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On Purpose with Jay Shetty
Peter Attia ON: Scientific Ways to Slow Down Aging & How Your Emotional Health is Impacting your Physical Health
Peter Attia ON: Scientific Ways to Slow Down Aging & How Your Emotional Health is Impacting your Physical Health

Peter Attia ON: Scientific Ways to Slow Down Aging & How Your Emotional Health is Impacting your Physical Health

On Purpose with Jay ShettyGo to Podcast Page

Jay Shetty, Peter Attia
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33 Clips
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Aug 7, 2023
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You talk to a person the day before they're going to die, they would give anything and everything for more chance at life, best-selling author and host. The number one, Health and Wellness podcast. Okay, Shetty
2:05
Hey everyone, welcome back to on purpose where you're choosing to listen to become happier, healthier, and more healed. That's our mission here to leave you feeling happier, healthier and more healed after listening to these conversations, these workshops every single day. And I'm so grateful to you for your commitment and dedication to yourself your investment in yourself, and lending your ears and your eyes to me, I know some of you listening every single day. So thank you and keep those reviews coming. Keep all of that positive energy.
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EG coming. It means the world to me. And today's guest is honestly, the person that I've been waiting to talk to all year because of scheduling, we kept missing each other. I was on a world tour. He is busy. Traveling is launched an incredible new book this year, helping people and I'm just so happy that we finally have in here at our La Studio. I'm talking about Peter Atia, the founder of early medical Medical Practice that applies the principles of medicine 3.0 to patients with the goal of lengthening, their lifespan and
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- Lee improving their health span. Peter is the host of the drive. If you don't already subscribe, make sure you do a podcast covering the topics of health and Medicine. Peter is also the author of the number one New York Times bestseller outlive the science and art of longevity, this is the book that I recommend. If you're going to read about your health right now, this is the book I want you to go. And get Peter is here, welcome to on purpose, and thank you for being here. Thank you so much Jay. I meant everything. I said I was
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You know really really looking forward to this conversation and I want to dive into many aspects of the book, many topics. I've also sourced questions from my team Community people real. Real life questions that I think people are really struggling with, but I actually want to start with your journey and your story because I've gone through similar moments in my life, where at a young age, I've had different health challenges when I started to get the right help and support. I started to realize how detrimental
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His health challenges could be long-term if I wasn't to shiftings and the problem is, I've always been a fairly healthy guy and had healthy habits. And so when you get that kind of news, it's kind of a longing and scary and can set fear into. Now, I know that in your journey, you were a generally healthy person, doing pretty healthy things. Only to find out that actually, you are prone or open to a terrible disease, down the road. So could you walk us through what it feels like?
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To think you're healthy to maybe even feel you're doing okay? But in reality there's something going on behind the scenes.
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Yeah I mean I think there were two sort of things that were a wake-up call for me and neither of these things happen immediately, I think it's just sometimes the realization that happens immediately. So the first one is I'd always been an athlete. My whole life insanely active, potentially even, you know, active to an unhealthy level. And, you know, the focus of that Obsession had always shifted. But at the point in the story that we're talking,
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About it. That's when I was sort of a ultra distance swimmer so I was you know probably in the Water Swimming 24 to 28 hours a week plus you know other types of training yet. You know I found out this is probably around 15 years ago that well actually, on top of that. I was sort of insulin resistant. I was overweight. And again, not that. I didn't know. I was overweight, you sort of can realize that, but but that I was sort of insulin resistant and you know, that's sort of the first step on the way towards type.
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Ooh, diabetes. It was really at that time. That I also, I think confronted my own family history. So just within my jeans the acknowledgement that, you know, basically every man in my family died prematurely of heart disease, not in some cases, very prematurely in their 40s. Those two realizations in my mid-30s, which also happened to coincide with the birth of my daughter, which my first child was a real wake-up call. And the realization that, you know, I needed to figure something out so that I didn't just, you know, March down the footsteps of what seem to be mine.
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Study and even then you are in the medical profession, right? Only
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although I had actually left medicine at this point. So after 10 years of medical training including medical school, I became sort of disillusion with medicine and left. So at the time that I'm having this realization, I'm actually in the world of finance and quite far from
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medicine. What was your biggest fear at the time? Like, if you could take yourself back to that moment, like, what was the fear that you have? Yeah,
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that I wouldn't be around to, you know, be with my grandkids and things of that nature.
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Nature, because I think, you know, prior to my daughter being born, I didn't really think I would be the kind of person who would find any joy, and having kids, and that changed in an instant. The second she was born, I'm sure there are lots of people who can relate to that. Probably more so men than women, I think, because the switch is a little more binary when we have kids and then the thought of, you know, I'm not going to relive this in 30 years with grandkids. I think that was probably the thing that was the most motivating factor. Wow. Yeah, it needs that kind of
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Have to get activated in. The reason I asked that question is, everyone who's listening or watching? I want you to think about what that fear, what that challenge is for you because often fear is a great motivator to keep going, but it's a great place to start and at our health almost starts there sometimes. Like I remember that I remember feeling like Superman when I was in my early 20s and then all of a sudden having certain health challenges, I got into chronic fatigue, I had polyps in my throat, that had to be lays it out. I lost my voice for a few months and
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That wasn't life-threatening but it was life-altering. In the sense that I couldn't communicate in the same way it was different. Getting my voice back and not feeling like it was as strong or powerful and then having gut issues and inflammation issues and acid issues, and all of these things. Again, like they weren't it's not the, my life was going to end that year, but it's like you start thinking, long-term? And you start thinking about, living a unhealthier harder life. When is the right time for people to consciously start, actually,
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Investing in their health. And I'm going to caveat that with what is generally happening and happening in the different Decades of our life. So what's happening between 0, to 10 10 to 20, 20 to 30, 30 to 40, 40 to 50? And when is the time, when you have a bit more control and ability to shift the trajectory of your health bar? Any of course, major complications or
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surprises. I've never actually been asked it that way, but the way you asked, it kind of makes me think about different things, the aging process.
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Process in some ways, there are some aspects of it that are moving in the wrong direction. The moment you were born. In other words, the moment of fetus comes into this world. There are certain aspects of Aging that are only getting worse. There are others that are not so you have to imagine now they're talking about different things. So I'll give you an example of each. Something that's getting worse. The second Airborne is the damage to your arteries. So we call this process, a
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This chlorosis is what leads to heart attacks and strokes heart attack. And stroke is the leading cause of death in the United States for both men and women and globally for both men and women. But it takes an awfully long time. That's why you've never heard of a baby having a heart attack. That's why teenagers don't have heart attacks and people in their 20s. It's almost unheard of they would have a heart attack but the disease is starting right away and we know this because when we've looked at people who have died prematurely from other causes car accidents, homicide suicide
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I'd and you look at their coronary arteries, you already see evidence of disease. So we know that this is happening right away and it's simply a matter of time until it reaches a critical level that results in disease. And of course, everybody is accelerating at a different rate based on many factors genetics, smoking high, blood pressure, metabolic Health, all these other things. But point being that something for which you could technically argue. It's never too soon to start prevention. Then there are other things in which we're actually getting better and better.
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Better until we reach a certain point and then we start to demise and an example, there might be sort of cognitive capacity, so we might have our greatest neuroplasticity in the first few years of life but we're also building on that and if we're in the right environment were exposed to the right things, we're actually getting, you know, better and better and better at our fluid intelligence and that probably reaches our Peak sometime in our third decade. So that's something where, you know, you're actually getting better and better and better, and then it slowly starts to decline.
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Klein. And then there are all sorts of things that are mixtures of these things. So for example, your physical capacity, your muscle mass strength, power type 2 muscle fibers cardiorespiratory Fitness, all of those things are also increasing in capacity again depending on which of those things we're talking about. If it's you know power and explosiveness that probably Peaks early in the third decade, if it's strength that Peaks a little bit later. Peak cardiorespiratory Fitness again in your 20s and then those things will start to decline. What
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Undoubtedly clear is for you. And I were pretty much in Decline. So most people listening to, this are in a state of Decline and part of the objective, I think ought to be to slow the rate of decline as much as possible, but there's another aspect to your question. I think is very important, right? Which is like, at what point should you start putting effort into this? And that's a very difficult question because it encompasses a couple of things when you talk to a person, let's do this as a thought experiment. You talk to a person the day.
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Before they're going to die. I mean, they would give anything and everything they have for more chance at life, despite how high their motivation is, there's no Runway left. Conversely, if you went into a high school and talked to a bunch of freshmen and said, I've got the program for you that is going to add 15 years to your life. I mean, they couldn't be less interested, right? So there's a Sweet Spot somewhere where I almost think people need to go through a little bit of
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The Klein kind of like what you described. It wasn't life threatening but you just need to realize that your fallible to sort of say hmm I can project this movie forward a couple of decades I've now mature enough to maybe see my parents see my grandparents Aunts Uncles, friends, People's Health, deteriorate and realize. That's a bit of a reality check that it's coming for me. But yet I still have long enough to bend the Arc of my life. And so I think those are the two curves that were trying.
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Intersect. Yeah, that's a great answer and I appreciate that and I feel the same way. Unfortunately always comes through some sort of pain or some sort of reality check or wake-up call that gets us going and it's interesting what you were saying about cognitive function and ability as well. There were studies that I read that said that the average age of most successful entrepreneurs is 37. And it's fascinating because we live in a world right now where everyone wants to be a successful entrepreneur by the time they 21 or 25 and we put these on
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Fish oil pressures on ourselves when actually there's so much more to it in the genetics versus environment debate. What have you? What's the latest in that space of? Like because I think we're not, you said you drove into your family's history. I think most of us are not fully aware of our family's history. Even though every time I saw dr. Growing up did always. Ask is there this in your family's history? Is there that first of all how will where do we need to be of our family's history? How important is that for people to figure out
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and second of all, what is that breakdown between genetics and personal environment and career and work?
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You know I think actually family history is such an important thing. It's one of these things that we stress to the nth degree with our patients so much so that you know, takes them weeks sometimes to gather the information that we want to know. Because we want to know and we give them 10 questions for each member of the family. So your parents your grandparents, your aunts and uncles your siblings. Like we want to know everything. Do they have? Hi.
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Blood pressure, they have high cholesterol. Do they take this medication to? They take that medication. What was their cognitive function like in the last decade of their life? You know what type of cancer is? Did they have? Did they have low bone density? You know, do they have osteoporosis? I mean, we really want to understand every detail about it and I think a big part of the reason why is contrary to what maybe people believe a genetic test, does not give you that information. So if you and I went out and got a genetic test and I don't just mean an OP, you know,
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Over the counter genetic test, like 23andMe. But I'm saying if we went out and got the best whole genome sequence, money could buy. We spend thousands and thousands of dollars and literally looked at every one of our, you know, 20 to 30,000 genes. We still wouldn't be able to impute from a risk standpoint, what you can gather from a very well collected family history. And the reason for that is most genes by themselves are not deterministic which really gets your second question. So if most genes are not deterministic they need something in the environment to sort of
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I grade them. Furthermore, most conditions that we care about are polygenic. It's easy to think of the sort of mendelian mono, Gene type conditions. They get a lot of attention and they're important to be sure but the vast majority of things that people care about cancer, heart disease, dementia. They are not really just related to a single Gene. And in many cases, we don't even know what the collection of genes look like. So Jean.
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Does matter. But I think we're going to get the majority of our information by understanding our family history in terms of susceptibility and the environment matters greatly. And the extension of that is of course you have great agency or
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that. Yeah. And what is the best methodology for getting the family history in a complete comprehensive way? That's
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actually going to can be hard, if members of the family are deceased. So for people your age and my age, you know, our grandparents, I mean, at least for me my grandparents are long gone. So it's, you know, dear parents, really remember and part of it just comes down to are they being prompted by the right?
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Now, again, to be honest in my family history, I have very limited understanding of grandparents because, you know, they just, I long enough ago and frankly, I don't think my parents were necessarily great historians of this. In my case, where the bulk of my understanding came from was that my dad came from a very large family, you know, there were 10 kids to that died. Young, so eight, that survive to adulthood and there I was able to elucidate really good information and really understand that there's something very
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bad going on with respect to heart disease on my mom's side. I could also see some issues with her two siblings as well. That also gave me a sense of, you know what, some predispositions might
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be. Where can people find those questions or how can they connect with that approach? No, it's a good question. I don't,
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we have a program that we've developed called early, which is like a digital product. That is our practice. I know that it is within their got it. Yeah, so people like look for early. I don't know if you I should know.
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To do this. If you go to like early medical.com, there's a way to find
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it, got it, got it, I'll get back to, ya know, I think that that kind of practical step is so needed. Because one of the biggest things when I was talking to my team and talking to the community about health, one of the biggest things that came out is Jay would just stuck on where to start. Like I don't know where to start. I don't there's just too much information out there. It's oversaturated everyone's going to do this and that it's almost like let's figure out your genetic history. Like that's a great place to start because that's where we
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Yeah,
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this program early is divided into 12 modules. We think each module would take you about a month to get through, and that's the first or second module. I think the first module is setting your goals and going through kind of this type of exercise. And then the second module is. Okay, how do you get your family history? How do you take that information and extract, what the implications are for you and then go from
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there. What's your take on a full body scans and that kind of testing? And how often should it be done? Because I think again, what's happening? I was talking to
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Some younger people in the audience is Gen Z and it was just like, going to see a doctor has become, like, not even a thought and I could see that in my generation, but I remember my parents generation that my mom will still call me up and be like, have you seen the dentist every 6 months? Like, have you been to the doctor every 12 months? Like, you know, my mom will still do that with me. But I find that that kind of culture is diminishing day by day because of a lack of trust because of a lack of transparency. So many different things could just be laziness and complacency,
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What is your take on getting checks which checks how often? And I guess the question is, how do people know how healthy they are? And early is a great plan but from the other point of view
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it depends on the type of scam. So for example, there are certain scans that are going to be very helpful at predicting risk from heart disease. So for example, a coronary calcium scan for the heart or a CT angiogram for the heart. Those are tests that I don't think are absolutely essential but they can be very helpful if you're trying to further stratify risk, you referred to a whole body.
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Scan. So the best example of a whole body scan that I think provides value is an MRI. The reason being is an MRI doesn't have radiation. Whereas, a whole-body, CT scan or a pet scan, would have staggering amounts of radiation. We would never want to do that, just from a screening perspective, but of course not all MRIs are created equal and anytime you're doing a screening test, you have to be aware of something called sensitivity and specificity. And these are really important parameters. We've put out a lot of content on this because I think it's very
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Be confusing for people. So sensitivity is the capacity of a test to detect something, if the something is present. So if you're looking at a sensitivity of an MRI scanner for cancer, the the sensitivity is, How likely is this to detect cancer? If cancer is present. So, on the topic of whole body, scanners MRIs are very sensitive and again, not all MRIs are created equal but I'm assuming we're talking about the best of the best. Yeah, that's good. News means, if you go into an MRI
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scanner and you have a cancer, the MRI is quite likely to pick it up. Now it does have some blind spots and every screening test has a blind spot. So a blind spot that's worth acknowledging for an MRI is a small calcified breast cancer that's easily going to get missed by an MRI and that's why it's not a substitute for mammography a woman would need to do both the next parameter of screening test is the specificity. This says, How likely is this test to give you a negative result?
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If indeed the condition is not present. So it's the mirror opposite of sensitivity. Here is where those whole body scanners are abysmal. They have very low specificity, what that translates to in English is they have a lot of false positives. I always tell patients, look, if you're going to go and get these scans and we Advocate that our patients do. But they we do it in a much more kind of robust way where it's part of a multiple system of screening tests. So that we're covering the basis of everything and trying to attach
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H to the strength and weakness of each study. But when it comes to that MRI we say look there's a really good chance you're going to come out of this test and there's going to be some false positives. We're going to need to chase down. So I always feel bad when people sign up to do these scans and they aren't aware of that because it generates sometimes more stress on the back
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end. Yeah, yeah, I went through that. We had an MRI done and they found like, almost like a group, or cluster of things in an area and the, well, that could be cancer than I had to.
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And do a endoscopy as well and luckily, they found it was nothing but I remember for that week before. Yep, I was like, that's it, it's all over here. It is like, you know, I need to, I think sometimes. If you're
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told up front, hey Jay, there's like a 15% chance. Yeah, I
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didn't. I was like, oh my God. Yeah, we ran and we
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want to make sure our patients understand and by the way, a subset of our patients probably 10% decide. I don't want to have the scan because I don't want to cope with
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that stress. Yeah, and it was real, I was like, all right.
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I'm gonna have to get focused on figuring this out because it sounds bad and I didn't have that layup as you said, and it's really interesting and that's what I find. So fascinating today, right? Like there's managing your health and then there's the stress and the pain that comes with figuring your health out. Whether it's the overexposure to too much information, whether it's bad information in the past and then we're like all, we'll just forget it. I don't want to do any of it. I mean that's what I feel your book does and that's what your work does. Is trying to help people figure out well.
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Give you all the information. Here's how you can know what's good for you and test it for you. And right for you, one of the things that I love that you talked about, is, you talked about the need to get rid of, you know, just focusing on a random die or following a random die. And actually looking at like eating habits and patterns that work for you and so just putting a little footnote for everyone who's listening, the book will walk you through, how to make sense of how to know what is right for you. What is wrong for you? Whether you should do something, which I think is like the
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Biggest anxiety driver for so many people. When it comes to their health. When it comes to food, I think fasting has become trendy. It's become a big thing that everyone's talking about, you know, we hear so much about every single diet and the world, there's always a new one that's coming on the surface. How have you helped people one-on-one actually discover what's right for them? Because I found that my eating patterns are very different to the trending habits of how to eat food and even fasting. Yeah, I mean, I think the first thing is, as you said, it's just
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When people understand that, the less you can pay attention to social media, fads and your news feed on Google or whatever the better acknowledge that there is surprisingly little known about the relationship between nutrition and health. And people are going to be shocked to hear that. Because I think most people think the exact opposite, most people think that nutrition is the most important pillar of health and the reality of it is outside of very extreme states. That's, that's really not true and the very little bit, we know about nutrition.
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Just frankly speaks to the challenge of scientific inquiry into something as difficult as nutrition to study. And the reason for that is you can't study us as humans very well. We're very messy subjects. So we're not like mice, where, you know, you can put us in a cage and control, what we're eating, and follow us through the duration of Our Lives. It doesn't work that way. So when you're trying to make inferences about nutrition in humans, you have to rely on poorly.
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Controlled studies called epidemiologic studies, which are fraught with all sorts of limitations that. I talk about in the book or if you're going to control the study, you can only do it for a very short period of time. There's only a short period of time in which I can control exactly what you're eating. So as a result of that, we don't know a lot. So I always want to start with what do we know. Well, we know that protein is a very important macronutrient. There are four macronutrients carbohydrates fats, proteins and alcohol. People kind of forget alcohol, but some more to understand it's very caloric and so it constitutes a
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source of energy. It's the worst macronutrient, but nevertheless, it's, you know, you'd be amazed. Sometimes people are going to like 15 to 20 percent of their calories from alcohol if they drink enough. So protein is really important and it's not a source of energy the way carbohydrates and fat is, but it's a structural macronutrient. And so I always start with that and say, look, rule. Number one, is you have to make sure you're getting enough protein and this is especially true if you're over 50 because if you're over 50, you start to become resistant to the effects of protein that's called antibiotic.
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Ends and loss of muscle mass in people, over 50 is a significant driver of mortality and it's in a significant driver of poor quality of life, you know, if you really start to think about it, even if a person is of sound mind and they're not, you know, suffering from some intractable disease later in life, a great source of misery is simply being physically unable to do things after that. It really comes down to what do we understand about energy balance?
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Lance. Well, we understand the too much nutrition. I call this over nutrition is bad and that the body historically developed lots of tools to store energy because that's what allowed us to evolve the way we did and up until I don't know 100 years ago or so that was a great skill to have. It's now supporting us in an in an environment of too much food. So now this ability that we had the superpower basically to store excess energy
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Become a liability in the United States. Certainly, the vast majority of people probably over 70 percent of people are over nourished and that's the thing. That's driving a lot of their poor health. If you're over nourished, you have to correct that problem. The way to correct that problem is to eat less. And there are three strategies to do that, one of them is to deliberately go about cutting calories, that's called calorie restriction or CR. The other one is called dietary restriction. That means limit certain things within the diet and if you are restrictive and
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enough that will indirectly also reduce total intake and then the third is fasting or time restricted eating where you create a narrower and narrower window each day in which to eat all of these things can work. And all of those things have significant limitations that you as an individual practicing. This need to
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know
27:24
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28:50
Yeah, it was incredible. I was looking at the just history of the design of plates and cups, randomly. I don't even know how I got there. How much bigger they're getting. She's how much do you get that getting? And it was insane for me to think that the way plates are designed the way cops are designed, the way anything's designed transforms, how we consume, and it's fascinating to think that just because of a larger plates, eyes were now eating larger amounts and we think it's normal in our time where someone
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Sort of think we were feasting.
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I'm sure you still get back to Europe all the time but like look at the difference in portion sizes. When you're in you know, Italy versus the United States, it's comical. What a difference. It
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is. Yeah, I remember as a kid coming to the states and obviously, when you're a kid, everything that's bigger is better. Yeah. And I remember like pulling over at the gas station and I'd see like this massive like, you know, jumbo thing to fill your drink up in and like you know forever refill to whatever it is. And just that called as a kid I was like this is the coolest thing of
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The world and now you look at me like, wow. That's you know, there's no need for that. So it's fascinating also how these cultural shifts and cultural changes have made some of these things harder for us today. So you said CR Dr. And T, are those those are the three that people need to experiment with each of those baked a sickly. If you are in that over nourished Camp, you need to employ some combination of crd are and or TR. And if you're adequately muscled,
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That's you just you can just focus on that if you're in adequately muscled you have the added challenge of needing to boost protein intake to match strength training while engaging in crd RTR. Yeah but the rob it is, that's it. Yeah, you know the rest of it the alphabet soup of diets is just it's all noise. I just encourage people to not fixate on the trend and just think about those different things because, you know, look each of the alphabet soup diet, fits into some form of Dr. I mean,
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And that's true, whether you're talking carnivore or vegan or everything in between, those are just forms of Dr and they can all be effective but you have to be aware of the limitations of each and make sure your circumventing
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them. Yeah, absolutely. Absolutely. I think that one of the things that there's a lot of question marks around as well from the community that they were asking was nutrition which you've beautifully clarified there but nutrition versus supplements. Yep. And the need for supplements and I think I would love to hear your takes on supplements that are working
31:19
Seeing types of supplements, types of ingredients, types of chemicals that are making a difference. Natural supplements to. I'd love to hear your thoughts on nootropics because I'm just hearing about nootropics everywhere right now adaptogens is you just tried as well. We've been we've been focusing on adaptogen. So I'd love to, let's talk about your take on great supplements, that everyone needs to take. Not not a brand but I mean like, yeah. And then you're taking nootropics and adaptogens. That would be
31:45
fantastic. I mean, I definitely do take some supplements, I'm always careful to kind of make
31:49
Disclosure. So one thing I do supplement I take something called Ag and I'm an investor in a g but I've been taking it long before I invested in it and I know the founder very well. I'm very under the hood of exactly how their products are made and sourced and for folks who aren't aware age. He's like a green that, you know, just mixing with water. I drink it every
32:08
morning. They sponsor the podcast are, do they? Yeah. Yeah. And my approach to that
32:14
is, if you buy the thesis that we need to be having x amount of,
32:19
Abel's a day and let's be clear and be transparent. I can't guarantee that. That is true because we don't know. That's another example of something that the epidemiology tells us is true, but there are many confounders there. But my view is that it's better to err on the side of that's probably true than the than the counter. So if you buy the thesis that you need x amount of vegetable a day, I actually find it very difficult to do that without exception.
32:50
There are lots of days I can but there are enough days that I can't. So my view of a supplement, like a g is, it's my belt and suspenders approach. It's, it's basically my way of guaranteeing that, by 7:00 in the morning. I've met my needs and then if I have a salad for lunch and dinner as well. Perfect, I went a little overboard, but that's better than the reverse to me. So
33:10
that's one and an AG specifically talking about that kind of a supplement. That's a vegetable Focus. Supplementary, not all supplements. That's right. Specifically focused on that's that's that's
33:19
Specific date. Yeah,
33:21
there's another supplement I take, which is a pro biotic. Now, no one has been a more vocal critic of the probiotic space than me. I have generally viewed it as a space that has demonstrated, no efficacy. Despite all the intentions in the world, in the past year I have sort of changed my take. So there is a study that came out that looked at a certain type of probiotic and noted that a certain type of bacteria in it.
33:49
It helped with the production of something called butyrate and this was actually helping with glucose disposal, the results of this study actually were pretty impressive as a relatively short study, a three-month study, but it demonstrated in the group that was actually taking this probiotic and this was in a blinded randomized trial that these patients with type 2. Diabetes. Had a significant reduction in blood glucose even though I don't have type 2 diabetes, I sort of subscribe to the idea that everybody benefits from lower blood glucose including those without diabetes. So that's a probiotic that I take. I don't have any involvement.
34:19
With the company, the company's called pendulum but I take their take their glucose control.
34:23
Probiotic. Can you walk us through a bit on glucose control because I think that's still an area that for people who know as well. Informed that that's an area that I I learned about probably in the last year and a half that has changed what I eat first thing in the morning. It's just what I'm eating at different times. Like to me I was just like or if I need a boost of something as long as it's a healthy sugar, it's fine. Not only to realize that, you know, causing spikes in my blood blood.
34:49
Clever. So could you walk us through that a little
34:51
bit? You know, glucose is this essential, very simple carbohydrate. Its kind of the final common pathway of most carbohydrates. There are other simple carbohydrates as well, fructose being one of them. So sugar, for example, table sugar is a, is a molecule of fructose in a molecule of glucose, but glucose is the is the most abundant carbohydrate final breakdown product and it's very highly regulated at any point in time, you're walking around.
35:19
With, you know, if you haven't eaten that day, somewhere between 4 and 5 grams of glucose in your blood may be say 4 to 6 grams of glucose in your blood, which is just over a tablespoon or teaspoon rather. So tiny, tiny amount. But you're using it constantly. And therefore, your liver is constantly putting more out into your circulation ever. So delicately and the balance of that is so fine that if that level were to be just twice as much if you were to go from one teaspoon to a teaspoon to 2 teaspoons.
35:49
Would be consistent with having type 2 diabetes or type 2. Diabetes is a condition where an individual can't control the amount of glucose in their blood. This is very problematic because glucose when it becomes too high starts sticking to proteins, and it starts causing damage all over the place. But primarily to small blood vessels. So blood vessels in the heart, blood vessels in the kidney, in the brain. If you're in an if you're you know in the extremities of the toes that's why people type 2 diabetes are more susceptible.
36:19
Septuple to amputations kidney disease, heart disease, Strokes Alzheimer's disease, all of these things, anything that compromises, blood flow, and oxygen. So it turns out that even if you don't have type 2 diabetes, and that today is just defined by a threshold of average blood glucose above 140, milligrams per deciliter. Even if you are not in that category, it still appears that your mortality goes down the lower your average blood glucose. So meaning within the normal range
36:49
Of glucose lower is still better people sometimes say, well, does that just mean? You know, you should never eat a food that raises blood glucose? No, that doesn't necessarily mean that. At all. What it means is, you need to be mindful of matching. Your glucose consumption to your capacity, to dispose of glucose. And those are factors that are, of course, highly impacted by how much you sleep. So, sleep interruptions in sleep dramatically reduce Your Capacity to put glucose.
37:19
Into your muscles. Which means glucose levels, get higher. It also has to do significantly with how much you exercise and how much muscle mass you have, so people can have completely different tolerances for glucose. I think I write quite a bit about this, which is, you know, basically trying to understand your your glucose tolerance. Level comes down to matching it with your insulin sensitivity, muscle mass activity levels, sleep, stress, Etc. Absolutely. Thank you so much and I got you off from movie, Let's away. So, so just to go back to this other point quickly. So there are lots of other supplements that I think can be really valuable.
37:49
Able, I think B vitamins are very important, especially methylated, B vitamins. Vitamin D is very important, many people. I think don't have sufficient levels of vitamin D. Think the data on vitamin D, we could do an entire podcast on that the clinical trials, looking at vitamin D levels are really poorly done, clinical trials. And so I think if a person looks out at the literature and the literature says there's no evidence that vitamin D really helps. I would argue pretty strongly that those trials haven't asked the right question and weren't designed correctly. So my view is it's better to probably err on the side of caution and make sure.
38:19
Vitamin D is probably somewhere between about 40 and 60, and if you're not achieving that through natural exposure to sunlight, which many people are not, then you're probably better off supplementing. There are a couple of other supplements. I really believe in, and I think magnesium is a very important one, and I think you have to be thoughtful about the form, in which you take magnesium. So, you can take magnesium in a slow absorbing form or a fast absorbing form. That's poorly absorbed technically, and I think we need both, right? So, I think that like a poorly absorbed magnesium would
38:49
Like a citrate glycinate or oxide, and those actually really help with bowel regularity. So, for anybody, who's a little bit constipated, or just, you know, kind of needs to be a little bit more regular. We always want to have in anywhere from two to five hundred milligrams of one of those forms, conversely. I think virtually everybody. Also benefits from a slow absorbing form of magnesium. The brand that I like, is called slow mag again, I don't have any affiliation with any of these companies, unless I'm disclosing it as I did with a G.
39:19
That actually, you know, so most people if they notice, oh, I have a little bit of cramping sometimes or, you know, I'm getting a little palpitations called PVC. Sometimes, those get a lot better with magnesium supplementation. So, so I think most people benefit from that. There's another type of magnesium that I'm a fan of called magnesium, L 3 and 8 which is magnesium paired to a transporter that gets the Magnesium into the brain. I think there's reasonable evidence. I wouldn't say it's incredible, but I think it's quite good.
39:49
Would that magnesium L 3 and 8 is beneficial to the brain and might even have some capacity to reduce the risk of dementia before bed. I tend to rely on ashwagandha which I believe you said is in there. So, I take a big dose of ashwagandha and Glycine. And again, I take that magnesium, Al 3, and 8. And those are kind of things that I think help with reducing cortisol and making it a little easier to sleep. Then the final supplement that I do think most people,
40:19
F it from. And there are probably many others but I'm just sort of going through that. I can think of would be fish oil. So most people probably don't consume enough Marine fat to get, what I think are ideal amount of EPA and DHA, which are two very special types of fats, called Omega 3, fatty acids, and EPA and DHA. I think the balance of evidence is quite strong that they're both.
40:49
Vishal to the heart and the Brain EPA probably a little bit more for the heart DHA. Probably a little bit more for the brain. I take a brand that I've had tested because you always want to be careful about contaminants here and it's made by a company called Carlson's. Again, I have no affiliation with them, but I take their EPA and DHA daily as well.
41:10
That's a fantastic summary for anyone who's looking. I'd like all those things. Yeah. You know, I think that's a brilliant summary and I really hope everyone is listening and watching, you know, get those
41:19
Those checks and tests done and and grab those supplements. Because again, I like what you're saying that it's all about erring on the side of caution, right? It's almost like protecting yourself being safe, rather than assuming that a you get this or be. It doesn't really matter. You know, is it that we used to find these supplements in other forms before, or as humans, we always ignored this and now we've suddenly figured it out or has our lifestyle, just got so stressful and intense that we need.
41:49
More of all of this to support the pace at which we
41:52
moving. That's a great question. I do think that the supplement world is such a slippery, dirty world that I always want to throw out a disclaimer, which is when I talk about these things, I'm also very diligent about the brands that I buy. So again, I have no affiliation with any of these entities but having looked at third party testing, I find the brand gero ja rrow the the brand pure encapsulations to be two of the most reputable.
42:19
Edible companies out there. So I'm basically always going to try to buy from them if I can even if I'm paying a little bit of a premium, your question is a very good one and I don't know how much you've paid attention to kind of the field of regenerative agriculture. But it's a topic that interests me quite a bit and The more I've read about it, the more I've come to realize that I actually think part of the problem is, our food today is far less nutrient dense than it once was. And so I do think
42:49
I think that many of us don't get the same quantity and density of nutrients today that we did for the same caloric intake. Say 50 years ago and the proponents of regenerative agriculture would argue that that a big part of that has to do with soil Health mmm-hmm. So is the health of the soil has deteriorated with more tillage more fertilizers, less crop rotation, all of these things. The net result of that is the plants themselves are less healthy.
43:19
So when you're eating a plant, you're getting less nutrient density. And of course when you're eating meat if you're an omnivore the meat is also less healthy and less nutrient dense because it's eating a less nutrient dense plant which is growing in a less nutrient dense soil. And so the old adage that, you know, it's hard to be healthier than the animal you eat, which can't be much healthier than the plant it eats, which can't be much healthier than the soil. It grows in brings this whole thing full circle. And so
43:49
I suspect that that plays a pretty significant role in it coupled with the changes in our lifestyle, right? So many of us would have got sufficient vitamin D, for example, in the past because we would have been outside more and we would have been active more and you know, today we aren't as one
44:02
example, are you seeing the rise of more regenerative farming and places to buy regenerative vegetables? Or yeah, I mean you that even a thing you know it
44:13
absolutely is and there are there are some great places. You know certainly one of my sincere hope.
44:19
Hopes is that, you know, we see we see a greater and greater movement to scale this because I do think regenerative agriculture is not only what I think of as one of the most important ways in which we can improve human health through nutrition. But but for folks who are also concerned with with climate change and the effects of anthropogenic CO2 regenerative agriculture probably has more potential to attenuate that than anything else inclusive of
44:49
Finding the entire Transportation grid. And that's a pretty bold statement.
44:52
It is. It's very boring. That's gonna dive into it too. Like what gives you confidence to make the boat? Stimuli what have you seen that has given you that conviction.
45:01
It really comes down to understanding the capacity for plants to fixate carbon. I'm sure everybody understands, you know, the basics of how how CO2 works. Right? So why, why is there a concern with the combustion of fossil fuels? Because when you're combusting, a fossil fuel, whether it
45:19
The coal or natural gas, you're taking carbon that was sequestered billions of years ago in the form of fossilized, you know, organic matter and your now liberating that carbon dioxide out. So how do we get carbon dioxide back in the system? Well plants, do that. So plants have a capacity to do something that no animal does, which is they fixate carbon. So they fixing carbon literally is just the chemical process of taking a carbon out of the out of CO2 and attaching it to another hydrocarbon. The way that regenerative agriculture
45:49
Works is by storing more and more CO2 and carbon specifically in the soil. So, right now, the way conventional agriculture works, when you're constantly tilling, the soil, your leaching carbon out of the soil. And so, you know, when you look at the mathematical models, that look at how much carbon could be, brought back into the ground and sequestered IE brought out of the atmosphere. It's more significant than the carbon that's being.
46:19
Put out through the combustion of fossil fuels. The reason I'm particularly excited about that is you're basically getting two wins for the price of one, right? So you're reducing atmospheric CO2, but doing so in a manner that's also very positive for our health. Because in doing that, you're increasing the soil health and by extension then the nutrient density of plants and ultimately animals and ourselves.
46:44
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how rude tanneritos a full house rewatch podcast is here. Join us as hosts Jodie Sweetin and Andrea
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Tucson. It's your journey
50:45
once you take gun regenerative, agriculture versus lab, produced vegetables, I have
50:51
yet to see any evidence that laboratory produced thanks to meats and vegetables can be done really well at scale or that they are particularly certainly any more viable in terms of the
51:05
And City I think in part it comes down to the complexity of soil, there's a great book. I would recommend for people who want to go really deep on this. I believe the book is called what your food 8 and it's it's a wonderful book. It's a bit of a deep dive. It's a nerdy book. It's not Light reading, and they go
51:23
into incredible detail about David. Montgomery
51:27
is yes, and there's another author as
51:28
well, a female. Yep, and be clay. Yep,
51:32
once you get under the hood of
51:34
How complex soil is. So, for example, many people talk about the human gut biome. And, you know, we talked a minute ago about probiotics, right? Well, the human gut biome is really complicated and we haven't figured out a way to perfectly model at. I mean, maybe we're just getting to the point where we can figure out if we add a little bit more of one bacteria. Can it make a difference in the direction that this thing goes? Well, turns out that soil is probably even more bio diverse and complicated than the bacteria in our gut. And so again I just
52:04
I think it's very difficult for us to sort of play Super farmer and think that we can kind of replicate. What Nature has figured out for, you know, literally a billion years. Well,
52:16
see ya. So your understanding is actually that we don't know enough about the complexity of this soil, which is actually what is impacting the quality of the vegetable or hence, then
52:29
all the way up to all the way up the
52:30
change. Hence even if we can produce a vegetable or meat
52:34
Me in a lab it won't have that
52:37
same that's my take on which says nothing about which says nothing. By the way, about the scale factor I think at the end of the day scale matters, like I mean food I think it's safe to say agriculture is the second largest industry in the world just in terms of like the magnitude of what it takes. You have to have solutions that work, broadly and by the way, I think that's still there are certainly proponents of
53:04
Of AG who say, it can be scaled, but I think that's an open question. Still regenerative. Agriculture writings, can it be scale? Yeah, to meet the needs of the
53:12
entire world. Yeah. What are the challenges with scaling that
53:15
it's a totally different infrastructure to truthfully rights not going to rely on as much automation? So for example, like you're not going to be able to rely, you know. So one of the Hallmarks of regenerative as you're not using fertilizer, you're not. So you're not using the nitrogen of a fertilizer, you're actually using the nitrogen of the
53:34
Miles. Another one is you're not using pesticides so your crop rotating instead of using pesticides and allowing you know the crops themselves to generate resistance by cycling them and not letting the pests, get used to the same crop, not to, you know, belabor the point. But all of a sudden the industry that is now dominated by the Pioneers, the cargill's, the monsanto's of the world. It's going to have to look very different. So I think that's a big challenge is going from Big to little. And then scaling little, if that
54:03
makes sense, we're in the play.
54:04
Is like if people are fascinated to have you been out to any regenerative agriculture Farms or
54:10
yeah, there's there's one outside of Austin. There's actually one here in California so
54:16
many, there's like the mean. There's
54:18
so the one out in California is called there's a documentary made about it called. I think the documentary is called biggest little farm. It's not too far from here, by the way, and my kids were obsessed with this. So we like, watch this documentary, like, I don't know, 15 times, but you'll get a sense of what it looks like, but
54:34
Yes. No, I mean, you, yeah, I think everybody can find regenerative farms near them. So really, it's just a question of helping Farmers, understand? Why ultimately it is in their best interest to do this. So economically. It makes more sense. But look, it's going to require the government completely changing incentive structures and changing the way they subsidize certain crops today. It's a big shift.
54:56
Yeah. What's your take on people trying to create Little Farms in their home? They are like mini growing.
55:02
Yeah, I mean, look, I think it's wonderful. I think if
55:04
Can grow your own vegetables. I mean, we have a vegetable garden and there's no question that the the the vegetables we grow, taste infinitely better than anything. We're going to buy at the grocery store
55:15
and how do you take care of the soil in your area? Or you're saying because it's untouched and naturally as. Yeah, I mean, we use we
55:22
compost our own stuff so but it's, you know, look at it's not even big enough to completely feed us, right, you know. It's there's work that goes into this and I have friends that that do have the time and effort to at
55:34
At least, you know, support themselves
55:36
fully. That's beautiful. Yeah, I love that. You know, my wife's really my wife's really big on that she wants to build a little vegetable garden in the back right now in the same way because that's one of her core beliefs as well. So
55:47
just this past weekend I was I had to put all this chicken wire around the fence where our garden is because these squirrels are figuring out a way to get under the fence and they're like eating all the tomatoes in the peppers and stuff and it's like my son who's 8. This is his project and it's just
56:04
As of nuts, when the squirrels are getting them.
56:06
So, what a great age to like, get connected to it? So great. Yeah, it's the land into the soil and to Growing. That's a beautiful. I love that. Yeah, we've had a go for problem. Four years here and it's like, so is always ruining the lawn and I'm like, well if I plant vegetables, there's vegetables are going to be gone.
56:23
Yeah, you have to be to be smart about
56:25
it. Yeah incredible. I want to make sure that everyone knows the book dives into cancer. Alzheimer's, we
56:34
Talked we're going to dive into exercise in a second. We talked about diet, you know, eating less eating patterns. I want to make sure because I don't want to either repeat things that are already in the book or repeat things. You've talked about another interviews and so I just want everyone who's listening to know that that, you know, it dives into multiple key diseases that were all struggling with today. And the biggest challenges, one thing I wanted to talk to you about, which I think you really wonderfully, highlighted was this
57:01
Challenge between physical health and emotional health. And you talked about the need for prioritizing emotional health as well. And I found that so much of my
57:14
Subtle. Emotional health was so based on physical health. So what I mean by that is I found that one point in doing all of my checks and test that. And by the way, I was doing, I was functioning at like a really optimal level. I was just feeling tired and when we did my tests we found that my vitamin D was at a 10. This was around 23 years ago and I realized the majority of the challenges I was having was because I was sleeping. We rented a home during Cove ID.
57:43
We moved from our apartment, and when we rented this space, I never slept well in that space, because it was just the most like noisy loud area. Because there were, it was, it was in the middle of too many animals, too many things at night, like going through the floorboards, like it was an old old space and so there was like, I was waking up multiple times which I don't usually go through. And so I started to find that a lot of my emotional challenges whether his fatigue.
58:13
Irritability, you know, stress because of that environment was causing emotional challenges, but it was actually coming from a physical space. That makes sense, for sure. And I think so often these days, I find a lot of us are just trying to solve everything in our mind rather than recognizing that often it's a chemical, its biological, it's, it's physical. So, I want to just point that out to people, because I think a lot of us like I could have done anything to change. I was working out. I always trying to sleep. Prior I was doing everything I possibly
58:43
Good. But because my vitamin D was at a level 10, there's not much you can do. And instead of take apart from taking Vitamin D supplements, how where are you saying this relationship? Where are you seeing this relationship between emotional health, and physical health?
58:58
Well, there are absolutely linked and, you know, I think that one of the things that I've observed, you know, my therapists will always asked me at the beginning of a session is, how are you doing physically? So, are you in pain, right? Is you know, we did.
59:13
Is your shoulder bug in? You is your back, bugging? You, do you have like an ulcer in your mouth? Something like, literally, something like that. How are you rested? And how much stress are you under? And their reason, I think, is those things, exacerbate vulnerabilities that we have on the emotional side on the mental side. So if you take an individual into parallel, same individual in two parallel universes, but in one situation, they have lots of issues going on physically, right? So
59:43
Not well rested. The vitamin D is low, they're in pain. And you have another individual for which everything is physically firing on all cylinders and you present them with the same emotional distress, you're going to see a completely different response. That's a big part of why I think it does matter to keep your physical health in order to optimize your emotional health. But I would also argue that you could still have your physical health in perfect order and you know, not become
1:00:13
In close to addressing your emotional
1:00:14
health, when you use the term emotional health, what does that constitute for you?
1:00:20
I try to distinguish it from mental health, right? I think mental health is a subset of emotional health, but it's the perhaps the more medicalized piece of it. So in medicine, we use something called the DSM, the diagnostic and statistical manual. I think we're in version 5 and that's the one that codifies psychiatric illnesses, right? Everything from depression anxiety, different personality disorders, and all sorts of things like that.
1:00:43
Those things clearly matter. But I'm talking about something that is applicable to everyone. Whereas those things might only be applicable to people who would meet diagnostic criteria. So emotional health in the sense, the way I think about it kind of encompasses your relationships with other people. Your sense of purpose, fulfillment, Happiness, joy spontaneity, all of these things that every human should be thinking about because every human is a part of those things.
1:01:13
In my case, you know, so the so the book is written, basically, it's 17 chapters, 16 of the chapters are me, you know, writing about it as the doctor. Yeah, the scientist. And then the last chapter which is about emotional health is me actually just writing about my personal experience and my own well transformation, I think would be an understatement. You know, I think that the most important lesson for me in the past decade has been that all the health stuff, that's that makes up.
1:01:43
Most of that book, how do you reduce your odds of getting cancer? How do you reduce your odds of getting heart disease? Alzheimer's disease, how do you make sure your muscles work better in the last decade of, you know, they're not all those things are very important, but if you're miserable none of it matters. Right? If your relationships suck, none of it matters and I can't state that enough, but I I couldn't have understood that a decade ago, you know? I
1:02:13
I had to personally experience things going really wrong. I had to nearly lose everything to realize. I've really missed the plot here and if I don't get this stuff addressed then the rest of this out, living doesn't mean
1:02:28
anything. What was the wake-up call for you? Or what was the,
1:02:31
I mean, I think if it was essentially almost losing my family, right? It was just being so so selfish. And so such an awful person that, you know, I finally woke up and realized how much
1:02:43
I was hurting everybody around me and I was confronted with that and confronted with the reality that I had no choice. But to go away and get help to sort of address, my own reasons. For why my coping mechanisms were so
1:02:57
- what, what made you so selfish and hopefully, where did that come from?
1:03:01
Well, I mean, again at the time I had no clue but I also the time I don't think I was even privy to understanding, what what I was doing, but obviously as
1:03:13
as I talked about in the chapter and I
1:03:17
What I basically learned is I think a lot of my adaptations had to do with, you know, certain things in my childhood some of which were you know I described as kind of Big T trauma and some of which are frankly just little T trauma. But collectively, they just produced a response and adaptation. I talk about this sort of model of trauma, where wounded children become adaptive children in adaptive children, are there to protect the wounded children and I think that's a remarkable trait of us as humans, right? We are very resilient, the
1:03:46
Is that a lot of those adaptations become maladaptive in adult life? And I think that's really what I was dealing with was so many of my adaptations. You know, for example, control Drive, Perfection anger. All of those things served me quite well as a child, but as a husband and as a father, they were not serving me well anymore. And all of the good that came from those adaptations. For example, a strong work ethic
1:04:16
Ethic a desire to to do, good was most more being done for the wrong reasons. It was I'll show them. I will, you know, I will matter, my self-esteem, will be based on performance Etc and I think all of that had to be turned on its head. For me, that was sort of my journey was learning how to undo all of the maladaptive behaviors to try to keep the good parts of the adaptation and then shed the
1:04:46
Harmful
1:04:47
ones. Why do you think it takes us? Thank you for sharing by the way, and I know you go into more depth in the book and I find this fascinating and I think people I'm so happy that you address it because I think people find it especially fascinating from coming from you because often they just seen as such separate things and separate Pursuits. But for you to unify them is really, really interesting. Why do you think it takes? So many of us so long to address the very root.
1:05:16
Cause of so much of our problems and you partly covered it there that some of these things become superpowers in the material world, like they're phenomenal, you know, manipulating the outside world, through control and perfectionism, Etc. But then in the inner world and the family tends to suffer from that. Why does it take us so long to Look Backwards? Almost to look for words in both our genetic background and are also genetic trauma. In that sense
1:05:46
And I don't think we want to.
1:05:51
Uncover painful things. Unless the pain that we're confronting, is greater than the pain. We're going to encounter by doing. So that's probably my simplest thought. As to why, I just think that, like, how many people without ever having experienced dental pain would go to the dentist, right? Like you do as a kid because you're sort of told but, but when I think about now, like, why do I put so much effort into taking care of my teeth? It's because I've learned how miserable it is.
1:06:21
When when I don't, I think until you experience enough discomfort in the present and in my case that came through the circumstances. I right about the pain of turning around and going back and exploring what happened and why? And and then embarking on the corrective steps and learning a whole new language and a whole new set of skills. I mean there's
1:06:51
In chemistry, we call that the activation energy of a chemical reaction, right? So, you know, every chemical reaction has to overcome source of some sort of activation energy and the higher that activation energy, the less likely that reaction is to take place. So enzymes, which people have heard, what's an enzyme? Do an enzyme or a catalyst will make that reaction more likely it lowers that barrier to Activation. So I think what we need in our life are catalysts, we need something.
1:07:21
NG. And unfortunately, I think sometimes it often has to be painful a loss to force us to do that. I make a point when I showed up in the first rehab place, I went to there is a, there's a woman that I met there who could sort of see from the look on my face that I wasn't happy to be there. She just said to me in a manner that was just so perfect. She said, hey, nobody shows up here on a winning streak, this is 100%
1:07:44
true. How did you help the people around you that you cared about?
1:07:50
Be patient as you went through your own Journey because I feel like it's really interesting. When we are trying to solve our own wounds and pain, it's already so hard, but because we've taken on responsibilities or commitments, whether that be in a marriage or as a parent, or even as a CEO or a boss or whatever it may be, it's like all of a sudden you have so many other commitments that you had taken on even before you realized you had to work on yourself. Did you?
1:08:20
Yourself helping them while you helped yourself to be around and be supportive as opposed to like tap out. And so you know what, we don't want to be around because I think we often look at like how a people helping us in our time of struggle. But sometimes it's like we already committed to them and then we realize that doesn't make any sense. It makes a ton of sense
1:08:39
and I will tell you I think it just speaks to how fortunate I am and perhaps why I feel. I have an obligation to talk about it which is I just think I was really lucky and that
1:08:50
The people around me, stood by me, and let me go through this and and gave me the chance to do it and stood by me because I don't, I don't think many people would have, I really, you know, I've said this to my wife many times, I described her as, like, you know, sort of Hall of Fame wife who didn't really need to stick by me. I think she had enough reasons to leave and take my kids away and just say to hell with that guy and that she didn't. I will forever pay that forward. And I think the same is true of people that I worked with who knew I was,
1:09:20
Going I think deep down believed that I was not a bad person. I was a good person who did very bad things and that I deserved another chance. I wish I could say I was supporting them on a journey, but I don't think I was, I think I was just reeling in pain and lucky that they stood by
1:09:37
me. Thank you for sharing that. That's that really hit me. That is, you know, don't expect people to catch you when you're falling but if they stand by you never let them leave your side because I think
1:09:50
I think most of us could probably the fortunate ones attest to that. I would say that about my wife to I'd say that about my parents had say that about the people that I'm surrounded by that. Sometimes I haven't had the capacity to help them. As I help myself, even though I intend to, but the problem sometimes is we do the Other Extreme where we demand them to help us. That's the balance, it's like the gratitude that you're displaying right now is actually like the right. I think a wonderful balance because we do
1:10:20
Rory, the go, I'm going to solve this myself and I don't need anyone or I want my family to solve my problems for me. Missing you like we live in one of those extremes and you're right you saying, well I tell myself, I did me. I didn't have the capacity to help then at the time, but now I'm just grateful and I'm humbled by the fact that they stayed here like there's some, there's some beauty to the and that really resonates. It's
1:10:44
probably four years after one of the events that I write about in this book, which was when my
1:10:50
Son, almost died. I was talking to Esther perel and I was just saying, I don't think I could ever forgive myself for what I did. And she said, that's okay. I think it's okay that you remember this for the rest of your life. I think there's a degree of humility you need to carry with you forever and I think that was really wise thing to say, right? Like I think it would have been easy to have said, no, no, you should just forget about this and move on but she's like, no, you should remember this forever. This is
1:11:20
Humility. You need to remember and she described it in a very elegant way which was you need to understand that. There's a monster in you and he's never going to go away. I'm confident you will keep him in the corner for the rest of his life but don't ever take an eye off him. Yeah. And don't ever think that just because you're better. Now. You're better for life. This is a constant process.
1:11:43
Yeah. And and remembering that there's a monster in you but you are not that
1:11:49
monster. That's right.
1:11:50
Yeah, he's over in the corner and you have the you are the one in charge of whether he stays in that
1:11:54
corner. Yeah. Reminds me I remember in my early experience of living as a monk. I said to one of my mom teachers, I was, I said, I just feel like I'll never overcome my ego, like, it just is too big. Like, there's, there's too much to deal with, and it's not that it's coming out in an externally gross way that it's manifesting. But I can't, I know it's there. You know, we've trained in self-awareness and, and I can see it.
1:12:20
And he said to me, yeah, it's always going to be there. Hey guys, it's not going anywhere and he said, it will always act as your anchor and ground, you and humble. You even when you soar to new heights, or whatever else, your life brings to you, that you knowing that it's, there is actually what will help you right? You know, stay grounded, which is such a beautiful reminder, as opposed to like, ego death. And we're gonna crush it and it's interesting with the health to write with emotional health, and physical health, that from what you said. The first thing you said today was
1:12:50
You know, there are certain things from the moment you're born that that's it already going in the wrong direction and we often think of like, how do I end this? So, how do I start this? How do I finish this? And it's like, well, most things are just in motion. They're not beginning or ending. They're just, you know, already happening. And, as you said earlier, we're trying to slow it down or we're trying to be aware of it where we're trying to monitor it. When you were speaking about your family there and you're talking about that emotional well-being, there's something
1:13:19
that came to mind. They were these two beautiful words you used, which one of them is used a lot but one of them not so much. We talked about joy and spontaneity and I love the word spontaneity. I think it's not used enough. When we talk about emotional health, Joy is used when the Challenger I find today when I'm talking to people is that, which so Overexposed to whether it's weather chemically with my dopamine or whether we're just talking about like Jo like fun pleasure. Instant gratification.
1:13:49
Which we've talked about for such a long time that everything feels boring. Almost, it's hard for people to get to a state of Joy or spontaneity. I find that a lot of people have a sense of, like, well, what's there to look forward to her like nothing's that great? It's okay. Like, you know, where as before and now it's like it feels like you've gotta up the result so hard in. The problem is even when you up it, like you're thinking that happiness is in.
1:14:19
In Europe on that yacht. Right. And it's like even if you got there, it won't actually even live up to that experience that you put in your mind, right? Because it was never about the physical manifestation of it was it was the idea that you've over exposed yourself to so much pleasure that now even the highest Pleasures don't satisfy or suffice. How do we work on that? Like what is the health and emotional version of approaching that problem? I wish I knew
1:14:49
And I think you're addressing one of the most important questions. And this is something I really struggle with because, you know, for me, I and I was just talking about this with someone earlier today. I think about the next decade of my life, this amazing time where I get to be with my kids, the most because, you know, as you're probably aware, the data are pretty clear that once your kids leave for college, the amount of time, you'll get to spend with them is quite small. I think it works out to basically,
1:15:19
you have a total of 19 years with your kids, 18 of which occur until they leave for college, and then one year is the sum total of time, you will spend with your kids, the rest of your life on average. So I look at that and I think I regret the time I've wasted so far, right? But so that's the stuff I talked about and now I'm here in the future. I think. Wow, the greatest source of Joy. I really experience is with my family.
1:15:49
That to me, is what spontaneity is, Right? Spontaneity, for me is an important. The reason I brought it up is I'm a very rigid person by Nature, like part of control for me, is rigidity deviating from my plan is a very hard thing to do, but I also realize it's a very important thing to do. So like I'm the kind of guy who makes lists on weekends, they do right? Like there's just every like there's a list of 12 things that have to be done on Saturday, and eight things that have to be done on Sunday. And you can imagine
1:16:19
In that, that that rigidity takes any spontaneity out of life. And one of the great things I've learned is how to screw the list. Sometimes the other day when I went to get, you know, had to go to Home Depot to get all the chicken wire to do the thing like that wasn't on the list that day, but I could see that my son was upset that the squirrels were eating his tomatoes. And I was like, you know what I mean? I'm supposed to be doing X, Y, & Z. Let's go to Home Depot. Yeah, I think, interestingly, anyone who does that, which I'm
1:16:49
Is everybody listening to this at some point can experience that? Those are probably the things that bring more joy than the yacht in Ibiza. It doesn't mean that you should never go on the yacht in Ibiza. Yeah, dang, good, just means. Yeah, yeah, I think it just means that don't dismiss the stuff that's right in front of you. And again, for most people I really do believe connection is that thing like just having intimate connection with friends and family, probably provides more of that than
1:17:19
Any of these other kind of material things. Yeah,
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1:20:55
And I think what you're saying is actually true and I want to clarify that point to that. I actually think that when you are not missing the simple things that are right in front of you, then when the big material thing is right in front of you, you won't miss that either. That's that's the point I believe like, I think that if someone is grateful for where they're at and what they see and what they experienced and are able to immerse themselves in it, then the same happens on vacation. The same happens on the yacht is hazard.
1:21:25
Thought experiment, like the idea is that the ability to experience a flower as a thought, experiment, in the most immersive way allows you to experience a garden, which allows you to experience a forest, which allows you know. It's, it's a you can't really fully experience the forest if you didn't know how to experience a leaf that idea of that much immerse. And I've and I've personally experienced both the presence and absence of those experiences where
1:21:55
Sometimes I'm walking up and down here or doing my morning hike, and you completely miss the view because you're on your phone, or even if your phones are not there, you're thinking about something. And then what and then second you look up and you wait a minute, like this was right there and so I think we all experience presence and absence and I found that beautiful. We think beautiful things will make us more presence but actually will be absent even in beautiful things if you're not present for the small things,
1:22:25
And I've seen that again and again and again and in your example I want and I'm just I'm only picking at this because I think there's so much lived experience in what you're saying and and the scientific background helps to it's like how have you also not ended up? Because it sounds like your kids and your family is just so important to you which is beautiful. And I think that's true for so many people but again I find that a lot of the people that I'm talking to a living at The Other Extreme where they like Jay I am so giving in to everything, my kids want to do, my family wants to do that. I don't
1:22:55
Even have any of my own habits and disciplines, right? Like, for you going to get chicken wire was a spontaneous moment of love for your son, who's worried about this project that he loves. Whereas for some people, all their living in is not spontaneity, but in urgency, and then they're not getting. I was speaking to a friend the other day and they were telling me Jay, I wake up at 6 a.m. but but what happened? Then I was kind of walking through their schedule with them for the day and helping them map habits and they were like, I don't
1:23:25
Know what? And I was like, well, when do you start cooking lunch? For example, that they as part of their day, they have to do and they were like 12. And I was like, so what happens between 6 a.m. and 12:00 noon? They're like, I don't know. And so, what do you mean? Like, you did not like that, six hours of Tumblr, where does it go? And then they were like, emails, phone calls, random people called random things happen. It's all like, I'm like, wow, you're waking up pretty early, which is amazing, but now, all of that six hours is just lost in kind of moving. How have you found that balance between, like, I love my children, I want to be there but
1:23:55
I also need to do everything I say in this book which takes time and energy.
1:23:59
I don't want to necessarily use myself as an example because I also realized like I have some really good things going for me, which is I have like an amazing spouse. And I have an amazing team and all of these things. But what everyone around me has figured out is, if you want to get the best out of me as a husband, as a father, as a friend, as a boss, as a colleague, whatever it is, if you want the best version of Peter, he also has to be well rested.
1:24:25
It has to be eating, well, he has to be exercising. He has to be doing the things that he has to do every day for his mental health. I am actually quite structured when it comes to that stuff because I'm very routined with how I do things. So, I do not take a single call or meeting with very rare exceptions once a month. There's an exception to this rule before 11 a.m. I am scheduled without a break from 11:00 to 5:00 every single day. So I
1:24:55
I have six hours of pure scheduled that I consider that not my time as my patients time. That's my team's time that's me giving 30 hours a week to everybody. I get up at about 6 from 6, to 11, is really sacred time. So six to seven is just coffee with my wife and playing with the kids. So my daughter of course, no, she's still sleeping but the boys were playing board games doing puzzles. Having coffee.
1:25:25
Doing whatever from 7 to 8 is work, just get the emails done, read, whatever I need to read etcetera etcetera from 8 to 11 is Hobby plus exercise. So every day I'm either in the simulator driving or shooting my bow and arrow and then I'm exercising from five till about 7:00 is family time. So I'm usually cooking dinner playing with the kids, go into you know Jiu-Jitsu whatever it is and then 9:53.
1:25:55
N is some combination of family time plus work and that's where there's has to be some flexibility. Like how much more work do I need to do and the price I pay for that is I have to work on weekends to write y because like I'm forcing the time to be spread out and so that means like yeah there's just, you know, there's other things I'm going to have to make sacrifices around but I guess my point of that is you have to kind of try to take hold of the schedule a little bit and sort of say,
1:26:25
There are certain things that are non-negotiable. So not exercising is a non-negotiable not having some time with my family is a non-negotiable. I rarely travel anymore, I used to travel 20 days a month, travel two to three days a month. Now, just very deliberate and conscious decisions about how I want to spend my time and the importance of, you know, taking care of my body in an effort, to take care of everything else. Absolutely no idea. And I definitely I agree. I don't think we want to use our
1:26:55
Ourselves as examples or, you know, as as the way to do it because everyone. So personally I think it's just useful, understanding that that structure is needed for that spontaneity. What might be more helpful for people to understand how I communicate this with my wife. So my wife is that person who will put everybody ahead of herself. So what I have to help my wife do is realize, hey, like, you need to go for a run to because that matters a lot to you and you need to go out with your friends.
1:27:25
Have drinks once every two weeks because that matters or you need to go and get a mani-pedi with your daughter and actually relax, I'll pitch in and do this other thing because I really feel strongly about you doing that. That's not something I would have done. Before before I would have just sort of said, hey, it's awesome, you're doing everything great. Yeah. So I think is a spouse. You want to sort of really understand that as true as that is for me. It's just as true for her. I
1:27:50
think that's the key thing in a and I we don't have kids but I can definitely say no relationship level. It's
1:27:55
like just because your partner can do something and is doing something doesn't mean that you should just accept that as reality for the rest of the time. And I see that that's one of the biggest challenges in relationships is people feel like their role is assumed because of what they've done in the past but no one checked with them as to whether they were okay, continuing to do it or whether they felt good doing it. And we think, well, they should tell us. If they don't like it, they would tell us. Like, I would tell them.
1:28:25
But often you find that someone? So ingrained in playing a role that they've even forgotten that they have needs or who they could be, or can be, or they feel this overbearing burden or urgency in their role that they just can't disconnect from it. So yeah, I think that's a great point. I lie, Peter, I mean, there's so many I really do want to talk to you, if you still have the time, I really do want to talk to you about cancer and maybe I'll Summers as well, because we went on a different direction which I wanted to go into.
1:28:55
Which I loved but I want to talk to you about cancer just because I lost I've lost three people in my life to cancer. I lost my uncle who has my mother's brother when I was around.
1:29:09
Gosh, maybe I was around.
1:29:13
Let me just about to be 18 or something like that. He had throat cancer and it was tough to see him go through. That is the first time someone in my direct Circle, I'd kind of witness the Journey of someone like, struggling going through pain. And then, you know, dying, a young age. He was like 57 years old. And then I saw my one of my probably my closest friend, who I lived as a monk with and he was still a monk when he passed away.
1:29:43
He had colon cancer and hope he was like my age. Like he died two years ago now. So like that is a bit old man. Couple years old. It's like 35 around around there about I believe some of that was genetic which we found out afterwards, or like during the process. And he went through tons of cycles of chemo and like he tried everything like that guy, had spirit and resilience and everything in it, you know, it was tough. And then I lost my spiritual mentor to bring.
1:30:13
Cancer in the same time, frame during the year of covitz. I also missed both of these people's funerals because I couldn't go back to London because you couldn't fly at the time. So anyway, all of that to say, I've just lost so many people to cancer and I think that's just not uncommon which is even throwing worse in one sense, like think everyone who's listening is like yeah Jamie too. And so I think it's so important to talk about because I don't know, was it one in three one end to is it I don't know what the stats are.
1:30:43
But yeah, I was it so common because it's so normal now and just someone having cancer, but at the same time, it's the most painful news in the world because you kind of feel like, you know, where it's going to go, what have we seen as proven ways of preventing and confronting cancer, both holistic and you know, traditional medicine, you know, the way I sort of think about it is there are three things to be thinking about three, three categories. So, the first, as you said is,
1:31:11
What steps can you take to prevent cancer? The second question is, if you get cancer, how can you catch it as early as possible? One thing we really do know is that if you treat a cancer earlier, your chances of, beating it go up and the longer, you wait to treat it. Meaning the later you catch it, the worse, your odds. And then, the third question is, if you do find cancer, what are the ideal treatment strategies will start with the first question? And this is the least satisfying, because
1:31:41
We don't know a whole lot about what's causing cancer. So we know two things for sure. We know that smoking is a Big Driver of cancer and we know that obesity is a Big Driver of cancer. Now, obesity is a bit of a misleading term because it's just kind of a overly simplistic way to think about what's actually happening.
1:32:03
The data say obesity, but really what it means is insulin resistance and inflammation. Those are two Hallmarks of obesity that are present in seventy eighty percent of cases of obesity. And if you look at the data more closely that's what's actually driving cancer. So it's not actually how much fat you have on your body. It's more how much fat is in certain parts of your body that are metabolically problematic. But after those two things smoking,
1:32:33
And instead of obesity, I just prefer to say poor metabolic Health, we have someone off examples. We know that there are certain types of exposures pesticide, you know, certain types of pesticides, for example, certain type of toxins, but those don't account for the significant majority of them. So for many people, cancer is still a mystery. In other words, whatever it cause whatever caused the initiation of the genetic mutations, that ultimately led to a cancer that the body was not able to on its own remedy is still a bit of a black box.
1:33:03
Box and some very prominent cancer biologist actually just argue that it's bad luck. In other words, it's a stochastic process. So our genes are constantly replicating but when mistakes are made, mutations occur and some of these mutations Drive cancer, and there's broadly speaking, two types of mutations. There are mutations in tumor suppressor genes. So, these are mutations in genes that are there to stop cancers when cancer is appear. And then there are mutations in what are called, oncogenes These are
1:33:33
The propagate cancer. So, mutations in any of these things can actually lead to cancer. So once you sort of accept that you're going to do everything in your power to not get cancer, which is to say, you're not going to smoke, you're going to be as metabolically healthy as possible, you're going to exercise sleep, do all those things, right? The next most important thing is thinking about your strategy for cancer screening. You know, this is where I probably differ significantly from the mainstream establishment view, which is actually kind of, you know, not that aggressive.
1:34:03
Sivan cancer. Screening, I would argue that we have to be very aggressive on cancer screening provided, we can get our minds around the problem. We discussed a little while ago, which is we understand that there is going to be the harder. You look for something. The more likely you are to find something that isn't relevant. If you understand that going in and you're willing to accept that risk and evaluate each finding in a thoughtful way. I think that for most people psychologically, and physically, the benefit is, is a net positive.
1:34:33
Of one it.
1:34:34
And so that means looking at things that are, for example, with a colonoscopy doing it earlier and more frequently than is the standard recommendation, as any recommendation is not to begin till you're 45. We would recommend that everybody even without a family history. Begin at least five years before that. It also means repeating colonoscopies more frequently especially in the finding of certain types of polyps whole body screening you talked about with certain types of MRIs, we also use something called the liquid biopsies. What's a blood test? That looks for really, really small fragments.
1:35:03
Of DNA in the blood and can identify the presence of cancer and the tissue of origin. Now, again, none of these tests are perfect so each of these tests have things that they're going to miss. But the idea is that the more you're layering these tests, the better your odds are finding something earlier. And then the final point is okay, well, what are the strategies we, you know, if should you have cancer? And this is where I think we just have a little bit more promised now than we did a decade ago. So, a decade ago because it was the first time I did this analysis in the previous 50 years. So from,
1:35:33
Do you know 60 years ago? Until 10 years ago, the overall survival Improvement in cancer was about 3%. Wow, is abysmal. But in the past 10 years it's been about another 8 percent. And while that doesn't sound remarkable, and the implication of that is half, the people who are diagnosed with cancer today will still die from cancer. It's the biologic insights, and the trajectory that were on right now that gives me much more hope and that is primarily based on
1:36:03
A couple of things. The first is, the field of Immunology has really taken off the tools that we have to harness the immune system to attack cancer have become so
1:36:15
dramatic immunotherapy. That's right.
1:36:18
That it really is I think within the next decade which I know seems like an infinite amount of time for someone who's got cancer right now, we're really seeing changes that I think are going to allow immunotherapies to go.
1:36:33
The niche place that they occupy in only working for certain types of cancers, like melanoma and kidney cancer to being able to go. After the Holy Grail of cancers, which are what we call the solid organ epithelial tumors. Rest pancreatic colon lung. These are the big cancers that do the majority of the killing 50 percent of cancer. Deaths are just five cancers, lung, colon breast, prostate,
1:37:03
eight pancreatic. That's more than fifty percent of all cancer, deaths until you have a solution. For those we're not, we don't have a solution, I can sir good. And I do believe that we are really moving in that
1:37:15
direction we've touched on this point, a few times of almost the stress about stress for health. And that's a really interesting way of thinking about, it's like the stress of all. I need to work out today. The stress of, I need to have my supplements to the stress of, I can't sleep. Why am I not sleeping, right? Like we stress about the things that are good for.
1:37:33
Us how have you helped your patients? Have you coach them through that? How do you guide people through that? Because I think a lot of people go well then I'm just not going to do anything because at least then I'm not stressed. I don't think that's the wisdom employer saying. I don't think you saying well yeah it's better not to have any stress at all. How do you help people to engage and you know use that stress in a healthy way or how do you guide patients through that stress? I mean I think every
1:38:02
patients different and I think
1:38:03
I think you have to sort of get to know the person a little bit and figure out what what's the underlying issue. So I do think that there are a lot of people who frankly self-sabotage going back to kind of like where I was. I mean my self-destructive behaviors, weren't coming directly at the expense of my physical health. They were coming at the expense of my emotional health, but I actually think there are a lot of people who have very similar stories to mine, but their manifestation is, it's coming at the expense of their physical health, they are sabotaging their ability, they
1:38:33
They're coming up with a million excuses, why they can't eat? Well, they can't exercise, they can't do this, they can't do that. And so you have to be able to get to the root of the problem. And so there are many patients where we just think, look, you're not going to get better without trauma-based therapy like until you come up with a way to care enough about yourself, to stop punishing yourself in this way because I do, I think people punish themselves in different ways. You could almost argue I used to punish myself by overdoing
1:39:03
All of those healthy things. Like some of the exercise I was doing, was actually a form of punishment. So, on the surface, you'd say boy, that guy's really healthy, but no, he wasn't. Another thing I always think about is when we're in the spirit of trying to build new habits, sometimes perfect is the enemy of good. Typically what I want is a win and I think that what people just need is a win and it doesn't have to be the biggest win. It just has to be om. So if you're looking at a person for whom nothing is optimal, don't try to fix all things at once.
1:39:33
Pick the one thing that you think they have the greatest odds of being able to make a difference on and just work on that and accept the fact that the other things will continue to be suboptimal, but you develop their confidence in that one thing. How about for 20 minutes a day? You do something active, you go and walk for 20 minutes a day. If you're talking about a person who's never lifted a finger, that would be a huge win, and you might do that before you get into the details of this type of training or that type of training, or we're going to tweak your nutrition and optimize your protein intake.
1:40:03
Take, I mean that's just overwhelming and you're probably just more likely to fail at everything and create kind of a compensatory negative reaction. But again, I don't think there's a paint-by-numbers approach. I think you in the way we do it with patients, I think you just have to treat everybody individually. And by the way, when something's not working, you have to accept it and pivot and try something that
1:40:21
is I think that's the key word pivot. Yeah, as a keyword, everyone, Peter idea, the book is called outlive the science and art of Longevity, if you don't already have it, please go and grab a copy.
1:40:33
I highly recommend are, of course, today's conversations, been fantastic. I've tried to touch on topics that Peter may not have been asked about a million different interviews. He's got fantastic interviews out there on so many awesome podcast as well. So if you're more interested in the pot we didn't cover, please do go and watch those and get informed Peter. It's been such a joy sitting down with you today. Honestly, there's been moments where I've been mind blown and moments where I've been taking a back and felt really, you know, in my body and really present where my feet are. And I'm just
1:41:03
Really grateful that we got to have this conversation. We got to share so much, incredible insights with our community today and I want you to make sure that you tag me in Peter on Instagram on Tick-Tock on threads with what you're learning, what you've taken away, one of the things you're going to apply and practice with what something you're going to experiment with this week. That would make me really happy. Is that you just take one thing away from this. And you'll, I'm going to try that out. Got to figure this out for myself. That would be an awesome place to start Peter. We end every episode with a final five.
1:41:33
A Fast Five. So these questions have to be answered, in one word, to one sentence, Max. So, Peter did these are your final five or your Fast Five. The first question is, what is the best health advice you've ever heard or
1:41:46
received exercise every day?
1:41:48
Second question, what is the worst Health advice you've ever heard or received do a cleanse? I interesting why? That's it. Yeah, okay. Oh, I just think that you know I've seen I've seen some of those things go really bad where people you know get really.
1:42:03
Fucked up and dehydrated and I've seen people actually taken some chemicals and compounds that dramatically alter liver function tests and things like that. Wow, okay. All right. Question number three, what something you're currently trying to unlearn continuing to work on perfectionism unlearning or D tuning? It question, number four, what something? That you're a very big proponent of but a lot of people may disagree with you and you're like, I'm not sure about it, maybe the importance
1:42:33
Of very heavy strength training in postmenopausal
1:42:38
women. Interesting let's dive into that because that's that's fascinating, I'm real specific un. That's
1:42:44
great. Women post menopause are so unbelievably susceptible to osteoporosis and osteopenia with the loss of estrogen. Unfortunately, many women in that situation are not getting hormone replacement therapy and so they're doubly susceptible to it. I think there's just a cultural belief that, you know, women don't need to lift weights and if they do
1:43:03
It's very light, but the truth of it is, you really need to lift heavy things to make your bones stronger. And that doesn't mean it has to be complicated stuff. Like squats or deadlifts, or things like that. But, you know, one of the most important things is carrying doing a farmers carry. So holding very heavy dumbbells in your hands and walking so important, and it doesn't matter how old
1:43:23
you are. God is great. Fifth and final question, if you could create one law that everyone in the world had to follow, what would it be?
1:43:31
You must go.
1:43:33
Into nature for at least an hour a day with no
1:43:37
electronics and just
1:43:39
be, just be outside, be in nature, but be untethered to electronics or obvious
1:43:47
distractions. Beautiful. Hey, that's fantastic. Thank you so much again for your time. Your energy your presence today. I hope this is the first of many times that you come back on on purpose. And again, if you don't already follow Peter Peter, where's the best place? You'd like to be able to find you. I know you are.
1:44:03
On Instagram and YouTube and everywhere.
1:44:04
But, yeah, I think everything is Peter. A TMD is all the handles everywhere. And so, thank you very much. I really appreciate this. Thank you.
1:44:11
If you loved this episode, you will enjoy my interview with dr. Daniel. Amen on how to change your life by changing your brain. If
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