, and how did he get involved in the book?

   1. SPSpeaker15:47

      kind of pivots to the next question, and Bill, you hinted at it a little bit. But a lot of people were kind of curious, you know, who is Bill Gifford? Like, what's his backstory? How did he get involved in the book? So do you kind of want to give a little rundown of kind of who you are, your story, and then ultimately how you initially got connected with Peter and the project, which was six years ago now?

   2. BGBill Gifford16:08

      Oof. It was, um, end of 2017.

   3. PAPeter Attia16:13

      End of '17.

   4. BGBill Gifford16:13

      Yeah. Yeah. I got an email out of the blue.

   5. PAPeter Attia16:17

      From me, right?

   6. BGBill Gifford16:18

      Yeah.

   7. PAPeter Attia16:18

      Yeah.

   8. BGBill Gifford16:18

      Yeah. And I, I knew who you were because I had read your... You know, I knew who you were, and I'd, I think in particular I'd read your insane 13-part series-

   9. PAPeter Attia16:28

      Oh, the cholesterol

   10. BGBill Gifford16:29

       ... about cholesterol.

   11. PAPeter Attia16:29

       Yeah, yeah. That's right. The-

   12. BGBill Gifford16:29

       I was like, "This is epic." Uh, and in, I had read that in the course of researching my own sort of more personal book about longevity, Spring Chicken, which came out in 2015. I thought I was done with longevity, honestly, but this seemed interesting. But sort of to reel back, I'm, I'm, um, [lips smack] you know, like where other kids' dads were throwing the football, passing the old baseball around, like my dad took me to the library. So I became a, a writer eventually, and I just love writing and words, and I thought I would be a, like a poet at one point when I was in college. But then I, I realized I like writing to people and sort of connecting with people and [inhales] evolved, um, from sort of general journalism into writing more and more about sort of scientific and medical topics and writing about like sports performance and then doping in cycling and then more general health-related topics and then [inhales] got interested in, like Peter did. You know, you reach a certain age and you're like, "Huh, what is happening here?" You know, "I'm not the guy I was 10 years ago." And there's this interesting process going on that's this big sort of biological mystery. It's super fascinating, and it has not been solved. It still has not been solved. Um, so yeah, so ended up writing about longevity. And I, I ended up writing, I write a lot about athletes too, so I found myself writing about older athletes as well. Like Phil Mahre, the skier, came back to racing when he was 50, so I followed him around, and he was competing against 22-year-olds. So, so that kind of, that kind of longevity kind of fascinates me as well.

   13. SPSpeaker18:18

       And Peter, I actually don't know if I know this story, but you mentioned you first reached out to Bill. So what caused you to do that throughout the writing process?

   14. PAPeter Attia18:26

       Well, so in 2016, I was working with an agent. Uh, this book got sold to a different publisher and, um, you know, I was the author of the book and, um, I'm working on it nights and weekends, you know, while I'm doing my day job. And I finally have kind of the first part of the book to submit. It was just under 40,000 words, and I submit it to my agent, who then submits it to the publisher. Now, by this point, the editor who had bought the book had left. So there's this woman, um, who was at the, who was at the publisher, and I, I seemed to like her, and I, I, I thought, I thought she really got the concept of the book. But unfortunately, and I guess this is not uncommon in publishing, within a couple months of me coming on with the publisher, she gets a better job at another publisher, so she's gone. So now another a- another editor basically comes on. It's now her book, but she doesn't really have as much invested in it. And so I submit this first section to them, and it is met with a very lukewarm response. Um, [lip smack] and they really had two huge criticisms of it. Um, the first was it's too technical. Um, and I, you know, I, I, I can, I can see, see why that's the case. The second was there was no story in it, right? There was no narrative. It was mostly just a scientific treatise on the subject matter. [sniffs] And so then my, I guess both my agent and the publisher said, "Look, we think you should bring a co-author in who can help massage and smooth this out and make it, you know, um, a better book for the layperson to read." So I said, "Okay. How, how do we go about doing that?" And they said, "We've got a long list of people to introduce you to." I said, "Great." So sure enough, the courting began. And every... This is back when I was in New York constantly because I was, you know, this, you know, this was back when I traveled a lot to, to work there. And so basically, every week that I'm in New York, I'm meeting another author. And usually what would happen is they would send me one of their books. I'd, you know, read as much of the book as I could get through or skim it or something, and then sit down with them. Um, and I kind of went through five or six of these, and it just-- I was like, "There's no way this person gets it." Like, this person has no clue what I'm trying to write about, and this is not gonna work. So then I talked to Bob Kaplan, and I said, "Bob, here's the problem. What do you-- Do you have any ideas?" He goes, "Yeah. Let's, let's go find somebody who's already written about what you find interesting and see." And the very first thing that I remembered... What year did you write that Bloomberg piece on rapamycin? Was that 2015?

   15. BGBill Gifford21:30

       So I think that came out, um, 2015.

   16. PAPeter Attia21:35

       Yeah.

   17. BGBill Gifford21:35

       Early.

   18. PAPeter Attia21:36

       So-

   19. BGBill Gifford21:37

       2015

   20. PAPeter Attia21:38

       ... and it, it's actually interesting that you wrote it back then 'cause this was still sort of pre-hype of geroscience.

   21. BGBill Gifford21:44

       Yeah.

   22. PAPeter Attia21:44

       But there was an article in Bloomberg, yeah, I guess 2015, that, you know, because I was obsessed with this stuff, I read everything that came out, and this was the first one that I read that I was like, "This is a very good article." Most of them were so simplistic. They just missed the point. But this was a very good article. Um, and so I said to Bill, I mean, I said to Bob, I said, "This is the guy 'cause he already gets it. I'm not gonna have to like, you know, explain to him this, that, or the other thing." Or at least I said like, "My intuition is that he will get it." And I don't-- Did I contact you through Twitter? How did I? I do remember reaching out to you. Was it through your website or through your a-

   23. BGBill Gifford22:27

       I think you just emailed me.

   24. PAPeter Attia22:28

       Yeah, yeah, yeah.

   25. BGBill Gifford22:29

       Yeah.

   26. PAPeter Attia22:29

       So somehow I just got Bill's email. Maybe it was on the article. And I, I, I don't remember what the email said, but I do remember we met for dinner on the Upper East Side-

   27. BGBill Gifford22:37

       Yeah

   28. PAPeter Attia22:37

       ... one day in late 2017.

   29. BGBill Gifford22:39

       Yep.

   30. PAPeter Attia22:39

       And I think I probably just said everything I just said now, which is, you know... And, and, and by that point, so what did I send you to read? What was the version I had sent you at that point?
5. 26:47 – 31:44

   How Peter's writing evolved over the six years it took to write this book

   1. SPSpeaker26:47

      what do you th- so, you know, you mentioned it was so hard to kind of write, and it obviously took a very long time. What do you think was so hard about the process? Was it translating the science into something that was more of a story? Was it figuring out how to verbalize the frameworks? Was it just getting what was in your head cohesively on paper?

   2. PAPeter Attia27:09

      I think there are a couple of things. So first of all, I love writing. I've been, you know, been blogging for, for as long as I can remember, but that's a very different style of writing. You know, Bill was talking about my 13-part cholesterol series. You don't have any constraints when you're blogging. You can go as deep as you want to go because you are attracting an audience of similar weirdos who are gonna go as far down the rabbit hole as you will take them. And so I think the biggest struggle I had switching to this kind of writing, and it's so funny for me to look at this version of the book now and compare it to what I was writing in 2018. And I remember Bill really tolerated a lot of my stupid things that I was writing and, and what, the basic, [laughs] basically how he tolerated it was he made a lot of footnotes.

   3. SPSpeaker28:05

      [laughs]

   4. PAPeter Attia28:06

      He was like, "All right, I really want to delete all of this-

   5. SPSpeaker28:08

      Let's put this in a footnote

   6. PAPeter Attia28:09

      ... but we're gonna make it a footnote." And of course, four years later, or three years later, I was the one deleting those footnotes, and I was like, "This is so gratuitous." Like, it doesn't matter that much. And, and that to me is a remarkable evolution, I guess, that everyone has to go through. You know, Bill presumably went through this 30 years ago, right? But for me, that was new. That was like, "No, but I do need to ex- explain the extracorporeal circulation of the liver in this section." And Bill is like, "I, I don't think that's really important." And I was like, "No, no, no, Bill, you don't understand. If the reader doesn't understand portal blood flow here, they will never understand why glycogen gets there." And he's like, "Peter, I can assure you, there are seven people who give a shit about that."

   7. BGBill Gifford28:54

      [laughs]

   8. PAPeter Attia28:55

      And I was like, "No, no, Bill, it's important." He's like, "All right, let's make it a footnote." "Fine, let's make it a footnote." I was pissed.

   9. SPSpeaker28:59

      [laughs]

   10. PAPeter Attia29:00

       And then of course two years later I'm like, "That's so goddamn irrelevant. Get rid of it."

   11. BGBill Gifford29:05

       But you have to know it, though. To be able to-

   12. PAPeter Attia29:07

       Yeah

   13. BGBill Gifford29:07

       ... write intelligently, like, you have to know it, and you have to know what's going on, and... But then you also have to decide, like, like, you have to know. It's, you know, you talk about, like, getting in the weeds, right?

   14. PAPeter Attia29:18

       Yeah.

   15. BGBill Gifford29:19

       And you have to know all the weeds to write well about science, but then you also have to, and I think ultimately we, we both got pretty good at this, like, get pretty harsh about, like, what you're gonna leave out. And we left out a lot of stuff. Like-

   16. PAPeter Attia29:34

       I mean, so much

   17. BGBill Gifford29:34

       ... the-

   18. PAPeter Attia29:35

       It, it's like-

   19. BGBill Gifford29:35

       ... stories and science

   20. PAPeter Attia29:37

       ... it's the, it's the, it's the, uh, I mean, I think I've told this story before, but I remember when I was writing probably my first or second scientific paper, you, you do a lot of experiments, most of which don't make it into the paper. And I forget who it was that told me this. I think his name was Dan Powell, was one of the postdocs that I was in the lab with, and he said, "You just have to learn how to kill your babies. You're, you're gonna throw out-

   21. BGBill Gifford30:02

       Yeah, it's the same

   22. PAPeter Attia30:02

       ... 90% of this."

   23. BGBill Gifford30:03

       Yeah.

   24. PAPeter Attia30:03

       And I just think that that for me was hard, getting to that point of, but will the reader, if the reader doesn't know all of this, you know, stuff below the surface, can they appreciate the piece of the iceberg above? And I, I think ultimately the readers will determine the, the, if we've struck that balance correctly. I think we have. Um, and I'll tell you why I think so. I think it became readily apparent when I read the audio version of the book because When you're reading it out loud, it's very different from when you read it the way one edits their own writing, 'cause you're, you're, you're obviously reading it much slower, and you realize the unnecessary interruptions of-

   25. SPSpeaker30:55

       Yeah

   26. PAPeter Attia30:55

       ... endless footnotes that are, you know, incremental in what they're adding.

   27. SPSpeaker31:05

       Yeah, it's kinda... It's interesting to hear you talk about it because I can't imagine. I haven't read the first iteration, which I think you said practically none of it made the final version, right?

   28. PAPeter Attia31:16

       Certainly in direct content, absolutely not. In spirit, some of it, but yeah.

   29. SPSpeaker31:21

       I just can't imagine what it was as if you handed them a whole manifesto, zero tactical advice, and literally explaining every little nuance of the liver. Like, I would just love to see the face of the person who came in after that publisher left and read this [chuckles] and just was like, "What the hell are we gonna do with this thing?"

   30. PAPeter Attia31:40

       I'm, I'm sure they were freaking out.
6. 31:44 – 36:38

   The structure of the book and what people can expect to learn

   1. SPSpeaker31:44

      think it makes sense to kinda talk a little bit—you mention it there, but there's three main parts to this book, right? So let's talk about what ultimately made it into this final version. Do you kinda wanna walk through what the structure of the book is, kinda some of the content? So we don't have to get into detail, but just kind of what people can expect to read about.

   2. PAPeter Attia32:05

      Yeah, I mean, look, there's three parts. Uh, I think the first part sets up the structure of the book. It gets the frameworks across. You'll certainly, uh, as a reader, understand the problem statement, right? And, and I, again, I think you can't solve or even attempt to solve complicated problems if you aren't asking the right questions and you don't have the right frameworks. That's something that we posit very clearly here, and that's really what part one is about. And that's not just explaining what longevity is and isn't, but it's explaining something called medicine 3.0, which is the vehicle through which you pursue this thing. Then, um, part two, um... Uh, sorry, I guess the other thing in part one is we—I'm, I'm blanking on where the delineation occurs, but I think part one also includes kind of some of the scientific underpinning, doesn't it? Or does that all get lumped in part two? I think that's part two with the horsemen.

   3. SPSpeaker33:03

      That's, that's part two.

   4. PAPeter Attia33:03

      Okay. Yeah, yeah, yeah.

   5. SPSpeaker33:04

      Yeah, centenarians.

   6. PAPeter Attia33:05

      So part two is probably the most technical part of the book, where we get into the scientific underpinning of everything coupled with get to know your opponents, basically, right? So, so there's no denying this. A big part of this book is trying to figure out how to live longer. Now, not in terms of science fiction living longer, but, I mean, I think we argue very convincingly that a person reading this book who puts these principles into practice is, is, is really thinking about e- elongating their life by five to 10 years. But to do that, you really have to understand what are the things that are coming to take your life. So we kind of go through all that in part two. Um, and then part three is how do you put this into practice? It is that which I initially didn't want to write about, but ultimately think, um... I, I, I don't know. I, I think that, I think that section just turned out better than I ever could've imagined it.

   7. SPSpeaker34:04

      Yeah, it kind of organically evolved and kept growing and, um, changing. Uh, but, you know, it, it-- Going back to part two, I think we were, we were looking at, um, you know, 'cause we're both fascinated by centenarians. We were looking at that chapter and kind of hammering out that chapter, and we kinda had a little bit of a revelation where it was like, "Wait, how..." It, it's not, like, a big mystery how these people live to 100 when most people live to 80. You know, they get heart disease much later, if at all. They get cancer much later, if at all, or maybe never. And they get neurodegenerative dis- disease, neurodegenerative disease later or never. And so it's kind of like that's the ballgame, right? You've gotta figure out how to delay all of those diseases, the, which you call the horsemen, right? So then we had to... And we didn't even contemplate writing these chapters at the beginning. And then we decided, no, we have to 'cause we have to like, like you say, like know, know the enemy, know the opponent.

   8. PAPeter Attia35:14

      That's right. Yeah, the first version of this, which is the first version that we wrote, which is the second version of the book, was way heavier in the molecular-

   9. SPSpeaker35:24

      Yeah

   10. PAPeter Attia35:24

       ... science of aging. So we came at this much more through let's go really deep into autophagy. Let's go really deep into nutrient sensing pathways. Let's go really deep into all of these things, which, of course, I found super interesting. But, um, ultimately, we pivoted much more towards this insight, which is there are two completely different strategies to live long. One is figure out a way to extend the period of time you live once you have a disease, and by the way, that's everything medicine 2.0 does. We're gonna wait till you have a disease, and we're gonna figure out a way to just drag you through that and keep you from dying. Okay, that strategy's worked a little bit. Strategy two, which is medicine 3.0, is no way. We have to figure out the time... We have to figure out a way to drag out the time you live without a disease. And to understand, you can't enter, you can't play that game if you don't know everything about these diseases. You have to become so intimately familiar with each of the horsemen, and, um, and of course, therefore, each of those horsemen has a very robust chapter.

   11. SPSpeaker36:37

       As I'm

7. 36:38 – 40:35

   How the writing of the book and the podcast interviews have shaped Peter's thinking and approach to translating science

   1. SPSpeaker36:38

      listening to you talk, I'm kinda curious. Do you think for as tough as it was to write the book and all the pain to go through that process over the years Do you think how you practice medicine with your patients, kind of what we talk about on the podcast, like weekly newsletters, how all that's structured, do you think it would evolve to what it is if you didn't write the book?

   2. PAPeter Attia37:00

      I th- I mean, I th- I think they help each other for sure. I, I think, um... I mean, you can't write well if you don't think well. Um, and you could argue it's hard to think well if you're not able to write well. So I think the relentless process of streamlining and figuring out how to get to the point sooner, all of those things would absolutely force me to, to reconsider how things were happening. By the way, I think a lot of what's written in there comes out of just the conversations I'm having with patients. Y- I do-- And in fact, I, I know there were certain times when I even asked patients, um, "Hey, do you mind if I record our Zoom today? Um, because I, I just wanna be able to go back and listen to how we talked about it." And they'd be like, "Sure." And so I would, you know, walk them through all of their cardiovascular disease risk, and then go back and listen to it after and go, "Okay. Yep, I, this is the way I would... This is, this is a good version of this talk." 'Cause I give the same talk to patients constantly, but sometimes they're, sometimes they hit better and sometimes they don't. And so having some recordings of those was really helpful to, to kinda go back and r-remember how, what worked.

   3. BGBill Gifford38:15

      I think the, when you started the podcast, I think it was about six months-

   4. PAPeter Attia38:19

      2018. Yeah

   5. BGBill Gifford38:19

      ... yes, about six months into the, the book-writing process. I think that gradually, that made you, um, more cognizant of, of how to communicate science and medical topics. I, I think maybe by nature, you're, you're a very data-driven, kind of mathematical guy, and you'll wanna maybe just present, like, numbers and, you know, facts straight up. And I think doing the podcast, you kinda learned how to, how to, how to kinda speak and, and, you know, introduce these subjects in a, in a more sort of user-friendly way. It was an interesting progression.

   6. PAPeter Attia39:02

      Yeah, that's true. We did start the, um, the, the, the... We started the podcast in June of, or yeah, June of 2018. And I remember in the summer of 2017, so before we were still working, when I was still working on version one, I was effectively podcasting but without podcasting.

   7. BGBill Gifford39:18

      Oh.

   8. PAPeter Attia39:18

      In other words, I was flying around interviewing people, you know?

   9. BGBill Gifford39:22

      Okay.

   10. PAPeter Attia39:23

       You know, s- go- going up to Boston to meet with David Sabatini, meeting with Matt Kaeberlein, meeting with the postdocs in their labs, sitting down and recording these interviews with them. And it was effectively my foray into podcasting without... But it was all for the book. You know, these were all just interviews that were used to sort of drive the book. Um, and yes, what an evolution in that. That's another... We'll save that for another discussion. But boy, h-how, how difficult podcasting is, too.

   11. SPSpeaker39:49

       Yeah. It's, it's kinda funny 'cause some of those initial interviews ended up being some of the first podcasts we released.

   12. PAPeter Attia39:57

       That's right. I think we did end up using at least three of probably a dozen of those as actual podcasts.

   13. SPSpeaker40:03

       And I think, too, the interview, the first interview we did with Inigo and Rick Johnson, that stemmed from you wanting to go talk to them for the book.

   14. PAPeter Attia40:13

       Yeah. Yeah.

   15. SPSpeaker40:14

       And we just kinda double-dipped.

   16. PAPeter Attia40:15

       Yep.

   17. SPSpeaker40:16

       So it is kind of funny to think about.

   18. BGBill Gifford40:17

       You know, a lot of those interviews would, would... You'd come back and you'd be like, "You gotta listen to this, Bill. You gotta listen to Inigo." And, you know. So tho- those fed into the, the, not only the writing of the book, but sort of the evolution of thinking behind-

   19. PAPeter Attia40:33

       Yeah

   20. BGBill Gifford40:33

       ... the book, so.

   21. SPSpeaker40:34

       And

8. 40:35 – 44:09

   Making the book stand the test of time despite the constant evolution of science and medicine

   1. SPSpeaker40:35

      it kinda fits in with a question we got asked quite a bit, which is, it took you six years to write the book. There was a lot that changed in those six years as it relates to science. There's a lot that's gonna change in the next 10 years. And you, when you announced the book, you kinda wrote about your goal with this book is it would still be applicable in 10 years. So kind of people were curious, you know, how do you think about, one, writing a book that can stand the test of time? Two, you know, what changed a lot in your mindset, and where did you evolve in that whole process?

   2. PAPeter Attia41:15

      I mean, I think a lot of things changed in me in, in the six years. Um, some of them just obviously very personal things, some of th- some of which I've written about in the book. Um, but I think more it has to do with emphasis, right? So there were things at the beginning that were much more the emphasis in my mind, and other things became more important over time. Uh, so for example, at the outset of the writing of this book, I probably placed more of an emphasis on nutrition than exercise as one of the important drivers, one of the important levers we have at our disposal. And I would say that my views on that have flipped. I think that exercise has a bigger impact than nutrition, and certainly on the positive side. Nutrition can have a pretty big negative impact, but once it's corrected, it's doesn't have this enormous upside. Whereas exercise has an enormous downside in its absence and an enormous upside in its presence. So that's, you know, that's a... You're, you're reading a different version of this book than you would have read six years ago with respect to that. Um-

   3. BGBill Gifford42:27

      Or two years ago.

   4. PAPeter Attia42:28

      Yeah, exactly.

   5. BGBill Gifford42:29

      One year ago.

   6. PAPeter Attia42:30

      Obviously, th- you know, a book, this book written five years ago would have not had anything about emotional health. There's not a lot on it, but there's, there's something on it, and it's, and I think it's relevant. Um, I think it's very framework focused, which I think lends to a more timeless piece. Because frameworks or scaffoldings are there upon which to place information and substitute information. So if the framework says delay the time that you do not have disease, that's relatively timeless as a strategy. Now we're gonna learn different things about these diseases. I-- In 10 years, my hope is that, you know, one-

   7. SPSpeaker43:16

      Yeah

   8. PAPeter Attia43:16

      ... taking one example, liquid biopsies should be a heck of a lot more valuable in 10 years than they are today. That's gonna completely change our approach and our efficacy of screening. So, so you'll have a different tactic that you'll use in a toolkit to go about the strategy, but the goal is still the same.

   9. SPSpeaker43:35

      So you're talking about liquid biopsies for cancer detection.

   10. PAPeter Attia43:38

       Yep. Yeah.

   11. SPSpeaker43:39

       Yeah. So if you can detect cancer much earlier, it's a wh- treating it's a whole different thing.

   12. PAPeter Attia43:45

       Yep.

   13. SPSpeaker43:47

       Yeah, and it's, it's interesting because anyone who's listened to the podcast for a long period of time will know, like, hear you talk about things in a different way as you learn more information. And I think sometimes a natural reaction from people is to be frustrated at that, being like, "Well, why did you say this one time and then you kinda changed your mind?" Like, you know. But I think

9. 44:09 – 48:00

   Objective, strategy, and tactics

   1. SPSpeaker44:09

      to what you just said, which is really important, it's probably worth spending a few minutes on it, is you focus heavily on objective, strategy, tactic, and that's probably the reason why in the initial version it had zero tactics, which a lot of people are probably like, "How do you write a book that doesn't tell people what to do?" But for you, it's how do you write a book that tells people what to... It's all about objective and strategy, because as new information comes in, the tactic may change, but the objective and strategy doesn't. Do you kinda maybe wanna talk people through how you think about that objective, strategy, tactic? Because I think it is applicable for anyone who's going to read the book to really understand that for knowing how to take this information and still make it applicable years down the road, not just months down the road.

   2. PAPeter Attia44:56

      Well, there's a whole chapter on it in part one, right? Which is like why, you know, why is it that we spend so much time hammering this idea? And, um, it's a simple concept, but it's amazing how often it's ignored. So for starters, you do have to define the objective. And, um, I won't say any more on that now, but again, the objective, you'd be amazed at how many people would struggle to define their objective. You know? "Oh, I'm taking this 27 different supplements 'cause I'm hacking my," you know, whatever. And it's like, okay, what is your objective? And if you can't clearly state that, then there's so much fog around this. The strategy's very important. And, um, again, you know, there's-- we open each chapter with a quote, but of the quotes, my favorite has to be the one that opens that chapter, which is the Sun Tzu quote about, uh, strategy. Uh, what is it? It's the, uh, uh, s-objectives, uh, sorry, strategy without, uh, "Tactics without strategy is the noise before defeat," or something like this.

   3. SPSpeaker45:59

      That's right.

   4. PAPeter Attia45:59

      Yeah.

   5. SPSpeaker45:59

      That's it.

   6. PAPeter Attia46:00

      And, um, so, so we go to great lengths using lots of examples to really help a person understand the difference between a strategy and then the tactics that they employ. Um, and we do this because we say the tactics are the most malleable things here. They're the things that are going to change the most. And to the, your previous question, those are the things that have already changed the most, right? So give you another example, right? Like how much emphasis did I use to place on fasting? How much emphasis do I place on fasting today? Totally different. Um, the, I am positive that there is some set of drugs that I am either not taking now or don't even know what they are now that I'll probably be taking in 10 years. And similarly, there's probably something I'm taking now that in 10 years I'm going to say, "The evidence for this sucks. I'm not gonna do it." So y-y-you know, if I can't take that and anchor it back to a strategy, which is the reason I would take this or wouldn't take this is because it feeds into th- one of these three overarching principles that guides this objective, um, then I'm, I'm really just doing a bunch of random things that aren't in concert.

   7. SPSpeaker47:11

      But you're also able and open to changing your mind. So, you know, one of the things I noticed early on is, like, you're not, like, a dogmatic person if you get information or a new interpretation of the existing data that kind of causes you to, to see something differently, and fasting is, is a big one. And frank- I was a little bit relieved actually, 'cause I knew I was gonna have to do it myself just to be able to write about it.

   8. PAPeter Attia47:42

      [laughs]

   9. SPSpeaker47:42

      But [chuckles] wasn't looking forward to it. But then you kind of got off the fasting. I think it had, it had served a purpose for you.

   10. PAPeter Attia47:51

       Yeah. And there, and again, there's, there's still times when I think it makes sense, but, but yes, it just is one specific example of, you know, this isn't something that everybody needs to be doing.

   11. SPSpeaker47:59

       And

10. 48:00 – 52:43

    Exciting possible progressions in science and medicine over the next decade

    1. SPSpeaker48:00

       one of the questions we got was, what areas of the book do you think within the next 10 years will evolve the most? You know, you mentioned there, like, liquid biopsies and cancer detection. Is there anything else that you kind of think about when you write this book if you're like, if I was gonna update this in 10 years and I had to make a guess on which sections I would want to refocus on, is there anything that you would think... Another way to think about it is, you know, what in this sphere are you kind of really excited about progress in the next 10 years?

    2. PAPeter Attia48:32

       I do think that, um, w-we've taken, we've gone out on a, uh, we, you know, taken a very aggressive posture on cancer screening, right? For the, for the reason that Bill alluded to a moment ago, which is, um, y-certainly in doing research for this book and getting really deep in the weeds, th-there simply is no ambiguity that the earlier you catch cancer, the better your odds are at treating it while it remains local. Um- Given the exact same histology of cancer, treating it when there are a billion cells versus treating it when there are 100 billion cells with the exact same therapy has such dramatically different outcomes that there should be no question about that. And so you, you basically have to put yourself into different camps. Are you of the mindset that we will come up with systemic cures for cancer regardless of size and stage in the next couple of decades? Or do you think it is more likely that we will get better and better at finding cancer when it is smaller and smaller and treating it with existing therapies? Now, those don't have to be mutually exclusive, but the question is which one of those do you think is more likely, and I think the latter is much more likely. And w- w- you know, we present it as such, right? You know, goal number one, don't get cancer. Goal number two, if you do get cancer, catch it as early as possible. And then, and only then, goal number three is we get into what are the most promising things. So I think that's another area where I, I, you know, what we're seeing right now with immunotherapy is so exciting, and I think we are right on kind of the verge of unlocking the next layer of immunotherapy, right? Which is once... And, and by the way, I think this gets to another part of your question, which is what else would I be excited about in 10 years that is not in this book, 'cause I think it's too soon for primetime. But if we could reprogram immune cells, so you've heard a lot of talk about reprogramming. Well, reprogramming gets talked about nonstop, and there's so much nonsense there. But there is one subset of the human body that if it could be reprogrammed would change the game, and that's the immune cell. If-- And, and by the way, that's much easier to reprogram than, like, you know, your heart or your liver, things like that, in my opinion, because of how easily we can access those cells. If we could epigenetically reprogram T cells, I, I think it's a totally different game when it comes to cancer therapy and, and cancer incidence.

    3. BGBill Gifford51:19

       I think, yeah, I, I would say maybe, uh, neurodegeneration.

    4. PAPeter Attia51:27

       Yeah, that's a good one too.

    5. BGBill Gifford51:27

       Like if-- But, but that's someplace where we're, we're kind of nowhere in terms of effective treatments for, um, Alzheimer's disease or Parkinson's disease.

    6. PAPeter Attia51:37

       Hopefully better data on prevention. You know, right now we've taken, and we do this in our practice as well, we're taking very much a kitchen sink approach, um, which is there are a handful of things that, especially for dementia, less clear for the movement disorders, there are a handful of things that unambiguously reduce your risk of dementia. Um, there seem to be at least three, four, if we were gonna be right, clear: exercise, uh, management of lipids on the AD and dementia side, sleep, and not having diabetes. L- Those, those things you can take to the bank. We talk about 27 other things for which the data are not clear yet. To have more clarity around that would be great.

    7. SPSpeaker52:26

       And as someone who's not in the scientific field, when-- how you talk about cancer makes a lot of sense in the idea of if the goal-- Like if you have better treatment the earlier catch it, you wanna screen as early as possible. But

11. 52:43 – 56:04

    What is holding back medicine 3.0 from being the norm?

    1. SPSpeaker52:43

       you talk about in the book kind of the difference between medicine 2.0 and 3.0 and how that's not the case now. Why, why do you think that's, I don't wanna say controversial approach to it, but why is that not the norm? 'Cause from the outside looking in, it's hard to poke holes in that idea.

    2. PAPeter Attia53:02

       Do you mean why is the traditional view of cancer screening different from kind of the view we present?

    3. SPSpeaker53:10

       Yes.

    4. PAPeter Attia53:11

       Um, I, I think i- if I'm going to be fair and charitable to the outside view, it would be that it's being-- Uh, we're, we're, we're basically asking two different questions, okay? So I think the question and the solution that we're proposing is at the individual level. Um, the, the outside view, I think, is at the pop- is at the population or societal level. So there was a recent study, um, that got a lot of attention in Europe, I think it was published in the New England Journal of Medicine, that looked at, uh, colonoscopies. Um, the study took a large group of people, and they were randomized into two groups. So one group was standard of care, don't do anything. The next group was suggested that they should have a colonoscopy in the next decade. Okay, at the end of the decade, they were compared for rates of colon cancer and colon cancer mortality and all-cause mortality. And while there was a slight benefit to the group that were recommended to get a colonoscopy, it was nothing to write home about. Uh, the, the relative and absolute difference in colon cancer and colon cancer deaths, while statistically significant, didn't seem very clinically significant. And opponents of colonoscopy said, "Look, this is proof positive that colonoscopies don't save lives." [lip smack] The reality of it is no, it's proof positive that telling people to maybe get a colonoscopy once every 10 years when, by the way, I think less than 40% of them actually did, probably doesn't save lives. That's very different from the example and the approach that we take. I mean, you know, I'm 50. I've already had three colonoscopies. I, I get them every three years, and I will continue to do that until my life expectancy is so short that it becomes irrelevant. And, um, a- again, totally different approach. Um, so we, we have to con- And, and am I suggesting that, you know- Everybody get a colonoscopy every three years? Of course I'm not, right? What I'm suggesting is that everybody think about their own risk-reward trade-off and decide what's the, what's the cost-benefit analysis. So there's an enormous cost to doing that. My insurance company doesn't pay for most of those. They've paid for one of the three. Um, there are risks of bowel preps, right? You can... You know, you do these-- You do a bowel prep in a person who's significantly older, who runs risks from the electrolyte abnormalities that come from those things. Th- all of those things have to be... You know, I, I certainly wouldn't want my 86-year-old dad getting a colonoscopy under any circumstance. That ship has sailed, right? He-- The bowel prep alone could injure him, let alone the sedation of it. So, so one has to be very thoughtful and measured in how they think about doing these things. Um, and I think the, the long answer to your question is, I think when people talk in blanket statements like cancer screening is bad, um, th- they're generally speaking through the lens of policy and population.

    5. SPSpeaker56:03

       And it

12. 56:04 – 1:06:36

    How the book compares to the podcast in terms of technicality and readability for the layman

    1. SPSpeaker56:04

       kinda leads to n-another question we saw come through quite a bit, which is, you know, sometimes on the podcast it can get technical, it can kinda get in the weeds. A lot of people were curious, how is the book compared to that in terms of technicality? Is it something that, obviously, if you're an MD, PhD, you're gonna be able to understand? But what about for just the layman? Do you think they'll be able to get as much out of the book, and was that kind of the hope in how you wrote it? And my guess is we can get Bill's response too, but-

    2. PAPeter Attia56:37

       I was actually gonna turn this question-

    3. SPSpeaker56:38

       [laughs]

    4. PAPeter Attia56:39

       ... over to Bill first, and, and then I'll, I'll throw-- I'll chime in. But I, I'd like to hear Bill's thoughts on that. I, I have a strong thought on this, but...

    5. BGBill Gifford56:46

       Well, I, I think we're both fascinated, probably you more than me, but go with... You know, ki- we kinda can kinda go down these rabbit holes of, of, you know, the technical details, which I call the alphabet soup. You know, once you start stringing together a lot of acronyms like, uh, APOE and, you know, PSEN and all this stuff, it turns into alphabet soup. Um, and I, I sorta think of the podcast as like your playground to, to go deep with these scientists. And it's tremendously valuable, right? 'Cause they don't have really other, a lot of other... You can't go on fresh air as a scientist and, and get into that level of detail. But, um, I would say it's considerably less technical than, than the podcast, but the, you know, the basic message and the, the kind of the lar-- You know, we cover a lot more ground, so we can't really go deep, too deep on any one particular topic. Like, I was listening to, um, uh, the, the, the episode about HDL.

    6. PAPeter Attia57:49

       Mm. With Dan Rader.

    7. BGBill Gifford57:50

       Super interesting, but, like, mind-bogglingly complicated, and we just didn't have the time or the, the need to go that deep. And, you know, I do hope that, you know, they figure out how to enhance the function of AD- HDL. But yeah, we couldn't go that far.

    8. PAPeter Attia58:09

       There were probably some sections... Actually, that's interesting. The cardiovascular section-

    9. BGBill Gifford58:13

       Pretty detailed, actually

    10. PAPeter Attia58:13

        ... we, we go pretty detailed in that section.

    11. BGBill Gifford58:15

        But we have to.

    12. PAPeter Attia58:15

        We... And, and again, I think part of it is we're, we're trying to add enormous value in writing this, right? Like, there's, there's a lotta kinda me-too books out there on this subject matter. And by me too, I just mean-

    13. BGBill Gifford58:27

        [laughs]

    14. PAPeter Attia58:27

        ... like, it's just another book that is literally adding no value.

    15. BGBill Gifford58:31

        Saying the same thing.

    16. PAPeter Attia58:32

        Yeah.

    17. BGBill Gifford58:32

        Yep.

    18. PAPeter Attia58:32

        It's just saying the same thing. And, and our goal here was, like, there's no chapter in this book, none, that should ever just be another version of checking that box. And so on the chapter of atherosclerosis, I mean, yeah, I think we do go probably deeper than certainly our editor would've wanted. Um, I think she was, kinda to her credit, just accepted the fact that she might not understand every word of it. But, um, it's... You don't need to necessarily understand every word of it to understand what to do about it. And, and, and if you do wanna go deeper, 'cause we do get into HDL, and we do comment on the fact that HDL functionality is not captured by HDL cholesterol, and HDL particle number, and ApoA concentration, and all of those things. And we do have to talk about the Mendelian randomizations and what they've taught us with respect to HDL cholesterol and what they haven't taught us, and things like that. So, um, that's probably, yeah, that's probably a little more technical than maybe the average person would want. But, but I, I, you know, I, I think that overall, this book is very readable by a person who is curious, and I agree that it is definitely a notch below the technical, um, depth of what we often do in our podcasts.

    19. BGBill Gifford59:58

        It's not a, it's not meant to be a textbook either, but kind of the way I think of it is you want people to learn thing, learn more than they expected without even realizing that they're learning. You know, kind of like package it in a story or a metaphor. And the atherosclerosis chapter is, is a good example of that, 'cause, you know, most people know, everybody knows about good and bad cholesterol, and, uh, I think Peter got a little triggered by that, and we just, we're just gonna go to town.

    20. SPSpeaker1:00:32

        And in the writing process, what was it-- how was that like between the both of you in the sense of were you often trying to keep Peter in check in terms of the scientific aspect of it, trying to bring stories in? Kind of how, how would you both do that throughout? Because obviously the book is... I mean, it's a good chunk now. It clearly could be four times as long if you went into the detail that you could go. So kind of where in the writing process did you decide, "Okay, th- like this deserves to go deep, this doesn't"? Was there ever disagreement about that or kinda how did that work?

    21. PAPeter Attia1:01:13

        Yeah, I mean, I think Bill, um, always thought about it through the lens of the reader, and I think there was a very healthy tension between us on those things, for sure. Um, and I say healthy because it was never... I, I don't, I don't think-- I think both of us would sit here and say, never once did we have a disagreement that was about ego, right? We had lots of disagreements about content, but it was like Bill saying, "I don't think a reader needs to know this," and I'm saying, "Bill, I think a reader does need to know this." And it wasn't about like, "I want to put this in because it's mine." Like it, it was never about that kind of stuff. So, so yeah, I think there was always a great and healthy tension about that. Um, I think once... You know, there's a backstory here which I, we didn't really get into, but this book basically got killed in 2020, and then it died. It, like, it was left. It was left for dead, and it only got revisited with a whole new publisher and a whole new editor and a whole new process. And so that process, which w-went fr- which was now 2021 into 2022, introduced a new player into the mix, which was our editor at Penguin. And [lip smack] um, I, I don't have anything to compare Diana to as far as other editors, but she struck me as relatively hands-off. I, I... Is that, would you-

    22. BGBill Gifford1:02:42

        Yeah. Yeah. So she would-

    23. PAPeter Attia1:02:42

        Is that, would she be described as more of a hands, more of a conceptual editor as opposed to a line editor?

    24. BGBill Gifford1:02:48

        Yeah, and she gave great sort of, um, you know, guidance and, um, you know, she had some give and take. But I think between you and I, like we, it took us about six months to kind of get the right voice and register right. Like how, who are we writing this book for?

    25. PAPeter Attia1:03:07

        Yeah.

    26. BGBill Gifford1:03:08

        And I, I think you weren't quite clear-

    27. PAPeter Attia1:03:12

        No

    28. BGBill Gifford1:03:12

        ... on who the book was for.

    29. PAPeter Attia1:03:12

        I think initially I was, I'm writing this like I would write a scientific article. I'm writing this like I would be writing in a journal, a scientific journal. And-

    30. BGBill Gifford1:03:22

        For people who know
13. 1:06:36 – 1:22:56

    Motivation to write the book and insights into challenges around the writing process

    1. SPSpeaker1:06:36

       of the questions we get asked a lot, which is, you often said this is the only book you're ever gonna write, and a lot of people are like, "There's no way." And I think even Bill joked that he doesn't think this is the only book you're gonna write. And whenever people would ask, I'd always be like, "Oh, there's not a chance Peter writes another book. Like, there's no way." But as I'm hearing you talk now, kind of thinking to myself, how do you not write another book in 10 years-

    2. BGBill Gifford1:07:01

       [chuckles]

    3. SPSpeaker1:07:01

       ... on an update to all this? Uh, so how do you-- 'Cause I know you, you went into this being like, "Look, I wanna write one book. I want it to contain everything," which is why you did the objective strategy tactics like we talked What makes you think that you'll actually never write another book?

    4. PAPeter Attia1:07:21

       You know, again, I think if we're being reasonable people, we could never say never, right? Um, I just think a couple of things would have to be true for me to write another book. So I, I, I say that. Um, one thing that would have to be true is I would have to have something to say. Like you, you... I think this process is so difficult, at least... I mean, I see these people that write a book a year. I don't understand how they're doing it. Um, so, uh, a- again, let's just put those people aside. But for someone like me to do this with the unbelievable inertia that's required to do it, the, the desire, the drive to need to say something must be so great that, that you have to be able to overcome that pain. So, so that's pr- that's condition number one. I would have to have something so overwhelming to talk about. The second condition is I would have to be at a different place in my life than I am today. I would not want to repeat what I have done for the past five years, which is work on something so difficult on nights and weekends. This has been, um, uh, I, I think it's just been... It, it's just, it's... I've paid a price for it that is probably higher than I would like to have paid, and I don't want to do that again. So, so I think the second equally important condition is I will need to be at a point in my life where I'm not working 24/7, and writing this will not kill me. Meaning, it's not something I have to do nights and weekends. I can write it during the daytime. And that just means my life looks different than it looks today, right? That means my kids are a lot older. That means I'm not working as hard on my practice or other things as I am today, where those are my jobs and this is my hobby. So I think if those two conditions were met, if I had something really amazing to write about or update or tweak, um, and I could do it in a civilized manner, I would be open to it.

    5. SPSpeaker1:09:20

       One of the questions that we got came through, which I thought was really interesting and fits well with the thread you just went on is, did you want or need to write this book? Because-

    6. PAPeter Attia1:09:30

       Hmm

    7. SPSpeaker1:09:30

       ... you mention it there. There's obviously no shortage of books on health, books on longevity, whatever you wanna call it. And so what... Going back to the framework you just laid out, what do you think to you was so important to say that you were like, "I need to get this out there and I need people to have these insights"?

    8. PAPeter Attia1:09:53

       I think it's hard to speak to the motivation at the outset because when, when I started this in 2016, it was, you know, two years before having a podcast. So it never occurred to me at that time to have a podcast, or I probably would have had a podcast. And maybe if I did have a podcast, I wouldn't have thought to write a book because in some ways, a podcast is an easier way to communicate. It's less formal, but it's easier, right? You can-- And you can communicate much more through a podcast. So I think the more interesting question for me to think about is let's go back to where we were in December of 2020, Bill. So, so basically in this, in February of 2020, this project is nuked. It's dead. We're done. Publisher's fired me.

    9. SPSpeaker1:10:40

       And nobody wants a book about longevity in the pandemic anyway.

    10. PAPeter Attia1:10:43

        Yeah, yeah. It's like, it's, it's over, and I'm over it, right? Like, I'm so frustrated that, uh... And I feel bad that I've wasted so much of Bill's time 'cause he's put in two full years at that point, and he's gonna have nothing to show for it, right? Like, he's not gonna have a book to show for it. Um, for me personally, I don't care. Like, I don't need a book, whatever. Um, and so I, I don't know. Bill and I probably didn't talk for nine months. It was sort of done. Like it w- I mean, I was like, you know... I felt bad and, but he, he, you know, and, and Bill didn't make me feel bad or anything like that. That was just the nature of things, right? We... So, so we kind of... That was the end of it until late, late, late 2020 when Michael Ovitz somehow asked me about it. And I don't know what brought it up. We were talking about his book, which I love, and somehow it came up that, oh, I, I'd kind of written a book too, but you know, it sort of got scrapped. And he was like: "Oh, send it to me." And so I called Bill and I was like: "Hey, Bill, do we still have the G Doc that has like, whatever the last version was of that thing before it died?" And he's like: "Yeah, I could probably find it." And I was like: "Do you mind sending it to me?" So he did, and I sent it to Michael, and I remember this was around Christmas of 2020. He read it in two weeks, which is saying something 'cause it was a pretty long-ass thing.

    11. SPSpeaker1:12:16

        Yeah.

    12. PAPeter Attia1:12:18

        And he said: "Look, man, this has got to be published." And I was like: "Well, we don't have a publisher." And I explained all the, you know, how much hair was on this dog. And, and then the rest is kind of history. He just said: "Well, yeah, yeah, yeah. No, no." He goes: "Look, I, I... You know, we'll get this published." Um, so that's really the q- the, the question then becomes why, at that moment in time, did I go back in the ring? [chuckles] 'Cause I was clearly out of the ring. I was o- you know, um, and by that point, we had a podcast. I mean, this was not... Like, I wasn't looking for things to do. And honestly, I think it kind of comes down to some of the stuff I write about in the very last chapter of the book. I think, I think there was a, a coming to peace with some o- some of my demons and a realization that I wanted to do it. I really did have a... I, I really had a strong desire to put this material out there in basically the form it's in now Which, um, turned out to be such a blessing. I, had it not been for getting fired by the old publisher, had it not been for COVID, had it not been for all of the crises that emerged, this book looks a lot different, and truthfully, I think it's not as good. Um, but to answer your question, I, I think it was want more than need, but I don't think that want really found its why until the end of 2020, the beginning of '21.

    13. SPSpeaker1:13:57

        Yeah, Bill, so hearing that, I mean, what are your thoughts on that process? And also during that nine months of silence, to you, did you ever think the book would see the light of day?

    14. BGBill Gifford1:14:09

        I think deep down, I, I knew that it would because there had been so much work that went into it, and there was so much that's original and interesting and amazing in it that I, I, I felt like it would be a, a tragedy if it wasn't published. And I was kind of depressed and sad for a while that it, it wasn't. So I was very glad to get your call about your friend Michael Ovitz wanting to see it. It was, "Yes."

    15. PAPeter Attia1:14:35

        Mm-hmm.

    16. BGBill Gifford1:14:35

        "This is gonna happen." And you know, I think it was kind of interesting watching Peter kind of like become a writer in certain ways. You're talking about like working on nights and weekends, and you're just kind of tortured by this thing that's like hanging over your head, and it won't go away. And you, you have... It has to be good. It has to be perfect, right? And so one of the stages of that process is deciding that the whole thing sucks, and you know, there's all kinds of stories about writers throwing their-

    17. SPSpeaker1:15:06

        Yeah

    18. BGBill Gifford1:15:07

        ... all their manuscripts in the fire and like, "Ah," they're, you know. And, and, and it's a process you have to go to and go through and, and especially in science writing, right? There's, there's like a first draft that, that, you know, we, we call it like the shitty first draft, and you, you have to write it. And it doesn't mean you're a shitty writer or a shitty thinker. It's just, you're just getting it all out there, and then it's like, what do we got, right? And then the process, you think you're done, right? 'Cause I remember finishing the first draft, it's like, "Okay, sweet. I'm done." And I think at about that point you had sent me an espresso machine.

    19. PAPeter Attia1:15:44

        Mm.

    20. BGBill Gifford1:15:46

        I was like, "This was nice of Peter to send me this espresso machine now that we're done." But we weren't done.

    21. PAPeter Attia1:15:51

        Weren't even close.

    22. BGBill Gifford1:15:52

        You know, you've got the first draft. It's like you've run the first half of the marathon. Like, don't put the sticker on your car. You gotta run the other half of the marathon before you're done. So yeah, it was a, it was a marathon.

    23. PAPeter Attia1:16:05

        And, and like a marathon, anybody who's run one or swum one or bike- you know, done these things, you know that the physiologic halfway point is not the-

    24. BGBill Gifford1:16:15

        Exactly

    25. PAPeter Attia1:16:16

        ... actual halfway point.

    26. BGBill Gifford1:16:17

        Yeah.

    27. PAPeter Attia1:16:17

        Like, uh-

    28. BGBill Gifford1:16:17

        Yeah

    29. PAPeter Attia1:16:18

        ... most, me and my wife just ran a marathon recently and, uh, uh, we, you know, in training for this, I mean, it was all about the training for the physiologic hits. And in that 26 miles, you don't physiologically hit the half point till 20. So you'll hurt as much in the last 6.2 miles. You will... It will be as difficult metabolically and physiologically in the last six miles as the first 20 were. And I think the same as, I, exactly the same for this writing process, right? The-

    30. BGBill Gifford1:16:47

        Yeah, yeah
14. 1:22:56 – 1:33:05

    Peter's decision to be the reader for the audiobook

    1. SPSpeaker1:22:56

       the audiobook. You kinda mentioned it there. I know you struggled a lot with should I read this or should I not? And part of it was, you know, you've said yourself, like, sometimes, like, reading that much, like, you'll struggle with. It was not only that, it was the time aspect, the commitment. What made you ultimately decide to read it? Because the overwhelming feedback we got from the audience was they didn't wanna hear someone else read this book if it wasn't you. And people will-- And I think this is where kind of having your own podcast probably hurt you is everyone knew your voice and knew what it sounded like. You weren't a voiceless figure who was just a writer. So what made you ultimately decide, all right, I'm gonna go do this audiobook?

    2. PAPeter Attia1:23:43

       Well, I mean, first I should explain why I didn't wanna do it, and I think I had some pretty good reasons for not wanting to do it. Uh, first of all, I'm not a great, um, out loud reader. Um, I think I do have mild dyslexia. Um, I, I certainly do when it comes to spelling, so I can't spell if my life depends on it. Um, and when you hear me read even to my kids, uh, y- like, you know, Reese is eight, so he can read. So if I'm reading to him, he's catching mistakes that I'm f- he's catching words that I'm flipping back and forth. Um, so that was one reason. There was just like, ugh, this is gonna be very hard for me to do. The second is I did the math pretty quickly, meaning I had figured out how long it took me to read a page. I multiplied it by how many pages there were in the book, and I knew that I was gonna basically be in a recording studio for two weeks. I also knew that that meant that that was the one week a year that I kind of wind down is between Christmas and New Year's. I was gonna be in a recording studio all day, every day. And I just knew how I felt, which was I'm exhausted. I'm exhausted, and I don't... I actually need a week to recharge. I don't need two more extra weeks of work. The third thing was when Rick Rubin was in town visiting over the summer, he was beginning the process of recording for his audiobook, and he had a sound engineer set up a studio in our basement. So he was beginning to do his read. Th-they, he and his family stayed with us for a couple weeks. And one day he was like, "Hey, why don't you go in the studio with my engineer and just read a bit and see how it goes?" And I was like, "All right. That's not a bad idea." So I did. And I read it, and I sent it to you guys, and you guys finally acknowledged what I was saying, which was, "Yeah, it's pretty rough." Like- Dude, there's no intonation in your voice. Like, you're, you sound like a robot reading that. So now we've got confirmation on my worst fear-

    3. BGBill Gifford1:25:44

       [chuckles]

    4. PAPeter Attia1:25:44

       ... which is I'm a lousy reader, coupled with all these other things, and-

    5. BGBill Gifford1:25:50

       I-

    6. PAPeter Attia1:25:52

       You know, so, so, so that, those were all the reasons I didn't wanna do it, and I think those were all very compelling. So on the flip side of that, I, I don't remember who suggested it, if it was you or somebody suggested that I at least meet with this woman named Stacy Snell, who I guess is a kind of a freelancer but works for Penguin, and she would be the producer/director of my audiobook. And, like, maybe Stacy had just said, "Let me, let me go and spend an afternoon with Peter and do some coaching." So sure enough, one day in, this is probably, like, November, she comes over here, and we do some reading. And for two hours we read, but she coached me on reading, and she gave me some really amazing tips that seemed so self-evident, but, uh, they made a difference. So for example, first is read slower, right? And, and I should have known this because I consume virtually all of my books in audio first, and then certain ones I go back and read in paper. But I listen at about 1.8 to 2X, depending on the author. And so in my mind, that's the cadence of an audiobook. But if you ever actually go and listen to an audiobook on 1X, I mean, it sounds like this. So what she reminded me was, you know, it needs to sound pretty slow at 1X speed. The other thing she said is, and she could tell right away, she's like, "You're not present when you're reading. It's clear-

    7. BGBill Gifford1:27:27

       Huh

    8. PAPeter Attia1:27:27

       ... to me how bored you are of this book, and I can't blame you for it. You've read every word 1,000 times, but your boredom is showing in your reading." She's like, "A good reader reads this like it's the first time they've seen these words."

    9. BGBill Gifford1:27:46

       Yeah.

    10. PAPeter Attia1:27:46

        She's like, "You have to get there." And I was like, "Wow." And she's like, "Oh, and by the way, reading slow makes that easier. The slower you read, the easier it is for you to be present with every word." So armed with Stacy's feedback, I, I decided I'm gonna do this. Um, and so a couple days before starting it, I had a session with one of my therapists, and obviously one of the things you talk about in therapy is like, "What are you, what are you worried about? What do... You know, what's, what's going on in your life?" And I said, "Well, you know, I'm really worried in, you know, a couple days I start this reading process." And so Katie said, "Well, what's your why? Why are you doing this? And let's write those down." So I had three reasons why I was writing this, and I wrote those three reasons down on a piece of paper, and those were with me in the recording studio.

    11. BGBill Gifford1:28:41

        Huh.

    12. PAPeter Attia1:28:41

        And the three reasons were very simply, um, one, the, the listeners of the podcast will expect this and deserve it. Uh, in other words, you know, we feel really grateful. Obviously, I don't need to just say this, but, you know, we have a very loyal group of listeners to this podcast. Um, and to your point, there is an expectation that the person who- whose voice they listen to is the one that reads it. Um, and I think it's a, it's, I think it's a correct expectation. I think they deserve that. Um, the second is a pet peeve of mine when I'm listening to technical books that are not read by the author is how many mistakes there are-

    13. BGBill Gifford1:29:22

        [chuckles]

    14. PAPeter Attia1:29:23

        ... when things are read incorrectly. It bothers me to no end. I mean, I remember listening to one book where the author had written the word causal multiple times, and every time the word causal was misread as casual.

    15. BGBill Gifford1:29:40

        Oof.

    16. PAPeter Attia1:29:40

        I mean, it's like, how that got missed, I don't know. But, but, you know, I thought about how many technical words are in this book, and I was like, "I'm gonna lose my mind-

    17. BGBill Gifford1:29:48

        [chuckles]

    18. PAPeter Attia1:29:48

        ... if a person..."

    19. BGBill Gifford1:29:50

        [laughs]

    20. PAPeter Attia1:29:50

        And I basically said, "I'm gonna end up having to be in the recording studio anyway-

    21. BGBill Gifford1:29:53

        Yeah

    22. PAPeter Attia1:29:53

        ... just to make sure everything is said correctly." Um, and then the third reason was just a very personal one, which was, you know, right now none of my kids are old enough to appreciate this book. None of them are gonna read this book anytime soon. But one day they will, and one day they might listen to it. Um, and in, and in fact, I thought further, and this is kind of a weird thing to think about 'cause we don't normally think this way, but, like, imagine Hemingway had read some of his audiobooks and now, like, distant relatives of his could, could listen to it and listen to him reading it. And I thought, like, long after I'm dead, my great-grandkids could still listen to this, but they'll hear me reading it, and I think that will be more valuable than hearing someone else read it. So it was really more of, like, something for kids and grandkids to one day have.

    23. BGBill Gifford1:30:44

        But it's also, you know, there, there are a lot of stories in there about-

    24. PAPeter Attia1:30:49

        Yes

    25. BGBill Gifford1:30:49

        ... your early life-

    26. PAPeter Attia1:30:50

        Yeah

    27. BGBill Gifford1:30:50

        ... and your, your medical career and, you know, some, there's some fairly dramatic, you know, ER stories and... You know, your story is kind of, like, embedded throughout the book, and especially in the last chapter. Um, so I think it would've... Like, you had to read it. You just didn't realize it.

    28. PAPeter Attia1:31:14

        Yeah, I think that's true.

    29. BGBill Gifford1:31:15

        But it is a daunting and, and kind of terrifying, uh, task at the same time, but I don't know. Are you glad you did it?

    30. PAPeter Attia1:31:23

        Oh, I'm a-
15. 1:33:05 – 1:43:59

    The many painstaking last-minute changes and edits that brought the book together and made it better

    1. SPSpeaker1:33:05

       And you kind of talked about it earlier where, you know, reading the book caused you to make some edits.

    2. PAPeter Attia1:33:11

       Some.

    3. SPSpeaker1:33:11

       Some edits, which-

    4. PAPeter Attia1:33:12

       [laughs]

    5. BGBill Gifford1:33:13

       563, or was it 863?

    6. PAPeter Attia1:33:15

       I mean, literally, I think that's the closest Bill and Diana came to wanting to kill me. I think if they could've, if they could've killed me and nobody would've found out about it, they probably would've and been like, "Oh, God, so tragic that something happened to Peter this week."

    7. SPSpeaker1:33:30

       [laughs]

    8. PAPeter Attia1:33:30

       "Well, you know, anyway-"

    9. BGBill Gifford1:33:31

       Archery accident

    10. PAPeter Attia1:33:31

        ..."posthumously, we, uh, we'll, we'll publish this book with your name on it."

    11. SPSpeaker1:33:35

        We'll release it as is. I think there, there is a little Easter egg in the audio version as well that's a little different, too, which probably also led to some of Diana's stress. Do you kind of want to talk about that piece of it?

    12. PAPeter Attia1:33:50

        Sure. So the... Before, before we turned the book over to Penguin, so back when, you know, it was in the, the old version that died, um, you know, it was a very similar structure to the way it is now, just a much longer, less elegant version. Um, but there was an ending to that chap- So, so the end of the book, the ch- 17th and final chapter had a, had an ending. And, um, I loved it. Bill was sort of ambivalent. Um, when Diana saw it, she hated it. She was like, "I don't get it. This sucks." And I was like, "What do you mean you don't get it?" I even, like, sent her YouTube videos to help her understand it, to get the reference. She's like, "I don't get it. It's, it's the dumbest thing I've ever seen. This is awful." And at this point, Bill was like, "Ah, I kind of see Diana's point. Like, I, I, I don't think it's good." And I was like-

    13. SPSpeaker1:34:45

        Yeah

    14. PAPeter Attia1:34:45

        ... and I was like, "All right, fine." So they took it out. So we took it out. And this is, you know, this is months ago. Like, I... It's long been forgotten. So I'm in the studio finishing, and I finish the whole book. And I said to Stacy, I said, "Hey, Stacy, do you want to see the alternative ending?" And she's like, "What do you mean?" And I was like, "This book ended with a totally different thing. It e- it... Where you see it ending now, there used to be a whole page after this." And she's like, "Oh, really? Let me see it." I was like, "Let me see if I can even find it." So I'm, like, rummaging through my computer, and I find it, and I, I give it to her, and I'm like, "Read it." And she reads it, and she's in tears. And I was like, "What do you think of that ending?" She goes, "I think it's beautiful." And I was like, "Well, what do you think... Do you want me to read that and we can decide if maybe that goes in?" And she's like, "Yeah, go." So I went back in the booth, and I read it. And I go home that day, and I email Bill and Diana, and I'm like, "All right, guys." And by the way, you got to put this in context. They are at the point of wanting to kill me for changing words at this point.

    15. SPSpeaker1:36:03

        [laughs]

    16. PAPeter Attia1:36:03

        Literally, I'm like, "Can we get rid of the 'the' here?" And, uh, you know, "This word needs to be like this versus this." Like, and I'm saying I want to add another page and a half to this manuscript. Like, it's going to screw up everything. And I won't get into the details of those conversations. They were not pleasant. But suffice it to say, the answer was, "Oh, hell no." And so I accepted the fact that it would never make its way into the written version of the book. But I said, "But would you at least entertain this being in the audio version?" And they were like, "Of course not. Like, you can't have the audio version end different from the written version." Um, and I, and we kind of left it at that, I think. But then I asked Stacy to send it once it was edited, and I just forwarded it on to Bill.

    17. BGBill Gifford1:36:56

        So it sounds good the way you read it, so I was like, "This sounds... This is good. This is moving." Tried to find a place to kind of massage it in or put it in some place, maybe not as the ending but, but some place in the manuscript, and it, that kind of didn't work, 'cause, I mean, that, without going into detail, like, that last chapter probably evolved the most of any chapter in the book. And we'd kind of gotten to a place where it was working, and, and that part had dropped out. So we kind of decided as a compromise to leave it in the audio as the kind of, like, director's, Stanley Kubrick director's cut, you know? Um, and I think it's great.

    18. PAPeter Attia1:37:38

        And it's not in the written. Yeah.

    19. BGBill Gifford1:37:39

        Yeah. But you know, honestly, like, I, I feel like as far as print, like, the last few paragraphs of the book and especially, like, the last line- ... is something that, like, sticks with me.

    20. PAPeter Attia1:37:53

        Mm.

    21. BGBill Gifford1:37:54

        And I think about that, I think about that every day, that line. And I won't say what it is, but every day when I walk the dogs, I think about that. And I think when I'm thinking about, like, what's, what am I gonna do today, like, how am I thinking about-

    22. PAPeter Attia1:38:10

        Mm

    23. BGBill Gifford1:38:10

        ... this day and, and the week to come, and everything, I, I, that line sings in my head so.

    24. PAPeter Attia1:38:19

        Yeah. So I think-

    25. BGBill Gifford1:38:20

        I'm glad it's there

    26. PAPeter Attia1:38:20

        ... we, I think we, I think we captured the best of both worlds. I think, I think it makes sense. Um, I think it would've been, even, even if we thought it could've been shoved in at the end, I think it would've been logistically impossible because of how it changes the pages of the book and stuff like that. So I think it's an elegant way to do it. And, and I know that also if people are anything like me, like, a lot of times you want an audiobook and you want the paper book. You want to put your, fold your pages, you wanna mark it over, you wanna, you know, um, do that kind of stuff. So, um, I think it worked out just fine.

    27. BGBill Gifford1:38:50

        And I, I was, I was, you know, frankly I was glad you were, on some level that you were making, like, little line edits and stuff like, 'cause, you know, it, it, it, it makes it better, you know? There's always stuff you can find that, that... You know, I did a lot of things that you probably didn't even notice, but, you know, w-

    28. PAPeter Attia1:39:09

        No, it got, it, it got so much better.

    29. BGBill Gifford1:39:10

        Yeah.

    30. PAPeter Attia1:39:10

        I mean, it, it, th- there is, like, a huge sprint at the end to just make this thing sound right.
16. 1:43:59 – 1:49:15

    Peter and Bill's favorite parts of the book

    1. SPSpeaker1:43:59

       last questions that we got, which I think is a really interesting question based on the whole conversation we had, and I think we can start with you, Bill, because I'm curious what you think as it relates to this, which is looking back at everything that ended up in the book, did you have a favorite chapter that you guys wrote? Is there anything that stands out where, like for whatever reason, you really look back fondly at that chapter?

    2. BGBill Gifford1:44:24

       So it's sort of like, um, picking a favorite child. But, um, geez, uh, so there are these, these four chapters, kind of core chapters about the horsemen diseases, right? Metabolic disorders, uh, atherosclerosis, heart disease, cancer, and Alzheimer's disease. And those were kind of-- They were not in the original plan. Um, and kind of the way those all came together, um, it was a huge, heavy lift to try and like understand each one of these disease processes, really. And it took a huge amount of research and me spending time with Bob Kaplan, who was kind of our, our research guru for, for the, the book project, and just kind of hammering these things out. Um, yeah, that, that was, that was pretty intense, a pretty intense experience, and I feel a, like a real sense of accomplishment about how those chapters all came out. I feel, I feel really good about them. But as far as like the chapter that, that progressed the most from like most improved, I think is, is the final chapter. Um, and just from where that started to where that ended up, I, I think, um, I think that has to be probably my favorite, favorite chapter.

    3. PAPeter Attia1:45:55

       It's interesting 'cause you didn't like that chapter initially.

    4. BGBill Gifford1:45:57

       No. No.

    5. PAPeter Attia1:45:57

       I know that you and Diana both didn't. That was probably your least favorite-

    6. BGBill Gifford1:46:01

       And, and Michael was like, you know, in the early discussions we had, Michael was like, "Is, is this-

    7. PAPeter Attia1:46:08

       It should be a separate book

    8. BGBill Gifford1:46:08

       ... is this part of the this book-

    9. PAPeter Attia1:46:10

       Yeah

    10. BGBill Gifford1:46:10

        ... or is this part of a different book?"

    11. PAPeter Attia1:46:11

        Yeah.

    12. BGBill Gifford1:46:11

        "The second book you're gonna write?"

    13. PAPeter Attia1:46:13

        Mm-hmm.

    14. BGBill Gifford1:46:14

        And I didn't agree with that either, but it, it had to change and, and you know, I'm always thinking about like, like Nick said, you know, where the, the reader is coming from, like you said. Um, so that chapter ended up being one of my favorites, probably my favorite.

    15. PAPeter Attia1:46:35

        I think there were sections of various chapters that I really like. I think that, I think that the insights that come out of the atherosclerosis chapter are so important and probably have the potential to save more lives than anything else. I, I really think that, um, I don't pull any punches in my [chuckles] , in my views on how we are mistreating, you know, this condition and why it does not need to be the leading cause of death. No chance of that. And I, I do think that in a-- And that's also one of those things where earlier versions of it didn't get to the point quick enough.

    16. BGBill Gifford1:47:13

        Right.

    17. PAPeter Attia1:47:14

        They had too-

    18. BGBill Gifford1:47:14

        Right

    19. PAPeter Attia1:47:14

        ... much in it that didn't matter enough, and it was really a very late, late addition was that the really clear pivot to the causality stuff at the end that I think is a much more insightful way to talk about it. So I'm very proud with how that turned out. I think for me, the exercise chapters. There are three chapters on exercise, which speaks to the importance that that plays in this book. And that was probably the one where even as recently as like July or August of last year, I was like, "I don't see how we get this to the finish line." Like, I don't see how this gets done. And we were trying at that time to do too much. And, um, and when we, when we instead focused on what we could do in a book, 'cause again, it's not a picture book, right? This is not, this is not a how to exercise book-

    20. BGBill Gifford1:48:15

        Yeah

    21. PAPeter Attia1:48:15

        ... where you're gonna have like a picture of every single step of like, "Here's how to deadlift. Here's how to do this. Here's how to do that." And we were trying to do all of that in writing at one point.

    22. BGBill Gifford1:48:25

        At an incredible level of detail. Just wasn't, wasn't happening.

    23. PAPeter Attia1:48:29

        That just couldn't make sense. Like, you can't explain these things in writing. And so I think a big aha moment we had was, A, let's restructure this, which we did. B, let's simply make a page of videos that explain some of these things so that we don't drown the reader in anatomic kinesthetic lingo that won't actually serve the purpose. And so when I look at how those three chapters form together and coalesce around the centenarian decathlon and the marginal decade, I'm, I'm, I'm really proud of that.

    24. SPSpeaker1:49:14

        And

17. 1:49:15 – 1:58:07

    The incredible team of people supporting the book

    1. SPSpeaker1:49:15

       you mentioned Bob's name a few times, kind of both of you, but I know this was, uh, beyond just the two of you. There was a lot of people involved in the research, the writing, the science piece. So anyone else kind of... 'Cause one of the questions that we got was, you know, how many people do you think were involved in the writing of this book?

    2. PAPeter Attia1:49:35

       Well, Bob did the heaviest lifting in terms of the-- 'Cause, 'cause, you know, Bob was working on kind of the research full-time. So basically, the way it would work is I would be writing and I would be saying, "Bob, I, I remember there was a study that sort of had this." Like, I mean, the end notes on this book are probably 500, right? So there was just a, probably more than that, right?

    3. BGBill Gifford1:49:56

       Yeah. Yeah, yeah.

    4. PAPeter Attia1:49:57

       Um, so- I would say, "Bob, you know, can you go and find me the citation of this study? I kind of vaguely remember reading it a year ago," blah, blah, blah, blah, blah. Or it would be, you know, "I wanna write about this. Is the answer this or this? Bob, can you go figure it out?" So this was, you know, this was really important research that was being done. But then the other thing that, that had to be done was all the fact-checking. And one of the things that I took as, as wise advice from other authors who had written scientific books is you can't just rely on a publisher to fact-check your book. They can fact-check some things, but you have to have an independent person to come in and do scientific fact-checking. So we had one analyst named Vin Miller, who did a lot of that work, 'cause Bob was too close to it at the time, right? If Bob's the guy pulling the citations, can't have Bob fact-check it. So had to have a separate analyst that was working on fact-checking. And then once we got into a much, much later version, then we had Bob go back and do specific certain fact-checks on certain things, which also [chuckles] meant—and God bless Bob, 'cause this was long after Bob had left.

    5. BGBill Gifford1:51:11

       [chuckles]

    6. PAPeter Attia1:51:12

       He came back and did a night weekend. Like, he was the guy that organized the endnotes. And that was another thing that just gave me chest pain. Like, I mean, the ch-

    7. BGBill Gifford1:51:21

       Yeah. Me too. [chuckles]

    8. PAPeter Attia1:51:22

       The unbelievable thought of what it would take to organize the endnotes to this book and the version control problems that we had with multiple different documents. I mean, it was so stressful. Um, and by the way, it should go without saying, people are gonna find mistakes in this. It- it's, it's impossible that we got it all right. It's impossible that we got every endnote perfectly. I, I guarantee you, we, we have a citation in there that we got wrong. Um, and, you know, uh, that's why you have second and third editions to books and, you know. So folks should let us know when they see those things, and, um, and we'll do that. But, um, I think we did as good a job as, as, as, as, as one could do in this regard, and, you know, having a lot of people to, to shoulder some of those lifts.

    9. BGBill Gifford1:52:10

       I spent a lot of time kind of, kind of putting my head together and on Zooms and, and going back and forth with Diana, kinda when you were off doing things and kind of trying to work out the kind of literary side of, of the book and how to structure it and how to, how to make these different chapters kind of move better, basically, is a better way of putting it. Um, so I, I worked very closely with Diana and Bob, actually. Bob would give me the full research download on, on... Literally, I'd say like, "Hey, Bob, like I'm, I'm trying to understand how APOE works," and boom, a G Doc would appear the next day with like tons of sites and studies. I'd just go down the, go down the rabbit hole with Bob about that. So he was great with that.

    10. SPSpeaker1:53:00

        Yeah, Bob has a endless number of G Docs. Like I, I would love to know-

    11. BGBill Gifford1:53:05

        Endless number of G Docs [laughs]

    12. SPSpeaker1:53:05

        ... how he stores all of them, because you ask Bob a question, you are getting a G Doc-

    13. BGBill Gifford1:53:11

        Yeah

    14. SPSpeaker1:53:12

        ... in response.

    15. BGBill Gifford1:53:12

        I spent like weeks-- We probably all spent weeks talking about the, the monkeys, the caloric restriction monkey studies.

    16. PAPeter Attia1:53:20

        I'm glad that they stayed in the book.

    17. BGBill Gifford1:53:22

        Oh, yeah. Oh, yeah. Yeah.

    18. PAPeter Attia1:53:22

        I was really worried that the Bethesda, Wisconsin, monkeys were gonna get chopped. But in the end-

    19. BGBill Gifford1:53:27

        Thank God, save the monkeys

    20. PAPeter Attia1:53:27

        ... we found a great place for them.

    21. BGBill Gifford1:53:29

        Yeah. Yeah.

    22. PAPeter Attia1:53:29

        And they're-- It's a fantastic story to tell. There, there are a lot of folks in here that, that, uh, you know, that I put in my acknowledgments. And, um, in fact, you know, it's pretty unusual, I think, that an author will read the acknowledgments in the audiobook. But, uh, there was no hesitation in my mind. It, it, it-- When we finished the book, and I said, "Look, I'm gonna not just read the epilogue, but the acknowledgments," they were like, "Oh, that's unusual. A lot of authors don't." But, um, you know, it's, uh, it's a, it's a very sincere, heartfelt thank you to a lot of people who have played an enormous role in sort of my broad education on this topic, which has been going on for more than a decade, and also some of the, the real specifics. Um, so, so, you know, broad education, you know, the podcast guests. Again, the podcast started basically as a research tool for the book. Um, and then of course, one of the things I do mention in the acknowledgment section, which is true and interesting, every single person that I ever sent a chapter out to for technical feedback and review did so. There's not one person that I sent a chapter to, and every chapter of this book, every technical chapter has been reviewed by-

    23. BGBill Gifford1:54:46

        Mm-hmm

    24. PAPeter Attia1:54:46

        ... a technical expert in that field.

    25. BGBill Gifford1:54:47

        At least one. Yeah.

    26. PAPeter Attia1:54:48

        At least one. That's right. And, and oftentimes, at least, you know, more than one. There is not one example where I said, "Hey, dear so-and-so, can you read this cancer chapter? Can you read this athero chapter? Can you read this?" Where that person didn't come back with incredible feedback. Um, and I'm, I'm, I mean, uh, the word is overused, but I'm humbled by that, and that means a lot to me, and, um, I think it makes this book a better book.

    27. SPSpeaker1:55:17

        When you decided to read the acknowledgments, did they try and get you to read the footnotes as well?

    28. PAPeter Attia1:55:21

        [laughs]

    29. SPSpeaker1:55:21

        Or is that not-- Did that not make the audiobook?

    30. PAPeter Attia1:55:24

        You know, it's funny. Um, and, and Bill, you probably don't even realize this, but I took a hit-or-miss approach on footnotes. Some of them I read, and some of them I actually didn't.

Episode duration: 1:58:07