Why You Need To Protect Your Joints If You Want to Live to Be 100 | Peter Attia on Health Theory

out. All right, in this episode with my boy Peter Attia, we discuss everything you're doing right now to shorten your life, why your insecurities are definitely holding you back, how to live a life worth living, and why nutrition isn't everything. Everybody, welcome to Health Theory. Today's guest is Dr. Peter Attia, MD. He's a former cancer surgeon and researcher who got his MD from Stanford, was the resident of the year at Johns Hopkins Hospital where he trained for 5 years and authored a comprehensive review of general surgery. He also spent 2 years at the NIH as a surgical oncology fellow, and just because he can, he also has a bachelor's of science degree in mechanical engineering and applied mathematics. And to round it all out, he's also an ultra-long distance swimmer who has completed such ridiculously arduous journeys as swimming from LA to Catalina Island in shark-infested waters. But what I want to know is, as somebody whose practice now focuses on longevity, is living forever possible? As you know, that is a a goal of mine. And uh why don't you want to live forever? Well, I to your first question, I don't think it is possible. I don't And I don't see anything on the horizon that makes it possible, at least not within the way that we think of what it means to be alive, meaning to be respiring cellularly. It's very difficult to imagine immortality when you untether and uncouple the uh not dying part with the preservation of health span, so specifically cognitive performance and physical performance. And I think more about those things now than I probably ever have before. I think a lot about sort of the physical stuff, so what does it really mean to be a hundred but function like a well-to-do 50 to 60-year-old. And and even if you're alive, how happy would you be? I mean, it would be I think for many people it would be quite frustrating. Or, you know, if you had grandkids or great-grandkids and you couldn't play with them. Or you couldn't tie your shoe. I mean, we actually use tying a shoe as one of the metrics to evaluate sort of flexibility and and certain physical performance. So, most people our age don't think of tying their shoe as a physical performance. And yet, when you would start to lose those things, I think you'd have a a radically different view of you know, what am I doing? But, how do you get there and and look, perform, and feel like the way we imagine a 60-year-old today? A fit 60-year-old. Cuz I know some 60-year-olds that are just amazing, right? So, how do you how do you take that to 100? And what would have to happen for us? Like, what do we really need to figure out? Is this a um flexibility problem, joints burning out problem, ATP problem? Like, what what's the big Um so so far, my my exploration to this topic has has suggested a couple of things. So, one is we do tend to disproportionately load joints over muscles. So, in an ideal world, you would want to figure out a way to exercise where you can maximally load the muscle while minimally loading the joint. So, there is a lot of joint failure that becomes problematic. I mean, and I'm separating the obvious, which is there's just too many people who aren't exercising enough or correctly at all. And so, they're just sort of withering away. But, if you come at this through the lens of okay, well, what if we're dealing with a subset of people who are committed to figuring out how can they exercise best? In many ways, it's just a lack of specificity, right? So, most people who exercise can't actually tell you why they're doing what they're doing. The 99.9% of us who don't get paid to play a sport and who aren't even really competing at a serious level outside the professional ranks, I don't think we know what our sport is. And I think the sport should be being the most kickass 100-year-old that ever lived. So, what would that look like? Like, what does it mean to be the most kick-ass 100-year-old? And I think you have to then reverse engineer all of the things one should be able to do. So, a kick-ass 100-year-old should be able to I I don't know. I'm making this up because I haven't fully codified this yet, but they should certainly be able to carry two 25-lb bags from a grocery store. They should be able to lift a 30-lb bag over their head to put it in a, you know, compartment of an airport uh of an airplane. They should be able to have a, you know, 25-lb little terror run at them, you know, I either great-grandchild or dip down into a squat and grab them and pick them up. They should be able to jump down on the floor and play with cars or dolls and stand up without assistance. And if you start to map out the 25 or 35 things, that becomes a new decathlon. So, instead of saying the decathlon is running this distance, jumping this far, swimming this far, it's like, great. Those are kind of arbitrary. Now, we're going to come up with like real-world things that you have to be able to do when you're 100 if you want to live what I would describe as potentially uh a more fulfilling physical life to enjoy the fruits of having not died by that point in your life. All right. So, how do we build towards that? I love this, by the way. Like, I always tell people, I want to live forever. I'm well aware that as of right now, I'm going to die. Um so, my thing is, how do we stay alive long enough to give time for these step function breakthroughs to happen? So, what do I do? Like, what are the things that I train or the hormone replacement therapies that I need to go What do I need to watch? What are those things that I should be doing? Taking a step back, I would say 3 years ago, 80 to 90% of my energy went into how to not die. Which basically Yeah, which is tantamount to how do you delay the onset of chronic disease. So, the mathematical equivalent of longevity from a lifespan perspective is creating a phase shift in disease onset. If you want to live to 100, it basically means you have to delay the onset by about two decades of every major chronic disease. So, it doesn't mean you can't get cancer or heart disease or any of these other things, but you better figure out a way to get them 20 years after the average person gets them. I would say now that occupies 50% of my brainwave energy, whatever, and much more time goes into two other things, which is how to minimize suffering, which is kind of an emotional problem, and then how to be this kickass 100-year-old. So, to the latter, um the model I have in my mind is that of sort of Bruce Lee. Bruce Lee sort of looked at each and every discipline of martial arts, including boxing and wrestling and things like that, and said, "Let me extract from each of these disciplines that which I believe is useful, discard those that I think are useless, and create a perfect fighting form that is truly geared toward self-defense. So, it is not a sport, there is no tournament, there is no rank, there is no belt, there is no sensei. It is, can you handle yourself in a life-or-death situation?" If I go to a yoga class, or if I do a Pilates class, invariably there's something in there that I think is really valuable. And truthfully, there's a bunch of stuff that I'm like, I don't need this. This is just If I had infinite time, this would be fine to do, but I don't have infinite time. So, now you apply a constraint to the problem, which is not only do you want to be sort of the best 100-year-old imaginable, what if you're only willing to spend 10 to 12 hours a week preparing for that? And so, you say, "Okay, well, so there's a new sport, which we define some of the parameters of. That's your new Olympics, and that Olympics is 50 years from now. How will you train for it if you're only willing to spend 10 to 12 hours a week training for it?" Well, my guess is you will take a lot of things from various disciplines, discard a lot of things, and sort of have to build a very bespoke routine around it that will involve the maintenance of muscle mass, joint integrity, flexibility, uh functional movement, balance, things that we don't even really think about anymore. How many times does someone who's 90 fall because they've lost their balance? And it's that fall that ultimately leads to their demise. How much of that the balancing do you think is neurological and how much is physical? They're just not doing enough physical [ __ ] to figure out to maintain that. My guess is it's probably both. There's a stability issue that starts to go away as you age. Also, the consequences of a fall become much more apparent. So, um it's probably not just the case that someone who's older falls that much more. It might be that the the severity of the injury becomes so much more severe. So, right now, if I were walking here and I tripped on that stair and fell, you know, maybe on a really, really bad day I break my wrist. But, most likely nothing happens. Uh In 50 years, if I do that same thing, the probability that something bad happens is going to be much greater. Yeah. Um but that said, I already can tell my balance is not what it was when I was 20. Mhm. When I was 15. I mean, I used to do I used to be able to do this exercise when I was 15 where I would do a with blindfolded I could do a single leg squat with the with the non-squatting leg straight out in front of me. So, I could go all the way to the floor and all the way up, arms crossed, blindfolded I could do 20 each leg. I can't do that once today with my eyes open. Mhm. So, admittedly, I'm nowhere near as strong as I used to be, so there's a strength component, but I also just clearly lack the balance. And so, so the question is now maybe that activity is a bit over, you know, it's that's just unnecessary. Um and again, I don't know what the answer is. I don't know if this means I need to get out there and practice on a tightrope or something like, but there's there's something that needs to be done. So, every time I do some sort of really well-thought-out workout, I find myself thinking, "God, like some percentage of this is so essential." All of those things need to be put into this new discipline, this new sport which is called, for lack of a better word, being a kick-ass 100-year-old. I definitely like the sport. Now, one thing that I found really interesting is so people complain a lot about lower back pain, talking about unnecessarily loading the lumbar. Um I found that if I don't deadlift, my lower back hurts, not if I do deadlift. Now, some of that is probably that I have decent form, it's certainly not exceptional, but I have decent form, I know how to avoid injury. Um but it is so weird to me that doing nothing will end up causing me pain in my lower back, but if I'm religious and I'm doing it, you know, once or twice a week every week, I feel bulletproof. The advantage of deadlifting and squatting to me is uh they reveal all of your errors in movement, right? Like they are I don't know how to describe it, but you can't hide from those movements. Like you can't take bad form into those things and not get revealed. Right. So, I like that. The question is, is it an unnecessary risk? Right? Am I one bad deadlift away from doing something stupid where And And again, I you know, I'm as empathetic and in love with those movements as anybody, but I also don't know if I need to do that to be the best version of myself as a 100-year-old. So, the stuff I've been doing for the last 4 to 6 weeks, um I basically haven't had more than 155 lb on my back in 6 weeks. And but by changing the form of what I'm doing and making everything a single leg movement, uh so a lot of courtesy squats, lateral lunges, incredibly strict lunges where you are so specifically loading the the front leg glute, I got to tell you like I'm not And then doing a lot of single leg body weight squats, but with meticulous form so that I'm fully loading the glute, not overloading the quad, which is my absolute common mistake. By doing these things, I don't feel like I've lost a step, but I absolutely know I'm loading myself less. Now, the question is, does that matter? And I don't think I know the answer yet. So, unfortunately, I feel like I'm still too early in this process to know what the finish line looks like. And there's other problems that we haven't even touched on, right? Like, what VO2 max and what aerobic base are necessary as a minimum threshold. Yeah, talk to me about that, cuz I hate cardio. But, it's one of those if I have to to have the kind of longevity, then so be it. and and the term cardio is itself so confusing, right? Because even if you think of what is VO2 max, I mean, most people think, well, that's really a a heart lung issue. It's actually not. It's more of a muscle issue. Interesting. Because that's where the the bottleneck is not in how much oxygen can you get in your lungs. The bottleneck is how much can your muscles utilize. So, when you look at, you know, the winner of the Tour de France or, you know, the gold medalist in, you know, cross-country skiing or the person who wins the Boston Marathon, like when you when you look at the most extreme endurance athletes who have these very high VO2 maxes, what's unique about these people is their muscles, which is counterintuitive cuz they're usually very slender individuals, but their muscles are so efficient at aerobic metabolism that they are able to extract so much oxygen out of blood. When you and I, you know, are at our maximum capacity, we're still breathing out, you know, 80% of the oxygen we breathed in. So, it's really not a gas exchange problem. It's a muscle problem. That said, VO2 max is a very specific energy system that probably gets a little more credit than it deserves. So, what are the alternatives? Well, um so so VO2 max is really, as its name suggests, it is So, the definition is what is your maximal extraction or utilization of oxygen? The way to experience what that is is go out and run for 4 minutes as hard as you possibly can. Yeah. That is that energy system. But, there are other energy systems, right? There are In cycling, we talk about seven different energy systems, but again, you can really simplify this and say there's sort of the energy system we're in right now, which is the smoking and joking energy system. At the far under end of the spectrum is this neuromuscular area where you're basically doing the most explosive movement imaginable for, you know, 10 to 15 seconds. And I suspect that for each of those energy systems, there's an there's a minimum threshold that you'd want to be above as you age. So, ways that you could test that would be I mean, any even someone our age probably knows if you carry two bags of groceries up four flights of stairs, most people are feeling that. Very few people get to the top of that fourth I I know that cuz that's my apartment's on the fourth floor. So, like [laughter] in New York, I'm always that, you know, I'm always paying attention to like what will happen when the when the day comes that this is not pleasant. Like when I'm deciding I have to take the elevator up these four flights of stairs. Um and so if that becomes the minimum threshold, then you and and then that you want to be there at 100, then you need to be there at 60, and you need to be there at 50, and you need to be there at 40. And so, I think part of it is just defining those things, and that determines then what's the level of training you need to do. But, I do think in this current environment of everybody loving high-intensity interval training, which I love just as much as the next person, that's really only training one energy system. And I think you if you ignore these other energy systems, you're you're sort of not fully optimizing around your performance. Translating that to this new sport, this 100-year-old kick-ass sport, I think it's just going to require a little more thought. I'm talking to orthopedic surgeons and saying, "Okay, talk to me about the injuries that are killing people." Cuz there's two types of orthopedic injuries that kill people. There's fast death and slow death. So, fast death is patient falls and, you know, within a day or so is dead from whatever the injury was. So, they, you know, break their femur, they have a fat embolism, they're dead. Or they fall and they hit their head and they, you know, have a cerebrovascular accident, they're dead. Um but then there's also the slow deaths, right? And these ones are, to me, far less talked about, but in many ways more tragic. Um so, so one of my closest friends, his father died recently. Um 89 years old, complications of Alzheimer's disease. He'd been diagnosed mm 8 months before he died. So, in some senses, you could say, "Well, the good news is he was spared he and his family were spared a lot of suffering because, you know, he's diagnosed in January, he died in August." But, when I went home for the funeral, I was sort of struck by how difficult it had been for him since he was 81. The two things he loved most in life, which were golf and tending to his yard, he couldn't do because of more chronic orthopedic injuries. So, he spent the last decade of his life kind of watching TV. And to me, that's the thing we have to be able to avoid. And uh you know, for me, I don't know what it's going to be when I'm 100, but I know that today, if I had to start say, you know, if someone said, "Well, you can't drive a race car and you can't shoot a bow and arrow and you can't lift weights." It doesn't doesn't matter how heavy it is, right? But you can't do these movements. Or you can't lay on the floor to play. Uh if I start if I had to give those things up, I'm not sure how much I'd want to kick around. And so, talking to these orthopedic surgeons is giving me a real insight into where those failures are coming from. And the single most important insight I've gained from them is something you alluded to at the outset, which is just joint overload. You know, so much of what we do is even while trying to be good, meaning trying to exercise and do these things is just disproportionately taking on risk. So, for I'll give you one silly example, right? A military press. Is there a time and a place for a military press? Absolutely. Does it have any role in my life? Absolutely not. Right? Why not? First of all, I don't need to load my spine in that way. And if I could get 80% of the benefit that I get out of a military press by doing loaded activities below my shoulder line, below my neck, and using more static loaded mo- movements above, and that gives me 80% of the benefit at 20% of the risk, that's exactly the kind of compromise I'm willing to make. And yet, I don't think we're applying that level of risk reward to how we exercise. That's really interesting, and I Do you have a fundamental insight into the way that humans are that you think leads us to do that? Because it You You once said, and I forget what you were talking about, but you said people just don't run the math. And this is a very good example of people just don't run the math. Well, we are um innately really, really bad at estimating risk. And, oddly enough, makes me wonder about you and race cars. So, what is it that draws you to race cars? Do you think you're accurately assessing the risk on that? I I I will say, you know, that's not an unusual question I get asked a lot. I I think that I feel safer in a race car than I do in my street car. Really? Absolutely. I feel far, far more frightened in the drive I have to take tonight from here to San Diego. Because I'm going to be on the 405 and the 5, and I know that 80% of people at some point on that drive are going to be checking their phone, or losing focus, or not paying attention. I don't know what percentage of them, maybe 10% of them are also going to be under the influence of alcohol, and uh they pose a infinitely greater threat to me than I I feel like I could ever face in a race car. So, other than driving, what are some just grotesque misjudgments of the risk in terms of behaviors that people do just on a daily basis? I think I think automotive is is a very big one. So, yeah, good that we got that one first. I think another one that people sort of misunderstand is alcohol. You know, I mean I I enjoy alcohol as much as anybody, but I don't think people understand how once you get beyond one to two drinks, like how harmful it is on your liver. And it's sort of like Tylenol, right? Like at any dose, Tylenol is really hard on your liver. But for most of us, because Tylenol has no good feeling associated with it, we don't really tend to use it more than we should. We, you know, if we have a headache, we take it and it makes the headache go away, and but but we don't find ourselves like taking four Tylenol every day just because of whatever reason. And yet, I'm I'm constantly amazed at how much people drink even when there's no apparent reason for it, right? So, so there's always a reason to have a drink, right? There's there you can always come up with a great reason to have a drink, but there's too many sort of blah reasons that people are drinking. So, I think that that that to me is an asymmetric and unnecessary risk. Meaning the pleasure that they're giving from that, you know, those four shitty Budweisers that they have isn't anything worth that potential downside it's causing in the long run. Which says nothing, by the way, of how often I think people do get behind the wheel of their car when they've had a drink in them. And if there's one thing I've learned in the simulator, it's how even one drink compromises your ability when it matters. So, I remember Simulator or driving simulator? Yeah, so I have a driving simulator at home, which is where I do much of my learning. Um but I remember one day I was like, yeah, I was going to go drive the sim after dinner and I had a glass of wine with dinner. I remember getting in the simulator and I was like, what in the hell is wrong with me here? Like I am missing every apex, my I'm just a little bit off, I'm a little bit off and I realized, oh, I had a glass of wine. Even one glass of wine is compromising me. Um so how many times have I gotten a car having two glasses of wine at a restaurant? The answer is tons. Was I legally drunk? No, I was well below 0.08. But if even if I'm 0.06, I'm legally fine, is that still a reasonable strategy? Right. And you know, I think the answer is it's probably not. You think there are dietary things that people are doing that have just an asymmetric risk reward? Yeah. You know, I'm probably kind of a a huge advocate for caloric restriction. Um at least intermittent bouts of caloric restriction. So I believe that the short-term discomfort of not eating for 5 days, once, twice, four, five times a year, going through a cycle like that, I think that the short-term inconvenience of that is trivial compared to the potential benefit of of a true fast, you know, water only fast for some period of time. And I still don't know what that minimum is. I think it's probably a minimum of 3 days are necessary to start to get some of the real benefits of autophagy, mitophagy, and things like that, but What's the difference between autophagy and mitophagy? Um autophagy is the cell eating itself and mitophagy specifically is the recycling of the mitochondria. Okay. Um So I think when someone says, and I have many patients or friends or family members who have said like, yeah, that's just there's no way I'm ever going to I could never give up food. Even transiently, I think. That's that's an asymmetric from? Like not not even being willing to give it a shot. Like what's the emotional hang-up? Cuz you were you used to be literally the epitome of the robotic eater just insanely strict. You said about 3 years ago you were like, "Nope, not doing that anymore." And I think to quote you exactly, "I no longer have the intestinal fortitude to eat like a robot." So there was something in you that it no longer was worth it. Yeah, that became much harder than what I do today, which is So so back then I wasn't doing any time restricted feeding. I wasn't doing any fasting. It was a pure form of dietary restriction. So my my sort of mental model for nutrition is everybody is starting out on one side eating the standard American diet. Abbreviated as SAD, which is an appropriate abbreviation. [laughter] And the the thing I always tell patients on day one is like, "Look, the good news is you can't get any worse than this. The only thing if you're starting at the SAD, the only thing you can do to make it worse is eat more of the SAD." Right. But it's like the standard American diet, and I don't believe this was deliberate, right? I don't think there's a conspiracy theory here. But just through a lot of bad luck uh has arrived at the absolute worst combination of macronutrients you could possibly imagine. Like you couldn't come up with a way to confuse someone's metabolism than to combine fats and carbohydrates in the ratios that they are combined in most of the foods that we would eat by default if we were left to our druthers. So from there I say, "Look, there's kind of two introductory moves, which are not mutually exclusive, but you can pick one or the other." The first is time restricted feeding. Where now you don't limit what you eat, you you limit when you eat it. And then the second is dietary restriction. You don't restrict when you eat, you don't restrict how much you eat, which you also don't restrict in time restricted feeding, but you restrict certain elements of what you eat. So, for those 3 years that I was on a ketogenic diet, which is I mean, probably one of the most demanding subsets of dietary restriction, um you know, I pulled that lever as hard as it could be pulled. Then you move into diets that sort of mimic fasting, um which is basically just another way of saying hypocaloric diets for transient uh periods of time. And then ultimately, even beyond that is fasting. Just you know, water only also for limited periods of time. Nowhere in there do I include constant caloric restriction. So, you know, reducing by 20 30% your energy intake indefinitely. I I think the data are pretty clear that that is not a winning strategy. There's something about the cycling into and out of catabolic versus anabolic state. You're basically clearing house, right? You're sort of getting the cells that are themselves defective, and hopefully the ones with the most effective mitochondria, we'd love to target those the most for other reasons. Um what you want to see is the regrowth. You want to when you refeed, you want to see the selective repopulation of the better cells. The most robust experiments done on this in primates did not really suggest that as the diet got better, the benefits of caloric restriction got better. In other words, the worse the diet, the better the benefit of caloric restriction, which points us to this idea that dietary restriction should still always be some component of a healthy nutrition strategy. Meaning like if you're eating like [ __ ] stop eating like [ __ ] stop eating. Because then you're eating like [ __ ] if you're if you're committed to never eating anywhere but McDonald's, caloric restriction will have a much bigger effect on you positively Right. than, you know, if your baseline intake is, you know, the way you would eat, for example. That kind of stuff at like the deep cellular level about where we're going and what this is going to look like is is really fascinating to me. Definitely not something that I have the kind of grip on even remotely close to what you do, but nonetheless seems like if you're really going to get to 100 at a high level, it seems like you're going to have to take that pretty seriously. Now, you've talked a lot about one of the tests that you want to make real is the ability to check for autophagy and to see in the blood. Um you've thrown out a couple times that this is like A, you probably know the people that would be creating this test, um and B, that it wouldn't be, you know, it's not measured in the billions. So, what what would that really take? Um is it something that could be commercialized and would give people the impetus to put the capital up for it or what does that future look like? From a funding perspective, again, this is not like the world's hardest problem to crack. Um but I if I'm going to be completely truthful, I don't know how commercially interesting it is. As a general rule, diagnostic tests are not very commercially interesting. Um my interests are not remotely commercial. My interest is in just knowing what to do. Mhm. It's like I want this test to tell me exactly what the right fasting protocol needs to be. Right. fasting 3 [clears throat] days a month, 7 days every 3 months, 14 days once a year? Like I want to know that. And there's no amount of money that would make it worth, you know, not knowing the answer to that question. Um Wow, that's a bold statement. Well, think about it. I'm not to suggest that like money doesn't matter and money you can't do great things with money. Like I want money just as much as the next person, but never at the expense. Like I don't want anything to get in the way of the knowledge that can drive living longer. That to me is such a priority that I I rather be poor, but know how to you know, live longer than have all the money in the world and lose my health. I totally get that. But, I will say one thing I want to talk about is you said that um one, you've said that you think that you eat dysfunctionally even if you don't have an eating disorder, which I actually thought was really interesting. And then you said that part of why you gave up the robotic eating was you were worried about how it's affecting your daughter's view of food. [snorts] Talk about that cuz I think certainly in this the movement that we're all going through right now, there's a real risk of that. That if I had had kids 5 years ago when I was like tear I was shredded. I was so myopically focused on everything that went in my mouth and I loved it about myself and I would rave about how much discipline I had. So, for sure if I had kids, they would have been wildly influenced by how much pride I took in not eating. And so, yeah, I do worry what that would have done. I thought it was super sensitive of you to recognize that and change. Yeah, I mean my brother actually was the he brought this point to my attention first, but he said, you know, be thoughtful about how you describe your own interactions with food. And when you're giving, you know, your kids input on what to eat or what not to eat, try to tether it less to, you know, body dysmorphic ideas and trigger it, you know, peg it more to performance issues, for example. Right? Because those things are still true, right? If you If you eat well or eat poorly, it affects your performance. It affects your cognition. It affects a lot of things. Um and if the focus is more on those things than on, you know, sort of "Daddy, why aren't you eating this?" Cuz I don't want to be fat. Well, [laughter] you know, that's And and look, there's a truth to it. Like I I mean, I'm a vain person. I I I'm not you know, I've come to a place where I've accepted the fact that I can I won't look like I used to look. Like cuz I'm not willing to put in that amount of sacrifice ever again. You and I have the luxury of being old enough to be able to think through that in a slightly uh less emotional way and at least make that make that choice when I think people who are younger um I don't know. I just don't know if they're equipped fully with the tools to make all of those decisions. I want to ask you about change. You have changed a lot in your life like multiple times from starting out and getting your degree in um engineering and mathematics and then ultimately pulling the first switcheroo over into medicine, then leaving medicine and becoming a consultant, then going into hardcore research and um doing uh nonprofit work, and then now back to medicine. What What has allowed you to constantly make those jumps or what propels you to make those jumps? I have been able to internalize something that I think is not innate to most people, which is the fallacy of a sunk cost. So, uh the sunk cost fallacy is something that gets talked about in, you know, any econ 101 class, right? So, you've uh you know, you're you're building a bridge and the you know, the cost of the bridge is $10 million and you're $9 million into it and the contractor says, "Ah, it's going to be another $11 million." Um for many people, they are evaluating that based on how much money they have already put into the project. And that becomes a very dangerous game because you can't get those dollars back. So, instead you have to evaluate it from the standpoint of exactly where you're standing at that moment in time. And for whatever reason, I've I've been able to stand at any point in my life and sort of say, "I want to do X. I'm going to evaluate that only through the lens of how many years do I have left on Earth and not at all through the lens of what have I already put into this. Um and I think that's just made it easier to do things that on the outside look odd, look orthogonal. And then to leave medicine um whatever it was 12 years ago that was something that a lot of people came to me and said, "You got to reconsider this. Like you've put far too much into this." And I just said like look, I'm going to do something for the next 40 years. I want it to be exactly what I want to do. And that's way better to me than saying, "Well, I'm going to do something that I don't really really want to do because I've spent the last 10 years doing it." Which is where I was. I'd put 10 years into medical school and training um post-graduate training. And it was like, "Look, that's that's 10 years I can't get back." Um and it's that's a fraction of the time that's still in front of me. So it just it just seemed very logical to me to always pursue my bliss. Um and also, I mean going back to something you said, I I think we're in a different world now. I mean I think the days are long gone of you do one thing for your whole life. I mean I think for some people that will be the way to do it and that's that's great, but it's no longer so ridiculous to have a career change every 5 years. I don't I don't know what I'll be doing in 10 years, but I'd be shocked if it looked exactly like what it looks like today. Like I think y- y- you know, if you're not growing, if you're not constantly being reminded of how much more how much higher you have to climb um I suspect it's I suspect life becomes a lot less fun. What drives you? I mean truthfully, I wish I could come up with a whole bunch of pleasant, you know, sort of nice things to say. I think in reality, unfortunately, a lot of my drive is insecurity. Um That is shocking. And I've heard you say that before. Um and the first time I heard you say it, I thought that's really fascinating because you're somebody who gives me insecurity. So, the fact that you feel insecurity is pretty fascinating. And so, as a driver, in what way does that drive you? David Foster Wallace said in in what what is unquestionably my absolute favorite 22 minutes that one could ever listen to, which is his commencement speech from 2005 called This Is Water. So, and and the first time I ever heard this, I it didn't resonate with me. I needed to hear it a few times before it really resonated, where he said, "If if if you if you worship power, you will forever feel powerless." Right? And and that doesn't really resonate with me cuz I'm not a power seeker, but I absolutely worship intellect. And and when he said the next words out of his mouth are, "You will forever feel like a fraud." I'm like, "That is so true." I find myself, at least on a daily basis, thinking, "Dude, I hope people don't find out how much I don't know." Wow. And and and and I wish I wasn't saying that. I mean, I wish I could I really wish I I wish I could say all of my motivations are pure. It's all I I'm you know, I'm Mother Teresa. I just want to fix every problem and make the world a better place, but the reality of it is, like, I think a significant amount of my motivation is just this complete desire to not be found out as a fraud who doesn't know stuff. I love that for two reasons. One, I think that and I'll speak very much for myself. From the moment I met you, I was like, this guy [ __ ] with my head. Like, there's just certain people where I'm like, I it's hard to feel smart around you. So, the the fascinating thing is, you know, to hear that uh that there's some of that driving you. Um and then two, hopefully people listening to this that that um aren't comparing themselves to you, but yet are looking at you going, "This guy's [ __ ] fascinating. I'm really interested." And they have like a warm feeling for you. Uh that's probably equal parts like, "Oh, he's compassionate towards humanity and that's rad." And then equal parts like "Wow, he's [ __ ] smart. That's, you know, he's got cool [ __ ] to say." And so, for them to hear that you can be so um open and honest about, "Oh, yeah, I have insecurity and um it's low self-esteem that's pushing me forward." Because they they will look at you and think it impossible that you could possibly have low self-esteem. Um which I think is really really good for people to see that that never goes away. And one of the things that I've always thought was I'm not going to call it a superpower, but something that I've been glad that I have for myself is my motives are always apparent to me even when they're ugly and petty. And yeah, I mean, there are times where like what's driving me for whatever reason is ugly, it's petty, it's um makes me feel worse about myself, whatever. But at least I have clarity on what it is. Yeah, I wish I could say I always could see it. I don't think I can. I think it requires a lot of I I don't think 2 years ago I could have acknowledged um what I can be much more brutally honest with myself about today. What happened that made that? I mean, you know, I've always seen therapists. My, you know, there's been very rare has there been a season in my life where I wasn't sort of searching for some sense of you know, why do I feel so tormented? And you know, one of them said the most insightful thing to me I've ever heard. You know, your entire life your entire life has been basically driven by um three skills, three things that you do um that you're really good at. And they're not good things, by the way, right? Emotional detachment rage and obsession. Wow. You Those are like the only three tools You're a guy that has a toolbox that has three tools and those are the three tools. And she said, "Look, you've got a lot of good stuff out of those tools. There are a lot of people who get those three tools and they just end up in jail. Mhm. So, you've managed to through a lot of luck um you know wind up not in jail, wind up as a quasi successful human being, a contributor to society, a father. Like, you've done some good stuff, but she just said, "You're sort of at the end of your rope with those three tools. Like, you can't get any more juice out of squeezing those things. There is no combination of emotional detachment, obsession, and rage that is going to produce anything of value and you're actually now at the diminishing part of the curve. So, now you're actually you're regressing. So, you're going to need new tools. And, you know, so in many ways I think that's what has allowed me to go back and say, "Okay, well, what what is the impetus of that? Why is the Why are these things happening? What you know who do I want to be in 5 years, right? Cuz I can't fathom what I Like, I can't fathom being any different in 5 days. So, I have to think bigger. I have to think of like, "Okay, in 5 years you want to be It's sort of like what we talked about at the outset. If if when you're 100, you want to be able to do these things, you can back out of that and say this is what you have to be able to do when you're, you know, 70 or 60. And similarly, if in 5 years, when my kids are aged this, this, and this I want to be this kind of a person. And right now I'm not on a path to be anywhere near that. In fact, I'm on a path to be completely different in a in a completely different place. Okay, so start backing out. What the person who can do those things in 5 years has to be able to do what in a month? How would they react in this situation versus how do you always react in a situation? People like me who are very good at doing things where harder work produces better results, like when that's your playbook and you are now confronted with trying to do something where that playbook doesn't work, it is ego-demoralizing. Right. Like if the answer is just swim further, like all you have to do is just keep swimming. Don't stop swimming. I got it. Like I That is my book, man. But if the answer is no, you now have to be able to control your emotions in a certain way. You now have to be able to, as you said, recognize in a moment when you have an emotional reaction, why it's what it's really about. Cuz it's never about what you think it's about. It's about something else. Can you stop yourself in the moment and recognize that? That is a new skill. And I'm a baby trying to learn that skill. And my old trick of just work harder, just work harder, it fails. So, in many senses, it's like the most intimidating thing I've ever tried to do, right? What's your process in all this? Like how are you actively getting better? One is just showing up every day, right? So, it's like you know, the last time I last week when it was the last time I spoke with one of these therapists, I just had a really miserable day. I mean, I just didn't want to talk to them at all. You know, I was in a really, really bad mood. And so, part of it, I guess, is you set yourself up around people who are never going to take your [ __ ] Right? So, you have therapists who for me, having these these collection of people around me, it's like they absolutely, positively don't let me get away with anything. You know? I I part of it, too, is just having really patient people around you because you're going to make a lot of mistakes in this process, right? So, you have to, you know, in my case I feel very fortunate. I have a spouse who is uh you know, I I would say more forgiving than probably she should be. She believes in the in the sort of like this is what you could be in 5 years. This is this is the guy you can be. So, when someone believes in that, they're much more willing to help you when you fall, they'll pick you up as opposed to point out that you fell. And do you have like a specific vision of yourself that you're building towards or chasing? I mean, I do. Um and it's not it's not a professional version of me. It's a personal version of me. If I get wave a magic wand, what kind of a husband, what kind of a father am I? And the reason I use those two as an example is it's unfortunate the people who are closest to me who always see the worst of me. And so, most of what I think about is how do you uh how do you show up for those people? Cuz if you can show up as the best version of you for those people, the trickle effect is everyone's going to be fine. Like you will be a great version of you with everybody. So, it's it's less about how do you show up at the TSA check gate when the person's obnoxious. I'm not I don't worry about that that much. That that's a relatively easy thing to control. But when you're taking out your problems on your kids or on your spouse, you know, to me that's that's the stuff that's just got to stop. And um and if you can get to that, to me that's like the that's the hill of the mountain. That's like that's the hill when you climb that. Well, at that point you're going to be treating everybody the way that they deserve to be treated, including yourself, by the way. I mean, as you probably know, um those of us who are the biggest you know, sort of jerks to others are usually jerks to ourselves. You're quite aware of how hard you are on other people when they make mistakes. Do you realize how hard you are on yourself? Look at Do you know what your self-talk is when you're making errors? And I And I started paying attention to it and I was like, "Wow. That's really That's harsh." Mhm. That's very harsh that you would that you that you think these things of yourself. Which again, it all comes back comes back to this insecurity. And at the outset I I I said um you know, whatever 5 years ago or 4 years ago, 90% of my bandwidth was on like how to not die and today that's only 50% of my bandwidth. The other 50% is the whole physical stuff we talked about. And then it's this, right? It's this um What does an examined life mean? And is it a life worth living? Um because you know, I I do think we suffer so much in our own heads uh more than we suffer any any other way. Um And I don't know the answer to that. I Here's what I know. I know that that's way harder than reducing the risk of heart disease. Um I know that's way harder than, you know, addressing that is way harder than fasting or doing all of these other things that are even non-pharmacologic interventions that I think can fix all those other things. And certainly for someone like me, it's harder than you know, exercising or being disciplined about all these other things. Um And I suspect in part because it's less amenable to doing. Right. Right? The things that we do um tend to be a little bit easier. But this is this is tough stuff. So, I don't know. I mean May Maybe part of the reason to want to live longer is to just give more runway to figure this out. 100%. No question. All right, man. With that, before I ask my last question, tell these guys where they can find you online. Oh, um so website is Peter Attia md.com and uh you can find everything there. So, the podcast although it's of course on all the usual places, you know, iTunes and such. Um, and then it's Peter Attia MD on social as well. Awesome. My final question, what is one thing that people could change that would have the biggest impact on their health? You're going to hate my answer, man. It's going to depend on where they are on each of these four metrics to begin with, meaning where they are on exercise, sleep, nutrition, and management of distress. So, in other words, the biggest impact will be the one in which you are most lacking for each of those. So, for example, somebody whose sleep is completely you know, abysmal, if they could address their sleep, that will probably have the biggest impact. For somebody whose nutrition is atrocious, addressing that will have the biggest impact. Um, if you ask that question in reverse, it's a little easier. A catastrophic interruption to which of those four things will have the greatest detriment on you? It's probably sleep. Oh. Right? So, again, not really appreciated, but if you take an extreme posture, how long can you go without eating? 2 months. How long can you go with not sleeping without becoming completely psychotic? I don't know. Days. Yeah. Right? Maybe 6, 7 days. I don't know the answer, but but you're going to more quickly uh completely lose it if you don't sleep than if you're blowing any of those other things. So, um, if someone's sleep is a is a real mess, um, it's it's remarkable what you can fix and how much of bad sleep permeates into other things. Mhm. Awesome. Great answer, Peter. Thank you so much for coming on the show, man. That was amazing. Guys, this is somebody who is one of the most extraordinary humans I've ever met. The way that they think about the world, the way that they're not afraid to change, the way that he has constantly evolved, that he's constantly pushing himself. I literally could have talked to him all day. The number of topics that we didn't get to cover is even longer than the ones that we did. Uh from everything, you know, why he does racing the way that he does and why that pushes and drives him to some of the extraordinary things that he's learning in the field of medicine and nutritional science is just absolutely astonishing. I highly encourage you to follow his podcast called The Drive with Peter Attia. It is amazing. The The breadth of things that he can talk about with just absolute clarity is really, really astonishing. But the coolest thing about him is that he is never afraid to say that he doesn't know. And that, when you find somebody that is hell-bent to get great at something, and at the same time they're just never afraid to say that they don't know. And you just saw the he's raw and real and not afraid to talk about the things um about himself that he's working on and pushing and trying to improve. He doesn't posture. He's not trying to look cool. But [ __ ] that makes him cool. So, I hope that you guys will dive into his world. He is somebody that's had a tremendous impact on me and I think he will have a similar impact on you. All right, if you haven't already, be sure to subscribe. And until next time, my friends, be legendary. Take care. [applause] Thank you again, man. That was wicked. Thank you guys so much for watching and being part of this community. If you haven't already, be sure to subscribe. You're going to get weekly videos on building a growth mindset, cultivating grit, and unlocking your full potential.