#613 - Dr Peter Attia - The Health Metrics That Matter Most For Longevity

25:51So the sort of the way that hemoglobin A1C is an integrating function of average glucose, right? It integrates glucose level over the previous three months roughly. We don't have a tool like that to measure M -Tore activity. So again, I think that the belief that we need to limit amino acids to limit emtore activity is kind of a backwards way to think about it. What that's really going to do is create a situation of sarcopenia, which is muscle, like loss of muscle as we age. Okay. Yeah. Surely though, if people are consuming three to four servings of 25 to 50 grams of protein per day, is that not just going to continue to just spike emtore?

26:38Does that not end up netting out at amtol just being elevated throughout the day. Not necessarily. You have to remember the duration that free amino acid stay in your circulation is pretty low. You're also probably still spending 12 to at least 14 hours a day when you're not eating. Even so, I'm someone who probably takes a lot of effort to consume 1 .8 to 2 grams of protein per kilogram of body weight. And that's going to be spread out over three to four meals, but there's probably still 14 hours a day when I'm not eating anything. And during that period of time, those amino acid levels are going to be really low.

27:19I heard about you doing some very extreme fasts over the last few years. Talk to me about those. Yeah, I don't do that anymore, but I used to do a lot of fasting for many years. I would, you know, do a seven to ten day fast quarterly and a three day fast monthly. That's intense. That seems intense. I'm someone that's done intermittent fasting. I sat down with David Sinclair four and a half years ago, I think, in his office at Harvard. And when David first came onto the scene, which was the first time I'd really, really heard intermittent fasting as being pushed as a longevity lever, I thought, well, this is great.

28:00It's something that I can do. It's for the lazy among us it actually makes eating food easier because we've managed to reword skipping breakfast as doing intermittent fasting but I found it incredibly difficult to blend stang -fit, stang muscular and doing intermittent fasting. I really really struggled to make that work. What have you got? First of all, why have you changed your approach to intermittent fasting? I know that you've gained a a ton of muscle recently, and how have you worked in blending your understanding of intimate and fasting and its positive benefits with the fact that you want to look good, feel good, perform well?

28:42Yeah, so again, I still think going back to kind of one of the three ways that you can reduce color again take, you can, you can calorie restrict directly. So just track and reduce globally. You can dietary restrict, which is pick certain elements within the diet carbs, fat, whatever restrict, or you can time restrict, create a smaller and smaller window in which to eat. The biggest drawback of that final strategy, which again is a viable strategy, but the biggest drawback of it, in my opinion, is the reduction in protein intake. So this has been borne out in the literature. So we've seen clinical trials that have documented this, that first and foremost, the time restricted feeding within that 24 hour period doesn't seem to produce any benefits above the caloric restriction that it brings.

29:29That's a very important caveat. Okay, it's just meaning there is nothing magical about the time restriction beyond the calories that are being restricted. Wow. Okay. So the hunger signal that people get, which is those of us that have taken like the the Sinclair Red Pill, this is a signal that I'm hungry, this is homie, this is happening, this is discomfort, this is good for me, has no different impact than small amounts of satiation throughout the day with. There's nothing that It has been measured or documented in any clinical trial that suggests that that is beneficial over the Clare restriction.

30:06In other words, if you're going to eat 2 ,000 calories, spread out over 12 hours, or you're going to eat 2 ,000 calories, spread out over six hours, where your time restricted feeding for 18 hours, we're not seeing any difference. Now, that's not... Here's what's interesting. That's often not what happens. So, what more likely happens is the person who calorie restricts has an easier time, believe it or not, maintaining muscle mass than the person who time restricts. Why? Probably for two reasons. Although this hasn't been fully teased out in the data because they're not tracking it this closely, but my impression is that when you time restrict, you're just less likely to eat as much protein.

30:51And secondly, as you kind of alluded to earlier, it's a delicate balance to get the right amount of amino acids into the muscles. You can't have too much and you can't have too little. So what you don't want to do is waste, for lack of a better word, your amino acids down a gluconeogenic pathway where they're basically being used as glucose substrate. What would cause that to happen? Either too much or too little. So it would be... And what's too much and what's too little? Yeah. sort of 10 to 20 grams of protein, the liver is going to preferentially take that and use it as glucose, and anything over about 50 grams the liver is going to say, I'm going to take that excess and also make it glucose.

31:28So let's just say your number is 180 grams of protein per day, eating 18 servings of 10 grams a day, not going to achieve optimal results, having one serving of 180 also not going to... I've tried both. Yeah, yeah. So that person really probably ought to be doing four servings of 45. Right. So you're saying, for most people, it seems like roughly a sweet spot is 25 to 50 grams per serving. Exactly. Right. So in this regard, and that time -restricted feeding guy has a really hard time doing that if he's going to be deliberate about that. How big is the gap? When does a feeding window stop? Yeah, great question.

32:08Probably about three or four hours. So it's basically impossible. For the time -restricted feeding person, unless they're willing to eat protein outside of their window. Right. Okay. Which if you are a dogmatic around. If you're dogmatic, it becomes very difficult. Correct. But if you're if you understand that there and what we do with our patients who and who want to do time restricted feeding, because I think it's the easiest one to do. Yep. Like you should agree. It's the easiest one conceptually to do. It's the easiest one to be compliant with. So what we would say is look, it's just about the calories.

32:38So I still want you to have a low calorie protein shake in the morning where you're going to have 200 calories of a protein shake that's basically just protein some cashew milk and a few frozen berries, but at least you got that protein dose in. The other thing that I would say leads to what we experience clinically as a lot of people losing muscle mass when they do this is a lot of people exercise in the morning, but their feeding window is in the evening. So now they're creating a little bit of a gap, especially if they're untrained. It's less less of an issue in a trained individual, but an untrained individual we do see some benefits to having the amino acids restored in greater proximity to the training.

33:22How worried should we be about artificial sweetness? You know, I don't know would be the short answer. I think that this is another one of those things where Boy people really love to demonize these things But if you really just want to look at the facts, let's talk about facts, right? So aspartame, which is the original kind of the OG sweetener, everybody loves to demonize Aspartame or Nutra suite. But the reality of it is, if there is toxicity to it, it's probably impossible to measure at regular doses. This is a substance that at least the last time I checked had more data on it from a safety perspective than any other molecule tested by the FDA.

34:05You're kidding. No, it's just because again, it's been around since the 1960s, right? So does that mean that if you consume the equivalent of 12 cans of diet soda a day, it's safe? Probably not, but we don't know, right? So where do I think these sweeteners potentially wreak the most havoc? you know, one is I think that they probably increase your appetite for sugar anyway. So if you're consuming them in an effort to avoid sugar, you have to be just mindful of the fact that am I robbing Peter to pay Paul? If you really want to eliminate sugar as one of your dietary strategies, you might just be better off reducing sweet things altogether.

34:54And what you'll discover, because I've done this myself. I've had periods in my life where I've been very dogmatic about restricting sugar. I'm not that dogmatic about it these days, right? But when I have been, you know, what are the things I noticed was how unbelievably sweet things are that I used to not think were that sweet. Like berries, you know, like, you know, raspberries aren't generally thought of as the sweetest thing in the world. But when you completely eliminate artificial sweeteners and regular sweeteners, you know, after a few months, berries become insanely sweet, 85 % chocolate becomes mind -bogglingly sweet as opposed to what most people would think of it as kind of bitter.

35:30There was a recent study published that looked at one particular sweetener, Rithra Tall, and it was a pretty poorly done study, but it asked some interesting questions, which is a metabolite of this potentially atherogenic. I was again, would it lead to or cause atherosclerosis? What's that? Cardiovascular disease, sort of the inflammatory disease of the coronary arteries and other arteries.

36:02Again, I think the data are pretty underwhelming that artificial sweeteners are harmful, but I also think there's probably a class of differences between them. So my personal favorite of all of them is something called alulose. Alulose is, it's basically natural. It is an enantimer of fructose, meaning it's a molecule that's almost identical to fructose with one very minor structural change. What's unique about it is it has, in my opinion, the best taste. Because the thing I don't like about artificial sweeteners is I just don't like the taste. I actually like the taste of sugar. I don't like the taste of saccharin.

36:43I don't really like the taste of aspera tame. I certainly don't like the taste of stevia. I mean, that makes me want to vomit. But alulose has the same taste, the same mouth feel as sugar. And the only drawback is it's only 70 % of sweet, which is not a real drawback because you could always dose it up if you want. It also has the added benefit of, it appears to actually reduce blood glucose a little bit. It appears to have an effect where it pulls glucose into the kidney and basically increases is the glomerular filtration of glucose. So it slightly lowers glucose. Not as potentally as something called an SGLT2 inhibitor, which is a class of drug that does that.

37:24But it's very interesting nonetheless. So I guess if I were thinking about how I would consume it, I would probably consume more allulose than other things. But unfortunately, it's still not that prevalent in foods. You have to just buy the allulose itself. So if I'm making something, I'll use allulose in it. What I like about this framing is it gets to one of the reasons why doing a randomized control trial for diet stuff is so hard because how are you going to be able to control for the psychological training that having a sweet thing, even if it is a zero calorie sweet thing, even if it's a zero calorie sweet thing with no downstream risks to your body unless you take it in same dosages, how are you going to be able to control for what that does psychologically to people's expectations of the sweetness of their foods, of the frequency of having sweet things throughout their diet.

38:12Yeah, I think that's a really nice little microcosm there. But what I want to do, I'm wearing a whip band at the moment, some people are drowning in data now, right? We've gone from a world where we need nothing to where some people know a lot, but I would guess on average, that even people who care about the health and fitness are still mostly not wearing a tracker. They're still mostly not getting blood panels done. They're still mostly not going and getting a full body MRI scan, etc. What are the most important metrics for someone who is completely unindctrinated into the world of looking at vital signs within their body?

38:51What are the most important metrics for people to be looking at? Well, I mean, again, I have a pretty long list on that because we're holding ourselves to a pretty high bar. So the way I think about this is what are the inputs to what I call the longevity risk assessment. So there are basically about seven or eight things that are a threat to your length of life and quality of life. We've talked about them already, right? So cardiovascular disease, cerebral vascular disease, cancer, neurodegenerative disease, orthopedic injury, emotional distress, like all those things, right? So how do we know how you're stacking up on all of those things?

39:33What are the inputs to do them? So, yeah, blood tests, family history, selective genetic testing, colonoscopy, MRI, liquid biopsy, VO2 max test, zone 2 test, dexoscan, I mean, the list is long. And I think in our matrix, we have over 40 things that go into that. or over 40 inputs that go into our risk assessment. And then that risk assessment leads to outputs. So what do you do in response to the ranking of risk based on those things? Okay, run the matrix, go and do those things, and then let's come back and measure and do again. So it's hard for me to say what the most important is because it really comes down to an individual.

40:17So if an individual shows up and they have a significant family history of cardiovascular disease, Well, look, a CT angiogram is going to be very important. And a blood test that's measuring LPLittle A lipids and APOB is essential because you have to know which of these things is responsible for that. Certainly a continuous blood pressure monitor or at a minimum, we would have patients checking their blood pressure at home two to three times a day for a month. Again, super low tech, right? You might think, how is that interesting? Well, it's enormously interesting because blood pressure is one of the biggest risk factors for Alzheimer's disease and cardiovascular disease.

40:56So, again, people are obsessed with things like their sleep data, but don't forget the really less sexy stuff that we could have measured forever such as blood pressure. But knowing how to measure blood pressure accurately is important. And I think undiagnosed hypertension is an epidemic in this country. What do people get wrong when measuring blood pressure? First thing they get wrong is they don't measure it. But assuming they do measure it, they're not stationary for five minutes before they measure it. They don't have the cuff on correctly. They don't have their arm in the right position. If your arm is too low or too high, you're going to get an inaccurate reading.

41:32Your arm really needs to be, the cuff needs to be right at the level of your heart. You have to be very close attention to where the cuff tells you to put it. You want to be about an inch above the brake in your arm. And there's a good cuff will tell you where, how to line it up with the brake heel artery in your arm. You don't want to have just had coffee right before you do it. You don't want to be sitting like I am with your legs crossed, your legs need to be uncrossed. So there's a whole protocol for how to do this. And there's a very good study called the Sprint Study that really established the measurement standard for how to establish a proper measurement for blood reading, which was five minutes It's sitting stationary without doing anything stimulating, measurement, five minutes of, you know, doing nothing again, repeat measurement, five minutes, repeat measurement.

42:19So 15 minutes to get three measurements, taking the average. That's a blood pressure. Now, we don't ask our patients to do that. We ask them to do it once, but two to three times a day. So you should even out any inconsistencies. Yeah. And you'll also notice trends like, are you normal in the mornings, but elevated in the afternoons. And you know, the data are really clear that anything above 120 over 80 has long -term risk associated with it. And so when we see people that have an elevated blood pressure, we want to make sure we're addressing that. And there's lots of ways to address it before you have to go down the pharmacologic path.

42:51But if you have to go down that path, you're much better off going down to protect your kidneys, your brain, your heart. What is good and what is bad about different types of cups, are automatic cups okay? Yeah, so the gold standard is of course a manual cuff. So having an actual person, yeah, who's got a stethoscope on the break ill artery and measuring your blood pressure. The problem is, unless you're, you know, you have, like for me, that's what I do typically because my wife can measure my blood pressure, even I can measure my own blood pressure. So marry someone who is trained of taking blood pressure.

43:25That's what you're saying. But the automated cuffs are pretty good. In me, they run high. So across the board, automatic, automated cuffs tend to run 10 to 15 millimeters per mercury high, systolicly, and they're accurate diastolicly. That's just a glitch. I have never been able to come up with a compelling explanation for why, but I'm not unique in this. We do see this in a number of people where the gold standard runs lower than the cuff. So the challenge of doing an manual cuff when you're at your doctor's office is the challenge of having your blood pressure checked at the doctor's office.

44:09For some people, it produces this syndrome -like white coat hypertension where - The moms got that. Yeah, they just, you sort of get, you know, and by the way, the other thing is, most of the time you walk into the doctor's office, they don't even adhere to this principle, right? Five minutes. Yeah, yeah, yeah, you sort of run in from the parking lot, run up the flight of stairs, sit down in the way. That was the last time you had a coffee. Yeah, blah, blah, blah. So again, I think that blood pressure is a very difficult thing to accurately glean in the doctor's office for all those reasons. And that's why I just think everybody should buy one.

44:37I don't have any affiliation with the company that makes these things, but there's a brand that I like called Omron OMRON. That's the one we tell our patients to get. You can get these things on Amazon. What are the most common lifestyle interventions? Let's say that someone does get to what that 120 over 80. Where should they go first? What do you think? Exercise is a big one. Aerobic exercise is an enormous way to lower blood pressure as is weight loss. So weight loss is going to be mostly driven by nutrition and then aerobic exercise and sleep. So because I track my blood pressure pretty regularly, two of the most obvious things that show up when I'm not well slept is, you know, higher blood glucose and higher blood pressure.

45:22I went to Medellin. I went to bio -accelerated down there and got a ton of stem cells for a week. Medellin's at altitude and they were coming in and testing my blood pressure three, four times a day, using that and I had a nurse doing it, which was nice to have the sense that it teams there for your health. That was, I really enjoyed that part and felt like I was being cared for, but at altitude and I'm a heavy guy, at altitude my blood pressure was not happy. So I came back and I thought, I really need to, I really need to make a change here. I really need to, because even if it is at altitude, et cetera, et cetera, I was in there with Al Jermaine Sterling, who is the current UFC 135 champ.

46:04And yes, Elite athlete, yes, best in the world, literally what he does, but he wasn't struggling. And I figured I probably could do with making a change here. What's the altitude there? I don't know. I don't know. High, higher than I'm used to. I presume. And you were getting stem cells for what? So they reached out and suggested that I go in and get a procedure. I've got two bulging disks, L3, L4 and L5S1. That's been an issue for a while. Although it is, I managed to get it to a very manageable place now, which I'm very happy with. with a little bit of rotator cuff. It just bro injuries, you know, like sometimes my knees are a little bit achy.

46:45I had a full Achilles detachment playing cricket a couple of years ago, most British way that you can do it. So I went in and I had 110 million through IV, two separate ones. Oxygen chamber, twice, two sessions of that, a bunch of vitamin IVs, two intraarticular shots into the shoulder. quadriceps tendon above and below the patella and then straight into the achilles and then a intradiscal injection into L3, L4 and every facet joint as well, demo number spine. Under general for the spine stuff which was great, under nothing for the local injections which which were spicy, but that was seven, eight, seven, eight weeks ago now, and three months is around about the time when this stuff's supposed to kick in.

47:43So I'm very much looking forward to seeing how that works. I enjoyed it. Psychologically, it was neutral, physically slightly difficult. The sort of, is it cytokine inflammation response is something to behold. for the next 24 hours. It felt like anyone that's had dorms after a three -month break from the gym imagine that kind of stiffness but exclusively in the tendons of the places that have been touched. Oh god, it was so localized and so I was laughing in for the next day as I sort of totted around like a robot. It was a very interesting experience. What about health metrics that people are overlooking?

48:27So we've mentioned, you know, Even the stuff that you've given there in terms of top line, probably VO2 max is your HIV, your resting heart rate, blah, blah, blah. Is there something that most people have... Well, think about how many people listening to us today do you think know their VO2 max? Very few. Yeah, very few. Yet there is no metric that I am aware of that is more highly correlated with the length of a person's life than their VO2 max. Why? Not even close. Why that particular metric? Well, there's probably two things going on, right? One, it actually does matter a lot. It's an amazing proxy for health.

49:01If you think about, have you had a VO2 max test done recently? Not recently. I had one done last one was probably four years ago. Okay. So think about how miserable it is, right? What is it testing? It is testing your maximal consumption of oxygen. Well to get to that level, we are stressing you to the highest degree possible. It is, as its name suggests, it is a maximal VO2 max test. So, the higher that number is, the more oxygen your muscles can utilize, the more fit you are, the healthier you are, the more capacity you have to avoid illness. And so, I think there's the biological reason for it.

49:42I think the other reason for it, as opposed to, say, your zone two threshold, which I think ubiquitous. It's very standardized. It's easy to test for conceptually, not necessarily physically. And so you have a metric that we can easily capture. So it's, for example, it's better than like a deadlift. And in deadlift, there's variability of form. There's too much risk of people getting hurt. It would be a harder metric to track. So you have this metric that you can track. And then the having a high number tells you something about the person, right? To have that number, you must be, to have a high number, you must be exercising a lot, and we know the benefits of exercising a lot, right?

50:29The person who has a VO2 max at the top 2 % of their age, I mean, by definition, they're doing a lot of exercise, and exercise has more benefit than probably any other single intervention we can do. So again, it's, I throw that out there because I say like, yeah, we know those things we know exercise matters, but when it comes right down to it most people don't know if they're fit enough. Most people don't know their VO2 max, most people don't know their ALMI, Appindicular Lean Mass Index. They don't actually know how much muscle mass they have. They don't know where they stack up for other people their age and sex, and yet that's also a highly, highly predictive metric of how long you're going to live.

51:10They don't actually know how strong they are. They don't know if they're in the top 25 % of their age or sex for strength. So I think it just comes back down to the basics, but we have to know these things. What gets measured gets managed. And if you're not measuring these things, I don't know what you're managing. What is the best protocol that you have found for improving VO2 max in terms of training? It's two things, right? So you want to think of the way I think of cardio respiratory fitness is it's a pyramid. So you have a base to a pyramid and you have a peak to the pyramid and you want the biggest possible pyramid.

51:50So the area of the pyramid is your total cardio respiratory. But also wide. Exactly. So the width of the pyramid is your zone too. That's your sort of aerobic efficiency metric. So if you and your VO2 max is the height of the pyramid. So if you want a high pyramid, you also need a high base. So you have to do training that widens the base and raises the peak. So the base widening training is what we call zone two training. So again, there's lots of ways to do that. But the simplest way to do it is to train at an RPE that barely allows you to maintain a conversation. So the way I describe it to people is I do my zone two on a bike on a trainer indoors, right?

52:35I'm listening to podcasts and audio books. It's a it's a pace of training where I'm mostly able to breathe through my nose, but that just speaks to the fact that I have pretty good airways. A better metric is, if my wife comes in and talks to me or if the phone rings and it's important and I pick it up, I can carry on a conversation, but it's strained. The person absolutely knows I'm exercising. Well, it takes something. There's no confusion, but I can speak. If I'm at the point where I can't speak, outside is own two. I'm into zone three. What's a heart rate? Is that, have you got any idea for you?

53:11Yeah. For me, it's typically a heart rate in the high one thirties. Okay, that's a little higher than I would have guessed. But I've got to find it, speak in a little cardiovascular fit. Well, but it also varies day by day. So yesterday I was having such a lousy day. Probably because I didn't sleep really well, that ended up being a heart rate of about 131 to 132. So it varies. I've had it days where it says low is 130, and days where it says high is 145. How old are you? 50. Wow, so that's still very fit. I'm gonna guess that'll speak to the fitness that you've got. Well, I think it just speaks to, the bigger point I think is that it just speaks to kind of the variability you have in heart rate between individuals.

53:52But then to train the peak of the pyramid, I think the most efficient way to do that is kind of, so VO2 max training is maximized between three and eight minute intervals. So if an interval, you will train VO2 max if you're doing something harder than that. If you're only doing something you can hold for 30 seconds or one minute, that will still give VO2 max benefit, but not nearly as much as if you can push it closer to three, four, five minutes, et cetera. So for me personally, I mostly do that at four minutes. So I'll do four minutes very hard, four minutes of recovery, four minutes very hard, four minutes of recovery.

54:31So I do those also on a bike usually and I'll do those outside on a hill. So there's a road cycling this. Yeah. So there's a hill near my house that is up. It's a it's just a straight hill that's not so steep like meaning I'm in the saddle. I don't have to be out of this. I'm just in the saddle looking at my power meter and my heart rate and just Going very very hard for four minutes Getting to the top feeling like I want to puke Going back down doing it again. Just repeat repeat repeat two sets. No, typically do four to six Okay, how often puke I just do that once a week, okay? And that seems to be well again It's remember what I'm training for now when I was training as a cyclist I was doing those types of workouts three times a week And they were much longer and much more grueling.

55:18But again, I was optimizing for a much broader array of fitness. But for today, for all I'm doing is, no, I'm just, you know, I'm just trying to be a good, I'm just trying to be fit as a person, not as an athlete. So yeah, once a week of doing a very hard VO2 max set, four times a week doing those lesser zone two sets. How long on zone two? 45 to 60 minutes a session. Okay, so you're looking at what 180 to 240 minutes, cumulative leap of week. Correct. So I'm basically doing four to five weeks of cardio training a week, which is, you know, depends who you ask. Like, by my historical standards, that's very, very low.

55:57Obviously, for some people that would still be considered a lot. I think, you know, I think it would be crazy not to want to capture the benefits of something like exercise. So we do, you know, sort of sit down with everybody and say, okay, how much time are you willing to put into exercise? And then that's how we sort of think about how to allocate time across all endeavors, strength, you know, stability, aerobic efficiency, peak aerobic power. We do take kind of a portfolio approach to that, but starting through the lens of how much time are you willing to put into it. So someone like me who's willing to put in 10 to 12 hours a week, that's, you know, you're all of the bases as much as you want.

56:38Absolutely. Yeah. Okay. So you've got four pillars, strength stability, VO2 max zone two. Yep. Strength and stability. Talk to us about that. So strength is probably the easier one for people to understand. You know, that's basically your ability to generate force. And of course, within strength, you have different, you know, different areas of strength. So I don't do a lot of maximal stuff anymore. So in other words, I'm rarely If ever I don't think I really ever go below three reps. So the the heaviest I will go is five reps stuff So I'll do you know, I'll do deadlifts that are five percent ish That's why you don't know you don't know you don't know you want to run because you're not doing it But I can sort of predict it because I do use a velocity tracker.

57:23So have you seen these? Yeah, yeah the boss speed things Yeah, so I do measure bar speed. So I can have a prediction of it. I can have a prediction of 1RM. But yeah, usually I'm sort of in the 5 to 15 rep range when I'm training. So I'm basically, but what I'm always trying to do is make sure I'm somewhere between 0 and 2 reps in reserve. So that's, I'm really training off reps in reserve. Okay. That's my overarching principle of training is. So, even if I'm at five, I'm probably training to one to two rep and reserve. If I'm at 15, I'm still one to two reps in reserve. There's the bodybuilders out there that want to do super sets and drop sets to failure that are tearing the hair out at the moment.

58:07Yeah, I'm sure. And again, there are absolutely sets where I do go to failure, but the truth of it is it's very hard to go to failure all the time. I think if people are being brutally honest with themselves, like... they still had another one or two set reps left at the time. Yeah, I don't, I mean, I, I, I know what it's like to go to failure. Um, and you don't, you, you only have so many of those matches every day. Um, so I don't even try to play that game. I just sort of say like, I know, I've learned that I've got, if I stop now, there's only two more I would get before I would violate my form so badly that I would either injure myself or, you know, just effective.

58:45Transcending ego lifting is, uh, one of the most difficult things that you can do, forget about the consistency and all of that. It's transcending ego lifting. Strength, formulating a strength protocol across the week. What are you prioritizing? You're prioritizing large lifts, you're prioritizing session length, etc. etc. Yeah. First of all, there's quite a bit of variability in my training, but generally I'm doing four days a week, and not generally. I'm always doing four days a week, and it's two days lower body, two days upper body. Now, I used to, I've for years also done three days of mixed longer sessions, but I prefer what I'm doing now.

59:23I prefer doing two lower body days, two upper body days. And yeah, I prioritize big lifts and I'm sort of working on, like so today I had 24 working sets of upper body. you know, on Monday I had 18 sets of lower body, 18 working sets of lower body, and probably on Friday it'll be a little bit more volume, it'll probably be 22 to 24 sets of lower body working. In that 5 to 15. Yes. Which is, ish, up, e, 8, e, 8 and a half. Yeah. Yeah. Sometimes maybe as little as seven on some things. Especially if you've had the shit night sleep. Yeah. The night before. Yeah. What, when you're looking at movements, for instance, what was your session this morning?

1:00:08Can you remember in terms of exercises? Yeah, so I did floor presses. Dumbbells. Yep, I did pull downs. I did incline press. I did row. I did, like incline curl overhead tricep extension. and then a preacher curl, you know, it's not a true preacher bench, but hanging over a bench, doing a preacher to create the same angle. And then laying tricep extension. And then always in between them, I'm doing stability work. So we didn't come to stability, but I'm doing, I do two dedicated days of stability a week. So Tuesday, Thursday, I do a full dedicated hour of stability training. And then on the off days, it's not Tuesday, Thursday, I'm getting in at least 20 minutes of stability per day on either side of the exercise, like throughout the workout.

1:01:05So the stuff that we've gone through so far, the gym bros will still understand what cardio is. The cardio bros will still understand what lifting is. Nobody understands what balance training is. No one understands. What are the principles behind this? No one's ever thought about stability training before. How do you integrate it into your workouts? And then also what does a dedicated It's very difficult to explain. It's actually, I think it was the hardest chapter in the book to write truthfully, because it's hard enough to show people in videos, or to have friends over who want to work out with me, and put them through the exercises.

1:01:46That's actually very difficult. So, you know, I lead with an analogy in the book where I talk about the difference between street cars and track cars because I'm a car nut and I being on the race track is probably one of my favorite things to do. And so the analogy I give is this which is if you take a street car with very high horsepower and you put it on track and you let it race against the track car which is lighter, less horsepower typically for a given engine size or for a given class size, slick tires on it, which one's gonna be faster? I mean, it's no comparison, right? The track car rips the street car into oblivion.

1:02:29Even though, by the way, the street car will go faster in a straight line. So the example that I use in the book is a real example. I compare it at the time, this is seven or eight years ago. My street car at the time was like a modified E92 M3. So I modified it, changed all the airflow. That thing was putting out 400 and 75 horsepower. Big German beast. Yep. And at the time, my track car was a spec E30 M3. I'm sorry, not even an M3, just a spec E30. Okay, right. But everything stripped out, roll cages in, stiff as hell. Stepping style. 165 horsepower. Wow, engines in it? Oh, this is stock engine.

1:03:14Yeah, it's a six in line. Right, okay. Yeah, yeah, yeah. So, so you've got the the stock 165 horsepower engine. It's very light. The car weighs like probably 2400 pounds versus the M3's 3400 pounds. M3's got street tires on it. This one's I'm running, you know, probably handcooks slicks on it. But to your point, the chassis stiff is a button suspension super stiff. And yeah, I was going faster in the straightaways in the M3, but my lap time was two seconds faster, which on a track is, might as well be a day, in the spec E30. And of course, what does it come down to? It's cornering speed. What is cornering speed come down to?

1:03:53It comes down to of the 165 -pultry horsepower in that engine. Every little bit of it is making it where it belongs. Remember, what is the name of the game in driving a race car? It's all about friction. It's all about power loss. It's all about transmitting what's happening in the crankshaft to the tire tire to the street. That's it You only have four points of contact with the outside world nothing else matters and so again We're not talking about aerodynamics because these aren't arrow cars, right? So in the in the street car First of all, I have much more slippage at the tires Because I've got I'm not running slicks secondly the chassis is so loose Right so allowing all over the public I've got all this all this energy law with energy leaking out of that car, not making it to the surface of the track.

1:04:44It's like having a laxity in a joint. That's right. So every time you're hurting your knee, you're hurting your elbow, something's hurting. That's an energy leak. So again, even if one doesn't care about performance, just from an injury perspective, this is something we want to avoid. We want to avoid it. And again, my introduction to stability only came the hard way. It's not like I was born out of the womb realizing this was an important thing. I mean, I had to go through horrible injuries to finally arrive at this place where I said, you know, I'm tired of being in pain. I'm tired of the fact that my elbow hurts when I do pull -ups.

1:05:25And, you know, oh, like half the time I deadlift or squat, my back hurts, you know, my SI joint hurts the next day. Like it was just kind of tired of that. And then I got very fortunate and that I landed in the company of a guy named, who I write about in the book briefly, his name is Michael Stromsness. And he's a practitioner of something called DNS, dynamic neuromuscular stabilization. And very first time I met him, you know, at the time I was like, my main complaint was basically my right SI joint and my right elbow. I had tennis elbow having never played tennis. And he said, all right, you know, take your shirt off and hop up on the bar and do some pull -ups.

1:06:04So I did and rattled off, you know, 15 pull -ups or something, which I could do easily at the time. And he's like, oh, that's horrible. Like those are those are... And by the way, these are good form pull -ups. I'm not doing like bro pull -ups where I'm like jerking up and down. I'm doing like full extension like everything perfect. And he's like, yeah, you have no capacity to control your scapula. So your scapula is winged and in doing so you are transmitting all of that force into your elbows. You cannot retract your scapula. You don't have the control. You don't have the stability in the scapula.

1:06:40So you're leaking energy through your scapula in terms of. So to make a very long story, short that, that which started in 2017 just took me so far down the rabbit hole of not just DNS, but other other schools have thought. I would later go on to meet someone named Beth Lewis through Michael who has her own expertise around other disciplines. And we basically just started piece by piece rebuilding my movements. And by the way, that meant spending a year not doing pull ups and not deadlifting as I relearned how to align my body again. And so today, I'll still spend two days a week working with a guy here in Austin named Kyler Brown, who's amazing, working on just dedicated DNS things.

1:07:28And again, if you watched the exercises I was doing, you would be thinking, what is he doing? You know, like, why is he doing, and why is he in these baby positions, like moving in these odd ways? But a lot of what DNS is based on is the idea that up until we were about two years old, we all moved almost perfectly. Most of our movement patterns that are corrupt, which we all have as adults, only started to kick in once we're about two. Maybe one, but generally about two. So there's a very predictable, you know, neuromuscular set of sequence of movements that are genetically programmed into us.

1:08:08The ability, you know, the way a child reaches for something, the way a child rolls, the way a child stands, the way a child gets into a bare position. All of these things are basically hardwired into us. And the goal of this type of training is to basically provide a software update on the crappy software we've overridden that system with. Let's say someone doesn't live in Austin, doesn't have access to your very smart friend. There are lots of DNS practitioners across the country. But you would advise doing this with instruction? I think so, yes. I think the complex and nuanced and you need to...

1:08:43I think DNS is very difficult to learn. I shouldn't say that. I haven't tried to learn it off videos and online and there might be ways to do it. But I think trying to find a practitioner is a good way to start. And then once you have it going, it's always great to continue on your own. And there's a lot of stuff I do with my friend Kyler that's not DNS. I mean, one of the issues I've been having injury -wise, I have very flexible ankles. I think a lot of former swimmers do. And so one of the drawbacks of that is when I do, I love doing box step -ups. We're both cut from the same cloth. I knew that you were a massive fan of these.

1:09:25They're my favorite movement for the lower body. I absolutely love doing them in all regards. I love doing them very, very heavy. I love doing them very, very slowly, all of these things. Well, because my ankles are so flexible and I can really, really dorsiflex, I have a tendency and see sometimes, because you know, when you wanna do a step up, the real key to it is preloading the glute and the ham. Right. Not bouncing off the floor. That's right. So to preload, you wanna be able to shift forward and glide the femur back. That creates an enormous stretch, eccentric stretch, so that that front leg is loaded, boom, you pop up.

1:10:01Okay, well, in doing so, I often will drive my knees so far over my toes because I have the flexibility in my ankles, but sometimes I'll develop a little bit of discomfort there in the front. So one of the things I'm working on with Kyler is solius strengthening to actually counteract that movement. Bring it back. Yeah. And so the amazing exercises that he has come up with for me to do solius strengthening, which again, you have to, you have to be very deliberate about doing that. It's easy to strengthen your gastrox. The solius requires more effort. I learned this intimately during my rehabilitation.

1:10:39I overshot it actually, it was hilarious. So there's not a good time to snap any killies, but during COVID wasn't bad. And I overshot it on my right leg, which is the one that snapped. And I ended up having to then work on my left more aggressively to catch it up because I ended up building up a calf that was big. I mean, I learned so much from that. The first thing was I had a 13 -day weight period because I was doing it on the NHS, although I managed to find one of the top three surgeons in the entirety of the UK through a friend who was on the NHS to come and do my reattachment, which was really, really great.

1:11:11It felt like being fitted in at the end of the day with a barber that needs to do the haircut and I was waiting around all day all day all day and then it got to the very end and we had to run it back and I had to go back tomorrow. I've been fasted all day because I was going to go into general and I was like blah blah blah. Anyway, a bunch of the things that I learned from that coming out the other side were how important it is to be able to deal with not just strength but plio, especially for that ankle position. But what I'm thinking here when you're talking about your challenges with box step ups, there's a guy called Dr.

1:11:45Eddie Joe PhD on Instagram. Now he took a massive hiatus for like three years, but he did these really great breakdowns of academic literature in infographics, which lend themselves to Instagram very nicely. I'll never forget this one from maybe four years ago, I think, and there'd been a study done looking at muscle fiber recruitment for glute exercises. And you look at the glute factory bum lab things for girls that want big glutes or me that's increasingly realized that my back gets better, the bigger that my bum gets. And glute bridge, donkey kickback, side raises, is all manner of fantastical exercises that girls do.

1:12:27And he drank them by the amount of muscle fiber recruitment. The top five exercises were step -ups or step -up variations. It's like step -up, cross -body step -up, like lateral step -up, something, something, something. And then maybe hex bar deadlift was in the sort of upper middle deadlift, another one. And then you get down toward like glute bridge kickback. and it's at 25 and I think it's 95 on this particular scale of this number was step up. So for anybody that wants to improve like lower body power, I just I absolutely adore that movement and it's so easy to do. We, you know, in the first iteration writing the book, I had intended to put so much detail in about instruction on like kind of the most important movements.

1:13:14In the end, it was getting too long. So what I did is I ended up creating videos for a hand and one of them is the step -up. So there's a pretty good video on the, like the bookle point people to where to go on our site to see it. And it's a pretty, I just watched it yesterday. It's a pretty good instructional video. Is it you doing it? It's me doing it with Beth and I talking through how to do a step -up. Cool. Weighted, unweighted, low -box, high -box, the whole thing. East -centric, concentric, what are the pitfalls? How do you, you know, how do you unload the ribs to, you know, do the movement correctly and all that stuff?

1:13:46So beautiful. Yeah. Yeah, I'm going back to some of the other, we've spoken about sweeteners. What about vaping? If you had to look at any of the science around vaping, it's kind of a little bit of a moral panic at the moment. If you look at certain areas of the ancestral paleo worlds on the internet, what's your thoughts on vaping and its potential? Let's come back to the risk -reward matrix. Again, I view everything through this two by two. What's the risk? Is it closer to getting hit by a tricycle or getting hit by a train? And what's the reward? Is it picking up a dollar or is it picking up a gold coin?

1:14:23So I think that the, I don't think we have sufficient data to say that it's picking up, that it's getting hit by a tricycle. I don't think the industry is standardized enough to be sure that what is being inhaled is sufficiently clean. Maybe it is. Maybe some companies are better than others. I mean, we could talk about that all day long, but I'm not personally willing to put my trust in that market, in that infrastructure in those companies whatsoever. So for me personally, this would be a no -brainer. There's no upside in it to me. What would you be concerned about going into your body? It's not just the nicotine, it's the stuff.

1:15:04Oh no, first of all, nicotine I love. I'm all about nicotine. How do you use nicotine in a safe way? I would chew gum or I would use I use like a Lawzinge or I choose there's like these little patches that you you know kind of suck Zin pouch what have you found is your favorite brand for those?

1:15:22I'm blanking on the name of the brand They come in a little round Colorful thing. I don't remember the name of the brand got you any using three makes five makes Unfortunately, I haven't bought in a while from these guys. I bought so many the first time by accident that I'm still living off the last two years worth. I literally just like an idiot accidentally bought ten times more than I'm like a prep up. Yeah. So, unfortunately, they only come in sevens, which is a no way dude. No, you can't do it all at once. That would be in my mouth for 30 seconds and then I would have to take it. Yeah, yeah.

1:15:57So I go in, out, in, out, in, out, in, out. I think they have a four as well. It's a little bit more manageable. truthfully, I think two milligrams is sort of the right dose. One to two milligrams is probably the sweet spot. And then you don't need to dick about taking it out. Yeah, yeah, yeah. So to be clear, like the nicotine is not the problem. Right? It's just like with cigarettes. Nicotine is not the problem with cigarettes. Yes, there's an intercom component to it. The problem is the toxicity of the vehicle that's delivering the nicotine in the form of tobacco. Well, with vaping, I don't have any sense of what's happening when you have a heated metal filament that is burning combustible products, some of which I may or may not be inhaling through a filter.

1:16:38What I'm saying is not that I know there's something wrong with this, but I'm saying I have no confidence in that industry to regulate itself or our regulatory agency to regulate them. Therefore, because I don't know where it is on the risk parameter, but I definitely don't feel comfortable saying it's getting hit by a tricycle. It could be getting hit by a small car. It could be getting hit by a train for all I know. It's just an unknown. And then how would I justify it? Well, unless I felt that the reward matrix was picking up gold coins, it just doesn't justify it to me. So is that a moral panic?

1:17:14I don't think so. I think it's just saying, like, what's the risk reward trade -off for it? Justified skepticism, perhaps. Another revolution that's going on at the moment, which I've been the sort of front row seat of has been alcohol and the reduction in the consumption of alcohol. I think people realizing it's no surprise that it's a really dangerous risk. But people who considered that one drink was okay, that two glasses of wine because this and reservoir are a troll coming from the red grapes, etc, etc. I was a club promoter for a very long time. So I was in the trenches partying hard for all of my 20s, which is why you're 90th to 100th your estimation, I think is, unfortunately, going to be a little bit too generous.

1:17:56But I went sober for six months, really loved it. Most to do with the lifestyle changes, cognitive improvements, what it meant in terms of habit, in terms of consistency, energy, money, time, all that stuff, came back to drinking, didn't like it, went back to sober for another six months, came back to drinking for a couple months, didn't like it, did a thousand days sober, never had an issue with substances. But just really loved what it had done for me. And, you know, five years, hands, six years, hands now, the low and no movement seems to be really, really gaining speed. Why is it so surprising?

1:18:34Now, why is it that something that ostensibly obviously wasn't that good for us is now only just beginning to kind of get some momentum of people thinking, oh, maybe this thing that makes me feel like a total pile of dog shit the next day is something that I shouldn't take all the time. I don't know, I can't speak to it. The only thing I could speculate is that with the rise of sleep trackers, I think you really have some objective data on the downside of alcohol. And I don't think anybody who's worn a who doesn't look at their heart rate variability, pre and post alcohol consumption or the fragmentation of their sleep is not saying what the hell.

1:19:12It's insane. Why is it such an impact for the uninductinated amongst us? Let's say that you've got a heart rate variability of 70. If you were to have two glasses of beer or two small glasses of wine on an evening finishing at 9 or 10 pm and then go to sleep on the night, it wouldn't surprise me if from 70 your heart rate variability is down in the 30s or the 40s. What is happening inside of the body that's causing that to happen? So alcohol is metabolized into different elements, but one of the metabolic byproducts of alcohol is quite toxic. And I suspect, I don't know, but I suspect what's happening is the toxicity of that is changing the autonomic nervous system.

1:19:56So what you want to be doing when you're sleeping is in a maximally parasympathetic state, that the so -called rest and digest state. And that's really what heart rate variability is measuring, right? Heart rate variability, along with other things such as heart rate itself and temperature, respiratory rate, are proxies for your autonomic nervous system. And anytime those things move in the wrong direction, so heart rate goes up, heart rate variability goes down, respiratory rate goes up, temperature goes up, all of those things happen when you drink. That, to me, is a very strong signal that something about the toxicity of the metabolic byproduct of ethanol is putting the body into more of a fight or flight response as opposed to a rest and digest response.

1:20:41It's so hilarious that the thing that a lot of people use and has been used for a long time. I can't get to sleep. I'll have a glass of whiskey. Isn't really aiding with sleep. It's just sedating people. Yeah, that's the insidious thing about it, right? Is people confuse sedation, consciousness, and sleep. And I love to tell the GLIB anecdote, right? Which is like, if I hit you over the head with a baseball bat, you would lie motionless for 12 hours. But of course, there is no confusion over the fact that you are not sleeping and nothing about that experience is good for your brain or your body in terms of rest and recovery.

1:21:14So, yes, alcohol is very sedating, but it doesn't promote sleep in the way that we know sleep works in terms of its stages and its functionality in terms of healing. Let's say that no one is looked at Alzheimer's or Neurodegenerative disease. What do we need to know? The first thing I think everybody needs to know, you're talking about from a personal risk standpoint or just understanding the disease. Personal risk. Okay. Yeah. So the first thing I, you know, we want to know from all of our patients is tell us your family history. Right. That, you know, there is a genetic component to this disease.

1:21:49So let's understand what your susceptibility is. Would you ask them that ahead of just saying go and get a genetic test? Oh, absolutely. Yeah. Because the, I think the family history is more telling than the genetic test. Wow. Okay. Because remember the genetic test we look at, we look at the most common gene, which is the gene that's easiest to test for, which is ApoE. There are a dozen other genes that we look at, but they're much harder to sift for. There aren't really great commercial tests for them. And God knows if there's something lurking that isn't part of this current paradigm of what we understand.

1:22:23Yeah, exactly. Did it show up? Yeah. If it showed up? Yeah, so right out of the gate, we want to know, is dementia in your family? If so, what type do we think it is? So, do we think it's Alzheimer's dementia? Do we think it's vascular dementia? Do we think it's front to temporal lobe dementia? Do we think it's Lewybody dementia? Is there Parkinson's disease? When you think about just comparing Parkinson's disease, Lewybody dementia, Alzheimer's disease. Those are three types of neurodegenerative diseases that are on a spectrum. Where Alzheimer's is the most cognitively destructive, Parkinson's is the most movement destructive.

1:23:02of the negative, Lewy body is taking bits of both of their playbook, right? So Lewy body is destructive to both movement and cognition. Well, we want to understand exactly what pattern you may or may not be a part of. We also want to understand age of onset. So tragically, there's a, fortunately, very, very rare, but still unfortunately prevalent form of early onset Alzheimer's disease. These are people who are afflicted in their 40s and 50s. Is that what Chris Hemsworth's got? No, no. He realized something during that. Yeah, Chris, Chris learned that he has two copies of the apoe forgene and the apoe forgene is the most common genetic, you know, the most common gene responsible for Alzheimer's disease.

1:23:48But it's not early on set. Right. It's a late onset predisposition. Okay. The early onset ones are called APP, PSEN1, PSEN2. So again, those can be tested for. We don't normally test for those because it's normally so apparent from family history. Of course. Now if we document that, we would of course test for it. Tragically, I think that's a variant of Alzheimer's disease that is, I think it's less clear how much you can prevent. Lifestyle independent, basically. Right. Whereas the one that Chris has, and that 25 % of the population has, if they have one copy of that gene, that's highly amenable to prevention, which really gets to why we want to know this stuff.

1:24:33You want to know this stuff because one, sometimes that's the motivation people need to take this seriously when they're 35 years old and young and indestructible because that's the time you want to actually act. And secondly, there are certain things that we know are even more important to people with that gene type. So it would factor into what medications we might use to lower cholesterol. It might factor into how much omega -3 EPA and DHA we would want them to take. It might factor into other choices we might make around nutrition. And even in people who are exercise time limited, it might factor into how we prescribe exercise.

1:25:08What are the biggest prophylactics against mental degradation of a time? So I did recently did a podcast on this. It's an AMA on my podcast that is 100 % devoted to all interventions that improve cognition and delay the onset of dementia. And I sort of broke it down into here are the things for which there is no ambiguity about the benefit. So enormous signal. I'm not going to talk much about them because it's I'll give you the basics on it. and then I spent the entire podcast talking about the gray stuff where there's probably a benefit, but it's harder to quantify. So you're asking what are those things that I didn't really talk about?

1:25:51It's basically exercise, lipid management, not having type 2 diabetes, and probably sleep, having adequate sleep. those are the no regret moves that have enormous impact. It's probably in that order. So it seems like looking at what we've spoken about so far today, and you mentioned it earlier on, you thought, diet was this unbelievably huge lever. It seems now that exercise is one of the longest, if not maybe the longest. I think it is that you're talking about. I think it is, yeah. Certainly the data would suggest that. So in other words, you go back to, so a hazard ratio is a very, it's an important tool in statistics to understand the relative risk or benefit of any intervention.

1:26:41So a hazard ratio of one means that this intervention has no benefit and no harm. A hazard ratio of 1 .5 means this intervention is 50 % riskier than the baseline. A hazard ratio of .75 means this intervention is 25 % less risky. When you just go off those numbers, what's the hazard ratio of smoking? Well, it depends on the study bits about 1 .4. That means, and that's for all cosmortality. That means that if you compare a smoker to a non -smoker, all things equal, at any point in time that smoker is 40 % more likely to die in a given year than the non -smoker. Devastating, right? If you look at hypertension, it's about 1 .2, 1 .21.

1:27:35So having high blood pressure means you're about 20 to 21 % more likely to die in a given year than someone who's identical to you in every way except they don't have high blood pressure. If you look at somebody with you know, atherosclerosis, so advanced cardiovascular disease. It's about 1 .25. If you look at somebody with end -stage kidney disease, so someone who's on dialysis, it's like 2 .75. I mean, there are 175 % more likely to die in a given year than someone who's not in end -stage renal disease. So now start comparing all of these other interventions I'm talking about. Well, let's go back to the VO2 max.

1:28:14If you take somebody who's in the bottom 25 % of fitness, which by definition 25 % of the population are, and you compare them to somebody who's in the top 2 % for their age, it's a 5 % that has a ratio of 5 % so that means it's 400 % difference in mortality. If I take somebody who is in the bottom quartile of strength and compare them to the top quartile of strength, it's about three as a hazard ratio. So when you go through these metrics of exercising or muscle mass or strength or cardiovascular fitness, it just dwarfs everything else, including diabetes, including smoking. So, and again, this isn't a zero -sum game.

1:29:04Like the goal is to get as many things on your side as possible. Be of normal weight. Don't have diabetes. Be sleeping well. Don't smoke. But be strong as hell. Have a high VO2 max. I mean, you want, you want to stack the odds as much in your favor as possible. There's no guarantee in life. And this, there's still an enormous stochastic random bad luck component to life. I could walk out of here and get hit by a car. But I'd like to control what I can control. So, heart disease is the biggest killer on the planet at the moment? Barnum. Why are our hearts so fragile? I mean, actually, I would argue they're not, right?

1:29:42If you consider what your heart is doing, right? It's this amazing organ that is beating nonstop without any instruction from you consciously And has this remarkable capacity to respond to your autonomic nervous system on demand, right? Someone runs through this door and startles us. Our heart rates are going to skyrocket. Instantly, we don't even need to tell it something bad is happening, right? I, you know, you go to, you know, get stem cells at elevation. Your heart rate knows to get jacked. So, so, so, so this thing isn't a remarkable muscle. But it has a narrow blood supply. And it doesn't have a remarkable capacity to re -vascularize itself.

1:30:35That's probably its biggest drawback. Other muscles in our body haven't much easier time undergoing angiogenesis. So if you suffered an occlusion of a blood vessel, a small blood vessel in your leg, it wouldn't cause as much trouble because you'd have an easier time creating collateral flow around it. But in the heart, that's less the case. And of course, the stakes are much higher. You probably wouldn't notice it if a silver dollar -sized patch of your quad stopped working. it wouldn't wreak as much havoc as if an equal size patch of your left ventricle stopped working. So the problem is that evolution didn't really care about atherosclerosis.

1:31:29That's really the problem. Right. So atherosclerosis is driven by factors that evolution wasn't at all caring about because they didn't interfere with reproductive fitness. So smoking, high blood pressure, and high APOB are the main drivers of atherosclerosis, and none of those things were on evolution's radar. In fact, you could argue, high APOB for a period of our human history would have been beneficial. APOB being the lipoprotein that wraps around LDL and VLDL would have played an important role in a scarce nutrient environment, which we were in up until a few hundred years ago. And today, of course, it creates a problem, right?

1:32:14Today, those APOB particles, those LDL particles are carrying cholesterol into our artery walls and our immune system, which by the way is doing the best job it can, like the little train that could, is treating that as though it's a foreign invader and mounting an enormous immune response. And it's that immune response that's actually leading to the creation of plaque that ultimately results in a heart attack. So when it comes to heart disease, it seems like there's two broad elements here. One would be restricting the things which cause risk and the other would be improving yourself from baseline.

1:32:50What are the big buckets in either of those? You mentioned smoking. smoking blood pressure in APOB. So if you just took those three things off the table, it's very hard to imagine how you can get atherosclerosis. So if you don't smoke, if you maintain a blood pressure at or below 120 over 80, and if your APOB is maintained at the physiologic level that kids have, you can't get atherosclerosis. How does someone know about their APOB? Simple blood test. It costs about 12 bucks. Okay, and how often do you need to get that done? I mean, I probably check mine three or four times a year. I probably check mine three times a year.

1:33:24And if it came back and said this is high, then you would try to ask the question, why is it high? How much of this is going to be fixable by diet? How much of this is going to be fixable pharmacologically? Truthfully, to get to the levels that are necessary to eradicate atherosclerosis for most people does require pharmacologic intervention. This is probably, in my opinion, if antibiotics represent the biggest win of medicine 2 .0, antilipid therapy would be the second biggest win. Okay, that's stopping the bad, improving the good for the heart. Yeah, so again, exercise, not surprising. Probably more so the benefit on cardio here, probably you're going to see more of a...

1:34:06The data would certainly suggest that cardio is the more important exercise of the two, but again, I always caution people, you're not just feeding your heart, you got to worry about your brain, you got to worry about your body. So we're never going to get into a cardio or strength paradigm, it's end, it's always going to be end, but just to be clear, the cardio training probably has a better impact on the heart. Sleep. So, poor sleep has devastating impact on the heart, probably through sympathetic overtone, hypercordisolemia, things like that. So stress becomes another thing that really matters.

1:34:40It's kind of, it's one of these sort of fuzzy terms that kind of seems like, oh, yeah, I stress, I'm sure. But I think the data are very clear that high levels of cortisol are really damaging to coronary arteries. And then, again, nutrition kind of factors in probably to the pharmacologic strategy. So there's no question that for, you know, if you're saying, what would be the most draconian nutrition step I could take to minimize my lipids, you could take that step. but you're probably creating three other problems in its wake, right? So if you went on like a 10 % fat diet, you would probably drop your lipid levels to very healthy levels.

1:35:28The problem is what other problems would you create? How do your hormones look? Yeah, how do your hormones look? How does your muscle mass, all these other things? And so what you call, you have life like, only having time some fun and you're diet. Right, so the way I think about it is, So if I can use pharmacology to solve a problem without creating another problem, that's a far better use case than using nutrition to solve a problem that creates a whole bunch of other problems. Because you can be more targeted. Yeah, understood. That's interesting. What about motivation? Like what do you think about motivations?

1:36:05Because we're talking here about all of these things that we could do and should do, and potentially need to do. But there's other competing goals that people have got as well in here. What have you found given that overwhelming number of things that you get exposed to? Brilliant, be good if I added this into my routine. You could get to the stage where there is no life left in your life. How do you map your intervention threshold and then try to stay adhering and compliant, given all of the stuff that there is to do? Well, I mean, I think everything has a season, right? So there's been periods of my life when I've been far more disciplined and far more regimented than others.

1:36:47And, um, again, I just, I kind of always want to remind myself that I never want to be in the situation where everything is off the rails. So if I'm really feeling stretched thin, if I'm really feeling like I can't do it all, then I have to start prioritizing. thing. Then I have to start, you know, if you're on a lifeboat and you can only take so many things, this is where it really matters that you think about what you need. And so if, you know, if, if, for example, when I was, you know, finishing the book and under, you know, unusual amounts of stress based on the demands of the book, the demands of my practice, the demands of the podcast, all these other things, I just made a very clear, unilateral decision, like there are certain things I'm not going to care about.

1:37:35And one One of them is going to be eating. Like, I'm going to indulge and kind of eat whatever the hell I want to eat. But I'm not going to compromise sleep or exercise. Because I know that those two things factor far more into my productivity, my cognitive, capacity, and my mood, truthfully. And yeah, in an ideal world, I would be firing on those cylinders plus eating perfectly. But I was like, look, sometimes I will, sometimes I won't. And if my assistant manages to be able to get me a great salad for lunch today, that's But if she can't and I feel and I'm starving and I just want to go and have a bowl of cereal so be it I'm just gonna have a bowl of cereal like I'm not going to beat myself up over this or let it bleed into some other areas and of course, you know, I hope that that's not something that I endure as forever and of course, you know, it doesn't you know, you just have to remember that You gotta remember why you're doing this right?

1:38:28So I think I don't know that motivation is the right word I think it's sort of purpose that that matters I don't really know what motivation means. At least for me personally, I'm sure for some people that word has meaning. For me, kind of purpose is the thing that matters. A more accurate word for me to have used would have probably been something like consistency over a long period of time for this, because we're looking at longevity by definition up until the end of life. You ask, you began this conversation asking what do I look like when I'm sl having sex when I'm 90, which means that you're making decisions in the now, which are very different to if you only have a five year or a ten year or even a 20 year timeline to what you do.

1:39:09You know, your training protocol, which the risk to reward, it may be fun to do this particular training style. It may be, well, what's the injury risk and what would the downstream costs of that be in 30, 40, 50 years' time? So it's all... I don't have great advice for how to get somebody there. I mean, I just know that I've crossed that threshold Probably in the last five years and I'm really happy about it I really it's it's actually created a much greater sense of calm in my life It less hurried in a way, so it's less yeah, and also just Less less harsh, you know, it used to be that every day I used to say this every day you have to burn at least one match and And a match for me being burned was a physical exertion to the point of wanting to puke.

1:40:03I had to do that at least once every single day. There was no workout, seven days a week that didn't at least produce that once. So even like if I was out on a recovery ride, I would still have to close the ride. I used to live at the top of a hill and it was a one kilometer hill and it would always be a one kilometer sprint to the death where I was always trying to hit a PR or every if I went into the weight room and the goal today was to deadlift it was like always going to try to PR and I mean I am so far from that mentality today that it's it gives it sometimes you know like I'll go in and I just don't feel right during the warm -up like it just doesn't feel good and I'll say you know what I'm not I'm gonna abort the deadlift today I'm gonna go and do some safer exercises where the stakes are a lot lower.

1:40:56And if I make a mistake, I'm not going to get punished for it the way I'm going to punished if I'm doing dead lifts and I, you know, don't have my form just right. And so yeah, you've got to be able to play the long game, I think. And I don't know what to tell somebody to get them there other than anchoring them to the marginal decade. Because if you know what you're training for, then of course you wouldn't take that risk, right? And I'm gonna say, I think what we have an epidemic of is people who don't know what they're training for. Like, you know, if you really stop them and ask them, like, are you doing this because you want to look good on the beach?

1:41:35Are you doing this because you want bragging rights? Are you doing this? Are the other guys at the gym look at you? Like, it's okay to say that the answer to those questions is yes, but at least be deliberate about what you're doing and why. Because if you are doing this to look good on the beach or to have bragging rights, then you might have to compromise some of your long -term goals. But at some point, you got to decide like what matters the most. What sacrifices did you need to make whilst writing this book? It's been a very long labor as far as I'm aware. There was a draft at some point that essentially just got totally burned two, two drafts.

1:42:13And it's not a small book. I mean, it's like a, it's a, it's a, it's a big boy. What did you have to sacrifice as someone that likes to get things right, likes to optimize? What did you have to sacrifice in order to? Well, I mean, I think I had to learn to compromise a little bit truthfully. You know, I had a co -author, I have an editor and I think I had to learn that sometimes they would have a point of that was different from my point of view, and I had to make concessions. And I actually think that in the end, those concessions were valuable. So one of the biggest conflicts early in the writing process, so I wrote the first version by myself, and nobody liked it.

1:42:57Right, so everybody was like, this is way too technical, and there's no story. There's no story. It's just a technical treatise on longevity. And I was, I really rejected their suggestion that this book needed to have part of me in it. I was like, that's going to be, that is going to have no credibility. It's just going to read like, you know, pop fiction garbage, like, blah, blah, blah, blah, Well, when I look at where that book is now, I realize, no, it had to have part of me in it. This is partly my story and it's the story of my patience. And it's basically a very technical book that is weaved together between the stories of people.

1:43:45And, you know, there's a saying, right, like, never make a point without telling a story, never tell a story without making a point. You know, this is something I really, really rejected in 2016, 2017, in the first iteration of that book. There are countless other examples of things where I was adamant that it needed to be done a certain way and luckily people around me who are smarter than me said, no, I don't think that's the way to do it. I think we need to cut this down a lot. And that's a hard thing to do when you're writing. When you're writing, there's this sort of thing that's called you learn to kill your babies.

1:44:23And that's a really hard thing to do. I had there were chapters of that book that were literally twice as long. And I thought they were really good. And... They're left on the cutting room floor. They're gone. And they're better now, shorter. It's OK that I didn't say everything that needed to be said. A bunch of things that we haven't spoken about so far today are heat, cold, sunlight, grounding, meditation, reguative practices, social connection. How do you map these onto the discussion about longevity? recently read a book by Robin Dunbar, friends, sorry, the social brain, his new one. And then he says one of the biggest discoveries that we've seen over the last decade has been the unbelievable power on health and longevity outcomes to having a social group has with us.

1:45:18Where do you fit all of this stuff in the heat, the cold, the sunlight, the grounding, the friends? How does all of that work? I mean, I put them in sort of different buckets, but I would agree with that, right?

1:45:30I be social creatures. And that doesn't, like, I'm an introvert, but which means, like, I don't like really being around that many people. And I certainly don't like being around strangers. But I would die if I was alone. So, you know, people who are introverts don't necessarily aren't immune from this either. And, by the way, I love playing thought experiments, right? So, you know, one of the thought experiments I would play with myself when I was sort of wrestling with this was, if you could have everything you wanted, you could achieve everything, you could be the most physically fit, you could have the most knowledge, you could have the most cars, race cars, and race tracks, and blah, blah, blah, blah, blah, but you live alone in this planet.

1:46:16All of your needs are met by robots that do everything else, right? So the robots are pulling the oil out of the ground to make the gasoline for your race cars and they're building it and they're farming your food or whatever it is. But you're alone. Think about that existence. You can't fathom an existence alone regardless of how good everything else is in your life. In fact, that would be the closest thing to hell that I think I could ever imagine. We certainly know at the extreme end of the spectrum that loneliness is an enormous predisposing factor for suicide. So suicide is just the most extreme form of emotional death.

1:46:59But I think there are a lot of people who never get close to suicide, but who then enter kind of the second orbit around suicide, which we would call parasyuicide. So engaging in behaviors that are ultimately reckless enough that they cost you their life. I mean, you would argue that smoking is parasyuicide. Excessive drinking is parasyuicide using dangerous illicit drugs that unfortunately nowadays are so often and laced with fentanyl is parasyuicide. Is driving a strip back three series with a V6 engine and roll cage parasyuicide? I don't think so. I think driving to the race track to do those things is basically parasyuicide.

1:47:34No, it's so funny. I actually brought my daughter to the race track for the first time two weeks ago. Cota? No, I went to Harris Hill. So I would love to bring her to Cota. I wanted to start her at Harris Hill. It's a smaller track. You don't get nearly as fast. and she was so reluctant for like a year to come. How old is she? She's 14. And I was like, she's like, well, what happens if we hit something? And I was like, well, I'll give you the way they design racetracks. It's like, it's anticipated that you're gonna lose control of the car sometimes. So everything is designed to minimize that. Plus the cars are in company safe.

1:48:10So then she finally came. I have a GoPro on the dash filming us driving. It is hilarious to watch her head like moving around and stuff because the, you know what a Hans is? Yeah. Yeah, so the belts came off her Hans. I don't think my coach strapped her in tight enough. And so pretty soon she's like, you know, she's still strapped in there, but she's not like I am. Like when I'm in there, like my Hans is like, and I showed the video to one of my buddies. He goes, she looks like one of those monkeys they used to put on rocket ships. Like, just like you just see a big helmet head like bobbling around.

1:48:42It's hilarious. But anyway, no, I would not describe that as peri -suicide. I would describe that as, no, no, when I describe skiing or other sort of risky sports, I just think you have to decide where they are within your risk behavior. But then you go even beyond that and I think there's, you know, behaviors that aren't going to kill you, but they're just going to make your life so miserable, right? Like having horrible relationships with people, that degrades the quality of your life. And while I do think that that does shorten your life ultimately, right, I do think that there are biochemical ways that that impact probably through stress hormones, probably through greater activation of sympathetic, an imbalance between sympathetic and peri -sympathetic flow.

1:49:27I think those things absolutely do impact our immune function, our cardiovascular function, all these things, even if they didn't. What's the point? I'm going to think about the enjoyment of life. We can break things down into an objective list of metrics and how does it impact the things that we can measure that are going up. But what's your felt sense of life like? Yeah, so go back to what you said in your marginal decade. And I think most people, when you ask them about their marginal decade, none of it's in isolation. It's, you said picking up grandkids, being able to walk your dog, which is a companion, being able to have conversations with other people.

1:50:04That's the cognitive piece. So I think when most people really think about this, they can't escape the fact that their quality of life is inextricably linked to interaction with other people. We haven't spoken about emotional health as an individual at the moment. It might surprise people to think about when you have the discussion about longevity, you're talking time on the planet, bone density, muscle mass, cardiovascular risk, etc., etc. What about emotional health? How should people even frame that in the discussion that we're having? I think it has to be top. I think it's right there with those other things.

1:50:47I don't think it's something that should be thought of as an afterthought. It matters just as much. Again, long life with poor emotional health is probably a curse.

1:51:02What's rejuvenative practices do you find best? You know, we 10, 12, 14 hours a week of sometimes punishing, sometimes sub punishing workouts and... Yeah, usually sub punishing, right? So call it 12 to 14 hours a week of exercise is very important for me. I do sauna four days a week. I tried to do four days a week. Session length. Minimum 30, so 30 to 60. At. 1 .96 to 200. You're taking a break? Who does? You must be. You'll stray through on that. I can. I usually will go 30 and then a quick break though. 60 at 200 would be. I've never done 60 at 200. I've done 60 at like 194. It's hard. Okay.

1:51:48Right. So full times a week. Yeah, four to five times a week. And by the way, that's doubly regenerative for me or rejuvenative depending on you. because like I'm again, I never do that alone, right? So I'm gonna do that with a friend, I'm gonna do that with my wife, and it's always just an awesome time to be, like last night talking about, my wife and I spent the whole time talking about a session she had with her therapist and how much she learned. And it was just so wonderful to have. Kind of backing multiple things on top. It's just being able to do multiple things at once that are both really beneficial.

1:52:22I like rucking, that's something we didn't really talk about. I don't really lump that into my exercise bucket of time, though it is obviously a great type of exercise, but because of the way that I'm doing it, which is I'm not taking any electronics with me and I'm not multitasking when I do it, it really is just as much about my brain as it is my body. So rucking, of course, just for folks who don't know, it's basically walking around with a very heavy backpack. So sweet spot is about a third of your body weight.

1:52:52And, you know, so I'll go and do about three, three, three and a half miles with as many hills as I can find. And I'm not taking anything. I'm not listening to podcasts or books or anything. I don't have my phone with me. So it's really just something that's unusual for me because usually I'm either working or if I'm exercising in the gym, I'm listening to music, if I'm on my bike. There's always multiple stimulus going on. Yeah, I'm listening to a podcast or something like that. But here it's truly just observing thoughts. What's your divisive choice for Ruk and GoRuk? Yes, absolutely. What is this guys?

1:53:27Is that... Do they do anything that isn't... Because they do the thing that's like a big penis coming out of your back where you can literally plate load it, right? I'm gonna guess you use a more... I have a pack. So there's an actual pack that has pockets in it to you drop the plates in it. Cool. And you've got what's like 60 pounds? Yeah, pounds in there. 60 and I have several packs. So I have one my wife has one we have one for anytime friends come over and I've just got like we've got tons of weight So away we go. Yeah, so it's like I like to do rucking what rucking meetings with friends. Okay.

1:53:59Yeah cool. So Solna rucking sauna cold. Yeah, we have a cold plunge love that as well. What are you aiming to hit per week that? Again, it depends is probably also about four times a week. And again, that's something I like doing with my wife, even though she's tiny, she can actually take the cold almost as much as I can. I have a lot more insulation than she does. Was for conversation than a sauna, perhaps. Yeah, not as much. The usually the conversation there is how much longer. Yeah, yeah, yeah, yeah, yeah. Okay. And then truthfully, I think the most sort of rejuvenating practice is playing.

1:54:36like I I'm really lucky because I have my daughter doesn't like to play as much but we still play like we you know we play volleyball she loves volleyball so anytime I can be out on the court with her playing volleyball I'm teaching her how to drive stick so that's something that she loves doing she'll be like that can we go and drive and it's like yep getting the pickup truck go to the parking lot and you know making her start on steep hills and stuff like that is awesome and my boys are eight and five and so all they do is play and so I get to play every single day. You're down on the ground.

1:55:06You're probably on the ground. You're playing Lego, jumping on a trampoline, goofing off. I like doing Lego myself. That's another super, that's a super enjoyable thing for me to do. What is your, I saw, did you post something saying that shares of Lego had increased by 25 % at some point and your wife had accused you of being single -handedly responding? Controvering to it. You moved the Lego market. Yeah, yeah, yeah. Wow. I got sent by a very good friend, Tim Bishop, from Australia, a Colosseum Lego set. This one of the three biggest Lego sets. So he sent me this. What's the one of the four?

1:55:41So the, yeah. Look, tell me what's the first biggest? The first biggest, I think, sucks. It's the world map. Lane. It's so lame. Right, second, third. Second is the Eiffel Tower. The new Eiffel Tower. There was an old one. The new one is really cool. Have you done that one? We have not. My boys wanted. My boys are just finishing the Titanic, which is the third largest and the Coliseum is the fourth. Right. And it's funny. My boys, I was putting them to bed last night and we were playing the rank order game, which one would you want. And I said that I think that I think the coolest is the Titanic followed by the Coliseum.

1:56:16Okay. Well, I've got that. Have you done it yet? No, I haven't even opened it up. Tim sent it to me with a letter about the man on the stadium floor. Yeah. Yeah. The Teddy Roosevelt. Yeah, which was very meaningful. And he shipped a thing from Australia. Oh, maybe he hasn't. Yeah, he must have done because it had the note in it. God, yeah, so he shipped it across the planet. You can do it. I mean, I find that I love doing Lego. I do that my favorite of the Technic cars. So I have all of them. OK. Do you do this? I'm going to get, because one of the other things that I had Kelly stare on the show yesterday, no, Monday this week.

1:56:50And there's this big movement at the moment for being on the ground. Yeah. Spending as much time hips below knees as possible. Do you consider that as well? Are you legoing? No, I do Lego on a table. It's like it's so complicated like I have I have multiple plates laid out with all the different pieces and stuff. Your workstation needs to be optimized. I can tell you are surgical with your Lego creation. But my I play on a floor with kids because kids play on the floor understood. Yeah, and that's also something that factors into how you think about this last decade of your life Which is if you want to play with grandkids like you're able to get down the ground and you have to get to their level.

1:57:25And that's why by the way, I think the step up is an amazing exercise. The step up is the movement that tells you you can get up off the floor. Mmm. So you won't think I haven't brought it up yet today. I've been playing around with a Vitruvian at home, which is kind of like a tonal, like magnetic drive training thing. They sent me one, two or three months ago. Did these things so much fucking fun? It's so cool. So you can imagine a like a stepper like one of those Reebok things that ladies in aerobic class would use a little bit bigger than that flat on the ground magnetic drive two cables that come out of it two nylon cables tons of attachments that go in can belt squat by slotting something between the two they can be a long while it goes between the two and use all these different bits as a bench as well and the bench has got one leg is shorter than the other so you can go flat or you can flip it and then it's an incline.

1:58:16It's so much. But is it working? Is it magnetic? Yeah. Okay. So you can have time and attention. If you start to fail on a rep, it'll, it'll dial the weight back and then as you get to the top, it'll turn it back on. So it can do eccentric only training and it goes up to 440 pounds of weight and doing step ups with that or doing my favorite movement with that is a front foot elevated split squat. So putting up onto that handles in either hand. It's so much fucking fun and it feels so how much room does it take? I'm not just literally just this the size of a Like the Reebok step. Yeah, that's it.

1:58:55And there's no more room to eat. How much are they? three grand and three three and a half and if you get like the Looks sweet of additional things the nicer handles the belt squad, etc You're probably looking at all in including shipping probably like on that three and a half something like that They're not a sponsor on the show, but they sent me this thing and if you had a Thousand square foot 500 square foot apartment in New York, you could slide it But it's got little wheels on it put it up against a wall We'd take up no room and do this thing Fucking crushes you it absolutely destroys you And there's the app as well that they've done something else.

1:59:32I thought was really cool. You can do not only individual workouts where there's a video and the person does it and it tells the machine what you're doing It gives you time in between for rest or to change the things over and you change it over with the guy or the girl But it can do in type programs where it it Pings you and says you need to do Lower body today and then you press it and then away you go I trained in the gym for nearly 20 years now and this thing's really fun. I really really enjoyed the Variation that it's added into my training. So you know thinking about Lego thinking about getting down on the ground thinking about stuff Ten years ago if you'd said oh you're gonna love box step -ups.

2:00:09It's a fuck off I'm not going to enjoy box step -ups. All of these different training modalities are great. Pickle balls great. I'm really enjoying it and I think that you mentioned it as well. Transitioning the goals that you've got. What are my aims? What are my priorities here? The first time I spoke to David Sinclair, I guess I four years ago, just after a first time he did Rogan and I thought, wow, this is really interesting. He learned about NMN and all this shit. I went to go and see him and it still sounded to me a lot. the longevity movement generally halfway between like something for other people because I was made of rubber and magic and 30 years old and just it was something over there.

2:00:50Whereas now it very much feels like I need to I really need to take heed of this. It's not just about learning it and teaching it to other people. It's like, okay, fuck like how do I start to integrate this into my life? And I think that a lot of more people are feeling that as Well now. Yeah. Well, I mean, the interesting thing is the relationship between the age of an individual and when they start to pay attention to these things and the younger you are, the greater your advantage in terms of the compounding benefit of the changes. So this is all about, you know, daily practice, right? This is all about day in and day out adhering to these things.

2:01:28But the drawback of being young is that marginal decade is a very abstract concept. Less motivating. Yeah, so it's harder for you to stay focused on a goal that's so far away. Conversely, when you look at people in their 60s, they're already on the downside. They've watched their parents go through this. They've watched people live and die through horrible marginal decades. They have all the motivation in the world if we want to use that word. They just have less room to alter the course if they're really far off. So I'll never know what the perfect time is to begin other than right now. The perfect time was yesterday.

2:02:14The next best time is today. But it's always interesting to observe that difference between the extremes of age. Dude, you become chronically aware of your own mortality as you went to the beginning of your 30s, I think. It's just, it's the first time where warmups take a little bit longer, where hangovers feel, they never felt that good, but they feel, they start to feel really, really rough. And it does, it's a very strange situation, especially as a guy, especially as a guy who's taken a lot of pride in the way he moves or looks or is fizzy and stuff, to start to kind of at the top of a rollercoaster, you go, oh, this isn't going up anymore.

2:02:51I'm kind of waitless at the top. And maybe this is the biggest or the fittest or the strongest that I'm ever going to be. And realizing that is like, oh, fuck, I need to, I need to think more carefully about this. But another side, you know, when we're talking about motivating young people to consider in your 20s or whatever to think about longevity, one of the prescriptions that you've got is, you know, have like a 15 to 30 minute window for sleep and for wake and like try and lock that in. If you do that throughout your 20s, you're not going to have a massive, number of life experiences. Now that being said, it's not a prescription you're still fine for you to go and travel and change time zones and all the rest of it.

2:03:26But there is a degree of like, just go and live life. And perhaps part of the reason that you're able to deal with that when you're younger is that it is more indicative of the kind of lifestyle that you're going to live. And then as you do get a little bit older, things are going to be routineised, kids will be need to be taken to school, work will require you to be at a place at a particular time. You can't just piss off and do a season in a beathor or like move to Hawaii for a couple of months and so whatever, right? And I think, I like the journey. I really enjoy the arc that I can feel happening with my training, with my fitness, with the way that I look at stuff.

2:03:57And thankfully, your friends grow with you and you tend to be friends with people that are your age. So you're all thinking about the same things. You're all thinking about like, dude, if you drink the wrong amount of water on a nighttime, do you have to get up and go out of the bathroom in the middle of the night? Like, fuck yeah, right. I feel like we need to do a bit of research on this. You know what I mean? Peter, I really appreciate you. I really appreciate your work. I think the book's fantastic. It's a labor of over half a decade for you. If people want to check out all of the stuff that you do, where should they go?

2:04:25I think everything is under my Peter Tia MD. So the website, we have a newsletter that comes out every Sunday that's, I think, pretty good. And then the podcast, the drive. Thanks, Peter. Thanks for us.