Ep 534 - Outlive (feat. Peter Attia)

Wow, wow, Wes.

Dr. Peter Atiyah, dude, thank you for coming.
Thank you for doing this. Thank you for doing this.
I'm really pumped. I read your book, so I'm kind of familiar with yourself.
Oh, thank you so much. I kind of like what you're about.
Thanks for having me. Thanks for doing the podcast.
And I guess I'll give you an introduction and correct me if I'm wrong. You were a medical doctor and you did cancer surgery, right? A general surgery with a focus on cancer.
With a focus on cancer. And then you of i like your origin story a lot and so from what i remember in your book you did this big swim like right it was like a marathon swim or something and how far did you swim uh it was about 21 miles that's insane so you did a 21 mile swim and then if i remember correctly you were eating a cheeseburger in celebration and your wife that was a slightly longer swim but yes yes now I know the story you're talking about okay yeah that I that honestly dude that made me laugh so hard that you did like a what I think that was like 25 miles or something 25 mile swim you go out to have a cheeseburger and I believe a coca-cola yeah and your wife more or less was like you're fat yeah dude that's the best and then you it launched you and then you just got the ultimate revenge it started like a super successful business how do you feel she was very sweet she said she just she didn't say your fast she goes you need to work on being less not thin that's worse though i'd rather someone be like you fat ass and be like you need to be less not thin but you just swam 25 miles yeah well that's wonderful though that is good though to have a woman to push you to those heights because then that's is that really like the genesis of you kind of branching out into like um i had actually already left medicine at that point i had been out of medicine for three years i was working at that time god what was i doing i was working at an energy company i think or maybe i was in finance or something.
I was, but I was like, I had nothing to do with time. God, what was I doing? I was working at an energy company,

I think, or maybe I was in finance or something. But I was like, I had nothing to do with medicine.
But that was right around the time my daughter was born as well. And so I think that was kind of the one-two punch.
It was sort of my daughter's born. And then I'm realizing actually, like, I'm not that healthy.
Even though I exercise a lot, I'm actually not that healthy. and that that those those two things were what kind of got me to be pretty obsessed with just trying to figure out how to not die prematurely the kids do that i have a two and a four-year-old and that really kind of i i actually thought you'll find this interesting i thought i was healthy i did all i was doing the um you know all these apps like i did the one where you like mail your poop and all that stuff and i did that it came back like dude you're like six years younger biologically i was like this is awesome did i had the fucking the aura thing i had that going on telling me i'm seven years younger than my age and then i took a blood panel dude i'm like pre-diabetic i was like what the fuck man it was like i thought i was like killing it i got it back and it was like i literally just found out two days ago so this this timing couldn't be more perfect my a what is it A1C, I think it was.
My A1C is like 5.7, which was like, but I did eat two bites of a pancake before my blood work, which I'm not supposed to do. Shouldn't impact the A1C.
Damn it, dude. I was fucking hoping that was the answer.
Yeah. So that is kind of crazy because you, and again, I don't, you know, I'm not the definition of fitness, but I'm not like, I wouldn't think, I thought I had the almost type two diabetes.
Well, it takes a while. Like you don't, no one wakes up diabetic, but also most people don't kind of don't recognize that it's a 10 year journey for most people.
Really? To get there. Yeah.
So what? I have like four, like four more years of pre-diabetes. I mean, I think that's impossible to predict for any one person, but, but we, we definitely know that disease is so much more complicated than people, I think, historically have thought of it.
People have historically said, well, I mean, type 2 diabetes is your pancreas can't make enough insulin, you can't get enough glucose out of your blood into the muscles, and eventually we just cut off some arbitrary number. We just say once you reach a certain level of blood glucose, then you have type 2 diabetes.
But, you know, to me, that's just not a great way to think about it. I think of it as a continuum and a spectrum.
And pre-diabetes is a step along the way. But we also know that the lower your blood sugar, the better.
So 5.7 is better than 5.8 is better than 5.9. But even though we would call you quote unquote normal at 5.6, I would argue five is much better than 5.6 gotcha i see what you're saying yeah yeah it was like for real joke because i was like dancing in the end zone on my wife because she's she is her biological age and i'm not rubbing it in but it was like whatever and i was like i'm five years older than her so i was like her peer biologically and i i was laughing you know i was these biologic clocks things are such a such a scam it is incredible i love it no i love it i love it it's brilliant marketing it is brilliant mark i woke up one day and i went like i lost half a year of my biological age i was like what the fuck did i do i like start went into a panic but yeah so the uh that was like a real revelation for me i was like holy shit man because my dad has type 2 diabetes and i was like yeah that's on him he eats ice cream all the time i'm healthy and i like got my blood work and i was like son of a bitch by the way i'm just breaking this right now i don't i don't this is breaking news this is breaking news this is this is like so timely i have free and i was actually it is very timely and i have been leveraging it emotionally in my household which is nice anytime my wife bothers me i'm like dude i have pre-diabetes this cortisol is going to mess up my insulin.
So I got a text message literally on the way over here from a buddy who just got a vasectomy yesterday. And we had recommended the urologist to him, who was going to do it.
So he goes, look, I just want to tell you, man, literally the best experience ever. The guy was incredible.
So funny. You know, he's got me draped like over the table.
So like, you know, he's like, there's a dra laying on my back like a c-section they do like they don't let you see yeah it's like you're sterile i want to keep you sterile right gotcha and the guy walks in the room first time he hasn't seen me doesn't see my face he just sees my my schlong and he goes oh i remember you but he was like but it was just all jokes and he's so he says today he goes you know look honestly zero pain at all uh but don't tell my wife i am going to milk this is 10 out of 10 pain for another week so important yeah yeah yeah so also the vasectomy you can't ejaculate for like what seven days or something that's a good question i don't know how many days i don't know how many days i don't know like seven my friend did it he uh he had to hold off yeah seven whole days and he said he went a little prematurely and said he had a little bit of pain so that's not good but yeah dude so that's that was kind of crazy man because again i've been doing all the the services because i haven't i haven't like been to a doctor forever because i'm like you know i go to it and this is i think was cool in your book you have like what was it health care 2.0 versus like three what was the latest yeah medicine 2.0 versus medicine 3.0. Yeah.
So 3.0 is kind of where

you're at. That's kind of more cutting edge.
2.0 is like what a step up from like medieval humors and yeah, but, but still important. I mean, we still want medicine 2.0 medicine 2.0 will take care of a problem when it shows up.
And if you, you know, if you, if you're in a car accident, you break your leg, you get pneumonia, you want, you want someone who knows how to deal with those problems. But it's a very different system from, hey, how do I take a guy whose hemoglobin A1C is 5.5, who no one, everyone thinks is just perfect, but I think he's on the path to actually being diabetic in 10 years.
And why would I wait till he's staring down the door when I could just make the changes now? And that was kind of my beef with doctors. I would go there and they and they're like nice i don't have anything against them but i go there and they're just kind of like yeah cholesterol is good and i'm like this is all we're worried about like this is it's and then they lowered the window to like blood pressure the one day i went in there and they're like oh by the way uh high blood pressure is lower now i'm like okay i didn't have a blood pressure problem but it's like i just feel like you go there and it's like, you're like a car.
You go in and they check like two things. You're like, man, you're good.
But so I really liked your book, how you're like, you want to check for more things and try to increase the health span, not just the lifespan. Because a lot of people are very unhealthy.
I thought I was a poster child for health, dude. I'm one of the suffering Americans.
I need Michelle Obama to come make me lunch, dude. I'm fucking fucked up right right now so what are you working on right now because the book has anything changed from the book and again correct me if i'm wrong but the summary was like the four horsemen that's the things that the four leading causes of death and there are what heart disease cancer cancer neurodegenerative diseases and dementing diseases like alzheimer's disease and metabolic disease that's me that's diabetes right and they overlap so when you have type 2 diabetes your risk of those other diseases goes up by 50 so that one sort of feeds into the other and also if you have cardiovascular disease your risk of dementia goes way up so oh really oh yeah damn that sucks yeah and you know what's weird too because i don't want to turn this into like a personal doctor visit but like i for real had like crazy brain fog like i couldn't i was like messing up recalling words and a lot of my my mom's side had um like dementia stuff when they got older so i started being like damn i might be like getting like early dementia and as soon as i learned about the high a1c and i don't know if that's like high enough to cause brain fog.
Like I was like, forget it. I forgot the word croissant.
I was like trying to think of that word. Couldn't think of that.
But I, as soon as I got off all the carbs and now I'm like basically doing like keto, my brain just like came right back to life. It's pretty nuts.
Yeah. I mean, I don't know that that's related to the A1C per se, but fluctuating levels of blood glucose are, make it just a little more difficult.
And some people are more sensitive to it than others. Some people, you know, they can eat all the carbs in the world and it doesn't seem to faze them.
And a lot of people are like, no, the moment I go to slower carbs or just no carbs at all or just more complex carbs, my energy levels normalize and so too does my attention. Yeah, dude, that happened for me.
And I also don't have to eat as much like i was eating so much man it would be like four cups of rice i mean i was just picking out yeah and then i as soon as i stopped eating that much carbs i eat like two meals a day and they're pretty like sparse so tell me about these pictures here oh thank you man um this i just figured it was funny it's just kind of like a um just an ample naked lady sitting at a picnic. So I literally picked the pictures very quickly.
This one, I just wanted very intense imagery. Yeah.
And so this is kind of like, you know, this is pleasant. It's a little complicated.
What do you think is going on here? Why is she naked? And who are these guys? These guys are up to no good for sure. I think these guys, it looks like they just got happened upon.
And someone's going, what the hell are you doing with that ample naked lady in the park? And this guy's like, I told you. But he's like fully dressed.
Yeah. Who's the girl in the background? So to answer your first question, this is a clothed male, naked female.
It's a fetish. That's going on.
And I think she's kind of like next. I think they're like, get over here.
Strip down so we we can have a naked picnic this caused a serious uproar back in the day when he this guy painted this it was a problem i believe i mean i can see why they they were like if you had someone pose this lady had to have been a prostitute and they're like that's totally scandalous yeah what year approximately was this i wish i knew i don't know if i had a guess i would say like maybe the 1800s i had a guess i could be wrong and that guy i don't know what that guy's hat's all about over there but yeah i mean it's sort of i don't want to profile him but but i have thoughts true it is a hat i don't recognize that hat and i do have my own suspicions as well but yeah i don't know i don't know if he's like i don't know what's going on he seems kind of distracted i think he's being caught she's just kind of getting caught there's just a lady in a pond maybe just kind of floating around oh that's interesting so i see that now i thought she was picking up apples but maybe she's washing her hands well in the pond you know one could only guess why but the uh but yeah so that's that was cool i thought that was a fun one this is very intense i like this and then, you know, toss a little crucifixion up there. Yeah, it's the rainbow crucifixion.
I don't know my biblical history well enough. I would embarrass myself if I asked dumb questions.
But is there a rainbow after the crucifixion? I would hope so. You know, God was rising back to heaven two days before, so I'd hope that.
No, I thought it was three days after this. Three days, my bad.
Three days, three days. Yeah, so that foreshadowed maybe the resurrection.
Could be, yeah, could be. But I honestly don't know.
I don't have any real knowledge. Can you imagine how brutal the world was when we crucified people? I think about it all the time.
How lucky are we to live in this candy-ass world of soft dude i try to tell it to people i have people tell me i'm so grateful it's insane because i try to tell people i'm like dude it was way different and other people like like those guys were thieves right yeah like that today you wouldn't even go to jail in most cities yeah they'll kill you and then you get crucified yeah and it also the procession was like a pretty nasty part of it just get walked through the streets spit upon rocks thrown at you i just i can't i can't fathom dude the social anxiety and by the way that's only 2 000 years ago which in the arc of human history is yesterday nothing that's nothing that's what i try to tell people man because there's a lot of people are like everything's always been the just different variations on the same themes. And I'm like, dude, it's gotten so much different from 2000 years ago.
It can still get so much different. Think about 500 years ago, right? Think about if you could be you or you could be the king of England 500 years ago with like, you know, now it sounds great until you get like a dental abscess and you realize there's no AC, there's no heat.
The food sucks. Yeah.
Like, I don't think you're going to be the king of England 500 years ago. The food still sucks in England.
Yeah, that's a good point. It's probably pre-fish and chips.
Yeah, that would actually suck. I never thought about being like the king of another country.
But it would be pretty there was a king in uh some medieval time like longer ago than that but they thought alcohol was like health stuff back in the day it was like the spirit it kind of was because water was so contaminated right yeah so you basically had two broad cultures that emerged from either the fermentation of alcohol of water right and alcohol to make to get rid of the bacteria or tea right you have sort of the the rise of the sort of tea culture where you boiled water but yeah the idea that you were just going to go and drink water was like i mean the fact that we're sitting here drinking this is yeah incredible it's pretty tight actually but yeah they had a king they uh they they were like they rubbed him down in like brandy maybe and then they were like all right we're gonna like rub this all over his body and like a candle got too close and just burnt the guy alive and all the high priests or whatever had to be like oh you must have been fucking evil yeah it's fucked up no one no one put two and two together they didn't understand exothermic chemical reactions damn dude so so let me ask you this what is your the gist of your book is basically And again correct me if i'm wrong but the gist was basically like we can pre-screen better and we can kind of promote wellness rather than waiting till somebody has like a horrible often irreversible disease and like try to fix it through kind of like nuking the yeah and and part of it is like you know what gets measured gets managed and so medicine 2.0 measures lifespan as the ultimate outcome, which is, that's been productive. That's, that's a good thing to measure.
I don't, I'm not suggesting we shouldn't care about lifespan because 150 years ago, lifespan was 40 years. Today it's 80.
That's insane. We doubled lifespan and that's all due to medicine 2.0.
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Oh yeah. Basically figuring out how to not kill women when they gave birth to children, how to keep babies alive when they were born, how to fight infections, how to wash our hands like that.
And then a little bit of stuff around trauma and critical care, like you doubled human lifespan, but we're not managing healthspan.

And so part of the argument is, okay, we've done pretty well on lifespan. We could do better, but we really have to manage healthspan.
And so if we think about things that make up healthspan,

it's sort of like, how much muscle mass do you have? How strong are you? How much endurance do

you have? How much flexibility and balance do you have? How quick is your cognitive performance? How happy are you? How are your relationships? How much joy do you have in your life? These things are softer and squishier. Some of them are pretty easy to measure, like VO2 max and muscle mass and strength.
Some of them are harder to measure, like cognitive performance. But if you don't measure something, there's no chance you're going to manage to it and i would just argue we have to we have to slightly tilt in the direction of doing more on that front yeah it'd also be cooler to go to the doctor and have him like hit the treadmill let's check your vo2 max yeah let me see how long you can dead hang for let me see your grip strength i'd be so much better than sitting there and just being like basically getting molested and leaving that's that's all you do you go there and they're like all right we're gonna what what is the coughing why do they do that why do they call hold your it's funny i thought you were gonna ask me to do it to you earlier when you said this is not an appointment i literally thought you're gonna whip your junk out and now check i'm just going just for the a dude you got to do the butt um it's they're checking for a hernia is that what it is yeah yeah well why is that like the, exactly.
There's so much other things to check. It's like, we're not going to do all this other stuff that would be useful.
We're just going to grab it. We're not going to look at a bunch of things, but I do want to stick my finger in the inguinal canal.
That's what I'm saying. Yeah.
And I'm going to make you cough. I'm glad they do that, but it's like, why did that get picked as opposed to all of this other stuff you're talking about? Do you think it has something to do with like, just like institutional, just repressed

homosexuality throughout the entire culture?

And that was like, I don't know.

But I will say this, like, I can't tell you how many rectal exams I've done.

And then I realized like, I mean, technically, a good a good urologist will tell you that

their finger is good enough to truly feel a prostate cancer that would otherwise not be picked up on a PSA or some other test. And I'll take them at their word.
But I think for the rest of us who don't do 20 a day. Yeah, I just I don't think my finger is good enough.
You know, don't say that. I mean, I'll work harder.
Yeah, that's crazy. So they're saying they can just feel like it just they've said like, look, man, you know, there's always that one case that slips through the crack where the guy has a normal PSA, no pun intended.
So they can tell. Yeah.
But they're like, yep, if you feel a certain type of super hard nodule on the prostate, that would be suspicious. Damn.
Yeah. Yeah, that is I do.
I think they really could have, you know, if doctors would embrace that, it'd be so much more fun. You go much more fun you go you kind of run on the treadmill dead hang you know they talk to you a little bit about it just seems so kind of sterile plank yeah there's like a bunch of basic tests everybody should be able to we should be able to see the people do i completely agree yeah i know that's so i i did really like your book for that reason hopefully that kind of stuff takes so what is so if that's the scope of the book where do you stand now is anything that time? Or is there anything that's like latest and greatest that's kind of like blowing your mind right now? I think my thinking is always evolving.
I would say, um, if I were writing that book today, I would actually kind of add a fifth horseman, um, which is anything that pertains to a weakened immune system. Um, so I'm just getting over a cold because I have three kids and two of them are young.
So basically I'm always in the, I'm always in the face of like some virus, right? So twice a year, I always get some stupid cold and it's no big deal. You know, I, it starts in my throat, blah, blah, blah.
It gets into my lungs. I hack up a bunch of junk and then I'm fine.
But you know, anyone who's been around older folks realizes that that's the kind of thing that can tip them over the edge when they're 80 years old. You know, a really bad infection, a flu, COVID, things that us, you know, 50-year-olds laugh at can become deadly.
And so from a research perspective, this is something I'm super interested in is how do we regenerate the immune system? So, you know, I'm in my 50s, my immune system is also in its 50s. Would it be amazing if when I'm in my 80s, I could still have an immune system that's maybe like in my 50s or 40s? The effect that that would have against, you know, mitigating the risk of fatal pneumonias, infections, and even cancers is huge because the immune system is the first line of defense against cancer.
Oh, really? Yep. Didn't they used to use like fevers for that too?

They would induce fevers to try to kill certain types of cancer? Yeah. And it wasn't very

successful because it's so nonspecific. Oh, okay.
Yeah. Cancer is the only way for the immune system

to eradicate cancer is it has to, you have to get the very, very, very specific T cell that

recognizes exactly that cancer. And you have to figure out a way to make enough of them that it,

you know,

you know, wins that war. And that rarely happens spontaneously.
I mean, the cases are, you know, documented in the literature. They're so rare.
But we now have drugs that can make that happen in about 10% of cases, which is huge. Yeah, that's pretty crazy.
So how would you, how would you, what's your research yielded? How do you think you can bolster the immune system or like, I mean, it depends. I don't know how technical the audience wants to get into this stuff, but so, so stop me when this has become unbearable.
For sure. So the, you know, we have DNA.
Okay. Okay.
So everyone's heard of DNA. DNA is the code that tells every cell how to make a protein.
So what tells DNA to turn on and off are something called methylation, little carbons that stick on the backbone or something called the epigenome. So DNA is regulated through this methylation pattern.
And as we age, that changes. Gotcha.
So we can look at a T cell, which is the type of cell that fights a cancer or an infection, and we can say, that's what an old one looks like. That's what a new one looks like.
Even though the DNA is the same, the epigenome above the genome, this methylation pattern looks different. And so the question is, what if we took the methylation pattern of an old T cell and made it look like a young T cell? Would it revert into a young T cell? So to me, that's certainly top two or three most interesting questions in aging research today.
That's pretty cool. And that makes sense because it's like the DNA, you're born with it.
And then the epi layer, that's like the kind of like pattern that's affected through the environment. That's what regulates it.
Exactly. Yeah.
And then so if you can kind of get into that and then so you could and it was stressed, too, because I noticed that was a big thing in your book. So and you can stress yourself to the point where your epigenome will just start being like everything, everything in the environment can affect that.
So it's affected just naturally through aging. So the passage of time affects it, but so does anything in the environment.
So whether you exercise, whether you smoke, whether you have diabetes or not, all of those things, good sleep, bad sleep, high stress, low stress, anything can tweak that in the right or wrong direction. Damn.
Okay. That's pretty cool.
But the gravitational pull of age is huge and that's the one i'm most interested in is like how would you because even the healthiest 80 year old has nowhere near the immune system of an unhealthy 30 year old yeah yeah and we also we saw that everyone was hoping against hope that mike tyson would just knock out jake paul and that was kind of like a bitter moment for a lot of people yeah you can't like age age is not like just can't do it yeah as father time is undefeated as everybody said yeah even with the even with like the trt what are your thoughts on that like in terms of like you know what age to kind of smash the glass and just go full upgrade i don't know that there's an age i would do it i mean i think the things that i would you know i had a long talk with a patient yesterday about this exact question and he's pretty young. He's like 36, um, does not have kids, but wants to have kids.
So that's a huge consideration. So in his situation, I would say like TRT is not a good idea.
Um, I, I suggested that he bank sperm and if he wants to go down that rabbit hole, and by the way, I don't think he needs to, cause I don't think his level, his levels are like kind of 50th percentile. He's not terribly symptomatic.
I would kind of eke out a bit more time, but I would rely on hormones that are going to ramp up his body's production of testosterone as opposed to just giving him testosterone, which will shut off his body's supply. Forever? No.
And it also, it's not something that happens overnight. Like, you know, he'd have to be on testosterone for a while before he would shut down his own production yeah so what are your thoughts on that on like that whole thing especially for 30 year olds do you think it's like good to kind of have that or you think it like should be kind of a long road i think you gotta i think you gotta you know take every case individually but if a 30 year old has his has testosterone that is so low that it's impacting him, I think you have to start by asking why.
Like, how bad is his sleep? How bad is his stress? How bad is every other factor going on? I mean, when I finished, God, when I was, you know, leaving my residency, my testosterone was 227, I think, which is insanely low. That's, you know, that's only two and a half times higher than a woman.
What? Yeah. Is that why doctor's hands are so soft every time I shake them? Damn, that's crazy.
That's for the rectal exam. So you just don't get the- That's true.
That's true. You wouldn't want to like my dad's- No, the no the um and and but the reason is pretty clear right because i was sleeping 28 to 30 hours a week damn right so you know horrible sleep deprivation is going to make it really difficult to make appropriate levels of testosterone and that makes it harder for you to sleep too when your testosterone gets lower i think probably a little bit but the causality is much more in the opposite direction.
Meaning the horrible sleep is destroyed. I see.
The production of testosterone and growth hormone. So, but of course at the time it never occurred to me to do anything about it.
You know, and once I, you know, was in a job where I could actually sleep each night, lo and behold, my testosterone kind of normalized. It peaked up.
Yeah. What do you think that's a good thing for people to actually

look at? I always get the feeling that like if you even go into one of those places, they're

going to hard sell you and you'll be on the T like before you know it. I think you should not go to

I'm trying to think of the right analogy. If, if you, if you walk into a store that, uh, only sells hammers, everything's a nail.
Yeah. Right.
So, so I, I think if you walk into a tea shop and all they do is male hormone optimization, I would say buyer beware because they, even if they internally have the best of intentions, like I just don't think they can get out of their own way. I also think you should be very wary of going to a place for any sort of therapy where they're selling you the therapy.
True. If my whole shtick is I'm here to give you the best hormones or supplements or whatever, and oh, by the way, on your way out, we'll sell them to you.
It's just such a conflict of interest. Yeah.
Yeah. So, um, so what do you, what do you think about the, like the, even like the internet companies that are like, like I did one, I don't know if it's nice to like name it or not, but like the ones that like you mail, like stool sample blood saliva.
And they're like, here's precision supplements for you and you alone. How do you think they're like, how much of that is kind of generic? And do you think some of those companies are really dialed in or like, um, I don't doubt that there

are ways to kind of sort of optimize supplements around biomarkers. Um, I just, I'm not sure that

it's as precise as people want to believe. I certainly don't think that I actually think

you can do a lot of supplement optimization off really basic blood work. Like I don't think

Thank you. want to believe.
I certainly don't think that, I actually think you can do a lot of supplement optimization off really basic blood work. Like I don't think, certainly, you know, a stool sample is not necessary because most probiotics can't even provide the bacteria you need to impact it.
I mean, your diet has a far greater role. Your fiber content has a far greater role on your gut biome and things that you'd be measuring in stool.
And obviously saliva, blood, urine can measure things that are relevant and interesting. There aren't that many things that I think are worth taking.
Like I think, yeah, if you're low in vitamin D and you're not getting enough sunlight, that makes sense. But that's a pretty simple blood test.
If your homocysteine is elevated, yeah, you probably should take some methylated B vitamins. And if you drop it by more than five or six points, you're probably doing a lot.
If your omega levels are low, fish oil probably helps if you're not willing to eat three servings of fish a week. But the true basics of this are really simple.
And then there's other supplements that probably make sense for most people, and you don't even need to test for them. Anybody who's active could probably justify taking creatine yeah um and there's no blood test that's going to tell you whether or not you need it we just know that you know to to fill and saturate total body storage you're going to need three to five grams per day so you know really that's yeah that was surprising that was like something i heard like in college like you know years ago when i'd lift, it was like creatine was almost like viewed as like a serious kind of like bodybuilder supplement.

Now everything I read is like, no, everyone needs a ton of creatine.

Yeah.

I mean, again, it's just if you're playing the game of optimizing, you're going to get a benefit,

probably about a 10% boost in performance for intensity and like super short intensity, i.e. the creatine phosphate energy system.
So kind of like high bursts of, you know, 10 second work and then anaerobic stuff. It's not going to improve much aerobically.
Yeah. But and you'll also get a little hypertrophy benefit because the muscles will get bigger when they bring more water.
That makes sense. Yeah.
If like my kids are like seven feet away and they're not listening, I could just run at them easy easy just hulk them down yeah that that's and that's my thing with fitness a lot of people and i'm sure i don't know if you've heard this you're you're kind of uh i'm sure you're like listenership is very health oriented but a lot of people get very like i don't know like very kind of scoffed they kind of scoff a lot of the stuff where they're like, who gives a shit?

And it's like I feel bad because like I do get it. If you're like in a job you hate, you're just totally crushed down by like your life circumstance.
Having somebody be like, dude, eat a banana and do jumping jacks. You're going to be like, dude, fuck you.
I don't want to think about this. But it also will make your life better.
Like I always like whenever I lose sight of that, whenever whenever I get too into my own like just stuff where I'm like, this isn't going well. I don't have time.

If I just take like an hour, even a half an hour,

and just like run as fast as i can it's like i feel like amazing yeah i always say that's like a nice dimension you can add to your life where it's like everyone's like you know like i want to get better in my job it's like just adding that like time yourself running 100 meters and then try to get a better time next week it just like it gives you're kind of making progress in. And also, you feel great as a result.
Yeah, I think this is where kind of social media really distorts reality. And the example you give is a great one, so if your health sucks and you're trying to figure out where you're going to find an extra two hours a week to do some form of self-care.
The last thing you need is some idiot influencer telling you to spend more time in the sauna and cold plunging. Like I can promise you that is not the first, second, third, fourth, or fifth best use of your time.
If you only have two hours a week, how would you break it down then? If you've only got, so, you know, I would start with what's the, let's do the absolute basics of blocking and tackling. So first thing I want to know is, are you getting at least seven hours of sleep a night? Because if you're not getting at least seven hours of sleep a night, it's going to be very difficult for you to do anything at your best.
So I don't want to interrupt you. My question with that is say like, you know, say you are tracking your sleep and you only get like 43 hours of deep sleep every night, even though you go to bed at like a proper time.
Does that matter as much of like REM versus deep sleep or like? I assume you in 43 minutes, but 43 minutes. I wish it's fucking.
I only get 43 hours of deep sleep a year. I'm doing the math quickly.
I don't know if you feel if a person says I well, and there are these, I linked to them in the book. There are a whole bunch of surveys you can get for free that just have you do like, you know, there, these are validated surveys that kind of go through daytime drowsiness and stuff like that.
If you're in bed seven to seven and a half hours a night, ideally eight, and you're, you know, your little sleep tracker says you're sleeping seven, but you're're not happy with your stages i wouldn't put a lot of stock into that unless you feel that there is a problem got you but if you're like no i feel fine and i fill out all the two surveys and they said i'm doing fine ignore the data that makes sense and stop wearing the tracker i know i gotta stop done with the tracker um so i was checking every day i'm like 43 fucking minutes yeah yeah like it Like it just creates more anxiety. It's just red.
I see red numbers.

Yeah.

Yeah.

Fuck.

I,

I haven't used,

I haven't used one of those in a longer time than I can remember.

Yeah.

Yeah.

So,

um,

so just do the next bucket.

Yeah.

So then the next bucket I want to know is what are,

you know,

what's your physical activity level?

So let's say this is a person who's got none.

They're doing none.

And they say,

look,

I've only got two extra hours.

I'm putting that entire two hours into exercise.

So I'm going to say,

we're going to do four 30 minute workouts a week.

Thank you. got none.
They're doing none. And they say, look, I've only got two extra hours.
I'm putting that entire two hours into exercise. So I'm going to say, we're going to do four 30-minute workouts a week.
And again, I'd have to know more about the person, but it could easily end up being, we're going to do two cardio sessions a week. We're going to do two strength sessions a week.
One of those cardio sessions per week is going to be kind of aerobic-based training where you're going at the same intensity the whole time. It's not that high.
You can still sort of almost carry out a conversation. It's a little hard to talk, but you could.
And then the other cardio session I would do say three days off of that would be more interval, kind of like what you were describing. So let's get on a, you know, if you, if you're at a gym and they have one of those, like, you know, um, air bikes, do something there, be on a treadmill, be outside.
It doesn't really matter. Like the goal, like this person will get so much benefit from two hours a week of exercise that it almost doesn't matter what they do.
And then the other two days a week, I'd have them do, um, two 30 minute whole body workouts at a gym where they never stopped moving. Okay.
So if you're doing it at home, it might be pushups, pull-ups, uh, wall sits, something like that. If you're at the luxury of being at a gym, you might just rotate machine to machine to machine and never stop.
And that would, I mean, that would just bring huge dividends. And then the last thing I'd do is in addition to that is just do a quick audit of their diet.
Yeah. You know, are you overweight? Are you adequate weight? Are you underweight? That determines whether you need to eat more or less.
And then are you getting enough protein? And, and honestly, like I wouldn't make it much more detailed than that. And so look with, with just a little bit of that insight, you've made better use of two hours a week.
You've got them to stop worrying about their sleep. You've maybe changed three little things in their diet.
I promise you that person in three months is going to feel significantly better. And then maybe, by the way, at that point, they're like, you know what? I wouldn't mind doing three hours a week of this exercise thing because I'm feeling kind of good.
And you know what? I kind of want to dial the diet in a little bit more. But again, the problem is too many people are consuming information that says, oh my God, you need to be on this supplement.
You need to be on this supplement. You need to be doing 30 minutes of this type of sauna and 20 minutes of this type of cold plunge.
And people are like, shut up. Yeah.
I can't do that. I mean, and to be clear, I love sauna and I love cold plunge, but it is like the 20th thing on my list of 21 things that is a part of my routine.
Yeah, that makes sense, man. That's actually cool to hear because it is like the solution is pretty basic and simple.
And that's the thing that gets me bummed out when like, you know, because I do think we live and I could just be wrong, but I feel like we live in a pretty nihilistic kind of age. And it's like it does suck when that spreads.
It's like a physical nihilism. Like, what the fuck's the point of even where it's like, dude, you'll feel so much better.
If I don't work out, I get depressed. It's like A to B easily.
If I don't do it for like two weeks, I'm just like depressed point of even where it's like dude you'll feel so much better if i don't work out i get depressed it's like a to b easily if i don't do it for like two weeks i'm i'm just like depressed and sad and it's like if you don't do it it's just yeah you feel terrible and i always i always like to try to you know like just get up and move your fucking body man there's so much so much better we were meant to move we were and meant to be outside that might be the other thing i would add is figure out a way to do something outdoors like whether it's a quick walk or incorporate some of that exercise outdoors you know what i started doing skateboarding at my ripe old age of 38 i just took it i just took it back i've been doing it when i was little and i just started it and it's weird do it that's a that's a real eye-opener when you take it an activity you did in childhood effortlessly and like let me try this again at 38 dude i i swear i burnt 900 something calories i skateboarded for an hour and 20 minutes and i was i was dying like cardio wise i was i was just doing like a little pump track where you kind of just like ride up on a wall dude i thought i was gonna die i used to do this all day when i was younger now i'm like it's like a real eye opener to be like all right where am i at because i do feel like especially uh i guess men and maybe women do it too but men specifically over index like i'm good and it's like try something that you did when you're younger and you're like holy shit i'm gonna pay my heart rate was like 170 the whole time just skateboarding and i wasn't even i was barely pushing i just had to like balance myself on this track it was it was amazing though i agree with you it's like find something you know to do and just kind of i don't know i feel like uh i do feel like we get too tunnel visioned into like the career stuff and it's like we need to you need to do that to survive but it's like the sacrifice of hours of time for like the quote-unquote rest time into like physical activity just pay dividends and all the other things you're trying to do anyway but yeah i always sound like a broken record but i'm like dude it's so important man it really is so yeah skateboarding is awesome we should go one time um you skate nope i do not at all have you ever nope and it's funny i mean growing up i was

certainly of that age when a lot of a lot of kids were skateboarding i don't know why it just never

appealed to me yeah um i was sort of busy in my own little world um my daughter did for a little

bit she's 16 now but she did probably like when she was 12 10 11 12 she was pretty into it

Thank you. um i was sort of busy in my own little world um my daughter did for a little bit she's 16 now but she did probably like when she was 12 10 11 12 she was pretty into it um the coolest thing i've picked up recently though it's not a physical activity but it's i'm freaking obsessed with it is chess really holy cow how do you how are you pretty good no i'm horrible i mean i'm just learning but but i love it yeah i can't stop playing yeah i just can't stop who do you who are you? Pretty good.
No, I'm horrible. I mean, I'm just learning, but I love it.
Yeah, I can't stop playing. Yeah, I can't stop.
Who do you who are you playing against? I'm just playing my boys. Really? Literally just the three of us.
Phone chess or physical chess? On the board. That's good.
Writing down every move, studying our moves after. Really? Like nerding out, watching YouTube videos.
I'm obsessed with this guy, Magnus Carlsen, who's the best chess player in the world. I've heard of best chess player actually dude i i can't stop watching chess porn really can't stop that's awesome can't stop that's you know how youtube figures out what you're about like my videographer for our podcast he comes he pulls me aside like three weeks ago he goes are you getting into chess i'm like how do you know he goes because like i'm managing our YouTube channel and like, it only populates just, it's just like pushing chess stuff all day.
That's awesome. I can't stop.
It is good for your brain at night, like watching chess videos. Oh, it's awful.
I'm like, it's nine 30. I should go to bed.
What's the open. What's your opening move? What do you go with? Oh, I'm typically like E4, you know, I, but I like to, I like to castle really early.
So I'm going to try to castle within about three or within four or five moves if i if i'm doing a kingside castle really yeah i like the the first move the horse just over your pawns you're like what's up yeah it's called there's a name for it i forget what it's called it's like the english or something but i like the horse i just fucking bang here's my motherfucking horse yeah no the knight's cool because again he can he can he can he can hop over people you move that fucked up l-shaped pattern but yeah i love chess too that is fun i i just say yeah i don't have anyone to play it with that's the thing it's like i don't and i don't it's it's how long does a chess game take one of my boys is super aggressive so the games are quick because he just comes out swinging does he really swings i like that he goes for the fences and then the other one is so conservative and so thoughtful that the games take like so long and i got us a little timer too so i'm like buddy that's nice yeah two hours to make the first 40 moves or you're disqualified that's good yeah yeah that's good yeah you got to think on your feet and the younger one the one super aggressive, is so competitive. Like if anyone in our family ever makes it and becomes like great, it's him.
Because you can't like hit the fire is insane. Really? When he loses, he tears up his sheets.
And I'm like, buddy, you shake my hand and we had a good game. He's just losing his mind that he lost a game of chess.
It's war. Yeah, it's war.
Is it true that the possibilities of the chessboard are kind of infinite?

They are truly infinite.

That's crazy.

It's a computationally infinite problem.

Damn. Or as close to, I mean, I shouldn't say infinite, right?

In that AI can.

Yeah.

But it's from a practical perspective, I think it's infinite.

Damn.

That's awesome.

That is cool.

I'm going to try it.

My kids are too young for that.

We and my daughter did one of those.

Your oldest is six?

Four.

Oh, four.

Okay.

Four.

Six is doable.

Six is totally doable.

I did chess.

We did one of those big ones.

We were on vacation.

We did one of those huge outdoor chess boards with the big pieces.

Yeah, yeah.

We did it, and I tried with my four-year-old.

By the end of it, it was like the queen and king were mommy and daddy, and the pawns are all of our babies and i was like all right man it sucks but yeah man that is amazing i once made the mistake of in a game like one of one of my my older one the one who's more conservative like he had you know he had a rook knight bishop in the back that hadn't moved. And it was like 25 moves in.
And I'm like, buddy, those guys over there are standing there like they got their thumbs up their butts. And now those two boys cannot stop saying that.
They just walk around every, anytime someone's not moving, why do you have your thumb up your butt? And my wife's like, why do you say this stuff to them? Like, you can't say anything like that. They're just going to say whatever you say.
It's weird. It's weird because my four-year-old is like language police in our house.
She like will learn that something's bad. And then she's just like horrified of the idea of saying it.
And she's like, if she hears us saying anything, like we even say the word hate. I don't know.
We didn't. This wasn't a rule for us, but I hate that.
She'll be like, don't say that. She like polices our language.
And we say like that. We said, my wife said freaking the other day.
She's like, mom, that's a bad word. It's bad.
Like, no, it's not. And she's like, and I was like, I was arguing.
My wife's like, no, just, just give her that one. She's like, it's, it's pretty nuts.
But yeah, that is true. They do parrot everything.
You really do got to watch what you say. Cause you can say whatever you want around them for the longest time.
And eventually you're like, oh, shit. You can talk shit on my neighbors.
You can hear this right now. Our youngest one, when he was, this is the super aggressive one.
So it's not surprising. I think when he was like three, we get a call from the preschool.
And they're like, yeah, you got to come and get them. My wife's like, what's going on? They're like, he said the F word.
Whoa. My wife's like, oh, I'll be right there.
But they made you get him for that? I'm like, this is a misunderstanding. And my wife's like, first of all, the kid is obsessed with rhyming.
So he almost assuredly was like, truck, truck, fuck, or something like that. And the woman is like, no, no.
He's actually the first kid we've ever heard use it properly oh no they're like what what was the situation and they're like well he was in circle time and um we were telling all the kids they had to be quiet and he wasn't being quiet and we're like hey if you're not quiet you're gonna have to get up and leave and he wouldn't be quiet so we got up and made him leave and he stood up apparently and just goes, fuck it. And then walked and got out of the corner.

Like. leave and he wouldn't be quiet so we got up and made him leave and he stood up apparently and just goes fuck it and then walked and got out of the corner like that's a coincidence yeah i'm like i don't i think he learned that from his mom yeah my daughter nailed a um she dropped something one time when she was really little and she was like shit i was like ah damn it that's that's right that's on me yeah i was like so that made you what are you like it was like a one-day suspension? Yeah, it was like he shit.
I was like, damn it. That's right.
That's on me. Yeah.
So that made you what? It was like a one day suspension. Yeah.
It was like he's on probation now. We ended up finding another preschool for him that he did great in.
Oh, that's cool. Yeah.
That's insane to like be like, you got to come get this kid. Yeah.
Although that could spread like wildfire. Yeah.
I guess I can see it from the point as well. No, that's lame's crazy to be like he must leave right now but i think they got to let that kind of stuff go that is that is tricky though man because especially that age it's like kids hit other kids and like you know some people are like this is this is like yeah it's like but i don't know i treat it like the dog park it's like they'll figure it out man if it's really bad there's got to be enough discomfort in the situation for the kids to evolve yeah exactly what i'm saying yeah because it's like dude you gotta let they're gonna do that man it's like you know me and my cousin got separated and uh we were in kindergarten together and then we went to the same school the next year and they were like am class bm class they can't be they can't be with each other at all but i thought i turned out all right so before you get out of here we are out of here, we're coming up on...
Where are we at right now, Josh? I don't want to keep you too long. Huh? Perfect.
The one thing that I feel like was in the book a lot, you talked about how... And again, always correct me if I'm wrong because I always have stuff in my head.
Stress was something you... Was it really on the back burner that you kind of put to kind of like the forefront of your thinking from the day- to day and a health perspective how where do you kind of stand on that and like what's like do you have any give any thoughts on that at all when i think about like what is the what is the thing that's going to kill me fastest i think it's undoubtedly stress um i just think it's you know i think it's the most insidious killer in a way because it's the hardest thing to measure directly.
You can sort of measure some of its indirect actions like on blood pressure and blood sugar, which both go in the wrong direction when stress is high. But I think there's even components of it that just even when blood sugar and blood pressure are normal, I still think it's just doing something to your brain, probably, and to your heart.
And again, I don't think anybody would feel good living in a zero stress environment. So it's mostly just about kind of managing how one responds to it.
And I think it goes beyond just stress. I think it's sort of like just overall, like satisfaction in life and contentment and, you know, enjoying your relationships with people.
You know, I interviewed this guy on my podcast, um, Bill Perkins, who wrote this incredible book. It's one of my favorite books.
It's called die with zero. And he writes about how you have basically, um, like, you know, you have time, you have money and you have experiences and, uh, starts about through health so health time and money okay and you're not optimizing for the most of any one of those you're optimizing for the net of fulfillment okay so too many people miss that right they're just like working working really really hard to get as much money as possible or as much fame as possible or they're like maniacally focused focused on their health.
And that's the only thing to think about. Or they're just trying to live as long as possible or make as much time for certain things.
But it's kind of how you put all those things together to optimize around fulfillment. So in this book, he writes about this idea of people aren't doing the equation correctly.
They're deferring too many experiences when they're young to do when they're old, but then they don't realize when they're old, their health is actually not, they're not actually able to do it when they have all the money in the world. They can't go and take the incredible vacation or if they can, their kids aren't with them or their kids aren't young.
So I think it's just kind of reframed a lot in my mind and made me realize that, you know, when our kids are young and we are incredibly healthy, that should be the time that we invest more in fulfillment and experiences as a family, which has just been a completely different mindset for me from where I was most of my life. Yeah.
Just going kind of like full blast. Yeah.
Make as much money as possible. Sleep when I'm dead.
Yeah. That's a big one.
Sorry about that bug, dude. That bug won't leave you alone.
It hasn't even come over to me at all. I mean, I must stink.
yeah that is that is kind of a yeah that's a big one sorry about that bug dude that bug won't leave you alone it hasn't even come over to me at all i mean i must stink yeah that is that is kind of a cool thing too man to uh because you don't really it's also something you don't really learn like nobody really tells you how to manage your stress you kind of mostly from what i gather you kind of just like watch your parents deal with stress and you're like all right and you just kind of like take those patterns and just apply them to your life and it's like it really does like i don't what i've been trying to do recently is like just take one day out of the week usually it's sunday because like we're all off everyone's hanging out and i just try to focus on like being as calm and at ease that's like top priority of my day usually it's like i gotta get this done i gotta this done and on one day a week i'll be like i'm only focused today my number one goal is to try to like stay in a state of like ease and kind of contentment if i get out of it i like before i'm like you know like well i just try to zero in on that that's been kind of like for me that's been like a bit of a revelation to be like oh i can move through like multiple days without completely spinning myself the fuck out and you know it's been i don't know it's been kind of nice and what do you think spins you out? Is it just busy? It's too much? Yeah, it's too much. Or is there a particular thing? Yeah, I mean, it could be anything.
My kid's not listening, kind of spins me out. If I'm trying to get up the steps and it takes 40 minutes and I'm kind of like, all right, let's go.
It could be anything. It could be like overwhelmed, like just situations at work I got to deal with that are just completely overwhelming, stuff in the house, you know, it's just like lack of sleep our kids are still so little that like our sleep gets fucked up um but yeah it is it's that it's usually like relational stress or just like work stuff those are two the two main things I kind of like can really spin me out and I would argue that most work stress is relational as well so I I kind of agree I think relationships are both the best part of life and the most stressful part of life yeah I.
So that's been kind of that's been my that's what's going on here, by the way. A lot of relational stress in that.
I can tell you right now. That is true.
But yeah, that is that's kind of the thing, man. It's like, well, this is my whole point is like you do have some say in how much a thing can like like you can get everything in for you.
Things come out of nowhere and you're like you get caught in it but it's learning how to be like all right something got me it's like laser tag like my thing's beeping i can kind of walk myself through this without like going on like a godzilla path you know what i mean yeah it's like i don't know that's been pretty helpful for me before i get caught that's that's my ultimate fate She's like, babe, babe, I'm having a naked victim with a prostitute.

She's right there, and they're coming out of the water just hawking me. It's not what it looks like.
But yeah, that is the number one, man. It's like, dude, it's managing stress, keeping yourself physically fit, because you can't...
Otherwise, what the fuck are we doing, man? Some people are just surviving, which is kind of... That sucks, but I don't know.
I feel like you can't like otherwise like what the fuck are we doing man it's like you know it's like unless you i mean some people are just surviving which is which is kind of that sucks but i don't know i feel like you can even i feel like people there's other countries where people are just surviving they still do cool stuff they're like big ornate jugs of water and they carry it around they like dance and stuff i don't know it's kind of sick i'm just trying to make people happy i don't know how to do it, I mean, is there anything else that's kicking in your mind? I don't think so. Well, I think you did it.
Thank you for coming and doing this. I apologize for the strange format.
But how do you feel about standing and I think it's hilarious? I think it is. This is the first standing podcast I've ever done, bro.
It's not bad. How do you feel about it? Honestly, you can you can hurt my feelings.
Honestly, I think I have better posture than than i normally do so i'm saying when you're sitting on a podcast you kind of like slouching forward standing keeps you on your feet it keeps the mind sharper like i feel like we're doing a political debate the way they're angled at each other too you know what i mean like i feel like i need a moderator to ask me a question that's the only thing that it would have been a little better if it was moderated moderated was moderated that's a good i'm more heated that's true yeah that is true i gotta work on being i wouldn't mind a teleprompter next time if you wouldn't mind teleprompter is nice i want a teleprompter there moderator there right more for sure yeah i mean we could bring some heat yeah i could bring some heat if you want the heat i have some burning hot questions i didn't ask them they're about a lawsuit so i was like why can't't know. You can't talk about lawsuits.
No one can ever talk about them. I know the lawyers say no.
Yeah, why? What's the point? Bring awareness. Yeah, I did.
I actually, I was researching. When you have someone on, I saw you're embroiled in a lawsuit and I said, hell yeah, dude.
That's what's up. The lawyers won't like that that is bullshit you can't talk

I mean dude

don't do it

but that is

like why

what the fuck's the problem

I don't know

whatever

anyway

well dude

thank you

is there anything

you want to plug

is there any

the book

obviously

read the book

dude

read the book

listen to the podcast

Peter Atiyah

thank you so much

thanks for having me